Artykuły w czasopismach na temat „Baptist Educational Center (New York, N.Y.)”

This article presents a theoretical review of the main evaluation approaches that marked the trajectory of educational evaluation in the international scenario. This is a bibliographical research that, based on the assessment literature, aimed at studying the various dimensions and different meanings that have historically constituted the educational evaluation field. Seven evaluation approaches are described: goal-based evaluation, evaluation based on scientific logic, value-based evaluation, decision-making evaluation, consumer-oriented evaluation, participant-centered evaluation, and qualitative evaluation. Each one of them is characterized according to its protagonists, objectives, conceptual approaches, theoretical orientations deriving from methodological assumptions, and the scholars who continued their respective approaches. Such international literature had a strong influence on Brazilian evaluation researchers who, based on these references, sought to support a field of knowledge that is still in the process of constitution and strengthening in our country.ResumoEste artigo apresenta uma revisão teórica das principais abordagens de avaliação que marcaram a trajetória da avaliação educacional no cenário internacional. Trata-se de uma pesquisa bibliográfica que, referenciada na literatura da avaliação, busca estudar as variadas dimensões e os diferentes sentidos que constituíram historicamente o campo da avaliação educacional. São descritas sete abordagens de avaliação: a avaliação baseada em objetivos, a avaliação baseada na lógica científica, a avaliação baseada no valor agregado, a avaliação a serviço da decisão, a avaliação orientada para consumidores, a avaliação centrada nos participantes e a avaliação qualitativa. Cada uma dessas abordagens é caracterizada segundo seus protagonistas, objetivos, enfoques conceituais, orientações teóricas decorrentes de pressupostos metodológicos e os estudiosos que deram continuidade nas suas respectivas abordagens. Essa literatura internacional exerceu forte influência sobre os pesquisadores brasileiros da avaliação que, fundamentados nesses referenciais, buscaram sustentar uma área de conhecimento que ainda se encontra em processo de constituição e fortalecimento em nosso país.Keywords: Educational evaluation, Evaluation approaches, Theories on evaluation.Palavras-chave: Avaliação educacional, Abordagens de avaliação, Teorias em avaliação.ReferencesALKIN, Marvin C.; CHRISTIE, Christina A. An evaluation theory tree. In: ALKIN, Marvin C. (Ed.). Evaluation roots: tracing theorists’ views and influences. London: Sage, 2004. p. 381-392.CAMPBELL, Donald T.; STANLEY, Julian C. Experimental and quasi-experimental designs for research on teaching. In: GAGE, N. L. (Ed.). Handbook of research on training. Chicago: Rand McNally, 1963. p. 1-84.DE KETELE, Jean-Marie. L’évaluation conjuguée en paradigmes. Revue Française de Pédagogie, Lyon, n. 103, p. 59-80, 1993.DIAS SOBRINHO, José. Campo e caminhos da avaliação: a avaliação da educação superior no Brasil. In: FREITAS, Luiz Carlos (Org.). Avaliação: construindo o campo e a crítica. Florianópolis: Insular, 2002. p. 13-62.FERNANDES, Domingos. Acerca da articulação de perspectivas e da construção teórica em avaliação educacional. In: ESTEBAN, Maria Teresa; AFONSO, Almerindo Janela (Orgs.). Olhares e interfaces: reflexões críticas sobre a avaliação. São Paulo: Cortez, 2010. p. 15-44.GUBA, Egon G.; LINCOLN, Yvonna S. Avaliação de quarta geração. Trad. Beth Honorato. Campinas: Editora da Unicamp, 2011.HOUSE, Ernest; HOWE, Kenneth R. Deliberative democratic evaluation in practice. In: STUFFLEBEAM, Daniel L.; MADAUS, George F.; KELLAGHAN, Thomas (Eds.). Evaluation models: viewpoints on educational and human services evaluation. Boston: Kluwer Academic Publishers, 2000. p. 409-422.MACDONALD, Barry. Uma classificação política dos estudos avaliativos. In: GOLDBERG, Maria Amélia Azevedo; SOUSA, Clarilza Prado de (Orgs.). Avaliação de programas educacionais: vicissitudes, controvérsias, desafios. São Paulo: EPU, 1982. p. 16-17.OWSTON, Ron. Models and Methods for Evaluation. In: SPECTOR, J. Michael et al. (Eds.). Handbook of Research on Educational Communications and Technology. New York: Lawrence Erlbaum Associates, 2008. p. 605-618.PARLETT, Malcolm; HAMILTON, David. Avaliação Iluminativa: uma nova abordagem no estudo de programas inovadores. In: GOLDBERG, Maria Amélia Azevedo; SOUSA, Clarilza Prado de (Orgs.). Avaliação de programas educacionais: vicissitudes, controvérsias, desafios. São Paulo: EPU, 1982. p. 38-45.SANDERS, William L.; HORN, Sandra P. The Tennessee value-added assessment system (TVAAS): mixed model methodology in educational assessment. Journal of Personnel Evaluation in Education, New York, v. 8, n. 3, p. 299-311, 1994.SANDERS, William L.; RIVERS, June C. Cumulative and residual effects of teachers on future student academic achievement. Knoxville: University of Tennessee Value-Added Research and Assessment Center, 1996.STAKE, Robert E. Evaluation the arts in education: a responsive approach. Columbus: Merril, 1975a.STAKE, Robert E. Program evaluation, particularly responsive evaluation. Kalamazoo: Western Michigan University Evaluation Center, 1975b. (Occasional paper n. 5).STUFFLEBEAM, Daniel L. Evaluation models. New directions for evaluation, San Francisco, n. 89, p. 7-98, 2001.STUFFLEBEAM, Daniel L.; SHINKFIELD, Anthony L. Evaluación sistemática: guía teórica y práctica. Trad. Carlos Losilla. Barcelona: Paidós, 1987.WORTHEN, Blaine R.; SANDERS, James S.; FITZPATRICK, Jody L. Avaliação de programas: concepções e práticas. Trad. Dinah de Abreu Azevedo. São Paulo: Gente, 2004.

Berdyaev, N. A. (1951). The kingdom of the spirit and the kingdom of Caesar. Paris: Umca-Press. Recovered from: https://vtoraya-literatura.com/pdf/berdyaev_tsarstvo_dukha_i_tsastvo_kesarya_1951__ocr.pdf. Berlinger, N., & Solomon, M. Z. (2018). Becoming Good Citizens of Aging Societies. Hastings center report, Vol. 48(3), 2–9. Bostrom, N. (2003). Are You Living in a Simulation? Philosophical Quarterly, Vol. 53(211), 243–255. Bostrom, N. (2016). Development of values. Artificial Intelligence: Stages. Threats. Strategies. Moscow: Publishing House "Mann, Ivanov and Ferber". Recovered from: https://element.ru/bookclub/chapters/433044/Iskusstvennyy_intellekt_Glava_iz_knigi. Goryachkovskaya, A. N. (2014). Philosophy of transhumanism: on the surrogates of being, the abduction of identity and euthanasia of humanity. Bulletin of V. N. Karazin Kharkiv National University. Series: Theory of Culture and Philosophy of Science, Vol. 1092, Issue 50. Recovered from: http://periodicals.karazin.ua/thcphs/issue/view/209. Gould, C. C. (2018). Solidarity and the problem of structural injustice in healthcare. Bioethics, Vol. 32(9), 541–552. Guerrini, C., Lewellyn, M., Majumder, M. et al. (2019). Donors, authors, and owners: how is genomic citizen science addressing interests in research outputs? BMC Medical Ethics, Vol. 20, Issue 1, Article number 84. Habermas, J. (2002). The future of human nature. Towards liberal eugenics. Moskva: Ves' Mir. Haker, H. (2019). Habermas and the Question of Bioethics. European journal for Philosophy of Religion, Issue 4, 61–86. Heidegger, M. (1967). Being And Time. Max Niemeyer loading facility in Tübinge. Recovered from: https://taradajko.org/get/books/sein_und_zeit.pdf. Kakkori, L. (2018). Postmodern as Secularization in Philosophy of Education. Educational Philosophy and Theory, Vol. 50(14), Special issue: SI, 1639–1640. Kroker, A., & Cook, D. (1986). The Postmodern Scene. 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Bulletin of the National University "Yaroslav the Wise Law Academy of Ukraine". Series: Philosophy, Vol. 1(36), 90–113. Odorcak, J. (2019). Exorganic Posthumanism and Brain-Computer Interface Technologies (BCI). Postmodern openings, Vol. 10(4), 193-208. Pavlov, A. V. (2019). Images of modernity in the 21st century: hypermodernism. Philosophical Journal, Vol. 12(2), 20–33. Piarce, D. (2015). The Hedonistic Imperative. eBook. Recovered from: https://ubq124.wordpress.com/2019/12/22/the-hedonistic-imperative-pdf. Polyakova, O. V. (2017). Commodification of the dead body: ethical and legal aspects. Bulletin of the RSUH. Series "Psychology. Pedagogy. Education", Vol. 2(8), 118–128. Recovered from: http://cyberleninka.ru/article/n/kommodifikatsiya-mertvogo-tela-etiko-pravovye-aspekty Popova, O. V. (2016). Man, its price and value: to the problem of body commodification in scientific knowledge. Epistemology and philosophy of science, Vol. 49(3), 140-157. 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In this essay, Rubén Gaztambide-Fernández reflects on the comments made in a forum convened to reflect on his article “Why the Arts Don't Do Anything: Toward a New Vision for Cultural Production in Education,” published in the Harvard Educational Review (HER)'s special issue entitled Expanding Our Vision for the Arts in Education (Vol. 83, No. 1). Participants in the forum (published in HER Vol. 83, No.3) were John Abodeely, manager of national partnerships, John F. Kennedy Center for the Arts, Washington, DC; Ken Cole, associate director, National Guild for Community Arts Education, New York City; Janna Graham, project curator of the Serpentine Gallery, Centre for Possible Studies, London; Ayanna N. Hudson, director of arts education, National Endowment for the Arts, Washington, DC; and Carmen Mörsch, head of the Research Institute for Art Education, Zurich University of the Arts. In his original essay, Gaztambide-Fernández makes the case that advocacy for arts education is trapped within a “rhetoric of effects” that relies too heavily on causal arguments for the arts, whether construed as instrumental or intrinsic. Gaztambide- Fernández further argues that what counts as “the arts” is based on traditional, Eurocentric, hierarchical notions of aesthetic experience. As an alternative, he suggests a “rhetoric of cultural production” that would focus on the cultural processes and experiences that ensue in particular contexts shaped by practices of symbolic work and creativity. Here the author engages the forum's discussion in an effort to clarify his argument and move the dialogue forward.

