Artículos de revistas sobre el tema "Internship programs – economic aspects – united states"

Music therapy education is unique in that it includes academic coursework, practicum, and internship. Due to the gap in the literature regarding students’ satisfaction, this is an important topic that must be assessed to improve future music therapy education. The purpose of this exploratory survey study was to investigate the educational satisfaction of final year undergraduate music therapy students, music therapy students who have finished undergraduate coursework but not started internship or are in a master’s equivalency music therapy program one or two semesters immediately before internship in the United States of America. The aspects of students’ satisfaction studied include academic experiences (e.g., coursework, practicum, internship), interactions with faculty/supervisors, and available resources (e.g., information, financial aid, availability of instruments). Findings showed that students were satisfied with their university experience, especially with the diverse client experiences and clinical work-related coursework. The largest concerns were excessive non-music therapy related courses, limited practicum supervision, and overabundance of outside work which led to students feeling overwhelmed. As the COVID-19 pandemic may have affected the level of participation and respondents’ responses, I will use this study as a baseline by which to compare the results of a future replication study. Educators may be able to use the findings when creating or making changes to educational policies, which may lead to higher students’ satisfaction.

The article is devoted to the political analysis of the tools used by the United States to withdraw Ukraine from the sphere of economic influence of Russia. Based on the analysis of the materials of individual projects and scientific publications, the authors come to conclusion that by 2002 the expected change of generations of political scientists and economists did not take place in the USA. The tone within the Ukrainian issue continued to be set by the veterans of the Cold War and the financial structures behind them. The fragmentation of the activities of the United States Agency for International Development (USAID) on the eve of the Ukrainian parliamentary elections made it possible to characterize the network principle of the distribution of financial resources allocated for the implementation of pre-planned framework political programs. It is noted that the American economic component was reliably hidden in the mechanisms of the formation of Ukrainian pre-election political blocs.

The global pandemic has affected the entire world from all kinds of aspects. People were forced to stay up home to avoid the virus, which led to the great depression both economically and culturally. A great number of small and medium-sized enterprises closed down on the economic side. For the cultural field, one of the most affected fields tends to be education. Because of the worldwide pandemic, most schools were shut down and students can only have classes through online access. Under this circumstance, various education-related issues arose. Almost all the Chinese international students were forced to go back to China or quarantined in the foreign culture due to the restrictions of travelling. Many Chinese international students happened to be stuck in negative emotions, which can be concluded as a lack of sense of belonging during these turbulent times. The lack of sense of belonging can mainly originate from three factors: socialization, academic performance, and internship application. This article will first look into the troubles caused by these three main factors and then develop targeted solutions to remit the condition and improve Chinese international students’ sense of belonging in the United States.

The pandemic caused by the spread of the novel coronavirus has presented challenges to the international community that it has never faced before. The high rate of spread of the infection and the economic, social and political challenges associated with it have pushed individual states and international organisations to the limit in proposing the most effective methods to combat the pandemic. The article examines various examples of government support for vaccine development programs in the United States, the European Union, the United Kingdom, China and Russia, as well as the specifics of using COVID-19 vaccination programs in these countries. Based on the data presented in the article, it is concluded that government support for these programs become one of the most effective ways to increase the availability of vaccines for large-scale vaccination of citizens. Particular attention is paid to aspects of the regulatory environment for vaccine approval in a time of pandemic, the financing of vaccination programs, and international cooperation at WHO and UN level to counter the novel coronavirus pandemic. Additionally, the article analyzes contracts for the supply of vaccines in the United States, the European Union and the United Kingdom. Based on the data presented in the article, a conclusion is drawn about the possible reasons for the delays in the supply of vaccines under contracts concluded by the countries of the European Union. The results of this study can be used in the future to plan other vaccine development programs and strengthen government policy in the field of combating infectious diseases, strengthening public and private partnerships in the health sector.

The current complex phenomenon of labor precarization has been extremely actively developed in the United States of America, especially over the past two decades. Undoubtedly, the main reason for the increase in the share of the precariat in the labor market is economic development based on a change in technological patterns, which is characterized in the capitalist economy, on the one hand, by an increase in the role of human capital, and on the other hand, by its overconcentration, including at the intra-country regional level. The emergence and development of a new form of labor relations invariably leads to the need to revise social policy. The regional aspects of the implementation of social programs considered in this paper, which are to some extent capable of mitigating the consequences of the instability of employment and the insecurity of labor relations in the United States for the period 2007–2020, serve as one of the explanations for the intensifying processes of regionalization observed in the country. The result of the study was the identification of two main aspects of the implementation of social programs at the level of subregions and individual states of the country. The first reflects the further regionalization of federal relations in terms of social support for the population, carried out without taking into account the growing precarization of labor in regions with the largest share of the precariat among the employed. The second aspect, which takes into account the structural features of the distribution of funding in the areas of education, health care and social protection of the population, reveals the authorities’ attempt to carry out balanced social programming in the subregions that are potential centers of the “new industrialization” of the American economy. This approach is aimed at preserving and qualitatively developing the human capital of the region by smoothing out the negative consequences of labor precarization.

During my years of working within the confines of the private country club world, one educational issue is clear in my mind and needs to be addressed. It has been my observation, that, many hospitality students in the United States discover too late that they were not suited to a career in the hospitality field because they were improperly guided by instructors as to the realities they will encounter in this profession. In considering a career in hospitality management one must first remember it is seldom glamorous. It is not at all like the popular television show “Hotel.” One must combine theoretical textbook knowledge and an equal amount of time working within the everyday structure of a properly-run establishment, be it a private country club, hotel or a fine restaurant. Then and only then can one truly assess if he or she is heading in the right direction. It is time for us in the United States to follow the practices that are so successful all over Europe. There greater emphasis is placed on job training for all students taking courses in the hospitality field, regardless of how high their goals are. The approach fosters the idea of dividing each semester equally between the classroom and a working establishment. By using this method, we give students the opportunity to see the good and bad aspects of the profession and also give them the chance to decide early, perhaps within the first year, if this is the type of career they really want to pursue. The practice has been observed at some of the U.S. post-secondary hospitality programs to provide students with a theoretical orientation and then send them out into the work force with the illusion that they are totally capable of earning and demanding high salaries. Hospitality employers today are seeking students with a combination of theoretical and “quality” practical training which provides a basis of knowledge on which the employing company can build. Only the internship experience can teach a student how to cultivate the wonderful gifts of communication, tolerance and interpersonal skills. While textbook knowledge is of the utmost importance, it must be coupled with on-the-job training to provide the student with a suitable entre to a career in hospitality, one which will hopefully be both stimulating and rewarding. The key to fulfilling this goal is through the use of a supervised, professional internship experience for students in post-secondary hospitality programs. Only this type vehicle affords them the best opportunity of applying the theory learned in the classroom to the practical working environment.

Purpose How will schools reinvent themselves to respond to the technological and economic demands of the mid-21st century? In response to the demands, a school district in the western region of the United States implemented a model patterned after the franchise business model. Two effective principals were tasked to simultaneously lead multiple high-risk elementary schools and to replicate the success they achieved from their flagship school. This paper aims to introduce the concept of franchise model schools. It also examines the innovative impact of the model as it relates to student achievement and leadership development. Design/methodology/approach The methodology for this research was a case study approach. This case study sought to examine teacher and school leaders' perceptions of the implementation of the franchise model school framework. The setting of this case study was five franchise model elementary schools in the western region of the United States. Participants of this study included 37 grade-level teacher leaders and 133 teacher respondents to an online questionnaire. Semi-structured focus group interviews were conducted with grade-level teacher leaders at each participating school. State and site-based academic assessments were also collected and analyzed. Findings Due to the novelty of the franchise model schools, the long-term effects on student outcomes are not yet discernable. Interviews with the teachers and school leaders revealed that staff morale was low after the initial implementation of the model and student assessment scores also decreased after the first year of implementation. The current pattern of student assessment revealed a decrease after the first year of implementation and a small increase after the second year. Findings revealed assistant principals within the model increased their leadership capacity and efficacy. Assistant principals felt confident in their ability to lead a school as principals. Originality/value The implementation of franchise model schools is unique to the United States education system. Minimal research exists which examines the novelty and impact of franchise model schools. This case study has the potential to inform school systems, policy-makers and educator preparation programs of new practices and innovative structures that can help meet the demands of obtaining a mid-21st-century education. For educational leadership preparation programs, the use of this model provides new practicum and internship opportunities for aspiring school administrators.

Objective: Despite the availability of high-paying, high-demand careers, few women and students from underrepresented racial and ethnic minorities enter undergraduate programs understanding what the geosciences are and associated available career opportunities. This problem is compounded for students from backgrounds underrepresented in the United States. High-impact practices, such as mentoring, internships, undergraduate research experiences, and cohort-building, increase recruitment and retention of underrepresented students in science, technology, engineering, and math at 4-year institutions. What is not yet clear is the impact these interventions have on underrepresented students at two-year colleges, where the STEM pathway has become a main postsecondary school entry point for these students due to the affordability, flexibility, and academic support provided. Therefore, we designed, implemented, and researched a year-long program providing underrepresented students at a two-year college exposure to several of these experiences. Methods: We interviewed program participants about their perceptions and experiences in the program. Analysis proceeded using constant comparison. Results: Participants reported benefits from networking opportunities, gains in confidence, and gains in job skills, while some reported challenges for participation such as communication and time expectation conflicts; participants also struggled to balance the program with employment needs on top of school requirements. Different aspects of the program benefited different students, suggesting that all of these experiences could support recruitment and foster interest in geoscience for underrepresented students at two-year colleges. Conclusion: We conclude with implications for future research, program enhancements, and time constraint and mentoring needs related to characteristics of two-year college students.

Copyright industries represent an important part of the developed economies. The effective protection of copyright fulfills an important role in the advancement of innovation and economic development. However, in the digital economy, the protection of copyrighted works poses numerous and very difficult challenges. The protected works usually targeted by criminals are computer programs, motion pictures, video games, and musical compositions. The estimated or actual harm to copyright owners can amount to billions of dollars. Moreover, these offenses are sometimes perpetrated in connection with other crimes, such as conspiracy to commit racketeering or money laundering. This paper argues that criminal enforcement of copyright can be an important safeguard of economic and information security interests. The paper discusses essential aspects regarding the criminal protection of copyright in the United States. Based on a theoretically-informed, yet empirically-driven approach, which takes into account a large corpus of data, consisting mostly of cases brought to courts of law, the paper discusses the main aspects of the phenomenon. Finally, the paper proposes a number of measures that would improve the protection copyrighted works. Keywords: Copyright, Economic Development, Cybercrime, Infringement, Security, Loss

The expansion of fruit production and markets into new geographic areas provides novel opportunities and challenges for the agricultural and marketing industries. Evidence that fruit consumption helps prevent nutrient deficiencies and reduces the risk of cardiovascular disease and cancer has assisted in the expansion of all aspects of the fruit industry. In today's competitive global market environment, producers need access to the best plant material available in terms of genetics and health if they are to maintain a competitive advantage in the market. An ever-increasing amount of plant material in the form of produce, nursery plants, and breeding stock moves vast distances, and this has resulted in an increased risk of pest and disease introductions into new areas. One of the primary concerns of the global fruit industry is a group of systemic pathogens for which there are no effective remedies once plants are infected. These pathogens and diseases require expensive management and control procedures at nurseries and by producers locally and nationally. Here, we review (i) the characteristics of some of these pathogens, (ii) the history and economic consequences of some notable disease epidemics caused by these pathogens, (iii) the changes in agricultural trade that have exacerbated the risk of pathogen introduction, (iv) the path to production of healthy plants through the U.S. National Clean Plant Network and state certification programs, (v) the economic value of clean stock to nurseries and fruit growers in the United States, and (vi) current efforts to develop and harmonize effective nursery certification programs within the United States as well as with global trading partners.

The study based on multivariate comparative analysis identifies the dominants of national strategies for the development of artificial intelligence (AI) of the global superpowers. The article examines both structural similarities of strategic documents and fundamental differences in goal setting and functional expectations of sovereign AI technologies. Projecting fundamental ideas of technical and economic paradigms onto national strategies for the development of AI allows the authors to put forward a hypothesis concerning the formation of a common European, Russian and American proto-models of the AI development state policy. The dialectical nature of AI technologies demands consideration of the ethical aspects of the AI technologies application in Germany, Russia and the United States. As a result of the study, the foundations of various fundamental approaches of states to the development of AI technologies were established. Possible scenarios for the development of national strategic programs in the medium term globally were assessed.

The subject of the study is the consideration of the minilateral formations in the framework of the implementation of US foreign policy. The object of the study is the US foreign policy towards China since the beginning of the 21st century. The author examines in detail such aspects as the interaction of the United States and its allies in the Asian region, within the framework of the formation of the anti-Chinese coalition association, as well as analyzing and drawing conclusions about the effectiveness of a number of large minilateral organizations. Particular attention is paid to the reactionary perception of the top leadership of the leadership and the public masses of China on the role of the United States in building minilateral formations in its foreign policy. The main conclusions of the study are: • The minilateral unions only accelerate the process of dividing the Asian region into pro-Chinese and pro-American. Such a competitive policy to attract Asian states to their trade, economic and political space will only complicate the process of finding a compromise point of view between the two great economic powers, as well as damage peace, prosperity and stability in the region in the long term; • The growing popularity in the formation of minilateral structures is a consequence of the growing confrontation between China and the USA over the past decade, and not the primary cause of contradictions; • To date, most of the programs that have a "minilateral connotation" have little effective impact for the American government, nevertheless they cannot be called unfulfilled. Taking into account the relatively recent acceleration in attracting an increasing number of countries to existing and newly formed formats, Washington expects to get positive results for itself in the next decade, provided that China's economic and technological development is consolidated. The scientific novelty is determined primarily by the fact that the work analyzes the mechanism and evolution of interstate relations between the United States and partner countries, as well as the peculiarities of their activities in the minilateral associations.

In this article the author examines the process of revising the Latin American vector of US foreign policy under the presidency of Donald Trump. In particular, the paper analyzes the economic and political aspects of a new US policy in the Latin American region. The main focus of the research is on the reorganization of US economic relations with the countries of the region and cancellation of various financial aid programs and multilateral agreements, including the North American Free Trade Agreement. The main hypothesis of the paper is that US foreign policy under the 45th president underwent a profound change towards diminishing the role of the Latin American region among other foreign policy priorities of the United States. Vivid confrontation with China and the Russian Federation became the center of the contemporary foreign policy course of Washington, making relations with Latin American countries of secondary importance. This shift created a certain power vacuum in the region and opened additional opportunities for extraregional players. China could arguably become one of such players as it is known to have utilized Washington’s weakening grip on the region to its own economic and political benefit, expanding the “One belt, one road” initiative.

The article lays out a hypothesis that the global order slides into a new bipolarity in the context of the escalating geo-economic and geopolitical confrontation between the two poles that currently dominate the world - the United States and China. The neo-bipolar construction cannot yet be regarded as an established new world order, but the general movement of the world economy and international relations in this direction is obvious. The neo-bipolar bipolar confrontation manifest itself with varying intensity in different regions of the world. The author argues that at present the peripheral regions which are strategically important for the prospects of competition are becoming an important testing ground for relatively “safe” elaboration of methods and tactics of geo-economic rivalry and h mutual exchange of systemic attacks. Today, Africa has become practically the leading theater of the new bipolar confrontation. The article analyzes the economic, military and strategic aspects of the rivalry between the United States and China on the African continent. It provides a comparative analysis of the new African strategies of the two superpowers adopted at the end of 2018. The author asserts that in the context of the emerging global bipolarity, the strategies of the USA and China represent antagonistic programs based on fundamentally different initial messages. In the case of the US strategy, this is to deter by denial the spread of the competitor’s influence using tough policies, including forceful (while not necessarily military) confrontational actions. While China seeks to neutralize the opposition of the United States and its allies to Beijing’s expansion on the continent and to win the freedom of interaction with any partners in Africa causing minimal direct confrontation possible. Therefore, despite the seemingly “peripheral” importance of the confrontation on the continent, for the establishment of a neo-bipolar world order, the proclamation of the new US regional geopolitical strategy, which focuses on the containment of China in the name of protecting democracy and independence, can serve not only for Africa, but for the whole planet the same milestone signal as Churchill’s Fulton speech for the final advent of bipolarity in the postwar world.

Structural competency is the trained ability to discern and acknowledge how health care outcomes are shaped by larger political, social, economic, policy, and legal forces and structures. Although structural competency has become an increasingly known framework for training and teaching, especially in the United States, it has usually not been used in nursing and nursing education. Moreover, very little is known about how to implement structural competency programs in conflict zones. Due to depoliticization that often prevails in both the higher education system and the health care system, the political conflict and the structural violence that significantly impact people’s health are rarely discussed in these systems. This article examines the potential contribution of structural competency training programs for nurses and nursing students in conflict areas by analyzing a program that has emphasized the impact of the Israeli–Palestinian conflict on the health of Jerusalem’s Palestinian residents. The article explains how this program has challenged the denial and silencing of conflict-related sociopolitical issues. At the same time, this program has created heated disagreements and friction. We suggest that structural competency training programs that are adapted to the political context in question may help nurses become organic intellectual leaders and agents of social change for those whose voices are not heard.

Abstract“Sho-goh-wah-pee-nay” or “sugar disease,” an Oji-Cree word (Native American Indian terminology), is more commonly known as “diabetes." Over the last 70 years, diabetes has become an epidemic within Native American Indian tribes. At about 16%, American Indians and Alaska Natives have the highest occurrence of diabetes in the United States. There are 566 federally recognized tribes. Drifting genes, obesity, and lower educational levels are among the well-known causes of disease management in this group. However, often forgotten are the socio-cultural aspects of this issue. Disease perception, diet, traditional medicine, poor communication, sedentary lifestyle, poor socio-economic status are most important obstacles. Various government-funded programs like National Diabetes Education Program, “We have the power to prevent diabetes” and “Move it! And reduce your risk of diabetes” and diabetes prevention program are in place. Similar guidelines should be developed for all the ethnic or tribal groups across the world before it becomes a pandemic.

The article considers the modern industrial vector of American economic policy. The course of economic policy formed by the end of J. Biden’s presidency – “bidenomics” – on the one hand, demonstrates a departure from the neoliberal course pursued in the last 40 years, and on the other hand, in terms of industrial policy, represents the development of the economic agenda introduced by the previous president D. Trump. His efforts in the area of domestic market protection and reshoring have had a partial positive effect, mainly in medium technology industries. The main programs of bidenomics aimed at reindustrialization are reviewed. The specific achievements of bidenomics in the economy as a whole, in the social sphere and in the field of industrial policy are analyzed. On the example of the solar energy industry, which belongs to the sixth technological mode, the main aspects of the fierce competition between the United States and China in the global markets of high-tech products are shown. In conclusion, a reasonable assumption is put forward about the achievement by the financial-industrial and intellectual elites of the USA of a relative consensus (“Tramp-Biden’s combine” of industrial policy) on the issue of radical change of the neoliberal paradigm of social development, which existed for more than 40 years.

