system_instruction
stringlengths 29
665
| user_request
stringlengths 15
882
| context_document
stringlengths 539
130k
| full_prompt
stringlengths 74
130k
| prompt
stringlengths 853
130k
| has_url_in_context
bool 2
classes | len_system
int64 5
108
| len_user
int64 2
144
| len_context
int64 90
19.9k
| target
float64 | row_id
int64 0
859
|
|---|---|---|---|---|---|---|---|---|---|---|
Do not use any outside sources. Only use the provided text to answer. Do not use any prior knowledge. Omit all filler.
|
Does this apply to me if I have ground-mounted solar panels in a field at my house that I use to sell back extra energy to the grid?
|
HB 2281 Initials EB Page 1 Natural Resources, Energy & Water ARIZONA HOUSE OF REPRESENTATIVES Fifty-sixth Legislature Second Regular Session HB 2281: solar royalties fund; county residents Sponsor: Representative Biasiucci, LD 30 Committee on Natural Resources, Energy & Water Overview Requires each county Board of Supervisors (BOS) to establish a County Resident Solar Royalties Fund (Fund). History Counties are required to adopt the standards for issuing permits for the use of certain solar energy devices. Various specifications must be met depending on if the solar energy device is used for: 1) construction with solar photovoltaic systems that are intended to connect to a utility system; or 2) solar water heating systems (A.R.S. § 11-323). Provisions 1. Requires the BOS of each county to establish a Fund to be administered by the county treasurer. (Sec. 1) 2. States that the Fund will be funded by each owner or operator of a solar panel in that county whose solar panel: a) is located in the relevant county; and b) is not: i. owned by a public service corporation that is regulated by the Arizona Corporation Commission (ACC) or by a public power entity that has service territory in Arizona; and ii. subject wholly to an exclusive power purchase agreement with either a public service corporation regulated by the ACC or a public power entity that has service territory in Arizona. (Sec. 1) 3. Requires the private owner or operator of a solar panel not owned by a public service corporation to pay the county where the solar panel is located 12.5% of every $1 that is received in revenues from the sale of kilowatt-hours from the solar panel. (Sec. 1) 4. Specifies these monies must be deposited in the Fund. (Sec. 1) 5. Requires the county treasurer to: a) determine the total amount of monies in the Fund and the total number of qualified individuals who live in the county; b) use monies in the Fund for administrative costs that do not exceed 10% of the monies in the Fund; c) pay, by check, each qualified resident of the county an equal distribution of the total amount of monies available in the Fund, after administrative costs are paid. (Sec. 1) ☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal Note HB 2281 Initials EB Page 2 Natural Resources, Energy & Water 6. States that the requirements of the Fund do not apply to solar panels that: a) produce power for only on-site use by a commercial or industrial user; b) does not export power to the grid; or c) is a rooftop solar power system, regardless of whether the system exports power to the grid. (Sec. 1)
|
System Instructions: Do not use any outside sources. Only use the provided text to answer. Do not use any prior knowledge. Omit all filler. Question: Does this apply to me if I have ground-mounted solar panels in a field at my house that I use to sell back extra energy to the grid? Context: HB 2281 Initials EB Page 1 Natural Resources, Energy & Water ARIZONA HOUSE OF REPRESENTATIVES Fifty-sixth Legislature Second Regular Session HB 2281: solar royalties fund; county residents Sponsor: Representative Biasiucci, LD 30 Committee on Natural Resources, Energy & Water Overview Requires each county Board of Supervisors (BOS) to establish a County Resident Solar Royalties Fund (Fund). History Counties are required to adopt the standards for issuing permits for the use of certain solar energy devices. Various specifications must be met depending on if the solar energy device is used for: 1) construction with solar photovoltaic systems that are intended to connect to a utility system; or 2) solar water heating systems (A.R.S. § 11-323). Provisions 1. Requires the BOS of each county to establish a Fund to be administered by the county treasurer. (Sec. 1) 2. States that the Fund will be funded by each owner or operator of a solar panel in that county whose solar panel: a) is located in the relevant county; and b) is not: i. owned by a public service corporation that is regulated by the Arizona Corporation Commission (ACC) or by a public power entity that has service territory in Arizona; and ii. subject wholly to an exclusive power purchase agreement with either a public service corporation regulated by the ACC or a public power entity that has service territory in Arizona. (Sec. 1) 3. Requires the private owner or operator of a solar panel not owned by a public service corporation to pay the county where the solar panel is located 12.5% of every $1 that is received in revenues from the sale of kilowatt-hours from the solar panel. (Sec. 1) 4. Specifies these monies must be deposited in the Fund. (Sec. 1) 5. Requires the county treasurer to: a) determine the total amount of monies in the Fund and the total number of qualified individuals who live in the county; b) use monies in the Fund for administrative costs that do not exceed 10% of the monies in the Fund; c) pay, by check, each qualified resident of the county an equal distribution of the total amount of monies available in the Fund, after administrative costs are paid. (Sec. 1) ☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal Note HB 2281 Initials EB Page 2 Natural Resources, Energy & Water 6. States that the requirements of the Fund do not apply to solar panels that: a) produce power for only on-site use by a commercial or industrial user; b) does not export power to the grid; or c) is a rooftop solar power system, regardless of whether the system exports power to the grid. (Sec. 1)
|
Do not use any outside sources. Only use the provided text to answer. Do not use any prior knowledge. Omit all filler.
EVIDENCE:
HB 2281 Initials EB Page 1 Natural Resources, Energy & Water ARIZONA HOUSE OF REPRESENTATIVES Fifty-sixth Legislature Second Regular Session HB 2281: solar royalties fund; county residents Sponsor: Representative Biasiucci, LD 30 Committee on Natural Resources, Energy & Water Overview Requires each county Board of Supervisors (BOS) to establish a County Resident Solar Royalties Fund (Fund). History Counties are required to adopt the standards for issuing permits for the use of certain solar energy devices. Various specifications must be met depending on if the solar energy device is used for: 1) construction with solar photovoltaic systems that are intended to connect to a utility system; or 2) solar water heating systems (A.R.S. § 11-323). Provisions 1. Requires the BOS of each county to establish a Fund to be administered by the county treasurer. (Sec. 1) 2. States that the Fund will be funded by each owner or operator of a solar panel in that county whose solar panel: a) is located in the relevant county; and b) is not: i. owned by a public service corporation that is regulated by the Arizona Corporation Commission (ACC) or by a public power entity that has service territory in Arizona; and ii. subject wholly to an exclusive power purchase agreement with either a public service corporation regulated by the ACC or a public power entity that has service territory in Arizona. (Sec. 1) 3. Requires the private owner or operator of a solar panel not owned by a public service corporation to pay the county where the solar panel is located 12.5% of every $1 that is received in revenues from the sale of kilowatt-hours from the solar panel. (Sec. 1) 4. Specifies these monies must be deposited in the Fund. (Sec. 1) 5. Requires the county treasurer to: a) determine the total amount of monies in the Fund and the total number of qualified individuals who live in the county; b) use monies in the Fund for administrative costs that do not exceed 10% of the monies in the Fund; c) pay, by check, each qualified resident of the county an equal distribution of the total amount of monies available in the Fund, after administrative costs are paid. (Sec. 1) ☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal Note HB 2281 Initials EB Page 2 Natural Resources, Energy & Water 6. States that the requirements of the Fund do not apply to solar panels that: a) produce power for only on-site use by a commercial or industrial user; b) does not export power to the grid; or c) is a rooftop solar power system, regardless of whether the system exports power to the grid. (Sec. 1)
USER:
Does this apply to me if I have ground-mounted solar panels in a field at my house that I use to sell back extra energy to the grid?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 22 | 28 | 452 | null | 65 |
Your answer should be drawn only from the provided context block. Respond concisely.
|
Of the circuit courts mentioned, which single court did not address Alabama but did address a state on the east coast?
|
Appellate Courts Split on Legal Challenges to State Laws Banning Certain Medical Treatments for Transgender Minors Updated April 4, 2024 Public debate and attention has focused on whether certain medical treatments should be available for transgender minors to address a discordance between a person’s sex characteristics and gender identity. A number of states have passed laws prohibiting specific treatments for minors, including puberty blocking medication (“puberty blockers”), hormones, and surgical procedures. Several states assert, among other things, that the treatments are too experimental and can have potentially irreversible effects. Parents of transgender minors, among others, argue that these laws deny critical medical care to transgender minors and discriminate based on sex or transgender status in violation of the Equal Protection Clause of the Fourteenth Amendment. Some litigation has also alleged that these laws violate state constitutions. In cases challenging the laws of Arkansas, Alabama, Tennessee, Kentucky, Indiana, and Idaho, plaintiffs sought federal court orders to preliminarily enjoin these states from enforcing the laws until final resolution of the cases. Several lower courts granted these preliminary injunctions, in part based on the conclusion that the plaintiffs were likely to succeed on the merits of their equal protection claims. Three federal courts of appeals analyzed whether the lower courts had erred in their rulings and issued opinions reaching different conclusions. The Eighth Circuit upheld a preliminary injunction of Arkansas’s law, while the Eleventh Circuit held that a district court erred in enjoining the Alabama law, and the Sixth Circuit reversed preliminary injunctions that were issued against the Kentucky and Tennessee laws. Two other appellate courts reviewed preliminary injunctions and issued orders without accompanying opinions as of yet. The Seventh Circuit, after hearing oral argument, issued a stay of the lower court’s preliminary injunction against application of Indiana’s law, meaning that the law can go into effect while the case proceeds. By contrast, the Ninth Circuit denied a motion to stay a preliminary injunction against Idaho’s law, meaning that that law may not be enforced for now. This Sidebar focuses on aspects of the appellate court opinions addressing whether plaintiffs are likely to prevail on their claims that the laws violate the Equal Protection Clause. The three courts that have issued opinions reached different conclusions on at least two important legal questions relevant to the issue: (1) whether the challenged laws amount to sex classifications within the meaning of the Equal Protection Clause, and (2) what standard of review a court should apply when analyzing these challenges. The Congressional Research Service https://crsreports.congress.gov LSB11057 Congressional Research Service 2 courts’ analyses of these questions are consequential, as the likelihood of a state action being upheld or invalidated under the Equal Protection Clause may turn significantly on how a court resolves them. These recent decisions not only dictate how lower courts within these circuits analyze such equal protection challenges, but also may inform other courts’ approaches to similar equal protection challenges. Equal Protection Background The Fourteenth Amendment’s Equal Protection Clause prohibits states from denying individuals “the equal protection of the laws.” In the most general terms, states must not classify or differentiate among similarly situated individuals in a manner that violates this constitutional guarantee. When analyzing an equal protection challenge, a court must first determine which legal standard to apply. The most deferential standard of equal protection review is rational basis, under which a court will generally uphold a challenged classification as long as it is reasonably related to a legitimate government purpose. Courts subject classifications based on sex, however, to a more stringent standard—intermediate scrutiny. If intermediate scrutiny applies, the parties seeking to defend a sex-based classification must show an “exceedingly persuasive justification” or “important government interest” for classifying individuals based on sex and must demonstrate that the classification is “substantially related” to achieving that interest. In equal protection challenges raised in another context—school restroom access—several federal appellate courts have concluded that laws prohibiting transgender individuals from access consistent with their gender identity amount to sex-based classifications subject to intermediate scrutiny. In addition, the Fourth and Ninth Circuits have held that transgender individuals constitute a quasi-suspect class for equal protection purposes—that is, a class of individuals who warrant heightened protection under the law—and that transgender-based classifications are subject to intermediate scrutiny on that basis. Challenges to State Laws in Federal Appellate Courts When analyzing the legal bases for the preliminary injunctions at issue, the appellate courts considering the challenges to the Arkansas, Tennessee, Kentucky, and Alabama laws differed on the applicable standard of review. The Eighth Circuit construed the Arkansas law as classifying individuals based on sex, held that intermediate scrutiny applied, and concluded it was likely that the plaintiffs would prevail on their claim. By contrast, both the Sixth and Eleventh Circuits held that rational basis review applied and that the challenged laws neither contained a sex classification nor targeted a quasi-suspect class. (The Sixth and Eleventh Circuits also rejected arguments related to the Due Process Clause of the Fourteenth Amendment, further discussion of which is beyond the scope of this Sidebar.) Eighth Circuit: Brandt v. Rutledge The Eighth Circuit affirmed a district court’s preliminary injunction of Arkansas’s law banning “gender transition procedures” for minors, reasoning that the law was a sex classification that did not satisfy intermediate scrutiny. Arkansas’s law bans procedures and drugs intended to remove or alter “physical or anatomical characteristics or features that are typical for the individual’s biological sex” or “create physiological or anatomical characteristics that resemble a sex different from the individual’s biological sex.” Specific medical services identified in the law include puberty blockers, “cross-sex hormones,” and “gender reassignment surgery.” Prohibited procedures do not include those for individuals “born with a medically verifiable disorder of sex development.” Reviewing the injunction, the Eighth Circuit reasoned that the law discriminates on the basis of sex because medical procedures permitted for minors of one sex are denied to minors of another sex. For instance, a minor born as a male can be prescribed testosterone, but a minor born as a female is not permitted to receive that treatment. The court thus viewed the law as subject to intermediate scrutiny. The Congressional Research Service 3 state’s asserted justification for the law was its interest in protecting minors from “experimental medical treatment” and regulating medical ethics. The Eighth Circuit concluded that there was substantial evidence to support the district court’s findings that the medical treatments were a recognized standard of care and “supported by medical evidence … subject to rigorous study.” The Eighth Circuit accordingly determined that the lower court was not wrong to conclude the law’s prohibition was likely to fail intermediate scrutiny, as it was not substantially related to the state’s interest in protecting minors from experimental treatment and regulation of medical ethics. The full Eighth Circuit later denied a petition for rehearing en banc, with five judges dissenting from the denial and several others indicating that an appeal from a final judgment would offer the court a more comprehensive record to review. Following a trial in the case, the district court entered a permanent injunction against enforcement of the law, and that decision is now pending before the Eighth Circuit, which has granted a petition for an initial hearing en banc. Eleventh Circuit: Eknes-Tucker v. Governor of Alabama In contrast to the Eighth Circuit’s analysis in Brandt, the Eleventh Circuit held that specific provisions of a similar Alabama law did not amount to a sex-based or quasi-suspect classification for equal protection purposes. The court concluded that the challenged provisions were “best understood as a law that targets specific medical interventions for minors,” or as classifying based on age, and that it was “exceedingly likely” that the provisions satisfied rational basis review. The challenged provisions of Alabama’s law prohibit any person from prescribing or administering “puberty blocking medication,” “supraphysiologic doses of testosterone or other androgens to females,” and “supraphysiologic doses of estrogen to males,” when given “to attempt[] to alter the appearance of or affirm the minor’s perception of his or her gender or sex, if that appearance or perception is inconsistent with the minor’s sex as defined in this act.” The law’s other provisions, which were not challenged in the Eknes-Tucker lawsuit, include a prohibition of specific surgical procedures. The Alabama law defines a minor as a person under the age of 19, and defines sex to mean “‘[t]he biological state of being male or female, based on the individual’s sex organs, chromosomes, and endogenous hormone profiles.’” The Eleventh Circuit rejected the plaintiffs’ assertion that the provisions classify based on sex because the law uses sex-based terms to criminalize certain treatments. The law refers to sex, the court decided, only because the medical interventions at issue concern physiological sex characteristics. “[I]t is difficult to imagine how a state might regulate the use of puberty blockers and cross-sex hormones . . . in specific terms without referencing sex in some way,” the court observed. More significantly, the court reasoned that the challenged provisions do not distinguish between men and women by denying an opportunity to one sex but not the other—a key feature of sex-based classifications for equal protection purposes. Rather, in the court’s view, the restrictions on puberty blockers and hormone treatment apply to all minors, regardless of sex. The appellate court also rejected the argument, adopted by the lower court, that a classification based on gender nonconformity “indirectly classifies on the basis of sex.” The appellate court held that the lower court had relied on inapposite precedent to reach that conclusion, including a Supreme Court decision interpreting Title VII of the Civil Rights Act of 1964. That decision, the court reasoned, addressed a federal statute, not the different text and meaning of the Equal Protection Clause, and did not concern the regulation of medical treatments. The Eleventh Circuit also rejected the view that transgender persons constitute a quasi-suspect class distinct from sex. The court did observe that the challenged provisions prohibit medical treatment for minors that only gender nonconforming or transgender individuals would want to undergo. Addressing that distinction, the court stated that the law would trigger heightened scrutiny if regulating medical treatment were “a pretext for invidious discrimination against such individuals.” In the case before the court, however, “the district court did not find that Alabama’s law was based on invidious discrimination.” Nor did the challenged Congressional Research Service 4 provisions “further any particular gender stereotype.” Rather, the provisions, in the court’s view, refer to and “reflect[] biological differences between males and females.” In a concurring opinion, Judge Brasher agreed that rational basis review was the applicable standard but added that even if intermediate scrutiny applied to the challenged provisions of Alabama’s law, it was likely the state would satisfy that standard. The plaintiffs have filed a petition seeking en banc review of the panel decision.
|
Your answer should be drawn only from the provided context block. Respond concisely. Of the circuit courts mentioned, which single court did not address Alabama but did address a state on the east coast? Appellate Courts Split on Legal Challenges to State Laws Banning Certain Medical Treatments for Transgender Minors Updated April 4, 2024 Public debate and attention has focused on whether certain medical treatments should be available for transgender minors to address a discordance between a person’s sex characteristics and gender identity. A number of states have passed laws prohibiting specific treatments for minors, including puberty blocking medication (“puberty blockers”), hormones, and surgical procedures. Several states assert, among other things, that the treatments are too experimental and can have potentially irreversible effects. Parents of transgender minors, among others, argue that these laws deny critical medical care to transgender minors and discriminate based on sex or transgender status in violation of the Equal Protection Clause of the Fourteenth Amendment. Some litigation has also alleged that these laws violate state constitutions. In cases challenging the laws of Arkansas, Alabama, Tennessee, Kentucky, Indiana, and Idaho, plaintiffs sought federal court orders to preliminarily enjoin these states from enforcing the laws until final resolution of the cases. Several lower courts granted these preliminary injunctions, in part based on the conclusion that the plaintiffs were likely to succeed on the merits of their equal protection claims. Three federal courts of appeals analyzed whether the lower courts had erred in their rulings and issued opinions reaching different conclusions. The Eighth Circuit upheld a preliminary injunction of Arkansas’s law, while the Eleventh Circuit held that a district court erred in enjoining the Alabama law, and the Sixth Circuit reversed preliminary injunctions that were issued against the Kentucky and Tennessee laws. Two other appellate courts reviewed preliminary injunctions and issued orders without accompanying opinions as of yet. The Seventh Circuit, after hearing oral argument, issued a stay of the lower court’s preliminary injunction against application of Indiana’s law, meaning that the law can go into effect while the case proceeds. By contrast, the Ninth Circuit denied a motion to stay a preliminary injunction against Idaho’s law, meaning that that law may not be enforced for now. This Sidebar focuses on aspects of the appellate court opinions addressing whether plaintiffs are likely to prevail on their claims that the laws violate the Equal Protection Clause. The three courts that have issued opinions reached different conclusions on at least two important legal questions relevant to the issue: (1) whether the challenged laws amount to sex classifications within the meaning of the Equal Protection Clause, and (2) what standard of review a court should apply when analyzing these challenges. The Congressional Research Service https://crsreports.congress.gov LSB11057 Congressional Research Service 2 courts’ analyses of these questions are consequential, as the likelihood of a state action being upheld or invalidated under the Equal Protection Clause may turn significantly on how a court resolves them. These recent decisions not only dictate how lower courts within these circuits analyze such equal protection challenges, but also may inform other courts’ approaches to similar equal protection challenges. Equal Protection Background The Fourteenth Amendment’s Equal Protection Clause prohibits states from denying individuals “the equal protection of the laws.” In the most general terms, states must not classify or differentiate among similarly situated individuals in a manner that violates this constitutional guarantee. When analyzing an equal protection challenge, a court must first determine which legal standard to apply. The most deferential standard of equal protection review is rational basis, under which a court will generally uphold a challenged classification as long as it is reasonably related to a legitimate government purpose. Courts subject classifications based on sex, however, to a more stringent standard—intermediate scrutiny. If intermediate scrutiny applies, the parties seeking to defend a sex-based classification must show an “exceedingly persuasive justification” or “important government interest” for classifying individuals based on sex and must demonstrate that the classification is “substantially related” to achieving that interest. In equal protection challenges raised in another context—school restroom access—several federal appellate courts have concluded that laws prohibiting transgender individuals from access consistent with their gender identity amount to sex-based classifications subject to intermediate scrutiny. In addition, the Fourth and Ninth Circuits have held that transgender individuals constitute a quasi-suspect class for equal protection purposes—that is, a class of individuals who warrant heightened protection under the law—and that transgender-based classifications are subject to intermediate scrutiny on that basis. Challenges to State Laws in Federal Appellate Courts When analyzing the legal bases for the preliminary injunctions at issue, the appellate courts considering the challenges to the Arkansas, Tennessee, Kentucky, and Alabama laws differed on the applicable standard of review. The Eighth Circuit construed the Arkansas law as classifying individuals based on sex, held that intermediate scrutiny applied, and concluded it was likely that the plaintiffs would prevail on their claim. By contrast, both the Sixth and Eleventh Circuits held that rational basis review applied and that the challenged laws neither contained a sex classification nor targeted a quasi-suspect class. (The Sixth and Eleventh Circuits also rejected arguments related to the Due Process Clause of the Fourteenth Amendment, further discussion of which is beyond the scope of this Sidebar.) Eighth Circuit: Brandt v. Rutledge The Eighth Circuit affirmed a district court’s preliminary injunction of Arkansas’s law banning “gender transition procedures” for minors, reasoning that the law was a sex classification that did not satisfy intermediate scrutiny. Arkansas’s law bans procedures and drugs intended to remove or alter “physical or anatomical characteristics or features that are typical for the individual’s biological sex” or “create physiological or anatomical characteristics that resemble a sex different from the individual’s biological sex.” Specific medical services identified in the law include puberty blockers, “cross-sex hormones,” and “gender reassignment surgery.” Prohibited procedures do not include those for individuals “born with a medically verifiable disorder of sex development.” Reviewing the injunction, the Eighth Circuit reasoned that the law discriminates on the basis of sex because medical procedures permitted for minors of one sex are denied to minors of another sex. For instance, a minor born as a male can be prescribed testosterone, but a minor born as a female is not permitted to receive that treatment. The court thus viewed the law as subject to intermediate scrutiny. The Congressional Research Service 3 state’s asserted justification for the law was its interest in protecting minors from “experimental medical treatment” and regulating medical ethics. The Eighth Circuit concluded that there was substantial evidence to support the district court’s findings that the medical treatments were a recognized standard of care and “supported by medical evidence … subject to rigorous study.” The Eighth Circuit accordingly determined that the lower court was not wrong to conclude the law’s prohibition was likely to fail intermediate scrutiny, as it was not substantially related to the state’s interest in protecting minors from experimental treatment and regulation of medical ethics. The full Eighth Circuit later denied a petition for rehearing en banc, with five judges dissenting from the denial and several others indicating that an appeal from a final judgment would offer the court a more comprehensive record to review. Following a trial in the case, the district court entered a permanent injunction against enforcement of the law, and that decision is now pending before the Eighth Circuit, which has granted a petition for an initial hearing en banc. Eleventh Circuit: Eknes-Tucker v. Governor of Alabama In contrast to the Eighth Circuit’s analysis in Brandt, the Eleventh Circuit held that specific provisions of a similar Alabama law did not amount to a sex-based or quasi-suspect classification for equal protection purposes. The court concluded that the challenged provisions were “best understood as a law that targets specific medical interventions for minors,” or as classifying based on age, and that it was “exceedingly likely” that the provisions satisfied rational basis review. The challenged provisions of Alabama’s law prohibit any person from prescribing or administering “puberty blocking medication,” “supraphysiologic doses of testosterone or other androgens to females,” and “supraphysiologic doses of estrogen to males,” when given “to attempt[] to alter the appearance of or affirm the minor’s perception of his or her gender or sex, if that appearance or perception is inconsistent with the minor’s sex as defined in this act.” The law’s other provisions, which were not challenged in the Eknes-Tucker lawsuit, include a prohibition of specific surgical procedures. The Alabama law defines a minor as a person under the age of 19, and defines sex to mean “‘[t]he biological state of being male or female, based on the individual’s sex organs, chromosomes, and endogenous hormone profiles.’” The Eleventh Circuit rejected the plaintiffs’ assertion that the provisions classify based on sex because the law uses sex-based terms to criminalize certain treatments. The law refers to sex, the court decided, only because the medical interventions at issue concern physiological sex characteristics. “[I]t is difficult to imagine how a state might regulate the use of puberty blockers and cross-sex hormones . . . in specific terms without referencing sex in some way,” the court observed. More significantly, the court reasoned that the challenged provisions do not distinguish between men and women by denying an opportunity to one sex but not the other—a key feature of sex-based classifications for equal protection purposes. Rather, in the court’s view, the restrictions on puberty blockers and hormone treatment apply to all minors, regardless of sex. The appellate court also rejected the argument, adopted by the lower court, that a classification based on gender nonconformity “indirectly classifies on the basis of sex.” The appellate court held that the lower court had relied on inapposite precedent to reach that conclusion, including a Supreme Court decision interpreting Title VII of the Civil Rights Act of 1964. That decision, the court reasoned, addressed a federal statute, not the different text and meaning of the Equal Protection Clause, and did not concern the regulation of medical treatments. The Eleventh Circuit also rejected the view that transgender persons constitute a quasi-suspect class distinct from sex. The court did observe that the challenged provisions prohibit medical treatment for minors that only gender nonconforming or transgender individuals would want to undergo. Addressing that distinction, the court stated that the law would trigger heightened scrutiny if regulating medical treatment were “a pretext for invidious discrimination against such individuals.” In the case before the court, however, “the district court did not find that Alabama’s law was based on invidious discrimination.” Nor did the challenged Congressional Research Service 4 provisions “further any particular gender stereotype.” Rather, the provisions, in the court’s view, refer to and “reflect[] biological differences between males and females.” In a concurring opinion, Judge Brasher agreed that rational basis review was the applicable standard but added that even if intermediate scrutiny applied to the challenged provisions of Alabama’s law, it was likely the state would satisfy that standard. The plaintiffs have filed a petition seeking en banc review of the panel decision.
|
Your answer should be drawn only from the provided context block. Respond concisely.
EVIDENCE:
Appellate Courts Split on Legal Challenges to State Laws Banning Certain Medical Treatments for Transgender Minors Updated April 4, 2024 Public debate and attention has focused on whether certain medical treatments should be available for transgender minors to address a discordance between a person’s sex characteristics and gender identity. A number of states have passed laws prohibiting specific treatments for minors, including puberty blocking medication (“puberty blockers”), hormones, and surgical procedures. Several states assert, among other things, that the treatments are too experimental and can have potentially irreversible effects. Parents of transgender minors, among others, argue that these laws deny critical medical care to transgender minors and discriminate based on sex or transgender status in violation of the Equal Protection Clause of the Fourteenth Amendment. Some litigation has also alleged that these laws violate state constitutions. In cases challenging the laws of Arkansas, Alabama, Tennessee, Kentucky, Indiana, and Idaho, plaintiffs sought federal court orders to preliminarily enjoin these states from enforcing the laws until final resolution of the cases. Several lower courts granted these preliminary injunctions, in part based on the conclusion that the plaintiffs were likely to succeed on the merits of their equal protection claims. Three federal courts of appeals analyzed whether the lower courts had erred in their rulings and issued opinions reaching different conclusions. The Eighth Circuit upheld a preliminary injunction of Arkansas’s law, while the Eleventh Circuit held that a district court erred in enjoining the Alabama law, and the Sixth Circuit reversed preliminary injunctions that were issued against the Kentucky and Tennessee laws. Two other appellate courts reviewed preliminary injunctions and issued orders without accompanying opinions as of yet. The Seventh Circuit, after hearing oral argument, issued a stay of the lower court’s preliminary injunction against application of Indiana’s law, meaning that the law can go into effect while the case proceeds. By contrast, the Ninth Circuit denied a motion to stay a preliminary injunction against Idaho’s law, meaning that that law may not be enforced for now. This Sidebar focuses on aspects of the appellate court opinions addressing whether plaintiffs are likely to prevail on their claims that the laws violate the Equal Protection Clause. The three courts that have issued opinions reached different conclusions on at least two important legal questions relevant to the issue: (1) whether the challenged laws amount to sex classifications within the meaning of the Equal Protection Clause, and (2) what standard of review a court should apply when analyzing these challenges. The Congressional Research Service https://crsreports.congress.gov LSB11057 Congressional Research Service 2 courts’ analyses of these questions are consequential, as the likelihood of a state action being upheld or invalidated under the Equal Protection Clause may turn significantly on how a court resolves them. These recent decisions not only dictate how lower courts within these circuits analyze such equal protection challenges, but also may inform other courts’ approaches to similar equal protection challenges. Equal Protection Background The Fourteenth Amendment’s Equal Protection Clause prohibits states from denying individuals “the equal protection of the laws.” In the most general terms, states must not classify or differentiate among similarly situated individuals in a manner that violates this constitutional guarantee. When analyzing an equal protection challenge, a court must first determine which legal standard to apply. The most deferential standard of equal protection review is rational basis, under which a court will generally uphold a challenged classification as long as it is reasonably related to a legitimate government purpose. Courts subject classifications based on sex, however, to a more stringent standard—intermediate scrutiny. If intermediate scrutiny applies, the parties seeking to defend a sex-based classification must show an “exceedingly persuasive justification” or “important government interest” for classifying individuals based on sex and must demonstrate that the classification is “substantially related” to achieving that interest. In equal protection challenges raised in another context—school restroom access—several federal appellate courts have concluded that laws prohibiting transgender individuals from access consistent with their gender identity amount to sex-based classifications subject to intermediate scrutiny. In addition, the Fourth and Ninth Circuits have held that transgender individuals constitute a quasi-suspect class for equal protection purposes—that is, a class of individuals who warrant heightened protection under the law—and that transgender-based classifications are subject to intermediate scrutiny on that basis. Challenges to State Laws in Federal Appellate Courts When analyzing the legal bases for the preliminary injunctions at issue, the appellate courts considering the challenges to the Arkansas, Tennessee, Kentucky, and Alabama laws differed on the applicable standard of review. The Eighth Circuit construed the Arkansas law as classifying individuals based on sex, held that intermediate scrutiny applied, and concluded it was likely that the plaintiffs would prevail on their claim. By contrast, both the Sixth and Eleventh Circuits held that rational basis review applied and that the challenged laws neither contained a sex classification nor targeted a quasi-suspect class. (The Sixth and Eleventh Circuits also rejected arguments related to the Due Process Clause of the Fourteenth Amendment, further discussion of which is beyond the scope of this Sidebar.) Eighth Circuit: Brandt v. Rutledge The Eighth Circuit affirmed a district court’s preliminary injunction of Arkansas’s law banning “gender transition procedures” for minors, reasoning that the law was a sex classification that did not satisfy intermediate scrutiny. Arkansas’s law bans procedures and drugs intended to remove or alter “physical or anatomical characteristics or features that are typical for the individual’s biological sex” or “create physiological or anatomical characteristics that resemble a sex different from the individual’s biological sex.” Specific medical services identified in the law include puberty blockers, “cross-sex hormones,” and “gender reassignment surgery.” Prohibited procedures do not include those for individuals “born with a medically verifiable disorder of sex development.” Reviewing the injunction, the Eighth Circuit reasoned that the law discriminates on the basis of sex because medical procedures permitted for minors of one sex are denied to minors of another sex. For instance, a minor born as a male can be prescribed testosterone, but a minor born as a female is not permitted to receive that treatment. The court thus viewed the law as subject to intermediate scrutiny. The Congressional Research Service 3 state’s asserted justification for the law was its interest in protecting minors from “experimental medical treatment” and regulating medical ethics. The Eighth Circuit concluded that there was substantial evidence to support the district court’s findings that the medical treatments were a recognized standard of care and “supported by medical evidence … subject to rigorous study.” The Eighth Circuit accordingly determined that the lower court was not wrong to conclude the law’s prohibition was likely to fail intermediate scrutiny, as it was not substantially related to the state’s interest in protecting minors from experimental treatment and regulation of medical ethics. The full Eighth Circuit later denied a petition for rehearing en banc, with five judges dissenting from the denial and several others indicating that an appeal from a final judgment would offer the court a more comprehensive record to review. Following a trial in the case, the district court entered a permanent injunction against enforcement of the law, and that decision is now pending before the Eighth Circuit, which has granted a petition for an initial hearing en banc. Eleventh Circuit: Eknes-Tucker v. Governor of Alabama In contrast to the Eighth Circuit’s analysis in Brandt, the Eleventh Circuit held that specific provisions of a similar Alabama law did not amount to a sex-based or quasi-suspect classification for equal protection purposes. The court concluded that the challenged provisions were “best understood as a law that targets specific medical interventions for minors,” or as classifying based on age, and that it was “exceedingly likely” that the provisions satisfied rational basis review. The challenged provisions of Alabama’s law prohibit any person from prescribing or administering “puberty blocking medication,” “supraphysiologic doses of testosterone or other androgens to females,” and “supraphysiologic doses of estrogen to males,” when given “to attempt[] to alter the appearance of or affirm the minor’s perception of his or her gender or sex, if that appearance or perception is inconsistent with the minor’s sex as defined in this act.” The law’s other provisions, which were not challenged in the Eknes-Tucker lawsuit, include a prohibition of specific surgical procedures. The Alabama law defines a minor as a person under the age of 19, and defines sex to mean “‘[t]he biological state of being male or female, based on the individual’s sex organs, chromosomes, and endogenous hormone profiles.’” The Eleventh Circuit rejected the plaintiffs’ assertion that the provisions classify based on sex because the law uses sex-based terms to criminalize certain treatments. The law refers to sex, the court decided, only because the medical interventions at issue concern physiological sex characteristics. “[I]t is difficult to imagine how a state might regulate the use of puberty blockers and cross-sex hormones . . . in specific terms without referencing sex in some way,” the court observed. More significantly, the court reasoned that the challenged provisions do not distinguish between men and women by denying an opportunity to one sex but not the other—a key feature of sex-based classifications for equal protection purposes. Rather, in the court’s view, the restrictions on puberty blockers and hormone treatment apply to all minors, regardless of sex. The appellate court also rejected the argument, adopted by the lower court, that a classification based on gender nonconformity “indirectly classifies on the basis of sex.” The appellate court held that the lower court had relied on inapposite precedent to reach that conclusion, including a Supreme Court decision interpreting Title VII of the Civil Rights Act of 1964. That decision, the court reasoned, addressed a federal statute, not the different text and meaning of the Equal Protection Clause, and did not concern the regulation of medical treatments. The Eleventh Circuit also rejected the view that transgender persons constitute a quasi-suspect class distinct from sex. The court did observe that the challenged provisions prohibit medical treatment for minors that only gender nonconforming or transgender individuals would want to undergo. Addressing that distinction, the court stated that the law would trigger heightened scrutiny if regulating medical treatment were “a pretext for invidious discrimination against such individuals.” In the case before the court, however, “the district court did not find that Alabama’s law was based on invidious discrimination.” Nor did the challenged Congressional Research Service 4 provisions “further any particular gender stereotype.” Rather, the provisions, in the court’s view, refer to and “reflect[] biological differences between males and females.” In a concurring opinion, Judge Brasher agreed that rational basis review was the applicable standard but added that even if intermediate scrutiny applied to the challenged provisions of Alabama’s law, it was likely the state would satisfy that standard. The plaintiffs have filed a petition seeking en banc review of the panel decision.
USER:
Of the circuit courts mentioned, which single court did not address Alabama but did address a state on the east coast?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 13 | 21 | 1,798 | null | 837 |
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
|
My house recently burned down, and I have decided to stay in a hotel until construction on my new house is completed. What rights do I have as a hotel customer? Please organize the information into a neat bullet-point list and limit your response to 150 words.
|
Your Rights at a Hotel or Motel in Tennessee If you stay at or live in a hotel or motel, you should know its rights and responsibilities as well as your own rights and responsibilities. Minimum Standards for Hotels and Motels in Tennessee The Tennessee Department of Health, and Department of Environment and Conservation, require minimum standards for all hotels and motels in Tennessee. Those standards cover utilities, maintenance, safety, and basic health, and are available in full online here. Make Sure that You Know Your Rights As a guest at a hotel or motel, you should ask for a copy of all contracts or agreements that you signed for your stay. These papers may set forth the hotel's or motel's requirements during your stay as well as your rights and responsibilities as a guest in the hotel or motel. Hotels and Motels Cannot Discriminate against You Under federal and state laws, hotels and motels are not allowed to discriminate against you (including, refusing or denying services, or kicking you out) because of your race, creed, color, national origin, religion, sex, disability, marital status or age unless it is for a good reason. After staying at a hotel or motel for 30 consistent days, you now have tenant rights. The Legal Aid Society in Tennessee successfully takes the position that once you've been there for 30 days, you're entitled to the same protection against eviction as a conventional tenant. That would mean the right to notice to cure or quit for a violation or unpaid rent, and to have your eviction case heard in court. You'd also have the same protections when it comes to repair issues, and retaliation. Refusal to Provide Services to You Hotels and motels have the right to refuse or deny services to you for the following reasons: -You refuse to pay or are unable to pay for the services offered by the hotel or motel -You are visibly intoxicated or disturbing the public -The hotel or motel reasonably believes that you are seeking services for an illegal reason -The hotel or motel reasonably believes that you are bringing dangerous items or substances onto the property -The hotel or motel is trying to limit the number of people staying at it -These rules must be visibly and clearly posted at the registration desk and in every room. Removing You from Your Room and the Property Hotels and motels have the right to remove you from your room and the property, even if you are living there, for the following reasons: -You refuse to pay and do not pay for the accommodations or services provided to you -You are visibly intoxicated or disturbing the public -The hotel or motel reasonably believes that you are involved in illegal activities during your stay -The hotel or motel reasonably believes that you are bringing dangerous items (such as guns or explosives) onto the property -You have violated a federal, state or local law involving the hotel or motel -You have violated a rule of the hotel or motel Under state law, you have a right to be notified of these six rules. In addition, you have a right to be notified of the rules of the hotel or motel. All of the rules must be visibly and clearly posted at the registration desk and in every room. Can a Hotel or Motel Sue You? Hotels and motels may sue you for any accommodations or services that you received from it without paying for them. In addition, hotels and motels may sue you for any damages that you cause. Those damages may include property damages, lost revenue if it is unable to use the room while it is being repaired, and restitution to any person who is injured due to the damages caused by you. What if Your Property or Luggage is Lost, Stolen or Destroyed? Hotels and motels may allow you to keep your valuable items (such as money or jewelry) in a safe during your stay. The hotel or motel may be liable for losses, up to $800, if your valuable items are lost, stolen or destroyed. Similarly, the hotel or motel may be liable for your lost or stolen luggage, up to $1,500, if it does not provide a place to keep your luggage during your stay. Can a Hotel or Motel Take, Sell or Destroy Your Property? Hotels and motels may place a lien on any property that your brought to your room (such as goods, clothes, baggage or furniture) if you owe any money to the hotel or motel, allowing the hotel to keep your property until you pay. Such liens may be placed on your belongings if you have stayed for one or more nights. In addition, if you owe money to the hotel or motel, it can auction off any and all of the luggage or property that you left there to pay off your debt. The hotel or motel must advertise such auctions at least ten days beforehand.
|
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. My house recently burned down, and I have decided to stay in a hotel until construction on my new house is completed. What rights do I have as a hotel customer? Please organize the information into a neat bullet-point list and limit your response to 150 words. Your Rights at a Hotel or Motel in Tennessee If you stay at or live in a hotel or motel, you should know its rights and responsibilities as well as your own rights and responsibilities. Minimum Standards for Hotels and Motels in Tennessee The Tennessee Department of Health, and Department of Environment and Conservation, require minimum standards for all hotels and motels in Tennessee. Those standards cover utilities, maintenance, safety, and basic health, and are available in full online here. Make Sure that You Know Your Rights As a guest at a hotel or motel, you should ask for a copy of all contracts or agreements that you signed for your stay. These papers may set forth the hotel's or motel's requirements during your stay as well as your rights and responsibilities as a guest in the hotel or motel. Hotels and Motels Cannot Discriminate against You Under federal and state laws, hotels and motels are not allowed to discriminate against you (including, refusing or denying services, or kicking you out) because of your race, creed, color, national origin, religion, sex, disability, marital status or age unless it is for a good reason. After staying at a hotel or motel for 30 consistent days, you now have tenant rights. The Legal Aid Society in Tennessee successfully takes the position that once you've been there for 30 days, you're entitled to the same protection against eviction as a conventional tenant. That would mean the right to notice to cure or quit for a violation or unpaid rent, and to have your eviction case heard in court. You'd also have the same protections when it comes to repair issues, and retaliation. Refusal to Provide Services to You Hotels and motels have the right to refuse or deny services to you for the following reasons: -You refuse to pay or are unable to pay for the services offered by the hotel or motel -You are visibly intoxicated or disturbing the public -The hotel or motel reasonably believes that you are seeking services for an illegal reason -The hotel or motel reasonably believes that you are bringing dangerous items or substances onto the property -The hotel or motel is trying to limit the number of people staying at it -These rules must be visibly and clearly posted at the registration desk and in every room. Removing You from Your Room and the Property Hotels and motels have the right to remove you from your room and the property, even if you are living there, for the following reasons: -You refuse to pay and do not pay for the accommodations or services provided to you -You are visibly intoxicated or disturbing the public -The hotel or motel reasonably believes that you are involved in illegal activities during your stay -The hotel or motel reasonably believes that you are bringing dangerous items (such as guns or explosives) onto the property -You have violated a federal, state or local law involving the hotel or motel -You have violated a rule of the hotel or motel Under state law, you have a right to be notified of these six rules. In addition, you have a right to be notified of the rules of the hotel or motel. All of the rules must be visibly and clearly posted at the registration desk and in every room. Can a Hotel or Motel Sue You? Hotels and motels may sue you for any accommodations or services that you received from it without paying for them. In addition, hotels and motels may sue you for any damages that you cause. Those damages may include property damages, lost revenue if it is unable to use the room while it is being repaired, and restitution to any person who is injured due to the damages caused by you. What if Your Property or Luggage is Lost, Stolen or Destroyed? Hotels and motels may allow you to keep your valuable items (such as money or jewelry) in a safe during your stay. The hotel or motel may be liable for losses, up to $800, if your valuable items are lost, stolen or destroyed. Similarly, the hotel or motel may be liable for your lost or stolen luggage, up to $1,500, if it does not provide a place to keep your luggage during your stay. Can a Hotel or Motel Take, Sell or Destroy Your Property? Hotels and motels may place a lien on any property that your brought to your room (such as goods, clothes, baggage or furniture) if you owe any money to the hotel or motel, allowing the hotel to keep your property until you pay. Such liens may be placed on your belongings if you have stayed for one or more nights. In addition, if you owe money to the hotel or motel, it can auction off any and all of the luggage or property that you left there to pay off your debt. The hotel or motel must advertise such auctions at least ten days beforehand. https://www.help4tn.org/node/1493/your-rights-hotel-or-motel-tennessee-help4tn-blog
|
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
EVIDENCE:
Your Rights at a Hotel or Motel in Tennessee If you stay at or live in a hotel or motel, you should know its rights and responsibilities as well as your own rights and responsibilities. Minimum Standards for Hotels and Motels in Tennessee The Tennessee Department of Health, and Department of Environment and Conservation, require minimum standards for all hotels and motels in Tennessee. Those standards cover utilities, maintenance, safety, and basic health, and are available in full online here. Make Sure that You Know Your Rights As a guest at a hotel or motel, you should ask for a copy of all contracts or agreements that you signed for your stay. These papers may set forth the hotel's or motel's requirements during your stay as well as your rights and responsibilities as a guest in the hotel or motel. Hotels and Motels Cannot Discriminate against You Under federal and state laws, hotels and motels are not allowed to discriminate against you (including, refusing or denying services, or kicking you out) because of your race, creed, color, national origin, religion, sex, disability, marital status or age unless it is for a good reason. After staying at a hotel or motel for 30 consistent days, you now have tenant rights. The Legal Aid Society in Tennessee successfully takes the position that once you've been there for 30 days, you're entitled to the same protection against eviction as a conventional tenant. That would mean the right to notice to cure or quit for a violation or unpaid rent, and to have your eviction case heard in court. You'd also have the same protections when it comes to repair issues, and retaliation. Refusal to Provide Services to You Hotels and motels have the right to refuse or deny services to you for the following reasons: -You refuse to pay or are unable to pay for the services offered by the hotel or motel -You are visibly intoxicated or disturbing the public -The hotel or motel reasonably believes that you are seeking services for an illegal reason -The hotel or motel reasonably believes that you are bringing dangerous items or substances onto the property -The hotel or motel is trying to limit the number of people staying at it -These rules must be visibly and clearly posted at the registration desk and in every room. Removing You from Your Room and the Property Hotels and motels have the right to remove you from your room and the property, even if you are living there, for the following reasons: -You refuse to pay and do not pay for the accommodations or services provided to you -You are visibly intoxicated or disturbing the public -The hotel or motel reasonably believes that you are involved in illegal activities during your stay -The hotel or motel reasonably believes that you are bringing dangerous items (such as guns or explosives) onto the property -You have violated a federal, state or local law involving the hotel or motel -You have violated a rule of the hotel or motel Under state law, you have a right to be notified of these six rules. In addition, you have a right to be notified of the rules of the hotel or motel. All of the rules must be visibly and clearly posted at the registration desk and in every room. Can a Hotel or Motel Sue You? Hotels and motels may sue you for any accommodations or services that you received from it without paying for them. In addition, hotels and motels may sue you for any damages that you cause. Those damages may include property damages, lost revenue if it is unable to use the room while it is being repaired, and restitution to any person who is injured due to the damages caused by you. What if Your Property or Luggage is Lost, Stolen or Destroyed? Hotels and motels may allow you to keep your valuable items (such as money or jewelry) in a safe during your stay. The hotel or motel may be liable for losses, up to $800, if your valuable items are lost, stolen or destroyed. Similarly, the hotel or motel may be liable for your lost or stolen luggage, up to $1,500, if it does not provide a place to keep your luggage during your stay. Can a Hotel or Motel Take, Sell or Destroy Your Property? Hotels and motels may place a lien on any property that your brought to your room (such as goods, clothes, baggage or furniture) if you owe any money to the hotel or motel, allowing the hotel to keep your property until you pay. Such liens may be placed on your belongings if you have stayed for one or more nights. In addition, if you owe money to the hotel or motel, it can auction off any and all of the luggage or property that you left there to pay off your debt. The hotel or motel must advertise such auctions at least ten days beforehand.
USER:
My house recently burned down, and I have decided to stay in a hotel until construction on my new house is completed. What rights do I have as a hotel customer? Please organize the information into a neat bullet-point list and limit your response to 150 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 47 | 835 | null | 611 |
Reference the prompt text for your answer only. Do not use outside sources or internal knowledge. If you cannot locate the information in the text, please respond with "I cannot locate the answer using the context block at this time."
|
Is it lawful to market flavored ENDS products?
|
Circuit Split over the Food and Drug Administration’s Denial of Applications Seeking to Market Flavored E-Cigarettes, Part 1 of 2 April 5, 2024 Electronic nicotine delivery system (ENDS) products—products that go by many common names, such as e-cigarettes and vape pens—are generally required to receive prior authorization from the Food and Drug Administration (FDA) before they can be lawfully marketed in the United States. Before FDA issued regulations in 2016 to subject these products to the premarket review process, however, many of them were already being sold on the U.S. market and were allowed to remain there while FDA implemented the application and review process. These products come in a variety of forms and flavors, from tobacco and menthol flavors based on the flavors of traditional combustible cigarettes to other flavors based on the flavors of fruit, candy, and other sweets (“flavored ENDS products”). While limited studies of certain ENDS products show that they contain substantially lower levels of toxins than combustible cigarettes, indicating a benefit to current adult smokers who switch completely to using ENDS products, flavored ENDS products have been shown to be particularly attractive to youth. In a 2016-2017 study, for instance, 93.2% of youth ENDS product users reported that their first use was with a flavored product. In 2018, the Surgeon General issued an advisory on the “e-cigarette epidemic among youth.” Since the initial deadline in September 2020 for ENDS product manufacturers to submit their premarket tobacco product applications (PMTAs), FDA has received millions of applications for ENDS products. To date, the agency has authorized 23 tobacco-flavored ENDS products for lawful marketing and has not authorized any flavored ENDS products. Many applicants that have received a marketing denial order (MDO) for their flavored ENDS products have filed petitions in U.S. Courts of Appeals throughout the country to challenge the denial of their PMTAs. Of the courts that have considered these petitions, the Second, Third, Fourth, Sixth, Seventh, Ninth, Tenth, and D.C. Circuits have sided with FDA and denied the petitions or requests to stay the agency’s MDOs. The Eleventh and Fifth Circuits, on the other hand, have sided with the ENDS manufacturers and vacated FDA’s MDOs, remanding the applications to FDA for reconsideration. This circuit split sets the stage for potential Supreme Court review regarding what information FDA may require applicants seeking to market flavored ENDS products to provide as part of their PMTAs. This two-part Sidebar examines the circuit split. Part I provides an overview of the Family Smoking Prevention and Tobacco Control Act (TCA) regulatory framework, relevant FDA actions related to ENDS products, and the agency’s review and denial of the PMTAs involving flavored ENDS products. Part II provides an overview of the litigation challenging those FDA orders, the court decisions to date, and certain preliminary observations for consideration by Congress.
|
Reference the prompt text for your answer only. Do not use outside sources or internal knowledge. If you cannot locate the information in the text, please respond with "I cannot locate the answer using the context block at this time." Question: Is it lawful to market flavored ENDS products? Circuit Split over the Food and Drug Administration’s Denial of Applications Seeking to Market Flavored E-Cigarettes, Part 1 of 2 April 5, 2024 Electronic nicotine delivery system (ENDS) products—products that go by many common names, such as e-cigarettes and vape pens—are generally required to receive prior authorization from the Food and Drug Administration (FDA) before they can be lawfully marketed in the United States. Before FDA issued regulations in 2016 to subject these products to the premarket review process, however, many of them were already being sold on the U.S. market and were allowed to remain there while FDA implemented the application and review process. These products come in a variety of forms and flavors, from tobacco and menthol flavors based on the flavors of traditional combustible cigarettes to other flavors based on the flavors of fruit, candy, and other sweets (“flavored ENDS products”). While limited studies of certain ENDS products show that they contain substantially lower levels of toxins than combustible cigarettes, indicating a benefit to current adult smokers who switch completely to using ENDS products, flavored ENDS products have been shown to be particularly attractive to youth. In a 2016-2017 study, for instance, 93.2% of youth ENDS product users reported that their first use was with a flavored product. In 2018, the Surgeon General issued an advisory on the “e-cigarette epidemic among youth.” Since the initial deadline in September 2020 for ENDS product manufacturers to submit their premarket tobacco product applications (PMTAs), FDA has received millions of applications for ENDS products. To date, the agency has authorized 23 tobacco-flavored ENDS products for lawful marketing and has not authorized any flavored ENDS products. Many applicants that have received a marketing denial order (MDO) for their flavored ENDS products have filed petitions in U.S. Courts of Appeals throughout the country to challenge the denial of their PMTAs. Of the courts that have considered these petitions, the Second, Third, Fourth, Sixth, Seventh, Ninth, Tenth, and D.C. Circuits have sided with FDA and denied the petitions or requests to stay the agency’s MDOs. The Eleventh and Fifth Circuits, on the other hand, have sided with the ENDS manufacturers and vacated FDA’s MDOs, remanding the applications to FDA for reconsideration. This circuit split sets the stage for potential Supreme Court review regarding what information FDA may require applicants seeking to market flavored ENDS products to provide as part of their PMTAs. This two-part Sidebar examines the circuit split. Part I provides an overview of the Family Smoking Prevention and Tobacco Control Act (TCA) regulatory framework, relevant FDA actions related to ENDS products, and the agency’s review and denial of the PMTAs involving flavored ENDS products. Part II provides an overview of the litigation challenging those FDA orders, the court decisions to date, and certain preliminary observations for consideration by Congress.
|
Reference the prompt text for your answer only. Do not use outside sources or internal knowledge. If you cannot locate the information in the text, please respond with "I cannot locate the answer using the context block at this time."
EVIDENCE:
Circuit Split over the Food and Drug Administration’s Denial of Applications Seeking to Market Flavored E-Cigarettes, Part 1 of 2 April 5, 2024 Electronic nicotine delivery system (ENDS) products—products that go by many common names, such as e-cigarettes and vape pens—are generally required to receive prior authorization from the Food and Drug Administration (FDA) before they can be lawfully marketed in the United States. Before FDA issued regulations in 2016 to subject these products to the premarket review process, however, many of them were already being sold on the U.S. market and were allowed to remain there while FDA implemented the application and review process. These products come in a variety of forms and flavors, from tobacco and menthol flavors based on the flavors of traditional combustible cigarettes to other flavors based on the flavors of fruit, candy, and other sweets (“flavored ENDS products”). While limited studies of certain ENDS products show that they contain substantially lower levels of toxins than combustible cigarettes, indicating a benefit to current adult smokers who switch completely to using ENDS products, flavored ENDS products have been shown to be particularly attractive to youth. In a 2016-2017 study, for instance, 93.2% of youth ENDS product users reported that their first use was with a flavored product. In 2018, the Surgeon General issued an advisory on the “e-cigarette epidemic among youth.” Since the initial deadline in September 2020 for ENDS product manufacturers to submit their premarket tobacco product applications (PMTAs), FDA has received millions of applications for ENDS products. To date, the agency has authorized 23 tobacco-flavored ENDS products for lawful marketing and has not authorized any flavored ENDS products. Many applicants that have received a marketing denial order (MDO) for their flavored ENDS products have filed petitions in U.S. Courts of Appeals throughout the country to challenge the denial of their PMTAs. Of the courts that have considered these petitions, the Second, Third, Fourth, Sixth, Seventh, Ninth, Tenth, and D.C. Circuits have sided with FDA and denied the petitions or requests to stay the agency’s MDOs. The Eleventh and Fifth Circuits, on the other hand, have sided with the ENDS manufacturers and vacated FDA’s MDOs, remanding the applications to FDA for reconsideration. This circuit split sets the stage for potential Supreme Court review regarding what information FDA may require applicants seeking to market flavored ENDS products to provide as part of their PMTAs. This two-part Sidebar examines the circuit split. Part I provides an overview of the Family Smoking Prevention and Tobacco Control Act (TCA) regulatory framework, relevant FDA actions related to ENDS products, and the agency’s review and denial of the PMTAs involving flavored ENDS products. Part II provides an overview of the litigation challenging those FDA orders, the court decisions to date, and certain preliminary observations for consideration by Congress.
USER:
Is it lawful to market flavored ENDS products?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 40 | 8 | 467 | null | 583 |
Answer in complete sentences, only use the context document, no outside knowledge.
|
According to the document, how many copies of Mario Kart 8 Deluxe have been sold?
|
**What's publicly known about "Switch 2"** Nintendo, notoriously secretive, has so far said nothing — or almost nothing — on the record about its next game console. As Nintendo Switch approaches its seventh birthday in March 2024, questions about how much longer it will last are natural: Seven years is a typical lifespan for a console generation, Switch sales are falling fast, and the technology powering the console is showing its age. But Nintendo has flatly refused to engage with those questions. Behind the scenes, however, Nintendo is gearing up for the release of its new machine, briefing its partners, and releasing development kits. Information has started to leak, and a picture of what form the console will take has begun to emerge, as well as when we can expect to hear about it and when we can expect to buy one. It’s no surprise that Nintendo is treading carefully. The Switch has been an enormous success — it’s the third-best-selling console of all time, behind only PlayStation 2 and Nintendo’s own DS handheld — which presents both a big opportunity and a big risk. Historically, Nintendo has struggled to follow its most popular formats: Wii and DS were followed by the flop of Wii U and the relative disappointment (in sales terms) of 3DS. Nintendo’s usual insistence on hardware innovation has proven as likely to alienate its audience as to find a new one. Will Nintendo break with its own tradition and follow the Switch with a more powerful take on the same formula, or will it try something different? Nintendo is targeting a March 2025 release for the successor to Switch, according to a Nikkei report (as spotted and translated by VGC) on Feb. 26. Nikkei corroborates earlier reporting by the specialist press that the console’s release had slipped out of its original late 2024 window. Nikkei has a few new details to add. First is that firm March window, as opposed to “early 2025” — indicating that Nintendo, as expected, still hopes to release Switch 2 in its next financial year. Secondly, Nintendo’s reason for the delay is not just ensuring a strong software lineup, but trying to build up enough inventory of the console itself to avoid the shortages and widespread reselling by scalpers that blighted the PlayStation 5’s launch. Thirdly and most ominously, Nikkei says that Switch 2’s release could slip beyond March if the software isn’t ready and if Nintendo hasn’t manufactured enough units. Elsewhere, Nikkei corroborates earlier reports that Switch 2 will be a hybrid portable device like Switch, and that it will feature a larger screen than the current model. Regarding its name, the answer is that we don’t know. It’s worth noting that Nintendo has never before named its consoles in numerical sequence, even when they were direct follow-ups to a previous generation, such as the Super Nintendo Entertainment System, Game Boy Advance, and Nintendo 3DS. Super Nintendo Switch (or Super Switch!) has a certain ring to it, if you ask us. But for now, “Switch 2” is a serviceable shorthand, and what we’ll use in this article. The answer here appears to be yes. Recent reporting by VGC, citing multiple sources after dev kits arrived at partner studios, said that the console “would be able to be used in portable mode, similar to the Nintendo Switch.” This was later corroborated by Nikkei. There’s no word yet on whether the console will feature detachable Joy-Con controllers like the Switch, or whether it will have a handheld-only variant like the Switch Lite. But early signs are that Nintendo is keen to follow closely in the footsteps of the 130-million-plus-selling Switch. It might be a bit bigger, though. A 2024 report from a Japanese analyst suggests the console will have an 8-inch screen, compared to the original Switch’s 6.2 inches and the Switch OLED model’s 7 inches. Nintendo hasn’t officially indicated when the Switch 2 will be released, but we have a few clues. Originally, multiple sources reported that the console was planned to debut in the second half of 2024. However, it now appears that Nintendo is targeting a March 2025 release date. Brazilian games journalist Pedro Henrique Lutti Lippe originally broke the news of the slip to 2025, saying that multiple sources said they were working on games that are set to launch alongside the Switch 2. Both Eurogamer and VGC heard similar claims from their sources. Nikkei then reported Nintendo was targeting March 2025 in an effort to avoid hardware shortages and ensure a strong lineup of games — but noted a slip beyond March was still possible. While this is later than we previously expected, it fits in with an October 2023 interview with Nintendo president Shuntaro Furukawa, who reiterated that the company would remain focused on Switch until the end of Nintendo’s current fiscal year in March 2024, and added that it would continue to support Switch with new titles in the following fiscal year. The shift from “focus” to “support” for the Switch implies that a new console will launch in Nintendo’s next fiscal year — so, between April 2024 and March 2025. This also lines up with what we know about declining Switch sales, the stage Nintendo is at in the development of the console, and the release schedule for Switch games. Nintendo previously ruled out releasing a new console before the end of March 2024, and it now has Switch games scheduled through summer 2024; the latest release on the current schedule is Luigi’s Mansion 2 HD, which has been given a summer 2024 slot. (It’s also worth noting that the recently announced remake of Paper Mario: The Thousand-Year Door doesn’t have a more precise release date than “2024.”) This does mean the Switch 2 will miss the 2024 holiday season, but it’ll give the company more time to stockpile some first-party titles, according to VGC sources. This is the big question, with many users hoping — or outright expecting — to carry forward their game libraries to Nintendo’s next console, as has become the norm with the latest generations of Xbox and PlayStation consoles. The answer remains unknown, and it’s not easy to predict, either. VGC’s report said that the backward compatibility of the machine “remains unclear.” Some third-party publishers were said to be worried about the potential impact on sales of next-gen titles if the machine is backward-compatible. For its part, Nintendo has (in a rare on-the-record comment) said it hopes to bring Switch users over to the new platform with their Nintendo accounts; if the Nintendo account system persists, that would in theory make it easy for users to access previous purchases. But that’s not the same thing as the console being technically capable of it. Nintendo has a decent, if not flawless, record for supporting backward compatibility. Wii played GameCube games, and Wii U played Wii games; Game Boy Advance was backward-compatible with Game Boy, and 3DS with DS. But the Switch, with its new game cartridge format, enforced a clean break with the past, and Nintendo has made a mint from rereleasing Wii U games on the machine, particularly the 55-million-selling Mario Kart 8 Deluxe. On balance, as long as the machine uses the same format for physical releases (see below), Nintendo’s record suggests that it will make the Switch 2 backward-compatible. However, there remain technical hurdles to implementing backward compatibility, and much will depend on the chip architecture Nintendo has chosen for the Switch 2, which is not currently known. Of all the console manufacturers, Nintendo’s ties to the retail industry are perhaps the strongest — stronger even than Sony’s — so Nintendo is extremely unlikely to go digital-only for the Switch 2, even if this would seem to make sense for a portable machine. Indeed, VGC’s report included the detail that the new console will have a cartridge slot for physical releases. This is as close to a dead cert as we can get with the Switch 2 — and it also happens to support the machine having the same or similar form factor as the Switch, as well as increasing the likelihood of backward compatibility. Thanks to Microsoft’s legal battles over its acquisition of Activision Blizzard, and reports of demos given by Nintendo to partners at Gamescom, we are beginning to get a sense of how capable the Switch 2’s hardware will be. Internal emails released as part of the FTC v. Microsoft case revealed that Activision executives met with Nintendo in December 2022 to discuss the console, and came away with the impression that performance would be close to “Gen8 platforms” — in other words, PlayStation 4 and Xbox One. (Activision Blizzard CEO Bobby Kotick later said that he had not seen tech specs for the machine, however.) If anything, the “Gen8” comparison sounds as though it might undersell the Switch 2’s capabilities. According to Eurogamer’s and VGC’s reporting on the behind-closed-doors Gamescom demos, Nintendo showed hardware targeting the specs of the console running The Matrix Awakens’ Unreal Engine 5 tech demo with ray tracing enabled and “visuals comparable to Sony’s and Microsoft’s current-gen consoles.” This doesn’t mean that the Switch 2 will be as powerful as PlayStation 5 and Xbox Series X. Instead, Nintendo is likely using clever techniques to reduce the demand on a less powerful graphics processor. VGC reported that the demo ran using Nvidia’s advanced DLSS upscaling technology, which uses AI to upscale the resolution of the image. Still, the mention of Unreal Engine 5 — which is establishing itself as the industry standard engine, targeting current console hardware — along with DLSS and ray tracing suggests that Nintendo is keen to get closer to PS5 and Xbox Series X in terms of performance, and perhaps make it more feasible for developers to port their home console releases on the Switch 2. Reporting by Reuters and Digital Foundry suggests the console will use a custom Nvidia chip that will be capable of both ray-tracing and DLSS. Also at Gamescom, a special, improved version of The Legend of Zelda: Breath of the Wild was shown, running at higher resolution and frame rate than it does on Switch. The Switch 2 will feature one tech downgrade, however: Reportedly, the console will feature an LCD screen, unlike the OLED screen seen in the current top-of-the-range Switch model, as a cost-cutting measure.
|
<SYSTEM INSTRUCTION> ======= Answer in complete sentences, only use the context document, no outside knowledge. ================ <CONTEXT> ======= **What's publicly known about "Switch 2"** Nintendo, notoriously secretive, has so far said nothing — or almost nothing — on the record about its next game console. As Nintendo Switch approaches its seventh birthday in March 2024, questions about how much longer it will last are natural: Seven years is a typical lifespan for a console generation, Switch sales are falling fast, and the technology powering the console is showing its age. But Nintendo has flatly refused to engage with those questions. Behind the scenes, however, Nintendo is gearing up for the release of its new machine, briefing its partners, and releasing development kits. Information has started to leak, and a picture of what form the console will take has begun to emerge, as well as when we can expect to hear about it and when we can expect to buy one. It’s no surprise that Nintendo is treading carefully. The Switch has been an enormous success — it’s the third-best-selling console of all time, behind only PlayStation 2 and Nintendo’s own DS handheld — which presents both a big opportunity and a big risk. Historically, Nintendo has struggled to follow its most popular formats: Wii and DS were followed by the flop of Wii U and the relative disappointment (in sales terms) of 3DS. Nintendo’s usual insistence on hardware innovation has proven as likely to alienate its audience as to find a new one. Will Nintendo break with its own tradition and follow the Switch with a more powerful take on the same formula, or will it try something different? Nintendo is targeting a March 2025 release for the successor to Switch, according to a Nikkei report (as spotted and translated by VGC) on Feb. 26. Nikkei corroborates earlier reporting by the specialist press that the console’s release had slipped out of its original late 2024 window. Nikkei has a few new details to add. First is that firm March window, as opposed to “early 2025” — indicating that Nintendo, as expected, still hopes to release Switch 2 in its next financial year. Secondly, Nintendo’s reason for the delay is not just ensuring a strong software lineup, but trying to build up enough inventory of the console itself to avoid the shortages and widespread reselling by scalpers that blighted the PlayStation 5’s launch. Thirdly and most ominously, Nikkei says that Switch 2’s release could slip beyond March if the software isn’t ready and if Nintendo hasn’t manufactured enough units. Elsewhere, Nikkei corroborates earlier reports that Switch 2 will be a hybrid portable device like Switch, and that it will feature a larger screen than the current model. Regarding its name, the answer is that we don’t know. It’s worth noting that Nintendo has never before named its consoles in numerical sequence, even when they were direct follow-ups to a previous generation, such as the Super Nintendo Entertainment System, Game Boy Advance, and Nintendo 3DS. Super Nintendo Switch (or Super Switch!) has a certain ring to it, if you ask us. But for now, “Switch 2” is a serviceable shorthand, and what we’ll use in this article. The answer here appears to be yes. Recent reporting by VGC, citing multiple sources after dev kits arrived at partner studios, said that the console “would be able to be used in portable mode, similar to the Nintendo Switch.” This was later corroborated by Nikkei. There’s no word yet on whether the console will feature detachable Joy-Con controllers like the Switch, or whether it will have a handheld-only variant like the Switch Lite. But early signs are that Nintendo is keen to follow closely in the footsteps of the 130-million-plus-selling Switch. It might be a bit bigger, though. A 2024 report from a Japanese analyst suggests the console will have an 8-inch screen, compared to the original Switch’s 6.2 inches and the Switch OLED model’s 7 inches. Nintendo hasn’t officially indicated when the Switch 2 will be released, but we have a few clues. Originally, multiple sources reported that the console was planned to debut in the second half of 2024. However, it now appears that Nintendo is targeting a March 2025 release date. Brazilian games journalist Pedro Henrique Lutti Lippe originally broke the news of the slip to 2025, saying that multiple sources said they were working on games that are set to launch alongside the Switch 2. Both Eurogamer and VGC heard similar claims from their sources. Nikkei then reported Nintendo was targeting March 2025 in an effort to avoid hardware shortages and ensure a strong lineup of games — but noted a slip beyond March was still possible. While this is later than we previously expected, it fits in with an October 2023 interview with Nintendo president Shuntaro Furukawa, who reiterated that the company would remain focused on Switch until the end of Nintendo’s current fiscal year in March 2024, and added that it would continue to support Switch with new titles in the following fiscal year. The shift from “focus” to “support” for the Switch implies that a new console will launch in Nintendo’s next fiscal year — so, between April 2024 and March 2025. This also lines up with what we know about declining Switch sales, the stage Nintendo is at in the development of the console, and the release schedule for Switch games. Nintendo previously ruled out releasing a new console before the end of March 2024, and it now has Switch games scheduled through summer 2024; the latest release on the current schedule is Luigi’s Mansion 2 HD, which has been given a summer 2024 slot. (It’s also worth noting that the recently announced remake of Paper Mario: The Thousand-Year Door doesn’t have a more precise release date than “2024.”) This does mean the Switch 2 will miss the 2024 holiday season, but it’ll give the company more time to stockpile some first-party titles, according to VGC sources. This is the big question, with many users hoping — or outright expecting — to carry forward their game libraries to Nintendo’s next console, as has become the norm with the latest generations of Xbox and PlayStation consoles. The answer remains unknown, and it’s not easy to predict, either. VGC’s report said that the backward compatibility of the machine “remains unclear.” Some third-party publishers were said to be worried about the potential impact on sales of next-gen titles if the machine is backward-compatible. For its part, Nintendo has (in a rare on-the-record comment) said it hopes to bring Switch users over to the new platform with their Nintendo accounts; if the Nintendo account system persists, that would in theory make it easy for users to access previous purchases. But that’s not the same thing as the console being technically capable of it. Nintendo has a decent, if not flawless, record for supporting backward compatibility. Wii played GameCube games, and Wii U played Wii games; Game Boy Advance was backward-compatible with Game Boy, and 3DS with DS. But the Switch, with its new game cartridge format, enforced a clean break with the past, and Nintendo has made a mint from rereleasing Wii U games on the machine, particularly the 55-million-selling Mario Kart 8 Deluxe. On balance, as long as the machine uses the same format for physical releases (see below), Nintendo’s record suggests that it will make the Switch 2 backward-compatible. However, there remain technical hurdles to implementing backward compatibility, and much will depend on the chip architecture Nintendo has chosen for the Switch 2, which is not currently known. Of all the console manufacturers, Nintendo’s ties to the retail industry are perhaps the strongest — stronger even than Sony’s — so Nintendo is extremely unlikely to go digital-only for the Switch 2, even if this would seem to make sense for a portable machine. Indeed, VGC’s report included the detail that the new console will have a cartridge slot for physical releases. This is as close to a dead cert as we can get with the Switch 2 — and it also happens to support the machine having the same or similar form factor as the Switch, as well as increasing the likelihood of backward compatibility. Thanks to Microsoft’s legal battles over its acquisition of Activision Blizzard, and reports of demos given by Nintendo to partners at Gamescom, we are beginning to get a sense of how capable the Switch 2’s hardware will be. Internal emails released as part of the FTC v. Microsoft case revealed that Activision executives met with Nintendo in December 2022 to discuss the console, and came away with the impression that performance would be close to “Gen8 platforms” — in other words, PlayStation 4 and Xbox One. (Activision Blizzard CEO Bobby Kotick later said that he had not seen tech specs for the machine, however.) If anything, the “Gen8” comparison sounds as though it might undersell the Switch 2’s capabilities. According to Eurogamer’s and VGC’s reporting on the behind-closed-doors Gamescom demos, Nintendo showed hardware targeting the specs of the console running The Matrix Awakens’ Unreal Engine 5 tech demo with ray tracing enabled and “visuals comparable to Sony’s and Microsoft’s current-gen consoles.” This doesn’t mean that the Switch 2 will be as powerful as PlayStation 5 and Xbox Series X. Instead, Nintendo is likely using clever techniques to reduce the demand on a less powerful graphics processor. VGC reported that the demo ran using Nvidia’s advanced DLSS upscaling technology, which uses AI to upscale the resolution of the image. Still, the mention of Unreal Engine 5 — which is establishing itself as the industry standard engine, targeting current console hardware — along with DLSS and ray tracing suggests that Nintendo is keen to get closer to PS5 and Xbox Series X in terms of performance, and perhaps make it more feasible for developers to port their home console releases on the Switch 2. Reporting by Reuters and Digital Foundry suggests the console will use a custom Nvidia chip that will be capable of both ray-tracing and DLSS. Also at Gamescom, a special, improved version of The Legend of Zelda: Breath of the Wild was shown, running at higher resolution and frame rate than it does on Switch. The Switch 2 will feature one tech downgrade, however: Reportedly, the console will feature an LCD screen, unlike the OLED screen seen in the current top-of-the-range Switch model, as a cost-cutting measure. ================ <QUESTION> ======= According to the document, how many copies of Mario Kart 8 Deluxe have been sold?
|
Answer in complete sentences, only use the context document, no outside knowledge.
EVIDENCE:
**What's publicly known about "Switch 2"** Nintendo, notoriously secretive, has so far said nothing — or almost nothing — on the record about its next game console. As Nintendo Switch approaches its seventh birthday in March 2024, questions about how much longer it will last are natural: Seven years is a typical lifespan for a console generation, Switch sales are falling fast, and the technology powering the console is showing its age. But Nintendo has flatly refused to engage with those questions. Behind the scenes, however, Nintendo is gearing up for the release of its new machine, briefing its partners, and releasing development kits. Information has started to leak, and a picture of what form the console will take has begun to emerge, as well as when we can expect to hear about it and when we can expect to buy one. It’s no surprise that Nintendo is treading carefully. The Switch has been an enormous success — it’s the third-best-selling console of all time, behind only PlayStation 2 and Nintendo’s own DS handheld — which presents both a big opportunity and a big risk. Historically, Nintendo has struggled to follow its most popular formats: Wii and DS were followed by the flop of Wii U and the relative disappointment (in sales terms) of 3DS. Nintendo’s usual insistence on hardware innovation has proven as likely to alienate its audience as to find a new one. Will Nintendo break with its own tradition and follow the Switch with a more powerful take on the same formula, or will it try something different? Nintendo is targeting a March 2025 release for the successor to Switch, according to a Nikkei report (as spotted and translated by VGC) on Feb. 26. Nikkei corroborates earlier reporting by the specialist press that the console’s release had slipped out of its original late 2024 window. Nikkei has a few new details to add. First is that firm March window, as opposed to “early 2025” — indicating that Nintendo, as expected, still hopes to release Switch 2 in its next financial year. Secondly, Nintendo’s reason for the delay is not just ensuring a strong software lineup, but trying to build up enough inventory of the console itself to avoid the shortages and widespread reselling by scalpers that blighted the PlayStation 5’s launch. Thirdly and most ominously, Nikkei says that Switch 2’s release could slip beyond March if the software isn’t ready and if Nintendo hasn’t manufactured enough units. Elsewhere, Nikkei corroborates earlier reports that Switch 2 will be a hybrid portable device like Switch, and that it will feature a larger screen than the current model. Regarding its name, the answer is that we don’t know. It’s worth noting that Nintendo has never before named its consoles in numerical sequence, even when they were direct follow-ups to a previous generation, such as the Super Nintendo Entertainment System, Game Boy Advance, and Nintendo 3DS. Super Nintendo Switch (or Super Switch!) has a certain ring to it, if you ask us. But for now, “Switch 2” is a serviceable shorthand, and what we’ll use in this article. The answer here appears to be yes. Recent reporting by VGC, citing multiple sources after dev kits arrived at partner studios, said that the console “would be able to be used in portable mode, similar to the Nintendo Switch.” This was later corroborated by Nikkei. There’s no word yet on whether the console will feature detachable Joy-Con controllers like the Switch, or whether it will have a handheld-only variant like the Switch Lite. But early signs are that Nintendo is keen to follow closely in the footsteps of the 130-million-plus-selling Switch. It might be a bit bigger, though. A 2024 report from a Japanese analyst suggests the console will have an 8-inch screen, compared to the original Switch’s 6.2 inches and the Switch OLED model’s 7 inches. Nintendo hasn’t officially indicated when the Switch 2 will be released, but we have a few clues. Originally, multiple sources reported that the console was planned to debut in the second half of 2024. However, it now appears that Nintendo is targeting a March 2025 release date. Brazilian games journalist Pedro Henrique Lutti Lippe originally broke the news of the slip to 2025, saying that multiple sources said they were working on games that are set to launch alongside the Switch 2. Both Eurogamer and VGC heard similar claims from their sources. Nikkei then reported Nintendo was targeting March 2025 in an effort to avoid hardware shortages and ensure a strong lineup of games — but noted a slip beyond March was still possible. While this is later than we previously expected, it fits in with an October 2023 interview with Nintendo president Shuntaro Furukawa, who reiterated that the company would remain focused on Switch until the end of Nintendo’s current fiscal year in March 2024, and added that it would continue to support Switch with new titles in the following fiscal year. The shift from “focus” to “support” for the Switch implies that a new console will launch in Nintendo’s next fiscal year — so, between April 2024 and March 2025. This also lines up with what we know about declining Switch sales, the stage Nintendo is at in the development of the console, and the release schedule for Switch games. Nintendo previously ruled out releasing a new console before the end of March 2024, and it now has Switch games scheduled through summer 2024; the latest release on the current schedule is Luigi’s Mansion 2 HD, which has been given a summer 2024 slot. (It’s also worth noting that the recently announced remake of Paper Mario: The Thousand-Year Door doesn’t have a more precise release date than “2024.”) This does mean the Switch 2 will miss the 2024 holiday season, but it’ll give the company more time to stockpile some first-party titles, according to VGC sources. This is the big question, with many users hoping — or outright expecting — to carry forward their game libraries to Nintendo’s next console, as has become the norm with the latest generations of Xbox and PlayStation consoles. The answer remains unknown, and it’s not easy to predict, either. VGC’s report said that the backward compatibility of the machine “remains unclear.” Some third-party publishers were said to be worried about the potential impact on sales of next-gen titles if the machine is backward-compatible. For its part, Nintendo has (in a rare on-the-record comment) said it hopes to bring Switch users over to the new platform with their Nintendo accounts; if the Nintendo account system persists, that would in theory make it easy for users to access previous purchases. But that’s not the same thing as the console being technically capable of it. Nintendo has a decent, if not flawless, record for supporting backward compatibility. Wii played GameCube games, and Wii U played Wii games; Game Boy Advance was backward-compatible with Game Boy, and 3DS with DS. But the Switch, with its new game cartridge format, enforced a clean break with the past, and Nintendo has made a mint from rereleasing Wii U games on the machine, particularly the 55-million-selling Mario Kart 8 Deluxe. On balance, as long as the machine uses the same format for physical releases (see below), Nintendo’s record suggests that it will make the Switch 2 backward-compatible. However, there remain technical hurdles to implementing backward compatibility, and much will depend on the chip architecture Nintendo has chosen for the Switch 2, which is not currently known. Of all the console manufacturers, Nintendo’s ties to the retail industry are perhaps the strongest — stronger even than Sony’s — so Nintendo is extremely unlikely to go digital-only for the Switch 2, even if this would seem to make sense for a portable machine. Indeed, VGC’s report included the detail that the new console will have a cartridge slot for physical releases. This is as close to a dead cert as we can get with the Switch 2 — and it also happens to support the machine having the same or similar form factor as the Switch, as well as increasing the likelihood of backward compatibility. Thanks to Microsoft’s legal battles over its acquisition of Activision Blizzard, and reports of demos given by Nintendo to partners at Gamescom, we are beginning to get a sense of how capable the Switch 2’s hardware will be. Internal emails released as part of the FTC v. Microsoft case revealed that Activision executives met with Nintendo in December 2022 to discuss the console, and came away with the impression that performance would be close to “Gen8 platforms” — in other words, PlayStation 4 and Xbox One. (Activision Blizzard CEO Bobby Kotick later said that he had not seen tech specs for the machine, however.) If anything, the “Gen8” comparison sounds as though it might undersell the Switch 2’s capabilities. According to Eurogamer’s and VGC’s reporting on the behind-closed-doors Gamescom demos, Nintendo showed hardware targeting the specs of the console running The Matrix Awakens’ Unreal Engine 5 tech demo with ray tracing enabled and “visuals comparable to Sony’s and Microsoft’s current-gen consoles.” This doesn’t mean that the Switch 2 will be as powerful as PlayStation 5 and Xbox Series X. Instead, Nintendo is likely using clever techniques to reduce the demand on a less powerful graphics processor. VGC reported that the demo ran using Nvidia’s advanced DLSS upscaling technology, which uses AI to upscale the resolution of the image. Still, the mention of Unreal Engine 5 — which is establishing itself as the industry standard engine, targeting current console hardware — along with DLSS and ray tracing suggests that Nintendo is keen to get closer to PS5 and Xbox Series X in terms of performance, and perhaps make it more feasible for developers to port their home console releases on the Switch 2. Reporting by Reuters and Digital Foundry suggests the console will use a custom Nvidia chip that will be capable of both ray-tracing and DLSS. Also at Gamescom, a special, improved version of The Legend of Zelda: Breath of the Wild was shown, running at higher resolution and frame rate than it does on Switch. The Switch 2 will feature one tech downgrade, however: Reportedly, the console will feature an LCD screen, unlike the OLED screen seen in the current top-of-the-range Switch model, as a cost-cutting measure.
USER:
According to the document, how many copies of Mario Kart 8 Deluxe have been sold?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 12 | 15 | 1,726 | null | 69 |
Do not use any information outside of the context.
|
According to the context, what are the pros and cons of using Motrin?
|
CLINICAL PHARMACOLOGY MOTRIN tablets contain ibuprofen which possesses analgesic and antipyretic activities. Its mode of action, like that of other NSAIDs, is not completely understood, but may be related to prostaglandin synthetase inhibition. In clinical studies in patients with rheumatoid arthritis and osteoarthritis, MOTRIN tablets have been shown to be comparable to aspirin in controlling pain and inflammation and to be associated with a statistically significant reduction in the milder gastrointestinal side effects. MOTRIN tablets may be well tolerated in some patients who have had gastrointestinal side effects with aspirin, but these patients when treated with MOTRIN tablets should be carefully followed for signs and symptoms of gastrointestinal ulceration and bleeding. Although it is not definitely known whether MOTRIN tablets causes less peptic ulceration than aspirin, in one study involving 885 patients with rheumatoid arthritis treated for up to one year, there were no reports of gastric ulceration with MOTRIN tablets whereas frank ulceration was reported in 13 patients in the aspirin group (statistically significant p<.001). Gastroscopic studies at varying doses show an increased tendency toward gastric irritation at higher doses. However, at comparable doses, gastric irritation is approximately half that seen with aspirin. In clinical studies in patients with rheumatoid arthritis, MOTRIN tablets have been shown to be comparable to indomethacin in controlling the signs and symptoms of disease activity and to be associated with a statistically significant reduction of the milder gastrointestinal and CNS side effects. Controlled studies have demonstrated that MOTRIN tablets are a more effective analgesic than propoxyphene for the relief of episiotomy pain, pain following dental extraction procedures, and for the relief of the symptoms of primary dysmenorrhea. In patients with primary dysmenorrhea, MOTRIN tablets have been shown to reduce elevated levels of prostaglandin activity in the menstrual fluid and to reduce resting and active intrauterine pressure, as well as the frequency of uterine contractions. The probable mechanism of action is to inhibit prostaglandin synthesis rather than simply to provide analgesia. INDICATIONS AND USAGE MOTRIN tablets are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis. MOTRIN tablets are indicated for relief of mild to moderate pain. MOTRIN tablets are also indicated for the treatment of primary dysmenorrhea. Controlled clinical trials to establish the safety and effectiveness of MOTRIN tablets in children have not been conducted. CONTRAINDICATIONS MOTRIN tablets are contraindicated in patients with known hypersensitivity to Ibuprofen. MOTRIN tablets should not be given to patients who have experienced asthma, urticaria, or allergictype reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients. MOTRIN tablets are contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery (see WARNINGS). WARNINGS CARDIOVASCULAR EFFECTS Cardiovascular Thrombotic Events Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. All NSAIDs, both COX-2 selective and nonselective, may have a similar risk. Patients with known CV disease or risk factors for CV disease may be at greater risk. To minimize the potential risk for an adverse CV event in patients treated with an NSAID, the lowest effective dose should be used for the shortest duration possible. Physicians and patients should remain alert for the development of such events, even in the absence of previous CV symptoms. Patients should be informed about the signs and/or symptoms of serious CV events and the steps to take if they occur. There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use. The concurrent use of aspirin and an NSAID does increase the risk of serious GI events (see GI WARNINGS). Two large, controlled clinical trials of a COX-2 selective NSAID for the treatment of pain in the first 10-14 days following CABG surgery found an increased incidence of myocardial infarction and stroke (see CONTRAINDICATIONS). Hypertension NSAIDs including MOTRIN tablets, can lead to onset of new hypertension or worsening of preexisting hypertension, either of which may contribute to the increased incidence of CV events. Patients taking thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs. NSAIDs, including MOTRIN tablets, should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy. Congestive Heart Failure and Edema Fluid retention and edema have been observed in some patients taking NSAIDs. MOTRIN tablets should be used with caution in patients with fluid retention or heart failure. Gastrointestinal Effects - Risk of Ulceration, Bleeding, and Perforation NSAIDs, including MOTRIN tablets, can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine,which can be fatal. These serious adverse events can occur at any time, with or without warning symptoms, in patients treated with NSAIDs. Only one in five patients, who develop a serious upper GI adverse event on NSAID therapy, is symptomatic. Upper GI ulcers, gross bleeding, or perforation caused by NSAIDs occur in approximately 1% of patients treated for 3-6 months, and in about 2-4% of patients treated for one year. These trends continue with longer duration of use, increasing the likelihood of developing a serious GI event at some time during the course of therapy. However, even short-term therapy is not without risk. NSAIDs should be prescribed with extreme caution in those with a prior history of ulcer disease or gastrointestinal bleeding. Patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients treated with neither of these risk factors. Other factors that increase the risk of GI bleeding in patients treated with NSAIDs include concomitant use of oral corticosteroids or anticoagulants, longer duration of NSAID therapy, smoking, use of alcohol, older age, and poor general health status. Most spontaneous reports of fatal GI events are in elderly or debilitated patients and therefore, special care should be taken in treating this population. To minimize the potential risk for an adverse GI event in patients treated with an NSAID, the lowest effective dose should be used for the shortest possible duration. Patients and physicians should remain alert for signs and symptoms of GI ulcerations and bleeding during NSAID therapy and promptly initiate additional evaluation and treatment if a serious GI event is suspected. This should include discontinuation of the NSAID until a serious GI adverse event is ruled out. For high-risk patients, alternate therapies that do not involve NSAIDs should be considered. Renal Effects Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of a NSAID may cause a dosedependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors, and the elderly. Discontinuation of NSAID therapy is usually followed by recovery to the pretreatment state. Advanced Renal Disease No information is available from controlled clinical studies regarding the use of MOTRIN tablets in patients with advanced renal disease. Therefore, treatment with MOTRIN tablets is not recommended in these patients with advanced renal disease. If MOTRIN tablet therapy must be initiated, close monitoring of the patients renal function is advisable. Anaphylactoid Reactions As with other NSAIDs, anaphylactoid reactions may occur in patients without known prior exposure to MOTRIN tablets. MOTRIN tablets should not be given to patients with the aspirin triad. This symptom complex typically occurs in asthmatic patients who experience rhinitis with or without nasal polyps, or who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs (see CONTRAINDICATIONS and PRECAUTIONS, Preexisting Asthma). Emergency help should be sought in cases where an anaphylactoid reaction occurs. Skin Reactions NSAIDs, including MOTRIN tablets, can cause serious skin adverse events such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. These serious events may occur without warning. Patients should be informed about the signs and symptoms of serious skin manifestations and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. Pregnancy In late pregnancy, as with other NSAIDs, MOTRIN tablets should be avoided because it may cause premature closure of the ductus arteriosus.
|
Question: According to the context, what are the pros and cons of using Motrin? System Instructions: Do not use any information outside of the context. Context: CLINICAL PHARMACOLOGY MOTRIN tablets contain ibuprofen which possesses analgesic and antipyretic activities. Its mode of action, like that of other NSAIDs, is not completely understood, but may be related to prostaglandin synthetase inhibition. In clinical studies in patients with rheumatoid arthritis and osteoarthritis, MOTRIN tablets have been shown to be comparable to aspirin in controlling pain and inflammation and to be associated with a statistically significant reduction in the milder gastrointestinal side effects. MOTRIN tablets may be well tolerated in some patients who have had gastrointestinal side effects with aspirin, but these patients when treated with MOTRIN tablets should be carefully followed for signs and symptoms of gastrointestinal ulceration and bleeding. Although it is not definitely known whether MOTRIN tablets causes less peptic ulceration than aspirin, in one study involving 885 patients with rheumatoid arthritis treated for up to one year, there were no reports of gastric ulceration with MOTRIN tablets whereas frank ulceration was reported in 13 patients in the aspirin group (statistically significant p<.001). Gastroscopic studies at varying doses show an increased tendency toward gastric irritation at higher doses. However, at comparable doses, gastric irritation is approximately half that seen with aspirin. In clinical studies in patients with rheumatoid arthritis, MOTRIN tablets have been shown to be comparable to indomethacin in controlling the signs and symptoms of disease activity and to be associated with a statistically significant reduction of the milder gastrointestinal and CNS side effects. Controlled studies have demonstrated that MOTRIN tablets are a more effective analgesic than propoxyphene for the relief of episiotomy pain, pain following dental extraction procedures, and for the relief of the symptoms of primary dysmenorrhea. In patients with primary dysmenorrhea, MOTRIN tablets have been shown to reduce elevated levels of prostaglandin activity in the menstrual fluid and to reduce resting and active intrauterine pressure, as well as the frequency of uterine contractions. The probable mechanism of action is to inhibit prostaglandin synthesis rather than simply to provide analgesia. INDICATIONS AND USAGE MOTRIN tablets are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis. MOTRIN tablets are indicated for relief of mild to moderate pain. MOTRIN tablets are also indicated for the treatment of primary dysmenorrhea. Controlled clinical trials to establish the safety and effectiveness of MOTRIN tablets in children have not been conducted. CONTRAINDICATIONS MOTRIN tablets are contraindicated in patients with known hypersensitivity to Ibuprofen. MOTRIN tablets should not be given to patients who have experienced asthma, urticaria, or allergictype reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients. MOTRIN tablets are contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery (see WARNINGS). WARNINGS CARDIOVASCULAR EFFECTS Cardiovascular Thrombotic Events Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. All NSAIDs, both COX-2 selective and nonselective, may have a similar risk. Patients with known CV disease or risk factors for CV disease may be at greater risk. To minimize the potential risk for an adverse CV event in patients treated with an NSAID, the lowest effective dose should be used for the shortest duration possible. Physicians and patients should remain alert for the development of such events, even in the absence of previous CV symptoms. Patients should be informed about the signs and/or symptoms of serious CV events and the steps to take if they occur. There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use. The concurrent use of aspirin and an NSAID does increase the risk of serious GI events (see GI WARNINGS). Two large, controlled clinical trials of a COX-2 selective NSAID for the treatment of pain in the first 10-14 days following CABG surgery found an increased incidence of myocardial infarction and stroke (see CONTRAINDICATIONS). Hypertension NSAIDs including MOTRIN tablets, can lead to onset of new hypertension or worsening of preexisting hypertension, either of which may contribute to the increased incidence of CV events. Patients taking thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs. NSAIDs, including MOTRIN tablets, should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy. Congestive Heart Failure and Edema Fluid retention and edema have been observed in some patients taking NSAIDs. MOTRIN tablets should be used with caution in patients with fluid retention or heart failure. Gastrointestinal Effects - Risk of Ulceration, Bleeding, and Perforation NSAIDs, including MOTRIN tablets, can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine,which can be fatal. These serious adverse events can occur at any time, with or without warning symptoms, in patients treated with NSAIDs. Only one in five patients, who develop a serious upper GI adverse event on NSAID therapy, is symptomatic. Upper GI ulcers, gross bleeding, or perforation caused by NSAIDs occur in approximately 1% of patients treated for 3-6 months, and in about 2-4% of patients treated for one year. These trends continue with longer duration of use, increasing the likelihood of developing a serious GI event at some time during the course of therapy. However, even short-term therapy is not without risk. NSAIDs should be prescribed with extreme caution in those with a prior history of ulcer disease or gastrointestinal bleeding. Patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients treated with neither of these risk factors. Other factors that increase the risk of GI bleeding in patients treated with NSAIDs include concomitant use of oral corticosteroids or anticoagulants, longer duration of NSAID therapy, smoking, use of alcohol, older age, and poor general health status. Most spontaneous reports of fatal GI events are in elderly or debilitated patients and therefore, special care should be taken in treating this population. To minimize the potential risk for an adverse GI event in patients treated with an NSAID, the lowest effective dose should be used for the shortest possible duration. Patients and physicians should remain alert for signs and symptoms of GI ulcerations and bleeding during NSAID therapy and promptly initiate additional evaluation and treatment if a serious GI event is suspected. This should include discontinuation of the NSAID until a serious GI adverse event is ruled out. For high-risk patients, alternate therapies that do not involve NSAIDs should be considered. Renal Effects Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of a NSAID may cause a dosedependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors, and the elderly. Discontinuation of NSAID therapy is usually followed by recovery to the pretreatment state. Advanced Renal Disease No information is available from controlled clinical studies regarding the use of MOTRIN tablets in patients with advanced renal disease. Therefore, treatment with MOTRIN tablets is not recommended in these patients with advanced renal disease. If MOTRIN tablet therapy must be initiated, close monitoring of the patients renal function is advisable. Anaphylactoid Reactions As with other NSAIDs, anaphylactoid reactions may occur in patients without known prior exposure to MOTRIN tablets. MOTRIN tablets should not be given to patients with the aspirin triad. This symptom complex typically occurs in asthmatic patients who experience rhinitis with or without nasal polyps, or who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs (see CONTRAINDICATIONS and PRECAUTIONS, Preexisting Asthma). Emergency help should be sought in cases where an anaphylactoid reaction occurs. Skin Reactions NSAIDs, including MOTRIN tablets, can cause serious skin adverse events such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. These serious events may occur without warning. Patients should be informed about the signs and symptoms of serious skin manifestations and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. Pregnancy In late pregnancy, as with other NSAIDs, MOTRIN tablets should be avoided because it may cause premature closure of the ductus arteriosus.
|
Do not use any information outside of the context.
EVIDENCE:
CLINICAL PHARMACOLOGY MOTRIN tablets contain ibuprofen which possesses analgesic and antipyretic activities. Its mode of action, like that of other NSAIDs, is not completely understood, but may be related to prostaglandin synthetase inhibition. In clinical studies in patients with rheumatoid arthritis and osteoarthritis, MOTRIN tablets have been shown to be comparable to aspirin in controlling pain and inflammation and to be associated with a statistically significant reduction in the milder gastrointestinal side effects. MOTRIN tablets may be well tolerated in some patients who have had gastrointestinal side effects with aspirin, but these patients when treated with MOTRIN tablets should be carefully followed for signs and symptoms of gastrointestinal ulceration and bleeding. Although it is not definitely known whether MOTRIN tablets causes less peptic ulceration than aspirin, in one study involving 885 patients with rheumatoid arthritis treated for up to one year, there were no reports of gastric ulceration with MOTRIN tablets whereas frank ulceration was reported in 13 patients in the aspirin group (statistically significant p<.001). Gastroscopic studies at varying doses show an increased tendency toward gastric irritation at higher doses. However, at comparable doses, gastric irritation is approximately half that seen with aspirin. In clinical studies in patients with rheumatoid arthritis, MOTRIN tablets have been shown to be comparable to indomethacin in controlling the signs and symptoms of disease activity and to be associated with a statistically significant reduction of the milder gastrointestinal and CNS side effects. Controlled studies have demonstrated that MOTRIN tablets are a more effective analgesic than propoxyphene for the relief of episiotomy pain, pain following dental extraction procedures, and for the relief of the symptoms of primary dysmenorrhea. In patients with primary dysmenorrhea, MOTRIN tablets have been shown to reduce elevated levels of prostaglandin activity in the menstrual fluid and to reduce resting and active intrauterine pressure, as well as the frequency of uterine contractions. The probable mechanism of action is to inhibit prostaglandin synthesis rather than simply to provide analgesia. INDICATIONS AND USAGE MOTRIN tablets are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis. MOTRIN tablets are indicated for relief of mild to moderate pain. MOTRIN tablets are also indicated for the treatment of primary dysmenorrhea. Controlled clinical trials to establish the safety and effectiveness of MOTRIN tablets in children have not been conducted. CONTRAINDICATIONS MOTRIN tablets are contraindicated in patients with known hypersensitivity to Ibuprofen. MOTRIN tablets should not be given to patients who have experienced asthma, urticaria, or allergictype reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients. MOTRIN tablets are contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery (see WARNINGS). WARNINGS CARDIOVASCULAR EFFECTS Cardiovascular Thrombotic Events Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. All NSAIDs, both COX-2 selective and nonselective, may have a similar risk. Patients with known CV disease or risk factors for CV disease may be at greater risk. To minimize the potential risk for an adverse CV event in patients treated with an NSAID, the lowest effective dose should be used for the shortest duration possible. Physicians and patients should remain alert for the development of such events, even in the absence of previous CV symptoms. Patients should be informed about the signs and/or symptoms of serious CV events and the steps to take if they occur. There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use. The concurrent use of aspirin and an NSAID does increase the risk of serious GI events (see GI WARNINGS). Two large, controlled clinical trials of a COX-2 selective NSAID for the treatment of pain in the first 10-14 days following CABG surgery found an increased incidence of myocardial infarction and stroke (see CONTRAINDICATIONS). Hypertension NSAIDs including MOTRIN tablets, can lead to onset of new hypertension or worsening of preexisting hypertension, either of which may contribute to the increased incidence of CV events. Patients taking thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs. NSAIDs, including MOTRIN tablets, should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy. Congestive Heart Failure and Edema Fluid retention and edema have been observed in some patients taking NSAIDs. MOTRIN tablets should be used with caution in patients with fluid retention or heart failure. Gastrointestinal Effects - Risk of Ulceration, Bleeding, and Perforation NSAIDs, including MOTRIN tablets, can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine,which can be fatal. These serious adverse events can occur at any time, with or without warning symptoms, in patients treated with NSAIDs. Only one in five patients, who develop a serious upper GI adverse event on NSAID therapy, is symptomatic. Upper GI ulcers, gross bleeding, or perforation caused by NSAIDs occur in approximately 1% of patients treated for 3-6 months, and in about 2-4% of patients treated for one year. These trends continue with longer duration of use, increasing the likelihood of developing a serious GI event at some time during the course of therapy. However, even short-term therapy is not without risk. NSAIDs should be prescribed with extreme caution in those with a prior history of ulcer disease or gastrointestinal bleeding. Patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients treated with neither of these risk factors. Other factors that increase the risk of GI bleeding in patients treated with NSAIDs include concomitant use of oral corticosteroids or anticoagulants, longer duration of NSAID therapy, smoking, use of alcohol, older age, and poor general health status. Most spontaneous reports of fatal GI events are in elderly or debilitated patients and therefore, special care should be taken in treating this population. To minimize the potential risk for an adverse GI event in patients treated with an NSAID, the lowest effective dose should be used for the shortest possible duration. Patients and physicians should remain alert for signs and symptoms of GI ulcerations and bleeding during NSAID therapy and promptly initiate additional evaluation and treatment if a serious GI event is suspected. This should include discontinuation of the NSAID until a serious GI adverse event is ruled out. For high-risk patients, alternate therapies that do not involve NSAIDs should be considered. Renal Effects Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of a NSAID may cause a dosedependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors, and the elderly. Discontinuation of NSAID therapy is usually followed by recovery to the pretreatment state. Advanced Renal Disease No information is available from controlled clinical studies regarding the use of MOTRIN tablets in patients with advanced renal disease. Therefore, treatment with MOTRIN tablets is not recommended in these patients with advanced renal disease. If MOTRIN tablet therapy must be initiated, close monitoring of the patients renal function is advisable. Anaphylactoid Reactions As with other NSAIDs, anaphylactoid reactions may occur in patients without known prior exposure to MOTRIN tablets. MOTRIN tablets should not be given to patients with the aspirin triad. This symptom complex typically occurs in asthmatic patients who experience rhinitis with or without nasal polyps, or who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs (see CONTRAINDICATIONS and PRECAUTIONS, Preexisting Asthma). Emergency help should be sought in cases where an anaphylactoid reaction occurs. Skin Reactions NSAIDs, including MOTRIN tablets, can cause serious skin adverse events such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. These serious events may occur without warning. Patients should be informed about the signs and symptoms of serious skin manifestations and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. Pregnancy In late pregnancy, as with other NSAIDs, MOTRIN tablets should be avoided because it may cause premature closure of the ductus arteriosus.
USER:
According to the context, what are the pros and cons of using Motrin?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 9 | 13 | 1,448 | null | 410 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
Should someone be worried about acquiring an infection in the hospital? Why? Why is this a bad thing on a governmental level? What is the difference between an uncomplicated UTI and a complicated UTI? Why is a polymicrobial bacteraemic UTIs particularly serious? How do these cases occur?
|
Healthcare-associated infections (HAIs) represent a significant public health burden, where an estimated 1 in 31 patients that enter a hospital will go on to develop an HAI, resulting in an additional $28.4 billion in healthcare-related expenses and 100,000 deaths1,2. Among HAIs, urinary tract infections (UTIs) are the most common, affecting over 400 million people worldwide in 2019 alone3. UTIs can be distinguished as complicated or uncomplicated. Up to 75–85% of uncomplicated UTIs are caused by uropathogenic Escherichia coli (UPEC)4,5,6. Unlike uncomplicated UTIs, catheter-associated UTI (CAUTI) is caused by a diverse range of pathogens, including UPEC (23.9%), fungal Candida spp. (17.8%), Enterococcus spp. (13.8%), P. aeruginosa (10.3%), and Klebsiella sp. (10.1%)7,8. Uncomplicated UTIs (uUTIs) predominantly affect pre-menopausal and non-pregnant women and occur in otherwise healthy individuals with no functional or structural abnormalities of the kidneys or urinary tract4. Complicated UTIs (cUTIs) occur in individuals with additional risk factors, including underlying health conditions and abnormalities or obstructions in the kidneys and urinary tract, pregnancy, and intermittent or long-term catheterization4. It is estimated that 15-25% of hospitalized patients will receive a urinary catheter and that 75% of healthcare-acquired UTIs are associated with catheterization9. Furthermore, the risk of bacterial colonization of a catheter increases 3–7% per day upon placement, with the risk of catheter colonization and associated complications near 100% in long-term catheterized patients10,11. The treatment of UTIs has been complicated by the rise of antimicrobial-resistant (AMR) uropathogens, many of which were cited as urgent or serious threats in the CDC’s 2019 Antibiotic Threats Report. These AMR pathogens were classified as: (i) urgent, carbapenem-resistant Acinetobacter and carbapenem-resistant Enterobacterales; and (ii) serious, drug-resistant Candida, ESBL- Enterobacterales, vancomycin-resistant enterococci (VRE), multidrug-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA)12. Indeed, a 2019 report listed UTIs as one of the leading global causes of AMR-associated deaths13. As these uropathogens become increasingly antibiotic-resistant, new treatment strategies are necessary to combat the rise of antibiotic-resistant UTIs. Another factor complicating the treatment of CAUTIs is the high prevalence of polymicrobial catheter colonization, with 31–87% of catheters and urine from catheterized patients colonized by two or more species, depending on the study14,15,16. Polymicrobial bacteraemic UTIs are associated with increased mortality relative to bacteraemic UTIs caused by a single uropathogen17. The relationships between the bacteria in these polymicrobial communities is still poorly understood, including the mechanistic drivers of the positive species interactions that promote species co-occurrence and the negative species interactions that prevent co-occurrence in the same microenvironment. During urinary catheterization, the host wounding response results in the deposition of host proteins, including fibrinogen, onto the catheter that can be used by several bacterial species as a food source and as a means to adhere to and form biofilms on the catheter18,19,20. Positive co-occurrences between species may thus result from pioneer species that are able to colonize the catheter and then recruit other microbial species, forming polymicrobial communities. While this has been demonstrated to occur in the polymicrobial communities of oral biofilms, wherein certain groups of bacteria, including streptococci and Actinomyces species, serve as the pioneering species that can adhere to enamel pellicle and facilitate the colonization of other microbial species, the establishment of pioneer species and the subsequent effects on colonization in CAUTI has yet to be fully elucidated21,22. Within these communities, “cross-feeding” or “cross-signaling” may occur to augment the growth and/or biofilm formation of one or more of the species. Further, it has been shown that E. faecalis can suppress the host innate immune response, allowing for augmented growth of E. coli in a co-infection model of CAUTI23. Negative co-occurrences may be due to competition for nutrients or alterations in host response. For instance, MRSA elicits a robust host response which may result in decreased co-colonization by other bacterial species that are unable to withstand this response24. Understanding the mechanisms that drive the formation and persistence of these communities is essential to designing new therapeutics that target the bacterial interactions that promote CAUTI.
|
[question] Should someone be worried about acquiring an infection in the hospital? Why? Why is this a bad thing on a governmental level? What is the difference between an uncomplicated UTI and a complicated UTI? Why is a polymicrobial bacteraemic UTIs particularly serious? How do these cases occur? ===================== [text] Healthcare-associated infections (HAIs) represent a significant public health burden, where an estimated 1 in 31 patients that enter a hospital will go on to develop an HAI, resulting in an additional $28.4 billion in healthcare-related expenses and 100,000 deaths1,2. Among HAIs, urinary tract infections (UTIs) are the most common, affecting over 400 million people worldwide in 2019 alone3. UTIs can be distinguished as complicated or uncomplicated. Up to 75–85% of uncomplicated UTIs are caused by uropathogenic Escherichia coli (UPEC)4,5,6. Unlike uncomplicated UTIs, catheter-associated UTI (CAUTI) is caused by a diverse range of pathogens, including UPEC (23.9%), fungal Candida spp. (17.8%), Enterococcus spp. (13.8%), P. aeruginosa (10.3%), and Klebsiella sp. (10.1%)7,8. Uncomplicated UTIs (uUTIs) predominantly affect pre-menopausal and non-pregnant women and occur in otherwise healthy individuals with no functional or structural abnormalities of the kidneys or urinary tract4. Complicated UTIs (cUTIs) occur in individuals with additional risk factors, including underlying health conditions and abnormalities or obstructions in the kidneys and urinary tract, pregnancy, and intermittent or long-term catheterization4. It is estimated that 15-25% of hospitalized patients will receive a urinary catheter and that 75% of healthcare-acquired UTIs are associated with catheterization9. Furthermore, the risk of bacterial colonization of a catheter increases 3–7% per day upon placement, with the risk of catheter colonization and associated complications near 100% in long-term catheterized patients10,11. The treatment of UTIs has been complicated by the rise of antimicrobial-resistant (AMR) uropathogens, many of which were cited as urgent or serious threats in the CDC’s 2019 Antibiotic Threats Report. These AMR pathogens were classified as: (i) urgent, carbapenem-resistant Acinetobacter and carbapenem-resistant Enterobacterales; and (ii) serious, drug-resistant Candida, ESBL- Enterobacterales, vancomycin-resistant enterococci (VRE), multidrug-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA)12. Indeed, a 2019 report listed UTIs as one of the leading global causes of AMR-associated deaths13. As these uropathogens become increasingly antibiotic-resistant, new treatment strategies are necessary to combat the rise of antibiotic-resistant UTIs. Another factor complicating the treatment of CAUTIs is the high prevalence of polymicrobial catheter colonization, with 31–87% of catheters and urine from catheterized patients colonized by two or more species, depending on the study14,15,16. Polymicrobial bacteraemic UTIs are associated with increased mortality relative to bacteraemic UTIs caused by a single uropathogen17. The relationships between the bacteria in these polymicrobial communities is still poorly understood, including the mechanistic drivers of the positive species interactions that promote species co-occurrence and the negative species interactions that prevent co-occurrence in the same microenvironment. During urinary catheterization, the host wounding response results in the deposition of host proteins, including fibrinogen, onto the catheter that can be used by several bacterial species as a food source and as a means to adhere to and form biofilms on the catheter18,19,20. Positive co-occurrences between species may thus result from pioneer species that are able to colonize the catheter and then recruit other microbial species, forming polymicrobial communities. While this has been demonstrated to occur in the polymicrobial communities of oral biofilms, wherein certain groups of bacteria, including streptococci and Actinomyces species, serve as the pioneering species that can adhere to enamel pellicle and facilitate the colonization of other microbial species, the establishment of pioneer species and the subsequent effects on colonization in CAUTI has yet to be fully elucidated21,22. Within these communities, “cross-feeding” or “cross-signaling” may occur to augment the growth and/or biofilm formation of one or more of the species. Further, it has been shown that E. faecalis can suppress the host innate immune response, allowing for augmented growth of E. coli in a co-infection model of CAUTI23. Negative co-occurrences may be due to competition for nutrients or alterations in host response. For instance, MRSA elicits a robust host response which may result in decreased co-colonization by other bacterial species that are unable to withstand this response24. Understanding the mechanisms that drive the formation and persistence of these communities is essential to designing new therapeutics that target the bacterial interactions that promote CAUTI. https://www.nature.com/articles/s41467-023-44095-0 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
Healthcare-associated infections (HAIs) represent a significant public health burden, where an estimated 1 in 31 patients that enter a hospital will go on to develop an HAI, resulting in an additional $28.4 billion in healthcare-related expenses and 100,000 deaths1,2. Among HAIs, urinary tract infections (UTIs) are the most common, affecting over 400 million people worldwide in 2019 alone3. UTIs can be distinguished as complicated or uncomplicated. Up to 75–85% of uncomplicated UTIs are caused by uropathogenic Escherichia coli (UPEC)4,5,6. Unlike uncomplicated UTIs, catheter-associated UTI (CAUTI) is caused by a diverse range of pathogens, including UPEC (23.9%), fungal Candida spp. (17.8%), Enterococcus spp. (13.8%), P. aeruginosa (10.3%), and Klebsiella sp. (10.1%)7,8. Uncomplicated UTIs (uUTIs) predominantly affect pre-menopausal and non-pregnant women and occur in otherwise healthy individuals with no functional or structural abnormalities of the kidneys or urinary tract4. Complicated UTIs (cUTIs) occur in individuals with additional risk factors, including underlying health conditions and abnormalities or obstructions in the kidneys and urinary tract, pregnancy, and intermittent or long-term catheterization4. It is estimated that 15-25% of hospitalized patients will receive a urinary catheter and that 75% of healthcare-acquired UTIs are associated with catheterization9. Furthermore, the risk of bacterial colonization of a catheter increases 3–7% per day upon placement, with the risk of catheter colonization and associated complications near 100% in long-term catheterized patients10,11. The treatment of UTIs has been complicated by the rise of antimicrobial-resistant (AMR) uropathogens, many of which were cited as urgent or serious threats in the CDC’s 2019 Antibiotic Threats Report. These AMR pathogens were classified as: (i) urgent, carbapenem-resistant Acinetobacter and carbapenem-resistant Enterobacterales; and (ii) serious, drug-resistant Candida, ESBL- Enterobacterales, vancomycin-resistant enterococci (VRE), multidrug-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA)12. Indeed, a 2019 report listed UTIs as one of the leading global causes of AMR-associated deaths13. As these uropathogens become increasingly antibiotic-resistant, new treatment strategies are necessary to combat the rise of antibiotic-resistant UTIs. Another factor complicating the treatment of CAUTIs is the high prevalence of polymicrobial catheter colonization, with 31–87% of catheters and urine from catheterized patients colonized by two or more species, depending on the study14,15,16. Polymicrobial bacteraemic UTIs are associated with increased mortality relative to bacteraemic UTIs caused by a single uropathogen17. The relationships between the bacteria in these polymicrobial communities is still poorly understood, including the mechanistic drivers of the positive species interactions that promote species co-occurrence and the negative species interactions that prevent co-occurrence in the same microenvironment. During urinary catheterization, the host wounding response results in the deposition of host proteins, including fibrinogen, onto the catheter that can be used by several bacterial species as a food source and as a means to adhere to and form biofilms on the catheter18,19,20. Positive co-occurrences between species may thus result from pioneer species that are able to colonize the catheter and then recruit other microbial species, forming polymicrobial communities. While this has been demonstrated to occur in the polymicrobial communities of oral biofilms, wherein certain groups of bacteria, including streptococci and Actinomyces species, serve as the pioneering species that can adhere to enamel pellicle and facilitate the colonization of other microbial species, the establishment of pioneer species and the subsequent effects on colonization in CAUTI has yet to be fully elucidated21,22. Within these communities, “cross-feeding” or “cross-signaling” may occur to augment the growth and/or biofilm formation of one or more of the species. Further, it has been shown that E. faecalis can suppress the host innate immune response, allowing for augmented growth of E. coli in a co-infection model of CAUTI23. Negative co-occurrences may be due to competition for nutrients or alterations in host response. For instance, MRSA elicits a robust host response which may result in decreased co-colonization by other bacterial species that are unable to withstand this response24. Understanding the mechanisms that drive the formation and persistence of these communities is essential to designing new therapeutics that target the bacterial interactions that promote CAUTI.
USER:
Should someone be worried about acquiring an infection in the hospital? Why? Why is this a bad thing on a governmental level? What is the difference between an uncomplicated UTI and a complicated UTI? Why is a polymicrobial bacteraemic UTIs particularly serious? How do these cases occur?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 47 | 652 | null | 689 |
You are an assistant for a marketing team. You analyze articles about companies and products and answer any questions the marketing team may have. Do not use any sources of external information in your answer. Base your answer solely on the article provided.
|
Is Michael Jordan mentioned in this article?
|
Our NIKE Brand product offerings are aligned around our consumer construct focused on Men's, Women's and Kids'. We also design products specifically for the Jordan Brand and Converse. We believe this approach allows us to create products that better meet individual consumer needs while accelerating our largest growth opportunities. NIKE's athletic footwear products are designed primarily for specific athletic use, although a large percentage of the products are worn for casual or leisure purposes. We place considerable emphasis on innovation and high-quality construction in the development and manufacturing of our products. Our Men's, Women's and Jordan Brand footwear products currently lead in footwear sales and we expect them to continue to do so. We also sell sports apparel, which features the same trademarks and are sold predominantly through the same marketing and distribution channels as athletic footwear. Our sports apparel, similar to our athletic footwear products, is designed primarily for athletic use, although many of the products are worn for casual or leisure purposes, and demonstrates our commitment to innovation and high-quality construction. Our Men's and Women's apparel products currently lead in apparel sales and we expect them to continue to do so. We often market footwear, apparel and accessories in "collections" of similar use or by category. We also market apparel with licensed college and professional team and league logos. We sell a line of performance equipment and accessories under the NIKE Brand name, including bags, socks, sport balls, eyewear, timepieces, digital devices, bats, gloves, protective equipment and other equipment designed for sports activities. We also sell small amounts of various plastic products to other manufacturers through our wholly-owned subsidiary, NIKE IHM, Inc., doing business as Air Manufacturing Innovation. Our Jordan Brand designs, distributes and licenses athletic and casual footwear, apparel and accessories predominantly focused on basketball performance and culture using the Jumpman trademark. Sales and operating results for Jordan Brand products are reported within the respective NIKE Brand geographic operating segments. Our wholly-owned subsidiary brand, Converse, headquartered in Boston, Massachusetts, designs, distributes and licenses casual sneakers, apparel and accessories under the Converse, Chuck Taylor, All Star, One Star, Star Chevron and Jack Purcell trademarks. Operating results of the Converse brand are reported on a stand-alone basis. In addition to the products we sell to our wholesale customers and directly to consumers through our NIKE Direct operations, we have also entered into license agreements that permit unaffiliated parties to manufacture and sell, using NIKE-owned trademarks, certain apparel, digital devices and applications and other equipment designed for sports activities.
|
You are an assistant for a marketing team. You analyze articles about companies and products and answer any questions the marketing team may have. Do not use any sources of external information in your answer. Base your answer solely on the article provided. Question: Is Michael Jordan mentioned in this article? Article: "Our NIKE Brand product offerings are aligned around our consumer construct focused on Men's, Women's and Kids'. We also design products specifically for the Jordan Brand and Converse. We believe this approach allows us to create products that better meet individual consumer needs while accelerating our largest growth opportunities. NIKE's athletic footwear products are designed primarily for specific athletic use, although a large percentage of the products are worn for casual or leisure purposes. We place considerable emphasis on innovation and high-quality construction in the development and manufacturing of our products. Our Men's, Women's and Jordan Brand footwear products currently lead in footwear sales and we expect them to continue to do so. We also sell sports apparel, which features the same trademarks and are sold predominantly through the same marketing and distribution channels as athletic footwear. Our sports apparel, similar to our athletic footwear products, is designed primarily for athletic use, although many of the products are worn for casual or leisure purposes, and demonstrates our commitment to innovation and high-quality construction. Our Men's and Women's apparel products currently lead in apparel sales and we expect them to continue to do so. We often market footwear, apparel and accessories in "collections" of similar use or by category. We also market apparel with licensed college and professional team and league logos. We sell a line of performance equipment and accessories under the NIKE Brand name, including bags, socks, sport balls, eyewear, timepieces, digital devices, bats, gloves, protective equipment and other equipment designed for sports activities. We also sell small amounts of various plastic products to other manufacturers through our wholly-owned subsidiary, NIKE IHM, Inc., doing business as Air Manufacturing Innovation. Our Jordan Brand designs, distributes and licenses athletic and casual footwear, apparel and accessories predominantly focused on basketball performance and culture using the Jumpman trademark. Sales and operating results for Jordan Brand products are reported within the respective NIKE Brand geographic operating segments. Our wholly-owned subsidiary brand, Converse, headquartered in Boston, Massachusetts, designs, distributes and licenses casual sneakers, apparel and accessories under the Converse, Chuck Taylor, All Star, One Star, Star Chevron and Jack Purcell trademarks. Operating results of the Converse brand are reported on a stand-alone basis. In addition to the products we sell to our wholesale customers and directly to consumers through our NIKE Direct operations, we have also entered into license agreements that permit unaffiliated parties to manufacture and sell, using NIKE-owned trademarks, certain apparel, digital devices and applications and other equipment designed for sports activities."
|
You are an assistant for a marketing team. You analyze articles about companies and products and answer any questions the marketing team may have. Do not use any sources of external information in your answer. Base your answer solely on the article provided.
EVIDENCE:
Our NIKE Brand product offerings are aligned around our consumer construct focused on Men's, Women's and Kids'. We also design products specifically for the Jordan Brand and Converse. We believe this approach allows us to create products that better meet individual consumer needs while accelerating our largest growth opportunities. NIKE's athletic footwear products are designed primarily for specific athletic use, although a large percentage of the products are worn for casual or leisure purposes. We place considerable emphasis on innovation and high-quality construction in the development and manufacturing of our products. Our Men's, Women's and Jordan Brand footwear products currently lead in footwear sales and we expect them to continue to do so. We also sell sports apparel, which features the same trademarks and are sold predominantly through the same marketing and distribution channels as athletic footwear. Our sports apparel, similar to our athletic footwear products, is designed primarily for athletic use, although many of the products are worn for casual or leisure purposes, and demonstrates our commitment to innovation and high-quality construction. Our Men's and Women's apparel products currently lead in apparel sales and we expect them to continue to do so. We often market footwear, apparel and accessories in "collections" of similar use or by category. We also market apparel with licensed college and professional team and league logos. We sell a line of performance equipment and accessories under the NIKE Brand name, including bags, socks, sport balls, eyewear, timepieces, digital devices, bats, gloves, protective equipment and other equipment designed for sports activities. We also sell small amounts of various plastic products to other manufacturers through our wholly-owned subsidiary, NIKE IHM, Inc., doing business as Air Manufacturing Innovation. Our Jordan Brand designs, distributes and licenses athletic and casual footwear, apparel and accessories predominantly focused on basketball performance and culture using the Jumpman trademark. Sales and operating results for Jordan Brand products are reported within the respective NIKE Brand geographic operating segments. Our wholly-owned subsidiary brand, Converse, headquartered in Boston, Massachusetts, designs, distributes and licenses casual sneakers, apparel and accessories under the Converse, Chuck Taylor, All Star, One Star, Star Chevron and Jack Purcell trademarks. Operating results of the Converse brand are reported on a stand-alone basis. In addition to the products we sell to our wholesale customers and directly to consumers through our NIKE Direct operations, we have also entered into license agreements that permit unaffiliated parties to manufacture and sell, using NIKE-owned trademarks, certain apparel, digital devices and applications and other equipment designed for sports activities.
USER:
Is Michael Jordan mentioned in this article?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 43 | 7 | 419 | null | 637 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
Hey I have a nintendo switch and thought about getting the OLED version. Hwoever, I hear the new switch is coming out pretty soon. But I thought it was releasing in 2024. Why are they pushing it to 2025? Also what will it look like and will I still be able to play my current games? Give me more than 300 words.
|
Nintendo Switch 2: Everything We Know About the New Console Nintendo’s new console is most likely arriving in 2025. Sarah Thwaites Avatar By Sarah Thwaites Updated: May 21, 2024 3:26 pm Posted: Apr 26, 2024 2:30 pm It’s been over six years since the Nintendo Switch launched in 2017, and after a long and successful reign, you may be wondering what new piece of hardware will be next. We’ve seen updates to the current switch with the OLED and Lite models, though we’re still in the dark on what Nintendo’s next-gen offering could be. After becoming the 3rd best-selling console in history this year, it’s fair to say that Nintendo might want to keep things close to its chest. Yet, even with all the secrecy surrounding the possibility of a new Nintendo Switch, we’ve collected all the details we could find about the mystery follow-up ahead of its eventual official announcement and release. Nintendo Switch 2 Release Date - Latest News While Nintendo hasn’t yet announced any official follow-up to their incredibly successful Nintendo Switch console, there are enough rumors swirling about to make us believe that the next Nintendo console will arrive sometime in 2025 rather than 2024. In February 2024, the Japanese publication Nikkei suggested that the proposed Nintendo Switch 2 would launch in March 2025 at the earliest, contradicting previous reports. While the article covered information we’ve heard before, like the proposed iterative design scheme, Nikkei did add that the 2025 date was likely due to the company stockpiling consoles to avoid scalping at launch. As any long-term Nintendo fan knows, procuring one of the company’s new consoles can be tricky business. Those who tried will remember how difficult it was to secure a Nintendo Switch at launch in 2017, with the console suffering from inflated pricing on the aftermarket due to crafty resellers. Adding to the intrigue about a potential date change, it looks like Nintendo won’t be exhibiting at this year’s Gamescom, an annual trade fair held in Cologne, Germany. As reported by GamesIndustry.biz, a representative of Nintendo of Europe issued a statement to the German outlet Games Wirtschaft, confirming the news. The statement reads, "Gamescom is a central event in Nintendo's event calendar. This year, however, after careful consideration, we decided against taking part in Cologne. Instead, players can try out the games for Nintendo Switch as part of other Germany-wide events." This decision, while not unprecedented for major players - PlayStation also missed the event in 2022 and 2023 - does raise the question of what we can expect from Nintendo in the latter half of 2024. Could this be a sign of a major announcement coming or a strategic shift in their marketing approach? Only time will tell. Nintendo’s president, Shuntaro Furukawa, confirmed in an interview with Nikkei, and translated by VGC, that Nintendo will support the current-gen Switch until at least March 2025. This sentiment is also backed up by previous comments Furukawa made regarding the future of the Nintendo Switch in a financial briefing Q&A in 2022. In this interview, he committed to focusing on “building long-term relationships with our consumers (through Nintendo Accounts)," he went on to reiterate ", While continuing to release new Nintendo Switch software for consumers to enjoy, we aim to maintain relationships across hardware generations through services that utilize Nintendo Accounts and by providing opportunities for them to experience our IP through other non-gaming channels." Even with all the juicy gossip, it’s best not to hold your breath on what’s coming from the Japanese tech titan’s next console until there is an official announcement; fingers crossed we’ll get that confirmation soon. Nintendo Switch 2 Price There are plenty of Nintendo Switch models to consider while shopping right now, with pricing shifting dramatically depending on the version you’re looking to invest in. Looking forward to a potential Switch 2, inflation and internal specs, amongst other variables, will likely play a part in what we’ll pay for a new console at launch. It’s hard to know what the pricing of this mystery device will be, but we’ve listed the RRP of the current range of Nintendo Switch models as a reference: Nintendo Switch Lite: $199.99 Nintendo Switch: $299.99 Nintendo Switch OLED: $349.99 Nintendo Switch 2 Models With the range of Nintendo Switch consoles currently on the market, you may be left wondering if you’ll have the same number of choices to pick between when the next iteration rolls around. The latest Nintendo Switch OLED model features a remarkable screen, and it feels like the future of the console, it being the most recent edition to Nintendo’s lineup. However, according to a VGC report, the next-gen Nintendo Switch may potentially feature an LCD screen instead. The current array of Nintendo Switch models are numerous and were released over the console’s multi-year lifespan, so it’s reasonable to believe there may be several versions of a potential Nintendo Switch follow-up, too. Nintendo Switch Design - What Will the Nintendo Switch 2 Look Like? There isn’t a lot of information on how Nintendo’s next-gen console will look, though there are plenty of features in the current-gen Nintendo Switch we’d love to see return for a follow-up console. VGC reported that development kits for the potential new console are already with partner studios, with sources citing some returning features. According to VGC’s report, the new Nintendo Switch could keep the portability of its predecessor and feature a cartridge slot for physical games. In May 2023, a patent was filed with the United States Patent Office and published in September, which suggests a potential revamped Joy-Con controller that would hopefully help with the notorious Joy-Con drift issue associated with the Nintendo Switch. The patent details a magnetic field for controls rather than the plastic circuit boards seen in the current generation console. However, it’s worth mentioning that patents don’t necessarily translate directly to future products, so there’s no guarantee on whether the Nintendo Switch 2 will feature updated Joy-Cons, and we’ll have to wait for official word from Nintendo on that front. Will the Nintendo Switch 2 be Backwards Compatible? As rumors swirl about the possibility of a Nintendo Switch 2, the question of backwards compatibility is naturally on everyone's lips. In the absence of any official reveals, there isn’t much to go on at this time. However, in a recent interview with Inverse, the aptly named Nintendo of America president, Doug Bowser, alluded to the future of the brand’s approach to software. While Bowser opted to deny commenting on anything related to the rumored console, he did talk about the Nintendo Account system that players’ digital libraries are currently tied to on the Nintendo Switch. “In the past, every device we transitioned to had a whole new account system. Creating the Nintendo Account will allow us to communicate with our players if and when we make a transition to a new platform, to help ease that process or transition.” This dedication to the Nintendo Account model could suggest that all of our favorite Nintendo Switch games may work on the company’s next console whenever it lands. Regardless, given the precious little that we know right now, we’ll have to take this information with a pinch of salt and not get ahead of ourselves. As it stands now, it is unclear whether or not Nintendo Switch accessories will be compatible with the new model either. It's possible that all of your Nintendo Switch controllers will work with the new console, but we don't yet know.
|
[question] Hey I have a nintendo switch and thought about getting the OLED version. Hwoever, I hear the new switch is coming out pretty soon. But I thought it was releasing in 2024. Why are they pushing it to 2025? Also what will it look like and will I still be able to play my current games? Give me more than 300 words. ===================== [text] Nintendo Switch 2: Everything We Know About the New Console Nintendo’s new console is most likely arriving in 2025. Sarah Thwaites Avatar By Sarah Thwaites Updated: May 21, 2024 3:26 pm Posted: Apr 26, 2024 2:30 pm It’s been over six years since the Nintendo Switch launched in 2017, and after a long and successful reign, you may be wondering what new piece of hardware will be next. We’ve seen updates to the current switch with the OLED and Lite models, though we’re still in the dark on what Nintendo’s next-gen offering could be. After becoming the 3rd best-selling console in history this year, it’s fair to say that Nintendo might want to keep things close to its chest. Yet, even with all the secrecy surrounding the possibility of a new Nintendo Switch, we’ve collected all the details we could find about the mystery follow-up ahead of its eventual official announcement and release. Nintendo Switch 2 Release Date - Latest News While Nintendo hasn’t yet announced any official follow-up to their incredibly successful Nintendo Switch console, there are enough rumors swirling about to make us believe that the next Nintendo console will arrive sometime in 2025 rather than 2024. In February 2024, the Japanese publication Nikkei suggested that the proposed Nintendo Switch 2 would launch in March 2025 at the earliest, contradicting previous reports. While the article covered information we’ve heard before, like the proposed iterative design scheme, Nikkei did add that the 2025 date was likely due to the company stockpiling consoles to avoid scalping at launch. As any long-term Nintendo fan knows, procuring one of the company’s new consoles can be tricky business. Those who tried will remember how difficult it was to secure a Nintendo Switch at launch in 2017, with the console suffering from inflated pricing on the aftermarket due to crafty resellers. Adding to the intrigue about a potential date change, it looks like Nintendo won’t be exhibiting at this year’s Gamescom, an annual trade fair held in Cologne, Germany. As reported by GamesIndustry.biz, a representative of Nintendo of Europe issued a statement to the German outlet Games Wirtschaft, confirming the news. The statement reads, "Gamescom is a central event in Nintendo's event calendar. This year, however, after careful consideration, we decided against taking part in Cologne. Instead, players can try out the games for Nintendo Switch as part of other Germany-wide events." This decision, while not unprecedented for major players - PlayStation also missed the event in 2022 and 2023 - does raise the question of what we can expect from Nintendo in the latter half of 2024. Could this be a sign of a major announcement coming or a strategic shift in their marketing approach? Only time will tell. Nintendo’s president, Shuntaro Furukawa, confirmed in an interview with Nikkei, and translated by VGC, that Nintendo will support the current-gen Switch until at least March 2025. This sentiment is also backed up by previous comments Furukawa made regarding the future of the Nintendo Switch in a financial briefing Q&A in 2022. In this interview, he committed to focusing on “building long-term relationships with our consumers (through Nintendo Accounts)," he went on to reiterate ", While continuing to release new Nintendo Switch software for consumers to enjoy, we aim to maintain relationships across hardware generations through services that utilize Nintendo Accounts and by providing opportunities for them to experience our IP through other non-gaming channels." Even with all the juicy gossip, it’s best not to hold your breath on what’s coming from the Japanese tech titan’s next console until there is an official announcement; fingers crossed we’ll get that confirmation soon. Nintendo Switch 2 Price There are plenty of Nintendo Switch models to consider while shopping right now, with pricing shifting dramatically depending on the version you’re looking to invest in. Looking forward to a potential Switch 2, inflation and internal specs, amongst other variables, will likely play a part in what we’ll pay for a new console at launch. It’s hard to know what the pricing of this mystery device will be, but we’ve listed the RRP of the current range of Nintendo Switch models as a reference: Nintendo Switch Lite: $199.99 Nintendo Switch: $299.99 Nintendo Switch OLED: $349.99 Nintendo Switch 2 Models With the range of Nintendo Switch consoles currently on the market, you may be left wondering if you’ll have the same number of choices to pick between when the next iteration rolls around. The latest Nintendo Switch OLED model features a remarkable screen, and it feels like the future of the console, it being the most recent edition to Nintendo’s lineup. However, according to a VGC report, the next-gen Nintendo Switch may potentially feature an LCD screen instead. The current array of Nintendo Switch models are numerous and were released over the console’s multi-year lifespan, so it’s reasonable to believe there may be several versions of a potential Nintendo Switch follow-up, too. Nintendo Switch Design - What Will the Nintendo Switch 2 Look Like? There isn’t a lot of information on how Nintendo’s next-gen console will look, though there are plenty of features in the current-gen Nintendo Switch we’d love to see return for a follow-up console. VGC reported that development kits for the potential new console are already with partner studios, with sources citing some returning features. According to VGC’s report, the new Nintendo Switch could keep the portability of its predecessor and feature a cartridge slot for physical games. In May 2023, a patent was filed with the United States Patent Office and published in September, which suggests a potential revamped Joy-Con controller that would hopefully help with the notorious Joy-Con drift issue associated with the Nintendo Switch. The patent details a magnetic field for controls rather than the plastic circuit boards seen in the current generation console. However, it’s worth mentioning that patents don’t necessarily translate directly to future products, so there’s no guarantee on whether the Nintendo Switch 2 will feature updated Joy-Cons, and we’ll have to wait for official word from Nintendo on that front. Will the Nintendo Switch 2 be Backwards Compatible? As rumors swirl about the possibility of a Nintendo Switch 2, the question of backwards compatibility is naturally on everyone's lips. In the absence of any official reveals, there isn’t much to go on at this time. However, in a recent interview with Inverse, the aptly named Nintendo of America president, Doug Bowser, alluded to the future of the brand’s approach to software. While Bowser opted to deny commenting on anything related to the rumored console, he did talk about the Nintendo Account system that players’ digital libraries are currently tied to on the Nintendo Switch. “In the past, every device we transitioned to had a whole new account system. Creating the Nintendo Account will allow us to communicate with our players if and when we make a transition to a new platform, to help ease that process or transition.” This dedication to the Nintendo Account model could suggest that all of our favorite Nintendo Switch games may work on the company’s next console whenever it lands. Regardless, given the precious little that we know right now, we’ll have to take this information with a pinch of salt and not get ahead of ourselves. As it stands now, it is unclear whether or not Nintendo Switch accessories will be compatible with the new model either. It's possible that all of your Nintendo Switch controllers will work with the new console, but we don't yet know. https://www.ign.com/articles/nintendo-switch-2-everything-we-know ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
Nintendo Switch 2: Everything We Know About the New Console Nintendo’s new console is most likely arriving in 2025. Sarah Thwaites Avatar By Sarah Thwaites Updated: May 21, 2024 3:26 pm Posted: Apr 26, 2024 2:30 pm It’s been over six years since the Nintendo Switch launched in 2017, and after a long and successful reign, you may be wondering what new piece of hardware will be next. We’ve seen updates to the current switch with the OLED and Lite models, though we’re still in the dark on what Nintendo’s next-gen offering could be. After becoming the 3rd best-selling console in history this year, it’s fair to say that Nintendo might want to keep things close to its chest. Yet, even with all the secrecy surrounding the possibility of a new Nintendo Switch, we’ve collected all the details we could find about the mystery follow-up ahead of its eventual official announcement and release. Nintendo Switch 2 Release Date - Latest News While Nintendo hasn’t yet announced any official follow-up to their incredibly successful Nintendo Switch console, there are enough rumors swirling about to make us believe that the next Nintendo console will arrive sometime in 2025 rather than 2024. In February 2024, the Japanese publication Nikkei suggested that the proposed Nintendo Switch 2 would launch in March 2025 at the earliest, contradicting previous reports. While the article covered information we’ve heard before, like the proposed iterative design scheme, Nikkei did add that the 2025 date was likely due to the company stockpiling consoles to avoid scalping at launch. As any long-term Nintendo fan knows, procuring one of the company’s new consoles can be tricky business. Those who tried will remember how difficult it was to secure a Nintendo Switch at launch in 2017, with the console suffering from inflated pricing on the aftermarket due to crafty resellers. Adding to the intrigue about a potential date change, it looks like Nintendo won’t be exhibiting at this year’s Gamescom, an annual trade fair held in Cologne, Germany. As reported by GamesIndustry.biz, a representative of Nintendo of Europe issued a statement to the German outlet Games Wirtschaft, confirming the news. The statement reads, "Gamescom is a central event in Nintendo's event calendar. This year, however, after careful consideration, we decided against taking part in Cologne. Instead, players can try out the games for Nintendo Switch as part of other Germany-wide events." This decision, while not unprecedented for major players - PlayStation also missed the event in 2022 and 2023 - does raise the question of what we can expect from Nintendo in the latter half of 2024. Could this be a sign of a major announcement coming or a strategic shift in their marketing approach? Only time will tell. Nintendo’s president, Shuntaro Furukawa, confirmed in an interview with Nikkei, and translated by VGC, that Nintendo will support the current-gen Switch until at least March 2025. This sentiment is also backed up by previous comments Furukawa made regarding the future of the Nintendo Switch in a financial briefing Q&A in 2022. In this interview, he committed to focusing on “building long-term relationships with our consumers (through Nintendo Accounts)," he went on to reiterate ", While continuing to release new Nintendo Switch software for consumers to enjoy, we aim to maintain relationships across hardware generations through services that utilize Nintendo Accounts and by providing opportunities for them to experience our IP through other non-gaming channels." Even with all the juicy gossip, it’s best not to hold your breath on what’s coming from the Japanese tech titan’s next console until there is an official announcement; fingers crossed we’ll get that confirmation soon. Nintendo Switch 2 Price There are plenty of Nintendo Switch models to consider while shopping right now, with pricing shifting dramatically depending on the version you’re looking to invest in. Looking forward to a potential Switch 2, inflation and internal specs, amongst other variables, will likely play a part in what we’ll pay for a new console at launch. It’s hard to know what the pricing of this mystery device will be, but we’ve listed the RRP of the current range of Nintendo Switch models as a reference: Nintendo Switch Lite: $199.99 Nintendo Switch: $299.99 Nintendo Switch OLED: $349.99 Nintendo Switch 2 Models With the range of Nintendo Switch consoles currently on the market, you may be left wondering if you’ll have the same number of choices to pick between when the next iteration rolls around. The latest Nintendo Switch OLED model features a remarkable screen, and it feels like the future of the console, it being the most recent edition to Nintendo’s lineup. However, according to a VGC report, the next-gen Nintendo Switch may potentially feature an LCD screen instead. The current array of Nintendo Switch models are numerous and were released over the console’s multi-year lifespan, so it’s reasonable to believe there may be several versions of a potential Nintendo Switch follow-up, too. Nintendo Switch Design - What Will the Nintendo Switch 2 Look Like? There isn’t a lot of information on how Nintendo’s next-gen console will look, though there are plenty of features in the current-gen Nintendo Switch we’d love to see return for a follow-up console. VGC reported that development kits for the potential new console are already with partner studios, with sources citing some returning features. According to VGC’s report, the new Nintendo Switch could keep the portability of its predecessor and feature a cartridge slot for physical games. In May 2023, a patent was filed with the United States Patent Office and published in September, which suggests a potential revamped Joy-Con controller that would hopefully help with the notorious Joy-Con drift issue associated with the Nintendo Switch. The patent details a magnetic field for controls rather than the plastic circuit boards seen in the current generation console. However, it’s worth mentioning that patents don’t necessarily translate directly to future products, so there’s no guarantee on whether the Nintendo Switch 2 will feature updated Joy-Cons, and we’ll have to wait for official word from Nintendo on that front. Will the Nintendo Switch 2 be Backwards Compatible? As rumors swirl about the possibility of a Nintendo Switch 2, the question of backwards compatibility is naturally on everyone's lips. In the absence of any official reveals, there isn’t much to go on at this time. However, in a recent interview with Inverse, the aptly named Nintendo of America president, Doug Bowser, alluded to the future of the brand’s approach to software. While Bowser opted to deny commenting on anything related to the rumored console, he did talk about the Nintendo Account system that players’ digital libraries are currently tied to on the Nintendo Switch. “In the past, every device we transitioned to had a whole new account system. Creating the Nintendo Account will allow us to communicate with our players if and when we make a transition to a new platform, to help ease that process or transition.” This dedication to the Nintendo Account model could suggest that all of our favorite Nintendo Switch games may work on the company’s next console whenever it lands. Regardless, given the precious little that we know right now, we’ll have to take this information with a pinch of salt and not get ahead of ourselves. As it stands now, it is unclear whether or not Nintendo Switch accessories will be compatible with the new model either. It's possible that all of your Nintendo Switch controllers will work with the new console, but we don't yet know.
USER:
Hey I have a nintendo switch and thought about getting the OLED version. Hwoever, I hear the new switch is coming out pretty soon. But I thought it was releasing in 2024. Why are they pushing it to 2025? Also what will it look like and will I still be able to play my current games? Give me more than 300 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 62 | 1,252 | null | 177 |
You must respond using only the information provided in the context.
|
What technological roadblocks are flying cars faced with as they navigate our current infrastructure?
|
ABSTRACT Flying vehicle-related technology development is progressing rapidly. As autonomous vehicles begin to be commercialized, interest in the development of flying vehicle technology is increasing. Recently, some countries have launched services that utilize flying car technology along with self-driving cars. The automobile industry is undergoing rapid change by combining IT technology with automobile technology. The center of this change is the flying car-related technology that will be integrated onto the car of the future. Flying vehicle technology will be combined with autonomous vehicle technology to develop into a tool for more convenient human life. This paper examines the trend of flying automobile technology in relation to the flow of automobile technology. Keywords: Flying Car, VTOL, Flying Car Technology Trend, PAV. 1. INTRODUCTION The era of self-driving cars, where cars come to pick up people and take them to their destinations, is approaching. A number of automobile companies and IT companies, including Google, are participating in the development of autonomous vehicles. The era of self-driving cars will become a future that everyone is familiar with. And now, a new means of transportation that goes beyond self-driving cars is attracting attention. After IT companies such as Google and Uber took the lead and showed interest in flying cars, interest in flying cars is growing, especially in the United States. Flying car is a concept that has recently emerged and there is no fully agreed definition yet. “Is a flying car a car or an airplane?” It is also ambiguous to answer these questions. Flying cars can run on the road or fly if necessary. Flying cars do not require a wide horizontal runway like airplanes, and are expected to take off and land by lifting the aircraft vertically. It can be used like a car on the road and can fly in the sky when necessary [9]. Many companies such as Airbus and Rolls-Royce of the UK are jumping into the competition to develop technology related to flying cars Progressive Academic Publishing, UK Page 2 www.idpublications.org GM unveiled the Cadillac flying car and electric shuttle concept car at CES 2021. At CES 2021, the world's largest ICT exhibition, GM said, "GM's future mobility concepts of flying cars and electric shuttles are means of transportation that can confirm GM's direction for the next five years.” Beyond the era of autonomous vehicles, we have now entered the stage of technology development for the era of flying cars [1, 2, 3, 11]. Flying cars, unlike self-driving cars, fly in the sky, so there are many more problems to be solved. In addition, global standards and definitions related to technology for flying cars have not been established. This paper intends to examine the technology trends related to these flying cars. 2. FLYING CAR RELATED ISSUES There are many problems to be solved in order for flying cars to be commercialized in the form of flying cars that are operated on the road and take off into the air when necessary [3, 4, 5]. Some of these issues are as follows: (1) Technical issues There are many technical problems with flying cars. Ultimately, only when flying cars become popular it will be able to achieve the goals of traffic congestion and convenience. It is important to develop technology that can lower the price of flying cars. Of course, if flying cars become popular and mass-produced, the price is expected to be lowered naturally. Technology to reduce noise generated by flying cars is also emerging as a problem to be solved. In addition, it is expected that popularization can be accelerated only when sensor-related technology development to ensure safety for operation and technology related to autonomous flight capable of flying without human intervention are developed. In addition, it is important to develop battery-related technology for a long flight. Only when these technical problems are resolved people will be able to use them safely. (2) System improvement and infrastructure establishment In relation to flying cars, optimistic predictions about the operation of aerial vehicles are predicted when the VTOL (Vertical Take-off and Landing) type of technology is introduced. On the other hand, in order to settle as a convenient means of transportation with the introduction of flying cars, the government's active policy change is necessary. It is necessary to build a dedicated space for PAV (Personal Air Vehicle) for vertical take-off and landing in the city. It is also essential to establish a place to charge the PAV's electricity. It is also necessary to enact systems and laws in parallel with the establishment of such infrastructure. Most countries have so far established systems and laws centered on automobiles, a means of transportation. A work must also be done to make these systems and laws fit the environment of the flying car, a new means of transportation. It is expected that it will take time for the construction of infrastructure for flying cars and the work of enacting systems and laws. If flying cars are commercialized, there is a possibility that traffic jams on the ground will occur in the sky. It is also essential to develop a system that can efficiently manage and control such traffic jams in the air. Flying cars are expected to make human life more convenient as a new means of transportation along with autonomous vehicles.
|
ABSTRACT Flying vehicle-related technology development is progressing rapidly. As autonomous vehicles begin to be commercialized, interest in the development of flying vehicle technology is increasing. Recently, some countries have launched services that utilize flying car technology along with self-driving cars. The automobile industry is undergoing rapid change by combining IT technology with automobile technology. The center of this change is the flying car-related technology that will be integrated onto the car of the future. Flying vehicle technology will be combined with autonomous vehicle technology to develop into a tool for more convenient human life. This paper examines the trend of flying automobile technology in relation to the flow of automobile technology. Keywords: Flying Car, VTOL, Flying Car Technology Trend, PAV. 1. INTRODUCTION The era of self-driving cars, where cars come to pick up people and take them to their destinations, is approaching. A number of automobile companies and IT companies, including Google, are participating in the development of autonomous vehicles. The era of self-driving cars will become a future that everyone is familiar with. And now, a new means of transportation that goes beyond self-driving cars is attracting attention. After IT companies such as Google and Uber took the lead and showed interest in flying cars, interest in flying cars is growing, especially in the United States. Flying car is a concept that has recently emerged and there is no fully agreed definition yet. “Is a flying car a car or an airplane?” It is also ambiguous to answer these questions. Flying cars can run on the road or fly if necessary. Flying cars do not require a wide horizontal runway like airplanes, and are expected to take off and land by lifting the aircraft vertically. It can be used like a car on the road and can fly in the sky when necessary [9]. Many companies such as Airbus and Rolls-Royce of the UK are jumping into the competition to develop technology related to flying cars Progressive Academic Publishing, UK Page 2 www.idpublications.org GM unveiled the Cadillac flying car and electric shuttle concept car at CES 2021. At CES 2021, the world's largest ICT exhibition, GM said, "GM's future mobility concepts of flying cars and electric shuttles are means of transportation that can confirm GM's direction for the next five years.” Beyond the era of autonomous vehicles, we have now entered the stage of technology development for the era of flying cars [1, 2, 3, 11]. Flying cars, unlike self-driving cars, fly in the sky, so there are many more problems to be solved. In addition, global standards and definitions related to technology for flying cars have not been established. This paper intends to examine the technology trends related to these flying cars. 2. FLYING CAR RELATED ISSUES There are many problems to be solved in order for flying cars to be commercialized in the form of flying cars that are operated on the road and take off into the air when necessary [3, 4, 5]. Some of these issues are as follows: (1) Technical issues There are many technical problems with flying cars. Ultimately, only when flying cars become popular it will be able to achieve the goals of traffic congestion and convenience. It is important to develop technology that can lower the price of flying cars. Of course, if flying cars become popular and mass-produced, the price is expected to be lowered naturally. Technology to reduce noise generated by flying cars is also emerging as a problem to be solved. In addition, it is expected that popularization can be accelerated only when sensor-related technology development to ensure safety for operation and technology related to autonomous flight capable of flying without human intervention are developed. In addition, it is important to develop battery-related technology for a long flight. Only when these technical problems are resolved people will be able to use them safely. (2) System improvement and infrastructure establishment In relation to flying cars, optimistic predictions about the operation of aerial vehicles are predicted when the VTOL (Vertical Take-off and Landing) type of technology is introduced. On the other hand, in order to settle as a convenient means of transportation with the introduction of flying cars, the government's active policy change is necessary. It is necessary to build a dedicated space for PAV (Personal Air Vehicle) for vertical take-off and landing in the city. It is also essential to establish a place to charge the PAV's electricity. It is also necessary to enact systems and laws in parallel with the establishment of such infrastructure. Most countries have so far established systems and laws centered on automobiles, a means of transportation. A work must also be done to make these systems and laws fit the environment of the flying car, a new means of transportation. It is expected that it will take time for the construction of infrastructure for flying cars and the work of enacting systems and laws. If flying cars are commercialized, there is a possibility that traffic jams on the ground will occur in the sky. It is also essential to develop a system that can efficiently manage and control such traffic jams in the air. Flying cars are expected to make human life more convenient as a new means of transportation along with autonomous vehicles. You must respond using only the information provided in the context. What technological roadblocks are flying cars faced with as they navigate our current infrastructure?
|
You must respond using only the information provided in the context.
EVIDENCE:
ABSTRACT Flying vehicle-related technology development is progressing rapidly. As autonomous vehicles begin to be commercialized, interest in the development of flying vehicle technology is increasing. Recently, some countries have launched services that utilize flying car technology along with self-driving cars. The automobile industry is undergoing rapid change by combining IT technology with automobile technology. The center of this change is the flying car-related technology that will be integrated onto the car of the future. Flying vehicle technology will be combined with autonomous vehicle technology to develop into a tool for more convenient human life. This paper examines the trend of flying automobile technology in relation to the flow of automobile technology. Keywords: Flying Car, VTOL, Flying Car Technology Trend, PAV. 1. INTRODUCTION The era of self-driving cars, where cars come to pick up people and take them to their destinations, is approaching. A number of automobile companies and IT companies, including Google, are participating in the development of autonomous vehicles. The era of self-driving cars will become a future that everyone is familiar with. And now, a new means of transportation that goes beyond self-driving cars is attracting attention. After IT companies such as Google and Uber took the lead and showed interest in flying cars, interest in flying cars is growing, especially in the United States. Flying car is a concept that has recently emerged and there is no fully agreed definition yet. “Is a flying car a car or an airplane?” It is also ambiguous to answer these questions. Flying cars can run on the road or fly if necessary. Flying cars do not require a wide horizontal runway like airplanes, and are expected to take off and land by lifting the aircraft vertically. It can be used like a car on the road and can fly in the sky when necessary [9]. Many companies such as Airbus and Rolls-Royce of the UK are jumping into the competition to develop technology related to flying cars Progressive Academic Publishing, UK Page 2 www.idpublications.org GM unveiled the Cadillac flying car and electric shuttle concept car at CES 2021. At CES 2021, the world's largest ICT exhibition, GM said, "GM's future mobility concepts of flying cars and electric shuttles are means of transportation that can confirm GM's direction for the next five years.” Beyond the era of autonomous vehicles, we have now entered the stage of technology development for the era of flying cars [1, 2, 3, 11]. Flying cars, unlike self-driving cars, fly in the sky, so there are many more problems to be solved. In addition, global standards and definitions related to technology for flying cars have not been established. This paper intends to examine the technology trends related to these flying cars. 2. FLYING CAR RELATED ISSUES There are many problems to be solved in order for flying cars to be commercialized in the form of flying cars that are operated on the road and take off into the air when necessary [3, 4, 5]. Some of these issues are as follows: (1) Technical issues There are many technical problems with flying cars. Ultimately, only when flying cars become popular it will be able to achieve the goals of traffic congestion and convenience. It is important to develop technology that can lower the price of flying cars. Of course, if flying cars become popular and mass-produced, the price is expected to be lowered naturally. Technology to reduce noise generated by flying cars is also emerging as a problem to be solved. In addition, it is expected that popularization can be accelerated only when sensor-related technology development to ensure safety for operation and technology related to autonomous flight capable of flying without human intervention are developed. In addition, it is important to develop battery-related technology for a long flight. Only when these technical problems are resolved people will be able to use them safely. (2) System improvement and infrastructure establishment In relation to flying cars, optimistic predictions about the operation of aerial vehicles are predicted when the VTOL (Vertical Take-off and Landing) type of technology is introduced. On the other hand, in order to settle as a convenient means of transportation with the introduction of flying cars, the government's active policy change is necessary. It is necessary to build a dedicated space for PAV (Personal Air Vehicle) for vertical take-off and landing in the city. It is also essential to establish a place to charge the PAV's electricity. It is also necessary to enact systems and laws in parallel with the establishment of such infrastructure. Most countries have so far established systems and laws centered on automobiles, a means of transportation. A work must also be done to make these systems and laws fit the environment of the flying car, a new means of transportation. It is expected that it will take time for the construction of infrastructure for flying cars and the work of enacting systems and laws. If flying cars are commercialized, there is a possibility that traffic jams on the ground will occur in the sky. It is also essential to develop a system that can efficiently manage and control such traffic jams in the air. Flying cars are expected to make human life more convenient as a new means of transportation along with autonomous vehicles.
USER:
What technological roadblocks are flying cars faced with as they navigate our current infrastructure?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 11 | 14 | 880 | null | 736 |
Answer based only on the information provided in the prompt.
|
Why are opioids used so much in the United States?
|
Policymakers interested in addressing the opioid epidemic may want to understand why the United States consumes a disproportionate amount of opioids. The scientific evidence suggests that many factors may influence this disparity between the United States and other economically advanced countries. This report synthesizes the scientific research to explain relevant factors regarding the difference between opioid consumption in the United States and other comparable industrialized countries, such as the G-7 countries. A review of scientific literature on international and domestic opioid use pointed to several factors affecting the difference in consumption per capita.3 Prescribing practices of health care providers appear to be a primary factor affecting consumption. U.S. health care providers prescribe opioids more frequently, at higher doses, and throughout more stages of pain treatment—including as a first-line treatment—than their European counterparts. Use of higher-potency opioids—with greater morphine milligram equivalents (MMEs) per dose—appears especially high in the United States compared with other countries. Although there is generally no agreed upon threshold value of what constitutes a “high potency” opioid,4 clinical guidelines and research studies often use MMEs per day or per dose to establish a threshold.5 The MME metric allows for standardization of dose across different opioid analgesics. Table 1 lists the MME conversion factors of several commonly used opioid analgesics, as defined by the U.S. Centers for Disease Control and Prevention (CDC).6 Clinical guidelines published by the World Health Organization (WHO) and others discourage using high-potency opioids and opioids as a first-line treatment for long-term chronic noncancer pain management.7 Several additional factors besides higher prescribing practices may explain the higher relative use of opioids in the United States. It is possible the United States has a greater prevalence of pain, and that Americans experience, or at least self-report, more intense pain. Americans may receive more opioids at more frequent points in care rather than more comprehensive approaches to pain management, such as those that use combinations of pharmaceutical, psychological, and physical therapies. Higher opioid-prescribing practices may be driven by insurance reimbursement systems that incentivize opioids over alternative pain treatments, cost structures that promote more efficient care, or evaluations that prioritize patient satisfaction and conflate it with pain management. Compared with most of its European counterparts, the U.S. medical system allows for more autonomy for health care providers, imposes fewer national government regulations on health care practices, and permits more direct-to-provider marketing practices. In addition, prescription drug monitoring programs (PDMPs) in the United States are decentralized. PDMPs in the United States are generally structured to monitor bad actors and generally not designed to promote best practices aligned with clinical guidance. More broadly, cultural differences, such as expectations about pain relief and entitlements to opioid treatment, may also explain the greater reliance on pharmacological treatments in the United States. Health care systems that provide more expansive access to care may allow for greater preventive care and more multimodal approaches to pain, in part because there may be fewer barriers to using these types of treatments. Moreover, providers operating in highly regulated systems may be less susceptible to the direct and indirect influences experienced by American providers, such as profit-driven fee-for-service incentives or direct-to-provider pharmaceutical marketing. The U.S. federal government leaves the majority of medical practice regulation to individual states. This decentralized system may impose rules governing prescribing practices (e.g., those instituted in European countries to prevent adverse outcomes of opioid use) at a slower pace than those imposed by centrally governed health care systems.
|
System Instructions: Answer based only on the information provided in the prompt. Question: Why are opioids used so much in the United States? Context: Policymakers interested in addressing the opioid epidemic may want to understand why the United States consumes a disproportionate amount of opioids. The scientific evidence suggests that many factors may influence this disparity between the United States and other economically advanced countries. This report synthesizes the scientific research to explain relevant factors regarding the difference between opioid consumption in the United States and other comparable industrialized countries, such as the G-7 countries. A review of scientific literature on international and domestic opioid use pointed to several factors affecting the difference in consumption per capita.3 Prescribing practices of health care providers appear to be a primary factor affecting consumption. U.S. health care providers prescribe opioids more frequently, at higher doses, and throughout more stages of pain treatment—including as a first-line treatment—than their European counterparts. Use of higher-potency opioids—with greater morphine milligram equivalents (MMEs) per dose—appears especially high in the United States compared with other countries. Although there is generally no agreed upon threshold value of what constitutes a “high potency” opioid,4 clinical guidelines and research studies often use MMEs per day or per dose to establish a threshold.5 The MME metric allows for standardization of dose across different opioid analgesics. Table 1 lists the MME conversion factors of several commonly used opioid analgesics, as defined by the U.S. Centers for Disease Control and Prevention (CDC).6 Clinical guidelines published by the World Health Organization (WHO) and others discourage using high-potency opioids and opioids as a first-line treatment for long-term chronic noncancer pain management.7 Several additional factors besides higher prescribing practices may explain the higher relative use of opioids in the United States. It is possible the United States has a greater prevalence of pain, and that Americans experience, or at least self-report, more intense pain. Americans may receive more opioids at more frequent points in care rather than more comprehensive approaches to pain management, such as those that use combinations of pharmaceutical, psychological, and physical therapies. Higher opioid-prescribing practices may be driven by insurance reimbursement systems that incentivize opioids over alternative pain treatments, cost structures that promote more efficient care, or evaluations that prioritize patient satisfaction and conflate it with pain management. Compared with most of its European counterparts, the U.S. medical system allows for more autonomy for health care providers, imposes fewer national government regulations on health care practices, and permits more direct-to-provider marketing practices. In addition, prescription drug monitoring programs (PDMPs) in the United States are decentralized. PDMPs in the United States are generally structured to monitor bad actors and generally not designed to promote best practices aligned with clinical guidance. More broadly, cultural differences, such as expectations about pain relief and entitlements to opioid treatment, may also explain the greater reliance on pharmacological treatments in the United States. Health care systems that provide more expansive access to care may allow for greater preventive care and more multimodal approaches to pain, in part because there may be fewer barriers to using these types of treatments. Moreover, providers operating in highly regulated systems may be less susceptible to the direct and indirect influences experienced by American providers, such as profit-driven fee-for-service incentives or direct-to-provider pharmaceutical marketing. The U.S. federal government leaves the majority of medical practice regulation to individual states. This decentralized system may impose rules governing prescribing practices (e.g., those instituted in European countries to prevent adverse outcomes of opioid use) at a slower pace than those imposed by centrally governed health care systems.
|
Answer based only on the information provided in the prompt.
EVIDENCE:
Policymakers interested in addressing the opioid epidemic may want to understand why the United States consumes a disproportionate amount of opioids. The scientific evidence suggests that many factors may influence this disparity between the United States and other economically advanced countries. This report synthesizes the scientific research to explain relevant factors regarding the difference between opioid consumption in the United States and other comparable industrialized countries, such as the G-7 countries. A review of scientific literature on international and domestic opioid use pointed to several factors affecting the difference in consumption per capita.3 Prescribing practices of health care providers appear to be a primary factor affecting consumption. U.S. health care providers prescribe opioids more frequently, at higher doses, and throughout more stages of pain treatment—including as a first-line treatment—than their European counterparts. Use of higher-potency opioids—with greater morphine milligram equivalents (MMEs) per dose—appears especially high in the United States compared with other countries. Although there is generally no agreed upon threshold value of what constitutes a “high potency” opioid,4 clinical guidelines and research studies often use MMEs per day or per dose to establish a threshold.5 The MME metric allows for standardization of dose across different opioid analgesics. Table 1 lists the MME conversion factors of several commonly used opioid analgesics, as defined by the U.S. Centers for Disease Control and Prevention (CDC).6 Clinical guidelines published by the World Health Organization (WHO) and others discourage using high-potency opioids and opioids as a first-line treatment for long-term chronic noncancer pain management.7 Several additional factors besides higher prescribing practices may explain the higher relative use of opioids in the United States. It is possible the United States has a greater prevalence of pain, and that Americans experience, or at least self-report, more intense pain. Americans may receive more opioids at more frequent points in care rather than more comprehensive approaches to pain management, such as those that use combinations of pharmaceutical, psychological, and physical therapies. Higher opioid-prescribing practices may be driven by insurance reimbursement systems that incentivize opioids over alternative pain treatments, cost structures that promote more efficient care, or evaluations that prioritize patient satisfaction and conflate it with pain management. Compared with most of its European counterparts, the U.S. medical system allows for more autonomy for health care providers, imposes fewer national government regulations on health care practices, and permits more direct-to-provider marketing practices. In addition, prescription drug monitoring programs (PDMPs) in the United States are decentralized. PDMPs in the United States are generally structured to monitor bad actors and generally not designed to promote best practices aligned with clinical guidance. More broadly, cultural differences, such as expectations about pain relief and entitlements to opioid treatment, may also explain the greater reliance on pharmacological treatments in the United States. Health care systems that provide more expansive access to care may allow for greater preventive care and more multimodal approaches to pain, in part because there may be fewer barriers to using these types of treatments. Moreover, providers operating in highly regulated systems may be less susceptible to the direct and indirect influences experienced by American providers, such as profit-driven fee-for-service incentives or direct-to-provider pharmaceutical marketing. The U.S. federal government leaves the majority of medical practice regulation to individual states. This decentralized system may impose rules governing prescribing practices (e.g., those instituted in European countries to prevent adverse outcomes of opioid use) at a slower pace than those imposed by centrally governed health care systems.
USER:
Why are opioids used so much in the United States?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 10 | 10 | 573 | null | 845 |
You must respond solely based on the provided context, so do not rely on external knowledge or sources. Answer in 100 words or less.
|
I don't agree terms of my digital copy. Without referencing the context, what does Disney say is the process of returning a digital movie code purchased in a combination disc + code package.
|
4. Paid Transactions Identity of Seller Sales are made by Disney DTC or the seller identified at the time of sale, if different. If you have questions about your order, please contact the seller at the address provided and they will assist you. Some digital storefronts on the Disney Services are operated by third parties and, in that case, different or additional sale terms may apply, which you should read when they are presented to you. Digital Content and Virtual Items We may make applications, games, software or other digital content available on the Disney Services for you to license for a one-time fee. When purchasing a license to access such material from a Disney Service, charges will be disclosed to you on the Disney Service before you complete the license purchase. Your purchase of a virtual item or in-game currency is a payment for a limited, non-assignable license to access and use such content or functionality in the Disney Services with no right to reproduce, distribute, communicate to the public, make available to the public or transform any Disney Service via any online media, in any media format or channel now known or hereafter devised (except as may be expressly described or contemplated within the Disney Service). Virtual items (including characters and character names) or in-game currency purchased or available to you in the Disney Services can only be used in connection with the Disney Services where you obtained them or where they were developed by you as a result of game play. These items are not redeemable or subject to refund and cannot be traded outside of the Disney Services for money or other items for value. We may modify or discontinue virtual items or ingame currency at any time. Digital Movie Codes Digital codes originally packaged in a combination disc + code package (a package that includes a DVD, Blu-Ray, and/or 4K/UHD disc(s) and a digital code) may not be sold separately and may be redeemed only by an individual who obtains the code in the original combination disc + code package, or by a family member of that individual. Digital codes are not authorized for redemption if sold separately. You may use digital movie codes to obtain licensed access to digital movies only as specifically authorized under these terms and conditions and the terms and conditions of the participating provider of digital content through which you access or download the digital movie. Digital movie codes sold, distributed, purchased, or transferred in a manner inconsistent with these terms and conditions are subject to being invalidated. Digital Movie Code Returns. If you do not agree to the above terms and conditions for redeeming a digital movie code obtained by you or a family member in an original combination disc + code package, you may return the combination disc + code package to Disney for a refund subject to the conditions provided at this link. Subscriptions Some Disney Services require paid subscriptions to access. By signing up for a subscription, you agreed that your subscription will be automatically renewed and, unless you cancel your subscription, you authorized us to charge your payment method for the renewal term. The period of auto-renewal will be the same as your initial subscription period unless otherwise disclosed to you at the time of sale. The renewal rate will be no more than the rate for the immediately prior subscription period, excluding any promotional and discount pricing, unless we notify you of a rate change prior to your auto-renewal, in which case you will have the right to cancel the renewal of your subscription. From time to time, we may offer a free trial subscription for a Disney Service. If you register for a free trial subscription, we will begin to bill your account when the free trial subscription expires, unless you cancel your subscription before that time. When you subscribe to a Disney Service (other than semi-annual and annual subscriptions), you have the right to cancel your contract within fourteen (14) days from the date the transaction is concluded and you will receive a full refund of the subscription fee paid. For semi-annual and annual subscriptions, if notice of cancellation is received within the first thirty (30) days following the first day of initial billing, you will receive a refund of the subscription fee paid. If we refund your subscription fee, you will still be obligated to pay other charges incurred by you in the course of using the Disney Service prior to the date of cancellation. If you pay a periodic subscription fee for a Disney Service, we will provide you with reasonable notice of changes to the fees or billing methods in advance of their effective date and you will be able to cancel your subscription prior to such change. If you subscribed online, we will give you the option of cancelling the subscription online. The Order Process You will have the opportunity to review and confirm your order, including delivery address (if applicable), payment method and product details. We will send to you a notice when we accept your order and our acceptance will be deemed complete and for all purposes to have been effectively communicated to you at the time we send the notice. At such time, the contract for sale will be made and become binding on both you and us. The risk of loss in any goods you purchase and the responsibility to insure them passes to you when the relevant goods are delivered. We reserve the right to refuse or cancel any order prior to delivery. Some situations that may result in your order being cancelled include system or typographical errors, inaccuracies in product or pricing information or product availability, fairness among customers where supplies are limited, or problems identified by our credit or fraud departments. We also may require additional verification or information before accepting an order. We will contact you if any portion of your order is cancelled or if additional information is required to accept your order. If your order is cancelled after we have processed your payment but prior to delivery, we will refund your payment. Payments and Billing When you provide payment information, you represent and warrant that the information is accurate, that you are authorized to use the payment method provided, and that you will notify us of changes to the payment information. We reserve the right to utilize third party payment card updating services to obtain current expiration dates on credit cards and debit cards. Right of Cancellation; Return of Goods You may have the right to cancel an order placed for a Disney Service - depending on the nature of the Disney Service. Please read the following information carefully so you understand your right of cancellation. If you wish to cancel, you must do so by following the cancellation instructions for the particular Disney Service. A sample cancellation form is available here. Cancelling Subscriptions Please see the information above on the process for cancelling subscriptions in our Subscriptions section. Digital Content When you purchase a license to access digital content or virtual items, you will be given an opportunity to consent to delivery at the time of purchase. By consenting to delivery, you acknowledge that you have lost the right to cancel. License purchase fees paid for digital content are non-refundable. Physical Goods You have the right, within thirty (30) days from the date of your receipt of physical goods, to cancel our contract with you and return the goods. This right does not apply to goods stated by us on the Disney Services to be non-returnable, including but not limited to: • Any products with a seal, where the seal is broken, such as audio and video recordings, computer software, and CD’s, DVD’s or other physical media that have been supplied in sealed packaging; and • Personalized items. Personalized Goods We reserve the right to refuse personalized orders at our discretion. Inappropriate use of our personalization service will cause your order to be cancelled and any payment refunded. These cancellation rights are separate and in addition to your rights should any item we supply be faulty. If you are returning goods that are not faulty, you may be required to pay for the cost of returning the goods to us and we may deduct a reasonable amount if you use the goods.
|
You must respond solely based on the provided context, so do not rely on external knowledge or sources. Answer in 100 words or less. context:4. Paid Transactions Identity of Seller Sales are made by Disney DTC or the seller identified at the time of sale, if different. If you have questions about your order, please contact the seller at the address provided and they will assist you. Some digital storefronts on the Disney Services are operated by third parties and, in that case, different or additional sale terms may apply, which you should read when they are presented to you. Digital Content and Virtual Items We may make applications, games, software or other digital content available on the Disney Services for you to license for a one-time fee. When purchasing a license to access such material from a Disney Service, charges will be disclosed to you on the Disney Service before you complete the license purchase. Your purchase of a virtual item or in-game currency is a payment for a limited, non-assignable license to access and use such content or functionality in the Disney Services with no right to reproduce, distribute, communicate to the public, make available to the public or transform any Disney Service via any online media, in any media format or channel now known or hereafter devised (except as may be expressly described or contemplated within the Disney Service). Virtual items (including characters and character names) or in-game currency purchased or available to you in the Disney Services can only be used in connection with the Disney Services where you obtained them or where they were developed by you as a result of game play. These items are not redeemable or subject to refund and cannot be traded outside of the Disney Services for money or other items for value. We may modify or discontinue virtual items or ingame currency at any time. Digital Movie Codes Digital codes originally packaged in a combination disc + code package (a package that includes a DVD, Blu-Ray, and/or 4K/UHD disc(s) and a digital code) may not be sold separately and may be redeemed only by an individual who obtains the code in the original combination disc + code package, or by a family member of that individual. Digital codes are not authorized for redemption if sold separately. You may use digital movie codes to obtain licensed access to digital movies only as specifically authorized under these terms and conditions and the terms and conditions of the participating provider of digital content through which you access or download the digital movie. Digital movie codes sold, distributed, purchased, or transferred in a manner inconsistent with these terms and conditions are subject to being invalidated. Digital Movie Code Returns. If you do not agree to the above terms and conditions for redeeming a digital movie code obtained by you or a family member in an original combination disc + code package, you may return the combination disc + code package to Disney for a refund subject to the conditions provided at this link. Subscriptions Some Disney Services require paid subscriptions to access. By signing up for a subscription, you agreed that your subscription will be automatically renewed and, unless you cancel your subscription, you authorized us to charge your payment method for the renewal term. The period of auto-renewal will be the same as your initial subscription period unless otherwise disclosed to you at the time of sale. The renewal rate will be no more than the rate for the immediately prior subscription period, excluding any promotional and discount pricing, unless we notify you of a rate change prior to your auto-renewal, in which case you will have the right to cancel the renewal of your subscription. From time to time, we may offer a free trial subscription for a Disney Service. If you register for a free trial subscription, we will begin to bill your account when the free trial subscription expires, unless you cancel your subscription before that time. When you subscribe to a Disney Service (other than semi-annual and annual subscriptions), you have the right to cancel your contract within fourteen (14) days from the date the transaction is concluded and you will receive a full refund of the subscription fee paid. For semi-annual and annual subscriptions, if notice of cancellation is received within the first thirty (30) days following the first day of initial billing, you will receive a refund of the subscription fee paid. If we refund your subscription fee, you will still be obligated to pay other charges incurred by you in the course of using the Disney Service prior to the date of cancellation. If you pay a periodic subscription fee for a Disney Service, we will provide you with reasonable notice of changes to the fees or billing methods in advance of their effective date and you will be able to cancel your subscription prior to such change. If you subscribed online, we will give you the option of cancelling the subscription online. The Order Process You will have the opportunity to review and confirm your order, including delivery address (if applicable), payment method and product details. We will send to you a notice when we accept your order and our acceptance will be deemed complete and for all purposes to have been effectively communicated to you at the time we send the notice. At such time, the contract for sale will be made and become binding on both you and us. The risk of loss in any goods you purchase and the responsibility to insure them passes to you when the relevant goods are delivered. We reserve the right to refuse or cancel any order prior to delivery. Some situations that may result in your order being cancelled include system or typographical errors, inaccuracies in product or pricing information or product availability, fairness among customers where supplies are limited, or problems identified by our credit or fraud departments. We also may require additional verification or information before accepting an order. We will contact you if any portion of your order is cancelled or if additional information is required to accept your order. If your order is cancelled after we have processed your payment but prior to delivery, we will refund your payment. Payments and Billing When you provide payment information, you represent and warrant that the information is accurate, that you are authorized to use the payment method provided, and that you will notify us of changes to the payment information. We reserve the right to utilize third party payment card updating services to obtain current expiration dates on credit cards and debit cards. Right of Cancellation; Return of Goods You may have the right to cancel an order placed for a Disney Service - depending on the nature of the Disney Service. Please read the following information carefully so you understand your right of cancellation. If you wish to cancel, you must do so by following the cancellation instructions for the particular Disney Service. A sample cancellation form is available here. Cancelling Subscriptions Please see the information above on the process for cancelling subscriptions in our Subscriptions section. Digital Content When you purchase a license to access digital content or virtual items, you will be given an opportunity to consent to delivery at the time of purchase. By consenting to delivery, you acknowledge that you have lost the right to cancel. License purchase fees paid for digital content are non-refundable. Physical Goods You have the right, within thirty (30) days from the date of your receipt of physical goods, to cancel our contract with you and return the goods. This right does not apply to goods stated by us on the Disney Services to be non-returnable, including but not limited to: • Any products with a seal, where the seal is broken, such as audio and video recordings, computer software, and CD’s, DVD’s or other physical media that have been supplied in sealed packaging; and • Personalized items. Personalized Goods We reserve the right to refuse personalized orders at our discretion. Inappropriate use of our personalization service will cause your order to be cancelled and any payment refunded. These cancellation rights are separate and in addition to your rights should any item we supply be faulty. If you are returning goods that are not faulty, you may be required to pay for the cost of returning the goods to us and we may deduct a reasonable amount if you use the goods. Question: I don't agree terms of my digital copy. Without referencing the context, what does Disney say is the process of returning a digital movie code purchased in a combination disc + code package.
|
You must respond solely based on the provided context, so do not rely on external knowledge or sources. Answer in 100 words or less.
EVIDENCE:
4. Paid Transactions Identity of Seller Sales are made by Disney DTC or the seller identified at the time of sale, if different. If you have questions about your order, please contact the seller at the address provided and they will assist you. Some digital storefronts on the Disney Services are operated by third parties and, in that case, different or additional sale terms may apply, which you should read when they are presented to you. Digital Content and Virtual Items We may make applications, games, software or other digital content available on the Disney Services for you to license for a one-time fee. When purchasing a license to access such material from a Disney Service, charges will be disclosed to you on the Disney Service before you complete the license purchase. Your purchase of a virtual item or in-game currency is a payment for a limited, non-assignable license to access and use such content or functionality in the Disney Services with no right to reproduce, distribute, communicate to the public, make available to the public or transform any Disney Service via any online media, in any media format or channel now known or hereafter devised (except as may be expressly described or contemplated within the Disney Service). Virtual items (including characters and character names) or in-game currency purchased or available to you in the Disney Services can only be used in connection with the Disney Services where you obtained them or where they were developed by you as a result of game play. These items are not redeemable or subject to refund and cannot be traded outside of the Disney Services for money or other items for value. We may modify or discontinue virtual items or ingame currency at any time. Digital Movie Codes Digital codes originally packaged in a combination disc + code package (a package that includes a DVD, Blu-Ray, and/or 4K/UHD disc(s) and a digital code) may not be sold separately and may be redeemed only by an individual who obtains the code in the original combination disc + code package, or by a family member of that individual. Digital codes are not authorized for redemption if sold separately. You may use digital movie codes to obtain licensed access to digital movies only as specifically authorized under these terms and conditions and the terms and conditions of the participating provider of digital content through which you access or download the digital movie. Digital movie codes sold, distributed, purchased, or transferred in a manner inconsistent with these terms and conditions are subject to being invalidated. Digital Movie Code Returns. If you do not agree to the above terms and conditions for redeeming a digital movie code obtained by you or a family member in an original combination disc + code package, you may return the combination disc + code package to Disney for a refund subject to the conditions provided at this link. Subscriptions Some Disney Services require paid subscriptions to access. By signing up for a subscription, you agreed that your subscription will be automatically renewed and, unless you cancel your subscription, you authorized us to charge your payment method for the renewal term. The period of auto-renewal will be the same as your initial subscription period unless otherwise disclosed to you at the time of sale. The renewal rate will be no more than the rate for the immediately prior subscription period, excluding any promotional and discount pricing, unless we notify you of a rate change prior to your auto-renewal, in which case you will have the right to cancel the renewal of your subscription. From time to time, we may offer a free trial subscription for a Disney Service. If you register for a free trial subscription, we will begin to bill your account when the free trial subscription expires, unless you cancel your subscription before that time. When you subscribe to a Disney Service (other than semi-annual and annual subscriptions), you have the right to cancel your contract within fourteen (14) days from the date the transaction is concluded and you will receive a full refund of the subscription fee paid. For semi-annual and annual subscriptions, if notice of cancellation is received within the first thirty (30) days following the first day of initial billing, you will receive a refund of the subscription fee paid. If we refund your subscription fee, you will still be obligated to pay other charges incurred by you in the course of using the Disney Service prior to the date of cancellation. If you pay a periodic subscription fee for a Disney Service, we will provide you with reasonable notice of changes to the fees or billing methods in advance of their effective date and you will be able to cancel your subscription prior to such change. If you subscribed online, we will give you the option of cancelling the subscription online. The Order Process You will have the opportunity to review and confirm your order, including delivery address (if applicable), payment method and product details. We will send to you a notice when we accept your order and our acceptance will be deemed complete and for all purposes to have been effectively communicated to you at the time we send the notice. At such time, the contract for sale will be made and become binding on both you and us. The risk of loss in any goods you purchase and the responsibility to insure them passes to you when the relevant goods are delivered. We reserve the right to refuse or cancel any order prior to delivery. Some situations that may result in your order being cancelled include system or typographical errors, inaccuracies in product or pricing information or product availability, fairness among customers where supplies are limited, or problems identified by our credit or fraud departments. We also may require additional verification or information before accepting an order. We will contact you if any portion of your order is cancelled or if additional information is required to accept your order. If your order is cancelled after we have processed your payment but prior to delivery, we will refund your payment. Payments and Billing When you provide payment information, you represent and warrant that the information is accurate, that you are authorized to use the payment method provided, and that you will notify us of changes to the payment information. We reserve the right to utilize third party payment card updating services to obtain current expiration dates on credit cards and debit cards. Right of Cancellation; Return of Goods You may have the right to cancel an order placed for a Disney Service - depending on the nature of the Disney Service. Please read the following information carefully so you understand your right of cancellation. If you wish to cancel, you must do so by following the cancellation instructions for the particular Disney Service. A sample cancellation form is available here. Cancelling Subscriptions Please see the information above on the process for cancelling subscriptions in our Subscriptions section. Digital Content When you purchase a license to access digital content or virtual items, you will be given an opportunity to consent to delivery at the time of purchase. By consenting to delivery, you acknowledge that you have lost the right to cancel. License purchase fees paid for digital content are non-refundable. Physical Goods You have the right, within thirty (30) days from the date of your receipt of physical goods, to cancel our contract with you and return the goods. This right does not apply to goods stated by us on the Disney Services to be non-returnable, including but not limited to: • Any products with a seal, where the seal is broken, such as audio and video recordings, computer software, and CD’s, DVD’s or other physical media that have been supplied in sealed packaging; and • Personalized items. Personalized Goods We reserve the right to refuse personalized orders at our discretion. Inappropriate use of our personalization service will cause your order to be cancelled and any payment refunded. These cancellation rights are separate and in addition to your rights should any item we supply be faulty. If you are returning goods that are not faulty, you may be required to pay for the cost of returning the goods to us and we may deduct a reasonable amount if you use the goods.
USER:
I don't agree terms of my digital copy. Without referencing the context, what does Disney say is the process of returning a digital movie code purchased in a combination disc + code package.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 33 | 1,395 | null | 117 |
When responding, restrict yourself to only information found within the given article - no other information is valid or necessary.
|
What are the current therapy practices to treat fibromyalgia according to the document?
|
International Journal of Molecular Sciences Review Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies Massimo E. Ma↵ei Department of Life Sciences and Systems Biology, University of Turin, 10135 Turin, Italy; massimo.ma↵[email protected]; Tel.: +39-011-670-5967 !"#!$%&'(! Received: 6 October 2020; Accepted: 22 October 2020; Published: 23 October 2020 !"#$%&' Abstract: Fibromyalgia (FM) is a syndrome that does not present a well-defined underlying organic disease. FM is a condition which has been associated with diseases such as infections, diabetes, psychiatric or neurological disorders, rheumatic pathologies, and is a disorder that rather than diagnosis of exclusion requires positive diagnosis. A multidimensional approach is required for the management of FM, including pain management, pharmacological therapies, behavioral therapy, patient education, and exercise. The purpose of this review is to summarize the recent advances in classification criteria and diagnostic criteria for FM as well as to explore pharmacotherapy and the use of alternative therapies including the use of plant bioactive molecules. Keywords: fibromyalgia; diagnosis; pharmacotherapy; alternative therapies; plant extracts; natural products 1. Introduction Fibromyalgia (FM) (earlier considered to be fibrositis, to stress the role of peripheral inflammation in the pathogenesis) is a syndrome that does not present a well-defined underlying organic disease. The primary driver of FM is sensitization, which includes central sensitivity syndromes generally referred to joint sti↵ness, chronic pain at multiple tender points, and systemic symptoms including cognitive dysfunction, sleep disturbances, anxiety, fatigue, and depressive episodes [1,2]. FM is a heterogeneous condition that is often associated to specific diseases such as infections, psychiatric or neurological disorders, diabetes and rheumatic pathologies. FM is more frequent in females, where it causes musculoskeletal pain [3] and a↵ects significantly the quality of life, often requiring an unexpected healthcare e↵ort and consistent social costs [4,5]. Usually, a patient-tailored approach requires a pharmacological treatment by considering the risk-benefit ratio of any medication. Being the third most common diagnosis in rheumatology clinics, FM prevalence within the general population appears to range from 1.3–8% [2]. To date there are no specific tests specific for FM. FM is currently recognized by the widespread pain index (which divides the body into 19 regions and scores how many regions are reported as painful) and a symptom severity score (SSS) that assesses cognitive symptoms, unrefreshing sleep and severity of fatigue [6]. It is not clear what causes FM and diagnosing assist the patients to face polysymptomatic distress, thereby reducing doubt and fear which are main psychological factors contributing to this central amplification mechanism [7]. In this review, an update on diagnosis and therapy of FM is provided along the discussion on the possibility of using pharmacological drugs, bioactive natural substances and alternative therapies to alleviate the symptomatology in combination or as alternative remedies to drugs. Int. J. Mol. Sci. 2020, 21, 7877 2 of 27 2. Diagnosis To date there is still a considerable controversy on the assessment and diagnosis of FM. Despite advances in the understanding of the pathologic process, FM remains undiagnosed in as many as 75% of people with the condition [8]. The first attempt for the FM classification criteria is dated 1990 and is based on studies performed in 16 centers in the U.S.A. and Canada in clinical and academic settings, gathering the both doubters and proponents [9]. Since then, several alternative methods of diagnosis have been proposed. In general, most of the researchers agree on the need to assess multiple domains in FM including pain, sleep, mood, functional status, fatigue, problems with concentration/memory (i.e. dyscognition) and tenderness/sti↵ness [5]. Four core areas were initially assessed: (1) pain intensity, (2) physical functioning, (3) emotional functioning, and (4) overall improvement/well-being [10]. About 70–80% of patients with FM also report having sleep disturbances and fatigue. Depressive symptoms, anxiety and mood states have also been included in FM diagnosis. An impairment in multiple areas of function, especially physical function is often reported by patients with FM [11] with a markedly impaired function and quality of life [8]. Since the late 19900 s, a top priority was the development of new disease-specific measures for each of the relevant domains in FM. Also, much attention was paid to studies supporting the valid use of existing instruments specifically in the context of FM [5]. Later on, in 2010, the tender point count was abandoned and the American College of Rheumatology (ACR) suggested preliminary diagnostic criteria which were considering the number of painful body regions evaluating the presence and severity of fatigue, cognitive difficulty, unrefreshed sleep and the extent of somatic symptoms. The diagnostic criteria are not based on laboratory or radiologic testing to diagnose FM and rely on a 0–12 Symptom Severity Scale (SSS) which is used to quantify FM-type symptom severity [12]. Furthermore, the SSS was proposed to be combined with the Widespread Pain Index (WPI) into a 0–31 Fibromyalgianess Scale (FS) [13]. With a specificity of 96.6% and sensitivity of 91.8%, a score 13 for FS was able to correctly classify 93% of patients identified as having FM based on the 1990 criteria [14]. ACR 2010 criteria were also found to be more sensitive than the ACR 1990 criteria, allowing underdiagnosed FM patients to be correctly identified and giving a treatment opportunity to those who had previously been untreated [15]. It is still unclear whether the diagnosis of FM has the same meaning with respect to severity in primary FM (PFM, a dominant disorder that occurs in the absence of another clinically important and dominant pain disorder) and secondary FM (SFM, which occurs in the presence of another clinically important and dominant medical disorder) [16]. Figure 1 shows the ACR 1990 criteria for the classification of fibromyalgia, whereas Figure 2 shows a graphical representation of the Symptom Severity Scale (SSS) plus the Extent of Somatic Symptoms (ESS). Figure 1. Widespread Pain Index from ACR 1990 criteria for the classification of fibromyalgia and related regions. Int. J. Mol. Sci. 2020, 21, 7877 3 of 27 Figure 2. Symptom Severity scale (SSS) and Extent of Somatic Symptoms (ESS). Table 1 shows a holist approach based on the assumption that a multitude of potential diagnoses is fundamental in order to avoid an FM misdiagnosis [17]. In 2013, alternative diagnostic criteria have been developed by some clinicians in the USA including more pain locations and a large range of symptoms than ACR 2010. A self-reported survey was composed of the 28-area pain location inventory and the 10 symptom items from the Symptom Impact Questionnaire (SIQ) [18]. However, when compared to the early 2010 criteria, these alternative criteria did not significantly contribute in di↵erentiating common chronic pain disorders from FM [1]. In 2015, the view of diagnostic criteria was altered by ACR by providing approval only for classification criteria and no longer considering endorsement of diagnostic criteria, stressing that diagnostic criteria are di↵erent from classification criteria and are beyond the remit of the ACR [19]. However, the suggestion that diagnostic and classification criteria represent 2 ends of a continuum implies that the continuum represents the accuracy of the criteria [20]. Classification criteria and diagnostic criteria could intersect; however, according to some authors the terms “diagnosis” and “classification criteria” should be considered as qualitatively distinct concepts. The proposed concept of “diagnostic criteria” [19] is challenging and may be hardly realizable, while diagnostic guidelines based on proper modelling techniques may be helpful for clinicians in particular settings [20]. In 2016, based on a generalized pain criterion and clinic usage data, a new revision of the 2010/2011 FM criteria was developed including the following criteria: 1) generalized pain, defined as pain present in at least 4 of 5 regions; 2) symptoms present at a similar level for at least three months; 3) a WPI 7 and SSS 5 or WPI of 4–6 and SSS 9; 4) a diagnosis of FM is valid irrespective of other diagnoses. Another important point is that the presence of other clinically important illnesses does not exclude a diagnosis of FM [21]. In 2018, considering important but less visible factors that have a profound influence on under- or over-diagnosis of FM provided a new gate to a holistic and real understanding of FM diagnosis, beyond existing arbitrary and constructional scores [22]. Int. J. Mol. Sci. 2020, 21, 7877 4 of 27 Table 1. ACR2010 and modified criteria for the diagnosis of fibromyalgia. Widespread pain index (WPI) Areas specification Number of areas in which the patient has had 0–19 points pain over the past week shoulder girdle, hip (buttock, trochanter), jaw, upper back, lower back, upper arm, upper leg, chest, neck, abdomen, lower arm, Areas to be considered and lower leg (all these areas should be considered bilaterally) Symptom Severity Scale (SSS) score Symptom Level of severity Symptom level Score For each of these 3 symptoms, indicate the level of severity over the past week Considering somatic symptoms in using the following scale: Fatigue general, indicate whether the patient has 0 = no problem Waking unrefreshed the following: 1 = slight or mild problems, generally Cognitive symptoms (e.g., working memory 0 = no symptoms Final score between 0 and 12 mild or intermittent capacity, recognition memory, verbal knowledge, 1 = few symptoms 2 = moderate; considerable problems, anxiety, and depression) 2 = a moderate number of symptoms often present and/or at a moderate level 3 = a great deal of symptoms 3 = severe; pervasive, continuous, life-disturbing problems Criteria Specification Conditions A patient satisfies diagnostic criteria for (a)WPI 7/19 and SS scale score 5 or WPI 3–6 and SS scale score 9 fibromyalgia if the following 3 conditions (b) symptoms have been present as a similar level for at least 3 months are met (c) the patient does not have a disorder that would otherwise explain the pain Modified criteria Specification Conditions Final Score (a)WPI (as above) A patient satisfies diagnostic criteria for (b) SS scale score (as above, but without The number of pain sites (WPI), the SS scale score, and the presence of associated fibromyalgia if the following 3 conditions extent of somatic symptoms) symptoms are summed to give a final score between 0 and 31 are met (c) presence of abdominal pain, depression, headaches (yes = 1, no = 0) Int. J. Mol. Sci. 2020, 21, 7877 5 of 27 In 2019, in cooperation with the WHO, an IASP Working Group has developed a classification system included in the International Classification of Diseases (ICD-11) where FM has been classified as chronic primary pain, to distinguish it from pain which is secondary to an underlying disease [23]. More recently, a study of about 500 patients under diagnosis of FM, revealed that 24.3% satisfied the FM criteria, while 20.9% received a clinician International Classification of Diseases (ICD) diagnosis of FM, with a 79.2% agreement between clinicians and criteria. The conclusions of this study pointed out a disagreement between ICD clinical diagnosis and criteria-based diagnosis of FM, calling into question meaning of a FM diagnosis, the validity of physician diagnosis and clinician bias [24]. FM is a disorder that cannot be based on diagnosis of exclusion, rather needing positive diagnosis [6], through a multidimensional FM diagnostic approach making diagnosis encompassing psychosocial stressors, subjective belief, psychological factors and somatic complaints [25]. The advent of the PSD scale identified a number of problems in FM research [16]. Recently, immunophenotyping analysis performed on blood samples of FM patients revealed a role of the Mu opioid receptor on B lymphocytes as a specific biomarker for FM [26]. Moreover, a rapid biomarker-based method for diagnosing FM has been developed by using vibrational spectroscopy to di↵erentiate patients with FM from those with other pain-related diseases. Unique IR and Raman spectral signatures were correlated with FM pain severity measured with FM impact questionnaire revised version (FIQR) [27]. Overall, these findings provide reliable diagnostic tests for di↵erentiating FM from other disorders, for establishing serologic biomarkers of FM-associated pain and were useful for the contribution of the legitimacy of FM as a truly painful disease. In summarizing aspects of FM learned through applications of criteria to patients and trials, Wolfe [28] identified 7 main concepts: 1) there is no way of objectively testing FM which also has no binding definition; 2) prevalence and acceptance of FM depend on factors largely external to the patient; 3) FM is a continuum and not a categorical disorder; 4) every feeling, symptom, physical finding, neuroscience measure, cost and outcome tells one very little about the disorder and its mechanisms when fibromyalgia to “normal subjects” is compared; 5) the range and content of symptoms might indicate that FM may not truly be a syndrome; 6) “pain and distress” type of FM subject identified in the general population [29] might be considered as part of the FM definition and; 7) caution is needed when accepting the current reductive neurobiological causal explanations as sufficient, since FM is a socially constructed and arbitrarily defined and diagnosed dimensional disorder. 3. Therapy 3.1. Pharmacotherapy of FM Clinical trials have failed to conclusively provide overall benefits of specific therapies to treat FM; therefore, current pharmacological treatments for patients su↵ering from FM are mainly directed to palliate some symptoms, with relevant clinical benefits experienced only by a minority of individuals from any one intervention. In those treated with pharmacotherapy, a 50%reduction in pain intensity is generally achieved only by 10% to 25% [30] However, some treatments seem to significantly improve the quality of life of certain FM patients [31]. Only a few drugs have been approved for use in the treatment of FM by the US FDA, whereas no drug has been approved for this indication by the European Medicines Agency. Thus patients with FM frequently need to be treated on an o↵-label basis [32]. Currently, only 25% to 40% pain reduction is granted by drugs and meaningful relief occurs in only 40% to 60%, in part due to dose-limiting adverse e↵ects and incomplete drug efficacy [33]. These limitations in clinical practice have led some to hypothesize that a combination of di↵erent analgesic drugs acting through di↵erent mechanisms may provide superior outcomes compared to monotherapy [34]. Moreover, drugs should be started at low doses and cautiously increased because some patients, either do not tolerate or benefit from drug therapy. Because sleep disturbance, pain and psychological distress are the most amenable to drug therapy, drugs should be chosen to manage the individual’s predominant symptoms [35]. Currently, several drugs are frequently used alone Int. J. Mol. Sci. 2020, 21, 7877 6 of 27 or in combination to manage FM symptoms; however, the US FDA indicated for FM only three: two selective serotonin and norepinephrine reuptake inhibitors (SNRIs), duloxetine and milnacipran, and an anticonvulsant, pregabalin [36]. In the next sections, the use of selected drugs aimed to alleviate FM will be described. 3.1.1. Cannabinoids in FM Therapy The cannabinoid system is ubiquitous in the animal kingdom and plays multiple functions with stabilizing e↵ects for the organism, including modulation of pain and stress, and the management of FM may have therapeutic potential by manipulating this system. The cannabinoid system contributes in maintaining equilibrium and stabilizing e↵ects on FM [37]. Moreover, the endocannabinoid neuromodulatory system is involved in multiple physiological functions, such as inflammation and immune recognition, endocrine function, cognition and memory, nausea, antinociception and vomiting, [38]. Deficiency in the endocannabinoid system has been correlated to FM [39], but without clear clinical evidence in support of this assumption [40]. The endocannabinoid system consists of two cannabinoid receptors, the CB1 and CB2 receptors [41]. In acute and chronic pain models, analgesic e↵ects are associated to CB1 agonists that act at many sites along pain transmission pathways, including activation of spinal, supraspinal and peripheral CB1 receptors, each independently decreasing nociception [42]. Delta 9-tetrahydrocannabinol (D9-THC or Dronabinol, 1) is the main active constituent of Cannabis sativa var indica, with psychoactive and pain-relieving properties. The non-selective binding to G-protein-coupled CB receptors is responsible for the pharmacological e↵ects induced by D9-THC. Cannabidiol (CBD, 2), a non-psychotropic constituent of cannabis, is a high potency antagonist of CB receptor agonists and an inverse agonist at the CB2 receptor [43]. CBD displays CB2 receptor inverse agonism, an action that appears to be responsible for its antagonism of CP55940 at the human CB2 receptor [44]. This CB2 receptor inverse agonist ability of CBD may contribute to its documented anti-inflammatory properties [44]. The main endocannabinoids are anandamide (N-arachidonoylethanolamine, AEA, 3) and 2-arachidonoylglycerol (2-AG, 4), AG), the activity of which is modulated by the hydrolyzing fatty acid palmitoylethanolamide (PEA, 5) and the endocannabinoid precursor arachidonic acid (AA, 6) [45]. AEA and 2-AG are functionally related to D9-THC [46]. It was found that stress induces a rapid anandamide release in several CNS regions resulting in stress-induced analgesia via CB1 receptors [47]. FM patients had significantly higher anandamide plasma levels [39,46]; however, it has been suggested that the origin of FM and chronic pain depend on a deficiency in the endocannabinoid signaling [45]. Monotherapies of FM based on D9-THC are based on the assumption that this compound acts as an analgesic drug; however, although a sub-population of FM patients reported significant benefits from the use of D9-THC, this statement cannot be made [48]. When the quality of life of FM patients who consumed cannabis was compared with FM subjects who were not cannabis users, a significant improvement of symptoms of FM in patients using cannabis was observed, although there was a variability of patterns [49]. The synthetic cannabinoid nabilone (7) showed of a superiority over placebo to reduce FM symptoms, with significant reductions in Visual Analog Scale (VAS) for pain, FM Impact Questionnaire (FIQ), and anxiety [42], indicating the efficacy of treating people with FM with nabilone. Nabilone was also e↵ective in improving sleep [50]; however, participants taking nabilone experienced more adverse events (such as dizziness/drowsiness, dry mouth and vertigo) than did participants taking placebo or amitriptyline (see below). The self-medication practice of herbal cannabis was associated with negative psychosocial parameters. Therefore, caution should be exercised in recommending the use of cannabinoids pending clarification of general health and psychosocial problems [51,52]. Figure 3 illustrates the chemical formulas of some cannabinoids and endocannabinoids. Int. J. Mol. Sci. 2020, 21, 7877 7 of 27 Figure 3. Structure formulae of some cannabinoids and related compounds. Numbers correspond to compound names cited in the text. 3.1.2. Opioids in FM Therapy One of the major natural sources of opioids is the medicinal plant Papaver somniferum. Although clinical evidence demonstrating the efficacy or e↵ectiveness of opioids analgesics is scanty, these molecules are widely used for the treatment of FM [53]. However, the long-term use of opioids in FM has been discouraged by several medical guidelines [54]. The use of opioids is documented in studies demonstrating increased endogenous opioid levels in the cerebrospinal fluid of patients with FM vs. controls [55]. These results prompted the interesting hypothesis that a more activated opioid system can be detected in individuals with FM, reflecting reduced receptor availability and increased release of endogenous opioids [54]. There is evidence from both single center, prospective, longitudinal and multicenter and observational clinical studies of negative e↵ects of the use of opioids in FM on patient outcomes compared with other therapies [56,57]. Moreover, opioid user groups showed less improvement in the SFM-36 subscale scores of general health perception and in the FIQ subscale scores of job ability, fatigue and physical impairment [58]. Furthermore, altered endogenous opioid analgesic activity in FM has been demonstrated and suggested as a possible reason for why exogenous opiates appear to have reduced efficacy [59]. Despite these facts, opioids have been prescribed for 10% to 60% of patients with FM as reported in large database sets [54]. When considered, the preference of patients appears towards opioids. In a survey, 75% of patients considered hydrocodone (8) plus acetaminophen to be helpful, and 67% considered oxycodone (9) plus acetaminophen to be helpful [60]. FM has been associated with preoperative opioid use, including hydrocodone [61], whereas there is limited information from randomized controlled trials on the benefits or harms of oxycodone when used to treat pain in FM [62]. A pilot study showed that naltrexone (10) reduced self-reported symptoms of FM (primarily daily pain and fatigue) [63] and further studies showed that low-dose naltrexone had a specific and clinically beneficial impact on FM. This opioid, which is widely available and inexpensive, Int. J. Mol. Sci. 2020, 21, 7877 8 of 27 was found to be safe and well-tolerated. Blocking peripheral opioid receptors with naloxone (11) was observed to prevent acute and chronic training-induced analgesia in a rat model of FM [64]; however, there were no significant e↵ects of naloxone nor nocebo on pressure pain threshold, deep tissue pain, temporal summation or conditioned pain modulation in chronic fatigue syndrome/FM patients [65]. A synthetic opioid receptor agonist that shows serotonin-norepinephrine reuptake inhibitor properties is tramadol (12); this compound is often prescribed for painful conditions [66]. Tramadol has been studied in humans who su↵er from FM [56], suggesting that tramadol may be e↵ective in treating FM [67]. The use of tramadol provides change in pain assessed by visual analogue scale and FM impact questionnaire; however, the reported side e↵ects include dizziness, headache, constipation, addiction, withdrawal, nausea, serotonin syndrome, somnolence, pruritus seizures, drug–drug interactions with antimigraine and antidepressants medications [66]. Therefore, it is recommended that tramadol application should be considered in refractory and more treatment-resistant cases of FM. Another weak opioid is codeine (13). In a comparative study, there was a significantly higher proportion of patients in the codeine-acetaminophen group reporting somnolence or constipation and a larger proportion of patients in the tramadol-acetaminophen group reporting headache. The overall results suggested that tramadol-acetaminophen tablets (37.5 mg/325 mg) were as e↵ective as codeine-acetaminophen capsules (30 mg/300 mg) in the treatment of chronic pain [68]. Fentanyl (14) works primarily by activating µ-opioid receptors and was found to be around 100 times stronger than morphine (15), although its e↵ects are more localized. Fentanyl injections reduced second pain from repeated heat taps in FM patients. Similar to reports of e↵ects of morphine on first and second pain, fentanyl had larger inhibitory e↵ects on slow temporal summation of second pain than on first pain from a nociceptor stimulation [69]. Since fentanyl can inhibit windup of second pain in FM patients, it can prevent the occurrence of intense summated second pain and thereby reduce its intensity by a greater extent than first or second pains evoked by single stimuli. Among the 70,237 drug-related deaths estimated in 2017 in the US, the sharpest increase occurred among those related to fentanyl analogs with almost 29,000 overdose deaths which represents more than 45% increase from 2016 to 2017 [70]. Because the numbers of overdoses and deaths due to fentanyl will continue to increase in the coming years, studies are needed to elucidate the physiological mechanisms underlying fentanyl overdose in order to develop e↵ective treatments aimed to reduce the risk of death [71]. Glial cell activation is one of the several other possible pathophysiologic mechanisms underlying the development of FM by contributing to central nervous system sensitization to nociceptive stimuli [72]. Pentoxifylline (16), a xanthine derivative used as a drug to treat muscle pain in people with peripheral artery disease, is a nonspecific cytokine inhibitor that has been shown to attenuate glial cell activation and to inhibit the synthesis of TNF↵, IL-1 , and IL-6 [73]. In theory, attenuating glial cell activation via the administration of pentoxifylline to individuals su↵ering from FM might be efficient in ameliorating their symptoms without being a globalist therapeutic approach targeting all possible pathophysiologic mechanisms of development of the syndrome [74]. With regards FM pathophysiology, serum brain-derived neurotrophic factors (BDNF) were found at higher levels in FM patients while BDNF methylation in exon 9 accounted for the regulation of protein expression. These data suggest that altered BDNF levels might represent a key mechanism explaining FM pathophysiology [75]. Opioid users were also observed to experience a decreased pain and symptom severity when ca↵eine (17) was consumed, but this was not observed in opioid nonusers, indicating ca↵eine may act as an opioid adjuvant in FM-like chronic pain patients. Therefore the consumption of ca↵eine along with the use of opioid analgesics could represent an alternative therapy with respect to opioids or ca↵eine alone [76]. Figure 4 shows the chemical formulae of some opioids used in FM therapy. Int. J. Mol. Sci. 2020, 21, 7877 9 of 27 Figure 4. Structure formulae of some opioids and related compounds. Numbers correspond to molecules cited in the text. 3.1.3. Gabapentinoids in FM Therapy Gabapentinoid drugs are US Food and Drug Administration (FDA) (but not in Europe) anticonvulsants approved for treatment of pain syndromes, including FM. However, FDA approved pregabalin (18) but not gabapentin (19) for FM treatment; nevertheless, gabapentin is often prescribed o↵-label for FM, presumably because it is substantially less expensive [77]. Pregabalin is a gamma-aminobutyric acid (GABA) analog and is a ligand for the ↵2 subunit of the calcium channel being able of reducing the ability of docked vesicles to fuse and release neurotransmitters [78]. Pregabalin shows e↵ects on cortical neural networks, particularly when basal neurons are under hyperexcitability. The pain measures and pregabalin impact on the cortical excitability was observed only in FM patients [79]. Pregabalin was also found to increase norepinephrine levels in reserpine-induced myalgia rats [80]. Because of its tolerability when used in combination with antidepressants, pregabalin use showed a very good benefit to risk ratio [81]. The starting approved dosage for pregabalin is at 150 mg daily [82]; however, the drug shows a higher e↵ectiveness when used at a dose of 300 or 600 mg/day. Lower pregabalin doses than those of clinical trials are used in clinical practice because higher doses are more likely to be intolerable [83]. A recent systematic review shows that a minority of people with moderate to severe pain due to FM treated with a daily dose of 300 to 600 mg of pregabalin had a reduction of pain intensity over a follow-up period of 12 to 26 weeks, with tolerable adverse e↵ects [84]. Thus, pregabalin is one of cardinal drugs used in the treatment of FM, and its clinical utility has been comprehensively demonstrated [85,86]. Nevertheless, there is still insufficient evidence to support or refute that gabapentin may reduce pain in FM [87]. Figure 5 depicts the chemical formulae of some gabapentinoids. Int. J. Mol. Sci. 2020, 21, 7877 10 of 27 Figure 5. Structure formulae of some gabapentinoids. Numbers correspond to molecules cited in the text. 3.1.4. Serotonin–Norepinephrine Reuptake Inhibitors in FM Therapy There is a wide use of serotonin and noradrenaline reuptake inhibitors (SNRIs). There is no unbiased evidence that serotonin selective reuptake inhibitors (SSRIs) are superior to placebo in treating depression in people with FM and for treating the key symptoms of FM, namely sleep problems, fatigue and pain. However, it should be considered that young adults aged 18 to 24, with major depressive disorder, showed an increased suicidal tendency when treated with SSRIs [88]. A recent Cochrane review evaluated the use of SNRIs including eighteen studies with a total of 7,903 adults diagnosed with FM, by using desvenlafaxine (20) and venlafaxine (21) in addition to duloxetine (22) and milnacipran (23), by considering various outcomes for SNRIs including health related quality of life, fatigue, sleep problems, pain and patient general impression, as well as safety and tolerability [89]. Fifty two percent of those receiving duloxetine and milnacipran had a clinically relevant benefit over placebo compared to 29% of those on placebo, with much or very much improvements in the intervention. On the other hand, reduction of pain intensity was not significantly di↵erent from placebo when desvenlafaxine was used. However, pain relief and reduction of fatigue was not clinically relevant for duloxetine and milnacipran in 50% or greater and did not improve the quality of life [90]. Same negative outcomes were found for reducing problems in sleep and the potential general benefits of duloxetine and milnacipran were outweighed by their potential harms. The efficacy of venlafaxine in the treatment of FM was studied to a lesser extent. The lack of consistency in venlafaxine dosing, placebo control and blinding make difficult to understand whether the molecule is e↵ective in treating FM. Nevertheless, tolerability and the lower cost of venlafaxine increases its potential use for the treatment of FM, by rendering the molecule a more a↵ordable option compared to the other, more expensive SNRIs [91]. Mirtazapine (24) promotes the release of noradrenaline and serotonin by blocking ↵2 -adrenergic autoreceptors and ↵2 -adrenergic heteroreceptors, respectively. Mirtazapine, by acting through 5-HT1A receptors and by blocking postsynaptic 5-HT2A , 5-HT2C , and 5-HT3 receptors is able to enhance serotonin neurotransmission [92]. For these properties, mirtazapine is classified as a noradrenergic and specific serotonergic antidepressant [93]. Mirtazapine appears to be a promising therapy to improve sleep, pain, and quality of life in patients with FM [94]. In Japanese patients with FM, mirtazapine caused a significantly greater reduction in the mean numerical rating scale pain score and remained significantly greater from week 6 onward, compared with placebo. However, Adverse mirtazapine caused adverse events including weight gain, somnolence and increased appetite when compared to placebo [92]. Among antidepressants, the tricyclic antidepressant (TCAs) amitriptyline (25) was studied more than other antidepressants. It is frequently used to assess comparative efficacy [95] and for many years amitriptyline has been a first-line treatment for FM. Although there is no supportive unbiased evidence for a beneficial e↵ect, the drug was successful for the treatment in many patients with FM. However, amitriptyline achieve satisfactory pain relief only by a minority of FM patients and is unlikely that any large randomized trials of amitriptyline will be conducted in FM to establish efficacy Int. J. Mol. Sci. 2020, 21, 7877 11 of 27 statistically, or measure the size of the e↵ect [96]. Figure 6 depicts the chemical formulae of some SNRIs and TCA. Figure 6. Chemical structure of some serotonin and noradrenaline reuptake inhibitors and a tricyclic antidepressant. Numbers correspond to molecules cited in the text. 3.2. Alternative Therapies for FM A survey of the European guidelines shows that most of the pharmacological therapies are relatively modest providing only weak recommendations for FM [97]. A multidimensional approach is therefore required for the management of FM, including pharmacological therapies along with behavioral therapy, exercise, patient education and pain management. A multidisciplinary approach combines pharmacotherapy with physical or cognitive interventions and natural remedies. Very often, patients seek help in alternative therapies due to the limited efficacy of the therapeutic options. The following sections discuss some of the most used alternative therapies to treat FM. 3.2.1. Acupunture Acupuncture shows low to moderate-level in improving pain and sti↵ness in people with FM. In some cases, acupuncture does not di↵er from sham acupuncture in improving sleep or global well-being or reducing pain or fatigue. The mechanisms of acupuncture action in FM treatment appears to be correlated to changes in serum serotonin levels [98]. Electro-acupuncture (EA) was more e↵ective than manual acupuncture (MA) for improving sleep, global well-being and fatigue and in the reduction of pain and sti↵ness. Although e↵ective, the e↵ect of acupuncture is not maintained at six months follow-up [99]. Moreover, there is a lack of evidence that real acupuncture significantly di↵ers from sham acupuncture with respect to improving the quality of life, both in the short and long term. However, acupuncture therapy is a safe treatment for patients with FM [100,101]. 3.2.2. Electric Stimulation As we discussed, FM, aside pain, is characterized by anxiety, depression and sleep disturbances, and by a complex cognitive dysfunctioning status known as “fibrofog” which is characterized by disturbance in working memory, attention and executive functions globally often referred by the patients as a sense of slowing down, clumsiness and confusion that have a profound impact on the ability to perform and e↵ectively plan daily activities [102,103]. Besides stimulation with acupuncture, the e↵ective modulation of brain areas has been obtained through non-invasive brain stimulation by Int. J. Mol. Sci. 2020, 21, 7877 12 of 27 magnetic or electric currents applied to the scalp like transcranial magnetic and electrical stimulation. In many cases, to relieve pain and improve general FM-related function, the use of anodal transcranial direct current stimulation over the primary motor cortex was found to be significantly more e↵ective than sham transcranial direct current stimulation [104]. If we consider that pharmacological and non-pharmacological treatments are often ine↵ective or transitory in their e↵ect on FM, therapeutic electrical stimulation appears to have a potential role [105]. Cognitive functions such as memory have been enhanced in FM patients by anodal transcranial direct current stimulation over the dorsolateral prefrontal cortex and has clinical relevance for top-down treatment approaches in FM [106]. In FM patients, modulation of hemodynamic responses by transcutaneous electrical nerve stimulation during delivery of nociceptive stimulation was also investigated and shown to be an e↵ective factor in FM treatment, although the underlying mechanism for these findings still needs to be clarified [107]. It has been recently demonstrated that both transcutaneous electric nerve stimulation and acupuncture applications seem to be beneficial in FM patients [108]. In a recent Positron Emission Tomography H2 15 O activation study it was shown that occipital nerve field stimulation acts through activation of the descending pain inhibitory pathway and the lateral pain pathway in FM, while electroencephalogram shows activation of those cortical areas that could be responsible for descending inhibition system recruitment [109]. Microcirculation is of great concern in patients with FM. Recently low-energy pulsed electromagnetic field therapy was found to increase a promising therapy to increase microcirlulation [110]; however, neither pain and sti↵ness were reduced nor functioning was improved by this therapy in women with FM [111]. The European Academy of Neurology, based on the method of GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) judged anodal transcranial direct currents stimulation of motor cortex as still inconclusive for treatment of FM [112]. Therefore, further studies are needed to determine optimal treatment protocols and to elucidate the mechanisms involved [113]. 3.2.3. Vibroacoustic and Rhythmic Sensory Stimulation Stimulation with sensory events such as pulsed or continuous auditory, vibrotactile and visual flickering stimuli are referred as rhythmic sensory stimulation [114]. Clinical studies have reported the application of vibroacoustic stimulation in the treatment of FM. In a clinal study, one group of patients with FM listened to a sequence of Bach’s compositions, another was subjected to vibratory stimuli on a combination of acupuncture points on the skin and a third group received no stimulation. The results showed that a greater e↵ect on FM symptoms was achieved by the combined use of music and vibration [115]. However, in another study, neither music nor musically fluctuating vibration had a significant e↵ect on tender point pain in FM patients when compared to placebo treatment [116]. Because thalamocortical dysrhythmia is implicated in FM and that low-frequency sound stimulation can play a regulatory function by driving neural rhythmic oscillatory activity, volunteers with FM were subjected to 23 min of low-frequency sound stimulation at 40 Hz, delivered using transducers in a supine position. Although no adverse e↵ects in patients receiving the treatment, no statistically and clinically relevant improvement were observed [117]. On the other hand, gamma-frequency rhythmic vibroacoustic stimulation was found to decrease FM symptoms (depression, sleep quality and pain interference) and ease associated comorbidities (depression and sleep disturbances), opening new avenues for further investigation of the e↵ects of rhythmic sensory stimulation on chronic pain conditions [118]. 3.2.4. Thermal Therapies Thermal therapies have been used to treat FM. Two main therapies are currently used: body warming and cryotherapy. Int. J. Mol. Sci. 2020, 21, 7877 13 of 27 Because FM is strongly linked to rheumatic aches, the application of heat by spa therapy (balneotherapy) appears as a natural choice for the treatment of FM [119]. Spa therapy is a popular treatment for FM in many European countries, as well as in Japan and Israel. A randomized prospective study of a 10-day treatment was done on 48 FM patients improving their quality of life [120] and showed that treatment of FM at the Dead Sea was both e↵ective and safe [121]. FM patients who were poorly responding to pharmacological therapies were subjected to mud-bath treatment. A cycle of mud bath applications showed beneficial e↵ects on FM patients whose evaluation parameters remained stable after 16 weeks in comparison to baseline [122]. In patients su↵ering from FM, mud bathing was also found to prevent muscle atrophy and inflammation and improve nutritional condition [123]. Nevertheless, despite positive results, the methodological limitations of available clinical studies, such as the lack of placebo double-blinded trials, preclude definitive conclusions on the e↵ect of body-warming therapies to treat FM [119,124]. A remedy widely used in sports related trauma is the application of cold as a therapeutic agent for pain relief. Cryotherapy refers to the use of low temperatures to decrease the inflammatory reaction, including oedema [125]. Cryotherapy induces several organism physiological reactions like increasing anti-inflammatory cytokines, beta-endorphins, ACTH, white blood cells, catecholamines and cortisol, immunostimulation due to noradrenalin response to cold, the increase in the level of plasma total antioxidant status and the reduction of pain through the alteration of nerve conduction [126]. When compared to control FM subjects, cryotherapy-treated FM patients reported a more pronounced improvement of the quality of life [127]. Whole body cryotherapy was also found to be a useful adjuvant therapy for FM [126]. 3.2.5. Hyperbaric Treatment Hyperbaric oxygen therapy (HBOT) has shown beneficial e↵ects for the prevention and treatment of pain [128], including migraine, cluster headache [129] and FM [130]. HBOT is supposed to induce neuroplasticity that leads to repair of chronically impaired brain functions. HBOT was also found to it improve the quality of life in post-stroke patients and mild traumatic brain injury patients [131]. Therefore, the increased oxygen concentration caused by HBOT is supposed to change the brain metabolism and glial function with a potential e↵ect on reducing the FM-associated brain abnormal activity [132]. HBOT was found to a↵ect the mitochondrial mechanisms resulting in functional brain changes, stimulate nitric oxide production thus alleviating hyperalgesia and promoting the NO-dependent release of endogenous opioids which appear to be involved in the antinociception prompted by HBOT [133]. In a clinical study, a significant di↵erence between the HBOT and control groups was found in the reduction in tender points and VAS scores after the first and fifteenth therapy sessions [130]. These results indicate that HBOT may play an important role in managing FM. 3.2.6. Laser Therapy and Phototherapy The use of di↵erent light wavelengths has been found to be an alternative therapy for FM. It is known that low-level laser therapy is a therapeutic factor, being able not only to target one event in the painful reception, but rather the extend its e↵ectiveness on the whole hierarchy of mechanisms of its origin and regulation [134]. Laser photobiomodulation therapy has been reported to be e↵ective in the treatment of a variety of myofascial musculoskeletal disorders, including FM [135]. The combination of laser therapy and the administration of the drug amitriptyline was found to be e↵ective on clinical symptoms and quality of life in FM; furthermore, gallium-arsenide laser therapy was found to be a safe and e↵ective treatment which can be used as a monotherapy or as a supplementary treatment to other therapeutic procedures in FM [136]. Evidence supported also the use of laser therapy in women su↵ering FM to improve pain and upper body range of motion, ultimately reducing the impact of FM [137,138]. Finally, a combination of phototherapy and exercise training was evaluated in patients with FM in a randomized controlled trial for chronic pain to o↵er valuable clinical evidence for objective assessment of the potential benefits and risks of procedures [139]. Int. J. Mol. Sci. 2020, 21, 7877 14 of 27 3.2.7. Exercise and Massage Exercise therapy seems to be an e↵ective component of treatment, yielding improvement in pain and other symptoms, as well as decreasing the burden of FM on the quality of life [140]. Exercise is generally acceptable by individuals with FM and was found to improve the ability to do daily activities and the quality of life and to decrease tiredness and pain [141]. However, it is important to know the e↵ects and specificities of di↵erent types of exercise. For instance, two or more types of exercise may combine strengthening, aerobic or stretching exercise; however, there is no substantial evidence that mixed exercise may improve sti↵ness [142]. Quality of life may be improved by muscle stretching exercise, especially with regard to physical functioning and pain, whereas depression is reduced by resistance training. A trial including a control group and two intervention groups, both of which receiving exercise programs created specifically for patients with FM, showed that both modalities were e↵ective in an exercise therapy program for FM [143]. A progressive muscle strengthening activity was also found to be a safe and e↵ective mode of exercise for FM patients [144]. Furthermore, strength and flexibility exercises in aerobic exercise rehabilitation for FM patients led to improvements in patients’ shoulder/hip range of motion and handgrip strength [145]. Among women with FM, the association between physical activity and daily function is mediated by the intensity of musculoskeletal pain, rather than depressive symptoms or body mass [146], with a link between clinical and experimental pain relief after the performance of isometric contractions [147]. A randomized controlled trial evaluated the e↵ects of yoga intervention on FM symptoms. Women performing yoga showed a significant improvement on standardized measures of FM symptoms and functioning, including fatigue, mood and pain, and in pain acceptance and other coping strategies [148]. Moreover, the combination with massage therapy program during three months influenced perceived stress index, cortisol concentrations, intensity of pain and quality of life of patients with FM [149]. In terms of societal costs and health care costs, quality of life and physical fitness in females with FM was improved by aquatic training and subsequent detraining [150,151]. Aquatic physical training was e↵ective in promoting increased oxygen uptake at peak cardiopulmonary exercise test in women with FM [152]. A systematic evaluation of the harms and benefits of aquatic exercise training in adults with FM showed that it may be beneficial for improving wellness, symptoms, and fitness in adults with FM [153,154]. A safe and clinically efficacious treatment of pain and other FM symptoms was also achieved by the combination of osteopathic manipulative medicine and pharmacologic treatment with gabapentin [155]. Dancing is a type of aerobic exercise that may be used in FM alternative therapy. Belly dancing was found to be e↵ective in improving functional capacity, pain, quality of life and improving body image of women with FM [156]. More recently, three months treatment of patients with FM with Zumba dancing was found to be e↵ective in improving pain and physical functioning [157]. Finally, Tai chi mind-body treatment was found to improve FM symptoms as much as aerobic exercise and longer duration of Tai chi showed greater improvement. According to a recent report, mind-body approaches may take part of the multidisciplinary management of FM and be considered an alternative therapeutic option [158]. 3.2.8. Probiotics and FM Therapy A tractable strategy for developing novel therapeutics for complex central nervous system disorders could rely on the so called microbiota-gut-brain axis management, because intestinal homeostasis may directly a↵ect brain functioning [159,160]. The pain intensity of patients with FM has been reported to be correlated with the degree of small intestinal bacterial overgrowth, which is often associated with an increased intestinal permeability whose values were significantly increased in the FM patients [161]. Preclinical trials indicate that the microbiota and its metabolome are likely involved in modulating brain processes and behaviors [162]. Therefore, FM patients should show better performance after the treatment with probiotics. In a double-blind, placebo-controlled, randomized design probiotic Int. J. Mol. Sci. 2020, 21, 7877 15 of 27 improved impulsive choice and decision-making in FM patients, but no other e↵ects were observed on cognition, quality of life, self-reported pain, FM impact, depressive or anxiety symptoms [163]. 3.2.9. Use of Plant Extracts and Natural Products for FM Treatment About 40% of drugs used to treat FM originate from natural products [164]; however, there are a few studies that prove the safe and e↵ective use of various plant extracts in FM therapy. Several plant extracts are currently used for their antinociceptive properties and potential to treat FM [165]. Papaver somniferum is probably the most ancient plant used for its antinociceptive properties [166], with chemical components able to interact with opioid receptors; among these morphine (15) which is not only the oldest, but is still the most e↵ective drug for the management of severe pain in clinical practice [167]. The use of opioids for FM treatment has been discussed above. Another important plant is Cannabis sativa. The major active constituent of Cannabis, D9-THC (1), has been shown to possess antinociceptive properties when assessed in several experimental models [168] (see also the discussion above on cannabinoids). Although there is still scarce evidence to support its role in the treatment of FM, a large consensus indicates that medical cannabis could be an e↵ective alternative for the treatment of FM symptoms [169]. The illicit use of herbal cannabis for FM treatment has been correlated to the inefficacy of current available medications, but is also linked to popular advocacy or familiarity with marijuana from recreational use. Therefore, physicians are requested to examine the global psychosocial well-being, and not focus only on the single outcome measure of pain [52,170]. Although medical cannabis treatment has a significant favorable e↵ect on patients with FM, 30% of patients experience adverse e↵ects [171] and 8% report dependence on cannabis [172]. VAS scores measured in 28 FM patients after 2 hours of cannabis use showed enhancement of relaxation and feeling of well-being, a reduction of pain and sti↵ness which were accompanied by an increase in somnolence. The mental health component summary score of the Short Form 36 Health Survey was higher in cannabis users than in non-users [49]. Among terpenoids, administration of trans- -caryophyllene (BCP, 26), a bicyclic sesquiterpene compound existing in the essential oil of many plants like Copaifera langsdforffii, Cananga odorata, Humulus lupulus, Piper nigrum and Syzygium aromaticum, which provide a high percentage of BCP along with interesting essential oil yields [173], significantly minimized the pain in both acute and chronic pain models [174]. BCP selectively binds to the cannabinoid 2 (CB2 ) receptor and is a functional CB2 agonist. Upon binding to the CB2 receptor, BCP inhibits adenylate cylcase, leads to intracellular calcium transients and weakly activates the mitogen-activated kinases Erk1/2 and p38 in primary human monocytes [175]. BCP, a safe compound with toxicity at doses higher than 2000 mg/kg body weight [176], was found to reduce the primary and secondary hyperalgesia produced by a chronic muscle pain model (which is considered to be an animal model for FM) [177]. Significant and dose-dependent antinociceptive response was produced by BCP without the presence of gastric damage [178]. Antiallodynic actions of BCP are exerted only through activation of local peripheral CB2 [179]. In neuropathic pain models, BCP reduced spinal neuroinflammation and the oral administration was more e↵ective than the subcutaneously injected synthetic CB2 agonist JWH-133 [180]. Recently, BCP was found to exert an analgesic e↵ect in an FM animal model through activation of the descending inhibitory pain pathway [181]. Thus, BCP may be highly e↵ective in the treatment of long-lasting, debilitating pain states, suggesting the interesting application of BCP in FM therapy. The analgesic properties of myrrh (Commiphora myrrha) have been known since ancient times and depend on the presence of bioactive sesquiterpenes with furanodiene skeletons which are able to interact with the opioid receptors [182,183]. C. myrrha extracts exerted a stronger suppression on carrageenan-induced mice paw edema with significant analgesic e↵ects [184] and were e↵ective against chronic inflammatory joint disease such as osteoarthritis [185]. In a preclinical trial, pain alleviation was obtained with C. myrrha extracts for many pathologies [186], indicating that extracts from this plant may have the potential to treat FM. Int. J. Mol. Sci. 2020, 21, 7877 16 of 27 Preclinical studies indicate a potential use of Hypericum perforatum (Hypericaceae), popularly known as St. John’s wort, in medical pain management [187] due to its phenolic compounds. Many phenolic compounds (e.g., flavonoids) from medicinal plants are promising candidates for new natural analgesic drugs [188]. Quercetin (27) showed analgesic activity and could reduce neuropathic pain by inhibiting mTOR/p70S6K pathway-mediated changes of synaptic morphology and synaptic protein levels in spinal dorsal horn neurons of db/db mice [189], while rutin (28) could inhibit the writhing response of mice induced by potassium antimony tartrate and showed to be a promising pharmacological approach to treat pain [190]. The analgesia potency of hyperin (29) was approximately 20-fold of morphine, while luteolin (30) presented e↵ective analgesic activities for both acute and chronic pain management. Some glycosides of kaempferol (e.g., kaempferol 3-O-sophoroside, 31) possess significant analgesic activity in the tail clip, tail flick, tail immersion, and acetic acid-induced writhing models, whereas baicalin (32) shows analgesic e↵ects in several kinds of pain [191]. Fisetin (33), a plant flavonoid polyphenol, has been reported to possess potent antioxidant, antinociceptive and neuroprotective activities. In rats, fisetin acts via modulation of decreased levels of biogenic amines and elevatesoxido-nitrosative stress and ROS to ameliorate allodynia, hyperalgesia, and depression in experimental reserpine-induced FM [192]. In a double-blind parallel-group clinical trial, outpatients with FM were randomized to receive either 15 mg of Crocus sativus (sa↵ron) extract or 30 mg duloxetine (22). No significant di↵erence was detected for any of the scales neither in terms of score changes from baseline to endpoint between the two treatment arms, indicating that sa↵ron and duloxetine had comparable efficacy in treatment of FM symptoms [193]. It is still unclear the efficacy of natural products extracted from plants in treating FM. However, some clinical data show promising results and more studies with adequate methodological quality are necessary in order to investigate the efficacy and safety of natural products as a support in FM therapy. Figure 7 depicts the chemical formulae of some antinociceptive natural products. Figure 7. Chemical structure of some natural compounds with antinociceptive activity. Int. J. Mol. Sci. 2020, 21, 7877 17 of 27 4. Conclusions Diagnosis of FM is based on clinical feature and criteria that still lack either a gold standard or at least supportive laboratory findings. FM diagnostic criteria may include heterogeneous patients also in clinical trials and this may impair evaluation of clinically meaningful treatment e↵ect. The review of the literature suggests that a multidisciplinary therapeutic approach, based on the combination of pharmacologic and alternative therapy (including thermal, light, electrostimulatory and body exercise treatments) could improve the quality of life and reduce pain and other symptoms related to FM. However, sometimes the ability of patients to participate to alternative therapies is impeded by the level of pain fatigue, poor sleep, and cognitive dysfunction. These patients may need to be managed with medications before initiating nonpharmacologic therapies. Although the use of some natural phytochemicals like BCP and phenolic compounds might replace other natural products such as D9-THC, because of reduced side e↵ects and higher tolerability, FM self medication practice may be ine↵ective and in some cases even detrimental. Therefore, providing FM patients with the correct information about their disorders may help monitoring pharmacological and alternative therapies. At the same time maintaining information will help patients to receive the appropriate medications and therapies [194]. Funding: This research received no external funding. Conflicts of Interest: The author declares no conflict of interest Abbreviations 2-AG 2-ArachidonoylGlycerol AA Arachidonic Acid ACR American College of Rheumatology ACTH Adrenocorticotropic hormone AEA N-arachidonoylethanolamine BDNF Brain-Derived Neurotrophic Factors CB1 Cannabinoid Receptor 1 CB2 Cannabinoid Receptor 2 CBD Cannabidiol CNS Central Nervous System EA Electro-Acupuncture ESS Extent of Somatic Symptoms FIQ FM Impact Questionnaire FIQR FM Impact Questionnaire Revised version FM Fibromyalgia FS Fibromyalgianess Scale GABA Gamma-Aminobutyric Acid Grading of Recommendations, Assessment, GRADE Development, and Evaluation HBOT Hyperbaric Oxygen Therapy ICD-11 International Classification of Diseases IL-1 Interleukin 1 beta IL-6 Interleukin 6 MA Manual Acupuncture PEA Palmitoylethanolamide PFM Primary FM ROS Reactive Oxygen Species SIQ Symptom Impact Questionnaire SFM Secondary FM SNRIs Serotonin and Norepinephrine Reuptake Inhibitors SSRIs Serotonin Selective Reuptake Inhibitors SSS Symptom Severity Scale TCAs Tricyclic Antidepressant TNF↵ Tumor necrosis factor alpha VAS Visual Analog Scale WPI Widespread Pain Index D9-THC Delta 9-tetrahydrocannabinol Int. J. Mol. Sci. 2020, 21, 7877 18 of 27 References 1. Wang, S.M.; Han, C.; Lee, S.J.; Patkar, A.A.; Masand, P.S.; Pae, C.U. Fibromyalgia diagnosis: A review of the past, present and future. Expert Rev. Neurother. 2015, 15, 667–679. [CrossRef] [PubMed] 2. Chinn, S.; Caldwell, W.; Gritsenko, K. Fibromyalgia pathogenesis and treatment options update. Curr. Pain Headache Rep. 2016, 20, 25. [CrossRef] [PubMed] 3. Blanco, I.; Beritze, N.; Arguelles, M.; Carcaba, V.; Fernandez, F.; Janciauskiene, S.; Oikonomopoulou, K.; de Serres, F.J.; Fernandez-Bustillo, E.; Hollenberg, M.D. Abnormal overexpression of mastocytes in skin biopsies of fibromyalgia patients. Clin. Rheumatol. 2010, 29, 1403–1412. [CrossRef] [PubMed] 4. Cabo-Meseguer, A.; Cerda-Olmedo, G.; Trillo-Mata, J.L. Fibromyalgia: Prevalence, epidemiologic profiles and economic costs. Med. Clin. 2017, 149, 441–448. [CrossRef] [PubMed] 5. Williams, D.A.; Schilling, S. Advances in the assessment of fibromyalgia. Rheum. Dis. Clin. N. Am. 2009, 35, 339–357. [CrossRef] [PubMed] 6. Rahman, A.; Underwood, M.; Carnes, D. Fibromyalgia. BMJ Br. Med. J. 2014, 348. [CrossRef] [PubMed] 7. McBeth, J.; Mulvey, M.R. Fibromyalgia: Mechanisms and potential impact of the acr 2010 classification criteria. Nat. Rev. Rheumatol. 2012, 8, 108–116. [CrossRef] [PubMed] 8. Arnold, L.M.; Clauw, D.J.; McCarberg, B.H.; FibroCollaborative. Improving the recognition and diagnosis of fibromyalgia. Mayo Clin. Proc. 2011, 86, 457–464. [CrossRef] 9. Wolfe, F.; Smythe, H.A.; Yunus, M.B.; Bennett, R.M.; Bombardier, C.; Goldenberg, D.L.; Tugwell, P.; Campbell, S.M.; Abeles, M.; Clark, P.; et al. The american-college-of-rheumatology 1990 criteria for the classification of fibromyalgia—Report of the multicenter criteria committee. Arthritis Rheum. 1990, 33, 160–172. [CrossRef] 10. Dworkin, R.H.; Turk, D.C.; McDermott, M.P.; Peirce-Sandner, S.; Burke, L.B.; Cowan, P.; Farrar, J.T.; Hertz, S.; Raja, S.N.; Rappaport, B.A.; et al. Interpreting the clinical importance of group di↵erences in chronic pain clinical trials: Immpact recommendations. Pain 2009, 146, 238–244. [CrossRef] 11. Arnold, L.M.; Cro↵ord, L.J.; Mease, P.J.; Burgess, S.M.; Palmer, S.C.; Abetz, L.; Martin, S.A. Patient perspectives on the impact of fibromyalgia. Patient Educ. Couns. 2008, 73, 114–120. [CrossRef] [PubMed] 12. Wolfe, F.; Hauser, W. Fibromyalgia diagnosis and diagnostic criteria. Ann. Med. 2011, 43, 495–502. [CrossRef] [PubMed] 13. Wolfe, F. New american college of rheumatology criteria for fibromyalgia: A twenty-year journey. Arthritis Care Res. 2010, 62, 583–584. [CrossRef] [PubMed] 14. Wolfe, F.; Clauw, D.J.; Fitzcharles, M.A.; Goldenberg, D.L.; Hauser, W.; Katz, R.S.; Mease, P.; Russell, A.S.; Russell, I.J.; Winfield, J.B. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the acr preliminary diagnostic criteria for fibromyalgia. J. Rheumatol. 2011, 38, 1113–1122. [CrossRef] 15. Oncu, J.; Iliser, R.; Kuran, B. Do new diagnostic criteria for fibromyalgia provide treatment opportunity to those previously untreated? J. Back Musculoskelet. Rehabil. 2013, 26, 437–443. [CrossRef] 16. Wolfe, F.; Walitt, B.; Rasker, J.J.; Hauser, W. Primary and secondary fibromyalgia are the same: The universality of polysymptomatic distress. J. Rheumatol. 2019, 46, 204–212. [CrossRef] 17. Bellato, E.; Marini, E.; Castoldi, F.; Barbasetti, N.; Mattei, L.; Bonasia, D.E.; Blonna, D. Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment. Pain Res. Treat. 2012, 2012, 426130. [CrossRef] 18. Bennett, R.M.; Friend, R.; Marcus, D.; Bernstein, C.; Han, B.K.; Yachoui, R.; Deodhar, A.; Kaell, A.; Bonafede, P.; Chino, A.; et al. Criteria for the diagnosis of fibromyalgia: Validation of the modified 2010 preliminary american college of rheumatology criteria and the development of alternative criteria. Arthritis Care Res. 2014, 66, 1364–1373. [CrossRef] 19. Aggarwal, R.; Ringold, S.; Khanna, D.; Neogi, T.; Johnson, S.R.; Miller, A.; Brunner, H.I.; Ogawa, R.; Felson, D.; Ogdie, A.; et al. Distinctions between diagnostic and classification criteria? Arthritis Care Res. 2015, 67, 891–897. [CrossRef] 20. Taylor, W.J.; Fransen, J. Distinctions between diagnostic and classification criteria: Comment on the article by Aggarwal et al. Arthritis Care Res. 2016, 68, 149–150. [CrossRef] 21. Wolfe, F.; Clauw, D.J.; Fitzcharles, M.A.; Goldenberg, D.L.; Hauser, W.; Katz, R.L.; Mease, P.J.; Russell, A.S.; Russell, I.J.; Walitt, B. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin. Arthritis Rheum. 2016, 46, 319–329. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 19 of 27 22. Bidari, A.; Parsa, B.G.; Ghalehbaghi, B. Challenges in fibromyalgia diagnosis: From meaning of symptoms to fibromyalgia labeling. Korean J. Pain 2018, 31, 147–154. [CrossRef] 23. Treede, R.D.; Rief, W.; Barke, A.; Aziz, Q.; Bennett, M.I.; Benoliel, R.; Cohen, M.; Evers, S.; Finnerup, N.B.; First, M.B.; et al. Chronic pain as a symptom or a disease: The IASP classification of chronic pain for the international classification of diseases (ICD-11). Pain 2019, 160, 19–27. [CrossRef] 24. Wolfe, F.; Schmukler, J.; Jamal, S.; Castrejon, I.; Gibson, K.A.; Srinivasan, S.; Hauser, W.; Pincus, T. Diagnosis of fibromyalgia: Disagreement between fibromyalgia criteria and clinician-based fibromyalgia diagnosis in a university clinic. Arthritis Care Res. 2019, 71, 343–351. [CrossRef] [PubMed] 25. Eich, W.; Bar, K.J.; Bernateck, M.; Burgmer, M.; Dexl, C.; Petzke, F.; Sommer, C.; Winkelmann, A.; Hauser, W. Definition, classification, clinical diagnosis and prognosis of fibromyalgia syndrome: Updated guidelines 2017 and overview of systematic review articles. Schmerz 2017, 31, 231–238. [CrossRef] [PubMed] 26. Ra↵aeli, W.; Malafoglia, V.; Bonci, A.; Tenti, M.; Ilari, S.; Gremigni, P.; Iannuccelli, C.; Gioia, C.; Di Franco, M.; Mollace, V.; et al. Identification of mor-positive b cell as possible innovative biomarker (mu lympho-marker) for chronic pain diagnosis in patients with fibromyalgia and osteoarthritis diseases. Int. J. Mol. Sci. 2020, 21, 15. [CrossRef] [PubMed] 27. Hackshaw, K.V.; Aykas, D.P.; Sigurdson, G.T.; Plans, M.; Madiai, F.; Yu, L.B.; Buffington, C.A.T.; Giusti, M.M.; Rodriguez-Saona, L. Metabolic fingerprinting for diagnosis of fibromyalgia and other rheumatologic disorders. J. Biol. Chem. 2019, 294, 2555–2568. [CrossRef] 28. Wolfe, F. Criteria for fibromyalgia? What is fibromyalgia? Limitations to current concepts of fibromyalgia and fibromyalgia criteria. Clin. Exp. Rheumatol. 2017, 35, S3–S5. 29. Walitt, B.; Nahin, R.L.; Katz, R.S.; Bergman, M.J.; Wolfe, F. The prevalence and characteristics of fibromyalgia in the 2012 national health interview survey. PLoS ONE 2015, 10, e0138024. [CrossRef] 30. Moore, R.A.; Straube, S.; Aldington, D. Pain measures and cut-o↵s—No worse than mild pain as a simple, universal outcome. Anaesthesia 2013, 68, 400–412. [CrossRef] 31. Espejo, J.A.; Garcia-Escudero, M.; Oltra, E. Unraveling the molecular determinants of manual therapy: An approach to integrative therapeutics for the treatment of fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis. Int. J. Mol. Sci. 2018, 19, 19. [CrossRef] [PubMed] 32. Calandre, E.P.; Rico-Villademoros, F.; Slim, M. An update on pharmacotherapy for the treatment of fibromyalgia. Expert Opin. Pharmacother. 2015, 16, 1347–1368. [CrossRef] [PubMed] 33. Thorpe, J.; Shum, B.; Moore, R.A.; Wi↵en, P.J.; Gilron, I. Combination pharmacotherapy for the treatment of fibromyalgia in adults. Cochrane Database Syst. Rev. 2018, 2. [CrossRef] [PubMed] 34. Mease, P.J.; Seymour, K. Fibromyalgia: Should the treatment paradigm be monotherapy or combination pharmacotherapy? Curr. Pain Headache Rep. 2008, 12, 399–405. [CrossRef] 35. Kwiatek, R. Treatment of fibromyalgia. Aust. Prescr. 2017, 40, 179–183. [CrossRef] 36. Wright, C.L.; Mist, S.D.; Ross, R.L.; Jones, K.D. Duloxetine for the treatment of fibromyalgia. Expert Rev. Clin. Immunol. 2010, 6, 745–756. [CrossRef] 37. Pacher, P.; Batkai, S.; Kunos, G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol. Rev. 2006, 58, 389–462. [CrossRef] 38. De Vries, M.; van Rijckevorsel, D.C.M.; Wilder-Smith, O.H.G.; van Goor, H. Dronabinol and chronic pain: Importance of mechanistic considerations. Expert Opin. Pharmacother. 2014, 15, 1525–1534. [CrossRef] 39. Russo, E.B. Clinical endocannabinoid deficiency (CECD)—Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocr. Lett. 2004, 25. (Reprinted from Neuroendocrinilogy, 2004, 25, 31–39). 40. Smith, S.C.; Wagner, M.S. Clinical endocannabinoid deficiency (CECD) revisited: Can this concept explain the therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocr. Lett. 2014, 35, 198–201. 41. Munro, S.; Thomas, K.L.; Abushaar, M. Molecular characterization of a peripheral receptor for cannabinoids. Nature 1993, 365, 61–65. [CrossRef] [PubMed] 42. Skrabek, R.Q.; Gallmova, L.; Ethans, K.; Perry, D. Nabilone for the treatment of pain in fibromyalgia. J. Pain 2008, 9, 164–173. [CrossRef] [PubMed] 43. Walitt, B.; Klose, P.; Fitzcharles, M.A.; Phillips, T.; Hauser, W. Cannabinoids for fibromyalgia. Cochrane Database Syst. Rev. 2016. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 20 of 27 44. Thomas, A.; Baillie, G.L.; Phillips, A.M.; Razdan, R.K.; Ross, R.A.; Pertwee, R.G. Cannabidiol displays unexpectedly high potency as an antagonist of cb1 and cb2 receptor agonists in vitro. Br. J. Pharmacol. 2007, 150, 613–623. [CrossRef] 45. Baumeister, D.; Eich, W.; Lerner, R.; Lutz, B.; Bindila, L.; Tesarz, J. Plasma parameters of the endocannabinoid system are unaltered in fibromyalgia. Psychother. Psychosom. 2018, 87, 377–379. [CrossRef] 46. Kaufmann, I.; Schelling, G.; Eisner, C.; Richter, H.P.; Krauseneck, T.; Vogeser, M.; Hauer, D.; Campolongo, P.; Chouker, A.; Beyer, A.; et al. Anandamide and neutrophil function in patients with fibromyalgia. Psychoneuroendocrinology 2008, 33, 676–685. [CrossRef] 47. Agarwal, N.; Pacher, P.; Tegeder, I.; Amaya, F.; Constantin, C.E.; Brenner, G.J.; Rubino, T.; Michalski, C.W.; Marsicano, G.; Monory, K.; et al. Cannabinoids mediate analgesia largely via peripheral type 1 cannabinoid receptors in nociceptors. Nat. Neurosci. 2007, 10, 870–879. [CrossRef] 48. Schley, M.; Legler, A.; Skopp, G.; Schmelz, M.; Konrad, C.; Rukwied, R. Delta-9-thc based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief. Curr. Med. Res. Opin. 2006, 22, 1269–1276. [CrossRef] 49. Fiz, J.; Duran, M.; Capella, D.; Carbonell, J.; Farre, M. Cannabis use in patients with fibromyalgia: E↵ect on symptoms relief and health-related quality of life. PLoS ONE 2011, 6, 5. [CrossRef] 50. Ware, M.A.; Fitzcharles, M.A.; Joseph, L.; Shir, Y. The e↵ects of nabilone on sleep in fibromyalgia: Results of a randomized controlled trial. Anesth. Analg. 2010, 110, 604–610. [CrossRef] 51. Fitzcharles, M.A.; Ste-Marie, P.A.; Goldenberg, D.L.; Pereira, J.X.; Abbey, S.; Choiniere, M.; Ko, G.; Moulin, D.E.; Panopalis, P.; Proulx, J.; et al. 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: Executive summary. Pain Res. Manag. 2013, 18, 119–126. [CrossRef] 52. Ste-Marie, P.A.; Fitzcharles, M.A.; Gamsa, A.; Ware, M.A.; Shir, Y. Association of herbal cannabis use with negative psychosocial parameters in patients with fibromyalgia. Arthritis Care Res. 2012, 64, 1202–1208. [CrossRef] [PubMed] 53. Painter, J.T.; Cro↵ord, L.J. Chronic opioid use in fibromyalgia syndrome a clinical review. JCR J. Clin. Rheumatol. 2013, 19, 72–77. [CrossRef] [PubMed] 54. Goldenberg, D.L.; Clauw, D.J.; Palmer, R.E.; Clair, A.G. Opioid use in fibromyalgia: A cautionary tale. Mayo Clin. Proc. 2016, 91, 640–648. [CrossRef] [PubMed] 55. Baraniuk, J.N.; Whalen, G.; Cunningham, J.; Clauw, D.J. Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain. BMC Musculoskelet. Disord. 2004, 5, 48. [CrossRef] 56. Fitzcharles, M.-A.; Faregh, N.; Ste-Marie, P.A.; Shir, Y. Opioid use in fibromyalgia is associated with negative health related measures in a prospective cohort study. Pain Res. Treat. 2013, 2013, 7. [CrossRef] 57. Peng, X.M.; Robinson, R.L.; Mease, P.; Kroenke, K.; Williams, D.A.; Chen, Y.; Faries, D.; Wohlreich, M.; McCarberg, B.; Hann, D. Long-term evaluation of opioid treatment in fibromyalgia. Clin. J. Pain 2015, 31, 7–13. [CrossRef] 58. Hwang, J.M.; Lee, B.J.; Oh, T.H.; Park, D.; Kim, C.H. Association between initial opioid use and response to a brief interdisciplinary treatment program in fibromyalgia. Medicine 2019, 98, 8. [CrossRef] 59. Harris, R.E.; Clauw, D.J.; Scott, D.J.; McLean, S.A.; Gracely, R.H.; Zubieta, J.K. Decreased central mu-opioid receptor availability in fibromyalgia. J. Neurosci. 2007, 27, 10000–10006. [CrossRef] 60. Bennett, R.M.; Jones, J.; Turk, D.C.; Russell, I.J.; Matallana, L. An internet survey of 2596 people with fibromyalgia. BMC Musculoskelet. Disord. 2007, 8, 27. 61. Hilliard, P.E.; Waljee, J.; Moser, S.; Metz, L.; Mathis, M.; Goesling, J.; Cron, D.; Clauw, D.J.; Englesbe, M.; Abecasis, G.; et al. Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgeryprevalence of preoperative opioid use and associated patient characteristicsprevalence of preoperative opioid use and associated patient characteristics. JAMA Surg. 2018, 153, 929–937. [PubMed] 62. Gaskell, H.; Moore, R.A.; Derry, S.; Stannard, C. Oxycodone for pain in fibromyalgia in adults. Cochrane Database Syst. Rev. 2016, 23. [CrossRef] 63. Ruette, P.; Stuyck, J.; Debeer, P. Neuropathic arthropathy of the shoulder and elbow associated with syringomyelia: A report of 3 cases. Acta Orthop. Belg. 2007, 73, 525–529. [PubMed] 64. Williams, E.R.; Ford, C.M.; Simonds, J.G.; Leal, A.K. Blocking peripheral opioid receptors with naloxone methiodide prevents acute and chronic training-induced analgesia in a rat model of fibromyalgia. FASEB J. 2017, 31, 1. Int. J. Mol. Sci. 2020, 21, 7877 21 of 27 65. Hermans, L.; Nijs, J.; Calders, P.; De Clerck, L.; Moorkens, G.; Hans, G.; Grosemans, S.; De Mettelinge, T.R.; Tuynman, J.; Meeus, M. Influence of morphine and naloxone on pain modulation in rheumatoid arthritis, chronic fatigue syndrome/fibromyalgia, and controls: A double-blind, randomized, placebo-controlled, cross-over study. Pain Pract. 2018, 18, 418–430. [CrossRef] 66. MacLean, A.J.B.; Schwartz, T.L. Tramadol for the treatment of fibromyalgia. Expert Rev. Neurother. 2015, 15, 469–475. [CrossRef] 67. Gur, A.; Calgan, N.; Nas, K.; Cevik, R.; Sarac, A.J. Low dose of tramadol in the treatment of fibromyalgia syndrome: A controlled clinical trial versus placebo. Ann. Rheum. Dis. 2006, 65, 556. 68. Mullican, W.S.; Lacy, J.R.; TRAMAP-ANAG-006 Study Group. Tramadol/acetaminophen combination tablets and codeine/acetaminophen combination capsules for the management of chronic pain: A comparative trial. Clin. Ther. 2001, 23, 1429–1445. [CrossRef] 69. Price, D.D.; Staud, R.; Robinson, M.E.; Mauderli, A.P.; Cannon, R.; Vierck, C.J. Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients. Pain 2002, 99, 49–59. [CrossRef] 70. Larabi, I.A.; Martin, M.; Fabresse, N.; Etting, I.; Edel, Y.; Pfau, G.; Alvarez, J.C. Hair testing for 3-fluorofentanyl, furanylfentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl and fentanyl by lc-ms/ms after unintentional overdose. Forensic Toxicol. 2020, 38, 277–286. [CrossRef] 71. Comer, S.D.; Cahill, C.M. Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment. Neurosci. Biobehav. Rev. 2019, 106, 49–57. [CrossRef] [PubMed] 72. Abeles, A.M.; Pillinger, M.H.; Solitar, B.M.; Abeles, M. Narrative review: The pathophysiology of fibromyalgia. Ann. Intern. Med. 2007, 146, 726–734. [CrossRef] 73. Watkins, L.R.; Maier, S.F. Immune regulation of central nervous system functions: From sickness responses to pathological pain. J. Intern. Med. 2005, 257, 139–155. [CrossRef] 74. Khalil, R.B. Pentoxifylline’s theoretical efficacy in the treatment of fibromyalgia syndrome. Pain Med. 2013, 14, 549–550. [CrossRef] 75. Polli, A.; Ghosh, M.; Bakusic, J.; Ickmans, K.; Monteyne, D.; Velkeniers, B.; Bekaert, B.; Godderis, L.; Nijs, J. DNA methylation and brain-derived neurotrophic factor expression account for symptoms and widespread hyperalgesia in patients with chronic fatigue syndrome and comorbid fibromyalgia. Arthritis Rheumatol. 2020. [CrossRef] 76. Scott, J.R.; Hassett, A.L.; Brummett, C.M.; Harris, R.E.; Clauw, D.J.; Harte, S.E. Ca↵eine as an opioid analgesic adjuvant in fibromyalgia. J. Pain Res. 2017, 10, 1801–1809. [CrossRef] [PubMed] 77. Goodman, C.W.; Brett, A.S. A clinical overview of o↵-label use of gabapentinoid drugs. JAMA Intern. Med. 2019, 179, 695–701. [CrossRef] 78. Micheva, K.D.; Buchanan, J.; Holz, R.W.; Smith, S.J. Retrograde regulation of synaptic vesicle endocytosis and recycling. Nat. Neurosci. 2003, 6, 925–932. [CrossRef] 79. Deitos, A.; Soldatelli, M.D.; Dussan-Sarria, J.A.; Souza, A.; Torres, I.L.D.; Fregni, F.; Caumo, W. Novel insights of e↵ects of pregabalin on neural mechanisms of intracortical disinhibition in physiopathology of fibromyalgia: An explanatory, randomized, double-blind crossover study. Front. Hum. Neurosci. 2018, 12, 14. [CrossRef] 80. Kiso, T.; Moriyama, A.; Furutani, M.; Matsuda, R.; Funatsu, Y. E↵ects of pregabalin and duloxetine on neurotransmitters in the dorsal horn of the spinal cord in a rat model of fibromyalgia. Eur. J. Pharmacol. 2018, 827, 117–124. [CrossRef] 81. Gerardi, M.C.; Atzeni, F.; Batticciotto, A.; Di Franco, M.; Rizzi, M.; Sarzi-Puttini, P. The safety of pregabalin in the treatment of fibromyalgia. Expert Opin. Drug Saf. 2016, 15, 1541–1548. [CrossRef] [PubMed] 82. Hirakata, M.; Yoshida, S.; Tanaka-Mizuno, S.; Kuwauchi, A.; Kawakami, K. Pregabalin prescription for neuropathic pain and fibromyalgia: A descriptive study using administrative database in Japan. Pain Res. Manag. 2018, 10. [CrossRef] [PubMed] 83. Asomaning, K.; Abramsky, S.; Liu, Q.; Zhou, X.; Sobel, R.E.; Watt, S. Pregabalin prescriptions in the United Kingdom: A drug utilisation study of the health improvement network (thin) primary care database. Int J. Clin. Pr. 2016, 70, 380–388. [CrossRef] 84. Ferreira-Dos-Santos, G.; Sousa, D.C.; Costa, J.; Vaz-Carneiro, A. Analysis of the cochrane review: Pregabalin for pain in fibromyalgia in adults. Cochrane database syst rev. 2016; 9: Cd011790 and 2016; 4: Cd009002. Acta Med. Port. 2018, 31, 376–381. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 22 of 27 85. Bhusal, S.; Diomampo, S.; Magrey, M.N. Clinical utility, safety, and efficacy of pregabalin in the treatment of fibromyalgia. Drug Healthc. Patient Saf. 2016, 8, 13–23. [CrossRef] 86. Arnold, L.M.; Choy, E.; Clauw, D.J.; Oka, H.; Whalen, E.; Semel, D.; Pauer, L.; Knapp, L. An evidence-based review of pregabalin for the treatment of fibromyalgia. Curr. Med. Res. Opin. 2018, 34, 1397–1409. [CrossRef] [PubMed] 87. Cooper, T.E.; Derry, S.; Wi↵en, P.J.; Moore, R.A. Gabapentin for fibromyalgia pain in adults. Cochrane Database Syst. Rev. 2017. [CrossRef] [PubMed] 88. Walitt, B.; Urrutia, G.; Nishishinya, M.B.; Cantrell, S.E.; Hauser, W. Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database Syst. Rev. 2015, 66. [CrossRef] 89. Welsch, P.; Uceyler, N.; Klose, P.; Walitt, B.; Hauser, W. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst. Rev. 2018, 111. [CrossRef] 90. Grubisic, F. Are serotonin and noradrenaline reuptake inhibitors e↵ective, tolerable, and safe for adults with fibromyalgia? A cochrane review summary with commentary. J. Musculoskelet. Neuronal. Interact. 2018, 18, 404–406. 91. VanderWeide, L.A.; Smith, S.M.; Trinkley, K.E. A systematic review of the efficacy of venlafaxine for the treatment of fibromyalgia. J. Clin. Pharm. Ther. 2015, 40, 1–6. [CrossRef] [PubMed] 92. Miki, K.; Murakami, M.; Oka, H.; Onozawa, K.; Yoshida, S.; Osada, K. Efficacy of mirtazapine for the treatment of fibromyalgia without concomitant depression: A randomized, double-blind, placebo-controlled phase IIa study in Japan. Pain 2016, 157, 2089–2096. [CrossRef] 93. Deboer, T. The pharmacologic profile of mirtazapine. J. Clin. Psychiatry 1996, 57, 19–25. 94. Ottman, A.A.; Warner, C.B.; Brown, J.N. The role of mirtazapine in patients with fibromyalgia: A systematic review. Rheumatol. Int. 2018, 38, 2217–2224. [CrossRef] [PubMed] 95. Rico-Villademoros, F.; Slim, M.; Calandre, E.P. Amitriptyline for the treatment of fibromyalgia: A comprehensive review. Expert Rev. Neurother. 2015, 15, 1123–1150. [CrossRef] 96. Moore, R.A.; Derry, S.; Aldington, D.; Cole, P.; Wi↵en, P.J. Amitriptyline for fibromyalgia in adults. Cochrane Database Syst. Rev. 2015. [CrossRef] 97. De Tommaso, M.; Delussi, M.; Ricci, K.; D’Angelo, G. Abdominal acupuncture changes cortical responses to nociceptive stimuli in fibromyalgia patients. CNS Neurosci. Ther. 2014, 20, 565–567. [CrossRef] 98. Karatay, S.; Okur, S.C.; Uzkeser, H.; Yildirim, K.; Akcay, F. E↵ects of acupuncture treatment on fibromyalgia symptoms, serotonin, and substance p levels: A randomized sham and placebo-controlled clinical trial. Pain Med. 2018, 19, 615–628. [CrossRef] 99. Deare, J.C.; Zheng, Z.; Xue, C.C.L.; Liu, J.P.; Shang, J.S.; Scott, S.W.; Littlejohn, G. Acupuncture for treating fibromyalgia. Cochrane Database Syst. Rev. 2013. [CrossRef] 100. Cao, H.J.; Li, X.; Han, M.; Liu, J.P. Acupoint stimulation for fibromyalgia: A systematic review of randomized controlled trials. Evid. Based Complementary Altern. Med. 2013, 2013, 1–15. [CrossRef] 101. Zhang, X.C.; Chen, H.; Xu, W.T.; Song, Y.Y.; Gu, Y.H.; Ni, G.X. Acupuncture therapy for fibromyalgia: A systematic review and meta-analysis of randomized controlled trials. J. Pain Res. 2019, 12, 527–542. [CrossRef] [PubMed] 102. Tesio, V.; Torta, D.M.E.; Colonna, F.; Leombruni, P.; Ghiggia, A.; Fusaro, E.; Geminiani, G.C.; Torta, R.; Castelli, L. Are fibromyalgia patients cognitively impaired? Objective and subjective neuropsychological evidence. Arthritis Care Res. 2015, 67, 143–150. [CrossRef] [PubMed] 103. Gelonch, O.; Garolera, M.; Valls, J.; Rossello, L.; Pifarre, J. Executive function in fibromyalgia: Comparing subjective and objective measures. Compr. Psychiatry 2016, 66, 113–122. [CrossRef] [PubMed] 104. Zhu, C.E.; Yu, B.; Zhang, W.; Chen, W.H.; Qi, Q.; Miao, Y. E↵ectiveness and safety of transcranial direct current stimulation in fibromyalgia: A systematic review and meta-analysis. J. Rehabil. Med. 2017, 49, 2–9. [CrossRef] 105. Brighina, F.; Curatolo, M.; Cosentino, G.; De Tommaso, M.; Battaglia, G.; Sarzi-Puttini, P.C.; Guggino, G.; Fierro, B. Brain modulation by electric currents in fibromyalgia: A structured review on non-invasive approach with transcranial electrical stimulation. Front. Hum. Neurosci. 2019, 13, 14. [CrossRef] 106. Dos Santos, V.S.; Zortea, M.; Alves, R.L.; Naziazeno, C.C.D.; Saldanha, J.S.; de Carvalho, S.D.R.; Leite, A.J.D.; Torres, I.L.D.; de Souza, A.; Calvetti, P.U.; et al. Cognitive e↵ects of transcranial direct current stimulation combined with working memory training in fibromyalgia: A randomized clinical trial. Sci Rep. 2018, 8, 11. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 23 of 27 107. Eken, A.; Kara, M.; Baskak, B.; Baltaci, A.; Gokcay, D. Di↵erential efficiency of transcutaneous electrical nerve stimulation in dominant versus nondominant hands in fibromyalgia: Placebo-controlled functional near-infrared spectroscopy study. Neurophotonics 2018, 5, 15. [CrossRef] 108. Yuksel, M.; Ayas, S.; Cabioglu, M.T.; Yilmaz, D.; Cabioglu, C. Quantitative data for transcutaneous electrical nerve stimulation and acupuncture e↵ectiveness in treatment of fibromyalgia syndrome. Evid. Based Complementary Altern. Med. 2019, 12, 362831. [CrossRef] 109. Ahmed, S.; Plazier, M.; Ost, J.; Stassijns, G.; Deleye, S.; Ceyssens, S.; Dupont, P.; Stroobants, S.; Staelens, S.; De Ridder, D.; et al. The e↵ect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: A water pet and EEG imaging study. BMC Neurol. 2018, 18, 10. [CrossRef] 110. Sutbeyaz, S.T.; Sezer, N.; Koseoglu, F.; Kibar, S. Low-frequency pulsed electromagnetic field therapy in fibromyalgia a randomized, double-blind, sham-controlled clinical study. Clin. J. Pain 2009, 25, 722–728. [CrossRef] 111. Multanen, J.; Hakkinen, A.; Heikkinen, P.; Kautiainen, H.; Mustalampi, S.; Ylinen, J. Pulsed electromagnetic field therapy in the treatment of pain and other symptoms in fibromyalgia: A randomized controlled study. Bioelectromagnetics 2018, 39, 405–413. [CrossRef] 112. Cruccu, G.; Garcia-Larrea, L.; Hansson, P.; Keindl, M.; Lefaucheur, J.P.; Paulus, W.; Taylor, R.; Tronnier, V.; Truini, A.; Attal, N. Ean guidelines on central neurostimulation therapy in chronic pain conditions. Eur. J. Neurol. 2016, 23, 1489–1499. [CrossRef] 113. Knijnik, L.M.; Dussan-Sarria, J.A.; Rozisky, J.R.; Torres, I.L.S.; Brunoni, A.R.; Fregni, F.; Caumo, W. Repetitive transcranial magnetic stimulation for fibromyalgia: Systematic review and meta-analysis. Pain Pract. 2016, 16, 294–304. [CrossRef] 114. Thut, G.; Schyns, P.G.; Gross, J. Entrainment of perceptually relevant brain oscillations by non-invasive rhythmic stimulation of the human brain. Front. Psychol. 2011, 2, 170. [CrossRef] 115. Weber, A.; Werneck, L.; Paiva, E.; Gans, P. E↵ects of music in combination with vibration in acupuncture points on the treatment of fibromyalgia. J. Altern. Complement. Med. 2015, 21, 77–82. [CrossRef] 116. Chesky, K.S.; Russell, I.J.; Lopez, Y.; Kondraske, G.V. Fibromyalgia tender point pain: A double-blind, placebo-controlled pilot study of music vibration using the music vibration table. J. Musculoskelet. Pain 1997, 5, 33–52. [CrossRef] 117. Naghdi, L.; Ahonen, H.; Macario, P.; Bartel, L. The e↵ect of low-frequency sound stimulation on patients with fibromyalgia: A clinical study. Pain Res. Manag. 2015, 20, E21–E27. [CrossRef] [PubMed] 118. Janzen, T.B.; Paneduro, D.; Picard, L.; Gordon, A.; Bartel, L.R. A parallel randomized controlled trial examining the e↵ects of rhythmic sensory stimulation on fibromyalgia symptoms. PLoS ONE 2019, 14, 19. [CrossRef] [PubMed] 119. Ablin, J.N.; Hauser, W.; Buskila, D. Spa Treatment (Balneotherapy) for Fibromyalgia—A Qualitative-Narrative Review and a Historical Perspective. Evid. Based Complementary Altern. Med. 2013, 2013, 638050. [CrossRef] [PubMed] 120. Neumann, L.; Sukenik, S.; Bolotin, A.; Abu-Shakra, M.; Amir, A.; Flusser, D.; Buskila, D. The e↵ect of balneotherapy at the dead sea on the quality of life of patients with fibromyalgia syndrome. Clin. Rheumatol. 2001, 20, 15–19. [CrossRef] 121. Mist, S.D.; Firestone, K.A.; Jones, K.D. Complementary and alternative exercise for fibromyalgia: A meta-analysis. J. Pain Res. 2013, 6, 247–260. [CrossRef] 122. Fioravanti, A.; Perpignano, G.; Tirri, G.; Cardinale, G.; Gianniti, C.; Lanza, C.E.; Loi, A.; Tirri, E.; Sfriso, P.; Cozzi, F. E↵ects of mud-bath treatment on fibromyalgia patients: A randomized clinical trial. Rheumatol. Int. 2007, 27, 1157–1161. [CrossRef] 123. Maeda, T.; Kudo, Y.; Horiuchi, T.; Makino, N. Clinical and anti-aging e↵ect of mud-bathing therapy for patients with fibromyalgia. Mol. Cell. Biochem. 2018, 444, 87–92. [CrossRef] 124. Guidelli, G.M.; Tenti, S.; De Nobili, E.; Fioravanti, A. Fibromyalgia syndrome and spa therapy: Myth or reality? Clin. Med. Insights Arthritis Musculoskelet. Disord. 2012, 5, 19–26. [CrossRef] 125. Ernst, E.; Fialka, V. Ice freezes pain—A review of the clinical e↵ectiveness of analgesic cold therapy. J. Pain Symptom Manag. 1994, 9, 56–59. [CrossRef] 126. Rivera, J.; Tercero, M.J.; Salas, J.S.; Gimeno, J.H.; Alejo, J.S. The e↵ect of cryotherapy on fibromyalgia: A randomised clinical trial carried out in a cryosauna cabin. Rheumatol. Int. 2018, 38, 2243–2250. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 24 of 27 127. Bettoni, L.; Bonomi, F.G.; Zani, V.; Manisco, L.; Indelicato, A.; Lanteri, P.; Banfi, G.; Lombardi, G. E↵ects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients. Clin. Rheumatol. 2013, 32, 1337–1345. [CrossRef] 128. Sutherland, A.M.; Clarke, H.A.; Katz, J.; Katznelson, R. Hyperbaric oxygen therapy: A new treatment for chronic pain? Pain Pract. 2016, 16, 620–628. [CrossRef] 129. Bennett, M.H.; French, C.; Schnabel, A.; Wasiak, J.; Kranke, P.; Weibel, S. Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache. Cochrane Database Syst. Rev. 2015. [CrossRef] 130. Yildiz, S.; Kiralp, M.Z.; Akin, A.; Keskin, I.; Ay, H.; Dursun, H.; Cimsit, M. A new treatment modality for fibromyalgia syndrome: Hyperbaric oxygen therapy. J. Int. Med Res. 2004, 32, 263–267. [CrossRef] [PubMed] 131. Boussi-Gross, R.; Golan, H.; Fishlev, G.; Bechor, Y.; Volkov, O.; Bergan, J.; Friedman, M.; Hoofien, D.; Shlamkovitch, N.; Ben-Jacob, E.; et al. Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury—Randomized prospective trial. PLoS ONE 2013, 8, e79995. [CrossRef] [PubMed] 132. Efrati, S.; Golan, H.; Bechor, Y.; Faran, Y.; Daphna-Tekoah, S.; Sekler, G.; Fishlev, G.; Ablin, J.N.; Bergan, J.; Volkov, O.; et al. Hyperbaric oxygen therapy can diminish fibromyalgia syndrome—Prospective clinical trial. PLoS ONE 2015, 10, e0127012. [CrossRef] [PubMed] 133. El-Shewy, K.M.; Kunbaz, A.; Gad, M.M.; Al-Husseini, M.J.; Saad, A.M.; Sammour, Y.M.; Abdel-Daim, M.M. Hyperbaric oxygen and aerobic exercise in the long-term treatment of fibromyalgia: A narrative review. Biomed. Pharmacother. 2019, 109, 629–638. [CrossRef] [PubMed] 134. Kisselev, S.B.; Moskvin, S.V. The use of laser therapy for patients with fibromyalgia: A critical literary review. J. Lasers Med. Sci. 2019, 10, 12–20. [CrossRef] 135. White, P.F.; Zafereo, J.; Elvir-Lazo, O.L.; Hernandez, H. Treatment of drug-resistant fibromyalgia symptoms using high-intensity laser therapy: A case-based review. Rheumatol. Int. 2018, 38, 517–523. [CrossRef] 136. Gur, A.; Karakoc, M.; Nas, K.; Cevik, R.; Sarac, A.J.; Ataoglu, S. E↵ects of low power laser and low dose amitriptyline therapy on clinical symptoms and quality of life in fibromyalgia: A single-blind, placebo-controlled trial. Rheumatol. Int. 2002, 22, 188–193. 137. Panton, L.; Simonavice, E.; Williams, K.; Mojock, C.; Kim, J.S.; Kingsley, J.D.; McMillan, V.; Mathis, R. E↵ects of class IV laser therapy on fibromyalgia impact and function in women with fibromyalgia. J. Altern. Complement. Med. 2013, 19, 445–452. [CrossRef] 138. Ruaro, J.A.; Frez, A.R.; Ruaro, M.B.; Nicolau, R.A. Low-level laser therapy to treat fibromyalgia. Lasers Med. Sci. 2014, 29, 1815–1819. [CrossRef] 139. Da Silva, M.M.; Albertini, R.; Leal, E.C.P.; de Carvalho, P.D.C.; Silva, J.A.; Bussadori, S.K.; de Oliveira, L.V.F.; Casarin, C.A.S.; Andrade, E.L.; Bocalini, D.S.; et al. E↵ects of exercise training and photobiomodulation therapy (extraphoto) on pain in women with fibromyalgia and temporomandibular disorder: Study protocol for a randomized controlled trial. Trials 2015, 16, 8. [CrossRef] 140. Busch, A.J.; Webber, S.C.; Brachaniec, M.; Bidonde, J.; Dal Bello-Haas, V.; Danyliw, A.D.; Overend, T.J.; Richards, R.S.; Sawant, A.; Schachter, C.L. Exercise therapy for fibromyalgia. Curr. Pain Headache Rep. 2011, 15, 358–367. [CrossRef] 141. Jones, K.D.; Adams, D.; Winters-Stone, K.; Burckhardt, C.S. A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988–2005). Health Qual. Life Outcomes 2006, 4, 67. [CrossRef] [PubMed] 142. Bidonde, J.; Busch, A.J.; Schachter, C.L.; Webber, S.C.; Musselman, K.E.; Overend, T.J.; Goes, S.M.; Dal Bello-Haas, V.; Boden, C. Mixed exercise training for adults with fibromyalgia. Cochrane Database Syst. Rev. 2019, 208. [CrossRef] 143. Assumpção, A.; Matsutani, L.A.; Yuan, S.L.; Santo, A.S.; Sauer, J.; Mango, P.; Marques, A.P. Muscle stretching exercises and resistance training in fibromyalgia: Which is better? A three-arm randomized controlled trial. Eur. J. Phys. Rehabil. Med. 2018, 54, 663–670. [CrossRef] 144. Nelson, N.L. Muscle strengthening activities and fibromyalgia: A review of pain and strength outcomes. J. Bodyw. Mov. Ther. 2015, 19, 370–376. [CrossRef] 145. Sanudo, B.; Galiano, D.; Carrasco, L.; Blagojevic, M.; de Hoyo, M.; Saxton, J. Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: A randomized controlled trial. Arch. Phys. Med. Rehabil. 2010, 91, 1838–1843. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 25 of 27 146. Umeda, M.; Corbin, L.W.; Maluf, K.S. Pain mediates the association between physical activity and the impact of fibromyalgia on daily function. Clin. Rheumatol. 2015, 34, 143–149. [CrossRef] [PubMed] 147. Bement, M.K.H.; Weyer, A.; Hartley, S.; Drewek, B.; Harkins, A.L.; Hunter, S.K. Pain perception after isometric exercise in women with fibromyalgia. Arch. Phys. Med. Rehabil. 2011, 92, 89–95. [CrossRef] 148. Carson, J.W.; Carson, K.M.; Jones, K.D.; Bennett, R.M.; Wright, C.L.; Mist, S.D. A pilot randomized controlled trial of the yoga of awareness program in the management of fibromyalgia. Pain 2010, 151, 530–539. [CrossRef] 149. De Oliveira, F.R.; Goncalves, L.C.V.; Borghi, F.; da Silva, L.; Gomes, A.E.; Trevisan, G.; de Souza, A.L.; Grassi-Kassisse, D.M.; Crege, D. Massage therapy in cortisol circadian rhythm, pain intensity, perceived stress index and quality of life of fibromyalgia syndrome patients. Complement. Ther. Clin. Pract. 2018, 30, 85–90. [CrossRef] 150. Tomas-Carus, P.; Hakkinen, A.; Gusi, N.; Leal, A.; Hakkinen, K.; Ortega-Alonso, A. Aquatic training and detraining on fitness and quality of life in fibromyalgia. Med. Sci. Sports Exerc. 2007, 39, 1044–1050. [CrossRef] 151. Gusi, N.; Tomas-Carus, P. Cost-utility of an 8-month aquatic training for women with fibromyalgia: A randomized controlled trial. Arthritis Res. Ther. 2008, 10, 8. [CrossRef] [PubMed] 152. Andrade, C.P.; Zamuner, A.R.; Forti, M.; Franca, T.F.; Tamburus, N.Y.; Silva, E. Oxygen uptake and body composition after aquatic physical training in women with fibromyalgia: A randomized controlled trial. Eur. J. Phys. Rehabil. Med. 2017, 53, 751–758. 153. Bidonde, J.; Busch, A.J.; Schachter, C.L.; Overend, T.J.; Kim, S.Y.; Goes, S.; Boden, C.; Foulds, H.J.A. Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst. Rev. 2017. [CrossRef] 154. Bidonde, J.; Busch, A.J.; Webber, S.C.; Schachter, C.L.; Danyliw, A.; Overend, T.J.; Richards, R.S.; Rader, T. Aquatic exercise training for fibromyalgia. Cochrane Database Syst. Rev. 2014, 177. [CrossRef] [PubMed] 155. Marske, C.; Bernard, N.; Palacios, A.; Wheeler, C.; Preiss, B.; Brown, M.; Bhattacharya, S.; Klapstein, G. Fibromyalgia with gabapentin and osteopathic manipulative medicine: A pilot study. J. Altern. Complement. Med. 2018, 24, 395–402. [CrossRef] [PubMed] 156. Baptista, A.S.; Villela, A.L.; Jones, A.; Natour, J. E↵ectiveness of dance in patients with fibromyalgia: A randomised, single-blind, controlled study. Clin. Exp. Rheumatol. 2012, 30, S18–S23. 157. Assunção, J.C.; Silva, H.J.D.; da Silva, J.F.C.; Cruz, R.D.; Lins, C.A.D.; de Souza, M.C. Zumba dancing can improve the pain and functional capacity in women with fibromyalgia. J. Bodyw. Mov. Ther. 2018, 22, 455–459. [CrossRef] 158. Wang, C.C.; Schmid, C.H.; Fielding, R.A.; Harvey, W.F.; Reid, K.F.; Price, L.L.; Driban, J.B.; Kalish, R.; Rones, R.; McAlindon, T. E↵ect of tai chi versus aerobic exercise for fibromyalgia: Comparative e↵ectiveness randomized controlled trial. BMJ Br. Med J. 2018, 360, 14. [CrossRef] 159. Cryan, J.F.; Dinan, T.G. Mind-altering microorganisms: The impact of the gut microbiota on brain and behaviour. Nat. Rev. Neurosci. 2012, 13, 701–712. [CrossRef] 160. Galland, L. The gut microbiome and the brain. J. Med. Food 2014, 17, 1261–1272. [CrossRef] 161. Goebel, A.; Buhner, S.; Schedel, R.; Lochs, H.; Sprotte, G. Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome. Rheumatology 2008, 47, 1223–1227. [CrossRef] 162. Mayer, E.A.; Tillisch, K.; Gupta, A. Gut/brain axis and the microbiota. J. Clin. Investig. 2015, 125, 926–938. [CrossRef] 163. Roman, P.; Estevez, A.F.; Mires, A.; Sanchez-Labraca, N.; Canadas, F.; Vivas, A.B.; Cardona, D. A pilot randomized controlled trial to explore cognitive and emotional e↵ects of probiotics in fibromyalgia. Sci Rep. 2018, 8, 9. [CrossRef] [PubMed] 164. Butler, D. Translational research: Crossing the valley of death. Nature 2008, 453, 840–842. [CrossRef] 165. Nascimento, S.D.; DeSantana, J.M.; Nampo, F.K.; Ribeiro, E.A.N.; da Silva, D.L.; Araujo, J.X.; Almeida, J.; Bonjardim, L.R.; Araujo, A.A.D.; Quintans, L.J. Efficacy and safety of medicinal plants or related natural products for fibromyalgia: A systematic review. Evid. Based Complementary Altern. Med. 2013. [CrossRef] [PubMed] 166. Brownstein, M.J. A brief-history of opiates, opioid-peptides, and opioid receptors. Proc. Natl. Acad. Sci. USA 1993, 90, 5391–5393. [CrossRef] 167. Benyhe, S. Morphine—New aspects in the study of an ancient compound. Life Sci. 1994, 55, 969–979. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 26 of 27 168. Meng, I.D.; Manning, B.H.; Martin, W.J.; Fields, H.L. An analgesia circuit activated by cannabinoids. Nature 1998, 395, 381–383. [CrossRef] 169. Sagy, I.; Schleider, L.B.L.; Abu-Shakra, M.; Novack, V. Safety and efficacy of medical cannabis in fibromyalgia. J. Clin. Med. 2019, 8, 12. [CrossRef] 170. Van de Donk, T.; Niesters, M.; Kowal, M.A.; Olofsen, E.; Dahan, A.; van Velzen, M. An experimental randomized study on the analgesic e↵ects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain 2019, 160, 860–869. [CrossRef] 171. Habib, G.; Artul, S. Medical cannabis for the treatment of fibromyalgia. JCR J. Clin. Rheumatol. 2018, 24, 255–258. [CrossRef] [PubMed] 172. Habib, G.; Avisar, I. The consumption of cannabis by fibromyalgia patients in Israel. Pain Res. Treat. 2018, 5, 7829427. [CrossRef] 173. Ma↵ei, M.E. Plant natural sources of the endocannabinoid (e)- -caryophyllene: A systematic quantitative analysis of published literature. Int. J. Mol. Sci. 2020, 21, 6540. [CrossRef] [PubMed] 174. Paula-Freire, L.I.G.; Andersen, M.L.; Gama, V.S.; Molska, G.R.; Carlini, E.L.A. The oral administration of trans-caryophyllene attenuates acute and chronic pain in mice. Phytomedicine 2014, 21, 356–362. [CrossRef] [PubMed] 175. Gertsch, J.; Leonti, M.; Raduner, S.; Racz, I.; Chen, J.Z.; Xie, X.Q.; Altmann, K.H.; Karsak, M.; Zimmer, A. Beta-caryophyllene is a dietary cannabinoid. Proc. Natl. Acad. Sci. USA 2008, 105, 9099–9104. [CrossRef] 176. Oliveira, G.L.D.; Machado, K.C.; Machado, K.C.; da Silva, A.; Feitosa, C.M.; Almeida, F.R.D. Non-clinical toxicity of beta-caryophyllene, a dietary cannabinoid: Absence of adverse e↵ects in female swiss mice. Regul. Toxicol. Pharmacol. 2018, 92, 338–346. [CrossRef] 177. Quintans, L.J.; Araujo, A.A.S.; Brito, R.G.; Santos, P.L.; Quintans, J.S.S.; Menezes, P.P.; Serafini, M.R.; Silva, G.F.; Carvalho, F.M.S.; Brogden, N.K.; et al. Beta-caryophyllene, a dietary cannabinoid, complexed with beta-cyclodextrin produced anti-hyperalgesic e↵ect involving the inhibition of Fos expression in superficial dorsal horn. Life Sci. 2016, 149, 34–41. [CrossRef] 178. Ibrahim, M.M.; Porreca, F.; Lai, J.; Albrecht, P.J.; Rice, F.L.; Khodorova, A.; Davar, G.; Makriyannis, A.; Vanderah, T.W.; Mata, H.P.; et al. Cb2 cannabinoid receptor activation produces antinociception by stimulating peripheral release of endogenous opioids. Proc. Natl. Acad. Sci. USA 2005, 102, 3093–3098. [CrossRef] 179. Fidyt, K.; Fiedorowicz, A.; Strzadala, L.; Szumny, A. Beta-caryophyllene and beta-caryophyllene oxide-natural compounds of anticancer and analgesic properties. Cancer Med. 2016, 5, 3007–3017. [CrossRef] 180. Klauke, A.L.; Racz, I.; Pradier, B.; Markert, A.; Zimmer, A.M.; Gertsch, J.; Zimmer, A. The cannabinoid cb2 receptor-selective phytocannabinoid beta-caryophyllene exerts analgesic e↵ects in mouse models of inflammatory and neuropathic pain. Eur. Neuropsychopharmacol. 2014, 24, 608–620. [CrossRef] 181. Melo, A.J.D.; Heimarth, L.; Carvalho, A.M.D.; Quintans, J.D.S.; Serafini, M.R.; Araujo, A.A.D.; Alves, P.B.; Ribeiro, A.M.; Shanmugam, S.; Quintans, L.J.; et al. Eplingiella fruticosa (Lamiaceae) Essential Oil Complexed with Beta-Cyclodextrin Improves Its Anti-Hyperalgesic E↵ect in a Chronic Widespread Non-Inflammatory Muscle Pain Animal Model. Food Chem. Toxicol. 2020, 135, 7. 182. Dolara, P.; Luceri, C.; Ghelardini, C.; Monserrat, C.; Aiolli, S.; Luceri, F.; Lodovici, M.; Menichetti, S.; Romanelli, M.N. Analgesic e↵ects of myrrh. Nature 1996, 379, 29. [CrossRef] [PubMed] 183. Borchardt, J.K. Myrrh: An analgesic with a 4000-year history. Drug News Perspect. 1996, 9, 554–557. 184. Su, S.L.; Hua, Y.Q.; Wang, Y.Y.; Gu, W.; Zhou, W.; Duan, J.A.; Jiang, H.F.; Chen, T.; Tang, Y.P. Evaluation of the anti-inflammatory and analgesic properties of individual and combined extracts from Commiphora myrrha, and Boswellia carterii. J. Ethnopharmacol. 2012, 139, 649–656. [CrossRef] 185. Lee, D.; Ju, M.K.; Kim, H. Commiphora extract mixture ameliorates monosodium iodoacetate-induced osteoarthritis. Nutrients 2020, 12, 17. [CrossRef] 186. Germano, A.; Occhipinti, A.; Barbero, F.; Ma↵ei, M.E. A pilot study on bioactive constituents and analgesic e↵ects of myrliq® , a Commiphora myrrha extract with a high furanodiene content. Biomed. Res. Int 2017, 2017, 3804356. [CrossRef] 187. Galeotti, N. Hypericum perforatum (St John’s Wort) beyond Depression: A Therapeutic Perspective for Pain Conditions. J. Ethnopharmacol. 2017, 200, 136–146. [CrossRef] 188. Khan, H.; Pervaiz, A.; Intagliata, S.; Das, N.; Venkata, K.C.N.; Atanasov, A.G.; Najda, A.; Nabavi, S.M.; Wang, D.D.; Pittala, V.; et al. The analgesic potential of glycosides derived from medicinal plants. DARU 2020, 28, 387–401. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 27 of 27 189. Wang, R.Y.; Qiu, Z.; Wang, G.Z.; Hu, Q.; Shi, N.H.; Zhang, Z.Q.; Wu, Y.Q.; Zhou, C.H. Quercetin attenuates diabetic neuropathic pain by inhibiting mtor/p70s6k pathway-mediated changes of synaptic morphology and synaptic protein levels in spinal dorsal horn of db/db mice. Eur. J. Pharmacol. 2020, 882, 7. [CrossRef] 190. Carvalho, T.T.; Mizokami, S.S.; Ferraz, C.R.; Manchope, M.F.; Borghi, S.M.; Fattori, V.; Calixto-Campos, C.; Camilios-Neto, D.; Casagrande, R.; Verri, W.A. The granulopoietic cytokine granulocyte colony-stimulating factor (G-CSF) induces pain: Analgesia by rutin. Inflammopharmacology 2019, 27, 1285–1296. [CrossRef] 191. Xiao, X.; Wang, X.Y.; Gui, X.; Chen, L.; Huang, B.K. Natural flavonoids as promising analgesic candidates: A systematic review. Chem. Biodivers. 2016, 13, 1427–1440. [CrossRef] 192. Yao, X.L.; Li, L.; Kandhare, A.D.; Mukherjee-Kandhare, A.A.; Bodhankar, S.L. Attenuation of reserpine-induced fibromyalgia via ros and serotonergic pathway modulation by fisetin, a plant flavonoid polyphenol. Exp. Ther. Med. 2020, 19, 1343–1355. [CrossRef] 193. Shakiba, M.; Moazen-Zadeh, E.; Noorbala, A.A.; Jafarinia, M.; Divsalar, P.; Kashani, L.; Shahmansouri, N.; Tafakhori, A.; Bayat, H.; Akhondzadeh, S. Sa↵ron (Crocus sativus) versus duloxetine for treatment of patients with fibromyalgia: A randomized double-blind clinical trial. Avicenna J. Phytomedicine 2018, 8, 513–523. 194. McCarberg, B.H. Clinical overview of fibromyalgia. Am. J. Ther. 2012, 19, 357–368. [CrossRef] [PubMed] Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. © 2020 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
|
When responding, restrict yourself to only information found within the given article - no other information is valid or necessary. What are the current therapy practices to treat fibromyalgia according to the document? International Journal of Molecular Sciences Review Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies Massimo E. Ma↵ei Department of Life Sciences and Systems Biology, University of Turin, 10135 Turin, Italy; massimo.ma↵[email protected]; Tel.: +39-011-670-5967 !"#!$%&'(! Received: 6 October 2020; Accepted: 22 October 2020; Published: 23 October 2020 !"#$%&' Abstract: Fibromyalgia (FM) is a syndrome that does not present a well-defined underlying organic disease. FM is a condition which has been associated with diseases such as infections, diabetes, psychiatric or neurological disorders, rheumatic pathologies, and is a disorder that rather than diagnosis of exclusion requires positive diagnosis. A multidimensional approach is required for the management of FM, including pain management, pharmacological therapies, behavioral therapy, patient education, and exercise. The purpose of this review is to summarize the recent advances in classification criteria and diagnostic criteria for FM as well as to explore pharmacotherapy and the use of alternative therapies including the use of plant bioactive molecules. Keywords: fibromyalgia; diagnosis; pharmacotherapy; alternative therapies; plant extracts; natural products 1. Introduction Fibromyalgia (FM) (earlier considered to be fibrositis, to stress the role of peripheral inflammation in the pathogenesis) is a syndrome that does not present a well-defined underlying organic disease. The primary driver of FM is sensitization, which includes central sensitivity syndromes generally referred to joint sti↵ness, chronic pain at multiple tender points, and systemic symptoms including cognitive dysfunction, sleep disturbances, anxiety, fatigue, and depressive episodes [1,2]. FM is a heterogeneous condition that is often associated to specific diseases such as infections, psychiatric or neurological disorders, diabetes and rheumatic pathologies. FM is more frequent in females, where it causes musculoskeletal pain [3] and a↵ects significantly the quality of life, often requiring an unexpected healthcare e↵ort and consistent social costs [4,5]. Usually, a patient-tailored approach requires a pharmacological treatment by considering the risk-benefit ratio of any medication. Being the third most common diagnosis in rheumatology clinics, FM prevalence within the general population appears to range from 1.3–8% [2]. To date there are no specific tests specific for FM. FM is currently recognized by the widespread pain index (which divides the body into 19 regions and scores how many regions are reported as painful) and a symptom severity score (SSS) that assesses cognitive symptoms, unrefreshing sleep and severity of fatigue [6]. It is not clear what causes FM and diagnosing assist the patients to face polysymptomatic distress, thereby reducing doubt and fear which are main psychological factors contributing to this central amplification mechanism [7]. In this review, an update on diagnosis and therapy of FM is provided along the discussion on the possibility of using pharmacological drugs, bioactive natural substances and alternative therapies to alleviate the symptomatology in combination or as alternative remedies to drugs. Int. J. Mol. Sci. 2020, 21, 7877 2 of 27 2. Diagnosis To date there is still a considerable controversy on the assessment and diagnosis of FM. Despite advances in the understanding of the pathologic process, FM remains undiagnosed in as many as 75% of people with the condition [8]. The first attempt for the FM classification criteria is dated 1990 and is based on studies performed in 16 centers in the U.S.A. and Canada in clinical and academic settings, gathering the both doubters and proponents [9]. Since then, several alternative methods of diagnosis have been proposed. In general, most of the researchers agree on the need to assess multiple domains in FM including pain, sleep, mood, functional status, fatigue, problems with concentration/memory (i.e. dyscognition) and tenderness/sti↵ness [5]. Four core areas were initially assessed: (1) pain intensity, (2) physical functioning, (3) emotional functioning, and (4) overall improvement/well-being [10]. About 70–80% of patients with FM also report having sleep disturbances and fatigue. Depressive symptoms, anxiety and mood states have also been included in FM diagnosis. An impairment in multiple areas of function, especially physical function is often reported by patients with FM [11] with a markedly impaired function and quality of life [8]. Since the late 19900 s, a top priority was the development of new disease-specific measures for each of the relevant domains in FM. Also, much attention was paid to studies supporting the valid use of existing instruments specifically in the context of FM [5]. Later on, in 2010, the tender point count was abandoned and the American College of Rheumatology (ACR) suggested preliminary diagnostic criteria which were considering the number of painful body regions evaluating the presence and severity of fatigue, cognitive difficulty, unrefreshed sleep and the extent of somatic symptoms. The diagnostic criteria are not based on laboratory or radiologic testing to diagnose FM and rely on a 0–12 Symptom Severity Scale (SSS) which is used to quantify FM-type symptom severity [12]. Furthermore, the SSS was proposed to be combined with the Widespread Pain Index (WPI) into a 0–31 Fibromyalgianess Scale (FS) [13]. With a specificity of 96.6% and sensitivity of 91.8%, a score 13 for FS was able to correctly classify 93% of patients identified as having FM based on the 1990 criteria [14]. ACR 2010 criteria were also found to be more sensitive than the ACR 1990 criteria, allowing underdiagnosed FM patients to be correctly identified and giving a treatment opportunity to those who had previously been untreated [15]. It is still unclear whether the diagnosis of FM has the same meaning with respect to severity in primary FM (PFM, a dominant disorder that occurs in the absence of another clinically important and dominant pain disorder) and secondary FM (SFM, which occurs in the presence of another clinically important and dominant medical disorder) [16]. Figure 1 shows the ACR 1990 criteria for the classification of fibromyalgia, whereas Figure 2 shows a graphical representation of the Symptom Severity Scale (SSS) plus the Extent of Somatic Symptoms (ESS). Figure 1. Widespread Pain Index from ACR 1990 criteria for the classification of fibromyalgia and related regions. Int. J. Mol. Sci. 2020, 21, 7877 3 of 27 Figure 2. Symptom Severity scale (SSS) and Extent of Somatic Symptoms (ESS). Table 1 shows a holist approach based on the assumption that a multitude of potential diagnoses is fundamental in order to avoid an FM misdiagnosis [17]. In 2013, alternative diagnostic criteria have been developed by some clinicians in the USA including more pain locations and a large range of symptoms than ACR 2010. A self-reported survey was composed of the 28-area pain location inventory and the 10 symptom items from the Symptom Impact Questionnaire (SIQ) [18]. However, when compared to the early 2010 criteria, these alternative criteria did not significantly contribute in di↵erentiating common chronic pain disorders from FM [1]. In 2015, the view of diagnostic criteria was altered by ACR by providing approval only for classification criteria and no longer considering endorsement of diagnostic criteria, stressing that diagnostic criteria are di↵erent from classification criteria and are beyond the remit of the ACR [19]. However, the suggestion that diagnostic and classification criteria represent 2 ends of a continuum implies that the continuum represents the accuracy of the criteria [20]. Classification criteria and diagnostic criteria could intersect; however, according to some authors the terms “diagnosis” and “classification criteria” should be considered as qualitatively distinct concepts. The proposed concept of “diagnostic criteria” [19] is challenging and may be hardly realizable, while diagnostic guidelines based on proper modelling techniques may be helpful for clinicians in particular settings [20]. In 2016, based on a generalized pain criterion and clinic usage data, a new revision of the 2010/2011 FM criteria was developed including the following criteria: 1) generalized pain, defined as pain present in at least 4 of 5 regions; 2) symptoms present at a similar level for at least three months; 3) a WPI 7 and SSS 5 or WPI of 4–6 and SSS 9; 4) a diagnosis of FM is valid irrespective of other diagnoses. Another important point is that the presence of other clinically important illnesses does not exclude a diagnosis of FM [21]. In 2018, considering important but less visible factors that have a profound influence on under- or over-diagnosis of FM provided a new gate to a holistic and real understanding of FM diagnosis, beyond existing arbitrary and constructional scores [22]. Int. J. Mol. Sci. 2020, 21, 7877 4 of 27 Table 1. ACR2010 and modified criteria for the diagnosis of fibromyalgia. Widespread pain index (WPI) Areas specification Number of areas in which the patient has had 0–19 points pain over the past week shoulder girdle, hip (buttock, trochanter), jaw, upper back, lower back, upper arm, upper leg, chest, neck, abdomen, lower arm, Areas to be considered and lower leg (all these areas should be considered bilaterally) Symptom Severity Scale (SSS) score Symptom Level of severity Symptom level Score For each of these 3 symptoms, indicate the level of severity over the past week Considering somatic symptoms in using the following scale: Fatigue general, indicate whether the patient has 0 = no problem Waking unrefreshed the following: 1 = slight or mild problems, generally Cognitive symptoms (e.g., working memory 0 = no symptoms Final score between 0 and 12 mild or intermittent capacity, recognition memory, verbal knowledge, 1 = few symptoms 2 = moderate; considerable problems, anxiety, and depression) 2 = a moderate number of symptoms often present and/or at a moderate level 3 = a great deal of symptoms 3 = severe; pervasive, continuous, life-disturbing problems Criteria Specification Conditions A patient satisfies diagnostic criteria for (a)WPI 7/19 and SS scale score 5 or WPI 3–6 and SS scale score 9 fibromyalgia if the following 3 conditions (b) symptoms have been present as a similar level for at least 3 months are met (c) the patient does not have a disorder that would otherwise explain the pain Modified criteria Specification Conditions Final Score (a)WPI (as above) A patient satisfies diagnostic criteria for (b) SS scale score (as above, but without The number of pain sites (WPI), the SS scale score, and the presence of associated fibromyalgia if the following 3 conditions extent of somatic symptoms) symptoms are summed to give a final score between 0 and 31 are met (c) presence of abdominal pain, depression, headaches (yes = 1, no = 0) Int. J. Mol. Sci. 2020, 21, 7877 5 of 27 In 2019, in cooperation with the WHO, an IASP Working Group has developed a classification system included in the International Classification of Diseases (ICD-11) where FM has been classified as chronic primary pain, to distinguish it from pain which is secondary to an underlying disease [23]. More recently, a study of about 500 patients under diagnosis of FM, revealed that 24.3% satisfied the FM criteria, while 20.9% received a clinician International Classification of Diseases (ICD) diagnosis of FM, with a 79.2% agreement between clinicians and criteria. The conclusions of this study pointed out a disagreement between ICD clinical diagnosis and criteria-based diagnosis of FM, calling into question meaning of a FM diagnosis, the validity of physician diagnosis and clinician bias [24]. FM is a disorder that cannot be based on diagnosis of exclusion, rather needing positive diagnosis [6], through a multidimensional FM diagnostic approach making diagnosis encompassing psychosocial stressors, subjective belief, psychological factors and somatic complaints [25]. The advent of the PSD scale identified a number of problems in FM research [16]. Recently, immunophenotyping analysis performed on blood samples of FM patients revealed a role of the Mu opioid receptor on B lymphocytes as a specific biomarker for FM [26]. Moreover, a rapid biomarker-based method for diagnosing FM has been developed by using vibrational spectroscopy to di↵erentiate patients with FM from those with other pain-related diseases. Unique IR and Raman spectral signatures were correlated with FM pain severity measured with FM impact questionnaire revised version (FIQR) [27]. Overall, these findings provide reliable diagnostic tests for di↵erentiating FM from other disorders, for establishing serologic biomarkers of FM-associated pain and were useful for the contribution of the legitimacy of FM as a truly painful disease. In summarizing aspects of FM learned through applications of criteria to patients and trials, Wolfe [28] identified 7 main concepts: 1) there is no way of objectively testing FM which also has no binding definition; 2) prevalence and acceptance of FM depend on factors largely external to the patient; 3) FM is a continuum and not a categorical disorder; 4) every feeling, symptom, physical finding, neuroscience measure, cost and outcome tells one very little about the disorder and its mechanisms when fibromyalgia to “normal subjects” is compared; 5) the range and content of symptoms might indicate that FM may not truly be a syndrome; 6) “pain and distress” type of FM subject identified in the general population [29] might be considered as part of the FM definition and; 7) caution is needed when accepting the current reductive neurobiological causal explanations as sufficient, since FM is a socially constructed and arbitrarily defined and diagnosed dimensional disorder. 3. Therapy 3.1. Pharmacotherapy of FM Clinical trials have failed to conclusively provide overall benefits of specific therapies to treat FM; therefore, current pharmacological treatments for patients su↵ering from FM are mainly directed to palliate some symptoms, with relevant clinical benefits experienced only by a minority of individuals from any one intervention. In those treated with pharmacotherapy, a 50%reduction in pain intensity is generally achieved only by 10% to 25% [30] However, some treatments seem to significantly improve the quality of life of certain FM patients [31]. Only a few drugs have been approved for use in the treatment of FM by the US FDA, whereas no drug has been approved for this indication by the European Medicines Agency. Thus patients with FM frequently need to be treated on an o↵-label basis [32]. Currently, only 25% to 40% pain reduction is granted by drugs and meaningful relief occurs in only 40% to 60%, in part due to dose-limiting adverse e↵ects and incomplete drug efficacy [33]. These limitations in clinical practice have led some to hypothesize that a combination of di↵erent analgesic drugs acting through di↵erent mechanisms may provide superior outcomes compared to monotherapy [34]. Moreover, drugs should be started at low doses and cautiously increased because some patients, either do not tolerate or benefit from drug therapy. Because sleep disturbance, pain and psychological distress are the most amenable to drug therapy, drugs should be chosen to manage the individual’s predominant symptoms [35]. Currently, several drugs are frequently used alone Int. J. Mol. Sci. 2020, 21, 7877 6 of 27 or in combination to manage FM symptoms; however, the US FDA indicated for FM only three: two selective serotonin and norepinephrine reuptake inhibitors (SNRIs), duloxetine and milnacipran, and an anticonvulsant, pregabalin [36]. In the next sections, the use of selected drugs aimed to alleviate FM will be described. 3.1.1. Cannabinoids in FM Therapy The cannabinoid system is ubiquitous in the animal kingdom and plays multiple functions with stabilizing e↵ects for the organism, including modulation of pain and stress, and the management of FM may have therapeutic potential by manipulating this system. The cannabinoid system contributes in maintaining equilibrium and stabilizing e↵ects on FM [37]. Moreover, the endocannabinoid neuromodulatory system is involved in multiple physiological functions, such as inflammation and immune recognition, endocrine function, cognition and memory, nausea, antinociception and vomiting, [38]. Deficiency in the endocannabinoid system has been correlated to FM [39], but without clear clinical evidence in support of this assumption [40]. The endocannabinoid system consists of two cannabinoid receptors, the CB1 and CB2 receptors [41]. In acute and chronic pain models, analgesic e↵ects are associated to CB1 agonists that act at many sites along pain transmission pathways, including activation of spinal, supraspinal and peripheral CB1 receptors, each independently decreasing nociception [42]. Delta 9-tetrahydrocannabinol (D9-THC or Dronabinol, 1) is the main active constituent of Cannabis sativa var indica, with psychoactive and pain-relieving properties. The non-selective binding to G-protein-coupled CB receptors is responsible for the pharmacological e↵ects induced by D9-THC. Cannabidiol (CBD, 2), a non-psychotropic constituent of cannabis, is a high potency antagonist of CB receptor agonists and an inverse agonist at the CB2 receptor [43]. CBD displays CB2 receptor inverse agonism, an action that appears to be responsible for its antagonism of CP55940 at the human CB2 receptor [44]. This CB2 receptor inverse agonist ability of CBD may contribute to its documented anti-inflammatory properties [44]. The main endocannabinoids are anandamide (N-arachidonoylethanolamine, AEA, 3) and 2-arachidonoylglycerol (2-AG, 4), AG), the activity of which is modulated by the hydrolyzing fatty acid palmitoylethanolamide (PEA, 5) and the endocannabinoid precursor arachidonic acid (AA, 6) [45]. AEA and 2-AG are functionally related to D9-THC [46]. It was found that stress induces a rapid anandamide release in several CNS regions resulting in stress-induced analgesia via CB1 receptors [47]. FM patients had significantly higher anandamide plasma levels [39,46]; however, it has been suggested that the origin of FM and chronic pain depend on a deficiency in the endocannabinoid signaling [45]. Monotherapies of FM based on D9-THC are based on the assumption that this compound acts as an analgesic drug; however, although a sub-population of FM patients reported significant benefits from the use of D9-THC, this statement cannot be made [48]. When the quality of life of FM patients who consumed cannabis was compared with FM subjects who were not cannabis users, a significant improvement of symptoms of FM in patients using cannabis was observed, although there was a variability of patterns [49]. The synthetic cannabinoid nabilone (7) showed of a superiority over placebo to reduce FM symptoms, with significant reductions in Visual Analog Scale (VAS) for pain, FM Impact Questionnaire (FIQ), and anxiety [42], indicating the efficacy of treating people with FM with nabilone. Nabilone was also e↵ective in improving sleep [50]; however, participants taking nabilone experienced more adverse events (such as dizziness/drowsiness, dry mouth and vertigo) than did participants taking placebo or amitriptyline (see below). The self-medication practice of herbal cannabis was associated with negative psychosocial parameters. Therefore, caution should be exercised in recommending the use of cannabinoids pending clarification of general health and psychosocial problems [51,52]. Figure 3 illustrates the chemical formulas of some cannabinoids and endocannabinoids. Int. J. Mol. Sci. 2020, 21, 7877 7 of 27 Figure 3. Structure formulae of some cannabinoids and related compounds. Numbers correspond to compound names cited in the text. 3.1.2. Opioids in FM Therapy One of the major natural sources of opioids is the medicinal plant Papaver somniferum. Although clinical evidence demonstrating the efficacy or e↵ectiveness of opioids analgesics is scanty, these molecules are widely used for the treatment of FM [53]. However, the long-term use of opioids in FM has been discouraged by several medical guidelines [54]. The use of opioids is documented in studies demonstrating increased endogenous opioid levels in the cerebrospinal fluid of patients with FM vs. controls [55]. These results prompted the interesting hypothesis that a more activated opioid system can be detected in individuals with FM, reflecting reduced receptor availability and increased release of endogenous opioids [54]. There is evidence from both single center, prospective, longitudinal and multicenter and observational clinical studies of negative e↵ects of the use of opioids in FM on patient outcomes compared with other therapies [56,57]. Moreover, opioid user groups showed less improvement in the SFM-36 subscale scores of general health perception and in the FIQ subscale scores of job ability, fatigue and physical impairment [58]. Furthermore, altered endogenous opioid analgesic activity in FM has been demonstrated and suggested as a possible reason for why exogenous opiates appear to have reduced efficacy [59]. Despite these facts, opioids have been prescribed for 10% to 60% of patients with FM as reported in large database sets [54]. When considered, the preference of patients appears towards opioids. In a survey, 75% of patients considered hydrocodone (8) plus acetaminophen to be helpful, and 67% considered oxycodone (9) plus acetaminophen to be helpful [60]. FM has been associated with preoperative opioid use, including hydrocodone [61], whereas there is limited information from randomized controlled trials on the benefits or harms of oxycodone when used to treat pain in FM [62]. A pilot study showed that naltrexone (10) reduced self-reported symptoms of FM (primarily daily pain and fatigue) [63] and further studies showed that low-dose naltrexone had a specific and clinically beneficial impact on FM. This opioid, which is widely available and inexpensive, Int. J. Mol. Sci. 2020, 21, 7877 8 of 27 was found to be safe and well-tolerated. Blocking peripheral opioid receptors with naloxone (11) was observed to prevent acute and chronic training-induced analgesia in a rat model of FM [64]; however, there were no significant e↵ects of naloxone nor nocebo on pressure pain threshold, deep tissue pain, temporal summation or conditioned pain modulation in chronic fatigue syndrome/FM patients [65]. A synthetic opioid receptor agonist that shows serotonin-norepinephrine reuptake inhibitor properties is tramadol (12); this compound is often prescribed for painful conditions [66]. Tramadol has been studied in humans who su↵er from FM [56], suggesting that tramadol may be e↵ective in treating FM [67]. The use of tramadol provides change in pain assessed by visual analogue scale and FM impact questionnaire; however, the reported side e↵ects include dizziness, headache, constipation, addiction, withdrawal, nausea, serotonin syndrome, somnolence, pruritus seizures, drug–drug interactions with antimigraine and antidepressants medications [66]. Therefore, it is recommended that tramadol application should be considered in refractory and more treatment-resistant cases of FM. Another weak opioid is codeine (13). In a comparative study, there was a significantly higher proportion of patients in the codeine-acetaminophen group reporting somnolence or constipation and a larger proportion of patients in the tramadol-acetaminophen group reporting headache. The overall results suggested that tramadol-acetaminophen tablets (37.5 mg/325 mg) were as e↵ective as codeine-acetaminophen capsules (30 mg/300 mg) in the treatment of chronic pain [68]. Fentanyl (14) works primarily by activating µ-opioid receptors and was found to be around 100 times stronger than morphine (15), although its e↵ects are more localized. Fentanyl injections reduced second pain from repeated heat taps in FM patients. Similar to reports of e↵ects of morphine on first and second pain, fentanyl had larger inhibitory e↵ects on slow temporal summation of second pain than on first pain from a nociceptor stimulation [69]. Since fentanyl can inhibit windup of second pain in FM patients, it can prevent the occurrence of intense summated second pain and thereby reduce its intensity by a greater extent than first or second pains evoked by single stimuli. Among the 70,237 drug-related deaths estimated in 2017 in the US, the sharpest increase occurred among those related to fentanyl analogs with almost 29,000 overdose deaths which represents more than 45% increase from 2016 to 2017 [70]. Because the numbers of overdoses and deaths due to fentanyl will continue to increase in the coming years, studies are needed to elucidate the physiological mechanisms underlying fentanyl overdose in order to develop e↵ective treatments aimed to reduce the risk of death [71]. Glial cell activation is one of the several other possible pathophysiologic mechanisms underlying the development of FM by contributing to central nervous system sensitization to nociceptive stimuli [72]. Pentoxifylline (16), a xanthine derivative used as a drug to treat muscle pain in people with peripheral artery disease, is a nonspecific cytokine inhibitor that has been shown to attenuate glial cell activation and to inhibit the synthesis of TNF↵, IL-1 , and IL-6 [73]. In theory, attenuating glial cell activation via the administration of pentoxifylline to individuals su↵ering from FM might be efficient in ameliorating their symptoms without being a globalist therapeutic approach targeting all possible pathophysiologic mechanisms of development of the syndrome [74]. With regards FM pathophysiology, serum brain-derived neurotrophic factors (BDNF) were found at higher levels in FM patients while BDNF methylation in exon 9 accounted for the regulation of protein expression. These data suggest that altered BDNF levels might represent a key mechanism explaining FM pathophysiology [75]. Opioid users were also observed to experience a decreased pain and symptom severity when ca↵eine (17) was consumed, but this was not observed in opioid nonusers, indicating ca↵eine may act as an opioid adjuvant in FM-like chronic pain patients. Therefore the consumption of ca↵eine along with the use of opioid analgesics could represent an alternative therapy with respect to opioids or ca↵eine alone [76]. Figure 4 shows the chemical formulae of some opioids used in FM therapy. Int. J. Mol. Sci. 2020, 21, 7877 9 of 27 Figure 4. Structure formulae of some opioids and related compounds. Numbers correspond to molecules cited in the text. 3.1.3. Gabapentinoids in FM Therapy Gabapentinoid drugs are US Food and Drug Administration (FDA) (but not in Europe) anticonvulsants approved for treatment of pain syndromes, including FM. However, FDA approved pregabalin (18) but not gabapentin (19) for FM treatment; nevertheless, gabapentin is often prescribed o↵-label for FM, presumably because it is substantially less expensive [77]. Pregabalin is a gamma-aminobutyric acid (GABA) analog and is a ligand for the ↵2 subunit of the calcium channel being able of reducing the ability of docked vesicles to fuse and release neurotransmitters [78]. Pregabalin shows e↵ects on cortical neural networks, particularly when basal neurons are under hyperexcitability. The pain measures and pregabalin impact on the cortical excitability was observed only in FM patients [79]. Pregabalin was also found to increase norepinephrine levels in reserpine-induced myalgia rats [80]. Because of its tolerability when used in combination with antidepressants, pregabalin use showed a very good benefit to risk ratio [81]. The starting approved dosage for pregabalin is at 150 mg daily [82]; however, the drug shows a higher e↵ectiveness when used at a dose of 300 or 600 mg/day. Lower pregabalin doses than those of clinical trials are used in clinical practice because higher doses are more likely to be intolerable [83]. A recent systematic review shows that a minority of people with moderate to severe pain due to FM treated with a daily dose of 300 to 600 mg of pregabalin had a reduction of pain intensity over a follow-up period of 12 to 26 weeks, with tolerable adverse e↵ects [84]. Thus, pregabalin is one of cardinal drugs used in the treatment of FM, and its clinical utility has been comprehensively demonstrated [85,86]. Nevertheless, there is still insufficient evidence to support or refute that gabapentin may reduce pain in FM [87]. Figure 5 depicts the chemical formulae of some gabapentinoids. Int. J. Mol. Sci. 2020, 21, 7877 10 of 27 Figure 5. Structure formulae of some gabapentinoids. Numbers correspond to molecules cited in the text. 3.1.4. Serotonin–Norepinephrine Reuptake Inhibitors in FM Therapy There is a wide use of serotonin and noradrenaline reuptake inhibitors (SNRIs). There is no unbiased evidence that serotonin selective reuptake inhibitors (SSRIs) are superior to placebo in treating depression in people with FM and for treating the key symptoms of FM, namely sleep problems, fatigue and pain. However, it should be considered that young adults aged 18 to 24, with major depressive disorder, showed an increased suicidal tendency when treated with SSRIs [88]. A recent Cochrane review evaluated the use of SNRIs including eighteen studies with a total of 7,903 adults diagnosed with FM, by using desvenlafaxine (20) and venlafaxine (21) in addition to duloxetine (22) and milnacipran (23), by considering various outcomes for SNRIs including health related quality of life, fatigue, sleep problems, pain and patient general impression, as well as safety and tolerability [89]. Fifty two percent of those receiving duloxetine and milnacipran had a clinically relevant benefit over placebo compared to 29% of those on placebo, with much or very much improvements in the intervention. On the other hand, reduction of pain intensity was not significantly di↵erent from placebo when desvenlafaxine was used. However, pain relief and reduction of fatigue was not clinically relevant for duloxetine and milnacipran in 50% or greater and did not improve the quality of life [90]. Same negative outcomes were found for reducing problems in sleep and the potential general benefits of duloxetine and milnacipran were outweighed by their potential harms. The efficacy of venlafaxine in the treatment of FM was studied to a lesser extent. The lack of consistency in venlafaxine dosing, placebo control and blinding make difficult to understand whether the molecule is e↵ective in treating FM. Nevertheless, tolerability and the lower cost of venlafaxine increases its potential use for the treatment of FM, by rendering the molecule a more a↵ordable option compared to the other, more expensive SNRIs [91]. Mirtazapine (24) promotes the release of noradrenaline and serotonin by blocking ↵2 -adrenergic autoreceptors and ↵2 -adrenergic heteroreceptors, respectively. Mirtazapine, by acting through 5-HT1A receptors and by blocking postsynaptic 5-HT2A , 5-HT2C , and 5-HT3 receptors is able to enhance serotonin neurotransmission [92]. For these properties, mirtazapine is classified as a noradrenergic and specific serotonergic antidepressant [93]. Mirtazapine appears to be a promising therapy to improve sleep, pain, and quality of life in patients with FM [94]. In Japanese patients with FM, mirtazapine caused a significantly greater reduction in the mean numerical rating scale pain score and remained significantly greater from week 6 onward, compared with placebo. However, Adverse mirtazapine caused adverse events including weight gain, somnolence and increased appetite when compared to placebo [92]. Among antidepressants, the tricyclic antidepressant (TCAs) amitriptyline (25) was studied more than other antidepressants. It is frequently used to assess comparative efficacy [95] and for many years amitriptyline has been a first-line treatment for FM. Although there is no supportive unbiased evidence for a beneficial e↵ect, the drug was successful for the treatment in many patients with FM. However, amitriptyline achieve satisfactory pain relief only by a minority of FM patients and is unlikely that any large randomized trials of amitriptyline will be conducted in FM to establish efficacy Int. J. Mol. Sci. 2020, 21, 7877 11 of 27 statistically, or measure the size of the e↵ect [96]. Figure 6 depicts the chemical formulae of some SNRIs and TCA. Figure 6. Chemical structure of some serotonin and noradrenaline reuptake inhibitors and a tricyclic antidepressant. Numbers correspond to molecules cited in the text. 3.2. Alternative Therapies for FM A survey of the European guidelines shows that most of the pharmacological therapies are relatively modest providing only weak recommendations for FM [97]. A multidimensional approach is therefore required for the management of FM, including pharmacological therapies along with behavioral therapy, exercise, patient education and pain management. A multidisciplinary approach combines pharmacotherapy with physical or cognitive interventions and natural remedies. Very often, patients seek help in alternative therapies due to the limited efficacy of the therapeutic options. The following sections discuss some of the most used alternative therapies to treat FM. 3.2.1. Acupunture Acupuncture shows low to moderate-level in improving pain and sti↵ness in people with FM. In some cases, acupuncture does not di↵er from sham acupuncture in improving sleep or global well-being or reducing pain or fatigue. The mechanisms of acupuncture action in FM treatment appears to be correlated to changes in serum serotonin levels [98]. Electro-acupuncture (EA) was more e↵ective than manual acupuncture (MA) for improving sleep, global well-being and fatigue and in the reduction of pain and sti↵ness. Although e↵ective, the e↵ect of acupuncture is not maintained at six months follow-up [99]. Moreover, there is a lack of evidence that real acupuncture significantly di↵ers from sham acupuncture with respect to improving the quality of life, both in the short and long term. However, acupuncture therapy is a safe treatment for patients with FM [100,101]. 3.2.2. Electric Stimulation As we discussed, FM, aside pain, is characterized by anxiety, depression and sleep disturbances, and by a complex cognitive dysfunctioning status known as “fibrofog” which is characterized by disturbance in working memory, attention and executive functions globally often referred by the patients as a sense of slowing down, clumsiness and confusion that have a profound impact on the ability to perform and e↵ectively plan daily activities [102,103]. Besides stimulation with acupuncture, the e↵ective modulation of brain areas has been obtained through non-invasive brain stimulation by Int. J. Mol. Sci. 2020, 21, 7877 12 of 27 magnetic or electric currents applied to the scalp like transcranial magnetic and electrical stimulation. In many cases, to relieve pain and improve general FM-related function, the use of anodal transcranial direct current stimulation over the primary motor cortex was found to be significantly more e↵ective than sham transcranial direct current stimulation [104]. If we consider that pharmacological and non-pharmacological treatments are often ine↵ective or transitory in their e↵ect on FM, therapeutic electrical stimulation appears to have a potential role [105]. Cognitive functions such as memory have been enhanced in FM patients by anodal transcranial direct current stimulation over the dorsolateral prefrontal cortex and has clinical relevance for top-down treatment approaches in FM [106]. In FM patients, modulation of hemodynamic responses by transcutaneous electrical nerve stimulation during delivery of nociceptive stimulation was also investigated and shown to be an e↵ective factor in FM treatment, although the underlying mechanism for these findings still needs to be clarified [107]. It has been recently demonstrated that both transcutaneous electric nerve stimulation and acupuncture applications seem to be beneficial in FM patients [108]. In a recent Positron Emission Tomography H2 15 O activation study it was shown that occipital nerve field stimulation acts through activation of the descending pain inhibitory pathway and the lateral pain pathway in FM, while electroencephalogram shows activation of those cortical areas that could be responsible for descending inhibition system recruitment [109]. Microcirculation is of great concern in patients with FM. Recently low-energy pulsed electromagnetic field therapy was found to increase a promising therapy to increase microcirlulation [110]; however, neither pain and sti↵ness were reduced nor functioning was improved by this therapy in women with FM [111]. The European Academy of Neurology, based on the method of GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) judged anodal transcranial direct currents stimulation of motor cortex as still inconclusive for treatment of FM [112]. Therefore, further studies are needed to determine optimal treatment protocols and to elucidate the mechanisms involved [113]. 3.2.3. Vibroacoustic and Rhythmic Sensory Stimulation Stimulation with sensory events such as pulsed or continuous auditory, vibrotactile and visual flickering stimuli are referred as rhythmic sensory stimulation [114]. Clinical studies have reported the application of vibroacoustic stimulation in the treatment of FM. In a clinal study, one group of patients with FM listened to a sequence of Bach’s compositions, another was subjected to vibratory stimuli on a combination of acupuncture points on the skin and a third group received no stimulation. The results showed that a greater e↵ect on FM symptoms was achieved by the combined use of music and vibration [115]. However, in another study, neither music nor musically fluctuating vibration had a significant e↵ect on tender point pain in FM patients when compared to placebo treatment [116]. Because thalamocortical dysrhythmia is implicated in FM and that low-frequency sound stimulation can play a regulatory function by driving neural rhythmic oscillatory activity, volunteers with FM were subjected to 23 min of low-frequency sound stimulation at 40 Hz, delivered using transducers in a supine position. Although no adverse e↵ects in patients receiving the treatment, no statistically and clinically relevant improvement were observed [117]. On the other hand, gamma-frequency rhythmic vibroacoustic stimulation was found to decrease FM symptoms (depression, sleep quality and pain interference) and ease associated comorbidities (depression and sleep disturbances), opening new avenues for further investigation of the e↵ects of rhythmic sensory stimulation on chronic pain conditions [118]. 3.2.4. Thermal Therapies Thermal therapies have been used to treat FM. Two main therapies are currently used: body warming and cryotherapy. Int. J. Mol. Sci. 2020, 21, 7877 13 of 27 Because FM is strongly linked to rheumatic aches, the application of heat by spa therapy (balneotherapy) appears as a natural choice for the treatment of FM [119]. Spa therapy is a popular treatment for FM in many European countries, as well as in Japan and Israel. A randomized prospective study of a 10-day treatment was done on 48 FM patients improving their quality of life [120] and showed that treatment of FM at the Dead Sea was both e↵ective and safe [121]. FM patients who were poorly responding to pharmacological therapies were subjected to mud-bath treatment. A cycle of mud bath applications showed beneficial e↵ects on FM patients whose evaluation parameters remained stable after 16 weeks in comparison to baseline [122]. In patients su↵ering from FM, mud bathing was also found to prevent muscle atrophy and inflammation and improve nutritional condition [123]. Nevertheless, despite positive results, the methodological limitations of available clinical studies, such as the lack of placebo double-blinded trials, preclude definitive conclusions on the e↵ect of body-warming therapies to treat FM [119,124]. A remedy widely used in sports related trauma is the application of cold as a therapeutic agent for pain relief. Cryotherapy refers to the use of low temperatures to decrease the inflammatory reaction, including oedema [125]. Cryotherapy induces several organism physiological reactions like increasing anti-inflammatory cytokines, beta-endorphins, ACTH, white blood cells, catecholamines and cortisol, immunostimulation due to noradrenalin response to cold, the increase in the level of plasma total antioxidant status and the reduction of pain through the alteration of nerve conduction [126]. When compared to control FM subjects, cryotherapy-treated FM patients reported a more pronounced improvement of the quality of life [127]. Whole body cryotherapy was also found to be a useful adjuvant therapy for FM [126]. 3.2.5. Hyperbaric Treatment Hyperbaric oxygen therapy (HBOT) has shown beneficial e↵ects for the prevention and treatment of pain [128], including migraine, cluster headache [129] and FM [130]. HBOT is supposed to induce neuroplasticity that leads to repair of chronically impaired brain functions. HBOT was also found to it improve the quality of life in post-stroke patients and mild traumatic brain injury patients [131]. Therefore, the increased oxygen concentration caused by HBOT is supposed to change the brain metabolism and glial function with a potential e↵ect on reducing the FM-associated brain abnormal activity [132]. HBOT was found to a↵ect the mitochondrial mechanisms resulting in functional brain changes, stimulate nitric oxide production thus alleviating hyperalgesia and promoting the NO-dependent release of endogenous opioids which appear to be involved in the antinociception prompted by HBOT [133]. In a clinical study, a significant di↵erence between the HBOT and control groups was found in the reduction in tender points and VAS scores after the first and fifteenth therapy sessions [130]. These results indicate that HBOT may play an important role in managing FM. 3.2.6. Laser Therapy and Phototherapy The use of di↵erent light wavelengths has been found to be an alternative therapy for FM. It is known that low-level laser therapy is a therapeutic factor, being able not only to target one event in the painful reception, but rather the extend its e↵ectiveness on the whole hierarchy of mechanisms of its origin and regulation [134]. Laser photobiomodulation therapy has been reported to be e↵ective in the treatment of a variety of myofascial musculoskeletal disorders, including FM [135]. The combination of laser therapy and the administration of the drug amitriptyline was found to be e↵ective on clinical symptoms and quality of life in FM; furthermore, gallium-arsenide laser therapy was found to be a safe and e↵ective treatment which can be used as a monotherapy or as a supplementary treatment to other therapeutic procedures in FM [136]. Evidence supported also the use of laser therapy in women su↵ering FM to improve pain and upper body range of motion, ultimately reducing the impact of FM [137,138]. Finally, a combination of phototherapy and exercise training was evaluated in patients with FM in a randomized controlled trial for chronic pain to o↵er valuable clinical evidence for objective assessment of the potential benefits and risks of procedures [139]. Int. J. Mol. Sci. 2020, 21, 7877 14 of 27 3.2.7. Exercise and Massage Exercise therapy seems to be an e↵ective component of treatment, yielding improvement in pain and other symptoms, as well as decreasing the burden of FM on the quality of life [140]. Exercise is generally acceptable by individuals with FM and was found to improve the ability to do daily activities and the quality of life and to decrease tiredness and pain [141]. However, it is important to know the e↵ects and specificities of di↵erent types of exercise. For instance, two or more types of exercise may combine strengthening, aerobic or stretching exercise; however, there is no substantial evidence that mixed exercise may improve sti↵ness [142]. Quality of life may be improved by muscle stretching exercise, especially with regard to physical functioning and pain, whereas depression is reduced by resistance training. A trial including a control group and two intervention groups, both of which receiving exercise programs created specifically for patients with FM, showed that both modalities were e↵ective in an exercise therapy program for FM [143]. A progressive muscle strengthening activity was also found to be a safe and e↵ective mode of exercise for FM patients [144]. Furthermore, strength and flexibility exercises in aerobic exercise rehabilitation for FM patients led to improvements in patients’ shoulder/hip range of motion and handgrip strength [145]. Among women with FM, the association between physical activity and daily function is mediated by the intensity of musculoskeletal pain, rather than depressive symptoms or body mass [146], with a link between clinical and experimental pain relief after the performance of isometric contractions [147]. A randomized controlled trial evaluated the e↵ects of yoga intervention on FM symptoms. Women performing yoga showed a significant improvement on standardized measures of FM symptoms and functioning, including fatigue, mood and pain, and in pain acceptance and other coping strategies [148]. Moreover, the combination with massage therapy program during three months influenced perceived stress index, cortisol concentrations, intensity of pain and quality of life of patients with FM [149]. In terms of societal costs and health care costs, quality of life and physical fitness in females with FM was improved by aquatic training and subsequent detraining [150,151]. Aquatic physical training was e↵ective in promoting increased oxygen uptake at peak cardiopulmonary exercise test in women with FM [152]. A systematic evaluation of the harms and benefits of aquatic exercise training in adults with FM showed that it may be beneficial for improving wellness, symptoms, and fitness in adults with FM [153,154]. A safe and clinically efficacious treatment of pain and other FM symptoms was also achieved by the combination of osteopathic manipulative medicine and pharmacologic treatment with gabapentin [155]. Dancing is a type of aerobic exercise that may be used in FM alternative therapy. Belly dancing was found to be e↵ective in improving functional capacity, pain, quality of life and improving body image of women with FM [156]. More recently, three months treatment of patients with FM with Zumba dancing was found to be e↵ective in improving pain and physical functioning [157]. Finally, Tai chi mind-body treatment was found to improve FM symptoms as much as aerobic exercise and longer duration of Tai chi showed greater improvement. According to a recent report, mind-body approaches may take part of the multidisciplinary management of FM and be considered an alternative therapeutic option [158]. 3.2.8. Probiotics and FM Therapy A tractable strategy for developing novel therapeutics for complex central nervous system disorders could rely on the so called microbiota-gut-brain axis management, because intestinal homeostasis may directly a↵ect brain functioning [159,160]. The pain intensity of patients with FM has been reported to be correlated with the degree of small intestinal bacterial overgrowth, which is often associated with an increased intestinal permeability whose values were significantly increased in the FM patients [161]. Preclinical trials indicate that the microbiota and its metabolome are likely involved in modulating brain processes and behaviors [162]. Therefore, FM patients should show better performance after the treatment with probiotics. In a double-blind, placebo-controlled, randomized design probiotic Int. J. Mol. Sci. 2020, 21, 7877 15 of 27 improved impulsive choice and decision-making in FM patients, but no other e↵ects were observed on cognition, quality of life, self-reported pain, FM impact, depressive or anxiety symptoms [163]. 3.2.9. Use of Plant Extracts and Natural Products for FM Treatment About 40% of drugs used to treat FM originate from natural products [164]; however, there are a few studies that prove the safe and e↵ective use of various plant extracts in FM therapy. Several plant extracts are currently used for their antinociceptive properties and potential to treat FM [165]. Papaver somniferum is probably the most ancient plant used for its antinociceptive properties [166], with chemical components able to interact with opioid receptors; among these morphine (15) which is not only the oldest, but is still the most e↵ective drug for the management of severe pain in clinical practice [167]. The use of opioids for FM treatment has been discussed above. Another important plant is Cannabis sativa. The major active constituent of Cannabis, D9-THC (1), has been shown to possess antinociceptive properties when assessed in several experimental models [168] (see also the discussion above on cannabinoids). Although there is still scarce evidence to support its role in the treatment of FM, a large consensus indicates that medical cannabis could be an e↵ective alternative for the treatment of FM symptoms [169]. The illicit use of herbal cannabis for FM treatment has been correlated to the inefficacy of current available medications, but is also linked to popular advocacy or familiarity with marijuana from recreational use. Therefore, physicians are requested to examine the global psychosocial well-being, and not focus only on the single outcome measure of pain [52,170]. Although medical cannabis treatment has a significant favorable e↵ect on patients with FM, 30% of patients experience adverse e↵ects [171] and 8% report dependence on cannabis [172]. VAS scores measured in 28 FM patients after 2 hours of cannabis use showed enhancement of relaxation and feeling of well-being, a reduction of pain and sti↵ness which were accompanied by an increase in somnolence. The mental health component summary score of the Short Form 36 Health Survey was higher in cannabis users than in non-users [49]. Among terpenoids, administration of trans- -caryophyllene (BCP, 26), a bicyclic sesquiterpene compound existing in the essential oil of many plants like Copaifera langsdforffii, Cananga odorata, Humulus lupulus, Piper nigrum and Syzygium aromaticum, which provide a high percentage of BCP along with interesting essential oil yields [173], significantly minimized the pain in both acute and chronic pain models [174]. BCP selectively binds to the cannabinoid 2 (CB2 ) receptor and is a functional CB2 agonist. Upon binding to the CB2 receptor, BCP inhibits adenylate cylcase, leads to intracellular calcium transients and weakly activates the mitogen-activated kinases Erk1/2 and p38 in primary human monocytes [175]. BCP, a safe compound with toxicity at doses higher than 2000 mg/kg body weight [176], was found to reduce the primary and secondary hyperalgesia produced by a chronic muscle pain model (which is considered to be an animal model for FM) [177]. Significant and dose-dependent antinociceptive response was produced by BCP without the presence of gastric damage [178]. Antiallodynic actions of BCP are exerted only through activation of local peripheral CB2 [179]. In neuropathic pain models, BCP reduced spinal neuroinflammation and the oral administration was more e↵ective than the subcutaneously injected synthetic CB2 agonist JWH-133 [180]. Recently, BCP was found to exert an analgesic e↵ect in an FM animal model through activation of the descending inhibitory pain pathway [181]. Thus, BCP may be highly e↵ective in the treatment of long-lasting, debilitating pain states, suggesting the interesting application of BCP in FM therapy. The analgesic properties of myrrh (Commiphora myrrha) have been known since ancient times and depend on the presence of bioactive sesquiterpenes with furanodiene skeletons which are able to interact with the opioid receptors [182,183]. C. myrrha extracts exerted a stronger suppression on carrageenan-induced mice paw edema with significant analgesic e↵ects [184] and were e↵ective against chronic inflammatory joint disease such as osteoarthritis [185]. In a preclinical trial, pain alleviation was obtained with C. myrrha extracts for many pathologies [186], indicating that extracts from this plant may have the potential to treat FM. Int. J. Mol. Sci. 2020, 21, 7877 16 of 27 Preclinical studies indicate a potential use of Hypericum perforatum (Hypericaceae), popularly known as St. John’s wort, in medical pain management [187] due to its phenolic compounds. Many phenolic compounds (e.g., flavonoids) from medicinal plants are promising candidates for new natural analgesic drugs [188]. Quercetin (27) showed analgesic activity and could reduce neuropathic pain by inhibiting mTOR/p70S6K pathway-mediated changes of synaptic morphology and synaptic protein levels in spinal dorsal horn neurons of db/db mice [189], while rutin (28) could inhibit the writhing response of mice induced by potassium antimony tartrate and showed to be a promising pharmacological approach to treat pain [190]. The analgesia potency of hyperin (29) was approximately 20-fold of morphine, while luteolin (30) presented e↵ective analgesic activities for both acute and chronic pain management. Some glycosides of kaempferol (e.g., kaempferol 3-O-sophoroside, 31) possess significant analgesic activity in the tail clip, tail flick, tail immersion, and acetic acid-induced writhing models, whereas baicalin (32) shows analgesic e↵ects in several kinds of pain [191]. Fisetin (33), a plant flavonoid polyphenol, has been reported to possess potent antioxidant, antinociceptive and neuroprotective activities. In rats, fisetin acts via modulation of decreased levels of biogenic amines and elevatesoxido-nitrosative stress and ROS to ameliorate allodynia, hyperalgesia, and depression in experimental reserpine-induced FM [192]. In a double-blind parallel-group clinical trial, outpatients with FM were randomized to receive either 15 mg of Crocus sativus (sa↵ron) extract or 30 mg duloxetine (22). No significant di↵erence was detected for any of the scales neither in terms of score changes from baseline to endpoint between the two treatment arms, indicating that sa↵ron and duloxetine had comparable efficacy in treatment of FM symptoms [193]. It is still unclear the efficacy of natural products extracted from plants in treating FM. However, some clinical data show promising results and more studies with adequate methodological quality are necessary in order to investigate the efficacy and safety of natural products as a support in FM therapy. Figure 7 depicts the chemical formulae of some antinociceptive natural products. Figure 7. Chemical structure of some natural compounds with antinociceptive activity. Int. J. Mol. Sci. 2020, 21, 7877 17 of 27 4. Conclusions Diagnosis of FM is based on clinical feature and criteria that still lack either a gold standard or at least supportive laboratory findings. FM diagnostic criteria may include heterogeneous patients also in clinical trials and this may impair evaluation of clinically meaningful treatment e↵ect. The review of the literature suggests that a multidisciplinary therapeutic approach, based on the combination of pharmacologic and alternative therapy (including thermal, light, electrostimulatory and body exercise treatments) could improve the quality of life and reduce pain and other symptoms related to FM. However, sometimes the ability of patients to participate to alternative therapies is impeded by the level of pain fatigue, poor sleep, and cognitive dysfunction. These patients may need to be managed with medications before initiating nonpharmacologic therapies. Although the use of some natural phytochemicals like BCP and phenolic compounds might replace other natural products such as D9-THC, because of reduced side e↵ects and higher tolerability, FM self medication practice may be ine↵ective and in some cases even detrimental. Therefore, providing FM patients with the correct information about their disorders may help monitoring pharmacological and alternative therapies. At the same time maintaining information will help patients to receive the appropriate medications and therapies [194]. Funding: This research received no external funding. Conflicts of Interest: The author declares no conflict of interest Abbreviations 2-AG 2-ArachidonoylGlycerol AA Arachidonic Acid ACR American College of Rheumatology ACTH Adrenocorticotropic hormone AEA N-arachidonoylethanolamine BDNF Brain-Derived Neurotrophic Factors CB1 Cannabinoid Receptor 1 CB2 Cannabinoid Receptor 2 CBD Cannabidiol CNS Central Nervous System EA Electro-Acupuncture ESS Extent of Somatic Symptoms FIQ FM Impact Questionnaire FIQR FM Impact Questionnaire Revised version FM Fibromyalgia FS Fibromyalgianess Scale GABA Gamma-Aminobutyric Acid Grading of Recommendations, Assessment, GRADE Development, and Evaluation HBOT Hyperbaric Oxygen Therapy ICD-11 International Classification of Diseases IL-1 Interleukin 1 beta IL-6 Interleukin 6 MA Manual Acupuncture PEA Palmitoylethanolamide PFM Primary FM ROS Reactive Oxygen Species SIQ Symptom Impact Questionnaire SFM Secondary FM SNRIs Serotonin and Norepinephrine Reuptake Inhibitors SSRIs Serotonin Selective Reuptake Inhibitors SSS Symptom Severity Scale TCAs Tricyclic Antidepressant TNF↵ Tumor necrosis factor alpha VAS Visual Analog Scale WPI Widespread Pain Index D9-THC Delta 9-tetrahydrocannabinol Int. J. Mol. Sci. 2020, 21, 7877 18 of 27 References 1. Wang, S.M.; Han, C.; Lee, S.J.; Patkar, A.A.; Masand, P.S.; Pae, C.U. Fibromyalgia diagnosis: A review of the past, present and future. Expert Rev. Neurother. 2015, 15, 667–679. [CrossRef] [PubMed] 2. Chinn, S.; Caldwell, W.; Gritsenko, K. Fibromyalgia pathogenesis and treatment options update. Curr. Pain Headache Rep. 2016, 20, 25. [CrossRef] [PubMed] 3. Blanco, I.; Beritze, N.; Arguelles, M.; Carcaba, V.; Fernandez, F.; Janciauskiene, S.; Oikonomopoulou, K.; de Serres, F.J.; Fernandez-Bustillo, E.; Hollenberg, M.D. Abnormal overexpression of mastocytes in skin biopsies of fibromyalgia patients. Clin. Rheumatol. 2010, 29, 1403–1412. [CrossRef] [PubMed] 4. Cabo-Meseguer, A.; Cerda-Olmedo, G.; Trillo-Mata, J.L. Fibromyalgia: Prevalence, epidemiologic profiles and economic costs. Med. Clin. 2017, 149, 441–448. [CrossRef] [PubMed] 5. Williams, D.A.; Schilling, S. Advances in the assessment of fibromyalgia. Rheum. Dis. Clin. N. Am. 2009, 35, 339–357. [CrossRef] [PubMed] 6. Rahman, A.; Underwood, M.; Carnes, D. Fibromyalgia. BMJ Br. Med. J. 2014, 348. [CrossRef] [PubMed] 7. McBeth, J.; Mulvey, M.R. Fibromyalgia: Mechanisms and potential impact of the acr 2010 classification criteria. Nat. Rev. Rheumatol. 2012, 8, 108–116. [CrossRef] [PubMed] 8. Arnold, L.M.; Clauw, D.J.; McCarberg, B.H.; FibroCollaborative. Improving the recognition and diagnosis of fibromyalgia. Mayo Clin. Proc. 2011, 86, 457–464. [CrossRef] 9. Wolfe, F.; Smythe, H.A.; Yunus, M.B.; Bennett, R.M.; Bombardier, C.; Goldenberg, D.L.; Tugwell, P.; Campbell, S.M.; Abeles, M.; Clark, P.; et al. The american-college-of-rheumatology 1990 criteria for the classification of fibromyalgia—Report of the multicenter criteria committee. Arthritis Rheum. 1990, 33, 160–172. [CrossRef] 10. Dworkin, R.H.; Turk, D.C.; McDermott, M.P.; Peirce-Sandner, S.; Burke, L.B.; Cowan, P.; Farrar, J.T.; Hertz, S.; Raja, S.N.; Rappaport, B.A.; et al. Interpreting the clinical importance of group di↵erences in chronic pain clinical trials: Immpact recommendations. Pain 2009, 146, 238–244. [CrossRef] 11. Arnold, L.M.; Cro↵ord, L.J.; Mease, P.J.; Burgess, S.M.; Palmer, S.C.; Abetz, L.; Martin, S.A. Patient perspectives on the impact of fibromyalgia. Patient Educ. Couns. 2008, 73, 114–120. [CrossRef] [PubMed] 12. Wolfe, F.; Hauser, W. Fibromyalgia diagnosis and diagnostic criteria. Ann. Med. 2011, 43, 495–502. [CrossRef] [PubMed] 13. Wolfe, F. New american college of rheumatology criteria for fibromyalgia: A twenty-year journey. Arthritis Care Res. 2010, 62, 583–584. [CrossRef] [PubMed] 14. Wolfe, F.; Clauw, D.J.; Fitzcharles, M.A.; Goldenberg, D.L.; Hauser, W.; Katz, R.S.; Mease, P.; Russell, A.S.; Russell, I.J.; Winfield, J.B. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the acr preliminary diagnostic criteria for fibromyalgia. J. Rheumatol. 2011, 38, 1113–1122. [CrossRef] 15. Oncu, J.; Iliser, R.; Kuran, B. Do new diagnostic criteria for fibromyalgia provide treatment opportunity to those previously untreated? J. Back Musculoskelet. Rehabil. 2013, 26, 437–443. [CrossRef] 16. Wolfe, F.; Walitt, B.; Rasker, J.J.; Hauser, W. Primary and secondary fibromyalgia are the same: The universality of polysymptomatic distress. J. Rheumatol. 2019, 46, 204–212. [CrossRef] 17. Bellato, E.; Marini, E.; Castoldi, F.; Barbasetti, N.; Mattei, L.; Bonasia, D.E.; Blonna, D. Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment. Pain Res. Treat. 2012, 2012, 426130. [CrossRef] 18. Bennett, R.M.; Friend, R.; Marcus, D.; Bernstein, C.; Han, B.K.; Yachoui, R.; Deodhar, A.; Kaell, A.; Bonafede, P.; Chino, A.; et al. Criteria for the diagnosis of fibromyalgia: Validation of the modified 2010 preliminary american college of rheumatology criteria and the development of alternative criteria. Arthritis Care Res. 2014, 66, 1364–1373. [CrossRef] 19. Aggarwal, R.; Ringold, S.; Khanna, D.; Neogi, T.; Johnson, S.R.; Miller, A.; Brunner, H.I.; Ogawa, R.; Felson, D.; Ogdie, A.; et al. Distinctions between diagnostic and classification criteria? Arthritis Care Res. 2015, 67, 891–897. [CrossRef] 20. Taylor, W.J.; Fransen, J. Distinctions between diagnostic and classification criteria: Comment on the article by Aggarwal et al. Arthritis Care Res. 2016, 68, 149–150. [CrossRef] 21. Wolfe, F.; Clauw, D.J.; Fitzcharles, M.A.; Goldenberg, D.L.; Hauser, W.; Katz, R.L.; Mease, P.J.; Russell, A.S.; Russell, I.J.; Walitt, B. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin. Arthritis Rheum. 2016, 46, 319–329. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 19 of 27 22. Bidari, A.; Parsa, B.G.; Ghalehbaghi, B. Challenges in fibromyalgia diagnosis: From meaning of symptoms to fibromyalgia labeling. Korean J. Pain 2018, 31, 147–154. [CrossRef] 23. Treede, R.D.; Rief, W.; Barke, A.; Aziz, Q.; Bennett, M.I.; Benoliel, R.; Cohen, M.; Evers, S.; Finnerup, N.B.; First, M.B.; et al. Chronic pain as a symptom or a disease: The IASP classification of chronic pain for the international classification of diseases (ICD-11). Pain 2019, 160, 19–27. [CrossRef] 24. Wolfe, F.; Schmukler, J.; Jamal, S.; Castrejon, I.; Gibson, K.A.; Srinivasan, S.; Hauser, W.; Pincus, T. Diagnosis of fibromyalgia: Disagreement between fibromyalgia criteria and clinician-based fibromyalgia diagnosis in a university clinic. Arthritis Care Res. 2019, 71, 343–351. [CrossRef] [PubMed] 25. Eich, W.; Bar, K.J.; Bernateck, M.; Burgmer, M.; Dexl, C.; Petzke, F.; Sommer, C.; Winkelmann, A.; Hauser, W. Definition, classification, clinical diagnosis and prognosis of fibromyalgia syndrome: Updated guidelines 2017 and overview of systematic review articles. Schmerz 2017, 31, 231–238. [CrossRef] [PubMed] 26. Ra↵aeli, W.; Malafoglia, V.; Bonci, A.; Tenti, M.; Ilari, S.; Gremigni, P.; Iannuccelli, C.; Gioia, C.; Di Franco, M.; Mollace, V.; et al. Identification of mor-positive b cell as possible innovative biomarker (mu lympho-marker) for chronic pain diagnosis in patients with fibromyalgia and osteoarthritis diseases. Int. J. Mol. Sci. 2020, 21, 15. [CrossRef] [PubMed] 27. Hackshaw, K.V.; Aykas, D.P.; Sigurdson, G.T.; Plans, M.; Madiai, F.; Yu, L.B.; Buffington, C.A.T.; Giusti, M.M.; Rodriguez-Saona, L. Metabolic fingerprinting for diagnosis of fibromyalgia and other rheumatologic disorders. J. Biol. Chem. 2019, 294, 2555–2568. [CrossRef] 28. Wolfe, F. Criteria for fibromyalgia? What is fibromyalgia? Limitations to current concepts of fibromyalgia and fibromyalgia criteria. Clin. Exp. Rheumatol. 2017, 35, S3–S5. 29. Walitt, B.; Nahin, R.L.; Katz, R.S.; Bergman, M.J.; Wolfe, F. The prevalence and characteristics of fibromyalgia in the 2012 national health interview survey. PLoS ONE 2015, 10, e0138024. [CrossRef] 30. Moore, R.A.; Straube, S.; Aldington, D. Pain measures and cut-o↵s—No worse than mild pain as a simple, universal outcome. Anaesthesia 2013, 68, 400–412. [CrossRef] 31. Espejo, J.A.; Garcia-Escudero, M.; Oltra, E. Unraveling the molecular determinants of manual therapy: An approach to integrative therapeutics for the treatment of fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis. Int. J. Mol. Sci. 2018, 19, 19. [CrossRef] [PubMed] 32. Calandre, E.P.; Rico-Villademoros, F.; Slim, M. An update on pharmacotherapy for the treatment of fibromyalgia. Expert Opin. Pharmacother. 2015, 16, 1347–1368. [CrossRef] [PubMed] 33. Thorpe, J.; Shum, B.; Moore, R.A.; Wi↵en, P.J.; Gilron, I. Combination pharmacotherapy for the treatment of fibromyalgia in adults. Cochrane Database Syst. Rev. 2018, 2. [CrossRef] [PubMed] 34. Mease, P.J.; Seymour, K. Fibromyalgia: Should the treatment paradigm be monotherapy or combination pharmacotherapy? Curr. Pain Headache Rep. 2008, 12, 399–405. [CrossRef] 35. Kwiatek, R. Treatment of fibromyalgia. Aust. Prescr. 2017, 40, 179–183. [CrossRef] 36. Wright, C.L.; Mist, S.D.; Ross, R.L.; Jones, K.D. Duloxetine for the treatment of fibromyalgia. Expert Rev. Clin. Immunol. 2010, 6, 745–756. [CrossRef] 37. Pacher, P.; Batkai, S.; Kunos, G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol. Rev. 2006, 58, 389–462. [CrossRef] 38. De Vries, M.; van Rijckevorsel, D.C.M.; Wilder-Smith, O.H.G.; van Goor, H. Dronabinol and chronic pain: Importance of mechanistic considerations. Expert Opin. Pharmacother. 2014, 15, 1525–1534. [CrossRef] 39. Russo, E.B. Clinical endocannabinoid deficiency (CECD)—Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocr. Lett. 2004, 25. (Reprinted from Neuroendocrinilogy, 2004, 25, 31–39). 40. Smith, S.C.; Wagner, M.S. Clinical endocannabinoid deficiency (CECD) revisited: Can this concept explain the therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocr. Lett. 2014, 35, 198–201. 41. Munro, S.; Thomas, K.L.; Abushaar, M. Molecular characterization of a peripheral receptor for cannabinoids. Nature 1993, 365, 61–65. [CrossRef] [PubMed] 42. Skrabek, R.Q.; Gallmova, L.; Ethans, K.; Perry, D. Nabilone for the treatment of pain in fibromyalgia. J. Pain 2008, 9, 164–173. [CrossRef] [PubMed] 43. Walitt, B.; Klose, P.; Fitzcharles, M.A.; Phillips, T.; Hauser, W. Cannabinoids for fibromyalgia. Cochrane Database Syst. Rev. 2016. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 20 of 27 44. Thomas, A.; Baillie, G.L.; Phillips, A.M.; Razdan, R.K.; Ross, R.A.; Pertwee, R.G. Cannabidiol displays unexpectedly high potency as an antagonist of cb1 and cb2 receptor agonists in vitro. Br. J. Pharmacol. 2007, 150, 613–623. [CrossRef] 45. Baumeister, D.; Eich, W.; Lerner, R.; Lutz, B.; Bindila, L.; Tesarz, J. Plasma parameters of the endocannabinoid system are unaltered in fibromyalgia. Psychother. Psychosom. 2018, 87, 377–379. [CrossRef] 46. Kaufmann, I.; Schelling, G.; Eisner, C.; Richter, H.P.; Krauseneck, T.; Vogeser, M.; Hauer, D.; Campolongo, P.; Chouker, A.; Beyer, A.; et al. Anandamide and neutrophil function in patients with fibromyalgia. Psychoneuroendocrinology 2008, 33, 676–685. [CrossRef] 47. Agarwal, N.; Pacher, P.; Tegeder, I.; Amaya, F.; Constantin, C.E.; Brenner, G.J.; Rubino, T.; Michalski, C.W.; Marsicano, G.; Monory, K.; et al. Cannabinoids mediate analgesia largely via peripheral type 1 cannabinoid receptors in nociceptors. Nat. Neurosci. 2007, 10, 870–879. [CrossRef] 48. Schley, M.; Legler, A.; Skopp, G.; Schmelz, M.; Konrad, C.; Rukwied, R. Delta-9-thc based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief. Curr. Med. Res. Opin. 2006, 22, 1269–1276. [CrossRef] 49. Fiz, J.; Duran, M.; Capella, D.; Carbonell, J.; Farre, M. Cannabis use in patients with fibromyalgia: E↵ect on symptoms relief and health-related quality of life. PLoS ONE 2011, 6, 5. [CrossRef] 50. Ware, M.A.; Fitzcharles, M.A.; Joseph, L.; Shir, Y. The e↵ects of nabilone on sleep in fibromyalgia: Results of a randomized controlled trial. Anesth. Analg. 2010, 110, 604–610. [CrossRef] 51. Fitzcharles, M.A.; Ste-Marie, P.A.; Goldenberg, D.L.; Pereira, J.X.; Abbey, S.; Choiniere, M.; Ko, G.; Moulin, D.E.; Panopalis, P.; Proulx, J.; et al. 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: Executive summary. Pain Res. Manag. 2013, 18, 119–126. [CrossRef] 52. Ste-Marie, P.A.; Fitzcharles, M.A.; Gamsa, A.; Ware, M.A.; Shir, Y. Association of herbal cannabis use with negative psychosocial parameters in patients with fibromyalgia. Arthritis Care Res. 2012, 64, 1202–1208. [CrossRef] [PubMed] 53. Painter, J.T.; Cro↵ord, L.J. Chronic opioid use in fibromyalgia syndrome a clinical review. JCR J. Clin. Rheumatol. 2013, 19, 72–77. [CrossRef] [PubMed] 54. Goldenberg, D.L.; Clauw, D.J.; Palmer, R.E.; Clair, A.G. Opioid use in fibromyalgia: A cautionary tale. Mayo Clin. Proc. 2016, 91, 640–648. [CrossRef] [PubMed] 55. Baraniuk, J.N.; Whalen, G.; Cunningham, J.; Clauw, D.J. Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain. BMC Musculoskelet. Disord. 2004, 5, 48. [CrossRef] 56. Fitzcharles, M.-A.; Faregh, N.; Ste-Marie, P.A.; Shir, Y. Opioid use in fibromyalgia is associated with negative health related measures in a prospective cohort study. Pain Res. Treat. 2013, 2013, 7. [CrossRef] 57. Peng, X.M.; Robinson, R.L.; Mease, P.; Kroenke, K.; Williams, D.A.; Chen, Y.; Faries, D.; Wohlreich, M.; McCarberg, B.; Hann, D. Long-term evaluation of opioid treatment in fibromyalgia. Clin. J. Pain 2015, 31, 7–13. [CrossRef] 58. Hwang, J.M.; Lee, B.J.; Oh, T.H.; Park, D.; Kim, C.H. Association between initial opioid use and response to a brief interdisciplinary treatment program in fibromyalgia. Medicine 2019, 98, 8. [CrossRef] 59. Harris, R.E.; Clauw, D.J.; Scott, D.J.; McLean, S.A.; Gracely, R.H.; Zubieta, J.K. Decreased central mu-opioid receptor availability in fibromyalgia. J. Neurosci. 2007, 27, 10000–10006. [CrossRef] 60. Bennett, R.M.; Jones, J.; Turk, D.C.; Russell, I.J.; Matallana, L. An internet survey of 2596 people with fibromyalgia. BMC Musculoskelet. Disord. 2007, 8, 27. 61. Hilliard, P.E.; Waljee, J.; Moser, S.; Metz, L.; Mathis, M.; Goesling, J.; Cron, D.; Clauw, D.J.; Englesbe, M.; Abecasis, G.; et al. Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgeryprevalence of preoperative opioid use and associated patient characteristicsprevalence of preoperative opioid use and associated patient characteristics. JAMA Surg. 2018, 153, 929–937. [PubMed] 62. Gaskell, H.; Moore, R.A.; Derry, S.; Stannard, C. Oxycodone for pain in fibromyalgia in adults. Cochrane Database Syst. Rev. 2016, 23. [CrossRef] 63. Ruette, P.; Stuyck, J.; Debeer, P. Neuropathic arthropathy of the shoulder and elbow associated with syringomyelia: A report of 3 cases. Acta Orthop. Belg. 2007, 73, 525–529. [PubMed] 64. Williams, E.R.; Ford, C.M.; Simonds, J.G.; Leal, A.K. Blocking peripheral opioid receptors with naloxone methiodide prevents acute and chronic training-induced analgesia in a rat model of fibromyalgia. FASEB J. 2017, 31, 1. Int. J. Mol. Sci. 2020, 21, 7877 21 of 27 65. Hermans, L.; Nijs, J.; Calders, P.; De Clerck, L.; Moorkens, G.; Hans, G.; Grosemans, S.; De Mettelinge, T.R.; Tuynman, J.; Meeus, M. Influence of morphine and naloxone on pain modulation in rheumatoid arthritis, chronic fatigue syndrome/fibromyalgia, and controls: A double-blind, randomized, placebo-controlled, cross-over study. Pain Pract. 2018, 18, 418–430. [CrossRef] 66. MacLean, A.J.B.; Schwartz, T.L. Tramadol for the treatment of fibromyalgia. Expert Rev. Neurother. 2015, 15, 469–475. [CrossRef] 67. Gur, A.; Calgan, N.; Nas, K.; Cevik, R.; Sarac, A.J. Low dose of tramadol in the treatment of fibromyalgia syndrome: A controlled clinical trial versus placebo. Ann. Rheum. Dis. 2006, 65, 556. 68. Mullican, W.S.; Lacy, J.R.; TRAMAP-ANAG-006 Study Group. Tramadol/acetaminophen combination tablets and codeine/acetaminophen combination capsules for the management of chronic pain: A comparative trial. Clin. Ther. 2001, 23, 1429–1445. [CrossRef] 69. Price, D.D.; Staud, R.; Robinson, M.E.; Mauderli, A.P.; Cannon, R.; Vierck, C.J. Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients. Pain 2002, 99, 49–59. [CrossRef] 70. Larabi, I.A.; Martin, M.; Fabresse, N.; Etting, I.; Edel, Y.; Pfau, G.; Alvarez, J.C. Hair testing for 3-fluorofentanyl, furanylfentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl and fentanyl by lc-ms/ms after unintentional overdose. Forensic Toxicol. 2020, 38, 277–286. [CrossRef] 71. Comer, S.D.; Cahill, C.M. Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment. Neurosci. Biobehav. Rev. 2019, 106, 49–57. [CrossRef] [PubMed] 72. Abeles, A.M.; Pillinger, M.H.; Solitar, B.M.; Abeles, M. Narrative review: The pathophysiology of fibromyalgia. Ann. Intern. Med. 2007, 146, 726–734. [CrossRef] 73. Watkins, L.R.; Maier, S.F. Immune regulation of central nervous system functions: From sickness responses to pathological pain. J. Intern. Med. 2005, 257, 139–155. [CrossRef] 74. Khalil, R.B. Pentoxifylline’s theoretical efficacy in the treatment of fibromyalgia syndrome. Pain Med. 2013, 14, 549–550. [CrossRef] 75. Polli, A.; Ghosh, M.; Bakusic, J.; Ickmans, K.; Monteyne, D.; Velkeniers, B.; Bekaert, B.; Godderis, L.; Nijs, J. DNA methylation and brain-derived neurotrophic factor expression account for symptoms and widespread hyperalgesia in patients with chronic fatigue syndrome and comorbid fibromyalgia. Arthritis Rheumatol. 2020. [CrossRef] 76. Scott, J.R.; Hassett, A.L.; Brummett, C.M.; Harris, R.E.; Clauw, D.J.; Harte, S.E. Ca↵eine as an opioid analgesic adjuvant in fibromyalgia. J. Pain Res. 2017, 10, 1801–1809. [CrossRef] [PubMed] 77. Goodman, C.W.; Brett, A.S. A clinical overview of o↵-label use of gabapentinoid drugs. JAMA Intern. Med. 2019, 179, 695–701. [CrossRef] 78. Micheva, K.D.; Buchanan, J.; Holz, R.W.; Smith, S.J. Retrograde regulation of synaptic vesicle endocytosis and recycling. Nat. Neurosci. 2003, 6, 925–932. [CrossRef] 79. Deitos, A.; Soldatelli, M.D.; Dussan-Sarria, J.A.; Souza, A.; Torres, I.L.D.; Fregni, F.; Caumo, W. Novel insights of e↵ects of pregabalin on neural mechanisms of intracortical disinhibition in physiopathology of fibromyalgia: An explanatory, randomized, double-blind crossover study. Front. Hum. Neurosci. 2018, 12, 14. [CrossRef] 80. Kiso, T.; Moriyama, A.; Furutani, M.; Matsuda, R.; Funatsu, Y. E↵ects of pregabalin and duloxetine on neurotransmitters in the dorsal horn of the spinal cord in a rat model of fibromyalgia. Eur. J. Pharmacol. 2018, 827, 117–124. [CrossRef] 81. Gerardi, M.C.; Atzeni, F.; Batticciotto, A.; Di Franco, M.; Rizzi, M.; Sarzi-Puttini, P. The safety of pregabalin in the treatment of fibromyalgia. Expert Opin. Drug Saf. 2016, 15, 1541–1548. [CrossRef] [PubMed] 82. Hirakata, M.; Yoshida, S.; Tanaka-Mizuno, S.; Kuwauchi, A.; Kawakami, K. Pregabalin prescription for neuropathic pain and fibromyalgia: A descriptive study using administrative database in Japan. Pain Res. Manag. 2018, 10. [CrossRef] [PubMed] 83. Asomaning, K.; Abramsky, S.; Liu, Q.; Zhou, X.; Sobel, R.E.; Watt, S. Pregabalin prescriptions in the United Kingdom: A drug utilisation study of the health improvement network (thin) primary care database. Int J. Clin. Pr. 2016, 70, 380–388. [CrossRef] 84. Ferreira-Dos-Santos, G.; Sousa, D.C.; Costa, J.; Vaz-Carneiro, A. Analysis of the cochrane review: Pregabalin for pain in fibromyalgia in adults. Cochrane database syst rev. 2016; 9: Cd011790 and 2016; 4: Cd009002. Acta Med. Port. 2018, 31, 376–381. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 22 of 27 85. Bhusal, S.; Diomampo, S.; Magrey, M.N. Clinical utility, safety, and efficacy of pregabalin in the treatment of fibromyalgia. Drug Healthc. Patient Saf. 2016, 8, 13–23. [CrossRef] 86. Arnold, L.M.; Choy, E.; Clauw, D.J.; Oka, H.; Whalen, E.; Semel, D.; Pauer, L.; Knapp, L. An evidence-based review of pregabalin for the treatment of fibromyalgia. Curr. Med. Res. Opin. 2018, 34, 1397–1409. [CrossRef] [PubMed] 87. Cooper, T.E.; Derry, S.; Wi↵en, P.J.; Moore, R.A. Gabapentin for fibromyalgia pain in adults. Cochrane Database Syst. Rev. 2017. [CrossRef] [PubMed] 88. Walitt, B.; Urrutia, G.; Nishishinya, M.B.; Cantrell, S.E.; Hauser, W. Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database Syst. Rev. 2015, 66. [CrossRef] 89. Welsch, P.; Uceyler, N.; Klose, P.; Walitt, B.; Hauser, W. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst. Rev. 2018, 111. [CrossRef] 90. Grubisic, F. Are serotonin and noradrenaline reuptake inhibitors e↵ective, tolerable, and safe for adults with fibromyalgia? A cochrane review summary with commentary. J. Musculoskelet. Neuronal. Interact. 2018, 18, 404–406. 91. VanderWeide, L.A.; Smith, S.M.; Trinkley, K.E. A systematic review of the efficacy of venlafaxine for the treatment of fibromyalgia. J. Clin. Pharm. Ther. 2015, 40, 1–6. [CrossRef] [PubMed] 92. Miki, K.; Murakami, M.; Oka, H.; Onozawa, K.; Yoshida, S.; Osada, K. Efficacy of mirtazapine for the treatment of fibromyalgia without concomitant depression: A randomized, double-blind, placebo-controlled phase IIa study in Japan. Pain 2016, 157, 2089–2096. [CrossRef] 93. Deboer, T. The pharmacologic profile of mirtazapine. J. Clin. Psychiatry 1996, 57, 19–25. 94. Ottman, A.A.; Warner, C.B.; Brown, J.N. The role of mirtazapine in patients with fibromyalgia: A systematic review. Rheumatol. Int. 2018, 38, 2217–2224. [CrossRef] [PubMed] 95. Rico-Villademoros, F.; Slim, M.; Calandre, E.P. Amitriptyline for the treatment of fibromyalgia: A comprehensive review. Expert Rev. Neurother. 2015, 15, 1123–1150. [CrossRef] 96. Moore, R.A.; Derry, S.; Aldington, D.; Cole, P.; Wi↵en, P.J. Amitriptyline for fibromyalgia in adults. Cochrane Database Syst. Rev. 2015. [CrossRef] 97. De Tommaso, M.; Delussi, M.; Ricci, K.; D’Angelo, G. Abdominal acupuncture changes cortical responses to nociceptive stimuli in fibromyalgia patients. CNS Neurosci. Ther. 2014, 20, 565–567. [CrossRef] 98. Karatay, S.; Okur, S.C.; Uzkeser, H.; Yildirim, K.; Akcay, F. E↵ects of acupuncture treatment on fibromyalgia symptoms, serotonin, and substance p levels: A randomized sham and placebo-controlled clinical trial. Pain Med. 2018, 19, 615–628. [CrossRef] 99. Deare, J.C.; Zheng, Z.; Xue, C.C.L.; Liu, J.P.; Shang, J.S.; Scott, S.W.; Littlejohn, G. Acupuncture for treating fibromyalgia. Cochrane Database Syst. Rev. 2013. [CrossRef] 100. Cao, H.J.; Li, X.; Han, M.; Liu, J.P. Acupoint stimulation for fibromyalgia: A systematic review of randomized controlled trials. Evid. Based Complementary Altern. Med. 2013, 2013, 1–15. [CrossRef] 101. Zhang, X.C.; Chen, H.; Xu, W.T.; Song, Y.Y.; Gu, Y.H.; Ni, G.X. Acupuncture therapy for fibromyalgia: A systematic review and meta-analysis of randomized controlled trials. J. Pain Res. 2019, 12, 527–542. [CrossRef] [PubMed] 102. Tesio, V.; Torta, D.M.E.; Colonna, F.; Leombruni, P.; Ghiggia, A.; Fusaro, E.; Geminiani, G.C.; Torta, R.; Castelli, L. Are fibromyalgia patients cognitively impaired? Objective and subjective neuropsychological evidence. Arthritis Care Res. 2015, 67, 143–150. [CrossRef] [PubMed] 103. Gelonch, O.; Garolera, M.; Valls, J.; Rossello, L.; Pifarre, J. Executive function in fibromyalgia: Comparing subjective and objective measures. Compr. Psychiatry 2016, 66, 113–122. [CrossRef] [PubMed] 104. Zhu, C.E.; Yu, B.; Zhang, W.; Chen, W.H.; Qi, Q.; Miao, Y. E↵ectiveness and safety of transcranial direct current stimulation in fibromyalgia: A systematic review and meta-analysis. J. Rehabil. Med. 2017, 49, 2–9. [CrossRef] 105. Brighina, F.; Curatolo, M.; Cosentino, G.; De Tommaso, M.; Battaglia, G.; Sarzi-Puttini, P.C.; Guggino, G.; Fierro, B. Brain modulation by electric currents in fibromyalgia: A structured review on non-invasive approach with transcranial electrical stimulation. Front. Hum. Neurosci. 2019, 13, 14. [CrossRef] 106. Dos Santos, V.S.; Zortea, M.; Alves, R.L.; Naziazeno, C.C.D.; Saldanha, J.S.; de Carvalho, S.D.R.; Leite, A.J.D.; Torres, I.L.D.; de Souza, A.; Calvetti, P.U.; et al. Cognitive e↵ects of transcranial direct current stimulation combined with working memory training in fibromyalgia: A randomized clinical trial. Sci Rep. 2018, 8, 11. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 23 of 27 107. Eken, A.; Kara, M.; Baskak, B.; Baltaci, A.; Gokcay, D. Di↵erential efficiency of transcutaneous electrical nerve stimulation in dominant versus nondominant hands in fibromyalgia: Placebo-controlled functional near-infrared spectroscopy study. Neurophotonics 2018, 5, 15. [CrossRef] 108. Yuksel, M.; Ayas, S.; Cabioglu, M.T.; Yilmaz, D.; Cabioglu, C. Quantitative data for transcutaneous electrical nerve stimulation and acupuncture e↵ectiveness in treatment of fibromyalgia syndrome. Evid. Based Complementary Altern. Med. 2019, 12, 362831. [CrossRef] 109. Ahmed, S.; Plazier, M.; Ost, J.; Stassijns, G.; Deleye, S.; Ceyssens, S.; Dupont, P.; Stroobants, S.; Staelens, S.; De Ridder, D.; et al. The e↵ect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: A water pet and EEG imaging study. BMC Neurol. 2018, 18, 10. [CrossRef] 110. Sutbeyaz, S.T.; Sezer, N.; Koseoglu, F.; Kibar, S. Low-frequency pulsed electromagnetic field therapy in fibromyalgia a randomized, double-blind, sham-controlled clinical study. Clin. J. Pain 2009, 25, 722–728. [CrossRef] 111. Multanen, J.; Hakkinen, A.; Heikkinen, P.; Kautiainen, H.; Mustalampi, S.; Ylinen, J. Pulsed electromagnetic field therapy in the treatment of pain and other symptoms in fibromyalgia: A randomized controlled study. Bioelectromagnetics 2018, 39, 405–413. [CrossRef] 112. Cruccu, G.; Garcia-Larrea, L.; Hansson, P.; Keindl, M.; Lefaucheur, J.P.; Paulus, W.; Taylor, R.; Tronnier, V.; Truini, A.; Attal, N. Ean guidelines on central neurostimulation therapy in chronic pain conditions. Eur. J. Neurol. 2016, 23, 1489–1499. [CrossRef] 113. Knijnik, L.M.; Dussan-Sarria, J.A.; Rozisky, J.R.; Torres, I.L.S.; Brunoni, A.R.; Fregni, F.; Caumo, W. Repetitive transcranial magnetic stimulation for fibromyalgia: Systematic review and meta-analysis. Pain Pract. 2016, 16, 294–304. [CrossRef] 114. Thut, G.; Schyns, P.G.; Gross, J. Entrainment of perceptually relevant brain oscillations by non-invasive rhythmic stimulation of the human brain. Front. Psychol. 2011, 2, 170. [CrossRef] 115. Weber, A.; Werneck, L.; Paiva, E.; Gans, P. E↵ects of music in combination with vibration in acupuncture points on the treatment of fibromyalgia. J. Altern. Complement. Med. 2015, 21, 77–82. [CrossRef] 116. Chesky, K.S.; Russell, I.J.; Lopez, Y.; Kondraske, G.V. Fibromyalgia tender point pain: A double-blind, placebo-controlled pilot study of music vibration using the music vibration table. J. Musculoskelet. Pain 1997, 5, 33–52. [CrossRef] 117. Naghdi, L.; Ahonen, H.; Macario, P.; Bartel, L. The e↵ect of low-frequency sound stimulation on patients with fibromyalgia: A clinical study. Pain Res. Manag. 2015, 20, E21–E27. [CrossRef] [PubMed] 118. Janzen, T.B.; Paneduro, D.; Picard, L.; Gordon, A.; Bartel, L.R. A parallel randomized controlled trial examining the e↵ects of rhythmic sensory stimulation on fibromyalgia symptoms. PLoS ONE 2019, 14, 19. [CrossRef] [PubMed] 119. Ablin, J.N.; Hauser, W.; Buskila, D. Spa Treatment (Balneotherapy) for Fibromyalgia—A Qualitative-Narrative Review and a Historical Perspective. Evid. Based Complementary Altern. Med. 2013, 2013, 638050. [CrossRef] [PubMed] 120. Neumann, L.; Sukenik, S.; Bolotin, A.; Abu-Shakra, M.; Amir, A.; Flusser, D.; Buskila, D. The e↵ect of balneotherapy at the dead sea on the quality of life of patients with fibromyalgia syndrome. Clin. Rheumatol. 2001, 20, 15–19. [CrossRef] 121. Mist, S.D.; Firestone, K.A.; Jones, K.D. Complementary and alternative exercise for fibromyalgia: A meta-analysis. J. Pain Res. 2013, 6, 247–260. [CrossRef] 122. Fioravanti, A.; Perpignano, G.; Tirri, G.; Cardinale, G.; Gianniti, C.; Lanza, C.E.; Loi, A.; Tirri, E.; Sfriso, P.; Cozzi, F. E↵ects of mud-bath treatment on fibromyalgia patients: A randomized clinical trial. Rheumatol. Int. 2007, 27, 1157–1161. [CrossRef] 123. Maeda, T.; Kudo, Y.; Horiuchi, T.; Makino, N. Clinical and anti-aging e↵ect of mud-bathing therapy for patients with fibromyalgia. Mol. Cell. Biochem. 2018, 444, 87–92. [CrossRef] 124. Guidelli, G.M.; Tenti, S.; De Nobili, E.; Fioravanti, A. Fibromyalgia syndrome and spa therapy: Myth or reality? Clin. Med. Insights Arthritis Musculoskelet. Disord. 2012, 5, 19–26. [CrossRef] 125. Ernst, E.; Fialka, V. Ice freezes pain—A review of the clinical e↵ectiveness of analgesic cold therapy. J. Pain Symptom Manag. 1994, 9, 56–59. [CrossRef] 126. Rivera, J.; Tercero, M.J.; Salas, J.S.; Gimeno, J.H.; Alejo, J.S. The e↵ect of cryotherapy on fibromyalgia: A randomised clinical trial carried out in a cryosauna cabin. Rheumatol. Int. 2018, 38, 2243–2250. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 24 of 27 127. Bettoni, L.; Bonomi, F.G.; Zani, V.; Manisco, L.; Indelicato, A.; Lanteri, P.; Banfi, G.; Lombardi, G. E↵ects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients. Clin. Rheumatol. 2013, 32, 1337–1345. [CrossRef] 128. Sutherland, A.M.; Clarke, H.A.; Katz, J.; Katznelson, R. Hyperbaric oxygen therapy: A new treatment for chronic pain? Pain Pract. 2016, 16, 620–628. [CrossRef] 129. Bennett, M.H.; French, C.; Schnabel, A.; Wasiak, J.; Kranke, P.; Weibel, S. Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache. Cochrane Database Syst. Rev. 2015. [CrossRef] 130. Yildiz, S.; Kiralp, M.Z.; Akin, A.; Keskin, I.; Ay, H.; Dursun, H.; Cimsit, M. A new treatment modality for fibromyalgia syndrome: Hyperbaric oxygen therapy. J. Int. Med Res. 2004, 32, 263–267. [CrossRef] [PubMed] 131. Boussi-Gross, R.; Golan, H.; Fishlev, G.; Bechor, Y.; Volkov, O.; Bergan, J.; Friedman, M.; Hoofien, D.; Shlamkovitch, N.; Ben-Jacob, E.; et al. Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury—Randomized prospective trial. PLoS ONE 2013, 8, e79995. [CrossRef] [PubMed] 132. Efrati, S.; Golan, H.; Bechor, Y.; Faran, Y.; Daphna-Tekoah, S.; Sekler, G.; Fishlev, G.; Ablin, J.N.; Bergan, J.; Volkov, O.; et al. Hyperbaric oxygen therapy can diminish fibromyalgia syndrome—Prospective clinical trial. PLoS ONE 2015, 10, e0127012. [CrossRef] [PubMed] 133. El-Shewy, K.M.; Kunbaz, A.; Gad, M.M.; Al-Husseini, M.J.; Saad, A.M.; Sammour, Y.M.; Abdel-Daim, M.M. Hyperbaric oxygen and aerobic exercise in the long-term treatment of fibromyalgia: A narrative review. Biomed. Pharmacother. 2019, 109, 629–638. [CrossRef] [PubMed] 134. Kisselev, S.B.; Moskvin, S.V. The use of laser therapy for patients with fibromyalgia: A critical literary review. J. Lasers Med. Sci. 2019, 10, 12–20. [CrossRef] 135. White, P.F.; Zafereo, J.; Elvir-Lazo, O.L.; Hernandez, H. Treatment of drug-resistant fibromyalgia symptoms using high-intensity laser therapy: A case-based review. Rheumatol. Int. 2018, 38, 517–523. [CrossRef] 136. Gur, A.; Karakoc, M.; Nas, K.; Cevik, R.; Sarac, A.J.; Ataoglu, S. E↵ects of low power laser and low dose amitriptyline therapy on clinical symptoms and quality of life in fibromyalgia: A single-blind, placebo-controlled trial. Rheumatol. Int. 2002, 22, 188–193. 137. Panton, L.; Simonavice, E.; Williams, K.; Mojock, C.; Kim, J.S.; Kingsley, J.D.; McMillan, V.; Mathis, R. E↵ects of class IV laser therapy on fibromyalgia impact and function in women with fibromyalgia. J. Altern. Complement. Med. 2013, 19, 445–452. [CrossRef] 138. Ruaro, J.A.; Frez, A.R.; Ruaro, M.B.; Nicolau, R.A. Low-level laser therapy to treat fibromyalgia. Lasers Med. Sci. 2014, 29, 1815–1819. [CrossRef] 139. Da Silva, M.M.; Albertini, R.; Leal, E.C.P.; de Carvalho, P.D.C.; Silva, J.A.; Bussadori, S.K.; de Oliveira, L.V.F.; Casarin, C.A.S.; Andrade, E.L.; Bocalini, D.S.; et al. E↵ects of exercise training and photobiomodulation therapy (extraphoto) on pain in women with fibromyalgia and temporomandibular disorder: Study protocol for a randomized controlled trial. Trials 2015, 16, 8. [CrossRef] 140. Busch, A.J.; Webber, S.C.; Brachaniec, M.; Bidonde, J.; Dal Bello-Haas, V.; Danyliw, A.D.; Overend, T.J.; Richards, R.S.; Sawant, A.; Schachter, C.L. Exercise therapy for fibromyalgia. Curr. Pain Headache Rep. 2011, 15, 358–367. [CrossRef] 141. Jones, K.D.; Adams, D.; Winters-Stone, K.; Burckhardt, C.S. A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988–2005). Health Qual. Life Outcomes 2006, 4, 67. [CrossRef] [PubMed] 142. Bidonde, J.; Busch, A.J.; Schachter, C.L.; Webber, S.C.; Musselman, K.E.; Overend, T.J.; Goes, S.M.; Dal Bello-Haas, V.; Boden, C. Mixed exercise training for adults with fibromyalgia. Cochrane Database Syst. Rev. 2019, 208. [CrossRef] 143. Assumpção, A.; Matsutani, L.A.; Yuan, S.L.; Santo, A.S.; Sauer, J.; Mango, P.; Marques, A.P. Muscle stretching exercises and resistance training in fibromyalgia: Which is better? A three-arm randomized controlled trial. Eur. J. Phys. Rehabil. Med. 2018, 54, 663–670. [CrossRef] 144. Nelson, N.L. Muscle strengthening activities and fibromyalgia: A review of pain and strength outcomes. J. Bodyw. Mov. Ther. 2015, 19, 370–376. [CrossRef] 145. Sanudo, B.; Galiano, D.; Carrasco, L.; Blagojevic, M.; de Hoyo, M.; Saxton, J. Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: A randomized controlled trial. Arch. Phys. Med. Rehabil. 2010, 91, 1838–1843. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 25 of 27 146. Umeda, M.; Corbin, L.W.; Maluf, K.S. Pain mediates the association between physical activity and the impact of fibromyalgia on daily function. Clin. Rheumatol. 2015, 34, 143–149. [CrossRef] [PubMed] 147. Bement, M.K.H.; Weyer, A.; Hartley, S.; Drewek, B.; Harkins, A.L.; Hunter, S.K. Pain perception after isometric exercise in women with fibromyalgia. Arch. Phys. Med. Rehabil. 2011, 92, 89–95. [CrossRef] 148. Carson, J.W.; Carson, K.M.; Jones, K.D.; Bennett, R.M.; Wright, C.L.; Mist, S.D. A pilot randomized controlled trial of the yoga of awareness program in the management of fibromyalgia. Pain 2010, 151, 530–539. [CrossRef] 149. De Oliveira, F.R.; Goncalves, L.C.V.; Borghi, F.; da Silva, L.; Gomes, A.E.; Trevisan, G.; de Souza, A.L.; Grassi-Kassisse, D.M.; Crege, D. Massage therapy in cortisol circadian rhythm, pain intensity, perceived stress index and quality of life of fibromyalgia syndrome patients. Complement. Ther. Clin. Pract. 2018, 30, 85–90. [CrossRef] 150. Tomas-Carus, P.; Hakkinen, A.; Gusi, N.; Leal, A.; Hakkinen, K.; Ortega-Alonso, A. Aquatic training and detraining on fitness and quality of life in fibromyalgia. Med. Sci. Sports Exerc. 2007, 39, 1044–1050. [CrossRef] 151. Gusi, N.; Tomas-Carus, P. Cost-utility of an 8-month aquatic training for women with fibromyalgia: A randomized controlled trial. Arthritis Res. Ther. 2008, 10, 8. [CrossRef] [PubMed] 152. Andrade, C.P.; Zamuner, A.R.; Forti, M.; Franca, T.F.; Tamburus, N.Y.; Silva, E. Oxygen uptake and body composition after aquatic physical training in women with fibromyalgia: A randomized controlled trial. Eur. J. Phys. Rehabil. Med. 2017, 53, 751–758. 153. Bidonde, J.; Busch, A.J.; Schachter, C.L.; Overend, T.J.; Kim, S.Y.; Goes, S.; Boden, C.; Foulds, H.J.A. Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst. Rev. 2017. [CrossRef] 154. Bidonde, J.; Busch, A.J.; Webber, S.C.; Schachter, C.L.; Danyliw, A.; Overend, T.J.; Richards, R.S.; Rader, T. Aquatic exercise training for fibromyalgia. Cochrane Database Syst. Rev. 2014, 177. [CrossRef] [PubMed] 155. Marske, C.; Bernard, N.; Palacios, A.; Wheeler, C.; Preiss, B.; Brown, M.; Bhattacharya, S.; Klapstein, G. Fibromyalgia with gabapentin and osteopathic manipulative medicine: A pilot study. J. Altern. Complement. Med. 2018, 24, 395–402. [CrossRef] [PubMed] 156. Baptista, A.S.; Villela, A.L.; Jones, A.; Natour, J. E↵ectiveness of dance in patients with fibromyalgia: A randomised, single-blind, controlled study. Clin. Exp. Rheumatol. 2012, 30, S18–S23. 157. Assunção, J.C.; Silva, H.J.D.; da Silva, J.F.C.; Cruz, R.D.; Lins, C.A.D.; de Souza, M.C. Zumba dancing can improve the pain and functional capacity in women with fibromyalgia. J. Bodyw. Mov. Ther. 2018, 22, 455–459. [CrossRef] 158. Wang, C.C.; Schmid, C.H.; Fielding, R.A.; Harvey, W.F.; Reid, K.F.; Price, L.L.; Driban, J.B.; Kalish, R.; Rones, R.; McAlindon, T. E↵ect of tai chi versus aerobic exercise for fibromyalgia: Comparative e↵ectiveness randomized controlled trial. BMJ Br. Med J. 2018, 360, 14. [CrossRef] 159. Cryan, J.F.; Dinan, T.G. Mind-altering microorganisms: The impact of the gut microbiota on brain and behaviour. Nat. Rev. Neurosci. 2012, 13, 701–712. [CrossRef] 160. Galland, L. The gut microbiome and the brain. J. Med. Food 2014, 17, 1261–1272. [CrossRef] 161. Goebel, A.; Buhner, S.; Schedel, R.; Lochs, H.; Sprotte, G. Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome. Rheumatology 2008, 47, 1223–1227. [CrossRef] 162. Mayer, E.A.; Tillisch, K.; Gupta, A. Gut/brain axis and the microbiota. J. Clin. Investig. 2015, 125, 926–938. [CrossRef] 163. Roman, P.; Estevez, A.F.; Mires, A.; Sanchez-Labraca, N.; Canadas, F.; Vivas, A.B.; Cardona, D. A pilot randomized controlled trial to explore cognitive and emotional e↵ects of probiotics in fibromyalgia. Sci Rep. 2018, 8, 9. [CrossRef] [PubMed] 164. Butler, D. Translational research: Crossing the valley of death. Nature 2008, 453, 840–842. [CrossRef] 165. Nascimento, S.D.; DeSantana, J.M.; Nampo, F.K.; Ribeiro, E.A.N.; da Silva, D.L.; Araujo, J.X.; Almeida, J.; Bonjardim, L.R.; Araujo, A.A.D.; Quintans, L.J. Efficacy and safety of medicinal plants or related natural products for fibromyalgia: A systematic review. Evid. Based Complementary Altern. Med. 2013. [CrossRef] [PubMed] 166. Brownstein, M.J. A brief-history of opiates, opioid-peptides, and opioid receptors. Proc. Natl. Acad. Sci. USA 1993, 90, 5391–5393. [CrossRef] 167. Benyhe, S. Morphine—New aspects in the study of an ancient compound. Life Sci. 1994, 55, 969–979. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 26 of 27 168. Meng, I.D.; Manning, B.H.; Martin, W.J.; Fields, H.L. An analgesia circuit activated by cannabinoids. Nature 1998, 395, 381–383. [CrossRef] 169. Sagy, I.; Schleider, L.B.L.; Abu-Shakra, M.; Novack, V. Safety and efficacy of medical cannabis in fibromyalgia. J. Clin. Med. 2019, 8, 12. [CrossRef] 170. Van de Donk, T.; Niesters, M.; Kowal, M.A.; Olofsen, E.; Dahan, A.; van Velzen, M. An experimental randomized study on the analgesic e↵ects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain 2019, 160, 860–869. [CrossRef] 171. Habib, G.; Artul, S. Medical cannabis for the treatment of fibromyalgia. JCR J. Clin. Rheumatol. 2018, 24, 255–258. [CrossRef] [PubMed] 172. Habib, G.; Avisar, I. The consumption of cannabis by fibromyalgia patients in Israel. Pain Res. Treat. 2018, 5, 7829427. [CrossRef] 173. Ma↵ei, M.E. Plant natural sources of the endocannabinoid (e)- -caryophyllene: A systematic quantitative analysis of published literature. Int. J. Mol. Sci. 2020, 21, 6540. [CrossRef] [PubMed] 174. Paula-Freire, L.I.G.; Andersen, M.L.; Gama, V.S.; Molska, G.R.; Carlini, E.L.A. The oral administration of trans-caryophyllene attenuates acute and chronic pain in mice. Phytomedicine 2014, 21, 356–362. [CrossRef] [PubMed] 175. Gertsch, J.; Leonti, M.; Raduner, S.; Racz, I.; Chen, J.Z.; Xie, X.Q.; Altmann, K.H.; Karsak, M.; Zimmer, A. Beta-caryophyllene is a dietary cannabinoid. Proc. Natl. Acad. Sci. USA 2008, 105, 9099–9104. [CrossRef] 176. Oliveira, G.L.D.; Machado, K.C.; Machado, K.C.; da Silva, A.; Feitosa, C.M.; Almeida, F.R.D. Non-clinical toxicity of beta-caryophyllene, a dietary cannabinoid: Absence of adverse e↵ects in female swiss mice. Regul. Toxicol. Pharmacol. 2018, 92, 338–346. [CrossRef] 177. Quintans, L.J.; Araujo, A.A.S.; Brito, R.G.; Santos, P.L.; Quintans, J.S.S.; Menezes, P.P.; Serafini, M.R.; Silva, G.F.; Carvalho, F.M.S.; Brogden, N.K.; et al. Beta-caryophyllene, a dietary cannabinoid, complexed with beta-cyclodextrin produced anti-hyperalgesic e↵ect involving the inhibition of Fos expression in superficial dorsal horn. Life Sci. 2016, 149, 34–41. [CrossRef] 178. Ibrahim, M.M.; Porreca, F.; Lai, J.; Albrecht, P.J.; Rice, F.L.; Khodorova, A.; Davar, G.; Makriyannis, A.; Vanderah, T.W.; Mata, H.P.; et al. Cb2 cannabinoid receptor activation produces antinociception by stimulating peripheral release of endogenous opioids. Proc. Natl. Acad. Sci. USA 2005, 102, 3093–3098. [CrossRef] 179. Fidyt, K.; Fiedorowicz, A.; Strzadala, L.; Szumny, A. Beta-caryophyllene and beta-caryophyllene oxide-natural compounds of anticancer and analgesic properties. Cancer Med. 2016, 5, 3007–3017. [CrossRef] 180. Klauke, A.L.; Racz, I.; Pradier, B.; Markert, A.; Zimmer, A.M.; Gertsch, J.; Zimmer, A. The cannabinoid cb2 receptor-selective phytocannabinoid beta-caryophyllene exerts analgesic e↵ects in mouse models of inflammatory and neuropathic pain. Eur. Neuropsychopharmacol. 2014, 24, 608–620. [CrossRef] 181. Melo, A.J.D.; Heimarth, L.; Carvalho, A.M.D.; Quintans, J.D.S.; Serafini, M.R.; Araujo, A.A.D.; Alves, P.B.; Ribeiro, A.M.; Shanmugam, S.; Quintans, L.J.; et al. Eplingiella fruticosa (Lamiaceae) Essential Oil Complexed with Beta-Cyclodextrin Improves Its Anti-Hyperalgesic E↵ect in a Chronic Widespread Non-Inflammatory Muscle Pain Animal Model. Food Chem. Toxicol. 2020, 135, 7. 182. Dolara, P.; Luceri, C.; Ghelardini, C.; Monserrat, C.; Aiolli, S.; Luceri, F.; Lodovici, M.; Menichetti, S.; Romanelli, M.N. Analgesic e↵ects of myrrh. Nature 1996, 379, 29. [CrossRef] [PubMed] 183. Borchardt, J.K. Myrrh: An analgesic with a 4000-year history. Drug News Perspect. 1996, 9, 554–557. 184. Su, S.L.; Hua, Y.Q.; Wang, Y.Y.; Gu, W.; Zhou, W.; Duan, J.A.; Jiang, H.F.; Chen, T.; Tang, Y.P. Evaluation of the anti-inflammatory and analgesic properties of individual and combined extracts from Commiphora myrrha, and Boswellia carterii. J. Ethnopharmacol. 2012, 139, 649–656. [CrossRef] 185. Lee, D.; Ju, M.K.; Kim, H. Commiphora extract mixture ameliorates monosodium iodoacetate-induced osteoarthritis. Nutrients 2020, 12, 17. [CrossRef] 186. Germano, A.; Occhipinti, A.; Barbero, F.; Ma↵ei, M.E. A pilot study on bioactive constituents and analgesic e↵ects of myrliq® , a Commiphora myrrha extract with a high furanodiene content. Biomed. Res. Int 2017, 2017, 3804356. [CrossRef] 187. Galeotti, N. Hypericum perforatum (St John’s Wort) beyond Depression: A Therapeutic Perspective for Pain Conditions. J. Ethnopharmacol. 2017, 200, 136–146. [CrossRef] 188. Khan, H.; Pervaiz, A.; Intagliata, S.; Das, N.; Venkata, K.C.N.; Atanasov, A.G.; Najda, A.; Nabavi, S.M.; Wang, D.D.; Pittala, V.; et al. The analgesic potential of glycosides derived from medicinal plants. DARU 2020, 28, 387–401. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 27 of 27 189. Wang, R.Y.; Qiu, Z.; Wang, G.Z.; Hu, Q.; Shi, N.H.; Zhang, Z.Q.; Wu, Y.Q.; Zhou, C.H. Quercetin attenuates diabetic neuropathic pain by inhibiting mtor/p70s6k pathway-mediated changes of synaptic morphology and synaptic protein levels in spinal dorsal horn of db/db mice. Eur. J. Pharmacol. 2020, 882, 7. [CrossRef] 190. Carvalho, T.T.; Mizokami, S.S.; Ferraz, C.R.; Manchope, M.F.; Borghi, S.M.; Fattori, V.; Calixto-Campos, C.; Camilios-Neto, D.; Casagrande, R.; Verri, W.A. The granulopoietic cytokine granulocyte colony-stimulating factor (G-CSF) induces pain: Analgesia by rutin. Inflammopharmacology 2019, 27, 1285–1296. [CrossRef] 191. Xiao, X.; Wang, X.Y.; Gui, X.; Chen, L.; Huang, B.K. Natural flavonoids as promising analgesic candidates: A systematic review. Chem. Biodivers. 2016, 13, 1427–1440. [CrossRef] 192. Yao, X.L.; Li, L.; Kandhare, A.D.; Mukherjee-Kandhare, A.A.; Bodhankar, S.L. Attenuation of reserpine-induced fibromyalgia via ros and serotonergic pathway modulation by fisetin, a plant flavonoid polyphenol. Exp. Ther. Med. 2020, 19, 1343–1355. [CrossRef] 193. Shakiba, M.; Moazen-Zadeh, E.; Noorbala, A.A.; Jafarinia, M.; Divsalar, P.; Kashani, L.; Shahmansouri, N.; Tafakhori, A.; Bayat, H.; Akhondzadeh, S. Sa↵ron (Crocus sativus) versus duloxetine for treatment of patients with fibromyalgia: A randomized double-blind clinical trial. Avicenna J. Phytomedicine 2018, 8, 513–523. 194. McCarberg, B.H. Clinical overview of fibromyalgia. Am. J. Ther. 2012, 19, 357–368. [CrossRef] [PubMed] Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. © 2020 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
|
When responding, restrict yourself to only information found within the given article - no other information is valid or necessary.