-Leslie G. Desmangles, Joan Dayan, Haiti, history, and the Gods. Berkeley: University of California Press, 1995. xxiii + 339 pp.-Barry Chevannes, James T. Houk, Spirits, blood, and drums: The Orisha religion in Trinidad. Philadelphia: Temple University Press, 1995. xvi + 238 pp.-Barry Chevannes, Walter F. Pitts, Jr., Old ship of Zion: The Afro-Baptist ritual in the African Diaspora. New York: Oxford University Press, 1993. xvi + 199 pp.-Robert J. Stewart, Lewin L. Williams, Caribbean theology. New York: Peter Lang, 1994. xiii + 231 pp.-Robert J. Stewart, Barry Chevannes, Rastafari and other African-Caribbean worldviews. London: Macmillan, 1995. xxv + 282 pp.-Michael Aceto, Maureen Warner-Lewis, Yoruba songs of Trinidad. London: Karnak House, 1994. 158 pp.''Trinidad Yoruba: From mother tongue to memory. Tuscaloosa: University of Alabama Press, 1996. xviii + 279 pp.-Erika Bourguignon, Nicola H. Götz, Obeah - Hexerei in der Karibik - zwischen Macht und Ohnmacht. Frankfurt am Main: Peter Lang, 1995. 256 pp.-John Murphy, Hernando Calvo Ospina, Salsa! Havana heat: Bronx Beat. London: Latin America Bureau, 1995. viii + 151 pp.-Donald R. Hill, Stephen Stuempfle, The steelband movement: The forging of a national art in Trinidad and Tobago. Philadelphia: University of Pennsylvania Press, 1995. xx + 289 pp.-Hilary McD. Beckles, Jay R. Mandle ,Caribbean Hoops: The development of West Indian basketball. Langhorne PA: Gordon and Breach, 1994. ix + 121 pp., Joan D. Mandle (eds)-Edmund Burke, III, Lewis R. Gordon ,Fanon: A critical reader. Oxford: Blackwell, 1996. xxi + 344 pp., T. Denean Sharpley-Whiting, Renée T. White (eds)-Keith Alan Sprouse, Ikenna Dieke, The primordial image: African, Afro-American, and Caribbean Mythopoetic text. New York: Peter Lang, 1993. xiv + 434 pp.-Keith Alan Sprouse, Wimal Dissanayake ,Self and colonial desire: Travel writings of V.S. Naipaul. New York : Peter Lang, 1993. vii + 160 pp., Carmen Wickramagamage (eds)-Yannick Tarrieu, Moira Ferguson, Jamaica Kincaid: Where the land meets the body: Charlottesville: University Press of Virginia, 1994. xiii + 205 pp.-Neil L. Whitehead, Vera Lawrence Hyatt ,Race, discourse, and the origin of the Americas: A new world view. Washington DC: Smithsonian Institution Press, 1995. xiii + 302 pp., Rex Nettleford (eds)-Neil L. Whitehead, Patricia Seed, Ceremonies of possession in Europe's conquest of the new world, 1492-1640. Cambridge: Cambridge University Press, 1995. viii + 199 pp.-Livio Sansone, Michiel Baud ,Etnicidad como estrategia en America Latina y en el Caribe. Arij Ouweneel & Patricio Silva. Quito: Ediciones Abya-Yala, 1996. 214 pp., Kees Koonings, Gert Oostindie (eds)-D.C. Griffith, Linda Basch ,Nations unbound: Transnational projects, postcolonial predicaments, and deterritorialized nation-states. Langhorne PA: Gordon and Breach, 1994. vii + 344 pp., Nina Glick Schiller, Cristina Szanton Blanc (eds)-John Stiles, Richard D.E. Burton ,French and West Indian: Martinique, Guadeloupe and French Guiana today. Charlottesville: University Press of Virginia; London: Macmillan Caribbean, 1995. xii + 202 pp., Fred Réno (eds)-Frank F. Taylor, Dennis J. Gayle ,Tourism marketing and management in the Caribbean. New York: Routledge, 1993. xxvi + 270 pp., Jonathan N. Goodrich (eds)-Ivelaw L. Griffith, John La Guerre, Structural adjustment: Public policy and administration in the Caribbean. St. Augustine: School of continuing studies, University of the West Indies, 1994. vii + 258 pp.-Luis Martínez-Fernández, Kelvin A. Santiago-Valles, 'Subject People' and colonial discourses: Economic transformation and social disorder in Puerto Rico, 1898-1947. Albany: State University of New York Press, 1994. xiii + 304 pp.-Alicia Pousada, Bonnie Urciuoli, Exposing prejudice: Puerto Rican experiences of language, race, and class. Boulder: Westview Press, 1996. xiv + 222 pp.-David A.B. Murray, Ian Lumsden, Machos, Maricones, and Gays: Cuba and homosexuality. Philadelphia: Temple University Press, 1996. xxvii + 263 pp.-Robert Fatton, Jr., Georges A. Fauriol, Haitian frustrations: Dilemmas for U.S. policy. Washington DC: Center for strategic & international studies, 1995. xii + 236 pp.-Leni Ashmore Sorensen, David Barry Gaspar ,More than Chattel: Black women and slavery in the Americas. Bloomington: Indiana University Press, 1996. xi + 341 pp., Darlene Clark Hine (eds)-A. Lynn Bolles, Verene Shepherd ,Engendering history: Caribbean women in historical perspective. Kingston: Ian Randle; London: James Currey, 1995. xxii + 406 pp., Bridget Brereton, Barbara Bailey (eds)-Bridget Brereton, Mary Turner, From chattel slaves to wage slaves: The dynamics of labour bargaining in the Americas. Kingston: Ian Randle; Bloomington: Indiana University Press; London: James Currey, 1995. x + 310 pp.-Carl E. Swanson, Duncan Crewe, Yellow Jack and the worm: British Naval administration in the West Indies, 1739-1748. Liverpool: Liverpool University Press, 1993. x + 321 pp.-Jerome Egger, Wim Hoogbergen, Het Kamp van Broos en Kaliko: De geschiedenis van een Afro-Surinaamse familie. Amsterdam: Prometheus, 1996. 213 pp.-Ellen Klinkers, Lila Gobardhan-Rambocus ,De erfenis van de slavernij. Paramaribo: Anton de Kom Universiteit, 1995. 297 pp., Maurits S. Hassankhan, Jerry L. Egger (eds)-Kevin K. Birth, Sylvia Moodie-Kublalsingh, The Cocoa Panyols of Trinidad: An oral record. London & New York: British Academic Press, 1994. xiii + 242 pp.-David R. Watters, C.N. Dubelaar, The Petroglyphs of the Lesser Antilles, the Virgin Islands and Trinidad. Amsterdam: Foundation for scientific research in the Caribbean region, 1995. vii + 492 pp.-Suzannah England, Mitchell W. Marken, Pottery from Spanish shipwrecks, 1500-1800. Gainesville: University Press of Florida, 1994. xvi + 264 pp.

This study aims to determine the implementation of curriculum in learning activities of pre-school children and develop motion pattern-based learning media for pre-school children. This research was carried out in thirty kindergartens in East Jakarta. It was conducted in 4 months, from June to October 2018. This research is included in the development and evaluation research (mixed method). The scope of the research is the implementation of curriculum and the development of learning media for pre-school children by using customized tools. Data was collected by using questionnaires and analyzed by using Guttman scale and Likert scale. Percentage of the implementation of learning for pre-schoolers in Kindergarten in East Jakarta is very good. The goal dimension got 98.2%, the content dimension got 99.3%, the method dimension got 99.3% and the evaluation dimension got 98.3%. The product of this study is a learning media that is adjusted to the implementation of motion pattern-based learning activities for pre-school children. Keywords: Early childhood education curriculum, Motion Pattern-Based Learning Media, Pre-school children References Arikunto, S. (2010). Prosedur Penelitian Suatu Pendekatan Praktik. Jakarta: Asdi Mahasatya. Arikunto, S. (2014). Prosedur Penelitian. Jakarta: Rineka Cipta. Ayob, A., Badzis, M., & Nordin, A. L.Abdullah, R. (2016). Kurikulum Permata Negara. Tanjong Malim: NCDRC, UPSI. Azia, R. S. (1976). Curriculum Principles and Foundation. New York: Harper and Row Publisher. Boyle, T., & Phelps, R. (2010). Curriculum To Acknowledge Diversity. The International Journal of Learning, 17(2), 357–370. Brady, L. (1995). Curriculum development (5th ed.). Sydney: Prentice-Hall. Cholimah, N. (2012). Pengembangan Kurikulum PAUD Berdasarkan Permen 58 Tahun 2009. Criticos. (1996). Media. Amazon. George A.Beauchamp. (1981). Curriculum Theory. F.E. Peacock Publisher. Jamaris, M. (2006). Perkembangan dan Pengembangan Anak Usia Dini Taman Kanak-kanak. Jakarta: Gramedia Widiasarana. Johnson, M. (1967). Intentionality in Education. New York: Center for Curriculum Research and Services. Kawaitouw, Y. I., Widiastuti, A. A., & Kurniawan, M. (2018). Unit Studies Curriculum: Strategi Guru Dalam Implementasi Kurikulum di Jungle School Sidomukti. Jurnal Pendidikan Usia Dini, 12(November), 371–380. Kerlinger, F. N. (1990). Asas-asas Penelitian Behavioral (3th ed.). Yogyakarta: Gajah Mada University Press. Langgulung, H. (1989). Manusia dan Pendidikan: Suatu Analisa Psikologik dan Pendidikan. Jakarta: Pustaka al-Husna. MacDonald, J. B. (1965). Educational Models for Instruction. Washington DC: The Association for Supervision and Curriculum Development. Morrison, G. S. (2012). Dasar-dasar Pendidikan Anak Usia Dini. Jakarta: Indeks. Olivia, P. F. (1992). Developing the Curriculum (Third Edit). New York: Harper Collins Publishers Inc. Ornstein, A. C. (2004). Curriculum:Foundation, Principles, and Issues. Boston: Pearson Education, Inc. Ozturk, I. H. (2011). Curriculum Reform and Teacher Autonomy in Turkey: the case of the History Teaching". International Journal of Instruction, 4 (2)(2), 113–127. Prihatini, P. (2014). Kajian Ide Kurikulum 2012 PAUD dan Implikasinya dalam Pengembangan KTSP. Cakrawala: Jurnal Pendidikan Anak USia Dini. Rahelly, Y. (2018). Implementasi Kurikulum 2013 Pendidikan Anak Usia Dini di Sumatera Selatan. Jurnal Pendidikan Usia Dini, 12(November), 381–390. https://doi.org/https://doi.org/10.21009/JPUD.122.19 Rohmansyah, N. A. (2017). Pengaruh Model Pembelajaran Problem Based Learning Terhadap Kemampuan Pemahaman Konsep Pendidikan Jasmani Pada Pembelajaran Tematik Terintegrasi Siswa Kelas IV. JURNAL PENJAKORA, 4(28–35). Saylor, J. G., & Alexander, W. M. (1981). Curriculum Planning for Better Teaching and Learning. Holt-Rinehart and Winston. Sujiono, Y. N. (2009). Konsep Dasar Pendidikan Anak Usia Dini. Jakarta: Indeks. Sukmadinata, N. S. (2000). Pengembangan Kurikulum Teori dan Praktek. Bandung: Remaja Rosdakarya. Sutapa, P. (2014). Pengembangan Model Pembelajaran Pendidikan Jasmani Berbasis Kinestetik Untuk Anak Usia Pra Sekolah. Yogyakarta. Webster. (1993). Webster’s New International Dictionary. GC Company. Widoyoko, E. P. (2012). Evaluasi Program Pembelajaran. Yogyakarta: Pustaka Pelajar. Winarno. (2011). Winarno. Metodologi dalam Penelitian Pendidikan Jasmani. Malang: Media Cakrawala Press. Winarso, W. (2017). Dasar Pengembangan Kurikulum Sekolah, (January 2015).

Introduction and Problem StatementAs the role of teleneurology expands, it is important to prepare trainees to perform virtual encounters proficiently.ObjectivesWe created a comprehensive multimodality teleneurology curriculum for residents to teach key aspects of telehealth encounters including the virtual examination and skill development across several environments.Methods and Curriculum DescriptionWe developed and implemented a teleneurology curriculum focused on teaching the virtual neurologic examination, measuring teleneurology competency, and providing opportunities for trainees to perform telehealth encounters in multiple settings. Residents (N = 22) were first surveyed on what methods would be most helpful to learn teleneurology. Trainees observed a faculty member conducting a teleneurology visit with another faculty member playing a patient. Residents then practiced a teleneurology encounter during a 10-minute objective structured clinical examination (OSCE) at a simulation center. After positive feedback from the fall of 2020, we adapted the OSCE to be completely remote in the spring of 2021 for senior residents. Trainees then performed teleneurology visits during their continuity clinics and subspecialty clinic rotations.Results and Assessment DataAll neurology residents from adult and child neurology and neuropsychiatry programs at New York University Grossman School of Medicine participated in the curriculum. Residents identified a variety of teaching modalities that would help them learn teleneurology: didactics with slides (25%), live demonstration (25%), simulated experience (23%), starting with live patients (23%), and articles/reading material (4%). To date, 68 trainees participated in the OSCE. Trainees who completed on-site and remote simulations reported increased comfort (p< 0.05) and interest in teleneurology (p< 0.05) and requested more access to simulations during training. Sensorimotor assessment and adequate visualization of the affected limb were identified as areas for improvement.Discussion and Lessons LearnedOur multimodal 3-year teleneurology curriculum provides opportunities for residents to learn and apply teleneurology. Survey tools helped strengthen the curriculum to optimize educational potential. We implemented a teleneurology simulation with and without the use of a simulation center. We plan to expand our teleneurology clinical and simulation experiences to trainees based on our data and further developments in teleneurology and to track the progress of teleneurology skills as residents advance through training.