Why should international educators encourage research abroad? The work of the students represented in this Special Volume of Frontiers exemplifies the best of undergraduate research abroad. Their research shows an achievement of one, or all, of the goals international educators typically set for learning abroad: linguistic competence, cross-cultural skills, cultural competence, and disciplinary learning. Research abroad often holds strong incentives for successful student learning. Students choose their own research topics, providing intrinsic motivation to move beyond superficial explorations of their topic. Fulfilling faculty expectations for student learning, whether in the form of a paper, thesis, data collection or ethnographic study provides extrinsic motivation. The value of disciplinary learning abroad, especially in course-based programs, disputed on home campuses. Undergraduate research abroad can demonstrate that the cultural context of learning enhances the disciplinary knowledge gained. Disciplinary learning in another cultural context can correct culturally-ingrained research biases. Students gain knowledge difficult to capture without the cultural exposure provided by the experience abroad, which informs their work with nuances of first-hand research, moving it beyond the intellectual. Home-campus faculty may be less skeptical of the merits of sending students abroad for disciplinary learning if that experience results in an increase in knowledge or a demonstration of the application of previously gained disciplinary knowledge in a new context. Developing research skills in an international context means that students must learn how to navigate in another culture. Students must interact with people who are not their peers and who are outside a traditional classroom setting. By approaching organizations and individuals that inform their research, students learn much about the workings of the culture. And success in one attempt to navigate a host-culture can lead to success in further attempts. For the student-researcher, persistence is necessary because their research goal depends on successfully gaining access to the information they require. Cross-cultural skills are the tools that enable student-researchers to accomplish their goals and finish their projects. In order to achieve this in non-English language locations, students must develop a certain level of linguistic competence or, if using an interpreter, basic forms of communication in the host language. They must develop these competencies not only in everyday topics, but also in their fields of research. How will they ask about their topic if they do not learn some of the vocabulary? How will they obtain the help or information they need if they cannot ask people for it in appropriate forms? Since a research project typically requires a number of weeks to complete, student-researchers are likely to use these linguistic skills on an on-going basis. As a result, the linguistic competency gained is reinforced, and becomes more permanent. This cultural and linguistic learning can lead students to develop generalized cross-cultural skills with the assistance of international educators. We can provide valuable help to students doing research by asking them questions that will encourage them to realize that these skills transfer into other cultural situations. Often it requires simple queries: “What did you do to get this information? Did you have someone specific in the culture that gave you good advice? How did you find this person? What steps did you take when you succeeded in doing a piece of your research? When you did not succeed how did you figure out what went wrong? What did you do to try again? Beyond these basic questions, there are larger ones that can spur on student learning: “What did you learn from doing this project that would allow you to do another one in a completely different culture? How did you make sure your project was culturally appropriate? Did you think about making your project useful for local people? How would you share these results in the most effective way?” In posing these questions, we encourage students to examine the specific context of their research, and also to consider a meta-level analysis that places their research in a broader context. The hope is that students will see these skills in the wider global context, and that future cultural learning will be analyzed in a similar manner and transferred into other cross-cultural situations. If we achieve this, then we have certainly met the highest goals of encouraging students to learn to transcend cultural differences in constructive ways and to adapt to differing cultural modes as appropriate. Student research abroad can be a powerful way to accomplish all types of cultural learning. Supporting Undergraduate Research Abroad Even with these benefits, not many undergraduate students undertake research opportunities abroad. Faculty may advise students that research in their chosen discipline is better done at home, given the resources of the home campus. Students may be told that their language skills are not strong enough or that they are simply not mature enough as scholars in their disciplines to conduct relevant research. Students may be encouraged to conduct research or participate in directed study, but not to do field work or participate in experiential learning. A student may be able to receive credit for an internship that requires a substantial paper, but not for an ethnographic study. Moreover, the very idea of conducting research may be daunting to some students. Efforts should be made to advertise existing research opportunities abroad and to encourage new ideas for conducting research. If undergraduate research is endorsed by the highest academic officers of our institutions, our Presidents, Provosts and Academic Deans, faculty are more likely to provide encouragement and support, and then students will be more likely to pursue these options. International educators can assist these efforts by creating programs that offer research options, advertising such programs, and, most importantly, finding funding sources for such efforts. In order for students to take advantage of possible opportunities, it may be necessary to find ways to register students who might otherwise travel abroad independently (and thereby not be registered at their home institutions) in credit-bearing programs that would make them eligible for funding. The National Security Education Program David L. Boren Undergraduate Scholarships provides a model that allows advanced undergraduates with strong language skills to apply for funding for individually-arranged, supervised independent study. International educators may also help by designing processes on the home campus that support student research abroad. Research can take many forms, from the use of original documents and artifacts in libraries, archives, and museums, to service-learning, conducting field work, joining a research group, conducting interviews, doing a creative project, or interning or volunteering for an organization. On-campus administrative processes should make clear to students what types of projects are eligible to receive credit. If a student expects to receive credit at their home institution, they need to be able to review easily the criteria for determining whether credit will be granted with the appropriate on-campus authority (e.g. academic dean, department head, or registrar). Receiving credit helps to motivate the student and to validate the undertaking; making the credit-granting process clear can make a big difference to students exploring these options. It also assures that there will be faculty input, if not throughout the project, at least in the determination of granting credit on the home campus. In designing programs abroad with research components, faculty involvement is essential. Indeed, faculty supervision and support can make or break such projects for students. Faculty supervisors on the home campus or abroad will be more likely to agree to support a student researcher if they feel that this is a recognized part of their teaching. The supervision of an independent study can be time-consuming. Do departments consider this supervision when assigning workloads? Is extra compensation provided? Should these financial concerns be addressed in the budgets of the abroad programs? Can students continue follow-up work with faculty after they return home? Faculty supervision of student research abroad may follow various models. In some cases, research is an integral part of a study abroad program. Arrangements may be made to train the student on-site, perhaps as part of a course. The student conducts the research on-site, under the supervision of a resident director, or an on-site faculty member, and the course ultimately becomes a part of the student’s academic record, along with all other courses taken abroad. Another model has a faculty member at the student’s home institution supervising the student, along with some support given by a local faculty member. This model requires effective communication between the student and the faculty member on the home campus. In both cases clear goals need to be established about the nature of the project, research methods, and the final product. Fortunately, many of these formats can follow timelines and processes already developed on the home campus. However, once in the host country, parameters may change. Students may discover new opportunities, or their original ideas and plans may not be feasible. The logistics of conducting research in an international setting may make it impossible to keep to the original goals. In addition to guiding research and assessing the final product, faculty can serve in other important roles. They may introduce students to opportunities to submit their work for publication, present it at professional conferences, or compete for academic awards. Undergraduate research funding from the home institution might require a student to present their findings. Some institutions organize annual opportunities for students to give oral presentations or poster sessions during research fairs or conferences on campus. Others have a journal of student research. Resources and opportunities that are provided to students who conduct research on campus should also be extended to those whose work is done overseas. In many cases students may use the research conducted abroad as the foundation for a senior thesis. Students may choose to conduct independent research abroad. If students do research and are not enrolled in a program (e.g., during the summer) and have been encouraged to do so by their institution, have received funds from their institution, and will perhaps receive credit, their home institution should prepare them for the experience. Faculty and administrators should conduct seminars, orientation programs, and research methodology sessions to prepare students. Institutions should consider offering benefits to individual students that they would normally offer to students going abroad on registered study abroad programs (i.e., access to emergency services). By regularizing these aspects of going abroad, even to conduct independent research, institutions will be better able to track students who are conducting research abroad. At the minimum, students going abroad independently should be directed to information sources on health, safety, and security preparations when traveling to the host country. Additionally, students should be made aware of any legal issues related to doing research, and have their proposals vetted through the usual campus channels such as institutional review boards. Outcomes of Student Research Little data exists on how many students conduct research abroad, or on how this experience affects their academic work when they return to campus as well as their career decisions after graduation. Currently the national data on study abroad from the Institute of International Education’s annual Open Doors report documents only participation in credit-bearing programs. No statistics are kept on the numbers of students conducting research abroad who will not receive credit for their research. Among the questions this lack of data raises are: Are these students more likely to attend graduate school in their major discipline and to look for opportunities to conduct research abroad? Are they more likely to pursue independent research in sites that are less common as study abroad destinations? If they conducted research in a foreign language, are they more likely to study this language at an advanced level? The Lincoln Commission articulates the need for more in-depth international educational experiences, of which research can play an important part: An understanding of the diverse cultures of the world, especially those of developing countries, should be an essential component of the 21st-century education of our nation’s students. Direct exposure to foreign languages and other aspects of these cultures can best be achieved through a meaningful study abroad experience. Broader global awareness among America’s future leaders will, in turn, lead to more effective U.S. foreign policy, greater security from terrorism and economic resilience in the increasingly competitive world of trade. The research benefits discussed above mesh well with the current national interests that call for broader global awareness, and international educators should seriously consider designing and supporting research opportunities as one of their efforts to increase such competencies. Conducting research abroad can be one of the most personally satisfying parts of a student’s undergraduate academic career. These undertakings can also be frustrating and fraught with difficulties unless there is good planning and communication with a students’ academic advisors. International educators can assist in making these opportunities as effective, safe, and rewarding as possible. Faculty and administrators should look for ways to help students overcome the potential barriers to a successful experience, including the credit-approval process, organizing faculty supervision, and accessing information about opportunities, as well as funding. Since undergraduate student research abroad can lead to improved linguistic competence, cross-cultural skills, cultural competence, and disciplinary knowledge, we should do everything we can to develop and promote it. Mell C. Bolen~ Brown University Pat Martin~ University of Pennsylvania About the IFSA Foundation: The IFSA Foundation was founded to assist the continuing advancement of international education through direct and indirect support of study abroad by undergraduate students from U.S. colleges and universities. This is the first foundation whose mission focuses exclusively on the advancement of study abroad as a major component of higher education in the United States The Directors of the Foundation believe that effective study abroad for U.S. students involves minimally a semester length experience and, wherever possible, close academic integration with recognized universities abroad and, in all cases, the provision by the program sponsors of comprehensive student services to maximize the academic and cultural benefit of the experience and provide for the welfare and security of students. The IFSA Foundation intends to concentrate on projects that will provide muchneeded strength to undergraduate study abroad in the United States: scholarships to extend opportunities (particularly among underrepresented groups); start-up funding for underdeveloped areas of semester and full year study abroad programs; and support for the development of innovative projects designed to broaden the scope of the undergraduate study abroad experience. The IFSA Foundation grants are given only to institutions; scholarship grants are not tied to participation of students on any particular program. For more information: http://www.theifsafoundation.org

International expansion of forest certification programs has occurred over the last three decades. Both public and private organizations have shown increased interest in becoming certified by one or more forest certification bodies, to assure the public that forest resources are managed adequately in sustaining forest health and socio-economic viability. The Forest Stewardship Council (FSC) program is globally used as a benchmark to implement forest certification at the national and regional levels. The Sustainable Forest Initiative (SFI) and the American Tree Farm System (ATFS) are also used throughout the United States. In Europe, individual countries such as Bulgaria and Turkey have also developed national forest certification programs. The SFI, ATFS and Bulgarian programs are further endorsed by the Programme for the Endorsement of Forest Certification (PEFC). The results of a qualitative analysis comparing the FSC forest certification program with the SFI, the ATFS, and the two European national programs (Bulgarian and Turkish) suggest that differences in these programs are not necessarily related to their language, but to the level of detail and prescriptiveness of each program. We find that the FSC is much more detailed and prescriptive in nearly all aspects considered for forest certification. In particular, we find that most of the elements considered in the FSC Principle 6 (Environmental Impact) are either only superficial, or not addressed at all, in the other four programs. Furthermore, the other programs appear to be less comprehensive and detailed in the substance of the FSC monitoring and assessment principles. In a few areas, the Turkish program requires more quantitative indicators for assessing forest management than the other programs. Though a comparison of the legal framework related to forest management in each of the studied countries was briefly introduced, our study focuses on the certification schemes themselves; it may contribute to policy discussions in the future development and implementation of other certification programs.

The article examines in detail the prospects for the inclusion of major oil countries in the Middle East, such as Saudi Arabia and Iran, in the BRICS organization, the political, economic and military aspects of such a move, as well as BRICS need that, especially in Russia and China, in order to get rid of the current global financial system based on the dollar, which is actively used by the USA to punish states. The importance and novelty of the article are evident in the presentation of the political transformations of the BRICS countries and the reconciliation between Saudi Arabia and Iran and the subsequent reduction of tensions as a result of growing political and economic cooperation and integration with the countries of the Middle East. The entry of the energy-producing countries of the Middle East into the BRICS organization is a necessary step for disengagement of the dollar from energy, which began in 1971. The study presented in this article concluded that the countries of the Middle East have military capabilities, natural resources, as well as development programs and projects to diversify sources of national production, which makes them a strategic addition to the BRICS. Many countries in the Middle East are seeking refuge from the hegemony of the United States of America by opening up to counter-alliances represented by the BRICS and joining the organization's development bank to achieve stability and promote the development of these countries.

Among Hispanic immigrants in the United States (US), learning English is considered necessary for economic and social achievement. Asa consequence, there is a high demand for English as a Second Language (ESL) classes. Despite the recognized benefits of ESL programs,both at the individual and social levels, more research is needed to identify education strategies that effectively promote all aspects of learningEnglish as a second language. This article describes an ESL curriculum that incorporates a theory-based pedagogical approach specificallydesigned for immigrant Hispanic adults on the US-Mexico border region. The article also describes the implementation of the curriculum aswell as the results of the evaluation, which was conducted using both quantitative and qualitative methods. Quantitative results indicate thatthe participants significantly improved their English proficiency (L2). Qualitative results suggest that participants were positively impactedby both the content and pedagogical approaches used by the curriculum. Their experience with the ESL class was positive in general. It canbe concluded that the curriculum achieved its objective. This approach could serve as a model for second language teaching for adults

The Marshall Plan, or the Recovery Program for Europe, was a successful and ambitious project of the United States of America to help Europe affected by World War II, which, thanks to US assistance, was able to restore and surpass the pre-war level of prosperity. The article is aimed at analyzing the investment aspects of implementation of the Marshall Plan. The article reveals the features of the Marshall Plan (history, goals, coordination, and differences from other assistance programs) and considers the investment aspects of its implementation in the annual context. Attention is mainly focused on production, agriculture and their dynamism and efficiency, as well as labor productivity. The attempt of the OEEC to study the possibilities of coordinating investments in Europe is analyzed. The role of auxiliary partner funds in local currency in the development of investment projects is disclosed. Some features of European trade and the European Payment Union are considered. The influence of the force majeure factor – the war in Korea – on reorientation of the Marshall Plan’s objectives from economic recovery to defense is disclosed. The deliberate, rational and large-scale investments helped Europe devastated by World War II to restore its prosperity and achieve prosperity. Thanks to investments, it was possible to significantly increase European production. However, the investments were used as efficiently as possible only in combination with other factors, such as: an established entrepreneurial culture, stable legislation and protection of investors’ rights, productivity growth and the use of advanced technologies in production. Studying the experience of implementing the Marshall Plan is useful given that Ukraine has also suffered significant damage as a result of russia’s military actions and will require huge efforts to restore the economy together with large-scale investments.

The presented study examines certain aspects of Mexico’s social policy from the 19th century to the implementation of the key programs of the 2019-2024 National Development Plan.Aim. The study aims to identify the major causes and find solutions to one of the main problems of social development in Mexico - social stratification.Tasks. The authors determine the sequence of historical, political, and economic actions that have influenced social inequality; examine the factors that have led to social stratification; analyzestatistics pertaining to reforms; examine the programs of Mexico’s 2019-2024 National Development Plan.Methods. This study uses general scientific methods of cognition to identify social development trends in Mexico’s socio-economic policy and the underlying internal and external factors, and to analyze the directions of the programs of Mexico’s 2019-2024 National Development Plan.Results. Social inequality in Mexico can be traced back to medieval times. Since the 19th century, oppressed people have been openly asserting their social standing. Significant social stratification and an overwhelming number of poor people with little education cannot resist the country’s political system. There is constant pressure from foreign countries, particularly from the United States, on the political order of Mexico through the promotion of foreign standards aimed at deriving profit for other countries and the Mexican elite. The country’s domestic regulation is carried out in the context of limited wage growth, lack of a progressive taxation system, and disparate accessibility of social benefits for different population groups. Since the beginning of the 21st century, introduction of socially oriented programs has reduced social inequality, but it remains too high in comparison with developed and developing countries.Conclusions. A study of the country’s socio-economic policy since the 19th century reveals features that are specific to Mexico: a very high level of corruption and criminality, social stratification with an overwhelming number of low-income people and general marginalization hinder the country’s social development and economic growth. The middle class is poorly developed and cannot provide the domestic consumption necessary for the stable development of Mexico and reduction of the country’s dependence on its trading partners. Population support measures are ineffective in the context of the established way of life.

<p class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: 'times new roman', times, serif; font-size: 14pt;">The use of All-Terrain Vehicles (ATVs) has gained considerable attention within the recreation industry. The incorporation of ATVs into tourism and recreational activities has demonstrated substantial economic potential for local economies. However, there is a lack of comprehensive knowledge regarding the economic impact of ATV recreation. This paper conducts an extensive review of existing literature from 2004 to 2022, evaluating the economic impact of ATVs on local economies in the United States. The review aims to identify commonalities and disparities among existing economic impact studies and assess whether these studies have included costs associated with ATV-induced environmental, societal, and public health damages in their economic assessments. To this end, there is a scarcity of scientific peer reviewed journal articles that exclusively focus on the economic impact of ATVs. As such, we reviewed a total of seven publications comprising reports. The results of our analysis shed light on similarities and differences in aspects of resident and non-resident ATV spending, type of ATV expenditures, and the approaches used to evaluate economic impact assessment. The findings indicate that existing studies have assessed the economic impact of ATVs solely based on gross expenditures, lacking comprehensive inclusion of the costs associated with ATV damages to the environment, society, and human health. This study advocates for the need for a more comprehensive consideration of both benefits and costs in the economic impact of ATVs to assist ATV business managers, policymakers, and researchers in making informed decisions and planning future programs.</span></p>

Subject of the study: the soft power of the United States in relation to the French Republic.The object of the study is the US-EU relations during the presidency of Donald Trump.For this study, the most relevant research methods are the retrospective method, which allows us to assess the changes that have occurred in D. Trump's foreign policy course towards Europe after his inauguration. Taking into account that the work focuses on the content of cultural, educational and other American programs implemented in Europe on the example of the French Republic, the method of content analysis was used. Among other things, a systematic approach was used in conducting research. The presidency of Donald Trump really had an ambiguous, in some aspects destructive effect on the development of a "soft-power" vector in American foreign policy. Despite the fact that, de jure, the US military departments called in the documentation for the leading role of the European Union in ensuring global security and maintaining NATO's activities, de facto, Trump's rhetoric undermined the traditionally friendly attitude of Europeans towards the United States. Since the perception of "attractiveness" is a key element of "soft-power" influence, the results of this study give grounds for the following conclusions. In the period from 2016 to 2021, American influence on Europe was weakened not only by provocative statements and actions regarding NATO funding, contradictions on trade and economic agreements and problems with the Paris Climate Agreement, but also by the elaboration of the cultural and educational vector of foreign policy. Thus, by 2021, the United States had a weakened influence on the French Republic, which allowed the French side to strengthen its influence on American students and strengthen its own position in the American intellectual and managerial environment. The novelty of the study: US foreign policy is studied from the position of soft-power influence on France in the context of intra-bloc interaction in NATO.

