Journal articles on the topic 'Living expenses, United States, 1910'

loannis Tserkezis, born in 1874, in Mazotos, a village in the Larnaca district of Cyprus, came from a poor family and was sent by his father to Smyrna, in 1888, aged 14, to seek employment to strengthen the family's income. The young Greek Cypriot's family was counting on help that would be provided to the young immigrant by his uncle (on his father 's side), who had been living in that multicultural Ottoman city for a considerable length of time. Despite his uncle 's efforts, the search for employment proved fruitless, and thus, after a brief period of time, Tserkezis was forced to return to his native country. He was not disheartened, though. He continued his efforts to find employment abroad during the years that followed. In 1899, he made efforts to settle in Alexandria and in 1902 went back to Smyrna, but both ventures proved unsuccessful. Up until then Tserkezis had chosen to emigrate to the most common destinations for the Cypriots of the time. That is, to Egypt or countries within the Ottoman Empire (Tserkezis 1988: 13-101).

Not so long ago, nearly all African-Americans living in the United States were subject to a multitude of racial restrictions officially prescribed and enforced by state governments and their local subsidiaries. Most of the Jim Crow system dated from 1890–1910. By the middle of the twentieth century, this system was well established, so much so that many people assumed that it had always existed and that it expressed the timeless folkways of the South. However, in what strikes the historian as an astonishingly brief period during the 1950s and 1960s, the edifice was largely torn down. The puzzle is this: How could any institutional apparatus so deeply embedded, long-standing, and apparently strong be toppled so quickly? Although many scholars have discussed aspects of the puzzle, no one has offered a simple, clear, and compelling explanation. We aim to do so in this essay.

Mortality differentials for 122 cities in the United States in 1910 are examined with specific attention given to the influence of public works projects. Sewage systems are found to have significantly reduced mortality, while water filtration systems had no impact. This runs counter to the theories and beliefs of many public health officials and sanitary engineers of the era. Other factors, including the racial and immigrant composition of the population, urban density, number of physicians, and the standard of living, are also examined.

Abstract The Elder Index is a cost of living indicator that measures the income older adults need to meet their living expenses while staying independent in the community, calculated on a county-by-county basis for the United States. Analyses based on the Elder Index show that a large segment of the age 65+ population has incomes below the Index, reflecting a level of insecurity that is considerably higher than suggested by the poverty rate. Moreover, comparison of the Elder Index to household income illustrates differences across states in the extent to which incomes cover the cost of necessary expenditures. In this paper we explore how cost of living contributes to subjective financial security among older people, as measured by the CFPB Financial Well-Being Score, using a data match of the Understanding America Study with the Elder Index. Results document this association, offering insight to spatial patterns of financial insecurity in later life.

Abstract This paper examines the effect of ethnic enclaves on economic outcomes of Norwegian immigrants in 1910 and 1920, the later part of the Age of Mass Migration. Using various identification strategies, including county fixed effects and an instrumental variables strategy based on chain migration, I consistently find that Norwegians living in larger enclaves in the United States had lower occupational earnings, were more likely to be in farming occupations, and were less likely to be in white-collar occupations. Results are robust to matching method and choice of occupational score. This earnings disadvantage is partly passed on to the second generation.

Reading problems for adults and school-age students have significant and varied costs. Existing as an illiterate citizen in the United States has monetary consequences such as living expenses, career relevance, and societal advancement. American employers spend money to edify prospective employees in areas of remedial reading, writing, and mathematical skills. Educators must act on scientific research to select appropriate literacy curriculum to teach students to read. As reading is not a natural process, teachers must teach students to read using materials aligned with the science of reading. Utilizing document analysis to evaluate learning to read instructional materials and strategies must incorporate all the fundamentals and modalities in one complete, research-based curriculum. Knowing how to purposefully evaluate literacy curriculum is necessary for teaching all students to read. A dynamic, reading curriculum evaluation tool is necessary to determine alignment to the science of reading with an accredited literacy curriculum.

INTRODUCTION: Resident physician salaries vary by region, though it is unknown how these variations compare to differences in living wages across the United States or what factors drive residency salary discrepancies. METHODS: Publicly available resident salary information was obtained from full-service training centers containing a neurosurgical residency program via institution-specific websites in February 2023 with information on post-graduate year (PGY)-1 through PGY-7 resident compensation for 2022-2023. Living wage calculations by city were generated via the Massachusetts Institute of Technology (MIT) Living-Wage Calculator. Resident salary to living-wage ratios were calculated using PGY-4 salary for each family composition living-wage. Univariate and multivariable analysis of PGY-4 resident salary on affordability was performed, accounting for proportion of expected living wages to taxes, transportation, housing, medical costs, childcare, and food as well as unionization and state income-tax status. RESULTS: 118 neurosurgery residency programs were included, 21 (17.9%) of which were unionized. Residents without children earned a salary greater than living-wage during all years, while single-parent families were unable to earn a living-wage until PGY-7. Residents with 1 child in in 2-adult (single-income) and 2-adult (double-income) families were unable to earn a living-wage until PGY-5 and PGY-3 respectively. Residents with more than 1 child failed to earn a living-wage. Multivariate regression analysis using PGY-4 salary:living-wage ratios in single-child, 2-parent homes showed food expenses and unionization status were always significant. On multivariate regression, unionization was significantly associated with lower living-wage ratios pre-stipend, improved post-stipend, and was again significantly lower after factoring in union dues. CONCLUSIONS: Current resident salaries often preclude a resident from earning a living-wage, especially among junior residents and those with children. Unionization is significantly associated with lower resident income to living-wage ratios.

In United States (U.S.), government-funded organizations, such as NLDAC, reimburse travel and subsistence expenses incurred during living-organ donation process. However, in Iran, there is a non-governmental organization called Iranian Kidney Foundation (IKF) that funds the direct and indirect costs of donors through charitable donations and contributions from participants in the exchange program. In this article, for countries outside the U.S. that currently use an equality approach, we propose a potential new compensation-apportionment approach (equitable approach) for kidney-exchange chains and compare it with the currently available system (equality approach) in terms of the apportionment of compensation in a kidney-exchange chain to cover the expenses incurred by the initiating living donor of the chain in the act of donation. To this end, we propose a mechanism to apportion compensation among all participating pairs based on the equity approach by utilizing a prediction model to calculate the probability of graft survival in each transplant operation. These probabilities are then used to define the utility of any transplantation, considering the quality of each pair’s donated and received kidney in the chain. Afterward, the corresponding cost is apportioned by a mechanism based on the normalized differences between the utility of donated and received kidneys for each incompatible pair of the chain. In summary, we demonstrate that by utilizing the equitable approach, there is more fairness and equity in the allocation of resources in organ-procurement systems, which results in more satisfaction among incompatible pairs. Additional future prospective studies are needed to assess this proposed equitable approach for kidney-exchange chains in countries outside the U.S., such as Iran, that currently use an equality approach.

Background. The demand for transplants leads to an increase in the demand for donor organs and as the result to their shortage all over the world. The United States is one of the world leaders in the number of donors and organ transplants. The article presents the results of an analysis focused on finding ways to improve the efficiency of the American donation and transplantation system. Purpose. The aim of the study is to analyze the organizational and legal components of the United States organ donation and transplantation system and identify possible ways to reform it. Materials and methods. The study carries out informational analysis and assessment of the effectiveness of the US donation and transplantation system based on the available official statistics for the period from 1991 to 2019, the results of the simulation of the application of the presumption of consent to posthumous donation, regulatory legal acts, insurance programs and scientific research of foreign and Russian scientists in the transplantation field. Results. A statistical data comparison showed that, despite the significant success of the United States in the development of donation and transplantation, there is a growing shortage of donor organs in the country, as in the whole world. The results of the analysis identified promising directions for reforming the donation and transplantation system in order to increase its effectiveness. There is great potential for increasing the supply of donor organs by the possible transition of the United States from the model of requested consent to the presumption of consent for posthumous donation. Centers for the procurement of donor organs have the least efficiency in the US organizational model of donation and transplantation. The financial vulnerability of living donors and organ donor recipients requires attention, because insurance programs do not cover their expenses, incl. on immunosuppressive drugs, due to the gap between the standards of care for organ donor recipients and the policies of insurance companies. The ongoing support measures or living donation are clearly insufficient. Conclusion. The directions of the US donation and transplantation system reforming identified in the course of the study require further elaboration and discussion in American society, the adoption of new regulatory legal acts, the development of new rules for the work of the system participants, adjustments to the assessment procedure, funding and support at the state and international level. Only a set of organizational, legal, financial and stimulating measures will help to increase the number of donor organs and the number of transplants.

In the first part of this study, the author brings out the need for an Arctic Region Council by examining what would be its main purposes. These would be to facilitate cooperation generally among its members and, in particular, with respect to the following matters: protection of the environment, coordination of scientific research, conservation of living resources, economic development, health and well-being of the Arctic inhabitants, and peaceful uses of the Arctic. The second part outlines the main reasons for the establishment of a Council by the conclusion of a treaty and presents the basic draft provisions of such treaty. These would cover: the geographical area of the Council's activities, the purposes of the Council, the conditions of membership, the main organs of the Council and their respective powers and mode of operation, the holding of meetings, the sharing of expenses, the settlement of disputes, the manner of entry into force, and the procedure of amendments and review. The founding Members of the Council would be the eight States whose territory projects north of the Arctic Circle: Canada, Denmark, Finland, Iceland, Norway, Russia, Sweden and the United States. Membership would be open to non-Arctic States having demonstrated a sufficient interest in Arctic issues, as well as to certain non-State entities such as the Northwest Territories and Greenland, and non-governmental organizations such as the Arctic Aboriginal Conference.

Tanzania is among the top five countries with a high burden of sickle cell disease (SCD) in the world. Even though the effects of SCD on quality of life have been documented in other countries including Nigeria and the United States of America, few are known from Tanzania. Therefore, this study focused on evaluating the effects of SCD on the quality of life among children living with SCD and their parents. The study employed a qualitative approach to interview purposively selected parents of children who have lived with SCD and have used hydroxyurea (HU) for more than 3 years. The in-depth interviews were conducted with 11 parents of children with SCD at the Muhimbili University of Health and Allied Sciences (MUHAS) in Dar-es-salaam, Tanzania. A semi-structured interview guide was used. Interviews were audio-recorded, transcribed, and thematically analyzed. Three themes were generated including psycho-social effects: family conflicts and divorce, limited access to education, stress and fear; financial effects: Employment limitation, reduced efficiency and productivity, loss of job and lack of self-keeping expenses; and physical effects: physical disability and dependence, and burden of the frequent crisis. Children living with SCD and their parents suffer psycho-social, financial, and physical impacts of the disease. Appropriate interventions should be introduced to minimize the observed effects as ways of improving the quality of life of the individuals living with SCD and their caregivers.

AbstractThe McNulty Family was known as the royal family of Irish entertainers. They were the hottest Irish entertainment act on the East Coast, and perhaps in all of North America, from the 1930s through the 1950s. Ann “Ma” McNulty was the leader; her son Peter played the violin and piano, sang, and danced; and her daughter Eileen sang and danced. They also acted and performed skits to accompany their songs and comedy routines. Their shows were a high-energy, fast-paced type of vaudeville event. Ann Burke was born in Kilteevan, County Roscommom, Ireland, in 1887 and emigrated to the United States in 1910. She married John McNulty in 1914 and was a widow by 1928. This emigrant, who played the melodeon, and her two talented children started to entertain people to make a living. At the height of their career in the early 1940s, in addition to appearing at several venues every week, they had two radio shows, wrote a weekly column for the Irish Advocate newspaper, and had released about eighty recordings. Their vaudeville style was an excellent compliment to their talents, where acting and dancing were part of the delivery of a song or comedy routine.

Objective: To examine geographic variations in health information use among older adults in the United States. Methods: We compared 15,531 adults (age 45 and older) across four U.S. regions. Descriptive analyses were conducted to assess health information seeking and use by year. The relationship between health information seeking or use and regional changes were assessed using binomial logistic regression. Binomial models were adjusted by socio-demographics, chronic conditions, and health information sources. Magnitude and direction of relationships were assessed using adjusted odds ratios (aORs), 95% confidence intervals (CIs), and p-values. Results: Only the Northeast region showed increases in health information seeking (3.8%) and use (4.5%) among older adults. However adjusted models showed those living in the Northeast were 28% less likely to use health information to maintain their health and 32% less likely to use health information to treat illness. Conclusion: As a result of the current pandemic, older adults are facing a growing burden from health care expenses. Inability to gather and use health information for personal safety or self care can potentially increase inequalities in health, especially for older adults without personal health care providers.

Background: Traffic-related air pollution (TRAP) refers to the wide range of air pollutants emitted by traffic that are dispersed into the ambient air. Emerging evidence shows that TRAP can increase asthma incidence in children. Living with asthma can carry a huge financial burden for individuals and families due to direct and indirect medical expenses, which can include costs of hospitalization, medical visits, medication, missed school days, and loss of wages from missed workdays for caregivers. Objective: The objective of this paper is to estimate the economic impact of childhood asthma incident cases attributable to nitrogen dioxide (NO2), a common traffic-related air pollutant in urban areas, in the United States at the state level. Methods: We calculate the direct and indirect costs of childhood asthma incident cases attributable to NO2 using previously published burden of disease estimates and per person asthma cost estimates. By multiplying the per person indirect and direct costs for each state with the NO2-attributable asthma incident cases in each state, we were able to estimate the total cost of childhood asthma cases attributable to NO2 in the United States. Results: The cost calculation estimates the total direct and indirect annual cost of childhood asthma cases attributable to NO2 in the year 2010 to be $178,900,138.989 (95% CI: $101,019,728.20–$256,980,126.65). The state with the highest cost burden is California with $24,501,859.84 (95% CI: $10,020,182.62–$38,982,261.250), and the state with the lowest cost burden is Montana with $88,880.12 (95% CI: $33,491.06–$144,269.18). Conclusion: This study estimates the annual costs of childhood asthma incident cases attributable to NO2 and demonstrates the importance of conducting economic impacts studies of TRAP. It is important for policy-making institutions to focus on this problem by advocating and supporting more studies on TRAP’s impact on the national economy and health, including these economic impact estimates in the decision-making process, and devising mitigation strategies to reduce TRAP and the population’s exposure.

The article argues that all medical waste requires a special approach as experience has shown that many substances used as safe pose a threat to human health and human life and cause irreparable damage to the environment. The expediency of reviewing certain categories of medical waste with their subsequent transfer to the category of household waste (office paper, office furniture, etc.) is specified. The need to pay more attention to waste in the cosmetics and perfume industry is emphasized as more and more pharmaceutical and chemical substances are used in this production. The article detects significant differences in some statistical indicators by year and the combination of medical and non-medical waste in one indicator, which indicates the imperfection of statistical accounting. The adequacy of medical waste management is revealed to depend on the standard of living in the country and the availability of effective public policy in this area, as well as the availability of natural resources in the required amount. The historical retrospective shows the changes in the attitude to disposable and reusable medical materials. The authors propose to use a table comparing the cost of disposal from different points of view, taking into account the necessary sanitary and hygienic requirements. The need to strengthen control over the rational use of disposable medical devices is emphasized, which in some cases makes it possible to significantly reduce the amount of waste and general medical expenses. A comparative analysis of the cost of medical waste disposal in the United States and Ukraine is conducted. The analysis shows that the United States has lower prices. Despite the rather carefully prescribed procedure for obtaining a license for activities in the field of medical waste management, the numerous abuses identified by inspections indicate the need to improve it.

How can an income tax system be designed to exploit human nature and a free market to create a poverty free society, while balancing budgets without disproportional tax burdens? Such a tax system, with universal character, is deduced from the following guiding principles: (1) a single tax rate applies to all income types and levels; (2) the tax rate adjusts to satisfy budget projections; (3) government transfer only supplements the income of households with self-generated income below the poverty line; (4) deductions for basic living expenses, itemized investments and capital losses are allowed; (5) deductions cannot be applied to government transfer. A general framework emerges with three parameters that determine a minimum allowed tax deduction, a maximum allowed itemized deduction, and a maximum deduction defined by income percentage. An income distribution that mimics the United States, and a series of log-normal distributions are considered to quantitatively compare detailed characteristics of this tax system to progressive and flat tax systems. To minimize government dependency while maximizing after-tax income, the effective tax rate (ETR) as a function of income percentile takes the shape of the letter, V, inspiring the name victory tax, where the middle class has the lowest ETR.

Cystic fibrosis (CF) is a chronic, progressive, genetic, and life-limiting lung disease that impacts approximately 105,000 individuals globally, including 40,000 individuals in the United States. In 2019, a revolutionary new drug, elexacaftor/ivacaftor/tezacaftor (ETI), was approved to manage some of the major symptoms of CF and dramatically increase the lifespan of people with cystic fibrosis (pwCF). Many individuals with CF cannot work full time and require Medicaid, Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), and other financial assistance programs to pay for treatments and medical expenses. Yet in recent years, pwCF who are on ETI have been increasingly losing benefits. A possible explanation for this is the effectiveness of ETI in improving lung function, creating the perception that pwCF are no longer disabled by their condition. Even with this “miracle" drug, pwCF continue to experience significant complications and vulnerabilities to their physical and mental health as well as limitations on daily living and employment. The compounded vulnerabilities these individuals experience leave them without a safety net. Social Security policies for pwCF require revisions to prevent further biopsychosocial damage to this population. Two policies will be recommended: leniency in redetermination, and CF education for those who make determination decisions.

[Purpose] The study aims to analyze the key features and issues of place-based promise programs in the United States to get implications for local government scholarships and national scholarships for talented local students. [Methods] To achieve this goal, a case study methodology targeting a single country was used, and 30 programs were targeted. [Results and Implications] Based on the results of the research, policy implications for local government scholarships are as follows. First, simple eligibility requirements should be provided and all those who meet the requirements should be able to receive the scholarship. Second, supporting the living expenses should be provided to students. Third, scholarships should be provided to students enrolled in local universities. Fourth, in addition to scholarships, additional support should be provided to achieve career planning for students below high school level, college success, and employment after graduation. Policy implications for national scholarships are as follows. First, the income criteria should be removed from the eligibility requirements so that high school students can know whether they will receive the scholarship before they apply for university. Second, in the case of specialized selection, clear criteria for eligibility should be set and posted on the website. Third, all students who meet the requirements should be able to receive the scholarship.

COVID-19 increased the prevalence of clinically significant anxiety in the United States. To investigate contributing factors we analyzed anxiety, reported online via monthly Generalized Anxiety Disorders-7 (GAD-7) surveys between April 2020 and May 2022, in association with self-reported worry about the health effects of COVID-19, economic difficulty, personal COVID-19 experience, and subjective social status. 333,292 anxiety surveys from 50,172 participants (82% non-Hispanic white; 73% female; median age 55, IQR 42–66) showed high levels of anxiety, especially early in the pandemic. Anxiety scores showed strong independent associations with worry about the health effects of COVID-19 for oneself or family members (GAD-7 score +3.28 for highest vs. lowest category; 95% confidence interval: 3.24, 3.33; p<0.0001 for trend) and with difficulty paying for basic living expenses (+2.06; 1.97, 2.15, p<0.0001) in multivariable regression models after adjusting for demographic characteristics, COVID-19 case rates and death rates, and personal COVID-19 experience. High levels of COVID-19 health worry and economic stress were each more common among participants reporting lower subjective social status, and median anxiety scores for those experiencing both were in the range considered indicative of moderate to severe clinical anxiety disorders. In summary, health worry and economic difficulty both contributed to high rates of anxiety during the first two years of the COVID-19 pandemic in the US, especially in disadvantaged socioeconomic groups. Programs to address both health concerns and economic insecurity in vulnerable populations could help mitigate pandemic impacts on anxiety and mental health.