This study aims to determine the effect of the whole language approach to the ability to read and write in English in early stages of children aged 5-6 years in one of the kindergartens in the Yogyakarta Special Region. The population in this study were 43 children who were in the age range of 5-6 years in the kindergarten. Twenty-nine participants were included in the experimental class subjects as well as the control class with posttest only control group design. Observation is a way to record data in research on early reading and writing ability. The results of Multivariate Anal- ysis of Covariance (Manova) to the data shows that 1) there is a difference in ability between the application of the whole language approach and the conventional approach to the ability to read the beginning of English; 2) there is a difference in ability between applying a whole language approach and a conventional approach to writing English beginning skills; 3) there is a difference in ability between the whole language approach and the conventional approach to the ability to read and write the beginning in English Keywords: Whole language approach, Early reading, Early writing, Early childhood Reference Abdurrahman, M. (2003). Pendidikan bagi Anak Berkesulitan Belajar. Jakarta: Rineka Cipta. Aisyah, S., Yarmi, G., & Bintoro, T. (2018). Pendekatan Whole Language dalam Pengembangan Kemampuan Membaca Permulaan Siswa Sekolah Dasar. Prosiding Seminar Nasional Pendidikan, 160–163. Alhaddad, A. S. (2014). Joedanian Literacy Education Should Whole Language be Implemented? European Scientific Journal, 10(8). Aulina, C. N., & Rezania, V. (2013). Metode Whole Language untuk Pembelajaran Bahasa Pada Anak TK. Pendidikan Usia Dini. Austring, B. D., & Sørensen, M. (2012). A Scandinavian View on the Aesthetics as a Learning Media. Journal of Modern Education Review, 2(2), 90–101. Cahyani, H., Courcy, M. de, & Barnett, J. (2018). Teachers’ code-switching in bilingual classrooms: exploring pedagogical and sociocultural functions. International Journal of Bilingual Education and Bilingualism, 21(4), 465–479. Cahyani, W. A. (2019). Pengembangan Model Pembelajaran Membaca pada Anak Usia Dini. Universitas Negeri Yogyakarta. CCSU NEWS. (2019). World’s Most Literate Nations Ranked. In WORLD’S MOST LITERATE NATIONS RANKED. Chodidjah, I. (2007). Teacher training for low proficiency level primary English language teachers: How it is working in Indonesia. In British Council (Ed.) 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The prevalence of ADHD children increases every year. Some researchers have shown that psychosocial behavior therapy (antecedents-consequences modification) was effective to decrease hyperactivity and increase attention to ADHD children. This study aims to find out the effectiveness of antecedents-consequences modification by parents and teachers to decrease hyperactivity and increase attention to a 6 years old boy with ADHD. The study was a single case experimental design. Psychosocial behavior therapy has been used with antecedents-consequences modification. The antecedents-consequences modification was applied by teacher at school and parents at home. Data were analyzed using Wilcoxon Signed Rank Test. Results showed that there’s a significant decrease of hyperactivity behavior and significant increase of doing his assignment both at school and also at home. Not only about the content of behavior therapy itself, but how to give the therapy is important. Parents and teacher should do the therapy consistently, immediately, specifically and saliency to reach the target of intervention. Keywords: ADHD Children, Antecedents, Consequences, Modification Reference: (APA), A. A. P. (2013). Diagnostic and Manual of Mental Disorder (5th ed.). Arlington: American Psychiatric Association. Amalia, R. (2018). Intervensi terhadap Anak Usia Dini yang Mengalami Gangguan ADHD Melalui Pendekatan Kognitif Perilaku dan Alderian Play Therapy. Jurnal Obsesi : Jurnal Pendidikan Anak Usia Dini, 2(1), 27. https://doi.org/10.31004/obsesi.v2i1.4 Anastopoulos, A.D; Farley, S. . (2003). A Cognitive Behavioural Training Program for Parents of Children with Attention-Deficit/Hyperactivity Disorder. In W. J. Kazdin, Alan E (Ed.), Evidence-based psychotherapies for children and adolescents (pp. 187–203). New York: Guildford Press. Barkley, Russell A; DuPaul, G.L ; McMurray, M. . (1990). A comprehensive evaluation of attention deficit disorder with and without hyperactivity. Journal of Consulting and Clinical Psychology, 58, 775–789. Barkley, R. A. (2006). Attention-deficit hyperactivity disorder : A handbook for diagnosis and treatment (3rd ed.). New York City: Guildford Press. Barlow, D.H ; Hersen, M. (1984). Single case experimental design : Strategies for studying behavior change (2nd ed.). New York: Pergamon Press. Baumeister, S., Wolf, I., Holz, N., Boecker-Schlier, R., Adamo, N., Holtmann, M., … Brandeis, D. (2018). Neurofeedback Training Effects on Inhibitory Brain Activation in ADHD: A Matter of Learning? Neuroscience, 378, 89–99. https://doi.org/10.1016/j.neuroscience.2016.09.025 Cantwell, D. P., & Baker, L. (1991). Association between attention deficit-hyperactivity disorder and learning disorders. Journal of Learning Disabilities, 24(2), 88–95. https://doi.org/10.1177/002221949102400205 Center for Children and Families. (2019). Evidence-based Psychosocial Treatment for ADHD Children and Adolescents. Retrieved from http://ccf.fiu.edu Davidson, G. C. (2010). Abnormal Psychology. New Jersey: Wiley. DuPaul, George; Stoner, G. (2003). ADHD in the schools. New York: Guildford Press. DuPaul, G., & Weyandt, L. (2006). School-based intervention for children with attention deficit hyperactivity disorder: Effects on academic, social, and behavioural functioning. International Journal of Disability, Development and Education, 53(2), 161–176. https://doi.org/10.1080/10349120600716141 Erinta, D. B. M. S. (2012). Efektivitas penerapan terapi permainan sosialisasi untuk menurunkan perilaku impulsif pada anak dengan attention deficit hyperactive disorder (ADHD). Jurnal Psikologi : Teori & Terapan, 3(1). Evans, Steven W; Owens, Julie; Bunford, M. N. (2014). Evidence-Based Psychosocial Treatments for Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. Journal Clinical Child Adolescence Psychology, 43(4), 527–551. https://doi.org/10.1038/jid.2014.371 Fabiano, G. A., Pelham, W. E., Coles, E. K., Gnagy, E. M., Chronis-Tuscano, A., & O’Connor, B. C. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29(2), 129–140. https://doi.org/10.1016/j.cpr.2008.11.001 Gerdes, A. C., Hoza, B., & Pelham, W. E. (2003). Attention-deficit/hyperactivity disordered boys’ relationships with their mothers and fathers: Child, mother, and father perceptions. Development and Psychopathology, 15(2), 363–382. https://doi.org/10.1017/S0954579403000208 Haas, S. M., Waschbusch, D. A., Pelham, W. E., King, S., Andrade, B. F., & Carrey, N. J. (2011). Treatment response in CP/ADHD children with callous/unemotional traits. Journal of Abnormal Child Psychology, 39(4), 541–552. https://doi.org/10.1007/s10802-010-9480-4 Helseth, S. A., Waschbusch, D. A., Gnagy, E. M., Onyango, A. N., Burrows-MacLean, L., Fabiano, G. A., … Pelham, W. E. (2015). Effects of behavioral and pharmacological therapies on peer reinforcement of deviancy in children with ADHD-Only, ADHD and conduct problems, and controls. Journal of Consulting and Clinical Psychology, 83(2), 280–292. https://doi.org/10.1037/a0038505 Hidayati, DM Ria ; Purwandari, E. (2010). Time Out : Alternatif Modifikasi Perilaku Anak ADHD (Attention Deficit/ Hyperacitivity Disorder). Indigenous, Jurnal Ilmiah Berkala Psikologi, 12(2), 101–114. Hinshaw, S. P., Owens, E. B., Wells, K. C., Kraemer, H. C., Abikoff, H. B., Arnold, L. E., … Wigal, T. (2000). Family processes and treatment outcome in the MTA: Negative/ineffective parenting practices in relation to multimodal treatment. Journal of Abnormal Child Psychology, 28(6), 555–568. https://doi.org/10.1023/A:1005183115230 Hinshaw, Stephen P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Schrodek, E., & Swanson, E. N. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: Continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of Consulting and Clinical Psychology,80(6), 1041–1051. https://doi.org/10.1037/a0029451 Jackson, N. A. (2003). A Survey of Music Therapy Methods and Their Role in the Treatment of Early Elementary School Children with ADHD. Journal of Music Therapy, 40(4), 302–323. https://doi.org/10.1093/jmt/40.4.302 Johnston, Charlotte; Mash, E. J. (2001). Families of Children With Attention-Deficit/Hyperactivity Disorder : Review and Recommendations for Future Research. Clinical Child and Family Psychology Review, 4(3), 183–207. Jr, W. E. P., Fabiano, G. A., & Pelham, W. E. (2008). Evidence-Based Psychosocial Treatments for Attention- Deficit / Hyperactivity Disorder (Vol. 4416). https://doi.org/10.1080/15374410701818681 Kaiser, N. M., McBurnett, K., & Pfiffner, L. J. (2011). Child ADHD severity and positive and negative parenting as predictors of child social functioning: Evaluation of three theoretical models. Journal of Attention Disorders, 15(3), 193–203. https://doi.org/10.1177/1087054709356171 Kazdin, A. E. (1984). Behavior Modification in Applied Settings. New York: Dorsey Press. Krasny-Pacini, A., & Evans, J. (2018). Single-case experimental designs to assess intervention effectiveness in rehabilitation: A practical guide. Annals of Physical and Rehabilitation Medicine, 61(3), 164–179. https://doi.org/10.1016/j.rehab.2017.12.002 Langberg, J. M., Molina, B. S. G., Arnold, L. E., Epstein, J. N., Altaye, M., Hinshaw, S. P., … Hechtman, L. (2011). Patterns and predictors of adolescent academic achievement and performance in a sample of children with attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 40(4), 519–531. https://doi.org/10.1080/15374416.2011.581620 Nigg, J.T ; Barkley, R. . (2014). (Attention-deficit Hyperactivity Disorder). In R. A. Barkley (Ed.), E-book Pediatric เรื่องPsychiatry (Third Edit, Vol. 54, pp. 1–17). Retrieved from http://www.thaipediatrics.org/pages/Doctor/Download/48aedb8880cab8c45637abc7493ecddd:e0a186938dc3b74657fd46d32fac5fe6 Pastor, P., Reuben, C., Duran, C., & Hawkins, L. J. (2015). Association between diagnosed ADHD and selected characteristics among children aged 4-17 years: United States, 2011-2013. NCHS Data Brief, (201), 201. Patterson, G. . (1982). Coercive Family Process. Eugene: Castalia. Pfiffner, L. J ; Barkley, R. . (1990). Educational Placement and Classroom Management. In R. A. Barkley (Ed.), Attention Deficit Hyperactivity Disorder : A Handbook for Diagnosis and Treatment. New York: Guildford Press. Pfiffner, Linda J; Barkley, R; DuPaul, G. (2006). Treatment of ADHD in school settings. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (3th ed., pp. 547–589). New York: Guildford Press. Pfiffner, L. J., Calzada, E., & McBurnett, K. (2000). Interventions to enhance social competence. Child and Adolescent Psychiatric Clinics of North America, 9(3), 689–709. https://doi.org/10.1016/s1056-4993(18)30113-5 Pfiffner, Linda J., Hinshaw, S. P., Owens, E., Zalecki, C., Kaiser, N. M., Villodas, M., & McBurnett, K. (2014). A two-site randomized clinical trial of integrated psychosocial treatment for ADHD-inattentive type. Journal of Consulting and Clinical Psychology, 82(6), 1115–1127. https://doi.org/10.1037/a0036887 Pfiffner, Linda J, & Haack, L. M. (2014). Behavior Management for School - Aged Children with ADHD. 23, 731–746. Pfiffner, Linda J, Hinshaw, S. P., Owens, E., Zalecki, C., Kaiser, N. M., Villodas, M., & Mcburnett, K. (2015). A two-site randomized clinical trial of Integrated Psychosocial Treatment for ADHD-Inattentive Type. Journal of Consulting and Clinical Psychology, 82(6), 1115–1127. https://doi.org/10.1037/a0036887.A Riddle, M. A., Yershova, K., Lazzaretto, D., Paykina, N., Yenokyan, G., Greenhill, L., … Posner, K. (2013). The preschool attention-deficit/hyperactivity disorder treatment study (PATS) 6-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 52(3). https://doi.org/10.1016/j.jaac.2012.12.007 Saputro, D. (2009). ADHD (Attention Deficit/ Hyperactivity Disorder). Jakarta: Sagung Seto. Schunk, D. H. (2012). Learning Theories : An Educational Perspective (6th ed.; Pearson Education, Ed.). Boston. Shriver, M. D., Segool, N., & Gortmaker, V. (2011). Behavior observations for linking assessment to treatment for selective mutism. Education and Treatment of Children, 34(3), 389–411. https://doi.org/10.1353/etc.2011.0023 Suyanto, B. N., & Wimbarti, S. (2019). Program Intervensi Musik terhadap Hiperaktivitas Anak Attention Deficit Hyperactivity Disorder (ADHD). Gadjah Mada Journal of Professional Psychology (GamaJPP), 5(1), 15. https://doi.org/10.22146/gamajpp.48584 Taylor, E. (2009). Developing ADHD. Journal of Child Psychology and Psychiatry, 50, 126–132. Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Pediatrics, 135(4), e994–e1001. https://doi.org/10.1542/peds.2014-3482 Tran, J. L. A., Sheng, R., Beaulieu, A., Villodas, M., McBurnett, K., Pfiffner, L. J., & Wilson, L. (2018). Cost-Effectiveness of a Behavioral Psychosocial Treatment Integrated Across Home and School for Pediatric ADHD-Inattentive Type. Administration and Policy in Mental Health and Mental Health Services Research, 45(5), 741–750. https://doi.org/10.1007/s10488-018-0857-y Tresco, K. E., Lefler, E. K., & Power, T. J. (2010). Psychosocial Interventions to Improve the School Performance of Students with Attention-Deficit/Hyperactivity Disorder. Mind & Brain : The Journal of Psychiatry, 1(2), 69–74. 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Tujuan dari penilitian ini yaitu untuk: Mengetahui hasil pengembangan busana kerja dari kain songket Bima. Jenis dari penelitian ini adalah penelitian Research and Development atau penelitian dan pengembangan dengan model PPE (Planning, Production and Evaluation) .Isntrumen yang digunakan dalam mengumpulkan data yaitu kuesioner. Data yang terkumpul dianalisis dengan teknik analisis deskriptif kuantitatif dan teknik analisis deskriptif kualitatif. Penelitian dilakukan dengan uji coba produk yang melibatkan dua ahli busana. Adapun hasil dari penelitian ini yaitu : 1) Dari hasil uji isi untuk kuisioner pengembangan busana kerja , terdapat 3 indikator yang terdiri dari 7 butir pertanyaan yang dinyatakan valid oleh ahli isi. 2) Hasil produk jika di konversikan kedalam persentase memiliki kualifikasi sangat baik dengan tingkat pencapaian 92,5%. 3) Perlu diperhatikan kesesuaian desain dengan hasil jadi busana kerja. 4). Pemilihan bahan yang tepat dapat menunjang pengembangan busana kerja.. Kata Kunci : PPE, Busana Kerja, Kain songket Bima.The aim of this study was to acknowledge the result of the development of work uniform from Bima songket cloth. Type of study used in this study was Research and Development with PPE (Planning, Production and Evaluation) model. The instrument used to collect the data was questionnaire. The data gathered then being analyzed by using descriptive qualitative and descriptive qualitative technique. The research was done by testing the product with involving the experts of contents and fashion. The result of the study was: 1) From the testing of contents for questionnaire in the development of work uniform, there were 3 indicators which consist of 7 questions that are declared as valid by contents expert. 2) The percentage of the converted product showed to have excellent qualification with achievement level in 92,5%. 3) Need to be noticed the comformity between the design and the result of work uniform. 4) The proper choice of the material can support the work uniform development. Key words: PPE, Work Uniform, Bima songket cloth.DAFTAR PUSTAKA Agustini, Sudiartha, G., Angendari, M. D. 2019. Pengembangan Busana Pesta Malam dengan Sumber Ide Dari Mitologi Kerajaan Yunani. Tersedia di: https://ejournal.undiksha.ac.id/index.php/JJPKK/article/view/22152.Diakses 10 Oktober 2019.Arikunto, S. 2006. Metode Penelitian Kualitatif. Jakarta: Bumi Aksara.Borg, W R & Gall, M D. 2003. Educational Research: an Introduction (7. ed). New York: Logman Inc.Chandra, J. 1994. Kreativitas, Bagaimana Menanam ,Membangun dan Mengembangkannya. Yogyakarta : Kanisius.Ernawati, Izweni, Weni, N. 2008. Tata Busana Jilid 1 untuk Sekolah Menengah Kejuruan. Jakarta: Direktorat Pembinaan Sekolah Menengah kejuruan.Haryawati, I L A., Sudiartha, I G., Angendari, M.D. 2019. Pembuatan Busana Fantasi dengan Sumber ide Dramatari Calonarang, tersedia di: https://ejournal.undiksha.ac.id/index.php/JJPKK/article/view/22151. Diakses 11 Januari 2020.Khayati, E. Z. 1998. Pembuatan busana III. Yogyakarta: IKIP Yogyakarta.Lestari, A P R P., Sudirtha, I G., Angendari, M D. 2019. Pengembangan Busana Fantasi dengan Sumber Ide Kekaisaran Jepang. Tersedia di: https://ejournal.undiksha.ac.id/index.php/JJPKK/article/view/15991. Diakses 11 Januari 2020.Munandar, S.C. Utami. 1992. Mengembangkan Bakat dan Kreativitas Anak Sekolah. Jakarta: PT. Gramedia Widiasarana Indonesia.Ngalimun, 2013. Perkembangan dan Pengembangan Kreativitas. Yogyakarta: Aswaja PressindoNurcahyani, L. 2018. Strategi Pengembangan Produk Kain Tenun Ikat Sintang. Tersedia di: https://jurnaldikbud.kemdikbud.go.id/index.php/jpnk/ article/view/530. Diakses 11 Januari 2020.Riyanto, A. A. 2003. Desain Busana. Bandung: Yapemdo.Robert, B. M. 2009. Instructional Design-The ADDIE Approach. New York: Springer.Rukmana, N.S.R., Yarmaidi, Y., Suwarni, N. 2014. Kain Songket dalam Upaya Pelestarian Budaya Daerah Palembang Muara Penimbung Ulu. Tersedia di: https://www.neliti.com/id/publications/247898/kain-songket-dalam-upaya-pelestarian-budaya-daerah-palembang-di-muara-penimbung. Diakses 11 Januari 2020.Soekarno. 2002. Buku Penuntun Membuat Pola Busana Tingkat Dasar. Jakarta: PT Gramedia Pustaka Utama.Sugiyono. 2009. Metode Penelitian Kuantitatif, Kualitati Dan R&D. Bandung : Alfa Beta.Sugiyono. 2014. Metode Penelitian Kuantitatif, Kualitatif dan R&D. Jakarta: Alfabeta.Sugiyono. 2019. Metode Penelitian Kuantitatif, Kualitatif dan R&B. Jakarta: Alfabeta.Tegeh, Made Dkk. 2014. Model Penelitian Pengembangan. Yokyakarta: Graha IlmuThiagarajan. 1974. Instructional Development for Training Teachers of Exceptional Children. Washinton DC: National Center for Improvement Educational System.