The article is devoted to the peculiarities of the formation of the US foreign policy strategy in the Near and Middle East in the 1950s and 1960s. The authors consider the key aspects of the study to be the peculiarities of the cooperation between the United States of America and Iran in the period of the 1950s and 1960s. 20th century. The policy of the USA in the given period is defined as that which was aimed at maintaining stability and supporting the independence of the countries of the above-mentioned area. In addition, the American leadership predicted the possibility of an "Islamic problem". The production of minerals in the region, as well as the need to prevent interference in the plans of the USA by the USSR, caused the United States to make efforts to maintain the role of the main suppliers of weapons, since it was impossible to allow a weakening of the influence on strategic interests, on the course of Iran's domestic and foreign policy. Despite the transitional period of the 1960s, intensive cooperation between Washington and Tehran continued. The USA was provided with assistance in the economic sphere, there were changes in the provision of military support from subsidies to the possibility of selling on credit. The aggressive reform program called the "White Revolution" of the early 1960s was an attempt to westernize Iran and strengthen its global status, which was also carried out with the active support of the United States. The authors identify nuclear programs as another direction of direct interaction between Tehran and Washington, the development course of which in Iran began in the late 1950s and early 1960s. Iran has cooperated with a number of allies of the Washington administration and has successfully developed its nuclear program within existing international restrictions. In 1963, Iran joined the Convention on the Prohibition of Nuclear Tests in Air, Space and Submarines, and in 1968 signed the Treaty on the Non-Proliferation of Nuclear Weapons. All this contributed to the country's integration into global world processes.

Ecological expertise is considered as a factor of the capitalization of land resources. The conducted research shows that without taking into account the environmental component of the national economy, the process of involving and capitalization of land resources in the economic circulation within the framework of the land development mechanism cannot be realized. The principles of ecological expertise in the article are presented in the form of a scheme. The introduction of green standards for the construction of Olympic facilities and infrastructure in Sochi is the most relevant example of the synthesis of economic, environmental and innovative aspects. Comparative characteristics of the international green standards BREEAM and LEED* (*BREAM (British Building Research Establishment Environmental Assessment Method) are presented. Comparative analysis showed that the BREEAM standard presupposes very stringent requirements (clearly formulated, not allowing deviations, a complicated cumbersome system, the high cost of obtaining approvals), while the LEED Standard is adapted only for the social and economic realities of the United States and provides for stringent requirements for the preparation of documentation, the lack of an independent audit of the evaluation activities; hard link of functionality with architectural forms that are not always acceptable outside of the USA. The application of green standards makes it possible to significantly increase the market value of land plots and necessitates the application of these standards in the development and implementation of investment and construction projects and programs.

The following paper discusses contemporary challenges of providing access to formally accredited higher education programs in the United States of America, and on a smaller scale also in Slovenia. It interprets the recent college admissions scandal within the historical framework of American educational policies, paired with its traditional social practices. In the initial sections, the paper provides a brief historical overview of the development of American (higher) education, the beginnings of which date as far back as the early 17th century. Back then, the very concept of formal and publicly accessible education was in its developmental stages. By focusing on a selection of historical aspects and educational trends within the American national context, the paper unveils the related expectations and attitudes toward acquiring formal education in the past. It lists a number of historically relevant changes, which have been implemented over the past century within the American educational system at state and federal levels. The latter have contributed to the development of contemporary approaches to education and have affected recent attitudes toward formal education in American society. The paper includes statistical data on enrolments and graduation rates in institutions of higher education in the United States and Slovenia, which offers an insight into the rising enrolment and graduation trends, and relates the figures to the importance of accessibility of education as an equalizer that should provide equality of opportunity for all, irrespective of social background or economic power. The accrued data and related research results support a favorable trend in accessibility of formal education in both countries, the US and Slovenia. This is an important finding, particularly in the context of the college tuition scandal, as it might at first sight create the impression that some of the highly valued and formally accredited institutions of higher education were subject to the influence of a powerful elite. The research results therefore support the trend of the educational system and the accrued knowledge assuming the role of the equalizer in leveling out certain aspects of social inequality.

Understanding human behavior is a complicated and complex endeavor. Academicians and practitioners need to understand the underlying beliefs and motivations to identify current trends and to effectively develop means of communication and education that encourage change in attitudes and behavior. Sociological research can provide information about how and why people make decisions; this information impacts the research and extension community, helping them formulate programs and present information in a way that increases adoption rates. Life cycle assessment can document how plant production impacts the environment. Production of ornamental plants (greenhouse, container, and field produced flowers trees and shrubs) accounted for 4.4% of the total annual on-farm income and 8.8% of the crop income produced in the United States in 2017, representing a substantial portion of farmgate receipts. Greenhouse and nursery growing operations can use this information to increase production and water application efficiency and decrease input costs. Information related to the environmental impacts of plant production, derived from life cycle assessment, can also inform consumer purchase decisions. Information from water footprint analysis quantifies the relative abundance and availability of water on a regional basis, helping growers understand water dynamics in their operation and informing consumer plant purchases based on water availability and conservation preference. Economics can motivate growers to adopt new practices based on whether they are saving or making money, and consumers modify product selection based on preference for how products are produced. Specialty crop producers, including nursery and greenhouse container operations, rely heavily on high quality water from surface and groundwater resources for crop production; but irrigation return flow from these operations can contribute to impairment of water resources. This review focuses on multiple facets of the socioeconomics of water use, reuse, and irrigation return flow management in nursery and greenhouse operations, focusing on grower and consumer perceptions of water; barriers to adoption of technology and innovations by growers; economic considerations for implementing new technologies; and understanding environmental constraints through life cycle assessment and water footprint analyses. Specialty crop producers can either voluntarily adapt practices gradually to benefit both economic and environmental sustainability or they may eventually be forced to change due to external factors (e.g., regulations). Producers need to have the most current information available to inform their decisions regarding water management.

Abstract The United States is experiencing rapid aging and increasing racial and ethnic diversity. Nevertheless, political rhetoric about immigrants has stoked negative assumptions and beliefs adding to fear and cultural misperceptions. Among those most affected are people of Hispanic/LatinX ethnicity, who comprise approximately 18% of the population. To address negative stereotypes, we sought to test how framing affected attitudes about Hispanic/LatinX immigrants and how people in different generations across the political spectrum respond to framing. As part of the “Latinos and Economic Security (LES),” a national research project funded by the Ford Foundation, we launched the “Well Being 501 Latino Economic Security” survey through the American Life Panel of RAND Corporation in 2018. Before answering the survey questions, participants (n=739) were randomly assigned to three different conditions: a 100-word priming statement focused on Hispanic/LatinX work ethic/religiosity/patriotism (33.29%), a 100-word priming statement focused on justice/equity/fairness (32.75%), and a control group with no priming statement (33.96%). We used multiple linear regression to examine relationships among demographic variables, age, political affiliation, and priming statements and attitudes toward Hispanic/LatinX immigrants. Key findings include: 1) age, political affiliation, education level, race and ethnicity, and gender explained 47.5% of the variance in attitudes; 2) baby boomers and generation X were significantly less tolerant of Hispanic/LatinX; 3) priming statements played a salient mediating role in neutralizing negative attitudes. By employing a developmental perspective, we proposed six recommendations from the aspects of reframing policy narrative and developing educational programs targeted at improving attitudes toward Hispanic/LatinX immigrants.

Background: A physician-scientist refers to a person with dual Medical Doctor (MD) and Doctor of Philosophy (PhD) degrees, i.e., a physician who has acquired medical knowledge and skills as well as scientific knowledge and research abilities. This study examines the background and current status of physician-scientists in Korea and suggests policy directions to foster physician-scientists suitable for Korea.Current Concepts: With the start of the medical graduate school system in 2005, the MD-PhD dual degree program was implemented under the name of “medical scientist”. With the discontinuation of the medical graduate school system, the term “medical scientist” was replaced with “physician-scientist”. The importance of physician-scientists for the development of biomedical research and industry has been consistently emphasized. Therefore, the government has recently initiated a support policy to train physician-scientists.Discussion and Conclusion: To successfully foster physician-scientists in Korea, the following government policy aspects should be strengthened. First, sufficient economic support should be provided so that physician-scientists could immerse themselves in biomedical research. Second, to guarantee stable employment for physician-scientists, a national research institution such as the National Institute of Health in the United States should be established. Finally, the educational programs of the medical schools should be revised to strengthen the research-related knowledge and skills of the medical students.

The relevance of the research lies in the insufficiently studied theoretical aspects of the application of precision farming technologies. The development programs of the industry in countries with developed agriculture contain separate elements for the development of precision farming technologies. The aim is to study the international practice of introducing precision farming technologies on the basis of national programs for the development of the agrarian sector of countries with developed agriculture. The United States occupies a leading position in the development of precision farming technologies. This became possible thanks to the implementation of the Food and Agriculture Cyber ​​Informatics and Tools (FACT) program, as well as the development of these technologies by private companies (Ag Leader Technology; AgJunction, Inc; CropMetrics LLC, etc.). In the People's Republic of China, in the Thirteenth Five-Year Plan for the Economic and Social Development of the Republic, Article 4 proclaims a course for the modernization of agriculture, which is designed for 2015-2020. It is planned to introduce a regional pilot project in the field of precision farming technologies based on IoT, increasing the level of intelligence and precision of agriculture. Japan has implemented the Strategic Innovation Promotion Program (SIP) for the next generation of agriculture, forestry and fisheries. Its main tasks include an automatic travel system for agricultural machinery under human supervision (by 2018), as well as an unmanned system for agricultural machinery with remote monitoring (by 2020). In total, 15.6 billion yen (11.5 billion rubles) was allocated for the implementation of these tasks in the period from 2014 to 2018. In Germany, 14 digital innovation parks have been created, aimed at developing both precision farming technologies and technologies of the Internet of things, big data and others.

The creator, Kenja McCray, is an Associate Professor of History at Atlanta Metropolitan State College (AMSC), where she teaches United States and African American history. AMSC is an institution within the University System of Georgia offering an affordable liberal arts education and committed to serving a diverse, urban student population. McCray has a B.A. from Spelman College, an M.A. from Clark Atlanta University, and a Ph.D. from Georgia State University. Her areas of interest are the 19th and 20th century U. S., African Americans, Africa and the diaspora, transnational histories, women, class and social history. The creator of this essay believes education should be a life-altering process, not only in the intellectual or the economic sense, but also cognitively uplifting. She experienced personal change in college through interacting with professors. She strives to give students a similarly inspirational experience. The encounter should be empowering and should change the way they see themselves and their relationships to the world. The intent of this creative piece is to share the creator’s contemplations on a rites of passage program in which she participated during her college years. She asserts that, given current cultural trends signaling a renewed interest in African-centered ideals and black pride, many aspects of the program could interest current students looking for safe spaces in increasingly intolerant times. This essay will interest researchers, student leaders, student activities advisors, and other administrators seeking to create and develop inclusive campus programs.

Abstract The cybersecurity of critical infrastructures is an essential topic within national and international security as 16 critical infrastructure sectors touch various aspects of American society. Because the failure to provide adequate cybersecurity controls within the critical infrastructure sectors renders the country open to an attack that could have a debilitating effect on security, national public health, safety, and economic security, this matter is so vital that there is the Presidential Policy Directive (PPD) 21 Critical Infrastructure Security and Resilience advances a national policy to strengthen and maintain secure, functioning and resilient critical infrastructure. An organization identified as the Cybersecurity and Infrastructure Security Agency (CISA) at the Department of Homeland Security (DHS) has the mission to be the risk advisor for the United States (US). Other organizations, such as the National Security Agency (NSA), have approved a specific Knowledge Unit (KU) to address cybersecurity for critical infrastructures associated with doctoral-level granting programs. To address this challenge, it is necessary to identify threats better and defend against them while mitigating risks to an acceptable level. Only then can a nation build a more secure and resilient infrastructure for the future while defending against present-day bad actors as cyberwarfare, cyber espionage, and cybersecurity attacks are the modern-day threats that need to be addressed in planning, designing, implementation, and maintenance. Therefore, the researchers developed a case study reviewing threats against different sectors defined in the PPD.

Hospitals in the United States are heavily impacted by public policies that affect them. for example, Medicare and Medicaid programs account for more than half the revenue in most of the nation's almost 5,000 community hospitals, including the almost 1,100 public hospitals controlled by state and local governments (American Hospital Association, 2012). the public hospitals are especially closely aligned with and controlled by governmental entities compared with hospitals with other kinds of sponsorship. This article addresses the management challenges at the intersection of the strategic management of public hospitals and their public policy environments. Public hospitals are complicated entities designed not only to provide health services but also in many cases to play key roles in health-related research and education and to play important general economic development roles in their communities. the multi-faceted strategic decision making in these organizations is as heavily affected by their public policy environments as by their business, demographic, technological or other external environments. Effectively managing the intersection of their public policy environments and their strategic management is indeed vital for contemporary public hospitals. This article is intended to clarify certain aspects of this intersection through a description and model of the strategic activity in public hospitals and the connection between this activity and their external environments. Specific attention is focused on the concept of public policy environments and their features. Attention is also given to how managers can assess public policy environments and incorporate the results into strategic activities.

To examine the effects of the sudden shift to online instruction due to the COVID-19 pandemic in the early months of 2020, we sought to get a firsthand understanding of the experiences of teachers who were required to make the change to full online teaching. Teaching online requires technological knowledge, but it also requires a different pedagogy in order to keep students engaged and motivated to learn. Many educators indicated that this was a significant challenge. Our goal was to illuminate teachers’ experiences in order to include their voices in changes to educator preparation programs. A total of 699 complete survey responses were received representing educators in several grade levels working in nine states in the United States. Qualitative analysis revealed that many responses were related to extant research on teachers’ self-efficacy. Thus, this paper will shed light on the experiences of educators during the first semester of 2020 including the months of January through April, and teachers’ perceived efficacy. We find that teachers felt more efficacious regarding aspects of online teaching over which they felt an internal locus of control, such as delivery of curriculum and their own skill in the use of technology. For items over which they had less control, such as parental support and involvement, student motivation, and student access to adequate technology, teachers indicated much less efficacy. The majority of responses paint a complicated and somewhat dismal picture of the loss of personal connection with their students. Based on these data, recommendations for both education preparation programs, and policy are discussed such as districts and schools must provide sufficient professional learning opportunities and create a culture of collaboration amongst teachers that can assist them in building internal school capacity for good online instruction for their students. The COVID-19 pandemic should be used as an opportunity to evaluate gaps in digital equity and make positive strides to ensure all students, regardless of race, disability, economic background, or geographic location, have full access to quality online education. Keywords: teacher preparation, educator preparation, online teaching, COVID-19, self-efficacy

The article highlights the historical aspects and preconditions for the creation of the International Monetary Fund (the IMF) and the World Bank, which since 1944 have been the most influential international financial organizations and have played the role of the world's largest creditors. The essence of the transformations of their activity caused by the phenomena of the new economic reality is revealed. The solution to the problems of financial stability on a global scale in the postwar period by the United States and the newly created the IMF was to peg national currencies to the US dollar in the Fund's arbitration. The events related to the crisis of the Bretton Woods system of single fixed exchange rates and the irreversible disruptions in the world circulation of oil and its derivatives in the 1970s were important reasons for changing the principles of the world monetary and financial system towards the introduction of free exchange. At the same time, due to the intensification of domestic trade and investment, there were abrupt outpacing transformations of the economies of the south-eastern part of the Asian continent. Following the irreversible events involving the collapse of the socialist camp, support for reform programs in transition economies has been added to the IMF's targets. The activities of the World Bank under the impact of these total changes were also significantly renewed. Further, the IMF and the World Bank began to work more closely, integrating anti-crisis approaches and measures, while remaining a universally recognized instrument of stabilization in the global dimension. The activities of the Bretton Woods organizations are aimed at assisting the governments of developing countries in implementing market economic policies to protect the rights of all forms of ownership, modernize institutional structures, achieve financial balance, and improve the social situation of all segments of the population. It is concluded that in order to ensure sustainable development, the strategic renewal of the IMF and the World Bank provides for the expansion of quotas to support structural reform programs, improve the allocation of credit and financial resources, support opportunities to meet the needs of socio-economic systems, develop human capital and efforts for solving macroeconomic problems, etc. The directions of impact of these international financial institutions on solving actual problems concerning climate change, displays of corruption, overcoming inequality, resistance to threats of destabilization, struggle against a pandemic of a coronavirus disease of COVID-19 are defined.

The article is dedicated to the United States’ achievements in space rivalry, its economic, geopolitical, scientific and technological aspects. Given the fact that the U.S. are faced with a difficult period in their history, they will try to restore the positive image of American democracy not only through traditional political methods, but also via scientific and technological leadership, including in the field of outer space exploration. The author focuses on NASA’s modern space programs, among which are initiatives that deal with landing on asteroids, exploring deep space, the Moon and Mars as well as attempts to commercialize outer space through space tourism. The author also compares the space program budgets of the U.S., Russia, China and some European countries. The article presents all these aspects in the current context, with paying attention to the STEM education (Science, Technology, Engineering, Mathematics). The goal is to understand why America still leads in space exploration and sets the bar. In conclusion, the author argues that Washington will keep prioritizing space industry and involve private companies in this field through allocating additional funding and granting tenders to those who are most competitive. In addition, achievements in the U.S. space program is a matter of international prestige and American leadership, given the fact that the image of the country has suffered a lot, especially amidst Trump’s bygone, yet controversial presidency. A successful implementation of Washington’s ambitions in outer space will strengthen both its leadership and its ties with Europe, which is strategically important for America in the times of political confrontation with Russia and China. In the article, the author primarily relies on descriptive and narrative scientific approaches, comparative and historical methods as well as systematic approach by analyzing NASA documents and publications, speeches of the U.S. presidents and specialized media outlets. The novelty of the article adds up to the fundamental analysis of the American space program through the lens of history and current times while focusing on its political, economic and technological aspects. Acknowledgements. The article was prepared within the project “Post-crisis world order: challenges and technologies, competition and cooperation” supported by the grant from Ministry of Science and Higher Education of the Russian Federation program for research projects in priority areas of scientific and technological development (Agreement № 075-15-2020-783).