EVIDENCE:
International Journal of Molecular Sciences Review Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies Massimo E. Ma↵ei Department of Life Sciences and Systems Biology, University of Turin, 10135 Turin, Italy; massimo.ma↵[email protected]; Tel.: +39-011-670-5967 !"#!$%&'(! Received: 6 October 2020; Accepted: 22 October 2020; Published: 23 October 2020 !"#$%&' Abstract: Fibromyalgia (FM) is a syndrome that does not present a well-defined underlying organic disease. FM is a condition which has been associated with diseases such as infections, diabetes, psychiatric or neurological disorders, rheumatic pathologies, and is a disorder that rather than diagnosis of exclusion requires positive diagnosis. A multidimensional approach is required for the management of FM, including pain management, pharmacological therapies, behavioral therapy, patient education, and exercise. The purpose of this review is to summarize the recent advances in classification criteria and diagnostic criteria for FM as well as to explore pharmacotherapy and the use of alternative therapies including the use of plant bioactive molecules. Keywords: fibromyalgia; diagnosis; pharmacotherapy; alternative therapies; plant extracts; natural products 1. Introduction Fibromyalgia (FM) (earlier considered to be fibrositis, to stress the role of peripheral inflammation in the pathogenesis) is a syndrome that does not present a well-defined underlying organic disease. The primary driver of FM is sensitization, which includes central sensitivity syndromes generally referred to joint sti↵ness, chronic pain at multiple tender points, and systemic symptoms including cognitive dysfunction, sleep disturbances, anxiety, fatigue, and depressive episodes [1,2]. FM is a heterogeneous condition that is often associated to specific diseases such as infections, psychiatric or neurological disorders, diabetes and rheumatic pathologies. FM is more frequent in females, where it causes musculoskeletal pain [3] and a↵ects significantly the quality of life, often requiring an unexpected healthcare e↵ort and consistent social costs [4,5]. Usually, a patient-tailored approach requires a pharmacological treatment by considering the risk-benefit ratio of any medication. Being the third most common diagnosis in rheumatology clinics, FM prevalence within the general population appears to range from 1.3–8% [2]. To date there are no specific tests specific for FM. FM is currently recognized by the widespread pain index (which divides the body into 19 regions and scores how many regions are reported as painful) and a symptom severity score (SSS) that assesses cognitive symptoms, unrefreshing sleep and severity of fatigue [6]. It is not clear what causes FM and diagnosing assist the patients to face polysymptomatic distress, thereby reducing doubt and fear which are main psychological factors contributing to this central amplification mechanism [7]. In this review, an update on diagnosis and therapy of FM is provided along the discussion on the possibility of using pharmacological drugs, bioactive natural substances and alternative therapies to alleviate the symptomatology in combination or as alternative remedies to drugs. Int. J. Mol. Sci. 2020, 21, 7877 2 of 27 2. Diagnosis To date there is still a considerable controversy on the assessment and diagnosis of FM. Despite advances in the understanding of the pathologic process, FM remains undiagnosed in as many as 75% of people with the condition [8]. The first attempt for the FM classification criteria is dated 1990 and is based on studies performed in 16 centers in the U.S.A. and Canada in clinical and academic settings, gathering the both doubters and proponents [9]. Since then, several alternative methods of diagnosis have been proposed. In general, most of the researchers agree on the need to assess multiple domains in FM including pain, sleep, mood, functional status, fatigue, problems with concentration/memory (i.e. dyscognition) and tenderness/sti↵ness [5]. Four core areas were initially assessed: (1) pain intensity, (2) physical functioning, (3) emotional functioning, and (4) overall improvement/well-being [10]. About 70–80% of patients with FM also report having sleep disturbances and fatigue. Depressive symptoms, anxiety and mood states have also been included in FM diagnosis. An impairment in multiple areas of function, especially physical function is often reported by patients with FM [11] with a markedly impaired function and quality of life [8]. Since the late 19900 s, a top priority was the development of new disease-specific measures for each of the relevant domains in FM. Also, much attention was paid to studies supporting the valid use of existing instruments specifically in the context of FM [5]. Later on, in 2010, the tender point count was abandoned and the American College of Rheumatology (ACR) suggested preliminary diagnostic criteria which were considering the number of painful body regions evaluating the presence and severity of fatigue, cognitive difficulty, unrefreshed sleep and the extent of somatic symptoms. The diagnostic criteria are not based on laboratory or radiologic testing to diagnose FM and rely on a 0–12 Symptom Severity Scale (SSS) which is used to quantify FM-type symptom severity [12]. Furthermore, the SSS was proposed to be combined with the Widespread Pain Index (WPI) into a 0–31 Fibromyalgianess Scale (FS) [13]. With a specificity of 96.6% and sensitivity of 91.8%, a score 13 for FS was able to correctly classify 93% of patients identified as having FM based on the 1990 criteria [14]. ACR 2010 criteria were also found to be more sensitive than the ACR 1990 criteria, allowing underdiagnosed FM patients to be correctly identified and giving a treatment opportunity to those who had previously been untreated [15]. It is still unclear whether the diagnosis of FM has the same meaning with respect to severity in primary FM (PFM, a dominant disorder that occurs in the absence of another clinically important and dominant pain disorder) and secondary FM (SFM, which occurs in the presence of another clinically important and dominant medical disorder) [16]. Figure 1 shows the ACR 1990 criteria for the classification of fibromyalgia, whereas Figure 2 shows a graphical representation of the Symptom Severity Scale (SSS) plus the Extent of Somatic Symptoms (ESS). Figure 1. Widespread Pain Index from ACR 1990 criteria for the classification of fibromyalgia and related regions. Int. J. Mol. Sci. 2020, 21, 7877 3 of 27 Figure 2. Symptom Severity scale (SSS) and Extent of Somatic Symptoms (ESS). Table 1 shows a holist approach based on the assumption that a multitude of potential diagnoses is fundamental in order to avoid an FM misdiagnosis [17]. In 2013, alternative diagnostic criteria have been developed by some clinicians in the USA including more pain locations and a large range of symptoms than ACR 2010. A self-reported survey was composed of the 28-area pain location inventory and the 10 symptom items from the Symptom Impact Questionnaire (SIQ) [18]. However, when compared to the early 2010 criteria, these alternative criteria did not significantly contribute in di↵erentiating common chronic pain disorders from FM [1]. In 2015, the view of diagnostic criteria was altered by ACR by providing approval only for classification criteria and no longer considering endorsement of diagnostic criteria, stressing that diagnostic criteria are di↵erent from classification criteria and are beyond the remit of the ACR [19]. However, the suggestion that diagnostic and classification criteria represent 2 ends of a continuum implies that the continuum represents the accuracy of the criteria [20]. Classification criteria and diagnostic criteria could intersect; however, according to some authors the terms “diagnosis” and “classification criteria” should be considered as qualitatively distinct concepts. The proposed concept of “diagnostic criteria” [19] is challenging and may be hardly realizable, while diagnostic guidelines based on proper modelling techniques may be helpful for clinicians in particular settings [20]. In 2016, based on a generalized pain criterion and clinic usage data, a new revision of the 2010/2011 FM criteria was developed including the following criteria: 1) generalized pain, defined as pain present in at least 4 of 5 regions; 2) symptoms present at a similar level for at least three months; 3) a WPI 7 and SSS 5 or WPI of 4–6 and SSS 9; 4) a diagnosis of FM is valid irrespective of other diagnoses. Another important point is that the presence of other clinically important illnesses does not exclude a diagnosis of FM [21]. In 2018, considering important but less visible factors that have a profound influence on under- or over-diagnosis of FM provided a new gate to a holistic and real understanding of FM diagnosis, beyond existing arbitrary and constructional scores [22]. Int. J. Mol. Sci. 2020, 21, 7877 4 of 27 Table 1. ACR2010 and modified criteria for the diagnosis of fibromyalgia. Widespread pain index (WPI) Areas specification Number of areas in which the patient has had 0–19 points pain over the past week shoulder girdle, hip (buttock, trochanter), jaw, upper back, lower back, upper arm, upper leg, chest, neck, abdomen, lower arm, Areas to be considered and lower leg (all these areas should be considered bilaterally) Symptom Severity Scale (SSS) score Symptom Level of severity Symptom level Score For each of these 3 symptoms, indicate the level of severity over the past week Considering somatic symptoms in using the following scale: Fatigue general, indicate whether the patient has 0 = no problem Waking unrefreshed the following: 1 = slight or mild problems, generally Cognitive symptoms (e.g., working memory 0 = no symptoms Final score between 0 and 12 mild or intermittent capacity, recognition memory, verbal knowledge, 1 = few symptoms 2 = moderate; considerable problems, anxiety, and depression) 2 = a moderate number of symptoms often present and/or at a moderate level 3 = a great deal of symptoms 3 = severe; pervasive, continuous, life-disturbing problems Criteria Specification Conditions A patient satisfies diagnostic criteria for (a)WPI 7/19 and SS scale score 5 or WPI 3–6 and SS scale score 9 fibromyalgia if the following 3 conditions (b) symptoms have been present as a similar level for at least 3 months are met (c) the patient does not have a disorder that would otherwise explain the pain Modified criteria Specification Conditions Final Score (a)WPI (as above) A patient satisfies diagnostic criteria for (b) SS scale score (as above, but without The number of pain sites (WPI), the SS scale score, and the presence of associated fibromyalgia if the following 3 conditions extent of somatic symptoms) symptoms are summed to give a final score between 0 and 31 are met (c) presence of abdominal pain, depression, headaches (yes = 1, no = 0) Int. J. Mol. Sci. 2020, 21, 7877 5 of 27 In 2019, in cooperation with the WHO, an IASP Working Group has developed a classification system included in the International Classification of Diseases (ICD-11) where FM has been classified as chronic primary pain, to distinguish it from pain which is secondary to an underlying disease [23]. More recently, a study of about 500 patients under diagnosis of FM, revealed that 24.3% satisfied the FM criteria, while 20.9% received a clinician International Classification of Diseases (ICD) diagnosis of FM, with a 79.2% agreement between clinicians and criteria. The conclusions of this study pointed out a disagreement between ICD clinical diagnosis and criteria-based diagnosis of FM, calling into question meaning of a FM diagnosis, the validity of physician diagnosis and clinician bias [24]. FM is a disorder that cannot be based on diagnosis of exclusion, rather needing positive diagnosis [6], through a multidimensional FM diagnostic approach making diagnosis encompassing psychosocial stressors, subjective belief, psychological factors and somatic complaints [25]. The advent of the PSD scale identified a number of problems in FM research [16]. Recently, immunophenotyping analysis performed on blood samples of FM patients revealed a role of the Mu opioid receptor on B lymphocytes as a specific biomarker for FM [26]. Moreover, a rapid biomarker-based method for diagnosing FM has been developed by using vibrational spectroscopy to di↵erentiate patients with FM from those with other pain-related diseases. Unique IR and Raman spectral signatures were correlated with FM pain severity measured with FM impact questionnaire revised version (FIQR) [27]. Overall, these findings provide reliable diagnostic tests for di↵erentiating FM from other disorders, for establishing serologic biomarkers of FM-associated pain and were useful for the contribution of the legitimacy of FM as a truly painful disease. In summarizing aspects of FM learned through applications of criteria to patients and trials, Wolfe [28] identified 7 main concepts: 1) there is no way of objectively testing FM which also has no binding definition; 2) prevalence and acceptance of FM depend on factors largely external to the patient; 3) FM is a continuum and not a categorical disorder; 4) every feeling, symptom, physical finding, neuroscience measure, cost and outcome tells one very little about the disorder and its mechanisms when fibromyalgia to “normal subjects” is compared; 5) the range and content of symptoms might indicate that FM may not truly be a syndrome; 6) “pain and distress” type of FM subject identified in the general population [29] might be considered as part of the FM definition and; 7) caution is needed when accepting the current reductive neurobiological causal explanations as sufficient, since FM is a socially constructed and arbitrarily defined and diagnosed dimensional disorder. 3. Therapy 3.1. Pharmacotherapy of FM Clinical trials have failed to conclusively provide overall benefits of specific therapies to treat FM; therefore, current pharmacological treatments for patients su↵ering from FM are mainly directed to palliate some symptoms, with relevant clinical benefits experienced only by a minority of individuals from any one intervention. In those treated with pharmacotherapy, a 50%reduction in pain intensity is generally achieved only by 10% to 25% [30] However, some treatments seem to significantly improve the quality of life of certain FM patients [31]. Only a few drugs have been approved for use in the treatment of FM by the US FDA, whereas no drug has been approved for this indication by the European Medicines Agency. Thus patients with FM frequently need to be treated on an o↵-label basis [32]. Currently, only 25% to 40% pain reduction is granted by drugs and meaningful relief occurs in only 40% to 60%, in part due to dose-limiting adverse e↵ects and incomplete drug efficacy [33]. These limitations in clinical practice have led some to hypothesize that a combination of di↵erent analgesic drugs acting through di↵erent mechanisms may provide superior outcomes compared to monotherapy [34]. Moreover, drugs should be started at low doses and cautiously increased because some patients, either do not tolerate or benefit from drug therapy. Because sleep disturbance, pain and psychological distress are the most amenable to drug therapy, drugs should be chosen to manage the individual’s predominant symptoms [35]. Currently, several drugs are frequently used alone Int. J. Mol. Sci. 2020, 21, 7877 6 of 27 or in combination to manage FM symptoms; however, the US FDA indicated for FM only three: two selective serotonin and norepinephrine reuptake inhibitors (SNRIs), duloxetine and milnacipran, and an anticonvulsant, pregabalin [36]. In the next sections, the use of selected drugs aimed to alleviate FM will be described. 3.1.1. Cannabinoids in FM Therapy The cannabinoid system is ubiquitous in the animal kingdom and plays multiple functions with stabilizing e↵ects for the organism, including modulation of pain and stress, and the management of FM may have therapeutic potential by manipulating this system. The cannabinoid system contributes in maintaining equilibrium and stabilizing e↵ects on FM [37]. Moreover, the endocannabinoid neuromodulatory system is involved in multiple physiological functions, such as inflammation and immune recognition, endocrine function, cognition and memory, nausea, antinociception and vomiting, [38]. Deficiency in the endocannabinoid system has been correlated to FM [39], but without clear clinical evidence in support of this assumption [40]. The endocannabinoid system consists of two cannabinoid receptors, the CB1 and CB2 receptors [41]. In acute and chronic pain models, analgesic e↵ects are associated to CB1 agonists that act at many sites along pain transmission pathways, including activation of spinal, supraspinal and peripheral CB1 receptors, each independently decreasing nociception [42]. Delta 9-tetrahydrocannabinol (D9-THC or Dronabinol, 1) is the main active constituent of Cannabis sativa var indica, with psychoactive and pain-relieving properties. The non-selective binding to G-protein-coupled CB receptors is responsible for the pharmacological e↵ects induced by D9-THC. Cannabidiol (CBD, 2), a non-psychotropic constituent of cannabis, is a high potency antagonist of CB receptor agonists and an inverse agonist at the CB2 receptor [43]. CBD displays CB2 receptor inverse agonism, an action that appears to be responsible for its antagonism of CP55940 at the human CB2 receptor [44]. This CB2 receptor inverse agonist ability of CBD may contribute to its documented anti-inflammatory properties [44]. The main endocannabinoids are anandamide (N-arachidonoylethanolamine, AEA, 3) and 2-arachidonoylglycerol (2-AG, 4), AG), the activity of which is modulated by the hydrolyzing fatty acid palmitoylethanolamide (PEA, 5) and the endocannabinoid precursor arachidonic acid (AA, 6) [45]. AEA and 2-AG are functionally related to D9-THC [46]. It was found that stress induces a rapid anandamide release in several CNS regions resulting in stress-induced analgesia via CB1 receptors [47]. FM patients had significantly higher anandamide plasma levels [39,46]; however, it has been suggested that the origin of FM and chronic pain depend on a deficiency in the endocannabinoid signaling [45]. Monotherapies of FM based on D9-THC are based on the assumption that this compound acts as an analgesic drug; however, although a sub-population of FM patients reported significant benefits from the use of D9-THC, this statement cannot be made [48]. When the quality of life of FM patients who consumed cannabis was compared with FM subjects who were not cannabis users, a significant improvement of symptoms of FM in patients using cannabis was observed, although there was a variability of patterns [49]. The synthetic cannabinoid nabilone (7) showed of a superiority over placebo to reduce FM symptoms, with significant reductions in Visual Analog Scale (VAS) for pain, FM Impact Questionnaire (FIQ), and anxiety [42], indicating the efficacy of treating people with FM with nabilone. Nabilone was also e↵ective in improving sleep [50]; however, participants taking nabilone experienced more adverse events (such as dizziness/drowsiness, dry mouth and vertigo) than did participants taking placebo or amitriptyline (see below). The self-medication practice of herbal cannabis was associated with negative psychosocial parameters. Therefore, caution should be exercised in recommending the use of cannabinoids pending clarification of general health and psychosocial problems [51,52]. Figure 3 illustrates the chemical formulas of some cannabinoids and endocannabinoids. Int. J. Mol. Sci. 2020, 21, 7877 7 of 27 Figure 3. Structure formulae of some cannabinoids and related compounds. Numbers correspond to compound names cited in the text. 3.1.2. Opioids in FM Therapy One of the major natural sources of opioids is the medicinal plant Papaver somniferum. Although clinical evidence demonstrating the efficacy or e↵ectiveness of opioids analgesics is scanty, these molecules are widely used for the treatment of FM [53]. However, the long-term use of opioids in FM has been discouraged by several medical guidelines [54]. The use of opioids is documented in studies demonstrating increased endogenous opioid levels in the cerebrospinal fluid of patients with FM vs. controls [55]. These results prompted the interesting hypothesis that a more activated opioid system can be detected in individuals with FM, reflecting reduced receptor availability and increased release of endogenous opioids [54]. There is evidence from both single center, prospective, longitudinal and multicenter and observational clinical studies of negative e↵ects of the use of opioids in FM on patient outcomes compared with other therapies [56,57]. Moreover, opioid user groups showed less improvement in the SFM-36 subscale scores of general health perception and in the FIQ subscale scores of job ability, fatigue and physical impairment [58]. Furthermore, altered endogenous opioid analgesic activity in FM has been demonstrated and suggested as a possible reason for why exogenous opiates appear to have reduced efficacy [59]. Despite these facts, opioids have been prescribed for 10% to 60% of patients with FM as reported in large database sets [54]. When considered, the preference of patients appears towards opioids. In a survey, 75% of patients considered hydrocodone (8) plus acetaminophen to be helpful, and 67% considered oxycodone (9) plus acetaminophen to be helpful [60]. FM has been associated with preoperative opioid use, including hydrocodone [61], whereas there is limited information from randomized controlled trials on the benefits or harms of oxycodone when used to treat pain in FM [62]. A pilot study showed that naltrexone (10) reduced self-reported symptoms of FM (primarily daily pain and fatigue) [63] and further studies showed that low-dose naltrexone had a specific and clinically beneficial impact on FM. This opioid, which is widely available and inexpensive, Int. J. Mol. Sci. 2020, 21, 7877 8 of 27 was found to be safe and well-tolerated. Blocking peripheral opioid receptors with naloxone (11) was observed to prevent acute and chronic training-induced analgesia in a rat model of FM [64]; however, there were no significant e↵ects of naloxone nor nocebo on pressure pain threshold, deep tissue pain, temporal summation or conditioned pain modulation in chronic fatigue syndrome/FM patients [65]. A synthetic opioid receptor agonist that shows serotonin-norepinephrine reuptake inhibitor properties is tramadol (12); this compound is often prescribed for painful conditions [66]. Tramadol has been studied in humans who su↵er from FM [56], suggesting that tramadol may be e↵ective in treating FM [67]. The use of tramadol provides change in pain assessed by visual analogue scale and FM impact questionnaire; however, the reported side e↵ects include dizziness, headache, constipation, addiction, withdrawal, nausea, serotonin syndrome, somnolence, pruritus seizures, drug–drug interactions with antimigraine and antidepressants medications [66]. Therefore, it is recommended that tramadol application should be considered in refractory and more treatment-resistant cases of FM. Another weak opioid is codeine (13). In a comparative study, there was a significantly higher proportion of patients in the codeine-acetaminophen group reporting somnolence or constipation and a larger proportion of patients in the tramadol-acetaminophen group reporting headache. The overall results suggested that tramadol-acetaminophen tablets (37.5 mg/325 mg) were as e↵ective as codeine-acetaminophen capsules (30 mg/300 mg) in the treatment of chronic pain [68]. Fentanyl (14) works primarily by activating µ-opioid receptors and was found to be around 100 times stronger than morphine (15), although its e↵ects are more localized. Fentanyl injections reduced second pain from repeated heat taps in FM patients. Similar to reports of e↵ects of morphine on first and second pain, fentanyl had larger inhibitory e↵ects on slow temporal summation of second pain than on first pain from a nociceptor stimulation [69]. Since fentanyl can inhibit windup of second pain in FM patients, it can prevent the occurrence of intense summated second pain and thereby reduce its intensity by a greater extent than first or second pains evoked by single stimuli. Among the 70,237 drug-related deaths estimated in 2017 in the US, the sharpest increase occurred among those related to fentanyl analogs with almost 29,000 overdose deaths which represents more than 45% increase from 2016 to 2017 [70]. Because the numbers of overdoses and deaths due to fentanyl will continue to increase in the coming years, studies are needed to elucidate the physiological mechanisms underlying fentanyl overdose in order to develop e↵ective treatments aimed to reduce the risk of death [71]. Glial cell activation is one of the several other possible pathophysiologic mechanisms underlying the development of FM by contributing to central nervous system sensitization to nociceptive stimuli [72]. Pentoxifylline (16), a xanthine derivative used as a drug to treat muscle pain in people with peripheral artery disease, is a nonspecific cytokine inhibitor that has been shown to attenuate glial cell activation and to inhibit the synthesis of TNF↵, IL-1 , and IL-6 [73]. In theory, attenuating glial cell activation via the administration of pentoxifylline to individuals su↵ering from FM might be efficient in ameliorating their symptoms without being a globalist therapeutic approach targeting all possible pathophysiologic mechanisms of development of the syndrome [74]. With regards FM pathophysiology, serum brain-derived neurotrophic factors (BDNF) were found at higher levels in FM patients while BDNF methylation in exon 9 accounted for the regulation of protein expression. These data suggest that altered BDNF levels might represent a key mechanism explaining FM pathophysiology [75]. Opioid users were also observed to experience a decreased pain and symptom severity when ca↵eine (17) was consumed, but this was not observed in opioid nonusers, indicating ca↵eine may act as an opioid adjuvant in FM-like chronic pain patients. Therefore the consumption of ca↵eine along with the use of opioid analgesics could represent an alternative therapy with respect to opioids or ca↵eine alone [76]. Figure 4 shows the chemical formulae of some opioids used in FM therapy. Int. J. Mol. Sci. 2020, 21, 7877 9 of 27 Figure 4. Structure formulae of some opioids and related compounds. Numbers correspond to molecules cited in the text. 3.1.3. Gabapentinoids in FM Therapy Gabapentinoid drugs are US Food and Drug Administration (FDA) (but not in Europe) anticonvulsants approved for treatment of pain syndromes, including FM. However, FDA approved pregabalin (18) but not gabapentin (19) for FM treatment; nevertheless, gabapentin is often prescribed o↵-label for FM, presumably because it is substantially less expensive [77]. Pregabalin is a gamma-aminobutyric acid (GABA) analog and is a ligand for the ↵2 subunit of the calcium channel being able of reducing the ability of docked vesicles to fuse and release neurotransmitters [78]. Pregabalin shows e↵ects on cortical neural networks, particularly when basal neurons are under hyperexcitability. The pain measures and pregabalin impact on the cortical excitability was observed only in FM patients [79]. Pregabalin was also found to increase norepinephrine levels in reserpine-induced myalgia rats [80]. Because of its tolerability when used in combination with antidepressants, pregabalin use showed a very good benefit to risk ratio [81]. The starting approved dosage for pregabalin is at 150 mg daily [82]; however, the drug shows a higher e↵ectiveness when used at a dose of 300 or 600 mg/day. Lower pregabalin doses than those of clinical trials are used in clinical practice because higher doses are more likely to be intolerable [83]. A recent systematic review shows that a minority of people with moderate to severe pain due to FM treated with a daily dose of 300 to 600 mg of pregabalin had a reduction of pain intensity over a follow-up period of 12 to 26 weeks, with tolerable adverse e↵ects [84]. Thus, pregabalin is one of cardinal drugs used in the treatment of FM, and its clinical utility has been comprehensively demonstrated [85,86]. Nevertheless, there is still insufficient evidence to support or refute that gabapentin may reduce pain in FM [87]. Figure 5 depicts the chemical formulae of some gabapentinoids. Int. J. Mol. Sci. 2020, 21, 7877 10 of 27 Figure 5. Structure formulae of some gabapentinoids. Numbers correspond to molecules cited in the text. 3.1.4. Serotonin–Norepinephrine Reuptake Inhibitors in FM Therapy There is a wide use of serotonin and noradrenaline reuptake inhibitors (SNRIs). There is no unbiased evidence that serotonin selective reuptake inhibitors (SSRIs) are superior to placebo in treating depression in people with FM and for treating the key symptoms of FM, namely sleep problems, fatigue and pain. However, it should be considered that young adults aged 18 to 24, with major depressive disorder, showed an increased suicidal tendency when treated with SSRIs [88]. A recent Cochrane review evaluated the use of SNRIs including eighteen studies with a total of 7,903 adults diagnosed with FM, by using desvenlafaxine (20) and venlafaxine (21) in addition to duloxetine (22) and milnacipran (23), by considering various outcomes for SNRIs including health related quality of life, fatigue, sleep problems, pain and patient general impression, as well as safety and tolerability [89]. Fifty two percent of those receiving duloxetine and milnacipran had a clinically relevant benefit over placebo compared to 29% of those on placebo, with much or very much improvements in the intervention. On the other hand, reduction of pain intensity was not significantly di↵erent from placebo when desvenlafaxine was used. However, pain relief and reduction of fatigue was not clinically relevant for duloxetine and milnacipran in 50% or greater and did not improve the quality of life [90]. Same negative outcomes were found for reducing problems in sleep and the potential general benefits of duloxetine and milnacipran were outweighed by their potential harms. The efficacy of venlafaxine in the treatment of FM was studied to a lesser extent. The lack of consistency in venlafaxine dosing, placebo control and blinding make difficult to understand whether the molecule is e↵ective in treating FM. Nevertheless, tolerability and the lower cost of venlafaxine increases its potential use for the treatment of FM, by rendering the molecule a more a↵ordable option compared to the other, more expensive SNRIs [91]. Mirtazapine (24) promotes the release of noradrenaline and serotonin by blocking ↵2 -adrenergic autoreceptors and ↵2 -adrenergic heteroreceptors, respectively. Mirtazapine, by acting through 5-HT1A receptors and by blocking postsynaptic 5-HT2A , 5-HT2C , and 5-HT3 receptors is able to enhance serotonin neurotransmission [92]. For these properties, mirtazapine is classified as a noradrenergic and specific serotonergic antidepressant [93]. Mirtazapine appears to be a promising therapy to improve sleep, pain, and quality of life in patients with FM [94]. In Japanese patients with FM, mirtazapine caused a significantly greater reduction in the mean numerical rating scale pain score and remained significantly greater from week 6 onward, compared with placebo. However, Adverse mirtazapine caused adverse events including weight gain, somnolence and increased appetite when compared to placebo [92]. Among antidepressants, the tricyclic antidepressant (TCAs) amitriptyline (25) was studied more than other antidepressants. It is frequently used to assess comparative efficacy [95] and for many years amitriptyline has been a first-line treatment for FM. Although there is no supportive unbiased evidence for a beneficial e↵ect, the drug was successful for the treatment in many patients with FM. However, amitriptyline achieve satisfactory pain relief only by a minority of FM patients and is unlikely that any large randomized trials of amitriptyline will be conducted in FM to establish efficacy Int. J. Mol. Sci. 2020, 21, 7877 11 of 27 statistically, or measure the size of the e↵ect [96]. Figure 6 depicts the chemical formulae of some SNRIs and TCA. Figure 6. Chemical structure of some serotonin and noradrenaline reuptake inhibitors and a tricyclic antidepressant. Numbers correspond to molecules cited in the text. 3.2. Alternative Therapies for FM A survey of the European guidelines shows that most of the pharmacological therapies are relatively modest providing only weak recommendations for FM [97]. A multidimensional approach is therefore required for the management of FM, including pharmacological therapies along with behavioral therapy, exercise, patient education and pain management. A multidisciplinary approach combines pharmacotherapy with physical or cognitive interventions and natural remedies. Very often, patients seek help in alternative therapies due to the limited efficacy of the therapeutic options. The following sections discuss some of the most used alternative therapies to treat FM. 3.2.1. Acupunture Acupuncture shows low to moderate-level in improving pain and sti↵ness in people with FM. In some cases, acupuncture does not di↵er from sham acupuncture in improving sleep or global well-being or reducing pain or fatigue. The mechanisms of acupuncture action in FM treatment appears to be correlated to changes in serum serotonin levels [98]. Electro-acupuncture (EA) was more e↵ective than manual acupuncture (MA) for improving sleep, global well-being and fatigue and in the reduction of pain and sti↵ness. Although e↵ective, the e↵ect of acupuncture is not maintained at six months follow-up [99]. Moreover, there is a lack of evidence that real acupuncture significantly di↵ers from sham acupuncture with respect to improving the quality of life, both in the short and long term. However, acupuncture therapy is a safe treatment for patients with FM [100,101]. 3.2.2. Electric Stimulation As we discussed, FM, aside pain, is characterized by anxiety, depression and sleep disturbances, and by a complex cognitive dysfunctioning status known as “fibrofog” which is characterized by disturbance in working memory, attention and executive functions globally often referred by the patients as a sense of slowing down, clumsiness and confusion that have a profound impact on the ability to perform and e↵ectively plan daily activities [102,103]. Besides stimulation with acupuncture, the e↵ective modulation of brain areas has been obtained through non-invasive brain stimulation by Int. J. Mol. Sci. 2020, 21, 7877 12 of 27 magnetic or electric currents applied to the scalp like transcranial magnetic and electrical stimulation. In many cases, to relieve pain and improve general FM-related function, the use of anodal transcranial direct current stimulation over the primary motor cortex was found to be significantly more e↵ective than sham transcranial direct current stimulation [104]. If we consider that pharmacological and non-pharmacological treatments are often ine↵ective or transitory in their e↵ect on FM, therapeutic electrical stimulation appears to have a potential role [105]. Cognitive functions such as memory have been enhanced in FM patients by anodal transcranial direct current stimulation over the dorsolateral prefrontal cortex and has clinical relevance for top-down treatment approaches in FM [106]. In FM patients, modulation of hemodynamic responses by transcutaneous electrical nerve stimulation during delivery of nociceptive stimulation was also investigated and shown to be an e↵ective factor in FM treatment, although the underlying mechanism for these findings still needs to be clarified [107]. It has been recently demonstrated that both transcutaneous electric nerve stimulation and acupuncture applications seem to be beneficial in FM patients [108]. In a recent Positron Emission Tomography H2 15 O activation study it was shown that occipital nerve field stimulation acts through activation of the descending pain inhibitory pathway and the lateral pain pathway in FM, while electroencephalogram shows activation of those cortical areas that could be responsible for descending inhibition system recruitment [109]. Microcirculation is of great concern in patients with FM. Recently low-energy pulsed electromagnetic field therapy was found to increase a promising therapy to increase microcirlulation [110]; however, neither pain and sti↵ness were reduced nor functioning was improved by this therapy in women with FM [111]. The European Academy of Neurology, based on the method of GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) judged anodal transcranial direct currents stimulation of motor cortex as still inconclusive for treatment of FM [112]. Therefore, further studies are needed to determine optimal treatment protocols and to elucidate the mechanisms involved [113]. 3.2.3. Vibroacoustic and Rhythmic Sensory Stimulation Stimulation with sensory events such as pulsed or continuous auditory, vibrotactile and visual flickering stimuli are referred as rhythmic sensory stimulation [114]. Clinical studies have reported the application of vibroacoustic stimulation in the treatment of FM. In a clinal study, one group of patients with FM listened to a sequence of Bach’s compositions, another was subjected to vibratory stimuli on a combination of acupuncture points on the skin and a third group received no stimulation. The results showed that a greater e↵ect on FM symptoms was achieved by the combined use of music and vibration [115]. However, in another study, neither music nor musically fluctuating vibration had a significant e↵ect on tender point pain in FM patients when compared to placebo treatment [116]. Because thalamocortical dysrhythmia is implicated in FM and that low-frequency sound stimulation can play a regulatory function by driving neural rhythmic oscillatory activity, volunteers with FM were subjected to 23 min of low-frequency sound stimulation at 40 Hz, delivered using transducers in a supine position. Although no adverse e↵ects in patients receiving the treatment, no statistically and clinically relevant improvement were observed [117]. On the other hand, gamma-frequency rhythmic vibroacoustic stimulation was found to decrease FM symptoms (depression, sleep quality and pain interference) and ease associated comorbidities (depression and sleep disturbances), opening new avenues for further investigation of the e↵ects of rhythmic sensory stimulation on chronic pain conditions [118]. 3.2.4. Thermal Therapies Thermal therapies have been used to treat FM. Two main therapies are currently used: body warming and cryotherapy. Int. J. Mol. Sci. 2020, 21, 7877 13 of 27 Because FM is strongly linked to rheumatic aches, the application of heat by spa therapy (balneotherapy) appears as a natural choice for the treatment of FM [119]. Spa therapy is a popular treatment for FM in many European countries, as well as in Japan and Israel. A randomized prospective study of a 10-day treatment was done on 48 FM patients improving their quality of life [120] and showed that treatment of FM at the Dead Sea was both e↵ective and safe [121]. FM patients who were poorly responding to pharmacological therapies were subjected to mud-bath treatment. A cycle of mud bath applications showed beneficial e↵ects on FM patients whose evaluation parameters remained stable after 16 weeks in comparison to baseline [122]. In patients su↵ering from FM, mud bathing was also found to prevent muscle atrophy and inflammation and improve nutritional condition [123]. Nevertheless, despite positive results, the methodological limitations of available clinical studies, such as the lack of placebo double-blinded trials, preclude definitive conclusions on the e↵ect of body-warming therapies to treat FM [119,124]. A remedy widely used in sports related trauma is the application of cold as a therapeutic agent for pain relief. Cryotherapy refers to the use of low temperatures to decrease the inflammatory reaction, including oedema [125]. Cryotherapy induces several organism physiological reactions like increasing anti-inflammatory cytokines, beta-endorphins, ACTH, white blood cells, catecholamines and cortisol, immunostimulation due to noradrenalin response to cold, the increase in the level of plasma total antioxidant status and the reduction of pain through the alteration of nerve conduction [126]. When compared to control FM subjects, cryotherapy-treated FM patients reported a more pronounced improvement of the quality of life [127]. Whole body cryotherapy was also found to be a useful adjuvant therapy for FM [126]. 3.2.5. Hyperbaric Treatment Hyperbaric oxygen therapy (HBOT) has shown beneficial e↵ects for the prevention and treatment of pain [128], including migraine, cluster headache [129] and FM [130]. HBOT is supposed to induce neuroplasticity that leads to repair of chronically impaired brain functions. HBOT was also found to it improve the quality of life in post-stroke patients and mild traumatic brain injury patients [131]. Therefore, the increased oxygen concentration caused by HBOT is supposed to change the brain metabolism and glial function with a potential e↵ect on reducing the FM-associated brain abnormal activity [132]. HBOT was found to a↵ect the mitochondrial mechanisms resulting in functional brain changes, stimulate nitric oxide production thus alleviating hyperalgesia and promoting the NO-dependent release of endogenous opioids which appear to be involved in the antinociception prompted by HBOT [133]. In a clinical study, a significant di↵erence between the HBOT and control groups was found in the reduction in tender points and VAS scores after the first and fifteenth therapy sessions [130]. These results indicate that HBOT may play an important role in managing FM. 3.2.6. Laser Therapy and Phototherapy The use of di↵erent light wavelengths has been found to be an alternative therapy for FM. It is known that low-level laser therapy is a therapeutic factor, being able not only to target one event in the painful reception, but rather the extend its e↵ectiveness on the whole hierarchy of mechanisms of its origin and regulation [134]. Laser photobiomodulation therapy has been reported to be e↵ective in the treatment of a variety of myofascial musculoskeletal disorders, including FM [135]. The combination of laser therapy and the administration of the drug amitriptyline was found to be e↵ective on clinical symptoms and quality of life in FM; furthermore, gallium-arsenide laser therapy was found to be a safe and e↵ective treatment which can be used as a monotherapy or as a supplementary treatment to other therapeutic procedures in FM [136]. Evidence supported also the use of laser therapy in women su↵ering FM to improve pain and upper body range of motion, ultimately reducing the impact of FM [137,138]. Finally, a combination of phototherapy and exercise training was evaluated in patients with FM in a randomized controlled trial for chronic pain to o↵er valuable clinical evidence for objective assessment of the potential benefits and risks of procedures [139]. Int. J. Mol. Sci. 2020, 21, 7877 14 of 27 3.2.7. Exercise and Massage Exercise therapy seems to be an e↵ective component of treatment, yielding improvement in pain and other symptoms, as well as decreasing the burden of FM on the quality of life [140]. Exercise is generally acceptable by individuals with FM and was found to improve the ability to do daily activities and the quality of life and to decrease tiredness and pain [141]. However, it is important to know the e↵ects and specificities of di↵erent types of exercise. For instance, two or more types of exercise may combine strengthening, aerobic or stretching exercise; however, there is no substantial evidence that mixed exercise may improve sti↵ness [142]. Quality of life may be improved by muscle stretching exercise, especially with regard to physical functioning and pain, whereas depression is reduced by resistance training. A trial including a control group and two intervention groups, both of which receiving exercise programs created specifically for patients with FM, showed that both modalities were e↵ective in an exercise therapy program for FM [143]. A progressive muscle strengthening activity was also found to be a safe and e↵ective mode of exercise for FM patients [144]. Furthermore, strength and flexibility exercises in aerobic exercise rehabilitation for FM patients led to improvements in patients’ shoulder/hip range of motion and handgrip strength [145]. Among women with FM, the association between physical activity and daily function is mediated by the intensity of musculoskeletal pain, rather than depressive symptoms or body mass [146], with a link between clinical and experimental pain relief after the performance of isometric contractions [147]. A randomized controlled trial evaluated the e↵ects of yoga intervention on FM symptoms. Women performing yoga showed a significant improvement on standardized measures of FM symptoms and functioning, including fatigue, mood and pain, and in pain acceptance and other coping strategies [148]. Moreover, the combination with massage therapy program during three months influenced perceived stress index, cortisol concentrations, intensity of pain and quality of life of patients with FM [149]. In terms of societal costs and health care costs, quality of life and physical fitness in females with FM was improved by aquatic training and subsequent detraining [150,151]. Aquatic physical training was e↵ective in promoting increased oxygen uptake at peak cardiopulmonary exercise test in women with FM [152]. A systematic evaluation of the harms and benefits of aquatic exercise training in adults with FM showed that it may be beneficial for improving wellness, symptoms, and fitness in adults with FM [153,154]. A safe and clinically efficacious treatment of pain and other FM symptoms was also achieved by the combination of osteopathic manipulative medicine and pharmacologic treatment with gabapentin [155]. Dancing is a type of aerobic exercise that may be used in FM alternative therapy. Belly dancing was found to be e↵ective in improving functional capacity, pain, quality of life and improving body image of women with FM [156]. More recently, three months treatment of patients with FM with Zumba dancing was found to be e↵ective in improving pain and physical functioning [157]. Finally, Tai chi mind-body treatment was found to improve FM symptoms as much as aerobic exercise and longer duration of Tai chi showed greater improvement. According to a recent report, mind-body approaches may take part of the multidisciplinary management of FM and be considered an alternative therapeutic option [158]. 3.2.8. Probiotics and FM Therapy A tractable strategy for developing novel therapeutics for complex central nervous system disorders could rely on the so called microbiota-gut-brain axis management, because intestinal homeostasis may directly a↵ect brain functioning [159,160]. The pain intensity of patients with FM has been reported to be correlated with the degree of small intestinal bacterial overgrowth, which is often associated with an increased intestinal permeability whose values were significantly increased in the FM patients [161]. Preclinical trials indicate that the microbiota and its metabolome are likely involved in modulating brain processes and behaviors [162]. Therefore, FM patients should show better performance after the treatment with probiotics. In a double-blind, placebo-controlled, randomized design probiotic Int. J. Mol. Sci. 2020, 21, 7877 15 of 27 improved impulsive choice and decision-making in FM patients, but no other e↵ects were observed on cognition, quality of life, self-reported pain, FM impact, depressive or anxiety symptoms [163]. 3.2.9. Use of Plant Extracts and Natural Products for FM Treatment About 40% of drugs used to treat FM originate from natural products [164]; however, there are a few studies that prove the safe and e↵ective use of various plant extracts in FM therapy. Several plant extracts are currently used for their antinociceptive properties and potential to treat FM [165]. Papaver somniferum is probably the most ancient plant used for its antinociceptive properties [166], with chemical components able to interact with opioid receptors; among these morphine (15) which is not only the oldest, but is still the most e↵ective drug for the management of severe pain in clinical practice [167]. The use of opioids for FM treatment has been discussed above. Another important plant is Cannabis sativa. The major active constituent of Cannabis, D9-THC (1), has been shown to possess antinociceptive properties when assessed in several experimental models [168] (see also the discussion above on cannabinoids). Although there is still scarce evidence to support its role in the treatment of FM, a large consensus indicates that medical cannabis could be an e↵ective alternative for the treatment of FM symptoms [169]. The illicit use of herbal cannabis for FM treatment has been correlated to the inefficacy of current available medications, but is also linked to popular advocacy or familiarity with marijuana from recreational use. Therefore, physicians are requested to examine the global psychosocial well-being, and not focus only on the single outcome measure of pain [52,170]. Although medical cannabis treatment has a significant favorable e↵ect on patients with FM, 30% of patients experience adverse e↵ects [171] and 8% report dependence on cannabis [172]. VAS scores measured in 28 FM patients after 2 hours of cannabis use showed enhancement of relaxation and feeling of well-being, a reduction of pain and sti↵ness which were accompanied by an increase in somnolence. The mental health component summary score of the Short Form 36 Health Survey was higher in cannabis users than in non-users [49]. Among terpenoids, administration of trans- -caryophyllene (BCP, 26), a bicyclic sesquiterpene compound existing in the essential oil of many plants like Copaifera langsdforffii, Cananga odorata, Humulus lupulus, Piper nigrum and Syzygium aromaticum, which provide a high percentage of BCP along with interesting essential oil yields [173], significantly minimized the pain in both acute and chronic pain models [174]. BCP selectively binds to the cannabinoid 2 (CB2 ) receptor and is a functional CB2 agonist. Upon binding to the CB2 receptor, BCP inhibits adenylate cylcase, leads to intracellular calcium transients and weakly activates the mitogen-activated kinases Erk1/2 and p38 in primary human monocytes [175]. BCP, a safe compound with toxicity at doses higher than 2000 mg/kg body weight [176], was found to reduce the primary and secondary hyperalgesia produced by a chronic muscle pain model (which is considered to be an animal model for FM) [177]. Significant and dose-dependent antinociceptive response was produced by BCP without the presence of gastric damage [178]. Antiallodynic actions of BCP are exerted only through activation of local peripheral CB2 [179]. In neuropathic pain models, BCP reduced spinal neuroinflammation and the oral administration was more e↵ective than the subcutaneously injected synthetic CB2 agonist JWH-133 [180]. Recently, BCP was found to exert an analgesic e↵ect in an FM animal model through activation of the descending inhibitory pain pathway [181]. Thus, BCP may be highly e↵ective in the treatment of long-lasting, debilitating pain states, suggesting the interesting application of BCP in FM therapy. The analgesic properties of myrrh (Commiphora myrrha) have been known since ancient times and depend on the presence of bioactive sesquiterpenes with furanodiene skeletons which are able to interact with the opioid receptors [182,183]. C. myrrha extracts exerted a stronger suppression on carrageenan-induced mice paw edema with significant analgesic e↵ects [184] and were e↵ective against chronic inflammatory joint disease such as osteoarthritis [185]. In a preclinical trial, pain alleviation was obtained with C. myrrha extracts for many pathologies [186], indicating that extracts from this plant may have the potential to treat FM. Int. J. Mol. Sci. 2020, 21, 7877 16 of 27 Preclinical studies indicate a potential use of Hypericum perforatum (Hypericaceae), popularly known as St. John’s wort, in medical pain management [187] due to its phenolic compounds. Many phenolic compounds (e.g., flavonoids) from medicinal plants are promising candidates for new natural analgesic drugs [188]. Quercetin (27) showed analgesic activity and could reduce neuropathic pain by inhibiting mTOR/p70S6K pathway-mediated changes of synaptic morphology and synaptic protein levels in spinal dorsal horn neurons of db/db mice [189], while rutin (28) could inhibit the writhing response of mice induced by potassium antimony tartrate and showed to be a promising pharmacological approach to treat pain [190]. The analgesia potency of hyperin (29) was approximately 20-fold of morphine, while luteolin (30) presented e↵ective analgesic activities for both acute and chronic pain management. Some glycosides of kaempferol (e.g., kaempferol 3-O-sophoroside, 31) possess significant analgesic activity in the tail clip, tail flick, tail immersion, and acetic acid-induced writhing models, whereas baicalin (32) shows analgesic e↵ects in several kinds of pain [191]. Fisetin (33), a plant flavonoid polyphenol, has been reported to possess potent antioxidant, antinociceptive and neuroprotective activities. In rats, fisetin acts via modulation of decreased levels of biogenic amines and elevatesoxido-nitrosative stress and ROS to ameliorate allodynia, hyperalgesia, and depression in experimental reserpine-induced FM [192]. In a double-blind parallel-group clinical trial, outpatients with FM were randomized to receive either 15 mg of Crocus sativus (sa↵ron) extract or 30 mg duloxetine (22). No significant di↵erence was detected for any of the scales neither in terms of score changes from baseline to endpoint between the two treatment arms, indicating that sa↵ron and duloxetine had comparable efficacy in treatment of FM symptoms [193]. It is still unclear the efficacy of natural products extracted from plants in treating FM. However, some clinical data show promising results and more studies with adequate methodological quality are necessary in order to investigate the efficacy and safety of natural products as a support in FM therapy. Figure 7 depicts the chemical formulae of some antinociceptive natural products. Figure 7. Chemical structure of some natural compounds with antinociceptive activity. Int. J. Mol. Sci. 2020, 21, 7877 17 of 27 4. Conclusions Diagnosis of FM is based on clinical feature and criteria that still lack either a gold standard or at least supportive laboratory findings. FM diagnostic criteria may include heterogeneous patients also in clinical trials and this may impair evaluation of clinically meaningful treatment e↵ect. The review of the literature suggests that a multidisciplinary therapeutic approach, based on the combination of pharmacologic and alternative therapy (including thermal, light, electrostimulatory and body exercise treatments) could improve the quality of life and reduce pain and other symptoms related to FM. However, sometimes the ability of patients to participate to alternative therapies is impeded by the level of pain fatigue, poor sleep, and cognitive dysfunction. These patients may need to be managed with medications before initiating nonpharmacologic therapies. Although the use of some natural phytochemicals like BCP and phenolic compounds might replace other natural products such as D9-THC, because of reduced side e↵ects and higher tolerability, FM self medication practice may be ine↵ective and in some cases even detrimental. Therefore, providing FM patients with the correct information about their disorders may help monitoring pharmacological and alternative therapies. At the same time maintaining information will help patients to receive the appropriate medications and therapies [194]. Funding: This research received no external funding. Conflicts of Interest: The author declares no conflict of interest Abbreviations 2-AG 2-ArachidonoylGlycerol AA Arachidonic Acid ACR American College of Rheumatology ACTH Adrenocorticotropic hormone AEA N-arachidonoylethanolamine BDNF Brain-Derived Neurotrophic Factors CB1 Cannabinoid Receptor 1 CB2 Cannabinoid Receptor 2 CBD Cannabidiol CNS Central Nervous System EA Electro-Acupuncture ESS Extent of Somatic Symptoms FIQ FM Impact Questionnaire FIQR FM Impact Questionnaire Revised version FM Fibromyalgia FS Fibromyalgianess Scale GABA Gamma-Aminobutyric Acid Grading of Recommendations, Assessment, GRADE Development, and Evaluation HBOT Hyperbaric Oxygen Therapy ICD-11 International Classification of Diseases IL-1 Interleukin 1 beta IL-6 Interleukin 6 MA Manual Acupuncture PEA Palmitoylethanolamide PFM Primary FM ROS Reactive Oxygen Species SIQ Symptom Impact Questionnaire SFM Secondary FM SNRIs Serotonin and Norepinephrine Reuptake Inhibitors SSRIs Serotonin Selective Reuptake Inhibitors SSS Symptom Severity Scale TCAs Tricyclic Antidepressant TNF↵ Tumor necrosis factor alpha VAS Visual Analog Scale WPI Widespread Pain Index D9-THC Delta 9-tetrahydrocannabinol Int. J. Mol. Sci. 2020, 21, 7877 18 of 27 References 1. Wang, S.M.; Han, C.; Lee, S.J.; Patkar, A.A.; Masand, P.S.; Pae, C.U. Fibromyalgia diagnosis: A review of the past, present and future. Expert Rev. Neurother. 2015, 15, 667–679. [CrossRef] [PubMed] 2. Chinn, S.; Caldwell, W.; Gritsenko, K. Fibromyalgia pathogenesis and treatment options update. Curr. Pain Headache Rep. 2016, 20, 25. [CrossRef] [PubMed] 3. Blanco, I.; Beritze, N.; Arguelles, M.; Carcaba, V.; Fernandez, F.; Janciauskiene, S.; Oikonomopoulou, K.; de Serres, F.J.; Fernandez-Bustillo, E.; Hollenberg, M.D. Abnormal overexpression of mastocytes in skin biopsies of fibromyalgia patients. Clin. Rheumatol. 2010, 29, 1403–1412. [CrossRef] [PubMed] 4. Cabo-Meseguer, A.; Cerda-Olmedo, G.; Trillo-Mata, J.L. Fibromyalgia: Prevalence, epidemiologic profiles and economic costs. Med. Clin. 2017, 149, 441–448. [CrossRef] [PubMed] 5. Williams, D.A.; Schilling, S. Advances in the assessment of fibromyalgia. Rheum. Dis. Clin. N. Am. 2009, 35, 339–357. [CrossRef] [PubMed] 6. Rahman, A.; Underwood, M.; Carnes, D. Fibromyalgia. BMJ Br. Med. J. 2014, 348. [CrossRef] [PubMed] 7. McBeth, J.; Mulvey, M.R. Fibromyalgia: Mechanisms and potential impact of the acr 2010 classification criteria. Nat. Rev. Rheumatol. 2012, 8, 108–116. [CrossRef] [PubMed] 8. Arnold, L.M.; Clauw, D.J.; McCarberg, B.H.; FibroCollaborative. Improving the recognition and diagnosis of fibromyalgia. Mayo Clin. Proc. 2011, 86, 457–464. [CrossRef] 9. Wolfe, F.; Smythe, H.A.; Yunus, M.B.; Bennett, R.M.; Bombardier, C.; Goldenberg, D.L.; Tugwell, P.; Campbell, S.M.; Abeles, M.; Clark, P.; et al. The american-college-of-rheumatology 1990 criteria for the classification of fibromyalgia—Report of the multicenter criteria committee. Arthritis Rheum. 1990, 33, 160–172. [CrossRef] 10. Dworkin, R.H.; Turk, D.C.; McDermott, M.P.; Peirce-Sandner, S.; Burke, L.B.; Cowan, P.; Farrar, J.T.; Hertz, S.; Raja, S.N.; Rappaport, B.A.; et al. Interpreting the clinical importance of group di↵erences in chronic pain clinical trials: Immpact recommendations. Pain 2009, 146, 238–244. [CrossRef] 11. Arnold, L.M.; Cro↵ord, L.J.; Mease, P.J.; Burgess, S.M.; Palmer, S.C.; Abetz, L.; Martin, S.A. Patient perspectives on the impact of fibromyalgia. Patient Educ. Couns. 2008, 73, 114–120. [CrossRef] [PubMed] 12. Wolfe, F.; Hauser, W. Fibromyalgia diagnosis and diagnostic criteria. Ann. Med. 2011, 43, 495–502. [CrossRef] [PubMed] 13. Wolfe, F. New american college of rheumatology criteria for fibromyalgia: A twenty-year journey. Arthritis Care Res. 2010, 62, 583–584. [CrossRef] [PubMed] 14. Wolfe, F.; Clauw, D.J.; Fitzcharles, M.A.; Goldenberg, D.L.; Hauser, W.; Katz, R.S.; Mease, P.; Russell, A.S.; Russell, I.J.; Winfield, J.B. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the acr preliminary diagnostic criteria for fibromyalgia. J. Rheumatol. 2011, 38, 1113–1122. [CrossRef] 15. Oncu, J.; Iliser, R.; Kuran, B. Do new diagnostic criteria for fibromyalgia provide treatment opportunity to those previously untreated? J. Back Musculoskelet. Rehabil. 2013, 26, 437–443. [CrossRef] 16. Wolfe, F.; Walitt, B.; Rasker, J.J.; Hauser, W. Primary and secondary fibromyalgia are the same: The universality of polysymptomatic distress. J. Rheumatol. 2019, 46, 204–212. [CrossRef] 17. Bellato, E.; Marini, E.; Castoldi, F.; Barbasetti, N.; Mattei, L.; Bonasia, D.E.; Blonna, D. Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment. Pain Res. Treat. 2012, 2012, 426130. [CrossRef] 18. Bennett, R.M.; Friend, R.; Marcus, D.; Bernstein, C.; Han, B.K.; Yachoui, R.; Deodhar, A.; Kaell, A.; Bonafede, P.; Chino, A.; et al. Criteria for the diagnosis of fibromyalgia: Validation of the modified 2010 preliminary american college of rheumatology criteria and the development of alternative criteria. Arthritis Care Res. 2014, 66, 1364–1373. [CrossRef] 19. Aggarwal, R.; Ringold, S.; Khanna, D.; Neogi, T.; Johnson, S.R.; Miller, A.; Brunner, H.I.; Ogawa, R.; Felson, D.; Ogdie, A.; et al. Distinctions between diagnostic and classification criteria? Arthritis Care Res. 2015, 67, 891–897. [CrossRef] 20. Taylor, W.J.; Fransen, J. Distinctions between diagnostic and classification criteria: Comment on the article by Aggarwal et al. Arthritis Care Res. 2016, 68, 149–150. [CrossRef] 21. Wolfe, F.; Clauw, D.J.; Fitzcharles, M.A.; Goldenberg, D.L.; Hauser, W.; Katz, R.L.; Mease, P.J.; Russell, A.S.; Russell, I.J.; Walitt, B. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin. Arthritis Rheum. 2016, 46, 319–329. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 19 of 27 22. Bidari, A.; Parsa, B.G.; Ghalehbaghi, B. Challenges in fibromyalgia diagnosis: From meaning of symptoms to fibromyalgia labeling. Korean J. Pain 2018, 31, 147–154. [CrossRef] 23. Treede, R.D.; Rief, W.; Barke, A.; Aziz, Q.; Bennett, M.I.; Benoliel, R.; Cohen, M.; Evers, S.; Finnerup, N.B.; First, M.B.; et al. Chronic pain as a symptom or a disease: The IASP classification of chronic pain for the international classification of diseases (ICD-11). Pain 2019, 160, 19–27. [CrossRef] 24. Wolfe, F.; Schmukler, J.; Jamal, S.; Castrejon, I.; Gibson, K.A.; Srinivasan, S.; Hauser, W.; Pincus, T. Diagnosis of fibromyalgia: Disagreement between fibromyalgia criteria and clinician-based fibromyalgia diagnosis in a university clinic. Arthritis Care Res. 2019, 71, 343–351. [CrossRef] [PubMed] 25. Eich, W.; Bar, K.J.; Bernateck, M.; Burgmer, M.; Dexl, C.; Petzke, F.; Sommer, C.; Winkelmann, A.; Hauser, W. Definition, classification, clinical diagnosis and prognosis of fibromyalgia syndrome: Updated guidelines 2017 and overview of systematic review articles. Schmerz 2017, 31, 231–238. [CrossRef] [PubMed] 26. Ra↵aeli, W.; Malafoglia, V.; Bonci, A.; Tenti, M.; Ilari, S.; Gremigni, P.; Iannuccelli, C.; Gioia, C.; Di Franco, M.; Mollace, V.; et al. Identification of mor-positive b cell as possible innovative biomarker (mu lympho-marker) for chronic pain diagnosis in patients with fibromyalgia and osteoarthritis diseases. Int. J. Mol. Sci. 2020, 21, 15. [CrossRef] [PubMed] 27. Hackshaw, K.V.; Aykas, D.P.; Sigurdson, G.T.; Plans, M.; Madiai, F.; Yu, L.B.; Buffington, C.A.T.; Giusti, M.M.; Rodriguez-Saona, L. Metabolic fingerprinting for diagnosis of fibromyalgia and other rheumatologic disorders. J. Biol. Chem. 2019, 294, 2555–2568. [CrossRef] 28. Wolfe, F. Criteria for fibromyalgia? What is fibromyalgia? Limitations to current concepts of fibromyalgia and fibromyalgia criteria. Clin. Exp. Rheumatol. 2017, 35, S3–S5. 29. Walitt, B.; Nahin, R.L.; Katz, R.S.; Bergman, M.J.; Wolfe, F. The prevalence and characteristics of fibromyalgia in the 2012 national health interview survey. PLoS ONE 2015, 10, e0138024. [CrossRef] 30. Moore, R.A.; Straube, S.; Aldington, D. Pain measures and cut-o↵s—No worse than mild pain as a simple, universal outcome. Anaesthesia 2013, 68, 400–412. [CrossRef] 31. Espejo, J.A.; Garcia-Escudero, M.; Oltra, E. Unraveling the molecular determinants of manual therapy: An approach to integrative therapeutics for the treatment of fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis. Int. J. Mol. Sci. 2018, 19, 19. [CrossRef] [PubMed] 32. Calandre, E.P.; Rico-Villademoros, F.; Slim, M. An update on pharmacotherapy for the treatment of fibromyalgia. Expert Opin. Pharmacother. 2015, 16, 1347–1368. [CrossRef] [PubMed] 33. Thorpe, J.; Shum, B.; Moore, R.A.; Wi↵en, P.J.; Gilron, I. Combination pharmacotherapy for the treatment of fibromyalgia in adults. Cochrane Database Syst. Rev. 2018, 2. [CrossRef] [PubMed] 34. Mease, P.J.; Seymour, K. Fibromyalgia: Should the treatment paradigm be monotherapy or combination pharmacotherapy? Curr. Pain Headache Rep. 2008, 12, 399–405. [CrossRef] 35. Kwiatek, R. Treatment of fibromyalgia. Aust. Prescr. 2017, 40, 179–183. [CrossRef] 36. Wright, C.L.; Mist, S.D.; Ross, R.L.; Jones, K.D. Duloxetine for the treatment of fibromyalgia. Expert Rev. Clin. Immunol. 2010, 6, 745–756. [CrossRef] 37. Pacher, P.; Batkai, S.; Kunos, G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol. Rev. 2006, 58, 389–462. [CrossRef] 38. De Vries, M.; van Rijckevorsel, D.C.M.; Wilder-Smith, O.H.G.; van Goor, H. Dronabinol and chronic pain: Importance of mechanistic considerations. Expert Opin. Pharmacother. 2014, 15, 1525–1534. [CrossRef] 39. Russo, E.B. Clinical endocannabinoid deficiency (CECD)—Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocr. Lett. 2004, 25. (Reprinted from Neuroendocrinilogy, 2004, 25, 31–39). 40. Smith, S.C.; Wagner, M.S. Clinical endocannabinoid deficiency (CECD) revisited: Can this concept explain the therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocr. Lett. 2014, 35, 198–201. 41. Munro, S.; Thomas, K.L.; Abushaar, M. Molecular characterization of a peripheral receptor for cannabinoids. Nature 1993, 365, 61–65. [CrossRef] [PubMed] 42. Skrabek, R.Q.; Gallmova, L.; Ethans, K.; Perry, D. Nabilone for the treatment of pain in fibromyalgia. J. Pain 2008, 9, 164–173. [CrossRef] [PubMed] 43. Walitt, B.; Klose, P.; Fitzcharles, M.A.; Phillips, T.; Hauser, W. Cannabinoids for fibromyalgia. Cochrane Database Syst. Rev. 2016. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 20 of 27 44. Thomas, A.; Baillie, G.L.; Phillips, A.M.; Razdan, R.K.; Ross, R.A.; Pertwee, R.G. Cannabidiol displays unexpectedly high potency as an antagonist of cb1 and cb2 receptor agonists in vitro. Br. J. Pharmacol. 2007, 150, 613–623. [CrossRef] 45. Baumeister, D.; Eich, W.; Lerner, R.; Lutz, B.; Bindila, L.; Tesarz, J. Plasma parameters of the endocannabinoid system are unaltered in fibromyalgia. Psychother. Psychosom. 2018, 87, 377–379. [CrossRef] 46. Kaufmann, I.; Schelling, G.; Eisner, C.; Richter, H.P.; Krauseneck, T.; Vogeser, M.; Hauer, D.; Campolongo, P.; Chouker, A.; Beyer, A.; et al. Anandamide and neutrophil function in patients with fibromyalgia. Psychoneuroendocrinology 2008, 33, 676–685. [CrossRef] 47. Agarwal, N.; Pacher, P.; Tegeder, I.; Amaya, F.; Constantin, C.E.; Brenner, G.J.; Rubino, T.; Michalski, C.W.; Marsicano, G.; Monory, K.; et al. Cannabinoids mediate analgesia largely via peripheral type 1 cannabinoid receptors in nociceptors. Nat. Neurosci. 2007, 10, 870–879. [CrossRef] 48. Schley, M.; Legler, A.; Skopp, G.; Schmelz, M.; Konrad, C.; Rukwied, R. Delta-9-thc based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief. Curr. Med. Res. Opin. 2006, 22, 1269–1276. [CrossRef] 49. Fiz, J.; Duran, M.; Capella, D.; Carbonell, J.; Farre, M. Cannabis use in patients with fibromyalgia: E↵ect on symptoms relief and health-related quality of life. PLoS ONE 2011, 6, 5. [CrossRef] 50. Ware, M.A.; Fitzcharles, M.A.; Joseph, L.; Shir, Y. The e↵ects of nabilone on sleep in fibromyalgia: Results of a randomized controlled trial. Anesth. Analg. 2010, 110, 604–610. [CrossRef] 51. Fitzcharles, M.A.; Ste-Marie, P.A.; Goldenberg, D.L.; Pereira, J.X.; Abbey, S.; Choiniere, M.; Ko, G.; Moulin, D.E.; Panopalis, P.; Proulx, J.; et al. 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: Executive summary. Pain Res. Manag. 2013, 18, 119–126. [CrossRef] 52. Ste-Marie, P.A.; Fitzcharles, M.A.; Gamsa, A.; Ware, M.A.; Shir, Y. Association of herbal cannabis use with negative psychosocial parameters in patients with fibromyalgia. Arthritis Care Res. 2012, 64, 1202–1208. [CrossRef] [PubMed] 53. Painter, J.T.; Cro↵ord, L.J. Chronic opioid use in fibromyalgia syndrome a clinical review. JCR J. Clin. Rheumatol. 2013, 19, 72–77. [CrossRef] [PubMed] 54. Goldenberg, D.L.; Clauw, D.J.; Palmer, R.E.; Clair, A.G. Opioid use in fibromyalgia: A cautionary tale. Mayo Clin. Proc. 2016, 91, 640–648. [CrossRef] [PubMed] 55. Baraniuk, J.N.; Whalen, G.; Cunningham, J.; Clauw, D.J. Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain. BMC Musculoskelet. Disord. 2004, 5, 48. [CrossRef] 56. Fitzcharles, M.-A.; Faregh, N.; Ste-Marie, P.A.; Shir, Y. Opioid use in fibromyalgia is associated with negative health related measures in a prospective cohort study. Pain Res. Treat. 2013, 2013, 7. [CrossRef] 57. Peng, X.M.; Robinson, R.L.; Mease, P.; Kroenke, K.; Williams, D.A.; Chen, Y.; Faries, D.; Wohlreich, M.; McCarberg, B.; Hann, D. Long-term evaluation of opioid treatment in fibromyalgia. Clin. J. Pain 2015, 31, 7–13. [CrossRef] 58. Hwang, J.M.; Lee, B.J.; Oh, T.H.; Park, D.; Kim, C.H. Association between initial opioid use and response to a brief interdisciplinary treatment program in fibromyalgia. Medicine 2019, 98, 8. [CrossRef] 59. Harris, R.E.; Clauw, D.J.; Scott, D.J.; McLean, S.A.; Gracely, R.H.; Zubieta, J.K. Decreased central mu-opioid receptor availability in fibromyalgia. J. Neurosci. 2007, 27, 10000–10006. [CrossRef] 60. Bennett, R.M.; Jones, J.; Turk, D.C.; Russell, I.J.; Matallana, L. An internet survey of 2596 people with fibromyalgia. BMC Musculoskelet. Disord. 2007, 8, 27. 61. Hilliard, P.E.; Waljee, J.; Moser, S.; Metz, L.; Mathis, M.; Goesling, J.; Cron, D.; Clauw, D.J.; Englesbe, M.; Abecasis, G.; et al. Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgeryprevalence of preoperative opioid use and associated patient characteristicsprevalence of preoperative opioid use and associated patient characteristics. JAMA Surg. 2018, 153, 929–937. [PubMed] 62. Gaskell, H.; Moore, R.A.; Derry, S.; Stannard, C. Oxycodone for pain in fibromyalgia in adults. Cochrane Database Syst. Rev. 2016, 23. [CrossRef] 63. Ruette, P.; Stuyck, J.; Debeer, P. Neuropathic arthropathy of the shoulder and elbow associated with syringomyelia: A report of 3 cases. Acta Orthop. Belg. 2007, 73, 525–529. [PubMed] 64. Williams, E.R.; Ford, C.M.; Simonds, J.G.; Leal, A.K. Blocking peripheral opioid receptors with naloxone methiodide prevents acute and chronic training-induced analgesia in a rat model of fibromyalgia. FASEB J. 2017, 31, 1. Int. J. Mol. Sci. 2020, 21, 7877 21 of 27 65. Hermans, L.; Nijs, J.; Calders, P.; De Clerck, L.; Moorkens, G.; Hans, G.; Grosemans, S.; De Mettelinge, T.R.; Tuynman, J.; Meeus, M. Influence of morphine and naloxone on pain modulation in rheumatoid arthritis, chronic fatigue syndrome/fibromyalgia, and controls: A double-blind, randomized, placebo-controlled, cross-over study. Pain Pract. 2018, 18, 418–430. [CrossRef] 66. MacLean, A.J.B.; Schwartz, T.L. Tramadol for the treatment of fibromyalgia. Expert Rev. Neurother. 2015, 15, 469–475. [CrossRef] 67. Gur, A.; Calgan, N.; Nas, K.; Cevik, R.; Sarac, A.J. Low dose of tramadol in the treatment of fibromyalgia syndrome: A controlled clinical trial versus placebo. Ann. Rheum. Dis. 2006, 65, 556. 68. Mullican, W.S.; Lacy, J.R.; TRAMAP-ANAG-006 Study Group. Tramadol/acetaminophen combination tablets and codeine/acetaminophen combination capsules for the management of chronic pain: A comparative trial. Clin. Ther. 2001, 23, 1429–1445. [CrossRef] 69. Price, D.D.; Staud, R.; Robinson, M.E.; Mauderli, A.P.; Cannon, R.; Vierck, C.J. Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients. Pain 2002, 99, 49–59. [CrossRef] 70. Larabi, I.A.; Martin, M.; Fabresse, N.; Etting, I.; Edel, Y.; Pfau, G.; Alvarez, J.C. Hair testing for 3-fluorofentanyl, furanylfentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl and fentanyl by lc-ms/ms after unintentional overdose. Forensic Toxicol. 2020, 38, 277–286. [CrossRef] 71. Comer, S.D.; Cahill, C.M. Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment. Neurosci. Biobehav. Rev. 2019, 106, 49–57. [CrossRef] [PubMed] 72. Abeles, A.M.; Pillinger, M.H.; Solitar, B.M.; Abeles, M. Narrative review: The pathophysiology of fibromyalgia. Ann. Intern. Med. 2007, 146, 726–734. [CrossRef] 73. Watkins, L.R.; Maier, S.F. Immune regulation of central nervous system functions: From sickness responses to pathological pain. J. Intern. Med. 2005, 257, 139–155. [CrossRef] 74. Khalil, R.B. Pentoxifylline’s theoretical efficacy in the treatment of fibromyalgia syndrome. Pain Med. 2013, 14, 549–550. [CrossRef] 75. Polli, A.; Ghosh, M.; Bakusic, J.; Ickmans, K.; Monteyne, D.; Velkeniers, B.; Bekaert, B.; Godderis, L.; Nijs, J. DNA methylation and brain-derived neurotrophic factor expression account for symptoms and widespread hyperalgesia in patients with chronic fatigue syndrome and comorbid fibromyalgia. Arthritis Rheumatol. 2020. [CrossRef] 76. Scott, J.R.; Hassett, A.L.; Brummett, C.M.; Harris, R.E.; Clauw, D.J.; Harte, S.E. Ca↵eine as an opioid analgesic adjuvant in fibromyalgia. J. Pain Res. 2017, 10, 1801–1809. [CrossRef] [PubMed] 77. Goodman, C.W.; Brett, A.S. A clinical overview of o↵-label use of gabapentinoid drugs. JAMA Intern. Med. 2019, 179, 695–701. [CrossRef] 78. Micheva, K.D.; Buchanan, J.; Holz, R.W.; Smith, S.J. Retrograde regulation of synaptic vesicle endocytosis and recycling. Nat. Neurosci. 2003, 6, 925–932. [CrossRef] 79. Deitos, A.; Soldatelli, M.D.; Dussan-Sarria, J.A.; Souza, A.; Torres, I.L.D.; Fregni, F.; Caumo, W. Novel insights of e↵ects of pregabalin on neural mechanisms of intracortical disinhibition in physiopathology of fibromyalgia: An explanatory, randomized, double-blind crossover study. Front. Hum. Neurosci. 2018, 12, 14. [CrossRef] 80. Kiso, T.; Moriyama, A.; Furutani, M.; Matsuda, R.; Funatsu, Y. E↵ects of pregabalin and duloxetine on neurotransmitters in the dorsal horn of the spinal cord in a rat model of fibromyalgia. Eur. J. Pharmacol. 2018, 827, 117–124. [CrossRef] 81. Gerardi, M.C.; Atzeni, F.; Batticciotto, A.; Di Franco, M.; Rizzi, M.; Sarzi-Puttini, P. The safety of pregabalin in the treatment of fibromyalgia. Expert Opin. Drug Saf. 2016, 15, 1541–1548. [CrossRef] [PubMed] 82. Hirakata, M.; Yoshida, S.; Tanaka-Mizuno, S.; Kuwauchi, A.; Kawakami, K. Pregabalin prescription for neuropathic pain and fibromyalgia: A descriptive study using administrative database in Japan. Pain Res. Manag. 2018, 10. [CrossRef] [PubMed] 83. Asomaning, K.; Abramsky, S.; Liu, Q.; Zhou, X.; Sobel, R.E.; Watt, S. Pregabalin prescriptions in the United Kingdom: A drug utilisation study of the health improvement network (thin) primary care database. Int J. Clin. Pr. 2016, 70, 380–388. [CrossRef] 84. Ferreira-Dos-Santos, G.; Sousa, D.C.; Costa, J.; Vaz-Carneiro, A. Analysis of the cochrane review: Pregabalin for pain in fibromyalgia in adults. Cochrane database syst rev. 2016; 9: Cd011790 and 2016; 4: Cd009002. Acta Med. Port. 2018, 31, 376–381. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 22 of 27 85. Bhusal, S.; Diomampo, S.; Magrey, M.N. Clinical utility, safety, and efficacy of pregabalin in the treatment of fibromyalgia. Drug Healthc. Patient Saf. 2016, 8, 13–23. [CrossRef] 86. Arnold, L.M.; Choy, E.; Clauw, D.J.; Oka, H.; Whalen, E.; Semel, D.; Pauer, L.; Knapp, L. An evidence-based review of pregabalin for the treatment of fibromyalgia. Curr. Med. Res. Opin. 2018, 34, 1397–1409. [CrossRef] [PubMed] 87. Cooper, T.E.; Derry, S.; Wi↵en, P.J.; Moore, R.A. Gabapentin for fibromyalgia pain in adults. Cochrane Database Syst. Rev. 2017. [CrossRef] [PubMed] 88. Walitt, B.; Urrutia, G.; Nishishinya, M.B.; Cantrell, S.E.; Hauser, W. Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database Syst. Rev. 2015, 66. [CrossRef] 89. Welsch, P.; Uceyler, N.; Klose, P.; Walitt, B.; Hauser, W. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst. Rev. 2018, 111. [CrossRef] 90. Grubisic, F. Are serotonin and noradrenaline reuptake inhibitors e↵ective, tolerable, and safe for adults with fibromyalgia? A cochrane review summary with commentary. J. Musculoskelet. Neuronal. Interact. 2018, 18, 404–406. 91. VanderWeide, L.A.; Smith, S.M.; Trinkley, K.E. A systematic review of the efficacy of venlafaxine for the treatment of fibromyalgia. J. Clin. Pharm. Ther. 2015, 40, 1–6. [CrossRef] [PubMed] 92. Miki, K.; Murakami, M.; Oka, H.; Onozawa, K.; Yoshida, S.; Osada, K. Efficacy of mirtazapine for the treatment of fibromyalgia without concomitant depression: A randomized, double-blind, placebo-controlled phase IIa study in Japan. Pain 2016, 157, 2089–2096. [CrossRef] 93. Deboer, T. The pharmacologic profile of mirtazapine. J. Clin. Psychiatry 1996, 57, 19–25. 94. Ottman, A.A.; Warner, C.B.; Brown, J.N. The role of mirtazapine in patients with fibromyalgia: A systematic review. Rheumatol. Int. 2018, 38, 2217–2224. [CrossRef] [PubMed] 95. Rico-Villademoros, F.; Slim, M.; Calandre, E.P. Amitriptyline for the treatment of fibromyalgia: A comprehensive review. Expert Rev. Neurother. 2015, 15, 1123–1150. [CrossRef] 96. Moore, R.A.; Derry, S.; Aldington, D.; Cole, P.; Wi↵en, P.J. Amitriptyline for fibromyalgia in adults. Cochrane Database Syst. Rev. 2015. [CrossRef] 97. De Tommaso, M.; Delussi, M.; Ricci, K.; D’Angelo, G. Abdominal acupuncture changes cortical responses to nociceptive stimuli in fibromyalgia patients. CNS Neurosci. Ther. 2014, 20, 565–567. [CrossRef] 98. Karatay, S.; Okur, S.C.; Uzkeser, H.; Yildirim, K.; Akcay, F. E↵ects of acupuncture treatment on fibromyalgia symptoms, serotonin, and substance p levels: A randomized sham and placebo-controlled clinical trial. Pain Med. 2018, 19, 615–628. [CrossRef] 99. Deare, J.C.; Zheng, Z.; Xue, C.C.L.; Liu, J.P.; Shang, J.S.; Scott, S.W.; Littlejohn, G. Acupuncture for treating fibromyalgia. Cochrane Database Syst. Rev. 2013. [CrossRef] 100. Cao, H.J.; Li, X.; Han, M.; Liu, J.P. Acupoint stimulation for fibromyalgia: A systematic review of randomized controlled trials. Evid. Based Complementary Altern. Med. 2013, 2013, 1–15. [CrossRef] 101. Zhang, X.C.; Chen, H.; Xu, W.T.; Song, Y.Y.; Gu, Y.H.; Ni, G.X. Acupuncture therapy for fibromyalgia: A systematic review and meta-analysis of randomized controlled trials. J. Pain Res. 2019, 12, 527–542. [CrossRef] [PubMed] 102. Tesio, V.; Torta, D.M.E.; Colonna, F.; Leombruni, P.; Ghiggia, A.; Fusaro, E.; Geminiani, G.C.; Torta, R.; Castelli, L. Are fibromyalgia patients cognitively impaired? Objective and subjective neuropsychological evidence. Arthritis Care Res. 2015, 67, 143–150. [CrossRef] [PubMed] 103. Gelonch, O.; Garolera, M.; Valls, J.; Rossello, L.; Pifarre, J. Executive function in fibromyalgia: Comparing subjective and objective measures. Compr. Psychiatry 2016, 66, 113–122. [CrossRef] [PubMed] 104. Zhu, C.E.; Yu, B.; Zhang, W.; Chen, W.H.; Qi, Q.; Miao, Y. E↵ectiveness and safety of transcranial direct current stimulation in fibromyalgia: A systematic review and meta-analysis. J. Rehabil. Med. 2017, 49, 2–9. [CrossRef] 105. Brighina, F.; Curatolo, M.; Cosentino, G.; De Tommaso, M.; Battaglia, G.; Sarzi-Puttini, P.C.; Guggino, G.; Fierro, B. Brain modulation by electric currents in fibromyalgia: A structured review on non-invasive approach with transcranial electrical stimulation. Front. Hum. Neurosci. 2019, 13, 14. [CrossRef] 106. Dos Santos, V.S.; Zortea, M.; Alves, R.L.; Naziazeno, C.C.D.; Saldanha, J.S.; de Carvalho, S.D.R.; Leite, A.J.D.; Torres, I.L.D.; de Souza, A.; Calvetti, P.U.; et al. Cognitive e↵ects of transcranial direct current stimulation combined with working memory training in fibromyalgia: A randomized clinical trial. Sci Rep. 2018, 8, 11. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 23 of 27 107. Eken, A.; Kara, M.; Baskak, B.; Baltaci, A.; Gokcay, D. Di↵erential efficiency of transcutaneous electrical nerve stimulation in dominant versus nondominant hands in fibromyalgia: Placebo-controlled functional near-infrared spectroscopy study. Neurophotonics 2018, 5, 15. [CrossRef] 108. Yuksel, M.; Ayas, S.; Cabioglu, M.T.; Yilmaz, D.; Cabioglu, C. Quantitative data for transcutaneous electrical nerve stimulation and acupuncture e↵ectiveness in treatment of fibromyalgia syndrome. Evid. Based Complementary Altern. Med. 2019, 12, 362831. [CrossRef] 109. Ahmed, S.; Plazier, M.; Ost, J.; Stassijns, G.; Deleye, S.; Ceyssens, S.; Dupont, P.; Stroobants, S.; Staelens, S.; De Ridder, D.; et al. The e↵ect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: A water pet and EEG imaging study. BMC Neurol. 2018, 18, 10. [CrossRef] 110. Sutbeyaz, S.T.; Sezer, N.; Koseoglu, F.; Kibar, S. Low-frequency pulsed electromagnetic field therapy in fibromyalgia a randomized, double-blind, sham-controlled clinical study. Clin. J. Pain 2009, 25, 722–728. [CrossRef] 111. Multanen, J.; Hakkinen, A.; Heikkinen, P.; Kautiainen, H.; Mustalampi, S.; Ylinen, J. Pulsed electromagnetic field therapy in the treatment of pain and other symptoms in fibromyalgia: A randomized controlled study. Bioelectromagnetics 2018, 39, 405–413. [CrossRef] 112. Cruccu, G.; Garcia-Larrea, L.; Hansson, P.; Keindl, M.; Lefaucheur, J.P.; Paulus, W.; Taylor, R.; Tronnier, V.; Truini, A.; Attal, N. Ean guidelines on central neurostimulation therapy in chronic pain conditions. Eur. J. Neurol. 2016, 23, 1489–1499. [CrossRef] 113. Knijnik, L.M.; Dussan-Sarria, J.A.; Rozisky, J.R.; Torres, I.L.S.; Brunoni, A.R.; Fregni, F.; Caumo, W. Repetitive transcranial magnetic stimulation for fibromyalgia: Systematic review and meta-analysis. Pain Pract. 2016, 16, 294–304. [CrossRef] 114. Thut, G.; Schyns, P.G.; Gross, J. Entrainment of perceptually relevant brain oscillations by non-invasive rhythmic stimulation of the human brain. Front. Psychol. 2011, 2, 170. [CrossRef] 115. Weber, A.; Werneck, L.; Paiva, E.; Gans, P. E↵ects of music in combination with vibration in acupuncture points on the treatment of fibromyalgia. J. Altern. Complement. Med. 2015, 21, 77–82. [CrossRef] 116. Chesky, K.S.; Russell, I.J.; Lopez, Y.; Kondraske, G.V. Fibromyalgia tender point pain: A double-blind, placebo-controlled pilot study of music vibration using the music vibration table. J. Musculoskelet. Pain 1997, 5, 33–52. [CrossRef] 117. Naghdi, L.; Ahonen, H.; Macario, P.; Bartel, L. The e↵ect of low-frequency sound stimulation on patients with fibromyalgia: A clinical study. Pain Res. Manag. 2015, 20, E21–E27. [CrossRef] [PubMed] 118. Janzen, T.B.; Paneduro, D.; Picard, L.; Gordon, A.; Bartel, L.R. A parallel randomized controlled trial examining the e↵ects of rhythmic sensory stimulation on fibromyalgia symptoms. PLoS ONE 2019, 14, 19. [CrossRef] [PubMed] 119. Ablin, J.N.; Hauser, W.; Buskila, D. Spa Treatment (Balneotherapy) for Fibromyalgia—A Qualitative-Narrative Review and a Historical Perspective. Evid. Based Complementary Altern. Med. 2013, 2013, 638050. [CrossRef] [PubMed] 120. Neumann, L.; Sukenik, S.; Bolotin, A.; Abu-Shakra, M.; Amir, A.; Flusser, D.; Buskila, D. The e↵ect of balneotherapy at the dead sea on the quality of life of patients with fibromyalgia syndrome. Clin. Rheumatol. 2001, 20, 15–19. [CrossRef] 121. Mist, S.D.; Firestone, K.A.; Jones, K.D. Complementary and alternative exercise for fibromyalgia: A meta-analysis. J. Pain Res. 2013, 6, 247–260. [CrossRef] 122. Fioravanti, A.; Perpignano, G.; Tirri, G.; Cardinale, G.; Gianniti, C.; Lanza, C.E.; Loi, A.; Tirri, E.; Sfriso, P.; Cozzi, F. E↵ects of mud-bath treatment on fibromyalgia patients: A randomized clinical trial. Rheumatol. Int. 2007, 27, 1157–1161. [CrossRef] 123. Maeda, T.; Kudo, Y.; Horiuchi, T.; Makino, N. Clinical and anti-aging e↵ect of mud-bathing therapy for patients with fibromyalgia. Mol. Cell. Biochem. 2018, 444, 87–92. [CrossRef] 124. Guidelli, G.M.; Tenti, S.; De Nobili, E.; Fioravanti, A. Fibromyalgia syndrome and spa therapy: Myth or reality? Clin. Med. Insights Arthritis Musculoskelet. Disord. 2012, 5, 19–26. [CrossRef] 125. Ernst, E.; Fialka, V. Ice freezes pain—A review of the clinical e↵ectiveness of analgesic cold therapy. J. Pain Symptom Manag. 1994, 9, 56–59. [CrossRef] 126. Rivera, J.; Tercero, M.J.; Salas, J.S.; Gimeno, J.H.; Alejo, J.S. The e↵ect of cryotherapy on fibromyalgia: A randomised clinical trial carried out in a cryosauna cabin. Rheumatol. Int. 2018, 38, 2243–2250. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 24 of 27 127. Bettoni, L.; Bonomi, F.G.; Zani, V.; Manisco, L.; Indelicato, A.; Lanteri, P.; Banfi, G.; Lombardi, G. E↵ects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients. Clin. Rheumatol. 2013, 32, 1337–1345. [CrossRef] 128. Sutherland, A.M.; Clarke, H.A.; Katz, J.; Katznelson, R. Hyperbaric oxygen therapy: A new treatment for chronic pain? Pain Pract. 2016, 16, 620–628. [CrossRef] 129. Bennett, M.H.; French, C.; Schnabel, A.; Wasiak, J.; Kranke, P.; Weibel, S. Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache. Cochrane Database Syst. Rev. 2015. [CrossRef] 130. Yildiz, S.; Kiralp, M.Z.; Akin, A.; Keskin, I.; Ay, H.; Dursun, H.; Cimsit, M. A new treatment modality for fibromyalgia syndrome: Hyperbaric oxygen therapy. J. Int. Med Res. 2004, 32, 263–267. [CrossRef] [PubMed] 131. Boussi-Gross, R.; Golan, H.; Fishlev, G.; Bechor, Y.; Volkov, O.; Bergan, J.; Friedman, M.; Hoofien, D.; Shlamkovitch, N.; Ben-Jacob, E.; et al. Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury—Randomized prospective trial. PLoS ONE 2013, 8, e79995. [CrossRef] [PubMed] 132. Efrati, S.; Golan, H.; Bechor, Y.; Faran, Y.; Daphna-Tekoah, S.; Sekler, G.; Fishlev, G.; Ablin, J.N.; Bergan, J.; Volkov, O.; et al. Hyperbaric oxygen therapy can diminish fibromyalgia syndrome—Prospective clinical trial. PLoS ONE 2015, 10, e0127012. [CrossRef] [PubMed] 133. El-Shewy, K.M.; Kunbaz, A.; Gad, M.M.; Al-Husseini, M.J.; Saad, A.M.; Sammour, Y.M.; Abdel-Daim, M.M. Hyperbaric oxygen and aerobic exercise in the long-term treatment of fibromyalgia: A narrative review. Biomed. Pharmacother. 2019, 109, 629–638. [CrossRef] [PubMed] 134. Kisselev, S.B.; Moskvin, S.V. The use of laser therapy for patients with fibromyalgia: A critical literary review. J. Lasers Med. Sci. 2019, 10, 12–20. [CrossRef] 135. White, P.F.; Zafereo, J.; Elvir-Lazo, O.L.; Hernandez, H. Treatment of drug-resistant fibromyalgia symptoms using high-intensity laser therapy: A case-based review. Rheumatol. Int. 2018, 38, 517–523. [CrossRef] 136. Gur, A.; Karakoc, M.; Nas, K.; Cevik, R.; Sarac, A.J.; Ataoglu, S. E↵ects of low power laser and low dose amitriptyline therapy on clinical symptoms and quality of life in fibromyalgia: A single-blind, placebo-controlled trial. Rheumatol. Int. 2002, 22, 188–193. 137. Panton, L.; Simonavice, E.; Williams, K.; Mojock, C.; Kim, J.S.; Kingsley, J.D.; McMillan, V.; Mathis, R. E↵ects of class IV laser therapy on fibromyalgia impact and function in women with fibromyalgia. J. Altern. Complement. Med. 2013, 19, 445–452. [CrossRef] 138. Ruaro, J.A.; Frez, A.R.; Ruaro, M.B.; Nicolau, R.A. Low-level laser therapy to treat fibromyalgia. Lasers Med. Sci. 2014, 29, 1815–1819. [CrossRef] 139. Da Silva, M.M.; Albertini, R.; Leal, E.C.P.; de Carvalho, P.D.C.; Silva, J.A.; Bussadori, S.K.; de Oliveira, L.V.F.; Casarin, C.A.S.; Andrade, E.L.; Bocalini, D.S.; et al. E↵ects of exercise training and photobiomodulation therapy (extraphoto) on pain in women with fibromyalgia and temporomandibular disorder: Study protocol for a randomized controlled trial. Trials 2015, 16, 8. [CrossRef] 140. Busch, A.J.; Webber, S.C.; Brachaniec, M.; Bidonde, J.; Dal Bello-Haas, V.; Danyliw, A.D.; Overend, T.J.; Richards, R.S.; Sawant, A.; Schachter, C.L. Exercise therapy for fibromyalgia. Curr. Pain Headache Rep. 2011, 15, 358–367. [CrossRef] 141. Jones, K.D.; Adams, D.; Winters-Stone, K.; Burckhardt, C.S. A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988–2005). Health Qual. Life Outcomes 2006, 4, 67. [CrossRef] [PubMed] 142. Bidonde, J.; Busch, A.J.; Schachter, C.L.; Webber, S.C.; Musselman, K.E.; Overend, T.J.; Goes, S.M.; Dal Bello-Haas, V.; Boden, C. Mixed exercise training for adults with fibromyalgia. Cochrane Database Syst. Rev. 2019, 208. [CrossRef] 143. Assumpção, A.; Matsutani, L.A.; Yuan, S.L.; Santo, A.S.; Sauer, J.; Mango, P.; Marques, A.P. Muscle stretching exercises and resistance training in fibromyalgia: Which is better? A three-arm randomized controlled trial. Eur. J. Phys. Rehabil. Med. 2018, 54, 663–670. [CrossRef] 144. Nelson, N.L. Muscle strengthening activities and fibromyalgia: A review of pain and strength outcomes. J. Bodyw. Mov. Ther. 2015, 19, 370–376. [CrossRef] 145. Sanudo, B.; Galiano, D.; Carrasco, L.; Blagojevic, M.; de Hoyo, M.; Saxton, J. Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: A randomized controlled trial. Arch. Phys. Med. Rehabil. 2010, 91, 1838–1843. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 25 of 27 146. Umeda, M.; Corbin, L.W.; Maluf, K.S. Pain mediates the association between physical activity and the impact of fibromyalgia on daily function. Clin. Rheumatol. 2015, 34, 143–149. [CrossRef] [PubMed] 147. Bement, M.K.H.; Weyer, A.; Hartley, S.; Drewek, B.; Harkins, A.L.; Hunter, S.K. Pain perception after isometric exercise in women with fibromyalgia. Arch. Phys. Med. Rehabil. 2011, 92, 89–95. [CrossRef] 148. Carson, J.W.; Carson, K.M.; Jones, K.D.; Bennett, R.M.; Wright, C.L.; Mist, S.D. A pilot randomized controlled trial of the yoga of awareness program in the management of fibromyalgia. Pain 2010, 151, 530–539. [CrossRef] 149. De Oliveira, F.R.; Goncalves, L.C.V.; Borghi, F.; da Silva, L.; Gomes, A.E.; Trevisan, G.; de Souza, A.L.; Grassi-Kassisse, D.M.; Crege, D. Massage therapy in cortisol circadian rhythm, pain intensity, perceived stress index and quality of life of fibromyalgia syndrome patients. Complement. Ther. Clin. Pract. 2018, 30, 85–90. [CrossRef] 150. Tomas-Carus, P.; Hakkinen, A.; Gusi, N.; Leal, A.; Hakkinen, K.; Ortega-Alonso, A. Aquatic training and detraining on fitness and quality of life in fibromyalgia. Med. Sci. Sports Exerc. 2007, 39, 1044–1050. [CrossRef] 151. Gusi, N.; Tomas-Carus, P. Cost-utility of an 8-month aquatic training for women with fibromyalgia: A randomized controlled trial. Arthritis Res. Ther. 2008, 10, 8. [CrossRef] [PubMed] 152. Andrade, C.P.; Zamuner, A.R.; Forti, M.; Franca, T.F.; Tamburus, N.Y.; Silva, E. Oxygen uptake and body composition after aquatic physical training in women with fibromyalgia: A randomized controlled trial. Eur. J. Phys. Rehabil. Med. 2017, 53, 751–758. 153. Bidonde, J.; Busch, A.J.; Schachter, C.L.; Overend, T.J.; Kim, S.Y.; Goes, S.; Boden, C.; Foulds, H.J.A. Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst. Rev. 2017. [CrossRef] 154. Bidonde, J.; Busch, A.J.; Webber, S.C.; Schachter, C.L.; Danyliw, A.; Overend, T.J.; Richards, R.S.; Rader, T. Aquatic exercise training for fibromyalgia. Cochrane Database Syst. Rev. 2014, 177. [CrossRef] [PubMed] 155. Marske, C.; Bernard, N.; Palacios, A.; Wheeler, C.; Preiss, B.; Brown, M.; Bhattacharya, S.; Klapstein, G. Fibromyalgia with gabapentin and osteopathic manipulative medicine: A pilot study. J. Altern. Complement. Med. 2018, 24, 395–402. [CrossRef] [PubMed] 156. Baptista, A.S.; Villela, A.L.; Jones, A.; Natour, J. E↵ectiveness of dance in patients with fibromyalgia: A randomised, single-blind, controlled study. Clin. Exp. Rheumatol. 2012, 30, S18–S23. 157. Assunção, J.C.; Silva, H.J.D.; da Silva, J.F.C.; Cruz, R.D.; Lins, C.A.D.; de Souza, M.C. Zumba dancing can improve the pain and functional capacity in women with fibromyalgia. J. Bodyw. Mov. Ther. 2018, 22, 455–459. [CrossRef] 158. Wang, C.C.; Schmid, C.H.; Fielding, R.A.; Harvey, W.F.; Reid, K.F.; Price, L.L.; Driban, J.B.; Kalish, R.; Rones, R.; McAlindon, T. E↵ect of tai chi versus aerobic exercise for fibromyalgia: Comparative e↵ectiveness randomized controlled trial. BMJ Br. Med J. 2018, 360, 14. [CrossRef] 159. Cryan, J.F.; Dinan, T.G. Mind-altering microorganisms: The impact of the gut microbiota on brain and behaviour. Nat. Rev. Neurosci. 2012, 13, 701–712. [CrossRef] 160. Galland, L. The gut microbiome and the brain. J. Med. Food 2014, 17, 1261–1272. [CrossRef] 161. Goebel, A.; Buhner, S.; Schedel, R.; Lochs, H.; Sprotte, G. Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome. Rheumatology 2008, 47, 1223–1227. [CrossRef] 162. Mayer, E.A.; Tillisch, K.; Gupta, A. Gut/brain axis and the microbiota. J. Clin. Investig. 2015, 125, 926–938. [CrossRef] 163. Roman, P.; Estevez, A.F.; Mires, A.; Sanchez-Labraca, N.; Canadas, F.; Vivas, A.B.; Cardona, D. A pilot randomized controlled trial to explore cognitive and emotional e↵ects of probiotics in fibromyalgia. Sci Rep. 2018, 8, 9. [CrossRef] [PubMed] 164. Butler, D. Translational research: Crossing the valley of death. Nature 2008, 453, 840–842. [CrossRef] 165. Nascimento, S.D.; DeSantana, J.M.; Nampo, F.K.; Ribeiro, E.A.N.; da Silva, D.L.; Araujo, J.X.; Almeida, J.; Bonjardim, L.R.; Araujo, A.A.D.; Quintans, L.J. Efficacy and safety of medicinal plants or related natural products for fibromyalgia: A systematic review. Evid. Based Complementary Altern. Med. 2013. [CrossRef] [PubMed] 166. Brownstein, M.J. A brief-history of opiates, opioid-peptides, and opioid receptors. Proc. Natl. Acad. Sci. USA 1993, 90, 5391–5393. [CrossRef] 167. Benyhe, S. Morphine—New aspects in the study of an ancient compound. Life Sci. 1994, 55, 969–979. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 26 of 27 168. Meng, I.D.; Manning, B.H.; Martin, W.J.; Fields, H.L. An analgesia circuit activated by cannabinoids. Nature 1998, 395, 381–383. [CrossRef] 169. Sagy, I.; Schleider, L.B.L.; Abu-Shakra, M.; Novack, V. Safety and efficacy of medical cannabis in fibromyalgia. J. Clin. Med. 2019, 8, 12. [CrossRef] 170. Van de Donk, T.; Niesters, M.; Kowal, M.A.; Olofsen, E.; Dahan, A.; van Velzen, M. An experimental randomized study on the analgesic e↵ects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain 2019, 160, 860–869. [CrossRef] 171. Habib, G.; Artul, S. Medical cannabis for the treatment of fibromyalgia. JCR J. Clin. Rheumatol. 2018, 24, 255–258. [CrossRef] [PubMed] 172. Habib, G.; Avisar, I. The consumption of cannabis by fibromyalgia patients in Israel. Pain Res. Treat. 2018, 5, 7829427. [CrossRef] 173. Ma↵ei, M.E. Plant natural sources of the endocannabinoid (e)- -caryophyllene: A systematic quantitative analysis of published literature. Int. J. Mol. Sci. 2020, 21, 6540. [CrossRef] [PubMed] 174. Paula-Freire, L.I.G.; Andersen, M.L.; Gama, V.S.; Molska, G.R.; Carlini, E.L.A. The oral administration of trans-caryophyllene attenuates acute and chronic pain in mice. Phytomedicine 2014, 21, 356–362. [CrossRef] [PubMed] 175. Gertsch, J.; Leonti, M.; Raduner, S.; Racz, I.; Chen, J.Z.; Xie, X.Q.; Altmann, K.H.; Karsak, M.; Zimmer, A. Beta-caryophyllene is a dietary cannabinoid. Proc. Natl. Acad. Sci. USA 2008, 105, 9099–9104. [CrossRef] 176. Oliveira, G.L.D.; Machado, K.C.; Machado, K.C.; da Silva, A.; Feitosa, C.M.; Almeida, F.R.D. Non-clinical toxicity of beta-caryophyllene, a dietary cannabinoid: Absence of adverse e↵ects in female swiss mice. Regul. Toxicol. Pharmacol. 2018, 92, 338–346. [CrossRef] 177. Quintans, L.J.; Araujo, A.A.S.; Brito, R.G.; Santos, P.L.; Quintans, J.S.S.; Menezes, P.P.; Serafini, M.R.; Silva, G.F.; Carvalho, F.M.S.; Brogden, N.K.; et al. Beta-caryophyllene, a dietary cannabinoid, complexed with beta-cyclodextrin produced anti-hyperalgesic e↵ect involving the inhibition of Fos expression in superficial dorsal horn. Life Sci. 2016, 149, 34–41. [CrossRef] 178. Ibrahim, M.M.; Porreca, F.; Lai, J.; Albrecht, P.J.; Rice, F.L.; Khodorova, A.; Davar, G.; Makriyannis, A.; Vanderah, T.W.; Mata, H.P.; et al. Cb2 cannabinoid receptor activation produces antinociception by stimulating peripheral release of endogenous opioids. Proc. Natl. Acad. Sci. USA 2005, 102, 3093–3098. [CrossRef] 179. Fidyt, K.; Fiedorowicz, A.; Strzadala, L.; Szumny, A. Beta-caryophyllene and beta-caryophyllene oxide-natural compounds of anticancer and analgesic properties. Cancer Med. 2016, 5, 3007–3017. [CrossRef] 180. Klauke, A.L.; Racz, I.; Pradier, B.; Markert, A.; Zimmer, A.M.; Gertsch, J.; Zimmer, A. The cannabinoid cb2 receptor-selective phytocannabinoid beta-caryophyllene exerts analgesic e↵ects in mouse models of inflammatory and neuropathic pain. Eur. Neuropsychopharmacol. 2014, 24, 608–620. [CrossRef] 181. Melo, A.J.D.; Heimarth, L.; Carvalho, A.M.D.; Quintans, J.D.S.; Serafini, M.R.; Araujo, A.A.D.; Alves, P.B.; Ribeiro, A.M.; Shanmugam, S.; Quintans, L.J.; et al. Eplingiella fruticosa (Lamiaceae) Essential Oil Complexed with Beta-Cyclodextrin Improves Its Anti-Hyperalgesic E↵ect in a Chronic Widespread Non-Inflammatory Muscle Pain Animal Model. Food Chem. Toxicol. 2020, 135, 7. 182. Dolara, P.; Luceri, C.; Ghelardini, C.; Monserrat, C.; Aiolli, S.; Luceri, F.; Lodovici, M.; Menichetti, S.; Romanelli, M.N. Analgesic e↵ects of myrrh. Nature 1996, 379, 29. [CrossRef] [PubMed] 183. Borchardt, J.K. Myrrh: An analgesic with a 4000-year history. Drug News Perspect. 1996, 9, 554–557. 184. Su, S.L.; Hua, Y.Q.; Wang, Y.Y.; Gu, W.; Zhou, W.; Duan, J.A.; Jiang, H.F.; Chen, T.; Tang, Y.P. Evaluation of the anti-inflammatory and analgesic properties of individual and combined extracts from Commiphora myrrha, and Boswellia carterii. J. Ethnopharmacol. 2012, 139, 649–656. [CrossRef] 185. Lee, D.; Ju, M.K.; Kim, H. Commiphora extract mixture ameliorates monosodium iodoacetate-induced osteoarthritis. Nutrients 2020, 12, 17. [CrossRef] 186. Germano, A.; Occhipinti, A.; Barbero, F.; Ma↵ei, M.E. A pilot study on bioactive constituents and analgesic e↵ects of myrliq® , a Commiphora myrrha extract with a high furanodiene content. Biomed. Res. Int 2017, 2017, 3804356. [CrossRef] 187. Galeotti, N. Hypericum perforatum (St John’s Wort) beyond Depression: A Therapeutic Perspective for Pain Conditions. J. Ethnopharmacol. 2017, 200, 136–146. [CrossRef] 188. Khan, H.; Pervaiz, A.; Intagliata, S.; Das, N.; Venkata, K.C.N.; Atanasov, A.G.; Najda, A.; Nabavi, S.M.; Wang, D.D.; Pittala, V.; et al. The analgesic potential of glycosides derived from medicinal plants. DARU 2020, 28, 387–401. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 27 of 27 189. Wang, R.Y.; Qiu, Z.; Wang, G.Z.; Hu, Q.; Shi, N.H.; Zhang, Z.Q.; Wu, Y.Q.; Zhou, C.H. Quercetin attenuates diabetic neuropathic pain by inhibiting mtor/p70s6k pathway-mediated changes of synaptic morphology and synaptic protein levels in spinal dorsal horn of db/db mice. Eur. J. Pharmacol. 2020, 882, 7. [CrossRef] 190. Carvalho, T.T.; Mizokami, S.S.; Ferraz, C.R.; Manchope, M.F.; Borghi, S.M.; Fattori, V.; Calixto-Campos, C.; Camilios-Neto, D.; Casagrande, R.; Verri, W.A. The granulopoietic cytokine granulocyte colony-stimulating factor (G-CSF) induces pain: Analgesia by rutin. Inflammopharmacology 2019, 27, 1285–1296. [CrossRef] 191. Xiao, X.; Wang, X.Y.; Gui, X.; Chen, L.; Huang, B.K. Natural flavonoids as promising analgesic candidates: A systematic review. Chem. Biodivers. 2016, 13, 1427–1440. [CrossRef] 192. Yao, X.L.; Li, L.; Kandhare, A.D.; Mukherjee-Kandhare, A.A.; Bodhankar, S.L. Attenuation of reserpine-induced fibromyalgia via ros and serotonergic pathway modulation by fisetin, a plant flavonoid polyphenol. Exp. Ther. Med. 2020, 19, 1343–1355. [CrossRef] 193. Shakiba, M.; Moazen-Zadeh, E.; Noorbala, A.A.; Jafarinia, M.; Divsalar, P.; Kashani, L.; Shahmansouri, N.; Tafakhori, A.; Bayat, H.; Akhondzadeh, S. Sa↵ron (Crocus sativus) versus duloxetine for treatment of patients with fibromyalgia: A randomized double-blind clinical trial. Avicenna J. Phytomedicine 2018, 8, 513–523. 194. McCarberg, B.H. Clinical overview of fibromyalgia. Am. J. Ther. 2012, 19, 357–368. [CrossRef] [PubMed] Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. © 2020 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
USER:
What are the current therapy practices to treat fibromyalgia according to the document?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 20 | 13 | 14,923 | null | 586 |
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
|
I am doing a medical research paper and found this article. Summarize me introduction and epidemiology part in the bulleted points format. Keep it under 200 words.
|
Introduction Staphylococcus aureus is a major bacterial human pathogen that causes a wide variety of clinical manifestations.[1] Infections are common both in community-acquired as well as hospital-acquired settings and treatment remains challenging to manage due to the emergence of multi-drug resistant strains such as MRSA (Methicillin-Resistant Staphylococcus aureus).[2][3] S. aureus is found in the environment and is also found in normal human flora, located on the skin and mucous membranes (most often the nasal area) of most healthy individuals.[1] S. aureus does not normally cause infection on healthy skin; however, if it is allowed to enter the bloodstream or internal tissues, these bacteria may cause a variety of potentially serious infections.[1] Transmission is typically from direct contact. However, some infections involve other transmission methods.[4] Go to: Etiology Staphylococcus aureus is Gram-positive bacteria (stain purple by Gram stain) that are cocci-shaped and tend to be arranged in clusters that are described as “grape-like.” On media, these organisms can grow in up to 10% salt, and colonies are often golden or yellow (aureus means golden or yellow). These organisms can grow aerobically or anaerobically (facultative) and at temperatures between 18 C and 40 C. Typical biochemical identification tests include catalase positive (all pathogenic Staphylococcus species), coagulase positive (to distinguish Staphylococcus aureus from other Staphylococcus species), novobiocin sensitive (to distinguish from Staphylococcus saprophyticus), and mannitol fermentation positive (to distinguish from Staphylococcus epidermidis).[4][1] MRSA strains carry a mec gene on the bacterial chromosome, which is a component of the larger Staphylococcal chromosomal cassette mec (SCCmec) region, conferring resistance to multiple antibiotics depending on the SCCmec type.[2] The mec gene encodes the protein PBP-2a (penicillin-binding protein 2a). PBP-2a is a penicillin-binding protein (PBP), or essential bacterial cell wall enzyme that catalyzes the production of the peptidoglycan in the bacterial cell wall. PBP-2A has a lower affinity to bind to beta-lactams (and other penicillin-derived antibiotics) when compared to other PBPs, so PBP-2A continues to catalyze the synthesis of the bacterial cell wall even in the presence of many antibiotics. As a result, S. aureus strains that synthesize PBP-2A can grow in the presence of many antibiotics, and these MRSA strains are resistant to many antibiotics. MRSA strains tend to be resistant to methicillin, nafcillin, oxacillin, and cephalosporins.[2][4] Go to: Epidemiology Staphylococcus aureus (including drug-resistant strains such as MRSA) are found on the skin and mucous membranes, and humans are the major reservoir for these organisms.[3][5] It is estimated that up to half of all adults are colonized, and approximately 15% of the population persistently carry S. aureus in the anterior nares. Some populations tend to have higher rates of S. aureus colonization (up to 80%), such as health care workers, persons who use needles on a regular basis (i.e., diabetics and intravenous (IV) drug users), hospitalized patients, and immunocompromised individuals. S. aureus can be transmitted person-to-person by direct contact or by fomites.[6][4][1] Go to: Pathophysiology S. aureus are one the most common bacterial infections in humans and are the causative agents of multiple human infections, including bacteremia, infective endocarditis, skin and soft tissue infections (e.g., impetigo, folliculitis, furuncles, carbuncles, cellulitis, scalded skin syndrome, and others), osteomyelitis, septic arthritis, prosthetic device infections, pulmonary infections (e.g., pneumonia and empyema), gastroenteritis, meningitis, toxic shock syndrome, and urinary tract infections.[6] Depending on the strains involved and the site of infection, these bacteria can cause invasive infections and/or toxin-mediated diseases.[6][7] The pathophysiology varies greatly depending on the type of S. aureus infection.[6] Mechanisms for evasion of the host immune response include the production of an antiphagocytic capsule, sequestering of host antibodies or antigen masking by Protein A, biofilm formation, intracellular survival, and blocking chemotaxis of leukocytes.[8][7] Binding of the bacteria to extracellular matrix proteins and fibronectin in infectious endocarditis is mediated by bacterial cell wall-associated proteins such as fibrinogen-binding proteins, clumping factors, and teichoic acids.[7] Also, Staphylococcal superantigens (TSST-1 or toxic shock syndrome toxin 1) are important virulence factors in infectious endocarditis, sepsis, as well as toxic shock syndrome.[9][10] Pneumonia infections are associated with the bacterial production of PVL (Panton-Valentine leukocidin), Protein A, and alpha-hemolysin, and infections are more common following influenza virus infection as well as a diagnosis of Cystic Fibrosis. Prosthetic device infections are often mediated by the ability of S. aureus strains to form biofilms as well as communicate using quorum sensing in a bacterial cell density-dependent manner. [11]
|
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I am doing a medical research paper and found this article. Summarize me introduction and epidemiology part in the bulleted points format. Keep it under 200 words. {passage 0} ========== Introduction Staphylococcus aureus is a major bacterial human pathogen that causes a wide variety of clinical manifestations.[1] Infections are common both in community-acquired as well as hospital-acquired settings and treatment remains challenging to manage due to the emergence of multi-drug resistant strains such as MRSA (Methicillin-Resistant Staphylococcus aureus).[2][3] S. aureus is found in the environment and is also found in normal human flora, located on the skin and mucous membranes (most often the nasal area) of most healthy individuals.[1] S. aureus does not normally cause infection on healthy skin; however, if it is allowed to enter the bloodstream or internal tissues, these bacteria may cause a variety of potentially serious infections.[1] Transmission is typically from direct contact. However, some infections involve other transmission methods.[4] Go to: Etiology Staphylococcus aureus is Gram-positive bacteria (stain purple by Gram stain) that are cocci-shaped and tend to be arranged in clusters that are described as “grape-like.” On media, these organisms can grow in up to 10% salt, and colonies are often golden or yellow (aureus means golden or yellow). These organisms can grow aerobically or anaerobically (facultative) and at temperatures between 18 C and 40 C. Typical biochemical identification tests include catalase positive (all pathogenic Staphylococcus species), coagulase positive (to distinguish Staphylococcus aureus from other Staphylococcus species), novobiocin sensitive (to distinguish from Staphylococcus saprophyticus), and mannitol fermentation positive (to distinguish from Staphylococcus epidermidis).[4][1] MRSA strains carry a mec gene on the bacterial chromosome, which is a component of the larger Staphylococcal chromosomal cassette mec (SCCmec) region, conferring resistance to multiple antibiotics depending on the SCCmec type.[2] The mec gene encodes the protein PBP-2a (penicillin-binding protein 2a). PBP-2a is a penicillin-binding protein (PBP), or essential bacterial cell wall enzyme that catalyzes the production of the peptidoglycan in the bacterial cell wall. PBP-2A has a lower affinity to bind to beta-lactams (and other penicillin-derived antibiotics) when compared to other PBPs, so PBP-2A continues to catalyze the synthesis of the bacterial cell wall even in the presence of many antibiotics. As a result, S. aureus strains that synthesize PBP-2A can grow in the presence of many antibiotics, and these MRSA strains are resistant to many antibiotics. MRSA strains tend to be resistant to methicillin, nafcillin, oxacillin, and cephalosporins.[2][4] Go to: Epidemiology Staphylococcus aureus (including drug-resistant strains such as MRSA) are found on the skin and mucous membranes, and humans are the major reservoir for these organisms.[3][5] It is estimated that up to half of all adults are colonized, and approximately 15% of the population persistently carry S. aureus in the anterior nares. Some populations tend to have higher rates of S. aureus colonization (up to 80%), such as health care workers, persons who use needles on a regular basis (i.e., diabetics and intravenous (IV) drug users), hospitalized patients, and immunocompromised individuals. S. aureus can be transmitted person-to-person by direct contact or by fomites.[6][4][1] Go to: Pathophysiology S. aureus are one the most common bacterial infections in humans and are the causative agents of multiple human infections, including bacteremia, infective endocarditis, skin and soft tissue infections (e.g., impetigo, folliculitis, furuncles, carbuncles, cellulitis, scalded skin syndrome, and others), osteomyelitis, septic arthritis, prosthetic device infections, pulmonary infections (e.g., pneumonia and empyema), gastroenteritis, meningitis, toxic shock syndrome, and urinary tract infections.[6] Depending on the strains involved and the site of infection, these bacteria can cause invasive infections and/or toxin-mediated diseases.[6][7] The pathophysiology varies greatly depending on the type of S. aureus infection.[6] Mechanisms for evasion of the host immune response include the production of an antiphagocytic capsule, sequestering of host antibodies or antigen masking by Protein A, biofilm formation, intracellular survival, and blocking chemotaxis of leukocytes.[8][7] Binding of the bacteria to extracellular matrix proteins and fibronectin in infectious endocarditis is mediated by bacterial cell wall-associated proteins such as fibrinogen-binding proteins, clumping factors, and teichoic acids.[7] Also, Staphylococcal superantigens (TSST-1 or toxic shock syndrome toxin 1) are important virulence factors in infectious endocarditis, sepsis, as well as toxic shock syndrome.[9][10] Pneumonia infections are associated with the bacterial production of PVL (Panton-Valentine leukocidin), Protein A, and alpha-hemolysin, and infections are more common following influenza virus infection as well as a diagnosis of Cystic Fibrosis. Prosthetic device infections are often mediated by the ability of S. aureus strains to form biofilms as well as communicate using quorum sensing in a bacterial cell density-dependent manner. [11] https://www.ncbi.nlm.nih.gov/books/NBK441868/
|
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
EVIDENCE:
Introduction Staphylococcus aureus is a major bacterial human pathogen that causes a wide variety of clinical manifestations.[1] Infections are common both in community-acquired as well as hospital-acquired settings and treatment remains challenging to manage due to the emergence of multi-drug resistant strains such as MRSA (Methicillin-Resistant Staphylococcus aureus).[2][3] S. aureus is found in the environment and is also found in normal human flora, located on the skin and mucous membranes (most often the nasal area) of most healthy individuals.[1] S. aureus does not normally cause infection on healthy skin; however, if it is allowed to enter the bloodstream or internal tissues, these bacteria may cause a variety of potentially serious infections.[1] Transmission is typically from direct contact. However, some infections involve other transmission methods.[4] Go to: Etiology Staphylococcus aureus is Gram-positive bacteria (stain purple by Gram stain) that are cocci-shaped and tend to be arranged in clusters that are described as “grape-like.” On media, these organisms can grow in up to 10% salt, and colonies are often golden or yellow (aureus means golden or yellow). These organisms can grow aerobically or anaerobically (facultative) and at temperatures between 18 C and 40 C. Typical biochemical identification tests include catalase positive (all pathogenic Staphylococcus species), coagulase positive (to distinguish Staphylococcus aureus from other Staphylococcus species), novobiocin sensitive (to distinguish from Staphylococcus saprophyticus), and mannitol fermentation positive (to distinguish from Staphylococcus epidermidis).[4][1] MRSA strains carry a mec gene on the bacterial chromosome, which is a component of the larger Staphylococcal chromosomal cassette mec (SCCmec) region, conferring resistance to multiple antibiotics depending on the SCCmec type.[2] The mec gene encodes the protein PBP-2a (penicillin-binding protein 2a). PBP-2a is a penicillin-binding protein (PBP), or essential bacterial cell wall enzyme that catalyzes the production of the peptidoglycan in the bacterial cell wall. PBP-2A has a lower affinity to bind to beta-lactams (and other penicillin-derived antibiotics) when compared to other PBPs, so PBP-2A continues to catalyze the synthesis of the bacterial cell wall even in the presence of many antibiotics. As a result, S. aureus strains that synthesize PBP-2A can grow in the presence of many antibiotics, and these MRSA strains are resistant to many antibiotics. MRSA strains tend to be resistant to methicillin, nafcillin, oxacillin, and cephalosporins.[2][4] Go to: Epidemiology Staphylococcus aureus (including drug-resistant strains such as MRSA) are found on the skin and mucous membranes, and humans are the major reservoir for these organisms.[3][5] It is estimated that up to half of all adults are colonized, and approximately 15% of the population persistently carry S. aureus in the anterior nares. Some populations tend to have higher rates of S. aureus colonization (up to 80%), such as health care workers, persons who use needles on a regular basis (i.e., diabetics and intravenous (IV) drug users), hospitalized patients, and immunocompromised individuals. S. aureus can be transmitted person-to-person by direct contact or by fomites.[6][4][1] Go to: Pathophysiology S. aureus are one the most common bacterial infections in humans and are the causative agents of multiple human infections, including bacteremia, infective endocarditis, skin and soft tissue infections (e.g., impetigo, folliculitis, furuncles, carbuncles, cellulitis, scalded skin syndrome, and others), osteomyelitis, septic arthritis, prosthetic device infections, pulmonary infections (e.g., pneumonia and empyema), gastroenteritis, meningitis, toxic shock syndrome, and urinary tract infections.[6] Depending on the strains involved and the site of infection, these bacteria can cause invasive infections and/or toxin-mediated diseases.[6][7] The pathophysiology varies greatly depending on the type of S. aureus infection.[6] Mechanisms for evasion of the host immune response include the production of an antiphagocytic capsule, sequestering of host antibodies or antigen masking by Protein A, biofilm formation, intracellular survival, and blocking chemotaxis of leukocytes.[8][7] Binding of the bacteria to extracellular matrix proteins and fibronectin in infectious endocarditis is mediated by bacterial cell wall-associated proteins such as fibrinogen-binding proteins, clumping factors, and teichoic acids.[7] Also, Staphylococcal superantigens (TSST-1 or toxic shock syndrome toxin 1) are important virulence factors in infectious endocarditis, sepsis, as well as toxic shock syndrome.[9][10] Pneumonia infections are associated with the bacterial production of PVL (Panton-Valentine leukocidin), Protein A, and alpha-hemolysin, and infections are more common following influenza virus infection as well as a diagnosis of Cystic Fibrosis. Prosthetic device infections are often mediated by the ability of S. aureus strains to form biofilms as well as communicate using quorum sensing in a bacterial cell density-dependent manner. [11]
USER:
I am doing a medical research paper and found this article. Summarize me introduction and epidemiology part in the bulleted points format. Keep it under 200 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 26 | 27 | 721 | null | 372 |
You may only use information contained within the provided content block.
|
What benefits do nasal cannula have over non-rebreathe masks?
|
Oxygen is a drug with a correct dosage When administered correctly may be life saving. Aim is to achieve adequate tissue oxygenation (without causing a significant decrease in ventilation and consequent hypercapnia or oxygen toxicity) Need to treat • Tissue hypoxia is difficult to recognize as clinical features are nonspecific –include dyspnoea cyanosis, tachypnoea, arrhythmias, altered mental state, coma. • Treatment of tissue hypoxia should correct any arterial hypoxemia (Cardiopulmonary defect/shunt e.g.-asthma, pneumonia, PE), any transport deficit (anaemia, low cardiac output), and underlying causes. • SaO2/PaO2 can be normal when tissue hypoxia is caused by low cardiac output states. Oxygen administration Equipment The method of delivery will depend on the type and severity of respiratory failure, breathing pattern, respiratory rate, risk of CO2 retention, need for humidification and patient compliance. Each oxygen delivery device comprises • An oxygen supply(>4L/min) • Flow rate 07.Oxygen administration 20 Hand book of Basic Medical Procedure Dr.M.Umakanth • Tubing • Interface + humidification 1) Nasal cannula These direct oxygen via 2 short prongs up the nasal passage They: • Can be used for long periods of time. • Prevent rebreathing. • Can be used during eating and talking. 2) Low flow oxygen masks These deliver oxygen concentrations that vary depending on the patient’s minute volume. Some rebreathing of exhaled gases. 3) Fixed performance masks These deliver constant concentration of oxygen independent of the patient’s minute volume. The masks contain ‘venturi’ barrels where relatively low rates of oxygen are forced through a narrow orifice producing a greater flow rate. 4) Partial and non-rebreathe masks This mask have a ‘reservoir’ bag that is filled with pure oxygen and depend on a system of valves which prevent mixing of exhaled gases with the incoming oxygen. Dr.M.Umakanth Hand book of Basic Medical Procedure 21 5) High flow Oxygen Masks or nasal prongs that generate flows of 50-120ml/ min using a high flow regulator to entrain air and oxygen at specific concentrations. It should always be used with humidification. Procedure • Introduce yourself, confirm patient’s identity, explain the condition, Obtain Verbal consent. • Choose an appropriate oxygen delivery device • Choose an initial dose… o Cardiac or respiratory arrest:100%. o Hypoxaemia with PaCO2 <5.3kPa:40-60%. o Hypoxaemia with PaCO2 >5.3kPa:24% initially. • Decide on the acceptable level of SaO2 or PaO2 and titrate oxygen accordingly. • If possible, try to measure a PaO2 in room air prior to giving supplementary oxygen. • Liaise with nursing staff, physiotherapist or outreach for support in setting up equipment. • Apply the oxygen and monitor via oxymetry(SaO2) and/or repeat ABG(PaO2) in 30 minutes. • If hypoxemia continue, then the patient may require respiratory support either invasively or non-invasivelyliaise with your seniors and/or the respiratory doctors. • Stop supplementary oxygen when tissue hypoxia or arterial hypoxaemia has resolved. 22 Hand book of Basic Medical Procedure Dr.M.Umakanth Equipment Required • NG tube • Disposable gloves • Lubricant gel • Cup of water • 50ml Syringe • Drainage bag (If necessary) • Adhesive tape • Paper towel • Plastic apron. Indication • Feeding (Ryle’s tube) • Patients who have an increased risk of aspiration • Decompression of stomach during bowel obstruction • Gastric larvage Contraindication • Severe Facial trauma • Basal skull fracture • Suspected oesophageal perforation • Grossly abnormal nasal anatomy Procedure • Introduce yourself, confirm patient’s identity, explain the procedure, and obtain verbal consent • Wash hands thoroughly, put on gloves and plastic apron. 08.Nasogastric(NG) tube Insertion Dr.M.Umakanth Hand book of Basic Medical Procedure 23 • Sit the patient up, slightly extending the neck. • Examine patient’s nose for deformity. • Use the tube to measure the length from the nares to the stomach, (Xiphisternum-earlobe-tip of nose) and note the distance. • Lubricate the tip(4-8cm) of the tube, avoiding blocking the lumen. • Insert into the nostril and advance directly posteriorly • Whilst advancing, ask the patient to take sip of water and hold it in their mouth. • Request the patient to swallow and, as the patient swallows, advance the tube down oesophagus. • Continue to advance the tube until 10-20cm beyond pre-measured distance to stomach (60-70cm total). • To confirm correct place ment o Aspirate some gastric contents with syringe and check fluid’s acidic pH(with litmus paper) confirmatory o If unsure, obtain a chest X-ray(CXR) with a view of the stomach. o Although commonly done on wards, injecting 5-10ml air into the tube whilst auscultating for babbling with stethoscope placed over stomach. • Remove guidewire if present • Either Place cap into the end of NG tube or attach a drainage bag. • Secure the tube in place by taping to nose. o 24 Hand book of Basic Medical Procedure Dr.M.Umakanth Complication • Discomfort, pain, gagging • Bleeding (at any site, but particularly nose) • Failure to correctly place tube e.g. Placement in trachea or bronchi • Perforation of esophagus and stomach • Electrolyte imbalance if rapid decompression of stomach. • Esophagitis • Nasal or retropharyngeal necrosis
|
You may only use information contained within the provided content block. Question: What benefits do nasal cannula have over non-rebreathe masks? Oxygen is a drug with a correct dosage When administered correctly may be life saving. Aim is to achieve adequate tissue oxygenation (without causing a significant decrease in ventilation and consequent hypercapnia or oxygen toxicity) Need to treat • Tissue hypoxia is difficult to recognize as clinical features are nonspecific –include dyspnoea cyanosis, tachypnoea, arrhythmias, altered mental state, coma. • Treatment of tissue hypoxia should correct any arterial hypoxemia (Cardiopulmonary defect/shunt e.g.-asthma, pneumonia, PE), any transport deficit (anaemia, low cardiac output), and underlying causes. • SaO2/PaO2 can be normal when tissue hypoxia is caused by low cardiac output states. Oxygen administration Equipment The method of delivery will depend on the type and severity of respiratory failure, breathing pattern, respiratory rate, risk of CO2 retention, need for humidification and patient compliance. Each oxygen delivery device comprises • An oxygen supply(>4L/min) • Flow rate 07.Oxygen administration 20 Hand book of Basic Medical Procedure Dr.M.Umakanth • Tubing • Interface + humidification 1) Nasal cannula These direct oxygen via 2 short prongs up the nasal passage They: • Can be used for long periods of time. • Prevent rebreathing. • Can be used during eating and talking. 2) Low flow oxygen masks These deliver oxygen concentrations that vary depending on the patient’s minute volume. Some rebreathing of exhaled gases. 3) Fixed performance masks These deliver constant concentration of oxygen independent of the patient’s minute volume. The masks contain ‘venturi’ barrels where relatively low rates of oxygen are forced through a narrow orifice producing a greater flow rate. 4) Partial and non-rebreathe masks This mask have a ‘reservoir’ bag that is filled with pure oxygen and depend on a system of valves which prevent mixing of exhaled gases with the incoming oxygen. Dr.M.Umakanth Hand book of Basic Medical Procedure 21 5) High flow Oxygen Masks or nasal prongs that generate flows of 50-120ml/ min using a high flow regulator to entrain air and oxygen at specific concentrations. It should always be used with humidification. Procedure • Introduce yourself, confirm patient’s identity, explain the condition, Obtain Verbal consent. • Choose an appropriate oxygen delivery device • Choose an initial dose… o Cardiac or respiratory arrest:100%. o Hypoxaemia with PaCO2 <5.3kPa:40-60%. o Hypoxaemia with PaCO2 >5.3kPa:24% initially. • Decide on the acceptable level of SaO2 or PaO2 and titrate oxygen accordingly. • If possible, try to measure a PaO2 in room air prior to giving supplementary oxygen. • Liaise with nursing staff, physiotherapist or outreach for support in setting up equipment. • Apply the oxygen and monitor via oxymetry(SaO2) and/or repeat ABG(PaO2) in 30 minutes. • If hypoxemia continue, then the patient may require respiratory support either invasively or non-invasivelyliaise with your seniors and/or the respiratory doctors. • Stop supplementary oxygen when tissue hypoxia or arterial hypoxaemia has resolved. 22 Hand book of Basic Medical Procedure Dr.M.Umakanth Equipment Required • NG tube • Disposable gloves • Lubricant gel • Cup of water • 50ml Syringe • Drainage bag (If necessary) • Adhesive tape • Paper towel • Plastic apron. Indication • Feeding (Ryle’s tube) • Patients who have an increased risk of aspiration • Decompression of stomach during bowel obstruction • Gastric larvage Contraindication • Severe Facial trauma • Basal skull fracture • Suspected oesophageal perforation • Grossly abnormal nasal anatomy Procedure • Introduce yourself, confirm patient’s identity, explain the procedure, and obtain verbal consent • Wash hands thoroughly, put on gloves and plastic apron. 08.Nasogastric(NG) tube Insertion Dr.M.Umakanth Hand book of Basic Medical Procedure 23 • Sit the patient up, slightly extending the neck. • Examine patient’s nose for deformity. • Use the tube to measure the length from the nares to the stomach, (Xiphisternum-earlobe-tip of nose) and note the distance. • Lubricate the tip(4-8cm) of the tube, avoiding blocking the lumen. • Insert into the nostril and advance directly posteriorly • Whilst advancing, ask the patient to take sip of water and hold it in their mouth. • Request the patient to swallow and, as the patient swallows, advance the tube down oesophagus. • Continue to advance the tube until 10-20cm beyond pre-measured distance to stomach (60-70cm total). • To confirm correct place ment o Aspirate some gastric contents with syringe and check fluid’s acidic pH(with litmus paper) confirmatory o If unsure, obtain a chest X-ray(CXR) with a view of the stomach. o Although commonly done on wards, injecting 5-10ml air into the tube whilst auscultating for babbling with stethoscope placed over stomach. • Remove guidewire if present • Either Place cap into the end of NG tube or attach a drainage bag. • Secure the tube in place by taping to nose. o 24 Hand book of Basic Medical Procedure Dr.M.Umakanth Complication • Discomfort, pain, gagging • Bleeding (at any site, but particularly nose) • Failure to correctly place tube e.g. Placement in trachea or bronchi • Perforation of esophagus and stomach • Electrolyte imbalance if rapid decompression of stomach. • Esophagitis • Nasal or retropharyngeal necrosis
|
You may only use information contained within the provided content block.
EVIDENCE:
Oxygen is a drug with a correct dosage When administered correctly may be life saving. Aim is to achieve adequate tissue oxygenation (without causing a significant decrease in ventilation and consequent hypercapnia or oxygen toxicity) Need to treat • Tissue hypoxia is difficult to recognize as clinical features are nonspecific –include dyspnoea cyanosis, tachypnoea, arrhythmias, altered mental state, coma. • Treatment of tissue hypoxia should correct any arterial hypoxemia (Cardiopulmonary defect/shunt e.g.-asthma, pneumonia, PE), any transport deficit (anaemia, low cardiac output), and underlying causes. • SaO2/PaO2 can be normal when tissue hypoxia is caused by low cardiac output states. Oxygen administration Equipment The method of delivery will depend on the type and severity of respiratory failure, breathing pattern, respiratory rate, risk of CO2 retention, need for humidification and patient compliance. Each oxygen delivery device comprises • An oxygen supply(>4L/min) • Flow rate 07.Oxygen administration 20 Hand book of Basic Medical Procedure Dr.M.Umakanth • Tubing • Interface + humidification 1) Nasal cannula These direct oxygen via 2 short prongs up the nasal passage They: • Can be used for long periods of time. • Prevent rebreathing. • Can be used during eating and talking. 2) Low flow oxygen masks These deliver oxygen concentrations that vary depending on the patient’s minute volume. Some rebreathing of exhaled gases. 3) Fixed performance masks These deliver constant concentration of oxygen independent of the patient’s minute volume. The masks contain ‘venturi’ barrels where relatively low rates of oxygen are forced through a narrow orifice producing a greater flow rate. 4) Partial and non-rebreathe masks This mask have a ‘reservoir’ bag that is filled with pure oxygen and depend on a system of valves which prevent mixing of exhaled gases with the incoming oxygen. Dr.M.Umakanth Hand book of Basic Medical Procedure 21 5) High flow Oxygen Masks or nasal prongs that generate flows of 50-120ml/ min using a high flow regulator to entrain air and oxygen at specific concentrations. It should always be used with humidification. Procedure • Introduce yourself, confirm patient’s identity, explain the condition, Obtain Verbal consent. • Choose an appropriate oxygen delivery device • Choose an initial dose… o Cardiac or respiratory arrest:100%. o Hypoxaemia with PaCO2 <5.3kPa:40-60%. o Hypoxaemia with PaCO2 >5.3kPa:24% initially. • Decide on the acceptable level of SaO2 or PaO2 and titrate oxygen accordingly. • If possible, try to measure a PaO2 in room air prior to giving supplementary oxygen. • Liaise with nursing staff, physiotherapist or outreach for support in setting up equipment. • Apply the oxygen and monitor via oxymetry(SaO2) and/or repeat ABG(PaO2) in 30 minutes. • If hypoxemia continue, then the patient may require respiratory support either invasively or non-invasivelyliaise with your seniors and/or the respiratory doctors. • Stop supplementary oxygen when tissue hypoxia or arterial hypoxaemia has resolved. 22 Hand book of Basic Medical Procedure Dr.M.Umakanth Equipment Required • NG tube • Disposable gloves • Lubricant gel • Cup of water • 50ml Syringe • Drainage bag (If necessary) • Adhesive tape • Paper towel • Plastic apron. Indication • Feeding (Ryle’s tube) • Patients who have an increased risk of aspiration • Decompression of stomach during bowel obstruction • Gastric larvage Contraindication • Severe Facial trauma • Basal skull fracture • Suspected oesophageal perforation • Grossly abnormal nasal anatomy Procedure • Introduce yourself, confirm patient’s identity, explain the procedure, and obtain verbal consent • Wash hands thoroughly, put on gloves and plastic apron. 08.Nasogastric(NG) tube Insertion Dr.M.Umakanth Hand book of Basic Medical Procedure 23 • Sit the patient up, slightly extending the neck. • Examine patient’s nose for deformity. • Use the tube to measure the length from the nares to the stomach, (Xiphisternum-earlobe-tip of nose) and note the distance. • Lubricate the tip(4-8cm) of the tube, avoiding blocking the lumen. • Insert into the nostril and advance directly posteriorly • Whilst advancing, ask the patient to take sip of water and hold it in their mouth. • Request the patient to swallow and, as the patient swallows, advance the tube down oesophagus. • Continue to advance the tube until 10-20cm beyond pre-measured distance to stomach (60-70cm total). • To confirm correct place ment o Aspirate some gastric contents with syringe and check fluid’s acidic pH(with litmus paper) confirmatory o If unsure, obtain a chest X-ray(CXR) with a view of the stomach. o Although commonly done on wards, injecting 5-10ml air into the tube whilst auscultating for babbling with stethoscope placed over stomach. • Remove guidewire if present • Either Place cap into the end of NG tube or attach a drainage bag. • Secure the tube in place by taping to nose. o 24 Hand book of Basic Medical Procedure Dr.M.Umakanth Complication • Discomfort, pain, gagging • Bleeding (at any site, but particularly nose) • Failure to correctly place tube e.g. Placement in trachea or bronchi • Perforation of esophagus and stomach • Electrolyte imbalance if rapid decompression of stomach. • Esophagitis • Nasal or retropharyngeal necrosis
USER:
What benefits do nasal cannula have over non-rebreathe masks?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 11 | 9 | 823 | null | 10 |
Draw your answer from the text below only.
|
Summarize the different resources offered and list the pros and cons of each.
|
Introduction CHFA’s vision is that everyone will have the opportunity for housing stability and economic prosperity, two things that underserved markets often consider out of reach. To support recent initiatives to reduce the homeownership gap between White homeowners and minority homeowners, CHFA is continuously engaging with community to learn how to provide products and services in a meaningful way. Throughout this engagement, CHFA has heard two consistent requests: to meet homebuyers where they are, and to provide expansive homebuying resources that they can trust to support them on the path to homeownership. Often, community members cite the overabundance of information as being overwhelming and sometimes misleading. As the state housing and finance authority, CHFA is looked to as a trusted resource, so we developed the Homebuyer’s Roadmap to help people access requested information at their own pace. The Homebuyer’s Roadmap is available online and in a printed folder with supplemental inserts so homebuyers can select the option that works best for them. It begins by introducing CHFA and helping the user understand CHFA’s mission and vision, along with how CHFA can help them on their homebuying journey, before breaking the homebuying process into 10 “stops on the homebuying journey.” The interactive online version allows users to “choose their own adventure” by selecting the stop of most interest based on where they are in the homebuying process. They can also dig deeper into topics of interest by using the additional resource links throughout, which open as pop-ups with summary information or in a new tab. For the printed folder, many of these additional resources are provided as inserts. Navigation is intuitive; no matter where the user is within the Roadmap, they can use the navigation ribbon on the right of the screen to visit other stops, or the overarching navigation buttons on the bottom-right to visit the home page or the “stops” page. The Roadmap also encourages continued engagement with CHFA: after the final stop, which shares resources to help people maintain homeownership, users can click to a final screen showing links to newsletters, homebuying classes, and our “Help for Homebuyers” site. The Roadmap has been well received. Since October 2023, it has been viewed by 1,335 users an average of 5.24 times each, showing that people are returning to use it as they progress in their homebuying journey. In addition, 182 people have requested a printed copy. It is innovative and meets a state housing need. Colorado Housing and Finance Authority CHFA Homebuyer’s Roadmap Homeownership – Empowering New Buyers Colorado Housing and Finance Authority CHFA Homebuyer’s Roadmap Homeownership – Empowering New Buyers Based on community feedback, we learned that there was a gap in current homebuying educational offerings. We heard from many potential homebuyers that while they wanted to be as informed as possible about the homebuying process, they felt overwhelmed by the sheer amount of information available. Other “roadmap” communications vacillated between two extremes: having limited space to convey adequate information (such as in a print flyer) or trying to include everything in an effort to educate, which resulted in readers losing focus or not being able to locate the exact information they were looking for (such as on a web page). CHFA’s own products illustrate this gap: we offer a high-level Steps to Homeownership on our site, a one- hour Homebuyer 101 webinar, and an in-depth homebuyer education class for certification (classes last between six to eight hours). The shorter, more high-level options are suited for those just getting started, and the longer class is great for those homebuyers who are moving forward with a purchase, but we were missing the middle piece: a resource that was interactive, allowing homebuyers to navigate at their own pace and quickly find more in-depth information. The design of the Roadmap was instrumental in this delivery. In addition to the intuitive navigation throughout, pop-ups, information buttons, and third-party links kept the screens uncluttered and let each user create their own experience. While there is a wealth of information, it never feels overwhelming. Utilizing movement throughout creates a fresh and engaging experience while highlighting the individual resources. It demonstrates effective use of resources, benefits outweighing costs, and a replicable development process. The Roadmap is an in-house product. Content was developed collaboratively by marketing and home finance team members, the design was completed in Adobe InDesign, and the finished digital product was easily uploaded and integrated into our website functionality. Content updates are easy to implement in the digital version, and we printed a low count of the folder to reduce waste when changes are needed. All the supplements in the folder are those that were already developed prior to the Roadmap launch and are used in other outreach and communication activities. A two-year content review schedule will help to ensure that information is accurate and current. Overall costs were minimal; the development was incorporated into staff project flow, and the only additional costs are for the small-batch folder printing and individual mailings for requests. The accessibility of the product is also a benefit: it is free, print versions are mailed within one business day of request, and no specific software is required for viewing the online version. It effectively employes partnerships with industry professionals. When creating the Roadmap, we wanted to deliver something that lenders, real estate agents, and homebuyer education providers could use with their customers to elevate themselves as a resource. Throughout development, feedback was sought from our Lender Advisory Group and real estate agents regarding content and utilization. Traditionally, our partners value CHFA collateral that they can leverage 2 for homebuyer engagement. In the words of one, “Why would we do it if CHFA already has and much better than we could?” It helps CHFA achieve strategic objectives. One of CHFA’s main goals (and a market differentiator) is that we require homebuyer education course completion to be eligible for our loan products. This is because we know that an informed homebuyer makes a successful homeowner. Many customers cite the course as one of the best values of being a CHFA customer. The Homebuyer’s Roadmap is yet another way for us to help homebuyers feel informed and confident when purchasing a home. As stated at the beginning, it is an accessible resource that helps to “meet people where they are,” be that where they are in the homebuying process, or in which medium they prefer (online or in print). By providing a simple design with interactive topics, the Homebuyer’s Roadmap allows homebuyers to “choose their own adventure” at the pace with which they are comfortable, and further establishes CHFA as a valuable resource for homebuyers and industry professionals.
|
Summarize the different resources offered and list the pros and cons of each. Draw your answer from the text below only. Introduction CHFA’s vision is that everyone will have the opportunity for housing stability and economic prosperity, two things that underserved markets often consider out of reach. To support recent initiatives to reduce the homeownership gap between White homeowners and minority homeowners, CHFA is continuously engaging with community to learn how to provide products and services in a meaningful way. Throughout this engagement, CHFA has heard two consistent requests: to meet homebuyers where they are, and to provide expansive homebuying resources that they can trust to support them on the path to homeownership. Often, community members cite the overabundance of information as being overwhelming and sometimes misleading. As the state housing and finance authority, CHFA is looked to as a trusted resource, so we developed the Homebuyer’s Roadmap to help people access requested information at their own pace. The Homebuyer’s Roadmap is available online and in a printed folder with supplemental inserts so homebuyers can select the option that works best for them. It begins by introducing CHFA and helping the user understand CHFA’s mission and vision, along with how CHFA can help them on their homebuying journey, before breaking the homebuying process into 10 “stops on the homebuying journey.” The interactive online version allows users to “choose their own adventure” by selecting the stop of most interest based on where they are in the homebuying process. They can also dig deeper into topics of interest by using the additional resource links throughout, which open as pop-ups with summary information or in a new tab. For the printed folder, many of these additional resources are provided as inserts. Navigation is intuitive; no matter where the user is within the Roadmap, they can use the navigation ribbon on the right of the screen to visit other stops, or the overarching navigation buttons on the bottom-right to visit the home page or the “stops” page. The Roadmap also encourages continued engagement with CHFA: after the final stop, which shares resources to help people maintain homeownership, users can click to a final screen showing links to newsletters, homebuying classes, and our “Help for Homebuyers” site. The Roadmap has been well received. Since October 2023, it has been viewed by 1,335 users an average of 5.24 times each, showing that people are returning to use it as they progress in their homebuying journey. In addition, 182 people have requested a printed copy. It is innovative and meets a state housing need. Colorado Housing and Finance Authority CHFA Homebuyer’s Roadmap Homeownership – Empowering New Buyers Colorado Housing and Finance Authority CHFA Homebuyer’s Roadmap Homeownership – Empowering New Buyers Based on community feedback, we learned that there was a gap in current homebuying educational offerings. We heard from many potential homebuyers that while they wanted to be as informed as possible about the homebuying process, they felt overwhelmed by the sheer amount of information available. Other “roadmap” communications vacillated between two extremes: having limited space to convey adequate information (such as in a print flyer) or trying to include everything in an effort to educate, which resulted in readers losing focus or not being able to locate the exact information they were looking for (such as on a web page). CHFA’s own products illustrate this gap: we offer a high-level Steps to Homeownership on our site, a one- hour Homebuyer 101 webinar, and an in-depth homebuyer education class for certification (classes last between six to eight hours). The shorter, more high-level options are suited for those just getting started, and the longer class is great for those homebuyers who are moving forward with a purchase, but we were missing the middle piece: a resource that was interactive, allowing homebuyers to navigate at their own pace and quickly find more in-depth information. The design of the Roadmap was instrumental in this delivery. In addition to the intuitive navigation throughout, pop-ups, information buttons, and third-party links kept the screens uncluttered and let each user create their own experience. While there is a wealth of information, it never feels overwhelming. Utilizing movement throughout creates a fresh and engaging experience while highlighting the individual resources. It demonstrates effective use of resources, benefits outweighing costs, and a replicable development process. The Roadmap is an in-house product. Content was developed collaboratively by marketing and home finance team members, the design was completed in Adobe InDesign, and the finished digital product was easily uploaded and integrated into our website functionality. Content updates are easy to implement in the digital version, and we printed a low count of the folder to reduce waste when changes are needed. All the supplements in the folder are those that were already developed prior to the Roadmap launch and are used in other outreach and communication activities. A two-year content review schedule will help to ensure that information is accurate and current. Overall costs were minimal; the development was incorporated into staff project flow, and the only additional costs are for the small-batch folder printing and individual mailings for requests. The accessibility of the product is also a benefit: it is free, print versions are mailed within one business day of request, and no specific software is required for viewing the online version. It effectively employes partnerships with industry professionals. When creating the Roadmap, we wanted to deliver something that lenders, real estate agents, and homebuyer education providers could use with their customers to elevate themselves as a resource. Throughout development, feedback was sought from our Lender Advisory Group and real estate agents regarding content and utilization. Traditionally, our partners value CHFA collateral that they can leverage 2 for homebuyer engagement. In the words of one, “Why would we do it if CHFA already has and much better than we could?” It helps CHFA achieve strategic objectives. One of CHFA’s main goals (and a market differentiator) is that we require homebuyer education course completion to be eligible for our loan products. This is because we know that an informed homebuyer makes a successful homeowner. Many customers cite the course as one of the best values of being a CHFA customer. The Homebuyer’s Roadmap is yet another way for us to help homebuyers feel informed and confident when purchasing a home. As stated at the beginning, it is an accessible resource that helps to “meet people where they are,” be that where they are in the homebuying process, or in which medium they prefer (online or in print). By providing a simple design with interactive topics, the Homebuyer’s Roadmap allows homebuyers to “choose their own adventure” at the pace with which they are comfortable, and further establishes CHFA as a valuable resource for homebuyers and industry professionals.
|
Draw your answer from the text below only.
EVIDENCE:
Introduction CHFA’s vision is that everyone will have the opportunity for housing stability and economic prosperity, two things that underserved markets often consider out of reach. To support recent initiatives to reduce the homeownership gap between White homeowners and minority homeowners, CHFA is continuously engaging with community to learn how to provide products and services in a meaningful way. Throughout this engagement, CHFA has heard two consistent requests: to meet homebuyers where they are, and to provide expansive homebuying resources that they can trust to support them on the path to homeownership. Often, community members cite the overabundance of information as being overwhelming and sometimes misleading. As the state housing and finance authority, CHFA is looked to as a trusted resource, so we developed the Homebuyer’s Roadmap to help people access requested information at their own pace. The Homebuyer’s Roadmap is available online and in a printed folder with supplemental inserts so homebuyers can select the option that works best for them. It begins by introducing CHFA and helping the user understand CHFA’s mission and vision, along with how CHFA can help them on their homebuying journey, before breaking the homebuying process into 10 “stops on the homebuying journey.” The interactive online version allows users to “choose their own adventure” by selecting the stop of most interest based on where they are in the homebuying process. They can also dig deeper into topics of interest by using the additional resource links throughout, which open as pop-ups with summary information or in a new tab. For the printed folder, many of these additional resources are provided as inserts. Navigation is intuitive; no matter where the user is within the Roadmap, they can use the navigation ribbon on the right of the screen to visit other stops, or the overarching navigation buttons on the bottom-right to visit the home page or the “stops” page. The Roadmap also encourages continued engagement with CHFA: after the final stop, which shares resources to help people maintain homeownership, users can click to a final screen showing links to newsletters, homebuying classes, and our “Help for Homebuyers” site. The Roadmap has been well received. Since October 2023, it has been viewed by 1,335 users an average of 5.24 times each, showing that people are returning to use it as they progress in their homebuying journey. In addition, 182 people have requested a printed copy. It is innovative and meets a state housing need. Colorado Housing and Finance Authority CHFA Homebuyer’s Roadmap Homeownership – Empowering New Buyers Colorado Housing and Finance Authority CHFA Homebuyer’s Roadmap Homeownership – Empowering New Buyers Based on community feedback, we learned that there was a gap in current homebuying educational offerings. We heard from many potential homebuyers that while they wanted to be as informed as possible about the homebuying process, they felt overwhelmed by the sheer amount of information available. Other “roadmap” communications vacillated between two extremes: having limited space to convey adequate information (such as in a print flyer) or trying to include everything in an effort to educate, which resulted in readers losing focus or not being able to locate the exact information they were looking for (such as on a web page). CHFA’s own products illustrate this gap: we offer a high-level Steps to Homeownership on our site, a one- hour Homebuyer 101 webinar, and an in-depth homebuyer education class for certification (classes last between six to eight hours). The shorter, more high-level options are suited for those just getting started, and the longer class is great for those homebuyers who are moving forward with a purchase, but we were missing the middle piece: a resource that was interactive, allowing homebuyers to navigate at their own pace and quickly find more in-depth information. The design of the Roadmap was instrumental in this delivery. In addition to the intuitive navigation throughout, pop-ups, information buttons, and third-party links kept the screens uncluttered and let each user create their own experience. While there is a wealth of information, it never feels overwhelming. Utilizing movement throughout creates a fresh and engaging experience while highlighting the individual resources. It demonstrates effective use of resources, benefits outweighing costs, and a replicable development process. The Roadmap is an in-house product. Content was developed collaboratively by marketing and home finance team members, the design was completed in Adobe InDesign, and the finished digital product was easily uploaded and integrated into our website functionality. Content updates are easy to implement in the digital version, and we printed a low count of the folder to reduce waste when changes are needed. All the supplements in the folder are those that were already developed prior to the Roadmap launch and are used in other outreach and communication activities. A two-year content review schedule will help to ensure that information is accurate and current. Overall costs were minimal; the development was incorporated into staff project flow, and the only additional costs are for the small-batch folder printing and individual mailings for requests. The accessibility of the product is also a benefit: it is free, print versions are mailed within one business day of request, and no specific software is required for viewing the online version. It effectively employes partnerships with industry professionals. When creating the Roadmap, we wanted to deliver something that lenders, real estate agents, and homebuyer education providers could use with their customers to elevate themselves as a resource. Throughout development, feedback was sought from our Lender Advisory Group and real estate agents regarding content and utilization. Traditionally, our partners value CHFA collateral that they can leverage 2 for homebuyer engagement. In the words of one, “Why would we do it if CHFA already has and much better than we could?” It helps CHFA achieve strategic objectives. One of CHFA’s main goals (and a market differentiator) is that we require homebuyer education course completion to be eligible for our loan products. This is because we know that an informed homebuyer makes a successful homeowner. Many customers cite the course as one of the best values of being a CHFA customer. The Homebuyer’s Roadmap is yet another way for us to help homebuyers feel informed and confident when purchasing a home. As stated at the beginning, it is an accessible resource that helps to “meet people where they are,” be that where they are in the homebuying process, or in which medium they prefer (online or in print). By providing a simple design with interactive topics, the Homebuyer’s Roadmap allows homebuyers to “choose their own adventure” at the pace with which they are comfortable, and further establishes CHFA as a valuable resource for homebuyers and industry professionals.
USER:
Summarize the different resources offered and list the pros and cons of each.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 8 | 13 | 1,107 | null | 628 |
Use only the document provided. If the question can not be answered then respond with 'I am unable to answer this request'
|
What are some ICT advances in the field of social touch?