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The purpose of this research and development research was (1) to produce a humanistic social-based learning model that was suitable for the mathematical communication skills of elementary school students and (2) to test its effectiveness. The type of research used was RnD with a 4-D development model developed by Thiagarajan. The research subjects on a small scale were 4 students of grade IV and on a wide scale were all students in grade IV of SD Taman Muda IP. The data analysis technique used descriptive qualitative and quantitative. Qualitative analysis technique was used to describe the stages of developing a humanistic social-based learning model in improving mathematical communication skills. Quantitative analysis techniques were utilized to test the validity, practicality, and effectiveness. Based on research data, validation tests from experts and practitioners, it can be concluded that the humanistic social-based learning model in improving the mathematical communication skills of elementary school students was valid, practical, and effective. After going through the validation stage, both experts and practitioners, the product developed was said to be valid (feasible and can be used). After being tested on a small scale and a large scale, the product developed was included in the practical and effective criteria. Thus, the developed model can be used as reference material in enriching the learning process in elementary schools so that it is hoped that student learning outcomes can alsobe enhanced Keywords: humanistic, communication, mathematics, social. References: Aloni, N. 2013. Empowering dialogues in humanistic education. Educational Philosophy and Theory, 45(10), 1067-1081. Ansari, B. I. 2012. Komunikasi Matematik dan Politik. Banda Aceh: Yayasan Pena. 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In recent years, STEAM (Science, Technology, Engineering, Art, and Mathematics) has received wide attention. STEAM complements early childhood learning needs in honing 2nd century skills. This study aims to introduce a loose section in early childhood learning to pre-service teachers and then to explore their perceptions of how to use loose parts in supporting STEAM. The study design uses qualitative phenomenological methods. FGDs (Focus Group Discussions) are used as data collection instruments. The findings point to two main themes that emerged from the discussion: a loose section that supports freedom of creation and problem solving. Freedom clearly supports science, mathematics and arts education while problem solving significantly supports engineering and technology education. Keywords: Early Childhood Educators, Loose-part, STEAM References: Allen, A. (2016). Don’t Fear STEM: You Already Teach It! Exchange, (231), 56–59. Ansberry, B. K., & Morgan, E. (2019). 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Khanna A, Goyal RS, Bhawsar R. Menstrual practices and reproductive problems Study of adolescent girls in Rajasthan. J Health Manag. 2005;7(1):91–107. Ersoy B, et al. Effects of different socioeconomic conditions on Menarche in Female Turkish Students. Early Hum Dev. 2004;76(2):115–25. Dongre AR, Deshmukh PR, Garg BS. The effect of community-based health education interventions on menstrual hygiene management among rural Indian adolescent girls. World Health Popul. 2007;9(3):48–54. Tang CS, Yeung DY, Lee AM. Psychosocial correlates of emotional Responses to menarche among Chinese adolescent girls. J Adolescent Health. 2003;33(3):193–201. Adhikari P, et al. Knowledge and practice regarding menstrual hygiene in rural adolescent girls in Nepal. Kathmandu Univ Med J (KUMJ). 2007;5(3):382–6 Ali TS, Rizvi SN. Menstrual knowledge and practices of female adolescents in urban Karachi, Pakistan. J Adolescent. 2010;33(4):531–41. Bobhate P, Shrivastava S et al.. This was a cross-sectional study of knowledge and practices regarding reproductive health among female adolescents in an urbsluminf Mumbai. J Fam Reprod Health. 2011;5(4):117–24. Dasgupta A, Sarkar M. Menstrual hygiene: how hygienic is the adolescent girl? Indian J Community Med. 2008;33(2):77–80. Goel MK, Kundan M. Psycho-social behavior of urban Indian adolescent girls during menstruation. Australas Med J. 2011;4(1):49–52. Shanbhag D, Shilpa R, D’Souza N, Josephine P, Singh J, Goud BR. Perceptions regarding menstruation and Practices during menstrual cycles among high school going adolescent girls in resource-limited settings around Bangalore City, Karnataka, India. Int J Collab Res Inter Med Public Health. 2012;4(7):1353–62. Tiwari H, Oza UN, Tiwari R. Knowledge, attitudes and beliefs about Menarche of adolescent girls in Anand District, Gujarat. East Mediterr Health J. 2006;12(3-4):428–33. Thakre SB, Thakre SS, Reddy M, Rathi N, Pathak K, Ughade S. 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Effect of health education on statistics and practices about menstruation among adolescent faculty girls of Kalamboli, Navi-Mumbai. fitness of Popul-Perspect issues. 2009;32(4):167–75 Narayan okay, Srinivasa D, Pelto P, Veerammal S. Puberty Rituals, Reproductive Understanding, and Health of Adolescent Girls in South India. Asia-percent Popul J. 2001;16(2):225–38. ARORA A, Mittal A, Pathania D, Mehta C, Bunger R. Impact of health education on understanding and practices about menstruation among adolescent college women in the rural part of the district Ambala, Haryana. Ind J Comm health. 2013;25(4):492–7. Lawan UM, Yusuf NW, Musa AB. Menstruation and menstrual hygiene among adolescent college women in Kano, Northwestern Nigeria. Afr J Reprod fitness. 2010;14(3):201–7. Zegeye DT, Megabiaw B, Mulu A. Age at menarche and the menstrual pattern in younger secondary college humans in Northwest Ethiopia. BMC Women’s Fitness. 2009;nine:29. Thakre SB, et al. Town-rural versions of menstrual troubles and practices of Female college students in Nagpur, India. Indian Pediatr. 2012;49(9):733–6. Udgiri R, Angadi MM, Patil S et al.. Expertise and practices concerning menstruation among adolescent women in a town slum in Bijapur. J Indian Med Assoc. 2010;108(8):514–6. Marvan ML, Molina-Abolnik M. Mexican youngsters’ revel in of menarche and attitudes toward menstruation: function of communique among moms and daughters. J Pediatr Adolesc Gynaecol. 2012;25(6):358–63. Sharma M, Gupta S. Menstrual sample and abnormalities in the immoderate college girls of Dharan: A cross-sectional test of the boarding faculty of Nepal Med Coll J.2003;5(1):34–6. Adinma ED, Adinma JI. Menstrual traits among south-eastern Nigerian adolescent faculty women West Afr J Med. 2009;28(2):110–3. Reis N, Kilic D, Engin R, Karabulutlu O. 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Assessment of dysmenorrhea and menstrual hygiene practices among adolescent girls in some nursing schools in LL-Minia governorate, Egypt. J Am Sci. 2011;7(9):216–23. Eswi A, Helal H, Elarousy W. Menstrual attitudes and knowledge of Egyptian female adolescents. J Am Sci. 2012;8(6):555–65. Omidvar S, Begum K. Factors influencing hygienic practices during menses among girls from South India: A cross-sectional study. Int J Collab Res Intern Med Public Health. 2010;2(12):411–23. Wong LP. Attitudes towards dysmenorrhea, impact, and treatment-seeking among adolescent girls: A rural school-based survey. Aust J Rural Health. 2011;19(4):218–23. Wong LP, Khoo EM. Menstrual-related attitudes and symptoms among Multiracial Asian adolescent females. Int J Behav Med. 2011;18(3):246–53. Sommer M. Ideologies of sexuality, menstruation, and risk: girls’ experiences of puberty and schooling in northern Tanzania. Cult Health Sex. 2009;11(4):383–98. Crichton J, et al. 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This study aims to analyze the level of psychological well-being of ex-drug addicted counselee in post-rehabilitation education. The study was conducted in 2 communities of post-rehabilitation education providers in Semarang city. The level of psychological well-being of 40 respondents was measured by filling in the 18-item psychological well-being scale developed by Ryff (r = 0.83; v = 0.97). Measurement includes indicators: (1) self-acceptance; (2) positive relationships with others; (3) autonomy; (4) environmental mastery; (5) purpose in life; and (6) personal growth. Hypothesis test results indicate that the level of psychological well-being of ex-drug addicted counselee in post-rehabilitation education is significantly greater or equal to 80 (t = 49,140; sig = 0,000). Based on the results of this study, it is recommended to further researchers to further explore certain differences in the level of psychological well-being of the counselee by the factors of age, demographics, educational background, and length of abstinence. In addition, further studies with a larger number of samples and questionnaire items are needed so that study results can be generalized to a wider population.Ardiantina, D. (2016). Studi Kasus Kehidupan Remaja Mantan Pecandu Narkoba. Jurnal Bimbingan dan Konseling, 5(1), 1-12.Astuti, R., & Ismandari, F. (2014). Gambaran Umum Penyalahgunaan Narkoba di Indonesia. Buletin Jendela Data dan Informasi Kesehatan. I, pp. 1-52. Jakarta: Kementrian Kesehatan RI.Aztri, S., & Milla, M. N. (2013). Rasa Berharga Dan Pelajaran Hidup Mencegah Kekambuhan Kembali Pada Pecandu Narkoba Studi Kualitatif Fenomenologis. Jurnal Psikologi, 9(1), 48-63.Bhandari, S., Dahal, M., & Neupane, G. (2015). Factors Associated With Drug Abuse Relapse: A Study On The Clients Of Rehabilitation Centers. Al-Ameen Journal of Medicine and Science, 8(4), 293-298.BNN. (2015). Laporan Akhir Survei Nasional Perkembangan Penyalahgunaan Narkoba Tahun Anggaran 2014. Jakarta: Badan Narkotika Nasional Indonesia.Buchanan, T. (2011). Attention Defi cit/Hyperactivity Disorder and Well-being: Is Social Impairment an Issue for College Students with ADHD? Journal of Postsecondary Education and Disability, 24(3), 193-210.Bukoye, R. O. (2017). Academic Stress and Drug Abuse as Factors Inhibiting Psychological Well-Being Among Undergraduates: It’s Counselling Implications. European Scientific Journal, 13(8), 60-74.Chong, J., & Lopez, D. (2008). Predictors of Relapse for American Indian Women After Substance Abuse Treatment. Journal of The National Center, 14(3), 24-47.Dogaheh, E. R., Jafari, F., Sadeghpour, A., Mirzaei, S., Maddahi, M. E., Hosseinkhanzadeh, A. A., & Arya, A. R. (2013). Psychological Well-Being and Quality of Sleep in Addicts under Methadone Maintenance Treatment. Research Papers, 1(2), 71-75.Fard, A. E., Rajabi, H., Delgoshad, A., Rad, S. A., & Akbari, S. (2014). The Possible Relationship between University Students' Personality Traits, Psychological Well-being and Addiction Potential. International Journal of Social Science Studies, 2(2), 120-125.Garcia, D., Nima, A. A., & Kjell, O. N. (2014). The Affective Profiles, Psychological Well-Being, and Harmony: Environmental Mastery and Self-Acceptance Predict the Sense of a Harmonious Life. PeerJ, 1-21.Green, M., & Elliott, M. (2010). Religion, Health, and Psychological Well-Being. Journal of Religion and Health, 49, 149-163.Greenfield, E., Vaillant, G., & Marks, N. (2009). Doformal religious participation and spiritual perceptions have independent linkages with diverse dimensions of psychological well-being? Journal of Health and Social Behavior, 50, 196–212.Haryadi, R. (2018). Prospek Konseling Komunitas bagi Individu Eks-Pecandu Narkoba (Studi Pada Lembaga Pasca-Rehabilitasi Narkoba Di Kota Semarang). Konseli (Jurnal Bimbingan dan Konseling), 5(1), 73 - 84.Ibrahim, F., & Kumar, N. (2009). Factors Effecting Drug Relapse in Malaysia: An Empirical Evidence. Asian Social Science, 5(12), 37-44.Lindfors, P., Berntsson, L., & Lundberg, U. (2007). Total workload as related to psychological well-being and symptoms in full-time employed female and male white-collar workers. International Journal of Behavior and Medicine, 13, 131-137.Martin, R. A., MacKinnon, S., Johnson, J., & Rohsenow, D. J. (2011). Purpose in life predicts treatment outcome among adult cocaine abusers in treatment. Journal of Substance Abuse Treatment, 40, 183–188.Ryff, C. D. (2014). Psychological Well-Being Revisited: Advanced in the Science and Practice of Eudaimonia. Psychoterapy and Psychosmoatics, 83, 10-28.Ryff, C. D., Love, G. D., Miyamoto, Y., Markus, H. R., Curhan, K. B., Kitayama, S., . . . Karasawa, M. (2014). Culture and the promotion of well-being in East and West: Understanding varieties of attunement to the surrounding context. In G. A. Fava, & C. Ruini, Increasing psychological well-being in clinical and education settings: Interventions and cultural contexts (Vol. 8th, pp. 1-19). New York: Springer.Schaefer, S. M., Boylan, J. M., Reekum, C. M., Lapate, R. C., Norris, C. J., Ryff, C. D., & Davidson, R. J. (2013). Purpose in Life Predicts Better Emotional Recovery for Negative Stimuli. Plos ONE, 8(11), 1-9.Schwartz, R. P., Kelly, S. M., O’Grady, K. E., Mitchell, S. G., Peterson, J. A., Reisinger, H. S., . . . Brown, B. S. (2008). Attitudes toward buprenorphine and methadone among opioid-dependent individuals. American Journal of Addicton, 17, 396–401.Seligman, M. E. (2010). Flourish: Positive Psychology and Positive Intervention. Michigan: University of Michigan.Sharma, A. K., Upadhyaya, S. K., Bansal, P., Nijhawan, M., & Sharma, D. (2012). A Study of Factors Affecting Relapse in Substance Abuse. Indian Journal of Science and Technology, 2(1), 31-35.Siddiqui, S. (2015). Impact of self-efficacy on psychological well-being among undergraduate students. The International Journal of Indian Psychology, 2(3), 5-17.Strauser, D., Lustig, D., & Çıftçı, A. (2008). Psychological well-being: its relation to work personality, vocational identity, and career thoughts. Journal of Psychology, 142, 21–35.Vasquez, C., & Castilla, C. (2007). Emociones Positivas y Crecimiento Postraumatico en el Cancer de Mama. Psicooncologia, 4, 385-404.