The article is devoted to the issues of international cooperation of the bodies regarding asset recovery and management with a purpose of combating transnational crime. It emphasizes the main provisions of international treaties on combating crime and provides an analysis of foreign legislation in the given sphere. The subject of the study is international legal regulation and problems of corrupt assets recovery, which required the application of interdisciplinary scientific approach in considering its economic, political, philosophical, historical and legal aspects. The purpose of the article is to highlight the main issues that arise when the states try to recover corrupt assets, as well as to provide national governments with appropriate recommendations, taking into account international instruments and best practices. The article considers world practice of conducting criminal proceedings and execution of court decisions. It covers the features and problems of specialized government bodies as for the recovery of the assets. The article is based on the application of a set of the following methodologies: philosophical, dialectical and synergetic. The study used the method of systematic analysis, which is the most commonly applied in criminological research to combat corruption. To achieve these purposes, the following research methods are used: analysis of theoretical sources and scientific literature; abstract-logical method in the process of theoretical generalizations and formation of conclusions; prognostic methods. The author applies the comparative method (i.e. the method of comparative jurisprudence) when comparing international documents with the legal norms of other states. Results. Foreign experience shows that development of a modern and effective system of combating organized corruption in any country is possible subject to application of legal norms that meet international standards, as well as the integrated use of advanced computer information technology. The author emphasize the need for OECD (Organization for Economic Co-operation and Development) member states to develop adequate regulations that will allow immediate disclosure and exchange of information on the freeze of assets with foreign jurisdiction, in order to ensure the effectiveness of the asset recovery procedure. Conclusions. It is recommended to adopt laws at the national level or to introduce a regulation in the criminal law of the state on illicit enrichment; to develop comprehensive national strategy; as well as to finance measures to recover corrupt assets within the framework of anti-corruption programs at the state level. It emphasizes the need to have a united state register of assets seized in criminal proceedings. In order to recover assets from abroad, states need to have political will and to use the latest technologies.

Many aspects of war and national defense appear to run in cycles. Indeed, the identification and explanation of these cycles is a favorite pastime of military scholars. Historians and political scientists characterize war as alternating cycles of offensive and defensive dominance. The idea of cyclicality may in fact be hardwired into academic discussions and understandings of war. For example, early war theorist Carl von Clausewitz described an ever-changing character of war undergirded by war’s fundamentally unchanging nature. Because the dominant theoretical understanding of war is that it holds a mixture of both fixed and constantly evolving elements, our concept of war may inherently lend itself to the idea of cycles. At the same time, however, the identification of cycles in war and national defense can be seen empirically. For example, the United States defense budget since World War II is notoriously cyclical, running through peaks and troughs in constant dollar terms roughly every fifteen to twenty years. Since peak defense funding periods do not always align with periods of war, it is not the dynamics of war alone that drive cyclical United States defense budgets but a mix of phenomena that includes economic cycles. Hence, in noting the cyclical nature of many aspects of defense, historians must further investigate to determine what dynamics and constraints may be at play in driving the cycle. While commercial technology continues as a driver of acquisition speed, especially for IT; the decentralization of acquisition decision- making and the delegation of decision authority to the military de- partments will likely encourage different priority balances to emerge in different sectors of the acquisition system. The delegation of acquisition authority to the United States Army has resulted in a significant internal reorganization of its acquisition functions. The Army is, for the first time, establishing a command focused on bringing together the wide variety of acquisition stake- holders in one structure, the Army Futures Command. Army Futures Command will bring the system for deciding requirements for new capabilities together with the acquisition process. In effect, the Army consolidates acquisition responsibilities within the service more closely under the control of the Army Chief of Staff, to whom the commander of Army Futures Command will report. The Army Futures Command will pursue a new modernization strategy, built around six major priorities, and hopes to significantly accelerate the delivery of new capability. By centralizing responsibility for requirements setting and acquisition execution in one command, the Army hopes to reduce the friction (and timespan) of coordinating across the Army’s multiple major communities. By contrast, the United States Air Force plans to extend its delegation of acquisition authority from OSD by redelegating this authority down to program executive officers and empowering program managers. This redelegation may reflect the relative maturity of the Air Force’s major programs, such as the KC-46 tanker and the B-21 bomber, where the high level strategic issues are decided (notably in both cases with cost control as the major priority), and the focus is on program execution. Matters of program execution are often best handled at the program level or as close to it as possible. However, less mature parts of the Air Force acquisition portfolio, such as recent efforts to design new systems for command and control and systems de- signed to approach space as a warfighting domain, may use the same decentralized authority to achieve different objectives. Notably, Air Force acquisition executive Will Roper is using the prototyping authority granted by Congress to rapidly demonstrate critical high-performance technologies, such as hypersonic strike systems called for in the National Defense Strategy. Decentralizing and distributing acquisition authority within military departments may lead to a variety of microcosms within the acquisition system where the balance of acquisition priorities is different. Other trends, however, will impact the acquisition system across its entire scope. Another major trend is the increasing functionality of weapon systems defined by software over hardware. The capability seen in the Air Force’s flight lines, in the Army’s motor pools, or in the Navy’s homeports is increasingly determined by lines of code rather than steel and aluminum. This trend has major implications for the acquisition system because it presents challenges to its basic structure, which was originally de- signed around an industrial production model. Software-defined systems break down the boundaries around which many organizations and processes are organized. Software-based systems don’t graduate from development to production to sustainment like hardware-based systems, presenting challenges to government budgeting mechanisms that are leading to calls for new funding categories that can deal with the iterative nature of software development and production. Consider the idea that a system which can send and receive electrons may serve many purposes, such as a communications device, a sensor, a weapon, and an electronic defense system. Software-based capabilities are steadily spreading, and they are a powerful reason why Under Secretary of Defense Ellen Lord appointed a special assistant, Jeff Boleng, for software acquisition. Boleng will “help oversee the development of software development policies and standards across DoD and offer advice on commercial software development best practices to Pentagon leadership . . . .” Perhaps the perfect embodiment of this trend towards software-driven capabilities is in artificial intelligence. How this trend will affect the balance of acquisition priorities in the future is difficult to predict, but one thing seems likely: change will remain dynamic rather than static, leading to continuous acquisition reform cycles for the years to come.

Helium is one of the most abundant in advanced medical technologies such as MRIs, and in cryogenics, aerospace applications, and microchip manufacturing. It is also used to fill party balloons. It’s essential, expensive, and supplies are running low. Helium is about 100 million times more abundant in one place—but that place is on the moon. While trace amounts can even be found in the very air we breathe, the gas is difficult to find in commercial quantities, and those quantities are usually found as a byproduct of natural gas discoveries. Historically, about 40% of the US supply of helium came from the Federal Helium Reserve, a US Bureau of Land Management (BLM)-operated storage reservoir, enrichment plant, and pipeline system near Amarillo, Texas. The reserve was set up in 1960 as a strategic repository so that BLM could supply crude helium to private helium refining companies, which in turn refined it and marketed it to consumers. In the mid-1990s, Congress passed a bill to sell off a large part of the reserve’s supply to help pay off the facility’s debt, and effectively set in motion the federal government’s exit from the helium business. In 2013, BLM said it would begin auctioning off an increased percentage of the reserve annually as part of the bill. Last year, BLM announced the closure of the reserve. At the time of the announcement, BLM Deputy Director for Policy and Programs William Perry Pendley said “now it is time for the US government to remove itself from the helium business and allow the private sector to further develop this industry to meet the supply needs of the United States, creating a sustainable economic model and jobs for Americans.” BLM held its final crude helium auction in 2019, with the price rising 135%, from $119/Mcf a year earlier to $280/Mcf. Market pricing for helium is difficult to know. It is not a traded commodity, and pricing is normally based on long-term, confidential contracts. It’s a niche market that suffers from a lack of detailed analysis due in large part to the availability of its closely held data. The helium industry shares many aspects of the oil and gas business. Commercial deposits are found via geological survey; then, once identified, drilling begins. Outside of the search and discovery, helium can also be a useful tool for those in the oil business. It can be used for leak detection and in specialized welding due to its inert properties and high heat transfer. Additionally, as the oil field moves more toward digitalization, storage of big data will need helium for the construction of storage drives and to keep server farms cool. Swapping Hydrocarbons for Helium As scientific developments advance, the need for helium increases—a notion not lost on Canada-based Avanti Energy. The company’s CEO Chris Bakker has more than 2 decades of experience in oil and gas, most recently working as a commercial negotiator with Encana/Ovintiv for major facilities and pipelines in the Montney gas play. Today, he and his team are looking for commercial helium deposits in southern Alberta and northern Montana.

Have you heard of the ITEP/TOEIC/TSE/BULLATS/TOEFL/CELTA/DELTA exams? Among many others, these exams are currently being promoted not only by educative institutions, but by a large number of local governments and even international relationship instances (Bunce, 2016). On this regard, it is imperative to wonder and analyze how the idea of taking language exams became into fashion and at what moment in history it became into a necessity, a requirement, or as synonym of social and academic status. On such basis this study aims at determining how the implementation of English international tests have contributed in the spread of English globally. The spread of the English language globally has occurred because of different factors. Clyne (2008) regards the demographic aspect as an important element for the growth and rapid evolution of this language. The effect of the use of the English language has reached almost all the areas of human domain such as the educational. The spread in this area has determined the future of many countries. On the field of education, a standardized visible system is clearly set. Most of the books and material used to teach English are based on the Common European Framework. This framework stablishes the standardization of teaching contents and methodologies which are later used and applied into exams to evaluate students´ English language proficiency around the world. CLIL (Content and Language Integrated Learning) programs have been implemented in schools in many countries of the world like Asia, Australia and Europe. “In recent years, LAC and CLIL are gaining intense attention particularly in context where English is learnt as a foreign language or as an international language” (Lin, 2016, p.1). Lin regards this implementation to the desire of countries like the Asian for becoming modern and take part in the development of a global economy. When comparing English with other languages it can be said that it is the pioneer in standardizing a language. According to Mulcaster (as cited by Crystal, 2003, p. 73) the English language had no competence internationally. If we take a look at other languages trying to do the same, it can be seen that they have not become as successful as English. It does not matter if those systems are better, they simply have not been able to reach that level of internationalization. The important fact here is that those countries in these case languages do not have the economic, political power, and the influence that The United States has. According to Sharifian (2010, p.192) the English language dominance originated along the colonialism period. Phillipson (as cited in Sharifian, 2010) explains that “many elites in society have strong links with the inner circle because they have been educated in inner circle countries”. The inner circle is referred to countries where the English language is spoken as a mother tongue. To conclude, this essay presents an analysis of the way standardized exams have contributed widely to the internationalization of English around the world. This standardized examination system has influenced in many aspects like education, negotiation, culture, ideology and public policy. It will present an overview about every aspect mentioned as well as the causes and effects of these factors which have influence in a positive and negative way in society. Besides, there will be presented examples in a general way about percentages of people who have taken standardized exams and how it has contributed to the expansion of English around the world.

Universities have always had international dimensions in their research, teaching, and service to society, but those dimensions were in general more ad hoc, fragmented, and implicit than explicit and comprehensive. In the last decade of the previous century, the increasing globalization and regionalization of economies and societies, combined with the requirements of the knowledge economy and the end of the Cold War, created a context for a more strategic approach to internationalization in higher education. International organizations such as the Organisation for Economic Cooperation and Development, the United Nations Educational, Scientific and Cultural Organization, and the World Bank, national governments, the European Union, and higher education organizations such as the International Association of Universities placed internationalization at the top of the reform agenda. Internationalization became a key change agent in higher education, in the developed world but also in emerging and developing societies. Mobility of students, scholars, and programs; reputation and branding (manifested by global and regional rankings); and a shift in paradigm from cooperation to competition (van der Wende, 2001) have been the main manifestations of the agenda of internationalization in higher education over the past 30 years. International education has become an industry, a source of revenue and a means for enhanced reputation. Quantitative data about the number of international degree-seeking students, of international talents and scholars, of students going for credits abroad, of agreements and memoranda of understanding, as well as of co-authored international publications in high impact academic journals, have not only been key manifestations of this perception of internationalization, but also have driven its agenda and actions. This perception has resulted in an increasing dominance of English in research but also teaching, has createdthe emergence of a whole new industry around internationalization, has forced national governments to stimulate institutions of higher education going international, and hasgenerated new buzz words such as “cross-border delivery” and “soft power” in the higher education arena. In the period 2010–2020, we have seen not only the number of international students double to 5 million in the past decade, but also we have noticed an increase in franchise operations, articulation programs, branch campuses, and online delivery of higher education. There is fierce competition for talented international students and scholars, and immigration policies have shifted from low-skill to high-skill immigration. National excellence programs have increased differentiation in higher education with more attention for a small number of international world-class universities and national flagship institutions that compete for these talents, for positions in the global rankings, for access to high impact journals, and for funding, at the cost of other institutions. There is also an increasing concern about the neo-colonial dimension. In the current global-knowledge society, the concept of internationalization of higher education has itself become globalized, demanding further consideration of its impact on policy and practice as more countries and types of institution around the world engage in the process. Internationalization should no longer be considered in terms of a westernized, largely Anglo-Saxon, and predominantly English-speaking paradigm. (Jones & de Wit, 2014, p. 28) Internationalization became defined by the generally accepted definition of Knight (2008): “The process of integrating an international, intercultural or global dimension into the purpose, functions and delivery of post-secondary education,” describing clearly the process in a general and value neutral way. Some of the main trends in internationalization in the past 30 years have been: More focused on internationalization abroad than on internationalization at home More ad hoc, fragmented, and marginal than strategic, comprehensive, and central in policies More in the interest of a small, elite subset of students and faculty than focused on global and intercultural outcomes for all Directed by a constantly shifting range of political, economic, social/cultural, and educational rationales, with increasing focus on economic motivations Increasingly driven by national, regional, and global rankings Little alignment between the international dimensions of the three core functions of higher education: education, research, and service to society Primarily a strategic choice and focus of institutions of higher education, and less a priority of national governments Less important in emerging and developing economies, and more of a particular strategic concern among developed economies In the past decade, however, one can observe a reaction to these trends. While mobility is still the most dominant factor in internationalization policies worldwide, there is increasing attention being paid to internationalization of the curriculum at home. There is also a stronger call for comprehensive internationalization, which addresses all aspects of education in an integrated way. Although economic rationales and rankings still drive the agenda of internationalization, there is more emphasis now being placed on other motivations for internationalization. For example, attention is being paid to integrating international dimensions into tertiary education quality assurance mechanisms, institutional policies related to student learning outcomes, and the work of national and discipline-specific accreditation agencies (de Wit, 2019). Traditional values that have driven international activities in higher education in the past, such as exchange and cooperation, peace and mutual understanding, human capital development, and solidarity, although still present in the vocabulary of international education, have moved to the sideline in a push for competition, revenue, and reputation/branding. Around the change of the century, we observed a first response to these developments. The movement for Internationalization at Home within the European Union started in 1999 in Malmö, Sweden, drawing more attention to the 95% of nonmobile students not participating in the successful flagship program of the EU, ERASMUS. In the United Kingdom and Australia, a similar movement asked for attention to internationalization of the curriculum and teaching and learning in response to the increased focus on recruiting income-generating international students. And in the United States, attention emerged around internationalizing campuses and developing more comprehensive approaches to internationalization as an alternative for the marginal and fragmented focus on undergraduate study abroad on the one hand and international student recruitment on the other. These reactions were and are important manifestations of concern about the competitive, elitist, and market direction of internationalization, and are a call for more attention to the qualitative dimensions of internationalization, such as citizenship development, employability, and improvement of the quality of research, education, and service to society. A wide range of academic scholars and international education practitioners have pushed for change with their publications and presentations. A study for the European Parliament on the state of internationalization in higher education gave this push an extra dimension. Not only did the study provide a comprehensive overview of the literature and the practice of internationalization in higher education around the world, but also—based on a global Delphi Exercise—it promoted a new agenda for internationalization for the future, by extending the definition of Knight (2008), defining internationalization as follows: The intentional process of integrating an international, intercultural or global dimension into the purpose, functions and delivery of post-secondary education, in order to enhance the quality of education and research for all students and staff and to make a meaningful contribution to society. (de Wit et al., 2015) This definition gave a normative direction to the process by emphasizing that such a process does not proceed by itself but needs clear intentions, that internationalization is not a goal in itself but needs to be directed toward quality improvement, that it should not be of interest to a small elite group of mobile students and scholars but directed to all students and scholars, and that it should make a contribution to society. Over the past 5 years this new approach has received positive attention, and at the start of a new decade it is important to see if this shift back to a more ethical and qualitative approach with respect to internationalization is indeed taking place and what new dimensions one can observe in that shift.