As countries throughout the world move towards universal health coverage, the obligation to realise the right to health for undocumented migrants has often been overlooked. With unprecedented millions on the move – including refugees, asylum seekers, internally displaced persons, and returnees – undocumented migrants represent a uniquely vulnerable subgroup, experiencing particular barriers to health related to their background as well as insecure living and working conditions. Their legal status under national law often restricts access to, and affordability of, healthcare services. While striving to ensure health for all, national governments face challenging priority setting dilemmas in deciding: who to include, which services to provide, and how to cover out-of-pocket expenses. Building on comparative experiences in Norway, Thailand and the United States – which reflect varied approaches to achieving universal health coverage – we assess whether these national approaches provide rights-based access to affordable essential healthcare services for undocumented migrants. To meet the shared Sustainable Development Goal on universal health coverage, the right to health must be realised for all persons – including undocumented migrants. To ensure universal health coverage in accordance with the right to health, governments must evaluate laws, regulations, policies and practices to evaluate: whether undocumented migrants are included, to which services they have access, and if these services are affordable. Achieving universal health coverage for everyone will require rights-based support for undocumented migrants.

The scholarly modeling of property tax has always posed a challenge, with two primary concerns to be addressed: first, maintaining sustainability in the collection, which is primarily a concern for local governments; and second, ensuring fair distribution, which is of greater concern for citizens. In today’s practices, assessment-based property tax increases unmatched expenses in bubble economies. There is a substitution problem in rapid falls, the tendency to not decrease the assessments gives way to black holes and opens the door to ghost cities. This paper proposes alternative approaches, aside from market/land value or last sold price, aimed at improving sustainability and fairness rates. The dataset examined is based on 93.7K records and 88 attributes for assessed value of properties within the City of Buffalo, the United States of America. Since the label (Total Value) is a numerical and continuous value, regression models are selected, where ensemble machine learning methods categorically work well with larger datasets, combined with weak learners, like decision trees. Stacked Ensemble led the least error for regression with 0.98 R2, followed by Gradient Boosting. Results show a 79% dominance of uncontrollable attributes, such as Land Value, Neighborhood, and Sale (last sold) Price, compared to controllable attributes, such as Total Living Area, Construction Grade, Second Story Area, and many others. This article suggests having a more balanced split between uncontrollable and controllable attributes would contribute to both sustainability and fair distribution.

Through a survey of 125 long-term resident households in Pima County, Arizona, this study finds that an immigration arrest costs each household an average of more than $24,000. These costs accumulate through the value of assets seized and not recovered, out-of-pocket costs for hiring an attorney, immigration bond, and other expenses involved in supporting an immediate family member as they navigate the immigration court system. But they also include lost income due to disruptions to employment resulting from the arrest, and a physical inability to work while in detention, appearing in court, and immediately following deportation. In this article, we discuss how, when measured at the scale of the household, these financial costs fail to discriminate according to immigration or citizenship status, and accumulate to affect issues of poverty, education, housing security, health and development, and generational wealth inequality — all matters of sustained interest to state and local government. In the second half of the article, we draw on our research findings to evaluate various policies that states, counties, and municipalities can implement to mitigate these financial burdens while promoting the overall well-being of their constituents. Policies considered include: The “Immigrant Welcoming City” paradigm The limitation of routine cooperation and custody transfer between local and federal law enforcement Expanding access to permissible forms of identification Universal representation for immigration defendants The cultivation of community bond funds The promotion of worker-owned cooperatives Although these kinds of state or local initiatives cannot replace meaningful federal action on immigration reform, they can do much to provide relief and promote economic security for established immigrant and mixed-status families living in the United States, while contributing to overall community well-being and economic vitality.

INTRODUCTION:Pigmented villonodular synovitis (PVNS) is a very rare, benign proliferative tumor affecting the inner lining of synovial joints and tendon sheets. Information on treatment needs of PVNS patients to inform drug development is currently scarce, hence we conducted qualitative research with patients using an online bulletin board (OBB) methodology to generate insights on objective and emotional aspects related to the medical journey and living with this disease.METHODS:OBB is an asynchronous, online qualitative market research tool that allows participants to comprehensively answer pre-defined questions in a comprehensive manner. Patients were recruited via physician referral and underwent screening questions to ensure eligibility for the study and willingness to participate. The discussion was moderated, structured, and allowed open answers and in response to other participants posts. Analysis was conducted using a combination of different qualitative analytical tools.RESULTS:The patient OBB ran for 4 days with eleven participants (n = 3 Canada, n = 4 United Kingdom, n = 4 United States of America) aged 28–57 years, suffering from PVNS for 2–27 years. The key patient insights were: (i) pain is the primary factor, constituting a significant emotional and psychological burden; (ii) surgery (arthroscopy) does not get rid of PVNS, relapse rate was high in these patients; and (iii) PVNS has a big financial impact on patients, their families, and the healthcare system, due in particular to time off work/lost wages (patient & caretaker), for healthcare system it is repeat costs for surgeries/hospital stays plus other medical expenses. We also identified orthopedic specialists/surgeons are the physicians who predominantly manage PVNS at this point, as surgery is the only option.CONCLUSIONS:This study shows the suitability of the OBB for uncovering qualitative patient insights to inform decision making and strategy in early pharmaceutical drug development. OBB lends itself very well to uncovering patient insights which might not be revealed in focus group or telephone interviews, particularly in a rare disease like this. PVNS patients are in need of a medical drug treatment which can reduce pain, relapses and provide an alternative to surgery, the current standard of care.

Flea-borne typhus, due to Rickettsia typhi and R. felis, is an infection causing fever, headache, rash, and diverse organ manifestations that can result in critical illness or death. This is the second part of a two-part series describing the rise, decline, and resurgence of flea-borne typhus (FBT) in the United States over the last century. These studies illustrate the influence of historical events, social conditions, technology, and public health interventions on the prevalence of a vector-borne disease. Flea-borne typhus was an emerging disease, primarily in the Southern USA and California, from 1910 to 1945. The primary reservoirs in this period were the rats Rattus norvegicus and Ra. rattus and the main vector was the Oriental rat flea (Xenopsylla cheopis). The period 1930 to 1945 saw a dramatic rise in the number of reported cases. This was due to conditions favorable to the proliferation of rodents and their fleas during the Depression and World War II years, including: dilapidated, overcrowded housing; poor environmental sanitation; and the difficulty of importing insecticides and rodenticides during wartime. About 42,000 cases were reported between 1931–1946, and the actual number of cases may have been three-fold higher. The number of annual cases of FBT peaked in 1944 at 5401 cases. American involvement in World War II, in the short term, further perpetuated the epidemic of FBT by the increased production of food crops in the American South and by promoting crowded and unsanitary conditions in the Southern cities. However, ultimately, World War II proved to be a powerful catalyst in the control of FBT by improving standards of living and providing the tools for typhus control, such as synthetic insecticides and novel rodenticides. A vigorous program for the control of FBT was conducted by the US Public Health Service from 1945 to 1952, using insecticides, rodenticides, and environmental sanitation and remediation. Government programs and relative economic prosperity in the South also resulted in slum clearance and improved housing, which reduced rodent harborage. By 1956, the number of cases of FBT in the United States had dropped dramatically to only 98. Federally funded projects for rat control continued until the mid-1980s. Effective antibiotics for FBT, such as the tetracyclines, came into clinical practice in the late 1940s. The first diagnostic test for FBT, the Weil-Felix test, was found to have inadequate sensitivity and specificity and was replaced by complement fixation in the 1940s and the indirect fluorescent antibody test in the 1980s. A second organism causing FBT, R. felis, was discovered in 1990. Flea-borne typhus persists in the United States, primarily in South and Central Texas, the Los Angeles area, and Hawaii. In the former two areas, the opossum (Didelphis virginiana) and cats have replaced rats as the primary reservoirs, with the cat flea (Ctenocephalides felis) now as the most important vector. In Hawaii, 73% of cases occur in Maui County because it has lower rainfall than other areas. Despite great successes against FBT in the post-World War II era, it has proved difficult to eliminate because it is now associated with our companion animals, stray pets, opossums, and the cat flea, an abundant and non-selective vector. In the new millennium, cases of FBT are increasing in Texas and California. In 2018–2019, Los Angeles County experienced a resurgence of FBT, with rats as the reservoir.

Evidence-based public health policy often comes years or decades after the underlying scientific breakthrough. The World Health Organization’s (WHO’s) provisional 10 μg/L arsenic (As) drinking water guideline was set in 1993 based on “analytical achievability.” In 2011, an additional proviso of “treatment performance” was added; a health-based risk assessment would lead to a lower and more protective guideline. Since the WHO does not require United Nations member states to submit copies of national drinking water regulations, there is no complete database of national drinking water standards or guidelines. In this study, we collated and analyzed all drinking water regulations for As from national governments worldwide. We found regulations for 176 countries. Of these countries, 136 have drinking water regulations that specify 10 μg/L As or less, while 40 have regulations that allow more than 10 μg/L of As; we could not find any evidence of regulations for 19 countries. The number of people living in countries that do not meet the WHO’s guideline constitutes 32% of the global population. Global As regulations are also strongly tied to national income, with high income countries more likely to meet the WHO’s guideline. In this study, we examined the health risk assessments that show a clear need for reducing As exposure to levels far below the current WHO provisional guideline. We also show that advances in analytical chemistry, drinking water treatment, and the possibility of accessing alternative drinking water supplies without As suggest that both low-income countries with limited resources and high-income countries with adequate resources can adopt a lower and more protective national drinking water standards or guidelines for As. Thus, we recommend that regulators and stake holders of all nations reassess the possibilities for improving public health and reducing health care expenses by adopting more stringent regulations for As in drinking water.

Abstract Individuals testing positive for BRCA1/2 genetic mutations, or hereditary breast and ovarian cancer mutations, are 33-55% more likely than women without these mutations to develop breast and/or ovarian cancers before the age of 70. While research involving these genetic mutations continues to emerge, there remains unanswered questions regarding prophylactic experiences and subsequent impacts on mental health within subgroups of BRCA1/2-positive women. The purpose of this analysis was to explore the impact of BRCA1/2 mutations, prophylactic surgeries, and surveillance regimens within the scope of everyday life within a sample of BRCA1/2 positive women from medically-underserved backgrounds living in the United States (US). A sample of 211 US adult women who have tested positive for BRCA1/2 mutations within the past 5 years and who identify with one or more medically-underserved populations (racial, ethnic, or sexual minority, person with a physical disability, chronically-ill, those in poverty, immigrant populations) elucidated compelling qualitative data. A total of 169 (80.1%) women completed open-ended questions at the end of the online survey. Thematic analysis was utilized to identify themes and subthemes concerning mental health, sources of stress, and methods of stress relief. The focus of the current analysis is on the sources of stress identified by the respondents. Fourteen subthemes were identified. The four most common stressors were concerns about post-treatment recovery (19% of respondents), recurrence of a new cancer (15%), medical unknown of having a genetic mutation that increases the risk of cancer (14%), and having to schedule and plan for continual surveillance (12%). The next five subthemes ranged from 7-9% and include waiting for medical results, personal finances and covering medical expenses, impact of the COVID-19 pandemic, pre-operative anxiety, and worrying about insurance coverage. Our findings support previous research on cancer stressors for women while adding important qualitative elements for a richer understanding. Furthermore, since much of the research on the lived experiences of BRCA1/2 has been on highly-educated, non-Hispanic white women, few studies have focused entirely on medically-underserved populations, which was the entirety of our sample. This work adds an important intersectional lens in which to better understand the experiences of living with a BRCA1/2 mutation. Citation Format: Kristi Tredway, Kate E. Dibble, Avonne E. Connor. A qualitative analysis of coping with genetically exacerbated risk of breast and ovarian cancers among medically-underserved women with BRCA1/2 mutations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3679.

Abstract Objectives Peripheral T-cell lymphomas (PTCLs) are a rare and aggressive type of non-Hodgkin lymphoma (NHL) associated with a poor prognosis. Common frontline (1L) regimens include brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone (A+CHP), and cyclophosphamide, doxorubicin, vincristine, and prednisone with or without the addition of etoposide (CHOP and CHOEP, respectively). Based on the 5-year update of the ECHELON-2 trial, patients with previously untreated CD30-expressing PTCL on A+CHP continued to demonstrate clinically meaningful improvements in progression-free survival (PFS) and overall survival (OS) compared with CHOP. Our objective was to estimate the future number of patients alive and progression free with A+CHP over 10-years, based on the 5-year follow-up results from ECHELON-2. Methods An oncology simulation model, from the United States perspective, was developed with a 1-month cycle length that estimates population-level outcomes of PTCL patients based on disease incidence, treatment patterns, PFS, and OS of commonly used regimens for PTCL. Incidence of PTCL, 19.26 cases per 100,000 persons, was derived using Surveillance, Epidemiology and End Results (SEER) estimates for NHL in 2020 and the estimated proportion of PTCL cases (~4%) within the NHL category, provided by the Lymphoma Research Foundation. To populate the base case model, treatment patterns following 1L utilization of CHOP (65%) and CHOEP (35%) were varied over time and compared to A+CHP (40%). The model also includes a portion of patients in remission in 1L who are eligible to receive transplant therapy. Additional model inputs were derived from: 1) ECHELON-2, with 5-year PFS rates of 51.4% (95% CI 42.8, 59.4) for A+CHP, 43.0% (95% CI 35.8, 50.0) for CHOP, and OS HR 0.72 (95% 0.53, 0.99); 2) published literature to inform PFS for consolidation and subsequent lines of therapy; and 3) expert clinicians' opinion on commonly used regimens for relapsed/refractory PTCL (included in the model were brentuximab vedotin, romidepsin, pralatrexate, ifosfamide in combination with carboplatin and etoposide [ICE], and gemcitabine-based regimens). Annual prevalence of patients living progression-free with PTCL in the 1L setting with each prescribed scenario was estimated for 10 years (year 2031) with and without the availability of A+CHP. Results The cumulative number of patients with newly diagnosed PTCL between 2026 and 2031 was estimated at 8,020. The number of patients alive and progression-free based on 1L treatment was estimated at 6,304 in a scenario without A+CHP and 7,414 with A+CHP (Δ+1,110, 17.6% increase) in 2031. It was also estimated that 1,203 patients would progress to second-line treatment with CHOP vs 1,119 patients with 1L A+CHP (Δ-84, 7.0% decrease) in 2031. Conclusions The durable and significant improvements in PFS and OS of A+CHP vs CHOP in the 5-year follow-up data from ECHELON-2 estimated an increase in the number of 1L PTCL patients who remain progression free and alive for greater than 10 years. This improvement in outcomes may translate into an increased prevalence of PTCL patients, reflecting an increased number of patients in remission and options to undergo transplant therapy when necessary. Disclosures Burke: Adaptive Biotechnologies: Consultancy; AstraZeneca: Consultancy; Roche/Genentech: Consultancy; SeaGen: Consultancy, Speakers Bureau; Beigene: Consultancy, Speakers Bureau; Epizyme: Consultancy; AbbVie: Consultancy; Bristol Myers Squibb: Consultancy; X4 Pharmaceuticals: Consultancy; Kymera: Consultancy; MorphoSys: Consultancy; Kura: Consultancy; Verastem: Consultancy. Yu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Bloudek: Seagen, Inc: Consultancy. Liu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Fanale: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Phillips: Genentech: Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Bayer: Consultancy, Research Funding; AstraZeneca: Consultancy; Incyte: Consultancy, Other: received travel expenses from Incyte, Research Funding; ADCT, BeiGene, Bristol Myers Squibb, Cardinal Health, Incyte, Karyopharm, Morphosys, Pharmacyclics, Seattle Genetics: Consultancy.

Abstract Objectives Doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) is the most common frontline (1L) regimen for patients with stage III or IV classical Hodgkin lymphoma (cHL), but about 30% of patients with stage III or IV cHL have refractory or relapsed disease after ABVD treatment. Based on the 5-year update of the ECHELON-1 trial, patients on 1L brentuximab vedotin, doxorubicin, vinblastine and dacarbazine (A+AVD) continued to demonstrate a robust and durable progression-free survival (PFS) improvement vs ABVD with a 32% reduction in the risk of progression or death (HR=0.681, nominal P=0.002). Our objective was to estimate the future number of patients with cHL who are alive and progression-free over 10-years with 1L A+AVD, based on the 5-year follow-up results from ECHELON-1. Methods An oncology simulation model, from the United States perspective, was developed with a 1-month cycle length that estimates population-level outcomes based on annual prevalence of cHL, considering disease incidence, treatment patterns, PFS, and overall survival of commonly used treatment regimens for stage III or IV cHL. Incidence of cHL was derived from the 2019 Surveillance, Epidemiology, and End Results (SEER) Program, assuming 95% of HL is classical of which 41% is stage III or IV. To populate the base case model, treatment patterns following 1L use of ABVD (64.5%) and positron emission tomography (PET)-adapted therapy (35.5%) were varied over time and compared to A+AVD (24%). For every model cycle, patients who experienced disease progression on 1L therapy discontinued therapy and transitioned to second-line (salvage) therapy. The transition from second-line therapy to transplant is also included in the model based on patient eligibility. Model inputs were informed by 1) real-world treatment utilization; 2) treatment-specific clinical trial data, including ECHELON-1 with 5-year PFS rates of 75.3% for ABVD (95% CI: 70.0, 85.0) and 82.2% for A+AVD (95% CI: 71.7, 78.5); and 3) expert clinicians' opinions. Annual prevalence of patients living progression-free with cHL in the 1L setting with each prescribing scenario was estimated for 10 years (year 2031) with and without the availability of A+AVD. Results The annual number of newly diagnosed patients with stage III or IV cHL at 10 years in 2031 was estimated at 3,586. The number of patients alive and progression-free in the 1L setting was 19,494 without A+AVD and 19,660 with A+AVD (Δ+166, 0.85% increase) in 2031. Overall, for every 100 patients prescribed A+AVD, it was predicted that an additional 6.5 patients per year achieved at least 5 years PFS and 4.2 to 4.7 fewer patients per year required a stem cell transplant (SCT), based on the 70% to 80% of eligible patient proceeding to SCT, respectively. Conclusions The durable PFS improvement of A+AVD vs ABVD in the 5-year follow-up data from ECHELON-1 resulted in increasing the number of patients with stage III or IV cHL who remain progression free for greater than 10 years and reducing future SCTs, based on this oncology simulation model for cHL. The significant improvement in PFS observed in the 5-year ECHELON-1 trial may translate to fewer patients with cHL developing primary refractory or relapsed disease and reduce the need for additional therapies including SCT. Disclosures Phillips: Genentech: Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Consultancy, Research Funding; Bayer: Consultancy, Research Funding; Incyte: Consultancy, Other: received travel expenses from Incyte, Research Funding; ADCT, BeiGene, Bristol Myers Squibb, Cardinal Health, Incyte, Karyopharm, Morphosys, Pharmacyclics, Seattle Genetics: Consultancy; AbbVie: Consultancy, Research Funding; AstraZeneca: Consultancy. Migliaccio-Walle: Seagen, Inc: Consultancy. Yu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Bloudek: Seagen, Inc: Consultancy. Liu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Fanale: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Burke: Beigene: Consultancy, Speakers Bureau; Verastem: Consultancy; Kymera: Consultancy; Bristol Myers Squibb: Consultancy; Adaptive Biotechnologies: Consultancy; MorphoSys: Consultancy; AstraZeneca: Consultancy; Roche/Genentech: Consultancy; Kura: Consultancy; Epizyme: Consultancy; X4 Pharmaceuticals: Consultancy; SeaGen: Consultancy, Speakers Bureau; AbbVie: Consultancy.