The paper presents research findings with 56 Roma children from Macedonia and Serbia between the ages of 3-6 years. The children’s knowledge of Romani as their mother tongue was assessed with a specially designed test. The test measures the children’s comprehension and production of different types of grammatical knowledge such as wh–questions, wh-complements, passive verbs, possessives, tense, aspect, the ability of the children to learn new nouns and new adjectives, and repetition of sentences. In addition, two pictured narratives about Theory of Mind were given to the children. The hypothesis of the authors was that knowledge of the complex grammatical categories by children will help them to understand better the Theory of Mind stories. The results show that Roma children by the age of 5 know most of the grammatical categories in their mother tongue and most of them understand Theory of Mind. References Bakalar, P. (2004). The IQ of Gypsies in Central Europe. 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Abstract Background There were seven opioid overdoses in this New York City (NYC) federally qualified health center from December 2018 through February 2019, reflecting the rising rate of overdose deaths in NYC overall at the time. In response to these overdoses, we sought to increase the readiness of health center staff to recognize and respond to opioid overdoses and decrease stigmatizing attitudes around opioid use disorder (OUD). Methods An hour-long training focusing on opioid overdose response was administered to clinical and non-clinical staff of all levels at the health center. This training included didactic education on topics such as the overdose epidemic, stigma around OUD, and opioid overdose response, as well as discussion. A structured assessment was administered immediately before and following the training to evaluate change in knowledge and attitudes. Additionally, participants completed a feedback survey immediately after the training to assess acceptability. Paired t-tests and analysis of variance tests were used to assess changes in pre- and post-test scores. Results Over 76% of the health center staff participated in the training (N = 310). There were large and significant increases in mean knowledge and attitudinal scores from pre- to post-test (p < .001 and p < .001, respectively). While there was no significant effect of profession on attitudinal change scores, profession did have a significant effect on knowledge change scores, with administrative staff, non-clinical support staff, other healthcare staff, and therapists learning significantly more than providers (p < .001). The training had high acceptability among participants from diverse departments and levels. Conclusions An interactive educational training increased staff’s knowledge and readiness to respond to an overdose as well as improved attitudes toward individuals living with OUD. Trial registration: This project was undertaken as a quality improvement initiative at the health center and as such was not formally supervised by the Institutional Review Board per their policies. Further, per the guidelines of the International Committee of Medical Journal Editors, registration is not necessary for clinical trials whose sole purpose is to assess an intervention’s effect on providers.

Abstract Background Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly referred to as nonalcoholic fatty liver disease, impacts 30% of the global population. This educational pilot focused on the role primary care providers may play in the delivery of guidelines-based metabolic dysfunction-associated steatohepatitis (MASH) care. Objective Accelerate the application of guidelines-based MASH care pathways to clinical workflows. Methods A panel of six hepatologists was convened in 2021 to develop the care pathway and the subsequent pilot occurred between 2022 – 2023. The pilot was conducted across three U.S. health systems: Boston Medical Center (Boston), Methodist Health System (Dallas), and Weill Cornell Medicine (New York). Clinicians were educated on the care pathway and completed baseline/follow-up assessments. 19 primary care clinicians participated in the educational pilot baseline assessment, nine primary care clinicians completed the two-month assessment, and 15 primary care clinicians completed the four-month assessment. The primary endpoint was to assess clinician-reported adherence to and satisfaction with the care pathway. The pilot was deemed exempt by the Western Consensus Group Institutional Review Board. Results At baseline, 38.10% (n = 8) of respondents felt they had received sufficient training on when to refer a patient suspected of metabolic dysfunction-associated liver disease to hepatology, and 42.86% (n = 9) had not referred any patients suspected of metabolic dysfunction-associated liver disease to hepatology within a month. At four months post-intervention, 79% (n = 15) of respondents agreed or strongly agreed they received sufficient training on when to refer a patient suspected of metabolic dysfunction-associated liver disease to hepatology, and there was a 25.7% increase in self-reported adherence to the institution’s referral guidelines. Barriers to care pathway adherence included burden of manually calculating fibrosis-4 scores and difficulty ordering non-invasive diagnostics. Conclusions With therapeutics anticipated to enter the market this year, health systems leadership must consider opportunities to streamline the identification, referral, and management of patients with metabolic dysfunction-associated steatohepatitis. Electronic integration of metabolic dysfunction-associated steatohepatitis care pathways may address implementation challenges.

Background: Cigarette smoking has been reported to be high among Lesbian, Gay, Bisexual, Transgendered and Queer (LGBTQ) populations. However, in-depth information on perception, knowledge, attitudes and behaviors, is limited. Methods: We analyzed 2016 data from the AHA-Tobacco Regulatory Addiction Center (A-TRAC) study on multi-ethnic LGBTQ groups living primarily in Chicago and New York City, ages 18-64, smokers and non-smokers. Twenty-nine focus groups and 99 individual surveys were conducted to obtain socio-demographic-economic characteristic and in-depth information on tobacco use, including cigarette smoking. Atlas.ti and SAS 9.4 were used for data analyses. Results: Of 99 participants, 58.8% of LGBTQ individuals reported smoking 100+ cigarettes during their life time; 49.5% (n=49) reported current cigarette smoking; and 17% reported frequent or occasional use of e-cigarette, e-hookah and/or other types of vaping. Age (25+) and low household income (<$20,000) were significantly associated with the use of cigarette smoking. While 70.2% stated that cigarette smoking is very dangerous to health and 43.2% of respondents said that tobacco use is a very serious problem in the LGBTQ community, current smokers were unlikely to quit smoking (67%). Focus group discussions revealed that smoking a cigarette is a form of stress relief, a way of “expressing yourself”, and a way of “fitting in”. Heavy marketing by the tobacco industry as well as stress associated with social discrimination, family and friend rejections and limited income, were also factors identified with tobacco use. These findings were particularly true among transgender women and bisexual men and women. Conclusions: Cigarette smoking was high among the LGBTQ individuals in our sample and they seems unlikely to quit. Social stressors appear to be a strong contributing factor. Educational efforts and culturally appropriate messages to this population, are critical.