Internships, externships, field experiences, cooperative work experiences, apprenticeships, practicums—There are probably as many combinations and adaptations of these terms in educational institutions as there are states and provinces in the United States and Canadal Yet all exist for the same purpose: to provide students opportunities to apply knowledge and skills learned in those educational institutions to the real world of work in the hospitality industry and to find out first-hand what a job in this industry really entails. Whether at entry level or supervisory level, students and industry benefit from this sometimes misunderstood, and often mismanaged, practical on-the-job experience. The Ohio Board of Regents, as with other state governing bodies, issues definitions and guidelines for a variety of industry work experiences. These give some uniformity within Ohio two year colleges, but even with this the structure and effectiveness of these experiences differ from college to college. The following chart summarizes the Ohio guidelines: The Columbus State Community College curriculum for Hospitality Management students includes two courses, Hospitality Management Cooperative Work Experiences I and II, requiring a minimum of 20 hours per week in employment during each of two 10-week academic quarters. The student receives two credits for each course. Ninety percent of the hospitality students have worked in the industry, so it is recommended they do not enroll in these courses until their last two quarters. Therefore, they can receive maximum opportunity to apply principles learned in previous coursework and work experience. Until two years ago, our hospitality co-op experiences were loosely structured with varying degrees of benefit to students. It was left almost totally to industry personnel to determine the jobs students would perform. Even though graduate follow-up surveys indicated that graduates felt their required work experiences were among the more valuable aspects of their courses of study, we felt we needed to make some changes to assure that all students were able to grow professionally as a result of the experiences. Our industry advisory committee reached impasse after impasse on essentials such as payment or non-payment, actual jobs to be performed, qualifications of the work site, and critical skills of graduates. It was commonly accepted, however, that there must be some opportunity to sharpen skills in human relations, communication skills, and problem solving if students are to become effective first-line supervisors. It was reinforced that the college cannot teach everything in two years and that we should rely on applied work experience to supplement the formal education. The community colleges offer open access, and the profile of the student differs from the traditional college student in the baccalaureate program. This must be considered in outlining requirements for an industry work experience. The student is usually from the local area and commutes within a 30 mile radius, is an adult learner who averages 27 years of age, is likely to have a family and financial responsibilities, and is already employed at least part-time and probably full-time. It is unrealistic to assume one can take this student away from a job necessary to pay the bills and require a non-paid or lower paid experience strictly for the educational benefits to be derived. A compromise was finally reached with our advisory group and it has worked well for students and for industry. A student already employed in a hospitality job may stay at that site—even continue to perform the same job duties at the current rate of pay, but additional opportunities are created. At the beginning of each quarter the instructor, student, and job supervisor together examine a set of expected educational program outcomes or competencies and evaluate the current strengths and weaknesses of that student. An individualized learning contract is negotiated to supplement and reinforce the expected outcomes based upon each student's career objective. Training objectives for the student are then established which can be achieved either within the current job, by transfer to another department within the organization, or by allowing the student to gain additional experience at the same site on a non-paid basis over and above the regular job for which the student would normally be paid. This assures that there will be career growth, and the student maintains the planned income. At the same time it does not place an unrealistic expectation upon the employer. Industry personnel are most cooperative, and rarely would a student need relocation. The instructor has weekly contact with each student in a seminar accompanying the co-op experience. In this seminar students discuss experiences and observations and there is further opportunity to participate in case studies and supervisory skill development. Unless problems develop, the instructor often makes interim follow-ups by telephone only, and will return to the site only for the final evaluation session with the student and supervisor. A grade is determined jointly by the instructor and supervisor including scores for job performance, achievement of established training objectives, and seminar participation. In those infrequent instances where a student was not already employed, job seeking skills are part of the co-op grade determination. Assistance is given by the instructor and college job placement personnel, but the student is ultimately responsible for obtaining employment. A student does have the option for a non-paid experience, arranged by the college, in which case there will be a set rotation of job stations within an organization. This required a more specific work schedule and a formal agreement outlining responsibilities of the student, college, and work site because of the liability involved. Instructor workload for coordinating work experiences is calculated by assigning one contact hour per week for the seminar and one quarter contact hour per week for each student enrolled in the co-op course. The college full-time faculty workload is 20 contact hours per week. One faculty person is assigned organizational responsibility for the seminars, but the student follow-up is completed by each student's faculty advisor. This works well because it gives all faculty the opportunity for interaction with industry personnel and provides variety in the teaching experience. And, of course, the advisor who has worked closely with the student through his or her academic career knows that student's abilities and needs best. What is the future of internships? Whether credit or not-for-credit, whether paid or non-paid, whether tightly, loosely or non-structured, industry internships are her to stay. Graduate surveys reinforce the fact that students find them invaluable. Industry personnel agree that applied work experience should supplement and reinforce classroom learning. There is no doubt that the experiences could often be better structured and executed, but they cannot be replaced! For the past several years, college educators have participated in serious discussions and conducted studies about the quality of American higher education. The American Association of Community and Junior Colleges (AACJC) has assumed leadership in the focus on assessment and outcomes of students' educational experiences. The emphasis on “value-added” education and assessment programs has pervaded our campuses. It is crucial that the education experience adequately prepare students for the workplace and for career mobility. The question arises as to how to measure whether a program actually meets this objective. An AACJC Policy Statementon Student Assessment suggests that colleges will be better able to meet diverse population needs and improve the overall rate of student success if they provide a comprehensive assessment program for all students using effective measures and tools. It suggests that traditional testing alone is inadequate and other appropriate measurements of program strengths and weaknesses must be developed. It is possible that at least one industry work experience or internship course, if taken during a student's last academic term and based on agreed upon objectives and mastery standards, could serve as a summative assessment measure to determine the effectiveness of learning that has taken place over the student's entire program. It could perhaps serve as the “capstone” course. As we grapple with this and other issues, perhaps the CHRIE Internship Technical Committee can delve into how we can more effectively make the industry internships an integral part of the teaching and learning process.

This volume of Frontiers: The Interdisciplinary Journal of Study Abroad offers a wide variety of approaches and topics in international education research. First, readers will note the geographic diversity that the articles represent; they examine study abroad topics in Africa, Argentina, Costa Rica, France, Nepal, Thailand, and Vietnam. Second, the articles cover a wide-range of issues, including language acquisition, risk management, recruitment of minority students for study abroad, evaluation of cultural integration, and financial inequities in study abroad. Third, this volume contains articles by a variety of authors, including U.S.-based study abroad administrators, faculty members, and on-site resident directors. Finally, the modes of inquiry are as varied as the topics and authors. Research approaches in this volume include survey instruments, interviews, participant observation, case studies, literature review, as well as analytical essays. This diversity of geography, issues, authors, and modes of inquiry has from the beginning characterized the content of Frontiers and been one of its chief strengths. When the first volume of Frontiers appeared in 1995, one was hard pressed to find many research-based and analytical studies in the field, let alone the diversity of such work that this volume represents. In this regard, Frontiers has matured along with the field of international education, and today, almost ten years later, this volume reflects the growing importance being placed on research on the critical aspects of our work. The opening article by Lilli Engle and John Engle, “Study Abroad Levels: Toward a Classification of Program Types,” offers a revolutionary perspective by which international educators may categorize and judge study abroad programs. Their proposed typology makes qualitative distinctions between study abroad program models based on their view of a spectrum of cultural immersion. Frontiers readers will find their analysis provocative, stimulating study abroad professionals to examine programming in useful ways. In “Women and Cultural Learning in Costa Rica: Reading the Contexts,” Adele Anderson reviews research on Costa Rica’s cultural context, student adjustment and tourism theory, relating them to American student experiences, and she includes data from ethnographic observations and interviews collected during three years as a resident director of short-term programs. Anderson introduces a tool that may be used by resident directors to guide student cultural adjustment more systematically. Mark Ritchie, an on-site resident director in Thailand, provides a very useful analysis of study abroad risk management in his article, “Risk Management in Study Abroad: Lessons from the Wilderness.” Ritchie draws upon the principles of wilderness education, especially as it is conducted in developing countries, in offering recommendations for study abroad risk management. Readers will appreciate his suggestions for reducing risk by applying the experiential techniques of wilderness education. J. Scott Van Der Meid’s study, “Asian Americans: Factors Influencing the Decision to Study Abroad,” examines the factors that influence Asian American students’ decision to study abroad, and provides useful suggestions for considering ways to increase study abroad participation among this population. As the field of study abroad continues to seek ways to increase minority participation in study abroad, Van Der Meid’s study offers a model for examining this question among all ethnic groups. In their analysis of an innovative Vietnam study abroad program, “History Lived and Learned: Students and Vietnam Veterans in an Integrative Study Abroad Course,” Raymond Scurfield, Leslie Root, and Andrew Wiest et al, analyze the collaborative learning experience of students and Vietnam veterans in a program that combined the teaching of Vietnam culture and military history with an exploration of the mental health aspects of combat and post-war recovery of the veterans. This article discusses the lessons learned from the experience of designing and implementing a study abroad program that integrates history education with therapeutic objectives. Jennifer Coffman and Kevin Brennan analyze the economic imbalance of African educational exchange with the United States in their article, “African Studies Abroad: Meaning and Impact of America’s Burgeoning Export Industry.” Coffman and Brennan recommend developing more equitable models of reciprocity by examining the economics of U.S. – African exchanges, and by reconsidering the ways in which African study abroad programs are conceived and implemented in light of their social and intellectual impact. “Development of Oral Communication Skills Abroad” by Christina Isabelli-Garcia examines the impact of a semester study abroad program in Argentina on the second language acquisition of three American university Spanish learners. Isabelli-Garcia’s study measures the development of two aspects of communications skills: first, fluency and performance in the oral functions of narration, and, second, description and supporting an opinion. Her study provides insight into the conditions of a study abroad program that best promote the acquisition of improved oral communication skills in a target language. In “Studying Abroad in Nepal: Assessing Impact,” Patricia Farrell and Murari Suvedi present the perceived impact of studying in Nepal on students’ academic program, personal development, and intellectual development. Using a survey instrument as well as interviews and case studies, the authors link the reported outcomes to the objectives of the study abroad program. We are pleased to include in this volume of Frontiers an essay by Patti McGill Peterson, “New Directions for the Global Century.” McGill Peterson’s analysis of the changing and challenging context for global education inspires us to meet the demands of the 21st century with determination, creativity, and enhanced global collaboration. This volume of Frontiers concludes with reviews of books of interest to international educators, each relating to diverse intellectual foundations of the field: Jean-Philippe Mathy’s Extrême-Occident: French Intellectuals and America, Louis Menand’s The Metaphysical Club: A Story of Ideas in America, and First Great Triumph: How Five Americans Made Their Country a World Power by Warren Zimmermann. We encourage our readers to continue to suggest books of interest, and to submit reviews for consideration. The update on the Forum on Education Abroad that appears at the back of this volume reflects the continuing fruitful collaboration between Frontiers and the Forum. Together with the Forum, Frontiers will continue to encourage and support research studies on study abroad topics, and to disseminate this research as widely as possible. The next volume of Frontiers, due to be published in November, 2004, will be our tenth anniversary volume. It is appropriate that this anniversary volume will be a Special Issue that focuses on the assessment of the learning outcomes of study abroad, a topic that reflects the maturation of a field that is now beginning to document the results of its activity. Other Special Issues that are in the planning stages include: curriculum integration and study abroad, the arts and study abroad, and student development and study abroad. Finally, I want to thank the new sponsors of Frontiers who, together with our existing sponsors, make the publication of this journal possible. The sponsors of Frontiers are institutions with a strong commitment to international education, and we are proud to be supported by them. The editorial board takes seriously its responsibility to provide the very best writing about and research on study abroad to our readers, and the support of our sponsors makes this mission possible. Brian J. Whalen Editor

The cardiometabolic health spectrum that encompasses atherosclerotic cardiovascular disease (ASCVD), dysglycemia, hypertension, diabetes, dyslipidemia, and their sequelae are associated with several contributing factors, including high caloric intake and poor-quality diet.1 ASCVD and diabetes are closely associated, and both are increasing worldwide, particularly in the developing world.2 Pakistan is part of the South Asian subcontinent with a high prevalence of ASCVD and diabetes. Besides many other factors, the composition, quality, and quantity of the food consumed in the South Asian subcontinent appear to play a significant role in the manifestation of these diseases.3 Pakistan has an extensive array of geographical regions, ethnicities, and cultures that determine their dietary patterns and lifestyle choices.4 When compared with India, Pakistani food has always been based on more animal proteins.5 Recent socioeconomic growth and exposure to other cultures, particularly the Western and Middle Eastern influence have affected Pakistan’s dietary patterns.6 Food choices have become more energy-dense with higher calories and high-fat content, including excessive use of saturated and trans-fat containing ingredients.7 The non-communicable diseases (NCDs) risk factor survey showed that 96.5% of the participants were consuming an unhealthy diet.6 The variety of food choices together with increasing use of sugar-sweetened carbonated and non-carbonated beverages and lack of physical activity has led to an overall increase in the body weight and prevalence of obesity in society over the last two to three decades. These factors have resulted in a significant rise in the incidence of cardio-metabolic diseases.2 More importantly, these new trend has affected our younger population with the onset of diabetes and ASCVD at an earlier age.7-9 Most of the research on nutrition, dietary patterns, and their association with CVD has been conducted in developed and resource-rich populations.10 Specific diets that are associated with better cardiovascular morbidity and mortality include the Mediterranean style, Dietary Approaches to Stop Hypertension (DASH) style, Healthy US-Style, and healthy vegetarian style diets.11-13 The guidelines on diet and nutrition for cardiovascular health from the major societies (AHA/ACC, European Society of Cardiology) are mostly based upon the data from the above mentioned dietary styles.14 Pakistan lacks applied nutritional guidelines that can be adapted for our general and patient populations. A valuable resource, Pakistan Dietary Guidelines for Better Nutrition (PDGN) was published by the Ministry of Planning, Government of Pakistan 2019 However; it is not formally incorporated into guidelines for our medical societies or resulted in meaningful governmental policies.15 Therefore, there is an urgent need to address the lack of framework on nutrition for Pakistani population. Not only a review and improvement in our diet is required, other aspects of primary and secondary prevention related to lifestyle modification need also to be incorporated. This necessitates a need to develop a national policy to focus on all aspects of improving cardiovascular health and to address the issues related to the advertisement of unhealthy food choices on electronic and print media. This approach has been taken up by the developed world with significant results in health for their populations.16 There has been a gradual reduction in smoking and consumption of fast food through national policies and promotion of measures such as availability of food labeling, reduction of trans fat content in the food, and encouragement of exercise and physical activity through the availability of playing areas, cycling routes and sports in schools.8,9 Similarly, a more recent change in imposing a tax levy on sugar-sweetened beverages has improved the uptake of sugar-free carbonated drinks.17 Comprehensive diet and nutrition policies and guidelines must be developed, with the participation of all the stakeholders, at a national level and endorsed by the Government, and to fully resource the implementation across Pakistan. National guidelines on diet and nutrition must be based on a deeper understanding of the geographical, cultural, social, and economic situation of Pakistan. There are huge wealth inequalities in Pakistan leading to pockets of the population where there is an abundance of unhealthy foods consumed due to the adoption of Western style fast-food choices. More epidemiological and scientific work is required to learn the extent of the problem, particularly the role of our current diet as a causative factor in cardio metabolic diseases specific to the Pakistani population. Working closely with the education sector to build nutritional and healthy lifestyle advice into the core curriculum would allow access to a significant proportion of the population. This will accentuate the critical role of initiating heart-healthy dietary habits early in life. Given the limitations of resources available, we must adopt and incorporate innovative and novel solutions to influence and educate our local population based on consistent standard guidelines. For example, social media and IT-based solutions are being utilised to educate and follow up participants in the HEAL-Ramadan and COMET-Health Programmes. A majority of our population has access to information through either social media or mass media (electronic and print). The use of this approach is found to be cost-effective, easily reproducible, and less labor-intensive for public health education, a very important aspect of lifestyle measures programs. For inclusivity, we must also explore education interventions for parts of the Pakistan population for which an electronic-based program may not be suitable. A clinical review in the next quarter’s issue of Pakistan Heart Journal and a position paper later in the year on this subject will further highlight this important aspect of cardiovascular health. Our current editorial provides an outline and syntax for future work in this important area. We propose that the framework provided should be deliberated and discussed with other key stakeholders to develop comprehensive national guidelines incorporating the input from the relevant quarters. Furthermore, dietary guidelines must form an essential aspect of primary and secondary management of the cardio-metabolic disease spectrum and must include other facets of lifestyle measures, such as optimal body mass index, exercise, and cessation of smoking in the population. References Wu JHY, Micha R, Mozaffarian D. Dietary fats and cardiometabolic disease: mechanisms and effects on risk factors and outcomes. Nat Rev Cardiol. 2019;16(10):581-601. Kapoor D, Iqbal R, Singh K, Jaacks LM, Shivashankar R, Sudha V, et al. Association of dietary patterns and dietary diversity with cardiometabolic disease risk factors among adults in South Asia: The CARRS study. Asia Pac J Clin Nutr. 2018;27(6):1332-43. Barolia R, Petrucka P, Higginbottom GA, Khan FFS, Clark AM. Motivators and Deterrents to Diet Change in Low Socio-Economic Pakistani Patients with Cardiovascular Disease. Glob Qual Nurs Res. 2019;6:2333393619883605. Mahal DG, Matsoukas IG. The Geographic Origins of Ethnic Groups in the Indian Subcontinent: Exploring Ancient Footprints with Y-DNA Haplogroups. Front Genet. 2018;9:4. Safdar NF, Bertone-Johnson E, Cordeiro L, Jafar TH, Cohen NL. Dietary patterns of Pakistani adults and their associations with sociodemographic, anthropometric and life-style factors. J Nutr Sci. 2014;2:e42. Rafique I, Saqib MAN, Munir MA, Qureshi H, Rizwanullah, Khan SA, et al. Prevalence of risk factors for noncommunicable diseases in adults: key findings from the Pakistan STEPS survey. East Mediterr Health J. 2018;24(1):33-41. Sadia A, Strodl E, Khawaja NG, Kausar R, Cooper MJ. Understanding eating and drinking behaviours in Pakistani university students: A conceptual model through qualitative enquiry. Appetite. 2021;161:105133. Iqbal R, Iqbal SP, Yakub M, Tareen AK, Iqbal MP. Major dietary patterns and risk of acute myocardial infarction in young, urban Pakistani population. Pak J Med Sci. 2015;31(5):1213-8. Titus AR, Kalousova L, Meza R, Levy DT, Thrasher JF, Elliott MR, Lantz PM, Fleischer NL. Smoke-Free Policies and Smoking Cessation in the United States, 2003-2015. Int J Environ Res Public Health. 2019;16(17):3200. Anton S, Ezzati A, Witt D, McLaren C, Vial P. The effects of intermittent fasting regimens in middle-age and older adults: Current state of evidence. Exp Gerontol. 2021;156:111617. Lichtenstein AH, Appel LJ, Vadiveloo M, Hu FB, Kris-Etherton PM, Rebholz CM, et al. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation. 2021;144(23):e472-e87. Kim RJ, Lopez R, Snair M, Tang A. Mediterranean diet adherence and metabolic syndrome in US adolescents. Int J Food Sci Nutr. 2021;72(4):537-47. Harnden KE, Frayn KN, Hodson L. Dietary Approaches to Stop Hypertension (DASH) diet: applicability and acceptability to a UK population. J Hum Nutr Diet. 2010;23(1):3-10. Ferraro RA, Fischer NM, Xun H, Michos ED. Nutrition and physical activity recommendations from the United States and European cardiovascular guidelines: a comparative review. Curr Opin Cardiol. 2020;35(5):508-16. Iqbal R, Tahir S, Ghulamhussain N. The need for dietary guidelines in Pakistan. J Pak Med Assoc. 2017;67(8):1258-61. Cámara M, Giner RM, González-Fandos E, López-García E, Mañes J, Portillo MP, et al. Food-Based Dietary Guidelines around the World: A Comparative Analysis to Update AESAN Scientific Committee Dietary Recommendations. Nutrients. 2021;13(9):3131. Teng AM, Jones AC, Mizdrak A, Signal L, Genç M, Wilson N. Impact of sugar-sweetened beverage taxes on purchases and dietary intake: Systematic review and meta-analysis. Obes Rev. 2019;20(9):1187-204.

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.