Over the last five years, the Center for Migration Studies of New York (CMS) has conducted four surveys of Catholic immigrant-serving institutions, programs, and ministries in the United States. These surveys identify the multi-faceted needs of immigrants and refugees, and examine the successes and challenges of Catholic institutions in responding to them. CMS administered its most recent survey, the Catholic Refugee and Immigrant Service Integration Survey (the “CRISIS Survey”) from December 14, 2020 through February 5, 2021. This survey explored the work of Catholic institutions during the Trump administration and the COVID-19 pandemic. The CRISIS Survey documents the reach, diversity, and productivity of Catholic institutions that worked with immigrants and refugees during a pandemic that particularly devastated their communities and an administration whose policies and rhetoric made their work far more difficult. At a time of rampant “Catholic decline” narratives, the survey also documents the reach, vitality, and relevance of Catholic immigrant-serving institutions. It identifies the obstacles encountered by immigrants in accessing Catholic programs and ministries — both organizational (funding, staffing, and siting) and exogenous (federal policies, the pandemic, and community opposition). It underscores the threat posed by US immigration policies to immigrants and to the work of Catholic institutions. Survey respondents reported that they offered new services during this period, such as: Financial assistance for families, particularly those at risk of losing housing or utilities. COVID-19 testing, education, contact tracing, and quarantine services. Mental health services. Grief support and assistance with funeral expenses. Delivery of food and sanitation supplies for infected and other homebound persons. Voter registration and Census promotion activities. Virtually all respondents provided services remotely during the pandemic. Many reported on difficulties faced by immigrants in accessing their services, due to poor internet connections, limited computer access, and lack of communications technology and training. Respondents identified several factors that negatively affected immigrants’ access to their services pre-pandemic. As in previous CMS surveys, these factors included lack of immigration status, negative community attitudes toward immigrants, fear of apprehension (particularly after traffic stops) and deportation, public transportation deficiencies, stigma over receipt of mental health services, and identification requirements to access public benefits. Respondents also reported on obstacles in working with immigrants during the pandemic. These included the pandemic itself, limited funding, demand that outpaced resources, government restrictions on relief and benefit eligibility, and (particularly for students) living arrangements, work, and family caretaking responsibilities. Respondents overwhelmingly believed that immigration enforcement, tied to fear of deportation, very negatively or somewhat negatively affected participation in their services and programs. In Catholic terms, they reported that nativist immigration policies, rhetoric, and media sources interfered with their practice of discipleship. One respondent stated, “Fear of ICE and round-ups, locally in our state and nationally, along with negative immigration rhetoric from the out-going president have made our clients very fearful to access services they rightly qualify for.” A healthcare provider reported that immigrants were “avoiding or delaying seeking treatment for COVID-19 for fear of apprehension and/or deportation.” Many said that enforcement partnerships between Immigration and Customs Enforcement and states and localities made immigrants fearful of reporting crimes or accessing government facilities. One said that potential sponsors feared coming forward to reunify with children. Respondents also cited as problems delays in family reunification, barriers to asylum-seekers entering the United States, decreased refugee admissions, and the Trump administration's rule on the public charge ground of inadmissibility. The report recommends that Catholic institutions take stock of the creative new programs, skills and capacities that they have developed during the pandemic and build on them. It also recommends that scholars and researchers prioritize independent, person-centered research that critically analyzes the work of Catholic immigrant-serving institutions. Such research would ask whether these institutions, in the words of Pope Francis, are putting “the person at the center, in his or her many aspects” and honoring the “fundamental equality” of every person. It would draw on the perspectives of immigrants served by Catholic institutions to examine the degree to which these institutions advance the rights, participation, and wellbeing of immigrants and their families in US society. Finally, it would analyze how Catholic institutions work with each other — within Arch/dioceses, regionally, nationally, and across these realms — in response to the cross-cutting needs of immigrants. The report recommends that Catholic institutions develop programmatic plans to ensure that immigrants can return to or can continue to access their programs and ministries as the pandemic subsides. These plans will need to combine communication strategies, financial support, and services such as transportation and childcare. In addition, Catholic institutions should make it a high priority to ensure that immigrants can access the infrastructure, platforms, and training that will allow them to access virtual services. They should also develop strategies to engage Catholics who do not understand, who ignore, or who work at cross-purposes to Catholic teaching and policy positions in this area. Finally, they should redouble their work with the administration and Congress to reform US immigration laws, and with states and localities to promote welcoming and inclusive communities.

Social innovations are activities aiming at implementation of social objectives, including mainly the improvement of life of individuals and social groups, together with public policy and management objectives. The essay indicates and discusses the most important contemporary problems, solving of which requires social innovations. Social innovations precondition the progress of civilisation. The world needs not only new technologies, but also new solutions of social and institutional nature that would be conducive to achieving social goals. Social innovations are experimental social actions of organisational and institutional nature that aim at improving the quality of life of individuals, communities, nations, companies, circles, or social groups. Their experimental nature stems from the fact of introducing unique and one-time solutions on a large scale, the end results of which are often difficult to be fully predicted. For example, it was difficult to believe that opening new labour markets for foreigners in the countries of the European Union, which can be treated as a social innovation aiming at development of the international labour market, will result in the rapid development of the low-cost airlines, the offer of which will be available to a larger group of recipients. In other words, social innovations differ from economic innovations, as they are not about implementation of new types of production or gaining new markets, but about satisfying new needs, which are not provided by the market. Therefore, the most important distinction consists in that social innovations are concerned with improving the well-being of individuals and communities by additional employment, or increased consumption, as well as participation in solving the problems of individuals and social groups [CSTP, 2011]. In general, social innovations are activities aiming at implementation of social objectives, including mainly the improvement of life of individuals and social groups together with the objectives of public policy and management [Kowalczyk, Sobiecki, 2017]. Their implementation requires global, national, and individual actions. This requires joint operations, both at the scale of the entire globe, as well as in particular interest groups. Why are social innovations a key point for the progress of civilisation? This is the effect of the clear domination of economic aspects and discrimination of social aspects of this progress. Until the 19th century, the economy was a part of a social structure. As described by K. Polanyi, it was submerged in social relations [Polanyi, 2010, p. 56]. In traditional societies, the economic system was in fact derived from the organisation of the society itself. The economy, consisting of small and dispersed craft businesses, was a part of the social, family, and neighbourhood structure. In the 20th century the situation reversed – the economy started to be the force shaping social structures, positions of individual groups, areas of wealth and poverty. The economy and the market mechanism have become independent from the world of politics and society. Today, the corporations control our lives. They decide what we eat, what we watch, what we wear, where we work and what we do [Bakan, 2006, p. 13]. The corporations started this spectacular “march to rule the world” in the late 19th century. After about a hundred years, at the end of the 20th century, the state under the pressure of corporations and globalisation, started a gradual, but systematic withdrawal from the economy, market and many other functions traditionally belonging to it. As a result, at the end of the last century, a corporation has become a dominant institution in the world. A characteristic feature of this condition is that it gives a complete priority to the interests of corporations. They make decisions of often adverse consequences for the entire social groups, regions, or local communities. They lead to social tensions, political breakdowns, and most often to repeated market turbulences. Thus, a substantial minority (corporations) obtain inconceivable benefits at the expense of the vast majority, that is broad professional and social groups. The lack of relative balance between the economy and society is a barrier to the progress of civilisation. A growing global concern is the problem of migration. The present crisis, left unresolved, in the long term will return multiplied. Today, there are about 500 million people living in Europe, 1.5 billion in Africa and the Middle East, but in 2100, the population of Europe will be about 400 million and of the Middle East and Africa approximately 4.5 billion. Solving this problem, mainly through social and political innovations, can take place only by a joint operation of highly developed and developing countries. Is it an easy task? It’s very difficult. Unfortunately, today, the world is going in the opposite direction. Instead of pursuing the community, empathic thinking, it aims towards nationalism and chauvinism. An example might be a part of the inaugural address of President Donald Trump, who said that the right of all nations is to put their own interests first. Of course, the United States of America will think about their own interests. As we go in the opposite direction, those who deal with global issues say – nothing will change, unless there is some great crisis, a major disaster that would cause that the great of this world will come to senses. J.E. Stiglitz [2004], contrary to the current thinking and practice, believes that a different and better world is possible. Globalisation contains the potential of countless benefits from which people both in developing and highly developed countries can benefit. But the practice so far proves that still it is not grown up enough to use its potential in a fair manner. What is needed are new solutions, most of all social and political innovations (political, because they involve a violation of the previous arrangement of interests). Failure to search for breakthrough innovations of social and political nature that would meet the modern challenges, can lead the world to a disaster. Social innovation, and not economic, because the contemporary civilisation problems have their roots in this dimension. A global problem, solution of which requires innovations of social and political nature, is the disruption of the balance between work and capital. In 2010, 400 richest people had assets such as the half of the poorer population of the world. In 2016, such part was in the possession of only 8 people. This shows the dramatic collapse of the balance between work and capital. The world cannot develop creating the technological progress while increasing unjustified inequalities, which inevitably lead to an outbreak of civil disturbances. This outbreak can have various organisation forms. In the days of the Internet and social media, it is easier to communicate with people. Therefore, paradoxically, some modern technologies create the conditions facilitating social protests. There is one more important and dangerous effect of implementing technological innovations without simultaneous creation and implementation of social innovations limiting the sky-rocketing increase of economic (followed by social) diversification. Sooner or later, technological progress will become so widespread that, due to the relatively low prices, it will make it possible for the weapons of mass destruction, especially biological and chemical weapons, to reach small terrorist groups. Then, a total, individualized war of global reach can develop. The individualisation of war will follow, as described by the famous German sociologist Ulrich Beck. To avoid this, it is worth looking at the achievements of the Polish scientist Michał Kalecki, who 75 years ago argued that capitalism alone is not able to develop. It is because it aggressively seeks profit growth, but cannot turn profit into some profitable investments. Therefore, when uncertainty grows, capitalism cannot develop itself, and it must be accompanied by external factors, named by Kalecki – external development factors. These factors include state expenses, finances and, in accordance with the nomenclature of Kalecki – epochal innovations. And what are the current possibilities of activation of the external factors? In short – modest. The countries are indebted, and the basis for the development in the last 20 years were loans, which contributed to the growth of debt of economic entities. What, then, should we do? It is necessary to look for cheaper solutions, but such that are effective, that is breakthrough innovations. These undoubtedly include social and political innovations. Contemporary social innovation is not about investing big money and expensive resources in production, e.g. of a very expensive vaccine, which would be available for a small group of recipients. Today’s social innovation should stimulate the use of lower amounts of resources to produce more products available to larger groups of recipients. The progress of civilisation happens only as a result of a sustainable development in economic, social, and now also ecological terms. Economic (business) innovations, which help accelerate the growth rate of production and services, contribute to economic development. Profits of corporations increase and, at the same time, the economic objectives of the corporations are realised. But are the objectives of the society as a whole and its members individually realised equally, in parallel? In the chain of social reproduction there are four repeated phases: production – distribution – exchange – consumption. The key point from the social point of view is the phase of distribution. But what are the rules of distribution, how much and who gets from this “cake” produced in the social process of production? In the today’s increasingly global economy, the most important mechanism of distribution is the market mechanism. However, in the long run, this mechanism leads to growing income and welfare disparities of various social groups. Although, the income and welfare diversity in itself is nothing wrong, as it is the result of the diversification of effectiveness of factors of production, including work, the growing disparities to a large extent cannot be justified. Economic situation of the society members increasingly depends not on the contribution of work, but on the size of the capital invested, and the market position of the economic entity, and on the “governing power of capital” on the market. It should also be noted that this diversification is also related to speculative activities. Disparities between the implemented economic and social innovations can lead to the collapse of the progress of civilisation. Nowadays, economic crises are often justified by, indeed, social and political considerations, such as marginalisation of nation states, imbalance of power (or imbalance of fear), religious conflicts, nationalism, chauvinism, etc. It is also considered that the first global financial crisis of the 21st century originated from the wrong social policy pursued by the US Government, which led to the creation of a gigantic public debt, which consequently led to an economic breakdown. This resulted in the financial crisis, but also in deepening of the social imbalances and widening of the circles of poverty and social exclusion. It can even be stated that it was a crisis in public confidence. Therefore, the causes of crises are the conflicts between the economic dimension of the development and its social dimension. Contemporary world is filled with various innovations of economic or business nature (including technological, product, marketing, and in part – organisational). The existing solutions can be a source of economic progress, which is a component of the progress of civilisation. However, economic innovations do not complete the entire progress of civilisation moreover, the saturation, and often supersaturation with implementations and economic innovations leads to an excessive use of material factors of production. As a consequence, it results in lowering of the efficiency of their use, unnecessary extra burden to the planet, and passing of the negative effects on the society and future generations (of consumers). On the other hand, it leads to forcing the consumption of durable consumer goods, and gathering them “just in case”, and also to the low degree of their use (e.g. more cars in a household than its members results in the additional load on traffic routes, which results in an increase in the inconvenience of movement of people, thus to the reduction of the quality of life). Introduction of yet another economic innovation will not solve this problem. It can be solved only by social innovations that are in a permanent shortage. A social innovation which fosters solving the issue of excessive accumulation of tangible production goods is a developing phenomenon called sharing economy. It is based on the principle: “the use of a service provided by some welfare does not require being its owner”. This principle allows for an economic use of resources located in households, but which have been “latent” so far. In this way, increasing of the scope of services provided (transport, residential and tourist accommodation) does not require any growth of additional tangible resources of factors of production. So, it contributes to the growth of household incomes, and inhibition of loading the planet with material goods processed by man [see Poniatowska-Jaksch, Sobiecki, 2016]. Another example: we live in times, in which, contrary to the law of T. Malthus, the planet is able to feed all people, that is to guarantee their minimum required nutrients. But still, millions of people die of starvation and malnutrition, but also due to obesity. Can this problem be solved with another economic innovation? Certainly not! Economic innovations will certainly help to partially solve the problem of nutrition, at least by the new methods of storing and preservation of foods, to reduce its waste in the phase of storage and transport. However, a key condition to solve this problem is to create and implement an innovation of a social nature (in many cases also political). We will not be able to speak about the progress of civilisation in a situation, where there are people dying of starvation and malnutrition. A growing global social concern, resulting from implementation of an economic (technological) innovation will be robotisation, and more specifically – the effects arising from its dissemination on a large scale. So far, the issue has been postponed due to globalisation of the labour market, which led to cheapening of the work factor by more than ten times in the countries of Asia or South America. But it ends slowly. Labour becomes more and more expensive, which means that the robots become relatively cheap. The mechanism leading to low prices of the labour factor expires. Wages increase, and this changes the relationship of the prices of capital and labour. Capital becomes relatively cheaper and cheaper, and this leads to reducing of the demand for work, at the same time increasing the demand for capital (in the form of robots). The introduction of robots will be an effect of the phenomenon of substitution of the factors of production. A cheaper factor (in this case capital in the form of robots) will be cheaper than the same activities performed by man. According to W. Szymański [2017], such change is a dysfunction of capitalism. A great challenge, because capitalism is based on the market-driven shaping of income. The market-driven shaping of income means that the income is derived from the sale of the factors of production. Most people have income from employment. Robots change this mechanism. It is estimated that scientific progress allows to create such number of robots that will replace billion people in the world. What will happen to those “superseded”, what will replace the income from human labour? Capitalism will face an institutional challenge, and must replace the market-driven shaping of income with another, new one. The introduction of robots means microeconomic battle with the barrier of demand. To sell more, one needs to cut costs. The costs are lowered by the introduction of robots, but the use of robots reduces the demand for human labour. Lowering the demand for human labour results in the reduction of employment, and lower wages. Lower wages result in the reduction of the demand for goods and services. To increase the demand for goods and services, the companies must lower their costs, so they increase the involvement of robots, etc. A mechanism of the vicious circle appears If such a mass substitution of the factors of production is unfavourable from the point of view of stimulating the development of the economy, then something must be done to improve the adverse price relations for labour. How can the conditions of competition between a robot and a man be made equal, at least partially? Robots should be taxed. Bill Gates, among others, is a supporter of such a solution. However, this is only one of the tools that can be used. The solution of the problem requires a change in the mechanism, so a breakthrough innovation of a social and political nature. We can say that technological and product innovations force the creation of social and political innovations (maybe institutional changes). Product innovations solve some problems (e.g. they contribute to the reduction of production costs), but at the same time, give rise to others. Progress of civilisation for centuries and even millennia was primarily an intellectual progress. It was difficult to discuss economic progress at that time. Then we had to deal with the imbalance between the economic and the social element. The insufficiency of the economic factor (otherwise than it is today) was the reason for the tensions and crises. Estimates of growth indicate that the increase in industrial production from ancient times to the first industrial revolution, that is until about 1700, was 0.1-0.2 per year on average. Only the next centuries brought about systematically increasing pace of economic growth. During 1700- 1820, it was 0.5% on an annual average, and between 1820-1913 – 1.5%, and between 1913-2012 – 3.0% [Piketty, 2015, p. 97]. So, the significant pace of the economic growth is found only at the turn of the 19th and 20th century. Additionally, the growth in this period refers predominantly to Europe and North America. The countries on other continents were either stuck in colonialism, structurally similar to the medieval period, or “lived” on the history of their former glory, as, for example, China and Japan, or to a lesser extent some countries of the Middle East and South America. The growth, having then the signs of the modern growth, that is the growth based on technological progress, was attributed mainly to Europe and the United States. The progress of civilisation requires the creation of new social initiatives. Social innovations are indeed an additional capital to keep the social structure in balance. The social capital is seen as a means and purpose and as a primary source of new values for the members of the society. Social innovations also motivate every citizen to actively participate in this process. It is necessary, because traditional ways of solving social problems, even those known for a long time as unemployment, ageing of the society, or exclusion of considerable social and professional groups from the social and economic development, simply fail. “Old” problems are joined by new ones, such as the increase of social inequalities, climate change, or rapidly growing environmental pollution. New phenomena and problems require new solutions, changes to existing procedures, programmes, and often a completely different approach and instruments [Kowalczyk, Sobiecki, 2017].