Abstract Context Walking groups run by trained individuals, lasting under an hour in a natural environment, may be a cost-effective way by which to encourage sustainable changes in physical activity as well as foster companionship and a shared experience of wellness among participants. Walk with a Doc (WWaD) is a national program that provides a platform for medical professionals, including physicians and medical students, to deliver a short talk on a health topic prior to walking side by side with patients and community members. Objectives To evaluate the WWaD Chapter at Stony Brook following implementation, a questionnaire was designed utilizing a mixed-methods approach (i.e., containing qualitative and quantitative items) and administered to all attendees monthly prior to the health discussion. The aim of the questionnaire was fourfold: first, to obtain participant demographics; second, to obtain information on attendees’ own perceptions of their health status and the role exercise plays in their health; third, to gain data on physical activity levels, including lengths of exercise sessions and types of activities performed; and fourth, to learn more about attendees’ motivations and goals for participating in the walks. Methods We received an IRB exemption. Physician and medical student volunteers were recruited from Stony Brook University Hospital, a suburban tertiary care center, to oversee program logistics. WWaD was scheduled to take place on the third Sunday of every month for 1 h at Heritage Park in Mount Sinai, New York. The event was advertised by volunteers to colleagues, peers, patients, and community members utilizing word of mouth, printed flyers, emails to listservs, and social media outlets. Each month, a physician volunteer oversaw a brief discussion (approximately 10 min in length). Results Over the course of the 5 month evaluation period, 91 individuals participated in the walks, including repeat attendees. After excluding duplicate or incomplete entries, data from 30 participants were included in this analysis. The majority of participants were female (n=24) with a mean age of 50 years (range, 23–98 years). Feedback on WWaD program elements was largely positive. Participants commended the monthly speakers for “informative talks” (n=6) on “interesting topics” (n=4), with plans to review the supplemental information in educational pamphlets following the walk (n=4). The brochures were also deemed “helpful.” Overwhelmingly, patients referred to the community gathering and team building aspects of WWaD as the “most enjoyable” aspect of the program (n=8) and a key driver for participation. Conclusions This mixed-methods study of the WWaD chapter at Stony Brook contributes to a growing body of evidence highlighting the value of walking groups as effective avenues for collaboration in producing accessible healthy behavior.

Previous studies contend that Philippines is still a ‘collectivist’ society (Cf. Hofstede Center; Cukur et al. 2004:613-634). In this collectivist or community-oriented society, individualism is not something that is highly valued. Being ‘individualistic’ is often associated to being narcissistic, loner, asocial, selfish, etc. However, one may ask whether the youth in the Philippines are not spared from this insidious culture of individualism, notwithstanding the seemingly dominant collective and communitarian character of the society. Although the overwhelming poverty is still the main problem in the Philippines, where according to Wostyn (2010:26) “only the wonderland of movies gives some respite to their consciousness of suffering and oppression”, the Filipino youth of today are also exposed to the consumeristic values of the ‘city’ and are not spared from the contradictions and insecurities posed by the pluralistic society. They are citizens of an increasing social and cultural pluralism characteristic of many liberal societies. Is it possible that individualism may also exist within this culture, especially among the younger generation? Is individualism slowly creeping in as caused by their exposure and easy access to modern technology, to higher education, mobility, interactions with other cultures, etc. Would this individualistic tendency have any influence on their religious beliefs, especially their belief on salvation? What would be the implications and challenges of these findings to the families in the Philippines? These are the questions we wish to answer in this study. 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This report presents the fundamentals and main characteristics of two educational models: the Comprehensive Application of Behavior Analysis to Schooling – CABAS and the Morningside Model of Genarative Instruction. Both models have been developed according to behavioral-analytic principals, based on scientific methods. Besides their effectiveness has been proved scientifically. The information presented here has been extracted from materials produced by the proponents of those models and mainly from the experience of one of the authors that spent one month visiting the schools that apply them and observed the classrooms of each model during two weeks. The characteristics that each approach present to enable an individualized instruction are highlighted, such as the division of students in homogeneous groups, the evaluation of the entering repertoire of students and the progress of teaching according to their rhythm. It’s presented here how they plan, carry out the teaching strategies and give consequences to student’s behavior, with positive reinforcement and avoidance of coercive control. Finally, analysis and comparisons between schools are presented, being also shown that they share more similarities than differences (what might be expected given the adoption of the same theoretical affiliation and the compliance with the principles of teaching programming), but also have some peculiarities with implications to learning, considering the focus on the high frequency of responses on CABAS schools and the focus on the development of more complex skills and the application of those on new contexts on Morningside. It’s pointed out the model’s proponents interest on their dissemination in Brazil and some considerations are made about the possibilities of its application in Brazil; among them, the one that, despite the different conditions of the schools, the models can offer elements to the inspiration of new practices that favor a teaching that more effectively meets the individual needs of the students.ResumoO presente texto apresenta os fundamentos e as principais características de dois modelos de escola que se desenvolvem segundo princípios analítico-comportamentais, baseados em métodos científicos e que possuem sua efetividade comprovada: o Comprehensive Application of Behavior Analysis to Schooling - CABAS (Aplicação Abrangente da Análise do Comportamento à Escolarização) e o Morningside Model of Genarative Instruction (Modelo Morningside de Instrução Generativa). As informações apresentadas aqui são produto da leitura de material produzido pelos proponentes de tais modelos e principalmente da experiência de um dos autores de um mês de visita às escolas que os aplicam, tendo observado as salas de aula de cada modelo por duas semanas. São destacadas as características que cada proposta apresenta para possibilitar uma instrução que atenda às necessidades individuais dos alunos, tais como a divisão em grupos homogêneos, a avaliação do repertório inicial dos alunos e o progresso de acordo com o ritmo dos mesmos. São apresentadas a forma como se dão o planejamento e a condução do ensino e a consequenciação dos comportamentos dos alunos, com reforçamento positivo e evitação de controle coercitivo. Por fim, são feitas análises e comparações entre as escolas que apresentam mais similaridades do que diferenças (dada a mesma afiliação teórica e ao seguimento dos princípios para a programação do ensino), mas que também possuem peculiaridades com implicações para a aprendizagem, considerando o foco na alta taxa de respostas dos alunos nas escolas CABAS e o foco no desenvolvimento de habilidades mais complexas e na aplicação destas habilidades em novos contextos na Morningside. É levantado o interesse dos proponentes dos modelos na sua disseminação para o Brasil e são traçadas considerações acerca das possibilidades de aplicação em nosso país; dentre elas, a de que, apesar das diferentes condições das escolas, os modelos podem oferecer elementos para a inspiração de novas práticas que favoreçam um ensino que atenda de modo mais efetivo às necessidades individuais dos alunos.Palavras-chave: Análise do comportamento aplicada, Ensino individualizado, CABAS, Morningside.Keywords: Applied Behavior Analysis, individualized teaching, CABAS, Morningside.ReferencesCABAS SCHOOLS. Morristown public schools. Disponível em: <http://www.cabasschools.org/morristown>. Acesso dia 24 de maio de 2018a.CABAS SCHOOLS. Who we are. Disponível em: <http://www.cabasschools.org/who-we-are>. Acesso dia 24 de maio de 2018b.SOUZA, D. G. de et al. Análise comportamental da aprendizagem de leitura e escrita e a construção de um currículo suplementar. In: HUBNER, M. M. C.; MARINOTTI, M. (Orgs.). Análise do comportamento para a educação: contribuições recentes. Santo André, SP: ESETec, 2004, p. 177-203. GREER, R. D. L’enfant terrible meets the educational crisis. Journal of Applied Behavior Analysis, [S.L.], v. 25, n. 1, p. 65-69, primavera 1992.GREER, R. D. Designing teaching strategies: an applied behavior analysis systems approach. San Diego, CA: Academic Press, 2002, 363 p.JOHNSON, K.; LAYNG, T. V. J. The Morningside model of generative instruction. In: GARDNER, R.; SAINATO, D. M.; COOPER, J. O.; HERON, T. E.; HEWARD, W. L.; ESHLEMAN, J.; GROSSI, T. A. (Orgs.). Behavior analysis in education: focus on measurably superior instruction. Pacific Grove, CA: Brookes/Cole Publishing Company, 1994, p. 173-197.JOHNSON, K.; STREET, E. M. The Morningside model of generative instruction: what it means to leave no child behind. Concord, MA: Cambridge Center for Behavioral Studies, 2004, 236 p.JOHNSON, K.; STREET, E. M. From the laboratory to the field and back again: Morningside Academy’s 32 years of improving students’ academic performance. The Behavior Analyst Today, Canada, v. 13, n. 1, p. 20-40, inverno 2012.KUBO, O.M.; BOTOMÉ, S.P. Ensino-aprendizagem: uma interação entre dois processos comportamentais. Interação em Psicologia, Paraná, v.5, p. 133-171, 2001.MORNINGSIDE ACADEMY. Who we serve. Disponível em: <http://www.morningsideacademy.org/about-morningside-academy/our-approach>. Acesso dia 24 de maio de 2018.SKINNER, B.F. The Technology of Teaching. Nova York: Appleton Century Crofts, 1968, 271 p.TWYMAN, J. S. The Fred S. Keller school. Journal of Applied Behavior Analysis, [S.L.], v. 31, n. 4, p. 695-701, inverno de 1998.