OBJECTIVES/SPECIFIC AIMS: Stigma has been recognized as a major impediment to accessing mental health care among Vietnamese and Asian Americans (Leong and Lau, 2001; Sadavoy et al., 2004; Wynaden et al., 2005; Fong and Tsuang, 2007). The underutilization of mental health care, and disparities in both access and outcomes have been attributed to a large extent to stigma and cultural characteristics of this population (Wynaden et al., 2005; Jang et al., 2009; Leung et al., 2010; Spencer et al., 2010; Jimenez et al., 2013; Augsberger et al., 2015). People with neurotic or behavioral disorders may be considered “bad” as many Vietnamese people believe it is a consequence of one’s improper behavior in a previous life, for which the person is now being punished (Nguyen, 2003). Mental disorders can also been seen as a sign of weakness, which contributes to ambivalence and avoidance of help-seeking (Fong and Tsuang, 2007). Equally important is the need to protect family reputation; having emotional problems often implies that the person has “bad blood” or is being punished for the sins of his/her ancestors (Herrick and Brown, 1998; Leong and Lau, 2001), which disgraces the entire family (Wynaden et al., 2005). In these cases, public stigma (as opposed to internal stigma) is the primary reason for delays in seeking help (Leong and Lau, 2001). Other research has also highlighted the influences of culture on how a disorder may be labeled in different settings, although the presentation of symptoms might be identical (see Angel and Thoits, 1987). In Vietnamese culture, mental disorders are often labeled điên (literally translated as “madness”). A điên person and his or her family are often severely disgraced; consequently the individuals and their family become reluctant to disclose and seek help for mental health problems for fear of rejection (Sadavoy et al., 2004). Despite the critical role of stigma in accessing mental health care, there has been little work in trying to understand how stigmatizing attitudes towards mental illness among Vietnamese Americans manifest themselves and the influences of acculturation on these attitudes. Some previous work indicated a significant level of mental illness stigma among Vietnamese Americans, and experiences of living in the United States might interact with the way stigma manifests among this population (Do et al., 2014). Stigma is a complex construct that warrants a deeper and more nuanced understanding (Castro et al., 2005). Much of the development of stigma-related concepts was based on the classic work by Goffman (1963); he defined stigma as a process by which an individual internalizes stigmatizing characteristics and develops fears and anxiety about being treated differently from others. Public stigma (defined by Corrigan, 2004) includes the general public’s negative beliefs about specific groups, in this case individuals and families with mental illness concerns, that contribute to discrimination. Public stigma toward mental illness acts not only as a major barrier to care, but can also exacerbate anxiety, depression, and adherence to treatment (Link et al., 1999; Sirey et al., 2001; Britt et al., 2008; Keyes et al., 2010). Link and Phelan (2001) conceptualized public stigma through four major components. The first component, labeling, occurs when people distinguish and label human differences that are socially relevant, for example, skin color. In the second component, stereotyping, cultural beliefs link the labeled persons to undesirable characteristics either in the mind or the body of such persons, for example people who are mentally ill are violent. The third component is separating “us” (the normal people) from “them” (the mentally ill) by the public. Finally, labeled persons experience status loss and discrimination, where they are devalued, rejected and excluded. Link and Phelan (2001) emphasized that stigmatization also depends on access to social, economic, and political power that allows these components to unfold. This study aims to answer the following research questions: (1) how does public stigma related to mental illness manifest among Vietnamese Americans? and (2) in what ways does acculturation influence stigma among this population? We investigate how the 4 components of stigma according to Link and Phelan (2001) operationalized and how they depend on the level of acculturation to the host society. Vietnamese Americans is the key ethnic minority group for this study for several reasons. Vietnamese immigration, which did not start in large numbers until the 1970s, has features that allow for a natural laboratory for comparisons of degree of acculturation. Previous research has shown significant intergenerational differences in the level of acculturation and mental health outcomes (e.g., Shapiro et al., 1999; Chung et al., 2000; Ying and Han, 2007). In this study, we used age group as a proxy indicator of acculturation, assuming that those who were born and raised in the United States (the 18–35 year olds) would be more Americanized than those who were born in Vietnam but spent a significant part of their younger years in the United States (the 36–55 year olds), and those who were born and grew up in Vietnam (the 56–75 year olds) would be most traditional Vietnamese. The language used in focus group discussions (FGDs) reflected some of the acculturation, where all FGDs with the youngest groups were done in English, and all FGDs with the oldest groups were done in Vietnamese. METHODS/STUDY POPULATION: Data were collected through a set of FGDs and key informant interviews (KIIs) with experts to explore the conceptualization and manifestation of mental illness public stigma among Vietnamese Americans in New Orleans. Six FGDs with a total of 51 participants were conducted. Participants were Vietnamese American men and women ages 18–75. Stratification was used to ensure representation in the following age/immigration pattern categories: (1) individuals age 56–75 who were born and grew up in Vietnam and immigrated to the United States after age 35; (2) individuals age 36–55 who were born in Vietnam but spent a significant part of their youth in the United States; and (3) individuals age 18–35 who were born and grew up in the United States. These groups likely represent different levels of acculturation, assuming that people who migrate at a younger age are more likely to assimilate to the host society than those who do at a later age. Separate FGDs were conducted with men and women. Eleven KIIS were conducted with 6 service providers and 5 community and religious leaders. In this analysis, we focused on mental illness public stigma from the FGD participants’ perspectives. FGDs were conducted in either English or Vietnamese, whichever participants felt more comfortable with, using semistructured interview guides. All interviews were audio recorded, transcribed and translated into English if conducted in Vietnamese. Data coding and analysis was done using NVivo version 11 (QSR International, 2015). The analysis process utilized a Consensual Qualitative Research (CQR) approach, a validated and well-established approach to collecting and analyzing qualitative data. CQR involves gathering textual data through semistructured interviews or focus groups, utilizing a data analysis process that fosters multiple perspectives, a consensus process to arrive at judgments about the meaning of data, an auditor to check the work of the research team, and the development of domains, core-ideas, and cross-analysis (Hill et al., 2005). The study was reviewed and approved by Tulane University’s Internal Review Board. RESULTS/ANTICIPATED RESULTS: Components of public stigma related to mental illness. The 4 components of public stigma manifest to different extents within the Vietnamese Americans in New Orleans. Labeling was among the strongest stigma components, while the evidence of the other components was mixed. Across groups of participants, Vietnamese Americans agreed that it was a common belief that people with mental disorders were “crazy,” “acting crazy,” or “madness.” “Not normal,” “sad,” and “depressed” were among other words used to describe the mentally ill. However, there were clear differences between younger and older Vietnamese on how they viewed these conditions. The youngest groups of participants tended to recognize the “craziness” and “madness” as a health condition that one would need to seek help for, whereas the oldest groups often stated that these conditions were short term and likely caused by family or economic problems, such as a divorce, or a bankruptcy. The middle-aged groups were somewhere in between. The evidence supporting the second component, stereotyping, was not strong among Vietnamese Americans. Most FGD participants agreed that although those with mental disorders may act differently, they were not distinguishable. In a few extreme cases, mentally ill individuals were described as petty thefts or being violent towards their family members. Similarly to the lack of strong evidence of stereotyping, there was also no evidence of the public separating the mentally ill (“them”) from “us”. It was nearly uniformly reported that they felt sympathetic to those with mental disorders and their family, and that they all recognized that they needed help, although the type of help was perceived differently across groups. The older participants often saw that emotional and financial support was needed to help individuals and families to pass through a temporary phase, whereas younger participants often reported that professional help was necessary. The last component, status loss and discrimination, had mixed evidence. While nearly no participants reported any explicit discriminatory behaviors observed and practiced towards individuals with mental disorders and their families, words like “discrimination” and “stigma” were used in all FGDs to describe direct social consequences of having a mental disorder. Social exclusion was common. Our older participants said: “They see less of you, when they see a flaw in you they don’t talk to you or care about you. That’s one thing the Vietnamese people are bad at, spreading false rumors and discrimination” (Older women FGD). One’s loss of status seemed certain if their or their loved one’s mental health status was disclosed. Shame, embarrassment, and being “frowned upon” were direct consequences of one’s mental health status disclosure and subsequently gossiped about. Anyone with mental disorders was certain to experience this, and virtually everyone in the community would reportedly do this to such a family. “You get frowned upon. In the Vietnamese culture, that’s [a family identified as one with mental health problems] the big no-no right there. When everybody frowns upon your family and your family name, that’s when it becomes a problem” (Young men FGD). This is tied directly to what our participants described as Vietnamese culture, where pride and family reputation were such a high priority that those with mental disorders needed to go to a great extent to protect—“We all know what saving face means” as reported by our young participants. Even among young participants, despite their awareness of mental illness and the need for professional help, the desire to avoid embarrassment and save face was so strong that one would think twice about seeking help. “No, you just don’t want to get embarrassed. I don’t want to go to the damn doctor and be like ‘Oh yeah, my brother got an issue. You can help him?’ Why would I do that? That’s embarrassing to myself…” (Young men FGD). Our middle-aged participants also reported: “If I go to that clinic [mental health or counseling clinic], I am hoping and praying that I won’t bump into somebody that I know from the community” (Middle-aged women FGD). Vietnamese people were also described as being very competitive among themselves, which led to the fact that if a family was known for having any problem, gossips would start and spread quickly wherever they go, and pretty soon, the family would be looked down by the entire community. “I think for Vietnamese people, they don’t help those that are in need. They know of your situation and laugh about it, see less of you, and distant themselves from you” (Older women FGD). Culture and mental illness stigma, much of the described stigma and discrimination expressed, and consequently the reluctance to seek help, was attributed to the lack of awareness of mental health and of mental health disorders. Many study participants across groups also emphasized a belief that Vietnamese Americans were often known for their perseverance and resilience, overcoming wars and natural disasters on their own. Mental disorders were reportedly seen as conditions that individuals and families needed to overcome on their own, rather than asking for help from outsiders. This aspect of Vietnamese culture is intertwined with the need to protect one’s family’s reputation, being passed on from one generation to the next, reinforcing the beliefs that help for mental disorders should come from within oneself and one’s family only. Consequently persons with mental health problems would be “Keeping it to themselves. Holding it in and believing in the power of their friends” (Middle-aged FGD) instead of seeking help. Another dimension of culture that was apparent from FGDs (as well as KIIs) was the mistrust in Western medicine. Not understanding how counseling or medicines work made one worry about approaching service providers or staying in treatment. The habit of Vietnamese people to only go see a doctor if they are sick with physical symptoms was also a hindrance to acknowledging mental illness and seeking care for it. Challenges, including the lack of vocabulary to express mental illness and symptoms, in the Vietnamese language, exaggerated the problem, even among those who had some understanding of mental disorders. It was said in the young men FGD that: “when you classify depression as an illness, no one wants to be sick,… if you call it an illness, no one wants to have that sort of illness, and it’s not an illness that you can physically see…” (Young men FGD). Another young man summarized so well the influence of culture on mental illness stigma: “Us Southeast Asian, like, from my parents specifically has Vietnam War refugees. I think the reason why they don’t talk about it is because it’s a barrier that they have to overcome themselves, right? As refugees, as people who have been through the war… [omitted]They don’t want to believe that they need help, and so the trauma that they carry when they give birth to us is carried on us as well. But due to the language barrier and also the, like, they say with the whole health care, in Vietnam I know that they don’t really believe in Western and Eurocentric medicine. So, from their understanding of how, like from their experience with colonization or French people, and how medicine works, they don’t believe in it” (Young men FGD). One characteristic of the Vietnamese culture that was also often mentioned by our FGD participants (as well as KIIs) was the lack of sharing and openness between generations, even within a family. Grandparents, parents, and children do not usually share and discuss each other’s problems. Parents and grandparents do not talk about problems because they need to appear strong and good in front of their children; children do not talk about problems because they are supposed to do well in all aspects, particularly in school. The competitiveness of Vietnamese and high expectations of younger generations again come into play here and create a vicious cycle. Young people are expected to do well in school, which put pressure on them and may result in mental health problems, yet, they cannot talk about it with their parents because they are not supposed to feel bad about school, and sharing is not encouraged. The Asian model minority myth and the expectations of parents that their children would do well in school and become doctors and lawyers were cited by many as a cause of mental health problems among young people. “Our parents are refugees, they had nothing and our parents want us to achieve this American Dream…. [omitted] It set expectations and images for us…. It was expected for all the Asians to be in the top 10, and for, like a little quick minute I thought I wasn’t going to make it, I was crying” (Yong men FGD). As a result, the mental health problems get worse. “If you’re feeling bad about something, you don’t feel like you can talk about it with anyone else, especially your family, because it is not something that is encouraged to be talked about anyway, so if you are feeling poorly and you don’t feel like you could talk to anybody, I think that just perpetuates the bad feelings” (Middle-aged women FGD). Acculturation and mental illness stigma Acculturation, the degree of assimilation to the host society, has changed some of the understanding of mental illness and stigmatizing attitudes. Differences across generations expressed in different FGDs indicated differences in perceptions towards mental illness that could be attributed to acculturation. For example, the young generation understood that mental illness was a health problem that was prevalent but less recognized in the Vietnamese community, whereas a prominent theme among the older participants was that mental illness was a temporary condition due to psychological stress, that it was a condition that only Caucasians had. Some of the components of public stigma related to mental illness seemed to vary between generations, for example the youngest participants were less likely to put a label on a person with mental health problems, or to stereotype them, compared to the oldest and middle-aged participants. This was attributed to their education, exposure to the media and information, and to them “being more Americanized.” However, there was no evidence that acculturation played an important role in changing the other components of public stigma, including stereotyping, separating, and status loss and discrimination. For example, the need to protect the family reputation was so important that our young participants shared: “If you damage their image, they will disown you before you damage that image” (Young men FGD). Young people, more likely to recognize mental health problems, were also more likely to share within the family and to seek help, but no more likely than their older counterparts to share outside of the family—“maybe you would go to counseling or go to therapy, but you wouldn’t tell people you’re doing that” (Young women FGD). The youngest participants in our study were facing a dilemma, in which they recognized mental health problems and the need for care, yet were still reluctant to seek care or talk about it publicly because of fears of damaging the family reputation and not living up to the parents’ expectations. Many young participants reported that it actually made it very difficult for them to navigate mental health issues between the 2 cultures, despite the awareness of the resources available. “I think it actually makes it harder. Only because you know to your parents and the culture, and your own people, it’s taboo, and it’s something that you don’t talk about. Just knowing that you have the resources to go seek it… You want advice from your family also, but you can’t connect the appointment to your family because you’re afraid to express that to your parents, you know? So I think that plays a big part, and knowing that you are up and coming, but you don’t want to do something to disappoint your family because they are so traditional” (Young men FGD). Some participants felt more comfortable talking about mental health problems, like depression, if it was their friend who experienced it and confided in them, but they would not necessarily felt open if it was their problem. Subtle cultural differences like this are likely overlooked by Western service providers. One older participant summarized it well “They [the young generation] are more Americanized. They are more open to other things [but] I think that mental health is still a barrier.” DISCUSSION/SIGNIFICANCE OF IMPACT: This study investigated how different components of public stigma related to mental illness manifest among Vietnamese Americans, a major ethnic group in the United States, and how acculturation may influence such stigma. The findings highlighted important components of public stigma, including labeling and status loss, but did not provide strong evidence of the other components within our study population. Strong cultural beliefs underlined the understanding of mental health and mental illness in general, and how people viewed people with mental illness. Several findings have been highlighted in previous studies with Asian immigrants elsewhere; for example, a study from the perspectives of health care providers in Canada found that the unfamiliarity with Western biomedicine and spiritual beliefs and practices of immigrant women interacted with social stigma in preventing immigrants from accessing care (O’Mahony and Donnelly, 2007). Fancher et al. (2010) reported similar findings regarding stigma, traditional beliefs about medicine, and culture among Vietnamese Americans. Acculturation played a role in changing stigmatizing attitudes as evidenced in intergenerational differences. However, being more Americanized did not equate to being more open, having less stigmatizing attitudes, or being more willing to seek care for mental health issues. Consistent with previous studies (Pedersen and Paves, 2014), we still found some level of stigma among young people aged 18–35, although some components were lessened with an increased level of acculturation. There was also a conflict among the younger generation, in which the need for mental health care was recognized but accessing care was no easier for them than for their parent and grandparent generations. The study’s findings are useful to adapt existing instruments to measure stigma to this population. The findings also have important program implications. One, they can be directly translated into basic supports for local primary and behavioral health care providers. Two, they can also be used to guide and inform the development and evaluation of an intervention and an additional study to validate the findings in other immigrant ethnic groups in the United States. Finally, based on results of the study, we can develop a conceptual framework that describes pathways through which social, cultural, and ecological factors can influence stigma and the ways in which stigma acts as a barrier to accessing mental health care among Vietnamese Americans. The guiding framework then can be validated and applied in future programs aimed to improve mental health care utilization among ethnic minorities.