|
REVIEW published: 27 May 2015 doi: 10.3389/fdigh.2015.00002 Social touch in human–computer interaction Jan B. F. van Erp 1,2 * and Alexander Toet 1 1 Perceptual and Cognitive Systems, TNO, Soesterberg, Netherlands, 2 Human Media Interaction, University of Twente, Enschede, Netherlands Edited by: Yoram Chisik, University of Madeira, Portugal Reviewed by: Mohamed Chetouani, Université Pierre et Marie Curie, France Gualtiero Volpe, Università degli Studi di Genova, Italy Hongying Meng, Brunel University London, UK *Correspondence: Jan B. F. van Erp, TNO Human Factors, Kampweg 5, Soesterberg 3769DE, Netherlands [email protected] Specialty section: This article was submitted to Human-Media Interaction, a section of the journal Frontiers in Digital Humanities Received: 06 February 2015 Paper pending published: 19 March 2015 Accepted: 08 May 2015 Published: 27 May 2015 Citation: van Erp JBF and Toet A (2015) Social touch in human–computer interaction. Front. Digit. Humanit. 2:2. doi: 10.3389/fdigh.2015.00002 Touch is our primary non-verbal communication channel for conveying intimate emotions and as such essential for our physical and emotional wellbeing. In our digital age, human social interaction is often mediated. However, even though there is increasing evidence that mediated touch affords affective communication, current communication systems (such as videoconferencing) still do not support communication through the sense of touch. As a result, mediated communication does not provide the intense affective experience of co-located communication. The need for ICT mediated or generated touch as an intuitive way of social communication is even further emphasized by the growing interest in the use of touch-enabled agents and robots for healthcare, teaching, and telepresence applications. Here, we review the important role of social touch in our daily life and the available evidence that affective touch can be mediated reliably between humans and between humans and digital agents. We base our observations on evidence from psychology, computer science, sociology, and neuroscience with focus on the first two. Our review shows that mediated affective touch can modulate physiological responses, increase trust and affection, help to establish bonds between humans and avatars or robots, and initiate pro-social behavior. We argue that ICT mediated or generated social touch can (a) intensify the perceived social presence of remote communication partners and (b) enable computer systems to more effectively convey affective information. However, this research field on the crossroads of ICT and psychology is still embryonic and we identify several topics that can help to mature the field in the following areas: establishing an overarching theoretical framework, employing better research methodologies, developing basic social touch building blocks, and solving specific ICT challenges. Keywords: affective touch, mediated touch, social touch, interpersonal touch, human–computer interaction, human–robot interaction, haptic, tactile Introduction Affective Touch in Interpersonal Communication The sense of touch is the earliest sense to develop in a human embryo (Gottlieb 1971) and is critical for mammals’ early social development and to grow up healthily (Harlow and Zimmermann 1959; Montagu 1972). The sense of touch is one of the first mediums of communication between newborns and parents. Interpersonal communication is to a large extent non-verbal and one of the primary purposes of non-verbal behavior is to communicate emotional states. Non-verbal communication includes facial expressions, prosody, gesture, and touch Frontiers in Digital Humanities | www.frontiersin.org 1 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI (Argyle 1975; Knapp and Hall 2010) of which touch is the primary modality for conveying intimate emotions (Field 2010; Morrison et al. 2010; App et al. 2011), for instance, in greetings, in corrections, and in (sexual) relationships. As touch implies direct physical interaction and co-location, it inherently has the potential to elicit feelings of social presence. The importance of touch as a modality in social communication is highlighted by the fact that the human skin has specific receptors to process affective touch (“the skin as a social organ”: Morrison et al. 2010) in addition to those for discriminative touch (Löken et al. 2009; Morrison et al. 2011; Gordon et al. 2013; McGlone et al. 2014), presumably like all mammals (Vrontou et al. 2013). ICT systems can employ human touch for information processing (discriminative touch) and communication (social touch) as well. Field (2010) and Gallace and Spence (2010)]. For these reasons, mediated interpersonal touch is our first topic of interest. Human–computer interaction applications increasingly deploy intelligent agents to support the social aspects of the interaction. Social agents (either embodied or virtual) already employ vision and audition to communicate social signals but generally lack touch capabilities. If we look at applications in robots and avatars, the first applications including touch facilitated information from user to system only, e.g., in the form of a touch screen or through specific touch sensors in a tangible interface. Social agents that can touch the user are of much more recent date. We believe that social agents could benefit from generating and perceiving social touch cues (van Erp 2012). Based on studies reviewed in this paper, we expect that people will feel a closer bond with agents or robots that use and respond to affective touch since they appear more human than machine-like and more trustworthy. Touch-enabled social agents are therefore our second topic of interest. Discriminative Touch in ICT Systems Conventional systems for human–computer interaction only occasionally employ the sense of touch and mainly provide information through vision and audition. One of the first large-scale applications of a tactile display was the vibration function on mobile phones, communicating the 1-bit message of an incoming call, and the number of systems that include the sense of touch has steadily increased over the past two decades. An important reason for the sparse use of touch is the supposed low bandwidth of the touch channel (Gallace et al. 2012). Although often underestimated, our touch sense is very well able to process large amounts of abstract information. For instance, blind people who are trained in Braille reading can actually read with their fingertips. This information processing capability is increasingly applied in our interaction with systems, and more complex information is being displayed, e.g., to reduce the risk of visual and auditory overload in car driving, to make us feel more immersed in virtual environments, or to realistically train and execute certain medical skills (van Erp and van Veen 2004; Self et al. 2008). Touch in Social Communication Social touch can take many forms in our daily lifes such as greetings (shaking hands, embracing, kissing, backslapping, and cheektweaking), in intimate communication (holding hands, cuddling, stroking, back scratching, massaging), and in corrections (punishment, spank on the bottom). Effects of social touch are apparent at many levels ranging from physiology to social behavior as we will discuss in the following sections. Social touches can elicit a range of strong experiences between pleasant and unpleasant, depending on among others the stimulus [e.g., unpleasant pinches evoking pain (nociception)] and location on the body (e.g., pleasant strokes in erogenous zones). In addition to touch in communication, touch can also be employed in psychotherapy (Phelan 2009) and nursing (Gleeson and Timmins 2005). Examples range from basic comforting touches and massaging to alternative therapies such as acu-pressure, Reiki, vibroacoustic therapy, and low-frequency vibration (Wigram 1996; Kvam 1997; Patrick 1999; Puhan et al. 2006; Prisby et al. 2008). See Dijk et al. (2013) for more examples on mental, healthrelated, and bodily effects of touch. In this paper, we focus on ICT mediated and generated social touch (the areas where psychology and computer science meet), meaning that areas of, for instance, Reiki and low-frequency vibration fall outside the scope of this paper. We first discuss the many roles of social touch in our daily life before continuing with ICT mediated inter-human touch and ICT generated and interpreted touch in human–agent interaction. In 1990s (Vallbo et al. 1993), the first reports on so-called C tactile afferents in human hairy skin were published. This neurophysiological channel in the skin reacts to soft, stroking touches, and its activity strongly depends on stroking speed (with an optimum in the speed range 3–10 cm/s) and has a high correlation with subjective ratings of the pleasantness of the touch. Research over the past decades has shown that this system is not involved in discriminative touch (Olausson et al. 2008) but underlies the emotional aspects of touch and the development and function of the social brain (McGlone et al. 2014). Social touches may activate both this pleasurable touch system and the discriminative touch Affective Touch in ICT Systems Incorporating the sense of touch in ICT systems started with discriminative touch as an information channel, often in addition to vision and audition (touch for information processing). We believe that we are on the averge of a second transition: adding social or affective touch to ICT systems (touch for social communication). In our digital era, an increasing amount of our social interactions is mediated, for example, through (cell) phones, video conferencing, text messaging, chat, or e-mail. Substituting direct contact, these modern technologies make it easy to stay in contact with distant friends and relatives, and they afford some degree of affective communication. For instance, an audio channel can transmit affective information through phonetic features like amplitude variation, pitch inflections, tempo, duration, filtration, tonality, or rhythm, while a video channel supports nonverbal information such as facial expressions and body gestures. However, current communication devices do not allow people to express their emotions through touch and may therefore lack a convincing experience of actual togetherness (social presence). This technology-induced touch deprivation may even degrade the potential beneficial effects of mediated social interaction [for reviews of the negative side effects of touch deprivation see Frontiers in Digital Humanities | www.frontiersin.org 2 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI system (reacting to, for instance, pressure, vibration, and skin stretch). caring, agreement, gratitude, and moral support. Cold feedback was consistently associated with negative issues. Touch, Physiological Functioning, and Wellbeing Touch to Communicate Emotions Hertenstein et al. (2006, 2009) showed that touch alone can effectively be used to convey distinct emotions such as anger, fear, and disgust. In addition, touch plays a role in communicating more complex social messages like trust, receptivity, affection (Mehrabian 1972; Burgoon 1991) and nurture, dependence, and affiliation (Argyle 1975). Touch can also enhance the meaning of other forms of verbal and non-verbal communication, e.g., touch amplifies the intensity of emotional displays from our face and voice (Knapp and Hall 2010). Examples of touches used to communicate emotions are shaking, pushing, and squeezing to communicate anger, hugging, patting, and stroking to communicate love (Gallace and Spence 2010). Jones and Yarbrough (1985) stated that a handshake, an encouraging pat on the back, a sensual caress, a nudge for attention, a tender kiss, or a gentle brush of the shoulder can all convey a vitality and immediacy that is at times far more powerful than language. According to App et al. (2011), touch is the preferred non-verbal communication channel for conveying intimate emotions like love and sympathy, confirmed by, for instance, Debrot et al. (2013) who showed that responsive touch between romantic partners enhances their affective state. McCance and Otley (1951) showed that licking and stroking of the mother animal is critical to start certain physiological processes in a new-born mammal. This indicates the direct link between skin stimulation and physiological processes, a link that is preserved later in life. For instance, gentle stroking touch can lower heart rate and blood pressure (Grewen et al. 2003), increase transient sympathetic reflexes and increase pain thresholds (Drescher et al. 1980; Uvnäs-Moberg 1997), and affect the secretion of stress hormones (Whitcher and Fisher 1979; Shermer 2004; Ditzen et al. 2007). Women holding their partner’s hand showed attenuated threat-related brain activity in response to mild electric shocks (Coan et al. 2006) and reported less pain in a cold pressor task (Master et al. 2009). Touch can also result in coupling or syncing of electrodermal activity of interacting (romantic) couples (ChatelGoldman et al. 2014). Interpersonal touch is the most commonly used method of comforting (Dolin and Booth-Butterfield 1993) and an instrument in nursing care (Bush 2001, Chang 2001, Henricson et al. 2008). For example, patients who were touched by a nurse during preoperative instructions experienced lower subjective and objective stress levels (Whitcher and Fisher 1979), than people who were not. In addition to touch affecting hormone levels, hormones (i.e., oxytocin) also affect the perception of interpersonal touch. Scheele et al. (2014) investigated the effect of oxytocin on the perception of a presumed male or female touch on male participants and found that oxytocin increased the rated pleasantness and brain activity of presumed female touches but not of male touches (all touches were delivered by the same female experimenter). Ellingsen et al. (2014) reported that after oxytocin submission, the effect of touch on the evaluation of facial expression increased. In addition, touch (handshaking in particular) can also play a role in social chemo-signaling. Handshaking can lead to the exchange of chemicals in sweat and behavioral data indicates that people more often sniff their hands after a greeting with a handshake than without a handshake (Frumin et al. 2015). Many social touches are reciprocal in nature (like cuddling and holding hands) and their dynamics rely on different mechanisms all having their own time scale: milliseconds for the detection of a touch (discriminative touch), hundreds of milliseconds and up for the experience of pleasurable touch, and seconds and up for physiological responses (including changes in hormone levels). How these processes interact and possibly reinforce each other is still terra incognita. Physiological responses can also be indirect, i.e., the result of social or empathetic mechanisms. Cooper et al. (2014) recently showed that the body temperature of people decreased when looking at a video of other people putting their hands in cold water. Another recent paradigm is to use thermal and haptically enhanced interpersonal speech communication. This showed that warm and cold signals were used to communicate the valence of messages (IJzerman and Semin 2009; Suhonen et al. 2012a). Warm messages were used to emphasize positive feelings and pleasant experiences, and to express empathy, comfort, closeness, Frontiers in Digital Humanities | www.frontiersin.org Touch to Elicit Emotions Not only can the sense of touch be used to communicate distinct emotions but also to elicit (Suk et al. 2009) and modulate human emotion. Please note that interpreting communicated emotions differs from eliciting emotions as the former may be considered as a cognitive task not resulting in physiological responses, e.g., one can perceive a touch as communicating anger without feeling angry. Starting with the James–Lange theory (James 1884; Cannon 1927; Damasio 1999), the conscious experience of emotion is the brain’s interpretation of physiological states. The existence of specific neurophysiological channels for affective touch and pain and the direct physiological reactions to touch indicate that there may be a direct link between tactile stimulation, physiological responses, and emotional experiences. Together with the distinct somatotopic mapping between bodily tactile sensations and different emotional feelings as found by Nummenmaa et al. (2013), one may assume that tactile stimulation of different bodily regions can elicit a wide range of emotions. Touch as a Behavior Modulator In addition to communicating and eliciting emotions, touch provides an effective means of influencing people’s attitudes toward persons, places, or services, their tendency to create bonds and their (pro-)social behaviors [see Gallace and Spence (2010) for an excellent overview]. This effect is referred to as the Midas touch: a brief, casual touch (often at the hand or arm) that is not necessarily consciously perceived named after king Midas from Greek mythology who had the ability to turn everything he touched into gold. For example, a half-second of hand-to-hand touch from a librarian fostered more favorable impressions of the library (Fisher et al. 1976), touching by a salesperson increased positive evaluations of the store (Hornik 1992), and touch can 3 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI also boost the attractiveness ratings of the toucher (Burgoon et al. 1992). Recipients of such “simple” Midas touches are also more likely to be more compliant or unselfish: willing to participate in a survey (Guéguen 2002) or to adhere to medication (Guéguen et al. 2010), volunteering for demonstrating in a course (Guéguen 2004), returning money left in a public phone (Kleinke 1977), spending more money in a shop (Hornik 1992), tipping more in a restaurant (Crusco and Wetzel 1984), helping with picking-up dropped items (Guéguen and Fischer-Lokou 2003), or giving away a cigarette (Joule and Guéguen 2007). In addition to these oneon-one examples, touch also plays a role in teams. For instance, physical touch enhances team performance of basketball players through building cooperation (Kraus et al. 2010). In clinical and professional situations, interpersonal touch can increase information flow and causes people to evaluate communication partners more favorably (Fisher et al. 1976). and Watts 2010; Tsetserukou 2010), pokes (Park et al. 2011), handholding (Gooch and Watts 2012; Toet et al. 2013), handshakes (Bailenson et al. 2007), strokes on the hand (Eichhorn et al. 2008), arm (Huisman et al. 2013) and cheek (Park et al. 2012), pinches, tickles (Furukawa et al. 2012), pats (Bonanni et al. 2006), squeezes (Rantala et al. 2013), thermal signals (Gooch and Watts 2010; Suhonen et al. 2012a,b), massages (Chung et al. 2009), and intimate sexual touches (Solon 2015). In addition to direct mediation, there is also an option to use indirect ways, for instance, through avatars in a virtual world. Devices like a haptic-jacket system can enhance the communication between users of virtual worlds such as Second Life by enabling the exchange of touch cues resembling encouraging pats and comforting hugs between users and their respective avatars (Hossain et al. 2011). The Huggable is a semi-autonomous robotic teddy bear equipped with somatic sensors, intended to facilitate affective haptic communication between two people (Lee et al. 2009) through a tangible rather than a virtual interface. Using these systems, people can not only exchange messages but also emotionally and physically feel the social presence of the communication partner (Tsetserukou and Neviarouskaya 2010). The above examples can be considered demonstrations of the potential devices and applications and the richness of social touch. Although it appears that virtual interfaces can effectively transmit emotion even with touch cues that are extremely degraded (e.g., a handshake that is lacking grip, temperature, dryness, and texture: Bailenson et al. 2007), the field lacks rigorous validation and systematic exploration of the critical parameters. The few exceptions are the work by Smith and MacLean (2007) and by Salminen et al. (2008). Smith and MacLean performed an extensive study into the possibilities and the design space of an interpersonal haptic link and concluded that emotion can indeed be communicated through this medium. Salminen et al. (2008) developed a friction-based horizontally rotating fingertip stimulator to investigate emotional experiences and behavioral responses to haptic stimulation and showed that people can rate these kind of stimuli as less or more unpleasant, arousing, avoidable, and dominating. Mediated Social Touch In the previous section, we showed that people communicate emotions through touch, and that inter-human touch can enhance wellbeing and modulate behavior. In interpersonal communication, we may use touch more frequently than we are aware of. Currently, interpersonal communication is often mediated and given the inherent human need for affective communication, mediated social interaction should preferably afford the same affective characteristics as face-to-face communication. However, despite the social richness of touch and its vital role in human social interaction, existing communication media still rely on vision and audition and do not support haptic interaction. For a more in-depth reflection on the general effects of mediated interpersonal communication, we refer to Konijn et al. (2008) and Ledbetter (2014). Tactile or kinesthetic interfaces in principle enable haptic communication between people who are physically apart, and may thus provide mediated social touch, with all the physical, emotional, and intellectual feedback it supplies (Cranny-Francis 2011). Recent experiments show that even simple forms of mediated touch have the ability to elicit a wide range of distinct affective feelings (Tsalamlal et al. 2014). This finding has stimulated the study and design of devices and systems that can communicate, elicit, enhance, or influence the emotional state of a human by means of mediated touch. Remote Collaboration Between Groups Collaborative virtual environments are increasingly used for distance education [e.g., Mikropoulos and Natsis (2011)], training simulations [e.g., Dev et al. (2007) and Flowers and Aggarwal (2014)], therapy treatments (Bohil et al. 2011), and for social interaction venues (McCall and Blascovich 2009). It has been shown that adding haptic feedback to the interaction between users of these environments significantly increases their perceived social presence (Basdogan et al. 2000; Sallnäs 2010). Another recent development is telepresence robots that enable users to physically interact with geographically remote persons and environments. Their ultimate goal is to provide users with the illusion of a physical presence in remote places. Telepresence robots combine physical and remote presence and have a wide range of potential social applications like remote embodied teleconferencing and teaching, visiting or monitoring elderly in care centers, and making patient rounds in medical facilities (Kristoffersson et al. 2013). To achieve an illusion of telepresence, the robot should be able to reciprocate the user’s behavior and to Remote Communication Between Partners Intimacy is of central importance in creating and maintaining strong emotional bonds. Humans have an important social and personal need to feel connected in order to maintain their interpersonal relationships (Kjeldskov et al. 2004). A large part of their interpersonal communication is emotional rather than factual (Kjeldskov et al. 2004). The vibration function on a mobile phone has been used to render emotional information for blind users (Réhman and Liu 2010) and a similar interface can convey emotional content in instant messaging (Shin et al. 2007). Also, a wide range of systems have been developed for the mediated representation of specific touch events between dyads such as kisses (Saadatian et al. 2014), hugs (Mueller et al. 2005; Cha et al. 2008; Teh et al. 2008; Gooch Frontiers in Digital Humanities | www.frontiersin.org 4 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI provide the user with real-time multisensory feedback. As far as we are aware of, systems including the sense of touch have not been described yet. provided by the user to the system, and closing the loop between these signals. Generating Social Touch Signals Lemmens et al. (2009) tested tactile jackets (and later blankets) to increase emotional experiences while watching movies and reported quite strong effects of well-designed vibration patterns. Dijk et al. (2013) developed a dance vest for deaf teenagers. This vest included an algorithm that translated music into vibration patterns presented through the vest. Although not generated by a social entity, experiencing music has a substantial emotional part as did the automatically generated vibration patterns. Beyond the scripted and one-way social touch cues employed in the examples above, human–computer interaction applications increasingly deploy intelligent agents to support the social aspects of the interaction (Nijholt 2014). Social agents are used to communicate, express, and perceive emotions, maintain social relationships, interpret natural cues, and develop social competencies (Fong et al. 2003; Li et al. 2011). Empathic communication in general may serve to establish and improve affective relations with social agents (Bickmore and Picard 2005), and may be considered as a fundamental requirement for social agents that are designed to function as social companions and therapists (Breazeal 2011). Initial studies have shown that human interaction with social robots can indeed have therapeutic value (Kanamori et al. 2003; Wada and Shibata 2007; Robinson et al. 2013). These agents typically use facial expressions, gesture, and speech to convey affective cues to the user. Social agents (either physically embodied as, e.g., robots or represented as on-screen virtual agents) may also use (mediated) touch technology to communicate with humans (Huisman et al. 2014a). In this case, the touch cue is not only mediated but also generated and interpreted by an electronic system instead of a human. The physical embodiment of robots gives them a direct capability to touch users, while avatars may use the technology designed for other HCI or mediated social touch applications to virtually touch their user. Several devices have been proposed that enable haptic interaction with virtual characters (Hossain et al. 2011; Rahman and El Saddik 2011; Huisman et al. 2014a). Only few studies investigated autonomous systems that touch users for affective or therapeutic purposes (Chen et al. 2011), or that use touch to communicate the affective state of artificial creatures to their users (Yohanan and MacLean 2012). Reactions to Mediated Touch at a Physiological, Behavioral, and Social Level Although the field generally lacks serious validation studies, there is mounting evidence that people use, experience, and react to direct and mediated social touch in similar ways Bailenson and Yee (2007), at the physiological, psychological, behavioral, and social level. At a physiological and psychological level, mediated affective touch on the forearm can reduce heart rate of participants that experienced a sad event (Cabibihan et al. 2012). Mediated touch affects the quality of a shared experience and increases the intimacy felt toward the other person (Takahashi et al. 2011). Stimulation of someone’s hand through mediated touch can modulate the quality of a remotely shared experience (e.g., the hilariousness of a movie) and increase sympathy for the communication partner (Takahashi et al. 2011). In a storytelling paradigm, participants experienced a significantly higher degree of connectedness with the storyteller when the speech was accompanied by remotely administered squeezes in the upper arm (Wang et al. 2012). Additional evidence for the potential effects of mediated touch are found in the fact that hugging a robot medium while talking increases affective feelings and attraction toward a conversation partner (Kuwamura et al. 2013; Nakanishi et al. 2013). Participants receiving tactile facial stimulation experienced a stranger receiving similar stimulation to be closer, more positive and more similar to themselves when they were provided with synchronous visual feedback (Paladino et al. 2010). At a behavioral level, the most important observation is that the effect of a mediated touch on people’s pro-social behavior is similar to that of a real touch. According to Haans and IJsselsteijn (2009a), a virtual Midas touch has effects in the same order of magnitude as a real Midas touch. At the social level, the use of mediated touch is only considered appropriate as a means of communication between people in close personal relationships (Rantala et al. 2013), and the mere fact that two people are willing to touch implies an element of trust and mutual understanding (Collier 1985). The interpretation of mediated touch depends on the type of interrelationship between sender and receiver (Rantala et al. 2013), similar to direct touch (Coan et al. 2006; Thompson and Hampton 2011) and like direct touch, mediated touch communication between strangers can cause discomfort (Smith and MacLean 2007). Recognizing and Interpreting Social Touch Signals Communication implies a two-way interaction and social robots and avatars should therefore not only be able to generate but also to recognize affectionate touches. For instance, robotic affective responses to touch may contribute to people’s quality of life (Cooney et al. 2014). Touch capability is not only “nice to have” but may even be a necessity: people expect social interaction with embodied social agents to the extent that physical embodiment without tactile interaction results in a negative appraisal of the robot (Lee et al. 2006). In a recent study on the suitability of social robots for the wellbeing of the elderly, all participants expressed their wish for the robot to feel pleasant to hold or stroke and to Social Touch Generated by ICT Systems The previous chapter dealt with devices that enable interpersonal social touch communication, i.e., a situation in which the touch signals are generated and interpreted by human users and only mediated through information and communication technology. One step beyond this is to include social touch in the communication between a user and a virtual entity. This implies three additional challenges: the generation of social touch signals from system to user, the interpretation of social touch signals Frontiers in Digital Humanities | www.frontiersin.org 5 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI respond to touch (Hutson et al. 2011). The well-known example of the pet seal Paro (Wada et al. 2010) shows how powerful a simple device can be in evoking social touches. Paro responds sec to being touched but does neither interpret social touch nor produce touch. Similar effects are reported for touching a humanoid robot on the shoulder: just being able to touch already significantly increases trust toward the robot (Dougherty and Scharfe 2011). Automatic recognition and interpretation of the affective content of human originated social touch is essential to support this interaction (Argall and Billard 2010). Different approaches to equipping robots with a sense of touch include covering them with an artificial skin that simulates the human somatosensory systems (Dahiya et al. 2010) or the use of fully embodied robots covered with a range of different (e.g., temperature, proximity, pressure) sensors (Stiehl et al. 2005). To fully capture a social touch requires sensors that go beyond those used in the more advanced area of haptics and that primarily involve discriminative touch (e.g., contact, pressure, resistance). At least sensors for temperature and soft, stroking touch should be included to capture important parameters of social touch. However, just equipping a system (robot, avatar, or interface) with touch sensors is not sufficient to enable affective haptic interaction. A system can only appreciate and respond to affective touch in a natural way when it is able (a) to determine where the touch was applied, (b) to assess what kind of tactile stimulation was applied, and (c) to appraise the affective quality of the touch (Nguyen et al. 2007). While video- and audio-based affect recognition have been widely investigated (Calvo and D’Mello 2010), there have only been a few studies on touch-based affect recognition. The results of these preliminary studies indicate that affect recognition based on tactile interaction between humans and robots is comparable to that between humans (Naya et al. 1999; Cooney et al. 2012; Altun and MacLean 2014; Jung et al. 2014; van Wingerden et al. 2014). Research on capturing emotions from touch input to a computer system (i.e., not in a social context) confirms the potential of the touch modality (Zacharatos et al. 2014). Several research groups worked on capturing emotions from traditional computer input devices like mouse and keyboard based on the assumption that a user’s emotional state affects the motor output system. A general finding is that typing speed correlates to valence with a decrease in typing speed for negative valence and increased speed for positive valence compared to typing speed in neutral emotional state (Tsihrintzis et al. 2008; Khanna and Sasikumar 2010). A more informative system includes the force pattern of the key strokes. Using this information, very high-accuracy rates (>90%) are reported (Lv et al. 2008) for categorizing six emotional states (neutral, anger, fear, happiness, sadness, and surprise). This technique requires force sensitive keyboards, which are not widely available. Touch screens are used by an increasing number of people and offer much richer interaction parameters than keystrokes such as scrolling, tapping, or stroking. Recent work by Gao et al. (2012) showed that in a particular game played on the iPod, touch inputs like stroke length, pressure, and speed were important features related to a participant’s verbal description of the emotional experience during the game. Using a linear SVM, classification performance reached 77% for four emotional classes Frontiers in Digital Humanities | www.frontiersin.org (excited, relaxed, frustrated, and bored), close to 90% for two levels of arousal, and close to 85% for two levels of valence. Closing the Loop A robot that has the ability to “feel,” “understand,” and “respond” to touch in a human-like way will be capable of more intuitive and meaningful interaction with humans. Currently, artificial entities that include touch capabilities either produce or interpret social touch, but not both. However, both are required to close the loop and come to real, bidirectional interaction. The latter may require strict adherence to, for instance, timing and immediacy; a handshake in which the partners are out-of-phase can be very awkward. And as Cranny-Francis (2011) states, violating the tactile regime may result in being rejected as alien and may seriously offend others. Reactions to Touching Robots and Avatars at a Physiological, Behavioral, and Social Level Although there are still very few studies in this field, and there has been hardly any real formal evaluation, the first results of touch interactions with artificial entities appear promising. For instance, people experience robots that interact by touch as less machinelike (Cramer et al. 2009). Yohanan and colleagues (Yohanan et al. 2005; Yohanan and MacLean 2012) designed several haptic creatures to study a robot’s communication of emotional state and concluded that participants experienced a broader range of affect when haptic renderings were applied. Basori et al. (2009) showed the feasibility of using vibration in combination with sound and facial expression in avatars to communicate emotion strength. Touch also assists in building a relationship with social actors: hand squeezes (delivered through an airbladder) can improve the relation with a virtual agent (Bickmore et al. 2010). Artificial hands equipped with synthetic skins can potentially replicate not only the biomechanical behavior but also the warmth (the “feel”) of the human hand (Cabibihan et al. 2009, 2010, 2011). Users perceived a higher degree of friendship and social presence when interacting with a zoomorphic social robot with a warmer skin (Park and Lee 2014). Recent experiments indicate that the warmth of a robotic hand mediating social touch contributed significantly to the feeling of social presence (Nakanishi et al. 2014) and holding a warm robot hand increased feelings of friendship and trust toward a robot (Nie et al. 2012). Kotranza and colleagues (Kotranza and Lok 2008; Kotranza et al. 2009) describe a virtual patient as a medical student’s training tool that is able to be touched and to touch back. These touchenabled virtual patients were treated more like real humans than virtual patients without touch capabilities (students expressed more empathy and used touch more frequently to comfort and reassure the virtual patient).The authors concluded that by adding haptic interaction to the virtual patient, the bandwidth of the student-virtual patient communication increases and approaches that of human–human communication. In a study on the interaction between toddlers and a small humanoid robot, Tanaka et al. (2007) found that social connectedness correlated with the amount of touch between the child and robot. In a study where participants were asked to brush off “dirt” from either virtual objects or virtual humans, they touched virtual humans with 6 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI less force than non-human objects, and they touched the face of a virtual human with less force than the torso, while male virtual humans were touched with more force than female virtual humans (Bailenson and Yee 2008). Huisman et al. (2014b) performed a study in which participants played a collaborative augmented reality game together with two virtual agents, visible in the same augmented reality space. During interaction, one of the virtual agents touched the user on the arm by means of a vibrotactile display. They found that the touching virtual agent was rated higher on affective adjectives than the non-touching agent. Finally, Nakagawa et al. (2011) created a situation in which a robot requested participants to perform a repetitive monotonous task. This request was accompanied by an active touch, a passive touch, or no touch. The result showed that the active touch increased people’s motivation to continue performing the monotonous task. This confirms the earlier finding of Haans and IJsselsteijn (2009a) that the effect of the virtual Midas touch is in the same order of magnitude as the real Midas touch effect. may stimulate the further development of mediated social touch devices. Another research topic is the presumed close link between social touch and emotions and the potential underlying neurophysiological mechanisms, i.e., the connection between social touch and the emotional brain. Multisensory and Contextual Cues The meaning and appreciation of touch critically depend on its context (Collier 1985; Camps et al. 2012), such as the relation between conversation partners (Burgoon et al. 1992; Thompson and Hampton 2011), the body location of the touch (Nguyen et al. 1975), and the communication partner’s culture (McDaniel and Andersen 1998). There is no one-to-one correspondence between a touch and its meaning (Jones and Yarbrough 1985). Hence, the touch channel should be coupled with other sensory channels to clarify its meaning (Wang and Quek 2010). An important research question is which multisensory and contextual cues are critical. Direct (i.e., unmediated) touch is usually a multisensory experience: during interpersonal touch, we typically experience not only tactile stimulation but also changes in warmth along with verbal and non-verbal visual, auditory, and olfactory signals. Nonverbal cues (when people both see, hear, feel, and possibly smell their interaction partner performing the touching) may render mediated haptic technology more transparent, thereby increasing perceived social presence and enhancing the convincingness or immediacy of social touch (Haans and IJsselsteijn 2009b, 2010). Also, since the sight of touch activates brain regions involved in somatosensory processing [Rolls (2010); even watching a videotaped version: Walker and McGlone (2015)], the addition of visual feedback may enhance the associated haptic experience. Another strong cue for physical presence is body warmth. In human social interaction, physical temperature also plays an important role in sending interpersonal warmth (trust) information. Thermal stimuli may therefore serve as a proxy for social presence and stimulate the establishment of social relationships (IJzerman and Semin 2010). In addition to these bottom-up, stimulus driven aspects, topdown factors like expectations/beliefs of the receiver should be accounted for (e.g., beliefs about the intent of the interaction partner, familiarity with the partner, affordances of a physically embodied agent, etc.) since they shape the perceived meaning of touch (Burgoon and Walther 1990; Gallace and Spence 2010; Suhonen et al. 2012b). Research Topics Mediated social touch is a relatively young field of research that has the potential to substantially enrich human–human and human–system interaction. Although it is still not clear to what extent mediated touch can reproduce real touch, converging evidence seems to show that mediated touch shares important effects with real touch. However, many studies have an anecdotal character without solid and/or generalizable conclusions and the key studies in this field have not been replicated yet. This does not necessarily mean that the results are erroneous but it indicates that the field has not matured enough and may suffer from a publication bias. We believe that we need advancements in the following four areas for the field to mature: building an overarching framework, developing social touch basic building blocks, improving current research methodologies, and solving specific ICT challenges. Framework The human skin in itself is a complex organ able to process many different stimulus dimensions such as pressure, vibration, stretch, and temperature (van Erp 2007). “Social touch” is what the brain makes of these stimulus characteristics (sensations) taking into account personality, previous experiences, social conventions, the context, the object or person providing the touch, and probably many more factors. The scientific domains involved in social touch each have interesting research questions and answering them helps the understanding of (real life or mediated) social touch. In addition, we need an overarching framework to link the results across disciplines, to foster multidisciplinary research, and to encourage the transition from exploratory research to hypothesis driven research. Social and Cultural Social touch has a strong (unwritten) etiquette (Cranny-Francis 2011). Important questions are how to develop a touch etiquette for mediated touch and for social agents that can touch (van Erp and Toet 2013), and how to incorporate social, cultural, and individual differences with respect to acceptance and meaning of a mediated or social agent’s touch. Individual differences may include gender, attitude toward robots, and technology and touch receptivity [the (dis-)liking of being touched, Bickmore et al. 2010]. An initial set of guidelines for this etiquette is given by van Erp and Toet (2013). In addition, we should consider possible ethical implications of the technology, ranging from affecting people’s behavior without them being aware of it to the threat of physical abuse “at a distance.” Neuroscience The recent finding that there exists a distinct somatotopic mapping between tactile sensations and different emotional feelings (Nummenmaa et al. 2013; Walker and McGlone 2015) suggests that it may also be of interest to determine a map of our responsiveness to interpersonal (mediated) touch across the skin surface (Gallace and Spence 2010). The availability of such a map Frontiers in Digital Humanities | www.frontiersin.org 7 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Social Touch Building Blocks Effect Measures Gallace and Spence (2010) noted that even the most advanced devices will not be able to deliver something that can approximate realistic interpersonal touch if we do not know exactly what needs to be communicated and how to communicate it. Our touch capabilities are very complex, and like mediated vision and audition, mediated touch will always be degraded compared to real touch. The question is how this degradation affects the effects aimed for. A priori, mediated haptic communication should closely resemble non-mediated communication in order to be intuitively processed without introducing ambiguity or increasing the cognitive load (Rantala et al. 2011). However, the results discussed in this paper [e.g., Bailenson et al. (2007), Smith and MacLean (2007), Haans and IJsselsteijn (2009a), Giannopoulos et al. (2011), and Rantala et al. (2013)] indicate that social touch is quite robust to degradations and it may not be necessary to mediate all physical parameters accurately or at all. However, it is currently not even clear how we can haptically represent valence and arousal, let alone that we have robust knowledge on which parameters of the rich and complex touch characteristics are crucial in relation to the intended effects. Ideally, we have a set of building blocks of social touch that can be applied and combined depending on the situation. Social touch can evoke effects at many different levels in the receiver: physiological, psychological, behavioral, and social, and it is likely that effects at these different levels also interact. For instance, (social) presence and emotions can reciprocally reinforce each other. Currently, a broad range of effect measures is applied, which makes it difficult to compare results, assess interactions between levels, and combine experimental results into an integrated perspective. This pleads for setting a uniform set of validated and standardized measures that covers the different levels and that is robust and sensitive to the hypothesized effects of social touch. This set could include basic physiological measures known to vary with emotional experience [e.g., heart rate variability and skin conductance; Hogervorst et al. 2014]; psychological and social measures reflecting trust, proximity, togetherness, and social presence (IJsselsteijn et al. 2003; Van Bel et al. 2008; van Bel et al. 2009), and behavioral measures, e.g., quantifying compliance and performance. Please note though that each set of measures will have its own pitfalls. For instance, see Brouwer et al. (2015) for a critical reflection on the use of neurophysiological measures to assess cognitive or mental state, and Bailenson and Yee (2008) on the use of self-report questionnaires. Specific ICT Challenges Enabling ICT mediated, generated, and/or interpreted social touch requires specific ICT knowledge and technology. We consider the following issues as most prominent. Methodology Not uncommon for research in the embryonic stage, mediated social touch research is going through a phase of haphazard, anecdotal studies demonstrating the concept and its’ potential. To mature, the field needs rigorous replication and methodological well-designed studies and protocols. The multidisciplinary nature of the field adds to the diversity in research approaches. Understanding Social Touches With a few exceptions, mediated social touch studies are restricted to producing a social touch and investigate its effects on a user. To use social touch in interaction means that the system should not only be able to generate social touches but also to receive and understand social touches provided by human users. Taken the richness of human touch into account, this is not trivial. We may currently not even have the necessary sensor suite to capture a social touch adequately, including parameters like sheer and tangential forces, compliance, temperature, skin stretch, etc. After adequate capturing, algorithms should determine the social appraisal of the touch. Currently, the first attempts to capture social touches with different emotional values on a single body location (e.g., the arm) and to use computer algorithms to classify them are undertaken (van Wingerden et al. 2014). Controlled Studies Only few studies have actually investigated mediated affect conveyance, and compared mediated with unmediated touch. Although it appears that mediated social touch can indeed to some extent convey emotions (Bailenson et al. 2007) and induce pro-social behavior [e.g., the Midas effect; Haans and IJsselsteijn (2009a)], it is still not known to what extent it can also elicit strong affective experiences (Haans and IJsselsteijn 2006) and how this all compares to real touch or other control conditions. Context Aware Computing and Social Signal Processing Protocols Previous studies on mediated haptic interpersonal communication mainly investigated the communication of deliberately performed (instructed) rather than naturally occurring emotions (Bailenson et al. 2007; Smith and MacLean 2007; Rantala et al. 2013). Although this protocol is very time efficient, it relies heavily on participants’ ability to spontaneously generate social touches with, for instance, a specific emotional value. This is comparable to the research domain of facial expression where often trained actors are used to produce expressions on demand. One may consider training people in producing social touches on demand or employ a protocol (scenario) that naturally evokes specific social signals rather than instruct naïve participants to produce them. Frontiers in Digital Humanities | www.frontiersin.org The meaning of a social touch is highly dependent on the accompanying verbal and non-verbal signals of the sender and the context in which the touch is applied. An ICT system involved in social touch interaction should take the relevant parameters into account, both in generating touch and in interpreting touch. To understand and manage social signals of a person, the system is communicating with is the main challenge in the – in itself relatively young – field of social signal processing (Vinciarelli et al. 2008). Context aware (Schilit et al. 1994) implies that the system can sense its environment and reason about it in the context of social touch. 8 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Current ICT advances like the embodiment of artificial entities, the development of advanced haptic and tactile display technologies and standards (van Erp et al. 2010, including initial guidelines for mediated social touch: van Erp and Toet 2013) enable the exploration of new ICT systems that employ this powerful communication option, for instance, to enhance communication between physically separated partners and increase trust in and compliance with artificial entities. There are two prerequisites to make these applications viable. First, inter-human social touch can be ICT mediated, and second, social touch can be ICT generated and understood, all without loss of effectiveness, efficiency, and user satisfaction. In this paper, we show that there is converging evidence that both prerequisites can be met. Mediated social touch shows effects at aforementioned levels, and these effects resemble those of a real touch, even if the mediated touch is severely degraded. We also report the first indications that a social touch can be generated by an artificial entity, although the evidence base is still small. Moreover, the first steps are taken to develop algorithms to automatically classify social touches produced by the user. Our review also shows that (mediated) social touch is an embryonic field relying for a large part on technology demonstrations with only a few systematic investigations. To advance the field, we believe the focus should be on the following four activities: developing an overarching framework (integrating neuroscience, computer science, and social and behavioral science), developing basic social touch building blocks (based on the critical social touch parameters), applying stricter research methodologies (use controlled studies, validated protocols, and standard effect measures), and realizing breakthroughs in ICT (classifying social touches, context aware computing, social signal processing, congruence, and enhancing touch cues). When we are successful in managing these challenges at the crossroads of ICT and psychology, we believe that (mediated) social touch can improve our wellbeing and quality of life, can bridge the gap between real and virtual (social) worlds, and can make artificial entities more human-like. Congruency in Time, Space, and Semantics As with most multimodal interactions, congruency of the signals in space, time, and meaning is of eminent importance. For instance, touches should be congruent with other (mediated) display modalities (visual, auditory, olfactory) to communicate the intended meaning. In addition, congruence in time and space between, for instance, a seen gesture and a resulting haptic sensation is required to support a common interaction metaphor based on real touch. It has been shown that combining mediated social touch with morphologically congruent imagery enhances perceived social presence, whereas incongruent imagery results in lower degrees of social presence (Haans and IJsselsteijn 2010). Especially in closed-loop interaction (e.g., when holding or shaking hands), signals that are out of sync may severely degrade the interaction, thus requiring (near) real-time processing of touch and other social signals and generation of adequate social touches in reaction. Enhancing Touch Cues Social touch seems robust to degradations and mediated touch does not need to replicate all physical parameters accurately. The flipside of degradation is enhancement. Future research should investigate to what extent the affective quality of the mediated touch signals can be enhanced by the addition of other communication channels or by controlling specific touch parameters. Touch parameters do not necessarily have to be mediated one-to-one, but, for instance, temperature and force profiles may be either amplified or attenuated. The additional options mediation can provide to social touch have not been explored yet. Conclusion Social touch is of eminent importance in inter-human social communication and grounded in specific neurophysiological processing channels. Social touch can have effects at many levels including physiological (heart rate and hormone levels), psychological (trust in others), and sociological (pro-social behavior toward others). In Proceedings of the International Conference on Computer Technology and Development (ICCTD ‘09), 416–420. Piscataway, NJ: IEEE Press. Bickmore, T.W., Fernando, R., Ring, L., and Schulman, D. 2010. Empathic touch by relational agents. IEEE Trans. Affect. Comput. 1: 60–71. doi:10.1109/T-AFFC. 2010.4 Bickmore, T.W., and Picard, R.W. 2005. Establishing and maintaining longterm human-computer relationships. ACM Trans. Comput. Hum. Interact. 12: 293–327. doi:10.1145/1067860.1067867 Bohil, C.J., Alicea, B., and Biocca, F.A. 2011. Virtual reality in neuroscience research and therapy. Nat. Rev. Neurosci. 12: 752–62. doi:10.1038/nrn3122 Bonanni, L., Vaucelle, C., Lieberman, J., and Zuckerman, O. 2006. TapTap: a haptic wearable for asynchronous distributed touch therapy. In Proceedings of the ACM Conference on Human Factors in Computing Systems CHI ‘06, 580–585. New York, NY: ACM. Breazeal, C. 2011. Social robots for health applications. In Proceedings of the IEEE 2011 Annual International Conference on Engineering in Medicine and Biology (EMBC), 5368–5371. Piscataway, NJ: IEEE. Brouwer, A.-M., Zander, T.O., van Erp, J.B.F., Korteling, J.E., and Bronkhorst, A.W. 2015. Using neurophysiological signals that reflect cognitive or affective state: six recommendations to avoid common pitfalls. Front. Neurosci. 9:136. doi:10.3389/fnins.2015.00136 Burgoon, J.K. 1991. Relational message interpretations of touch, conversational distance, and posture. J. Nonverbal Behav. 15:233–59. doi:10.1007/BF00986924 References Altun, K., and MacLean, K.E. 2014. Recognizing affect in human touch of a robot. Pattern Recognit. Lett. doi:10.1016/j.patrec.2014.10.016 App, B., McIntosh, D.N., Reed, C.L., and Hertenstein, M.J. 2011. Nonverbal channel use in communication of emotion: how may depend on why. Emotion 11: 603–17. doi:10.1037/a0023164 Argall, B.D., and Billard, A.G. 2010. A survey of tactile human-robot interactions. Rob. Auton. Syst. 58: 1159–76. doi:10.1016/j.robot.2010.07.002 Argyle, M. 1975. Bodily Communication. 2nd ed. London, UK: Methuen. Bailenson, J.N., and Yee, N. 2007. Virtual interpersonal touch and digital chameleons. J. Nonverbal Behav. 31: 225–42. doi:10.1007/s10919-007-0034-6 Bailenson, J.N., and Yee, N. 2008. Virtual interpersonal touch: haptic interaction and copresence in collaborative virtual environments. Multimed. Tools Appl. 37: 5–14. doi:10.1007/s11042-007-0171-2 Bailenson, J.N., Yee, N., Brave, S., Merget, D., and Koslow, D. 2007. Virtual interpersonal touch: expressing and recognizing emotions through haptic devices. Hum. Comput. Interact. 22: 325–53. doi:10.1080/07370020701493509 Basdogan, C., Ho, C.-H., Srinivasan, M.A., and Slater, M. 2000. An experimental study on the role of touch in shared virtual environments. ACM Trans. Comput. Hum. Interact. 7: 443–60. doi:10.1145/365058.365082 Basori, A.H., Bade, A., Sunar, M.S., Daman, D., and Saari, N. 2009. Haptic vibration for emotional expression of avatar to enhance the realism of virtual reality. Frontiers in Digital Humanities | www.frontiersin.org 9 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Burgoon, J.K., and Walther, J.B. 1990. Nonverbal expectancies and the evaluative consequences of violations. Hum. Comm. Res. 17: 232–65. doi:10.1111/j. 1468-2958.1990.tb00232.x Burgoon, J.K., Walther, J.B., and Baesler, E.J. 1992. Interpretations, evaluations, and consequences of interpersonal touch. Hum. Comm. Res. 19: 237–63. doi:10.1111/ j.1468-2958.1992.tb00301.x Bush, E. 2001. The use of human touch to improve the well-being of older adults: A holistic nursing intervention. J. Holist. Nurs. 19(3):256–270. doi:10.1177/ 089801010101900306 Cabibihan, J.-J., Ahmed, I., and Ge, S.S. 2011. Force and motion analyses of the human patting gesture for robotic social touching. In Proceedings of the 2011 IEEE 5th International Conference on Cybernetics and Intelligent Systems (CIS), 165–169. Piscataway, NJ: IEEE. Cabibihan, J.-J., Jegadeesan, R., Salehi, S., and Ge, S.S. 2010. Synthetic skins with humanlike warmth. In Social Robotics, Edited by S. Ge, H. Li, J.J. Cabibihan, and Y. Tan, 362–371. Berlin: Springer. Cabibihan, J.-J., Pradipta, R., Chew, Y., and Ge, S. 2009. Towards humanlike social touch for prosthetics and sociable robotics: Handshake experiments and finger phalange indentations. In Advances in Robotics, Edited by J.H. Kim, S. Ge, P. Vadakkepat, N. Jesse, A. Al Manum, K. Puthusserypady, et al., 73–79 Berlin: Springer. doi:10.1007/978-3-642-03983-6_11 Cabibihan, J.-J., Zheng, L., and Cher, C.K.T. 2012. Affective tele-touch. In Social Robotics, Edited by S. Ge, O. Khatib, J.J. Cabibihan, R. Simmons, and M.A. Williams, 348–356. Berlin: Springer. Calvo, R.A., and D’Mello, S. 2010. Affect detection: an interdisciplinary review of models, methods, and their applications. IEEE Trans. Affect. Comput. 1: 18–37. doi:10.1109/T-AFFC.2010.1 Camps, J., Tuteleers, C., Stouten, J., and Nelissen, J. 2012. A situational touch: how touch affects people’s decision behavior. Social Influence 8: 237–50. doi:10.1080/ 15534510.2012.719479 Cannon, W.B. 1927. The James-Lange theory of emotions: a critical examination and an alternative theory. Am. J. Psychol. 39: 106–24. doi:10.2307/1415404 Cha, J., Eid, M., Barghout, A., and Rahman, A.M. 2008. HugMe: an interpersonal haptic communication system. In IEEE International Workshop on Haptic Audio visual Environments and Games (HAVE 2008), 99–102. Piscataway, NJ: IEEE. Chang, S.O. 2001. The conceptual structure of physical touch in caring. J. Adv. Nurs. 33(6): 820–827. doi:10.1046/j.1365-2648.2001.01721.x Chatel-Goldman, J., Congedo, M., Jutten, C., and Schwartz, J.L. 2014. Touch increases autonomic coupling between romantic partners. Front. Behav. Neurosci. 8:95. doi:10.3389/fnbeh.2014.00095 Chen, T.L., King, C.-H., Thomaz, A.L., and Kemp, C.C. 2011. Touched by a robot: an investigation of subjective responses to robot-initiated touch. In Proceedings of the 6th International Conference on Human-Robot Interaction HRI ‘11, 457–464. New York, NY: ACM. Chung, K., Chiu, C., Xiao, X., and Chi, P.Y.P. 2009. Stress outsourced: a haptic social network via crowdsourcing. In CHI ‘09 Extended Abstracts on Human Factors in Computing Systems, Edited by D.R. Olsen, K. Hinckley, M. Ringel-Morris, S. Hudson and S. Greenberg, 2439–2448. New York, NY: ACM. doi:10.1145/ 1520340.1520346 Coan, J.A., Schaefer, H.S., and Davidson, R.J. 2006. Lending a hand: social regulation of the neural response to threat. Psychol. Sci. 17: 1032–9. doi:10.1111/j. 1467-9280.2006.01832.x Collier, G. 1985. Emotional Expression. Hillsdale, NJ: Lawrence Erlbaum Associates Inc. Cooney, M.D., Nishio, S., and Ishiguro, H. 2012. Recognizing affection for a touchbased interaction with a humanoid robot. In IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), 1420–1427. Piscataway, NJ: IEEE. Cooney, M.D., Nishio, S., and Ishiguro, H. 2014. Importance of touch for conveying affection in a multimodal interaction with a small humanoid robot. Int. J. Hum. Rob. 12(1): 1550002. doi:10.1142/S0219843615500024 Cooper, E.A., Garlick, J., Featherstone, E., Voon, V., Singer, T., Critchley, H.D., et al. 2014. You turn me cold: evidence for temperature contagion. PLoS One 9:e116126. doi:10.1371/journal.pone.0116126 Cramer, H., Kemper, N., Amin, A., Wielinga, B., and Evers, V. 2009. “Give me a hug”: the effects of touch and autonomy on people’s responses to embodied social agents. Comput. Anim. Virtual Worlds 20: 437–45. doi:10.1002/cav.317 Cranny-Francis, A. 2011. Semefulness: a social semiotics of touch. Soc. Semiotics 21: 463–81. doi:10.1080/10350330.2011.591993 Frontiers in Digital Humanities | www.frontiersin.org Crusco, A.H., and Wetzel, C.G. 1984. The midas touch: the effects of interpersonal touch on restaurant tipping. Pers. Soc. Psychol. B 10: 512–7. doi:10.1177/ 0146167284104003 Dahiya, R.S., Metta, G., Valle, M., and Sandini, G. 2010. Tactile sensing – from humans to humanoids. IEEE Trans. Rob. 26: 1–20. doi:10.1109/TRO.2009. 2033627 Damasio, A. 1999. The Feeling of What Happens: Body and Emotion in the Making of Consciousness. London, UK: Heinemann. Debrot, A., Schoebi, D., Perrez, M., and Horn, A.B. 2013. Touch as an interpersonal emotion regulation process in couples’ daily lives: the mediating role of psychological intimacy. Pers. Soc. Psychol. B 39: 1373–85. doi:10.1177/ 0146167213497592 Dev, P., Youngblood, P., Heinrichs, W.L., and Kusumoto, L. 2007. Virtual worlds and team training. Anesthesiol. Clin. 25: 321–36. doi:10.1016/j.anclin.2007.03. 001 Dijk, E.O., Nijholt, A., van Erp, J.B.F., Wolferen, G.V., and Kuyper, E. 2013. Audiotactile stimulation: a tool to improve health and well-being? Int. J. Auton. Adapt. Commun. Syst. 6: 305–23. doi:10.1504/IJAACS.2013.056818 Ditzen, B., Neumann, I.D., Bodenmann, G., von Dawans, B., Turner, R.A., Ehlert, U., et al. 2007. Effects of different kinds of couple interaction on cortisol and heart rate responses to stress in women. Psychoneuroendocrinology 32: 565–74. doi:10.1016/j.psyneuen.2007.03.011 Dolin, D.J., and Booth-Butterfield, M. 1993. Reach out and touch someone: analysis of nonverbal comforting responses. Commun. Q. 41: 383–93. doi:10.1080/ 01463379309369899 Dougherty, E., and Scharfe, H. 2011. Initial formation of trust: designing an interaction with geminoid-DK to promote a positive attitude for cooperation. In Social Robotics, Edited by B. Mutlu, C. Bartneck, J. Ham, V. Evers, and T. Kanda, 95–103. Berlin: Springer. Drescher, V.M., Gantt, W.H., and Whitehead, W.E. 1980. Heart rate response to touch. Psychosom. Med. 42: 559–65. doi:10.1097/00006842-198011000-00004 Eichhorn, E., Wettach, R., and Hornecker, E. 2008. A stroking device for spatially separated couples. In Proceedings of the 10th International Conference on Human Computer Interaction with Mobile Devices and Services Mobile HCI ‘08, 303–306. New York, NY: ACM. Ellingsen, D.M., Wessberg, J., Chelnokova, O., Olausson, H., Aeng, B., and Eknes, S. 2014. In touch with your emotions: oxytocin and touch change social impressions while others’ facial expressions can alter touch. Psychoneuroendocrinology 39: 11–20. doi:10.1016/j.psyneuen.2013.09.017 Field, T. 2010. Touch for socioemotional and physical well-being: a review. Dev. Rev. 30: 367–83. doi:10.1016/j.dr.2011.01.001 Fisher, J.D., Rytting, M., and Heslin, R. 1976. Hands touching hands: affective and evaluative effects of an interpersonal touch. Sociometry 39: 416–21. doi:10.2307/ 3033506 Flowers, M.G., and Aggarwal, R. 2014. Second LifeTM : a novel simulation platform for the training of surgical residents. Expert Rev. Med. Devices 11: 101–3. doi:10. 1586/17434440.2014.863706 Fong, T., Nourbakhsh, I., and Dautenhahn, K. 2003. A survey of socially interactive robots. Rob. Auton. Syst. 42: 143–66. doi:10.1016/S0921-8890(02) 00372-X Frumin, I., Perl, O., Endevelt-Shapira, Y., Eisen, A., Eshel, N., Heller, I., et al. 2015. A social chemosignaling function for human handshaking. Elife 4: e05154. doi:10.7554/eLife.05154 Furukawa, M., Kajimoto, H., and Tachi, S. 2012. KUSUGURI: a shared tactile interface for bidirectional tickling. In Proceedings of the 3rd Augmented Human International Conference AH ‘12, 1–8. New York, NY: ACM. Gallace, A., Ngo, M.K., Sulaitis, J., and Spence, C. 2012. Multisensory presence in virtual reality: possibilities & limitations. In Multiple Sensorial Media Advances and Applications: New Developments in MulSeMedia, Edited by G. Ghinea, F. Andres and S.R. Gulliver, 1–40. Vancouver, BC: IGI Global. Gallace, A., and Spence, C. 2010. The science of interpersonal touch: an overview. Neurosci. Biobehav. Rev. 34: 246–59. doi:10.1016/j.neubiorev.2008.10.004 Gao, Y., Bianchi-Berthouze, N., and Meng, H. 2012. What does touch tell us about emotions in touchscreen-based gameplay? ACM Trans. Comput. Hum. Interact. 19: 1–30. doi:10.1145/2395131.2395138 Giannopoulos, E., Wang, Z., Peer, A., Buss, M., and Slater, M. 2011. Comparison of people’s responses to real and virtual handshakes within a virtual environment. Brain Res. Bull. 85: 276–82. doi:10.1016/j.brainresbull.2010.11.012 10 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Gleeson, M., and Timmins, F. 2005. A review of the use and clinical effectiveness of touch as a nursing intervention. Clin. Effect. Nurs. 9: 69–77. doi:10.1016/j.cein. 2004.12.002 Gooch, D., and Watts, L. 2010. Communicating social presence through thermal hugs. In Proceedings of First Workshop on Social Interaction in Spatially Separated Environments (SISSI2010), Edited by F. Schmid, T. Hesselmann, S. Boll, K. Cheverst, and L. Kulik, 11–19. Copenhagen: International Society for Presence Research. Gooch, D., and Watts, L. 2012. Yourgloves, hothands and hotmits: devices to hold hands at a distance. In Proceedings of the 25th Annual ACM Symposium on User Interface Software and Technology UIST ‘12, 157–166. New York, NY: ACM. Gordon, I., Voos, A.C., Bennett, R.H., Bolling, D.Z., Pelphrey, K.A. and Kaiser, M.D. 2013. Brain mechanisms for processing affective touch. Hum. Brain Mapp. 34(4):914–922. doi:10.1002/hbm.21480 Gottlieb, G. 1971. Ontogenesis of sensory function in birds and mammals. In The Biopsychology of Development, Edited by E. Tobach, L.R. Aronson, and E. Shaw, 67–128. New York, NY: Academic Press. Grewen, K.M., Anderson, B.J., Girdler, S.S., and Light, K.C. 2003. Warm partner contact is related to lower cardiovascular reactivity. Behav. Med. 29: 123–30. doi:10.1080/08964280309596065 Guéguen, N. 2002. Touch, awraness of touch, and compliance with a request. Percept. Mot. Skills 95: 355–60. doi:10.2466/pms.2002.95.2.355 Guéguen, N. 2004. Nonverbal encouragement of participation in a course: the effect of touching. Soc. Psychol. Educ. 7: 89–98. doi:10.1023/B:SPOE.0000010691. 30834.14 Guéguen, N., and Fischer-Lokou, J. 2003. Tactile contact and spontaneous help: an evaluation in a natural setting. J. Soc. Psychol. 143: 785–7. doi:10.1080/ 00224540309600431 Guéguen, N., Meineri, S., and Charles-Sire, V. 2010. Improving medication adherence by using practitioner nonverbal techniques: a field experiment on the effect of touch. J. Behav. Med. 33: 466–73. doi:10.1007/s10865-010-9277-5 Haans, A., and IJsselsteijn, W.A. 2006. Mediated social touch: a review of current research and future directions. Virtual Reality 9: 149–59. doi:10.1007/ s10055-005-0014-2 Haans, A., and IJsselsteijn, W.A. (2009a). The virtual Midas Touch: helping behavior after a mediated social touch. IEEE Trans. Haptics 2: 136–40. doi:10.1109/TOH. 2009.20 Haans, A., and IJsselsteijn, W.A. (2009b). I’m always touched by your presence, dear: combining mediated social touch with morphologically correct visual feedback. In Proceedings of Presence 2009, 1–6. Los Angeles, CA: International Society for Presence Research. Haans, A., and IJsselsteijn, W.A. 2010. Combining mediated social touch with vision: from self-attribution to telepresence? In Proceedings of Special Symposium at EuroHaptics 2010: Haptic and Audio-Visual Stimuli: Enhancing Experiences and Interaction, Edited by A. Nijholt, E.O. Dijk, and P.M.C. Lemmens, 35–46 Enschede:University of Twente. Henricson, M., Ersson, A., Määttä, S., Segesten, K., and Berglund, A.L. 2008. The outcome of tactile touch on stress parameters in intensive care: A randomized controlled trial. Complement. Ther. Clin. Prac. 14(4): 244–254. Harlow, H.F., and Zimmermann, R.R. 1959. Affectional responses in the infant monkey; orphaned baby monkeys develop a strong and persistent attachment to inanimate surrogate mothers. Science 130: 421–32. doi:10.1126/science.130. 3373.421 Hertenstein, M.J., Holmes, R., McCullough, M., and Keltner, D. 2009. The communication of emotion via touch. Emotion 9: 566–73. doi:10.1037/a0016108 Hertenstein, M.J., Keltner, D., App, B., Bulleit, B.A., and Jaskolka, A.R. 2006. Touch communicates distinct emotions. Emotion 6: 528–33. doi:10.1037/1528-3542.6. 3.528 Hogervorst, M.A., Brouwer, A.-M., and van Erp, J.B.F. 2014. Combining and comparing EEG, peripheral physiology and eye-related measures for the assessment of mental workload. Front. Neurosci. 8:322. doi:10.3389/fnins.2014.00322 Hornik, J. 1992. Tactile stimulation and consumer response. J. Consum. Res. 19: 449–58. doi:10.1086/209314 Hossain, S.K.A., Rahman, A.S.M.M., and El Saddik, A. 2011. Measurements of multimodal approach to haptic interaction in second life interpersonal communication system. IEEE Trans. Instrum. Meas. 60: 3547–58. doi:10.1109/TIM. 2011.2161148 Huisman, G., Bruijnes, M., Kolkmeier, J., Jung, M.M., Darriba Frederiks, A., and Rybarczyk, Y. (2014a). Touching virtual agents: embodiment and mind. In Innovative and Creative Developments in Multimodal Interaction Systems, Edited Frontiers in Digital Humanities | www.frontiersin.org by Y. Rybarczyk, T. Cardoso, J. Rosas, and L. Camarinha-Matos, 114–138. Berlin: Springer. Huisman, G., Kolkmeier, J., and Heylen, D. (2014b). Simulated social touch in a collaborative game. In Haptics: Neuroscience, Devices, Modeling, and Applications, Edited by M. Auvray and C. Duriez, 248–256. Berlin: Springer. Huisman, G., Darriba Frederiks, A., Van Dijk, E.M.A.G., Kröse, B.J.A., and Heylen, D.K.J. 2013. Self touch to touch others: designing the tactile sleeve for social touch. In Online Proceedings of TEI’13. Available at: http://www.tei-conf.org/13/ sites/default/files/page-files/Huisman.pdf Hutson, S., Lim, S., Bentley, P.J., Bianchi-Berthouze, N., and Bowling, A. 2011. Investigating the suitability of social robots for the wellbeing of the elderly. In Affective Computing and Intelligent Interaction, Edited by S. D’Mello, A. Graesser, B. Schuller, and J.C. Martin, 578–587. Berlin: Springer. IJsselsteijn, W.A., van Baren, J., and van Lanen, F. 2003. Staying in touch: social presence and connectedness through synchronous and asynchronous communication media (Part III). In Human-Computer Interaction: Theory and Practice, Edited by C. Stephanidis and J. Jacko, 924–928. Boca Raton, FL: CRC Press. IJzerman, H., and Semin, G.R. 2009. The thermometer of social relations: mapping social proximity on temperature. Psychol. Sci. 20: 1214–20. doi:10.1111/j. 1467-9280.2009.02434.x IJzerman, H., and Semin, G.R. 2010. Temperature perceptions as a ground for social proximity. J. Exp. Soc. Psychol. 46: 867–73. doi:10.1016/j.jesp.2010.07.015 James, W. 1884. What is an emotion? Mind 9: 188–205. doi:10.1093/mind/os-IX. 34.188 Jones, S.E., and Yarbrough, A.E. 1985. A naturalistic study of the meanings of touch. Comm. Monogr. 52: 19–56. doi:10.1080/03637758509376094 Joule, R.V., and Guéguen, N. 2007. Touch, compliance, and awareness of tactile contact. Percept. Mot. Skills 104: 581–8. doi:10.2466/pms.104.2.581-588 Jung, M.M., Poppe, R., Poel, M., and Heylen, D.K.J. 2014. Touching the VOID – introducing CoST: corpus of social touch. In Proceedings of the 16th International Conference on Multimodal Interaction (ICMI ‘14), 120–127. New York, NY: ACM. Kanamori, M., Suzuki, M., Oshiro, H., Tanaka, M., Inoguchi, T., Takasugi, H., et al. 2003. Pilot study on improvement of quality of life among elderly using a pet-type robot. In Proceedings of the IEEE International Symposium on Computational Intelligence in Robotics and Automation, 107–112. Piscataway, NJ: IEEE. Khanna, P., and Sasikumar, M. 2010. Recognising emotions from keyboard stroke pattern. Int. J. Comput. Appl. 11: 1–5. doi:10.5120/1614-2170 Kjeldskov, J., Gibbs, M., Vetere, F., Howard, S., Pedell, S., Mecoles, K., et al. 2004. Using cultural probes to explore mediated intimacy. Australas J. Inf. Syst. 11. Available at: http://journal.acs.org.au/index.php/ajis/article/view/128 Kleinke, C.L. 1977. Compliance to requests made by gazing and touching experimenters in field settings. J. Exp. Soc. Psychol. 13: 218–23. doi:10.1016/ 0022-1031(77)90044-0 Knapp, M.L., and Hall, J.A. 2010. Nonverbal Communication in Human Interaction (7th ed.). Boston, MA: Wadsworth, CENGAGE Learning. Konijn, E.A., Utz, S., Tanis, M., and Barnes, S.B. 2008. Mediated Interpersonal Communication. New York, NY: Routledge. Kotranza, A., and Lok, B. 2008. Virtual human + tangible interface = mixed reality human: an initial exploration with a virtual breast exam patient. In Proceedings of the IEEE Virtual Reality Conference 2008 (VR ‘08), 99–106. Piscataway, NJ: IEEE. Kotranza, A., Lok, B., Deladisma, A., Pugh, C.M., and Lind, D.S. 2009. Mixed reality humans: evaluating behavior, usability, and acceptability. IEEE Trans. Vis. Comput. Graph. 15: 369–82. doi:10.1109/TVCG.2008.195 Kraus, M.W., Huang, C., and Keltner, D. 2010. Tactile communication, cooperation, and performance: an ethological study of the NBA. Emotion 10: 745–9. doi:10. 1037/a0019382 Kristoffersson, A., Coradeschi, S., and Loutfi, A. 2013. A review of mobile robotic telepresence. Adv. Hum. Comput. Int. 2013: 1–17. doi:10.1155/2013/ 902316 Kuwamura, K., Sakai, K., Minato, T., Nishio, S., and Ishiguro, H. 2013. Hugvie: a medium that fosters love. In The 22nd IEEE International Symposium on Robot and Human Interactive Communication, 70–75. Gyeongju: IEEE. Kvam, M.H. 1997. The effect of vibroacoustic therapy. Physiotherapy 83: 290–5. doi:10.1016/S0031-9406(05)66176-7 Ledbetter, A.M. 2014. The past and future of technology in interpersonal communication theory and research. Commun. Stud. 65: 456–9. doi:10.1080/10510974. 2014.927298 11 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Lee, J.K., Stiehl, W.D., Toscano, R.L., and Breazeal, C. 2009. Semi-autonomous robot avatar as a medium for family communication and education. Adv. Rob. 23: 1925–49. doi:10.1163/016918609X12518783330324 Lee, K.M., Jung, Y., Kim, J., and Kim, S.R. 2006. Are physically embodied social agents better than disembodied social agents? The effects of physical embodiment, tactile interaction, and people’s loneliness in human-robot interaction. Int. J. Hum. Comput. Stud. 64: 962–73. doi:10.1016/j.ijhcs.2006.05.002 Lemmens, P., Crompvoets, F., Brokken, D., van den Eerenbeemd, J., and de Vries, G.J. 2009. A body-conforming tactile jacket to enrich movie viewing. In EuroHaptics Conference, 2009 and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems. World Haptics 2009. Third Joint, 7–12. Piscataway, NJ: IEEE Press. Li, H., Cabibihan, J.-J., and Tan, Y. 2011. Towards an effective design of social robots. Int. J. Soc. Rob. 3: 333–5. doi:10.1007/s12369-011-0121-z Löken, L.S., Wessberg, J., Morrison, I., McGlone, F., and Olausson, H. 2009. Coding of pleasant touch by unmyelinated afferents in humans. Nat. Neurosci. 12(5): 547–548. doi:10.1038/nn.2312 Lv, H.-R., Lin, Z.-L., Yin, W.-J., and Dong, J. 2008. Emotion recognition based on pressure sensor keyboards. In IEEE International Conference on Multimedia and Expo 2008, 1089–1092. Piscataway, NJ: IEEE. Master, S.L., Eisenberger, N.I., Taylor, S.E., Naliboff, B.D., Shirinyan, D., and Lieberman, M.D. 2009. A picture’s worth: partner photographs reduce experimentally induced pain. Psychol. Sci. 20: 1316–8. doi:10.1111/j.1467-9280.2009.02444.x McCall, C., and Blascovich, J. 2009. How, when, and why to use digital experimental virtual environments to study social behavior. Soc. Pers. Psychol. Compass 3: 744–58. doi:10.1111/j.1751-9004.2009.00195.x McCance, R.A., and Otley, M. 1951. Course of the blood urea in newborn rats, pigs and kittens. J. Physiol. 113: 18–22. doi:10.1113/jphysiol.1951.sp004552 McDaniel, E., and Andersen, P.A. 1998. International patterns of interpersonal tactile communication: a field study. J. Nonverbal Behav. 22: 59–75. doi:10.1023/ A:1022952509743 McGlone, F., Wessberg, J., and Olausson, H. 2014. Discriminative and affective touch: sensing and feeling. Neuron 82: 737–55. doi:10.1016/j.neuron.2014. 05.001 Mehrabian, A. 1972. Nonverbal Communication. Chicago, IL: Aldine-Atherton. Mikropoulos, T.A., and Natsis, A. 2011. Educational virtual environments: a tenyear review of empirical research (1999-2009). Comput. Educ. 56: 769–80. doi:10. 1016/j.compedu.2010.10.020 Montagu, A. 1972. Touching: The Human Significance of the Skin. New York, NY: Harper & Row Publishers. Morrison, I., Löken, L., and Olausson, H. 2010. The skin as a social organ. Exp. Brain Res. 204: 305–14. doi:10.1007/s00221-009-2007-y Morrison, I., Björnsdotter, M., and Olausson, H. 2011. Vicarious responses to social touch in posterior insular cortex are tuned to pleasant caressing speeds. J. Neurosci. 31(26):9554–9562. Mueller, F., Vetere, F., Gibbs, M.R., Kjeldskov, J., Pedell, S., and Howard, S. 2005. Hug over a distance. In CHI ‘05 Extended Abstracts on Human Factors in Computing Systems, Edited by G. van der Veer and C. Gale, 1673–1676. New York, NY: ACM. doi:10.1145/1056808.1056994 Nakagawa, K., Shiomi, M., Shinozawa, K., Matsumura, R., Ishiguro, H., and Hagita, N. 2011. Effect of robot’s active touch on people’s motivation. In Proceedings of the 6th International Conference on Human-Robot Interaction HRI ‘11, 465–472. New York, NY: ACM. Nakanishi, H., Tanaka, K., and Wada, Y. 2014. Remote handshaking: touch enhances video-mediated social telepresence. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems CHI’14, 2143–2152. New York, NY: ACM. Nakanishi, J., Kuwamura, K., Minato, T., Nishio, S., and Ishiguro, H. 2013. Evoking affection for a communication partner by a robotic communication medium. In The First International Conference on Human-Agent Interaction (iHAI 2013), 1–8. Available at: http://hai-conference.net/ihai2013/proceedings/pdf/III-1-4.pdf Naya, F., Yamato, J., and Shinozawa, K. 1999. Recognizing human touching behaviors using a haptic interface for a pet-robot. In Conference Proceedings of the IEEE International Conference on Systems, Man, and Cybernetics (IEEE SMC ‘99), 1030–1034. Piscataway, NJ: IEEE. Nguyen, N., Wachsmuth, I., and Kopp, S. 2007. Touch perception and emotional appraisal for a virtual agent. In Proceedings of the 2nd Workshop Emotion and Computing-Current Research and Future Impact, Edited by D. Reichardt and P. Levi, 17–22. Stuttgart: Berufsakademie Stuttgart. Frontiers in Digital Humanities | www.frontiersin.org Nguyen, T., Heslin, R., and Nguyen, M.L. 1975. The meanings of touch: sex differences. J. Commun. 25: 92–103. doi:10.1111/j.1460-2466. 1975.tb00610.x Nie, J., Park, M., Marin, A.L., and Sundar, S.S. 2012. Can you hold my hand? Physical warmth in human-robot interaction. In Proceeedings of the 7th ACM/IEEE International Conference on Human-Robot Interaction (HRI), 201–202. Piscataway, NJ: IEEE. Nijholt, A. 2014. Breaking fresh ground in human-media interaction research. Front. ICT 1:4. doi:10.3389/fict.2014.00004 Nummenmaa, L., Glerean, E., Hari, R., and Hietanen, J.K. 2013. Bodily maps of emotions. Proc. Natl. Acad. Sci. U.S.A. 111: 646–51. doi:10.1073/pnas. 1321664111 Olausson, H.W., Cole, J., Vallbo, Å, McGlone, F., Elam, M., Krämer, H.H., et al. 2008. Unmyelinated tactile afferents have opposite effects on insular and somatosensory cortical processing. Neurosci. Lett. 436: 128–32. doi:10.1016/j.neulet.2008. 03.015 Paladino, M.P., Mazzurega, M., Pavani, F., and Schubert, T.W. 2010. Synchronous multisensory stimulation blurs self-other boundaries. Psychol. Sci. 21: 1202–7. doi:10.1177/0956797610379234 Park, E., and Lee, J. 2014. I am a warm robot: the effects of temperature in physical human – robot interaction. Robotica 32: 133–42. doi:10.1017/ S026357471300074X Park, Y.W., Bae, S.H., and Nam, T.J. 2012. How do Couples Use CheekTouch Over Phone Calls? New York, NY: ACM. 763–6. Park, Y.W., Hwang, S., and Nam, T.J. 2011. Poke: emotional touch delivery through an inflatable surface over interpersonal mobile communications. In Adjunct Proceedings of the 24th Annual ACM Symposium Adjunct on User Interface Software and Technology UIST ‘11, 61–62. New York, NY: ACM. Patrick, G. 1999. The effects of vibroacoustic music on symptom reduction. IEEE Eng. Med. Biol. Mag. 18: 97–100. doi:10.1109/51.752987 Phelan, J.E. 2009. Exploring the use of touch in the psychotherapeutic setting: a phenomenological review. Psychotherapy (Chic) 46: 97–111. doi:10.1037/a0014751 Prisby, R.D., Lafage-Proust, M.-H., Malaval, L., Belli, A., and Vico, L. 2008. Effects of whole body vibration on the skeleton and other organ systems in man and animal models: what we know and what we need to know. Ageing Res. Rev. 7: 319–29. doi:10.1016/j.arr.2008.07.004 Puhan, M.A., Suarez, A., Cascio, C.L., Zahn, A., Heitz, M., and Braendli, O. 2006. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ 332: 266–70. doi:10.1136/bmj.38705. 470590.55 Rahman, A.S.M.M., and El Saddik, A. 2011. HKiss: real world based haptic interaction with virtual 3D avatars. In Proceedings of the 2011 IEEE International Conference on Multimedia and Expo (ICME), 1–6. Piscataway, NJ: IEEE. Rantala, J., Raisamo, R., Lylykangas, J., Ahmaniemi, T., Raisamo, J., Rantala, J., et al. 2011. The role of gesture types and spatial feedback in haptic communication. IEEE Trans. Haptics 4: 295–306. doi:10.1109/TOH.2011.4 Rantala, J., Salminen, K., Raisamo, R., and Surakka, V. 2013. Touch gestures in communicating emotional intention via vibrotactile stimulation. Int. J. Hum. Comput. Stud. 7: 679–90. doi:10.1016/j.ijhcs.2013.02.004 Réhman, S., and Liu, L. 2010. iFeeling: vibrotactile rendering of human emotions on mobile phones. In Mobile Multimedia Processing, Edited by X. Jiang, M.Y. Ma, and C. Chen, 1–20. Berlin: Springer. Robinson, H., MacDonald, B., Kerse, N., and Broadbent, E. 2013. The psychosocial effects of a companion robot: a randomized controlled trial. J. Am. Med. Dir. Assoc. 14: 661–7. doi:10.1016/j.jamda.2013.02.007 Rolls, E.T. 2010. The affective and cognitive processing of touch, oral texture, and temperature in the brain. Neurosci. Biobehav. Rev. 34: 237–45. doi:10.1016/j. neubiorev.2008.03.010 Saadatian, E., Samani, H., Parsani, R., Pandey, A.V., Li, J., Tejada, L., et al. 2014. Mediating intimacy in long-distance relationships using kiss messaging. Int. J. Hum. Comput. Stud. 72: 736–46. doi:10.1016/j.ijhcs.2014.05.004 Sallnäs, E.L. 2010. Haptic feedback increases perceived social presence. In Haptics: Generating and Perceiving Tangible Sensations, Part II, Edited by A.M. Kappers, J.B. Erp, W.M. Bergmann Tiest, and F.C. Helm, 178–185. Berlin: Springer. Salminen, K., Surakka, V., Lylykangas, J., Raisamo, R., Saarinen, R., Raisamo, R., et al. 2008. Emotional and behavioral responses to haptic stimulation. In Proceeding of the Twenty-Sixth Annual SIGCHI Conference on Human Factors in Computing Systems, 1555–1562. New York, NY: ACM Press. 12 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Scheele, D., Kendrick, K.M., Khouri, C., Kretzer, E., Schläpfer, T.E., StoffelWagner, B., et al. 2014. An oxytocin-induced facilitation of neural and emotional responses to social touch correlates inversely with autism traits. Neuropsychopharmacology 39: 2078–85. doi:10.1038/npp.2014.78 Schilit, B., Adams, N., and Want, R. 1994. Context-aware computing applications. In First Workshop on Mobile Computing Systems and Applications (WMCSA 1994), 85–90. Piscataway, NJ: IEEE. Self, B.P., van Erp, J.B.F., Eriksson, L., and Elliott, L.R. 2008. Human factors issues of tactile displays for military environments. In Tactile Displays for Navigation, Orientation and Communication in Military Environments, Edited by J.B.F. van Erp and B.P. Self, 3. Neuillu-sur-Seine: NATO RTO. Shermer, M. 2004. A bounty of science. Sci. Am. 290: 33. doi:10.1038/ scientificamerican0204-33 Shin, H., Lee, J., Park, J., Kim, Y., Oh, H., and Lee, T. 2007. A tactile emotional interface for instant messenger chat. In Proceedings of the 2007 Conference on Human Interface, Edited by M.J. Smith and G. Salvendy, 166–175. Berlin: Springer. Smith, J., and MacLean, K. 2007. Communicating emotion through a haptic link: design space and methodology. Int. J. Hum. Comput. Stud. 65: 376–87. doi:10. 1016/j.ijhcs.2006.11.006 Solon, O. 2015. These sex tech toys will blow your mind. WIRED. Available at: http://www.wired.co.uk/news/archive/2014-06/27/sex-tech Stiehl, W.D., Lieberman, J., Breazeal, C., Basel, L., Lalla, L., and Wolf, M. 2005. Design of a therapeutic robotic companion for relational, affective touch. In IEEE International Workshop on Robot and Human Interactive Communication (ROMAN 2005), 408–415. Piscataway, NJ: IEEE. Suhonen, K., Müller, S., Rantala, J., Väänänen-Vainio-Mattila, K., Raisamo, R., and Lantz, V. (2012a). Haptically augmented remote speech communication: a study of user practices and experiences. In Proceedings of the 7th Nordic Conference on Human-Computer Interaction: Making Sense Through Design NordiCHI ‘12, 361–369. New York, NY: ACM. Suhonen, K., Väänänen-Vainio-Mattila, K., and Mäkelä, K. (2012b). User experiences and expectations of vibrotactile, thermal and squeeze feedback in interpersonal communication. In Proceedings of the 26th Annual BCS Interaction Specialist Group Conference on People and Computers BCS-HCI ‘12, 205–214. New York, NY: ACM. Suk, H.-J., Jeong, S.-H., Hang, T.-H., and Kwon, D.-S. 2009. Tactile sensation as emotion elicitor. Kansei Eng. Int. 8(2): 147–52. Takahashi, K., Mitsuhashi, H., Murata, K., Norieda, S., and Watanabe, K. 2011. Improving shared experiences by haptic telecommunication. In 2011 International Conference on Biometrics and Kansei Engineering (ICBAKE), 210–215. Los Alamitos, CA: IEEE. doi:10.1109/ICBAKE.2011.19 Tanaka, F., Cicourel, A., and Movellan, J.R. 2007. Socialization between toddlers and robots at an early childhood education center. Proc. Natl. Acad. Sci. U.S.A. 104: 17954–8. doi:10.1073/pnas.0707769104 Teh, J.K.S., Cheok, A.D., Peiris, R.L., Choi, Y., Thuong, V., and Lai, S. 2008. Huggy pajama: a mobile parent and child hugging communication system. In Proceedings of the 7th International Conference on Interaction Design and Children IDC ‘08, 250–257. New York, NY: ACM. Thompson, E.H., and Hampton, J.A. 2011. The effect of relationship status on communicating emotions through touch. Cognit. Emot. 25: 295–306. doi:10. 1080/02699931.2010.492957 Toet, A., van Erp, J.B.F., Petrignani, F.F., Dufrasnes, M.H., Sadhashivan, A., van Alphen, D., et al. 2013. Reach out and touch somebody’s virtual hand. Affectively connected through mediated touch. In Proceedings of the 2013 Humaine Association Conference on Affective Computing and Intelligent Interaction, 786–791. Piscataway, NJ: IEEE Computer Society. Tsalamlal, M.Y., Ouarti, N., Martin, J.C., and Ammi, M. 2014. Haptic communication of dimensions of emotions using air jet based tactile stimulation. J. Multimodal User Interfaces 9(1): 69–77. doi:10.1007/s12193-014 -0162-3 Tsetserukou, D. 2010. HaptiHug: a novel haptic display for communication of hug over a distance. In Haptics: Generating and Perceiving Tangible Sensations, Edited by A.M. Kappers, J.B. Erp, W.M. Bergmann Tiest, and F.C. Helm, 340–347. Berlin: Springer. Tsetserukou, D., and Neviarouskaya, A. 2010. Innovative real-time communication system with rich emotional and haptic channels. In Haptics: Generating and Frontiers in Digital Humanities | www.frontiersin.org Perceiving Tangible Sensations, Edited by A.M. Kappers, J.B. van Erp, W.M. Bergmann Tiest, and F.C. Helm, 306–313. Berlin: Springer. Tsihrintzis, G.A., Virvou, M., Alepis, E., and Stathopoulou, I.O. 2008. Towards improving visual-facial emotion recognition through use of complementary keyboard-stroke pattern information. In Fifth International Conference on Information Technology: New Generations (ITNG 2008), 32–37. Piscataway, NJ: IEEE. Uvnäs-Moberg, K. 1997. Physiological and endocrine effects of social contact. Ann. N. Y. Acad. Sci. 807: 146–63. doi:10.1111/j.1749-6632.1997.tb51917.x Vallbo, A., Olausson, H., Wessberg, J., and Norrsell, U. 1993. A system of unmyelinated afferents for innocuous mechanoreception in the human skin. Brain Res. 628: 301–4. doi:10.1016/0006-8993(93)90968-S Van Bel, D.T., IJsselsteijn, W.A., and de Kort, Y.A.W. 2008. Interpersonal connectedness: conceptualization and directions for a measurement instrument. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI’08), 3129–3134. New York, NY: ACM. van Bel, D.T., Smolders, K.C.H.J., IJsselsteijn, W.A., and de Kort, Y.A.W. 2009. Social connectedness: concept and measurement. In Proceedings of the 5th International Conference on Intelligent Environments, Edited by V. Callaghan, A. Kameas, A. Reyes, D. Royo, and M. Weber, 67–74. Amsterdam: IOS Press. van Erp, J.B.F. 2007. Tactile Displays for Navigation and Orientation: Perception and Behaviour. Utrecht: Utrecht University. van Erp, J.B.F. 2012. The ten rules of touch: guidelines for social agents and robots that can touch. In Proceedings of the 25th Annual Conference on Computer Animation and Social Agents (CASA 2012), Singapore: Nanayang Technological University. van Erp, J.B.F., Kyung, K.-U., Kassner, S., Carter, J., Brewster, S., Weber, G., et al. 2010. Setting the standards for haptic and tactile interactions: ISO’s work. In Haptics: Generating and Perceiving Tangible Sensations. Proceedings of Eurohaptics 2010, Edited by A.M.L. Kappers, J.B.F. van Erp, W.M. Bergmann Tiest, and F.C.T. van der Helm, 353–358. Heidelberg: Springer. van Erp, J.B.F., and Toet, A. 2013. How to touch humans. Guidelines for social agents and robots that can touch. In Proceedings of the 2013 Humaine Association Conference on Affective Computing and Intelligent Interaction, 780–785. Geneva:IEEE Computer Society. doi:10.1109/ACII.2013.77145 van Erp, J.B.F., and van Veen, H.A.H.C. 2004. Vibrotactile in-vehicle navigation system. Transp. Res. Part F Traffic Psychol. Behav. 7: 247–56. doi:10.1016/j.trf. 2004.09.003 van Wingerden, S., Uebbing, T.J., Jung, M.M., and Poel, M. 2014. A neural network based approach to social touch classification. In Proceedings of the 2014 Workshop on Emotion Representation and Modelling in Human-Computer-InteractionSystems (ERM4HCI ‘14), 7–12. New York, NY: ACM. Vinciarelli, A., Pantic, M., Bourlard, H., and Pentland, A. 2008. Social signal processing: state-of-the-art and future perspectives of an emerging domain. In Proceedings of the 16th ACM International Conference on Multimedia, 1061–1070. New York, NY: ACM. Vrontou, S., Wong, A.M., Rau, K.K., Koerber, H.R., and Anderson, D.J. 2013. Genetic identification of C fibres that detect massage-like stroking of hairy skin in vivo. Nature 493: 669–73. doi:10.1038/nature11810 Wada, K., Ikeda, Y., Inoue, K., and Uehara, R. 2010. Development and preliminary evaluation of a caregiver’s manual for robot therapy using the therapeutic seal robot Paro. In Proceedings of the IEEE International Workshop on Robot and Human Interactive Communication (RO-MAN 2010), 533–538. Piscataway, NJ: IEEE. Wada, K., and Shibata, T. 2007. Living with seal robots – its sociopsychological and physiological influences on the elderly at a care house. IEEE Trans. Rob. 23: 972–80. doi:10.1109/TRO.2007.906261 Walker, S.C., and McGlone, F.P. 2015. Perceived pleasantness of social touch reflects the anatomical distribution and velocity tuning of C-tactile afferents: an affective homunculus. In Program No. 339.14/HH22. 2014 Neuroscience Meeting Planner, Washington, DC: Society for Neuroscience. Wang, R., and Quek, F. 2010. Touch & talk: contextualizing remote touch for affective interaction. In Proceedings of the 4th International Conference on Tangible, Embedded, and Embodied Interaction (TEI ‘10), 13–20. New York, NY: ACM. Wang, R., Quek, F., Tatar, D., Teh, K.S., and Cheok, A.D. 2012. Keep in touch: channel, expectation and experience. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems CHI ‘12, 139–148. New York, NY: ACM. 13 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Whitcher, S.J., and Fisher, J.D. 1979. Multidimensional reaction to therapeutic touch in a hospital setting. J. Pers. Soc. Psychol. 37: 87–96. doi:10.1037/0022-3514.37. 1.87 Wigram, A.L. 1996. The Effects of Vibroacoustic Therapy on Clinical and NonClinical Populations. Ph.D. thesis, St. George’s Hospital Medical School, London University, London. Yohanan, S., Chan, M., Hopkins, J., Sun, H., and MacLean, K. 2005. Hapticat: exploration of affective touch. In Proceedings of the 7th International Conference on Multimodal Interfaces (ICMI ‘05), 222–229. New York, NY: ACM. Yohanan, S., and MacLean, K. 2012. The role of affective touch in human-robot interaction: human intent and expectations in touching the haptic creature. Int. J. Soc. Rob. 4: 163–80. doi:10.1007/s12369-011-0126-7 Frontiers in Digital Humanities | www.frontiersin.org Zacharatos, H., Gatzoulis, C., and Chrysanthou, Y.L. 2014. Automatic emotion recognition based on body movement analysis: a survey. IEEE CGA 34: 35–45. doi:10.1109/MCG.2014.106 Conflict of Interest Statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Copyright © 2015 van Erp and Toet. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. 14 May 2015 | Volume 2 | Article 2
|
Use only the document provided. If the question can not be answered then respond with 'I am unable to answer this request' What are some ICT advances in the field of social touch? REVIEW published: 27 May 2015 doi: 10.3389/fdigh.2015.00002 Social touch in human–computer interaction Jan B. F. van Erp 1,2 * and Alexander Toet 1 1 Perceptual and Cognitive Systems, TNO, Soesterberg, Netherlands, 2 Human Media Interaction, University of Twente, Enschede, Netherlands Edited by: Yoram Chisik, University of Madeira, Portugal Reviewed by: Mohamed Chetouani, Université Pierre et Marie Curie, France Gualtiero Volpe, Università degli Studi di Genova, Italy Hongying Meng, Brunel University London, UK *Correspondence: Jan B. F. van Erp, TNO Human Factors, Kampweg 5, Soesterberg 3769DE, Netherlands [email protected] Specialty section: This article was submitted to Human-Media Interaction, a section of the journal Frontiers in Digital Humanities Received: 06 February 2015 Paper pending published: 19 March 2015 Accepted: 08 May 2015 Published: 27 May 2015 Citation: van Erp JBF and Toet A (2015) Social touch in human–computer interaction. Front. Digit. Humanit. 2:2. doi: 10.3389/fdigh.2015.00002 Touch is our primary non-verbal communication channel for conveying intimate emotions and as such essential for our physical and emotional wellbeing. In our digital age, human social interaction is often mediated. However, even though there is increasing evidence that mediated touch affords affective communication, current communication systems (such as videoconferencing) still do not support communication through the sense of touch. As a result, mediated communication does not provide the intense affective experience of co-located communication. The need for ICT mediated or generated touch as an intuitive way of social communication is even further emphasized by the growing interest in the use of touch-enabled agents and robots for healthcare, teaching, and telepresence applications. Here, we review the important role of social touch in our daily life and the available evidence that affective touch can be mediated reliably between humans and between humans and digital agents. We base our observations on evidence from psychology, computer science, sociology, and neuroscience with focus on the first two. Our review shows that mediated affective touch can modulate physiological responses, increase trust and affection, help to establish bonds between humans and avatars or robots, and initiate pro-social behavior. We argue that ICT mediated or generated social touch can (a) intensify the perceived social presence of remote communication partners and (b) enable computer systems to more effectively convey affective information. However, this research field on the crossroads of ICT and psychology is still embryonic and we identify several topics that can help to mature the field in the following areas: establishing an overarching theoretical framework, employing better research methodologies, developing basic social touch building blocks, and solving specific ICT challenges. Keywords: affective touch, mediated touch, social touch, interpersonal touch, human–computer interaction, human–robot interaction, haptic, tactile Introduction Affective Touch in Interpersonal Communication The sense of touch is the earliest sense to develop in a human embryo (Gottlieb 1971) and is critical for mammals’ early social development and to grow up healthily (Harlow and Zimmermann 1959; Montagu 1972). The sense of touch is one of the first mediums of communication between newborns and parents. Interpersonal communication is to a large extent non-verbal and one of the primary purposes of non-verbal behavior is to communicate emotional states. Non-verbal communication includes facial expressions, prosody, gesture, and touch Frontiers in Digital Humanities | www.frontiersin.org 1 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI (Argyle 1975; Knapp and Hall 2010) of which touch is the primary modality for conveying intimate emotions (Field 2010; Morrison et al. 2010; App et al. 2011), for instance, in greetings, in corrections, and in (sexual) relationships. As touch implies direct physical interaction and co-location, it inherently has the potential to elicit feelings of social presence. The importance of touch as a modality in social communication is highlighted by the fact that the human skin has specific receptors to process affective touch (“the skin as a social organ”: Morrison et al. 2010) in addition to those for discriminative touch (Löken et al. 2009; Morrison et al. 2011; Gordon et al. 2013; McGlone et al. 2014), presumably like all mammals (Vrontou et al. 2013). ICT systems can employ human touch for information processing (discriminative touch) and communication (social touch) as well. Field (2010) and Gallace and Spence (2010)]. For these reasons, mediated interpersonal touch is our first topic of interest. Human–computer interaction applications increasingly deploy intelligent agents to support the social aspects of the interaction. Social agents (either embodied or virtual) already employ vision and audition to communicate social signals but generally lack touch capabilities. If we look at applications in robots and avatars, the first applications including touch facilitated information from user to system only, e.g., in the form of a touch screen or through specific touch sensors in a tangible interface. Social agents that can touch the user are of much more recent date. We believe that social agents could benefit from generating and perceiving social touch cues (van Erp 2012). Based on studies reviewed in this paper, we expect that people will feel a closer bond with agents or robots that use and respond to affective touch since they appear more human than machine-like and more trustworthy. Touch-enabled social agents are therefore our second topic of interest. Discriminative Touch in ICT Systems Conventional systems for human–computer interaction only occasionally employ the sense of touch and mainly provide information through vision and audition. One of the first large-scale applications of a tactile display was the vibration function on mobile phones, communicating the 1-bit message of an incoming call, and the number of systems that include the sense of touch has steadily increased over the past two decades. An important reason for the sparse use of touch is the supposed low bandwidth of the touch channel (Gallace et al. 2012). Although often underestimated, our touch sense is very well able to process large amounts of abstract information. For instance, blind people who are trained in Braille reading can actually read with their fingertips. This information processing capability is increasingly applied in our interaction with systems, and more complex information is being displayed, e.g., to reduce the risk of visual and auditory overload in car driving, to make us feel more immersed in virtual environments, or to realistically train and execute certain medical skills (van Erp and van Veen 2004; Self et al. 2008). Touch in Social Communication Social touch can take many forms in our daily lifes such as greetings (shaking hands, embracing, kissing, backslapping, and cheektweaking), in intimate communication (holding hands, cuddling, stroking, back scratching, massaging), and in corrections (punishment, spank on the bottom). Effects of social touch are apparent at many levels ranging from physiology to social behavior as we will discuss in the following sections. Social touches can elicit a range of strong experiences between pleasant and unpleasant, depending on among others the stimulus [e.g., unpleasant pinches evoking pain (nociception)] and location on the body (e.g., pleasant strokes in erogenous zones). In addition to touch in communication, touch can also be employed in psychotherapy (Phelan 2009) and nursing (Gleeson and Timmins 2005). Examples range from basic comforting touches and massaging to alternative therapies such as acu-pressure, Reiki, vibroacoustic therapy, and low-frequency vibration (Wigram 1996; Kvam 1997; Patrick 1999; Puhan et al. 2006; Prisby et al. 2008). See Dijk et al. (2013) for more examples on mental, healthrelated, and bodily effects of touch. In this paper, we focus on ICT mediated and generated social touch (the areas where psychology and computer science meet), meaning that areas of, for instance, Reiki and low-frequency vibration fall outside the scope of this paper. We first discuss the many roles of social touch in our daily life before continuing with ICT mediated inter-human touch and ICT generated and interpreted touch in human–agent interaction. In 1990s (Vallbo et al. 1993), the first reports on so-called C tactile afferents in human hairy skin were published. This neurophysiological channel in the skin reacts to soft, stroking touches, and its activity strongly depends on stroking speed (with an optimum in the speed range 3–10 cm/s) and has a high correlation with subjective ratings of the pleasantness of the touch. Research over the past decades has shown that this system is not involved in discriminative touch (Olausson et al. 2008) but underlies the emotional aspects of touch and the development and function of the social brain (McGlone et al. 2014). Social touches may activate both this pleasurable touch system and the discriminative touch Affective Touch in ICT Systems Incorporating the sense of touch in ICT systems started with discriminative touch as an information channel, often in addition to vision and audition (touch for information processing). We believe that we are on the averge of a second transition: adding social or affective touch to ICT systems (touch for social communication). In our digital era, an increasing amount of our social interactions is mediated, for example, through (cell) phones, video conferencing, text messaging, chat, or e-mail. Substituting direct contact, these modern technologies make it easy to stay in contact with distant friends and relatives, and they afford some degree of affective communication. For instance, an audio channel can transmit affective information through phonetic features like amplitude variation, pitch inflections, tempo, duration, filtration, tonality, or rhythm, while a video channel supports nonverbal information such as facial expressions and body gestures. However, current communication devices do not allow people to express their emotions through touch and may therefore lack a convincing experience of actual togetherness (social presence). This technology-induced touch deprivation may even degrade the potential beneficial effects of mediated social interaction [for reviews of the negative side effects of touch deprivation see Frontiers in Digital Humanities | www.frontiersin.org 2 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI system (reacting to, for instance, pressure, vibration, and skin stretch). caring, agreement, gratitude, and moral support. Cold feedback was consistently associated with negative issues. Touch, Physiological Functioning, and Wellbeing Touch to Communicate Emotions Hertenstein et al. (2006, 2009) showed that touch alone can effectively be used to convey distinct emotions such as anger, fear, and disgust. In addition, touch plays a role in communicating more complex social messages like trust, receptivity, affection (Mehrabian 1972; Burgoon 1991) and nurture, dependence, and affiliation (Argyle 1975). Touch can also enhance the meaning of other forms of verbal and non-verbal communication, e.g., touch amplifies the intensity of emotional displays from our face and voice (Knapp and Hall 2010). Examples of touches used to communicate emotions are shaking, pushing, and squeezing to communicate anger, hugging, patting, and stroking to communicate love (Gallace and Spence 2010). Jones and Yarbrough (1985) stated that a handshake, an encouraging pat on the back, a sensual caress, a nudge for attention, a tender kiss, or a gentle brush of the shoulder can all convey a vitality and immediacy that is at times far more powerful than language. According to App et al. (2011), touch is the preferred non-verbal communication channel for conveying intimate emotions like love and sympathy, confirmed by, for instance, Debrot et al. (2013) who showed that responsive touch between romantic partners enhances their affective state. McCance and Otley (1951) showed that licking and stroking of the mother animal is critical to start certain physiological processes in a new-born mammal. This indicates the direct link between skin stimulation and physiological processes, a link that is preserved later in life. For instance, gentle stroking touch can lower heart rate and blood pressure (Grewen et al. 2003), increase transient sympathetic reflexes and increase pain thresholds (Drescher et al. 1980; Uvnäs-Moberg 1997), and affect the secretion of stress hormones (Whitcher and Fisher 1979; Shermer 2004; Ditzen et al. 2007). Women holding their partner’s hand showed attenuated threat-related brain activity in response to mild electric shocks (Coan et al. 2006) and reported less pain in a cold pressor task (Master et al. 2009). Touch can also result in coupling or syncing of electrodermal activity of interacting (romantic) couples (ChatelGoldman et al. 2014). Interpersonal touch is the most commonly used method of comforting (Dolin and Booth-Butterfield 1993) and an instrument in nursing care (Bush 2001, Chang 2001, Henricson et al. 2008). For example, patients who were touched by a nurse during preoperative instructions experienced lower subjective and objective stress levels (Whitcher and Fisher 1979), than people who were not. In addition to touch affecting hormone levels, hormones (i.e., oxytocin) also affect the perception of interpersonal touch. Scheele et al. (2014) investigated the effect of oxytocin on the perception of a presumed male or female touch on male participants and found that oxytocin increased the rated pleasantness and brain activity of presumed female touches but not of male touches (all touches were delivered by the same female experimenter). Ellingsen et al. (2014) reported that after oxytocin submission, the effect of touch on the evaluation of facial expression increased. In addition, touch (handshaking in particular) can also play a role in social chemo-signaling. Handshaking can lead to the exchange of chemicals in sweat and behavioral data indicates that people more often sniff their hands after a greeting with a handshake than without a handshake (Frumin et al. 2015). Many social touches are reciprocal in nature (like cuddling and holding hands) and their dynamics rely on different mechanisms all having their own time scale: milliseconds for the detection of a touch (discriminative touch), hundreds of milliseconds and up for the experience of pleasurable touch, and seconds and up for physiological responses (including changes in hormone levels). How these processes interact and possibly reinforce each other is still terra incognita. Physiological responses can also be indirect, i.e., the result of social or empathetic mechanisms. Cooper et al. (2014) recently showed that the body temperature of people decreased when looking at a video of other people putting their hands in cold water. Another recent paradigm is to use thermal and haptically enhanced interpersonal speech communication. This showed that warm and cold signals were used to communicate the valence of messages (IJzerman and Semin 2009; Suhonen et al. 2012a). Warm messages were used to emphasize positive feelings and pleasant experiences, and to express empathy, comfort, closeness, Frontiers in Digital Humanities | www.frontiersin.org Touch to Elicit Emotions Not only can the sense of touch be used to communicate distinct emotions but also to elicit (Suk et al. 2009) and modulate human emotion. Please note that interpreting communicated emotions differs from eliciting emotions as the former may be considered as a cognitive task not resulting in physiological responses, e.g., one can perceive a touch as communicating anger without feeling angry. Starting with the James–Lange theory (James 1884; Cannon 1927; Damasio 1999), the conscious experience of emotion is the brain’s interpretation of physiological states. The existence of specific neurophysiological channels for affective touch and pain and the direct physiological reactions to touch indicate that there may be a direct link between tactile stimulation, physiological responses, and emotional experiences. Together with the distinct somatotopic mapping between bodily tactile sensations and different emotional feelings as found by Nummenmaa et al. (2013), one may assume that tactile stimulation of different bodily regions can elicit a wide range of emotions. Touch as a Behavior Modulator In addition to communicating and eliciting emotions, touch provides an effective means of influencing people’s attitudes toward persons, places, or services, their tendency to create bonds and their (pro-)social behaviors [see Gallace and Spence (2010) for an excellent overview]. This effect is referred to as the Midas touch: a brief, casual touch (often at the hand or arm) that is not necessarily consciously perceived named after king Midas from Greek mythology who had the ability to turn everything he touched into gold. For example, a half-second of hand-to-hand touch from a librarian fostered more favorable impressions of the library (Fisher et al. 1976), touching by a salesperson increased positive evaluations of the store (Hornik 1992), and touch can 3 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI also boost the attractiveness ratings of the toucher (Burgoon et al. 1992). Recipients of such “simple” Midas touches are also more likely to be more compliant or unselfish: willing to participate in a survey (Guéguen 2002) or to adhere to medication (Guéguen et al. 2010), volunteering for demonstrating in a course (Guéguen 2004), returning money left in a public phone (Kleinke 1977), spending more money in a shop (Hornik 1992), tipping more in a restaurant (Crusco and Wetzel 1984), helping with picking-up dropped items (Guéguen and Fischer-Lokou 2003), or giving away a cigarette (Joule and Guéguen 2007). In addition to these oneon-one examples, touch also plays a role in teams. For instance, physical touch enhances team performance of basketball players through building cooperation (Kraus et al. 2010). In clinical and professional situations, interpersonal touch can increase information flow and causes people to evaluate communication partners more favorably (Fisher et al. 1976). and Watts 2010; Tsetserukou 2010), pokes (Park et al. 2011), handholding (Gooch and Watts 2012; Toet et al. 2013), handshakes (Bailenson et al. 2007), strokes on the hand (Eichhorn et al. 2008), arm (Huisman et al. 2013) and cheek (Park et al. 2012), pinches, tickles (Furukawa et al. 2012), pats (Bonanni et al. 2006), squeezes (Rantala et al. 2013), thermal signals (Gooch and Watts 2010; Suhonen et al. 2012a,b), massages (Chung et al. 2009), and intimate sexual touches (Solon 2015). In addition to direct mediation, there is also an option to use indirect ways, for instance, through avatars in a virtual world. Devices like a haptic-jacket system can enhance the communication between users of virtual worlds such as Second Life by enabling the exchange of touch cues resembling encouraging pats and comforting hugs between users and their respective avatars (Hossain et al. 2011). The Huggable is a semi-autonomous robotic teddy bear equipped with somatic sensors, intended to facilitate affective haptic communication between two people (Lee et al. 2009) through a tangible rather than a virtual interface. Using these systems, people can not only exchange messages but also emotionally and physically feel the social presence of the communication partner (Tsetserukou and Neviarouskaya 2010). The above examples can be considered demonstrations of the potential devices and applications and the richness of social touch. Although it appears that virtual interfaces can effectively transmit emotion even with touch cues that are extremely degraded (e.g., a handshake that is lacking grip, temperature, dryness, and texture: Bailenson et al. 2007), the field lacks rigorous validation and systematic exploration of the critical parameters. The few exceptions are the work by Smith and MacLean (2007) and by Salminen et al. (2008). Smith and MacLean performed an extensive study into the possibilities and the design space of an interpersonal haptic link and concluded that emotion can indeed be communicated through this medium. Salminen et al. (2008) developed a friction-based horizontally rotating fingertip stimulator to investigate emotional experiences and behavioral responses to haptic stimulation and showed that people can rate these kind of stimuli as less or more unpleasant, arousing, avoidable, and dominating. Mediated Social Touch In the previous section, we showed that people communicate emotions through touch, and that inter-human touch can enhance wellbeing and modulate behavior. In interpersonal communication, we may use touch more frequently than we are aware of. Currently, interpersonal communication is often mediated and given the inherent human need for affective communication, mediated social interaction should preferably afford the same affective characteristics as face-to-face communication. However, despite the social richness of touch and its vital role in human social interaction, existing communication media still rely on vision and audition and do not support haptic interaction. For a more in-depth reflection on the general effects of mediated interpersonal communication, we refer to Konijn et al. (2008) and Ledbetter (2014). Tactile or kinesthetic interfaces in principle enable haptic communication between people who are physically apart, and may thus provide mediated social touch, with all the physical, emotional, and intellectual feedback it supplies (Cranny-Francis 2011). Recent experiments show that even simple forms of mediated touch have the ability to elicit a wide range of distinct affective feelings (Tsalamlal et al. 2014). This finding has stimulated the study and design of devices and systems that can communicate, elicit, enhance, or influence the emotional state of a human by means of mediated touch. Remote Collaboration Between Groups Collaborative virtual environments are increasingly used for distance education [e.g., Mikropoulos and Natsis (2011)], training simulations [e.g., Dev et al. (2007) and Flowers and Aggarwal (2014)], therapy treatments (Bohil et al. 2011), and for social interaction venues (McCall and Blascovich 2009). It has been shown that adding haptic feedback to the interaction between users of these environments significantly increases their perceived social presence (Basdogan et al. 2000; Sallnäs 2010). Another recent development is telepresence robots that enable users to physically interact with geographically remote persons and environments. Their ultimate goal is to provide users with the illusion of a physical presence in remote places. Telepresence robots combine physical and remote presence and have a wide range of potential social applications like remote embodied teleconferencing and teaching, visiting or monitoring elderly in care centers, and making patient rounds in medical facilities (Kristoffersson et al. 2013). To achieve an illusion of telepresence, the robot should be able to reciprocate the user’s behavior and to Remote Communication Between Partners Intimacy is of central importance in creating and maintaining strong emotional bonds. Humans have an important social and personal need to feel connected in order to maintain their interpersonal relationships (Kjeldskov et al. 2004). A large part of their interpersonal communication is emotional rather than factual (Kjeldskov et al. 2004). The vibration function on a mobile phone has been used to render emotional information for blind users (Réhman and Liu 2010) and a similar interface can convey emotional content in instant messaging (Shin et al. 2007). Also, a wide range of systems have been developed for the mediated representation of specific touch events between dyads such as kisses (Saadatian et al. 2014), hugs (Mueller et al. 2005; Cha et al. 2008; Teh et al. 2008; Gooch Frontiers in Digital Humanities | www.frontiersin.org 4 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI provide the user with real-time multisensory feedback. As far as we are aware of, systems including the sense of touch have not been described yet. provided by the user to the system, and closing the loop between these signals. Generating Social Touch Signals Lemmens et al. (2009) tested tactile jackets (and later blankets) to increase emotional experiences while watching movies and reported quite strong effects of well-designed vibration patterns. Dijk et al. (2013) developed a dance vest for deaf teenagers. This vest included an algorithm that translated music into vibration patterns presented through the vest. Although not generated by a social entity, experiencing music has a substantial emotional part as did the automatically generated vibration patterns. Beyond the scripted and one-way social touch cues employed in the examples above, human–computer interaction applications increasingly deploy intelligent agents to support the social aspects of the interaction (Nijholt 2014). Social agents are used to communicate, express, and perceive emotions, maintain social relationships, interpret natural cues, and develop social competencies (Fong et al. 2003; Li et al. 2011). Empathic communication in general may serve to establish and improve affective relations with social agents (Bickmore and Picard 2005), and may be considered as a fundamental requirement for social agents that are designed to function as social companions and therapists (Breazeal 2011). Initial studies have shown that human interaction with social robots can indeed have therapeutic value (Kanamori et al. 2003; Wada and Shibata 2007; Robinson et al. 2013). These agents typically use facial expressions, gesture, and speech to convey affective cues to the user. Social agents (either physically embodied as, e.g., robots or represented as on-screen virtual agents) may also use (mediated) touch technology to communicate with humans (Huisman et al. 2014a). In this case, the touch cue is not only mediated but also generated and interpreted by an electronic system instead of a human. The physical embodiment of robots gives them a direct capability to touch users, while avatars may use the technology designed for other HCI or mediated social touch applications to virtually touch their user. Several devices have been proposed that enable haptic interaction with virtual characters (Hossain et al. 2011; Rahman and El Saddik 2011; Huisman et al. 2014a). Only few studies investigated autonomous systems that touch users for affective or therapeutic purposes (Chen et al. 2011), or that use touch to communicate the affective state of artificial creatures to their users (Yohanan and MacLean 2012). Reactions to Mediated Touch at a Physiological, Behavioral, and Social Level Although the field generally lacks serious validation studies, there is mounting evidence that people use, experience, and react to direct and mediated social touch in similar ways Bailenson and Yee (2007), at the physiological, psychological, behavioral, and social level. At a physiological and psychological level, mediated affective touch on the forearm can reduce heart rate of participants that experienced a sad event (Cabibihan et al. 2012). Mediated touch affects the quality of a shared experience and increases the intimacy felt toward the other person (Takahashi et al. 2011). Stimulation of someone’s hand through mediated touch can modulate the quality of a remotely shared experience (e.g., the hilariousness of a movie) and increase sympathy for the communication partner (Takahashi et al. 2011). In a storytelling paradigm, participants experienced a significantly higher degree of connectedness with the storyteller when the speech was accompanied by remotely administered squeezes in the upper arm (Wang et al. 2012). Additional evidence for the potential effects of mediated touch are found in the fact that hugging a robot medium while talking increases affective feelings and attraction toward a conversation partner (Kuwamura et al. 2013; Nakanishi et al. 2013). Participants receiving tactile facial stimulation experienced a stranger receiving similar stimulation to be closer, more positive and more similar to themselves when they were provided with synchronous visual feedback (Paladino et al. 2010). At a behavioral level, the most important observation is that the effect of a mediated touch on people’s pro-social behavior is similar to that of a real touch. According to Haans and IJsselsteijn (2009a), a virtual Midas touch has effects in the same order of magnitude as a real Midas touch. At the social level, the use of mediated touch is only considered appropriate as a means of communication between people in close personal relationships (Rantala et al. 2013), and the mere fact that two people are willing to touch implies an element of trust and mutual understanding (Collier 1985). The interpretation of mediated touch depends on the type of interrelationship between sender and receiver (Rantala et al. 2013), similar to direct touch (Coan et al. 2006; Thompson and Hampton 2011) and like direct touch, mediated touch communication between strangers can cause discomfort (Smith and MacLean 2007). Recognizing and Interpreting Social Touch Signals Communication implies a two-way interaction and social robots and avatars should therefore not only be able to generate but also to recognize affectionate touches. For instance, robotic affective responses to touch may contribute to people’s quality of life (Cooney et al. 2014). Touch capability is not only “nice to have” but may even be a necessity: people expect social interaction with embodied social agents to the extent that physical embodiment without tactile interaction results in a negative appraisal of the robot (Lee et al. 2006). In a recent study on the suitability of social robots for the wellbeing of the elderly, all participants expressed their wish for the robot to feel pleasant to hold or stroke and to Social Touch Generated by ICT Systems The previous chapter dealt with devices that enable interpersonal social touch communication, i.e., a situation in which the touch signals are generated and interpreted by human users and only mediated through information and communication technology. One step beyond this is to include social touch in the communication between a user and a virtual entity. This implies three additional challenges: the generation of social touch signals from system to user, the interpretation of social touch signals Frontiers in Digital Humanities | www.frontiersin.org 5 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI respond to touch (Hutson et al. 2011). The well-known example of the pet seal Paro (Wada et al. 2010) shows how powerful a simple device can be in evoking social touches. Paro responds sec to being touched but does neither interpret social touch nor produce touch. Similar effects are reported for touching a humanoid robot on the shoulder: just being able to touch already significantly increases trust toward the robot (Dougherty and Scharfe 2011). Automatic recognition and interpretation of the affective content of human originated social touch is essential to support this interaction (Argall and Billard 2010). Different approaches to equipping robots with a sense of touch include covering them with an artificial skin that simulates the human somatosensory systems (Dahiya et al. 2010) or the use of fully embodied robots covered with a range of different (e.g., temperature, proximity, pressure) sensors (Stiehl et al. 2005). To fully capture a social touch requires sensors that go beyond those used in the more advanced area of haptics and that primarily involve discriminative touch (e.g., contact, pressure, resistance). At least sensors for temperature and soft, stroking touch should be included to capture important parameters of social touch. However, just equipping a system (robot, avatar, or interface) with touch sensors is not sufficient to enable affective haptic interaction. A system can only appreciate and respond to affective touch in a natural way when it is able (a) to determine where the touch was applied, (b) to assess what kind of tactile stimulation was applied, and (c) to appraise the affective quality of the touch (Nguyen et al. 2007). While video- and audio-based affect recognition have been widely investigated (Calvo and D’Mello 2010), there have only been a few studies on touch-based affect recognition. The results of these preliminary studies indicate that affect recognition based on tactile interaction between humans and robots is comparable to that between humans (Naya et al. 1999; Cooney et al. 2012; Altun and MacLean 2014; Jung et al. 2014; van Wingerden et al. 2014). Research on capturing emotions from touch input to a computer system (i.e., not in a social context) confirms the potential of the touch modality (Zacharatos et al. 2014). Several research groups worked on capturing emotions from traditional computer input devices like mouse and keyboard based on the assumption that a user’s emotional state affects the motor output system. A general finding is that typing speed correlates to valence with a decrease in typing speed for negative valence and increased speed for positive valence compared to typing speed in neutral emotional state (Tsihrintzis et al. 2008; Khanna and Sasikumar 2010). A more informative system includes the force pattern of the key strokes. Using this information, very high-accuracy rates (>90%) are reported (Lv et al. 2008) for categorizing six emotional states (neutral, anger, fear, happiness, sadness, and surprise). This technique requires force sensitive keyboards, which are not widely available. Touch screens are used by an increasing number of people and offer much richer interaction parameters than keystrokes such as scrolling, tapping, or stroking. Recent work by Gao et al. (2012) showed that in a particular game played on the iPod, touch inputs like stroke length, pressure, and speed were important features related to a participant’s verbal description of the emotional experience during the game. Using a linear SVM, classification performance reached 77% for four emotional classes Frontiers in Digital Humanities | www.frontiersin.org (excited, relaxed, frustrated, and bored), close to 90% for two levels of arousal, and close to 85% for two levels of valence. Closing the Loop A robot that has the ability to “feel,” “understand,” and “respond” to touch in a human-like way will be capable of more intuitive and meaningful interaction with humans. Currently, artificial entities that include touch capabilities either produce or interpret social touch, but not both. However, both are required to close the loop and come to real, bidirectional interaction. The latter may require strict adherence to, for instance, timing and immediacy; a handshake in which the partners are out-of-phase can be very awkward. And as Cranny-Francis (2011) states, violating the tactile regime may result in being rejected as alien and may seriously offend others. Reactions to Touching Robots and Avatars at a Physiological, Behavioral, and Social Level Although there are still very few studies in this field, and there has been hardly any real formal evaluation, the first results of touch interactions with artificial entities appear promising. For instance, people experience robots that interact by touch as less machinelike (Cramer et al. 2009). Yohanan and colleagues (Yohanan et al. 2005; Yohanan and MacLean 2012) designed several haptic creatures to study a robot’s communication of emotional state and concluded that participants experienced a broader range of affect when haptic renderings were applied. Basori et al. (2009) showed the feasibility of using vibration in combination with sound and facial expression in avatars to communicate emotion strength. Touch also assists in building a relationship with social actors: hand squeezes (delivered through an airbladder) can improve the relation with a virtual agent (Bickmore et al. 2010). Artificial hands equipped with synthetic skins can potentially replicate not only the biomechanical behavior but also the warmth (the “feel”) of the human hand (Cabibihan et al. 2009, 2010, 2011). Users perceived a higher degree of friendship and social presence when interacting with a zoomorphic social robot with a warmer skin (Park and Lee 2014). Recent experiments indicate that the warmth of a robotic hand mediating social touch contributed significantly to the feeling of social presence (Nakanishi et al. 2014) and holding a warm robot hand increased feelings of friendship and trust toward a robot (Nie et al. 2012). Kotranza and colleagues (Kotranza and Lok 2008; Kotranza et al. 2009) describe a virtual patient as a medical student’s training tool that is able to be touched and to touch back. These touchenabled virtual patients were treated more like real humans than virtual patients without touch capabilities (students expressed more empathy and used touch more frequently to comfort and reassure the virtual patient).The authors concluded that by adding haptic interaction to the virtual patient, the bandwidth of the student-virtual patient communication increases and approaches that of human–human communication. In a study on the interaction between toddlers and a small humanoid robot, Tanaka et al. (2007) found that social connectedness correlated with the amount of touch between the child and robot. In a study where participants were asked to brush off “dirt” from either virtual objects or virtual humans, they touched virtual humans with 6 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI less force than non-human objects, and they touched the face of a virtual human with less force than the torso, while male virtual humans were touched with more force than female virtual humans (Bailenson and Yee 2008). Huisman et al. (2014b) performed a study in which participants played a collaborative augmented reality game together with two virtual agents, visible in the same augmented reality space. During interaction, one of the virtual agents touched the user on the arm by means of a vibrotactile display. They found that the touching virtual agent was rated higher on affective adjectives than the non-touching agent. Finally, Nakagawa et al. (2011) created a situation in which a robot requested participants to perform a repetitive monotonous task. This request was accompanied by an active touch, a passive touch, or no touch. The result showed that the active touch increased people’s motivation to continue performing the monotonous task. This confirms the earlier finding of Haans and IJsselsteijn (2009a) that the effect of the virtual Midas touch is in the same order of magnitude as the real Midas touch effect. may stimulate the further development of mediated social touch devices. Another research topic is the presumed close link between social touch and emotions and the potential underlying neurophysiological mechanisms, i.e., the connection between social touch and the emotional brain. Multisensory and Contextual Cues The meaning and appreciation of touch critically depend on its context (Collier 1985; Camps et al. 2012), such as the relation between conversation partners (Burgoon et al. 1992; Thompson and Hampton 2011), the body location of the touch (Nguyen et al. 1975), and the communication partner’s culture (McDaniel and Andersen 1998). There is no one-to-one correspondence between a touch and its meaning (Jones and Yarbrough 1985). Hence, the touch channel should be coupled with other sensory channels to clarify its meaning (Wang and Quek 2010). An important research question is which multisensory and contextual cues are critical. Direct (i.e., unmediated) touch is usually a multisensory experience: during interpersonal touch, we typically experience not only tactile stimulation but also changes in warmth along with verbal and non-verbal visual, auditory, and olfactory signals. Nonverbal cues (when people both see, hear, feel, and possibly smell their interaction partner performing the touching) may render mediated haptic technology more transparent, thereby increasing perceived social presence and enhancing the convincingness or immediacy of social touch (Haans and IJsselsteijn 2009b, 2010). Also, since the sight of touch activates brain regions involved in somatosensory processing [Rolls (2010); even watching a videotaped version: Walker and McGlone (2015)], the addition of visual feedback may enhance the associated haptic experience. Another strong cue for physical presence is body warmth. In human social interaction, physical temperature also plays an important role in sending interpersonal warmth (trust) information. Thermal stimuli may therefore serve as a proxy for social presence and stimulate the establishment of social relationships (IJzerman and Semin 2010). In addition to these bottom-up, stimulus driven aspects, topdown factors like expectations/beliefs of the receiver should be accounted for (e.g., beliefs about the intent of the interaction partner, familiarity with the partner, affordances of a physically embodied agent, etc.) since they shape the perceived meaning of touch (Burgoon and Walther 1990; Gallace and Spence 2010; Suhonen et al. 2012b). Research Topics Mediated social touch is a relatively young field of research that has the potential to substantially enrich human–human and human–system interaction. Although it is still not clear to what extent mediated touch can reproduce real touch, converging evidence seems to show that mediated touch shares important effects with real touch. However, many studies have an anecdotal character without solid and/or generalizable conclusions and the key studies in this field have not been replicated yet. This does not necessarily mean that the results are erroneous but it indicates that the field has not matured enough and may suffer from a publication bias. We believe that we need advancements in the following four areas for the field to mature: building an overarching framework, developing social touch basic building blocks, improving current research methodologies, and solving specific ICT challenges. Framework The human skin in itself is a complex organ able to process many different stimulus dimensions such as pressure, vibration, stretch, and temperature (van Erp 2007). “Social touch” is what the brain makes of these stimulus characteristics (sensations) taking into account personality, previous experiences, social conventions, the context, the object or person providing the touch, and probably many more factors. The scientific domains involved in social touch each have interesting research questions and answering them helps the understanding of (real life or mediated) social touch. In addition, we need an overarching framework to link the results across disciplines, to foster multidisciplinary research, and to encourage the transition from exploratory research to hypothesis driven research. Social and Cultural Social touch has a strong (unwritten) etiquette (Cranny-Francis 2011). Important questions are how to develop a touch etiquette for mediated touch and for social agents that can touch (van Erp and Toet 2013), and how to incorporate social, cultural, and individual differences with respect to acceptance and meaning of a mediated or social agent’s touch. Individual differences may include gender, attitude toward robots, and technology and touch receptivity [the (dis-)liking of being touched, Bickmore et al. 2010]. An initial set of guidelines for this etiquette is given by van Erp and Toet (2013). In addition, we should consider possible ethical implications of the technology, ranging from affecting people’s behavior without them being aware of it to the threat of physical abuse “at a distance.” Neuroscience The recent finding that there exists a distinct somatotopic mapping between tactile sensations and different emotional feelings (Nummenmaa et al. 2013; Walker and McGlone 2015) suggests that it may also be of interest to determine a map of our responsiveness to interpersonal (mediated) touch across the skin surface (Gallace and Spence 2010). The availability of such a map Frontiers in Digital Humanities | www.frontiersin.org 7 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Social Touch Building Blocks Effect Measures Gallace and Spence (2010) noted that even the most advanced devices will not be able to deliver something that can approximate realistic interpersonal touch if we do not know exactly what needs to be communicated and how to communicate it. Our touch capabilities are very complex, and like mediated vision and audition, mediated touch will always be degraded compared to real touch. The question is how this degradation affects the effects aimed for. A priori, mediated haptic communication should closely resemble non-mediated communication in order to be intuitively processed without introducing ambiguity or increasing the cognitive load (Rantala et al. 2011). However, the results discussed in this paper [e.g., Bailenson et al. (2007), Smith and MacLean (2007), Haans and IJsselsteijn (2009a), Giannopoulos et al. (2011), and Rantala et al. (2013)] indicate that social touch is quite robust to degradations and it may not be necessary to mediate all physical parameters accurately or at all. However, it is currently not even clear how we can haptically represent valence and arousal, let alone that we have robust knowledge on which parameters of the rich and complex touch characteristics are crucial in relation to the intended effects. Ideally, we have a set of building blocks of social touch that can be applied and combined depending on the situation. Social touch can evoke effects at many different levels in the receiver: physiological, psychological, behavioral, and social, and it is likely that effects at these different levels also interact. For instance, (social) presence and emotions can reciprocally reinforce each other. Currently, a broad range of effect measures is applied, which makes it difficult to compare results, assess interactions between levels, and combine experimental results into an integrated perspective. This pleads for setting a uniform set of validated and standardized measures that covers the different levels and that is robust and sensitive to the hypothesized effects of social touch. This set could include basic physiological measures known to vary with emotional experience [e.g., heart rate variability and skin conductance; Hogervorst et al. 2014]; psychological and social measures reflecting trust, proximity, togetherness, and social presence (IJsselsteijn et al. 2003; Van Bel et al. 2008; van Bel et al. 2009), and behavioral measures, e.g., quantifying compliance and performance. Please note though that each set of measures will have its own pitfalls. For instance, see Brouwer et al. (2015) for a critical reflection on the use of neurophysiological measures to assess cognitive or mental state, and Bailenson and Yee (2008) on the use of self-report questionnaires. Specific ICT Challenges Enabling ICT mediated, generated, and/or interpreted social touch requires specific ICT knowledge and technology. We consider the following issues as most prominent. Methodology Not uncommon for research in the embryonic stage, mediated social touch research is going through a phase of haphazard, anecdotal studies demonstrating the concept and its’ potential. To mature, the field needs rigorous replication and methodological well-designed studies and protocols. The multidisciplinary nature of the field adds to the diversity in research approaches. Understanding Social Touches With a few exceptions, mediated social touch studies are restricted to producing a social touch and investigate its effects on a user. To use social touch in interaction means that the system should not only be able to generate social touches but also to receive and understand social touches provided by human users. Taken the richness of human touch into account, this is not trivial. We may currently not even have the necessary sensor suite to capture a social touch adequately, including parameters like sheer and tangential forces, compliance, temperature, skin stretch, etc. After adequate capturing, algorithms should determine the social appraisal of the touch. Currently, the first attempts to capture social touches with different emotional values on a single body location (e.g., the arm) and to use computer algorithms to classify them are undertaken (van Wingerden et al. 2014). Controlled Studies Only few studies have actually investigated mediated affect conveyance, and compared mediated with unmediated touch. Although it appears that mediated social touch can indeed to some extent convey emotions (Bailenson et al. 2007) and induce pro-social behavior [e.g., the Midas effect; Haans and IJsselsteijn (2009a)], it is still not known to what extent it can also elicit strong affective experiences (Haans and IJsselsteijn 2006) and how this all compares to real touch or other control conditions. Context Aware Computing and Social Signal Processing Protocols Previous studies on mediated haptic interpersonal communication mainly investigated the communication of deliberately performed (instructed) rather than naturally occurring emotions (Bailenson et al. 2007; Smith and MacLean 2007; Rantala et al. 2013). Although this protocol is very time efficient, it relies heavily on participants’ ability to spontaneously generate social touches with, for instance, a specific emotional value. This is comparable to the research domain of facial expression where often trained actors are used to produce expressions on demand. One may consider training people in producing social touches on demand or employ a protocol (scenario) that naturally evokes specific social signals rather than instruct naïve participants to produce them. Frontiers in Digital Humanities | www.frontiersin.org The meaning of a social touch is highly dependent on the accompanying verbal and non-verbal signals of the sender and the context in which the touch is applied. An ICT system involved in social touch interaction should take the relevant parameters into account, both in generating touch and in interpreting touch. To understand and manage social signals of a person, the system is communicating with is the main challenge in the – in itself relatively young – field of social signal processing (Vinciarelli et al. 2008). Context aware (Schilit et al. 1994) implies that the system can sense its environment and reason about it in the context of social touch. 8 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Current ICT advances like the embodiment of artificial entities, the development of advanced haptic and tactile display technologies and standards (van Erp et al. 2010, including initial guidelines for mediated social touch: van Erp and Toet 2013) enable the exploration of new ICT systems that employ this powerful communication option, for instance, to enhance communication between physically separated partners and increase trust in and compliance with artificial entities. There are two prerequisites to make these applications viable. First, inter-human social touch can be ICT mediated, and second, social touch can be ICT generated and understood, all without loss of effectiveness, efficiency, and user satisfaction. In this paper, we show that there is converging evidence that both prerequisites can be met. Mediated social touch shows effects at aforementioned levels, and these effects resemble those of a real touch, even if the mediated touch is severely degraded. We also report the first indications that a social touch can be generated by an artificial entity, although the evidence base is still small. Moreover, the first steps are taken to develop algorithms to automatically classify social touches produced by the user. Our review also shows that (mediated) social touch is an embryonic field relying for a large part on technology demonstrations with only a few systematic investigations. To advance the field, we believe the focus should be on the following four activities: developing an overarching framework (integrating neuroscience, computer science, and social and behavioral science), developing basic social touch building blocks (based on the critical social touch parameters), applying stricter research methodologies (use controlled studies, validated protocols, and standard effect measures), and realizing breakthroughs in ICT (classifying social touches, context aware computing, social signal processing, congruence, and enhancing touch cues). When we are successful in managing these challenges at the crossroads of ICT and psychology, we believe that (mediated) social touch can improve our wellbeing and quality of life, can bridge the gap between real and virtual (social) worlds, and can make artificial entities more human-like. Congruency in Time, Space, and Semantics As with most multimodal interactions, congruency of the signals in space, time, and meaning is of eminent importance. For instance, touches should be congruent with other (mediated) display modalities (visual, auditory, olfactory) to communicate the intended meaning. In addition, congruence in time and space between, for instance, a seen gesture and a resulting haptic sensation is required to support a common interaction metaphor based on real touch. It has been shown that combining mediated social touch with morphologically congruent imagery enhances perceived social presence, whereas incongruent imagery results in lower degrees of social presence (Haans and IJsselsteijn 2010). Especially in closed-loop interaction (e.g., when holding or shaking hands), signals that are out of sync may severely degrade the interaction, thus requiring (near) real-time processing of touch and other social signals and generation of adequate social touches in reaction. Enhancing Touch Cues Social touch seems robust to degradations and mediated touch does not need to replicate all physical parameters accurately. The flipside of degradation is enhancement. Future research should investigate to what extent the affective quality of the mediated touch signals can be enhanced by the addition of other communication channels or by controlling specific touch parameters. Touch parameters do not necessarily have to be mediated one-to-one, but, for instance, temperature and force profiles may be either amplified or attenuated. The additional options mediation can provide to social touch have not been explored yet. Conclusion Social touch is of eminent importance in inter-human social communication and grounded in specific neurophysiological processing channels. Social touch can have effects at many levels including physiological (heart rate and hormone levels), psychological (trust in others), and sociological (pro-social behavior toward others). In Proceedings of the International Conference on Computer Technology and Development (ICCTD ‘09), 416–420. Piscataway, NJ: IEEE Press. Bickmore, T.W., Fernando, R., Ring, L., and Schulman, D. 2010. Empathic touch by relational agents. IEEE Trans. Affect. Comput. 1: 60–71. doi:10.1109/T-AFFC. 2010.4 Bickmore, T.W., and Picard, R.W. 2005. Establishing and maintaining longterm human-computer relationships. ACM Trans. Comput. Hum. Interact. 12: 293–327. doi:10.1145/1067860.1067867 Bohil, C.J., Alicea, B., and Biocca, F.A. 2011. Virtual reality in neuroscience research and therapy. Nat. Rev. Neurosci. 12: 752–62. doi:10.1038/nrn3122 Bonanni, L., Vaucelle, C., Lieberman, J., and Zuckerman, O. 2006. TapTap: a haptic wearable for asynchronous distributed touch therapy. In Proceedings of the ACM Conference on Human Factors in Computing Systems CHI ‘06, 580–585. New York, NY: ACM. Breazeal, C. 2011. Social robots for health applications. In Proceedings of the IEEE 2011 Annual International Conference on Engineering in Medicine and Biology (EMBC), 5368–5371. Piscataway, NJ: IEEE. Brouwer, A.-M., Zander, T.O., van Erp, J.B.F., Korteling, J.E., and Bronkhorst, A.W. 2015. Using neurophysiological signals that reflect cognitive or affective state: six recommendations to avoid common pitfalls. Front. Neurosci. 9:136. doi:10.3389/fnins.2015.00136 Burgoon, J.K. 1991. Relational message interpretations of touch, conversational distance, and posture. J. Nonverbal Behav. 15:233–59. doi:10.1007/BF00986924 References Altun, K., and MacLean, K.E. 2014. Recognizing affect in human touch of a robot. Pattern Recognit. Lett. doi:10.1016/j.patrec.2014.10.016 App, B., McIntosh, D.N., Reed, C.L., and Hertenstein, M.J. 2011. Nonverbal channel use in communication of emotion: how may depend on why. Emotion 11: 603–17. doi:10.1037/a0023164 Argall, B.D., and Billard, A.G. 2010. A survey of tactile human-robot interactions. Rob. Auton. Syst. 58: 1159–76. doi:10.1016/j.robot.2010.07.002 Argyle, M. 1975. Bodily Communication. 2nd ed. London, UK: Methuen. Bailenson, J.N., and Yee, N. 2007. Virtual interpersonal touch and digital chameleons. J. Nonverbal Behav. 31: 225–42. doi:10.1007/s10919-007-0034-6 Bailenson, J.N., and Yee, N. 2008. Virtual interpersonal touch: haptic interaction and copresence in collaborative virtual environments. Multimed. Tools Appl. 37: 5–14. doi:10.1007/s11042-007-0171-2 Bailenson, J.N., Yee, N., Brave, S., Merget, D., and Koslow, D. 2007. Virtual interpersonal touch: expressing and recognizing emotions through haptic devices. Hum. Comput. Interact. 22: 325–53. doi:10.1080/07370020701493509 Basdogan, C., Ho, C.-H., Srinivasan, M.A., and Slater, M. 2000. An experimental study on the role of touch in shared virtual environments. ACM Trans. Comput. Hum. Interact. 7: 443–60. doi:10.1145/365058.365082 Basori, A.H., Bade, A., Sunar, M.S., Daman, D., and Saari, N. 2009. Haptic vibration for emotional expression of avatar to enhance the realism of virtual reality. Frontiers in Digital Humanities | www.frontiersin.org 9 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Burgoon, J.K., and Walther, J.B. 1990. Nonverbal expectancies and the evaluative consequences of violations. Hum. Comm. Res. 17: 232–65. doi:10.1111/j. 1468-2958.1990.tb00232.x Burgoon, J.K., Walther, J.B., and Baesler, E.J. 1992. Interpretations, evaluations, and consequences of interpersonal touch. Hum. Comm. Res. 19: 237–63. doi:10.1111/ j.1468-2958.1992.tb00301.x Bush, E. 2001. The use of human touch to improve the well-being of older adults: A holistic nursing intervention. J. Holist. Nurs. 19(3):256–270. doi:10.1177/ 089801010101900306 Cabibihan, J.-J., Ahmed, I., and Ge, S.S. 2011. Force and motion analyses of the human patting gesture for robotic social touching. In Proceedings of the 2011 IEEE 5th International Conference on Cybernetics and Intelligent Systems (CIS), 165–169. Piscataway, NJ: IEEE. Cabibihan, J.-J., Jegadeesan, R., Salehi, S., and Ge, S.S. 2010. Synthetic skins with humanlike warmth. In Social Robotics, Edited by S. Ge, H. Li, J.J. Cabibihan, and Y. Tan, 362–371. Berlin: Springer. Cabibihan, J.-J., Pradipta, R., Chew, Y., and Ge, S. 2009. Towards humanlike social touch for prosthetics and sociable robotics: Handshake experiments and finger phalange indentations. In Advances in Robotics, Edited by J.H. Kim, S. Ge, P. Vadakkepat, N. Jesse, A. Al Manum, K. Puthusserypady, et al., 73–79 Berlin: Springer. doi:10.1007/978-3-642-03983-6_11 Cabibihan, J.-J., Zheng, L., and Cher, C.K.T. 2012. Affective tele-touch. In Social Robotics, Edited by S. Ge, O. Khatib, J.J. Cabibihan, R. Simmons, and M.A. Williams, 348–356. Berlin: Springer. Calvo, R.A., and D’Mello, S. 2010. Affect detection: an interdisciplinary review of models, methods, and their applications. IEEE Trans. Affect. Comput. 1: 18–37. doi:10.1109/T-AFFC.2010.1 Camps, J., Tuteleers, C., Stouten, J., and Nelissen, J. 2012. A situational touch: how touch affects people’s decision behavior. Social Influence 8: 237–50. doi:10.1080/ 15534510.2012.719479 Cannon, W.B. 1927. The James-Lange theory of emotions: a critical examination and an alternative theory. Am. J. Psychol. 39: 106–24. doi:10.2307/1415404 Cha, J., Eid, M., Barghout, A., and Rahman, A.M. 2008. HugMe: an interpersonal haptic communication system. In IEEE International Workshop on Haptic Audio visual Environments and Games (HAVE 2008), 99–102. Piscataway, NJ: IEEE. Chang, S.O. 2001. The conceptual structure of physical touch in caring. J. Adv. Nurs. 33(6): 820–827. doi:10.1046/j.1365-2648.2001.01721.x Chatel-Goldman, J., Congedo, M., Jutten, C., and Schwartz, J.L. 2014. Touch increases autonomic coupling between romantic partners. Front. Behav. Neurosci. 8:95. doi:10.3389/fnbeh.2014.00095 Chen, T.L., King, C.-H., Thomaz, A.L., and Kemp, C.C. 2011. Touched by a robot: an investigation of subjective responses to robot-initiated touch. In Proceedings of the 6th International Conference on Human-Robot Interaction HRI ‘11, 457–464. New York, NY: ACM. Chung, K., Chiu, C., Xiao, X., and Chi, P.Y.P. 2009. Stress outsourced: a haptic social network via crowdsourcing. In CHI ‘09 Extended Abstracts on Human Factors in Computing Systems, Edited by D.R. Olsen, K. Hinckley, M. Ringel-Morris, S. Hudson and S. Greenberg, 2439–2448. New York, NY: ACM. doi:10.1145/ 1520340.1520346 Coan, J.A., Schaefer, H.S., and Davidson, R.J. 2006. Lending a hand: social regulation of the neural response to threat. Psychol. Sci. 17: 1032–9. doi:10.1111/j. 1467-9280.2006.01832.x Collier, G. 1985. Emotional Expression. Hillsdale, NJ: Lawrence Erlbaum Associates Inc. Cooney, M.D., Nishio, S., and Ishiguro, H. 2012. Recognizing affection for a touchbased interaction with a humanoid robot. In IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), 1420–1427. Piscataway, NJ: IEEE. Cooney, M.D., Nishio, S., and Ishiguro, H. 2014. Importance of touch for conveying affection in a multimodal interaction with a small humanoid robot. Int. J. Hum. Rob. 12(1): 1550002. doi:10.1142/S0219843615500024 Cooper, E.A., Garlick, J., Featherstone, E., Voon, V., Singer, T., Critchley, H.D., et al. 2014. You turn me cold: evidence for temperature contagion. PLoS One 9:e116126. doi:10.1371/journal.pone.0116126 Cramer, H., Kemper, N., Amin, A., Wielinga, B., and Evers, V. 2009. “Give me a hug”: the effects of touch and autonomy on people’s responses to embodied social agents. Comput. Anim. Virtual Worlds 20: 437–45. doi:10.1002/cav.317 Cranny-Francis, A. 2011. Semefulness: a social semiotics of touch. Soc. Semiotics 21: 463–81. doi:10.1080/10350330.2011.591993 Frontiers in Digital Humanities | www.frontiersin.org Crusco, A.H., and Wetzel, C.G. 1984. The midas touch: the effects of interpersonal touch on restaurant tipping. Pers. Soc. Psychol. B 10: 512–7. doi:10.1177/ 0146167284104003 Dahiya, R.S., Metta, G., Valle, M., and Sandini, G. 2010. Tactile sensing – from humans to humanoids. IEEE Trans. Rob. 26: 1–20. doi:10.1109/TRO.2009. 2033627 Damasio, A. 1999. The Feeling of What Happens: Body and Emotion in the Making of Consciousness. London, UK: Heinemann. Debrot, A., Schoebi, D., Perrez, M., and Horn, A.B. 2013. Touch as an interpersonal emotion regulation process in couples’ daily lives: the mediating role of psychological intimacy. Pers. Soc. Psychol. B 39: 1373–85. doi:10.1177/ 0146167213497592 Dev, P., Youngblood, P., Heinrichs, W.L., and Kusumoto, L. 2007. Virtual worlds and team training. Anesthesiol. Clin. 25: 321–36. doi:10.1016/j.anclin.2007.03. 001 Dijk, E.O., Nijholt, A., van Erp, J.B.F., Wolferen, G.V., and Kuyper, E. 2013. Audiotactile stimulation: a tool to improve health and well-being? Int. J. Auton. Adapt. Commun. Syst. 6: 305–23. doi:10.1504/IJAACS.2013.056818 Ditzen, B., Neumann, I.D., Bodenmann, G., von Dawans, B., Turner, R.A., Ehlert, U., et al. 2007. Effects of different kinds of couple interaction on cortisol and heart rate responses to stress in women. Psychoneuroendocrinology 32: 565–74. doi:10.1016/j.psyneuen.2007.03.011 Dolin, D.J., and Booth-Butterfield, M. 1993. Reach out and touch someone: analysis of nonverbal comforting responses. Commun. Q. 41: 383–93. doi:10.1080/ 01463379309369899 Dougherty, E., and Scharfe, H. 2011. Initial formation of trust: designing an interaction with geminoid-DK to promote a positive attitude for cooperation. In Social Robotics, Edited by B. Mutlu, C. Bartneck, J. Ham, V. Evers, and T. Kanda, 95–103. Berlin: Springer. Drescher, V.M., Gantt, W.H., and Whitehead, W.E. 1980. Heart rate response to touch. Psychosom. Med. 42: 559–65. doi:10.1097/00006842-198011000-00004 Eichhorn, E., Wettach, R., and Hornecker, E. 2008. A stroking device for spatially separated couples. In Proceedings of the 10th International Conference on Human Computer Interaction with Mobile Devices and Services Mobile HCI ‘08, 303–306. New York, NY: ACM. Ellingsen, D.M., Wessberg, J., Chelnokova, O., Olausson, H., Aeng, B., and Eknes, S. 2014. In touch with your emotions: oxytocin and touch change social impressions while others’ facial expressions can alter touch. Psychoneuroendocrinology 39: 11–20. doi:10.1016/j.psyneuen.2013.09.017 Field, T. 2010. Touch for socioemotional and physical well-being: a review. Dev. Rev. 30: 367–83. doi:10.1016/j.dr.2011.01.001 Fisher, J.D., Rytting, M., and Heslin, R. 1976. Hands touching hands: affective and evaluative effects of an interpersonal touch. Sociometry 39: 416–21. doi:10.2307/ 3033506 Flowers, M.G., and Aggarwal, R. 2014. Second LifeTM : a novel simulation platform for the training of surgical residents. Expert Rev. Med. Devices 11: 101–3. doi:10. 1586/17434440.2014.863706 Fong, T., Nourbakhsh, I., and Dautenhahn, K. 2003. A survey of socially interactive robots. Rob. Auton. Syst. 42: 143–66. doi:10.1016/S0921-8890(02) 00372-X Frumin, I., Perl, O., Endevelt-Shapira, Y., Eisen, A., Eshel, N., Heller, I., et al. 2015. A social chemosignaling function for human handshaking. Elife 4: e05154. doi:10.7554/eLife.05154 Furukawa, M., Kajimoto, H., and Tachi, S. 2012. KUSUGURI: a shared tactile interface for bidirectional tickling. In Proceedings of the 3rd Augmented Human International Conference AH ‘12, 1–8. New York, NY: ACM. Gallace, A., Ngo, M.K., Sulaitis, J., and Spence, C. 2012. Multisensory presence in virtual reality: possibilities & limitations. In Multiple Sensorial Media Advances and Applications: New Developments in MulSeMedia, Edited by G. Ghinea, F. Andres and S.R. Gulliver, 1–40. Vancouver, BC: IGI Global. Gallace, A., and Spence, C. 2010. The science of interpersonal touch: an overview. Neurosci. Biobehav. Rev. 34: 246–59. doi:10.1016/j.neubiorev.2008.10.004 Gao, Y., Bianchi-Berthouze, N., and Meng, H. 2012. What does touch tell us about emotions in touchscreen-based gameplay? ACM Trans. Comput. Hum. Interact. 19: 1–30. doi:10.1145/2395131.2395138 Giannopoulos, E., Wang, Z., Peer, A., Buss, M., and Slater, M. 2011. Comparison of people’s responses to real and virtual handshakes within a virtual environment. Brain Res. Bull. 85: 276–82. doi:10.1016/j.brainresbull.2010.11.012 10 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Gleeson, M., and Timmins, F. 2005. A review of the use and clinical effectiveness of touch as a nursing intervention. Clin. Effect. Nurs. 9: 69–77. doi:10.1016/j.cein. 2004.12.002 Gooch, D., and Watts, L. 2010. Communicating social presence through thermal hugs. In Proceedings of First Workshop on Social Interaction in Spatially Separated Environments (SISSI2010), Edited by F. Schmid, T. Hesselmann, S. Boll, K. Cheverst, and L. Kulik, 11–19. Copenhagen: International Society for Presence Research. Gooch, D., and Watts, L. 2012. Yourgloves, hothands and hotmits: devices to hold hands at a distance. In Proceedings of the 25th Annual ACM Symposium on User Interface Software and Technology UIST ‘12, 157–166. New York, NY: ACM. Gordon, I., Voos, A.C., Bennett, R.H., Bolling, D.Z., Pelphrey, K.A. and Kaiser, M.D. 2013. Brain mechanisms for processing affective touch. Hum. Brain Mapp. 34(4):914–922. doi:10.1002/hbm.21480 Gottlieb, G. 1971. Ontogenesis of sensory function in birds and mammals. In The Biopsychology of Development, Edited by E. Tobach, L.R. Aronson, and E. Shaw, 67–128. New York, NY: Academic Press. Grewen, K.M., Anderson, B.J., Girdler, S.S., and Light, K.C. 2003. Warm partner contact is related to lower cardiovascular reactivity. Behav. Med. 29: 123–30. doi:10.1080/08964280309596065 Guéguen, N. 2002. Touch, awraness of touch, and compliance with a request. Percept. Mot. Skills 95: 355–60. doi:10.2466/pms.2002.95.2.355 Guéguen, N. 2004. Nonverbal encouragement of participation in a course: the effect of touching. Soc. Psychol. Educ. 7: 89–98. doi:10.1023/B:SPOE.0000010691. 30834.14 Guéguen, N., and Fischer-Lokou, J. 2003. Tactile contact and spontaneous help: an evaluation in a natural setting. J. Soc. Psychol. 143: 785–7. doi:10.1080/ 00224540309600431 Guéguen, N., Meineri, S., and Charles-Sire, V. 2010. Improving medication adherence by using practitioner nonverbal techniques: a field experiment on the effect of touch. J. Behav. Med. 33: 466–73. doi:10.1007/s10865-010-9277-5 Haans, A., and IJsselsteijn, W.A. 2006. Mediated social touch: a review of current research and future directions. Virtual Reality 9: 149–59. doi:10.1007/ s10055-005-0014-2 Haans, A., and IJsselsteijn, W.A. (2009a). The virtual Midas Touch: helping behavior after a mediated social touch. IEEE Trans. Haptics 2: 136–40. doi:10.1109/TOH. 2009.20 Haans, A., and IJsselsteijn, W.A. (2009b). I’m always touched by your presence, dear: combining mediated social touch with morphologically correct visual feedback. In Proceedings of Presence 2009, 1–6. Los Angeles, CA: International Society for Presence Research. Haans, A., and IJsselsteijn, W.A. 2010. Combining mediated social touch with vision: from self-attribution to telepresence? In Proceedings of Special Symposium at EuroHaptics 2010: Haptic and Audio-Visual Stimuli: Enhancing Experiences and Interaction, Edited by A. Nijholt, E.O. Dijk, and P.M.C. Lemmens, 35–46 Enschede:University of Twente. Henricson, M., Ersson, A., Määttä, S., Segesten, K., and Berglund, A.L. 2008. The outcome of tactile touch on stress parameters in intensive care: A randomized controlled trial. Complement. Ther. Clin. Prac. 14(4): 244–254. Harlow, H.F., and Zimmermann, R.R. 1959. Affectional responses in the infant monkey; orphaned baby monkeys develop a strong and persistent attachment to inanimate surrogate mothers. Science 130: 421–32. doi:10.1126/science.130. 3373.421 Hertenstein, M.J., Holmes, R., McCullough, M., and Keltner, D. 2009. The communication of emotion via touch. Emotion 9: 566–73. doi:10.1037/a0016108 Hertenstein, M.J., Keltner, D., App, B., Bulleit, B.A., and Jaskolka, A.R. 2006. Touch communicates distinct emotions. Emotion 6: 528–33. doi:10.1037/1528-3542.6. 3.528 Hogervorst, M.A., Brouwer, A.-M., and van Erp, J.B.F. 2014. Combining and comparing EEG, peripheral physiology and eye-related measures for the assessment of mental workload. Front. Neurosci. 8:322. doi:10.3389/fnins.2014.00322 Hornik, J. 1992. Tactile stimulation and consumer response. J. Consum. Res. 19: 449–58. doi:10.1086/209314 Hossain, S.K.A., Rahman, A.S.M.M., and El Saddik, A. 2011. Measurements of multimodal approach to haptic interaction in second life interpersonal communication system. IEEE Trans. Instrum. Meas. 60: 3547–58. doi:10.1109/TIM. 2011.2161148 Huisman, G., Bruijnes, M., Kolkmeier, J., Jung, M.M., Darriba Frederiks, A., and Rybarczyk, Y. (2014a). Touching virtual agents: embodiment and mind. In Innovative and Creative Developments in Multimodal Interaction Systems, Edited Frontiers in Digital Humanities | www.frontiersin.org by Y. Rybarczyk, T. Cardoso, J. Rosas, and L. Camarinha-Matos, 114–138. Berlin: Springer. Huisman, G., Kolkmeier, J., and Heylen, D. (2014b). Simulated social touch in a collaborative game. In Haptics: Neuroscience, Devices, Modeling, and Applications, Edited by M. Auvray and C. Duriez, 248–256. Berlin: Springer. Huisman, G., Darriba Frederiks, A., Van Dijk, E.M.A.G., Kröse, B.J.A., and Heylen, D.K.J. 2013. Self touch to touch others: designing the tactile sleeve for social touch. In Online Proceedings of TEI’13. Available at: http://www.tei-conf.org/13/ sites/default/files/page-files/Huisman.pdf Hutson, S., Lim, S., Bentley, P.J., Bianchi-Berthouze, N., and Bowling, A. 2011. Investigating the suitability of social robots for the wellbeing of the elderly. In Affective Computing and Intelligent Interaction, Edited by S. D’Mello, A. Graesser, B. Schuller, and J.C. Martin, 578–587. Berlin: Springer. IJsselsteijn, W.A., van Baren, J., and van Lanen, F. 2003. Staying in touch: social presence and connectedness through synchronous and asynchronous communication media (Part III). In Human-Computer Interaction: Theory and Practice, Edited by C. Stephanidis and J. Jacko, 924–928. Boca Raton, FL: CRC Press. IJzerman, H., and Semin, G.R. 2009. The thermometer of social relations: mapping social proximity on temperature. Psychol. Sci. 20: 1214–20. doi:10.1111/j. 1467-9280.2009.02434.x IJzerman, H., and Semin, G.R. 2010. Temperature perceptions as a ground for social proximity. J. Exp. Soc. Psychol. 46: 867–73. doi:10.1016/j.jesp.2010.07.015 James, W. 1884. What is an emotion? Mind 9: 188–205. doi:10.1093/mind/os-IX. 34.188 Jones, S.E., and Yarbrough, A.E. 1985. A naturalistic study of the meanings of touch. Comm. Monogr. 52: 19–56. doi:10.1080/03637758509376094 Joule, R.V., and Guéguen, N. 2007. Touch, compliance, and awareness of tactile contact. Percept. Mot. Skills 104: 581–8. doi:10.2466/pms.104.2.581-588 Jung, M.M., Poppe, R., Poel, M., and Heylen, D.K.J. 2014. Touching the VOID – introducing CoST: corpus of social touch. In Proceedings of the 16th International Conference on Multimodal Interaction (ICMI ‘14), 120–127. New York, NY: ACM. Kanamori, M., Suzuki, M., Oshiro, H., Tanaka, M., Inoguchi, T., Takasugi, H., et al. 2003. Pilot study on improvement of quality of life among elderly using a pet-type robot. In Proceedings of the IEEE International Symposium on Computational Intelligence in Robotics and Automation, 107–112. Piscataway, NJ: IEEE. Khanna, P., and Sasikumar, M. 2010. Recognising emotions from keyboard stroke pattern. Int. J. Comput. Appl. 11: 1–5. doi:10.5120/1614-2170 Kjeldskov, J., Gibbs, M., Vetere, F., Howard, S., Pedell, S., Mecoles, K., et al. 2004. Using cultural probes to explore mediated intimacy. Australas J. Inf. Syst. 11. Available at: http://journal.acs.org.au/index.php/ajis/article/view/128 Kleinke, C.L. 1977. Compliance to requests made by gazing and touching experimenters in field settings. J. Exp. Soc. Psychol. 13: 218–23. doi:10.1016/ 0022-1031(77)90044-0 Knapp, M.L., and Hall, J.A. 2010. Nonverbal Communication in Human Interaction (7th ed.). Boston, MA: Wadsworth, CENGAGE Learning. Konijn, E.A., Utz, S., Tanis, M., and Barnes, S.B. 2008. Mediated Interpersonal Communication. New York, NY: Routledge. Kotranza, A., and Lok, B. 2008. Virtual human + tangible interface = mixed reality human: an initial exploration with a virtual breast exam patient. In Proceedings of the IEEE Virtual Reality Conference 2008 (VR ‘08), 99–106. Piscataway, NJ: IEEE. Kotranza, A., Lok, B., Deladisma, A., Pugh, C.M., and Lind, D.S. 2009. Mixed reality humans: evaluating behavior, usability, and acceptability. IEEE Trans. Vis. Comput. Graph. 15: 369–82. doi:10.1109/TVCG.2008.195 Kraus, M.W., Huang, C., and Keltner, D. 2010. Tactile communication, cooperation, and performance: an ethological study of the NBA. Emotion 10: 745–9. doi:10. 1037/a0019382 Kristoffersson, A., Coradeschi, S., and Loutfi, A. 2013. A review of mobile robotic telepresence. Adv. Hum. Comput. Int. 2013: 1–17. doi:10.1155/2013/ 902316 Kuwamura, K., Sakai, K., Minato, T., Nishio, S., and Ishiguro, H. 2013. Hugvie: a medium that fosters love. In The 22nd IEEE International Symposium on Robot and Human Interactive Communication, 70–75. Gyeongju: IEEE. Kvam, M.H. 1997. The effect of vibroacoustic therapy. Physiotherapy 83: 290–5. doi:10.1016/S0031-9406(05)66176-7 Ledbetter, A.M. 2014. The past and future of technology in interpersonal communication theory and research. Commun. Stud. 65: 456–9. doi:10.1080/10510974. 2014.927298 11 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Lee, J.K., Stiehl, W.D., Toscano, R.L., and Breazeal, C. 2009. Semi-autonomous robot avatar as a medium for family communication and education. Adv. Rob. 23: 1925–49. doi:10.1163/016918609X12518783330324 Lee, K.M., Jung, Y., Kim, J., and Kim, S.R. 2006. Are physically embodied social agents better than disembodied social agents? The effects of physical embodiment, tactile interaction, and people’s loneliness in human-robot interaction. Int. J. Hum. Comput. Stud. 64: 962–73. doi:10.1016/j.ijhcs.2006.05.002 Lemmens, P., Crompvoets, F., Brokken, D., van den Eerenbeemd, J., and de Vries, G.J. 2009. A body-conforming tactile jacket to enrich movie viewing. In EuroHaptics Conference, 2009 and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems. World Haptics 2009. Third Joint, 7–12. Piscataway, NJ: IEEE Press. Li, H., Cabibihan, J.-J., and Tan, Y. 2011. Towards an effective design of social robots. Int. J. Soc. Rob. 3: 333–5. doi:10.1007/s12369-011-0121-z Löken, L.S., Wessberg, J., Morrison, I., McGlone, F., and Olausson, H. 2009. Coding of pleasant touch by unmyelinated afferents in humans. Nat. Neurosci. 12(5): 547–548. doi:10.1038/nn.2312 Lv, H.-R., Lin, Z.-L., Yin, W.-J., and Dong, J. 2008. Emotion recognition based on pressure sensor keyboards. In IEEE International Conference on Multimedia and Expo 2008, 1089–1092. Piscataway, NJ: IEEE. Master, S.L., Eisenberger, N.I., Taylor, S.E., Naliboff, B.D., Shirinyan, D., and Lieberman, M.D. 2009. A picture’s worth: partner photographs reduce experimentally induced pain. Psychol. Sci. 20: 1316–8. doi:10.1111/j.1467-9280.2009.02444.x McCall, C., and Blascovich, J. 2009. How, when, and why to use digital experimental virtual environments to study social behavior. Soc. Pers. Psychol. Compass 3: 744–58. doi:10.1111/j.1751-9004.2009.00195.x McCance, R.A., and Otley, M. 1951. Course of the blood urea in newborn rats, pigs and kittens. J. Physiol. 113: 18–22. doi:10.1113/jphysiol.1951.sp004552 McDaniel, E., and Andersen, P.A. 1998. International patterns of interpersonal tactile communication: a field study. J. Nonverbal Behav. 22: 59–75. doi:10.1023/ A:1022952509743 McGlone, F., Wessberg, J., and Olausson, H. 2014. Discriminative and affective touch: sensing and feeling. Neuron 82: 737–55. doi:10.1016/j.neuron.2014. 05.001 Mehrabian, A. 1972. Nonverbal Communication. Chicago, IL: Aldine-Atherton. Mikropoulos, T.A., and Natsis, A. 2011. Educational virtual environments: a tenyear review of empirical research (1999-2009). Comput. Educ. 56: 769–80. doi:10. 1016/j.compedu.2010.10.020 Montagu, A. 1972. Touching: The Human Significance of the Skin. New York, NY: Harper & Row Publishers. Morrison, I., Löken, L., and Olausson, H. 2010. The skin as a social organ. Exp. Brain Res. 204: 305–14. doi:10.1007/s00221-009-2007-y Morrison, I., Björnsdotter, M., and Olausson, H. 2011. Vicarious responses to social touch in posterior insular cortex are tuned to pleasant caressing speeds. J. Neurosci. 31(26):9554–9562. Mueller, F., Vetere, F., Gibbs, M.R., Kjeldskov, J., Pedell, S., and Howard, S. 2005. Hug over a distance. In CHI ‘05 Extended Abstracts on Human Factors in Computing Systems, Edited by G. van der Veer and C. Gale, 1673–1676. New York, NY: ACM. doi:10.1145/1056808.1056994 Nakagawa, K., Shiomi, M., Shinozawa, K., Matsumura, R., Ishiguro, H., and Hagita, N. 2011. Effect of robot’s active touch on people’s motivation. In Proceedings of the 6th International Conference on Human-Robot Interaction HRI ‘11, 465–472. New York, NY: ACM. Nakanishi, H., Tanaka, K., and Wada, Y. 2014. Remote handshaking: touch enhances video-mediated social telepresence. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems CHI’14, 2143–2152. New York, NY: ACM. Nakanishi, J., Kuwamura, K., Minato, T., Nishio, S., and Ishiguro, H. 2013. Evoking affection for a communication partner by a robotic communication medium. In The First International Conference on Human-Agent Interaction (iHAI 2013), 1–8. Available at: http://hai-conference.net/ihai2013/proceedings/pdf/III-1-4.pdf Naya, F., Yamato, J., and Shinozawa, K. 1999. Recognizing human touching behaviors using a haptic interface for a pet-robot. In Conference Proceedings of the IEEE International Conference on Systems, Man, and Cybernetics (IEEE SMC ‘99), 1030–1034. Piscataway, NJ: IEEE. Nguyen, N., Wachsmuth, I., and Kopp, S. 2007. Touch perception and emotional appraisal for a virtual agent. In Proceedings of the 2nd Workshop Emotion and Computing-Current Research and Future Impact, Edited by D. Reichardt and P. Levi, 17–22. Stuttgart: Berufsakademie Stuttgart. Frontiers in Digital Humanities | www.frontiersin.org Nguyen, T., Heslin, R., and Nguyen, M.L. 1975. The meanings of touch: sex differences. J. Commun. 25: 92–103. doi:10.1111/j.1460-2466. 1975.tb00610.x Nie, J., Park, M., Marin, A.L., and Sundar, S.S. 2012. Can you hold my hand? Physical warmth in human-robot interaction. In Proceeedings of the 7th ACM/IEEE International Conference on Human-Robot Interaction (HRI), 201–202. Piscataway, NJ: IEEE. Nijholt, A. 2014. Breaking fresh ground in human-media interaction research. Front. ICT 1:4. doi:10.3389/fict.2014.00004 Nummenmaa, L., Glerean, E., Hari, R., and Hietanen, J.K. 2013. Bodily maps of emotions. Proc. Natl. Acad. Sci. U.S.A. 111: 646–51. doi:10.1073/pnas. 1321664111 Olausson, H.W., Cole, J., Vallbo, Å, McGlone, F., Elam, M., Krämer, H.H., et al. 2008. Unmyelinated tactile afferents have opposite effects on insular and somatosensory cortical processing. Neurosci. Lett. 436: 128–32. doi:10.1016/j.neulet.2008. 03.015 Paladino, M.P., Mazzurega, M., Pavani, F., and Schubert, T.W. 2010. Synchronous multisensory stimulation blurs self-other boundaries. Psychol. Sci. 21: 1202–7. doi:10.1177/0956797610379234 Park, E., and Lee, J. 2014. I am a warm robot: the effects of temperature in physical human – robot interaction. Robotica 32: 133–42. doi:10.1017/ S026357471300074X Park, Y.W., Bae, S.H., and Nam, T.J. 2012. How do Couples Use CheekTouch Over Phone Calls? New York, NY: ACM. 763–6. Park, Y.W., Hwang, S., and Nam, T.J. 2011. Poke: emotional touch delivery through an inflatable surface over interpersonal mobile communications. In Adjunct Proceedings of the 24th Annual ACM Symposium Adjunct on User Interface Software and Technology UIST ‘11, 61–62. New York, NY: ACM. Patrick, G. 1999. The effects of vibroacoustic music on symptom reduction. IEEE Eng. Med. Biol. Mag. 18: 97–100. doi:10.1109/51.752987 Phelan, J.E. 2009. Exploring the use of touch in the psychotherapeutic setting: a phenomenological review. Psychotherapy (Chic) 46: 97–111. doi:10.1037/a0014751 Prisby, R.D., Lafage-Proust, M.-H., Malaval, L., Belli, A., and Vico, L. 2008. Effects of whole body vibration on the skeleton and other organ systems in man and animal models: what we know and what we need to know. Ageing Res. Rev. 7: 319–29. doi:10.1016/j.arr.2008.07.004 Puhan, M.A., Suarez, A., Cascio, C.L., Zahn, A., Heitz, M., and Braendli, O. 2006. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ 332: 266–70. doi:10.1136/bmj.38705. 470590.55 Rahman, A.S.M.M., and El Saddik, A. 2011. HKiss: real world based haptic interaction with virtual 3D avatars. In Proceedings of the 2011 IEEE International Conference on Multimedia and Expo (ICME), 1–6. Piscataway, NJ: IEEE. Rantala, J., Raisamo, R., Lylykangas, J., Ahmaniemi, T., Raisamo, J., Rantala, J., et al. 2011. The role of gesture types and spatial feedback in haptic communication. IEEE Trans. Haptics 4: 295–306. doi:10.1109/TOH.2011.4 Rantala, J., Salminen, K., Raisamo, R., and Surakka, V. 2013. Touch gestures in communicating emotional intention via vibrotactile stimulation. Int. J. Hum. Comput. Stud. 7: 679–90. doi:10.1016/j.ijhcs.2013.02.004 Réhman, S., and Liu, L. 2010. iFeeling: vibrotactile rendering of human emotions on mobile phones. In Mobile Multimedia Processing, Edited by X. Jiang, M.Y. Ma, and C. Chen, 1–20. Berlin: Springer. Robinson, H., MacDonald, B., Kerse, N., and Broadbent, E. 2013. The psychosocial effects of a companion robot: a randomized controlled trial. J. Am. Med. Dir. Assoc. 14: 661–7. doi:10.1016/j.jamda.2013.02.007 Rolls, E.T. 2010. The affective and cognitive processing of touch, oral texture, and temperature in the brain. Neurosci. Biobehav. Rev. 34: 237–45. doi:10.1016/j. neubiorev.2008.03.010 Saadatian, E., Samani, H., Parsani, R., Pandey, A.V., Li, J., Tejada, L., et al. 2014. Mediating intimacy in long-distance relationships using kiss messaging. Int. J. Hum. Comput. Stud. 72: 736–46. doi:10.1016/j.ijhcs.2014.05.004 Sallnäs, E.L. 2010. Haptic feedback increases perceived social presence. In Haptics: Generating and Perceiving Tangible Sensations, Part II, Edited by A.M. Kappers, J.B. Erp, W.M. Bergmann Tiest, and F.C. Helm, 178–185. Berlin: Springer. Salminen, K., Surakka, V., Lylykangas, J., Raisamo, R., Saarinen, R., Raisamo, R., et al. 2008. Emotional and behavioral responses to haptic stimulation. In Proceeding of the Twenty-Sixth Annual SIGCHI Conference on Human Factors in Computing Systems, 1555–1562. New York, NY: ACM Press. 12 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Scheele, D., Kendrick, K.M., Khouri, C., Kretzer, E., Schläpfer, T.E., StoffelWagner, B., et al. 2014. An oxytocin-induced facilitation of neural and emotional responses to social touch correlates inversely with autism traits. Neuropsychopharmacology 39: 2078–85. doi:10.1038/npp.2014.78 Schilit, B., Adams, N., and Want, R. 1994. Context-aware computing applications. In First Workshop on Mobile Computing Systems and Applications (WMCSA 1994), 85–90. Piscataway, NJ: IEEE. Self, B.P., van Erp, J.B.F., Eriksson, L., and Elliott, L.R. 2008. Human factors issues of tactile displays for military environments. In Tactile Displays for Navigation, Orientation and Communication in Military Environments, Edited by J.B.F. van Erp and B.P. Self, 3. Neuillu-sur-Seine: NATO RTO. Shermer, M. 2004. A bounty of science. Sci. Am. 290: 33. doi:10.1038/ scientificamerican0204-33 Shin, H., Lee, J., Park, J., Kim, Y., Oh, H., and Lee, T. 2007. A tactile emotional interface for instant messenger chat. In Proceedings of the 2007 Conference on Human Interface, Edited by M.J. Smith and G. Salvendy, 166–175. Berlin: Springer. Smith, J., and MacLean, K. 2007. Communicating emotion through a haptic link: design space and methodology. Int. J. Hum. Comput. Stud. 65: 376–87. doi:10. 1016/j.ijhcs.2006.11.006 Solon, O. 2015. These sex tech toys will blow your mind. WIRED. Available at: http://www.wired.co.uk/news/archive/2014-06/27/sex-tech Stiehl, W.D., Lieberman, J., Breazeal, C., Basel, L., Lalla, L., and Wolf, M. 2005. Design of a therapeutic robotic companion for relational, affective touch. In IEEE International Workshop on Robot and Human Interactive Communication (ROMAN 2005), 408–415. Piscataway, NJ: IEEE. Suhonen, K., Müller, S., Rantala, J., Väänänen-Vainio-Mattila, K., Raisamo, R., and Lantz, V. (2012a). Haptically augmented remote speech communication: a study of user practices and experiences. In Proceedings of the 7th Nordic Conference on Human-Computer Interaction: Making Sense Through Design NordiCHI ‘12, 361–369. New York, NY: ACM. Suhonen, K., Väänänen-Vainio-Mattila, K., and Mäkelä, K. (2012b). User experiences and expectations of vibrotactile, thermal and squeeze feedback in interpersonal communication. In Proceedings of the 26th Annual BCS Interaction Specialist Group Conference on People and Computers BCS-HCI ‘12, 205–214. New York, NY: ACM. Suk, H.-J., Jeong, S.-H., Hang, T.-H., and Kwon, D.-S. 2009. Tactile sensation as emotion elicitor. Kansei Eng. Int. 8(2): 147–52. Takahashi, K., Mitsuhashi, H., Murata, K., Norieda, S., and Watanabe, K. 2011. Improving shared experiences by haptic telecommunication. In 2011 International Conference on Biometrics and Kansei Engineering (ICBAKE), 210–215. Los Alamitos, CA: IEEE. doi:10.1109/ICBAKE.2011.19 Tanaka, F., Cicourel, A., and Movellan, J.R. 2007. Socialization between toddlers and robots at an early childhood education center. Proc. Natl. Acad. Sci. U.S.A. 104: 17954–8. doi:10.1073/pnas.0707769104 Teh, J.K.S., Cheok, A.D., Peiris, R.L., Choi, Y., Thuong, V., and Lai, S. 2008. Huggy pajama: a mobile parent and child hugging communication system. In Proceedings of the 7th International Conference on Interaction Design and Children IDC ‘08, 250–257. New York, NY: ACM. Thompson, E.H., and Hampton, J.A. 2011. The effect of relationship status on communicating emotions through touch. Cognit. Emot. 25: 295–306. doi:10. 1080/02699931.2010.492957 Toet, A., van Erp, J.B.F., Petrignani, F.F., Dufrasnes, M.H., Sadhashivan, A., van Alphen, D., et al. 2013. Reach out and touch somebody’s virtual hand. Affectively connected through mediated touch. In Proceedings of the 2013 Humaine Association Conference on Affective Computing and Intelligent Interaction, 786–791. Piscataway, NJ: IEEE Computer Society. Tsalamlal, M.Y., Ouarti, N., Martin, J.C., and Ammi, M. 2014. Haptic communication of dimensions of emotions using air jet based tactile stimulation. J. Multimodal User Interfaces 9(1): 69–77. doi:10.1007/s12193-014 -0162-3 Tsetserukou, D. 2010. HaptiHug: a novel haptic display for communication of hug over a distance. In Haptics: Generating and Perceiving Tangible Sensations, Edited by A.M. Kappers, J.B. Erp, W.M. Bergmann Tiest, and F.C. Helm, 340–347. Berlin: Springer. Tsetserukou, D., and Neviarouskaya, A. 2010. Innovative real-time communication system with rich emotional and haptic channels. In Haptics: Generating and Frontiers in Digital Humanities | www.frontiersin.org Perceiving Tangible Sensations, Edited by A.M. Kappers, J.B. van Erp, W.M. Bergmann Tiest, and F.C. Helm, 306–313. Berlin: Springer. Tsihrintzis, G.A., Virvou, M., Alepis, E., and Stathopoulou, I.O. 2008. Towards improving visual-facial emotion recognition through use of complementary keyboard-stroke pattern information. In Fifth International Conference on Information Technology: New Generations (ITNG 2008), 32–37. Piscataway, NJ: IEEE. Uvnäs-Moberg, K. 1997. Physiological and endocrine effects of social contact. Ann. N. Y. Acad. Sci. 807: 146–63. doi:10.1111/j.1749-6632.1997.tb51917.x Vallbo, A., Olausson, H., Wessberg, J., and Norrsell, U. 1993. A system of unmyelinated afferents for innocuous mechanoreception in the human skin. Brain Res. 628: 301–4. doi:10.1016/0006-8993(93)90968-S Van Bel, D.T., IJsselsteijn, W.A., and de Kort, Y.A.W. 2008. Interpersonal connectedness: conceptualization and directions for a measurement instrument. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI’08), 3129–3134. New York, NY: ACM. van Bel, D.T., Smolders, K.C.H.J., IJsselsteijn, W.A., and de Kort, Y.A.W. 2009. Social connectedness: concept and measurement. In Proceedings of the 5th International Conference on Intelligent Environments, Edited by V. Callaghan, A. Kameas, A. Reyes, D. Royo, and M. Weber, 67–74. Amsterdam: IOS Press. van Erp, J.B.F. 2007. Tactile Displays for Navigation and Orientation: Perception and Behaviour. Utrecht: Utrecht University. van Erp, J.B.F. 2012. The ten rules of touch: guidelines for social agents and robots that can touch. In Proceedings of the 25th Annual Conference on Computer Animation and Social Agents (CASA 2012), Singapore: Nanayang Technological University. van Erp, J.B.F., Kyung, K.-U., Kassner, S., Carter, J., Brewster, S., Weber, G., et al. 2010. Setting the standards for haptic and tactile interactions: ISO’s work. In Haptics: Generating and Perceiving Tangible Sensations. Proceedings of Eurohaptics 2010, Edited by A.M.L. Kappers, J.B.F. van Erp, W.M. Bergmann Tiest, and F.C.T. van der Helm, 353–358. Heidelberg: Springer. van Erp, J.B.F., and Toet, A. 2013. How to touch humans. Guidelines for social agents and robots that can touch. In Proceedings of the 2013 Humaine Association Conference on Affective Computing and Intelligent Interaction, 780–785. Geneva:IEEE Computer Society. doi:10.1109/ACII.2013.77145 van Erp, J.B.F., and van Veen, H.A.H.C. 2004. Vibrotactile in-vehicle navigation system. Transp. Res. Part F Traffic Psychol. Behav. 7: 247–56. doi:10.1016/j.trf. 2004.09.003 van Wingerden, S., Uebbing, T.J., Jung, M.M., and Poel, M. 2014. A neural network based approach to social touch classification. In Proceedings of the 2014 Workshop on Emotion Representation and Modelling in Human-Computer-InteractionSystems (ERM4HCI ‘14), 7–12. New York, NY: ACM. Vinciarelli, A., Pantic, M., Bourlard, H., and Pentland, A. 2008. Social signal processing: state-of-the-art and future perspectives of an emerging domain. In Proceedings of the 16th ACM International Conference on Multimedia, 1061–1070. New York, NY: ACM. Vrontou, S., Wong, A.M., Rau, K.K., Koerber, H.R., and Anderson, D.J. 2013. Genetic identification of C fibres that detect massage-like stroking of hairy skin in vivo. Nature 493: 669–73. doi:10.1038/nature11810 Wada, K., Ikeda, Y., Inoue, K., and Uehara, R. 2010. Development and preliminary evaluation of a caregiver’s manual for robot therapy using the therapeutic seal robot Paro. In Proceedings of the IEEE International Workshop on Robot and Human Interactive Communication (RO-MAN 2010), 533–538. Piscataway, NJ: IEEE. Wada, K., and Shibata, T. 2007. Living with seal robots – its sociopsychological and physiological influences on the elderly at a care house. IEEE Trans. Rob. 23: 972–80. doi:10.1109/TRO.2007.906261 Walker, S.C., and McGlone, F.P. 2015. Perceived pleasantness of social touch reflects the anatomical distribution and velocity tuning of C-tactile afferents: an affective homunculus. In Program No. 339.14/HH22. 2014 Neuroscience Meeting Planner, Washington, DC: Society for Neuroscience. Wang, R., and Quek, F. 2010. Touch & talk: contextualizing remote touch for affective interaction. In Proceedings of the 4th International Conference on Tangible, Embedded, and Embodied Interaction (TEI ‘10), 13–20. New York, NY: ACM. Wang, R., Quek, F., Tatar, D., Teh, K.S., and Cheok, A.D. 2012. Keep in touch: channel, expectation and experience. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems CHI ‘12, 139–148. New York, NY: ACM. 13 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Whitcher, S.J., and Fisher, J.D. 1979. Multidimensional reaction to therapeutic touch in a hospital setting. J. Pers. Soc. Psychol. 37: 87–96. doi:10.1037/0022-3514.37. 1.87 Wigram, A.L. 1996. The Effects of Vibroacoustic Therapy on Clinical and NonClinical Populations. Ph.D. thesis, St. George’s Hospital Medical School, London University, London. Yohanan, S., Chan, M., Hopkins, J., Sun, H., and MacLean, K. 2005. Hapticat: exploration of affective touch. In Proceedings of the 7th International Conference on Multimodal Interfaces (ICMI ‘05), 222–229. New York, NY: ACM. Yohanan, S., and MacLean, K. 2012. The role of affective touch in human-robot interaction: human intent and expectations in touching the haptic creature. Int. J. Soc. Rob. 4: 163–80. doi:10.1007/s12369-011-0126-7 Frontiers in Digital Humanities | www.frontiersin.org Zacharatos, H., Gatzoulis, C., and Chrysanthou, Y.L. 2014. Automatic emotion recognition based on body movement analysis: a survey. IEEE CGA 34: 35–45. doi:10.1109/MCG.2014.106 Conflict of Interest Statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Copyright © 2015 van Erp and Toet. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. 14 May 2015 | Volume 2 | Article 2
|
Use only the document provided. If the question can not be answered then respond with 'I am unable to answer this request'
EVIDENCE:
REVIEW published: 27 May 2015 doi: 10.3389/fdigh.2015.00002 Social touch in human–computer interaction Jan B. F. van Erp 1,2 * and Alexander Toet 1 1 Perceptual and Cognitive Systems, TNO, Soesterberg, Netherlands, 2 Human Media Interaction, University of Twente, Enschede, Netherlands Edited by: Yoram Chisik, University of Madeira, Portugal Reviewed by: Mohamed Chetouani, Université Pierre et Marie Curie, France Gualtiero Volpe, Università degli Studi di Genova, Italy Hongying Meng, Brunel University London, UK *Correspondence: Jan B. F. van Erp, TNO Human Factors, Kampweg 5, Soesterberg 3769DE, Netherlands [email protected] Specialty section: This article was submitted to Human-Media Interaction, a section of the journal Frontiers in Digital Humanities Received: 06 February 2015 Paper pending published: 19 March 2015 Accepted: 08 May 2015 Published: 27 May 2015 Citation: van Erp JBF and Toet A (2015) Social touch in human–computer interaction. Front. Digit. Humanit. 2:2. doi: 10.3389/fdigh.2015.00002 Touch is our primary non-verbal communication channel for conveying intimate emotions and as such essential for our physical and emotional wellbeing. In our digital age, human social interaction is often mediated. However, even though there is increasing evidence that mediated touch affords affective communication, current communication systems (such as videoconferencing) still do not support communication through the sense of touch. As a result, mediated communication does not provide the intense affective experience of co-located communication. The need for ICT mediated or generated touch as an intuitive way of social communication is even further emphasized by the growing interest in the use of touch-enabled agents and robots for healthcare, teaching, and telepresence applications. Here, we review the important role of social touch in our daily life and the available evidence that affective touch can be mediated reliably between humans and between humans and digital agents. We base our observations on evidence from psychology, computer science, sociology, and neuroscience with focus on the first two. Our review shows that mediated affective touch can modulate physiological responses, increase trust and affection, help to establish bonds between humans and avatars or robots, and initiate pro-social behavior. We argue that ICT mediated or generated social touch can (a) intensify the perceived social presence of remote communication partners and (b) enable computer systems to more effectively convey affective information. However, this research field on the crossroads of ICT and psychology is still embryonic and we identify several topics that can help to mature the field in the following areas: establishing an overarching theoretical framework, employing better research methodologies, developing basic social touch building blocks, and solving specific ICT challenges. Keywords: affective touch, mediated touch, social touch, interpersonal touch, human–computer interaction, human–robot interaction, haptic, tactile Introduction Affective Touch in Interpersonal Communication The sense of touch is the earliest sense to develop in a human embryo (Gottlieb 1971) and is critical for mammals’ early social development and to grow up healthily (Harlow and Zimmermann 1959; Montagu 1972). The sense of touch is one of the first mediums of communication between newborns and parents. Interpersonal communication is to a large extent non-verbal and one of the primary purposes of non-verbal behavior is to communicate emotional states. Non-verbal communication includes facial expressions, prosody, gesture, and touch Frontiers in Digital Humanities | www.frontiersin.org 1 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI (Argyle 1975; Knapp and Hall 2010) of which touch is the primary modality for conveying intimate emotions (Field 2010; Morrison et al. 2010; App et al. 2011), for instance, in greetings, in corrections, and in (sexual) relationships. As touch implies direct physical interaction and co-location, it inherently has the potential to elicit feelings of social presence. The importance of touch as a modality in social communication is highlighted by the fact that the human skin has specific receptors to process affective touch (“the skin as a social organ”: Morrison et al. 2010) in addition to those for discriminative touch (Löken et al. 2009; Morrison et al. 2011; Gordon et al. 2013; McGlone et al. 2014), presumably like all mammals (Vrontou et al. 2013). ICT systems can employ human touch for information processing (discriminative touch) and communication (social touch) as well. Field (2010) and Gallace and Spence (2010)]. For these reasons, mediated interpersonal touch is our first topic of interest. Human–computer interaction applications increasingly deploy intelligent agents to support the social aspects of the interaction. Social agents (either embodied or virtual) already employ vision and audition to communicate social signals but generally lack touch capabilities. If we look at applications in robots and avatars, the first applications including touch facilitated information from user to system only, e.g., in the form of a touch screen or through specific touch sensors in a tangible interface. Social agents that can touch the user are of much more recent date. We believe that social agents could benefit from generating and perceiving social touch cues (van Erp 2012). Based on studies reviewed in this paper, we expect that people will feel a closer bond with agents or robots that use and respond to affective touch since they appear more human than machine-like and more trustworthy. Touch-enabled social agents are therefore our second topic of interest. Discriminative Touch in ICT Systems Conventional systems for human–computer interaction only occasionally employ the sense of touch and mainly provide information through vision and audition. One of the first large-scale applications of a tactile display was the vibration function on mobile phones, communicating the 1-bit message of an incoming call, and the number of systems that include the sense of touch has steadily increased over the past two decades. An important reason for the sparse use of touch is the supposed low bandwidth of the touch channel (Gallace et al. 2012). Although often underestimated, our touch sense is very well able to process large amounts of abstract information. For instance, blind people who are trained in Braille reading can actually read with their fingertips. This information processing capability is increasingly applied in our interaction with systems, and more complex information is being displayed, e.g., to reduce the risk of visual and auditory overload in car driving, to make us feel more immersed in virtual environments, or to realistically train and execute certain medical skills (van Erp and van Veen 2004; Self et al. 2008). Touch in Social Communication Social touch can take many forms in our daily lifes such as greetings (shaking hands, embracing, kissing, backslapping, and cheektweaking), in intimate communication (holding hands, cuddling, stroking, back scratching, massaging), and in corrections (punishment, spank on the bottom). Effects of social touch are apparent at many levels ranging from physiology to social behavior as we will discuss in the following sections. Social touches can elicit a range of strong experiences between pleasant and unpleasant, depending on among others the stimulus [e.g., unpleasant pinches evoking pain (nociception)] and location on the body (e.g., pleasant strokes in erogenous zones). In addition to touch in communication, touch can also be employed in psychotherapy (Phelan 2009) and nursing (Gleeson and Timmins 2005). Examples range from basic comforting touches and massaging to alternative therapies such as acu-pressure, Reiki, vibroacoustic therapy, and low-frequency vibration (Wigram 1996; Kvam 1997; Patrick 1999; Puhan et al. 2006; Prisby et al. 2008). See Dijk et al. (2013) for more examples on mental, healthrelated, and bodily effects of touch. In this paper, we focus on ICT mediated and generated social touch (the areas where psychology and computer science meet), meaning that areas of, for instance, Reiki and low-frequency vibration fall outside the scope of this paper. We first discuss the many roles of social touch in our daily life before continuing with ICT mediated inter-human touch and ICT generated and interpreted touch in human–agent interaction. In 1990s (Vallbo et al. 1993), the first reports on so-called C tactile afferents in human hairy skin were published. This neurophysiological channel in the skin reacts to soft, stroking touches, and its activity strongly depends on stroking speed (with an optimum in the speed range 3–10 cm/s) and has a high correlation with subjective ratings of the pleasantness of the touch. Research over the past decades has shown that this system is not involved in discriminative touch (Olausson et al. 2008) but underlies the emotional aspects of touch and the development and function of the social brain (McGlone et al. 2014). Social touches may activate both this pleasurable touch system and the discriminative touch Affective Touch in ICT Systems Incorporating the sense of touch in ICT systems started with discriminative touch as an information channel, often in addition to vision and audition (touch for information processing). We believe that we are on the averge of a second transition: adding social or affective touch to ICT systems (touch for social communication). In our digital era, an increasing amount of our social interactions is mediated, for example, through (cell) phones, video conferencing, text messaging, chat, or e-mail. Substituting direct contact, these modern technologies make it easy to stay in contact with distant friends and relatives, and they afford some degree of affective communication. For instance, an audio channel can transmit affective information through phonetic features like amplitude variation, pitch inflections, tempo, duration, filtration, tonality, or rhythm, while a video channel supports nonverbal information such as facial expressions and body gestures. However, current communication devices do not allow people to express their emotions through touch and may therefore lack a convincing experience of actual togetherness (social presence). This technology-induced touch deprivation may even degrade the potential beneficial effects of mediated social interaction [for reviews of the negative side effects of touch deprivation see Frontiers in Digital Humanities | www.frontiersin.org 2 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI system (reacting to, for instance, pressure, vibration, and skin stretch). caring, agreement, gratitude, and moral support. Cold feedback was consistently associated with negative issues. Touch, Physiological Functioning, and Wellbeing Touch to Communicate Emotions Hertenstein et al. (2006, 2009) showed that touch alone can effectively be used to convey distinct emotions such as anger, fear, and disgust. In addition, touch plays a role in communicating more complex social messages like trust, receptivity, affection (Mehrabian 1972; Burgoon 1991) and nurture, dependence, and affiliation (Argyle 1975). Touch can also enhance the meaning of other forms of verbal and non-verbal communication, e.g., touch amplifies the intensity of emotional displays from our face and voice (Knapp and Hall 2010). Examples of touches used to communicate emotions are shaking, pushing, and squeezing to communicate anger, hugging, patting, and stroking to communicate love (Gallace and Spence 2010). Jones and Yarbrough (1985) stated that a handshake, an encouraging pat on the back, a sensual caress, a nudge for attention, a tender kiss, or a gentle brush of the shoulder can all convey a vitality and immediacy that is at times far more powerful than language. According to App et al. (2011), touch is the preferred non-verbal communication channel for conveying intimate emotions like love and sympathy, confirmed by, for instance, Debrot et al. (2013) who showed that responsive touch between romantic partners enhances their affective state. McCance and Otley (1951) showed that licking and stroking of the mother animal is critical to start certain physiological processes in a new-born mammal. This indicates the direct link between skin stimulation and physiological processes, a link that is preserved later in life. For instance, gentle stroking touch can lower heart rate and blood pressure (Grewen et al. 2003), increase transient sympathetic reflexes and increase pain thresholds (Drescher et al. 1980; Uvnäs-Moberg 1997), and affect the secretion of stress hormones (Whitcher and Fisher 1979; Shermer 2004; Ditzen et al. 2007). Women holding their partner’s hand showed attenuated threat-related brain activity in response to mild electric shocks (Coan et al. 2006) and reported less pain in a cold pressor task (Master et al. 2009). Touch can also result in coupling or syncing of electrodermal activity of interacting (romantic) couples (ChatelGoldman et al. 2014). Interpersonal touch is the most commonly used method of comforting (Dolin and Booth-Butterfield 1993) and an instrument in nursing care (Bush 2001, Chang 2001, Henricson et al. 2008). For example, patients who were touched by a nurse during preoperative instructions experienced lower subjective and objective stress levels (Whitcher and Fisher 1979), than people who were not. In addition to touch affecting hormone levels, hormones (i.e., oxytocin) also affect the perception of interpersonal touch. Scheele et al. (2014) investigated the effect of oxytocin on the perception of a presumed male or female touch on male participants and found that oxytocin increased the rated pleasantness and brain activity of presumed female touches but not of male touches (all touches were delivered by the same female experimenter). Ellingsen et al. (2014) reported that after oxytocin submission, the effect of touch on the evaluation of facial expression increased. In addition, touch (handshaking in particular) can also play a role in social chemo-signaling. Handshaking can lead to the exchange of chemicals in sweat and behavioral data indicates that people more often sniff their hands after a greeting with a handshake than without a handshake (Frumin et al. 2015). Many social touches are reciprocal in nature (like cuddling and holding hands) and their dynamics rely on different mechanisms all having their own time scale: milliseconds for the detection of a touch (discriminative touch), hundreds of milliseconds and up for the experience of pleasurable touch, and seconds and up for physiological responses (including changes in hormone levels). How these processes interact and possibly reinforce each other is still terra incognita. Physiological responses can also be indirect, i.e., the result of social or empathetic mechanisms. Cooper et al. (2014) recently showed that the body temperature of people decreased when looking at a video of other people putting their hands in cold water. Another recent paradigm is to use thermal and haptically enhanced interpersonal speech communication. This showed that warm and cold signals were used to communicate the valence of messages (IJzerman and Semin 2009; Suhonen et al. 2012a). Warm messages were used to emphasize positive feelings and pleasant experiences, and to express empathy, comfort, closeness, Frontiers in Digital Humanities | www.frontiersin.org Touch to Elicit Emotions Not only can the sense of touch be used to communicate distinct emotions but also to elicit (Suk et al. 2009) and modulate human emotion. Please note that interpreting communicated emotions differs from eliciting emotions as the former may be considered as a cognitive task not resulting in physiological responses, e.g., one can perceive a touch as communicating anger without feeling angry. Starting with the James–Lange theory (James 1884; Cannon 1927; Damasio 1999), the conscious experience of emotion is the brain’s interpretation of physiological states. The existence of specific neurophysiological channels for affective touch and pain and the direct physiological reactions to touch indicate that there may be a direct link between tactile stimulation, physiological responses, and emotional experiences. Together with the distinct somatotopic mapping between bodily tactile sensations and different emotional feelings as found by Nummenmaa et al. (2013), one may assume that tactile stimulation of different bodily regions can elicit a wide range of emotions. Touch as a Behavior Modulator In addition to communicating and eliciting emotions, touch provides an effective means of influencing people’s attitudes toward persons, places, or services, their tendency to create bonds and their (pro-)social behaviors [see Gallace and Spence (2010) for an excellent overview]. This effect is referred to as the Midas touch: a brief, casual touch (often at the hand or arm) that is not necessarily consciously perceived named after king Midas from Greek mythology who had the ability to turn everything he touched into gold. For example, a half-second of hand-to-hand touch from a librarian fostered more favorable impressions of the library (Fisher et al. 1976), touching by a salesperson increased positive evaluations of the store (Hornik 1992), and touch can 3 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI also boost the attractiveness ratings of the toucher (Burgoon et al. 1992). Recipients of such “simple” Midas touches are also more likely to be more compliant or unselfish: willing to participate in a survey (Guéguen 2002) or to adhere to medication (Guéguen et al. 2010), volunteering for demonstrating in a course (Guéguen 2004), returning money left in a public phone (Kleinke 1977), spending more money in a shop (Hornik 1992), tipping more in a restaurant (Crusco and Wetzel 1984), helping with picking-up dropped items (Guéguen and Fischer-Lokou 2003), or giving away a cigarette (Joule and Guéguen 2007). In addition to these oneon-one examples, touch also plays a role in teams. For instance, physical touch enhances team performance of basketball players through building cooperation (Kraus et al. 2010). In clinical and professional situations, interpersonal touch can increase information flow and causes people to evaluate communication partners more favorably (Fisher et al. 1976). and Watts 2010; Tsetserukou 2010), pokes (Park et al. 2011), handholding (Gooch and Watts 2012; Toet et al. 2013), handshakes (Bailenson et al. 2007), strokes on the hand (Eichhorn et al. 2008), arm (Huisman et al. 2013) and cheek (Park et al. 2012), pinches, tickles (Furukawa et al. 2012), pats (Bonanni et al. 2006), squeezes (Rantala et al. 2013), thermal signals (Gooch and Watts 2010; Suhonen et al. 2012a,b), massages (Chung et al. 2009), and intimate sexual touches (Solon 2015). In addition to direct mediation, there is also an option to use indirect ways, for instance, through avatars in a virtual world. Devices like a haptic-jacket system can enhance the communication between users of virtual worlds such as Second Life by enabling the exchange of touch cues resembling encouraging pats and comforting hugs between users and their respective avatars (Hossain et al. 2011). The Huggable is a semi-autonomous robotic teddy bear equipped with somatic sensors, intended to facilitate affective haptic communication between two people (Lee et al. 2009) through a tangible rather than a virtual interface. Using these systems, people can not only exchange messages but also emotionally and physically feel the social presence of the communication partner (Tsetserukou and Neviarouskaya 2010). The above examples can be considered demonstrations of the potential devices and applications and the richness of social touch. Although it appears that virtual interfaces can effectively transmit emotion even with touch cues that are extremely degraded (e.g., a handshake that is lacking grip, temperature, dryness, and texture: Bailenson et al. 2007), the field lacks rigorous validation and systematic exploration of the critical parameters. The few exceptions are the work by Smith and MacLean (2007) and by Salminen et al. (2008). Smith and MacLean performed an extensive study into the possibilities and the design space of an interpersonal haptic link and concluded that emotion can indeed be communicated through this medium. Salminen et al. (2008) developed a friction-based horizontally rotating fingertip stimulator to investigate emotional experiences and behavioral responses to haptic stimulation and showed that people can rate these kind of stimuli as less or more unpleasant, arousing, avoidable, and dominating. Mediated Social Touch In the previous section, we showed that people communicate emotions through touch, and that inter-human touch can enhance wellbeing and modulate behavior. In interpersonal communication, we may use touch more frequently than we are aware of. Currently, interpersonal communication is often mediated and given the inherent human need for affective communication, mediated social interaction should preferably afford the same affective characteristics as face-to-face communication. However, despite the social richness of touch and its vital role in human social interaction, existing communication media still rely on vision and audition and do not support haptic interaction. For a more in-depth reflection on the general effects of mediated interpersonal communication, we refer to Konijn et al. (2008) and Ledbetter (2014). Tactile or kinesthetic interfaces in principle enable haptic communication between people who are physically apart, and may thus provide mediated social touch, with all the physical, emotional, and intellectual feedback it supplies (Cranny-Francis 2011). Recent experiments show that even simple forms of mediated touch have the ability to elicit a wide range of distinct affective feelings (Tsalamlal et al. 2014). This finding has stimulated the study and design of devices and systems that can communicate, elicit, enhance, or influence the emotional state of a human by means of mediated touch. Remote Collaboration Between Groups Collaborative virtual environments are increasingly used for distance education [e.g., Mikropoulos and Natsis (2011)], training simulations [e.g., Dev et al. (2007) and Flowers and Aggarwal (2014)], therapy treatments (Bohil et al. 2011), and for social interaction venues (McCall and Blascovich 2009). It has been shown that adding haptic feedback to the interaction between users of these environments significantly increases their perceived social presence (Basdogan et al. 2000; Sallnäs 2010). Another recent development is telepresence robots that enable users to physically interact with geographically remote persons and environments. Their ultimate goal is to provide users with the illusion of a physical presence in remote places. Telepresence robots combine physical and remote presence and have a wide range of potential social applications like remote embodied teleconferencing and teaching, visiting or monitoring elderly in care centers, and making patient rounds in medical facilities (Kristoffersson et al. 2013). To achieve an illusion of telepresence, the robot should be able to reciprocate the user’s behavior and to Remote Communication Between Partners Intimacy is of central importance in creating and maintaining strong emotional bonds. Humans have an important social and personal need to feel connected in order to maintain their interpersonal relationships (Kjeldskov et al. 2004). A large part of their interpersonal communication is emotional rather than factual (Kjeldskov et al. 2004). The vibration function on a mobile phone has been used to render emotional information for blind users (Réhman and Liu 2010) and a similar interface can convey emotional content in instant messaging (Shin et al. 2007). Also, a wide range of systems have been developed for the mediated representation of specific touch events between dyads such as kisses (Saadatian et al. 2014), hugs (Mueller et al. 2005; Cha et al. 2008; Teh et al. 2008; Gooch Frontiers in Digital Humanities | www.frontiersin.org 4 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI provide the user with real-time multisensory feedback. As far as we are aware of, systems including the sense of touch have not been described yet. provided by the user to the system, and closing the loop between these signals. Generating Social Touch Signals Lemmens et al. (2009) tested tactile jackets (and later blankets) to increase emotional experiences while watching movies and reported quite strong effects of well-designed vibration patterns. Dijk et al. (2013) developed a dance vest for deaf teenagers. This vest included an algorithm that translated music into vibration patterns presented through the vest. Although not generated by a social entity, experiencing music has a substantial emotional part as did the automatically generated vibration patterns. Beyond the scripted and one-way social touch cues employed in the examples above, human–computer interaction applications increasingly deploy intelligent agents to support the social aspects of the interaction (Nijholt 2014). Social agents are used to communicate, express, and perceive emotions, maintain social relationships, interpret natural cues, and develop social competencies (Fong et al. 2003; Li et al. 2011). Empathic communication in general may serve to establish and improve affective relations with social agents (Bickmore and Picard 2005), and may be considered as a fundamental requirement for social agents that are designed to function as social companions and therapists (Breazeal 2011). Initial studies have shown that human interaction with social robots can indeed have therapeutic value (Kanamori et al. 2003; Wada and Shibata 2007; Robinson et al. 2013). These agents typically use facial expressions, gesture, and speech to convey affective cues to the user. Social agents (either physically embodied as, e.g., robots or represented as on-screen virtual agents) may also use (mediated) touch technology to communicate with humans (Huisman et al. 2014a). In this case, the touch cue is not only mediated but also generated and interpreted by an electronic system instead of a human. The physical embodiment of robots gives them a direct capability to touch users, while avatars may use the technology designed for other HCI or mediated social touch applications to virtually touch their user. Several devices have been proposed that enable haptic interaction with virtual characters (Hossain et al. 2011; Rahman and El Saddik 2011; Huisman et al. 2014a). Only few studies investigated autonomous systems that touch users for affective or therapeutic purposes (Chen et al. 2011), or that use touch to communicate the affective state of artificial creatures to their users (Yohanan and MacLean 2012). Reactions to Mediated Touch at a Physiological, Behavioral, and Social Level Although the field generally lacks serious validation studies, there is mounting evidence that people use, experience, and react to direct and mediated social touch in similar ways Bailenson and Yee (2007), at the physiological, psychological, behavioral, and social level. At a physiological and psychological level, mediated affective touch on the forearm can reduce heart rate of participants that experienced a sad event (Cabibihan et al. 2012). Mediated touch affects the quality of a shared experience and increases the intimacy felt toward the other person (Takahashi et al. 2011). Stimulation of someone’s hand through mediated touch can modulate the quality of a remotely shared experience (e.g., the hilariousness of a movie) and increase sympathy for the communication partner (Takahashi et al. 2011). In a storytelling paradigm, participants experienced a significantly higher degree of connectedness with the storyteller when the speech was accompanied by remotely administered squeezes in the upper arm (Wang et al. 2012). Additional evidence for the potential effects of mediated touch are found in the fact that hugging a robot medium while talking increases affective feelings and attraction toward a conversation partner (Kuwamura et al. 2013; Nakanishi et al. 2013). Participants receiving tactile facial stimulation experienced a stranger receiving similar stimulation to be closer, more positive and more similar to themselves when they were provided with synchronous visual feedback (Paladino et al. 2010). At a behavioral level, the most important observation is that the effect of a mediated touch on people’s pro-social behavior is similar to that of a real touch. According to Haans and IJsselsteijn (2009a), a virtual Midas touch has effects in the same order of magnitude as a real Midas touch. At the social level, the use of mediated touch is only considered appropriate as a means of communication between people in close personal relationships (Rantala et al. 2013), and the mere fact that two people are willing to touch implies an element of trust and mutual understanding (Collier 1985). The interpretation of mediated touch depends on the type of interrelationship between sender and receiver (Rantala et al. 2013), similar to direct touch (Coan et al. 2006; Thompson and Hampton 2011) and like direct touch, mediated touch communication between strangers can cause discomfort (Smith and MacLean 2007). Recognizing and Interpreting Social Touch Signals Communication implies a two-way interaction and social robots and avatars should therefore not only be able to generate but also to recognize affectionate touches. For instance, robotic affective responses to touch may contribute to people’s quality of life (Cooney et al. 2014). Touch capability is not only “nice to have” but may even be a necessity: people expect social interaction with embodied social agents to the extent that physical embodiment without tactile interaction results in a negative appraisal of the robot (Lee et al. 2006). In a recent study on the suitability of social robots for the wellbeing of the elderly, all participants expressed their wish for the robot to feel pleasant to hold or stroke and to Social Touch Generated by ICT Systems The previous chapter dealt with devices that enable interpersonal social touch communication, i.e., a situation in which the touch signals are generated and interpreted by human users and only mediated through information and communication technology. One step beyond this is to include social touch in the communication between a user and a virtual entity. This implies three additional challenges: the generation of social touch signals from system to user, the interpretation of social touch signals Frontiers in Digital Humanities | www.frontiersin.org 5 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI respond to touch (Hutson et al. 2011). The well-known example of the pet seal Paro (Wada et al. 2010) shows how powerful a simple device can be in evoking social touches. Paro responds sec to being touched but does neither interpret social touch nor produce touch. Similar effects are reported for touching a humanoid robot on the shoulder: just being able to touch already significantly increases trust toward the robot (Dougherty and Scharfe 2011). Automatic recognition and interpretation of the affective content of human originated social touch is essential to support this interaction (Argall and Billard 2010). Different approaches to equipping robots with a sense of touch include covering them with an artificial skin that simulates the human somatosensory systems (Dahiya et al. 2010) or the use of fully embodied robots covered with a range of different (e.g., temperature, proximity, pressure) sensors (Stiehl et al. 2005). To fully capture a social touch requires sensors that go beyond those used in the more advanced area of haptics and that primarily involve discriminative touch (e.g., contact, pressure, resistance). At least sensors for temperature and soft, stroking touch should be included to capture important parameters of social touch. However, just equipping a system (robot, avatar, or interface) with touch sensors is not sufficient to enable affective haptic interaction. A system can only appreciate and respond to affective touch in a natural way when it is able (a) to determine where the touch was applied, (b) to assess what kind of tactile stimulation was applied, and (c) to appraise the affective quality of the touch (Nguyen et al. 2007). While video- and audio-based affect recognition have been widely investigated (Calvo and D’Mello 2010), there have only been a few studies on touch-based affect recognition. The results of these preliminary studies indicate that affect recognition based on tactile interaction between humans and robots is comparable to that between humans (Naya et al. 1999; Cooney et al. 2012; Altun and MacLean 2014; Jung et al. 2014; van Wingerden et al. 2014). Research on capturing emotions from touch input to a computer system (i.e., not in a social context) confirms the potential of the touch modality (Zacharatos et al. 2014). Several research groups worked on capturing emotions from traditional computer input devices like mouse and keyboard based on the assumption that a user’s emotional state affects the motor output system. A general finding is that typing speed correlates to valence with a decrease in typing speed for negative valence and increased speed for positive valence compared to typing speed in neutral emotional state (Tsihrintzis et al. 2008; Khanna and Sasikumar 2010). A more informative system includes the force pattern of the key strokes. Using this information, very high-accuracy rates (>90%) are reported (Lv et al. 2008) for categorizing six emotional states (neutral, anger, fear, happiness, sadness, and surprise). This technique requires force sensitive keyboards, which are not widely available. Touch screens are used by an increasing number of people and offer much richer interaction parameters than keystrokes such as scrolling, tapping, or stroking. Recent work by Gao et al. (2012) showed that in a particular game played on the iPod, touch inputs like stroke length, pressure, and speed were important features related to a participant’s verbal description of the emotional experience during the game. Using a linear SVM, classification performance reached 77% for four emotional classes Frontiers in Digital Humanities | www.frontiersin.org (excited, relaxed, frustrated, and bored), close to 90% for two levels of arousal, and close to 85% for two levels of valence. Closing the Loop A robot that has the ability to “feel,” “understand,” and “respond” to touch in a human-like way will be capable of more intuitive and meaningful interaction with humans. Currently, artificial entities that include touch capabilities either produce or interpret social touch, but not both. However, both are required to close the loop and come to real, bidirectional interaction. The latter may require strict adherence to, for instance, timing and immediacy; a handshake in which the partners are out-of-phase can be very awkward. And as Cranny-Francis (2011) states, violating the tactile regime may result in being rejected as alien and may seriously offend others. Reactions to Touching Robots and Avatars at a Physiological, Behavioral, and Social Level Although there are still very few studies in this field, and there has been hardly any real formal evaluation, the first results of touch interactions with artificial entities appear promising. For instance, people experience robots that interact by touch as less machinelike (Cramer et al. 2009). Yohanan and colleagues (Yohanan et al. 2005; Yohanan and MacLean 2012) designed several haptic creatures to study a robot’s communication of emotional state and concluded that participants experienced a broader range of affect when haptic renderings were applied. Basori et al. (2009) showed the feasibility of using vibration in combination with sound and facial expression in avatars to communicate emotion strength. Touch also assists in building a relationship with social actors: hand squeezes (delivered through an airbladder) can improve the relation with a virtual agent (Bickmore et al. 2010). Artificial hands equipped with synthetic skins can potentially replicate not only the biomechanical behavior but also the warmth (the “feel”) of the human hand (Cabibihan et al. 2009, 2010, 2011). Users perceived a higher degree of friendship and social presence when interacting with a zoomorphic social robot with a warmer skin (Park and Lee 2014). Recent experiments indicate that the warmth of a robotic hand mediating social touch contributed significantly to the feeling of social presence (Nakanishi et al. 2014) and holding a warm robot hand increased feelings of friendship and trust toward a robot (Nie et al. 2012). Kotranza and colleagues (Kotranza and Lok 2008; Kotranza et al. 2009) describe a virtual patient as a medical student’s training tool that is able to be touched and to touch back. These touchenabled virtual patients were treated more like real humans than virtual patients without touch capabilities (students expressed more empathy and used touch more frequently to comfort and reassure the virtual patient).The authors concluded that by adding haptic interaction to the virtual patient, the bandwidth of the student-virtual patient communication increases and approaches that of human–human communication. In a study on the interaction between toddlers and a small humanoid robot, Tanaka et al. (2007) found that social connectedness correlated with the amount of touch between the child and robot. In a study where participants were asked to brush off “dirt” from either virtual objects or virtual humans, they touched virtual humans with 6 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI less force than non-human objects, and they touched the face of a virtual human with less force than the torso, while male virtual humans were touched with more force than female virtual humans (Bailenson and Yee 2008). Huisman et al. (2014b) performed a study in which participants played a collaborative augmented reality game together with two virtual agents, visible in the same augmented reality space. During interaction, one of the virtual agents touched the user on the arm by means of a vibrotactile display. They found that the touching virtual agent was rated higher on affective adjectives than the non-touching agent. Finally, Nakagawa et al. (2011) created a situation in which a robot requested participants to perform a repetitive monotonous task. This request was accompanied by an active touch, a passive touch, or no touch. The result showed that the active touch increased people’s motivation to continue performing the monotonous task. This confirms the earlier finding of Haans and IJsselsteijn (2009a) that the effect of the virtual Midas touch is in the same order of magnitude as the real Midas touch effect. may stimulate the further development of mediated social touch devices. Another research topic is the presumed close link between social touch and emotions and the potential underlying neurophysiological mechanisms, i.e., the connection between social touch and the emotional brain. Multisensory and Contextual Cues The meaning and appreciation of touch critically depend on its context (Collier 1985; Camps et al. 2012), such as the relation between conversation partners (Burgoon et al. 1992; Thompson and Hampton 2011), the body location of the touch (Nguyen et al. 1975), and the communication partner’s culture (McDaniel and Andersen 1998). There is no one-to-one correspondence between a touch and its meaning (Jones and Yarbrough 1985). Hence, the touch channel should be coupled with other sensory channels to clarify its meaning (Wang and Quek 2010). An important research question is which multisensory and contextual cues are critical. Direct (i.e., unmediated) touch is usually a multisensory experience: during interpersonal touch, we typically experience not only tactile stimulation but also changes in warmth along with verbal and non-verbal visual, auditory, and olfactory signals. Nonverbal cues (when people both see, hear, feel, and possibly smell their interaction partner performing the touching) may render mediated haptic technology more transparent, thereby increasing perceived social presence and enhancing the convincingness or immediacy of social touch (Haans and IJsselsteijn 2009b, 2010). Also, since the sight of touch activates brain regions involved in somatosensory processing [Rolls (2010); even watching a videotaped version: Walker and McGlone (2015)], the addition of visual feedback may enhance the associated haptic experience. Another strong cue for physical presence is body warmth. In human social interaction, physical temperature also plays an important role in sending interpersonal warmth (trust) information. Thermal stimuli may therefore serve as a proxy for social presence and stimulate the establishment of social relationships (IJzerman and Semin 2010). In addition to these bottom-up, stimulus driven aspects, topdown factors like expectations/beliefs of the receiver should be accounted for (e.g., beliefs about the intent of the interaction partner, familiarity with the partner, affordances of a physically embodied agent, etc.) since they shape the perceived meaning of touch (Burgoon and Walther 1990; Gallace and Spence 2010; Suhonen et al. 2012b). Research Topics Mediated social touch is a relatively young field of research that has the potential to substantially enrich human–human and human–system interaction. Although it is still not clear to what extent mediated touch can reproduce real touch, converging evidence seems to show that mediated touch shares important effects with real touch. However, many studies have an anecdotal character without solid and/or generalizable conclusions and the key studies in this field have not been replicated yet. This does not necessarily mean that the results are erroneous but it indicates that the field has not matured enough and may suffer from a publication bias. We believe that we need advancements in the following four areas for the field to mature: building an overarching framework, developing social touch basic building blocks, improving current research methodologies, and solving specific ICT challenges. Framework The human skin in itself is a complex organ able to process many different stimulus dimensions such as pressure, vibration, stretch, and temperature (van Erp 2007). “Social touch” is what the brain makes of these stimulus characteristics (sensations) taking into account personality, previous experiences, social conventions, the context, the object or person providing the touch, and probably many more factors. The scientific domains involved in social touch each have interesting research questions and answering them helps the understanding of (real life or mediated) social touch. In addition, we need an overarching framework to link the results across disciplines, to foster multidisciplinary research, and to encourage the transition from exploratory research to hypothesis driven research. Social and Cultural Social touch has a strong (unwritten) etiquette (Cranny-Francis 2011). Important questions are how to develop a touch etiquette for mediated touch and for social agents that can touch (van Erp and Toet 2013), and how to incorporate social, cultural, and individual differences with respect to acceptance and meaning of a mediated or social agent’s touch. Individual differences may include gender, attitude toward robots, and technology and touch receptivity [the (dis-)liking of being touched, Bickmore et al. 2010]. An initial set of guidelines for this etiquette is given by van Erp and Toet (2013). In addition, we should consider possible ethical implications of the technology, ranging from affecting people’s behavior without them being aware of it to the threat of physical abuse “at a distance.” Neuroscience The recent finding that there exists a distinct somatotopic mapping between tactile sensations and different emotional feelings (Nummenmaa et al. 2013; Walker and McGlone 2015) suggests that it may also be of interest to determine a map of our responsiveness to interpersonal (mediated) touch across the skin surface (Gallace and Spence 2010). The availability of such a map Frontiers in Digital Humanities | www.frontiersin.org 7 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Social Touch Building Blocks Effect Measures Gallace and Spence (2010) noted that even the most advanced devices will not be able to deliver something that can approximate realistic interpersonal touch if we do not know exactly what needs to be communicated and how to communicate it. Our touch capabilities are very complex, and like mediated vision and audition, mediated touch will always be degraded compared to real touch. The question is how this degradation affects the effects aimed for. A priori, mediated haptic communication should closely resemble non-mediated communication in order to be intuitively processed without introducing ambiguity or increasing the cognitive load (Rantala et al. 2011). However, the results discussed in this paper [e.g., Bailenson et al. (2007), Smith and MacLean (2007), Haans and IJsselsteijn (2009a), Giannopoulos et al. (2011), and Rantala et al. (2013)] indicate that social touch is quite robust to degradations and it may not be necessary to mediate all physical parameters accurately or at all. However, it is currently not even clear how we can haptically represent valence and arousal, let alone that we have robust knowledge on which parameters of the rich and complex touch characteristics are crucial in relation to the intended effects. Ideally, we have a set of building blocks of social touch that can be applied and combined depending on the situation. Social touch can evoke effects at many different levels in the receiver: physiological, psychological, behavioral, and social, and it is likely that effects at these different levels also interact. For instance, (social) presence and emotions can reciprocally reinforce each other. Currently, a broad range of effect measures is applied, which makes it difficult to compare results, assess interactions between levels, and combine experimental results into an integrated perspective. This pleads for setting a uniform set of validated and standardized measures that covers the different levels and that is robust and sensitive to the hypothesized effects of social touch. This set could include basic physiological measures known to vary with emotional experience [e.g., heart rate variability and skin conductance; Hogervorst et al. 2014]; psychological and social measures reflecting trust, proximity, togetherness, and social presence (IJsselsteijn et al. 2003; Van Bel et al. 2008; van Bel et al. 2009), and behavioral measures, e.g., quantifying compliance and performance. Please note though that each set of measures will have its own pitfalls. For instance, see Brouwer et al. (2015) for a critical reflection on the use of neurophysiological measures to assess cognitive or mental state, and Bailenson and Yee (2008) on the use of self-report questionnaires. Specific ICT Challenges Enabling ICT mediated, generated, and/or interpreted social touch requires specific ICT knowledge and technology. We consider the following issues as most prominent. Methodology Not uncommon for research in the embryonic stage, mediated social touch research is going through a phase of haphazard, anecdotal studies demonstrating the concept and its’ potential. To mature, the field needs rigorous replication and methodological well-designed studies and protocols. The multidisciplinary nature of the field adds to the diversity in research approaches. Understanding Social Touches With a few exceptions, mediated social touch studies are restricted to producing a social touch and investigate its effects on a user. To use social touch in interaction means that the system should not only be able to generate social touches but also to receive and understand social touches provided by human users. Taken the richness of human touch into account, this is not trivial. We may currently not even have the necessary sensor suite to capture a social touch adequately, including parameters like sheer and tangential forces, compliance, temperature, skin stretch, etc. After adequate capturing, algorithms should determine the social appraisal of the touch. Currently, the first attempts to capture social touches with different emotional values on a single body location (e.g., the arm) and to use computer algorithms to classify them are undertaken (van Wingerden et al. 2014). Controlled Studies Only few studies have actually investigated mediated affect conveyance, and compared mediated with unmediated touch. Although it appears that mediated social touch can indeed to some extent convey emotions (Bailenson et al. 2007) and induce pro-social behavior [e.g., the Midas effect; Haans and IJsselsteijn (2009a)], it is still not known to what extent it can also elicit strong affective experiences (Haans and IJsselsteijn 2006) and how this all compares to real touch or other control conditions. Context Aware Computing and Social Signal Processing Protocols Previous studies on mediated haptic interpersonal communication mainly investigated the communication of deliberately performed (instructed) rather than naturally occurring emotions (Bailenson et al. 2007; Smith and MacLean 2007; Rantala et al. 2013). Although this protocol is very time efficient, it relies heavily on participants’ ability to spontaneously generate social touches with, for instance, a specific emotional value. This is comparable to the research domain of facial expression where often trained actors are used to produce expressions on demand. One may consider training people in producing social touches on demand or employ a protocol (scenario) that naturally evokes specific social signals rather than instruct naïve participants to produce them. Frontiers in Digital Humanities | www.frontiersin.org The meaning of a social touch is highly dependent on the accompanying verbal and non-verbal signals of the sender and the context in which the touch is applied. An ICT system involved in social touch interaction should take the relevant parameters into account, both in generating touch and in interpreting touch. To understand and manage social signals of a person, the system is communicating with is the main challenge in the – in itself relatively young – field of social signal processing (Vinciarelli et al. 2008). Context aware (Schilit et al. 1994) implies that the system can sense its environment and reason about it in the context of social touch. 8 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Current ICT advances like the embodiment of artificial entities, the development of advanced haptic and tactile display technologies and standards (van Erp et al. 2010, including initial guidelines for mediated social touch: van Erp and Toet 2013) enable the exploration of new ICT systems that employ this powerful communication option, for instance, to enhance communication between physically separated partners and increase trust in and compliance with artificial entities. There are two prerequisites to make these applications viable. First, inter-human social touch can be ICT mediated, and second, social touch can be ICT generated and understood, all without loss of effectiveness, efficiency, and user satisfaction. In this paper, we show that there is converging evidence that both prerequisites can be met. Mediated social touch shows effects at aforementioned levels, and these effects resemble those of a real touch, even if the mediated touch is severely degraded. We also report the first indications that a social touch can be generated by an artificial entity, although the evidence base is still small. Moreover, the first steps are taken to develop algorithms to automatically classify social touches produced by the user. Our review also shows that (mediated) social touch is an embryonic field relying for a large part on technology demonstrations with only a few systematic investigations. To advance the field, we believe the focus should be on the following four activities: developing an overarching framework (integrating neuroscience, computer science, and social and behavioral science), developing basic social touch building blocks (based on the critical social touch parameters), applying stricter research methodologies (use controlled studies, validated protocols, and standard effect measures), and realizing breakthroughs in ICT (classifying social touches, context aware computing, social signal processing, congruence, and enhancing touch cues). When we are successful in managing these challenges at the crossroads of ICT and psychology, we believe that (mediated) social touch can improve our wellbeing and quality of life, can bridge the gap between real and virtual (social) worlds, and can make artificial entities more human-like. Congruency in Time, Space, and Semantics As with most multimodal interactions, congruency of the signals in space, time, and meaning is of eminent importance. For instance, touches should be congruent with other (mediated) display modalities (visual, auditory, olfactory) to communicate the intended meaning. In addition, congruence in time and space between, for instance, a seen gesture and a resulting haptic sensation is required to support a common interaction metaphor based on real touch. It has been shown that combining mediated social touch with morphologically congruent imagery enhances perceived social presence, whereas incongruent imagery results in lower degrees of social presence (Haans and IJsselsteijn 2010). Especially in closed-loop interaction (e.g., when holding or shaking hands), signals that are out of sync may severely degrade the interaction, thus requiring (near) real-time processing of touch and other social signals and generation of adequate social touches in reaction. Enhancing Touch Cues Social touch seems robust to degradations and mediated touch does not need to replicate all physical parameters accurately. The flipside of degradation is enhancement. Future research should investigate to what extent the affective quality of the mediated touch signals can be enhanced by the addition of other communication channels or by controlling specific touch parameters. Touch parameters do not necessarily have to be mediated one-to-one, but, for instance, temperature and force profiles may be either amplified or attenuated. The additional options mediation can provide to social touch have not been explored yet. Conclusion Social touch is of eminent importance in inter-human social communication and grounded in specific neurophysiological processing channels. Social touch can have effects at many levels including physiological (heart rate and hormone levels), psychological (trust in others), and sociological (pro-social behavior toward others). In Proceedings of the International Conference on Computer Technology and Development (ICCTD ‘09), 416–420. Piscataway, NJ: IEEE Press. Bickmore, T.W., Fernando, R., Ring, L., and Schulman, D. 2010. Empathic touch by relational agents. IEEE Trans. Affect. Comput. 1: 60–71. doi:10.1109/T-AFFC. 2010.4 Bickmore, T.W., and Picard, R.W. 2005. Establishing and maintaining longterm human-computer relationships. ACM Trans. Comput. Hum. Interact. 12: 293–327. doi:10.1145/1067860.1067867 Bohil, C.J., Alicea, B., and Biocca, F.A. 2011. Virtual reality in neuroscience research and therapy. Nat. Rev. Neurosci. 12: 752–62. doi:10.1038/nrn3122 Bonanni, L., Vaucelle, C., Lieberman, J., and Zuckerman, O. 2006. TapTap: a haptic wearable for asynchronous distributed touch therapy. In Proceedings of the ACM Conference on Human Factors in Computing Systems CHI ‘06, 580–585. New York, NY: ACM. Breazeal, C. 2011. Social robots for health applications. In Proceedings of the IEEE 2011 Annual International Conference on Engineering in Medicine and Biology (EMBC), 5368–5371. Piscataway, NJ: IEEE. Brouwer, A.-M., Zander, T.O., van Erp, J.B.F., Korteling, J.E., and Bronkhorst, A.W. 2015. Using neurophysiological signals that reflect cognitive or affective state: six recommendations to avoid common pitfalls. Front. Neurosci. 9:136. doi:10.3389/fnins.2015.00136 Burgoon, J.K. 1991. Relational message interpretations of touch, conversational distance, and posture. J. Nonverbal Behav. 15:233–59. doi:10.1007/BF00986924 References Altun, K., and MacLean, K.E. 2014. Recognizing affect in human touch of a robot. Pattern Recognit. Lett. doi:10.1016/j.patrec.2014.10.016 App, B., McIntosh, D.N., Reed, C.L., and Hertenstein, M.J. 2011. Nonverbal channel use in communication of emotion: how may depend on why. Emotion 11: 603–17. doi:10.1037/a0023164 Argall, B.D., and Billard, A.G. 2010. A survey of tactile human-robot interactions. Rob. Auton. Syst. 58: 1159–76. doi:10.1016/j.robot.2010.07.002 Argyle, M. 1975. Bodily Communication. 2nd ed. London, UK: Methuen. Bailenson, J.N., and Yee, N. 2007. Virtual interpersonal touch and digital chameleons. J. Nonverbal Behav. 31: 225–42. doi:10.1007/s10919-007-0034-6 Bailenson, J.N., and Yee, N. 2008. Virtual interpersonal touch: haptic interaction and copresence in collaborative virtual environments. Multimed. Tools Appl. 37: 5–14. doi:10.1007/s11042-007-0171-2 Bailenson, J.N., Yee, N., Brave, S., Merget, D., and Koslow, D. 2007. Virtual interpersonal touch: expressing and recognizing emotions through haptic devices. Hum. Comput. Interact. 22: 325–53. doi:10.1080/07370020701493509 Basdogan, C., Ho, C.-H., Srinivasan, M.A., and Slater, M. 2000. An experimental study on the role of touch in shared virtual environments. ACM Trans. Comput. Hum. Interact. 7: 443–60. doi:10.1145/365058.365082 Basori, A.H., Bade, A., Sunar, M.S., Daman, D., and Saari, N. 2009. Haptic vibration for emotional expression of avatar to enhance the realism of virtual reality. Frontiers in Digital Humanities | www.frontiersin.org 9 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Burgoon, J.K., and Walther, J.B. 1990. Nonverbal expectancies and the evaluative consequences of violations. Hum. Comm. Res. 17: 232–65. doi:10.1111/j. 1468-2958.1990.tb00232.x Burgoon, J.K., Walther, J.B., and Baesler, E.J. 1992. Interpretations, evaluations, and consequences of interpersonal touch. Hum. Comm. Res. 19: 237–63. doi:10.1111/ j.1468-2958.1992.tb00301.x Bush, E. 2001. The use of human touch to improve the well-being of older adults: A holistic nursing intervention. J. Holist. Nurs. 19(3):256–270. doi:10.1177/ 089801010101900306 Cabibihan, J.-J., Ahmed, I., and Ge, S.S. 2011. Force and motion analyses of the human patting gesture for robotic social touching. In Proceedings of the 2011 IEEE 5th International Conference on Cybernetics and Intelligent Systems (CIS), 165–169. Piscataway, NJ: IEEE. Cabibihan, J.-J., Jegadeesan, R., Salehi, S., and Ge, S.S. 2010. Synthetic skins with humanlike warmth. In Social Robotics, Edited by S. Ge, H. Li, J.J. Cabibihan, and Y. Tan, 362–371. Berlin: Springer. Cabibihan, J.-J., Pradipta, R., Chew, Y., and Ge, S. 2009. Towards humanlike social touch for prosthetics and sociable robotics: Handshake experiments and finger phalange indentations. In Advances in Robotics, Edited by J.H. Kim, S. Ge, P. Vadakkepat, N. Jesse, A. Al Manum, K. Puthusserypady, et al., 73–79 Berlin: Springer. doi:10.1007/978-3-642-03983-6_11 Cabibihan, J.-J., Zheng, L., and Cher, C.K.T. 2012. Affective tele-touch. In Social Robotics, Edited by S. Ge, O. Khatib, J.J. Cabibihan, R. Simmons, and M.A. Williams, 348–356. Berlin: Springer. Calvo, R.A., and D’Mello, S. 2010. Affect detection: an interdisciplinary review of models, methods, and their applications. IEEE Trans. Affect. Comput. 1: 18–37. doi:10.1109/T-AFFC.2010.1 Camps, J., Tuteleers, C., Stouten, J., and Nelissen, J. 2012. A situational touch: how touch affects people’s decision behavior. Social Influence 8: 237–50. doi:10.1080/ 15534510.2012.719479 Cannon, W.B. 1927. The James-Lange theory of emotions: a critical examination and an alternative theory. Am. J. Psychol. 39: 106–24. doi:10.2307/1415404 Cha, J., Eid, M., Barghout, A., and Rahman, A.M. 2008. HugMe: an interpersonal haptic communication system. In IEEE International Workshop on Haptic Audio visual Environments and Games (HAVE 2008), 99–102. Piscataway, NJ: IEEE. Chang, S.O. 2001. The conceptual structure of physical touch in caring. J. Adv. Nurs. 33(6): 820–827. doi:10.1046/j.1365-2648.2001.01721.x Chatel-Goldman, J., Congedo, M., Jutten, C., and Schwartz, J.L. 2014. Touch increases autonomic coupling between romantic partners. Front. Behav. Neurosci. 8:95. doi:10.3389/fnbeh.2014.00095 Chen, T.L., King, C.-H., Thomaz, A.L., and Kemp, C.C. 2011. Touched by a robot: an investigation of subjective responses to robot-initiated touch. In Proceedings of the 6th International Conference on Human-Robot Interaction HRI ‘11, 457–464. New York, NY: ACM. Chung, K., Chiu, C., Xiao, X., and Chi, P.Y.P. 2009. Stress outsourced: a haptic social network via crowdsourcing. In CHI ‘09 Extended Abstracts on Human Factors in Computing Systems, Edited by D.R. Olsen, K. Hinckley, M. Ringel-Morris, S. Hudson and S. Greenberg, 2439–2448. New York, NY: ACM. doi:10.1145/ 1520340.1520346 Coan, J.A., Schaefer, H.S., and Davidson, R.J. 2006. Lending a hand: social regulation of the neural response to threat. Psychol. Sci. 17: 1032–9. doi:10.1111/j. 1467-9280.2006.01832.x Collier, G. 1985. Emotional Expression. Hillsdale, NJ: Lawrence Erlbaum Associates Inc. Cooney, M.D., Nishio, S., and Ishiguro, H. 2012. Recognizing affection for a touchbased interaction with a humanoid robot. In IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), 1420–1427. Piscataway, NJ: IEEE. Cooney, M.D., Nishio, S., and Ishiguro, H. 2014. Importance of touch for conveying affection in a multimodal interaction with a small humanoid robot. Int. J. Hum. Rob. 12(1): 1550002. doi:10.1142/S0219843615500024 Cooper, E.A., Garlick, J., Featherstone, E., Voon, V., Singer, T., Critchley, H.D., et al. 2014. You turn me cold: evidence for temperature contagion. PLoS One 9:e116126. doi:10.1371/journal.pone.0116126 Cramer, H., Kemper, N., Amin, A., Wielinga, B., and Evers, V. 2009. “Give me a hug”: the effects of touch and autonomy on people’s responses to embodied social agents. Comput. Anim. Virtual Worlds 20: 437–45. doi:10.1002/cav.317 Cranny-Francis, A. 2011. Semefulness: a social semiotics of touch. Soc. Semiotics 21: 463–81. doi:10.1080/10350330.2011.591993 Frontiers in Digital Humanities | www.frontiersin.org Crusco, A.H., and Wetzel, C.G. 1984. The midas touch: the effects of interpersonal touch on restaurant tipping. Pers. Soc. Psychol. B 10: 512–7. doi:10.1177/ 0146167284104003 Dahiya, R.S., Metta, G., Valle, M., and Sandini, G. 2010. Tactile sensing – from humans to humanoids. IEEE Trans. Rob. 26: 1–20. doi:10.1109/TRO.2009. 2033627 Damasio, A. 1999. The Feeling of What Happens: Body and Emotion in the Making of Consciousness. London, UK: Heinemann. Debrot, A., Schoebi, D., Perrez, M., and Horn, A.B. 2013. Touch as an interpersonal emotion regulation process in couples’ daily lives: the mediating role of psychological intimacy. Pers. Soc. Psychol. B 39: 1373–85. doi:10.1177/ 0146167213497592 Dev, P., Youngblood, P., Heinrichs, W.L., and Kusumoto, L. 2007. Virtual worlds and team training. Anesthesiol. Clin. 25: 321–36. doi:10.1016/j.anclin.2007.03. 001 Dijk, E.O., Nijholt, A., van Erp, J.B.F., Wolferen, G.V., and Kuyper, E. 2013. Audiotactile stimulation: a tool to improve health and well-being? Int. J. Auton. Adapt. Commun. Syst. 6: 305–23. doi:10.1504/IJAACS.2013.056818 Ditzen, B., Neumann, I.D., Bodenmann, G., von Dawans, B., Turner, R.A., Ehlert, U., et al. 2007. Effects of different kinds of couple interaction on cortisol and heart rate responses to stress in women. Psychoneuroendocrinology 32: 565–74. doi:10.1016/j.psyneuen.2007.03.011 Dolin, D.J., and Booth-Butterfield, M. 1993. Reach out and touch someone: analysis of nonverbal comforting responses. Commun. Q. 41: 383–93. doi:10.1080/ 01463379309369899 Dougherty, E., and Scharfe, H. 2011. Initial formation of trust: designing an interaction with geminoid-DK to promote a positive attitude for cooperation. In Social Robotics, Edited by B. Mutlu, C. Bartneck, J. Ham, V. Evers, and T. Kanda, 95–103. Berlin: Springer. Drescher, V.M., Gantt, W.H., and Whitehead, W.E. 1980. Heart rate response to touch. Psychosom. Med. 42: 559–65. doi:10.1097/00006842-198011000-00004 Eichhorn, E., Wettach, R., and Hornecker, E. 2008. A stroking device for spatially separated couples. In Proceedings of the 10th International Conference on Human Computer Interaction with Mobile Devices and Services Mobile HCI ‘08, 303–306. New York, NY: ACM. Ellingsen, D.M., Wessberg, J., Chelnokova, O., Olausson, H., Aeng, B., and Eknes, S. 2014. In touch with your emotions: oxytocin and touch change social impressions while others’ facial expressions can alter touch. Psychoneuroendocrinology 39: 11–20. doi:10.1016/j.psyneuen.2013.09.017 Field, T. 2010. Touch for socioemotional and physical well-being: a review. Dev. Rev. 30: 367–83. doi:10.1016/j.dr.2011.01.001 Fisher, J.D., Rytting, M., and Heslin, R. 1976. Hands touching hands: affective and evaluative effects of an interpersonal touch. Sociometry 39: 416–21. doi:10.2307/ 3033506 Flowers, M.G., and Aggarwal, R. 2014. Second LifeTM : a novel simulation platform for the training of surgical residents. Expert Rev. Med. Devices 11: 101–3. doi:10. 1586/17434440.2014.863706 Fong, T., Nourbakhsh, I., and Dautenhahn, K. 2003. A survey of socially interactive robots. Rob. Auton. Syst. 42: 143–66. doi:10.1016/S0921-8890(02) 00372-X Frumin, I., Perl, O., Endevelt-Shapira, Y., Eisen, A., Eshel, N., Heller, I., et al. 2015. A social chemosignaling function for human handshaking. Elife 4: e05154. doi:10.7554/eLife.05154 Furukawa, M., Kajimoto, H., and Tachi, S. 2012. KUSUGURI: a shared tactile interface for bidirectional tickling. In Proceedings of the 3rd Augmented Human International Conference AH ‘12, 1–8. New York, NY: ACM. Gallace, A., Ngo, M.K., Sulaitis, J., and Spence, C. 2012. Multisensory presence in virtual reality: possibilities & limitations. In Multiple Sensorial Media Advances and Applications: New Developments in MulSeMedia, Edited by G. Ghinea, F. Andres and S.R. Gulliver, 1–40. Vancouver, BC: IGI Global. Gallace, A., and Spence, C. 2010. The science of interpersonal touch: an overview. Neurosci. Biobehav. Rev. 34: 246–59. doi:10.1016/j.neubiorev.2008.10.004 Gao, Y., Bianchi-Berthouze, N., and Meng, H. 2012. What does touch tell us about emotions in touchscreen-based gameplay? ACM Trans. Comput. Hum. Interact. 19: 1–30. doi:10.1145/2395131.2395138 Giannopoulos, E., Wang, Z., Peer, A., Buss, M., and Slater, M. 2011. Comparison of people’s responses to real and virtual handshakes within a virtual environment. Brain Res. Bull. 85: 276–82. doi:10.1016/j.brainresbull.2010.11.012 10 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Gleeson, M., and Timmins, F. 2005. A review of the use and clinical effectiveness of touch as a nursing intervention. Clin. Effect. Nurs. 9: 69–77. doi:10.1016/j.cein. 2004.12.002 Gooch, D., and Watts, L. 2010. Communicating social presence through thermal hugs. In Proceedings of First Workshop on Social Interaction in Spatially Separated Environments (SISSI2010), Edited by F. Schmid, T. Hesselmann, S. Boll, K. Cheverst, and L. Kulik, 11–19. Copenhagen: International Society for Presence Research. Gooch, D., and Watts, L. 2012. Yourgloves, hothands and hotmits: devices to hold hands at a distance. In Proceedings of the 25th Annual ACM Symposium on User Interface Software and Technology UIST ‘12, 157–166. New York, NY: ACM. Gordon, I., Voos, A.C., Bennett, R.H., Bolling, D.Z., Pelphrey, K.A. and Kaiser, M.D. 2013. Brain mechanisms for processing affective touch. Hum. Brain Mapp. 34(4):914–922. doi:10.1002/hbm.21480 Gottlieb, G. 1971. Ontogenesis of sensory function in birds and mammals. In The Biopsychology of Development, Edited by E. Tobach, L.R. Aronson, and E. Shaw, 67–128. New York, NY: Academic Press. Grewen, K.M., Anderson, B.J., Girdler, S.S., and Light, K.C. 2003. Warm partner contact is related to lower cardiovascular reactivity. Behav. Med. 29: 123–30. doi:10.1080/08964280309596065 Guéguen, N. 2002. Touch, awraness of touch, and compliance with a request. Percept. Mot. Skills 95: 355–60. doi:10.2466/pms.2002.95.2.355 Guéguen, N. 2004. Nonverbal encouragement of participation in a course: the effect of touching. Soc. Psychol. Educ. 7: 89–98. doi:10.1023/B:SPOE.0000010691. 30834.14 Guéguen, N., and Fischer-Lokou, J. 2003. Tactile contact and spontaneous help: an evaluation in a natural setting. J. Soc. Psychol. 143: 785–7. doi:10.1080/ 00224540309600431 Guéguen, N., Meineri, S., and Charles-Sire, V. 2010. Improving medication adherence by using practitioner nonverbal techniques: a field experiment on the effect of touch. J. Behav. Med. 33: 466–73. doi:10.1007/s10865-010-9277-5 Haans, A., and IJsselsteijn, W.A. 2006. Mediated social touch: a review of current research and future directions. Virtual Reality 9: 149–59. doi:10.1007/ s10055-005-0014-2 Haans, A., and IJsselsteijn, W.A. (2009a). The virtual Midas Touch: helping behavior after a mediated social touch. IEEE Trans. Haptics 2: 136–40. doi:10.1109/TOH. 2009.20 Haans, A., and IJsselsteijn, W.A. (2009b). I’m always touched by your presence, dear: combining mediated social touch with morphologically correct visual feedback. In Proceedings of Presence 2009, 1–6. Los Angeles, CA: International Society for Presence Research. Haans, A., and IJsselsteijn, W.A. 2010. Combining mediated social touch with vision: from self-attribution to telepresence? In Proceedings of Special Symposium at EuroHaptics 2010: Haptic and Audio-Visual Stimuli: Enhancing Experiences and Interaction, Edited by A. Nijholt, E.O. Dijk, and P.M.C. Lemmens, 35–46 Enschede:University of Twente. Henricson, M., Ersson, A., Määttä, S., Segesten, K., and Berglund, A.L. 2008. The outcome of tactile touch on stress parameters in intensive care: A randomized controlled trial. Complement. Ther. Clin. Prac. 14(4): 244–254. Harlow, H.F., and Zimmermann, R.R. 1959. Affectional responses in the infant monkey; orphaned baby monkeys develop a strong and persistent attachment to inanimate surrogate mothers. Science 130: 421–32. doi:10.1126/science.130. 3373.421 Hertenstein, M.J., Holmes, R., McCullough, M., and Keltner, D. 2009. The communication of emotion via touch. Emotion 9: 566–73. doi:10.1037/a0016108 Hertenstein, M.J., Keltner, D., App, B., Bulleit, B.A., and Jaskolka, A.R. 2006. Touch communicates distinct emotions. Emotion 6: 528–33. doi:10.1037/1528-3542.6. 3.528 Hogervorst, M.A., Brouwer, A.-M., and van Erp, J.B.F. 2014. Combining and comparing EEG, peripheral physiology and eye-related measures for the assessment of mental workload. Front. Neurosci. 8:322. doi:10.3389/fnins.2014.00322 Hornik, J. 1992. Tactile stimulation and consumer response. J. Consum. Res. 19: 449–58. doi:10.1086/209314 Hossain, S.K.A., Rahman, A.S.M.M., and El Saddik, A. 2011. Measurements of multimodal approach to haptic interaction in second life interpersonal communication system. IEEE Trans. Instrum. Meas. 60: 3547–58. doi:10.1109/TIM. 2011.2161148 Huisman, G., Bruijnes, M., Kolkmeier, J., Jung, M.M., Darriba Frederiks, A., and Rybarczyk, Y. (2014a). Touching virtual agents: embodiment and mind. In Innovative and Creative Developments in Multimodal Interaction Systems, Edited Frontiers in Digital Humanities | www.frontiersin.org by Y. Rybarczyk, T. Cardoso, J. Rosas, and L. Camarinha-Matos, 114–138. Berlin: Springer. Huisman, G., Kolkmeier, J., and Heylen, D. (2014b). Simulated social touch in a collaborative game. In Haptics: Neuroscience, Devices, Modeling, and Applications, Edited by M. Auvray and C. Duriez, 248–256. Berlin: Springer. Huisman, G., Darriba Frederiks, A., Van Dijk, E.M.A.G., Kröse, B.J.A., and Heylen, D.K.J. 2013. Self touch to touch others: designing the tactile sleeve for social touch. In Online Proceedings of TEI’13. Available at: http://www.tei-conf.org/13/ sites/default/files/page-files/Huisman.pdf Hutson, S., Lim, S., Bentley, P.J., Bianchi-Berthouze, N., and Bowling, A. 2011. Investigating the suitability of social robots for the wellbeing of the elderly. In Affective Computing and Intelligent Interaction, Edited by S. D’Mello, A. Graesser, B. Schuller, and J.C. Martin, 578–587. Berlin: Springer. IJsselsteijn, W.A., van Baren, J., and van Lanen, F. 2003. Staying in touch: social presence and connectedness through synchronous and asynchronous communication media (Part III). In Human-Computer Interaction: Theory and Practice, Edited by C. Stephanidis and J. Jacko, 924–928. Boca Raton, FL: CRC Press. IJzerman, H., and Semin, G.R. 2009. The thermometer of social relations: mapping social proximity on temperature. Psychol. Sci. 20: 1214–20. doi:10.1111/j. 1467-9280.2009.02434.x IJzerman, H., and Semin, G.R. 2010. Temperature perceptions as a ground for social proximity. J. Exp. Soc. Psychol. 46: 867–73. doi:10.1016/j.jesp.2010.07.015 James, W. 1884. What is an emotion? Mind 9: 188–205. doi:10.1093/mind/os-IX. 34.188 Jones, S.E., and Yarbrough, A.E. 1985. A naturalistic study of the meanings of touch. Comm. Monogr. 52: 19–56. doi:10.1080/03637758509376094 Joule, R.V., and Guéguen, N. 2007. Touch, compliance, and awareness of tactile contact. Percept. Mot. Skills 104: 581–8. doi:10.2466/pms.104.2.581-588 Jung, M.M., Poppe, R., Poel, M., and Heylen, D.K.J. 2014. Touching the VOID – introducing CoST: corpus of social touch. In Proceedings of the 16th International Conference on Multimodal Interaction (ICMI ‘14), 120–127. New York, NY: ACM. Kanamori, M., Suzuki, M., Oshiro, H., Tanaka, M., Inoguchi, T., Takasugi, H., et al. 2003. Pilot study on improvement of quality of life among elderly using a pet-type robot. In Proceedings of the IEEE International Symposium on Computational Intelligence in Robotics and Automation, 107–112. Piscataway, NJ: IEEE. Khanna, P., and Sasikumar, M. 2010. Recognising emotions from keyboard stroke pattern. Int. J. Comput. Appl. 11: 1–5. doi:10.5120/1614-2170 Kjeldskov, J., Gibbs, M., Vetere, F., Howard, S., Pedell, S., Mecoles, K., et al. 2004. Using cultural probes to explore mediated intimacy. Australas J. Inf. Syst. 11. Available at: http://journal.acs.org.au/index.php/ajis/article/view/128 Kleinke, C.L. 1977. Compliance to requests made by gazing and touching experimenters in field settings. J. Exp. Soc. Psychol. 13: 218–23. doi:10.1016/ 0022-1031(77)90044-0 Knapp, M.L., and Hall, J.A. 2010. Nonverbal Communication in Human Interaction (7th ed.). Boston, MA: Wadsworth, CENGAGE Learning. Konijn, E.A., Utz, S., Tanis, M., and Barnes, S.B. 2008. Mediated Interpersonal Communication. New York, NY: Routledge. Kotranza, A., and Lok, B. 2008. Virtual human + tangible interface = mixed reality human: an initial exploration with a virtual breast exam patient. In Proceedings of the IEEE Virtual Reality Conference 2008 (VR ‘08), 99–106. Piscataway, NJ: IEEE. Kotranza, A., Lok, B., Deladisma, A., Pugh, C.M., and Lind, D.S. 2009. Mixed reality humans: evaluating behavior, usability, and acceptability. IEEE Trans. Vis. Comput. Graph. 15: 369–82. doi:10.1109/TVCG.2008.195 Kraus, M.W., Huang, C., and Keltner, D. 2010. Tactile communication, cooperation, and performance: an ethological study of the NBA. Emotion 10: 745–9. doi:10. 1037/a0019382 Kristoffersson, A., Coradeschi, S., and Loutfi, A. 2013. A review of mobile robotic telepresence. Adv. Hum. Comput. Int. 2013: 1–17. doi:10.1155/2013/ 902316 Kuwamura, K., Sakai, K., Minato, T., Nishio, S., and Ishiguro, H. 2013. Hugvie: a medium that fosters love. In The 22nd IEEE International Symposium on Robot and Human Interactive Communication, 70–75. Gyeongju: IEEE. Kvam, M.H. 1997. The effect of vibroacoustic therapy. Physiotherapy 83: 290–5. doi:10.1016/S0031-9406(05)66176-7 Ledbetter, A.M. 2014. The past and future of technology in interpersonal communication theory and research. Commun. Stud. 65: 456–9. doi:10.1080/10510974. 2014.927298 11 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Lee, J.K., Stiehl, W.D., Toscano, R.L., and Breazeal, C. 2009. Semi-autonomous robot avatar as a medium for family communication and education. Adv. Rob. 23: 1925–49. doi:10.1163/016918609X12518783330324 Lee, K.M., Jung, Y., Kim, J., and Kim, S.R. 2006. Are physically embodied social agents better than disembodied social agents? The effects of physical embodiment, tactile interaction, and people’s loneliness in human-robot interaction. Int. J. Hum. Comput. Stud. 64: 962–73. doi:10.1016/j.ijhcs.2006.05.002 Lemmens, P., Crompvoets, F., Brokken, D., van den Eerenbeemd, J., and de Vries, G.J. 2009. A body-conforming tactile jacket to enrich movie viewing. In EuroHaptics Conference, 2009 and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems. World Haptics 2009. Third Joint, 7–12. Piscataway, NJ: IEEE Press. Li, H., Cabibihan, J.-J., and Tan, Y. 2011. Towards an effective design of social robots. Int. J. Soc. Rob. 3: 333–5. doi:10.1007/s12369-011-0121-z Löken, L.S., Wessberg, J., Morrison, I., McGlone, F., and Olausson, H. 2009. Coding of pleasant touch by unmyelinated afferents in humans. Nat. Neurosci. 12(5): 547–548. doi:10.1038/nn.2312 Lv, H.-R., Lin, Z.-L., Yin, W.-J., and Dong, J. 2008. Emotion recognition based on pressure sensor keyboards. In IEEE International Conference on Multimedia and Expo 2008, 1089–1092. Piscataway, NJ: IEEE. Master, S.L., Eisenberger, N.I., Taylor, S.E., Naliboff, B.D., Shirinyan, D., and Lieberman, M.D. 2009. A picture’s worth: partner photographs reduce experimentally induced pain. Psychol. Sci. 20: 1316–8. doi:10.1111/j.1467-9280.2009.02444.x McCall, C., and Blascovich, J. 2009. How, when, and why to use digital experimental virtual environments to study social behavior. Soc. Pers. Psychol. Compass 3: 744–58. doi:10.1111/j.1751-9004.2009.00195.x McCance, R.A., and Otley, M. 1951. Course of the blood urea in newborn rats, pigs and kittens. J. Physiol. 113: 18–22. doi:10.1113/jphysiol.1951.sp004552 McDaniel, E., and Andersen, P.A. 1998. International patterns of interpersonal tactile communication: a field study. J. Nonverbal Behav. 22: 59–75. doi:10.1023/ A:1022952509743 McGlone, F., Wessberg, J., and Olausson, H. 2014. Discriminative and affective touch: sensing and feeling. Neuron 82: 737–55. doi:10.1016/j.neuron.2014. 05.001 Mehrabian, A. 1972. Nonverbal Communication. Chicago, IL: Aldine-Atherton. Mikropoulos, T.A., and Natsis, A. 2011. Educational virtual environments: a tenyear review of empirical research (1999-2009). Comput. Educ. 56: 769–80. doi:10. 1016/j.compedu.2010.10.020 Montagu, A. 1972. Touching: The Human Significance of the Skin. New York, NY: Harper & Row Publishers. Morrison, I., Löken, L., and Olausson, H. 2010. The skin as a social organ. Exp. Brain Res. 204: 305–14. doi:10.1007/s00221-009-2007-y Morrison, I., Björnsdotter, M., and Olausson, H. 2011. Vicarious responses to social touch in posterior insular cortex are tuned to pleasant caressing speeds. J. Neurosci. 31(26):9554–9562. Mueller, F., Vetere, F., Gibbs, M.R., Kjeldskov, J., Pedell, S., and Howard, S. 2005. Hug over a distance. In CHI ‘05 Extended Abstracts on Human Factors in Computing Systems, Edited by G. van der Veer and C. Gale, 1673–1676. New York, NY: ACM. doi:10.1145/1056808.1056994 Nakagawa, K., Shiomi, M., Shinozawa, K., Matsumura, R., Ishiguro, H., and Hagita, N. 2011. Effect of robot’s active touch on people’s motivation. In Proceedings of the 6th International Conference on Human-Robot Interaction HRI ‘11, 465–472. New York, NY: ACM. Nakanishi, H., Tanaka, K., and Wada, Y. 2014. Remote handshaking: touch enhances video-mediated social telepresence. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems CHI’14, 2143–2152. New York, NY: ACM. Nakanishi, J., Kuwamura, K., Minato, T., Nishio, S., and Ishiguro, H. 2013. Evoking affection for a communication partner by a robotic communication medium. In The First International Conference on Human-Agent Interaction (iHAI 2013), 1–8. Available at: http://hai-conference.net/ihai2013/proceedings/pdf/III-1-4.pdf Naya, F., Yamato, J., and Shinozawa, K. 1999. Recognizing human touching behaviors using a haptic interface for a pet-robot. In Conference Proceedings of the IEEE International Conference on Systems, Man, and Cybernetics (IEEE SMC ‘99), 1030–1034. Piscataway, NJ: IEEE. Nguyen, N., Wachsmuth, I., and Kopp, S. 2007. Touch perception and emotional appraisal for a virtual agent. In Proceedings of the 2nd Workshop Emotion and Computing-Current Research and Future Impact, Edited by D. Reichardt and P. Levi, 17–22. Stuttgart: Berufsakademie Stuttgart. Frontiers in Digital Humanities | www.frontiersin.org Nguyen, T., Heslin, R., and Nguyen, M.L. 1975. The meanings of touch: sex differences. J. Commun. 25: 92–103. doi:10.1111/j.1460-2466. 1975.tb00610.x Nie, J., Park, M., Marin, A.L., and Sundar, S.S. 2012. Can you hold my hand? Physical warmth in human-robot interaction. In Proceeedings of the 7th ACM/IEEE International Conference on Human-Robot Interaction (HRI), 201–202. Piscataway, NJ: IEEE. Nijholt, A. 2014. Breaking fresh ground in human-media interaction research. Front. ICT 1:4. doi:10.3389/fict.2014.00004 Nummenmaa, L., Glerean, E., Hari, R., and Hietanen, J.K. 2013. Bodily maps of emotions. Proc. Natl. Acad. Sci. U.S.A. 111: 646–51. doi:10.1073/pnas. 1321664111 Olausson, H.W., Cole, J., Vallbo, Å, McGlone, F., Elam, M., Krämer, H.H., et al. 2008. Unmyelinated tactile afferents have opposite effects on insular and somatosensory cortical processing. Neurosci. Lett. 436: 128–32. doi:10.1016/j.neulet.2008. 03.015 Paladino, M.P., Mazzurega, M., Pavani, F., and Schubert, T.W. 2010. Synchronous multisensory stimulation blurs self-other boundaries. Psychol. Sci. 21: 1202–7. doi:10.1177/0956797610379234 Park, E., and Lee, J. 2014. I am a warm robot: the effects of temperature in physical human – robot interaction. Robotica 32: 133–42. doi:10.1017/ S026357471300074X Park, Y.W., Bae, S.H., and Nam, T.J. 2012. How do Couples Use CheekTouch Over Phone Calls? New York, NY: ACM. 763–6. Park, Y.W., Hwang, S., and Nam, T.J. 2011. Poke: emotional touch delivery through an inflatable surface over interpersonal mobile communications. In Adjunct Proceedings of the 24th Annual ACM Symposium Adjunct on User Interface Software and Technology UIST ‘11, 61–62. New York, NY: ACM. Patrick, G. 1999. The effects of vibroacoustic music on symptom reduction. IEEE Eng. Med. Biol. Mag. 18: 97–100. doi:10.1109/51.752987 Phelan, J.E. 2009. Exploring the use of touch in the psychotherapeutic setting: a phenomenological review. Psychotherapy (Chic) 46: 97–111. doi:10.1037/a0014751 Prisby, R.D., Lafage-Proust, M.-H., Malaval, L., Belli, A., and Vico, L. 2008. Effects of whole body vibration on the skeleton and other organ systems in man and animal models: what we know and what we need to know. Ageing Res. Rev. 7: 319–29. doi:10.1016/j.arr.2008.07.004 Puhan, M.A., Suarez, A., Cascio, C.L., Zahn, A., Heitz, M., and Braendli, O. 2006. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ 332: 266–70. doi:10.1136/bmj.38705. 470590.55 Rahman, A.S.M.M., and El Saddik, A. 2011. HKiss: real world based haptic interaction with virtual 3D avatars. In Proceedings of the 2011 IEEE International Conference on Multimedia and Expo (ICME), 1–6. Piscataway, NJ: IEEE. Rantala, J., Raisamo, R., Lylykangas, J., Ahmaniemi, T., Raisamo, J., Rantala, J., et al. 2011. The role of gesture types and spatial feedback in haptic communication. IEEE Trans. Haptics 4: 295–306. doi:10.1109/TOH.2011.4 Rantala, J., Salminen, K., Raisamo, R., and Surakka, V. 2013. Touch gestures in communicating emotional intention via vibrotactile stimulation. Int. J. Hum. Comput. Stud. 7: 679–90. doi:10.1016/j.ijhcs.2013.02.004 Réhman, S., and Liu, L. 2010. iFeeling: vibrotactile rendering of human emotions on mobile phones. In Mobile Multimedia Processing, Edited by X. Jiang, M.Y. Ma, and C. Chen, 1–20. Berlin: Springer. Robinson, H., MacDonald, B., Kerse, N., and Broadbent, E. 2013. The psychosocial effects of a companion robot: a randomized controlled trial. J. Am. Med. Dir. Assoc. 14: 661–7. doi:10.1016/j.jamda.2013.02.007 Rolls, E.T. 2010. The affective and cognitive processing of touch, oral texture, and temperature in the brain. Neurosci. Biobehav. Rev. 34: 237–45. doi:10.1016/j. neubiorev.2008.03.010 Saadatian, E., Samani, H., Parsani, R., Pandey, A.V., Li, J., Tejada, L., et al. 2014. Mediating intimacy in long-distance relationships using kiss messaging. Int. J. Hum. Comput. Stud. 72: 736–46. doi:10.1016/j.ijhcs.2014.05.004 Sallnäs, E.L. 2010. Haptic feedback increases perceived social presence. In Haptics: Generating and Perceiving Tangible Sensations, Part II, Edited by A.M. Kappers, J.B. Erp, W.M. Bergmann Tiest, and F.C. Helm, 178–185. Berlin: Springer. Salminen, K., Surakka, V., Lylykangas, J., Raisamo, R., Saarinen, R., Raisamo, R., et al. 2008. Emotional and behavioral responses to haptic stimulation. In Proceeding of the Twenty-Sixth Annual SIGCHI Conference on Human Factors in Computing Systems, 1555–1562. New York, NY: ACM Press. 12 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Scheele, D., Kendrick, K.M., Khouri, C., Kretzer, E., Schläpfer, T.E., StoffelWagner, B., et al. 2014. An oxytocin-induced facilitation of neural and emotional responses to social touch correlates inversely with autism traits. Neuropsychopharmacology 39: 2078–85. doi:10.1038/npp.2014.78 Schilit, B., Adams, N., and Want, R. 1994. Context-aware computing applications. In First Workshop on Mobile Computing Systems and Applications (WMCSA 1994), 85–90. Piscataway, NJ: IEEE. Self, B.P., van Erp, J.B.F., Eriksson, L., and Elliott, L.R. 2008. Human factors issues of tactile displays for military environments. In Tactile Displays for Navigation, Orientation and Communication in Military Environments, Edited by J.B.F. van Erp and B.P. Self, 3. Neuillu-sur-Seine: NATO RTO. Shermer, M. 2004. A bounty of science. Sci. Am. 290: 33. doi:10.1038/ scientificamerican0204-33 Shin, H., Lee, J., Park, J., Kim, Y., Oh, H., and Lee, T. 2007. A tactile emotional interface for instant messenger chat. In Proceedings of the 2007 Conference on Human Interface, Edited by M.J. Smith and G. Salvendy, 166–175. Berlin: Springer. Smith, J., and MacLean, K. 2007. Communicating emotion through a haptic link: design space and methodology. Int. J. Hum. Comput. Stud. 65: 376–87. doi:10. 1016/j.ijhcs.2006.11.006 Solon, O. 2015. These sex tech toys will blow your mind. WIRED. Available at: http://www.wired.co.uk/news/archive/2014-06/27/sex-tech Stiehl, W.D., Lieberman, J., Breazeal, C., Basel, L., Lalla, L., and Wolf, M. 2005. Design of a therapeutic robotic companion for relational, affective touch. In IEEE International Workshop on Robot and Human Interactive Communication (ROMAN 2005), 408–415. Piscataway, NJ: IEEE. Suhonen, K., Müller, S., Rantala, J., Väänänen-Vainio-Mattila, K., Raisamo, R., and Lantz, V. (2012a). Haptically augmented remote speech communication: a study of user practices and experiences. In Proceedings of the 7th Nordic Conference on Human-Computer Interaction: Making Sense Through Design NordiCHI ‘12, 361–369. New York, NY: ACM. Suhonen, K., Väänänen-Vainio-Mattila, K., and Mäkelä, K. (2012b). User experiences and expectations of vibrotactile, thermal and squeeze feedback in interpersonal communication. In Proceedings of the 26th Annual BCS Interaction Specialist Group Conference on People and Computers BCS-HCI ‘12, 205–214. New York, NY: ACM. Suk, H.-J., Jeong, S.-H., Hang, T.-H., and Kwon, D.-S. 2009. Tactile sensation as emotion elicitor. Kansei Eng. Int. 8(2): 147–52. Takahashi, K., Mitsuhashi, H., Murata, K., Norieda, S., and Watanabe, K. 2011. Improving shared experiences by haptic telecommunication. In 2011 International Conference on Biometrics and Kansei Engineering (ICBAKE), 210–215. Los Alamitos, CA: IEEE. doi:10.1109/ICBAKE.2011.19 Tanaka, F., Cicourel, A., and Movellan, J.R. 2007. Socialization between toddlers and robots at an early childhood education center. Proc. Natl. Acad. Sci. U.S.A. 104: 17954–8. doi:10.1073/pnas.0707769104 Teh, J.K.S., Cheok, A.D., Peiris, R.L., Choi, Y., Thuong, V., and Lai, S. 2008. Huggy pajama: a mobile parent and child hugging communication system. In Proceedings of the 7th International Conference on Interaction Design and Children IDC ‘08, 250–257. New York, NY: ACM. Thompson, E.H., and Hampton, J.A. 2011. The effect of relationship status on communicating emotions through touch. Cognit. Emot. 25: 295–306. doi:10. 1080/02699931.2010.492957 Toet, A., van Erp, J.B.F., Petrignani, F.F., Dufrasnes, M.H., Sadhashivan, A., van Alphen, D., et al. 2013. Reach out and touch somebody’s virtual hand. Affectively connected through mediated touch. In Proceedings of the 2013 Humaine Association Conference on Affective Computing and Intelligent Interaction, 786–791. Piscataway, NJ: IEEE Computer Society. Tsalamlal, M.Y., Ouarti, N., Martin, J.C., and Ammi, M. 2014. Haptic communication of dimensions of emotions using air jet based tactile stimulation. J. Multimodal User Interfaces 9(1): 69–77. doi:10.1007/s12193-014 -0162-3 Tsetserukou, D. 2010. HaptiHug: a novel haptic display for communication of hug over a distance. In Haptics: Generating and Perceiving Tangible Sensations, Edited by A.M. Kappers, J.B. Erp, W.M. Bergmann Tiest, and F.C. Helm, 340–347. Berlin: Springer. Tsetserukou, D., and Neviarouskaya, A. 2010. Innovative real-time communication system with rich emotional and haptic channels. In Haptics: Generating and Frontiers in Digital Humanities | www.frontiersin.org Perceiving Tangible Sensations, Edited by A.M. Kappers, J.B. van Erp, W.M. Bergmann Tiest, and F.C. Helm, 306–313. Berlin: Springer. Tsihrintzis, G.A., Virvou, M., Alepis, E., and Stathopoulou, I.O. 2008. Towards improving visual-facial emotion recognition through use of complementary keyboard-stroke pattern information. In Fifth International Conference on Information Technology: New Generations (ITNG 2008), 32–37. Piscataway, NJ: IEEE. Uvnäs-Moberg, K. 1997. Physiological and endocrine effects of social contact. Ann. N. Y. Acad. Sci. 807: 146–63. doi:10.1111/j.1749-6632.1997.tb51917.x Vallbo, A., Olausson, H., Wessberg, J., and Norrsell, U. 1993. A system of unmyelinated afferents for innocuous mechanoreception in the human skin. Brain Res. 628: 301–4. doi:10.1016/0006-8993(93)90968-S Van Bel, D.T., IJsselsteijn, W.A., and de Kort, Y.A.W. 2008. Interpersonal connectedness: conceptualization and directions for a measurement instrument. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI’08), 3129–3134. New York, NY: ACM. van Bel, D.T., Smolders, K.C.H.J., IJsselsteijn, W.A., and de Kort, Y.A.W. 2009. Social connectedness: concept and measurement. In Proceedings of the 5th International Conference on Intelligent Environments, Edited by V. Callaghan, A. Kameas, A. Reyes, D. Royo, and M. Weber, 67–74. Amsterdam: IOS Press. van Erp, J.B.F. 2007. Tactile Displays for Navigation and Orientation: Perception and Behaviour. Utrecht: Utrecht University. van Erp, J.B.F. 2012. The ten rules of touch: guidelines for social agents and robots that can touch. In Proceedings of the 25th Annual Conference on Computer Animation and Social Agents (CASA 2012), Singapore: Nanayang Technological University. van Erp, J.B.F., Kyung, K.-U., Kassner, S., Carter, J., Brewster, S., Weber, G., et al. 2010. Setting the standards for haptic and tactile interactions: ISO’s work. In Haptics: Generating and Perceiving Tangible Sensations. Proceedings of Eurohaptics 2010, Edited by A.M.L. Kappers, J.B.F. van Erp, W.M. Bergmann Tiest, and F.C.T. van der Helm, 353–358. Heidelberg: Springer. van Erp, J.B.F., and Toet, A. 2013. How to touch humans. Guidelines for social agents and robots that can touch. In Proceedings of the 2013 Humaine Association Conference on Affective Computing and Intelligent Interaction, 780–785. Geneva:IEEE Computer Society. doi:10.1109/ACII.2013.77145 van Erp, J.B.F., and van Veen, H.A.H.C. 2004. Vibrotactile in-vehicle navigation system. Transp. Res. Part F Traffic Psychol. Behav. 7: 247–56. doi:10.1016/j.trf. 2004.09.003 van Wingerden, S., Uebbing, T.J., Jung, M.M., and Poel, M. 2014. A neural network based approach to social touch classification. In Proceedings of the 2014 Workshop on Emotion Representation and Modelling in Human-Computer-InteractionSystems (ERM4HCI ‘14), 7–12. New York, NY: ACM. Vinciarelli, A., Pantic, M., Bourlard, H., and Pentland, A. 2008. Social signal processing: state-of-the-art and future perspectives of an emerging domain. In Proceedings of the 16th ACM International Conference on Multimedia, 1061–1070. New York, NY: ACM. Vrontou, S., Wong, A.M., Rau, K.K., Koerber, H.R., and Anderson, D.J. 2013. Genetic identification of C fibres that detect massage-like stroking of hairy skin in vivo. Nature 493: 669–73. doi:10.1038/nature11810 Wada, K., Ikeda, Y., Inoue, K., and Uehara, R. 2010. Development and preliminary evaluation of a caregiver’s manual for robot therapy using the therapeutic seal robot Paro. In Proceedings of the IEEE International Workshop on Robot and Human Interactive Communication (RO-MAN 2010), 533–538. Piscataway, NJ: IEEE. Wada, K., and Shibata, T. 2007. Living with seal robots – its sociopsychological and physiological influences on the elderly at a care house. IEEE Trans. Rob. 23: 972–80. doi:10.1109/TRO.2007.906261 Walker, S.C., and McGlone, F.P. 2015. Perceived pleasantness of social touch reflects the anatomical distribution and velocity tuning of C-tactile afferents: an affective homunculus. In Program No. 339.14/HH22. 2014 Neuroscience Meeting Planner, Washington, DC: Society for Neuroscience. Wang, R., and Quek, F. 2010. Touch & talk: contextualizing remote touch for affective interaction. In Proceedings of the 4th International Conference on Tangible, Embedded, and Embodied Interaction (TEI ‘10), 13–20. New York, NY: ACM. Wang, R., Quek, F., Tatar, D., Teh, K.S., and Cheok, A.D. 2012. Keep in touch: channel, expectation and experience. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems CHI ‘12, 139–148. New York, NY: ACM. 13 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Whitcher, S.J., and Fisher, J.D. 1979. Multidimensional reaction to therapeutic touch in a hospital setting. J. Pers. Soc. Psychol. 37: 87–96. doi:10.1037/0022-3514.37. 1.87 Wigram, A.L. 1996. The Effects of Vibroacoustic Therapy on Clinical and NonClinical Populations. Ph.D. thesis, St. George’s Hospital Medical School, London University, London. Yohanan, S., Chan, M., Hopkins, J., Sun, H., and MacLean, K. 2005. Hapticat: exploration of affective touch. In Proceedings of the 7th International Conference on Multimodal Interfaces (ICMI ‘05), 222–229. New York, NY: ACM. Yohanan, S., and MacLean, K. 2012. The role of affective touch in human-robot interaction: human intent and expectations in touching the haptic creature. Int. J. Soc. Rob. 4: 163–80. doi:10.1007/s12369-011-0126-7 Frontiers in Digital Humanities | www.frontiersin.org Zacharatos, H., Gatzoulis, C., and Chrysanthou, Y.L. 2014. Automatic emotion recognition based on body movement analysis: a survey. IEEE CGA 34: 35–45. doi:10.1109/MCG.2014.106 Conflict of Interest Statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Copyright © 2015 van Erp and Toet. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. 14 May 2015 | Volume 2 | Article 2
USER:
What are some ICT advances in the field of social touch?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 22 | 11 | 14,150 | null | 669 |
You must respond using only information contained in the prompt and provided provided text. Answer with a header followed by bullet points.
|
What are some exercises for initial strengthening during latarjet recovery?
|
P a g e 1 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. PHYSICAL THERAPY PROTOCOL AFTER LATARJET PROCEDURE: The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an open Latarjet procedure. It is no means intended to be a substitute for one’s clinical decision making regarding the progression of a patient’s post-operative course based on their physical exam/findings, individual progress, and/or the presence of postoperative complications. If a clinician requires assistance in the progression of a postoperative patient, they should consult with the referring Surgeon. Depending on the intraoperatively determined bone quality of the bone block, the surgeon defines in the operative report when pendulum exercises, passive range of motion (PROM), active range of motion (AROM) may be started. Accordingly, the postoperative protocol is defined individually for each patient by the surgeon and recorded in the operation report. P a g e 2 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase I – Immediate Post-Surgical Phase (Week 1-4): Goals: • Protect the integrity of the surgical repair • Achieve gradual restoration of passive range of motion (PROM) • Enhance/ensure adequate scapular function Precautions: • No active range of motion (AROM) of Shoulder • Maintain arm in sling, remove only for exercise for elbow, wrist and fingers, only removing for showering. Shower with arm held at side • No lifting of objects • No shoulder motion behind back • No excessive stretching or sudden movements • No supporting of body weight by hands • Keep incision clean and dry • Patient education regarding limited use of upper extremity despite the potential lack of or minimal pain or other symptoms DAY 1 TO 6: • Abduction brace or pillow / sling except when performing distal upper extremity exercises. Begin restoring AROM of elbow/wrist/hand of operative extremity • Sleep in brace or pillow / sling • Scapular clock exercises progressed to scapular isometric exercises • Ball squeezes • Cryotherapy for pain and inflammation -Day 1-2: as much as possible -Day 3-6: post activity, or for pain, or for comfort (IMPORTANT: USE TOWEL TO PROTECT SKIN AND PAUSE CRYOTHERAPY AT LEAST FOR 20 MIN/HOUR TO PREVENT FROSTBITES) P a g e 3 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. DAY 7 TO 28: • Continue use of brace/ pillow / sling • Continue Elbow, wrist, and finger AROM / resisted • Begin shoulder PROM (do not force any painful motion) in first two weeks or as directed by surgeon • Forward flexion and elevation to tolerance • Abduction in the plane of the scapula to tolerance • Internal rotation (IR) to 45 degrees at 30 degrees of abduction • External rotation (ER) in the plane of the scapula from 0-25 degrees or as directed by surgeon; begin at 30- 40 degrees of abduction; respect anterior capsule tissue integrity with ER range of motion; seek guidance from intraoperative measurements of external rotation ROM • Active and manual scapula strengthening exercises: Exercises: shoulder shrug and roll • Pendulum Exercises: (start of pendulum exercises is defined by the surgeon in the OR report. Do not start pendulum exercises if the operation report states that pendulum exercises should be started from the 6th or 8th postoperative week.). pendulum exercises • Start passive ROM (PROM): The PROM exercises should be supervised by the physiotherapist during the first session. In addition, the PROM home exercises should be trained by the physiotherapist. (start of passive ROM is defined by the surgeon in the OR report. Do not start PROM exercises if the operation report states that PROM exercises should be started from the 6th or 8th postoperative week). P a g e 4 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase II – Intermediate Phase (Week 5-8): Goals: • Do not overstress healing tissue • Discontinue brace / sling at end of week 6 • Gradually start active range of motion • Initiate active assisted range of motion (AAROM) under guidance of physical therapy: • Begin light waist level activities Precautions: • No active movement of shoulder till adequate PROM with good mechanics • No lifting with affected upper extremity • No excessive external rotation ROM / stretching. seek guidance from intraoperative measurements of external rotation ROM) • Do not perform activities or strengthening exercises that place an excessive load on the anterior capsule of the shoulder joint (i.e. no pushups, pec fly, etc..) • Do not perform scaption with internal rotation (empty can) during any stage of rehabilitation due to the possibility of impingement • Continued patient education: posture, joint protection, positioning, hygiene, etc. Exercises: 1. flexion in supine position 2. sitting assisted forward reach (elevation) 3. standing wall-assisted forward flexion 4. Cane-Assisted External Rotation at 20 degrees, 45 degrees abduction 5. Doorway Standing External Rotation 6. Scapular plane Abduction to Tolerance 7. Active Range of Motion Forward Flexion in the Scapular Plane 8. Active Range Of Motion External Rotation in Multiple Positions: Side-Lying or Sitting P a g e 5 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase III – strengthening phase (week 9-12): Goal: • Maintain Full AROM and Maintain Full PROM • Gradual restoration of shoulder strength, power, and endurance (Elastic bands) •Gradual return to functional activities Precautions: • No heavy lifting of objects (no heavier than 5 lbs.) • No sudden lifting or pushing activities • No sudden jerking motions • No heavy lifting of objects (no heavier than 5 lbs.) • No sudden lifting or pushing activities • No sudden jerking motions Start of strengthening with elastic bands and light weights is defined by the surgeon in the OR report. Do not start strengthening if the operation report states that strengthening should be started later. In patients with poor bone quality, strengthening is occasionally started later. Exercises: 1. Active Range of Motion External Rotation with Band Strengthening 2. Active Range of Motion Internal Rotation with Band Strengthening 3. Row with Resistance Band 4. Towel/Hand-assisted Internal Rotation Stretch 5. Side lying Internal Rotation Stretch at 70 and 90 Degrees 6. Cross-Body Stretch 7. Water (pool) therapy Standing in water with float under arm, lower body into water to help stretch into flexion 8. Standing in water with float under arm, lower body to side to help with external rotation P a g e 6 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase IV Advanced strengthening phase (week 13- 22): About 12 weeks postoperatively, a CT scan is performed to determine whether the bone block has healed. Depending on the findings, the surgeon will decide whether to move on to phase IV. Goals: • Maintain full non-painful active ROM • Advance conditioning exercises for Enhanced functional use of UE • Improve muscular strength, power, and endurance (light weights) • Gradual return to full functional activities • Continue to perform ROM stretching, if motion is not complete Exercises: • Side-lying External Rotation with Towel • Full Can in the Scapular Plane • Prone Scaption • Diagonal • Dynamic Hug • Internal Rotation at 90 Degrees Abduction • Forward Band Punch • Sitting Supported External Rotation at 90 Degrees • Standing Unsupported External Rotation at 90 Degrees • Biceps Curl Phase V – Return to activity phase (week 23): Goals: • Gradual return to strenuous work activities • Gradual return to recreational activities • Gradual return to sport activities • Continue strengthening and stretching • Continue stretching, if motion is tight • May initiate interval sport program
|
What are some exercises for initial strengthening during latarjet recovery? You must respond using only information contained in the prompt and provided provided text. Answer with a header followed by bullet points. P a g e 1 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. PHYSICAL THERAPY PROTOCOL AFTER LATARJET PROCEDURE: The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an open Latarjet procedure. It is no means intended to be a substitute for one’s clinical decision making regarding the progression of a patient’s post-operative course based on their physical exam/findings, individual progress, and/or the presence of postoperative complications. If a clinician requires assistance in the progression of a postoperative patient, they should consult with the referring Surgeon. Depending on the intraoperatively determined bone quality of the bone block, the surgeon defines in the operative report when pendulum exercises, passive range of motion (PROM), active range of motion (AROM) may be started. Accordingly, the postoperative protocol is defined individually for each patient by the surgeon and recorded in the operation report. P a g e 2 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase I – Immediate Post-Surgical Phase (Week 1-4): Goals: • Protect the integrity of the surgical repair • Achieve gradual restoration of passive range of motion (PROM) • Enhance/ensure adequate scapular function Precautions: • No active range of motion (AROM) of Shoulder • Maintain arm in sling, remove only for exercise for elbow, wrist and fingers, only removing for showering. Shower with arm held at side • No lifting of objects • No shoulder motion behind back • No excessive stretching or sudden movements • No supporting of body weight by hands • Keep incision clean and dry • Patient education regarding limited use of upper extremity despite the potential lack of or minimal pain or other symptoms DAY 1 TO 6: • Abduction brace or pillow / sling except when performing distal upper extremity exercises. Begin restoring AROM of elbow/wrist/hand of operative extremity • Sleep in brace or pillow / sling • Scapular clock exercises progressed to scapular isometric exercises • Ball squeezes • Cryotherapy for pain and inflammation -Day 1-2: as much as possible -Day 3-6: post activity, or for pain, or for comfort (IMPORTANT: USE TOWEL TO PROTECT SKIN AND PAUSE CRYOTHERAPY AT LEAST FOR 20 MIN/HOUR TO PREVENT FROSTBITES) P a g e 3 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. DAY 7 TO 28: • Continue use of brace/ pillow / sling • Continue Elbow, wrist, and finger AROM / resisted • Begin shoulder PROM (do not force any painful motion) in first two weeks or as directed by surgeon • Forward flexion and elevation to tolerance • Abduction in the plane of the scapula to tolerance • Internal rotation (IR) to 45 degrees at 30 degrees of abduction • External rotation (ER) in the plane of the scapula from 0-25 degrees or as directed by surgeon; begin at 30- 40 degrees of abduction; respect anterior capsule tissue integrity with ER range of motion; seek guidance from intraoperative measurements of external rotation ROM • Active and manual scapula strengthening exercises: Exercises: shoulder shrug and roll • Pendulum Exercises: (start of pendulum exercises is defined by the surgeon in the OR report. Do not start pendulum exercises if the operation report states that pendulum exercises should be started from the 6th or 8th postoperative week.). pendulum exercises • Start passive ROM (PROM): The PROM exercises should be supervised by the physiotherapist during the first session. In addition, the PROM home exercises should be trained by the physiotherapist. (start of passive ROM is defined by the surgeon in the OR report. Do not start PROM exercises if the operation report states that PROM exercises should be started from the 6th or 8th postoperative week). P a g e 4 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase II – Intermediate Phase (Week 5-8): Goals: • Do not overstress healing tissue • Discontinue brace / sling at end of week 6 • Gradually start active range of motion • Initiate active assisted range of motion (AAROM) under guidance of physical therapy: • Begin light waist level activities Precautions: • No active movement of shoulder till adequate PROM with good mechanics • No lifting with affected upper extremity • No excessive external rotation ROM / stretching. seek guidance from intraoperative measurements of external rotation ROM) • Do not perform activities or strengthening exercises that place an excessive load on the anterior capsule of the shoulder joint (i.e. no pushups, pec fly, etc..) • Do not perform scaption with internal rotation (empty can) during any stage of rehabilitation due to the possibility of impingement • Continued patient education: posture, joint protection, positioning, hygiene, etc. Exercises: 1. flexion in supine position 2. sitting assisted forward reach (elevation) 3. standing wall-assisted forward flexion 4. Cane-Assisted External Rotation at 20 degrees, 45 degrees abduction 5. Doorway Standing External Rotation 6. Scapular plane Abduction to Tolerance 7. Active Range of Motion Forward Flexion in the Scapular Plane 8. Active Range Of Motion External Rotation in Multiple Positions: Side-Lying or Sitting P a g e 5 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase III – strengthening phase (week 9-12): Goal: • Maintain Full AROM and Maintain Full PROM • Gradual restoration of shoulder strength, power, and endurance (Elastic bands) •Gradual return to functional activities Precautions: • No heavy lifting of objects (no heavier than 5 lbs.) • No sudden lifting or pushing activities • No sudden jerking motions • No heavy lifting of objects (no heavier than 5 lbs.) • No sudden lifting or pushing activities • No sudden jerking motions Start of strengthening with elastic bands and light weights is defined by the surgeon in the OR report. Do not start strengthening if the operation report states that strengthening should be started later. In patients with poor bone quality, strengthening is occasionally started later. Exercises: 1. Active Range of Motion External Rotation with Band Strengthening 2. Active Range of Motion Internal Rotation with Band Strengthening 3. Row with Resistance Band 4. Towel/Hand-assisted Internal Rotation Stretch 5. Side lying Internal Rotation Stretch at 70 and 90 Degrees 6. Cross-Body Stretch 7. Water (pool) therapy Standing in water with float under arm, lower body into water to help stretch into flexion 8. Standing in water with float under arm, lower body to side to help with external rotation P a g e 6 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase IV Advanced strengthening phase (week 13- 22): About 12 weeks postoperatively, a CT scan is performed to determine whether the bone block has healed. Depending on the findings, the surgeon will decide whether to move on to phase IV. Goals: • Maintain full non-painful active ROM • Advance conditioning exercises for Enhanced functional use of UE • Improve muscular strength, power, and endurance (light weights) • Gradual return to full functional activities • Continue to perform ROM stretching, if motion is not complete Exercises: • Side-lying External Rotation with Towel • Full Can in the Scapular Plane • Prone Scaption • Diagonal • Dynamic Hug • Internal Rotation at 90 Degrees Abduction • Forward Band Punch • Sitting Supported External Rotation at 90 Degrees • Standing Unsupported External Rotation at 90 Degrees • Biceps Curl Phase V – Return to activity phase (week 23): Goals: • Gradual return to strenuous work activities • Gradual return to recreational activities • Gradual return to sport activities • Continue strengthening and stretching • Continue stretching, if motion is tight • May initiate interval sport program
|
You must respond using only information contained in the prompt and provided provided text. Answer with a header followed by bullet points.
EVIDENCE:
P a g e 1 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. PHYSICAL THERAPY PROTOCOL AFTER LATARJET PROCEDURE: The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an open Latarjet procedure. It is no means intended to be a substitute for one’s clinical decision making regarding the progression of a patient’s post-operative course based on their physical exam/findings, individual progress, and/or the presence of postoperative complications. If a clinician requires assistance in the progression of a postoperative patient, they should consult with the referring Surgeon. Depending on the intraoperatively determined bone quality of the bone block, the surgeon defines in the operative report when pendulum exercises, passive range of motion (PROM), active range of motion (AROM) may be started. Accordingly, the postoperative protocol is defined individually for each patient by the surgeon and recorded in the operation report. P a g e 2 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase I – Immediate Post-Surgical Phase (Week 1-4): Goals: • Protect the integrity of the surgical repair • Achieve gradual restoration of passive range of motion (PROM) • Enhance/ensure adequate scapular function Precautions: • No active range of motion (AROM) of Shoulder • Maintain arm in sling, remove only for exercise for elbow, wrist and fingers, only removing for showering. Shower with arm held at side • No lifting of objects • No shoulder motion behind back • No excessive stretching or sudden movements • No supporting of body weight by hands • Keep incision clean and dry • Patient education regarding limited use of upper extremity despite the potential lack of or minimal pain or other symptoms DAY 1 TO 6: • Abduction brace or pillow / sling except when performing distal upper extremity exercises. Begin restoring AROM of elbow/wrist/hand of operative extremity • Sleep in brace or pillow / sling • Scapular clock exercises progressed to scapular isometric exercises • Ball squeezes • Cryotherapy for pain and inflammation -Day 1-2: as much as possible -Day 3-6: post activity, or for pain, or for comfort (IMPORTANT: USE TOWEL TO PROTECT SKIN AND PAUSE CRYOTHERAPY AT LEAST FOR 20 MIN/HOUR TO PREVENT FROSTBITES) P a g e 3 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. DAY 7 TO 28: • Continue use of brace/ pillow / sling • Continue Elbow, wrist, and finger AROM / resisted • Begin shoulder PROM (do not force any painful motion) in first two weeks or as directed by surgeon • Forward flexion and elevation to tolerance • Abduction in the plane of the scapula to tolerance • Internal rotation (IR) to 45 degrees at 30 degrees of abduction • External rotation (ER) in the plane of the scapula from 0-25 degrees or as directed by surgeon; begin at 30- 40 degrees of abduction; respect anterior capsule tissue integrity with ER range of motion; seek guidance from intraoperative measurements of external rotation ROM • Active and manual scapula strengthening exercises: Exercises: shoulder shrug and roll • Pendulum Exercises: (start of pendulum exercises is defined by the surgeon in the OR report. Do not start pendulum exercises if the operation report states that pendulum exercises should be started from the 6th or 8th postoperative week.). pendulum exercises • Start passive ROM (PROM): The PROM exercises should be supervised by the physiotherapist during the first session. In addition, the PROM home exercises should be trained by the physiotherapist. (start of passive ROM is defined by the surgeon in the OR report. Do not start PROM exercises if the operation report states that PROM exercises should be started from the 6th or 8th postoperative week). P a g e 4 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase II – Intermediate Phase (Week 5-8): Goals: • Do not overstress healing tissue • Discontinue brace / sling at end of week 6 • Gradually start active range of motion • Initiate active assisted range of motion (AAROM) under guidance of physical therapy: • Begin light waist level activities Precautions: • No active movement of shoulder till adequate PROM with good mechanics • No lifting with affected upper extremity • No excessive external rotation ROM / stretching. seek guidance from intraoperative measurements of external rotation ROM) • Do not perform activities or strengthening exercises that place an excessive load on the anterior capsule of the shoulder joint (i.e. no pushups, pec fly, etc..) • Do not perform scaption with internal rotation (empty can) during any stage of rehabilitation due to the possibility of impingement • Continued patient education: posture, joint protection, positioning, hygiene, etc. Exercises: 1. flexion in supine position 2. sitting assisted forward reach (elevation) 3. standing wall-assisted forward flexion 4. Cane-Assisted External Rotation at 20 degrees, 45 degrees abduction 5. Doorway Standing External Rotation 6. Scapular plane Abduction to Tolerance 7. Active Range of Motion Forward Flexion in the Scapular Plane 8. Active Range Of Motion External Rotation in Multiple Positions: Side-Lying or Sitting P a g e 5 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase III – strengthening phase (week 9-12): Goal: • Maintain Full AROM and Maintain Full PROM • Gradual restoration of shoulder strength, power, and endurance (Elastic bands) •Gradual return to functional activities Precautions: • No heavy lifting of objects (no heavier than 5 lbs.) • No sudden lifting or pushing activities • No sudden jerking motions • No heavy lifting of objects (no heavier than 5 lbs.) • No sudden lifting or pushing activities • No sudden jerking motions Start of strengthening with elastic bands and light weights is defined by the surgeon in the OR report. Do not start strengthening if the operation report states that strengthening should be started later. In patients with poor bone quality, strengthening is occasionally started later. Exercises: 1. Active Range of Motion External Rotation with Band Strengthening 2. Active Range of Motion Internal Rotation with Band Strengthening 3. Row with Resistance Band 4. Towel/Hand-assisted Internal Rotation Stretch 5. Side lying Internal Rotation Stretch at 70 and 90 Degrees 6. Cross-Body Stretch 7. Water (pool) therapy Standing in water with float under arm, lower body into water to help stretch into flexion 8. Standing in water with float under arm, lower body to side to help with external rotation P a g e 6 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase IV Advanced strengthening phase (week 13- 22): About 12 weeks postoperatively, a CT scan is performed to determine whether the bone block has healed. Depending on the findings, the surgeon will decide whether to move on to phase IV. Goals: • Maintain full non-painful active ROM • Advance conditioning exercises for Enhanced functional use of UE • Improve muscular strength, power, and endurance (light weights) • Gradual return to full functional activities • Continue to perform ROM stretching, if motion is not complete Exercises: • Side-lying External Rotation with Towel • Full Can in the Scapular Plane • Prone Scaption • Diagonal • Dynamic Hug • Internal Rotation at 90 Degrees Abduction • Forward Band Punch • Sitting Supported External Rotation at 90 Degrees • Standing Unsupported External Rotation at 90 Degrees • Biceps Curl Phase V – Return to activity phase (week 23): Goals: • Gradual return to strenuous work activities • Gradual return to recreational activities • Gradual return to sport activities • Continue strengthening and stretching • Continue stretching, if motion is tight • May initiate interval sport program
USER:
What are some exercises for initial strengthening during latarjet recovery?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 22 | 10 | 1,309 | null | 63 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
My computer has been acting weird and idk what's wrong. It doesn't load as fast as it did before. Im gonna get something to clean it up but idk where to start. Like virus scanners or malware? Which would be the best option? After that I'll clean the dust with a vacuum. could that be the issue too? give me three reasons why i should choose each program and three cons.
|
Bitdefender consistently impresses with its ability to identify threats and stop them in their tracks. Malware files are pinpointed even before they begin downloading, web trackers are likewise rooted out and blocked, and if you try to access a site with known threats you'll receive a warning that's hard to miss (or ignore.) AV-Comparatives, a third-party test lab, reported positive results when it put Bitdefender to the test. The solution blocked 99.4% of threats (coming in second only to the likes of Norton and McAfee) and didn't have a huge impact on the speed of computer processes. When I put Bitdefender under the microscope myself, I saw it block real-world ransomware before it could wreak havoc. However, I did notice that the Ransomware Remediation feature isn't enabled by default—so you'll need to dive into the settings to ensure that your files remain secure. Earlier this year, Bitdefender released a decryptor for the MortalKombat ransomware—free of charge, providing the company's commitment to countering cyberattacks. Victims across the US were targeted at random by ransomware, which spread through bogus emails containing a .ZIP attachment and a BAT loader script. To tackle this threat, the decryptor backs up affected files before attempting decryption, just in case, and can be executed via the command line. Bitdefender gets straight to work with a full scan when you start using it, and combs through your system in its entirety to look for threats and intruders. This is par for the course, although Bitdefender took almost a full hour to complete a scan of 50 Gb executable files. It's possible to configure scans, customize them, and set them to run on a schedule or on-demand, and Quick Scans can even be run once a day, or weekly, and dig into individual files. I found Bitdefender incredibly easy to use—so even if you're new to the world of antivirus, you'll have no trouble navigating sleek and well-designed apps. You can even customize the dashboard by adding or removing default features. So, if you don't make use of the VPN, you can substitute it in a few clicks for the password manager or scan manager. Most of the features you'll need are already enabled by default, too, which means you won't have to spend ages configuring each and every setting. However, if you do need help with particular tools, you can count on Bitdefender's in-program tutorials to help you make the most of these privacy-enhancing functionalities. Bitdefender's Total Security plan is available from $39.99 for a single year—although the price does jump to $95 after this introductory period. However, you can take advantage of a 30-day money-back guarantee to put the solution through its paces, run your own tests, and see whether its suite of tools is worth the investment. Norton is tough on threats and has earned excellent scores in several third-party protection tests, including our own. I was also impressed with Norton’s scan speed—it took 29 minutes for the solution to complete its initial scan of 50 Gb of files. It’s not the quickest antivirus I've seen, but still beats the likes of Bitdefender and Avast. Norton shines when it comes to identifying threats, however. My tests, and those conducted by AV-Compatatives, found that it blocked all attacks before the malware could be downloaded. Norton is also incredibly good at blocking dangerous URLs and preventing you from landing on a page that's determined to ruin your day. You'll see a warning message with additional information about the malware and a heads-up about other sites that contain the same threat. The Safe Web browser extension gives you even more peace of mind by adding site ratings to search results, helping you steer clear of dodgy domains. Norton wants to help you get better at identifying and avoiding threats, too, as evidenced by the development of an AI-powered chatbot. Dubbed "Norton Genie", the bot can let you know whether that suspicious email you received is legitimate or a phishing attempt—and all you have to do is send it a screenshot or copy and paste some of the text. The Norton Secure VPN isn't my favorite VPN on the market, but does a solid job of keeping your IP address hidden, your browsing private, and can even unblock a decent amount of streaming services. Combining the VPN with the intelligent firewall really maximizes your digital security, and you'll be alerted right away if an untrustworthy program attempts to connect to the internet. You can allow or block the connection, and Norton gives you plenty of detail (like the age of the program and the URL it's attempting to reach) to help you make a security-conscious decision. Avast One is the newest offering from Avast, and comes packed with all of the malware protection, advanced features, and ease of use you'd expect from an industry veteran. You'll also be able to use the solution on any Windows, Mac, Android, or iOS device. Avast One's scan speeds were pretty average, taking 32 minutes to complete a scan of 50 Gb of executable files. These scans are hugely customizable, too, and give you granular control over where you want the solution to focus. Smart Scans take a few seconds to check for malware and dodgy browser add-ons, Targeted Scans look at specified folders and files, and Full Scans comb through your entire system. Very few providers can keep up with Avast One when it comes to identifying and removing malware. None of my tests were able to crack its protection, and the latest report from AV-Comparitives revealed that it scored an outstanding 99.97% detection rate. So, you can rest assured that no threats will make it through to your device unseen. Avast One shores up its security with a firewall that keeps tabs on your network traffic to thwart hackers, and can block your access to malicious websites to prevent infections. I also like that its Ransomware Shield was able to find folders containing user documents and automatically add them to its protect list. The solution rounds out its antivirus package with useful extras—and the sheer amount of these features is what makes Avast One worth checking out. All of its paid subscriptions come with the HideMyAss!-powered SecureLine VPN, but if you're on the Essential plan, you'll have to deal with a limit of 5 Gb per week and a single server location. Despite these setbacks, this is still more than you need to catch up on your favorite Netflix shows. Opt for a more expensive subscription and the VPN breaks free of these shackles. You'll have more than 50 server locations to choose from, and you'll also be alerted if you try to access a banking site, sensitive domain, or even a store without switching the VPN on first. This is a lifesaver if you want to go about your business without leaving an identifiable trail. Avast One's features just keep coming. Subscribers get a password manager that'll check for compromised details, parental controls, webcam monitoring, and anti-phishing tools that ensure all aspects of your online life are secure. If you're ready to take the plunge, there are three paid subscriptions to choose from. The Individual plan gets you access to all of the aforementioned tools and licenses for five devices, whereas the Family and Premium plans bump this number up to thirty (the latter also comes with an identity monitory that'll let you know if your data ends up on the dark web). Thanks to the Essential plan, however, you can try a limited version of the product without paying a penny.
|
[question] My computer has been acting weird and idk what's wrong. It doesn't load as fast as it did before. Im gonna get something to clean it up but idk where to start. Like virus scanners or malware? Which would be the best option? After that I'll clean the dust with a vacuum. could that be the issue too? give me three reasons why i should choose each program and three cons. ===================== [text] Bitdefender consistently impresses with its ability to identify threats and stop them in their tracks. Malware files are pinpointed even before they begin downloading, web trackers are likewise rooted out and blocked, and if you try to access a site with known threats you'll receive a warning that's hard to miss (or ignore.) AV-Comparatives, a third-party test lab, reported positive results when it put Bitdefender to the test. The solution blocked 99.4% of threats (coming in second only to the likes of Norton and McAfee) and didn't have a huge impact on the speed of computer processes. When I put Bitdefender under the microscope myself, I saw it block real-world ransomware before it could wreak havoc. However, I did notice that the Ransomware Remediation feature isn't enabled by default—so you'll need to dive into the settings to ensure that your files remain secure. Earlier this year, Bitdefender released a decryptor for the MortalKombat ransomware—free of charge, providing the company's commitment to countering cyberattacks. Victims across the US were targeted at random by ransomware, which spread through bogus emails containing a .ZIP attachment and a BAT loader script. To tackle this threat, the decryptor backs up affected files before attempting decryption, just in case, and can be executed via the command line. Bitdefender gets straight to work with a full scan when you start using it, and combs through your system in its entirety to look for threats and intruders. This is par for the course, although Bitdefender took almost a full hour to complete a scan of 50 Gb executable files. It's possible to configure scans, customize them, and set them to run on a schedule or on-demand, and Quick Scans can even be run once a day, or weekly, and dig into individual files. I found Bitdefender incredibly easy to use—so even if you're new to the world of antivirus, you'll have no trouble navigating sleek and well-designed apps. You can even customize the dashboard by adding or removing default features. So, if you don't make use of the VPN, you can substitute it in a few clicks for the password manager or scan manager. Most of the features you'll need are already enabled by default, too, which means you won't have to spend ages configuring each and every setting. However, if you do need help with particular tools, you can count on Bitdefender's in-program tutorials to help you make the most of these privacy-enhancing functionalities. Bitdefender's Total Security plan is available from $39.99 for a single year—although the price does jump to $95 after this introductory period. However, you can take advantage of a 30-day money-back guarantee to put the solution through its paces, run your own tests, and see whether its suite of tools is worth the investment. Norton is tough on threats and has earned excellent scores in several third-party protection tests, including our own. I was also impressed with Norton’s scan speed—it took 29 minutes for the solution to complete its initial scan of 50 Gb of files. It’s not the quickest antivirus I've seen, but still beats the likes of Bitdefender and Avast. Norton shines when it comes to identifying threats, however. My tests, and those conducted by AV-Compatatives, found that it blocked all attacks before the malware could be downloaded. Norton is also incredibly good at blocking dangerous URLs and preventing you from landing on a page that's determined to ruin your day. You'll see a warning message with additional information about the malware and a heads-up about other sites that contain the same threat. The Safe Web browser extension gives you even more peace of mind by adding site ratings to search results, helping you steer clear of dodgy domains. Norton wants to help you get better at identifying and avoiding threats, too, as evidenced by the development of an AI-powered chatbot. Dubbed "Norton Genie", the bot can let you know whether that suspicious email you received is legitimate or a phishing attempt—and all you have to do is send it a screenshot or copy and paste some of the text. The Norton Secure VPN isn't my favorite VPN on the market, but does a solid job of keeping your IP address hidden, your browsing private, and can even unblock a decent amount of streaming services. Combining the VPN with the intelligent firewall really maximizes your digital security, and you'll be alerted right away if an untrustworthy program attempts to connect to the internet. You can allow or block the connection, and Norton gives you plenty of detail (like the age of the program and the URL it's attempting to reach) to help you make a security-conscious decision. Avast One is the newest offering from Avast, and comes packed with all of the malware protection, advanced features, and ease of use you'd expect from an industry veteran. You'll also be able to use the solution on any Windows, Mac, Android, or iOS device. Avast One's scan speeds were pretty average, taking 32 minutes to complete a scan of 50 Gb of executable files. These scans are hugely customizable, too, and give you granular control over where you want the solution to focus. Smart Scans take a few seconds to check for malware and dodgy browser add-ons, Targeted Scans look at specified folders and files, and Full Scans comb through your entire system. Very few providers can keep up with Avast One when it comes to identifying and removing malware. None of my tests were able to crack its protection, and the latest report from AV-Comparitives revealed that it scored an outstanding 99.97% detection rate. So, you can rest assured that no threats will make it through to your device unseen. Avast One shores up its security with a firewall that keeps tabs on your network traffic to thwart hackers, and can block your access to malicious websites to prevent infections. I also like that its Ransomware Shield was able to find folders containing user documents and automatically add them to its protect list. The solution rounds out its antivirus package with useful extras—and the sheer amount of these features is what makes Avast One worth checking out. All of its paid subscriptions come with the HideMyAss!-powered SecureLine VPN, but if you're on the Essential plan, you'll have to deal with a limit of 5 Gb per week and a single server location. Despite these setbacks, this is still more than you need to catch up on your favorite Netflix shows. Opt for a more expensive subscription and the VPN breaks free of these shackles. You'll have more than 50 server locations to choose from, and you'll also be alerted if you try to access a banking site, sensitive domain, or even a store without switching the VPN on first. This is a lifesaver if you want to go about your business without leaving an identifiable trail. Avast One's features just keep coming. Subscribers get a password manager that'll check for compromised details, parental controls, webcam monitoring, and anti-phishing tools that ensure all aspects of your online life are secure. If you're ready to take the plunge, there are three paid subscriptions to choose from. The Individual plan gets you access to all of the aforementioned tools and licenses for five devices, whereas the Family and Premium plans bump this number up to thirty (the latter also comes with an identity monitory that'll let you know if your data ends up on the dark web). Thanks to the Essential plan, however, you can try a limited version of the product without paying a penny. https://www.techradar.com/best/best-antivirus ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
Bitdefender consistently impresses with its ability to identify threats and stop them in their tracks. Malware files are pinpointed even before they begin downloading, web trackers are likewise rooted out and blocked, and if you try to access a site with known threats you'll receive a warning that's hard to miss (or ignore.) AV-Comparatives, a third-party test lab, reported positive results when it put Bitdefender to the test. The solution blocked 99.4% of threats (coming in second only to the likes of Norton and McAfee) and didn't have a huge impact on the speed of computer processes. When I put Bitdefender under the microscope myself, I saw it block real-world ransomware before it could wreak havoc. However, I did notice that the Ransomware Remediation feature isn't enabled by default—so you'll need to dive into the settings to ensure that your files remain secure. Earlier this year, Bitdefender released a decryptor for the MortalKombat ransomware—free of charge, providing the company's commitment to countering cyberattacks. Victims across the US were targeted at random by ransomware, which spread through bogus emails containing a .ZIP attachment and a BAT loader script. To tackle this threat, the decryptor backs up affected files before attempting decryption, just in case, and can be executed via the command line. Bitdefender gets straight to work with a full scan when you start using it, and combs through your system in its entirety to look for threats and intruders. This is par for the course, although Bitdefender took almost a full hour to complete a scan of 50 Gb executable files. It's possible to configure scans, customize them, and set them to run on a schedule or on-demand, and Quick Scans can even be run once a day, or weekly, and dig into individual files. I found Bitdefender incredibly easy to use—so even if you're new to the world of antivirus, you'll have no trouble navigating sleek and well-designed apps. You can even customize the dashboard by adding or removing default features. So, if you don't make use of the VPN, you can substitute it in a few clicks for the password manager or scan manager. Most of the features you'll need are already enabled by default, too, which means you won't have to spend ages configuring each and every setting. However, if you do need help with particular tools, you can count on Bitdefender's in-program tutorials to help you make the most of these privacy-enhancing functionalities. Bitdefender's Total Security plan is available from $39.99 for a single year—although the price does jump to $95 after this introductory period. However, you can take advantage of a 30-day money-back guarantee to put the solution through its paces, run your own tests, and see whether its suite of tools is worth the investment. Norton is tough on threats and has earned excellent scores in several third-party protection tests, including our own. I was also impressed with Norton’s scan speed—it took 29 minutes for the solution to complete its initial scan of 50 Gb of files. It’s not the quickest antivirus I've seen, but still beats the likes of Bitdefender and Avast. Norton shines when it comes to identifying threats, however. My tests, and those conducted by AV-Compatatives, found that it blocked all attacks before the malware could be downloaded. Norton is also incredibly good at blocking dangerous URLs and preventing you from landing on a page that's determined to ruin your day. You'll see a warning message with additional information about the malware and a heads-up about other sites that contain the same threat. The Safe Web browser extension gives you even more peace of mind by adding site ratings to search results, helping you steer clear of dodgy domains. Norton wants to help you get better at identifying and avoiding threats, too, as evidenced by the development of an AI-powered chatbot. Dubbed "Norton Genie", the bot can let you know whether that suspicious email you received is legitimate or a phishing attempt—and all you have to do is send it a screenshot or copy and paste some of the text. The Norton Secure VPN isn't my favorite VPN on the market, but does a solid job of keeping your IP address hidden, your browsing private, and can even unblock a decent amount of streaming services. Combining the VPN with the intelligent firewall really maximizes your digital security, and you'll be alerted right away if an untrustworthy program attempts to connect to the internet. You can allow or block the connection, and Norton gives you plenty of detail (like the age of the program and the URL it's attempting to reach) to help you make a security-conscious decision. Avast One is the newest offering from Avast, and comes packed with all of the malware protection, advanced features, and ease of use you'd expect from an industry veteran. You'll also be able to use the solution on any Windows, Mac, Android, or iOS device. Avast One's scan speeds were pretty average, taking 32 minutes to complete a scan of 50 Gb of executable files. These scans are hugely customizable, too, and give you granular control over where you want the solution to focus. Smart Scans take a few seconds to check for malware and dodgy browser add-ons, Targeted Scans look at specified folders and files, and Full Scans comb through your entire system. Very few providers can keep up with Avast One when it comes to identifying and removing malware. None of my tests were able to crack its protection, and the latest report from AV-Comparitives revealed that it scored an outstanding 99.97% detection rate. So, you can rest assured that no threats will make it through to your device unseen. Avast One shores up its security with a firewall that keeps tabs on your network traffic to thwart hackers, and can block your access to malicious websites to prevent infections. I also like that its Ransomware Shield was able to find folders containing user documents and automatically add them to its protect list. The solution rounds out its antivirus package with useful extras—and the sheer amount of these features is what makes Avast One worth checking out. All of its paid subscriptions come with the HideMyAss!-powered SecureLine VPN, but if you're on the Essential plan, you'll have to deal with a limit of 5 Gb per week and a single server location. Despite these setbacks, this is still more than you need to catch up on your favorite Netflix shows. Opt for a more expensive subscription and the VPN breaks free of these shackles. You'll have more than 50 server locations to choose from, and you'll also be alerted if you try to access a banking site, sensitive domain, or even a store without switching the VPN on first. This is a lifesaver if you want to go about your business without leaving an identifiable trail. Avast One's features just keep coming. Subscribers get a password manager that'll check for compromised details, parental controls, webcam monitoring, and anti-phishing tools that ensure all aspects of your online life are secure. If you're ready to take the plunge, there are three paid subscriptions to choose from. The Individual plan gets you access to all of the aforementioned tools and licenses for five devices, whereas the Family and Premium plans bump this number up to thirty (the latter also comes with an identity monitory that'll let you know if your data ends up on the dark web). Thanks to the Essential plan, however, you can try a limited version of the product without paying a penny.
USER:
My computer has been acting weird and idk what's wrong. It doesn't load as fast as it did before. Im gonna get something to clean it up but idk where to start. Like virus scanners or malware? Which would be the best option? After that I'll clean the dust with a vacuum. could that be the issue too? give me three reasons why i should choose each program and three cons.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 71 | 1,261 | null | 735 |
Do not draw on external or prior knowledge to respond to the user prompt. Only use the context block. Respond in five sentences or fewer.
|
Paraphrase the measures the company has taken to improve the quality of life of cows.
|
In 2022, 50 farms in Ben & Jerry’s Northeast dairy supply chain participated in the Milk with Dignity Program. They employed over 200 farmworkers covered through the program. During 2022, participating farm owners and farmworkers made over 300 inquiries to MDSC, 25% of which related to workplace health and safety, 22% to wages and related issues, 12% to schedules and rest, and 18% to housing conditions. Additionally, since the program launched, over $4.4 million from Ben & Jerry’s has supported farms’ improvements to working and housing conditions, including $2.9 million in raises to meet minimum wages (which reached $12.55 per hour in Vermont in 2022) and $1.49 million in bonuses, paid vacation and sick time, housing improvements, new personal protective equipment, and other safety improvements. Farms have continued to make concrete progress toward full compliance with standards such as the rights to at least eight consecutive hours of per workday, one day of per week, and comprehensive occupational safety and health protections. Excellent Life for Cows The care for dairy cows is critically important and we rely on independent third-party standards to advance animal care in our supply. In 2021 and 2022, we audited farms to both our Caring Dairy Standard and the Global Animal Partnership (GAP) Dairy care standard. The audits identifed specifc opportunities to improve care while also highlighting industry-level barriers that may impede broader adoption of higher-level certifcations. Our farm partners are interested in continuous improvements with approximately 20% becoming GAP certifed, a not insignifcant step above standard industry performance, after undergoing the rigorous audits. Regenerative and Circular Agriculture Our farm partners recognize the growing pressure to fnd viable solutions to the climate crisis and are thoughtful and engaged collaborators in trialing new on-farm management practices to track and increase carbon sequestration, biodiversity, and build soil health. In preparation for a deeper dive into low carbon dairy, we conducted individual farm greenhouse gas (GHG) footprints using the Cool Farm Tool. 2022 also marked the third, and last, year of Prove It Projects carried out by Ben & Jerry’s Caring Dairy Farmer Innovators. Prove It Projects were designed to provide farmers with insights and opportunities to test run practices in regenerative concepts in the real-life laboratory of their own farms. The practices farmers “proved” to have value are then adopted into their own farm management and shared with the broader Ben & Jerry’s community. In 2022, each of the 27 Farmer Innovators selected two on-farm research projects from a list of 11 previously identifed projects, implementing a total of 54 projects. Several practices farmers tested stood out as providing benefcial outcomes: Nitrogen inhibitors showed advantages in yield and reduced input needs. • Changes to grazing management could help increase on-farm forage and cut production costs. • Multi-species cover crops were more viable with diferent planting techniques. • Farmers are still addressing habitat biodiversity, in what is a multi-year endeavor. In all, the three years of Prove It Projects have provided farmers with valuable insights while also informing the next iteration of Ben & Jerry’s farmer innovation pilots in hopes to drive Low Carbon Dairy farming.
|
system instructions: Do not draw on external or prior knowledge to respond to the user prompt. Only use the context block. Respond in five sentences or fewer. user prompt: Paraphrase the measures the company has taken to improve the quality of life of cows. context block: In 2022, 50 farms in Ben & Jerry’s Northeast dairy supply chain participated in the Milk with Dignity Program. They employed over 200 farmworkers covered through the program. During 2022, participating farm owners and farmworkers made over 300 inquiries to MDSC, 25% of which related to workplace health and safety, 22% to wages and related issues, 12% to schedules and rest, and 18% to housing conditions. Additionally, since the program launched, over $4.4 million from Ben & Jerry’s has supported farms’ improvements to working and housing conditions, including $2.9 million in raises to meet minimum wages (which reached $12.55 per hour in Vermont in 2022) and $1.49 million in bonuses, paid vacation and sick time, housing improvements, new personal protective equipment, and other safety improvements. Farms have continued to make concrete progress toward full compliance with standards such as the rights to at least eight consecutive hours of per workday, one day of per week, and comprehensive occupational safety and health protections. Excellent Life for Cows The care for dairy cows is critically important and we rely on independent third-party standards to advance animal care in our supply. In 2021 and 2022, we audited farms to both our Caring Dairy Standard and the Global Animal Partnership (GAP) Dairy care standard. The audits identifed specifc opportunities to improve care while also highlighting industry-level barriers that may impede broader adoption of higher-level certifcations. Our farm partners are interested in continuous improvements with approximately 20% becoming GAP certifed, a not insignifcant step above standard industry performance, after undergoing the rigorous audits. Regenerative and Circular Agriculture Our farm partners recognize the growing pressure to fnd viable solutions to the climate crisis and are thoughtful and engaged collaborators in trialing new on-farm management practices to track and increase carbon sequestration, biodiversity, and build soil health. In preparation for a deeper dive into low carbon dairy, we conducted individual farm greenhouse gas (GHG) footprints using the Cool Farm Tool. 2022 also marked the third, and last, year of Prove It Projects carried out by Ben & Jerry’s Caring Dairy Farmer Innovators. Prove It Projects were designed to provide farmers with insights and opportunities to test run practices in regenerative concepts in the real-life laboratory of their own farms. The practices farmers “proved” to have value are then adopted into their own farm management and shared with the broader Ben & Jerry’s community. In 2022, each of the 27 Farmer Innovators selected two on-farm research projects from a list of 11 previously identifed projects, implementing a total of 54 projects. Several practices farmers tested stood out as providing benefcial outcomes: Nitrogen inhibitors showed advantages in yield and reduced input needs. • Changes to grazing management could help increase on-farm forage and cut production costs. • Multi-species cover crops were more viable with diferent planting techniques. • Farmers are still addressing habitat biodiversity, in what is a multi-year endeavor. In all, the three years of Prove It Projects have provided farmers with valuable insights while also informing the next iteration of Ben & Jerry’s farmer innovation pilots in hopes to drive Low Carbon Dairy farming.
|
Do not draw on external or prior knowledge to respond to the user prompt. Only use the context block. Respond in five sentences or fewer.
EVIDENCE:
In 2022, 50 farms in Ben & Jerry’s Northeast dairy supply chain participated in the Milk with Dignity Program. They employed over 200 farmworkers covered through the program. During 2022, participating farm owners and farmworkers made over 300 inquiries to MDSC, 25% of which related to workplace health and safety, 22% to wages and related issues, 12% to schedules and rest, and 18% to housing conditions. Additionally, since the program launched, over $4.4 million from Ben & Jerry’s has supported farms’ improvements to working and housing conditions, including $2.9 million in raises to meet minimum wages (which reached $12.55 per hour in Vermont in 2022) and $1.49 million in bonuses, paid vacation and sick time, housing improvements, new personal protective equipment, and other safety improvements. Farms have continued to make concrete progress toward full compliance with standards such as the rights to at least eight consecutive hours of per workday, one day of per week, and comprehensive occupational safety and health protections. Excellent Life for Cows The care for dairy cows is critically important and we rely on independent third-party standards to advance animal care in our supply. In 2021 and 2022, we audited farms to both our Caring Dairy Standard and the Global Animal Partnership (GAP) Dairy care standard. The audits identifed specifc opportunities to improve care while also highlighting industry-level barriers that may impede broader adoption of higher-level certifcations. Our farm partners are interested in continuous improvements with approximately 20% becoming GAP certifed, a not insignifcant step above standard industry performance, after undergoing the rigorous audits. Regenerative and Circular Agriculture Our farm partners recognize the growing pressure to fnd viable solutions to the climate crisis and are thoughtful and engaged collaborators in trialing new on-farm management practices to track and increase carbon sequestration, biodiversity, and build soil health. In preparation for a deeper dive into low carbon dairy, we conducted individual farm greenhouse gas (GHG) footprints using the Cool Farm Tool. 2022 also marked the third, and last, year of Prove It Projects carried out by Ben & Jerry’s Caring Dairy Farmer Innovators. Prove It Projects were designed to provide farmers with insights and opportunities to test run practices in regenerative concepts in the real-life laboratory of their own farms. The practices farmers “proved” to have value are then adopted into their own farm management and shared with the broader Ben & Jerry’s community. In 2022, each of the 27 Farmer Innovators selected two on-farm research projects from a list of 11 previously identifed projects, implementing a total of 54 projects. Several practices farmers tested stood out as providing benefcial outcomes: Nitrogen inhibitors showed advantages in yield and reduced input needs. • Changes to grazing management could help increase on-farm forage and cut production costs. • Multi-species cover crops were more viable with diferent planting techniques. • Farmers are still addressing habitat biodiversity, in what is a multi-year endeavor. In all, the three years of Prove It Projects have provided farmers with valuable insights while also informing the next iteration of Ben & Jerry’s farmer innovation pilots in hopes to drive Low Carbon Dairy farming.
USER:
Paraphrase the measures the company has taken to improve the quality of life of cows.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 25 | 15 | 517 | null | 500 |
You formulate answers based solely on the material provided by the user without reference to external facts or knowledge.
|
Can you list all the knife brands that sell knives suitable for sharpening at a 14-degree angle? List them according to the minimum angle at which their knives can be sharpened, starting with the smallest.
|
Knife sharpening angles Manufacturer´s recommendations The recommended angle of your knife is often written on the knife’s packaging. If you don’t find it there you can often find it on the manufacturer’s website. Below you’ll find the angle recommendations from some “well-known” knife manufacturers. Please note that despite the fact that the vast majority of knives are dual-bevel, knife manufacturers list their edge angles based on the number of degrees of a single bevel. For example, dual bevel listed as 15 degrees is actually two 15-degree angles, or 30 degrees total. Therefore, all angles in this document is listed as single bevel angles. Cangshan Cangshan knives are sharpened to an Asian-style 16-degree edge. Learn more at their website. Chroma A Chroma knife should be sharpened to 10-20 degrees. Learn more at their website. F. DICK (Friedr. DICK) Dick recommends 15-20 degrees for their DICK Hoof Knives. Learn more at their website. Fischer-Bargoin Fischer-Bargoin recommends an angle of 15-20 degrees. Learn more at their website. Global Global recommends an angle of 10-15 degrees. Learn more at their website. Korin Korin knives recommends a 10-20 degrees angle on their Western style knives. For their traditional Japanese knife see please go to the website. Learn more at their website. MAC MAC knives have factory edges of 15 degrees. Their recommendation is 10-15 degrees. Learn more at their website. Messermeister Messermeister Elité and Park Plaza knives have a 15-degree angle. Learn more at their website. Starting in 2018, the Four Seasons knife collection now features a 15-degree angle. Learn more at their website. Shun and Kai Shun recommends a 16-degree angle of Shun and Kai double-beveled knives. Learn more at their website. Victorinox Victorinox indicates the total cutting angle. Sharpening a Victorinox should be between 30 to 40 degrees, which is 15-20 degrees on each side. Learn more at their website. Wüsthof The sharpening angle for standard blades is 14 degrees, and for Asian-style blades (Santokus, Nakiris, Chai Daos) it’s 10 degrees. Learn more at their website. Zwilling J. A. Henckels and Miyabi The angle between the blade and the steel should be approximately 15 degrees for ZWILLING knives. Santoku knives and all MIYABI and Kramer made by ZWILLING knives need to be 9-12 degrees. Learn more at their website. Set the existing knife angle using Tormek Marker Method If you want to repeat an existing angle but don’t know the angle of your knife, the easiest way is to use the Tormek Marker Method with a black permanent marker. By following three simple steps you can quickly get the correct angle. 1. Color the bevel, mount the knife in the jig and place it onto the Universal Support. 2. Turn the grinding wheel by hand and check where the coloring is removed, 3. Raise or lower the Universal Support until the coloring is removed from the tip to the heel. Now, the angle is just right and it’s time to start sharpening!
|
You formulate answers based solely on the material provided by the user without reference to external facts or knowledge. Can you list all the knife brands that sell knives suitable for sharpening at a 14-degree angle? List them according to the minimum angle at which their knives can be sharpened, starting with the smallest. Knife sharpening angles Manufacturer´s recommendations The recommended angle of your knife is often written on the knife’s packaging. If you don’t find it there you can often find it on the manufacturer’s website. Below you’ll find the angle recommendations from some “well-known” knife manufacturers. Please note that despite the fact that the vast majority of knives are dual-bevel, knife manufacturers list their edge angles based on the number of degrees of a single bevel. For example, dual bevel listed as 15 degrees is actually two 15-degree angles, or 30 degrees total. Therefore, all angles in this document is listed as single bevel angles. Cangshan Cangshan knives are sharpened to an Asian-style 16-degree edge. Learn more at their website. Chroma A Chroma knife should be sharpened to 10-20 degrees. Learn more at their website. F. DICK (Friedr. DICK) Dick recommends 15-20 degrees for their DICK Hoof Knives. Learn more at their website. Fischer-Bargoin Fischer-Bargoin recommends an angle of 15-20 degrees. Learn more at their website. Global Global recommends an angle of 10-15 degrees. Learn more at their website. Korin Korin knives recommends a 10-20 degrees angle on their Western style knives. For their traditional Japanese knife see please go to the website. Learn more at their website. MAC MAC knives have factory edges of 15 degrees. Their recommendation is 10-15 degrees. Learn more at their website. Messermeister Messermeister Elité and Park Plaza knives have a 15-degree angle. Learn more at their website. Starting in 2018, the Four Seasons knife collection now features a 15-degree angle. Learn more at their website. Shun and Kai Shun recommends a 16-degree angle of Shun and Kai double-beveled knives. Learn more at their website. Victorinox Victorinox indicates the total cutting angle. Sharpening a Victorinox should be between 30 to 40 degrees, which is 15-20 degrees on each side. Learn more at their website. Wüsthof The sharpening angle for standard blades is 14 degrees, and for Asian-style blades (Santokus, Nakiris, Chai Daos) it’s 10 degrees. Learn more at their website. Zwilling J. A. Henckels and Miyabi The angle between the blade and the steel should be approximately 15 degrees for ZWILLING knives. Santoku knives and all MIYABI and Kramer made by ZWILLING knives need to be 9-12 degrees. Learn more at their website. Set the existing knife angle using Tormek Marker Method If you want to repeat an existing angle but don’t know the angle of your knife, the easiest way is to use the Tormek Marker Method with a black permanent marker. By following three simple steps you can quickly get the correct angle. 1. Color the bevel, mount the knife in the jig and place it onto the Universal Support. 2. Turn the grinding wheel by hand and check where the coloring is removed, 3. Raise or lower the Universal Support until the coloring is removed from the tip to the heel. Now, the angle is just right and it’s time to start sharpening!
|
You formulate answers based solely on the material provided by the user without reference to external facts or knowledge.
EVIDENCE:
Knife sharpening angles Manufacturer´s recommendations The recommended angle of your knife is often written on the knife’s packaging. If you don’t find it there you can often find it on the manufacturer’s website. Below you’ll find the angle recommendations from some “well-known” knife manufacturers. Please note that despite the fact that the vast majority of knives are dual-bevel, knife manufacturers list their edge angles based on the number of degrees of a single bevel. For example, dual bevel listed as 15 degrees is actually two 15-degree angles, or 30 degrees total. Therefore, all angles in this document is listed as single bevel angles. Cangshan Cangshan knives are sharpened to an Asian-style 16-degree edge. Learn more at their website. Chroma A Chroma knife should be sharpened to 10-20 degrees. Learn more at their website. F. DICK (Friedr. DICK) Dick recommends 15-20 degrees for their DICK Hoof Knives. Learn more at their website. Fischer-Bargoin Fischer-Bargoin recommends an angle of 15-20 degrees. Learn more at their website. Global Global recommends an angle of 10-15 degrees. Learn more at their website. Korin Korin knives recommends a 10-20 degrees angle on their Western style knives. For their traditional Japanese knife see please go to the website. Learn more at their website. MAC MAC knives have factory edges of 15 degrees. Their recommendation is 10-15 degrees. Learn more at their website. Messermeister Messermeister Elité and Park Plaza knives have a 15-degree angle. Learn more at their website. Starting in 2018, the Four Seasons knife collection now features a 15-degree angle. Learn more at their website. Shun and Kai Shun recommends a 16-degree angle of Shun and Kai double-beveled knives. Learn more at their website. Victorinox Victorinox indicates the total cutting angle. Sharpening a Victorinox should be between 30 to 40 degrees, which is 15-20 degrees on each side. Learn more at their website. Wüsthof The sharpening angle for standard blades is 14 degrees, and for Asian-style blades (Santokus, Nakiris, Chai Daos) it’s 10 degrees. Learn more at their website. Zwilling J. A. Henckels and Miyabi The angle between the blade and the steel should be approximately 15 degrees for ZWILLING knives. Santoku knives and all MIYABI and Kramer made by ZWILLING knives need to be 9-12 degrees. Learn more at their website. Set the existing knife angle using Tormek Marker Method If you want to repeat an existing angle but don’t know the angle of your knife, the easiest way is to use the Tormek Marker Method with a black permanent marker. By following three simple steps you can quickly get the correct angle. 1. Color the bevel, mount the knife in the jig and place it onto the Universal Support. 2. Turn the grinding wheel by hand and check where the coloring is removed, 3. Raise or lower the Universal Support until the coloring is removed from the tip to the heel. Now, the angle is just right and it’s time to start sharpening!
USER:
Can you list all the knife brands that sell knives suitable for sharpening at a 14-degree angle? List them according to the minimum angle at which their knives can be sharpened, starting with the smallest.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 19 | 35 | 489 | null | 1 |
Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here.
|
What percentage of Canadians have at least one credit card, and how many pay them off monthly?
|
The Bottom Line Credit cards offer valuable benefits for both consumers and retailers. And the majority of Canadians use their credit card as a method of payment rather than a means of borrowing. Credit card benefits For Consumers A credit card is a convenient and flexible payment tool accepted in more than 200 countries and at millions of locations worldwide. Benefits include: • Access to unsecured credit (no collateral required against amounts charged). • Interest-free payment from time of purchase to the end of the billing period. • Instant payment of purchases, allowing for instant receipt of goods and services. Focus: Credit Cards: Statistics and Facts Focus Sheet • Credit cards provide interest-free credit from the time of purchase to the end of the billing period • More than 70% of Canadians pay their credit card balance in full each month1 , so for them the interest rate is zero • For those who choose to carry a balance: o Credit cards offer access to unsecured credit (no collateral required) o There are many low interest rate cards on the market and over 30 of those cards have an interest rate of under 13% FAST FACTS • Coverage for purchases if the item is damaged, stolen or not delivered within 90 days. • 24/7 access. • Fraud protection with zero liability to the consumer in cases of fraud. • Other rewards and benefits, such as air travel points, car insurance, damage and loss insurance and extended warranty programs. For retailers Retailers are not required to accept credit cards, but do so to provide payments options for their customers. Retailers that do accept credit cards receive many benefits, including: • Reaching a large customer base – Credit cards are the preferred method of payment for many customers, and customers will select retailers that allow them to choose their preferred method of payment. • Fast, guaranteed payment, which can reduce line-ups at checkout. If every credit card transaction took an extra 30 seconds, it would use up an additional 27 million hours of staff time each year. • The ability of accepting credit without worrying about the creditworthiness of customers, insufficient funds or outstanding receivables. • Reduced cash on hand and cash handling time and costs, including counting cash at the end of the day, armoured transport, higher likelihood of theft and pilfering and potential mistakes by cashiers. • Expanded markets; ability to sell to customers throughout Canada and around the world in the currency used by the retailer. • Access to innovative new payments – innovations in payment options introduced by banks and credit card companies, such as contactless cards and online and mobile payments, benefit retailers and make it easier for customer to make purchases. Moreover, a very large majority (94 per cent) of merchants say their business benefits from accepting credit cards.2 • Sixty-nine per cent of merchants say they benefit from letting customers earn rewards on their purchases. 3 Competition and choice When making a purchase, consumers can choose to use cash, cheques, debit cards, credit cards as well as electronic payments services like PayPal and Interac Online. Nearly nine out of ten adult Canadians have at least one credit card4 and this method of payment is the choice for the overwhelming majority of retail e-commerce transactions. When it comes to choosing a credit card, banks offer consumers a wide variety of products. Customers may choose among standard cards without an annual fee, premium cards that offer rewards and features, and low-rate cards if the interest rate is a key consideration influencing the card choice. • Hundreds of institutions in Canada, including banks, credit unions, retailers, caisses populaires, trust companies and finance companies offer credit card products. • 76.2 million Visa and MasterCard cards are in circulation in Canada. 5 • There are many low-rate cards on the market and over 30 of those cards have an interest rate of under 13%. • Eight in 10 (84 per cent) consumers are satisfied with their credit cards and roughly the same proportion (86 per cent) say they offer great value. 6 • Canadians appreciate their rewards points programs and the majority use them to help make a family vacation more attainable with travel points, save money on their grocery bills with cash-back rewards or use their rewards points to donate to a favourite charity. • Research has found that eighty-three per cent of consumers use a credit card that provides them with rewards. 7 • 58 per cent of Canadians who are frequent credit card users listed “receiving discounts/loyalty points/rewards’’ as their main reason for frequently using credit cards for purchases. 8 • Roughly two-thirds of consumers (65 per cent) say credit card purchases are advantageous to merchants and directly help them grow their businesses. 9 Consumers should visit the Financial Consumer Agency of Canada (FCAC) website www.fcac.gc.ca, for an extensive list of cards and features, and use the credit card comparison tool to help select the card that best suits their needs. Strong regulations 10 Consumers with credit cards from banks are protected by Bank Act regulations that require: • Statements to include itemized transactions, the amount you must pay on or before the due date in order to have the benefit of a grace period. • Disclosure of the previous month’s payments and the current month’s purchases, credit advances, as well as interest and non-interest charges. • Disclosure of the interest rate at the time of solicitation or application, and on every monthly statement. • Plain language information for customers. • Rules on advertising. • Limits on consumer liability in the event of fraud. Credit card pricing There are a number of factors that influence card fees and interest rates. • An interest-free period from purchase to payment, depending on the card, as long as the balance is paid in full when owing. • Access to unsecured credit where no collateral is needed, which makes it a higher risk for the credit card issuer. • Significant costs to operating the credit card system including processing a large volume of transactions, technology that is constantly updated to support transactions, preparing and mailing statements, collecting payments and the costs for providing value- added rewards programs. Most Canadians pay cards off every month • A Payments Canada survey found that 71% of Canadians pay their balance off in full every month. 11 • Banks work with clients who are concerned about their debt, helping them get control of their finances or choose more suitable credit products. Banks also support non-profit credit counseling services. The Canadian Bankers Association is the voice of more than 60 domestic and foreign banks that help drive Canada’s economic growth and prosperity. The CBA advocates for public policies that contribute to a sound, thriving banking system to ensure Canadians can succeed in their financial goals. Last updated: March 2023 1 Canadian Payment Methods and Trends Report 2022: 71% of Canadians pay their balance off in full every month. https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf 2 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 3 Ibid 4 Canadian Payment Methods and Trends Report 2019: https://leger360.com/wp- content/uploads/2019/12/canadianpaymentmethod sandtrendsreport_2019.pdf p. 17 5 CBA credit card statistics as of January 2021 6 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 7 ibid 8 Canadian Payment Methods and Trends Report 2022, pg 27: https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf 9 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 10 Note – these protections only extend to federally-regulated financial institutions (not other card issuers) 11 Canadian Payment Methods and Trends Report 2022: 71% of Canadians pay their balance off in full every month. https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf
|
Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here. What percentage of Canadians have at least one credit card, and how many pay them off monthly? The Bottom Line Credit cards offer valuable benefits for both consumers and retailers. And the majority of Canadians use their credit card as a method of payment rather than a means of borrowing. Credit card benefits For Consumers A credit card is a convenient and flexible payment tool accepted in more than 200 countries and at millions of locations worldwide. Benefits include: • Access to unsecured credit (no collateral required against amounts charged). • Interest-free payment from time of purchase to the end of the billing period. • Instant payment of purchases, allowing for instant receipt of goods and services. Focus: Credit Cards: Statistics and Facts Focus Sheet • Credit cards provide interest-free credit from the time of purchase to the end of the billing period • More than 70% of Canadians pay their credit card balance in full each month1 , so for them the interest rate is zero • For those who choose to carry a balance: o Credit cards offer access to unsecured credit (no collateral required) o There are many low interest rate cards on the market and over 30 of those cards have an interest rate of under 13% FAST FACTS • Coverage for purchases if the item is damaged, stolen or not delivered within 90 days. • 24/7 access. • Fraud protection with zero liability to the consumer in cases of fraud. • Other rewards and benefits, such as air travel points, car insurance, damage and loss insurance and extended warranty programs. For retailers Retailers are not required to accept credit cards, but do so to provide payments options for their customers. Retailers that do accept credit cards receive many benefits, including: • Reaching a large customer base – Credit cards are the preferred method of payment for many customers, and customers will select retailers that allow them to choose their preferred method of payment. • Fast, guaranteed payment, which can reduce line-ups at checkout. If every credit card transaction took an extra 30 seconds, it would use up an additional 27 million hours of staff time each year. • The ability of accepting credit without worrying about the creditworthiness of customers, insufficient funds or outstanding receivables. • Reduced cash on hand and cash handling time and costs, including counting cash at the end of the day, armoured transport, higher likelihood of theft and pilfering and potential mistakes by cashiers. • Expanded markets; ability to sell to customers throughout Canada and around the world in the currency used by the retailer. • Access to innovative new payments – innovations in payment options introduced by banks and credit card companies, such as contactless cards and online and mobile payments, benefit retailers and make it easier for customer to make purchases. Moreover, a very large majority (94 per cent) of merchants say their business benefits from accepting credit cards.2 • Sixty-nine per cent of merchants say they benefit from letting customers earn rewards on their purchases. 3 Competition and choice When making a purchase, consumers can choose to use cash, cheques, debit cards, credit cards as well as electronic payments services like PayPal and Interac Online. Nearly nine out of ten adult Canadians have at least one credit card4 and this method of payment is the choice for the overwhelming majority of retail e-commerce transactions. When it comes to choosing a credit card, banks offer consumers a wide variety of products. Customers may choose among standard cards without an annual fee, premium cards that offer rewards and features, and low-rate cards if the interest rate is a key consideration influencing the card choice. • Hundreds of institutions in Canada, including banks, credit unions, retailers, caisses populaires, trust companies and finance companies offer credit card products. • 76.2 million Visa and MasterCard cards are in circulation in Canada. 5 • There are many low-rate cards on the market and over 30 of those cards have an interest rate of under 13%. • Eight in 10 (84 per cent) consumers are satisfied with their credit cards and roughly the same proportion (86 per cent) say they offer great value. 6 • Canadians appreciate their rewards points programs and the majority use them to help make a family vacation more attainable with travel points, save money on their grocery bills with cash-back rewards or use their rewards points to donate to a favourite charity. • Research has found that eighty-three per cent of consumers use a credit card that provides them with rewards. 7 • 58 per cent of Canadians who are frequent credit card users listed “receiving discounts/loyalty points/rewards’’ as their main reason for frequently using credit cards for purchases. 8 • Roughly two-thirds of consumers (65 per cent) say credit card purchases are advantageous to merchants and directly help them grow their businesses. 9 Consumers should visit the Financial Consumer Agency of Canada (FCAC) website www.fcac.gc.ca, for an extensive list of cards and features, and use the credit card comparison tool to help select the card that best suits their needs. Strong regulations 10 Consumers with credit cards from banks are protected by Bank Act regulations that require: • Statements to include itemized transactions, the amount you must pay on or before the due date in order to have the benefit of a grace period. • Disclosure of the previous month’s payments and the current month’s purchases, credit advances, as well as interest and non-interest charges. • Disclosure of the interest rate at the time of solicitation or application, and on every monthly statement. • Plain language information for customers. • Rules on advertising. • Limits on consumer liability in the event of fraud. Credit card pricing There are a number of factors that influence card fees and interest rates. • An interest-free period from purchase to payment, depending on the card, as long as the balance is paid in full when owing. • Access to unsecured credit where no collateral is needed, which makes it a higher risk for the credit card issuer. • Significant costs to operating the credit card system including processing a large volume of transactions, technology that is constantly updated to support transactions, preparing and mailing statements, collecting payments and the costs for providing value- added rewards programs. Most Canadians pay cards off every month • A Payments Canada survey found that 71% of Canadians pay their balance off in full every month. 11 • Banks work with clients who are concerned about their debt, helping them get control of their finances or choose more suitable credit products. Banks also support non-profit credit counseling services. The Canadian Bankers Association is the voice of more than 60 domestic and foreign banks that help drive Canada’s economic growth and prosperity. The CBA advocates for public policies that contribute to a sound, thriving banking system to ensure Canadians can succeed in their financial goals. Last updated: March 2023 1 Canadian Payment Methods and Trends Report 2022: 71% of Canadians pay their balance off in full every month. https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf 2 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 3 Ibid 4 Canadian Payment Methods and Trends Report 2019: https://leger360.com/wp- content/uploads/2019/12/canadianpaymentmethod sandtrendsreport_2019.pdf p. 17 5 CBA credit card statistics as of January 2021 6 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 7 ibid 8 Canadian Payment Methods and Trends Report 2022, pg 27: https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf 9 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 10 Note – these protections only extend to federally-regulated financial institutions (not other card issuers) 11 Canadian Payment Methods and Trends Report 2022: 71% of Canadians pay their balance off in full every month. https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf
|
Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here.
EVIDENCE:
The Bottom Line Credit cards offer valuable benefits for both consumers and retailers. And the majority of Canadians use their credit card as a method of payment rather than a means of borrowing. Credit card benefits For Consumers A credit card is a convenient and flexible payment tool accepted in more than 200 countries and at millions of locations worldwide. Benefits include: • Access to unsecured credit (no collateral required against amounts charged). • Interest-free payment from time of purchase to the end of the billing period. • Instant payment of purchases, allowing for instant receipt of goods and services. Focus: Credit Cards: Statistics and Facts Focus Sheet • Credit cards provide interest-free credit from the time of purchase to the end of the billing period • More than 70% of Canadians pay their credit card balance in full each month1 , so for them the interest rate is zero • For those who choose to carry a balance: o Credit cards offer access to unsecured credit (no collateral required) o There are many low interest rate cards on the market and over 30 of those cards have an interest rate of under 13% FAST FACTS • Coverage for purchases if the item is damaged, stolen or not delivered within 90 days. • 24/7 access. • Fraud protection with zero liability to the consumer in cases of fraud. • Other rewards and benefits, such as air travel points, car insurance, damage and loss insurance and extended warranty programs. For retailers Retailers are not required to accept credit cards, but do so to provide payments options for their customers. Retailers that do accept credit cards receive many benefits, including: • Reaching a large customer base – Credit cards are the preferred method of payment for many customers, and customers will select retailers that allow them to choose their preferred method of payment. • Fast, guaranteed payment, which can reduce line-ups at checkout. If every credit card transaction took an extra 30 seconds, it would use up an additional 27 million hours of staff time each year. • The ability of accepting credit without worrying about the creditworthiness of customers, insufficient funds or outstanding receivables. • Reduced cash on hand and cash handling time and costs, including counting cash at the end of the day, armoured transport, higher likelihood of theft and pilfering and potential mistakes by cashiers. • Expanded markets; ability to sell to customers throughout Canada and around the world in the currency used by the retailer. • Access to innovative new payments – innovations in payment options introduced by banks and credit card companies, such as contactless cards and online and mobile payments, benefit retailers and make it easier for customer to make purchases. Moreover, a very large majority (94 per cent) of merchants say their business benefits from accepting credit cards.2 • Sixty-nine per cent of merchants say they benefit from letting customers earn rewards on their purchases. 3 Competition and choice When making a purchase, consumers can choose to use cash, cheques, debit cards, credit cards as well as electronic payments services like PayPal and Interac Online. Nearly nine out of ten adult Canadians have at least one credit card4 and this method of payment is the choice for the overwhelming majority of retail e-commerce transactions. When it comes to choosing a credit card, banks offer consumers a wide variety of products. Customers may choose among standard cards without an annual fee, premium cards that offer rewards and features, and low-rate cards if the interest rate is a key consideration influencing the card choice. • Hundreds of institutions in Canada, including banks, credit unions, retailers, caisses populaires, trust companies and finance companies offer credit card products. • 76.2 million Visa and MasterCard cards are in circulation in Canada. 5 • There are many low-rate cards on the market and over 30 of those cards have an interest rate of under 13%. • Eight in 10 (84 per cent) consumers are satisfied with their credit cards and roughly the same proportion (86 per cent) say they offer great value. 6 • Canadians appreciate their rewards points programs and the majority use them to help make a family vacation more attainable with travel points, save money on their grocery bills with cash-back rewards or use their rewards points to donate to a favourite charity. • Research has found that eighty-three per cent of consumers use a credit card that provides them with rewards. 7 • 58 per cent of Canadians who are frequent credit card users listed “receiving discounts/loyalty points/rewards’’ as their main reason for frequently using credit cards for purchases. 8 • Roughly two-thirds of consumers (65 per cent) say credit card purchases are advantageous to merchants and directly help them grow their businesses. 9 Consumers should visit the Financial Consumer Agency of Canada (FCAC) website www.fcac.gc.ca, for an extensive list of cards and features, and use the credit card comparison tool to help select the card that best suits their needs. Strong regulations 10 Consumers with credit cards from banks are protected by Bank Act regulations that require: • Statements to include itemized transactions, the amount you must pay on or before the due date in order to have the benefit of a grace period. • Disclosure of the previous month’s payments and the current month’s purchases, credit advances, as well as interest and non-interest charges. • Disclosure of the interest rate at the time of solicitation or application, and on every monthly statement. • Plain language information for customers. • Rules on advertising. • Limits on consumer liability in the event of fraud. Credit card pricing There are a number of factors that influence card fees and interest rates. • An interest-free period from purchase to payment, depending on the card, as long as the balance is paid in full when owing. • Access to unsecured credit where no collateral is needed, which makes it a higher risk for the credit card issuer. • Significant costs to operating the credit card system including processing a large volume of transactions, technology that is constantly updated to support transactions, preparing and mailing statements, collecting payments and the costs for providing value- added rewards programs. Most Canadians pay cards off every month • A Payments Canada survey found that 71% of Canadians pay their balance off in full every month. 11 • Banks work with clients who are concerned about their debt, helping them get control of their finances or choose more suitable credit products. Banks also support non-profit credit counseling services. The Canadian Bankers Association is the voice of more than 60 domestic and foreign banks that help drive Canada’s economic growth and prosperity. The CBA advocates for public policies that contribute to a sound, thriving banking system to ensure Canadians can succeed in their financial goals. Last updated: March 2023 1 Canadian Payment Methods and Trends Report 2022: 71% of Canadians pay their balance off in full every month. https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf 2 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 3 Ibid 4 Canadian Payment Methods and Trends Report 2019: https://leger360.com/wp- content/uploads/2019/12/canadianpaymentmethod sandtrendsreport_2019.pdf p. 17 5 CBA credit card statistics as of January 2021 6 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 7 ibid 8 Canadian Payment Methods and Trends Report 2022, pg 27: https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf 9 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 10 Note – these protections only extend to federally-regulated financial institutions (not other card issuers) 11 Canadian Payment Methods and Trends Report 2022: 71% of Canadians pay their balance off in full every month. https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf
USER:
What percentage of Canadians have at least one credit card, and how many pay them off monthly?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 24 | 17 | 1,277 | null | 42 |
Answer the prompt using only the provide text and nothing else. Your answer must be at least 4 sentences but no more than 6 sentences. Your answer must also be in paragraph format with no lists.
|
I have a year and a month left on my lease and my landlord is going to evict me even though I've paid my rent, how long do I have to leave after they actually start the process?
|
Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 11 a claim of housing discrimination based on a protected category. V. ENDING A LEASE A periodic lease (month-to-month or year-to-year) most often ends in one of three ways: • You move out before the end of the term • You or the landlord gives notice 15 days before the end of the term that the lease will not renew • You or the landlord materially breaches the lease A lease for a fixed period of time most often ends in one of three ways: • You move out before the end of the term • The term of the lease expires and the parties do not agree to renew • You or the landlord materially breaches the lease A. Early Termination There is no stand-alone right to terminate a lease early, and many lease agreements do not allow a tenant to terminate early. If you voluntarily move out before the end of the lease, the lease does not allow for early termination, and the landlord has not breached any of their obligations, then you will likely be responsible for paying rent until the lease expires or until the landlord rents the unit to a new tenant. In Pennsylvania, the landlord has no obligation to locate a new tenant to rent the unit. If you move out early, the landlord may be able to make you pay rent for the rest of the lease term. B. Security Deposit Refund and Deductions To have your security deposit refunded, you must provide the landlord with a forwarding address and return the keys to the property. 68 P.S. § 250.512(e). Before leaving, clean the unit as thoroughly as possible and take photos to document its condition. Within 30 days after you have moved out, the landlord must either return the entire security deposit or send you a list of damages, the cost of repairs, and any money remaining from the security deposit. 68 P.S. § 250.512(a). Permissible deductions include “actual damages” to the rental unit. Id. If the landlord does not provide a written list of damages within 30 days, they may not keep any part of the security deposit. 68 P.S. § 250.512(b). You may then sue to recover double the amount of the deposit minus any actual damages as determined by a court. 68 P.S. § 250.512(c). If, within 30 days, the landlord fails to pay you the difference between the security deposit and the actual damages to the property, the landlord is liable for double the amount by which the Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 12 security deposit exceeds the actual damages to the property. 68 P.S. § 250.512(b)-(c). If you break the lease, the security deposit may be forfeited. 68 P.S. § 250.512(a). C. Eviction A landlord may seek to evict you if you fail to pay rent, fail to move out at the end of the lease, or violate a term of the lease. 68 P.S. § 250.501(a). Landlord “self-help” eviction is prohibited – i.e., landlord may not change your locks or shut off your utility service to initiate an eviction. Instead, the landlord must follow the process below. Some cities in Pennsylvania, such as Philadelphia, may have eviction diversion or mediation programs designed to help you and the landlord come to an agreement without using the court process or creating an eviction record. 1. Notice to Quit To begin eviction, the landlord must first give you a written eviction notice known as a Notice to Quit. • If the eviction is for failure to pay rent or for use of illegal drugs, the Notice to Quit must give the tenant 10 days to leave voluntarily. 68 P.S. §§ 250.501(b), 250.505-A. • If the eviction is for a breach of any other condition of the lease and the lease is for one year or less (or an indeterminate time), the notice to quit must give the tenant 15 days to leave voluntarily. 68 P.S. § 250.501(b). • If the eviction is for a breach any other condition of the lease and the lease is for more than one year, the notice to quit must give the tenant 30 days to leave voluntarily. 68 P.S. § 250.501(b). The landlord must notify you of the notice to quit in one of three ways, 68 P.S. § 250.501(f): • Give you the notice personally • Leave the notice at the main building of the leased property • Post the notice conspicuously on the leased property Notice requirements may be and are often waived in the lease under a Waiver of Notice to Quit provision. If the notice is validly waived, the landlord is permitted to take you to court (see Landlord Tenant Complaint (Part V.C.2) below), without any advance notice. 68 P.S. § 250.501(e). The Office of Attorney General encourages all landlords across the Commonwealth to deal fairly with tenants by not including Waiver of Notice to Quit provisions in lease agreements and by providing tenants with notice before beginning eviction proceedings. Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 13 2. Landlord-Tenant Complaint If you do not voluntarily leave the unit within the time period listed in the notice to quit, the landlord still cannot evict you themselves. Instead, the landlord must file a legal action in court often referred to as a Landlord-Tenant Complaint. The complaint will be filed with your county’s Magisterial District Court, or in Philadelphia, the Philadelphia Municipal Court, or in Allegheny County, the Housing Court. The complaint will ask for possession of the unit and may also ask for back rent or damages. 246 Pa. Code § 503. After the complaint is filed, the court will issue a summons to you, which is a copy of the complaint and a notice to appear at a hearing on a specific date and time. 246 Pa. Code § 504. The court will serve the summons by mailing a copy to you at your last known address by First- Class Mail. 246 Pa. Code § 506. A sheriff or certified constable will also serve you with the summons personally or by posting it conspicuously on the leased property. Id. If you have any claims against the landlord for breach of the lease—for example, a breach of the Implied Warranty of Habitability (Part IV.C)—you may file a counterclaim, but you must do so before the date of the hearing. 246 Pa. Code § 508. Each court will have slightly different rules for how it processes landlord-tenant complaints. Make sure to check the local rules (sometimes called local civil rules or rules and procedures) for the court where the complaint was filed to make sure you are aware of how the court operates. For example, the Philadelphia Municipal Court will continue (i.e., postpone) the hearing on a landlord-tenant complaint if the tenant has filed a complaint which has been accepted by the Philadelphia Fair Housing Commission prior to the date the landlord filed the complaint for eviction. 3. Hearing & Judgment At the hearing, you and the landlord will each have an opportunity to present your case. 246 Pa. Code § 512. You may bring a lawyer to help you. You may also bring documents, photos, emails, records, and other evidence to support your case. It is extremely important that you do not miss your hearing date. If you miss or are late to your hearing date, the landlord wins by default. If you cannot attend the hearing, contact the court and ask if the hearing can be rescheduled. At the end of the hearing or within three days, the judge will make a decision, called a Notice of Judgment. 246 Pa. Code § 514(C). • Judgment in favor of the landlord: If the judge rules in favor of the landlord, then the Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 14 landlord will be granted possession of the unit. 246 Pa. Code § 514. The judge may also require you to pay damages and unpaid rent. Id. • Judgment in favor of the tenant: If the judge rules in your favor, then the landlord must do what the judge orders them to do, such as allowing you to remain in the unit or paying you money. 4. Appeal You have 10 days after entry of judgement against you to file an appeal in the court of common pleas. 68 P.S. § 250.513; 246 Pa. Code § 1008. The appeal will block an actual eviction (in legal terminology, operate as a supersedeas) only if you deposit with the court either three months’ rent or the amount the judge ordered you to pay, whichever is less. 246 Pa. Code § 1008(B). If you are low-income, you can file a tenant’s affidavit and deposit one third of your monthly rent. 246 Pa. Code § 1008(C). In both situations, you will also have to deposit rent each month while the appeal is pending. 246 Pa. Code § 1008(B), (C). The money will be held in escrow by the court. 5. Order of Possession Even if judgment is entered in favor of the landlord, the landlord still cannot evict you themselves. Instead, the landlord must wait 10 days after entry of judgment and then ask the court to issue an order of possession. 246 Pa. Code § 515(B). The court will serve the order of possession by mailing a copy to you at your last known address by First-Class Mail. 246 Pa. Code § 517. A sheriff or certified constable will also serve you with the order of possession personally or by posting it conspicuously on the leased property. Id. The order of possession will require you to vacate the residential unit within 10 days after the date of service. 246 Pa. Code § 517(2). If you remain in the rental unit on the 11th day following service of the order of possession, then you can be forcibly evicted. 246 Pa. Code § 519(B). If you are forcibly evicted and leave possessions behind, the landlord must notify you by First- Class Mail of your right to retrieve the property. 68 P.S. § 250.505a(d), (e). You have 10 days from the postmark date of the notice to either retrieve your possessions or ask that your landlord store your possessions for up to 30 days. Id. If you ask your landlord to store your possessions, you will be responsible for any costs. Id. If you do not contact the landlord or retrieve your property, the landlord can dispose of it. Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 15 6. Domestic Violence Survivor If you are a victim of domestic violence,13 then you have 30 days to appeal a judgment in favor of the landlord. 68 P.S. § 250.513(b). If the landlord obtains an order of possession before the 30 days have passed, you can file a domestic violence affidavit with the court to stay (i.e., freeze) the order of possession pending an appeal or until the end of the 30 days. 246 Pa. Code § 514.1. 7. Satisfaction of Judgment for Nonpayment of Rent If the eviction is only for failure to pay rent, a tenant can stop the eviction by paying—any point before actual eviction—the full amount of unpaid rent and other fees. 246 Pa. Code § 518. Once that happens, one more step needs to be taken: the landlord should enter with the court that the judgment has been satisfied. 246 Pa. Code § 341. If your landlord does not do so, you should file a written request to have the judgment marked satisfied with the court and serve it on the landlord. 246 Pa. Code § 341. If the landlord does not enter that the judgment has been satisfied within 90 days of a written request without good cause, the landlord will be liable to the tenant for 1% of the judgment amount, at least $250 and up to $2,500, every month the judgment is not marked satisfied. 42 Pa. Cons. Stat. § 8104(b). 8. Eviction Records An “eviction record” is an official record—court filings, transcripts and orders, for example— that contains information about a past or ongoing lawsuit to evict a tenant. There is no uniform requirement across all Pennsylvania courts for what details must be included in an eviction record; there is no guarantee that the information contained in eviction records tells the whole story. An eviction record may also show, incorrectly, that a tenant who was evicted for failure to pay rent has not satisfied the judgment just because the landlord has failed to have the judgment marked satisfied with the court. Pennsylvania does not automatically seal or expunge eviction records, even if the case is withdrawn. Some cities in Pennsylvania, such as Philadelphia, may have eviction diversion or mediation programs designed to help you and the landlord come to an agreement without using the court process or creating an eviction record.
|
Answer the prompt using only the provide text and nothing else. Your answer must be at least 4 sentences but no more than 6 sentences. Your answer must also be in paragraph format with no lists. Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 11 a claim of housing discrimination based on a protected category. V. ENDING A LEASE A periodic lease (month-to-month or year-to-year) most often ends in one of three ways: • You move out before the end of the term • You or the landlord gives notice 15 days before the end of the term that the lease will not renew • You or the landlord materially breaches the lease A lease for a fixed period of time most often ends in one of three ways: • You move out before the end of the term • The term of the lease expires and the parties do not agree to renew • You or the landlord materially breaches the lease A. Early Termination There is no stand-alone right to terminate a lease early, and many lease agreements do not allow a tenant to terminate early. If you voluntarily move out before the end of the lease, the lease does not allow for early termination, and the landlord has not breached any of their obligations, then you will likely be responsible for paying rent until the lease expires or until the landlord rents the unit to a new tenant. In Pennsylvania, the landlord has no obligation to locate a new tenant to rent the unit. If you move out early, the landlord may be able to make you pay rent for the rest of the lease term. B. Security Deposit Refund and Deductions To have your security deposit refunded, you must provide the landlord with a forwarding address and return the keys to the property. 68 P.S. § 250.512(e). Before leaving, clean the unit as thoroughly as possible and take photos to document its condition. Within 30 days after you have moved out, the landlord must either return the entire security deposit or send you a list of damages, the cost of repairs, and any money remaining from the security deposit. 68 P.S. § 250.512(a). Permissible deductions include “actual damages” to the rental unit. Id. If the landlord does not provide a written list of damages within 30 days, they may not keep any part of the security deposit. 68 P.S. § 250.512(b). You may then sue to recover double the amount of the deposit minus any actual damages as determined by a court. 68 P.S. § 250.512(c). If, within 30 days, the landlord fails to pay you the difference between the security deposit and the actual damages to the property, the landlord is liable for double the amount by which the Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 12 security deposit exceeds the actual damages to the property. 68 P.S. § 250.512(b)-(c). If you break the lease, the security deposit may be forfeited. 68 P.S. § 250.512(a). C. Eviction A landlord may seek to evict you if you fail to pay rent, fail to move out at the end of the lease, or violate a term of the lease. 68 P.S. § 250.501(a). Landlord “self-help” eviction is prohibited – i.e., landlord may not change your locks or shut off your utility service to initiate an eviction. Instead, the landlord must follow the process below. Some cities in Pennsylvania, such as Philadelphia, may have eviction diversion or mediation programs designed to help you and the landlord come to an agreement without using the court process or creating an eviction record. 1. Notice to Quit To begin eviction, the landlord must first give you a written eviction notice known as a Notice to Quit. • If the eviction is for failure to pay rent or for use of illegal drugs, the Notice to Quit must give the tenant 10 days to leave voluntarily. 68 P.S. §§ 250.501(b), 250.505-A. • If the eviction is for a breach of any other condition of the lease and the lease is for one year or less (or an indeterminate time), the notice to quit must give the tenant 15 days to leave voluntarily. 68 P.S. § 250.501(b). • If the eviction is for a breach any other condition of the lease and the lease is for more than one year, the notice to quit must give the tenant 30 days to leave voluntarily. 68 P.S. § 250.501(b). The landlord must notify you of the notice to quit in one of three ways, 68 P.S. § 250.501(f): • Give you the notice personally • Leave the notice at the main building of the leased property • Post the notice conspicuously on the leased property Notice requirements may be and are often waived in the lease under a Waiver of Notice to Quit provision. If the notice is validly waived, the landlord is permitted to take you to court (see Landlord Tenant Complaint (Part V.C.2) below), without any advance notice. 68 P.S. § 250.501(e). The Office of Attorney General encourages all landlords across the Commonwealth to deal fairly with tenants by not including Waiver of Notice to Quit provisions in lease agreements and by providing tenants with notice before beginning eviction proceedings. Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 13 2. Landlord-Tenant Complaint If you do not voluntarily leave the unit within the time period listed in the notice to quit, the landlord still cannot evict you themselves. Instead, the landlord must file a legal action in court often referred to as a Landlord-Tenant Complaint. The complaint will be filed with your county’s Magisterial District Court, or in Philadelphia, the Philadelphia Municipal Court, or in Allegheny County, the Housing Court. The complaint will ask for possession of the unit and may also ask for back rent or damages. 246 Pa. Code § 503. After the complaint is filed, the court will issue a summons to you, which is a copy of the complaint and a notice to appear at a hearing on a specific date and time. 246 Pa. Code § 504. The court will serve the summons by mailing a copy to you at your last known address by First- Class Mail. 246 Pa. Code § 506. A sheriff or certified constable will also serve you with the summons personally or by posting it conspicuously on the leased property. Id. If you have any claims against the landlord for breach of the lease—for example, a breach of the Implied Warranty of Habitability (Part IV.C)—you may file a counterclaim, but you must do so before the date of the hearing. 246 Pa. Code § 508. Each court will have slightly different rules for how it processes landlord-tenant complaints. Make sure to check the local rules (sometimes called local civil rules or rules and procedures) for the court where the complaint was filed to make sure you are aware of how the court operates. For example, the Philadelphia Municipal Court will continue (i.e., postpone) the hearing on a landlord-tenant complaint if the tenant has filed a complaint which has been accepted by the Philadelphia Fair Housing Commission prior to the date the landlord filed the complaint for eviction. 3. Hearing & Judgment At the hearing, you and the landlord will each have an opportunity to present your case. 246 Pa. Code § 512. You may bring a lawyer to help you. You may also bring documents, photos, emails, records, and other evidence to support your case. It is extremely important that you do not miss your hearing date. If you miss or are late to your hearing date, the landlord wins by default. If you cannot attend the hearing, contact the court and ask if the hearing can be rescheduled. At the end of the hearing or within three days, the judge will make a decision, called a Notice of Judgment. 246 Pa. Code § 514(C). • Judgment in favor of the landlord: If the judge rules in favor of the landlord, then the Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 14 landlord will be granted possession of the unit. 246 Pa. Code § 514. The judge may also require you to pay damages and unpaid rent. Id. • Judgment in favor of the tenant: If the judge rules in your favor, then the landlord must do what the judge orders them to do, such as allowing you to remain in the unit or paying you money. 4. Appeal You have 10 days after entry of judgement against you to file an appeal in the court of common pleas. 68 P.S. § 250.513; 246 Pa. Code § 1008. The appeal will block an actual eviction (in legal terminology, operate as a supersedeas) only if you deposit with the court either three months’ rent or the amount the judge ordered you to pay, whichever is less. 246 Pa. Code § 1008(B). If you are low-income, you can file a tenant’s affidavit and deposit one third of your monthly rent. 246 Pa. Code § 1008(C). In both situations, you will also have to deposit rent each month while the appeal is pending. 246 Pa. Code § 1008(B), (C). The money will be held in escrow by the court. 5. Order of Possession Even if judgment is entered in favor of the landlord, the landlord still cannot evict you themselves. Instead, the landlord must wait 10 days after entry of judgment and then ask the court to issue an order of possession. 246 Pa. Code § 515(B). The court will serve the order of possession by mailing a copy to you at your last known address by First-Class Mail. 246 Pa. Code § 517. A sheriff or certified constable will also serve you with the order of possession personally or by posting it conspicuously on the leased property. Id. The order of possession will require you to vacate the residential unit within 10 days after the date of service. 246 Pa. Code § 517(2). If you remain in the rental unit on the 11th day following service of the order of possession, then you can be forcibly evicted. 246 Pa. Code § 519(B). If you are forcibly evicted and leave possessions behind, the landlord must notify you by First- Class Mail of your right to retrieve the property. 68 P.S. § 250.505a(d), (e). You have 10 days from the postmark date of the notice to either retrieve your possessions or ask that your landlord store your possessions for up to 30 days. Id. If you ask your landlord to store your possessions, you will be responsible for any costs. Id. If you do not contact the landlord or retrieve your property, the landlord can dispose of it. Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 15 6. Domestic Violence Survivor If you are a victim of domestic violence,13 then you have 30 days to appeal a judgment in favor of the landlord. 68 P.S. § 250.513(b). If the landlord obtains an order of possession before the 30 days have passed, you can file a domestic violence affidavit with the court to stay (i.e., freeze) the order of possession pending an appeal or until the end of the 30 days. 246 Pa. Code § 514.1. 7. Satisfaction of Judgment for Nonpayment of Rent If the eviction is only for failure to pay rent, a tenant can stop the eviction by paying—any point before actual eviction—the full amount of unpaid rent and other fees. 246 Pa. Code § 518. Once that happens, one more step needs to be taken: the landlord should enter with the court that the judgment has been satisfied. 246 Pa. Code § 341. If your landlord does not do so, you should file a written request to have the judgment marked satisfied with the court and serve it on the landlord. 246 Pa. Code § 341. If the landlord does not enter that the judgment has been satisfied within 90 days of a written request without good cause, the landlord will be liable to the tenant for 1% of the judgment amount, at least $250 and up to $2,500, every month the judgment is not marked satisfied. 42 Pa. Cons. Stat. § 8104(b). 8. Eviction Records An “eviction record” is an official record—court filings, transcripts and orders, for example— that contains information about a past or ongoing lawsuit to evict a tenant. There is no uniform requirement across all Pennsylvania courts for what details must be included in an eviction record; there is no guarantee that the information contained in eviction records tells the whole story. An eviction record may also show, incorrectly, that a tenant who was evicted for failure to pay rent has not satisfied the judgment just because the landlord has failed to have the judgment marked satisfied with the court. Pennsylvania does not automatically seal or expunge eviction records, even if the case is withdrawn. Some cities in Pennsylvania, such as Philadelphia, may have eviction diversion or mediation programs designed to help you and the landlord come to an agreement without using the court process or creating an eviction record. I have a year and a month left on my lease and my landlord is going to evict me even though I've paid my rent, how long do I have to leave after they actually start the process?
|
Answer the prompt using only the provide text and nothing else. Your answer must be at least 4 sentences but no more than 6 sentences. Your answer must also be in paragraph format with no lists.