Tujuan dalam penelitian ini adalah untuk mengetahui Peran Komitmen organisasional yang terdiri dari komitment afektif, normative, dan kontinuan dan Kompensasi baik itu kompensasi finansial dan non-finansial terhadap Kepuasan kerja dengan moderasi Budaya organisasi sebagai variabel penguat atau memperlemah pada karyawan PT.PLN (Persero) Unit Induk Wilayah Kalimantan Barat. Sampel dalam penelitian ini adalah 200 orang karyawan dan data yang dapat di olah sebanyak 200 sampel. PT.PLN (Persero) Unit Induk Wilayah Kalimantan Barat. Data dianalisis menggunakan WrapPls 6.0 dan SPSS 16 untuk menguji Uji asumsi Normalitas dan Linieritas.Hasil penelitian ini menyimpulkan bahwa komitmen organisasi berpengaruh positif terhadap kepuasan kerja karyawan PT.PLN (Persero) Unit Induk Wilayah Kalimantan Barat. Kompensasi juag berpengaruh positif terhadap kepuasan kerja karyawan PT.PLN (Persero) Unit Induk Wilayah Kalimantan Barat. 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As competências socioemocionais têm-se demostrado um fator importante para a promoção de relações positivas e redução de riscos psicológicos. O objetivo deste trabalho foi identificar e analisar as publicações online acerca desta temática por meio de uma revisão sistemática da literatura ibero-latina. Os descritores utilizados foram sócio-emotional competences ou sócio-emotional skillsna base de dados SciELO. Foram encontrados 65 trabalhos. Aplicado o critério de exclusão, 46 trabalhos foram analisados. Os resultados exibiram uma pulverização de publicações ao longo dos anos, constituídas predominante no ano de 2016 (15,2%), em idioma espanhol (63%). As publicações foram analisadas de acordo com as metodologias empregadas, e o método quantitativo foi o mais utilizado (47,8%). O Brasil (28,5%) como o país com maior incidência, e a faixa de desenvolvimento adulta (57,9%). Por fim, 48 instrumentos foram citados, em sua maioria, não se relacionando com o constructo competências socioemocionais. Apresentaram lacunas referentes às publicações sobre competência socioemocional. Inferem-se mais pesquisas a cerca da temática devido à importância do tema para uma vida mais saudável.Descritores: Habilidades Sociais; Aptidão; Emoções; Avaliação; Psicologia.ReferênciasCarvalho RS, Silva RRD. Currículos socioemocionais, habilidades do século XXI e o investimento econômico na educação: as novas políticas curriculares em exame. Educ Rev. 2017;63:173-90.Smolka ALB, Laplane ALF, Magiolino LLS, Dainez D. O problema da avaliação das habilidades socioemocionais como política pública: explicitando controvérsias e argumentos. Educ Soc. 2015;36(130):219-42.Gondim SMG, Morais FA, Brantes CAA. Socio-emotional competences: a key factor on the development of work competences. Rev Psicol Organ Trab. 2014;14(4):394-406.Rosendo D, Lapa FB. 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Abstract Background/Aims Ixekizumab (IXE) is a high-affinity, monoclonal antibody targeting IL-17A and is approved for the treatment of psoriasis (PsO), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and non-radiographic axial spondyloarthritis (nr-axSpA) with objective signs of inflammation. We report long-term, end-of-study-program, safety outcomes in adult patients with PsO, PsA and axSpA who received at least one dose of IXE over 5 years (PsO) or 3 years (PsA and axSpA). Methods An integrated safety analysis consisting of data from 25 randomised clinical trials (RCTs; 17 PsO, 4 PsA, 4 axSpA) was used to examine long-term safety of IXE. Rates of treatment-emergent adverse events (TEAEs), serious AEs (SAEs) and AEs of special interest were analyzed for all pooled studies by years of therapy and overall through March 2022, and reported as exposure-adjusted incidence rates (IRs) per 100 patient-years (PY) at successive year intervals. Additional safety outcomes included selected safety topics of interest (among others). Results A total of 6892 patients with PsO, 1401 patients with PsA, and 932 patients with axSpA, with a cumulative IXE exposure of 18025.7 PY for PsO, 2247.7 PY for PsA, and 2097.7 PY for axSpA were included in this analysis. The IRs per 100 PY for any TEAE were as follows: patients with PsO=32.5; PsA=50.3; axSpA=38.0. The most commonly reported TEAEs were nasopharyngitis (PsO, IR = 8.8; PsA, IR = 9.0; axSpA IR = 8.4) and upper respiratory tract infection (PsO, IR = 6.2; PsA, IR = 8.3; axSpA IR = 5.8). Serious AEs were reported by 969 patients with PsO (IR = 5.4), 134 patients with PsA (IR = 6), and 101 patients with axSpA (IR = 4.8). Forty-five deaths were reported (PsO=36 [IR = 0.2]; PsA=6 [IR = 0.3]; axSpA=3 [IR = 0.1]). The IRs per 100 PY of discontinuation from the study drug due to AE were as follows: PsO, 2.9; PsA, 5.1; axSpA, 3.1. IRs of injection site reactions were: PsO, 5.9; PsA, 11.6; axSpA, 7.4. IRs of allergic reactions were: PsO, 5.6; PsA, 4.5; axSpA, 4.2. IRs of serious infections were low (PsO, IR = 1.3; PsA, IR = 1.2; axSpA, IR = 1.1). IRs of Candida were low across all indications (PsO, 1.9; PsA, 2.0; axSpA, 1.2), as were IRs of opportunistic infections (PsO, 1.8; PsA, 1.8; axSpA, 1.3). IRs were also low across all indications for depression, major adverse cerebro-cardiovascular events and malignancies (all IRs ≤1.6). Cases of inflammatory bowel disease (IBD) were uncommon (IRs ≤0.8 across indications). Conclusion In this updated analysis with 18025.7 PY for PsO, 2247.7 PY for PsA, and 2097.7 PY for axSpA, IXE maintained a long-term safety profile up to 5 years, consistent with previous reports. Disclosure A. Deodhar: Grants/research support; A.D. received direct payments from Eli Lilly and Company as a scientific consultant/speaker, and payments (investigator) made to Oregon Medical Research Center. A. Blauvelt: Consultancies; A.B. received consulting fee from AbbVie, Abcentra, Affibody, Aligos, Almirall, Alumis, Amgen, Anaptysbio, Arcutis, Arena, Aslan, Athenex, Boehringer Ingelheim, Bristol-Myers Squibb, Cara Therapeutics, Dermavant, EcoR1, Escient, Evelo, Evommune, Forte, Galderma, HighlightII Pharma, Incyte, Janssen, Landos, Leo, Merck, Novartis, Pfizer, Rapt, Regeneron, Sanofi Genzyme, Spherix Global Insights, TLL Pharmaceutical, TrialSpark, UCB Pharma, Vibliome, and Xencor. Member of speakers’ bureau; A.B. discloses direct payment for speaker bureaus from AbbVie, UCB. S. Schwartzman: Consultancies; S.S. is a consultant with AbbVie, Janssen, Lilly, Myriad, Novartis, Regeneron, Sanofi, UCB, Stelexis, Jubilant, and Teijin. Grants/research support; S.S. reports grants/contracts from Eli Lilly and Company, is a board member on the National Psoriasis Foundation Medical Board and part of the Scientific Advisory Board at Myriad. C. Salvarani: None. M. Feely: Shareholder/stock ownership; M.F. is an employee and shareholder at Eli Lilly and Company. Other; M.F. participated on a Data Safety Monitoring or Advisory Board at Eli Lilly and Company, is a Clinical Instructor in Dermatology at Mount Sinai and discloses previous employment with MC Medical Group, reimbursement of fees from Eli Lilly and Company and from Advisory Boards at the DREAM USA South Beach Symposium, is a current member of the AAD Investment Committee, Prevention Medical Review Board and ASDS Social Media Ambassador, and former member of the WDS Practice Advisory Committee, WDS Finance and Investment Committee, WDS Fundraising and Philanthropic Activities Committee, and former AAD Media Expert Team member and NPF Social Ambassador. A. Kronbergs: Shareholder/stock ownership; A.K. is an employee and shareholder at Eli Lilly and Company. N. Eberhart: Shareholder/stock ownership; N.E. is an employee and shareholder at Eli Lilly and Company. D. Zhu: Shareholder/stock ownership; D.Z. is an employee and shareholder at Eli Lilly and Company. E. Mevel: Shareholder/stock ownership; E.M. is an employee and shareholder at Eli Lilly and Company. T. Holzkaemper: Shareholder/stock ownership; T.H. is an employee and shareholder at Eli Lilly and Company. E. Krishnan: Shareholder/stock ownership; E.K. is an employee and shareholder at Eli Lilly and Company. M. Lebwohl: Consultancies; M.L. also reports consulting fees from AnaptysBio, Arcutis, Inc., Arena Pharmaceuticals, Aristea Therapeutics, Avotres Therapeutics, BioMX, Boehringer-Ingelheim, Brickell Biotech, Castle Biosciences,, Corevitas, Dermavant Sciences, Evommune, Inc., Facilitatation of International Dermatology Education, Forte Biosciences, Foundation for Research and Education in Dermatology, Hexima Ltd., Meiji Seika Pharma, Mindera, National Society of Cutaneous Medicine, New York College of Podiatric Medicine, Pfizer, Seanergy, SUN Pharma, Verrica, and Vial. Grants/research support; M.L. reports grants/contracts from Abbvie, Amgen, Arcutis, Avotres, Boehringer Ingelheim, Cara Therapeutics, Dermavant Sciences, Eli Lilly, Incyte, Inozyme, Janssen Research & Development, LLC, Ortho Dermatologics, Regeneron, and UCB, Inc. P. Rahman: Consultancies; P.R. received consulting fees from AbbVie, Janssen, Novartis, Eli Lilly and Company and Pfizer. Grants/research support; P.R. discloses grants or contracts received from Janssen and Novartis. H. Marzo-Ortega: Consultancies; H.M-O. also discloses consulting fees from Abbvie, Eli Lilly and Company, Janssen, Moonlake, Novartis, Pfizer, and UCB. Honoraria; H.M-O. discloses payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Abbvie, Biogen, Eli-Lilly, Janssen, Novartis, Pfizer, and UCB. Grants/research support; H.M-O. discloses grants or contracts received from Janssen, Novartis and UCB. Other; H. M-O. additionally discloses support for attending meetings and/or travel from UCB, participation on a Data Safety Monitoring Board or Advisory Board at Pfizer, leadership or fiduciary role in other board, society (paid or unpaid) in the Executive Committee ASAS, the Medical Advisory Board of NASS and as Chair of the British Society for Spondyloarthritis. C. Bullock: Shareholder/stock ownership; C. Bullock is an employee and minor shareholder in Lilly.

Photo by Priscilla Du Preez on Unsplash ABSTRACT White bioethicists owe a duty to the field and medicine to participate in anti-racist initiatives in our institutions. Given that medicine is steeped in biological essentialist assumptions about race, it is important that, as awareness of health disparities grows, physicians and medical educators are also educated on structural racism as the root cause. Bioethicists may be uniquely positioned to participate in and spearhead some of this work. There are many avenues for this kind of advocacy; however, this paper focuses on a faculty development initiative. The initiative entailed several workshops with key educators in an urban medical school. This paper will describe the curriculum, including assignments and breakout activities, and recommend future work. INTRODUCTION White bioethicists who work in academic medicine have a professional responsibility to confront anti-Black racism in our institutions. I want to share my experience running a workshop about structural racism based on the cycle of race essentialism (Figure 1). The workshop’s purpose was to shift attention to the sociopolitical forces of domination and oppression that drive racism and to challenge current assumptions like race essentialism. BACKGROUND Race essentialism is the “belief in a genetic or biological essence that defines all members of a racial category.”[1] Medical professionals and larger institutions are only now taking heed of the effects of racism and how they exacerbate racial health disparities in medicine.[2] Without adequate education surrounding the historical and current forces that lead to these disparities, there is a risk that notions of biological racial essentialism that already persist in medicine will be reinforced. Many health professionals incorrectly assume that differences in outcome across races are caused by some inherent or immutable feature of the people who belong to those races. Therefore, the focus for providers lies at the bottom of the figure: racial health disparities. Dorothy Roberts made clear in her book Fatal Invention that race is not a classification of the natural world. It is meaningful only insofar as human behavior and structural oppression have made it meaningful, but it does not delineate distinct biological categories of the human species.[3] The right side of the figure lists two categories that I argue are obscured and inherently overlooked by healthcare practitioners. The forces that we must focus on are those at the top of the figure—racism, power, domination, capitalism, and politics. These are the forces that create and enforce race. They create the notion of strict biological differences across racial lines to maintain systems of power and oppression.[4] Figure 1: Root Causes of Racial Disparities are Obscured from View To most physicians, the notion that blackness is socially or politically constructed rather than an innate biological reality can be difficult to grasp. Healthcare professionals have been treating Black and white bodies differently for centuries.[5] As racial disparities persist, it is important to take a step back and ensure that doctors are educated about the structural reasons for those disparities. This statement brings us to the role of bioethics and the influence of white bioethicists. In an article earlier this year, Dr. Keisha Ray noted that “Bioethics as a whole owes black bioethics and all of the other subgroups that focus on marginalized people’s health a great deal for helping bioethics to remain relevant in a time when people are asking academia to do more to create real, lasting social change.”[6] Bioethicists like me who work in academia need to push our institutions to make that change. The responsibility is arguably even more significant for those who work in academic medicine, which is part of a more extensive American system that has perpetuated racial disparity.[7] l. A Curriculum for Educating Healthcare Practitioners At my institution, I designed a workshop series for educators. The group in the workshop was chosen based on each person’s high number of contact hours with medical students. In addition, they were educational leaders responsible for developing and directing curriculum, handling issues and concerns in the classroom, and determining which faculty would have teaching roles. My objectives were to 1) reveal the right part of the diagram, showing that structural racism and power were the root causes of racial health disparities, and 2) alleviate discomfort and shame when discussing race and racism. Therefore, if the curriculum achieved both objectives, educators would be better equipped to respond empathetically to concerns about racism in medicine and medical school, empowered to work on anti-racist initiatives, and develop trust among one another and with me. My further hope was that we could continue as brainstorming partners in confronting racism. The workshops began with an intentional tone setting to establish commonality and trust. I talked about my whiteness and emphasized that if we couldn't make ourselves vulnerable to being uncomfortable in this space, it would be difficult to be genuine and authentic when discussing race with our students (or patients). I assigned a podcast before each session. The first was about structural racism to establish some facts and a basis of historical knowledge.[8] Then, I assigned a podcast called Truth’s Table, featuring a discussion with Harriet Washington, author of Medical Apartheid.[9] I chose this conversation because it involved three Black women discussing the impact of medical apartheid and centuries of abuse of Black bodies on modern fears and mistrust of the health care system. I wanted the participants to understand patients’ fears of medicine. The third podcast I chose was Howard Stevenson discussing the anxiety that can come up when we discuss race—to help normalize this response and move us beyond our gut reaction toward a more thoughtful and mindful response.[10] Fourth was a podcast with Jennifer Eberhardt, opening up a discussion about bias and microaggressions.[11] And finally, a podcast on anti-racist health systems to start a conversation about moving forward and working together to improve our field.[12] During each session, we did one breakout activity. We talked about how we, as non-Black people, benefit from systems of oppression. We discussed our reactions to racism being called out—often defensiveness and anger—and worked on brainstorming a more mindful response rooted in empathy and curiosity. We practiced the Observe Think Feel Desire (OTFD) framework for addressing microaggressions in the classrooms.[13] And we practiced handling hot moments in the classroom regarding race and racism. Workshop participants conducted a self-assessment following the series. A majority rated themselves as better understanding structural racism and feeling better equipped to handle racism in teaching. But the self-assessment results are neither scientific nor particularly meaningful—I used them primarily as feedback for workshop design. When approached by a black student pointing out racism, I have noticed that faculty who participated are more likely to pause, lower defenses, maintain curiosity and empathy, and seek out other group participants for advice. CONCLUSION Attendees valued the workshop and renewed their dedication to anti-racist practices. Additionally, our medical school has now formed a curricular anti-racist task force. Healthcare practitioners can better serve those seeking care with improved awareness of how past racism influences current behaviors. Faculty development is one way of improving the vestiges of structural racism. We may all have different skills from which to draw for this work—faculty development is certainly not the only avenue. However, structural change is likely even more effective. Those who have power in academic medicine, mainly when some of that power is derived from whiteness, should engage in anti-racist work in our institutions. - [1] Soylu Yalcinkaya N, Estrada-Villalta S, Adams G. The (Biological or Cultural) Essence of Essentialism: Implications for Policy Support among Dominant and Subordinated Groups. Front Psychol. 2017;8:900. Published 2017 May 30. [2] Higgins-Dunn, N., Feuer, W., Lovelace, B., Kim, J. Coronavirus Pandemic and George Floyd Protests Highlight Health Disparities for Black People. CNBC. Jun 11, 2020. https://www.cnbc.com/2020/06/11/coronavirus-george-floyd-protests-show-racial-disparities-in-health.html. [3] Roberts, D. Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-First Century. New York: The New Press; 2011. 4. [4] Jordan WD. Historical origins of the one-drop racial rule in the United States. Journal of Critical Mixed Race Studies. 2014;1(1). https://escholarship.org/uc/item/91g761b3 [5] Amutah, C., et al. Misrepresenting Race — The Role of Medical Schools in Propagating Physician Bias. NEJM. 2021; 384(9): 872-877. https://www.nejm.org/doi/full/10.1056/nejmms2025768 [6] Ray, K. Black Bioethics and How the Failures of the Profession Paved the Way for Its Existence. Hastings Center Bioethics Forum Essay. 2020. Available at https://www.thehastingscenter.org/black-bioethics-and-how-the-failures-of-the-profession-paved-the-way-for-its-existence/. [7] AMA Equity Strategic Plan. Page 25. https://www.ama-assn.org/system/files/2021-05/ama-equity-strategic-plan.pdf. Accessed Dec 28, 2021. [8] Tarchichi, T.R., Owusu-Onsah, S., and Brown, T.P. Racism in Medicine Part Two – How is Race a Social Determinant of Health? PHM From Pittsburgh Podcast. 2020. https://podcasts.apple.com/us/podcast/phm-from-pittsburgh/id1176709862?i=1000484987639. Accessed November 7, 2021. [9] Washington, H.A. You Okay, Sis? Medical Apartheid with Harriet A. Washington. Truth’s Table. 2019. https://podcasts.apple.com/us/podcast/truths-table/id1212429230?i=1000433010203. Accessed November 7, 2021. [10] Stevenson, H.C. How to Resolve Racially Stressful Situations. TEDMED. 2017. https://www.ted.com/talks/howard_c_stevenson_how_to_resolve_racially_stressful_situations/up-next. Accessed November 7, 2021. [11] Eberhardt, J.L. How Racial Bias Works – And How to Disrupt It. TED Talks Daily. 2020. https://podcasts.apple.com/us/podcast/how-racial-bias-works-how-to-disrupt-it-jennifer-eberhardt/id160904630?i=1000478505882. Accessed November 7, 2021. [12] Khazanchi, R., Nolen, L., Fields, N. Antiracism in Medicine Series – Episode 5 – Racism, Power, and Policy: Building the Antiracist Health Systems of the Future. Clinical Problem Solvers Anti-Racism Podcast Series. 2021. https://clinicalproblemsolving.com/2021/01/19/episode-155-antiracism-in-medicine-series-episode-5-racism-power-and-policy/. Accessed November 7, 2021. [13] Cheung, F., Ganote, C., and Souza, T. Microresistance as a Way to Respond to Microaggressions on Zoom and in Real Life. Faculty Focus. April 7, 2021. https://www.facultyfocus.com/articles/academic-leadership/microresistance-as-a-way-to-respond-to-microaggressions-on-zoom-and-in-real-life/. Accessed November 7, 2021.