Photo by Nathan Dumlao on Unsplash ABSTRACT The demographic of physicians in the United States has failed to include a proportionate population of Latinos in the United States. In what follows, I shall argue that the medical school admission process places an undue burden on low-income Latino applicants. Hence, the underrepresentation of Latinos in medical schools is an injustice. This injustice relates to the poor community health of the Latino community. Health disparities such as diabetes, HIV infection, and cancer mortality are higher amongst the Latino community. The current representation of Latino medical students is not representative of those in the United States. INTRODUCTION The demographic of physicians in the United States has failed to include a proportionate number of Latinos, meaning people of Latin American origin. Medical schools serve as the gatekeepers to the medical field, and they can alter the profession based on whom they admit. With over 60 million Latinos in the United States, people of Latin American origin comprise the largest minority group in the nation.[1] In 2020-2021, only 6.7 percent of total US medical school enrollees and only 4 percent of medical school leadership identified as Latino.[2] Latino physicians can connect to a historically marginalized community that faces barriers including language, customs, income, socioeconomic status, and health literacy. I argue that the medical school admissions process places an undue burden on low-income Latino applicants. This paper explores the underrepresentation of Latinos in medical schools as an injustice. A further injustice occurs as the barriers to medical education result in fewer Latino doctors to effectively deliver health care and preventive health advice to their communities in a culturally competent way. I. Latino Community Health Data The terms Latino and Hispanic have largely been considered interchangeable. US government departments, such as the US Census Bureau and the Centers for Disease Control and Prevention (CDC), define Hispanic people as those with originating familial ties to native Spanish-speaking countries, most of whom are from Latin America. The term Latino is more inclusive because it refers to all of those with strong originating ties to countries in Latin America, including those coming from countries such as Brazil and Belize who are not native Spanish speakers. Throughout this work, I refer to the term Latino because it is more inclusive, although the data retrieved from US government departments may refer to the population as Hispanic. “Low-income” refers to the qualifying economic criteria for the AAMC’s Fee Assistance Program Poverty Guidelines.[3] The AAMC Fee Assistance Program is designed to help individuals who do not have the financial means to pay the total costs of applying to medical school. For this paper, low-income refers to those who qualify for this program. The US government gathers data about Latino community health and its health risks. The Latino community has a higher poverty rate than the non-Hispanic white community.[4] Latino community health has long trailed that of white people collectively. For example, the Latino community experiences higher levels of preventable diseases, including hypertension, diabetes, and hepatitis, than the non-Hispanic white community does.[5] The CDC collects data about Latino community health and provides statistics to the public. Latinos in the United States trail only non-Hispanic blacks in prevalence of obesity. The Latino adult obesity rates are 45.7 percent for males and 43.7 percent for females.[6] Of the 1.2 million people infected with HIV in the United States, 294,200 are Latino.[7] The infection rate of chlamydia is 392.6 per 100,000 ― 1.9 times the rate in the non-Hispanic white population.[8] The tuberculosis incidence rate is eight times higher than that of non-Hispanic white people at 4.4 per 100,000.[9] Furthermore, Latinos have the third highest death rate for hepatitis C among all races and ethnic groups.[10] The prevalence of total diabetes, diagnosed and undiagnosed, among adults aged 18 and older also remains higher than that of non-Hispanic whites at 14.7 percent compared to 11.9 percent.[11] The high disease rate evidences the poor health of the community. Furthermore, 19 percent of Latinos in the United States remain uninsured.[12] Almost a quarter of the Latino population in the United States lives in poverty.[13] The high incidence of disease, lack of insurance, and high poverty rate create a frail health status for the Latino community in the United States. The medical conditions seen are largely preventable, and the incident rates can be lowered with greater investments in Latino community health. Considering the health disparities between Latino and non-Hispanic White people, there is an ethical imperative to provide better medical care and guidance to the Latino community. II. Ethical and Practical Importance of Increasing the Number of Latino Physicians Minorities respond more positively to patient-physician interactions and are more willing to undergo preventative healthcare when matched with a physician of their racial or ethnic background.[14] Latino medical doctors may lead to an improvement in overall community health through improved communication and trusting relationships. Patient-physician racial concordance leads to greater patient satisfaction with their physicians.[15] Identifying with the ethnicity of a physician may lead to greater confidence in the physician-patient relationship, resulting in more engagement on the patient’s behalf. A randomized study regarding African American men and the race of their attending physician found an increase in requests for preventative care when assigned to a black doctor.[16] Although the subjects were African American men, the study has implications applicable to other minority racial and ethnic groups. The application process is unjust for low-income Latinos. The low matriculation of Latinos in medical schools represents a missed opportunity to alleviate the poor community health of the Latino population in the United States. Medical school also would create an opportunity to address health issues that plague the Latino community. Becoming a physician allows low-income Latinos to climb the social ladder and enter the spaces in health care that have traditionally been closed off to them. Nonwhite physicians significantly serve underserved communities.[17] Increasing the number of Latino doctors can boost their presence, potentially improving care for underserved individuals. Teaching physicians cultural competence is not enough to address the health disparities the Latino community faces. Latino physicians are best equipped to understand the healthcare needs of low-income Latinos. I contend that reforming the application process represents the most straightforward method to augment the number of Latino physicians who wish to work in predominantly Latino or diverse communities, thereby improving healthcare for the Latino community. III. Cultural Tenets Affecting Healthcare Interactions “Poor cultural competence can lead to decreased patient satisfaction, which may cause the patient not to attend future appointments or seek further care.”[18] Latino community health is negatively affected when medical professionals misinterpret cultural beliefs. Cultural tenets like a reservation towards medication, a deep sense of respect for the physician, and an obligation to support the family financially and through advocacy affect how Latinos seek and use the healthcare system.[19] First, the Latino population's negative cultural beliefs about medication add a barrier to patient compliance. It is highlighted that fear of dependence upon medicine leads to trouble with medication regimens.[20] The fear stems from the negative perception of addiction in the Latino community. Taking as little medication as possible avoids the chance of addiction occurring, which is why many take the prescribed medicine only until they feel healthier, regardless of the prescribing regimen. Some would rather not take any medication because of the deep-rooted fear. Physicians must address this concern by communicating the importance of patient compliance to remedy the health issue. Explaining that proper use of the medication as prescribed will ensure the best route to alleviate the condition and minimize the occurrence of dependence. Extra time spent addressing concerns and checking for comprehension may combat the negative perception of medication. Second, the theme of respeto, or respect, seems completely harmless to most people. After all, how can being respectful lead to bad health? This occurs when respect is understood as paternalism. Some patients may relinquish their decision-making to the physician. The physician might not act with beneficence, in this instance, because of the cultural dissonance in the physician-patient relationship that may lead to medical misinterpretation. A well-meaning physician might not realize that the patient is unlikely to speak up about their goals of care and will follow the physician’s recommendations without challenging them. That proves costly because a key aspect of the medical usefulness of a patient’s family history is obtaining it through dialogue. The Latino patient may refrain from relaying health concerns because of the misconceived belief that it’s the doctor’s job to know what to ask. Asking the physician questions may be considered a sign of disrespect, even if it applies to signs, symptoms, feelings, or medical procedures the patient may not understand.[21] Respeto is dangerous because it restricts the patients from playing an active role in their health. Physicians cannot derive what medical information may be relevant to the patient without their cooperation. And physicians without adequate cultural competency may not know they need to ask more specific questions. Cultural competency may help, but a like-minded physician raised similarly would be a more natural fit. “A key component of physician-patient communication is the ability of patients to articulate concerns, reservations, and lack of understanding through questions.”[22] As a patient, engaging with a physician of one’s cultural background fortifies a strong physician-patient relationship. Latino physicians are in the position to explain to the patients that respeto is not lost during a physician-patient dialogue. In turn, the physician can express that out of their value of respeto, and the profession compels them to place the patient’s best interest above all. This entails physicians advocating on behalf of the patients to ask questions and check for comprehension, as is required to obtain informed consent. Latino physicians may not have a cultural barrier and may already organically understand this aspect of their patient’s traditional relationship with physicians. The common ground of respeto can be used to improve the health of the Latino community just as it can serve as a barrier for someone from a different background. Third, in some Latino cultures, there is an expectation to contribute to the family financially or in other ways and, above all, advocate on the family’s behalf. Familial obligations entail more than simply translating or accompanying family members to their appointments. They include actively advocating for just treatment in terms of services. Navigating institutions, such as hospitals, in a foreign landscape proves difficult for underrepresented minorities like Latinos who are new to the United States. These difficulties can sometimes lead to them being taken advantage of, as they might not fully understand their rights, the available resources, or the standard procedures within these institutions. The language barrier and unfamiliar institutional policies may misinterpret patients’ needs or requests. Furthermore, acting outside of said institution’s policy norms may be erroneously interpreted as actions of an uncooperative patient leading to negative interactions between the medical staff and the Latino patient. The expectation of familial contribution is later revisited as it serves as a constraint to the low-income Latino medical school applicant. Time is factored out to meet these expectations, and a moral dilemma to financially contribute to the family dynamic rather than delay the contribution to pursue medical school discourages Latinos from applying. IV. How the Medical School Admission Process is Creating an Undue Burden for Low-Income Latino Applicants Applying a bioethics framework to the application process highlights its flaws. Justice is a central bioethical tenet relevant to the analysis of the MD admissions process. The year-long medical school application process begins with the primary application. The student enters information about the courses taken, completes short answer questions and essays, and uploads information about recommenders. Secondary applications are awarded to some medical students depending on the institutions’ policies. Some schools ask all applicants for secondary applications, while others select which applicants to send secondary requests. Finally, interviews are conducted after a review of both primary and secondary applications. This is the last step before receiving an admissions decision. The medical school application process creates undue restrictions against underserved communities. It is understood that matriculating into medical school and becoming a doctor should be difficult. The responsibilities of a physician are immense, and the consequences of actions or inactions may put the patients’ lives in jeopardy. Medical schools should hold high standards because of the responsibility and expertise required to provide optimal healthcare. However, I argue that the application process places an undue burden on low-income Latino applicants that is not beneficial to optimal health care. The burden placed on low-income Latino applicants through the application process is excessive and not necessary to forge qualified medical students. The financial aspect of the medical school application has made the profession virtually inaccessible to the working class. The medical school application proves costly because of the various expenses, including primary applications, secondary applications, and interview logistics. There is financial aid for applications, but navigating some aid to undertake test prep, the Medical College Admission Test (MCAT), and the travel for interviews proves more difficult. Although not mandatory, prep courses give people a competitive edge.[23] The MCAT is one of the key elements of an application, and many medical schools will not consider applications that do not reach their score threshold. This practically makes the preparatory courses mandatory for a competitive score. The preparatory courses themselves cost in the thousands of dollars. There has been talk about adjusting the standardized test score requirements for applicants from medically underserved backgrounds. I believe the practice of holding strict cutoffs for MCAT scores is detrimental to low-income Latino applicants, especially considering the average MCAT scores for Latinos trail that of white people. The American Association of Medical Colleges’ recent data for the matriculating class of 2021 illustrates the wide gap in MCAT scores: Latino applicants average 500.2, and Latino matriculants average 506.6, compared to white applicants, who average 507.5 and white matriculants, who average 512.7.[24] This discrepancy suggests that considerations beyond scores do play some role in medical school matriculation. However, the MCAT scores remain a predominant factor, and there is room to value other factors more and limit the weight given to scores. The practice of screening out applicants based solely on MCAT scores impedes low-income Latino applicants from matriculating into medical school. Valuing the MCAT above all other admissions criteria limits the opportunities for those from underserved communities, who tend to score lower on the exam. One indicator of a potentially great physician may be overcoming obstacles or engaging in scientific or clinical experiences. There are aspects of the application where the applicant can expand on their experiences, and the personal statement allows them to showcase their passion for medicine. These should hold as much weight as the MCAT. The final indicator of a good candidate should not solely rest on standardized tests. There is a cost per medical school that is sent to the primary application. The average medical school matriculant applies to about 16 universities, which drives up the cost of sending the applications.[25] According to the American Association of Medical Colleges, the application fee for the first school is $170, and each additional school is an additional $42. Sending secondary applications after the initial application is an additional cost that ranges by university. The American Medical College Application Service (AMCAS), the primary application portal for Medical Doctorate schools in the United States and Canada, offers the Fee Assistance Program (FAP) to aid low-income medical school applicants. The program reduces the cost of the MCAT from $325 to $130, includes a complimentary Medical School Admission Requirements (MSAR) subscription, and fee waivers for one AMCAS application covering up to 20 schools.[26] The program is an important aid for low-income Latino students who would otherwise not be able to afford to send multiple applications. Although the aid is a great resource, there are other expenses of the application process that the program cannot cover. For a low-income applicant, the burden of the application cost is felt intensely. A study analyzing the American Medical College Application Service (AMCAS) data for applicants and matriculants from 2014 to 2019 revealed an association between income and acceptance into medical school. They state, “Combining all years, the likelihood of acceptance into an MD program increased stepwise by income. The adjusted rate of acceptance was 24.32 percent for applicants with income less than $50 000, 27.57 percent for $50 000 - $74 999, 29.90 percent for $75 000 - $124 999, 33.27 percent for $125 000 - $199 999, and 36.91 percent for $200,000 or greater.”[27] It becomes a discouraging factor when it is difficult to obtain the necessary funds. The interview process for medical schools may prove costly because of travel, lodging, and time. In-person interviews may require applicants to travel from their residence to other cities or states. The applicant must find their own transportation and housing during the interview process, ranging from a single day to multiple days. Being granted multiple interviews becomes bittersweet for low-income applicants because they are morally distraught, knowing the universities are interested yet understanding the high financial cost of the interviews. The expense of multiple interviews can impede an applicant from progressing in the application process. Medical schools do not typically cover travel expenses for the interview process. Only 4 percent of medical school faculty identify as Latino.[28] The medical school admission board members reviewing the application lack Latino representation.[29] Because of this, it is extremely difficult for a low-income Latino applicant to portray hardships that the board members would understand. Furthermore, the section to discuss any hardships only allows for 200 words. This limited space makes it extremely difficult to explain the nuances of navigating higher education as a low-income Latino. Explaining those difficulties is then restricted to the interview process. However, that comes late in the application process when most applicants have been filtered out of consideration. The lack of diversity among the board members, combined with the minimal space to explain hardships or burdens, impedes a connection to be formed between the Latino applicants and the board members. It is not equitable that this population cannot relate to their admissions reviewers because of cultural barriers. Gatekeeping clinical experience inadvertently favors higher socioeconomic status applicants. Most medical schools require physician shadowing or clinical work, which can be difficult to obtain with no personal connections to the field. Using clinical experience on the application is another way that Latinos are disadvantaged compared to people who have more professional connections or doctors in the family and social circles. The already competitive market for clinical care opportunities is reduced by nepotism, which does not work in favor of Latino applicants. Yet some programs are designed to help low-income students find opportunities, such as Johns Hopkins’ Careers in Science and Medicine Summer Internship Program, which provides clinical experience and health professions mentoring.[30] Without social and professional ties to health care professionals, they are forced to enter a competitive job and volunteer market in clinical care and apply to these tailored programs not offered at all academic institutions. While it is not unique to Latinos, the time commitment of the application process is especially harsh on low-income students because they have financial burdens that can determine their survival. Some students help their families pay for food, rent, and utilities, making devoting time to the application process more problematic. As noted earlier, Latino applicants may also have to set aside time to advocate for their families. Because the applicants tend to be more in tune with the dominant American culture, they are often assigned the family advocate role. They must actively advocate for their family members' well-being. The role of a family advocate, with both its financial and other supportive roles ascribed to low-income Latino applicants, is an added strain that complicates the medical school application. As a member of a historically marginalized community, one must be proactive to ensure that ethical treatment is received. Ordinary tasks such as attending a doctor's appointment or meeting with a bank account manager may require diligent oversight. Applicants must ensure the standard of service is applied uniformly to their family as it is to the rest of the population. This applies to business services and healthcare. It can be discouraging to approach a field that does not have many people from your background. The lack of representation emphasizes the applicant's isolation going through the process. There is not a large group of Latinos in medicine to look to for guidance.[31] The group cohesiveness that many communities experience through a rigorous process is not established among low-income Latino applicants. They may feel like outsiders to the profession. Encountering medical professionals of similar backgrounds gives people the confidence to pursue the medical profession. V. Medical School Admission Data This section will rely on the most recent MD medical school students, the 2020-2021 class. The data includes demographic information such as income and ethnicity. The statistics used in this section were retrieved from scholarly peer-reviewed articles and the Medical School Admission Requirement (MSAR) database. Both sources of data are discussed in more detail throughout the section. The data reveals that only 6.7 percent of medical students for the 2020-2021 school year identify as Latino.[32] The number of Latino students in medical school is not proportional to the Latino community in the United States. While Latinos comprise almost 20 percent of the US population (62.1 million), they comprise only 6.7 percent of the medical student population.[33] Below are three case studies of medical schools in cities with a high Latino population. VI. Medical School Application Process Case Studies a) New York University Grossman School of Medicine is situated in Manhattan, where a diverse population of Latinos reside. The population of the borough of Manhattan is approximately 1,629,153, with 26 percent of the population identifying as Latino.[34] As many medical schools do, Grossman School of Medicine advertises an MD Student Diversity Recruitment program. The program, entitled Prospective MD Student Liaison Program, is aimed such that “students from backgrounds that are underrepresented in medicine are welcomed and supported throughout their academic careers.”[35] The program intervenes with underrepresented students during the interview process of the medical school application. All students invited to interviews can participate in the Prospective MD Student Liaison Program. They just need to ask to be part of it. That entails being matched with a current medical student in either the Black and Latinx Student Association (BALSA) or LGBTQMed who will share their experiences navigating medical school. Apart from the liaison program, NYU participates in the Science Technology Entry Program (STEP), which provides academic guidance to middle and high school students who are underrepresented minorities.[36] With the set programs in place, one would expect to find a significantly larger proportion of Latino medical students in the university. The Medical School Admission Requirement (MSAR) database compiled extensive data about participants in the medical school; the data range from tuition to student body demographics. Of the admitted medical students in 2021, only 16 out of 108 identified as Latino, despite the much larger Latino population of New York.[37] Furthermore, only 4 percent of the admitted students classify themselves as being from a disadvantaged status.[38] The current efforts to increase medical school diversity are not producing adequate results at NYU. Although the Latino representation in this medical school may be higher than that in others, it does not reflect the number of Latinos in Manhattan. The Prospective MD Student Liaison Program intervenes at a late stage of the medical school application process. It would be more beneficial for a program to cover the entire application process. The lack of Latino medical students makes it difficult for prospective students to seek advice from Latino students. Introducing low-income Latino applicants to enrolled Latino medical students would serve as a guiding tool throughout the application process. An early introduction could encourage the applicants to apply and provide a resourceful ally in the application process when, in many circumstances, there would be none. Latino medical students can share their experiences of overcoming cultural and social barriers to enter medical school. b) The Latino population in Philadelphia is over 250,000, constituting about 15 percent of the 1.6 million inhabitants.