EVIDENCE:
Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 11 a claim of housing discrimination based on a protected category. V. ENDING A LEASE A periodic lease (month-to-month or year-to-year) most often ends in one of three ways: • You move out before the end of the term • You or the landlord gives notice 15 days before the end of the term that the lease will not renew • You or the landlord materially breaches the lease A lease for a fixed period of time most often ends in one of three ways: • You move out before the end of the term • The term of the lease expires and the parties do not agree to renew • You or the landlord materially breaches the lease A. Early Termination There is no stand-alone right to terminate a lease early, and many lease agreements do not allow a tenant to terminate early. If you voluntarily move out before the end of the lease, the lease does not allow for early termination, and the landlord has not breached any of their obligations, then you will likely be responsible for paying rent until the lease expires or until the landlord rents the unit to a new tenant. In Pennsylvania, the landlord has no obligation to locate a new tenant to rent the unit. If you move out early, the landlord may be able to make you pay rent for the rest of the lease term. B. Security Deposit Refund and Deductions To have your security deposit refunded, you must provide the landlord with a forwarding address and return the keys to the property. 68 P.S. § 250.512(e). Before leaving, clean the unit as thoroughly as possible and take photos to document its condition. Within 30 days after you have moved out, the landlord must either return the entire security deposit or send you a list of damages, the cost of repairs, and any money remaining from the security deposit. 68 P.S. § 250.512(a). Permissible deductions include “actual damages” to the rental unit. Id. If the landlord does not provide a written list of damages within 30 days, they may not keep any part of the security deposit. 68 P.S. § 250.512(b). You may then sue to recover double the amount of the deposit minus any actual damages as determined by a court. 68 P.S. § 250.512(c). If, within 30 days, the landlord fails to pay you the difference between the security deposit and the actual damages to the property, the landlord is liable for double the amount by which the Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 12 security deposit exceeds the actual damages to the property. 68 P.S. § 250.512(b)-(c). If you break the lease, the security deposit may be forfeited. 68 P.S. § 250.512(a). C. Eviction A landlord may seek to evict you if you fail to pay rent, fail to move out at the end of the lease, or violate a term of the lease. 68 P.S. § 250.501(a). Landlord “self-help” eviction is prohibited – i.e., landlord may not change your locks or shut off your utility service to initiate an eviction. Instead, the landlord must follow the process below. Some cities in Pennsylvania, such as Philadelphia, may have eviction diversion or mediation programs designed to help you and the landlord come to an agreement without using the court process or creating an eviction record. 1. Notice to Quit To begin eviction, the landlord must first give you a written eviction notice known as a Notice to Quit. • If the eviction is for failure to pay rent or for use of illegal drugs, the Notice to Quit must give the tenant 10 days to leave voluntarily. 68 P.S. §§ 250.501(b), 250.505-A. • If the eviction is for a breach of any other condition of the lease and the lease is for one year or less (or an indeterminate time), the notice to quit must give the tenant 15 days to leave voluntarily. 68 P.S. § 250.501(b). • If the eviction is for a breach any other condition of the lease and the lease is for more than one year, the notice to quit must give the tenant 30 days to leave voluntarily. 68 P.S. § 250.501(b). The landlord must notify you of the notice to quit in one of three ways, 68 P.S. § 250.501(f): • Give you the notice personally • Leave the notice at the main building of the leased property • Post the notice conspicuously on the leased property Notice requirements may be and are often waived in the lease under a Waiver of Notice to Quit provision. If the notice is validly waived, the landlord is permitted to take you to court (see Landlord Tenant Complaint (Part V.C.2) below), without any advance notice. 68 P.S. § 250.501(e). The Office of Attorney General encourages all landlords across the Commonwealth to deal fairly with tenants by not including Waiver of Notice to Quit provisions in lease agreements and by providing tenants with notice before beginning eviction proceedings. Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 13 2. Landlord-Tenant Complaint If you do not voluntarily leave the unit within the time period listed in the notice to quit, the landlord still cannot evict you themselves. Instead, the landlord must file a legal action in court often referred to as a Landlord-Tenant Complaint. The complaint will be filed with your county’s Magisterial District Court, or in Philadelphia, the Philadelphia Municipal Court, or in Allegheny County, the Housing Court. The complaint will ask for possession of the unit and may also ask for back rent or damages. 246 Pa. Code § 503. After the complaint is filed, the court will issue a summons to you, which is a copy of the complaint and a notice to appear at a hearing on a specific date and time. 246 Pa. Code § 504. The court will serve the summons by mailing a copy to you at your last known address by First- Class Mail. 246 Pa. Code § 506. A sheriff or certified constable will also serve you with the summons personally or by posting it conspicuously on the leased property. Id. If you have any claims against the landlord for breach of the lease—for example, a breach of the Implied Warranty of Habitability (Part IV.C)—you may file a counterclaim, but you must do so before the date of the hearing. 246 Pa. Code § 508. Each court will have slightly different rules for how it processes landlord-tenant complaints. Make sure to check the local rules (sometimes called local civil rules or rules and procedures) for the court where the complaint was filed to make sure you are aware of how the court operates. For example, the Philadelphia Municipal Court will continue (i.e., postpone) the hearing on a landlord-tenant complaint if the tenant has filed a complaint which has been accepted by the Philadelphia Fair Housing Commission prior to the date the landlord filed the complaint for eviction. 3. Hearing & Judgment At the hearing, you and the landlord will each have an opportunity to present your case. 246 Pa. Code § 512. You may bring a lawyer to help you. You may also bring documents, photos, emails, records, and other evidence to support your case. It is extremely important that you do not miss your hearing date. If you miss or are late to your hearing date, the landlord wins by default. If you cannot attend the hearing, contact the court and ask if the hearing can be rescheduled. At the end of the hearing or within three days, the judge will make a decision, called a Notice of Judgment. 246 Pa. Code § 514(C). • Judgment in favor of the landlord: If the judge rules in favor of the landlord, then the Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 14 landlord will be granted possession of the unit. 246 Pa. Code § 514. The judge may also require you to pay damages and unpaid rent. Id. • Judgment in favor of the tenant: If the judge rules in your favor, then the landlord must do what the judge orders them to do, such as allowing you to remain in the unit or paying you money. 4. Appeal You have 10 days after entry of judgement against you to file an appeal in the court of common pleas. 68 P.S. § 250.513; 246 Pa. Code § 1008. The appeal will block an actual eviction (in legal terminology, operate as a supersedeas) only if you deposit with the court either three months’ rent or the amount the judge ordered you to pay, whichever is less. 246 Pa. Code § 1008(B). If you are low-income, you can file a tenant’s affidavit and deposit one third of your monthly rent. 246 Pa. Code § 1008(C). In both situations, you will also have to deposit rent each month while the appeal is pending. 246 Pa. Code § 1008(B), (C). The money will be held in escrow by the court. 5. Order of Possession Even if judgment is entered in favor of the landlord, the landlord still cannot evict you themselves. Instead, the landlord must wait 10 days after entry of judgment and then ask the court to issue an order of possession. 246 Pa. Code § 515(B). The court will serve the order of possession by mailing a copy to you at your last known address by First-Class Mail. 246 Pa. Code § 517. A sheriff or certified constable will also serve you with the order of possession personally or by posting it conspicuously on the leased property. Id. The order of possession will require you to vacate the residential unit within 10 days after the date of service. 246 Pa. Code § 517(2). If you remain in the rental unit on the 11th day following service of the order of possession, then you can be forcibly evicted. 246 Pa. Code § 519(B). If you are forcibly evicted and leave possessions behind, the landlord must notify you by First- Class Mail of your right to retrieve the property. 68 P.S. § 250.505a(d), (e). You have 10 days from the postmark date of the notice to either retrieve your possessions or ask that your landlord store your possessions for up to 30 days. Id. If you ask your landlord to store your possessions, you will be responsible for any costs. Id. If you do not contact the landlord or retrieve your property, the landlord can dispose of it. Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 15 6. Domestic Violence Survivor If you are a victim of domestic violence,13 then you have 30 days to appeal a judgment in favor of the landlord. 68 P.S. § 250.513(b). If the landlord obtains an order of possession before the 30 days have passed, you can file a domestic violence affidavit with the court to stay (i.e., freeze) the order of possession pending an appeal or until the end of the 30 days. 246 Pa. Code § 514.1. 7. Satisfaction of Judgment for Nonpayment of Rent If the eviction is only for failure to pay rent, a tenant can stop the eviction by paying—any point before actual eviction—the full amount of unpaid rent and other fees. 246 Pa. Code § 518. Once that happens, one more step needs to be taken: the landlord should enter with the court that the judgment has been satisfied. 246 Pa. Code § 341. If your landlord does not do so, you should file a written request to have the judgment marked satisfied with the court and serve it on the landlord. 246 Pa. Code § 341. If the landlord does not enter that the judgment has been satisfied within 90 days of a written request without good cause, the landlord will be liable to the tenant for 1% of the judgment amount, at least $250 and up to $2,500, every month the judgment is not marked satisfied. 42 Pa. Cons. Stat. § 8104(b). 8. Eviction Records An “eviction record” is an official record—court filings, transcripts and orders, for example— that contains information about a past or ongoing lawsuit to evict a tenant. There is no uniform requirement across all Pennsylvania courts for what details must be included in an eviction record; there is no guarantee that the information contained in eviction records tells the whole story. An eviction record may also show, incorrectly, that a tenant who was evicted for failure to pay rent has not satisfied the judgment just because the landlord has failed to have the judgment marked satisfied with the court. Pennsylvania does not automatically seal or expunge eviction records, even if the case is withdrawn. Some cities in Pennsylvania, such as Philadelphia, may have eviction diversion or mediation programs designed to help you and the landlord come to an agreement without using the court process or creating an eviction record.
USER:
I have a year and a month left on my lease and my landlord is going to evict me even though I've paid my rent, how long do I have to leave after they actually start the process?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 36 | 38 | 2,184 | null | 634 |
Only provide commentary from the context included.
|
Is acupuncture a beneficial treatment for leg pain in patients with sciatica?
|
1 Effect of acupuncture on leg pain in patients with sciatica due to lumbar disc 2 herniation: A prospective, randomised, controlled trial 3 4 Guang-Xia Shia , Fang-Ting Yua , Guang-Xia Nib , Wen-Jun Wanc , Xiao-Qing Zhoud , 5 Li-Qiong Wanga , Jian-Feng Tua , Shi-Yan Yana , Xiu-Li Menge , Jing-Wen Yanga , 6 Hong-Chun Xiangf , Hai-Yang Fug , Lei Tangc , Beng Zhangd , Xiao-Lan Jie , Guo-Wei 7 Caif*, Cun-Zhi Liua,h** 8 a International Acupuncture and Moxibustion Innovation Institute, School of 9 Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, 10 Beijing, China 11 bSchool of Acupuncture-Moxibustion and Tuina, School of Health and Rehabilitation, 12 Nanjing University of Chinese Medicine, Nanjing, China 13 cDepartment of Rehabilitation, The Central Hospital of Wuhan, Tongji Medical 14 College, Huazhong University of Science and Technology, Wuhan, China 15 dDepartment of Acupuncture and Moxibustion, Shenzhen Hospital, Beijing University 16 of Chinese Medicine, Shenzhen, China 17 ePain Medicine Center, Peking University Third Hospital, Beijing, China 18 fDepartment of Acupuncture, Union Hospital, Tongji Medical College, Huazhong 19 University of Science and Technology, Wuhan, China 20 gDepartment of Acupuncture, Affiliated Hospital of Nanjing University of Chinese 21 Medicine, Nanjing, China 22 hDepartment of Acupuncture, Dongzhimen Hospital Affiliated to Beijing University 23 of Chinese Medicine, Beijing, China 24 Corresponding author* 25 Department of Acupuncture, Union Hospital, Tongji Medical College, Huazhong 26 University of Science and Technology, Wuhan, China. No. 1277 Jiefang Avenue, 27 Jianghan District, Wuhan 430022,China. 28 E-mail Address: [email protected] (G.-W. Cai) 29 Corresponding author** 30 International Acupuncture and Moxibustion Innovation Institute, School of 31 Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No.11 32 Bei San Huan Dong Lu, Chaoyang District, Beijing 100021, China. E-mail 33 Address:[email protected] (C.-Z. Liu) 34 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 35 Summary 36 Background Sciatica is a condition including unilateral leg pain that is more severe 37 than low back pain, and causes severe discomfort and functional limitation. We 38 investigated the effect of acupuncture on leg pain in patients with sciatica due to 39 lumbar disc herniation. 40 Methods In this multi-centre, prospective, randomised trial, we enrolled patients with 41 sciatica due to lumbar disc herniation at 6 hospitals in China. Patients were randomly 42 assigned (1:1:1) to receive either acupuncture at the acupoints on the disease-affected 43 meridian (DAM), or the non-affected meridian (NAM), or the sham acupuncture (SA) 44 3 times weekly for 4 weeks. The primary end point was the change in visual analogue 45 scale (VAS, 0-100) of leg pain intensity from baseline to week 4. This study is 46 registered with Chictr.org.cn, ChiCTR2000030680. 47 Finding Between Jun 9th, 2020, and Sep 27th, 2020, 142 patients were assessed for 48 eligibility, 90 patients (30 patients per group) were enrolled and included in the 49 intention-to-treat analysis. A greater reduction of leg pain intensity was observed in 50 the DAM group than in the other groups: -22.2 mm than the SA group (95%CI, -31.4 51 to -13.0, P <0.001) , and -19.3mm than the NAM group (95% CI, -28.4 to -10.1; P 52 <0.001). However, we did not observe a significant difference in the change of leg 53 pain intensity between the NAM group and the SA group (between-group difference 54 -3.0 [95% CI, -12.0 to 6.1], P=0.520). There were no serious adverse events. 55 Interpretation Compared with SA, acupuncture at the acupoints on the 56 disease-affected meridian, but not the non-affected meridian, significantly reduces the 57 leg pain intensity in patients with sciatica due to lumbar disc herniation. These 58 findings suggest that the meridian-based specificity of acupoint is a considerable 59 factor in the acupuncture treatment. A larger, sufficiently powered trial is needed to 60 accurately assess efficacy. 61 62 Funding The National Key R&D Program of China (No: 2019YFC1712103) and the 63 National Science Fund for Distinguished Young Scholars (No:81825024). 64 Keywords: Acupuncture; leg pain; Acupoint selection; Meridian-based; Sciatica 65 66 67 68 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 69 Research in context 70 Evidence before this study 71 Using the key words "sciatica" and "acupuncture"，we searched PubMed for articles 72 published between Jan 1, 1947 and Jan 5, 2024. Despite an extensive literature search, 73 only a limited number of studies were available. There is ambiguous evidence about 74 the use of acupuncture, with most studies contrasting one another in addition to the 75 lack of high-quality trials. Since the choice of more appropriate acupoints for 76 stimulation is meaningful for acupuncture, studies that investigate the effect of 77 acupuncture on different acupoint program are urgently needed. 78 Added value of this study 79 This multi-centre, assessor and statistician-blinded trial addressed the above 80 limitations by showing that, compared with sham acupuncture, acupuncture at the 81 acupoints on the disease-affected meridian, but not the non-affected meridian, 82 significantly reduces the leg pain intensity in patients with sciatica due to lumbar disc 83 herniation. 84 Implications of all the available evidence 85 We found that acupuncture at the acupoint on the disease-affected meridian had 86 superior and clinically relevant benefits in reducing pain intensity to a greater degree 87 than acupuncture at NAM or SA. The finding is of vital significance to clinical work, 88 as meridian-based specificity of acupoint is one of the most determining factors in the 89 efficacy of acupuncture. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 90 Introduction 91 Sciatica is a common health problem in the general population with a lifetime 92 prevalence of 10% to 43%, depending on different etiologies [1-2]. It is characterised 93 by radiating leg pain starting from the low back, at times accompanied by sensory or 94 motor deficits. In most cases, sciatica is attributable to lumbar disk disorders [3]. The 95 overall prognosis is worse than low back pain, particularly if leg pain extends distal to 96 the knee with signs of nerve root compression, increasing risk for unfavorable 97 outcomes and health care use [4]. Spontaneous recovery occurs in most patients; 98 however, many endure substantial pain and prolonged disability, as 34% reported 99 chronic pain beyond 2 years [5-6]. Optimal pharmacological treatment is unclear due 100 to uncertain benefits or high rates of adverse effects[7-8]. Surgery has been 101 demonstrated to ameliorate sciatica in the early stage, but a proportion of patients do 102 not meet surgical standards or hesitate about the potential complications [9]. The 103 dilemma has led to a soaring increase in complementary and alternative medicine, 104 such as acupuncture [10]. 105 Acupuncture has been recommended for management of low back pain by clinical 106 practice guideline from the American College of Physicians [11-12]. Several studies 107 have also shown that acupuncture was beneficial in treating leg pain, although others 108 have reported discrepancies concerning the efficacy of true vs sham acupuncture[10]. 109 The inconsistent findings may result from variations in study design and insufficient 110 sample size. We conducted this trial to preliminarily evaluate the efficacy and safety 111 of acupuncture in terms of reduction in leg pain with sciatica patients. 112 Acupuncture is garnering increased attention as an effective treatment for pain 113 managemengt, one important issue is whether acupoint choice influences the benefits 114 of acupuncture[10]. However, a well-recognized acupoint program has yet not been 115 established, yielding heterogeneous results across relative studies[13]. Therefore, the 116 second aim of this study was to compare the difference of acupuncture efficacy in 117 patients receiving acupuncture at the acupoints of the disease-affected meridian 118 (DAM), the non-affected meridian (NAM), or sham acupuncture (SA). 119 120 Methods 121 Study design and participants 122 This mult-centre, three-arm, prospective randomised trial was conducted in the 123 inpatient departments of 6 tertiary hospitals in China between Jun 9, 2020 and Sep27, This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 124 2020. The study protocol was approved by the local ethics committee at the 125 coordinating center and each study site (No. 2020BZHYLL0105), and registered with 126 the Chinese Clinical Trial Registry on Chictr.org.cn, ChiCTR2000030680. The 127 protocol has been published previously [14] and is available in open-access full text 128 and in Supplement 1. All patients provided written informed consent before 129 enrolment. 130 Eligible patients were aged 18 to 70 years old , reported leg pain extending below 131 the knee in a nerve root distribution over 4 weeks, had a lumbar disc herniation 132 confirmed by examination signs (positive result on straight leg raise test or sensory or 133 motor deficit in a pattern consistent with a lumbar nerve root) [15], and scored 40 mm 134 or higher on the 100-mm VAS [16]. Imaging (magnetic resonance imaging with or 135 without computed tomography) corroborating a root-level lesion concordant with 136 symptoms and/or signs was determined by the trial clinician. Exclusion criteria were a 137 history or diagnostic result that suggested an inherited neuropathy or neuropathy 138 attributable to other causes, had undergone surgery for lumbar disc herniation within 139 the past 6 months or plan to have spinal surgery or other interventional therapies 140 during next 4 weeks, continually took antiepileptic medication, antidepressant 141 medication, opioids or corticosteroids; had cardiovascular, liver, kidney, or 142 hematopoietic system diseases, mental health disorders, other severe coexisting 143 diseases (e.g., cancer), pregnant, breastfeeding, or women planning conception during 144 the study. Patients participating in other clinical studies within the past 3 months or 145 receiving acupuncture within 6 months were also excluded. The screening process 146 was conducted in the way of in-person visits by trial clinicians. 147 Randomisation and masking 148 The study protocol was explained to all enrolled patients before randomisation. 149 After written informed consent was obtained, patients were allocated randomly (1:1:1) 150 to the three arms: DAM, NAM or SA. Randomisation was performed with a random 151 block size of six. A randomisation sequence was created by a biostatistician who did 152 not participate in the implementation or statistical analysis of trial. The assessor and 153 statistician were blinded to treatment allocation throughout data collection and 154 analysis. 155 Procedures and interventions 156 To exploratively observe whether the effects of acupoint located on two kinds of 157 meridians are different, this trial set two acupuncture groups, in which patients This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 158 received acupuncture at acupoints on the disease-affected meridian (DAM), or the 159 non-affected meridian (NAM), respectively. The bladder (BL) and gallbladder (GB) 160 meridians are directly in the same dermatomes of the sciatic nerve. Since these 161 meridians are consistent with sciatic pain distribution, they are regarded as the 162 disease-affected meridians. 163 Patients assigned to the DAM group received semi-standardized treatment at 164 acupoints on the bladder/gallbladder meridians. Bilateral BL25 and BL26, which 165 localized at the same level as the inferior border of the spinous process of the fourth 166 and the fifth lumbar vertebra (the commonest positions of disc rupture), were needled 167 as obligatory acupoints. For those having symptoms at the posterior side of the leg, 168 BL54, BL36, BL40, BL57, and BL60 were needled as adjunctive acupoints; similarly, 169 GB30, GB31, GB33, GB34, and GB39 were adjunctive acupoints for patients with 170 symptoms at lateral side. For patients who had pain at both posterior and lateral sides, 171 acupuncturists were instructed to select 5 of the 10 adjunctive acupoints. 172 According to the principle of the Traditional Chinese Medicine theory, the liver 173 meridian, the spleen meridian, and the kidney meridian are commonly treated to 174 improve the functional status of the body. These meridians distribute at the inner side, 175 less related to sciatica symptoms, and are regarded as non-affected meridians. For 176 patients in the NAM group, bilateral EX-B7, EX-B4, and unilateral LR9, LR8, LR5, 177 KI7, and SP4 that on the non-affected meridians were selected . 178 Patients assigned to the SA group received acupuncture at 7 non-acupoints which 179 not localized on meridians and with no manipulations. 180 All acupuncture treatments were performed by two senior acupuncturists (length of 181 services ≥5 years), who consistently applied the same standardised protocols. After 182 identifying the location of acupoints, sterile acupuncture needles (length 40 mm, 183 diameter 0.30 mm; Hwato, Suzhou Medical Appliance Factory, China) were inserted, 184 followed by 30s manipulation to acquire Deqi (a sensation of aching, soreness, 185 swelling, heaviness, or numbness). Blunt-tipped placebo needles with similar 186 appearances to conventional needles but no skin penetration were used in the SA 187 group. To maximize the blinding of patients and to fix blunt-tipped placebo needles, 188 adhesive pads were placed on points in all groups. Patients in all groups started 189 treatment on the day of randomization and received twelve 30-minute sessions over 4 190 consecutive weeks at 3 sessions per week (ideally every other day). This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 191 Pain medication was offered if necessary and included paracetamol and optionally 192 non-steroidal anti-inflammatory drugs (Celebrex), short acting opioids, or both. We 193 used questionnaires to monitor the use of pain medication and other co-interventions. 194 Outcomes 195 The primary outcome was the change of leg pain intensity over the preceding 24 196 hours from baseline to week 4 as measured on the VAS. Participants were asked to 197 rate their average leg pain during the last 24 hours out of 100, with 0 representing no 198 leg pain and 100 representing the worst pain imaginable. 199 Secondary outcomes included VAS for leg pain and back pain intensity at other 200 time points. We observed the Oswestry Disability Index (ODI, examining perceived 201 functional disability in 10 activities of daily living), Sciatica Frequency and 202 Bothersomeness Index (SFBI, rating the extent of frequency and bothersomeness of 203 sciatica respectively), 36-item Short Form Health Survey (SF-36, evaluating the 204 quality of life with physical and mental components) . 205 We also assessed levels on the global perceived recovery (assessed by a 7-point 206 Likert self-rating scale with options from “completely recovered” to “worse than 207 ever”) and degrees of the straight leg raise test. 208 The Credibility/Expectancy Questionnaire (CEQ) was used to assess the credibility 209 and expectancy of patients to acupuncture treatment after the first treatment. 210 Moreover, patients were also invited to guess their group for blinding assessment at 211 week 2 and week 4. Adverse events were documented by patients and outcome 212 assessors throughout the trial. All adverse events were categorized as 213 treatment-related or non-treatment-related and followed up until resolution. 214 The researchers in charge of the scale assessment were asked to use the fixed 215 guiding words on the questionnaires to have a conversation with the patient without 216 redundant communication. Due to the trial site and population, we used Chinese 217 versions of the assessment scales that were confirmed to have moderate or higher 218 clinical responsiveness and are suitable for clinical efficacy evaluation. 219 Statistical analysis 220 We designed our trial to determine whether there was a difference between each 221 acupuncture group and the sham acupuncture group in terms of leg pain intensity. 222 According to the method of upper confidence limit, a sample size ranging from 20 to 223 40 could be the guideline for choosing the size of a pilot sample. Considering the 224 overall resource input issues (eg, funding availability and expected completion time), This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 225 the total sample size was preset at 90 patients, 30 patients per group. We performed 226 analyses following the intention-to-treat principle with all randomly assigned patients 227 included. 228 For the primary outcome, analysis of covariance was applied to test the difference 229 between groups in leg pain intensity with baseline values adjusted. Missing data were 230 imputed using multiple imputation method. To address the robustness of the results, 231 we performed a per-protocol analysis for the primary outcome, covering patients who 232 complete 10 sessions or more and had no major protocol violations (e.g., using 233 additional treatments during the treatment period). One-way ANOVA was performed 234 for the secondary outcomes including leg pain at each measuring time point, back 235 pain, ODI, SFBI, SF-36, CEQ, PDQ, global perceived recovery scores, and degrees of 236 straight leg raise test. The blinding assessment, the proportion of patients using 237 additional treatments and adverse event rates were analyzed using the χ2 test or Fisher 238 exact test. Between-group differences were tested through the least significance 239 difference (LSD)-t test. Categorical variables are presented as n (%) and continuous 240 variables are presented as the mean (SD) or median (interquartile range, IQR) . All 241 tests applied were two-tailed, p < 0.05 was considered statistically significant. An 242 independent statistician completed the analyses using IBM SPSS Statistics version 20 243 (IBM Corp, Armonk, NY). 244 Role of the funding source 245 The funder of the study had no role in the study design, data collection, data 246 analysis, or writing of the report. All authors had full access to the data in the study 247 and gave the final approval of the manuscript and agree to be accountable for all 248 aspects of work. 249 Results 250 Patient characteristics 251 Between Jun 9th, 2020, and Sep 27th, 2020, 142 patients were assessed for 252 eligibility, 90 patients (30 patients per group) were enrolled and included in the 253 intention-to-treat analysis (Figure 1). Mean age of patients was 44.2 (SD 14.9) years, 254 and 51 (56.7%) were female. Mean symptom duration was 2.0 years (IQR 0.7 to 4.1) 255 with a mean VAS score of 62.3 (SD 14.3) mm for their leg pain intensity. Overall, 75 256 (83.3%) patients completed the assigned 12 sessions of study interventions, and 82 257 (91.1%) received at least 10 sessions. The primary outcome visit was attended by 82 258 patients at week 4, corresponding to a follow-up rate of 91.1%, which was maintained This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 259 to week 26. There was no difference among groups regarding the usual risk factors for 260 sciatica, such as gender, age, body-mass index, or Disk herniation level, which 261 confirmed that the groups were well matched. The baseline characteristics of patients 262 are summarized in Table 1. 263 After receiving 4-week treatment, the change of leg pain intensity decreased by 264 -36.6 mm (95% CI, -43.1 to -30.2) in the DAM group, by -17.4 mm in the NAM 265 group and by -14.4 mm (95% CI, -20.9 to -8.0) in the SA group. Changes in the leg 266 pain intensity over 4-week period differed significantly among the 3 groups. A greater 267 reduction was observed in the DAM group than in the other groups: -22.2 mm 268 reduction in leg pain intensity than in the SA group (95% CI, -31.4 to -13.0, P＜ 269 0.001) , and -19.3 mm reduction in leg pain intensity than in the NAM group (95% CI, 270 -28.4 to -10.1; P <0.001). While no significant change in leg pain intensity was 271 observed between the NAM and SA groups (mean difference, -3.0 mm, 95% CI, -12.0 272 to 6.1, P=0.52) (Figure 2). 273 We observed that outcomes at the 26-week follow-up were similar in direction to 274 the those at the end of an 4-week period. At week 26, a difference in the change of leg 275 pain intensity were present between the DAM and SA groups (mean difference, -13.3 276 mm, 95% CI, -23.2 to -2.8, P=0.01), between the DAM and NAM groups (mean 277 difference, -13.4 mm, 95%CI, -23.6 to -3.1, P=0.011), but not between the NAM and 278 SA groups (mean difference, 0.1 mm, 95% CI, -10.3 to 10.5, P=0.99) (Figure 2). 279 Sensitive analyses did not alter the result in the primary analysis (eTable 1 and eTable 280 2 in Supplement 2). 281 We found a greater reduction in back pain intensity over SA for patients who 282 received DAM at week 4 (mean difference, -18.0 mm, 95% CI, -27.7 to -8.4, P＜ 283 0.001). The difference in back pain changes was not significant between the NAM 284 and SA groups at week 4 (mean difference, -4.2 mm, 95% CI, -13.6 to 5.3, P=0.38). 285 At week 26, no difference was detected in back pain relief across the 3 groups. 286 We also found a greater decrease in disability scores in the DAM group over SA at 287 week 4 (mean difference, -10.7 points, 95% CI, -18.3 to -3.1, P=0.007), while there 288 was no difference between the NAM and SA groups (mean difference, -3.1 points, 289 95%CI, -10.6 to 4.3, P=0.41). Similar results were observed at week 26, which 290 favored acupuncture at DAM (mean difference between DAM and SA, -11.1 points, This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 291 95%CI, -19.4 to -2.8, P=0.01) rather than acupuncture at the NAM (mean difference 292 between NAM and SA, -2.7 points, 95%CI, -11.0 to -5.7, P=0.53). 293 Compared to SA, patients in the DAM group reported better symptom 294 improvement on the global perceived recovery test, and lower scores in both 295 frequency and bothersomeness scales on the SFBI. Nonetheless, the measurement of 296 the quality of life, or the degree of the straight leg raise test did not show a difference 297 across the 3 groups (Table 2). Five (16.7%) patients in the DAM group and 4 (13.3%) 298 patients in the SA group take rescue medicine for a short period (eTable 3 in 299 Supplement 2). For blinding assessment, we found no difference across groups in the 300 proportion of patients who correctly guessed the kind of intervention they had 301 received at week 2 and week 4 (eTable 4 in Supplement 2). Outcomes measured at 302 other time points were shown in eTable 5 and e Figure in Supplement 2. 303 Adverse events 304 Three (10%) patients in the NAM group reported post-needling pain which 305 decreased in the following week spontaneously. Adverse events unrelated to the study 306 interventions including increased leg pain, dizziness, insomnia, etc, were all rated as 307 mild to moderate (eTable 6 in Supplement 2). No serious adverse event occurred 308 during the study period. 309 Interpretation 310 To our knowledge, our study is a multi-center clinical trial to show the beneficial 311 effect of acupuncture for patients with moderate-to-severe sciatica of varying duration 312 and is the first to explore the meridian-based acupoint program in this field. We found 313 that acupuncture at the DAM had superior and clinically relevant benefits in reducing 314 leg pain intensity to a greater degree than acupuncture at NAM or SA. Improvements 315 in functional disability, back pain, frequency and bothersomeness and global 316 perceived recovery were also found. Moreover, no significant differences was 317 observed with respect to any outcome between NAM and SA groups. 318 The findings of the current study demonstrate that acupuncture at the acupoints on 319 the disease-affected meridian was clinically beneficial and superior to SA for leg pain. 320 We acknowledge the commonly recognised minimally clinically important difference 321 (MCID) is 10-20 of 100 for pain intensity [16]. The clinically important mean leg 322 pain reduction at the 4-week of treatment in DAM group was -22.2 mm, and 323 continued the trend of a mean clinical important result at 26-week follow-up (-13.3 324 mm). Before our study, Liu and colleagues evaluated the effect of acupuncture in This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 325 relieving leg pain for patients with chronic discogenic sciatica compared with sham 326 acupuncture [13]. Acupuncture showed a small but not clinically relevant effect, with 327 a between-group difference in the 4-week on mean VAS score for leg pain was 7.28， 328 which is not reach the MCID. More acupoints on the disease-affected meridian were 329 adapted in our trial (7 v 4 acupoints on the bladder and/or the gallbladder meridian) 330 which may interpret the discrepancy. 331 Our findings are consistent with a meta-analysis showing that acupuncture was 332 more effective than conventional medicine in managing the pain associated with 333 sciatica, with a significantly greater reduction in pain intensity by 12.5 (95% CI: 334 −16.3 to −8.6) [17]. It is worth noting that the most commonly used acupoints were 335 Huantiao (GB 32), Weizhong (BL 40), and Yanglingquan (GB 34), all on the bladder 336 and/or gallbladder meridians that were directly related with dermatomal distributions 337 of sciatic nerve. Acupuncture at the DAM was more effective than at the NAM in 338 alleviating pain severity during the 4-week treatment and the follow-up period. The 339 acupoints in NAM group are mainly located on the Liver, Spleen and Kidney 340 meridian, which are not affected directly by sciatica in Traditional Chinese Medicine. 341 We speculate that the varied efficacy between the DAM and NAM relate to 342 meridian-based acupoint specificity. 343 Acupuncture at the DAM showed significant superiority in the primary outcome 344 and in most of the second outcomes at the end of therapy. However, no significant 345 differences were observed in the quality of life or the degree of the straight leg raise 346 test among the three groups. The health status and body function are more likely be 347 affected by physical factors and psychological factors [18-19]. In addition, pain may 348 limit function, so as pain decreases, function (straight leg raise) may increase until 349 pain again limits functional capacity. This may explain the improvement in pain 350 without measurable proved function [20]. 351 In Dr. Vickers’ and his groups 2018 update of the meta-analysis of acupuncture for 352 chronic pain study, the authors did not finding any statistically significant influence 353 from point selection on treatment outcome by acupuncture [11]. Another two clinical 354 trials on acupuncture for low back pain, where the first showed no difference between 355 two different acupuncture recipes [21] and the subsequent detected no difference 356 between and real and sham acupuncture (where the sham treatment involved different 357 bodily locations) [22]. The efficacy of acupuncture is related to the dose, point This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 358 selection and treatment time (duration and frequency), and we could not isolate which 359 components contributed to the benefits. Our study only partially answer that acupoint 360 choice could influence the efficacy of acupuncture. 361 Practice guidelines recommend an initial period of conservative care focused on 362 non-pharmacologic treatments for persons with recent-onset sciatica, except in rare 363 instances of rapidly progressing or severe neurologic deficits that may require 364 immediate surgical intervention. In this study, acupuncture hastened pain and 365 functional improvement, indicating that acupuncture could be offered to patients with 366 sciatica lasting at least 4 weeks (mean duration of 2.0 years) as promising 367 non-pharmacologic care. However, prior studies enrolled patients with more acute 368 conditions who may have been more prone to spontaneous recovery than our 369 participants, which limit the generalizability of the trial findings. 370 Acupuncture has regionally specific effect or segmental effect [23-24]. Acupoints 371 located directly on injured nerves could inhibit the nociceptive pathway at the same 372 spinal level and give an analgesic effect at the same dermatomal level [25]. However, 373 the underlying mechanism is not fully elucidated and is worthy of further study. 374 This study had several strengths. Rigorous methods have been used to test the 375 preliminary efficacy of acupuncture in this pilot study. The use of blunt-tipped 376 placebo needles ensured the implementation of blinding, which can make the patients 377 have the feeling of acupuncture under the premise that the needle tip does not 378 penetrate the skin. The high recruitment rate has reflected the willingness to 379 participate among patients with sciatica. The compliance rate (83.3%) and follow-up 380 rate (91.1%) for this pilot trial are satisfactory. Therefore, the current study may 381 provide a more accurate basis for assessing the sample size and selection of 382 acupuncture acupoints for the large-scale trial to be conducted. 383 Limitations 384 Some limitations have to be acknowledged. First, we run this multi-center trial in 385 order to text the feasiblity to implement a large-scale RCT to further confirm the 386 efficacy of acupuncture in this regard. However, with only 90 participants spread over 387 six centers, the effect from the numerous treatment centers should be probably 388 accounted. Second, due to the nature of acupuncture, it was not possible to blind 389 acupuncturists to treatment assignment. But they were trained in advance to follow a 390 standard operating procedure and keep equal communication with patients. Third, 391 although sensitive analysis indicated similar conclusions, the robustness of our This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 392 finding was decreased by the small sample size with a wide credible interval 393 generated, thus further studies with sufficient sample size are needed. Fourth, a 394 treatment that offered 3 sessions per week for continuous 4 weeks was proposed to be 395 burdensome for part of the patients, especially for those who are employed. Treatment 396 with a gradually decreased frequency should be applied in future studies. 397 Conclusion 398 Acupuncture was safely administered in patients with mild to moderate sciatica 399 caused by lumbar disc herniation. To accurately assess the efficacy, a larger, 400 sufficiently powered trial is needed. Acupuncture at the acupoint on the 401 disease-affected meridian had superior and clinically relevant benefits in reducing 402 pain intensity to a greater degree than acupuncture at NAM or SA. Data supported the 403 meridian-based specificity of acupoint is one of the most determining factors in the 404 efficacy of acupuncture. 405 406 References 407 1. Gadjradj PS, Rubinstein SM, Peul WC, et al. Full endoscopic versus open 408 discectomy for sciatica: randomised controlled non-inferiority trial. BMJ. 2022; 409 376:e065846. 410 2. Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and 411 prevalence estimates. Spine. 2008; 33:2464-2472. 412 3. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 413 2007; 334:1313-1317. 414 4. Deyo RA, Mirza SK. Herniated Lumbar Intervertebral Disk. N Engl J Med. 2016; 415 374:1763-1772. 416 5. Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015; 372:1240-1248. 417 6. Mehling WE, Gopisetty V, Bartmess E, et al. The prognosis of acute low back 418 pain in primary care in the United States: a 2-year prospective cohort study. Spine. 419 2012; 37:678-684. 420 7. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. 421 BMJ. 2019; 367:l6273. 422 8. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for 423 the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 424 2014 ;14(1):180-191. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 425 9. Manchikanti L, Knezevic E, Latchaw RE, et al. Comparative Systematic Review 426 and Meta-Analysis of Cochrane Review of Epidural Injections for Lumbar 427 Radiculopathy or Sciatica. Pain physician. 2022; 25:E889-e916. 428 10. Ji M, Wang X, Chen M, et al. The Efficacy of Acupuncture for the Treatment of 429 Sciatica: A Systematic Review and Meta-Analysis. Evid Based Complement 430 Alternat Med. 2015;2015:192808. 431 11. Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for Chronic Pain: 432 Update of an Individual Patient Data Meta-Analysis. J Pain. 2018;19(5):455-474. 433 12. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive Treatments for Acute, 434 Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the 435 American College of Physicians. Ann Intern Med. 2017;166(7):514-530. 436 13. Huang Z, Liu S, Zhou J, Yao Q, Liu Z. Efficacy and Safety of Acupuncture for 437 Chronic Discogenic Sciatica, a Randomized Controlled Sham Acupuncture Trial. 438 Pain Med. 2019;20(11): 2303-2310. 439 14. Yu FT, Ni GX, Cai GW, et al. Efficacy of acupuncture for sciatica: study 440 protocol for a randomized controlled pilot trial. Trials. 2021;22:34. 441 15. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. 442 BMJ 2019;367:l6273. 443 16. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: 444 what is moderate pain in millimetres? Pain. 1997;72:95-7. 445 17. Schroeder K, Richards S. Non-specific low back pain. Lancet 2012;379:482-91 446 18. Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context 447 effects on health outcomes: A systematic review. Lancet 448 2001;357(9258):757-762 449 19. Ropper AH, Zafonte RD. Sciatica. New Engl J Med 2015;372(13):1225–1240. 450 20. Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney 451 K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA. A randomized trial 452 comparing acupuncture, simulated acupuncture, and usual care for chronic low 453 back pain. Arch Intern Med. 2009;169(9):858-866. 454 21. Donna Kalauokalani, Daniel C Cherkin, Karen J Sherman. A comparison of 455 physician and nonphysician acupuncture treatment for chronic low back pain. 456 Clin J Pain. 2005;21(5):406-411. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 457 22. Goldberg H, Firtch W, Tyburski M, et al. Oral steroids for acute radiculopathy 458 due to a herniated lumbar disk: a randomized clinical trial. JAMA. 459 2015;313:1915-1923. 460 23. Zhang R, Lao L, Ren K, Berman B. Mechanisms of 461 acupuncture-electroacupuncture on persistent pain. Anesthesiology. 462 2014;120(2):482-503. 463 24. Cheng K. Neuroanatomical basis of acupuncture treatment for some common 464 illnesses. Acupunct Med. 2009;27(2):61-4. 465 25. Cheng KJ. Neuroanatomical basis of acupuncture treatment for some common 466 illnesses. Acupuncture in medicine: journal of the British Medical Acupuncture 467 Society. 2009;27:61-64. 468 469 Figure legends 470 Figure 1. Modified CONSORT flow diagram. 471 Figure 2. VAS scores for leg pain intensity. 472 Tables 473 Table 1. Baseline characteristics of participants. 474 Table 2. Primary and secondary outcomes measured at week 4 and week 26. 475 476 Contributors 477 CZL is the guarantor for the article. CZL, GXS and FTY designed the trial. GWC, 478 GXN, WJW, XQZ, and XLM offered administrative support. FTY, HCX, HYF, LT, 479 BZ, and XLJ recruited and followed up patients. LQW, JFT and JWY were 480 responsible for study monitoring. SYY and JWY take responsibility for the accuracy 481 of the data analysis. All authors had full access to the data in the study and gave the 482 final approval of the manuscript and agree to be accountable for all aspects of work. 483 484 Data sharing statement 485 Data are available from the corresponding author on reasonable request. 486 Declaration of interests 487 The authors declare no conflict of interest. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed Figure 1. Modified CONSORT flow diagram. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed Figure 2. VAS scores for leg pain intensity. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 1 Table 1. Baseline characteristics of participants. Characteristic DAM group (n=30) NAM group (n=30) SA group (n=30) Age, year, mean (SD) 41.6 (14.7) 44.8 (15.0) 46.1 (15.1) Sex, no. (%) Female 21 (70.0) 16 (53.3) 14 (46.7) Male 9 (30.0) 14 (46.7) 16 (53.3) Marital status, no. (%) Married 22 (73.3) 23 (76.7) 24 (80.0) Single 8 (26.7) 7 (23.3) 6 (20.0) Occupation, no. (%) Mental work 24 (80.0) 24 (80.0) 20 (66.7) Manual work 6 (20.0) 6 (20.0) 10 (33.3) BMI, kg/m2, mean (SD) 22.6 (3.1) 23.3 (2.5) 23.0 (2.7) Duration of sciatica, year, median (IQR) 1.7 (0.4, 5.0) 1.8 (0.7, 3.3) 2.1 (0.7, 6.3) History of acupuncture, no. (%) Yes 13 (43.3) 15 (50.0) 9 (30.0) No 17 (56.7) 15 (50.0) 21 (70.0) Positive straight leg raise test, no. (%) 12 (40.0) 19 (63.3) 16 (53.3) Numbness, no. (%) 20 (66.7) 17 (56.7) 23 (76.7) Tingling, no. (%) 17 (56.7) 21 (70.0) 17 (56.7) Sensory deficit, no. (%) 4 (13.3) 3 (10.0) 3 (10.0) Muscle weakness, no. (%) 8 (26.7) 8 (26.7) 8 (26.7) This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 2 Reflex changes, no. (%) 1 (3.3) 1 (3.3) 1 (3.3) Disk herniation level, no. (%) L3-L4 2 (6.7) 0 (0.0) 0 (0.0) L4-L5 6 (20.0) 14 (46.7) 7 (23.3) L5-S1 9 (30.0) 4 (13.3) 8 (26.7) More than one level 13 (43.3) 12 (40.0) 15 (50.0) Leg pain intensity*, mm, mean (SD) 59.5 (12.3) 63.2 (14.8) 64.3 (15.7) Back pain intensity*, mm, mean (SD) 58.9 (25.2) 56.2 (23.6) 54.6 (26.0) ODI score†, mean (SD) 38.3 (13.0) 38.0 (15.7) 38.2 (14.8) SFBI score‡, mean (SD) Frequency 13.7 (4.4) 14.5 (4.5) 13.7 (5.2) Bothersomeness 12.3 (3.6) 12.5 (3.9) 12.9 (5.0) SF-36 score§, mean (SD) Physical Component 28.5 (10.4) 33.5 (11.5) 31.0 (10.3) Mental Component 52.4 (12.1) 47.6 (15.3) 49.9 (13.1) PDQ score¶, mean (SD) 10.5 (5.5) 12.3 (5.4) 10.7 (6.3) Credibility score**, mean (SD) 0.3 (2.5) 0 (2.6) -0.3 (2.8) Expectancy score**, mean (SD) 0.5 (2.6) -0.4 (3.0) -0.1 (2.7) * Scores range from 0 to 100, with higher scores indicating more severe pain. † Scores range from 0 to 100, with higher scores indicating worse disability. ‡ Scores range from 0 to 24, with higher scores indicating more severe symptoms. § Scores are based on normative data and have a mean (±SD) of 50±10, with higher scores indicating a better This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 3 quality of life. ¶ Scores range from 0 to 30, with higher scores indicating more neuropathic pain. ** Scale has Mean = 0.0 (SD = 1.0) since the items were converted to z-scores before averaging. DAM, the disease-affected meridian; NAM, the non-affected meridian; SA, Sham acupuncture. SD, standard deviation; IQR, interquartile range; BMI, body mass index; ODI, Oswestry Disability Index; SFBI, Sciatica Frequency and Bothersomeness Index; SF-36, 36-item Short Form Health Survey; PDQ, PainDETECT questionnaire. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 4 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 1 Table 2. Primary and secondary outcomes at week 4 and week 26 DAM vs SA NAM vs SA DAM vs NAM Outcome DAM group NAM group SA group P value Difference P value Difference P value Difference P value Primary outcome Change of leg pain intensity at week 4* -36.6 (-43.1, -30.2) -17.4 (-23.8, -11.0) -14.4 (-20.9, -8.0) ＜0.001 -22.2 (-31.4, -13.0) ＜0.001 -3.0 (-12.0, 6.1) 0.520 -19.3 (-28.4, -10.1) ＜0.001 Secondary outcomes Change of leg pain intensity at week 26‡ -35.5 (-42.8, –28.3) -22.2 (-29.3, -15.0) -22.2 (-29.7, -14.7) 0.016 -13.3 (-23.2, -2.8) 0.014 0.1 (-10.3, -10.5) 0.989 -13.4 (-23.6, -3.1) 0.011 Change of back pain intensity Week 4† -34.9 (-41.7, -28.2) -21.1 (-27.6, -14.6) -16.9 (-23.8, -10.0) 0.001 -18.0 (-27.7, -8.4) ＜0.001 -4.2 (-13.6, 5.3) 0.380 -13.8 (-23.2, -4.5) 0.004 Week 26‡ -33.5 (-41.6, -25.4) -23.6 (-31.8, -15.5) -22.7 (-31.1, -14.2) 0.128 -10.8 (-22.6, 0.9) 0.07 -1.0 (-12.7, 10.8) 0.871 -9.9 (-21.4, -1.6) 0.092 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 2 ODI score Week 4† 18.0 (13.9, 22.1) 25.5 (19.6, 31.5) 28.7 (22.6, 34.7) 0.019 -10.7 (-18.3, -3.1) 0.007 -3.1 (-10.6, 4.3) 0.406 -7.5 (-14.9, -0.1) 0.046 Week 26‡ 14.9 (10.0, 19.8) 23.3 (17.1, 29.5) 26.0 (19.1, 32.8) 0.025 -11.1 (-19.4, -2.8) 0.010 -2.7 (-11.0, 5.7) 0.527 -8.4 (-16.6, -0.3) 0.043 SFBI frequency score Week 4† 6.6 (4.9, 8.4) 10.6 (8.7, 12.5) 10.8 (8.5, 13.1) 0.005 -4.1 (-6.9, -1.4) 0.004 -0.2 (-2.9, 2.5) 0.874 -3.9 (-6.6, -1.2) 0.005 Week 26‡ 5.8 (3.7, 7.8) 10.1 (7.8, 12.5) 10.0 (7.4, 12.5) 0.010 -4.2 (-7.4, -1.0) 0.011 0.2 (-3.1, 3.4) 0.928 -4.4 (-7.5, -1.2) 0.007 SFBI bothersomeness score Week 4† 5.6 (4.0, 7.1) 8.9 (7.2, 10.6) 10.2 (8.1, 12.2) 0.001 -4.6 (-7.1, -2.1) ＜0.001 -1.3 (-3.7, 1.2) 0.306 -3.3 (-5.8, -0.9) 0.007 Week 26‡ 4.9 (3.2, 6.6) 8.5 (6.5, 10.5) 9.0 (6.6, 11.4) 0.007 -4.1 (-6.9, -1.3) 0.004 -0.5 (-3.3, 2.3) 0.742 -3.7 (-6.4, -0.9) 0.009 SF-36 physical component score Week 4† 37.3 (32.8, 41.7) 37.7 (33.7, 41.6) 33.8 (28.9, 38.7) 0.390 3.5 (-2.7, 9.6) 0.268 3.9 (-2.2, 9.9) 0.206 -0.4 (-6.4, 5.6) 0.888 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 3 Week 26§ 44.7 (39.9, 49.4) 40.1 (35.3, 44.8) 37.4 (32.0, 42.8) 0.104 7.3 (0.4, 14.2) 0.038 2.7 (-4.2, 9.5) 0.443 4.6 (-2.0, 11.3) 0.166 SF-36 mental component score Week 4† 53.7 (49.7, 57.6) 48.6 (43.2, 54.0) 51.9 (47.2, 56.7) 0.287 1.8 (-4.9, 8.4) 0.600 -3.3 (-9.9, 3.2) 0.314 5.1 (-1.4, 11.6) 0.122 Week 26§ 55.1 (51.7, 58.4) 51.2 (46.0, 56.4) 53.3 (48.6, 58.1) 0.438 1.7 (-4.5, 8.0) 0.580 -2.1 (-8.4, 4.1) 0.496 3.9 (-2.1, 9.8) 0.201 Degree of straight leg raise test Week 4¶ 70.1 (63.8, 76.5) 67.2 (61.0, 73.4) 68.5 (61.6, 75.3) 0.797 1.7 (-7.3, 10.6) 0.708 -1.3 (-10.1, 7.6) 0.774 3.0 (-5.8, 11.7) 0.502 Week 26** 74.9 (70.7, 79.1) 70.3 (62.7, 77.9) 69.8 (64.1, 75.4) 0.402 5.1 (-3.2, 13.4) 0.222 0.5 (-7.7, 8.7) 0.902 4.6 (-3.6, 12.8) 0.267 PDQ score Week 4† 6.7 (4.4, 9.2) 9.3 (7.8, 10.8) 8.0 (5.8, 10.2) 0.193 -2.5 (-5.3, 0.2) 0.071 1.3 (-1.5, 4.1) 0.351 -1.2 (-4.1, 1.6) 0.392 Week 26‡ 4.9 (3.3, 6.4) 9.0 (7.7, 10.4) 8.1 (6.0, 10.1) 0.001 -4.1 (-6.4, -1.9) ＜0.001 1.0 (-1.3, 3.3) 0.408 -3.2 (-5.5, -0.9) 0.007 Global perceived This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 4 recovery Week 4† 1.5 (1.2, 1.9) 2.6 (2.1, 3.1) 2.9 (2.4, 3.5) ＜0.001 -1.4 (-2.1, -0.7) ＜0.001 -0.3 (-1.0, 0.3) 0.301 -1.1 (-1.7, -0.4) 0.001 Week 26‡ 1.8 (1.4, 2.2) 2.6 (2.1, 3.0) 2.8 (2.3, 3.3) 0.005 -1.0 (-1.7, -0.4) 0.002 -0.2 (-0.9, 0.4) 0.460 -0.8 (-1.4, -0.2) 0.014 Estimates are expressed as mean (95%CI). * Data imputed through the last observation carried forward approach. † The number of participants providing data was 27 in the DAM group, 29 in the NAM group and 26 in the SA group at week 4. ‡ The number of participants providing data was 28 in the DAM group, 28 in the NAM group and 26 in the SA group at week 26. §The number of participants providing data was 28 in the DAM group, 28 in the NAM group and 24 in the SA group at week 26. ¶ The number of participants providing data was 27 in the DAM group, 28 in the NAM group and 26 in the SA group at week 4. ** The number of participants providing data was 25 in the DAM group, 26 in the NAM group and 25 in the SA group at week 26. DAM, the disease-affected meridian; NAM, the non-affected meridian; SA, Sham acupuncture. ODI, Oswestry Disability Index; SFBI, Sciatica Frequency and Bothersomeness Index; SF-36, 36-item Short Form Health Survey; PDQ, PainDETECT questionnaire. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 5 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed
|
Only provide commentary from the context included. Is acupuncture a beneficial treatment for leg pain in patients with sciatica? 1 Effect of acupuncture on leg pain in patients with sciatica due to lumbar disc 2 herniation: A prospective, randomised, controlled trial 3 4 Guang-Xia Shia , Fang-Ting Yua , Guang-Xia Nib , Wen-Jun Wanc , Xiao-Qing Zhoud , 5 Li-Qiong Wanga , Jian-Feng Tua , Shi-Yan Yana , Xiu-Li Menge , Jing-Wen Yanga , 6 Hong-Chun Xiangf , Hai-Yang Fug , Lei Tangc , Beng Zhangd , Xiao-Lan Jie , Guo-Wei 7 Caif*, Cun-Zhi Liua,h** 8 a International Acupuncture and Moxibustion Innovation Institute, School of 9 Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, 10 Beijing, China 11 bSchool of Acupuncture-Moxibustion and Tuina, School of Health and Rehabilitation, 12 Nanjing University of Chinese Medicine, Nanjing, China 13 cDepartment of Rehabilitation, The Central Hospital of Wuhan, Tongji Medical 14 College, Huazhong University of Science and Technology, Wuhan, China 15 dDepartment of Acupuncture and Moxibustion, Shenzhen Hospital, Beijing University 16 of Chinese Medicine, Shenzhen, China 17 ePain Medicine Center, Peking University Third Hospital, Beijing, China 18 fDepartment of Acupuncture, Union Hospital, Tongji Medical College, Huazhong 19 University of Science and Technology, Wuhan, China 20 gDepartment of Acupuncture, Affiliated Hospital of Nanjing University of Chinese 21 Medicine, Nanjing, China 22 hDepartment of Acupuncture, Dongzhimen Hospital Affiliated to Beijing University 23 of Chinese Medicine, Beijing, China 24 Corresponding author* 25 Department of Acupuncture, Union Hospital, Tongji Medical College, Huazhong 26 University of Science and Technology, Wuhan, China. No. 1277 Jiefang Avenue, 27 Jianghan District, Wuhan 430022,China. 28 E-mail Address: [email protected] (G.-W. Cai) 29 Corresponding author** 30 International Acupuncture and Moxibustion Innovation Institute, School of 31 Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No.11 32 Bei San Huan Dong Lu, Chaoyang District, Beijing 100021, China. E-mail 33 Address:[email protected] (C.-Z. Liu) 34 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 35 Summary 36 Background Sciatica is a condition including unilateral leg pain that is more severe 37 than low back pain, and causes severe discomfort and functional limitation. We 38 investigated the effect of acupuncture on leg pain in patients with sciatica due to 39 lumbar disc herniation. 40 Methods In this multi-centre, prospective, randomised trial, we enrolled patients with 41 sciatica due to lumbar disc herniation at 6 hospitals in China. Patients were randomly 42 assigned (1:1:1) to receive either acupuncture at the acupoints on the disease-affected 43 meridian (DAM), or the non-affected meridian (NAM), or the sham acupuncture (SA) 44 3 times weekly for 4 weeks. The primary end point was the change in visual analogue 45 scale (VAS, 0-100) of leg pain intensity from baseline to week 4. This study is 46 registered with Chictr.org.cn, ChiCTR2000030680. 47 Finding Between Jun 9th, 2020, and Sep 27th, 2020, 142 patients were assessed for 48 eligibility, 90 patients (30 patients per group) were enrolled and included in the 49 intention-to-treat analysis. A greater reduction of leg pain intensity was observed in 50 the DAM group than in the other groups: -22.2 mm than the SA group (95%CI, -31.4 51 to -13.0, P <0.001) , and -19.3mm than the NAM group (95% CI, -28.4 to -10.1; P 52 <0.001). However, we did not observe a significant difference in the change of leg 53 pain intensity between the NAM group and the SA group (between-group difference 54 -3.0 [95% CI, -12.0 to 6.1], P=0.520). There were no serious adverse events. 55 Interpretation Compared with SA, acupuncture at the acupoints on the 56 disease-affected meridian, but not the non-affected meridian, significantly reduces the 57 leg pain intensity in patients with sciatica due to lumbar disc herniation. These 58 findings suggest that the meridian-based specificity of acupoint is a considerable 59 factor in the acupuncture treatment. A larger, sufficiently powered trial is needed to 60 accurately assess efficacy. 61 62 Funding The National Key R&D Program of China (No: 2019YFC1712103) and the 63 National Science Fund for Distinguished Young Scholars (No:81825024). 64 Keywords: Acupuncture; leg pain; Acupoint selection; Meridian-based; Sciatica 65 66 67 68 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 69 Research in context 70 Evidence before this study 71 Using the key words "sciatica" and "acupuncture"，we searched PubMed for articles 72 published between Jan 1, 1947 and Jan 5, 2024. Despite an extensive literature search, 73 only a limited number of studies were available. There is ambiguous evidence about 74 the use of acupuncture, with most studies contrasting one another in addition to the 75 lack of high-quality trials. Since the choice of more appropriate acupoints for 76 stimulation is meaningful for acupuncture, studies that investigate the effect of 77 acupuncture on different acupoint program are urgently needed. 78 Added value of this study 79 This multi-centre, assessor and statistician-blinded trial addressed the above 80 limitations by showing that, compared with sham acupuncture, acupuncture at the 81 acupoints on the disease-affected meridian, but not the non-affected meridian, 82 significantly reduces the leg pain intensity in patients with sciatica due to lumbar disc 83 herniation. 84 Implications of all the available evidence 85 We found that acupuncture at the acupoint on the disease-affected meridian had 86 superior and clinically relevant benefits in reducing pain intensity to a greater degree 87 than acupuncture at NAM or SA. The finding is of vital significance to clinical work, 88 as meridian-based specificity of acupoint is one of the most determining factors in the 89 efficacy of acupuncture. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 90 Introduction 91 Sciatica is a common health problem in the general population with a lifetime 92 prevalence of 10% to 43%, depending on different etiologies [1-2]. It is characterised 93 by radiating leg pain starting from the low back, at times accompanied by sensory or 94 motor deficits. In most cases, sciatica is attributable to lumbar disk disorders [3]. The 95 overall prognosis is worse than low back pain, particularly if leg pain extends distal to 96 the knee with signs of nerve root compression, increasing risk for unfavorable 97 outcomes and health care use [4]. Spontaneous recovery occurs in most patients; 98 however, many endure substantial pain and prolonged disability, as 34% reported 99 chronic pain beyond 2 years [5-6]. Optimal pharmacological treatment is unclear due 100 to uncertain benefits or high rates of adverse effects[7-8]. Surgery has been 101 demonstrated to ameliorate sciatica in the early stage, but a proportion of patients do 102 not meet surgical standards or hesitate about the potential complications [9]. The 103 dilemma has led to a soaring increase in complementary and alternative medicine, 104 such as acupuncture [10]. 105 Acupuncture has been recommended for management of low back pain by clinical 106 practice guideline from the American College of Physicians [11-12]. Several studies 107 have also shown that acupuncture was beneficial in treating leg pain, although others 108 have reported discrepancies concerning the efficacy of true vs sham acupuncture[10]. 109 The inconsistent findings may result from variations in study design and insufficient 110 sample size. We conducted this trial to preliminarily evaluate the efficacy and safety 111 of acupuncture in terms of reduction in leg pain with sciatica patients. 112 Acupuncture is garnering increased attention as an effective treatment for pain 113 managemengt, one important issue is whether acupoint choice influences the benefits 114 of acupuncture[10]. However, a well-recognized acupoint program has yet not been 115 established, yielding heterogeneous results across relative studies[13]. Therefore, the 116 second aim of this study was to compare the difference of acupuncture efficacy in 117 patients receiving acupuncture at the acupoints of the disease-affected meridian 118 (DAM), the non-affected meridian (NAM), or sham acupuncture (SA). 119 120 Methods 121 Study design and participants 122 This mult-centre, three-arm, prospective randomised trial was conducted in the 123 inpatient departments of 6 tertiary hospitals in China between Jun 9, 2020 and Sep27, This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 124 2020. The study protocol was approved by the local ethics committee at the 125 coordinating center and each study site (No. 2020BZHYLL0105), and registered with 126 the Chinese Clinical Trial Registry on Chictr.org.cn, ChiCTR2000030680. The 127 protocol has been published previously [14] and is available in open-access full text 128 and in Supplement 1. All patients provided written informed consent before 129 enrolment. 130 Eligible patients were aged 18 to 70 years old , reported leg pain extending below 131 the knee in a nerve root distribution over 4 weeks, had a lumbar disc herniation 132 confirmed by examination signs (positive result on straight leg raise test or sensory or 133 motor deficit in a pattern consistent with a lumbar nerve root) [15], and scored 40 mm 134 or higher on the 100-mm VAS [16]. Imaging (magnetic resonance imaging with or 135 without computed tomography) corroborating a root-level lesion concordant with 136 symptoms and/or signs was determined by the trial clinician. Exclusion criteria were a 137 history or diagnostic result that suggested an inherited neuropathy or neuropathy 138 attributable to other causes, had undergone surgery for lumbar disc herniation within 139 the past 6 months or plan to have spinal surgery or other interventional therapies 140 during next 4 weeks, continually took antiepileptic medication, antidepressant 141 medication, opioids or corticosteroids; had cardiovascular, liver, kidney, or 142 hematopoietic system diseases, mental health disorders, other severe coexisting 143 diseases (e.g., cancer), pregnant, breastfeeding, or women planning conception during 144 the study. Patients participating in other clinical studies within the past 3 months or 145 receiving acupuncture within 6 months were also excluded. The screening process 146 was conducted in the way of in-person visits by trial clinicians. 147 Randomisation and masking 148 The study protocol was explained to all enrolled patients before randomisation. 149 After written informed consent was obtained, patients were allocated randomly (1:1:1) 150 to the three arms: DAM, NAM or SA. Randomisation was performed with a random 151 block size of six. A randomisation sequence was created by a biostatistician who did 152 not participate in the implementation or statistical analysis of trial. The assessor and 153 statistician were blinded to treatment allocation throughout data collection and 154 analysis. 155 Procedures and interventions 156 To exploratively observe whether the effects of acupoint located on two kinds of 157 meridians are different, this trial set two acupuncture groups, in which patients This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 158 received acupuncture at acupoints on the disease-affected meridian (DAM), or the 159 non-affected meridian (NAM), respectively. The bladder (BL) and gallbladder (GB) 160 meridians are directly in the same dermatomes of the sciatic nerve. Since these 161 meridians are consistent with sciatic pain distribution, they are regarded as the 162 disease-affected meridians. 163 Patients assigned to the DAM group received semi-standardized treatment at 164 acupoints on the bladder/gallbladder meridians. Bilateral BL25 and BL26, which 165 localized at the same level as the inferior border of the spinous process of the fourth 166 and the fifth lumbar vertebra (the commonest positions of disc rupture), were needled 167 as obligatory acupoints. For those having symptoms at the posterior side of the leg, 168 BL54, BL36, BL40, BL57, and BL60 were needled as adjunctive acupoints; similarly, 169 GB30, GB31, GB33, GB34, and GB39 were adjunctive acupoints for patients with 170 symptoms at lateral side. For patients who had pain at both posterior and lateral sides, 171 acupuncturists were instructed to select 5 of the 10 adjunctive acupoints. 172 According to the principle of the Traditional Chinese Medicine theory, the liver 173 meridian, the spleen meridian, and the kidney meridian are commonly treated to 174 improve the functional status of the body. These meridians distribute at the inner side, 175 less related to sciatica symptoms, and are regarded as non-affected meridians. For 176 patients in the NAM group, bilateral EX-B7, EX-B4, and unilateral LR9, LR8, LR5, 177 KI7, and SP4 that on the non-affected meridians were selected . 178 Patients assigned to the SA group received acupuncture at 7 non-acupoints which 179 not localized on meridians and with no manipulations. 180 All acupuncture treatments were performed by two senior acupuncturists (length of 181 services ≥5 years), who consistently applied the same standardised protocols. After 182 identifying the location of acupoints, sterile acupuncture needles (length 40 mm, 183 diameter 0.30 mm; Hwato, Suzhou Medical Appliance Factory, China) were inserted, 184 followed by 30s manipulation to acquire Deqi (a sensation of aching, soreness, 185 swelling, heaviness, or numbness). Blunt-tipped placebo needles with similar 186 appearances to conventional needles but no skin penetration were used in the SA 187 group. To maximize the blinding of patients and to fix blunt-tipped placebo needles, 188 adhesive pads were placed on points in all groups. Patients in all groups started 189 treatment on the day of randomization and received twelve 30-minute sessions over 4 190 consecutive weeks at 3 sessions per week (ideally every other day). This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 191 Pain medication was offered if necessary and included paracetamol and optionally 192 non-steroidal anti-inflammatory drugs (Celebrex), short acting opioids, or both. We 193 used questionnaires to monitor the use of pain medication and other co-interventions. 194 Outcomes 195 The primary outcome was the change of leg pain intensity over the preceding 24 196 hours from baseline to week 4 as measured on the VAS. Participants were asked to 197 rate their average leg pain during the last 24 hours out of 100, with 0 representing no 198 leg pain and 100 representing the worst pain imaginable. 199 Secondary outcomes included VAS for leg pain and back pain intensity at other 200 time points. We observed the Oswestry Disability Index (ODI, examining perceived 201 functional disability in 10 activities of daily living), Sciatica Frequency and 202 Bothersomeness Index (SFBI, rating the extent of frequency and bothersomeness of 203 sciatica respectively), 36-item Short Form Health Survey (SF-36, evaluating the 204 quality of life with physical and mental components) . 205 We also assessed levels on the global perceived recovery (assessed by a 7-point 206 Likert self-rating scale with options from “completely recovered” to “worse than 207 ever”) and degrees of the straight leg raise test. 208 The Credibility/Expectancy Questionnaire (CEQ) was used to assess the credibility 209 and expectancy of patients to acupuncture treatment after the first treatment. 210 Moreover, patients were also invited to guess their group for blinding assessment at 211 week 2 and week 4. Adverse events were documented by patients and outcome 212 assessors throughout the trial. All adverse events were categorized as 213 treatment-related or non-treatment-related and followed up until resolution. 214 The researchers in charge of the scale assessment were asked to use the fixed 215 guiding words on the questionnaires to have a conversation with the patient without 216 redundant communication. Due to the trial site and population, we used Chinese 217 versions of the assessment scales that were confirmed to have moderate or higher 218 clinical responsiveness and are suitable for clinical efficacy evaluation. 219 Statistical analysis 220 We designed our trial to determine whether there was a difference between each 221 acupuncture group and the sham acupuncture group in terms of leg pain intensity. 222 According to the method of upper confidence limit, a sample size ranging from 20 to 223 40 could be the guideline for choosing the size of a pilot sample. Considering the 224 overall resource input issues (eg, funding availability and expected completion time), This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 225 the total sample size was preset at 90 patients, 30 patients per group. We performed 226 analyses following the intention-to-treat principle with all randomly assigned patients 227 included. 228 For the primary outcome, analysis of covariance was applied to test the difference 229 between groups in leg pain intensity with baseline values adjusted. Missing data were 230 imputed using multiple imputation method. To address the robustness of the results, 231 we performed a per-protocol analysis for the primary outcome, covering patients who 232 complete 10 sessions or more and had no major protocol violations (e.g., using 233 additional treatments during the treatment period). One-way ANOVA was performed 234 for the secondary outcomes including leg pain at each measuring time point, back 235 pain, ODI, SFBI, SF-36, CEQ, PDQ, global perceived recovery scores, and degrees of 236 straight leg raise test. The blinding assessment, the proportion of patients using 237 additional treatments and adverse event rates were analyzed using the χ2 test or Fisher 238 exact test. Between-group differences were tested through the least significance 239 difference (LSD)-t test. Categorical variables are presented as n (%) and continuous 240 variables are presented as the mean (SD) or median (interquartile range, IQR) . All 241 tests applied were two-tailed, p < 0.05 was considered statistically significant. An 242 independent statistician completed the analyses using IBM SPSS Statistics version 20 243 (IBM Corp, Armonk, NY). 244 Role of the funding source 245 The funder of the study had no role in the study design, data collection, data 246 analysis, or writing of the report. All authors had full access to the data in the study 247 and gave the final approval of the manuscript and agree to be accountable for all 248 aspects of work. 249 Results 250 Patient characteristics 251 Between Jun 9th, 2020, and Sep 27th, 2020, 142 patients were assessed for 252 eligibility, 90 patients (30 patients per group) were enrolled and included in the 253 intention-to-treat analysis (Figure 1). Mean age of patients was 44.2 (SD 14.9) years, 254 and 51 (56.7%) were female. Mean symptom duration was 2.0 years (IQR 0.7 to 4.1) 255 with a mean VAS score of 62.3 (SD 14.3) mm for their leg pain intensity. Overall, 75 256 (83.3%) patients completed the assigned 12 sessions of study interventions, and 82 257 (91.1%) received at least 10 sessions. The primary outcome visit was attended by 82 258 patients at week 4, corresponding to a follow-up rate of 91.1%, which was maintained This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 259 to week 26. There was no difference among groups regarding the usual risk factors for 260 sciatica, such as gender, age, body-mass index, or Disk herniation level, which 261 confirmed that the groups were well matched. The baseline characteristics of patients 262 are summarized in Table 1. 263 After receiving 4-week treatment, the change of leg pain intensity decreased by 264 -36.6 mm (95% CI, -43.1 to -30.2) in the DAM group, by -17.4 mm in the NAM 265 group and by -14.4 mm (95% CI, -20.9 to -8.0) in the SA group. Changes in the leg 266 pain intensity over 4-week period differed significantly among the 3 groups. A greater 267 reduction was observed in the DAM group than in the other groups: -22.2 mm 268 reduction in leg pain intensity than in the SA group (95% CI, -31.4 to -13.0, P＜ 269 0.001) , and -19.3 mm reduction in leg pain intensity than in the NAM group (95% CI, 270 -28.4 to -10.1; P <0.001). While no significant change in leg pain intensity was 271 observed between the NAM and SA groups (mean difference, -3.0 mm, 95% CI, -12.0 272 to 6.1, P=0.52) (Figure 2). 273 We observed that outcomes at the 26-week follow-up were similar in direction to 274 the those at the end of an 4-week period. At week 26, a difference in the change of leg 275 pain intensity were present between the DAM and SA groups (mean difference, -13.3 276 mm, 95% CI, -23.2 to -2.8, P=0.01), between the DAM and NAM groups (mean 277 difference, -13.4 mm, 95%CI, -23.6 to -3.1, P=0.011), but not between the NAM and 278 SA groups (mean difference, 0.1 mm, 95% CI, -10.3 to 10.5, P=0.99) (Figure 2). 279 Sensitive analyses did not alter the result in the primary analysis (eTable 1 and eTable 280 2 in Supplement 2). 281 We found a greater reduction in back pain intensity over SA for patients who 282 received DAM at week 4 (mean difference, -18.0 mm, 95% CI, -27.7 to -8.4, P＜ 283 0.001). The difference in back pain changes was not significant between the NAM 284 and SA groups at week 4 (mean difference, -4.2 mm, 95% CI, -13.6 to 5.3, P=0.38). 285 At week 26, no difference was detected in back pain relief across the 3 groups. 286 We also found a greater decrease in disability scores in the DAM group over SA at 287 week 4 (mean difference, -10.7 points, 95% CI, -18.3 to -3.1, P=0.007), while there 288 was no difference between the NAM and SA groups (mean difference, -3.1 points, 289 95%CI, -10.6 to 4.3, P=0.41). Similar results were observed at week 26, which 290 favored acupuncture at DAM (mean difference between DAM and SA, -11.1 points, This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 291 95%CI, -19.4 to -2.8, P=0.01) rather than acupuncture at the NAM (mean difference 292 between NAM and SA, -2.7 points, 95%CI, -11.0 to -5.7, P=0.53). 293 Compared to SA, patients in the DAM group reported better symptom 294 improvement on the global perceived recovery test, and lower scores in both 295 frequency and bothersomeness scales on the SFBI. Nonetheless, the measurement of 296 the quality of life, or the degree of the straight leg raise test did not show a difference 297 across the 3 groups (Table 2). Five (16.7%) patients in the DAM group and 4 (13.3%) 298 patients in the SA group take rescue medicine for a short period (eTable 3 in 299 Supplement 2). For blinding assessment, we found no difference across groups in the 300 proportion of patients who correctly guessed the kind of intervention they had 301 received at week 2 and week 4 (eTable 4 in Supplement 2). Outcomes measured at 302 other time points were shown in eTable 5 and e Figure in Supplement 2. 303 Adverse events 304 Three (10%) patients in the NAM group reported post-needling pain which 305 decreased in the following week spontaneously. Adverse events unrelated to the study 306 interventions including increased leg pain, dizziness, insomnia, etc, were all rated as 307 mild to moderate (eTable 6 in Supplement 2). No serious adverse event occurred 308 during the study period. 309 Interpretation 310 To our knowledge, our study is a multi-center clinical trial to show the beneficial 311 effect of acupuncture for patients with moderate-to-severe sciatica of varying duration 312 and is the first to explore the meridian-based acupoint program in this field. We found 313 that acupuncture at the DAM had superior and clinically relevant benefits in reducing 314 leg pain intensity to a greater degree than acupuncture at NAM or SA. Improvements 315 in functional disability, back pain, frequency and bothersomeness and global 316 perceived recovery were also found. Moreover, no significant differences was 317 observed with respect to any outcome between NAM and SA groups. 318 The findings of the current study demonstrate that acupuncture at the acupoints on 319 the disease-affected meridian was clinically beneficial and superior to SA for leg pain. 320 We acknowledge the commonly recognised minimally clinically important difference 321 (MCID) is 10-20 of 100 for pain intensity [16]. The clinically important mean leg 322 pain reduction at the 4-week of treatment in DAM group was -22.2 mm, and 323 continued the trend of a mean clinical important result at 26-week follow-up (-13.3 324 mm). Before our study, Liu and colleagues evaluated the effect of acupuncture in This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 325 relieving leg pain for patients with chronic discogenic sciatica compared with sham 326 acupuncture [13]. Acupuncture showed a small but not clinically relevant effect, with 327 a between-group difference in the 4-week on mean VAS score for leg pain was 7.28， 328 which is not reach the MCID. More acupoints on the disease-affected meridian were 329 adapted in our trial (7 v 4 acupoints on the bladder and/or the gallbladder meridian) 330 which may interpret the discrepancy. 331 Our findings are consistent with a meta-analysis showing that acupuncture was 332 more effective than conventional medicine in managing the pain associated with 333 sciatica, with a significantly greater reduction in pain intensity by 12.5 (95% CI: 334 −16.3 to −8.6) [17]. It is worth noting that the most commonly used acupoints were 335 Huantiao (GB 32), Weizhong (BL 40), and Yanglingquan (GB 34), all on the bladder 336 and/or gallbladder meridians that were directly related with dermatomal distributions 337 of sciatic nerve. Acupuncture at the DAM was more effective than at the NAM in 338 alleviating pain severity during the 4-week treatment and the follow-up period. The 339 acupoints in NAM group are mainly located on the Liver, Spleen and Kidney 340 meridian, which are not affected directly by sciatica in Traditional Chinese Medicine. 341 We speculate that the varied efficacy between the DAM and NAM relate to 342 meridian-based acupoint specificity. 343 Acupuncture at the DAM showed significant superiority in the primary outcome 344 and in most of the second outcomes at the end of therapy. However, no significant 345 differences were observed in the quality of life or the degree of the straight leg raise 346 test among the three groups. The health status and body function are more likely be 347 affected by physical factors and psychological factors [18-19]. In addition, pain may 348 limit function, so as pain decreases, function (straight leg raise) may increase until 349 pain again limits functional capacity. This may explain the improvement in pain 350 without measurable proved function [20]. 351 In Dr. Vickers’ and his groups 2018 update of the meta-analysis of acupuncture for 352 chronic pain study, the authors did not finding any statistically significant influence 353 from point selection on treatment outcome by acupuncture [11]. Another two clinical 354 trials on acupuncture for low back pain, where the first showed no difference between 355 two different acupuncture recipes [21] and the subsequent detected no difference 356 between and real and sham acupuncture (where the sham treatment involved different 357 bodily locations) [22]. The efficacy of acupuncture is related to the dose, point This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 358 selection and treatment time (duration and frequency), and we could not isolate which 359 components contributed to the benefits. Our study only partially answer that acupoint 360 choice could influence the efficacy of acupuncture. 361 Practice guidelines recommend an initial period of conservative care focused on 362 non-pharmacologic treatments for persons with recent-onset sciatica, except in rare 363 instances of rapidly progressing or severe neurologic deficits that may require 364 immediate surgical intervention. In this study, acupuncture hastened pain and 365 functional improvement, indicating that acupuncture could be offered to patients with 366 sciatica lasting at least 4 weeks (mean duration of 2.0 years) as promising 367 non-pharmacologic care. However, prior studies enrolled patients with more acute 368 conditions who may have been more prone to spontaneous recovery than our 369 participants, which limit the generalizability of the trial findings. 370 Acupuncture has regionally specific effect or segmental effect [23-24]. Acupoints 371 located directly on injured nerves could inhibit the nociceptive pathway at the same 372 spinal level and give an analgesic effect at the same dermatomal level [25]. However, 373 the underlying mechanism is not fully elucidated and is worthy of further study. 374 This study had several strengths. Rigorous methods have been used to test the 375 preliminary efficacy of acupuncture in this pilot study. The use of blunt-tipped 376 placebo needles ensured the implementation of blinding, which can make the patients 377 have the feeling of acupuncture under the premise that the needle tip does not 378 penetrate the skin. The high recruitment rate has reflected the willingness to 379 participate among patients with sciatica. The compliance rate (83.3%) and follow-up 380 rate (91.1%) for this pilot trial are satisfactory. Therefore, the current study may 381 provide a more accurate basis for assessing the sample size and selection of 382 acupuncture acupoints for the large-scale trial to be conducted. 383 Limitations 384 Some limitations have to be acknowledged. First, we run this multi-center trial in 385 order to text the feasiblity to implement a large-scale RCT to further confirm the 386 efficacy of acupuncture in this regard. However, with only 90 participants spread over 387 six centers, the effect from the numerous treatment centers should be probably 388 accounted. Second, due to the nature of acupuncture, it was not possible to blind 389 acupuncturists to treatment assignment. But they were trained in advance to follow a 390 standard operating procedure and keep equal communication with patients. Third, 391 although sensitive analysis indicated similar conclusions, the robustness of our This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 392 finding was decreased by the small sample size with a wide credible interval 393 generated, thus further studies with sufficient sample size are needed. Fourth, a 394 treatment that offered 3 sessions per week for continuous 4 weeks was proposed to be 395 burdensome for part of the patients, especially for those who are employed. Treatment 396 with a gradually decreased frequency should be applied in future studies. 397 Conclusion 398 Acupuncture was safely administered in patients with mild to moderate sciatica 399 caused by lumbar disc herniation. To accurately assess the efficacy, a larger, 400 sufficiently powered trial is needed. Acupuncture at the acupoint on the 401 disease-affected meridian had superior and clinically relevant benefits in reducing 402 pain intensity to a greater degree than acupuncture at NAM or SA. Data supported the 403 meridian-based specificity of acupoint is one of the most determining factors in the 404 efficacy of acupuncture. 405 406 References 407 1. Gadjradj PS, Rubinstein SM, Peul WC, et al. Full endoscopic versus open 408 discectomy for sciatica: randomised controlled non-inferiority trial. BMJ. 2022; 409 376:e065846. 410 2. Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and 411 prevalence estimates. Spine. 2008; 33:2464-2472. 412 3. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 413 2007; 334:1313-1317. 414 4. Deyo RA, Mirza SK. Herniated Lumbar Intervertebral Disk. N Engl J Med. 2016; 415 374:1763-1772. 416 5. Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015; 372:1240-1248. 417 6. Mehling WE, Gopisetty V, Bartmess E, et al. The prognosis of acute low back 418 pain in primary care in the United States: a 2-year prospective cohort study. Spine. 419 2012; 37:678-684. 420 7. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. 421 BMJ. 2019; 367:l6273. 422 8. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for 423 the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 424 2014 ;14(1):180-191. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 425 9. Manchikanti L, Knezevic E, Latchaw RE, et al. Comparative Systematic Review 426 and Meta-Analysis of Cochrane Review of Epidural Injections for Lumbar 427 Radiculopathy or Sciatica. Pain physician. 2022; 25:E889-e916. 428 10. Ji M, Wang X, Chen M, et al. The Efficacy of Acupuncture for the Treatment of 429 Sciatica: A Systematic Review and Meta-Analysis. Evid Based Complement 430 Alternat Med. 2015;2015:192808. 431 11. Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for Chronic Pain: 432 Update of an Individual Patient Data Meta-Analysis. J Pain. 2018;19(5):455-474. 433 12. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive Treatments for Acute, 434 Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the 435 American College of Physicians. Ann Intern Med. 2017;166(7):514-530. 436 13. Huang Z, Liu S, Zhou J, Yao Q, Liu Z. Efficacy and Safety of Acupuncture for 437 Chronic Discogenic Sciatica, a Randomized Controlled Sham Acupuncture Trial. 438 Pain Med. 2019;20(11): 2303-2310. 439 14. Yu FT, Ni GX, Cai GW, et al. Efficacy of acupuncture for sciatica: study 440 protocol for a randomized controlled pilot trial. Trials. 2021;22:34. 441 15. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. 442 BMJ 2019;367:l6273. 443 16. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: 444 what is moderate pain in millimetres? Pain. 1997;72:95-7. 445 17. Schroeder K, Richards S. Non-specific low back pain. Lancet 2012;379:482-91 446 18. Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context 447 effects on health outcomes: A systematic review. Lancet 448 2001;357(9258):757-762 449 19. Ropper AH, Zafonte RD. Sciatica. New Engl J Med 2015;372(13):1225–1240. 450 20. Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney 451 K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA. A randomized trial 452 comparing acupuncture, simulated acupuncture, and usual care for chronic low 453 back pain. Arch Intern Med. 2009;169(9):858-866. 454 21. Donna Kalauokalani, Daniel C Cherkin, Karen J Sherman. A comparison of 455 physician and nonphysician acupuncture treatment for chronic low back pain. 456 Clin J Pain. 2005;21(5):406-411. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 457 22. Goldberg H, Firtch W, Tyburski M, et al. Oral steroids for acute radiculopathy 458 due to a herniated lumbar disk: a randomized clinical trial. JAMA. 459 2015;313:1915-1923. 460 23. Zhang R, Lao L, Ren K, Berman B. Mechanisms of 461 acupuncture-electroacupuncture on persistent pain. Anesthesiology. 462 2014;120(2):482-503. 463 24. Cheng K. Neuroanatomical basis of acupuncture treatment for some common 464 illnesses. Acupunct Med. 2009;27(2):61-4. 465 25. Cheng KJ. Neuroanatomical basis of acupuncture treatment for some common 466 illnesses. Acupuncture in medicine: journal of the British Medical Acupuncture 467 Society. 2009;27:61-64. 468 469 Figure legends 470 Figure 1. Modified CONSORT flow diagram. 471 Figure 2. VAS scores for leg pain intensity. 472 Tables 473 Table 1. Baseline characteristics of participants. 474 Table 2. Primary and secondary outcomes measured at week 4 and week 26. 475 476 Contributors 477 CZL is the guarantor for the article. CZL, GXS and FTY designed the trial. GWC, 478 GXN, WJW, XQZ, and XLM offered administrative support. FTY, HCX, HYF, LT, 479 BZ, and XLJ recruited and followed up patients. LQW, JFT and JWY were 480 responsible for study monitoring. SYY and JWY take responsibility for the accuracy 481 of the data analysis. All authors had full access to the data in the study and gave the 482 final approval of the manuscript and agree to be accountable for all aspects of work. 483 484 Data sharing statement 485 Data are available from the corresponding author on reasonable request. 486 Declaration of interests 487 The authors declare no conflict of interest. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed Figure 1. Modified CONSORT flow diagram. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed Figure 2. VAS scores for leg pain intensity. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 1 Table 1. Baseline characteristics of participants. Characteristic DAM group (n=30) NAM group (n=30) SA group (n=30) Age, year, mean (SD) 41.6 (14.7) 44.8 (15.0) 46.1 (15.1) Sex, no. (%) Female 21 (70.0) 16 (53.3) 14 (46.7) Male 9 (30.0) 14 (46.7) 16 (53.3) Marital status, no. (%) Married 22 (73.3) 23 (76.7) 24 (80.0) Single 8 (26.7) 7 (23.3) 6 (20.0) Occupation, no. (%) Mental work 24 (80.0) 24 (80.0) 20 (66.7) Manual work 6 (20.0) 6 (20.0) 10 (33.3) BMI, kg/m2, mean (SD) 22.6 (3.1) 23.3 (2.5) 23.0 (2.7) Duration of sciatica, year, median (IQR) 1.7 (0.4, 5.0) 1.8 (0.7, 3.3) 2.1 (0.7, 6.3) History of acupuncture, no. (%) Yes 13 (43.3) 15 (50.0) 9 (30.0) No 17 (56.7) 15 (50.0) 21 (70.0) Positive straight leg raise test, no. (%) 12 (40.0) 19 (63.3) 16 (53.3) Numbness, no. (%) 20 (66.7) 17 (56.7) 23 (76.7) Tingling, no. (%) 17 (56.7) 21 (70.0) 17 (56.7) Sensory deficit, no. (%) 4 (13.3) 3 (10.0) 3 (10.0) Muscle weakness, no. (%) 8 (26.7) 8 (26.7) 8 (26.7) This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 2 Reflex changes, no. (%) 1 (3.3) 1 (3.3) 1 (3.3) Disk herniation level, no. (%) L3-L4 2 (6.7) 0 (0.0) 0 (0.0) L4-L5 6 (20.0) 14 (46.7) 7 (23.3) L5-S1 9 (30.0) 4 (13.3) 8 (26.7) More than one level 13 (43.3) 12 (40.0) 15 (50.0) Leg pain intensity*, mm, mean (SD) 59.5 (12.3) 63.2 (14.8) 64.3 (15.7) Back pain intensity*, mm, mean (SD) 58.9 (25.2) 56.2 (23.6) 54.6 (26.0) ODI score†, mean (SD) 38.3 (13.0) 38.0 (15.7) 38.2 (14.8) SFBI score‡, mean (SD) Frequency 13.7 (4.4) 14.5 (4.5) 13.7 (5.2) Bothersomeness 12.3 (3.6) 12.5 (3.9) 12.9 (5.0) SF-36 score§, mean (SD) Physical Component 28.5 (10.4) 33.5 (11.5) 31.0 (10.3) Mental Component 52.4 (12.1) 47.6 (15.3) 49.9 (13.1) PDQ score¶, mean (SD) 10.5 (5.5) 12.3 (5.4) 10.7 (6.3) Credibility score**, mean (SD) 0.3 (2.5) 0 (2.6) -0.3 (2.8) Expectancy score**, mean (SD) 0.5 (2.6) -0.4 (3.0) -0.1 (2.7) * Scores range from 0 to 100, with higher scores indicating more severe pain. † Scores range from 0 to 100, with higher scores indicating worse disability. ‡ Scores range from 0 to 24, with higher scores indicating more severe symptoms. § Scores are based on normative data and have a mean (±SD) of 50±10, with higher scores indicating a better This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 3 quality of life. ¶ Scores range from 0 to 30, with higher scores indicating more neuropathic pain. ** Scale has Mean = 0.0 (SD = 1.0) since the items were converted to z-scores before averaging. DAM, the disease-affected meridian; NAM, the non-affected meridian; SA, Sham acupuncture. SD, standard deviation; IQR, interquartile range; BMI, body mass index; ODI, Oswestry Disability Index; SFBI, Sciatica Frequency and Bothersomeness Index; SF-36, 36-item Short Form Health Survey; PDQ, PainDETECT questionnaire. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 4 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 1 Table 2. Primary and secondary outcomes at week 4 and week 26 DAM vs SA NAM vs SA DAM vs NAM Outcome DAM group NAM group SA group P value Difference P value Difference P value Difference P value Primary outcome Change of leg pain intensity at week 4* -36.6 (-43.1, -30.2) -17.4 (-23.8, -11.0) -14.4 (-20.9, -8.0) ＜0.001 -22.2 (-31.4, -13.0) ＜0.001 -3.0 (-12.0, 6.1) 0.520 -19.3 (-28.4, -10.1) ＜0.001 Secondary outcomes Change of leg pain intensity at week 26‡ -35.5 (-42.8, –28.3) -22.2 (-29.3, -15.0) -22.2 (-29.7, -14.7) 0.016 -13.3 (-23.2, -2.8) 0.014 0.1 (-10.3, -10.5) 0.989 -13.4 (-23.6, -3.1) 0.011 Change of back pain intensity Week 4† -34.9 (-41.7, -28.2) -21.1 (-27.6, -14.6) -16.9 (-23.8, -10.0) 0.001 -18.0 (-27.7, -8.4) ＜0.001 -4.2 (-13.6, 5.3) 0.380 -13.8 (-23.2, -4.5) 0.004 Week 26‡ -33.5 (-41.6, -25.4) -23.6 (-31.8, -15.5) -22.7 (-31.1, -14.2) 0.128 -10.8 (-22.6, 0.9) 0.07 -1.0 (-12.7, 10.8) 0.871 -9.9 (-21.4, -1.6) 0.092 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 2 ODI score Week 4† 18.0 (13.9, 22.1) 25.5 (19.6, 31.5) 28.7 (22.6, 34.7) 0.019 -10.7 (-18.3, -3.1) 0.007 -3.1 (-10.6, 4.3) 0.406 -7.5 (-14.9, -0.1) 0.046 Week 26‡ 14.9 (10.0, 19.8) 23.3 (17.1, 29.5) 26.0 (19.1, 32.8) 0.025 -11.1 (-19.4, -2.8) 0.010 -2.7 (-11.0, 5.7) 0.527 -8.4 (-16.6, -0.3) 0.043 SFBI frequency score Week 4† 6.6 (4.9, 8.4) 10.6 (8.7, 12.5) 10.8 (8.5, 13.1) 0.005 -4.1 (-6.9, -1.4) 0.004 -0.2 (-2.9, 2.5) 0.874 -3.9 (-6.6, -1.2) 0.005 Week 26‡ 5.8 (3.7, 7.8) 10.1 (7.8, 12.5) 10.0 (7.4, 12.5) 0.010 -4.2 (-7.4, -1.0) 0.011 0.2 (-3.1, 3.4) 0.928 -4.4 (-7.5, -1.2) 0.007 SFBI bothersomeness score Week 4† 5.6 (4.0, 7.1) 8.9 (7.2, 10.6) 10.2 (8.1, 12.2) 0.001 -4.6 (-7.1, -2.1) ＜0.001 -1.3 (-3.7, 1.2) 0.306 -3.3 (-5.8, -0.9) 0.007 Week 26‡ 4.9 (3.2, 6.6) 8.5 (6.5, 10.5) 9.0 (6.6, 11.4) 0.007 -4.1 (-6.9, -1.3) 0.004 -0.5 (-3.3, 2.3) 0.742 -3.7 (-6.4, -0.9) 0.009 SF-36 physical component score Week 4† 37.3 (32.8, 41.7) 37.7 (33.7, 41.6) 33.8 (28.9, 38.7) 0.390 3.5 (-2.7, 9.6) 0.268 3.9 (-2.2, 9.9) 0.206 -0.4 (-6.4, 5.6) 0.888 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 3 Week 26§ 44.7 (39.9, 49.4) 40.1 (35.3, 44.8) 37.4 (32.0, 42.8) 0.104 7.3 (0.4, 14.2) 0.038 2.7 (-4.2, 9.5) 0.443 4.6 (-2.0, 11.3) 0.166 SF-36 mental component score Week 4† 53.7 (49.7, 57.6) 48.6 (43.2, 54.0) 51.9 (47.2, 56.7) 0.287 1.8 (-4.9, 8.4) 0.600 -3.3 (-9.9, 3.2) 0.314 5.1 (-1.4, 11.6) 0.122 Week 26§ 55.1 (51.7, 58.4) 51.2 (46.0, 56.4) 53.3 (48.6, 58.1) 0.438 1.7 (-4.5, 8.0) 0.580 -2.1 (-8.4, 4.1) 0.496 3.9 (-2.1, 9.8) 0.201 Degree of straight leg raise test Week 4¶ 70.1 (63.8, 76.5) 67.2 (61.0, 73.4) 68.5 (61.6, 75.3) 0.797 1.7 (-7.3, 10.6) 0.708 -1.3 (-10.1, 7.6) 0.774 3.0 (-5.8, 11.7) 0.502 Week 26** 74.9 (70.7, 79.1) 70.3 (62.7, 77.9) 69.8 (64.1, 75.4) 0.402 5.1 (-3.2, 13.4) 0.222 0.5 (-7.7, 8.7) 0.902 4.6 (-3.6, 12.8) 0.267 PDQ score Week 4† 6.7 (4.4, 9.2) 9.3 (7.8, 10.8) 8.0 (5.8, 10.2) 0.193 -2.5 (-5.3, 0.2) 0.071 1.3 (-1.5, 4.1) 0.351 -1.2 (-4.1, 1.6) 0.392 Week 26‡ 4.9 (3.3, 6.4) 9.0 (7.7, 10.4) 8.1 (6.0, 10.1) 0.001 -4.1 (-6.4, -1.9) ＜0.001 1.0 (-1.3, 3.3) 0.408 -3.2 (-5.5, -0.9) 0.007 Global perceived This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 4 recovery Week 4† 1.5 (1.2, 1.9) 2.6 (2.1, 3.1) 2.9 (2.4, 3.5) ＜0.001 -1.4 (-2.1, -0.7) ＜0.001 -0.3 (-1.0, 0.3) 0.301 -1.1 (-1.7, -0.4) 0.001 Week 26‡ 1.8 (1.4, 2.2) 2.6 (2.1, 3.0) 2.8 (2.3, 3.3) 0.005 -1.0 (-1.7, -0.4) 0.002 -0.2 (-0.9, 0.4) 0.460 -0.8 (-1.4, -0.2) 0.014 Estimates are expressed as mean (95%CI). * Data imputed through the last observation carried forward approach. † The number of participants providing data was 27 in the DAM group, 29 in the NAM group and 26 in the SA group at week 4. ‡ The number of participants providing data was 28 in the DAM group, 28 in the NAM group and 26 in the SA group at week 26. §The number of participants providing data was 28 in the DAM group, 28 in the NAM group and 24 in the SA group at week 26. ¶ The number of participants providing data was 27 in the DAM group, 28 in the NAM group and 26 in the SA group at week 4. ** The number of participants providing data was 25 in the DAM group, 26 in the NAM group and 25 in the SA group at week 26. DAM, the disease-affected meridian; NAM, the non-affected meridian; SA, Sham acupuncture. ODI, Oswestry Disability Index; SFBI, Sciatica Frequency and Bothersomeness Index; SF-36, 36-item Short Form Health Survey; PDQ, PainDETECT questionnaire. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 5 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed
|
Only provide commentary from the context included.
EVIDENCE:
1 Effect of acupuncture on leg pain in patients with sciatica due to lumbar disc 2 herniation: A prospective, randomised, controlled trial 3 4 Guang-Xia Shia , Fang-Ting Yua , Guang-Xia Nib , Wen-Jun Wanc , Xiao-Qing Zhoud , 5 Li-Qiong Wanga , Jian-Feng Tua , Shi-Yan Yana , Xiu-Li Menge , Jing-Wen Yanga , 6 Hong-Chun Xiangf , Hai-Yang Fug , Lei Tangc , Beng Zhangd , Xiao-Lan Jie , Guo-Wei 7 Caif*, Cun-Zhi Liua,h** 8 a International Acupuncture and Moxibustion Innovation Institute, School of 9 Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, 10 Beijing, China 11 bSchool of Acupuncture-Moxibustion and Tuina, School of Health and Rehabilitation, 12 Nanjing University of Chinese Medicine, Nanjing, China 13 cDepartment of Rehabilitation, The Central Hospital of Wuhan, Tongji Medical 14 College, Huazhong University of Science and Technology, Wuhan, China 15 dDepartment of Acupuncture and Moxibustion, Shenzhen Hospital, Beijing University 16 of Chinese Medicine, Shenzhen, China 17 ePain Medicine Center, Peking University Third Hospital, Beijing, China 18 fDepartment of Acupuncture, Union Hospital, Tongji Medical College, Huazhong 19 University of Science and Technology, Wuhan, China 20 gDepartment of Acupuncture, Affiliated Hospital of Nanjing University of Chinese 21 Medicine, Nanjing, China 22 hDepartment of Acupuncture, Dongzhimen Hospital Affiliated to Beijing University 23 of Chinese Medicine, Beijing, China 24 Corresponding author* 25 Department of Acupuncture, Union Hospital, Tongji Medical College, Huazhong 26 University of Science and Technology, Wuhan, China. No. 1277 Jiefang Avenue, 27 Jianghan District, Wuhan 430022,China. 28 E-mail Address: [email protected] (G.-W. Cai) 29 Corresponding author** 30 International Acupuncture and Moxibustion Innovation Institute, School of 31 Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No.11 32 Bei San Huan Dong Lu, Chaoyang District, Beijing 100021, China. E-mail 33 Address:[email protected] (C.-Z. Liu) 34 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 35 Summary 36 Background Sciatica is a condition including unilateral leg pain that is more severe 37 than low back pain, and causes severe discomfort and functional limitation. We 38 investigated the effect of acupuncture on leg pain in patients with sciatica due to 39 lumbar disc herniation. 40 Methods In this multi-centre, prospective, randomised trial, we enrolled patients with 41 sciatica due to lumbar disc herniation at 6 hospitals in China. Patients were randomly 42 assigned (1:1:1) to receive either acupuncture at the acupoints on the disease-affected 43 meridian (DAM), or the non-affected meridian (NAM), or the sham acupuncture (SA) 44 3 times weekly for 4 weeks. The primary end point was the change in visual analogue 45 scale (VAS, 0-100) of leg pain intensity from baseline to week 4. This study is 46 registered with Chictr.org.cn, ChiCTR2000030680. 47 Finding Between Jun 9th, 2020, and Sep 27th, 2020, 142 patients were assessed for 48 eligibility, 90 patients (30 patients per group) were enrolled and included in the 49 intention-to-treat analysis. A greater reduction of leg pain intensity was observed in 50 the DAM group than in the other groups: -22.2 mm than the SA group (95%CI, -31.4 51 to -13.0, P <0.001) , and -19.3mm than the NAM group (95% CI, -28.4 to -10.1; P 52 <0.001). However, we did not observe a significant difference in the change of leg 53 pain intensity between the NAM group and the SA group (between-group difference 54 -3.0 [95% CI, -12.0 to 6.1], P=0.520). There were no serious adverse events. 55 Interpretation Compared with SA, acupuncture at the acupoints on the 56 disease-affected meridian, but not the non-affected meridian, significantly reduces the 57 leg pain intensity in patients with sciatica due to lumbar disc herniation. These 58 findings suggest that the meridian-based specificity of acupoint is a considerable 59 factor in the acupuncture treatment. A larger, sufficiently powered trial is needed to 60 accurately assess efficacy. 61 62 Funding The National Key R&D Program of China (No: 2019YFC1712103) and the 63 National Science Fund for Distinguished Young Scholars (No:81825024). 64 Keywords: Acupuncture; leg pain; Acupoint selection; Meridian-based; Sciatica 65 66 67 68 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 69 Research in context 70 Evidence before this study 71 Using the key words "sciatica" and "acupuncture"，we searched PubMed for articles 72 published between Jan 1, 1947 and Jan 5, 2024. Despite an extensive literature search, 73 only a limited number of studies were available. There is ambiguous evidence about 74 the use of acupuncture, with most studies contrasting one another in addition to the 75 lack of high-quality trials. Since the choice of more appropriate acupoints for 76 stimulation is meaningful for acupuncture, studies that investigate the effect of 77 acupuncture on different acupoint program are urgently needed. 78 Added value of this study 79 This multi-centre, assessor and statistician-blinded trial addressed the above 80 limitations by showing that, compared with sham acupuncture, acupuncture at the 81 acupoints on the disease-affected meridian, but not the non-affected meridian, 82 significantly reduces the leg pain intensity in patients with sciatica due to lumbar disc 83 herniation. 84 Implications of all the available evidence 85 We found that acupuncture at the acupoint on the disease-affected meridian had 86 superior and clinically relevant benefits in reducing pain intensity to a greater degree 87 than acupuncture at NAM or SA. The finding is of vital significance to clinical work, 88 as meridian-based specificity of acupoint is one of the most determining factors in the 89 efficacy of acupuncture. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 90 Introduction 91 Sciatica is a common health problem in the general population with a lifetime 92 prevalence of 10% to 43%, depending on different etiologies [1-2]. It is characterised 93 by radiating leg pain starting from the low back, at times accompanied by sensory or 94 motor deficits. In most cases, sciatica is attributable to lumbar disk disorders [3]. The 95 overall prognosis is worse than low back pain, particularly if leg pain extends distal to 96 the knee with signs of nerve root compression, increasing risk for unfavorable 97 outcomes and health care use [4]. Spontaneous recovery occurs in most patients; 98 however, many endure substantial pain and prolonged disability, as 34% reported 99 chronic pain beyond 2 years [5-6]. Optimal pharmacological treatment is unclear due 100 to uncertain benefits or high rates of adverse effects[7-8]. Surgery has been 101 demonstrated to ameliorate sciatica in the early stage, but a proportion of patients do 102 not meet surgical standards or hesitate about the potential complications [9]. The 103 dilemma has led to a soaring increase in complementary and alternative medicine, 104 such as acupuncture [10]. 105 Acupuncture has been recommended for management of low back pain by clinical 106 practice guideline from the American College of Physicians [11-12]. Several studies 107 have also shown that acupuncture was beneficial in treating leg pain, although others 108 have reported discrepancies concerning the efficacy of true vs sham acupuncture[10]. 109 The inconsistent findings may result from variations in study design and insufficient 110 sample size. We conducted this trial to preliminarily evaluate the efficacy and safety 111 of acupuncture in terms of reduction in leg pain with sciatica patients. 112 Acupuncture is garnering increased attention as an effective treatment for pain 113 managemengt, one important issue is whether acupoint choice influences the benefits 114 of acupuncture[10]. However, a well-recognized acupoint program has yet not been 115 established, yielding heterogeneous results across relative studies[13]. Therefore, the 116 second aim of this study was to compare the difference of acupuncture efficacy in 117 patients receiving acupuncture at the acupoints of the disease-affected meridian 118 (DAM), the non-affected meridian (NAM), or sham acupuncture (SA). 119 120 Methods 121 Study design and participants 122 This mult-centre, three-arm, prospective randomised trial was conducted in the 123 inpatient departments of 6 tertiary hospitals in China between Jun 9, 2020 and Sep27, This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 124 2020. The study protocol was approved by the local ethics committee at the 125 coordinating center and each study site (No. 2020BZHYLL0105), and registered with 126 the Chinese Clinical Trial Registry on Chictr.org.cn, ChiCTR2000030680. The 127 protocol has been published previously [14] and is available in open-access full text 128 and in Supplement 1. All patients provided written informed consent before 129 enrolment. 130 Eligible patients were aged 18 to 70 years old , reported leg pain extending below 131 the knee in a nerve root distribution over 4 weeks, had a lumbar disc herniation 132 confirmed by examination signs (positive result on straight leg raise test or sensory or 133 motor deficit in a pattern consistent with a lumbar nerve root) [15], and scored 40 mm 134 or higher on the 100-mm VAS [16]. Imaging (magnetic resonance imaging with or 135 without computed tomography) corroborating a root-level lesion concordant with 136 symptoms and/or signs was determined by the trial clinician. Exclusion criteria were a 137 history or diagnostic result that suggested an inherited neuropathy or neuropathy 138 attributable to other causes, had undergone surgery for lumbar disc herniation within 139 the past 6 months or plan to have spinal surgery or other interventional therapies 140 during next 4 weeks, continually took antiepileptic medication, antidepressant 141 medication, opioids or corticosteroids; had cardiovascular, liver, kidney, or 142 hematopoietic system diseases, mental health disorders, other severe coexisting 143 diseases (e.g., cancer), pregnant, breastfeeding, or women planning conception during 144 the study. Patients participating in other clinical studies within the past 3 months or 145 receiving acupuncture within 6 months were also excluded. The screening process 146 was conducted in the way of in-person visits by trial clinicians. 147 Randomisation and masking 148 The study protocol was explained to all enrolled patients before randomisation. 149 After written informed consent was obtained, patients were allocated randomly (1:1:1) 150 to the three arms: DAM, NAM or SA. Randomisation was performed with a random 151 block size of six. A randomisation sequence was created by a biostatistician who did 152 not participate in the implementation or statistical analysis of trial. The assessor and 153 statistician were blinded to treatment allocation throughout data collection and 154 analysis. 155 Procedures and interventions 156 To exploratively observe whether the effects of acupoint located on two kinds of 157 meridians are different, this trial set two acupuncture groups, in which patients This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 158 received acupuncture at acupoints on the disease-affected meridian (DAM), or the 159 non-affected meridian (NAM), respectively. The bladder (BL) and gallbladder (GB) 160 meridians are directly in the same dermatomes of the sciatic nerve. Since these 161 meridians are consistent with sciatic pain distribution, they are regarded as the 162 disease-affected meridians. 163 Patients assigned to the DAM group received semi-standardized treatment at 164 acupoints on the bladder/gallbladder meridians. Bilateral BL25 and BL26, which 165 localized at the same level as the inferior border of the spinous process of the fourth 166 and the fifth lumbar vertebra (the commonest positions of disc rupture), were needled 167 as obligatory acupoints. For those having symptoms at the posterior side of the leg, 168 BL54, BL36, BL40, BL57, and BL60 were needled as adjunctive acupoints; similarly, 169 GB30, GB31, GB33, GB34, and GB39 were adjunctive acupoints for patients with 170 symptoms at lateral side. For patients who had pain at both posterior and lateral sides, 171 acupuncturists were instructed to select 5 of the 10 adjunctive acupoints. 172 According to the principle of the Traditional Chinese Medicine theory, the liver 173 meridian, the spleen meridian, and the kidney meridian are commonly treated to 174 improve the functional status of the body. These meridians distribute at the inner side, 175 less related to sciatica symptoms, and are regarded as non-affected meridians. For 176 patients in the NAM group, bilateral EX-B7, EX-B4, and unilateral LR9, LR8, LR5, 177 KI7, and SP4 that on the non-affected meridians were selected . 178 Patients assigned to the SA group received acupuncture at 7 non-acupoints which 179 not localized on meridians and with no manipulations. 180 All acupuncture treatments were performed by two senior acupuncturists (length of 181 services ≥5 years), who consistently applied the same standardised protocols. After 182 identifying the location of acupoints, sterile acupuncture needles (length 40 mm, 183 diameter 0.30 mm; Hwato, Suzhou Medical Appliance Factory, China) were inserted, 184 followed by 30s manipulation to acquire Deqi (a sensation of aching, soreness, 185 swelling, heaviness, or numbness). Blunt-tipped placebo needles with similar 186 appearances to conventional needles but no skin penetration were used in the SA 187 group. To maximize the blinding of patients and to fix blunt-tipped placebo needles, 188 adhesive pads were placed on points in all groups. Patients in all groups started 189 treatment on the day of randomization and received twelve 30-minute sessions over 4 190 consecutive weeks at 3 sessions per week (ideally every other day). This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 191 Pain medication was offered if necessary and included paracetamol and optionally 192 non-steroidal anti-inflammatory drugs (Celebrex), short acting opioids, or both. We 193 used questionnaires to monitor the use of pain medication and other co-interventions. 194 Outcomes 195 The primary outcome was the change of leg pain intensity over the preceding 24 196 hours from baseline to week 4 as measured on the VAS. Participants were asked to 197 rate their average leg pain during the last 24 hours out of 100, with 0 representing no 198 leg pain and 100 representing the worst pain imaginable. 199 Secondary outcomes included VAS for leg pain and back pain intensity at other 200 time points. We observed the Oswestry Disability Index (ODI, examining perceived 201 functional disability in 10 activities of daily living), Sciatica Frequency and 202 Bothersomeness Index (SFBI, rating the extent of frequency and bothersomeness of 203 sciatica respectively), 36-item Short Form Health Survey (SF-36, evaluating the 204 quality of life with physical and mental components) . 205 We also assessed levels on the global perceived recovery (assessed by a 7-point 206 Likert self-rating scale with options from “completely recovered” to “worse than 207 ever”) and degrees of the straight leg raise test. 208 The Credibility/Expectancy Questionnaire (CEQ) was used to assess the credibility 209 and expectancy of patients to acupuncture treatment after the first treatment. 210 Moreover, patients were also invited to guess their group for blinding assessment at 211 week 2 and week 4. Adverse events were documented by patients and outcome 212 assessors throughout the trial. All adverse events were categorized as 213 treatment-related or non-treatment-related and followed up until resolution. 214 The researchers in charge of the scale assessment were asked to use the fixed 215 guiding words on the questionnaires to have a conversation with the patient without 216 redundant communication. Due to the trial site and population, we used Chinese 217 versions of the assessment scales that were confirmed to have moderate or higher 218 clinical responsiveness and are suitable for clinical efficacy evaluation. 219 Statistical analysis 220 We designed our trial to determine whether there was a difference between each 221 acupuncture group and the sham acupuncture group in terms of leg pain intensity. 222 According to the method of upper confidence limit, a sample size ranging from 20 to 223 40 could be the guideline for choosing the size of a pilot sample. Considering the 224 overall resource input issues (eg, funding availability and expected completion time), This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 225 the total sample size was preset at 90 patients, 30 patients per group. We performed 226 analyses following the intention-to-treat principle with all randomly assigned patients 227 included. 228 For the primary outcome, analysis of covariance was applied to test the difference 229 between groups in leg pain intensity with baseline values adjusted. Missing data were 230 imputed using multiple imputation method. To address the robustness of the results, 231 we performed a per-protocol analysis for the primary outcome, covering patients who 232 complete 10 sessions or more and had no major protocol violations (e.g., using 233 additional treatments during the treatment period). One-way ANOVA was performed 234 for the secondary outcomes including leg pain at each measuring time point, back 235 pain, ODI, SFBI, SF-36, CEQ, PDQ, global perceived recovery scores, and degrees of 236 straight leg raise test. The blinding assessment, the proportion of patients using 237 additional treatments and adverse event rates were analyzed using the χ2 test or Fisher 238 exact test. Between-group differences were tested through the least significance 239 difference (LSD)-t test. Categorical variables are presented as n (%) and continuous 240 variables are presented as the mean (SD) or median (interquartile range, IQR) . All 241 tests applied were two-tailed, p < 0.05 was considered statistically significant. An 242 independent statistician completed the analyses using IBM SPSS Statistics version 20 243 (IBM Corp, Armonk, NY). 244 Role of the funding source 245 The funder of the study had no role in the study design, data collection, data 246 analysis, or writing of the report. All authors had full access to the data in the study 247 and gave the final approval of the manuscript and agree to be accountable for all 248 aspects of work. 249 Results 250 Patient characteristics 251 Between Jun 9th, 2020, and Sep 27th, 2020, 142 patients were assessed for 252 eligibility, 90 patients (30 patients per group) were enrolled and included in the 253 intention-to-treat analysis (Figure 1). Mean age of patients was 44.2 (SD 14.9) years, 254 and 51 (56.7%) were female. Mean symptom duration was 2.0 years (IQR 0.7 to 4.1) 255 with a mean VAS score of 62.3 (SD 14.3) mm for their leg pain intensity. Overall, 75 256 (83.3%) patients completed the assigned 12 sessions of study interventions, and 82 257 (91.1%) received at least 10 sessions. The primary outcome visit was attended by 82 258 patients at week 4, corresponding to a follow-up rate of 91.1%, which was maintained This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 259 to week 26. There was no difference among groups regarding the usual risk factors for 260 sciatica, such as gender, age, body-mass index, or Disk herniation level, which 261 confirmed that the groups were well matched. The baseline characteristics of patients 262 are summarized in Table 1. 263 After receiving 4-week treatment, the change of leg pain intensity decreased by 264 -36.6 mm (95% CI, -43.1 to -30.2) in the DAM group, by -17.4 mm in the NAM 265 group and by -14.4 mm (95% CI, -20.9 to -8.0) in the SA group. Changes in the leg 266 pain intensity over 4-week period differed significantly among the 3 groups. A greater 267 reduction was observed in the DAM group than in the other groups: -22.2 mm 268 reduction in leg pain intensity than in the SA group (95% CI, -31.4 to -13.0, P＜ 269 0.001) , and -19.3 mm reduction in leg pain intensity than in the NAM group (95% CI, 270 -28.4 to -10.1; P <0.001). While no significant change in leg pain intensity was 271 observed between the NAM and SA groups (mean difference, -3.0 mm, 95% CI, -12.0 272 to 6.1, P=0.52) (Figure 2). 273 We observed that outcomes at the 26-week follow-up were similar in direction to 274 the those at the end of an 4-week period. At week 26, a difference in the change of leg 275 pain intensity were present between the DAM and SA groups (mean difference, -13.3 276 mm, 95% CI, -23.2 to -2.8, P=0.01), between the DAM and NAM groups (mean 277 difference, -13.4 mm, 95%CI, -23.6 to -3.1, P=0.011), but not between the NAM and 278 SA groups (mean difference, 0.1 mm, 95% CI, -10.3 to 10.5, P=0.99) (Figure 2). 279 Sensitive analyses did not alter the result in the primary analysis (eTable 1 and eTable 280 2 in Supplement 2). 281 We found a greater reduction in back pain intensity over SA for patients who 282 received DAM at week 4 (mean difference, -18.0 mm, 95% CI, -27.7 to -8.4, P＜ 283 0.001). The difference in back pain changes was not significant between the NAM 284 and SA groups at week 4 (mean difference, -4.2 mm, 95% CI, -13.6 to 5.3, P=0.38). 285 At week 26, no difference was detected in back pain relief across the 3 groups. 286 We also found a greater decrease in disability scores in the DAM group over SA at 287 week 4 (mean difference, -10.7 points, 95% CI, -18.3 to -3.1, P=0.007), while there 288 was no difference between the NAM and SA groups (mean difference, -3.1 points, 289 95%CI, -10.6 to 4.3, P=0.41). Similar results were observed at week 26, which 290 favored acupuncture at DAM (mean difference between DAM and SA, -11.1 points, This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 291 95%CI, -19.4 to -2.8, P=0.01) rather than acupuncture at the NAM (mean difference 292 between NAM and SA, -2.7 points, 95%CI, -11.0 to -5.7, P=0.53). 293 Compared to SA, patients in the DAM group reported better symptom 294 improvement on the global perceived recovery test, and lower scores in both 295 frequency and bothersomeness scales on the SFBI. Nonetheless, the measurement of 296 the quality of life, or the degree of the straight leg raise test did not show a difference 297 across the 3 groups (Table 2). Five (16.7%) patients in the DAM group and 4 (13.3%) 298 patients in the SA group take rescue medicine for a short period (eTable 3 in 299 Supplement 2). For blinding assessment, we found no difference across groups in the 300 proportion of patients who correctly guessed the kind of intervention they had 301 received at week 2 and week 4 (eTable 4 in Supplement 2). Outcomes measured at 302 other time points were shown in eTable 5 and e Figure in Supplement 2. 303 Adverse events 304 Three (10%) patients in the NAM group reported post-needling pain which 305 decreased in the following week spontaneously. Adverse events unrelated to the study 306 interventions including increased leg pain, dizziness, insomnia, etc, were all rated as 307 mild to moderate (eTable 6 in Supplement 2). No serious adverse event occurred 308 during the study period. 309 Interpretation 310 To our knowledge, our study is a multi-center clinical trial to show the beneficial 311 effect of acupuncture for patients with moderate-to-severe sciatica of varying duration 312 and is the first to explore the meridian-based acupoint program in this field. We found 313 that acupuncture at the DAM had superior and clinically relevant benefits in reducing 314 leg pain intensity to a greater degree than acupuncture at NAM or SA. Improvements 315 in functional disability, back pain, frequency and bothersomeness and global 316 perceived recovery were also found. Moreover, no significant differences was 317 observed with respect to any outcome between NAM and SA groups. 318 The findings of the current study demonstrate that acupuncture at the acupoints on 319 the disease-affected meridian was clinically beneficial and superior to SA for leg pain. 320 We acknowledge the commonly recognised minimally clinically important difference 321 (MCID) is 10-20 of 100 for pain intensity [16]. The clinically important mean leg 322 pain reduction at the 4-week of treatment in DAM group was -22.2 mm, and 323 continued the trend of a mean clinical important result at 26-week follow-up (-13.3 324 mm). Before our study, Liu and colleagues evaluated the effect of acupuncture in This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 325 relieving leg pain for patients with chronic discogenic sciatica compared with sham 326 acupuncture [13]. Acupuncture showed a small but not clinically relevant effect, with 327 a between-group difference in the 4-week on mean VAS score for leg pain was 7.28， 328 which is not reach the MCID. More acupoints on the disease-affected meridian were 329 adapted in our trial (7 v 4 acupoints on the bladder and/or the gallbladder meridian) 330 which may interpret the discrepancy. 331 Our findings are consistent with a meta-analysis showing that acupuncture was 332 more effective than conventional medicine in managing the pain associated with 333 sciatica, with a significantly greater reduction in pain intensity by 12.5 (95% CI: 334 −16.3 to −8.6) [17]. It is worth noting that the most commonly used acupoints were 335 Huantiao (GB 32), Weizhong (BL 40), and Yanglingquan (GB 34), all on the bladder 336 and/or gallbladder meridians that were directly related with dermatomal distributions 337 of sciatic nerve. Acupuncture at the DAM was more effective than at the NAM in 338 alleviating pain severity during the 4-week treatment and the follow-up period. The 339 acupoints in NAM group are mainly located on the Liver, Spleen and Kidney 340 meridian, which are not affected directly by sciatica in Traditional Chinese Medicine. 341 We speculate that the varied efficacy between the DAM and NAM relate to 342 meridian-based acupoint specificity. 343 Acupuncture at the DAM showed significant superiority in the primary outcome 344 and in most of the second outcomes at the end of therapy. However, no significant 345 differences were observed in the quality of life or the degree of the straight leg raise 346 test among the three groups. The health status and body function are more likely be 347 affected by physical factors and psychological factors [18-19]. In addition, pain may 348 limit function, so as pain decreases, function (straight leg raise) may increase until 349 pain again limits functional capacity. This may explain the improvement in pain 350 without measurable proved function [20]. 351 In Dr. Vickers’ and his groups 2018 update of the meta-analysis of acupuncture for 352 chronic pain study, the authors did not finding any statistically significant influence 353 from point selection on treatment outcome by acupuncture [11]. Another two clinical 354 trials on acupuncture for low back pain, where the first showed no difference between 355 two different acupuncture recipes [21] and the subsequent detected no difference 356 between and real and sham acupuncture (where the sham treatment involved different 357 bodily locations) [22]. The efficacy of acupuncture is related to the dose, point This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 358 selection and treatment time (duration and frequency), and we could not isolate which 359 components contributed to the benefits. Our study only partially answer that acupoint 360 choice could influence the efficacy of acupuncture. 361 Practice guidelines recommend an initial period of conservative care focused on 362 non-pharmacologic treatments for persons with recent-onset sciatica, except in rare 363 instances of rapidly progressing or severe neurologic deficits that may require 364 immediate surgical intervention. In this study, acupuncture hastened pain and 365 functional improvement, indicating that acupuncture could be offered to patients with 366 sciatica lasting at least 4 weeks (mean duration of 2.0 years) as promising 367 non-pharmacologic care. However, prior studies enrolled patients with more acute 368 conditions who may have been more prone to spontaneous recovery than our 369 participants, which limit the generalizability of the trial findings. 370 Acupuncture has regionally specific effect or segmental effect [23-24]. Acupoints 371 located directly on injured nerves could inhibit the nociceptive pathway at the same 372 spinal level and give an analgesic effect at the same dermatomal level [25]. However, 373 the underlying mechanism is not fully elucidated and is worthy of further study. 374 This study had several strengths. Rigorous methods have been used to test the 375 preliminary efficacy of acupuncture in this pilot study. The use of blunt-tipped 376 placebo needles ensured the implementation of blinding, which can make the patients 377 have the feeling of acupuncture under the premise that the needle tip does not 378 penetrate the skin. The high recruitment rate has reflected the willingness to 379 participate among patients with sciatica. The compliance rate (83.3%) and follow-up 380 rate (91.1%) for this pilot trial are satisfactory. Therefore, the current study may 381 provide a more accurate basis for assessing the sample size and selection of 382 acupuncture acupoints for the large-scale trial to be conducted. 383 Limitations 384 Some limitations have to be acknowledged. First, we run this multi-center trial in 385 order to text the feasiblity to implement a large-scale RCT to further confirm the 386 efficacy of acupuncture in this regard. However, with only 90 participants spread over 387 six centers, the effect from the numerous treatment centers should be probably 388 accounted. Second, due to the nature of acupuncture, it was not possible to blind 389 acupuncturists to treatment assignment. But they were trained in advance to follow a 390 standard operating procedure and keep equal communication with patients. Third, 391 although sensitive analysis indicated similar conclusions, the robustness of our This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 392 finding was decreased by the small sample size with a wide credible interval 393 generated, thus further studies with sufficient sample size are needed. Fourth, a 394 treatment that offered 3 sessions per week for continuous 4 weeks was proposed to be 395 burdensome for part of the patients, especially for those who are employed. Treatment 396 with a gradually decreased frequency should be applied in future studies. 397 Conclusion 398 Acupuncture was safely administered in patients with mild to moderate sciatica 399 caused by lumbar disc herniation. To accurately assess the efficacy, a larger, 400 sufficiently powered trial is needed. Acupuncture at the acupoint on the 401 disease-affected meridian had superior and clinically relevant benefits in reducing 402 pain intensity to a greater degree than acupuncture at NAM or SA. Data supported the 403 meridian-based specificity of acupoint is one of the most determining factors in the 404 efficacy of acupuncture. 405 406 References 407 1. Gadjradj PS, Rubinstein SM, Peul WC, et al. Full endoscopic versus open 408 discectomy for sciatica: randomised controlled non-inferiority trial. BMJ. 2022; 409 376:e065846. 410 2. Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and 411 prevalence estimates. Spine. 2008; 33:2464-2472. 412 3. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 413 2007; 334:1313-1317. 414 4. Deyo RA, Mirza SK. Herniated Lumbar Intervertebral Disk. N Engl J Med. 2016; 415 374:1763-1772. 416 5. Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015; 372:1240-1248. 417 6. Mehling WE, Gopisetty V, Bartmess E, et al. The prognosis of acute low back 418 pain in primary care in the United States: a 2-year prospective cohort study. Spine. 419 2012; 37:678-684. 420 7. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. 421 BMJ. 2019; 367:l6273. 422 8. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for 423 the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 424 2014 ;14(1):180-191. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 425 9. Manchikanti L, Knezevic E, Latchaw RE, et al. Comparative Systematic Review 426 and Meta-Analysis of Cochrane Review of Epidural Injections for Lumbar 427 Radiculopathy or Sciatica. Pain physician. 2022; 25:E889-e916. 428 10. Ji M, Wang X, Chen M, et al. The Efficacy of Acupuncture for the Treatment of 429 Sciatica: A Systematic Review and Meta-Analysis. Evid Based Complement 430 Alternat Med. 2015;2015:192808. 431 11. Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for Chronic Pain: 432 Update of an Individual Patient Data Meta-Analysis. J Pain. 2018;19(5):455-474. 433 12. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive Treatments for Acute, 434 Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the 435 American College of Physicians. Ann Intern Med. 2017;166(7):514-530. 436 13. Huang Z, Liu S, Zhou J, Yao Q, Liu Z. Efficacy and Safety of Acupuncture for 437 Chronic Discogenic Sciatica, a Randomized Controlled Sham Acupuncture Trial. 438 Pain Med. 2019;20(11): 2303-2310. 439 14. Yu FT, Ni GX, Cai GW, et al. Efficacy of acupuncture for sciatica: study 440 protocol for a randomized controlled pilot trial. Trials. 2021;22:34. 441 15. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. 442 BMJ 2019;367:l6273. 443 16. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: 444 what is moderate pain in millimetres? Pain. 1997;72:95-7. 445 17. Schroeder K, Richards S. Non-specific low back pain. Lancet 2012;379:482-91 446 18. Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context 447 effects on health outcomes: A systematic review. Lancet 448 2001;357(9258):757-762 449 19. Ropper AH, Zafonte RD. Sciatica. New Engl J Med 2015;372(13):1225–1240. 450 20. Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney 451 K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA. A randomized trial 452 comparing acupuncture, simulated acupuncture, and usual care for chronic low 453 back pain. Arch Intern Med. 2009;169(9):858-866. 454 21. Donna Kalauokalani, Daniel C Cherkin, Karen J Sherman. A comparison of 455 physician and nonphysician acupuncture treatment for chronic low back pain. 456 Clin J Pain. 2005;21(5):406-411. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 457 22. Goldberg H, Firtch W, Tyburski M, et al. Oral steroids for acute radiculopathy 458 due to a herniated lumbar disk: a randomized clinical trial. JAMA. 459 2015;313:1915-1923. 460 23. Zhang R, Lao L, Ren K, Berman B. Mechanisms of 461 acupuncture-electroacupuncture on persistent pain. Anesthesiology. 462 2014;120(2):482-503. 463 24. Cheng K. Neuroanatomical basis of acupuncture treatment for some common 464 illnesses. Acupunct Med. 2009;27(2):61-4. 465 25. Cheng KJ. Neuroanatomical basis of acupuncture treatment for some common 466 illnesses. Acupuncture in medicine: journal of the British Medical Acupuncture 467 Society. 2009;27:61-64. 468 469 Figure legends 470 Figure 1. Modified CONSORT flow diagram. 471 Figure 2. VAS scores for leg pain intensity. 472 Tables 473 Table 1. Baseline characteristics of participants. 474 Table 2. Primary and secondary outcomes measured at week 4 and week 26. 475 476 Contributors 477 CZL is the guarantor for the article. CZL, GXS and FTY designed the trial. GWC, 478 GXN, WJW, XQZ, and XLM offered administrative support. FTY, HCX, HYF, LT, 479 BZ, and XLJ recruited and followed up patients. LQW, JFT and JWY were 480 responsible for study monitoring. SYY and JWY take responsibility for the accuracy 481 of the data analysis. All authors had full access to the data in the study and gave the 482 final approval of the manuscript and agree to be accountable for all aspects of work. 483 484 Data sharing statement 485 Data are available from the corresponding author on reasonable request. 486 Declaration of interests 487 The authors declare no conflict of interest. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed Figure 1. Modified CONSORT flow diagram. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed Figure 2. VAS scores for leg pain intensity. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 1 Table 1. Baseline characteristics of participants. Characteristic DAM group (n=30) NAM group (n=30) SA group (n=30) Age, year, mean (SD) 41.6 (14.7) 44.8 (15.0) 46.1 (15.1) Sex, no. (%) Female 21 (70.0) 16 (53.3) 14 (46.7) Male 9 (30.0) 14 (46.7) 16 (53.3) Marital status, no. (%) Married 22 (73.3) 23 (76.7) 24 (80.0) Single 8 (26.7) 7 (23.3) 6 (20.0) Occupation, no. (%) Mental work 24 (80.0) 24 (80.0) 20 (66.7) Manual work 6 (20.0) 6 (20.0) 10 (33.3) BMI, kg/m2, mean (SD) 22.6 (3.1) 23.3 (2.5) 23.0 (2.7) Duration of sciatica, year, median (IQR) 1.7 (0.4, 5.0) 1.8 (0.7, 3.3) 2.1 (0.7, 6.3) History of acupuncture, no. (%) Yes 13 (43.3) 15 (50.0) 9 (30.0) No 17 (56.7) 15 (50.0) 21 (70.0) Positive straight leg raise test, no. (%) 12 (40.0) 19 (63.3) 16 (53.3) Numbness, no. (%) 20 (66.7) 17 (56.7) 23 (76.7) Tingling, no. (%) 17 (56.7) 21 (70.0) 17 (56.7) Sensory deficit, no. (%) 4 (13.3) 3 (10.0) 3 (10.0) Muscle weakness, no. (%) 8 (26.7) 8 (26.7) 8 (26.7) This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 2 Reflex changes, no. (%) 1 (3.3) 1 (3.3) 1 (3.3) Disk herniation level, no. (%) L3-L4 2 (6.7) 0 (0.0) 0 (0.0) L4-L5 6 (20.0) 14 (46.7) 7 (23.3) L5-S1 9 (30.0) 4 (13.3) 8 (26.7) More than one level 13 (43.3) 12 (40.0) 15 (50.0) Leg pain intensity*, mm, mean (SD) 59.5 (12.3) 63.2 (14.8) 64.3 (15.7) Back pain intensity*, mm, mean (SD) 58.9 (25.2) 56.2 (23.6) 54.6 (26.0) ODI score†, mean (SD) 38.3 (13.0) 38.0 (15.7) 38.2 (14.8) SFBI score‡, mean (SD) Frequency 13.7 (4.4) 14.5 (4.5) 13.7 (5.2) Bothersomeness 12.3 (3.6) 12.5 (3.9) 12.9 (5.0) SF-36 score§, mean (SD) Physical Component 28.5 (10.4) 33.5 (11.5) 31.0 (10.3) Mental Component 52.4 (12.1) 47.6 (15.3) 49.9 (13.1) PDQ score¶, mean (SD) 10.5 (5.5) 12.3 (5.4) 10.7 (6.3) Credibility score**, mean (SD) 0.3 (2.5) 0 (2.6) -0.3 (2.8) Expectancy score**, mean (SD) 0.5 (2.6) -0.4 (3.0) -0.1 (2.7) * Scores range from 0 to 100, with higher scores indicating more severe pain. † Scores range from 0 to 100, with higher scores indicating worse disability. ‡ Scores range from 0 to 24, with higher scores indicating more severe symptoms. § Scores are based on normative data and have a mean (±SD) of 50±10, with higher scores indicating a better This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 3 quality of life. ¶ Scores range from 0 to 30, with higher scores indicating more neuropathic pain. ** Scale has Mean = 0.0 (SD = 1.0) since the items were converted to z-scores before averaging. DAM, the disease-affected meridian; NAM, the non-affected meridian; SA, Sham acupuncture. SD, standard deviation; IQR, interquartile range; BMI, body mass index; ODI, Oswestry Disability Index; SFBI, Sciatica Frequency and Bothersomeness Index; SF-36, 36-item Short Form Health Survey; PDQ, PainDETECT questionnaire. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 4 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 1 Table 2. Primary and secondary outcomes at week 4 and week 26 DAM vs SA NAM vs SA DAM vs NAM Outcome DAM group NAM group SA group P value Difference P value Difference P value Difference P value Primary outcome Change of leg pain intensity at week 4* -36.6 (-43.1, -30.2) -17.4 (-23.8, -11.0) -14.4 (-20.9, -8.0) ＜0.001 -22.2 (-31.4, -13.0) ＜0.001 -3.0 (-12.0, 6.1) 0.520 -19.3 (-28.4, -10.1) ＜0.001 Secondary outcomes Change of leg pain intensity at week 26‡ -35.5 (-42.8, –28.3) -22.2 (-29.3, -15.0) -22.2 (-29.7, -14.7) 0.016 -13.3 (-23.2, -2.8) 0.014 0.1 (-10.3, -10.5) 0.989 -13.4 (-23.6, -3.1) 0.011 Change of back pain intensity Week 4† -34.9 (-41.7, -28.2) -21.1 (-27.6, -14.6) -16.9 (-23.8, -10.0) 0.001 -18.0 (-27.7, -8.4) ＜0.001 -4.2 (-13.6, 5.3) 0.380 -13.8 (-23.2, -4.5) 0.004 Week 26‡ -33.5 (-41.6, -25.4) -23.6 (-31.8, -15.5) -22.7 (-31.1, -14.2) 0.128 -10.8 (-22.6, 0.9) 0.07 -1.0 (-12.7, 10.8) 0.871 -9.9 (-21.4, -1.6) 0.092 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 2 ODI score Week 4† 18.0 (13.9, 22.1) 25.5 (19.6, 31.5) 28.7 (22.6, 34.7) 0.019 -10.7 (-18.3, -3.1) 0.007 -3.1 (-10.6, 4.3) 0.406 -7.5 (-14.9, -0.1) 0.046 Week 26‡ 14.9 (10.0, 19.8) 23.3 (17.1, 29.5) 26.0 (19.1, 32.8) 0.025 -11.1 (-19.4, -2.8) 0.010 -2.7 (-11.0, 5.7) 0.527 -8.4 (-16.6, -0.3) 0.043 SFBI frequency score Week 4† 6.6 (4.9, 8.4) 10.6 (8.7, 12.5) 10.8 (8.5, 13.1) 0.005 -4.1 (-6.9, -1.4) 0.004 -0.2 (-2.9, 2.5) 0.874 -3.9 (-6.6, -1.2) 0.005 Week 26‡ 5.8 (3.7, 7.8) 10.1 (7.8, 12.5) 10.0 (7.4, 12.5) 0.010 -4.2 (-7.4, -1.0) 0.011 0.2 (-3.1, 3.4) 0.928 -4.4 (-7.5, -1.2) 0.007 SFBI bothersomeness score Week 4† 5.6 (4.0, 7.1) 8.9 (7.2, 10.6) 10.2 (8.1, 12.2) 0.001 -4.6 (-7.1, -2.1) ＜0.001 -1.3 (-3.7, 1.2) 0.306 -3.3 (-5.8, -0.9) 0.007 Week 26‡ 4.9 (3.2, 6.6) 8.5 (6.5, 10.5) 9.0 (6.6, 11.4) 0.007 -4.1 (-6.9, -1.3) 0.004 -0.5 (-3.3, 2.3) 0.742 -3.7 (-6.4, -0.9) 0.009 SF-36 physical component score Week 4† 37.3 (32.8, 41.7) 37.7 (33.7, 41.6) 33.8 (28.9, 38.7) 0.390 3.5 (-2.7, 9.6) 0.268 3.9 (-2.2, 9.9) 0.206 -0.4 (-6.4, 5.6) 0.888 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 3 Week 26§ 44.7 (39.9, 49.4) 40.1 (35.3, 44.8) 37.4 (32.0, 42.8) 0.104 7.3 (0.4, 14.2) 0.038 2.7 (-4.2, 9.5) 0.443 4.6 (-2.0, 11.3) 0.166 SF-36 mental component score Week 4† 53.7 (49.7, 57.6) 48.6 (43.2, 54.0) 51.9 (47.2, 56.7) 0.287 1.8 (-4.9, 8.4) 0.600 -3.3 (-9.9, 3.2) 0.314 5.1 (-1.4, 11.6) 0.122 Week 26§ 55.1 (51.7, 58.4) 51.2 (46.0, 56.4) 53.3 (48.6, 58.1) 0.438 1.7 (-4.5, 8.0) 0.580 -2.1 (-8.4, 4.1) 0.496 3.9 (-2.1, 9.8) 0.201 Degree of straight leg raise test Week 4¶ 70.1 (63.8, 76.5) 67.2 (61.0, 73.4) 68.5 (61.6, 75.3) 0.797 1.7 (-7.3, 10.6) 0.708 -1.3 (-10.1, 7.6) 0.774 3.0 (-5.8, 11.7) 0.502 Week 26** 74.9 (70.7, 79.1) 70.3 (62.7, 77.9) 69.8 (64.1, 75.4) 0.402 5.1 (-3.2, 13.4) 0.222 0.5 (-7.7, 8.7) 0.902 4.6 (-3.6, 12.8) 0.267 PDQ score Week 4† 6.7 (4.4, 9.2) 9.3 (7.8, 10.8) 8.0 (5.8, 10.2) 0.193 -2.5 (-5.3, 0.2) 0.071 1.3 (-1.5, 4.1) 0.351 -1.2 (-4.1, 1.6) 0.392 Week 26‡ 4.9 (3.3, 6.4) 9.0 (7.7, 10.4) 8.1 (6.0, 10.1) 0.001 -4.1 (-6.4, -1.9) ＜0.001 1.0 (-1.3, 3.3) 0.408 -3.2 (-5.5, -0.9) 0.007 Global perceived This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 4 recovery Week 4† 1.5 (1.2, 1.9) 2.6 (2.1, 3.1) 2.9 (2.4, 3.5) ＜0.001 -1.4 (-2.1, -0.7) ＜0.001 -0.3 (-1.0, 0.3) 0.301 -1.1 (-1.7, -0.4) 0.001 Week 26‡ 1.8 (1.4, 2.2) 2.6 (2.1, 3.0) 2.8 (2.3, 3.3) 0.005 -1.0 (-1.7, -0.4) 0.002 -0.2 (-0.9, 0.4) 0.460 -0.8 (-1.4, -0.2) 0.014 Estimates are expressed as mean (95%CI). * Data imputed through the last observation carried forward approach. † The number of participants providing data was 27 in the DAM group, 29 in the NAM group and 26 in the SA group at week 4. ‡ The number of participants providing data was 28 in the DAM group, 28 in the NAM group and 26 in the SA group at week 26. §The number of participants providing data was 28 in the DAM group, 28 in the NAM group and 24 in the SA group at week 26. ¶ The number of participants providing data was 27 in the DAM group, 28 in the NAM group and 26 in the SA group at week 4. ** The number of participants providing data was 25 in the DAM group, 26 in the NAM group and 25 in the SA group at week 26. DAM, the disease-affected meridian; NAM, the non-affected meridian; SA, Sham acupuncture. ODI, Oswestry Disability Index; SFBI, Sciatica Frequency and Bothersomeness Index; SF-36, 36-item Short Form Health Survey; PDQ, PainDETECT questionnaire. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 5 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed
USER:
Is acupuncture a beneficial treatment for leg pain in patients with sciatica?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 7 | 12 | 7,313 | null | 529 |
Use only information from the provided context
|
how does rop apply to photographs?
|
State Right of Publicity Laws The ROP is protected in some form by the laws of most U.S. states, and the number of states that recognize this right has expanded over the past several decades. One study found that 35 states recognized the ROP as of 2020. ROP laws generally create a private right of action for the unauthorized commercial use of another person’s NIL. For example, if a manufacturer uses a famous athlete’s name or face in a TV commercial without her permission, the athlete could sue the manufacturer for violating her ROP, and a court could order the manufacturer to pay damages and stop showing the commercial. What constitutes an unauthorized commercial use of NIL can vary from state to state. Some states’ ROP laws may apply only to advertising, while others more broadly apply to any use that commercially benefits the user, such as video game or comic book characters based on real people. Other notable differences between the ROP laws of various states concern questions such as: • Is the ROP protected by statute, common law, or both? Twenty-five states have enacted statutes protecting the ROP. In some of these states, including California, the ROP is protected by both statutes and common law (law derived from court opinions). In Congressional Research Service https://crsreports.congress.gov LSB11052 Congressional Research Service 2 other states, including Delaware, the ROP is protected by common law only, sometimes as an application of a common law “right of privacy.” • What parts of a person’s identity does the ROP protect? The ROP often only protects a person’s NIL, voice, and signature. In some states, the ROP also includes someone’s “distinctive appearance, gestures, or mannerisms.” Courts have construed certain states’ ROP laws to protect more abstract aspects of personal identity, finding defendants liable for using an image of a famous driver’s race car, a blonde robot performing Vanna White’s role on a game show, or the catch phrase “here’s Johnny.” • Do all individuals enjoy the ROP? State laws vary as to whether all persons or only those with “commercially valuable” NIL (such as celebrities) may assert ROP claims. • Does the ROP survive a person’s death? In some states, the ROP is descendible, meaning it can be asserted by one’s heirs after a person dies. States that recognize a descendible (or postmortem) ROP differ as to their duration, with postmortem rights lasting 20 years in Virginia, 70 years in California, and 100 years in Oklahoma, for instance. Under Tennessee law, postmortem ROP may last indefinitely. In other states, the ROP is not descendible, or else courts have not resolved the issue. Often, the law of the state in which a person is domiciled—or, where they were domiciled when they died—governs their ROP. Indiana’s ROP statute, however, allows suit “regardless of a personality’s domicile” for infringing materials “disseminated within Indiana.” This law may allow non-Indiana plaintiffs to sue for infringing materials that are made available in Indiana via television or the internet. Intersection of Right of Publicity and Federal IP Laws Although the ROP is distinct from the forms of IP already protected by federal law, it is related in some ways to trademarks and copyrights. If Congress chooses to regulate the ROP via federal law, it may consider how best to harmonize the ROP with existing trademark and copyright laws. Trademarks While the ROP generally protects commercial uses of a person’s identity, trademarks protect commercial uses of words, names, and other symbols that distinguish one person’s goods from others. The ROP may overlap with trademarks in cases where aspects of a person’s NIL can be trademarked. A person’s name, for instance, may be trademarked if it acquires a distinctive meaning and is used commercially to identify goods or services (e.g., McDonald’s). The ROP may be seen as serving a similar function to trademarks, although some scholars have criticized the theoretical foundations and expansion of the ROP. Trademark infringement occurs when someone without authorization uses a trademark in a way that creates a likelihood of confusion for consumers. The Lanham Act—the federal trademark law—also establishes a cause of action for “false endorsement,” which provides additional protection that overlaps with the ROP. False endorsement occurs when a person’s identity is used in a way that is likely to confuse consumers into believing that the person recommends a product. In 2023, for instance, actor Tom Hanks alerted fans that an AI-generated replica of him was being used to advertise a dental plan without his permission; such scenarios might give rise to both state ROP and Lanham Act false endorsement claims. State ROP laws can provide broader protection than the Lanham Act, however, as they often prohibit unauthorized commercial uses of NIL regardless of whether they imply any sponsorship or confuse consumers. In addition, some courts have held only individuals with “recognizability” (such as Hanks) may sue for false endorsement, whereas many state laws allow all individuals to sue for ROP violations. Congressional Research Service 3 Copyrights Copyrights protect original works of authorship that are “fixed” (i.e., recorded) in a “tangible medium,” including books, paintings, music recordings, and films. The Copyright Act gives copyright owners the “exclusive right” to reproduce (copy), perform, display, and distribute copyrighted works and to make derivative works (adaptations) from them. Generally, a work’s author automatically owns the copyright but may sell or license it to others. In short, whereas ROP laws prohibit unauthorized uses of another person’s identity, copyright law prohibits unauthorized uses of another’s creative works. As one illustration, in January 2024, the estate of comedian George Carlin filed a lawsuit based on an unauthorized comedy program delivered in an AI-generated imitation of Carlin’s voice. The complaint claims defendants infringed their copyrights by making copies of Carlin’s works to train the AI model— similar to other AI-related copyright lawsuits noted in a separate Legal Sidebar—and that defendants violated Carlin’s ROP under California law by using his NIL to promote the comedy program and other media. The ROP intersects with copyright law inasmuch as both fictional and nonfictional copyrighted works often include the NIL of real people, including descriptions, portrayals, recordings, or performances of those people. For example, people depicted in photographs often do not hold the copyright, since the photographer is usually considered the author, but they may have ROP interests implicated by how those photos are used. These rights may come into conflict, such as when a copyright owner displays photographs in a way that commercially exploits the NIL of people shown in the photographs. Section 301 of the Copyright Act provides that the Copyright Act preempts (supersedes) any state law rights that are “equivalent to” a copyright holder’s exclusive rights. Some commentators argue courts have inconsistently applied Section 301 in cases where copyrights conflict with the ROP. Some courts have dismissed lawsuits that allege copyright holders violated the ROP by exercising their exclusive rights under the Copyright Act. For instance, in 2017, one court held that Section 301 preempted a suit claiming the sale of photographs of NCAA athletes violated the athletes’ ROP. Other courts have held that Section 301 does not preempt ROP claims based on advertising. For example, one court held that a sports announcer’s ROP claim was not preempted where an excerpt of his voice from a copyrighted broadcast was used in a commercial for a video game. Congress could clarify the scope of copyright preemption of ROP claims by amending Section 301. In addition, if Congress enacts any new protections for ROP at the federal level, it may specify under what circumstances copyright would preempt such protections. ROP laws can protect commercial interests in live performances, which cannot be copyrighted unless they are “fixed” (e.g., filmed). In the Supreme Court’s only ROP case to date, for instance, a performer sued a television company for broadcasting his “human cannonball” act, undermining ticket sales for the act. The Supreme Court held that the First Amendment did not prevent the performer from asserting a ROP claim against the company. As an exception to the rule that live performances have no copyright protection, in 1994 Congress provided criminal and civil liability for recording and distributing live music performances without permission, although some courts have questioned these laws’ constitutionality.
|
Use only information from the provided context how does rop apply to photographs? State Right of Publicity Laws The ROP is protected in some form by the laws of most U.S. states, and the number of states that recognize this right has expanded over the past several decades. One study found that 35 states recognized the ROP as of 2020. ROP laws generally create a private right of action for the unauthorized commercial use of another person’s NIL. For example, if a manufacturer uses a famous athlete’s name or face in a TV commercial without her permission, the athlete could sue the manufacturer for violating her ROP, and a court could order the manufacturer to pay damages and stop showing the commercial. What constitutes an unauthorized commercial use of NIL can vary from state to state. Some states’ ROP laws may apply only to advertising, while others more broadly apply to any use that commercially benefits the user, such as video game or comic book characters based on real people. Other notable differences between the ROP laws of various states concern questions such as: • Is the ROP protected by statute, common law, or both? Twenty-five states have enacted statutes protecting the ROP. In some of these states, including California, the ROP is protected by both statutes and common law (law derived from court opinions). In Congressional Research Service https://crsreports.congress.gov LSB11052 Congressional Research Service 2 other states, including Delaware, the ROP is protected by common law only, sometimes as an application of a common law “right of privacy.” • What parts of a person’s identity does the ROP protect? The ROP often only protects a person’s NIL, voice, and signature. In some states, the ROP also includes someone’s “distinctive appearance, gestures, or mannerisms.” Courts have construed certain states’ ROP laws to protect more abstract aspects of personal identity, finding defendants liable for using an image of a famous driver’s race car, a blonde robot performing Vanna White’s role on a game show, or the catch phrase “here’s Johnny.” • Do all individuals enjoy the ROP? State laws vary as to whether all persons or only those with “commercially valuable” NIL (such as celebrities) may assert ROP claims. • Does the ROP survive a person’s death? In some states, the ROP is descendible, meaning it can be asserted by one’s heirs after a person dies. States that recognize a descendible (or postmortem) ROP differ as to their duration, with postmortem rights lasting 20 years in Virginia, 70 years in California, and 100 years in Oklahoma, for instance. Under Tennessee law, postmortem ROP may last indefinitely. In other states, the ROP is not descendible, or else courts have not resolved the issue. Often, the law of the state in which a person is domiciled—or, where they were domiciled when they died—governs their ROP. Indiana’s ROP statute, however, allows suit “regardless of a personality’s domicile” for infringing materials “disseminated within Indiana.” This law may allow non-Indiana plaintiffs to sue for infringing materials that are made available in Indiana via television or the internet. Intersection of Right of Publicity and Federal IP Laws Although the ROP is distinct from the forms of IP already protected by federal law, it is related in some ways to trademarks and copyrights. If Congress chooses to regulate the ROP via federal law, it may consider how best to harmonize the ROP with existing trademark and copyright laws. Trademarks While the ROP generally protects commercial uses of a person’s identity, trademarks protect commercial uses of words, names, and other symbols that distinguish one person’s goods from others. The ROP may overlap with trademarks in cases where aspects of a person’s NIL can be trademarked. A person’s name, for instance, may be trademarked if it acquires a distinctive meaning and is used commercially to identify goods or services (e.g., McDonald’s). The ROP may be seen as serving a similar function to trademarks, although some scholars have criticized the theoretical foundations and expansion of the ROP. Trademark infringement occurs when someone without authorization uses a trademark in a way that creates a likelihood of confusion for consumers. The Lanham Act—the federal trademark law—also establishes a cause of action for “false endorsement,” which provides additional protection that overlaps with the ROP. False endorsement occurs when a person’s identity is used in a way that is likely to confuse consumers into believing that the person recommends a product. In 2023, for instance, actor Tom Hanks alerted fans that an AI-generated replica of him was being used to advertise a dental plan without his permission; such scenarios might give rise to both state ROP and Lanham Act false endorsement claims. State ROP laws can provide broader protection than the Lanham Act, however, as they often prohibit unauthorized commercial uses of NIL regardless of whether they imply any sponsorship or confuse consumers. In addition, some courts have held only individuals with “recognizability” (such as Hanks) may sue for false endorsement, whereas many state laws allow all individuals to sue for ROP violations. Congressional Research Service 3 Copyrights Copyrights protect original works of authorship that are “fixed” (i.e., recorded) in a “tangible medium,” including books, paintings, music recordings, and films. The Copyright Act gives copyright owners the “exclusive right” to reproduce (copy), perform, display, and distribute copyrighted works and to make derivative works (adaptations) from them. Generally, a work’s author automatically owns the copyright but may sell or license it to others. In short, whereas ROP laws prohibit unauthorized uses of another person’s identity, copyright law prohibits unauthorized uses of another’s creative works. As one illustration, in January 2024, the estate of comedian George Carlin filed a lawsuit based on an unauthorized comedy program delivered in an AI-generated imitation of Carlin’s voice. The complaint claims defendants infringed their copyrights by making copies of Carlin’s works to train the AI model— similar to other AI-related copyright lawsuits noted in a separate Legal Sidebar—and that defendants violated Carlin’s ROP under California law by using his NIL to promote the comedy program and other media. The ROP intersects with copyright law inasmuch as both fictional and nonfictional copyrighted works often include the NIL of real people, including descriptions, portrayals, recordings, or performances of those people. For example, people depicted in photographs often do not hold the copyright, since the photographer is usually considered the author, but they may have ROP interests implicated by how those photos are used. These rights may come into conflict, such as when a copyright owner displays photographs in a way that commercially exploits the NIL of people shown in the photographs. Section 301 of the Copyright Act provides that the Copyright Act preempts (supersedes) any state law rights that are “equivalent to” a copyright holder’s exclusive rights. Some commentators argue courts have inconsistently applied Section 301 in cases where copyrights conflict with the ROP. Some courts have dismissed lawsuits that allege copyright holders violated the ROP by exercising their exclusive rights under the Copyright Act. For instance, in 2017, one court held that Section 301 preempted a suit claiming the sale of photographs of NCAA athletes violated the athletes’ ROP. Other courts have held that Section 301 does not preempt ROP claims based on advertising. For example, one court held that a sports announcer’s ROP claim was not preempted where an excerpt of his voice from a copyrighted broadcast was used in a commercial for a video game. Congress could clarify the scope of copyright preemption of ROP claims by amending Section 301. In addition, if Congress enacts any new protections for ROP at the federal level, it may specify under what circumstances copyright would preempt such protections. ROP laws can protect commercial interests in live performances, which cannot be copyrighted unless they are “fixed” (e.g., filmed). In the Supreme Court’s only ROP case to date, for instance, a performer sued a television company for broadcasting his “human cannonball” act, undermining ticket sales for the act. The Supreme Court held that the First Amendment did not prevent the performer from asserting a ROP claim against the company. As an exception to the rule that live performances have no copyright protection, in 1994 Congress provided criminal and civil liability for recording and distributing live music performances without permission, although some courts have questioned these laws’ constitutionality.
|
Use only information from the provided context
EVIDENCE:
State Right of Publicity Laws The ROP is protected in some form by the laws of most U.S. states, and the number of states that recognize this right has expanded over the past several decades. One study found that 35 states recognized the ROP as of 2020. ROP laws generally create a private right of action for the unauthorized commercial use of another person’s NIL. For example, if a manufacturer uses a famous athlete’s name or face in a TV commercial without her permission, the athlete could sue the manufacturer for violating her ROP, and a court could order the manufacturer to pay damages and stop showing the commercial. What constitutes an unauthorized commercial use of NIL can vary from state to state. Some states’ ROP laws may apply only to advertising, while others more broadly apply to any use that commercially benefits the user, such as video game or comic book characters based on real people. Other notable differences between the ROP laws of various states concern questions such as: • Is the ROP protected by statute, common law, or both? Twenty-five states have enacted statutes protecting the ROP. In some of these states, including California, the ROP is protected by both statutes and common law (law derived from court opinions). In Congressional Research Service https://crsreports.congress.gov LSB11052 Congressional Research Service 2 other states, including Delaware, the ROP is protected by common law only, sometimes as an application of a common law “right of privacy.” • What parts of a person’s identity does the ROP protect? The ROP often only protects a person’s NIL, voice, and signature. In some states, the ROP also includes someone’s “distinctive appearance, gestures, or mannerisms.” Courts have construed certain states’ ROP laws to protect more abstract aspects of personal identity, finding defendants liable for using an image of a famous driver’s race car, a blonde robot performing Vanna White’s role on a game show, or the catch phrase “here’s Johnny.” • Do all individuals enjoy the ROP? State laws vary as to whether all persons or only those with “commercially valuable” NIL (such as celebrities) may assert ROP claims. • Does the ROP survive a person’s death? In some states, the ROP is descendible, meaning it can be asserted by one’s heirs after a person dies. States that recognize a descendible (or postmortem) ROP differ as to their duration, with postmortem rights lasting 20 years in Virginia, 70 years in California, and 100 years in Oklahoma, for instance. Under Tennessee law, postmortem ROP may last indefinitely. In other states, the ROP is not descendible, or else courts have not resolved the issue. Often, the law of the state in which a person is domiciled—or, where they were domiciled when they died—governs their ROP. Indiana’s ROP statute, however, allows suit “regardless of a personality’s domicile” for infringing materials “disseminated within Indiana.” This law may allow non-Indiana plaintiffs to sue for infringing materials that are made available in Indiana via television or the internet. Intersection of Right of Publicity and Federal IP Laws Although the ROP is distinct from the forms of IP already protected by federal law, it is related in some ways to trademarks and copyrights. If Congress chooses to regulate the ROP via federal law, it may consider how best to harmonize the ROP with existing trademark and copyright laws. Trademarks While the ROP generally protects commercial uses of a person’s identity, trademarks protect commercial uses of words, names, and other symbols that distinguish one person’s goods from others. The ROP may overlap with trademarks in cases where aspects of a person’s NIL can be trademarked. A person’s name, for instance, may be trademarked if it acquires a distinctive meaning and is used commercially to identify goods or services (e.g., McDonald’s). The ROP may be seen as serving a similar function to trademarks, although some scholars have criticized the theoretical foundations and expansion of the ROP. Trademark infringement occurs when someone without authorization uses a trademark in a way that creates a likelihood of confusion for consumers. The Lanham Act—the federal trademark law—also establishes a cause of action for “false endorsement,” which provides additional protection that overlaps with the ROP. False endorsement occurs when a person’s identity is used in a way that is likely to confuse consumers into believing that the person recommends a product. In 2023, for instance, actor Tom Hanks alerted fans that an AI-generated replica of him was being used to advertise a dental plan without his permission; such scenarios might give rise to both state ROP and Lanham Act false endorsement claims. State ROP laws can provide broader protection than the Lanham Act, however, as they often prohibit unauthorized commercial uses of NIL regardless of whether they imply any sponsorship or confuse consumers. In addition, some courts have held only individuals with “recognizability” (such as Hanks) may sue for false endorsement, whereas many state laws allow all individuals to sue for ROP violations. Congressional Research Service 3 Copyrights Copyrights protect original works of authorship that are “fixed” (i.e., recorded) in a “tangible medium,” including books, paintings, music recordings, and films. The Copyright Act gives copyright owners the “exclusive right” to reproduce (copy), perform, display, and distribute copyrighted works and to make derivative works (adaptations) from them. Generally, a work’s author automatically owns the copyright but may sell or license it to others. In short, whereas ROP laws prohibit unauthorized uses of another person’s identity, copyright law prohibits unauthorized uses of another’s creative works. As one illustration, in January 2024, the estate of comedian George Carlin filed a lawsuit based on an unauthorized comedy program delivered in an AI-generated imitation of Carlin’s voice. The complaint claims defendants infringed their copyrights by making copies of Carlin’s works to train the AI model— similar to other AI-related copyright lawsuits noted in a separate Legal Sidebar—and that defendants violated Carlin’s ROP under California law by using his NIL to promote the comedy program and other media. The ROP intersects with copyright law inasmuch as both fictional and nonfictional copyrighted works often include the NIL of real people, including descriptions, portrayals, recordings, or performances of those people. For example, people depicted in photographs often do not hold the copyright, since the photographer is usually considered the author, but they may have ROP interests implicated by how those photos are used. These rights may come into conflict, such as when a copyright owner displays photographs in a way that commercially exploits the NIL of people shown in the photographs. Section 301 of the Copyright Act provides that the Copyright Act preempts (supersedes) any state law rights that are “equivalent to” a copyright holder’s exclusive rights. Some commentators argue courts have inconsistently applied Section 301 in cases where copyrights conflict with the ROP. Some courts have dismissed lawsuits that allege copyright holders violated the ROP by exercising their exclusive rights under the Copyright Act. For instance, in 2017, one court held that Section 301 preempted a suit claiming the sale of photographs of NCAA athletes violated the athletes’ ROP. Other courts have held that Section 301 does not preempt ROP claims based on advertising. For example, one court held that a sports announcer’s ROP claim was not preempted where an excerpt of his voice from a copyrighted broadcast was used in a commercial for a video game. Congress could clarify the scope of copyright preemption of ROP claims by amending Section 301. In addition, if Congress enacts any new protections for ROP at the federal level, it may specify under what circumstances copyright would preempt such protections. ROP laws can protect commercial interests in live performances, which cannot be copyrighted unless they are “fixed” (e.g., filmed). In the Supreme Court’s only ROP case to date, for instance, a performer sued a television company for broadcasting his “human cannonball” act, undermining ticket sales for the act. The Supreme Court held that the First Amendment did not prevent the performer from asserting a ROP claim against the company. As an exception to the rule that live performances have no copyright protection, in 1994 Congress provided criminal and civil liability for recording and distributing live music performances without permission, although some courts have questioned these laws’ constitutionality.
USER:
how does rop apply to photographs?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 7 | 6 | 1,368 | null | 167 |
Answer questions based solely on the text provided. Do not use any prior knowledge or other resources.
|
Using bullet points, summarise Florida's restrictions on foreign ownership of land.
|
Recent State Laws Differ in Their Restrictions State laws differ in their approaches and requirements. For example, some states enacted information- gathering laws that mandate disclosure of, or require studies on, foreign ownership of U.S. land. Other laws directly prohibit certain transactions and may require divestiture of foreign-owned land. Some restrictions apply only to agricultural land; others to land near military installations, critical infrastructure, or economically valuable sites; and others to all real property within the state. State laws also vary as to which groups are subject to land ownership restrictions. Some seek to regulate real property transactions with individuals and entities from a list of named countries. Others aim to govern purchases by all non-U.S. citizens. Another set addresses purchases by individuals and entities from countries identified on lists maintained under federal law, such as the International Traffic in Arms Regulations (Tables 1 and 2 of 22 C.F.R. § 126); the foreign adversaries list generated under Executive Order 13873 and its implementing regulations; sanctions lists maintained by the Office of Foreign Assets Control (OFAC) in the Department of the Treasury; or countries of particular concern designated by the U.S. Secretary of State. SB 264 Creates Two Sets of Restrictions on Land Ownership in Florida Florida’s law, SB 264 (codified at Florida Statutes §§ 692.201–.205), effective July 1, 2023, creates two sets of land ownership restrictions. The first set applies to foreign principals connected with foreign countries of concern (defined as China, Russia, Iran, North Korea, Cuba, the Venezuelan regime of Nicolás Maduro, and Syria). Foreign principals are defined as the foreign governments themselves, certain corporate and political bodies, and individuals domiciled in the countries of concern who are not U.S. citizens or lawful permanent residents. Individuals and entities in these groups cannot acquire or own agricultural land in Florida or real property within 10 miles of a military installation or critical infrastructure facility in the state. SB 264’s second set of restrictions applies only to certain individuals and entities connected with the People’s Republic of China (PRC)—the PRC itself, certain political bodies and individual members of the PRC or the Communist Party of China, companies organized under PRC law or that have their principal place of business there, and individuals domiciled in the PRC who are not U.S. citizens or lawful permanent residents. These PRC-connected individuals and entities cannot purchase any real property in Florida, absent an exception. Both sets of restrictions exempt de minimis investments in some securities or companies registered with the Securities and Exchange Commission. Individuals with nontourist visas or who have been granted asylum may also purchase one parcel up to 2 acres in size that is not within 5 miles of a military installation. Preexisting land owners that acquired their property before SB 264 became effective can continue to own their parcels, but they cannot buy additional land unless permitted by law. SB 264 requires all foreign principals—both existing owners and new purchasers—to register land ownership with state officials if the parcel is within 10 miles of a military installation or critical infrastructure. Some PRC-connected individuals and entities must register regardless of the parcel’s location.
|
Answer questions based solely on the text provided. Do not use any prior knowledge or other resources. "Recent State Laws Differ in Their Restrictions State laws differ in their approaches and requirements. For example, some states enacted information- gathering laws that mandate disclosure of, or require studies on, foreign ownership of U.S. land. Other laws directly prohibit certain transactions and may require divestiture of foreign-owned land. Some restrictions apply only to agricultural land; others to land near military installations, critical infrastructure, or economically valuable sites; and others to all real property within the state. State laws also vary as to which groups are subject to land ownership restrictions. Some seek to regulate real property transactions with individuals and entities from a list of named countries. Others aim to govern purchases by all non-U.S. citizens. Another set addresses purchases by individuals and entities from countries identified on lists maintained under federal law, such as the International Traffic in Arms Regulations (Tables 1 and 2 of 22 C.F.R. § 126); the foreign adversaries list generated under Executive Order 13873 and its implementing regulations; sanctions lists maintained by the Office of Foreign Assets Control (OFAC) in the Department of the Treasury; or countries of particular concern designated by the U.S. Secretary of State. SB 264 Creates Two Sets of Restrictions on Land Ownership in Florida Florida’s law, SB 264 (codified at Florida Statutes §§ 692.201–.205), effective July 1, 2023, creates two sets of land ownership restrictions. The first set applies to foreign principals connected with foreign countries of concern (defined as China, Russia, Iran, North Korea, Cuba, the Venezuelan regime of Nicolás Maduro, and Syria). Foreign principals are defined as the foreign governments themselves, certain corporate and political bodies, and individuals domiciled in the countries of concern who are not U.S. citizens or lawful permanent residents. Individuals and entities in these groups cannot acquire or own agricultural land in Florida or real property within 10 miles of a military installation or critical infrastructure facility in the state. SB 264’s second set of restrictions applies only to certain individuals and entities connected with the People’s Republic of China (PRC)—the PRC itself, certain political bodies and individual members of the PRC or the Communist Party of China, companies organized under PRC law or that have their principal place of business there, and individuals domiciled in the PRC who are not U.S. citizens or lawful permanent residents. These PRC-connected individuals and entities cannot purchase any real property in Florida, absent an exception. Both sets of restrictions exempt de minimis investments in some securities or companies registered with the Securities and Exchange Commission. Individuals with nontourist visas or who have been granted asylum may also purchase one parcel up to 2 acres in size that is not within 5 miles of a military installation. Preexisting land owners that acquired their property before SB 264 became effective can continue to own their parcels, but they cannot buy additional land unless permitted by law. SB 264 requires all foreign principals—both existing owners and new purchasers—to register land ownership with state officials if the parcel is within 10 miles of a military installation or critical infrastructure. Some PRC-connected individuals and entities must register regardless of the parcel’s location." Using bullet points, summarise Florida's restrictions on foreign ownership of land.
|
Answer questions based solely on the text provided. Do not use any prior knowledge or other resources.
EVIDENCE:
Recent State Laws Differ in Their Restrictions State laws differ in their approaches and requirements. For example, some states enacted information- gathering laws that mandate disclosure of, or require studies on, foreign ownership of U.S. land. Other laws directly prohibit certain transactions and may require divestiture of foreign-owned land. Some restrictions apply only to agricultural land; others to land near military installations, critical infrastructure, or economically valuable sites; and others to all real property within the state. State laws also vary as to which groups are subject to land ownership restrictions. Some seek to regulate real property transactions with individuals and entities from a list of named countries. Others aim to govern purchases by all non-U.S. citizens. Another set addresses purchases by individuals and entities from countries identified on lists maintained under federal law, such as the International Traffic in Arms Regulations (Tables 1 and 2 of 22 C.F.R. § 126); the foreign adversaries list generated under Executive Order 13873 and its implementing regulations; sanctions lists maintained by the Office of Foreign Assets Control (OFAC) in the Department of the Treasury; or countries of particular concern designated by the U.S. Secretary of State. SB 264 Creates Two Sets of Restrictions on Land Ownership in Florida Florida’s law, SB 264 (codified at Florida Statutes §§ 692.201–.205), effective July 1, 2023, creates two sets of land ownership restrictions. The first set applies to foreign principals connected with foreign countries of concern (defined as China, Russia, Iran, North Korea, Cuba, the Venezuelan regime of Nicolás Maduro, and Syria). Foreign principals are defined as the foreign governments themselves, certain corporate and political bodies, and individuals domiciled in the countries of concern who are not U.S. citizens or lawful permanent residents. Individuals and entities in these groups cannot acquire or own agricultural land in Florida or real property within 10 miles of a military installation or critical infrastructure facility in the state. SB 264’s second set of restrictions applies only to certain individuals and entities connected with the People’s Republic of China (PRC)—the PRC itself, certain political bodies and individual members of the PRC or the Communist Party of China, companies organized under PRC law or that have their principal place of business there, and individuals domiciled in the PRC who are not U.S. citizens or lawful permanent residents. These PRC-connected individuals and entities cannot purchase any real property in Florida, absent an exception. Both sets of restrictions exempt de minimis investments in some securities or companies registered with the Securities and Exchange Commission. Individuals with nontourist visas or who have been granted asylum may also purchase one parcel up to 2 acres in size that is not within 5 miles of a military installation. Preexisting land owners that acquired their property before SB 264 became effective can continue to own their parcels, but they cannot buy additional land unless permitted by law. SB 264 requires all foreign principals—both existing owners and new purchasers—to register land ownership with state officials if the parcel is within 10 miles of a military installation or critical infrastructure. Some PRC-connected individuals and entities must register regardless of the parcel’s location.
USER:
Using bullet points, summarise Florida's restrictions on foreign ownership of land.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 17 | 11 | 521 | null | 76 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
My weight has gotten out of control ever since I had my daughter. I'm considering gastric bypass surgery. I know that there are risks with every surgery. Summarize what the procedure entails, the risks, how it impacts nutrients and compares to other options.
|
Roux-en-Y gastric bypass involves creating a small gastric pouch, about the size of an egg, by stapling off the upper section of the stomach and then attaching it to a section of the intestines called the Roux limb. Simply put, this procedure both reshapes the stomach and reroutes the intestines by bypassing a large portion of the small intestine. This procedure promotes weight loss because it… Reduces the amount of food that your stomach can hold Limits the number of calories and nutrients that your body can absorb Changes your gut hormones affecting both appetite and intake Research also shows that the average weight loss associated with the Roux-en-Y gastric bypass is about 70% excess weight, which is about 10% higher than the average weight loss associated with the gastric sleeve. The total amount of weight you lose depends on your type of surgery and the changes you make in your lifestyle habits. Medical benefits of gastric bypass surgery [box] Gastric bypass can help you to reduce your risk of obesity-related health problems including… Gastroesophageal reflux disease Heart disease High blood pressure High cholesterol Hyperlipidemia Relief of musculoskeletal pain Obstructive sleep apnea Type 2 diabetes Stroke Cancer Infertility So, you might be thinking that these medical benefits sound similar to those related to other bariatric surgeries… and you would be right. However, one noted difference in Roux-en-Y gastric bypass is related to the amount of time it takes to see results. Research published in the Texas Heart Institute Journal reveals that it is possible for the blood sugar of a diabetic patient to return to normal following Roux-en-Y gastric bypass before substantial weight loss takes place. It is estimated that approximately 40% of obese patients with type 2 diabetes go into remission within days or weeks after Roux-en-Y Gastric Bypass. So, what about the financial benefits related to bariatric surgery? It’s possible that the high upfront cost of bariatric surgery can be intimidating, but research shows that it can be worth it in the long run (or actually a shorter run than you might think). One study published in the Obesity Reviews reveals that obesity alone, without any other related diseases or conditions, can cost an additional $1723 dollars a year. If you are thinking that isn’t a lot of money… Just wait until you factor in other conditions like diabetes. A study published by the Obesity Society estimated the yearly cost for managing diabetes is about $13,243 dollars. Now that’s a significant amount of money. Historically for bariatric surgery patients, the initial investment averaged about $29,000 for open surgeries in 2004-2007 and $19,000 for laparoscopic surgeries in 2004-2007. Results from a study published by Surgery for Obesity and Related Diseases found that 1 year after bariatric surgery the improvement in the quality of life was similar between the Sleeve Gastrectomy and Gastric Bypass. However, this study found a greater increase in physical functioning after Roux-en-Y Gastric Bypass. Short-term Complications of Gastric Bypass or abdominal surgery can include: Excessive bleeding Infection Adverse reactions to anesthesia Blood clots Perforation Stricture Lung or breathing problems Leaks in your gastrointestinal system Long-Term Complications of Gastric Bypass can include: Bowel obstruction Dumping syndrome Gallstones Hernias Low blood sugar Malnutrition/Nutrient Deficiencies Stomach perforation Ulcers Vomiting One study published by the NCBI found that anywhere from 3% to 20% of patients following Roux-en-Y Gastric Bypass had Long-term complications that could require reoperation. Due to the nature of the surgery and how it impacts absorption of nutrients it is important to be aware of Nutrient Deficiencies that can occur.
|
"================ <TEXT PASSAGE> ======= Roux-en-Y gastric bypass involves creating a small gastric pouch, about the size of an egg, by stapling off the upper section of the stomach and then attaching it to a section of the intestines called the Roux limb. Simply put, this procedure both reshapes the stomach and reroutes the intestines by bypassing a large portion of the small intestine. This procedure promotes weight loss because it… Reduces the amount of food that your stomach can hold Limits the number of calories and nutrients that your body can absorb Changes your gut hormones affecting both appetite and intake Research also shows that the average weight loss associated with the Roux-en-Y gastric bypass is about 70% excess weight, which is about 10% higher than the average weight loss associated with the gastric sleeve. The total amount of weight you lose depends on your type of surgery and the changes you make in your lifestyle habits. Medical benefits of gastric bypass surgery [box] Gastric bypass can help you to reduce your risk of obesity-related health problems including… Gastroesophageal reflux disease Heart disease High blood pressure High cholesterol Hyperlipidemia Relief of musculoskeletal pain Obstructive sleep apnea Type 2 diabetes Stroke Cancer Infertility So, you might be thinking that these medical benefits sound similar to those related to other bariatric surgeries… and you would be right. However, one noted difference in Roux-en-Y gastric bypass is related to the amount of time it takes to see results. Research published in the Texas Heart Institute Journal reveals that it is possible for the blood sugar of a diabetic patient to return to normal following Roux-en-Y gastric bypass before substantial weight loss takes place. It is estimated that approximately 40% of obese patients with type 2 diabetes go into remission within days or weeks after Roux-en-Y Gastric Bypass. So, what about the financial benefits related to bariatric surgery? It’s possible that the high upfront cost of bariatric surgery can be intimidating, but research shows that it can be worth it in the long run (or actually a shorter run than you might think). One study published in the Obesity Reviews reveals that obesity alone, without any other related diseases or conditions, can cost an additional $1723 dollars a year. If you are thinking that isn’t a lot of money… Just wait until you factor in other conditions like diabetes. A study published by the Obesity Society estimated the yearly cost for managing diabetes is about $13,243 dollars. Now that’s a significant amount of money. Historically for bariatric surgery patients, the initial investment averaged about $29,000 for open surgeries in 2004-2007 and $19,000 for laparoscopic surgeries in 2004-2007. Results from a study published by Surgery for Obesity and Related Diseases found that 1 year after bariatric surgery the improvement in the quality of life was similar between the Sleeve Gastrectomy and Gastric Bypass. However, this study found a greater increase in physical functioning after Roux-en-Y Gastric Bypass. Short-term Complications of Gastric Bypass or abdominal surgery can include: Excessive bleeding Infection Adverse reactions to anesthesia Blood clots Perforation Stricture Lung or breathing problems Leaks in your gastrointestinal system Long-Term Complications of Gastric Bypass can include: Bowel obstruction Dumping syndrome Gallstones Hernias Low blood sugar Malnutrition/Nutrient Deficiencies Stomach perforation Ulcers Vomiting One study published by the NCBI found that anywhere from 3% to 20% of patients following Roux-en-Y Gastric Bypass had Long-term complications that could require reoperation. Due to the nature of the surgery and how it impacts absorption of nutrients it is important to be aware of Nutrient Deficiencies that can occur. https://www.barilife.com/blog/pros-and-cons-of-gastric-bypass/ ================ <QUESTION> ======= My weight has gotten out of control ever since I had my daughter. I'm considering gastric bypass surgery. I know that there are risks with every surgery. Summarize what the procedure entails, the risks, how it impacts nutrients and compares to other options. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
Roux-en-Y gastric bypass involves creating a small gastric pouch, about the size of an egg, by stapling off the upper section of the stomach and then attaching it to a section of the intestines called the Roux limb. Simply put, this procedure both reshapes the stomach and reroutes the intestines by bypassing a large portion of the small intestine. This procedure promotes weight loss because it… Reduces the amount of food that your stomach can hold Limits the number of calories and nutrients that your body can absorb Changes your gut hormones affecting both appetite and intake Research also shows that the average weight loss associated with the Roux-en-Y gastric bypass is about 70% excess weight, which is about 10% higher than the average weight loss associated with the gastric sleeve. The total amount of weight you lose depends on your type of surgery and the changes you make in your lifestyle habits. Medical benefits of gastric bypass surgery [box] Gastric bypass can help you to reduce your risk of obesity-related health problems including… Gastroesophageal reflux disease Heart disease High blood pressure High cholesterol Hyperlipidemia Relief of musculoskeletal pain Obstructive sleep apnea Type 2 diabetes Stroke Cancer Infertility So, you might be thinking that these medical benefits sound similar to those related to other bariatric surgeries… and you would be right. However, one noted difference in Roux-en-Y gastric bypass is related to the amount of time it takes to see results. Research published in the Texas Heart Institute Journal reveals that it is possible for the blood sugar of a diabetic patient to return to normal following Roux-en-Y gastric bypass before substantial weight loss takes place. It is estimated that approximately 40% of obese patients with type 2 diabetes go into remission within days or weeks after Roux-en-Y Gastric Bypass. So, what about the financial benefits related to bariatric surgery? It’s possible that the high upfront cost of bariatric surgery can be intimidating, but research shows that it can be worth it in the long run (or actually a shorter run than you might think). One study published in the Obesity Reviews reveals that obesity alone, without any other related diseases or conditions, can cost an additional $1723 dollars a year. If you are thinking that isn’t a lot of money… Just wait until you factor in other conditions like diabetes. A study published by the Obesity Society estimated the yearly cost for managing diabetes is about $13,243 dollars. Now that’s a significant amount of money. Historically for bariatric surgery patients, the initial investment averaged about $29,000 for open surgeries in 2004-2007 and $19,000 for laparoscopic surgeries in 2004-2007. Results from a study published by Surgery for Obesity and Related Diseases found that 1 year after bariatric surgery the improvement in the quality of life was similar between the Sleeve Gastrectomy and Gastric Bypass. However, this study found a greater increase in physical functioning after Roux-en-Y Gastric Bypass. Short-term Complications of Gastric Bypass or abdominal surgery can include: Excessive bleeding Infection Adverse reactions to anesthesia Blood clots Perforation Stricture Lung or breathing problems Leaks in your gastrointestinal system Long-Term Complications of Gastric Bypass can include: Bowel obstruction Dumping syndrome Gallstones Hernias Low blood sugar Malnutrition/Nutrient Deficiencies Stomach perforation Ulcers Vomiting One study published by the NCBI found that anywhere from 3% to 20% of patients following Roux-en-Y Gastric Bypass had Long-term complications that could require reoperation. Due to the nature of the surgery and how it impacts absorption of nutrients it is important to be aware of Nutrient Deficiencies that can occur.
USER:
My weight has gotten out of control ever since I had my daughter. I'm considering gastric bypass surgery. I know that there are risks with every surgery. Summarize what the procedure entails, the risks, how it impacts nutrients and compares to other options.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 43 | 592 | null | 313 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
As you know AI is advancing in every field, I'm bit interested in healthcare as it is my domain. How is generative AI being used in healthcare system?
|
Revolutionizing Healthcare: The Transformative Power of AI May 17, 2024 By Kevin Riddleberger, Co-founder, DispatchHealth Kevin Riddleberger, PA-C, MBA, co-founder and chief strategy officer at DispatchHealth. As the co-founder of a pioneering digital health company and a seasoned physician associate, I have navigated the forefront of healthcare innovation over the last decade. Our journey has witnessed both incremental advancements and radical shifts, but none as transformative as the current wave led by Artificial Intelligence (AI). This technological revolution promises to redefine healthcare delivery and management, bringing profound changes that were once the realm of science fiction into today’s clinical practices. The impact on the healthcare society will be bigger than electricity, the computer or the internet by many multiples. Research published in the New England Journal of Medicine last year indicates that generative AI has improved patient outcomes by up to 45% in clinical trials, particularly in the treatment of chronic diseases such as diabetes and heart disease, through personalized medicine and management plans. While a report by McKinsey & Company predicts that generative AI could help reduce healthcare costs in the United States by up to $150 billion annually by 2026 through automation of administrative tasks and optimization of clinical workflows. Just last year, I highlighted in a thought leadership piece a typical day in the life of a clinician leveraging generative AI models embedded in their daily workflow. Since then we have witnessed an explosion of venture capital in companies to the tune of billions of dollars due to immense impact on healthcare operations and drug discoveries. Generative AI models are crucial for achieving the Quintuple Aim of healthcare, enhancing care quality, provider satisfaction, and patient engagement while reducing costs and improving health populations. The volume of medical literature published annually is overwhelming, with estimates suggesting it would take decades for a clinician to process a year’s worth of research. We have long surpassed the power of the human brain and need augmentation quickly. The Expanding Role of AI in Healthcare AI’s integration into healthcare is set to usher in transformative changes, including the development of personalized treatment plans tailored to individual genetic profiles and lifestyles, and virtual health assistants available 24/7, providing real-time, accurate medical advice. The expectation is that AI will manage over 85% of customer interactions in healthcare by 2025, reducing the need for human intervention and allowing healthcare professionals to focus more on patient care. This shift towards technology-dependent care teams emphasizes AI’s role as a partner in healthcare, enhancing our capabilities to serve and care. While technology won’t replace humans, it will become a more integral member of the care team. The future of care delivery will lie in a technology-dependent care team approach, where healthcare workers focus on their greatest comparative advantages over technology. In the quest for top-of-license care, clinician roles, decision making processes, and workflows will evolve by embedding this transformative technology. Companies Leading the AI Healthcare Revolution Eko Health: Known for its AI-powered cardiac monitoring tools, Eko has developed algorithms that significantly improve the detection of heart conditions in routine screenings, potentially reducing the rates of undiagnosed cardiac issues by up to 30%. Eko recently was awarded by the FDA the first AI to aid heart failure detection during routine check-ups using their stethoscopes. Butterfly Network: Their portable ultrasound device, powered by AI, has democratized medical imaging, making it more accessible and affordable. Introducing AI-powered POCUS is proving to increase diagnostic speed and accuracy in point of care settings thus minimizing more expensive imaging studies required. Abridge and Nuance These companies are at the forefront of conversational AI, significantly reducing the clerical burden on clinicians, with both platforms now seamlessly integrated into Epic systems. The technologies use AI to transcribe and structure medical conversations during patient visits, which helps in ensuring that crucial information is captured accurately and can be easily referenced later, reducing the 70+ hours of documentation per clinician every month. Hippocratic AI: The product is a novel staffing marketplace where companies can “hire” auto-pilot generative AI-powered agents to conduct low-risk, non-diagnostic, patient-facing services to help solve the massive healthcare staffing crisis. The company’s vision is centered around how generative AI can provide super staffing and healthcare abundance and equity in our industry. Glass Health: An emerging player, Glass Health uses AI to integrate various data sources to provide a holistic view of patient health, aiding in more comprehensive care planning and clinical decision support at the point of care. Looking Forward: Embracing the Future of Medicine AI is a strategy enabler, not a strategy in itself. Effective AI adopters in healthcare will prioritize integrated governance over isolated initiatives, using AI as a tool to support strategic endeavors and to incorporate data as a key competitive asset. While AI presents unprecedented opportunities for advancement, it also brings challenges such as data privacy concerns, the need for robust ethical frameworks to prevent bias, and the importance of maintaining the human touch in medicine. Addressing these issues is crucial as we integrate more AI tools into clinical settings. The American Academy of PAs (AAPA) has recently developed an AI task force to guide future legislation and ensure that the PA profession is safeguarded in future regulatory frameworks, and I am proud to be part of this esteemed group moving forward. As we prepare for the upcoming annual AAPA conference in Houston, I look forward to engaging with healthcare professionals and leaders to discuss the future of medicine and AI’s role. The opportunity to hear from pioneers like Daniel Kraft, MD and leading a panel discussion on healthcare innovation will further our understanding and implementation of AI technologies.These events at the AAPA conference underscore the vibrant, dynamic nature of our profession and the central role that innovation plays in driving us forward. I am eager to share ideas with fellow thought leaders and continue pushing the boundaries of what is possible in healthcare. As we stand on the brink of a technological revolution in healthcare, driven by artificial intelligence, our responsibilities are manifold. We must not only embrace AI and its capabilities but also guide its integration thoughtfully and ethically to enhance patient care and improve health outcomes. The promise of AI in healthcare is vast and exciting, and I am optimistic about the transformative changes we are about to witness. Let us step boldly into this future, equipped with knowledge, inspired by innovation, and committed to the betterment of patient care worldwide. Let’s not be afraid but rather be bold and embrace the evolution of technology to advance our industry and our profession.
|
"================ <TEXT PASSAGE> ======= Revolutionizing Healthcare: The Transformative Power of AI May 17, 2024 By Kevin Riddleberger, Co-founder, DispatchHealth Kevin Riddleberger, PA-C, MBA, co-founder and chief strategy officer at DispatchHealth. As the co-founder of a pioneering digital health company and a seasoned physician associate, I have navigated the forefront of healthcare innovation over the last decade. Our journey has witnessed both incremental advancements and radical shifts, but none as transformative as the current wave led by Artificial Intelligence (AI). This technological revolution promises to redefine healthcare delivery and management, bringing profound changes that were once the realm of science fiction into today’s clinical practices. The impact on the healthcare society will be bigger than electricity, the computer or the internet by many multiples. Research published in the New England Journal of Medicine last year indicates that generative AI has improved patient outcomes by up to 45% in clinical trials, particularly in the treatment of chronic diseases such as diabetes and heart disease, through personalized medicine and management plans. While a report by McKinsey & Company predicts that generative AI could help reduce healthcare costs in the United States by up to $150 billion annually by 2026 through automation of administrative tasks and optimization of clinical workflows. Just last year, I highlighted in a thought leadership piece a typical day in the life of a clinician leveraging generative AI models embedded in their daily workflow. Since then we have witnessed an explosion of venture capital in companies to the tune of billions of dollars due to immense impact on healthcare operations and drug discoveries. Generative AI models are crucial for achieving the Quintuple Aim of healthcare, enhancing care quality, provider satisfaction, and patient engagement while reducing costs and improving health populations. The volume of medical literature published annually is overwhelming, with estimates suggesting it would take decades for a clinician to process a year’s worth of research. We have long surpassed the power of the human brain and need augmentation quickly. The Expanding Role of AI in Healthcare AI’s integration into healthcare is set to usher in transformative changes, including the development of personalized treatment plans tailored to individual genetic profiles and lifestyles, and virtual health assistants available 24/7, providing real-time, accurate medical advice. The expectation is that AI will manage over 85% of customer interactions in healthcare by 2025, reducing the need for human intervention and allowing healthcare professionals to focus more on patient care. This shift towards technology-dependent care teams emphasizes AI’s role as a partner in healthcare, enhancing our capabilities to serve and care. While technology won’t replace humans, it will become a more integral member of the care team. The future of care delivery will lie in a technology-dependent care team approach, where healthcare workers focus on their greatest comparative advantages over technology. In the quest for top-of-license care, clinician roles, decision making processes, and workflows will evolve by embedding this transformative technology. Companies Leading the AI Healthcare Revolution Eko Health: Known for its AI-powered cardiac monitoring tools, Eko has developed algorithms that significantly improve the detection of heart conditions in routine screenings, potentially reducing the rates of undiagnosed cardiac issues by up to 30%. Eko recently was awarded by the FDA the first AI to aid heart failure detection during routine check-ups using their stethoscopes. Butterfly Network: Their portable ultrasound device, powered by AI, has democratized medical imaging, making it more accessible and affordable. Introducing AI-powered POCUS is proving to increase diagnostic speed and accuracy in point of care settings thus minimizing more expensive imaging studies required. Abridge and Nuance These companies are at the forefront of conversational AI, significantly reducing the clerical burden on clinicians, with both platforms now seamlessly integrated into Epic systems. The technologies use AI to transcribe and structure medical conversations during patient visits, which helps in ensuring that crucial information is captured accurately and can be easily referenced later, reducing the 70+ hours of documentation per clinician every month. Hippocratic AI: The product is a novel staffing marketplace where companies can “hire” auto-pilot generative AI-powered agents to conduct low-risk, non-diagnostic, patient-facing services to help solve the massive healthcare staffing crisis. The company’s vision is centered around how generative AI can provide super staffing and healthcare abundance and equity in our industry. Glass Health: An emerging player, Glass Health uses AI to integrate various data sources to provide a holistic view of patient health, aiding in more comprehensive care planning and clinical decision support at the point of care. Looking Forward: Embracing the Future of Medicine AI is a strategy enabler, not a strategy in itself. Effective AI adopters in healthcare will prioritize integrated governance over isolated initiatives, using AI as a tool to support strategic endeavors and to incorporate data as a key competitive asset. While AI presents unprecedented opportunities for advancement, it also brings challenges such as data privacy concerns, the need for robust ethical frameworks to prevent bias, and the importance of maintaining the human touch in medicine. Addressing these issues is crucial as we integrate more AI tools into clinical settings. The American Academy of PAs (AAPA) has recently developed an AI task force to guide future legislation and ensure that the PA profession is safeguarded in future regulatory frameworks, and I am proud to be part of this esteemed group moving forward. As we prepare for the upcoming annual AAPA conference in Houston, I look forward to engaging with healthcare professionals and leaders to discuss the future of medicine and AI’s role. The opportunity to hear from pioneers like Daniel Kraft, MD and leading a panel discussion on healthcare innovation will further our understanding and implementation of AI technologies.These events at the AAPA conference underscore the vibrant, dynamic nature of our profession and the central role that innovation plays in driving us forward. I am eager to share ideas with fellow thought leaders and continue pushing the boundaries of what is possible in healthcare. As we stand on the brink of a technological revolution in healthcare, driven by artificial intelligence, our responsibilities are manifold. We must not only embrace AI and its capabilities but also guide its integration thoughtfully and ethically to enhance patient care and improve health outcomes. The promise of AI in healthcare is vast and exciting, and I am optimistic about the transformative changes we are about to witness. Let us step boldly into this future, equipped with knowledge, inspired by innovation, and committed to the betterment of patient care worldwide. Let’s not be afraid but rather be bold and embrace the evolution of technology to advance our industry and our profession. https://www.aapa.org/news-central/2024/05/revolutionizing-healthcare-the-transformative-power-of-ai/ ================ <QUESTION> ======= As you know AI is advancing in every field, I'm bit interested in healthcare as it is my domain. How is generative AI being used in healthcare system? ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
Revolutionizing Healthcare: The Transformative Power of AI May 17, 2024 By Kevin Riddleberger, Co-founder, DispatchHealth Kevin Riddleberger, PA-C, MBA, co-founder and chief strategy officer at DispatchHealth. As the co-founder of a pioneering digital health company and a seasoned physician associate, I have navigated the forefront of healthcare innovation over the last decade. Our journey has witnessed both incremental advancements and radical shifts, but none as transformative as the current wave led by Artificial Intelligence (AI). This technological revolution promises to redefine healthcare delivery and management, bringing profound changes that were once the realm of science fiction into today’s clinical practices. The impact on the healthcare society will be bigger than electricity, the computer or the internet by many multiples. Research published in the New England Journal of Medicine last year indicates that generative AI has improved patient outcomes by up to 45% in clinical trials, particularly in the treatment of chronic diseases such as diabetes and heart disease, through personalized medicine and management plans. While a report by McKinsey & Company predicts that generative AI could help reduce healthcare costs in the United States by up to $150 billion annually by 2026 through automation of administrative tasks and optimization of clinical workflows. Just last year, I highlighted in a thought leadership piece a typical day in the life of a clinician leveraging generative AI models embedded in their daily workflow. Since then we have witnessed an explosion of venture capital in companies to the tune of billions of dollars due to immense impact on healthcare operations and drug discoveries. Generative AI models are crucial for achieving the Quintuple Aim of healthcare, enhancing care quality, provider satisfaction, and patient engagement while reducing costs and improving health populations. The volume of medical literature published annually is overwhelming, with estimates suggesting it would take decades for a clinician to process a year’s worth of research. We have long surpassed the power of the human brain and need augmentation quickly. The Expanding Role of AI in Healthcare AI’s integration into healthcare is set to usher in transformative changes, including the development of personalized treatment plans tailored to individual genetic profiles and lifestyles, and virtual health assistants available 24/7, providing real-time, accurate medical advice. The expectation is that AI will manage over 85% of customer interactions in healthcare by 2025, reducing the need for human intervention and allowing healthcare professionals to focus more on patient care. This shift towards technology-dependent care teams emphasizes AI’s role as a partner in healthcare, enhancing our capabilities to serve and care. While technology won’t replace humans, it will become a more integral member of the care team. The future of care delivery will lie in a technology-dependent care team approach, where healthcare workers focus on their greatest comparative advantages over technology. In the quest for top-of-license care, clinician roles, decision making processes, and workflows will evolve by embedding this transformative technology. Companies Leading the AI Healthcare Revolution Eko Health: Known for its AI-powered cardiac monitoring tools, Eko has developed algorithms that significantly improve the detection of heart conditions in routine screenings, potentially reducing the rates of undiagnosed cardiac issues by up to 30%. Eko recently was awarded by the FDA the first AI to aid heart failure detection during routine check-ups using their stethoscopes. Butterfly Network: Their portable ultrasound device, powered by AI, has democratized medical imaging, making it more accessible and affordable. Introducing AI-powered POCUS is proving to increase diagnostic speed and accuracy in point of care settings thus minimizing more expensive imaging studies required. Abridge and Nuance These companies are at the forefront of conversational AI, significantly reducing the clerical burden on clinicians, with both platforms now seamlessly integrated into Epic systems. The technologies use AI to transcribe and structure medical conversations during patient visits, which helps in ensuring that crucial information is captured accurately and can be easily referenced later, reducing the 70+ hours of documentation per clinician every month. Hippocratic AI: The product is a novel staffing marketplace where companies can “hire” auto-pilot generative AI-powered agents to conduct low-risk, non-diagnostic, patient-facing services to help solve the massive healthcare staffing crisis. The company’s vision is centered around how generative AI can provide super staffing and healthcare abundance and equity in our industry. Glass Health: An emerging player, Glass Health uses AI to integrate various data sources to provide a holistic view of patient health, aiding in more comprehensive care planning and clinical decision support at the point of care. Looking Forward: Embracing the Future of Medicine AI is a strategy enabler, not a strategy in itself. Effective AI adopters in healthcare will prioritize integrated governance over isolated initiatives, using AI as a tool to support strategic endeavors and to incorporate data as a key competitive asset. While AI presents unprecedented opportunities for advancement, it also brings challenges such as data privacy concerns, the need for robust ethical frameworks to prevent bias, and the importance of maintaining the human touch in medicine. Addressing these issues is crucial as we integrate more AI tools into clinical settings. The American Academy of PAs (AAPA) has recently developed an AI task force to guide future legislation and ensure that the PA profession is safeguarded in future regulatory frameworks, and I am proud to be part of this esteemed group moving forward. As we prepare for the upcoming annual AAPA conference in Houston, I look forward to engaging with healthcare professionals and leaders to discuss the future of medicine and AI’s role. The opportunity to hear from pioneers like Daniel Kraft, MD and leading a panel discussion on healthcare innovation will further our understanding and implementation of AI technologies.These events at the AAPA conference underscore the vibrant, dynamic nature of our profession and the central role that innovation plays in driving us forward. I am eager to share ideas with fellow thought leaders and continue pushing the boundaries of what is possible in healthcare. As we stand on the brink of a technological revolution in healthcare, driven by artificial intelligence, our responsibilities are manifold. We must not only embrace AI and its capabilities but also guide its integration thoughtfully and ethically to enhance patient care and improve health outcomes. The promise of AI in healthcare is vast and exciting, and I am optimistic about the transformative changes we are about to witness. Let us step boldly into this future, equipped with knowledge, inspired by innovation, and committed to the betterment of patient care worldwide. Let’s not be afraid but rather be bold and embrace the evolution of technology to advance our industry and our profession.
USER:
As you know AI is advancing in every field, I'm bit interested in healthcare as it is my domain. How is generative AI being used in healthcare system?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 28 | 1,094 | null | 296 |
Only use information from the provided context. Produce two paragraphs of 8 sentences each when answering.
|
Does a school participating in NSLP also have to participate in SBP and Seamless Summer Option?
|
NSLP and SBP (the school meals programs) provide federal support for meals served in roughly 90,000 public and private elementary and secondary schools nationwide. They also support meals served in a smaller number of residential child care institutions. Schools receive federal aid in the form of cash reimbursements for every meal they serve that meets federal nutritional requirements (limited to one breakfast and lunch per child daily). The largest subsidies are provided for free and reduced-price meals served to eligible students based on income eligibility and categorical eligibility rules (discussed below). Schools also receive a certain amount of commodity assistance per lunch served (discussed previously). Schools participating in NSLP have the option of providing afterschool snacks through the program, and schools participating in NSLP or SBP have the option of providing summer meals and snacks through the Seamless Summer Option (discussed in the “After-School Meals and Snacks” and “Seamless Summer Option” sections). Schools are not required by federal law to participate in NSLP or SBP; however, some states require schools to have a school lunch and/or breakfast program, and some require schools to operate such programs through NSLP and/or SBP. Some states also provide state funding for the school meals programs, including nine states (as of the cover date of this report) that have authorized funding to provide free meals to all students. Schools that do not participate in the federal school meals programs may still operate locally funded meal programs. The Healthy, Hunger-Free Kids Act of 2010 (HHFKA; P.L. 111-296) made several changes to the school meals programs. Among those changes was a requirement that USDA update the nutrition standards for school meals and create new nutritional requirements for foods sold in NSLP and SBP schools within a certain timeframe. The law also created the Community Eligibility Provision, through which eligible schools can provide free meals to all students. These changes are discussed further within this section. NSLP and SBP are two separate programs, and schools can choose to operate one and not the other. The programs are discussed together in this report because they share many of the same requirements. Differences between the programs are noted where applicable. Participation in SBP tends to be lower than in NSLP for several reasons, including the traditionally required early arrival by students in order to receive a meal before school starts. This section discusses topics specific to the school meals programs. Other food service topics relevant to child nutrition programs more broadly (e.g., the farm to school program) are discussed in the “Other Child Nutrition Activities” section.
|
System Instruction: Only use information from the provided context. Produce two paragraphs of 8 sentences each when answering. Question: Does a school participating in NSLP also have to participate in SBP and Seamless Summer Option? Context: NSLP and SBP (the school meals programs) provide federal support for meals served in roughly 90,000 public and private elementary and secondary schools nationwide. They also support meals served in a smaller number of residential child care institutions. Schools receive federal aid in the form of cash reimbursements for every meal they serve that meets federal nutritional requirements (limited to one breakfast and lunch per child daily). The largest subsidies are provided for free and reduced-price meals served to eligible students based on income eligibility and categorical eligibility rules (discussed below). Schools also receive a certain amount of commodity assistance per lunch served (discussed previously). Schools participating in NSLP have the option of providing afterschool snacks through the program, and schools participating in NSLP or SBP have the option of providing summer meals and snacks through the Seamless Summer Option (discussed in the “After-School Meals and Snacks” and “Seamless Summer Option” sections). Schools are not required by federal law to participate in NSLP or SBP; however, some states require schools to have a school lunch and/or breakfast program, and some require schools to operate such programs through NSLP and/or SBP. Some states also provide state funding for the school meals programs, including nine states (as of the cover date of this report) that have authorized funding to provide free meals to all students. Schools that do not participate in the federal school meals programs may still operate locally funded meal programs. The Healthy, Hunger-Free Kids Act of 2010 (HHFKA; P.L. 111-296) made several changes to the school meals programs. Among those changes was a requirement that USDA update the nutrition standards for school meals and create new nutritional requirements for foods sold in NSLP and SBP schools within a certain timeframe. The law also created the Community Eligibility Provision, through which eligible schools can provide free meals to all students. These changes are discussed further within this section. NSLP and SBP are two separate programs, and schools can choose to operate one and not the other. The programs are discussed together in this report because they share many of the same requirements. Differences between the programs are noted where applicable. Participation in SBP tends to be lower than in NSLP for several reasons, including the traditionally required early arrival by students in order to receive a meal before school starts. This section discusses topics specific to the school meals programs. Other food service topics relevant to child nutrition programs more broadly (e.g., the farm to school program) are discussed in the “Other Child Nutrition Activities” section.
|
Only use information from the provided context. Produce two paragraphs of 8 sentences each when answering.
EVIDENCE:
NSLP and SBP (the school meals programs) provide federal support for meals served in roughly 90,000 public and private elementary and secondary schools nationwide. They also support meals served in a smaller number of residential child care institutions. Schools receive federal aid in the form of cash reimbursements for every meal they serve that meets federal nutritional requirements (limited to one breakfast and lunch per child daily). The largest subsidies are provided for free and reduced-price meals served to eligible students based on income eligibility and categorical eligibility rules (discussed below). Schools also receive a certain amount of commodity assistance per lunch served (discussed previously). Schools participating in NSLP have the option of providing afterschool snacks through the program, and schools participating in NSLP or SBP have the option of providing summer meals and snacks through the Seamless Summer Option (discussed in the “After-School Meals and Snacks” and “Seamless Summer Option” sections). Schools are not required by federal law to participate in NSLP or SBP; however, some states require schools to have a school lunch and/or breakfast program, and some require schools to operate such programs through NSLP and/or SBP. Some states also provide state funding for the school meals programs, including nine states (as of the cover date of this report) that have authorized funding to provide free meals to all students. Schools that do not participate in the federal school meals programs may still operate locally funded meal programs. The Healthy, Hunger-Free Kids Act of 2010 (HHFKA; P.L. 111-296) made several changes to the school meals programs. Among those changes was a requirement that USDA update the nutrition standards for school meals and create new nutritional requirements for foods sold in NSLP and SBP schools within a certain timeframe. The law also created the Community Eligibility Provision, through which eligible schools can provide free meals to all students. These changes are discussed further within this section. NSLP and SBP are two separate programs, and schools can choose to operate one and not the other. The programs are discussed together in this report because they share many of the same requirements. Differences between the programs are noted where applicable. Participation in SBP tends to be lower than in NSLP for several reasons, including the traditionally required early arrival by students in order to receive a meal before school starts. This section discusses topics specific to the school meals programs. Other food service topics relevant to child nutrition programs more broadly (e.g., the farm to school program) are discussed in the “Other Child Nutrition Activities” section.
USER:
Does a school participating in NSLP also have to participate in SBP and Seamless Summer Option?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 16 | 16 | 426 | null | 502 |
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
|
I have a hernia in my lower back and my doctor wants to do a laminotomy. I want to know more information about this surgery. Please explain the different types of spinal decompression surgeries and what I should expect. Use more than 400 words.
|
What is spinal decompression surgery? Spinal decompression surgery is performed to relieve symptoms related to compression of the spinal cord or its roots, which may include back or neck pain and radiating limb pain (radiculopathy). What symptoms does spinal decompression surgery treat? Spinal nerve compression symptoms include pain, altered sensations, muscle weakness or dysfunction, and even gait abnormalities. These symptoms can be caused by a wide variety of conditions. In some of these, such as in cervical spinal stenosis that leads to cervical myelopathy, you may feel symptoms in the arms, hands, legs or feet, and/or have balance problems, or even incontinence issues (bowel dysfunction, unexpected need to urinate, etc.). A rapid onset of these symptoms can indicate a condition known as cauda equina syndrome, which can cause paralysis and other serious problems if not addressed in a timely manner. Pain and other symptoms treated by these surgeries are most common in the lower back (lumbar spine), followed by the neck (cervical spine). Symptoms in the upper back (thoracic spine) are possible but less common because it is the most stable part of the spine, due in part to its being connected to the rib cage. Neuropathies may involve feelings of numbness or a "pins and needles" tingling sensation and cause weakness or instability, primarily in lower the back. What happens during spinal decompression surgery? Every type of spinal decompression modifies or removes bone, spinal disc or soft tissues that are causing compression of a nerve. The techniques vary according to which tissues are causing the compression. For example, laminoplasty involves the reshaping of part of a vertebral lamina, a laminotomy the making of a small hole the lamina, and a laminectomy the complete removal of a lamina, all to relieve pressure on the nerves. What types of spine decompression surgery are there? Types of spine decompression surgery performed at HSS include laminectomy, laminotomy, laminoplasty, discectomy and microdiscectomy, among others. Lumbar decompression surgery may be used to address problems in the lower back, such as lumbar laminectomy, laminotomy, or microdiscectomy. Types of spinal decompression surgery Laminectomy is the removal in one or more vertebrae of the lamina (bony roof over the spinal canal). This decompresses both sides (left and right) of the canal. Laminotomy is removal of a small portion of the lamina to decompress one side (left or right) of the canal. This leaves most of the lamina intact. Microsurgical laminoplasty is a minimally invasive surgical decompression technique that uses small incisions viewed through an operating microscope. (Find a laminoplasty spine specialist.) Microdiscectomy (also known as spinal microdecompression surgery): This minimally invasive spine procedure is commonly performed on patients who have sciatica and/or a herniated disc in the lumbar section of the spine (lower back). Using muscle-sparing incisions, this removes portions of a herniated disc that is putting pressure on the spinal nerve and causing pain. Minimally invasive lumbar discectomy (also known as endoscopic percutaneous disc removal) is similar to microdiscectomy and uses a scope to make very small incisions in the skin, through which a portion of the herniated disc that is compressing spinal nerves is removed. Decompression with fusion Some decompression surgeries may require the addition of a fusion procedure simultaneously. This depends on the type of disease being treated and the technique being used to address the disease. This includes lumbar decompressions, such as lumbar interbody fusion (LIF) techniques, which may indirectly decompress the spine, or cervical decompressions, such as anterior cervical discectomy and fusion (ACDF surgery), which are dependent on the differential anatomy of the spine. Who is a good candidate for spinal decompression surgery? Decompression surgery can be a good option for people who have back or neck pain and/or neuropathies due to nerve compression caused by a herniated disc, spinal stenosis, spondylolisthesis, and for whom nonsurgical methods such as physical therapy, epidural steroid injections or pain management regimens have failed to provide relief. Find an HSS spine surgeon by decompression procedure all spinal decompression laminectomy laminoplasty discectomy and microdiscectomy Will I have to go under anesthesia for spinal decompression surgery? Most spinal decompression surgeries will be performed under general anesthesia, with the patient completely unconscious. Some modern techniques allow for spinal surgery under regional anesthesia (either spinal or epidural anesthesia). These techniques allow patients to breathe on their own without the need for mechanical assistance. These techniques may reduce complications associated with general anesthesia but are not widely available and may be performed on a case-by-case basis. How long will I stay in the hospital after spinal decompression surgery? In many cases, patients undergoing decompressions such as a laminectomy, discectomy, or microdiscectomy can go home the same day. This is often the case with a laminectomy, microdiscectomy, and there is research to suggest that even multilevel ACDF surgeries may be safely done on an outpatient basis. Some patients having spinal decompression may need to stay one or more nights including those who have chronic diseases or sleep. Some patients require a spinal fusion may stay overnight and return home one or two days after surgery. Rarely, a patient may need to stay as many longer. In addition, some decompression spine surgeries may be planned as an ambulatory (outpatient) procedure, but then converted to an overnight stay to monitor the patient. In one study of more than 1,000 patients who underwent an ambulatory one- or two-level lumbar decompression, 58% ended up staying over at least one night. How soon can I walk after a decompression spine surgery? At HSS patients are encouraged to walk the same day of most decompression surgeries. How soon can I return to work after spinal decompression? Depending on the specific procedure and other factors, patients generally are able to return to work between two and four weeks after surgery. Some patients who have a microdiscectomy decompression may be able to return to work after less than two weeks. What is the recovery time of spinal decompression surgery? The recovery time for decompression surgery alone is generally faster compared to procedures that include a fusion. Owing to the wide range of decompression surgery types and the number of spinal levels addressed with surgery there is likewise some variability in recovery duration. There is recent evidence that microdiscectomy patients can return to physical therapy and low impact aerobic exercise within four weeks of surgery. Patients undergoing laminectomy procedure can expect surgery pain to ease within two to four weeks of surgery and starting physical therapy and other activities by about six weeks. Fusion procedures are likewise highly variable and recovery times prolonged, approaching three to six months before patients can return to exercise or sports activities. Please confer with your surgeon regarding your procedure and expected recovery. What is the success rate of spinal decompression surgery? Precise success rates of spinal decompression surgery can be difficult to calculate due to the wide variety of procedures, severity of spinal conditions, and the age and health of individual patients. Patients can expect a significant decrease in their pain and an improvement in their overall function.
|
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I have a hernia in my lower back and my doctor wants to do a laminotomy. I want to know more information about this surgery. Please explain the different types of spinal decompression surgeries and what I should expect. Use more than 400 words. What is spinal decompression surgery? Spinal decompression surgery is performed to relieve symptoms related to compression of the spinal cord or its roots, which may include back or neck pain and radiating limb pain (radiculopathy). What symptoms does spinal decompression surgery treat? Spinal nerve compression symptoms include pain, altered sensations, muscle weakness or dysfunction, and even gait abnormalities. These symptoms can be caused by a wide variety of conditions. In some of these, such as in cervical spinal stenosis that leads to cervical myelopathy, you may feel symptoms in the arms, hands, legs or feet, and/or have balance problems, or even incontinence issues (bowel dysfunction, unexpected need to urinate, etc.). A rapid onset of these symptoms can indicate a condition known as cauda equina syndrome, which can cause paralysis and other serious problems if not addressed in a timely manner. Pain and other symptoms treated by these surgeries are most common in the lower back (lumbar spine), followed by the neck (cervical spine). Symptoms in the upper back (thoracic spine) are possible but less common because it is the most stable part of the spine, due in part to its being connected to the rib cage. Neuropathies may involve feelings of numbness or a "pins and needles" tingling sensation and cause weakness or instability, primarily in lower the back. What happens during spinal decompression surgery? Every type of spinal decompression modifies or removes bone, spinal disc or soft tissues that are causing compression of a nerve. The techniques vary according to which tissues are causing the compression. For example, laminoplasty involves the reshaping of part of a vertebral lamina, a laminotomy the making of a small hole the lamina, and a laminectomy the complete removal of a lamina, all to relieve pressure on the nerves. What types of spine decompression surgery are there? Types of spine decompression surgery performed at HSS include laminectomy, laminotomy, laminoplasty, discectomy and microdiscectomy, among others. Lumbar decompression surgery may be used to address problems in the lower back, such as lumbar laminectomy, laminotomy, or microdiscectomy. Types of spinal decompression surgery Laminectomy is the removal in one or more vertebrae of the lamina (bony roof over the spinal canal). This decompresses both sides (left and right) of the canal. Laminotomy is removal of a small portion of the lamina to decompress one side (left or right) of the canal. This leaves most of the lamina intact. Microsurgical laminoplasty is a minimally invasive surgical decompression technique that uses small incisions viewed through an operating microscope. (Find a laminoplasty spine specialist.) Microdiscectomy (also known as spinal microdecompression surgery): This minimally invasive spine procedure is commonly performed on patients who have sciatica and/or a herniated disc in the lumbar section of the spine (lower back). Using muscle-sparing incisions, this removes portions of a herniated disc that is putting pressure on the spinal nerve and causing pain. Minimally invasive lumbar discectomy (also known as endoscopic percutaneous disc removal) is similar to microdiscectomy and uses a scope to make very small incisions in the skin, through which a portion of the herniated disc that is compressing spinal nerves is removed. Decompression with fusion Some decompression surgeries may require the addition of a fusion procedure simultaneously. This depends on the type of disease being treated and the technique being used to address the disease. This includes lumbar decompressions, such as lumbar interbody fusion (LIF) techniques, which may indirectly decompress the spine, or cervical decompressions, such as anterior cervical discectomy and fusion (ACDF surgery), which are dependent on the differential anatomy of the spine. Who is a good candidate for spinal decompression surgery? Decompression surgery can be a good option for people who have back or neck pain and/or neuropathies due to nerve compression caused by a herniated disc, spinal stenosis, spondylolisthesis, and for whom nonsurgical methods such as physical therapy, epidural steroid injections or pain management regimens have failed to provide relief. Find an HSS spine surgeon by decompression procedure all spinal decompression laminectomy laminoplasty discectomy and microdiscectomy Will I have to go under anesthesia for spinal decompression surgery? Most spinal decompression surgeries will be performed under general anesthesia, with the patient completely unconscious. Some modern techniques allow for spinal surgery under regional anesthesia (either spinal or epidural anesthesia). These techniques allow patients to breathe on their own without the need for mechanical assistance. These techniques may reduce complications associated with general anesthesia but are not widely available and may be performed on a case-by-case basis. How long will I stay in the hospital after spinal decompression surgery? In many cases, patients undergoing decompressions such as a laminectomy, discectomy, or microdiscectomy can go home the same day. This is often the case with a laminectomy, microdiscectomy, and there is research to suggest that even multilevel ACDF surgeries may be safely done on an outpatient basis. Some patients having spinal decompression may need to stay one or more nights including those who have chronic diseases or sleep. Some patients require a spinal fusion may stay overnight and return home one or two days after surgery. Rarely, a patient may need to stay as many longer. In addition, some decompression spine surgeries may be planned as an ambulatory (outpatient) procedure, but then converted to an overnight stay to monitor the patient. In one study of more than 1,000 patients who underwent an ambulatory one- or two-level lumbar decompression, 58% ended up staying over at least one night. How soon can I walk after a decompression spine surgery? At HSS patients are encouraged to walk the same day of most decompression surgeries. How soon can I return to work after spinal decompression? Depending on the specific procedure and other factors, patients generally are able to return to work between two and four weeks after surgery. Some patients who have a microdiscectomy decompression may be able to return to work after less than two weeks. What is the recovery time of spinal decompression surgery? The recovery time for decompression surgery alone is generally faster compared to procedures that include a fusion. Owing to the wide range of decompression surgery types and the number of spinal levels addressed with surgery there is likewise some variability in recovery duration. There is recent evidence that microdiscectomy patients can return to physical therapy and low impact aerobic exercise within four weeks of surgery. Patients undergoing laminectomy procedure can expect surgery pain to ease within two to four weeks of surgery and starting physical therapy and other activities by about six weeks. Fusion procedures are likewise highly variable and recovery times prolonged, approaching three to six months before patients can return to exercise or sports activities. Please confer with your surgeon regarding your procedure and expected recovery. What is the success rate of spinal decompression surgery? Precise success rates of spinal decompression surgery can be difficult to calculate due to the wide variety of procedures, severity of spinal conditions, and the age and health of individual patients. Patients can expect a significant decrease in their pain and an improvement in their overall function. https://www.hss.edu/condition-list_spinal-decompression-surgery.asp
|
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
EVIDENCE:
What is spinal decompression surgery? Spinal decompression surgery is performed to relieve symptoms related to compression of the spinal cord or its roots, which may include back or neck pain and radiating limb pain (radiculopathy). What symptoms does spinal decompression surgery treat? Spinal nerve compression symptoms include pain, altered sensations, muscle weakness or dysfunction, and even gait abnormalities. These symptoms can be caused by a wide variety of conditions. In some of these, such as in cervical spinal stenosis that leads to cervical myelopathy, you may feel symptoms in the arms, hands, legs or feet, and/or have balance problems, or even incontinence issues (bowel dysfunction, unexpected need to urinate, etc.). A rapid onset of these symptoms can indicate a condition known as cauda equina syndrome, which can cause paralysis and other serious problems if not addressed in a timely manner. Pain and other symptoms treated by these surgeries are most common in the lower back (lumbar spine), followed by the neck (cervical spine). Symptoms in the upper back (thoracic spine) are possible but less common because it is the most stable part of the spine, due in part to its being connected to the rib cage. Neuropathies may involve feelings of numbness or a "pins and needles" tingling sensation and cause weakness or instability, primarily in lower the back. What happens during spinal decompression surgery? Every type of spinal decompression modifies or removes bone, spinal disc or soft tissues that are causing compression of a nerve. The techniques vary according to which tissues are causing the compression. For example, laminoplasty involves the reshaping of part of a vertebral lamina, a laminotomy the making of a small hole the lamina, and a laminectomy the complete removal of a lamina, all to relieve pressure on the nerves. What types of spine decompression surgery are there? Types of spine decompression surgery performed at HSS include laminectomy, laminotomy, laminoplasty, discectomy and microdiscectomy, among others. Lumbar decompression surgery may be used to address problems in the lower back, such as lumbar laminectomy, laminotomy, or microdiscectomy. Types of spinal decompression surgery Laminectomy is the removal in one or more vertebrae of the lamina (bony roof over the spinal canal). This decompresses both sides (left and right) of the canal. Laminotomy is removal of a small portion of the lamina to decompress one side (left or right) of the canal. This leaves most of the lamina intact. Microsurgical laminoplasty is a minimally invasive surgical decompression technique that uses small incisions viewed through an operating microscope. (Find a laminoplasty spine specialist.) Microdiscectomy (also known as spinal microdecompression surgery): This minimally invasive spine procedure is commonly performed on patients who have sciatica and/or a herniated disc in the lumbar section of the spine (lower back). Using muscle-sparing incisions, this removes portions of a herniated disc that is putting pressure on the spinal nerve and causing pain. Minimally invasive lumbar discectomy (also known as endoscopic percutaneous disc removal) is similar to microdiscectomy and uses a scope to make very small incisions in the skin, through which a portion of the herniated disc that is compressing spinal nerves is removed. Decompression with fusion Some decompression surgeries may require the addition of a fusion procedure simultaneously. This depends on the type of disease being treated and the technique being used to address the disease. This includes lumbar decompressions, such as lumbar interbody fusion (LIF) techniques, which may indirectly decompress the spine, or cervical decompressions, such as anterior cervical discectomy and fusion (ACDF surgery), which are dependent on the differential anatomy of the spine. Who is a good candidate for spinal decompression surgery? Decompression surgery can be a good option for people who have back or neck pain and/or neuropathies due to nerve compression caused by a herniated disc, spinal stenosis, spondylolisthesis, and for whom nonsurgical methods such as physical therapy, epidural steroid injections or pain management regimens have failed to provide relief. Find an HSS spine surgeon by decompression procedure all spinal decompression laminectomy laminoplasty discectomy and microdiscectomy Will I have to go under anesthesia for spinal decompression surgery? Most spinal decompression surgeries will be performed under general anesthesia, with the patient completely unconscious. Some modern techniques allow for spinal surgery under regional anesthesia (either spinal or epidural anesthesia). These techniques allow patients to breathe on their own without the need for mechanical assistance. These techniques may reduce complications associated with general anesthesia but are not widely available and may be performed on a case-by-case basis. How long will I stay in the hospital after spinal decompression surgery? In many cases, patients undergoing decompressions such as a laminectomy, discectomy, or microdiscectomy can go home the same day. This is often the case with a laminectomy, microdiscectomy, and there is research to suggest that even multilevel ACDF surgeries may be safely done on an outpatient basis. Some patients having spinal decompression may need to stay one or more nights including those who have chronic diseases or sleep. Some patients require a spinal fusion may stay overnight and return home one or two days after surgery. Rarely, a patient may need to stay as many longer. In addition, some decompression spine surgeries may be planned as an ambulatory (outpatient) procedure, but then converted to an overnight stay to monitor the patient. In one study of more than 1,000 patients who underwent an ambulatory one- or two-level lumbar decompression, 58% ended up staying over at least one night. How soon can I walk after a decompression spine surgery? At HSS patients are encouraged to walk the same day of most decompression surgeries. How soon can I return to work after spinal decompression? Depending on the specific procedure and other factors, patients generally are able to return to work between two and four weeks after surgery. Some patients who have a microdiscectomy decompression may be able to return to work after less than two weeks. What is the recovery time of spinal decompression surgery? The recovery time for decompression surgery alone is generally faster compared to procedures that include a fusion. Owing to the wide range of decompression surgery types and the number of spinal levels addressed with surgery there is likewise some variability in recovery duration. There is recent evidence that microdiscectomy patients can return to physical therapy and low impact aerobic exercise within four weeks of surgery. Patients undergoing laminectomy procedure can expect surgery pain to ease within two to four weeks of surgery and starting physical therapy and other activities by about six weeks. Fusion procedures are likewise highly variable and recovery times prolonged, approaching three to six months before patients can return to exercise or sports activities. Please confer with your surgeon regarding your procedure and expected recovery. What is the success rate of spinal decompression surgery? Precise success rates of spinal decompression surgery can be difficult to calculate due to the wide variety of procedures, severity of spinal conditions, and the age and health of individual patients. Patients can expect a significant decrease in their pain and an improvement in their overall function.
USER:
I have a hernia in my lower back and my doctor wants to do a laminotomy. I want to know more information about this surgery. Please explain the different types of spinal decompression surgeries and what I should expect. Use more than 400 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 44 | 1,172 | null | 490 |
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
|
I am going to have surgery next week and my doctor sent a form home with me with a questionnaire to fill out before I go in for the surgery. Using this article for reference, can you tell me what medications may interfere with anesthesia and why? Use at least 500 words.
|
4 types of medications that can interfere with anesthesia BY Molly Adams Patients with cancer may take all kinds of medications – whether they’re used to treat cancer, its side effects, or other conditions that have nothing to do with a cancer diagnosis. While medications are a part of daily life for many of us, there are times when you should adjust your dose or even stop taking certain medicines. “Before you undergo anesthesia for any reason, you want to be sure you’re not taking any medicines that may cause a problem with anesthesia or your procedure,” says Shannon Popovich, M.D., medical director of MD Anderson’s Perioperative Evaluation and Management Center. Here, Popovich shares four types of medication to be mindful of before anesthesia. 1. Blood pressure and heart failure medications Patients may take these to help treat high blood pressure or heart failure. These drugs include beta-blockers, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors or diuretics. When a patient is under anesthesia, we monitor their blood pressure very closely, and some of these medications can lower your blood pressure more when combined with anesthesia. If you’re taking any medication to lower your blood pressure, that can really complicate our efforts to maintain your blood pressure during surgery or any other treatment performed under anesthesia. We generally suggest patients stop taking ACE inhibitors, angiotensin receptor blockers or direct renin inhibitors 24 hours before undergoing anesthesia to reduce the risk of your blood pressure falling too low when combined with anesthesia. Beta-blockers, calcium channel blockers and medications for heart failure should be taken as usual. They’re not as likely to complicate your blood pressure during anesthesia. 2. Type 2 diabetes medications Certain drugs used to help regulate blood sugars for patients with diabetes and pre-diabetes should be discussed with your physician before receiving anesthesia. Two specific classes of drugs are particularly concerning: GLP-1 agonists and SGLT-2 inhibitors. Medications called GLP-1 agonists (Semaglutide) before anesthesia can increase the risk of vomiting and aspiration because they slow the time it takes for food to leave your stomach. Even when patients stop eating for the advised period before anesthesia, these drugs may still cause them to have a full stomach. We generally ask patients to temporarily stop taking these medications based on how often they take them. For example, if you take the drug once a week, stop taking it a week before anesthesia. If you take it once a day, hold it the day of surgery, and consider holding it the day before to reduce your risk of a full stomach. SGLT-2 inhibitors are known to place patients at risk for euglycemic ketoacidosis when the body is under stress or they are fasting. This is a dangerous condition, and these medications should be held 3 to 4 days before anesthesia, depending on which drug you’re taking. Talk to your prescribing doctor to learn what they recommend for you. If you’re concerned about how holding your diabetes medication may affect your blood glucose levels, talk to your endocrinologist or prescribing doctor to see what they recommend. If you take insulin to help manage Type 1 diabetes, continue taking it as you normally do. MD Anderson patients will discuss specific recommendations with the Perioperative Evaluation and Management team or Endocrinology teams before anesthesia. Insulin taken for Type 2 diabetes may be adjusted in the 24 hours before anesthesia as instructed by your doctor. But be sure to tell your care team about your medication and dosage. 3. Weight loss medications Although some diabetes medications, like GLP-1 agonists, may help patients with weight loss, there’s another class of drugs solely aimed at weight loss. These are stimulants and work by decreasing appetite and increasing your heart rate. That stimulation can have an unwanted effect when combined with anesthesia. Drugs that contain phentermine need to be held for 4 days before anesthesia, but when combined with another medication (like topiramate) may need to be slowly tapered off over time. Be sure to talk to your care team about your dose and type of medication so we can wean you off safely. 4. Blood thinners and blood clotting drugs If you’re undergoing anesthesia before surgery, you might need to stop blood thinning medications – even over-the-counter ones like ibuprofen or Advil – to avoid the risk of excessive bleeding. Talk with your surgeon or proceduralist about any blood thinners you’re taking. For less-invasive procedures like MRI, you should be able to keep taking blood thinners as normal. Some medications are important to keep taking Most patients will be able to start taking their regular medications again soon after waking up from anesthesia. In many cases, you may be able to start taking your medications again after you’ve had something to eat and are cleared after surgery. Although there are several medications to avoid before anesthesia, there are many you can – and should keep taking. Patients who take birth control should continue doing so to avoid the risk of becoming pregnant. This is especially important for patients undergoing chemotherapy or radiation therapy, which can be dangerous to unborn babies. Antidepressants, anxiety medication and most medicines used to treat ADHD are also safe to continue. If you use sleep aids to help ease insomnia, you can also keep taking them as directed. The most important thing is to be honest about any drugs you’re taking – prescription or not – so your care team can give you the best advice for your unique needs.
|
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I am going to have surgery next week and my doctor sent a form home with me with a questionnaire to fill out before I go in for the surgery. Using this article for reference, can you tell me what medications may interfere with anesthesia and why? Use at least 500 words. {passage 0} ========== 4 types of medications that can interfere with anesthesia BY Molly Adams Patients with cancer may take all kinds of medications – whether they’re used to treat cancer, its side effects, or other conditions that have nothing to do with a cancer diagnosis. While medications are a part of daily life for many of us, there are times when you should adjust your dose or even stop taking certain medicines. “Before you undergo anesthesia for any reason, you want to be sure you’re not taking any medicines that may cause a problem with anesthesia or your procedure,” says Shannon Popovich, M.D., medical director of MD Anderson’s Perioperative Evaluation and Management Center. Here, Popovich shares four types of medication to be mindful of before anesthesia. 1. Blood pressure and heart failure medications Patients may take these to help treat high blood pressure or heart failure. These drugs include beta-blockers, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors or diuretics. When a patient is under anesthesia, we monitor their blood pressure very closely, and some of these medications can lower your blood pressure more when combined with anesthesia. If you’re taking any medication to lower your blood pressure, that can really complicate our efforts to maintain your blood pressure during surgery or any other treatment performed under anesthesia. We generally suggest patients stop taking ACE inhibitors, angiotensin receptor blockers or direct renin inhibitors 24 hours before undergoing anesthesia to reduce the risk of your blood pressure falling too low when combined with anesthesia. Beta-blockers, calcium channel blockers and medications for heart failure should be taken as usual. They’re not as likely to complicate your blood pressure during anesthesia. 2. Type 2 diabetes medications Certain drugs used to help regulate blood sugars for patients with diabetes and pre-diabetes should be discussed with your physician before receiving anesthesia. Two specific classes of drugs are particularly concerning: GLP-1 agonists and SGLT-2 inhibitors. Medications called GLP-1 agonists (Semaglutide) before anesthesia can increase the risk of vomiting and aspiration because they slow the time it takes for food to leave your stomach. Even when patients stop eating for the advised period before anesthesia, these drugs may still cause them to have a full stomach. We generally ask patients to temporarily stop taking these medications based on how often they take them. For example, if you take the drug once a week, stop taking it a week before anesthesia. If you take it once a day, hold it the day of surgery, and consider holding it the day before to reduce your risk of a full stomach. SGLT-2 inhibitors are known to place patients at risk for euglycemic ketoacidosis when the body is under stress or they are fasting. This is a dangerous condition, and these medications should be held 3 to 4 days before anesthesia, depending on which drug you’re taking. Talk to your prescribing doctor to learn what they recommend for you. If you’re concerned about how holding your diabetes medication may affect your blood glucose levels, talk to your endocrinologist or prescribing doctor to see what they recommend. If you take insulin to help manage Type 1 diabetes, continue taking it as you normally do. MD Anderson patients will discuss specific recommendations with the Perioperative Evaluation and Management team or Endocrinology teams before anesthesia. Insulin taken for Type 2 diabetes may be adjusted in the 24 hours before anesthesia as instructed by your doctor. But be sure to tell your care team about your medication and dosage. 3. Weight loss medications Although some diabetes medications, like GLP-1 agonists, may help patients with weight loss, there’s another class of drugs solely aimed at weight loss. These are stimulants and work by decreasing appetite and increasing your heart rate. That stimulation can have an unwanted effect when combined with anesthesia. Drugs that contain phentermine need to be held for 4 days before anesthesia, but when combined with another medication (like topiramate) may need to be slowly tapered off over time. Be sure to talk to your care team about your dose and type of medication so we can wean you off safely. 4. Blood thinners and blood clotting drugs If you’re undergoing anesthesia before surgery, you might need to stop blood thinning medications – even over-the-counter ones like ibuprofen or Advil – to avoid the risk of excessive bleeding. Talk with your surgeon or proceduralist about any blood thinners you’re taking. For less-invasive procedures like MRI, you should be able to keep taking blood thinners as normal. Some medications are important to keep taking Most patients will be able to start taking their regular medications again soon after waking up from anesthesia. In many cases, you may be able to start taking your medications again after you’ve had something to eat and are cleared after surgery. Although there are several medications to avoid before anesthesia, there are many you can – and should keep taking. Patients who take birth control should continue doing so to avoid the risk of becoming pregnant. This is especially important for patients undergoing chemotherapy or radiation therapy, which can be dangerous to unborn babies. Antidepressants, anxiety medication and most medicines used to treat ADHD are also safe to continue. If you use sleep aids to help ease insomnia, you can also keep taking them as directed. The most important thing is to be honest about any drugs you’re taking – prescription or not – so your care team can give you the best advice for your unique needs. https://www.mdanderson.org/cancerwise/4-types-of-medications-that-can-interfere-with-anesthesia.h00-159623379.html
|
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
EVIDENCE:
4 types of medications that can interfere with anesthesia BY Molly Adams Patients with cancer may take all kinds of medications – whether they’re used to treat cancer, its side effects, or other conditions that have nothing to do with a cancer diagnosis. While medications are a part of daily life for many of us, there are times when you should adjust your dose or even stop taking certain medicines. “Before you undergo anesthesia for any reason, you want to be sure you’re not taking any medicines that may cause a problem with anesthesia or your procedure,” says Shannon Popovich, M.D., medical director of MD Anderson’s Perioperative Evaluation and Management Center. Here, Popovich shares four types of medication to be mindful of before anesthesia. 1. Blood pressure and heart failure medications Patients may take these to help treat high blood pressure or heart failure. These drugs include beta-blockers, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors or diuretics. When a patient is under anesthesia, we monitor their blood pressure very closely, and some of these medications can lower your blood pressure more when combined with anesthesia. If you’re taking any medication to lower your blood pressure, that can really complicate our efforts to maintain your blood pressure during surgery or any other treatment performed under anesthesia. We generally suggest patients stop taking ACE inhibitors, angiotensin receptor blockers or direct renin inhibitors 24 hours before undergoing anesthesia to reduce the risk of your blood pressure falling too low when combined with anesthesia. Beta-blockers, calcium channel blockers and medications for heart failure should be taken as usual. They’re not as likely to complicate your blood pressure during anesthesia. 2. Type 2 diabetes medications Certain drugs used to help regulate blood sugars for patients with diabetes and pre-diabetes should be discussed with your physician before receiving anesthesia. Two specific classes of drugs are particularly concerning: GLP-1 agonists and SGLT-2 inhibitors. Medications called GLP-1 agonists (Semaglutide) before anesthesia can increase the risk of vomiting and aspiration because they slow the time it takes for food to leave your stomach. Even when patients stop eating for the advised period before anesthesia, these drugs may still cause them to have a full stomach. We generally ask patients to temporarily stop taking these medications based on how often they take them. For example, if you take the drug once a week, stop taking it a week before anesthesia. If you take it once a day, hold it the day of surgery, and consider holding it the day before to reduce your risk of a full stomach. SGLT-2 inhibitors are known to place patients at risk for euglycemic ketoacidosis when the body is under stress or they are fasting. This is a dangerous condition, and these medications should be held 3 to 4 days before anesthesia, depending on which drug you’re taking. Talk to your prescribing doctor to learn what they recommend for you. If you’re concerned about how holding your diabetes medication may affect your blood glucose levels, talk to your endocrinologist or prescribing doctor to see what they recommend. If you take insulin to help manage Type 1 diabetes, continue taking it as you normally do. MD Anderson patients will discuss specific recommendations with the Perioperative Evaluation and Management team or Endocrinology teams before anesthesia. Insulin taken for Type 2 diabetes may be adjusted in the 24 hours before anesthesia as instructed by your doctor. But be sure to tell your care team about your medication and dosage. 3. Weight loss medications Although some diabetes medications, like GLP-1 agonists, may help patients with weight loss, there’s another class of drugs solely aimed at weight loss. These are stimulants and work by decreasing appetite and increasing your heart rate. That stimulation can have an unwanted effect when combined with anesthesia. Drugs that contain phentermine need to be held for 4 days before anesthesia, but when combined with another medication (like topiramate) may need to be slowly tapered off over time. Be sure to talk to your care team about your dose and type of medication so we can wean you off safely. 4. Blood thinners and blood clotting drugs If you’re undergoing anesthesia before surgery, you might need to stop blood thinning medications – even over-the-counter ones like ibuprofen or Advil – to avoid the risk of excessive bleeding. Talk with your surgeon or proceduralist about any blood thinners you’re taking. For less-invasive procedures like MRI, you should be able to keep taking blood thinners as normal. Some medications are important to keep taking Most patients will be able to start taking their regular medications again soon after waking up from anesthesia. In many cases, you may be able to start taking your medications again after you’ve had something to eat and are cleared after surgery. Although there are several medications to avoid before anesthesia, there are many you can – and should keep taking. Patients who take birth control should continue doing so to avoid the risk of becoming pregnant. This is especially important for patients undergoing chemotherapy or radiation therapy, which can be dangerous to unborn babies. Antidepressants, anxiety medication and most medicines used to treat ADHD are also safe to continue. If you use sleep aids to help ease insomnia, you can also keep taking them as directed. The most important thing is to be honest about any drugs you’re taking – prescription or not – so your care team can give you the best advice for your unique needs.
USER:
I am going to have surgery next week and my doctor sent a form home with me with a questionnaire to fill out before I go in for the surgery. Using this article for reference, can you tell me what medications may interfere with anesthesia and why? Use at least 500 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 26 | 52 | 916 | null | 720 |
For this question, make sure you only use the information I give to you. Focus on terms the average person would understand.
|
Identify the difference between dividends and earnings.
|
1. Amortization: Refers to the process of gradually paying off a debt or loan over a specific period of time through regular, scheduled payments. These payments typically consist of both principal and interest. 2. Backlog: A buildup of work that has not been completed or processed within a specific period. When a company receives an order or new contract for a product, undelivered products to fulfill that contract become part of the company’s backlog. 3. Balance Sheet: Financial statement that provides a snapshot of a company's financial position at a specific point in time. It is one of the financial statements used by businesses, investors, creditors, and analysts to assess the company's financial health and performance. The balance sheet follows the accounting equation that assets must equal liabilities plus equity. 4. Bid & Proposal Costs: Refers to the costs incurred in preparing, submitting, and supporting bids and proposals (whether or not solicited) on potential contracts (Government or not). These typically indirect costs are allowable to the extent they are allocable, reasonable, and not otherwise unallowable. 5. Booking (e.g., Orders): Refers to the value of new contracts, modifications, task orders, or options signed in an accounting period. 6. Cash Flow: Refers to the inflows (coming in) and outflows (going out) of cash of a company. 7. Cash Flow Statement: Financial statement that provides an overview of the cash generated and used by a business during a specific period of time. It is one of the key financial statements used by businesses, investors, and analysts to assess the financial health and liquidity of a company. The cash flow statement is divided into three main sections: 1) Operating Activities: Reports the cash generated or used in the core operating activities of the business. 2) Investing Activities: Details cash transactions related to the purchase and sale of long-term assets and investments. 3) Financing Activities: Reflects cash transactions related to the company's financing activities. It includes activities such as issuing or repurchasing stock, borrowing, or repaying debt, and paying dividends. 8. Common Size Financial Analysis: Method of evaluating and comparing financial statements by expressing each line item as a percentage of a base item (e.g., revenue for income statement or assets for balance sheet). The purpose of common size analysis is to provide insights into the relative proportions of different components within a financial statement, allowing for better comparison of companies of different sizes or of the same company over different periods. 9. Cost of Sales or Cost of Goods Sold: Represents the costs associated with producing or purchasing the goods that a company sells during a specific period. It is a crucial metric for businesses, as it is subtracted from the total revenue to calculate the gross profit 10. Current Assets: Any balance sheet accounts owned by a company that can be converted to cash through liquidation, sales, or use within one year. Examples may include cash (or equivalent), accounts receivable, prepaid expenses, raw materials, inventory (work-in-process or finished goods), short-term investments, etc. 11. Current Liabilities: Any balance sheet accounts that are obligations by a company that are due to be paid within one year. Examples may include accounts payable, payroll, taxes, utilities, rental fees, shortterm notes payable, etc. 12. Debt Ratio: A financial leverage metric based on a company’s total debt to total assets from the Balance Sheet. Debt Ratio = Total Liabilities / Total Assets (less Depreciation). 13. Depreciation: Refers to the decrease in the value of an asset over time due to various factors such as wear and tear, obsolescence, or other forms of reduction in its usefulness. It is a common accounting concept used to allocate the cost of a tangible asset (like machinery, vehicles, buildings, etc.) over its useful life. Often an expense item on the Income Statement. 14. Discount rate: Refers to the interest rate used to determine the present value of future cash flows. The concept is fundamental in the field of discounted cash flow (DCF) analysis, which is a method used to value an investment or project by discounting its expected future cash flows back to their present value. 15. Dividends: Payments made by a company to its shareholders, typically in the form of cash or additional shares of stock. They represent a portion of the company's profits that is distributed to its owners. 16. Earnings: Typically refers to the profits or net income of a business during a specific period. Earnings represent the financial performance of a company and are a key indicator of its profitability, 17. Earnings per Share (EPS, ratio): Financial profitability metric that represents the portion of a company's profit allocated to each outstanding share of common stock. It is a widely used indicator of a company's profitability and is often considered a key measure of financial performance. Calculated as net income minus preferred dividends divided by average number of common shares. 18. Earnings Before Interest and Taxes (EBIT): A measure of a company's operating performance and profitability before deducting interest expenses and taxes. EBIT is often used to analyze a company's core operating profitability without the influence of financial structure or tax considerations. EBIT provides a metric that allows for comparisons of the operating performance of different companies, as it excludes the impact of financing and taxation. (See operating income) 19. Free Cash Flow (FCF): Metric that represents the cash generated by a company's operations that is available for distribution to creditors and investors (both equity and debt holders) after all operating expenses, capital expenditures, and taxes have been deducted. It means the company has the ability to distribute cash to investors, pay down debt, or reinvest in the business. FCF=Operating Cash Flow - Capital Expenditures 20. Gross Profit: Metric represents the difference between revenue and the cost of sales during a specific period. While gross profit provides useful insights, it doesn't consider other operating expenses or nonoperating income, so it's often used in conjunction with other financial metrics to get a more comprehensive view of a company's overall financial health. Gross Profit = Sales – Cost of Sales. 21. Gross Profit Margin: Financial metric that measures the percentage of revenue that exceeds the cost of sales. It is a key indicator of a company's profitability and efficiency in managing its production and supply chain costs. 22. Income (or Profit): This is a metric that reflects the Income Statement’s bottom line or the amount of money a business has left over after all expenses. Gross income is the amount earned before expenses. (also known as gross profit). See Net Income. 23. Income Statement: Financial statement used to summarize company revenue, costs, and expenses over a specific period, usually a fiscal quarter or year. The main purpose of an income statement is to provide a snapshot of a company's financial performance during a given time frame. 24. Internal Rate of Return (IRR): Metric in financial analysis to estimate and compare the profitability of potential investments. Represents the expected compound annual rate of return that will be earned on a project. Typically, investments with higher IRRs are preferred as companies decide which projects to invest in.
|
For this question, make sure you only use the information I give to you. Focus on terms the average person would understand. 1. Amortization: Refers to the process of gradually paying off a debt or loan over a specific period of time through regular, scheduled payments. These payments typically consist of both principal and interest. 2. Backlog: A buildup of work that has not been completed or processed within a specific period. When a company receives an order or new contract for a product, undelivered products to fulfill that contract become part of the company’s backlog. 3. Balance Sheet: Financial statement that provides a snapshot of a company's financial position at a specific point in time. It is one of the financial statements used by businesses, investors, creditors, and analysts to assess the company's financial health and performance. The balance sheet follows the accounting equation that assets must equal liabilities plus equity. 4. Bid & Proposal Costs: Refers to the costs incurred in preparing, submitting, and supporting bids and proposals (whether or not solicited) on potential contracts (Government or not). These typically indirect costs are allowable to the extent they are allocable, reasonable, and not otherwise unallowable. 5. Booking (e.g., Orders): Refers to the value of new contracts, modifications, task orders, or options signed in an accounting period. 6. Cash Flow: Refers to the inflows (coming in) and outflows (going out) of cash of a company. 7. Cash Flow Statement: Financial statement that provides an overview of the cash generated and used by a business during a specific period of time. It is one of the key financial statements used by businesses, investors, and analysts to assess the financial health and liquidity of a company. The cash flow statement is divided into three main sections: 1) Operating Activities: Reports the cash generated or used in the core operating activities of the business. 2) Investing Activities: Details cash transactions related to the purchase and sale of long-term assets and investments. 3) Financing Activities: Reflects cash transactions related to the company's financing activities. It includes activities such as issuing or repurchasing stock, borrowing, or repaying debt, and paying dividends. 8. Common Size Financial Analysis: Method of evaluating and comparing financial statements by expressing each line item as a percentage of a base item (e.g., revenue for income statement or assets for balance sheet). The purpose of common size analysis is to provide insights into the relative proportions of different components within a financial statement, allowing for better comparison of companies of different sizes or of the same company over different periods. 9. Cost of Sales or Cost of Goods Sold: Represents the costs associated with producing or purchasing the goods that a company sells during a specific period. It is a crucial metric for businesses, as it is subtracted from the total revenue to calculate the gross profit 10. Current Assets: Any balance sheet accounts owned by a company that can be converted to cash through liquidation, sales, or use within one year. Examples may include cash (or equivalent), accounts receivable, prepaid expenses, raw materials, inventory (work-in-process or finished goods), short-term investments, etc. 11. Current Liabilities: Any balance sheet accounts that are obligations by a company that are due to be paid within one year. Examples may include accounts payable, payroll, taxes, utilities, rental fees, shortterm notes payable, etc. 12. Debt Ratio: A financial leverage metric based on a company’s total debt to total assets from the Balance Sheet. Debt Ratio = Total Liabilities / Total Assets (less Depreciation). 13. Depreciation: Refers to the decrease in the value of an asset over time due to various factors such as wear and tear, obsolescence, or other forms of reduction in its usefulness. It is a common accounting concept used to allocate the cost of a tangible asset (like machinery, vehicles, buildings, etc.) over its useful life. Often an expense item on the Income Statement. 14. Discount rate: Refers to the interest rate used to determine the present value of future cash flows. The concept is fundamental in the field of discounted cash flow (DCF) analysis, which is a method used to value an investment or project by discounting its expected future cash flows back to their present value. 15. Dividends: Payments made by a company to its shareholders, typically in the form of cash or additional shares of stock. They represent a portion of the company's profits that is distributed to its owners. 16. Earnings: Typically refers to the profits or net income of a business during a specific period. Earnings represent the financial performance of a company and are a key indicator of its profitability, 17. Earnings per Share (EPS, ratio): Financial profitability metric that represents the portion of a company's profit allocated to each outstanding share of common stock. It is a widely used indicator of a company's profitability and is often considered a key measure of financial performance. Calculated as net income minus preferred dividends divided by average number of common shares. 18. Earnings Before Interest and Taxes (EBIT): A measure of a company's operating performance and profitability before deducting interest expenses and taxes. EBIT is often used to analyze a company's core operating profitability without the influence of financial structure or tax considerations. EBIT provides a metric that allows for comparisons of the operating performance of different companies, as it excludes the impact of financing and taxation. (See operating income) 19. Free Cash Flow (FCF): Metric that represents the cash generated by a company's operations that is available for distribution to creditors and investors (both equity and debt holders) after all operating expenses, capital expenditures, and taxes have been deducted. It means the company has the ability to distribute cash to investors, pay down debt, or reinvest in the business. FCF=Operating Cash Flow - Capital Expenditures 20. Gross Profit: Metric represents the difference between revenue and the cost of sales during a specific period. While gross profit provides useful insights, it doesn't consider other operating expenses or nonoperating income, so it's often used in conjunction with other financial metrics to get a more comprehensive view of a company's overall financial health. Gross Profit = Sales – Cost of Sales. 21. Gross Profit Margin: Financial metric that measures the percentage of revenue that exceeds the cost of sales. It is a key indicator of a company's profitability and efficiency in managing its production and supply chain costs. 22. Income (or Profit): This is a metric that reflects the Income Statement’s bottom line or the amount of money a business has left over after all expenses. Gross income is the amount earned before expenses. (also known as gross profit). See Net Income. 23. Income Statement: Financial statement used to summarize company revenue, costs, and expenses over a specific period, usually a fiscal quarter or year. The main purpose of an income statement is to provide a snapshot of a company's financial performance during a given time frame. 24. Internal Rate of Return (IRR): Metric in financial analysis to estimate and compare the profitability of potential investments. Represents the expected compound annual rate of return that will be earned on a project. Typically, investments with higher IRRs are preferred as companies decide which projects to invest in. Identify the difference between dividends and earnings.
|
For this question, make sure you only use the information I give to you. Focus on terms the average person would understand.
EVIDENCE:
1. Amortization: Refers to the process of gradually paying off a debt or loan over a specific period of time through regular, scheduled payments. These payments typically consist of both principal and interest. 2. Backlog: A buildup of work that has not been completed or processed within a specific period. When a company receives an order or new contract for a product, undelivered products to fulfill that contract become part of the company’s backlog. 3. Balance Sheet: Financial statement that provides a snapshot of a company's financial position at a specific point in time. It is one of the financial statements used by businesses, investors, creditors, and analysts to assess the company's financial health and performance. The balance sheet follows the accounting equation that assets must equal liabilities plus equity. 4. Bid & Proposal Costs: Refers to the costs incurred in preparing, submitting, and supporting bids and proposals (whether or not solicited) on potential contracts (Government or not). These typically indirect costs are allowable to the extent they are allocable, reasonable, and not otherwise unallowable. 5. Booking (e.g., Orders): Refers to the value of new contracts, modifications, task orders, or options signed in an accounting period. 6. Cash Flow: Refers to the inflows (coming in) and outflows (going out) of cash of a company. 7. Cash Flow Statement: Financial statement that provides an overview of the cash generated and used by a business during a specific period of time. It is one of the key financial statements used by businesses, investors, and analysts to assess the financial health and liquidity of a company. The cash flow statement is divided into three main sections: 1) Operating Activities: Reports the cash generated or used in the core operating activities of the business. 2) Investing Activities: Details cash transactions related to the purchase and sale of long-term assets and investments. 3) Financing Activities: Reflects cash transactions related to the company's financing activities. It includes activities such as issuing or repurchasing stock, borrowing, or repaying debt, and paying dividends. 8. Common Size Financial Analysis: Method of evaluating and comparing financial statements by expressing each line item as a percentage of a base item (e.g., revenue for income statement or assets for balance sheet). The purpose of common size analysis is to provide insights into the relative proportions of different components within a financial statement, allowing for better comparison of companies of different sizes or of the same company over different periods. 9. Cost of Sales or Cost of Goods Sold: Represents the costs associated with producing or purchasing the goods that a company sells during a specific period. It is a crucial metric for businesses, as it is subtracted from the total revenue to calculate the gross profit 10. Current Assets: Any balance sheet accounts owned by a company that can be converted to cash through liquidation, sales, or use within one year. Examples may include cash (or equivalent), accounts receivable, prepaid expenses, raw materials, inventory (work-in-process or finished goods), short-term investments, etc. 11. Current Liabilities: Any balance sheet accounts that are obligations by a company that are due to be paid within one year. Examples may include accounts payable, payroll, taxes, utilities, rental fees, shortterm notes payable, etc. 12. Debt Ratio: A financial leverage metric based on a company’s total debt to total assets from the Balance Sheet. Debt Ratio = Total Liabilities / Total Assets (less Depreciation). 13. Depreciation: Refers to the decrease in the value of an asset over time due to various factors such as wear and tear, obsolescence, or other forms of reduction in its usefulness. It is a common accounting concept used to allocate the cost of a tangible asset (like machinery, vehicles, buildings, etc.) over its useful life. Often an expense item on the Income Statement. 14. Discount rate: Refers to the interest rate used to determine the present value of future cash flows. The concept is fundamental in the field of discounted cash flow (DCF) analysis, which is a method used to value an investment or project by discounting its expected future cash flows back to their present value. 15. Dividends: Payments made by a company to its shareholders, typically in the form of cash or additional shares of stock. They represent a portion of the company's profits that is distributed to its owners. 16. Earnings: Typically refers to the profits or net income of a business during a specific period. Earnings represent the financial performance of a company and are a key indicator of its profitability, 17. Earnings per Share (EPS, ratio): Financial profitability metric that represents the portion of a company's profit allocated to each outstanding share of common stock. It is a widely used indicator of a company's profitability and is often considered a key measure of financial performance. Calculated as net income minus preferred dividends divided by average number of common shares. 18. Earnings Before Interest and Taxes (EBIT): A measure of a company's operating performance and profitability before deducting interest expenses and taxes. EBIT is often used to analyze a company's core operating profitability without the influence of financial structure or tax considerations. EBIT provides a metric that allows for comparisons of the operating performance of different companies, as it excludes the impact of financing and taxation. (See operating income) 19. Free Cash Flow (FCF): Metric that represents the cash generated by a company's operations that is available for distribution to creditors and investors (both equity and debt holders) after all operating expenses, capital expenditures, and taxes have been deducted. It means the company has the ability to distribute cash to investors, pay down debt, or reinvest in the business. FCF=Operating Cash Flow - Capital Expenditures 20. Gross Profit: Metric represents the difference between revenue and the cost of sales during a specific period. While gross profit provides useful insights, it doesn't consider other operating expenses or nonoperating income, so it's often used in conjunction with other financial metrics to get a more comprehensive view of a company's overall financial health. Gross Profit = Sales – Cost of Sales. 21. Gross Profit Margin: Financial metric that measures the percentage of revenue that exceeds the cost of sales. It is a key indicator of a company's profitability and efficiency in managing its production and supply chain costs. 22. Income (or Profit): This is a metric that reflects the Income Statement’s bottom line or the amount of money a business has left over after all expenses. Gross income is the amount earned before expenses. (also known as gross profit). See Net Income. 23. Income Statement: Financial statement used to summarize company revenue, costs, and expenses over a specific period, usually a fiscal quarter or year. The main purpose of an income statement is to provide a snapshot of a company's financial performance during a given time frame. 24. Internal Rate of Return (IRR): Metric in financial analysis to estimate and compare the profitability of potential investments. Represents the expected compound annual rate of return that will be earned on a project. Typically, investments with higher IRRs are preferred as companies decide which projects to invest in.
USER:
Identify the difference between dividends and earnings.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 22 | 7 | 1,183 | null | 543 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
Summarize the text in 5 sentences with 20 words. Then provide a two-sentence example of an important quantitative finding. Finally, list the 5 limitations of the study.
|
Discussion Our most important finding is the inverse correlation between the presence of a chronic disease and the likelihood of treatment of an unrelated disorder. In no case did the presence of the chronic disease justify withholding an effective medical treatment. The results are compatible with the theory that one disease provides protection against other diseases, but this theory is unlikely to be correct, given medical pathophysiology and shared underlying predisposing factors.19–22 Instead, our findings suggest a shortfall in health care — specifically, that unrelated disorders are relatively neglected in patients with chronic medical diseases. Our work has several limitations, of which three merit emphasis. First, the study was not a randomized trial: it is not possible to assign patients randomly to have or not to have a chronic disease. Subtle confounding could contribute to and possibly justify the observed differences. However, imbalances related to age, sex, insurance status or carrier, ability to pay, or random chance would not explain the findings. Second, optimal rates of secondary treatments are controversial. In theory, our findings could be explained by postulating the overtreatment of patients who do not have chronic diseases. If true, this postulate could represent a potentially more common failure in medical decision making. Finally, the mechanism underlying the results remains a topic for future research — in particular, the question of whether the second disease is not detected in the presence of the first or whether it is detected but not treated. The observed results might arise from several sources. Patients with chronic diseases may be exhausted and reluctant to accept multiple interventions. Clinicians are often busy and may strive to keep care simple, particularly if they do not have relatively more time for the patients with relatively more complicated conditions. A chronic disease — particularly chronic psychosis — may also limit communication between patient and doctor. Universal insurance coverage could also contribute if the implicit goal of equity is achieved by doing something for all but a lot for none. The results, however, cannot be attributed either to a tendency toward prescribing multiple medications for the elderly or to barriers in access to medical care, both of which work against finding any negative associations.23–25 Similarly, the results cannot be attributed to fraud in which more than one person uses the same health insurance card.26,27 Unrelated treatments are not always indicated for patients who have chronic diseases. Chronic diseases are sometimes associated with reduced life expectancy, making long-term preventive therapy unrewarding. Adding supplementary medications often increases the risk of unwanted drug interactions and the potential for an adverse event. Prescribing additional medications for an unrelated disorder might also alter a patient's compliance with essential medications and indirectly cause harm. Time constraints, communication problems, the patient's preferences, and the priorities of the specialist involved sometimes make it difficult to address more than one problem effectively in any one patient. Finally, it is often sensible to postpone minor treatments until major problems are resolved. The unrelated treatments we chose had important implications for each selected chronic disease. Patients with diabetes mellitus are at increased risk for atherosclerosis and may be particularly likely to benefit from estrogen-replacement therapy.28,29 The reserve capacity of patients with pulmonary emphysema is seriously compromised, and they may be unable to tolerate even a small cardiovascular event.30,31 Patients with psychotic syndromes are often sensitive to discomfort and theoretically might have further worsening of their mental status as a result of joint pain.32,33 In all three examples, inadvertent undertreatment may have consequences. Furthermore, these examples are similar to other reported cases of mistakes in the care of patients who have more than one illness.34–36
|
"================ <TEXT PASSAGE> ======= Discussion Our most important finding is the inverse correlation between the presence of a chronic disease and the likelihood of treatment of an unrelated disorder. In no case did the presence of the chronic disease justify withholding an effective medical treatment. The results are compatible with the theory that one disease provides protection against other diseases, but this theory is unlikely to be correct, given medical pathophysiology and shared underlying predisposing factors.19–22 Instead, our findings suggest a shortfall in health care — specifically, that unrelated disorders are relatively neglected in patients with chronic medical diseases. Our work has several limitations, of which three merit emphasis. First, the study was not a randomized trial: it is not possible to assign patients randomly to have or not to have a chronic disease. Subtle confounding could contribute to and possibly justify the observed differences. However, imbalances related to age, sex, insurance status or carrier, ability to pay, or random chance would not explain the findings. Second, optimal rates of secondary treatments are controversial. In theory, our findings could be explained by postulating the overtreatment of patients who do not have chronic diseases. If true, this postulate could represent a potentially more common failure in medical decision making. Finally, the mechanism underlying the results remains a topic for future research — in particular, the question of whether the second disease is not detected in the presence of the first or whether it is detected but not treated. The observed results might arise from several sources. Patients with chronic diseases may be exhausted and reluctant to accept multiple interventions. Clinicians are often busy and may strive to keep care simple, particularly if they do not have relatively more time for the patients with relatively more complicated conditions. A chronic disease — particularly chronic psychosis — may also limit communication between patient and doctor. Universal insurance coverage could also contribute if the implicit goal of equity is achieved by doing something for all but a lot for none. The results, however, cannot be attributed either to a tendency toward prescribing multiple medications for the elderly or to barriers in access to medical care, both of which work against finding any negative associations.23–25 Similarly, the results cannot be attributed to fraud in which more than one person uses the same health insurance card.26,27 Unrelated treatments are not always indicated for patients who have chronic diseases. Chronic diseases are sometimes associated with reduced life expectancy, making long-term preventive therapy unrewarding. Adding supplementary medications often increases the risk of unwanted drug interactions and the potential for an adverse event. Prescribing additional medications for an unrelated disorder might also alter a patient's compliance with essential medications and indirectly cause harm. Time constraints, communication problems, the patient's preferences, and the priorities of the specialist involved sometimes make it difficult to address more than one problem effectively in any one patient. Finally, it is often sensible to postpone minor treatments until major problems are resolved. The unrelated treatments we chose had important implications for each selected chronic disease. Patients with diabetes mellitus are at increased risk for atherosclerosis and may be particularly likely to benefit from estrogen-replacement therapy.28,29 The reserve capacity of patients with pulmonary emphysema is seriously compromised, and they may be unable to tolerate even a small cardiovascular event.30,31 Patients with psychotic syndromes are often sensitive to discomfort and theoretically might have further worsening of their mental status as a result of joint pain.32,33 In all three examples, inadvertent undertreatment may have consequences. Furthermore, these examples are similar to other reported cases of mistakes in the care of patients who have more than one illness.34–36 https://www.nejm.org/doi/full/10.1056/NEJM199805213382106 ================ <QUESTION> ======= Summarize the text in 5 sentences with 20 words. Then provide a two-sentence example of an important quantitative finding. Finally, list the 5 limitations of the study. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
Discussion Our most important finding is the inverse correlation between the presence of a chronic disease and the likelihood of treatment of an unrelated disorder. In no case did the presence of the chronic disease justify withholding an effective medical treatment. The results are compatible with the theory that one disease provides protection against other diseases, but this theory is unlikely to be correct, given medical pathophysiology and shared underlying predisposing factors.19–22 Instead, our findings suggest a shortfall in health care — specifically, that unrelated disorders are relatively neglected in patients with chronic medical diseases. Our work has several limitations, of which three merit emphasis. First, the study was not a randomized trial: it is not possible to assign patients randomly to have or not to have a chronic disease. Subtle confounding could contribute to and possibly justify the observed differences. However, imbalances related to age, sex, insurance status or carrier, ability to pay, or random chance would not explain the findings. Second, optimal rates of secondary treatments are controversial. In theory, our findings could be explained by postulating the overtreatment of patients who do not have chronic diseases. If true, this postulate could represent a potentially more common failure in medical decision making. Finally, the mechanism underlying the results remains a topic for future research — in particular, the question of whether the second disease is not detected in the presence of the first or whether it is detected but not treated. The observed results might arise from several sources. Patients with chronic diseases may be exhausted and reluctant to accept multiple interventions. Clinicians are often busy and may strive to keep care simple, particularly if they do not have relatively more time for the patients with relatively more complicated conditions. A chronic disease — particularly chronic psychosis — may also limit communication between patient and doctor. Universal insurance coverage could also contribute if the implicit goal of equity is achieved by doing something for all but a lot for none. The results, however, cannot be attributed either to a tendency toward prescribing multiple medications for the elderly or to barriers in access to medical care, both of which work against finding any negative associations.23–25 Similarly, the results cannot be attributed to fraud in which more than one person uses the same health insurance card.26,27 Unrelated treatments are not always indicated for patients who have chronic diseases. Chronic diseases are sometimes associated with reduced life expectancy, making long-term preventive therapy unrewarding. Adding supplementary medications often increases the risk of unwanted drug interactions and the potential for an adverse event. Prescribing additional medications for an unrelated disorder might also alter a patient's compliance with essential medications and indirectly cause harm. Time constraints, communication problems, the patient's preferences, and the priorities of the specialist involved sometimes make it difficult to address more than one problem effectively in any one patient. Finally, it is often sensible to postpone minor treatments until major problems are resolved. The unrelated treatments we chose had important implications for each selected chronic disease. Patients with diabetes mellitus are at increased risk for atherosclerosis and may be particularly likely to benefit from estrogen-replacement therapy.28,29 The reserve capacity of patients with pulmonary emphysema is seriously compromised, and they may be unable to tolerate even a small cardiovascular event.30,31 Patients with psychotic syndromes are often sensitive to discomfort and theoretically might have further worsening of their mental status as a result of joint pain.32,33 In all three examples, inadvertent undertreatment may have consequences. Furthermore, these examples are similar to other reported cases of mistakes in the care of patients who have more than one illness.34–36
USER:
Summarize the text in 5 sentences with 20 words. Then provide a two-sentence example of an important quantitative finding. Finally, list the 5 limitations of the study.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 27 | 605 | null | 641 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
What happens when faces are quickly flashed in one's peripheral vision? Summarize the role of peripheral vision in the flashed face distortion effect in 200 words or fewer.
|
In our lifetimes, we encounter hundreds of thousands of faces. Each person's unique exposure to faces largely determines their "face space"—a model of how we encode, perceive, and remember the faces that we see. Cross-cultural differences, such as the other-race effect, demonstrate that we are generally more accurate at recognizing faces of ethnicities we are more familiar with. But even within cultures, people differ greatly in which faces will elicit a sense of trustworthiness, approachability, or attractiveness. Another factor has an even greater effect on how we perceive a face—where the face is positioned relative to our central or peripheral vision. Something very strange happens when a sequence of faces is quickly presented in our peripheral vision. This was first demonstrated in 2011 in a powerful illusion discovered by Jason Tangen, Sean Murphy, and Matthew Thompson, called the "flashed face distortion effect" After a few seconds of staring at the central fixation cross, the faces peripherally presented faces start to appear deformed, cartoonish, and even grotesque. However, upon closer inspection, one can tell the faces are perfectly normal and have not been altered. Several studies have attempted to explain the mechanisms underlying this phenomenon. Is it the fact that the faces are aligned at the eyes? Is it because they are presented quickly (4-5 faces per second)? Is it dependent on which faces follow each other or how centrally or peripherally they are shown? The Role of Peripheral Vision A study by Bowden et al. (2019) explored the role of peripheral vision. We know that everything in peripheral vision looks blurry compared to central vision. This is because peripheral stimuli are processed by retinal rod cells that have poor spatial acuity. So it could be that the intrinsic blur of peripheral vision makes the faces appear distorted. However, Bowden et al. compared peripherally presented faces to centrally presented faces manipulated by blur. Although they found some evidence of face distortion in central vision using blurred faces, the effect was much larger when using un-blurred peripheral faces. Another study by Balas and Pearson (2019) tested additional factors that may influence the illusion. They again found that peripheral presentation makes a big difference, as does the presentation speed. Notably, the orientation of the faces presented did not seem to matter. In other words, upside-down faces produced a similar distortion effect as upright faces. This is surprising because, in most aspects of face perception, upside-down faces produce weak effects due to their general unfamiliarity (a prime example of this is the Thatcher Effect). Do We All Perceive the Same Distortions When Looking at Peripherally Flashed Faces? Earlier research by Afraz and Cavanagh (2009) found that peripheral distortion effects are quite idiosyncratic. Their study presented participants with faces and other stimuli in different positions of their peripheral vision. Participants were asked to make various judgments, such as the gender and age of faces or the aspect ratio of shapes. They found that the very same stimulus can appear differently depending on where it is placed within the observer's peripheral vision. For example, a neutral face might appear male in the upper right corner, but in the lower right corner, the same face might appear female. These differences are stable over time for a particular observer but vary substantially between observers. Therefore, the particularities of the visual distortions we experience in peripheral vision may be responsible for the particular ways flashed faces appear distorted. Further research is needed to identify the neural mechanisms behind these effects, whether they occur when we observe non-human faces, and whether they serve any adaptive purpose.
|
"================ <TEXT PASSAGE> ======= In our lifetimes, we encounter hundreds of thousands of faces. Each person's unique exposure to faces largely determines their "face space"—a model of how we encode, perceive, and remember the faces that we see. Cross-cultural differences, such as the other-race effect, demonstrate that we are generally more accurate at recognizing faces of ethnicities we are more familiar with. But even within cultures, people differ greatly in which faces will elicit a sense of trustworthiness, approachability, or attractiveness. Another factor has an even greater effect on how we perceive a face—where the face is positioned relative to our central or peripheral vision. Something very strange happens when a sequence of faces is quickly presented in our peripheral vision. This was first demonstrated in 2011 in a powerful illusion discovered by Jason Tangen, Sean Murphy, and Matthew Thompson, called the "flashed face distortion effect" After a few seconds of staring at the central fixation cross, the faces peripherally presented faces start to appear deformed, cartoonish, and even grotesque. However, upon closer inspection, one can tell the faces are perfectly normal and have not been altered. Several studies have attempted to explain the mechanisms underlying this phenomenon. Is it the fact that the faces are aligned at the eyes? Is it because they are presented quickly (4-5 faces per second)? Is it dependent on which faces follow each other or how centrally or peripherally they are shown? The Role of Peripheral Vision A study by Bowden et al. (2019) explored the role of peripheral vision. We know that everything in peripheral vision looks blurry compared to central vision. This is because peripheral stimuli are processed by retinal rod cells that have poor spatial acuity. So it could be that the intrinsic blur of peripheral vision makes the faces appear distorted. However, Bowden et al. compared peripherally presented faces to centrally presented faces manipulated by blur. Although they found some evidence of face distortion in central vision using blurred faces, the effect was much larger when using un-blurred peripheral faces. Another study by Balas and Pearson (2019) tested additional factors that may influence the illusion. They again found that peripheral presentation makes a big difference, as does the presentation speed. Notably, the orientation of the faces presented did not seem to matter. In other words, upside-down faces produced a similar distortion effect as upright faces. This is surprising because, in most aspects of face perception, upside-down faces produce weak effects due to their general unfamiliarity (a prime example of this is the Thatcher Effect). Do We All Perceive the Same Distortions When Looking at Peripherally Flashed Faces? Earlier research by Afraz and Cavanagh (2009) found that peripheral distortion effects are quite idiosyncratic. Their study presented participants with faces and other stimuli in different positions of their peripheral vision. Participants were asked to make various judgments, such as the gender and age of faces or the aspect ratio of shapes. They found that the very same stimulus can appear differently depending on where it is placed within the observer's peripheral vision. For example, a neutral face might appear male in the upper right corner, but in the lower right corner, the same face might appear female. These differences are stable over time for a particular observer but vary substantially between observers. Therefore, the particularities of the visual distortions we experience in peripheral vision may be responsible for the particular ways flashed faces appear distorted. Further research is needed to identify the neural mechanisms behind these effects, whether they occur when we observe non-human faces, and whether they serve any adaptive purpose. https://www.psychologytoday.com/us/blog/illusions-delusions-and-reality/202303/why-faces-look-distorted-in-our-periphery ================ <QUESTION> ======= What happens when faces are quickly flashed in one's peripheral vision? Summarize the role of peripheral vision in the flashed face distortion effect in 200 words or fewer. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
In our lifetimes, we encounter hundreds of thousands of faces. Each person's unique exposure to faces largely determines their "face space"—a model of how we encode, perceive, and remember the faces that we see. Cross-cultural differences, such as the other-race effect, demonstrate that we are generally more accurate at recognizing faces of ethnicities we are more familiar with. But even within cultures, people differ greatly in which faces will elicit a sense of trustworthiness, approachability, or attractiveness. Another factor has an even greater effect on how we perceive a face—where the face is positioned relative to our central or peripheral vision. Something very strange happens when a sequence of faces is quickly presented in our peripheral vision. This was first demonstrated in 2011 in a powerful illusion discovered by Jason Tangen, Sean Murphy, and Matthew Thompson, called the "flashed face distortion effect" After a few seconds of staring at the central fixation cross, the faces peripherally presented faces start to appear deformed, cartoonish, and even grotesque. However, upon closer inspection, one can tell the faces are perfectly normal and have not been altered. Several studies have attempted to explain the mechanisms underlying this phenomenon. Is it the fact that the faces are aligned at the eyes? Is it because they are presented quickly (4-5 faces per second)? Is it dependent on which faces follow each other or how centrally or peripherally they are shown? The Role of Peripheral Vision A study by Bowden et al. (2019) explored the role of peripheral vision. We know that everything in peripheral vision looks blurry compared to central vision. This is because peripheral stimuli are processed by retinal rod cells that have poor spatial acuity. So it could be that the intrinsic blur of peripheral vision makes the faces appear distorted. However, Bowden et al. compared peripherally presented faces to centrally presented faces manipulated by blur. Although they found some evidence of face distortion in central vision using blurred faces, the effect was much larger when using un-blurred peripheral faces. Another study by Balas and Pearson (2019) tested additional factors that may influence the illusion. They again found that peripheral presentation makes a big difference, as does the presentation speed. Notably, the orientation of the faces presented did not seem to matter. In other words, upside-down faces produced a similar distortion effect as upright faces. This is surprising because, in most aspects of face perception, upside-down faces produce weak effects due to their general unfamiliarity (a prime example of this is the Thatcher Effect). Do We All Perceive the Same Distortions When Looking at Peripherally Flashed Faces? Earlier research by Afraz and Cavanagh (2009) found that peripheral distortion effects are quite idiosyncratic. Their study presented participants with faces and other stimuli in different positions of their peripheral vision. Participants were asked to make various judgments, such as the gender and age of faces or the aspect ratio of shapes. They found that the very same stimulus can appear differently depending on where it is placed within the observer's peripheral vision. For example, a neutral face might appear male in the upper right corner, but in the lower right corner, the same face might appear female. These differences are stable over time for a particular observer but vary substantially between observers. Therefore, the particularities of the visual distortions we experience in peripheral vision may be responsible for the particular ways flashed faces appear distorted. Further research is needed to identify the neural mechanisms behind these effects, whether they occur when we observe non-human faces, and whether they serve any adaptive purpose.
USER:
What happens when faces are quickly flashed in one's peripheral vision? Summarize the role of peripheral vision in the flashed face distortion effect in 200 words or fewer.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 28 | 596 | null | 807 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
Currently learning about IoT it implementations, use cases and so on. How it impact our lives and industries. What industries, technologies implement this and what benefits we receive from them? What are some examples where this technology is used? Explain in less than 500 words.
|
What is the Internet of Things (IoT)? The term IoT, or Internet of Things, refers to the collective network of connected devices and the technology that facilitates communication between devices and the cloud, as well as between the devices themselves. Thanks to the advent of inexpensive computer chips and high bandwidth telecommunication, we now have billions of devices connected to the internet. This means everyday devices like toothbrushes, vacuums, cars, and machines can use sensors to collect data and respond intelligently to users. The Internet of Things integrates everyday “things” with the internet. Computer Engineers have been adding sensors and processors to everyday objects since the 90s. However, progress was initially slow because the chips were big and bulky. Low power computer chips called RFID tags were first used to track expensive equipment. As computing devices shrank in size, these chips also became smaller, faster, and smarter over time. The cost of integrating computing power into small objects has now dropped considerably. For example, you can add connectivity with Alexa voice services capabilities to MCUs with less than 1MB embedded RAM, such as for light switches. A whole industry has sprung up with a focus on filling our homes, businesses, and offices with IoT devices. These smart objects can automatically transmit data to and from the Internet. All these “invisible computing devices” and the technology associated with them are collectively referred to as the Internet of Things. How does IoT work? A typical IoT system works through the real-time collection and exchange of data. An IoT system has three components: Smart devices This is a device, like a television, security camera, or exercise equipment that has been given computing capabilities. It collects data from its environment, user inputs, or usage patterns and communicates data over the internet to and from its IoT application. IoT application An IoT application is a collection of services and software that integrates data received from various IoT devices. It uses machine learning or artificial intelligence (AI) technology to analyze this data and make informed decisions. These decisions are communicated back to the IoT device and the IoT device then responds intelligently to inputs. A graphical user interface The IoT device or fleet of devices can be managed through a graphical user interface. Common examples include a mobile application or website that can be used to register and control smart devices. What are examples of IoT devices? Let’s look at some examples of IoT systems in use today: Connected cars There are many ways vehicles, such as cars, can be connected to the internet. It can be through smart dashcams, infotainment systems, or even the vehicle's connected gateway. They collect data from the accelerator, brakes, speedometer, odometer, wheels, and fuel tanks to monitor both driver performance and vehicle health. Connected cars have a range of uses: Monitoring rental car fleets to increase fuel efficiency and reduce costs. Helping parents track the driving behavior of their children. Notifying friends and family automatically in case of a car crash. Predicting and preventing vehicle maintenance needs. Connected homes Smart home devices are mainly focused on improving the efficiency and safety of the house, as well as improving home networking. Devices like smart outlets monitor electricity usage and smart thermostats provide better temperature control. Hydroponic systems can use IoT sensors to manage the garden while IoT smoke detectors can detect tobacco smoke. Home security systems like door locks, security cameras, and water leak detectors can detect and prevent threats, and send alerts to homeowners. Connected devices for the home can be used for: Automatically turning off devices not being used. Rental property management and maintenance. Finding misplaced items like keys or wallets. Automating daily tasks like vacuuming, making coffee, etc. Smart cities IoT applications have made urban planning and infrastructure maintenance more efficient. Governments are using IoT applications to tackle problems in infrastructure, health, and the environment. IoT applications can be used for: Measuring air quality and radiation levels. Reducing energy bills with smart lighting systems. Detecting maintenance needs for critical infrastructures such as streets, bridges, and pipelines. Increasing profits through efficient parking management. Smart buildings Buildings such as college campuses and commercial buildings use IoT applications to drive greater operational efficiencies. IoT devices can be use in smart buildings for: Reducing energy consumption. Lowering maintenance costs. Utilizing work spaces more efficiently. What is Industrial IoT? Industrial IoT (IIoT) refers to smart devices used in manufacturing, retail, health, and other enterprises to create business efficiencies. Industrial devices, from sensors to equipment, give business owners detailed, real-time data that can be used to improve business processes. They provide insights on supply chain management, logistics, human resource, and production – decreasing costs and increasing revenue streams. Let’s look at existing smart industrial systems in different verticals: Manufacturing Enterprise IoT in manufacturing uses predictive maintenance to reduce unplanned downtime and wearable technology to improve worker safety. IoT applications can predict machine failure before it happens, reducing production downtime. Wearables in helmets and wristbands, as well as computer vision cameras, are used to warn workers about potential hazards. Automobile Sensor-driven analytics and robotics increase efficiency in automobile manufacturing and maintenance. For example, industrial sensors are used to provide 3D real-time images of internal vehicle components. Diagnostics and troubleshooting can be done much faster while the IoT system orders replacement parts automatically. Logistics and transport Commercial and Industrial IoT devices can help with supply chain management, including inventory management, vendor relationships, fleet management, and scheduled maintenance. Shipping companies use Industrial IoT applications to keep track of assets and optimize fuel consumption on shipping routes. The technology is especially useful for tight temperature control in refrigerated containers. Supply chain managers make informed predictions through smart routing and rerouting algorithms. Retail Amazon is driving innovation in automation and human-machine collaboration in retail. Amazon facilities make use of internet-connected robots for tracking, locating, sorting, and moving products. How can IoT improve our lives? The Internet of Things has a wide-ranging impact on human life and work. It allows machines to do more heavy lifting, take over tedious tasks and make life more healthy, productive, and comfortable. For example, connected devices could change your entire morning routine. When you hit the snooze button, your alarm clock would automatically get the coffee machine to turn on and open your window blinds. Your refrigerator would auto-detect finishing groceries and order them for home delivery. Your smart oven would tell you the menu for the day — it might even cook pre-assembled ingredients and make sure your lunch is ready. Your smartwatch will schedule meetings as your connected car automatically sets the GPS to stop for a fuel refill. The opportunities are endless in an IoT world! What are the benefits of IoT for business? Accelerate innovation The Internet of Things gives businesses access to advanced analytics that uncover new opportunities. For example, businesses can create highly targeted advertising campaigns by collecting data on customer behavior. Turn data into insights and actions with AI and ML Collected data and historical trends can be used to predict future outcomes. For example, warranty information can be paired with IoT-collected data to predict maintenance incidents. This can be used to proactively provide customer service and build customer loyalty. Increase security Continuous monitoring of digital and physical infrastructure can optimize performance, improve efficiency and reduce safety risks. For example, data collected from an onsite monitor can be combined with hardware and firmware version data to automatically schedule system updates. Scale differentiated solutions IoT technologies can be deployed in a customer focused way to increase satisfaction. For example, trending products can be restocked promptly to avoid shortages.
|
[question] Currently learning about IoT it implementations, use cases and so on. How it impact our lives and industries. What industries, technologies implement this and what benefits we receive from them? What are some examples where this technology is used? Explain in less than 500 words. ===================== [text] What is the Internet of Things (IoT)? The term IoT, or Internet of Things, refers to the collective network of connected devices and the technology that facilitates communication between devices and the cloud, as well as between the devices themselves. Thanks to the advent of inexpensive computer chips and high bandwidth telecommunication, we now have billions of devices connected to the internet. This means everyday devices like toothbrushes, vacuums, cars, and machines can use sensors to collect data and respond intelligently to users. The Internet of Things integrates everyday “things” with the internet. Computer Engineers have been adding sensors and processors to everyday objects since the 90s. However, progress was initially slow because the chips were big and bulky. Low power computer chips called RFID tags were first used to track expensive equipment. As computing devices shrank in size, these chips also became smaller, faster, and smarter over time. The cost of integrating computing power into small objects has now dropped considerably. For example, you can add connectivity with Alexa voice services capabilities to MCUs with less than 1MB embedded RAM, such as for light switches. A whole industry has sprung up with a focus on filling our homes, businesses, and offices with IoT devices. These smart objects can automatically transmit data to and from the Internet. All these “invisible computing devices” and the technology associated with them are collectively referred to as the Internet of Things. How does IoT work? A typical IoT system works through the real-time collection and exchange of data. An IoT system has three components: Smart devices This is a device, like a television, security camera, or exercise equipment that has been given computing capabilities. It collects data from its environment, user inputs, or usage patterns and communicates data over the internet to and from its IoT application. IoT application An IoT application is a collection of services and software that integrates data received from various IoT devices. It uses machine learning or artificial intelligence (AI) technology to analyze this data and make informed decisions. These decisions are communicated back to the IoT device and the IoT device then responds intelligently to inputs. A graphical user interface The IoT device or fleet of devices can be managed through a graphical user interface. Common examples include a mobile application or website that can be used to register and control smart devices. What are examples of IoT devices? Let’s look at some examples of IoT systems in use today: Connected cars There are many ways vehicles, such as cars, can be connected to the internet. It can be through smart dashcams, infotainment systems, or even the vehicle's connected gateway. They collect data from the accelerator, brakes, speedometer, odometer, wheels, and fuel tanks to monitor both driver performance and vehicle health. Connected cars have a range of uses: Monitoring rental car fleets to increase fuel efficiency and reduce costs. Helping parents track the driving behavior of their children. Notifying friends and family automatically in case of a car crash. Predicting and preventing vehicle maintenance needs. Connected homes Smart home devices are mainly focused on improving the efficiency and safety of the house, as well as improving home networking. Devices like smart outlets monitor electricity usage and smart thermostats provide better temperature control. Hydroponic systems can use IoT sensors to manage the garden while IoT smoke detectors can detect tobacco smoke. Home security systems like door locks, security cameras, and water leak detectors can detect and prevent threats, and send alerts to homeowners. Connected devices for the home can be used for: Automatically turning off devices not being used. Rental property management and maintenance. Finding misplaced items like keys or wallets. Automating daily tasks like vacuuming, making coffee, etc. Smart cities IoT applications have made urban planning and infrastructure maintenance more efficient. Governments are using IoT applications to tackle problems in infrastructure, health, and the environment. IoT applications can be used for: Measuring air quality and radiation levels. Reducing energy bills with smart lighting systems. Detecting maintenance needs for critical infrastructures such as streets, bridges, and pipelines. Increasing profits through efficient parking management. Smart buildings Buildings such as college campuses and commercial buildings use IoT applications to drive greater operational efficiencies. IoT devices can be use in smart buildings for: Reducing energy consumption. Lowering maintenance costs. Utilizing work spaces more efficiently. What is Industrial IoT? Industrial IoT (IIoT) refers to smart devices used in manufacturing, retail, health, and other enterprises to create business efficiencies. Industrial devices, from sensors to equipment, give business owners detailed, real-time data that can be used to improve business processes. They provide insights on supply chain management, logistics, human resource, and production – decreasing costs and increasing revenue streams. Let’s look at existing smart industrial systems in different verticals: Manufacturing Enterprise IoT in manufacturing uses predictive maintenance to reduce unplanned downtime and wearable technology to improve worker safety. IoT applications can predict machine failure before it happens, reducing production downtime. Wearables in helmets and wristbands, as well as computer vision cameras, are used to warn workers about potential hazards. Automobile Sensor-driven analytics and robotics increase efficiency in automobile manufacturing and maintenance. For example, industrial sensors are used to provide 3D real-time images of internal vehicle components. Diagnostics and troubleshooting can be done much faster while the IoT system orders replacement parts automatically. Logistics and transport Commercial and Industrial IoT devices can help with supply chain management, including inventory management, vendor relationships, fleet management, and scheduled maintenance. Shipping companies use Industrial IoT applications to keep track of assets and optimize fuel consumption on shipping routes. The technology is especially useful for tight temperature control in refrigerated containers. Supply chain managers make informed predictions through smart routing and rerouting algorithms. Retail Amazon is driving innovation in automation and human-machine collaboration in retail. Amazon facilities make use of internet-connected robots for tracking, locating, sorting, and moving products. How can IoT improve our lives? The Internet of Things has a wide-ranging impact on human life and work. It allows machines to do more heavy lifting, take over tedious tasks and make life more healthy, productive, and comfortable. For example, connected devices could change your entire morning routine. When you hit the snooze button, your alarm clock would automatically get the coffee machine to turn on and open your window blinds. Your refrigerator would auto-detect finishing groceries and order them for home delivery. Your smart oven would tell you the menu for the day — it might even cook pre-assembled ingredients and make sure your lunch is ready. Your smartwatch will schedule meetings as your connected car automatically sets the GPS to stop for a fuel refill. The opportunities are endless in an IoT world! What are the benefits of IoT for business? Accelerate innovation The Internet of Things gives businesses access to advanced analytics that uncover new opportunities. For example, businesses can create highly targeted advertising campaigns by collecting data on customer behavior. Turn data into insights and actions with AI and ML Collected data and historical trends can be used to predict future outcomes. For example, warranty information can be paired with IoT-collected data to predict maintenance incidents. This can be used to proactively provide customer service and build customer loyalty. Increase security Continuous monitoring of digital and physical infrastructure can optimize performance, improve efficiency and reduce safety risks. For example, data collected from an onsite monitor can be combined with hardware and firmware version data to automatically schedule system updates. Scale differentiated solutions IoT technologies can be deployed in a customer focused way to increase satisfaction. For example, trending products can be restocked promptly to avoid shortages. https://aws.amazon.com/what-is/iot/#:~:text=The%20term%20IoT%2C%20or%20Internet,as%20between%20the%20devices%20themselves. ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
What is the Internet of Things (IoT)? The term IoT, or Internet of Things, refers to the collective network of connected devices and the technology that facilitates communication between devices and the cloud, as well as between the devices themselves. Thanks to the advent of inexpensive computer chips and high bandwidth telecommunication, we now have billions of devices connected to the internet. This means everyday devices like toothbrushes, vacuums, cars, and machines can use sensors to collect data and respond intelligently to users. The Internet of Things integrates everyday “things” with the internet. Computer Engineers have been adding sensors and processors to everyday objects since the 90s. However, progress was initially slow because the chips were big and bulky. Low power computer chips called RFID tags were first used to track expensive equipment. As computing devices shrank in size, these chips also became smaller, faster, and smarter over time. The cost of integrating computing power into small objects has now dropped considerably. For example, you can add connectivity with Alexa voice services capabilities to MCUs with less than 1MB embedded RAM, such as for light switches. A whole industry has sprung up with a focus on filling our homes, businesses, and offices with IoT devices. These smart objects can automatically transmit data to and from the Internet. All these “invisible computing devices” and the technology associated with them are collectively referred to as the Internet of Things. How does IoT work? A typical IoT system works through the real-time collection and exchange of data. An IoT system has three components: Smart devices This is a device, like a television, security camera, or exercise equipment that has been given computing capabilities. It collects data from its environment, user inputs, or usage patterns and communicates data over the internet to and from its IoT application. IoT application An IoT application is a collection of services and software that integrates data received from various IoT devices. It uses machine learning or artificial intelligence (AI) technology to analyze this data and make informed decisions. These decisions are communicated back to the IoT device and the IoT device then responds intelligently to inputs. A graphical user interface The IoT device or fleet of devices can be managed through a graphical user interface. Common examples include a mobile application or website that can be used to register and control smart devices. What are examples of IoT devices? Let’s look at some examples of IoT systems in use today: Connected cars There are many ways vehicles, such as cars, can be connected to the internet. It can be through smart dashcams, infotainment systems, or even the vehicle's connected gateway. They collect data from the accelerator, brakes, speedometer, odometer, wheels, and fuel tanks to monitor both driver performance and vehicle health. Connected cars have a range of uses: Monitoring rental car fleets to increase fuel efficiency and reduce costs. Helping parents track the driving behavior of their children. Notifying friends and family automatically in case of a car crash. Predicting and preventing vehicle maintenance needs. Connected homes Smart home devices are mainly focused on improving the efficiency and safety of the house, as well as improving home networking. Devices like smart outlets monitor electricity usage and smart thermostats provide better temperature control. Hydroponic systems can use IoT sensors to manage the garden while IoT smoke detectors can detect tobacco smoke. Home security systems like door locks, security cameras, and water leak detectors can detect and prevent threats, and send alerts to homeowners. Connected devices for the home can be used for: Automatically turning off devices not being used. Rental property management and maintenance. Finding misplaced items like keys or wallets. Automating daily tasks like vacuuming, making coffee, etc. Smart cities IoT applications have made urban planning and infrastructure maintenance more efficient. Governments are using IoT applications to tackle problems in infrastructure, health, and the environment. IoT applications can be used for: Measuring air quality and radiation levels. Reducing energy bills with smart lighting systems. Detecting maintenance needs for critical infrastructures such as streets, bridges, and pipelines. Increasing profits through efficient parking management. Smart buildings Buildings such as college campuses and commercial buildings use IoT applications to drive greater operational efficiencies. IoT devices can be use in smart buildings for: Reducing energy consumption. Lowering maintenance costs. Utilizing work spaces more efficiently. What is Industrial IoT? Industrial IoT (IIoT) refers to smart devices used in manufacturing, retail, health, and other enterprises to create business efficiencies. Industrial devices, from sensors to equipment, give business owners detailed, real-time data that can be used to improve business processes. They provide insights on supply chain management, logistics, human resource, and production – decreasing costs and increasing revenue streams. Let’s look at existing smart industrial systems in different verticals: Manufacturing Enterprise IoT in manufacturing uses predictive maintenance to reduce unplanned downtime and wearable technology to improve worker safety. IoT applications can predict machine failure before it happens, reducing production downtime. Wearables in helmets and wristbands, as well as computer vision cameras, are used to warn workers about potential hazards. Automobile Sensor-driven analytics and robotics increase efficiency in automobile manufacturing and maintenance. For example, industrial sensors are used to provide 3D real-time images of internal vehicle components. Diagnostics and troubleshooting can be done much faster while the IoT system orders replacement parts automatically. Logistics and transport Commercial and Industrial IoT devices can help with supply chain management, including inventory management, vendor relationships, fleet management, and scheduled maintenance. Shipping companies use Industrial IoT applications to keep track of assets and optimize fuel consumption on shipping routes. The technology is especially useful for tight temperature control in refrigerated containers. Supply chain managers make informed predictions through smart routing and rerouting algorithms. Retail Amazon is driving innovation in automation and human-machine collaboration in retail. Amazon facilities make use of internet-connected robots for tracking, locating, sorting, and moving products. How can IoT improve our lives? The Internet of Things has a wide-ranging impact on human life and work. It allows machines to do more heavy lifting, take over tedious tasks and make life more healthy, productive, and comfortable. For example, connected devices could change your entire morning routine. When you hit the snooze button, your alarm clock would automatically get the coffee machine to turn on and open your window blinds. Your refrigerator would auto-detect finishing groceries and order them for home delivery. Your smart oven would tell you the menu for the day — it might even cook pre-assembled ingredients and make sure your lunch is ready. Your smartwatch will schedule meetings as your connected car automatically sets the GPS to stop for a fuel refill. The opportunities are endless in an IoT world! What are the benefits of IoT for business? Accelerate innovation The Internet of Things gives businesses access to advanced analytics that uncover new opportunities. For example, businesses can create highly targeted advertising campaigns by collecting data on customer behavior. Turn data into insights and actions with AI and ML Collected data and historical trends can be used to predict future outcomes. For example, warranty information can be paired with IoT-collected data to predict maintenance incidents. This can be used to proactively provide customer service and build customer loyalty. Increase security Continuous monitoring of digital and physical infrastructure can optimize performance, improve efficiency and reduce safety risks. For example, data collected from an onsite monitor can be combined with hardware and firmware version data to automatically schedule system updates. Scale differentiated solutions IoT technologies can be deployed in a customer focused way to increase satisfaction. For example, trending products can be restocked promptly to avoid shortages.
USER:
Currently learning about IoT it implementations, use cases and so on. How it impact our lives and industries. What industries, technologies implement this and what benefits we receive from them? What are some examples where this technology is used? Explain in less than 500 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 45 | 1,270 | null | 617 |
Please limit your knowledge to the document. Avoid generalizations and ensure accuracy by directly referencing the document's arguments and examples.
|
How to fix a phone that won't turn on.
|
How to fix a phone that won't turn on * * * * * Our phones help us stay connected, so when they stop working (or worse, won't turn on), there's a lot we can't doÑfrom texting and calling to surfing the web and watching videos on apps like TikTok¨ and Instagram¨. Asurion Experts come acrossÊphone repairÊissues like this every day. They help millions of customers get the most out of their favorite tech, whether it's aÊbroken Xbox Series XªÊor aÊswollen laptop battery. If your phone hasn't been turning on like it should, check out their tips for getting your device working again (so you can get back to enjoying that video of Adam Sandler leaving IHOP). Why won't my phone turn on? There are several possible reasons why your phone won't turn on, from battery failure to software issues. But most times you can narrow it down to a few common problems, including: * A drained battery.ÊYour phone may be unresponsive because the battery is dead. Find outÊways to minimize battery drainÊon an Android device.Ê * Water or physical damage.ÊDropped your phone in the sink recently? Even a small amount ofÊliquidÊcan do major damage if it gets inside your device.ÊDropping your phoneÊon a hard surface can also do some internal damage, even if there aren't noticeable cracks or breaks. * A software glitch.ÊWhen an iPhone¨ won't turn on or theÊscreen is black, it could be a software issue. The same goes for Androidª devices. Certain apps and programs occasionally prevent your phone from working properly, especially if it crashes during a software or system update. Device won't power on? We can help We'll do a free device diagnostic to find out what's wrongÑvisit your local store or schedule a repair. Schedule a repair What to do if your phone won't turn on If you're having issues with an unresponsive phone, don't panic. There are several ways to get it back up and running without going to extremes (like buying a new device). Here's how to fix a phone that won't turn on, according to our experts: 1. Restart the phone The problem could be that your phone is frozen. Try restarting it the normal way, and if that doesn't work, you may have to force restart your device. For an iPhone 11 that won't turn on, as well as other new iPhone models, follow these steps: 1. Press and quickly release the Volume Up button, then do the same with the Volume Down button. 2. Press and hold the Power button until your device restarts. Need to restart a Google Pixelª that won't turn on or another Android phone that isn't working? Just perform a power cycle. The steps are simple: 1. Press and hold the Power button for about 30 seconds. For some models, like a Samsung¨ phone, you may also have to hold the Volume Down button at the same time, but it should only take a few seconds. 2. Wait until your screen turns on to release the buttons. 2. Charge the battery Plugging in your phone for 15Ð25 minutes may do the trick. Connect your device to a charger and give it some juice. If the battery symbol appears on the screen, be sure your phone gains enough power before you try turning it on. Then check out our tips onÊhow to improve yourÊiPhoneÊorÊAndroid battery life. What if my phone died and won't turn on or charge? If you've tried charging your phone and it won't turn on, there may be dust and dirt clogging the charging port or a problem with the USB or lightning cable. Check out our guide forÊhow to clean your phone's charging portÊif you need more help. 3. Enable Safe Mode Using Safe Mode for your Android will disable third-party apps that may be causing an issue for your device andÑif all goes wellÑallow it to turn on. For iPhone users, skip to step four. How to enter Safe Mode on your Android: 1. Press and hold the Power button. 2. When your phone begins to boot up, press and hold the Volume down button until you see ÒSafe ModeÓ appear on your screen. 3. To exit Safe Mode, restart your device. 4. Check for damage Sometimes cracks, breaks, and corrosion on your phone aren't visible right away. Try shining a light on the screen and removing your phone case to check for any physical damage. You can also try calling your device to see if it vibrates or rings. Water damage? Here areÊ8 ways to dry your phoneÊfast. 5. Perform a factory reset When your Android or iPhone won't power on, restoring your device to its factory settings may be your only option. But this should be a last resort, after you've tried everything else, because it erases nearly all the data on your device. If you can'tÊperform a factory reset on your iPhoneÊbecause of a frozen or black screen, connect it to a computer and use a program like Finder¨ or iTunes¨ to enter Recovery Mode. ForÊSamsung Galaxy¨ S8, newer models, and other devices, you canÊfactory reset your Android phoneÊby following our guide. If you've tried these steps and still need a little help, we're right around the corner. Schedule a repair at theÊnearest uBreakiFix¨ by Asurion storeÊand our certified experts can get your device back up and running as soon as the same day.
|
Please limit your knowledge to the document. Avoid generalizations and ensure accuracy by directly referencing the document's arguments and examples. How to fix a phone that won't turn on. How to fix a phone that won't turn on * * * * * Our phones help us stay connected, so when they stop working (or worse, won't turn on), there's a lot we can't doÑfrom texting and calling to surfing the web and watching videos on apps like TikTok¨ and Instagram¨. Asurion Experts come acrossÊphone repairÊissues like this every day. They help millions of customers get the most out of their favorite tech, whether it's aÊbroken Xbox Series XªÊor aÊswollen laptop battery. If your phone hasn't been turning on like it should, check out their tips for getting your device working again (so you can get back to enjoying that video of Adam Sandler leaving IHOP). Why won't my phone turn on? There are several possible reasons why your phone won't turn on, from battery failure to software issues. But most times you can narrow it down to a few common problems, including: * A drained battery.ÊYour phone may be unresponsive because the battery is dead. Find outÊways to minimize battery drainÊon an Android device.Ê * Water or physical damage.ÊDropped your phone in the sink recently? Even a small amount ofÊliquidÊcan do major damage if it gets inside your device.ÊDropping your phoneÊon a hard surface can also do some internal damage, even if there aren't noticeable cracks or breaks. * A software glitch.ÊWhen an iPhone¨ won't turn on or theÊscreen is black, it could be a software issue. The same goes for Androidª devices. Certain apps and programs occasionally prevent your phone from working properly, especially if it crashes during a software or system update. Device won't power on? We can help We'll do a free device diagnostic to find out what's wrongÑvisit your local store or schedule a repair. Schedule a repair What to do if your phone won't turn on If you're having issues with an unresponsive phone, don't panic. There are several ways to get it back up and running without going to extremes (like buying a new device). Here's how to fix a phone that won't turn on, according to our experts: 1. Restart the phone The problem could be that your phone is frozen. Try restarting it the normal way, and if that doesn't work, you may have to force restart your device. For an iPhone 11 that won't turn on, as well as other new iPhone models, follow these steps: 1. Press and quickly release the Volume Up button, then do the same with the Volume Down button. 2. Press and hold the Power button until your device restarts. Need to restart a Google Pixelª that won't turn on or another Android phone that isn't working? Just perform a power cycle. The steps are simple: 1. Press and hold the Power button for about 30 seconds. For some models, like a Samsung¨ phone, you may also have to hold the Volume Down button at the same time, but it should only take a few seconds. 2. Wait until your screen turns on to release the buttons. 2. Charge the battery Plugging in your phone for 15Ð25 minutes may do the trick. Connect your device to a charger and give it some juice. If the battery symbol appears on the screen, be sure your phone gains enough power before you try turning it on. Then check out our tips onÊhow to improve yourÊiPhoneÊorÊAndroid battery life. What if my phone died and won't turn on or charge? If you've tried charging your phone and it won't turn on, there may be dust and dirt clogging the charging port or a problem with the USB or lightning cable. Check out our guide forÊhow to clean your phone's charging portÊif you need more help. 3. Enable Safe Mode Using Safe Mode for your Android will disable third-party apps that may be causing an issue for your device andÑif all goes wellÑallow it to turn on. For iPhone users, skip to step four. How to enter Safe Mode on your Android: 1. Press and hold the Power button. 2. When your phone begins to boot up, press and hold the Volume down button until you see ÒSafe ModeÓ appear on your screen. 3. To exit Safe Mode, restart your device. 4. Check for damage Sometimes cracks, breaks, and corrosion on your phone aren't visible right away. Try shining a light on the screen and removing your phone case to check for any physical damage. You can also try calling your device to see if it vibrates or rings. Water damage? Here areÊ8 ways to dry your phoneÊfast. 5. Perform a factory reset When your Android or iPhone won't power on, restoring your device to its factory settings may be your only option. But this should be a last resort, after you've tried everything else, because it erases nearly all the data on your device. If you can'tÊperform a factory reset on your iPhoneÊbecause of a frozen or black screen, connect it to a computer and use a program like Finder¨ or iTunes¨ to enter Recovery Mode. ForÊSamsung Galaxy¨ S8, newer models, and other devices, you canÊfactory reset your Android phoneÊby following our guide. If you've tried these steps and still need a little help, we're right around the corner. Schedule a repair at theÊnearest uBreakiFix¨ by Asurion storeÊand our certified experts can get your device back up and running as soon as the same day.
|
Please limit your knowledge to the document. Avoid generalizations and ensure accuracy by directly referencing the document's arguments and examples.