Background: Allogeneic hematopoietic cell transplantation (alloHCT) is a potentially curative treatment for individuals diagnosed with blood cancers and disorders. Most transplant centers (TCs) require a caregiver for 24 hours per day, seven days per week, for at least 100 days post-alloHCT. However, there is limited knowledge of the evidence behind this requirement. Additionally, these requirements can have implications for caregivers in multiple aspects of their lives. This study aimed to learn more about alloHCT caregiver experiences in the first 100 days post-alloHCT to explore the impact of caregiver requirements. Methods: Web-based interviews were conducted from May 2022-February 2023 with a convenience sample of adult caregivers of adult alloHCT patients in the United States (US). Caregivers' patients were 100 days to 1-year post-alloHCT, with no relapse. Interviews were recorded and transcribed; thematic analysis was conducted by two independent reviewers. These results focus on the themes of housing, finances and employment, which arose during the interviews. Results: Sixteen caregivers participated, and included spouses (n=12, 75%), parents (n=3, 19%), and a fiancé (n=1, 6%). They generally cared for patients who received an unrelated alloHCT (n=14, 87.5%), and there was representation from all regions in the US.. The median distance from the caregiver's home to the TC was 55 miles (range: 3 to 2000 miles). Caregivers who needed to relocate described staying with family, in hotels, transplant housing, or renting an apartment. Caregivers also described the stressor of having to figure out where to stay, with a tight timeline and requirements for cleanliness and distance to the TC, as well as the difficulty of relocating to a new city without knowing anyone, the area or traffic patterns, and described the need for affordable options. Those with access to housing with other alloHCT caregivers/patients found support from others going through similar experiences. Of the caregivers who did not need to relocate, one noted the convenience of family living nearby; and another described household emergencies that resulted in financial and logistical challenges. Financial challenges mentioned by caregivers included medication, transportation, unexpected expenses, the importance of navigating finances, and the experience of not making enough money to meet their needs, while making too much money to qualify for financial assistance. Some also learned about financial assistance when it was too late or when it would have been helpful earlier and were not sure how they were expected to find these opportunities. Those who received financial assistance, regardless of the amount, were very grateful and noted it made a difference in their experience. Though caregivers shared their financial challenges, many noted they felt “lucky” or “privileged,” recognizing that if circumstances had been different, they, or others in less fortunate financial circumstances, may have had more difficulties. Caregivers were variably employed and included those who were retired, employed, self-employed, and not employed. Those who were employed mentioned the importance of the Family Medical Leave Act (FMLA), but also described the need to work to maintain income and health insurance. Employed caregivers also shared they were able to work effectively and provide care, despite some being told by their TC that they could not. The majority of those employed credited their ability to work to their employers' support and flexibility. Conclusions: This study interviewed adult caregivers of adults receiving alloHCT in the US to understand the caregiver experience and to explore the impact of caregiver requirements. The current caregiver requirement of most TCs can be a barrier not only to patients, but to caregivers. In this study, caregivers shared their housing, financial, and employment experiences. Knowledge of these experiences can help inform interventions to help support caregivers, and inform strategies to transform the caregiver requirement to allow for individual situations. Further information is needed on barriers faced by individuals unable to access alloHCT and patients who may not have had a caregiver. Results from this study will facilitate the development of programs to help improve patient and caregiver experiences.

Abstract Introduction: Adolescents and young adults (AYAs), particularly those 19-34, are the most highly uninsured age group in the United States. AYAs lacking any insurance or having public health insurance have been consistently found to have worse survival after a cancer diagnosis than those with private insurance, highlighting the need to better understand survival disparities and improve outcomes in this population. We examined the association of health insurance with stage at diagnosis, cancer treatment, location of cancer care, healthcare utilization, and chronic medical conditions/late effects (e.g., cardiovascular, respiratory, and endocrine diseases) and survival. Methods: We included data on AYAs diagnosed with common cancers between the ages of 15-39 in the United States. We used complementary data sources to understand outcomes including cancer registries, electronic health records, surveys (e.g., AYA Health Outcomes and Patient Experience Study (HOPE)), and linkages to healthcare enrollment and utilization databases. Data from the California Cancer Registry (CCR) provided information on stage at diagnosis, location of cancer care, and selected Commission on Cancer (CoC) quality of care measures. CCR-Medicaid linked datasets identified the timing of insurance enrollment and CCR California Department of Healthcare Access and Information (-HCAI) linked dataset provided information on hospitalization and emergency department diagnoses and procedures. Medical Expenditure Panel Survey (MEPS) identified health care utilization and medical expenditures among AYAs with chronic medical conditions/late effects. Results: Prior to the full implementation of the Affordable Care Act (ACA), 50% of AYAs with Medicaid insurance received this insurance at cancer diagnosis or were discontinuously enrolled just prior to or after cancer diagnosis. AYAs enrolled in Medicaid were more likely to be diagnosed at a later cancer stage than AYAs with private health insurance. The duration and continuity of Medicaid enrollment influenced these associations, with AYAs who enrolled at diagnosis more than 2.0 times, AYAs intermittently enrolled 1.7 to 1.9 times, and AYAs continuously enrolled 1.4-1.5 times more likely to have later stage disease than those with private insurance. Clinical trial enrollment, which is associated with receiving appropriate initial treatment in the AYA HOPE study, was lower among AYAs who were uninsured versus privately insured in 2006, but doubled in 2012/2013, such that there were no longer differences in clinical trial enrollment by health insurance type. In AYAs diagnosed with breast and colon cancer in 2014-2021, those with Medicaid insurance were less likely to meet CoC quality of care measures on chemotherapy and radiation administration, including radiation administered following breast conserving surgery within 1 year of breast cancer diagnosis (adjusted odds ratio (OR): 0.63; 95% confidence interval (CI) 0.52-0.76) and adjuvant chemotherapy administered within 4 months of diagnosis for stage III colon cancer OR: 0.52; CI 0.36-0.74). Among AYAs with acute lymphoblastic leukemia, those who were publicly insured were less likely in New York and Texas and more likely in California to receive care at a specialized cancer center, which was associated with better survival outcomes. Within an integrated healthcare setting, among 2-5-year AYA cancer survivors, healthcare utilization varied by health insurance source. Specifically, AYAs with public insurance were less more likely in any year to have no oncology or primary care visits and to utilize the emergency department. Data from multiple sources have identified that AYA cancer survivors with late effects were more likely to be publicly insured, with MEPS data identifying that AYAs with late effects had substantially greater medical expenses, prescription medications and healthcare utilization. Finally, in an analysis of CCR-Medicaid, we found AYAs with Medicaid insurance experience worse cancer-specific survival compared with those with private/military insurance. Conclusion: Continuous medical insurance is important for AYA cancer survivors to maintain regular contact with the healthcare system, particularly for preventive care, early cancer detection, timely treatment, and appropriate survivorship care. While the ACA significantly reduced the proportion of uninsured AYAs, a substantial portion of working-age adults remain underinsured, experiencing gaps in coverage or high out-of-pocket costs, that results in not getting needed health care due to cost. Those lacking health insurance or experiencing gaps in coverage are disproportionately poor, young, and living with a chronic health problem. Not being able to afford plan premiums and cost-sharing requirements or loss of Medicaid eligibility are among the most cited reasons for lacking insurance or experiencing coverage gaps. This can lead to significant financial burden in the AYA population that then exacerbates insurance related access barriers to appropriate treatment and survivorship care. This underscores the need for policies to improve the continuity and quality of insurance options. In addition, given the complexity of insurance coverage, educational interventions to increase health insurance literacy among AYA cancer survivors may increase their ability to successfully navigate health systems, use their insurance to the fullest, and avoid unnecessary out-of-pocket costs. Our data also emphasize the need for policies to enhance access to specialized cancer care for AYAs overall and with Medicaid insurance, such as the California Cancer Care Equity Act, which enables Medicaid enrollees diagnosed with a complex cancer to request a referral to specialty cancer hospitals where emerging and effective cancer therapies and clinical trials are available. Citation Format: Theresa H M Keegan, Frances M. Maguire, Renata Abrahão, Helen M. Parsons. Health insurance and outcome disparities in adolescents and young adults with cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr SY15-02.

This paper aims to portray the overall picture of poverty in the world and mentions the key solution to overcome poverty from a critical perspective. The data and figures were quoted from a number of researchers and organizations in the field of poverty around the world. Simultaneously, the information strengthens the correlations among poverty and lack of education. Only appropriate philosophies of education can improve the country’s socio-economic conditions and contribute to effective solutions to worldwide poverty. In the 21st century, despite the rapid development of science and technology with a series of inventions brought into the world to make life more comfortable, human poverty remains a global problem, especially in developing countries. Poverty, according to Lister (2004), is reflected by the state of “low living standards and/or inability to participate fully in society because of lack of material resources” (p.7). The impact and serious consequences of poverty on multiple aspects of human life have been realized by different organizations and researchers from different contexts (Fraser, 2000; Lister, 2004; Lipman, 2004; Lister, 2008). This paper will indicate some of the concepts and research results on poverty. Figures and causes of poverty, and some solutions from education as a key breaker to poverty will also be discussed. Creating a universal definition of poverty is not simple (Nyasulu, 2010). There are conflicts among different groups of people defining poverty, based on different views and fields. Some writers, according to Nyasulu, tend to connect poverty with social problems, while others focus on political or other causes. However, the reality of poverty needs to be considered from different sides and ways; for that reason, the diversity of definitions assigned to poverty can help form the basis on which interventions are drawn (Ife and Tesoriero, 2006). For instance, in dealing with poverty issues, it is essential to intervene politically; economic intervention is very necessary to any definition of this matter. A political definition necessitates political interventions in dealing with poverty, and economic definitions inevitably lead to economic interventions. Similarly, Księżopolski (1999) uses several models to show the perspectives on poverty as marginal, motivation and socialist. These models look at poverty and solutions from different angles. Socialists, for example, emphasize the responsibilities of social organization. The state manages the micro levels and distributes the shares of national gross resources, at the same time fighting to maintain the narrow gap among classes. In his book, Księżopolski (1999) also emphasizes the changes and new values of charity funds or financial aid from churches or organizations recognized by the Poor Law. Speaking specifically, in the new stages poverty has been recognized differently, and support is also delivered in limited categories related to more specific and visible objectives, with the aim of helping the poor change their own status for sustainable improvement. Three ways of categorizing the poor and locating them in the appropriate places are (1) the powerless, (2) who is willing to work and (3) who is dodging work. Basically, poverty is determined not to belong to any specific cultures or politics; otherwise, it refers to the situation in which people’s earnings cannot support their minimum living standard (Rowntree, 1910). Human living standard is defined in Alfredsson & Eide’s work (1999) as follows: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” (p. 524). In addition, poverty is measured by Global Hunger Index (GHI), which is calculated by the International Food Policy Institute (IFPRI) every year. The GHI measures hunger not only globally, but also by country and region. To have the figures multi-dimensionally, the GHI is based on three indicators: 1. Undernourishment: the proportion of the undernourished as a percentage of the population (reflecting the share of the population with insufficient calorie intake). 2. Child underweight: the proportion of children under age 5 who are underweight (low weight for their age, reflecting wasting, stunted growth or both), which is one indicator of child under-nutrition. 3. Child mortality: the mortality rate of children under 5 (partially reflecting the fatal synergy of inadequate dietary intake and unhealthy environments). Apart from the individual aspects and the above measurement based on nutrition, which help partly imagine poverty, poverty is more complicated, not just being closely related to human physical life but badly affecting spiritual life. According to Jones and Novak (1999 cited in Lister, 2008), poverty not only characterizes the precarious financial situation but also makes people self-deprecating. Poverty turns itself into the roots of shame, guilt, humiliation and resistance. It leads the poor to the end of the road, and they will never call for help except in the worst situations. Education can help people escape poverty or make it worse. In fact, inequality in education has stolen opportunity for fighting poverty from people in many places around the world, in both developed and developing countries (Lipman, 2004). Lipman confirms: “Students need an education that instills a sense of hope and possibility that they can make a difference in their own family, school, and community and in the broader national and global community while it prepare them for multiple life choices.” (p.181) Bradshaw (2005) synthesizes five main causes of poverty: (1) individual deficiencies, (2) cultural belief systems that support subcultures of poverty, (3) economic, political and social distortions or discrimination, (4) geographical disparities and (5) cumulative and cyclical interdependencies. The researcher suggests the most appropriate solution corresponding with each cause. This reflects the diverse causes of poverty; otherwise, poverty easily happens because of social and political issues. From the literature review, it can be said that poverty comes from complex causes and reasons, and is not a problem of any single individual or country. Poverty has brought about serious consequences and needs to be dealt with by many methods and collective effort of many countries and organizations. This paper will focus on representing some alarming figures on poverty, problems of poverty and then the education as a key breaker to poverty. According to a statistics in 2012 on poverty from the United Nations Development Program (UNDP), nearly half the world's population lives below the poverty line, of which is less than $1.25 a day . In a statistics in 2015, of every 1,000 children, 93 do not live to age 5 , and about 448 million babies are stillborn each year . Poverty in the world is happening alarmingly. According to a World Bank study, the risk of poverty continues to increase on a global scale and, of the 2009 slowdown in economic growth, which led to higher prices for fuel and food, further pushed 53 million people into poverty in addition to almost 155 million in 2008. From 1990 to 2009, the average GHI in the world decreased by nearly one-fifth. Many countries had success in solving the problem of child nutrition; however, the mortality rate of children under 5 and the proportion of undernourished people are still high. From 2011 to 2013, the number of hungry people in the world was estimated at 842 million, down 17 percent compared with the period 1990 to 1992, according to a report released by the Food and Agriculture Organization of the United Nations (FAO) titled “The State of Food Insecurity in the World 2013” . Although poverty in some African countries had been improved in this stage, sub-Saharan Africa still maintained an area with high the highest percentage of hungry people in the world. The consequences and big problems resulting from poverty are terrible in the extreme. The following will illustrate the overall picture under the issues of health, unemployment, education and society and politics ➢ Health issues: According a report by Manos Unidas, a non- government organization (NGO) in Spain , poverty kills more than 30,000 children under age 5 worldwide every day, and 11 million children die each year because of poverty. Currently, 42 million people are living with HIV, 39 million of them in developing countries. The Manos Unidas report also shows that 15 million children globally have been orphaned because of AIDS. Scientists predict that by 2020 a number of African countries will have lost a quarter of their population to this disease. Simultaneously, chronic drought and lack of clean water have not only hindered economic development but also caused disastrous consequences of serious diseases across Africa. In fact, only 58 percent of Africans have access to clean water; as a result, the average life expectancy in Africa is the lowest in the world, just 45 years old (Bui, 2010). ➢ Unemployment issues: According to the United Nations, the youth unemployment rate in Africa is the highest in the world: 25.6 percent in the Middle East and North Africa. Unemployment with growth rates of 10 percent a year is one of the key issues causing poverty in African and negatively affecting programs and development plans. Total African debt amounts to $425 billion (Bui, 2010). In addition, joblessness caused by the global economic downturn pushed more than 140 million people in Asia into extreme poverty in 2009, the International Labor Organization (ILO) warned in a report titled The Fallout in Asia, prepared for the High-Level Regional Forum on Responding to the Economic Crisis in Asia and the Pacific, in Manila from Feb. 18 to 20, 2009 . Surprisingly, this situation also happens in developed countries. About 12.5 million people in the United Kingdom (accounting for 20 percent of the population) are living below the poverty line, and in 2005, 35 million people in the United States could not live without charity. At present, 620 million people in Asia are living on less than $1 per day; half of them are in India and China, two countries whose economies are considered to be growing. ➢ Education issues: Going to school is one of the basic needs of human beings, but poor people cannot achieve it. Globally, 130 million children do not attend school, 55 percent of them girls, and 82 million children have lost their childhoods by marrying too soon (Bui, 2010). Similarly, two-thirds of the 759 million illiterate people in total are women. Specifically, the illiteracy rate in Africa keeps increasing, accounting for about 40 percent of the African population at age 15 and over 50 percent of women at age 25. The number of illiterate people in the six countries with the highest number of illiterate people in the world - China, India, Indonesia, Brazil, Bangladesh and Egypt - reached 510 million, accounting for 70 percent of total global illiteracy. ➢ Social and political issues: Poverty leads to a number of social problems and instability in political systems of countries around the world. Actually, 246 million children are underage labors, including 72 million under age 10. Simultaneously, according to an estimate by the United Nations (UN), about 100 million children worldwide are living on the streets. For years, Africa has suffered a chronic refugee problem, with more than 7 million refugees currently and over 200 million people without homes because of a series of internal conflicts and civil wars. Poverty threatens stability and development; it also directly influences human development. Solving the problems caused by poverty takes a lot of time and resources, but afterward they can focus on developing their societies. Poverty has become a global issue with political significance of particular importance. It is a potential cause of political and social instability, even leading to violence and war not only within a country, but also in the whole world. Poverty and injustice together have raised fierce conflicts in international relations; if these conflicts are not satisfactorily resolved by peaceful means, war will inevitably break out. Obviously, poverty plus lack of understanding lead to disastrous consequences such as population growth, depletion of water resources, energy scarcity, pollution, food shortages and serious diseases (especially HIV/AIDS), which are not easy to control; simultaneously, poverty plus injustice will cause international crimes such as terrorism, drug and human trafficking, and money laundering. Among recognizable four issues above which reflected the serious consequences of poverty, the third ones, education, if being prioritized in intervention over other issues in the fighting against poverty is believed to bring more effectiveness in resolving the problems from the roots. In fact, human being with the possibility of being educated resulted from their distinctive linguistic ability makes them differential from other beings species on the earth (Barrow and Woods 2006, p.22). With education, human can be aware and more critical with their situations, they are aimed with abilities to deal with social problems as well as adversity for a better life; however, inequality in education has stolen opportunity for fighting poverty from unprivileged people (Lipman, 2004). An appropriate education can help increase chances for human to deal with all of the issues related to poverty; simultaneously it can narrow the unexpected side-effect of making poverty worse. A number of philosophies from ancient Greek to contemporary era focus on the aspect of education with their own epistemology, for example, idealism of Plato encouraged students to be truth seekers and pragmatism of Dewey enhanced the individual needs of students (Gutex, 1997). Education, more later on, especially critical pedagogy focuses on developing people independently and critically which is essential for poor people to have ability of being aware of what they are facing and then to have equivalent solutions for their problems. In other words, critical pedagogy helps people emancipate themselves and from that they can contribute to transform the situations or society they live in. In this sense, in his most influential work titled “Pedagogy of the Oppressed” (1972), Paulo Freire carried out his critical pedagogy by building up a community network of peasants- the marginalized and unprivileged party in his context, aiming at awakening their awareness about who they are and their roles in society at that time. To do so, he involved the peasants into a problem-posing education which was different from the traditional model of banking education with the technique of dialogue. Dialogue wasn’t just simply for people to learn about each other; but it was for figuring out the same voice; more importantly, for cooperation to build a social network for changing society. The peasants in such an educational community would be relieved from stressfulness and the feeling of being outsiders when all of them could discuss and exchange ideas with each other about the issues from their “praxis”. Praxis which was derived from what people act and linked to some values in their social lives, was defined by Freire as “reflection and action upon the world in order to transform it” (p.50). Critical pedagogy dialogical approach in Pedagogy of the Oppressed of Freire seems to be one of the helpful ways for solving poverty for its close connection to the nature of equality. It doesn’t require any highly intellectual teachers who lead the process; instead, everything happens naturally and the answers are identified by the emancipation of the learners themselves. It can be said that the effectiveness of this pedagogy for people to escape poverty comes from its direct impact on human critical consciousness; from that, learners would be fully aware of their current situations and self- figure out the appropriate solutions for their own. In addition, equality which was one of the essences making learners in critical pedagogy intellectually emancipate was reflected via the work titled “The Ignorant Schoolmaster” by Jacques Rancière (1991). In this work, the teacher and students seemed to be equal in terms of the knowledge. The explicator- teacher Joseph Jacotot employed the interrogative approach which was discovered to be universal because “he taught what he didn’t know”. Obviously, this teacher taught French to Flemish students while he couldn’t speak his students’ language. The ignorance which was not used in the literal sense but a metaphor showed that learners can absolutely realize their capacity for self-emancipation without the traditional teaching of transmission of knowledge from teachers. Regarding this, Rancière (1991, p.17) stated “that every common person might conceive his human dignity, take the measure of his intellectual capacity, and decide how to use it”. This education is so meaningful for poor people by being able to evoking their courageousness to develop themselves when they always try to stay away from the community due the fact that poverty is the roots of shame, guilt, humiliation and resistance (Novak, 1999). The contribution of critical pedagogy to solving poverty by changing the consciousness of people from their immanence is summarized by Freire’s argument in his “Pedagogy of Indignation” as follows: “It is certain that men and women can change the world for the better, can make it less unjust, but they can do so from starting point of concrete reality they “come upon” in their generation. They cannot do it on the basis of reveries, false dreams, or pure illusion”. (p.31) To sum up, education could be an extremely helpful way of solving poverty regarding the possibilities from the applications of studies in critical pedagogy for educational and social issues. Therefore, among the world issues, poverty could be possibly resolved in accordance with the indigenous people’s understanding of their praxis, their actions, cognitive transformation, and the solutions with emancipation in terms of the following keynotes: First, because the poor are powerless, they usually fall into the states of self-deprecation, shame, guilt and humiliation, as previously mentioned. In other words, they usually build a barrier between themselves and society, or they resist changing their status. Therefore, approaching them is not a simple matter; it requires much time and the contributions of psychologists and sociologists in learning about their aspirations, as well as evoking and nurturing the will and capacities of individuals, then providing people with chances to carry out their own potential for overcoming obstacles in life. Second, poverty happens easily in remote areas not endowed with favorable conditions for development. People there haven’t had a lot of access to modern civilization; nor do they earn a lot of money for a better life. Low literacy, together with the lack of healthy forms of entertainment and despair about life without exit, easily lead people into drug addiction, gambling and alcoholism. In other words, the vicious circle of poverty and powerlessness usually leads the poor to a dead end. Above all, they are lonely and need to be listened to, shared with and led to escape from their states. Community meetings for exchanging ideas, communicating and immediate intervening, along with appropriate forms of entertainment, should be held frequently to meet the expectations of the poor, direct them to appropriate jobs and, step by step, change their favorite habits of entertainment. Last but not least, poor people should be encouraged to participate in social forums where they can both raise their voices about their situations and make valuable suggestions for dealing with their poverty. Children from poor families should be completely exempted from school fees to encourage them to go to school, and curriculum should also focus on raising community awareness of poverty issues through extracurricular and volunteer activities, such as meeting and talking with the community, helping poor people with odd jobs, or simply spending time listening to them. Not a matter of any individual country, poverty has become a major problem, a threat to the survival, stability and development of the world and humanity. Globalization has become a bridge linking countries; for that reason, instability in any country can directly and deeply affect the stability of others. The international community has been joining hands to solve poverty; many anti-poverty organizations, including FAO (Food and Agriculture Organization), BecA (the Biosciences eastern and central Africa), UN-REDD (the United Nations Programme on Reducing Emissions from Deforestation and Forest Degradation), BRAC (Building Resources Across Communities), UNDP (United Nations Development Programme), WHO (World Health Organization) and Manos Unidas, operate both regionally and internationally, making some achievements by reducing the number of hungry people, estimated 842 million in the period 1990 to 1992, by 17 percent in 2011- to 2013 . The diverse methods used to deal with poverty have invested billions of dollars in education, health and healing. The Millennium Development Goals set by UNDP put forward eight solutions for addressing issues related to poverty holistically: 1) Eradicate extreme poverty and hunger. 2) Achieve universal primary education. 3) Promote gender equality and empower women. 4) Reduce child mortality. 5) Improve maternal health. 6) Combat HIV/AIDS, malaria and other diseases. 7) Ensure environmental sustainability. 8) Develop a global partnership for development. Although all of the mentioned solutions carried out directly by countries and organizations not only focus on the roots of poverty but break its circle, it is recognized that the solutions do not emphasize the role of the poor themselves which a critical pedagogy does. More than anyone, the poor should have a sense of their poverty so that they can become responsible for their own fate and actively fight poverty instead of waiting for help. It is not different from the cores of critical theory in solving educational and political issues that the poor should be aware and conscious about their situation and reflected context. It is required a critical transformation from their own praxis which would allow them to go through a process of learning, sharing, solving problems, and leading to social movements. This is similar to the method of giving poor people fish hooks rather than giving them fish. The government and people of any country understand better than anyone else clearly the strengths and characteristics of their homelands. It follows that they can efficiently contribute to causing poverty, preventing the return of poverty, and solving consequences of the poverty in their countries by many ways, especially a critical pedagogy; and indirectly narrow the scale of poverty in the world. In a word, the wars against poverty take time, money, energy and human resources, and they are absolutely not simple to end. Again, the poor and the challenged should be educated to be fully aware of their situation to that they can overcome poverty themselves. They need to be respected and receive sharing from the community. All forms of discrimination should be condemned and excluded from human society. When whole communities join hands in solving this universal problem, the endless circle of poverty can be addressed definitely someday. More importantly, every country should be responsible for finding appropriate ways to overcome poverty before receiving supports from other countries as well as the poor self-conscious responsibilities about themselves before receiving supports from the others, but the methods leading them to emancipation for their own transformation and later the social change.