[39] According to MSAR, the cohort of students starting at Drexel University College of Medicine, located in Philadelphia, in 2021 was only 7.6 percent Latino.[40] 18 percent of matriculated students identify as having disadvantaged status, while 21 percent identify as coming from a medically underserved community.[41] Drexel University College of Medicine claims that “Students who attend racially and ethnically diverse medical schools are better prepared to care for patients in a diverse society.”[42] They promote diversity with various student organizations within the college, including the following: Student National Medical Association (SNMA), Latino Medical Student Association (LMSA), Drexel Black Doctors Network, LGBT Medical Student Group, and Drexel Mentoring and Pipeline Program (DMAPP). The Student Center for Diversity and Inclusion of the College of Medicine offers support groups for underrepresented medical students. The support offered at Drexel occurs at the point of matriculation, not for prospective students. The one program that does seem to be a guide for prospective students is the Drexel Pathway to Medical School program. Drexel Pathway to Medical School is a one-year master’s program with early assurance into the College of Medicine and may serve as a gateway for prospective Latino Students.[43] The graduate program is tailored for students who are considered medically underserved or socioeconomically disadvantaged and have done well in the traditional pre-medical school coursework. It is a competitive program that receives between 500 and 700 applicants for the 65 available seats. The assurance of entry into medical school makes the Drexel Pathway to Medical School a beneficial program in aiding Latino representation in medicine. Drexel sets forth minimum requirements for the program that show the school is willing to consider students without the elite scores and grades required of many schools. MCAT scores must be in the 25th percentile or higher, and the overall or science GPA must be at least 2.9.[44] The appealing factor of this program is its mission to attract medically underserved students. This is a tool to increase diversity in medical school. Prospective low-income Latino students can view this as a graduate program tailored to communities like theirs. However, this one-year program is not tuition-free. It may be tempting to assume that patients prefer doctors with exceptional academic records. There's an argument against admitting individuals with lower test scores into medical schools, rooted in the belief that this approach does not necessarily serve the best interests of health care. The argument asserts that the immense responsibility of practicing medicine should be entrusted to the most qualified candidates. Programs like the Drexel Pathway to Medical School are designed to address the lower academic achievements often seen in underrepresented communities. Their purpose is not to admit underqualified individuals into medical school but to bridge the educational gap, helping these individuals take the necessary steps to become qualified physicians. c) The University of California San Francisco School of Medicine reports that 23 percent of its first-year class identifies as Latino, while 34 percent consider themselves disadvantaged.[45] The Office of Diversity and Outreach is concerned with increasing the number of matriculants from underserved communities. UCSF has instilled moral commitments and conducts pipeline and outreach programs to increase the diversity of its medical school student body. The Differences Matter Initiative that the university has undertaken is a complex years-long restructuring of the medical school aimed at making the medical system equitable, diverse, and inclusive.[46] The five-phase commitment includes restructuring the leadership of the medical school, establishing anti-oppression and anti-racism competencies, and critically analyzing the role race, ethnicity, gender, and sexual orientation play in medicine. UCSF offers a post-baccalaureate program specifically tailored to disadvantaged and underserved students. The program’s curriculum includes MCAT preparation, skills workshops, science courses, and medical school application workshops.[47] The MCAT preparation and medical school application workshops serve as a great tool for prospective Latino applicants. UCSF seems to do better than most medical schools regarding Latino medical students. San Francisco has a population of 873,965, of which 15.2 percent are Latino.[48] The large population of Latino medical students indicates that the school’s efforts to increase diversity are working. The 23 percent Latino matriculating class of 2021 better represents the number of Latinos in the United States, which makes up about a fifth of the population. With this current data, it is important to closely dissect the efforts UCSF has taken to increase diversity in its medical school. Their Differences Matter initiative instills a commitment to diversifying their medical school. As mentioned, the school's leadership has been restructuring to include a diverse administrative body. This allows low-income Latino applicants to relate to the admissions committee reviewing their application. With a hopeful outlook, the high percentage of Latino applicants may reflect comprehension of the application process and the anticipated medical school atmosphere and rigor among Latino applicants and demonstrate that the admissions committee understands the applicants. However, there are still uncertainties about the demographics of the Latino student population in the medical school. Although it is a relatively high percentage, it is necessary to decipher which proportion of those students are low-income Latino Americans. UCSF School of Medicine can serve as a model to uplift the Latino community in a historically unattainable profession. VII. Proposed Reform for Current Medical School Application One reform would be toward the reviewing admissions committee, which has the power to change the class composition. By increasing the diversity of the admissions committee itself, schools can give minority applicants a greater opportunity to connect to someone with a similar background through their application. It would address low-income Latino applicants feeling they cannot “get personal” in their application. These actions are necessary because it is not just to have a representative administration for only a portion of the public. Of the three medical schools examined, the University of California San Francisco has the highest percentage of Latino applicants in their entering class. They express an initiative to increase diversity within their medical school leadership via the Differences Matter initiative. This active role in increasing diversity within the medical school leadership may play a role in UCSF’s high percentage of Latino matriculants. That serves as an important step in creating an equitable application process for Latino applicants. An important consideration is whether the medical school administration at UCSF mirrors the Latino population in the United States. The importance of whether the medical school administration at UCSF mirrors the Latino population in the United States lies in its potential to foster diversity, inclusivity, and cultural competence in medical education, as well as to positively impact the healthcare outcomes and experiences of the Latino community. A diverse administration can serve as role models for students and aspiring professionals from underrepresented backgrounds. It can inspire individuals who might otherwise feel excluded or underrepresented in their career pursuits, including aspiring Latino medical students. Furthermore, a diverse leadership can help develop curricula, policies, and practices that are culturally sensitive and relevant, which is essential for addressing health disparities and providing equitable healthcare. It is also important to have transparency so the public knows the number of low-income Latino individuals in medical school. The Latino statistics from the medical school generally include international students. That speaks to diversity but misses the important aspect of uplifting the low-income Latino population of the United States. Passing off wealthy international students from Latin America to claim a culturally diverse class is misleading as it does not reflect income diversity. Doing so gives the incorrect perception that the medical school is accurately representing the Latino population of the United States. There must be a change in how the application process introduces interviews. It needs to be introduced earlier so the admissions committee can form early, well-rounded inferences about an applicant. The interview allows for personal connections with committee members that otherwise would not be established through the primary application. The current framework has the interviews as one of the last aspects of the application process before admissions decisions are reached. At this point in the application process, many low-income Latinos may have been screened out. I understand this is not an easy feat to accomplish. This will lead to an increase in interviews to be managed by the admissions committee. The burden can be strategically minimized by first conducting video interviews with applicants the admission committee is interested in moving forward and those that they are unsure about because of a weakness in a certain area of the application. The video interview provides a more formal connection between the applicants and admission committee reviewers. It allows the applicant to provide a narrative through spoken words and can come off as a more intimate window into their characteristics. It would also allow for an opportunity to explain hardships and what is unique. From this larger pool of video-interviewed applicants, the admission committee can narrow down to traditional in-person interviews. A form of these video interviews may be already in place in some medical school application process. I believe making this practice widespread throughout medical schools will provide an opportunity to increase the diversity of medical school students. There must be an increase in the number of programs dedicated to serving as a gateway to clinical experience for low-income Latino applicants. These programs provide the necessary networking environment needed to get clinical experience. It is important to consider that networking with clinical professionals is an admissions factor that detrimentally affects the low-income Latino population. One of the organizations that aids underserved communities, not limited to Latinos, in clinical exposure is the Summer Clinical Oncology Research Experience (SCORE) program.[49] The SCORE program, conducted by Memorial Sloan Kettering Cancer Center, provides its participants with mentorship opportunities in medicine and science. In doing so, strong connections are made in clinical environments. Low-income Latinos seek these opportunities as they have limited exposure to such an environment. I argue that it is in the medical school’s best interest to develop programs of this nature to construct a more diverse applicant pool. These programs are in the best interest of medical schools because they are culturing a well-prepared applicant pool. It should not be left to the goodwill of a handful of organizations to cultivate clinically experienced individuals from minority communities. Medical schools have an ethical obligation to produce well-suited physicians from all backgrounds. Justice is not upheld when low-income Latinos are disproportionally represented in medical schools. Programs tailored for low-income Latinos supplement the networking this population lacks, which is fundamental to obtaining clinical experience. These programs help alleviate the burden of an applicant’s low socioeconomic status in attaining clinical exposure. VIII. Additional Considerations Affecting the Medical School Application Process and Latino Community Health A commitment to practicing medicine in low-income Latino communities can be established to improve Latino community health.[50] Programs, such as the National Health Service Corps, encourage clinicians to practice in underserved areas by forgiving academic loans for years of work.[51] Increasing the number of clinicians in underserved communities can lead to a positive correlation with better health. It would be ideal to have programs for low-income Latino medical students that incentivize practicing in areas with a high population of underserved Latinos. This would provide the Latino community with physicians of a similar cultural background to attend to them, creating a deeper physician-patient relationship that has been missing in this community. Outreach for prospective Latino applicants by Latino medical students and physicians could encourage an increased applicant turnout. This effort can guide low-income Latinos who do not see much representation in the medical field. It would serve as a motivating factor and an opportunity to network within the medical field. Since there are few Latino physicians and medical students, a large effort must be made to make their presence known. IX. Further Investigation Required It is important to investigate the causes of medical school rejections of low-income Latinos. Understanding this piece of information would provide insight into the specific difficulties this population has with the medical school application. From there, the requirements can be subjected to bioethical analysis to determine whether those unfulfilled requirements serve as undue restrictions. The aspect of legacy students, children of former alumni, proves to be a difficult subject to find data on and merits further research. Legacy students are often given preferred admission into universities.[52] It is necessary to understand how this affects the medical school admissions process and whether it comes at a cost to students that are not legacy. It does not seem like these preferences are something universities are willing to disclose. The aspect of legacy preferences in admissions decisions could be detrimental to low-income Latino applicants if their parents are not college-educated in the United States, which often is the case. It would be beneficial to note how many Latinos in medical school are low-income. The MSAR report denotes the number of Latino-identified students per medical school class at an institution and the number of students who identify as coming from low resources. They do not specify which of the Latino students come from low-income families. This information would be useful to decipher how many people from the low-income Latino community are matriculating into medical schools. CONCLUSION It is an injustice that low-income Latinos are grossly underrepresented in medical school. It would remain an injustice even if the health of the Latino community in the United States were good. The current operation of medical school admission is based on a guild-like mentality, which perpetuates through barriers to admissions. It remains an exclusive club with processes that favor the wealthy over those who cannot devote money and time to the prerequisites such as test preparation courses and clinical internships. This has come at the expense of the Latino community in the United States in the form of both fewer Latino doctors and fewer current medical students. It is reasonable to hope that addressing the injustice of the underrepresentation of low-income Latinos in the medical field would improve Latino community health. With such a large demographic, the lack of representation in the medical field is astonishing. The Latino population faces cultural barriers when seeking healthcare, and the best way to combat that is with a familiar face. An increase in Latino medical students would lead to more physicians that not only can culturally relate to the Latino community, but that are a part of it. This opens the door for a comprehensive understanding between the patient and physician. As described in my thesis, Latino physicians can bridge cultural gaps that have proven detrimental to that patient population. That may help patients make informed decisions, exercising their full autonomy. The lack of representation of low-income Latinos in medicine is a long-known issue. Here, I have connected how the physician-patient relationship can be positively improved with an increase in low-income Latino physicians through various reforms in the admissions process. My hope is to have analyzed the problem of under-representation in a way that points toward further research and thoughtful reforms that can truly contribute to the process of remedying this issue. - [1] Passel, J. S., Lopez, M. H., & Cohn, D. (2022, February 3). U.S. Hispanic population continued its geographic spread in the 2010s. Pew Research Center. https://www.pewresearch.org/fact-tank/2022/02/03/u-s-hispanic-population-continued-its-geographic-spread-in-the-2010s/ [2] Ramirez, A. G., Lepe, R., & Cigarroa, F. (2021). Uplifting the Latino Population From Obscurity to the Forefront of Health Care, Public Health Intervention, and Societal Presence. JAMA, 326(7), 597–598. https://doi.org/10.1001/jama.2021.11997 [3] Association of American Medical Colleges. (2023). Who is eligible to participate in the fee assistance program? https://students-residents.aamc.org/fee-assistance-program/who-eligble-participate-fee-assistance-mprogram [4] U.S. Department of Health and Human Services Office of Minority Health. (2021). Profile: Hispanic/Latino Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 [5] Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. (2020). Center for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db360.htm; Center for Disease Control and Prevention. (2019). National Diabetes Statistic Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf; Hispanics / Latinos | Health Disparities | CDC. (2020, September 14). Health Disparities in HIV, Viral Hepatitis, STDs, and TB. https://www.cdc.gov/nchhstp/healthdisparities/hispanics.html [6] Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. (2020). Center for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db360.htm [7] Center for Disease Control and Prevention. (2021, October). Estimated HIV incidence and prevalence in the United States 2015–2019. https://www.cdc.gov/hiv/pdf/group/racialethnic/hispanic-latino/cdc-hiv-group-hispanic-latino-factsheet.pdf [8] Hispanics / Latinos | Health Disparities | CDC. (2020, September 14). Health Disparities in HIV, Viral Hepatitis, STDs, and TB. https://www.cdc.gov/nchhstp/healthdisparities/hispanics.html [9] CDC. (2020). [10] CDC. (2020). [11] Center for Disease Control and Prevention. (2019). National Diabetes Statistic Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf [12] Office of the Assistant Secretary for Planning and Evaluation. (2021, October). Issue Brief No. HP-2021-2. Health Insurance Coverage and Access to Care Among Latinos: Recent Trends and Key Challenges. U.S. Department of Health and Human Services. https://aspe.hhs.gov/reports/health-insurance-coverage-access-care-among-latinos [13] U.S. Department of Health and Human Services Office of Minority Health. (2021). Profile: Hispanic/Latino Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 [14] Alsan, M., Garrick, O., & Graziani, G. (2019). Does Diversity Matter for Health? Experimental Evidence from Oakland. American Economic Review, 109(12), 4071–4111. https://doi.org/10.1257/aer.20181446 [15] Takeshita, J., Wang, S., Loren, A. W., Mitra, N., Shults, J., Shin, D. B., & Sawinski, D. L. (2020). Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Network Open, 3(11). https://doi.org/10.1001/jamanetworkopen.2020.24583 [16] Alsan, et. al. (2019). [17] Marrast, L., Zallman, L., Woolhandler, S., Bor, D. H., & McCormick, D. (2014). Minority physicians’ role in the care of underserved patients. JAMA Internal Medicine, 174(2), 289. https://doi.org/10.1001/jamainternmed.2013.12756 (“Nonwhite physicians cared for 53.5% of minority and 70.4% of non-English speaking patients.” Increasing the number of Latino doctors could lead to more nonwhite physicians to care for the underserved populations as they serve those populations at disproportionate rates. This may lead to better care for the patients.) [18] Cersosimo, E., & Musi, N. (2011). Improving Treatment in Hispanic/Latino Patients. The American Journal of Medicine, 124(10), S16–S21. https://doi.org/10.1016/j.amjmed.2011.07.019 [19] Flores, G. (2000). Culture and the patient-physician relationship: Achieving cultural competency in health care. The Journal of Pediatrics, 136(1), 14–23. https://doi.org/10.1016/s0022-3476(00)90043-x [20] Cersosimo & Musi. (2011). [21] Flores. (2000). [22] Torres, D. (2019). Knowing How to Ask Good Questions: Comparing Latinos and Non-Latino Whites Enrolled in a Cardiovascular Disease Prevention Study. The Permanente Journal. https://doi.org/10.7812/tpp/18-258 [23] The Princeton Review. (n.d.). Score 513+ on the MCAT, Guaranteed! | The Princeton Review. [24] 2021 FACTS: Applicants and Matriculants Data. (2022). AAMC. https://www.aamc.org/data-reports/students-residents/interactive-data/2021-facts-applicants-and-matriculants-data [25] The Princeton Review. (n.d.). How Many Med Schools Should You Apply To? https://www.princetonreview.com/med-school-advice/how-many-med-schools-should-you-apply-to [26] Association of American Medical Colleges. (n.d.). Fee Assistance Program (FAP). AAMC. https://students-residents.aamc.org/fee-assistance-program/fee-assistance-program-fap [27] Nguyen, M., Desai, M. M., Fancher, T. L., Chaudhry, S. I., Mason, H. R. C., & Boatright, D. (2023). Temporal trends in childhood household income among applicants and matriculants to medical school and the likelihood of acceptance by income, 2014-2019. JAMA. https://doi.org/10.1001/jama.2023.5654 [28] Ramirez, et al. (2021). [29] Ko, M. J., Henderson, M. C., Fancher, T. L., London, M., Simon, M., & Hardeman, R. R. (2023). US medical school admissions leaders’ experiences with barriers to and advancements in diversity, equity, and inclusion. JAMA Network Open, 6(2), e2254928. https://doi.org/10.1001/jamanetworkopen.2022.54928 [30] Johns Hopkins University School of Medicine. (n.d.). JHU CSM SIP. Johns Hopkins Initiative for Careers in Science and Medicine - the Summer Internship Program. https://csmsip.cellbio.jhmi.edu/ [31] Figure 18. Percentage of all active physicians by race/ethnicity, 2018 | AAMC. (2018). AAMC. https://www.aamc.org/data-reports/workforce/data/figure-18-percentage-all-active-physicians-race/ethnicity-2018 [32] Ramirez, et al. (2021). [33] Passel, et al. (2022). [34] Census Reporter. (n.d.). Census profile: Manhattan borough, New York County, NY. https://censusreporter.org/profiles/06000US3606144919-manhattan-borough-new-york-county-ny/ [35] MD Student Diversity Recruitment. (2022). NYU Langone Health. https://med.nyu.edu/our-community/why-nyu-grossman-school-medicine/diversity-inclusion/recruiting-diversity/md-student-diversity-recruitment [36] NYU. (n.d.). STEP Pre-College Program. New York University. https://www.nyu.edu/admissions/undergraduate-admissions/how-to-apply/all-freshmen-applicants/opportunity-programs/pre-college-programs.html [37] Association of American Medical Colleges. (2022). NYU Grossman School of Medicine. Medical School Admission Requirements (MSAR). https://mec.aamc.org/msar-ui/#/medSchoolDetails/152 [38] Association of American Medical Colleges. (2022). [39] U.S. Census Bureau. (2021). U.S. Census Bureau QuickFacts: Philadelphia County, Pennsylvania. Census Bureau QuickFacts. https://www.census.gov/quickfacts/philadelphiacountypennsylvania [40] Association of American Medical Colleges. (2022). Drexel University College of Medicine. Medical School Admission Requirements. https://mec.aamc.org/msar-ui/#/medSchoolDetails/833 [41] Association of American Medical Colleges. (2022). [42] Drexel University College of Medicine. (n.d.). Diversity, Equity & Inclusion For Students. https://drexel.edu/medicine/about/diversity/diversity-for-students/ [43] Drexel University College of Medicine. (n.d.-b). Drexel Pathway to Medical School. https://drexel.edu/medicine/academics/graduate-school/drexel-pathway-to-medical-school/ [44] Drexel University College of Medicine. Drexel Pathway to Medical School. [45] Association of American Medical Colleges. (2022). University of California, San Francisco, School of Medicine. Medical School Admission Requirements. https://mec.aamc.org/msar-ui/#/medSchoolDetails/108 [46] The Regents of the University of California. (n.d.). Differences Matter. UCSF School of Medicine. https://medschool.ucsf.edu/differences-matter [47] The Regents of the University of California. (n.d.-b). Post Baccalaureate Program | UCSF Medical Education. UCSF Medical Education. https://meded.ucsf.edu/post-baccalaureate-program [48] United States Census Bureau. (2021). U.S. Census Bureau QuickFacts: San Francisco County, California. Census Bureau QuickFacts. https://www.census.gov/quickfacts/sanfranciscocountycalifornia [49] Memorial Sloan Kettering Cancer Center. (n.d.). Student Programs. https://www.mskcc.org/about/leadership/office-faculty-development/student-programs [50] Alsan, et al. (2021). [51] National Health Service Corps. (2021, November 2). Mission, Work, and Impact | NHSC. https://nhsc.hrsa.gov/about-us [52] Elam, C. L., & Wagoner, N. E. (2012). Legacy Admissions in Medical School. AMA Journal of Ethics, 14(12), 946–949. https://doi.org/10.1001/virtualmentor.2012.14.12.ecas3-1212

One of the most crucial measures for accomplishing sustainable development is the application of Green Infrastructure (GI), which could effectively coordinate social, environmental, and economic growth. Different publications on GI were analyzed in this research using bibliometric and visualization techniques with the help of the programs CiteSpace and VOSviewer, which were accessed through the Web of Science database. The number of publications relating to GI has increased dramatically over the past few decades, with research done in the United States and Europe taking the lead. Journal of Environmental Management, Urban Planning and Landscaping, and Urban Greening & Urban Forestry are the most often referenced periodicals for green infrastructure research. Investigation of co-cited literature has shown that several aspects of GI are studied, including their effect on human health and ecosystem; their management, appraisals, and design; and the evaluation of a particular feature of GI. Results from a keyword cluster analysis for "green infrastructure" show that most previous research has focused on this topic in four main areas: stormwater regulation, natural ecosystems, biodiversity preservation, and climate change.