EVIDENCE:
How to fix a phone that won't turn on * * * * * Our phones help us stay connected, so when they stop working (or worse, won't turn on), there's a lot we can't doÑfrom texting and calling to surfing the web and watching videos on apps like TikTok¨ and Instagram¨. Asurion Experts come acrossÊphone repairÊissues like this every day. They help millions of customers get the most out of their favorite tech, whether it's aÊbroken Xbox Series XªÊor aÊswollen laptop battery. If your phone hasn't been turning on like it should, check out their tips for getting your device working again (so you can get back to enjoying that video of Adam Sandler leaving IHOP). Why won't my phone turn on? There are several possible reasons why your phone won't turn on, from battery failure to software issues. But most times you can narrow it down to a few common problems, including: * A drained battery.ÊYour phone may be unresponsive because the battery is dead. Find outÊways to minimize battery drainÊon an Android device.Ê * Water or physical damage.ÊDropped your phone in the sink recently? Even a small amount ofÊliquidÊcan do major damage if it gets inside your device.ÊDropping your phoneÊon a hard surface can also do some internal damage, even if there aren't noticeable cracks or breaks. * A software glitch.ÊWhen an iPhone¨ won't turn on or theÊscreen is black, it could be a software issue. The same goes for Androidª devices. Certain apps and programs occasionally prevent your phone from working properly, especially if it crashes during a software or system update. Device won't power on? We can help We'll do a free device diagnostic to find out what's wrongÑvisit your local store or schedule a repair. Schedule a repair What to do if your phone won't turn on If you're having issues with an unresponsive phone, don't panic. There are several ways to get it back up and running without going to extremes (like buying a new device). Here's how to fix a phone that won't turn on, according to our experts: 1. Restart the phone The problem could be that your phone is frozen. Try restarting it the normal way, and if that doesn't work, you may have to force restart your device. For an iPhone 11 that won't turn on, as well as other new iPhone models, follow these steps: 1. Press and quickly release the Volume Up button, then do the same with the Volume Down button. 2. Press and hold the Power button until your device restarts. Need to restart a Google Pixelª that won't turn on or another Android phone that isn't working? Just perform a power cycle. The steps are simple: 1. Press and hold the Power button for about 30 seconds. For some models, like a Samsung¨ phone, you may also have to hold the Volume Down button at the same time, but it should only take a few seconds. 2. Wait until your screen turns on to release the buttons. 2. Charge the battery Plugging in your phone for 15Ð25 minutes may do the trick. Connect your device to a charger and give it some juice. If the battery symbol appears on the screen, be sure your phone gains enough power before you try turning it on. Then check out our tips onÊhow to improve yourÊiPhoneÊorÊAndroid battery life. What if my phone died and won't turn on or charge? If you've tried charging your phone and it won't turn on, there may be dust and dirt clogging the charging port or a problem with the USB or lightning cable. Check out our guide forÊhow to clean your phone's charging portÊif you need more help. 3. Enable Safe Mode Using Safe Mode for your Android will disable third-party apps that may be causing an issue for your device andÑif all goes wellÑallow it to turn on. For iPhone users, skip to step four. How to enter Safe Mode on your Android: 1. Press and hold the Power button. 2. When your phone begins to boot up, press and hold the Volume down button until you see ÒSafe ModeÓ appear on your screen. 3. To exit Safe Mode, restart your device. 4. Check for damage Sometimes cracks, breaks, and corrosion on your phone aren't visible right away. Try shining a light on the screen and removing your phone case to check for any physical damage. You can also try calling your device to see if it vibrates or rings. Water damage? Here areÊ8 ways to dry your phoneÊfast. 5. Perform a factory reset When your Android or iPhone won't power on, restoring your device to its factory settings may be your only option. But this should be a last resort, after you've tried everything else, because it erases nearly all the data on your device. If you can'tÊperform a factory reset on your iPhoneÊbecause of a frozen or black screen, connect it to a computer and use a program like Finder¨ or iTunes¨ to enter Recovery Mode. ForÊSamsung Galaxy¨ S8, newer models, and other devices, you canÊfactory reset your Android phoneÊby following our guide. If you've tried these steps and still need a little help, we're right around the corner. Schedule a repair at theÊnearest uBreakiFix¨ by Asurion storeÊand our certified experts can get your device back up and running as soon as the same day.
USER:
How to fix a phone that won't turn on.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 20 | 9 | 897 | null | 290 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
Discuss the similarities and differences between a simple installment loan and a mortgage. Explain in what situations one option should be chosen over the other. Limit the discussion to 250 words.
|
Installment Loans A loan is something that is borrowed. In the case where this is a sum of money the amount that will be paid by the borrower will include the original amount plus interest. Some loans require full payment on the maturity date of the loan. The maturity date is when all principal and/or interest must be repaid to the the lender. Consider a one year loan of $1000 at a simple interest rate of 5%. At the end of one year (the maturity date) the borrower will pay back the original $1000 plus the interest of $50 for a total of $1050. For major purchases such as vehicles or furniture there is a different type of loan, called the installment loan. The average consumer cannot afford to pay $25000 or more for a new vehicle and they may not want to wait three or four years until they have saved enough money to do so. The qualifying consumer has the option of paying for the item with an installment loan. Installment loans do not require full repayment of the loan on a specific date. With an installment loan the borrower is required to make regular (installment) payments until the loan is paid off. Each installment payment will include an interest charge. An installment loan can vary in length from a few years to perhaps twenty years or more (in the case of real estate). Consider an installment loan for a $4000 television. The purchaser takes out a $4000 loan with a four-year term at an interest rate of 4.5%. The monthly installment payments will be $91.21. Although the television has a purchase price of $4000, the total cost to the purchaser will be more than $4000. The total of the installment payments will be: Total Installment Payments = Number of Installment Payments x Payment Amount = 4 years x 12 payments/year x $91.21/mth = $4378.08 The $4000 television ends up costing $4378.08 because the consumer is charged interest. Each payment includes an interest component that adds to the overall cost of the item. The total of the interest charges is referred to as the finance charge on the loan. Finance Charge The finance charge is the sum of the interest charges on a loan. These interest charges are embedded in the installment payments. To calculate the finance charge: Finance Charge = Total Installment Payments – Loan Amount = (Number of Installment Payments x Payment Amount) – Loan Amount For the $4000 television the finance charge will be calculated as follows: Finance charge = Total Installment Payments – Loan Amount = (4 years x 12 payments/year x $91.21/payment) – $4000 = $4378.08 – $4000 = $378.08 Over the 4-year term of the loan the purchaser will have paid the $4000 loan amount plus an additional $378.08 in interest (the finance charge). Sometimes the borrower will make an initial payment at the time of purchase. This is called a down payment. When a down payment is made the remaining amount is the amount financed or the loan amount. Amount Financed The amount financed or loan amount is the purchase price of the item less any down payment: Amount Financed = Purchase Price – Down Payment Consider the $4000 television. Assume the purchaser makes a down payment of $1500. The amount financed is: Purchase Price – Down Payment = $4000 – $1500 = $2500. In this case the purchaser borrows $2500 rather than $4000. The amount financed is therefore $2500. Assuming the same 4-year term and an interest rate of 4.5%, the installment payments on the $2500 will be reduced to $57.01 per month. In this case the finance charge will be calculated as follows: Finance charge = Total Installment Payments – Loan Amount = (4 years x 12 payments/year x $57.01/payment) – $2500 = $2736.48 – $2500 = $236.48 With the down payment of $2500 the total finance charges will be reduced to $236.48 from $378.08. The total cost of the television to the purchaser will be: Purchase Price + Finance Charge = $4000 + $236.48 = $4236.48 Alternatively we can calculate: Total Installment Payment + Down Payment = $2736.48 + $1500 = $4236.48 As one can see, the finance charges are a hidden but added cost. This cost will become more pronounced with more expensive purchases such as with real estate. Loan Payments When consumers obtain installment loans they often just trust the lender to determine the installment (periodic) loan payments. In Example1 Paul purchased a home entertainment system at a total cost of $6000. He obtained a three year loan at an interest rate of 7.5%. If Paul attempts to calculate his monthly payment by simply dividing the loan amount by the number of payments he will underestimate his monthly payment as he has ignored the interest component: $6000 ÷ 36 = $166.67 Paul’s actual monthly payment of $186.64 is slightly higher than Paul’s estimate because of the interest component. The actual amount of a periodic loan payment can be determined using a formula, a table or technology. In this section we will illustrate the use of a formula. Amortization Amortization is the process of spreading out a loan into a series of fixed payments. A portion of each payment will be applied to the interest charge and a portion will be applied to the principal amount of the loan. Although each payment is equal, the amount that applies to the interest versus the prinipal will change with each payment period. We can get a better sense of the impact that a loan payment has by examining the amortization schedule for a loan. Consider the amortization table for the installment loan in Example 5. Recall that the loan amount is $5000 at 6% for 5 years and annual payments are $1186.98. Note then that for each year the sum of the interest and principal is equivalent to the payment of $1186.98. Refer to Figure 1 for the amortization schedule of this loan. Mortgages A long term loan that is used for the purchase of a house is called a mortgage. It is called a mortgage because the lending agency requires that the house be used as collateral for the loan. This means that if the mortgage holder is unable to make the payments the lender can take possession of the house. Mortgages generally tend to be for longer time periods than an installment loan and the terms of the mortgage will often change over the course of the mortgage. Take for example the purchase of a house with a twenty year mortgage. The purchaser might sign a mortgage agreement for a five year term. The mortgage agreement will include the interest rate, the frequency of payments and additional rules which may allow the mortgage holder to make lump sum payments or change the payment amount. At the end of the five year term a new agreement will be required and the conditions of the mortgage usually change. Although it is possible to do the calculations manually, that is beyond the scope of this book. We will use technology to calculate the periodic payments and interest charges and to generate an amortization schedule. Example 8 will illustrate that amortizing a mortgage is similar to amortizing other loans except that the mortgage amortization generally involves many more payment periods.
|
[question] Discuss the similarities and differences between a simple installment loan and a mortgage. Explain in what situations one option should be chosen over the other. Limit the discussion to 250 words. ===================== [text] Installment Loans A loan is something that is borrowed. In the case where this is a sum of money the amount that will be paid by the borrower will include the original amount plus interest. Some loans require full payment on the maturity date of the loan. The maturity date is when all principal and/or interest must be repaid to the the lender. Consider a one year loan of $1000 at a simple interest rate of 5%. At the end of one year (the maturity date) the borrower will pay back the original $1000 plus the interest of $50 for a total of $1050. For major purchases such as vehicles or furniture there is a different type of loan, called the installment loan. The average consumer cannot afford to pay $25000 or more for a new vehicle and they may not want to wait three or four years until they have saved enough money to do so. The qualifying consumer has the option of paying for the item with an installment loan. Installment loans do not require full repayment of the loan on a specific date. With an installment loan the borrower is required to make regular (installment) payments until the loan is paid off. Each installment payment will include an interest charge. An installment loan can vary in length from a few years to perhaps twenty years or more (in the case of real estate). Consider an installment loan for a $4000 television. The purchaser takes out a $4000 loan with a four-year term at an interest rate of 4.5%. The monthly installment payments will be $91.21. Although the television has a purchase price of $4000, the total cost to the purchaser will be more than $4000. The total of the installment payments will be: Total Installment Payments = Number of Installment Payments x Payment Amount = 4 years x 12 payments/year x $91.21/mth = $4378.08 The $4000 television ends up costing $4378.08 because the consumer is charged interest. Each payment includes an interest component that adds to the overall cost of the item. The total of the interest charges is referred to as the finance charge on the loan. Finance Charge The finance charge is the sum of the interest charges on a loan. These interest charges are embedded in the installment payments. To calculate the finance charge: Finance Charge = Total Installment Payments – Loan Amount = (Number of Installment Payments x Payment Amount) – Loan Amount For the $4000 television the finance charge will be calculated as follows: Finance charge = Total Installment Payments – Loan Amount = (4 years x 12 payments/year x $91.21/payment) – $4000 = $4378.08 – $4000 = $378.08 Over the 4-year term of the loan the purchaser will have paid the $4000 loan amount plus an additional $378.08 in interest (the finance charge). Sometimes the borrower will make an initial payment at the time of purchase. This is called a down payment. When a down payment is made the remaining amount is the amount financed or the loan amount. Amount Financed The amount financed or loan amount is the purchase price of the item less any down payment: Amount Financed = Purchase Price – Down Payment Consider the $4000 television. Assume the purchaser makes a down payment of $1500. The amount financed is: Purchase Price – Down Payment = $4000 – $1500 = $2500. In this case the purchaser borrows $2500 rather than $4000. The amount financed is therefore $2500. Assuming the same 4-year term and an interest rate of 4.5%, the installment payments on the $2500 will be reduced to $57.01 per month. In this case the finance charge will be calculated as follows: Finance charge = Total Installment Payments – Loan Amount = (4 years x 12 payments/year x $57.01/payment) – $2500 = $2736.48 – $2500 = $236.48 With the down payment of $2500 the total finance charges will be reduced to $236.48 from $378.08. The total cost of the television to the purchaser will be: Purchase Price + Finance Charge = $4000 + $236.48 = $4236.48 Alternatively we can calculate: Total Installment Payment + Down Payment = $2736.48 + $1500 = $4236.48 As one can see, the finance charges are a hidden but added cost. This cost will become more pronounced with more expensive purchases such as with real estate. Loan Payments When consumers obtain installment loans they often just trust the lender to determine the installment (periodic) loan payments. In Example1 Paul purchased a home entertainment system at a total cost of $6000. He obtained a three year loan at an interest rate of 7.5%. If Paul attempts to calculate his monthly payment by simply dividing the loan amount by the number of payments he will underestimate his monthly payment as he has ignored the interest component: $6000 ÷ 36 = $166.67 Paul’s actual monthly payment of $186.64 is slightly higher than Paul’s estimate because of the interest component. The actual amount of a periodic loan payment can be determined using a formula, a table or technology. In this section we will illustrate the use of a formula. Amortization Amortization is the process of spreading out a loan into a series of fixed payments. A portion of each payment will be applied to the interest charge and a portion will be applied to the principal amount of the loan. Although each payment is equal, the amount that applies to the interest versus the prinipal will change with each payment period. We can get a better sense of the impact that a loan payment has by examining the amortization schedule for a loan. Consider the amortization table for the installment loan in Example 5. Recall that the loan amount is $5000 at 6% for 5 years and annual payments are $1186.98. Note then that for each year the sum of the interest and principal is equivalent to the payment of $1186.98. Refer to Figure 1 for the amortization schedule of this loan. Mortgages A long term loan that is used for the purchase of a house is called a mortgage. It is called a mortgage because the lending agency requires that the house be used as collateral for the loan. This means that if the mortgage holder is unable to make the payments the lender can take possession of the house. Mortgages generally tend to be for longer time periods than an installment loan and the terms of the mortgage will often change over the course of the mortgage. Take for example the purchase of a house with a twenty year mortgage. The purchaser might sign a mortgage agreement for a five year term. The mortgage agreement will include the interest rate, the frequency of payments and additional rules which may allow the mortgage holder to make lump sum payments or change the payment amount. At the end of the five year term a new agreement will be required and the conditions of the mortgage usually change. Although it is possible to do the calculations manually, that is beyond the scope of this book. We will use technology to calculate the periodic payments and interest charges and to generate an amortization schedule. Example 8 will illustrate that amortizing a mortgage is similar to amortizing other loans except that the mortgage amortization generally involves many more payment periods. https://opentextbc.ca/businesstechnicalmath/chapter/9-5-loans-mortgages/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
Installment Loans A loan is something that is borrowed. In the case where this is a sum of money the amount that will be paid by the borrower will include the original amount plus interest. Some loans require full payment on the maturity date of the loan. The maturity date is when all principal and/or interest must be repaid to the the lender. Consider a one year loan of $1000 at a simple interest rate of 5%. At the end of one year (the maturity date) the borrower will pay back the original $1000 plus the interest of $50 for a total of $1050. For major purchases such as vehicles or furniture there is a different type of loan, called the installment loan. The average consumer cannot afford to pay $25000 or more for a new vehicle and they may not want to wait three or four years until they have saved enough money to do so. The qualifying consumer has the option of paying for the item with an installment loan. Installment loans do not require full repayment of the loan on a specific date. With an installment loan the borrower is required to make regular (installment) payments until the loan is paid off. Each installment payment will include an interest charge. An installment loan can vary in length from a few years to perhaps twenty years or more (in the case of real estate). Consider an installment loan for a $4000 television. The purchaser takes out a $4000 loan with a four-year term at an interest rate of 4.5%. The monthly installment payments will be $91.21. Although the television has a purchase price of $4000, the total cost to the purchaser will be more than $4000. The total of the installment payments will be: Total Installment Payments = Number of Installment Payments x Payment Amount = 4 years x 12 payments/year x $91.21/mth = $4378.08 The $4000 television ends up costing $4378.08 because the consumer is charged interest. Each payment includes an interest component that adds to the overall cost of the item. The total of the interest charges is referred to as the finance charge on the loan. Finance Charge The finance charge is the sum of the interest charges on a loan. These interest charges are embedded in the installment payments. To calculate the finance charge: Finance Charge = Total Installment Payments – Loan Amount = (Number of Installment Payments x Payment Amount) – Loan Amount For the $4000 television the finance charge will be calculated as follows: Finance charge = Total Installment Payments – Loan Amount = (4 years x 12 payments/year x $91.21/payment) – $4000 = $4378.08 – $4000 = $378.08 Over the 4-year term of the loan the purchaser will have paid the $4000 loan amount plus an additional $378.08 in interest (the finance charge). Sometimes the borrower will make an initial payment at the time of purchase. This is called a down payment. When a down payment is made the remaining amount is the amount financed or the loan amount. Amount Financed The amount financed or loan amount is the purchase price of the item less any down payment: Amount Financed = Purchase Price – Down Payment Consider the $4000 television. Assume the purchaser makes a down payment of $1500. The amount financed is: Purchase Price – Down Payment = $4000 – $1500 = $2500. In this case the purchaser borrows $2500 rather than $4000. The amount financed is therefore $2500. Assuming the same 4-year term and an interest rate of 4.5%, the installment payments on the $2500 will be reduced to $57.01 per month. In this case the finance charge will be calculated as follows: Finance charge = Total Installment Payments – Loan Amount = (4 years x 12 payments/year x $57.01/payment) – $2500 = $2736.48 – $2500 = $236.48 With the down payment of $2500 the total finance charges will be reduced to $236.48 from $378.08. The total cost of the television to the purchaser will be: Purchase Price + Finance Charge = $4000 + $236.48 = $4236.48 Alternatively we can calculate: Total Installment Payment + Down Payment = $2736.48 + $1500 = $4236.48 As one can see, the finance charges are a hidden but added cost. This cost will become more pronounced with more expensive purchases such as with real estate. Loan Payments When consumers obtain installment loans they often just trust the lender to determine the installment (periodic) loan payments. In Example1 Paul purchased a home entertainment system at a total cost of $6000. He obtained a three year loan at an interest rate of 7.5%. If Paul attempts to calculate his monthly payment by simply dividing the loan amount by the number of payments he will underestimate his monthly payment as he has ignored the interest component: $6000 ÷ 36 = $166.67 Paul’s actual monthly payment of $186.64 is slightly higher than Paul’s estimate because of the interest component. The actual amount of a periodic loan payment can be determined using a formula, a table or technology. In this section we will illustrate the use of a formula. Amortization Amortization is the process of spreading out a loan into a series of fixed payments. A portion of each payment will be applied to the interest charge and a portion will be applied to the principal amount of the loan. Although each payment is equal, the amount that applies to the interest versus the prinipal will change with each payment period. We can get a better sense of the impact that a loan payment has by examining the amortization schedule for a loan. Consider the amortization table for the installment loan in Example 5. Recall that the loan amount is $5000 at 6% for 5 years and annual payments are $1186.98. Note then that for each year the sum of the interest and principal is equivalent to the payment of $1186.98. Refer to Figure 1 for the amortization schedule of this loan. Mortgages A long term loan that is used for the purchase of a house is called a mortgage. It is called a mortgage because the lending agency requires that the house be used as collateral for the loan. This means that if the mortgage holder is unable to make the payments the lender can take possession of the house. Mortgages generally tend to be for longer time periods than an installment loan and the terms of the mortgage will often change over the course of the mortgage. Take for example the purchase of a house with a twenty year mortgage. The purchaser might sign a mortgage agreement for a five year term. The mortgage agreement will include the interest rate, the frequency of payments and additional rules which may allow the mortgage holder to make lump sum payments or change the payment amount. At the end of the five year term a new agreement will be required and the conditions of the mortgage usually change. Although it is possible to do the calculations manually, that is beyond the scope of this book. We will use technology to calculate the periodic payments and interest charges and to generate an amortization schedule. Example 8 will illustrate that amortizing a mortgage is similar to amortizing other loans except that the mortgage amortization generally involves many more payment periods.
USER:
Discuss the similarities and differences between a simple installment loan and a mortgage. Explain in what situations one option should be chosen over the other. Limit the discussion to 250 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 31 | 1,219 | null | 779 |
Using only the information included in the prompt/context block, answer the prompt in one paragraph or less.
|
How is the self employment tax rate distributed?
|
What Is The Self-Employment Tax Rate? The self-employment tax rate is 15.3 percent, with 12.4 percent allocated to the Social Security system and the other 2.9 percent going to Medicare. If you worked as an employee of a company, your employer would pay half, which means only 6.2 percent would be taken out of your wages for Social Security and 1.45 percent for Medicare. But as a self-employed individual, you are considered both the employer and the employee, which makes the entire selfemployment tax burden yours. You do, however, get a tax deduction for one-half of the self-employed taxes paid as an abovethe-line deduction to arrive at adjusted gross income.
|
What Is The Self-Employment Tax Rate? The self-employment tax rate is 15.3 percent, with 12.4 percent allocated to the Social Security system and the other 2.9 percent going to Medicare. If you worked as an employee of a company, your employer would pay half, which means only 6.2 percent would be taken out of your wages for Social Security and 1.45 percent for Medicare. But as a self-employed individual, you are considered both the employer and the employee, which makes the entire selfemployment tax burden yours. You do, however, get a tax deduction for one-half of the self-employed taxes paid as an abovethe-line deduction to arrive at adjusted gross income. Using only the information included in the prompt/context block, answer the prompt in one paragraph or less. How is the self employment tax rate distributed?
|
Using only the information included in the prompt/context block, answer the prompt in one paragraph or less.
EVIDENCE:
What Is The Self-Employment Tax Rate? The self-employment tax rate is 15.3 percent, with 12.4 percent allocated to the Social Security system and the other 2.9 percent going to Medicare. If you worked as an employee of a company, your employer would pay half, which means only 6.2 percent would be taken out of your wages for Social Security and 1.45 percent for Medicare. But as a self-employed individual, you are considered both the employer and the employee, which makes the entire selfemployment tax burden yours. You do, however, get a tax deduction for one-half of the self-employed taxes paid as an abovethe-line deduction to arrive at adjusted gross income.
USER:
How is the self employment tax rate distributed?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 17 | 8 | 110 | null | 212 |
Only use the information contained within the provided text to answer the question. Do not use outside sources. Write a full sentence and use a bullet point. Ensure the entire sentence is in italics.
|
Why is a digital detox so important?
|
Digital Detox Guide Do you check your email, texts, voicemails, Facebook, or Twitter feed within an hour of waking up or going to sleep? While you’re in line at the store? During dinner with your family? Would you check it at a church while waiting for a funeral to start? Do a little thought experiment with me here. Imagine yourself sitting in a public place, not doing anything, just staring into space. How would you feel? Although many of us spent most of our childhoods daydreaming, adulthood seems to be about trying to keeping our minds from wandering, and trying to stay on task. Rarely do we just let ourselves stare into space these days. Look around: We can’t even stand to wait at a stoplight for 10 seconds without checking our smartphones. Why not? Because it’s uncomfortable for us not to be doing anything. At the very least, it’s boring. More than being boring, however, downtime and daydreaming are threatening to our sense of self. If busyness and multi-tasking and being pressed for time can be equated with significance, success, and productivity then downtime and daydreaming must be signs of insignificance, failure, and inefficiency. And when we feel insignificant and unsuccessful, we also tend to feel guilty for not working, ashamed that we aren’t important enough to be doing something, and anxious about our status. In the lab, these emotions are more painful than the actual physical pain of an electric shock. I’m endlessly fascinated by a series of studies led by Tim Wilson where the research subjects were put alone in a room, with nothing to do. The researchers describe their work: In 11 studies, we found that participants typically did not enjoy spending 6 to 15 minutes in a room by themselves with nothing to do but think, that they enjoyed doing mundane external activities much more, and that many preferred to administer electric shocks to themselves instead of being left alone with their thoughts. Most people seem to prefer to be doing something rather than nothing, even if that something is negative. You read that right: Many people (67 percent of men and 25 percent of women, to be exact) actually gave themselves painful electric shocks instead of just sitting there doing nothing–after they had indicated to the researchers that they would pay money NOT to be shocked again. One guy shocked himself 190 times in 15 minutes. When we can’t tolerate the feelings that come up when we aren’t doing anything, or when we can’t tolerate a lack of stimulation, we feel uncomfortable when we have downtime. As a result, we forfeit our downtime and all its benefits by seeking external stimulation, which is usually readily available in our purse or pocket (rather than an electric shock machine). Instead of just staring out the window on the bus, we read through our Facebook feed. Instead of being alone with our thoughts for a minute, we check our email waiting in line at the grocery store. Instead of enjoying our dinner, we mindlessly shovel food in our mouths while staring at a screen. THE BENEFITS OF UNPLUGGING In the grand scheme of things, digital usage rarely leads to meaning or fulfillment. But unplugging for at least one day per week will make you happier (in addition to giving you hours and hours to do the things that bring meaning to your life). Here’s why: 1. Detoxing from social media and digital information promotes overall wellbeing and mental health. Social media use is associated with narcissism, depression, loneliness, and other negative feelings like anger, envy, misery, and frustration. So, it’s hardly surprising that taking a break for a few days can improve our mood and overall happiness. 2. Your sleep will become more restorative, and sleep improves everything from health and happiness to performance and productivity. Physiologically, you’ll have an easier time sleeping because the low-energy blue light emitted by our tablets and smartphones stimulates chemical messengers in our brains that make us more alert and suppresses others (like melatonin) that help us fall asleep. In addition, you’ll have an easier time sleeping because you won’t be exciting your brain with new or stimulating information right efore bedtime. Social media, messages, and email can easily trigger the release of adrenalin, which makes it nearly impossible to fall asleep quickly. And needless to say, the less time it takes you to fall asleep at night, the more time you’ll have in the morning. 3. Bonus: You’ll feel less lonely and more connected, and feeling connected is the best predictor of happiness that we have. Though we think social media makes us feel more connected to others, ironically, it can also make us feel quite alone. Seeing friends and acquaintances post about how happy they are can actually trigger feelings of misery and loneliness, research shows. The benefits of unplugging from time to time are clearly enormous. But if unplugging isn’t undertaken properly, people often experience withdrawal symptoms, like feelings of agitation, guilt, and a compulsive and distracting desire to check our phones. THE SCIENCE OF CHECKING One survey found that 80% of 18 to 44-year-olds check their smartphones within the first 15 minutes of waking up–and that 89% of younger users, those ages 18- 24, reach for their device within 15 minutes of waking up. Seventy-four percent reach for it immediately after waking up. A quarter of those surveyed could not recall a time during the day that their device was not within reach or in the same room. Another study found that people tend to check their email about every 15 minutes; another found that in 2007 the average knowledge worker opened their email 50 times a day, while using instant messaging 77 times a day—imagine what that might be today, over a decade later, now that smartphones are ubiquitous and given the evidence that we spend more time checking than ever before. So, we check our smartphones constantly. Is that bad? A study of college students at Kent State University found that people who check their phones frequently tend to experience higher levels of distress during their leisure time (when they intend to relax). Similarly, Elizabeth Dunn and Kostadin Kushlev regulated how frequently participants checked their email throughout the day. Those striving to check only three times a day were less tense and less stressed overall. Moreover, checking constantly reduces our productivity. All that checking interrupts us from accomplishing our more important work; with each derailment, it takes us on average about a half hour to get back on track. So why do we check constantly, and first thing in the morning, if it just makes us tense and keeps us from getting our work done? Because it also feels, well…awesome. The Internet and electronic communications engage many of our senses—often simultaneously. All that checking excites our brain, providing the novelty and stimulation it adores. So even though disconnecting from the devices and communications that make us tense and decrease our productivity seems like a logical thing to do, your novelty-and-stimulation-seeking brain won’t want to do it. In fact, it will tell you that you are being more productive when you are online and connected to your messages than when you are disconnected and focusing on something important. This point is worth lingering on: how productive we are does not correlate well with how productive we feel. Multitasking and checking a lot feel productive because our brains are so stimulated when we are doing it. But it isn’t actually productive; one Stanford study showed that while media multitaskers tended to perceive themselves to be performing better, they actually tended to perform worse on every measure the researchers studied. Much of our checking and busyness, to paraphrase Shakespeare, is all sound and fury, no meaning or significance. You can sit all day in front of your computer checking and responding to email but accomplish not one of your priorities. It may feel like a more valuable activity, because it feels more productive. But it is neither. Now that we’ve established the benefits of unplugging and the dangers of checking, here’s how to unplug in a way that will lead to the best weekend EVER. Going unplugged for one day over the weekend will send many people into withdrawal. They will literally experience jitters, anxiety, and discomfort akin to physical pain. If you were in rehab for Opioid addiction, they might give you medication (like Methadone) to ease the pain. Unplugging is like a detox because the symptoms we experience when we stop checking our phones compulsively are uncomfortable; remember, many people would rather receive a painful electric shock than stand the pain of not checking, of not being “productive.” If you need rehab, here’s how to invent your own methadone. The idea is to do something naturally rewarding for your brain to ease the boredom, anxiety, and general twitchiness that tends to descend upon us when we unplug from technology. Unless you are some sort of superhero, you will not be able to cure yourself of your internet/device/email addiction perfectly the first time. So what to do if you’re struggling? 1. Don’t get too emotional about your slip or succumb to selfcriticism. Instead, forgive yourself. Remind yourself that lapses are part of the process, and that feeling guilty or bad about your behavior will not increase your future success. 2. Figure out what the problem is. This may be blazingly obvious, but in order to do better tomorrow, you’ll need to know what is causing your trip-ups. What temptation can you remove? Were you stressed or tired or hungry—and if so, how can you prevent that the next time? 3. Beware the “What the Hell” effect. Say you’ve sworn not to check your email before breakfast, but you’ve been online since your alarm went off…three hours ago. You’re now at risk for what researchers formally call the Abstinence Violation Effect (AVE) and jokingly call the “what the hell effect.” 4. Rededicate yourself to your detox (now, in this instant, not tomorrow). Why do you want to make the changes that you do? How will you benefit? Do a little deep breathing and calm contemplation of your goals. 5. Beware of moral licensing. This is a potential landmine to avoid on your better days: as you notice how well you are doing staying unplugged, don’t let yourself feel so good about the progress you are making that you unleash what researchers call the “licensing effect.”
|
[DOCUMENT] Digital Detox Guide Do you check your email, texts, voicemails, Facebook, or Twitter feed within an hour of waking up or going to sleep? While you’re in line at the store? During dinner with your family? Would you check it at a church while waiting for a funeral to start? Do a little thought experiment with me here. Imagine yourself sitting in a public place, not doing anything, just staring into space. How would you feel? Although many of us spent most of our childhoods daydreaming, adulthood seems to be about trying to keeping our minds from wandering, and trying to stay on task. Rarely do we just let ourselves stare into space these days. Look around: We can’t even stand to wait at a stoplight for 10 seconds without checking our smartphones. Why not? Because it’s uncomfortable for us not to be doing anything. At the very least, it’s boring. More than being boring, however, downtime and daydreaming are threatening to our sense of self. If busyness and multi-tasking and being pressed for time can be equated with significance, success, and productivity then downtime and daydreaming must be signs of insignificance, failure, and inefficiency. And when we feel insignificant and unsuccessful, we also tend to feel guilty for not working, ashamed that we aren’t important enough to be doing something, and anxious about our status. In the lab, these emotions are more painful than the actual physical pain of an electric shock. I’m endlessly fascinated by a series of studies led by Tim Wilson where the research subjects were put alone in a room, with nothing to do. The researchers describe their work: In 11 studies, we found that participants typically did not enjoy spending 6 to 15 minutes in a room by themselves with nothing to do but think, that they enjoyed doing mundane external activities much more, and that many preferred to administer electric shocks to themselves instead of being left alone with their thoughts. Most people seem to prefer to be doing something rather than nothing, even if that something is negative. You read that right: Many people (67 percent of men and 25 percent of women, to be exact) actually gave themselves painful electric shocks instead of just sitting there doing nothing–after they had indicated to the researchers that they would pay money NOT to be shocked again. One guy shocked himself 190 times in 15 minutes. When we can’t tolerate the feelings that come up when we aren’t doing anything, or when we can’t tolerate a lack of stimulation, we feel uncomfortable when we have downtime. As a result, we forfeit our downtime and all its benefits by seeking external stimulation, which is usually readily available in our purse or pocket (rather than an electric shock machine). Instead of just staring out the window on the bus, we read through our Facebook feed. Instead of being alone with our thoughts for a minute, we check our email waiting in line at the grocery store. Instead of enjoying our dinner, we mindlessly shovel food in our mouths while staring at a screen. THE BENEFITS OF UNPLUGGING In the grand scheme of things, digital usage rarely leads to meaning or fulfillment. But unplugging for at least one day per week will make you happier (in addition to giving you hours and hours to do the things that bring meaning to your life). Here’s why: 1. Detoxing from social media and digital information promotes overall wellbeing and mental health. Social media use is associated with narcissism, depression, loneliness, and other negative feelings like anger, envy, misery, and frustration. So, it’s hardly surprising that taking a break for a few days can improve our mood and overall happiness. 2. Your sleep will become more restorative, and sleep improves everything from health and happiness to performance and productivity. Physiologically, you’ll have an easier time sleeping because the low-energy blue light emitted by our tablets and smartphones stimulates chemical messengers in our brains that make us more alert and suppresses others (like melatonin) that help us fall asleep. In addition, you’ll have an easier time sleeping because you won’t be exciting your brain with new or stimulating information right efore bedtime. Social media, messages, and email can easily trigger the release of adrenalin, which makes it nearly impossible to fall asleep quickly. And needless to say, the less time it takes you to fall asleep at night, the more time you’ll have in the morning. 3. Bonus: You’ll feel less lonely and more connected, and feeling connected is the best predictor of happiness that we have. Though we think social media makes us feel more connected to others, ironically, it can also make us feel quite alone. Seeing friends and acquaintances post about how happy they are can actually trigger feelings of misery and loneliness, research shows. The benefits of unplugging from time to time are clearly enormous. But if unplugging isn’t undertaken properly, people often experience withdrawal symptoms, like feelings of agitation, guilt, and a compulsive and distracting desire to check our phones. THE SCIENCE OF CHECKING One survey found that 80% of 18 to 44-year-olds check their smartphones within the first 15 minutes of waking up–and that 89% of younger users, those ages 18- 24, reach for their device within 15 minutes of waking up. Seventy-four percent reach for it immediately after waking up. A quarter of those surveyed could not recall a time during the day that their device was not within reach or in the same room. Another study found that people tend to check their email about every 15 minutes; another found that in 2007 the average knowledge worker opened their email 50 times a day, while using instant messaging 77 times a day—imagine what that might be today, over a decade later, now that smartphones are ubiquitous and given the evidence that we spend more time checking than ever before. So, we check our smartphones constantly. Is that bad? A study of college students at Kent State University found that people who check their phones frequently tend to experience higher levels of distress during their leisure time (when they intend to relax). Similarly, Elizabeth Dunn and Kostadin Kushlev regulated how frequently participants checked their email throughout the day. Those striving to check only three times a day were less tense and less stressed overall. Moreover, checking constantly reduces our productivity. All that checking interrupts us from accomplishing our more important work; with each derailment, it takes us on average about a half hour to get back on track. So why do we check constantly, and first thing in the morning, if it just makes us tense and keeps us from getting our work done? Because it also feels, well…awesome. The Internet and electronic communications engage many of our senses—often simultaneously. All that checking excites our brain, providing the novelty and stimulation it adores. So even though disconnecting from the devices and communications that make us tense and decrease our productivity seems like a logical thing to do, your novelty-and-stimulation-seeking brain won’t want to do it. In fact, it will tell you that you are being more productive when you are online and connected to your messages than when you are disconnected and focusing on something important. This point is worth lingering on: how productive we are does not correlate well with how productive we feel. Multitasking and checking a lot feel productive because our brains are so stimulated when we are doing it. But it isn’t actually productive; one Stanford study showed that while media multitaskers tended to perceive themselves to be performing better, they actually tended to perform worse on every measure the researchers studied. Much of our checking and busyness, to paraphrase Shakespeare, is all sound and fury, no meaning or significance. You can sit all day in front of your computer checking and responding to email but accomplish not one of your priorities. It may feel like a more valuable activity, because it feels more productive. But it is neither. Now that we’ve established the benefits of unplugging and the dangers of checking, here’s how to unplug in a way that will lead to the best weekend EVER. Going unplugged for one day over the weekend will send many people into withdrawal. They will literally experience jitters, anxiety, and discomfort akin to physical pain. If you were in rehab for Opioid addiction, they might give you medication (like Methadone) to ease the pain. Unplugging is like a detox because the symptoms we experience when we stop checking our phones compulsively are uncomfortable; remember, many people would rather receive a painful electric shock than stand the pain of not checking, of not being “productive.” If you need rehab, here’s how to invent your own methadone. The idea is to do something naturally rewarding for your brain to ease the boredom, anxiety, and general twitchiness that tends to descend upon us when we unplug from technology. Unless you are some sort of superhero, you will not be able to cure yourself of your internet/device/email addiction perfectly the first time. So what to do if you’re struggling? 1. Don’t get too emotional about your slip or succumb to selfcriticism. Instead, forgive yourself. Remind yourself that lapses are part of the process, and that feeling guilty or bad about your behavior will not increase your future success. 2. Figure out what the problem is. This may be blazingly obvious, but in order to do better tomorrow, you’ll need to know what is causing your trip-ups. What temptation can you remove? Were you stressed or tired or hungry—and if so, how can you prevent that the next time? 3. Beware the “What the Hell” effect. Say you’ve sworn not to check your email before breakfast, but you’ve been online since your alarm went off…three hours ago. You’re now at risk for what researchers formally call the Abstinence Violation Effect (AVE) and jokingly call the “what the hell effect.” 4. Rededicate yourself to your detox (now, in this instant, not tomorrow). Why do you want to make the changes that you do? How will you benefit? Do a little deep breathing and calm contemplation of your goals. 5. Beware of moral licensing. This is a potential landmine to avoid on your better days: as you notice how well you are doing staying unplugged, don’t let yourself feel so good about the progress you are making that you unleash what researchers call the “licensing effect.” [QUESTION] Why is a digital detox so important? [TASK INSTRUCTIONS] Only use the information contained within the provided text to answer the question. Do not use outside sources. Write a full sentence and use a bullet point. Ensure the entire sentence is in italics.
|
Only use the information contained within the provided text to answer the question. Do not use outside sources. Write a full sentence and use a bullet point. Ensure the entire sentence is in italics.
EVIDENCE:
Digital Detox Guide Do you check your email, texts, voicemails, Facebook, or Twitter feed within an hour of waking up or going to sleep? While you’re in line at the store? During dinner with your family? Would you check it at a church while waiting for a funeral to start? Do a little thought experiment with me here. Imagine yourself sitting in a public place, not doing anything, just staring into space. How would you feel? Although many of us spent most of our childhoods daydreaming, adulthood seems to be about trying to keeping our minds from wandering, and trying to stay on task. Rarely do we just let ourselves stare into space these days. Look around: We can’t even stand to wait at a stoplight for 10 seconds without checking our smartphones. Why not? Because it’s uncomfortable for us not to be doing anything. At the very least, it’s boring. More than being boring, however, downtime and daydreaming are threatening to our sense of self. If busyness and multi-tasking and being pressed for time can be equated with significance, success, and productivity then downtime and daydreaming must be signs of insignificance, failure, and inefficiency. And when we feel insignificant and unsuccessful, we also tend to feel guilty for not working, ashamed that we aren’t important enough to be doing something, and anxious about our status. In the lab, these emotions are more painful than the actual physical pain of an electric shock. I’m endlessly fascinated by a series of studies led by Tim Wilson where the research subjects were put alone in a room, with nothing to do. The researchers describe their work: In 11 studies, we found that participants typically did not enjoy spending 6 to 15 minutes in a room by themselves with nothing to do but think, that they enjoyed doing mundane external activities much more, and that many preferred to administer electric shocks to themselves instead of being left alone with their thoughts. Most people seem to prefer to be doing something rather than nothing, even if that something is negative. You read that right: Many people (67 percent of men and 25 percent of women, to be exact) actually gave themselves painful electric shocks instead of just sitting there doing nothing–after they had indicated to the researchers that they would pay money NOT to be shocked again. One guy shocked himself 190 times in 15 minutes. When we can’t tolerate the feelings that come up when we aren’t doing anything, or when we can’t tolerate a lack of stimulation, we feel uncomfortable when we have downtime. As a result, we forfeit our downtime and all its benefits by seeking external stimulation, which is usually readily available in our purse or pocket (rather than an electric shock machine). Instead of just staring out the window on the bus, we read through our Facebook feed. Instead of being alone with our thoughts for a minute, we check our email waiting in line at the grocery store. Instead of enjoying our dinner, we mindlessly shovel food in our mouths while staring at a screen. THE BENEFITS OF UNPLUGGING In the grand scheme of things, digital usage rarely leads to meaning or fulfillment. But unplugging for at least one day per week will make you happier (in addition to giving you hours and hours to do the things that bring meaning to your life). Here’s why: 1. Detoxing from social media and digital information promotes overall wellbeing and mental health. Social media use is associated with narcissism, depression, loneliness, and other negative feelings like anger, envy, misery, and frustration. So, it’s hardly surprising that taking a break for a few days can improve our mood and overall happiness. 2. Your sleep will become more restorative, and sleep improves everything from health and happiness to performance and productivity. Physiologically, you’ll have an easier time sleeping because the low-energy blue light emitted by our tablets and smartphones stimulates chemical messengers in our brains that make us more alert and suppresses others (like melatonin) that help us fall asleep. In addition, you’ll have an easier time sleeping because you won’t be exciting your brain with new or stimulating information right efore bedtime. Social media, messages, and email can easily trigger the release of adrenalin, which makes it nearly impossible to fall asleep quickly. And needless to say, the less time it takes you to fall asleep at night, the more time you’ll have in the morning. 3. Bonus: You’ll feel less lonely and more connected, and feeling connected is the best predictor of happiness that we have. Though we think social media makes us feel more connected to others, ironically, it can also make us feel quite alone. Seeing friends and acquaintances post about how happy they are can actually trigger feelings of misery and loneliness, research shows. The benefits of unplugging from time to time are clearly enormous. But if unplugging isn’t undertaken properly, people often experience withdrawal symptoms, like feelings of agitation, guilt, and a compulsive and distracting desire to check our phones. THE SCIENCE OF CHECKING One survey found that 80% of 18 to 44-year-olds check their smartphones within the first 15 minutes of waking up–and that 89% of younger users, those ages 18- 24, reach for their device within 15 minutes of waking up. Seventy-four percent reach for it immediately after waking up. A quarter of those surveyed could not recall a time during the day that their device was not within reach or in the same room. Another study found that people tend to check their email about every 15 minutes; another found that in 2007 the average knowledge worker opened their email 50 times a day, while using instant messaging 77 times a day—imagine what that might be today, over a decade later, now that smartphones are ubiquitous and given the evidence that we spend more time checking than ever before. So, we check our smartphones constantly. Is that bad? A study of college students at Kent State University found that people who check their phones frequently tend to experience higher levels of distress during their leisure time (when they intend to relax). Similarly, Elizabeth Dunn and Kostadin Kushlev regulated how frequently participants checked their email throughout the day. Those striving to check only three times a day were less tense and less stressed overall. Moreover, checking constantly reduces our productivity. All that checking interrupts us from accomplishing our more important work; with each derailment, it takes us on average about a half hour to get back on track. So why do we check constantly, and first thing in the morning, if it just makes us tense and keeps us from getting our work done? Because it also feels, well…awesome. The Internet and electronic communications engage many of our senses—often simultaneously. All that checking excites our brain, providing the novelty and stimulation it adores. So even though disconnecting from the devices and communications that make us tense and decrease our productivity seems like a logical thing to do, your novelty-and-stimulation-seeking brain won’t want to do it. In fact, it will tell you that you are being more productive when you are online and connected to your messages than when you are disconnected and focusing on something important. This point is worth lingering on: how productive we are does not correlate well with how productive we feel. Multitasking and checking a lot feel productive because our brains are so stimulated when we are doing it. But it isn’t actually productive; one Stanford study showed that while media multitaskers tended to perceive themselves to be performing better, they actually tended to perform worse on every measure the researchers studied. Much of our checking and busyness, to paraphrase Shakespeare, is all sound and fury, no meaning or significance. You can sit all day in front of your computer checking and responding to email but accomplish not one of your priorities. It may feel like a more valuable activity, because it feels more productive. But it is neither. Now that we’ve established the benefits of unplugging and the dangers of checking, here’s how to unplug in a way that will lead to the best weekend EVER. Going unplugged for one day over the weekend will send many people into withdrawal. They will literally experience jitters, anxiety, and discomfort akin to physical pain. If you were in rehab for Opioid addiction, they might give you medication (like Methadone) to ease the pain. Unplugging is like a detox because the symptoms we experience when we stop checking our phones compulsively are uncomfortable; remember, many people would rather receive a painful electric shock than stand the pain of not checking, of not being “productive.” If you need rehab, here’s how to invent your own methadone. The idea is to do something naturally rewarding for your brain to ease the boredom, anxiety, and general twitchiness that tends to descend upon us when we unplug from technology. Unless you are some sort of superhero, you will not be able to cure yourself of your internet/device/email addiction perfectly the first time. So what to do if you’re struggling? 1. Don’t get too emotional about your slip or succumb to selfcriticism. Instead, forgive yourself. Remind yourself that lapses are part of the process, and that feeling guilty or bad about your behavior will not increase your future success. 2. Figure out what the problem is. This may be blazingly obvious, but in order to do better tomorrow, you’ll need to know what is causing your trip-ups. What temptation can you remove? Were you stressed or tired or hungry—and if so, how can you prevent that the next time? 3. Beware the “What the Hell” effect. Say you’ve sworn not to check your email before breakfast, but you’ve been online since your alarm went off…three hours ago. You’re now at risk for what researchers formally call the Abstinence Violation Effect (AVE) and jokingly call the “what the hell effect.” 4. Rededicate yourself to your detox (now, in this instant, not tomorrow). Why do you want to make the changes that you do? How will you benefit? Do a little deep breathing and calm contemplation of your goals. 5. Beware of moral licensing. This is a potential landmine to avoid on your better days: as you notice how well you are doing staying unplugged, don’t let yourself feel so good about the progress you are making that you unleash what researchers call the “licensing effect.”
USER:
Why is a digital detox so important?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 34 | 7 | 1,747 | null | 555 |
Answer the question using only information gathered from the prompt. Every time you name an animal, capitalize it.
|
For each animal mentioned in the document, summarize the text pertaining to it.
|
Hatchery Salmon Naturally spawned fish are genetically diverse and therefore considered to be more vigorous than the genetically more similar hatchery fish. Consequently, agency scientists have distinguished between hatchery-raised and wild salmon to maximize production of the latter. Over the years, these distinctions have been controversial in several respects. In 1993 NMFS issued its Interim Hatchery Listing Policy on how to consider hatchery fish in listing determinations for Pacific salmon and steelhead species. The interim policy concluded that hatchery fish could be in the same evolutionarily significant unit (ESU) as wild fish.20 Eventually, a federal court found that the interim policy violated the ESA by listing below the species level. The court found that if hatchery and wild salmon were in the same ESU, they should not have different listing status.21 NMFS revised the policy to reflect the court’s decision. The final hatchery listing policy (HLP) was released four years later, in 2005.22 The HLP requires NMFS to consider the status of the ESU as a whole, rather than the status of only the wild fish within the ESU, when determining whether to list the species. It also provides that the entire ESU would be listed, rather than just the wild fish. Two suits were filed in two different district courts. One suit challenged how the HLP affected steelhead trout. Two types of groups sued in the steelhead case: groups that wanted wild fish considered as distinct from hatchery fish, and groups that wanted to require NMFS to make no distinction between the origins of fish. The court found the HLP was invalid because it was not based on the best available scientific data.23 The court found the HLP undermined a fundamental purpose of the ESA—to preserve natural, self-sustaining populations. The court further found it scientifically questionable whether risk assessment criteria developed by NMFS for making status determinations could be applied to fish populations that included both hatchery and wild fish, since the criteria were designed to be applied only to wild fish. NMFS’s downlisting of steelhead from endangered to threatened by applying the HLP was ruled invalid. But the court upheld the NMFS decision to include hatchery and wild fish in the same ESU. The Ninth Circuit Court of Appeals upheld only a portion of the steelhead decision.24 The appellate court distinguished between the two steps of the listing process: defining the species, and then determining whether the species should be listed. The Ninth Circuit agreed with NMFS that the effects of hatchery fish on wild fish could be considered at the listing phase, not the definitional stage. The court gave discretion to NMFS’s science, although it noted that there may not be scientific consensus regarding the threat hatchery fish pose to wild fish. The appellate court reversed the lower court’s holding that downlisting the fish was invalid, finding that hatchery fish did not necessarily put wild fish at risk. A second suit was based on how the HLP affected salmon. In this case, the court held that NMFS properly considered hatchery and wild fish as having different extinction risks in its listing decision.25 The court rejected the plaintiffs’ argument that special regulations regarding taking salmon had to apply uniformly to hatchery and wild fish. The Ninth Circuit Court affirmed the lower court’s decision.26 Steller Sea Lions The western population of Steller sea lions was listed in 1990 as endangered under the ESA, and their abundance has been declining for several decades. 27 Starting in late 1998, NMFS prepared three biological opinions28 that were based on the hypothesis that intense fishing for pollock, Pacific cod, and Atka mackerel off Alaska was causing localized depletion of these fish and therefore starving Steller sea lions. Critics among commercial fishermen argued that NMFS based its biological opinion on a scientifically untested hypothesis to make a jeopardy finding on fishing levels and practices under the ESA, while NMFS insisted on a higher standard of certainty for the science under the Magnuson-Stevens Fishery Conservation and Management Act, supporting fishery management measures to address localized fish depletion problems. In a fourth biological opinion on authorization of these fisheries, NMFS took a different approach, after Steller sea lion feeding studies and population trends at some rookery sites raised questions about the localized depletion hypothesis. Litigation on this issue was settled early in 2003.29 In response, NMFS (1) published an addendum to its 2001 biological opinion to clarify the effects of the fisheries on Steller sea lions and their critical habitat and (2) completed a Final Programmatic Supplemental Environmental Impact Statement and Record of Decision concerning the Alaska groundfish fishery. In early December 2010, NMFS restrictions on commercial Atka mackerel and Pacific cod fishing in the western Aleutians to protect western Steller sea lions reignited this controversy.30 As a result of litigation challenging the NMFS determination that commercial fishing jeopardized those Steller sea lions, a court ordered NMFS to prepare an environmental impact statement for Steller sea lion protection measures. 31 Gray Wolves in Eastern States Wolves are an adaptable species, as shown by their behavior and by their presence in a tremendous variety of ecosystems.32 Variations in color, size, and bone structure have led some mammalogists to designate wolves in different areas as different subspecies or populations, whereas other experts would recognize only a single species with variability. Biologists commonly describe their colleagues as lumpers or splitters, based on their inclinations in classifying organisms. As the names suggest, lumpers are those who tend to minimize differences, and see one or a few species, perhaps with some variations, while splitters tend to emphasize those differences, dividing a species into many subspecies, or populations. As one well-known mammalogist once stated: “Splitters make very small units—their opponents say that if they can tell two animals apart, they place them in different genera, and if they cannot tell them apart, they place them in different species. Lumpers make large units—their opponents say that if a carnivore is neither a dog nor a bear they call it a cat.” 33 For wolves, which are (or were) found in temperate and polar areas throughout the Northern Hemisphere, some observers (splitters) have argued that there are as many as 24 subspecies in North America and 8 in Europe and Asia.34 More recently, lumpers have had the upper hand in the scientific community. However, that tide may be changing. In May 2011, the U.S. Fish and Wildlife Service (FWS) proposed recognizing a third species of wolf (Canis lycaon), in addition to the gray and red wolf.35 The wolves being considered for this new species designation live (or lived) primarily in the eastern United States. In the ESA context, the academic debate has considerable significance. Under the ESA, if a taxon is listed (for example the genus Hylobates), then all of the species of gibbons which belong to that genus are all protected. Similarly, if Canis lupus is listed, then all wolves (subspecies, and DPS) belonging to that species are all protected. However, if FWS concludes that there are animals commonly referred to as wolves, but which do not belong to Canis lupus at all, then those wolves would lose their ESA protections unless or until they won ESA protection on their own merits. From a scientific viewpoint, designating wolves found in the eastern United States as a separate species is not assured. For example, the encyclopedic Mammal Species of the World discusses the validity of Canis lycaon as a distinct species and concludes that evidence for separation is equivocal.36 However, it does not currently consider this wolf in the East to be a distinct species. Moreover, the North American consortium of national professionals who manage the Integrated Taxonomic Information System (ITIS, the source considered authoritative on taxonomy and taxonomic validity in the United States and its territories, Mexico, and Canada) currently considers this wolf as a subspecies (Canis lupus lycaon). 37 The validity debate considers evidence related to mitochondrial DNA, morphology, evidence of hybridization with coyotes, the natural variability of widely distributed species, and the extremely low population densities that make conclusive evidence difficult to obtain. A change in the taxonomic status would, in effect, de-list any remaining eastern wolves on the basis of that new status, rather than on an assessment of its conservation status. Only a new decision to list would return such wolves to a protected status.
|
Context: Hatchery Salmon Naturally spawned fish are genetically diverse and therefore considered to be more vigorous than the genetically more similar hatchery fish. Consequently, agency scientists have distinguished between hatchery-raised and wild salmon to maximize production of the latter. Over the years, these distinctions have been controversial in several respects. In 1993 NMFS issued its Interim Hatchery Listing Policy on how to consider hatchery fish in listing determinations for Pacific salmon and steelhead species. The interim policy concluded that hatchery fish could be in the same evolutionarily significant unit (ESU) as wild fish.20 Eventually, a federal court found that the interim policy violated the ESA by listing below the species level. The court found that if hatchery and wild salmon were in the same ESU, they should not have different listing status.21 NMFS revised the policy to reflect the court’s decision. The final hatchery listing policy (HLP) was released four years later, in 2005.22 The HLP requires NMFS to consider the status of the ESU as a whole, rather than the status of only the wild fish within the ESU, when determining whether to list the species. It also provides that the entire ESU would be listed, rather than just the wild fish. Two suits were filed in two different district courts. One suit challenged how the HLP affected steelhead trout. Two types of groups sued in the steelhead case: groups that wanted wild fish considered as distinct from hatchery fish, and groups that wanted to require NMFS to make no distinction between the origins of fish. The court found the HLP was invalid because it was not based on the best available scientific data.23 The court found the HLP undermined a fundamental purpose of the ESA—to preserve natural, self-sustaining populations. The court further found it scientifically questionable whether risk assessment criteria developed by NMFS for making status determinations could be applied to fish populations that included both hatchery and wild fish, since the criteria were designed to be applied only to wild fish. NMFS’s downlisting of steelhead from endangered to threatened by applying the HLP was ruled invalid. But the court upheld the NMFS decision to include hatchery and wild fish in the same ESU. The Ninth Circuit Court of Appeals upheld only a portion of the steelhead decision.24 The appellate court distinguished between the two steps of the listing process: defining the species, and then determining whether the species should be listed. The Ninth Circuit agreed with NMFS that the effects of hatchery fish on wild fish could be considered at the listing phase, not the definitional stage. The court gave discretion to NMFS’s science, although it noted that there may not be scientific consensus regarding the threat hatchery fish pose to wild fish. The appellate court reversed the lower court’s holding that downlisting the fish was invalid, finding that hatchery fish did not necessarily put wild fish at risk. A second suit was based on how the HLP affected salmon. In this case, the court held that NMFS properly considered hatchery and wild fish as having different extinction risks in its listing decision.25 The court rejected the plaintiffs’ argument that special regulations regarding taking salmon had to apply uniformly to hatchery and wild fish. The Ninth Circuit Court affirmed the lower court’s decision.26 Steller Sea Lions The western population of Steller sea lions was listed in 1990 as endangered under the ESA, and their abundance has been declining for several decades. 27 Starting in late 1998, NMFS prepared three biological opinions28 that were based on the hypothesis that intense fishing for pollock, Pacific cod, and Atka mackerel off Alaska was causing localized depletion of these fish and therefore starving Steller sea lions. Critics among commercial fishermen argued that NMFS based its biological opinion on a scientifically untested hypothesis to make a jeopardy finding on fishing levels and practices under the ESA, while NMFS insisted on a higher standard of certainty for the science under the Magnuson-Stevens Fishery Conservation and Management Act, supporting fishery management measures to address localized fish depletion problems. In a fourth biological opinion on authorization of these fisheries, NMFS took a different approach, after Steller sea lion feeding studies and population trends at some rookery sites raised questions about the localized depletion hypothesis. Litigation on this issue was settled early in 2003.29 In response, NMFS (1) published an addendum to its 2001 biological opinion to clarify the effects of the fisheries on Steller sea lions and their critical habitat and (2) completed a Final Programmatic Supplemental Environmental Impact Statement and Record of Decision concerning the Alaska groundfish fishery. In early December 2010, NMFS restrictions on commercial Atka mackerel and Pacific cod fishing in the western Aleutians to protect western Steller sea lions reignited this controversy.30 As a result of litigation challenging the NMFS determination that commercial fishing jeopardized those Steller sea lions, a court ordered NMFS to prepare an environmental impact statement for Steller sea lion protection measures. 31 Gray Wolves in Eastern States Wolves are an adaptable species, as shown by their behavior and by their presence in a tremendous variety of ecosystems.32 Variations in color, size, and bone structure have led some mammalogists to designate wolves in different areas as different subspecies or populations, whereas other experts would recognize only a single species with variability. Biologists commonly describe their colleagues as lumpers or splitters, based on their inclinations in classifying organisms. As the names suggest, lumpers are those who tend to minimize differences, and see one or a few species, perhaps with some variations, while splitters tend to emphasize those differences, dividing a species into many subspecies, or populations. As one well-known mammalogist once stated: “Splitters make very small units—their opponents say that if they can tell two animals apart, they place them in different genera, and if they cannot tell them apart, they place them in different species. Lumpers make large units—their opponents say that if a carnivore is neither a dog nor a bear they call it a cat.” 33 For wolves, which are (or were) found in temperate and polar areas throughout the Northern Hemisphere, some observers (splitters) have argued that there are as many as 24 subspecies in North America and 8 in Europe and Asia.34 More recently, lumpers have had the upper hand in the scientific community. However, that tide may be changing. In May 2011, the U.S. Fish and Wildlife Service (FWS) proposed recognizing a third species of wolf (Canis lycaon), in addition to the gray and red wolf.35 The wolves being considered for this new species designation live (or lived) primarily in the eastern United States. In the ESA context, the academic debate has considerable significance. Under the ESA, if a taxon is listed (for example the genus Hylobates), then all of the species of gibbons which belong to that genus are all protected. Similarly, if Canis lupus is listed, then all wolves (subspecies, and DPS) belonging to that species are all protected. However, if FWS concludes that there are animals commonly referred to as wolves, but which do not belong to Canis lupus at all, then those wolves would lose their ESA protections unless or until they won ESA protection on their own merits. From a scientific viewpoint, designating wolves found in the eastern United States as a separate species is not assured. For example, the encyclopedic Mammal Species of the World discusses the validity of Canis lycaon as a distinct species and concludes that evidence for separation is equivocal.36 However, it does not currently consider this wolf in the East to be a distinct species. Moreover, the North American consortium of national professionals who manage the Integrated Taxonomic Information System (ITIS, the source considered authoritative on taxonomy and taxonomic validity in the United States and its territories, Mexico, and Canada) currently considers this wolf as a subspecies (Canis lupus lycaon). 37 The validity debate considers evidence related to mitochondrial DNA, morphology, evidence of hybridization with coyotes, the natural variability of widely distributed species, and the extremely low population densities that make conclusive evidence difficult to obtain. A change in the taxonomic status would, in effect, de-list any remaining eastern wolves on the basis of that new status, rather than on an assessment of its conservation status. Only a new decision to list would return such wolves to a protected status. Question: For each animal mentioned in the document, summarize the text pertaining to it. System Instructions: Answer the question using only information gathered from the prompt. Every time you name an animal, capitalize it.
|
Answer the question using only information gathered from the prompt. Every time you name an animal, capitalize it.
EVIDENCE:
Hatchery Salmon Naturally spawned fish are genetically diverse and therefore considered to be more vigorous than the genetically more similar hatchery fish. Consequently, agency scientists have distinguished between hatchery-raised and wild salmon to maximize production of the latter. Over the years, these distinctions have been controversial in several respects. In 1993 NMFS issued its Interim Hatchery Listing Policy on how to consider hatchery fish in listing determinations for Pacific salmon and steelhead species. The interim policy concluded that hatchery fish could be in the same evolutionarily significant unit (ESU) as wild fish.20 Eventually, a federal court found that the interim policy violated the ESA by listing below the species level. The court found that if hatchery and wild salmon were in the same ESU, they should not have different listing status.21 NMFS revised the policy to reflect the court’s decision. The final hatchery listing policy (HLP) was released four years later, in 2005.22 The HLP requires NMFS to consider the status of the ESU as a whole, rather than the status of only the wild fish within the ESU, when determining whether to list the species. It also provides that the entire ESU would be listed, rather than just the wild fish. Two suits were filed in two different district courts. One suit challenged how the HLP affected steelhead trout. Two types of groups sued in the steelhead case: groups that wanted wild fish considered as distinct from hatchery fish, and groups that wanted to require NMFS to make no distinction between the origins of fish. The court found the HLP was invalid because it was not based on the best available scientific data.23 The court found the HLP undermined a fundamental purpose of the ESA—to preserve natural, self-sustaining populations. The court further found it scientifically questionable whether risk assessment criteria developed by NMFS for making status determinations could be applied to fish populations that included both hatchery and wild fish, since the criteria were designed to be applied only to wild fish. NMFS’s downlisting of steelhead from endangered to threatened by applying the HLP was ruled invalid. But the court upheld the NMFS decision to include hatchery and wild fish in the same ESU. The Ninth Circuit Court of Appeals upheld only a portion of the steelhead decision.24 The appellate court distinguished between the two steps of the listing process: defining the species, and then determining whether the species should be listed. The Ninth Circuit agreed with NMFS that the effects of hatchery fish on wild fish could be considered at the listing phase, not the definitional stage. The court gave discretion to NMFS’s science, although it noted that there may not be scientific consensus regarding the threat hatchery fish pose to wild fish. The appellate court reversed the lower court’s holding that downlisting the fish was invalid, finding that hatchery fish did not necessarily put wild fish at risk. A second suit was based on how the HLP affected salmon. In this case, the court held that NMFS properly considered hatchery and wild fish as having different extinction risks in its listing decision.25 The court rejected the plaintiffs’ argument that special regulations regarding taking salmon had to apply uniformly to hatchery and wild fish. The Ninth Circuit Court affirmed the lower court’s decision.26 Steller Sea Lions The western population of Steller sea lions was listed in 1990 as endangered under the ESA, and their abundance has been declining for several decades. 27 Starting in late 1998, NMFS prepared three biological opinions28 that were based on the hypothesis that intense fishing for pollock, Pacific cod, and Atka mackerel off Alaska was causing localized depletion of these fish and therefore starving Steller sea lions. Critics among commercial fishermen argued that NMFS based its biological opinion on a scientifically untested hypothesis to make a jeopardy finding on fishing levels and practices under the ESA, while NMFS insisted on a higher standard of certainty for the science under the Magnuson-Stevens Fishery Conservation and Management Act, supporting fishery management measures to address localized fish depletion problems. In a fourth biological opinion on authorization of these fisheries, NMFS took a different approach, after Steller sea lion feeding studies and population trends at some rookery sites raised questions about the localized depletion hypothesis. Litigation on this issue was settled early in 2003.29 In response, NMFS (1) published an addendum to its 2001 biological opinion to clarify the effects of the fisheries on Steller sea lions and their critical habitat and (2) completed a Final Programmatic Supplemental Environmental Impact Statement and Record of Decision concerning the Alaska groundfish fishery. In early December 2010, NMFS restrictions on commercial Atka mackerel and Pacific cod fishing in the western Aleutians to protect western Steller sea lions reignited this controversy.30 As a result of litigation challenging the NMFS determination that commercial fishing jeopardized those Steller sea lions, a court ordered NMFS to prepare an environmental impact statement for Steller sea lion protection measures. 31 Gray Wolves in Eastern States Wolves are an adaptable species, as shown by their behavior and by their presence in a tremendous variety of ecosystems.32 Variations in color, size, and bone structure have led some mammalogists to designate wolves in different areas as different subspecies or populations, whereas other experts would recognize only a single species with variability. Biologists commonly describe their colleagues as lumpers or splitters, based on their inclinations in classifying organisms. As the names suggest, lumpers are those who tend to minimize differences, and see one or a few species, perhaps with some variations, while splitters tend to emphasize those differences, dividing a species into many subspecies, or populations. As one well-known mammalogist once stated: “Splitters make very small units—their opponents say that if they can tell two animals apart, they place them in different genera, and if they cannot tell them apart, they place them in different species. Lumpers make large units—their opponents say that if a carnivore is neither a dog nor a bear they call it a cat.” 33 For wolves, which are (or were) found in temperate and polar areas throughout the Northern Hemisphere, some observers (splitters) have argued that there are as many as 24 subspecies in North America and 8 in Europe and Asia.34 More recently, lumpers have had the upper hand in the scientific community. However, that tide may be changing. In May 2011, the U.S. Fish and Wildlife Service (FWS) proposed recognizing a third species of wolf (Canis lycaon), in addition to the gray and red wolf.35 The wolves being considered for this new species designation live (or lived) primarily in the eastern United States. In the ESA context, the academic debate has considerable significance. Under the ESA, if a taxon is listed (for example the genus Hylobates), then all of the species of gibbons which belong to that genus are all protected. Similarly, if Canis lupus is listed, then all wolves (subspecies, and DPS) belonging to that species are all protected. However, if FWS concludes that there are animals commonly referred to as wolves, but which do not belong to Canis lupus at all, then those wolves would lose their ESA protections unless or until they won ESA protection on their own merits. From a scientific viewpoint, designating wolves found in the eastern United States as a separate species is not assured. For example, the encyclopedic Mammal Species of the World discusses the validity of Canis lycaon as a distinct species and concludes that evidence for separation is equivocal.36 However, it does not currently consider this wolf in the East to be a distinct species. Moreover, the North American consortium of national professionals who manage the Integrated Taxonomic Information System (ITIS, the source considered authoritative on taxonomy and taxonomic validity in the United States and its territories, Mexico, and Canada) currently considers this wolf as a subspecies (Canis lupus lycaon). 37 The validity debate considers evidence related to mitochondrial DNA, morphology, evidence of hybridization with coyotes, the natural variability of widely distributed species, and the extremely low population densities that make conclusive evidence difficult to obtain. A change in the taxonomic status would, in effect, de-list any remaining eastern wolves on the basis of that new status, rather than on an assessment of its conservation status. Only a new decision to list would return such wolves to a protected status.
USER:
For each animal mentioned in the document, summarize the text pertaining to it.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 18 | 13 | 1,386 | null | 831 |
the model should only respond using information presented in the prompt/context block. the model response should contain at least three bullet points.
|
Please summarize the three articles mentioned
|
Legislative History Congress enacted the UCMJ in 1950, and it entered into force in 1951. At the time of enactment, Article 43 provided that there was no statute of limitations for “desertion or absence without leave in time of war, or with aiding the enemy, mutiny, or murder” and set a three-year statute of limitations for most other offenses, including rape. Article 120 provided that a person guilty of rape “shall be punished by death or such other punishment as a court-martial may direct.” Article 55, then as now, prohibits “[p]unishment by flogging, or by branding, marking, or tattooing on the body, or any other cruel or unusual punishment.” Amendments to Article 43 As relevant to Briggs and Collins, Congress has amended Article 43 three times. In 1986, Congress provided that there was no statute of limitations for “any offense punishable by death” and set a five-year statute of limitations for most other offenses. These statutes of limitations mirrored their civilian counterparts, which are codified at 18 U.S.C. § 3281 for offenses punishable by death, and § 3282 for other offenses. Congress again amended Article 43 in 2003, setting a twenty-five-year statute of limitations for child abuse offenses, including rape of a child under Article 120. Most recently, Congress amended Article 43 in the National Defense Authorization Act for Fiscal Year 2006 (2006 NDAA) in a section titled “Extension of Statute of Limitations for Murder, Rape, and Child Abuse Offenses under the [UCMJ].” The 2006 amendments provided that there is no statute of limitations for “murder or rape, or [for] any other offenses punishable by death” and modified the twenty-five-year statute of limitations for child abuse offenses other than rape. In an accompanying report, the Senate Committee on Armed Services described the amendments as “clarify[ing] that all murders are included in the class of offenses that has an unlimited statute of limitations . . . [and] includ[ing] rape in that class of offenses.” Amendments to Article 120 As with Article 43, Congress has amended Article 120 several times since its enactment. Of note, in the 2006 NDAA, Congress amended Article 120 to specify that a person guilty of rape “shall be punished as a court-martial may direct,” removing the statutory authority to punish rape by death. Judicial Interpretations Before Briggs and Collins, the Supreme Court had not interpreted Articles 43, 55, or 120, but several lower courts, including the U.S. Court of Appeals for the Armed Forces (CAAF), had done so. Three cases are particularly relevant to Briggs and Collins. First, in the 1983 case United States v. Matthews, the CAAF (then known as the U.S. Court of Military Appeals) addressed whether Article 55 protected servicemembers from cruel and unusual punishment in the same manner as the Eighth Amendment to the U.S. Constitution. Specifically, the court considered whether the Eighth Amendment’s prohibition on cruel and unusual punishment barred the imposition of the death penalty on a servicemember found guilty of rape and murder. The court held that “a servicemember is entitled both by statute [under Article 55] and under the Eighth Amendment to protection against ‘cruel and unusual punishments.’” It recognized, however, that, “since in many ways the military community is unique, . . . there may be circumstances under which the rules governing capital punishment of servicemembers will be different from those applicable to civilians.” Congressional Research Service 3 In dicta, the Matthews court further observed that, while “Congress obviously intended that in cases where an accused servicemember is convicted of . . . rape, the court-martial members should have the option to adjudge a death sentence,” this intent “[p]robably . . . cannot be constitutionally effectuated in a case where the rape of an adult female is involved, . . . at least, where there is no purpose unique to the military mission that would be served by allowing the death penalty for this offense.” The court based its reasoning on the Supreme Court’s 1977 holding in Coker v. Georgia that “a sentence of death is grossly disproportionate and excessive punishment for the crime of rape and is therefore forbidden by the Eighth Amendment as cruel and unusual punishment.” Second, in the 1998 case Willenbring v. Neurauter, the CAAF held there was no statute of limitations for rape, relying on the contemporaneous language of Articles 43(a) (“A person charged . . . with any offense punishable by death, may be tried and punished at any time without limitation”) and 120(a) (any person “guilty of rape . . . shall be punished by death or such other punishment as a court-martial may direct”). The CAAF considered its decision in Matthews and the Supreme Court’s decision in Coker but held that the 1986 amendment to Article 43 “was meant to apply to the most serious offenses without listing each one in the statute.” The CAAF concluded that rape under Article 120 was an offense that Congress deemed punishable by death, regardless of whether such a sentence constitutionally could be imposed. Third, and most recently, in the 2018 case United States v. Mangahas, the CAAF overruled Willenbring. Relying on Coker, the CAAF reasoned that where “there is no set of circumstances under which the death penalty could constitutionally be imposed for the rape of an adult woman, that offense is simply not ‘punishable by death.’” Recognizing that “Willenbring gave short shrift to this highly salient point,” the court overruled its prior decision. The CAAF concluded that because rape was not constitutionally punishable by death, rapes committed between 1986 and 2006 are subject to a five-year statute of limitations under Article 43
|
System instruction: the model should only respond using information presented in the prompt/context block. the model response should contain at least three bullet points. context: Legislative History Congress enacted the UCMJ in 1950, and it entered into force in 1951. At the time of enactment, Article 43 provided that there was no statute of limitations for “desertion or absence without leave in time of war, or with aiding the enemy, mutiny, or murder” and set a three-year statute of limitations for most other offenses, including rape. Article 120 provided that a person guilty of rape “shall be punished by death or such other punishment as a court-martial may direct.” Article 55, then as now, prohibits “[p]unishment by flogging, or by branding, marking, or tattooing on the body, or any other cruel or unusual punishment.” Amendments to Article 43 As relevant to Briggs and Collins, Congress has amended Article 43 three times. In 1986, Congress provided that there was no statute of limitations for “any offense punishable by death” and set a five-year statute of limitations for most other offenses. These statutes of limitations mirrored their civilian counterparts, which are codified at 18 U.S.C. § 3281 for offenses punishable by death, and § 3282 for other offenses. Congress again amended Article 43 in 2003, setting a twenty-five-year statute of limitations for child abuse offenses, including rape of a child under Article 120. Most recently, Congress amended Article 43 in the National Defense Authorization Act for Fiscal Year 2006 (2006 NDAA) in a section titled “Extension of Statute of Limitations for Murder, Rape, and Child Abuse Offenses under the [UCMJ].” The 2006 amendments provided that there is no statute of limitations for “murder or rape, or [for] any other offenses punishable by death” and modified the twenty-five-year statute of limitations for child abuse offenses other than rape. In an accompanying report, the Senate Committee on Armed Services described the amendments as “clarify[ing] that all murders are included in the class of offenses that has an unlimited statute of limitations . . . [and] includ[ing] rape in that class of offenses.” Amendments to Article 120 As with Article 43, Congress has amended Article 120 several times since its enactment. Of note, in the 2006 NDAA, Congress amended Article 120 to specify that a person guilty of rape “shall be punished as a court-martial may direct,” removing the statutory authority to punish rape by death. Judicial Interpretations Before Briggs and Collins, the Supreme Court had not interpreted Articles 43, 55, or 120, but several lower courts, including the U.S. Court of Appeals for the Armed Forces (CAAF), had done so. Three cases are particularly relevant to Briggs and Collins. First, in the 1983 case United States v. Matthews, the CAAF (then known as the U.S. Court of Military Appeals) addressed whether Article 55 protected servicemembers from cruel and unusual punishment in the same manner as the Eighth Amendment to the U.S. Constitution. Specifically, the court considered whether the Eighth Amendment’s prohibition on cruel and unusual punishment barred the imposition of the death penalty on a servicemember found guilty of rape and murder. The court held that “a servicemember is entitled both by statute [under Article 55] and under the Eighth Amendment to protection against ‘cruel and unusual punishments.’” It recognized, however, that, “since in many ways the military community is unique, . . . there may be circumstances under which the rules governing capital punishment of servicemembers will be different from those applicable to civilians.” Congressional Research Service 3 In dicta, the Matthews court further observed that, while “Congress obviously intended that in cases where an accused servicemember is convicted of . . . rape, the court-martial members should have the option to adjudge a death sentence,” this intent “[p]robably . . . cannot be constitutionally effectuated in a case where the rape of an adult female is involved, . . . at least, where there is no purpose unique to the military mission that would be served by allowing the death penalty for this offense.” The court based its reasoning on the Supreme Court’s 1977 holding in Coker v. Georgia that “a sentence of death is grossly disproportionate and excessive punishment for the crime of rape and is therefore forbidden by the Eighth Amendment as cruel and unusual punishment.” Second, in the 1998 case Willenbring v. Neurauter, the CAAF held there was no statute of limitations for rape, relying on the contemporaneous language of Articles 43(a) (“A person charged . . . with any offense punishable by death, may be tried and punished at any time without limitation”) and 120(a) (any person “guilty of rape . . . shall be punished by death or such other punishment as a court-martial may direct”). The CAAF considered its decision in Matthews and the Supreme Court’s decision in Coker but held that the 1986 amendment to Article 43 “was meant to apply to the most serious offenses without listing each one in the statute.” The CAAF concluded that rape under Article 120 was an offense that Congress deemed punishable by death, regardless of whether such a sentence constitutionally could be imposed. Third, and most recently, in the 2018 case United States v. Mangahas, the CAAF overruled Willenbring. Relying on Coker, the CAAF reasoned that where “there is no set of circumstances under which the death penalty could constitutionally be imposed for the rape of an adult woman, that offense is simply not ‘punishable by death.’” Recognizing that “Willenbring gave short shrift to this highly salient point,” the court overruled its prior decision. The CAAF concluded that because rape was not constitutionally punishable by death, rapes committed between 1986 and 2006 are subject to a five-year statute of limitations under Article 43 question: please summarize the three articles mentioned
|
the model should only respond using information presented in the prompt/context block. the model response should contain at least three bullet points.
EVIDENCE:
Legislative History Congress enacted the UCMJ in 1950, and it entered into force in 1951. At the time of enactment, Article 43 provided that there was no statute of limitations for “desertion or absence without leave in time of war, or with aiding the enemy, mutiny, or murder” and set a three-year statute of limitations for most other offenses, including rape. Article 120 provided that a person guilty of rape “shall be punished by death or such other punishment as a court-martial may direct.” Article 55, then as now, prohibits “[p]unishment by flogging, or by branding, marking, or tattooing on the body, or any other cruel or unusual punishment.” Amendments to Article 43 As relevant to Briggs and Collins, Congress has amended Article 43 three times. In 1986, Congress provided that there was no statute of limitations for “any offense punishable by death” and set a five-year statute of limitations for most other offenses. These statutes of limitations mirrored their civilian counterparts, which are codified at 18 U.S.C. § 3281 for offenses punishable by death, and § 3282 for other offenses. Congress again amended Article 43 in 2003, setting a twenty-five-year statute of limitations for child abuse offenses, including rape of a child under Article 120. Most recently, Congress amended Article 43 in the National Defense Authorization Act for Fiscal Year 2006 (2006 NDAA) in a section titled “Extension of Statute of Limitations for Murder, Rape, and Child Abuse Offenses under the [UCMJ].” The 2006 amendments provided that there is no statute of limitations for “murder or rape, or [for] any other offenses punishable by death” and modified the twenty-five-year statute of limitations for child abuse offenses other than rape. In an accompanying report, the Senate Committee on Armed Services described the amendments as “clarify[ing] that all murders are included in the class of offenses that has an unlimited statute of limitations . . . [and] includ[ing] rape in that class of offenses.” Amendments to Article 120 As with Article 43, Congress has amended Article 120 several times since its enactment. Of note, in the 2006 NDAA, Congress amended Article 120 to specify that a person guilty of rape “shall be punished as a court-martial may direct,” removing the statutory authority to punish rape by death. Judicial Interpretations Before Briggs and Collins, the Supreme Court had not interpreted Articles 43, 55, or 120, but several lower courts, including the U.S. Court of Appeals for the Armed Forces (CAAF), had done so. Three cases are particularly relevant to Briggs and Collins. First, in the 1983 case United States v. Matthews, the CAAF (then known as the U.S. Court of Military Appeals) addressed whether Article 55 protected servicemembers from cruel and unusual punishment in the same manner as the Eighth Amendment to the U.S. Constitution. Specifically, the court considered whether the Eighth Amendment’s prohibition on cruel and unusual punishment barred the imposition of the death penalty on a servicemember found guilty of rape and murder. The court held that “a servicemember is entitled both by statute [under Article 55] and under the Eighth Amendment to protection against ‘cruel and unusual punishments.’” It recognized, however, that, “since in many ways the military community is unique, . . . there may be circumstances under which the rules governing capital punishment of servicemembers will be different from those applicable to civilians.” Congressional Research Service 3 In dicta, the Matthews court further observed that, while “Congress obviously intended that in cases where an accused servicemember is convicted of . . . rape, the court-martial members should have the option to adjudge a death sentence,” this intent “[p]robably . . . cannot be constitutionally effectuated in a case where the rape of an adult female is involved, . . . at least, where there is no purpose unique to the military mission that would be served by allowing the death penalty for this offense.” The court based its reasoning on the Supreme Court’s 1977 holding in Coker v. Georgia that “a sentence of death is grossly disproportionate and excessive punishment for the crime of rape and is therefore forbidden by the Eighth Amendment as cruel and unusual punishment.” Second, in the 1998 case Willenbring v. Neurauter, the CAAF held there was no statute of limitations for rape, relying on the contemporaneous language of Articles 43(a) (“A person charged . . . with any offense punishable by death, may be tried and punished at any time without limitation”) and 120(a) (any person “guilty of rape . . . shall be punished by death or such other punishment as a court-martial may direct”). The CAAF considered its decision in Matthews and the Supreme Court’s decision in Coker but held that the 1986 amendment to Article 43 “was meant to apply to the most serious offenses without listing each one in the statute.” The CAAF concluded that rape under Article 120 was an offense that Congress deemed punishable by death, regardless of whether such a sentence constitutionally could be imposed. Third, and most recently, in the 2018 case United States v. Mangahas, the CAAF overruled Willenbring. Relying on Coker, the CAAF reasoned that where “there is no set of circumstances under which the death penalty could constitutionally be imposed for the rape of an adult woman, that offense is simply not ‘punishable by death.’” Recognizing that “Willenbring gave short shrift to this highly salient point,” the court overruled its prior decision. The CAAF concluded that because rape was not constitutionally punishable by death, rapes committed between 1986 and 2006 are subject to a five-year statute of limitations under Article 43
USER:
Please summarize the three articles mentioned
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 22 | 6 | 930 | null | 672 |
This task requires you to draw your answer from the given text only. Do not use any outside resources or prior knowledge. Your answer must be 100 words or less.
|
What arguments did the US Court of appeals reject?
|
In April 2024, the Federal Trade Commission (FTC) issued a rule prohibiting most employers from entering into or enforcing non-compete agreements with workers, subject to exceptions for the sale of a business and preexisting non-competes with senior executives. The rule (the Non-Compete Rule) implicates unsettled issues regarding the FTC’s authority to issue substantive competition regulations. Lawsuits challenging the rule followed. In one of those cases, a federal district court has declared the Non-Compete Rule unlawful and barred the FTC from enforcing it nationwide. Shortly before that decision, another court held that a separate challenge to the rule was likely to succeed and preliminarily enjoined the rule’s enforcement against the named plaintiff in that case. A third court has taken a more favorable view of the Non-Compete Rule, denying a motion for a preliminary injunction and concluding that the plaintiff had not established a reasonable probability that the rule exceeds the FTC’s legal authority. This Legal Sidebar provides background on the Non-Compete Rule and associated legal issues, along with an overview of the litigation challenging it. Background The Non-Compete Rule The Non-Compete Rule makes it unlawful to enter into or enforce a non-compete clause with any worker who is not a senior executive. The rule prohibits employers from entering into non-competes with senior executives after the rule’s effective date, but allows employers to enforce preexisting non-competes with senior executives. The rule defines the term “senior executive” to mean a worker who occupied a “policy-making position” and received total compensation of at least $151,164 in the preceding year. The rule’s prohibitions are subject to an exception for non-compete clauses entered into pursuant to a bona fide sale of a business entity, a person’s ownership interest in a business entity, or all or substantially all of a business entity’s operating assets. Congressional Research Service https://crsreports.congress.gov LSB11228 Congressional Research Service 2 The rule defines the term “non-compete clause” to mean a term or condition of employment that “prohibits,” “penalizes,” or “functions to prevent” a worker from seeking or accepting work with a different person after the conclusion of the employment that includes the term or condition. The rule explains that this definition encompasses “de facto” or “functional” non-competes—for example, “forfeiture-for-competition” clauses that extinguish an employer’s obligation to pay promised compensation or benefits if a worker accepts another job. The rule does not, however, categorically prohibit non-disclosure agreements (NDAs) or non-solicitation agreements. The Non-Compete Rule defines the term “worker” to include employees and independent contractors. That term does not include franchisees in the context of a franchisor-franchisee relationship, but does include employees of a franchisor or franchisee. Employers that fall outside of the FTC’s jurisdiction under the FTC Act are not subject to the rule. These employers include certain banks, savings and loan institutions, federal credit unions, common carriers, air carriers, and “persons, partnerships, or corporations insofar as they are subject to the Packers and Stockyards Act.” Corporations that are not “organized to carry on business for [their] own profit or that of [their] members” are also excluded from the FTC Act’s coverage. The rule explains that simply claiming non-profit status under the tax code is not sufficient to qualify for this exclusion. Instead, the FTC evaluates the economic realities of an entity’s activities to determine whether the exclusion applies. The Non-Compete Rule requires employers to provide “clear and conspicuous notice” to workers subject to prohibited non-compete clauses that the clauses “will not be, and cannot legally be” enforced. Legal Authority The FTC relied on Sections 5 and 6(g) of the Federal Trade Commission Act (FTC Act) in promulgating the Non-Compete Rule. Section 5 prohibits “unfair methods of competition” (UMC) and empowers the FTC to enforce that prohibition through adjudication. Section 6 is titled “Additional powers of Commission.” It confers a range of authorities, most of which involve investigations and the publication of reports. The provision also includes Section 6(g), which empowers the FTC to “from time to time classify corporations and . . . to make rules and regulations for the purpose of carrying out” the FTC Act. Sections 5 and 6(g) were both part of the original FTC Act, which Congress enacted in 1914. Since the statute’s enactment, Congress has adopted several laws granting the FTC rulemaking authority over discrete subjects, including the Wool Products Labeling Act, the Textile Fiber Products Identification Act, the Fur Products Labeling Act, the Flammable Fabrics Act, and the Fair Packaging and Labeling Act. The FTC first asserted that Section 6(g) endows it with general substantive rulemaking power in 1962, and the agency adopted a number of trade regulation rules in the years that followed. Some of those rules defined certain conduct as both a UMC and an “unfair or deceptive act or practice” (UDAP)—a separate category of conduct prohibited by Section 5. Other rules relied only on the FTC’s UDAP power. One rule relied solely on the FTC’s competition authority, but was never enforced and has been repealed. In the 1970s, a trade association challenged the FTC’s authority to issue substantive rules under Section 6(g) in National Petroleum Refiners Association v. FTC. The trade association argued that Section 6(g) authorized only procedural rules, emphasizing that the FTC had not asserted substantive rulemaking authority under Section 6(g) until 1962 and that FTC officials had occasionally denied the existence of such authority. The trade association also contended that Congress’s enactment of several statutes granting the FTC specific rulemaking authorities implied that the FTC lacked general rulemaking authority. The U.S. Court of Appeals for the D.C. Circuit rejected those arguments. In affirming the FTC’s power to issue legislative rules under Section 6(g), the court relied on appellate decisions construing similar statutes as authorizing substantive rulemaking, the advantages of rulemaking in effectuating the FTC Congressional Research Service 3 Act’s purposes, and the absence of any limiting language in the statutory text. The D.C. Circuit downplayed the fact that the FTC had not claimed general rulemaking authority until 1962, reasoning that the agency’s earlier interpretation of its legal authority did not warrant judicial deference. The court also concluded that Congress may have provided the FTC with more specific rulemaking authorities based on “uncertainty, understandable caution, and a desire to avoid litigation,” rather than a firm conviction that the FTC lacked general rulemaking authority. Two years after the National Petroleum Refiners decision, Congress enacted the Magnuson-Moss Act, which imposed special procedural requirements for the FTC’s UDAP rules and eliminated the FTC’s authority to issue such rules under Section 6(g). Magnuson-Moss did not by its terms affect the FTC’s authority to issue UMC rules: the statute included a provision disclaiming an intent to affect “any authority of the Commission to prescribe rules (including interpretive rules), and general statements of policy, with respect to unfair methods of competition.” Despite this language in Magnuson-Moss, the FTC’s putative authority to issue UMC rules has been dormant since the enactment of that statute. The Non-Compete Rule marks the first rule promulgated under Section 6(g) since the 1970s and the second rule ever that relies solely upon the FTC’s competition authority.
|
This task requires you to draw your answer from the given text only. Do not use any outside resources or prior knowledge. Your answer must be 100 words or less. In April 2024, the Federal Trade Commission (FTC) issued a rule prohibiting most employers from entering into or enforcing non-compete agreements with workers, subject to exceptions for the sale of a business and preexisting non-competes with senior executives. The rule (the Non-Compete Rule) implicates unsettled issues regarding the FTC’s authority to issue substantive competition regulations. Lawsuits challenging the rule followed. In one of those cases, a federal district court has declared the Non-Compete Rule unlawful and barred the FTC from enforcing it nationwide. Shortly before that decision, another court held that a separate challenge to the rule was likely to succeed and preliminarily enjoined the rule’s enforcement against the named plaintiff in that case. A third court has taken a more favorable view of the Non-Compete Rule, denying a motion for a preliminary injunction and concluding that the plaintiff had not established a reasonable probability that the rule exceeds the FTC’s legal authority. This Legal Sidebar provides background on the Non-Compete Rule and associated legal issues, along with an overview of the litigation challenging it. Background The Non-Compete Rule The Non-Compete Rule makes it unlawful to enter into or enforce a non-compete clause with any worker who is not a senior executive. The rule prohibits employers from entering into non-competes with senior executives after the rule’s effective date, but allows employers to enforce preexisting non-competes with senior executives. The rule defines the term “senior executive” to mean a worker who occupied a “policy-making position” and received total compensation of at least $151,164 in the preceding year. The rule’s prohibitions are subject to an exception for non-compete clauses entered into pursuant to a bona fide sale of a business entity, a person’s ownership interest in a business entity, or all or substantially all of a business entity’s operating assets. Congressional Research Service https://crsreports.congress.gov LSB11228 Congressional Research Service 2 The rule defines the term “non-compete clause” to mean a term or condition of employment that “prohibits,” “penalizes,” or “functions to prevent” a worker from seeking or accepting work with a different person after the conclusion of the employment that includes the term or condition. The rule explains that this definition encompasses “de facto” or “functional” non-competes—for example, “forfeiture-for-competition” clauses that extinguish an employer’s obligation to pay promised compensation or benefits if a worker accepts another job. The rule does not, however, categorically prohibit non-disclosure agreements (NDAs) or non-solicitation agreements. The Non-Compete Rule defines the term “worker” to include employees and independent contractors. That term does not include franchisees in the context of a franchisor-franchisee relationship, but does include employees of a franchisor or franchisee. Employers that fall outside of the FTC’s jurisdiction under the FTC Act are not subject to the rule. These employers include certain banks, savings and loan institutions, federal credit unions, common carriers, air carriers, and “persons, partnerships, or corporations insofar as they are subject to the Packers and Stockyards Act.” Corporations that are not “organized to carry on business for [their] own profit or that of [their] members” are also excluded from the FTC Act’s coverage. The rule explains that simply claiming non-profit status under the tax code is not sufficient to qualify for this exclusion. Instead, the FTC evaluates the economic realities of an entity’s activities to determine whether the exclusion applies. The Non-Compete Rule requires employers to provide “clear and conspicuous notice” to workers subject to prohibited non-compete clauses that the clauses “will not be, and cannot legally be” enforced. Legal Authority The FTC relied on Sections 5 and 6(g) of the Federal Trade Commission Act (FTC Act) in promulgating the Non-Compete Rule. Section 5 prohibits “unfair methods of competition” (UMC) and empowers the FTC to enforce that prohibition through adjudication. Section 6 is titled “Additional powers of Commission.” It confers a range of authorities, most of which involve investigations and the publication of reports. The provision also includes Section 6(g), which empowers the FTC to “from time to time classify corporations and . . . to make rules and regulations for the purpose of carrying out” the FTC Act. Sections 5 and 6(g) were both part of the original FTC Act, which Congress enacted in 1914. Since the statute’s enactment, Congress has adopted several laws granting the FTC rulemaking authority over discrete subjects, including the Wool Products Labeling Act, the Textile Fiber Products Identification Act, the Fur Products Labeling Act, the Flammable Fabrics Act, and the Fair Packaging and Labeling Act. The FTC first asserted that Section 6(g) endows it with general substantive rulemaking power in 1962, and the agency adopted a number of trade regulation rules in the years that followed. Some of those rules defined certain conduct as both a UMC and an “unfair or deceptive act or practice” (UDAP)—a separate category of conduct prohibited by Section 5. Other rules relied only on the FTC’s UDAP power. One rule relied solely on the FTC’s competition authority, but was never enforced and has been repealed. In the 1970s, a trade association challenged the FTC’s authority to issue substantive rules under Section 6(g) in National Petroleum Refiners Association v. FTC. The trade association argued that Section 6(g) authorized only procedural rules, emphasizing that the FTC had not asserted substantive rulemaking authority under Section 6(g) until 1962 and that FTC officials had occasionally denied the existence of such authority. The trade association also contended that Congress’s enactment of several statutes granting the FTC specific rulemaking authorities implied that the FTC lacked general rulemaking authority. The U.S. Court of Appeals for the D.C. Circuit rejected those arguments. In affirming the FTC’s power to issue legislative rules under Section 6(g), the court relied on appellate decisions construing similar statutes as authorizing substantive rulemaking, the advantages of rulemaking in effectuating the FTC Congressional Research Service 3 Act’s purposes, and the absence of any limiting language in the statutory text. The D.C. Circuit downplayed the fact that the FTC had not claimed general rulemaking authority until 1962, reasoning that the agency’s earlier interpretation of its legal authority did not warrant judicial deference. The court also concluded that Congress may have provided the FTC with more specific rulemaking authorities based on “uncertainty, understandable caution, and a desire to avoid litigation,” rather than a firm conviction that the FTC lacked general rulemaking authority. Two years after the National Petroleum Refiners decision, Congress enacted the Magnuson-Moss Act, which imposed special procedural requirements for the FTC’s UDAP rules and eliminated the FTC’s authority to issue such rules under Section 6(g). Magnuson-Moss did not by its terms affect the FTC’s authority to issue UMC rules: the statute included a provision disclaiming an intent to affect “any authority of the Commission to prescribe rules (including interpretive rules), and general statements of policy, with respect to unfair methods of competition.” Despite this language in Magnuson-Moss, the FTC’s putative authority to issue UMC rules has been dormant since the enactment of that statute. The Non-Compete Rule marks the first rule promulgated under Section 6(g) since the 1970s and the second rule ever that relies solely upon the FTC’s competition authority. What arguments did the US Court of appeals reject?
|
This task requires you to draw your answer from the given text only. Do not use any outside resources or prior knowledge. Your answer must be 100 words or less.
EVIDENCE:
In April 2024, the Federal Trade Commission (FTC) issued a rule prohibiting most employers from entering into or enforcing non-compete agreements with workers, subject to exceptions for the sale of a business and preexisting non-competes with senior executives. The rule (the Non-Compete Rule) implicates unsettled issues regarding the FTC’s authority to issue substantive competition regulations. Lawsuits challenging the rule followed. In one of those cases, a federal district court has declared the Non-Compete Rule unlawful and barred the FTC from enforcing it nationwide. Shortly before that decision, another court held that a separate challenge to the rule was likely to succeed and preliminarily enjoined the rule’s enforcement against the named plaintiff in that case. A third court has taken a more favorable view of the Non-Compete Rule, denying a motion for a preliminary injunction and concluding that the plaintiff had not established a reasonable probability that the rule exceeds the FTC’s legal authority. This Legal Sidebar provides background on the Non-Compete Rule and associated legal issues, along with an overview of the litigation challenging it. Background The Non-Compete Rule The Non-Compete Rule makes it unlawful to enter into or enforce a non-compete clause with any worker who is not a senior executive. The rule prohibits employers from entering into non-competes with senior executives after the rule’s effective date, but allows employers to enforce preexisting non-competes with senior executives. The rule defines the term “senior executive” to mean a worker who occupied a “policy-making position” and received total compensation of at least $151,164 in the preceding year. The rule’s prohibitions are subject to an exception for non-compete clauses entered into pursuant to a bona fide sale of a business entity, a person’s ownership interest in a business entity, or all or substantially all of a business entity’s operating assets. Congressional Research Service https://crsreports.congress.gov LSB11228 Congressional Research Service 2 The rule defines the term “non-compete clause” to mean a term or condition of employment that “prohibits,” “penalizes,” or “functions to prevent” a worker from seeking or accepting work with a different person after the conclusion of the employment that includes the term or condition. The rule explains that this definition encompasses “de facto” or “functional” non-competes—for example, “forfeiture-for-competition” clauses that extinguish an employer’s obligation to pay promised compensation or benefits if a worker accepts another job. The rule does not, however, categorically prohibit non-disclosure agreements (NDAs) or non-solicitation agreements. The Non-Compete Rule defines the term “worker” to include employees and independent contractors. That term does not include franchisees in the context of a franchisor-franchisee relationship, but does include employees of a franchisor or franchisee. Employers that fall outside of the FTC’s jurisdiction under the FTC Act are not subject to the rule. These employers include certain banks, savings and loan institutions, federal credit unions, common carriers, air carriers, and “persons, partnerships, or corporations insofar as they are subject to the Packers and Stockyards Act.” Corporations that are not “organized to carry on business for [their] own profit or that of [their] members” are also excluded from the FTC Act’s coverage. The rule explains that simply claiming non-profit status under the tax code is not sufficient to qualify for this exclusion. Instead, the FTC evaluates the economic realities of an entity’s activities to determine whether the exclusion applies. The Non-Compete Rule requires employers to provide “clear and conspicuous notice” to workers subject to prohibited non-compete clauses that the clauses “will not be, and cannot legally be” enforced. Legal Authority The FTC relied on Sections 5 and 6(g) of the Federal Trade Commission Act (FTC Act) in promulgating the Non-Compete Rule. Section 5 prohibits “unfair methods of competition” (UMC) and empowers the FTC to enforce that prohibition through adjudication. Section 6 is titled “Additional powers of Commission.” It confers a range of authorities, most of which involve investigations and the publication of reports. The provision also includes Section 6(g), which empowers the FTC to “from time to time classify corporations and . . . to make rules and regulations for the purpose of carrying out” the FTC Act. Sections 5 and 6(g) were both part of the original FTC Act, which Congress enacted in 1914. Since the statute’s enactment, Congress has adopted several laws granting the FTC rulemaking authority over discrete subjects, including the Wool Products Labeling Act, the Textile Fiber Products Identification Act, the Fur Products Labeling Act, the Flammable Fabrics Act, and the Fair Packaging and Labeling Act. The FTC first asserted that Section 6(g) endows it with general substantive rulemaking power in 1962, and the agency adopted a number of trade regulation rules in the years that followed. Some of those rules defined certain conduct as both a UMC and an “unfair or deceptive act or practice” (UDAP)—a separate category of conduct prohibited by Section 5. Other rules relied only on the FTC’s UDAP power. One rule relied solely on the FTC’s competition authority, but was never enforced and has been repealed. In the 1970s, a trade association challenged the FTC’s authority to issue substantive rules under Section 6(g) in National Petroleum Refiners Association v. FTC. The trade association argued that Section 6(g) authorized only procedural rules, emphasizing that the FTC had not asserted substantive rulemaking authority under Section 6(g) until 1962 and that FTC officials had occasionally denied the existence of such authority. The trade association also contended that Congress’s enactment of several statutes granting the FTC specific rulemaking authorities implied that the FTC lacked general rulemaking authority. The U.S. Court of Appeals for the D.C. Circuit rejected those arguments. In affirming the FTC’s power to issue legislative rules under Section 6(g), the court relied on appellate decisions construing similar statutes as authorizing substantive rulemaking, the advantages of rulemaking in effectuating the FTC Congressional Research Service 3 Act’s purposes, and the absence of any limiting language in the statutory text. The D.C. Circuit downplayed the fact that the FTC had not claimed general rulemaking authority until 1962, reasoning that the agency’s earlier interpretation of its legal authority did not warrant judicial deference. The court also concluded that Congress may have provided the FTC with more specific rulemaking authorities based on “uncertainty, understandable caution, and a desire to avoid litigation,” rather than a firm conviction that the FTC lacked general rulemaking authority. Two years after the National Petroleum Refiners decision, Congress enacted the Magnuson-Moss Act, which imposed special procedural requirements for the FTC’s UDAP rules and eliminated the FTC’s authority to issue such rules under Section 6(g). Magnuson-Moss did not by its terms affect the FTC’s authority to issue UMC rules: the statute included a provision disclaiming an intent to affect “any authority of the Commission to prescribe rules (including interpretive rules), and general statements of policy, with respect to unfair methods of competition.” Despite this language in Magnuson-Moss, the FTC’s putative authority to issue UMC rules has been dormant since the enactment of that statute. The Non-Compete Rule marks the first rule promulgated under Section 6(g) since the 1970s and the second rule ever that relies solely upon the FTC’s competition authority.
USER:
What arguments did the US Court of appeals reject?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 30 | 9 | 1,172 | null | 317 |
You must respond only using the information provided in the prompt context. No outside information or prior knowledge can be utilized in your answer.
|
When can a person give consent to process their data?
|
Lawfulness of processing 1. Processing shall be lawful only if and to the extent that at least one of the following applies: (a) the data subject has given consent to the processing of his or her personal data for one or more specific purposes; (b) processing is necessary for the performance of a contract to which the data subject is party or in order to take steps at the request of the data subject prior to entering into a contract; (c) processing is necessary for compliance with a legal obligation to which the controller is subject; (d) processing is necessary in order to protect the vital interests of the data subject or of another natural person; (e) processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller; (f) processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party, except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject which require protection of personal data, in particular where the data subject is a child. Point (f) of the first subparagraph shall not apply to processing carried out by public authorities in the performance of their tasks. 2. Member States may maintain or introduce more specific provisions to adapt the application of the rules of this Regulation with regard to processing for compliance with points (c) and (e) of paragraph 1 by determining more precisely specific requirements for the processing and other measures to ensure lawful and fair processing including for other specific processing situations as provided for in Chapter IX. 3. The basis for the processing referred to in point (c) and (e) of paragraph 1 shall be laid down by: (a) Union law; or (b) Member State law to which the controller is subject. The purpose of the processing shall be determined in that legal basis or, as regards the processing referred to in point (e) of paragraph 1, shall be necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller. That legal basis may contain specific provisions to adapt the application of rules of this Regulation, inter alia: the general conditions governing the lawfulness of processing by the controller; the types of data which are subject to the processing; the data subjects concerned; the entities to, and the purposes for which, the personal data may be disclosed; the purpose limitation; storage periods; and processing operations and processing procedures, including measures to ensure lawful and fair processing such as those for other specific L 119/36 EN Official Journal of the European Union 4.5.2016 processing situations as provided for in Chapter IX. The Union or the Member State law shall meet an objective of public interest and be proportionate to the legitimate aim pursued. 4. Where the processing for a purpose other than that for which the personal data have been collected is not based on the data subject's consent or on a Union or Member State law which constitutes a necessary and proportionate measure in a democratic society to safeguard the objectives referred to in Article 23(1), the controller shall, in order to ascertain whether processing for another purpose is compatible with the purpose for which the personal data are initially collected, take into account, inter alia: (a) any link between the purposes for which the personal data have been collected and the purposes of the intended further processing; (b) the context in which the personal data have been collected, in particular regarding the relationship between data subjects and the controller; (c) the nature of the personal data, in particular whether special categories of personal data are processed, pursuant to Article 9, or whether personal data related to criminal convictions and offences are processed, pursuant to Article 10; (d) the possible consequences of the intended further processing for data subjects; (e) the existence of appropriate safeguards, which may include encryption or pseudonymisation. Article 7 Conditions for consent 1. Where processing is based on consent, the controller shall be able to demonstrate that the data subject has consented to processing of his or her personal data. 2. If the data subject's consent is given in the context of a written declaration which also concerns other matters, the request for consent shall be presented in a manner which is clearly distinguishable from the other matters, in an intelligible and easily accessible form, using clear and plain language. Any part of such a declaration which constitutes an infringement of this Regulation shall not be binding. 3. The data subject shall have the right to withdraw his or her consent at any time. The withdrawal of consent shall not affect the lawfulness of processing based on consent before its withdrawal. Prior to giving consent, the data subject shall be informed thereof. It shall be as easy to withdraw as to give consent. 4. When assessing whether consent is freely given, utmost account shall be taken of whether, inter alia, the performance of a contract, including the provision of a service, is conditional on consent to the processing of personal data that is not necessary for the performance of that contract. Article 8 Conditions applicable to child's consent in relation to information society services 1. Where point (a) of Article 6(1) applies, in relation to the offer of information society services directly to a child, the processing of the personal data of a child shall be lawful where the child is at least 16 years old. Where the child is below the age of 16 years, such processing shall be lawful only if and to the extent that consent is given or authorised by the holder of parental responsibility over the child. Member States may provide by law for a lower age for those purposes provided that such lower age is not below 13 years. 4.5.2016 EN Official Journal of the European Union L 119/37 2. The controller shall make reasonable efforts to verify in such cases that consent is given or authorised by the holder of parental responsibility over the child, taking into consideration available technology. 3. Paragraph 1 shall not affect the general contract law of Member States such as the rules on the validity, formation or effect of a contract in relation to a child. Article 9 Processing of special categories of personal data 1. Processing of personal data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, and the processing of genetic data, biometric data for the purpose of uniquely identifying a natural person, data concerning health or data concerning a natural person's sex life or sexual orientation shall be prohibited. 2. Paragraph 1 shall not apply if one of the following applies: (a) the data subject has given explicit consent to the processing of those personal data for one or more specified purposes, except where Union or Member State law provide that the prohibition referred to in paragraph 1 may not be lifted by the data subject; (b) processing is necessary for the purposes of carrying out the obligations and exercising specific rights of the controller or of the data subject in the field of employment and social security and social protection law in so far as it is authorised by Union or Member State law or a collective agreement pursuant to Member State law providing for appropriate safeguards for the fundamental rights and the interests of the data subject; (c) processing is necessary to protect the vital interests of the data subject or of another natural person where the data subject is physically or legally incapable of giving consent; (d) processing is carried out in the course of its legitimate activities with appropriate safeguards by a foundation, association or any other not-for-profit body with a political, philosophical, religious or trade union aim and on condition that the processing relates solely to the members or to former members of the body or to persons who have regular contact with it in connection with its purposes and that the personal data are not disclosed outside that body without the consent of the data subjects; (e) processing relates to personal data which are manifestly made public by the data subject; (f) processing is necessary for the establishment, exercise or defence of legal claims or whenever courts are acting in their judicial capacity;
|
You must respond only using the information provided in the prompt context. No outside information or prior knowledge can be utilized in your answer. When can a person give consent to process their data? Lawfulness of processing 1. Processing shall be lawful only if and to the extent that at least one of the following applies: (a) the data subject has given consent to the processing of his or her personal data for one or more specific purposes; (b) processing is necessary for the performance of a contract to which the data subject is party or in order to take steps at the request of the data subject prior to entering into a contract; (c) processing is necessary for compliance with a legal obligation to which the controller is subject; (d) processing is necessary in order to protect the vital interests of the data subject or of another natural person; (e) processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller; (f) processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party, except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject which require protection of personal data, in particular where the data subject is a child. Point (f) of the first subparagraph shall not apply to processing carried out by public authorities in the performance of their tasks. 2. Member States may maintain or introduce more specific provisions to adapt the application of the rules of this Regulation with regard to processing for compliance with points (c) and (e) of paragraph 1 by determining more precisely specific requirements for the processing and other measures to ensure lawful and fair processing including for other specific processing situations as provided for in Chapter IX. 3. The basis for the processing referred to in point (c) and (e) of paragraph 1 shall be laid down by: (a) Union law; or (b) Member State law to which the controller is subject. The purpose of the processing shall be determined in that legal basis or, as regards the processing referred to in point (e) of paragraph 1, shall be necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller. That legal basis may contain specific provisions to adapt the application of rules of this Regulation, inter alia: the general conditions governing the lawfulness of processing by the controller; the types of data which are subject to the processing; the data subjects concerned; the entities to, and the purposes for which, the personal data may be disclosed; the purpose limitation; storage periods; and processing operations and processing procedures, including measures to ensure lawful and fair processing such as those for other specific L 119/36 EN Official Journal of the European Union 4.5.2016 processing situations as provided for in Chapter IX. The Union or the Member State law shall meet an objective of public interest and be proportionate to the legitimate aim pursued. 4. Where the processing for a purpose other than that for which the personal data have been collected is not based on the data subject's consent or on a Union or Member State law which constitutes a necessary and proportionate measure in a democratic society to safeguard the objectives referred to in Article 23(1), the controller shall, in order to ascertain whether processing for another purpose is compatible with the purpose for which the personal data are initially collected, take into account, inter alia: (a) any link between the purposes for which the personal data have been collected and the purposes of the intended further processing; (b) the context in which the personal data have been collected, in particular regarding the relationship between data subjects and the controller; (c) the nature of the personal data, in particular whether special categories of personal data are processed, pursuant to Article 9, or whether personal data related to criminal convictions and offences are processed, pursuant to Article 10; (d) the possible consequences of the intended further processing for data subjects; (e) the existence of appropriate safeguards, which may include encryption or pseudonymisation. Article 7 Conditions for consent 1. Where processing is based on consent, the controller shall be able to demonstrate that the data subject has consented to processing of his or her personal data. 2. If the data subject's consent is given in the context of a written declaration which also concerns other matters, the request for consent shall be presented in a manner which is clearly distinguishable from the other matters, in an intelligible and easily accessible form, using clear and plain language. Any part of such a declaration which constitutes an infringement of this Regulation shall not be binding. 3. The data subject shall have the right to withdraw his or her consent at any time. The withdrawal of consent shall not affect the lawfulness of processing based on consent before its withdrawal. Prior to giving consent, the data subject shall be informed thereof. It shall be as easy to withdraw as to give consent. 4. When assessing whether consent is freely given, utmost account shall be taken of whether, inter alia, the performance of a contract, including the provision of a service, is conditional on consent to the processing of personal data that is not necessary for the performance of that contract. Article 8 Conditions applicable to child's consent in relation to information society services 1. Where point (a) of Article 6(1) applies, in relation to the offer of information society services directly to a child, the processing of the personal data of a child shall be lawful where the child is at least 16 years old. Where the child is below the age of 16 years, such processing shall be lawful only if and to the extent that consent is given or authorised by the holder of parental responsibility over the child. Member States may provide by law for a lower age for those purposes provided that such lower age is not below 13 years. 4.5.2016 EN Official Journal of the European Union L 119/37 2. The controller shall make reasonable efforts to verify in such cases that consent is given or authorised by the holder of parental responsibility over the child, taking into consideration available technology. 3. Paragraph 1 shall not affect the general contract law of Member States such as the rules on the validity, formation or effect of a contract in relation to a child. Article 9 Processing of special categories of personal data 1. Processing of personal data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, and the processing of genetic data, biometric data for the purpose of uniquely identifying a natural person, data concerning health or data concerning a natural person's sex life or sexual orientation shall be prohibited. 2. Paragraph 1 shall not apply if one of the following applies: (a) the data subject has given explicit consent to the processing of those personal data for one or more specified purposes, except where Union or Member State law provide that the prohibition referred to in paragraph 1 may not be lifted by the data subject; (b) processing is necessary for the purposes of carrying out the obligations and exercising specific rights of the controller or of the data subject in the field of employment and social security and social protection law in so far as it is authorised by Union or Member State law or a collective agreement pursuant to Member State law providing for appropriate safeguards for the fundamental rights and the interests of the data subject; (c) processing is necessary to protect the vital interests of the data subject or of another natural person where the data subject is physically or legally incapable of giving consent; (d) processing is carried out in the course of its legitimate activities with appropriate safeguards by a foundation, association or any other not-for-profit body with a political, philosophical, religious or trade union aim and on condition that the processing relates solely to the members or to former members of the body or to persons who have regular contact with it in connection with its purposes and that the personal data are not disclosed outside that body without the consent of the data subjects; (e) processing relates to personal data which are manifestly made public by the data subject; (f) processing is necessary for the establishment, exercise or defence of legal claims or whenever courts are acting in their judicial capacity;
|
You must respond only using the information provided in the prompt context. No outside information or prior knowledge can be utilized in your answer.
EVIDENCE:
Lawfulness of processing 1. Processing shall be lawful only if and to the extent that at least one of the following applies: (a) the data subject has given consent to the processing of his or her personal data for one or more specific purposes; (b) processing is necessary for the performance of a contract to which the data subject is party or in order to take steps at the request of the data subject prior to entering into a contract; (c) processing is necessary for compliance with a legal obligation to which the controller is subject; (d) processing is necessary in order to protect the vital interests of the data subject or of another natural person; (e) processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller; (f) processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party, except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject which require protection of personal data, in particular where the data subject is a child. Point (f) of the first subparagraph shall not apply to processing carried out by public authorities in the performance of their tasks. 2. Member States may maintain or introduce more specific provisions to adapt the application of the rules of this Regulation with regard to processing for compliance with points (c) and (e) of paragraph 1 by determining more precisely specific requirements for the processing and other measures to ensure lawful and fair processing including for other specific processing situations as provided for in Chapter IX. 3. The basis for the processing referred to in point (c) and (e) of paragraph 1 shall be laid down by: (a) Union law; or (b) Member State law to which the controller is subject. The purpose of the processing shall be determined in that legal basis or, as regards the processing referred to in point (e) of paragraph 1, shall be necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller. That legal basis may contain specific provisions to adapt the application of rules of this Regulation, inter alia: the general conditions governing the lawfulness of processing by the controller; the types of data which are subject to the processing; the data subjects concerned; the entities to, and the purposes for which, the personal data may be disclosed; the purpose limitation; storage periods; and processing operations and processing procedures, including measures to ensure lawful and fair processing such as those for other specific L 119/36 EN Official Journal of the European Union 4.5.2016 processing situations as provided for in Chapter IX. The Union or the Member State law shall meet an objective of public interest and be proportionate to the legitimate aim pursued. 4. Where the processing for a purpose other than that for which the personal data have been collected is not based on the data subject's consent or on a Union or Member State law which constitutes a necessary and proportionate measure in a democratic society to safeguard the objectives referred to in Article 23(1), the controller shall, in order to ascertain whether processing for another purpose is compatible with the purpose for which the personal data are initially collected, take into account, inter alia: (a) any link between the purposes for which the personal data have been collected and the purposes of the intended further processing; (b) the context in which the personal data have been collected, in particular regarding the relationship between data subjects and the controller; (c) the nature of the personal data, in particular whether special categories of personal data are processed, pursuant to Article 9, or whether personal data related to criminal convictions and offences are processed, pursuant to Article 10; (d) the possible consequences of the intended further processing for data subjects; (e) the existence of appropriate safeguards, which may include encryption or pseudonymisation. Article 7 Conditions for consent 1. Where processing is based on consent, the controller shall be able to demonstrate that the data subject has consented to processing of his or her personal data. 2. If the data subject's consent is given in the context of a written declaration which also concerns other matters, the request for consent shall be presented in a manner which is clearly distinguishable from the other matters, in an intelligible and easily accessible form, using clear and plain language. Any part of such a declaration which constitutes an infringement of this Regulation shall not be binding. 3. The data subject shall have the right to withdraw his or her consent at any time. The withdrawal of consent shall not affect the lawfulness of processing based on consent before its withdrawal. Prior to giving consent, the data subject shall be informed thereof. It shall be as easy to withdraw as to give consent. 4. When assessing whether consent is freely given, utmost account shall be taken of whether, inter alia, the performance of a contract, including the provision of a service, is conditional on consent to the processing of personal data that is not necessary for the performance of that contract. Article 8 Conditions applicable to child's consent in relation to information society services 1. Where point (a) of Article 6(1) applies, in relation to the offer of information society services directly to a child, the processing of the personal data of a child shall be lawful where the child is at least 16 years old. Where the child is below the age of 16 years, such processing shall be lawful only if and to the extent that consent is given or authorised by the holder of parental responsibility over the child. Member States may provide by law for a lower age for those purposes provided that such lower age is not below 13 years. 4.5.2016 EN Official Journal of the European Union L 119/37 2. The controller shall make reasonable efforts to verify in such cases that consent is given or authorised by the holder of parental responsibility over the child, taking into consideration available technology. 3. Paragraph 1 shall not affect the general contract law of Member States such as the rules on the validity, formation or effect of a contract in relation to a child. Article 9 Processing of special categories of personal data 1. Processing of personal data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, and the processing of genetic data, biometric data for the purpose of uniquely identifying a natural person, data concerning health or data concerning a natural person's sex life or sexual orientation shall be prohibited. 2. Paragraph 1 shall not apply if one of the following applies: (a) the data subject has given explicit consent to the processing of those personal data for one or more specified purposes, except where Union or Member State law provide that the prohibition referred to in paragraph 1 may not be lifted by the data subject; (b) processing is necessary for the purposes of carrying out the obligations and exercising specific rights of the controller or of the data subject in the field of employment and social security and social protection law in so far as it is authorised by Union or Member State law or a collective agreement pursuant to Member State law providing for appropriate safeguards for the fundamental rights and the interests of the data subject; (c) processing is necessary to protect the vital interests of the data subject or of another natural person where the data subject is physically or legally incapable of giving consent; (d) processing is carried out in the course of its legitimate activities with appropriate safeguards by a foundation, association or any other not-for-profit body with a political, philosophical, religious or trade union aim and on condition that the processing relates solely to the members or to former members of the body or to persons who have regular contact with it in connection with its purposes and that the personal data are not disclosed outside that body without the consent of the data subjects; (e) processing relates to personal data which are manifestly made public by the data subject; (f) processing is necessary for the establishment, exercise or defence of legal claims or whenever courts are acting in their judicial capacity;
USER:
When can a person give consent to process their data?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 10 | 1,413 | null | 57 |
Only use the document provided. Limit the response to two sentences. Provide a piece of evidence from the text after your answer.
|
What do the three elements of the cycle of risk mitigation and and crisis management strategies entail?
|
**Risk, Crisis and Resilience Services** Global Reach, Rapid Response and Local Expertise Your safety and security are our mission. We provide clear, targeted, flexible pre- and post-incident solutions built around that primary priority. Our expert team has operated in more than 80 countries and across multiple disciplines, including kidnap for ransom, extortion, detention and evacuation as well as security training, risk assessments and business continuity planning. Our team of specialist crisis and risk advisors are strategically located across North America, Europe, Africa, the Middle East and Asia. Constellis’ risk analysts monitor, research and advise on current and emerging threats. This enables us to deliver a global spread of expertise and vital rapid-response capabilities with outstanding local and regional knowledge, contacts and language capabilities. Managing Organizational Risk Organizations need to take risks in order to succeed. Managing that risk allows opportunities to be pursued while reducing the potential for negative impact. Our Risk, Crisis and Resilience services help corporate and governmental institutions, international organizations and small to medium sized businesses disrupt threats and eliminate vulnerabilities to effectively exercise control over the risks taken while enhancing organizational resilience. We work with our customers to employ a full cycle of risk mitigation and crisis management strategies: Avert We help reduce the likelihood of a serious incident. Improved threat and vulnerability awareness Anticipating dangers Comprehensive context & risk assessment Enhanced risk treatment measures Good risk intelligence Reliable travel tracking Effective personal safety & security training Prepare We ready you to protect your business and mitigate negative consequences in worst-case scenarios. Broad scenario development Extensive contingency & continuity planning Crisis management training Respond We ensure timely deployment of appropriate internal and external resources. Manage an incident Provide business continuity Bring the situation under control as quickly as possible Risk, Crisis and Resilience Services We incorporate all the current risk, crisis, business continuity and organizational resilience standards in our methodology including ISO 31000, 22301, 22316, BS 65000, CEN/TS 17091 as well as the principles of Enterprise Security Risk Management. Our bespoke approach is tailored to each customer’s unique needs and concerns. Our risk, crisis and resilience services incorporate the following: Personnel Risk Your people are your greatest asset and ensuring their safety and security is not only an essential part of being a good employer but also a necessary step in meeting your duty of care obligations. Our personnel risk services ensure that you are providing the right information and training for the people who work for you to help them look after themselves and make better decisions and also enable you to properly assist them when they encounter problems. These tailored services include: Personal security training (HEAT) Travel security briefings Travel safety & security planning Travel safety platform through our partner LifeLine Response: Global threat intel Location-based tracking Proactive travel security alerts 2-way mass notification Organizational Risk Organizations face numerous risks not only when operating in complex and fragile environments but also in those places where they least expect to encounter problems. We lead the way for our customers, helping them to develop policies, processes and procedures, allowing them to evaluate and manage risk and succeed in their business endeavors. Good risk management is about facilitating operations and managing risk to an acceptable level, not obstructing business activities. Our organizational risk advisory and management services provide the necessary support to ensure that you have the right system and management in place to meet your needs. These services include: Security risk briefings Threat monitoring Strategic risk assessments Organizational resilience reviews Security management planning Security management training Crisis Management When the worst happens, we deliver rapid, targeted and adaptable crisis management, communications and response solutions to enable our customers to overcome the challenges they face. Constellis’ crisis response consultants are well-versed in providing advice and support in the heat of a crisis as well as before a crisis strikes, helping you to be better prepared to deal with all the problems you may face when a critical incident threatens your business. We cover all kinds of crisis scenarios and have extensive experience in dealing with kidnapping, piracy, extortion and detention. We offer a turnkey solution that comprises training, planning, response and recovery services including: Crisis response for all scenarios Crisis management planning Crisis communications planning Business continuity planning Contingency planning (including evacuation) Crisis management training Crisis simulation exercises Crisis communications training Insight and Analysis Accurate, timely information is an essential component to any risk management program. At Constellis, our insight and analysis services integrate strategic understanding with local and empirical knowledge, enabling our customers to make effective decisions for existing operations and future investments. We draw on a large network of resources to deliver social, economic, political and security intelligence to our customers through bespoke reporting services including: Security Threat Assessments Geographical Risk Analysis & Reporting Kidnap for Ransom Analysis & Reporting Special Assignments
|
<System Instruction> ======= Only use the document provided. Limit the response to two sentences. Provide a piece of evidence from the text after your answer. ---------- <Context> ======= **Risk, Crisis and Resilience Services** Global Reach, Rapid Response and Local Expertise Your safety and security are our mission. We provide clear, targeted, flexible pre- and post-incident solutions built around that primary priority. Our expert team has operated in more than 80 countries and across multiple disciplines, including kidnap for ransom, extortion, detention and evacuation as well as security training, risk assessments and business continuity planning. Our team of specialist crisis and risk advisors are strategically located across North America, Europe, Africa, the Middle East and Asia. Constellis’ risk analysts monitor, research and advise on current and emerging threats. This enables us to deliver a global spread of expertise and vital rapid-response capabilities with outstanding local and regional knowledge, contacts and language capabilities. Managing Organizational Risk Organizations need to take risks in order to succeed. Managing that risk allows opportunities to be pursued while reducing the potential for negative impact. Our Risk, Crisis and Resilience services help corporate and governmental institutions, international organizations and small to medium sized businesses disrupt threats and eliminate vulnerabilities to effectively exercise control over the risks taken while enhancing organizational resilience. We work with our customers to employ a full cycle of risk mitigation and crisis management strategies: Avert We help reduce the likelihood of a serious incident. Improved threat and vulnerability awareness Anticipating dangers Comprehensive context & risk assessment Enhanced risk treatment measures Good risk intelligence Reliable travel tracking Effective personal safety & security training Prepare We ready you to protect your business and mitigate negative consequences in worst-case scenarios. Broad scenario development Extensive contingency & continuity planning Crisis management training Respond We ensure timely deployment of appropriate internal and external resources. Manage an incident Provide business continuity Bring the situation under control as quickly as possible Risk, Crisis and Resilience Services We incorporate all the current risk, crisis, business continuity and organizational resilience standards in our methodology including ISO 31000, 22301, 22316, BS 65000, CEN/TS 17091 as well as the principles of Enterprise Security Risk Management. Our bespoke approach is tailored to each customer’s unique needs and concerns. Our risk, crisis and resilience services incorporate the following: Personnel Risk Your people are your greatest asset and ensuring their safety and security is not only an essential part of being a good employer but also a necessary step in meeting your duty of care obligations. Our personnel risk services ensure that you are providing the right information and training for the people who work for you to help them look after themselves and make better decisions and also enable you to properly assist them when they encounter problems. These tailored services include: Personal security training (HEAT) Travel security briefings Travel safety & security planning Travel safety platform through our partner LifeLine Response: Global threat intel Location-based tracking Proactive travel security alerts 2-way mass notification Organizational Risk Organizations face numerous risks not only when operating in complex and fragile environments but also in those places where they least expect to encounter problems. We lead the way for our customers, helping them to develop policies, processes and procedures, allowing them to evaluate and manage risk and succeed in their business endeavors. Good risk management is about facilitating operations and managing risk to an acceptable level, not obstructing business activities. Our organizational risk advisory and management services provide the necessary support to ensure that you have the right system and management in place to meet your needs. These services include: Security risk briefings Threat monitoring Strategic risk assessments Organizational resilience reviews Security management planning Security management training Crisis Management When the worst happens, we deliver rapid, targeted and adaptable crisis management, communications and response solutions to enable our customers to overcome the challenges they face. Constellis’ crisis response consultants are well-versed in providing advice and support in the heat of a crisis as well as before a crisis strikes, helping you to be better prepared to deal with all the problems you may face when a critical incident threatens your business. We cover all kinds of crisis scenarios and have extensive experience in dealing with kidnapping, piracy, extortion and detention. We offer a turnkey solution that comprises training, planning, response and recovery services including: Crisis response for all scenarios Crisis management planning Crisis communications planning Business continuity planning Contingency planning (including evacuation) Crisis management training Crisis simulation exercises Crisis communications training Insight and Analysis Accurate, timely information is an essential component to any risk management program. At Constellis, our insight and analysis services integrate strategic understanding with local and empirical knowledge, enabling our customers to make effective decisions for existing operations and future investments. We draw on a large network of resources to deliver social, economic, political and security intelligence to our customers through bespoke reporting services including: Security Threat Assessments Geographical Risk Analysis & Reporting Kidnap for Ransom Analysis & Reporting Special Assignments ---------- <Question> ======= What do the three elements of the cycle of risk mitigation and and crisis management strategies entail?
|
Only use the document provided. Limit the response to two sentences. Provide a piece of evidence from the text after your answer.
EVIDENCE:
**Risk, Crisis and Resilience Services** Global Reach, Rapid Response and Local Expertise Your safety and security are our mission. We provide clear, targeted, flexible pre- and post-incident solutions built around that primary priority. Our expert team has operated in more than 80 countries and across multiple disciplines, including kidnap for ransom, extortion, detention and evacuation as well as security training, risk assessments and business continuity planning. Our team of specialist crisis and risk advisors are strategically located across North America, Europe, Africa, the Middle East and Asia. Constellis’ risk analysts monitor, research and advise on current and emerging threats. This enables us to deliver a global spread of expertise and vital rapid-response capabilities with outstanding local and regional knowledge, contacts and language capabilities. Managing Organizational Risk Organizations need to take risks in order to succeed. Managing that risk allows opportunities to be pursued while reducing the potential for negative impact. Our Risk, Crisis and Resilience services help corporate and governmental institutions, international organizations and small to medium sized businesses disrupt threats and eliminate vulnerabilities to effectively exercise control over the risks taken while enhancing organizational resilience. We work with our customers to employ a full cycle of risk mitigation and crisis management strategies: Avert We help reduce the likelihood of a serious incident. Improved threat and vulnerability awareness Anticipating dangers Comprehensive context & risk assessment Enhanced risk treatment measures Good risk intelligence Reliable travel tracking Effective personal safety & security training Prepare We ready you to protect your business and mitigate negative consequences in worst-case scenarios. Broad scenario development Extensive contingency & continuity planning Crisis management training Respond We ensure timely deployment of appropriate internal and external resources. Manage an incident Provide business continuity Bring the situation under control as quickly as possible Risk, Crisis and Resilience Services We incorporate all the current risk, crisis, business continuity and organizational resilience standards in our methodology including ISO 31000, 22301, 22316, BS 65000, CEN/TS 17091 as well as the principles of Enterprise Security Risk Management. Our bespoke approach is tailored to each customer’s unique needs and concerns. Our risk, crisis and resilience services incorporate the following: Personnel Risk Your people are your greatest asset and ensuring their safety and security is not only an essential part of being a good employer but also a necessary step in meeting your duty of care obligations. Our personnel risk services ensure that you are providing the right information and training for the people who work for you to help them look after themselves and make better decisions and also enable you to properly assist them when they encounter problems. These tailored services include: Personal security training (HEAT) Travel security briefings Travel safety & security planning Travel safety platform through our partner LifeLine Response: Global threat intel Location-based tracking Proactive travel security alerts 2-way mass notification Organizational Risk Organizations face numerous risks not only when operating in complex and fragile environments but also in those places where they least expect to encounter problems. We lead the way for our customers, helping them to develop policies, processes and procedures, allowing them to evaluate and manage risk and succeed in their business endeavors. Good risk management is about facilitating operations and managing risk to an acceptable level, not obstructing business activities. Our organizational risk advisory and management services provide the necessary support to ensure that you have the right system and management in place to meet your needs. These services include: Security risk briefings Threat monitoring Strategic risk assessments Organizational resilience reviews Security management planning Security management training Crisis Management When the worst happens, we deliver rapid, targeted and adaptable crisis management, communications and response solutions to enable our customers to overcome the challenges they face. Constellis’ crisis response consultants are well-versed in providing advice and support in the heat of a crisis as well as before a crisis strikes, helping you to be better prepared to deal with all the problems you may face when a critical incident threatens your business. We cover all kinds of crisis scenarios and have extensive experience in dealing with kidnapping, piracy, extortion and detention. We offer a turnkey solution that comprises training, planning, response and recovery services including: Crisis response for all scenarios Crisis management planning Crisis communications planning Business continuity planning Contingency planning (including evacuation) Crisis management training Crisis simulation exercises Crisis communications training Insight and Analysis Accurate, timely information is an essential component to any risk management program. At Constellis, our insight and analysis services integrate strategic understanding with local and empirical knowledge, enabling our customers to make effective decisions for existing operations and future investments. We draw on a large network of resources to deliver social, economic, political and security intelligence to our customers through bespoke reporting services including: Security Threat Assessments Geographical Risk Analysis & Reporting Kidnap for Ransom Analysis & Reporting Special Assignments
USER:
What do the three elements of the cycle of risk mitigation and and crisis management strategies entail?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 22 | 17 | 807 | null | 791 |
You will only respond using the given context and include no information not readily available in the text.
|
What were the immediate and long-term impacts of Right-to-Work laws on employment and wages?
|
Federal Policies and American Labor Relations The National Labor Relations Act/Wagner Act (NLRA) of 1935 was passed by Congress to protect workers’ rights to unionization. NLRA states and defines the rights of employees to organize and bargain collectively with their employers through representatives of their own choosing (i.e., elected union leaders). The NLRA identified workers’ rights to form a union, join a union, and to strike in an effort to secure better working conditions (National Labor Relations Board, 1997). “The act also created a new National Labor Relations Board (NLRB) to arbitrate deadlocked labor- management disputes, guarantee democratic union elections and penalize unfair labor practices by employers” (Cooper, 2004, p. 2). Furthermore, NLRA prohibited employers from setting up a company union and firing or otherwise discriminating against workers who organized or joined unions (Encyclopedia Britannica, 2007). Prior to the passage of NLRA, the federal government had been largely antagonistic to union organizing. Labor unions across the country faced significant challenges in social action initiatives aimed at ensuring adequate wages, benefits and the reduction of industry health hazards. During the first half of the twentieth century, for example, laborers who attempted to organize protective associations frequently found themselves prosecuted for and convicted of conspiracy (to do what?) (Beik, 2005). With the onset of the Great Depression, and an unemployment rate of 24.9 percent in 1933 , the national political framework shifted its focus from the protection of the business sector to the protection of workers and individuals through the creation of New Deal policies (e.g., Social Security and Civilian Conservation Corps). These policies hoped to create a social safety net that would prevent further economic disaster. Due to the power of business interests and persons advocating a free market society, many New Deal policies had been declared unconstitutional by the United States Supreme Court, including the previous labor legislation – the National Industry Recovery Act of 1933 which authorized the President to regulate businesses in the interests of promoting fair competition, supporting prices and competition, creating jobs for the unemployed, and stimulating the United States economy to recover from the Great Depression (Babson, 1999). Thus, many businesses believed that the NLRA would follow the same path. In April of 1937, however, the NLRA was declared constitutional by the Supreme Court, highlighting the increased power of labor unions on national politics and policymaking (Beik, 2005). In 1935, 15 percent of American workers were unionized. By 1945, the proportion had risen to 35 percent (Babson, 1999). During this time there were three primary types of union/employer structural arrangements: the agency shop, the union shop, and the closed shop. Cooper (2004) describes the arrangements as follows: • Agency Shop: The union’s contract does not mandate that all employees join the union, but it does mandate that the employees pay agency fees. • Union Shop: The union’s contract requires that all employees join the union within a specified amount of time after becoming employed. • Closed Shop: The union’s contract mandates that the employer only hire union members (pg. 2). 1945 marked the peak of American unionization with over one-third of American workers belonging to labor unions. Organized labor reached the zenith of its power in the U.S. from 1935 – 1947 (Beik, 2005). Many business leaders, however, began to lobby for a loosening of union power insisting that businesses and individuals were, due to the NLRA, prevented from exercising their right of association and employment procedures. At the same time, the political landscape was changing and anti-communism was used as a key argument to stymie the power of unions. Labor unions were seen as a corrupt socialist tactic and, thus, could be associated with the red scare. The public also began to demand action after the World War Two coal strikes and the postwar strikes in steel, autos and other industries were perceived to have damaged the economy. With the increasing constituent pressure and the election in 1944 of the pro-business and pro-states’ rights Republican congress, the second significant piece of national labor legislation was passed, the 1947 Taft-Hartley Act. Taft-Hartley effectively overturned many of the rights guaranteed by NLRA and outlawed the closed shop arrangement (Cooper, 2004). Moreover, “section 14(b) of Taft-Hartley made Right-to-Work laws legal and gave states the power to pass laws to outlaw both agency and union shops” (Cooper, 2004, p. 10). This provision afforded states the opportunity to pass laws that forbade the establishment of businesses and/or union contracts where union membership was a condition of employment; thus, the age of RTW began. Right-to-Work Laws Immediately following the passage of the Taft-Hartley Act states began to enact Right-to- Work laws. The basic concept of RTW is that workers should not be obligated to join or give support to a union as a condition of employment (Kersey, 2007).2 The main objectives of RTW laws have, to this day, shared similar purposes. These objectives include: a. the promotion of individual freedom; b. the creation of a pro-business atmosphere aimed at spurring economic growth; c. the elimination of the power of union organization. As of January 1, 2006, 22 states had passed RTW legislation. It is important to note that a regional divide exists with regard to the establishment of RTW laws... most of the states with RTW laws are located in the southeast, Midwest and Rocky Mountain States. These states have traditionally maintained lower rates of unionization -- 18% in 1947, 52% lower than their non-RTW counterparts (Beik, 1998). Right-to-Work Laws and Employment One of the key arguments offered by proponents of RTW legislation is that the laws increase employment. Proponents believe that, if businesses are not required to operate under union wage contracts, they will remain profitable due to decreased labor costs and the economic landscape will encourage cross-state relocation of businesses; thus, employment opportunities will increase for all citizens. “Opponents, however, argue that most job growth occurs from in-state business expansion not the relocation of businesses from a non-RTW to a RTW state” (Oklahoma League of Economists, 1996, paragraph 2). The unemployment rates in RTW states pre and post RTW passage, as well as the comparison of RTW to non-RTW states, provide important insights in to the impact of RTW legislation on employment across jurisdictions. Overall, the unemployment rates in RTW states are lower than non-RTW states. For example, the unemployment rate between 1978 and 2000 averaged 5.8percent in RTW states versus 6.3percent in non-RTW states. Additionally, between 1970 and 2000 overall employment increased by 2.9percent annually in RTW states versus 2.0percent in non-RTW states. This trend has continued, although tightening, into the 2000s; between 2001 and 2006 RTW states had a median 4.8percent unemployment rate compared to 5.1 percent for non-RTW states (Kersey, 2007). As of March 2010, RTW states had an average unemployment rate of 8.6% while the rate in non-RTW states stood at 9.4% (Bureau of Labor Statistics [BLS], 2010). Another aspect of the impact that RTW laws have on employment relates to the type and condition of employment between the two types of states. The share of manufacturing employment in the U.S. in 1950 was 35percent of the workforce. This figure declined to 13 percent in 2004 (Fischer & Rupert, 2005). Many RTW advocates believe pro-business laws, such as RTW, lessen manufacturing losses by creating a conducive business atmosphere. While both types of states have not been able to stem the national tide, data indicates that manufacturing employment in RTW states has decreased at a much lower rate than in their non-RTW counterparts where manufacturing employment has seen significant decreases. Between 2001 and 2006 the typical RTW state saw manufacturing employment decline 1.5percent annually, equaling 7.1percent overall. Non-RTW states, however, faced even sharper declines, averaging 3.0 percent annually and 13.7 percent over the five year period. Every non-RTW state but one, Alaska, lost manufacturing jobs during that period, while five RTW states registered at least modest gains in this area (Wright, 2007). In terms of job conditions, the government data shows that in 2003 the rate of workplace fatalities per 100,000 workers was highest in right-to-work states. The rate of workplace deaths is 51 percent higher in RTW states (BLS, 2006). Nineteen of the top 25 states for worker fatality rates were RTW states, while three of the bottom 25 states were RTW states (Bureau of Labor Statistics [BLS], 2003). Further, in a study of New York City construction site fatalities, it was found that 93 percent of deaths happened at non-union sites (Walter, 2007). The same holds true in the coal mining industry where 87 percent of fatalities between 2007 and 2009 occurred at non-union mines (U.S. House of Representatives Committee on Education and Labor, 2007). Right-to-Work and Job Growth Holmes (1998) argues that large manufacturing establishments are more likely to be attracted to RTW states because larger plants are more likely to be unionized. RTW laws, according to manufacturers, help maintain competiveness and encourage development in the strained sector. He also found that eight of the ten states with the highest manufacturing employment growth rates are RTW states. All ten states with the lowest growth rates are non-RTW states. Opponents charge that the laws depress individual worker wages at the expense of profits and capitalist objectives. From 1977 through 1999, Gross State Product (GSP), the market value of all goods and services produced in a state, increased 0.5 percent faster in RTW states than in non-RTW states (Wilson, 2002). Right-to-Work Laws and Wages One condition of employment is the impact of RTW laws on wages. This includes both absolute wages and the overall wage distribution across income and racial lines following RTW passage. There are currently 132,604,980 workers in the United States (U.S.). The American worker, as of July 2009, earned an average of $44,901 per year. This translates in to an average hourly wage of $22.36 (Bureau of Labor Statistics [BLS], 2009). Leading researchers disagree on the impact of RTW laws on wages. For example, 16 of the 18 states are estimated to have had higher average wages in 2000 as a result of their RTW status (Reed, 2003). On the other hand, Bureau of Labor Statistics (BLS) data reveals that average annual pay is higher in non-RTW states. In addition, income polarization is higher in RTW states, with a higher percentage of workers earning the minimum wage (even when controlling for education level) than in non-RTW states. After years of economic development, the portion of heads of household earning around the minimum wage is still 35.5 percent (4.4 percentage points) higher in RTW than in high-union-density states" (Cassell, 2001). Lawrence Mishel (2001) of the Economic Policy Institute found that in 2000 the median wage for workers living in RTW states was $11.45, while wages for those living in non -RTW states were $13.00, indicating that wages were 11.9 percent lower in RTW states. He further concluded that previous research citing wage increases in RTW states were directly attributable to the improved income characteristics of those residing in large cities located on a state border with a non-RTW state. At the same time, when looking at weekly and hourly wages by industry between RTW and non-RTW states adjusted for cost-of-living, RTW states have higher wages in two key industries. For example, in manufacturing workers in RTW states earn an average of $717 weekly and $17.89 hourly while their non-RTW counterparts earn $672 and $16.80. In education and health services, those amounts are $717 and $21.34 for RTW and $650 and $20.06 for non-RTW. These differing statistics question the true RTW impact on wage increases and the quality of employment.
|
You will only respond using the given context and include no information not readily available in the text. What were the immediate and long-term impacts of Right-to-Work laws on employment and wages? Federal Policies and American Labor Relations The National Labor Relations Act/Wagner Act (NLRA) of 1935 was passed by Congress to protect workers’ rights to unionization. NLRA states and defines the rights of employees to organize and bargain collectively with their employers through representatives of their own choosing (i.e., elected union leaders). The NLRA identified workers’ rights to form a union, join a union, and to strike in an effort to secure better working conditions (National Labor Relations Board, 1997). “The act also created a new National Labor Relations Board (NLRB) to arbitrate deadlocked labor- management disputes, guarantee democratic union elections and penalize unfair labor practices by employers” (Cooper, 2004, p. 2). Furthermore, NLRA prohibited employers from setting up a company union and firing or otherwise discriminating against workers who organized or joined unions (Encyclopedia Britannica, 2007). Prior to the passage of NLRA, the federal government had been largely antagonistic to union organizing. Labor unions across the country faced significant challenges in social action initiatives aimed at ensuring adequate wages, benefits and the reduction of industry health hazards. During the first half of the twentieth century, for example, laborers who attempted to organize protective associations frequently found themselves prosecuted for and convicted of conspiracy (to do what?) (Beik, 2005). With the onset of the Great Depression, and an unemployment rate of 24.9 percent in 1933 , the national political framework shifted its focus from the protection of the business sector to the protection of workers and individuals through the creation of New Deal policies (e.g., Social Security and Civilian Conservation Corps). These policies hoped to create a social safety net that would prevent further economic disaster. Due to the power of business interests and persons advocating a free market society, many New Deal policies had been declared unconstitutional by the United States Supreme Court, including the previous labor legislation – the National Industry Recovery Act of 1933 which authorized the President to regulate businesses in the interests of promoting fair competition, supporting prices and competition, creating jobs for the unemployed, and stimulating the United States economy to recover from the Great Depression (Babson, 1999). Thus, many businesses believed that the NLRA would follow the same path. In April of 1937, however, the NLRA was declared constitutional by the Supreme Court, highlighting the increased power of labor unions on national politics and policymaking (Beik, 2005). In 1935, 15 percent of American workers were unionized. By 1945, the proportion had risen to 35 percent (Babson, 1999). During this time there were three primary types of union/employer structural arrangements: the agency shop, the union shop, and the closed shop. Cooper (2004) describes the arrangements as follows: • Agency Shop: The union’s contract does not mandate that all employees join the union, but it does mandate that the employees pay agency fees. • Union Shop: The union’s contract requires that all employees join the union within a specified amount of time after becoming employed. • Closed Shop: The union’s contract mandates that the employer only hire union members (pg. 2). 1945 marked the peak of American unionization with over one-third of American workers belonging to labor unions. Organized labor reached the zenith of its power in the U.S. from 1935 – 1947 (Beik, 2005). Many business leaders, however, began to lobby for a loosening of union power insisting that businesses and individuals were, due to the NLRA, prevented from exercising their right of association and employment procedures. At the same time, the political landscape was changing and anti-communism was used as a key argument to stymie the power of unions. Labor unions were seen as a corrupt socialist tactic and, thus, could be associated with the red scare. The public also began to demand action after the World War Two coal strikes and the postwar strikes in steel, autos and other industries were perceived to have damaged the economy. With the increasing constituent pressure and the election in 1944 of the pro-business and pro-states’ rights Republican congress, the second significant piece of national labor legislation was passed, the 1947 Taft-Hartley Act. Taft-Hartley effectively overturned many of the rights guaranteed by NLRA and outlawed the closed shop arrangement (Cooper, 2004). Moreover, “section 14(b) of Taft-Hartley made Right-to-Work laws legal and gave states the power to pass laws to outlaw both agency and union shops” (Cooper, 2004, p. 10). This provision afforded states the opportunity to pass laws that forbade the establishment of businesses and/or union contracts where union membership was a condition of employment; thus, the age of RTW began. Right-to-Work Laws Immediately following the passage of the Taft-Hartley Act states began to enact Right-to- Work laws. The basic concept of RTW is that workers should not be obligated to join or give support to a union as a condition of employment (Kersey, 2007).2 The main objectives of RTW laws have, to this day, shared similar purposes. These objectives include: a. the promotion of individual freedom; b. the creation of a pro-business atmosphere aimed at spurring economic growth; c. the elimination of the power of union organization. As of January 1, 2006, 22 states had passed RTW legislation. It is important to note that a regional divide exists with regard to the establishment of RTW laws... most of the states with RTW laws are located in the southeast, Midwest and Rocky Mountain States. These states have traditionally maintained lower rates of unionization -- 18% in 1947, 52% lower than their non-RTW counterparts (Beik, 1998). Right-to-Work Laws and Employment One of the key arguments offered by proponents of RTW legislation is that the laws increase employment. Proponents believe that, if businesses are not required to operate under union wage contracts, they will remain profitable due to decreased labor costs and the economic landscape will encourage cross-state relocation of businesses; thus, employment opportunities will increase for all citizens. “Opponents, however, argue that most job growth occurs from in-state business expansion not the relocation of businesses from a non-RTW to a RTW state” (Oklahoma League of Economists, 1996, paragraph 2). The unemployment rates in RTW states pre and post RTW passage, as well as the comparison of RTW to non-RTW states, provide important insights in to the impact of RTW legislation on employment across jurisdictions. Overall, the unemployment rates in RTW states are lower than non-RTW states. For example, the unemployment rate between 1978 and 2000 averaged 5.8percent in RTW states versus 6.3percent in non-RTW states. Additionally, between 1970 and 2000 overall employment increased by 2.9percent annually in RTW states versus 2.0percent in non-RTW states. This trend has continued, although tightening, into the 2000s; between 2001 and 2006 RTW states had a median 4.8percent unemployment rate compared to 5.1 percent for non-RTW states (Kersey, 2007). As of March 2010, RTW states had an average unemployment rate of 8.6% while the rate in non-RTW states stood at 9.4% (Bureau of Labor Statistics [BLS], 2010). Another aspect of the impact that RTW laws have on employment relates to the type and condition of employment between the two types of states. The share of manufacturing employment in the U.S. in 1950 was 35percent of the workforce. This figure declined to 13 percent in 2004 (Fischer & Rupert, 2005). Many RTW advocates believe pro-business laws, such as RTW, lessen manufacturing losses by creating a conducive business atmosphere. While both types of states have not been able to stem the national tide, data indicates that manufacturing employment in RTW states has decreased at a much lower rate than in their non-RTW counterparts where manufacturing employment has seen significant decreases. Between 2001 and 2006 the typical RTW state saw manufacturing employment decline 1.5percent annually, equaling 7.1percent overall. Non-RTW states, however, faced even sharper declines, averaging 3.0 percent annually and 13.7 percent over the five year period. Every non-RTW state but one, Alaska, lost manufacturing jobs during that period, while five RTW states registered at least modest gains in this area (Wright, 2007). In terms of job conditions, the government data shows that in 2003 the rate of workplace fatalities per 100,000 workers was highest in right-to-work states. The rate of workplace deaths is 51 percent higher in RTW states (BLS, 2006). Nineteen of the top 25 states for worker fatality rates were RTW states, while three of the bottom 25 states were RTW states (Bureau of Labor Statistics [BLS], 2003). Further, in a study of New York City construction site fatalities, it was found that 93 percent of deaths happened at non-union sites (Walter, 2007). The same holds true in the coal mining industry where 87 percent of fatalities between 2007 and 2009 occurred at non-union mines (U.S. House of Representatives Committee on Education and Labor, 2007). Right-to-Work and Job Growth Holmes (1998) argues that large manufacturing establishments are more likely to be attracted to RTW states because larger plants are more likely to be unionized. RTW laws, according to manufacturers, help maintain competiveness and encourage development in the strained sector. He also found that eight of the ten states with the highest manufacturing employment growth rates are RTW states. All ten states with the lowest growth rates are non-RTW states. Opponents charge that the laws depress individual worker wages at the expense of profits and capitalist objectives. From 1977 through 1999, Gross State Product (GSP), the market value of all goods and services produced in a state, increased 0.5 percent faster in RTW states than in non-RTW states (Wilson, 2002). Right-to-Work Laws and Wages One condition of employment is the impact of RTW laws on wages. This includes both absolute wages and the overall wage distribution across income and racial lines following RTW passage. There are currently 132,604,980 workers in the United States (U.S.). The American worker, as of July 2009, earned an average of $44,901 per year. This translates in to an average hourly wage of $22.36 (Bureau of Labor Statistics [BLS], 2009). Leading researchers disagree on the impact of RTW laws on wages. For example, 16 of the 18 states are estimated to have had higher average wages in 2000 as a result of their RTW status (Reed, 2003). On the other hand, Bureau of Labor Statistics (BLS) data reveals that average annual pay is higher in non-RTW states. In addition, income polarization is higher in RTW states, with a higher percentage of workers earning the minimum wage (even when controlling for education level) than in non-RTW states. After years of economic development, the portion of heads of household earning around the minimum wage is still 35.5 percent (4.4 percentage points) higher in RTW than in high-union-density states" (Cassell, 2001). Lawrence Mishel (2001) of the Economic Policy Institute found that in 2000 the median wage for workers living in RTW states was $11.45, while wages for those living in non -RTW states were $13.00, indicating that wages were 11.9 percent lower in RTW states. He further concluded that previous research citing wage increases in RTW states were directly attributable to the improved income characteristics of those residing in large cities located on a state border with a non-RTW state. At the same time, when looking at weekly and hourly wages by industry between RTW and non-RTW states adjusted for cost-of-living, RTW states have higher wages in two key industries. For example, in manufacturing workers in RTW states earn an average of $717 weekly and $17.89 hourly while their non-RTW counterparts earn $672 and $16.80. In education and health services, those amounts are $717 and $21.34 for RTW and $650 and $20.06 for non-RTW. These differing statistics question the true RTW impact on wage increases and the quality of employment.
|
You will only respond using the given context and include no information not readily available in the text.
EVIDENCE:
Federal Policies and American Labor Relations The National Labor Relations Act/Wagner Act (NLRA) of 1935 was passed by Congress to protect workers’ rights to unionization. NLRA states and defines the rights of employees to organize and bargain collectively with their employers through representatives of their own choosing (i.e., elected union leaders). The NLRA identified workers’ rights to form a union, join a union, and to strike in an effort to secure better working conditions (National Labor Relations Board, 1997). “The act also created a new National Labor Relations Board (NLRB) to arbitrate deadlocked labor- management disputes, guarantee democratic union elections and penalize unfair labor practices by employers” (Cooper, 2004, p. 2). Furthermore, NLRA prohibited employers from setting up a company union and firing or otherwise discriminating against workers who organized or joined unions (Encyclopedia Britannica, 2007). Prior to the passage of NLRA, the federal government had been largely antagonistic to union organizing. Labor unions across the country faced significant challenges in social action initiatives aimed at ensuring adequate wages, benefits and the reduction of industry health hazards. During the first half of the twentieth century, for example, laborers who attempted to organize protective associations frequently found themselves prosecuted for and convicted of conspiracy (to do what?) (Beik, 2005). With the onset of the Great Depression, and an unemployment rate of 24.9 percent in 1933 , the national political framework shifted its focus from the protection of the business sector to the protection of workers and individuals through the creation of New Deal policies (e.g., Social Security and Civilian Conservation Corps). These policies hoped to create a social safety net that would prevent further economic disaster. Due to the power of business interests and persons advocating a free market society, many New Deal policies had been declared unconstitutional by the United States Supreme Court, including the previous labor legislation – the National Industry Recovery Act of 1933 which authorized the President to regulate businesses in the interests of promoting fair competition, supporting prices and competition, creating jobs for the unemployed, and stimulating the United States economy to recover from the Great Depression (Babson, 1999). Thus, many businesses believed that the NLRA would follow the same path. In April of 1937, however, the NLRA was declared constitutional by the Supreme Court, highlighting the increased power of labor unions on national politics and policymaking (Beik, 2005). In 1935, 15 percent of American workers were unionized. By 1945, the proportion had risen to 35 percent (Babson, 1999). During this time there were three primary types of union/employer structural arrangements: the agency shop, the union shop, and the closed shop. Cooper (2004) describes the arrangements as follows: • Agency Shop: The union’s contract does not mandate that all employees join the union, but it does mandate that the employees pay agency fees. • Union Shop: The union’s contract requires that all employees join the union within a specified amount of time after becoming employed. • Closed Shop: The union’s contract mandates that the employer only hire union members (pg. 2). 1945 marked the peak of American unionization with over one-third of American workers belonging to labor unions. Organized labor reached the zenith of its power in the U.S. from 1935 – 1947 (Beik, 2005). Many business leaders, however, began to lobby for a loosening of union power insisting that businesses and individuals were, due to the NLRA, prevented from exercising their right of association and employment procedures. At the same time, the political landscape was changing and anti-communism was used as a key argument to stymie the power of unions. Labor unions were seen as a corrupt socialist tactic and, thus, could be associated with the red scare. The public also began to demand action after the World War Two coal strikes and the postwar strikes in steel, autos and other industries were perceived to have damaged the economy. With the increasing constituent pressure and the election in 1944 of the pro-business and pro-states’ rights Republican congress, the second significant piece of national labor legislation was passed, the 1947 Taft-Hartley Act. Taft-Hartley effectively overturned many of the rights guaranteed by NLRA and outlawed the closed shop arrangement (Cooper, 2004). Moreover, “section 14(b) of Taft-Hartley made Right-to-Work laws legal and gave states the power to pass laws to outlaw both agency and union shops” (Cooper, 2004, p. 10). This provision afforded states the opportunity to pass laws that forbade the establishment of businesses and/or union contracts where union membership was a condition of employment; thus, the age of RTW began. Right-to-Work Laws Immediately following the passage of the Taft-Hartley Act states began to enact Right-to- Work laws. The basic concept of RTW is that workers should not be obligated to join or give support to a union as a condition of employment (Kersey, 2007).2 The main objectives of RTW laws have, to this day, shared similar purposes. These objectives include: a. the promotion of individual freedom; b. the creation of a pro-business atmosphere aimed at spurring economic growth; c. the elimination of the power of union organization. As of January 1, 2006, 22 states had passed RTW legislation. It is important to note that a regional divide exists with regard to the establishment of RTW laws... most of the states with RTW laws are located in the southeast, Midwest and Rocky Mountain States. These states have traditionally maintained lower rates of unionization -- 18% in 1947, 52% lower than their non-RTW counterparts (Beik, 1998). Right-to-Work Laws and Employment One of the key arguments offered by proponents of RTW legislation is that the laws increase employment. Proponents believe that, if businesses are not required to operate under union wage contracts, they will remain profitable due to decreased labor costs and the economic landscape will encourage cross-state relocation of businesses; thus, employment opportunities will increase for all citizens. “Opponents, however, argue that most job growth occurs from in-state business expansion not the relocation of businesses from a non-RTW to a RTW state” (Oklahoma League of Economists, 1996, paragraph 2). The unemployment rates in RTW states pre and post RTW passage, as well as the comparison of RTW to non-RTW states, provide important insights in to the impact of RTW legislation on employment across jurisdictions. Overall, the unemployment rates in RTW states are lower than non-RTW states. For example, the unemployment rate between 1978 and 2000 averaged 5.8percent in RTW states versus 6.3percent in non-RTW states. Additionally, between 1970 and 2000 overall employment increased by 2.9percent annually in RTW states versus 2.0percent in non-RTW states. This trend has continued, although tightening, into the 2000s; between 2001 and 2006 RTW states had a median 4.8percent unemployment rate compared to 5.1 percent for non-RTW states (Kersey, 2007). As of March 2010, RTW states had an average unemployment rate of 8.6% while the rate in non-RTW states stood at 9.4% (Bureau of Labor Statistics [BLS], 2010). Another aspect of the impact that RTW laws have on employment relates to the type and condition of employment between the two types of states. The share of manufacturing employment in the U.S. in 1950 was 35percent of the workforce. This figure declined to 13 percent in 2004 (Fischer & Rupert, 2005). Many RTW advocates believe pro-business laws, such as RTW, lessen manufacturing losses by creating a conducive business atmosphere. While both types of states have not been able to stem the national tide, data indicates that manufacturing employment in RTW states has decreased at a much lower rate than in their non-RTW counterparts where manufacturing employment has seen significant decreases. Between 2001 and 2006 the typical RTW state saw manufacturing employment decline 1.5percent annually, equaling 7.1percent overall. Non-RTW states, however, faced even sharper declines, averaging 3.0 percent annually and 13.7 percent over the five year period. Every non-RTW state but one, Alaska, lost manufacturing jobs during that period, while five RTW states registered at least modest gains in this area (Wright, 2007). In terms of job conditions, the government data shows that in 2003 the rate of workplace fatalities per 100,000 workers was highest in right-to-work states. The rate of workplace deaths is 51 percent higher in RTW states (BLS, 2006). Nineteen of the top 25 states for worker fatality rates were RTW states, while three of the bottom 25 states were RTW states (Bureau of Labor Statistics [BLS], 2003). Further, in a study of New York City construction site fatalities, it was found that 93 percent of deaths happened at non-union sites (Walter, 2007). The same holds true in the coal mining industry where 87 percent of fatalities between 2007 and 2009 occurred at non-union mines (U.S. House of Representatives Committee on Education and Labor, 2007). Right-to-Work and Job Growth Holmes (1998) argues that large manufacturing establishments are more likely to be attracted to RTW states because larger plants are more likely to be unionized. RTW laws, according to manufacturers, help maintain competiveness and encourage development in the strained sector. He also found that eight of the ten states with the highest manufacturing employment growth rates are RTW states. All ten states with the lowest growth rates are non-RTW states. Opponents charge that the laws depress individual worker wages at the expense of profits and capitalist objectives. From 1977 through 1999, Gross State Product (GSP), the market value of all goods and services produced in a state, increased 0.5 percent faster in RTW states than in non-RTW states (Wilson, 2002). Right-to-Work Laws and Wages One condition of employment is the impact of RTW laws on wages. This includes both absolute wages and the overall wage distribution across income and racial lines following RTW passage. There are currently 132,604,980 workers in the United States (U.S.). The American worker, as of July 2009, earned an average of $44,901 per year. This translates in to an average hourly wage of $22.36 (Bureau of Labor Statistics [BLS], 2009). Leading researchers disagree on the impact of RTW laws on wages. For example, 16 of the 18 states are estimated to have had higher average wages in 2000 as a result of their RTW status (Reed, 2003). On the other hand, Bureau of Labor Statistics (BLS) data reveals that average annual pay is higher in non-RTW states. In addition, income polarization is higher in RTW states, with a higher percentage of workers earning the minimum wage (even when controlling for education level) than in non-RTW states. After years of economic development, the portion of heads of household earning around the minimum wage is still 35.5 percent (4.4 percentage points) higher in RTW than in high-union-density states" (Cassell, 2001). Lawrence Mishel (2001) of the Economic Policy Institute found that in 2000 the median wage for workers living in RTW states was $11.45, while wages for those living in non -RTW states were $13.00, indicating that wages were 11.9 percent lower in RTW states. He further concluded that previous research citing wage increases in RTW states were directly attributable to the improved income characteristics of those residing in large cities located on a state border with a non-RTW state. At the same time, when looking at weekly and hourly wages by industry between RTW and non-RTW states adjusted for cost-of-living, RTW states have higher wages in two key industries. For example, in manufacturing workers in RTW states earn an average of $717 weekly and $17.89 hourly while their non-RTW counterparts earn $672 and $16.80. In education and health services, those amounts are $717 and $21.34 for RTW and $650 and $20.06 for non-RTW. These differing statistics question the true RTW impact on wage increases and the quality of employment.
USER:
What were the immediate and long-term impacts of Right-to-Work laws on employment and wages?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 18 | 14 | 1,927 | null | 535 |
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
|
Discuss the purpose of Artificial Intelligence in relationship with the financial industry as outlined in this article. Keep the response under 200 words and do not use the word technology
|
Artificial Intelligence and Machine Learning in Financial Services The financial industry’s adoption of artificial intelligence (AI) and machine learning (ML) is evolving as financial firms employ ever greater levels of technology and automation to deliver services. Expanding on earlier models of quantitative analysis, AI/ML has often been adopted in finance to solve discrete challenges, such as maximizing profit and minimizing risk. Yet the industry’s adoption of the newer technology also occurs against perceptions that are steeped in tradition and historical financial regulation, and regulators want to ensure that the technology does not sidestep regulations frequently described as technology neutral. Technological advances in computer hardware, capacity, and data storage—which permit the collection and analysis of data—helped fuel the development and use of AI/ML technologies in finance. Unlike older algorithms that automated human-coded rules, new AI models can “learn” by themselves and make inferences and recommendations not identified by modelers in advance. This shift in technology has also enabled the use of new types of data including alternative data (i.e., data that the consumer credit bureaus do not traditionally use), unstructured data (images or social media posts, etc.), and unlabeled information data—which, when combined, extend the technologies’ uses to new financial services or products. Different parts of the financial services industry have adopted AI/ML technology to varying degrees and for various purposes. Some uses of AI/ML include powering chatbots in customer service functions, identifying investment opportunities and/or executing trades, augmenting lending models or (more sparingly) making lending decisions, and identifying and preventing fraud. The extent to which a sector or firm adopts various technologies reflects a variety of factors, including a firm’s ability to fund internal development and regulatory requirements. The increased use of AI/ML to deliver financial services has attracted attention and led to numerous policy issues and subsequent policy actions. Such policy actions culminated in (1) the establishment of a task force on AI in the 116 th Congress and the more recent working group in the House Committee on Financial Services in the 118th and (2) 2019 and 2023 executive orders. The evolving legislative and regulatory framework regarding AI/ML use in finance is likely, at least in part, to influence the development of AI/ML financial services applications. Various financial regulators have indicated that regulated entities are subject to the full range of laws and regulations regardless of the technology used. Additionally, some regulators have identified regulations and issued guidance of particular relevance to financial firms employing AI/ML technologies. Financial industry policymakers face competing pressures. Financial service providers and technology companies are likely to continue adopting and promoting AI/ML to save time and money and promote accessibility, accuracy, and regulatory compliance. However, challenges and risks in the form of bias, potential for systemic risk and manipulation, affordability, and consequences for employment remain. Determining whether the existing regulatory structure is sufficient—or whether one that is more closely tailored to the technological capacities of the evolving technology is necessary—has emerged as a key consideration. Should Congress consider the legislative framework governing AI/ML in finance, industry and consumers alike will expect that it weighs the benefits of innovation with existing and potential future challenges and risks.
|
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> Discuss the purpose of Artificial Intelligence in relationship with the financial industry as outlined in this article. Keep the response under 200 words and do not use the word technology <TEXT> Artificial Intelligence and Machine Learning in Financial Services The financial industry’s adoption of artificial intelligence (AI) and machine learning (ML) is evolving as financial firms employ ever greater levels of technology and automation to deliver services. Expanding on earlier models of quantitative analysis, AI/ML has often been adopted in finance to solve discrete challenges, such as maximizing profit and minimizing risk. Yet the industry’s adoption of the newer technology also occurs against perceptions that are steeped in tradition and historical financial regulation, and regulators want to ensure that the technology does not sidestep regulations frequently described as technology neutral. Technological advances in computer hardware, capacity, and data storage—which permit the collection and analysis of data—helped fuel the development and use of AI/ML technologies in finance. Unlike older algorithms that automated human-coded rules, new AI models can “learn” by themselves and make inferences and recommendations not identified by modelers in advance. This shift in technology has also enabled the use of new types of data including alternative data (i.e., data that the consumer credit bureaus do not traditionally use), unstructured data (images or social media posts, etc.), and unlabeled information data—which, when combined, extend the technologies’ uses to new financial services or products. Different parts of the financial services industry have adopted AI/ML technology to varying degrees and for various purposes. Some uses of AI/ML include powering chatbots in customer service functions, identifying investment opportunities and/or executing trades, augmenting lending models or (more sparingly) making lending decisions, and identifying and preventing fraud. The extent to which a sector or firm adopts various technologies reflects a variety of factors, including a firm’s ability to fund internal development and regulatory requirements. The increased use of AI/ML to deliver financial services has attracted attention and led to numerous policy issues and subsequent policy actions. Such policy actions culminated in (1) the establishment of a task force on AI in the 116 th Congress and the more recent working group in the House Committee on Financial Services in the 118th and (2) 2019 and 2023 executive orders. The evolving legislative and regulatory framework regarding AI/ML use in finance is likely, at least in part, to influence the development of AI/ML financial services applications. Various financial regulators have indicated that regulated entities are subject to the full range of laws and regulations regardless of the technology used. Additionally, some regulators have identified regulations and issued guidance of particular relevance to financial firms employing AI/ML technologies. Financial industry policymakers face competing pressures. Financial service providers and technology companies are likely to continue adopting and promoting AI/ML to save time and money and promote accessibility, accuracy, and regulatory compliance. However, challenges and risks in the form of bias, potential for systemic risk and manipulation, affordability, and consequences for employment remain. Determining whether the existing regulatory structure is sufficient—or whether one that is more closely tailored to the technological capacities of the evolving technology is necessary—has emerged as a key consideration. Should Congress consider the legislative framework governing AI/ML in finance, industry and consumers alike will expect that it weighs the benefits of innovation with existing and potential future challenges and risks. https://crsreports.congress.gov/product/pdf/R/R47997
|
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
EVIDENCE:
Artificial Intelligence and Machine Learning in Financial Services The financial industry’s adoption of artificial intelligence (AI) and machine learning (ML) is evolving as financial firms employ ever greater levels of technology and automation to deliver services. Expanding on earlier models of quantitative analysis, AI/ML has often been adopted in finance to solve discrete challenges, such as maximizing profit and minimizing risk. Yet the industry’s adoption of the newer technology also occurs against perceptions that are steeped in tradition and historical financial regulation, and regulators want to ensure that the technology does not sidestep regulations frequently described as technology neutral. Technological advances in computer hardware, capacity, and data storage—which permit the collection and analysis of data—helped fuel the development and use of AI/ML technologies in finance. Unlike older algorithms that automated human-coded rules, new AI models can “learn” by themselves and make inferences and recommendations not identified by modelers in advance. This shift in technology has also enabled the use of new types of data including alternative data (i.e., data that the consumer credit bureaus do not traditionally use), unstructured data (images or social media posts, etc.), and unlabeled information data—which, when combined, extend the technologies’ uses to new financial services or products. Different parts of the financial services industry have adopted AI/ML technology to varying degrees and for various purposes. Some uses of AI/ML include powering chatbots in customer service functions, identifying investment opportunities and/or executing trades, augmenting lending models or (more sparingly) making lending decisions, and identifying and preventing fraud. The extent to which a sector or firm adopts various technologies reflects a variety of factors, including a firm’s ability to fund internal development and regulatory requirements. The increased use of AI/ML to deliver financial services has attracted attention and led to numerous policy issues and subsequent policy actions. Such policy actions culminated in (1) the establishment of a task force on AI in the 116 th Congress and the more recent working group in the House Committee on Financial Services in the 118th and (2) 2019 and 2023 executive orders. The evolving legislative and regulatory framework regarding AI/ML use in finance is likely, at least in part, to influence the development of AI/ML financial services applications. Various financial regulators have indicated that regulated entities are subject to the full range of laws and regulations regardless of the technology used. Additionally, some regulators have identified regulations and issued guidance of particular relevance to financial firms employing AI/ML technologies. Financial industry policymakers face competing pressures. Financial service providers and technology companies are likely to continue adopting and promoting AI/ML to save time and money and promote accessibility, accuracy, and regulatory compliance. However, challenges and risks in the form of bias, potential for systemic risk and manipulation, affordability, and consequences for employment remain. Determining whether the existing regulatory structure is sufficient—or whether one that is more closely tailored to the technological capacities of the evolving technology is necessary—has emerged as a key consideration. Should Congress consider the legislative framework governing AI/ML in finance, industry and consumers alike will expect that it weighs the benefits of innovation with existing and potential future challenges and risks.
USER:
Discuss the purpose of Artificial Intelligence in relationship with the financial industry as outlined in this article. Keep the response under 200 words and do not use the word technology
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 20 | 30 | 523 | null | 272 |
Only use information provided in the document to answer, don't use external knowledge.
|
In the context of the described medical study in the provided text, what task (or tasks) do "Neoantigens" have?
|
**Mismatch repair deficiency doesn’t always boost immunotherapy response** Mismatch repair deficiency occurs when tumor cells have a mutation in one of several genes that normally correct mistakes in the DNA code. Without that DNA spellchecker, the tumor constantly accumulates genetic mutations, leading to a high tumor mutational burden. To investigate why some tumors with deficient mismatch repair don’t respond to immune checkpoint inhibitors, Dr. Westcott and his colleagues genetically engineered mice to spontaneously grow lung or colorectal tumors that were either deficient in mismatch repair or had functioning mismatch repair. Tumors that were deficient in mismatch repair had many more mutations than tumors with functioning mismatch repair, the researchers confirmed. When they treated both sets of mice with an immune checkpoint inhibitor, they found an unexpected result: mismatch repair–deficient tumors didn’t shrink any more than tumors with functioning mismatch repair. In further experiments, the team figured out why. It came down to both the diversity and the type of mutations in the tumors, Dr. Westcott explained. The mismatch repair–deficient tumors had a lot of genetic diversity, meaning each mutation was only in a small fraction of cancer cells. And cancer-killing immune cells couldn't efficiently attack tumors with high genetic diversity, the researchers found. But when they created tumors in which all of the cancer cells had the same mutations, immune checkpoint inhibitors shrank the tumors and kept them at bay for months. The type of mutation also appeared to influence how immune system responds to tumors. Some mutations cause tumor cells to produce abnormal bits of proteins on their surface, called neoantigens. Neoantigens help the immune system spot cancer cells, whereas other types of mutations are less likely to jump-start the immune system. Cancer-killing immune cells launched a massive attack against tumors in which all of the cancer cells had the same neoantigen, called clonal neoantigens. But that attack weakened when only a fraction of the cancer cells had the neoantigen, the researchers found.
|
{document} ======= **Mismatch repair deficiency doesn’t always boost immunotherapy response** Mismatch repair deficiency occurs when tumor cells have a mutation in one of several genes that normally correct mistakes in the DNA code. Without that DNA spellchecker, the tumor constantly accumulates genetic mutations, leading to a high tumor mutational burden. To investigate why some tumors with deficient mismatch repair don’t respond to immune checkpoint inhibitors, Dr. Westcott and his colleagues genetically engineered mice to spontaneously grow lung or colorectal tumors that were either deficient in mismatch repair or had functioning mismatch repair. Tumors that were deficient in mismatch repair had many more mutations than tumors with functioning mismatch repair, the researchers confirmed. When they treated both sets of mice with an immune checkpoint inhibitor, they found an unexpected result: mismatch repair–deficient tumors didn’t shrink any more than tumors with functioning mismatch repair. In further experiments, the team figured out why. It came down to both the diversity and the type of mutations in the tumors, Dr. Westcott explained. The mismatch repair–deficient tumors had a lot of genetic diversity, meaning each mutation was only in a small fraction of cancer cells. And cancer-killing immune cells couldn't efficiently attack tumors with high genetic diversity, the researchers found. But when they created tumors in which all of the cancer cells had the same mutations, immune checkpoint inhibitors shrank the tumors and kept them at bay for months. The type of mutation also appeared to influence how immune system responds to tumors. Some mutations cause tumor cells to produce abnormal bits of proteins on their surface, called neoantigens. Neoantigens help the immune system spot cancer cells, whereas other types of mutations are less likely to jump-start the immune system. Cancer-killing immune cells launched a massive attack against tumors in which all of the cancer cells had the same neoantigen, called clonal neoantigens. But that attack weakened when only a fraction of the cancer cells had the neoantigen, the researchers found. ================ {question} ======= In the context of the described medical study in the provided text, what task (or tasks) do "Neoantigens" have? ================ {task description} ======= Only use information provided in the document to answer, don't use external knowledge.
|
Only use information provided in the document to answer, don't use external knowledge.
EVIDENCE:
**Mismatch repair deficiency doesn’t always boost immunotherapy response** Mismatch repair deficiency occurs when tumor cells have a mutation in one of several genes that normally correct mistakes in the DNA code. Without that DNA spellchecker, the tumor constantly accumulates genetic mutations, leading to a high tumor mutational burden. To investigate why some tumors with deficient mismatch repair don’t respond to immune checkpoint inhibitors, Dr. Westcott and his colleagues genetically engineered mice to spontaneously grow lung or colorectal tumors that were either deficient in mismatch repair or had functioning mismatch repair. Tumors that were deficient in mismatch repair had many more mutations than tumors with functioning mismatch repair, the researchers confirmed. When they treated both sets of mice with an immune checkpoint inhibitor, they found an unexpected result: mismatch repair–deficient tumors didn’t shrink any more than tumors with functioning mismatch repair. In further experiments, the team figured out why. It came down to both the diversity and the type of mutations in the tumors, Dr. Westcott explained. The mismatch repair–deficient tumors had a lot of genetic diversity, meaning each mutation was only in a small fraction of cancer cells. And cancer-killing immune cells couldn't efficiently attack tumors with high genetic diversity, the researchers found. But when they created tumors in which all of the cancer cells had the same mutations, immune checkpoint inhibitors shrank the tumors and kept them at bay for months. The type of mutation also appeared to influence how immune system responds to tumors. Some mutations cause tumor cells to produce abnormal bits of proteins on their surface, called neoantigens. Neoantigens help the immune system spot cancer cells, whereas other types of mutations are less likely to jump-start the immune system. Cancer-killing immune cells launched a massive attack against tumors in which all of the cancer cells had the same neoantigen, called clonal neoantigens. But that attack weakened when only a fraction of the cancer cells had the neoantigen, the researchers found.
USER:
In the context of the described medical study in the provided text, what task (or tasks) do "Neoantigens" have?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 13 | 19 | 324 | null | 15 |
Only use information from the supplied context. Do not use outside information. Do not use extraneous text. Use bullets in at least some capacity to answer the questions. Your response should be under 100 words.
|
What are the five broad categories of business?
|
Defining a successful business EVERY ENTREPRENEUR ASPIRES to create a successful business, and investors certainly want management to run successful businesses. So what determines whether a business is being successful? Before answering this question, it is helpful to define what a business is and the various forms it can take. A business is a commercial operation that provides products or services with the aim of making a profit for the benefit of its owners. The significant point is “for the benefit of its owners”, which differentiates it from a government or not-for-profit organisation, such as a charity, where the activity is conducted for the benefit of the people it serves. A profit is an essential element of running a successful business. It is a trading surplus whereby the revenues earned exceed the costs. This surplus belongs to the owners of the business to use as they choose: to take for themselves, to reinvest back in the business, or a mixture of the two. For a government organisation or charity, any surplus is reinvested in the activities to further benefit the people it serves. Business structure A business can take many forms, ranging from a sole trader to a large multinational company. The principal aim of making a profit for its owners is still the same. A person starting out and setting up a business will take all the risk and reward as the venture gets under way. As the business grows it can be advantageous to share the risk with others and separate the business activities from those of the owner by establishing a company. A company is a legal entity in its own right that is separate from its 2017 Guide Financial Management.indd 1 22/01/2018 13:36 2 guide to financial management owners. An investor is risking only the money paid for buying some shares in the company. If the company ceases trading, the shareholders (owners) are not liable to make up any shortfall between the value of the company’s assets and its liabilities. There are five broad categories of business: ■ Sole trader. Someone who sets up a business alone and takes all the risk and reward of running it, and who may employ staff. ■ Partnership. Two or more people who set up a business together. The partners have joint ownership and share the risk and reward of running the business. Like a sole trader they may employ staff. ■ Limited liability partnership (LLP). A hybrid of a partnership and a company which provides the owners with the limited risk of a company and the shared ownership and tax status of a partnership. ■ Private company. Usually a small organisation raising its money from a few private investors. The shares may be difficult to trade as they are not listed on any stock market. Investors’ liability in private and public companies is limited to the amount of their investment. ■ Public company. Typically a large organisation that is usually listed on a stock exchange. Because of its size it may require significant investment, and hence it may need to draw investment from many investors. In this book the focus is mainly on companies, though the principles can be equally well applied to a sole trader, a partnership and indeed not-for-profit organisations. The role of the board The directors of a company are people hired (and at times fired) by the shareholders to be stewards of their investment. However, they need to balance this with their primary fiduciary duty as a director, which is to act in the best interests of the company. Collectively, a board of directors has overall responsibility for running a company successfully. This is achieved by setting and implementing its strategy. 2017 Guide Financial Management.indd 2 22/01/2018 13:36 Defining a successful business 3 In fulfilling the strategic aims of the company, the board will be responsible for making sure not only that the company has the necessary resources in terms of investment, assets and people, but also that there are appropriate operating controls and procedures for managing business risk and making sure that all monies that flow through the business are properly accounted for. What is a successful business? The media love to report on successful entrepreneurs and tell of how they beat the odds as they built their business and became household names. The media also enjoy revelling in the collapse of mighty organisations and unpicking the journey to their downfall. So what is it that defines business success or failure? Many descriptions are used to describe success, including “the business is profitable”, “revenue is growing” and “the share price is rising”. All these attributes are elements of success, though individually they do not embrace the totality. To be successful in business is to “create a sustainable superior return on investment”. The core element of this definition is “return on investment” (ROI). The business, having been built from money provided by investors, has a responsibility to reward those investors for risking their money in the venture. The ROI is a measure of the reward being generated. The concept is similar to a savings account, where an amount of money is placed on deposit with a bank and the investor earns interest on it. Despite the banking crisis of 2008 and its aftermath, the investment in a savings account is still seen as low risk and consequently the return that the investor will make is similarly low. Therefore, if a deposit of $1,000 is placed in a bank and the gross interest earned over a year is $30, the ROI can be expressed as being 3%. For a business to be successful it needs to reward investors by making them wealthier than they would have been by putting their money in a savings account. Why should they accept the greater risk of investing in a business, with all the uncertainty it faces, if they are 2017 Guide Financial Management.indd 3 22/01/2018 13:36 4 guide to financial management not going to be any better off? The return that investors would require might be double or more than a savings account, depending on the perceived risk, which will be related to factors such as the nature and maturity of the business. The return in a business is derived from the profit it generates compared with the money invested to achieve that profit. Therefore, if investors place $1,000 in a business and the operating profit over a year is $200, the ROI can be expressed as being 20%. Some examples of the returns achieved by companies in 2016 and stated in their annual reports are Walmart (a retailer) 15.5%, ExxonMobil (an oil company) 3.9% and Anglo American (an international mining company) 11.0%. Generating a “superior” return is to achieve a ROI that is greater than the rate achieved by businesses running similar activities in similar markets, and so to be successful is to generate a return that is at least as good as that achieved by your competitors, but ideally better than them. A “sustainable” superior return is perhaps the most difficult objective to achieve. It means generating a superior rate of return year in, year out. A business may be flying high when its products or services are in fashion. But the fall can be swift when its products or services are no longer in vogue and the business has gone from producing superior returns to producing inferior ones. To be sustainable is to continuously develop the business proposition in a way that keeps customers buying the company’s products or services in preference to those of its competitors. Innovation, technology and cost reduction are all activities that can help maintain a sustainable return. For example, the returns generated by the mobile phone company Nokia in 2006 were almost 46%. They resulted from a pre-eminence in a growing market coupled with an ability to continue to introduce new technology and ignite passion for the company’s latest products. Subsequently, Nokia failed to offer leading technology and was late in offering smartphones. As a result, it lost customers and the superior returns declined; in 2012 Nokia reported losses of €2.3 billion and was finally bought by Microsoft in April 2014. At the same time as Nokia was declining, Apple, its American rival, was rising. The two companies’ ROI between 2006 and 2012 is shown in Figure 1.1. On creating a superior ROI the directors of a company have two choices. They can either distribute the wealth to the investors or retain it in the business. The second option depends on whether the directors can identify further investment opportunities that will create even more wealth in the future. Profits can be retained in a company while investment opportunities are identified. However, this is only in the short term as investors (particularly in public companies) will demand the cash be “earning or returning”. Wealth is created for investors in a business in two ways: ■ annual income – a distribution of profit to the investor (by way of a dividend); ■ capital growth – a reinvestment back in the business to increase its value (share price). Shareholder value The term “shareholder value” is also used to describe success. Two definitions of shareholder value are: ■ a concept that focuses strategic and operational decision-making on steadily increasing a company’s value for shareholders; ■ maximising shareholder benefit by focusing on raising company earnings and the share price. These definitions focus more on increasing the value of a business in the long term rather than delivering a profit in the short term. An example would be Amazon, one of the best-known online retailers, where the initial strategy was to invest in building the distribution network and customer base as the foundation of the business. Once customer numbers grew the profits would emerge. Throughout its early years the company was creating long-term value while making large losses. During this period Amazon’s share price was volatile as it reflected changing views on the future benefits that would arise for investors. For a mature business, an example would be its investment in research and development to provide the products and revenue streams of the future. This investment can create shareholder value because of the potential it is judged to provide. However, the danger is that success is built on a future promise, and in a fast-changing world the future is always uncertain. For example, AstraZeneca, a pharmaceutical company, had taken years to develop a new lung cancer drug only to find in July 2017 that the trials had failed: its share price fell 16% in one day. For a company that is quoted on a stock market, there is the expectation to achieve a sufficient ROI every year while also investing to create future value. Once the business has started to make profits, any performance that is worse than the previous year is likely to meet with an adverse reaction from analysts and investors, which in many instances can lead to a forced change of management. In February 2017 Unilever, a food company, defended a hostile bid from Kraft Foods on the basis that it would complete a “comprehensive review of options available to accelerate delivery of value for the benefit of our shareholders”. Like all other global companies, it battles to produce the ever more superior results that stockmarket investors look for. The details of the measures used to monitor ROI and shareholder value creation are explained in Chapter 14.
|
Only use information from the supplied context. Do not use outside information. Do not use extraneous text. Use bullets in at least some capacity to answer the questions. Your response should be under 100 words. What are the five broad categories of business? Defining a successful business EVERY ENTREPRENEUR ASPIRES to create a successful business, and investors certainly want management to run successful businesses. So what determines whether a business is being successful? Before answering this question, it is helpful to define what a business is and the various forms it can take. A business is a commercial operation that provides products or services with the aim of making a profit for the benefit of its owners. The significant point is “for the benefit of its owners”, which differentiates it from a government or not-for-profit organisation, such as a charity, where the activity is conducted for the benefit of the people it serves. A profit is an essential element of running a successful business. It is a trading surplus whereby the revenues earned exceed the costs. This surplus belongs to the owners of the business to use as they choose: to take for themselves, to reinvest back in the business, or a mixture of the two. For a government organisation or charity, any surplus is reinvested in the activities to further benefit the people it serves. Business structure A business can take many forms, ranging from a sole trader to a large multinational company. The principal aim of making a profit for its owners is still the same. A person starting out and setting up a business will take all the risk and reward as the venture gets under way. As the business grows it can be advantageous to share the risk with others and separate the business activities from those of the owner by establishing a company. A company is a legal entity in its own right that is separate from its 2017 Guide Financial Management.indd 1 22/01/2018 13:36 2 guide to financial management owners. An investor is risking only the money paid for buying some shares in the company. If the company ceases trading, the shareholders (owners) are not liable to make up any shortfall between the value of the company’s assets and its liabilities. There are five broad categories of business: ■ Sole trader. Someone who sets up a business alone and takes all the risk and reward of running it, and who may employ staff. ■ Partnership. Two or more people who set up a business together. The partners have joint ownership and share the risk and reward of running the business. Like a sole trader they may employ staff. ■ Limited liability partnership (LLP). A hybrid of a partnership and a company which provides the owners with the limited risk of a company and the shared ownership and tax status of a partnership. ■ Private company. Usually a small organisation raising its money from a few private investors. The shares may be difficult to trade as they are not listed on any stock market. Investors’ liability in private and public companies is limited to the amount of their investment. ■ Public company. Typically a large organisation that is usually listed on a stock exchange. Because of its size it may require significant investment, and hence it may need to draw investment from many investors. In this book the focus is mainly on companies, though the principles can be equally well applied to a sole trader, a partnership and indeed not-for-profit organisations. The role of the board The directors of a company are people hired (and at times fired) by the shareholders to be stewards of their investment. However, they need to balance this with their primary fiduciary duty as a director, which is to act in the best interests of the company. Collectively, a board of directors has overall responsibility for running a company successfully. This is achieved by setting and implementing its strategy. 2017 Guide Financial Management.indd 2 22/01/2018 13:36 Defining a successful business 3 In fulfilling the strategic aims of the company, the board will be responsible for making sure not only that the company has the necessary resources in terms of investment, assets and people, but also that there are appropriate operating controls and procedures for managing business risk and making sure that all monies that flow through the business are properly accounted for. What is a successful business? The media love to report on successful entrepreneurs and tell of how they beat the odds as they built their business and became household names. The media also enjoy revelling in the collapse of mighty organisations and unpicking the journey to their downfall. So what is it that defines business success or failure? Many descriptions are used to describe success, including “the business is profitable”, “revenue is growing” and “the share price is rising”. All these attributes are elements of success, though individually they do not embrace the totality. To be successful in business is to “create a sustainable superior return on investment”. The core element of this definition is “return on investment” (ROI). The business, having been built from money provided by investors, has a responsibility to reward those investors for risking their money in the venture. The ROI is a measure of the reward being generated. The concept is similar to a savings account, where an amount of money is placed on deposit with a bank and the investor earns interest on it. Despite the banking crisis of 2008 and its aftermath, the investment in a savings account is still seen as low risk and consequently the return that the investor will make is similarly low. Therefore, if a deposit of $1,000 is placed in a bank and the gross interest earned over a year is $30, the ROI can be expressed as being 3%. For a business to be successful it needs to reward investors by making them wealthier than they would have been by putting their money in a savings account. Why should they accept the greater risk of investing in a business, with all the uncertainty it faces, if they are 2017 Guide Financial Management.indd 3 22/01/2018 13:36 4 guide to financial management not going to be any better off? The return that investors would require might be double or more than a savings account, depending on the perceived risk, which will be related to factors such as the nature and maturity of the business. The return in a business is derived from the profit it generates compared with the money invested to achieve that profit. Therefore, if investors place $1,000 in a business and the operating profit over a year is $200, the ROI can be expressed as being 20%. Some examples of the returns achieved by companies in 2016 and stated in their annual reports are Walmart (a retailer) 15.5%, ExxonMobil (an oil company) 3.9% and Anglo American (an international mining company) 11.0%. Generating a “superior” return is to achieve a ROI that is greater than the rate achieved by businesses running similar activities in similar markets, and so to be successful is to generate a return that is at least as good as that achieved by your competitors, but ideally better than them. A “sustainable” superior return is perhaps the most difficult objective to achieve. It means generating a superior rate of return year in, year out. A business may be flying high when its products or services are in fashion. But the fall can be swift when its products or services are no longer in vogue and the business has gone from producing superior returns to producing inferior ones. To be sustainable is to continuously develop the business proposition in a way that keeps customers buying the company’s products or services in preference to those of its competitors. Innovation, technology and cost reduction are all activities that can help maintain a sustainable return. For example, the returns generated by the mobile phone company Nokia in 2006 were almost 46%. They resulted from a pre-eminence in a growing market coupled with an ability to continue to introduce new technology and ignite passion for the company’s latest products. Subsequently, Nokia failed to offer leading technology and was late in offering smartphones. As a result, it lost customers and the superior returns declined; in 2012 Nokia reported losses of €2.3 billion and was finally bought by Microsoft in April 2014. At the same time as Nokia was declining, Apple, its American rival, was rising. The two companies’ ROI between 2006 and 2012 is shown in Figure 1.1. On creating a superior ROI the directors of a company have two choices. They can either distribute the wealth to the investors or retain it in the business. The second option depends on whether the directors can identify further investment opportunities that will create even more wealth in the future. Profits can be retained in a company while investment opportunities are identified. However, this is only in the short term as investors (particularly in public companies) will demand the cash be “earning or returning”. Wealth is created for investors in a business in two ways: ■ annual income – a distribution of profit to the investor (by way of a dividend); ■ capital growth – a reinvestment back in the business to increase its value (share price). Shareholder value The term “shareholder value” is also used to describe success. Two definitions of shareholder value are: ■ a concept that focuses strategic and operational decision-making on steadily increasing a company’s value for shareholders; ■ maximising shareholder benefit by focusing on raising company earnings and the share price. These definitions focus more on increasing the value of a business in the long term rather than delivering a profit in the short term. An example would be Amazon, one of the best-known online retailers, where the initial strategy was to invest in building the distribution network and customer base as the foundation of the business. Once customer numbers grew the profits would emerge. Throughout its early years the company was creating long-term value while making large losses. During this period Amazon’s share price was volatile as it reflected changing views on the future benefits that would arise for investors. For a mature business, an example would be its investment in research and development to provide the products and revenue streams of the future. This investment can create shareholder value because of the potential it is judged to provide. However, the danger is that success is built on a future promise, and in a fast-changing world the future is always uncertain. For example, AstraZeneca, a pharmaceutical company, had taken years to develop a new lung cancer drug only to find in July 2017 that the trials had failed: its share price fell 16% in one day. For a company that is quoted on a stock market, there is the expectation to achieve a sufficient ROI every year while also investing to create future value. Once the business has started to make profits, any performance that is worse than the previous year is likely to meet with an adverse reaction from analysts and investors, which in many instances can lead to a forced change of management. In February 2017 Unilever, a food company, defended a hostile bid from Kraft Foods on the basis that it would complete a “comprehensive review of options available to accelerate delivery of value for the benefit of our shareholders”. Like all other global companies, it battles to produce the ever more superior results that stockmarket investors look for. The details of the measures used to monitor ROI and shareholder value creation are explained in Chapter 14.
|
Only use information from the supplied context. Do not use outside information. Do not use extraneous text. Use bullets in at least some capacity to answer the questions. Your response should be under 100 words.
EVIDENCE:
Defining a successful business EVERY ENTREPRENEUR ASPIRES to create a successful business, and investors certainly want management to run successful businesses. So what determines whether a business is being successful? Before answering this question, it is helpful to define what a business is and the various forms it can take. A business is a commercial operation that provides products or services with the aim of making a profit for the benefit of its owners. The significant point is “for the benefit of its owners”, which differentiates it from a government or not-for-profit organisation, such as a charity, where the activity is conducted for the benefit of the people it serves. A profit is an essential element of running a successful business. It is a trading surplus whereby the revenues earned exceed the costs. This surplus belongs to the owners of the business to use as they choose: to take for themselves, to reinvest back in the business, or a mixture of the two. For a government organisation or charity, any surplus is reinvested in the activities to further benefit the people it serves. Business structure A business can take many forms, ranging from a sole trader to a large multinational company. The principal aim of making a profit for its owners is still the same. A person starting out and setting up a business will take all the risk and reward as the venture gets under way. As the business grows it can be advantageous to share the risk with others and separate the business activities from those of the owner by establishing a company. A company is a legal entity in its own right that is separate from its 2017 Guide Financial Management.indd 1 22/01/2018 13:36 2 guide to financial management owners. An investor is risking only the money paid for buying some shares in the company. If the company ceases trading, the shareholders (owners) are not liable to make up any shortfall between the value of the company’s assets and its liabilities. There are five broad categories of business: ■ Sole trader. Someone who sets up a business alone and takes all the risk and reward of running it, and who may employ staff. ■ Partnership. Two or more people who set up a business together. The partners have joint ownership and share the risk and reward of running the business. Like a sole trader they may employ staff. ■ Limited liability partnership (LLP). A hybrid of a partnership and a company which provides the owners with the limited risk of a company and the shared ownership and tax status of a partnership. ■ Private company. Usually a small organisation raising its money from a few private investors. The shares may be difficult to trade as they are not listed on any stock market. Investors’ liability in private and public companies is limited to the amount of their investment. ■ Public company. Typically a large organisation that is usually listed on a stock exchange. Because of its size it may require significant investment, and hence it may need to draw investment from many investors. In this book the focus is mainly on companies, though the principles can be equally well applied to a sole trader, a partnership and indeed not-for-profit organisations. The role of the board The directors of a company are people hired (and at times fired) by the shareholders to be stewards of their investment. However, they need to balance this with their primary fiduciary duty as a director, which is to act in the best interests of the company. Collectively, a board of directors has overall responsibility for running a company successfully. This is achieved by setting and implementing its strategy. 2017 Guide Financial Management.indd 2 22/01/2018 13:36 Defining a successful business 3 In fulfilling the strategic aims of the company, the board will be responsible for making sure not only that the company has the necessary resources in terms of investment, assets and people, but also that there are appropriate operating controls and procedures for managing business risk and making sure that all monies that flow through the business are properly accounted for. What is a successful business? The media love to report on successful entrepreneurs and tell of how they beat the odds as they built their business and became household names. The media also enjoy revelling in the collapse of mighty organisations and unpicking the journey to their downfall. So what is it that defines business success or failure? Many descriptions are used to describe success, including “the business is profitable”, “revenue is growing” and “the share price is rising”. All these attributes are elements of success, though individually they do not embrace the totality. To be successful in business is to “create a sustainable superior return on investment”. The core element of this definition is “return on investment” (ROI). The business, having been built from money provided by investors, has a responsibility to reward those investors for risking their money in the venture. The ROI is a measure of the reward being generated. The concept is similar to a savings account, where an amount of money is placed on deposit with a bank and the investor earns interest on it. Despite the banking crisis of 2008 and its aftermath, the investment in a savings account is still seen as low risk and consequently the return that the investor will make is similarly low. Therefore, if a deposit of $1,000 is placed in a bank and the gross interest earned over a year is $30, the ROI can be expressed as being 3%. For a business to be successful it needs to reward investors by making them wealthier than they would have been by putting their money in a savings account. Why should they accept the greater risk of investing in a business, with all the uncertainty it faces, if they are 2017 Guide Financial Management.indd 3 22/01/2018 13:36 4 guide to financial management not going to be any better off? The return that investors would require might be double or more than a savings account, depending on the perceived risk, which will be related to factors such as the nature and maturity of the business. The return in a business is derived from the profit it generates compared with the money invested to achieve that profit. Therefore, if investors place $1,000 in a business and the operating profit over a year is $200, the ROI can be expressed as being 20%. Some examples of the returns achieved by companies in 2016 and stated in their annual reports are Walmart (a retailer) 15.5%, ExxonMobil (an oil company) 3.9% and Anglo American (an international mining company) 11.0%. Generating a “superior” return is to achieve a ROI that is greater than the rate achieved by businesses running similar activities in similar markets, and so to be successful is to generate a return that is at least as good as that achieved by your competitors, but ideally better than them. A “sustainable” superior return is perhaps the most difficult objective to achieve. It means generating a superior rate of return year in, year out. A business may be flying high when its products or services are in fashion. But the fall can be swift when its products or services are no longer in vogue and the business has gone from producing superior returns to producing inferior ones. To be sustainable is to continuously develop the business proposition in a way that keeps customers buying the company’s products or services in preference to those of its competitors. Innovation, technology and cost reduction are all activities that can help maintain a sustainable return. For example, the returns generated by the mobile phone company Nokia in 2006 were almost 46%. They resulted from a pre-eminence in a growing market coupled with an ability to continue to introduce new technology and ignite passion for the company’s latest products. Subsequently, Nokia failed to offer leading technology and was late in offering smartphones. As a result, it lost customers and the superior returns declined; in 2012 Nokia reported losses of €2.3 billion and was finally bought by Microsoft in April 2014. At the same time as Nokia was declining, Apple, its American rival, was rising. The two companies’ ROI between 2006 and 2012 is shown in Figure 1.1. On creating a superior ROI the directors of a company have two choices. They can either distribute the wealth to the investors or retain it in the business. The second option depends on whether the directors can identify further investment opportunities that will create even more wealth in the future. Profits can be retained in a company while investment opportunities are identified. However, this is only in the short term as investors (particularly in public companies) will demand the cash be “earning or returning”. Wealth is created for investors in a business in two ways: ■ annual income – a distribution of profit to the investor (by way of a dividend); ■ capital growth – a reinvestment back in the business to increase its value (share price). Shareholder value The term “shareholder value” is also used to describe success. Two definitions of shareholder value are: ■ a concept that focuses strategic and operational decision-making on steadily increasing a company’s value for shareholders; ■ maximising shareholder benefit by focusing on raising company earnings and the share price. These definitions focus more on increasing the value of a business in the long term rather than delivering a profit in the short term. An example would be Amazon, one of the best-known online retailers, where the initial strategy was to invest in building the distribution network and customer base as the foundation of the business. Once customer numbers grew the profits would emerge. Throughout its early years the company was creating long-term value while making large losses. During this period Amazon’s share price was volatile as it reflected changing views on the future benefits that would arise for investors. For a mature business, an example would be its investment in research and development to provide the products and revenue streams of the future. This investment can create shareholder value because of the potential it is judged to provide. However, the danger is that success is built on a future promise, and in a fast-changing world the future is always uncertain. For example, AstraZeneca, a pharmaceutical company, had taken years to develop a new lung cancer drug only to find in July 2017 that the trials had failed: its share price fell 16% in one day. For a company that is quoted on a stock market, there is the expectation to achieve a sufficient ROI every year while also investing to create future value. Once the business has started to make profits, any performance that is worse than the previous year is likely to meet with an adverse reaction from analysts and investors, which in many instances can lead to a forced change of management. In February 2017 Unilever, a food company, defended a hostile bid from Kraft Foods on the basis that it would complete a “comprehensive review of options available to accelerate delivery of value for the benefit of our shareholders”. Like all other global companies, it battles to produce the ever more superior results that stockmarket investors look for. The details of the measures used to monitor ROI and shareholder value creation are explained in Chapter 14.
USER:
What are the five broad categories of business?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 35 | 8 | 1,903 | null | 432 |
Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand.
|
What investigations should be done on the patients with the recurrent miscarrages?
|
Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited 23 Review J Clin Gynecol Obstet. 2022;11(2):23-26 Recurrent First Trimester Miscarriage: A Typical Case Presentation and Evidence-Based Management Review Vikram Talaulikar Abstract Recurrent miscarriage (RM), also known as recurrent pregnancy loss, is a distressing condition which affects about 1% of couples trying to achieve a pregnancy. It can be challenging for both patients and clinicians as the cause remains unexplained in at least 50% of cou- ples despite multiple investigations. A systematic and evidence-based approach to testing and management is important to avoid tests or treatments which are unnecessary or of unproven benefit. Access to specialist RM clinic services and psychological support forms a key part of the management of couples with RM. Keywords: Recurrent miscarriage; Treatment; Progesterone Introduction It is estimated that up to one in four natural pregnancies end up in a miscarriage which is defined as loss of pregnancy prior to viability (24 weeks’ gestation) [1]. Recurrent miscarriage (RM) is traditionally defined in the United Kingdom (UK) as three or more consecutive miscarriages and it can affect about 1% of couples trying for a pregnancy [2]. The definition of RM varies between countries with some clinical guidelines recom- mending investigations and treatment following two or more miscarriages. The Royal College of Obstetricians and Gynecologists (RCOG) has issued guidance on management of RM in the UK [2]. An updated version of this guideline is currently under consultation and will be released shortly. This article describes an illustrative typical clinical sce- nario related to RM and reviews the current best practice rec- ommendations for management of RM. Clinical Case The patient, 37 years old, has attended her general practition- er’s clinic following a recent pregnancy loss. She and her part- ner have been trying for a pregnancy for past 18 months but have suffered from three miscarriages between 6 and 8 weeks’ gestation. Her last miscarriage happened 2 months ago, and she has resumed her periods 2 weeks back. All the miscar- riages were managed conservatively without any medical or surgical interventions. She has regular menstrual cycles (25 - 26 days long) and does not report any dysmenorrhea or menor- rhagia. She is upset about the pregnancy losses, wondering if it was her fault and whether something can be done in the next pregnancy to change the outcome. History Consultations referring to RM should be performed in a sensi- tive manner. When discussing previous miscarriages, it is im- portant to enquire about the gestation at which pregnancy loss occurred. Pregnancy loss before 9 - 10 weeks usually (but not always) indicates a pre-placental cause, which may be either fetal (chromosomal) or endometrial (implantation disorder) in origin while that after this gestation could indicate problems such as thrombophilia, placental disorders, or problems with uterine structure. History of pregnancy loss after 12 weeks as- sociated with painless cervical dilatation and rupture of mem- branes suggests cervical weakness. Information should be obtained about how the previous miscarriages were managed: was the miscarriage completed naturally or whether medical or surgical management was required? Any possibility of uterine infection following miscarriage should be explored. Changes in the menstrual flow (hypomenorrhea) following possible infection of re- tained products of conception or uterine curettage could in- dicate the possibility of intrauterine adhesions. History of excess alcohol consumption or smoking should be obtained to offer advice on reducing risk of future miscarriage. Medi- cal and relevant family history should be obtained as un- controlled maternal medical conditions such as diabetes, thyroid or rheumatological disorders can impact the risk of miscarriage in future pregnancies. All miscarriages which the patient suffered from happened before 8 weeks gesta- Manuscript submitted February 11, 2022, accepted March 29, 2022 Published online April 12, 2022 University College London Hospital, London NW1 2BU, UK. Email: [email protected] doi: https://doi.org/10.14740/jcgo797 24 Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org Management of Recurrent Miscarriage J Clin Gynecol Obstet. 2022;11(2):23-26 tion and she bled naturally on all occasions suggesting a likely pre-placental fetal or endometrial cause for her preg- nancy loss. Examination On examination, patient’s body mass index (BMI) was within a normal range (23). Pelvic or speculum examination, guided by clinical history, can be useful as part of initial assessment especially if the woman has presented with irregular bleeding or abnormal vaginal discharge in which case cervix should be visualized to rule out other gynecological pathology such as ectropion/polyp and triple swabs should be obtained. The patient did not report any changes to her menstrual cycles or abnormal discharge following miscarriage. Risk factors and investigations The patient and her partner should be referred to and cared for in a dedicated RM clinic [2]. Psychological support and com- munication in a sensitive manner are extremely important. A discussion about potential risk factors for future miscarriage and testing should cover the following. Age Increasing female age increases the chances of a genetically abnormal pregnancy as the number and quality of oocytes decrease [1]. Women between 20 and 35 years old have the lowest risk of miscarriage while women above the age of 40 years have at least a 50% chance of miscarriage with every pregnancy [3, 4]. BMI High BMI (> 30) increases the risk of miscarriage [5]. Other risk factors Other risk factors include previous miscarriages, smoking and excess alcohol consumption. The patient is 37 years old and has already had three mis- carriages which increase her risk of future miscarriage to about 40% [6]. Causes of RM investigations The patient should be offered investigations for the causes of RM as listed in Table 1. Antiphospholipid syndrome (APS) This is an acquired thrombophilia which affects 15% of women with RM [2] and is diagnosed based on high levels of anticardiolipin antibodies and/or lupus anticoagulant along with evidence of adverse pregnancy outcomes (RM before 10 weeks or loss of one genetically normal pregnancy after 10 weeks or one or more preterm births before 34 weeks due to placental dysfunction) or unprovoked thrombosis. APS causes inhibition of trophoblast function, activation of complement system and thrombosis at the uteroplacental interface and is treated with a combination of aspirin and low molecular weight heparin in pregnancy [1]. Inherited thrombophilias such as factor V Leiden mutation, prothrombin mutation, protein C, protein S and antithrombin III deficiency have an uncertain role in first trimester RM and currently such tests should only be offered in the context of research. The patient had a negative APS screen. Genetic Parental balanced structural chromosomal anomalies can cause RM (2-5% of couples with RM). The risk of miscar- riage is influenced by the size and the genetic content of the rearranged chromosomal segments. Karyotyping of products of conception should be offered at the time of any future mis- carriage and parental karyotyping should follow if analysis of products of conception indicates that a genetic abnormal- ity may have resulted from an unbalanced translocation [2, 3]. Parental karyotyping is not recommended routinely due to low incidence of translocations and relatively high cost as- sociated with testing. Table 1. Causes and Relevant Investigations for Recurrent First Trimester Miscarriage Cause Test Genetic-balanced chromosomal translocations Karyotyping of products of conception (if abnormal result detected - parental karyotyping) Antiphospholipid syndrome Blood test for anticardiolipin antibodies and/or lupus anticoagulant (blood tests should be performed at least 6 weeks after any pregnancy loss and a repeat confirmatory test should be arranged at least 12 weeks after an initial positive screen) Endocrine (if evidence of clinical disorder or risk factors): thyroid, diabetes Thyroid function test (serum free T4 and thyroid-stimulating hormone levels); thyroid peroxidase antibodies; HbA1c Uterine abnormalities such as septate uterus or intracavitary lesions Transvaginal ultrasound scan Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org 25 Talaulikar J Clin Gynecol Obstet. 2022;11(2):23-26 Endocrine If there is clinical evidence of poorly controlled diabetes or thyroid dysfunction, appropriate blood tests should be per- formed [2]. The patient did not have any symptoms or signs suggestive of endocrine problems and had had a thyroid hor- mone profile at the time of her last miscarriage which revealed normal results. Uterine abnormalities Uterine abnormalities such as septate uterus or any other uter- ine cavity pathology such as intrauterine adhesions (especially following an episode of uterine instrumentation and infection), submucous fibroids or polyps should be ruled out by offering a pelvic ultrasound as these may be amenable to treatment by surgery (hysteroscopy +/- laparoscopy) [2, 7]. The patient was offered a transvaginal scan which showed a regular uterine cavity. The evidence regarding the effects of male partners on RM is weak and no specific testing can be recommended as part of investigations [1]. Advice Lifestyle advice should always be offered to couples with RM. The patient should be advised to maintain a normal BMI, avoid excess alcohol/smoking, and take pre-conception folic acid [2, 3]. Currently, there is lack of evidence that preimplantation genetic testing for aneuploidy screening (PGT-A) is superior to expectant management in RM patients [3]. If chromosomal translocation was identified at the time of future miscarriage, genetic counselling should be offered to the patient. Repro- ductive options following genetic counselling would include proceeding to a further natural pregnancy with or without a prenatal diagnosis test, gamete donation and adoption [2]. As in this case, despite thorough investigations, no clear underlying pathology is identifiable in at least 50% of cou- ples with RM (often labelled as “unexplained RM”) [7, 8]. The couple should be reassured about good prognosis for a live birth in future pregnancies and offered supportive care in dedi- cated early pregnancy unit. Many RM units offer empirical treatment with low dose oral aspirin (75 mg daily) and vaginal natural progesterone (400 mg once/twice daily) from positive pregnancy test until 12 - 14 weeks of pregnancy on a “low harm, possible benefit” basis for unexplained RM. The use of aspirin is not recommended in current clinical guidelines due to debate over its clinical effectiveness. Based on the evidence so far, it appears that the use of progesterone supplements is beneficial particularly in women with previous miscarriages who bleed in early pregnancy [9, 10]. The patient conceived again 5 months following her third miscarriage and had a successful pregnancy and live birth. She was prescribed vaginal progesterone pessaries from 7 weeks until 14 weeks of pregnancy following one episode of vaginal bleeding. Conclusions Couples with RM should be offered psychological support and be referred to a dedicated RM service for investigations. Most couples will have no identifiable pathology, and in such cases, there is good prognosis for future successful pregnancy. Learning points RM affects about 1% of couples trying for a pregnancy and no clear underlying pathology is identifiable despite investiga- tions in at least 50% of couples. Refer couples with RM to a dedicated RM service for in- vestigations and plan for future pregnancies. Offer psychological support and reassure couples with no identifiable pathology about good prognosis for future preg- nancy without pharmacological intervention. Acknowledgments None to declare. Financial Disclosure No funding was received for preparation of this manuscript. Conflict of Interest There is no conflict of interest to declare. Author Contributions VT wrote and finalized the manuscript. Data Availability The author declares that data supporting the findings of this study are available within the article. References 1. Shields R, Hawkes A, Quenby S. Clinical approach to recurrent pregnancy loss. Review, Obstetrics, Gynae- cology and Reproductive Medicine. 2020:30(11):331- 336. 2. The investigation and treatment of couples with recurrent first trimester and second-trimester miscarriage. 2011. Green-top Guideline No. 17 April. https://www.rcog.org. uk/globalassets/documents/guidelines/gtg_17.pdf. 3. Homer HA. Modern management of recurrent miscar- 26 Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org Management of Recurrent Miscarriage J Clin Gynecol Obstet. 2022;11(2):23-26 riage. Aust N Z J Obstet Gynaecol. 2019;59(1):36-44. 4. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ. 2000;320(7251):1708-1712. 5. Boots C, Stephenson MD. Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin Reprod Med. 2011;29(6):507-513. 6. Regan L, Braude PR, Trembath PL. Influence of past re- productive performance on risk of spontaneous abortion. BMJ. 1989;299(6698):541-545. 7. Jaslow CR, Carney JL, Kutteh WH. Diagnostic factors identified in 1020 women with two versus three or more recurrent pregnancy losses. Fertil Steril. 2010;93(4):1234- 1243. 8. Stirrat GM. Recurrent miscarriage. Lancet. 1990; 336(8716):673-675. 9. Coomarasamy A, Devall AJ, Cheed V, Harb H, Middleton LJ, Gallos ID, Williams H, et al. A randomized trial of progesterone in women with bleeding in early pregnancy. N Engl J Med. 2019;380(19):1815-1824. 10. Coomarasamy A, Williams H, Truchanowicz E, Seed PT, Small R, Quenby S, Gupta P, et al. A randomized trial of progesterone in women with recurrent miscarriages. N Engl J Med. 2015;373(22):2141-2148.
|
Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand. What investigations should be done on the patients with the recurrent miscarrages? Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited 23 Review J Clin Gynecol Obstet. 2022;11(2):23-26 Recurrent First Trimester Miscarriage: A Typical Case Presentation and Evidence-Based Management Review Vikram Talaulikar Abstract Recurrent miscarriage (RM), also known as recurrent pregnancy loss, is a distressing condition which affects about 1% of couples trying to achieve a pregnancy. It can be challenging for both patients and clinicians as the cause remains unexplained in at least 50% of cou- ples despite multiple investigations. A systematic and evidence-based approach to testing and management is important to avoid tests or treatments which are unnecessary or of unproven benefit. Access to specialist RM clinic services and psychological support forms a key part of the management of couples with RM. Keywords: Recurrent miscarriage; Treatment; Progesterone Introduction It is estimated that up to one in four natural pregnancies end up in a miscarriage which is defined as loss of pregnancy prior to viability (24 weeks’ gestation) [1]. Recurrent miscarriage (RM) is traditionally defined in the United Kingdom (UK) as three or more consecutive miscarriages and it can affect about 1% of couples trying for a pregnancy [2]. The definition of RM varies between countries with some clinical guidelines recom- mending investigations and treatment following two or more miscarriages. The Royal College of Obstetricians and Gynecologists (RCOG) has issued guidance on management of RM in the UK [2]. An updated version of this guideline is currently under consultation and will be released shortly. This article describes an illustrative typical clinical sce- nario related to RM and reviews the current best practice rec- ommendations for management of RM. Clinical Case The patient, 37 years old, has attended her general practition- er’s clinic following a recent pregnancy loss. She and her part- ner have been trying for a pregnancy for past 18 months but have suffered from three miscarriages between 6 and 8 weeks’ gestation. Her last miscarriage happened 2 months ago, and she has resumed her periods 2 weeks back. All the miscar- riages were managed conservatively without any medical or surgical interventions. She has regular menstrual cycles (25 - 26 days long) and does not report any dysmenorrhea or menor- rhagia. She is upset about the pregnancy losses, wondering if it was her fault and whether something can be done in the next pregnancy to change the outcome. History Consultations referring to RM should be performed in a sensi- tive manner. When discussing previous miscarriages, it is im- portant to enquire about the gestation at which pregnancy loss occurred. Pregnancy loss before 9 - 10 weeks usually (but not always) indicates a pre-placental cause, which may be either fetal (chromosomal) or endometrial (implantation disorder) in origin while that after this gestation could indicate problems such as thrombophilia, placental disorders, or problems with uterine structure. History of pregnancy loss after 12 weeks as- sociated with painless cervical dilatation and rupture of mem- branes suggests cervical weakness. Information should be obtained about how the previous miscarriages were managed: was the miscarriage completed naturally or whether medical or surgical management was required? Any possibility of uterine infection following miscarriage should be explored. Changes in the menstrual flow (hypomenorrhea) following possible infection of re- tained products of conception or uterine curettage could in- dicate the possibility of intrauterine adhesions. History of excess alcohol consumption or smoking should be obtained to offer advice on reducing risk of future miscarriage. Medi- cal and relevant family history should be obtained as un- controlled maternal medical conditions such as diabetes, thyroid or rheumatological disorders can impact the risk of miscarriage in future pregnancies. All miscarriages which the patient suffered from happened before 8 weeks gesta- Manuscript submitted February 11, 2022, accepted March 29, 2022 Published online April 12, 2022 University College London Hospital, London NW1 2BU, UK. Email: [email protected] doi: https://doi.org/10.14740/jcgo797 24 Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org Management of Recurrent Miscarriage J Clin Gynecol Obstet. 2022;11(2):23-26 tion and she bled naturally on all occasions suggesting a likely pre-placental fetal or endometrial cause for her preg- nancy loss. Examination On examination, patient’s body mass index (BMI) was within a normal range (23). Pelvic or speculum examination, guided by clinical history, can be useful as part of initial assessment especially if the woman has presented with irregular bleeding or abnormal vaginal discharge in which case cervix should be visualized to rule out other gynecological pathology such as ectropion/polyp and triple swabs should be obtained. The patient did not report any changes to her menstrual cycles or abnormal discharge following miscarriage. Risk factors and investigations The patient and her partner should be referred to and cared for in a dedicated RM clinic [2]. Psychological support and com- munication in a sensitive manner are extremely important. A discussion about potential risk factors for future miscarriage and testing should cover the following. Age Increasing female age increases the chances of a genetically abnormal pregnancy as the number and quality of oocytes decrease [1]. Women between 20 and 35 years old have the lowest risk of miscarriage while women above the age of 40 years have at least a 50% chance of miscarriage with every pregnancy [3, 4]. BMI High BMI (> 30) increases the risk of miscarriage [5]. Other risk factors Other risk factors include previous miscarriages, smoking and excess alcohol consumption. The patient is 37 years old and has already had three mis- carriages which increase her risk of future miscarriage to about 40% [6]. Causes of RM investigations The patient should be offered investigations for the causes of RM as listed in Table 1. Antiphospholipid syndrome (APS) This is an acquired thrombophilia which affects 15% of women with RM [2] and is diagnosed based on high levels of anticardiolipin antibodies and/or lupus anticoagulant along with evidence of adverse pregnancy outcomes (RM before 10 weeks or loss of one genetically normal pregnancy after 10 weeks or one or more preterm births before 34 weeks due to placental dysfunction) or unprovoked thrombosis. APS causes inhibition of trophoblast function, activation of complement system and thrombosis at the uteroplacental interface and is treated with a combination of aspirin and low molecular weight heparin in pregnancy [1]. Inherited thrombophilias such as factor V Leiden mutation, prothrombin mutation, protein C, protein S and antithrombin III deficiency have an uncertain role in first trimester RM and currently such tests should only be offered in the context of research. The patient had a negative APS screen. Genetic Parental balanced structural chromosomal anomalies can cause RM (2-5% of couples with RM). The risk of miscar- riage is influenced by the size and the genetic content of the rearranged chromosomal segments. Karyotyping of products of conception should be offered at the time of any future mis- carriage and parental karyotyping should follow if analysis of products of conception indicates that a genetic abnormal- ity may have resulted from an unbalanced translocation [2, 3]. Parental karyotyping is not recommended routinely due to low incidence of translocations and relatively high cost as- sociated with testing. Table 1. Causes and Relevant Investigations for Recurrent First Trimester Miscarriage Cause Test Genetic-balanced chromosomal translocations Karyotyping of products of conception (if abnormal result detected - parental karyotyping) Antiphospholipid syndrome Blood test for anticardiolipin antibodies and/or lupus anticoagulant (blood tests should be performed at least 6 weeks after any pregnancy loss and a repeat confirmatory test should be arranged at least 12 weeks after an initial positive screen) Endocrine (if evidence of clinical disorder or risk factors): thyroid, diabetes Thyroid function test (serum free T4 and thyroid-stimulating hormone levels); thyroid peroxidase antibodies; HbA1c Uterine abnormalities such as septate uterus or intracavitary lesions Transvaginal ultrasound scan Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org 25 Talaulikar J Clin Gynecol Obstet. 2022;11(2):23-26 Endocrine If there is clinical evidence of poorly controlled diabetes or thyroid dysfunction, appropriate blood tests should be per- formed [2]. The patient did not have any symptoms or signs suggestive of endocrine problems and had had a thyroid hor- mone profile at the time of her last miscarriage which revealed normal results. Uterine abnormalities Uterine abnormalities such as septate uterus or any other uter- ine cavity pathology such as intrauterine adhesions (especially following an episode of uterine instrumentation and infection), submucous fibroids or polyps should be ruled out by offering a pelvic ultrasound as these may be amenable to treatment by surgery (hysteroscopy +/- laparoscopy) [2, 7]. The patient was offered a transvaginal scan which showed a regular uterine cavity. The evidence regarding the effects of male partners on RM is weak and no specific testing can be recommended as part of investigations [1]. Advice Lifestyle advice should always be offered to couples with RM. The patient should be advised to maintain a normal BMI, avoid excess alcohol/smoking, and take pre-conception folic acid [2, 3]. Currently, there is lack of evidence that preimplantation genetic testing for aneuploidy screening (PGT-A) is superior to expectant management in RM patients [3]. If chromosomal translocation was identified at the time of future miscarriage, genetic counselling should be offered to the patient. Repro- ductive options following genetic counselling would include proceeding to a further natural pregnancy with or without a prenatal diagnosis test, gamete donation and adoption [2]. As in this case, despite thorough investigations, no clear underlying pathology is identifiable in at least 50% of cou- ples with RM (often labelled as “unexplained RM”) [7, 8]. The couple should be reassured about good prognosis for a live birth in future pregnancies and offered supportive care in dedi- cated early pregnancy unit. Many RM units offer empirical treatment with low dose oral aspirin (75 mg daily) and vaginal natural progesterone (400 mg once/twice daily) from positive pregnancy test until 12 - 14 weeks of pregnancy on a “low harm, possible benefit” basis for unexplained RM. The use of aspirin is not recommended in current clinical guidelines due to debate over its clinical effectiveness. Based on the evidence so far, it appears that the use of progesterone supplements is beneficial particularly in women with previous miscarriages who bleed in early pregnancy [9, 10]. The patient conceived again 5 months following her third miscarriage and had a successful pregnancy and live birth. She was prescribed vaginal progesterone pessaries from 7 weeks until 14 weeks of pregnancy following one episode of vaginal bleeding. Conclusions Couples with RM should be offered psychological support and be referred to a dedicated RM service for investigations. Most couples will have no identifiable pathology, and in such cases, there is good prognosis for future successful pregnancy. Learning points RM affects about 1% of couples trying for a pregnancy and no clear underlying pathology is identifiable despite investiga- tions in at least 50% of couples. Refer couples with RM to a dedicated RM service for in- vestigations and plan for future pregnancies. Offer psychological support and reassure couples with no identifiable pathology about good prognosis for future preg- nancy without pharmacological intervention. Acknowledgments None to declare. Financial Disclosure No funding was received for preparation of this manuscript. Conflict of Interest There is no conflict of interest to declare. Author Contributions VT wrote and finalized the manuscript. Data Availability The author declares that data supporting the findings of this study are available within the article. References 1. Shields R, Hawkes A, Quenby S. Clinical approach to recurrent pregnancy loss. Review, Obstetrics, Gynae- cology and Reproductive Medicine. 2020:30(11):331- 336. 2. The investigation and treatment of couples with recurrent first trimester and second-trimester miscarriage. 2011. Green-top Guideline No. 17 April. https://www.rcog.org. uk/globalassets/documents/guidelines/gtg_17.pdf. 3. Homer HA. Modern management of recurrent miscar- 26 Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org Management of Recurrent Miscarriage J Clin Gynecol Obstet. 2022;11(2):23-26 riage. Aust N Z J Obstet Gynaecol. 2019;59(1):36-44. 4. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ. 2000;320(7251):1708-1712. 5. Boots C, Stephenson MD. Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin Reprod Med. 2011;29(6):507-513. 6. Regan L, Braude PR, Trembath PL. Influence of past re- productive performance on risk of spontaneous abortion. BMJ. 1989;299(6698):541-545. 7. Jaslow CR, Carney JL, Kutteh WH. Diagnostic factors identified in 1020 women with two versus three or more recurrent pregnancy losses. Fertil Steril. 2010;93(4):1234- 1243. 8. Stirrat GM. Recurrent miscarriage. Lancet. 1990; 336(8716):673-675. 9. Coomarasamy A, Devall AJ, Cheed V, Harb H, Middleton LJ, Gallos ID, Williams H, et al. A randomized trial of progesterone in women with bleeding in early pregnancy. N Engl J Med. 2019;380(19):1815-1824. 10. Coomarasamy A, Williams H, Truchanowicz E, Seed PT, Small R, Quenby S, Gupta P, et al. A randomized trial of progesterone in women with recurrent miscarriages. N Engl J Med. 2015;373(22):2141-2148.
|
Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand.
EVIDENCE:
Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited 23 Review J Clin Gynecol Obstet. 2022;11(2):23-26 Recurrent First Trimester Miscarriage: A Typical Case Presentation and Evidence-Based Management Review Vikram Talaulikar Abstract Recurrent miscarriage (RM), also known as recurrent pregnancy loss, is a distressing condition which affects about 1% of couples trying to achieve a pregnancy. It can be challenging for both patients and clinicians as the cause remains unexplained in at least 50% of cou- ples despite multiple investigations. A systematic and evidence-based approach to testing and management is important to avoid tests or treatments which are unnecessary or of unproven benefit. Access to specialist RM clinic services and psychological support forms a key part of the management of couples with RM. Keywords: Recurrent miscarriage; Treatment; Progesterone Introduction It is estimated that up to one in four natural pregnancies end up in a miscarriage which is defined as loss of pregnancy prior to viability (24 weeks’ gestation) [1]. Recurrent miscarriage (RM) is traditionally defined in the United Kingdom (UK) as three or more consecutive miscarriages and it can affect about 1% of couples trying for a pregnancy [2]. The definition of RM varies between countries with some clinical guidelines recom- mending investigations and treatment following two or more miscarriages. The Royal College of Obstetricians and Gynecologists (RCOG) has issued guidance on management of RM in the UK [2]. An updated version of this guideline is currently under consultation and will be released shortly. This article describes an illustrative typical clinical sce- nario related to RM and reviews the current best practice rec- ommendations for management of RM. Clinical Case The patient, 37 years old, has attended her general practition- er’s clinic following a recent pregnancy loss. She and her part- ner have been trying for a pregnancy for past 18 months but have suffered from three miscarriages between 6 and 8 weeks’ gestation. Her last miscarriage happened 2 months ago, and she has resumed her periods 2 weeks back. All the miscar- riages were managed conservatively without any medical or surgical interventions. She has regular menstrual cycles (25 - 26 days long) and does not report any dysmenorrhea or menor- rhagia. She is upset about the pregnancy losses, wondering if it was her fault and whether something can be done in the next pregnancy to change the outcome. History Consultations referring to RM should be performed in a sensi- tive manner. When discussing previous miscarriages, it is im- portant to enquire about the gestation at which pregnancy loss occurred. Pregnancy loss before 9 - 10 weeks usually (but not always) indicates a pre-placental cause, which may be either fetal (chromosomal) or endometrial (implantation disorder) in origin while that after this gestation could indicate problems such as thrombophilia, placental disorders, or problems with uterine structure. History of pregnancy loss after 12 weeks as- sociated with painless cervical dilatation and rupture of mem- branes suggests cervical weakness. Information should be obtained about how the previous miscarriages were managed: was the miscarriage completed naturally or whether medical or surgical management was required? Any possibility of uterine infection following miscarriage should be explored. Changes in the menstrual flow (hypomenorrhea) following possible infection of re- tained products of conception or uterine curettage could in- dicate the possibility of intrauterine adhesions. History of excess alcohol consumption or smoking should be obtained to offer advice on reducing risk of future miscarriage. Medi- cal and relevant family history should be obtained as un- controlled maternal medical conditions such as diabetes, thyroid or rheumatological disorders can impact the risk of miscarriage in future pregnancies. All miscarriages which the patient suffered from happened before 8 weeks gesta- Manuscript submitted February 11, 2022, accepted March 29, 2022 Published online April 12, 2022 University College London Hospital, London NW1 2BU, UK. Email: [email protected] doi: https://doi.org/10.14740/jcgo797 24 Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org Management of Recurrent Miscarriage J Clin Gynecol Obstet. 2022;11(2):23-26 tion and she bled naturally on all occasions suggesting a likely pre-placental fetal or endometrial cause for her preg- nancy loss. Examination On examination, patient’s body mass index (BMI) was within a normal range (23). Pelvic or speculum examination, guided by clinical history, can be useful as part of initial assessment especially if the woman has presented with irregular bleeding or abnormal vaginal discharge in which case cervix should be visualized to rule out other gynecological pathology such as ectropion/polyp and triple swabs should be obtained. The patient did not report any changes to her menstrual cycles or abnormal discharge following miscarriage. Risk factors and investigations The patient and her partner should be referred to and cared for in a dedicated RM clinic [2]. Psychological support and com- munication in a sensitive manner are extremely important. A discussion about potential risk factors for future miscarriage and testing should cover the following. Age Increasing female age increases the chances of a genetically abnormal pregnancy as the number and quality of oocytes decrease [1]. Women between 20 and 35 years old have the lowest risk of miscarriage while women above the age of 40 years have at least a 50% chance of miscarriage with every pregnancy [3, 4]. BMI High BMI (> 30) increases the risk of miscarriage [5]. Other risk factors Other risk factors include previous miscarriages, smoking and excess alcohol consumption. The patient is 37 years old and has already had three mis- carriages which increase her risk of future miscarriage to about 40% [6]. Causes of RM investigations The patient should be offered investigations for the causes of RM as listed in Table 1. Antiphospholipid syndrome (APS) This is an acquired thrombophilia which affects 15% of women with RM [2] and is diagnosed based on high levels of anticardiolipin antibodies and/or lupus anticoagulant along with evidence of adverse pregnancy outcomes (RM before 10 weeks or loss of one genetically normal pregnancy after 10 weeks or one or more preterm births before 34 weeks due to placental dysfunction) or unprovoked thrombosis. APS causes inhibition of trophoblast function, activation of complement system and thrombosis at the uteroplacental interface and is treated with a combination of aspirin and low molecular weight heparin in pregnancy [1]. Inherited thrombophilias such as factor V Leiden mutation, prothrombin mutation, protein C, protein S and antithrombin III deficiency have an uncertain role in first trimester RM and currently such tests should only be offered in the context of research. The patient had a negative APS screen. Genetic Parental balanced structural chromosomal anomalies can cause RM (2-5% of couples with RM). The risk of miscar- riage is influenced by the size and the genetic content of the rearranged chromosomal segments. Karyotyping of products of conception should be offered at the time of any future mis- carriage and parental karyotyping should follow if analysis of products of conception indicates that a genetic abnormal- ity may have resulted from an unbalanced translocation [2, 3]. Parental karyotyping is not recommended routinely due to low incidence of translocations and relatively high cost as- sociated with testing. Table 1. Causes and Relevant Investigations for Recurrent First Trimester Miscarriage Cause Test Genetic-balanced chromosomal translocations Karyotyping of products of conception (if abnormal result detected - parental karyotyping) Antiphospholipid syndrome Blood test for anticardiolipin antibodies and/or lupus anticoagulant (blood tests should be performed at least 6 weeks after any pregnancy loss and a repeat confirmatory test should be arranged at least 12 weeks after an initial positive screen) Endocrine (if evidence of clinical disorder or risk factors): thyroid, diabetes Thyroid function test (serum free T4 and thyroid-stimulating hormone levels); thyroid peroxidase antibodies; HbA1c Uterine abnormalities such as septate uterus or intracavitary lesions Transvaginal ultrasound scan Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org 25 Talaulikar J Clin Gynecol Obstet. 2022;11(2):23-26 Endocrine If there is clinical evidence of poorly controlled diabetes or thyroid dysfunction, appropriate blood tests should be per- formed [2]. The patient did not have any symptoms or signs suggestive of endocrine problems and had had a thyroid hor- mone profile at the time of her last miscarriage which revealed normal results. Uterine abnormalities Uterine abnormalities such as septate uterus or any other uter- ine cavity pathology such as intrauterine adhesions (especially following an episode of uterine instrumentation and infection), submucous fibroids or polyps should be ruled out by offering a pelvic ultrasound as these may be amenable to treatment by surgery (hysteroscopy +/- laparoscopy) [2, 7]. The patient was offered a transvaginal scan which showed a regular uterine cavity. The evidence regarding the effects of male partners on RM is weak and no specific testing can be recommended as part of investigations [1]. Advice Lifestyle advice should always be offered to couples with RM. The patient should be advised to maintain a normal BMI, avoid excess alcohol/smoking, and take pre-conception folic acid [2, 3]. Currently, there is lack of evidence that preimplantation genetic testing for aneuploidy screening (PGT-A) is superior to expectant management in RM patients [3]. If chromosomal translocation was identified at the time of future miscarriage, genetic counselling should be offered to the patient. Repro- ductive options following genetic counselling would include proceeding to a further natural pregnancy with or without a prenatal diagnosis test, gamete donation and adoption [2]. As in this case, despite thorough investigations, no clear underlying pathology is identifiable in at least 50% of cou- ples with RM (often labelled as “unexplained RM”) [7, 8]. The couple should be reassured about good prognosis for a live birth in future pregnancies and offered supportive care in dedi- cated early pregnancy unit. Many RM units offer empirical treatment with low dose oral aspirin (75 mg daily) and vaginal natural progesterone (400 mg once/twice daily) from positive pregnancy test until 12 - 14 weeks of pregnancy on a “low harm, possible benefit” basis for unexplained RM. The use of aspirin is not recommended in current clinical guidelines due to debate over its clinical effectiveness. Based on the evidence so far, it appears that the use of progesterone supplements is beneficial particularly in women with previous miscarriages who bleed in early pregnancy [9, 10]. The patient conceived again 5 months following her third miscarriage and had a successful pregnancy and live birth. She was prescribed vaginal progesterone pessaries from 7 weeks until 14 weeks of pregnancy following one episode of vaginal bleeding. Conclusions Couples with RM should be offered psychological support and be referred to a dedicated RM service for investigations. Most couples will have no identifiable pathology, and in such cases, there is good prognosis for future successful pregnancy. Learning points RM affects about 1% of couples trying for a pregnancy and no clear underlying pathology is identifiable despite investiga- tions in at least 50% of couples. Refer couples with RM to a dedicated RM service for in- vestigations and plan for future pregnancies. Offer psychological support and reassure couples with no identifiable pathology about good prognosis for future preg- nancy without pharmacological intervention. Acknowledgments None to declare. Financial Disclosure No funding was received for preparation of this manuscript. Conflict of Interest There is no conflict of interest to declare. Author Contributions VT wrote and finalized the manuscript. Data Availability The author declares that data supporting the findings of this study are available within the article. References 1. Shields R, Hawkes A, Quenby S. Clinical approach to recurrent pregnancy loss. Review, Obstetrics, Gynae- cology and Reproductive Medicine. 2020:30(11):331- 336. 2. The investigation and treatment of couples with recurrent first trimester and second-trimester miscarriage. 2011. Green-top Guideline No. 17 April. https://www.rcog.org. uk/globalassets/documents/guidelines/gtg_17.pdf. 3. Homer HA. Modern management of recurrent miscar- 26 Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org Management of Recurrent Miscarriage J Clin Gynecol Obstet. 2022;11(2):23-26 riage. Aust N Z J Obstet Gynaecol. 2019;59(1):36-44. 4. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ. 2000;320(7251):1708-1712. 5. Boots C, Stephenson MD. Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin Reprod Med. 2011;29(6):507-513. 6. Regan L, Braude PR, Trembath PL. Influence of past re- productive performance on risk of spontaneous abortion. BMJ. 1989;299(6698):541-545. 7. Jaslow CR, Carney JL, Kutteh WH. Diagnostic factors identified in 1020 women with two versus three or more recurrent pregnancy losses. Fertil Steril. 2010;93(4):1234- 1243. 8. Stirrat GM. Recurrent miscarriage. Lancet. 1990; 336(8716):673-675. 9. Coomarasamy A, Devall AJ, Cheed V, Harb H, Middleton LJ, Gallos ID, Williams H, et al. A randomized trial of progesterone in women with bleeding in early pregnancy. N Engl J Med. 2019;380(19):1815-1824. 10. Coomarasamy A, Williams H, Truchanowicz E, Seed PT, Small R, Quenby S, Gupta P, et al. A randomized trial of progesterone in women with recurrent miscarriages. N Engl J Med. 2015;373(22):2141-2148.
USER:
What investigations should be done on the patients with the recurrent miscarrages?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 21 | 12 | 2,184 | null | 503 |
Use only the article provided to answer the question, do not utilize any outside knowledge. Answer in full sentences.
|
Where did the Elysian speakers' name came from?
|
Elysian Speakers: Turning Your Home into a Sonic Heaven The culmination of a special three-year R&D project, Wharfedale’s new flagship speakers are the ultimate expression of pure musical enjoyment embedded at the heart of this famous British brand. Cambridgeshire, England – In Greek mythology, the Elysian Fields are a heavenly place where the heroic and the virtuous are rewarded in the afterlife. Elysian, as an adjective, means blissful – a fitting name for Wharfedale’s new flagship loudspeakers, conceived to deliver blissful sonic reward to music lovers seeking heavenly respite from the rigours of daily life. Two Elysian loudspeakers have been created; a large standmount model called Elysian 2 (£4,500 per pair) and a floorstanding speaker named Elysian 4 (£6,500 per pair). Both speakers were developed concurrently with the EVO4 Series, which launched towards the end of 2019 and sits immediately below Elysian in Wharfedale’s new hierarchy. Elysian and EVO4 share many design elements, having benefitted from the same R&D process as part of a unified project. The core speakers in both ranges are three-way designs, sporting an unusual and sophisticated driver array including an Air Motion Transformer (AMT) high-frequency unit. But with Elysian, each component part is engineered to the very highest standard. The drivers, the crossover, the cabinet – every aspect has been developed in harmony and without cost constraint to push the project to its performance limit. Many of these elements were trickled down, remodelled and engineered in a more affordable form to create the EVO4 Series, enabling the speakers in this range to deliver astounding value for money. With the EVO4 Series already winning major awards, now is the time for Wharfedale to unleash Elysian. Elysian AMT Treble Unit In the 1940s, Wharfedale’s founder, Gilbert Briggs, developed the first two-way speaker for domestic use, radical for its separate treble and bass drivers combined via a crossover. Early treble units, such as Brigg’s famous Super 3, resembled small cones as the necessity for reproducing high frequencies demanded the use of low-mass diaphragms. It was subsequently realized that the dome in the centre of the cone was doing most of the work and this gave rise to the now ubiquitous dome tweeter. Dome treble units have dominated the hi-fi scene for decades, but they are not necessarily the ideal way of reproducing the exact harmonics of the musical waveform. In order to reduce moving mass, the dome has to be small and use ultra-thin materials, both of which counteract its efficiency and accuracy. The AMT is a radically different way of moving air, using a large, pleated, lightweight diaphragm driven across its surface by rows of strategically placed metallic strips immersed in a strong magnetic field. The pleats in the diaphragm contract and expand under the influence of the musical drive, squeezing the air between them to form the desired waveform. Not only is this an efficient way of moving air, it is also highly accurate as the diaphragm is under close control of the motor system at all times. The result is a wide bandwidth transducer that achieves extremely low distortion and wonderful musical detail, with scintillating speed and dynamic ability. The development of this AMT unit was a key part of the Elysian/EVO4 project. The Elysian AMT is larger and of higher specification than the one used in the EVO4 Series, featuring an ultra-lightweight diaphragm material called PET and an acoustically damped rear chamber, delivering even more spellbindingly clear and sweetly extended high frequencies. Elysian Midrange Driver In the spirit of Gilbert Briggs, who was well known for experimenting with new driver materials, Wharfedale investigated a range of options to match the sensitivity and accuracy of the AMT treble unit. The company settled on a proprietary woven glass fibre matrix, formed into a 150mm cone. This provides a superb combination of low mass and high strength, with the addition of a high-plasticity coating to control its acoustic behaviour. With such a low-mass cone, only a low-damping, foamed, rubber-like material would match for the surround – again, coated for durability. A central phase plug is specially shaped to linearise the output across a wide bandwidth, even off-axis, enhancing a natural response to the music that can be heard anywhere the listener wishes to sit. This midrange driver enables the Elysian speakers to deliver voices and instruments with astonishing realism. Vocalists seem to be present in the room with the listener – simply close your eyes and listen to the palpable presence of singers in the acoustic space. Elysian Bass Driver The midrange unit is matched with a glass fibre matrix cone for the bass unit, in this case terminated with a highly flexible rubber surround and driven by a specially developed low-distortion motor system. In order to plumb the depths of the lowest frequencies in recorded music, the 220mm bass units – one in the Elysian 2, two in the Elysian 4 – are capable of reaching down below 28Hz in-room, revealing the full body and impact of percussion, stringed and wind instruments. The bass units are loaded by an advanced version of Wharfedale’s signature slot-loaded port. Christened SLPP (Slot-Loaded Profiled Port), it ensures that the rear output of the bass units is not wasted. Instead, the lowest frequency energy is vented to a slot at the base of the speaker, specially profiled to equalise the high internal pressure to the low pressure in the room. This reduces the distortion that is typical of bass reflex systems and increases the port’s efficiency. In addition, because the air is dispersed uniformly in the room, the speakers are less fussy about siting. Elysian Crossover Network The drivers’ output is combined via a sophisticated crossover network, fine-tuned over hundreds of hours of listening tests to ensure a seamless blend between the drive units. Of particular note is the phase consistency across the driver output, permitting a wide range of seating positions and encouraging the power response to be highly linear throughout the listening room. Only the highest grade, acoustically transparent components are used throughout the crossover network, ensuring all the musical detail is heard with nothing held back. Elysian Cabinet The Elysian speaker cabinets are designed to enhance the acoustic output of the drivers and provide a piece of furniture of which the owner can be justly proud. Handcrafted veneers are enhanced by true piano finish lacquers, hand-polished to six levels of depth to give a truly beautiful finish. Beneath the veneer is a sandwich of woods of differing density, designed to reduce panel resonance to below audibility. Named PROS (Panel Resonance Optimization System), this multi-layer construction also inhibits the leakage of unwanted sound energy from inside the cabinet, which would otherwise interfere with the forward output of the drive units. Both Elysian models have a wide stature that complements the output of the drive units by helping them match to the acoustics of the room – an aspect of home audio reproduction that has been largely overlooked amid the modern trend to design slim, compact loudspeakers. One key aspect is the wide baffle, finished with radiused edges to smooth the flow of sonic energy around the cabinet. Speaking about the development of Elysian, Wharfedale’s Director of Acoustic Design, Peter Comeau, said: “Our aim for the Elysian/EVO4 project was to deliver a new flagship for Wharfedale (Elysian) whilst creating design elements that could be trickled down to a more affordable, mid-range series (EVO4). While we are justly proud of the value for money offered by the EVO4 Series, the two Elysian models represent the pinnacle of our achievements – loudspeakers that deliver an exceptional high-end performance yet still cost much less than many of the models with which they compete.” Comeau added, “The cabinet design, in combination with the drive units, allows the Elysian speakers to convey the full body of instruments like cello and bass guitar, without constraining the dynamics of the musical recital. Whether you’re listening to solo piano, a full orchestra, a jazz trio or a rock band, these speakers bring the thrill and excitement of the performance to your listening room.” The Wharfedale Elysian 2 and Elysian 4 are available in the UK from this month. RRPs are £4,500 per pair (£4,900 with matching stands) and £6,500 per pair respectively. Finish options are walnut, black or white, hand-finished in high-gloss piano lacquer.
|
[Task Instruction] ================== Use only the article provided to answer the question, do not utilize any outside knowledge. Answer in full sentences. ---------- [Question] ================== Where did the Elysian speakers' name came from? ---------- [Text] ================== Elysian Speakers: Turning Your Home into a Sonic Heaven The culmination of a special three-year R&D project, Wharfedale’s new flagship speakers are the ultimate expression of pure musical enjoyment embedded at the heart of this famous British brand. Cambridgeshire, England – In Greek mythology, the Elysian Fields are a heavenly place where the heroic and the virtuous are rewarded in the afterlife. Elysian, as an adjective, means blissful – a fitting name for Wharfedale’s new flagship loudspeakers, conceived to deliver blissful sonic reward to music lovers seeking heavenly respite from the rigours of daily life. Two Elysian loudspeakers have been created; a large standmount model called Elysian 2 (£4,500 per pair) and a floorstanding speaker named Elysian 4 (£6,500 per pair). Both speakers were developed concurrently with the EVO4 Series, which launched towards the end of 2019 and sits immediately below Elysian in Wharfedale’s new hierarchy. Elysian and EVO4 share many design elements, having benefitted from the same R&D process as part of a unified project. The core speakers in both ranges are three-way designs, sporting an unusual and sophisticated driver array including an Air Motion Transformer (AMT) high-frequency unit. But with Elysian, each component part is engineered to the very highest standard. The drivers, the crossover, the cabinet – every aspect has been developed in harmony and without cost constraint to push the project to its performance limit. Many of these elements were trickled down, remodelled and engineered in a more affordable form to create the EVO4 Series, enabling the speakers in this range to deliver astounding value for money. With the EVO4 Series already winning major awards, now is the time for Wharfedale to unleash Elysian. Elysian AMT Treble Unit In the 1940s, Wharfedale’s founder, Gilbert Briggs, developed the first two-way speaker for domestic use, radical for its separate treble and bass drivers combined via a crossover. Early treble units, such as Brigg’s famous Super 3, resembled small cones as the necessity for reproducing high frequencies demanded the use of low-mass diaphragms. It was subsequently realized that the dome in the centre of the cone was doing most of the work and this gave rise to the now ubiquitous dome tweeter. Dome treble units have dominated the hi-fi scene for decades, but they are not necessarily the ideal way of reproducing the exact harmonics of the musical waveform. In order to reduce moving mass, the dome has to be small and use ultra-thin materials, both of which counteract its efficiency and accuracy. The AMT is a radically different way of moving air, using a large, pleated, lightweight diaphragm driven across its surface by rows of strategically placed metallic strips immersed in a strong magnetic field. The pleats in the diaphragm contract and expand under the influence of the musical drive, squeezing the air between them to form the desired waveform. Not only is this an efficient way of moving air, it is also highly accurate as the diaphragm is under close control of the motor system at all times. The result is a wide bandwidth transducer that achieves extremely low distortion and wonderful musical detail, with scintillating speed and dynamic ability. The development of this AMT unit was a key part of the Elysian/EVO4 project. The Elysian AMT is larger and of higher specification than the one used in the EVO4 Series, featuring an ultra-lightweight diaphragm material called PET and an acoustically damped rear chamber, delivering even more spellbindingly clear and sweetly extended high frequencies. Elysian Midrange Driver In the spirit of Gilbert Briggs, who was well known for experimenting with new driver materials, Wharfedale investigated a range of options to match the sensitivity and accuracy of the AMT treble unit. The company settled on a proprietary woven glass fibre matrix, formed into a 150mm cone. This provides a superb combination of low mass and high strength, with the addition of a high-plasticity coating to control its acoustic behaviour. With such a low-mass cone, only a low-damping, foamed, rubber-like material would match for the surround – again, coated for durability. A central phase plug is specially shaped to linearise the output across a wide bandwidth, even off-axis, enhancing a natural response to the music that can be heard anywhere the listener wishes to sit. This midrange driver enables the Elysian speakers to deliver voices and instruments with astonishing realism. Vocalists seem to be present in the room with the listener – simply close your eyes and listen to the palpable presence of singers in the acoustic space. Elysian Bass Driver The midrange unit is matched with a glass fibre matrix cone for the bass unit, in this case terminated with a highly flexible rubber surround and driven by a specially developed low-distortion motor system. In order to plumb the depths of the lowest frequencies in recorded music, the 220mm bass units – one in the Elysian 2, two in the Elysian 4 – are capable of reaching down below 28Hz in-room, revealing the full body and impact of percussion, stringed and wind instruments. The bass units are loaded by an advanced version of Wharfedale’s signature slot-loaded port. Christened SLPP (Slot-Loaded Profiled Port), it ensures that the rear output of the bass units is not wasted. Instead, the lowest frequency energy is vented to a slot at the base of the speaker, specially profiled to equalise the high internal pressure to the low pressure in the room. This reduces the distortion that is typical of bass reflex systems and increases the port’s efficiency. In addition, because the air is dispersed uniformly in the room, the speakers are less fussy about siting. Elysian Crossover Network The drivers’ output is combined via a sophisticated crossover network, fine-tuned over hundreds of hours of listening tests to ensure a seamless blend between the drive units. Of particular note is the phase consistency across the driver output, permitting a wide range of seating positions and encouraging the power response to be highly linear throughout the listening room. Only the highest grade, acoustically transparent components are used throughout the crossover network, ensuring all the musical detail is heard with nothing held back. Elysian Cabinet The Elysian speaker cabinets are designed to enhance the acoustic output of the drivers and provide a piece of furniture of which the owner can be justly proud. Handcrafted veneers are enhanced by true piano finish lacquers, hand-polished to six levels of depth to give a truly beautiful finish. Beneath the veneer is a sandwich of woods of differing density, designed to reduce panel resonance to below audibility. Named PROS (Panel Resonance Optimization System), this multi-layer construction also inhibits the leakage of unwanted sound energy from inside the cabinet, which would otherwise interfere with the forward output of the drive units. Both Elysian models have a wide stature that complements the output of the drive units by helping them match to the acoustics of the room – an aspect of home audio reproduction that has been largely overlooked amid the modern trend to design slim, compact loudspeakers. One key aspect is the wide baffle, finished with radiused edges to smooth the flow of sonic energy around the cabinet. Speaking about the development of Elysian, Wharfedale’s Director of Acoustic Design, Peter Comeau, said: “Our aim for the Elysian/EVO4 project was to deliver a new flagship for Wharfedale (Elysian) whilst creating design elements that could be trickled down to a more affordable, mid-range series (EVO4). While we are justly proud of the value for money offered by the EVO4 Series, the two Elysian models represent the pinnacle of our achievements – loudspeakers that deliver an exceptional high-end performance yet still cost much less than many of the models with which they compete.” Comeau added, “The cabinet design, in combination with the drive units, allows the Elysian speakers to convey the full body of instruments like cello and bass guitar, without constraining the dynamics of the musical recital. Whether you’re listening to solo piano, a full orchestra, a jazz trio or a rock band, these speakers bring the thrill and excitement of the performance to your listening room.” The Wharfedale Elysian 2 and Elysian 4 are available in the UK from this month. RRPs are £4,500 per pair (£4,900 with matching stands) and £6,500 per pair respectively. Finish options are walnut, black or white, hand-finished in high-gloss piano lacquer.
|
Use only the article provided to answer the question, do not utilize any outside knowledge. Answer in full sentences.
EVIDENCE:
Elysian Speakers: Turning Your Home into a Sonic Heaven The culmination of a special three-year R&D project, Wharfedale’s new flagship speakers are the ultimate expression of pure musical enjoyment embedded at the heart of this famous British brand. Cambridgeshire, England – In Greek mythology, the Elysian Fields are a heavenly place where the heroic and the virtuous are rewarded in the afterlife. Elysian, as an adjective, means blissful – a fitting name for Wharfedale’s new flagship loudspeakers, conceived to deliver blissful sonic reward to music lovers seeking heavenly respite from the rigours of daily life. Two Elysian loudspeakers have been created; a large standmount model called Elysian 2 (£4,500 per pair) and a floorstanding speaker named Elysian 4 (£6,500 per pair). Both speakers were developed concurrently with the EVO4 Series, which launched towards the end of 2019 and sits immediately below Elysian in Wharfedale’s new hierarchy. Elysian and EVO4 share many design elements, having benefitted from the same R&D process as part of a unified project. The core speakers in both ranges are three-way designs, sporting an unusual and sophisticated driver array including an Air Motion Transformer (AMT) high-frequency unit. But with Elysian, each component part is engineered to the very highest standard. The drivers, the crossover, the cabinet – every aspect has been developed in harmony and without cost constraint to push the project to its performance limit. Many of these elements were trickled down, remodelled and engineered in a more affordable form to create the EVO4 Series, enabling the speakers in this range to deliver astounding value for money. With the EVO4 Series already winning major awards, now is the time for Wharfedale to unleash Elysian. Elysian AMT Treble Unit In the 1940s, Wharfedale’s founder, Gilbert Briggs, developed the first two-way speaker for domestic use, radical for its separate treble and bass drivers combined via a crossover. Early treble units, such as Brigg’s famous Super 3, resembled small cones as the necessity for reproducing high frequencies demanded the use of low-mass diaphragms. It was subsequently realized that the dome in the centre of the cone was doing most of the work and this gave rise to the now ubiquitous dome tweeter. Dome treble units have dominated the hi-fi scene for decades, but they are not necessarily the ideal way of reproducing the exact harmonics of the musical waveform. In order to reduce moving mass, the dome has to be small and use ultra-thin materials, both of which counteract its efficiency and accuracy. The AMT is a radically different way of moving air, using a large, pleated, lightweight diaphragm driven across its surface by rows of strategically placed metallic strips immersed in a strong magnetic field. The pleats in the diaphragm contract and expand under the influence of the musical drive, squeezing the air between them to form the desired waveform. Not only is this an efficient way of moving air, it is also highly accurate as the diaphragm is under close control of the motor system at all times. The result is a wide bandwidth transducer that achieves extremely low distortion and wonderful musical detail, with scintillating speed and dynamic ability. The development of this AMT unit was a key part of the Elysian/EVO4 project. The Elysian AMT is larger and of higher specification than the one used in the EVO4 Series, featuring an ultra-lightweight diaphragm material called PET and an acoustically damped rear chamber, delivering even more spellbindingly clear and sweetly extended high frequencies. Elysian Midrange Driver In the spirit of Gilbert Briggs, who was well known for experimenting with new driver materials, Wharfedale investigated a range of options to match the sensitivity and accuracy of the AMT treble unit. The company settled on a proprietary woven glass fibre matrix, formed into a 150mm cone. This provides a superb combination of low mass and high strength, with the addition of a high-plasticity coating to control its acoustic behaviour. With such a low-mass cone, only a low-damping, foamed, rubber-like material would match for the surround – again, coated for durability. A central phase plug is specially shaped to linearise the output across a wide bandwidth, even off-axis, enhancing a natural response to the music that can be heard anywhere the listener wishes to sit. This midrange driver enables the Elysian speakers to deliver voices and instruments with astonishing realism. Vocalists seem to be present in the room with the listener – simply close your eyes and listen to the palpable presence of singers in the acoustic space. Elysian Bass Driver The midrange unit is matched with a glass fibre matrix cone for the bass unit, in this case terminated with a highly flexible rubber surround and driven by a specially developed low-distortion motor system. In order to plumb the depths of the lowest frequencies in recorded music, the 220mm bass units – one in the Elysian 2, two in the Elysian 4 – are capable of reaching down below 28Hz in-room, revealing the full body and impact of percussion, stringed and wind instruments. The bass units are loaded by an advanced version of Wharfedale’s signature slot-loaded port. Christened SLPP (Slot-Loaded Profiled Port), it ensures that the rear output of the bass units is not wasted. Instead, the lowest frequency energy is vented to a slot at the base of the speaker, specially profiled to equalise the high internal pressure to the low pressure in the room. This reduces the distortion that is typical of bass reflex systems and increases the port’s efficiency. In addition, because the air is dispersed uniformly in the room, the speakers are less fussy about siting. Elysian Crossover Network The drivers’ output is combined via a sophisticated crossover network, fine-tuned over hundreds of hours of listening tests to ensure a seamless blend between the drive units. Of particular note is the phase consistency across the driver output, permitting a wide range of seating positions and encouraging the power response to be highly linear throughout the listening room. Only the highest grade, acoustically transparent components are used throughout the crossover network, ensuring all the musical detail is heard with nothing held back. Elysian Cabinet The Elysian speaker cabinets are designed to enhance the acoustic output of the drivers and provide a piece of furniture of which the owner can be justly proud. Handcrafted veneers are enhanced by true piano finish lacquers, hand-polished to six levels of depth to give a truly beautiful finish. Beneath the veneer is a sandwich of woods of differing density, designed to reduce panel resonance to below audibility. Named PROS (Panel Resonance Optimization System), this multi-layer construction also inhibits the leakage of unwanted sound energy from inside the cabinet, which would otherwise interfere with the forward output of the drive units. Both Elysian models have a wide stature that complements the output of the drive units by helping them match to the acoustics of the room – an aspect of home audio reproduction that has been largely overlooked amid the modern trend to design slim, compact loudspeakers. One key aspect is the wide baffle, finished with radiused edges to smooth the flow of sonic energy around the cabinet. Speaking about the development of Elysian, Wharfedale’s Director of Acoustic Design, Peter Comeau, said: “Our aim for the Elysian/EVO4 project was to deliver a new flagship for Wharfedale (Elysian) whilst creating design elements that could be trickled down to a more affordable, mid-range series (EVO4). While we are justly proud of the value for money offered by the EVO4 Series, the two Elysian models represent the pinnacle of our achievements – loudspeakers that deliver an exceptional high-end performance yet still cost much less than many of the models with which they compete.” Comeau added, “The cabinet design, in combination with the drive units, allows the Elysian speakers to convey the full body of instruments like cello and bass guitar, without constraining the dynamics of the musical recital. Whether you’re listening to solo piano, a full orchestra, a jazz trio or a rock band, these speakers bring the thrill and excitement of the performance to your listening room.” The Wharfedale Elysian 2 and Elysian 4 are available in the UK from this month. RRPs are £4,500 per pair (£4,900 with matching stands) and £6,500 per pair respectively. Finish options are walnut, black or white, hand-finished in high-gloss piano lacquer.
USER:
Where did the Elysian speakers' name came from?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 19 | 8 | 1,385 | null | 621 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
Provide me a summary of EI based on this reference, but organize it into two sections with one about the system itself and one about the actual benefits.
|
1.1.1 Summary The EI program, which is insurance-based, is designed to protect individuals who have lost their job for reasons outside their control, while they look for new employment or upgrade their skills. It may also help unemployed individuals across the country find employment. The EI program also provides temporary financial assistance to workers who are sick, pregnant, caring for a newborn or newly adopted child, or caring for a family member who has a serious medical condition. The EI program marked its 75th year in 2015, having been implemented in 1940. The last major reform occurred in 1996. At that time, the program introduced changes to better reflect its primary objective of promoting employment, and to better emphasize that access to the program is linked to significant work attachment. 1.1.2 Roles and responsibilities Employment and Social Development Canada (ESDC) is the department of the Government of Canada responsible for developing, managing and delivering programs and services. The Minister of Employment and Social Development is responsible for the EI act, except for PART IV - Insurable Earnings and Collection of Premiums, and PART VII - Benefit Repayment. The Canada Revenue Agency is responsible for resolving any questions pertaining to the insurability of employment or earnings (Part IV), and for the collection of EI premiums (Part VII). Service Canada is a federal institution that is part of ESDC. Service Canada oversees all legislative provisions of the act, including the determination of benefit eligibility and entitlement, and issues EI benefits (Part I) directly to EI claimants. Its role is to provide timely and accurate EI benefit payments and services, and to support EI claimants through each stage of the service delivery process. It strives to accurately and efficiently provide benefit information, respond to enquiries, assist employers, process claims and provide the means to request a formal reconsideration of a decision, or to appeal decisions. Provinces and territories deliver the majority of Employment Benefits and National Employment Services (Part II). These benefits and services are delivered through Labour Market Development Agreements (LMDA) funded by the Government of Canada. Through these agreements, Government of Canada funding enables provinces and territories to design, deliver and manage skills and employment programs for unemployed individuals, particularly for those who are eligible for EI benefits. The Canada Employment Insurance Commission (CEIC) is a departmental corporation of ESDC. It plays a key role in administering the EI program, including the making of regulations, with the approval of the Governor-in-Council, and reviewing, as well as approving, policies related to the EI program administration and delivery. In addition to its role in EI premium rate setting, the CEIC produces the annual EI Monitoring and Assessment Report. The Social Security Tribunal of Canada (SST) is an independent administrative body composed of a General Division and Appeal Division, that makes decisions on appeals related to the Act. 1.1.3 EI premiums & Insurable Employment All workers employed in insurable employment are required to pay EI premiums. The fact that a worker can or cannot qualify for EI benefits is not a criterion to determine whether EI premiums are payable, as it is the employment, and not the individual that is insured. The fundamental requirement for an employment to be insurable is that there is an employer-employee relationship; i.e. the person is not self-employed. CRA holds the responsibility for making decisions as to whether an employment is insurable or not, and whether EI premiums are payable with respect to that employment. 1.1.4 Purpose of Employment Insurance benefits As previously stated, Part I of the EI program provides temporary income support to workers who have lost their job for reasons outside their control, while they look for new employment or upgrade their skills. EI Part I also provides temporary financial assistance to workers who are sick, pregnant, caring for a newborn or newly adopted child, or caring for a family member who has a serious medical condition. The purpose of Part II of the EI Act is to provide employment assistance to eligible insured participants, through various programs and services. 1.1.5 Types of Employment Insurance benefits There are a number of types of EI benefits available: Regular benefits are available to individuals who lose their jobs for reasons outside their control and who are available for and actively seeking employment. Special benefits are available to insured workers and self-employed individuals who are too sick to work, are pregnant or have recently given birth, are providing care to a newborn or newly adopted child, or who must be away from work temporarily to provide care or support to a family member with a serious medical condition. Special benefits include: Maternity benefits: for biological mothers who are pregnant or have given birth. These benefits cover the period surrounding the child's birth (up to 15 weeks). Parental benefits: for any legal parent to care for their newborn or newly adopted child or children. One parent can receive these benefits, or they can share benefits between them (up to 40 weeks of standard parental benefits or 69 weeks of extended parental benefits when sharing). However, one parent cannot receive more than 35 weeks of standard parental benefits or 61 weeks of extended parental benefits. Sickness benefits: for people who cannot work due to injury, illness, or the need to be isolated in quarantine because they may be carrying a disease (up to 26Footnote1 weeks). Compassionate Care benefits: for people who must be away from work temporarily to provide care or support to a family member who is gravely ill with a significant risk of death within 26 weeks. One family member can receive these benefits, or they can be shared between several family members (up to 26 weeks). Family Caregiver benefits: for family members who must be away from work temporarily to care for or support a critically ill or injured family member. One family member can receive these benefits or they can be shared between several family members (up to 35 weeks for caring for a child; up to 15 weeks for caring for an adult). In certain circumstances various types of special benefits may be combined up to a maximum of 102 weeks of benefits within a maximum 104 week benefit period. Fishing benefits – are for eligible self-employed fishers who do not meet the eligibility requirements for EI regular benefits in their region. Job creation partnerships, work sharing, training benefits: for clients participating in developmental programs. [March 2019]
|
[question] Provide me a summary of EI based on this reference, but organize it into two sections with one about the system itself and one about the actual benefits. ===================== [text] 1.1.1 Summary The EI program, which is insurance-based, is designed to protect individuals who have lost their job for reasons outside their control, while they look for new employment or upgrade their skills. It may also help unemployed individuals across the country find employment. The EI program also provides temporary financial assistance to workers who are sick, pregnant, caring for a newborn or newly adopted child, or caring for a family member who has a serious medical condition. The EI program marked its 75th year in 2015, having been implemented in 1940. The last major reform occurred in 1996. At that time, the program introduced changes to better reflect its primary objective of promoting employment, and to better emphasize that access to the program is linked to significant work attachment. 1.1.2 Roles and responsibilities Employment and Social Development Canada (ESDC) is the department of the Government of Canada responsible for developing, managing and delivering programs and services. The Minister of Employment and Social Development is responsible for the EI act, except for PART IV - Insurable Earnings and Collection of Premiums, and PART VII - Benefit Repayment. The Canada Revenue Agency is responsible for resolving any questions pertaining to the insurability of employment or earnings (Part IV), and for the collection of EI premiums (Part VII). Service Canada is a federal institution that is part of ESDC. Service Canada oversees all legislative provisions of the act, including the determination of benefit eligibility and entitlement, and issues EI benefits (Part I) directly to EI claimants. Its role is to provide timely and accurate EI benefit payments and services, and to support EI claimants through each stage of the service delivery process. It strives to accurately and efficiently provide benefit information, respond to enquiries, assist employers, process claims and provide the means to request a formal reconsideration of a decision, or to appeal decisions. Provinces and territories deliver the majority of Employment Benefits and National Employment Services (Part II). These benefits and services are delivered through Labour Market Development Agreements (LMDA) funded by the Government of Canada. Through these agreements, Government of Canada funding enables provinces and territories to design, deliver and manage skills and employment programs for unemployed individuals, particularly for those who are eligible for EI benefits. The Canada Employment Insurance Commission (CEIC) is a departmental corporation of ESDC. It plays a key role in administering the EI program, including the making of regulations, with the approval of the Governor-in-Council, and reviewing, as well as approving, policies related to the EI program administration and delivery. In addition to its role in EI premium rate setting, the CEIC produces the annual EI Monitoring and Assessment Report. The Social Security Tribunal of Canada (SST) is an independent administrative body composed of a General Division and Appeal Division, that makes decisions on appeals related to the Act. 1.1.3 EI premiums & Insurable Employment All workers employed in insurable employment are required to pay EI premiums. The fact that a worker can or cannot qualify for EI benefits is not a criterion to determine whether EI premiums are payable, as it is the employment, and not the individual that is insured. The fundamental requirement for an employment to be insurable is that there is an employer-employee relationship; i.e. the person is not self-employed. CRA holds the responsibility for making decisions as to whether an employment is insurable or not, and whether EI premiums are payable with respect to that employment. 1.1.4 Purpose of Employment Insurance benefits As previously stated, Part I of the EI program provides temporary income support to workers who have lost their job for reasons outside their control, while they look for new employment or upgrade their skills. EI Part I also provides temporary financial assistance to workers who are sick, pregnant, caring for a newborn or newly adopted child, or caring for a family member who has a serious medical condition. The purpose of Part II of the EI Act is to provide employment assistance to eligible insured participants, through various programs and services. 1.1.5 Types of Employment Insurance benefits There are a number of types of EI benefits available: Regular benefits are available to individuals who lose their jobs for reasons outside their control and who are available for and actively seeking employment. Special benefits are available to insured workers and self-employed individuals who are too sick to work, are pregnant or have recently given birth, are providing care to a newborn or newly adopted child, or who must be away from work temporarily to provide care or support to a family member with a serious medical condition. Special benefits include: Maternity benefits: for biological mothers who are pregnant or have given birth. These benefits cover the period surrounding the child's birth (up to 15 weeks). Parental benefits: for any legal parent to care for their newborn or newly adopted child or children. One parent can receive these benefits, or they can share benefits between them (up to 40 weeks of standard parental benefits or 69 weeks of extended parental benefits when sharing). However, one parent cannot receive more than 35 weeks of standard parental benefits or 61 weeks of extended parental benefits. Sickness benefits: for people who cannot work due to injury, illness, or the need to be isolated in quarantine because they may be carrying a disease (up to 26Footnote1 weeks). Compassionate Care benefits: for people who must be away from work temporarily to provide care or support to a family member who is gravely ill with a significant risk of death within 26 weeks. One family member can receive these benefits, or they can be shared between several family members (up to 26 weeks). Family Caregiver benefits: for family members who must be away from work temporarily to care for or support a critically ill or injured family member. One family member can receive these benefits or they can be shared between several family members (up to 35 weeks for caring for a child; up to 15 weeks for caring for an adult). In certain circumstances various types of special benefits may be combined up to a maximum of 102 weeks of benefits within a maximum 104 week benefit period. Fishing benefits – are for eligible self-employed fishers who do not meet the eligibility requirements for EI regular benefits in their region. Job creation partnerships, work sharing, training benefits: for clients participating in developmental programs. [March 2019] https://www.canada.ca/en/employment-social-development/programs/ei/ei-list/reports/digest/chapter-1/authority.html#a1_1_1 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
1.1.1 Summary The EI program, which is insurance-based, is designed to protect individuals who have lost their job for reasons outside their control, while they look for new employment or upgrade their skills. It may also help unemployed individuals across the country find employment. The EI program also provides temporary financial assistance to workers who are sick, pregnant, caring for a newborn or newly adopted child, or caring for a family member who has a serious medical condition. The EI program marked its 75th year in 2015, having been implemented in 1940. The last major reform occurred in 1996. At that time, the program introduced changes to better reflect its primary objective of promoting employment, and to better emphasize that access to the program is linked to significant work attachment. 1.1.2 Roles and responsibilities Employment and Social Development Canada (ESDC) is the department of the Government of Canada responsible for developing, managing and delivering programs and services. The Minister of Employment and Social Development is responsible for the EI act, except for PART IV - Insurable Earnings and Collection of Premiums, and PART VII - Benefit Repayment. The Canada Revenue Agency is responsible for resolving any questions pertaining to the insurability of employment or earnings (Part IV), and for the collection of EI premiums (Part VII). Service Canada is a federal institution that is part of ESDC. Service Canada oversees all legislative provisions of the act, including the determination of benefit eligibility and entitlement, and issues EI benefits (Part I) directly to EI claimants. Its role is to provide timely and accurate EI benefit payments and services, and to support EI claimants through each stage of the service delivery process. It strives to accurately and efficiently provide benefit information, respond to enquiries, assist employers, process claims and provide the means to request a formal reconsideration of a decision, or to appeal decisions. Provinces and territories deliver the majority of Employment Benefits and National Employment Services (Part II). These benefits and services are delivered through Labour Market Development Agreements (LMDA) funded by the Government of Canada. Through these agreements, Government of Canada funding enables provinces and territories to design, deliver and manage skills and employment programs for unemployed individuals, particularly for those who are eligible for EI benefits. The Canada Employment Insurance Commission (CEIC) is a departmental corporation of ESDC. It plays a key role in administering the EI program, including the making of regulations, with the approval of the Governor-in-Council, and reviewing, as well as approving, policies related to the EI program administration and delivery. In addition to its role in EI premium rate setting, the CEIC produces the annual EI Monitoring and Assessment Report. The Social Security Tribunal of Canada (SST) is an independent administrative body composed of a General Division and Appeal Division, that makes decisions on appeals related to the Act. 1.1.3 EI premiums & Insurable Employment All workers employed in insurable employment are required to pay EI premiums. The fact that a worker can or cannot qualify for EI benefits is not a criterion to determine whether EI premiums are payable, as it is the employment, and not the individual that is insured. The fundamental requirement for an employment to be insurable is that there is an employer-employee relationship; i.e. the person is not self-employed. CRA holds the responsibility for making decisions as to whether an employment is insurable or not, and whether EI premiums are payable with respect to that employment. 1.1.4 Purpose of Employment Insurance benefits As previously stated, Part I of the EI program provides temporary income support to workers who have lost their job for reasons outside their control, while they look for new employment or upgrade their skills. EI Part I also provides temporary financial assistance to workers who are sick, pregnant, caring for a newborn or newly adopted child, or caring for a family member who has a serious medical condition. The purpose of Part II of the EI Act is to provide employment assistance to eligible insured participants, through various programs and services. 1.1.5 Types of Employment Insurance benefits There are a number of types of EI benefits available: Regular benefits are available to individuals who lose their jobs for reasons outside their control and who are available for and actively seeking employment. Special benefits are available to insured workers and self-employed individuals who are too sick to work, are pregnant or have recently given birth, are providing care to a newborn or newly adopted child, or who must be away from work temporarily to provide care or support to a family member with a serious medical condition. Special benefits include: Maternity benefits: for biological mothers who are pregnant or have given birth. These benefits cover the period surrounding the child's birth (up to 15 weeks). Parental benefits: for any legal parent to care for their newborn or newly adopted child or children. One parent can receive these benefits, or they can share benefits between them (up to 40 weeks of standard parental benefits or 69 weeks of extended parental benefits when sharing). However, one parent cannot receive more than 35 weeks of standard parental benefits or 61 weeks of extended parental benefits. Sickness benefits: for people who cannot work due to injury, illness, or the need to be isolated in quarantine because they may be carrying a disease (up to 26Footnote1 weeks). Compassionate Care benefits: for people who must be away from work temporarily to provide care or support to a family member who is gravely ill with a significant risk of death within 26 weeks. One family member can receive these benefits, or they can be shared between several family members (up to 26 weeks). Family Caregiver benefits: for family members who must be away from work temporarily to care for or support a critically ill or injured family member. One family member can receive these benefits or they can be shared between several family members (up to 35 weeks for caring for a child; up to 15 weeks for caring for an adult). In certain circumstances various types of special benefits may be combined up to a maximum of 102 weeks of benefits within a maximum 104 week benefit period. Fishing benefits – are for eligible self-employed fishers who do not meet the eligibility requirements for EI regular benefits in their region. Job creation partnerships, work sharing, training benefits: for clients participating in developmental programs. [March 2019]
USER:
Provide me a summary of EI based on this reference, but organize it into two sections with one about the system itself and one about the actual benefits.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 28 | 1,071 | null | 137 |
Please answer from the text only and do not extrapolate from the source material.
|
What are the different ways to induce labor for an expectant mother?
|
Department of Obstetrics and Gynecology - 1 - Induction of Labor What is induction of labor? Induction of labor is a medical procedure that softens the cervix (the opening to the womb or uterus) and starts contractions (muscle movements that help push the baby out of the uterus). This procedure is a way to plan when your labor (childbirth) will start, instead of waiting until labor starts on its own. The goal of an induction is to have a safe vaginal birth within 24 hours. What happens during an induction procedure? We use standard medications and techniques to soften and dilate (widen) the cervix so it can reach 10 centimeters (cm) wide. A safe and effective induction procedure includes the following: Misoprostol (Cytotec®) • This is a small pill that your provider will place in the vagina every 3 hours at the start of your induction until the cervix is 3-4 cm dilated. • Misoprostol causes your cervix to soften and open and starts your contractions. Balloon • When your cervix is between 1-3 cm dilated, your provider will place a soft balloon at the top of the cervix. This causes your cervix to soften and dilate. • This balloon can also be placed in the OB Triage or in the clinic before your scheduled induction. Then you will be admitted to the hospital later in the day. Department of Obstetrics and Gynecology Induction of Labor - 2 - • Misoprostol is used in combination with the balloon. Amniotomy • When your cervix is around 3-4 cm dilated, your provider will remove the balloon. Then they will use a device to break the bag of water around your baby. This procedure is called an amniotomy. • The amniotomy causes more contractions to help labor progress. Oxytocin (Pitocin®) • Starting around when your cervix is 3-4 cm dilated, your provider will give you oxytocin through an IV (a needle inserted into your vein). • This medication causes contractions, and it can be easily increased or decreased to avoid having too many contractions. Sometimes oxytocin is also used instead of misoprostol earlier in the induction process. Other steps throughout your induction procedure: • We will do cervical exams every 2-4 hours to confirm that the induction process is going well. • We will do continuous fetal monitoring (medical checks on the baby) to make sure that the baby is doing well throughout the process. • We will place an IV at the start of your induction. Department of Obstetrics and Gynecology Induction of Labor - 3 - Timeline (by centimeters dilated) of the induction procedures and medications: What are the benefits of induction? Induction for a medical reason For some medical conditions, induction of labor is recommended to reduce the risk of complications (medical problems) for both the pregnant person and the baby. Timing your birth instead of waiting for spontaneous labor (whenever labor naturally starts on its own) decreases the chance that your medical conditions will get worse. It also decreases the risk of stillbirth (when a baby dies during pregnancy or birth). Some of these medical conditions include: • Pre-eclampsia and high blood pressure • Diabetes • Low amniotic fluid (oligohydramnios) • When the baby is much smaller than expected Ask your doctor, nurse, or midwife if you have a condition where early birth is recommended. Induction after 39 weeks of pregnancy Induction of labor can be done safely after 39 weeks for pregnant people who do not have a medical reason for early birth. Potential benefits include: • Reduced risk of developing high blood pressure or pre-eclampsia later in pregnancy Department of Obstetrics and Gynecology Induction of Labor - 4 - • Decreased risk of stillbirth (if induced before 42 weeks) • Possibly making it less likely that you will need a Cesarean birth (a surgery to deliver a baby through a cut made through the belly, also called a C-section) What are the risks of induction? • We monitor the baby’s heartbeat continuously because sometimes labor can be harmful to babies. If this is the case, you might need urgent or emergency interventions (including Cesarean birth). • An induction of labor can fail if your cervix does not dilate to 10 cm, despite all efforts to help labor progress. If this happens, you will need a Cesarean birth. Your doctor, midwife and nurse will regularly keep you updated on next steps for care. • If an induction takes too long (more than 24 hours), there is a higher risk of bleeding, infection, and Cesarean birth. • Patients who are induced have a longer hospital stay before birth compared to patients who have spontaneous labor. • It may be harder for you to rest during the early parts of your labor. What are alternatives to induction? • Waiting for spontaneous labor • Cesarean birth How can I help my induction go well? • During the early part of the induction, try to rest as much as possible, drink fluids, and snack lightly. • When your contractions get stronger, rock on a birth ball or use the shower to make yourself more comfortable. Being upright (instead of lying down) and active helps your labor move forward. Department of Obstetrics and Gynecology Induction of Labor - 5 - Disclaimer: This document contains information and/or instructional materials developed by University of Michigan (U-M) Health for the typical patient with your condition. It may include links to online content that was not created by U-M Health and for which U-M Health does not assume responsibility. It does not replace medical advice from your health care provider because your experience may differ from that of the typical patient. Talk to your health care provider if you have any questions about this document, your condition, or your treatment plan. Authors: Joanne Bailey, CNM PhD, Jourdan Triebwasser, MD Edited by: Brittany Batell, MPH MSW Patient Education by U-M Health is licensed under a Creative Commons AttributionNonCommercial-ShareAlike 4.0 International Public License. Last revised 02/2024 • Change positions often, especially if you have an epidural (an injection of medication that blocks pain during labor). • Plan to have a support team (your partner, family member, doula, friend) with you. Having ongoing labor support after your contractions get stronger decreases the possibility of a Cesarean birth and improves your labor and birth experience. • Before you come to the hospital for your induction, learn about ways to push effectively after the cervix is 10 cm dilated. What can I eat and drink during an induction? During an induction, you can eat food without animal protein or fat. Once you get an epidural or once you’re in active labor, you can have clear liquids (like water, apple or grape juice, gelatin, popsicles). What does a scheduled induction look like? On the day that your induction is scheduled, you should arrive at the Birth Center at the time you are scheduled (unless you are contacted that day with different instructions). Please note that we may have to delay your induction 1 day or more, depending on how busy it is in the Birth Center. We try to give you as much advance notice as possible about delays.
|
Please answer from the text only and do not extrapolate from the source material. What are the different ways to induce labor for an expectant mother? Department of Obstetrics and Gynecology - 1 - Induction of Labor What is induction of labor? Induction of labor is a medical procedure that softens the cervix (the opening to the womb or uterus) and starts contractions (muscle movements that help push the baby out of the uterus). This procedure is a way to plan when your labor (childbirth) will start, instead of waiting until labor starts on its own. The goal of an induction is to have a safe vaginal birth within 24 hours. What happens during an induction procedure? We use standard medications and techniques to soften and dilate (widen) the cervix so it can reach 10 centimeters (cm) wide. A safe and effective induction procedure includes the following: Misoprostol (Cytotec®) • This is a small pill that your provider will place in the vagina every 3 hours at the start of your induction until the cervix is 3-4 cm dilated. • Misoprostol causes your cervix to soften and open and starts your contractions. Balloon • When your cervix is between 1-3 cm dilated, your provider will place a soft balloon at the top of the cervix. This causes your cervix to soften and dilate. • This balloon can also be placed in the OB Triage or in the clinic before your scheduled induction. Then you will be admitted to the hospital later in the day. Department of Obstetrics and Gynecology Induction of Labor - 2 - • Misoprostol is used in combination with the balloon. Amniotomy • When your cervix is around 3-4 cm dilated, your provider will remove the balloon. Then they will use a device to break the bag of water around your baby. This procedure is called an amniotomy. • The amniotomy causes more contractions to help labor progress. Oxytocin (Pitocin®) • Starting around when your cervix is 3-4 cm dilated, your provider will give you oxytocin through an IV (a needle inserted into your vein). • This medication causes contractions, and it can be easily increased or decreased to avoid having too many contractions. Sometimes oxytocin is also used instead of misoprostol earlier in the induction process. Other steps throughout your induction procedure: • We will do cervical exams every 2-4 hours to confirm that the induction process is going well. • We will do continuous fetal monitoring (medical checks on the baby) to make sure that the baby is doing well throughout the process. • We will place an IV at the start of your induction. Department of Obstetrics and Gynecology Induction of Labor - 3 - Timeline (by centimeters dilated) of the induction procedures and medications: What are the benefits of induction? Induction for a medical reason For some medical conditions, induction of labor is recommended to reduce the risk of complications (medical problems) for both the pregnant person and the baby. Timing your birth instead of waiting for spontaneous labor (whenever labor naturally starts on its own) decreases the chance that your medical conditions will get worse. It also decreases the risk of stillbirth (when a baby dies during pregnancy or birth). Some of these medical conditions include: • Pre-eclampsia and high blood pressure • Diabetes • Low amniotic fluid (oligohydramnios) • When the baby is much smaller than expected Ask your doctor, nurse, or midwife if you have a condition where early birth is recommended. Induction after 39 weeks of pregnancy Induction of labor can be done safely after 39 weeks for pregnant people who do not have a medical reason for early birth. Potential benefits include: • Reduced risk of developing high blood pressure or pre-eclampsia later in pregnancy Department of Obstetrics and Gynecology Induction of Labor - 4 - • Decreased risk of stillbirth (if induced before 42 weeks) • Possibly making it less likely that you will need a Cesarean birth (a surgery to deliver a baby through a cut made through the belly, also called a C-section) What are the risks of induction? • We monitor the baby’s heartbeat continuously because sometimes labor can be harmful to babies. If this is the case, you might need urgent or emergency interventions (including Cesarean birth). • An induction of labor can fail if your cervix does not dilate to 10 cm, despite all efforts to help labor progress. If this happens, you will need a Cesarean birth. Your doctor, midwife and nurse will regularly keep you updated on next steps for care. • If an induction takes too long (more than 24 hours), there is a higher risk of bleeding, infection, and Cesarean birth. • Patients who are induced have a longer hospital stay before birth compared to patients who have spontaneous labor. • It may be harder for you to rest during the early parts of your labor. What are alternatives to induction? • Waiting for spontaneous labor • Cesarean birth How can I help my induction go well? • During the early part of the induction, try to rest as much as possible, drink fluids, and snack lightly. • When your contractions get stronger, rock on a birth ball or use the shower to make yourself more comfortable. Being upright (instead of lying down) and active helps your labor move forward. Department of Obstetrics and Gynecology Induction of Labor - 5 - Disclaimer: This document contains information and/or instructional materials developed by University of Michigan (U-M) Health for the typical patient with your condition. It may include links to online content that was not created by U-M Health and for which U-M Health does not assume responsibility. It does not replace medical advice from your health care provider because your experience may differ from that of the typical patient. Talk to your health care provider if you have any questions about this document, your condition, or your treatment plan. Authors: Joanne Bailey, CNM PhD, Jourdan Triebwasser, MD Edited by: Brittany Batell, MPH MSW Patient Education by U-M Health is licensed under a Creative Commons AttributionNonCommercial-ShareAlike 4.0 International Public License. Last revised 02/2024 • Change positions often, especially if you have an epidural (an injection of medication that blocks pain during labor). • Plan to have a support team (your partner, family member, doula, friend) with you. Having ongoing labor support after your contractions get stronger decreases the possibility of a Cesarean birth and improves your labor and birth experience. • Before you come to the hospital for your induction, learn about ways to push effectively after the cervix is 10 cm dilated. What can I eat and drink during an induction? During an induction, you can eat food without animal protein or fat. Once you get an epidural or once you’re in active labor, you can have clear liquids (like water, apple or grape juice, gelatin, popsicles). What does a scheduled induction look like? On the day that your induction is scheduled, you should arrive at the Birth Center at the time you are scheduled (unless you are contacted that day with different instructions). Please note that we may have to delay your induction 1 day or more, depending on how busy it is in the Birth Center. We try to give you as much advance notice as possible about delays.
|
Please answer from the text only and do not extrapolate from the source material.
EVIDENCE:
Department of Obstetrics and Gynecology - 1 - Induction of Labor What is induction of labor? Induction of labor is a medical procedure that softens the cervix (the opening to the womb or uterus) and starts contractions (muscle movements that help push the baby out of the uterus). This procedure is a way to plan when your labor (childbirth) will start, instead of waiting until labor starts on its own. The goal of an induction is to have a safe vaginal birth within 24 hours. What happens during an induction procedure? We use standard medications and techniques to soften and dilate (widen) the cervix so it can reach 10 centimeters (cm) wide. A safe and effective induction procedure includes the following: Misoprostol (Cytotec®) • This is a small pill that your provider will place in the vagina every 3 hours at the start of your induction until the cervix is 3-4 cm dilated. • Misoprostol causes your cervix to soften and open and starts your contractions. Balloon • When your cervix is between 1-3 cm dilated, your provider will place a soft balloon at the top of the cervix. This causes your cervix to soften and dilate. • This balloon can also be placed in the OB Triage or in the clinic before your scheduled induction. Then you will be admitted to the hospital later in the day. Department of Obstetrics and Gynecology Induction of Labor - 2 - • Misoprostol is used in combination with the balloon. Amniotomy • When your cervix is around 3-4 cm dilated, your provider will remove the balloon. Then they will use a device to break the bag of water around your baby. This procedure is called an amniotomy. • The amniotomy causes more contractions to help labor progress. Oxytocin (Pitocin®) • Starting around when your cervix is 3-4 cm dilated, your provider will give you oxytocin through an IV (a needle inserted into your vein). • This medication causes contractions, and it can be easily increased or decreased to avoid having too many contractions. Sometimes oxytocin is also used instead of misoprostol earlier in the induction process. Other steps throughout your induction procedure: • We will do cervical exams every 2-4 hours to confirm that the induction process is going well. • We will do continuous fetal monitoring (medical checks on the baby) to make sure that the baby is doing well throughout the process. • We will place an IV at the start of your induction. Department of Obstetrics and Gynecology Induction of Labor - 3 - Timeline (by centimeters dilated) of the induction procedures and medications: What are the benefits of induction? Induction for a medical reason For some medical conditions, induction of labor is recommended to reduce the risk of complications (medical problems) for both the pregnant person and the baby. Timing your birth instead of waiting for spontaneous labor (whenever labor naturally starts on its own) decreases the chance that your medical conditions will get worse. It also decreases the risk of stillbirth (when a baby dies during pregnancy or birth). Some of these medical conditions include: • Pre-eclampsia and high blood pressure • Diabetes • Low amniotic fluid (oligohydramnios) • When the baby is much smaller than expected Ask your doctor, nurse, or midwife if you have a condition where early birth is recommended. Induction after 39 weeks of pregnancy Induction of labor can be done safely after 39 weeks for pregnant people who do not have a medical reason for early birth. Potential benefits include: • Reduced risk of developing high blood pressure or pre-eclampsia later in pregnancy Department of Obstetrics and Gynecology Induction of Labor - 4 - • Decreased risk of stillbirth (if induced before 42 weeks) • Possibly making it less likely that you will need a Cesarean birth (a surgery to deliver a baby through a cut made through the belly, also called a C-section) What are the risks of induction? • We monitor the baby’s heartbeat continuously because sometimes labor can be harmful to babies. If this is the case, you might need urgent or emergency interventions (including Cesarean birth). • An induction of labor can fail if your cervix does not dilate to 10 cm, despite all efforts to help labor progress. If this happens, you will need a Cesarean birth. Your doctor, midwife and nurse will regularly keep you updated on next steps for care. • If an induction takes too long (more than 24 hours), there is a higher risk of bleeding, infection, and Cesarean birth. • Patients who are induced have a longer hospital stay before birth compared to patients who have spontaneous labor. • It may be harder for you to rest during the early parts of your labor. What are alternatives to induction? • Waiting for spontaneous labor • Cesarean birth How can I help my induction go well? • During the early part of the induction, try to rest as much as possible, drink fluids, and snack lightly. • When your contractions get stronger, rock on a birth ball or use the shower to make yourself more comfortable. Being upright (instead of lying down) and active helps your labor move forward. Department of Obstetrics and Gynecology Induction of Labor - 5 - Disclaimer: This document contains information and/or instructional materials developed by University of Michigan (U-M) Health for the typical patient with your condition. It may include links to online content that was not created by U-M Health and for which U-M Health does not assume responsibility. It does not replace medical advice from your health care provider because your experience may differ from that of the typical patient. Talk to your health care provider if you have any questions about this document, your condition, or your treatment plan. Authors: Joanne Bailey, CNM PhD, Jourdan Triebwasser, MD Edited by: Brittany Batell, MPH MSW Patient Education by U-M Health is licensed under a Creative Commons AttributionNonCommercial-ShareAlike 4.0 International Public License. Last revised 02/2024 • Change positions often, especially if you have an epidural (an injection of medication that blocks pain during labor). • Plan to have a support team (your partner, family member, doula, friend) with you. Having ongoing labor support after your contractions get stronger decreases the possibility of a Cesarean birth and improves your labor and birth experience. • Before you come to the hospital for your induction, learn about ways to push effectively after the cervix is 10 cm dilated. What can I eat and drink during an induction? During an induction, you can eat food without animal protein or fat. Once you get an epidural or once you’re in active labor, you can have clear liquids (like water, apple or grape juice, gelatin, popsicles). What does a scheduled induction look like? On the day that your induction is scheduled, you should arrive at the Birth Center at the time you are scheduled (unless you are contacted that day with different instructions). Please note that we may have to delay your induction 1 day or more, depending on how busy it is in the Birth Center. We try to give you as much advance notice as possible about delays.
USER:
What are the different ways to induce labor for an expectant mother?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 14 | 12 | 1,196 | null | 702 |
This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Do not use bullet points. Limit your response to 100 words.
|
How do regulators' powers achieve their goals?
|
Regulatory Powers Regulators implement policy using their powers, which vary by agency. Powers, which can also be thought of as tools, can be grouped into a few broad categories: • Licensing, chartering, or registration. A starting point for understanding the regulatory system is that most activities cannot be undertaken unless a firm, individual, or market has received the proper credentials from the appropriate state or federal regulator. Each type of charter, license, or registration granted by the respective regulator governs the sets of financial activities that the holder is permitted to engage in. For example, a firm cannot accept federally insured 3 U.S. Government Accountability Office (GAO), Financial Regulation, GAO-16-175, February 2016, https://www.gao.gov/assets/680/675400.pdf. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 3 deposits unless it is chartered as a bank, thrift, or credit union by a depository institution regulator. Likewise, an individual generally cannot buy and sell securities to others unless licensed as a broker-dealer.4 To be granted a license, charter, or registration, the recipient must accept the terms and conditions that accompany it. Depending on the type, those conditions could include regulatory oversight, training requirements, and a requirement to act according to a set of standards or code of ethics. Failure to meet the terms and conditions could result in fines, penalties, remedial actions, license or charter revocation, or criminal charges. • Rulemaking. Regulators issue rules (regulations) through the rulemaking process to implement statutory mandates.5 Typically, statutory mandates provide regulators with a policy goal in general terms, and regulations fill in the specifics. Rules lay out the guidelines for how market participants may or may not act to comply with the mandate. • Oversight and supervision. Regulators ensure that their rules are adhered to through oversight and supervision. This allows regulators to observe market participants’ behavior and instruct them to modify or cease improper behavior. Supervision may entail active, ongoing monitoring (as for banks) or investigating complaints and allegations ex post (as is common in securities markets). In some cases, such as banking, supervision includes periodic examinations and inspections, whereas in other cases, regulators rely more heavily on selfreporting. Regulators explain supervisory priorities and points of emphasis by issuing supervisory letters and guidance. • Enforcement. Regulators can compel firms to modify their behavior through enforcement powers. Enforcement powers include the ability to issue fines, penalties, and cease-and-desist orders; to undertake criminal or civil actions in court or administrative proceedings or arbitrations; and to revoke licenses and charters. In some cases, regulators initiate legal action at their own prompting or in response to consumer or investor complaints. In other cases, regulators explicitly allow consumers and investors to sue for damages when firms do not comply with regulations, or they provide legal protection to firms that do comply. • Resolution. Some regulators have the power to resolve a failing firm by taking control of the firm and initiating conservatorship (i.e., the regulator runs the firm on an ongoing basis) or receivership (i.e., the regulator winds the firm down). Other types of failing financial firms are resolved through bankruptcy, a judicial process separate from the regulators. Goals of Regulation Financial regulation is primarily intended to achieve the following underlying policy outcomes:6 • Market efficiency and integrity. Regulators seek to ensure that markets operate efficiently and that market participants have confidence in the market’s integrity. 4 One may obtain separate licenses to be a broker or a dealer, but in practice, many obtain both. 5 For more information, see CRS Report R41546, A Brief Overview of Rulemaking and Judicial Review, by Todd Garvey. 6 Regulators are also tasked with promoting certain social goals, such as community reinvestment or affordable housing. Because this report focuses on regulation, it will not discuss social goals. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 4 Liquidity, low costs, the presence of many buyers and sellers, the availability of information, and a lack of excessive volatility are examples of the characteristics of an efficient market. Regulation can also improve market efficiency by addressing market failures, such as principal-agent problems,7 asymmetric information,8 and moral hazard.9 Regulators contribute to market integrity by ensuring that activities are transparent, contracts can be enforced, and the “rules of the game” they set are enforced. Integrity generally leads to greater efficiency. • Consumer and investor protection. Regulators seek to ensure that consumers or investors do not suffer from fraud, discrimination, manipulation, and theft. Regulators try to prevent exploitative or abusive practices intended to take advantage of unwitting consumers or investors. In some cases, protection is limited to enabling consumers and investors to understand the inherent risks when they enter into a transaction. In other cases, protection is based on the principle of suitability—efforts to ensure that more risky products or product features are accessible only to financially sophisticated or secure consumers or investors. • Capital formation and access to credit. Regulators seek to ensure that firms and consumers are able to access credit and capital to meet their needs such that credit and economic activity can grow at a healthy rate. Regulators try to ensure that capital and credit are available to all worthy borrowers, regardless of personal characteristics, such as race, gender, and location. Examples are fair lending laws and fair housing goals. • Illicit activity prevention. Regulators seek to ensure that the financial system cannot be used to support criminal and terrorist activity. Examples are policies to prevent money laundering, tax evasion, terrorism financing, and the contravention of financial sanctions. • Taxpayer protection. Regulators seek to ensure that losses or failures in financial markets do not result in federal government payouts or the assumption of liabilities that are ultimately borne by taxpayers. Only certain types of financial activity are explicitly backed by the federal government or by regulatorrun insurance schemes that are backed by the federal government, such as the Deposit Insurance Fund (DIF) run by the FDIC. Such schemes are self-financed by the insured firms through premium payments unless the losses exceed the insurance fund, in which case taxpayer money is used temporarily or permanently to fill the gap. In the case of a financial crisis, the government may decide that the “least bad” option is to provide funds in ways not explicitly promised or previously contemplated to restore stability. “Bailouts” of large failing firms in 2008 are the most well-known examples. In this sense, there may be implicit taxpayer backing of parts or all of the financial system. • Financial stability. Financial regulation seeks to maintain financial stability through preventive and palliative measures that mitigate systemic risk. At times, financial markets stop functioning well—markets freeze, participants panic, 7 For example, financial agents may have incentives to make decisions that are not in the best interests of their clients, and clients may not be able to adequately monitor their behavior. 8 For example, firms issuing securities know more about their financial prospects than do investors purchasing those securities, which can result in a “lemons” problem in which low-quality firms drive high-quality firms out of the marketplace. 9 For example, individuals may act more imprudently if they are insured against a risk. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 5 credit becomes unavailable, and multiple firms fail. Financial instability can be localized (to a specific market or activity) or more general. Sometimes instability can be contained and quelled through market actions or policy intervention; at other times, instability metastasizes and does broader damage to the real economy. The most recent example of the latter was the financial crisis of 2007- 2009. Traditionally, financial stability concerns have centered on banking, but the recent crisis illustrates the potential for systemic risk to arise in other parts of the financial system as well. These regulatory goals are sometimes complementary but at other times conflict with each other. For example, without an adequate level of consumer and investor protections, fewer individuals may be willing to participate in financial markets, and efficiency and capital formation could suffer. But, at some point, too many consumer and investor safeguards and protections could make credit and capital prohibitively expensive, reducing market efficiency and capital formation. Regulation generally aims to seek a middle ground between these two extremes in which regulatory burden is as small as possible and regulatory benefits are as large as possible. Because some firms can cope with regulatory burden better than others can, sometimes regulation is tailored so that smaller firms, for example, are exempted from a regulation or face a streamlined version of a regulation. As a result, when taking any action, regulators balance the tradeoffs between their various goals.
|
This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Do not use bullet points. Limit your response to 100 words. Regulatory Powers Regulators implement policy using their powers, which vary by agency. Powers, which can also be thought of as tools, can be grouped into a few broad categories: • Licensing, chartering, or registration. A starting point for understanding the regulatory system is that most activities cannot be undertaken unless a firm, individual, or market has received the proper credentials from the appropriate state or federal regulator. Each type of charter, license, or registration granted by the respective regulator governs the sets of financial activities that the holder is permitted to engage in. For example, a firm cannot accept federally insured 3 U.S. Government Accountability Office (GAO), Financial Regulation, GAO-16-175, February 2016, https://www.gao.gov/assets/680/675400.pdf. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 3 deposits unless it is chartered as a bank, thrift, or credit union by a depository institution regulator. Likewise, an individual generally cannot buy and sell securities to others unless licensed as a broker-dealer.4 To be granted a license, charter, or registration, the recipient must accept the terms and conditions that accompany it. Depending on the type, those conditions could include regulatory oversight, training requirements, and a requirement to act according to a set of standards or code of ethics. Failure to meet the terms and conditions could result in fines, penalties, remedial actions, license or charter revocation, or criminal charges. • Rulemaking. Regulators issue rules (regulations) through the rulemaking process to implement statutory mandates.5 Typically, statutory mandates provide regulators with a policy goal in general terms, and regulations fill in the specifics. Rules lay out the guidelines for how market participants may or may not act to comply with the mandate. • Oversight and supervision. Regulators ensure that their rules are adhered to through oversight and supervision. This allows regulators to observe market participants’ behavior and instruct them to modify or cease improper behavior. Supervision may entail active, ongoing monitoring (as for banks) or investigating complaints and allegations ex post (as is common in securities markets). In some cases, such as banking, supervision includes periodic examinations and inspections, whereas in other cases, regulators rely more heavily on selfreporting. Regulators explain supervisory priorities and points of emphasis by issuing supervisory letters and guidance. • Enforcement. Regulators can compel firms to modify their behavior through enforcement powers. Enforcement powers include the ability to issue fines, penalties, and cease-and-desist orders; to undertake criminal or civil actions in court or administrative proceedings or arbitrations; and to revoke licenses and charters. In some cases, regulators initiate legal action at their own prompting or in response to consumer or investor complaints. In other cases, regulators explicitly allow consumers and investors to sue for damages when firms do not comply with regulations, or they provide legal protection to firms that do comply. • Resolution. Some regulators have the power to resolve a failing firm by taking control of the firm and initiating conservatorship (i.e., the regulator runs the firm on an ongoing basis) or receivership (i.e., the regulator winds the firm down). Other types of failing financial firms are resolved through bankruptcy, a judicial process separate from the regulators. Goals of Regulation Financial regulation is primarily intended to achieve the following underlying policy outcomes:6 • Market efficiency and integrity. Regulators seek to ensure that markets operate efficiently and that market participants have confidence in the market’s integrity. 4 One may obtain separate licenses to be a broker or a dealer, but in practice, many obtain both. 5 For more information, see CRS Report R41546, A Brief Overview of Rulemaking and Judicial Review, by Todd Garvey. 6 Regulators are also tasked with promoting certain social goals, such as community reinvestment or affordable housing. Because this report focuses on regulation, it will not discuss social goals. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 4 Liquidity, low costs, the presence of many buyers and sellers, the availability of information, and a lack of excessive volatility are examples of the characteristics of an efficient market. Regulation can also improve market efficiency by addressing market failures, such as principal-agent problems,7 asymmetric information,8 and moral hazard.9 Regulators contribute to market integrity by ensuring that activities are transparent, contracts can be enforced, and the “rules of the game” they set are enforced. Integrity generally leads to greater efficiency. • Consumer and investor protection. Regulators seek to ensure that consumers or investors do not suffer from fraud, discrimination, manipulation, and theft. Regulators try to prevent exploitative or abusive practices intended to take advantage of unwitting consumers or investors. In some cases, protection is limited to enabling consumers and investors to understand the inherent risks when they enter into a transaction. In other cases, protection is based on the principle of suitability—efforts to ensure that more risky products or product features are accessible only to financially sophisticated or secure consumers or investors. • Capital formation and access to credit. Regulators seek to ensure that firms and consumers are able to access credit and capital to meet their needs such that credit and economic activity can grow at a healthy rate. Regulators try to ensure that capital and credit are available to all worthy borrowers, regardless of personal characteristics, such as race, gender, and location. Examples are fair lending laws and fair housing goals. • Illicit activity prevention. Regulators seek to ensure that the financial system cannot be used to support criminal and terrorist activity. Examples are policies to prevent money laundering, tax evasion, terrorism financing, and the contravention of financial sanctions. • Taxpayer protection. Regulators seek to ensure that losses or failures in financial markets do not result in federal government payouts or the assumption of liabilities that are ultimately borne by taxpayers. Only certain types of financial activity are explicitly backed by the federal government or by regulatorrun insurance schemes that are backed by the federal government, such as the Deposit Insurance Fund (DIF) run by the FDIC. Such schemes are self-financed by the insured firms through premium payments unless the losses exceed the insurance fund, in which case taxpayer money is used temporarily or permanently to fill the gap. In the case of a financial crisis, the government may decide that the “least bad” option is to provide funds in ways not explicitly promised or previously contemplated to restore stability. “Bailouts” of large failing firms in 2008 are the most well-known examples. In this sense, there may be implicit taxpayer backing of parts or all of the financial system. • Financial stability. Financial regulation seeks to maintain financial stability through preventive and palliative measures that mitigate systemic risk. At times, financial markets stop functioning well—markets freeze, participants panic, 7 For example, financial agents may have incentives to make decisions that are not in the best interests of their clients, and clients may not be able to adequately monitor their behavior. 8 For example, firms issuing securities know more about their financial prospects than do investors purchasing those securities, which can result in a “lemons” problem in which low-quality firms drive high-quality firms out of the marketplace. 9 For example, individuals may act more imprudently if they are insured against a risk. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 5 credit becomes unavailable, and multiple firms fail. Financial instability can be localized (to a specific market or activity) or more general. Sometimes instability can be contained and quelled through market actions or policy intervention; at other times, instability metastasizes and does broader damage to the real economy. The most recent example of the latter was the financial crisis of 2007- 2009. Traditionally, financial stability concerns have centered on banking, but the recent crisis illustrates the potential for systemic risk to arise in other parts of the financial system as well. These regulatory goals are sometimes complementary but at other times conflict with each other. For example, without an adequate level of consumer and investor protections, fewer individuals may be willing to participate in financial markets, and efficiency and capital formation could suffer. But, at some point, too many consumer and investor safeguards and protections could make credit and capital prohibitively expensive, reducing market efficiency and capital formation. Regulation generally aims to seek a middle ground between these two extremes in which regulatory burden is as small as possible and regulatory benefits are as large as possible. Because some firms can cope with regulatory burden better than others can, sometimes regulation is tailored so that smaller firms, for example, are exempted from a regulation or face a streamlined version of a regulation. As a result, when taking any action, regulators balance the tradeoffs between their various goals. How do regulators' powers achieve their goals?
|
This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Do not use bullet points. Limit your response to 100 words.