People with disabilities encounter many financial expenses that those without disabilities do not incur. In this article, we provide estimates of the extra costs associated with living with a disability in the United States. Drawing on four nationally representative surveys, we estimate that a household containing an adult with a work disability requires, on average, 29% more income (or an additional $18,322 a year for a household at the median income level) to obtain the same standard of living as a comparable household without a member with a disability. Single adults with disabilities are estimated to have higher costs than those with disabilities who are married, and adults with cognitive impairments are estimated to have higher costs compared to those with other kinds of impairments. We further calculate the federal poverty rate for households that include adults with disabilities adjusted for the direct additional costs of disability. The rate rises from 24% to 35% after adjusting for the extra costs of disability, which would result in an estimated 2.2 million more people with disabilities counted as poor. This suggests that the official poverty measure in the United States substantially underestimates the degree of deprivation experienced by people with disabilities.

OBJECTIVES We describe the change in the percentage of children lacking continuous and adequate health insurance (underinsurance) from 2016 to 2019. We also examine the relationships between child health complexity and insurance type with underinsurance. METHODS Secondary analysis of US children in the National Survey of Children’s Health combined 2016–2019 dataset who had continuous and adequate health insurance. We calculated differences in point estimates, with 95% confidence intervals (CIs), to describe changes in our outcomes over the study period. We used multivariable logistic regression adjusted for sociodemographic characteristics and examined relationships between child health complexity and insurance type with underinsurance. RESULTS From 2016 to 2019, the proportion of US children experiencing underinsurance rose from 30.6% to 34.0% (+3.4%; 95% CI, +1.9% to +4.9%), an additional 2.4 million children. This trend was driven by rising insurance inadequacy (24.8% to 27.9% [+3.1%; 95% CI, +1.7% to +4.5%]), which was mainly experienced as unreasonable out-of-pocket medical expenses. Although the estimate of children lacking continuous insurance coverage rose from 8.1% to 8.7% (+0.6%), it was not significant at the 95% CI (−0.5% to +1.7%). We observed significant growth in underinsurance among White and multiracial children, children living in households with income ≥200% of the federal poverty limit, and those with private health insurance. Increased child health complexity and private insurance were significantly associated with experiencing underinsurance (adjusted odds ratio, 1.9 and 3.5, respectively). CONCLUSIONS Underinsurance is increasing among US children because of rising inadequacy. Reforms to the child health insurance system are necessary to curb this problem.

A study released from the University of Nebraska at Omaha (UNO) Office of Latino and Latin American Studies (OLLAS) chronicles the current state of Mexican-origin residents of Nebraska, finding that while the numbers of immigrants moving into Nebraska has slowed in recent years, the population continues to grow and become more a part of the state’s demographic makeup. The study, which was also funded in part by the Sherwood Foundation, examined more than a century of census data from the United States, finding that the more than 140,000 Mexican-origin residents in Nebraska as of 2012 has rapidly increased since 1910 when there were less than 300 Mexicans living across the state.

Abstract This article appraises kin availability and migration timing on French-Canadian child mortality in an early twentieth-century North American industrial city. The analysis is based on the exploitation of an original dataset constructed by linking the 1910 census data (IPUMS-Full Count) for Manchester, New Hampshire to Quebec Catholic marriage records (BALSAC) and geocoding census data at the household level (Sanborn Fire Insurance Maps). Our results suggest that the presence of maternal and paternal grandmothers in the city living in different households were associated with reduced child mortality and that French-Canadian women who arrived in the United States as children or young adults experienced higher child mortality compared to second-generation French Canadians and those who migrated at a later age.

Carpal tunnel syndrome (CTS) is a common cause of medical and workforce-related expenses in the United States. It is also frustrating for patients who have difficulty using the affected hand, impairing their activities of daily living and decreasing their quality of life. By utilizing the philosophy of osteopathic medicine, providers can better implement a treatment plan by working with the patient to find one that incorporates all aspects of the patient’s environment. By using the practice of osteopathic manipulative therapy (OMT), osteopathic physicians can often effectively treat the patient’s symptoms without side effects found in medications. This is especially useful in patients who may be unable to take certain medications, such as pregnant patients. Other treatment modalities are also reviewed in this manuscript.

BACKGROUND: Vertigo and dizziness are extremely common conditions in the adult population and therefore place a significant social and economic burden on both patients and the healthcare system. However, limited information is available for the economic burden of vertigo and dizziness across various health care settings. OBJECTIVE: Estimate the economic burden of vertigo and dizziness, controlling for demographic, socioeconomic, and clinical comorbidities. METHODS: A retrospective analysis of data from the Medical Expenditures Panel Survey (2007–2015) was performed to analyze individuals with vertigo or dizziness from a nationally representative sample of the United States. Participants were included via self-reported data and International Classification of Diseases, 9th Revision Clinical Modification codes. A cross-validated 2-component generalized linear model was utilized to assess vertigo and dizziness expenditures across demographic, socioeconomic and clinical characteristics while controlling for covariates. Costs and utilization across various health care service sectors, including inpatient, outpatient, emergency department, home health, and prescription medications were evaluated. RESULTS: Of 221,273 patients over 18 years, 5,275 (66% female, 34% male) reported either vertigo or dizziness during 2007–2015. More patients with vertigo or dizziness were female, older, non-Hispanic Caucasian, publicly insured, and had significant clinical comorbidities compared to patients without either condition. Furthermore, each of these demographic, socioeconomic, and clinical characteristics lead to significantly elevated costs due to having these conditions for patients. Significantly higher medical expenditures and utilization across various healthcare sectors were associated with vertigo or dizziness (p < 0.001). The mean incremental annual healthcare expenditure directly associated with vertigo or dizziness was $2,658.73 (95% CI: 1868.79, 3385.66) after controlling for socioeconomic and demographic characteristics. Total annual medical expenditures for patients with dizziness or vertigo was $48.1 billion. CONCLUSION: Vertigo and dizziness lead to substantial expenses for patients across various healthcare settings. Determining how to limit costs and improve the delivery of care for these patients is of the utmost importance given the severe morbidity, disruption to daily living, and major socioeconomic burden associated with these conditions.

ObjectiveBetter understanding the impact of social determinants of health (SDOH) barriers from the patient perspective is crucial to improve holistic patient support in generalized myasthenia gravis (gMG), a rare autoimmune disorder with high disease and treatment burden. The objective of this study was to identify economic challenges experienced by individuals living with gMG and SDOH barriers to better address current unmet needs.MethodsAdults (18–75 years) living with gMG and experiencing SDOH barriers in the United States were recruited to a mixed-methods study including qualitative interviews and a web-based quantitative survey. Quotas were implemented to include a balanced spread of baseline demographic categories including insurance type, living environment, and employment status among the study sample. Direct and indirect economic challenges were identified by degree of concern.ResultsThe survey was completed by 38 individuals living with gMG, the majority of whom were enrolled in public insurance and not employed. The most commonly reported major economic concerns were managing funds for emergency care (66%), loss of income (61%), and non-medical expenses (58%), highlighting the diversity of economic challenges. Individuals who were using public insurance plans, living in non-urban environments, and unemployed experienced pronounced challenges around managing non-medical costs and accessing government assistance.ConclusionBoth direct and indirect costs were emphasized as major concerns among individuals living with gMG and SDOH barriers. Increasing access to relevant, personalized, and holistic resources, including care management, should be prioritized to improve disease management and outcomes for individuals living with gMG.

Abstract With only a few exceptions, the historical study of individual-level correlates of child mortality in the United States has been limited to the period surrounding the turn of the twentieth century, when children ever born and children surviving data collected by the 1900 and 1910 censuses allow indirect estimation of child mortality. The recent release of linked census data, such as the IPUMS MLP datasets, allows a different type of indirect estimation over a longer period. By following couples across subsequent decennial censuses, it is possible to infer child mortality by measuring whether couples’ own children in the first census were still present in the second census. We focus our analysis on children aged 1–3 in the first of two linked censuses, who were less likely to be undercounted by the census than infants, and unlikely to be living apart from their parents in the second census. We estimate child mortality over the intervening decade and use OLS regression to correlate that mortality to the residence location and socioeconomic characteristics of their parents’ households. We limit our analysis to three panel datasets for married couples linked between the 1850–60, 1860–70, and 1870–80 censuses, when real estate and personal estate wealth data were collected. Our results indicate a significant negative relationship between wealth and child mortality across all regions of the United States and over the entire period examined.

In nine of the last 10 years, the United States Department of Agriculture (USDA) has reported that the average funds generated on-farm for farm operators to meet living expenses and debt obligations have been negative. This paper pieces together disparate data to understand why farm operators in the most productive agricultural systems on the planet are systematically losing money. The data-driven narrative we present highlights some troubling trends in US farm operator livelihoods. Though US farms are more productive than ever before, rising input costs, volatile production values, and rising land rents have left farmers with unprecedented levels of farm debt, low on-farm incomes, and high reliance on federal programs. For many US farm operators, the indicators of a “good livelihood”—stability, security, equitable rewards for work—are largely absent. We conclude by proposing three axes of intervention that would help US agriculture better sustain all farmers' livelihoods, a crucial step toward improving overall agricultural sustainability: (1) increase the diversity of people, crops, and cropping systems, (2) improve equity in access to land, support, and capital, and (3) improve the quality, accessibility, and content of data to facilitate monitoring of multiple indicators of agricultural “success.”

Thirty‐seven interviews of Mexican American women who crossed the border into the United States during the era of the Mexican Revolution of 1910 were analyzed using constructivist grounded theory methods. The intent is to expand the occupational therapy profession’s occupational consciousness and cultivate cultural humility. Four themes emerged from the data: suffering, work, yearning for an education, and compassion for others. The findings suggest that environmental barriers such as hierarchy (patriarchy and discrimination) and physical barriers (limited access to built environments, lack of nonexploitative work opportunities, and hostile educational institutions) prevented occupational participation. Small acts of resistance through everyday living (finding joy, playing, self‐sufficiency, and community organizing) were identified as facilitators of occupational participation. The research findings challenge proposed assumptions found within the occupational therapy literature: (1) humans and occupations exist as separate from their environments, and (2) work, productivity, and leisure contribute positively to health. The Transformative Model of Occupational Therapy is introduced as a decolonized framework that inextricably links individual health to community and global health. The model centers play, social participation, work, and education as occupations that contribute to the common good. These occupations are kept in equilibrium within the Four Pillars of Culture (self‐determination, compassion, sustainability, and language) or the cultural values identified and derived from the stories.

Knee osteoarthritis (OA) is a highly prevalent disease among the elderly population that results in joint degeneration, leading to reduced mobility and challenging daily living. Patients can choose from various treatment options depending on the stage of joint degeneration. In developing countries such as Pakistan, it is crucial to comprehend the financial burden borne by patients and their families due to this condition's high prevalence. Therefore, this exploratory study aimed to assess the financial burden of knee OA patients seeking healthcare services by analyzing the healthcare costs and expenses incurred by them. A purposive sampling technique was employed to recruit 112 knee OA patients undergoing any treatment modality from public and private hospitals in Lahore. A semistructured questionnaire collected patients' sociodemographic information and overall out-of-pocket health expenditures. Descriptive statistics and the Mann‒Whitney U test were utilized for data analysis. The patients' mean age was 53.69 ± 11.73 years, with 10.26 ± 4.83 years of education. Stage III knee OA was the most common diagnosis (30.36%), followed by stage IV (28.57%), stage II (22.32%), and stage I (18.75%). The direct medical cost was significantly higher [United States dollars (USD) 2,590.97] among patients who underwent surgery than among those who opted for alternative treatment procedures (USD 192.10) (p = 0.001). Similarly, the indirect medical cost was significantly higher (USD 371.75) among patients who underwent surgery than among those who chose other treatment options (USD 23.66) (p = 0.001). The overall cost of illness was 6.02 times higher among patients who had surgery (USD 3,050.93) than among those who opted for other treatment modalities (USD 507.19) (p = 0.001). The study’s findings provide insights into the financial burden borne by knee OA patients' families, emphasizing the need for policymakers to intervene. By understanding the costs of illness borne by patients and their families, policymakers can develop targeted interventions to alleviate the financial burden and improve access to healthcare services for knee OA patients.

The music therapy internship represents the culmination of students’ clinical training. Currently, most music therapy internships are unpaid while other healthcare professions offer paid internship options or do not require an internship. The purpose of this position paper was to conduct a SWOT (strengths, weaknesses, opportunities, and threats) analysis and initiate dialogue regarding paid music therapy internships in the United States. Designed to initiate dialogue and conversation, this article is not a research paper. I conducted an initial SWOT analysis on paid music therapy internships. I then shared the analysis with music therapy students, internship directors, clinicians, business owners, and faculty and integrated their feedback. Although the SWOT analysis indicated that the current internship model can result in strong clinicians, there are weaknesses regarding workforce diversity, accessibility, and finances. There may be numerous opportunities for the profession to strengthen itself through paid internships. The profession’s mission and values regarding increased access to music therapy for service users, greater workforce diversity, and quality of care amid escalating tuition and cost of living expenses are consequential factors that may influence paid music therapy internships. Although paid internships may be beyond the control of clinical training directors and thus may not be feasible in all contexts, the large number of unpaid internships may hinder the music therapy profession from thriving and advancing toward its mission. The profession may have an opportunity to use its own agency by valuing itself through paid music therapy internships. Questions and considerations are provided to conclude the paper.

Drawing upon popular magazines, newspapers, blogs, Web sites, and videos, this essay compares the media framing of six, “fat” political figures from around the world. Framing refers to the suggested interpretations that are imbedded in media reports (Entman; McCombs and Ghanem; Seo, Dillard and Shen). As Robert Entman explains, framing is the process of culling a few elements of perceived reality and assembling a narrative that highlights connections among them to promote a particular interpretation. Frames introduce or raise the salience of certain ideas. Fully developed frames typically perform several functions, such as problem definition and moral judgment. Framing is connected to the [covert] wielding of power as, for example, when a particular frame is intentionally applied to obscure other frames. This comparative international study is an inquiry into “what people and societies make of the reality of [human weight]” (Marilyn Wann as quoted in Rothblum 3), especially in the political arena. The cultural and historical dimensions of human weight are illustrated by the practice of force-feeding girls and young women in Mauritania, because “fat” women have higher status and are more sought after as brides (Frenkiel). The current study, however, focuses on “fat” politics. The research questions that guide the study are: [RQ1] which terms do commentators utilize to describe political figures as “fat”? [RQ2] Why is the term “fat” utilized in the political arena? [RQ3] To what extent can one detect gender, national, or other differences in the manner in which the term “fat” is used in the political arena? After a brief introduction to the current media obsession with fat, the analysis begins in 1908 with William Howard Taft, the 330 pound, twenty-seventh President of the United States. The other political figures are: Chris Christie (Governor of New Jersey), Bill Clinton (forty-second President of the United States), Michelle Obama (current First Lady of the United States), Carla Bruni (former First Lady of France), and Julia Gillard (former Prime Minister of Australia). The final section presents some conclusions that may help readers and viewers to take a more critical perspective on “fat politics.” All of the individuals selected for this study are powerful, rich, and privileged. What may be notable is that their experiences of fat shaming by the media are different. This study explores those differences, while suggesting that, in some cases, their weight and appearance are being attacked to undercut their legitimate and referent power (Gaski). Media Obsession with Fat “Fat,” or “obesity,” the more scientific term that reflects the medicalisation of “fat” (Sobal) and which seems to hold sway today, is a topic with which the media currently is obsessed, both in Asia and in the United States. A quick Google search using the word “obesity” reports over 73 million hits. Ambady Ramachandran and Chamukuttan Snehalatha report on “The Rising Burden of Obesity in Asia” in a journal article that emphasizes the term “burden.” The word “epidemic” is featured prominently in a 2013 medical news report. According to the latter, obesity among men was at 13.8 per cent in Mongolia and 19.3 per cent in Australia, while the overall obesity rate has increased 46 per cent in Japan and has quadrupled in China (“Rising Epidemic”). Both articles use the word “rising” in their titles, a fear-laden term that suggests a worsening condition. In the United States, obesity also is portrayed as an “epidemic.” While some progress is being made, the obesity rate nonetheless increased in sixteen states in 2013, with Louisiana at 34.7 per cent as the highest. “Extreme obesity” in the United States has grown dramatically over thirty years to 6.3 per cent. The framing of obesity as a health/medical issue has made obesity more likely to reinforce social stereotypes (Saguy and Riley). In addition, the “thematic framing” (Shugart) of obesity as a moral failure means that “obesity” is a useful tool for undermining political figures who are fat. While the media pay considerable attention to the psychological impact of obesity, such as in “fat shaming,” the media, ironically, participate in fat shaming. Shame is defined as an emotional “consequence of the evaluation of failure” and often is induced by critics who attack the person and not the behavior (Boudewyns, Turner and Paquin). However, in a backlash against fat shaming, “Who you callin' fat?” is now a popular byline in articles and in YouTube videos (Reagan). Nevertheless, the dynamics of fat are even more complicated than an attack-and-response model can capture. For example, in an odd instance of how women cannot win, Rachel Frederickson, the recent winner of the TV competition The Biggest Loser, was attacked for being “too thin” (Ceja and Valine). Framing fat, therefore, is a complex process. Fat shaming is only one way that the media frame fat. However, fat shaming does not appear to be a major factor in media coverage of William Howard Taft, the first person in this study. William Howard Taft William Howard Taft was elected the 27th President of the United States in 1908 and served 1909-1913. Whitehouse.com describes Taft as “Large, jovial, conscientious…” Indeed, comments on the happy way that he carried his “large” size (330 pounds) are the main focus here. This ‹happy fat› framing is much different than the media framing associated with ‹fat shaming›. His happy personality was often mentioned, as can be seen in his 1930 obituary in The New York Times: “Mr. Taft was often called the most human President who ever sat in the White House. The mantle of office did not hide his winning personality in any way” (“Taft Gained Peaks”). Notice how “large” and “jovial” are combined in the framing of Taft. Despite his size, Taft was known to be a good dancer (Bromley 129). Two other words associated with Taft are “rotund” (round, plump, chubby) and “pudgy.” These terms seem a bit old-fashioned in 2015. “Rotund” comes from the Latin for “round,” “circular,” “spherical.” “Pudgy,” a somewhat newer term, comes from the colloquial for “short and thick” (Etymology Online). Taft was comfortable with being called “pudgy.” A story about Taft’s portrait in the Smithsonian’s National Portrait Gallery in Washington, D.C. illustrates the point: Artist William Schevill was a longtime acquaintance of Taft and painted him several times between 1905 and 1910. Friendship did not keep Taft from criticizing the artist, and on one occasion he asked Schevill to rework a portrait. On one point, however, the rotund Taft never interfered. When someone said that he should not tolerate Schevill's making him look so pudgy in his likenesses, he simply answered, "But I am pudgy." (Kain) Taft’s self-acceptance, as seen in the portrait by Schevill (circa 1910), stands in contrast to the discomfort caused by media framing of other fat political figures in the era of more intense media scrutiny. Chris Christie Governor Christie has tried to be comfortable with his size (300+ pounds), but may have succumbed to the medicalisation of fat and the less than positive framing of his appearance. As Christie took the national stage in the aftermath of Hurricane Sandy (2012), and subsequently explored running for President, he may have felt pressure to look more “healthy” and “attractive.” Even while scoring political points for his leadership in the aftermath of Superstorm Sandy, Christie’s large size was apparent. Filmed in his blue Governor jacket during an ABC TV News report that can be accessed as a YouTube video, Christie obviously was much larger than the four other persons on the speakers’ platform (“Jersey Shore Devastated”). In the current media climate, being known for your weight may be a political liability. A 2015 Rutgers’ Eagleton Poll found that 53 percent of respondents said that Governor Christie did not have “the right look” to be President (Capehart). While fat traditionally has been associated with laziness, it now is associated with health issues, too. The media framing of fat as ‹morbidly obese› may have been one factor that led Christie to undergo weight loss surgery in 2013. After the surgery, he reportedly lost a significant amount of weight. Yet his new look was partially tarnished by media reports on the specifics of lap-band-surgery. One report in The New York Daily News stressed that the surgery is not for everyone, and that it still requires much work on the part of the patient before any long-term weight loss can be achieved (Engel). Bill Clinton Never as heavy as Governor Christie, Bill Clinton nonetheless received considerable media fat-attention of two sorts. First, he could be portrayed as a kind of ‹happy fat “Bubba”› who enjoyed eating high cholesterol fast food. Because of his charm and rhetorical ability (linked to the political necessity of appearing to understand the “average person”), Clinton could make political headway by emphasizing his Arkansas roots and eating a hamburger. This vision of Bill Clinton as a redneck, fast-food devouring “Bubba” was spoofed in a popular 1992 Saturday Night Live skit (“President-Elect Bill Clinton Stops by a McDonald's”). In 2004, after his quadruple bypass surgery, the media adopted another way to frame Bill Clinton. Clinton became the poster-child for coronary heart disease. Soon he would be framed as the ‹transformed Bubba›, who now consumed a healthier diet. ‹Bill Clinton-as-vegan› framing fit nicely with the national emphasis on nutrition, including the widespread advocacy for a largely plant-based diet (see film Forks over Knives). Michelle Obama Another political figure in the United States, whom the media has connected both to fast food and healthy nutrition, is Michelle Obama. Now in her second term as First Lady, Michelle Obama is associated with the national campaign for healthier school lunches. At the same time, critics call her “fat” and a “hypocrite.” A harsh diatribe against Obama was revealed by Media Matters for America in the personal attacks on Michelle Obama as “too fat” to be a credible source on nutrition. Dr. Keith Ablow, a FOX News medical adviser said, Michelle Obama needs to “drop a few” [pounds]. “Who is she to be giving nutrition advice?” Another biting attack on Obama can be seen in a mocking 2011 Breitbart cartoon that portrayed Michelle Obama devouring hamburgers while saying, “Please pass the bacon” (Hahn). Even though these attacks come from conservative media utterly opposed to the presidency of Barack Obama, they nonetheless reflect a more widespread political use of media framing. In the case of Michelle Obama, the media sometimes cannot decide if she is “statuesque” or “fat.” She is reported to be 5’11 tall, but her overall appearance has been described as “toned” (in her trademark sleeveless dresses) yet never as “thin.” The media’s ambivalence toward tall/large women is evident in the recent online arguments over whether Robyn Lawley, named one of the “rookies of the year” by the Sports Illustrated Swimsuit issue, has a “normal” body or a “plus-size” body (Blair). Therefore, we have two forms of media framing in the case of Michelle Obama. First, there is the ‹fat hypocrite› frame, an ad hominem framing that she should not be a spokesperson for nutrition. This first form of framing, perhaps, is linked to the traditional tendency to tear down political figures, to take them off their pedestals. The second form of media framing is a ‹large woman ambiguity› frame. If you are big and tall, are you “fat”? Carla Bruni Carla Bruni, a model and singer/songwriter, was married in 2008 to French President Nicolas Sarkozy (who served 2007 to 2012). In 2011, Bruni gave birth to a daughter, Giulia. After 2011, Bruni reports many attacks on her as being too “fat” (Kim; Strang). Her case is quite interesting, because it goes beyond ‹fat shaming› to illustrate two themes not previously discussed. First, the attacks on Bruni seem to connect age and fat. Specifically, Bruni’s narrative introduces the frame: ‹weight loss is difficult after giving birth›. Motherhood is taxing enough, but it becomes even more difficulty when the media are watching your waist line. It is implied that older mothers should receive more sympathy. The second frame represents an odd form of reverse fat shaming: ‹I am so sick and tired of skinny people saying they are fat›. As Bruni explains: “I’m kind of tall, with good-size shoulders, and when I am 40 pounds overweight, I don’t even look fat—I just look ugly” (Orth). Critics charge that celebs like Bruni not only do not look fat, they are not fat. Moreover, celebs are misguided in trying to cultivate sympathy that is needed by people who actually are fat. Several blogs echo this sentiment. The site Whisper displays a poster that states: “I am so sick and tired of skinny people saying they are fat.” According to Anarie in another blog, the comment, “I’m fat, too,” is misplaced but may be offered as a form of “sisterhood.” One of the best examples of the strong reaction to celebs’ fat claims is the case of actress Jennifer Lawrence. According The Gloss, Lawrence isn’t chubby. She isn’t ugly. She fits the very narrow parameters for what we consider beautiful, and has been rewarded significantly for it. There’s something a bit tone deaf in pretending not to have thin or attractive privilege when you’re one of the most successful actresses in Hollywood, consistently lauded for your looks. (Sonenshein) In sum, the attempt to make political gain out of “I’m fat” comments, may backfire and lead to a loss in political capital. Julia Gillard The final political figure in this study is Julia Eileen Gillard. She is described on Wikipedia as“…a former Australian politician who served as the 27th Prime Minister of Australia, and the Australian Labor Party leader from 2010 to 2013. She was the first woman to hold either position” (“Julia Gillard”). Gillard’s case provides a useful example of how the media can frame feminism and fat in almost opposite manners. The first version of framing, ‹woman inappropriately attacks fat men›, is set forth in a flashback video on YouTube. Political enemies of Gillard posted the video of Gillard attacking fat male politicians. The video clip includes the technique of having Gillard mouth and repeat over and over again the phrase, “fat men”…”fat men”…”fat men” (“Gillard Attacks”). The effect is to make Gillard look arrogant, insensitive, and shrill. The not-so-subtle message is that a woman should not call men fat, because a woman would not want men to call her fat. The second version of framing in the Gillard case, ironically, has a feminist leader calling Gillard “fat” on a popular Australian TV show. Australian-born Germaine Greer, iconic feminist activist and author of The Female Eunuch (1970 international best seller), commented that Gillard wore ill-fitting jackets and that “You’ve got a big arse, Julia” (“You’ve Got”). Greer’s remarks surprised and disappointed many commentators. The Melbourne Herald Sun offered the opinion that Greer has “big mouth” (“Germaine Greer’s”). The Gillard case seems to support the theory that female politicians may have a more difficult time navigating weight and appearance than male politicians. An experimental study by Beth Miller and Jennifer Lundgren suggests “weight bias exists for obese female political candidates, but that large body size may be an asset for male candidates” (p. 712). Conclusion This study has at least partially answered the original research questions. [RQ1] Which terms do commentators utilize to describe political figures as “fat”? The terms include: fat, fat arse, fat f***, large, heavy, obese, plus size, pudgy, and rotund. The media frames include: ‹happy fat›, ‹fat shaming›, ‹morbidly obese›, ‹happy fat “Bubba›, ‹transformed “Bubba›, ‹fat hypocrite›, ‹large woman ambiguity›, ‹weight gain women may experience after giving birth›, ‹I am so sick and tired of skinny people saying they are fat›, ‹woman inappropriately attacks fat men›, and ‹feminist inappropriately attacks fat woman›. [RQ2] Why is the term “fat” utilized in the political arena? Opponents in attack mode, to discredit a political figure, often use the term “fat”. It can imply that the person is “unhealthy” or has a character flaw. In the attack mode, critics can use “fat” as a tool to minimize a political figure’s legitimate and referent power. [RQ3] To what extent can one detect gender, national, or other differences in the manner in which the term “fat” is used in the political arena? In the United States, “obesity” is the dominant term, and is associated with the medicalisation of fat. Obesity is linked to health concerns, such as coronary heart disease. Weight bias and fat shaming seem to have a disproportionate impact on women. This study also has left many unanswered questions. Future research might fruitfully explore more of the international and intercultural differences in fat framing, as well as the differences between the fat shaming of elites and the fat shaming of so-called ordinary citizens.References Anarie. “Sick and Tired.” 7 July 2013. 17 May 2015 ‹http://www.sparkpeople.com/ma/sick-of--thin-people-saying-they-are-fat!/1/1/31404459›. Blair, Kevin. “Rookie Robyn Lawley Is the First Plus-Size Model to Be Featured in the Sports Illustrated Swimsuit Issue.” 6 Feb. 2015. 22 Apr. 2015 ‹http://www.starpulse.com/news/Kevin_Blair/2015/02/06/rookie-robin-lawley-is-the-first-pluss›. Boudewyns, Vanessa, Monique Turner, and Ryan Paquin. “Shame-Free Guilt Appeals.” Psychology & Marketing 23 July 2013. doi: 10.1002/mar.20647. Bromley, Michael L. William Howard Taft and the First Motoring Presidency. Jefferson, NC: McFarland & Company, 2007. Capehart, Jonathan. “Chris Christie’s Dirty Image Problem.” 18 Feb. 2015. 22 Apr. 2015 ‹http://www.washingtonpost.com/blogs/post-partisan/wp/2015/02/18/chris-christies-dirty-image-problem/›.“Carla Bruni.” n.d. 22 Apr. 2015 ‹http://www.biography.com/people/carla-bruni-17183782›. Ceja, Berenice, and Karissa Valine. “Women Can’t Win: Gender Irony and the E-Politics of Food in The Biggest Loser.” Unpublished manuscript. Humboldt State University, 2015. “Chris Christie to Consider.” 17 April 2012. 22 Apr. 2015 ‹http://www.seeyounexttuesday.com-468›. Conason, Joe. “Bill Clinton Explains Why He Became a Vegan.” AARP The Magazine, Aug./Sep. 2013. 22 Apr. 2015 ‹http://www.aarp.org/health/healthy-living/info-08-2013/bill-clinton-vegan.html›. Engel, Meredith. “Lap Band Surgery.” New York Daily News. 24 Sep. 2014. 22 Apr. 2015 ‹http://www.nydailynews.com/life-style/health/lap-band-surgery-helped-chris-christie-article-1.1951266›. Entman, Robert M. “Framing Bias: Media in the Distribution of Power.” Journal of Communication 57 (2007): 163-173. Etymology Online. n.d. 22 Apr. 2015 ‹http://etymonline.com/›. Frenkiel, Olenka. “Forced to Be Fat.” The Sunday Mail (Queensland, Australia). 13 Nov. 2005: 64. Gaski, John. “Interrelations among a Channel Entity's Power Sources: Impact of the Expert, Referent, and Legitimate Power Sources.” Journal of Marketing Research 23 (Feb. 1986): 62-77. Hahn, Laura. “Irony and Food Politics.” Communication and Critical/Cultural Studies 12 Feb. 2015. doi: 10.1080/14791420.2015.1014185.“Julia Gillard.” n.d. 22 Apr. 2015 ‹http://en.wikipedia.org/wiki/Julia_Gillard›. Kain, Erik. “A History of Fat Presidents.” Forbes.com 28 Sep. 2011. 22 Apr. 2015 ‹http://www.forbes.com/sites/erikkain/2011/09/28/a-history-of-fat-presidents/›.Kim, Eun Kyung. “Carla Bruni on Media: They Get Really Nasty.” 22 Apr. 2015 ‹http://www.today.com/news/carla-bruni-media-they-get-really-nasty-6C9733510›. McCombs, Max, and S.I. Ghanem. “The Convergence of Agenda Setting and Framing.” In Stephen D. Reese, Oscar. H. Gandy, Jr., and August Grant (eds.), Framing Public Life: Perspectives on Media and Our Understanding of the Social World. Mahwah, NJ: Erlbaum, 2001. 67-83. Miller, Beth, and Jennifer Lundgren. “An Experimental Study on the Role of Weight Bias in Candidate Evaluation.” Obesity 18 (Apr. 2010): 712-718. Orth, Maureen. “Carla on a Hot Tin Roof.” Vanity Fair June 2013. 22 Apr. 2015 ‹http://www.vanityfair.com/hollywood/2013/06/carla-bruni-musical-career-album›. “President-Elect Bill Clinton Stops by a McDonalds.” n.d. 22 Apr. 2015 ‹https://screen.yahoo.com/clinton-mcdonalds-000000491.html›. Ramachandran, Ambady, and Chamukuttan Snehalatha. “The Rising Burden of Obesity in Asia.” Journal of Obesity (2010). doi: 10.1155/2010868573. 22 Apr. 2015 ‹http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939400/›.Reagan, Gillian. “Ex-Chubettes Unite! Former Fat Kids Let It All Out.” New York Observer 22 Apr. 2008. 22 Apr. 2015 ‹http://observer.com/2008/04/exchubettes-unite-former-fat-kids-let-it-all-out/›. “Rising Epidemic of Obesity in Asia.” News Medical 21 Feb. 2013. 23 Apr. 2015 ‹http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939400/›. Rothblum, Esther. “Why a Journal on Fat Studies?” Fat Studies 1 (2012): 3-5. Saguy, Abigail C., and Kevin W. Riley. “Weighing Both Sides: Morality, Mortality, and Framing Contests over Obesity.” Journal of Health Politics, Policy and Law 30.5 (2005): 869-921. Seo, Kiwon, James P. Dillard, and Fuyuan Shen. “The Effects of Message Framing and Visual Image on Persuasion. Communication Quarterly 61 (2013): 564-583. Shugart, Helene A. “Heavy Viewing: Emergent Frames in Contemporary News Coverage of Obesity.” Health Communication 26 (Oct./Nov. 2011): 635-648. Sobal, Jeffery. “The Medicalization and Demedicalization of Obesity.” Eating Agendas: Food and Nutrition as Social Problems. Ed. Jeffery Sobal and Donna Maurer. New York: Aldine de Gruyter, 1995. 67-90. Sonenshein, Julia. “Jennifer Lawrence Does More Harm than Good with Her ‘I’m Chubby’ Comments.” 3 Jan. 2014. 16 May 2015 ‹http://www.thegloss.com/2014/01/03/culture/jennifer-lawrence-fat-comments-body-image/#ixzz3aWTEg35U›. Strang, Fay. ”Carla Bruni Admits Used Therapy.” 3 May 2013. 22 Apr. 2015 ‹http://www.dailymail.co.uk/tvshowbiz/article-2318719/Carla-Bruni-admits-used-therapy-deal-comments-fat-giving-birth-forties.html›. “Taft Gained Peaks in Unusual Career.” The New York Times 9 March 1930. 22 Apr. 2015 ‹http://www.nytimes.com/learning/general/onthisday/bday/0915.html›. Vedantam, Shankar. “Clinton's Heart Bypass Surgery Called a Success.” Washington Post 7 Sep. 2004: A01. “William Howard Taft.” Whitehouse.com. n.d. 12 May 2015. Whisper. n.d. 16 May 2015 ‹https://sh.whisper/o5o8bf3810d45295605bce53f8082Db6ddb29/I-am-so-sick-and-tired-of-skinny-people-saying-that-they-are-fat›. “You’ve Got a Big Arse, Julia. Germaine Greer Advice for Julia Gillard.” Politics and Porn in a Post-Feminist World. 24 Aug. 2012. 22 Apr. 2015 ‹https://www.youtube.com/watch?v=8lFtww!D3ss›. See also: ‹http://www.smh.com.au/federal-politics/political-news/greer-defends-fat-arse-pm-comment-20120827-24x5i.html›.