EVIDENCE:
Regulatory Powers Regulators implement policy using their powers, which vary by agency. Powers, which can also be thought of as tools, can be grouped into a few broad categories: • Licensing, chartering, or registration. A starting point for understanding the regulatory system is that most activities cannot be undertaken unless a firm, individual, or market has received the proper credentials from the appropriate state or federal regulator. Each type of charter, license, or registration granted by the respective regulator governs the sets of financial activities that the holder is permitted to engage in. For example, a firm cannot accept federally insured 3 U.S. Government Accountability Office (GAO), Financial Regulation, GAO-16-175, February 2016, https://www.gao.gov/assets/680/675400.pdf. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 3 deposits unless it is chartered as a bank, thrift, or credit union by a depository institution regulator. Likewise, an individual generally cannot buy and sell securities to others unless licensed as a broker-dealer.4 To be granted a license, charter, or registration, the recipient must accept the terms and conditions that accompany it. Depending on the type, those conditions could include regulatory oversight, training requirements, and a requirement to act according to a set of standards or code of ethics. Failure to meet the terms and conditions could result in fines, penalties, remedial actions, license or charter revocation, or criminal charges. • Rulemaking. Regulators issue rules (regulations) through the rulemaking process to implement statutory mandates.5 Typically, statutory mandates provide regulators with a policy goal in general terms, and regulations fill in the specifics. Rules lay out the guidelines for how market participants may or may not act to comply with the mandate. • Oversight and supervision. Regulators ensure that their rules are adhered to through oversight and supervision. This allows regulators to observe market participants’ behavior and instruct them to modify or cease improper behavior. Supervision may entail active, ongoing monitoring (as for banks) or investigating complaints and allegations ex post (as is common in securities markets). In some cases, such as banking, supervision includes periodic examinations and inspections, whereas in other cases, regulators rely more heavily on selfreporting. Regulators explain supervisory priorities and points of emphasis by issuing supervisory letters and guidance. • Enforcement. Regulators can compel firms to modify their behavior through enforcement powers. Enforcement powers include the ability to issue fines, penalties, and cease-and-desist orders; to undertake criminal or civil actions in court or administrative proceedings or arbitrations; and to revoke licenses and charters. In some cases, regulators initiate legal action at their own prompting or in response to consumer or investor complaints. In other cases, regulators explicitly allow consumers and investors to sue for damages when firms do not comply with regulations, or they provide legal protection to firms that do comply. • Resolution. Some regulators have the power to resolve a failing firm by taking control of the firm and initiating conservatorship (i.e., the regulator runs the firm on an ongoing basis) or receivership (i.e., the regulator winds the firm down). Other types of failing financial firms are resolved through bankruptcy, a judicial process separate from the regulators. Goals of Regulation Financial regulation is primarily intended to achieve the following underlying policy outcomes:6 • Market efficiency and integrity. Regulators seek to ensure that markets operate efficiently and that market participants have confidence in the market’s integrity. 4 One may obtain separate licenses to be a broker or a dealer, but in practice, many obtain both. 5 For more information, see CRS Report R41546, A Brief Overview of Rulemaking and Judicial Review, by Todd Garvey. 6 Regulators are also tasked with promoting certain social goals, such as community reinvestment or affordable housing. Because this report focuses on regulation, it will not discuss social goals. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 4 Liquidity, low costs, the presence of many buyers and sellers, the availability of information, and a lack of excessive volatility are examples of the characteristics of an efficient market. Regulation can also improve market efficiency by addressing market failures, such as principal-agent problems,7 asymmetric information,8 and moral hazard.9 Regulators contribute to market integrity by ensuring that activities are transparent, contracts can be enforced, and the “rules of the game” they set are enforced. Integrity generally leads to greater efficiency. • Consumer and investor protection. Regulators seek to ensure that consumers or investors do not suffer from fraud, discrimination, manipulation, and theft. Regulators try to prevent exploitative or abusive practices intended to take advantage of unwitting consumers or investors. In some cases, protection is limited to enabling consumers and investors to understand the inherent risks when they enter into a transaction. In other cases, protection is based on the principle of suitability—efforts to ensure that more risky products or product features are accessible only to financially sophisticated or secure consumers or investors. • Capital formation and access to credit. Regulators seek to ensure that firms and consumers are able to access credit and capital to meet their needs such that credit and economic activity can grow at a healthy rate. Regulators try to ensure that capital and credit are available to all worthy borrowers, regardless of personal characteristics, such as race, gender, and location. Examples are fair lending laws and fair housing goals. • Illicit activity prevention. Regulators seek to ensure that the financial system cannot be used to support criminal and terrorist activity. Examples are policies to prevent money laundering, tax evasion, terrorism financing, and the contravention of financial sanctions. • Taxpayer protection. Regulators seek to ensure that losses or failures in financial markets do not result in federal government payouts or the assumption of liabilities that are ultimately borne by taxpayers. Only certain types of financial activity are explicitly backed by the federal government or by regulatorrun insurance schemes that are backed by the federal government, such as the Deposit Insurance Fund (DIF) run by the FDIC. Such schemes are self-financed by the insured firms through premium payments unless the losses exceed the insurance fund, in which case taxpayer money is used temporarily or permanently to fill the gap. In the case of a financial crisis, the government may decide that the “least bad” option is to provide funds in ways not explicitly promised or previously contemplated to restore stability. “Bailouts” of large failing firms in 2008 are the most well-known examples. In this sense, there may be implicit taxpayer backing of parts or all of the financial system. • Financial stability. Financial regulation seeks to maintain financial stability through preventive and palliative measures that mitigate systemic risk. At times, financial markets stop functioning well—markets freeze, participants panic, 7 For example, financial agents may have incentives to make decisions that are not in the best interests of their clients, and clients may not be able to adequately monitor their behavior. 8 For example, firms issuing securities know more about their financial prospects than do investors purchasing those securities, which can result in a “lemons” problem in which low-quality firms drive high-quality firms out of the marketplace. 9 For example, individuals may act more imprudently if they are insured against a risk. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 5 credit becomes unavailable, and multiple firms fail. Financial instability can be localized (to a specific market or activity) or more general. Sometimes instability can be contained and quelled through market actions or policy intervention; at other times, instability metastasizes and does broader damage to the real economy. The most recent example of the latter was the financial crisis of 2007- 2009. Traditionally, financial stability concerns have centered on banking, but the recent crisis illustrates the potential for systemic risk to arise in other parts of the financial system as well. These regulatory goals are sometimes complementary but at other times conflict with each other. For example, without an adequate level of consumer and investor protections, fewer individuals may be willing to participate in financial markets, and efficiency and capital formation could suffer. But, at some point, too many consumer and investor safeguards and protections could make credit and capital prohibitively expensive, reducing market efficiency and capital formation. Regulation generally aims to seek a middle ground between these two extremes in which regulatory burden is as small as possible and regulatory benefits are as large as possible. Because some firms can cope with regulatory burden better than others can, sometimes regulation is tailored so that smaller firms, for example, are exempted from a regulation or face a streamlined version of a regulation. As a result, when taking any action, regulators balance the tradeoffs between their various goals.
USER:
How do regulators' powers achieve their goals?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 39 | 7 | 1,443 | null | 287 |
If you cannot answer using the context alone, say "I cannot answer that." Draw your answer from the text only. Use full sentences in your response.
|
What works have been cited?
|
2.1 IntroductionDefining terminology is a useful starting point when reading or writing on the subject of service to prevent any confusion or assumptions that we all understand the terms to mean the same thing. So, what do we mean by goods, products and services? This is a book about service, but what is a ‘service’ and how is it different to ‘goods’ or ‘products’? Whilst most people intuitively know the difference between a product and service, actually defining this difference with clarity and accuracy of text is not straight forward. The terms ‘goods’ and ‘products’ appear to be used interchangeably in much of the literature, but even here we can find debate about meaning (Araujo and Spring 2006; Callon 1991, 2002). However, for the sake of brevity we will here accept that they both refer to the same thing and focus on attempts to differentiate goods and services. This quest is far from straightfor-ward. Since the early eighteenth century academics and scholars from different domains have attempted to define these terms explicitly (Say 1803; Levitt 1981; Hill 1999; Gadrey 2000). In this chapter we will attempt to illustrate their findings in order to provide some background to the debate. 2.2 GoodsIn the eighteenth century Adam Smith (1776) stated that goods have exchange-able value and so a characteristic of a good is that its ownership rights can be established and exchanged. Goods can be considered as embodying specialised knowledge in a way that is highly advantageous for promoting the division of labour (Smith 1776; Demsetz 1993). Nassau Senior (1863) described goods as material things, meaning that goods are tangible and have physical dimensions. These concepts were still accepted over 100 years later when The System of National Accounts (SNA) (1993) defined goods as physical objects for which a demand exists, over which ownership rights can be established and whose owner-ship can be transferred from one institutional unit to another by engaging in transactions on markets. Hill (1999) summed up the major characteristics of goods as an entity that exists independently of its owner and preserves its identity through time; his definition supporting of that of the SNA. Following these defini-tions we can outline a set of attributes for goods:Physical objects for which a demand exists•Their physical attributes are preserved over time•Ownership rights can be established•They exist independently of their owner•They are exchangeable•Unit ownership rights can be exchanged between institutions•They can be traded on markets•They embody specialised knowledge in a way that is highly advantageous for •promoting the division of labourThese attributes are broadly accepted by academics and reflect 200 years of ongoing debate. 2.3 ServicesAlthough we have found a long standing agreement over the definition of products/goods and their characteristics, the definition of services has never reached consen-sus. Consequently it is hard to obtain full acceptance about the distinction between goods and services. Here we will present some of the different perspectives on service from the literature. 2.4 Intangible, Heterogeneous, Inseparable & Perishable (IHIP) CharacteristicsAs marketers began to recognise and emphasise the importance of services (Fisk et al. 1993) they consequently called for services to form a separate part of a com-panies’ marketing strategy (Lovelock 1983). A major contribution to the services debate was a classification consisting of four features: •Intangible •Heterogeneous
|
If you cannot answer using the context alone, say "I cannot answer that." Draw your answer from the text only. Use full sentences in your response. What works have been cited? 2.1 IntroductionDefining terminology is a useful starting point when reading or writing on the subject of service to prevent any confusion or assumptions that we all understand the terms to mean the same thing. So, what do we mean by goods, products and services? This is a book about service, but what is a ‘service’ and how is it different to ‘goods’ or ‘products’? Whilst most people intuitively know the difference between a product and service, actually defining this difference with clarity and accuracy of text is not straight forward. The terms ‘goods’ and ‘products’ appear to be used interchangeably in much of the literature, but even here we can find debate about meaning (Araujo and Spring 2006; Callon 1991, 2002). However, for the sake of brevity we will here accept that they both refer to the same thing and focus on attempts to differentiate goods and services. This quest is far from straightfor-ward. Since the early eighteenth century academics and scholars from different domains have attempted to define these terms explicitly (Say 1803; Levitt 1981; Hill 1999; Gadrey 2000). In this chapter we will attempt to illustrate their findings in order to provide some background to the debate. 2.2 GoodsIn the eighteenth century Adam Smith (1776) stated that goods have exchange-able value and so a characteristic of a good is that its ownership rights can be established and exchanged. Goods can be considered as embodying specialised knowledge in a way that is highly advantageous for promoting the division of labour (Smith 1776; Demsetz 1993). Nassau Senior (1863) described goods as material things, meaning that goods are tangible and have physical dimensions. These concepts were still accepted over 100 years later when The System of National Accounts (SNA) (1993) defined goods as physical objects for which a demand exists, over which ownership rights can be established and whose owner-ship can be transferred from one institutional unit to another by engaging in transactions on markets. Hill (1999) summed up the major characteristics of goods as an entity that exists independently of its owner and preserves its identity through time; his definition supporting of that of the SNA. Following these defini-tions we can outline a set of attributes for goods:Physical objects for which a demand exists•Their physical attributes are preserved over time•Ownership rights can be established•They exist independently of their owner•They are exchangeable•Unit ownership rights can be exchanged between institutions•They can be traded on markets•They embody specialised knowledge in a way that is highly advantageous for •promoting the division of labourThese attributes are broadly accepted by academics and reflect 200 years of ongoing debate. 2.3 ServicesAlthough we have found a long standing agreement over the definition of products/goods and their characteristics, the definition of services has never reached consen-sus. Consequently it is hard to obtain full acceptance about the distinction between goods and services. Here we will present some of the different perspectives on service from the literature. 2.4 Intangible, Heterogeneous, Inseparable & Perishable (IHIP) CharacteristicsAs marketers began to recognise and emphasise the importance of services (Fisk et al. 1993) they consequently called for services to form a separate part of a com-panies’ marketing strategy (Lovelock 1983). A major contribution to the services debate was a classification consisting of four features: •Intangible •Heterogeneous
|
If you cannot answer using the context alone, say "I cannot answer that." Draw your answer from the text only. Use full sentences in your response.
EVIDENCE:
2.1 IntroductionDefining terminology is a useful starting point when reading or writing on the subject of service to prevent any confusion or assumptions that we all understand the terms to mean the same thing. So, what do we mean by goods, products and services? This is a book about service, but what is a ‘service’ and how is it different to ‘goods’ or ‘products’? Whilst most people intuitively know the difference between a product and service, actually defining this difference with clarity and accuracy of text is not straight forward. The terms ‘goods’ and ‘products’ appear to be used interchangeably in much of the literature, but even here we can find debate about meaning (Araujo and Spring 2006; Callon 1991, 2002). However, for the sake of brevity we will here accept that they both refer to the same thing and focus on attempts to differentiate goods and services. This quest is far from straightfor-ward. Since the early eighteenth century academics and scholars from different domains have attempted to define these terms explicitly (Say 1803; Levitt 1981; Hill 1999; Gadrey 2000). In this chapter we will attempt to illustrate their findings in order to provide some background to the debate. 2.2 GoodsIn the eighteenth century Adam Smith (1776) stated that goods have exchange-able value and so a characteristic of a good is that its ownership rights can be established and exchanged. Goods can be considered as embodying specialised knowledge in a way that is highly advantageous for promoting the division of labour (Smith 1776; Demsetz 1993). Nassau Senior (1863) described goods as material things, meaning that goods are tangible and have physical dimensions. These concepts were still accepted over 100 years later when The System of National Accounts (SNA) (1993) defined goods as physical objects for which a demand exists, over which ownership rights can be established and whose owner-ship can be transferred from one institutional unit to another by engaging in transactions on markets. Hill (1999) summed up the major characteristics of goods as an entity that exists independently of its owner and preserves its identity through time; his definition supporting of that of the SNA. Following these defini-tions we can outline a set of attributes for goods:Physical objects for which a demand exists•Their physical attributes are preserved over time•Ownership rights can be established•They exist independently of their owner•They are exchangeable•Unit ownership rights can be exchanged between institutions•They can be traded on markets•They embody specialised knowledge in a way that is highly advantageous for •promoting the division of labourThese attributes are broadly accepted by academics and reflect 200 years of ongoing debate. 2.3 ServicesAlthough we have found a long standing agreement over the definition of products/goods and their characteristics, the definition of services has never reached consen-sus. Consequently it is hard to obtain full acceptance about the distinction between goods and services. Here we will present some of the different perspectives on service from the literature. 2.4 Intangible, Heterogeneous, Inseparable & Perishable (IHIP) CharacteristicsAs marketers began to recognise and emphasise the importance of services (Fisk et al. 1993) they consequently called for services to form a separate part of a com-panies’ marketing strategy (Lovelock 1983). A major contribution to the services debate was a classification consisting of four features: •Intangible •Heterogeneous
USER:
What works have been cited?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 26 | 5 | 541 | null | 451 |
Answer in paragraph format. Only use the context provided for your answer.
|
What factors led to Temu's success?
|
THE RISE OF TEMU: A Shopping App Revolutionizing the Retail Experience Introduction In recent years, the retail industry has witnessed a significant shift towards online shopping. The emergence of E-commerce platforms has transformed the way consumers shop, providing convenience and access to a wide range of products. This case study explores the rise of Temu, a shopping app that has disrupted the traditional retail landscape and revolutionized the shopping experience for millions of users. Temu, a rising star in the world of online shopping, offers a vast array of fashion products, beauty items, and home goods. This Chinese-owned digital marketplace has quickly become the top free shopping app, outshining giants like Shein, Amazon, and Walmart. Temu’s business model connects customers directly to suppliers. By forging strong relationships with retailers, they’ve managed to keep prices low and maintain a vast network of suppliers. At the core of Temu’s rapid growth and competitive pricing is their innovative Next-Gen Manufacturing (NGM) model. Launched in September 2022, this Boston-based e-commerce platform serves markets in the US, Canada, Australia, and New Zealand. The NGM model revolutionizes the retail process by enabling manufacturers to produce merchandise with more precision, reducing unsold inventory and waste. However customers do complain about longer delivery times. It is unknown to what extent this is a result of the NGM model. By connecting shoppers directly with manufacturers and offering real-time insights, Temu is able to cut warehousing and transportation costs, resulting in savings of at least 50% compared to traditional processes. This cost-saving approach allows the company to offer near-wholesale prices, as they remove hidden costs and focus on accurately forecasting sales and demand. While Temu.com is gaining popularity, it faces stiff competition from other Chinese online wholesale stores like AliExpress, DHGate, Banggood, and DealExtreme. These platforms offer a wide range of products at competitive prices, along with diverse shipping options and payment methods. However, Temu stands out with its NGM model, which empowers manufacturers to create customized products. The increased visibility of demand and supply accelerates distribution and eliminates the need for large warehouses. Another distinguishing factor of Temu is its claims on sustainability and social responsibility. The NGM model promotes a more sustainable e-commerce landscape by enabling manufacturers to produce merchandise that fits the needs of consumers, leading to lower unsold inventory and waste. Significance of Temu’s Innovative approach to Shopping In the rapidly evolving world of e-commerce, convenience and speed have become the pillars on which success is built. As consumers increasingly turn to online shopping to meet their needs, the demand for faster shopping times has never been higher. Enter TEMU, the innovative new ecommerce platform that promises to redefine the shopping experience with lightning-fast shipping. TEMU's shopping prowess to traditional e-commerce platforms, makes it stand out and elevates the shopping journey for customers. Speed of Delivery: One of the most glaring advantages TEMU brings to the table is its lightning-fast shipping times. Unlike traditional platforms that often offer standard shipping that can take days or even weeks, TEMU has set a new standard with its express delivery options. With strategically located warehouses and a streamlined logistics network, TEMU ensures that customers receive their orders in record time, sometimes as soon as within a few hours of placing an order. This kind of speed sets TEMU apart from traditional e-commerce platforms, where delays in processing and shipping can often lead to frustration and disappointment for customers. Inventory Management: TEMU's commitment to swift delivery is closely tied to its advanced inventory management system. Traditional platforms often struggle to keep up with the demand, leading to instances where popular items are out of stock or on backorder. TEMU's innovative approach utilizes real-time data analytics to predict customer demands and stock products accordingly. This approach significantly reduces the chances of running out of stock, thus ensuring that customers can find what they want when they want it. Customer Satisfaction: In the world of e-commerce, customer satisfaction is paramount. TEMU's emphasis on fast shipping addresses one of the most common pain points for online shoppers – the waiting game. Traditional platforms often face challenges in providing consistent shipping times, leading to varied customer experiences. TEMU's commitment to speedy delivery contributes to higher levels of customer satisfaction by providing a more reliable and predictable shopping experience. Competitive Edge: As e-commerce continues to grow, the market becomes increasingly saturated with both established giants and new entrants. TEMU's focus on faster shipping times gives it a distinct competitive edge. It appeals to consumers who prioritize efficiency and convenience in their shopping experience. In contrast, traditional platforms may find themselves having to adapt quickly or risk losing customers to the allure of TEMU's swiffer service. Sustainability and Environmental Impact: While speed is a significant selling point for TEMU, it's essential to consider the environmental impact of such rapid shipping. Expedited shipping often requires additional resources, such as expedited transportation and packaging materials. Traditional platforms might adopt more sustainable shipping practices, such as grouping orders or optimizing delivery routes to reduce their carbon footprint. TEMU must balance its commitment to speed with environmental responsibility to ensure a positive long-term impact. Brief Overview of Temu Temu (pronounced ‘tee-moo’) is a Boston-based online marketplace founded by Pinduoduo’s parent company PDD Holding. Its business model is likened to Chinese shopping platforms SHEIN, Wish, and Alibaba – which are based on the sale of large quantities of products at prices that are so low they are almost unbelievable. Temu was founded in the USA in 2022 and is a subsidiary of PDD Holdings Inc., which is listed on Nasdaq and headquartered in Shanghai. Temu operates as an online marketplace similar to AliExpress, Walmart, and Wish, focusing on offering affordable goods. Temu allows Chinese vendors to sell to shoppers and ship directly to them without having to store products in U.S. warehouses.The company acts as an intermediary between sellers (primarily from China) and buyers without maintaining its own inventory. Temu promotes social commerce, encouraging potential buyers to find more buyers to avail discounts. The app employs gamification to engage customers and offers free shipping by circumventing customs duties. The platform allows suppliers based in China to sell and ship directly to customers without having to rely on warehouses in the destination countries . Online purchases on Temu can be made using a web browser or via a dedicated mobile application.Temu offers free products to some users which encourage new people to install the app through affiliate codes, social media and gamification. It also uses online advertising on Facebook and Instagram and many online platforms. The Temu platform went live for the first time in the United States in September 2022 and in February 2023, Temu was launched in Canada. That same month, the company aired a Super Bowl commercial advert . In March 2023, Temu was launched in Australia and New Zealand. The following month, Temu was launched in France , Italy , Germany , the Netherlands , Spain and the United Kingdom. Naturally, the prices charged by the site defy all competition (sneakers for €11, manicure kit for less than €5, phone holder for €1.80, etc.), so much so that the platform has adopted an eloquent slogan: “Buy like a Billionaire”. As the specialist in Chinese digital companies Jeffrey Towson explains to Le Monde, the platform does not yet make a margin, in order to establish itself quickly in the targeted countries. At the end of 2022, the Temu application became the most downloaded application in the United States. The TEMU (Shop Like a Millionaire) Shopping app is now boasting over 100 million Downloads on PlayStore and AppStore with over 4.7 Million reviews and about 12+ Ratings. Three months after its launch in the United States, the application was at the top of downloads. In the European Union, where the platform arrived in April (in France, the United Kingdom, Italy, the Netherlands, Spain and Germany), the success is similar. In recent days, it has been the most downloaded application in France on iOS and Android. As of April 2023, the app has been downloaded 10 million times since its launch in September 2022 and it is currently available in around 100 countries. Temu’s wide range of products is particularly appealing to consumers, combined with a gamified online shopping experience that encourages customers to try their luck and buy more and more. With its impressive growth and distinct strategy, Temu’s business model warrants a closer look. Key Factors that contributed to its initial success Leveraging the power of mobile technology, Temu aimed to bridge the gap between online and offline retail, offering a unique platform that combined the benefits of both worlds. It introduced several innovative features for better customer experience that set it apart from competitors and propelled its rapid rise to popularity. These Key Features and Functionality are; Augmented Reality (AR) Shopping: Temu integrated AR technology into its app, allowing users to virtually try on clothing, visualize furniture in their homes, and experience products before making a purchase. This feature enhanced the shopping experience and reduced the need for physical store visits. Personalized Recommendations: Temu leveraged artificial intelligence and machine learning algorithms to analyze user preferences, browsing history, and purchase behavior. Based on these insights, the app provided personalized product recommendations to users, leading to higher customer satisfaction and increased sales.Certainly! Temu's personalized recommendations were generated through a combination of artificial intelligence (AI) and machine learning algorithms. Here's an overview of how the feature worked: Data Collection: Temu collected vast amounts of user data to understand individual preferences and behavior. This data included user interactions within the app, such as product searches, views, clicks, and purchases, as well as demographic information and user-provided preferences. Data Processing and Analysis: The collected data was processed and analyzed using AI and machine learning algorithms. These algorithms examined patterns, correlations, and relationships within the data to identify user preferences, interests, and buying patterns. User Profiling: Based on the analysis, Temu created user profiles that encompassed various attributes, such as preferred product categories, brands, price ranges, and style preferences. The profiles were continually updated and refined as new data was collected and analyzed. Collaborative Filtering: One common technique used by Temu was collaborative filtering. This approach compares a user's profile with the profiles of other similar users to identify products or items that users with similar preferences enjoyed or purchased. By finding similarities between users, collaborative filtering could suggest relevant products to a particular user based on the preferences of users with similar tastes. Content-Based Filtering: Another technique employed by Temu was content-based filtering. This method focused on the characteristics and attributes of products themselves. It analyzed product descriptions, features, tags, and other metadata to identify similarities and correlations between products. For example, if a user showed a preference for certain brands or specific features, content-based filtering could recommend similar products that match those preferences. Machine Learning and Iterative Refinement: Temu's algorithms continuously learned and improved over time. As users interacted with the app and provided feedback, the algorithms adjusted their recommendations based on the user's responses and behavior. Machine learning techniques enabled the system to adapt and refine its recommendations based on real-time user feedback. Real-Time Contextual Factors: In addition to user preferences, Temu also considered real-time contextual factors, such as trending products, seasonal trends, and popular items in the user's location. These factors were incorporated into the recommendation algorithms to ensure up-to-date and relevant suggestions. By leveraging AI, machine learning, and user data, Temu's personalized recommendation system aimed to understand each user's unique preferences and deliver tailored product suggestions. The algorithms continually evolved to provide increasingly accurate and relevant recommendations, enhancing the user experience and facilitating personalized shopping journeys. Social Commerce Integration: Recognizing the power of social media, Temu incorporated social commerce features, enabling users to share products, create wish lists, and seek recommendations from friends and influencers. This integration expanded Temu's reach and facilitated organic growth through user-generated content. Seamless Checkout and Delivery: Temu prioritized a frictionless shopping experience by streamlining the checkout process and offering multiple secure payment options. Additionally, it partnered with reliable logistics providers to ensure prompt and efficient product delivery, enhancing customer satisfaction and loyalty. Seamless Checkout and Payment Options: Temu focused on streamlining the checkout process to provide a seamless and hassle-free experience for users. It offered multiple secure payment options, including credit/debit cards, mobile wallets, and payment gateways, allowing users to choose their preferred method. This flexibility and ease of payment contributed to a smoother transaction process and reduced cart abandonment rates.Temu implemented several measures to ensure the security of payment options for its users; Secure Payment Gateways: Temu has partnered with trusted and secure payment gateways to handle the processing of user payments. These payment gateways employ robust security measures such as encryption, tokenization, and secure socket layer (SSL) protocols to protect sensitive payment information during transmission. Encryption: Temu has implemented encryption protocols to safeguard user payment data. This involves encrypting sensitive information such as credit card details, bank account numbers, and personal information to prevent unauthorized access or interception. Encryption ensures that even if the data is intercepted, it remains unreadable and unusable to unauthorized parties. Compliance with Payment Card Industry Data Security Standards (PCI DSS): Temu has adhered to the Payment Card Industry Data Security Standards, which are industry-wide standards established to ensure the secure handling of cardholder data. Compliance with PCI DSS involves maintaining a secure network, implementing strong access controls, regularly monitoring and testing systems, and maintaining an information security policy. Two-Factor Authentication (2FA): Temu has implemented two-factor authentication as an additional layer of security for payment transactions. This requires users to provide two forms of verification, such as a password and a unique code sent to their mobile device, to authenticate their identity before completing a payment. Fraud Detection Systems: Temu has employed fraud detection systems and algorithms to identify and prevent fraudulent payment activities. These systems analyze various factors, such as user behavior, transaction patterns, and known fraud indicators, to detect and flag suspicious transactions for further verification or intervention. Regular Security Audits: Temu has conducted regular security audits and assessments to identify vulnerabilities and ensure that all payment systems and processes meet the highest security standards. This includes conducting penetration testing, code reviews, and vulnerability scans to proactively identify and address any potential security weaknesses. User Education and Awareness: Temu has implemented user education programs to raise awareness about safe online payment practices. This could include educating users about the importance of strong passwords, avoiding phishing attempts, and regularly monitoring their payment transactions for any unauthorized activity. Order Tracking and Delivery Updates: Temu provided users with real-time order tracking and delivery updates. Users could monitor the progress of their orders and receive notifications regarding shipment status, estimated delivery time, and any delays. This feature enhanced transparency and kept users informed throughout the delivery process, improving overall customer satisfaction. User Reviews and Ratings: To facilitate informed purchasing decisions, Temu incorporated user reviews and ratings for products. Users could leave feedback and rate their purchases, helping others make well-informed choices. This feature added a layer of trust and credibility to the shopping experience and fostered a community-driven approach to product evaluation. Virtual Stylist and Fashion Advice: Temu introduced a virtual stylist feature that offered personalized fashion advice and styling tips. Users could provide information about their preferences, body type, and occasion, and receive tailored recommendations for outfits and accessories. This feature catered to users seeking fashion inspiration and guidance, enhancing their shopping experience. Temu’s Virtual Stylist feature works in the following ways; It helps Users of the Temu app to create a profile by providing information about their preferences, body type, style preferences, and any specific fashion requirements they may have. The virtual stylist feature uses algorithms and machine learning techniques to analyze the user's profile and understand their style preferences. It considers factors such as color preferences, patterns, clothing types, and previous purchases. The feature assists users in recommendations. Based on the user's profile and preferences, the virtual stylist recommends outfits, clothing items, or accessories that align with their style. These recommendations may include images, descriptions, and links to purchase the recommended items. The feature also provides style tips, fashion trends, and suggestions to help users stay updated and make informed fashion choices. It helps users in Interactive Communication. The virtual stylist often offers Interactive communication channels such as chatbots or messaging systems. Users ask questions, seek styling advice, or provide feedback to further refine the recommendations. The feature helps Integration with User Feedback,it learns and improves over time by incorporating user feedback and preferences. As users interact with the feature, their feedback and engagement help train the algorithm to provide more accurate and personalized recommendations Growth and Adoption over time Temu was ranked No. 12 in the 2022 holiday traffic, topping retailers like Kohl’s and Wayfair. With an average of 41.0 million visitors in November and December, Temu surpassed major ecommerce sites like Kohl’s, Wayfair, and Nordstrom, and was within striking distance of Macy’s. Temu surged ahead of low-price Chinese goods sellers Shein and Wish.com in dramatic fashion. Not only did Temu quickly surpass Wish.com amid its recent downswing, it also managed to leapfrog Shein’s impressive recent gains. Shein’s steady rise has the company now looking to raise capital at a reported $64 billion valuation as reported by Reuters. Wish.com, by comparison, has been hemorrhaging money and has plummeted 98% from its peak stock price, with a market cap below $400 million. Using cheap wares to attract customers can work, but profitability is a challenge when operating under tight margins. High acquisition costs can be a killer, and there will also be a need to pivot into higher-margin goods. Temu is keying on its mobile app for loyalty. Temu’s bargain-basement prices make purchases a low consideration in most cases. Its best use case is when customers realize a need (“Shoot, I left my iPhone charger at the hotel and need another one”) and can buy quickly and cheaply. The app can drive habit formation around this, and the more that shoppers rely on the app the less likely Temu will have to pay for ads to drive conversions. Temu exploded out of the gates and its rapid rise warrants attention. As something of a Wish.com clone, there’s reason to be skeptical it can find long-term profitable growth when its early stage capital eventually rationalizes. Whether Temu avoids a similar fate will come down to whether it can improve upon the Wish.com playbook to build a loyal and engaged user base and drastically reduce customer acquisition costs over time. A killer TikTok strategy and sticky mobile app was key to achieving what its predecessor could not. As originally featured in the Retail Daily newsletter, Amazon has been the most downloaded shopping app in the US for a very long time. It managed to beat local competitors like Walmart, and even international competition from apps like Wish. But with the coming of Temu it looked like Amazon had finally met its match. Going all the way back to 2020, Amazon's shopping app was averaging around 550K downloads per week in the US, according to our estimates. The summer of 2022 was strong, pushing Amazon's downloads to more than double with a range between 800K and 1.2M weekly downloads. And that spike didn't slow down until February, 2023, after which downloads really started sloping down. SHEIN, a clothing retailer that sells "fast fashion" shipped from China, has been chasing Amazon's tail since it launched. Key word being "chasing". SHEIN averaged a little over half of Amazon's downloads back in 2020. They got close a few times but not enough to really take the lead. In January of 2023, that changed and SHEIN's downloads are now about double those of Amazon in the US. SHEIN saw 617K downloads from the App Store + Google Play in the US last week, according to our estimates. And SHEIN isn't even Amazon's biggest threat right now but Temu, a China-based retailer that sells a variety of goods, from clothes to furniture, at very low prices, since its launch late last year. The holiday shopping season was big for Temu. It averaged 2M new downloads every week between November and December, according to our estimates. Downloads dropped since, which makes sense overall, but are still astronomically high in comparison. Temu saw 1.3M new downloads last week in the US. This is a big problem for Amazon which may mean the next Prime Day will be a little more exciting than the last few. And yes, Temu is one of the biggest spends on Apple Search Ads which helps it get those downloads. Challenges Addressed by Temu The traditional retail model is almost getting outdated thereby posing several challenges. While the “customer is always right” mantra has held true for quite some time, the amount of power wielded by consumers has never been higher than it is right now. Customers are no longer forced to choose between just a couple of options when looking to purchase new luxury goods. Not only has the number of retailers expanded exponentially in recent years, but so has the information available to customers. The amount of choice people enjoy today has also led to a waning of brand loyalty, with customers switching between retailers and online/in-store channels from purchase to purchase, depending which best serves their needs at the time. Luxury retailers are not immune to this trend either, as even wealthy customers now tend to shop around for the best option. This decline in brand loyalty customers presents a unique retailing problem, as retailers try to find new and innovative ways to appeal to buyers – both existing and potential; Consumers are Choosing Multichannel Buying Experiences: With more complete e-retail experiences available, and shipping times greatly reduced, it is little wonder around 96% of Americans utilize online shopping in one way or another. However, those same Americans spend about 65% of their total shopping budget in traditional brick-and-mortar locations. In other words, while almost everyone is shopping online, they are making more purchases in stores. Customers are moving seamlessly between online and offline experiences, and are open to retailers who can best facilitate these transitions. Closing the divide between online and offline retail, Temu solves some issues. It is focused on creating a second-to-none customer experience across all channels. Customers are looking for retailers they can trust to deliver exceptional service time and again. They have the right customer which has helped them to create an omnichannel customer experience for consumers to interact wherever and however they wish by incorporating real-time feedback across channels and devices – engaging the customer wherever they may be. Customers Expect a Seamless Experience: When transitioning between online and in-store experiences, customers not only want the same products to be available, they also want their experience to be seamless. This means, if they are a regular online customer, they want to be treated like a regular customer when they visit a brick-andmortar location. This is quite problematic. However, Temu has created this type of fluid online/offline experience for their customers, it has ceased pitting its channels against one another. Centralized customer data has helped it build a seamless, fluid experience beginning with an easily-accessible customer profile. Retailers lacks an outstanding Experience To Attract Customer Loyalty: Customer experience is the biggest contributor towards brand loyalty, the Traditional Retail model makes it difficult to build a good customer experience.Negative experience being the most significant factor in affecting a customer’s likelihood to make a repeat visit. Most customers also serve people in their own working lives, meaning when they are on the other side of the counter, they want to feel important.While promotions and offers can certainly contribute towards helping customers feel like they are special, the real key to an outstanding experience is personalization which the retail model falls short of. Getting to know customers from their previous purchases and interests can help retailers drive loyalty. These insights can be gleaned from data, or even a simple conversation.Temu addresses this challenge by rendering coupons, bonuses and reduced cost to existing and new customers. It is equally personalized with the user. A Siloed Marketing Infrastructure Makes It Expensive and Unwieldy to get Your Message Across; The traditional retail model features separate channels, which makes customer data to become siloed very easily. If all the moving parts of a marketing department are not communicating efficiently and working together, customers become overwhelmed with conflicting or repeated messages. This bombardment of marketing communications has easily had the opposite of the intended effect and driven customers to competitors with a clearer and more congruent message. The right technology and communication procedures can ensure all arms of a marketing team are on the same page. Temu as a modern retailer has been engaging with their customers across many different channels. From SMS, to email and social media, multi-channel communications are essential to engagement which, in turn, drives the creation of the perfect customer experience. So Many Technologies Exist to Drive Marketing and Sales, but They Don’t Seem to Work Together: While the amount of data gathered by businesses keeps growing at an alarming rate, the number of staff available to analyze it is staying more-or-less the same. What’s important, then, is making sure all this data is being used in the correct way and not contributing towards the data silo problem. This means finding a technology solution which can handle the huge amount of data being generated and ensure it is focused in a direction which best benefits rather than overwhelms marketing efforts. The data scientist approach to marketing is only going to become more prevalent as time goes on when creating a truly unified omnichannel service.Temu has ensured that all existing technologies work together which is why they get best results. Only in the combining of streamlined un-siloed data science, seamless cross-channel customer service and marketing, and authentic personalization, can traditional retailers create buyer experiences which can combat the fickle nature of the modern consumer and lead just like Temu. Strategies Implemented to Revolutionize The Retail Industry Temu adopted and implemented some strategies which accounted for its success. Temu’s business model is built around low prices. It offers even more discounts and lower prices than SHEIN, with special offers such as items sold for as little as one cent. Temu further differentiates itself by offering free shipping and returns to customers, which is made possible by PDD Holding’s extensive network of suppliers and shipping partners. An efficient logistics network is not to be underestimated, as problems with supply and distribution networks are seen as a major factor in the failure of Alibaba and Wish to break into the Western market.. Aside this, the following strategies were implemented; Combining Shopping and Entertainment: One-fifth of online shoppers in the U.S. say they miss the in-store shopping experience when they shop online. Temu aimed to bridge this gap and introduced games into the shopping process. By playing games like Fishland, Coin Spin, Card Flip, and others, customers can win rewards that ultimately lead to more time spent on the site and a dopamine rush from winning free items. To keep people playing these games, however, the app relies heavily on referrals, another core business strategy. These games were designed to be simple, addictive, rewarding, and increase user engagement and retention. According to app intelligence firm Sensor Tower, Temu’s average daily sessions per user in the US increased by 23% from October 2022 to January 2023. Some other games in Canada include scratch cards, card games, and cash games. Temu: Shared Shopping Experience: Group Buying is a familiar concept in Asia that Temu has extended to its Western customer base. Essentially, it has increased customers’ bargaining power by forming groups to share a bulk discount. This plays into the aforementioned referral program, which gives discounts to customers who bring new clients to the app and enables a shared shopping experience. Affiliate Programs and Heavy Advertising: As SHEIN had already proven effective, Temu sent free items to a large number of influencers and micro-influencers to promote Temu on YouTube and TikTok. A younger customer base of users under the age of 35 is particularly attractive to Temu, as younger consumers are typically less able and willing to pay large sums for products. Seeing a favorite internet personality or a personal acquaintance promoting the products has led to many young customers to imitate the purchase. Temu’s omnipresence on TikTok and YouTube is seen as a key factor in why this marketplace has taken off so quickly. A strong presence on TikTok and YouTube: Temu has leveraged the power of social media platforms, especially TikTok and YouTube, to spread awareness and generate buzz about its products and offers. The hashtag #temu on TikTok has amassed over 1.3 billion views, while Temu’s official YouTube account videos have grossed over 215 million views since last August. Temu’s marketing strategy relies on creating viral content that showcases its products entertainingly and engagingly, such as unboxing videos, product reviews, challenges, and giveaways. Temu also collaborates with influencers and celebrities with large followings on these platforms. Temu’s Audience: Temu’s primary target audience has been the young and price-conscious generation of online shoppers looking for bargains and discounts. According to a report by Daxue Consulting, the majority of Temu’s followers (32.68%) are aged 25-34, followed by 18-24 (28.57%) and 35-44 (21.43%). Temu appeals to these consumers by offering personalized recommendations based on their preferences and browsing history and gamified features that allow them to earn credits, gifts, and better deals by playing in-app games or inviting their friends to join the app. Referrals: A Win-Win Strategy for Users and Temu Temu has implemented a referral program encouraging users to invite friends and contacts to join the app in exchange for credits and gifts. Users can share their referral links or codes on social media platforms like Facebook, Instagram, and TikTok. For example, users can join a “Fashion Lovers” team and get $20 in credits by inviting five friends who also love fashion within 24 hours. These referrals help users save money on their purchases, help Temu acquire new customers, and expand its network of sellers. Temu’s Marketing and Growth Strategy that led to its Rise Temu's growth has been remarkable in a short period of time. It reached the top downloads in the shopping category of both Apple's App Store and Google Play and is quickly establishing itself as a high-potential and innovative player in the e-commerce industry. Its success is ultimately its low prices, unlocked by their innovative Next-Gen Manufacturing (NGM) model. It employed a multifaceted marketing strategy to drive user acquisition and brand awareness which has been working greatly for them; Influencer Collaborations: To reach a wider audience, Temu has been collaborating with popular social media influencers and celebrities who promoted the app and shared their shopping experiences. Influencers came from a wide range of individuals, including fashion bloggers, lifestyle influencers, beauty gurus, tech enthusiasts, or experts in specific product categories.This strategy generated buzz and created a sense of credibility and trust among potential users. This marketing strategy was successfully implemented through; Influencer Selection: Temu carefully identified and selected influencers who aligned with its target audience, brand values, and product offerings. These influencers typically had a strong online presence, a relevant niche or expertise, and a sizable following. Temu considered factors such as engagement rates, authenticity, and the influencer's ability to create appealing and relatable content. Exclusive Partnerships: Temu forged exclusive partnerships with influencers, often signing them as brand ambassadors or collaborators. These collaborations involved long-term commitments, where influencers actively promoted Temu's app and its features on their social media platforms, websites, or blogs. The exclusivity of these partnerships helped establish a strong association between the influencers and Temu, increasing brand loyalty and credibility. Sponsored Content: Temu engaged influencers to create sponsored content that showcased the app's features, user experience, and the benefits of using Temu for shopping. Influencers shared their personal experiences, demonstrated the app's functionalities, and highlighted the unique advantages of using Temu over other shopping platforms. This content was often shared through blog posts, social media posts, videos, and live streams. Product Reviews and Recommendations: Influencers played a crucial role in reviewing and recommending products available on Temu. They shared their honest opinions and experiences using products from various brands. Their reviews and recommendations helped build trust and credibility among their followers, encouraging them to explore and purchase products through Temu. Giveaways and Contests: Temu collaborated with influencers to host giveaways and contests, where users had the chance to win exclusive prizes or discounts by engaging with the app or participating in specific promotional activities. These initiatives created buzz, generated user excitement, and attracted new users to the platform. Affiliate Marketing: Temu employed affiliate marketing strategies with influencers, where influencers received a commission or referral fee for every user who downloaded the app or made a purchase through their unique referral links. This incentivized influencers to actively promote Temu and its offerings, as their earnings were directly tied to the success of their referrals. Event Participation: Temu partnered with influencers for events such as product launches, fashion shows, or brand campaigns. Influencers attended these events, shared live updates, and provided behind-the-scenes content to their followers, creating a sense of exclusivity and fostering excitement around Temu's activities. User-generated Content: Temu encouraged influencers and their followers to create usergenerated content related to the app. This could include unboxing videos, styling tips, or hauls showcasing products purchased through Temu. Such content served as social proof and encouraged other users to engage with the app and make purchases. Overall, Temu's collaborations with influencers helped amplify its brand message, expand its reach to new audiences, and establish credibility within the social media landscape. By leveraging the influence and creative abilities of influencers, Temu successfully tapped into their followers' trust and engagement, driving user acquisition, and fostering a positive brand image. User Referral Program: Temu has been incentivizing existing users to refer the app to their friends and family by offering discounts or exclusive rewards. This word-of-mouth marketing approach contributed to the app's exponential growth and user acquisition. Targeted Digital Advertising: Temu has been leveraging targeted digital advertising campaigns across various digital platforms like Facebook, Instagram, Twitter, TikTok and soon Telegram focusing on specific demographics and user segments. By tailoring their messaging and creative assets, Temu effectively reached potential users with personalized content. Expansion into New Markets: After gaining traction in its home market, Temu has been expanding its operations into international markets. It strategically entered regions with high smartphone penetration and a growing ecommerce ecosystem. This expansion allowed Temu to tap into a larger customer base and establish itself as a global player in the shopping app industry. Partnerships with Brands and Retailers: Recognizing the importance of strategic alliances, Temu has been forging partnerships with renowned brands and retailers. These collaborations involved exclusive product launches, limitededition collections, and promotional campaigns. By aligning with established names in the retail industry, Temu gained credibility and attracted a wider range of customers. Continuous Innovation: Temu has been prioritizing continuous innovation to stay ahead of the competition. It regularly updated its app with new features and enhancements based on user feedback and emerging trends. For example, it introduced a virtual stylist feature that offered personalized fashion advice and styling tips, further enhancing the user experience. Data-driven Insights: Temu has been leveraging the vast amount of user data it collected to gain valuable insights into consumer behavior, preferences, and trends. These insights were used to refine its product offering, improve targeted advertising efforts, and optimize the overall shopping experience. By harnessing the power of data, Temu was able to make data-informed decisions and stay attuned to evolving customer needs. Seamless Integration with Physical Stores: Recognizing the importance of the omnichannel experience, Temu has been integrating its app with physical stores. It introduced features like in-store barcode scanning, which allowed users to access product information, read reviews, and make purchases directly from their smartphones while inside partner retail locations. This integration blurred the lines between online and offline shopping and provided a seamless and unified experience. Social Impact Initiatives: Temu also has also been focusing on social impact initiatives to connect with socially conscious consumers. It launched sustainable product collections, partnered with NGOs for charitable causes, and implemented eco-friendly packaging practices. These initiatives resonated with environmentally and socially conscious users, further strengthening Temu's brand reputation and loyalty. Continuous Customer Support: Temu has been placing strong emphasis on customer support and responsiveness. It established dedicated customer service channels, including live chat support and a comprehensive FAQ section. Timely and effective customer support enhanced user satisfaction, resolved issues promptly, and fostered a positive brand image. A heavy paid media strategy: Like other well-funded internet companies, Temu appears to be spending heavily for app installs and on search ads. Search for almost any commodity product—especially if your search includes the word “cheap”—and you’re likely to find a Google result for Temu. Temu also gained attention with multiple Super Bowl spots, putting it on the map for many US consumers for the first time. Results and Impacts The rise of Temu as a shopping app has revolutionized the Retail Industry and also Consumer Experience; User Base and Revenue Growth: Within two years of its launch, Temu has amassed millions of active users and experienced exponential revenue growth. Its user-centric approach and innovative features resonated with consumers, driving adoption and usage. Enhanced Customer Experience: Temu's focus on personalization, convenience, and seamless shopping experiences has elevated customer satisfaction levels. Users appreciated the ability to try on products virtually, receive tailored recommendations, and enjoy hassle-free transactions. Disruption of Traditional Retail: The Traditional Retail industry has suffered relatively as a result of the rise of Temu as a Shopping App. It has greatly disrupted traditional brick-and-mortar retail, with many businesses. This is so because with their new innovation, they have explored other parts(online) which the traditional retailers do not have. Its rise has posed several challenges for traditional retailers as they struggle to adapt to the changing landscape; Online Presence and Digital Transformation: Traditional retailers are still struggling with establishing a strong online presence and undergoing digital transformation. Building and maintaining an effective e-commerce website or app requires technical expertise, investment in infrastructure, and a shift in mindset. Adapting to the digital realm is now very challenging for retailers who have primarily operated in brick-and-mortar stores. Competition with E-commerce Giants: E-commerce platforms like Temu with significant resources, a broad customer base, and strong brand recognition which makes it difficult for Traditional retailers to compete with in terms of pricing, product selection, and customer convenience. It can be challenging for them to match the speed, efficiency, and scale of operations offered by online marketplaces. Supply Chain and Logistics: Traditional retailers have gotten used to managing inventory primarily for physical stores and now face challenges in adapting their supply chain and logistics operations to accommodate online sales. Efficient inventory management, order fulfillment, and last-mile delivery is quite complex and requires adjustments to meet the demands of e-commerce customers. Customer Expectations and Experience: Online shoppers have come to expect a seamless and personalized shopping experience. Traditional retailers now struggle to meet these expectations, especially provided they have very limited experience in online customer engagement, personalization, and tailoring recommendations. Adapting to a customer-centric approach and providing a consistent omnichannel experience can be a significant challenge. Data and Analytics: E-commerce platforms like Temu rely heavily on data and analytics to understand customer behavior, preferences, and trends. Traditional retailers have limited experience in collecting, analyzing, and utilizing customer data effectively. Harnessing data to make data-driven decisions and optimize operations is now a significant hurdle for retailers transitioning to an online model. Operational Costs and Margins: Traditional retailers are facing financial challenges to adapt to ecommerce. Online operations require investments in technology, infrastructure, marketing, and fulfillment capabilities. Retailers need to reevaluate their pricing strategies, optimize operational costs, and find ways to maintain profitability in the face of increased competition and potentially lower margins. Brand Differentiation and Customer Loyalty: Building a strong brand and fostering customer loyalty has proven to be more challenging in the online space. Traditional retailers may have developed a loyal customer base through in-person interactions and personalized service. Translating that loyalty to the digital realm and effectively differentiating their brand from competitors needs innovative strategies and marketing efforts which will take time. By leveraging technology and understanding evolving consumer behaviors, Temu has disrupted the retail industry, reshaped shopping habits, and set new standards for convenience and engagement in the digital age; Temu’s Setbacks Despite its rapid rise, its relationship with sister company Pinduoduo has brought about several challenges in delivery of goods as compared to its competitors and other areas; According to reports published in Times, Temu is beginning to develop a reputation for undelivered packages, mysterious charges, incorrect orders and unresponsive customer service. Temu itself acknowledges that its orders take longer to arrive than those from Amazon—typically 7-15 business days as they come from “overseas warehouses.” In a series of Facebook messages with Times, Roper Malloy, a client complained of spending $178 on gifts from Temu for her family, including two drones and some makeup for her daughter which has never arrived. She said she has contacted the company several times for a refund, which has also yet to arrive. On May 17, 2023, Montana Governor Greg Gianforte banned Temu from statewide government devices, as well as ByteDance apps (including TikTok ) , Telegram , and WeChat. In June 2023, the U.S. House Select Committee on U.S.- Chinese Communist Party Strategic Competition stated that Temu did not maintain "even the facade of a meaningful compliance program" with the law. Uyghur on Forced Labor Prevention to keep goods made by forced labor off its platform. In October, the Boston branch of the Better Business Bureau opened up a file on Temu and has received 31 complaints about the website. Temu currently has a C rating on the BBB, and an average customer rating of 1.4 stars out of 5, although from only 20 reviews. (Complaints are separate from reviews, which do not factor into BBB’s official rating.) McGovern at the BBB mentioned that, it’s unusual for such a new company to receive so many complaints in such a short amount of time. Temu has acknowledged and responded to every complaint posted to the BBB website, but many of those complaints remain unresolved. Temu’s sister company, Pinduoduo, has long been accused of hosting sales of counterfeits, illegal goods, or products that do not match their descriptions. (Pinduoduo wrote in its SEC filings that it immediately removes unauthorized products or misleading information on its platform, and freezes the accounts of sellers on the site who violate its policies.) There have been no BBB complaints that allege the goods Temu ships are counterfeit or fake. Additionally, in 2021, the deaths of two Pinduoduo employees spurred investigations and boycotts over the company’s working conditions, according to the New York Times. How Temu could affect the U.S. economy In May 2023, the U.S.-China Economic and Security Review Commission raised concerns about risks to users' personal data on Temu as a shopping app affiliated with Pinduoduo, which was removed from Google Play after some of its versions were found to contain malware. Schmidt, at Vanderbilt, who specializes in security and privacy, is of the opinion that Temu’s data and privacy practices aren’t out of the ordinary; The company collects lots of personal data about users and then deploys that data to sell ads. However, he says that Temu’s rise could have a bigger impact not in terms of privacy concerns, but in terms of pressure on American companies and workers. If more and more American consumers flock to Temu to buy cut-rate goods, that could pressure Amazon and other competitors to slash their prices too which would affect wages. Areas for Improvements Despite its innovative business model and commitment to sustainability, Temu still has some areas that need improvement; Real-Time Shopping: Cost-Effectiveness vs. Plagiarism and Exploitation: Temu’s most innovative and effective strategy has been highly ambivalent and criticized. Similar to SHEIN, Temu has been using a reverse-manufacturing model that relays customer feedback directly to manufacturers. Starting off with smaller quantities that are offered on the marketplace, products in high demand are reordered, while others are replaced. According to Temu, this results in environmental efficiency because product inventory is aligned with customer demand in real time. In addition, a greater number of products can be offered than with traditional retail strategies. With this method, SHEIN was able to launch 150,000 new items in 2020, beating its competitors by a wide margin. Temu Has to Fight Criticism: Critics point to several detrimental effects of this type of 'ultra-fast' commerce: To ensure low prices, manufacturers must keep costs down, contributing to the continued poverty of workers in manufacturing countries. The same goes for product quality and environmental friendliness: Cheap products that break easily contribute to increasing amounts of waste, returned products tend to be dumped rather than recycled or resold, and the high number of new products sold is only possible by ripping off SME fashion designers and creators. TrustPilot reviews reveal a 2.9-star average, with the majority of one-star reviews citing long shipping times, low-quality items, and poor customer service. Low quality items can become a sustainability issue in itself, since those products have a higher chance of ending up in landfill. It’s essential for Temu to address these concerns and maintain a balance between low prices and customer satisfaction. Lessons Learned Temu's rise as a shopping app exemplifies the transformative power of technology in the retail industry. Its success serves as an inspiration for other businesses seeking to adapt and thrive in the digital era. Overall, the rise of Temu as a shopping app has been driven by its commitment to innovation, personalized experiences, strategic partnerships, and a customer-centric approach. The marketplace Temu has achieved impressive success with its business model of offering low-priced products and free shipping, combined with a gamified shopping experience. Temu's strategy also includes group buying, referrals, affiliate programs, and heavy advertising on social media platforms. While Temu's real-time shopping model, which involves relaying customer feedback directly to manufacturers, is seen as innovative and cost-effective, it has also garnered criticism. Critics argue that this approach can lead to environmental issues, exploitation of workers, and plagiarism of designs from small and medium-sized fashion creators. Despite these concerns, Temu's combination of low prices, gamified shopping, and heavy advertising on platforms like TikTok and YouTube has made it a major player in the ultra-fast eCommerce sector. However, Temu's most controversial strategy is its real-time shopping model akin to that of SHEIN, which relays customer feedback directly to manufacturers. While this model increases costeffectiveness and product variety, critics argue that it contributes to environmental degradation, exploitation of workers, and plagiarism of fashion designers. Nonetheless, Temu's growth and distinct strategy make it a noteworthy player in this emerging business model of ultra-fast eCommerce, and it will be interesting to see how this trend plays out in the future. Actionable Takeaways for other Businesses in the Retail Industry Traditional Retailers who wish to also rise like Temu should consider the following steps; Develop a User-Friendly E-commerce Website: Create a well-designed, intuitive, and user-friendly e-commerce website that offers a seamless shopping experience. Ensure that the website is responsive, optimized for mobile devices, and provides easy navigation, product search, and checkout processes. Emphasize Branding and Differentiation: Clearly define the brand identity and unique selling propositions of your retail business. Highlight what sets your products apart from competitors and communicate a compelling brand story to engage online customers. Use high-quality visuals and persuasive copywriting to convey your brand message effectively. Optimize for Search Engines: Implement search engine optimization (SEO) techniques to improve the visibility of your website in search engine results. Conduct keyword research to understand the terms and phrases your target audience is searching for, and optimize your website's content, meta tags, and URLs accordingly. Leverage Social Media: Use social media platforms to build an online community, engage with customers, and promote your products. Regularly post engaging content, including product updates, customer testimonials, and behind-the-scenes glimpses. Encourage user-generated content and respond promptly to customer inquiries and feedback. Invest in Digital Marketing: Develop a comprehensive digital marketing strategy that includes online advertising, email marketing, influencer collaborations, and content marketing. Target specific customer segments and utilize data-driven approaches to reach your audience effectively and drive traffic to your website. Provide Excellent Customer Service: Offer exceptional customer service across all online channels, including live chat, email, and social media. Respond promptly to customer inquiries, provide accurate product information, and address any issues or concerns in a timely manner. Personalize the customer experience as much as possible to build trust and loyalty. Implement Online Customer Engagement Tools: Incorporate tools such as live chat, product reviews, ratings, and personalized recommendations to enhance customer engagement and create a sense of interactivity on your website. Encourage customer feedback and testimonials to build social proof and credibility. Collaborate with Influencers and Online Communities: Partner with relevant influencers or online communities in your industry to extend your reach and tap into their established audiences. Engage in collaborations, product reviews, or sponsorships to increase brand visibility and credibility. Analyze and Optimize: Continuously monitor and analyze website metrics, customer behavior, and online marketing campaigns. Utilize analytics tools to gain insights into what is working and what needs improvement. Optimize your online presence based on data-driven decisions to enhance the user experience and drive conversions. Adapt to Changing Trends: Stay up to date with the latest e-commerce trends, technologies, and consumer preferences. Be willing to experiment, adapt, and embrace new technologies or platforms that can enhance your online presence and provide a competitive edge. By implementing these strategies, traditional retailers can establish a strong online presence, attract online customers, and compete effectively in the digital marketplace. It's important to continuously evaluate and refine your online presence based on customer feedback, market trends, and emerging technologies to stay ahead of the competition. Future Outlook The rise of Temu as a shopping app has been remarkable, and it has successfully disrupted the retail experience by implementing innovative strategies and business models. Looking ahead, there are several key factors that will shape the future outlook of Temu and determine its continued success in the competitive online shopping market; Expansion into New Markets: Temu has already expanded its operations to several countries, including the US, Canada, Australia, New Zealand, France, Italy, Germany, the Netherlands, Spain, and the United Kingdom. To sustain its growth, Temu will likely continue to explore opportunities for expansion into new markets, both within and outside of these regions. This expansion will allow the platform to reach a larger customer base and tap into new consumer preferences and demands. Improvement in Delivery Times: One area of concern for customers is the longer delivery times associated with Temu's Next-Gen Manufacturing (NGM) model. To address this issue, Temu may invest in optimizing its supply chain and logistics processes. By streamlining operations and partnering with efficient shipping providers, Temu can reduce delivery times and enhance the overall customer experience. Enhanced Customer Engagement: Temu's success is partly attributed to its gamification strategies and social commerce approach. To maintain customer engagement and loyalty, Temu will need to continuously innovate and introduce new features that incentivize users to stay active on the platform. This could include personalized recommendations, rewards programs, and interactive shopping experiences. Sustainability and Social Responsibility: Temu has positioned itself as a platform that promotes sustainability and social responsibility through its NGM model, which reduces unsold inventory and waste. Going forward, it will be crucial for Temu to uphold these values and communicate its commitment to sustainability to customers. This can be achieved through transparent supply chain practices, eco-friendly packaging options, and partnerships with ethical suppliers. Competition and Differentiation: While Temu has gained significant traction, it faces strong competition from other Chinese online wholesale platforms and established e-commerce giants. To stay ahead, Temu will need to continue differentiating itself through its NGM model, competitive pricing, and unique product offerings. It should also focus on building a strong brand identity and nurturing customer trust through excellent customer service and reliable purchase protection. navigate the competitive landscape. With its innovative approach and commitment to customer satisfaction, Temu has the potential to continue reshaping the online Conclusion Conclusively, Temu has emerged as a shopping app that is revolutionizing the retail experience through its Next-Gen Manufacturing model and direct-to-supplier approach. By focusing on cost savings, customization, and sustainability, Temu has gained a competitive edge in the market. With a lot of consumer goods being produced in China it makes sense that more and more e-commerce platforms are Chinese. The success of Temu and its competitors showcases the power of connecting customers directly with suppliers, ultimately reshaping the way people shop online. TEMU's emergence in the e-commerce landscape with its lightning-fast shipping times has undoubtedly stirred the industry. By setting new standards for efficiency and customer satisfaction, TEMU challenges traditional platforms to step up their game. While the convenience of rapid shipping is undeniable, the long-term sustainability and overall impact of this approach must also be considered. As consumers continue to prioritize convenience and speed, the success of TEMU may very well influence how the e-commerce ecosystem evolves in the years to come. However, to sustain its growth and success, Temu must adapt to evolving customer preferences, optimize its operations, and effectively.
|
Answer in paragraph format. Only use the context provided for your answer. What factors led to Temu's success? THE RISE OF TEMU: A Shopping App Revolutionizing the Retail Experience Introduction In recent years, the retail industry has witnessed a significant shift towards online shopping. The emergence of E-commerce platforms has transformed the way consumers shop, providing convenience and access to a wide range of products. This case study explores the rise of Temu, a shopping app that has disrupted the traditional retail landscape and revolutionized the shopping experience for millions of users. Temu, a rising star in the world of online shopping, offers a vast array of fashion products, beauty items, and home goods. This Chinese-owned digital marketplace has quickly become the top free shopping app, outshining giants like Shein, Amazon, and Walmart. Temu’s business model connects customers directly to suppliers. By forging strong relationships with retailers, they’ve managed to keep prices low and maintain a vast network of suppliers. At the core of Temu’s rapid growth and competitive pricing is their innovative Next-Gen Manufacturing (NGM) model. Launched in September 2022, this Boston-based e-commerce platform serves markets in the US, Canada, Australia, and New Zealand. The NGM model revolutionizes the retail process by enabling manufacturers to produce merchandise with more precision, reducing unsold inventory and waste. However customers do complain about longer delivery times. It is unknown to what extent this is a result of the NGM model. By connecting shoppers directly with manufacturers and offering real-time insights, Temu is able to cut warehousing and transportation costs, resulting in savings of at least 50% compared to traditional processes. This cost-saving approach allows the company to offer near-wholesale prices, as they remove hidden costs and focus on accurately forecasting sales and demand. While Temu.com is gaining popularity, it faces stiff competition from other Chinese online wholesale stores like AliExpress, DHGate, Banggood, and DealExtreme. These platforms offer a wide range of products at competitive prices, along with diverse shipping options and payment methods. However, Temu stands out with its NGM model, which empowers manufacturers to create customized products. The increased visibility of demand and supply accelerates distribution and eliminates the need for large warehouses. Another distinguishing factor of Temu is its claims on sustainability and social responsibility. The NGM model promotes a more sustainable e-commerce landscape by enabling manufacturers to produce merchandise that fits the needs of consumers, leading to lower unsold inventory and waste. Significance of Temu’s Innovative approach to Shopping In the rapidly evolving world of e-commerce, convenience and speed have become the pillars on which success is built. As consumers increasingly turn to online shopping to meet their needs, the demand for faster shopping times has never been higher. Enter TEMU, the innovative new ecommerce platform that promises to redefine the shopping experience with lightning-fast shipping. TEMU's shopping prowess to traditional e-commerce platforms, makes it stand out and elevates the shopping journey for customers. Speed of Delivery: One of the most glaring advantages TEMU brings to the table is its lightning-fast shipping times. Unlike traditional platforms that often offer standard shipping that can take days or even weeks, TEMU has set a new standard with its express delivery options. With strategically located warehouses and a streamlined logistics network, TEMU ensures that customers receive their orders in record time, sometimes as soon as within a few hours of placing an order. This kind of speed sets TEMU apart from traditional e-commerce platforms, where delays in processing and shipping can often lead to frustration and disappointment for customers. Inventory Management: TEMU's commitment to swift delivery is closely tied to its advanced inventory management system. Traditional platforms often struggle to keep up with the demand, leading to instances where popular items are out of stock or on backorder. TEMU's innovative approach utilizes real-time data analytics to predict customer demands and stock products accordingly. This approach significantly reduces the chances of running out of stock, thus ensuring that customers can find what they want when they want it. Customer Satisfaction: In the world of e-commerce, customer satisfaction is paramount. TEMU's emphasis on fast shipping addresses one of the most common pain points for online shoppers – the waiting game. Traditional platforms often face challenges in providing consistent shipping times, leading to varied customer experiences. TEMU's commitment to speedy delivery contributes to higher levels of customer satisfaction by providing a more reliable and predictable shopping experience. Competitive Edge: As e-commerce continues to grow, the market becomes increasingly saturated with both established giants and new entrants. TEMU's focus on faster shipping times gives it a distinct competitive edge. It appeals to consumers who prioritize efficiency and convenience in their shopping experience. In contrast, traditional platforms may find themselves having to adapt quickly or risk losing customers to the allure of TEMU's swiffer service. Sustainability and Environmental Impact: While speed is a significant selling point for TEMU, it's essential to consider the environmental impact of such rapid shipping. Expedited shipping often requires additional resources, such as expedited transportation and packaging materials. Traditional platforms might adopt more sustainable shipping practices, such as grouping orders or optimizing delivery routes to reduce their carbon footprint. TEMU must balance its commitment to speed with environmental responsibility to ensure a positive long-term impact. Brief Overview of Temu Temu (pronounced ‘tee-moo’) is a Boston-based online marketplace founded by Pinduoduo’s parent company PDD Holding. Its business model is likened to Chinese shopping platforms SHEIN, Wish, and Alibaba – which are based on the sale of large quantities of products at prices that are so low they are almost unbelievable. Temu was founded in the USA in 2022 and is a subsidiary of PDD Holdings Inc., which is listed on Nasdaq and headquartered in Shanghai. Temu operates as an online marketplace similar to AliExpress, Walmart, and Wish, focusing on offering affordable goods. Temu allows Chinese vendors to sell to shoppers and ship directly to them without having to store products in U.S. warehouses.The company acts as an intermediary between sellers (primarily from China) and buyers without maintaining its own inventory. Temu promotes social commerce, encouraging potential buyers to find more buyers to avail discounts. The app employs gamification to engage customers and offers free shipping by circumventing customs duties. The platform allows suppliers based in China to sell and ship directly to customers without having to rely on warehouses in the destination countries . Online purchases on Temu can be made using a web browser or via a dedicated mobile application.Temu offers free products to some users which encourage new people to install the app through affiliate codes, social media and gamification. It also uses online advertising on Facebook and Instagram and many online platforms. The Temu platform went live for the first time in the United States in September 2022 and in February 2023, Temu was launched in Canada. That same month, the company aired a Super Bowl commercial advert . In March 2023, Temu was launched in Australia and New Zealand. The following month, Temu was launched in France , Italy , Germany , the Netherlands , Spain and the United Kingdom. Naturally, the prices charged by the site defy all competition (sneakers for €11, manicure kit for less than €5, phone holder for €1.80, etc.), so much so that the platform has adopted an eloquent slogan: “Buy like a Billionaire”. As the specialist in Chinese digital companies Jeffrey Towson explains to Le Monde, the platform does not yet make a margin, in order to establish itself quickly in the targeted countries. At the end of 2022, the Temu application became the most downloaded application in the United States. The TEMU (Shop Like a Millionaire) Shopping app is now boasting over 100 million Downloads on PlayStore and AppStore with over 4.7 Million reviews and about 12+ Ratings. Three months after its launch in the United States, the application was at the top of downloads. In the European Union, where the platform arrived in April (in France, the United Kingdom, Italy, the Netherlands, Spain and Germany), the success is similar. In recent days, it has been the most downloaded application in France on iOS and Android. As of April 2023, the app has been downloaded 10 million times since its launch in September 2022 and it is currently available in around 100 countries. Temu’s wide range of products is particularly appealing to consumers, combined with a gamified online shopping experience that encourages customers to try their luck and buy more and more. With its impressive growth and distinct strategy, Temu’s business model warrants a closer look. Key Factors that contributed to its initial success Leveraging the power of mobile technology, Temu aimed to bridge the gap between online and offline retail, offering a unique platform that combined the benefits of both worlds. It introduced several innovative features for better customer experience that set it apart from competitors and propelled its rapid rise to popularity. These Key Features and Functionality are; Augmented Reality (AR) Shopping: Temu integrated AR technology into its app, allowing users to virtually try on clothing, visualize furniture in their homes, and experience products before making a purchase. This feature enhanced the shopping experience and reduced the need for physical store visits. Personalized Recommendations: Temu leveraged artificial intelligence and machine learning algorithms to analyze user preferences, browsing history, and purchase behavior. Based on these insights, the app provided personalized product recommendations to users, leading to higher customer satisfaction and increased sales.Certainly! Temu's personalized recommendations were generated through a combination of artificial intelligence (AI) and machine learning algorithms. Here's an overview of how the feature worked: Data Collection: Temu collected vast amounts of user data to understand individual preferences and behavior. This data included user interactions within the app, such as product searches, views, clicks, and purchases, as well as demographic information and user-provided preferences. Data Processing and Analysis: The collected data was processed and analyzed using AI and machine learning algorithms. These algorithms examined patterns, correlations, and relationships within the data to identify user preferences, interests, and buying patterns. User Profiling: Based on the analysis, Temu created user profiles that encompassed various attributes, such as preferred product categories, brands, price ranges, and style preferences. The profiles were continually updated and refined as new data was collected and analyzed. Collaborative Filtering: One common technique used by Temu was collaborative filtering. This approach compares a user's profile with the profiles of other similar users to identify products or items that users with similar preferences enjoyed or purchased. By finding similarities between users, collaborative filtering could suggest relevant products to a particular user based on the preferences of users with similar tastes. Content-Based Filtering: Another technique employed by Temu was content-based filtering. This method focused on the characteristics and attributes of products themselves. It analyzed product descriptions, features, tags, and other metadata to identify similarities and correlations between products. For example, if a user showed a preference for certain brands or specific features, content-based filtering could recommend similar products that match those preferences. Machine Learning and Iterative Refinement: Temu's algorithms continuously learned and improved over time. As users interacted with the app and provided feedback, the algorithms adjusted their recommendations based on the user's responses and behavior. Machine learning techniques enabled the system to adapt and refine its recommendations based on real-time user feedback. Real-Time Contextual Factors: In addition to user preferences, Temu also considered real-time contextual factors, such as trending products, seasonal trends, and popular items in the user's location. These factors were incorporated into the recommendation algorithms to ensure up-to-date and relevant suggestions. By leveraging AI, machine learning, and user data, Temu's personalized recommendation system aimed to understand each user's unique preferences and deliver tailored product suggestions. The algorithms continually evolved to provide increasingly accurate and relevant recommendations, enhancing the user experience and facilitating personalized shopping journeys. Social Commerce Integration: Recognizing the power of social media, Temu incorporated social commerce features, enabling users to share products, create wish lists, and seek recommendations from friends and influencers. This integration expanded Temu's reach and facilitated organic growth through user-generated content. Seamless Checkout and Delivery: Temu prioritized a frictionless shopping experience by streamlining the checkout process and offering multiple secure payment options. Additionally, it partnered with reliable logistics providers to ensure prompt and efficient product delivery, enhancing customer satisfaction and loyalty. Seamless Checkout and Payment Options: Temu focused on streamlining the checkout process to provide a seamless and hassle-free experience for users. It offered multiple secure payment options, including credit/debit cards, mobile wallets, and payment gateways, allowing users to choose their preferred method. This flexibility and ease of payment contributed to a smoother transaction process and reduced cart abandonment rates.Temu implemented several measures to ensure the security of payment options for its users; Secure Payment Gateways: Temu has partnered with trusted and secure payment gateways to handle the processing of user payments. These payment gateways employ robust security measures such as encryption, tokenization, and secure socket layer (SSL) protocols to protect sensitive payment information during transmission. Encryption: Temu has implemented encryption protocols to safeguard user payment data. This involves encrypting sensitive information such as credit card details, bank account numbers, and personal information to prevent unauthorized access or interception. Encryption ensures that even if the data is intercepted, it remains unreadable and unusable to unauthorized parties. Compliance with Payment Card Industry Data Security Standards (PCI DSS): Temu has adhered to the Payment Card Industry Data Security Standards, which are industry-wide standards established to ensure the secure handling of cardholder data. Compliance with PCI DSS involves maintaining a secure network, implementing strong access controls, regularly monitoring and testing systems, and maintaining an information security policy. Two-Factor Authentication (2FA): Temu has implemented two-factor authentication as an additional layer of security for payment transactions. This requires users to provide two forms of verification, such as a password and a unique code sent to their mobile device, to authenticate their identity before completing a payment. Fraud Detection Systems: Temu has employed fraud detection systems and algorithms to identify and prevent fraudulent payment activities. These systems analyze various factors, such as user behavior, transaction patterns, and known fraud indicators, to detect and flag suspicious transactions for further verification or intervention. Regular Security Audits: Temu has conducted regular security audits and assessments to identify vulnerabilities and ensure that all payment systems and processes meet the highest security standards. This includes conducting penetration testing, code reviews, and vulnerability scans to proactively identify and address any potential security weaknesses. User Education and Awareness: Temu has implemented user education programs to raise awareness about safe online payment practices. This could include educating users about the importance of strong passwords, avoiding phishing attempts, and regularly monitoring their payment transactions for any unauthorized activity. Order Tracking and Delivery Updates: Temu provided users with real-time order tracking and delivery updates. Users could monitor the progress of their orders and receive notifications regarding shipment status, estimated delivery time, and any delays. This feature enhanced transparency and kept users informed throughout the delivery process, improving overall customer satisfaction. User Reviews and Ratings: To facilitate informed purchasing decisions, Temu incorporated user reviews and ratings for products. Users could leave feedback and rate their purchases, helping others make well-informed choices. This feature added a layer of trust and credibility to the shopping experience and fostered a community-driven approach to product evaluation. Virtual Stylist and Fashion Advice: Temu introduced a virtual stylist feature that offered personalized fashion advice and styling tips. Users could provide information about their preferences, body type, and occasion, and receive tailored recommendations for outfits and accessories. This feature catered to users seeking fashion inspiration and guidance, enhancing their shopping experience. Temu’s Virtual Stylist feature works in the following ways; It helps Users of the Temu app to create a profile by providing information about their preferences, body type, style preferences, and any specific fashion requirements they may have. The virtual stylist feature uses algorithms and machine learning techniques to analyze the user's profile and understand their style preferences. It considers factors such as color preferences, patterns, clothing types, and previous purchases. The feature assists users in recommendations. Based on the user's profile and preferences, the virtual stylist recommends outfits, clothing items, or accessories that align with their style. These recommendations may include images, descriptions, and links to purchase the recommended items. The feature also provides style tips, fashion trends, and suggestions to help users stay updated and make informed fashion choices. It helps users in Interactive Communication. The virtual stylist often offers Interactive communication channels such as chatbots or messaging systems. Users ask questions, seek styling advice, or provide feedback to further refine the recommendations. The feature helps Integration with User Feedback,it learns and improves over time by incorporating user feedback and preferences. As users interact with the feature, their feedback and engagement help train the algorithm to provide more accurate and personalized recommendations Growth and Adoption over time Temu was ranked No. 12 in the 2022 holiday traffic, topping retailers like Kohl’s and Wayfair. With an average of 41.0 million visitors in November and December, Temu surpassed major ecommerce sites like Kohl’s, Wayfair, and Nordstrom, and was within striking distance of Macy’s. Temu surged ahead of low-price Chinese goods sellers Shein and Wish.com in dramatic fashion. Not only did Temu quickly surpass Wish.com amid its recent downswing, it also managed to leapfrog Shein’s impressive recent gains. Shein’s steady rise has the company now looking to raise capital at a reported $64 billion valuation as reported by Reuters. Wish.com, by comparison, has been hemorrhaging money and has plummeted 98% from its peak stock price, with a market cap below $400 million. Using cheap wares to attract customers can work, but profitability is a challenge when operating under tight margins. High acquisition costs can be a killer, and there will also be a need to pivot into higher-margin goods. Temu is keying on its mobile app for loyalty. Temu’s bargain-basement prices make purchases a low consideration in most cases. Its best use case is when customers realize a need (“Shoot, I left my iPhone charger at the hotel and need another one”) and can buy quickly and cheaply. The app can drive habit formation around this, and the more that shoppers rely on the app the less likely Temu will have to pay for ads to drive conversions. Temu exploded out of the gates and its rapid rise warrants attention. As something of a Wish.com clone, there’s reason to be skeptical it can find long-term profitable growth when its early stage capital eventually rationalizes. Whether Temu avoids a similar fate will come down to whether it can improve upon the Wish.com playbook to build a loyal and engaged user base and drastically reduce customer acquisition costs over time. A killer TikTok strategy and sticky mobile app was key to achieving what its predecessor could not. As originally featured in the Retail Daily newsletter, Amazon has been the most downloaded shopping app in the US for a very long time. It managed to beat local competitors like Walmart, and even international competition from apps like Wish. But with the coming of Temu it looked like Amazon had finally met its match. Going all the way back to 2020, Amazon's shopping app was averaging around 550K downloads per week in the US, according to our estimates. The summer of 2022 was strong, pushing Amazon's downloads to more than double with a range between 800K and 1.2M weekly downloads. And that spike didn't slow down until February, 2023, after which downloads really started sloping down. SHEIN, a clothing retailer that sells "fast fashion" shipped from China, has been chasing Amazon's tail since it launched. Key word being "chasing". SHEIN averaged a little over half of Amazon's downloads back in 2020. They got close a few times but not enough to really take the lead. In January of 2023, that changed and SHEIN's downloads are now about double those of Amazon in the US. SHEIN saw 617K downloads from the App Store + Google Play in the US last week, according to our estimates. And SHEIN isn't even Amazon's biggest threat right now but Temu, a China-based retailer that sells a variety of goods, from clothes to furniture, at very low prices, since its launch late last year. The holiday shopping season was big for Temu. It averaged 2M new downloads every week between November and December, according to our estimates. Downloads dropped since, which makes sense overall, but are still astronomically high in comparison. Temu saw 1.3M new downloads last week in the US. This is a big problem for Amazon which may mean the next Prime Day will be a little more exciting than the last few. And yes, Temu is one of the biggest spends on Apple Search Ads which helps it get those downloads. Challenges Addressed by Temu The traditional retail model is almost getting outdated thereby posing several challenges. While the “customer is always right” mantra has held true for quite some time, the amount of power wielded by consumers has never been higher than it is right now. Customers are no longer forced to choose between just a couple of options when looking to purchase new luxury goods. Not only has the number of retailers expanded exponentially in recent years, but so has the information available to customers. The amount of choice people enjoy today has also led to a waning of brand loyalty, with customers switching between retailers and online/in-store channels from purchase to purchase, depending which best serves their needs at the time. Luxury retailers are not immune to this trend either, as even wealthy customers now tend to shop around for the best option. This decline in brand loyalty customers presents a unique retailing problem, as retailers try to find new and innovative ways to appeal to buyers – both existing and potential; Consumers are Choosing Multichannel Buying Experiences: With more complete e-retail experiences available, and shipping times greatly reduced, it is little wonder around 96% of Americans utilize online shopping in one way or another. However, those same Americans spend about 65% of their total shopping budget in traditional brick-and-mortar locations. In other words, while almost everyone is shopping online, they are making more purchases in stores. Customers are moving seamlessly between online and offline experiences, and are open to retailers who can best facilitate these transitions. Closing the divide between online and offline retail, Temu solves some issues. It is focused on creating a second-to-none customer experience across all channels. Customers are looking for retailers they can trust to deliver exceptional service time and again. They have the right customer which has helped them to create an omnichannel customer experience for consumers to interact wherever and however they wish by incorporating real-time feedback across channels and devices – engaging the customer wherever they may be. Customers Expect a Seamless Experience: When transitioning between online and in-store experiences, customers not only want the same products to be available, they also want their experience to be seamless. This means, if they are a regular online customer, they want to be treated like a regular customer when they visit a brick-andmortar location. This is quite problematic. However, Temu has created this type of fluid online/offline experience for their customers, it has ceased pitting its channels against one another. Centralized customer data has helped it build a seamless, fluid experience beginning with an easily-accessible customer profile. Retailers lacks an outstanding Experience To Attract Customer Loyalty: Customer experience is the biggest contributor towards brand loyalty, the Traditional Retail model makes it difficult to build a good customer experience.Negative experience being the most significant factor in affecting a customer’s likelihood to make a repeat visit. Most customers also serve people in their own working lives, meaning when they are on the other side of the counter, they want to feel important.While promotions and offers can certainly contribute towards helping customers feel like they are special, the real key to an outstanding experience is personalization which the retail model falls short of. Getting to know customers from their previous purchases and interests can help retailers drive loyalty. These insights can be gleaned from data, or even a simple conversation.Temu addresses this challenge by rendering coupons, bonuses and reduced cost to existing and new customers. It is equally personalized with the user. A Siloed Marketing Infrastructure Makes It Expensive and Unwieldy to get Your Message Across; The traditional retail model features separate channels, which makes customer data to become siloed very easily. If all the moving parts of a marketing department are not communicating efficiently and working together, customers become overwhelmed with conflicting or repeated messages. This bombardment of marketing communications has easily had the opposite of the intended effect and driven customers to competitors with a clearer and more congruent message. The right technology and communication procedures can ensure all arms of a marketing team are on the same page. Temu as a modern retailer has been engaging with their customers across many different channels. From SMS, to email and social media, multi-channel communications are essential to engagement which, in turn, drives the creation of the perfect customer experience. So Many Technologies Exist to Drive Marketing and Sales, but They Don’t Seem to Work Together: While the amount of data gathered by businesses keeps growing at an alarming rate, the number of staff available to analyze it is staying more-or-less the same. What’s important, then, is making sure all this data is being used in the correct way and not contributing towards the data silo problem. This means finding a technology solution which can handle the huge amount of data being generated and ensure it is focused in a direction which best benefits rather than overwhelms marketing efforts. The data scientist approach to marketing is only going to become more prevalent as time goes on when creating a truly unified omnichannel service.Temu has ensured that all existing technologies work together which is why they get best results. Only in the combining of streamlined un-siloed data science, seamless cross-channel customer service and marketing, and authentic personalization, can traditional retailers create buyer experiences which can combat the fickle nature of the modern consumer and lead just like Temu. Strategies Implemented to Revolutionize The Retail Industry Temu adopted and implemented some strategies which accounted for its success. Temu’s business model is built around low prices. It offers even more discounts and lower prices than SHEIN, with special offers such as items sold for as little as one cent. Temu further differentiates itself by offering free shipping and returns to customers, which is made possible by PDD Holding’s extensive network of suppliers and shipping partners. An efficient logistics network is not to be underestimated, as problems with supply and distribution networks are seen as a major factor in the failure of Alibaba and Wish to break into the Western market.. Aside this, the following strategies were implemented; Combining Shopping and Entertainment: One-fifth of online shoppers in the U.S. say they miss the in-store shopping experience when they shop online. Temu aimed to bridge this gap and introduced games into the shopping process. By playing games like Fishland, Coin Spin, Card Flip, and others, customers can win rewards that ultimately lead to more time spent on the site and a dopamine rush from winning free items. To keep people playing these games, however, the app relies heavily on referrals, another core business strategy. These games were designed to be simple, addictive, rewarding, and increase user engagement and retention. According to app intelligence firm Sensor Tower, Temu’s average daily sessions per user in the US increased by 23% from October 2022 to January 2023. Some other games in Canada include scratch cards, card games, and cash games. Temu: Shared Shopping Experience: Group Buying is a familiar concept in Asia that Temu has extended to its Western customer base. Essentially, it has increased customers’ bargaining power by forming groups to share a bulk discount. This plays into the aforementioned referral program, which gives discounts to customers who bring new clients to the app and enables a shared shopping experience. Affiliate Programs and Heavy Advertising: As SHEIN had already proven effective, Temu sent free items to a large number of influencers and micro-influencers to promote Temu on YouTube and TikTok. A younger customer base of users under the age of 35 is particularly attractive to Temu, as younger consumers are typically less able and willing to pay large sums for products. Seeing a favorite internet personality or a personal acquaintance promoting the products has led to many young customers to imitate the purchase. Temu’s omnipresence on TikTok and YouTube is seen as a key factor in why this marketplace has taken off so quickly. A strong presence on TikTok and YouTube: Temu has leveraged the power of social media platforms, especially TikTok and YouTube, to spread awareness and generate buzz about its products and offers. The hashtag #temu on TikTok has amassed over 1.3 billion views, while Temu’s official YouTube account videos have grossed over 215 million views since last August. Temu’s marketing strategy relies on creating viral content that showcases its products entertainingly and engagingly, such as unboxing videos, product reviews, challenges, and giveaways. Temu also collaborates with influencers and celebrities with large followings on these platforms. Temu’s Audience: Temu’s primary target audience has been the young and price-conscious generation of online shoppers looking for bargains and discounts. According to a report by Daxue Consulting, the majority of Temu’s followers (32.68%) are aged 25-34, followed by 18-24 (28.57%) and 35-44 (21.43%). Temu appeals to these consumers by offering personalized recommendations based on their preferences and browsing history and gamified features that allow them to earn credits, gifts, and better deals by playing in-app games or inviting their friends to join the app. Referrals: A Win-Win Strategy for Users and Temu Temu has implemented a referral program encouraging users to invite friends and contacts to join the app in exchange for credits and gifts. Users can share their referral links or codes on social media platforms like Facebook, Instagram, and TikTok. For example, users can join a “Fashion Lovers” team and get $20 in credits by inviting five friends who also love fashion within 24 hours. These referrals help users save money on their purchases, help Temu acquire new customers, and expand its network of sellers. Temu’s Marketing and Growth Strategy that led to its Rise Temu's growth has been remarkable in a short period of time. It reached the top downloads in the shopping category of both Apple's App Store and Google Play and is quickly establishing itself as a high-potential and innovative player in the e-commerce industry. Its success is ultimately its low prices, unlocked by their innovative Next-Gen Manufacturing (NGM) model. It employed a multifaceted marketing strategy to drive user acquisition and brand awareness which has been working greatly for them; Influencer Collaborations: To reach a wider audience, Temu has been collaborating with popular social media influencers and celebrities who promoted the app and shared their shopping experiences. Influencers came from a wide range of individuals, including fashion bloggers, lifestyle influencers, beauty gurus, tech enthusiasts, or experts in specific product categories.This strategy generated buzz and created a sense of credibility and trust among potential users. This marketing strategy was successfully implemented through; Influencer Selection: Temu carefully identified and selected influencers who aligned with its target audience, brand values, and product offerings. These influencers typically had a strong online presence, a relevant niche or expertise, and a sizable following. Temu considered factors such as engagement rates, authenticity, and the influencer's ability to create appealing and relatable content. Exclusive Partnerships: Temu forged exclusive partnerships with influencers, often signing them as brand ambassadors or collaborators. These collaborations involved long-term commitments, where influencers actively promoted Temu's app and its features on their social media platforms, websites, or blogs. The exclusivity of these partnerships helped establish a strong association between the influencers and Temu, increasing brand loyalty and credibility. Sponsored Content: Temu engaged influencers to create sponsored content that showcased the app's features, user experience, and the benefits of using Temu for shopping. Influencers shared their personal experiences, demonstrated the app's functionalities, and highlighted the unique advantages of using Temu over other shopping platforms. This content was often shared through blog posts, social media posts, videos, and live streams. Product Reviews and Recommendations: Influencers played a crucial role in reviewing and recommending products available on Temu. They shared their honest opinions and experiences using products from various brands. Their reviews and recommendations helped build trust and credibility among their followers, encouraging them to explore and purchase products through Temu. Giveaways and Contests: Temu collaborated with influencers to host giveaways and contests, where users had the chance to win exclusive prizes or discounts by engaging with the app or participating in specific promotional activities. These initiatives created buzz, generated user excitement, and attracted new users to the platform. Affiliate Marketing: Temu employed affiliate marketing strategies with influencers, where influencers received a commission or referral fee for every user who downloaded the app or made a purchase through their unique referral links. This incentivized influencers to actively promote Temu and its offerings, as their earnings were directly tied to the success of their referrals. Event Participation: Temu partnered with influencers for events such as product launches, fashion shows, or brand campaigns. Influencers attended these events, shared live updates, and provided behind-the-scenes content to their followers, creating a sense of exclusivity and fostering excitement around Temu's activities. User-generated Content: Temu encouraged influencers and their followers to create usergenerated content related to the app. This could include unboxing videos, styling tips, or hauls showcasing products purchased through Temu. Such content served as social proof and encouraged other users to engage with the app and make purchases. Overall, Temu's collaborations with influencers helped amplify its brand message, expand its reach to new audiences, and establish credibility within the social media landscape. By leveraging the influence and creative abilities of influencers, Temu successfully tapped into their followers' trust and engagement, driving user acquisition, and fostering a positive brand image. User Referral Program: Temu has been incentivizing existing users to refer the app to their friends and family by offering discounts or exclusive rewards. This word-of-mouth marketing approach contributed to the app's exponential growth and user acquisition. Targeted Digital Advertising: Temu has been leveraging targeted digital advertising campaigns across various digital platforms like Facebook, Instagram, Twitter, TikTok and soon Telegram focusing on specific demographics and user segments. By tailoring their messaging and creative assets, Temu effectively reached potential users with personalized content. Expansion into New Markets: After gaining traction in its home market, Temu has been expanding its operations into international markets. It strategically entered regions with high smartphone penetration and a growing ecommerce ecosystem. This expansion allowed Temu to tap into a larger customer base and establish itself as a global player in the shopping app industry. Partnerships with Brands and Retailers: Recognizing the importance of strategic alliances, Temu has been forging partnerships with renowned brands and retailers. These collaborations involved exclusive product launches, limitededition collections, and promotional campaigns. By aligning with established names in the retail industry, Temu gained credibility and attracted a wider range of customers. Continuous Innovation: Temu has been prioritizing continuous innovation to stay ahead of the competition. It regularly updated its app with new features and enhancements based on user feedback and emerging trends. For example, it introduced a virtual stylist feature that offered personalized fashion advice and styling tips, further enhancing the user experience. Data-driven Insights: Temu has been leveraging the vast amount of user data it collected to gain valuable insights into consumer behavior, preferences, and trends. These insights were used to refine its product offering, improve targeted advertising efforts, and optimize the overall shopping experience. By harnessing the power of data, Temu was able to make data-informed decisions and stay attuned to evolving customer needs. Seamless Integration with Physical Stores: Recognizing the importance of the omnichannel experience, Temu has been integrating its app with physical stores. It introduced features like in-store barcode scanning, which allowed users to access product information, read reviews, and make purchases directly from their smartphones while inside partner retail locations. This integration blurred the lines between online and offline shopping and provided a seamless and unified experience. Social Impact Initiatives: Temu also has also been focusing on social impact initiatives to connect with socially conscious consumers. It launched sustainable product collections, partnered with NGOs for charitable causes, and implemented eco-friendly packaging practices. These initiatives resonated with environmentally and socially conscious users, further strengthening Temu's brand reputation and loyalty. Continuous Customer Support: Temu has been placing strong emphasis on customer support and responsiveness. It established dedicated customer service channels, including live chat support and a comprehensive FAQ section. Timely and effective customer support enhanced user satisfaction, resolved issues promptly, and fostered a positive brand image. A heavy paid media strategy: Like other well-funded internet companies, Temu appears to be spending heavily for app installs and on search ads. Search for almost any commodity product—especially if your search includes the word “cheap”—and you’re likely to find a Google result for Temu. Temu also gained attention with multiple Super Bowl spots, putting it on the map for many US consumers for the first time. Results and Impacts The rise of Temu as a shopping app has revolutionized the Retail Industry and also Consumer Experience; User Base and Revenue Growth: Within two years of its launch, Temu has amassed millions of active users and experienced exponential revenue growth. Its user-centric approach and innovative features resonated with consumers, driving adoption and usage. Enhanced Customer Experience: Temu's focus on personalization, convenience, and seamless shopping experiences has elevated customer satisfaction levels. Users appreciated the ability to try on products virtually, receive tailored recommendations, and enjoy hassle-free transactions. Disruption of Traditional Retail: The Traditional Retail industry has suffered relatively as a result of the rise of Temu as a Shopping App. It has greatly disrupted traditional brick-and-mortar retail, with many businesses. This is so because with their new innovation, they have explored other parts(online) which the traditional retailers do not have. Its rise has posed several challenges for traditional retailers as they struggle to adapt to the changing landscape; Online Presence and Digital Transformation: Traditional retailers are still struggling with establishing a strong online presence and undergoing digital transformation. Building and maintaining an effective e-commerce website or app requires technical expertise, investment in infrastructure, and a shift in mindset. Adapting to the digital realm is now very challenging for retailers who have primarily operated in brick-and-mortar stores. Competition with E-commerce Giants: E-commerce platforms like Temu with significant resources, a broad customer base, and strong brand recognition which makes it difficult for Traditional retailers to compete with in terms of pricing, product selection, and customer convenience. It can be challenging for them to match the speed, efficiency, and scale of operations offered by online marketplaces. Supply Chain and Logistics: Traditional retailers have gotten used to managing inventory primarily for physical stores and now face challenges in adapting their supply chain and logistics operations to accommodate online sales. Efficient inventory management, order fulfillment, and last-mile delivery is quite complex and requires adjustments to meet the demands of e-commerce customers. Customer Expectations and Experience: Online shoppers have come to expect a seamless and personalized shopping experience. Traditional retailers now struggle to meet these expectations, especially provided they have very limited experience in online customer engagement, personalization, and tailoring recommendations. Adapting to a customer-centric approach and providing a consistent omnichannel experience can be a significant challenge. Data and Analytics: E-commerce platforms like Temu rely heavily on data and analytics to understand customer behavior, preferences, and trends. Traditional retailers have limited experience in collecting, analyzing, and utilizing customer data effectively. Harnessing data to make data-driven decisions and optimize operations is now a significant hurdle for retailers transitioning to an online model. Operational Costs and Margins: Traditional retailers are facing financial challenges to adapt to ecommerce. Online operations require investments in technology, infrastructure, marketing, and fulfillment capabilities. Retailers need to reevaluate their pricing strategies, optimize operational costs, and find ways to maintain profitability in the face of increased competition and potentially lower margins. Brand Differentiation and Customer Loyalty: Building a strong brand and fostering customer loyalty has proven to be more challenging in the online space. Traditional retailers may have developed a loyal customer base through in-person interactions and personalized service. Translating that loyalty to the digital realm and effectively differentiating their brand from competitors needs innovative strategies and marketing efforts which will take time. By leveraging technology and understanding evolving consumer behaviors, Temu has disrupted the retail industry, reshaped shopping habits, and set new standards for convenience and engagement in the digital age; Temu’s Setbacks Despite its rapid rise, its relationship with sister company Pinduoduo has brought about several challenges in delivery of goods as compared to its competitors and other areas; According to reports published in Times, Temu is beginning to develop a reputation for undelivered packages, mysterious charges, incorrect orders and unresponsive customer service. Temu itself acknowledges that its orders take longer to arrive than those from Amazon—typically 7-15 business days as they come from “overseas warehouses.” In a series of Facebook messages with Times, Roper Malloy, a client complained of spending $178 on gifts from Temu for her family, including two drones and some makeup for her daughter which has never arrived. She said she has contacted the company several times for a refund, which has also yet to arrive. On May 17, 2023, Montana Governor Greg Gianforte banned Temu from statewide government devices, as well as ByteDance apps (including TikTok ) , Telegram , and WeChat. In June 2023, the U.S. House Select Committee on U.S.- Chinese Communist Party Strategic Competition stated that Temu did not maintain "even the facade of a meaningful compliance program" with the law. Uyghur on Forced Labor Prevention to keep goods made by forced labor off its platform. In October, the Boston branch of the Better Business Bureau opened up a file on Temu and has received 31 complaints about the website. Temu currently has a C rating on the BBB, and an average customer rating of 1.4 stars out of 5, although from only 20 reviews. (Complaints are separate from reviews, which do not factor into BBB’s official rating.) McGovern at the BBB mentioned that, it’s unusual for such a new company to receive so many complaints in such a short amount of time. Temu has acknowledged and responded to every complaint posted to the BBB website, but many of those complaints remain unresolved. Temu’s sister company, Pinduoduo, has long been accused of hosting sales of counterfeits, illegal goods, or products that do not match their descriptions. (Pinduoduo wrote in its SEC filings that it immediately removes unauthorized products or misleading information on its platform, and freezes the accounts of sellers on the site who violate its policies.) There have been no BBB complaints that allege the goods Temu ships are counterfeit or fake. Additionally, in 2021, the deaths of two Pinduoduo employees spurred investigations and boycotts over the company’s working conditions, according to the New York Times. How Temu could affect the U.S. economy In May 2023, the U.S.-China Economic and Security Review Commission raised concerns about risks to users' personal data on Temu as a shopping app affiliated with Pinduoduo, which was removed from Google Play after some of its versions were found to contain malware. Schmidt, at Vanderbilt, who specializes in security and privacy, is of the opinion that Temu’s data and privacy practices aren’t out of the ordinary; The company collects lots of personal data about users and then deploys that data to sell ads. However, he says that Temu’s rise could have a bigger impact not in terms of privacy concerns, but in terms of pressure on American companies and workers. If more and more American consumers flock to Temu to buy cut-rate goods, that could pressure Amazon and other competitors to slash their prices too which would affect wages. Areas for Improvements Despite its innovative business model and commitment to sustainability, Temu still has some areas that need improvement; Real-Time Shopping: Cost-Effectiveness vs. Plagiarism and Exploitation: Temu’s most innovative and effective strategy has been highly ambivalent and criticized. Similar to SHEIN, Temu has been using a reverse-manufacturing model that relays customer feedback directly to manufacturers. Starting off with smaller quantities that are offered on the marketplace, products in high demand are reordered, while others are replaced. According to Temu, this results in environmental efficiency because product inventory is aligned with customer demand in real time. In addition, a greater number of products can be offered than with traditional retail strategies. With this method, SHEIN was able to launch 150,000 new items in 2020, beating its competitors by a wide margin. Temu Has to Fight Criticism: Critics point to several detrimental effects of this type of 'ultra-fast' commerce: To ensure low prices, manufacturers must keep costs down, contributing to the continued poverty of workers in manufacturing countries. The same goes for product quality and environmental friendliness: Cheap products that break easily contribute to increasing amounts of waste, returned products tend to be dumped rather than recycled or resold, and the high number of new products sold is only possible by ripping off SME fashion designers and creators. TrustPilot reviews reveal a 2.9-star average, with the majority of one-star reviews citing long shipping times, low-quality items, and poor customer service. Low quality items can become a sustainability issue in itself, since those products have a higher chance of ending up in landfill. It’s essential for Temu to address these concerns and maintain a balance between low prices and customer satisfaction. Lessons Learned Temu's rise as a shopping app exemplifies the transformative power of technology in the retail industry. Its success serves as an inspiration for other businesses seeking to adapt and thrive in the digital era. Overall, the rise of Temu as a shopping app has been driven by its commitment to innovation, personalized experiences, strategic partnerships, and a customer-centric approach. The marketplace Temu has achieved impressive success with its business model of offering low-priced products and free shipping, combined with a gamified shopping experience. Temu's strategy also includes group buying, referrals, affiliate programs, and heavy advertising on social media platforms. While Temu's real-time shopping model, which involves relaying customer feedback directly to manufacturers, is seen as innovative and cost-effective, it has also garnered criticism. Critics argue that this approach can lead to environmental issues, exploitation of workers, and plagiarism of designs from small and medium-sized fashion creators. Despite these concerns, Temu's combination of low prices, gamified shopping, and heavy advertising on platforms like TikTok and YouTube has made it a major player in the ultra-fast eCommerce sector. However, Temu's most controversial strategy is its real-time shopping model akin to that of SHEIN, which relays customer feedback directly to manufacturers. While this model increases costeffectiveness and product variety, critics argue that it contributes to environmental degradation, exploitation of workers, and plagiarism of fashion designers. Nonetheless, Temu's growth and distinct strategy make it a noteworthy player in this emerging business model of ultra-fast eCommerce, and it will be interesting to see how this trend plays out in the future. Actionable Takeaways for other Businesses in the Retail Industry Traditional Retailers who wish to also rise like Temu should consider the following steps; Develop a User-Friendly E-commerce Website: Create a well-designed, intuitive, and user-friendly e-commerce website that offers a seamless shopping experience. Ensure that the website is responsive, optimized for mobile devices, and provides easy navigation, product search, and checkout processes. Emphasize Branding and Differentiation: Clearly define the brand identity and unique selling propositions of your retail business. Highlight what sets your products apart from competitors and communicate a compelling brand story to engage online customers. Use high-quality visuals and persuasive copywriting to convey your brand message effectively. Optimize for Search Engines: Implement search engine optimization (SEO) techniques to improve the visibility of your website in search engine results. Conduct keyword research to understand the terms and phrases your target audience is searching for, and optimize your website's content, meta tags, and URLs accordingly. Leverage Social Media: Use social media platforms to build an online community, engage with customers, and promote your products. Regularly post engaging content, including product updates, customer testimonials, and behind-the-scenes glimpses. Encourage user-generated content and respond promptly to customer inquiries and feedback. Invest in Digital Marketing: Develop a comprehensive digital marketing strategy that includes online advertising, email marketing, influencer collaborations, and content marketing. Target specific customer segments and utilize data-driven approaches to reach your audience effectively and drive traffic to your website. Provide Excellent Customer Service: Offer exceptional customer service across all online channels, including live chat, email, and social media. Respond promptly to customer inquiries, provide accurate product information, and address any issues or concerns in a timely manner. Personalize the customer experience as much as possible to build trust and loyalty. Implement Online Customer Engagement Tools: Incorporate tools such as live chat, product reviews, ratings, and personalized recommendations to enhance customer engagement and create a sense of interactivity on your website. Encourage customer feedback and testimonials to build social proof and credibility. Collaborate with Influencers and Online Communities: Partner with relevant influencers or online communities in your industry to extend your reach and tap into their established audiences. Engage in collaborations, product reviews, or sponsorships to increase brand visibility and credibility. Analyze and Optimize: Continuously monitor and analyze website metrics, customer behavior, and online marketing campaigns. Utilize analytics tools to gain insights into what is working and what needs improvement. Optimize your online presence based on data-driven decisions to enhance the user experience and drive conversions. Adapt to Changing Trends: Stay up to date with the latest e-commerce trends, technologies, and consumer preferences. Be willing to experiment, adapt, and embrace new technologies or platforms that can enhance your online presence and provide a competitive edge. By implementing these strategies, traditional retailers can establish a strong online presence, attract online customers, and compete effectively in the digital marketplace. It's important to continuously evaluate and refine your online presence based on customer feedback, market trends, and emerging technologies to stay ahead of the competition. Future Outlook The rise of Temu as a shopping app has been remarkable, and it has successfully disrupted the retail experience by implementing innovative strategies and business models. Looking ahead, there are several key factors that will shape the future outlook of Temu and determine its continued success in the competitive online shopping market; Expansion into New Markets: Temu has already expanded its operations to several countries, including the US, Canada, Australia, New Zealand, France, Italy, Germany, the Netherlands, Spain, and the United Kingdom. To sustain its growth, Temu will likely continue to explore opportunities for expansion into new markets, both within and outside of these regions. This expansion will allow the platform to reach a larger customer base and tap into new consumer preferences and demands. Improvement in Delivery Times: One area of concern for customers is the longer delivery times associated with Temu's Next-Gen Manufacturing (NGM) model. To address this issue, Temu may invest in optimizing its supply chain and logistics processes. By streamlining operations and partnering with efficient shipping providers, Temu can reduce delivery times and enhance the overall customer experience. Enhanced Customer Engagement: Temu's success is partly attributed to its gamification strategies and social commerce approach. To maintain customer engagement and loyalty, Temu will need to continuously innovate and introduce new features that incentivize users to stay active on the platform. This could include personalized recommendations, rewards programs, and interactive shopping experiences. Sustainability and Social Responsibility: Temu has positioned itself as a platform that promotes sustainability and social responsibility through its NGM model, which reduces unsold inventory and waste. Going forward, it will be crucial for Temu to uphold these values and communicate its commitment to sustainability to customers. This can be achieved through transparent supply chain practices, eco-friendly packaging options, and partnerships with ethical suppliers. Competition and Differentiation: While Temu has gained significant traction, it faces strong competition from other Chinese online wholesale platforms and established e-commerce giants. To stay ahead, Temu will need to continue differentiating itself through its NGM model, competitive pricing, and unique product offerings. It should also focus on building a strong brand identity and nurturing customer trust through excellent customer service and reliable purchase protection. navigate the competitive landscape. With its innovative approach and commitment to customer satisfaction, Temu has the potential to continue reshaping the online Conclusion Conclusively, Temu has emerged as a shopping app that is revolutionizing the retail experience through its Next-Gen Manufacturing model and direct-to-supplier approach. By focusing on cost savings, customization, and sustainability, Temu has gained a competitive edge in the market. With a lot of consumer goods being produced in China it makes sense that more and more e-commerce platforms are Chinese. The success of Temu and its competitors showcases the power of connecting customers directly with suppliers, ultimately reshaping the way people shop online. TEMU's emergence in the e-commerce landscape with its lightning-fast shipping times has undoubtedly stirred the industry. By setting new standards for efficiency and customer satisfaction, TEMU challenges traditional platforms to step up their game. While the convenience of rapid shipping is undeniable, the long-term sustainability and overall impact of this approach must also be considered. As consumers continue to prioritize convenience and speed, the success of TEMU may very well influence how the e-commerce ecosystem evolves in the years to come. However, to sustain its growth and success, Temu must adapt to evolving customer preferences, optimize its operations, and effectively.
|
Answer in paragraph format. Only use the context provided for your answer.
EVIDENCE:
THE RISE OF TEMU: A Shopping App Revolutionizing the Retail Experience Introduction In recent years, the retail industry has witnessed a significant shift towards online shopping. The emergence of E-commerce platforms has transformed the way consumers shop, providing convenience and access to a wide range of products. This case study explores the rise of Temu, a shopping app that has disrupted the traditional retail landscape and revolutionized the shopping experience for millions of users. Temu, a rising star in the world of online shopping, offers a vast array of fashion products, beauty items, and home goods. This Chinese-owned digital marketplace has quickly become the top free shopping app, outshining giants like Shein, Amazon, and Walmart. Temu’s business model connects customers directly to suppliers. By forging strong relationships with retailers, they’ve managed to keep prices low and maintain a vast network of suppliers. At the core of Temu’s rapid growth and competitive pricing is their innovative Next-Gen Manufacturing (NGM) model. Launched in September 2022, this Boston-based e-commerce platform serves markets in the US, Canada, Australia, and New Zealand. The NGM model revolutionizes the retail process by enabling manufacturers to produce merchandise with more precision, reducing unsold inventory and waste. However customers do complain about longer delivery times. It is unknown to what extent this is a result of the NGM model. By connecting shoppers directly with manufacturers and offering real-time insights, Temu is able to cut warehousing and transportation costs, resulting in savings of at least 50% compared to traditional processes. This cost-saving approach allows the company to offer near-wholesale prices, as they remove hidden costs and focus on accurately forecasting sales and demand. While Temu.com is gaining popularity, it faces stiff competition from other Chinese online wholesale stores like AliExpress, DHGate, Banggood, and DealExtreme. These platforms offer a wide range of products at competitive prices, along with diverse shipping options and payment methods. However, Temu stands out with its NGM model, which empowers manufacturers to create customized products. The increased visibility of demand and supply accelerates distribution and eliminates the need for large warehouses. Another distinguishing factor of Temu is its claims on sustainability and social responsibility. The NGM model promotes a more sustainable e-commerce landscape by enabling manufacturers to produce merchandise that fits the needs of consumers, leading to lower unsold inventory and waste. Significance of Temu’s Innovative approach to Shopping In the rapidly evolving world of e-commerce, convenience and speed have become the pillars on which success is built. As consumers increasingly turn to online shopping to meet their needs, the demand for faster shopping times has never been higher. Enter TEMU, the innovative new ecommerce platform that promises to redefine the shopping experience with lightning-fast shipping. TEMU's shopping prowess to traditional e-commerce platforms, makes it stand out and elevates the shopping journey for customers. Speed of Delivery: One of the most glaring advantages TEMU brings to the table is its lightning-fast shipping times. Unlike traditional platforms that often offer standard shipping that can take days or even weeks, TEMU has set a new standard with its express delivery options. With strategically located warehouses and a streamlined logistics network, TEMU ensures that customers receive their orders in record time, sometimes as soon as within a few hours of placing an order. This kind of speed sets TEMU apart from traditional e-commerce platforms, where delays in processing and shipping can often lead to frustration and disappointment for customers. Inventory Management: TEMU's commitment to swift delivery is closely tied to its advanced inventory management system. Traditional platforms often struggle to keep up with the demand, leading to instances where popular items are out of stock or on backorder. TEMU's innovative approach utilizes real-time data analytics to predict customer demands and stock products accordingly. This approach significantly reduces the chances of running out of stock, thus ensuring that customers can find what they want when they want it. Customer Satisfaction: In the world of e-commerce, customer satisfaction is paramount. TEMU's emphasis on fast shipping addresses one of the most common pain points for online shoppers – the waiting game. Traditional platforms often face challenges in providing consistent shipping times, leading to varied customer experiences. TEMU's commitment to speedy delivery contributes to higher levels of customer satisfaction by providing a more reliable and predictable shopping experience. Competitive Edge: As e-commerce continues to grow, the market becomes increasingly saturated with both established giants and new entrants. TEMU's focus on faster shipping times gives it a distinct competitive edge. It appeals to consumers who prioritize efficiency and convenience in their shopping experience. In contrast, traditional platforms may find themselves having to adapt quickly or risk losing customers to the allure of TEMU's swiffer service. Sustainability and Environmental Impact: While speed is a significant selling point for TEMU, it's essential to consider the environmental impact of such rapid shipping. Expedited shipping often requires additional resources, such as expedited transportation and packaging materials. Traditional platforms might adopt more sustainable shipping practices, such as grouping orders or optimizing delivery routes to reduce their carbon footprint. TEMU must balance its commitment to speed with environmental responsibility to ensure a positive long-term impact. Brief Overview of Temu Temu (pronounced ‘tee-moo’) is a Boston-based online marketplace founded by Pinduoduo’s parent company PDD Holding. Its business model is likened to Chinese shopping platforms SHEIN, Wish, and Alibaba – which are based on the sale of large quantities of products at prices that are so low they are almost unbelievable. Temu was founded in the USA in 2022 and is a subsidiary of PDD Holdings Inc., which is listed on Nasdaq and headquartered in Shanghai. Temu operates as an online marketplace similar to AliExpress, Walmart, and Wish, focusing on offering affordable goods. Temu allows Chinese vendors to sell to shoppers and ship directly to them without having to store products in U.S. warehouses.The company acts as an intermediary between sellers (primarily from China) and buyers without maintaining its own inventory. Temu promotes social commerce, encouraging potential buyers to find more buyers to avail discounts. The app employs gamification to engage customers and offers free shipping by circumventing customs duties. The platform allows suppliers based in China to sell and ship directly to customers without having to rely on warehouses in the destination countries . Online purchases on Temu can be made using a web browser or via a dedicated mobile application.Temu offers free products to some users which encourage new people to install the app through affiliate codes, social media and gamification. It also uses online advertising on Facebook and Instagram and many online platforms. The Temu platform went live for the first time in the United States in September 2022 and in February 2023, Temu was launched in Canada. That same month, the company aired a Super Bowl commercial advert . In March 2023, Temu was launched in Australia and New Zealand. The following month, Temu was launched in France , Italy , Germany , the Netherlands , Spain and the United Kingdom. Naturally, the prices charged by the site defy all competition (sneakers for €11, manicure kit for less than €5, phone holder for €1.80, etc.), so much so that the platform has adopted an eloquent slogan: “Buy like a Billionaire”. As the specialist in Chinese digital companies Jeffrey Towson explains to Le Monde, the platform does not yet make a margin, in order to establish itself quickly in the targeted countries. At the end of 2022, the Temu application became the most downloaded application in the United States. The TEMU (Shop Like a Millionaire) Shopping app is now boasting over 100 million Downloads on PlayStore and AppStore with over 4.7 Million reviews and about 12+ Ratings. Three months after its launch in the United States, the application was at the top of downloads. In the European Union, where the platform arrived in April (in France, the United Kingdom, Italy, the Netherlands, Spain and Germany), the success is similar. In recent days, it has been the most downloaded application in France on iOS and Android. As of April 2023, the app has been downloaded 10 million times since its launch in September 2022 and it is currently available in around 100 countries. Temu’s wide range of products is particularly appealing to consumers, combined with a gamified online shopping experience that encourages customers to try their luck and buy more and more. With its impressive growth and distinct strategy, Temu’s business model warrants a closer look. Key Factors that contributed to its initial success Leveraging the power of mobile technology, Temu aimed to bridge the gap between online and offline retail, offering a unique platform that combined the benefits of both worlds. It introduced several innovative features for better customer experience that set it apart from competitors and propelled its rapid rise to popularity. These Key Features and Functionality are; Augmented Reality (AR) Shopping: Temu integrated AR technology into its app, allowing users to virtually try on clothing, visualize furniture in their homes, and experience products before making a purchase. This feature enhanced the shopping experience and reduced the need for physical store visits. Personalized Recommendations: Temu leveraged artificial intelligence and machine learning algorithms to analyze user preferences, browsing history, and purchase behavior. Based on these insights, the app provided personalized product recommendations to users, leading to higher customer satisfaction and increased sales.Certainly! Temu's personalized recommendations were generated through a combination of artificial intelligence (AI) and machine learning algorithms. Here's an overview of how the feature worked: Data Collection: Temu collected vast amounts of user data to understand individual preferences and behavior. This data included user interactions within the app, such as product searches, views, clicks, and purchases, as well as demographic information and user-provided preferences. Data Processing and Analysis: The collected data was processed and analyzed using AI and machine learning algorithms. These algorithms examined patterns, correlations, and relationships within the data to identify user preferences, interests, and buying patterns. User Profiling: Based on the analysis, Temu created user profiles that encompassed various attributes, such as preferred product categories, brands, price ranges, and style preferences. The profiles were continually updated and refined as new data was collected and analyzed. Collaborative Filtering: One common technique used by Temu was collaborative filtering. This approach compares a user's profile with the profiles of other similar users to identify products or items that users with similar preferences enjoyed or purchased. By finding similarities between users, collaborative filtering could suggest relevant products to a particular user based on the preferences of users with similar tastes. Content-Based Filtering: Another technique employed by Temu was content-based filtering. This method focused on the characteristics and attributes of products themselves. It analyzed product descriptions, features, tags, and other metadata to identify similarities and correlations between products. For example, if a user showed a preference for certain brands or specific features, content-based filtering could recommend similar products that match those preferences. Machine Learning and Iterative Refinement: Temu's algorithms continuously learned and improved over time. As users interacted with the app and provided feedback, the algorithms adjusted their recommendations based on the user's responses and behavior. Machine learning techniques enabled the system to adapt and refine its recommendations based on real-time user feedback. Real-Time Contextual Factors: In addition to user preferences, Temu also considered real-time contextual factors, such as trending products, seasonal trends, and popular items in the user's location. These factors were incorporated into the recommendation algorithms to ensure up-to-date and relevant suggestions. By leveraging AI, machine learning, and user data, Temu's personalized recommendation system aimed to understand each user's unique preferences and deliver tailored product suggestions. The algorithms continually evolved to provide increasingly accurate and relevant recommendations, enhancing the user experience and facilitating personalized shopping journeys. Social Commerce Integration: Recognizing the power of social media, Temu incorporated social commerce features, enabling users to share products, create wish lists, and seek recommendations from friends and influencers. This integration expanded Temu's reach and facilitated organic growth through user-generated content. Seamless Checkout and Delivery: Temu prioritized a frictionless shopping experience by streamlining the checkout process and offering multiple secure payment options. Additionally, it partnered with reliable logistics providers to ensure prompt and efficient product delivery, enhancing customer satisfaction and loyalty. Seamless Checkout and Payment Options: Temu focused on streamlining the checkout process to provide a seamless and hassle-free experience for users. It offered multiple secure payment options, including credit/debit cards, mobile wallets, and payment gateways, allowing users to choose their preferred method. This flexibility and ease of payment contributed to a smoother transaction process and reduced cart abandonment rates.Temu implemented several measures to ensure the security of payment options for its users; Secure Payment Gateways: Temu has partnered with trusted and secure payment gateways to handle the processing of user payments. These payment gateways employ robust security measures such as encryption, tokenization, and secure socket layer (SSL) protocols to protect sensitive payment information during transmission. Encryption: Temu has implemented encryption protocols to safeguard user payment data. This involves encrypting sensitive information such as credit card details, bank account numbers, and personal information to prevent unauthorized access or interception. Encryption ensures that even if the data is intercepted, it remains unreadable and unusable to unauthorized parties. Compliance with Payment Card Industry Data Security Standards (PCI DSS): Temu has adhered to the Payment Card Industry Data Security Standards, which are industry-wide standards established to ensure the secure handling of cardholder data. Compliance with PCI DSS involves maintaining a secure network, implementing strong access controls, regularly monitoring and testing systems, and maintaining an information security policy. Two-Factor Authentication (2FA): Temu has implemented two-factor authentication as an additional layer of security for payment transactions. This requires users to provide two forms of verification, such as a password and a unique code sent to their mobile device, to authenticate their identity before completing a payment. Fraud Detection Systems: Temu has employed fraud detection systems and algorithms to identify and prevent fraudulent payment activities. These systems analyze various factors, such as user behavior, transaction patterns, and known fraud indicators, to detect and flag suspicious transactions for further verification or intervention. Regular Security Audits: Temu has conducted regular security audits and assessments to identify vulnerabilities and ensure that all payment systems and processes meet the highest security standards. This includes conducting penetration testing, code reviews, and vulnerability scans to proactively identify and address any potential security weaknesses. User Education and Awareness: Temu has implemented user education programs to raise awareness about safe online payment practices. This could include educating users about the importance of strong passwords, avoiding phishing attempts, and regularly monitoring their payment transactions for any unauthorized activity. Order Tracking and Delivery Updates: Temu provided users with real-time order tracking and delivery updates. Users could monitor the progress of their orders and receive notifications regarding shipment status, estimated delivery time, and any delays. This feature enhanced transparency and kept users informed throughout the delivery process, improving overall customer satisfaction. User Reviews and Ratings: To facilitate informed purchasing decisions, Temu incorporated user reviews and ratings for products. Users could leave feedback and rate their purchases, helping others make well-informed choices. This feature added a layer of trust and credibility to the shopping experience and fostered a community-driven approach to product evaluation. Virtual Stylist and Fashion Advice: Temu introduced a virtual stylist feature that offered personalized fashion advice and styling tips. Users could provide information about their preferences, body type, and occasion, and receive tailored recommendations for outfits and accessories. This feature catered to users seeking fashion inspiration and guidance, enhancing their shopping experience. Temu’s Virtual Stylist feature works in the following ways; It helps Users of the Temu app to create a profile by providing information about their preferences, body type, style preferences, and any specific fashion requirements they may have. The virtual stylist feature uses algorithms and machine learning techniques to analyze the user's profile and understand their style preferences. It considers factors such as color preferences, patterns, clothing types, and previous purchases. The feature assists users in recommendations. Based on the user's profile and preferences, the virtual stylist recommends outfits, clothing items, or accessories that align with their style. These recommendations may include images, descriptions, and links to purchase the recommended items. The feature also provides style tips, fashion trends, and suggestions to help users stay updated and make informed fashion choices. It helps users in Interactive Communication. The virtual stylist often offers Interactive communication channels such as chatbots or messaging systems. Users ask questions, seek styling advice, or provide feedback to further refine the recommendations. The feature helps Integration with User Feedback,it learns and improves over time by incorporating user feedback and preferences. As users interact with the feature, their feedback and engagement help train the algorithm to provide more accurate and personalized recommendations Growth and Adoption over time Temu was ranked No. 12 in the 2022 holiday traffic, topping retailers like Kohl’s and Wayfair. With an average of 41.0 million visitors in November and December, Temu surpassed major ecommerce sites like Kohl’s, Wayfair, and Nordstrom, and was within striking distance of Macy’s. Temu surged ahead of low-price Chinese goods sellers Shein and Wish.com in dramatic fashion. Not only did Temu quickly surpass Wish.com amid its recent downswing, it also managed to leapfrog Shein’s impressive recent gains. Shein’s steady rise has the company now looking to raise capital at a reported $64 billion valuation as reported by Reuters. Wish.com, by comparison, has been hemorrhaging money and has plummeted 98% from its peak stock price, with a market cap below $400 million. Using cheap wares to attract customers can work, but profitability is a challenge when operating under tight margins. High acquisition costs can be a killer, and there will also be a need to pivot into higher-margin goods. Temu is keying on its mobile app for loyalty. Temu’s bargain-basement prices make purchases a low consideration in most cases. Its best use case is when customers realize a need (“Shoot, I left my iPhone charger at the hotel and need another one”) and can buy quickly and cheaply. The app can drive habit formation around this, and the more that shoppers rely on the app the less likely Temu will have to pay for ads to drive conversions. Temu exploded out of the gates and its rapid rise warrants attention. As something of a Wish.com clone, there’s reason to be skeptical it can find long-term profitable growth when its early stage capital eventually rationalizes. Whether Temu avoids a similar fate will come down to whether it can improve upon the Wish.com playbook to build a loyal and engaged user base and drastically reduce customer acquisition costs over time. A killer TikTok strategy and sticky mobile app was key to achieving what its predecessor could not. As originally featured in the Retail Daily newsletter, Amazon has been the most downloaded shopping app in the US for a very long time. It managed to beat local competitors like Walmart, and even international competition from apps like Wish. But with the coming of Temu it looked like Amazon had finally met its match. Going all the way back to 2020, Amazon's shopping app was averaging around 550K downloads per week in the US, according to our estimates. The summer of 2022 was strong, pushing Amazon's downloads to more than double with a range between 800K and 1.2M weekly downloads. And that spike didn't slow down until February, 2023, after which downloads really started sloping down. SHEIN, a clothing retailer that sells "fast fashion" shipped from China, has been chasing Amazon's tail since it launched. Key word being "chasing". SHEIN averaged a little over half of Amazon's downloads back in 2020. They got close a few times but not enough to really take the lead. In January of 2023, that changed and SHEIN's downloads are now about double those of Amazon in the US. SHEIN saw 617K downloads from the App Store + Google Play in the US last week, according to our estimates. And SHEIN isn't even Amazon's biggest threat right now but Temu, a China-based retailer that sells a variety of goods, from clothes to furniture, at very low prices, since its launch late last year. The holiday shopping season was big for Temu. It averaged 2M new downloads every week between November and December, according to our estimates. Downloads dropped since, which makes sense overall, but are still astronomically high in comparison. Temu saw 1.3M new downloads last week in the US. This is a big problem for Amazon which may mean the next Prime Day will be a little more exciting than the last few. And yes, Temu is one of the biggest spends on Apple Search Ads which helps it get those downloads. Challenges Addressed by Temu The traditional retail model is almost getting outdated thereby posing several challenges. While the “customer is always right” mantra has held true for quite some time, the amount of power wielded by consumers has never been higher than it is right now. Customers are no longer forced to choose between just a couple of options when looking to purchase new luxury goods. Not only has the number of retailers expanded exponentially in recent years, but so has the information available to customers. The amount of choice people enjoy today has also led to a waning of brand loyalty, with customers switching between retailers and online/in-store channels from purchase to purchase, depending which best serves their needs at the time. Luxury retailers are not immune to this trend either, as even wealthy customers now tend to shop around for the best option. This decline in brand loyalty customers presents a unique retailing problem, as retailers try to find new and innovative ways to appeal to buyers – both existing and potential; Consumers are Choosing Multichannel Buying Experiences: With more complete e-retail experiences available, and shipping times greatly reduced, it is little wonder around 96% of Americans utilize online shopping in one way or another. However, those same Americans spend about 65% of their total shopping budget in traditional brick-and-mortar locations. In other words, while almost everyone is shopping online, they are making more purchases in stores. Customers are moving seamlessly between online and offline experiences, and are open to retailers who can best facilitate these transitions. Closing the divide between online and offline retail, Temu solves some issues. It is focused on creating a second-to-none customer experience across all channels. Customers are looking for retailers they can trust to deliver exceptional service time and again. They have the right customer which has helped them to create an omnichannel customer experience for consumers to interact wherever and however they wish by incorporating real-time feedback across channels and devices – engaging the customer wherever they may be. Customers Expect a Seamless Experience: When transitioning between online and in-store experiences, customers not only want the same products to be available, they also want their experience to be seamless. This means, if they are a regular online customer, they want to be treated like a regular customer when they visit a brick-andmortar location. This is quite problematic. However, Temu has created this type of fluid online/offline experience for their customers, it has ceased pitting its channels against one another. Centralized customer data has helped it build a seamless, fluid experience beginning with an easily-accessible customer profile. Retailers lacks an outstanding Experience To Attract Customer Loyalty: Customer experience is the biggest contributor towards brand loyalty, the Traditional Retail model makes it difficult to build a good customer experience.Negative experience being the most significant factor in affecting a customer’s likelihood to make a repeat visit. Most customers also serve people in their own working lives, meaning when they are on the other side of the counter, they want to feel important.While promotions and offers can certainly contribute towards helping customers feel like they are special, the real key to an outstanding experience is personalization which the retail model falls short of. Getting to know customers from their previous purchases and interests can help retailers drive loyalty. These insights can be gleaned from data, or even a simple conversation.Temu addresses this challenge by rendering coupons, bonuses and reduced cost to existing and new customers. It is equally personalized with the user. A Siloed Marketing Infrastructure Makes It Expensive and Unwieldy to get Your Message Across; The traditional retail model features separate channels, which makes customer data to become siloed very easily. If all the moving parts of a marketing department are not communicating efficiently and working together, customers become overwhelmed with conflicting or repeated messages. This bombardment of marketing communications has easily had the opposite of the intended effect and driven customers to competitors with a clearer and more congruent message. The right technology and communication procedures can ensure all arms of a marketing team are on the same page. Temu as a modern retailer has been engaging with their customers across many different channels. From SMS, to email and social media, multi-channel communications are essential to engagement which, in turn, drives the creation of the perfect customer experience. So Many Technologies Exist to Drive Marketing and Sales, but They Don’t Seem to Work Together: While the amount of data gathered by businesses keeps growing at an alarming rate, the number of staff available to analyze it is staying more-or-less the same. What’s important, then, is making sure all this data is being used in the correct way and not contributing towards the data silo problem. This means finding a technology solution which can handle the huge amount of data being generated and ensure it is focused in a direction which best benefits rather than overwhelms marketing efforts. The data scientist approach to marketing is only going to become more prevalent as time goes on when creating a truly unified omnichannel service.Temu has ensured that all existing technologies work together which is why they get best results. Only in the combining of streamlined un-siloed data science, seamless cross-channel customer service and marketing, and authentic personalization, can traditional retailers create buyer experiences which can combat the fickle nature of the modern consumer and lead just like Temu. Strategies Implemented to Revolutionize The Retail Industry Temu adopted and implemented some strategies which accounted for its success. Temu’s business model is built around low prices. It offers even more discounts and lower prices than SHEIN, with special offers such as items sold for as little as one cent. Temu further differentiates itself by offering free shipping and returns to customers, which is made possible by PDD Holding’s extensive network of suppliers and shipping partners. An efficient logistics network is not to be underestimated, as problems with supply and distribution networks are seen as a major factor in the failure of Alibaba and Wish to break into the Western market.. Aside this, the following strategies were implemented; Combining Shopping and Entertainment: One-fifth of online shoppers in the U.S. say they miss the in-store shopping experience when they shop online. Temu aimed to bridge this gap and introduced games into the shopping process. By playing games like Fishland, Coin Spin, Card Flip, and others, customers can win rewards that ultimately lead to more time spent on the site and a dopamine rush from winning free items. To keep people playing these games, however, the app relies heavily on referrals, another core business strategy. These games were designed to be simple, addictive, rewarding, and increase user engagement and retention. According to app intelligence firm Sensor Tower, Temu’s average daily sessions per user in the US increased by 23% from October 2022 to January 2023. Some other games in Canada include scratch cards, card games, and cash games. Temu: Shared Shopping Experience: Group Buying is a familiar concept in Asia that Temu has extended to its Western customer base. Essentially, it has increased customers’ bargaining power by forming groups to share a bulk discount. This plays into the aforementioned referral program, which gives discounts to customers who bring new clients to the app and enables a shared shopping experience. Affiliate Programs and Heavy Advertising: As SHEIN had already proven effective, Temu sent free items to a large number of influencers and micro-influencers to promote Temu on YouTube and TikTok. A younger customer base of users under the age of 35 is particularly attractive to Temu, as younger consumers are typically less able and willing to pay large sums for products. Seeing a favorite internet personality or a personal acquaintance promoting the products has led to many young customers to imitate the purchase. Temu’s omnipresence on TikTok and YouTube is seen as a key factor in why this marketplace has taken off so quickly. A strong presence on TikTok and YouTube: Temu has leveraged the power of social media platforms, especially TikTok and YouTube, to spread awareness and generate buzz about its products and offers. The hashtag #temu on TikTok has amassed over 1.3 billion views, while Temu’s official YouTube account videos have grossed over 215 million views since last August. Temu’s marketing strategy relies on creating viral content that showcases its products entertainingly and engagingly, such as unboxing videos, product reviews, challenges, and giveaways. Temu also collaborates with influencers and celebrities with large followings on these platforms. Temu’s Audience: Temu’s primary target audience has been the young and price-conscious generation of online shoppers looking for bargains and discounts. According to a report by Daxue Consulting, the majority of Temu’s followers (32.68%) are aged 25-34, followed by 18-24 (28.57%) and 35-44 (21.43%). Temu appeals to these consumers by offering personalized recommendations based on their preferences and browsing history and gamified features that allow them to earn credits, gifts, and better deals by playing in-app games or inviting their friends to join the app. Referrals: A Win-Win Strategy for Users and Temu Temu has implemented a referral program encouraging users to invite friends and contacts to join the app in exchange for credits and gifts. Users can share their referral links or codes on social media platforms like Facebook, Instagram, and TikTok. For example, users can join a “Fashion Lovers” team and get $20 in credits by inviting five friends who also love fashion within 24 hours. These referrals help users save money on their purchases, help Temu acquire new customers, and expand its network of sellers. Temu’s Marketing and Growth Strategy that led to its Rise Temu's growth has been remarkable in a short period of time. It reached the top downloads in the shopping category of both Apple's App Store and Google Play and is quickly establishing itself as a high-potential and innovative player in the e-commerce industry. Its success is ultimately its low prices, unlocked by their innovative Next-Gen Manufacturing (NGM) model. It employed a multifaceted marketing strategy to drive user acquisition and brand awareness which has been working greatly for them; Influencer Collaborations: To reach a wider audience, Temu has been collaborating with popular social media influencers and celebrities who promoted the app and shared their shopping experiences. Influencers came from a wide range of individuals, including fashion bloggers, lifestyle influencers, beauty gurus, tech enthusiasts, or experts in specific product categories.This strategy generated buzz and created a sense of credibility and trust among potential users. This marketing strategy was successfully implemented through; Influencer Selection: Temu carefully identified and selected influencers who aligned with its target audience, brand values, and product offerings. These influencers typically had a strong online presence, a relevant niche or expertise, and a sizable following. Temu considered factors such as engagement rates, authenticity, and the influencer's ability to create appealing and relatable content. Exclusive Partnerships: Temu forged exclusive partnerships with influencers, often signing them as brand ambassadors or collaborators. These collaborations involved long-term commitments, where influencers actively promoted Temu's app and its features on their social media platforms, websites, or blogs. The exclusivity of these partnerships helped establish a strong association between the influencers and Temu, increasing brand loyalty and credibility. Sponsored Content: Temu engaged influencers to create sponsored content that showcased the app's features, user experience, and the benefits of using Temu for shopping. Influencers shared their personal experiences, demonstrated the app's functionalities, and highlighted the unique advantages of using Temu over other shopping platforms. This content was often shared through blog posts, social media posts, videos, and live streams. Product Reviews and Recommendations: Influencers played a crucial role in reviewing and recommending products available on Temu. They shared their honest opinions and experiences using products from various brands. Their reviews and recommendations helped build trust and credibility among their followers, encouraging them to explore and purchase products through Temu. Giveaways and Contests: Temu collaborated with influencers to host giveaways and contests, where users had the chance to win exclusive prizes or discounts by engaging with the app or participating in specific promotional activities. These initiatives created buzz, generated user excitement, and attracted new users to the platform. Affiliate Marketing: Temu employed affiliate marketing strategies with influencers, where influencers received a commission or referral fee for every user who downloaded the app or made a purchase through their unique referral links. This incentivized influencers to actively promote Temu and its offerings, as their earnings were directly tied to the success of their referrals. Event Participation: Temu partnered with influencers for events such as product launches, fashion shows, or brand campaigns. Influencers attended these events, shared live updates, and provided behind-the-scenes content to their followers, creating a sense of exclusivity and fostering excitement around Temu's activities. User-generated Content: Temu encouraged influencers and their followers to create usergenerated content related to the app. This could include unboxing videos, styling tips, or hauls showcasing products purchased through Temu. Such content served as social proof and encouraged other users to engage with the app and make purchases. Overall, Temu's collaborations with influencers helped amplify its brand message, expand its reach to new audiences, and establish credibility within the social media landscape. By leveraging the influence and creative abilities of influencers, Temu successfully tapped into their followers' trust and engagement, driving user acquisition, and fostering a positive brand image. User Referral Program: Temu has been incentivizing existing users to refer the app to their friends and family by offering discounts or exclusive rewards. This word-of-mouth marketing approach contributed to the app's exponential growth and user acquisition. Targeted Digital Advertising: Temu has been leveraging targeted digital advertising campaigns across various digital platforms like Facebook, Instagram, Twitter, TikTok and soon Telegram focusing on specific demographics and user segments. By tailoring their messaging and creative assets, Temu effectively reached potential users with personalized content. Expansion into New Markets: After gaining traction in its home market, Temu has been expanding its operations into international markets. It strategically entered regions with high smartphone penetration and a growing ecommerce ecosystem. This expansion allowed Temu to tap into a larger customer base and establish itself as a global player in the shopping app industry. Partnerships with Brands and Retailers: Recognizing the importance of strategic alliances, Temu has been forging partnerships with renowned brands and retailers. These collaborations involved exclusive product launches, limitededition collections, and promotional campaigns. By aligning with established names in the retail industry, Temu gained credibility and attracted a wider range of customers. Continuous Innovation: Temu has been prioritizing continuous innovation to stay ahead of the competition. It regularly updated its app with new features and enhancements based on user feedback and emerging trends. For example, it introduced a virtual stylist feature that offered personalized fashion advice and styling tips, further enhancing the user experience. Data-driven Insights: Temu has been leveraging the vast amount of user data it collected to gain valuable insights into consumer behavior, preferences, and trends. These insights were used to refine its product offering, improve targeted advertising efforts, and optimize the overall shopping experience. By harnessing the power of data, Temu was able to make data-informed decisions and stay attuned to evolving customer needs. Seamless Integration with Physical Stores: Recognizing the importance of the omnichannel experience, Temu has been integrating its app with physical stores. It introduced features like in-store barcode scanning, which allowed users to access product information, read reviews, and make purchases directly from their smartphones while inside partner retail locations. This integration blurred the lines between online and offline shopping and provided a seamless and unified experience. Social Impact Initiatives: Temu also has also been focusing on social impact initiatives to connect with socially conscious consumers. It launched sustainable product collections, partnered with NGOs for charitable causes, and implemented eco-friendly packaging practices. These initiatives resonated with environmentally and socially conscious users, further strengthening Temu's brand reputation and loyalty. Continuous Customer Support: Temu has been placing strong emphasis on customer support and responsiveness. It established dedicated customer service channels, including live chat support and a comprehensive FAQ section. Timely and effective customer support enhanced user satisfaction, resolved issues promptly, and fostered a positive brand image. A heavy paid media strategy: Like other well-funded internet companies, Temu appears to be spending heavily for app installs and on search ads. Search for almost any commodity product—especially if your search includes the word “cheap”—and you’re likely to find a Google result for Temu. Temu also gained attention with multiple Super Bowl spots, putting it on the map for many US consumers for the first time. Results and Impacts The rise of Temu as a shopping app has revolutionized the Retail Industry and also Consumer Experience; User Base and Revenue Growth: Within two years of its launch, Temu has amassed millions of active users and experienced exponential revenue growth. Its user-centric approach and innovative features resonated with consumers, driving adoption and usage. Enhanced Customer Experience: Temu's focus on personalization, convenience, and seamless shopping experiences has elevated customer satisfaction levels. Users appreciated the ability to try on products virtually, receive tailored recommendations, and enjoy hassle-free transactions. Disruption of Traditional Retail: The Traditional Retail industry has suffered relatively as a result of the rise of Temu as a Shopping App. It has greatly disrupted traditional brick-and-mortar retail, with many businesses. This is so because with their new innovation, they have explored other parts(online) which the traditional retailers do not have. Its rise has posed several challenges for traditional retailers as they struggle to adapt to the changing landscape; Online Presence and Digital Transformation: Traditional retailers are still struggling with establishing a strong online presence and undergoing digital transformation. Building and maintaining an effective e-commerce website or app requires technical expertise, investment in infrastructure, and a shift in mindset. Adapting to the digital realm is now very challenging for retailers who have primarily operated in brick-and-mortar stores. Competition with E-commerce Giants: E-commerce platforms like Temu with significant resources, a broad customer base, and strong brand recognition which makes it difficult for Traditional retailers to compete with in terms of pricing, product selection, and customer convenience. It can be challenging for them to match the speed, efficiency, and scale of operations offered by online marketplaces. Supply Chain and Logistics: Traditional retailers have gotten used to managing inventory primarily for physical stores and now face challenges in adapting their supply chain and logistics operations to accommodate online sales. Efficient inventory management, order fulfillment, and last-mile delivery is quite complex and requires adjustments to meet the demands of e-commerce customers. Customer Expectations and Experience: Online shoppers have come to expect a seamless and personalized shopping experience. Traditional retailers now struggle to meet these expectations, especially provided they have very limited experience in online customer engagement, personalization, and tailoring recommendations. Adapting to a customer-centric approach and providing a consistent omnichannel experience can be a significant challenge. Data and Analytics: E-commerce platforms like Temu rely heavily on data and analytics to understand customer behavior, preferences, and trends. Traditional retailers have limited experience in collecting, analyzing, and utilizing customer data effectively. Harnessing data to make data-driven decisions and optimize operations is now a significant hurdle for retailers transitioning to an online model. Operational Costs and Margins: Traditional retailers are facing financial challenges to adapt to ecommerce. Online operations require investments in technology, infrastructure, marketing, and fulfillment capabilities. Retailers need to reevaluate their pricing strategies, optimize operational costs, and find ways to maintain profitability in the face of increased competition and potentially lower margins. Brand Differentiation and Customer Loyalty: Building a strong brand and fostering customer loyalty has proven to be more challenging in the online space. Traditional retailers may have developed a loyal customer base through in-person interactions and personalized service. Translating that loyalty to the digital realm and effectively differentiating their brand from competitors needs innovative strategies and marketing efforts which will take time. By leveraging technology and understanding evolving consumer behaviors, Temu has disrupted the retail industry, reshaped shopping habits, and set new standards for convenience and engagement in the digital age; Temu’s Setbacks Despite its rapid rise, its relationship with sister company Pinduoduo has brought about several challenges in delivery of goods as compared to its competitors and other areas; According to reports published in Times, Temu is beginning to develop a reputation for undelivered packages, mysterious charges, incorrect orders and unresponsive customer service. Temu itself acknowledges that its orders take longer to arrive than those from Amazon—typically 7-15 business days as they come from “overseas warehouses.” In a series of Facebook messages with Times, Roper Malloy, a client complained of spending $178 on gifts from Temu for her family, including two drones and some makeup for her daughter which has never arrived. She said she has contacted the company several times for a refund, which has also yet to arrive. On May 17, 2023, Montana Governor Greg Gianforte banned Temu from statewide government devices, as well as ByteDance apps (including TikTok ) , Telegram , and WeChat. In June 2023, the U.S. House Select Committee on U.S.- Chinese Communist Party Strategic Competition stated that Temu did not maintain "even the facade of a meaningful compliance program" with the law. Uyghur on Forced Labor Prevention to keep goods made by forced labor off its platform. In October, the Boston branch of the Better Business Bureau opened up a file on Temu and has received 31 complaints about the website. Temu currently has a C rating on the BBB, and an average customer rating of 1.4 stars out of 5, although from only 20 reviews. (Complaints are separate from reviews, which do not factor into BBB’s official rating.) McGovern at the BBB mentioned that, it’s unusual for such a new company to receive so many complaints in such a short amount of time. Temu has acknowledged and responded to every complaint posted to the BBB website, but many of those complaints remain unresolved. Temu’s sister company, Pinduoduo, has long been accused of hosting sales of counterfeits, illegal goods, or products that do not match their descriptions. (Pinduoduo wrote in its SEC filings that it immediately removes unauthorized products or misleading information on its platform, and freezes the accounts of sellers on the site who violate its policies.) There have been no BBB complaints that allege the goods Temu ships are counterfeit or fake. Additionally, in 2021, the deaths of two Pinduoduo employees spurred investigations and boycotts over the company’s working conditions, according to the New York Times. How Temu could affect the U.S. economy In May 2023, the U.S.-China Economic and Security Review Commission raised concerns about risks to users' personal data on Temu as a shopping app affiliated with Pinduoduo, which was removed from Google Play after some of its versions were found to contain malware. Schmidt, at Vanderbilt, who specializes in security and privacy, is of the opinion that Temu’s data and privacy practices aren’t out of the ordinary; The company collects lots of personal data about users and then deploys that data to sell ads. However, he says that Temu’s rise could have a bigger impact not in terms of privacy concerns, but in terms of pressure on American companies and workers. If more and more American consumers flock to Temu to buy cut-rate goods, that could pressure Amazon and other competitors to slash their prices too which would affect wages. Areas for Improvements Despite its innovative business model and commitment to sustainability, Temu still has some areas that need improvement; Real-Time Shopping: Cost-Effectiveness vs. Plagiarism and Exploitation: Temu’s most innovative and effective strategy has been highly ambivalent and criticized. Similar to SHEIN, Temu has been using a reverse-manufacturing model that relays customer feedback directly to manufacturers. Starting off with smaller quantities that are offered on the marketplace, products in high demand are reordered, while others are replaced. According to Temu, this results in environmental efficiency because product inventory is aligned with customer demand in real time. In addition, a greater number of products can be offered than with traditional retail strategies. With this method, SHEIN was able to launch 150,000 new items in 2020, beating its competitors by a wide margin. Temu Has to Fight Criticism: Critics point to several detrimental effects of this type of 'ultra-fast' commerce: To ensure low prices, manufacturers must keep costs down, contributing to the continued poverty of workers in manufacturing countries. The same goes for product quality and environmental friendliness: Cheap products that break easily contribute to increasing amounts of waste, returned products tend to be dumped rather than recycled or resold, and the high number of new products sold is only possible by ripping off SME fashion designers and creators. TrustPilot reviews reveal a 2.9-star average, with the majority of one-star reviews citing long shipping times, low-quality items, and poor customer service. Low quality items can become a sustainability issue in itself, since those products have a higher chance of ending up in landfill. It’s essential for Temu to address these concerns and maintain a balance between low prices and customer satisfaction. Lessons Learned Temu's rise as a shopping app exemplifies the transformative power of technology in the retail industry. Its success serves as an inspiration for other businesses seeking to adapt and thrive in the digital era. Overall, the rise of Temu as a shopping app has been driven by its commitment to innovation, personalized experiences, strategic partnerships, and a customer-centric approach. The marketplace Temu has achieved impressive success with its business model of offering low-priced products and free shipping, combined with a gamified shopping experience. Temu's strategy also includes group buying, referrals, affiliate programs, and heavy advertising on social media platforms. While Temu's real-time shopping model, which involves relaying customer feedback directly to manufacturers, is seen as innovative and cost-effective, it has also garnered criticism. Critics argue that this approach can lead to environmental issues, exploitation of workers, and plagiarism of designs from small and medium-sized fashion creators. Despite these concerns, Temu's combination of low prices, gamified shopping, and heavy advertising on platforms like TikTok and YouTube has made it a major player in the ultra-fast eCommerce sector. However, Temu's most controversial strategy is its real-time shopping model akin to that of SHEIN, which relays customer feedback directly to manufacturers. While this model increases costeffectiveness and product variety, critics argue that it contributes to environmental degradation, exploitation of workers, and plagiarism of fashion designers. Nonetheless, Temu's growth and distinct strategy make it a noteworthy player in this emerging business model of ultra-fast eCommerce, and it will be interesting to see how this trend plays out in the future. Actionable Takeaways for other Businesses in the Retail Industry Traditional Retailers who wish to also rise like Temu should consider the following steps; Develop a User-Friendly E-commerce Website: Create a well-designed, intuitive, and user-friendly e-commerce website that offers a seamless shopping experience. Ensure that the website is responsive, optimized for mobile devices, and provides easy navigation, product search, and checkout processes. Emphasize Branding and Differentiation: Clearly define the brand identity and unique selling propositions of your retail business. Highlight what sets your products apart from competitors and communicate a compelling brand story to engage online customers. Use high-quality visuals and persuasive copywriting to convey your brand message effectively. Optimize for Search Engines: Implement search engine optimization (SEO) techniques to improve the visibility of your website in search engine results. Conduct keyword research to understand the terms and phrases your target audience is searching for, and optimize your website's content, meta tags, and URLs accordingly. Leverage Social Media: Use social media platforms to build an online community, engage with customers, and promote your products. Regularly post engaging content, including product updates, customer testimonials, and behind-the-scenes glimpses. Encourage user-generated content and respond promptly to customer inquiries and feedback. Invest in Digital Marketing: Develop a comprehensive digital marketing strategy that includes online advertising, email marketing, influencer collaborations, and content marketing. Target specific customer segments and utilize data-driven approaches to reach your audience effectively and drive traffic to your website. Provide Excellent Customer Service: Offer exceptional customer service across all online channels, including live chat, email, and social media. Respond promptly to customer inquiries, provide accurate product information, and address any issues or concerns in a timely manner. Personalize the customer experience as much as possible to build trust and loyalty. Implement Online Customer Engagement Tools: Incorporate tools such as live chat, product reviews, ratings, and personalized recommendations to enhance customer engagement and create a sense of interactivity on your website. Encourage customer feedback and testimonials to build social proof and credibility. Collaborate with Influencers and Online Communities: Partner with relevant influencers or online communities in your industry to extend your reach and tap into their established audiences. Engage in collaborations, product reviews, or sponsorships to increase brand visibility and credibility. Analyze and Optimize: Continuously monitor and analyze website metrics, customer behavior, and online marketing campaigns. Utilize analytics tools to gain insights into what is working and what needs improvement. Optimize your online presence based on data-driven decisions to enhance the user experience and drive conversions. Adapt to Changing Trends: Stay up to date with the latest e-commerce trends, technologies, and consumer preferences. Be willing to experiment, adapt, and embrace new technologies or platforms that can enhance your online presence and provide a competitive edge. By implementing these strategies, traditional retailers can establish a strong online presence, attract online customers, and compete effectively in the digital marketplace. It's important to continuously evaluate and refine your online presence based on customer feedback, market trends, and emerging technologies to stay ahead of the competition. Future Outlook The rise of Temu as a shopping app has been remarkable, and it has successfully disrupted the retail experience by implementing innovative strategies and business models. Looking ahead, there are several key factors that will shape the future outlook of Temu and determine its continued success in the competitive online shopping market; Expansion into New Markets: Temu has already expanded its operations to several countries, including the US, Canada, Australia, New Zealand, France, Italy, Germany, the Netherlands, Spain, and the United Kingdom. To sustain its growth, Temu will likely continue to explore opportunities for expansion into new markets, both within and outside of these regions. This expansion will allow the platform to reach a larger customer base and tap into new consumer preferences and demands. Improvement in Delivery Times: One area of concern for customers is the longer delivery times associated with Temu's Next-Gen Manufacturing (NGM) model. To address this issue, Temu may invest in optimizing its supply chain and logistics processes. By streamlining operations and partnering with efficient shipping providers, Temu can reduce delivery times and enhance the overall customer experience. Enhanced Customer Engagement: Temu's success is partly attributed to its gamification strategies and social commerce approach. To maintain customer engagement and loyalty, Temu will need to continuously innovate and introduce new features that incentivize users to stay active on the platform. This could include personalized recommendations, rewards programs, and interactive shopping experiences. Sustainability and Social Responsibility: Temu has positioned itself as a platform that promotes sustainability and social responsibility through its NGM model, which reduces unsold inventory and waste. Going forward, it will be crucial for Temu to uphold these values and communicate its commitment to sustainability to customers. This can be achieved through transparent supply chain practices, eco-friendly packaging options, and partnerships with ethical suppliers. Competition and Differentiation: While Temu has gained significant traction, it faces strong competition from other Chinese online wholesale platforms and established e-commerce giants. To stay ahead, Temu will need to continue differentiating itself through its NGM model, competitive pricing, and unique product offerings. It should also focus on building a strong brand identity and nurturing customer trust through excellent customer service and reliable purchase protection. navigate the competitive landscape. With its innovative approach and commitment to customer satisfaction, Temu has the potential to continue reshaping the online Conclusion Conclusively, Temu has emerged as a shopping app that is revolutionizing the retail experience through its Next-Gen Manufacturing model and direct-to-supplier approach. By focusing on cost savings, customization, and sustainability, Temu has gained a competitive edge in the market. With a lot of consumer goods being produced in China it makes sense that more and more e-commerce platforms are Chinese. The success of Temu and its competitors showcases the power of connecting customers directly with suppliers, ultimately reshaping the way people shop online. TEMU's emergence in the e-commerce landscape with its lightning-fast shipping times has undoubtedly stirred the industry. By setting new standards for efficiency and customer satisfaction, TEMU challenges traditional platforms to step up their game. While the convenience of rapid shipping is undeniable, the long-term sustainability and overall impact of this approach must also be considered. As consumers continue to prioritize convenience and speed, the success of TEMU may very well influence how the e-commerce ecosystem evolves in the years to come. However, to sustain its growth and success, Temu must adapt to evolving customer preferences, optimize its operations, and effectively.
USER:
What factors led to Temu's success?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 12 | 6 | 8,937 | null | 528 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
Analyzing the impact of new technologies and shifting legislation, how did compliance of the new financial technologies, for instance, blockchain and cryptocurrency, evolve? Also, what are the consequences for retail and product industries in the aspects of cybersecurity and consumers’ protection? Kindly write the paper outlining the following and including specific regulations/technological advancement, and effects on operational financial compliance and safety of retail products.
|
In recent years, blockchain and cryptocurrency technologies have disrupted traditional financial systems, bringing about significant changes in compliance and regulatory frameworks. This article explores how these technologies influence financial regulations and their broader implications for various industries, including retail and cybersecurity. Blockchain and Cryptocurrency: A Brief Overview Blockchain technology, which underpins cryptocurrencies like Bitcoin and Ethereum, is a decentralized ledger that records transactions across a network of computers. Its features—transparency, security, and immutability—pose both opportunities and challenges for financial regulators. Cryptocurrencies, digital assets using cryptography for security, have gained prominence as alternative investment vehicles and payment methods. Impact on Financial Regulation The rise of cryptocurrencies has led to a reevaluation of financial regulations. Traditional financial systems are governed by a range of regulations designed to prevent fraud, money laundering, and other illicit activities. As cryptocurrencies operate outside conventional banking systems, regulators have had to adapt their approaches to address these new challenges. Anti-Money Laundering (AML) and Know Your Customer (KYC) Regulations: Cryptocurrencies have attracted regulatory attention due to their potential for facilitating money laundering and other illegal activities. In response, jurisdictions like the European Union have enacted measures such as the Fifth Anti-Money Laundering Directive (5AMLD), which requires cryptocurrency exchanges and wallet providers to comply with AML and KYC regulations. This includes verifying customer identities and monitoring transactions to prevent illicit activities. Financial Action Task Force (FATF) Guidelines: The FATF, an international body that sets standards for combating money laundering and terrorist financing, has issued guidelines for the cryptocurrency industry. These guidelines mandate that virtual asset service providers (VASPs) adhere to similar regulatory standards as traditional financial institutions, including transaction monitoring and reporting requirements. Regulatory Responses in Different Regions: Different countries have taken varied approaches to cryptocurrency regulation. For instance, the United States has implemented a patchwork of federal and state regulations, with agencies like the Securities and Exchange Commission (SEC) and the Commodity Futures Trading Commission (CFTC) overseeing different aspects of the market. In contrast, countries like China have imposed strict bans on cryptocurrency trading and mining, reflecting a more cautious stance. Implications for Retail and Product Industries The adoption of cryptocurrencies in retail and product industries introduces both opportunities and risks. As more retailers accept digital currencies as payment, they must navigate new regulatory and cybersecurity challenges. Cybersecurity Concerns: Retailers accepting cryptocurrencies must enhance their cybersecurity measures to protect against potential breaches. Blockchain technology, while secure, is not immune to attacks. Hacks targeting cryptocurrency exchanges and digital wallets have highlighted the need for robust security protocols. Retailers must invest in secure payment systems and educate staff on best practices for managing digital assets. Consumer Protection: The use of cryptocurrencies in retail transactions raises questions about consumer protection. Regulatory bodies are working to establish standards for ensuring fair practices and protecting consumer rights. For example, regulations may require retailers to provide clear information about the risks associated with cryptocurrency transactions and to implement mechanisms for resolving disputes. Impact on Product Safety: In the product sector, the integration of blockchain technology offers potential benefits such as improved traceability and transparency in supply chains. Blockchain can be used to track the provenance of goods, verify authenticity, and ensure compliance with safety standards. However, the technology also necessitates updates to existing regulatory frameworks to address issues related to data privacy and accuracy. Conclusion Blockchain and cryptocurrency technologies are reshaping the financial landscape, prompting significant changes in regulatory frameworks. As these technologies continue to evolve, regulators and industries must adapt to new challenges and opportunities. By staying informed and proactive, stakeholders can navigate the complexities of the digital economy while ensuring compliance and protecting consumer interests.
|
"================ <TEXT PASSAGE> ======= In recent years, blockchain and cryptocurrency technologies have disrupted traditional financial systems, bringing about significant changes in compliance and regulatory frameworks. This article explores how these technologies influence financial regulations and their broader implications for various industries, including retail and cybersecurity. Blockchain and Cryptocurrency: A Brief Overview Blockchain technology, which underpins cryptocurrencies like Bitcoin and Ethereum, is a decentralized ledger that records transactions across a network of computers. Its features—transparency, security, and immutability—pose both opportunities and challenges for financial regulators. Cryptocurrencies, digital assets using cryptography for security, have gained prominence as alternative investment vehicles and payment methods. Impact on Financial Regulation The rise of cryptocurrencies has led to a reevaluation of financial regulations. Traditional financial systems are governed by a range of regulations designed to prevent fraud, money laundering, and other illicit activities. As cryptocurrencies operate outside conventional banking systems, regulators have had to adapt their approaches to address these new challenges. Anti-Money Laundering (AML) and Know Your Customer (KYC) Regulations: Cryptocurrencies have attracted regulatory attention due to their potential for facilitating money laundering and other illegal activities. In response, jurisdictions like the European Union have enacted measures such as the Fifth Anti-Money Laundering Directive (5AMLD), which requires cryptocurrency exchanges and wallet providers to comply with AML and KYC regulations. This includes verifying customer identities and monitoring transactions to prevent illicit activities. Financial Action Task Force (FATF) Guidelines: The FATF, an international body that sets standards for combating money laundering and terrorist financing, has issued guidelines for the cryptocurrency industry. These guidelines mandate that virtual asset service providers (VASPs) adhere to similar regulatory standards as traditional financial institutions, including transaction monitoring and reporting requirements. Regulatory Responses in Different Regions: Different countries have taken varied approaches to cryptocurrency regulation. For instance, the United States has implemented a patchwork of federal and state regulations, with agencies like the Securities and Exchange Commission (SEC) and the Commodity Futures Trading Commission (CFTC) overseeing different aspects of the market. In contrast, countries like China have imposed strict bans on cryptocurrency trading and mining, reflecting a more cautious stance. Implications for Retail and Product Industries The adoption of cryptocurrencies in retail and product industries introduces both opportunities and risks. As more retailers accept digital currencies as payment, they must navigate new regulatory and cybersecurity challenges. Cybersecurity Concerns: Retailers accepting cryptocurrencies must enhance their cybersecurity measures to protect against potential breaches. Blockchain technology, while secure, is not immune to attacks. Hacks targeting cryptocurrency exchanges and digital wallets have highlighted the need for robust security protocols. Retailers must invest in secure payment systems and educate staff on best practices for managing digital assets. Consumer Protection: The use of cryptocurrencies in retail transactions raises questions about consumer protection. Regulatory bodies are working to establish standards for ensuring fair practices and protecting consumer rights. For example, regulations may require retailers to provide clear information about the risks associated with cryptocurrency transactions and to implement mechanisms for resolving disputes. Impact on Product Safety: In the product sector, the integration of blockchain technology offers potential benefits such as improved traceability and transparency in supply chains. Blockchain can be used to track the provenance of goods, verify authenticity, and ensure compliance with safety standards. However, the technology also necessitates updates to existing regulatory frameworks to address issues related to data privacy and accuracy. Conclusion Blockchain and cryptocurrency technologies are reshaping the financial landscape, prompting significant changes in regulatory frameworks. As these technologies continue to evolve, regulators and industries must adapt to new challenges and opportunities. By staying informed and proactive, stakeholders can navigate the complexities of the digital economy while ensuring compliance and protecting consumer interests. https://www.fatf-gafi.org/en/publications/Fatfrecommendations/targeted-update-virtual-assets-vasps-2024.html ================ <QUESTION> ======= Analyzing the impact of new technologies and shifting legislation, how did compliance of the new financial technologies, for instance, blockchain and cryptocurrency, evolve? Also, what are the consequences for retail and product industries in the aspects of cybersecurity and consumers’ protection? Kindly write the paper outlining the following and including specific regulations/technological advancement, and effects on operational financial compliance and safety of retail products. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
In recent years, blockchain and cryptocurrency technologies have disrupted traditional financial systems, bringing about significant changes in compliance and regulatory frameworks. This article explores how these technologies influence financial regulations and their broader implications for various industries, including retail and cybersecurity. Blockchain and Cryptocurrency: A Brief Overview Blockchain technology, which underpins cryptocurrencies like Bitcoin and Ethereum, is a decentralized ledger that records transactions across a network of computers. Its features—transparency, security, and immutability—pose both opportunities and challenges for financial regulators. Cryptocurrencies, digital assets using cryptography for security, have gained prominence as alternative investment vehicles and payment methods. Impact on Financial Regulation The rise of cryptocurrencies has led to a reevaluation of financial regulations. Traditional financial systems are governed by a range of regulations designed to prevent fraud, money laundering, and other illicit activities. As cryptocurrencies operate outside conventional banking systems, regulators have had to adapt their approaches to address these new challenges. Anti-Money Laundering (AML) and Know Your Customer (KYC) Regulations: Cryptocurrencies have attracted regulatory attention due to their potential for facilitating money laundering and other illegal activities. In response, jurisdictions like the European Union have enacted measures such as the Fifth Anti-Money Laundering Directive (5AMLD), which requires cryptocurrency exchanges and wallet providers to comply with AML and KYC regulations. This includes verifying customer identities and monitoring transactions to prevent illicit activities. Financial Action Task Force (FATF) Guidelines: The FATF, an international body that sets standards for combating money laundering and terrorist financing, has issued guidelines for the cryptocurrency industry. These guidelines mandate that virtual asset service providers (VASPs) adhere to similar regulatory standards as traditional financial institutions, including transaction monitoring and reporting requirements. Regulatory Responses in Different Regions: Different countries have taken varied approaches to cryptocurrency regulation. For instance, the United States has implemented a patchwork of federal and state regulations, with agencies like the Securities and Exchange Commission (SEC) and the Commodity Futures Trading Commission (CFTC) overseeing different aspects of the market. In contrast, countries like China have imposed strict bans on cryptocurrency trading and mining, reflecting a more cautious stance. Implications for Retail and Product Industries The adoption of cryptocurrencies in retail and product industries introduces both opportunities and risks. As more retailers accept digital currencies as payment, they must navigate new regulatory and cybersecurity challenges. Cybersecurity Concerns: Retailers accepting cryptocurrencies must enhance their cybersecurity measures to protect against potential breaches. Blockchain technology, while secure, is not immune to attacks. Hacks targeting cryptocurrency exchanges and digital wallets have highlighted the need for robust security protocols. Retailers must invest in secure payment systems and educate staff on best practices for managing digital assets. Consumer Protection: The use of cryptocurrencies in retail transactions raises questions about consumer protection. Regulatory bodies are working to establish standards for ensuring fair practices and protecting consumer rights. For example, regulations may require retailers to provide clear information about the risks associated with cryptocurrency transactions and to implement mechanisms for resolving disputes. Impact on Product Safety: In the product sector, the integration of blockchain technology offers potential benefits such as improved traceability and transparency in supply chains. Blockchain can be used to track the provenance of goods, verify authenticity, and ensure compliance with safety standards. However, the technology also necessitates updates to existing regulatory frameworks to address issues related to data privacy and accuracy. Conclusion Blockchain and cryptocurrency technologies are reshaping the financial landscape, prompting significant changes in regulatory frameworks. As these technologies continue to evolve, regulators and industries must adapt to new challenges and opportunities. By staying informed and proactive, stakeholders can navigate the complexities of the digital economy while ensuring compliance and protecting consumer interests.
USER:
Analyzing the impact of new technologies and shifting legislation, how did compliance of the new financial technologies, for instance, blockchain and cryptocurrency, evolve? Also, what are the consequences for retail and product industries in the aspects of cybersecurity and consumers’ protection? Kindly write the paper outlining the following and including specific regulations/technological advancement, and effects on operational financial compliance and safety of retail products.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 64 | 603 | null | 300 |
Answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points.
|
Summarize why pain control is important.
|
Vital Signs The surgeon, anesthesiologist, physician’s assistant, or nurse practitioner will write an order that specifies how often the vital signs should be checked. Measuring the pulse and blood pressure every 15 minutes in the first hour after the operation is not unusual. The CNA should always let the supervising nurse or physician know about a fever or an abnormal pulse or blood pressure. This is especially important when caring for a post-operative patient. Slight deviations of pulse and blood pressure may be normal after surgery, but these should still be reported. It should not be assumed that a pulse greater than 100, or a systolic blood pressure that is low, are of no concern. Mental Status Drowsiness is expected after surgery. This can be minimal or it may be significant. However, excessive drowsiness or drowsiness that is not improving is not normal. A nurse or physician should be informed if a patient’s mental status appears abnormal. Pain Pain is inevitable following surgery. An incision has been made through the skin, and the swelling and bleeding at the incision increase pressure on nerve endings, contributing to the pain. Some patients will inform the CNA or nurse about their pain and request medications, but others will not. The CNA should always ask the post-operative patient if pain is occurring, but should also be observant to recognize the nonverbal signs of pain. A patient may decide to endure the pain without taking pain medication because of feeling wary about accepting medication. Aside from specifically asking the patient about pain, the CNA should look for objective information and nonverbal cues that indicate the presence of pain. Does the patient grimace when asked to move? Is the patient hesitant about performing coughing and deep breathing exercises? Is the patient’s blood pressure and heart rate elevated? If the patient is showing evidence of any of the above, the CNA may reasonably assume that a significant level of pain is occurring. Pain control is important as it increases patient compliance with post-operative movement and surgical wound healing measures, and the speed of recovery. It is also important to address physical suffering in the post-operative phase to improve standard quality measures of patient comfort during hospital care. The level of pain a patient has will depend in part on what operation was performed. The pain associated with a minor procedure should be mild, but if the patient has had a major orthopedic surgery, such as hip surgery, the pain can be severe. There is no “normal” level of pain and each person has an individual level of tolerance. If the procedure was a simple one, and the patient is significantly uncomfortable, this may indicate a problem. If the CNA notices the patient is uncomfortable, a nurse or physician should always be informed. If the patient is requesting pain medication more frequently than it has been prescribed, this is a warning sign. Many healthcare facilities use pain scales to assess a patient’s level of pain. A typical pain scale is the 1-10 scale. The patient is asked to remember the worst pain ever experienced and consider that a level 10. The patient is then asked to remember a painful experience that was very minor and consider that a level 1. After that, the patient is asked to assign the current level of pain a number on the 1-10 pain scale. The CNA would ask the patient, for example, “If the worst pain you have ever felt was a 10 and a very minor pain you’ve experienced was a 1, what would you consider your current level of pain to be?” Surgical Dressing A surgical dressing is a sterile cover applied over the incision. A dressing can be a small bandage, or it may be a large, complicated affair with gauze pads and tape. The surgeon will write orders that specify how to care for the dressing. It is very important to follow these orders exactly. The CNA should not change or adjust the dressing in any way that has not been ordered. The dressing should be checked frequently to make sure it is intact and that there are no loose edges. Any bleeding or unusual drainage should be noted, and if the CNA notices either one, a supervising nurse or physician needs to be notified.
|
Answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points. Summarize why pain control is important. Vital Signs The surgeon, anesthesiologist, physician’s assistant, or nurse practitioner will write an order that specifies how often the vital signs should be checked. Measuring the pulse and blood pressure every 15 minutes in the first hour after the operation is not unusual. The CNA should always let the supervising nurse or physician know about a fever or an abnormal pulse or blood pressure. This is especially important when caring for a post-operative patient. Slight deviations of pulse and blood pressure may be normal after surgery, but these should still be reported. It should not be assumed that a pulse greater than 100, or a systolic blood pressure that is low, are of no concern. Mental Status Drowsiness is expected after surgery. This can be minimal or it may be significant. However, excessive drowsiness or drowsiness that is not improving is not normal. A nurse or physician should be informed if a patient’s mental status appears abnormal. Pain Pain is inevitable following surgery. An incision has been made through the skin, and the swelling and bleeding at the incision increase pressure on nerve endings, contributing to the pain. Some patients will inform the CNA or nurse about their pain and request medications, but others will not. The CNA should always ask the post-operative patient if pain is occurring, but should also be observant to recognize the nonverbal signs of pain. A patient may decide to endure the pain without taking pain medication because of feeling wary about accepting medication. Aside from specifically asking the patient about pain, the CNA should look for objective information and nonverbal cues that indicate the presence of pain. Does the patient grimace when asked to move? Is the patient hesitant about performing coughing and deep breathing exercises? Is the patient’s blood pressure and heart rate elevated? If the patient is showing evidence of any of the above, the CNA may reasonably assume that a significant level of pain is occurring. Pain control is important as it increases patient compliance with post-operative movement and surgical wound healing measures, and the speed of recovery. It is also important to address physical suffering in the post-operative phase to improve standard quality measures of patient comfort during hospital care. The level of pain a patient has will depend in part on what operation was performed. The pain associated with a minor procedure should be mild, but if the patient has had a major orthopedic surgery, such as hip surgery, the pain can be severe. There is no “normal” level of pain and each person has an individual level of tolerance. If the procedure was a simple one, and the patient is significantly uncomfortable, this may indicate a problem. If the CNA notices the patient is uncomfortable, a nurse or physician should always be informed. If the patient is requesting pain medication more frequently than it has been prescribed, this is a warning sign. Many healthcare facilities use pain scales to assess a patient’s level of pain. A typical pain scale is the 1-10 scale. The patient is asked to remember the worst pain ever experienced and consider that a level 10. The patient is then asked to remember a painful experience that was very minor and consider that a level 1. After that, the patient is asked to assign the current level of pain a number on the 1-10 pain scale. The CNA would ask the patient, for example, “If the worst pain you have ever felt was a 10 and a very minor pain you’ve experienced was a 1, what would you consider your current level of pain to be?” Surgical Dressing A surgical dressing is a sterile cover applied over the incision. A dressing can be a small bandage, or it may be a large, complicated affair with gauze pads and tape. The surgeon will write orders that specify how to care for the dressing. It is very important to follow these orders exactly. The CNA should not change or adjust the dressing in any way that has not been ordered. The dressing should be checked frequently to make sure it is intact and that there are no loose edges. Any bleeding or unusual drainage should be noted, and if the CNA notices either one, a supervising nurse or physician needs to be notified.
|
Answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points.
EVIDENCE:
Vital Signs The surgeon, anesthesiologist, physician’s assistant, or nurse practitioner will write an order that specifies how often the vital signs should be checked. Measuring the pulse and blood pressure every 15 minutes in the first hour after the operation is not unusual. The CNA should always let the supervising nurse or physician know about a fever or an abnormal pulse or blood pressure. This is especially important when caring for a post-operative patient. Slight deviations of pulse and blood pressure may be normal after surgery, but these should still be reported. It should not be assumed that a pulse greater than 100, or a systolic blood pressure that is low, are of no concern. Mental Status Drowsiness is expected after surgery. This can be minimal or it may be significant. However, excessive drowsiness or drowsiness that is not improving is not normal. A nurse or physician should be informed if a patient’s mental status appears abnormal. Pain Pain is inevitable following surgery. An incision has been made through the skin, and the swelling and bleeding at the incision increase pressure on nerve endings, contributing to the pain. Some patients will inform the CNA or nurse about their pain and request medications, but others will not. The CNA should always ask the post-operative patient if pain is occurring, but should also be observant to recognize the nonverbal signs of pain. A patient may decide to endure the pain without taking pain medication because of feeling wary about accepting medication. Aside from specifically asking the patient about pain, the CNA should look for objective information and nonverbal cues that indicate the presence of pain. Does the patient grimace when asked to move? Is the patient hesitant about performing coughing and deep breathing exercises? Is the patient’s blood pressure and heart rate elevated? If the patient is showing evidence of any of the above, the CNA may reasonably assume that a significant level of pain is occurring. Pain control is important as it increases patient compliance with post-operative movement and surgical wound healing measures, and the speed of recovery. It is also important to address physical suffering in the post-operative phase to improve standard quality measures of patient comfort during hospital care. The level of pain a patient has will depend in part on what operation was performed. The pain associated with a minor procedure should be mild, but if the patient has had a major orthopedic surgery, such as hip surgery, the pain can be severe. There is no “normal” level of pain and each person has an individual level of tolerance. If the procedure was a simple one, and the patient is significantly uncomfortable, this may indicate a problem. If the CNA notices the patient is uncomfortable, a nurse or physician should always be informed. If the patient is requesting pain medication more frequently than it has been prescribed, this is a warning sign. Many healthcare facilities use pain scales to assess a patient’s level of pain. A typical pain scale is the 1-10 scale. The patient is asked to remember the worst pain ever experienced and consider that a level 10. The patient is then asked to remember a painful experience that was very minor and consider that a level 1. After that, the patient is asked to assign the current level of pain a number on the 1-10 pain scale. The CNA would ask the patient, for example, “If the worst pain you have ever felt was a 10 and a very minor pain you’ve experienced was a 1, what would you consider your current level of pain to be?” Surgical Dressing A surgical dressing is a sterile cover applied over the incision. A dressing can be a small bandage, or it may be a large, complicated affair with gauze pads and tape. The surgeon will write orders that specify how to care for the dressing. It is very important to follow these orders exactly. The CNA should not change or adjust the dressing in any way that has not been ordered. The dressing should be checked frequently to make sure it is intact and that there are no loose edges. Any bleeding or unusual drainage should be noted, and if the CNA notices either one, a supervising nurse or physician needs to be notified.
USER:
Summarize why pain control is important.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 29 | 6 | 717 | null | 752 |
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
|
My spouse is pregnant, and I saw the term "Apgar" in a pamphlet at the OB's office at a recent prenatal visit. I looked up the term online and found this article. Please explain Agpar and its significance to health outcomes.
|
Introduction The Apgar score is based on five components (skin color, heart rate, reflex irritability, muscle tone, and respiration). Each item is scored from 0 to 2 with a total score of 7–10 as normal and the highest score of 10 representing the optimal condition. The Apgar score has been used worldwide as a vitality index for almost every newborn immediately after birth. Methods Study Population We conducted a population-based cohort study using data from Danish national registers. A total of 2,272,473 live singletons were identified during 1978–2015 from the Danish Medical Birth Registry . We excluded 1,001 births with missing information on sex and 41,252 births with no valid information on 5-min Apgar scores (including the score of 0). We further excluded 16,398 infants who died or emigrated from Denmark before the age of 1 year. The final cohort comprised 2,213,822 births. Discussion Main Findings In this large population-based cohort study, during childhood, we found individuals with even clinically “normal” Apgar score range of 7–9 still had higher risks of overall mental disorders and some specific diagnoses: organic disorders and a series of neurodevelopmental disorders (intellectual disability, pervasive developmental disorders, childhood autism, and ADHD). It is also interesting to observe that compromised Apgar scores were at elevated risks of developing organic disorders and neurotic disorders, which were reported for the first time. During early adulthood, compromised 5-min Apgar scores were not found to be associated with mental disorders. Comparisons With Other Studies To our knowledge, this is the first study to examine the association of the full spectrum of mental disorders with the 5-min Apgar score. Our findings indicate the strongest associations for intellectual disability in childhood, which corroborates the results from previous studies. Most previous studies were based on results of different non-standardized intelligence tests, and cross-sectional or descriptive designs, except a recent Swedish study, by virtue of clinically confirmed diagnosis and cohort design, reporting that term infants with low 5-min Apgar score had a higher risk of severe neurologic morbidity, including a 9-fold risk of intellectual disability. However, the Swedish study only captured cases before 14 years of age and only adjusted for year of birth, maternal age, parity, and smoking. Similarly, we observed 3~5-fold risks of intellectual disability in childhood (until 18 years of age), and we were able to adjust for not only the aforementioned confounders but also parental psychiatric history and socioeconomic status, indicating a more robust association. In addition, ADHD and autism were another two widely studied neurodevelopment disorders in relation to Apgar score during childhood, but existing results were inconsistent, which may be due to heterogeneity of methodology, in particular categorizations of Apgar scores and definition of outcomes. For example, some studies used pervasive developmental disorder (ICD-10 codes: F84) as a proxy to define autism, which includes but is not limited to autism. To reduce the possibility of misclassification, we only focused on childhood autism–the typical and most severe type of autism–to explore the association. Our findings further support that compromised 5-min Apgar scores were associated with childhood autism. Furthermore, we observed that individuals with a compromised 5-min Apgar score had higher risks of organic disorder and neurotic disorder during childhood, which have not been reported previously. These findings imply that less-than-optimal Apgar scores at birth may be an indicator for a broad scope of mental disorders in childhood, not merely neurodevelopmental disorders. There have been scarce studies examining the association between low Apgar score and adulthood mental health. We did not find that compromised 5-min Apgar scores were associated with mental disorders during early adulthood, which may be attributed to incomplete records of Apgar scores during the initial establishment of the Danish Medical Birth Register (MBR). We observed that participants with suboptimal Apgar scores at 5 min tended to have higher risks of organic disorders, schizophrenia, neurotic disorders, and personality disorders, and the low statistical precisions may probably be due to limited cases in the low Apgar score groups. Considering that the maximum attained age in our study was only up to 39 years, the follow-up between 19 and 39 years was not long enough to detect some late-onset mental disorders (e.g., dementia), therefore, future studies with extended follow-up to late adulthood are warranted. Current guidelines recommend Apgar scores of 7 or higher to be reassuring, hence, infants with these scores are often assumed to constitute a homogeneous group. Nevertheless, recent studies showed that even reassuring Apgar scores of 7–9 are associated with higher risks of neonatal mortality, neonatal morbidity, and adverse long-term neurological outcomes, compared with an Apgar score of 10. We found a dose-response increasing the overall risk of mental disorders with decreasing Apgar score of 9 toward 7. Furthermore, individuals with “normal” scores of 7–9 carried increased risks of a wide range of neurodevelopmental disorders, such as intellectual disability, pervasive developmental disorders, childhood autism, and ADHD. Similarly, prior studies based on developmental screening scales found children aged 5 years with 5-min Apgar scores of 7–9 were more vulnerable on the emotional or physical health domain of the Early Development Instrument. Recently, a large transnational study also suggested that low Apgar scores of 7–9 were associated with a higher risk of autistic disorder but without controlling for socioeconomic status and paternal psychiatric history. Our findings are in line with those of previous studies by showing that reassuring Apgar scores 7–9 are associated with various neurodevelopmental disorders in childhood. These findings support that 5-min Apgar scores routinely available in contemporary neonatal settings, even within the normal range 7–9, are not totally reassuring. The causes of mental disorders are multifactorial. Adverse prenatal events (e.g., gestational diabetes mellitus, preterm, and restricted fetal growth) are important risk factors and could have a programming effect on fetal brain development, resulting in increased risk for psychopathology later in life. In this study, adjusting for gestational age at birth and fetal growth status did not substantially change the risks, indicating that preterm birth or restricted fetal growth do not strongly modify the relations between low Apgar scores at birth and subsequent mental disorders. Although Apgar scores are not clear on any causal pathway of pathogenesis, less-than-optimal Apgar scores at birth may be a potential sign of the cumulative effect of those adverse prenatal events. Especially, the clinically reassuring but suboptimal score range 7–9 may indicate subtle but still detrimental intrauterine insults which will act negatively on fetal brain development. In clinical settings, a distressed infant will receive resuscitation well before the 5-min Apgar score is assigned, so the score 7–9 could not well reflect severe conditions prior to the assessment. That may be one of the reasons we observed exposure to the scores 7–9 was associated with an increased risk of mental disorders. In this study, a novel finding that a compromised 5-min Apgar score was linked to increased risks of organic disorder and neurotic disorder was reported. Organic disorder comprises a range of mental disorders based on a demonstrable etiology in cerebral disease, brain injury, or other insults leading to cerebral dysfunction. Increased risk of organic disorder with low Apgar score implies adverse prenatal insults (e.g., hypoxia-ischemia, white matter injury, reduced blood flow, malnutrition) exert a long-lasting impact on brain function in later life. With regard to neurotic disorder, its prevalence is relevant to low levels of socioeconomic status (SES). In this study, we found individuals with compromised Apgar scores tended to be born in families with worse SES (e.g., mothers live alone and have a low education level). It is, therefore, possible that SES factors at least partially mediate the observed association between compromised Apgar scores and neurotic disorder.
|
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== My spouse is pregnant, and I saw the term "Apgar" in a pamphlet at the OB's office at a recent prenatal visit. I looked up the term online and found this article. Please explain Agpar and its significance to health outcomes. {passage 0} ========== Introduction The Apgar score is based on five components (skin color, heart rate, reflex irritability, muscle tone, and respiration). Each item is scored from 0 to 2 with a total score of 7–10 as normal and the highest score of 10 representing the optimal condition. The Apgar score has been used worldwide as a vitality index for almost every newborn immediately after birth. Methods Study Population We conducted a population-based cohort study using data from Danish national registers. A total of 2,272,473 live singletons were identified during 1978–2015 from the Danish Medical Birth Registry . We excluded 1,001 births with missing information on sex and 41,252 births with no valid information on 5-min Apgar scores (including the score of 0). We further excluded 16,398 infants who died or emigrated from Denmark before the age of 1 year. The final cohort comprised 2,213,822 births. Discussion Main Findings In this large population-based cohort study, during childhood, we found individuals with even clinically “normal” Apgar score range of 7–9 still had higher risks of overall mental disorders and some specific diagnoses: organic disorders and a series of neurodevelopmental disorders (intellectual disability, pervasive developmental disorders, childhood autism, and ADHD). It is also interesting to observe that compromised Apgar scores were at elevated risks of developing organic disorders and neurotic disorders, which were reported for the first time. During early adulthood, compromised 5-min Apgar scores were not found to be associated with mental disorders. Comparisons With Other Studies To our knowledge, this is the first study to examine the association of the full spectrum of mental disorders with the 5-min Apgar score. Our findings indicate the strongest associations for intellectual disability in childhood, which corroborates the results from previous studies. Most previous studies were based on results of different non-standardized intelligence tests, and cross-sectional or descriptive designs, except a recent Swedish study, by virtue of clinically confirmed diagnosis and cohort design, reporting that term infants with low 5-min Apgar score had a higher risk of severe neurologic morbidity, including a 9-fold risk of intellectual disability. However, the Swedish study only captured cases before 14 years of age and only adjusted for year of birth, maternal age, parity, and smoking. Similarly, we observed 3~5-fold risks of intellectual disability in childhood (until 18 years of age), and we were able to adjust for not only the aforementioned confounders but also parental psychiatric history and socioeconomic status, indicating a more robust association. In addition, ADHD and autism were another two widely studied neurodevelopment disorders in relation to Apgar score during childhood, but existing results were inconsistent, which may be due to heterogeneity of methodology, in particular categorizations of Apgar scores and definition of outcomes. For example, some studies used pervasive developmental disorder (ICD-10 codes: F84) as a proxy to define autism, which includes but is not limited to autism. To reduce the possibility of misclassification, we only focused on childhood autism–the typical and most severe type of autism–to explore the association. Our findings further support that compromised 5-min Apgar scores were associated with childhood autism. Furthermore, we observed that individuals with a compromised 5-min Apgar score had higher risks of organic disorder and neurotic disorder during childhood, which have not been reported previously. These findings imply that less-than-optimal Apgar scores at birth may be an indicator for a broad scope of mental disorders in childhood, not merely neurodevelopmental disorders. There have been scarce studies examining the association between low Apgar score and adulthood mental health. We did not find that compromised 5-min Apgar scores were associated with mental disorders during early adulthood, which may be attributed to incomplete records of Apgar scores during the initial establishment of the Danish Medical Birth Register (MBR). We observed that participants with suboptimal Apgar scores at 5 min tended to have higher risks of organic disorders, schizophrenia, neurotic disorders, and personality disorders, and the low statistical precisions may probably be due to limited cases in the low Apgar score groups. Considering that the maximum attained age in our study was only up to 39 years, the follow-up between 19 and 39 years was not long enough to detect some late-onset mental disorders (e.g., dementia), therefore, future studies with extended follow-up to late adulthood are warranted. Current guidelines recommend Apgar scores of 7 or higher to be reassuring, hence, infants with these scores are often assumed to constitute a homogeneous group. Nevertheless, recent studies showed that even reassuring Apgar scores of 7–9 are associated with higher risks of neonatal mortality, neonatal morbidity, and adverse long-term neurological outcomes, compared with an Apgar score of 10. We found a dose-response increasing the overall risk of mental disorders with decreasing Apgar score of 9 toward 7. Furthermore, individuals with “normal” scores of 7–9 carried increased risks of a wide range of neurodevelopmental disorders, such as intellectual disability, pervasive developmental disorders, childhood autism, and ADHD. Similarly, prior studies based on developmental screening scales found children aged 5 years with 5-min Apgar scores of 7–9 were more vulnerable on the emotional or physical health domain of the Early Development Instrument. Recently, a large transnational study also suggested that low Apgar scores of 7–9 were associated with a higher risk of autistic disorder but without controlling for socioeconomic status and paternal psychiatric history. Our findings are in line with those of previous studies by showing that reassuring Apgar scores 7–9 are associated with various neurodevelopmental disorders in childhood. These findings support that 5-min Apgar scores routinely available in contemporary neonatal settings, even within the normal range 7–9, are not totally reassuring. The causes of mental disorders are multifactorial. Adverse prenatal events (e.g., gestational diabetes mellitus, preterm, and restricted fetal growth) are important risk factors and could have a programming effect on fetal brain development, resulting in increased risk for psychopathology later in life. In this study, adjusting for gestational age at birth and fetal growth status did not substantially change the risks, indicating that preterm birth or restricted fetal growth do not strongly modify the relations between low Apgar scores at birth and subsequent mental disorders. Although Apgar scores are not clear on any causal pathway of pathogenesis, less-than-optimal Apgar scores at birth may be a potential sign of the cumulative effect of those adverse prenatal events. Especially, the clinically reassuring but suboptimal score range 7–9 may indicate subtle but still detrimental intrauterine insults which will act negatively on fetal brain development. In clinical settings, a distressed infant will receive resuscitation well before the 5-min Apgar score is assigned, so the score 7–9 could not well reflect severe conditions prior to the assessment. That may be one of the reasons we observed exposure to the scores 7–9 was associated with an increased risk of mental disorders. In this study, a novel finding that a compromised 5-min Apgar score was linked to increased risks of organic disorder and neurotic disorder was reported. Organic disorder comprises a range of mental disorders based on a demonstrable etiology in cerebral disease, brain injury, or other insults leading to cerebral dysfunction. Increased risk of organic disorder with low Apgar score implies adverse prenatal insults (e.g., hypoxia-ischemia, white matter injury, reduced blood flow, malnutrition) exert a long-lasting impact on brain function in later life. With regard to neurotic disorder, its prevalence is relevant to low levels of socioeconomic status (SES). In this study, we found individuals with compromised Apgar scores tended to be born in families with worse SES (e.g., mothers live alone and have a low education level). It is, therefore, possible that SES factors at least partially mediate the observed association between compromised Apgar scores and neurotic disorder. https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.796544/full#F1
|
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
EVIDENCE:
Introduction The Apgar score is based on five components (skin color, heart rate, reflex irritability, muscle tone, and respiration). Each item is scored from 0 to 2 with a total score of 7–10 as normal and the highest score of 10 representing the optimal condition. The Apgar score has been used worldwide as a vitality index for almost every newborn immediately after birth. Methods Study Population We conducted a population-based cohort study using data from Danish national registers. A total of 2,272,473 live singletons were identified during 1978–2015 from the Danish Medical Birth Registry . We excluded 1,001 births with missing information on sex and 41,252 births with no valid information on 5-min Apgar scores (including the score of 0). We further excluded 16,398 infants who died or emigrated from Denmark before the age of 1 year. The final cohort comprised 2,213,822 births. Discussion Main Findings In this large population-based cohort study, during childhood, we found individuals with even clinically “normal” Apgar score range of 7–9 still had higher risks of overall mental disorders and some specific diagnoses: organic disorders and a series of neurodevelopmental disorders (intellectual disability, pervasive developmental disorders, childhood autism, and ADHD). It is also interesting to observe that compromised Apgar scores were at elevated risks of developing organic disorders and neurotic disorders, which were reported for the first time. During early adulthood, compromised 5-min Apgar scores were not found to be associated with mental disorders. Comparisons With Other Studies To our knowledge, this is the first study to examine the association of the full spectrum of mental disorders with the 5-min Apgar score. Our findings indicate the strongest associations for intellectual disability in childhood, which corroborates the results from previous studies. Most previous studies were based on results of different non-standardized intelligence tests, and cross-sectional or descriptive designs, except a recent Swedish study, by virtue of clinically confirmed diagnosis and cohort design, reporting that term infants with low 5-min Apgar score had a higher risk of severe neurologic morbidity, including a 9-fold risk of intellectual disability. However, the Swedish study only captured cases before 14 years of age and only adjusted for year of birth, maternal age, parity, and smoking. Similarly, we observed 3~5-fold risks of intellectual disability in childhood (until 18 years of age), and we were able to adjust for not only the aforementioned confounders but also parental psychiatric history and socioeconomic status, indicating a more robust association. In addition, ADHD and autism were another two widely studied neurodevelopment disorders in relation to Apgar score during childhood, but existing results were inconsistent, which may be due to heterogeneity of methodology, in particular categorizations of Apgar scores and definition of outcomes. For example, some studies used pervasive developmental disorder (ICD-10 codes: F84) as a proxy to define autism, which includes but is not limited to autism. To reduce the possibility of misclassification, we only focused on childhood autism–the typical and most severe type of autism–to explore the association. Our findings further support that compromised 5-min Apgar scores were associated with childhood autism. Furthermore, we observed that individuals with a compromised 5-min Apgar score had higher risks of organic disorder and neurotic disorder during childhood, which have not been reported previously. These findings imply that less-than-optimal Apgar scores at birth may be an indicator for a broad scope of mental disorders in childhood, not merely neurodevelopmental disorders. There have been scarce studies examining the association between low Apgar score and adulthood mental health. We did not find that compromised 5-min Apgar scores were associated with mental disorders during early adulthood, which may be attributed to incomplete records of Apgar scores during the initial establishment of the Danish Medical Birth Register (MBR). We observed that participants with suboptimal Apgar scores at 5 min tended to have higher risks of organic disorders, schizophrenia, neurotic disorders, and personality disorders, and the low statistical precisions may probably be due to limited cases in the low Apgar score groups. Considering that the maximum attained age in our study was only up to 39 years, the follow-up between 19 and 39 years was not long enough to detect some late-onset mental disorders (e.g., dementia), therefore, future studies with extended follow-up to late adulthood are warranted. Current guidelines recommend Apgar scores of 7 or higher to be reassuring, hence, infants with these scores are often assumed to constitute a homogeneous group. Nevertheless, recent studies showed that even reassuring Apgar scores of 7–9 are associated with higher risks of neonatal mortality, neonatal morbidity, and adverse long-term neurological outcomes, compared with an Apgar score of 10. We found a dose-response increasing the overall risk of mental disorders with decreasing Apgar score of 9 toward 7. Furthermore, individuals with “normal” scores of 7–9 carried increased risks of a wide range of neurodevelopmental disorders, such as intellectual disability, pervasive developmental disorders, childhood autism, and ADHD. Similarly, prior studies based on developmental screening scales found children aged 5 years with 5-min Apgar scores of 7–9 were more vulnerable on the emotional or physical health domain of the Early Development Instrument. Recently, a large transnational study also suggested that low Apgar scores of 7–9 were associated with a higher risk of autistic disorder but without controlling for socioeconomic status and paternal psychiatric history. Our findings are in line with those of previous studies by showing that reassuring Apgar scores 7–9 are associated with various neurodevelopmental disorders in childhood. These findings support that 5-min Apgar scores routinely available in contemporary neonatal settings, even within the normal range 7–9, are not totally reassuring. The causes of mental disorders are multifactorial. Adverse prenatal events (e.g., gestational diabetes mellitus, preterm, and restricted fetal growth) are important risk factors and could have a programming effect on fetal brain development, resulting in increased risk for psychopathology later in life. In this study, adjusting for gestational age at birth and fetal growth status did not substantially change the risks, indicating that preterm birth or restricted fetal growth do not strongly modify the relations between low Apgar scores at birth and subsequent mental disorders. Although Apgar scores are not clear on any causal pathway of pathogenesis, less-than-optimal Apgar scores at birth may be a potential sign of the cumulative effect of those adverse prenatal events. Especially, the clinically reassuring but suboptimal score range 7–9 may indicate subtle but still detrimental intrauterine insults which will act negatively on fetal brain development. In clinical settings, a distressed infant will receive resuscitation well before the 5-min Apgar score is assigned, so the score 7–9 could not well reflect severe conditions prior to the assessment. That may be one of the reasons we observed exposure to the scores 7–9 was associated with an increased risk of mental disorders. In this study, a novel finding that a compromised 5-min Apgar score was linked to increased risks of organic disorder and neurotic disorder was reported. Organic disorder comprises a range of mental disorders based on a demonstrable etiology in cerebral disease, brain injury, or other insults leading to cerebral dysfunction. Increased risk of organic disorder with low Apgar score implies adverse prenatal insults (e.g., hypoxia-ischemia, white matter injury, reduced blood flow, malnutrition) exert a long-lasting impact on brain function in later life. With regard to neurotic disorder, its prevalence is relevant to low levels of socioeconomic status (SES). In this study, we found individuals with compromised Apgar scores tended to be born in families with worse SES (e.g., mothers live alone and have a low education level). It is, therefore, possible that SES factors at least partially mediate the observed association between compromised Apgar scores and neurotic disorder.
USER:
My spouse is pregnant, and I saw the term "Apgar" in a pamphlet at the OB's office at a recent prenatal visit. I looked up the term online and found this article. Please explain Agpar and its significance to health outcomes.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 26 | 41 | 1,265 | null | 622 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
Based on this text, describe Ellana's background in medicine. Also, summarize her concerns about the changes that she is witnessing while working in Emergency Medicine.
|
Thank you, Senator Markey and Senator Warren for having me this morning. My name is Ellana Stinson. I am a board-certified emergency medicine physician and have practiced emergency medicine for 15 years. From 2013 to 2020, I worked on staff as an emergency medicine physician at Carney Hospital, Good Samaritan and the former Quincy Hospital, all part of the Steward Health System. In addition, over the past 11 years, I have worked intermittently throughout the country at various facilities run and operated by HCA, Envision, Tenant, Team Health and CHS. When I entered medicine, I deeply loved what I did. Caring for patients in their most vulnerable moments and working in beautifully orchestrated chaos while bearing witness to so many life changing moments filled me with pride at the end of each shift. Unfortunately, so much of what I loved about Emergency Medicine has changed drastically over the years. Initially, my time at Carney felt very fresh and fulfilling. Being able to serve a very diverse population in the Dorchester neighborhood of Boston was essentially how I always imagined my career trajectory, serving the most vulnerable populations. But when I could no longer care for my patients the way I would want a loved one treated, I had to make decisions to stay or go. Having spent time at several other Stewart facilities briefly, I began to realize how resources were being dwindled down and pulled from each facility. Most of the facilities no longer had certain speciality services and Quincy Hospital, eventually was taken down to bare bones before its ultimate closure. Not having blood products, respiratory therapy at times or certain specialty services no longer felt like I was able to provide safe or quality care. What is happening here in the Commonwealth is happening around the country. We have now seen the buyouts, mergers and acquisitions led by private equity firms of over 30% of hospitals in the US. Having spent time at other PE sites around the country the level of deprivation was seemingly worse in some areas. Increased wait times and critical shortage of staff leading to dangerous boarding levels and critically dangerous patient to nurse ratios in the emergency department, seeing upwards to 14 to 1 ratios at times. All of this only to be exacerbated by the pandemic which resulted in increased cost of care, infection rates, mortality and even death. Practicing medicine in many PE led places is no longer about patient safety and quality, but about making medical decisions and judgment due corporate decision making with profit motives at the expense of patients. Forcing staff to see patients in the waiting room in order to have it appear wait times were being reduced and improving door to doc times, calling codes for sepsis and strokes in order to find innovative ways to make profits. Increasingly daunting metrics required of physicians and other staff to meet were nearly unattainable and unsafe in many instances, but very much expected. In addition, many sites across the country began to remove emergency physicians from in-network, resulting in higher bills for patients known as surprise billing. These profit gaining practices not only harm patients but also increase financial burdens on patients who do not have a choice of where they will go when they are experiencing crushing chest pain or stroke-like symptoms. Especially when the next closest facility has been in some of my experiences, upwards to an hour away. Most of the facilities I worked in were in very vulnerable populations that were mostly people of color, low income, or had limited access to other facilities or primary care services. Forcing them to only seek their care at a PE backed site. It is also known that most of the buyouts are of hospitals and facilities already struggling or with higher Medicaid and Medicare populations which ultimately affects our most vulnerable populations. It is critical we consider not only the impact these facilities have on our health care system, but also on the worsening care access and quality being provided to those communities already harmed by historical injury. The financialization of medicine will continue to exacerbate health disparities despite work being done on the ground to close these gaps. In addition, these Private Equity backed facilities are where I typically run into other emergency physicians of color. As it pertains to myself and my colleagues, these practices often felt unsafe, which sparked many questions of medical legal risk as well as the emotional toll it takes on all of us who enter this profession to do no harm. In addition, being on staff at a PE backed facility also would not qualify physicians swimming in student debt for loan forgiveness. A profession once competitive when I first began my medical journey is now one of the least competitive fields to enter as students bear witness to the destruction of the profession. In 2023, 554 of the residency spots went unfilled. We also saw more PE backed hospitals opening residency programs that were not adequately equipped to provide the proper training for an emergency medicine trainee. We train to deal with hard stuff, but we are running out of options on how to continue providing safe and adequate care at these PE run facilities.
|
"================ <TEXT PASSAGE> ======= Thank you, Senator Markey and Senator Warren for having me this morning. My name is Ellana Stinson. I am a board-certified emergency medicine physician and have practiced emergency medicine for 15 years. From 2013 to 2020, I worked on staff as an emergency medicine physician at Carney Hospital, Good Samaritan and the former Quincy Hospital, all part of the Steward Health System. In addition, over the past 11 years, I have worked intermittently throughout the country at various facilities run and operated by HCA, Envision, Tenant, Team Health and CHS. When I entered medicine, I deeply loved what I did. Caring for patients in their most vulnerable moments and working in beautifully orchestrated chaos while bearing witness to so many life changing moments filled me with pride at the end of each shift. Unfortunately, so much of what I loved about Emergency Medicine has changed drastically over the years. Initially, my time at Carney felt very fresh and fulfilling. Being able to serve a very diverse population in the Dorchester neighborhood of Boston was essentially how I always imagined my career trajectory, serving the most vulnerable populations. But when I could no longer care for my patients the way I would want a loved one treated, I had to make decisions to stay or go. Having spent time at several other Stewart facilities briefly, I began to realize how resources were being dwindled down and pulled from each facility. Most of the facilities no longer had certain speciality services and Quincy Hospital, eventually was taken down to bare bones before its ultimate closure. Not having blood products, respiratory therapy at times or certain specialty services no longer felt like I was able to provide safe or quality care. What is happening here in the Commonwealth is happening around the country. We have now seen the buyouts, mergers and acquisitions led by private equity firms of over 30% of hospitals in the US. Having spent time at other PE sites around the country the level of deprivation was seemingly worse in some areas. Increased wait times and critical shortage of staff leading to dangerous boarding levels and critically dangerous patient to nurse ratios in the emergency department, seeing upwards to 14 to 1 ratios at times. All of this only to be exacerbated by the pandemic which resulted in increased cost of care, infection rates, mortality and even death. Practicing medicine in many PE led places is no longer about patient safety and quality, but about making medical decisions and judgment due corporate decision making with profit motives at the expense of patients. Forcing staff to see patients in the waiting room in order to have it appear wait times were being reduced and improving door to doc times, calling codes for sepsis and strokes in order to find innovative ways to make profits. Increasingly daunting metrics required of physicians and other staff to meet were nearly unattainable and unsafe in many instances, but very much expected. In addition, many sites across the country began to remove emergency physicians from in-network, resulting in higher bills for patients known as surprise billing. These profit gaining practices not only harm patients but also increase financial burdens on patients who do not have a choice of where they will go when they are experiencing crushing chest pain or stroke-like symptoms. Especially when the next closest facility has been in some of my experiences, upwards to an hour away. Most of the facilities I worked in were in very vulnerable populations that were mostly people of color, low income, or had limited access to other facilities or primary care services. Forcing them to only seek their care at a PE backed site. It is also known that most of the buyouts are of hospitals and facilities already struggling or with higher Medicaid and Medicare populations which ultimately affects our most vulnerable populations. It is critical we consider not only the impact these facilities have on our health care system, but also on the worsening care access and quality being provided to those communities already harmed by historical injury. The financialization of medicine will continue to exacerbate health disparities despite work being done on the ground to close these gaps. In addition, these Private Equity backed facilities are where I typically run into other emergency physicians of color. As it pertains to myself and my colleagues, these practices often felt unsafe, which sparked many questions of medical legal risk as well as the emotional toll it takes on all of us who enter this profession to do no harm. In addition, being on staff at a PE backed facility also would not qualify physicians swimming in student debt for loan forgiveness. A profession once competitive when I first began my medical journey is now one of the least competitive fields to enter as students bear witness to the destruction of the profession. In 2023, 554 of the residency spots went unfilled. We also saw more PE backed hospitals opening residency programs that were not adequately equipped to provide the proper training for an emergency medicine trainee. We train to deal with hard stuff, but we are running out of options on how to continue providing safe and adequate care at these PE run facilities. https://www.help.senate.gov/imo/media/doc/0758d69f-e26d-35a0-da6a-de806d3f5f1c/Stinson%20Testimony.pdf ================ <QUESTION> ======= Based on this text, describe Ellana's background in medicine. Also, summarize her concerns about the changes that she is witnessing while working in Emergency Medicine. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
Thank you, Senator Markey and Senator Warren for having me this morning. My name is Ellana Stinson. I am a board-certified emergency medicine physician and have practiced emergency medicine for 15 years. From 2013 to 2020, I worked on staff as an emergency medicine physician at Carney Hospital, Good Samaritan and the former Quincy Hospital, all part of the Steward Health System. In addition, over the past 11 years, I have worked intermittently throughout the country at various facilities run and operated by HCA, Envision, Tenant, Team Health and CHS. When I entered medicine, I deeply loved what I did. Caring for patients in their most vulnerable moments and working in beautifully orchestrated chaos while bearing witness to so many life changing moments filled me with pride at the end of each shift. Unfortunately, so much of what I loved about Emergency Medicine has changed drastically over the years. Initially, my time at Carney felt very fresh and fulfilling. Being able to serve a very diverse population in the Dorchester neighborhood of Boston was essentially how I always imagined my career trajectory, serving the most vulnerable populations. But when I could no longer care for my patients the way I would want a loved one treated, I had to make decisions to stay or go. Having spent time at several other Stewart facilities briefly, I began to realize how resources were being dwindled down and pulled from each facility. Most of the facilities no longer had certain speciality services and Quincy Hospital, eventually was taken down to bare bones before its ultimate closure. Not having blood products, respiratory therapy at times or certain specialty services no longer felt like I was able to provide safe or quality care. What is happening here in the Commonwealth is happening around the country. We have now seen the buyouts, mergers and acquisitions led by private equity firms of over 30% of hospitals in the US. Having spent time at other PE sites around the country the level of deprivation was seemingly worse in some areas. Increased wait times and critical shortage of staff leading to dangerous boarding levels and critically dangerous patient to nurse ratios in the emergency department, seeing upwards to 14 to 1 ratios at times. All of this only to be exacerbated by the pandemic which resulted in increased cost of care, infection rates, mortality and even death. Practicing medicine in many PE led places is no longer about patient safety and quality, but about making medical decisions and judgment due corporate decision making with profit motives at the expense of patients. Forcing staff to see patients in the waiting room in order to have it appear wait times were being reduced and improving door to doc times, calling codes for sepsis and strokes in order to find innovative ways to make profits. Increasingly daunting metrics required of physicians and other staff to meet were nearly unattainable and unsafe in many instances, but very much expected. In addition, many sites across the country began to remove emergency physicians from in-network, resulting in higher bills for patients known as surprise billing. These profit gaining practices not only harm patients but also increase financial burdens on patients who do not have a choice of where they will go when they are experiencing crushing chest pain or stroke-like symptoms. Especially when the next closest facility has been in some of my experiences, upwards to an hour away. Most of the facilities I worked in were in very vulnerable populations that were mostly people of color, low income, or had limited access to other facilities or primary care services. Forcing them to only seek their care at a PE backed site. It is also known that most of the buyouts are of hospitals and facilities already struggling or with higher Medicaid and Medicare populations which ultimately affects our most vulnerable populations. It is critical we consider not only the impact these facilities have on our health care system, but also on the worsening care access and quality being provided to those communities already harmed by historical injury. The financialization of medicine will continue to exacerbate health disparities despite work being done on the ground to close these gaps. In addition, these Private Equity backed facilities are where I typically run into other emergency physicians of color. As it pertains to myself and my colleagues, these practices often felt unsafe, which sparked many questions of medical legal risk as well as the emotional toll it takes on all of us who enter this profession to do no harm. In addition, being on staff at a PE backed facility also would not qualify physicians swimming in student debt for loan forgiveness. A profession once competitive when I first began my medical journey is now one of the least competitive fields to enter as students bear witness to the destruction of the profession. In 2023, 554 of the residency spots went unfilled. We also saw more PE backed hospitals opening residency programs that were not adequately equipped to provide the proper training for an emergency medicine trainee. We train to deal with hard stuff, but we are running out of options on how to continue providing safe and adequate care at these PE run facilities.
USER:
Based on this text, describe Ellana's background in medicine. Also, summarize her concerns about the changes that she is witnessing while working in Emergency Medicine.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 25 | 878 | null | 195 |
System Instruction: This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge.
|
Question: What limitations of the PDA were solved for with the PWFA?
|
Several different federal laws protect workers from discrimination based on pregnancy. The oldest of these, the Pregnancy Discrimination Act (PDA), generally protects job applicants and employees from adverse action—for example, firing, demotion, refusal to hire, or forced leave— because of pregnancy or related conditions. The PDA also addresses harassment based on pregnancy and bans retaliation against workers for making complaints about pregnancy discrimination. Pregnancy-related conditions can include fertility treatments, medical complications, delivery, postpartum conditions, and lactation. The PDA was enacted as an amendment to Title VII of the Civil Rights Act of 1964, which protects against sex discrimination (as well as certain other forms of discrimination) in employment. As construed by the Supreme Court, the PDA does not generally require employers to make changes in working conditions to accommodate pregnant workers unless employers provide accommodations to other similarly situated nonpregnant workers. So while employers cannot fire workers for being pregnant, this statute (depending on the facts) may not require them to make workplace changes (e.g., scheduling flexibility, an extra bathroom break) simply because employees’ demands are pregnancy-related. The Pregnant Workers Fairness Act (PWFA), passed in 2022 and effective June 27, 2023, mandates additional protections for pregnant workers. Modeled on the Americans with Disabilities Act (ADA), it requires employers to modify workplace conditions where needed to accommodate pregnancy-related conditions as long as an accommodation is reasonable and does not present an undue hardship to the employer. The PWFA requires a reasonable accommodation, after a case-specific assessment, even if a pregnancy-related condition does not amount to a disability, and even if the accommodation includes reassignment of an essential job function. Relief from an essential job function is only required, however, if it is temporary. In addition, under the PWFA, an employer may not require an employee to take leave if a reasonable accommodation would allow her to keep working. Some pregnant people face pregnancy-related impairments serious enough to satisfy the ADA’s definition of a “disability” and may, along with any PDA or PWFA claims, bring ADA claims for accommodations. Separately, many workers can invoke the Family and Medical Leave Act (FMLA) for unpaid leave for pregnancy-related medical needs. After childbirth, provisions of the Fair Labor Standards Act (FLSA) entitle most nursing mothers to appropriate breaks and accommodations for expressing breast milk. Preceding the passage of the PWFA, many advocates and legislators proposed expanding legal protections for pregnancy. Proposals included new pregnancy accommodation requirements (modeled on disability law), antidiscrimination measures (expanding current statutes), and leave entitlements (in line with many analogous mandates for reemployment rights or leave entitlements to protect workers engaged in endeavors such as military service). The PWFA focused on this first approach: accommodations. In addition, many states have strengthened rights for pregnant workers in recent years, and the PWFA does not preempt those laws when they offer greater protection.
|
Several different federal laws protect workers from discrimination based on pregnancy. The oldest of these, the Pregnancy Discrimination Act (PDA), generally protects job applicants and employees from adverse action—for example, firing, demotion, refusal to hire, or forced leave— because of pregnancy or related conditions. The PDA also addresses harassment based on pregnancy and bans retaliation against workers for making complaints about pregnancy discrimination. Pregnancy-related conditions can include fertility treatments, medical complications, delivery, postpartum conditions, and lactation. The PDA was enacted as an amendment to Title VII of the Civil Rights Act of 1964, which protects against sex discrimination (as well as certain other forms of discrimination) in employment. As construed by the Supreme Court, the PDA does not generally require employers to make changes in working conditions to accommodate pregnant workers unless employers provide accommodations to other similarly situated nonpregnant workers. So while employers cannot fire workers for being pregnant, this statute (depending on the facts) may not require them to make workplace changes (e.g., scheduling flexibility, an extra bathroom break) simply because employees’ demands are pregnancy-related. The Pregnant Workers Fairness Act (PWFA), passed in 2022 and effective June 27, 2023, mandates additional protections for pregnant workers. Modeled on the Americans with Disabilities Act (ADA), it requires employers to modify workplace conditions where needed to accommodate pregnancy-related conditions as long as an accommodation is reasonable and does not present an undue hardship to the employer. The PWFA requires a reasonable accommodation, after a case-specific assessment, even if a pregnancy-related condition does not amount to a disability, and even if the accommodation includes reassignment of an essential job function. Relief from an essential job function is only required, however, if it is temporary. In addition, under the PWFA, an employer may not require an employee to take leave if a reasonable accommodation would allow her to keep working. Some pregnant people face pregnancy-related impairments serious enough to satisfy the ADA’s definition of a “disability” and may, along with any PDA or PWFA claims, bring ADA claims for accommodations. Separately, many workers can invoke the Family and Medical Leave Act (FMLA) for unpaid leave for pregnancy-related medical needs. After childbirth, provisions of the Fair Labor Standards Act (FLSA) entitle most nursing mothers to appropriate breaks and accommodations for expressing breast milk. Preceding the passage of the PWFA, many advocates and legislators proposed expanding legal protections for pregnancy. Proposals included new pregnancy accommodation requirements (modeled on disability law), antidiscrimination measures (expanding current statutes), and leave entitlements (in line with many analogous mandates for reemployment rights or leave entitlements to protect workers engaged in endeavors such as military service). The PWFA focused on this first approach: accommodations. In addition, many states have strengthened rights for pregnant workers in recent years, and the PWFA does not preempt those laws when they offer greater protection. System Instruction: This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Question: What limitations of the PDA were solved for with the PWFA?
|
System Instruction: This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge.
EVIDENCE:
Several different federal laws protect workers from discrimination based on pregnancy. The oldest of these, the Pregnancy Discrimination Act (PDA), generally protects job applicants and employees from adverse action—for example, firing, demotion, refusal to hire, or forced leave— because of pregnancy or related conditions. The PDA also addresses harassment based on pregnancy and bans retaliation against workers for making complaints about pregnancy discrimination. Pregnancy-related conditions can include fertility treatments, medical complications, delivery, postpartum conditions, and lactation. The PDA was enacted as an amendment to Title VII of the Civil Rights Act of 1964, which protects against sex discrimination (as well as certain other forms of discrimination) in employment. As construed by the Supreme Court, the PDA does not generally require employers to make changes in working conditions to accommodate pregnant workers unless employers provide accommodations to other similarly situated nonpregnant workers. So while employers cannot fire workers for being pregnant, this statute (depending on the facts) may not require them to make workplace changes (e.g., scheduling flexibility, an extra bathroom break) simply because employees’ demands are pregnancy-related. The Pregnant Workers Fairness Act (PWFA), passed in 2022 and effective June 27, 2023, mandates additional protections for pregnant workers. Modeled on the Americans with Disabilities Act (ADA), it requires employers to modify workplace conditions where needed to accommodate pregnancy-related conditions as long as an accommodation is reasonable and does not present an undue hardship to the employer. The PWFA requires a reasonable accommodation, after a case-specific assessment, even if a pregnancy-related condition does not amount to a disability, and even if the accommodation includes reassignment of an essential job function. Relief from an essential job function is only required, however, if it is temporary. In addition, under the PWFA, an employer may not require an employee to take leave if a reasonable accommodation would allow her to keep working. Some pregnant people face pregnancy-related impairments serious enough to satisfy the ADA’s definition of a “disability” and may, along with any PDA or PWFA claims, bring ADA claims for accommodations. Separately, many workers can invoke the Family and Medical Leave Act (FMLA) for unpaid leave for pregnancy-related medical needs. After childbirth, provisions of the Fair Labor Standards Act (FLSA) entitle most nursing mothers to appropriate breaks and accommodations for expressing breast milk. Preceding the passage of the PWFA, many advocates and legislators proposed expanding legal protections for pregnancy. Proposals included new pregnancy accommodation requirements (modeled on disability law), antidiscrimination measures (expanding current statutes), and leave entitlements (in line with many analogous mandates for reemployment rights or leave entitlements to protect workers engaged in endeavors such as military service). The PWFA focused on this first approach: accommodations. In addition, many states have strengthened rights for pregnant workers in recent years, and the PWFA does not preempt those laws when they offer greater protection.
USER:
Question: What limitations of the PDA were solved for with the PWFA?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 30 | 12 | 469 | null | 34 |
To answer, forget everything you know and use only the information I provide in the context block. Provide your answer in 150 words or less. If you cannot answer using the context alone, say "I cannot determine the answer to that due to lack of context."
|
Aside from the potential loss of revenue from home distillation and the known dangers of consuming contaminated alcohol in homemade spirits, why do governments continue to prohibit the legal home production of distilled alcoholic beverages?
|
The dollar figures involved are informative. When alcohol is made on a large scale, as it is for the fuel-alcohol industry (gasohol) its cost of manufacture is about 25 cents per litre. This is for 100% alcohol. If diluted to the 40% commonly used for vodka, gin and other distilled spirits a litre would contain about 10 cents worth of alcohol. The retail price of a litre of vodka will lie somewhere between $10 and $20 depending on the country and the level of taxation. Some of the difference is due to the scale of manufacture, the purity of the product, transportation, the profit margin, etc. but even allowing for these factors the tax burden on the consumer is extremely high. Is it any wonder that an unscrupulous operator will attempt to sell his alcohol direct to the consumer, perhaps at half the normal retail price which would still give him a very handsome profit? Or is it any wonder that the authorities crack down hard on anyone attempting to interfere with their huge source of revenue, their milch cow? This battle between illicit alcohol producers (moon-shiners) or importers (smugglers) and the authorities has now become the stuff of legend. Consider the number of stories written or movies made about desperate men rolling barrels of rum up a beach at midnight! Or about the battles between gangsters and police during prohibition days in the United States! Unfortunately, such stories have been taken too much to heart by the general public so that the whole idea of distillation, and the spirits made by this process, is now perceived as being inherently more wicked than the gentle art of beer- or wine-making. And the “wickedness” is a strong deterrent to most people. 18 It is understandable why a government would wish to put a stop to smuggling and moonshining for commercial purposes, that is to say in order to re-sell the product and avoid the payment of taxes. But why would there be a complete ban on distillation by amateurs, on a small scale and for their own use? At the risk of being tediously repetitious it is worth reminding ourselves again (and again) that distillation is one of the most innocuous activities imaginable. It doesn't produce a drop of alcohol. Not a drop. What it does is take the beer which you have quite legally made by fermentation and remove all the noxious, poisonous substances which appear inevitably as by-products in all fermentations. Far from making alcohol, a little will actually be lost during this purification process. Instead of prohibiting it, the authorities should really be encouraging distillation by amateurs. And the general public, which is so rightly health-conscious these days, would be more than justified in demanding the right to do so. In attempting to find the reason for governments to ban the purification of beer or wine by distillation the first thing which comes to mind is the potential loss of revenue. After all, if everyone started making their own spirits at home the loss of revenue could be considerable. But this cannot be the real reason because the home production of beer and wine for one's own use is legal, and both are taxable when sold commercially, so the authorities must not be all that concerned about the loss of revenue when people make their own alcoholic beverages. A possible, and somewhat cynical, explanation for the prohibition of home distillation is based on the following reasoning: Home-made beer and wine are usually so inferior to a good commercial product that only the most dedicated amateurs will go to the trouble of first making and then drinking such doubtful concoctions. Consequently, there is no real threat to the sale of commercial products nor to the revenues generated by taxation. If, however, home distillation were permitted, every Tom, Dick and Harriette would be in a position to make a gin or vodka which was every bit as good as the finest commercial product on the market. This could, it might be argued, make serious inroads into commercial sales and into government revenues. Further thought, however, makes it very unlikely that amateur production of spirits would have any appreciable effect on commercial sales. For one thing the equipment is moderately expensive and it is necessary to follow directions rather carefully when using it so it is unlikely that the 19 practice would ever become really widespread. Moreover, many people prefer scotch, rye, rum, etc. to gin and vodka and it is only the latter which can be made safely and effectively by the amateur. So, if distillation were legalized for amateurs, it would probably become nothing more than an interesting hobby, just like making wine, and offer little competition to commercial producers. No, we have to look deeper than this in our search for a reason why governments have a hang-up about distillation. You see, it is not just amateurs who are penalized. Commercial producers also feel the heavy hand of government prejudice and disapproval. This is illustrated by several restrictions which apply in many countries. One is the fact that the advertising of beer and wine on television is permitted whereas the advertising of distilled spirits is prohibited. Another concerns the tax imposed on distilled alcoholic products --- per unit of alcohol the tax on the distilled product is much higher than it is on beer and wine. A third restriction on spirits can be seen in the alcoholic beverage section of supermarkets ---- beer and wine are sold, and possibly fortified wines such as vermouth, but raise the alcohol concentration to 40% and the ancient shibboleth of 'hard spirits' reigns supreme. This is grossly unfair discrimination and naturally of great concern to distillers. As they point out, a glass of gin and tonic, a glass of wine, and a bottle of beer all contain similar amounts of alcohol, so it is inequitable to tax their product at a higher level. So just why is there this official discrimination against distilled alcoholic beverages? Irrational attitudes are always difficult to deal with, but in order to reform the law we have to deal with it, and this requires that we try to understand the thinking behind it. The drug involved is ethyl alcohol, an acknowledged mood-modifier, but ethyl alcohol itself is not singled out by governments as being the bad actor. The alcohol in beer, wine and gin are identical and imbibed in similar quantities will have identical effects in terms of mood modification. No, apparently distillation per se is perceived as evil, to the point where even owning the equipment is illegal. There is only one explanation which seems to fit all the facts and this is that governments and their officials fail to make a distinction between concentration and amount. Actually, quite a lot of people have this problem. Just because beer has 5% alcohol and gin has 40% does not mean that the 20 gin-drinker is eight times more likely to over-indulge than the beer drinker. The fact of the matter is that anti-social behaviour such as hooliganism at sporting events is invariably caused by beer drinkers. And many studies of drinking and driving have shown that the vast majority of those pulled over have been drinking beer, not spirits. People drink until they've had enough, or feel in a certain mood, and if this takes five, ten, or even more beers then that is the number which will be drunk. It is the testosterone concentration which causes the problem, not the alcohol concentration. A few attempts have been made to dig deeper into the reasons behind the official attitude to distillation but it is a frustrating experience. Invariably the person spoken to seems bewildered by the question, almost as though one had asked why it was illegal to murder someone. One individual explained patiently and kindly that it was because the law is the law. Another made the extraordinary statement that distillation was prohibited because it makes alcohol and this is illegal. (Of course distillation does not make alcohol. Alcohol is made by fermentation, not by distillation, and in any case fermentation to make beer and wine for one's own consumption is completely legal).
|
Aside from the potential loss of revenue from home distillation and the known dangers of consuming contaminated alcohol in homemade spirits, why do governments continue to prohibit the legal home production of distilled alcoholic beverages? To answer, forget everything you know and use only the information I provide in the context block. Provide your answer in 150 words or less. If you cannot answer using the context alone, say "I cannot determine the answer to that due to lack of context." Context: The dollar figures involved are informative. When alcohol is made on a large scale, as it is for the fuel-alcohol industry (gasohol) its cost of manufacture is about 25 cents per litre. This is for 100% alcohol. If diluted to the 40% commonly used for vodka, gin and other distilled spirits a litre would contain about 10 cents worth of alcohol. The retail price of a litre of vodka will lie somewhere between $10 and $20 depending on the country and the level of taxation. Some of the difference is due to the scale of manufacture, the purity of the product, transportation, the profit margin, etc. but even allowing for these factors the tax burden on the consumer is extremely high. Is it any wonder that an unscrupulous operator will attempt to sell his alcohol direct to the consumer, perhaps at half the normal retail price which would still give him a very handsome profit? Or is it any wonder that the authorities crack down hard on anyone attempting to interfere with their huge source of revenue, their milch cow? This battle between illicit alcohol producers (moon-shiners) or importers (smugglers) and the authorities has now become the stuff of legend. Consider the number of stories written or movies made about desperate men rolling barrels of rum up a beach at midnight! Or about the battles between gangsters and police during prohibition days in the United States! Unfortunately, such stories have been taken too much to heart by the general public so that the whole idea of distillation, and the spirits made by this process, is now perceived as being inherently more wicked than the gentle art of beer- or wine-making. And the “wickedness” is a strong deterrent to most people. 18 It is understandable why a government would wish to put a stop to smuggling and moonshining for commercial purposes, that is to say in order to re-sell the product and avoid the payment of taxes. But why would there be a complete ban on distillation by amateurs, on a small scale and for their own use? At the risk of being tediously repetitious it is worth reminding ourselves again (and again) that distillation is one of the most innocuous activities imaginable. It doesn't produce a drop of alcohol. Not a drop. What it does is take the beer which you have quite legally made by fermentation and remove all the noxious, poisonous substances which appear inevitably as by-products in all fermentations. Far from making alcohol, a little will actually be lost during this purification process. Instead of prohibiting it, the authorities should really be encouraging distillation by amateurs. And the general public, which is so rightly health-conscious these days, would be more than justified in demanding the right to do so. In attempting to find the reason for governments to ban the purification of beer or wine by distillation the first thing which comes to mind is the potential loss of revenue. After all, if everyone started making their own spirits at home the loss of revenue could be considerable. But this cannot be the real reason because the home production of beer and wine for one's own use is legal, and both are taxable when sold commercially, so the authorities must not be all that concerned about the loss of revenue when people make their own alcoholic beverages. A possible, and somewhat cynical, explanation for the prohibition of home distillation is based on the following reasoning: Home-made beer and wine are usually so inferior to a good commercial product that only the most dedicated amateurs will go to the trouble of first making and then drinking such doubtful concoctions. Consequently, there is no real threat to the sale of commercial products nor to the revenues generated by taxation. If, however, home distillation were permitted, every Tom, Dick and Harriette would be in a position to make a gin or vodka which was every bit as good as the finest commercial product on the market. This could, it might be argued, make serious inroads into commercial sales and into government revenues. Further thought, however, makes it very unlikely that amateur production of spirits would have any appreciable effect on commercial sales. For one thing the equipment is moderately expensive and it is necessary to follow directions rather carefully when using it so it is unlikely that the 19 practice would ever become really widespread. Moreover, many people prefer scotch, rye, rum, etc. to gin and vodka and it is only the latter which can be made safely and effectively by the amateur. So, if distillation were legalized for amateurs, it would probably become nothing more than an interesting hobby, just like making wine, and offer little competition to commercial producers. No, we have to look deeper than this in our search for a reason why governments have a hang-up about distillation. You see, it is not just amateurs who are penalized. Commercial producers also feel the heavy hand of government prejudice and disapproval. This is illustrated by several restrictions which apply in many countries. One is the fact that the advertising of beer and wine on television is permitted whereas the advertising of distilled spirits is prohibited. Another concerns the tax imposed on distilled alcoholic products --- per unit of alcohol the tax on the distilled product is much higher than it is on beer and wine. A third restriction on spirits can be seen in the alcoholic beverage section of supermarkets ---- beer and wine are sold, and possibly fortified wines such as vermouth, but raise the alcohol concentration to 40% and the ancient shibboleth of 'hard spirits' reigns supreme. This is grossly unfair discrimination and naturally of great concern to distillers. As they point out, a glass of gin and tonic, a glass of wine, and a bottle of beer all contain similar amounts of alcohol, so it is inequitable to tax their product at a higher level. So just why is there this official discrimination against distilled alcoholic beverages? Irrational attitudes are always difficult to deal with, but in order to reform the law we have to deal with it, and this requires that we try to understand the thinking behind it. The drug involved is ethyl alcohol, an acknowledged mood-modifier, but ethyl alcohol itself is not singled out by governments as being the bad actor. The alcohol in beer, wine and gin are identical and imbibed in similar quantities will have identical effects in terms of mood modification. No, apparently distillation per se is perceived as evil, to the point where even owning the equipment is illegal. There is only one explanation which seems to fit all the facts and this is that governments and their officials fail to make a distinction between concentration and amount. Actually, quite a lot of people have this problem. Just because beer has 5% alcohol and gin has 40% does not mean that the 20 gin-drinker is eight times more likely to over-indulge than the beer drinker. The fact of the matter is that anti-social behaviour such as hooliganism at sporting events is invariably caused by beer drinkers. And many studies of drinking and driving have shown that the vast majority of those pulled over have been drinking beer, not spirits. People drink until they've had enough, or feel in a certain mood, and if this takes five, ten, or even more beers then that is the number which will be drunk. It is the testosterone concentration which causes the problem, not the alcohol concentration. A few attempts have been made to dig deeper into the reasons behind the official attitude to distillation but it is a frustrating experience. Invariably the person spoken to seems bewildered by the question, almost as though one had asked why it was illegal to murder someone. One individual explained patiently and kindly that it was because the law is the law. Another made the extraordinary statement that distillation was prohibited because it makes alcohol and this is illegal. (Of course distillation does not make alcohol. Alcohol is made by fermentation, not by distillation, and in any case fermentation to make beer and wine for one's own consumption is completely legal).
|
To answer, forget everything you know and use only the information I provide in the context block. Provide your answer in 150 words or less. If you cannot answer using the context alone, say "I cannot determine the answer to that due to lack of context."
EVIDENCE:
The dollar figures involved are informative. When alcohol is made on a large scale, as it is for the fuel-alcohol industry (gasohol) its cost of manufacture is about 25 cents per litre. This is for 100% alcohol. If diluted to the 40% commonly used for vodka, gin and other distilled spirits a litre would contain about 10 cents worth of alcohol. The retail price of a litre of vodka will lie somewhere between $10 and $20 depending on the country and the level of taxation. Some of the difference is due to the scale of manufacture, the purity of the product, transportation, the profit margin, etc. but even allowing for these factors the tax burden on the consumer is extremely high. Is it any wonder that an unscrupulous operator will attempt to sell his alcohol direct to the consumer, perhaps at half the normal retail price which would still give him a very handsome profit? Or is it any wonder that the authorities crack down hard on anyone attempting to interfere with their huge source of revenue, their milch cow? This battle between illicit alcohol producers (moon-shiners) or importers (smugglers) and the authorities has now become the stuff of legend. Consider the number of stories written or movies made about desperate men rolling barrels of rum up a beach at midnight! Or about the battles between gangsters and police during prohibition days in the United States! Unfortunately, such stories have been taken too much to heart by the general public so that the whole idea of distillation, and the spirits made by this process, is now perceived as being inherently more wicked than the gentle art of beer- or wine-making. And the “wickedness” is a strong deterrent to most people. 18 It is understandable why a government would wish to put a stop to smuggling and moonshining for commercial purposes, that is to say in order to re-sell the product and avoid the payment of taxes. But why would there be a complete ban on distillation by amateurs, on a small scale and for their own use? At the risk of being tediously repetitious it is worth reminding ourselves again (and again) that distillation is one of the most innocuous activities imaginable. It doesn't produce a drop of alcohol. Not a drop. What it does is take the beer which you have quite legally made by fermentation and remove all the noxious, poisonous substances which appear inevitably as by-products in all fermentations. Far from making alcohol, a little will actually be lost during this purification process. Instead of prohibiting it, the authorities should really be encouraging distillation by amateurs. And the general public, which is so rightly health-conscious these days, would be more than justified in demanding the right to do so. In attempting to find the reason for governments to ban the purification of beer or wine by distillation the first thing which comes to mind is the potential loss of revenue. After all, if everyone started making their own spirits at home the loss of revenue could be considerable. But this cannot be the real reason because the home production of beer and wine for one's own use is legal, and both are taxable when sold commercially, so the authorities must not be all that concerned about the loss of revenue when people make their own alcoholic beverages. A possible, and somewhat cynical, explanation for the prohibition of home distillation is based on the following reasoning: Home-made beer and wine are usually so inferior to a good commercial product that only the most dedicated amateurs will go to the trouble of first making and then drinking such doubtful concoctions. Consequently, there is no real threat to the sale of commercial products nor to the revenues generated by taxation. If, however, home distillation were permitted, every Tom, Dick and Harriette would be in a position to make a gin or vodka which was every bit as good as the finest commercial product on the market. This could, it might be argued, make serious inroads into commercial sales and into government revenues. Further thought, however, makes it very unlikely that amateur production of spirits would have any appreciable effect on commercial sales. For one thing the equipment is moderately expensive and it is necessary to follow directions rather carefully when using it so it is unlikely that the 19 practice would ever become really widespread. Moreover, many people prefer scotch, rye, rum, etc. to gin and vodka and it is only the latter which can be made safely and effectively by the amateur. So, if distillation were legalized for amateurs, it would probably become nothing more than an interesting hobby, just like making wine, and offer little competition to commercial producers. No, we have to look deeper than this in our search for a reason why governments have a hang-up about distillation. You see, it is not just amateurs who are penalized. Commercial producers also feel the heavy hand of government prejudice and disapproval. This is illustrated by several restrictions which apply in many countries. One is the fact that the advertising of beer and wine on television is permitted whereas the advertising of distilled spirits is prohibited. Another concerns the tax imposed on distilled alcoholic products --- per unit of alcohol the tax on the distilled product is much higher than it is on beer and wine. A third restriction on spirits can be seen in the alcoholic beverage section of supermarkets ---- beer and wine are sold, and possibly fortified wines such as vermouth, but raise the alcohol concentration to 40% and the ancient shibboleth of 'hard spirits' reigns supreme. This is grossly unfair discrimination and naturally of great concern to distillers. As they point out, a glass of gin and tonic, a glass of wine, and a bottle of beer all contain similar amounts of alcohol, so it is inequitable to tax their product at a higher level. So just why is there this official discrimination against distilled alcoholic beverages? Irrational attitudes are always difficult to deal with, but in order to reform the law we have to deal with it, and this requires that we try to understand the thinking behind it. The drug involved is ethyl alcohol, an acknowledged mood-modifier, but ethyl alcohol itself is not singled out by governments as being the bad actor. The alcohol in beer, wine and gin are identical and imbibed in similar quantities will have identical effects in terms of mood modification. No, apparently distillation per se is perceived as evil, to the point where even owning the equipment is illegal. There is only one explanation which seems to fit all the facts and this is that governments and their officials fail to make a distinction between concentration and amount. Actually, quite a lot of people have this problem. Just because beer has 5% alcohol and gin has 40% does not mean that the 20 gin-drinker is eight times more likely to over-indulge than the beer drinker. The fact of the matter is that anti-social behaviour such as hooliganism at sporting events is invariably caused by beer drinkers. And many studies of drinking and driving have shown that the vast majority of those pulled over have been drinking beer, not spirits. People drink until they've had enough, or feel in a certain mood, and if this takes five, ten, or even more beers then that is the number which will be drunk. It is the testosterone concentration which causes the problem, not the alcohol concentration. A few attempts have been made to dig deeper into the reasons behind the official attitude to distillation but it is a frustrating experience. Invariably the person spoken to seems bewildered by the question, almost as though one had asked why it was illegal to murder someone. One individual explained patiently and kindly that it was because the law is the law. Another made the extraordinary statement that distillation was prohibited because it makes alcohol and this is illegal. (Of course distillation does not make alcohol. Alcohol is made by fermentation, not by distillation, and in any case fermentation to make beer and wine for one's own consumption is completely legal).
USER:
Aside from the potential loss of revenue from home distillation and the known dangers of consuming contaminated alcohol in homemade spirits, why do governments continue to prohibit the legal home production of distilled alcoholic beverages?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 46 | 35 | 1,367 | null | 286 |
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
|
I have an idea for a new product but I need a manufacturer to produce it for me. How do I know someone won't steal my idea, and what kinds of failsafe should I have in place in case they do try to steal my idea?
|
How does using an NDA with U.S. manufacturers protect your idea? The NDA or no disclosure agreement is a promise to keep your idea secret. They can’t file a patent application because it would publish as a patent or pre-grant publication. They can’t market your invention. These would all be considered a breach of the NDA. But, how do you get manufacturers to sign the NDA? Early on during the conversation, don’t ask the manufacturer to sign a nondisclosure agreement. That will put them on the defensive. They’ll just reject you. Most companies won’t want to sign a non-disclosure agreement immediately. NDAs are viewed as an invitation to a lawsuit since they require them to keep your information confidential. If there is even an appearance of a breach, they are afraid that you will sue them. Rather, a better approach is to see if, in general, they can make your product. Talk about generic matters first. You and the manufacturer can get a feel for each other first to see if you’re a good fit. After a while, you’ll come to a point where you need to share your idea with them. You’ve done your due diligence and you believe that this manufacturer might be a good fit for you. They’ll also want to hear your idea so that they can gain your business. It’s at this point that you should ask them to sign a non-disclosure agreement. How does using an NNN agreement with Chinese manufacturers protect your idea? The NNN agreement works in the same way as the NDA to protect your idea. The Chinese manufacturer is agreeing to protect your idea. But, how do you get a Chinese manufacturer to sign an NDA? First, don’t call it an NDA. Just ask them to sign an NNN agreement which stands for non-disclosure, non-compete, and non-use. It’s their version of the NDA. Because of that, you’ll get less pushback from manufacturers in China since they’re used to signing these agreements. Click here to download a sample NNN Agreement. How does using multiple manufacturers prevent your manufacturers from stealing your idea? You could split up the production of your product amongst 2 or more manufacturers. This only works if your product has multiple components. In this way, no one manufacturer would know what the product is and don’t have all of the information to steal the idea from you. How does documenting your idea prevents a manufacturer from stealing your idea? You should document your idea to protect yourself against the manufacturer. The document we are referring to is an inventor’s notebook. It’s typically a dated running log of your ideas in a bound book. By documenting your ideas in an inventor’s notebook, you can establish which ideas are yours. If the manufacturer claims an idea is theirs, you can prove that you already had that idea by showing them your inventor’s notebook. Let’s see how this plays out in a typical scenario. You’ve done your due diligence and selected a manufacturer. You’ve entered into a nondisclosure agreement then you tell the manufacturer about your idea. As you and the manufacturer brainstorm how to make the product, the manufacturer suggests a feature for the product. They claim that feature as their own. Does that feature belong to the manufacturer? Or do you own the intellectual property? That’s the dispute between the manufacturer and you. By showing them your inventor’s notebook, you can show the manufacturer that you already thought of that feature. You can establish that the feature already belongs to you. The manufacturer might argue that you fabricated the document after the fact. However, it’s harder to do with a running logbook that’s dated. How a patent application prevents your manufacturer from stealing your idea? The patent application provides further proof that you invented a particular idea. In the event the manufacturer suggests a feature for your product, the patent application establishes that feature as your own if it’s already in there. They can’t argue that you fabricated the document after the fact because the USPTO establishes the filing date of that document. How a patent prevents your manufacturer from stealing your idea? A design patent can prevent your manufacturer from using the molds that you paid for to make and sell products to others. If they use your molds, those products would be infringing on your design patent. You can sue them for patent infringement. Moreover, if you get a utility patent, the manufacturer can’t infringe on your utility patent. Otherwise, you would sue them for patent infringement. In order to more effectively protect yourself against manufacturers, the final agreement between you and the manufacturer should include an assignment of all inventions that they come up with while they are working on your project. For example, if they came up with a feature that you like, you should be able to get a patent for that. After all, you paid them money to make products for you. You can read more about this in: Nondisclosure Agreements and other basic agreements.
|
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I have an idea for a new product but I need a manufacturer to produce it for me. How do I know someone won't steal my idea, and what kinds of failsafe should I have in place in case they do try to steal my idea? {passage 0} ========== How does using an NDA with U.S. manufacturers protect your idea? The NDA or no disclosure agreement is a promise to keep your idea secret. They can’t file a patent application because it would publish as a patent or pre-grant publication. They can’t market your invention. These would all be considered a breach of the NDA. But, how do you get manufacturers to sign the NDA? Early on during the conversation, don’t ask the manufacturer to sign a nondisclosure agreement. That will put them on the defensive. They’ll just reject you. Most companies won’t want to sign a non-disclosure agreement immediately. NDAs are viewed as an invitation to a lawsuit since they require them to keep your information confidential. If there is even an appearance of a breach, they are afraid that you will sue them. Rather, a better approach is to see if, in general, they can make your product. Talk about generic matters first. You and the manufacturer can get a feel for each other first to see if you’re a good fit. After a while, you’ll come to a point where you need to share your idea with them. You’ve done your due diligence and you believe that this manufacturer might be a good fit for you. They’ll also want to hear your idea so that they can gain your business. It’s at this point that you should ask them to sign a non-disclosure agreement. How does using an NNN agreement with Chinese manufacturers protect your idea? The NNN agreement works in the same way as the NDA to protect your idea. The Chinese manufacturer is agreeing to protect your idea. But, how do you get a Chinese manufacturer to sign an NDA? First, don’t call it an NDA. Just ask them to sign an NNN agreement which stands for non-disclosure, non-compete, and non-use. It’s their version of the NDA. Because of that, you’ll get less pushback from manufacturers in China since they’re used to signing these agreements. Click here to download a sample NNN Agreement. How does using multiple manufacturers prevent your manufacturers from stealing your idea? You could split up the production of your product amongst 2 or more manufacturers. This only works if your product has multiple components. In this way, no one manufacturer would know what the product is and don’t have all of the information to steal the idea from you. How does documenting your idea prevents a manufacturer from stealing your idea? You should document your idea to protect yourself against the manufacturer. The document we are referring to is an inventor’s notebook. It’s typically a dated running log of your ideas in a bound book. By documenting your ideas in an inventor’s notebook, you can establish which ideas are yours. If the manufacturer claims an idea is theirs, you can prove that you already had that idea by showing them your inventor’s notebook. Let’s see how this plays out in a typical scenario. You’ve done your due diligence and selected a manufacturer. You’ve entered into a nondisclosure agreement then you tell the manufacturer about your idea. As you and the manufacturer brainstorm how to make the product, the manufacturer suggests a feature for the product. They claim that feature as their own. Does that feature belong to the manufacturer? Or do you own the intellectual property? That’s the dispute between the manufacturer and you. By showing them your inventor’s notebook, you can show the manufacturer that you already thought of that feature. You can establish that the feature already belongs to you. The manufacturer might argue that you fabricated the document after the fact. However, it’s harder to do with a running logbook that’s dated. How a patent application prevents your manufacturer from stealing your idea? The patent application provides further proof that you invented a particular idea. In the event the manufacturer suggests a feature for your product, the patent application establishes that feature as your own if it’s already in there. They can’t argue that you fabricated the document after the fact because the USPTO establishes the filing date of that document. How a patent prevents your manufacturer from stealing your idea? A design patent can prevent your manufacturer from using the molds that you paid for to make and sell products to others. If they use your molds, those products would be infringing on your design patent. You can sue them for patent infringement. Moreover, if you get a utility patent, the manufacturer can’t infringe on your utility patent. Otherwise, you would sue them for patent infringement. In order to more effectively protect yourself against manufacturers, the final agreement between you and the manufacturer should include an assignment of all inventions that they come up with while they are working on your project. For example, if they came up with a feature that you like, you should be able to get a patent for that. After all, you paid them money to make products for you. You can read more about this in: Nondisclosure Agreements and other basic agreements. https://ocpatentlawyer.com/how-to-prevent-your-manufacturer-from-stealing-your-idea/
|
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
EVIDENCE:
How does using an NDA with U.S. manufacturers protect your idea? The NDA or no disclosure agreement is a promise to keep your idea secret. They can’t file a patent application because it would publish as a patent or pre-grant publication. They can’t market your invention. These would all be considered a breach of the NDA. But, how do you get manufacturers to sign the NDA? Early on during the conversation, don’t ask the manufacturer to sign a nondisclosure agreement. That will put them on the defensive. They’ll just reject you. Most companies won’t want to sign a non-disclosure agreement immediately. NDAs are viewed as an invitation to a lawsuit since they require them to keep your information confidential. If there is even an appearance of a breach, they are afraid that you will sue them. Rather, a better approach is to see if, in general, they can make your product. Talk about generic matters first. You and the manufacturer can get a feel for each other first to see if you’re a good fit. After a while, you’ll come to a point where you need to share your idea with them. You’ve done your due diligence and you believe that this manufacturer might be a good fit for you. They’ll also want to hear your idea so that they can gain your business. It’s at this point that you should ask them to sign a non-disclosure agreement. How does using an NNN agreement with Chinese manufacturers protect your idea? The NNN agreement works in the same way as the NDA to protect your idea. The Chinese manufacturer is agreeing to protect your idea. But, how do you get a Chinese manufacturer to sign an NDA? First, don’t call it an NDA. Just ask them to sign an NNN agreement which stands for non-disclosure, non-compete, and non-use. It’s their version of the NDA. Because of that, you’ll get less pushback from manufacturers in China since they’re used to signing these agreements. Click here to download a sample NNN Agreement. How does using multiple manufacturers prevent your manufacturers from stealing your idea? You could split up the production of your product amongst 2 or more manufacturers. This only works if your product has multiple components. In this way, no one manufacturer would know what the product is and don’t have all of the information to steal the idea from you. How does documenting your idea prevents a manufacturer from stealing your idea? You should document your idea to protect yourself against the manufacturer. The document we are referring to is an inventor’s notebook. It’s typically a dated running log of your ideas in a bound book. By documenting your ideas in an inventor’s notebook, you can establish which ideas are yours. If the manufacturer claims an idea is theirs, you can prove that you already had that idea by showing them your inventor’s notebook. Let’s see how this plays out in a typical scenario. You’ve done your due diligence and selected a manufacturer. You’ve entered into a nondisclosure agreement then you tell the manufacturer about your idea. As you and the manufacturer brainstorm how to make the product, the manufacturer suggests a feature for the product. They claim that feature as their own. Does that feature belong to the manufacturer? Or do you own the intellectual property? That’s the dispute between the manufacturer and you. By showing them your inventor’s notebook, you can show the manufacturer that you already thought of that feature. You can establish that the feature already belongs to you. The manufacturer might argue that you fabricated the document after the fact. However, it’s harder to do with a running logbook that’s dated. How a patent application prevents your manufacturer from stealing your idea? The patent application provides further proof that you invented a particular idea. In the event the manufacturer suggests a feature for your product, the patent application establishes that feature as your own if it’s already in there. They can’t argue that you fabricated the document after the fact because the USPTO establishes the filing date of that document. How a patent prevents your manufacturer from stealing your idea? A design patent can prevent your manufacturer from using the molds that you paid for to make and sell products to others. If they use your molds, those products would be infringing on your design patent. You can sue them for patent infringement. Moreover, if you get a utility patent, the manufacturer can’t infringe on your utility patent. Otherwise, you would sue them for patent infringement. In order to more effectively protect yourself against manufacturers, the final agreement between you and the manufacturer should include an assignment of all inventions that they come up with while they are working on your project. For example, if they came up with a feature that you like, you should be able to get a patent for that. After all, you paid them money to make products for you. You can read more about this in: Nondisclosure Agreements and other basic agreements.
USER:
I have an idea for a new product but I need a manufacturer to produce it for me. How do I know someone won't steal my idea, and what kinds of failsafe should I have in place in case they do try to steal my idea?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 26 | 46 | 842 | null | 314 |
No information from beyond the provided context block can be used in formulating your answer. Formulate your response using full paragraphs.
|
Provide a summary of all of the facets that are checked for compliance.
|
2 General Principles and Legality Checking 3.2.1 Objective of Article 3 An important objective of the Regulations in Article 3 is to enable cars to race closely, by ensuring that the aerodynamic performance loss of a car following another car is kept to a minimum. In order to verify whether this objective has been achieved, Competitors may be required on request to supply the FIA with any relevant information. 2024 Formula 1 Technical Regulations 13 25 April 2023 © 2023 Fédération Internationale de l’Automobile Issue 1 In any case the Intellectual Property of this information, will remain the property of the Competitor, will be protected and not divulged to any third party. 3.2.2 Aerodynamic Influence With the exception of the driver adjustable bodywork described in Article 3.10.10 (in addition to minimal parts solely associated with its actuation) and the flexible seals specifically permitted by Articles 3.13 and 3.14.4, all aerodynamic components or bodywork influencing the car’s aerodynamic performance must be rigidly secured and immobile with respect to their frame of reference defined in Article 3.3. Furthermore, these components must produce a uniform, solid, hard, continuous, impervious surface under all circumstances. Any device or construction that is designed to bridge the gap between the sprung part of the car and the ground is prohibited under all circumstances. With the exception of the parts necessary for the adjustment described in Article 3.10.10, or any incidental movement due to the steering system, any car system, device or procedure which uses driver movement as a means of altering the aerodynamic characteristics of the car is prohibited. The Aerodynamic influence of any component of the car not considered to be bodywork must be incidental to its main function. Any design which aims to maximise such an aerodynamic influence is prohibited. 3.2.3 Symmetry All bodywork must be nominally symmetrical with respect to Y=0. Consequently, and unless otherwise specified, any regulation in Article 3 concerning one side of the car will be assumed to be valid for the other side of the car and references to maximum permissible numbers of components in Article 3 will also refer to the one side of the car. Minimal exceptions to the requirement of symmetry of this Article will be accepted for the installation of non-symmetrical mechanical components of the car, for asymmetrical cooling requirements or for asymmetrical angle adjustment of the front flap defined in Article 3.9.7. Bodywork on the unsprung mass must respect this Article when the suspension position of each wheel is virtually re-orientated so that its wheel coordinate system axes (described in Article 2.11.3) are parallel to their respective axis of the car coordinate system (described in Article 2.11.1). 3.2.4 Digital legality checking The assessment of the car’s compliance with the Aerodynamic Regulations will be carried out digitally using CAD models provided by the teams. In these models: a. Components may only be designed to the edge of a Reference Volume or with a precise geometrical feature, or to the limit of a geometrical criterion (save for the normal round-off discrepancies of the CAD system), when the regulations specifically require an aspect of the bodywork to be designed to this limit, or it can be demonstrated that the design does not rely on lying exactly on this limit to conform to the regulations, such that it is possible for the physical bodywork to comply. b. Components which must follow a precise shape, surface or plane must be designed without any tolerance, save for the normal round-off discrepancies of the CAD system. 3.2.5 Physical legality checking The cars may be measured during a Competition in order to check their conformance to the CAD models discussed in Article 3.2.4 and to ensure they remain inside the Reference Volumes. a. Unless otherwise specified, a tolerance of ±3mm will be accepted for manufacturing purposes only with respect to the CAD surfaces. Where measured surfaces lie outside of this tolerance but remain within the Reference Volumes, a Competitor may be required to provide additional information (e.g. revised CAD geometry) to demonstrate compliance with the regulations. Any discrepancies contrived to create a special aerodynamic effect or surface finish will not be permitted. 2024 Formula 1 Technical Regulations 14 25 April 2023 © 2023 Fédération Internationale de l’Automobile Issue 1 b. Irrespective of a), geometrical discrepancies at the limits of the Reference Volumes must be such that the measured component remains inside the Reference Volume. c. A positional tolerance of +/- 2mm will be accepted for the Front Wing Bodywork, Rear Wing Bodywork, Exhaust Tailpipe, Floor Bodywork behind XR=0, and Tail. This will be assessed by realigning each of the groups of Reference Volumes and Reference Surfaces that define the assemblies, by up to 2mm from their original position, to best fit the measured geometry. d. Irrespective of b), a tolerance of Z=+/-2mm will be accepted for parts of the car lying on the Z=0 plane, with -375 ≤ Y ≤ 375 and ahead of XR=0. e. Minimal discrepancies from the CAD surfaces will also be accepted in the following cases: i. Minimal repairs carried out on aerodynamic components and approved by the FIA ii. Tape, provided it does not achieve an aerodynamic effect otherwise not permitted by Article 3 iii. Junctions between bodywork panels iv. Local bodywork fixing details 3.2.6 Datum Points All cars must be equipped with mountings for optical targets that enable the car’s datum to be determined for scrutineering in the following locations: i. One on the forward part of the top of the survival cell. ii. Two positioned symmetrically about Y=0 on the top of the survival cell close to XB=0. iii. Two positioned symmetrically about Y=0 on the side of the survival cell close to XB=0. iv. Two positioned symmetrically about Y=0 on the side of the survival cell close to the rear mounts of the secondary roll structure. v. Two positioned symmetrically about Y=0 within an axis-aligned cuboid with an interior diagonal defined by points [XC=0, 175, 970] and [XC=150, -175, 870]. vi. One probed point on the RIS or gearbox case. In all cases, a file with required datum points must be supplied for each survival cell. For deflection testing, all cars must be provided with a means of mounting a reference artefact to the RIS. This mounting may be temporary, but must be rigid with respect to the underlying car structure. Full details of the requirements are given in the Appendix the Technical and Sporting Regulations. 3.2.7 Section titles and Article titles within this article have no regulatory value. 3.2.8 Static pressure tappings are permitted in surfaces, provided that they; i. Have an internal diameter of no more than 2mm. ii. They are flush with the underlying geometry. iii. Are only connected to pressure sensors, or are blanked, without leakage. 3.3.1 Bodywork which is part of the sprung mass of the car The only sprung mass bodywork permitted is that defined under Articles 3.5 to 3.12 and under Articles 3.1.1.a.ii to iv. The frame of reference for every part of the car classified as Sprung Mass Bodywork is the coordinate system defined in Article 2.11.1. Any bodywork that is trimmed or filleted in Article 3.11 must first be declared as belonging to one of the groups defined in Articles 3.5 to 3.10. Unless otherwise stated, the compliance of an individual bodywork group to Article 3 will be assessed independently and prior to any trimming, filleting and assembly operation referred to in Article 3.11, and the FIA may request to see any discarded geometry after final assembly. Once the final assembly is completed, any bodywork surfaces no longer exposed to an external airstream or internal duct may be modified, providing they remain unexposed. 3.3.2 Wheel Bodywork The only wheel bodywork permitted is that defined under Article 3.13. With the exception of wheel covers, as defined in Article 3.13.7, the frame of reference for every part of the car classified as Wheel Bodywork is the corresponding upright structure and the corresponding coordinate system defined in Article 2.11.3. The frame of reference for any wheel cover, as defined in Article 3.13.7 is the corresponding wheel rim. 3.3.3 Suspension Fairings The only suspension fairings permitted are those defined under Article 3.14. In order to assess compliance with Article 3.2.2, the frame of reference of any suspension fairing is the structural suspension member that it is attached to.
|
System Instructions: No information from beyond the provided context block can be used in formulating your answer. Formulate your response using full paragraphs. Question: Provide a summary of all of the facets that are checked for compliance. Context Block: 2 General Principles and Legality Checking 3.2.1 Objective of Article 3 An important objective of the Regulations in Article 3 is to enable cars to race closely, by ensuring that the aerodynamic performance loss of a car following another car is kept to a minimum. In order to verify whether this objective has been achieved, Competitors may be required on request to supply the FIA with any relevant information. 2024 Formula 1 Technical Regulations 13 25 April 2023 © 2023 Fédération Internationale de l’Automobile Issue 1 In any case the Intellectual Property of this information, will remain the property of the Competitor, will be protected and not divulged to any third party. 3.2.2 Aerodynamic Influence With the exception of the driver adjustable bodywork described in Article 3.10.10 (in addition to minimal parts solely associated with its actuation) and the flexible seals specifically permitted by Articles 3.13 and 3.14.4, all aerodynamic components or bodywork influencing the car’s aerodynamic performance must be rigidly secured and immobile with respect to their frame of reference defined in Article 3.3. Furthermore, these components must produce a uniform, solid, hard, continuous, impervious surface under all circumstances. Any device or construction that is designed to bridge the gap between the sprung part of the car and the ground is prohibited under all circumstances. With the exception of the parts necessary for the adjustment described in Article 3.10.10, or any incidental movement due to the steering system, any car system, device or procedure which uses driver movement as a means of altering the aerodynamic characteristics of the car is prohibited. The Aerodynamic influence of any component of the car not considered to be bodywork must be incidental to its main function. Any design which aims to maximise such an aerodynamic influence is prohibited. 3.2.3 Symmetry All bodywork must be nominally symmetrical with respect to Y=0. Consequently, and unless otherwise specified, any regulation in Article 3 concerning one side of the car will be assumed to be valid for the other side of the car and references to maximum permissible numbers of components in Article 3 will also refer to the one side of the car. Minimal exceptions to the requirement of symmetry of this Article will be accepted for the installation of non-symmetrical mechanical components of the car, for asymmetrical cooling requirements or for asymmetrical angle adjustment of the front flap defined in Article 3.9.7. Bodywork on the unsprung mass must respect this Article when the suspension position of each wheel is virtually re-orientated so that its wheel coordinate system axes (described in Article 2.11.3) are parallel to their respective axis of the car coordinate system (described in Article 2.11.1). 3.2.4 Digital legality checking The assessment of the car’s compliance with the Aerodynamic Regulations will be carried out digitally using CAD models provided by the teams. In these models: a. Components may only be designed to the edge of a Reference Volume or with a precise geometrical feature, or to the limit of a geometrical criterion (save for the normal round-off discrepancies of the CAD system), when the regulations specifically require an aspect of the bodywork to be designed to this limit, or it can be demonstrated that the design does not rely on lying exactly on this limit to conform to the regulations, such that it is possible for the physical bodywork to comply. b. Components which must follow a precise shape, surface or plane must be designed without any tolerance, save for the normal round-off discrepancies of the CAD system. 3.2.5 Physical legality checking The cars may be measured during a Competition in order to check their conformance to the CAD models discussed in Article 3.2.4 and to ensure they remain inside the Reference Volumes. a. Unless otherwise specified, a tolerance of ±3mm will be accepted for manufacturing purposes only with respect to the CAD surfaces. Where measured surfaces lie outside of this tolerance but remain within the Reference Volumes, a Competitor may be required to provide additional information (e.g. revised CAD geometry) to demonstrate compliance with the regulations. Any discrepancies contrived to create a special aerodynamic effect or surface finish will not be permitted. 2024 Formula 1 Technical Regulations 14 25 April 2023 © 2023 Fédération Internationale de l’Automobile Issue 1 b. Irrespective of a), geometrical discrepancies at the limits of the Reference Volumes must be such that the measured component remains inside the Reference Volume. c. A positional tolerance of +/- 2mm will be accepted for the Front Wing Bodywork, Rear Wing Bodywork, Exhaust Tailpipe, Floor Bodywork behind XR=0, and Tail. This will be assessed by realigning each of the groups of Reference Volumes and Reference Surfaces that define the assemblies, by up to 2mm from their original position, to best fit the measured geometry. d. Irrespective of b), a tolerance of Z=+/-2mm will be accepted for parts of the car lying on the Z=0 plane, with -375 ≤ Y ≤ 375 and ahead of XR=0. e. Minimal discrepancies from the CAD surfaces will also be accepted in the following cases: i. Minimal repairs carried out on aerodynamic components and approved by the FIA ii. Tape, provided it does not achieve an aerodynamic effect otherwise not permitted by Article 3 iii. Junctions between bodywork panels iv. Local bodywork fixing details 3.2.6 Datum Points All cars must be equipped with mountings for optical targets that enable the car’s datum to be determined for scrutineering in the following locations: i. One on the forward part of the top of the survival cell. ii. Two positioned symmetrically about Y=0 on the top of the survival cell close to XB=0. iii. Two positioned symmetrically about Y=0 on the side of the survival cell close to XB=0. iv. Two positioned symmetrically about Y=0 on the side of the survival cell close to the rear mounts of the secondary roll structure. v. Two positioned symmetrically about Y=0 within an axis-aligned cuboid with an interior diagonal defined by points [XC=0, 175, 970] and [XC=150, -175, 870]. vi. One probed point on the RIS or gearbox case. In all cases, a file with required datum points must be supplied for each survival cell. For deflection testing, all cars must be provided with a means of mounting a reference artefact to the RIS. This mounting may be temporary, but must be rigid with respect to the underlying car structure. Full details of the requirements are given in the Appendix the Technical and Sporting Regulations. 3.2.7 Section titles and Article titles within this article have no regulatory value. 3.2.8 Static pressure tappings are permitted in surfaces, provided that they; i. Have an internal diameter of no more than 2mm. ii. They are flush with the underlying geometry. iii. Are only connected to pressure sensors, or are blanked, without leakage. 3.3.1 Bodywork which is part of the sprung mass of the car The only sprung mass bodywork permitted is that defined under Articles 3.5 to 3.12 and under Articles 3.1.1.a.ii to iv. The frame of reference for every part of the car classified as Sprung Mass Bodywork is the coordinate system defined in Article 2.11.1. Any bodywork that is trimmed or filleted in Article 3.11 must first be declared as belonging to one of the groups defined in Articles 3.5 to 3.10. Unless otherwise stated, the compliance of an individual bodywork group to Article 3 will be assessed independently and prior to any trimming, filleting and assembly operation referred to in Article 3.11, and the FIA may request to see any discarded geometry after final assembly. Once the final assembly is completed, any bodywork surfaces no longer exposed to an external airstream or internal duct may be modified, providing they remain unexposed. 3.3.2 Wheel Bodywork The only wheel bodywork permitted is that defined under Article 3.13. With the exception of wheel covers, as defined in Article 3.13.7, the frame of reference for every part of the car classified as Wheel Bodywork is the corresponding upright structure and the corresponding coordinate system defined in Article 2.11.3. The frame of reference for any wheel cover, as defined in Article 3.13.7 is the corresponding wheel rim. 3.3.3 Suspension Fairings The only suspension fairings permitted are those defined under Article 3.14. In order to assess compliance with Article 3.2.2, the frame of reference of any suspension fairing is the structural suspension member that it is attached to.
|
No information from beyond the provided context block can be used in formulating your answer. Formulate your response using full paragraphs.
EVIDENCE:
2 General Principles and Legality Checking 3.2.1 Objective of Article 3 An important objective of the Regulations in Article 3 is to enable cars to race closely, by ensuring that the aerodynamic performance loss of a car following another car is kept to a minimum. In order to verify whether this objective has been achieved, Competitors may be required on request to supply the FIA with any relevant information. 2024 Formula 1 Technical Regulations 13 25 April 2023 © 2023 Fédération Internationale de l’Automobile Issue 1 In any case the Intellectual Property of this information, will remain the property of the Competitor, will be protected and not divulged to any third party. 3.2.2 Aerodynamic Influence With the exception of the driver adjustable bodywork described in Article 3.10.10 (in addition to minimal parts solely associated with its actuation) and the flexible seals specifically permitted by Articles 3.13 and 3.14.4, all aerodynamic components or bodywork influencing the car’s aerodynamic performance must be rigidly secured and immobile with respect to their frame of reference defined in Article 3.3. Furthermore, these components must produce a uniform, solid, hard, continuous, impervious surface under all circumstances. Any device or construction that is designed to bridge the gap between the sprung part of the car and the ground is prohibited under all circumstances. With the exception of the parts necessary for the adjustment described in Article 3.10.10, or any incidental movement due to the steering system, any car system, device or procedure which uses driver movement as a means of altering the aerodynamic characteristics of the car is prohibited. The Aerodynamic influence of any component of the car not considered to be bodywork must be incidental to its main function. Any design which aims to maximise such an aerodynamic influence is prohibited. 3.2.3 Symmetry All bodywork must be nominally symmetrical with respect to Y=0. Consequently, and unless otherwise specified, any regulation in Article 3 concerning one side of the car will be assumed to be valid for the other side of the car and references to maximum permissible numbers of components in Article 3 will also refer to the one side of the car. Minimal exceptions to the requirement of symmetry of this Article will be accepted for the installation of non-symmetrical mechanical components of the car, for asymmetrical cooling requirements or for asymmetrical angle adjustment of the front flap defined in Article 3.9.7. Bodywork on the unsprung mass must respect this Article when the suspension position of each wheel is virtually re-orientated so that its wheel coordinate system axes (described in Article 2.11.3) are parallel to their respective axis of the car coordinate system (described in Article 2.11.1). 3.2.4 Digital legality checking The assessment of the car’s compliance with the Aerodynamic Regulations will be carried out digitally using CAD models provided by the teams. In these models: a. Components may only be designed to the edge of a Reference Volume or with a precise geometrical feature, or to the limit of a geometrical criterion (save for the normal round-off discrepancies of the CAD system), when the regulations specifically require an aspect of the bodywork to be designed to this limit, or it can be demonstrated that the design does not rely on lying exactly on this limit to conform to the regulations, such that it is possible for the physical bodywork to comply. b. Components which must follow a precise shape, surface or plane must be designed without any tolerance, save for the normal round-off discrepancies of the CAD system. 3.2.5 Physical legality checking The cars may be measured during a Competition in order to check their conformance to the CAD models discussed in Article 3.2.4 and to ensure they remain inside the Reference Volumes. a. Unless otherwise specified, a tolerance of ±3mm will be accepted for manufacturing purposes only with respect to the CAD surfaces. Where measured surfaces lie outside of this tolerance but remain within the Reference Volumes, a Competitor may be required to provide additional information (e.g. revised CAD geometry) to demonstrate compliance with the regulations. Any discrepancies contrived to create a special aerodynamic effect or surface finish will not be permitted. 2024 Formula 1 Technical Regulations 14 25 April 2023 © 2023 Fédération Internationale de l’Automobile Issue 1 b. Irrespective of a), geometrical discrepancies at the limits of the Reference Volumes must be such that the measured component remains inside the Reference Volume. c. A positional tolerance of +/- 2mm will be accepted for the Front Wing Bodywork, Rear Wing Bodywork, Exhaust Tailpipe, Floor Bodywork behind XR=0, and Tail. This will be assessed by realigning each of the groups of Reference Volumes and Reference Surfaces that define the assemblies, by up to 2mm from their original position, to best fit the measured geometry. d. Irrespective of b), a tolerance of Z=+/-2mm will be accepted for parts of the car lying on the Z=0 plane, with -375 ≤ Y ≤ 375 and ahead of XR=0. e. Minimal discrepancies from the CAD surfaces will also be accepted in the following cases: i. Minimal repairs carried out on aerodynamic components and approved by the FIA ii. Tape, provided it does not achieve an aerodynamic effect otherwise not permitted by Article 3 iii. Junctions between bodywork panels iv. Local bodywork fixing details 3.2.6 Datum Points All cars must be equipped with mountings for optical targets that enable the car’s datum to be determined for scrutineering in the following locations: i. One on the forward part of the top of the survival cell. ii. Two positioned symmetrically about Y=0 on the top of the survival cell close to XB=0. iii. Two positioned symmetrically about Y=0 on the side of the survival cell close to XB=0. iv. Two positioned symmetrically about Y=0 on the side of the survival cell close to the rear mounts of the secondary roll structure. v. Two positioned symmetrically about Y=0 within an axis-aligned cuboid with an interior diagonal defined by points [XC=0, 175, 970] and [XC=150, -175, 870]. vi. One probed point on the RIS or gearbox case. In all cases, a file with required datum points must be supplied for each survival cell. For deflection testing, all cars must be provided with a means of mounting a reference artefact to the RIS. This mounting may be temporary, but must be rigid with respect to the underlying car structure. Full details of the requirements are given in the Appendix the Technical and Sporting Regulations. 3.2.7 Section titles and Article titles within this article have no regulatory value. 3.2.8 Static pressure tappings are permitted in surfaces, provided that they; i. Have an internal diameter of no more than 2mm. ii. They are flush with the underlying geometry. iii. Are only connected to pressure sensors, or are blanked, without leakage. 3.3.1 Bodywork which is part of the sprung mass of the car The only sprung mass bodywork permitted is that defined under Articles 3.5 to 3.12 and under Articles 3.1.1.a.ii to iv. The frame of reference for every part of the car classified as Sprung Mass Bodywork is the coordinate system defined in Article 2.11.1. Any bodywork that is trimmed or filleted in Article 3.11 must first be declared as belonging to one of the groups defined in Articles 3.5 to 3.10. Unless otherwise stated, the compliance of an individual bodywork group to Article 3 will be assessed independently and prior to any trimming, filleting and assembly operation referred to in Article 3.11, and the FIA may request to see any discarded geometry after final assembly. Once the final assembly is completed, any bodywork surfaces no longer exposed to an external airstream or internal duct may be modified, providing they remain unexposed. 3.3.2 Wheel Bodywork The only wheel bodywork permitted is that defined under Article 3.13. With the exception of wheel covers, as defined in Article 3.13.7, the frame of reference for every part of the car classified as Wheel Bodywork is the corresponding upright structure and the corresponding coordinate system defined in Article 2.11.3. The frame of reference for any wheel cover, as defined in Article 3.13.7 is the corresponding wheel rim. 3.3.3 Suspension Fairings The only suspension fairings permitted are those defined under Article 3.14. In order to assess compliance with Article 3.2.2, the frame of reference of any suspension fairing is the structural suspension member that it is attached to.
USER:
Provide a summary of all of the facets that are checked for compliance.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 21 | 13 | 1,388 | null | 547 |
When responding, restrict yourself to only information found within the given article - no other information is valid or necessary.
|
What are the steps to returning Bundle, bonus, and defective items?
|
Marketplace seller's return policy, and how to return a Marketplace product, visit our Returning a Marketplace Product page. On this page: • General return and exchange policy • Cellular and wireless devices • Bundle, bonus, and defective items • Non-returnable items • Product condition requirements • Shipping charges and Environmental Handling Fees General return and exchange policy Most products sold by Best Buy can be returned or exchanged within 30 days from the date of your in-store purchase, or 30 days from the date your online order is delivered. The exceptions to this policy are cellular and wireless devices (details below) and non-returnable items (details below). All products must be returned in their original packaging. The product must be in like-new condition (i.e., no signs of use), and some products can only be returned or exchanged if the packaging is unopened. Read the complete policy details below for full details. To process a return or exchange, you will need to provide the following: • The original receipt (invoice) from your purchase. • The original method of payment. Payment card purchases will be refunded to the original payment card. Store credit will be given for returns with gift receipts. • Original packaging and all items originally included by the manufacturer or by Best Buy (including manuals, accessories, gifts with purchase, bonus items, and any other included items) • Your name, address, phone number, and signature. Valid government-issued photo ID may be requested to confirm this information. Cellular and wireless devices Best Buy adheres to the CRTC Wireless Code of Conduct and the rights of the consumer. Subject to usage restrictions set by the carriers, cellular and wireless devices can be returned up to15 days from the date of your in-store purchase, or 15 days from the date your online order is delivered. The return period is up to 30 days for any person who has self-identified as a person with a disability. For more information about the CRTC Wireless Code of Conduct, you can visit the Wireless Code of Canada webpage. Cellular and wireless devices include cell phones and smartphones, and carrier-activated tablets, mobile hotspots, and wearables. Before returning a cellular or wireless device, make sure to disable the security settings. See more details in the “Disabling security settings on certain devices” section below. Bundle, bonus, and defective items Returning a bonus item Bonus items, or free gifts, are items that were included free with certain purchases. If you wish to return a bonus item, you will need to return both the item that you paid for and the bonus item to be eligible for a refund. Bonus items can be exchanged only if they are defective. All other terms and conditions of the Best Buy Return and Exchange Policies apply. Returning a bundle item Bundle items are items that came as part of a combo or package promotion with another item. Bundling items together allows us to offer them to you at a (combined) lower price than if you were to purchase them each separately. If you decide to return one or more of the items included in a bundle, you will be charged the stand-alone price for each item you wish to keep, which may be higher than the bundled price, then refunded for the items you wish to return. All other terms and conditions of the Best Buy Return and Exchange Policies apply. Returning a defective item A defective item can be returned or exchanged within 30 days, and must be in its original packaging with all items originally included by the manufacturer or by Best Buy. Non-returnable items The following products cannot be returned: • Major appliances that are Open Box, floor models, and/or of the Miele brand • Service, delivery, and installation fees • Gift cards and pre-paid cards • Digital downloads (such as digital software and video games) • Books, magazines, and copyright materials • Food, vitamins, and supplements • Earrings • Intimate products • Oura Ring Sizing Kits • Personal protective equipment (PPE) • Seasonal holiday goods • Shopping bags Product condition requirements Most items can be returned or exchanged even if the box or packaging has been opened, with the exception of non-returnable items and certain items that must be unopened. If the box or packaging is opened, the product must be in like-new condition, with no signs of use. Additional conditions apply to the following items: e All furniture must be unassembled. This includes indoor and outdoor furniture, nursery and baby furniture, and all other types of furniture. e Fashion apparel, linens, bedding, maternity products, and baby clothes, shoes, and accessories must be unused, unworn (if applicable), unlaundered, and still have the original tags attached. e Cell phones, smartphones, wireless devices, computers (laptop and desktop), tablets, iPads, and eReaders must have all security settings disabled. See more details in the "Disabling security settings on certain devices" section below. e Electric bikes and scooters must be returned in their original packaging. Restocking fees on certain opened items There are no restocking fees when returning unopened items, or when returning most items that have been opened. However, a restocking fee of 15% of the purchase price will apply to the following items only if the original packaging is opened: • Action cameras and camcorders • DSLR and mirrorless cameras • Camera drones • Camera lenses and flashes Electric bikes and scooters must be returned with their original packaging. A restocking fee of 15% of the purchase price will only be applied if the original packaging is not included with the return. items eligible for return or exchange only if unopened The following products can only be returned or exchanged if the original packaging is unopened: • Major appliances • except Open Box, floor models, and Miele major appliances, which are all non-returnable. • Baby, nursery, and maternity products • except baby monitors, gates, and highchairs, which can be returned if opened. • Beauty, grooming, and personal care products • except hair dryers, hair straighteners, and curling irons, which can be returned if opened. • Fitness equipment • Computer components and upgrades • Physical software, blank media (e.g., blank CDs), and entertainment media (including video games, music, and movies) • Office supply consumables (ink, toner, etc.) • Paper supplies (paper, writing instruments, etc.) • Headphones, PC headsets, gaming headsets, and virtual reality headsets • Microphones • DJ and karaoke equipment, musical instrument consumables (e.g., guitar strings, etc.), and wind instruments (e.g., harmonicas) • Beverage dispensers or soda machines with compressed gas • Photo film • Batteries • Cleaning supplies and chemicals
|
When responding, restrict yourself to only information found within the given article - no other information is valid or necessary. What are the steps to returning Bundle, bonus, and defective items? Marketplace seller's return policy, and how to return a Marketplace product, visit our Returning a Marketplace Product page. On this page: • General return and exchange policy • Cellular and wireless devices • Bundle, bonus, and defective items • Non-returnable items • Product condition requirements • Shipping charges and Environmental Handling Fees General return and exchange policy Most products sold by Best Buy can be returned or exchanged within 30 days from the date of your in-store purchase, or 30 days from the date your online order is delivered. The exceptions to this policy are cellular and wireless devices (details below) and non-returnable items (details below). All products must be returned in their original packaging. The product must be in like-new condition (i.e., no signs of use), and some products can only be returned or exchanged if the packaging is unopened. Read the complete policy details below for full details. To process a return or exchange, you will need to provide the following: • The original receipt (invoice) from your purchase. • The original method of payment. Payment card purchases will be refunded to the original payment card. Store credit will be given for returns with gift receipts. • Original packaging and all items originally included by the manufacturer or by Best Buy (including manuals, accessories, gifts with purchase, bonus items, and any other included items) • Your name, address, phone number, and signature. Valid government-issued photo ID may be requested to confirm this information. Cellular and wireless devices Best Buy adheres to the CRTC Wireless Code of Conduct and the rights of the consumer. Subject to usage restrictions set by the carriers, cellular and wireless devices can be returned up to15 days from the date of your in-store purchase, or 15 days from the date your online order is delivered. The return period is up to 30 days for any person who has self-identified as a person with a disability. For more information about the CRTC Wireless Code of Conduct, you can visit the Wireless Code of Canada webpage. Cellular and wireless devices include cell phones and smartphones, and carrier-activated tablets, mobile hotspots, and wearables. Before returning a cellular or wireless device, make sure to disable the security settings. See more details in the “Disabling security settings on certain devices” section below. Bundle, bonus, and defective items Returning a bonus item Bonus items, or free gifts, are items that were included free with certain purchases. If you wish to return a bonus item, you will need to return both the item that you paid for and the bonus item to be eligible for a refund. Bonus items can be exchanged only if they are defective. All other terms and conditions of the Best Buy Return and Exchange Policies apply. Returning a bundle item Bundle items are items that came as part of a combo or package promotion with another item. Bundling items together allows us to offer them to you at a (combined) lower price than if you were to purchase them each separately. If you decide to return one or more of the items included in a bundle, you will be charged the stand-alone price for each item you wish to keep, which may be higher than the bundled price, then refunded for the items you wish to return. All other terms and conditions of the Best Buy Return and Exchange Policies apply. Returning a defective item A defective item can be returned or exchanged within 30 days, and must be in its original packaging with all items originally included by the manufacturer or by Best Buy. Non-returnable items The following products cannot be returned: • Major appliances that are Open Box, floor models, and/or of the Miele brand • Service, delivery, and installation fees • Gift cards and pre-paid cards • Digital downloads (such as digital software and video games) • Books, magazines, and copyright materials • Food, vitamins, and supplements • Earrings • Intimate products • Oura Ring Sizing Kits • Personal protective equipment (PPE) • Seasonal holiday goods • Shopping bags Product condition requirements Most items can be returned or exchanged even if the box or packaging has been opened, with the exception of non-returnable items and certain items that must be unopened. If the box or packaging is opened, the product must be in like-new condition, with no signs of use. Additional conditions apply to the following items: e All furniture must be unassembled. This includes indoor and outdoor furniture, nursery and baby furniture, and all other types of furniture. e Fashion apparel, linens, bedding, maternity products, and baby clothes, shoes, and accessories must be unused, unworn (if applicable), unlaundered, and still have the original tags attached. e Cell phones, smartphones, wireless devices, computers (laptop and desktop), tablets, iPads, and eReaders must have all security settings disabled. See more details in the "Disabling security settings on certain devices" section below. e Electric bikes and scooters must be returned in their original packaging. Restocking fees on certain opened items There are no restocking fees when returning unopened items, or when returning most items that have been opened. However, a restocking fee of 15% of the purchase price will apply to the following items only if the original packaging is opened: • Action cameras and camcorders • DSLR and mirrorless cameras • Camera drones • Camera lenses and flashes Electric bikes and scooters must be returned with their original packaging. A restocking fee of 15% of the purchase price will only be applied if the original packaging is not included with the return. items eligible for return or exchange only if unopened The following products can only be returned or exchanged if the original packaging is unopened: • Major appliances • except Open Box, floor models, and Miele major appliances, which are all non-returnable. • Baby, nursery, and maternity products • except baby monitors, gates, and highchairs, which can be returned if opened. • Beauty, grooming, and personal care products • except hair dryers, hair straighteners, and curling irons, which can be returned if opened. • Fitness equipment • Computer components and upgrades • Physical software, blank media (e.g., blank CDs), and entertainment media (including video games, music, and movies) • Office supply consumables (ink, toner, etc.) • Paper supplies (paper, writing instruments, etc.) • Headphones, PC headsets, gaming headsets, and virtual reality headsets • Microphones • DJ and karaoke equipment, musical instrument consumables (e.g., guitar strings, etc.), and wind instruments (e.g., harmonicas) • Beverage dispensers or soda machines with compressed gas • Photo film • Batteries • Cleaning supplies and chemicals
|
When responding, restrict yourself to only information found within the given article - no other information is valid or necessary.
EVIDENCE:
Marketplace seller's return policy, and how to return a Marketplace product, visit our Returning a Marketplace Product page. On this page: • General return and exchange policy • Cellular and wireless devices • Bundle, bonus, and defective items • Non-returnable items • Product condition requirements • Shipping charges and Environmental Handling Fees General return and exchange policy Most products sold by Best Buy can be returned or exchanged within 30 days from the date of your in-store purchase, or 30 days from the date your online order is delivered. The exceptions to this policy are cellular and wireless devices (details below) and non-returnable items (details below). All products must be returned in their original packaging. The product must be in like-new condition (i.e., no signs of use), and some products can only be returned or exchanged if the packaging is unopened. Read the complete policy details below for full details. To process a return or exchange, you will need to provide the following: • The original receipt (invoice) from your purchase. • The original method of payment. Payment card purchases will be refunded to the original payment card. Store credit will be given for returns with gift receipts. • Original packaging and all items originally included by the manufacturer or by Best Buy (including manuals, accessories, gifts with purchase, bonus items, and any other included items) • Your name, address, phone number, and signature. Valid government-issued photo ID may be requested to confirm this information. Cellular and wireless devices Best Buy adheres to the CRTC Wireless Code of Conduct and the rights of the consumer. Subject to usage restrictions set by the carriers, cellular and wireless devices can be returned up to15 days from the date of your in-store purchase, or 15 days from the date your online order is delivered. The return period is up to 30 days for any person who has self-identified as a person with a disability. For more information about the CRTC Wireless Code of Conduct, you can visit the Wireless Code of Canada webpage. Cellular and wireless devices include cell phones and smartphones, and carrier-activated tablets, mobile hotspots, and wearables. Before returning a cellular or wireless device, make sure to disable the security settings. See more details in the “Disabling security settings on certain devices” section below. Bundle, bonus, and defective items Returning a bonus item Bonus items, or free gifts, are items that were included free with certain purchases. If you wish to return a bonus item, you will need to return both the item that you paid for and the bonus item to be eligible for a refund. Bonus items can be exchanged only if they are defective. All other terms and conditions of the Best Buy Return and Exchange Policies apply. Returning a bundle item Bundle items are items that came as part of a combo or package promotion with another item. Bundling items together allows us to offer them to you at a (combined) lower price than if you were to purchase them each separately. If you decide to return one or more of the items included in a bundle, you will be charged the stand-alone price for each item you wish to keep, which may be higher than the bundled price, then refunded for the items you wish to return. All other terms and conditions of the Best Buy Return and Exchange Policies apply. Returning a defective item A defective item can be returned or exchanged within 30 days, and must be in its original packaging with all items originally included by the manufacturer or by Best Buy. Non-returnable items The following products cannot be returned: • Major appliances that are Open Box, floor models, and/or of the Miele brand • Service, delivery, and installation fees • Gift cards and pre-paid cards • Digital downloads (such as digital software and video games) • Books, magazines, and copyright materials • Food, vitamins, and supplements • Earrings • Intimate products • Oura Ring Sizing Kits • Personal protective equipment (PPE) • Seasonal holiday goods • Shopping bags Product condition requirements Most items can be returned or exchanged even if the box or packaging has been opened, with the exception of non-returnable items and certain items that must be unopened. If the box or packaging is opened, the product must be in like-new condition, with no signs of use. Additional conditions apply to the following items: e All furniture must be unassembled. This includes indoor and outdoor furniture, nursery and baby furniture, and all other types of furniture. e Fashion apparel, linens, bedding, maternity products, and baby clothes, shoes, and accessories must be unused, unworn (if applicable), unlaundered, and still have the original tags attached. e Cell phones, smartphones, wireless devices, computers (laptop and desktop), tablets, iPads, and eReaders must have all security settings disabled. See more details in the "Disabling security settings on certain devices" section below. e Electric bikes and scooters must be returned in their original packaging. Restocking fees on certain opened items There are no restocking fees when returning unopened items, or when returning most items that have been opened. However, a restocking fee of 15% of the purchase price will apply to the following items only if the original packaging is opened: • Action cameras and camcorders • DSLR and mirrorless cameras • Camera drones • Camera lenses and flashes Electric bikes and scooters must be returned with their original packaging. A restocking fee of 15% of the purchase price will only be applied if the original packaging is not included with the return. items eligible for return or exchange only if unopened The following products can only be returned or exchanged if the original packaging is unopened: • Major appliances • except Open Box, floor models, and Miele major appliances, which are all non-returnable. • Baby, nursery, and maternity products • except baby monitors, gates, and highchairs, which can be returned if opened. • Beauty, grooming, and personal care products • except hair dryers, hair straighteners, and curling irons, which can be returned if opened. • Fitness equipment • Computer components and upgrades • Physical software, blank media (e.g., blank CDs), and entertainment media (including video games, music, and movies) • Office supply consumables (ink, toner, etc.) • Paper supplies (paper, writing instruments, etc.) • Headphones, PC headsets, gaming headsets, and virtual reality headsets • Microphones • DJ and karaoke equipment, musical instrument consumables (e.g., guitar strings, etc.), and wind instruments (e.g., harmonicas) • Beverage dispensers or soda machines with compressed gas • Photo film • Batteries • Cleaning supplies and chemicals
USER:
What are the steps to returning Bundle, bonus, and defective items?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 20 | 11 | 1,096 | null | 333 |
All information in the response should be sourced from the information provided in the prompt.
|
What are the mental effects of experiencing an anaphylaxis episode as they relate to growth and continued living?
|
After Anaphylaxis: Learning From the Experience Having experienced your own allergic reaction or witnessing someone else having an allergic reaction, especially a severe one (anaphylaxis), can be extremely upsetting and scary. Nevertheless, it can be an opportunity to learn and feel more confident. Embrace the experience and learn from it. In order for it to not let it get you down, here are things to think about: Are you sure of the trigger that caused the allergic reaction? Confirm with your doctor! Review if it is an obvious exposure to a known allergen trigger or if it is a mystery. You would not want to be avoiding a food that is not the real trigger nor want to miss an unexpected food allergen that is a true trigger. If it is not clear what triggered the reaction, it is especially important to review with your doctor. Keep ingredient labels, consider storing any leftover food, and ask for all possible ingredients or known allergens used around the food that caused the problem. Do not assume it was a cross contact. Consider where it happened, what your child was doing at the time, and any circumstances that are different than usual. Did you respond to the symptoms with appropriate treatment? Always more to learn! This is a great learning opportunity to review with your doctor how you recognized and treated the allergic reaction. What did you do right? What could you have done better? After-care of anaphylaxis includes addressing the emotional toll! o You may be sad, nervous, and distrustful for a while. This is completely normal. This feeling should pass with time. Normal routines should return in a few weeks. It is normal for people to feel guilty, worried, anxious or unsure about “what is safe”. o Accidents happen; it is a learning experience and an opportunity to do better. See the next page on “Handling the Emotional Impact of Anaphylaxis” for more details. Stay Positive Focus on all of the success in daily life, not just on food allergy or this reaction. The reaction was a setback, but you managed and learned! Reward positive behaviors (carrying/using medications, “no thank you” to unsafe foods, asking good questions, etc.). What to do if things are not the same after having anaphylaxis Experiencing anaphylaxis can sometimes result in longer-term increased anxiety, or lead to post-traumatic stress. It may cause a feeling of “not knowing what is safe anymore”. This can result in avoidance of food or situations that everyone knows is safe but cause too much anxiety. If life is not back to normal in a few weeks, it may become necessary to address negative behaviors and feelings. You may need help. That is normal and it is OK! In the companion sheet, we provide some more information about what to expect after anaphylaxis and how to address the emotional impact pro-actively. Help is available. Talk to your doctor about referral to a mental health professional. Very effective approaches are available and can make life-changing improvements. Some examples of what you can do: Learn coaching techniques to help your child face safe but anxiety-provoking situations. Learn whether the experience is “expected and normal” after an anaphylactic reaction or should be addressed with more assistance to get back on track. Learn relaxation techniques. Learn about the benefits of counseling, cognitive behavioral treatment or medications. These approaches are only recommended if they are essential to help get through an episode of increased stress. Handling the Emotional Impact of Anaphylaxis – Tips & Suggestions Anaphylactic reactions can be stressful. This handout reviews general points that both parents and patients may wish to consider in the immediate and long-term management of the emotional impact. These are general suggestions and may not be applicable to all individuals. Please talk to your physician about individualized care from a mental health expert if needed. THE EMOTIONAL IMPACT OF A REACTION EVOLVES OVER TIME – WHAT ONE DOES AND FEELS DURING OR IMMEDIATELY AFTER THE EVENT IS NOT THE SAME AS WHAT HAPPENS LATER ON. WHAT TO DO DURING ANAPHYLAXIS OR SUSPECTED ANAPHYLAXIS? Follow your Doctor’s orders regarding the administration of epinephrine, anti-histamines and further emergency care, if needed. Parent: try to project calm while doing so, if possible. However, if you are not calm and cannot project it, do not get too upset about it. The task now is to handle the event itself. WHAT TO DO IMMEDIATELY AFTER THE EVENT IS UNDER CONTROL? OK to admit that you are or were afraid, if that is the case. Parent: try to point out that the event was handled well, if that were the case. Parent: ask the child how he or she feels - but do not persist. It is ok if the child does not want to talk. If the child discloses distress, say that this is normal and that indeed, the event was distressing. Validate the emotion and emphasize safety. Physical contact (e.g. a hug) may be appropriate. WHAT TO DO LATER ON (WEEKS / MONTHS)? If indicated, there may be a need to re-evaluate “safety” (what is and is not safe to eat) given the event. This is best done with the help of an allergist. Ask your child how they feel. Try to send the message that your child can talk with you about feeling distressed, that it is normal to feel some stress even after the event has passed, and that it is a good idea to speak with you about it. Initially, there may be increased anxiety in general, or in situations that were previously thought of as safe. This is normal. This anxiety is expected to get better over the course of a few months (not necessarily immediately). If it does not subside, or if it gets worse after a month, intervention / assistance may be needed. Adjustment after the event may include addressing the feeling that the world is less safe. The event may lead to a re-evaluation of safety; the task is to arrive at a new understanding of safety. Sometimes, this process gets derailed and the child’s feelings that she or he are not safe turn into persistent distress, an anxiety disorder, a post-traumatic stress disorder (PTSD), and other reactions. Those are best managed with the help of a mental health professional. Relaxation techniques, cognitive-behavioral therapy, supportive therapy, and psychiatric medications are all options that would work for specific types of symptoms in specific instances. The preference should be for short-term, targeted interventions, unless a chronic mental health condition is diagnosed in addition to a specific response to an event. THE SILVER LINING Overcoming a period of distress may increase resilience and help the patient face other future challenges!
|
system instructions: All information should be sourced solely from the information provided in the prompt. question: What are the mental effects of experiencing an anaphylaxis episode as they relate to growth and continued living? context block: After Anaphylaxis: Learning From the Experience Having experienced your own allergic reaction or witnessing someone else having an allergic reaction, especially a severe one (anaphylaxis), can be extremely upsetting and scary. Nevertheless, it can be an opportunity to learn and feel more confident. Embrace the experience and learn from it. In order for it to not let it get you down, here are things to think about: Are you sure of the trigger that caused the allergic reaction? Confirm with your doctor! Review if it is an obvious exposure to a known allergen trigger or if it is a mystery. You would not want to be avoiding a food that is not the real trigger nor want to miss an unexpected food allergen that is a true trigger. If it is not clear what triggered the reaction, it is especially important to review with your doctor. Keep ingredient labels, consider storing any leftover food, and ask for all possible ingredients or known allergens used around the food that caused the problem. Do not assume it was a cross contact. Consider where it happened, what your child was doing at the time, and any circumstances that are different than usual. Did you respond to the symptoms with appropriate treatment? Always more to learn! This is a great learning opportunity to review with your doctor how you recognized and treated the allergic reaction. What did you do right? What could you have done better? After-care of anaphylaxis includes addressing the emotional toll! o You may be sad, nervous, and distrustful for a while. This is completely normal. This feeling should pass with time. Normal routines should return in a few weeks. It is normal for people to feel guilty, worried, anxious or unsure about “what is safe”. o Accidents happen; it is a learning experience and an opportunity to do better. See the next page on “Handling the Emotional Impact of Anaphylaxis” for more details. Stay Positive Focus on all of the success in daily life, not just on food allergy or this reaction. The reaction was a setback, but you managed and learned! Reward positive behaviors (carrying/using medications, “no thank you” to unsafe foods, asking good questions, etc.). What to do if things are not the same after having anaphylaxis Experiencing anaphylaxis can sometimes result in longer-term increased anxiety, or lead to post-traumatic stress. It may cause a feeling of “not knowing what is safe anymore”. This can result in avoidance of food or situations that everyone knows is safe but cause too much anxiety. If life is not back to normal in a few weeks, it may become necessary to address negative behaviors and feelings. You may need help. That is normal and it is OK! In the companion sheet, we provide some more information about what to expect after anaphylaxis and how to address the emotional impact pro-actively. Help is available. Talk to your doctor about referral to a mental health professional. Very effective approaches are available and can make life-changing improvements. Some examples of what you can do: Learn coaching techniques to help your child face safe but anxiety-provoking situations. Learn whether the experience is “expected and normal” after an anaphylactic reaction or should be addressed with more assistance to get back on track. Learn relaxation techniques. Learn about the benefits of counseling, cognitive behavioral treatment or medications. These approaches are only recommended if they are essential to help get through an episode of increased stress. Handling the Emotional Impact of Anaphylaxis – Tips & Suggestions Anaphylactic reactions can be stressful. This handout reviews general points that both parents and patients may wish to consider in the immediate and long-term management of the emotional impact. These are general suggestions and may not be applicable to all individuals. Please talk to your physician about individualized care from a mental health expert if needed. THE EMOTIONAL IMPACT OF A REACTION EVOLVES OVER TIME – WHAT ONE DOES AND FEELS DURING OR IMMEDIATELY AFTER THE EVENT IS NOT THE SAME AS WHAT HAPPENS LATER ON. WHAT TO DO DURING ANAPHYLAXIS OR SUSPECTED ANAPHYLAXIS? Follow your Doctor’s orders regarding the administration of epinephrine, anti-histamines and further emergency care, if needed. Parent: try to project calm while doing so, if possible. However, if you are not calm and cannot project it, do not get too upset about it. The task now is to handle the event itself. WHAT TO DO IMMEDIATELY AFTER THE EVENT IS UNDER CONTROL? OK to admit that you are or were afraid, if that is the case. Parent: try to point out that the event was handled well, if that were the case. Parent: ask the child how he or she feels - but do not persist. It is ok if the child does not want to talk. If the child discloses distress, say that this is normal and that indeed, the event was distressing. Validate the emotion and emphasize safety. Physical contact (e.g. a hug) may be appropriate. WHAT TO DO LATER ON (WEEKS / MONTHS)? If indicated, there may be a need to re-evaluate “safety” (what is and is not safe to eat) given the event. This is best done with the help of an allergist. Ask your child how they feel. Try to send the message that your child can talk with you about feeling distressed, that it is normal to feel some stress even after the event has passed, and that it is a good idea to speak with you about it. Initially, there may be increased anxiety in general, or in situations that were previously thought of as safe. This is normal. This anxiety is expected to get better over the course of a few months (not necessarily immediately). If it does not subside, or if it gets worse after a month, intervention / assistance may be needed. Adjustment after the event may include addressing the feeling that the world is less safe. The event may lead to a re-evaluation of safety; the task is to arrive at a new understanding of safety. Sometimes, this process gets derailed and the child’s feelings that she or he are not safe turn into persistent distress, an anxiety disorder, a post-traumatic stress disorder (PTSD), and other reactions. Those are best managed with the help of a mental health professional. Relaxation techniques, cognitive-behavioral therapy, supportive therapy, and psychiatric medications are all options that would work for specific types of symptoms in specific instances. The preference should be for short-term, targeted interventions, unless a chronic mental health condition is diagnosed in addition to a specific response to an event. THE SILVER LINING Overcoming a period of distress may increase resilience and help the patient face other future challenges!
|
All information in the response should be sourced from the information provided in the prompt.