Dear readers! We will celebrate the Taras Shevchenko Scientific Society’s 150th anniversary in December. This is the first global Ukrainian union of scientists, the multidisciplinary Academy of Sciences of the Ukrainian people, which laid the foundation for shaping and developing Ukrainian science in the world, serving Ukraine and preserving national identity. In addition, February 15, 2023, marked the 125th anniversary of the creation of the Medical Commission and the publication of the “Medical Collection”, which published contributions from medical specialists in Europe and all of Ukraine. This was the first professional organization of physicians and the first edition of their scientific works that disseminated the achievements of Ukrainian medical scientists and practicing physicians globally and advocated for international recognition of Ukrainian medical science. The Ukrainian Medical Society, created in Lviv in 1910, played a significant role in developing a national union of physicians and public health professionals. These two organizations together created the foundations for international recognition of the Ukrainian nation in the field of medicine and its entry into global scientific discourse. Over centuries, Ukraine’s medical scientists and professionals actively represented and continue to advocate for their country worldwide, especially in recent years, which have been a great test for our nation and state. For nine years, Ukraine has endured the conditions of an imperialistic war and full-scale invasion of our land brought on by the Russian Federation. Thanks to the falsehoods and insidious propaganda of the Russian Federation, from 2014 until early 2022, the world interpreted events in Ukraine in muted colors. Ukraine, at all levels of society and various professional bodies, including medical facilities, warned of future military consequences. During this period, the Moscow-Ukraine war impacted the activities of medical and public health organizations in Ukraine. At all international events, Ukrainian medical scientists and doctors showcased their national professional organizations, set up appropriate displays, actively used Ukrainian symbols, and presented reports and scientific developments specifically focused on the consequences of war, such as military injuries and psychological problems that affect the health of citizens, especially children, and clearly laid the blame at the feet of the enemy – the Russian Federation, which occupied parts of the territory of Ukraine and destroyed peaceful lives of our citizens. Many conferences devoted to military medicine were held in Ukraine. But the world did not react and remained silent, including medical and scientific organizations. After February 24, 2022, civilized nations of this world realized that the destruction of an entire country and its people by the Russian Empire in the center of Europe is a moral challenge to democratic principles, and such a war can threaten their own security as well. For the second consecutive year, Ukrainian medical professionals are living in the conditions of a large-scale war with the Russian Federation, which is destroying Ukraine, its children, and its people. Further occupation of Ukrainian territories in the north, south, and east has led to severe consequences: executions of civilians, torture chambers, rape, destruction and theft of people’s homes, destruction of schools, hospitals, and museums, and grain blackmail. Throughout Ukraine’s territory, there has been the bombing of residential buildings, medical facilities, preschool and school institutions, universities, cultural and historical buildings, destruction of bridges, power plants, oil refineries, and other critical infrastructure. At the end of February and the beginning of March 2022, the scientific community of Ukraine, in general, and the medical community, in particular, turned to the global community with appeals to support Ukraine in the fight against the evil empire and help Ukrainian refugee scientists who were forced to save their families and themselves from the savagery of the Russian onslaught [1]. So, on February 28, 2022, the Ukrainian Association of Immunologists and Allergists issued a video appeal to medical scientists around the world, including the Russian Federation, in the hope that these professionals might exert some influence on their politicians and the military of the Russian Federation, to help stop mass killings of innocent civilians and the destruction of our land and environment [2]. This appeal received the full support of our colleagues around the world, notably the European Academy of Allergy and Clinical Immunology (EAAKI), the World Association of Allergists (WAO), the European Federation of Immunological Societies (EFIS), and other professional societies. In contrast, Russian medical scientists proclaimed their approval of the “special military operation” in Ukraine conducted by their state, and university rectors even published an official letter of endorsement [3]. Physicians in many countries supported Ukraine practically and scientifically during this difficult time. For example, on March 10, 2022, the World Medical Association (WMA) and the Standing Committee of Physicians of Europe (CPME) created the Fund for Medical Aid to Ukraine. The first humanitarian medical aid arrived in Ukraine at the end of March 2022, which has continued to this point [4]. The European Commission launched the portal “European Research Area for Ukraine” (ERA4Ukraine). The ERA4Ukraine initiative provides an opportunity to support Ukrainian scientists, including physicians, constantly informing about existing opportunities at the European and national levels regarding grants, jobs, involvement in the implementation of new and ongoing research projects, provision of places to live, fi-nancial assistance, and so on. This aid is provided by 42 European countries. A public group of students and scientists from academic institutions in Europe disseminates information about opportunities for support at the university, national, and international levels for postgraduate students and scientists who are directly associated with academic institutions in Ukraine, including medical ones. The American-Ukrainian Foundation (USUF) from Washington has its representative office in Ukraine and provides targeted assistance based on evaluated and endorsed applications for the support of medical scientists. Science for Ukraine and SAVEUASTARTUP [5] are particularly active in helping scientists and physicians. It is important to attract support from foreign and international organizations for medical scientists who stay and work in Ukraine in the form of grants for research, high-value equipment, restoration of scientific and clinical medical infrastructure, expansion of access to information resources, and support in the publishing of scientific and medical reports. In this difficult time, the Shevchenko Society intensified its work, particularly the medical commission: it published targeted issues of the “Medical Sciences” journal focusing on topics addressing military medicine, held scientific conferences dedicated to military medicine and medical assistance to war victims, as well as patients with orphan diseases and those with primary immunodeficiencies. An important initiative and successful project of Canadian colleagues helped expand diagnostic opportunities for rheumatological patients and provided them with access to advanced biological therapies in wartime. During the war, the Federation of Public Medical Associations of Ukraine and the World Federation of Ukrainian Medical Societies joined the Union of European Medical Specialists (UEMS), the oldest and most influential medical union in the EU, to protect and promote the interests of physicians, to support and popularize the highest standards of medical education and quality of medical aid, which is a very important step on Ukraine’s way to the EU [6]. Several important scientific opportunities were made available for our physicians in various fields. These were supported by international professional organizations and provided the opportunity for free participation of our specialists in European and world conferences and congresses, open access to demonstrations of scientific events, free access to international scientometric databases, free or discounted printing of introductory professional journals, internships of our scientists, and training opportunities for students. Thus, medical libraries of Ukraine were able to provide users with open access to many scientific and informational resources: “BRITISH MEDICAL JOURNAL,” “SPRINGER NATURE,” “MC-GRAW HILL,” “SCOPUS,” “WEB OF SCIENCE,” “WOLTERS KLUWER,” “THIEME MEDICAL PUBLISHERS,” “EBSCO,” and “CAPSULE.” We are deeply grateful for our foreign colleagues’ “friendly shoulder” and sincere help to Ukrainian science. But this aid only mitigates the consequences of the savage war perpetrated by the Russian Federation. The primary problem clearly lies with the terrorist regime in the Kremlin, which militarizes all spheres of life, including science, and conducts hybrid information warfare with the whole world through the insidious use of science and medicine. Statements about “science outside of politics” and “science has no borders” are highly misleading because Russian science is working to support this terrible war and constitutes a weapon of this state. Each speech and published article is made “under the flag” of the Russian Federation and aims to demonstrate how they are still members of the international scientific community. Regrettably, this creates the appearance of the scientific community’s acceptance of terrorism and genocide committed by the Russian Federation in Ukraine. Scientists are not absolved of responsibility for the actions of the state where they live and work and support it. For Russian leaders, science is a powerful tool for achieving this goal [7]. The ruling elite, other war criminals and terrorists of the Russian state should be tried by special international courts [8], and Russian scientists should be morally and ethically held to account in the global scientific and professional community. It is also absolutely appropriate for countries that profess democracy and freedom to impose scientific sanctions. Moreover, in these circumstances, the sanctioning of scientists is fully compliant with the resolutions of the European Union [9] and the Congress of the United States of America [10]. Ukrainian scientists appeal to the international community to impose sanctions on Russian science [11], [12], [13] because it is in the interests of the Russian Federation to wage a protracted war, and they are successfully employing all possible human and financial resources [14]. The Federation of European Biochemical Societies, European Magnetism Association [15], Journal of Molecular Structure [16], and the Clarivate Company, which manages the Web of Science database, were noted for their worthy actions towards the scientists of the terrorist country – a complete refusal to cooperate with them. The “Open Letter of Ukrainian Scientists and the Diaspora” clearly indicates the actions that must be taken by the civilized scientific community that wants a normal future for our planet: - not to accept for consideration scientific publications originating from the Russian Federation in any scientific journal or conference proceeding; - stop all subscriptions made by scientific institutions of the Russian Federation to any scientific literature; - stop the access of scientific institutions from the Russian Federation to international research infrastructure, equipment, and scientific databases; - ban the sale of scientific instruments and consumables to the Russian Federation; - deprive scientific organizations of the Russian Federation and persons associated with them of access to any international funding for scientific research [17]. While this terrible war continues, it is necessary to maintain a united front in the international scientific community. We ask medical scientists to step up in opposition to Russian science, which will encourage a more rapid end to the war. It is in the interests of our common civilization and human values to defeat this empire of evil, which constantly strives to lull the world to sleep [18,19]. Only then can science and medicine solve the global problems of humanity, as was proclaimed by 177 Nobel laureates right after the war began.[20]. We ask every medical scientist in the world to make their choice so that our children and we can all have a civilized future that can enhance humanity’s spiritual and intellectual development. Glory to Ukraine!

The term “coffee palace” was primarily used in Australia to describe the temperance hotels that were built in the last decades of the 19th century, although there are references to the term also being used to a lesser extent in the United Kingdom (Denby 174). Built in response to the worldwide temperance movement, which reached its pinnacle in the 1880s in Australia, coffee palaces were hotels that did not serve alcohol. This was a unique time in Australia’s architectural development as the economic boom fuelled by the gold rush in the 1850s, and the demand for ostentatious display that gathered momentum during the following years, afforded the use of richly ornamental High Victorian architecture and resulted in very majestic structures; hence the term “palace” (Freeland 121). The often multi-storied coffee palaces were found in every capital city as well as regional areas such as Geelong and Broken Hill, and locales as remote as Maria Island on the east coast of Tasmania. Presented as upholding family values and discouraging drunkenness, the coffee palaces were most popular in seaside resorts such as Barwon Heads in Victoria, where they catered to families. Coffee palaces were also constructed on a grand scale to provide accommodation for international and interstate visitors attending the international exhibitions held in Sydney (1879) and Melbourne (1880 and 1888). While the temperance movement lasted well over 100 years, the life of coffee palaces was relatively short-lived. Nevertheless, coffee palaces were very much part of Australia’s cultural landscape. In this article, I examine the rise and demise of coffee palaces associated with the temperance movement and argue that coffee palaces established in the name of abstinence were modelled on the coffee houses that spread throughout Europe and North America in the 17th and 18th centuries during the Enlightenment—a time when the human mind could be said to have been liberated from inebriation and the dogmatic state of ignorance. The Temperance Movement At a time when newspapers are full of lurid stories about binge-drinking and the alleged ill-effects of the liberalisation of licensing laws, as well as concerns over the growing trend of marketing easy-to-drink products (such as the so-called “alcopops”) to teenagers, it is difficult to think of a period when the total suppression of the alcohol trade was seriously debated in Australia. The cause of temperance has almost completely vanished from view, yet for well over a century—from 1830 to the outbreak of the Second World War—the control or even total abolition of the liquor trade was a major political issue—one that split the country, brought thousands onto the streets in demonstrations, and influenced the outcome of elections. Between 1911 and 1925 referenda to either limit or prohibit the sale of alcohol were held in most States. While moves to bring about abolition failed, Fitzgerald notes that almost one in three Australian voters expressed their support for prohibition of alcohol in their State (145). Today, the temperance movement’s platform has largely been forgotten, killed off by the practical example of the United States, where prohibition of the legal sale of alcohol served only to hand control of the liquor traffic to organised crime. Coffee Houses and the Enlightenment Although tea has long been considered the beverage of sobriety, it was coffee that came to be regarded as the very antithesis of alcohol. When the first coffee house opened in London in the early 1650s, customers were bewildered by this strange new drink from the Middle East—hot, bitter, and black as soot. But those who tried coffee were, reports Ellis, soon won over, and coffee houses were opened across London, Oxford, and Cambridge and, in the following decades, Europe and North America. Tea, equally exotic, entered the English market slightly later than coffee (in 1664), but was more expensive and remained a rarity long after coffee had become ubiquitous in London (Ellis 123-24). The impact of the introduction of coffee into Europe during the seventeenth century was particularly noticeable since the most common beverages of the time, even at breakfast, were weak “small beer” and wine. Both were safer to drink than water, which was liable to be contaminated. Coffee, like beer, was made using boiled water and, therefore, provided a new and safe alternative to alcoholic drinks. There was also the added benefit that those who drank coffee instead of alcohol began the day alert rather than mildly inebriated (Standage 135). It was also thought that coffee had a stimulating effect upon the “nervous system,” so much so that the French called coffee une boisson intellectuelle (an intellectual beverage), because of its stimulating effect on the brain (Muskett 71). In Oxford, the British called their coffee houses “penny universities,” a penny then being the price of a cup of coffee (Standage 158). Coffee houses were, moreover, more than places that sold coffee. Unlike other institutions of the period, rank and birth had no place (Ellis 59). The coffee house became the centre of urban life, creating a distinctive social culture by treating all customers as equals. Egalitarianism, however, did not extend to women—at least not in London. Around its egalitarian (but male) tables, merchants discussed and conducted business, writers and poets held discussions, scientists demonstrated experiments, and philosophers deliberated ideas and reforms. For the price of a cup (or “dish” as it was then known) of coffee, a man could read the latest pamphlets and newsletters, chat with other patrons, strike business deals, keep up with the latest political gossip, find out what other people thought of a new book, or take part in literary or philosophical discussions. Like today’s Internet, Twitter, and Facebook, Europe’s coffee houses functioned as an information network where ideas circulated and spread from coffee house to coffee house. In this way, drinking coffee in the coffee house became a metaphor for people getting together to share ideas in a sober environment, a concept that remains today. According to Standage, this information network fuelled the Enlightenment (133), prompting an explosion of creativity. Coffee houses provided an entirely new environment for political, financial, scientific, and literary change, as people gathered, discussed, and debated issues within their walls. Entrepreneurs and scientists teamed up to form companies to exploit new inventions and discoveries in manufacturing and mining, paving the way for the Industrial Revolution (Standage 163). The stock market and insurance companies also had their birth in the coffee house. As a result, coffee was seen to be the epitome of modernity and progress and, as such, was the ideal beverage for the Age of Reason. By the 19th century, however, the era of coffee houses had passed. Most of them had evolved into exclusive men’s clubs, each geared towards a certain segment of society. Tea was now more affordable and fashionable, and teahouses, which drew clientele from both sexes, began to grow in popularity. Tea, however, had always been Australia’s most popular non-alcoholic drink. Tea (and coffee) along with other alien plants had been part of the cargo unloaded onto Australian shores with the First Fleet in 1788. Coffee, mainly from Brazil and Jamaica, remained a constant import but was taxed more heavily than tea and was, therefore, more expensive. Furthermore, tea was much easier to make than coffee. To brew tea, all that is needed is to add boiling water, coffee, in contrast, required roasting, grinding and brewing. According to Symons, until the 1930s, Australians were the largest consumers of tea in the world (19). In spite of this, and as coffee, since its introduction into Europe, was regarded as the antidote to alcohol, the temperance movement established coffee palaces. In the early 1870s in Britain, the temperance movement had revived the coffee house to provide an alternative to the gin taverns that were so attractive to the working classes of the Industrial Age (Clarke 5). Unlike the earlier coffee house, this revived incarnation provided accommodation and was open to men, women and children. “Cheap and wholesome food,” was available as well as reading rooms supplied with newspapers and periodicals, and games and smoking rooms (Clarke 20). In Australia, coffee palaces did not seek the working classes, as clientele: at least in the cities they were largely for the nouveau riche. Coffee Palaces The discovery of gold in 1851 changed the direction of the Australian economy. An investment boom followed, with an influx of foreign funds and English banks lending freely to colonial speculators. By the 1880s, the manufacturing and construction sectors of the economy boomed and land prices were highly inflated. Governments shared in the wealth and ploughed money into urban infrastructure, particularly railways. Spurred on by these positive economic conditions and the newly extended inter-colonial rail network, international exhibitions were held in both Sydney and Melbourne. To celebrate modern technology and design in an industrial age, international exhibitions were phenomena that had spread throughout Europe and much of the world from the mid-19th century. According to Davison, exhibitions were “integral to the culture of nineteenth century industrialising societies” (158). In particular, these exhibitions provided the colonies with an opportunity to demonstrate to the world their economic power and achievements in the sciences, the arts and education, as well as to promote their commerce and industry. Massive purpose-built buildings were constructed to house the exhibition halls. In Sydney, the Garden Palace was erected in the Botanic Gardens for the 1879 Exhibition (it burnt down in 1882). In Melbourne, the Royal Exhibition Building, now a World Heritage site, was built in the Carlton Gardens for the 1880 Exhibition and extended for the 1888 Centennial Exhibition. Accommodation was required for the some one million interstate and international visitors who were to pass through the gates of the Garden Palace in Sydney. To meet this need, the temperance movement, keen to provide alternative accommodation to licensed hotels, backed the establishment of Sydney’s coffee palaces. The Sydney Coffee Palace Hotel Company was formed in 1878 to operate and manage a number of coffee palaces constructed during the 1870s. These were designed to compete with hotels by “offering all the ordinary advantages of those establishments without the allurements of the drink” (Murdoch). Coffee palaces were much more than ordinary hotels—they were often multi-purpose or mixed-use buildings that included a large number of rooms for accommodation as well as ballrooms and other leisure facilities to attract people away from pubs. As the Australian Town and Country Journal reveals, their services included the supply of affordable, wholesome food, either in the form of regular meals or occasional refreshments, cooked in kitchens fitted with the latest in culinary accoutrements. These “culinary temples” also provided smoking rooms, chess and billiard rooms, and rooms where people could read books, periodicals and all the local and national papers for free (121). Similar to the coffee houses of the Enlightenment, the coffee palaces brought businessmen, artists, writers, engineers, and scientists attending the exhibitions together to eat and drink (non-alcoholic), socialise and conduct business. The Johnson’s Temperance Coffee Palace located in York Street in Sydney produced a practical guide for potential investors and businessmen titled International Exhibition Visitors Pocket Guide to Sydney. It included information on the location of government departments, educational institutions, hospitals, charitable organisations, and embassies, as well as a list of the tariffs on goods from food to opium (1–17). Women, particularly the Woman’s Christian Temperance Union (WCTU) were a formidable force in the temperance movement (intemperance was generally regarded as a male problem and, more specifically, a husband problem). Murdoch argues, however, that much of the success of the push to establish coffee palaces was due to male politicians with business interests, such as the one-time Victorian premiere James Munro. Considered a stern, moral church-going leader, Munro expanded the temperance movement into a fanatical force with extraordinary power, which is perhaps why the temperance movement had its greatest following in Victoria (Murdoch). Several prestigious hotels were constructed to provide accommodation for visitors to the international exhibitions in Melbourne. Munro was responsible for building many of the city’s coffee palaces, including the Victoria (1880) and the Federal Coffee Palace (1888) in Collins Street. After establishing the Grand Coffee Palace Company, Munro took over the Grand Hotel (now the Windsor) in 1886. Munro expanded the hotel to accommodate some of the two million visitors who were to attend the Centenary Exhibition, renamed it the Grand Coffee Palace, and ceremoniously burnt its liquor licence at the official opening (Murdoch). By 1888 there were more than 50 coffee palaces in the city of Melbourne alone and Munro held thousands of shares in coffee palaces, including those in Geelong and Broken Hill. With its opening planned to commemorate the centenary of the founding of Australia and the 1888 International Exhibition, the construction of the Federal Coffee Palace, one of the largest hotels in Australia, was perhaps the greatest monument to the temperance movement. Designed in the French Renaissance style, the façade was embellished with statues, griffins and Venus in a chariot drawn by four seahorses. The building was crowned with an iron-framed domed tower. New passenger elevators—first demonstrated at the Sydney Exhibition—allowed the building to soar to seven storeys. According to the Federal Coffee Palace Visitor’s Guide, which was presented to every visitor, there were three lifts for passengers and others for luggage. Bedrooms were located on the top five floors, while the stately ground and first floors contained majestic dining, lounge, sitting, smoking, writing, and billiard rooms. There were electric service bells, gaslights, and kitchens “fitted with the most approved inventions for aiding proficients [sic] in the culinary arts,” while the luxury brand Pears soap was used in the lavatories and bathrooms (16–17). In 1891, a spectacular financial crash brought the economic boom to an abrupt end. The British economy was in crisis and to meet the predicament, English banks withdrew their funds in Australia. There was a wholesale collapse of building companies, mortgage banks and other financial institutions during 1891 and 1892 and much of the banking system was halted during 1893 (Attard). Meanwhile, however, while the eastern States were in the economic doldrums, gold was discovered in 1892 at Coolgardie and Kalgoorlie in Western Australia and, within two years, the west of the continent was transformed. As gold poured back to the capital city of Perth, the long dormant settlement hurriedly caught up and began to emulate the rest of Australia, including the construction of ornately detailed coffee palaces (Freeman 130). By 1904, Perth had 20 coffee palaces. When the No. 2 Coffee Palace opened in Pitt Street, Sydney, in 1880, the Australian Town and Country Journal reported that coffee palaces were “not only fashionable, but appear to have acquired a permanent footing in Sydney” (121). The coffee palace era, however, was relatively short-lived. Driven more by reformist and economic zeal than by good business sense, many were in financial trouble when the 1890’s Depression hit. Leading figures in the temperance movement were also involved in land speculation and building societies and when these schemes collapsed, many, including Munro, were financially ruined. Many of the palaces closed or were forced to apply for liquor licences in order to stay afloat. Others developed another life after the temperance movement’s influence waned and the coffee palace fad faded, and many were later demolished to make way for more modern buildings. The Federal was licensed in 1923 and traded as the Federal Hotel until its demolition in 1973. The Victoria, however, did not succumb to a liquor licence until 1967. The Sydney Coffee Palace in Woolloomooloo became the Sydney Eye Hospital and, more recently, smart apartments. Some fine examples still survive as reminders of Australia’s social and cultural heritage. The Windsor in Melbourne’s Spring Street and the Broken Hill Hotel, a massive three-story iconic pub in the outback now called simply “The Palace,” are some examples. Tea remained the beverage of choice in Australia until the 1950s when the lifting of government controls on the importation of coffee and the influence of American foodways coincided with the arrival of espresso-loving immigrants. As Australians were introduced to the espresso machine, the short black, the cappuccino, and the café latte and (reminiscent of the Enlightenment), the post-war malaise was shed in favour of the energy and vigour of modernist thought and creativity, fuelled in at least a small part by caffeine and the emergent café culture (Teffer). Although the temperance movement’s attempt to provide an alternative to the ubiquitous pubs failed, coffee has now outstripped the consumption of tea and today’s café culture ensures that wherever coffee is consumed, there is the possibility of a continuation of the Enlightenment’s lively discussions, exchange of news, and dissemination of ideas and information in a sober environment. References Attard, Bernard. “The Economic History of Australia from 1788: An Introduction.” EH.net Encyclopedia. 5 Feb. (2012) ‹http://eh.net/encyclopedia/article/attard.australia›. Blainey, Anna. “The Prohibition and Total Abstinence Movement in Australia 1880–1910.” Food, Power and Community: Essays in the History of Food and Drink. Ed. Robert Dare. Adelaide: Wakefield Press, 1999. 142–52. Boyce, Francis Bertie. “Shall I Vote for No License?” An address delivered at the Convention of the Parramatta Branch of New South Wales Alliance, 3 September 1906. 3rd ed. Parramatta: New South Wales Alliance, 1907. Clarke, James Freeman. Coffee Houses and Coffee Palaces in England. Boston: George H. Ellis, 1882. “Coffee Palace, No. 2.” Australian Town and Country Journal. 17 Jul. 1880: 121. Davison, Graeme. “Festivals of Nationhood: The International Exhibitions.” Australian Cultural History. Eds. S. L. Goldberg and F. B. Smith. Cambridge: Cambridge UP, 1989. 158–77. Denby, Elaine. Grand Hotels: Reality and Illusion. London: Reaktion Books, 2002. Ellis, Markman. The Coffee House: A Cultural History. London: Weidenfeld & Nicolson, 2004. Federal Coffee Palace. The Federal Coffee Palace Visitors’ Guide to Melbourne, Its Suburbs, and Other Parts of the Colony of Victoria: Views of the Principal Public and Commercial Buildings in Melbourne, With a Bird’s Eye View of the City; and History of the Melbourne International Exhibition of 1880, etc. Melbourne: Federal Coffee House Company, 1888. Fitzgerald, Ross, and Trevor Jordan. Under the Influence: A History of Alcohol in Australia. Sydney: Harper Collins, 2009. Freeland, John. The Australian Pub. Melbourne: Sun Books, 1977. Johnson’s Temperance Coffee Palace. International Exhibition Visitors Pocket Guide to Sydney, Restaurant and Temperance Hotel. Sydney: Johnson’s Temperance Coffee Palace, 1879. Mitchell, Ann M. “Munro, James (1832–1908).” Australian Dictionary of Biography. Canberra: National Centre of Biography, Australian National U, 2006-12. 5 Feb. 2012 ‹http://adb.anu.edu.au/biography/munro-james-4271/text6905›. Murdoch, Sally. “Coffee Palaces.” Encyclopaedia of Melbourne. Eds. Andrew Brown-May and Shurlee Swain. 5 Feb. 2012 ‹http://www.emelbourne.net.au/biogs/EM00371b.htm›. Muskett, Philip E. The Art of Living in Australia. New South Wales: Kangaroo Press, 1987. Standage, Tom. A History of the World in 6 Glasses. New York: Walker & Company, 2005. Sydney Coffee Palace Hotel Company Limited. Memorandum of Association of the Sydney Coffee Palace Hotel Company, Ltd. Sydney: Samuel Edward Lees, 1879. Symons, Michael. One Continuous Picnic: A Gastronomic History of Australia. Melbourne: Melbourne UP, 2007. Teffer, Nicola. Coffee Customs. Exhibition Catalogue. Sydney: Customs House, 2005.