EVIDENCE:
After Anaphylaxis: Learning From the Experience Having experienced your own allergic reaction or witnessing someone else having an allergic reaction, especially a severe one (anaphylaxis), can be extremely upsetting and scary. Nevertheless, it can be an opportunity to learn and feel more confident. Embrace the experience and learn from it. In order for it to not let it get you down, here are things to think about: Are you sure of the trigger that caused the allergic reaction? Confirm with your doctor! Review if it is an obvious exposure to a known allergen trigger or if it is a mystery. You would not want to be avoiding a food that is not the real trigger nor want to miss an unexpected food allergen that is a true trigger. If it is not clear what triggered the reaction, it is especially important to review with your doctor. Keep ingredient labels, consider storing any leftover food, and ask for all possible ingredients or known allergens used around the food that caused the problem. Do not assume it was a cross contact. Consider where it happened, what your child was doing at the time, and any circumstances that are different than usual. Did you respond to the symptoms with appropriate treatment? Always more to learn! This is a great learning opportunity to review with your doctor how you recognized and treated the allergic reaction. What did you do right? What could you have done better? After-care of anaphylaxis includes addressing the emotional toll! o You may be sad, nervous, and distrustful for a while. This is completely normal. This feeling should pass with time. Normal routines should return in a few weeks. It is normal for people to feel guilty, worried, anxious or unsure about “what is safe”. o Accidents happen; it is a learning experience and an opportunity to do better. See the next page on “Handling the Emotional Impact of Anaphylaxis” for more details. Stay Positive Focus on all of the success in daily life, not just on food allergy or this reaction. The reaction was a setback, but you managed and learned! Reward positive behaviors (carrying/using medications, “no thank you” to unsafe foods, asking good questions, etc.). What to do if things are not the same after having anaphylaxis Experiencing anaphylaxis can sometimes result in longer-term increased anxiety, or lead to post-traumatic stress. It may cause a feeling of “not knowing what is safe anymore”. This can result in avoidance of food or situations that everyone knows is safe but cause too much anxiety. If life is not back to normal in a few weeks, it may become necessary to address negative behaviors and feelings. You may need help. That is normal and it is OK! In the companion sheet, we provide some more information about what to expect after anaphylaxis and how to address the emotional impact pro-actively. Help is available. Talk to your doctor about referral to a mental health professional. Very effective approaches are available and can make life-changing improvements. Some examples of what you can do: Learn coaching techniques to help your child face safe but anxiety-provoking situations. Learn whether the experience is “expected and normal” after an anaphylactic reaction or should be addressed with more assistance to get back on track. Learn relaxation techniques. Learn about the benefits of counseling, cognitive behavioral treatment or medications. These approaches are only recommended if they are essential to help get through an episode of increased stress. Handling the Emotional Impact of Anaphylaxis – Tips & Suggestions Anaphylactic reactions can be stressful. This handout reviews general points that both parents and patients may wish to consider in the immediate and long-term management of the emotional impact. These are general suggestions and may not be applicable to all individuals. Please talk to your physician about individualized care from a mental health expert if needed. THE EMOTIONAL IMPACT OF A REACTION EVOLVES OVER TIME – WHAT ONE DOES AND FEELS DURING OR IMMEDIATELY AFTER THE EVENT IS NOT THE SAME AS WHAT HAPPENS LATER ON. WHAT TO DO DURING ANAPHYLAXIS OR SUSPECTED ANAPHYLAXIS? Follow your Doctor’s orders regarding the administration of epinephrine, anti-histamines and further emergency care, if needed. Parent: try to project calm while doing so, if possible. However, if you are not calm and cannot project it, do not get too upset about it. The task now is to handle the event itself. WHAT TO DO IMMEDIATELY AFTER THE EVENT IS UNDER CONTROL? OK to admit that you are or were afraid, if that is the case. Parent: try to point out that the event was handled well, if that were the case. Parent: ask the child how he or she feels - but do not persist. It is ok if the child does not want to talk. If the child discloses distress, say that this is normal and that indeed, the event was distressing. Validate the emotion and emphasize safety. Physical contact (e.g. a hug) may be appropriate. WHAT TO DO LATER ON (WEEKS / MONTHS)? If indicated, there may be a need to re-evaluate “safety” (what is and is not safe to eat) given the event. This is best done with the help of an allergist. Ask your child how they feel. Try to send the message that your child can talk with you about feeling distressed, that it is normal to feel some stress even after the event has passed, and that it is a good idea to speak with you about it. Initially, there may be increased anxiety in general, or in situations that were previously thought of as safe. This is normal. This anxiety is expected to get better over the course of a few months (not necessarily immediately). If it does not subside, or if it gets worse after a month, intervention / assistance may be needed. Adjustment after the event may include addressing the feeling that the world is less safe. The event may lead to a re-evaluation of safety; the task is to arrive at a new understanding of safety. Sometimes, this process gets derailed and the child’s feelings that she or he are not safe turn into persistent distress, an anxiety disorder, a post-traumatic stress disorder (PTSD), and other reactions. Those are best managed with the help of a mental health professional. Relaxation techniques, cognitive-behavioral therapy, supportive therapy, and psychiatric medications are all options that would work for specific types of symptoms in specific instances. The preference should be for short-term, targeted interventions, unless a chronic mental health condition is diagnosed in addition to a specific response to an event. THE SILVER LINING Overcoming a period of distress may increase resilience and help the patient face other future challenges!
USER:
What are the mental effects of experiencing an anaphylaxis episode as they relate to growth and continued living?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 15 | 18 | 1,119 | null | 182 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
Compare how technology has affected children's attention space to how reading affects it. What are the technological advances that negatively shifted the way children's attention span works? Also what are some that positively affects attention span? Give me no more than 750 words.
|
How Technology Is Changing the Way Children Think and Focus Are your children prepared to think and focus for success in 21st-century life? Posted December 4, 2012 | Reviewed by Lybi Ma Key points Attention is a highly malleable quality and most directly influenced by the environment in which it is used. The internet creates a learning environment in which consistent attention is impossible, imagination is unnecessary, and memory is inhibited. Video games improve visual-spatial capabilities, increase attentional ability, reaction times, and the ability to identify details among clutter. Thinking. The capacity to reflect, reason, and draw conclusions based on our experiences, knowledge, and insights. It’s what makes us human and has enabled us to communicate, create, build, advance, and become civilized. Thinking encompasses so many aspects of who our children are and what they do, from observing, learning, remembering, questioning, and judging to innovating, arguing, deciding, and acting. There is also little doubt that all of the new technologies, led by the internet, are shaping the way we think in ways obvious and subtle, deliberate and unintentional, and advantageous and detrimental The uncertain reality is that, with this new technological frontier in its infancy and developments emerging at a rapid pace, we have neither the benefit of historical hindsight nor the time to ponder or examine the value and cost of these advancements in terms of how it influences our children’s ability to think. There is, however, a growing body of research that technology can be both beneficial and harmful to different ways in which children think. Moreover, this influence isn’t just affecting children on the surface of their thinking. Rather, because their brains are still developing and malleable, frequent exposure by so-called digital natives to technology is actually wiring the brain in ways very different than in previous generations. What is clear is that, as with advances throughout history, the technology that is available determines how our brains develop. For example, as the technology writer Nicholas Carr has observed, the emergence of reading encouraged our brains to be focused and imaginative. In contrast, the rise of the internet is strengthening our ability to scan information rapidly and efficiently. The effects of technology on children are complicated, with both benefits and costs. Whether technology helps or hurts in the development of your children’s thinking depends on what specific technology is used and how and what frequency it is used. At least early in their lives, the power to dictate your children’s relationship with technology and, as a result, its influence on them, from synaptic activity to conscious thought. Over the next several weeks, I’m going to focus on the areas in which the latest thinking and research has shown technology to have the greatest influence on how children think: attention, information overload, decision making, and memory/learning. Importantly, all of these areas are ones in which you can have a counteracting influence on how technology affects your children. Attention You can think of attention as the gateway to thinking. Without it, other aspects of thinking, namely, perception, memory, language, learning, creativity, reasoning, problem-solving, and decision making are greatly diminished or can’t occur at all. The ability of your children to learn to focus effectively and consistently lays the foundation for almost all aspects of their growth and is fundamental to their development into successful and happy people. Attention has been found to be a highly malleable quality and most directly influenced by the environment in which it is used. This selective attention can be found in the animal kingdom in which different species develop attentional skills that help them function and survive. For example, wolves, lions, tigers, and other predators have highly tuned visual attention that enables them to spot and track their prey. In contrast, their prey, including deer and antelope, have well-developed auditory attention that allows them to hear approaching predators. In both cases, animals’ attentional abilities have developed based on the environment in which they live. The same holds true for human development. Whether infant recognition of their parents’ faces or students paying attention in class, children’s immediate environment determines the kind of attention that they develop. In generations past, for example, children directed considerable amounts of their time to reading, an activity that offered few distractions and required intense and sustained attention, imagination, and memory. The advent of television altered that attention by offering children visual stimuli, fragmented attention, and little need for imagination. Then the internet was invented and children were thrust into a vastly different environment in which, because distraction is the norm, consistent attention is impossible, imagination is unnecessary, and memory is inhibited. Technology conditions the brain to pay attention to information very differently than reading. The metaphor that Nicholas Carr uses is the difference between scuba diving and jet skiing. Book reading is like scuba diving in which the diver is submerged in a quiet, visually restricted, slow-paced setting with few distractions and, as a result, is required to focus narrowly and think deeply on the limited information that is available to them. In contrast, using the internet is like jet skiing, in which the jet skier is skimming along the surface of the water at high speed, exposed to a broad vista, surrounded by many distractions, and only able to focus fleetingly on any one thing. In fact, studies have shown that reading uninterrupted text results in faster completion and better understanding, recall, and learning than those who read text filled with hyperlinks and ads. Those who read a text-only version of a presentation, as compared to one that included video, found the presentation to be more engaging, informative, and entertaining, a finding contrary to conventional wisdom, to be sure. Additionally, contrary to conventional educational wisdom, students who were allowed internet access during class didn’t recall the lecture nor did they perform as well on a test of the material as those who weren’t “wired” during class. Finally, reading develops reflection, critical thinking, problem-solving, and vocabulary better than visual media. Exposure to technology isn’t all bad. Research shows that, for example, video games and other screen media improve visual-spatial capabilities, increase attentional ability, reaction times, and the capacity to identify details among clutter. Also, rather than making children stupid, it may just be making them different. For example, the ubiquitous use of internet search engines is causing children to become less adept at remembering things and more skilled at remembering where to find things. Given the ease with which information can be found these days, it only stands to reason that knowing where to look is becoming more important for children than actually knowing something. Not having to retain information in our brain may allow it to engage in more “higher-order” processing such as contemplation, critical thinking, and problem-solving. What does all this mean for raising your children? The bottom line is that too much screen time and not enough other activities, such as reading, playing games, and good old unstructured and imaginative play, will result in your children having their brains wired in ways that may make them less, not more, prepared to thrive in this crazy new world of technology.
|
[question] Compare how technology has affected children's attention space to how reading affects it. What are the technological advances that negatively shifted the way children's attention span works? Also what are some that positively affects attention span? Give me no more than 750 words. ===================== [text] How Technology Is Changing the Way Children Think and Focus Are your children prepared to think and focus for success in 21st-century life? Posted December 4, 2012 | Reviewed by Lybi Ma Key points Attention is a highly malleable quality and most directly influenced by the environment in which it is used. The internet creates a learning environment in which consistent attention is impossible, imagination is unnecessary, and memory is inhibited. Video games improve visual-spatial capabilities, increase attentional ability, reaction times, and the ability to identify details among clutter. Thinking. The capacity to reflect, reason, and draw conclusions based on our experiences, knowledge, and insights. It’s what makes us human and has enabled us to communicate, create, build, advance, and become civilized. Thinking encompasses so many aspects of who our children are and what they do, from observing, learning, remembering, questioning, and judging to innovating, arguing, deciding, and acting. There is also little doubt that all of the new technologies, led by the internet, are shaping the way we think in ways obvious and subtle, deliberate and unintentional, and advantageous and detrimental The uncertain reality is that, with this new technological frontier in its infancy and developments emerging at a rapid pace, we have neither the benefit of historical hindsight nor the time to ponder or examine the value and cost of these advancements in terms of how it influences our children’s ability to think. There is, however, a growing body of research that technology can be both beneficial and harmful to different ways in which children think. Moreover, this influence isn’t just affecting children on the surface of their thinking. Rather, because their brains are still developing and malleable, frequent exposure by so-called digital natives to technology is actually wiring the brain in ways very different than in previous generations. What is clear is that, as with advances throughout history, the technology that is available determines how our brains develop. For example, as the technology writer Nicholas Carr has observed, the emergence of reading encouraged our brains to be focused and imaginative. In contrast, the rise of the internet is strengthening our ability to scan information rapidly and efficiently. The effects of technology on children are complicated, with both benefits and costs. Whether technology helps or hurts in the development of your children’s thinking depends on what specific technology is used and how and what frequency it is used. At least early in their lives, the power to dictate your children’s relationship with technology and, as a result, its influence on them, from synaptic activity to conscious thought. Over the next several weeks, I’m going to focus on the areas in which the latest thinking and research has shown technology to have the greatest influence on how children think: attention, information overload, decision making, and memory/learning. Importantly, all of these areas are ones in which you can have a counteracting influence on how technology affects your children. Attention You can think of attention as the gateway to thinking. Without it, other aspects of thinking, namely, perception, memory, language, learning, creativity, reasoning, problem-solving, and decision making are greatly diminished or can’t occur at all. The ability of your children to learn to focus effectively and consistently lays the foundation for almost all aspects of their growth and is fundamental to their development into successful and happy people. Attention has been found to be a highly malleable quality and most directly influenced by the environment in which it is used. This selective attention can be found in the animal kingdom in which different species develop attentional skills that help them function and survive. For example, wolves, lions, tigers, and other predators have highly tuned visual attention that enables them to spot and track their prey. In contrast, their prey, including deer and antelope, have well-developed auditory attention that allows them to hear approaching predators. In both cases, animals’ attentional abilities have developed based on the environment in which they live. The same holds true for human development. Whether infant recognition of their parents’ faces or students paying attention in class, children’s immediate environment determines the kind of attention that they develop. In generations past, for example, children directed considerable amounts of their time to reading, an activity that offered few distractions and required intense and sustained attention, imagination, and memory. The advent of television altered that attention by offering children visual stimuli, fragmented attention, and little need for imagination. Then the internet was invented and children were thrust into a vastly different environment in which, because distraction is the norm, consistent attention is impossible, imagination is unnecessary, and memory is inhibited. Technology conditions the brain to pay attention to information very differently than reading. The metaphor that Nicholas Carr uses is the difference between scuba diving and jet skiing. Book reading is like scuba diving in which the diver is submerged in a quiet, visually restricted, slow-paced setting with few distractions and, as a result, is required to focus narrowly and think deeply on the limited information that is available to them. In contrast, using the internet is like jet skiing, in which the jet skier is skimming along the surface of the water at high speed, exposed to a broad vista, surrounded by many distractions, and only able to focus fleetingly on any one thing. In fact, studies have shown that reading uninterrupted text results in faster completion and better understanding, recall, and learning than those who read text filled with hyperlinks and ads. Those who read a text-only version of a presentation, as compared to one that included video, found the presentation to be more engaging, informative, and entertaining, a finding contrary to conventional wisdom, to be sure. Additionally, contrary to conventional educational wisdom, students who were allowed internet access during class didn’t recall the lecture nor did they perform as well on a test of the material as those who weren’t “wired” during class. Finally, reading develops reflection, critical thinking, problem-solving, and vocabulary better than visual media. Exposure to technology isn’t all bad. Research shows that, for example, video games and other screen media improve visual-spatial capabilities, increase attentional ability, reaction times, and the capacity to identify details among clutter. Also, rather than making children stupid, it may just be making them different. For example, the ubiquitous use of internet search engines is causing children to become less adept at remembering things and more skilled at remembering where to find things. Given the ease with which information can be found these days, it only stands to reason that knowing where to look is becoming more important for children than actually knowing something. Not having to retain information in our brain may allow it to engage in more “higher-order” processing such as contemplation, critical thinking, and problem-solving. What does all this mean for raising your children? The bottom line is that too much screen time and not enough other activities, such as reading, playing games, and good old unstructured and imaginative play, will result in your children having their brains wired in ways that may make them less, not more, prepared to thrive in this crazy new world of technology. https://www.psychologytoday.com/us/blog/the-power-of-prime/201212/how-technology-is-changing-the-way-children-think-and-focus?msockid=314010dc793467982e9a043678f6665c ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
How Technology Is Changing the Way Children Think and Focus Are your children prepared to think and focus for success in 21st-century life? Posted December 4, 2012 | Reviewed by Lybi Ma Key points Attention is a highly malleable quality and most directly influenced by the environment in which it is used. The internet creates a learning environment in which consistent attention is impossible, imagination is unnecessary, and memory is inhibited. Video games improve visual-spatial capabilities, increase attentional ability, reaction times, and the ability to identify details among clutter. Thinking. The capacity to reflect, reason, and draw conclusions based on our experiences, knowledge, and insights. It’s what makes us human and has enabled us to communicate, create, build, advance, and become civilized. Thinking encompasses so many aspects of who our children are and what they do, from observing, learning, remembering, questioning, and judging to innovating, arguing, deciding, and acting. There is also little doubt that all of the new technologies, led by the internet, are shaping the way we think in ways obvious and subtle, deliberate and unintentional, and advantageous and detrimental The uncertain reality is that, with this new technological frontier in its infancy and developments emerging at a rapid pace, we have neither the benefit of historical hindsight nor the time to ponder or examine the value and cost of these advancements in terms of how it influences our children’s ability to think. There is, however, a growing body of research that technology can be both beneficial and harmful to different ways in which children think. Moreover, this influence isn’t just affecting children on the surface of their thinking. Rather, because their brains are still developing and malleable, frequent exposure by so-called digital natives to technology is actually wiring the brain in ways very different than in previous generations. What is clear is that, as with advances throughout history, the technology that is available determines how our brains develop. For example, as the technology writer Nicholas Carr has observed, the emergence of reading encouraged our brains to be focused and imaginative. In contrast, the rise of the internet is strengthening our ability to scan information rapidly and efficiently. The effects of technology on children are complicated, with both benefits and costs. Whether technology helps or hurts in the development of your children’s thinking depends on what specific technology is used and how and what frequency it is used. At least early in their lives, the power to dictate your children’s relationship with technology and, as a result, its influence on them, from synaptic activity to conscious thought. Over the next several weeks, I’m going to focus on the areas in which the latest thinking and research has shown technology to have the greatest influence on how children think: attention, information overload, decision making, and memory/learning. Importantly, all of these areas are ones in which you can have a counteracting influence on how technology affects your children. Attention You can think of attention as the gateway to thinking. Without it, other aspects of thinking, namely, perception, memory, language, learning, creativity, reasoning, problem-solving, and decision making are greatly diminished or can’t occur at all. The ability of your children to learn to focus effectively and consistently lays the foundation for almost all aspects of their growth and is fundamental to their development into successful and happy people. Attention has been found to be a highly malleable quality and most directly influenced by the environment in which it is used. This selective attention can be found in the animal kingdom in which different species develop attentional skills that help them function and survive. For example, wolves, lions, tigers, and other predators have highly tuned visual attention that enables them to spot and track their prey. In contrast, their prey, including deer and antelope, have well-developed auditory attention that allows them to hear approaching predators. In both cases, animals’ attentional abilities have developed based on the environment in which they live. The same holds true for human development. Whether infant recognition of their parents’ faces or students paying attention in class, children’s immediate environment determines the kind of attention that they develop. In generations past, for example, children directed considerable amounts of their time to reading, an activity that offered few distractions and required intense and sustained attention, imagination, and memory. The advent of television altered that attention by offering children visual stimuli, fragmented attention, and little need for imagination. Then the internet was invented and children were thrust into a vastly different environment in which, because distraction is the norm, consistent attention is impossible, imagination is unnecessary, and memory is inhibited. Technology conditions the brain to pay attention to information very differently than reading. The metaphor that Nicholas Carr uses is the difference between scuba diving and jet skiing. Book reading is like scuba diving in which the diver is submerged in a quiet, visually restricted, slow-paced setting with few distractions and, as a result, is required to focus narrowly and think deeply on the limited information that is available to them. In contrast, using the internet is like jet skiing, in which the jet skier is skimming along the surface of the water at high speed, exposed to a broad vista, surrounded by many distractions, and only able to focus fleetingly on any one thing. In fact, studies have shown that reading uninterrupted text results in faster completion and better understanding, recall, and learning than those who read text filled with hyperlinks and ads. Those who read a text-only version of a presentation, as compared to one that included video, found the presentation to be more engaging, informative, and entertaining, a finding contrary to conventional wisdom, to be sure. Additionally, contrary to conventional educational wisdom, students who were allowed internet access during class didn’t recall the lecture nor did they perform as well on a test of the material as those who weren’t “wired” during class. Finally, reading develops reflection, critical thinking, problem-solving, and vocabulary better than visual media. Exposure to technology isn’t all bad. Research shows that, for example, video games and other screen media improve visual-spatial capabilities, increase attentional ability, reaction times, and the capacity to identify details among clutter. Also, rather than making children stupid, it may just be making them different. For example, the ubiquitous use of internet search engines is causing children to become less adept at remembering things and more skilled at remembering where to find things. Given the ease with which information can be found these days, it only stands to reason that knowing where to look is becoming more important for children than actually knowing something. Not having to retain information in our brain may allow it to engage in more “higher-order” processing such as contemplation, critical thinking, and problem-solving. What does all this mean for raising your children? The bottom line is that too much screen time and not enough other activities, such as reading, playing games, and good old unstructured and imaginative play, will result in your children having their brains wired in ways that may make them less, not more, prepared to thrive in this crazy new world of technology.
USER:
Compare how technology has affected children's attention space to how reading affects it. What are the technological advances that negatively shifted the way children's attention span works? Also what are some that positively affects attention span? Give me no more than 750 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 43 | 1,191 | null | 49 |
Rely only on the context document, with no outside information.
|
Based on the document, was the user satisfied with the product?
|
**AirPod Pro (2nd Gen) Customer Review** the sound quality and bass of these earphones are clear and exceptional for listening to both music and podcasts; it's like i'm hearing all of my favorite music again with new ears, including background harmonies and production qualities that i didn't notice before. they are so lightweight and comfortable, and i haven't had any issues with them falling out, which was a concern for me as someone who goes to the gym and wears glasses. they connected to my apple devices quickly and effortlessly, and they're very aesthetically beautiful and stylish in person. the noise cancellation feature is excellent and effectively blocks out background noise, sometimes so much so that i'm unaware of my surroundings, but the level of noise cancellation and volume can be adjusted based on your surroundings. there is also a feature where siri can read your notifications as they come in, which some people may find useful. you can answer, mute, unmute, and end calls by pressing them, and there are even more features that i haven't played with yet. they are SO worth the hype and the price tag. i am beyond satisfied with my purchase, and as a music lover, i think they're really going to improve my quality of life. i will never go back to any other earphone brand. thank you!
|
<Task Instructions> ========== Rely only on the context document, with no outside information. ---------- <Passage> ========== **AirPod Pro (2nd Gen) Customer Review** the sound quality and bass of these earphones are clear and exceptional for listening to both music and podcasts; it's like i'm hearing all of my favorite music again with new ears, including background harmonies and production qualities that i didn't notice before. they are so lightweight and comfortable, and i haven't had any issues with them falling out, which was a concern for me as someone who goes to the gym and wears glasses. they connected to my apple devices quickly and effortlessly, and they're very aesthetically beautiful and stylish in person. the noise cancellation feature is excellent and effectively blocks out background noise, sometimes so much so that i'm unaware of my surroundings, but the level of noise cancellation and volume can be adjusted based on your surroundings. there is also a feature where siri can read your notifications as they come in, which some people may find useful. you can answer, mute, unmute, and end calls by pressing them, and there are even more features that i haven't played with yet. they are SO worth the hype and the price tag. i am beyond satisfied with my purchase, and as a music lover, i think they're really going to improve my quality of life. i will never go back to any other earphone brand. thank you! ---------- <Question> ========== Based on the document, was the user satisfied with the product?
|
Rely only on the context document, with no outside information.
EVIDENCE:
**AirPod Pro (2nd Gen) Customer Review** the sound quality and bass of these earphones are clear and exceptional for listening to both music and podcasts; it's like i'm hearing all of my favorite music again with new ears, including background harmonies and production qualities that i didn't notice before. they are so lightweight and comfortable, and i haven't had any issues with them falling out, which was a concern for me as someone who goes to the gym and wears glasses. they connected to my apple devices quickly and effortlessly, and they're very aesthetically beautiful and stylish in person. the noise cancellation feature is excellent and effectively blocks out background noise, sometimes so much so that i'm unaware of my surroundings, but the level of noise cancellation and volume can be adjusted based on your surroundings. there is also a feature where siri can read your notifications as they come in, which some people may find useful. you can answer, mute, unmute, and end calls by pressing them, and there are even more features that i haven't played with yet. they are SO worth the hype and the price tag. i am beyond satisfied with my purchase, and as a music lover, i think they're really going to improve my quality of life. i will never go back to any other earphone brand. thank you!
USER:
Based on the document, was the user satisfied with the product?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 10 | 11 | 225 | null | 518 |
Respond succinctly and directly. Refer only to the provided document. After your answer, provide any relevant quotes from the source document in italics.
|
Using only the context document, what are the 4 plant-based diet indexes?
|
**Plant‐Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All‐Cause Mortality in a General Population of Middle‐Aged Adults** Abstract Background Previous studies have documented the cardiometabolic health benefits of plant‐based diets; however, these studies were conducted in selected study populations that had narrow generalizability. Methods and Results We used data from a community‐based cohort of middle‐aged adults (n=12 168) in the ARIC (Atherosclerosis Risk in Communities) study who were followed up from 1987 through 2016. Participants’ diet was classified using 4 diet indexes. In the overall plant‐based diet index and provegetarian diet index, higher intakes of all or selected plant foods received higher scores; in the healthy plant‐based diet index, higher intakes of only the healthy plant foods received higher scores; in the less healthy plant‐based diet index, higher intakes of only the less healthy plant foods received higher scores. In all indexes, higher intakes of animal foods received lower scores. Results from Cox proportional hazards models showed that participants in the highest versus lowest quintile for adherence to overall plant‐based diet index or provegetarian diet had a 16%, 31% to 32%, and 18% to 25% lower risk of cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality, respectively, after adjusting for important confounders (all P<0.05 for trend). Higher adherence to a healthy plant‐based diet index was associated with a 19% and 11% lower risk of cardiovascular disease mortality and all‐cause mortality, respectively, but not incident cardiovascular disease (P<0.05 for trend). No associations were observed between the less healthy plant‐based diet index and the outcomes. Conclusions Diets higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population. Clinical Perspective What Is New? • Plant‐based diets, diets that emphasize higher intakes of plant foods and lower intakes of animal foods, are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality in a general US adult population. • Healthful plant‐based diets, diets higher in nutrient‐dense plant foods and lower in refined carbohydrates and animal foods, are associated with a lower risk of cardiovascular disease mortality and all‐cause mortality, but not incident cardiovascular disease. What Are the Clinical Implications? • Our results suggest that dietary patterns that are relatively higher in plant foods and relatively lower in animal foods may confer benefits for cardiovascular health. • Future research examining whether the quality of plant foods (healthful versus less healthful) within the framework of an overall plant‐based diet is associated with cardiovascular disease and all‐cause mortality is warranted. Introduction Plant‐based diets are dietary patterns that emphasize higher intakes of plant foods and are low in animal foods. Vegetarian diets, a type of plant‐based diet, with a focus on restriction of different types of animal foods (meat, poultry, or fish), have been associated with a lower risk of cardiovascular risk factors, such as obesity, hypertension, type 2 diabetes mellitus, and ischemic heart disease.1, 2, 3 However, prospective cohort studies have shown mixed results on the associations with cardiovascular disease mortality and all‐cause mortality.4, 5, 6 These previous studies were conducted in selected study populations that were mostly composed of Seventh‐Day Adventists, vegetarians, or health‐conscious individuals; thus, they had relatively narrow generalizability.4, 5, 7, 8, 9 Although prior studies have characterized participants’ diets using a relatively simple classification method based on frequency of animal food consumption,4, 5, 6 there have since been more comprehensive attempts to assess an individual's diet using plant‐based diet indexes.10, 11, 12, 13 These indexes give higher scores for higher consumption of plant foods and lower consumption of animal foods, allowing researchers to examine whether the degree of adherence to an overall plant‐based diet is associated with health outcomes. Studies that used such indexes (ie, an overall plant‐based diet index [PDI] or a provegetarian diet index) found that greater adherence to these diets was associated with a lower risk of type 2 diabetes mellitus, coronary heart disease, and all‐cause mortality.10, 11, 12 In addition, some plant‐based indexes separately scored healthful (whole grains, vegetables, and plant proteins) and unhealthful (refined carbohydrates and sugar) plant sources of food. Healthful plant‐based diets, which scored higher intakes of only healthful plant foods higher, were more strongly inversely associated with type 2 diabetes mellitus and coronary heart disease than the overall plant‐based diets.11, 12 In contrast, greater adherence to less healthful (unhealthful) plant‐based diets, which scored higher intakes of only less healthful plant foods higher, were associated with a higher risk of these conditions.11, 12 Given the limited evidence on plant‐based diets in the general population and recent developments in plant‐based diet scores, the objectives of the present study were as follows: (1) to evaluate whether overall plant‐based diets are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality in a general US population; and (2) to assess if the association differed by adherence to healthful and less healthful plant‐based diets using 4 a priori defined plant‐based diet scores (overall plant‐based diet, healthy plant‐based diet, less healthy plant‐based diet, and provegetarian diet indexes). Study Design We used data from a community‐based cohort of middle‐aged men and women (45–64 years of age at baseline, n=15 792) in the ARIC study. From 1987 to 1989, participants from 4 US communities (Washington County, Maryland; Forsyth County, North Carolina; Minneapolis, MN; and Jackson, MS) were enrolled in the study. Follow‐up visits occurred in 1990 to 1992 (visit 2), 1993 to 1995 (visit 3), 1996 to 1998 (visit 4), 2011 to 2013 (visit 5), and 2016 to 2017 (visit 6).14 The Institutional Review Board at each study site approved the study protocol, and participants provided informed consent. Dietary Assessment At baseline and visit 3, participants’ usual intake of foods and beverages was assessed by trained interviewers using a modified version of the 66‐item semiquantitative Willett food frequency questionnaire. Participants indicated the frequency with which they consumed foods and beverages of a defined serving size in the previous year. Visual guides, such as glasses and measuring cups, were provided for participants to estimate portion size. The reliability of the food frequency questionnaire was assessed in a random sample of ARIC study participants (n=419) from all 4 study sites at visit 2.15 Nutrient and total energy intakes were derived through multiplying consumption of food by nutrient content of each item in the food frequency questionnaire. Plant‐Based Diet Scores The ARIC study did not assess whether participants were following a plant‐based diet. We used established plant‐based diet scores (PDI, healthy plant‐based diet index [hPDI], less healthy [unhealthy] plant‐based diet index [uPDI], and provegetarian diet index) to assess participants’ degree of adherence to plant‐based diets on the basis of their reported dietary intake on the food frequency questionnaire. We used these 4 plant‐based diet indexes to provide comprehensive and nuanced characterization of dietary intakes because the indexes differed from each other in scoring of food groups within the indexes. For instance, the PDI was more comprehensive than the provegetarian index in that the PDI assessed dietary intakes of plant foods high in refined carbohydrates (fruit juices, sugar‐sweetened beverages, sweets, and desserts). Consistent with some ethically motivated dietary patterns that are focused on the exclusion of animal sources of food and have less of an emphasis on the quality of plant foods, the provegetarian diet index provides a more simplistic score of the diet in that these refined carbohydrate food groups were not assessed. Further details on differences and construction of the scores have been published previously and are available in Data S1.10, 11, 12, 13, 16 The PDI, hPDI, and uPDI had a possible range from 17 to 85, and the provegetarian diet index had a possible range from 11 to 55. All scores were divided into quintiles for analyses. Outcome Assessment Incident cardiovascular disease events and deaths (cardiovascular and all cause) were ascertained through annual telephone calls with participants or proxies, active surveillance of local hospital discharge records and state death records, and linkage to the National Death Index from baseline to December 31, 2016. Incident cardiovascular disease was defined as a composite outcome of coronary heart disease, stroke, and heart failure. Incident coronary heart disease was defined as hospitalized myocardial infarction or fatal coronary heart disease.17 Incident stroke was defined as definite or probable stroke, which was adjudicated.18 Incident heart failure was defined as hospitalization or death, with International Classification of Diseases, Ninth Revision (ICD‐9), code 428 or International Classification of Diseases, Tenth Revision (ICD‐10), code I50.19 All‐cause mortality was defined as deaths attributable to any cause, and cardiovascular disease mortality was defined as deaths with ICD‐9 codes 390 to 459 or ICD‐10 codes I00 to I99. Covariate Assessment At baseline, participants’ sociodemographic information (age, sex, race/ethnicity, and education), health behaviors (cigarette smoking, frequency and duration of physical activity, alcohol intake, and margarine intake), medication use (lipid‐lowering medication use, antihypertensive medication use, or diabetes mellitus medication use), and health conditions (diagnosis of diseases) were collected by self‐reports. Trained staff measured participants’ weight and height, which was used to calculate body mass index (BMI; kg/m2). Those whose BMI was ≤25 kg/m2 were classified as normal weight, those whose BMI was from 25 to <30 kg/m2 were classified as overweight, and those whose BMI was ≥30 kg/m2 were classified as obese. An enzymatic method was used to measure total cholesterol concentration.20 A certified technician measured participants’ blood pressure 3 times, and the second and third measurements were averaged. The modified hexokinase/glucose‐6‐phosphate dehydrogenase method was used to measure blood glucose concentrations. Baseline kidney function (estimated glomerular filtration rate) was estimated from serum creatinine measurement using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation.21 We defined hypertension as systolic blood pressure of ≥140 mm Hg, diastolic blood pressure of ≥90 mm Hg, or antihypertensive medication use in the past 2 weeks. We defined diabetes mellitus as fasting glucose concentration of ≥126 mg/dL, nonfasting blood glucose concentration of ≥200 mg/dL, self‐reported physician's diagnosis of diabetes mellitus, or diabetes mellitus medication use in the past 2 weeks.
|
{Task Information} ================== Respond succinctly and directly. Refer only to the provided document. After your answer, provide any relevant quotes from the source document in italics. ================ {Query} ================== Using only the context document, what are the 4 plant-based diet indexes? ================ {Passage} ================== **Plant‐Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All‐Cause Mortality in a General Population of Middle‐Aged Adults** Abstract Background Previous studies have documented the cardiometabolic health benefits of plant‐based diets; however, these studies were conducted in selected study populations that had narrow generalizability. Methods and Results We used data from a community‐based cohort of middle‐aged adults (n=12 168) in the ARIC (Atherosclerosis Risk in Communities) study who were followed up from 1987 through 2016. Participants’ diet was classified using 4 diet indexes. In the overall plant‐based diet index and provegetarian diet index, higher intakes of all or selected plant foods received higher scores; in the healthy plant‐based diet index, higher intakes of only the healthy plant foods received higher scores; in the less healthy plant‐based diet index, higher intakes of only the less healthy plant foods received higher scores. In all indexes, higher intakes of animal foods received lower scores. Results from Cox proportional hazards models showed that participants in the highest versus lowest quintile for adherence to overall plant‐based diet index or provegetarian diet had a 16%, 31% to 32%, and 18% to 25% lower risk of cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality, respectively, after adjusting for important confounders (all P<0.05 for trend). Higher adherence to a healthy plant‐based diet index was associated with a 19% and 11% lower risk of cardiovascular disease mortality and all‐cause mortality, respectively, but not incident cardiovascular disease (P<0.05 for trend). No associations were observed between the less healthy plant‐based diet index and the outcomes. Conclusions Diets higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population. Clinical Perspective What Is New? • Plant‐based diets, diets that emphasize higher intakes of plant foods and lower intakes of animal foods, are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality in a general US adult population. • Healthful plant‐based diets, diets higher in nutrient‐dense plant foods and lower in refined carbohydrates and animal foods, are associated with a lower risk of cardiovascular disease mortality and all‐cause mortality, but not incident cardiovascular disease. What Are the Clinical Implications? • Our results suggest that dietary patterns that are relatively higher in plant foods and relatively lower in animal foods may confer benefits for cardiovascular health. • Future research examining whether the quality of plant foods (healthful versus less healthful) within the framework of an overall plant‐based diet is associated with cardiovascular disease and all‐cause mortality is warranted. Introduction Plant‐based diets are dietary patterns that emphasize higher intakes of plant foods and are low in animal foods. Vegetarian diets, a type of plant‐based diet, with a focus on restriction of different types of animal foods (meat, poultry, or fish), have been associated with a lower risk of cardiovascular risk factors, such as obesity, hypertension, type 2 diabetes mellitus, and ischemic heart disease.1, 2, 3 However, prospective cohort studies have shown mixed results on the associations with cardiovascular disease mortality and all‐cause mortality.4, 5, 6 These previous studies were conducted in selected study populations that were mostly composed of Seventh‐Day Adventists, vegetarians, or health‐conscious individuals; thus, they had relatively narrow generalizability.4, 5, 7, 8, 9 Although prior studies have characterized participants’ diets using a relatively simple classification method based on frequency of animal food consumption,4, 5, 6 there have since been more comprehensive attempts to assess an individual's diet using plant‐based diet indexes.10, 11, 12, 13 These indexes give higher scores for higher consumption of plant foods and lower consumption of animal foods, allowing researchers to examine whether the degree of adherence to an overall plant‐based diet is associated with health outcomes. Studies that used such indexes (ie, an overall plant‐based diet index [PDI] or a provegetarian diet index) found that greater adherence to these diets was associated with a lower risk of type 2 diabetes mellitus, coronary heart disease, and all‐cause mortality.10, 11, 12 In addition, some plant‐based indexes separately scored healthful (whole grains, vegetables, and plant proteins) and unhealthful (refined carbohydrates and sugar) plant sources of food. Healthful plant‐based diets, which scored higher intakes of only healthful plant foods higher, were more strongly inversely associated with type 2 diabetes mellitus and coronary heart disease than the overall plant‐based diets.11, 12 In contrast, greater adherence to less healthful (unhealthful) plant‐based diets, which scored higher intakes of only less healthful plant foods higher, were associated with a higher risk of these conditions.11, 12 Given the limited evidence on plant‐based diets in the general population and recent developments in plant‐based diet scores, the objectives of the present study were as follows: (1) to evaluate whether overall plant‐based diets are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality in a general US population; and (2) to assess if the association differed by adherence to healthful and less healthful plant‐based diets using 4 a priori defined plant‐based diet scores (overall plant‐based diet, healthy plant‐based diet, less healthy plant‐based diet, and provegetarian diet indexes). Study Design We used data from a community‐based cohort of middle‐aged men and women (45–64 years of age at baseline, n=15 792) in the ARIC study. From 1987 to 1989, participants from 4 US communities (Washington County, Maryland; Forsyth County, North Carolina; Minneapolis, MN; and Jackson, MS) were enrolled in the study. Follow‐up visits occurred in 1990 to 1992 (visit 2), 1993 to 1995 (visit 3), 1996 to 1998 (visit 4), 2011 to 2013 (visit 5), and 2016 to 2017 (visit 6).14 The Institutional Review Board at each study site approved the study protocol, and participants provided informed consent. Dietary Assessment At baseline and visit 3, participants’ usual intake of foods and beverages was assessed by trained interviewers using a modified version of the 66‐item semiquantitative Willett food frequency questionnaire. Participants indicated the frequency with which they consumed foods and beverages of a defined serving size in the previous year. Visual guides, such as glasses and measuring cups, were provided for participants to estimate portion size. The reliability of the food frequency questionnaire was assessed in a random sample of ARIC study participants (n=419) from all 4 study sites at visit 2.15 Nutrient and total energy intakes were derived through multiplying consumption of food by nutrient content of each item in the food frequency questionnaire. Plant‐Based Diet Scores The ARIC study did not assess whether participants were following a plant‐based diet. We used established plant‐based diet scores (PDI, healthy plant‐based diet index [hPDI], less healthy [unhealthy] plant‐based diet index [uPDI], and provegetarian diet index) to assess participants’ degree of adherence to plant‐based diets on the basis of their reported dietary intake on the food frequency questionnaire. We used these 4 plant‐based diet indexes to provide comprehensive and nuanced characterization of dietary intakes because the indexes differed from each other in scoring of food groups within the indexes. For instance, the PDI was more comprehensive than the provegetarian index in that the PDI assessed dietary intakes of plant foods high in refined carbohydrates (fruit juices, sugar‐sweetened beverages, sweets, and desserts). Consistent with some ethically motivated dietary patterns that are focused on the exclusion of animal sources of food and have less of an emphasis on the quality of plant foods, the provegetarian diet index provides a more simplistic score of the diet in that these refined carbohydrate food groups were not assessed. Further details on differences and construction of the scores have been published previously and are available in Data S1.10, 11, 12, 13, 16 The PDI, hPDI, and uPDI had a possible range from 17 to 85, and the provegetarian diet index had a possible range from 11 to 55. All scores were divided into quintiles for analyses. Outcome Assessment Incident cardiovascular disease events and deaths (cardiovascular and all cause) were ascertained through annual telephone calls with participants or proxies, active surveillance of local hospital discharge records and state death records, and linkage to the National Death Index from baseline to December 31, 2016. Incident cardiovascular disease was defined as a composite outcome of coronary heart disease, stroke, and heart failure. Incident coronary heart disease was defined as hospitalized myocardial infarction or fatal coronary heart disease.17 Incident stroke was defined as definite or probable stroke, which was adjudicated.18 Incident heart failure was defined as hospitalization or death, with International Classification of Diseases, Ninth Revision (ICD‐9), code 428 or International Classification of Diseases, Tenth Revision (ICD‐10), code I50.19 All‐cause mortality was defined as deaths attributable to any cause, and cardiovascular disease mortality was defined as deaths with ICD‐9 codes 390 to 459 or ICD‐10 codes I00 to I99. Covariate Assessment At baseline, participants’ sociodemographic information (age, sex, race/ethnicity, and education), health behaviors (cigarette smoking, frequency and duration of physical activity, alcohol intake, and margarine intake), medication use (lipid‐lowering medication use, antihypertensive medication use, or diabetes mellitus medication use), and health conditions (diagnosis of diseases) were collected by self‐reports. Trained staff measured participants’ weight and height, which was used to calculate body mass index (BMI; kg/m2). Those whose BMI was ≤25 kg/m2 were classified as normal weight, those whose BMI was from 25 to <30 kg/m2 were classified as overweight, and those whose BMI was ≥30 kg/m2 were classified as obese. An enzymatic method was used to measure total cholesterol concentration.20 A certified technician measured participants’ blood pressure 3 times, and the second and third measurements were averaged. The modified hexokinase/glucose‐6‐phosphate dehydrogenase method was used to measure blood glucose concentrations. Baseline kidney function (estimated glomerular filtration rate) was estimated from serum creatinine measurement using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation.21 We defined hypertension as systolic blood pressure of ≥140 mm Hg, diastolic blood pressure of ≥90 mm Hg, or antihypertensive medication use in the past 2 weeks. We defined diabetes mellitus as fasting glucose concentration of ≥126 mg/dL, nonfasting blood glucose concentration of ≥200 mg/dL, self‐reported physician's diagnosis of diabetes mellitus, or diabetes mellitus medication use in the past 2 weeks.
|
Respond succinctly and directly. Refer only to the provided document. After your answer, provide any relevant quotes from the source document in italics.
EVIDENCE:
**Plant‐Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All‐Cause Mortality in a General Population of Middle‐Aged Adults** Abstract Background Previous studies have documented the cardiometabolic health benefits of plant‐based diets; however, these studies were conducted in selected study populations that had narrow generalizability. Methods and Results We used data from a community‐based cohort of middle‐aged adults (n=12 168) in the ARIC (Atherosclerosis Risk in Communities) study who were followed up from 1987 through 2016. Participants’ diet was classified using 4 diet indexes. In the overall plant‐based diet index and provegetarian diet index, higher intakes of all or selected plant foods received higher scores; in the healthy plant‐based diet index, higher intakes of only the healthy plant foods received higher scores; in the less healthy plant‐based diet index, higher intakes of only the less healthy plant foods received higher scores. In all indexes, higher intakes of animal foods received lower scores. Results from Cox proportional hazards models showed that participants in the highest versus lowest quintile for adherence to overall plant‐based diet index or provegetarian diet had a 16%, 31% to 32%, and 18% to 25% lower risk of cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality, respectively, after adjusting for important confounders (all P<0.05 for trend). Higher adherence to a healthy plant‐based diet index was associated with a 19% and 11% lower risk of cardiovascular disease mortality and all‐cause mortality, respectively, but not incident cardiovascular disease (P<0.05 for trend). No associations were observed between the less healthy plant‐based diet index and the outcomes. Conclusions Diets higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population. Clinical Perspective What Is New? • Plant‐based diets, diets that emphasize higher intakes of plant foods and lower intakes of animal foods, are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality in a general US adult population. • Healthful plant‐based diets, diets higher in nutrient‐dense plant foods and lower in refined carbohydrates and animal foods, are associated with a lower risk of cardiovascular disease mortality and all‐cause mortality, but not incident cardiovascular disease. What Are the Clinical Implications? • Our results suggest that dietary patterns that are relatively higher in plant foods and relatively lower in animal foods may confer benefits for cardiovascular health. • Future research examining whether the quality of plant foods (healthful versus less healthful) within the framework of an overall plant‐based diet is associated with cardiovascular disease and all‐cause mortality is warranted. Introduction Plant‐based diets are dietary patterns that emphasize higher intakes of plant foods and are low in animal foods. Vegetarian diets, a type of plant‐based diet, with a focus on restriction of different types of animal foods (meat, poultry, or fish), have been associated with a lower risk of cardiovascular risk factors, such as obesity, hypertension, type 2 diabetes mellitus, and ischemic heart disease.1, 2, 3 However, prospective cohort studies have shown mixed results on the associations with cardiovascular disease mortality and all‐cause mortality.4, 5, 6 These previous studies were conducted in selected study populations that were mostly composed of Seventh‐Day Adventists, vegetarians, or health‐conscious individuals; thus, they had relatively narrow generalizability.4, 5, 7, 8, 9 Although prior studies have characterized participants’ diets using a relatively simple classification method based on frequency of animal food consumption,4, 5, 6 there have since been more comprehensive attempts to assess an individual's diet using plant‐based diet indexes.10, 11, 12, 13 These indexes give higher scores for higher consumption of plant foods and lower consumption of animal foods, allowing researchers to examine whether the degree of adherence to an overall plant‐based diet is associated with health outcomes. Studies that used such indexes (ie, an overall plant‐based diet index [PDI] or a provegetarian diet index) found that greater adherence to these diets was associated with a lower risk of type 2 diabetes mellitus, coronary heart disease, and all‐cause mortality.10, 11, 12 In addition, some plant‐based indexes separately scored healthful (whole grains, vegetables, and plant proteins) and unhealthful (refined carbohydrates and sugar) plant sources of food. Healthful plant‐based diets, which scored higher intakes of only healthful plant foods higher, were more strongly inversely associated with type 2 diabetes mellitus and coronary heart disease than the overall plant‐based diets.11, 12 In contrast, greater adherence to less healthful (unhealthful) plant‐based diets, which scored higher intakes of only less healthful plant foods higher, were associated with a higher risk of these conditions.11, 12 Given the limited evidence on plant‐based diets in the general population and recent developments in plant‐based diet scores, the objectives of the present study were as follows: (1) to evaluate whether overall plant‐based diets are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality in a general US population; and (2) to assess if the association differed by adherence to healthful and less healthful plant‐based diets using 4 a priori defined plant‐based diet scores (overall plant‐based diet, healthy plant‐based diet, less healthy plant‐based diet, and provegetarian diet indexes). Study Design We used data from a community‐based cohort of middle‐aged men and women (45–64 years of age at baseline, n=15 792) in the ARIC study. From 1987 to 1989, participants from 4 US communities (Washington County, Maryland; Forsyth County, North Carolina; Minneapolis, MN; and Jackson, MS) were enrolled in the study. Follow‐up visits occurred in 1990 to 1992 (visit 2), 1993 to 1995 (visit 3), 1996 to 1998 (visit 4), 2011 to 2013 (visit 5), and 2016 to 2017 (visit 6).14 The Institutional Review Board at each study site approved the study protocol, and participants provided informed consent. Dietary Assessment At baseline and visit 3, participants’ usual intake of foods and beverages was assessed by trained interviewers using a modified version of the 66‐item semiquantitative Willett food frequency questionnaire. Participants indicated the frequency with which they consumed foods and beverages of a defined serving size in the previous year. Visual guides, such as glasses and measuring cups, were provided for participants to estimate portion size. The reliability of the food frequency questionnaire was assessed in a random sample of ARIC study participants (n=419) from all 4 study sites at visit 2.15 Nutrient and total energy intakes were derived through multiplying consumption of food by nutrient content of each item in the food frequency questionnaire. Plant‐Based Diet Scores The ARIC study did not assess whether participants were following a plant‐based diet. We used established plant‐based diet scores (PDI, healthy plant‐based diet index [hPDI], less healthy [unhealthy] plant‐based diet index [uPDI], and provegetarian diet index) to assess participants’ degree of adherence to plant‐based diets on the basis of their reported dietary intake on the food frequency questionnaire. We used these 4 plant‐based diet indexes to provide comprehensive and nuanced characterization of dietary intakes because the indexes differed from each other in scoring of food groups within the indexes. For instance, the PDI was more comprehensive than the provegetarian index in that the PDI assessed dietary intakes of plant foods high in refined carbohydrates (fruit juices, sugar‐sweetened beverages, sweets, and desserts). Consistent with some ethically motivated dietary patterns that are focused on the exclusion of animal sources of food and have less of an emphasis on the quality of plant foods, the provegetarian diet index provides a more simplistic score of the diet in that these refined carbohydrate food groups were not assessed. Further details on differences and construction of the scores have been published previously and are available in Data S1.10, 11, 12, 13, 16 The PDI, hPDI, and uPDI had a possible range from 17 to 85, and the provegetarian diet index had a possible range from 11 to 55. All scores were divided into quintiles for analyses. Outcome Assessment Incident cardiovascular disease events and deaths (cardiovascular and all cause) were ascertained through annual telephone calls with participants or proxies, active surveillance of local hospital discharge records and state death records, and linkage to the National Death Index from baseline to December 31, 2016. Incident cardiovascular disease was defined as a composite outcome of coronary heart disease, stroke, and heart failure. Incident coronary heart disease was defined as hospitalized myocardial infarction or fatal coronary heart disease.17 Incident stroke was defined as definite or probable stroke, which was adjudicated.18 Incident heart failure was defined as hospitalization or death, with International Classification of Diseases, Ninth Revision (ICD‐9), code 428 or International Classification of Diseases, Tenth Revision (ICD‐10), code I50.19 All‐cause mortality was defined as deaths attributable to any cause, and cardiovascular disease mortality was defined as deaths with ICD‐9 codes 390 to 459 or ICD‐10 codes I00 to I99. Covariate Assessment At baseline, participants’ sociodemographic information (age, sex, race/ethnicity, and education), health behaviors (cigarette smoking, frequency and duration of physical activity, alcohol intake, and margarine intake), medication use (lipid‐lowering medication use, antihypertensive medication use, or diabetes mellitus medication use), and health conditions (diagnosis of diseases) were collected by self‐reports. Trained staff measured participants’ weight and height, which was used to calculate body mass index (BMI; kg/m2). Those whose BMI was ≤25 kg/m2 were classified as normal weight, those whose BMI was from 25 to <30 kg/m2 were classified as overweight, and those whose BMI was ≥30 kg/m2 were classified as obese. An enzymatic method was used to measure total cholesterol concentration.20 A certified technician measured participants’ blood pressure 3 times, and the second and third measurements were averaged. The modified hexokinase/glucose‐6‐phosphate dehydrogenase method was used to measure blood glucose concentrations. Baseline kidney function (estimated glomerular filtration rate) was estimated from serum creatinine measurement using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation.21 We defined hypertension as systolic blood pressure of ≥140 mm Hg, diastolic blood pressure of ≥90 mm Hg, or antihypertensive medication use in the past 2 weeks. We defined diabetes mellitus as fasting glucose concentration of ≥126 mg/dL, nonfasting blood glucose concentration of ≥200 mg/dL, self‐reported physician's diagnosis of diabetes mellitus, or diabetes mellitus medication use in the past 2 weeks.
USER:
Using only the context document, what are the 4 plant-based diet indexes?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 23 | 12 | 1,669 | null | 102 |
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
|
I'm starting up a business and need to decide very soon if I should have a brick-and-mortar or an online business, or if it's worth it to have both. Summarize key points in this article regarding the shift to online shopping and what I need to consider if I choose to operate solely online. Please make sure its 400 words or less.
|
Just as hybrid office-remote work arrangements have become more common, retail is becoming increasingly hybrid. The line between brick and mortar and e-commerce is now blurry, and in this evolving retail environment, many entrepreneurs are wondering the best way to position their small businesses for a prosperous year. Industry experts offered their predictions for the retail trends to watch this year. Tech will continue to shape retail Technology is always remaking the retail environment, from creating self-service kiosks in stores to supporting the e-commerce boom. However, with the rapid evolution of digital technology, artificial intelligence and machine learning — and the need for retailers to stand out from the e-commerce crowd — tech adoption has become more pressing. The rate at which business owners opened e-commerce shops and consumers shopped online increased dramatically during the COVID-19 pandemic, and the trend has continued into the post-pandemic era. “Companies that put e-commerce at the heart of their business strategies are prepared for the post-COVID-19 era,” said Yomi Kastro, founder and CEO of e-commerce platform Inveon. “There is an enormous opportunity for industries that are still more used to physical shopping, such as fast-moving consumer goods and pharmaceuticals.” Even brick-and-mortar retailers should have some semblance of an e-commerce presence. Many consumers prefer to shop from the comfort of their own homes or at the spur of the moment. Consider offering your bestselling items in an e-commerce store to give your customers the option of purchasing your most popular products without visiting your physical location. Retailers are reducing packaging waste. As consumers become more environmentally conscious, look for retailers and brands to reduce their packaging waste, said Anthony Martin, CEO of Choice Mutual Insurance Agency. “Organizations will be more conscious about using recyclable or biodegradable packaging materials, which can be easily recycled or break down naturally in the environment,” he said. The movement toward more sustainable packaging can be seen in the emergence of companies developing new packaging materials out of plant-derived materials. Furniture giant IKEA, for example, said it plans to eliminate plastic packaging for new products by 2025 and all products by 2028. Many other large brands are moving in the same direction. Technology will shape retail workforce management. Hiring and retaining quality workers will likely remain a challenge for retailers. One way businesses can adapt is by offering hybrid roles in which salespeople interact with customers online, thereby increasing their talent pool and reducing geographical limitations on the workers they can recruit. “An hourly workforce has unique pay rules, labor regulations, compliance obligations and scheduling needs,” he said. “Companies need technology that can support their growing requirements and evolve with their business. The pandemic [accelerated] the adoption of new digital technologies, which can save organizations money by increasing efficiencies and improving the experience of their employees.” Did You Know? Consumers are increasingly comfortable shopping online, which means retailers will need to have an e-commerce presence to see success in [year]. To get your online shop started the right way, check out our article on overcoming common e-commerce challenges. U.S. retailers need to protect consumer data Consumer data protection will continue to be a major concern for U.S. retailers. High-profile data breaches not only cost retailers money but also damage their brands. And the stakes have only been heightened since the adoption of consumer data privacy laws such as the European Union’s General Data Protection Regulation (GDPR) and the California Consumer Privacy Act (CCPA). “With the landscape of Google getting rid of third-party cookies and Apple accelerating its privacy-first approach, businesses of all sizes will become under greater scrutiny for how they protect customer data,” said Steffen Schebesta, CEO of global digital marketing platform Sendinblue. “My sense is that the learning curve will be steep for American companies, and if penalties apply, the lessons will be expensive. It will get especially messy if the regulations are not enacted on a federal level. This would force businesses to deal with state-by-state regulations.” While retail businesses collect consumer data for valid purposes, they need to ensure that information is highly protected from cyberattacks. Failure to defend sensitive customer data, such as financial information, could lead to massive lawsuits and fines, not to mention serious damage to brand reputation and lost opportunities for future business. Micro fulfillment centers bring merchandise closer to buyers With the e-commerce boom of recent years, massive fulfillment centers became a symbol of commerce. Jonathan Morav, head of product strategy at retail fulfillment company Fabric, said companies are now looking more to micro fulfillment centers, far smaller facilities that can be located closer to the residential areas where their customers live. They also enable businesses to take advantage of falling commercial real estate prices in downtown cities. Underutilized space in malls and parking lots can hold micro fulfillment centers. While an average Amazon fulfillment center is around 800,000 square feet, a micro fulfillment center typically takes up less than 50,000 square feet and is often as small as 10,000 square feet, while still fulfilling the expectations of fast, free shipping, Morav said. Brick-and-mortar retailers will create special customer experiences Brick-and-mortar retailers have faced significant challenges as the industry has evolved. Retailers have a better chance of being successful if they create unique and memorable customer experiences by personalizing the shopping journey and making it fun. Personal shopping services will increase. Personal shopping services include online preorder and pickup, personal shoppers who walk customers through the showroom floor and much more. Personal shopping services create an extra layer of customer service that can enhance the overall experience and is difficult for e-commerce stores to replicate. Did You Know? Personalized shopping services don’t just enhance the customer experience; they create opportunities to cross-sell and upsell customers to drive more revenue. Automation in pricing will continue to rise In recent years, more and more companies have relied on automated technology to ensure their prices are properly set. Expect automated pricing tech to become even more commonplace, helping retailers reduce the amount of labor required by their staff. Omri Traub, an executive at restaurant point-of-sale software company Toast, expects automation to play an even bigger part in this arena going forward. He pointed to “a new wave of companies” that provide such automation solutions as a service. Once implemented, he said, the tech will provide “low implementation costs and [reductions in] operating costs.” Marketing and customer engagement will see changes. Customers now primarily engage with small retail stores in an online, mobile-friendly model. That’s shifted the paradigm for marketers and customer engagement specialists, and the trend will continue this year. Social media will continue to introduce customers to brands. Social media is a major driver of the customer journey and online sales for many companies. Going forward, experts expect that hashtags and meme culture will play as large a role as traditional advertising methods for successful small businesses and their younger customers. One way that will happen, Gabor said, is through “creative social commerce,” in which platforms such as TikTok and Instagram fuel online shopping. This includes experiential marketing, such as live events that are streamed over social media platforms. Whether people engage with the brand in person or online, these types of events offer widespread exposure. Influencers will keep playing a big role. Love them or hate them, influencers will remain relevant for nearly every retail brand. With companies highlighting authentic voices, Gabor said, consumers will be able to look for leadership among those individuals. Key Takeaway Consumers expect to be able to interact with your brand from their mobile devices, and they will continue looking to influencers for brand and product recommendations.
|
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> I'm starting up a business and need to decide very soon if I should have a brick-and-mortar or an online business, or if it's worth it to have both. Summarize key points in this article regarding the shift to online shopping and what I need to consider if I choose to operate solely online. Please make sure its 400 words or less. <TEXT> Just as hybrid office-remote work arrangements have become more common, retail is becoming increasingly hybrid. The line between brick and mortar and e-commerce is now blurry, and in this evolving retail environment, many entrepreneurs are wondering the best way to position their small businesses for a prosperous year. Industry experts offered their predictions for the retail trends to watch this year. Tech will continue to shape retail Technology is always remaking the retail environment, from creating self-service kiosks in stores to supporting the e-commerce boom. However, with the rapid evolution of digital technology, artificial intelligence and machine learning — and the need for retailers to stand out from the e-commerce crowd — tech adoption has become more pressing. The rate at which business owners opened e-commerce shops and consumers shopped online increased dramatically during the COVID-19 pandemic, and the trend has continued into the post-pandemic era. “Companies that put e-commerce at the heart of their business strategies are prepared for the post-COVID-19 era,” said Yomi Kastro, founder and CEO of e-commerce platform Inveon. “There is an enormous opportunity for industries that are still more used to physical shopping, such as fast-moving consumer goods and pharmaceuticals.” Even brick-and-mortar retailers should have some semblance of an e-commerce presence. Many consumers prefer to shop from the comfort of their own homes or at the spur of the moment. Consider offering your bestselling items in an e-commerce store to give your customers the option of purchasing your most popular products without visiting your physical location. Retailers are reducing packaging waste. As consumers become more environmentally conscious, look for retailers and brands to reduce their packaging waste, said Anthony Martin, CEO of Choice Mutual Insurance Agency. “Organizations will be more conscious about using recyclable or biodegradable packaging materials, which can be easily recycled or break down naturally in the environment,” he said. The movement toward more sustainable packaging can be seen in the emergence of companies developing new packaging materials out of plant-derived materials. Furniture giant IKEA, for example, said it plans to eliminate plastic packaging for new products by 2025 and all products by 2028. Many other large brands are moving in the same direction. Technology will shape retail workforce management. Hiring and retaining quality workers will likely remain a challenge for retailers. One way businesses can adapt is by offering hybrid roles in which salespeople interact with customers online, thereby increasing their talent pool and reducing geographical limitations on the workers they can recruit. “An hourly workforce has unique pay rules, labor regulations, compliance obligations and scheduling needs,” he said. “Companies need technology that can support their growing requirements and evolve with their business. The pandemic [accelerated] the adoption of new digital technologies, which can save organizations money by increasing efficiencies and improving the experience of their employees.” Did You Know? Consumers are increasingly comfortable shopping online, which means retailers will need to have an e-commerce presence to see success in [year]. To get your online shop started the right way, check out our article on overcoming common e-commerce challenges. U.S. retailers need to protect consumer data Consumer data protection will continue to be a major concern for U.S. retailers. High-profile data breaches not only cost retailers money but also damage their brands. And the stakes have only been heightened since the adoption of consumer data privacy laws such as the European Union’s General Data Protection Regulation (GDPR) and the California Consumer Privacy Act (CCPA). “With the landscape of Google getting rid of third-party cookies and Apple accelerating its privacy-first approach, businesses of all sizes will become under greater scrutiny for how they protect customer data,” said Steffen Schebesta, CEO of global digital marketing platform Sendinblue. “My sense is that the learning curve will be steep for American companies, and if penalties apply, the lessons will be expensive. It will get especially messy if the regulations are not enacted on a federal level. This would force businesses to deal with state-by-state regulations.” While retail businesses collect consumer data for valid purposes, they need to ensure that information is highly protected from cyberattacks. Failure to defend sensitive customer data, such as financial information, could lead to massive lawsuits and fines, not to mention serious damage to brand reputation and lost opportunities for future business. Micro fulfillment centers bring merchandise closer to buyers With the e-commerce boom of recent years, massive fulfillment centers became a symbol of commerce. Jonathan Morav, head of product strategy at retail fulfillment company Fabric, said companies are now looking more to micro fulfillment centers, far smaller facilities that can be located closer to the residential areas where their customers live. They also enable businesses to take advantage of falling commercial real estate prices in downtown cities. Underutilized space in malls and parking lots can hold micro fulfillment centers. While an average Amazon fulfillment center is around 800,000 square feet, a micro fulfillment center typically takes up less than 50,000 square feet and is often as small as 10,000 square feet, while still fulfilling the expectations of fast, free shipping, Morav said. Brick-and-mortar retailers will create special customer experiences Brick-and-mortar retailers have faced significant challenges as the industry has evolved. Retailers have a better chance of being successful if they create unique and memorable customer experiences by personalizing the shopping journey and making it fun. Personal shopping services will increase. Personal shopping services include online preorder and pickup, personal shoppers who walk customers through the showroom floor and much more. Personal shopping services create an extra layer of customer service that can enhance the overall experience and is difficult for e-commerce stores to replicate. Did You Know? Personalized shopping services don’t just enhance the customer experience; they create opportunities to cross-sell and upsell customers to drive more revenue. Automation in pricing will continue to rise In recent years, more and more companies have relied on automated technology to ensure their prices are properly set. Expect automated pricing tech to become even more commonplace, helping retailers reduce the amount of labor required by their staff. Omri Traub, an executive at restaurant point-of-sale software company Toast, expects automation to play an even bigger part in this arena going forward. He pointed to “a new wave of companies” that provide such automation solutions as a service. Once implemented, he said, the tech will provide “low implementation costs and [reductions in] operating costs.” Marketing and customer engagement will see changes. Customers now primarily engage with small retail stores in an online, mobile-friendly model. That’s shifted the paradigm for marketers and customer engagement specialists, and the trend will continue this year. Social media will continue to introduce customers to brands. Social media is a major driver of the customer journey and online sales for many companies. Going forward, experts expect that hashtags and meme culture will play as large a role as traditional advertising methods for successful small businesses and their younger customers. One way that will happen, Gabor said, is through “creative social commerce,” in which platforms such as TikTok and Instagram fuel online shopping. This includes experiential marketing, such as live events that are streamed over social media platforms. Whether people engage with the brand in person or online, these types of events offer widespread exposure. Influencers will keep playing a big role. Love them or hate them, influencers will remain relevant for nearly every retail brand. With companies highlighting authentic voices, Gabor said, consumers will be able to look for leadership among those individuals. Key Takeaway Consumers expect to be able to interact with your brand from their mobile devices, and they will continue looking to influencers for brand and product recommendations. https://www.businessnewsdaily.com/9836-future-of-retail.html
|
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
EVIDENCE:
Just as hybrid office-remote work arrangements have become more common, retail is becoming increasingly hybrid. The line between brick and mortar and e-commerce is now blurry, and in this evolving retail environment, many entrepreneurs are wondering the best way to position their small businesses for a prosperous year. Industry experts offered their predictions for the retail trends to watch this year. Tech will continue to shape retail Technology is always remaking the retail environment, from creating self-service kiosks in stores to supporting the e-commerce boom. However, with the rapid evolution of digital technology, artificial intelligence and machine learning — and the need for retailers to stand out from the e-commerce crowd — tech adoption has become more pressing. The rate at which business owners opened e-commerce shops and consumers shopped online increased dramatically during the COVID-19 pandemic, and the trend has continued into the post-pandemic era. “Companies that put e-commerce at the heart of their business strategies are prepared for the post-COVID-19 era,” said Yomi Kastro, founder and CEO of e-commerce platform Inveon. “There is an enormous opportunity for industries that are still more used to physical shopping, such as fast-moving consumer goods and pharmaceuticals.” Even brick-and-mortar retailers should have some semblance of an e-commerce presence. Many consumers prefer to shop from the comfort of their own homes or at the spur of the moment. Consider offering your bestselling items in an e-commerce store to give your customers the option of purchasing your most popular products without visiting your physical location. Retailers are reducing packaging waste. As consumers become more environmentally conscious, look for retailers and brands to reduce their packaging waste, said Anthony Martin, CEO of Choice Mutual Insurance Agency. “Organizations will be more conscious about using recyclable or biodegradable packaging materials, which can be easily recycled or break down naturally in the environment,” he said. The movement toward more sustainable packaging can be seen in the emergence of companies developing new packaging materials out of plant-derived materials. Furniture giant IKEA, for example, said it plans to eliminate plastic packaging for new products by 2025 and all products by 2028. Many other large brands are moving in the same direction. Technology will shape retail workforce management. Hiring and retaining quality workers will likely remain a challenge for retailers. One way businesses can adapt is by offering hybrid roles in which salespeople interact with customers online, thereby increasing their talent pool and reducing geographical limitations on the workers they can recruit. “An hourly workforce has unique pay rules, labor regulations, compliance obligations and scheduling needs,” he said. “Companies need technology that can support their growing requirements and evolve with their business. The pandemic [accelerated] the adoption of new digital technologies, which can save organizations money by increasing efficiencies and improving the experience of their employees.” Did You Know? Consumers are increasingly comfortable shopping online, which means retailers will need to have an e-commerce presence to see success in [year]. To get your online shop started the right way, check out our article on overcoming common e-commerce challenges. U.S. retailers need to protect consumer data Consumer data protection will continue to be a major concern for U.S. retailers. High-profile data breaches not only cost retailers money but also damage their brands. And the stakes have only been heightened since the adoption of consumer data privacy laws such as the European Union’s General Data Protection Regulation (GDPR) and the California Consumer Privacy Act (CCPA). “With the landscape of Google getting rid of third-party cookies and Apple accelerating its privacy-first approach, businesses of all sizes will become under greater scrutiny for how they protect customer data,” said Steffen Schebesta, CEO of global digital marketing platform Sendinblue. “My sense is that the learning curve will be steep for American companies, and if penalties apply, the lessons will be expensive. It will get especially messy if the regulations are not enacted on a federal level. This would force businesses to deal with state-by-state regulations.” While retail businesses collect consumer data for valid purposes, they need to ensure that information is highly protected from cyberattacks. Failure to defend sensitive customer data, such as financial information, could lead to massive lawsuits and fines, not to mention serious damage to brand reputation and lost opportunities for future business. Micro fulfillment centers bring merchandise closer to buyers With the e-commerce boom of recent years, massive fulfillment centers became a symbol of commerce. Jonathan Morav, head of product strategy at retail fulfillment company Fabric, said companies are now looking more to micro fulfillment centers, far smaller facilities that can be located closer to the residential areas where their customers live. They also enable businesses to take advantage of falling commercial real estate prices in downtown cities. Underutilized space in malls and parking lots can hold micro fulfillment centers. While an average Amazon fulfillment center is around 800,000 square feet, a micro fulfillment center typically takes up less than 50,000 square feet and is often as small as 10,000 square feet, while still fulfilling the expectations of fast, free shipping, Morav said. Brick-and-mortar retailers will create special customer experiences Brick-and-mortar retailers have faced significant challenges as the industry has evolved. Retailers have a better chance of being successful if they create unique and memorable customer experiences by personalizing the shopping journey and making it fun. Personal shopping services will increase. Personal shopping services include online preorder and pickup, personal shoppers who walk customers through the showroom floor and much more. Personal shopping services create an extra layer of customer service that can enhance the overall experience and is difficult for e-commerce stores to replicate. Did You Know? Personalized shopping services don’t just enhance the customer experience; they create opportunities to cross-sell and upsell customers to drive more revenue. Automation in pricing will continue to rise In recent years, more and more companies have relied on automated technology to ensure their prices are properly set. Expect automated pricing tech to become even more commonplace, helping retailers reduce the amount of labor required by their staff. Omri Traub, an executive at restaurant point-of-sale software company Toast, expects automation to play an even bigger part in this arena going forward. He pointed to “a new wave of companies” that provide such automation solutions as a service. Once implemented, he said, the tech will provide “low implementation costs and [reductions in] operating costs.” Marketing and customer engagement will see changes. Customers now primarily engage with small retail stores in an online, mobile-friendly model. That’s shifted the paradigm for marketers and customer engagement specialists, and the trend will continue this year. Social media will continue to introduce customers to brands. Social media is a major driver of the customer journey and online sales for many companies. Going forward, experts expect that hashtags and meme culture will play as large a role as traditional advertising methods for successful small businesses and their younger customers. One way that will happen, Gabor said, is through “creative social commerce,” in which platforms such as TikTok and Instagram fuel online shopping. This includes experiential marketing, such as live events that are streamed over social media platforms. Whether people engage with the brand in person or online, these types of events offer widespread exposure. Influencers will keep playing a big role. Love them or hate them, influencers will remain relevant for nearly every retail brand. With companies highlighting authentic voices, Gabor said, consumers will be able to look for leadership among those individuals. Key Takeaway Consumers expect to be able to interact with your brand from their mobile devices, and they will continue looking to influencers for brand and product recommendations.
USER:
I'm starting up a business and need to decide very soon if I should have a brick-and-mortar or an online business, or if it's worth it to have both. Summarize key points in this article regarding the shift to online shopping and what I need to consider if I choose to operate solely online. Please make sure its 400 words or less.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 20 | 62 | 1,269 | null | 687 |
Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand.
|
What are the negative and positive aspects of virtual teaching for the instructors?
|
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/377123871 More I-talk in student teachers’ written reflections indicates higher stress during VR teaching Article in Computers & Education · April 2024 DOI: 10.1016/j.compedu.2024.104987 CITATIONS 0 READS 70 4 authors: Andrea Westphal University of Greifswald 53 PUBLICATIONS 305 CITATIONS SEE PROFILE Eric Richter Universität Potsdam 45 PUBLICATIONS 495 CITATIONS SEE PROFILE Rebecca Lazarides Universität Potsdam 145 PUBLICATIONS 1,980 CITATIONS SEE PROFILE Yizhen Huang Universität Potsdam 19 PUBLICATIONS 208 CITATIONS SEE PROFILE All content following this page was uploaded by Eric Richter on 12 January 2024. The user has requested enhancement of the downloaded file. Computers & Education 212 (2024) 104987 Available online 3 January 2024 0360-1315/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). More I-talk in student teachers’ written reflections indicates higher stress during VR teaching Andrea Westphal a,* , Eric Richter b , Rebecca Lazarides b , Yizhen Huang b a University of Greifswald, Department of Education, Steinbeckerstr. 15, 17487, Greifswald, Germany b University of Potsdam, Department of Education, Karl-Liebknecht-Straße 24-25, 14476, Potsdam, Germany ARTICLE INFO Keywords: Augmented and virtual reality Improving classroom teaching Teacher professional development ABSTRACT Video-based reflection on one’s own teaching represents a crucial tool in teacher education. When student teachers reflect on negative classroom events, it elicits “self-focused attention,” which has been associated with more intense negative emotionality. Self-focused attention can be quantitatively captured using first-person singular pronouns (“I,” “me,” “my”) in written reflections by, for instance, student teachers. What is unclear is whether student teachers’ use of these firstperson singular pronouns in their written reflections is linked to and predicts their negative affective experiences during teaching. For the present study, a fully immersive virtual reality (VR) classroom was implemented in which student teachers taught a lesson, provided written reflections on their teaching, and then taught a second lesson. We measured N = 59 student teachers’ self-reported stress and heartrate responses while teaching in the VR classroom and determined the percentage of first-person singular pronouns in their written reflections. Firstly, our results showed that the use of first-person singular pronouns provides incremental information on manual ratings of student teachers’ foci in their written reflections. Secondly, student teachers’ heartrates during instruction—a measure of physiological stress—were associated with the use of first-person singular pronouns in subsequent written reflections. Thirdly, the use of first-person singular pronouns predicted the increase in physiological stress from the first to the second round of VR teaching. We discuss implications for automated feedback and for designing reflective tasks. 1. Introduction Teaching is often seen as a challenging profession (Chang, 2009; Westphal et al., 2022; . The transition to school practice, at least when it takes place in real school classrooms, is especially demanding for student teachers1 (Goddard et al., 2006; Hultell et al., 2013; Voss & Kunter, 2020). Fully immersive virtual reality (VR) classrooms provide a safe environment for student teachers to gain hands-on teaching experience (Gold & Windscheid, 2020 ; Lin, 2023; Lugrin et al., 2016; Pendergast et al., 2022; Remacle et al., 2023; Richter et al., 2022; Seufert et al., 2022). Ke and Xu (2020) suggested that active learning processes (“diving in”) and reflective * Corresponding author. E-mail addresses: [email protected] (A. Westphal), [email protected] (E. Richter), rebecca.lazarides@uni-potsdam. de (R. Lazarides), [email protected] (Y. Huang). 1 In our study, the term “student teachers” refers to those prospective teachers who have not yet begun the supervised teaching portion of their teacher education program. Contents lists available at ScienceDirect Computers & Education journal homepage: www.elsevier.com/locate/compedu https://doi.org/10.1016/j.compedu.2024.104987 Received 21 November 2022; Received in revised form 11 November 2023; Accepted 2 January 2024 Computers & Education 212 (2024) 104987 2 learning processes (“stepping out”) can be easily combined in VR classrooms. Thus, it may be useful to practice reflecting on classroom situations from a more distanced perspective using VR classrooms early on in teacher education to help student teachers make a smooth transition into the classroom. Because the setting is standardized and similar for all student teachers, VR classrooms allow us to more accurately research the contributing factors and consequences of student teachers’ self-reflection; the highly controllable setting increases the internal validity of research findings (Huang et al., 2021; Richter et al., 2022). This is of particular interest for research looking at the interrelationships between student teachers’ affects in relation to their classroom experiences and their reflections upon those experiences. VR classrooms allow us, for instance, to apply a finding from experimental psychology to the field of teacher education. Research in the fields of experimental psychology and clinical psychology has shown that self-focus after negative events is accompanied by greater negative affect (e.g., Mor & Winquist, 2002). This finding has been explained by dysfunctional emotion-regulation strategies (e.g., Nook et al., 2017). Applied to the context of teacher education, these findings may imply that student teachers who are less skilled at transitioning between a more immersed perspective and a more distanced perspective on challenging classroom events may experience more negative affect. The degree of a person’s self-focus can be determined based on the frequency with which they use first-person singular pronouns (e.g., “I,” “me,” “my”); this has also been called “I-talk” (Tackman et al., 2019). It would be highly relevant to examine this link between self-focused attention in written reflections—as reflected by more frequent I-talk—and negative affect during instruction in the field of teacher education, because knowledge about the link between the use of first-person singular pronouns and negative affect could be implemented in automated feedback systems to help identify student teachers at risk of intense stress and burnout, allowing them to be offered personalized feedback and support. To date, however, these questions have not been explored. To examine whether student teachers’ use of first-person singular pronouns is an indicator of the stress level they experience in the classroom, and whether it can predict changes in a student teachers’ stress, a highly standardized teaching situation is preferable, because it ensures that all student teachers under study are reflecting on the same learning environment and on similar classroom events at all measurement occasions. A VR classroom creates just such a setting. In the present study, class size in the VR classroom was manipulated to induce higher levels of stress (large-class-size condition with a higher number of student avatars) and lower levels of stress (small-class-size condition with a lower number of student avatars). Initially, we checked whether the use of first-person pronouns in written reflections provides incremental information about subsequent manual ratings of student-teachers’ foci (whether on their own actions vs. student actions vs. the learning environment) in these reflections. In addition, we examine whether student teachers who experience more self-reported stress and physiological stress (as measured by heartrate response) while teaching in a VR classroom use more first-person singular pronouns in written reflections on their teaching. We also explore whether student teachers’ use of first-person singular pronouns in written reflections predicts the increase in stress in a subsequent VR lesson. 1.1. Reflection in teacher education: Technological advances “Reflection” has been defined as “deliberate, purposeful, metacognitive thinking and/or action” (Koˇsir et al., 2015, p. 113) that is believed to enhance instructional quality (Chernikova et al., 2020) by improving student teachers’ “noticing” and “knowledge-based reasoning” (Stürmer et al., 2013; van Es & Sherin, 2008). Noticing is understood as a teachers’ ability to focus their attention on relevant classroom events (van Es & Sherin, 2002). Knowledge-based reasoning is defined as teachers’ ability to apply their professional knowledge in order to interpret these classroom events (Borko, 2004; van Es & Sherin, 2002). In teacher education programs, reflection is implemented in different ways, with student teachers reflecting on classroom videos of other teachers or on video recordings of their own teaching (Kleinknecht & Schneider, 2013). Technological advances have made it possible to design VR classrooms that student teachers experience as realistic and authentic classroom settings (Huang et al., 2021; Wiepke et al., 2019, allowing them to practice and subsequently reflect on video recordings of their own teaching. Beyond the practical advantages for student teacher education (e.g., the approval of students, parents, educators, and administrators is not required), an important benefit of VR classrooms is the standardized classroom setting in which all student teachers experience similar classroom events for which they can be prepared in advance. This enables teacher educators to more easily provide relevant professional knowledge tailored to managing critical classroom events in the VR classroom; when reflecting on video recordings of their own teaching in the VR setting, student teachers may thus be more able to apply relevant professional knowledge. Video-based reflection generally involves written or oral reflections after viewing classroom videos; it is recommended that these reflections follow a three-step process (e.g., Prilop et al., 2021). Firstly, student teachers are instructed to describe the relevant classroom events; secondly, they are asked to evaluate and interpret these events; and, thirdly, they are required to identify alternative classroom behaviors (e.g., Prilop et al., 2021). When describing relevant classroom events, student teachers may focus either on their own actions, students’ actions, or on the learning environment as a whole (Kleinknecht & Schneider, 2013; Lohse-Bossenz et al., 2019). Previous research has been resoundingly positive on the benefits of video-based reflection for student teachers’ professional vision (e. g., Stürmer et al., 2013; Weber et al., 2020). Very few studies shed light on the affective experiences associated with video-based reflection (Kleinknecht, 2021). Although Kleinknecht and Schneider (2013) suggested that reflecting on other teachers’ videos can induce more negative affect than reflecting on one’s own teaching videos, several studies have shown that reflecting on one’s own videos elicits intense emotional involvement (Borko et al., 2008; Seidel et al., 2011; Zhang et al., 2011). What is unclear, however, is to what extent student teachers’ attentional focus (i.e., focusing on own thoughts, actions, or emotions) in the video-based reflection of their own videos relates to their experiences of negative affect or stress. A. Westphal et al. Computers & Education 212 (2024) 104987 3 1.2. “I-talk” as a linguistic marker of self-focused attention and negative affect In the fields of experimental psychology and clinical psychology, there is increasing empirical evidence indicating that there is a relationship between self-focused attention and greater negative affect (e.g., Mor & Winquist, 2002; Nook et al., 2017). For instance, studies using correlational designs showed that self-report measures of self-focus—such as the Public and Private Self-Consciousness Scale (Fenigstein et al., 1975), but also sentence completion tasks (Exner, 1973; Wegner & Giuliano, 1980)—are associated with self-report measures of state or trait negative affect in non-clinical and clinical samples (for an overview, see the meta-analysis by Mor & Winquist, 2002). Other studies showed that self-referential language (so-called “I-talk”)—as a linguistic marker of an individual’s self-focus—is associated with more intense negative emotionality in non-clinical samples (Kern et al., 2014; Mehl et al., 2006; Yarkoni, 2010; Yee et al., 2011; see also meta-analysis by Edwards & Holtzman, 2017) and is a marker of depression (Dunnack & Park, 2009; Rude et al., 2004; Zimmermann et al., 2016). An extensive multi-lab multi-language study with data from more than 4700 participants recently confirmed that the use of first-person singular pronouns is linked to more intense negative emotionality and depression (Tackman et al., 2019). The association between I-talk and depression has been explained to some extent by negative emotionality (Tackman et al., 2019). This indicates that “I-talk” might reflect a broader dispositional tendency towards feelings of distress, but “[t] his possibility is a topic of ongoing research” (Berry-Blunt et al., 2021, p. 5). Although frequent I-talk is seen as maladaptive, it may be a way of processing negative affect (e.g., after receiving deprecatory information about oneself), as a recent literature review concluded (Berry-Blunt et al., 2021). This would suggest that greater negative affect provokes I-talk. Experimental research did not find any evidence that inducing negative affect by showing participants negative pictures led to more I-talk (e.g., Bernard, Baddeley, Rodriguez, & Burke, 2016). In line with Bernard, Baddeley, Rodriguez, and Burke (2016) suggestion, it may be the case that negative affect only leads to more I-talk when elicited by self-deprecating information. This proposition is consistent with research on the negative affective experiences of teasing and ostracism, which do lead to more frequent I-talk (Klauke et al., 2020; Kowalski, 2000). The reverse may also be true, however. Taking a more distanced perspective—as indicated by less I-talk—may over time change an individual’s dispositional negative emotionality (Berry-Blunt et al., 2021). Distancing, i.e., shifting one’s perspective to be more “distant” from or less immersed in a negative event, is an adaptive emotion-regulation strategy that is characterized by a lower level of self-focused attention and can help reduce negative affect (Kross & Ayduk, 2008). The suggestion that repeated distancing may reduce an individual’s tendency to experience negative affect (Berry-Blunt et al., 2021) would explain why I-talk predicts future depressive symptoms in patients (Dunnack & Park, 2009; Zimmermann et al., 2016). Even in the short term, less I-talk may lead to less negative affect: Experimental research confirmed that distancing—i.e., using no I-talk when talking about one’s own emotions while preparing a stressful speech—can lessen negative affect after having given the speech (Kross et al., 2014, Study 3). Thus, the causal direction of the link between I-talk and negative emotionality is less clear, but there may be a bidirectional relationship. 1.3. Gender differences in the association between self-focus and negative affect Based on meta-analytical findings that women exhibit a greater tendency to ruminatively self-focus than men when experiencing depression (Johnson & Whisman, 2013), it has been suggested that the positive association between negative emotionality and the use of first-person singular pronouns is larger for women than it is for men (e.g., Tackman et al., 2019). When examining these gender differences, Tackman et al. (2019) underlined that the use of first-person singular pronouns seems to be driven by low-arousal negative distress in women. In contrast, it appears that men’s use of first-person singular pronouns is driven by high-arousal negative distress (Tackman et al., 2019). Thus, the use of first-person singular pronouns may be an indicator of different affective experiences in women and men (Fast & Funder, 2010) and, thus, gender should be taken into account when studying the relationship between self-focus and negative affect. 1.4. Distinguishing different forms of self-focus in written reflections Different strands of research differ in their operationalization of self-focus. In research on reflection in teacher training, manual ratings indicate the extent to which student teachers focus on their own actions and thoughts, on students’ actions, or on the learning environment (e.g., Kleinknecht & Schneider, 2013). In experimental psychology, self-focus is often operationalized via the use of first-person singular pronouns (Berry-Blunt et al., 2021; Mor & Winquist, 2002). This strand of research has argued that individuals can take a more or less immersed or distanced perspective on their own actions and thoughts by using more or fewer first-person singular pronouns (Kross & Ayduk, 2008; Kross et al., 2014). When reflecting on their own teaching, some student teachers may distance themselves from the experience and therefore rarely use first-person singular pronouns, while others may immerse themselves in the experience and use first-person singular pronouns more frequently. As such, both indicators of self-focus (qualitative ratings vs. first-person singular pronouns) should provide incremental information about student teachers’ self-focus in their written reflections. For student teachers taking a more immersive perspective on their own teaching, objective first-person singular pronouns (i.e., “me,” “myself”) may reflect a more dysfunctional form of self-focus than subjective first-person singular pronouns (i.e., “I”) (Zimmermann et al., 2016). While subjective pronouns reflect an “active or self-as-actor form of self-focus,” objective pronouns reflect a “passive or self-as-target form of self-focus” (James, 1890; Tackman et al., 2019, p. 819) that may indicate an even more detrimental style of processing self-relevant information (Zimmermann et al., 2016; see also more and less dysfunctional questions in Ehring, 2020). This poses the question of whether the relationship between the use of first-person pronouns and negative affect is driven mainly by objective first-person pronouns (Zimmermann et al., 2016). As such, “it is important to evaluate whether and how the A. Westphal et al. Computers & Education 212 (2024) 104987 4 association between depression and I-talk varies as a function of first-person singular pronoun type” (Tackman et al., 2019, p. 819). Previous evidence on whether subjective and objective first-person pronouns differentially relate to negative affect is mixed (there is support in the study by Zimmermann et al., 2016; but no or inconsistent differences in the studies by Dunnack & Park, 2009; Tackman et al., 2019). But the distinction between subjective and objective first-person singular pronouns appears to be essential in our study, in which the relationship between the use of first-person pronouns and negative affect is examined for the first time in the context of teacher training. 1.5. Present study Negative emotionality may be critical for student teachers when they reflect on their own teaching, yet research has rarely concentrated on the role of negative emotionality for reflective processes (Kleinknecht, 2021). Meanwhile, research in the field of experimental psychology indicates that negative affect may provoke self-focused attention as indicated by the use of first-person singular pronouns (Berry-Blunt et al., 2021). Moreover, self-focused attention may also increase the tendency towards experiencing negative affect (Berry-Blunt et al., 2021). What we do not know is whether this applies to the context of teacher education where student teachers reflect on their own teaching. Studying this link between self-focus and negative affect in the context of student teachers’ written reflections can provide valuable cues for diagnostic tools, automated feedback systems, and the improvement of student teachers’ professional self-regulation. We used a VR classroom setting, and thus a highly standardized teaching situation, to ensure that student teachers were reflecting on similar classroom events as we examined the following research questions: (1) Do student teachers who exhibit a greater focus on their own actions (instead of students’ actions or the classroom environment) use more subjective and objective first-person singular pronouns in written reflections on their teaching? Here, the assumption could be that those student teachers who use subjective and objective first-person singular pronouns more frequently also tend to focus on themselves rather than on the students in class or on the classroom environment. However, there is no previous research combining manual ratings of student teachers’ foci (whether on their own actions vs. student actions vs. the learning environment) with student teachers’ subjective and objective use of first-person singular pronouns when reflecting on their own teaching. Thus, it is unclear to what extent manual ratings of student teachers’ foci correspond to the subjective and objective use of first-person pronouns in written reflections on their teaching. We seek to address this research gap as an exploratory question. (2) Do student teachers who experience more self-reported stress and physiological stress (as measured by heartrate response) while teaching in a VR classroom use more subjective and objective first-person singular pronouns in written reflections of their teaching? Building on empirical evidence showing that negative affect may provoke self-focused attention, we analyze whether student teachers who experience higher levels of negative affect when teaching in the VR classroom more frequently use subjective and objective first-person singular pronouns in their written reflections. The class size in the VR classroom, i.e., the number of student avatars, was manipulated to evoke higher levels (large-class-size condition) and lower levels of negative affect (small-class-size condition(Huang et al., 2022). We hypothesize that student teachers who experience more negative affect—operationalized via self-reported and physiological stress—when teaching in the VR classroom for the first time will use more subjective and objective first-person singular pronouns in their written reflections. (3) Does student teachers’ use of subjective and objective first-person singular pronouns in written reflections of their teaching predict their increase in stress in a subsequent VR lesson? We postulate that student teachers who use more subjective and objective first-person singular pronouns in their written reflections will experience a greater increase in self-reported and physiological stress in the second VR classroom (as compared to the stress levels experienced when teaching in the VR classroom for the first time). 2. Material and methods 2.1. Sample and procedure Participants were N = 65 student teachers enrolled at the University of (anonymized for review) in Germany. Four of the participating students did not hand in their written reflection and two additional students did not participate in the second VR practice session, limiting our analyses to n = 59 students. Student teachers were on average 24 years old (SD = 4.57) and 49% identified as female, 51% as male, none as diverse. Most students were third-year bachelor students (58%; second-year: 27%; fourth-year: 14%). These student teachers participated in a weekly seminar on classroom management. The seminar included two 10-min practice sessions in a VR classroom that took place two weeks apart. Both VR practice sessions followed a standardized procedure. Participants were first given a brief standardized audio introduction on how to interact with the VR environment. Participants were then given a brief lecture about an a priori determined topic in the VR classroom to deliver to avatar students. During the first VR teaching experience, participants taught about the US electoral system and the 2020 US election. For the second VR teaching experience, A. Westphal et al. Computers & Education 212 (2024) 104987 5 participants taught about sustainability. All the instructional materials that participants needed to accomplish the teaching task were prepared and provided by the course instructor one week before the teaching exercise. During their VR teaching session, participants were exposed to various on-task and off-task behaviors from the avatar students, such as asking topic-related questions, chatting, or throwing paper balls. All avatar student actions were prescribed and therefore the same for all participants in both the class with 10 student avatars and the class with 30 student avatars. Immediately after their teaching experience in the VR classroom, the student teachers reported on their stress levels in an online questionnaire. In addition, the student teachers handed in a written reflection on their VR teaching session in the week following the first VR practice session.2 Prior to writing their reflections, the student teachers received guidance on the three-step reflection process. In this process, they were instructed to describe three relevant classroom situations (Step 1), evaluate and interpret these situations based on their professional knowledge (Step 2), and outline alternatives for classroom situations that they evaluated negatively (Step 3). Before writing their reflections, student teachers were given time to repeatedly watch the video of the VR classroom situation in which they had taught. 2.2. Design of the VR classroom The VR classroom was designed to resemble an upper secondary school classroom in Germany (e.g., (Wiepke et al., 2021)). It was set up with five rows and three columns of school desks and chairs with avatar students (see Appendix). Avatar students’ names were displayed on name tags placed on their desks and had a wide range of physical characteristics, such as skin tone, hairstyle, and clothing. Student teachers were randomly assigned to teach a class of either 10 or 30 student avatars when teaching the VR classroom for the first time and again when teaching it for the second time. The avatar students engaged in a range of behaviors that included both ontask and off-task actions. These actions ranged from constructive activities, such as writing in a notebook, to less productive actions, such as throwing a paper ball. The avatar students maintained a natural seated posture and a neutral demeanour, occasionally redirecting their attention by shifting their gaze or adjusting their body orientation in response to the participants’ movements. The selection of off-task behaviors was based on a compilation of common disruptive behaviors documented in the academic literature (Borko, 2016; Wolff et al., 2016). All parameters governing the avatar students’ behaviors, including initiation time, duration, spatial location, and behavior type, were carefully scripted to maintain uniformity across experimental conditions. This ensured that the behaviors enacted by the avatar students remained consistent between the scenarios with 10 avatar students and those with 30 avatar students in the classroom. We were using the HTC VIVE headset which has a resolution of 1080 x 1200 pixels per eye with a 108◦ field of view and a refresh rate of 90 Hz. The headset was connected to a laptop (Alienware) with a 2.2-GHz Intel Core i7-8750H processor, with 16 GB of RAM, and a NVIDIA GeForce RTX 2060 with 6 GB of VRAM graphic card, where the VR classroom software was operated. Essentially, participants could move around in reality while experiencing multisensory feedback in the VR classroom. Previous studies have confirmed that the technical setup in our VR classroom created an immersive soundscape which student teachers experienced as realistic and authentic (Wiepke et al., 2019, 2021). Student teachers were equally distributed across the four conditions (small class size VR1, small class size VR2: 21%; small class size VR1, large class size VR2: 23%; large class size VR1, small class size VR2: 25%; large class size VR1, large class size VR2: 28%).3 Thus, some teachers taught under the same conditions twice, while other teachers taught one VR session in the small class size condition and the other VR session in the large class size condition. Student teachers teaching in the VR classroom were instructed to teach their lesson as they would in a real classroom i.e., walking around the room and using similar observational and nonverbal behavior when interacting with the avatar students as they would with non-virtual students. 2.3. Measures 2.3.1. Self-reported stress in the VR classroom We measured the stress that student teachers experienced during the VR scenario using two items (“How tense did you feel in the VR classroom?” and “How did you feel emotionally during the VR classroom?”; e.g., Delaney & Brodie, 2000). Items were answered on a 9-point Likert-type scale ranging from 1 (calm, relaxed, composed) to 9 (tense). The internal consistency was good (αT1 = 0.83; αT2 = 0.85). 2.3.2. Physiological indicator of stress in the VR classroom We operationalized student teachers’ physiological stress reactions based on their heartrate (beats per minute, BPM). Student teachers’ BPM was measured using an armband optical HR sensor (Polar OH1) at 0.3s intervals when teaching in the VR classroom. Prior to starting the VR scenarios, each student teachers’ baseline heartrate was measured at 0.3s intervals while student teachers were asked to sit quietly and stay still. These baseline measures were used to control for individual differences in cardiovascular activity. We then aggregated both heartrate measurements during the baseline phase and heartrate measurements during the VR teaching. The differences between student teachers’ heartrate during teaching and student teachers’ baseline heartrate was used as a physiological 2 Students also reflected on the second VR classroom three months afterwards based on a video recording. Given the time span between this VR classroom and the written reflection, we didn’t include these written reflections in our analyses. 3 Percentages do not total 100 because of rounding. A. Westphal et al. Computers & Education 212 (2024) 104987 6 indicator of student teachers’ stress response. 2.3.3. Self-referential language We used the R package stringr (Wickham, 2019) to estimate the frequency of subjective and objective first-person singular pronouns. For each written reflection, we computed the percentage of subjective first-person singular pronouns (German: “ich”; English: “I”) and the percentage of objective first-person singular pronouns (German: “mich,” “mir”; English: “me,” “myself”).4 2.3.4. Manual ratings of focus and depth in written reflections Two independent raters manually rated the focus (as either student teachers’ own actions, student avatars’ actions, learning environment, or no focus) and depth (description, evaluating/explaining, or reflecting on alternatives) in student teachers’ written reflections using the software MAXQDA and following the procedure of Lohse-Bossenz et al. (2019; Kleinknecht & Groschner, ¨ 2016). Interrater agreement was good (κ = 0.75). For our analyses, we used the coverage percentage, i.e., the number of characters in the coded segment in relation to the total number of characters in the text. 2.4. Statistical analyses To test the hypotheses, we conducted regression analyses using the R package MplusAutomation (Hallquist & Wiley, 2018) and MLR as the estimation method. A manipulation check on our data was conducted by Huang et al. (2022) who probed whether student teachers experienced more self-reported and physiological stress when teaching a VR classroom in the large-size condition than in the small-size condition. We initially examined whether student teachers who used more subjective and objective first-person singular pronouns focused more frequently on themselves rather than on the avatar students in class or on the classroom environment (RQ1). To do so, we distinguished between student teachers who used subjective first-person singular pronouns with low frequency (i.e., ≤0.5 SD below M), average frequency (≥0.5 SD below M and ≤0.5 SD above M), and high frequency (≥0.5 SD above M). A multivariate analysis of variance was conducted with the subjective use of first-person singular pronouns (low, average, or high) as the between-person factor and the relative frequency of the student teachers’ reflection focus (the student teacher, student avatars, or learning environment) as the dependent variable. The analysis was then repeated for the objective use of first-person singular pronouns. To examine our second research question, we then regressed subjective and objective first-person singular pronoun use in the written reflections of the first VR classroom on self-reported stress in these VR sessions (RQ2). We controlled for gender.5 Within this model, we allowed the use of subjective and objective first-person singular pronouns to correlate. We specified an analogous model with physiological stress as the predictor. In a second step, we regressed self-reported stress during the second VR classroom teaching session on the subjective and objective use of first-person singular pronouns while controlling for self-reported stress during the first VR classroom teaching session (RQ3). Gender and class size in the second VR classroom teaching session were used as covariates. Thus, regression coefficients of pronoun use and gender indicate whether these variables explain changes in self-reported stress in the second, as compared to the first, VR classroom teaching session. Analyses were conducted separately for the use of subjective and objective first-person singular pronouns to probe whether subjective and objective first-person pronouns differentially relate to negative affect (instead of examining incremental effects). Analogous models were computed for physiological stress. Due to technical difficulties when transferring the heartrate data onto the storage device, heartrate while teaching in the VR classroom was only available for 40 students. There were only 29 students for whom heartrate responses were present in both VR classrooms. We examined whether values were missing completely at random using the MCAR-Test (Little, 1988) implemented in the R package naniar (Tierney et al., 2021). The test yielded non-significant results (χ2 = 17.5, df = 25, p = 0.864) indicating that the values were missing completely at random. We applied the full-information maximum-likelihood approach (FIML; Enders, 2001) to obtain appropriate estimates and standard errors. 3. Results A manipulation check on our data Huang et al., 2022)showed that student teachers experienced more self-reported and physiological stress when teaching a VR class in the large-size condition than in the small-size condition. Descriptive results (Table 1) and a dependent t-test showed that self-reported stress was greater in the first VR session than in the second VR session, t(54) = 4.89, p < 0.001. In contrast, physiological stress did not differ statistically significantly between the two VR sessions, t(28) = 0.68, p = 0.503. 3.1. Subjective and objective first-person singular pronouns and manual ratings of focus in written reflections Pertaining to our first research question, we checked whether student teachers with a more frequent use of subjective and objective first-person singular pronouns focused more often on themselves rather than on the avatar students in class or on the classroom environment (Fig. 1a and b). A multivariate analysis of variance with the subjective use of first-person singular pronouns (low, average, or high) as a between-person factor and relative frequency of student teachers’ focus of reflection on their own actions (as opposed to focus on student avatars or the learning environment) as a dependent variable showed no statistically significant effect, F(6, 4 The objective first-person singular pronoun “meiner” is rarely used and was not considered here—following the suggestion by Tackman et al. (2019)—because it overlaps with the more frequently used possessive pronoun “meiner”. 5 We did not look for interaction effects between the use of first-person singular pronouns and gender as our sample was small. A. Westphal et al. Computers & Education 212 (2024) 104987 7 108) = 0.59, p = 0.74. Similarly, we found no statistically significant difference between students with low, average, or high frequency of the objective use of first-person singular pronouns on the relative frequency of student teachers’ reflection being focused on their own actions, F(6, 108) = 1.18, p = 0.32. Thus, high subjective or objective first-person singular pronoun use was not reflected in a greater focus on student teachers’ own actions in written reflections (as indicated by manual ratings). 3.2. Do student teachers who experience more stress in the VR session use more subjective and objective first-person singular pronouns in their written reflections? To answer our second research question regarding the relationship between student teachers’ stress in the VR session and the use of subjective and objective first-person singular pronouns, we conducted cross-sectional regression analyses. Our results showed that selfreported stress experienced during the first VR teaching session was not statistically significantly associated with the use of subjective and objective first-person singular pronouns (Table 2). Gender showed a statistically significant association with subjective and objective pronoun use, indicating that student teachers who identified as male used subjective and objective first-person singular pronouns more frequently than student teachers who identified as female. In contrast, physiological stress experienced during the first VR teaching session was statistically and positively associated with both the use of subjective and the use of objective first-person singular pronouns. Thus, student teachers who experienced greater physiological stress when teaching in the VR classroom used more subjective or objective first-person singular pronouns in their written reflections. Beyond physiological stress, associations between gender and the use of subjective or objective first-person pronouns were not statistically significant. 3.3. Do student teachers who use more subjective and objective first-person singular pronouns in their written reflections experience a greater increase in stress in the second VR session? Concerning our third research question, we examined whether student teachers who used more subjective and objective firstperson singular pronouns in their written reflection experienced a greater increase in stress in the second VR session. When regressing the self-reported stress that participants experienced during the second VR teaching session, the use of subjective firstperson singular pronouns was not a statistically significant predictor when controlling for self-reported stress in the first VR teaching session, gender and class size during the second VR teaching session (Table 3, Model 3a). The use of objective first-person singular pronouns emerged as a statistically significant predictor of self-reported stress during the second VR teaching session (Table 3, Model 3b). This was not in line with our cross-sectional findings and we therefore conducted additional analyses, which revealed that the association between the use of objective first-person singular pronouns and self-reported stress was explained by the level of physiological stress in the first VR teaching session (Table A2 in Appendix). Concerning the covariates, gender and class size were not statistically significant predictors of self-reported stress in both models (Models 3a-b, Table 3). Associations between self-reported stress experienced in the first and in the second VR teaching session were statistically significant, indicating that student teachers who experienced more self-reported stress in the first VR teaching session reported more self-reported stress in the second VR teaching session. Associations between physiological stress during the second VR teaching session and the use of subjective first-person singular pronouns were statistically significant when controlling for physiological stress experienced during the first VR teaching session and class size in the second VR session (Table 3, Model 4a). Thus, student teachers who used more subjective first-person singular pronouns in their written reflections of the first VR teaching session experienced a stronger increase in physiological stress during the second VR teaching session. We found no association between physiological stress during the second VR teaching session and the use of objective first-person singular pronouns (Table 3, Model 4b). Regarding the covariates, gender was not a statistically significant predictor of physiological stress in either model, while a greater class size for the second VR classroom was associated with greater physiological stress (Models 4a-b, Table 3). Student teachers who experienced greater physiological stress in the first VR teaching session exhibited more intense physiological stress in the second VR teaching session. 4. Discussion Negative affect can play a crucial role in student teachers’ reflection, but it has barely been studied (Kleinknecht, 2021). The Table 1 Descriptive statistics. N M SD Min Max Psychological stress VR1 58 5.22 1.70 2.00 9.00 Psychological stress VR2 55 3.97 1.78 1.50 9.00 Physiological stress VR1 40 60.36 22.25 21.56 108.38 Physiological stress VR2 46 56.88 24.40 7.86 97.90 Subjective pronouns VR1 59 3.61 2.16 0.00 9.18 Objective pronouns VR1 59 1.13 1.12 0.00 5.10 Note. Physiological stress = difference between heartrate (BPM) while teaching and baseline heartrate (BPM). Subjective pronouns = relative frequency of subjective first-person singular pronouns in written reflection. Objective pronouns = relative frequency of objective first-person singular pronouns in written reflection. Gender: 0 = female. A. Westphal et al. Computers & Education 212 (2024) 104987 8 (caption on next page) A. Westphal et al. Computers & Education 212 (2024) 104987 9 present study applied psychological research on the relationship between negative affect and self-focus—which would potentially be valuable for diagnostic tools, automated feedback systems, and the improvement of emotion regulation—to the context of student teachers’ reflections. Initially, we looked at whether student teachers who used more subjective and objective first-person singular pronouns focused more frequently on themselves rather than on the avatar students in the VR class or on the classroom environment as a whole. In addition, we examined whether student teachers’ negative affect while teaching in a VR classroom—in terms of higher self-reported stress and heartrate—affected their self-focus in written reflections operationalized via the subjective and objective use of first-person singular pronouns. We also explored whether the use of subjective and objective first-person singular pronouns relates to stress in a subsequent teaching session in a VR classroom. Initially, we found that there were no differences in manual ratings of focus between student teachers with a low, average, or high subjective or objective use of first-person singular pronouns. This is in line with findings illustrating that individuals can regard their own actions and thoughts from a more or less immersed or distanced standpoint, which is reflected in their more or less frequent use of subjective and objective first-person singular pronouns (Kross & Ayduk, 2008; Kross et al., 2014). While one student teacher, for instance, described classroom disruptions during his lesson from a more immersed perspective, pointing out how it made him feel (“Some classroom disturbances made me upset […]. The interruptions kept me from getting back to where I started and from finishing properly.”), another student started his reflection by taking a more distanced perspective, describing his own actions from a third-person perspective (“There is a recurring loss of the common thread due to class disruptions and the teacher trying to address every minor disruption.”). Thus, the use of subjective and objective first-person singular pronouns provides incremental information to manual ratings of focus in written reflections. Future research examining student teachers’ focus when reflecting on their own teaching could therefore benefit from incorporating different measures of self-focus. Fig. 1. a Focus in written reflections from content analysis by use of subjective first-person singular pronouns Note. Low use of subjective firstperson singular pronouns ≤0.5 SD below M. Average use of subjective first-person singular pronouns ≥0.5 SD below M and ≤0.5 SD above M. High use of subjective first-person singular pronouns ≥0.5 SD above M. 1b Focus in written reflections from content analysis by use of objective firstperson singular pronouns. Table 2 Predicting first-person singular pronoun use in written reflection by self-reported and physiological stress in first VR teaching session. Subjective pronouns Objective pronouns β p 95% CI β p 95% CI Model 1 Intercept 0.74 0.110 [-0.16, 1.65] 0.17 0.700 [-0.68, 1.02] Self-reported stress 0.21 0.100 [-0.04, 0.45] 0.20 0.160 [-0.08, 0.47] Gender 0.28* 0.020 [ 0.05, 0.51] 0.23* 0.040 [ 0.01, 0.45] R2 0.12 0.09 Model 2 Intercept 0.47 0.240 [-0.31, 1.24] − 0.06 0.850 [-0.66, 0.54] Physiological stress 0.35*** 0.000 [ 0.13, 0.57] 0.32* 0.010 [ 0.09, 0.55] Gender 0.24 0.030 [0.02, 0.47] 0.20 0.110 [-0.04, 0.44] R2 0.18 0.14 Note. Coefficients are standardized. Gender: 0 = female. Table 3 Predicting self-reported and physiological stress in subsequent VR teaching session by use of first-person singular pronouns in written reflection of previous VR teaching session. β p 95% CI β p 95% CI Self-reported stress VR2 Model 3a Model 3b Intercept 1.38* 0.020 [ 0.24, 2.52] 1.20* 0.040 [ 0.05, 2.34] Self-rep. stress VR1 0.37*** <0.001 [ 0.12, 0.61] 0.33* 0.010 [ 0.10, 0.57] Class size in VR2 − 0.16 0.190 [-0.39, 0.08] − 0.10 0.410 [-0.35, 0.14] Subj. pronouns VR1 0.06 0.650 [-0.22, 0.35] Obj. pronouns VR1 0.29* 0.030 [ 0.02, 0.55] Gender 0.07 0.590 [-0.19, 0.34] 0.04 0.770 [-0.20, 0.27] R2 0.18 0.23 Physiological stress VR2 Model 4a Model 4b Intercept − 1.29*** <0.001 [-1.89, − 0.69] − 1.17*** <0.001 [-1.74, − 0.60] Phys. stress VR1 0.26*** <0.001 [ 0.09, 0.42] 0.25*** <0.001 [ 0.09, 0.41] Class size in VR2 0.83*** <0.001 [ 0.75, 0.92] 0.84*** <0.001 [ 0.75, 0.93] Subj. pronouns VR1 0.18* 0.040 [0.01, 0.35] Obj. pronouns VR1 0.17 0.060 [-0.01, 0.35] Gender 0.05 0.560 [-0.12, 0.22] 0.05 0.510 [-0.11, 0.21] R2 0.72 0.71 Note. Coefficients are standardized. Gender: 0 = female. Class size: 0 = small. A. Westphal et al. Computers & Education 212 (2024) 104987 10 Our results also indicate that student teachers who experienced more physiological stress when teaching in the VR classroom used more subjective and objective first-person singular pronouns in their written reflections. This finding is consistent with research showing that negative affective experiences may provoke the use of subjective and objective first-person singular pronouns as a way to process negative self-relevant information (Berry-Blunt et al., 2021; Klauke et al., 2020; Kowalski, 2000). However, given their cross-sectional nature, our results could also indicate that student teachers who use less linguistic distancing—i.e., who are more immersed into a situation, indicated by a greater use of subjective and objective first-person singular pronouns—experience higher levels of negative affect, which is also in line with previous findings (Shahane et al., 2023). Our study is the first to confirm that this association can be replicated in the context of student teachers’ reflections on their own teaching. Our results further amplify existing research by revealing that this relationship generalizes to a physiological indicator of negative affect, namely to individuals’ heartrates. In terms of gender differences, our results suggested that student teachers who identified as male used more subjective and objective first-person singular pronouns than student teachers who identified as female. These gender differences disappeared when controlling for physiological stress experienced during the VR teaching session. The finding that men used subjective and objective first-person singular pronouns more frequently than women is not in line with related research that shows a greater tendency in women to ruminatively self-focus when depressed, and thus experiencing high levels of negative affect (Johnson & Whisman, 2013). It has, however, been suggested that men’s use of subjective and objective first-person singular pronouns is an indicator of high-arousal negative distress, while women’s use of first-person singular pronouns is driven by low-arousal negative distress (Tackman et al., 2019). In our study, student teachers were reflecting on a teaching situation that had the potential to elicit high-arousal negative distress. Indeed, we found that, when controlling for physiological stress experienced during the VR session, gender differences in the use of subjective and objective first-person singular pronouns disappeared. These results further support the notion that the use of first-person singular pronouns may be an indicator of different affective experiences in women and men (Fast & Funder, 2010). In addition, we found that greater use of subjective first-person singular pronouns led to higher physiological stress in the subsequent VR session. Thus, we found some indication that student teachers who took a more distanced perspective experienced reduced future stress (as suggested by Berry-Blunt et al., 2021; Zimmermann et al., 2016). This is in line with research showing that individuals who spontaneously use more linguistic distancing when reflecting on negative and positive events report lower levels of stress in these and in subsequent situations, and overall greater well-being (Shahane et al., 2023). Despite the fact that the use of subjective and objective first-person singular pronouns may be a strategy that student teachers use to process negative teaching experiences, this strategy—referred to as rumination—is considered maladaptive (e.g., Mor & Winquist, 2002). Rumination—i.e., the strategy of regulating negative mood by repeatedly focusing one’s attention on one’s own negative experiences, and the causes and effects (Nolen-Hoksema, 1991)—has been associated with depression (Hong, 2007), inefficient problem-solving, and lower self-efficacy (Lyubomirsky et al., 2003; Reindl et al., 2020). Teachers who ruminate more experience higher levels of stress in the classroom and are more susceptible to burnout (Koˇsir et al., 2015). We assessed naturally occurring differences in the use of subjective and objective first-person singular pronouns and may therefore have underestimated the benefits of taking a more distanced perspective. Future studies with greater sample sizes and power should aim to explore whether a similar effect might emerge for objective first-person pronouns, for which we found a marginally significant p-value. In contrast, our data did not support the association between self-reported negative affect and the use of subjective and objective first-person singular pronouns. Berry-Blunt et al. (2021) proposed that some psychometric units, i.e., “facets, nuances, and items” (p. 8) might capture I-talk better than others; our self-report measure of stress may not have been ideal in this respect. Moreover, the self-report was assessed after the VR session, which potentially led to lower congruence between physiological and self-reported stress responses than when self-report is assessed continuously during the stressful situation (Campbell & Ehlert, 2012). 4.1. Pedagogical implications While reflection can improve student teachers’ professional vision, and is therefore seen as an important tool in teacher education (e.g., Stürmer et al., 2013; Weber et al., 2020), less is known about its potential to assist adaptive emotion regulation strategies that teachers need in order to be able to cope with challenging classroom events (Chang, 2009). Reappraising a challenging situation is seen as an effective strategy (Gross, 2002) by which teachers change how they think about an event and thereby decrease its emotional impact (Chang, 2009; Gross, 2022). When engaging in reappraisal, teachers may reduce their use of first-person singular pronouns, indicating their greater psychological distance to a challenging situation (Nook et al., 2020). Our findings indicate that an increased self-focus in student teachers’ written reflections—as indicated by a more frequent use of subjective first-person singular pronouns—is associated with greater physiological stress. Automated feedback systems could build on this finding by identifying student teachers who repeatedly experience elevated stress and are thus at risk for depression and burnout. This could complement feedback on the quality of their written reflections (Wulff et al., 2022, 2023). We found some indication that taking a more distanced perspective—as indicated by less frequent use of subjective first-person pronouns—reduces future stress (as suggested by Berry-Blunt et al., 2021; Shahane et al., 2023; Zimmermann et al., 2016). Practicing taking a more distanced perspective on negative events is not only seen as an adaptive emotion-regulation strategy (Kross & Ayduk, 2008), it may over time change a student teacher’s tendency to experience stress (for a similar suggestion outside the context of teacher education, see Berry-Blunt et al., 2021). A structured practice of reappraisal can facilitate adaptive emotion regulation (Christou-Champi et al., 2015). Thus, training student teachers to use more reappraisal and put more distance between themselves and challenging classroom situations when reflecting on their teaching could be a viable strategy to help them cope with stress. In addition, Ehring (2020) suggests that ruminative thinking, i.e., focusing one’s attention on one’s own negative experiences, can be transformed into more adaptive information processing by focusing attention on A. Westphal et al. Computers & Education 212 (2024) 104987 11 physical reactions and emotions in a specific situation and fostering self-compassion, which has been shown to be incompatible with ruminative thinking (Watkins, 2016). Combining video-based reflection on one’s own teaching with reappraisal and mindfulness-based strategies could be a promising way to foster student teachers’ professional vision, as well as their well-being and stress-resistance. 4.2. Limitations and future research The current study has some limitations. The sample size of the study was small. Our results should therefore be replicated using a larger sample, which could more effectively detect small effects. By providing a highly standardized setting, the VR classroom increases the internal validity of our research findings, which may come at the cost of ecological validity. It has been argued that VR creates a perceptual illusion and “the real power of VR […] [is that] even though you know it is an illusion, this does not change your perception or your response to it” (Slater, 2018, p. 2). Some features of the VR environment, such as a realistic display of the environment, a smooth display of motion and view changes, and control of behaviors, are seen as essential to increase the likelihood of optimal learning in VR (Dalgarno & Lee, 2010; Delamarre et al., 2021). Prior studies showed that student teachers perceived our VR classroom as realistic and authentic Wiepke et al., 2019, 2021. Student teachers trained in our VR classroom showed similar reflection processes compared to students reflecting on real classroom videos and showed a substantial increase in reflection-related self-efficacy over time (Richter et al., 2022). Nevertheless, more validation studies are needed to evaluate the transferability of the positive results of the participation in a VR learning setting to authentic classrooms. Moreover, future studies should investigate whether our findings are generalizable to non-virtual classroom environments and to in-service teachers. Studies should also incorporate further self-report measures of negative affect to “identify […] the smaller psychometric units (e.g., trait facets, nuances, and items) that best capture I-talk” (Berry-Blunt et al., 2021, p. 8). To better understand the temporal dynamics between negative affect and self-focused attention, a longitudinal study with multiple measurements is necessary. Such a study design could help explain the extent to which situation-specific and personal characteristics play a role in the interplay between the use of subjective and objective first-person singular pronouns and negative affect. The extent to which student teachers can be trained to more professionally process negative events could be explored by experimentally manipulating the ways in which student teachers describe and evaluate negative classroom events—taking either a distanced or a self-immersed perspective—by prompting student teachers to use distanced vs. self-referential language or by instructing them to reframe negative events vs. self-immerse in their emotions (see also Nook et al., 2017). Intervention studies could be a promising approach to help identify how reflection could be implemented in a way that is beneficial for student teachers’ professional vision and their emotion regulation, without overwhelming them. 5. Conclusions Thanks to a standardized VR classroom environment, our study is the first to provide evidence that student teachers’ self-focus in their written reflections is linked to the stress they experience while teaching. Our multimodal assessment of stress—based on student teachers’ self-reports and heartrate responses—allowed for a differentiated approach to studying emotions in the VR learning environment. Not only can we show that the association between negative affect and self-focus—measured via I-talk—holds in student teachers’ written reflections on their own teaching, but our study also adds to previous findings by showing that this link can be generalized to individuals’ heartrates, representing a physiological indicator of negative affect. These results point to the potential that reflecting on one’s own teaching may have for practicing adaptive emotion regulation strategies in teacher education programs. Credit author statement AW: Conceptualization. Formal analysis. Writing – original draft, Reviewing and Editing, ER: Conceptualization. Investigation. Data curation. Project administration. Writing- Reviewing and Editing, RL: Writing- Reviewing and Editing, YH: Investigation, Project administration. Declaration of competing interest None. Data availability The authors do not have permission to share data. A. Westphal et al. Computers & Education 212 (2024) 104987 12 APPENDIX Table A.1 Descriptive statistics for baseline heartrate and heartrate in VR teaching session N M SD Min Max Baseline BPM T1 42 96.92 30.88 44.41 173.62 Baseline BPM T2 50 102.37 30.03 40.34 175.88 BPM in VR session T1 57 161.14 20.44 125.02 196.45 BPM in VR session T2 55 160.65 20.00 115.57 196.59 Note. Measures used to compute physiological stress, i.e., difference in heartrate between baseline and VR session. Table A.2 Predicting self-reported stress in subsequent VR teaching session by physiological stress and use of firstperson singular pronouns in written reflection of previous VR teaching session β p 95% CI Self-reported stress VR2 Model 5a Intercept 0.39 0.560 [-0.93, 1.71] Self-reported stress VR1 0.31* 0.010 [ 0.06, 0.55] Physiological stress VR1 0.29* 0.040 [ 0.01, 0.57] Class size in VR2 − 0.06 0.640 [-0.31, 0.19] Objective pronouns VR1 0.24 0.110 [-0.05, 0.54] Gender 0.06 0.620 [-0.18, 0.30] R2 0.28 Note. Coefficients are standardized. Gender: 0 = female. Class size: 0 = small. Fig. A1. VR Classroom from the perspective of student teachers. A. Westphal et al. Computers & Education 212 (2024) 104987 13 Fig. A.2. Student teacher teaching in VR Classroom. References Bernard, J. D., Baddeley, J. L., Rodriguez, B. F., & Burke, P. A. (2016). Depression, language, and affect: An examination of the influence of baseline depression and affect induction on language. Journal of Language and Social Psychology, 35(3), 317–326. https://doi.org/10.1177/0261927X15589186 Berry-Blunt, A. K., Holtzman, S. H., Donnellan, M. B., & Mehl, M. R. (2021). The story of “I” tracking: Psychological implications of self-referential language use. Social and Personality Psychology Compass, 15(2), Article e12647. https://doi.org/10.1111/spc3.12647 Borko, H. (2004). Professional development and teacher learning: Mapping the terrain. Educational Researcher, 33(8), 3–15, 10.3102%2F0013189X033008003. Borko, H. (2016). Methodological contributions to video-based studies of classroom teaching and learning: A commentary. ZDM, 48(1), 213–218, 10/gfs2vk. Borko, H., Jacobs, J., Eiteljorg, E., & Pittman, M. E. (2008). Video as a tool for fostering productive discussions in mathematics professional development. Teaching and Teacher Education, 24(2), 417–436. https://doi.org/10.1016/j.tate.2006.11.012 Campbell, J., & Ehlert, U. (2012). Acute psychosocial stress: Does the emotional stress response correspond with physiological responses? Psychoneuroendocrinology, 37(8), 1111–1134. https://doi.org/10.1016/j.psyneuen.2011.12.010 Chang, M. L. (2009). An appraisal perspective of teacher burnout: Examining the emotional work of teachers. Educational Psychology Review, 21, 193–218. https://doi. org/10.1007/s10648-009-9106-y Chernikova, O., Heitzmann, N., Fink, M. C., Timothy, V., Seidel, T., Fischer, F., & DFG Research group COSIMA.. (2020). Facilitating diagnostic competences in higher education - a meta-analysis in medical and teacher education. Educational Psychology Review, 32, 157–196. https://doi.org/10.1007/s10648-019-09492-2 Christou-Champi, S., Farrow, T. F., & Webb, T. L. (2015). Automatic control of negative emotions: Evidence that structured practice increases the efficiency of emotion regulation. Cognition & Emotion, 29(2), 319–331. https://doi.org/10.1080/02699931.2014.901213 Dalgarno, B., & Lee, M. J. (2010). What are the learning affordances of 3-D virtual environments? British Journal of Educational Technology, 41(1), 10–32. https://doi. org/10.14221/ajte.2016v41n1.8 Delamarre, A., Shernoff, E., Buche, C., Frazier, S., Gabbard, J., & Lisetti, C. (2021). The interactive virtual training for teachers (IVT-T) to practice classroom behavior management. International Journal of Human-Computer Studies, 152, Article 102646. https://doi.org/10.1016/j.ijhcs.2021.102646 Delaney, J. P. A., & Brodie, D. A. (2000). Effects of short-term psychological stress on the time and frequency domains of heart-rate variability. Perceptual and Motor Skills, 91(2), 515–524. https://doi.org/10.2466/pms.2000.91.2.515 Dunnack, E. S., & Park, C. L. (2009). The effect of an expressive writing intervention on pronouns: The surprising case of I. Journal of Loss & Trauma, 14(6), 436–446. https://doi.org/10.1080/15325020902925084 Edwards, T., & Holtzman, N. S. (2017). A meta-analysis of correlations between depression and first singular pronoun use. Journal of Research in Personality, 68, 63–68. https://doi.org/10.1016/j.jrp.2017.02.005 Ehring, T. (2020). Die ruminationsfokussierte Kognitive Verhaltenstherapie [Rumination-focused cognitive-Behavioral Therapy]. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 68(3), 150–159. https://doi.org/10.1024/1661-4747/a000414 Enders, C. K. (2001). The impact of nonnormality on full information maximum-likelihood estimation for structural equation models with missing data. Psychological Methods, 6, 352–370. https://doi.org/10.1037/1082-989X.6.4.352 Exner, J. E., Jr. (1973). The self focus sentence completion: A study of egocentricity. Journal of Personality Assessment, 37(5), 437–455. https://doi.org/10.1080/ 00223891.1973.10119902 Fast, L. A., & Funder, D. C. (2010). Gender differences in the correlates of self-referent word use: Authority, entitlement, and depressive symptoms. Journal of Personality, 78, 313–338. https://doi.org/10.1111/j.1467-6494.2009.00617.x Fenigstein, A., Scheier, M. F., & Buss, A. H. (1975). Public and private self-consciousness: Assessment and theory. Journal of Consulting and Clinical Psychology, 43(4), 522–527. https://doi.org/10.1037/h0076760 Goddard, R., O’brien, P., & Goddard, M. (2006). Work environment predictors of beginning teacher burnout. British Educational Research Journal, 32(6), 857–874. https://doi.org/10.1080/01411920600989511Gold,B.,&Windscheid. J. (2020). Observing 360-degree classroom videos – Effects of video type on presence, emotions, workload, classroom observations, and ratings of teaching quality. Computers & Education, 156, 103960. Gold, B., & Windscheid, J. (2020). Observing 360-degree classroom videos–Effects of video type on presence, emotions, workload, classroom observations, and ratings of teaching quality. Computers & Education, 156, 103960. https://doi.org/10.1016/j.compedu.2020.103960. Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281–291, 10.1017.S0048577201393198. Hallquist, M. N., & Wiley, J. F. (2018). MplusAutomation: An R package for facilitating large-scale latent variable analyses in Mplus. Structural Equation Modeling: A Multidisciplinary Journal, 25(4), 621–638. https://doi.org/10.1080/10705511.2017.1402334 Hong, R. Y. (2007). Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behavior Research and Therapy, 45 (2), 277–290. https://doi.org/10.1016/j.brat.2006.03.006 Huang, Y., Richter, E., Kleickmann, T., & Richter, D. (2022). Class size affects preservice teachers’ physiological and psychological stress reactions: An experiment in a virtual reality classroom. Computers & Education, 184, 104503. https://doi.org/10.1016/j.compedu.2022.104503. Huang, Y., Richter, E., Kleickmann, T., Wiepke, A., & Richter, D. (2021). Classroom complexity affects student teachers’ behavior in a VR classroom. Computers & Education, 163, 104100. https://doi.org/10.1016/j.compedu.2020.104100. Hultell, D., Melin, B., & Gustavsson, J. P. (2013). Getting personal with teacher burnout: A longitudinal study on the development of burnout using a person-based approach. Teaching and Teacher Education, 32, 75–86. https://doi.org/10.1016/j.tate.2013.01.007 James, W. (1890). The principles of psychology. New York, NY: Holt & Co. Johnson, D. P., & Whisman, M. A. (2013). Gender differences in rumination: A meta-analysis. Personality and Individual Differences, 55, 367–374. https://doi.org/ 10.1016/j.paid.2013.03.019 Ke, F., & Xu, X. (2020). Virtual reality simulation-based learning of teaching with alternative perspectives taking. British Journal of Educational Technology, 51(6), 2544–2557. https://doi.org/10.1111/bjet.12936 A. Westphal et al. Computers & Education 212 (2024) 104987 14 Kern, M. L., Eichstaedt, J. C., Schwartz, H. A., Dziurzynski, L., Ungar, L. H., Stillwell, D. J., Kosinski, M., Ramones, S. M., & Seligman, M. E. P. (2014). The online social self: An open vocabulary approach to personality. Assessment, 21(2), 158–169. https://doi.org/10.1177/1073191113514104 Klauke, F., Müller-Frommeyer, L. C., & Kauffeld, S. (2020). Writing about the silence: Identifying the language of ostracism. Journal of Language and Social Psychology, 39(5–6), 751–763. https://doi.org/10.1177/0261927X19884599 Kleinknecht, M. (2021). Emotionen von Lehrkraften ¨ in unterrichtsvideobasierten Fortbildungen [Teachers’ emotions in video-based training]. In M. Gl¨ aser-Zikuda, F. Hofmann, & V. Frederking (Eds.), Emotionen im Unterricht: Psychologische, padagogische ¨ und fachdidaktische Perspektiven [Emotions in the classroom: Psychological, pedagogical and didactical perspectives] (pp. 231–243). Stuttgart, Germany: Kohlhammer Verlag, 2021. Kleinknecht, M., & Groschner, ¨ A. (2016). Fostering preservice teachers’ noticing with structured video feedback: Results of an online- and video-based intervention study. Teaching and Teacher Education, 59, 45–56. https://doi.org/10.1016/j.tate.2016.05.020 Kleinknecht, M., & Schneider, J. (2013). What do teachers think and feel when analyzing videos of themselves and other teachers teaching? Teaching and Teacher Education, 33, 13–23. https://doi.org/10.1016/j.tate.2013.02.002 Koˇsir, K., Tement, S., Licardo, M., & Habe, K. (2015). Two sides of the same coin? The role of rumination and reflection in elementary school teachers’ classroom stress and burnout. Teaching and Teacher Education, 47, 131–141. Kowalski, R. M. (2000). “I was only kidding!” Victims’ and perpetrators’ perceptions of teasing. Personality and Social Psychology Bulletin, 26, 231–241. https://doi. org/10.1177/0146167200264009 Kross, E., & Ayduk, O. (2008). Facilitating adaptive emotional analysis: Distinguishing distanced-analysis of depressive experiences from immersed-analysis and distraction. Personality and Social Psychology Bulletin, 34(7), 924–938, 10.1177%2F0146167208315938. Kross, E., Bruehlman-Senecal, E., Park, J., Burson, A., Dougherty, A., Shablack, H., Bremner, R., Moser, J., & Ayduk, O. (2014). Self-talk as a regulatory mechanism: How you do it matters. Journal of Personality and Social Psychology, 106(2), 304–324. https://doi.org/10.1037/a0035173 Lin, Y. C. (2023). Using virtual classroom simulations in a mathematics methods course to develop pre-service primary mathematics teachers’ noticing skills. British Journal of Educational Technology, 54(3), 734–753. https://doi.org/10.1111/bjet.13291 Little, R. J. A. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202. https://doi.org/10.2307/2290157 Lohse-Bossenz, H., Schonknecht, ¨ L., & Brandtner, M. (2019). Entwicklung und Validierung eines Fragebogens zur Erfassung Reflexionsbezogener Selbstwirksamkeit von Lehrkraften ¨ im Vorbereitungsdienst [Development and validation of a questionnaire assessing pre-service teachers’ self-efficacy in reflection]. Empirische Padagogik, ¨ 33(2), 164–179. Lugrin, J.-L., Latoschik, M. E., Habel, M., Roth, D., Seufert, C., & Grafe, S. (2016). Breaking bad behaviors: A new tool for learning classroom management using virtual reality. Frontiers in ICT, 3(26). https://doi.org/10.3389/fict.2016.00026 Lyubomirsky, S., Kasri, F., & Zehm, K. (2003). Dysphoric rumination impairs concentration on academic tasks. Cognitive Therapy and Research, 27(3), 309–330. https://doi.org/10.1023/A:1023918517378 Mehl, M. R., Gosling, S. D., & Pennebaker, J. W. (2006). Personality in its natural habitat: Manifestations and implicit folk theories of personality in daily life. Journal of Personality and Social Psychology, 90(5), 862–877. https://doi.org/10.1037/0022-3514.90.5.862 Mor, N., & Winquist, J. (2002). Self-focused attention and negative affect: A meta-analysis. Psychological Bulletin, 128(4), 638–662. https://doi.org/10.1037/0033- 2909.128.4.638 Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569–582. https://doi.org/10.1037/0021-843X.100.4.569 Nook, E. C., Schleider, J. L., & Somerville, L. H. (2017). A linguistic signature of psychological distancing in emotion regulation. Journal of Experimental Psychology: General, 146(3), 337–346. https://doi.org/10.1037/xge0000263 Nook, E. C., Vidal Bustamante, C. M., Cho, H. Y., & Somerville, L. H. (2020). Use of linguistic distancing and cognitive reappraisal strategies during emotion regulation in children, adolescents, and young adults. Emotion, 20(4), 525. https://doi.org/10.1037/emo0000570 Pendergast, D., O’Brien, M., Prestridge, S., & Exley, B. (2022). Self-efficacy in a 3-dimensional virtual reality classroom—initial teacher education students’ experiences. Education Sciences, 12(6), 368. https://doi.org/10.3390/educsci12060368 Prilop, C. N., Weber, K. E., & Kleinknecht, M. (2021). The role of expert feedback in the development of pre-service teachers’ professional vision of classroom management in an online blended learning environment. Teaching and Teacher Education, 99, Article 103276. https://doi.org/10.1016/j.tate.2020.103276 Reindl, M., Tulis, M., & Dresel, M. (2020). Profiles of emotional and motivational self-regulation following errors: Associations with learning. Learning and Individual Differences, 77, Article 101806. https://doi.org/10.1016/j.lindif.2019.101806 Remacle, A., Bouchard, S., & Morsomme, D. (2023). Can teaching simulations in a virtual classroom help trainee teachers to develop oral communication skills and self-efficacy? A randomized controlled trial. Computers & Education, 200, Article 104808. https://doi.org/10.1016/j.compedu.2023.104808 Richter, E., Hußner, I., Huang, Y., Richter, D., & Lazarides, R. (2022). Video-based reflection in teacher education: Comparing virtual reality and real classroom videos. Computers & Education, 24(3), Article 104601. https://doi.org/10.1016/j.compedu.2022.104601 Rude, S., Gortner, E.-M., & Pennebaker, J. W. (2004). Language use of depressed and depression-vulnerable college students. Cognition & Emotion, 18(8), 1121–1133. https://doi.org/10.1080/02699930441000030 Seidel, T., Stürmer, K., Blomberg, G., Kobarg, M., & Schwindt, K. (2011). Teacher learning from analysis of videotaped classroom situations: Does it make a difference whether teachers observe their own teaching or that of others? Teaching and Teacher Education, 27(2), 259–267. https://doi.org/10.1016/j.tate.2010.08.009 Seufert, C., Oberdorfer, ¨ S., Roth, A., Grafe, S., Lugrin, J. L., & Latoschik, M. E. (2022). Classroom management competency enhancement for student teachers using a fully immersive virtual classroom. Computers & Education, 179, Article 104410. https://doi.org/10.1016/j.compedu.2021.104410 Shahane, A. D., Godfrey, D. A., & Denny, B. T. (2023). Predicting real-world emotion and health from spontaneously assessed linguistic distancing using novel scalable technology. Emotion. Advance online publication. https://doi.org/10.1037/emo0001211 Stürmer, K., Konings, ¨ K. D., & Seidel, T. (2013). Declarative knowledge and professional vision in teacher education: Effect of courses in teaching and learning. British Journal of Educational Psychology, 83(3), 467–483. https://doi.org/10.1111/j.2044-8279.2012.02075.x Tackman, A. M., Sbarra, D. A., Carey, A. L., Donnellan, M. B., Horn, A. B., Holtzman, N. S., Edwards, T. S., Pennebaker, J. W., & Mehl, M. R. (2019). Depression, negative emotionality, and self-referential language: A multi-lab, multi-measure, and multi-language-task research synthesis. Journal of Personality and Social Psychology, 116(5), 817–834. https://doi.org/10.1037/pspp0000187 Tierney, N., Cook, D., McBain, M., & Fay, C. (2021). naniar: Data structures, summaries, and visualisations for missing data. R package version 0.6.1 https://CRAN.Rproject.org/package=naniarv. van Es, E. A., & Sherin, M. G. (2002). Learning to notice: Scaffolding new teachers’ interpretations of classroom interactions. Journal of Technology and Teacher Education, 10(4), 571–596. https://www.learntechlib.org/primary/p/9171/. van Es, E. A., & Sherin, M. G. (2008). Mathematics teachers’ “learning to notice” in the context of a video club. Teaching and Teacher Education, 24(2), 244–276. https://doi.org/10.1016/j.tate.2006.11.005 Voss, T., & Kunter, M. (2020). “Reality shock” of beginning teachers? Changes in teacher candidates’ emotional exhaustion and constructivist-oriented beliefs. Journal of Teacher Education, 71(3), 292–306. https://doi.org/10.1177/0022487119839700 Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. New York: Guilford. Weber, K. E., Prilop, C. N., Viehoff, S., Gold, B., & Kleinknecht, M. (2020). Fordert ¨ eine videobasierte intervention im praktikum die professionelle wahrnehmung von Klassenführung?—eine quantitativ-inhaltsanalytische messung von Subprozessen professioneller wahrnehmung [does a video-based practicum intervention provide a realistic picture of classroom management? A quantitative content analysis of the subprocesses of professional awareness]. Zeitschrift für Erziehungswissenschaft, 23, 343–365. https://doi.org/10.1007/s11618-020-00939-9 Wegner, D. M., & Giuliano, T. (1980). Arousal-induced attention to self. Journal of Personality and Social Psychology, 38(5), 719–726. https://doi.org/10.1037/0022- 3514.38.5.719 A. Westphal et al. Computers & Education 212 (2024) 104987 15 Westphal, A., Kalinowski, E., Hoferichter, C. J., & Vock, M. (2022). K− 12 teachers’ stress and burnout during the COVID-19 pandemic: A systematic review. Frontiers in psychology, 13, 920326. https://doi.org/10.3389/fpsyg.2022.920326. Wickham, H. (2019). stringr: Simple, consistent wrappers for common string operations. R package version 1.4.0. https://CRAN.R-project.org/package=stringr. Wiepke, A., Heinemann, B., Lucke, U., & Schroeder, U. (2021). Jenseits des eigenen Klassenzimmers: Perspektiven & Weiterentwicklungen des VR-Klassenzimmers [Beyond the own classroom: Perspectives & further developments of the VR classroom.]. DELFI 2021 - Die 19. Fachtagung Bildungstechnologien [Educational technologies symposium], 331–336. http://dl.gi.de/handle/20.500.12116/37031. Wolff, C. E., Jarodzka, H., van den Bogert, N., & Boshuizen, H. P. A. (2016). Teacher vision: Expert and novice teachers’ perception of problematic classroom management scenes. Instructional Science, 44(3), 243–265, 10/f8tcpm. Wulff, P., Westphal, A., Mientus, L., Nowak, A., & Borowski, A. (2023, January). Enhancing writing analytics in science education research with machine learning and natural language processing—Formative assessment of science and non-science preservice teachers’ written reflections. In Frontiers in Education, 7, Article 1061461. https://doi.org/10.3389/feduc.2022.1061461. Frontiers. Wulff, P., Buschhüter, D., Westphal, A., Mientus, L., Nowak, A., & Borowski, A. (2022). Bridging the gap between qualitative and quantitative assessment in science education research with machine learning—A case for pretrained language models-based clustering. Journal of Science Education and Technology, 31(4), 490–513. https://doi.org/10.1007/s10956-022-09969-w. Yarkoni, T. (2010). Personality in 100,000 words: A large-scale analysis of personality and word use among bloggers. Journal of Research in Personality, 44(3), 363–373. https://doi.org/10.1016/j.jrp.2010.04.001 Yee, N., Harris, H., Jabon, M., & Bailenson, J. N. (2011). The expression of personality in virtual worlds. Social Psychological and Personality Science, 2(1), 5–12. https://doi.org/10.1177/1948550610379056 Zhang, M., Lundeberg, M., Koehler, M. J., & Eberhardt, J. (2011). Understanding affordances and challenges of three types of video for teacher professional development. Teaching and Teacher Education, 27(2), 454–462. https://doi.org/10.1016/j.tate.2010.09.015 Zimmermann, J., Brockmeyer, T., Hunn, M., Schauenburg, H., & Wolf, M. (2016). First-person pronoun use in spoken language as a predictor of future depressive symptoms: Preliminary evidence from a clinical sample of depressed patients. Clinical Psychology & Psychotherapy, 24(2), 384–391. https://doi.org/10.1002/ cpp.2006 Wiepke, A., Richter, E., Zender, R., & Richter, D. (2019). Einsatz von Virtual Reality zum Aufbau von Klassenmanagement-Kompetenzen im Lehramtsstudium [Use of virtual reality for training student teachers’ classroom management competencies]. DELFI, 2019. https://doi.org/10.18420/delfi2019_319 A. Westphal et al. View publication stats
|
Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand. What are the negative and positive aspects of virtual teaching for the instructors? See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/377123871 More I-talk in student teachers’ written reflections indicates higher stress during VR teaching Article in Computers & Education · April 2024 DOI: 10.1016/j.compedu.2024.104987 CITATIONS 0 READS 70 4 authors: Andrea Westphal University of Greifswald 53 PUBLICATIONS 305 CITATIONS SEE PROFILE Eric Richter Universität Potsdam 45 PUBLICATIONS 495 CITATIONS SEE PROFILE Rebecca Lazarides Universität Potsdam 145 PUBLICATIONS 1,980 CITATIONS SEE PROFILE Yizhen Huang Universität Potsdam 19 PUBLICATIONS 208 CITATIONS SEE PROFILE All content following this page was uploaded by Eric Richter on 12 January 2024. The user has requested enhancement of the downloaded file. Computers & Education 212 (2024) 104987 Available online 3 January 2024 0360-1315/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). More I-talk in student teachers’ written reflections indicates higher stress during VR teaching Andrea Westphal a,* , Eric Richter b , Rebecca Lazarides b , Yizhen Huang b a University of Greifswald, Department of Education, Steinbeckerstr. 15, 17487, Greifswald, Germany b University of Potsdam, Department of Education, Karl-Liebknecht-Straße 24-25, 14476, Potsdam, Germany ARTICLE INFO Keywords: Augmented and virtual reality Improving classroom teaching Teacher professional development ABSTRACT Video-based reflection on one’s own teaching represents a crucial tool in teacher education. When student teachers reflect on negative classroom events, it elicits “self-focused attention,” which has been associated with more intense negative emotionality. Self-focused attention can be quantitatively captured using first-person singular pronouns (“I,” “me,” “my”) in written reflections by, for instance, student teachers. What is unclear is whether student teachers’ use of these firstperson singular pronouns in their written reflections is linked to and predicts their negative affective experiences during teaching. For the present study, a fully immersive virtual reality (VR) classroom was implemented in which student teachers taught a lesson, provided written reflections on their teaching, and then taught a second lesson. We measured N = 59 student teachers’ self-reported stress and heartrate responses while teaching in the VR classroom and determined the percentage of first-person singular pronouns in their written reflections. Firstly, our results showed that the use of first-person singular pronouns provides incremental information on manual ratings of student teachers’ foci in their written reflections. Secondly, student teachers’ heartrates during instruction—a measure of physiological stress—were associated with the use of first-person singular pronouns in subsequent written reflections. Thirdly, the use of first-person singular pronouns predicted the increase in physiological stress from the first to the second round of VR teaching. We discuss implications for automated feedback and for designing reflective tasks. 1. Introduction Teaching is often seen as a challenging profession (Chang, 2009; Westphal et al., 2022; . The transition to school practice, at least when it takes place in real school classrooms, is especially demanding for student teachers1 (Goddard et al., 2006; Hultell et al., 2013; Voss & Kunter, 2020). Fully immersive virtual reality (VR) classrooms provide a safe environment for student teachers to gain hands-on teaching experience (Gold & Windscheid, 2020 ; Lin, 2023; Lugrin et al., 2016; Pendergast et al., 2022; Remacle et al., 2023; Richter et al., 2022; Seufert et al., 2022). Ke and Xu (2020) suggested that active learning processes (“diving in”) and reflective * Corresponding author. E-mail addresses: [email protected] (A. Westphal), [email protected] (E. Richter), rebecca.lazarides@uni-potsdam. de (R. Lazarides), [email protected] (Y. Huang). 1 In our study, the term “student teachers” refers to those prospective teachers who have not yet begun the supervised teaching portion of their teacher education program. Contents lists available at ScienceDirect Computers & Education journal homepage: www.elsevier.com/locate/compedu https://doi.org/10.1016/j.compedu.2024.104987 Received 21 November 2022; Received in revised form 11 November 2023; Accepted 2 January 2024 Computers & Education 212 (2024) 104987 2 learning processes (“stepping out”) can be easily combined in VR classrooms. Thus, it may be useful to practice reflecting on classroom situations from a more distanced perspective using VR classrooms early on in teacher education to help student teachers make a smooth transition into the classroom. Because the setting is standardized and similar for all student teachers, VR classrooms allow us to more accurately research the contributing factors and consequences of student teachers’ self-reflection; the highly controllable setting increases the internal validity of research findings (Huang et al., 2021; Richter et al., 2022). This is of particular interest for research looking at the interrelationships between student teachers’ affects in relation to their classroom experiences and their reflections upon those experiences. VR classrooms allow us, for instance, to apply a finding from experimental psychology to the field of teacher education. Research in the fields of experimental psychology and clinical psychology has shown that self-focus after negative events is accompanied by greater negative affect (e.g., Mor & Winquist, 2002). This finding has been explained by dysfunctional emotion-regulation strategies (e.g., Nook et al., 2017). Applied to the context of teacher education, these findings may imply that student teachers who are less skilled at transitioning between a more immersed perspective and a more distanced perspective on challenging classroom events may experience more negative affect. The degree of a person’s self-focus can be determined based on the frequency with which they use first-person singular pronouns (e.g., “I,” “me,” “my”); this has also been called “I-talk” (Tackman et al., 2019). It would be highly relevant to examine this link between self-focused attention in written reflections—as reflected by more frequent I-talk—and negative affect during instruction in the field of teacher education, because knowledge about the link between the use of first-person singular pronouns and negative affect could be implemented in automated feedback systems to help identify student teachers at risk of intense stress and burnout, allowing them to be offered personalized feedback and support. To date, however, these questions have not been explored. To examine whether student teachers’ use of first-person singular pronouns is an indicator of the stress level they experience in the classroom, and whether it can predict changes in a student teachers’ stress, a highly standardized teaching situation is preferable, because it ensures that all student teachers under study are reflecting on the same learning environment and on similar classroom events at all measurement occasions. A VR classroom creates just such a setting. In the present study, class size in the VR classroom was manipulated to induce higher levels of stress (large-class-size condition with a higher number of student avatars) and lower levels of stress (small-class-size condition with a lower number of student avatars). Initially, we checked whether the use of first-person pronouns in written reflections provides incremental information about subsequent manual ratings of student-teachers’ foci (whether on their own actions vs. student actions vs. the learning environment) in these reflections. In addition, we examine whether student teachers who experience more self-reported stress and physiological stress (as measured by heartrate response) while teaching in a VR classroom use more first-person singular pronouns in written reflections on their teaching. We also explore whether student teachers’ use of first-person singular pronouns in written reflections predicts the increase in stress in a subsequent VR lesson. 1.1. Reflection in teacher education: Technological advances “Reflection” has been defined as “deliberate, purposeful, metacognitive thinking and/or action” (Koˇsir et al., 2015, p. 113) that is believed to enhance instructional quality (Chernikova et al., 2020) by improving student teachers’ “noticing” and “knowledge-based reasoning” (Stürmer et al., 2013; van Es & Sherin, 2008). Noticing is understood as a teachers’ ability to focus their attention on relevant classroom events (van Es & Sherin, 2002). Knowledge-based reasoning is defined as teachers’ ability to apply their professional knowledge in order to interpret these classroom events (Borko, 2004; van Es & Sherin, 2002). In teacher education programs, reflection is implemented in different ways, with student teachers reflecting on classroom videos of other teachers or on video recordings of their own teaching (Kleinknecht & Schneider, 2013). Technological advances have made it possible to design VR classrooms that student teachers experience as realistic and authentic classroom settings (Huang et al., 2021; Wiepke et al., 2019, allowing them to practice and subsequently reflect on video recordings of their own teaching. Beyond the practical advantages for student teacher education (e.g., the approval of students, parents, educators, and administrators is not required), an important benefit of VR classrooms is the standardized classroom setting in which all student teachers experience similar classroom events for which they can be prepared in advance. This enables teacher educators to more easily provide relevant professional knowledge tailored to managing critical classroom events in the VR classroom; when reflecting on video recordings of their own teaching in the VR setting, student teachers may thus be more able to apply relevant professional knowledge. Video-based reflection generally involves written or oral reflections after viewing classroom videos; it is recommended that these reflections follow a three-step process (e.g., Prilop et al., 2021). Firstly, student teachers are instructed to describe the relevant classroom events; secondly, they are asked to evaluate and interpret these events; and, thirdly, they are required to identify alternative classroom behaviors (e.g., Prilop et al., 2021). When describing relevant classroom events, student teachers may focus either on their own actions, students’ actions, or on the learning environment as a whole (Kleinknecht & Schneider, 2013; Lohse-Bossenz et al., 2019). Previous research has been resoundingly positive on the benefits of video-based reflection for student teachers’ professional vision (e. g., Stürmer et al., 2013; Weber et al., 2020). Very few studies shed light on the affective experiences associated with video-based reflection (Kleinknecht, 2021). Although Kleinknecht and Schneider (2013) suggested that reflecting on other teachers’ videos can induce more negative affect than reflecting on one’s own teaching videos, several studies have shown that reflecting on one’s own videos elicits intense emotional involvement (Borko et al., 2008; Seidel et al., 2011; Zhang et al., 2011). What is unclear, however, is to what extent student teachers’ attentional focus (i.e., focusing on own thoughts, actions, or emotions) in the video-based reflection of their own videos relates to their experiences of negative affect or stress. A. Westphal et al. Computers & Education 212 (2024) 104987 3 1.2. “I-talk” as a linguistic marker of self-focused attention and negative affect In the fields of experimental psychology and clinical psychology, there is increasing empirical evidence indicating that there is a relationship between self-focused attention and greater negative affect (e.g., Mor & Winquist, 2002; Nook et al., 2017). For instance, studies using correlational designs showed that self-report measures of self-focus—such as the Public and Private Self-Consciousness Scale (Fenigstein et al., 1975), but also sentence completion tasks (Exner, 1973; Wegner & Giuliano, 1980)—are associated with self-report measures of state or trait negative affect in non-clinical and clinical samples (for an overview, see the meta-analysis by Mor & Winquist, 2002). Other studies showed that self-referential language (so-called “I-talk”)—as a linguistic marker of an individual’s self-focus—is associated with more intense negative emotionality in non-clinical samples (Kern et al., 2014; Mehl et al., 2006; Yarkoni, 2010; Yee et al., 2011; see also meta-analysis by Edwards & Holtzman, 2017) and is a marker of depression (Dunnack & Park, 2009; Rude et al., 2004; Zimmermann et al., 2016). An extensive multi-lab multi-language study with data from more than 4700 participants recently confirmed that the use of first-person singular pronouns is linked to more intense negative emotionality and depression (Tackman et al., 2019). The association between I-talk and depression has been explained to some extent by negative emotionality (Tackman et al., 2019). This indicates that “I-talk” might reflect a broader dispositional tendency towards feelings of distress, but “[t] his possibility is a topic of ongoing research” (Berry-Blunt et al., 2021, p. 5). Although frequent I-talk is seen as maladaptive, it may be a way of processing negative affect (e.g., after receiving deprecatory information about oneself), as a recent literature review concluded (Berry-Blunt et al., 2021). This would suggest that greater negative affect provokes I-talk. Experimental research did not find any evidence that inducing negative affect by showing participants negative pictures led to more I-talk (e.g., Bernard, Baddeley, Rodriguez, & Burke, 2016). In line with Bernard, Baddeley, Rodriguez, and Burke (2016) suggestion, it may be the case that negative affect only leads to more I-talk when elicited by self-deprecating information. This proposition is consistent with research on the negative affective experiences of teasing and ostracism, which do lead to more frequent I-talk (Klauke et al., 2020; Kowalski, 2000). The reverse may also be true, however. Taking a more distanced perspective—as indicated by less I-talk—may over time change an individual’s dispositional negative emotionality (Berry-Blunt et al., 2021). Distancing, i.e., shifting one’s perspective to be more “distant” from or less immersed in a negative event, is an adaptive emotion-regulation strategy that is characterized by a lower level of self-focused attention and can help reduce negative affect (Kross & Ayduk, 2008). The suggestion that repeated distancing may reduce an individual’s tendency to experience negative affect (Berry-Blunt et al., 2021) would explain why I-talk predicts future depressive symptoms in patients (Dunnack & Park, 2009; Zimmermann et al., 2016). Even in the short term, less I-talk may lead to less negative affect: Experimental research confirmed that distancing—i.e., using no I-talk when talking about one’s own emotions while preparing a stressful speech—can lessen negative affect after having given the speech (Kross et al., 2014, Study 3). Thus, the causal direction of the link between I-talk and negative emotionality is less clear, but there may be a bidirectional relationship. 1.3. Gender differences in the association between self-focus and negative affect Based on meta-analytical findings that women exhibit a greater tendency to ruminatively self-focus than men when experiencing depression (Johnson & Whisman, 2013), it has been suggested that the positive association between negative emotionality and the use of first-person singular pronouns is larger for women than it is for men (e.g., Tackman et al., 2019). When examining these gender differences, Tackman et al. (2019) underlined that the use of first-person singular pronouns seems to be driven by low-arousal negative distress in women. In contrast, it appears that men’s use of first-person singular pronouns is driven by high-arousal negative distress (Tackman et al., 2019). Thus, the use of first-person singular pronouns may be an indicator of different affective experiences in women and men (Fast & Funder, 2010) and, thus, gender should be taken into account when studying the relationship between self-focus and negative affect. 1.4. Distinguishing different forms of self-focus in written reflections Different strands of research differ in their operationalization of self-focus. In research on reflection in teacher training, manual ratings indicate the extent to which student teachers focus on their own actions and thoughts, on students’ actions, or on the learning environment (e.g., Kleinknecht & Schneider, 2013). In experimental psychology, self-focus is often operationalized via the use of first-person singular pronouns (Berry-Blunt et al., 2021; Mor & Winquist, 2002). This strand of research has argued that individuals can take a more or less immersed or distanced perspective on their own actions and thoughts by using more or fewer first-person singular pronouns (Kross & Ayduk, 2008; Kross et al., 2014). When reflecting on their own teaching, some student teachers may distance themselves from the experience and therefore rarely use first-person singular pronouns, while others may immerse themselves in the experience and use first-person singular pronouns more frequently. As such, both indicators of self-focus (qualitative ratings vs. first-person singular pronouns) should provide incremental information about student teachers’ self-focus in their written reflections. For student teachers taking a more immersive perspective on their own teaching, objective first-person singular pronouns (i.e., “me,” “myself”) may reflect a more dysfunctional form of self-focus than subjective first-person singular pronouns (i.e., “I”) (Zimmermann et al., 2016). While subjective pronouns reflect an “active or self-as-actor form of self-focus,” objective pronouns reflect a “passive or self-as-target form of self-focus” (James, 1890; Tackman et al., 2019, p. 819) that may indicate an even more detrimental style of processing self-relevant information (Zimmermann et al., 2016; see also more and less dysfunctional questions in Ehring, 2020). This poses the question of whether the relationship between the use of first-person pronouns and negative affect is driven mainly by objective first-person pronouns (Zimmermann et al., 2016). As such, “it is important to evaluate whether and how the A. Westphal et al. Computers & Education 212 (2024) 104987 4 association between depression and I-talk varies as a function of first-person singular pronoun type” (Tackman et al., 2019, p. 819). Previous evidence on whether subjective and objective first-person pronouns differentially relate to negative affect is mixed (there is support in the study by Zimmermann et al., 2016; but no or inconsistent differences in the studies by Dunnack & Park, 2009; Tackman et al., 2019). But the distinction between subjective and objective first-person singular pronouns appears to be essential in our study, in which the relationship between the use of first-person pronouns and negative affect is examined for the first time in the context of teacher training. 1.5. Present study Negative emotionality may be critical for student teachers when they reflect on their own teaching, yet research has rarely concentrated on the role of negative emotionality for reflective processes (Kleinknecht, 2021). Meanwhile, research in the field of experimental psychology indicates that negative affect may provoke self-focused attention as indicated by the use of first-person singular pronouns (Berry-Blunt et al., 2021). Moreover, self-focused attention may also increase the tendency towards experiencing negative affect (Berry-Blunt et al., 2021). What we do not know is whether this applies to the context of teacher education where student teachers reflect on their own teaching. Studying this link between self-focus and negative affect in the context of student teachers’ written reflections can provide valuable cues for diagnostic tools, automated feedback systems, and the improvement of student teachers’ professional self-regulation. We used a VR classroom setting, and thus a highly standardized teaching situation, to ensure that student teachers were reflecting on similar classroom events as we examined the following research questions: (1) Do student teachers who exhibit a greater focus on their own actions (instead of students’ actions or the classroom environment) use more subjective and objective first-person singular pronouns in written reflections on their teaching? Here, the assumption could be that those student teachers who use subjective and objective first-person singular pronouns more frequently also tend to focus on themselves rather than on the students in class or on the classroom environment. However, there is no previous research combining manual ratings of student teachers’ foci (whether on their own actions vs. student actions vs. the learning environment) with student teachers’ subjective and objective use of first-person singular pronouns when reflecting on their own teaching. Thus, it is unclear to what extent manual ratings of student teachers’ foci correspond to the subjective and objective use of first-person pronouns in written reflections on their teaching. We seek to address this research gap as an exploratory question. (2) Do student teachers who experience more self-reported stress and physiological stress (as measured by heartrate response) while teaching in a VR classroom use more subjective and objective first-person singular pronouns in written reflections of their teaching? Building on empirical evidence showing that negative affect may provoke self-focused attention, we analyze whether student teachers who experience higher levels of negative affect when teaching in the VR classroom more frequently use subjective and objective first-person singular pronouns in their written reflections. The class size in the VR classroom, i.e., the number of student avatars, was manipulated to evoke higher levels (large-class-size condition) and lower levels of negative affect (small-class-size condition(Huang et al., 2022). We hypothesize that student teachers who experience more negative affect—operationalized via self-reported and physiological stress—when teaching in the VR classroom for the first time will use more subjective and objective first-person singular pronouns in their written reflections. (3) Does student teachers’ use of subjective and objective first-person singular pronouns in written reflections of their teaching predict their increase in stress in a subsequent VR lesson? We postulate that student teachers who use more subjective and objective first-person singular pronouns in their written reflections will experience a greater increase in self-reported and physiological stress in the second VR classroom (as compared to the stress levels experienced when teaching in the VR classroom for the first time). 2. Material and methods 2.1. Sample and procedure Participants were N = 65 student teachers enrolled at the University of (anonymized for review) in Germany. Four of the participating students did not hand in their written reflection and two additional students did not participate in the second VR practice session, limiting our analyses to n = 59 students. Student teachers were on average 24 years old (SD = 4.57) and 49% identified as female, 51% as male, none as diverse. Most students were third-year bachelor students (58%; second-year: 27%; fourth-year: 14%). These student teachers participated in a weekly seminar on classroom management. The seminar included two 10-min practice sessions in a VR classroom that took place two weeks apart. Both VR practice sessions followed a standardized procedure. Participants were first given a brief standardized audio introduction on how to interact with the VR environment. Participants were then given a brief lecture about an a priori determined topic in the VR classroom to deliver to avatar students. During the first VR teaching experience, participants taught about the US electoral system and the 2020 US election. For the second VR teaching experience, A. Westphal et al. Computers & Education 212 (2024) 104987 5 participants taught about sustainability. All the instructional materials that participants needed to accomplish the teaching task were prepared and provided by the course instructor one week before the teaching exercise. During their VR teaching session, participants were exposed to various on-task and off-task behaviors from the avatar students, such as asking topic-related questions, chatting, or throwing paper balls. All avatar student actions were prescribed and therefore the same for all participants in both the class with 10 student avatars and the class with 30 student avatars. Immediately after their teaching experience in the VR classroom, the student teachers reported on their stress levels in an online questionnaire. In addition, the student teachers handed in a written reflection on their VR teaching session in the week following the first VR practice session.2 Prior to writing their reflections, the student teachers received guidance on the three-step reflection process. In this process, they were instructed to describe three relevant classroom situations (Step 1), evaluate and interpret these situations based on their professional knowledge (Step 2), and outline alternatives for classroom situations that they evaluated negatively (Step 3). Before writing their reflections, student teachers were given time to repeatedly watch the video of the VR classroom situation in which they had taught. 2.2. Design of the VR classroom The VR classroom was designed to resemble an upper secondary school classroom in Germany (e.g., (Wiepke et al., 2021)). It was set up with five rows and three columns of school desks and chairs with avatar students (see Appendix). Avatar students’ names were displayed on name tags placed on their desks and had a wide range of physical characteristics, such as skin tone, hairstyle, and clothing. Student teachers were randomly assigned to teach a class of either 10 or 30 student avatars when teaching the VR classroom for the first time and again when teaching it for the second time. The avatar students engaged in a range of behaviors that included both ontask and off-task actions. These actions ranged from constructive activities, such as writing in a notebook, to less productive actions, such as throwing a paper ball. The avatar students maintained a natural seated posture and a neutral demeanour, occasionally redirecting their attention by shifting their gaze or adjusting their body orientation in response to the participants’ movements. The selection of off-task behaviors was based on a compilation of common disruptive behaviors documented in the academic literature (Borko, 2016; Wolff et al., 2016). All parameters governing the avatar students’ behaviors, including initiation time, duration, spatial location, and behavior type, were carefully scripted to maintain uniformity across experimental conditions. This ensured that the behaviors enacted by the avatar students remained consistent between the scenarios with 10 avatar students and those with 30 avatar students in the classroom. We were using the HTC VIVE headset which has a resolution of 1080 x 1200 pixels per eye with a 108◦ field of view and a refresh rate of 90 Hz. The headset was connected to a laptop (Alienware) with a 2.2-GHz Intel Core i7-8750H processor, with 16 GB of RAM, and a NVIDIA GeForce RTX 2060 with 6 GB of VRAM graphic card, where the VR classroom software was operated. Essentially, participants could move around in reality while experiencing multisensory feedback in the VR classroom. Previous studies have confirmed that the technical setup in our VR classroom created an immersive soundscape which student teachers experienced as realistic and authentic (Wiepke et al., 2019, 2021). Student teachers were equally distributed across the four conditions (small class size VR1, small class size VR2: 21%; small class size VR1, large class size VR2: 23%; large class size VR1, small class size VR2: 25%; large class size VR1, large class size VR2: 28%).3 Thus, some teachers taught under the same conditions twice, while other teachers taught one VR session in the small class size condition and the other VR session in the large class size condition. Student teachers teaching in the VR classroom were instructed to teach their lesson as they would in a real classroom i.e., walking around the room and using similar observational and nonverbal behavior when interacting with the avatar students as they would with non-virtual students. 2.3. Measures 2.3.1. Self-reported stress in the VR classroom We measured the stress that student teachers experienced during the VR scenario using two items (“How tense did you feel in the VR classroom?” and “How did you feel emotionally during the VR classroom?”; e.g., Delaney & Brodie, 2000). Items were answered on a 9-point Likert-type scale ranging from 1 (calm, relaxed, composed) to 9 (tense). The internal consistency was good (αT1 = 0.83; αT2 = 0.85). 2.3.2. Physiological indicator of stress in the VR classroom We operationalized student teachers’ physiological stress reactions based on their heartrate (beats per minute, BPM). Student teachers’ BPM was measured using an armband optical HR sensor (Polar OH1) at 0.3s intervals when teaching in the VR classroom. Prior to starting the VR scenarios, each student teachers’ baseline heartrate was measured at 0.3s intervals while student teachers were asked to sit quietly and stay still. These baseline measures were used to control for individual differences in cardiovascular activity. We then aggregated both heartrate measurements during the baseline phase and heartrate measurements during the VR teaching. The differences between student teachers’ heartrate during teaching and student teachers’ baseline heartrate was used as a physiological 2 Students also reflected on the second VR classroom three months afterwards based on a video recording. Given the time span between this VR classroom and the written reflection, we didn’t include these written reflections in our analyses. 3 Percentages do not total 100 because of rounding. A. Westphal et al. Computers & Education 212 (2024) 104987 6 indicator of student teachers’ stress response. 2.3.3. Self-referential language We used the R package stringr (Wickham, 2019) to estimate the frequency of subjective and objective first-person singular pronouns. For each written reflection, we computed the percentage of subjective first-person singular pronouns (German: “ich”; English: “I”) and the percentage of objective first-person singular pronouns (German: “mich,” “mir”; English: “me,” “myself”).4 2.3.4. Manual ratings of focus and depth in written reflections Two independent raters manually rated the focus (as either student teachers’ own actions, student avatars’ actions, learning environment, or no focus) and depth (description, evaluating/explaining, or reflecting on alternatives) in student teachers’ written reflections using the software MAXQDA and following the procedure of Lohse-Bossenz et al. (2019; Kleinknecht & Groschner, ¨ 2016). Interrater agreement was good (κ = 0.75). For our analyses, we used the coverage percentage, i.e., the number of characters in the coded segment in relation to the total number of characters in the text. 2.4. Statistical analyses To test the hypotheses, we conducted regression analyses using the R package MplusAutomation (Hallquist & Wiley, 2018) and MLR as the estimation method. A manipulation check on our data was conducted by Huang et al. (2022) who probed whether student teachers experienced more self-reported and physiological stress when teaching a VR classroom in the large-size condition than in the small-size condition. We initially examined whether student teachers who used more subjective and objective first-person singular pronouns focused more frequently on themselves rather than on the avatar students in class or on the classroom environment (RQ1). To do so, we distinguished between student teachers who used subjective first-person singular pronouns with low frequency (i.e., ≤0.5 SD below M), average frequency (≥0.5 SD below M and ≤0.5 SD above M), and high frequency (≥0.5 SD above M). A multivariate analysis of variance was conducted with the subjective use of first-person singular pronouns (low, average, or high) as the between-person factor and the relative frequency of the student teachers’ reflection focus (the student teacher, student avatars, or learning environment) as the dependent variable. The analysis was then repeated for the objective use of first-person singular pronouns. To examine our second research question, we then regressed subjective and objective first-person singular pronoun use in the written reflections of the first VR classroom on self-reported stress in these VR sessions (RQ2). We controlled for gender.5 Within this model, we allowed the use of subjective and objective first-person singular pronouns to correlate. We specified an analogous model with physiological stress as the predictor. In a second step, we regressed self-reported stress during the second VR classroom teaching session on the subjective and objective use of first-person singular pronouns while controlling for self-reported stress during the first VR classroom teaching session (RQ3). Gender and class size in the second VR classroom teaching session were used as covariates. Thus, regression coefficients of pronoun use and gender indicate whether these variables explain changes in self-reported stress in the second, as compared to the first, VR classroom teaching session. Analyses were conducted separately for the use of subjective and objective first-person singular pronouns to probe whether subjective and objective first-person pronouns differentially relate to negative affect (instead of examining incremental effects). Analogous models were computed for physiological stress. Due to technical difficulties when transferring the heartrate data onto the storage device, heartrate while teaching in the VR classroom was only available for 40 students. There were only 29 students for whom heartrate responses were present in both VR classrooms. We examined whether values were missing completely at random using the MCAR-Test (Little, 1988) implemented in the R package naniar (Tierney et al., 2021). The test yielded non-significant results (χ2 = 17.5, df = 25, p = 0.864) indicating that the values were missing completely at random. We applied the full-information maximum-likelihood approach (FIML; Enders, 2001) to obtain appropriate estimates and standard errors. 3. Results A manipulation check on our data Huang et al., 2022)showed that student teachers experienced more self-reported and physiological stress when teaching a VR class in the large-size condition than in the small-size condition. Descriptive results (Table 1) and a dependent t-test showed that self-reported stress was greater in the first VR session than in the second VR session, t(54) = 4.89, p < 0.001. In contrast, physiological stress did not differ statistically significantly between the two VR sessions, t(28) = 0.68, p = 0.503. 3.1. Subjective and objective first-person singular pronouns and manual ratings of focus in written reflections Pertaining to our first research question, we checked whether student teachers with a more frequent use of subjective and objective first-person singular pronouns focused more often on themselves rather than on the avatar students in class or on the classroom environment (Fig. 1a and b). A multivariate analysis of variance with the subjective use of first-person singular pronouns (low, average, or high) as a between-person factor and relative frequency of student teachers’ focus of reflection on their own actions (as opposed to focus on student avatars or the learning environment) as a dependent variable showed no statistically significant effect, F(6, 4 The objective first-person singular pronoun “meiner” is rarely used and was not considered here—following the suggestion by Tackman et al. (2019)—because it overlaps with the more frequently used possessive pronoun “meiner”. 5 We did not look for interaction effects between the use of first-person singular pronouns and gender as our sample was small. A. Westphal et al. Computers & Education 212 (2024) 104987 7 108) = 0.59, p = 0.74. Similarly, we found no statistically significant difference between students with low, average, or high frequency of the objective use of first-person singular pronouns on the relative frequency of student teachers’ reflection being focused on their own actions, F(6, 108) = 1.18, p = 0.32. Thus, high subjective or objective first-person singular pronoun use was not reflected in a greater focus on student teachers’ own actions in written reflections (as indicated by manual ratings). 3.2. Do student teachers who experience more stress in the VR session use more subjective and objective first-person singular pronouns in their written reflections? To answer our second research question regarding the relationship between student teachers’ stress in the VR session and the use of subjective and objective first-person singular pronouns, we conducted cross-sectional regression analyses. Our results showed that selfreported stress experienced during the first VR teaching session was not statistically significantly associated with the use of subjective and objective first-person singular pronouns (Table 2). Gender showed a statistically significant association with subjective and objective pronoun use, indicating that student teachers who identified as male used subjective and objective first-person singular pronouns more frequently than student teachers who identified as female. In contrast, physiological stress experienced during the first VR teaching session was statistically and positively associated with both the use of subjective and the use of objective first-person singular pronouns. Thus, student teachers who experienced greater physiological stress when teaching in the VR classroom used more subjective or objective first-person singular pronouns in their written reflections. Beyond physiological stress, associations between gender and the use of subjective or objective first-person pronouns were not statistically significant. 3.3. Do student teachers who use more subjective and objective first-person singular pronouns in their written reflections experience a greater increase in stress in the second VR session? Concerning our third research question, we examined whether student teachers who used more subjective and objective firstperson singular pronouns in their written reflection experienced a greater increase in stress in the second VR session. When regressing the self-reported stress that participants experienced during the second VR teaching session, the use of subjective firstperson singular pronouns was not a statistically significant predictor when controlling for self-reported stress in the first VR teaching session, gender and class size during the second VR teaching session (Table 3, Model 3a). The use of objective first-person singular pronouns emerged as a statistically significant predictor of self-reported stress during the second VR teaching session (Table 3, Model 3b). This was not in line with our cross-sectional findings and we therefore conducted additional analyses, which revealed that the association between the use of objective first-person singular pronouns and self-reported stress was explained by the level of physiological stress in the first VR teaching session (Table A2 in Appendix). Concerning the covariates, gender and class size were not statistically significant predictors of self-reported stress in both models (Models 3a-b, Table 3). Associations between self-reported stress experienced in the first and in the second VR teaching session were statistically significant, indicating that student teachers who experienced more self-reported stress in the first VR teaching session reported more self-reported stress in the second VR teaching session. Associations between physiological stress during the second VR teaching session and the use of subjective first-person singular pronouns were statistically significant when controlling for physiological stress experienced during the first VR teaching session and class size in the second VR session (Table 3, Model 4a). Thus, student teachers who used more subjective first-person singular pronouns in their written reflections of the first VR teaching session experienced a stronger increase in physiological stress during the second VR teaching session. We found no association between physiological stress during the second VR teaching session and the use of objective first-person singular pronouns (Table 3, Model 4b). Regarding the covariates, gender was not a statistically significant predictor of physiological stress in either model, while a greater class size for the second VR classroom was associated with greater physiological stress (Models 4a-b, Table 3). Student teachers who experienced greater physiological stress in the first VR teaching session exhibited more intense physiological stress in the second VR teaching session. 4. Discussion Negative affect can play a crucial role in student teachers’ reflection, but it has barely been studied (Kleinknecht, 2021). The Table 1 Descriptive statistics. N M SD Min Max Psychological stress VR1 58 5.22 1.70 2.00 9.00 Psychological stress VR2 55 3.97 1.78 1.50 9.00 Physiological stress VR1 40 60.36 22.25 21.56 108.38 Physiological stress VR2 46 56.88 24.40 7.86 97.90 Subjective pronouns VR1 59 3.61 2.16 0.00 9.18 Objective pronouns VR1 59 1.13 1.12 0.00 5.10 Note. Physiological stress = difference between heartrate (BPM) while teaching and baseline heartrate (BPM). Subjective pronouns = relative frequency of subjective first-person singular pronouns in written reflection. Objective pronouns = relative frequency of objective first-person singular pronouns in written reflection. Gender: 0 = female. A. Westphal et al. Computers & Education 212 (2024) 104987 8 (caption on next page) A. Westphal et al. Computers & Education 212 (2024) 104987 9 present study applied psychological research on the relationship between negative affect and self-focus—which would potentially be valuable for diagnostic tools, automated feedback systems, and the improvement of emotion regulation—to the context of student teachers’ reflections. Initially, we looked at whether student teachers who used more subjective and objective first-person singular pronouns focused more frequently on themselves rather than on the avatar students in the VR class or on the classroom environment as a whole. In addition, we examined whether student teachers’ negative affect while teaching in a VR classroom—in terms of higher self-reported stress and heartrate—affected their self-focus in written reflections operationalized via the subjective and objective use of first-person singular pronouns. We also explored whether the use of subjective and objective first-person singular pronouns relates to stress in a subsequent teaching session in a VR classroom. Initially, we found that there were no differences in manual ratings of focus between student teachers with a low, average, or high subjective or objective use of first-person singular pronouns. This is in line with findings illustrating that individuals can regard their own actions and thoughts from a more or less immersed or distanced standpoint, which is reflected in their more or less frequent use of subjective and objective first-person singular pronouns (Kross & Ayduk, 2008; Kross et al., 2014). While one student teacher, for instance, described classroom disruptions during his lesson from a more immersed perspective, pointing out how it made him feel (“Some classroom disturbances made me upset […]. The interruptions kept me from getting back to where I started and from finishing properly.”), another student started his reflection by taking a more distanced perspective, describing his own actions from a third-person perspective (“There is a recurring loss of the common thread due to class disruptions and the teacher trying to address every minor disruption.”). Thus, the use of subjective and objective first-person singular pronouns provides incremental information to manual ratings of focus in written reflections. Future research examining student teachers’ focus when reflecting on their own teaching could therefore benefit from incorporating different measures of self-focus. Fig. 1. a Focus in written reflections from content analysis by use of subjective first-person singular pronouns Note. Low use of subjective firstperson singular pronouns ≤0.5 SD below M. Average use of subjective first-person singular pronouns ≥0.5 SD below M and ≤0.5 SD above M. High use of subjective first-person singular pronouns ≥0.5 SD above M. 1b Focus in written reflections from content analysis by use of objective firstperson singular pronouns. Table 2 Predicting first-person singular pronoun use in written reflection by self-reported and physiological stress in first VR teaching session. Subjective pronouns Objective pronouns β p 95% CI β p 95% CI Model 1 Intercept 0.74 0.110 [-0.16, 1.65] 0.17 0.700 [-0.68, 1.02] Self-reported stress 0.21 0.100 [-0.04, 0.45] 0.20 0.160 [-0.08, 0.47] Gender 0.28* 0.020 [ 0.05, 0.51] 0.23* 0.040 [ 0.01, 0.45] R2 0.12 0.09 Model 2 Intercept 0.47 0.240 [-0.31, 1.24] − 0.06 0.850 [-0.66, 0.54] Physiological stress 0.35*** 0.000 [ 0.13, 0.57] 0.32* 0.010 [ 0.09, 0.55] Gender 0.24 0.030 [0.02, 0.47] 0.20 0.110 [-0.04, 0.44] R2 0.18 0.14 Note. Coefficients are standardized. Gender: 0 = female. Table 3 Predicting self-reported and physiological stress in subsequent VR teaching session by use of first-person singular pronouns in written reflection of previous VR teaching session. β p 95% CI β p 95% CI Self-reported stress VR2 Model 3a Model 3b Intercept 1.38* 0.020 [ 0.24, 2.52] 1.20* 0.040 [ 0.05, 2.34] Self-rep. stress VR1 0.37*** <0.001 [ 0.12, 0.61] 0.33* 0.010 [ 0.10, 0.57] Class size in VR2 − 0.16 0.190 [-0.39, 0.08] − 0.10 0.410 [-0.35, 0.14] Subj. pronouns VR1 0.06 0.650 [-0.22, 0.35] Obj. pronouns VR1 0.29* 0.030 [ 0.02, 0.55] Gender 0.07 0.590 [-0.19, 0.34] 0.04 0.770 [-0.20, 0.27] R2 0.18 0.23 Physiological stress VR2 Model 4a Model 4b Intercept − 1.29*** <0.001 [-1.89, − 0.69] − 1.17*** <0.001 [-1.74, − 0.60] Phys. stress VR1 0.26*** <0.001 [ 0.09, 0.42] 0.25*** <0.001 [ 0.09, 0.41] Class size in VR2 0.83*** <0.001 [ 0.75, 0.92] 0.84*** <0.001 [ 0.75, 0.93] Subj. pronouns VR1 0.18* 0.040 [0.01, 0.35] Obj. pronouns VR1 0.17 0.060 [-0.01, 0.35] Gender 0.05 0.560 [-0.12, 0.22] 0.05 0.510 [-0.11, 0.21] R2 0.72 0.71 Note. Coefficients are standardized. Gender: 0 = female. Class size: 0 = small. A. Westphal et al. Computers & Education 212 (2024) 104987 10 Our results also indicate that student teachers who experienced more physiological stress when teaching in the VR classroom used more subjective and objective first-person singular pronouns in their written reflections. This finding is consistent with research showing that negative affective experiences may provoke the use of subjective and objective first-person singular pronouns as a way to process negative self-relevant information (Berry-Blunt et al., 2021; Klauke et al., 2020; Kowalski, 2000). However, given their cross-sectional nature, our results could also indicate that student teachers who use less linguistic distancing—i.e., who are more immersed into a situation, indicated by a greater use of subjective and objective first-person singular pronouns—experience higher levels of negative affect, which is also in line with previous findings (Shahane et al., 2023). Our study is the first to confirm that this association can be replicated in the context of student teachers’ reflections on their own teaching. Our results further amplify existing research by revealing that this relationship generalizes to a physiological indicator of negative affect, namely to individuals’ heartrates. In terms of gender differences, our results suggested that student teachers who identified as male used more subjective and objective first-person singular pronouns than student teachers who identified as female. These gender differences disappeared when controlling for physiological stress experienced during the VR teaching session. The finding that men used subjective and objective first-person singular pronouns more frequently than women is not in line with related research that shows a greater tendency in women to ruminatively self-focus when depressed, and thus experiencing high levels of negative affect (Johnson & Whisman, 2013). It has, however, been suggested that men’s use of subjective and objective first-person singular pronouns is an indicator of high-arousal negative distress, while women’s use of first-person singular pronouns is driven by low-arousal negative distress (Tackman et al., 2019). In our study, student teachers were reflecting on a teaching situation that had the potential to elicit high-arousal negative distress. Indeed, we found that, when controlling for physiological stress experienced during the VR session, gender differences in the use of subjective and objective first-person singular pronouns disappeared. These results further support the notion that the use of first-person singular pronouns may be an indicator of different affective experiences in women and men (Fast & Funder, 2010). In addition, we found that greater use of subjective first-person singular pronouns led to higher physiological stress in the subsequent VR session. Thus, we found some indication that student teachers who took a more distanced perspective experienced reduced future stress (as suggested by Berry-Blunt et al., 2021; Zimmermann et al., 2016). This is in line with research showing that individuals who spontaneously use more linguistic distancing when reflecting on negative and positive events report lower levels of stress in these and in subsequent situations, and overall greater well-being (Shahane et al., 2023). Despite the fact that the use of subjective and objective first-person singular pronouns may be a strategy that student teachers use to process negative teaching experiences, this strategy—referred to as rumination—is considered maladaptive (e.g., Mor & Winquist, 2002). Rumination—i.e., the strategy of regulating negative mood by repeatedly focusing one’s attention on one’s own negative experiences, and the causes and effects (Nolen-Hoksema, 1991)—has been associated with depression (Hong, 2007), inefficient problem-solving, and lower self-efficacy (Lyubomirsky et al., 2003; Reindl et al., 2020). Teachers who ruminate more experience higher levels of stress in the classroom and are more susceptible to burnout (Koˇsir et al., 2015). We assessed naturally occurring differences in the use of subjective and objective first-person singular pronouns and may therefore have underestimated the benefits of taking a more distanced perspective. Future studies with greater sample sizes and power should aim to explore whether a similar effect might emerge for objective first-person pronouns, for which we found a marginally significant p-value. In contrast, our data did not support the association between self-reported negative affect and the use of subjective and objective first-person singular pronouns. Berry-Blunt et al. (2021) proposed that some psychometric units, i.e., “facets, nuances, and items” (p. 8) might capture I-talk better than others; our self-report measure of stress may not have been ideal in this respect. Moreover, the self-report was assessed after the VR session, which potentially led to lower congruence between physiological and self-reported stress responses than when self-report is assessed continuously during the stressful situation (Campbell & Ehlert, 2012). 4.1. Pedagogical implications While reflection can improve student teachers’ professional vision, and is therefore seen as an important tool in teacher education (e.g., Stürmer et al., 2013; Weber et al., 2020), less is known about its potential to assist adaptive emotion regulation strategies that teachers need in order to be able to cope with challenging classroom events (Chang, 2009). Reappraising a challenging situation is seen as an effective strategy (Gross, 2002) by which teachers change how they think about an event and thereby decrease its emotional impact (Chang, 2009; Gross, 2022). When engaging in reappraisal, teachers may reduce their use of first-person singular pronouns, indicating their greater psychological distance to a challenging situation (Nook et al., 2020). Our findings indicate that an increased self-focus in student teachers’ written reflections—as indicated by a more frequent use of subjective first-person singular pronouns—is associated with greater physiological stress. Automated feedback systems could build on this finding by identifying student teachers who repeatedly experience elevated stress and are thus at risk for depression and burnout. This could complement feedback on the quality of their written reflections (Wulff et al., 2022, 2023). We found some indication that taking a more distanced perspective—as indicated by less frequent use of subjective first-person pronouns—reduces future stress (as suggested by Berry-Blunt et al., 2021; Shahane et al., 2023; Zimmermann et al., 2016). Practicing taking a more distanced perspective on negative events is not only seen as an adaptive emotion-regulation strategy (Kross & Ayduk, 2008), it may over time change a student teacher’s tendency to experience stress (for a similar suggestion outside the context of teacher education, see Berry-Blunt et al., 2021). A structured practice of reappraisal can facilitate adaptive emotion regulation (Christou-Champi et al., 2015). Thus, training student teachers to use more reappraisal and put more distance between themselves and challenging classroom situations when reflecting on their teaching could be a viable strategy to help them cope with stress. In addition, Ehring (2020) suggests that ruminative thinking, i.e., focusing one’s attention on one’s own negative experiences, can be transformed into more adaptive information processing by focusing attention on A. Westphal et al. Computers & Education 212 (2024) 104987 11 physical reactions and emotions in a specific situation and fostering self-compassion, which has been shown to be incompatible with ruminative thinking (Watkins, 2016). Combining video-based reflection on one’s own teaching with reappraisal and mindfulness-based strategies could be a promising way to foster student teachers’ professional vision, as well as their well-being and stress-resistance. 4.2. Limitations and future research The current study has some limitations. The sample size of the study was small. Our results should therefore be replicated using a larger sample, which could more effectively detect small effects. By providing a highly standardized setting, the VR classroom increases the internal validity of our research findings, which may come at the cost of ecological validity. It has been argued that VR creates a perceptual illusion and “the real power of VR […] [is that] even though you know it is an illusion, this does not change your perception or your response to it” (Slater, 2018, p. 2). Some features of the VR environment, such as a realistic display of the environment, a smooth display of motion and view changes, and control of behaviors, are seen as essential to increase the likelihood of optimal learning in VR (Dalgarno & Lee, 2010; Delamarre et al., 2021). Prior studies showed that student teachers perceived our VR classroom as realistic and authentic Wiepke et al., 2019, 2021. Student teachers trained in our VR classroom showed similar reflection processes compared to students reflecting on real classroom videos and showed a substantial increase in reflection-related self-efficacy over time (Richter et al., 2022). Nevertheless, more validation studies are needed to evaluate the transferability of the positive results of the participation in a VR learning setting to authentic classrooms. Moreover, future studies should investigate whether our findings are generalizable to non-virtual classroom environments and to in-service teachers. Studies should also incorporate further self-report measures of negative affect to “identify […] the smaller psychometric units (e.g., trait facets, nuances, and items) that best capture I-talk” (Berry-Blunt et al., 2021, p. 8). To better understand the temporal dynamics between negative affect and self-focused attention, a longitudinal study with multiple measurements is necessary. Such a study design could help explain the extent to which situation-specific and personal characteristics play a role in the interplay between the use of subjective and objective first-person singular pronouns and negative affect. The extent to which student teachers can be trained to more professionally process negative events could be explored by experimentally manipulating the ways in which student teachers describe and evaluate negative classroom events—taking either a distanced or a self-immersed perspective—by prompting student teachers to use distanced vs. self-referential language or by instructing them to reframe negative events vs. self-immerse in their emotions (see also Nook et al., 2017). Intervention studies could be a promising approach to help identify how reflection could be implemented in a way that is beneficial for student teachers’ professional vision and their emotion regulation, without overwhelming them. 5. Conclusions Thanks to a standardized VR classroom environment, our study is the first to provide evidence that student teachers’ self-focus in their written reflections is linked to the stress they experience while teaching. Our multimodal assessment of stress—based on student teachers’ self-reports and heartrate responses—allowed for a differentiated approach to studying emotions in the VR learning environment. Not only can we show that the association between negative affect and self-focus—measured via I-talk—holds in student teachers’ written reflections on their own teaching, but our study also adds to previous findings by showing that this link can be generalized to individuals’ heartrates, representing a physiological indicator of negative affect. These results point to the potential that reflecting on one’s own teaching may have for practicing adaptive emotion regulation strategies in teacher education programs. Credit author statement AW: Conceptualization. Formal analysis. Writing – original draft, Reviewing and Editing, ER: Conceptualization. Investigation. Data curation. Project administration. Writing- Reviewing and Editing, RL: Writing- Reviewing and Editing, YH: Investigation, Project administration. Declaration of competing interest None. Data availability The authors do not have permission to share data. A. Westphal et al. Computers & Education 212 (2024) 104987 12 APPENDIX Table A.1 Descriptive statistics for baseline heartrate and heartrate in VR teaching session N M SD Min Max Baseline BPM T1 42 96.92 30.88 44.41 173.62 Baseline BPM T2 50 102.37 30.03 40.34 175.88 BPM in VR session T1 57 161.14 20.44 125.02 196.45 BPM in VR session T2 55 160.65 20.00 115.57 196.59 Note. Measures used to compute physiological stress, i.e., difference in heartrate between baseline and VR session. Table A.2 Predicting self-reported stress in subsequent VR teaching session by physiological stress and use of firstperson singular pronouns in written reflection of previous VR teaching session β p 95% CI Self-reported stress VR2 Model 5a Intercept 0.39 0.560 [-0.93, 1.71] Self-reported stress VR1 0.31* 0.010 [ 0.06, 0.55] Physiological stress VR1 0.29* 0.040 [ 0.01, 0.57] Class size in VR2 − 0.06 0.640 [-0.31, 0.19] Objective pronouns VR1 0.24 0.110 [-0.05, 0.54] Gender 0.06 0.620 [-0.18, 0.30] R2 0.28 Note. Coefficients are standardized. Gender: 0 = female. Class size: 0 = small. Fig. A1. VR Classroom from the perspective of student teachers. A. Westphal et al. Computers & Education 212 (2024) 104987 13 Fig. A.2. Student teacher teaching in VR Classroom. References Bernard, J. D., Baddeley, J. L., Rodriguez, B. F., & Burke, P. A. (2016). Depression, language, and affect: An examination of the influence of baseline depression and affect induction on language. Journal of Language and Social Psychology, 35(3), 317–326. https://doi.org/10.1177/0261927X15589186 Berry-Blunt, A. K., Holtzman, S. H., Donnellan, M. B., & Mehl, M. R. (2021). The story of “I” tracking: Psychological implications of self-referential language use. Social and Personality Psychology Compass, 15(2), Article e12647. https://doi.org/10.1111/spc3.12647 Borko, H. (2004). Professional development and teacher learning: Mapping the terrain. Educational Researcher, 33(8), 3–15, 10.3102%2F0013189X033008003. Borko, H. (2016). Methodological contributions to video-based studies of classroom teaching and learning: A commentary. ZDM, 48(1), 213–218, 10/gfs2vk. Borko, H., Jacobs, J., Eiteljorg, E., & Pittman, M. E. (2008). Video as a tool for fostering productive discussions in mathematics professional development. Teaching and Teacher Education, 24(2), 417–436. https://doi.org/10.1016/j.tate.2006.11.012 Campbell, J., & Ehlert, U. (2012). Acute psychosocial stress: Does the emotional stress response correspond with physiological responses? Psychoneuroendocrinology, 37(8), 1111–1134. https://doi.org/10.1016/j.psyneuen.2011.12.010 Chang, M. L. (2009). An appraisal perspective of teacher burnout: Examining the emotional work of teachers. Educational Psychology Review, 21, 193–218. https://doi. org/10.1007/s10648-009-9106-y Chernikova, O., Heitzmann, N., Fink, M. C., Timothy, V., Seidel, T., Fischer, F., & DFG Research group COSIMA.. (2020). Facilitating diagnostic competences in higher education - a meta-analysis in medical and teacher education. Educational Psychology Review, 32, 157–196. https://doi.org/10.1007/s10648-019-09492-2 Christou-Champi, S., Farrow, T. F., & Webb, T. L. (2015). Automatic control of negative emotions: Evidence that structured practice increases the efficiency of emotion regulation. Cognition & Emotion, 29(2), 319–331. https://doi.org/10.1080/02699931.2014.901213 Dalgarno, B., & Lee, M. J. (2010). What are the learning affordances of 3-D virtual environments? British Journal of Educational Technology, 41(1), 10–32. https://doi. org/10.14221/ajte.2016v41n1.8 Delamarre, A., Shernoff, E., Buche, C., Frazier, S., Gabbard, J., & Lisetti, C. (2021). The interactive virtual training for teachers (IVT-T) to practice classroom behavior management. International Journal of Human-Computer Studies, 152, Article 102646. https://doi.org/10.1016/j.ijhcs.2021.102646 Delaney, J. P. A., & Brodie, D. A. (2000). Effects of short-term psychological stress on the time and frequency domains of heart-rate variability. Perceptual and Motor Skills, 91(2), 515–524. https://doi.org/10.2466/pms.2000.91.2.515 Dunnack, E. S., & Park, C. L. (2009). The effect of an expressive writing intervention on pronouns: The surprising case of I. Journal of Loss & Trauma, 14(6), 436–446. https://doi.org/10.1080/15325020902925084 Edwards, T., & Holtzman, N. S. (2017). A meta-analysis of correlations between depression and first singular pronoun use. Journal of Research in Personality, 68, 63–68. https://doi.org/10.1016/j.jrp.2017.02.005 Ehring, T. (2020). Die ruminationsfokussierte Kognitive Verhaltenstherapie [Rumination-focused cognitive-Behavioral Therapy]. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 68(3), 150–159. https://doi.org/10.1024/1661-4747/a000414 Enders, C. K. (2001). The impact of nonnormality on full information maximum-likelihood estimation for structural equation models with missing data. Psychological Methods, 6, 352–370. https://doi.org/10.1037/1082-989X.6.4.352 Exner, J. E., Jr. (1973). The self focus sentence completion: A study of egocentricity. Journal of Personality Assessment, 37(5), 437–455. https://doi.org/10.1080/ 00223891.1973.10119902 Fast, L. A., & Funder, D. C. (2010). Gender differences in the correlates of self-referent word use: Authority, entitlement, and depressive symptoms. Journal of Personality, 78, 313–338. https://doi.org/10.1111/j.1467-6494.2009.00617.x Fenigstein, A., Scheier, M. F., & Buss, A. H. (1975). Public and private self-consciousness: Assessment and theory. Journal of Consulting and Clinical Psychology, 43(4), 522–527. https://doi.org/10.1037/h0076760 Goddard, R., O’brien, P., & Goddard, M. (2006). Work environment predictors of beginning teacher burnout. British Educational Research Journal, 32(6), 857–874. https://doi.org/10.1080/01411920600989511Gold,B.,&Windscheid. J. (2020). Observing 360-degree classroom videos – Effects of video type on presence, emotions, workload, classroom observations, and ratings of teaching quality. Computers & Education, 156, 103960. Gold, B., & Windscheid, J. (2020). Observing 360-degree classroom videos–Effects of video type on presence, emotions, workload, classroom observations, and ratings of teaching quality. Computers & Education, 156, 103960. https://doi.org/10.1016/j.compedu.2020.103960. Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281–291, 10.1017.S0048577201393198. Hallquist, M. N., & Wiley, J. F. (2018). MplusAutomation: An R package for facilitating large-scale latent variable analyses in Mplus. Structural Equation Modeling: A Multidisciplinary Journal, 25(4), 621–638. https://doi.org/10.1080/10705511.2017.1402334 Hong, R. Y. (2007). Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behavior Research and Therapy, 45 (2), 277–290. https://doi.org/10.1016/j.brat.2006.03.006 Huang, Y., Richter, E., Kleickmann, T., & Richter, D. (2022). Class size affects preservice teachers’ physiological and psychological stress reactions: An experiment in a virtual reality classroom. Computers & Education, 184, 104503. https://doi.org/10.1016/j.compedu.2022.104503. Huang, Y., Richter, E., Kleickmann, T., Wiepke, A., & Richter, D. (2021). Classroom complexity affects student teachers’ behavior in a VR classroom. Computers & Education, 163, 104100. https://doi.org/10.1016/j.compedu.2020.104100. Hultell, D., Melin, B., & Gustavsson, J. P. (2013). Getting personal with teacher burnout: A longitudinal study on the development of burnout using a person-based approach. Teaching and Teacher Education, 32, 75–86. https://doi.org/10.1016/j.tate.2013.01.007 James, W. (1890). The principles of psychology. New York, NY: Holt & Co. Johnson, D. P., & Whisman, M. A. (2013). Gender differences in rumination: A meta-analysis. Personality and Individual Differences, 55, 367–374. https://doi.org/ 10.1016/j.paid.2013.03.019 Ke, F., & Xu, X. (2020). Virtual reality simulation-based learning of teaching with alternative perspectives taking. British Journal of Educational Technology, 51(6), 2544–2557. https://doi.org/10.1111/bjet.12936 A. Westphal et al. Computers & Education 212 (2024) 104987 14 Kern, M. L., Eichstaedt, J. C., Schwartz, H. A., Dziurzynski, L., Ungar, L. H., Stillwell, D. J., Kosinski, M., Ramones, S. M., & Seligman, M. E. P. (2014). The online social self: An open vocabulary approach to personality. Assessment, 21(2), 158–169. https://doi.org/10.1177/1073191113514104 Klauke, F., Müller-Frommeyer, L. C., & Kauffeld, S. (2020). Writing about the silence: Identifying the language of ostracism. Journal of Language and Social Psychology, 39(5–6), 751–763. https://doi.org/10.1177/0261927X19884599 Kleinknecht, M. (2021). Emotionen von Lehrkraften ¨ in unterrichtsvideobasierten Fortbildungen [Teachers’ emotions in video-based training]. In M. Gl¨ aser-Zikuda, F. Hofmann, & V. Frederking (Eds.), Emotionen im Unterricht: Psychologische, padagogische ¨ und fachdidaktische Perspektiven [Emotions in the classroom: Psychological, pedagogical and didactical perspectives] (pp. 231–243). Stuttgart, Germany: Kohlhammer Verlag, 2021. Kleinknecht, M., & Groschner, ¨ A. (2016). Fostering preservice teachers’ noticing with structured video feedback: Results of an online- and video-based intervention study. Teaching and Teacher Education, 59, 45–56. https://doi.org/10.1016/j.tate.2016.05.020 Kleinknecht, M., & Schneider, J. (2013). What do teachers think and feel when analyzing videos of themselves and other teachers teaching? Teaching and Teacher Education, 33, 13–23. https://doi.org/10.1016/j.tate.2013.02.002 Koˇsir, K., Tement, S., Licardo, M., & Habe, K. (2015). Two sides of the same coin? The role of rumination and reflection in elementary school teachers’ classroom stress and burnout. Teaching and Teacher Education, 47, 131–141. Kowalski, R. M. (2000). “I was only kidding!” Victims’ and perpetrators’ perceptions of teasing. Personality and Social Psychology Bulletin, 26, 231–241. https://doi. org/10.1177/0146167200264009 Kross, E., & Ayduk, O. (2008). Facilitating adaptive emotional analysis: Distinguishing distanced-analysis of depressive experiences from immersed-analysis and distraction. Personality and Social Psychology Bulletin, 34(7), 924–938, 10.1177%2F0146167208315938. Kross, E., Bruehlman-Senecal, E., Park, J., Burson, A., Dougherty, A., Shablack, H., Bremner, R., Moser, J., & Ayduk, O. (2014). Self-talk as a regulatory mechanism: How you do it matters. Journal of Personality and Social Psychology, 106(2), 304–324. https://doi.org/10.1037/a0035173 Lin, Y. C. (2023). Using virtual classroom simulations in a mathematics methods course to develop pre-service primary mathematics teachers’ noticing skills. British Journal of Educational Technology, 54(3), 734–753. https://doi.org/10.1111/bjet.13291 Little, R. J. A. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202. https://doi.org/10.2307/2290157 Lohse-Bossenz, H., Schonknecht, ¨ L., & Brandtner, M. (2019). Entwicklung und Validierung eines Fragebogens zur Erfassung Reflexionsbezogener Selbstwirksamkeit von Lehrkraften ¨ im Vorbereitungsdienst [Development and validation of a questionnaire assessing pre-service teachers’ self-efficacy in reflection]. Empirische Padagogik, ¨ 33(2), 164–179. Lugrin, J.-L., Latoschik, M. E., Habel, M., Roth, D., Seufert, C., & Grafe, S. (2016). Breaking bad behaviors: A new tool for learning classroom management using virtual reality. Frontiers in ICT, 3(26). https://doi.org/10.3389/fict.2016.00026 Lyubomirsky, S., Kasri, F., & Zehm, K. (2003). Dysphoric rumination impairs concentration on academic tasks. Cognitive Therapy and Research, 27(3), 309–330. https://doi.org/10.1023/A:1023918517378 Mehl, M. R., Gosling, S. D., & Pennebaker, J. W. (2006). Personality in its natural habitat: Manifestations and implicit folk theories of personality in daily life. Journal of Personality and Social Psychology, 90(5), 862–877. https://doi.org/10.1037/0022-3514.90.5.862 Mor, N., & Winquist, J. (2002). Self-focused attention and negative affect: A meta-analysis. Psychological Bulletin, 128(4), 638–662. https://doi.org/10.1037/0033- 2909.128.4.638 Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569–582. https://doi.org/10.1037/0021-843X.100.4.569 Nook, E. C., Schleider, J. L., & Somerville, L. H. (2017). A linguistic signature of psychological distancing in emotion regulation. Journal of Experimental Psychology: General, 146(3), 337–346. https://doi.org/10.1037/xge0000263 Nook, E. C., Vidal Bustamante, C. M., Cho, H. Y., & Somerville, L. H. (2020). Use of linguistic distancing and cognitive reappraisal strategies during emotion regulation in children, adolescents, and young adults. Emotion, 20(4), 525. https://doi.org/10.1037/emo0000570 Pendergast, D., O’Brien, M., Prestridge, S., & Exley, B. (2022). Self-efficacy in a 3-dimensional virtual reality classroom—initial teacher education students’ experiences. Education Sciences, 12(6), 368. https://doi.org/10.3390/educsci12060368 Prilop, C. N., Weber, K. E., & Kleinknecht, M. (2021). The role of expert feedback in the development of pre-service teachers’ professional vision of classroom management in an online blended learning environment. Teaching and Teacher Education, 99, Article 103276. https://doi.org/10.1016/j.tate.2020.103276 Reindl, M., Tulis, M., & Dresel, M. (2020). Profiles of emotional and motivational self-regulation following errors: Associations with learning. Learning and Individual Differences, 77, Article 101806. https://doi.org/10.1016/j.lindif.2019.101806 Remacle, A., Bouchard, S., & Morsomme, D. (2023). Can teaching simulations in a virtual classroom help trainee teachers to develop oral communication skills and self-efficacy? A randomized controlled trial. Computers & Education, 200, Article 104808. https://doi.org/10.1016/j.compedu.2023.104808 Richter, E., Hußner, I., Huang, Y., Richter, D., & Lazarides, R. (2022). Video-based reflection in teacher education: Comparing virtual reality and real classroom videos. Computers & Education, 24(3), Article 104601. https://doi.org/10.1016/j.compedu.2022.104601 Rude, S., Gortner, E.-M., & Pennebaker, J. W. (2004). Language use of depressed and depression-vulnerable college students. Cognition & Emotion, 18(8), 1121–1133. https://doi.org/10.1080/02699930441000030 Seidel, T., Stürmer, K., Blomberg, G., Kobarg, M., & Schwindt, K. (2011). Teacher learning from analysis of videotaped classroom situations: Does it make a difference whether teachers observe their own teaching or that of others? Teaching and Teacher Education, 27(2), 259–267. https://doi.org/10.1016/j.tate.2010.08.009 Seufert, C., Oberdorfer, ¨ S., Roth, A., Grafe, S., Lugrin, J. L., & Latoschik, M. E. (2022). Classroom management competency enhancement for student teachers using a fully immersive virtual classroom. Computers & Education, 179, Article 104410. https://doi.org/10.1016/j.compedu.2021.104410 Shahane, A. D., Godfrey, D. A., & Denny, B. T. (2023). Predicting real-world emotion and health from spontaneously assessed linguistic distancing using novel scalable technology. Emotion. Advance online publication. https://doi.org/10.1037/emo0001211 Stürmer, K., Konings, ¨ K. D., & Seidel, T. (2013). Declarative knowledge and professional vision in teacher education: Effect of courses in teaching and learning. British Journal of Educational Psychology, 83(3), 467–483. https://doi.org/10.1111/j.2044-8279.2012.02075.x Tackman, A. M., Sbarra, D. A., Carey, A. L., Donnellan, M. B., Horn, A. B., Holtzman, N. S., Edwards, T. S., Pennebaker, J. W., & Mehl, M. R. (2019). Depression, negative emotionality, and self-referential language: A multi-lab, multi-measure, and multi-language-task research synthesis. Journal of Personality and Social Psychology, 116(5), 817–834. https://doi.org/10.1037/pspp0000187 Tierney, N., Cook, D., McBain, M., & Fay, C. (2021). naniar: Data structures, summaries, and visualisations for missing data. R package version 0.6.1 https://CRAN.Rproject.org/package=naniarv. van Es, E. A., & Sherin, M. G. (2002). Learning to notice: Scaffolding new teachers’ interpretations of classroom interactions. Journal of Technology and Teacher Education, 10(4), 571–596. https://www.learntechlib.org/primary/p/9171/. van Es, E. A., & Sherin, M. G. (2008). Mathematics teachers’ “learning to notice” in the context of a video club. Teaching and Teacher Education, 24(2), 244–276. https://doi.org/10.1016/j.tate.2006.11.005 Voss, T., & Kunter, M. (2020). “Reality shock” of beginning teachers? Changes in teacher candidates’ emotional exhaustion and constructivist-oriented beliefs. Journal of Teacher Education, 71(3), 292–306. https://doi.org/10.1177/0022487119839700 Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. New York: Guilford. Weber, K. E., Prilop, C. N., Viehoff, S., Gold, B., & Kleinknecht, M. (2020). Fordert ¨ eine videobasierte intervention im praktikum die professionelle wahrnehmung von Klassenführung?—eine quantitativ-inhaltsanalytische messung von Subprozessen professioneller wahrnehmung [does a video-based practicum intervention provide a realistic picture of classroom management? A quantitative content analysis of the subprocesses of professional awareness]. Zeitschrift für Erziehungswissenschaft, 23, 343–365. https://doi.org/10.1007/s11618-020-00939-9 Wegner, D. M., & Giuliano, T. (1980). Arousal-induced attention to self. Journal of Personality and Social Psychology, 38(5), 719–726. https://doi.org/10.1037/0022- 3514.38.5.719 A. Westphal et al. Computers & Education 212 (2024) 104987 15 Westphal, A., Kalinowski, E., Hoferichter, C. J., & Vock, M. (2022). K− 12 teachers’ stress and burnout during the COVID-19 pandemic: A systematic review. Frontiers in psychology, 13, 920326. https://doi.org/10.3389/fpsyg.2022.920326. Wickham, H. (2019). stringr: Simple, consistent wrappers for common string operations. R package version 1.4.0. https://CRAN.R-project.org/package=stringr. Wiepke, A., Heinemann, B., Lucke, U., & Schroeder, U. (2021). Jenseits des eigenen Klassenzimmers: Perspektiven & Weiterentwicklungen des VR-Klassenzimmers [Beyond the own classroom: Perspectives & further developments of the VR classroom.]. DELFI 2021 - Die 19. Fachtagung Bildungstechnologien [Educational technologies symposium], 331–336. http://dl.gi.de/handle/20.500.12116/37031. Wolff, C. E., Jarodzka, H., van den Bogert, N., & Boshuizen, H. P. A. (2016). Teacher vision: Expert and novice teachers’ perception of problematic classroom management scenes. Instructional Science, 44(3), 243–265, 10/f8tcpm. Wulff, P., Westphal, A., Mientus, L., Nowak, A., & Borowski, A. (2023, January). Enhancing writing analytics in science education research with machine learning and natural language processing—Formative assessment of science and non-science preservice teachers’ written reflections. In Frontiers in Education, 7, Article 1061461. https://doi.org/10.3389/feduc.2022.1061461. Frontiers. Wulff, P., Buschhüter, D., Westphal, A., Mientus, L., Nowak, A., & Borowski, A. (2022). Bridging the gap between qualitative and quantitative assessment in science education research with machine learning—A case for pretrained language models-based clustering. Journal of Science Education and Technology, 31(4), 490–513. https://doi.org/10.1007/s10956-022-09969-w. Yarkoni, T. (2010). Personality in 100,000 words: A large-scale analysis of personality and word use among bloggers. Journal of Research in Personality, 44(3), 363–373. https://doi.org/10.1016/j.jrp.2010.04.001 Yee, N., Harris, H., Jabon, M., & Bailenson, J. N. (2011). The expression of personality in virtual worlds. Social Psychological and Personality Science, 2(1), 5–12. https://doi.org/10.1177/1948550610379056 Zhang, M., Lundeberg, M., Koehler, M. J., & Eberhardt, J. (2011). Understanding affordances and challenges of three types of video for teacher professional development. Teaching and Teacher Education, 27(2), 454–462. https://doi.org/10.1016/j.tate.2010.09.015 Zimmermann, J., Brockmeyer, T., Hunn, M., Schauenburg, H., & Wolf, M. (2016). First-person pronoun use in spoken language as a predictor of future depressive symptoms: Preliminary evidence from a clinical sample of depressed patients. Clinical Psychology & Psychotherapy, 24(2), 384–391. https://doi.org/10.1002/ cpp.2006 Wiepke, A., Richter, E., Zender, R., & Richter, D. (2019). Einsatz von Virtual Reality zum Aufbau von Klassenmanagement-Kompetenzen im Lehramtsstudium [Use of virtual reality for training student teachers’ classroom management competencies]. DELFI, 2019. https://doi.org/10.18420/delfi2019_319 A. Westphal et al. View publication stats
|
Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand.
EVIDENCE:
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/377123871 More I-talk in student teachers’ written reflections indicates higher stress during VR teaching Article in Computers & Education · April 2024 DOI: 10.1016/j.compedu.2024.104987 CITATIONS 0 READS 70 4 authors: Andrea Westphal University of Greifswald 53 PUBLICATIONS 305 CITATIONS SEE PROFILE Eric Richter Universität Potsdam 45 PUBLICATIONS 495 CITATIONS SEE PROFILE Rebecca Lazarides Universität Potsdam 145 PUBLICATIONS 1,980 CITATIONS SEE PROFILE Yizhen Huang Universität Potsdam 19 PUBLICATIONS 208 CITATIONS SEE PROFILE All content following this page was uploaded by Eric Richter on 12 January 2024. The user has requested enhancement of the downloaded file. Computers & Education 212 (2024) 104987 Available online 3 January 2024 0360-1315/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). More I-talk in student teachers’ written reflections indicates higher stress during VR teaching Andrea Westphal a,* , Eric Richter b , Rebecca Lazarides b , Yizhen Huang b a University of Greifswald, Department of Education, Steinbeckerstr. 15, 17487, Greifswald, Germany b University of Potsdam, Department of Education, Karl-Liebknecht-Straße 24-25, 14476, Potsdam, Germany ARTICLE INFO Keywords: Augmented and virtual reality Improving classroom teaching Teacher professional development ABSTRACT Video-based reflection on one’s own teaching represents a crucial tool in teacher education. When student teachers reflect on negative classroom events, it elicits “self-focused attention,” which has been associated with more intense negative emotionality. Self-focused attention can be quantitatively captured using first-person singular pronouns (“I,” “me,” “my”) in written reflections by, for instance, student teachers. What is unclear is whether student teachers’ use of these firstperson singular pronouns in their written reflections is linked to and predicts their negative affective experiences during teaching. For the present study, a fully immersive virtual reality (VR) classroom was implemented in which student teachers taught a lesson, provided written reflections on their teaching, and then taught a second lesson. We measured N = 59 student teachers’ self-reported stress and heartrate responses while teaching in the VR classroom and determined the percentage of first-person singular pronouns in their written reflections. Firstly, our results showed that the use of first-person singular pronouns provides incremental information on manual ratings of student teachers’ foci in their written reflections. Secondly, student teachers’ heartrates during instruction—a measure of physiological stress—were associated with the use of first-person singular pronouns in subsequent written reflections. Thirdly, the use of first-person singular pronouns predicted the increase in physiological stress from the first to the second round of VR teaching. We discuss implications for automated feedback and for designing reflective tasks. 1. Introduction Teaching is often seen as a challenging profession (Chang, 2009; Westphal et al., 2022; . The transition to school practice, at least when it takes place in real school classrooms, is especially demanding for student teachers1 (Goddard et al., 2006; Hultell et al., 2013; Voss & Kunter, 2020). Fully immersive virtual reality (VR) classrooms provide a safe environment for student teachers to gain hands-on teaching experience (Gold & Windscheid, 2020 ; Lin, 2023; Lugrin et al., 2016; Pendergast et al., 2022; Remacle et al., 2023; Richter et al., 2022; Seufert et al., 2022). Ke and Xu (2020) suggested that active learning processes (“diving in”) and reflective * Corresponding author. E-mail addresses: [email protected] (A. Westphal), [email protected] (E. Richter), rebecca.lazarides@uni-potsdam. de (R. Lazarides), [email protected] (Y. Huang). 1 In our study, the term “student teachers” refers to those prospective teachers who have not yet begun the supervised teaching portion of their teacher education program. Contents lists available at ScienceDirect Computers & Education journal homepage: www.elsevier.com/locate/compedu https://doi.org/10.1016/j.compedu.2024.104987 Received 21 November 2022; Received in revised form 11 November 2023; Accepted 2 January 2024 Computers & Education 212 (2024) 104987 2 learning processes (“stepping out”) can be easily combined in VR classrooms. Thus, it may be useful to practice reflecting on classroom situations from a more distanced perspective using VR classrooms early on in teacher education to help student teachers make a smooth transition into the classroom. Because the setting is standardized and similar for all student teachers, VR classrooms allow us to more accurately research the contributing factors and consequences of student teachers’ self-reflection; the highly controllable setting increases the internal validity of research findings (Huang et al., 2021; Richter et al., 2022). This is of particular interest for research looking at the interrelationships between student teachers’ affects in relation to their classroom experiences and their reflections upon those experiences. VR classrooms allow us, for instance, to apply a finding from experimental psychology to the field of teacher education. Research in the fields of experimental psychology and clinical psychology has shown that self-focus after negative events is accompanied by greater negative affect (e.g., Mor & Winquist, 2002). This finding has been explained by dysfunctional emotion-regulation strategies (e.g., Nook et al., 2017). Applied to the context of teacher education, these findings may imply that student teachers who are less skilled at transitioning between a more immersed perspective and a more distanced perspective on challenging classroom events may experience more negative affect. The degree of a person’s self-focus can be determined based on the frequency with which they use first-person singular pronouns (e.g., “I,” “me,” “my”); this has also been called “I-talk” (Tackman et al., 2019). It would be highly relevant to examine this link between self-focused attention in written reflections—as reflected by more frequent I-talk—and negative affect during instruction in the field of teacher education, because knowledge about the link between the use of first-person singular pronouns and negative affect could be implemented in automated feedback systems to help identify student teachers at risk of intense stress and burnout, allowing them to be offered personalized feedback and support. To date, however, these questions have not been explored. To examine whether student teachers’ use of first-person singular pronouns is an indicator of the stress level they experience in the classroom, and whether it can predict changes in a student teachers’ stress, a highly standardized teaching situation is preferable, because it ensures that all student teachers under study are reflecting on the same learning environment and on similar classroom events at all measurement occasions. A VR classroom creates just such a setting. In the present study, class size in the VR classroom was manipulated to induce higher levels of stress (large-class-size condition with a higher number of student avatars) and lower levels of stress (small-class-size condition with a lower number of student avatars). Initially, we checked whether the use of first-person pronouns in written reflections provides incremental information about subsequent manual ratings of student-teachers’ foci (whether on their own actions vs. student actions vs. the learning environment) in these reflections. In addition, we examine whether student teachers who experience more self-reported stress and physiological stress (as measured by heartrate response) while teaching in a VR classroom use more first-person singular pronouns in written reflections on their teaching. We also explore whether student teachers’ use of first-person singular pronouns in written reflections predicts the increase in stress in a subsequent VR lesson. 1.1. Reflection in teacher education: Technological advances “Reflection” has been defined as “deliberate, purposeful, metacognitive thinking and/or action” (Koˇsir et al., 2015, p. 113) that is believed to enhance instructional quality (Chernikova et al., 2020) by improving student teachers’ “noticing” and “knowledge-based reasoning” (Stürmer et al., 2013; van Es & Sherin, 2008). Noticing is understood as a teachers’ ability to focus their attention on relevant classroom events (van Es & Sherin, 2002). Knowledge-based reasoning is defined as teachers’ ability to apply their professional knowledge in order to interpret these classroom events (Borko, 2004; van Es & Sherin, 2002). In teacher education programs, reflection is implemented in different ways, with student teachers reflecting on classroom videos of other teachers or on video recordings of their own teaching (Kleinknecht & Schneider, 2013). Technological advances have made it possible to design VR classrooms that student teachers experience as realistic and authentic classroom settings (Huang et al., 2021; Wiepke et al., 2019, allowing them to practice and subsequently reflect on video recordings of their own teaching. Beyond the practical advantages for student teacher education (e.g., the approval of students, parents, educators, and administrators is not required), an important benefit of VR classrooms is the standardized classroom setting in which all student teachers experience similar classroom events for which they can be prepared in advance. This enables teacher educators to more easily provide relevant professional knowledge tailored to managing critical classroom events in the VR classroom; when reflecting on video recordings of their own teaching in the VR setting, student teachers may thus be more able to apply relevant professional knowledge. Video-based reflection generally involves written or oral reflections after viewing classroom videos; it is recommended that these reflections follow a three-step process (e.g., Prilop et al., 2021). Firstly, student teachers are instructed to describe the relevant classroom events; secondly, they are asked to evaluate and interpret these events; and, thirdly, they are required to identify alternative classroom behaviors (e.g., Prilop et al., 2021). When describing relevant classroom events, student teachers may focus either on their own actions, students’ actions, or on the learning environment as a whole (Kleinknecht & Schneider, 2013; Lohse-Bossenz et al., 2019). Previous research has been resoundingly positive on the benefits of video-based reflection for student teachers’ professional vision (e. g., Stürmer et al., 2013; Weber et al., 2020). Very few studies shed light on the affective experiences associated with video-based reflection (Kleinknecht, 2021). Although Kleinknecht and Schneider (2013) suggested that reflecting on other teachers’ videos can induce more negative affect than reflecting on one’s own teaching videos, several studies have shown that reflecting on one’s own videos elicits intense emotional involvement (Borko et al., 2008; Seidel et al., 2011; Zhang et al., 2011). What is unclear, however, is to what extent student teachers’ attentional focus (i.e., focusing on own thoughts, actions, or emotions) in the video-based reflection of their own videos relates to their experiences of negative affect or stress. A. Westphal et al. Computers & Education 212 (2024) 104987 3 1.2. “I-talk” as a linguistic marker of self-focused attention and negative affect In the fields of experimental psychology and clinical psychology, there is increasing empirical evidence indicating that there is a relationship between self-focused attention and greater negative affect (e.g., Mor & Winquist, 2002; Nook et al., 2017). For instance, studies using correlational designs showed that self-report measures of self-focus—such as the Public and Private Self-Consciousness Scale (Fenigstein et al., 1975), but also sentence completion tasks (Exner, 1973; Wegner & Giuliano, 1980)—are associated with self-report measures of state or trait negative affect in non-clinical and clinical samples (for an overview, see the meta-analysis by Mor & Winquist, 2002). Other studies showed that self-referential language (so-called “I-talk”)—as a linguistic marker of an individual’s self-focus—is associated with more intense negative emotionality in non-clinical samples (Kern et al., 2014; Mehl et al., 2006; Yarkoni, 2010; Yee et al., 2011; see also meta-analysis by Edwards & Holtzman, 2017) and is a marker of depression (Dunnack & Park, 2009; Rude et al., 2004; Zimmermann et al., 2016). An extensive multi-lab multi-language study with data from more than 4700 participants recently confirmed that the use of first-person singular pronouns is linked to more intense negative emotionality and depression (Tackman et al., 2019). The association between I-talk and depression has been explained to some extent by negative emotionality (Tackman et al., 2019). This indicates that “I-talk” might reflect a broader dispositional tendency towards feelings of distress, but “[t] his possibility is a topic of ongoing research” (Berry-Blunt et al., 2021, p. 5). Although frequent I-talk is seen as maladaptive, it may be a way of processing negative affect (e.g., after receiving deprecatory information about oneself), as a recent literature review concluded (Berry-Blunt et al., 2021). This would suggest that greater negative affect provokes I-talk. Experimental research did not find any evidence that inducing negative affect by showing participants negative pictures led to more I-talk (e.g., Bernard, Baddeley, Rodriguez, & Burke, 2016). In line with Bernard, Baddeley, Rodriguez, and Burke (2016) suggestion, it may be the case that negative affect only leads to more I-talk when elicited by self-deprecating information. This proposition is consistent with research on the negative affective experiences of teasing and ostracism, which do lead to more frequent I-talk (Klauke et al., 2020; Kowalski, 2000). The reverse may also be true, however. Taking a more distanced perspective—as indicated by less I-talk—may over time change an individual’s dispositional negative emotionality (Berry-Blunt et al., 2021). Distancing, i.e., shifting one’s perspective to be more “distant” from or less immersed in a negative event, is an adaptive emotion-regulation strategy that is characterized by a lower level of self-focused attention and can help reduce negative affect (Kross & Ayduk, 2008). The suggestion that repeated distancing may reduce an individual’s tendency to experience negative affect (Berry-Blunt et al., 2021) would explain why I-talk predicts future depressive symptoms in patients (Dunnack & Park, 2009; Zimmermann et al., 2016). Even in the short term, less I-talk may lead to less negative affect: Experimental research confirmed that distancing—i.e., using no I-talk when talking about one’s own emotions while preparing a stressful speech—can lessen negative affect after having given the speech (Kross et al., 2014, Study 3). Thus, the causal direction of the link between I-talk and negative emotionality is less clear, but there may be a bidirectional relationship. 1.3. Gender differences in the association between self-focus and negative affect Based on meta-analytical findings that women exhibit a greater tendency to ruminatively self-focus than men when experiencing depression (Johnson & Whisman, 2013), it has been suggested that the positive association between negative emotionality and the use of first-person singular pronouns is larger for women than it is for men (e.g., Tackman et al., 2019). When examining these gender differences, Tackman et al. (2019) underlined that the use of first-person singular pronouns seems to be driven by low-arousal negative distress in women. In contrast, it appears that men’s use of first-person singular pronouns is driven by high-arousal negative distress (Tackman et al., 2019). Thus, the use of first-person singular pronouns may be an indicator of different affective experiences in women and men (Fast & Funder, 2010) and, thus, gender should be taken into account when studying the relationship between self-focus and negative affect. 1.4. Distinguishing different forms of self-focus in written reflections Different strands of research differ in their operationalization of self-focus. In research on reflection in teacher training, manual ratings indicate the extent to which student teachers focus on their own actions and thoughts, on students’ actions, or on the learning environment (e.g., Kleinknecht & Schneider, 2013). In experimental psychology, self-focus is often operationalized via the use of first-person singular pronouns (Berry-Blunt et al., 2021; Mor & Winquist, 2002). This strand of research has argued that individuals can take a more or less immersed or distanced perspective on their own actions and thoughts by using more or fewer first-person singular pronouns (Kross & Ayduk, 2008; Kross et al., 2014). When reflecting on their own teaching, some student teachers may distance themselves from the experience and therefore rarely use first-person singular pronouns, while others may immerse themselves in the experience and use first-person singular pronouns more frequently. As such, both indicators of self-focus (qualitative ratings vs. first-person singular pronouns) should provide incremental information about student teachers’ self-focus in their written reflections. For student teachers taking a more immersive perspective on their own teaching, objective first-person singular pronouns (i.e., “me,” “myself”) may reflect a more dysfunctional form of self-focus than subjective first-person singular pronouns (i.e., “I”) (Zimmermann et al., 2016). While subjective pronouns reflect an “active or self-as-actor form of self-focus,” objective pronouns reflect a “passive or self-as-target form of self-focus” (James, 1890; Tackman et al., 2019, p. 819) that may indicate an even more detrimental style of processing self-relevant information (Zimmermann et al., 2016; see also more and less dysfunctional questions in Ehring, 2020). This poses the question of whether the relationship between the use of first-person pronouns and negative affect is driven mainly by objective first-person pronouns (Zimmermann et al., 2016). As such, “it is important to evaluate whether and how the A. Westphal et al. Computers & Education 212 (2024) 104987 4 association between depression and I-talk varies as a function of first-person singular pronoun type” (Tackman et al., 2019, p. 819). Previous evidence on whether subjective and objective first-person pronouns differentially relate to negative affect is mixed (there is support in the study by Zimmermann et al., 2016; but no or inconsistent differences in the studies by Dunnack & Park, 2009; Tackman et al., 2019). But the distinction between subjective and objective first-person singular pronouns appears to be essential in our study, in which the relationship between the use of first-person pronouns and negative affect is examined for the first time in the context of teacher training. 1.5. Present study Negative emotionality may be critical for student teachers when they reflect on their own teaching, yet research has rarely concentrated on the role of negative emotionality for reflective processes (Kleinknecht, 2021). Meanwhile, research in the field of experimental psychology indicates that negative affect may provoke self-focused attention as indicated by the use of first-person singular pronouns (Berry-Blunt et al., 2021). Moreover, self-focused attention may also increase the tendency towards experiencing negative affect (Berry-Blunt et al., 2021). What we do not know is whether this applies to the context of teacher education where student teachers reflect on their own teaching. Studying this link between self-focus and negative affect in the context of student teachers’ written reflections can provide valuable cues for diagnostic tools, automated feedback systems, and the improvement of student teachers’ professional self-regulation. We used a VR classroom setting, and thus a highly standardized teaching situation, to ensure that student teachers were reflecting on similar classroom events as we examined the following research questions: (1) Do student teachers who exhibit a greater focus on their own actions (instead of students’ actions or the classroom environment) use more subjective and objective first-person singular pronouns in written reflections on their teaching? Here, the assumption could be that those student teachers who use subjective and objective first-person singular pronouns more frequently also tend to focus on themselves rather than on the students in class or on the classroom environment. However, there is no previous research combining manual ratings of student teachers’ foci (whether on their own actions vs. student actions vs. the learning environment) with student teachers’ subjective and objective use of first-person singular pronouns when reflecting on their own teaching. Thus, it is unclear to what extent manual ratings of student teachers’ foci correspond to the subjective and objective use of first-person pronouns in written reflections on their teaching. We seek to address this research gap as an exploratory question. (2) Do student teachers who experience more self-reported stress and physiological stress (as measured by heartrate response) while teaching in a VR classroom use more subjective and objective first-person singular pronouns in written reflections of their teaching? Building on empirical evidence showing that negative affect may provoke self-focused attention, we analyze whether student teachers who experience higher levels of negative affect when teaching in the VR classroom more frequently use subjective and objective first-person singular pronouns in their written reflections. The class size in the VR classroom, i.e., the number of student avatars, was manipulated to evoke higher levels (large-class-size condition) and lower levels of negative affect (small-class-size condition(Huang et al., 2022). We hypothesize that student teachers who experience more negative affect—operationalized via self-reported and physiological stress—when teaching in the VR classroom for the first time will use more subjective and objective first-person singular pronouns in their written reflections. (3) Does student teachers’ use of subjective and objective first-person singular pronouns in written reflections of their teaching predict their increase in stress in a subsequent VR lesson? We postulate that student teachers who use more subjective and objective first-person singular pronouns in their written reflections will experience a greater increase in self-reported and physiological stress in the second VR classroom (as compared to the stress levels experienced when teaching in the VR classroom for the first time). 2. Material and methods 2.1. Sample and procedure Participants were N = 65 student teachers enrolled at the University of (anonymized for review) in Germany. Four of the participating students did not hand in their written reflection and two additional students did not participate in the second VR practice session, limiting our analyses to n = 59 students. Student teachers were on average 24 years old (SD = 4.57) and 49% identified as female, 51% as male, none as diverse. Most students were third-year bachelor students (58%; second-year: 27%; fourth-year: 14%). These student teachers participated in a weekly seminar on classroom management. The seminar included two 10-min practice sessions in a VR classroom that took place two weeks apart. Both VR practice sessions followed a standardized procedure. Participants were first given a brief standardized audio introduction on how to interact with the VR environment. Participants were then given a brief lecture about an a priori determined topic in the VR classroom to deliver to avatar students. During the first VR teaching experience, participants taught about the US electoral system and the 2020 US election. For the second VR teaching experience, A. Westphal et al. Computers & Education 212 (2024) 104987 5 participants taught about sustainability. All the instructional materials that participants needed to accomplish the teaching task were prepared and provided by the course instructor one week before the teaching exercise. During their VR teaching session, participants were exposed to various on-task and off-task behaviors from the avatar students, such as asking topic-related questions, chatting, or throwing paper balls. All avatar student actions were prescribed and therefore the same for all participants in both the class with 10 student avatars and the class with 30 student avatars. Immediately after their teaching experience in the VR classroom, the student teachers reported on their stress levels in an online questionnaire. In addition, the student teachers handed in a written reflection on their VR teaching session in the week following the first VR practice session.2 Prior to writing their reflections, the student teachers received guidance on the three-step reflection process. In this process, they were instructed to describe three relevant classroom situations (Step 1), evaluate and interpret these situations based on their professional knowledge (Step 2), and outline alternatives for classroom situations that they evaluated negatively (Step 3). Before writing their reflections, student teachers were given time to repeatedly watch the video of the VR classroom situation in which they had taught. 2.2. Design of the VR classroom The VR classroom was designed to resemble an upper secondary school classroom in Germany (e.g., (Wiepke et al., 2021)). It was set up with five rows and three columns of school desks and chairs with avatar students (see Appendix). Avatar students’ names were displayed on name tags placed on their desks and had a wide range of physical characteristics, such as skin tone, hairstyle, and clothing. Student teachers were randomly assigned to teach a class of either 10 or 30 student avatars when teaching the VR classroom for the first time and again when teaching it for the second time. The avatar students engaged in a range of behaviors that included both ontask and off-task actions. These actions ranged from constructive activities, such as writing in a notebook, to less productive actions, such as throwing a paper ball. The avatar students maintained a natural seated posture and a neutral demeanour, occasionally redirecting their attention by shifting their gaze or adjusting their body orientation in response to the participants’ movements. The selection of off-task behaviors was based on a compilation of common disruptive behaviors documented in the academic literature (Borko, 2016; Wolff et al., 2016). All parameters governing the avatar students’ behaviors, including initiation time, duration, spatial location, and behavior type, were carefully scripted to maintain uniformity across experimental conditions. This ensured that the behaviors enacted by the avatar students remained consistent between the scenarios with 10 avatar students and those with 30 avatar students in the classroom. We were using the HTC VIVE headset which has a resolution of 1080 x 1200 pixels per eye with a 108◦ field of view and a refresh rate of 90 Hz. The headset was connected to a laptop (Alienware) with a 2.2-GHz Intel Core i7-8750H processor, with 16 GB of RAM, and a NVIDIA GeForce RTX 2060 with 6 GB of VRAM graphic card, where the VR classroom software was operated. Essentially, participants could move around in reality while experiencing multisensory feedback in the VR classroom. Previous studies have confirmed that the technical setup in our VR classroom created an immersive soundscape which student teachers experienced as realistic and authentic (Wiepke et al., 2019, 2021). Student teachers were equally distributed across the four conditions (small class size VR1, small class size VR2: 21%; small class size VR1, large class size VR2: 23%; large class size VR1, small class size VR2: 25%; large class size VR1, large class size VR2: 28%).3 Thus, some teachers taught under the same conditions twice, while other teachers taught one VR session in the small class size condition and the other VR session in the large class size condition. Student teachers teaching in the VR classroom were instructed to teach their lesson as they would in a real classroom i.e., walking around the room and using similar observational and nonverbal behavior when interacting with the avatar students as they would with non-virtual students. 2.3. Measures 2.3.1. Self-reported stress in the VR classroom We measured the stress that student teachers experienced during the VR scenario using two items (“How tense did you feel in the VR classroom?” and “How did you feel emotionally during the VR classroom?”; e.g., Delaney & Brodie, 2000). Items were answered on a 9-point Likert-type scale ranging from 1 (calm, relaxed, composed) to 9 (tense). The internal consistency was good (αT1 = 0.83; αT2 = 0.85). 2.3.2. Physiological indicator of stress in the VR classroom We operationalized student teachers’ physiological stress reactions based on their heartrate (beats per minute, BPM). Student teachers’ BPM was measured using an armband optical HR sensor (Polar OH1) at 0.3s intervals when teaching in the VR classroom. Prior to starting the VR scenarios, each student teachers’ baseline heartrate was measured at 0.3s intervals while student teachers were asked to sit quietly and stay still. These baseline measures were used to control for individual differences in cardiovascular activity. We then aggregated both heartrate measurements during the baseline phase and heartrate measurements during the VR teaching. The differences between student teachers’ heartrate during teaching and student teachers’ baseline heartrate was used as a physiological 2 Students also reflected on the second VR classroom three months afterwards based on a video recording. Given the time span between this VR classroom and the written reflection, we didn’t include these written reflections in our analyses. 3 Percentages do not total 100 because of rounding. A. Westphal et al. Computers & Education 212 (2024) 104987 6 indicator of student teachers’ stress response. 2.3.3. Self-referential language We used the R package stringr (Wickham, 2019) to estimate the frequency of subjective and objective first-person singular pronouns. For each written reflection, we computed the percentage of subjective first-person singular pronouns (German: “ich”; English: “I”) and the percentage of objective first-person singular pronouns (German: “mich,” “mir”; English: “me,” “myself”).4 2.3.4. Manual ratings of focus and depth in written reflections Two independent raters manually rated the focus (as either student teachers’ own actions, student avatars’ actions, learning environment, or no focus) and depth (description, evaluating/explaining, or reflecting on alternatives) in student teachers’ written reflections using the software MAXQDA and following the procedure of Lohse-Bossenz et al. (2019; Kleinknecht & Groschner, ¨ 2016). Interrater agreement was good (κ = 0.75). For our analyses, we used the coverage percentage, i.e., the number of characters in the coded segment in relation to the total number of characters in the text. 2.4. Statistical analyses To test the hypotheses, we conducted regression analyses using the R package MplusAutomation (Hallquist & Wiley, 2018) and MLR as the estimation method. A manipulation check on our data was conducted by Huang et al. (2022) who probed whether student teachers experienced more self-reported and physiological stress when teaching a VR classroom in the large-size condition than in the small-size condition. We initially examined whether student teachers who used more subjective and objective first-person singular pronouns focused more frequently on themselves rather than on the avatar students in class or on the classroom environment (RQ1). To do so, we distinguished between student teachers who used subjective first-person singular pronouns with low frequency (i.e., ≤0.5 SD below M), average frequency (≥0.5 SD below M and ≤0.5 SD above M), and high frequency (≥0.5 SD above M). A multivariate analysis of variance was conducted with the subjective use of first-person singular pronouns (low, average, or high) as the between-person factor and the relative frequency of the student teachers’ reflection focus (the student teacher, student avatars, or learning environment) as the dependent variable. The analysis was then repeated for the objective use of first-person singular pronouns. To examine our second research question, we then regressed subjective and objective first-person singular pronoun use in the written reflections of the first VR classroom on self-reported stress in these VR sessions (RQ2). We controlled for gender.5 Within this model, we allowed the use of subjective and objective first-person singular pronouns to correlate. We specified an analogous model with physiological stress as the predictor. In a second step, we regressed self-reported stress during the second VR classroom teaching session on the subjective and objective use of first-person singular pronouns while controlling for self-reported stress during the first VR classroom teaching session (RQ3). Gender and class size in the second VR classroom teaching session were used as covariates. Thus, regression coefficients of pronoun use and gender indicate whether these variables explain changes in self-reported stress in the second, as compared to the first, VR classroom teaching session. Analyses were conducted separately for the use of subjective and objective first-person singular pronouns to probe whether subjective and objective first-person pronouns differentially relate to negative affect (instead of examining incremental effects). Analogous models were computed for physiological stress. Due to technical difficulties when transferring the heartrate data onto the storage device, heartrate while teaching in the VR classroom was only available for 40 students. There were only 29 students for whom heartrate responses were present in both VR classrooms. We examined whether values were missing completely at random using the MCAR-Test (Little, 1988) implemented in the R package naniar (Tierney et al., 2021). The test yielded non-significant results (χ2 = 17.5, df = 25, p = 0.864) indicating that the values were missing completely at random. We applied the full-information maximum-likelihood approach (FIML; Enders, 2001) to obtain appropriate estimates and standard errors. 3. Results A manipulation check on our data Huang et al., 2022)showed that student teachers experienced more self-reported and physiological stress when teaching a VR class in the large-size condition than in the small-size condition. Descriptive results (Table 1) and a dependent t-test showed that self-reported stress was greater in the first VR session than in the second VR session, t(54) = 4.89, p < 0.001. In contrast, physiological stress did not differ statistically significantly between the two VR sessions, t(28) = 0.68, p = 0.503. 3.1. Subjective and objective first-person singular pronouns and manual ratings of focus in written reflections Pertaining to our first research question, we checked whether student teachers with a more frequent use of subjective and objective first-person singular pronouns focused more often on themselves rather than on the avatar students in class or on the classroom environment (Fig. 1a and b). A multivariate analysis of variance with the subjective use of first-person singular pronouns (low, average, or high) as a between-person factor and relative frequency of student teachers’ focus of reflection on their own actions (as opposed to focus on student avatars or the learning environment) as a dependent variable showed no statistically significant effect, F(6, 4 The objective first-person singular pronoun “meiner” is rarely used and was not considered here—following the suggestion by Tackman et al. (2019)—because it overlaps with the more frequently used possessive pronoun “meiner”. 5 We did not look for interaction effects between the use of first-person singular pronouns and gender as our sample was small. A. Westphal et al. Computers & Education 212 (2024) 104987 7 108) = 0.59, p = 0.74. Similarly, we found no statistically significant difference between students with low, average, or high frequency of the objective use of first-person singular pronouns on the relative frequency of student teachers’ reflection being focused on their own actions, F(6, 108) = 1.18, p = 0.32. Thus, high subjective or objective first-person singular pronoun use was not reflected in a greater focus on student teachers’ own actions in written reflections (as indicated by manual ratings). 3.2. Do student teachers who experience more stress in the VR session use more subjective and objective first-person singular pronouns in their written reflections? To answer our second research question regarding the relationship between student teachers’ stress in the VR session and the use of subjective and objective first-person singular pronouns, we conducted cross-sectional regression analyses. Our results showed that selfreported stress experienced during the first VR teaching session was not statistically significantly associated with the use of subjective and objective first-person singular pronouns (Table 2). Gender showed a statistically significant association with subjective and objective pronoun use, indicating that student teachers who identified as male used subjective and objective first-person singular pronouns more frequently than student teachers who identified as female. In contrast, physiological stress experienced during the first VR teaching session was statistically and positively associated with both the use of subjective and the use of objective first-person singular pronouns. Thus, student teachers who experienced greater physiological stress when teaching in the VR classroom used more subjective or objective first-person singular pronouns in their written reflections. Beyond physiological stress, associations between gender and the use of subjective or objective first-person pronouns were not statistically significant. 3.3. Do student teachers who use more subjective and objective first-person singular pronouns in their written reflections experience a greater increase in stress in the second VR session? Concerning our third research question, we examined whether student teachers who used more subjective and objective firstperson singular pronouns in their written reflection experienced a greater increase in stress in the second VR session. When regressing the self-reported stress that participants experienced during the second VR teaching session, the use of subjective firstperson singular pronouns was not a statistically significant predictor when controlling for self-reported stress in the first VR teaching session, gender and class size during the second VR teaching session (Table 3, Model 3a). The use of objective first-person singular pronouns emerged as a statistically significant predictor of self-reported stress during the second VR teaching session (Table 3, Model 3b). This was not in line with our cross-sectional findings and we therefore conducted additional analyses, which revealed that the association between the use of objective first-person singular pronouns and self-reported stress was explained by the level of physiological stress in the first VR teaching session (Table A2 in Appendix). Concerning the covariates, gender and class size were not statistically significant predictors of self-reported stress in both models (Models 3a-b, Table 3). Associations between self-reported stress experienced in the first and in the second VR teaching session were statistically significant, indicating that student teachers who experienced more self-reported stress in the first VR teaching session reported more self-reported stress in the second VR teaching session. Associations between physiological stress during the second VR teaching session and the use of subjective first-person singular pronouns were statistically significant when controlling for physiological stress experienced during the first VR teaching session and class size in the second VR session (Table 3, Model 4a). Thus, student teachers who used more subjective first-person singular pronouns in their written reflections of the first VR teaching session experienced a stronger increase in physiological stress during the second VR teaching session. We found no association between physiological stress during the second VR teaching session and the use of objective first-person singular pronouns (Table 3, Model 4b). Regarding the covariates, gender was not a statistically significant predictor of physiological stress in either model, while a greater class size for the second VR classroom was associated with greater physiological stress (Models 4a-b, Table 3). Student teachers who experienced greater physiological stress in the first VR teaching session exhibited more intense physiological stress in the second VR teaching session. 4. Discussion Negative affect can play a crucial role in student teachers’ reflection, but it has barely been studied (Kleinknecht, 2021). The Table 1 Descriptive statistics. N M SD Min Max Psychological stress VR1 58 5.22 1.70 2.00 9.00 Psychological stress VR2 55 3.97 1.78 1.50 9.00 Physiological stress VR1 40 60.36 22.25 21.56 108.38 Physiological stress VR2 46 56.88 24.40 7.86 97.90 Subjective pronouns VR1 59 3.61 2.16 0.00 9.18 Objective pronouns VR1 59 1.13 1.12 0.00 5.10 Note. Physiological stress = difference between heartrate (BPM) while teaching and baseline heartrate (BPM). Subjective pronouns = relative frequency of subjective first-person singular pronouns in written reflection. Objective pronouns = relative frequency of objective first-person singular pronouns in written reflection. Gender: 0 = female. A. Westphal et al. Computers & Education 212 (2024) 104987 8 (caption on next page) A. Westphal et al. Computers & Education 212 (2024) 104987 9 present study applied psychological research on the relationship between negative affect and self-focus—which would potentially be valuable for diagnostic tools, automated feedback systems, and the improvement of emotion regulation—to the context of student teachers’ reflections. Initially, we looked at whether student teachers who used more subjective and objective first-person singular pronouns focused more frequently on themselves rather than on the avatar students in the VR class or on the classroom environment as a whole. In addition, we examined whether student teachers’ negative affect while teaching in a VR classroom—in terms of higher self-reported stress and heartrate—affected their self-focus in written reflections operationalized via the subjective and objective use of first-person singular pronouns. We also explored whether the use of subjective and objective first-person singular pronouns relates to stress in a subsequent teaching session in a VR classroom. Initially, we found that there were no differences in manual ratings of focus between student teachers with a low, average, or high subjective or objective use of first-person singular pronouns. This is in line with findings illustrating that individuals can regard their own actions and thoughts from a more or less immersed or distanced standpoint, which is reflected in their more or less frequent use of subjective and objective first-person singular pronouns (Kross & Ayduk, 2008; Kross et al., 2014). While one student teacher, for instance, described classroom disruptions during his lesson from a more immersed perspective, pointing out how it made him feel (“Some classroom disturbances made me upset […]. The interruptions kept me from getting back to where I started and from finishing properly.”), another student started his reflection by taking a more distanced perspective, describing his own actions from a third-person perspective (“There is a recurring loss of the common thread due to class disruptions and the teacher trying to address every minor disruption.”). Thus, the use of subjective and objective first-person singular pronouns provides incremental information to manual ratings of focus in written reflections. Future research examining student teachers’ focus when reflecting on their own teaching could therefore benefit from incorporating different measures of self-focus. Fig. 1. a Focus in written reflections from content analysis by use of subjective first-person singular pronouns Note. Low use of subjective firstperson singular pronouns ≤0.5 SD below M. Average use of subjective first-person singular pronouns ≥0.5 SD below M and ≤0.5 SD above M. High use of subjective first-person singular pronouns ≥0.5 SD above M. 1b Focus in written reflections from content analysis by use of objective firstperson singular pronouns. Table 2 Predicting first-person singular pronoun use in written reflection by self-reported and physiological stress in first VR teaching session. Subjective pronouns Objective pronouns β p 95% CI β p 95% CI Model 1 Intercept 0.74 0.110 [-0.16, 1.65] 0.17 0.700 [-0.68, 1.02] Self-reported stress 0.21 0.100 [-0.04, 0.45] 0.20 0.160 [-0.08, 0.47] Gender 0.28* 0.020 [ 0.05, 0.51] 0.23* 0.040 [ 0.01, 0.45] R2 0.12 0.09 Model 2 Intercept 0.47 0.240 [-0.31, 1.24] − 0.06 0.850 [-0.66, 0.54] Physiological stress 0.35*** 0.000 [ 0.13, 0.57] 0.32* 0.010 [ 0.09, 0.55] Gender 0.24 0.030 [0.02, 0.47] 0.20 0.110 [-0.04, 0.44] R2 0.18 0.14 Note. Coefficients are standardized. Gender: 0 = female. Table 3 Predicting self-reported and physiological stress in subsequent VR teaching session by use of first-person singular pronouns in written reflection of previous VR teaching session. β p 95% CI β p 95% CI Self-reported stress VR2 Model 3a Model 3b Intercept 1.38* 0.020 [ 0.24, 2.52] 1.20* 0.040 [ 0.05, 2.34] Self-rep. stress VR1 0.37*** <0.001 [ 0.12, 0.61] 0.33* 0.010 [ 0.10, 0.57] Class size in VR2 − 0.16 0.190 [-0.39, 0.08] − 0.10 0.410 [-0.35, 0.14] Subj. pronouns VR1 0.06 0.650 [-0.22, 0.35] Obj. pronouns VR1 0.29* 0.030 [ 0.02, 0.55] Gender 0.07 0.590 [-0.19, 0.34] 0.04 0.770 [-0.20, 0.27] R2 0.18 0.23 Physiological stress VR2 Model 4a Model 4b Intercept − 1.29*** <0.001 [-1.89, − 0.69] − 1.17*** <0.001 [-1.74, − 0.60] Phys. stress VR1 0.26*** <0.001 [ 0.09, 0.42] 0.25*** <0.001 [ 0.09, 0.41] Class size in VR2 0.83*** <0.001 [ 0.75, 0.92] 0.84*** <0.001 [ 0.75, 0.93] Subj. pronouns VR1 0.18* 0.040 [0.01, 0.35] Obj. pronouns VR1 0.17 0.060 [-0.01, 0.35] Gender 0.05 0.560 [-0.12, 0.22] 0.05 0.510 [-0.11, 0.21] R2 0.72 0.71 Note. Coefficients are standardized. Gender: 0 = female. Class size: 0 = small. A. Westphal et al. Computers & Education 212 (2024) 104987 10 Our results also indicate that student teachers who experienced more physiological stress when teaching in the VR classroom used more subjective and objective first-person singular pronouns in their written reflections. This finding is consistent with research showing that negative affective experiences may provoke the use of subjective and objective first-person singular pronouns as a way to process negative self-relevant information (Berry-Blunt et al., 2021; Klauke et al., 2020; Kowalski, 2000). However, given their cross-sectional nature, our results could also indicate that student teachers who use less linguistic distancing—i.e., who are more immersed into a situation, indicated by a greater use of subjective and objective first-person singular pronouns—experience higher levels of negative affect, which is also in line with previous findings (Shahane et al., 2023). Our study is the first to confirm that this association can be replicated in the context of student teachers’ reflections on their own teaching. Our results further amplify existing research by revealing that this relationship generalizes to a physiological indicator of negative affect, namely to individuals’ heartrates. In terms of gender differences, our results suggested that student teachers who identified as male used more subjective and objective first-person singular pronouns than student teachers who identified as female. These gender differences disappeared when controlling for physiological stress experienced during the VR teaching session. The finding that men used subjective and objective first-person singular pronouns more frequently than women is not in line with related research that shows a greater tendency in women to ruminatively self-focus when depressed, and thus experiencing high levels of negative affect (Johnson & Whisman, 2013). It has, however, been suggested that men’s use of subjective and objective first-person singular pronouns is an indicator of high-arousal negative distress, while women’s use of first-person singular pronouns is driven by low-arousal negative distress (Tackman et al., 2019). In our study, student teachers were reflecting on a teaching situation that had the potential to elicit high-arousal negative distress. Indeed, we found that, when controlling for physiological stress experienced during the VR session, gender differences in the use of subjective and objective first-person singular pronouns disappeared. These results further support the notion that the use of first-person singular pronouns may be an indicator of different affective experiences in women and men (Fast & Funder, 2010). In addition, we found that greater use of subjective first-person singular pronouns led to higher physiological stress in the subsequent VR session. Thus, we found some indication that student teachers who took a more distanced perspective experienced reduced future stress (as suggested by Berry-Blunt et al., 2021; Zimmermann et al., 2016). This is in line with research showing that individuals who spontaneously use more linguistic distancing when reflecting on negative and positive events report lower levels of stress in these and in subsequent situations, and overall greater well-being (Shahane et al., 2023). Despite the fact that the use of subjective and objective first-person singular pronouns may be a strategy that student teachers use to process negative teaching experiences, this strategy—referred to as rumination—is considered maladaptive (e.g., Mor & Winquist, 2002). Rumination—i.e., the strategy of regulating negative mood by repeatedly focusing one’s attention on one’s own negative experiences, and the causes and effects (Nolen-Hoksema, 1991)—has been associated with depression (Hong, 2007), inefficient problem-solving, and lower self-efficacy (Lyubomirsky et al., 2003; Reindl et al., 2020). Teachers who ruminate more experience higher levels of stress in the classroom and are more susceptible to burnout (Koˇsir et al., 2015). We assessed naturally occurring differences in the use of subjective and objective first-person singular pronouns and may therefore have underestimated the benefits of taking a more distanced perspective. Future studies with greater sample sizes and power should aim to explore whether a similar effect might emerge for objective first-person pronouns, for which we found a marginally significant p-value. In contrast, our data did not support the association between self-reported negative affect and the use of subjective and objective first-person singular pronouns. Berry-Blunt et al. (2021) proposed that some psychometric units, i.e., “facets, nuances, and items” (p. 8) might capture I-talk better than others; our self-report measure of stress may not have been ideal in this respect. Moreover, the self-report was assessed after the VR session, which potentially led to lower congruence between physiological and self-reported stress responses than when self-report is assessed continuously during the stressful situation (Campbell & Ehlert, 2012). 4.1. Pedagogical implications While reflection can improve student teachers’ professional vision, and is therefore seen as an important tool in teacher education (e.g., Stürmer et al., 2013; Weber et al., 2020), less is known about its potential to assist adaptive emotion regulation strategies that teachers need in order to be able to cope with challenging classroom events (Chang, 2009). Reappraising a challenging situation is seen as an effective strategy (Gross, 2002) by which teachers change how they think about an event and thereby decrease its emotional impact (Chang, 2009; Gross, 2022). When engaging in reappraisal, teachers may reduce their use of first-person singular pronouns, indicating their greater psychological distance to a challenging situation (Nook et al., 2020). Our findings indicate that an increased self-focus in student teachers’ written reflections—as indicated by a more frequent use of subjective first-person singular pronouns—is associated with greater physiological stress. Automated feedback systems could build on this finding by identifying student teachers who repeatedly experience elevated stress and are thus at risk for depression and burnout. This could complement feedback on the quality of their written reflections (Wulff et al., 2022, 2023). We found some indication that taking a more distanced perspective—as indicated by less frequent use of subjective first-person pronouns—reduces future stress (as suggested by Berry-Blunt et al., 2021; Shahane et al., 2023; Zimmermann et al., 2016). Practicing taking a more distanced perspective on negative events is not only seen as an adaptive emotion-regulation strategy (Kross & Ayduk, 2008), it may over time change a student teacher’s tendency to experience stress (for a similar suggestion outside the context of teacher education, see Berry-Blunt et al., 2021). A structured practice of reappraisal can facilitate adaptive emotion regulation (Christou-Champi et al., 2015). Thus, training student teachers to use more reappraisal and put more distance between themselves and challenging classroom situations when reflecting on their teaching could be a viable strategy to help them cope with stress. In addition, Ehring (2020) suggests that ruminative thinking, i.e., focusing one’s attention on one’s own negative experiences, can be transformed into more adaptive information processing by focusing attention on A. Westphal et al. Computers & Education 212 (2024) 104987 11 physical reactions and emotions in a specific situation and fostering self-compassion, which has been shown to be incompatible with ruminative thinking (Watkins, 2016). Combining video-based reflection on one’s own teaching with reappraisal and mindfulness-based strategies could be a promising way to foster student teachers’ professional vision, as well as their well-being and stress-resistance. 4.2. Limitations and future research The current study has some limitations. The sample size of the study was small. Our results should therefore be replicated using a larger sample, which could more effectively detect small effects. By providing a highly standardized setting, the VR classroom increases the internal validity of our research findings, which may come at the cost of ecological validity. It has been argued that VR creates a perceptual illusion and “the real power of VR […] [is that] even though you know it is an illusion, this does not change your perception or your response to it” (Slater, 2018, p. 2). Some features of the VR environment, such as a realistic display of the environment, a smooth display of motion and view changes, and control of behaviors, are seen as essential to increase the likelihood of optimal learning in VR (Dalgarno & Lee, 2010; Delamarre et al., 2021). Prior studies showed that student teachers perceived our VR classroom as realistic and authentic Wiepke et al., 2019, 2021. Student teachers trained in our VR classroom showed similar reflection processes compared to students reflecting on real classroom videos and showed a substantial increase in reflection-related self-efficacy over time (Richter et al., 2022). Nevertheless, more validation studies are needed to evaluate the transferability of the positive results of the participation in a VR learning setting to authentic classrooms. Moreover, future studies should investigate whether our findings are generalizable to non-virtual classroom environments and to in-service teachers. Studies should also incorporate further self-report measures of negative affect to “identify […] the smaller psychometric units (e.g., trait facets, nuances, and items) that best capture I-talk” (Berry-Blunt et al., 2021, p. 8). To better understand the temporal dynamics between negative affect and self-focused attention, a longitudinal study with multiple measurements is necessary. Such a study design could help explain the extent to which situation-specific and personal characteristics play a role in the interplay between the use of subjective and objective first-person singular pronouns and negative affect. The extent to which student teachers can be trained to more professionally process negative events could be explored by experimentally manipulating the ways in which student teachers describe and evaluate negative classroom events—taking either a distanced or a self-immersed perspective—by prompting student teachers to use distanced vs. self-referential language or by instructing them to reframe negative events vs. self-immerse in their emotions (see also Nook et al., 2017). Intervention studies could be a promising approach to help identify how reflection could be implemented in a way that is beneficial for student teachers’ professional vision and their emotion regulation, without overwhelming them. 5. Conclusions Thanks to a standardized VR classroom environment, our study is the first to provide evidence that student teachers’ self-focus in their written reflections is linked to the stress they experience while teaching. Our multimodal assessment of stress—based on student teachers’ self-reports and heartrate responses—allowed for a differentiated approach to studying emotions in the VR learning environment. Not only can we show that the association between negative affect and self-focus—measured via I-talk—holds in student teachers’ written reflections on their own teaching, but our study also adds to previous findings by showing that this link can be generalized to individuals’ heartrates, representing a physiological indicator of negative affect. These results point to the potential that reflecting on one’s own teaching may have for practicing adaptive emotion regulation strategies in teacher education programs. Credit author statement AW: Conceptualization. Formal analysis. Writing – original draft, Reviewing and Editing, ER: Conceptualization. Investigation. Data curation. Project administration. Writing- Reviewing and Editing, RL: Writing- Reviewing and Editing, YH: Investigation, Project administration. Declaration of competing interest None. Data availability The authors do not have permission to share data. A. Westphal et al. Computers & Education 212 (2024) 104987 12 APPENDIX Table A.1 Descriptive statistics for baseline heartrate and heartrate in VR teaching session N M SD Min Max Baseline BPM T1 42 96.92 30.88 44.41 173.62 Baseline BPM T2 50 102.37 30.03 40.34 175.88 BPM in VR session T1 57 161.14 20.44 125.02 196.45 BPM in VR session T2 55 160.65 20.00 115.57 196.59 Note. Measures used to compute physiological stress, i.e., difference in heartrate between baseline and VR session. Table A.2 Predicting self-reported stress in subsequent VR teaching session by physiological stress and use of firstperson singular pronouns in written reflection of previous VR teaching session β p 95% CI Self-reported stress VR2 Model 5a Intercept 0.39 0.560 [-0.93, 1.71] Self-reported stress VR1 0.31* 0.010 [ 0.06, 0.55] Physiological stress VR1 0.29* 0.040 [ 0.01, 0.57] Class size in VR2 − 0.06 0.640 [-0.31, 0.19] Objective pronouns VR1 0.24 0.110 [-0.05, 0.54] Gender 0.06 0.620 [-0.18, 0.30] R2 0.28 Note. Coefficients are standardized. Gender: 0 = female. Class size: 0 = small. Fig. A1. VR Classroom from the perspective of student teachers. A. Westphal et al. Computers & Education 212 (2024) 104987 13 Fig. A.2. Student teacher teaching in VR Classroom. References Bernard, J. D., Baddeley, J. L., Rodriguez, B. F., & Burke, P. A. (2016). Depression, language, and affect: An examination of the influence of baseline depression and affect induction on language. Journal of Language and Social Psychology, 35(3), 317–326. https://doi.org/10.1177/0261927X15589186 Berry-Blunt, A. K., Holtzman, S. H., Donnellan, M. B., & Mehl, M. R. (2021). The story of “I” tracking: Psychological implications of self-referential language use. Social and Personality Psychology Compass, 15(2), Article e12647. https://doi.org/10.1111/spc3.12647 Borko, H. (2004). Professional development and teacher learning: Mapping the terrain. Educational Researcher, 33(8), 3–15, 10.3102%2F0013189X033008003. Borko, H. (2016). Methodological contributions to video-based studies of classroom teaching and learning: A commentary. ZDM, 48(1), 213–218, 10/gfs2vk. Borko, H., Jacobs, J., Eiteljorg, E., & Pittman, M. E. (2008). Video as a tool for fostering productive discussions in mathematics professional development. Teaching and Teacher Education, 24(2), 417–436. https://doi.org/10.1016/j.tate.2006.11.012 Campbell, J., & Ehlert, U. (2012). Acute psychosocial stress: Does the emotional stress response correspond with physiological responses? Psychoneuroendocrinology, 37(8), 1111–1134. https://doi.org/10.1016/j.psyneuen.2011.12.010 Chang, M. L. (2009). An appraisal perspective of teacher burnout: Examining the emotional work of teachers. Educational Psychology Review, 21, 193–218. https://doi. org/10.1007/s10648-009-9106-y Chernikova, O., Heitzmann, N., Fink, M. C., Timothy, V., Seidel, T., Fischer, F., & DFG Research group COSIMA.. (2020). Facilitating diagnostic competences in higher education - a meta-analysis in medical and teacher education. Educational Psychology Review, 32, 157–196. https://doi.org/10.1007/s10648-019-09492-2 Christou-Champi, S., Farrow, T. F., & Webb, T. L. (2015). Automatic control of negative emotions: Evidence that structured practice increases the efficiency of emotion regulation. Cognition & Emotion, 29(2), 319–331. https://doi.org/10.1080/02699931.2014.901213 Dalgarno, B., & Lee, M. J. (2010). What are the learning affordances of 3-D virtual environments? British Journal of Educational Technology, 41(1), 10–32. https://doi. org/10.14221/ajte.2016v41n1.8 Delamarre, A., Shernoff, E., Buche, C., Frazier, S., Gabbard, J., & Lisetti, C. (2021). The interactive virtual training for teachers (IVT-T) to practice classroom behavior management. International Journal of Human-Computer Studies, 152, Article 102646. https://doi.org/10.1016/j.ijhcs.2021.102646 Delaney, J. P. A., & Brodie, D. A. (2000). Effects of short-term psychological stress on the time and frequency domains of heart-rate variability. Perceptual and Motor Skills, 91(2), 515–524. https://doi.org/10.2466/pms.2000.91.2.515 Dunnack, E. S., & Park, C. L. (2009). The effect of an expressive writing intervention on pronouns: The surprising case of I. Journal of Loss & Trauma, 14(6), 436–446. https://doi.org/10.1080/15325020902925084 Edwards, T., & Holtzman, N. S. (2017). A meta-analysis of correlations between depression and first singular pronoun use. Journal of Research in Personality, 68, 63–68. https://doi.org/10.1016/j.jrp.2017.02.005 Ehring, T. (2020). Die ruminationsfokussierte Kognitive Verhaltenstherapie [Rumination-focused cognitive-Behavioral Therapy]. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 68(3), 150–159. https://doi.org/10.1024/1661-4747/a000414 Enders, C. K. (2001). The impact of nonnormality on full information maximum-likelihood estimation for structural equation models with missing data. Psychological Methods, 6, 352–370. https://doi.org/10.1037/1082-989X.6.4.352 Exner, J. E., Jr. (1973). The self focus sentence completion: A study of egocentricity. Journal of Personality Assessment, 37(5), 437–455. https://doi.org/10.1080/ 00223891.1973.10119902 Fast, L. A., & Funder, D. C. (2010). Gender differences in the correlates of self-referent word use: Authority, entitlement, and depressive symptoms. Journal of Personality, 78, 313–338. https://doi.org/10.1111/j.1467-6494.2009.00617.x Fenigstein, A., Scheier, M. F., & Buss, A. H. (1975). Public and private self-consciousness: Assessment and theory. Journal of Consulting and Clinical Psychology, 43(4), 522–527. https://doi.org/10.1037/h0076760 Goddard, R., O’brien, P., & Goddard, M. (2006). Work environment predictors of beginning teacher burnout. British Educational Research Journal, 32(6), 857–874. https://doi.org/10.1080/01411920600989511Gold,B.,&Windscheid. J. (2020). Observing 360-degree classroom videos – Effects of video type on presence, emotions, workload, classroom observations, and ratings of teaching quality. Computers & Education, 156, 103960. Gold, B., & Windscheid, J. (2020). Observing 360-degree classroom videos–Effects of video type on presence, emotions, workload, classroom observations, and ratings of teaching quality. Computers & Education, 156, 103960. https://doi.org/10.1016/j.compedu.2020.103960. Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281–291, 10.1017.S0048577201393198. Hallquist, M. N., & Wiley, J. F. (2018). MplusAutomation: An R package for facilitating large-scale latent variable analyses in Mplus. Structural Equation Modeling: A Multidisciplinary Journal, 25(4), 621–638. https://doi.org/10.1080/10705511.2017.1402334 Hong, R. Y. (2007). Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behavior Research and Therapy, 45 (2), 277–290. https://doi.org/10.1016/j.brat.2006.03.006 Huang, Y., Richter, E., Kleickmann, T., & Richter, D. (2022). Class size affects preservice teachers’ physiological and psychological stress reactions: An experiment in a virtual reality classroom. Computers & Education, 184, 104503. https://doi.org/10.1016/j.compedu.2022.104503. Huang, Y., Richter, E., Kleickmann, T., Wiepke, A., & Richter, D. (2021). Classroom complexity affects student teachers’ behavior in a VR classroom. Computers & Education, 163, 104100. https://doi.org/10.1016/j.compedu.2020.104100. Hultell, D., Melin, B., & Gustavsson, J. P. (2013). Getting personal with teacher burnout: A longitudinal study on the development of burnout using a person-based approach. Teaching and Teacher Education, 32, 75–86. https://doi.org/10.1016/j.tate.2013.01.007 James, W. (1890). The principles of psychology. New York, NY: Holt & Co. Johnson, D. P., & Whisman, M. A. (2013). Gender differences in rumination: A meta-analysis. Personality and Individual Differences, 55, 367–374. https://doi.org/ 10.1016/j.paid.2013.03.019 Ke, F., & Xu, X. (2020). Virtual reality simulation-based learning of teaching with alternative perspectives taking. British Journal of Educational Technology, 51(6), 2544–2557. https://doi.org/10.1111/bjet.12936 A. Westphal et al. Computers & Education 212 (2024) 104987 14 Kern, M. L., Eichstaedt, J. C., Schwartz, H. A., Dziurzynski, L., Ungar, L. H., Stillwell, D. J., Kosinski, M., Ramones, S. M., & Seligman, M. E. P. (2014). The online social self: An open vocabulary approach to personality. Assessment, 21(2), 158–169. https://doi.org/10.1177/1073191113514104 Klauke, F., Müller-Frommeyer, L. C., & Kauffeld, S. (2020). Writing about the silence: Identifying the language of ostracism. Journal of Language and Social Psychology, 39(5–6), 751–763. https://doi.org/10.1177/0261927X19884599 Kleinknecht, M. (2021). Emotionen von Lehrkraften ¨ in unterrichtsvideobasierten Fortbildungen [Teachers’ emotions in video-based training]. In M. Gl¨ aser-Zikuda, F. Hofmann, & V. Frederking (Eds.), Emotionen im Unterricht: Psychologische, padagogische ¨ und fachdidaktische Perspektiven [Emotions in the classroom: Psychological, pedagogical and didactical perspectives] (pp. 231–243). Stuttgart, Germany: Kohlhammer Verlag, 2021. Kleinknecht, M., & Groschner, ¨ A. (2016). Fostering preservice teachers’ noticing with structured video feedback: Results of an online- and video-based intervention study. Teaching and Teacher Education, 59, 45–56. https://doi.org/10.1016/j.tate.2016.05.020 Kleinknecht, M., & Schneider, J. (2013). What do teachers think and feel when analyzing videos of themselves and other teachers teaching? Teaching and Teacher Education, 33, 13–23. https://doi.org/10.1016/j.tate.2013.02.002 Koˇsir, K., Tement, S., Licardo, M., & Habe, K. (2015). Two sides of the same coin? The role of rumination and reflection in elementary school teachers’ classroom stress and burnout. Teaching and Teacher Education, 47, 131–141. Kowalski, R. M. (2000). “I was only kidding!” Victims’ and perpetrators’ perceptions of teasing. Personality and Social Psychology Bulletin, 26, 231–241. https://doi. org/10.1177/0146167200264009 Kross, E., & Ayduk, O. (2008). Facilitating adaptive emotional analysis: Distinguishing distanced-analysis of depressive experiences from immersed-analysis and distraction. Personality and Social Psychology Bulletin, 34(7), 924–938, 10.1177%2F0146167208315938. Kross, E., Bruehlman-Senecal, E., Park, J., Burson, A., Dougherty, A., Shablack, H., Bremner, R., Moser, J., & Ayduk, O. (2014). Self-talk as a regulatory mechanism: How you do it matters. Journal of Personality and Social Psychology, 106(2), 304–324. https://doi.org/10.1037/a0035173 Lin, Y. C. (2023). Using virtual classroom simulations in a mathematics methods course to develop pre-service primary mathematics teachers’ noticing skills. British Journal of Educational Technology, 54(3), 734–753. https://doi.org/10.1111/bjet.13291 Little, R. J. A. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202. https://doi.org/10.2307/2290157 Lohse-Bossenz, H., Schonknecht, ¨ L., & Brandtner, M. (2019). Entwicklung und Validierung eines Fragebogens zur Erfassung Reflexionsbezogener Selbstwirksamkeit von Lehrkraften ¨ im Vorbereitungsdienst [Development and validation of a questionnaire assessing pre-service teachers’ self-efficacy in reflection]. Empirische Padagogik, ¨ 33(2), 164–179. Lugrin, J.-L., Latoschik, M. E., Habel, M., Roth, D., Seufert, C., & Grafe, S. (2016). Breaking bad behaviors: A new tool for learning classroom management using virtual reality. Frontiers in ICT, 3(26). https://doi.org/10.3389/fict.2016.00026 Lyubomirsky, S., Kasri, F., & Zehm, K. (2003). Dysphoric rumination impairs concentration on academic tasks. Cognitive Therapy and Research, 27(3), 309–330. https://doi.org/10.1023/A:1023918517378 Mehl, M. R., Gosling, S. D., & Pennebaker, J. W. (2006). Personality in its natural habitat: Manifestations and implicit folk theories of personality in daily life. Journal of Personality and Social Psychology, 90(5), 862–877. https://doi.org/10.1037/0022-3514.90.5.862 Mor, N., & Winquist, J. (2002). Self-focused attention and negative affect: A meta-analysis. Psychological Bulletin, 128(4), 638–662. https://doi.org/10.1037/0033- 2909.128.4.638 Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569–582. https://doi.org/10.1037/0021-843X.100.4.569 Nook, E. C., Schleider, J. L., & Somerville, L. H. (2017). A linguistic signature of psychological distancing in emotion regulation. Journal of Experimental Psychology: General, 146(3), 337–346. https://doi.org/10.1037/xge0000263 Nook, E. C., Vidal Bustamante, C. M., Cho, H. Y., & Somerville, L. H. (2020). Use of linguistic distancing and cognitive reappraisal strategies during emotion regulation in children, adolescents, and young adults. Emotion, 20(4), 525. https://doi.org/10.1037/emo0000570 Pendergast, D., O’Brien, M., Prestridge, S., & Exley, B. (2022). Self-efficacy in a 3-dimensional virtual reality classroom—initial teacher education students’ experiences. Education Sciences, 12(6), 368. https://doi.org/10.3390/educsci12060368 Prilop, C. N., Weber, K. E., & Kleinknecht, M. (2021). The role of expert feedback in the development of pre-service teachers’ professional vision of classroom management in an online blended learning environment. Teaching and Teacher Education, 99, Article 103276. https://doi.org/10.1016/j.tate.2020.103276 Reindl, M., Tulis, M., & Dresel, M. (2020). Profiles of emotional and motivational self-regulation following errors: Associations with learning. Learning and Individual Differences, 77, Article 101806. https://doi.org/10.1016/j.lindif.2019.101806 Remacle, A., Bouchard, S., & Morsomme, D. (2023). Can teaching simulations in a virtual classroom help trainee teachers to develop oral communication skills and self-efficacy? A randomized controlled trial. Computers & Education, 200, Article 104808. https://doi.org/10.1016/j.compedu.2023.104808 Richter, E., Hußner, I., Huang, Y., Richter, D., & Lazarides, R. (2022). Video-based reflection in teacher education: Comparing virtual reality and real classroom videos. Computers & Education, 24(3), Article 104601. https://doi.org/10.1016/j.compedu.2022.104601 Rude, S., Gortner, E.-M., & Pennebaker, J. W. (2004). Language use of depressed and depression-vulnerable college students. Cognition & Emotion, 18(8), 1121–1133. https://doi.org/10.1080/02699930441000030 Seidel, T., Stürmer, K., Blomberg, G., Kobarg, M., & Schwindt, K. (2011). Teacher learning from analysis of videotaped classroom situations: Does it make a difference whether teachers observe their own teaching or that of others? Teaching and Teacher Education, 27(2), 259–267. https://doi.org/10.1016/j.tate.2010.08.009 Seufert, C., Oberdorfer, ¨ S., Roth, A., Grafe, S., Lugrin, J. L., & Latoschik, M. E. (2022). Classroom management competency enhancement for student teachers using a fully immersive virtual classroom. Computers & Education, 179, Article 104410. https://doi.org/10.1016/j.compedu.2021.104410 Shahane, A. D., Godfrey, D. A., & Denny, B. T. (2023). Predicting real-world emotion and health from spontaneously assessed linguistic distancing using novel scalable technology. Emotion. Advance online publication. https://doi.org/10.1037/emo0001211 Stürmer, K., Konings, ¨ K. D., & Seidel, T. (2013). Declarative knowledge and professional vision in teacher education: Effect of courses in teaching and learning. British Journal of Educational Psychology, 83(3), 467–483. https://doi.org/10.1111/j.2044-8279.2012.02075.x Tackman, A. M., Sbarra, D. A., Carey, A. L., Donnellan, M. B., Horn, A. B., Holtzman, N. S., Edwards, T. S., Pennebaker, J. W., & Mehl, M. R. (2019). Depression, negative emotionality, and self-referential language: A multi-lab, multi-measure, and multi-language-task research synthesis. Journal of Personality and Social Psychology, 116(5), 817–834. https://doi.org/10.1037/pspp0000187 Tierney, N., Cook, D., McBain, M., & Fay, C. (2021). naniar: Data structures, summaries, and visualisations for missing data. R package version 0.6.1 https://CRAN.Rproject.org/package=naniarv. van Es, E. A., & Sherin, M. G. (2002). Learning to notice: Scaffolding new teachers’ interpretations of classroom interactions. Journal of Technology and Teacher Education, 10(4), 571–596. https://www.learntechlib.org/primary/p/9171/. van Es, E. A., & Sherin, M. G. (2008). Mathematics teachers’ “learning to notice” in the context of a video club. Teaching and Teacher Education, 24(2), 244–276. https://doi.org/10.1016/j.tate.2006.11.005 Voss, T., & Kunter, M. (2020). “Reality shock” of beginning teachers? Changes in teacher candidates’ emotional exhaustion and constructivist-oriented beliefs. Journal of Teacher Education, 71(3), 292–306. https://doi.org/10.1177/0022487119839700 Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. New York: Guilford. Weber, K. E., Prilop, C. N., Viehoff, S., Gold, B., & Kleinknecht, M. (2020). Fordert ¨ eine videobasierte intervention im praktikum die professionelle wahrnehmung von Klassenführung?—eine quantitativ-inhaltsanalytische messung von Subprozessen professioneller wahrnehmung [does a video-based practicum intervention provide a realistic picture of classroom management? A quantitative content analysis of the subprocesses of professional awareness]. Zeitschrift für Erziehungswissenschaft, 23, 343–365. https://doi.org/10.1007/s11618-020-00939-9 Wegner, D. M., & Giuliano, T. (1980). Arousal-induced attention to self. Journal of Personality and Social Psychology, 38(5), 719–726. https://doi.org/10.1037/0022- 3514.38.5.719 A. Westphal et al. Computers & Education 212 (2024) 104987 15 Westphal, A., Kalinowski, E., Hoferichter, C. J., & Vock, M. (2022). K− 12 teachers’ stress and burnout during the COVID-19 pandemic: A systematic review. Frontiers in psychology, 13, 920326. https://doi.org/10.3389/fpsyg.2022.920326. Wickham, H. (2019). stringr: Simple, consistent wrappers for common string operations. R package version 1.4.0. https://CRAN.R-project.org/package=stringr. Wiepke, A., Heinemann, B., Lucke, U., & Schroeder, U. (2021). Jenseits des eigenen Klassenzimmers: Perspektiven & Weiterentwicklungen des VR-Klassenzimmers [Beyond the own classroom: Perspectives & further developments of the VR classroom.]. DELFI 2021 - Die 19. Fachtagung Bildungstechnologien [Educational technologies symposium], 331–336. http://dl.gi.de/handle/20.500.12116/37031. Wolff, C. E., Jarodzka, H., van den Bogert, N., & Boshuizen, H. P. A. (2016). Teacher vision: Expert and novice teachers’ perception of problematic classroom management scenes. Instructional Science, 44(3), 243–265, 10/f8tcpm. Wulff, P., Westphal, A., Mientus, L., Nowak, A., & Borowski, A. (2023, January). Enhancing writing analytics in science education research with machine learning and natural language processing—Formative assessment of science and non-science preservice teachers’ written reflections. In Frontiers in Education, 7, Article 1061461. https://doi.org/10.3389/feduc.2022.1061461. Frontiers. Wulff, P., Buschhüter, D., Westphal, A., Mientus, L., Nowak, A., & Borowski, A. (2022). Bridging the gap between qualitative and quantitative assessment in science education research with machine learning—A case for pretrained language models-based clustering. Journal of Science Education and Technology, 31(4), 490–513. https://doi.org/10.1007/s10956-022-09969-w. Yarkoni, T. (2010). Personality in 100,000 words: A large-scale analysis of personality and word use among bloggers. Journal of Research in Personality, 44(3), 363–373. https://doi.org/10.1016/j.jrp.2010.04.001 Yee, N., Harris, H., Jabon, M., & Bailenson, J. N. (2011). The expression of personality in virtual worlds. Social Psychological and Personality Science, 2(1), 5–12. https://doi.org/10.1177/1948550610379056 Zhang, M., Lundeberg, M., Koehler, M. J., & Eberhardt, J. (2011). Understanding affordances and challenges of three types of video for teacher professional development. Teaching and Teacher Education, 27(2), 454–462. https://doi.org/10.1016/j.tate.2010.09.015 Zimmermann, J., Brockmeyer, T., Hunn, M., Schauenburg, H., & Wolf, M. (2016). First-person pronoun use in spoken language as a predictor of future depressive symptoms: Preliminary evidence from a clinical sample of depressed patients. Clinical Psychology & Psychotherapy, 24(2), 384–391. https://doi.org/10.1002/ cpp.2006 Wiepke, A., Richter, E., Zender, R., & Richter, D. (2019). Einsatz von Virtual Reality zum Aufbau von Klassenmanagement-Kompetenzen im Lehramtsstudium [Use of virtual reality for training student teachers’ classroom management competencies]. DELFI, 2019. https://doi.org/10.18420/delfi2019_319 A. Westphal et al. View publication stats
USER:
What are the negative and positive aspects of virtual teaching for the instructors?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 21 | 13 | 11,323 | null | 651 |
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
|
What is the technical difference between a VPN and an Extranet, and how do both get utilized safely in an enterprise environment without breaking connections between computers?
|
2.3 VPNs and Extranets The term 'extranet' is commonly used to refer to a scenario whereby two or more companies have networked access to a limited amount of each other's corporate data. For example a manufacturing company might use an extranet for its suppliers to allow it to query databases for the pricing and availability of components, and then to order and track the status of outstanding orders. Another example is joint software development, for instance, company A allows one development group within company B to access its operating system source code, and company B allows one development group in company A to access its security software. Note that the access policies can get arbitrarily complex. For example company B may internally restrict access to its security software to groups in certain geographic locations to comply with export control laws, for example. A key feature of an extranet is thus the control of who can access what data, and this is essentially a policy decision. Policy decisions are typically enforced today at the interconnection points between different domains, for example between a private network and the Internet, or between a software test lab and the rest of the company network. The enforcement may be done via a firewall, router with access list functionality, application gateway, or any similar device capable of applying policy to transit traffic. Policy controls may be implemented within a corporate network, in addition to between corporate networks. Also the interconnections between networks could be a set of bilateral links, or could be a separate network, perhaps maintained by an industry consortium. This separate network could itself be a VPN or a physical network. Introducing VPNs into a network does not require any change to this model. Policy can be enforced between two VPNs, or between a VPN and the Internet, in exactly the same manner as is done today without VPNs. For example two VPNs could be interconnected, which each administration locally imposing its own policy controls, via a firewall, on all traffic that enters its VPN from the outside, whether from another VPN or from the Internet. This model of a VPN provides for a separation of policy from the underlying mode of packet transport used. For example, a router may direct voice traffic to ATM Virtual Channel Connections (VCCs) for guaranteed QoS, non-local internal company traffic to secure tunnels, and other traffic to a link to the Internet. In the past the secure tunnels may have been frame relay circuits, now they may also be secure IP tunnels or MPLS Label Switched Paths (LSPs) Gleeson, et al. Informational [Page 9] RFC 2764 IP Based Virtual Private Networks February 2000 Other models of a VPN are also possible. For example there is a model whereby a set of application flows is mapped into a VPN. As the policy rules imposed by a network administrator can get quite complex, the number of distinct sets of application flows that are used in the policy rulebase, and hence the number of VPNs, can thus grow quite large, and there can be multiple overlapping VPNs. However there is little to be gained by introducing such new complexity into a network. Instead a VPN should be viewed as a direct analogue to a physical network, as this allows the leveraging of existing protocols and procedures, and the current expertise and skill sets of network administrators and customers.
|
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> What is the technical difference between a VPN and an Extranet, and how do both get utilized safely in an enterprise environment without breaking connections between computers? <TEXT> 2.3 VPNs and Extranets The term 'extranet' is commonly used to refer to a scenario whereby two or more companies have networked access to a limited amount of each other's corporate data. For example a manufacturing company might use an extranet for its suppliers to allow it to query databases for the pricing and availability of components, and then to order and track the status of outstanding orders. Another example is joint software development, for instance, company A allows one development group within company B to access its operating system source code, and company B allows one development group in company A to access its security software. Note that the access policies can get arbitrarily complex. For example company B may internally restrict access to its security software to groups in certain geographic locations to comply with export control laws, for example. A key feature of an extranet is thus the control of who can access what data, and this is essentially a policy decision. Policy decisions are typically enforced today at the interconnection points between different domains, for example between a private network and the Internet, or between a software test lab and the rest of the company network. The enforcement may be done via a firewall, router with access list functionality, application gateway, or any similar device capable of applying policy to transit traffic. Policy controls may be implemented within a corporate network, in addition to between corporate networks. Also the interconnections between networks could be a set of bilateral links, or could be a separate network, perhaps maintained by an industry consortium. This separate network could itself be a VPN or a physical network. Introducing VPNs into a network does not require any change to this model. Policy can be enforced between two VPNs, or between a VPN and the Internet, in exactly the same manner as is done today without VPNs. For example two VPNs could be interconnected, which each administration locally imposing its own policy controls, via a firewall, on all traffic that enters its VPN from the outside, whether from another VPN or from the Internet. This model of a VPN provides for a separation of policy from the underlying mode of packet transport used. For example, a router may direct voice traffic to ATM Virtual Channel Connections (VCCs) for guaranteed QoS, non-local internal company traffic to secure tunnels, and other traffic to a link to the Internet. In the past the secure tunnels may have been frame relay circuits, now they may also be secure IP tunnels or MPLS Label Switched Paths (LSPs) Gleeson, et al. Informational [Page 9] RFC 2764 IP Based Virtual Private Networks February 2000 Other models of a VPN are also possible. For example there is a model whereby a set of application flows is mapped into a VPN. As the policy rules imposed by a network administrator can get quite complex, the number of distinct sets of application flows that are used in the policy rulebase, and hence the number of VPNs, can thus grow quite large, and there can be multiple overlapping VPNs. However there is little to be gained by introducing such new complexity into a network. Instead a VPN should be viewed as a direct analogue to a physical network, as this allows the leveraging of existing protocols and procedures, and the current expertise and skill sets of network administrators and customers. https://rfc-editor.org/rfc/rfc2764
|
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
EVIDENCE:
2.3 VPNs and Extranets The term 'extranet' is commonly used to refer to a scenario whereby two or more companies have networked access to a limited amount of each other's corporate data. For example a manufacturing company might use an extranet for its suppliers to allow it to query databases for the pricing and availability of components, and then to order and track the status of outstanding orders. Another example is joint software development, for instance, company A allows one development group within company B to access its operating system source code, and company B allows one development group in company A to access its security software. Note that the access policies can get arbitrarily complex. For example company B may internally restrict access to its security software to groups in certain geographic locations to comply with export control laws, for example. A key feature of an extranet is thus the control of who can access what data, and this is essentially a policy decision. Policy decisions are typically enforced today at the interconnection points between different domains, for example between a private network and the Internet, or between a software test lab and the rest of the company network. The enforcement may be done via a firewall, router with access list functionality, application gateway, or any similar device capable of applying policy to transit traffic. Policy controls may be implemented within a corporate network, in addition to between corporate networks. Also the interconnections between networks could be a set of bilateral links, or could be a separate network, perhaps maintained by an industry consortium. This separate network could itself be a VPN or a physical network. Introducing VPNs into a network does not require any change to this model. Policy can be enforced between two VPNs, or between a VPN and the Internet, in exactly the same manner as is done today without VPNs. For example two VPNs could be interconnected, which each administration locally imposing its own policy controls, via a firewall, on all traffic that enters its VPN from the outside, whether from another VPN or from the Internet. This model of a VPN provides for a separation of policy from the underlying mode of packet transport used. For example, a router may direct voice traffic to ATM Virtual Channel Connections (VCCs) for guaranteed QoS, non-local internal company traffic to secure tunnels, and other traffic to a link to the Internet. In the past the secure tunnels may have been frame relay circuits, now they may also be secure IP tunnels or MPLS Label Switched Paths (LSPs) Gleeson, et al. Informational [Page 9] RFC 2764 IP Based Virtual Private Networks February 2000 Other models of a VPN are also possible. For example there is a model whereby a set of application flows is mapped into a VPN. As the policy rules imposed by a network administrator can get quite complex, the number of distinct sets of application flows that are used in the policy rulebase, and hence the number of VPNs, can thus grow quite large, and there can be multiple overlapping VPNs. However there is little to be gained by introducing such new complexity into a network. Instead a VPN should be viewed as a direct analogue to a physical network, as this allows the leveraging of existing protocols and procedures, and the current expertise and skill sets of network administrators and customers.
USER:
What is the technical difference between a VPN and an Extranet, and how do both get utilized safely in an enterprise environment without breaking connections between computers?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 20 | 27 | 567 | null | 41 |
You must respond using only information provided in the prompt. Explain your reasoning with at least three supporting points.
|
What are some examples of spillover related to one's level of financial literacy?
|
A lack of information is sometimes the cause of poor financial decisions. When one party has more information than the other party, economists describe this imbalance as “asymmetric information.” In the market for financial services, where the provider often knows more about the product, there is a potential risk to the consumer and the economy. Financial education is a tool for helping individuals manage and mitigate risk. Individuals who are better financially prepared can avoid unexpected expenses, steer away from frauds and scams, and avoid taking on risks that they do not understand or cannot afford to bear. By improving financial literacy and education, the federal government can play an important role in facilitating a vibrant and efficient marketplace, which in turn empowers individuals to make informed financial decisions. In supporting financial literacy and education, the government can create positive spillovers (or positive externalities) from a more financially literate population. A more informed population tends to be more productive and thus boosts economic activity. A stronger economy can result in more jobs and higher wages for others. Financial education can also help avoid negative spillovers (or negative externalities) from a less financially literate population. A negative externality is an economic 26. GAO, April 2014. 14 Federal Financial Literacy Reform: Coordinating and Improving Financial Literacy Efforts activity that imposes a cost or negative impact on an unrelated third party. These negative externalities cause inefficiencies in the market.27 For example, when a borrower with low financial literacy defaults on an ill-advised loan, the lender will bear some of these costs. On the other hand, friends and family members, the government and others may also bear the cost of that decision. Family members may directly help pay off a loan, or cosign on future loans, increasing their own debt-to-income ratios. Thus, the original two parties to the loan do not bear the entire cost of the transaction. The financial crisis of 2007-2008 demonstrated how individuals and families with limited financial literacy can be among those most dramatically affected by downturns in the economy. Since Treasury’s mission includes a mandate to maintain a strong economy “by promoting the conditions that enable economic growth and stability at home and abroad,”28 it is important to keep in mind the role that individual financial capability has in the prosperity and financial health of the nation. The federal government cannot, and should not, bear the sole responsibility for ensuring the financial capability of individuals and households. Since the creation of the FLEC, it has been clear that federal agencies are not solely, or even predominantly, responsible for providing financial education to Americans. State and local governments, nonprofits and the private sector rightly have interests in promoting better financial decision-making. For example, some employers view financial health similar to physical health and include this as part of their benefits package because of its impact on their bottom line. These non-government entities are able to respond to needs more quickly, develop customized strategies to deliver financial education, and remain engaged and follow up with those served over time. Given the substantial accomplishments and opportunities for improved financial education provided by various stakeholders outside of the federal government, it is appropriate to consider the suitable federal role. Treasury’s outreach to stakeholders has revealed the desire for the federal government to play an overarching leadership and guidance role, rather than trying to directly reach all Americans with financial education lessons. By embracing this role, the federal government can improve the quality and reach of financial education activities by promoting best practices, sharing evidence, creating specific resources where appropriate, and deploying policy solutions to support the U.S. financial education infrastructure. The federal government, then, can be a partner, a source of trusted information and tools, and a leader to the many financial education providers striving to improve financial literacy and capability of their nation. 27. See, for example: Hastings, Justine S., Madrian, Brigitte C. and Skimmyhorn,William L. “Financial Literacy, Financial Education and Economic Outcomes,” Annu Rev Econom. 2013 May 1; 5: 347–373, 2013, available at: https://dx.doi. org/10.1146%2Fannurev-economics-082312-125807; Lusardi, Annamaria and Mitchell, Olivia S. “The Economic Importance of Financial Literacy: Theory and Evidence”, Journal of Economic Literature 2014, 52(1), 5-44, 2014, available at: https://www. aeaweb.org/articles?id=10.1257/jel.52.1.5. 28. U.S. Department of the Treasury, “Role of the Treasury”, webpage, available at: https://home.treasury.gov/about/general-information/ role-of-the-treasury. Section 1: Governance of Federal Financial Literacy and Education Efforts 15 Recommendation Treasury recommends that the primary federal role for financial literacy and education should be to empower financial education providers as opposed to trying to directly reach every American household. This federal role could include developing and implementing policy, encouraging research, and other activities, including conducting financial education programs, and developing educational resources as needed to advance best practices and standards to equip Americans with the skills, knowledge, and tools to confidently make informed financial decisions and improve their financial well-being. The federal government should also consider the impact of the lack of financial literacy on households and the risk to the economy from negative externalities and market failures. Financial literacy and education should be seen as a vehicle to guard against market failures and foster competitive markets. Leadership and Accountability for Federal Financial Literacy and Education The FLEC’s structure and operations have been informal, with the Treasury providing staff support and management, including organizing public meetings, scheduling informal briefings, and managing reports to Congress and the public. While it is clear that there is an important federal role in financial education, the structure of financial education across the federal government has not been conducive to both attaining measurable outcomes and coordinating activities in order to maximize the government’s return on investment. As noted by the OMB Report and the GAO report, financial education activities exist in many different agencies, often without a requirement that they use or build on programs or resources already paid for by taxpayers. Congress created the FLEC with a purpose to coordinate these activities, yet the authorities of the FLEC, as well as its structure, do not provide it with the ability to hold members accountable for coordination, efficiency or outcomes. As GAO noted, “We acknowledge that the governance structure of the Commission presents challenges in addressing resource issues: it relies on the consensus of multiple agencies, has no independent budget, and no legal authority to compel members to act.”29 The FLEC’s lack of clear decision-making processes and defined roles and responsibilities has impeded its ability to effectively carry out its national strategy for financial literacy, and its statutory mandates of both improving financial education, and streamlining and improving federal financial education activities. As a result, the FLEC lacks an effective organizational structure to facilitate goal-setting and decision-making and accountability for outcomes. A more clear and focused leadership structure is needed to guide the work of the FLEC. In addition to structural impediments to coordination, performance and outcome data have not been used systematically to assess the effectiveness of federal activities 29. GAO, April 2014. 16 Federal Financial Literacy Reform: Coordinating and Improving Financial Literacy Efforts and provide a basis to streamline, augment or improve them. Outcomes should reflect the ability of Americans to attain improved financial decision-making as opposed to being activity driven. The GAO has noted that “financial literacy program evaluations are most reliable and effective when they measure the programs’ impact on consumers’ behavior.”30 By adopting measures that member agencies directly impact (performance measures), and indirectly affect (outcome measures), the FLEC will be able to better assess the effectiveness of financial education activities and thus make improvements in the future. Recommendations Treasury recommends the FLEC establish bylaws to set clear expectations for its decision-making and roles, including establishing a six-member Executive Committee comprised of Treasury (chair), CFPB (vice chair), and ED, HUD, DOL and DoD. The Executive Committee will be responsible for crafting, with input from other FLEC members, a shared agenda for action and priorities, and be accountable to report on achievement of that agenda. The agenda would be voted on and approved by a majority of the members.
|
You must respond using only information provided in the prompt. Explain your reasoning with at least three supporting points. A lack of information is sometimes the cause of poor financial decisions. When one party has more information than the other party, economists describe this imbalance as “asymmetric information.” In the market for financial services, where the provider often knows more about the product, there is a potential risk to the consumer and the economy. Financial education is a tool for helping individuals manage and mitigate risk. Individuals who are better financially prepared can avoid unexpected expenses, steer away from frauds and scams, and avoid taking on risks that they do not understand or cannot afford to bear. By improving financial literacy and education, the federal government can play an important role in facilitating a vibrant and efficient marketplace, which in turn empowers individuals to make informed financial decisions. In supporting financial literacy and education, the government can create positive spillovers (or positive externalities) from a more financially literate population. A more informed population tends to be more productive and thus boosts economic activity. A stronger economy can result in more jobs and higher wages for others. Financial education can also help avoid negative spillovers (or negative externalities) from a less financially literate population. A negative externality is an economic 26. GAO, April 2014. 14 Federal Financial Literacy Reform: Coordinating and Improving Financial Literacy Efforts activity that imposes a cost or negative impact on an unrelated third party. These negative externalities cause inefficiencies in the market.27 For example, when a borrower with low financial literacy defaults on an ill-advised loan, the lender will bear some of these costs. On the other hand, friends and family members, the government and others may also bear the cost of that decision. Family members may directly help pay off a loan, or cosign on future loans, increasing their own debt-to-income ratios. Thus, the original two parties to the loan do not bear the entire cost of the transaction. The financial crisis of 2007-2008 demonstrated how individuals and families with limited financial literacy can be among those most dramatically affected by downturns in the economy. Since Treasury’s mission includes a mandate to maintain a strong economy “by promoting the conditions that enable economic growth and stability at home and abroad,”28 it is important to keep in mind the role that individual financial capability has in the prosperity and financial health of the nation. The federal government cannot, and should not, bear the sole responsibility for ensuring the financial capability of individuals and households. Since the creation of the FLEC, it has been clear that federal agencies are not solely, or even predominantly, responsible for providing financial education to Americans. State and local governments, nonprofits and the private sector rightly have interests in promoting better financial decision-making. For example, some employers view financial health similar to physical health and include this as part of their benefits package because of its impact on their bottom line. These non-government entities are able to respond to needs more quickly, develop customized strategies to deliver financial education, and remain engaged and follow up with those served over time. Given the substantial accomplishments and opportunities for improved financial education provided by various stakeholders outside of the federal government, it is appropriate to consider the suitable federal role. Treasury’s outreach to stakeholders has revealed the desire for the federal government to play an overarching leadership and guidance role, rather than trying to directly reach all Americans with financial education lessons. By embracing this role, the federal government can improve the quality and reach of financial education activities by promoting best practices, sharing evidence, creating specific resources where appropriate, and deploying policy solutions to support the U.S. financial education infrastructure. The federal government, then, can be a partner, a source of trusted information and tools, and a leader to the many financial education providers striving to improve financial literacy and capability of their nation. 27. See, for example: Hastings, Justine S., Madrian, Brigitte C. and Skimmyhorn,William L. “Financial Literacy, Financial Education and Economic Outcomes,” Annu Rev Econom. 2013 May 1; 5: 347–373, 2013, available at: https://dx.doi. org/10.1146%2Fannurev-economics-082312-125807; Lusardi, Annamaria and Mitchell, Olivia S. “The Economic Importance of Financial Literacy: Theory and Evidence”, Journal of Economic Literature 2014, 52(1), 5-44, 2014, available at: https://www. aeaweb.org/articles?id=10.1257/jel.52.1.5. 28. U.S. Department of the Treasury, “Role of the Treasury”, webpage, available at: https://home.treasury.gov/about/general-information/ role-of-the-treasury. Section 1: Governance of Federal Financial Literacy and Education Efforts 15 Recommendation Treasury recommends that the primary federal role for financial literacy and education should be to empower financial education providers as opposed to trying to directly reach every American household. This federal role could include developing and implementing policy, encouraging research, and other activities, including conducting financial education programs, and developing educational resources as needed to advance best practices and standards to equip Americans with the skills, knowledge, and tools to confidently make informed financial decisions and improve their financial well-being. The federal government should also consider the impact of the lack of financial literacy on households and the risk to the economy from negative externalities and market failures. Financial literacy and education should be seen as a vehicle to guard against market failures and foster competitive markets. Leadership and Accountability for Federal Financial Literacy and Education The FLEC’s structure and operations have been informal, with the Treasury providing staff support and management, including organizing public meetings, scheduling informal briefings, and managing reports to Congress and the public. While it is clear that there is an important federal role in financial education, the structure of financial education across the federal government has not been conducive to both attaining measurable outcomes and coordinating activities in order to maximize the government’s return on investment. As noted by the OMB Report and the GAO report, financial education activities exist in many different agencies, often without a requirement that they use or build on programs or resources already paid for by taxpayers. Congress created the FLEC with a purpose to coordinate these activities, yet the authorities of the FLEC, as well as its structure, do not provide it with the ability to hold members accountable for coordination, efficiency or outcomes. As GAO noted, “We acknowledge that the governance structure of the Commission presents challenges in addressing resource issues: it relies on the consensus of multiple agencies, has no independent budget, and no legal authority to compel members to act.”29 The FLEC’s lack of clear decision-making processes and defined roles and responsibilities has impeded its ability to effectively carry out its national strategy for financial literacy, and its statutory mandates of both improving financial education, and streamlining and improving federal financial education activities. As a result, the FLEC lacks an effective organizational structure to facilitate goal-setting and decision-making and accountability for outcomes. A more clear and focused leadership structure is needed to guide the work of the FLEC. In addition to structural impediments to coordination, performance and outcome data have not been used systematically to assess the effectiveness of federal activities 29. GAO, April 2014. 16 Federal Financial Literacy Reform: Coordinating and Improving Financial Literacy Efforts and provide a basis to streamline, augment or improve them. Outcomes should reflect the ability of Americans to attain improved financial decision-making as opposed to being activity driven. The GAO has noted that “financial literacy program evaluations are most reliable and effective when they measure the programs’ impact on consumers’ behavior.”30 By adopting measures that member agencies directly impact (performance measures), and indirectly affect (outcome measures), the FLEC will be able to better assess the effectiveness of financial education activities and thus make improvements in the future. Recommendations Treasury recommends the FLEC establish bylaws to set clear expectations for its decision-making and roles, including establishing a six-member Executive Committee comprised of Treasury (chair), CFPB (vice chair), and ED, HUD, DOL and DoD. The Executive Committee will be responsible for crafting, with input from other FLEC members, a shared agenda for action and priorities, and be accountable to report on achievement of that agenda. The agenda would be voted on and approved by a majority of the members. What are some examples of spillover related to one's level of financial literacy?
|
You must respond using only information provided in the prompt. Explain your reasoning with at least three supporting points.