Photo ID 158378414 © Eduard Muzhevskyi | Dreamstime.com ABSTRACT There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities. INTRODUCTION Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve. BACKGROUND Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes.[1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research.[2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.”[3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops.[4] Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture. I. Global Cultural Perspective of Embryonic Stem Cells Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense,[5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research.[6] Consequently, global engagement in ESC research depends on social-cultural acceptability. a. US and Rights-Based Cultures In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism,[7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.”[8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed.[9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field.[10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture.[11] b. Ubuntu and Collective Cultures African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama, which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,”[12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth.[13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole. Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value.[14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society. Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.”[15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail. Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable.[16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus[17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines.[18] Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim.[19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research.[20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF. Their use is conditioned on consent, and available only to married couples.[21] The community's receptiveness to stem cell research depends on including communitarian African ethics. c. Asia Some Asian countries also have a collective model of ethics and decision making.[22] In China, the ethics model promotes a sincere respect for life or human dignity,[23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life.[25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research.[26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions.[27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency.[28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021.[29] However, issues still need to be addressed in implementing effective IRB review and approval procedures. The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy,[30] research ethics should also adapt to ensure respect for the values of its represented peoples. Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies.[31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells.[32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval,[33] and in another instance, the oocyte source was unclear and possibly violated ethical standards.[34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust. d. Middle East Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells,[35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research.[36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors.[37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so.[38] Jordan has a positive research ethics culture.[39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial.[40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation.[41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.”[42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes. e. Europe In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected.[43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44] For example, in Germany, Lebenzusammenhang, or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.”[45] Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount.[46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007.[47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization.[48] Spain’s approach differs still, with a comprehensive regulatory framework.[49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility.[50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices.[51] II. Religious Perspectives on ESC Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives. The Qur'an states: “And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.”[52] Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception.[53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible.[54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research.[55] In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided.[56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden.[57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all.[58] Acceptance varies on applied beliefs and interpretations. Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero,[59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all.[60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime.[61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit.[62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets.[63] Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life.[64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception:[65] “If she is found pregnant, until the fortieth day it is mere fluid,”[66] Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation.[67] Stem cell research is accepted due to application of these religious laws. We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory, which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions.[68] We only wish to show that the interaction with morality varies between cultures and countries. III. A Flexible Ethical Approach The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities. While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe.[69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation. For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent.[70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context,[71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders. This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research. Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values.[72] An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions.[73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion. IV. Concerns Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values.[74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions. Other concerns include medical tourism, which may promote health inequities.[75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments.[76] For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.”[77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices.[78] The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.”[79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds.[80] CONCLUSION While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research. For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society. This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model. - [1] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice. Orthopedic reviews, 14(3), 37498. https://doi.org/10.52965/001c.37498 [2] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice. Orthopedic reviews, 14(3), 37498. https://doi.org/10.52965/001c.37498 [3] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities. International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk; Kimmelman, J., Hyun, I., Benvenisty, N. et al. Policy: Global standards for stem-cell research. Nature 533, 311–313 (2016). https://doi.org/10.1038/533311a [4] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities. International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk [5] Concerning the moral philosophies of stem cell research, our paper does not posit a personal moral stance nor delve into the “when” of human life begins. To read further about the philosophical debate, consider the following sources: Sandel M. J. (2004). Embryo ethics--the moral logic of stem-cell research. The New England journal of medicine, 351(3), 207–209. https://doi.org/10.1056/NEJMp048145; George, R. P., & Lee, P. (2020, September 26). Acorns and Embryos. The New Atlantis. https://www.thenewatlantis.com/publications/acorns-and-embryos; Sagan, A., & Singer, P. (2007). The moral status of stem cells. Metaphilosophy, 38(2/3), 264–284. http://www.jstor.org/stable/24439776; McHugh P. R. (2004). Zygote and "clonote"--the ethical use of embryonic stem cells. The New England journal of medicine, 351(3), 209–211. https://doi.org/10.1056/NEJMp048147; Kurjak, A., & Tripalo, A. (2004). The facts and doubts about beginning of the human life and personality. Bosnian journal of basic medical sciences, 4(1), 5–14. https://doi.org/10.17305/bjbms.2004.3453 [6] Vazin, T., & Freed, W. J. (2010). Human embryonic stem cells: derivation, culture, and differentiation: a review. Restorative neurology and neuroscience, 28(4), 589–603. https://doi.org/10.3233/RNN-2010-0543 [7] Socially, at its core, the Western approach to ethics is widely principle-based, autonomy being one of the key factors to ensure a fundamental respect for persons within research. For information regarding autonomy in research, see: Department of Health, Education, and Welfare, & National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978). The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research.; For a more in-depth review of autonomy within the US, see: Beauchamp, T. L., & Childress, J. F. (1994). Principles of Biomedical Ethics. Oxford University Press. [8] Sherley v. Sebelius, 644 F.3d 388 (D.C. Cir. 2011), citing 45 C.F.R. 46.204(b) and [42 U.S.C. § 289g(b)]. https://www.cadc.uscourts.gov/internet/opinions.nsf/6c690438a9b43dd685257a64004ebf99/$file/11-5241-1391178.pdf [9] Stem Cell Research Enhancement Act of 2005, H. R. 810, 109th Cong. (2001). https://www.govtrack.us/congress/bills/109/hr810/text; Bush, G. W. (2006, July 19). Message to the House of Representatives. National Archives and Records Administration. https://georgewbush-whitehouse.archives.gov/news/releases/2006/07/20060719-5.html [10] National Archives and Records Administration. (2009, March 9). Executive order 13505 -- removing barriers to responsible scientific research involving human stem cells. National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/removing-barriers-responsible-scientific-research-involving-human-stem-cells [11] Hurlbut, W. B. (2006). Science, Religion, and the Politics of Stem Cells. Social Research, 73(3), 819–834. http://www.jstor.org/stable/40971854 [12] Akpa-Inyang, Francis & Chima, Sylvester. (2021). South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study. BMC Medical Ethics. 22. 10.1186/s12910-021-00678-4. [13] Source for further reading: Tangwa G. B. (2007). Moral status of embryonic stem cells: perspective of an African villager. Bioethics, 21(8), 449–457. https://doi.org/10.1111/j.1467-8519.2007.00582.x , see also Mnisi, F. M. (2020). An African analysis based on ethics of Ubuntu - are human embryonic stem cell patents morally justifiable? African Insight, 49(4). [14] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [15] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [16] Jackson, C.S., Pepper, M.S. Opportunities and barriers to establishing a cell therapy programme in South Africa. Stem Cell Res Ther 4, 54 (2013). https://doi.org/10.1186/scrt204; Pew Research Center. (2014, May 1). Public health a major priority in African nations. Pew Research Center’s Global Attitudes Project. https://www.pewresearch.org/global/2014/05/01/public-health-a-major-priority-in-african-nations/ [17] Department of Health Republic of South Africa. (2021). Health Research Priorities (revised) for South Africa 2021-2024. National Health Research Strategy. https://www.health.gov.za/wp-content/uploads/2022/05/National-Health-Research-Priorities-2021-2024.pdf [18] Oosthuizen, H. (2013). Legal and Ethical Issues in Stem Cell Research in South Africa. In: Beran, R. (eds) Legal and Forensic Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32338-6_80, see also: Gaobotse G (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [19] United States Bureau of Citizenship and Immigration Services. (1998). Tunisia: Information on the status of Christian conversions in Tunisia. UNHCR Web Archive. https://webarchive.archive.unhcr.org/20230522142618/https://www.refworld.org/docid/3df0be9a2.html [20] Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [21] Kooli, C. Review of assisted reproduction techniques, laws, and regulations in Muslim countries. Middle East Fertil Soc J 24, 8 (2020). https://doi.org/10.1186/s43043-019-0011-0; Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [22] Pang M. C. (1999). Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Journal of medical ethics, 25(3), 247–253. https://doi.org/10.1136/jme.25.3.247 [23] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [24] Wang, Y., Xue, Y., & Guo, H. D. (2022). Intervention effects of traditional Chinese medicine on stem cell therapy of myocardial infarction. Frontiers in pharmacology, 13, 1013740. https://doi.org/10.3389/fphar.2022.1013740 [25] Li, X.-T., & Zhao, J. (2012). Chapter 4: An Approach to the Nature of Qi in TCM- Qi and Bioenergy. In Recent Advances in Theories and Practice of Chinese Medicine (p. 79). InTech. [26] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students. Stem cells international, 2021, 6667743. https://doi.org/10.1155/2021/6667743 [27] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students. Stem cells international, 2021, 6667743. https://doi.org/10.1155/2021/6667743 [28] Zhang, J. Y. (2017). Lost in translation? accountability and governance of Clinical Stem Cell Research in China. Regenerative Medicine, 12(6), 647–656. https://doi.org/10.2217/rme-2017-0035 [29] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [30] Chen, H., Wei, T., Wang, H. et al. Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017. BMC Public Health 22, 434 (2022). https://doi.org/10.1186/s12889-022-12839-0 [31] Azuma, K. Regulatory Landscape of Regenerative Medicine in Japan. Curr Stem Cell Rep 1, 118–128 (2015). https://doi.org/10.1007/s40778-015-0012-6 [32] Harris, R. (2005, May 19). Researchers Report Advance in Stem Cell Production. NPR. https://www.npr.org/2005/05/19/4658967/researchers-report-advance-in-stem-cell-production [33] Park, S. (2012). South Korea steps up stem-cell work. Nature. https://doi.org/10.1038/nature.2012.10565 [34] Resnik, D. B., Shamoo, A. E., & Krimsky, S. (2006). Fraudulent human embryonic stem cell research in South Korea: lessons learned. Accountability in research, 13(1), 101–109. https://doi.org/10.1080/08989620600634193. [35] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [36]Association for the Advancement of Blood and Biotherapies. https://www.aabb.org/regulatory-and-advocacy/regulatory-affairs/regulatory-for-cellular-therapies/international-competent-authorities/saudi-arabia [37] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [38] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics, 23(3), 260–268. https://doi.org/10.1111/dewb.12355; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know. Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know [39] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [40] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [41] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [42] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France. Biotechnology Law Report, 32(6), 349–356. https://doi.org/10.1089/blr.2013.9865 [45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf [47] Regulation of Stem Cell Research in Germany. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany [48] Regulation of Stem Cell Research in Finland. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland [49] Regulation of Stem Cell Research in Spain. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain [50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered: Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110. Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ... Revista do Colegio Brasileiro de Cirurgioes, 41(5), 374–377. https://doi.org/10.1590/0100-69912014005013 Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India. Routledge. For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe [51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights. Cultura (Iasi, Romania), 14(2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent? Research Ethics, 13(1), 23-41. https://doi.org/10.1177/1747016116650235 [52] The Qur'an (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23 [53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life. Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/ [54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics, 31:399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386 [55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association, 12(4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf. [56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52. https://doi.org/10.5372/1905-7415.0801.260 [57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation. Journal of Religion and Health, 30(1), 35–41. http://www.jstor.org/stable/27510629; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva. A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm [59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. ((King James Bible. (1999). Oxford University Press. (original work published 1769)) Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…” In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David. Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…” These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth. [60] It should be noted that abortion is not supported as well. [61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day. Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html [62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells. Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology. Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf. [63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed. Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/ [64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. Journal of halacha and contemporary society, (43), 49–68.; Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [65] Schenker J. G. (2008). The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law). Journal of assisted reproduction and genetics, 25(6), 271–276. https://doi.org/10.1007/s10815-008-9221-6 [66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet). Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en [67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [68] Gert, B. (2007). Common morality: Deciding what to do. Oxford Univ. Press. [69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association.; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. U.S. Department of Health and Human Services. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html [70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes. Journal of assisted reproduction and genetics, 35(7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine, 10(12), 1715–1716. https://doi.org/10.1002/sctm.21-0234 [71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA. Reproductive biomedicine online, 18(5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8 [72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa. Clinical trials (London, England), 3(3), 306–313. https://doi.org/10.1191/1740774506cn150oa [73] Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Georgetown University Press, 2012. [74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity. Research Ethics, 14(3), 1-17. https://doi.org/10.1177/1747016117739939 [75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry. Voices in Bioethics, 8. https://doi.org/10.52214/vib.v8i.9894 [76] Stem Cell Tourism: False Hope for Real Money. Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism, See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis. Voices in Bioethics, 3. https://doi.org/10.7916/vib.v3i.6027 [77]Song, P. (2011) The proliferation of stem cell therapies in post-Mao China: problematizing ethical regulation, New Genetics and Society, 30:2, 141-153, DOI: 10.1080/14636778.2011.574375 [78] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [79] International Society for Stem Cell Research. (2024). Standards in stem cell research. International Society for Stem Cell Research. https://www.isscr.org/guidelines/5-standards-in-stem-cell-research [80] Benjamin, R. (2013). People’s science bodies and rights on the Stem Cell Frontier. Stanford University Press.