EVIDENCE:
A lack of information is sometimes the cause of poor financial decisions. When one party has more information than the other party, economists describe this imbalance as “asymmetric information.” In the market for financial services, where the provider often knows more about the product, there is a potential risk to the consumer and the economy. Financial education is a tool for helping individuals manage and mitigate risk. Individuals who are better financially prepared can avoid unexpected expenses, steer away from frauds and scams, and avoid taking on risks that they do not understand or cannot afford to bear. By improving financial literacy and education, the federal government can play an important role in facilitating a vibrant and efficient marketplace, which in turn empowers individuals to make informed financial decisions. In supporting financial literacy and education, the government can create positive spillovers (or positive externalities) from a more financially literate population. A more informed population tends to be more productive and thus boosts economic activity. A stronger economy can result in more jobs and higher wages for others. Financial education can also help avoid negative spillovers (or negative externalities) from a less financially literate population. A negative externality is an economic 26. GAO, April 2014. 14 Federal Financial Literacy Reform: Coordinating and Improving Financial Literacy Efforts activity that imposes a cost or negative impact on an unrelated third party. These negative externalities cause inefficiencies in the market.27 For example, when a borrower with low financial literacy defaults on an ill-advised loan, the lender will bear some of these costs. On the other hand, friends and family members, the government and others may also bear the cost of that decision. Family members may directly help pay off a loan, or cosign on future loans, increasing their own debt-to-income ratios. Thus, the original two parties to the loan do not bear the entire cost of the transaction. The financial crisis of 2007-2008 demonstrated how individuals and families with limited financial literacy can be among those most dramatically affected by downturns in the economy. Since Treasury’s mission includes a mandate to maintain a strong economy “by promoting the conditions that enable economic growth and stability at home and abroad,”28 it is important to keep in mind the role that individual financial capability has in the prosperity and financial health of the nation. The federal government cannot, and should not, bear the sole responsibility for ensuring the financial capability of individuals and households. Since the creation of the FLEC, it has been clear that federal agencies are not solely, or even predominantly, responsible for providing financial education to Americans. State and local governments, nonprofits and the private sector rightly have interests in promoting better financial decision-making. For example, some employers view financial health similar to physical health and include this as part of their benefits package because of its impact on their bottom line. These non-government entities are able to respond to needs more quickly, develop customized strategies to deliver financial education, and remain engaged and follow up with those served over time. Given the substantial accomplishments and opportunities for improved financial education provided by various stakeholders outside of the federal government, it is appropriate to consider the suitable federal role. Treasury’s outreach to stakeholders has revealed the desire for the federal government to play an overarching leadership and guidance role, rather than trying to directly reach all Americans with financial education lessons. By embracing this role, the federal government can improve the quality and reach of financial education activities by promoting best practices, sharing evidence, creating specific resources where appropriate, and deploying policy solutions to support the U.S. financial education infrastructure. The federal government, then, can be a partner, a source of trusted information and tools, and a leader to the many financial education providers striving to improve financial literacy and capability of their nation. 27. See, for example: Hastings, Justine S., Madrian, Brigitte C. and Skimmyhorn,William L. “Financial Literacy, Financial Education and Economic Outcomes,” Annu Rev Econom. 2013 May 1; 5: 347–373, 2013, available at: https://dx.doi. org/10.1146%2Fannurev-economics-082312-125807; Lusardi, Annamaria and Mitchell, Olivia S. “The Economic Importance of Financial Literacy: Theory and Evidence”, Journal of Economic Literature 2014, 52(1), 5-44, 2014, available at: https://www. aeaweb.org/articles?id=10.1257/jel.52.1.5. 28. U.S. Department of the Treasury, “Role of the Treasury”, webpage, available at: https://home.treasury.gov/about/general-information/ role-of-the-treasury. Section 1: Governance of Federal Financial Literacy and Education Efforts 15 Recommendation Treasury recommends that the primary federal role for financial literacy and education should be to empower financial education providers as opposed to trying to directly reach every American household. This federal role could include developing and implementing policy, encouraging research, and other activities, including conducting financial education programs, and developing educational resources as needed to advance best practices and standards to equip Americans with the skills, knowledge, and tools to confidently make informed financial decisions and improve their financial well-being. The federal government should also consider the impact of the lack of financial literacy on households and the risk to the economy from negative externalities and market failures. Financial literacy and education should be seen as a vehicle to guard against market failures and foster competitive markets. Leadership and Accountability for Federal Financial Literacy and Education The FLEC’s structure and operations have been informal, with the Treasury providing staff support and management, including organizing public meetings, scheduling informal briefings, and managing reports to Congress and the public. While it is clear that there is an important federal role in financial education, the structure of financial education across the federal government has not been conducive to both attaining measurable outcomes and coordinating activities in order to maximize the government’s return on investment. As noted by the OMB Report and the GAO report, financial education activities exist in many different agencies, often without a requirement that they use or build on programs or resources already paid for by taxpayers. Congress created the FLEC with a purpose to coordinate these activities, yet the authorities of the FLEC, as well as its structure, do not provide it with the ability to hold members accountable for coordination, efficiency or outcomes. As GAO noted, “We acknowledge that the governance structure of the Commission presents challenges in addressing resource issues: it relies on the consensus of multiple agencies, has no independent budget, and no legal authority to compel members to act.”29 The FLEC’s lack of clear decision-making processes and defined roles and responsibilities has impeded its ability to effectively carry out its national strategy for financial literacy, and its statutory mandates of both improving financial education, and streamlining and improving federal financial education activities. As a result, the FLEC lacks an effective organizational structure to facilitate goal-setting and decision-making and accountability for outcomes. A more clear and focused leadership structure is needed to guide the work of the FLEC. In addition to structural impediments to coordination, performance and outcome data have not been used systematically to assess the effectiveness of federal activities 29. GAO, April 2014. 16 Federal Financial Literacy Reform: Coordinating and Improving Financial Literacy Efforts and provide a basis to streamline, augment or improve them. Outcomes should reflect the ability of Americans to attain improved financial decision-making as opposed to being activity driven. The GAO has noted that “financial literacy program evaluations are most reliable and effective when they measure the programs’ impact on consumers’ behavior.”30 By adopting measures that member agencies directly impact (performance measures), and indirectly affect (outcome measures), the FLEC will be able to better assess the effectiveness of financial education activities and thus make improvements in the future. Recommendations Treasury recommends the FLEC establish bylaws to set clear expectations for its decision-making and roles, including establishing a six-member Executive Committee comprised of Treasury (chair), CFPB (vice chair), and ED, HUD, DOL and DoD. The Executive Committee will be responsible for crafting, with input from other FLEC members, a shared agenda for action and priorities, and be accountable to report on achievement of that agenda. The agenda would be voted on and approved by a majority of the members.
USER:
What are some examples of spillover related to one's level of financial literacy?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 19 | 13 | 1,335 | null | 553 |
Use the provided context to answer the question. Do not rely on information external to the document. Do not hallucinate any information outside the document.
|
Explain the bills described in the following context in detail. Connect the information so that a layman can understand, but do not omit any aspect of the laws.
|
Bills in the 116th Congress Legislation Commissioning Agency Analyses In January 2019, the House passed three bills that would commission studies concerning the use of virtual currencies for illicit purposes. H.R. 56, the Financial Technology Protection Act, would establish an Independent Financial Technology Task Force to Combat Terrorism and Illicit Financing (Task Force) led by the Treasury Secretary.98 The bill would direct the Task Force to (1) “conduct independent research on terrorist and illicit use of new financial technologies, including digital currencies,” and (2) “develop legislative and regulatory proposals to improve counter-terrorist and counter-illicit financing efforts.” 99 H.R. 56 would further require the Task Force to annually report its findings to Congress.100 The bill would also establish two programs to incentivize members of the public to assist the federal government’s efforts to combat the illicit use of virtual currencies. First, the bill would direct the Treasury Secretary to establish a reward of up to $450,000 for persons who “provide[] information leading to the conviction of an individual involved with terrorist use of digital currencies.” 101 Second, the bill would direct the Treasury Secretary to create a grant program “for the development of tools and programs to detect terrorist and illicit use of digital currencies.”102 After passing the House in January 2019, H.R. 56 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. A second bill, H.R. 428, the Homeland Security Assessment of Terrorists’ Use of Virtual Currencies Act, would similarly commission an analysis of the use of virtual currencies by terrorists. 103 Specifically, H.R. 428 would direct the Under Secretary of Homeland Security for Intelligence and Analysis to conduct a “threat assessment” analyzing “the actual and potential threat posed by individuals using virtual currency to carry out activities in furtherance of an act of terrorism, including the provision of material support or resources to a foreign terrorist organization.” 104 After passing the House in January 2019, H.R. 428 was referred to the Senate Committee on Homeland Security and Governmental Affairs. Finally, H.R. 502, the Fight Illicit Networks and Detect Trafficking Act (the FIND Trafficking Act), would direct the Government Accountability Office (GAO) to conduct a study “on how virtual currencies and online marketplaces are used to facilitate sex and drug trafficking.” 105 The bill would require GAO to provide Congress with a report summarizing the results of the study, together with any recommendations for legislative or regulatory action that would assist the federal government in combatting the use of virtual currencies to facilitate sex and drug trafficking.106 After passing the House in January 2019, H.R. 56 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. H.R. 1414, FinCEN Improvement Act of 2019 In March 2019, the House passed H.R. 1414, the FinCEN Improvement Act of 2019.107 The bill would, among other things, clarify that FinCEN’s statutory power to coordinate with foreign financial intelligence units on antiterrorism and AML initiatives108 “includ[es] matters involving emerging technologies or value that substitutes for currency.” 109 After passing the House in March 2019, H.R. 1414 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. H.R. 528, Blockchain Regulatory Certainty Act In January 2019, H.R. 528, the Blockchain Regulatory Certainty Act, was introduced in the House of Representatives. 110 The bill would create a safe harbor from federal and state money transmitter licensing and registration requirements for certain blockchain developers. Specifically, the bill would provide that noncontrolling “blockchain developers” and providers of a “blockchain service” shall not be treated as “money transmitters,” MSBs, “or any other State or Federal legal designation[s] requiring licensing or registration as a condition to acting as a blockchain developer or provider of a blockchain service.” 111 A blockchain developer or provider of a blockchain service would qualify as a noncontrolling developer or provider as long as it does not have control over users’ digital currency in the regular course of business.112 Some commentators have argued that such a safe harbor is necessary to provide legal certainty to actors in the virtual currency space, including persons who contribute code to virtual currency platforms or develop blockchain-related software but do not take custody of others’ virtual currency. 113 However, another commentator has noted that it is “debat[able]” whether federal registration requirements apply to such persons. 114 H.R. 528 was referred to the House Committee on Financial Services and the House Committee on the Judiciary in January 2019.
|
SYSTEM INSTRUCTION: Use the provided context to answer the question. Do not rely on information external to the document. Do not hallucinate any information outside the document. CONTEXT: Bills in the 116th Congress Legislation Commissioning Agency Analyses In January 2019, the House passed three bills that would commission studies concerning the use of virtual currencies for illicit purposes. H.R. 56, the Financial Technology Protection Act, would establish an Independent Financial Technology Task Force to Combat Terrorism and Illicit Financing (Task Force) led by the Treasury Secretary.98 The bill would direct the Task Force to (1) “conduct independent research on terrorist and illicit use of new financial technologies, including digital currencies,” and (2) “develop legislative and regulatory proposals to improve counter-terrorist and counter-illicit financing efforts.” 99 H.R. 56 would further require the Task Force to annually report its findings to Congress.100 The bill would also establish two programs to incentivize members of the public to assist the federal government’s efforts to combat the illicit use of virtual currencies. First, the bill would direct the Treasury Secretary to establish a reward of up to $450,000 for persons who “provide[] information leading to the conviction of an individual involved with terrorist use of digital currencies.” 101 Second, the bill would direct the Treasury Secretary to create a grant program “for the development of tools and programs to detect terrorist and illicit use of digital currencies.”102 After passing the House in January 2019, H.R. 56 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. A second bill, H.R. 428, the Homeland Security Assessment of Terrorists’ Use of Virtual Currencies Act, would similarly commission an analysis of the use of virtual currencies by terrorists. 103 Specifically, H.R. 428 would direct the Under Secretary of Homeland Security for Intelligence and Analysis to conduct a “threat assessment” analyzing “the actual and potential threat posed by individuals using virtual currency to carry out activities in furtherance of an act of terrorism, including the provision of material support or resources to a foreign terrorist organization.” 104 After passing the House in January 2019, H.R. 428 was referred to the Senate Committee on Homeland Security and Governmental Affairs. Finally, H.R. 502, the Fight Illicit Networks and Detect Trafficking Act (the FIND Trafficking Act), would direct the Government Accountability Office (GAO) to conduct a study “on how virtual currencies and online marketplaces are used to facilitate sex and drug trafficking.” 105 The bill would require GAO to provide Congress with a report summarizing the results of the study, together with any recommendations for legislative or regulatory action that would assist the federal government in combatting the use of virtual currencies to facilitate sex and drug trafficking.106 After passing the House in January 2019, H.R. 56 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. H.R. 1414, FinCEN Improvement Act of 2019 In March 2019, the House passed H.R. 1414, the FinCEN Improvement Act of 2019.107 The bill would, among other things, clarify that FinCEN’s statutory power to coordinate with foreign financial intelligence units on antiterrorism and AML initiatives108 “includ[es] matters involving emerging technologies or value that substitutes for currency.” 109 After passing the House in March 2019, H.R. 1414 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. H.R. 528, Blockchain Regulatory Certainty Act In January 2019, H.R. 528, the Blockchain Regulatory Certainty Act, was introduced in the House of Representatives. 110 The bill would create a safe harbor from federal and state money transmitter licensing and registration requirements for certain blockchain developers. Specifically, the bill would provide that noncontrolling “blockchain developers” and providers of a “blockchain service” shall not be treated as “money transmitters,” MSBs, “or any other State or Federal legal designation[s] requiring licensing or registration as a condition to acting as a blockchain developer or provider of a blockchain service.” 111 A blockchain developer or provider of a blockchain service would qualify as a noncontrolling developer or provider as long as it does not have control over users’ digital currency in the regular course of business.112 Some commentators have argued that such a safe harbor is necessary to provide legal certainty to actors in the virtual currency space, including persons who contribute code to virtual currency platforms or develop blockchain-related software but do not take custody of others’ virtual currency. 113 However, another commentator has noted that it is “debat[able]” whether federal registration requirements apply to such persons. 114 H.R. 528 was referred to the House Committee on Financial Services and the House Committee on the Judiciary in January 2019. Question: Explain the bills described in the following context in detail. Connect the information so that a layman can understand, but do not omit any aspect of the laws.
|
Use the provided context to answer the question. Do not rely on information external to the document. Do not hallucinate any information outside the document.
EVIDENCE:
Bills in the 116th Congress Legislation Commissioning Agency Analyses In January 2019, the House passed three bills that would commission studies concerning the use of virtual currencies for illicit purposes. H.R. 56, the Financial Technology Protection Act, would establish an Independent Financial Technology Task Force to Combat Terrorism and Illicit Financing (Task Force) led by the Treasury Secretary.98 The bill would direct the Task Force to (1) “conduct independent research on terrorist and illicit use of new financial technologies, including digital currencies,” and (2) “develop legislative and regulatory proposals to improve counter-terrorist and counter-illicit financing efforts.” 99 H.R. 56 would further require the Task Force to annually report its findings to Congress.100 The bill would also establish two programs to incentivize members of the public to assist the federal government’s efforts to combat the illicit use of virtual currencies. First, the bill would direct the Treasury Secretary to establish a reward of up to $450,000 for persons who “provide[] information leading to the conviction of an individual involved with terrorist use of digital currencies.” 101 Second, the bill would direct the Treasury Secretary to create a grant program “for the development of tools and programs to detect terrorist and illicit use of digital currencies.”102 After passing the House in January 2019, H.R. 56 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. A second bill, H.R. 428, the Homeland Security Assessment of Terrorists’ Use of Virtual Currencies Act, would similarly commission an analysis of the use of virtual currencies by terrorists. 103 Specifically, H.R. 428 would direct the Under Secretary of Homeland Security for Intelligence and Analysis to conduct a “threat assessment” analyzing “the actual and potential threat posed by individuals using virtual currency to carry out activities in furtherance of an act of terrorism, including the provision of material support or resources to a foreign terrorist organization.” 104 After passing the House in January 2019, H.R. 428 was referred to the Senate Committee on Homeland Security and Governmental Affairs. Finally, H.R. 502, the Fight Illicit Networks and Detect Trafficking Act (the FIND Trafficking Act), would direct the Government Accountability Office (GAO) to conduct a study “on how virtual currencies and online marketplaces are used to facilitate sex and drug trafficking.” 105 The bill would require GAO to provide Congress with a report summarizing the results of the study, together with any recommendations for legislative or regulatory action that would assist the federal government in combatting the use of virtual currencies to facilitate sex and drug trafficking.106 After passing the House in January 2019, H.R. 56 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. H.R. 1414, FinCEN Improvement Act of 2019 In March 2019, the House passed H.R. 1414, the FinCEN Improvement Act of 2019.107 The bill would, among other things, clarify that FinCEN’s statutory power to coordinate with foreign financial intelligence units on antiterrorism and AML initiatives108 “includ[es] matters involving emerging technologies or value that substitutes for currency.” 109 After passing the House in March 2019, H.R. 1414 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. H.R. 528, Blockchain Regulatory Certainty Act In January 2019, H.R. 528, the Blockchain Regulatory Certainty Act, was introduced in the House of Representatives. 110 The bill would create a safe harbor from federal and state money transmitter licensing and registration requirements for certain blockchain developers. Specifically, the bill would provide that noncontrolling “blockchain developers” and providers of a “blockchain service” shall not be treated as “money transmitters,” MSBs, “or any other State or Federal legal designation[s] requiring licensing or registration as a condition to acting as a blockchain developer or provider of a blockchain service.” 111 A blockchain developer or provider of a blockchain service would qualify as a noncontrolling developer or provider as long as it does not have control over users’ digital currency in the regular course of business.112 Some commentators have argued that such a safe harbor is necessary to provide legal certainty to actors in the virtual currency space, including persons who contribute code to virtual currency platforms or develop blockchain-related software but do not take custody of others’ virtual currency. 113 However, another commentator has noted that it is “debat[able]” whether federal registration requirements apply to such persons. 114 H.R. 528 was referred to the House Committee on Financial Services and the House Committee on the Judiciary in January 2019.
USER:
Explain the bills described in the following context in detail. Connect the information so that a layman can understand, but do not omit any aspect of the laws.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 25 | 28 | 733 | null | 366 |
Use only the information provided below to formulate your answer, and format the answer using bullet points where appropriate.
|
Compare the financial facts and figures of families with children to families without children.
|
Many families are in financial distress, and families with children are especially vulnerable. Thirty-eight percent of families with children under age 18 living at home are struggling to get by, compared with 33 percent of families without children at home (figure 1). Financial distress can arise from a range of factors, from a specific hardship— 28 percent of families with children experienced a financial hardship in the past year, compared with 23 percent of families without children—to a simple lack of sufficient income. Twenty-four percent of families with children spent more than their income last year, compared with 19 percent of families without children. Raising children is expensive, and the costs have been rising over time. According to the USDA, the typical two-parent family can expect to spend between $13,000 and $15,000 per child per year for children born in 2013, meaning that the average cost of raising a child is expected to be $245,000 over 18 years (Lino 2014). A family with two children can expect to spend almost half its income on its children each year. Not only are children expensive, but families with children tend to have lower incomes than families without children. In 2014, the median income for families with children was about $62,000, compared with about $68,000 for families without children (figure 2). While men’s earnings increase after fatherhood, women with children have lower average earnings than women without children. These differences hold true even when looking only at working people and when controlling for years of experience and other attributes (Budig 2014; Pal and Waldfogel 2014). As single-mother families become more common, the “fatherhood bump” no longer offsets the “motherhood penalty” for many families. Public benefits are not enough to offset the increased cost of having children. Available federal programs such as Medicaid, SNAP (the Supplemental Nutrition Assistance Program), and TANF, as well as tax incentives such as the EITC (the earned income tax credit) lift millions of families with children out of poverty (Sherman, Trisi, and Parrott 2013), but they are often not enough to lift families out of financial distress. Many of the programs that focus on families with children are shrinking, despite the increased costs of having children. Total federal spending on children, currently 10 percent of the federal budget, is projected to decline to less than 8 percent in 2025, while adult Social Security, Medicare, and Medicaid spending is projected to increase to 49 percent (Isaacs et al. 2015). Some of the differences between families with and without children at home may be attributable to older families whose children are no longer at home or younger families who do not have children yet, rather than adults of childrearing age without children. If we look only at families where the survey respondent is under age 65, we see that families with and without children are equally likely to be struggling to get by and to experience a hardship, but families with children are still more likely to spend more than their incomes. This suggests that older families are doing better than younger families. Because many of these adults are retired and not earning income, households headed by adults 65 years and older have a lower median income than the general population: $40,000 versus $54,000 in 2014 (US Census Bureau 2014). However, these households also have higher wealth. The mean net worth of families headed by someone ages 65–74 was over $1 million in 2013, compared with just $75,500 for families with heads under age 35 (Bricker et al. 2014). Families with children are more likely to think that they are doing better than they were five years ago than families without children (47 and 38 percent, respectively; figure 3). Yet while 47 percent of families with children think they are doing better than they were in 2009, only 31 percent think they are doing better than they were in 2013 (not shown). This is consistent with recovery from the recession occurring after 2009 but before 2013. After adjusting for inflation, median incomes for families with children decreased 1.9 percent between 2009 and 2014 while incomes for families without children increased by 2.6 percent over the same period. Even though families with children appear less financially healthy than years past, they are more likely to feel their situations have improved. This feeling may reflect improved economic security as children age and child care costs decline.
|
Use only the information provided below to formulate your answer, and format the answer using bullet points where appropriate. Compare the financial facts and figures of families with children to families without children. Many families are in financial distress, and families with children are especially vulnerable. Thirty-eight percent of families with children under age 18 living at home are struggling to get by, compared with 33 percent of families without children at home (figure 1). Financial distress can arise from a range of factors, from a specific hardship— 28 percent of families with children experienced a financial hardship in the past year, compared with 23 percent of families without children—to a simple lack of sufficient income. Twenty-four percent of families with children spent more than their income last year, compared with 19 percent of families without children. Raising children is expensive, and the costs have been rising over time. According to the USDA, the typical two-parent family can expect to spend between $13,000 and $15,000 per child per year for children born in 2013, meaning that the average cost of raising a child is expected to be $245,000 over 18 years (Lino 2014). A family with two children can expect to spend almost half its income on its children each year. Not only are children expensive, but families with children tend to have lower incomes than families without children. In 2014, the median income for families with children was about $62,000, compared with about $68,000 for families without children (figure 2). While men’s earnings increase after fatherhood, women with children have lower average earnings than women without children. These differences hold true even when looking only at working people and when controlling for years of experience and other attributes (Budig 2014; Pal and Waldfogel 2014). As single-mother families become more common, the “fatherhood bump” no longer offsets the “motherhood penalty” for many families. Public benefits are not enough to offset the increased cost of having children. Available federal programs such as Medicaid, SNAP (the Supplemental Nutrition Assistance Program), and TANF, as well as tax incentives such as the EITC (the earned income tax credit) lift millions of families with children out of poverty (Sherman, Trisi, and Parrott 2013), but they are often not enough to lift families out of financial distress. Many of the programs that focus on families with children are shrinking, despite the increased costs of having children. Total federal spending on children, currently 10 percent of the federal budget, is projected to decline to less than 8 percent in 2025, while adult Social Security, Medicare, and Medicaid spending is projected to increase to 49 percent (Isaacs et al. 2015). Some of the differences between families with and without children at home may be attributable to older families whose children are no longer at home or younger families who do not have children yet, rather than adults of childrearing age without children. If we look only at families where the survey respondent is under age 65, we see that families with and without children are equally likely to be struggling to get by and to experience a hardship, but families with children are still more likely to spend more than their incomes. This suggests that older families are doing better than younger families. Because many of these adults are retired and not earning income, households headed by adults 65 years and older have a lower median income than the general population: $40,000 versus $54,000 in 2014 (US Census Bureau 2014). However, these households also have higher wealth. The mean net worth of families headed by someone ages 65–74 was over $1 million in 2013, compared with just $75,500 for families with heads under age 35 (Bricker et al. 2014). Families with children are more likely to think that they are doing better than they were five years ago than families without children (47 and 38 percent, respectively; figure 3). Yet while 47 percent of families with children think they are doing better than they were in 2009, only 31 percent think they are doing better than they were in 2013 (not shown). This is consistent with recovery from the recession occurring after 2009 but before 2013. After adjusting for inflation, median incomes for families with children decreased 1.9 percent between 2009 and 2014 while incomes for families without children increased by 2.6 percent over the same period. Even though families with children appear less financially healthy than years past, they are more likely to feel their situations have improved. This feeling may reflect improved economic security as children age and child care costs decline.
|
Use only the information provided below to formulate your answer, and format the answer using bullet points where appropriate.
EVIDENCE:
Many families are in financial distress, and families with children are especially vulnerable. Thirty-eight percent of families with children under age 18 living at home are struggling to get by, compared with 33 percent of families without children at home (figure 1). Financial distress can arise from a range of factors, from a specific hardship— 28 percent of families with children experienced a financial hardship in the past year, compared with 23 percent of families without children—to a simple lack of sufficient income. Twenty-four percent of families with children spent more than their income last year, compared with 19 percent of families without children. Raising children is expensive, and the costs have been rising over time. According to the USDA, the typical two-parent family can expect to spend between $13,000 and $15,000 per child per year for children born in 2013, meaning that the average cost of raising a child is expected to be $245,000 over 18 years (Lino 2014). A family with two children can expect to spend almost half its income on its children each year. Not only are children expensive, but families with children tend to have lower incomes than families without children. In 2014, the median income for families with children was about $62,000, compared with about $68,000 for families without children (figure 2). While men’s earnings increase after fatherhood, women with children have lower average earnings than women without children. These differences hold true even when looking only at working people and when controlling for years of experience and other attributes (Budig 2014; Pal and Waldfogel 2014). As single-mother families become more common, the “fatherhood bump” no longer offsets the “motherhood penalty” for many families. Public benefits are not enough to offset the increased cost of having children. Available federal programs such as Medicaid, SNAP (the Supplemental Nutrition Assistance Program), and TANF, as well as tax incentives such as the EITC (the earned income tax credit) lift millions of families with children out of poverty (Sherman, Trisi, and Parrott 2013), but they are often not enough to lift families out of financial distress. Many of the programs that focus on families with children are shrinking, despite the increased costs of having children. Total federal spending on children, currently 10 percent of the federal budget, is projected to decline to less than 8 percent in 2025, while adult Social Security, Medicare, and Medicaid spending is projected to increase to 49 percent (Isaacs et al. 2015). Some of the differences between families with and without children at home may be attributable to older families whose children are no longer at home or younger families who do not have children yet, rather than adults of childrearing age without children. If we look only at families where the survey respondent is under age 65, we see that families with and without children are equally likely to be struggling to get by and to experience a hardship, but families with children are still more likely to spend more than their incomes. This suggests that older families are doing better than younger families. Because many of these adults are retired and not earning income, households headed by adults 65 years and older have a lower median income than the general population: $40,000 versus $54,000 in 2014 (US Census Bureau 2014). However, these households also have higher wealth. The mean net worth of families headed by someone ages 65–74 was over $1 million in 2013, compared with just $75,500 for families with heads under age 35 (Bricker et al. 2014). Families with children are more likely to think that they are doing better than they were five years ago than families without children (47 and 38 percent, respectively; figure 3). Yet while 47 percent of families with children think they are doing better than they were in 2009, only 31 percent think they are doing better than they were in 2013 (not shown). This is consistent with recovery from the recession occurring after 2009 but before 2013. After adjusting for inflation, median incomes for families with children decreased 1.9 percent between 2009 and 2014 while incomes for families without children increased by 2.6 percent over the same period. Even though families with children appear less financially healthy than years past, they are more likely to feel their situations have improved. This feeling may reflect improved economic security as children age and child care costs decline.
USER:
Compare the financial facts and figures of families with children to families without children.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 19 | 14 | 733 | null | 534 |
Only use the context provided to you, never use the information you have stored in your system already.
|
What factors are used in order to determine stare decisis?
|
THE AMERICAN LEGAL SYSTEM MADE EASY Chapter 1 discussed the software of the American lawyer (i.e., in terms of the thinking process operating within the minds of U.S.-licensed legal professionals). This chapter, in contrast, examines the hardware in terms of the conceptual component parts within the software of the American lawyer and legal system. Specifically, the hardware is based in part on the black letter law embedded within the American legal infrastructure, which this chapter will now briefly overview. Common Law Versus Other Domestic Laws American law is based on common law from the United Kingdom as one of its core legal pillars (which is then buttressed by, among other sources, the U.S. Constitution, court cases, statutes, restatements, decrees, treatises, and various other rules and regulations). Common law follows the principle of stare decisis (Latin, meaning “stand by your decision”). Stare decisis is a legal principle stating that prior court decisions (e.g., holdings, conclusions, rulings) must be recognized as precedent case law. If a case is deemed a precedent case, then lower courts are compelled to rule in the same way as the precedent case. This applies only if the precedent case is binding or mandatory. The rationale for stare decisis and precedent cases is judicial efficiency, fairness to the parties, predictability, and a check and balance on arbitrary behavior. In common law countries, juries and oral arguments by lawyers often can take a greater or more visible role compared to in civil law countries (which may not have jury trials), in which the judge can play a more central and prominent role (of course, exceptions can exist). American Law 101 Examples of jurisdictions that use the common law system include the following: • United Kingdom except Scotland • United States except Louisiana • Ireland • Former British colony and/or Commonwealth territories/countries, including India except Goa, Australia, New Zealand, Singapore, and Canada except Quebec • Pakistan • Bangladesh In contrast, generally under civil law (derived from the French-German legal tradition), statutes and other similar legal sources represent relatively greater legal authority than does case law. Under civil law, neither precedent cases nor stare decisis exist. The rationale for this is greater judicial freedom to decide cases on a case-by-case basis. Some people argue, however, that this system may come at the cost of less predictability and consistency regarding case law conclusions (with similar legal issues and/or facts). Examples of jurisdictions that use the civil law system include the following: • Most European Union (EU) nations, including Germany and France where civil law was derived, but not the United Kingdom, Ireland, or Cyprus • Most of continental Latin America except Guyana and Belize • Congo • Azerbaijan • Iraq • Russia • Turkey • Egypt • Madagascar • Lebanon • Switzerland • Indonesia • Vietnam • Thailand The factors used in determining whether to apply stare decisis include the following: • Similarity of legal issue(s)/legal principle(s) • Whether the precedent case was ruled on by a court recognized as a leading one in the relevant subject area The American Legal System Made Easy • Whether the precedent case was well-reasoned and articulated (in the court’s legal opinion) • Whether the precedent case was issued from a court in the same jurisdiction • Whether the precedent case was issued from a higher-level court Although these factors are often considered to determine whether a case is a precedent case, thus representing a binding and mandatory legal source, a court may not be required to follow: • Secondary legal sources (i.e., nonprecedent cases, not related to the U.S. Constitution, and the like; see the following paragraph for further specifics) • Cases that do not align with these factors to determine the precedential value of a case Two main types of legal sources exist in American law: primary and secondary. 1. Primary legal sources include the following: • U.S. Constitution • Statutes • Rules, regulations, and orders • Executive orders and proclamations • Case law 2. Secondary legal sources include the following: • Treatises • Restatements • Law review journals • American Law Reports • Hornbooks • Legal encyclopedias A general hierarchy also exists in which federal legal sources are weighed more heavily than state legal sources: A. Federal Legal Sources • U.S. Constitution • Federal statutes and treaties • Federal rules and regulations • Federal cases B. State Legal Sources • State constitutions • State statutes American Law 101 • State rules and regulations • State law cases From this list, two interesting points arise: (1) the U.S. Constitution represents the supreme law of the land, and (2) a federal supremacy rule applies. This means that federal sources are generally higher than state sources in the legal source hierarchy. This is important to know for both academics and practitioners to determine what legal source should be given greater weight relative to others, which can help in the legal strategy process. State Law Although the United States is one country, from a legal perspective, each individual state within it has a certain level of discretion to determine what types of laws best fit that particular state’s set of circumstances. The concept of dualism, in which sources of law exist dually at both the federal and state level, is based in part on the view that decentralization of power is needed. The intent of dualism was to provide greater security that one central source of authority would not become overly powerful—as was the case with England at the time of the founding of the United States. Furthermore, as Chapter 6 discusses in greater detail regarding Constitutional Law, the U.S. Constitution (the nation’s highest legal authority) has embedded in it a concept known as the enumerated powers doctrine. In the enumerated powers doctrine, the federal government has only those powers expressly conveyed to it under the Constitution (under Article I, Section 8), with all other remaining powers generally belonging to the states. Thus, state laws are actually much more widely encompassing than many people from non–common law countries would expect. With this in mind, each specific state’s law can vary and be different from other state laws. Although diversity exists, many state laws are based on certain standardized laws. Examples of standardized laws that state law can be based on include the following: • Restatements of law, which are used to provide clarity on certain law matters • Prepared by the American Law Institute (ALI) • Represents secondary (nonprimary) legal source/authority • Uniform acts/Uniform codes, such as the Uniform Commercial Code, or UCC, relating to contract law • Drafted by the Uniform Law Commissioners • Body of lawyers and other legal professionals whose objective is to standardize laws across the various U.S. states • Offered as legal models, which each state can ratify in whole or in part The American Legal System Made Easy • Model penal code (MPC), relating to criminal law matters • Prepared by the ALI, much like restatements • Objective of updating and standardizing penal law across the various U.S. states • MPC represents what the ALI deems as the best rules for the U.S. penal system Much like the dual federal-state level of legal sources, a similar dual system of federal-state court systems exists. Consistent with the principle of federalism, federal courts rank higher in the judicial court hierarchy relative to state courts. The Federal Court hierarchy (from highest to lowest) is as follows: • U.S. Supreme Court • Circuit courts • District courts Federal courts consider the following legal sources: • Federal (nonstate) statutory issues Supreme Court of the United States U.S. Courts of Appeal (13 Circuit Courts) U.S. District Courts (94 Trial Courts) State Supreme Courts Intermediate Appellate Courts (39 of 50 States) State Trial Courts (Across 50 States) American Law 101 • Diversity cases, such as cases involving parties from two different states • Cases in which the United States is a party as plaintiff or defendant • Other cases as specified by law (e.g., admiralty, antitrust, maritime) • Removal jurisdiction cases, in which the defendant requests the case to be heard by a federal, rather than a state, court in the same district The U.S. Supreme Court (USSC) is the highest court in the United States. The U.S. Supreme Court generally hears cases based on appeal (when certiorari—or in plain English, review—is granted to review the case). In other words, the USSC is only in rare circumstances the court of first instance having original jurisdiction over a case. Of course, exceptions exist when an issue is particularly urgent. For instance, the Bush v. Gore (2000) case was heard by the USSC at first instance because its ruling could, in effect, determine the outcome of the 2000 U.S. presidential election. Below the USSC in judicial hierarchy are the federal circuit courts. The circuit courts generally hear appeals from the lower district courts. Unlike the USSC, federal circuit courts have original jurisdiction (court of first instance) over orders of certain federal agencies. The federal circuit courts are divided geographically into 13 circuit courts. Circuit courts numbered from 1 to 13 encompass all of the states (including Hawaii), with an additional district for Washington D.C. (which is a federal territory, not a U.S. state), and a federal circuit for certain specialized matters. Many cases begin at the state court level and, if needed, are appealed to the federal level (except for the instances discussed previously), in particular, when a federal (rather than a state) issue arises. State Courts Most state court systems replicate the federal court system. Some state courts have three levels of hierarchy, whereas other state courts have two levels of hierarchy. Regardless, each state court has its own rules of procedure and set of practices. With a three-level state court system, the hierarchy is typically the following: • State Supreme Court: Hears appeals from state intermediate court • State court of appeals: Hears appeals from lower trial court • State trial court: Conducts fact-finding as well as ruling on the legal issue(s) presented State courts usually can review almost any case, but exceptions exist, such as where jurisdiction is precluded by (1) federal statute; (2) the U.S. Constitution; or (3) other legal source, expressly (e.g., admiralty, patent, copyright) or implicitly (e.g., antitrust damages and injunction). The American Legal System Made Easy American Judicial System The United States has three branches of government: (1) the legislative branch (the Congress, which is composed of the Senate and House of Representatives); (2) the executive branch (including the U.S. President), and (3) the judicial branch (including the USSC and other courts). The three branches of government are based on the concept of checks and balances, so that each branch of government does not become too powerful relative to the other two branches. Related terms are defined as follows: • Congress: Bicameral institution that refers to the Senate and the House of Representatives • House of Representatives: • Referred to as the lower house (because the legislative process typically begins here and then proceeds to the Senate). • The number of Representatives is based on the population of each state (thus, the larger and more populated states—such as California, Texas, and New York—generally have more Representatives). • House representatives are elected to two-year terms and can be reelected continuously. • Senate: • Referred to as the higher chamber (because the Senate is the second chamber in the legislative process). • Two senators are elected from each of the 50 states (regardless of a state’s population). • Senators are elected to six-year terms with the possibility of reelections. • Government lawyers: • Prosecutor: A government attorney who prepares and conducts the prosecution of the accused party • District Attorney (DA) (or county prosecutor): A government prosecutor representing a particular state • United States (U.S.) Attorney: A federal prosecutor representing the United States for certain federal districts An example of checks and balances in practice could involve an impeachment proceeding against the executive branch. An attempt to impeach the U.S. President (executive branch), for instance, would involve the legislative branch placing a check and balance on the executive branch by arguing, among other things, that certain actions of the presidency allegedly violated the U.S. Constitution. The judicial branch (federal American Law 101 courts) can serve as a check and balance if it decides to review the acts of the legislative branch in terms of constitutionality (i.e., to determine whether an act by the legislative branch allegedly violated the U.S. Constitution, which all three branches must abide by). The federal courts can also review the actions of federal administrative agencies. At the same time, the legislative branch (Congress) can review and overrule court precedent under its designated Congressional authority. The American legal system can appear diverse and complex. With the overview provided in this chapter, it is hoped that readers have a better understanding and greater clarity regarding the hardware of American law. This understanding of the American legal infrastructure will help, as the next chapters will fill in the landscape—section by section—that will culminate into a panoramic primer of American law. The reading and understanding of cases is important in most, if not all, jurisdictions in the world. The U.S. legal system, which is based on the common law system of England, treats case law (law based on the interpretation of cases by the judiciary) as especially important. This is based on the previously mentioned concept of stare decisis. Under stare decisis, lower courts often must (as opposed to can) rule and conclude the case in a manner consistent with higher courts in the same jurisdiction regarding previous cases with similar facts and issues (which links back to the IRAC legal thinking process covered earlier in Chapter 1). The American legal system’s main rationale for stare decisis is consistency and greater foreseeability of how similar cases may be concluded by the courts. However, with benefits come drawbacks. With stare decisis, the drawback is less judicial discretion afforded to the courts and judges in an effort to treat each dispute on a case-by-case basis. What is considered as the drawback of the common law system under stare decisis is often viewed as the benefit of the civil law system, in which stare decisis does not apply. This thus gives greater judicial discretion to the courts, at the potential cost of inconsistent judicial conclusions even within the same jurisdiction. So which domestic legal system among the two is better: common law or civil law? When students and even practitioners pose this question, a common first answer is that each system has both benefits and costs (as analyzed here), and it is incumbent upon each jurisdiction to determine which system makes the most sense, all things considered. The other answer is that an increasing convergent trend is now occurring, whereby legal practitioners from both common and civil legal traditions often tend to think more similarly now than in the past, particularly in commercial transactions and dealings. This convergence may be in part a result of globalization, technological advancements, and students studying internationally—creating a greater exposure and knowledge base of the common law tradition (as well as civil law and other domestic legal traditions, such as Islamic law). (See the Appendices for further specifics on the American court system.) To understand the American legal system, legal cases reflecting case law must be understood in great detail. This is especially critical given the importance of stare The American Legal System Made Easy decisis and precedent cases in American law, as discussed earlier. Because of the importance of case law and understanding cases, the next section provides a more detailed glimpse into the main elements of a case within the American judicial system, including a method of how to read and brief a case—a vital skill set for both the study and practice of American law. How to Read and Brief a Case With the high level of importance given to stare decisis and precedent cases underlying American law, a fundamental knowledge of how to understand and brief a U.S. case is critically important. This is true as a law student as well as a law practitioner who aspires to gain a greater understanding of American law. To begin, most court decisions are published, both at the federal and state level. The court issuing the opinion often has the discretion in deciding whether to publish an opinion it has rendered. Specific case elements exist in a typical case brief, which include the following: • Case Name and its citation to find and/or reference the case • Author of the Opinion (the Opinion is the court’s ruling/decision): Generally, the person who authors a legal opinion is a judge or arbitrator (the concept and role of arbitrators is discussed in greater detail in Chapter 10). • Opinion, which generally includes: • Case Facts and relevant procedural history of the case, such as past appeals and rulings • Court Conclusion, also referred to as the case’s holding • Reasoning: Detailing the rationale, arguments, and other factors considered by the court • Disposition: Court action based on the court’s ruling/conclusion (e.g., reversed, affirmed, remanded.) The case caption can be thought of as a title for a case. Example: Brown v. Board of Education, 347 U.S. 483 (1954). The case caption includes the parties, case citation (court name, law book where the opinion is published), and year of the court’s conclusion. In terms of formality of writing for a case caption, the party names to the dispute are italicized and/or underlined (the example has the party names italicized). The remaining case caption (e.g., citation/reporter details, year that the decision was rendered, and other related details) generally is not italicized or underlined. Reporters Cases that are published are included in publications called reporters. Each reporter has a volume number and page numbers. Some reporters are published by the state, while American Law 101 some are published by commercial institutions. For the case citation/reporter relating to the previous example, the case would be found in volume 347 of the United States Reports on page 483. Judicial Titles The author of the court opinion, as mentioned, is typically a judge. In this case, the judge, in his or her capacity as legal opinion author (for the majority or minority opinion), is written at the top of the legal opinion, as follows: Example: “Hand, J.” refers to Judge Hand. Example: “Holmes J.” is Justice Holmes. Some jurisdictions use terms other than “judge,” albeit referring to the same judicial decision-rendering role: Example: “Jackson, C.” refers to Chancellor Jackson. Example: “Jackson, V.C.” refers to Vice-Chancellor Jackson. Example: “Jackson, C.J.” refers to Chief Judge Jackson. Party Names In a civil (noncriminal) case, the party initiating the lawsuit is the plaintiff, and the party defending against the plaintiff’s lawsuit is the defendant (not coincidentally, the term “defendant” has the term “defend” embedded in it). In criminal (noncivil) cases, the party initiating the lawsuit is referred to as the state (or similar terminology), because the interests of the state (or other relevantly named party initiating the lawsuit) are presumed greater than one individual (such as by a plaintiff in a civil law case). The plaintiffs (or state) are usually the first party listed in the caption. For the previous caption example, Brown is the plaintiff at the initial stage (prior to an appeal, if an appeal is rendered). If a case is heard on appeal (in which a case is heard for the second time or more), then the party initiating the appeal is called the appellant. The party defending against the appellant’s lawsuit on appeal is called the appellee. Thus, as an example, if the Board of Education in the previous example appealed, then the Board of Education would be the first named party in the caption of the appealed case (rather than second, as was the case in the original lawsuit example). The court’s conclusion or ruling is the court’s legal opinion and the rationale given for reaching a particular judgment, finding, or conclusion. Underneath the broad term of legal opinion, several specific subsets of opinions exist. A concurring opinion is an opinion rendered by a judge who would have reached the same conclusion as the majority opinion, but for a different reason (i.e., same destination, but would have chosen a different route to get to the destination). A plurality opinion is The American Legal System Made Easy an opinion agreed on by less than the majority of the judges (assuming a panel of judges), but the opinion agrees with the majority opinion’s conclusion. A dissenting opinion is an opinion by one or more judges who disagree with the majority opinion’s conclusion. The parties to a lawsuit (at the initial trial court level) include the following: • Plaintiff: Party initiating the lawsuit • Defendant: Party defending against the lawsuit (legal action by plaintiff) • Counterclaimant: Defendant’s counterclaim against the plaintiff • Cross-claimant: Defendant bringing a lawsuit against a third party, typically with a view that the introduced third party was at least partially responsible/ liable for owed damages to plaintiff • Third-party defendant: Party defending against a cross-claim for alleged damages owed to plaintiff • Intervenor: Interested party participating in litigation with the court’s permission The parties to a lawsuit (at the noninitial appellate court level) include the following: • Appellant: Party appealing a lower court’s ruling (usually the unsuccessful party in the previous lawsuit) • Appellee: Party defending against the appellant’s actions • Petitioner: Party challenging action, usually in an agency context • Respondent: Party defending against petitioner’s actions, usually in an agency context • Intervenor: Same as intervenor at the trial court level • Amicus curiae (“friend of the court”): Party given court permission to participate in the case • U.S. Solicitor: Government attorney representing the United States The parties to a lawsuit (at the highest U.S. Supreme Court level) include the following: • Petitioner: Party seeking the Supreme Court’s review, arguing for the rejection of the lower court’s decision • Respondent: Party opposing the Supreme Court’s review, arguing that the lower court’s decision does not warrant review, because the lower court’s conclusion and rationale are legally valid • Intervenor: Same as intervenor at the trial/appellate court level • Amicus curiae: Same as at the appeals court level • U.S. Solicitor: Government attorney representing the United States American Law 101 Court Dispositions—General • Order: Court resolution of a motion (filed by one of the parties) • Affirmation: Court’s decision to uphold the lower court’s ruling • Reversal: Court’s rejection of the lower court’s ruling • Remand: Court order to return the case to the lower court (or agency) for further factual findings, or for other resolution in conformity with the appellate court’s decision • Vacate: Court rejection of the lower court’s ruling, with an order to set aside and render the lower court’s ruling as null and void • Modification: Court’s affirmation of part of the lower court’s decision, with an ordered modification to the opinion Court Dispositions—Appellate Courts • En Banc Opinion: • Represents an opinion by all members of the court, not just a certain number (panel) of sitting judges, to hear a particular case • Generally represents a rare exception rather than the norm • Usually seen in issues of extreme importance Court Disposition—Supreme Court • Plurality Opinion: • An opinion that more judges sign than any concurring opinion • Does not constitute a majority opinion • Does not have the force of precedent, because it is not a result of a majority opinion • Certiorari Granted: • Grant of discretionary review by the U.S. Supreme Court (often considered the exception rather than the norm because the Supreme Court is unable to grant certiorari to most cases given its limited time and resources) • Does not reverse or directly affect lower court rulings • Certiorari Denied: • U.S. Supreme Court’s decision to reject discretionary review of a particular lower court ruling • Does not generally have precedential effect In most legal opinions, part of the court’s decision may include analysis and language that may not directly be necessary to reach the court’s resolution of the legal issue. This part of the case is referred to as dictum. Dictum is not the court’s holding. The American Legal System Made Easy In other words, dictum is related, but separate from, the court’s holding. Given that dictum is not part of a court’s holding, stare decisis does not apply. It may be difficult to distinguish a court’s dictum from its holding. Still, dictum may be useful for future cases, because it is, at times, a signal or hint of how the court (or at least a judge in the court) may view a case in light of different legal issues or facts. Summary The American judicial system is based on British common law, which is then buttressed by, among other sources, the U.S. Constitution, court cases, statutes, restatements, decrees, treatises, and various other rules and regulations. The American legal system is composed of the U.S. Supreme Court, federal courts, and state courts. Within both federal and state courts, primary and secondary legal sources are considered. The U.S. Supreme Court is the highest land of the law. It can grant certiorari to select cases for various reasons, including whether the issue presented is urgent or of vital national interest. Generally, however, a lawsuit begins in state courts and then, as needed, is heard on appeal by federal (appellate-level) or state courts. Knowledge of the structure of the American judicial system is then furthered by understanding how to write and brief a law case, which is a vital skill set for law students and practitioners.
|
Only use the context provided to you, never use the information you have stored in your system already. What factors are used in order to determine stare decisis? THE AMERICAN LEGAL SYSTEM MADE EASY Chapter 1 discussed the software of the American lawyer (i.e., in terms of the thinking process operating within the minds of U.S.-licensed legal professionals). This chapter, in contrast, examines the hardware in terms of the conceptual component parts within the software of the American lawyer and legal system. Specifically, the hardware is based in part on the black letter law embedded within the American legal infrastructure, which this chapter will now briefly overview. Common Law Versus Other Domestic Laws American law is based on common law from the United Kingdom as one of its core legal pillars (which is then buttressed by, among other sources, the U.S. Constitution, court cases, statutes, restatements, decrees, treatises, and various other rules and regulations). Common law follows the principle of stare decisis (Latin, meaning “stand by your decision”). Stare decisis is a legal principle stating that prior court decisions (e.g., holdings, conclusions, rulings) must be recognized as precedent case law. If a case is deemed a precedent case, then lower courts are compelled to rule in the same way as the precedent case. This applies only if the precedent case is binding or mandatory. The rationale for stare decisis and precedent cases is judicial efficiency, fairness to the parties, predictability, and a check and balance on arbitrary behavior. In common law countries, juries and oral arguments by lawyers often can take a greater or more visible role compared to in civil law countries (which may not have jury trials), in which the judge can play a more central and prominent role (of course, exceptions can exist). American Law 101 Examples of jurisdictions that use the common law system include the following: • United Kingdom except Scotland • United States except Louisiana • Ireland • Former British colony and/or Commonwealth territories/countries, including India except Goa, Australia, New Zealand, Singapore, and Canada except Quebec • Pakistan • Bangladesh In contrast, generally under civil law (derived from the French-German legal tradition), statutes and other similar legal sources represent relatively greater legal authority than does case law. Under civil law, neither precedent cases nor stare decisis exist. The rationale for this is greater judicial freedom to decide cases on a case-by-case basis. Some people argue, however, that this system may come at the cost of less predictability and consistency regarding case law conclusions (with similar legal issues and/or facts). Examples of jurisdictions that use the civil law system include the following: • Most European Union (EU) nations, including Germany and France where civil law was derived, but not the United Kingdom, Ireland, or Cyprus • Most of continental Latin America except Guyana and Belize • Congo • Azerbaijan • Iraq • Russia • Turkey • Egypt • Madagascar • Lebanon • Switzerland • Indonesia • Vietnam • Thailand The factors used in determining whether to apply stare decisis include the following: • Similarity of legal issue(s)/legal principle(s) • Whether the precedent case was ruled on by a court recognized as a leading one in the relevant subject area The American Legal System Made Easy • Whether the precedent case was well-reasoned and articulated (in the court’s legal opinion) • Whether the precedent case was issued from a court in the same jurisdiction • Whether the precedent case was issued from a higher-level court Although these factors are often considered to determine whether a case is a precedent case, thus representing a binding and mandatory legal source, a court may not be required to follow: • Secondary legal sources (i.e., nonprecedent cases, not related to the U.S. Constitution, and the like; see the following paragraph for further specifics) • Cases that do not align with these factors to determine the precedential value of a case Two main types of legal sources exist in American law: primary and secondary. 1. Primary legal sources include the following: • U.S. Constitution • Statutes • Rules, regulations, and orders • Executive orders and proclamations • Case law 2. Secondary legal sources include the following: • Treatises • Restatements • Law review journals • American Law Reports • Hornbooks • Legal encyclopedias A general hierarchy also exists in which federal legal sources are weighed more heavily than state legal sources: A. Federal Legal Sources • U.S. Constitution • Federal statutes and treaties • Federal rules and regulations • Federal cases B. State Legal Sources • State constitutions • State statutes American Law 101 • State rules and regulations • State law cases From this list, two interesting points arise: (1) the U.S. Constitution represents the supreme law of the land, and (2) a federal supremacy rule applies. This means that federal sources are generally higher than state sources in the legal source hierarchy. This is important to know for both academics and practitioners to determine what legal source should be given greater weight relative to others, which can help in the legal strategy process. State Law Although the United States is one country, from a legal perspective, each individual state within it has a certain level of discretion to determine what types of laws best fit that particular state’s set of circumstances. The concept of dualism, in which sources of law exist dually at both the federal and state level, is based in part on the view that decentralization of power is needed. The intent of dualism was to provide greater security that one central source of authority would not become overly powerful—as was the case with England at the time of the founding of the United States. Furthermore, as Chapter 6 discusses in greater detail regarding Constitutional Law, the U.S. Constitution (the nation’s highest legal authority) has embedded in it a concept known as the enumerated powers doctrine. In the enumerated powers doctrine, the federal government has only those powers expressly conveyed to it under the Constitution (under Article I, Section 8), with all other remaining powers generally belonging to the states. Thus, state laws are actually much more widely encompassing than many people from non–common law countries would expect. With this in mind, each specific state’s law can vary and be different from other state laws. Although diversity exists, many state laws are based on certain standardized laws. Examples of standardized laws that state law can be based on include the following: • Restatements of law, which are used to provide clarity on certain law matters • Prepared by the American Law Institute (ALI) • Represents secondary (nonprimary) legal source/authority • Uniform acts/Uniform codes, such as the Uniform Commercial Code, or UCC, relating to contract law • Drafted by the Uniform Law Commissioners • Body of lawyers and other legal professionals whose objective is to standardize laws across the various U.S. states • Offered as legal models, which each state can ratify in whole or in part The American Legal System Made Easy • Model penal code (MPC), relating to criminal law matters • Prepared by the ALI, much like restatements • Objective of updating and standardizing penal law across the various U.S. states • MPC represents what the ALI deems as the best rules for the U.S. penal system Much like the dual federal-state level of legal sources, a similar dual system of federal-state court systems exists. Consistent with the principle of federalism, federal courts rank higher in the judicial court hierarchy relative to state courts. The Federal Court hierarchy (from highest to lowest) is as follows: • U.S. Supreme Court • Circuit courts • District courts Federal courts consider the following legal sources: • Federal (nonstate) statutory issues Supreme Court of the United States U.S. Courts of Appeal (13 Circuit Courts) U.S. District Courts (94 Trial Courts) State Supreme Courts Intermediate Appellate Courts (39 of 50 States) State Trial Courts (Across 50 States) American Law 101 • Diversity cases, such as cases involving parties from two different states • Cases in which the United States is a party as plaintiff or defendant • Other cases as specified by law (e.g., admiralty, antitrust, maritime) • Removal jurisdiction cases, in which the defendant requests the case to be heard by a federal, rather than a state, court in the same district The U.S. Supreme Court (USSC) is the highest court in the United States. The U.S. Supreme Court generally hears cases based on appeal (when certiorari—or in plain English, review—is granted to review the case). In other words, the USSC is only in rare circumstances the court of first instance having original jurisdiction over a case. Of course, exceptions exist when an issue is particularly urgent. For instance, the Bush v. Gore (2000) case was heard by the USSC at first instance because its ruling could, in effect, determine the outcome of the 2000 U.S. presidential election. Below the USSC in judicial hierarchy are the federal circuit courts. The circuit courts generally hear appeals from the lower district courts. Unlike the USSC, federal circuit courts have original jurisdiction (court of first instance) over orders of certain federal agencies. The federal circuit courts are divided geographically into 13 circuit courts. Circuit courts numbered from 1 to 13 encompass all of the states (including Hawaii), with an additional district for Washington D.C. (which is a federal territory, not a U.S. state), and a federal circuit for certain specialized matters. Many cases begin at the state court level and, if needed, are appealed to the federal level (except for the instances discussed previously), in particular, when a federal (rather than a state) issue arises. State Courts Most state court systems replicate the federal court system. Some state courts have three levels of hierarchy, whereas other state courts have two levels of hierarchy. Regardless, each state court has its own rules of procedure and set of practices. With a three-level state court system, the hierarchy is typically the following: • State Supreme Court: Hears appeals from state intermediate court • State court of appeals: Hears appeals from lower trial court • State trial court: Conducts fact-finding as well as ruling on the legal issue(s) presented State courts usually can review almost any case, but exceptions exist, such as where jurisdiction is precluded by (1) federal statute; (2) the U.S. Constitution; or (3) other legal source, expressly (e.g., admiralty, patent, copyright) or implicitly (e.g., antitrust damages and injunction). The American Legal System Made Easy American Judicial System The United States has three branches of government: (1) the legislative branch (the Congress, which is composed of the Senate and House of Representatives); (2) the executive branch (including the U.S. President), and (3) the judicial branch (including the USSC and other courts). The three branches of government are based on the concept of checks and balances, so that each branch of government does not become too powerful relative to the other two branches. Related terms are defined as follows: • Congress: Bicameral institution that refers to the Senate and the House of Representatives • House of Representatives: • Referred to as the lower house (because the legislative process typically begins here and then proceeds to the Senate). • The number of Representatives is based on the population of each state (thus, the larger and more populated states—such as California, Texas, and New York—generally have more Representatives). • House representatives are elected to two-year terms and can be reelected continuously. • Senate: • Referred to as the higher chamber (because the Senate is the second chamber in the legislative process). • Two senators are elected from each of the 50 states (regardless of a state’s population). • Senators are elected to six-year terms with the possibility of reelections. • Government lawyers: • Prosecutor: A government attorney who prepares and conducts the prosecution of the accused party • District Attorney (DA) (or county prosecutor): A government prosecutor representing a particular state • United States (U.S.) Attorney: A federal prosecutor representing the United States for certain federal districts An example of checks and balances in practice could involve an impeachment proceeding against the executive branch. An attempt to impeach the U.S. President (executive branch), for instance, would involve the legislative branch placing a check and balance on the executive branch by arguing, among other things, that certain actions of the presidency allegedly violated the U.S. Constitution. The judicial branch (federal American Law 101 courts) can serve as a check and balance if it decides to review the acts of the legislative branch in terms of constitutionality (i.e., to determine whether an act by the legislative branch allegedly violated the U.S. Constitution, which all three branches must abide by). The federal courts can also review the actions of federal administrative agencies. At the same time, the legislative branch (Congress) can review and overrule court precedent under its designated Congressional authority. The American legal system can appear diverse and complex. With the overview provided in this chapter, it is hoped that readers have a better understanding and greater clarity regarding the hardware of American law. This understanding of the American legal infrastructure will help, as the next chapters will fill in the landscape—section by section—that will culminate into a panoramic primer of American law. The reading and understanding of cases is important in most, if not all, jurisdictions in the world. The U.S. legal system, which is based on the common law system of England, treats case law (law based on the interpretation of cases by the judiciary) as especially important. This is based on the previously mentioned concept of stare decisis. Under stare decisis, lower courts often must (as opposed to can) rule and conclude the case in a manner consistent with higher courts in the same jurisdiction regarding previous cases with similar facts and issues (which links back to the IRAC legal thinking process covered earlier in Chapter 1). The American legal system’s main rationale for stare decisis is consistency and greater foreseeability of how similar cases may be concluded by the courts. However, with benefits come drawbacks. With stare decisis, the drawback is less judicial discretion afforded to the courts and judges in an effort to treat each dispute on a case-by-case basis. What is considered as the drawback of the common law system under stare decisis is often viewed as the benefit of the civil law system, in which stare decisis does not apply. This thus gives greater judicial discretion to the courts, at the potential cost of inconsistent judicial conclusions even within the same jurisdiction. So which domestic legal system among the two is better: common law or civil law? When students and even practitioners pose this question, a common first answer is that each system has both benefits and costs (as analyzed here), and it is incumbent upon each jurisdiction to determine which system makes the most sense, all things considered. The other answer is that an increasing convergent trend is now occurring, whereby legal practitioners from both common and civil legal traditions often tend to think more similarly now than in the past, particularly in commercial transactions and dealings. This convergence may be in part a result of globalization, technological advancements, and students studying internationally—creating a greater exposure and knowledge base of the common law tradition (as well as civil law and other domestic legal traditions, such as Islamic law). (See the Appendices for further specifics on the American court system.) To understand the American legal system, legal cases reflecting case law must be understood in great detail. This is especially critical given the importance of stare The American Legal System Made Easy decisis and precedent cases in American law, as discussed earlier. Because of the importance of case law and understanding cases, the next section provides a more detailed glimpse into the main elements of a case within the American judicial system, including a method of how to read and brief a case—a vital skill set for both the study and practice of American law. How to Read and Brief a Case With the high level of importance given to stare decisis and precedent cases underlying American law, a fundamental knowledge of how to understand and brief a U.S. case is critically important. This is true as a law student as well as a law practitioner who aspires to gain a greater understanding of American law. To begin, most court decisions are published, both at the federal and state level. The court issuing the opinion often has the discretion in deciding whether to publish an opinion it has rendered. Specific case elements exist in a typical case brief, which include the following: • Case Name and its citation to find and/or reference the case • Author of the Opinion (the Opinion is the court’s ruling/decision): Generally, the person who authors a legal opinion is a judge or arbitrator (the concept and role of arbitrators is discussed in greater detail in Chapter 10). • Opinion, which generally includes: • Case Facts and relevant procedural history of the case, such as past appeals and rulings • Court Conclusion, also referred to as the case’s holding • Reasoning: Detailing the rationale, arguments, and other factors considered by the court • Disposition: Court action based on the court’s ruling/conclusion (e.g., reversed, affirmed, remanded.) The case caption can be thought of as a title for a case. Example: Brown v. Board of Education, 347 U.S. 483 (1954). The case caption includes the parties, case citation (court name, law book where the opinion is published), and year of the court’s conclusion. In terms of formality of writing for a case caption, the party names to the dispute are italicized and/or underlined (the example has the party names italicized). The remaining case caption (e.g., citation/reporter details, year that the decision was rendered, and other related details) generally is not italicized or underlined. Reporters Cases that are published are included in publications called reporters. Each reporter has a volume number and page numbers. Some reporters are published by the state, while American Law 101 some are published by commercial institutions. For the case citation/reporter relating to the previous example, the case would be found in volume 347 of the United States Reports on page 483. Judicial Titles The author of the court opinion, as mentioned, is typically a judge. In this case, the judge, in his or her capacity as legal opinion author (for the majority or minority opinion), is written at the top of the legal opinion, as follows: Example: “Hand, J.” refers to Judge Hand. Example: “Holmes J.” is Justice Holmes. Some jurisdictions use terms other than “judge,” albeit referring to the same judicial decision-rendering role: Example: “Jackson, C.” refers to Chancellor Jackson. Example: “Jackson, V.C.” refers to Vice-Chancellor Jackson. Example: “Jackson, C.J.” refers to Chief Judge Jackson. Party Names In a civil (noncriminal) case, the party initiating the lawsuit is the plaintiff, and the party defending against the plaintiff’s lawsuit is the defendant (not coincidentally, the term “defendant” has the term “defend” embedded in it). In criminal (noncivil) cases, the party initiating the lawsuit is referred to as the state (or similar terminology), because the interests of the state (or other relevantly named party initiating the lawsuit) are presumed greater than one individual (such as by a plaintiff in a civil law case). The plaintiffs (or state) are usually the first party listed in the caption. For the previous caption example, Brown is the plaintiff at the initial stage (prior to an appeal, if an appeal is rendered). If a case is heard on appeal (in which a case is heard for the second time or more), then the party initiating the appeal is called the appellant. The party defending against the appellant’s lawsuit on appeal is called the appellee. Thus, as an example, if the Board of Education in the previous example appealed, then the Board of Education would be the first named party in the caption of the appealed case (rather than second, as was the case in the original lawsuit example). The court’s conclusion or ruling is the court’s legal opinion and the rationale given for reaching a particular judgment, finding, or conclusion. Underneath the broad term of legal opinion, several specific subsets of opinions exist. A concurring opinion is an opinion rendered by a judge who would have reached the same conclusion as the majority opinion, but for a different reason (i.e., same destination, but would have chosen a different route to get to the destination). A plurality opinion is The American Legal System Made Easy an opinion agreed on by less than the majority of the judges (assuming a panel of judges), but the opinion agrees with the majority opinion’s conclusion. A dissenting opinion is an opinion by one or more judges who disagree with the majority opinion’s conclusion. The parties to a lawsuit (at the initial trial court level) include the following: • Plaintiff: Party initiating the lawsuit • Defendant: Party defending against the lawsuit (legal action by plaintiff) • Counterclaimant: Defendant’s counterclaim against the plaintiff • Cross-claimant: Defendant bringing a lawsuit against a third party, typically with a view that the introduced third party was at least partially responsible/ liable for owed damages to plaintiff • Third-party defendant: Party defending against a cross-claim for alleged damages owed to plaintiff • Intervenor: Interested party participating in litigation with the court’s permission The parties to a lawsuit (at the noninitial appellate court level) include the following: • Appellant: Party appealing a lower court’s ruling (usually the unsuccessful party in the previous lawsuit) • Appellee: Party defending against the appellant’s actions • Petitioner: Party challenging action, usually in an agency context • Respondent: Party defending against petitioner’s actions, usually in an agency context • Intervenor: Same as intervenor at the trial court level • Amicus curiae (“friend of the court”): Party given court permission to participate in the case • U.S. Solicitor: Government attorney representing the United States The parties to a lawsuit (at the highest U.S. Supreme Court level) include the following: • Petitioner: Party seeking the Supreme Court’s review, arguing for the rejection of the lower court’s decision • Respondent: Party opposing the Supreme Court’s review, arguing that the lower court’s decision does not warrant review, because the lower court’s conclusion and rationale are legally valid • Intervenor: Same as intervenor at the trial/appellate court level • Amicus curiae: Same as at the appeals court level • U.S. Solicitor: Government attorney representing the United States American Law 101 Court Dispositions—General • Order: Court resolution of a motion (filed by one of the parties) • Affirmation: Court’s decision to uphold the lower court’s ruling • Reversal: Court’s rejection of the lower court’s ruling • Remand: Court order to return the case to the lower court (or agency) for further factual findings, or for other resolution in conformity with the appellate court’s decision • Vacate: Court rejection of the lower court’s ruling, with an order to set aside and render the lower court’s ruling as null and void • Modification: Court’s affirmation of part of the lower court’s decision, with an ordered modification to the opinion Court Dispositions—Appellate Courts • En Banc Opinion: • Represents an opinion by all members of the court, not just a certain number (panel) of sitting judges, to hear a particular case • Generally represents a rare exception rather than the norm • Usually seen in issues of extreme importance Court Disposition—Supreme Court • Plurality Opinion: • An opinion that more judges sign than any concurring opinion • Does not constitute a majority opinion • Does not have the force of precedent, because it is not a result of a majority opinion • Certiorari Granted: • Grant of discretionary review by the U.S. Supreme Court (often considered the exception rather than the norm because the Supreme Court is unable to grant certiorari to most cases given its limited time and resources) • Does not reverse or directly affect lower court rulings • Certiorari Denied: • U.S. Supreme Court’s decision to reject discretionary review of a particular lower court ruling • Does not generally have precedential effect In most legal opinions, part of the court’s decision may include analysis and language that may not directly be necessary to reach the court’s resolution of the legal issue. This part of the case is referred to as dictum. Dictum is not the court’s holding. The American Legal System Made Easy In other words, dictum is related, but separate from, the court’s holding. Given that dictum is not part of a court’s holding, stare decisis does not apply. It may be difficult to distinguish a court’s dictum from its holding. Still, dictum may be useful for future cases, because it is, at times, a signal or hint of how the court (or at least a judge in the court) may view a case in light of different legal issues or facts. Summary The American judicial system is based on British common law, which is then buttressed by, among other sources, the U.S. Constitution, court cases, statutes, restatements, decrees, treatises, and various other rules and regulations. The American legal system is composed of the U.S. Supreme Court, federal courts, and state courts. Within both federal and state courts, primary and secondary legal sources are considered. The U.S. Supreme Court is the highest land of the law. It can grant certiorari to select cases for various reasons, including whether the issue presented is urgent or of vital national interest. Generally, however, a lawsuit begins in state courts and then, as needed, is heard on appeal by federal (appellate-level) or state courts. Knowledge of the structure of the American judicial system is then furthered by understanding how to write and brief a law case, which is a vital skill set for law students and practitioners.
|
Only use the context provided to you, never use the information you have stored in your system already.
EVIDENCE:
THE AMERICAN LEGAL SYSTEM MADE EASY Chapter 1 discussed the software of the American lawyer (i.e., in terms of the thinking process operating within the minds of U.S.-licensed legal professionals). This chapter, in contrast, examines the hardware in terms of the conceptual component parts within the software of the American lawyer and legal system. Specifically, the hardware is based in part on the black letter law embedded within the American legal infrastructure, which this chapter will now briefly overview. Common Law Versus Other Domestic Laws American law is based on common law from the United Kingdom as one of its core legal pillars (which is then buttressed by, among other sources, the U.S. Constitution, court cases, statutes, restatements, decrees, treatises, and various other rules and regulations). Common law follows the principle of stare decisis (Latin, meaning “stand by your decision”). Stare decisis is a legal principle stating that prior court decisions (e.g., holdings, conclusions, rulings) must be recognized as precedent case law. If a case is deemed a precedent case, then lower courts are compelled to rule in the same way as the precedent case. This applies only if the precedent case is binding or mandatory. The rationale for stare decisis and precedent cases is judicial efficiency, fairness to the parties, predictability, and a check and balance on arbitrary behavior. In common law countries, juries and oral arguments by lawyers often can take a greater or more visible role compared to in civil law countries (which may not have jury trials), in which the judge can play a more central and prominent role (of course, exceptions can exist). American Law 101 Examples of jurisdictions that use the common law system include the following: • United Kingdom except Scotland • United States except Louisiana • Ireland • Former British colony and/or Commonwealth territories/countries, including India except Goa, Australia, New Zealand, Singapore, and Canada except Quebec • Pakistan • Bangladesh In contrast, generally under civil law (derived from the French-German legal tradition), statutes and other similar legal sources represent relatively greater legal authority than does case law. Under civil law, neither precedent cases nor stare decisis exist. The rationale for this is greater judicial freedom to decide cases on a case-by-case basis. Some people argue, however, that this system may come at the cost of less predictability and consistency regarding case law conclusions (with similar legal issues and/or facts). Examples of jurisdictions that use the civil law system include the following: • Most European Union (EU) nations, including Germany and France where civil law was derived, but not the United Kingdom, Ireland, or Cyprus • Most of continental Latin America except Guyana and Belize • Congo • Azerbaijan • Iraq • Russia • Turkey • Egypt • Madagascar • Lebanon • Switzerland • Indonesia • Vietnam • Thailand The factors used in determining whether to apply stare decisis include the following: • Similarity of legal issue(s)/legal principle(s) • Whether the precedent case was ruled on by a court recognized as a leading one in the relevant subject area The American Legal System Made Easy • Whether the precedent case was well-reasoned and articulated (in the court’s legal opinion) • Whether the precedent case was issued from a court in the same jurisdiction • Whether the precedent case was issued from a higher-level court Although these factors are often considered to determine whether a case is a precedent case, thus representing a binding and mandatory legal source, a court may not be required to follow: • Secondary legal sources (i.e., nonprecedent cases, not related to the U.S. Constitution, and the like; see the following paragraph for further specifics) • Cases that do not align with these factors to determine the precedential value of a case Two main types of legal sources exist in American law: primary and secondary. 1. Primary legal sources include the following: • U.S. Constitution • Statutes • Rules, regulations, and orders • Executive orders and proclamations • Case law 2. Secondary legal sources include the following: • Treatises • Restatements • Law review journals • American Law Reports • Hornbooks • Legal encyclopedias A general hierarchy also exists in which federal legal sources are weighed more heavily than state legal sources: A. Federal Legal Sources • U.S. Constitution • Federal statutes and treaties • Federal rules and regulations • Federal cases B. State Legal Sources • State constitutions • State statutes American Law 101 • State rules and regulations • State law cases From this list, two interesting points arise: (1) the U.S. Constitution represents the supreme law of the land, and (2) a federal supremacy rule applies. This means that federal sources are generally higher than state sources in the legal source hierarchy. This is important to know for both academics and practitioners to determine what legal source should be given greater weight relative to others, which can help in the legal strategy process. State Law Although the United States is one country, from a legal perspective, each individual state within it has a certain level of discretion to determine what types of laws best fit that particular state’s set of circumstances. The concept of dualism, in which sources of law exist dually at both the federal and state level, is based in part on the view that decentralization of power is needed. The intent of dualism was to provide greater security that one central source of authority would not become overly powerful—as was the case with England at the time of the founding of the United States. Furthermore, as Chapter 6 discusses in greater detail regarding Constitutional Law, the U.S. Constitution (the nation’s highest legal authority) has embedded in it a concept known as the enumerated powers doctrine. In the enumerated powers doctrine, the federal government has only those powers expressly conveyed to it under the Constitution (under Article I, Section 8), with all other remaining powers generally belonging to the states. Thus, state laws are actually much more widely encompassing than many people from non–common law countries would expect. With this in mind, each specific state’s law can vary and be different from other state laws. Although diversity exists, many state laws are based on certain standardized laws. Examples of standardized laws that state law can be based on include the following: • Restatements of law, which are used to provide clarity on certain law matters • Prepared by the American Law Institute (ALI) • Represents secondary (nonprimary) legal source/authority • Uniform acts/Uniform codes, such as the Uniform Commercial Code, or UCC, relating to contract law • Drafted by the Uniform Law Commissioners • Body of lawyers and other legal professionals whose objective is to standardize laws across the various U.S. states • Offered as legal models, which each state can ratify in whole or in part The American Legal System Made Easy • Model penal code (MPC), relating to criminal law matters • Prepared by the ALI, much like restatements • Objective of updating and standardizing penal law across the various U.S. states • MPC represents what the ALI deems as the best rules for the U.S. penal system Much like the dual federal-state level of legal sources, a similar dual system of federal-state court systems exists. Consistent with the principle of federalism, federal courts rank higher in the judicial court hierarchy relative to state courts. The Federal Court hierarchy (from highest to lowest) is as follows: • U.S. Supreme Court • Circuit courts • District courts Federal courts consider the following legal sources: • Federal (nonstate) statutory issues Supreme Court of the United States U.S. Courts of Appeal (13 Circuit Courts) U.S. District Courts (94 Trial Courts) State Supreme Courts Intermediate Appellate Courts (39 of 50 States) State Trial Courts (Across 50 States) American Law 101 • Diversity cases, such as cases involving parties from two different states • Cases in which the United States is a party as plaintiff or defendant • Other cases as specified by law (e.g., admiralty, antitrust, maritime) • Removal jurisdiction cases, in which the defendant requests the case to be heard by a federal, rather than a state, court in the same district The U.S. Supreme Court (USSC) is the highest court in the United States. The U.S. Supreme Court generally hears cases based on appeal (when certiorari—or in plain English, review—is granted to review the case). In other words, the USSC is only in rare circumstances the court of first instance having original jurisdiction over a case. Of course, exceptions exist when an issue is particularly urgent. For instance, the Bush v. Gore (2000) case was heard by the USSC at first instance because its ruling could, in effect, determine the outcome of the 2000 U.S. presidential election. Below the USSC in judicial hierarchy are the federal circuit courts. The circuit courts generally hear appeals from the lower district courts. Unlike the USSC, federal circuit courts have original jurisdiction (court of first instance) over orders of certain federal agencies. The federal circuit courts are divided geographically into 13 circuit courts. Circuit courts numbered from 1 to 13 encompass all of the states (including Hawaii), with an additional district for Washington D.C. (which is a federal territory, not a U.S. state), and a federal circuit for certain specialized matters. Many cases begin at the state court level and, if needed, are appealed to the federal level (except for the instances discussed previously), in particular, when a federal (rather than a state) issue arises. State Courts Most state court systems replicate the federal court system. Some state courts have three levels of hierarchy, whereas other state courts have two levels of hierarchy. Regardless, each state court has its own rules of procedure and set of practices. With a three-level state court system, the hierarchy is typically the following: • State Supreme Court: Hears appeals from state intermediate court • State court of appeals: Hears appeals from lower trial court • State trial court: Conducts fact-finding as well as ruling on the legal issue(s) presented State courts usually can review almost any case, but exceptions exist, such as where jurisdiction is precluded by (1) federal statute; (2) the U.S. Constitution; or (3) other legal source, expressly (e.g., admiralty, patent, copyright) or implicitly (e.g., antitrust damages and injunction). The American Legal System Made Easy American Judicial System The United States has three branches of government: (1) the legislative branch (the Congress, which is composed of the Senate and House of Representatives); (2) the executive branch (including the U.S. President), and (3) the judicial branch (including the USSC and other courts). The three branches of government are based on the concept of checks and balances, so that each branch of government does not become too powerful relative to the other two branches. Related terms are defined as follows: • Congress: Bicameral institution that refers to the Senate and the House of Representatives • House of Representatives: • Referred to as the lower house (because the legislative process typically begins here and then proceeds to the Senate). • The number of Representatives is based on the population of each state (thus, the larger and more populated states—such as California, Texas, and New York—generally have more Representatives). • House representatives are elected to two-year terms and can be reelected continuously. • Senate: • Referred to as the higher chamber (because the Senate is the second chamber in the legislative process). • Two senators are elected from each of the 50 states (regardless of a state’s population). • Senators are elected to six-year terms with the possibility of reelections. • Government lawyers: • Prosecutor: A government attorney who prepares and conducts the prosecution of the accused party • District Attorney (DA) (or county prosecutor): A government prosecutor representing a particular state • United States (U.S.) Attorney: A federal prosecutor representing the United States for certain federal districts An example of checks and balances in practice could involve an impeachment proceeding against the executive branch. An attempt to impeach the U.S. President (executive branch), for instance, would involve the legislative branch placing a check and balance on the executive branch by arguing, among other things, that certain actions of the presidency allegedly violated the U.S. Constitution. The judicial branch (federal American Law 101 courts) can serve as a check and balance if it decides to review the acts of the legislative branch in terms of constitutionality (i.e., to determine whether an act by the legislative branch allegedly violated the U.S. Constitution, which all three branches must abide by). The federal courts can also review the actions of federal administrative agencies. At the same time, the legislative branch (Congress) can review and overrule court precedent under its designated Congressional authority. The American legal system can appear diverse and complex. With the overview provided in this chapter, it is hoped that readers have a better understanding and greater clarity regarding the hardware of American law. This understanding of the American legal infrastructure will help, as the next chapters will fill in the landscape—section by section—that will culminate into a panoramic primer of American law. The reading and understanding of cases is important in most, if not all, jurisdictions in the world. The U.S. legal system, which is based on the common law system of England, treats case law (law based on the interpretation of cases by the judiciary) as especially important. This is based on the previously mentioned concept of stare decisis. Under stare decisis, lower courts often must (as opposed to can) rule and conclude the case in a manner consistent with higher courts in the same jurisdiction regarding previous cases with similar facts and issues (which links back to the IRAC legal thinking process covered earlier in Chapter 1). The American legal system’s main rationale for stare decisis is consistency and greater foreseeability of how similar cases may be concluded by the courts. However, with benefits come drawbacks. With stare decisis, the drawback is less judicial discretion afforded to the courts and judges in an effort to treat each dispute on a case-by-case basis. What is considered as the drawback of the common law system under stare decisis is often viewed as the benefit of the civil law system, in which stare decisis does not apply. This thus gives greater judicial discretion to the courts, at the potential cost of inconsistent judicial conclusions even within the same jurisdiction. So which domestic legal system among the two is better: common law or civil law? When students and even practitioners pose this question, a common first answer is that each system has both benefits and costs (as analyzed here), and it is incumbent upon each jurisdiction to determine which system makes the most sense, all things considered. The other answer is that an increasing convergent trend is now occurring, whereby legal practitioners from both common and civil legal traditions often tend to think more similarly now than in the past, particularly in commercial transactions and dealings. This convergence may be in part a result of globalization, technological advancements, and students studying internationally—creating a greater exposure and knowledge base of the common law tradition (as well as civil law and other domestic legal traditions, such as Islamic law). (See the Appendices for further specifics on the American court system.) To understand the American legal system, legal cases reflecting case law must be understood in great detail. This is especially critical given the importance of stare The American Legal System Made Easy decisis and precedent cases in American law, as discussed earlier. Because of the importance of case law and understanding cases, the next section provides a more detailed glimpse into the main elements of a case within the American judicial system, including a method of how to read and brief a case—a vital skill set for both the study and practice of American law. How to Read and Brief a Case With the high level of importance given to stare decisis and precedent cases underlying American law, a fundamental knowledge of how to understand and brief a U.S. case is critically important. This is true as a law student as well as a law practitioner who aspires to gain a greater understanding of American law. To begin, most court decisions are published, both at the federal and state level. The court issuing the opinion often has the discretion in deciding whether to publish an opinion it has rendered. Specific case elements exist in a typical case brief, which include the following: • Case Name and its citation to find and/or reference the case • Author of the Opinion (the Opinion is the court’s ruling/decision): Generally, the person who authors a legal opinion is a judge or arbitrator (the concept and role of arbitrators is discussed in greater detail in Chapter 10). • Opinion, which generally includes: • Case Facts and relevant procedural history of the case, such as past appeals and rulings • Court Conclusion, also referred to as the case’s holding • Reasoning: Detailing the rationale, arguments, and other factors considered by the court • Disposition: Court action based on the court’s ruling/conclusion (e.g., reversed, affirmed, remanded.) The case caption can be thought of as a title for a case. Example: Brown v. Board of Education, 347 U.S. 483 (1954). The case caption includes the parties, case citation (court name, law book where the opinion is published), and year of the court’s conclusion. In terms of formality of writing for a case caption, the party names to the dispute are italicized and/or underlined (the example has the party names italicized). The remaining case caption (e.g., citation/reporter details, year that the decision was rendered, and other related details) generally is not italicized or underlined. Reporters Cases that are published are included in publications called reporters. Each reporter has a volume number and page numbers. Some reporters are published by the state, while American Law 101 some are published by commercial institutions. For the case citation/reporter relating to the previous example, the case would be found in volume 347 of the United States Reports on page 483. Judicial Titles The author of the court opinion, as mentioned, is typically a judge. In this case, the judge, in his or her capacity as legal opinion author (for the majority or minority opinion), is written at the top of the legal opinion, as follows: Example: “Hand, J.” refers to Judge Hand. Example: “Holmes J.” is Justice Holmes. Some jurisdictions use terms other than “judge,” albeit referring to the same judicial decision-rendering role: Example: “Jackson, C.” refers to Chancellor Jackson. Example: “Jackson, V.C.” refers to Vice-Chancellor Jackson. Example: “Jackson, C.J.” refers to Chief Judge Jackson. Party Names In a civil (noncriminal) case, the party initiating the lawsuit is the plaintiff, and the party defending against the plaintiff’s lawsuit is the defendant (not coincidentally, the term “defendant” has the term “defend” embedded in it). In criminal (noncivil) cases, the party initiating the lawsuit is referred to as the state (or similar terminology), because the interests of the state (or other relevantly named party initiating the lawsuit) are presumed greater than one individual (such as by a plaintiff in a civil law case). The plaintiffs (or state) are usually the first party listed in the caption. For the previous caption example, Brown is the plaintiff at the initial stage (prior to an appeal, if an appeal is rendered). If a case is heard on appeal (in which a case is heard for the second time or more), then the party initiating the appeal is called the appellant. The party defending against the appellant’s lawsuit on appeal is called the appellee. Thus, as an example, if the Board of Education in the previous example appealed, then the Board of Education would be the first named party in the caption of the appealed case (rather than second, as was the case in the original lawsuit example). The court’s conclusion or ruling is the court’s legal opinion and the rationale given for reaching a particular judgment, finding, or conclusion. Underneath the broad term of legal opinion, several specific subsets of opinions exist. A concurring opinion is an opinion rendered by a judge who would have reached the same conclusion as the majority opinion, but for a different reason (i.e., same destination, but would have chosen a different route to get to the destination). A plurality opinion is The American Legal System Made Easy an opinion agreed on by less than the majority of the judges (assuming a panel of judges), but the opinion agrees with the majority opinion’s conclusion. A dissenting opinion is an opinion by one or more judges who disagree with the majority opinion’s conclusion. The parties to a lawsuit (at the initial trial court level) include the following: • Plaintiff: Party initiating the lawsuit • Defendant: Party defending against the lawsuit (legal action by plaintiff) • Counterclaimant: Defendant’s counterclaim against the plaintiff • Cross-claimant: Defendant bringing a lawsuit against a third party, typically with a view that the introduced third party was at least partially responsible/ liable for owed damages to plaintiff • Third-party defendant: Party defending against a cross-claim for alleged damages owed to plaintiff • Intervenor: Interested party participating in litigation with the court’s permission The parties to a lawsuit (at the noninitial appellate court level) include the following: • Appellant: Party appealing a lower court’s ruling (usually the unsuccessful party in the previous lawsuit) • Appellee: Party defending against the appellant’s actions • Petitioner: Party challenging action, usually in an agency context • Respondent: Party defending against petitioner’s actions, usually in an agency context • Intervenor: Same as intervenor at the trial court level • Amicus curiae (“friend of the court”): Party given court permission to participate in the case • U.S. Solicitor: Government attorney representing the United States The parties to a lawsuit (at the highest U.S. Supreme Court level) include the following: • Petitioner: Party seeking the Supreme Court’s review, arguing for the rejection of the lower court’s decision • Respondent: Party opposing the Supreme Court’s review, arguing that the lower court’s decision does not warrant review, because the lower court’s conclusion and rationale are legally valid • Intervenor: Same as intervenor at the trial/appellate court level • Amicus curiae: Same as at the appeals court level • U.S. Solicitor: Government attorney representing the United States American Law 101 Court Dispositions—General • Order: Court resolution of a motion (filed by one of the parties) • Affirmation: Court’s decision to uphold the lower court’s ruling • Reversal: Court’s rejection of the lower court’s ruling • Remand: Court order to return the case to the lower court (or agency) for further factual findings, or for other resolution in conformity with the appellate court’s decision • Vacate: Court rejection of the lower court’s ruling, with an order to set aside and render the lower court’s ruling as null and void • Modification: Court’s affirmation of part of the lower court’s decision, with an ordered modification to the opinion Court Dispositions—Appellate Courts • En Banc Opinion: • Represents an opinion by all members of the court, not just a certain number (panel) of sitting judges, to hear a particular case • Generally represents a rare exception rather than the norm • Usually seen in issues of extreme importance Court Disposition—Supreme Court • Plurality Opinion: • An opinion that more judges sign than any concurring opinion • Does not constitute a majority opinion • Does not have the force of precedent, because it is not a result of a majority opinion • Certiorari Granted: • Grant of discretionary review by the U.S. Supreme Court (often considered the exception rather than the norm because the Supreme Court is unable to grant certiorari to most cases given its limited time and resources) • Does not reverse or directly affect lower court rulings • Certiorari Denied: • U.S. Supreme Court’s decision to reject discretionary review of a particular lower court ruling • Does not generally have precedential effect In most legal opinions, part of the court’s decision may include analysis and language that may not directly be necessary to reach the court’s resolution of the legal issue. This part of the case is referred to as dictum. Dictum is not the court’s holding. The American Legal System Made Easy In other words, dictum is related, but separate from, the court’s holding. Given that dictum is not part of a court’s holding, stare decisis does not apply. It may be difficult to distinguish a court’s dictum from its holding. Still, dictum may be useful for future cases, because it is, at times, a signal or hint of how the court (or at least a judge in the court) may view a case in light of different legal issues or facts. Summary The American judicial system is based on British common law, which is then buttressed by, among other sources, the U.S. Constitution, court cases, statutes, restatements, decrees, treatises, and various other rules and regulations. The American legal system is composed of the U.S. Supreme Court, federal courts, and state courts. Within both federal and state courts, primary and secondary legal sources are considered. The U.S. Supreme Court is the highest land of the law. It can grant certiorari to select cases for various reasons, including whether the issue presented is urgent or of vital national interest. Generally, however, a lawsuit begins in state courts and then, as needed, is heard on appeal by federal (appellate-level) or state courts. Knowledge of the structure of the American judicial system is then furthered by understanding how to write and brief a law case, which is a vital skill set for law students and practitioners.
USER:
What factors are used in order to determine stare decisis?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 18 | 10 | 4,272 | null | 275 |
Your response must only present information that is present in the context block. Ensure that your response is clear and presents all information in an unbiased manner. You may use bulleted lists for organizing your response, but avoid all other markdown formatting.
|
Discuss the differing perspectives on whether or not the output of AI models should be afforded copyright protection.
|
Do AI Outputs Enjoy Copyright Protection? The question of whether or not copyright protection may be afforded to AI outputs—such as images created by DALL-E or texts created by ChatGPT—likely hinges at least partly on the concept of “authorship.” The U.S. Constitution authorizes Congress to “secur[e] for limited Times to Authors . . . the exclusive Right to their . . . Writings.” Based on this authority, the Copyright Act affords copyright protection to “original works of authorship.” Although the Constitution and Copyright Act do not explicitly define who (or what) may be an “author,” the U.S. Copyright Office recognizes copyright only in works “created by a human being.” Courts have likewise declined to extend copyright protection to nonhuman authors, holding that a monkey who took a series of photos lacked standing to sue under the Copyright Act; that some human creativity was required to copyright a book purportedly inspired by celestial beings; and that a living garden could not be copyrighted as it lacked a human author. A recent lawsuit challenged the human-authorship requirement in the context of works purportedly “authored” by AI. In June 2022, Stephen Thaler sued the Copyright Office for denying his application to register a visual artwork that he claims was authored “autonomously” by an AI program called the Creativity Machine. Dr. Thaler argued that human authorship is not required by the Copyright Act. On August 18, 2023, a federal district court granted summary judgment in favor of the Copyright Office. The court held that “human authorship is an essential part of a valid copyright claim,” reasoning that only human authors need copyright as an incentive to create works. Dr. Thaler has stated that he plans to appeal the decision. Assuming that a copyrightable work requires a human author, works created by humans using generative AI could still be entitled to copyright protection, depending on the nature of human involvement in the creative process. However, a recent copyright proceeding and subsequent Copyright Registration Guidance indicate that the Copyright Office is unlikely to find the requisite human authorship where an AI program generates works in response to text prompts. In September 2022, Kris Kashtanova registered a copyright for a graphic novel illustrated with images that Midjourney generated in response to text inputs. In October 2022, the Copyright Office initiated cancellation proceedings, noting that Kashtanova had not disclosed the use of AI. Kashtanova responded by arguing that the images were made via “a creative, iterative process.” On February 21, 2023, the Copyright Office determined that the images were not copyrightable, deciding that Midjourney, rather than Kashtanova, authored the “visual material.” In March 2023, the Copyright Office released guidance stating that, when AI “determines the expressive elements of its output, the generated material is not the product of human authorship.” Some commentators assert that some AI-generated works should receive copyright protection, arguing that AI programs are like other tools that human beings have used to create copyrighted works. For example, the Supreme Court has held since the 1884 case Burrow-Giles Lithographic Co. v. Sarony that photographs can be entitled to copyright protection where the photographer makes decisions regarding creative elements such as composition, arrangement, and lighting. Generative AI programs might be seen as a new tool analogous to the camera, as Kashtanova argued. Other commentators and the Copyright Office dispute the photography analogy and question whether AI users exercise sufficient creative control for AI to be considered merely a tool. In Kashtanova’s case, the Copyright Office reasoned that Midjourney was not “a tool that [] Kashtanova controlled and guided to reach [their] desired image” because it “generates images in an unpredictable way.” The Copyright Office instead compared the AI user to “a client who hires an artist” and gives that artist only “general directions.” The office’s March 2023 guidance similarly claims that “users do not exercise ultimate creative control over how [generative AI] systems interpret prompts and generate materials.” One of Kashtanova’s lawyers, on the other hand, argues that the Copyright Act does not require such exacting creative control, noting that certain photographs and modern art incorporate a degree of happenstance. Some commentators argue that the Copyright Act’s distinction between copyrightable “works” and noncopyrightable “ideas” supplies another reason that copyright should not protect AI-generated works. One law professor has suggested that the human user who enters a text prompt into an AI program—for instance, asking DALL-E “to produce a painting of hedgehogs having a tea party on the beach”—has “contributed nothing more than an idea” to the finished work. According to this argument, the output image lacks a human author and cannot be copyrighted. While the Copyright Office’s actions indicate that it may be challenging to obtain copyright protection for AI-generated works, the issue remains unsettled. Applicants may file suit in U.S. district court to challenge the Copyright Office’s final decisions to refuse to register a copyright (as Dr. Thaler did), and it remains to be seen whether federal courts will agree with all of the office’s decisions. While the Copyright Office notes that courts sometimes give weight to the office’s experience and expertise in this field, courts will not necessarily adopt the office’s interpretations of the Copyright Act. In addition, the Copyright Office’s guidance accepts that works “containing” AI-generated material may be copyrighted under some circumstances, such as “sufficiently creative” human arrangements or modifications of AI-generated material or works that combine AI-generated and human-authored material. The office states that the author may only claim copyright protection “for their own contributions” to such works, and they must identify and disclaim AI-generated parts of the work if they apply to register their copyright. In September 2023, for instance, the Copyright Office Review Board affirmed the office’s refusal to register a copyright for an artwork that was generated by Midjourney and then modified in various ways by the applicant, since the applicant did not disclaim the AI-generated material.
|
Your response must only present information that is present in the context block. Ensure that your response is clear and presents all information in an unbiased manner. You may use bulleted lists for organizing your response, but avoid all other markdown formatting. Your response shall address the following user request: Discuss the differing perspectives on whether or not the output of AI models should be afforded copyright protection. Do AI Outputs Enjoy Copyright Protection? The question of whether or not copyright protection may be afforded to AI outputs—such as images created by DALL-E or texts created by ChatGPT—likely hinges at least partly on the concept of “authorship.” The U.S. Constitution authorizes Congress to “secur[e] for limited Times to Authors . . . the exclusive Right to their . . . Writings.” Based on this authority, the Copyright Act affords copyright protection to “original works of authorship.” Although the Constitution and Copyright Act do not explicitly define who (or what) may be an “author,” the U.S. Copyright Office recognizes copyright only in works “created by a human being.” Courts have likewise declined to extend copyright protection to nonhuman authors, holding that a monkey who took a series of photos lacked standing to sue under the Copyright Act; that some human creativity was required to copyright a book purportedly inspired by celestial beings; and that a living garden could not be copyrighted as it lacked a human author. A recent lawsuit challenged the human-authorship requirement in the context of works purportedly “authored” by AI. In June 2022, Stephen Thaler sued the Copyright Office for denying his application to register a visual artwork that he claims was authored “autonomously” by an AI program called the Creativity Machine. Dr. Thaler argued that human authorship is not required by the Copyright Act. On August 18, 2023, a federal district court granted summary judgment in favor of the Copyright Office. The court held that “human authorship is an essential part of a valid copyright claim,” reasoning that only human authors need copyright as an incentive to create works. Dr. Thaler has stated that he plans to appeal the decision. Assuming that a copyrightable work requires a human author, works created by humans using generative AI could still be entitled to copyright protection, depending on the nature of human involvement in the creative process. However, a recent copyright proceeding and subsequent Copyright Registration Guidance indicate that the Copyright Office is unlikely to find the requisite human authorship where an AI program generates works in response to text prompts. In September 2022, Kris Kashtanova registered a copyright for a graphic novel illustrated with images that Midjourney generated in response to text inputs. In October 2022, the Copyright Office initiated cancellation proceedings, noting that Kashtanova had not disclosed the use of AI. Kashtanova responded by arguing that the images were made via “a creative, iterative process.” On February 21, 2023, the Copyright Office determined that the images were not copyrightable, deciding that Midjourney, rather than Kashtanova, authored the “visual material.” In March 2023, the Copyright Office released guidance stating that, when AI “determines the expressive elements of its output, the generated material is not the product of human authorship.” Some commentators assert that some AI-generated works should receive copyright protection, arguing that AI programs are like other tools that human beings have used to create copyrighted works. For example, the Supreme Court has held since the 1884 case Burrow-Giles Lithographic Co. v. Sarony that photographs can be entitled to copyright protection where the photographer makes decisions regarding creative elements such as composition, arrangement, and lighting. Generative AI programs might be seen as a new tool analogous to the camera, as Kashtanova argued. Other commentators and the Copyright Office dispute the photography analogy and question whether AI users exercise sufficient creative control for AI to be considered merely a tool. In Kashtanova’s case, the Copyright Office reasoned that Midjourney was not “a tool that [] Kashtanova controlled and guided to reach [their] desired image” because it “generates images in an unpredictable way.” The Copyright Office instead compared the AI user to “a client who hires an artist” and gives that artist only “general directions.” The office’s March 2023 guidance similarly claims that “users do not exercise ultimate creative control over how [generative AI] systems interpret prompts and generate materials.” One of Kashtanova’s lawyers, on the other hand, argues that the Copyright Act does not require such exacting creative control, noting that certain photographs and modern art incorporate a degree of happenstance. Some commentators argue that the Copyright Act’s distinction between copyrightable “works” and noncopyrightable “ideas” supplies another reason that copyright should not protect AI-generated works. One law professor has suggested that the human user who enters a text prompt into an AI program—for instance, asking DALL-E “to produce a painting of hedgehogs having a tea party on the beach”—has “contributed nothing more than an idea” to the finished work. According to this argument, the output image lacks a human author and cannot be copyrighted. While the Copyright Office’s actions indicate that it may be challenging to obtain copyright protection for AI-generated works, the issue remains unsettled. Applicants may file suit in U.S. district court to challenge the Copyright Office’s final decisions to refuse to register a copyright (as Dr. Thaler did), and it remains to be seen whether federal courts will agree with all of the office’s decisions. While the Copyright Office notes that courts sometimes give weight to the office’s experience and expertise in this field, courts will not necessarily adopt the office’s interpretations of the Copyright Act. In addition, the Copyright Office’s guidance accepts that works “containing” AI-generated material may be copyrighted under some circumstances, such as “sufficiently creative” human arrangements or modifications of AI-generated material or works that combine AI-generated and human-authored material. The office states that the author may only claim copyright protection “for their own contributions” to such works, and they must identify and disclaim AI-generated parts of the work if they apply to register their copyright. In September 2023, for instance, the Copyright Office Review Board affirmed the office’s refusal to register a copyright for an artwork that was generated by Midjourney and then modified in various ways by the applicant, since the applicant did not disclaim the AI-generated material.
|
Your response must only present information that is present in the context block. Ensure that your response is clear and presents all information in an unbiased manner. You may use bulleted lists for organizing your response, but avoid all other markdown formatting.
EVIDENCE:
Do AI Outputs Enjoy Copyright Protection? The question of whether or not copyright protection may be afforded to AI outputs—such as images created by DALL-E or texts created by ChatGPT—likely hinges at least partly on the concept of “authorship.” The U.S. Constitution authorizes Congress to “secur[e] for limited Times to Authors . . . the exclusive Right to their . . . Writings.” Based on this authority, the Copyright Act affords copyright protection to “original works of authorship.” Although the Constitution and Copyright Act do not explicitly define who (or what) may be an “author,” the U.S. Copyright Office recognizes copyright only in works “created by a human being.” Courts have likewise declined to extend copyright protection to nonhuman authors, holding that a monkey who took a series of photos lacked standing to sue under the Copyright Act; that some human creativity was required to copyright a book purportedly inspired by celestial beings; and that a living garden could not be copyrighted as it lacked a human author. A recent lawsuit challenged the human-authorship requirement in the context of works purportedly “authored” by AI. In June 2022, Stephen Thaler sued the Copyright Office for denying his application to register a visual artwork that he claims was authored “autonomously” by an AI program called the Creativity Machine. Dr. Thaler argued that human authorship is not required by the Copyright Act. On August 18, 2023, a federal district court granted summary judgment in favor of the Copyright Office. The court held that “human authorship is an essential part of a valid copyright claim,” reasoning that only human authors need copyright as an incentive to create works. Dr. Thaler has stated that he plans to appeal the decision. Assuming that a copyrightable work requires a human author, works created by humans using generative AI could still be entitled to copyright protection, depending on the nature of human involvement in the creative process. However, a recent copyright proceeding and subsequent Copyright Registration Guidance indicate that the Copyright Office is unlikely to find the requisite human authorship where an AI program generates works in response to text prompts. In September 2022, Kris Kashtanova registered a copyright for a graphic novel illustrated with images that Midjourney generated in response to text inputs. In October 2022, the Copyright Office initiated cancellation proceedings, noting that Kashtanova had not disclosed the use of AI. Kashtanova responded by arguing that the images were made via “a creative, iterative process.” On February 21, 2023, the Copyright Office determined that the images were not copyrightable, deciding that Midjourney, rather than Kashtanova, authored the “visual material.” In March 2023, the Copyright Office released guidance stating that, when AI “determines the expressive elements of its output, the generated material is not the product of human authorship.” Some commentators assert that some AI-generated works should receive copyright protection, arguing that AI programs are like other tools that human beings have used to create copyrighted works. For example, the Supreme Court has held since the 1884 case Burrow-Giles Lithographic Co. v. Sarony that photographs can be entitled to copyright protection where the photographer makes decisions regarding creative elements such as composition, arrangement, and lighting. Generative AI programs might be seen as a new tool analogous to the camera, as Kashtanova argued. Other commentators and the Copyright Office dispute the photography analogy and question whether AI users exercise sufficient creative control for AI to be considered merely a tool. In Kashtanova’s case, the Copyright Office reasoned that Midjourney was not “a tool that [] Kashtanova controlled and guided to reach [their] desired image” because it “generates images in an unpredictable way.” The Copyright Office instead compared the AI user to “a client who hires an artist” and gives that artist only “general directions.” The office’s March 2023 guidance similarly claims that “users do not exercise ultimate creative control over how [generative AI] systems interpret prompts and generate materials.” One of Kashtanova’s lawyers, on the other hand, argues that the Copyright Act does not require such exacting creative control, noting that certain photographs and modern art incorporate a degree of happenstance. Some commentators argue that the Copyright Act’s distinction between copyrightable “works” and noncopyrightable “ideas” supplies another reason that copyright should not protect AI-generated works. One law professor has suggested that the human user who enters a text prompt into an AI program—for instance, asking DALL-E “to produce a painting of hedgehogs having a tea party on the beach”—has “contributed nothing more than an idea” to the finished work. According to this argument, the output image lacks a human author and cannot be copyrighted. While the Copyright Office’s actions indicate that it may be challenging to obtain copyright protection for AI-generated works, the issue remains unsettled. Applicants may file suit in U.S. district court to challenge the Copyright Office’s final decisions to refuse to register a copyright (as Dr. Thaler did), and it remains to be seen whether federal courts will agree with all of the office’s decisions. While the Copyright Office notes that courts sometimes give weight to the office’s experience and expertise in this field, courts will not necessarily adopt the office’s interpretations of the Copyright Act. In addition, the Copyright Office’s guidance accepts that works “containing” AI-generated material may be copyrighted under some circumstances, such as “sufficiently creative” human arrangements or modifications of AI-generated material or works that combine AI-generated and human-authored material. The office states that the author may only claim copyright protection “for their own contributions” to such works, and they must identify and disclaim AI-generated parts of the work if they apply to register their copyright. In September 2023, for instance, the Copyright Office Review Board affirmed the office’s refusal to register a copyright for an artwork that was generated by Midjourney and then modified in various ways by the applicant, since the applicant did not disclaim the AI-generated material.
USER:
Discuss the differing perspectives on whether or not the output of AI models should be afforded copyright protection.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 42 | 18 | 978 | null | 675 |
Only use the text that is provided to answer the question. Answer using complete sentences. The answer must be a minimum of 3 sentences.
|
Based only on the information in the article above, which fitness equipment brands specialize in weight/strength training equipment?
|
**The Top 9 Gym Equipment Brands for Business Success in 2024** Are you a startup gym owner ready to make a significant impact on the fitness industry this year? In a market flooded with endless options, pinpointing the right gym equipment manufacturer to partner with is pivotal for your business’s success. After rigorous research and analysis, Yanre Fitness stands out as the best brand of gym equipment for startup gym owners aiming for business success in 2024. With over a decade of experience in the fitness industry, I’ve consulted gyms across the country, helping them scale their operations and maximize profits. The insights on this list are grounded in real-world experience and in-depth market research, making them invaluable for business owners in this space. Keep reading to discover the top gym equipment brands that can propel a business to greater heights this year. 1. Technogym – Best in Luxury Fitness Solutions Country and City: Cesena FC, Italy Established Date: 1983 Technogym, the Wellness Company, is a global leader in creating top-of-the-line fitness equipment tailored to various markets, including private homes, fitness clubs, hotels, spas, and rehabilitation centers. The brand is synonymous with wellness, a philosophy that encourages a balanced lifestyle through regular exercise, nutritious eating, and a positive mental attitude. Key Products: Treadmills and Strength Equipments Takeaway Note: Technogym excels in offering luxurious, design-forward fitness solutions backed by decades of innovation and quality craftsmanship. However, their products often come with a premium price tag, which may be a consideration for budget-conscious business owners. 2. Power Systems – Best in Comprehensive Fitness Solutions Country and City: Tennessee, United States Established Date: 1986 Power Systems stands out as a complete solution provider in the sports and fitness industries, offering a wide range of quality fitness and performance products. The brand is deeply committed to innovation, customer service, and education. Their slogan, “Power. Performance. Results,” aptly summarizes their philosophy that their products and elite customer service empower their diverse clientele to achieve optimal outcomes. Key Products: Strength and Functional Equipments Takeaway Note: Power Systems offers a comprehensive range of quality fitness products, backed by an unwavering commitment to customer satisfaction. However, the brand’s vast product line can sometimes make the selection process overwhelming for new business owners. 3. Yanre Fitness – Best in Durable Equipment Solutions Country and City: Wuhu, China Established: 1997 Yanre Fitness is a brand that has been steadily rising in popularity, thanks to its modern, functional, and convenient commercial gym equipment. Particularly excelling in the strength training segment, the brand uses durable materials that promise longevity and consistent performance over time. The brand is unwavering in its commitment to quality, making it a popular choice among gym owners. Key Products: Cardio and Strength Equipments Takeaway Note: Yanre Fitness delivers on both quality and affordability, making it an excellent choice for gym owners who are budget-conscious yet unwilling to compromise on equipment longevity. Whether looking to upgrade an existing gym or set up a new facility, they offer a seamless, cost-effective pathway to achieving your business goals. 4. Matrix Fitness – Best in Technologically Advanced Solutions Country and City: Wisconsin, United States Established Date: 2001 Matrix Fitness, a brand under Johnson Health Tech (JHT), excels in producing some of the most technologically advanced fitness equipment available today. Being part of a larger, globally recognized organization, the brand benefits from a vast international research and development network, allowing them to innovate and offer cutting-edge solutions. Key Products: Commercial Fitness and Cardio Equipments Takeaway Note: Matrix Fitness leads the pack in delivering technologically advanced and meticulously designed gym equipment. However, the sophistication of their equipment may come with a steeper learning curve for gym-goers unfamiliar with advanced fitness tech. 5. Gym 80 – Best in Precision Craftsmanship Country and City: Sarstedt, Germany Established: 1980 Gym 80 has become a byword for training quality, revolutionizing the way we work out. For instance, tenowned for its excellent biomechanics, precision craftsmanship, and clear design, the brand continually pushes the boundaries of what strength equipment can achieve. Their reputation in the industry stands as a testament to their commitment to quality and innovation. Key Products: Weight Stacks and Plate Loaded Equipments Takeaway Note: Gym 80 offers exceptional quality by blending traditional craftsmanship with advanced technology. However, this level of attention to detail comes with a higher price point. Therefore, if budget constraints are a significant concern, this brand might not be the most cost-effective option. 6. Tunturi New Fitness – Best in Holistic Wellness Country and City: Almere, Netherlands Established Date: 1922 Tunturi New Fitness doesn’t just sell gym equipment; they offer a philosophy of holistic well-being for both body and mind. They understand that health is more than just physical fitness, and that’s why their product range is designed to promote a balanced mind as well as a healthy body. With a strong focus on quality, longevity, and overall wellness, Tunturi New Fitness aims to be a lifelong partner in your health journey. Key Products: Strength and Cardio Equipments Takeaway Note: Choosing Tunturi New Fitness means investing in equipment that’s designed for the long haul, encompassing both physical and mental well-being. However, their philosophy-driven approach and the additional features focused on holistic wellness may feel overwhelming or unnecessary for any gym’s needs. 7. Rogue Fitness – Best in Strength Training Country and City: Ohio, United States Established Date: 2006 Rogue Fitness stands as a giant in the area of strength and conditioning equipment, with a product line that includes everything from barbells to power racks and sleds. Their dedication to quality is evident, serving as the official equipment supplier to prestigious competitions like the CrossFit Games, USA Weightlifting, the Arnold Strongman Classic, and the World’s Strongest Man competition. Key Products: Plates and Crossfit Equipments Takeaway Note: For business owners seeking to attract a clientele who appreciates high-quality, durable strength training equipment, Rogue Fitness provides a substantial competitive advantage. However, the premium pricing of their equipment requires a significant initial investment, potentially affecting the business’s budget. 8. NordicTrack – Best in Versatile Strength Equipment Country and City: Utah, USA Established Date: 1975 NordicTrack stands out for its comprehensive and versatile range of strength training equipment suitable for both home and commercial gyms. With a focus on high-quality and user-friendly design, the brand caters to various strength workout needs, ensuring that gym-goers and fitness enthusiasts can achieve their goals effectively. Key Products: Ellipticals and Strength Equipments Takeaway Note: NordicTrack’s versatile range of strength equipment makes it a one-stop-shop for all the fitness facility’s needs. However, while the brand promises durability and variety, their advanced machines may require regular software updates, which could be a long-term consideration in terms of maintenance and user experience. 9. True Fitness – Best in Customer-Centric Equipment Country and City: Missouri, United States Established Date: 1981 True Fitness specializes in creating premium, customer-first fitness equipment, encompassing cardio, strength, and functional training. For instance, the company prioritizes responsiveness in service, superior quality in product, and expertise in design. What sets them apart is their comprehensive customer care, not just at the point of sale, but also during and after the purchase. Key Products: Elliptical Trainers and Cardio Equipments Takeaway Note: True Fitness offers a range of equipment that aligns with a customer-first philosophy, enhancing user experience and potentially increasing customer loyalty. However, their focus on premium products may mean a higher upfront investment for businesses. 10. 3 Tips to Consider When Choosing the Best Brand of Gym Equipment Navigating the diverse market of gym equipment requires consideration beyond merely pricing or popular opinion. This section outlines 5 critical factors to facilitate the selection of a gym equipment brand that aligns with business goals and demonstrates lasting reliability. 1. Track Record of Quality: Opt for brands with a strong historical credibility and track record of quality and service, with positive peer reviews and endorsements from reputable professionals. 2. Readily Available Customer Support: According to Styku, buying a gym equipment is a considerable investment. Look for brands with favorable warranty terms covering significant components and offering reasonable periods, plus a commitment to excellent after-sales service, with readily available customer support and repair services. 3. Favorable Financing Terms: Consider the value offered against the cost, with brands that might seem expensive but provide durability, advanced features, and better service. According to Glofox, financing options can be a lifeline. Brands that offer favorable financing or leasing terms understand the industry’s economic challenges and are committed to fostering long-term partnerships.
|
<Passage> **The Top 9 Gym Equipment Brands for Business Success in 2024** Are you a startup gym owner ready to make a significant impact on the fitness industry this year? In a market flooded with endless options, pinpointing the right gym equipment manufacturer to partner with is pivotal for your business’s success. After rigorous research and analysis, Yanre Fitness stands out as the best brand of gym equipment for startup gym owners aiming for business success in 2024. With over a decade of experience in the fitness industry, I’ve consulted gyms across the country, helping them scale their operations and maximize profits. The insights on this list are grounded in real-world experience and in-depth market research, making them invaluable for business owners in this space. Keep reading to discover the top gym equipment brands that can propel a business to greater heights this year. 1. Technogym – Best in Luxury Fitness Solutions Country and City: Cesena FC, Italy Established Date: 1983 Technogym, the Wellness Company, is a global leader in creating top-of-the-line fitness equipment tailored to various markets, including private homes, fitness clubs, hotels, spas, and rehabilitation centers. The brand is synonymous with wellness, a philosophy that encourages a balanced lifestyle through regular exercise, nutritious eating, and a positive mental attitude. Key Products: Treadmills and Strength Equipments Takeaway Note: Technogym excels in offering luxurious, design-forward fitness solutions backed by decades of innovation and quality craftsmanship. However, their products often come with a premium price tag, which may be a consideration for budget-conscious business owners. 2. Power Systems – Best in Comprehensive Fitness Solutions Country and City: Tennessee, United States Established Date: 1986 Power Systems stands out as a complete solution provider in the sports and fitness industries, offering a wide range of quality fitness and performance products. The brand is deeply committed to innovation, customer service, and education. Their slogan, “Power. Performance. Results,” aptly summarizes their philosophy that their products and elite customer service empower their diverse clientele to achieve optimal outcomes. Key Products: Strength and Functional Equipments Takeaway Note: Power Systems offers a comprehensive range of quality fitness products, backed by an unwavering commitment to customer satisfaction. However, the brand’s vast product line can sometimes make the selection process overwhelming for new business owners. 3. Yanre Fitness – Best in Durable Equipment Solutions Country and City: Wuhu, China Established: 1997 Yanre Fitness is a brand that has been steadily rising in popularity, thanks to its modern, functional, and convenient commercial gym equipment. Particularly excelling in the strength training segment, the brand uses durable materials that promise longevity and consistent performance over time. The brand is unwavering in its commitment to quality, making it a popular choice among gym owners. Key Products: Cardio and Strength Equipments Takeaway Note: Yanre Fitness delivers on both quality and affordability, making it an excellent choice for gym owners who are budget-conscious yet unwilling to compromise on equipment longevity. Whether looking to upgrade an existing gym or set up a new facility, they offer a seamless, cost-effective pathway to achieving your business goals. 4. Matrix Fitness – Best in Technologically Advanced Solutions Country and City: Wisconsin, United States Established Date: 2001 Matrix Fitness, a brand under Johnson Health Tech (JHT), excels in producing some of the most technologically advanced fitness equipment available today. Being part of a larger, globally recognized organization, the brand benefits from a vast international research and development network, allowing them to innovate and offer cutting-edge solutions. Key Products: Commercial Fitness and Cardio Equipments Takeaway Note: Matrix Fitness leads the pack in delivering technologically advanced and meticulously designed gym equipment. However, the sophistication of their equipment may come with a steeper learning curve for gym-goers unfamiliar with advanced fitness tech. 5. Gym 80 – Best in Precision Craftsmanship Country and City: Sarstedt, Germany Established: 1980 Gym 80 has become a byword for training quality, revolutionizing the way we work out. For instance, tenowned for its excellent biomechanics, precision craftsmanship, and clear design, the brand continually pushes the boundaries of what strength equipment can achieve. Their reputation in the industry stands as a testament to their commitment to quality and innovation. Key Products: Weight Stacks and Plate Loaded Equipments Takeaway Note: Gym 80 offers exceptional quality by blending traditional craftsmanship with advanced technology. However, this level of attention to detail comes with a higher price point. Therefore, if budget constraints are a significant concern, this brand might not be the most cost-effective option. 6. Tunturi New Fitness – Best in Holistic Wellness Country and City: Almere, Netherlands Established Date: 1922 Tunturi New Fitness doesn’t just sell gym equipment; they offer a philosophy of holistic well-being for both body and mind. They understand that health is more than just physical fitness, and that’s why their product range is designed to promote a balanced mind as well as a healthy body. With a strong focus on quality, longevity, and overall wellness, Tunturi New Fitness aims to be a lifelong partner in your health journey. Key Products: Strength and Cardio Equipments Takeaway Note: Choosing Tunturi New Fitness means investing in equipment that’s designed for the long haul, encompassing both physical and mental well-being. However, their philosophy-driven approach and the additional features focused on holistic wellness may feel overwhelming or unnecessary for any gym’s needs. 7. Rogue Fitness – Best in Strength Training Country and City: Ohio, United States Established Date: 2006 Rogue Fitness stands as a giant in the area of strength and conditioning equipment, with a product line that includes everything from barbells to power racks and sleds. Their dedication to quality is evident, serving as the official equipment supplier to prestigious competitions like the CrossFit Games, USA Weightlifting, the Arnold Strongman Classic, and the World’s Strongest Man competition. Key Products: Plates and Crossfit Equipments Takeaway Note: For business owners seeking to attract a clientele who appreciates high-quality, durable strength training equipment, Rogue Fitness provides a substantial competitive advantage. However, the premium pricing of their equipment requires a significant initial investment, potentially affecting the business’s budget. 8. NordicTrack – Best in Versatile Strength Equipment Country and City: Utah, USA Established Date: 1975 NordicTrack stands out for its comprehensive and versatile range of strength training equipment suitable for both home and commercial gyms. With a focus on high-quality and user-friendly design, the brand caters to various strength workout needs, ensuring that gym-goers and fitness enthusiasts can achieve their goals effectively. Key Products: Ellipticals and Strength Equipments Takeaway Note: NordicTrack’s versatile range of strength equipment makes it a one-stop-shop for all the fitness facility’s needs. However, while the brand promises durability and variety, their advanced machines may require regular software updates, which could be a long-term consideration in terms of maintenance and user experience. 9. True Fitness – Best in Customer-Centric Equipment Country and City: Missouri, United States Established Date: 1981 True Fitness specializes in creating premium, customer-first fitness equipment, encompassing cardio, strength, and functional training. For instance, the company prioritizes responsiveness in service, superior quality in product, and expertise in design. What sets them apart is their comprehensive customer care, not just at the point of sale, but also during and after the purchase. Key Products: Elliptical Trainers and Cardio Equipments Takeaway Note: True Fitness offers a range of equipment that aligns with a customer-first philosophy, enhancing user experience and potentially increasing customer loyalty. However, their focus on premium products may mean a higher upfront investment for businesses. 10. 3 Tips to Consider When Choosing the Best Brand of Gym Equipment Navigating the diverse market of gym equipment requires consideration beyond merely pricing or popular opinion. This section outlines 5 critical factors to facilitate the selection of a gym equipment brand that aligns with business goals and demonstrates lasting reliability. 1. Track Record of Quality: Opt for brands with a strong historical credibility and track record of quality and service, with positive peer reviews and endorsements from reputable professionals. 2. Readily Available Customer Support: According to Styku, buying a gym equipment is a considerable investment. Look for brands with favorable warranty terms covering significant components and offering reasonable periods, plus a commitment to excellent after-sales service, with readily available customer support and repair services. 3. Favorable Financing Terms: Consider the value offered against the cost, with brands that might seem expensive but provide durability, advanced features, and better service. According to Glofox, financing options can be a lifeline. Brands that offer favorable financing or leasing terms understand the industry’s economic challenges and are committed to fostering long-term partnerships. ================ <Question> Based only on the information in the article above, which fitness equipment brands specialize in weight/strength training equipment? ================ <Instruction> Only use the text that is provided to answer the question. Answer using complete sentences. The answer must be a minimum of 3 sentences.
|
Only use the text that is provided to answer the question. Answer using complete sentences. The answer must be a minimum of 3 sentences.
EVIDENCE:
**The Top 9 Gym Equipment Brands for Business Success in 2024** Are you a startup gym owner ready to make a significant impact on the fitness industry this year? In a market flooded with endless options, pinpointing the right gym equipment manufacturer to partner with is pivotal for your business’s success. After rigorous research and analysis, Yanre Fitness stands out as the best brand of gym equipment for startup gym owners aiming for business success in 2024. With over a decade of experience in the fitness industry, I’ve consulted gyms across the country, helping them scale their operations and maximize profits. The insights on this list are grounded in real-world experience and in-depth market research, making them invaluable for business owners in this space. Keep reading to discover the top gym equipment brands that can propel a business to greater heights this year. 1. Technogym – Best in Luxury Fitness Solutions Country and City: Cesena FC, Italy Established Date: 1983 Technogym, the Wellness Company, is a global leader in creating top-of-the-line fitness equipment tailored to various markets, including private homes, fitness clubs, hotels, spas, and rehabilitation centers. The brand is synonymous with wellness, a philosophy that encourages a balanced lifestyle through regular exercise, nutritious eating, and a positive mental attitude. Key Products: Treadmills and Strength Equipments Takeaway Note: Technogym excels in offering luxurious, design-forward fitness solutions backed by decades of innovation and quality craftsmanship. However, their products often come with a premium price tag, which may be a consideration for budget-conscious business owners. 2. Power Systems – Best in Comprehensive Fitness Solutions Country and City: Tennessee, United States Established Date: 1986 Power Systems stands out as a complete solution provider in the sports and fitness industries, offering a wide range of quality fitness and performance products. The brand is deeply committed to innovation, customer service, and education. Their slogan, “Power. Performance. Results,” aptly summarizes their philosophy that their products and elite customer service empower their diverse clientele to achieve optimal outcomes. Key Products: Strength and Functional Equipments Takeaway Note: Power Systems offers a comprehensive range of quality fitness products, backed by an unwavering commitment to customer satisfaction. However, the brand’s vast product line can sometimes make the selection process overwhelming for new business owners. 3. Yanre Fitness – Best in Durable Equipment Solutions Country and City: Wuhu, China Established: 1997 Yanre Fitness is a brand that has been steadily rising in popularity, thanks to its modern, functional, and convenient commercial gym equipment. Particularly excelling in the strength training segment, the brand uses durable materials that promise longevity and consistent performance over time. The brand is unwavering in its commitment to quality, making it a popular choice among gym owners. Key Products: Cardio and Strength Equipments Takeaway Note: Yanre Fitness delivers on both quality and affordability, making it an excellent choice for gym owners who are budget-conscious yet unwilling to compromise on equipment longevity. Whether looking to upgrade an existing gym or set up a new facility, they offer a seamless, cost-effective pathway to achieving your business goals. 4. Matrix Fitness – Best in Technologically Advanced Solutions Country and City: Wisconsin, United States Established Date: 2001 Matrix Fitness, a brand under Johnson Health Tech (JHT), excels in producing some of the most technologically advanced fitness equipment available today. Being part of a larger, globally recognized organization, the brand benefits from a vast international research and development network, allowing them to innovate and offer cutting-edge solutions. Key Products: Commercial Fitness and Cardio Equipments Takeaway Note: Matrix Fitness leads the pack in delivering technologically advanced and meticulously designed gym equipment. However, the sophistication of their equipment may come with a steeper learning curve for gym-goers unfamiliar with advanced fitness tech. 5. Gym 80 – Best in Precision Craftsmanship Country and City: Sarstedt, Germany Established: 1980 Gym 80 has become a byword for training quality, revolutionizing the way we work out. For instance, tenowned for its excellent biomechanics, precision craftsmanship, and clear design, the brand continually pushes the boundaries of what strength equipment can achieve. Their reputation in the industry stands as a testament to their commitment to quality and innovation. Key Products: Weight Stacks and Plate Loaded Equipments Takeaway Note: Gym 80 offers exceptional quality by blending traditional craftsmanship with advanced technology. However, this level of attention to detail comes with a higher price point. Therefore, if budget constraints are a significant concern, this brand might not be the most cost-effective option. 6. Tunturi New Fitness – Best in Holistic Wellness Country and City: Almere, Netherlands Established Date: 1922 Tunturi New Fitness doesn’t just sell gym equipment; they offer a philosophy of holistic well-being for both body and mind. They understand that health is more than just physical fitness, and that’s why their product range is designed to promote a balanced mind as well as a healthy body. With a strong focus on quality, longevity, and overall wellness, Tunturi New Fitness aims to be a lifelong partner in your health journey. Key Products: Strength and Cardio Equipments Takeaway Note: Choosing Tunturi New Fitness means investing in equipment that’s designed for the long haul, encompassing both physical and mental well-being. However, their philosophy-driven approach and the additional features focused on holistic wellness may feel overwhelming or unnecessary for any gym’s needs. 7. Rogue Fitness – Best in Strength Training Country and City: Ohio, United States Established Date: 2006 Rogue Fitness stands as a giant in the area of strength and conditioning equipment, with a product line that includes everything from barbells to power racks and sleds. Their dedication to quality is evident, serving as the official equipment supplier to prestigious competitions like the CrossFit Games, USA Weightlifting, the Arnold Strongman Classic, and the World’s Strongest Man competition. Key Products: Plates and Crossfit Equipments Takeaway Note: For business owners seeking to attract a clientele who appreciates high-quality, durable strength training equipment, Rogue Fitness provides a substantial competitive advantage. However, the premium pricing of their equipment requires a significant initial investment, potentially affecting the business’s budget. 8. NordicTrack – Best in Versatile Strength Equipment Country and City: Utah, USA Established Date: 1975 NordicTrack stands out for its comprehensive and versatile range of strength training equipment suitable for both home and commercial gyms. With a focus on high-quality and user-friendly design, the brand caters to various strength workout needs, ensuring that gym-goers and fitness enthusiasts can achieve their goals effectively. Key Products: Ellipticals and Strength Equipments Takeaway Note: NordicTrack’s versatile range of strength equipment makes it a one-stop-shop for all the fitness facility’s needs. However, while the brand promises durability and variety, their advanced machines may require regular software updates, which could be a long-term consideration in terms of maintenance and user experience. 9. True Fitness – Best in Customer-Centric Equipment Country and City: Missouri, United States Established Date: 1981 True Fitness specializes in creating premium, customer-first fitness equipment, encompassing cardio, strength, and functional training. For instance, the company prioritizes responsiveness in service, superior quality in product, and expertise in design. What sets them apart is their comprehensive customer care, not just at the point of sale, but also during and after the purchase. Key Products: Elliptical Trainers and Cardio Equipments Takeaway Note: True Fitness offers a range of equipment that aligns with a customer-first philosophy, enhancing user experience and potentially increasing customer loyalty. However, their focus on premium products may mean a higher upfront investment for businesses. 10. 3 Tips to Consider When Choosing the Best Brand of Gym Equipment Navigating the diverse market of gym equipment requires consideration beyond merely pricing or popular opinion. This section outlines 5 critical factors to facilitate the selection of a gym equipment brand that aligns with business goals and demonstrates lasting reliability. 1. Track Record of Quality: Opt for brands with a strong historical credibility and track record of quality and service, with positive peer reviews and endorsements from reputable professionals. 2. Readily Available Customer Support: According to Styku, buying a gym equipment is a considerable investment. Look for brands with favorable warranty terms covering significant components and offering reasonable periods, plus a commitment to excellent after-sales service, with readily available customer support and repair services. 3. Favorable Financing Terms: Consider the value offered against the cost, with brands that might seem expensive but provide durability, advanced features, and better service. According to Glofox, financing options can be a lifeline. Brands that offer favorable financing or leasing terms understand the industry’s economic challenges and are committed to fostering long-term partnerships.
USER:
Based only on the information in the article above, which fitness equipment brands specialize in weight/strength training equipment?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 18 | 1,411 | null | 832 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
Can you explain to me in layman's terms what the SAFE Bet Act is and what it is proposing into law? Answer in a minimum of 200 words.
|
Rep. Paul Tonko and Sen. Richard Blumenthal announced details of their new Supporting Affordability and Fairness with Every Bet (SAFE) Bet Act during a press conference on Thursday. Bill would create federal oversight of state-run sports betting The overarching idea of the bill is to let states continue to regulate and oversee sports betting but to implement a set of federal minimum standards that state regulators and operators need to meet. States would be required to apply to the Department of Justice in order to get the greenlight to run a regulated market. Those federal standards cover a wide range of topics related to responsible and problem gambling. Unlike Tonko’s previous bill, the Betting on Our Future Act, which sought to ban all electronic advertising of sports betting, this version would allow it, but with several limitations. The bill would prohibit advertising during primetime hours as well as during live sporting events, implement language restrictions on words like “bonus”, “odds boost” and “no-sweat”, prohibit education about how to bet within the advertising and limit celebrity spokespeople from offering suggested bets to users. Bill would introduce affordability checks, limit ads, prohibit AI The legislation also takes a nod from other markets like the U.K. and includes what would be the first mandated affordability checks for sports bettors in the regulated U.S. market. Bettors would not be able to deposit via credit card, they would be limited to five deposits a day and operators would need to run affordability checks on bettors wagering at least $1,000 in a one-day period or $10,000 in a 30-day period. Bettors whose wagering exceeds more than 30% of their income would not be approved to bet. The bill would greenlight several reports, including from the Substance Abuse Mental Health Services Administration (SAMHSA), the Surgeon General’s office and the Center for Disease Control and would also introduce a national self-exclusion list. Finally, the bill would take proactive steps to limit the use of AI by sportsbook operators to track bettor behavior, create personalized betting offers or to generate gambling products like microbes. In-game betting was a major focus of the press conference, with lawmakers and representatives from the National Public Health Institute suggesting that the proliferation of in-game and microbetting was not what the government anticipated when the Supreme Court overturned the Professional and Amateur Sports Protection Act (PASPA). They did not call out DraftKings by name but specifically mentioned DraftKings’s acquisition of Simplebet as an indicator of what they feel is a problem. While Blumenthal also introduced the Gambling Addiction Recovery, Investment and Treatment (GRIT) Act at the start of the year, which would allocate the funds collected on the federal excise tax on sports betting and use them to fund problem gambling initiatives, the subject of funding did not come up during Thursday’s press event. Based on the limited information around the bill, it seems to only apply to sports betting and would not impact other forms of gambling such as casinos, online casinos or the lottery. Trade orgs quick to speak out against SAFE Bet Act Trade groups within the industry were quick to respond to the press conference expressing concerns about the proposed legislation. “Today’s regulated sports wagering operators are contributing billions in state taxes across the U.S., protecting consumers from dangerous neighborhood bookies and illegal offshore websites, and working diligently with over 5,000 state and tribal regulators and other stakeholders to ensure a commitment to responsibility and positive play. Six years into legal sports betting, introducing heavy-handed federal prohibitions is a slap in the face to state legislatures and gaming regulators who have dedicated countless time and resources to developing thoughtful frameworks unique to their jurisdictions, and have continued to iterate as their marketplaces evolve,” said American Gaming Associaton Senior Vice President of Government Relations Chris Cylke. iDEA Growth issued a statement on the measure as well, saying, in part: “iDEA remains committed to working with lawmakers, regulators, and stakeholders to enhance player protections in a way that empowers states and preserves the benefits of a well-regulated, competitive market. We urge Congress to reject this misguided federal mandate and instead support state-based solutions that are already working across the country. The SAFE Bet Act’s blanket, one-size-fits-all requirements on advertising, affordability checks, and artificial intelligence stifle the autonomy of states and tribal governments, many of which have implemented their own robust regulatory frameworks tailored to the needs of their constituents. These measures not only infringe on states’ rights but also risk undermining the operational flexibility that has allowed the legal sports betting industry to thrive, create jobs, and generate critical tax revenue that supports education, infrastructure, and other vital services.” Since the repeal of PASPA, several federal bills have been introduced regarding sports wagering, but none have made much progress or even advanced out of committee.
|
[question] Can you explain to me in layman's terms what the SAFE Bet Act is and what it is proposing into law? Answer in a minimum of 200 words. ===================== [text] Rep. Paul Tonko and Sen. Richard Blumenthal announced details of their new Supporting Affordability and Fairness with Every Bet (SAFE) Bet Act during a press conference on Thursday. Bill would create federal oversight of state-run sports betting The overarching idea of the bill is to let states continue to regulate and oversee sports betting but to implement a set of federal minimum standards that state regulators and operators need to meet. States would be required to apply to the Department of Justice in order to get the greenlight to run a regulated market. Those federal standards cover a wide range of topics related to responsible and problem gambling. Unlike Tonko’s previous bill, the Betting on Our Future Act, which sought to ban all electronic advertising of sports betting, this version would allow it, but with several limitations. The bill would prohibit advertising during primetime hours as well as during live sporting events, implement language restrictions on words like “bonus”, “odds boost” and “no-sweat”, prohibit education about how to bet within the advertising and limit celebrity spokespeople from offering suggested bets to users. Bill would introduce affordability checks, limit ads, prohibit AI The legislation also takes a nod from other markets like the U.K. and includes what would be the first mandated affordability checks for sports bettors in the regulated U.S. market. Bettors would not be able to deposit via credit card, they would be limited to five deposits a day and operators would need to run affordability checks on bettors wagering at least $1,000 in a one-day period or $10,000 in a 30-day period. Bettors whose wagering exceeds more than 30% of their income would not be approved to bet. The bill would greenlight several reports, including from the Substance Abuse Mental Health Services Administration (SAMHSA), the Surgeon General’s office and the Center for Disease Control and would also introduce a national self-exclusion list. Finally, the bill would take proactive steps to limit the use of AI by sportsbook operators to track bettor behavior, create personalized betting offers or to generate gambling products like microbes. In-game betting was a major focus of the press conference, with lawmakers and representatives from the National Public Health Institute suggesting that the proliferation of in-game and microbetting was not what the government anticipated when the Supreme Court overturned the Professional and Amateur Sports Protection Act (PASPA). They did not call out DraftKings by name but specifically mentioned DraftKings’s acquisition of Simplebet as an indicator of what they feel is a problem. While Blumenthal also introduced the Gambling Addiction Recovery, Investment and Treatment (GRIT) Act at the start of the year, which would allocate the funds collected on the federal excise tax on sports betting and use them to fund problem gambling initiatives, the subject of funding did not come up during Thursday’s press event. Based on the limited information around the bill, it seems to only apply to sports betting and would not impact other forms of gambling such as casinos, online casinos or the lottery. Trade orgs quick to speak out against SAFE Bet Act Trade groups within the industry were quick to respond to the press conference expressing concerns about the proposed legislation. “Today’s regulated sports wagering operators are contributing billions in state taxes across the U.S., protecting consumers from dangerous neighborhood bookies and illegal offshore websites, and working diligently with over 5,000 state and tribal regulators and other stakeholders to ensure a commitment to responsibility and positive play. Six years into legal sports betting, introducing heavy-handed federal prohibitions is a slap in the face to state legislatures and gaming regulators who have dedicated countless time and resources to developing thoughtful frameworks unique to their jurisdictions, and have continued to iterate as their marketplaces evolve,” said American Gaming Associaton Senior Vice President of Government Relations Chris Cylke. iDEA Growth issued a statement on the measure as well, saying, in part: “iDEA remains committed to working with lawmakers, regulators, and stakeholders to enhance player protections in a way that empowers states and preserves the benefits of a well-regulated, competitive market. We urge Congress to reject this misguided federal mandate and instead support state-based solutions that are already working across the country. The SAFE Bet Act’s blanket, one-size-fits-all requirements on advertising, affordability checks, and artificial intelligence stifle the autonomy of states and tribal governments, many of which have implemented their own robust regulatory frameworks tailored to the needs of their constituents. These measures not only infringe on states’ rights but also risk undermining the operational flexibility that has allowed the legal sports betting industry to thrive, create jobs, and generate critical tax revenue that supports education, infrastructure, and other vital services.” Since the repeal of PASPA, several federal bills have been introduced regarding sports wagering, but none have made much progress or even advanced out of committee. https://sbcamericas.com/2024/09/12/safe-bet-act-details/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
Rep. Paul Tonko and Sen. Richard Blumenthal announced details of their new Supporting Affordability and Fairness with Every Bet (SAFE) Bet Act during a press conference on Thursday. Bill would create federal oversight of state-run sports betting The overarching idea of the bill is to let states continue to regulate and oversee sports betting but to implement a set of federal minimum standards that state regulators and operators need to meet. States would be required to apply to the Department of Justice in order to get the greenlight to run a regulated market. Those federal standards cover a wide range of topics related to responsible and problem gambling. Unlike Tonko’s previous bill, the Betting on Our Future Act, which sought to ban all electronic advertising of sports betting, this version would allow it, but with several limitations. The bill would prohibit advertising during primetime hours as well as during live sporting events, implement language restrictions on words like “bonus”, “odds boost” and “no-sweat”, prohibit education about how to bet within the advertising and limit celebrity spokespeople from offering suggested bets to users. Bill would introduce affordability checks, limit ads, prohibit AI The legislation also takes a nod from other markets like the U.K. and includes what would be the first mandated affordability checks for sports bettors in the regulated U.S. market. Bettors would not be able to deposit via credit card, they would be limited to five deposits a day and operators would need to run affordability checks on bettors wagering at least $1,000 in a one-day period or $10,000 in a 30-day period. Bettors whose wagering exceeds more than 30% of their income would not be approved to bet. The bill would greenlight several reports, including from the Substance Abuse Mental Health Services Administration (SAMHSA), the Surgeon General’s office and the Center for Disease Control and would also introduce a national self-exclusion list. Finally, the bill would take proactive steps to limit the use of AI by sportsbook operators to track bettor behavior, create personalized betting offers or to generate gambling products like microbes. In-game betting was a major focus of the press conference, with lawmakers and representatives from the National Public Health Institute suggesting that the proliferation of in-game and microbetting was not what the government anticipated when the Supreme Court overturned the Professional and Amateur Sports Protection Act (PASPA). They did not call out DraftKings by name but specifically mentioned DraftKings’s acquisition of Simplebet as an indicator of what they feel is a problem. While Blumenthal also introduced the Gambling Addiction Recovery, Investment and Treatment (GRIT) Act at the start of the year, which would allocate the funds collected on the federal excise tax on sports betting and use them to fund problem gambling initiatives, the subject of funding did not come up during Thursday’s press event. Based on the limited information around the bill, it seems to only apply to sports betting and would not impact other forms of gambling such as casinos, online casinos or the lottery. Trade orgs quick to speak out against SAFE Bet Act Trade groups within the industry were quick to respond to the press conference expressing concerns about the proposed legislation. “Today’s regulated sports wagering operators are contributing billions in state taxes across the U.S., protecting consumers from dangerous neighborhood bookies and illegal offshore websites, and working diligently with over 5,000 state and tribal regulators and other stakeholders to ensure a commitment to responsibility and positive play. Six years into legal sports betting, introducing heavy-handed federal prohibitions is a slap in the face to state legislatures and gaming regulators who have dedicated countless time and resources to developing thoughtful frameworks unique to their jurisdictions, and have continued to iterate as their marketplaces evolve,” said American Gaming Associaton Senior Vice President of Government Relations Chris Cylke. iDEA Growth issued a statement on the measure as well, saying, in part: “iDEA remains committed to working with lawmakers, regulators, and stakeholders to enhance player protections in a way that empowers states and preserves the benefits of a well-regulated, competitive market. We urge Congress to reject this misguided federal mandate and instead support state-based solutions that are already working across the country. The SAFE Bet Act’s blanket, one-size-fits-all requirements on advertising, affordability checks, and artificial intelligence stifle the autonomy of states and tribal governments, many of which have implemented their own robust regulatory frameworks tailored to the needs of their constituents. These measures not only infringe on states’ rights but also risk undermining the operational flexibility that has allowed the legal sports betting industry to thrive, create jobs, and generate critical tax revenue that supports education, infrastructure, and other vital services.” Since the repeal of PASPA, several federal bills have been introduced regarding sports wagering, but none have made much progress or even advanced out of committee.
USER:
Can you explain to me in layman's terms what the SAFE Bet Act is and what it is proposing into law? Answer in a minimum of 200 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 28 | 803 | null | 303 |
You must answer based solely on the information provided, no outside information is allowed.
|
What caused the boat to sink?
|
December 24, the day Peterson said he was fishing, was gray, damp, and cold with a bit of wind. Few people were at the Berkeley Marina. When questioned by police, Peterson would not say what he was hoping to catch, but the fishing searches performed from his computer earlier in the month had included searches relating to sturgeon and striped bass. Angelo Cuanang, a published author on fishing in the San Francisco Bay who was accepted by the court as an expert fisherman, testified that Brooks Island was the wrong place to seek sturgeon, which congregated in a different part of the bay that time of year. Sturgeon also preferred live bait to lures, and Peterson’s rod was too weak to catch them. Anchoring was essential to reel in sturgeon; the homemade cement anchor in his boat would have been inadequate. Finally, it was illegal to troll for sturgeon, as Peterson claimed to have done. Peterson’s lures and the time of year he was fishing were also wrong for catching striped bass. The prosecution’s theory was as follows: Peterson killed Laci sometime on the night of December 23 or morning of December 24. On the morning of the 24th, Peterson let their dog McKenzie out with his leash on to make it appear something had happened while Laci was walking him. He wrapped Laci’s body in a tarp in the bed of his truck, covered her with the patio umbrellas, drove to the warehouse, and then moved her body into his boat. He drove to the Berkeley Marina, motored out to an area near Brooks Island, and slipped her body, attached to homemade concrete weights like the homemade anchor Peterson had made, into the bay. Peterson then returned to Modesto, dropped off the boat at the warehouse, put the boat cover out back under a leaky gas blower so that any scent would be obscured, washed his clothes, and proceeded with the ruse that Laci was missing, hoping her body would never be discovered. The defense argued the police had not diligently pursued whether a person or persons other than Peterson were more likely responsible for Laci’s disappearance and murder. The defense presented evidence that a burglary had occurred on the Petersons’ street the week of her disappearance and argued that the police failed adequately to follow up on whether that burglary had any connection to Laci’s disappearance. It also presented evidence that a stranger had gone to several houses on December 23 asking for money and, one neighbor thought, casing houses for burglaries, and so might have had something to do with her disappearance. Testimony was presented thatthe same neighbor, walking with a police officer on Christmas Day to look for the stranger, had seen a pair of sandals lying in the road 150 feet from the Petersons’ home; the neighbor wondered at the time if they might have any connection to Laci’s disappearance, but the officer just left them there. To support the possibility of a third party’s involvement, the defense challenged the prosecution’s theory that Conner died December 23 or 24, presenting its own expert who testified based on ultrasounds and other evidence that Conner lived until after Christmas.The defense also sought to challenge other aspects of the prosecution’s case. To rebut the dog-trailing evidence, the defense called Ronald Seitz, a second dog handler who also had his dog try to find Laci’s scent at the Berkeley Marina on December 28. The dog, T.J., was given Laci’s slipper as a scent object, but discovered no scent trail. To rebut the inference that Peterson had a financial incentive to kill Laci, the defense presented a financial expert who testified that TradeCorp U.S.A. and the Petersons were both reasonably financially healthy. To portray the prosecution’s theory as physically impossible, the defense also sought to introduce video of a demonstration with a weighted 150-pound dummy in a boat on the bay in which a defense firm employee, trying to dump the dummy out, sank the boat. As will be discussed below, the trial court excluded the video. The defense offered explanations for the circumstances of Peterson’s behavior in April. His use of his mother’s name to purchase a car was at her suggestion, to avoid having it impounded. He had large amounts of cash because she gave it to him to reimburse him for money erroneously withdrawn from his bank account rather than hers. Finally, he had his brother’s driver’s license because the club where he was going to golf that day gave discounts for local residents such as his brother. The jury found Peterson guilty of murder in the first degree for killing Laci and murder in the second degree for killing Conner. (See Pen. Code, §§ 187, 189.) It found true the sole charged special circumstance, for multiple murder. Peterson had no criminal record nor any history of violent acts. At the penalty phase, the prosecution relied exclusively on the circumstances of the crime and victim impact evidence. Four members of Laci’s immediate family — her mother, Sharon; her stepfather, Ron Grantski; her brother, Brent; and her sister, Amy — testified. They described who Laci was as a person, shared photographs, memories, and vignettes from her life, and conveyed the grief and loss they each felt after the deaths of Laci and her unborn child. Through friends, family, neighbors, teachers, coworkers, employers, and other witnesses, the defense offered evidence that Peterson had been a kind and positive member of the community. Peterson grew up in a loving family, displayed a patient and gentle disposition, and was a solid student. As part of his high school community service requirement, Peterson worked at a home for the elderly and tutored homeless children. He started his own business and worked a variety of other jobs while in college. According to the defense, Peterson was always calm with Laci. Indeed, witnesses testified Peterson was calm at all times — at work, on the golf course, and in his dealings with all those around him. Friends and family testified to the impact the trial had had on Peterson’s relatives and indicated they believed, if sentenced to life in prison, Peterson could make a positive impact on the lives of others. In closing argument, defense counsel described Peterson’s life as one worth saving and argued that lingering doubt about Peterson’s guilt should also weigh in favor of a life verdict.
|
You must answer based solely on the information provided, no outside information is allowed. What caused the boat to sink? December 24, the day Peterson said he was fishing, was gray, damp, and cold with a bit of wind. Few people were at the Berkeley Marina. When questioned by police, Peterson would not say what he was hoping to catch, but the fishing searches performed from his computer earlier in the month had included searches relating to sturgeon and striped bass. Angelo Cuanang, a published author on fishing in the San Francisco Bay who was accepted by the court as an expert fisherman, testified that Brooks Island was the wrong place to seek sturgeon, which congregated in a different part of the bay that time of year. Sturgeon also preferred live bait to lures, and Peterson’s rod was too weak to catch them. Anchoring was essential to reel in sturgeon; the homemade cement anchor in his boat would have been inadequate. Finally, it was illegal to troll for sturgeon, as Peterson claimed to have done. Peterson’s lures and the time of year he was fishing were also wrong for catching striped bass. The prosecution’s theory was as follows: Peterson killed Laci sometime on the night of December 23 or morning of December 24. On the morning of the 24th, Peterson let their dog McKenzie out with his leash on to make it appear something had happened while Laci was walking him. He wrapped Laci’s body in a tarp in the bed of his truck, covered her with the patio umbrellas, drove to the warehouse, and then moved her body into his boat. He drove to the Berkeley Marina, motored out to an area near Brooks Island, and slipped her body, attached to homemade concrete weights like the homemade anchor Peterson had made, into the bay. Peterson then returned to Modesto, dropped off the boat at the warehouse, put the boat cover out back under a leaky gas blower so that any scent would be obscured, washed his clothes, and proceeded with the ruse that Laci was missing, hoping her body would never be discovered. The defense argued the police had not diligently pursued whether a person or persons other than Peterson were more likely responsible for Laci’s disappearance and murder. The defense presented evidence that a burglary had occurred on the Petersons’ street the week of her disappearance and argued that the police failed adequately to follow up on whether that burglary had any connection to Laci’s disappearance. It also presented evidence that a stranger had gone to several houses on December 23 asking for money and, one neighbor thought, casing houses for burglaries, and so might have had something to do with her disappearance. Testimony was presented thatthe same neighbor, walking with a police officer on Christmas Day to look for the stranger, had seen a pair of sandals lying in the road 150 feet from the Petersons’ home; the neighbor wondered at the time if they might have any connection to Laci’s disappearance, but the officer just left them there. To support the possibility of a third party’s involvement, the defense challenged the prosecution’s theory that Conner died December 23 or 24, presenting its own expert who testified based on ultrasounds and other evidence that Conner lived until after Christmas.The defense also sought to challenge other aspects of the prosecution’s case. To rebut the dog-trailing evidence, the defense called Ronald Seitz, a second dog handler who also had his dog try to find Laci’s scent at the Berkeley Marina on December 28. The dog, T.J., was given Laci’s slipper as a scent object, but discovered no scent trail. To rebut the inference that Peterson had a financial incentive to kill Laci, the defense presented a financial expert who testified that TradeCorp U.S.A. and the Petersons were both reasonably financially healthy. To portray the prosecution’s theory as physically impossible, the defense also sought to introduce video of a demonstration with a weighted 150-pound dummy in a boat on the bay in which a defense firm employee, trying to dump the dummy out, sank the boat. As will be discussed below, the trial court excluded the video. The defense offered explanations for the circumstances of Peterson’s behavior in April. His use of his mother’s name to purchase a car was at her suggestion, to avoid having it impounded. He had large amounts of cash because she gave it to him to reimburse him for money erroneously withdrawn from his bank account rather than hers. Finally, he had his brother’s driver’s license because the club where he was going to golf that day gave discounts for local residents such as his brother. The jury found Peterson guilty of murder in the first degree for killing Laci and murder in the second degree for killing Conner. (See Pen. Code, §§ 187, 189.) It found true the sole charged special circumstance, for multiple murder. Peterson had no criminal record nor any history of violent acts. At the penalty phase, the prosecution relied exclusively on the circumstances of the crime and victim impact evidence. Four members of Laci’s immediate family — her mother, Sharon; her stepfather, Ron Grantski; her brother, Brent; and her sister, Amy — testified. They described who Laci was as a person, shared photographs, memories, and vignettes from her life, and conveyed the grief and loss they each felt after the deaths of Laci and her unborn child. Through friends, family, neighbors, teachers, coworkers, employers, and other witnesses, the defense offered evidence that Peterson had been a kind and positive member of the community. Peterson grew up in a loving family, displayed a patient and gentle disposition, and was a solid student. As part of his high school community service requirement, Peterson worked at a home for the elderly and tutored homeless children. He started his own business and worked a variety of other jobs while in college. According to the defense, Peterson was always calm with Laci. Indeed, witnesses testified Peterson was calm at all times — at work, on the golf course, and in his dealings with all those around him. Friends and family testified to the impact the trial had had on Peterson’s relatives and indicated they believed, if sentenced to life in prison, Peterson could make a positive impact on the lives of others. In closing argument, defense counsel described Peterson’s life as one worth saving and argued that lingering doubt about Peterson’s guilt should also weigh in favor of a life verdict.
|
You must answer based solely on the information provided, no outside information is allowed.
EVIDENCE:
December 24, the day Peterson said he was fishing, was gray, damp, and cold with a bit of wind. Few people were at the Berkeley Marina. When questioned by police, Peterson would not say what he was hoping to catch, but the fishing searches performed from his computer earlier in the month had included searches relating to sturgeon and striped bass. Angelo Cuanang, a published author on fishing in the San Francisco Bay who was accepted by the court as an expert fisherman, testified that Brooks Island was the wrong place to seek sturgeon, which congregated in a different part of the bay that time of year. Sturgeon also preferred live bait to lures, and Peterson’s rod was too weak to catch them. Anchoring was essential to reel in sturgeon; the homemade cement anchor in his boat would have been inadequate. Finally, it was illegal to troll for sturgeon, as Peterson claimed to have done. Peterson’s lures and the time of year he was fishing were also wrong for catching striped bass. The prosecution’s theory was as follows: Peterson killed Laci sometime on the night of December 23 or morning of December 24. On the morning of the 24th, Peterson let their dog McKenzie out with his leash on to make it appear something had happened while Laci was walking him. He wrapped Laci’s body in a tarp in the bed of his truck, covered her with the patio umbrellas, drove to the warehouse, and then moved her body into his boat. He drove to the Berkeley Marina, motored out to an area near Brooks Island, and slipped her body, attached to homemade concrete weights like the homemade anchor Peterson had made, into the bay. Peterson then returned to Modesto, dropped off the boat at the warehouse, put the boat cover out back under a leaky gas blower so that any scent would be obscured, washed his clothes, and proceeded with the ruse that Laci was missing, hoping her body would never be discovered. The defense argued the police had not diligently pursued whether a person or persons other than Peterson were more likely responsible for Laci’s disappearance and murder. The defense presented evidence that a burglary had occurred on the Petersons’ street the week of her disappearance and argued that the police failed adequately to follow up on whether that burglary had any connection to Laci’s disappearance. It also presented evidence that a stranger had gone to several houses on December 23 asking for money and, one neighbor thought, casing houses for burglaries, and so might have had something to do with her disappearance. Testimony was presented thatthe same neighbor, walking with a police officer on Christmas Day to look for the stranger, had seen a pair of sandals lying in the road 150 feet from the Petersons’ home; the neighbor wondered at the time if they might have any connection to Laci’s disappearance, but the officer just left them there. To support the possibility of a third party’s involvement, the defense challenged the prosecution’s theory that Conner died December 23 or 24, presenting its own expert who testified based on ultrasounds and other evidence that Conner lived until after Christmas.The defense also sought to challenge other aspects of the prosecution’s case. To rebut the dog-trailing evidence, the defense called Ronald Seitz, a second dog handler who also had his dog try to find Laci’s scent at the Berkeley Marina on December 28. The dog, T.J., was given Laci’s slipper as a scent object, but discovered no scent trail. To rebut the inference that Peterson had a financial incentive to kill Laci, the defense presented a financial expert who testified that TradeCorp U.S.A. and the Petersons were both reasonably financially healthy. To portray the prosecution’s theory as physically impossible, the defense also sought to introduce video of a demonstration with a weighted 150-pound dummy in a boat on the bay in which a defense firm employee, trying to dump the dummy out, sank the boat. As will be discussed below, the trial court excluded the video. The defense offered explanations for the circumstances of Peterson’s behavior in April. His use of his mother’s name to purchase a car was at her suggestion, to avoid having it impounded. He had large amounts of cash because she gave it to him to reimburse him for money erroneously withdrawn from his bank account rather than hers. Finally, he had his brother’s driver’s license because the club where he was going to golf that day gave discounts for local residents such as his brother. The jury found Peterson guilty of murder in the first degree for killing Laci and murder in the second degree for killing Conner. (See Pen. Code, §§ 187, 189.) It found true the sole charged special circumstance, for multiple murder. Peterson had no criminal record nor any history of violent acts. At the penalty phase, the prosecution relied exclusively on the circumstances of the crime and victim impact evidence. Four members of Laci’s immediate family — her mother, Sharon; her stepfather, Ron Grantski; her brother, Brent; and her sister, Amy — testified. They described who Laci was as a person, shared photographs, memories, and vignettes from her life, and conveyed the grief and loss they each felt after the deaths of Laci and her unborn child. Through friends, family, neighbors, teachers, coworkers, employers, and other witnesses, the defense offered evidence that Peterson had been a kind and positive member of the community. Peterson grew up in a loving family, displayed a patient and gentle disposition, and was a solid student. As part of his high school community service requirement, Peterson worked at a home for the elderly and tutored homeless children. He started his own business and worked a variety of other jobs while in college. According to the defense, Peterson was always calm with Laci. Indeed, witnesses testified Peterson was calm at all times — at work, on the golf course, and in his dealings with all those around him. Friends and family testified to the impact the trial had had on Peterson’s relatives and indicated they believed, if sentenced to life in prison, Peterson could make a positive impact on the lives of others. In closing argument, defense counsel described Peterson’s life as one worth saving and argued that lingering doubt about Peterson’s guilt should also weigh in favor of a life verdict.
USER:
What caused the boat to sink?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 14 | 6 | 1,066 | null | 113 |
Answer the prompt only using the provided text as your source of information. Do not use any external sources or prior knowledge.
|
List every strange law pertaining to an animal.
|
Alabama: • Anniston: You may not wear blue jeans down Noble Street. • Bear wrestling matches are prohibited. • Dominoes may not be played on Sunday. • It is illegal for a driver to be blindfolded while operating a vehicle. • It is illegal to wear a fake moustache that causes laughter in church. • It is legal to drive the wrong way down a one-way street if you have a lantern attached to the front of your automobile. • Montgomery: It is considered an offense to open an umbrella on a street, for fear of it spooking horses. • You cannot chain your alligator to a fire hydrant. • You may not drive barefooted. • You may not have an ice cream cone in your back pocket at any time. Alaska: • Even though it is legal to hunt a bear, it is illegal to wake a bear and take a picture for photo opportunities. • In Alaska it is illegal to whisper in someone's ear while they are moose hunting. • It is considered an offense to push a live moose out of a moving airplane. • Kangaroos are not allowed in barber shops at any time. • Moose may not be viewed from an airplane. Arizona: • Donkeys cannot sleep in bathtubs. • Glendale: Cars may not be driven in reverse. • Hunting camels is prohibited. • It is illegal for men and women over the age of 18 to have less than one missing tooth visible when smiling. • It is unlawful to refuse a person a glass of water. • Mohave County: A decree declares that anyone caught stealing soap must wash with it until it is all used up. Arkansas: • A law provides that school teachers who bob their hair will not get a raise. • Alligators may not be kept in bathtubs. • Arkansas must be pronounced "Arkansaw" • In Arkansas it is illegal to buy or sell blue light bulbs. California: • Baldwin Park: Nobody is allowed to ride a bicycle in a swimming pool. • Blythe: You are not permitted to wear cowboy boots unless you already own at least two cows. • Burlingame: It is illegal to spit, except on baseball diamonds; Carmel Ice cream may not be eaten while standing on the sidewalk. (Repealed when Clint Eastwood was mayor); Women may not wear high heels while in the city limits. • Community leaders passed an ordinance that makes it illegal for anyone to try and stop a child from playfully jumping over puddles of water. • Hollywood: It is illegal to drive more than two thousand sheep down Hollywood Boulevard at one time. • In California it is illegal to have caller ID • In California it's against regulations to let phones ring more than nine times in state offices. • It is illegal to cry on the witness stand. • Lodi: It is illegal to own or sell "Silly String". • It is illegal to set a mouse trap without a hunting license. • Women may not drive in a house coat. Colorado: • Car dealers may not show cars on a Sunday. • Cripple Creek: It is illegal to bring your horse or pack mule above the ground floor of any building. • Denver: The dog catcher must notify dogs of impounding by posting, for three consecutive days, a notice on a tree in the city park and along a public road running through said park; it is unlawful to lend your vacuum cleaner to your next-door neighbor; it is illegal to mistreat rats; you may not drive a black car on Sundays. • In Colorado it's now legal to remove the furniture tags that say, "Do Not Remove Under Penalty of Law." • It is illegal to mistreat rats in Denver. • In Colorado it's now legal to remove the furniture tags that say, "Do Not Remove Under Penalty of Law." • Pueblo: It is illegal to let a dandelion grow within the city limits. • Sterling: Cats may not run loose without having been fit with a taillight. Connecticut: • A local ordinance in Atwoodville, Connecticut prohibits people from playing Scrabble while waiting for a politician to speak. • A pickle is not officially a pickle unless it bounces • Balloons with advertising on them are illegal in Hartford, Conn. • Bloomfield, Conn: It's against the law to eat in your car. • Devon: It is unlawful to walk backwards after sunset. • Guilford: Only white Christmas lights are allowed for display. • Hartford: You aren't allowed to cross a street while walking on your hands. • You may not educate dogs
|
System instruction: Answer the prompt only using the provided text as your source of information. Do not use any external sources or prior knowledge. User question: List every strange law pertaining to an animal. Context block: Alabama: • Anniston: You may not wear blue jeans down Noble Street. • Bear wrestling matches are prohibited. • Dominoes may not be played on Sunday. • It is illegal for a driver to be blindfolded while operating a vehicle. • It is illegal to wear a fake moustache that causes laughter in church. • It is legal to drive the wrong way down a one-way street if you have a lantern attached to the front of your automobile. • Montgomery: It is considered an offense to open an umbrella on a street, for fear of it spooking horses. • You cannot chain your alligator to a fire hydrant. • You may not drive barefooted. • You may not have an ice cream cone in your back pocket at any time. Alaska: • Even though it is legal to hunt a bear, it is illegal to wake a bear and take a picture for photo opportunities. • In Alaska it is illegal to whisper in someone's ear while they are moose hunting. • It is considered an offense to push a live moose out of a moving airplane. • Kangaroos are not allowed in barber shops at any time. • Moose may not be viewed from an airplane. Arizona: • Donkeys cannot sleep in bathtubs. • Glendale: Cars may not be driven in reverse. • Hunting camels is prohibited. • It is illegal for men and women over the age of 18 to have less than one missing tooth visible when smiling. • It is unlawful to refuse a person a glass of water. • Mohave County: A decree declares that anyone caught stealing soap must wash with it until it is all used up. Arkansas: • A law provides that school teachers who bob their hair will not get a raise. • Alligators may not be kept in bathtubs. • Arkansas must be pronounced "Arkansaw" • In Arkansas it is illegal to buy or sell blue light bulbs. California: • Baldwin Park: Nobody is allowed to ride a bicycle in a swimming pool. • Blythe: You are not permitted to wear cowboy boots unless you already own at least two cows. • Burlingame: It is illegal to spit, except on baseball diamonds; Carmel Ice cream may not be eaten while standing on the sidewalk. (Repealed when Clint Eastwood was mayor); Women may not wear high heels while in the city limits. • Community leaders passed an ordinance that makes it illegal for anyone to try and stop a child from playfully jumping over puddles of water. • Hollywood: It is illegal to drive more than two thousand sheep down Hollywood Boulevard at one time. • In California it is illegal to have caller ID • In California it's against regulations to let phones ring more than nine times in state offices. • It is illegal to cry on the witness stand. • Lodi: It is illegal to own or sell "Silly String". • It is illegal to set a mouse trap without a hunting license. • Women may not drive in a house coat. Colorado: • Car dealers may not show cars on a Sunday. • Cripple Creek: It is illegal to bring your horse or pack mule above the ground floor of any building. • Denver: The dog catcher must notify dogs of impounding by posting, for three consecutive days, a notice on a tree in the city park and along a public road running through said park; it is unlawful to lend your vacuum cleaner to your next-door neighbor; it is illegal to mistreat rats; you may not drive a black car on Sundays. • In Colorado it's now legal to remove the furniture tags that say, "Do Not Remove Under Penalty of Law." • It is illegal to mistreat rats in Denver. • In Colorado it's now legal to remove the furniture tags that say, "Do Not Remove Under Penalty of Law." • Pueblo: It is illegal to let a dandelion grow within the city limits. • Sterling: Cats may not run loose without having been fit with a taillight. Connecticut: • A local ordinance in Atwoodville, Connecticut prohibits people from playing Scrabble while waiting for a politician to speak. • A pickle is not officially a pickle unless it bounces • Balloons with advertising on them are illegal in Hartford, Conn. • Bloomfield, Conn: It's against the law to eat in your car. • Devon: It is unlawful to walk backwards after sunset. • Guilford: Only white Christmas lights are allowed for display. • Hartford: You aren't allowed to cross a street while walking on your hands. • You may not educate dogs
|
Answer the prompt only using the provided text as your source of information. Do not use any external sources or prior knowledge.
EVIDENCE:
Alabama: • Anniston: You may not wear blue jeans down Noble Street. • Bear wrestling matches are prohibited. • Dominoes may not be played on Sunday. • It is illegal for a driver to be blindfolded while operating a vehicle. • It is illegal to wear a fake moustache that causes laughter in church. • It is legal to drive the wrong way down a one-way street if you have a lantern attached to the front of your automobile. • Montgomery: It is considered an offense to open an umbrella on a street, for fear of it spooking horses. • You cannot chain your alligator to a fire hydrant. • You may not drive barefooted. • You may not have an ice cream cone in your back pocket at any time. Alaska: • Even though it is legal to hunt a bear, it is illegal to wake a bear and take a picture for photo opportunities. • In Alaska it is illegal to whisper in someone's ear while they are moose hunting. • It is considered an offense to push a live moose out of a moving airplane. • Kangaroos are not allowed in barber shops at any time. • Moose may not be viewed from an airplane. Arizona: • Donkeys cannot sleep in bathtubs. • Glendale: Cars may not be driven in reverse. • Hunting camels is prohibited. • It is illegal for men and women over the age of 18 to have less than one missing tooth visible when smiling. • It is unlawful to refuse a person a glass of water. • Mohave County: A decree declares that anyone caught stealing soap must wash with it until it is all used up. Arkansas: • A law provides that school teachers who bob their hair will not get a raise. • Alligators may not be kept in bathtubs. • Arkansas must be pronounced "Arkansaw" • In Arkansas it is illegal to buy or sell blue light bulbs. California: • Baldwin Park: Nobody is allowed to ride a bicycle in a swimming pool. • Blythe: You are not permitted to wear cowboy boots unless you already own at least two cows. • Burlingame: It is illegal to spit, except on baseball diamonds; Carmel Ice cream may not be eaten while standing on the sidewalk. (Repealed when Clint Eastwood was mayor); Women may not wear high heels while in the city limits. • Community leaders passed an ordinance that makes it illegal for anyone to try and stop a child from playfully jumping over puddles of water. • Hollywood: It is illegal to drive more than two thousand sheep down Hollywood Boulevard at one time. • In California it is illegal to have caller ID • In California it's against regulations to let phones ring more than nine times in state offices. • It is illegal to cry on the witness stand. • Lodi: It is illegal to own or sell "Silly String". • It is illegal to set a mouse trap without a hunting license. • Women may not drive in a house coat. Colorado: • Car dealers may not show cars on a Sunday. • Cripple Creek: It is illegal to bring your horse or pack mule above the ground floor of any building. • Denver: The dog catcher must notify dogs of impounding by posting, for three consecutive days, a notice on a tree in the city park and along a public road running through said park; it is unlawful to lend your vacuum cleaner to your next-door neighbor; it is illegal to mistreat rats; you may not drive a black car on Sundays. • In Colorado it's now legal to remove the furniture tags that say, "Do Not Remove Under Penalty of Law." • It is illegal to mistreat rats in Denver. • In Colorado it's now legal to remove the furniture tags that say, "Do Not Remove Under Penalty of Law." • Pueblo: It is illegal to let a dandelion grow within the city limits. • Sterling: Cats may not run loose without having been fit with a taillight. Connecticut: • A local ordinance in Atwoodville, Connecticut prohibits people from playing Scrabble while waiting for a politician to speak. • A pickle is not officially a pickle unless it bounces • Balloons with advertising on them are illegal in Hartford, Conn. • Bloomfield, Conn: It's against the law to eat in your car. • Devon: It is unlawful to walk backwards after sunset. • Guilford: Only white Christmas lights are allowed for display. • Hartford: You aren't allowed to cross a street while walking on your hands. • You may not educate dogs
USER:
List every strange law pertaining to an animal.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 22 | 8 | 778 | null | 749 |
Only use the provided text to respond. Do not use any outside sources.
|
What are the two options for license plate size?
|
Be it enacted by the Legislature of the State of Arizona: 2 Section 1. Section 28-2351, Arizona Revised Statutes, is amended to 3 read: 4 28-2351. License plate provided; design 5 A. Notwithstanding any other law, the department shall provide to 6 every owner one license plate for each vehicle registered. At the request 7 of the owner and on payment of a fee in an amount prescribed by the 8 director by rule, the department shall provide one additional license 9 plate for a vehicle for which a special plate is requested pursuant to 10 this chapter. 11 B. The license plate shall display the number assigned to the 12 vehicle and to the owner of the vehicle and the name of this state, which 13 may be abbreviated. The director shall coat the license plate with a 14 reflective material that is consistent with the determination of the 15 department regarding the color and design of license plates and special 16 plates. The director shall design the license plate and the letters and 17 numerals on the license plate to be of sufficient size to be plainly 18 readable during daylight from a distance of one hundred feet. In addition 19 to the standard license plate issued for a trailer before August 12, 2005, 20 the director shall issue a license plate for trailers that has a design 21 that is similar to the standard size license plate for trailers but that 22 is the same size as the license plate for motorcycles. The trailer owner 23 shall notify the department which size license plate the owner wants for 24 the trailer. 25 C. In addition to the requirements PRESCRIBED in subsection B of 26 this section, for all license plates, including all special plates, that 27 are designed or redesigned on or after September 24, 2022: 28 1. The background color of the license plate shall contrast 29 significantly with the color of the letters and numerals on the license 30 plate and with the name of this state on the license plate. 31 2. The name of this state shall appear on the license plate in 32 capital letters in sans serif font and be three-fourths of an inch in 33 height. 34 D. Notwithstanding any other law, the department shall not contract 35 with a nongovernmental entity to purchase or secure reflective material 36 for the plates issued by the department unless the department has made a 37 reasonable effort to secure qualified bids or proposals from as many 38 individual responsible respondents as possible.
|
Only use the provided text to respond. Do not use any outside sources. Be it enacted by the Legislature of the State of Arizona: 2 Section 1. Section 28-2351, Arizona Revised Statutes, is amended to 3 read: 4 28-2351. License plate provided; design 5 A. Notwithstanding any other law, the department shall provide to 6 every owner one license plate for each vehicle registered. At the request 7 of the owner and on payment of a fee in an amount prescribed by the 8 director by rule, the department shall provide one additional license 9 plate for a vehicle for which a special plate is requested pursuant to 10 this chapter. 11 B. The license plate shall display the number assigned to the 12 vehicle and to the owner of the vehicle and the name of this state, which 13 may be abbreviated. The director shall coat the license plate with a 14 reflective material that is consistent with the determination of the 15 department regarding the color and design of license plates and special 16 plates. The director shall design the license plate and the letters and 17 numerals on the license plate to be of sufficient size to be plainly 18 readable during daylight from a distance of one hundred feet. In addition 19 to the standard license plate issued for a trailer before August 12, 2005, 20 the director shall issue a license plate for trailers that has a design 21 that is similar to the standard size license plate for trailers but that 22 is the same size as the license plate for motorcycles. The trailer owner 23 shall notify the department which size license plate the owner wants for 24 the trailer. 25 C. In addition to the requirements PRESCRIBED in subsection B of 26 this section, for all license plates, including all special plates, that 27 are designed or redesigned on or after September 24, 2022: 28 1. The background color of the license plate shall contrast 29 significantly with the color of the letters and numerals on the license 30 plate and with the name of this state on the license plate. 31 2. The name of this state shall appear on the license plate in 32 capital letters in sans serif font and be three-fourths of an inch in 33 height. 34 D. Notwithstanding any other law, the department shall not contract 35 with a nongovernmental entity to purchase or secure reflective material 36 for the plates issued by the department unless the department has made a 37 reasonable effort to secure qualified bids or proposals from as many 38 individual responsible respondents as possible. What are the two options for license plate size?
|
Only use the provided text to respond. Do not use any outside sources.
EVIDENCE:
Be it enacted by the Legislature of the State of Arizona: 2 Section 1. Section 28-2351, Arizona Revised Statutes, is amended to 3 read: 4 28-2351. License plate provided; design 5 A. Notwithstanding any other law, the department shall provide to 6 every owner one license plate for each vehicle registered. At the request 7 of the owner and on payment of a fee in an amount prescribed by the 8 director by rule, the department shall provide one additional license 9 plate for a vehicle for which a special plate is requested pursuant to 10 this chapter. 11 B. The license plate shall display the number assigned to the 12 vehicle and to the owner of the vehicle and the name of this state, which 13 may be abbreviated. The director shall coat the license plate with a 14 reflective material that is consistent with the determination of the 15 department regarding the color and design of license plates and special 16 plates. The director shall design the license plate and the letters and 17 numerals on the license plate to be of sufficient size to be plainly 18 readable during daylight from a distance of one hundred feet. In addition 19 to the standard license plate issued for a trailer before August 12, 2005, 20 the director shall issue a license plate for trailers that has a design 21 that is similar to the standard size license plate for trailers but that 22 is the same size as the license plate for motorcycles. The trailer owner 23 shall notify the department which size license plate the owner wants for 24 the trailer. 25 C. In addition to the requirements PRESCRIBED in subsection B of 26 this section, for all license plates, including all special plates, that 27 are designed or redesigned on or after September 24, 2022: 28 1. The background color of the license plate shall contrast 29 significantly with the color of the letters and numerals on the license 30 plate and with the name of this state on the license plate. 31 2. The name of this state shall appear on the license plate in 32 capital letters in sans serif font and be three-fourths of an inch in 33 height. 34 D. Notwithstanding any other law, the department shall not contract 35 with a nongovernmental entity to purchase or secure reflective material 36 for the plates issued by the department unless the department has made a 37 reasonable effort to secure qualified bids or proposals from as many 38 individual responsible respondents as possible.
USER:
What are the two options for license plate size?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 13 | 9 | 430 | null | 437 |
For this task, you are only to answer questions based entirely on the information provided in the prompt. No external resources or prior knowledge are allowed in this case.
|
In simple language, tell me about the Supreme Court's Code of Conduct?
|
Recent Changes to Supreme Court Financial Disclosure Requirements Statutory Updates On May 13, 2022, President Biden signed the Courthouse Ethics and Transparency Act, which requires online publication of financial disclosure reports of judicial officers (including Supreme Court Justices), bankruptcy judges, and magistrate judges. While the EIGA always mandated public access to judicial officer financial disclosure reports, there was no central database to access the filings, and reports were available only “in paper documents or on thumb drives.” The new law directed the Administrative Office of the United States Courts (AO) to establish a “searchable internet database to enable public access to any report required to be filed” under the EIGA. The AO launched the public database on November 7, 2022, and the public can now access electronic versions of federal judges’ reports. The EIGA’s allowance for security-related redactions in judicial branch financial disclosure reports remains unchanged. The Courthouse Ethics and Transparency Act also extended the STOCK Act’s PTR requirements to judicial officers (including Supreme Court Justices), bankruptcy judges, and magistrate judges. Under the provisions discussed above, federal judges are now required to report any purchase, sale, or exchange of securities that exceeds $1,000 within 45 days of the transaction. The new public database includes access to all of these periodic transaction reports. Regulatory Updates Interpretation of the EIGA’s financial disclosure requirements as applied to judicial officers and employees has also recently changed. As mentioned above, the Committee on Financial Disclosure within the Judicial Conference prescribes rules regarding financial disclosure by judicial officers. Those rules are found in Volume 2, Part D, of the Guide to Judiciary Policy. As noted above, as part of their financial disclosure reports, all covered individuals are statutorily required to report gifts received from any source other than a relative with the exception of “food, lodging, or entertainment received as personal hospitality.” The EIGA defines personal hospitality of any individual as “hospitality extended for a nonbusiness purpose by an individual, not a corporation or organization, at the personal residence of that individual or the individual’s family or on property or facilities owned by that individual or the individual’s family.” According to a March 2023 letter from the director of the AO, the Committee on Financial Disclosure revised its regulations, effective March 14, 2023, specifically regarding the definition of personal hospitality. These updated regulations appear in the notes that accompany the definition of personal hospitality: (1) The personal hospitality gift reporting exemption applies only to food, lodging, or entertainment and is intended to cover such gifts of a personal, non-business nature. Therefore, the reporting exemption does not include: gifts other than food, lodging or entertainment, such as transportation that substitutes for commercial transportation; gifts extended for a business purpose; Congressional Research Service 4 gifts extended at property or facilities owned by an entity, rather than by an individual or an individual’s family, even if the entity is owned wholly or in part by an individual or an individual’s family; gifts paid for by any individual or entity other than the individual providing the hospitality, or for which the individual providing the hospitality receives reimbursement or a tax deduction related to furnishing the hospitality; or gifts extended at a commercial property, e.g., a resort or restaurant, or at a property that is regularly rented out to others for a business purpose. The notes also clarify that judicial officers and employees are never permitted “to solicit or accept anything of value from a person seeking official action from or doing business with the court or other entity served by the judicial officer or employee, or from any other person whose interests may be substantially affected by the performance or nonperformance of the judge’s official duties.” There is some uncertainty as to whether these regulations apply to the Supreme Court. Although the regulations explicitly include Justices in the definition of judicial officer, some have questioned whether the Judicial Conference has authority over the Supreme Court. In his 2011 Year-End Report, the Chief Justice explained that because the “Judicial Conference is an instrument for the management of the lower federal courts, its committees have no mandate to prescribe rules or standards for any other body.” Nonetheless, at least one Associate Justice has indicated his intention to follow the 2023 guidance going forward, and, as discussed further below, the Justices have stated that they comply with current Judicial Conference regulations on financial disclosure. Supreme Court Code of Conduct On November 13, 2023, the United States Supreme Court announced it was, for the first time, adopting a Code of Conduct “to set out succinctly and gather in one place the ethics rules and principles that guide the conduct of the Members of the Court.” Noting that most of the rules and principles within the Code “are not new,” the Court explained that the Code “largely represents a codification of principles that we have long regarded as governing our conduct.” The Code, discussed in more detail in another Legal Sidebar, is a set of five ethical canons and accompanying commentary. The canons are nearly the same as the existing canons in the Code of Conduct for U.S. Judges, which applies only to lower federal judges. While many provisions of the Supreme Court Code generally address conflicts of interest and appearances of impropriety, specific Code provisions discuss requirements related to financial activities and compliance with the EIGA. For example, Canon 4(H) declares the Justices’ commitment to comply with financial disclosure laws, and the commentary accompanying the Code states that the Justices comply with the EIGA, STOCK Act, and current Judicial Conference regulations on financial disclosure. Although the Code affirms the Justices’ compliance with existing financial disclosure laws and regulations, it seemingly does not impose any new financial disclosure requirements on the Justices. Considerations for Congress Financial disclosure laws are used to identify potential or actual conflicts of interest in order to promote integrity in the federal government. Congress may consider options to modify or clarify current financial disclosure requirements for judicial officers. For example, the Supreme Court Ethics, Recusal, and Transparency Act would, according to its sponsor, “improve disclosure of travel and hospitality for judges” by requiring the counselor to the Chief Justice (with approval of the Chief Justice) to adopt rules regarding disclosure of gifts, travel, and income that are “at least as rigorous as the House and Senate disclosure rules.” This proposal was introduced before the Justices released their November 2023 Code of Conduct, and it is unclear to what extent the Code may overlap with some of the requirements that this bill would impose. Congressional Research Service 5 LSB10949 · VERSION 2 · UPDATED Financial disclosure is only one facet of a wider theme of government ethics. The EIGA, as amended, includes not only the financial disclosure requirements discussed above but also gift and outside earned income and employment limitations that apply to all officers and employees of the government. While the Judicial Conference’s implementing regulations for these laws exclude Supreme Court Justices from coverage, the commentary accompanying the recent Supreme Court Code of Conduct states that the Justices comply with current Judicial Conference regulations on gifts, foreign gifts and decorations, and outside earned income, honoraria, and employment in addition to regulations about financial disclosure. This is consistent with the Justices’ long-standing voluntary compliance with certain Judicial Conference regulations. The Code, however, does not include any enforcement mechanisms, meaning there is no process to address alleged violations of the Code. Proposed legislation about Supreme Court financial disclosure and other ethics requirements, including congressional attempts to enforce the Supreme Court Code of Conduct through legislation or oversight, may raise questions regarding Congress’s authority to regulate the Supreme Court. Some scholars have suggested that Chief Justice Roberts in his 2011 Year-End Report questioned whether Congress may impose ethical requirements on the Supreme Court. Other scholars have argued that while constitutional obstacles—such as separation-of-powers issues—may exist, the Constitution does provide Congress with authority to regulate Supreme Court ethics. This authority, however, is untested, leaving a wide array of questions unanswered regarding the validity of current law and the extent to which Congress may impose future regulations. Despite any doubts as to congressional authority, the Justices, through their newly released Code of Conduct, have acknowledged that they file “the same financial disclosure reports as other federal judges.” Without enforcement mechanisms in the Code, however, compliance with federal ethics laws may be left to the discretion of the Justices.
|
[For this task, you are only to answer questions based entirely on the information provided in the prompt. No external resources or prior knowledge are allowed in this case.] [In simple language, tell me about the Supreme Court's Code of Conduct?] [Recent Changes to Supreme Court Financial Disclosure Requirements Statutory Updates On May 13, 2022, President Biden signed the Courthouse Ethics and Transparency Act, which requires online publication of financial disclosure reports of judicial officers (including Supreme Court Justices), bankruptcy judges, and magistrate judges. While the EIGA always mandated public access to judicial officer financial disclosure reports, there was no central database to access the filings, and reports were available only “in paper documents or on thumb drives.” The new law directed the Administrative Office of the United States Courts (AO) to establish a “searchable internet database to enable public access to any report required to be filed” under the EIGA. The AO launched the public database on November 7, 2022, and the public can now access electronic versions of federal judges’ reports. The EIGA’s allowance for security-related redactions in judicial branch financial disclosure reports remains unchanged. The Courthouse Ethics and Transparency Act also extended the STOCK Act’s PTR requirements to judicial officers (including Supreme Court Justices), bankruptcy judges, and magistrate judges. Under the provisions discussed above, federal judges are now required to report any purchase, sale, or exchange of securities that exceeds $1,000 within 45 days of the transaction. The new public database includes access to all of these periodic transaction reports. Regulatory Updates Interpretation of the EIGA’s financial disclosure requirements as applied to judicial officers and employees has also recently changed. As mentioned above, the Committee on Financial Disclosure within the Judicial Conference prescribes rules regarding financial disclosure by judicial officers. Those rules are found in Volume 2, Part D, of the Guide to Judiciary Policy. As noted above, as part of their financial disclosure reports, all covered individuals are statutorily required to report gifts received from any source other than a relative with the exception of “food, lodging, or entertainment received as personal hospitality.” The EIGA defines personal hospitality of any individual as “hospitality extended for a nonbusiness purpose by an individual, not a corporation or organization, at the personal residence of that individual or the individual’s family or on property or facilities owned by that individual or the individual’s family.” According to a March 2023 letter from the director of the AO, the Committee on Financial Disclosure revised its regulations, effective March 14, 2023, specifically regarding the definition of personal hospitality. These updated regulations appear in the notes that accompany the definition of personal hospitality: (1) The personal hospitality gift reporting exemption applies only to food, lodging, or entertainment and is intended to cover such gifts of a personal, non-business nature. Therefore, the reporting exemption does not include: gifts other than food, lodging or entertainment, such as transportation that substitutes for commercial transportation; gifts extended for a business purpose; Congressional Research Service 4 gifts extended at property or facilities owned by an entity, rather than by an individual or an individual’s family, even if the entity is owned wholly or in part by an individual or an individual’s family; gifts paid for by any individual or entity other than the individual providing the hospitality, or for which the individual providing the hospitality receives reimbursement or a tax deduction related to furnishing the hospitality; or gifts extended at a commercial property, e.g., a resort or restaurant, or at a property that is regularly rented out to others for a business purpose. The notes also clarify that judicial officers and employees are never permitted “to solicit or accept anything of value from a person seeking official action from or doing business with the court or other entity served by the judicial officer or employee, or from any other person whose interests may be substantially affected by the performance or nonperformance of the judge’s official duties.” There is some uncertainty as to whether these regulations apply to the Supreme Court. Although the regulations explicitly include Justices in the definition of judicial officer, some have questioned whether the Judicial Conference has authority over the Supreme Court. In his 2011 Year-End Report, the Chief Justice explained that because the “Judicial Conference is an instrument for the management of the lower federal courts, its committees have no mandate to prescribe rules or standards for any other body.” Nonetheless, at least one Associate Justice has indicated his intention to follow the 2023 guidance going forward, and, as discussed further below, the Justices have stated that they comply with current Judicial Conference regulations on financial disclosure. Supreme Court Code of Conduct On November 13, 2023, the United States Supreme Court announced it was, for the first time, adopting a Code of Conduct “to set out succinctly and gather in one place the ethics rules and principles that guide the conduct of the Members of the Court.” Noting that most of the rules and principles within the Code “are not new,” the Court explained that the Code “largely represents a codification of principles that we have long regarded as governing our conduct.” The Code, discussed in more detail in another Legal Sidebar, is a set of five ethical canons and accompanying commentary. The canons are nearly the same as the existing canons in the Code of Conduct for U.S. Judges, which applies only to lower federal judges. While many provisions of the Supreme Court Code generally address conflicts of interest and appearances of impropriety, specific Code provisions discuss requirements related to financial activities and compliance with the EIGA. For example, Canon 4(H) declares the Justices’ commitment to comply with financial disclosure laws, and the commentary accompanying the Code states that the Justices comply with the EIGA, STOCK Act, and current Judicial Conference regulations on financial disclosure. Although the Code affirms the Justices’ compliance with existing financial disclosure laws and regulations, it seemingly does not impose any new financial disclosure requirements on the Justices. Considerations for Congress Financial disclosure laws are used to identify potential or actual conflicts of interest in order to promote integrity in the federal government. Congress may consider options to modify or clarify current financial disclosure requirements for judicial officers. For example, the Supreme Court Ethics, Recusal, and Transparency Act would, according to its sponsor, “improve disclosure of travel and hospitality for judges” by requiring the counselor to the Chief Justice (with approval of the Chief Justice) to adopt rules regarding disclosure of gifts, travel, and income that are “at least as rigorous as the House and Senate disclosure rules.” This proposal was introduced before the Justices released their November 2023 Code of Conduct, and it is unclear to what extent the Code may overlap with some of the requirements that this bill would impose. Congressional Research Service 5 LSB10949 · VERSION 2 · UPDATED Financial disclosure is only one facet of a wider theme of government ethics. The EIGA, as amended, includes not only the financial disclosure requirements discussed above but also gift and outside earned income and employment limitations that apply to all officers and employees of the government. While the Judicial Conference’s implementing regulations for these laws exclude Supreme Court Justices from coverage, the commentary accompanying the recent Supreme Court Code of Conduct states that the Justices comply with current Judicial Conference regulations on gifts, foreign gifts and decorations, and outside earned income, honoraria, and employment in addition to regulations about financial disclosure. This is consistent with the Justices’ long-standing voluntary compliance with certain Judicial Conference regulations. The Code, however, does not include any enforcement mechanisms, meaning there is no process to address alleged violations of the Code. Proposed legislation about Supreme Court financial disclosure and other ethics requirements, including congressional attempts to enforce the Supreme Court Code of Conduct through legislation or oversight, may raise questions regarding Congress’s authority to regulate the Supreme Court. Some scholars have suggested that Chief Justice Roberts in his 2011 Year-End Report questioned whether Congress may impose ethical requirements on the Supreme Court. Other scholars have argued that while constitutional obstacles—such as separation-of-powers issues—may exist, the Constitution does provide Congress with authority to regulate Supreme Court ethics. This authority, however, is untested, leaving a wide array of questions unanswered regarding the validity of current law and the extent to which Congress may impose future regulations. Despite any doubts as to congressional authority, the Justices, through their newly released Code of Conduct, have acknowledged that they file “the same financial disclosure reports as other federal judges.” Without enforcement mechanisms in the Code, however, compliance with federal ethics laws may be left to the discretion of the Justices.]
|
For this task, you are only to answer questions based entirely on the information provided in the prompt. No external resources or prior knowledge are allowed in this case.
EVIDENCE:
Recent Changes to Supreme Court Financial Disclosure Requirements Statutory Updates On May 13, 2022, President Biden signed the Courthouse Ethics and Transparency Act, which requires online publication of financial disclosure reports of judicial officers (including Supreme Court Justices), bankruptcy judges, and magistrate judges. While the EIGA always mandated public access to judicial officer financial disclosure reports, there was no central database to access the filings, and reports were available only “in paper documents or on thumb drives.” The new law directed the Administrative Office of the United States Courts (AO) to establish a “searchable internet database to enable public access to any report required to be filed” under the EIGA. The AO launched the public database on November 7, 2022, and the public can now access electronic versions of federal judges’ reports. The EIGA’s allowance for security-related redactions in judicial branch financial disclosure reports remains unchanged. The Courthouse Ethics and Transparency Act also extended the STOCK Act’s PTR requirements to judicial officers (including Supreme Court Justices), bankruptcy judges, and magistrate judges. Under the provisions discussed above, federal judges are now required to report any purchase, sale, or exchange of securities that exceeds $1,000 within 45 days of the transaction. The new public database includes access to all of these periodic transaction reports. Regulatory Updates Interpretation of the EIGA’s financial disclosure requirements as applied to judicial officers and employees has also recently changed. As mentioned above, the Committee on Financial Disclosure within the Judicial Conference prescribes rules regarding financial disclosure by judicial officers. Those rules are found in Volume 2, Part D, of the Guide to Judiciary Policy. As noted above, as part of their financial disclosure reports, all covered individuals are statutorily required to report gifts received from any source other than a relative with the exception of “food, lodging, or entertainment received as personal hospitality.” The EIGA defines personal hospitality of any individual as “hospitality extended for a nonbusiness purpose by an individual, not a corporation or organization, at the personal residence of that individual or the individual’s family or on property or facilities owned by that individual or the individual’s family.” According to a March 2023 letter from the director of the AO, the Committee on Financial Disclosure revised its regulations, effective March 14, 2023, specifically regarding the definition of personal hospitality. These updated regulations appear in the notes that accompany the definition of personal hospitality: (1) The personal hospitality gift reporting exemption applies only to food, lodging, or entertainment and is intended to cover such gifts of a personal, non-business nature. Therefore, the reporting exemption does not include: gifts other than food, lodging or entertainment, such as transportation that substitutes for commercial transportation; gifts extended for a business purpose; Congressional Research Service 4 gifts extended at property or facilities owned by an entity, rather than by an individual or an individual’s family, even if the entity is owned wholly or in part by an individual or an individual’s family; gifts paid for by any individual or entity other than the individual providing the hospitality, or for which the individual providing the hospitality receives reimbursement or a tax deduction related to furnishing the hospitality; or gifts extended at a commercial property, e.g., a resort or restaurant, or at a property that is regularly rented out to others for a business purpose. The notes also clarify that judicial officers and employees are never permitted “to solicit or accept anything of value from a person seeking official action from or doing business with the court or other entity served by the judicial officer or employee, or from any other person whose interests may be substantially affected by the performance or nonperformance of the judge’s official duties.” There is some uncertainty as to whether these regulations apply to the Supreme Court. Although the regulations explicitly include Justices in the definition of judicial officer, some have questioned whether the Judicial Conference has authority over the Supreme Court. In his 2011 Year-End Report, the Chief Justice explained that because the “Judicial Conference is an instrument for the management of the lower federal courts, its committees have no mandate to prescribe rules or standards for any other body.” Nonetheless, at least one Associate Justice has indicated his intention to follow the 2023 guidance going forward, and, as discussed further below, the Justices have stated that they comply with current Judicial Conference regulations on financial disclosure. Supreme Court Code of Conduct On November 13, 2023, the United States Supreme Court announced it was, for the first time, adopting a Code of Conduct “to set out succinctly and gather in one place the ethics rules and principles that guide the conduct of the Members of the Court.” Noting that most of the rules and principles within the Code “are not new,” the Court explained that the Code “largely represents a codification of principles that we have long regarded as governing our conduct.” The Code, discussed in more detail in another Legal Sidebar, is a set of five ethical canons and accompanying commentary. The canons are nearly the same as the existing canons in the Code of Conduct for U.S. Judges, which applies only to lower federal judges. While many provisions of the Supreme Court Code generally address conflicts of interest and appearances of impropriety, specific Code provisions discuss requirements related to financial activities and compliance with the EIGA. For example, Canon 4(H) declares the Justices’ commitment to comply with financial disclosure laws, and the commentary accompanying the Code states that the Justices comply with the EIGA, STOCK Act, and current Judicial Conference regulations on financial disclosure. Although the Code affirms the Justices’ compliance with existing financial disclosure laws and regulations, it seemingly does not impose any new financial disclosure requirements on the Justices. Considerations for Congress Financial disclosure laws are used to identify potential or actual conflicts of interest in order to promote integrity in the federal government. Congress may consider options to modify or clarify current financial disclosure requirements for judicial officers. For example, the Supreme Court Ethics, Recusal, and Transparency Act would, according to its sponsor, “improve disclosure of travel and hospitality for judges” by requiring the counselor to the Chief Justice (with approval of the Chief Justice) to adopt rules regarding disclosure of gifts, travel, and income that are “at least as rigorous as the House and Senate disclosure rules.” This proposal was introduced before the Justices released their November 2023 Code of Conduct, and it is unclear to what extent the Code may overlap with some of the requirements that this bill would impose. Congressional Research Service 5 LSB10949 · VERSION 2 · UPDATED Financial disclosure is only one facet of a wider theme of government ethics. The EIGA, as amended, includes not only the financial disclosure requirements discussed above but also gift and outside earned income and employment limitations that apply to all officers and employees of the government. While the Judicial Conference’s implementing regulations for these laws exclude Supreme Court Justices from coverage, the commentary accompanying the recent Supreme Court Code of Conduct states that the Justices comply with current Judicial Conference regulations on gifts, foreign gifts and decorations, and outside earned income, honoraria, and employment in addition to regulations about financial disclosure. This is consistent with the Justices’ long-standing voluntary compliance with certain Judicial Conference regulations. The Code, however, does not include any enforcement mechanisms, meaning there is no process to address alleged violations of the Code. Proposed legislation about Supreme Court financial disclosure and other ethics requirements, including congressional attempts to enforce the Supreme Court Code of Conduct through legislation or oversight, may raise questions regarding Congress’s authority to regulate the Supreme Court. Some scholars have suggested that Chief Justice Roberts in his 2011 Year-End Report questioned whether Congress may impose ethical requirements on the Supreme Court. Other scholars have argued that while constitutional obstacles—such as separation-of-powers issues—may exist, the Constitution does provide Congress with authority to regulate Supreme Court ethics. This authority, however, is untested, leaving a wide array of questions unanswered regarding the validity of current law and the extent to which Congress may impose future regulations. Despite any doubts as to congressional authority, the Justices, through their newly released Code of Conduct, have acknowledged that they file “the same financial disclosure reports as other federal judges.” Without enforcement mechanisms in the Code, however, compliance with federal ethics laws may be left to the discretion of the Justices.
USER:
In simple language, tell me about the Supreme Court's Code of Conduct?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 29 | 12 | 1,402 | null | 491 |
Your answer must be drawn from the context block provided, only. You are prohibited from using other sources or drawing from prior knowledge. Provide a brief, bolded heading for your response that gives context. The body of the answer should be no longer than 200 words.
|
What new requirements for states would the proposed FY2024 legislation create?
|
Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 12 President’s Budget Proposal for FY2024 The FY2024 budget request included several provisions intended to improve the administration and integrity of the UI program.51 These provisions included updating the factors used in determining administrative funding levels, a package of integrity-focused provisions, funding to continue to address fraud and IT modernization within the UI system, and additional funding to continue to build and support the UI Integrity Center’s Integrity Data Hub (IDH) cross-match systems. It also included an additional, broader package of proposed reforms to address systemic fraud such as identity theft and other fraud in the UI program, increase funding for the COVID-19 Fraud Strike Force Teams, and provide additional funding for Inspectors General (including the DOL Inspector General). Proposed UI Program Administrative Funding The FY2024 budget request included $3.5 billion for administration of the UI system, which was an increase over the FY2023 budget request amount of $3.1 billion.52 This amount included almost $3.0 billion “reflecting the Administration’s economic assumptions and updated workload- processing and salary factors” to administer UI.53 Additionally, the budget request for UI administration included $550 million in funding for RESEA. Separately, the budget request would have provided a fourth installment of $6 million to modernize IT infrastructure and would also have provided $150 million for program integrity purposes, including state grants to reduce fraud through identity verification services and other IT infrastructure improvements. The President’s budget proposal for FY2024 also proposed an alteration to the formula that determines the federal appropriation for state UI administration, which would have been the first substantive update in decades. Specifically, this proposal would have updated assumptions related to UI claims processing and state UI workforce salary rates, as prior assumptions for these factors were not capturing current administrative costs in states. Proposed Program Integrity Legislation The President’s FY2024 budget request also recommended a package of legislative changes to improve UI program integrity and to provide additional funding to states to help ensure proper UI payments. These proposals would have • codifed the requirement for states to data match with the National Directory of New Hires (NDNH; administered by the Department of Health and Human Services) and the Prisoner Update Processing System (PUPS, administered by the Social Security Administration) to help ensure that UI benefits are correctly paid to eligible individuals in a timely manner;54 51 DOL, Fiscal 2024 Budget, Volume 1: FY2024 Congressional Budget Justification, Employment and Training Administration, State Unemployment Insurance and Employment Service Operations, https://www.dol.gov/sites/ dolgov/files/general/budget/2024/CBJ-2024-V1-07.pdf (hereinafter “FY24 SUIESO Chapter”). 52 For an overview of current funding for UI administration, see CRS In Focus IF10838, Funding the State Administration of Unemployment Compensation (UC) Benefits. 53 FY24 SUIESO Chapter, Page 23, available at https://www.dol.gov/sites/dolgov/files/general/budget/2024/CBJ-2024- V1-07.pdf#page=27. 54 One way that states can ensure that UI benefits are correctly paid to eligible individuals in a timely manner is by accessing available data sources to match claimant information with eligibility-related characteristics. States are (continued...) Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 13 • required states to disclose information to the DOL Office of the Inspector General (DOL-OIG) in order to streamline DOL-OIG’s ability to conduct audits and investigations in the UI program; this includes authorizing DOL-OIG to have direct access to the Interstate Connection Network (ICON), which is used for the electronic transmission of interstate claims, as well as the IDH system, which is used in cross matching UI claimants against other databases to prevent and detect fraud and improper payments;55 • allowed the DOL Secretary to require a portion of a state’s administrative grant to be used to correct failing performance and/or have the state participate in required technical assistance activities offered by DOL;56 • authorized states to retain up to 5% of recovered fraudulent UI overpayments for program integrity use;57 • required states to use penalty and interest collections solely for UI administration;58 • provided states the authority to issue a formal warning when claimants do not clearly meet the work search requirements;59 and • allowed states to use contract support in recovery efforts under the Treasury Offset Program (TOP).60 President’s Budget Proposal for FY2025 As in FY2024, the President’s Budget Proposal for FY2025 budget request includes the same reform proposals intended to improve the administration and integrity of the UI program (see the section on “Proposed Program Integrity Legislation”).61 currently required, via DOL program guidance, to use the National Directory of New Hires (NDNH) to make sure, for instance, that UI claimants have not returned to work (for permanent-law UI programs, see DOL, ETA, “National Effort to Reduce Improper Payments in the Unemployment Insurance (UI) Program,” UIPL No. 19-11, June 10, 2011, https://wdr.doleta.gov/directives/attach/UIPL/UIPL19-11.pdf; and DOL, ETA, “National Directory of New Hires (NDNH) and State Directory of New Hires (SDNH) Guidance and Best Practices,” UIPL No. 13-19, June 17, 2019, https://wdr.doleta.gov/directives/attach/UIPL/UIPL_13-19.pdf). Currently, there is no statutory requirement for states to use NDNH or several other related data cross matches. 55 For background on recent DOL-OIG challenges related to direct access to state UI data, see the section on “Data Access” at https://www.oig.dol.gov/doloiguioversightwork.htm. 56 For an overview of the federal funding of state UI administration, see CRS In Focus IF10838, Funding the State Administration of Unemployment Compensation (UC) Benefits. 57 For an overview of UI fraud recovery issues, see CRS Insight IN12127, Unemployment Insurance Overpayment and Fraud Recovery and H.R. 1163. 58 In some situations, states apply fines and civil penalties when fraud is involved with UI benefit overpayments. See DOL, 2022 Comparison of State Unemployment Insurance Laws, Table 6-3, https://oui.doleta.gov/unemploy/pdf/ uilawcompar/2022/overpayments.pdf#page=6. 59 Under federal law (SSA §303(a)(12)), each state’s UI laws must require that individuals be able to work, available for work, and actively seeking work, as a condition of benefit eligibility, among other requirements. 60 Under federal law (SSA §303(m)), states must recover UI overpayments due to fraud and to misreported work from an individual’s federal income tax refund through the TOP. States may use contractors for recovery of SUTA debts but are prohibited from using contractors for recovery of UC and EB payments. For details, see DOL, ETA, “Recovery of Certain Unemployment Compensation Debts under the Treasury Offset Program,” UIPL 02-19, December 12, 2018, https://www.dol.gov/agencies/eta/advisories/unemployment-insurance-program-letter-no-02-19. 61 DOL, Fiscal 2025 Budget, Volume 1: FY2024 Congressional Budget Justification, Employment and Training (continued...) Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 14 The FY2025 budget request includes $3.4 billion for administration of the UI system.62 This amount is $84 million less than the FY2024 budget request, but $280 million more that the FY2024 enacted appropriation of $3.1 billion.63 The budget request also includes $388 million in funding for RESEA and proposes changes to the distribution formula for RESEA grants to states. Separately, the budget would also request a fifth installment of $6 million to modernize critical information technology infrastructure essential to the states’ administration of the UI program and $25 million to fund the national identity verification offering that the Department launched to help states combat identity fraud in the UI system. Laws Enacted in the 118th Congress This section provides summary information on the one piece of legislation with UI provisions enacted in the 118th Congress, at the time of this report. P.L. 118-5, the Fiscal Responsibility Act of 2023 The Fiscal Responsibility Act of 2023 (FRA; P.L. 118-5; June 3, 2023) included three provisions that (1) rescinded specified amounts of unobligated UI administrative funding made available by the American Rescue Plan Act of 2021 (ARPA; P.L. 117-2; March 11, 2021), (2) effectively reduced budgetary adjustments to discretionary spending limits for Reemployment Services and Eligibility Assessments, and (3) rescinded all unobligated funds for Short-Time Compensation grants created under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136; March 27, 2020). ARPA provided $2 billion in additional UI administrative funding to the U.S. DOL in FY2021 to “detect and prevent fraud, promote equitable access, and ensure the timely payment of benefits.” This funding was made available until expended and can be used for (1) federal administrative costs, (2) system-wide infrastructure, and (3) grants to states and territories administering all UI benefits for program integrity and fraud prevention purposes, including for identity verification and faster claims processing.
|
Your answer must be drawn from the context block provided, only. You are prohibited from using other sources or drawing from prior knowledge. Provide a brief, bolded heading for your response that gives context. The body of the answer should be no longer than 200 words. What new requirements for states would the proposed FY2024 legislation create? Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 12 President’s Budget Proposal for FY2024 The FY2024 budget request included several provisions intended to improve the administration and integrity of the UI program.51 These provisions included updating the factors used in determining administrative funding levels, a package of integrity-focused provisions, funding to continue to address fraud and IT modernization within the UI system, and additional funding to continue to build and support the UI Integrity Center’s Integrity Data Hub (IDH) cross-match systems. It also included an additional, broader package of proposed reforms to address systemic fraud such as identity theft and other fraud in the UI program, increase funding for the COVID-19 Fraud Strike Force Teams, and provide additional funding for Inspectors General (including the DOL Inspector General). Proposed UI Program Administrative Funding The FY2024 budget request included $3.5 billion for administration of the UI system, which was an increase over the FY2023 budget request amount of $3.1 billion.52 This amount included almost $3.0 billion “reflecting the Administration’s economic assumptions and updated workload- processing and salary factors” to administer UI.53 Additionally, the budget request for UI administration included $550 million in funding for RESEA. Separately, the budget request would have provided a fourth installment of $6 million to modernize IT infrastructure and would also have provided $150 million for program integrity purposes, including state grants to reduce fraud through identity verification services and other IT infrastructure improvements. The President’s budget proposal for FY2024 also proposed an alteration to the formula that determines the federal appropriation for state UI administration, which would have been the first substantive update in decades. Specifically, this proposal would have updated assumptions related to UI claims processing and state UI workforce salary rates, as prior assumptions for these factors were not capturing current administrative costs in states. Proposed Program Integrity Legislation The President’s FY2024 budget request also recommended a package of legislative changes to improve UI program integrity and to provide additional funding to states to help ensure proper UI payments. These proposals would have • codifed the requirement for states to data match with the National Directory of New Hires (NDNH; administered by the Department of Health and Human Services) and the Prisoner Update Processing System (PUPS, administered by the Social Security Administration) to help ensure that UI benefits are correctly paid to eligible individuals in a timely manner;54 51 DOL, Fiscal 2024 Budget, Volume 1: FY2024 Congressional Budget Justification, Employment and Training Administration, State Unemployment Insurance and Employment Service Operations, https://www.dol.gov/sites/ dolgov/files/general/budget/2024/CBJ-2024-V1-07.pdf (hereinafter “FY24 SUIESO Chapter”). 52 For an overview of current funding for UI administration, see CRS In Focus IF10838, Funding the State Administration of Unemployment Compensation (UC) Benefits. 53 FY24 SUIESO Chapter, Page 23, available at https://www.dol.gov/sites/dolgov/files/general/budget/2024/CBJ-2024- V1-07.pdf#page=27. 54 One way that states can ensure that UI benefits are correctly paid to eligible individuals in a timely manner is by accessing available data sources to match claimant information with eligibility-related characteristics. States are (continued...) Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 13 • required states to disclose information to the DOL Office of the Inspector General (DOL-OIG) in order to streamline DOL-OIG’s ability to conduct audits and investigations in the UI program; this includes authorizing DOL-OIG to have direct access to the Interstate Connection Network (ICON), which is used for the electronic transmission of interstate claims, as well as the IDH system, which is used in cross matching UI claimants against other databases to prevent and detect fraud and improper payments;55 • allowed the DOL Secretary to require a portion of a state’s administrative grant to be used to correct failing performance and/or have the state participate in required technical assistance activities offered by DOL;56 • authorized states to retain up to 5% of recovered fraudulent UI overpayments for program integrity use;57 • required states to use penalty and interest collections solely for UI administration;58 • provided states the authority to issue a formal warning when claimants do not clearly meet the work search requirements;59 and • allowed states to use contract support in recovery efforts under the Treasury Offset Program (TOP).60 President’s Budget Proposal for FY2025 As in FY2024, the President’s Budget Proposal for FY2025 budget request includes the same reform proposals intended to improve the administration and integrity of the UI program (see the section on “Proposed Program Integrity Legislation”).61 currently required, via DOL program guidance, to use the National Directory of New Hires (NDNH) to make sure, for instance, that UI claimants have not returned to work (for permanent-law UI programs, see DOL, ETA, “National Effort to Reduce Improper Payments in the Unemployment Insurance (UI) Program,” UIPL No. 19-11, June 10, 2011, https://wdr.doleta.gov/directives/attach/UIPL/UIPL19-11.pdf; and DOL, ETA, “National Directory of New Hires (NDNH) and State Directory of New Hires (SDNH) Guidance and Best Practices,” UIPL No. 13-19, June 17, 2019, https://wdr.doleta.gov/directives/attach/UIPL/UIPL_13-19.pdf). Currently, there is no statutory requirement for states to use NDNH or several other related data cross matches. 55 For background on recent DOL-OIG challenges related to direct access to state UI data, see the section on “Data Access” at https://www.oig.dol.gov/doloiguioversightwork.htm. 56 For an overview of the federal funding of state UI administration, see CRS In Focus IF10838, Funding the State Administration of Unemployment Compensation (UC) Benefits. 57 For an overview of UI fraud recovery issues, see CRS Insight IN12127, Unemployment Insurance Overpayment and Fraud Recovery and H.R. 1163. 58 In some situations, states apply fines and civil penalties when fraud is involved with UI benefit overpayments. See DOL, 2022 Comparison of State Unemployment Insurance Laws, Table 6-3, https://oui.doleta.gov/unemploy/pdf/ uilawcompar/2022/overpayments.pdf#page=6. 59 Under federal law (SSA §303(a)(12)), each state’s UI laws must require that individuals be able to work, available for work, and actively seeking work, as a condition of benefit eligibility, among other requirements. 60 Under federal law (SSA §303(m)), states must recover UI overpayments due to fraud and to misreported work from an individual’s federal income tax refund through the TOP. States may use contractors for recovery of SUTA debts but are prohibited from using contractors for recovery of UC and EB payments. For details, see DOL, ETA, “Recovery of Certain Unemployment Compensation Debts under the Treasury Offset Program,” UIPL 02-19, December 12, 2018, https://www.dol.gov/agencies/eta/advisories/unemployment-insurance-program-letter-no-02-19. 61 DOL, Fiscal 2025 Budget, Volume 1: FY2024 Congressional Budget Justification, Employment and Training (continued...) Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 14 The FY2025 budget request includes $3.4 billion for administration of the UI system.62 This amount is $84 million less than the FY2024 budget request, but $280 million more that the FY2024 enacted appropriation of $3.1 billion.63 The budget request also includes $388 million in funding for RESEA and proposes changes to the distribution formula for RESEA grants to states. Separately, the budget would also request a fifth installment of $6 million to modernize critical information technology infrastructure essential to the states’ administration of the UI program and $25 million to fund the national identity verification offering that the Department launched to help states combat identity fraud in the UI system. Laws Enacted in the 118th Congress This section provides summary information on the one piece of legislation with UI provisions enacted in the 118th Congress, at the time of this report. P.L. 118-5, the Fiscal Responsibility Act of 2023 The Fiscal Responsibility Act of 2023 (FRA; P.L. 118-5; June 3, 2023) included three provisions that (1) rescinded specified amounts of unobligated UI administrative funding made available by the American Rescue Plan Act of 2021 (ARPA; P.L. 117-2; March 11, 2021), (2) effectively reduced budgetary adjustments to discretionary spending limits for Reemployment Services and Eligibility Assessments, and (3) rescinded all unobligated funds for Short-Time Compensation grants created under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136; March 27, 2020). ARPA provided $2 billion in additional UI administrative funding to the U.S. DOL in FY2021 to “detect and prevent fraud, promote equitable access, and ensure the timely payment of benefits.” This funding was made available until expended and can be used for (1) federal administrative costs, (2) system-wide infrastructure, and (3) grants to states and territories administering all UI benefits for program integrity and fraud prevention purposes, including for identity verification and faster claims processing.
|
Your answer must be drawn from the context block provided, only. You are prohibited from using other sources or drawing from prior knowledge. Provide a brief, bolded heading for your response that gives context. The body of the answer should be no longer than 200 words.
EVIDENCE:
Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 12 President’s Budget Proposal for FY2024 The FY2024 budget request included several provisions intended to improve the administration and integrity of the UI program.51 These provisions included updating the factors used in determining administrative funding levels, a package of integrity-focused provisions, funding to continue to address fraud and IT modernization within the UI system, and additional funding to continue to build and support the UI Integrity Center’s Integrity Data Hub (IDH) cross-match systems. It also included an additional, broader package of proposed reforms to address systemic fraud such as identity theft and other fraud in the UI program, increase funding for the COVID-19 Fraud Strike Force Teams, and provide additional funding for Inspectors General (including the DOL Inspector General). Proposed UI Program Administrative Funding The FY2024 budget request included $3.5 billion for administration of the UI system, which was an increase over the FY2023 budget request amount of $3.1 billion.52 This amount included almost $3.0 billion “reflecting the Administration’s economic assumptions and updated workload- processing and salary factors” to administer UI.53 Additionally, the budget request for UI administration included $550 million in funding for RESEA. Separately, the budget request would have provided a fourth installment of $6 million to modernize IT infrastructure and would also have provided $150 million for program integrity purposes, including state grants to reduce fraud through identity verification services and other IT infrastructure improvements. The President’s budget proposal for FY2024 also proposed an alteration to the formula that determines the federal appropriation for state UI administration, which would have been the first substantive update in decades. Specifically, this proposal would have updated assumptions related to UI claims processing and state UI workforce salary rates, as prior assumptions for these factors were not capturing current administrative costs in states. Proposed Program Integrity Legislation The President’s FY2024 budget request also recommended a package of legislative changes to improve UI program integrity and to provide additional funding to states to help ensure proper UI payments. These proposals would have • codifed the requirement for states to data match with the National Directory of New Hires (NDNH; administered by the Department of Health and Human Services) and the Prisoner Update Processing System (PUPS, administered by the Social Security Administration) to help ensure that UI benefits are correctly paid to eligible individuals in a timely manner;54 51 DOL, Fiscal 2024 Budget, Volume 1: FY2024 Congressional Budget Justification, Employment and Training Administration, State Unemployment Insurance and Employment Service Operations, https://www.dol.gov/sites/ dolgov/files/general/budget/2024/CBJ-2024-V1-07.pdf (hereinafter “FY24 SUIESO Chapter”). 52 For an overview of current funding for UI administration, see CRS In Focus IF10838, Funding the State Administration of Unemployment Compensation (UC) Benefits. 53 FY24 SUIESO Chapter, Page 23, available at https://www.dol.gov/sites/dolgov/files/general/budget/2024/CBJ-2024- V1-07.pdf#page=27. 54 One way that states can ensure that UI benefits are correctly paid to eligible individuals in a timely manner is by accessing available data sources to match claimant information with eligibility-related characteristics. States are (continued...) Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 13 • required states to disclose information to the DOL Office of the Inspector General (DOL-OIG) in order to streamline DOL-OIG’s ability to conduct audits and investigations in the UI program; this includes authorizing DOL-OIG to have direct access to the Interstate Connection Network (ICON), which is used for the electronic transmission of interstate claims, as well as the IDH system, which is used in cross matching UI claimants against other databases to prevent and detect fraud and improper payments;55 • allowed the DOL Secretary to require a portion of a state’s administrative grant to be used to correct failing performance and/or have the state participate in required technical assistance activities offered by DOL;56 • authorized states to retain up to 5% of recovered fraudulent UI overpayments for program integrity use;57 • required states to use penalty and interest collections solely for UI administration;58 • provided states the authority to issue a formal warning when claimants do not clearly meet the work search requirements;59 and • allowed states to use contract support in recovery efforts under the Treasury Offset Program (TOP).60 President’s Budget Proposal for FY2025 As in FY2024, the President’s Budget Proposal for FY2025 budget request includes the same reform proposals intended to improve the administration and integrity of the UI program (see the section on “Proposed Program Integrity Legislation”).61 currently required, via DOL program guidance, to use the National Directory of New Hires (NDNH) to make sure, for instance, that UI claimants have not returned to work (for permanent-law UI programs, see DOL, ETA, “National Effort to Reduce Improper Payments in the Unemployment Insurance (UI) Program,” UIPL No. 19-11, June 10, 2011, https://wdr.doleta.gov/directives/attach/UIPL/UIPL19-11.pdf; and DOL, ETA, “National Directory of New Hires (NDNH) and State Directory of New Hires (SDNH) Guidance and Best Practices,” UIPL No. 13-19, June 17, 2019, https://wdr.doleta.gov/directives/attach/UIPL/UIPL_13-19.pdf). Currently, there is no statutory requirement for states to use NDNH or several other related data cross matches. 55 For background on recent DOL-OIG challenges related to direct access to state UI data, see the section on “Data Access” at https://www.oig.dol.gov/doloiguioversightwork.htm. 56 For an overview of the federal funding of state UI administration, see CRS In Focus IF10838, Funding the State Administration of Unemployment Compensation (UC) Benefits. 57 For an overview of UI fraud recovery issues, see CRS Insight IN12127, Unemployment Insurance Overpayment and Fraud Recovery and H.R. 1163. 58 In some situations, states apply fines and civil penalties when fraud is involved with UI benefit overpayments. See DOL, 2022 Comparison of State Unemployment Insurance Laws, Table 6-3, https://oui.doleta.gov/unemploy/pdf/ uilawcompar/2022/overpayments.pdf#page=6. 59 Under federal law (SSA §303(a)(12)), each state’s UI laws must require that individuals be able to work, available for work, and actively seeking work, as a condition of benefit eligibility, among other requirements. 60 Under federal law (SSA §303(m)), states must recover UI overpayments due to fraud and to misreported work from an individual’s federal income tax refund through the TOP. States may use contractors for recovery of SUTA debts but are prohibited from using contractors for recovery of UC and EB payments. For details, see DOL, ETA, “Recovery of Certain Unemployment Compensation Debts under the Treasury Offset Program,” UIPL 02-19, December 12, 2018, https://www.dol.gov/agencies/eta/advisories/unemployment-insurance-program-letter-no-02-19. 61 DOL, Fiscal 2025 Budget, Volume 1: FY2024 Congressional Budget Justification, Employment and Training (continued...) Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 14 The FY2025 budget request includes $3.4 billion for administration of the UI system.62 This amount is $84 million less than the FY2024 budget request, but $280 million more that the FY2024 enacted appropriation of $3.1 billion.63 The budget request also includes $388 million in funding for RESEA and proposes changes to the distribution formula for RESEA grants to states. Separately, the budget would also request a fifth installment of $6 million to modernize critical information technology infrastructure essential to the states’ administration of the UI program and $25 million to fund the national identity verification offering that the Department launched to help states combat identity fraud in the UI system. Laws Enacted in the 118th Congress This section provides summary information on the one piece of legislation with UI provisions enacted in the 118th Congress, at the time of this report. P.L. 118-5, the Fiscal Responsibility Act of 2023 The Fiscal Responsibility Act of 2023 (FRA; P.L. 118-5; June 3, 2023) included three provisions that (1) rescinded specified amounts of unobligated UI administrative funding made available by the American Rescue Plan Act of 2021 (ARPA; P.L. 117-2; March 11, 2021), (2) effectively reduced budgetary adjustments to discretionary spending limits for Reemployment Services and Eligibility Assessments, and (3) rescinded all unobligated funds for Short-Time Compensation grants created under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136; March 27, 2020). ARPA provided $2 billion in additional UI administrative funding to the U.S. DOL in FY2021 to “detect and prevent fraud, promote equitable access, and ensure the timely payment of benefits.” This funding was made available until expended and can be used for (1) federal administrative costs, (2) system-wide infrastructure, and (3) grants to states and territories administering all UI benefits for program integrity and fraud prevention purposes, including for identity verification and faster claims processing.
USER:
What new requirements for states would the proposed FY2024 legislation create?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 46 | 11 | 1,367 | null | 526 |
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
|
Can you extract the key information from this text, and summarize what IPv6 Quality-of-Service is and how it applies to a software engineer who primarily works on web-based technologies?
|
IPv6 Quality-of-Service Capabilities A host can use the flow label and the traffic fields in the IPv6 header. A host uses these fields to identify those packets for which the host requests special handling by IPv6 routers. For example, the host can request non-default quality of service or real-time service. This important capability enables the support of applications that require some degree of consistent throughput, delay, or jitter. These types of applications are known as multi media or real-time applications. Flow Labels A source can use the 20-bit flow label field in the IPv6 header. A source can use this field to label those packets for which the source requests special handling by the IPv6 routers. For example, a source can request non-default quality of service or real-time service. This aspect of IPv6 is still experimental and subject to change as the requirements for flow support in the Internet become clearer. Some hosts or routers do not support the functions of the flow label field. These hosts or routers are required to set the field to zero when originating a packet. Hosts or routers forward the field without changes when forwarding a packet. Hosts or routers ignore the field when receiving a packet. What Is a Flow? A flow is a sequence of packets that are sent from a particular source to a particular, unicast or multicast, destination. The source also requires special handling by the intervening routers. The nature of the special handling might be conveyed to the routers by a control protocol. The control protocol can be a resource reservation protocol. The special handling also might be conveyed by information within the flow's packets, for example, in a hop-by-hop option. Active flows from a source to a destination can be multiple. Active flows can also contain traffic that is not associated with any flow. The combination of a source address and a nonzero flow label uniquely identifies a flow. Packets that do not belong to a flow carry a flow label of zero. The flow's source node assigns a flow label to a flow. New flow labels must be chosen randomly, in a “pseudo” manner. New flow labels must also be chosen uniformly from the range 1 to FFFFF hex. This random allocation makes any set of bits within the flow label field suitable for use as a hash key by routers. The routers can use the hash key to look up the state that is associated with the flow. Packets Belonging to the Same Flow All packets that belong to the same flow must be sent with the same source address, same destination address, and same nonzero flow label. If any of those packets include a hop-by-hop options header, then the packets must be originated with the contents of the hop-by-hop options header. The next header field of the hop-by-hop options header is excluded. If any of those packets include a routing header, then the packets must be originated with the same contents in all extension headers. The same contents include all extensions before the routing header and the routing header. The next header field in the routing header is excluded. The routers or destinations are permitted, but not required, to verify that these conditions are satisfied. If a violation is detected, the violation should be reported to the source. The violation is reported by a problem message for an ICMP parameter, Code 0. The violation points to the high-order octet of the flow label field. The high-order octet is offset one octet within the IPv6 packet. Routers are free to set up the flow-handling state for any flow. Routers do not need explicit flow establishment information from a control protocol, a hop-by-hop option, or other means. For example, when a router receives a packet from a particular source with an unknown, non-zero flow label, a router can process its IPv6 header. The router processes any necessary extension headers in the same way that the router processes extension headers with the flow label field set to zero. The routers also determine the next-hop interface. The routers might also update a hop-by-hop option, advance the pointer and addresses in a routing header, or decide how to queue the packet. The decision to queue the packet is based on the Traffic Class field of the packet. The routers can then choose to remember the results of the processing steps. Then, the routers can cache the information. The routers use the source address and the flow label as the cache key. Subsequent packets, with the same source address and flow label, can then be handled by referring to the cached information. The routers do not need to examine all those fields. The routers can assume that the fields are unchanged from the first packet that is checked in the flow. Traffic Class The nodes that originate a packet must identify different classes or different priorities of IPv6 packets. The nodes use the Traffic Class field in the IPv6 header to make this identification. The routers that forward the packets also use the Traffic Class field for the same purpose. The following general requirements apply to the Traffic Class field: The service interface to the IPv6 service within a node must supply the value of the Traffic Class bits for an upper-layer protocol. The Traffic Class bits must be in packets that are originated by that upper-layer protocol. The default value must be zero for all of the 8 bits. Nodes that support some of the Traffic Class bits or all of the Traffic Class bits can change the value of those bits. The nodes can change only the values in packets that the nodes originate, forward, or receive, as required for that specific use. Nodes should ignore and leave unchanged any bits of the Traffic Class field for which the nodes do not support a specific use. The Traffic Class bits in a received packet might not be the same value that is sent by the packet's source. Therefore, the upper-layer protocol must not assume that the values are the same.
|
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Can you extract the key information from this text, and summarize what IPv6 Quality-of-Service is and how it applies to a software engineer who primarily works on web-based technologies? IPv6 Quality-of-Service Capabilities A host can use the flow label and the traffic fields in the IPv6 header. A host uses these fields to identify those packets for which the host requests special handling by IPv6 routers. For example, the host can request non-default quality of service or real-time service. This important capability enables the support of applications that require some degree of consistent throughput, delay, or jitter. These types of applications are known as multi media or real-time applications. Flow Labels A source can use the 20-bit flow label field in the IPv6 header. A source can use this field to label those packets for which the source requests special handling by the IPv6 routers. For example, a source can request non-default quality of service or real-time service. This aspect of IPv6 is still experimental and subject to change as the requirements for flow support in the Internet become clearer. Some hosts or routers do not support the functions of the flow label field. These hosts or routers are required to set the field to zero when originating a packet. Hosts or routers forward the field without changes when forwarding a packet. Hosts or routers ignore the field when receiving a packet. What Is a Flow? A flow is a sequence of packets that are sent from a particular source to a particular, unicast or multicast, destination. The source also requires special handling by the intervening routers. The nature of the special handling might be conveyed to the routers by a control protocol. The control protocol can be a resource reservation protocol. The special handling also might be conveyed by information within the flow's packets, for example, in a hop-by-hop option. Active flows from a source to a destination can be multiple. Active flows can also contain traffic that is not associated with any flow. The combination of a source address and a nonzero flow label uniquely identifies a flow. Packets that do not belong to a flow carry a flow label of zero. The flow's source node assigns a flow label to a flow. New flow labels must be chosen randomly, in a “pseudo” manner. New flow labels must also be chosen uniformly from the range 1 to FFFFF hex. This random allocation makes any set of bits within the flow label field suitable for use as a hash key by routers. The routers can use the hash key to look up the state that is associated with the flow. Packets Belonging to the Same Flow All packets that belong to the same flow must be sent with the same source address, same destination address, and same nonzero flow label. If any of those packets include a hop-by-hop options header, then the packets must be originated with the contents of the hop-by-hop options header. The next header field of the hop-by-hop options header is excluded. If any of those packets include a routing header, then the packets must be originated with the same contents in all extension headers. The same contents include all extensions before the routing header and the routing header. The next header field in the routing header is excluded. The routers or destinations are permitted, but not required, to verify that these conditions are satisfied. If a violation is detected, the violation should be reported to the source. The violation is reported by a problem message for an ICMP parameter, Code 0. The violation points to the high-order octet of the flow label field. The high-order octet is offset one octet within the IPv6 packet. Routers are free to set up the flow-handling state for any flow. Routers do not need explicit flow establishment information from a control protocol, a hop-by-hop option, or other means. For example, when a router receives a packet from a particular source with an unknown, non-zero flow label, a router can process its IPv6 header. The router processes any necessary extension headers in the same way that the router processes extension headers with the flow label field set to zero. The routers also determine the next-hop interface. The routers might also update a hop-by-hop option, advance the pointer and addresses in a routing header, or decide how to queue the packet. The decision to queue the packet is based on the Traffic Class field of the packet. The routers can then choose to remember the results of the processing steps. Then, the routers can cache the information. The routers use the source address and the flow label as the cache key. Subsequent packets, with the same source address and flow label, can then be handled by referring to the cached information. The routers do not need to examine all those fields. The routers can assume that the fields are unchanged from the first packet that is checked in the flow. Traffic Class The nodes that originate a packet must identify different classes or different priorities of IPv6 packets. The nodes use the Traffic Class field in the IPv6 header to make this identification. The routers that forward the packets also use the Traffic Class field for the same purpose. The following general requirements apply to the Traffic Class field: The service interface to the IPv6 service within a node must supply the value of the Traffic Class bits for an upper-layer protocol. The Traffic Class bits must be in packets that are originated by that upper-layer protocol. The default value must be zero for all of the 8 bits. Nodes that support some of the Traffic Class bits or all of the Traffic Class bits can change the value of those bits. The nodes can change only the values in packets that the nodes originate, forward, or receive, as required for that specific use. Nodes should ignore and leave unchanged any bits of the Traffic Class field for which the nodes do not support a specific use. The Traffic Class bits in a received packet might not be the same value that is sent by the packet's source. Therefore, the upper-layer protocol must not assume that the values are the same. https://docs.oracle.com/cd/E19683-01/817-0573/chapter1-25/index.html
|
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
EVIDENCE:
IPv6 Quality-of-Service Capabilities A host can use the flow label and the traffic fields in the IPv6 header. A host uses these fields to identify those packets for which the host requests special handling by IPv6 routers. For example, the host can request non-default quality of service or real-time service. This important capability enables the support of applications that require some degree of consistent throughput, delay, or jitter. These types of applications are known as multi media or real-time applications. Flow Labels A source can use the 20-bit flow label field in the IPv6 header. A source can use this field to label those packets for which the source requests special handling by the IPv6 routers. For example, a source can request non-default quality of service or real-time service. This aspect of IPv6 is still experimental and subject to change as the requirements for flow support in the Internet become clearer. Some hosts or routers do not support the functions of the flow label field. These hosts or routers are required to set the field to zero when originating a packet. Hosts or routers forward the field without changes when forwarding a packet. Hosts or routers ignore the field when receiving a packet. What Is a Flow? A flow is a sequence of packets that are sent from a particular source to a particular, unicast or multicast, destination. The source also requires special handling by the intervening routers. The nature of the special handling might be conveyed to the routers by a control protocol. The control protocol can be a resource reservation protocol. The special handling also might be conveyed by information within the flow's packets, for example, in a hop-by-hop option. Active flows from a source to a destination can be multiple. Active flows can also contain traffic that is not associated with any flow. The combination of a source address and a nonzero flow label uniquely identifies a flow. Packets that do not belong to a flow carry a flow label of zero. The flow's source node assigns a flow label to a flow. New flow labels must be chosen randomly, in a “pseudo” manner. New flow labels must also be chosen uniformly from the range 1 to FFFFF hex. This random allocation makes any set of bits within the flow label field suitable for use as a hash key by routers. The routers can use the hash key to look up the state that is associated with the flow. Packets Belonging to the Same Flow All packets that belong to the same flow must be sent with the same source address, same destination address, and same nonzero flow label. If any of those packets include a hop-by-hop options header, then the packets must be originated with the contents of the hop-by-hop options header. The next header field of the hop-by-hop options header is excluded. If any of those packets include a routing header, then the packets must be originated with the same contents in all extension headers. The same contents include all extensions before the routing header and the routing header. The next header field in the routing header is excluded. The routers or destinations are permitted, but not required, to verify that these conditions are satisfied. If a violation is detected, the violation should be reported to the source. The violation is reported by a problem message for an ICMP parameter, Code 0. The violation points to the high-order octet of the flow label field. The high-order octet is offset one octet within the IPv6 packet. Routers are free to set up the flow-handling state for any flow. Routers do not need explicit flow establishment information from a control protocol, a hop-by-hop option, or other means. For example, when a router receives a packet from a particular source with an unknown, non-zero flow label, a router can process its IPv6 header. The router processes any necessary extension headers in the same way that the router processes extension headers with the flow label field set to zero. The routers also determine the next-hop interface. The routers might also update a hop-by-hop option, advance the pointer and addresses in a routing header, or decide how to queue the packet. The decision to queue the packet is based on the Traffic Class field of the packet. The routers can then choose to remember the results of the processing steps. Then, the routers can cache the information. The routers use the source address and the flow label as the cache key. Subsequent packets, with the same source address and flow label, can then be handled by referring to the cached information. The routers do not need to examine all those fields. The routers can assume that the fields are unchanged from the first packet that is checked in the flow. Traffic Class The nodes that originate a packet must identify different classes or different priorities of IPv6 packets. The nodes use the Traffic Class field in the IPv6 header to make this identification. The routers that forward the packets also use the Traffic Class field for the same purpose. The following general requirements apply to the Traffic Class field: The service interface to the IPv6 service within a node must supply the value of the Traffic Class bits for an upper-layer protocol. The Traffic Class bits must be in packets that are originated by that upper-layer protocol. The default value must be zero for all of the 8 bits. Nodes that support some of the Traffic Class bits or all of the Traffic Class bits can change the value of those bits. The nodes can change only the values in packets that the nodes originate, forward, or receive, as required for that specific use. Nodes should ignore and leave unchanged any bits of the Traffic Class field for which the nodes do not support a specific use. The Traffic Class bits in a received packet might not be the same value that is sent by the packet's source. Therefore, the upper-layer protocol must not assume that the values are the same.
USER:
Can you extract the key information from this text, and summarize what IPv6 Quality-of-Service is and how it applies to a software engineer who primarily works on web-based technologies?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 29 | 1,011 | null | 141 |
Draw your answer only from the provided text. Give your answer in bullet points. If you cannot fully answer the question with only the provided information, say “I’m sorry, I cannot answer that question due to a lack of context”.
|
Find and summarize how nanotechnology is being used to treat cancer and influenza, highlighting the different methods, each in three to five sentences.
|
What Is Nanotechnology? Most current applications of nanotechnology are evolutionary in nature, offering incremental improvements to existing products and generally modest economic and societal benefits. For example, nanotechnology has been used in display screens to improve picture quality, color, and brightness, provide wider viewing angles, reduce power consumption and extend product lives; in automobile bumpers, cargo beds, and step-assists to reduce weight, increase resistance to dents and scratches, and eliminate rust; in clothes to increase resistance to staining, wrinkling, and bacterial growth and to provide lighter-weight body armor; and in sporting goods, such as baseball bats and golf clubs, to improve performance.4 Nanotechnology plays a central role in some current applications with substantial economic value. For example, nanotechnology is a fundamental enabling technology in nearly all microchips and is fundamental to improvements in chip speed, size, weight, and energy use. Similarly, nanotechnology has substantially increased the storage density of non-volatile flash memory and computer hard drives. In the longer term, proponents of nanotechnology believe it may deliver revolutionary advances with profound economic and societal implications. The applications they discuss involve various degrees of speculation and varying time-frames. The examples below suggest a few of the areas where revolutionary advances may emerge, and for which early R&D efforts may provide insights into how such advances might be achieved. Detection and treatment of diseases. A wide range of nanotechnology applications are being developed to detect and treat diseases: *Cancer. Current nanotechnology disease detection efforts include the development of sensors that can identify biomarkers—such as altered genes,5 receptor proteins that are indicative of newly-developing blood vessels associated with early tumor development, 6 and prostate specific antigens (PSA)7—that may provide an early indicator of cancer.8 Some of these approaches are currently in clinical trials or have been approved for use by the Food and Drug Administration.9 One approach uses carbon nanotubes and nanowires to identify the unique molecular signals of cancer biomarkers. Another approach uses nanoscale cantilevers—resembling a row of diving boards—treated with molecules that bind only with cancer biomarkers. When these molecules bind, the additional weight alters the resonant frequency of the cantilevers indicating the presence and concentration of these biomarkers. Nanotechnology also holds promise for showing the presence, location, and/or contours of cancer, cardiovascular disease, or neurological disease. Current R&D efforts employ metallic, magnetic, and polymeric nanoparticles with strong imaging characteristics attached to an antibody or other agent that binds selectively with targeted cells. The imaging results can be used to guide surgical procedures and to monitor the effectiveness of non-surgical therapies in killing the disease or slowing its growth. Nanotechnology may also offer new cancer treatment approaches. For example, researchers have developed a chemically engineered adenovirus nanoparticle to deliver a molecule that stimulates the immune system10 and a nanoparticle that safely shuts down a key enzyme in cancer cells. 11 Another approach employs nanoshells with a core of silica and an outer metallic shell that can be engineered to concentrate at cancer lesion sites. Once at the sites, a harmless energy source (such as near-infrared light) can be used to cause the nanoshells to heat, killing the cancer cells they are attached to.12 Yet another treatment uses a dual cancer-killing approach. A gold nanoshell containing a chemotherapy drug attaches itself to a cancer cell. The shell is then heated using a near-infrared light source, killing the cancer cells in the vicinity while also rupturing the shell, releasing the chemotherapy drug inside the tumor. 13 Another approach would employ a nanoparticle to carry three or more different drugs and release them “in response to three distinct triggering mechanisms.”14 * Ebola. In February 2015, amid the Ebola outbreak in West Africa that began in 2014, the Food and Drug Administration provided emergency authorization of a nanotechnology-enabled antigen test for the detection of Ebola viruses. * Influenza. Medical researchers at the National Institutes for Health are using nanotechnology in the development of a molecule they intend to serve as a universal influenza vaccine that “stimulates the production of antibodies to fight against the ever-changing flu virus.” 15 * Diabetes. Diabetes is the target of a nano-enabled skin patch that painlessly delivers insulin using an array of microneedles, each of which contains more than 100 million vesicles that release insulin in response to the detection of high glucose levels.1
|
Find and summarize how nanotechnology is being used to treat cancer and influenza, highlighting the different methods, each in three to five sentences. Draw your answer only from the provided text. Give your answer in bullet points. If you cannot fully answer the question with only the provided information, say “I’m sorry, I cannot answer that question due to a lack of context”. Context: What Is Nanotechnology? Most current applications of nanotechnology are evolutionary in nature, offering incremental improvements to existing products and generally modest economic and societal benefits. For example, nanotechnology has been used in display screens to improve picture quality, color, and brightness, provide wider viewing angles, reduce power consumption and extend product lives; in automobile bumpers, cargo beds, and step-assists to reduce weight, increase resistance to dents and scratches, and eliminate rust; in clothes to increase resistance to staining, wrinkling, and bacterial growth and to provide lighter-weight body armor; and in sporting goods, such as baseball bats and golf clubs, to improve performance.4 Nanotechnology plays a central role in some current applications with substantial economic value. For example, nanotechnology is a fundamental enabling technology in nearly all microchips and is fundamental to improvements in chip speed, size, weight, and energy use. Similarly, nanotechnology has substantially increased the storage density of non-volatile flash memory and computer hard drives. In the longer term, proponents of nanotechnology believe it may deliver revolutionary advances with profound economic and societal implications. The applications they discuss involve various degrees of speculation and varying time-frames. The examples below suggest a few of the areas where revolutionary advances may emerge, and for which early R&D efforts may provide insights into how such advances might be achieved. Detection and treatment of diseases. A wide range of nanotechnology applications are being developed to detect and treat diseases: *Cancer. Current nanotechnology disease detection efforts include the development of sensors that can identify biomarkers—such as altered genes,5 receptor proteins that are indicative of newly-developing blood vessels associated with early tumor development, 6 and prostate specific antigens (PSA)7—that may provide an early indicator of cancer.8 Some of these approaches are currently in clinical trials or have been approved for use by the Food and Drug Administration.9 One approach uses carbon nanotubes and nanowires to identify the unique molecular signals of cancer biomarkers. Another approach uses nanoscale cantilevers—resembling a row of diving boards—treated with molecules that bind only with cancer biomarkers. When these molecules bind, the additional weight alters the resonant frequency of the cantilevers indicating the presence and concentration of these biomarkers. Nanotechnology also holds promise for showing the presence, location, and/or contours of cancer, cardiovascular disease, or neurological disease. Current R&D efforts employ metallic, magnetic, and polymeric nanoparticles with strong imaging characteristics attached to an antibody or other agent that binds selectively with targeted cells. The imaging results can be used to guide surgical procedures and to monitor the effectiveness of non-surgical therapies in killing the disease or slowing its growth. Nanotechnology may also offer new cancer treatment approaches. For example, researchers have developed a chemically engineered adenovirus nanoparticle to deliver a molecule that stimulates the immune system10 and a nanoparticle that safely shuts down a key enzyme in cancer cells. 11 Another approach employs nanoshells with a core of silica and an outer metallic shell that can be engineered to concentrate at cancer lesion sites. Once at the sites, a harmless energy source (such as near-infrared light) can be used to cause the nanoshells to heat, killing the cancer cells they are attached to.12 Yet another treatment uses a dual cancer-killing approach. A gold nanoshell containing a chemotherapy drug attaches itself to a cancer cell. The shell is then heated using a near-infrared light source, killing the cancer cells in the vicinity while also rupturing the shell, releasing the chemotherapy drug inside the tumor. 13 Another approach would employ a nanoparticle to carry three or more different drugs and release them “in response to three distinct triggering mechanisms.”14 * Ebola. In February 2015, amid the Ebola outbreak in West Africa that began in 2014, the Food and Drug Administration provided emergency authorization of a nanotechnology-enabled antigen test for the detection of Ebola viruses. * Influenza. Medical researchers at the National Institutes for Health are using nanotechnology in the development of a molecule they intend to serve as a universal influenza vaccine that “stimulates the production of antibodies to fight against the ever-changing flu virus.” 15 * Diabetes. Diabetes is the target of a nano-enabled skin patch that painlessly delivers insulin using an array of microneedles, each of which contains more than 100 million vesicles that release insulin in response to the detection of high glucose levels.1
|
Draw your answer only from the provided text. Give your answer in bullet points. If you cannot fully answer the question with only the provided information, say “I’m sorry, I cannot answer that question due to a lack of context”.
EVIDENCE:
What Is Nanotechnology? Most current applications of nanotechnology are evolutionary in nature, offering incremental improvements to existing products and generally modest economic and societal benefits. For example, nanotechnology has been used in display screens to improve picture quality, color, and brightness, provide wider viewing angles, reduce power consumption and extend product lives; in automobile bumpers, cargo beds, and step-assists to reduce weight, increase resistance to dents and scratches, and eliminate rust; in clothes to increase resistance to staining, wrinkling, and bacterial growth and to provide lighter-weight body armor; and in sporting goods, such as baseball bats and golf clubs, to improve performance.4 Nanotechnology plays a central role in some current applications with substantial economic value. For example, nanotechnology is a fundamental enabling technology in nearly all microchips and is fundamental to improvements in chip speed, size, weight, and energy use. Similarly, nanotechnology has substantially increased the storage density of non-volatile flash memory and computer hard drives. In the longer term, proponents of nanotechnology believe it may deliver revolutionary advances with profound economic and societal implications. The applications they discuss involve various degrees of speculation and varying time-frames. The examples below suggest a few of the areas where revolutionary advances may emerge, and for which early R&D efforts may provide insights into how such advances might be achieved. Detection and treatment of diseases. A wide range of nanotechnology applications are being developed to detect and treat diseases: *Cancer. Current nanotechnology disease detection efforts include the development of sensors that can identify biomarkers—such as altered genes,5 receptor proteins that are indicative of newly-developing blood vessels associated with early tumor development, 6 and prostate specific antigens (PSA)7—that may provide an early indicator of cancer.8 Some of these approaches are currently in clinical trials or have been approved for use by the Food and Drug Administration.9 One approach uses carbon nanotubes and nanowires to identify the unique molecular signals of cancer biomarkers. Another approach uses nanoscale cantilevers—resembling a row of diving boards—treated with molecules that bind only with cancer biomarkers. When these molecules bind, the additional weight alters the resonant frequency of the cantilevers indicating the presence and concentration of these biomarkers. Nanotechnology also holds promise for showing the presence, location, and/or contours of cancer, cardiovascular disease, or neurological disease. Current R&D efforts employ metallic, magnetic, and polymeric nanoparticles with strong imaging characteristics attached to an antibody or other agent that binds selectively with targeted cells. The imaging results can be used to guide surgical procedures and to monitor the effectiveness of non-surgical therapies in killing the disease or slowing its growth. Nanotechnology may also offer new cancer treatment approaches. For example, researchers have developed a chemically engineered adenovirus nanoparticle to deliver a molecule that stimulates the immune system10 and a nanoparticle that safely shuts down a key enzyme in cancer cells. 11 Another approach employs nanoshells with a core of silica and an outer metallic shell that can be engineered to concentrate at cancer lesion sites. Once at the sites, a harmless energy source (such as near-infrared light) can be used to cause the nanoshells to heat, killing the cancer cells they are attached to.12 Yet another treatment uses a dual cancer-killing approach. A gold nanoshell containing a chemotherapy drug attaches itself to a cancer cell. The shell is then heated using a near-infrared light source, killing the cancer cells in the vicinity while also rupturing the shell, releasing the chemotherapy drug inside the tumor. 13 Another approach would employ a nanoparticle to carry three or more different drugs and release them “in response to three distinct triggering mechanisms.”14 * Ebola. In February 2015, amid the Ebola outbreak in West Africa that began in 2014, the Food and Drug Administration provided emergency authorization of a nanotechnology-enabled antigen test for the detection of Ebola viruses. * Influenza. Medical researchers at the National Institutes for Health are using nanotechnology in the development of a molecule they intend to serve as a universal influenza vaccine that “stimulates the production of antibodies to fight against the ever-changing flu virus.” 15 * Diabetes. Diabetes is the target of a nano-enabled skin patch that painlessly delivers insulin using an array of microneedles, each of which contains more than 100 million vesicles that release insulin in response to the detection of high glucose levels.1
USER:
Find and summarize how nanotechnology is being used to treat cancer and influenza, highlighting the different methods, each in three to five sentences.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 40 | 23 | 714 | null | 706 |
Create your answer using only information found in the given context.
|
What are some factors that stop people from eating meat?
|
Recent research has identified the major motivations and constraints around vegetarian and vegan diets [30 ]. The main motivations to move towards a vegetarian or vegan diet are animal welfare, the environment and personal health, whilst the major barriers are sensory enjoyment of animal Sustainability 2019, 11, 6844 3 of 17 products, convenience and financial cost [ 30 ]. Mullee et al. [31 ] found that, when asked about possible reasons for eating a more vegetarian diet, the most popular option chosen by omnivores and semivegetarians was their health. The environment and animal welfare were chosen by fewer participants, and for omnivores, these reasons ranked below ‘to discover new tastes’, ‘to reduce weight’, and ‘no reason’. This finding has been replicated elsewhere [32 ,33 ] and implies that, for those not currently reducing their meat consumption, potential personal benefits are more important than environmental or ethical benefits. More specifically, consumers often recognise health benefits such as decreased saturated fat intake, increased fruit and vegetable intake and disease prevention [ 32, 34]. On the other hand, some worry about not getting enough protein or iron from a vegetarian diet [35]. Interestingly, this prioritisation of health motives appears to be reversed for vegetarians and vegans. According to a survey published by Humane League Labs [36], whilst health and nutrition reasons for reducing animal product consumption are the most commonly cited by omnivores and semivegetarians, animal welfare is the most common reason given by vegetarians and vegans. This is logical, because improving one’s health or reducing one’s environmental impact can be achieved by consuming incrementally fewer animal products; viewing animal products as the product of animal suffering and exploitation, however, is more conducive to eschewing them altogether. In a systematic review of consumer perceptions of sustainable protein consumption, Hartmann and Siegrist [37 ] found that it is common for consumers to underestimate the ecological impact of meat consumption. This has been observed in many different studies [33 ,38 – 40 ] and may imply a lack of knowledge about the environmental impact of meat consumption. Alternatively, this could reflect that consumers are generally unwilling to reduce their meat consumption [40 ] and are subsequently motivated to minimise their perceptions of the negative consequences of their choices [41]. Indeed, such motivated reasoning appears to be evident with respect to animal welfare issues. Most people eat meat but disapprove of harming animals, a conflict that has been dubbed ‘the meat paradox’ [42 ]. Rothgerber [ 43] identified a number of ways in which dissonance around harming animals arises in meat-eaters, and a number of strategies which are used to reduce this dissonance. Dissonance-reducing strategies include denial of animal mind, denial of animals’ ability to feel pain and dissociating meat from its animal origin [ 43 ]. This motivated reasoning results in a number of odd conclusions, such as lower mental capacity being ascribed to food animals compared to nonfood animals and increased denial of animal mind when one anticipates immediate meat consumption [ 44]. One can understand the motivation to continue eating animal products; the literature has identified several considerable constraints to adopting a vegetarian or vegan diet. Studies have consistently found that the strongest of these is simply enjoyment of eating meat [34 , 45, 46]. This was by far the number one reason for not being vegetarian in a recent UK survey [ 47 ] and was the biggest constraint for online survey respondents who indicated that they do not want to go vegetarian or vegan [ 36]. Despite the many potential benefits, the taste of meat and animal products is enough of a barrier to prevent dietary change for most people. The second most important barrier is convenience, with many consumers saying vegetarian dishes are difficult to prepare and that there is a lack of options when eating out [ 33 ,38 ,48 ]. Humane League Labs [36 ] found that a lack of options when eating out was the most common factor that people said made it difficult to eat meat-free meals, whilst Schenk, Rössel and Scholz [30 ] have argued that the additional time, knowledge and effort required to buy and prepare vegetarian or vegan food is especially a barrier to those newly transitioning diets. Finally, for some, there is a financial barrier [49], although there is considerably less consensus on this in the literature [30]. A UK survey found that the high cost of meat substitutes was a barrier for 58% of consumers, though this survey conducted by VoucherCodesPro [ 47 ] may have been inclined to focus on financial considerations. Another study found that a vegetarian diet is actually cheaper than one containing meat, but that a vegan diet is most expensive of all [ 22 ]. This may be due to the relatively high cost of plant-based milks and other specialist products. Sustainability 2019, 11, 6844 4 of 17 The present study investigates UK meat-eaters’ views of various aspects of vegetarianism and veganism. Whilst the common motivators and constraints to vegetarian and vegan diets are well documented, there is a paucity of open data assessing how meat-eaters evaluate the relevant aspects of each of these diets. This study seeks to address this gap by providing quantitative evaluations of the relevant aspects of vegetarian and vegan diets. Additionally, there is currently no quantitative comparison of these factors with respect to vegetarianism versus veganism. Therefore, this study compares ratings of common motivators and barriers between vegetarian and vegan diets. Finally, little is known about how these evaluations of vegetarian and vegan diets vary amongst different demographic groups. Therefore, this study examines the overall mean ratings of each of these factors and investigates how these views vary between different demographics. 2. Methods 2.1. Participants Meat-eaters living in the UK aged 18 and over were recruited (n = 1000). Participants were recruited through the online research platform, Prolific, and each participant was paid £0.45 for a 5 min survey. Recruiting participants through this type of online platform has its limitations, including the possibility of recruiting an unrepresentative sample, and asking questions in a contrived setting which may not be ecologically valid [ 50]. Nonetheless, this sampling technique does offer low cost and fast recruitment of specifiable samples, and the use of Prolific as a recruitment tool in academic research is therefore increasingly common and generally considered acceptable [51 –53 ]. Although recruitment was for meat-eaters only, there was a small number of vegetarians in the original dataset (n = 25); these participants were removed, and their responses were replaced with more meat-eaters. The final sample was 49.8% male and 49.8% female (0.3% did not disclose gender, 0.1% ‘other’), and the mean age was 34.02 (SD = 11.67). 2.2. Procedure This study received ethical approval from the University of Bath’s Department of Psychology Ethics Committee (PREC 18-219). The full anonymised dataset is available via OSF (see Supplementary Materials). First, participants read some brief information about the study and gave their consent to take part. They were then given definitions of vegetarianism and veganism and asked to give their opinions about 11 different aspects of vegetarian and vegan diets using 7-point bipolar scales. The order of these scales and the order in which participants were asked about vegetarianism and veganism were randomised to control for order effects. Next, participants answered questions about their intended consumption of meat and their intended consumption of animal products ‘one month from today’. On 6-point scales, participants could indicate that they would eliminate, greatly reduce, slightly reduce, maintain about the same, slightly increase or greatly increase their consumption of both meat, and animal products generally. Similar scales have been used in previous research [54,55]. It is worth noting that this measure is conservative. Compared to asking about intentions to reduce consumption in general, defining a specific action and a specific, short time period is likely to make participants reflect critically about their own likely behaviour. Additionally, as participants answered this question, they saw the phrase ‘Thank you for being honest!’ which was intended to mitigate the social desirability effect (i.e., over-reporting of intentions to reduce animal product consumption). Finally, participants gave demographic information, including their age, gender, political orientation, education and income. They also indicated whether they ate ‘at least occasionally’ beef, lamb, pork, chicken, fish, eggs and dairy. Participants were then debriefed and compensated.
|
What are some factors that stop people from eating meat? Create your answer using only information found in the given context. Recent research has identified the major motivations and constraints around vegetarian and vegan diets [30 ]. The main motivations to move towards a vegetarian or vegan diet are animal welfare, the environment and personal health, whilst the major barriers are sensory enjoyment of animal products, convenience and financial cost [ 30 ]. Mullee et al. [31 ] found that, when asked about possible reasons for eating a more vegetarian diet, the most popular option chosen by omnivores and semivegetarians was their health. The environment and animal welfare were chosen by fewer participants, and for omnivores, these reasons ranked below ‘to discover new tastes’, ‘to reduce weight’, and ‘no reason’. This finding has been replicated elsewhere [32 ,33 ] and implies that, for those not currently reducing their meat consumption, potential personal benefits are more important than environmental or ethical benefits. More specifically, consumers often recognise health benefits such as decreased saturated fat intake, increased fruit and vegetable intake and disease prevention [ 32, 34]. On the other hand, some worry about not getting enough protein or iron from a vegetarian diet [35]. Interestingly, this prioritisation of health motives appears to be reversed for vegetarians and vegans. According to a survey published by Humane League Labs [36], whilst health and nutrition reasons for reducing animal product consumption are the most commonly cited by omnivores and semivegetarians, animal welfare is the most common reason given by vegetarians and vegans. This is logical, because improving one’s health or reducing one’s environmental impact can be achieved by consuming incrementally fewer animal products; viewing animal products as the product of animal suffering and exploitation, however, is more conducive to eschewing them altogether. In a systematic review of consumer perceptions of sustainable protein consumption, Hartmann and Siegrist [37 ] found that it is common for consumers to underestimate the ecological impact of meat consumption. This has been observed in many different studies [33 ,38 – 40 ] and may imply a lack of knowledge about the environmental impact of meat consumption. Alternatively, this could reflect that consumers are generally unwilling to reduce their meat consumption [40 ] and are subsequently motivated to minimise their perceptions of the negative consequences of their choices [41]. Indeed, such motivated reasoning appears to be evident with respect to animal welfare issues. Most people eat meat but disapprove of harming animals, a conflict that has been dubbed ‘the meat paradox’ [42 ]. Rothgerber [ 43] identified a number of ways in which dissonance around harming animals arises in meat-eaters, and a number of strategies which are used to reduce this dissonance. Dissonance-reducing strategies include denial of animal mind, denial of animals’ ability to feel pain and dissociating meat from its animal origin [ 43 ]. This motivated reasoning results in a number of odd conclusions, such as lower mental capacity being ascribed to food animals compared to nonfood animals and increased denial of animal mind when one anticipates immediate meat consumption [ 44]. One can understand the motivation to continue eating animal products; the literature has identified several considerable constraints to adopting a vegetarian or vegan diet. Studies have consistently found that the strongest of these is simply enjoyment of eating meat [34 , 45, 46]. This was by far the number one reason for not being vegetarian in a recent UK survey [ 47 ] and was the biggest constraint for online survey respondents who indicated that they do not want to go vegetarian or vegan [ 36]. Despite the many potential benefits, the taste of meat and animal products is enough of a barrier to prevent dietary change for most people. The second most important barrier is convenience, with many consumers saying vegetarian dishes are difficult to prepare and that there is a lack of options when eating out [ 33 ,38 ,48 ]. Humane League Labs [36 ] found that a lack of options when eating out was the most common factor that people said made it difficult to eat meat-free meals, whilst Schenk, Rössel and Scholz [30 ] have argued that the additional time, knowledge and effort required to buy and prepare vegetarian or vegan food is especially a barrier to those newly transitioning diets. Finally, for some, there is a financial barrier [49], although there is considerably less consensus on this in the literature [30]. A UK survey found that the high cost of meat substitutes was a barrier for 58% of consumers, though this survey conducted by VoucherCodesPro [ 47 ] may have been inclined to focus on financial considerations. Another study found that a vegetarian diet is actually cheaper than one containing meat, but that a vegan diet is most expensive of all [ 22 ]. This may be due to the relatively high cost of plant-based milks and other specialist products. The present study investigates UK meat-eaters’ views of various aspects of vegetarianism and veganism. Whilst the common motivators and constraints to vegetarian and vegan diets are well documented, there is a paucity of open data assessing how meat-eaters evaluate the relevant aspects of each of these diets. This study seeks to address this gap by providing quantitative evaluations of the relevant aspects of vegetarian and vegan diets. Additionally, there is currently no quantitative comparison of these factors with respect to vegetarianism versus veganism. Therefore, this study compares ratings of common motivators and barriers between vegetarian and vegan diets. Finally, little is known about how these evaluations of vegetarian and vegan diets vary amongst different demographic groups. Therefore, this study examines the overall mean ratings of each of these factors and investigates how these views vary between different demographics. 2. Methods 2.1. Participants Meat-eaters living in the UK aged 18 and over were recruited (n = 1000). Participants were recruited through the online research platform, Prolific, and each participant was paid £0.45 for a 5 min survey. Recruiting participants through this type of online platform has its limitations, including the possibility of recruiting an unrepresentative sample, and asking questions in a contrived setting which may not be ecologically valid [ 50]. Nonetheless, this sampling technique does offer low cost and fast recruitment of specifiable samples, and the use of Prolific as a recruitment tool in academic research is therefore increasingly common and generally considered acceptable [51 –53 ]. Although recruitment was for meat-eaters only, there was a small number of vegetarians in the original dataset (n = 25); these participants were removed, and their responses were replaced with more meat-eaters. The final sample was 49.8% male and 49.8% female (0.3% did not disclose gender, 0.1% ‘other’), and the mean age was 34.02 (SD = 11.67). 2.2. Procedure This study received ethical approval from the University of Bath’s Department of Psychology Ethics Committee (PREC 18-219). The full anonymised dataset is available via OSF (see Supplementary Materials). First, participants read some brief information about the study and gave their consent to take part. They were then given definitions of vegetarianism and veganism and asked to give their opinions about 11 different aspects of vegetarian and vegan diets using 7-point bipolar scales. The order of these scales and the order in which participants were asked about vegetarianism and veganism were randomised to control for order effects. Next, participants answered questions about their intended consumption of meat and their intended consumption of animal products ‘one month from today’. On 6-point scales, participants could indicate that they would eliminate, greatly reduce, slightly reduce, maintain about the same, slightly increase or greatly increase their consumption of both meat, and animal products generally. Similar scales have been used in previous research [54,55]. It is worth noting that this measure is conservative. Compared to asking about intentions to reduce consumption in general, defining a specific action and a specific, short time period is likely to make participants reflect critically about their own likely behaviour. Additionally, as participants answered this question, they saw the phrase ‘Thank you for being honest!’ which was intended to mitigate the social desirability effect (i.e., over-reporting of intentions to reduce animal product consumption). Finally, participants gave demographic information, including their age, gender, political orientation, education and income. They also indicated whether they ate ‘at least occasionally’ beef, lamb, pork, chicken, fish, eggs and dairy. Participants were then debriefed and compensated.
|
Create your answer using only information found in the given context.
EVIDENCE:
Recent research has identified the major motivations and constraints around vegetarian and vegan diets [30 ]. The main motivations to move towards a vegetarian or vegan diet are animal welfare, the environment and personal health, whilst the major barriers are sensory enjoyment of animal Sustainability 2019, 11, 6844 3 of 17 products, convenience and financial cost [ 30 ]. Mullee et al. [31 ] found that, when asked about possible reasons for eating a more vegetarian diet, the most popular option chosen by omnivores and semivegetarians was their health. The environment and animal welfare were chosen by fewer participants, and for omnivores, these reasons ranked below ‘to discover new tastes’, ‘to reduce weight’, and ‘no reason’. This finding has been replicated elsewhere [32 ,33 ] and implies that, for those not currently reducing their meat consumption, potential personal benefits are more important than environmental or ethical benefits. More specifically, consumers often recognise health benefits such as decreased saturated fat intake, increased fruit and vegetable intake and disease prevention [ 32, 34]. On the other hand, some worry about not getting enough protein or iron from a vegetarian diet [35]. Interestingly, this prioritisation of health motives appears to be reversed for vegetarians and vegans. According to a survey published by Humane League Labs [36], whilst health and nutrition reasons for reducing animal product consumption are the most commonly cited by omnivores and semivegetarians, animal welfare is the most common reason given by vegetarians and vegans. This is logical, because improving one’s health or reducing one’s environmental impact can be achieved by consuming incrementally fewer animal products; viewing animal products as the product of animal suffering and exploitation, however, is more conducive to eschewing them altogether. In a systematic review of consumer perceptions of sustainable protein consumption, Hartmann and Siegrist [37 ] found that it is common for consumers to underestimate the ecological impact of meat consumption. This has been observed in many different studies [33 ,38 – 40 ] and may imply a lack of knowledge about the environmental impact of meat consumption. Alternatively, this could reflect that consumers are generally unwilling to reduce their meat consumption [40 ] and are subsequently motivated to minimise their perceptions of the negative consequences of their choices [41]. Indeed, such motivated reasoning appears to be evident with respect to animal welfare issues. Most people eat meat but disapprove of harming animals, a conflict that has been dubbed ‘the meat paradox’ [42 ]. Rothgerber [ 43] identified a number of ways in which dissonance around harming animals arises in meat-eaters, and a number of strategies which are used to reduce this dissonance. Dissonance-reducing strategies include denial of animal mind, denial of animals’ ability to feel pain and dissociating meat from its animal origin [ 43 ]. This motivated reasoning results in a number of odd conclusions, such as lower mental capacity being ascribed to food animals compared to nonfood animals and increased denial of animal mind when one anticipates immediate meat consumption [ 44]. One can understand the motivation to continue eating animal products; the literature has identified several considerable constraints to adopting a vegetarian or vegan diet. Studies have consistently found that the strongest of these is simply enjoyment of eating meat [34 , 45, 46]. This was by far the number one reason for not being vegetarian in a recent UK survey [ 47 ] and was the biggest constraint for online survey respondents who indicated that they do not want to go vegetarian or vegan [ 36]. Despite the many potential benefits, the taste of meat and animal products is enough of a barrier to prevent dietary change for most people. The second most important barrier is convenience, with many consumers saying vegetarian dishes are difficult to prepare and that there is a lack of options when eating out [ 33 ,38 ,48 ]. Humane League Labs [36 ] found that a lack of options when eating out was the most common factor that people said made it difficult to eat meat-free meals, whilst Schenk, Rössel and Scholz [30 ] have argued that the additional time, knowledge and effort required to buy and prepare vegetarian or vegan food is especially a barrier to those newly transitioning diets. Finally, for some, there is a financial barrier [49], although there is considerably less consensus on this in the literature [30]. A UK survey found that the high cost of meat substitutes was a barrier for 58% of consumers, though this survey conducted by VoucherCodesPro [ 47 ] may have been inclined to focus on financial considerations. Another study found that a vegetarian diet is actually cheaper than one containing meat, but that a vegan diet is most expensive of all [ 22 ]. This may be due to the relatively high cost of plant-based milks and other specialist products. Sustainability 2019, 11, 6844 4 of 17 The present study investigates UK meat-eaters’ views of various aspects of vegetarianism and veganism. Whilst the common motivators and constraints to vegetarian and vegan diets are well documented, there is a paucity of open data assessing how meat-eaters evaluate the relevant aspects of each of these diets. This study seeks to address this gap by providing quantitative evaluations of the relevant aspects of vegetarian and vegan diets. Additionally, there is currently no quantitative comparison of these factors with respect to vegetarianism versus veganism. Therefore, this study compares ratings of common motivators and barriers between vegetarian and vegan diets. Finally, little is known about how these evaluations of vegetarian and vegan diets vary amongst different demographic groups. Therefore, this study examines the overall mean ratings of each of these factors and investigates how these views vary between different demographics. 2. Methods 2.1. Participants Meat-eaters living in the UK aged 18 and over were recruited (n = 1000). Participants were recruited through the online research platform, Prolific, and each participant was paid £0.45 for a 5 min survey. Recruiting participants through this type of online platform has its limitations, including the possibility of recruiting an unrepresentative sample, and asking questions in a contrived setting which may not be ecologically valid [ 50]. Nonetheless, this sampling technique does offer low cost and fast recruitment of specifiable samples, and the use of Prolific as a recruitment tool in academic research is therefore increasingly common and generally considered acceptable [51 –53 ]. Although recruitment was for meat-eaters only, there was a small number of vegetarians in the original dataset (n = 25); these participants were removed, and their responses were replaced with more meat-eaters. The final sample was 49.8% male and 49.8% female (0.3% did not disclose gender, 0.1% ‘other’), and the mean age was 34.02 (SD = 11.67). 2.2. Procedure This study received ethical approval from the University of Bath’s Department of Psychology Ethics Committee (PREC 18-219). The full anonymised dataset is available via OSF (see Supplementary Materials). First, participants read some brief information about the study and gave their consent to take part. They were then given definitions of vegetarianism and veganism and asked to give their opinions about 11 different aspects of vegetarian and vegan diets using 7-point bipolar scales. The order of these scales and the order in which participants were asked about vegetarianism and veganism were randomised to control for order effects. Next, participants answered questions about their intended consumption of meat and their intended consumption of animal products ‘one month from today’. On 6-point scales, participants could indicate that they would eliminate, greatly reduce, slightly reduce, maintain about the same, slightly increase or greatly increase their consumption of both meat, and animal products generally. Similar scales have been used in previous research [54,55]. It is worth noting that this measure is conservative. Compared to asking about intentions to reduce consumption in general, defining a specific action and a specific, short time period is likely to make participants reflect critically about their own likely behaviour. Additionally, as participants answered this question, they saw the phrase ‘Thank you for being honest!’ which was intended to mitigate the social desirability effect (i.e., over-reporting of intentions to reduce animal product consumption). Finally, participants gave demographic information, including their age, gender, political orientation, education and income. They also indicated whether they ate ‘at least occasionally’ beef, lamb, pork, chicken, fish, eggs and dairy. Participants were then debriefed and compensated.
USER:
What are some factors that stop people from eating meat?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 11 | 10 | 1,387 | null | 548 |
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
|
Can you summarize what happened in the Qualitex Co. v. Jacobson Products Co. decision? What act supported the right to include color to qualify as a trademark? Explain in a minimum of 200 words how the act's language supported Qualitex Co.'s opinion.
|
The case before us grows out of petitioner Qualitex Company's use (since the 1950's) of a special shade of green-gold color on the pads that it makes and sells to dry cleaning firms for use on dry cleaning presses. In 1989, respondent J acobson Products (a Qualitex rival) began to sell its own press pads to dry cleaning firms; and it colored those pads a similar green gold. In 1991, Qualitex registered the special greengold color on press pads with the Patent and Trademark Office as a trademark. Registration No. 1,633,711 (Feb. 5, 1991). Qualitex subsequently added a trademark infringement count, 15 U. s. C. § 1114(1), to an unfair competition claim, § 1125(a), in a lawsuit it had already filed challenging Jacobson's use of the green-gold color. Qualitex won the lawsuit in the District Court. 21 U. S. P. Q. 2d 1457 (CD Cal. 1991). But, the Court of Appeals for the Ninth Circuit set aside the judgment in Qualitex's favor on the trademark infringement claim because, in that Circuit's view, the Lanham Act does not permit Qualitex, or anyone else, to register "color alone" as a trademark. 13 F.3d 1297, 1300, 1302 (1994). The Courts of Appeals have differed as to whether or not the law recognizes the use of color alone as a trademark. Compare NutraSweet Co. v. Stadt Corp., 917 F.2d 1024, 1028 (CA7 1990) (absolute prohibition against protection of color alone), with In re Owens-Corning Fiberglas Corp., 774 F.2d 1116, 1128 (CA Fed. 1985) (allowing registration of color pink for fiberglass insulation), and Master Distributors, Inc. v. Pako Corp., 986 F.2d 219, 224 (CA8 1993) (declining to establish per se prohibition against protecting color alone as a trademark). Therefore, this Court granted certiorari. 512 162 u. S. 1287 (1994). We now hold that there is no rule absolutely barring the use of color alone, and we reverse the judgment of the Ninth Circuit. II The Lanham Act gives a seller or producer the exclusive right to "register" a trademark, 15 U. S. C. § 1052 (1988 ed. and Supp. V), and to prevent his or her competitors from using that trademark, § 1114(1). Both the language of the Act and the basic underlying principles of trademark law would seem to include color within the universe of things that can qualify as a trademark. The language of the Lanham Act describes that universe in the broadest of terms. It says that trademarks "includ[e] any word, name, symbol, or device, or any combination thereof." § 1127. Since human beings might use as a "symbol" or "device" almost anything at all that is capable of carrying meaning, this language, read literally, is not restrictive. The courts and the Patent and Trademark Office have authorized for use as a mark a particular shape (of a Coca-Cola bottle), a particular sound (of NBC's three chimes), and even a particular scent (of plumeria blossoms on sewing thread). See, e. g., Registration No. 696,147 (Apr. 12, 1960); Registration Nos. 523,616 (Apr. 4, 1950) and 916,522 (July 13, 1971); In re Clarke, 17 U. S. P. Q. 2d 1238, 1240 (TTAB 1990). If a shape, a sound, and a fragrance can act as symbols why, one might ask, can a color not do the same? A color is also capable of satisfying the more important part of the statutory definition of a trademark, which requires that a person "us[e]" or "inten[d] to use" the mark "to identify and distinguish his or her goods, including a unique product, from those manufactured or sold by others and to indicate the source of the goods, even if that source is unknown." 15 U. S. C. § 1127. True, a product's color is unlike "fanciful," "arbitrary," or "suggestive" words or designs, which almost automatically tell a customer that they refer to a brand. Abercrombie & Fitch Co. v. Hunting World, Inc., 537 F.2d 4, 9-10 (CA2 1976) (Friendly, J.); see Two Pesos, Inc. v. Taco Cabana, Inc., 505 U. S. 763, 768 (1992). The imaginary word "Suntost," or the words "Suntost Marmalade," on a jar of orange jam immediately would signal a brand or a product "source"; the jam's orange color does not do so. But, over time, customers may come to treat a particular color on a product or its packaging (say, a color that in context seems unusual, such as pink on a firm's insulating material or red on the head of a large industrial bolt) as signifying a brand. And, if so, that color would have come to identify and distinguish the goods-i. e., "to indicate" their "source"-much in the way that descriptive words on a product (say, "Trim" on nail clippers or "Car- Freshner" on deodorizer) can come to indicate a product's origin. See, e. g., J. Wiss & Sons Co. v. W E. Bassett Co., 59 C. C. P. A. 1269, 1271 (Pat.), 462 F.2d 567, 569 (1972); Car-Freshner Corp. v. Turtle Wax, Inc., 268 F. Supp. 162, 164 (SDNY 1967). In this circumstance, trademark law says that the word (e. g., "Trim"), although not inherently distinctive, has developed "secondary meaning." See Inwood Laboratories, Inc. v. Ives Laboratories, Inc., 456 U. S. 844, 851, n. 11 (1982) ("[S]econdary meaning" is acquired when "in the minds of the public, the primary significance of a product feature ... is to identify the source of the product rather than the product itself"). Again, one might ask, if trademark law permits a descriptive word with secondary meaning to act as a mark, why would it not permit a color, under similar circumstances, to do the same? We cannot find in the basic objectives of trademark law any obvious theoretical objection to the use of color alone as a trademark, where that color has attained "secondary meaning" and therefore identifies and distinguishes a particular brand (and thus indicates its "source"). In principle, trademark law, by preventing others from copying a sourceidentifying mark, "reduce[s] the customer's costs of shopping and making purchasing decisions," 1 J. McCarthy, McCarthy on Trademarks and Unfair Competition § 2.01[2], p. 2-3 (3d ed. 1994) (hereinafter McCarthy), for it quickly and easily assures a potential customer that this item-the item with this mark-is made by the same producer as other similarly marked items that he or she liked (or disliked) in the past. At the same time, the law helps assure a producer that it (and not an imitating competitor) will reap the financial, reputation-related rewards associated with a desirable product. The law thereby "encourage[s] the production of quality products," ibid., and simultaneously discourages those who hope to sell inferior products by capitalizing on a consumer's inability quickly to evaluate the quality of an item offered for sale. See, e. g., 3 L. Altman, Callmann on Unfair Competition, Trademarks and Monopolies § 17.03 (4th ed. 1983); Landes & Posner, The Economics of Trademark Law, 78 T. M. Rep. 267, 271-272 (1988); Park 'N Fly, Inc. v. Dollar Park & Fly, Inc., 469 U. S. 189, 198 (1985); S. Rep. No. 100515, p. 4 (1988). It is the source-distinguishing ability of a mark-not its ontological status as color, shape, fragrance, word, or sign-that permits it to serve these basic purposes. See Landes & Posner, Trademark Law: An Economic Perspective, 30 J. Law & Econ. 265, 290 (1987). And, for that reason, it is difficult to find, in basic trademark objectives, a reason to disqualify absolutely the use of a color as a mark.
|
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Can you summarize what happened in the Qualitex Co. v. Jacobson Products Co. decision? What act supported the right to include color to qualify as a trademark? Explain in a minimum of 200 words how the act's language supported Qualitex Co.'s opinion. The case before us grows out of petitioner Qualitex Company's use (since the 1950's) of a special shade of green-gold color on the pads that it makes and sells to dry cleaning firms for use on dry cleaning presses. In 1989, respondent J acobson Products (a Qualitex rival) began to sell its own press pads to dry cleaning firms; and it colored those pads a similar green gold. In 1991, Qualitex registered the special greengold color on press pads with the Patent and Trademark Office as a trademark. Registration No. 1,633,711 (Feb. 5, 1991). Qualitex subsequently added a trademark infringement count, 15 U. s. C. § 1114(1), to an unfair competition claim, § 1125(a), in a lawsuit it had already filed challenging Jacobson's use of the green-gold color. Qualitex won the lawsuit in the District Court. 21 U. S. P. Q. 2d 1457 (CD Cal. 1991). But, the Court of Appeals for the Ninth Circuit set aside the judgment in Qualitex's favor on the trademark infringement claim because, in that Circuit's view, the Lanham Act does not permit Qualitex, or anyone else, to register "color alone" as a trademark. 13 F.3d 1297, 1300, 1302 (1994). The Courts of Appeals have differed as to whether or not the law recognizes the use of color alone as a trademark. Compare NutraSweet Co. v. Stadt Corp., 917 F.2d 1024, 1028 (CA7 1990) (absolute prohibition against protection of color alone), with In re Owens-Corning Fiberglas Corp., 774 F.2d 1116, 1128 (CA Fed. 1985) (allowing registration of color pink for fiberglass insulation), and Master Distributors, Inc. v. Pako Corp., 986 F.2d 219, 224 (CA8 1993) (declining to establish per se prohibition against protecting color alone as a trademark). Therefore, this Court granted certiorari. 512 162 u. S. 1287 (1994). We now hold that there is no rule absolutely barring the use of color alone, and we reverse the judgment of the Ninth Circuit. II The Lanham Act gives a seller or producer the exclusive right to "register" a trademark, 15 U. S. C. § 1052 (1988 ed. and Supp. V), and to prevent his or her competitors from using that trademark, § 1114(1). Both the language of the Act and the basic underlying principles of trademark law would seem to include color within the universe of things that can qualify as a trademark. The language of the Lanham Act describes that universe in the broadest of terms. It says that trademarks "includ[e] any word, name, symbol, or device, or any combination thereof." § 1127. Since human beings might use as a "symbol" or "device" almost anything at all that is capable of carrying meaning, this language, read literally, is not restrictive. The courts and the Patent and Trademark Office have authorized for use as a mark a particular shape (of a Coca-Cola bottle), a particular sound (of NBC's three chimes), and even a particular scent (of plumeria blossoms on sewing thread). See, e. g., Registration No. 696,147 (Apr. 12, 1960); Registration Nos. 523,616 (Apr. 4, 1950) and 916,522 (July 13, 1971); In re Clarke, 17 U. S. P. Q. 2d 1238, 1240 (TTAB 1990). If a shape, a sound, and a fragrance can act as symbols why, one might ask, can a color not do the same? A color is also capable of satisfying the more important part of the statutory definition of a trademark, which requires that a person "us[e]" or "inten[d] to use" the mark "to identify and distinguish his or her goods, including a unique product, from those manufactured or sold by others and to indicate the source of the goods, even if that source is unknown." 15 U. S. C. § 1127. True, a product's color is unlike "fanciful," "arbitrary," or "suggestive" words or designs, which almost automatically tell a customer that they refer to a brand. Abercrombie & Fitch Co. v. Hunting World, Inc., 537 F.2d 4, 9-10 (CA2 1976) (Friendly, J.); see Two Pesos, Inc. v. Taco Cabana, Inc., 505 U. S. 763, 768 (1992). The imaginary word "Suntost," or the words "Suntost Marmalade," on a jar of orange jam immediately would signal a brand or a product "source"; the jam's orange color does not do so. But, over time, customers may come to treat a particular color on a product or its packaging (say, a color that in context seems unusual, such as pink on a firm's insulating material or red on the head of a large industrial bolt) as signifying a brand. And, if so, that color would have come to identify and distinguish the goods-i. e., "to indicate" their "source"-much in the way that descriptive words on a product (say, "Trim" on nail clippers or "Car- Freshner" on deodorizer) can come to indicate a product's origin. See, e. g., J. Wiss & Sons Co. v. W E. Bassett Co., 59 C. C. P. A. 1269, 1271 (Pat.), 462 F.2d 567, 569 (1972); Car-Freshner Corp. v. Turtle Wax, Inc., 268 F. Supp. 162, 164 (SDNY 1967). In this circumstance, trademark law says that the word (e. g., "Trim"), although not inherently distinctive, has developed "secondary meaning." See Inwood Laboratories, Inc. v. Ives Laboratories, Inc., 456 U. S. 844, 851, n. 11 (1982) ("[S]econdary meaning" is acquired when "in the minds of the public, the primary significance of a product feature ... is to identify the source of the product rather than the product itself"). Again, one might ask, if trademark law permits a descriptive word with secondary meaning to act as a mark, why would it not permit a color, under similar circumstances, to do the same? We cannot find in the basic objectives of trademark law any obvious theoretical objection to the use of color alone as a trademark, where that color has attained "secondary meaning" and therefore identifies and distinguishes a particular brand (and thus indicates its "source"). In principle, trademark law, by preventing others from copying a sourceidentifying mark, "reduce[s] the customer's costs of shopping and making purchasing decisions," 1 J. McCarthy, McCarthy on Trademarks and Unfair Competition § 2.01[2], p. 2-3 (3d ed. 1994) (hereinafter McCarthy), for it quickly and easily assures a potential customer that this item-the item with this mark-is made by the same producer as other similarly marked items that he or she liked (or disliked) in the past. At the same time, the law helps assure a producer that it (and not an imitating competitor) will reap the financial, reputation-related rewards associated with a desirable product. The law thereby "encourage[s] the production of quality products," ibid., and simultaneously discourages those who hope to sell inferior products by capitalizing on a consumer's inability quickly to evaluate the quality of an item offered for sale. See, e. g., 3 L. Altman, Callmann on Unfair Competition, Trademarks and Monopolies § 17.03 (4th ed. 1983); Landes & Posner, The Economics of Trademark Law, 78 T. M. Rep. 267, 271-272 (1988); Park 'N Fly, Inc. v. Dollar Park & Fly, Inc., 469 U. S. 189, 198 (1985); S. Rep. No. 100515, p. 4 (1988). It is the source-distinguishing ability of a mark-not its ontological status as color, shape, fragrance, word, or sign-that permits it to serve these basic purposes. See Landes & Posner, Trademark Law: An Economic Perspective, 30 J. Law & Econ. 265, 290 (1987). And, for that reason, it is difficult to find, in basic trademark objectives, a reason to disqualify absolutely the use of a color as a mark. https://supreme.justia.com/cases/federal/us/514/159/
|
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
EVIDENCE:
The case before us grows out of petitioner Qualitex Company's use (since the 1950's) of a special shade of green-gold color on the pads that it makes and sells to dry cleaning firms for use on dry cleaning presses. In 1989, respondent J acobson Products (a Qualitex rival) began to sell its own press pads to dry cleaning firms; and it colored those pads a similar green gold. In 1991, Qualitex registered the special greengold color on press pads with the Patent and Trademark Office as a trademark. Registration No. 1,633,711 (Feb. 5, 1991). Qualitex subsequently added a trademark infringement count, 15 U. s. C. § 1114(1), to an unfair competition claim, § 1125(a), in a lawsuit it had already filed challenging Jacobson's use of the green-gold color. Qualitex won the lawsuit in the District Court. 21 U. S. P. Q. 2d 1457 (CD Cal. 1991). But, the Court of Appeals for the Ninth Circuit set aside the judgment in Qualitex's favor on the trademark infringement claim because, in that Circuit's view, the Lanham Act does not permit Qualitex, or anyone else, to register "color alone" as a trademark. 13 F.3d 1297, 1300, 1302 (1994). The Courts of Appeals have differed as to whether or not the law recognizes the use of color alone as a trademark. Compare NutraSweet Co. v. Stadt Corp., 917 F.2d 1024, 1028 (CA7 1990) (absolute prohibition against protection of color alone), with In re Owens-Corning Fiberglas Corp., 774 F.2d 1116, 1128 (CA Fed. 1985) (allowing registration of color pink for fiberglass insulation), and Master Distributors, Inc. v. Pako Corp., 986 F.2d 219, 224 (CA8 1993) (declining to establish per se prohibition against protecting color alone as a trademark). Therefore, this Court granted certiorari. 512 162 u. S. 1287 (1994). We now hold that there is no rule absolutely barring the use of color alone, and we reverse the judgment of the Ninth Circuit. II The Lanham Act gives a seller or producer the exclusive right to "register" a trademark, 15 U. S. C. § 1052 (1988 ed. and Supp. V), and to prevent his or her competitors from using that trademark, § 1114(1). Both the language of the Act and the basic underlying principles of trademark law would seem to include color within the universe of things that can qualify as a trademark. The language of the Lanham Act describes that universe in the broadest of terms. It says that trademarks "includ[e] any word, name, symbol, or device, or any combination thereof." § 1127. Since human beings might use as a "symbol" or "device" almost anything at all that is capable of carrying meaning, this language, read literally, is not restrictive. The courts and the Patent and Trademark Office have authorized for use as a mark a particular shape (of a Coca-Cola bottle), a particular sound (of NBC's three chimes), and even a particular scent (of plumeria blossoms on sewing thread). See, e. g., Registration No. 696,147 (Apr. 12, 1960); Registration Nos. 523,616 (Apr. 4, 1950) and 916,522 (July 13, 1971); In re Clarke, 17 U. S. P. Q. 2d 1238, 1240 (TTAB 1990). If a shape, a sound, and a fragrance can act as symbols why, one might ask, can a color not do the same? A color is also capable of satisfying the more important part of the statutory definition of a trademark, which requires that a person "us[e]" or "inten[d] to use" the mark "to identify and distinguish his or her goods, including a unique product, from those manufactured or sold by others and to indicate the source of the goods, even if that source is unknown." 15 U. S. C. § 1127. True, a product's color is unlike "fanciful," "arbitrary," or "suggestive" words or designs, which almost automatically tell a customer that they refer to a brand. Abercrombie & Fitch Co. v. Hunting World, Inc., 537 F.2d 4, 9-10 (CA2 1976) (Friendly, J.); see Two Pesos, Inc. v. Taco Cabana, Inc., 505 U. S. 763, 768 (1992). The imaginary word "Suntost," or the words "Suntost Marmalade," on a jar of orange jam immediately would signal a brand or a product "source"; the jam's orange color does not do so. But, over time, customers may come to treat a particular color on a product or its packaging (say, a color that in context seems unusual, such as pink on a firm's insulating material or red on the head of a large industrial bolt) as signifying a brand. And, if so, that color would have come to identify and distinguish the goods-i. e., "to indicate" their "source"-much in the way that descriptive words on a product (say, "Trim" on nail clippers or "Car- Freshner" on deodorizer) can come to indicate a product's origin. See, e. g., J. Wiss & Sons Co. v. W E. Bassett Co., 59 C. C. P. A. 1269, 1271 (Pat.), 462 F.2d 567, 569 (1972); Car-Freshner Corp. v. Turtle Wax, Inc., 268 F. Supp. 162, 164 (SDNY 1967). In this circumstance, trademark law says that the word (e. g., "Trim"), although not inherently distinctive, has developed "secondary meaning." See Inwood Laboratories, Inc. v. Ives Laboratories, Inc., 456 U. S. 844, 851, n. 11 (1982) ("[S]econdary meaning" is acquired when "in the minds of the public, the primary significance of a product feature ... is to identify the source of the product rather than the product itself"). Again, one might ask, if trademark law permits a descriptive word with secondary meaning to act as a mark, why would it not permit a color, under similar circumstances, to do the same? We cannot find in the basic objectives of trademark law any obvious theoretical objection to the use of color alone as a trademark, where that color has attained "secondary meaning" and therefore identifies and distinguishes a particular brand (and thus indicates its "source"). In principle, trademark law, by preventing others from copying a sourceidentifying mark, "reduce[s] the customer's costs of shopping and making purchasing decisions," 1 J. McCarthy, McCarthy on Trademarks and Unfair Competition § 2.01[2], p. 2-3 (3d ed. 1994) (hereinafter McCarthy), for it quickly and easily assures a potential customer that this item-the item with this mark-is made by the same producer as other similarly marked items that he or she liked (or disliked) in the past. At the same time, the law helps assure a producer that it (and not an imitating competitor) will reap the financial, reputation-related rewards associated with a desirable product. The law thereby "encourage[s] the production of quality products," ibid., and simultaneously discourages those who hope to sell inferior products by capitalizing on a consumer's inability quickly to evaluate the quality of an item offered for sale. See, e. g., 3 L. Altman, Callmann on Unfair Competition, Trademarks and Monopolies § 17.03 (4th ed. 1983); Landes & Posner, The Economics of Trademark Law, 78 T. M. Rep. 267, 271-272 (1988); Park 'N Fly, Inc. v. Dollar Park & Fly, Inc., 469 U. S. 189, 198 (1985); S. Rep. No. 100515, p. 4 (1988). It is the source-distinguishing ability of a mark-not its ontological status as color, shape, fragrance, word, or sign-that permits it to serve these basic purposes. See Landes & Posner, Trademark Law: An Economic Perspective, 30 J. Law & Econ. 265, 290 (1987). And, for that reason, it is difficult to find, in basic trademark objectives, a reason to disqualify absolutely the use of a color as a mark.
USER:
Can you summarize what happened in the Qualitex Co. v. Jacobson Products Co. decision? What act supported the right to include color to qualify as a trademark? Explain in a minimum of 200 words how the act's language supported Qualitex Co.'s opinion.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 42 | 1,238 | null | 609 |
You can only respond using the information in the context block. Do not list any similarities between the two fields.
|
What are the differences between public accounting and private/corporate?
|
University of Nebraska at Omaha School of Accounting THE ACCOUNTING PROFESSION The accounting profession has been around for hundreds of years and is incorrectly perceived as nerdy, shy, quiet people who sit and “crunch” numbers. While accounting, by nature, does require a basic understanding of math, there is so much more to an accounting career than just numbers. A career in accounting is challenging, but with challenge comes rewards and opportunities. This profession can provide an exciting path to meet and work with people from different backgrounds as well as opportunities to travel the world. Because accountants offer a specific skill-set they are typically highly compensated through competitive salaries and, in a growing number of instances, allowed flexible work schedules. The demand for talented, knowledgeable accountants has historically been high and is projected to increase over the next few years. The Bureau of Labor Statistics estimates that the accounting job field will grow an additional 139,900 jobs through the year 20261. The U.S. News and World Report ranks “Accountant” #3 on the list of “Best Business Jobs” because of the substantial salary amounts and the job security the profession provides. 2 Every business needs at least one accountant if not several accountants to help track and manage costs, assist with reporting, calculate federal, state and local tax liabilities, along with many other tasks. Also many individuals rely on accountants to help with tax planning, personal finance and wealth building. Because of this there are several different types of accountants that expand beyond the standard bookkeeper or tax preparer that most people associate with the term “accountant”. AREAS OF ACCOUNTING The accounting profession can be broken between public accountants and private accountants. Regardless if someone goes into public or private accounting, each professional must have certain skills above and beyond the education requirements. Most accountants must be detailed oriented, have the ability to organize and manage time effectively. Those that work in accounting, contrary to the typical accountant stereotype, must also have outstanding people skills and be able to communicate effectively. Additionally, each business and public accounting firm use different software when performing different job duties; therefore, accountants must be knowledgeable and comfortable with computers and have the capability to learn new systems quickly. All accountants are expected to be proficient in Microsoft Office especially Microsoft Excel. Also, successful accountants are analytical. They can think beyond the numbers and assist with making businesses more efficient. Below highlights the differences, lists the potential career paths and salary information for public vs. private accountants. Public Accounting: - Definition: accountants that serve businesses, governments, non-profits, and individuals by providing various accounting services. Those services include tax return preparation, financial statement preparation, financial statement audit or review, and various consulting related to business transactions. - Requirements: These accountants typically have a bachelor’s degree in accounting. Most individuals that work in public accounting must be a Certified Public Accountant (CPA) and be licensed with the state. - Why choose public accounting? It’s called public accounting because these accountants work with the public and must be able to communicate effortlessly. Public accountants work continuously with colleagues to complete projects as well as with clients to meet their specific needs. Those that choose public accounting are typically outgoing personalities that are also highly driven, goal oriented, and have a passion for serving others. It should be noted that usually it is easier for an accounting career to move from public accounting to private accounting (it’s challenging to go from private accounting to public without having to start over again in lower entry level positions). - Public accounting has various options in-and-of itself. While public accounting firms offer a variety of services, the main services provided fall under tax preparation and audits of financial statements. These are very different and require different skill sets. o Tax preparers must be knowledgeable in local, state and federal tax laws. However, they do more than just tax return preparation. Tax professionals work with businesses as well as individuals assisting with tax planning, financial planning, estate planning, and tax research. Tax preparers have steady work all through-out the year but work through a “busy season” from January through April 15th. These individuals mostly work out of the firm’s office but must be willing to do some travel to visit clients. o Auditors must be knowledgeable in Generally Accepted Accounting Principles (GAAP). These auditors provide an opinion on whether or not a business’s financial statements have been prepared according to GAAP. Auditors typically must gather information and complete their audits on location in the client’s office which could take days, weeks or months depending on the size of the client and the service being provided. Therefore, an auditor must be willing to travel and work in close proximity with others. Auditors also have steady work through-out the year but have periodic busy seasons depending on the type of clients they have. Private/Corporate Accounting: - Definition: accountants that work inside a business, governmental entity or a non-profit that use financial accounting and/or managerial accounting knowledge to build financial statements and other reports to assist in evaluating various business decisions. -Requirements: These accountants typically have a bachelor’s degree in accounting. Those that want to separate themselves from the rest will go on and receive a master’s degree and/or a professional accounting license. - Below are some (not all) typical job titles that fall in the area of private/corporate accounting: o Bookkeeper o Billing Clerk o Payroll Clerk o Inventory Analyst o Purchasing Manager o Collections Clerk o General Accountant o Cost Accountant o Tax Accountant o Internal Auditor o IT Auditor o Controller o Treasurer o Chief Financial Officer - Why choose private/corporate accounting? From the small sample of job titles above it can be noted that corporate accounting provides a vast amount of options for those that want to work inside a business or other organization. Many people are drawn to corporate accounting because they have more flexibility to design a career path that truly incorporates their interests whether it be cost management, tax compliance, account receivable management, etc. These accountants must still be able to work with others but in some positions, corporate accounting does provide a quieter, more secluded work space compared to public accounting. Additionally, many corporate accounting positions do not require a CPA license or a master’s degree making it easier to enter an accounting career (However, the CPA license, other professional accounting licenses and/or a Master’s degree will make it easier to move up in an accounting career.)
|
Question: What are the differences between public accounting and private/corporate? System Instructions: You can only respond using the information in the context block. Do not list any similarities between the two fields. Context: University of Nebraska at Omaha School of Accounting THE ACCOUNTING PROFESSION The accounting profession has been around for hundreds of years and is incorrectly perceived as nerdy, shy, quiet people who sit and “crunch” numbers. While accounting, by nature, does require a basic understanding of math, there is so much more to an accounting career than just numbers. A career in accounting is challenging, but with challenge comes rewards and opportunities. This profession can provide an exciting path to meet and work with people from different backgrounds as well as opportunities to travel the world. Because accountants offer a specific skill-set they are typically highly compensated through competitive salaries and, in a growing number of instances, allowed flexible work schedules. The demand for talented, knowledgeable accountants has historically been high and is projected to increase over the next few years. The Bureau of Labor Statistics estimates that the accounting job field will grow an additional 139,900 jobs through the year 20261. The U.S. News and World Report ranks “Accountant” #3 on the list of “Best Business Jobs” because of the substantial salary amounts and the job security the profession provides. 2 Every business needs at least one accountant if not several accountants to help track and manage costs, assist with reporting, calculate federal, state and local tax liabilities, along with many other tasks. Also many individuals rely on accountants to help with tax planning, personal finance and wealth building. Because of this there are several different types of accountants that expand beyond the standard bookkeeper or tax preparer that most people associate with the term “accountant”. AREAS OF ACCOUNTING The accounting profession can be broken between public accountants and private accountants. Regardless if someone goes into public or private accounting, each professional must have certain skills above and beyond the education requirements. Most accountants must be detailed oriented, have the ability to organize and manage time effectively. Those that work in accounting, contrary to the typical accountant stereotype, must also have outstanding people skills and be able to communicate effectively. Additionally, each business and public accounting firm use different software when performing different job duties; therefore, accountants must be knowledgeable and comfortable with computers and have the capability to learn new systems quickly. All accountants are expected to be proficient in Microsoft Office especially Microsoft Excel. Also, successful accountants are analytical. They can think beyond the numbers and assist with making businesses more efficient. Below highlights the differences, lists the potential career paths and salary information for public vs. private accountants. Public Accounting: - Definition: accountants that serve businesses, governments, non-profits, and individuals by providing various accounting services. Those services include tax return preparation, financial statement preparation, financial statement audit or review, and various consulting related to business transactions. - Requirements: These accountants typically have a bachelor’s degree in accounting. Most individuals that work in public accounting must be a Certified Public Accountant (CPA) and be licensed with the state. - Why choose public accounting? It’s called public accounting because these accountants work with the public and must be able to communicate effortlessly. Public accountants work continuously with colleagues to complete projects as well as with clients to meet their specific needs. Those that choose public accounting are typically outgoing personalities that are also highly driven, goal oriented, and have a passion for serving others. It should be noted that usually it is easier for an accounting career to move from public accounting to private accounting (it’s challenging to go from private accounting to public without having to start over again in lower entry level positions). - Public accounting has various options in-and-of itself. While public accounting firms offer a variety of services, the main services provided fall under tax preparation and audits of financial statements. These are very different and require different skill sets. o Tax preparers must be knowledgeable in local, state and federal tax laws. However, they do more than just tax return preparation. Tax professionals work with businesses as well as individuals assisting with tax planning, financial planning, estate planning, and tax research. Tax preparers have steady work all through-out the year but work through a “busy season” from January through April 15th. These individuals mostly work out of the firm’s office but must be willing to do some travel to visit clients. o Auditors must be knowledgeable in Generally Accepted Accounting Principles (GAAP). These auditors provide an opinion on whether or not a business’s financial statements have been prepared according to GAAP. Auditors typically must gather information and complete their audits on location in the client’s office which could take days, weeks or months depending on the size of the client and the service being provided. Therefore, an auditor must be willing to travel and work in close proximity with others. Auditors also have steady work through-out the year but have periodic busy seasons depending on the type of clients they have. Private/Corporate Accounting: - Definition: accountants that work inside a business, governmental entity or a non-profit that use financial accounting and/or managerial accounting knowledge to build financial statements and other reports to assist in evaluating various business decisions. -Requirements: These accountants typically have a bachelor’s degree in accounting. Those that want to separate themselves from the rest will go on and receive a master’s degree and/or a professional accounting license. - Below are some (not all) typical job titles that fall in the area of private/corporate accounting: o Bookkeeper o Billing Clerk o Payroll Clerk o Inventory Analyst o Purchasing Manager o Collections Clerk o General Accountant o Cost Accountant o Tax Accountant o Internal Auditor o IT Auditor o Controller o Treasurer o Chief Financial Officer - Why choose private/corporate accounting? From the small sample of job titles above it can be noted that corporate accounting provides a vast amount of options for those that want to work inside a business or other organization. Many people are drawn to corporate accounting because they have more flexibility to design a career path that truly incorporates their interests whether it be cost management, tax compliance, account receivable management, etc. These accountants must still be able to work with others but in some positions, corporate accounting does provide a quieter, more secluded work space compared to public accounting. Additionally, many corporate accounting positions do not require a CPA license or a master’s degree making it easier to enter an accounting career (However, the CPA license, other professional accounting licenses and/or a Master’s degree will make it easier to move up in an accounting career.)
|
You can only respond using the information in the context block. Do not list any similarities between the two fields.
EVIDENCE:
University of Nebraska at Omaha School of Accounting THE ACCOUNTING PROFESSION The accounting profession has been around for hundreds of years and is incorrectly perceived as nerdy, shy, quiet people who sit and “crunch” numbers. While accounting, by nature, does require a basic understanding of math, there is so much more to an accounting career than just numbers. A career in accounting is challenging, but with challenge comes rewards and opportunities. This profession can provide an exciting path to meet and work with people from different backgrounds as well as opportunities to travel the world. Because accountants offer a specific skill-set they are typically highly compensated through competitive salaries and, in a growing number of instances, allowed flexible work schedules. The demand for talented, knowledgeable accountants has historically been high and is projected to increase over the next few years. The Bureau of Labor Statistics estimates that the accounting job field will grow an additional 139,900 jobs through the year 20261. The U.S. News and World Report ranks “Accountant” #3 on the list of “Best Business Jobs” because of the substantial salary amounts and the job security the profession provides. 2 Every business needs at least one accountant if not several accountants to help track and manage costs, assist with reporting, calculate federal, state and local tax liabilities, along with many other tasks. Also many individuals rely on accountants to help with tax planning, personal finance and wealth building. Because of this there are several different types of accountants that expand beyond the standard bookkeeper or tax preparer that most people associate with the term “accountant”. AREAS OF ACCOUNTING The accounting profession can be broken between public accountants and private accountants. Regardless if someone goes into public or private accounting, each professional must have certain skills above and beyond the education requirements. Most accountants must be detailed oriented, have the ability to organize and manage time effectively. Those that work in accounting, contrary to the typical accountant stereotype, must also have outstanding people skills and be able to communicate effectively. Additionally, each business and public accounting firm use different software when performing different job duties; therefore, accountants must be knowledgeable and comfortable with computers and have the capability to learn new systems quickly. All accountants are expected to be proficient in Microsoft Office especially Microsoft Excel. Also, successful accountants are analytical. They can think beyond the numbers and assist with making businesses more efficient. Below highlights the differences, lists the potential career paths and salary information for public vs. private accountants. Public Accounting: - Definition: accountants that serve businesses, governments, non-profits, and individuals by providing various accounting services. Those services include tax return preparation, financial statement preparation, financial statement audit or review, and various consulting related to business transactions. - Requirements: These accountants typically have a bachelor’s degree in accounting. Most individuals that work in public accounting must be a Certified Public Accountant (CPA) and be licensed with the state. - Why choose public accounting? It’s called public accounting because these accountants work with the public and must be able to communicate effortlessly. Public accountants work continuously with colleagues to complete projects as well as with clients to meet their specific needs. Those that choose public accounting are typically outgoing personalities that are also highly driven, goal oriented, and have a passion for serving others. It should be noted that usually it is easier for an accounting career to move from public accounting to private accounting (it’s challenging to go from private accounting to public without having to start over again in lower entry level positions). - Public accounting has various options in-and-of itself. While public accounting firms offer a variety of services, the main services provided fall under tax preparation and audits of financial statements. These are very different and require different skill sets. o Tax preparers must be knowledgeable in local, state and federal tax laws. However, they do more than just tax return preparation. Tax professionals work with businesses as well as individuals assisting with tax planning, financial planning, estate planning, and tax research. Tax preparers have steady work all through-out the year but work through a “busy season” from January through April 15th. These individuals mostly work out of the firm’s office but must be willing to do some travel to visit clients. o Auditors must be knowledgeable in Generally Accepted Accounting Principles (GAAP). These auditors provide an opinion on whether or not a business’s financial statements have been prepared according to GAAP. Auditors typically must gather information and complete their audits on location in the client’s office which could take days, weeks or months depending on the size of the client and the service being provided. Therefore, an auditor must be willing to travel and work in close proximity with others. Auditors also have steady work through-out the year but have periodic busy seasons depending on the type of clients they have. Private/Corporate Accounting: - Definition: accountants that work inside a business, governmental entity or a non-profit that use financial accounting and/or managerial accounting knowledge to build financial statements and other reports to assist in evaluating various business decisions. -Requirements: These accountants typically have a bachelor’s degree in accounting. Those that want to separate themselves from the rest will go on and receive a master’s degree and/or a professional accounting license. - Below are some (not all) typical job titles that fall in the area of private/corporate accounting: o Bookkeeper o Billing Clerk o Payroll Clerk o Inventory Analyst o Purchasing Manager o Collections Clerk o General Accountant o Cost Accountant o Tax Accountant o Internal Auditor o IT Auditor o Controller o Treasurer o Chief Financial Officer - Why choose private/corporate accounting? From the small sample of job titles above it can be noted that corporate accounting provides a vast amount of options for those that want to work inside a business or other organization. Many people are drawn to corporate accounting because they have more flexibility to design a career path that truly incorporates their interests whether it be cost management, tax compliance, account receivable management, etc. These accountants must still be able to work with others but in some positions, corporate accounting does provide a quieter, more secluded work space compared to public accounting. Additionally, many corporate accounting positions do not require a CPA license or a master’s degree making it easier to enter an accounting career (However, the CPA license, other professional accounting licenses and/or a Master’s degree will make it easier to move up in an accounting career.)
USER:
What are the differences between public accounting and private/corporate?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 20 | 9 | 1,088 | null | 648 |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.