Photo by Sean Pollock on Unsplash ABSTRACT Bioethics and Corporate Social Responsibility (CSR) were born out of similar concerns, such as the reaction to scandal and the restraint of irresponsible actions by individuals and organizations. However, these fields of knowledge are seldom explored together. This article attempts to explain the motives behind the gap between bioethics and CSR, while arguing that their shared agenda – combined with their contrasting principles and goals – suggests there is potential for fruitful dialogue that enables the actualization of bioethical agendas and provides a direction for CSR in health-related organizations. INTRODUCTION Bioethics and Corporate Social Responsibility (CSR) seem to be cut from the same cloth: the concern for human rights and the response to scandal. Both are tools for the governance of organizations, shaping how power flows and decisions are made. They have taken the shape of specialized committees, means of stakeholder inclusion at deliberative forums, compliance programs, and internal processes. It should be surprising, then, that these two fields of study and practice have developed separately, only recently re-approaching one another. There have been displays of this reconnection both in academic and corporate spaces, with bioethics surfacing as part of the discourse of CSR and compliance initiatives. However, this is still a relatively timid effort. Even though the bioethics-CSR divide presents mostly reasonable explanations for this difficult relationship between the disciplines, current proposals suggest there is much to be gained from a stronger relationship between them. This article explores the common history of bioethics and corporate social responsibility and identifies their common features and differences. It then explores the dispute of jurisdictions due to professional and academic “pedigree” and incompatibilities in the ideological and teleological spheres as possible causes for the divide. The discussion turns to paths for improving the reflexivity of both disciplines and, therefore, their openness to mutual contributions. I. Cut Out of the Same Cloth The earliest record of the word “bioethics” dates back to 1927 as a term that designates one’s ethical responsibility toward not only human beings but other lifeforms as well, such as animals and plants.[1] Based on Kantian ethics, the term was coined as a response to the great prestige science held at its time. It remained largely forgotten until the 1970s, when it resurfaced in the United States[2] as the body of knowledge that can be employed to ensure the responsible pursuit and application of science. The resurgence was prompted by a response to widespread irresponsible attitudes toward science and grounded in a pluralistic perspective of morality.[3] In the second half of the twentieth century, states and the international community assumed the duty to protect human rights, and bioethics became a venue for discussing rights.[4] There is both a semantic gap and a contextual gap between these two iterations, with some of them already being established. Corporate social responsibility is often attributed to the Berle-Dodd debate. The discussion was characterized by diverging views on the extent of the responsibility of managers.[5] It was later settled as positioning the company, especially the large firm, as an entity whose existence is fomented by the law due to its service to the community. The concept has evolved with time, departing from a largely philanthropic meaning to being ingrained in nearly every aspect of a company’s operations. This includes investments, entrepreneurship models, and its relationship to stakeholders, leading to an increasing operationalization and globalization of the concept.[6] At first sight, these two movements seem to stem from different contexts. Despite the difference, it is also possible to tell a joint history of bioethics and CSR, with their point of contact being a generalized concern with technological and social changes that surfaced in the sixties. The publishing of Silent Spring in 1962 by Rachel Carson exemplifies this growing concern over the sustainability of the ruling economic growth model of its time by commenting on the effects of large-scale agriculture and the use of pesticides in the population of bees, one of the most relevant pollinators of crops consumed by humans. The book influenced both the author responsible for the coining bioethics in the 1971[7] and early CSR literature.[8] By initiating a debate over the sustainability of economic models, the environmentalist discourse became a precursor to vigorous social movements for civil rights. Bioethics was part of the trend as it would be carried forward by movements such as feminism and the patients’ rights movement.[9] Bioethics would gradually move from a public discourse centered around the responsible use of science and technology to academic and government spaces.[10] This evolution led to an increasing emphasis on intellectual rigor and governance. The transformation would unravel the effort to take effective action against scandal and turn bioethical discourse into governance practices,[11] such as bioethics and research ethics committees. The publication of the Belmont Report[12] in the aftermath of the Tuskegee Syphilis Experiment, as well as the creation of committees such as the “God Committee,”[13] which aimed to develop and enforce criteria for allocating scarce dialysis machines, exemplify this shift. On the side of CSR, this period represents, at first, a stronger pact between businesses and society due to more stringent environmental and consumer regulations. But afterward, a joint trend emerged: on one side, the deregulation within the context of neoliberalism, and on the other, the operationalization of corporate social responsibility as a response to societal concerns.[14] The 1990s saw both opportunities and crises that derived from globalization. In the political arena, the end of the Cold War led to an impasse in the discourse concerning human rights,[15] which previously had been split between the defense of civil and political rights on one side and social rights on the other. But at the same time, agendas that were previously restricted territorially became institutionalized on a global scale.[16] Events such as the European Environment Agency (1990), ECO92 in Rio de Janeiro (1992), and the UN Global Compact (2000) are some examples of the globalization of CSR. This process of institutionalization would also mirror a crisis in CSR, given that its voluntarist core would be deemed lackluster due to the lack of corporate accountability. The business and human rights movement sought to produce new binding instruments – usually state-based – that could ensure that businesses would comply with their duties to respect human rights.[17] This rule-creation process has been called legalization: a shift from business standards to norms of varying degrees of obligation, precision, and delegation.[18] Bioethics has also experienced its own renewed identity in the developed world, perhaps because of its reconnection to public and global health. Global health has been the object of study for centuries under other labels (e.g., the use of tropical medicine to assist colonial expeditions) but it resurfaced in the political agenda recently after the pandemics of AIDS and respiratory diseases.[19] Bioethics has been accused from the inside of ignoring matters beyond the patient-provider relationship,[20] including those related to public health and/or governance. Meanwhile, scholars claimed the need to expand the discourse to global health.[21] In some countries, bioethics developed a tight relationship with public health, such as Brazil,[22] due to its connections to the sanitary reform movement. The United Kingdom has also followed a different path, prioritizing governance practices and the use of pre-established institutions in a more community-oriented approach.[23] The Universal Declaration on Bioethics and Rights followed this shift toward a social dimension of bioethics despite being subject to criticism due to its human rights-based approach in a field characterized by ethical pluralism.[24] This scenario suggests bioethics and CSR have developed out of similar concerns: the protection of human rights and concerns over responsible development – be it economic, scientific, or technological. However, the interaction between these two fields (as well as business and human rights) is fairly recent both in academic and business settings. There might be a divide between these fields and their practitioners. II. A Tale of Jurisdictions It can be argued that CSR and business and human rights did not face jurisdictional disputes. These fields owe much of their longevity to their roots in institutional economics, whose debates, such as the Berle-Dodd debate, were based on interdisciplinary dialogue and the abandonment of sectorial divisions and public-private dichotomies.[25] There was opposition to this approach to the role of companies in society that could have implications for CSR’s interdisciplinarity, such as the understanding that corporate activities should be restricted to profit maximization.[26] Yet, those were often oppositions to CSR or business and human rights themselves. The birth of bioethics in the USA can be traced back to jurisdictional disputes over the realm of medicine and life sciences.[27] The dispute unfolded between representatives of science and those of “society’s conscience,” whether through bioethics as a form of applied ethics or other areas of knowledge such as theology.[28] Amid the civil rights movements, outsiders would gain access to the social sphere of medicine, simultaneously bringing it to the public debate and emphasizing the decision-making process as the center of the medical practice.[29] This led to the emergence of the bioethicist as a professional whose background in philosophy, theology, or social sciences deemed the bioethicist qualified to speak on behalf of the social consciousness. In other locations this interaction would play out differently: whether as an investigation of philosophically implied issues, a communal effort with professional institutions to enhance decision-making capability, or a concern with access to healthcare.[30] In these situations, the emergence and regulation of bioethics would be way less rooted in disputes over jurisdictions. This contentious birth of bioethics would have several implications, most related to where the bioethicist belongs. After the civil rights movements subsided, bioethics moved from the public sphere into an ivory tower: intellectual, secular, and isolated. The scope of the bioethicist would be increasingly limited to the spaces of academia and hospitals, where it would be narrowed to the clinical environment.[31] This would become the comfort zone of professionals, much to the detriment of social concerns. This scenario was convenient to social groups that sought to affirm their protagonism in the public arena, with conservative and progressive movements alike questioning the legitimacy of bioethics in the political discourse.[32] Even within the walls of hospitals and clinics, bioethics would not be excused from criticism. Afterall, the work of bioethicists is often unregulated and lacks the same kind of accountability that doctors and lawyers have. Then, is there a role to be played by the bioethicist? This trend of isolation leads to a plausible explanation for why bioethics did not develop an extensive collaboration with corporate social responsibility nor with business and human rights. Despite stemming from similar agendas, bioethics’ orientation towards the private sphere resulted in a limited perspective on the broader implications of its decisions. This existential crisis of the discipline led to a re-evaluation of its nature and purpose. Its relevance has been reaffirmed due to the epistemic advantage of philosophy when engaging normative issues. Proper training enables the bioethicist to avoid falling into traps of subjectivism or moralism, which are unable to address the complexity of decision-making. It also prevents the naïve seduction of “scientifying” ethics.[33] This is the starting point of a multitude of roles that can be attributed to the bioethicists. There are three main responsibilities that fall under bioethics: (i) activism in biopolicy, through the engagement in the creation of laws, jurisprudence, and public policies; (ii) the exercise of bioethics expertise, be it through the specialized knowledge in philosophical thought, its ability to juggle multiple languages related to various disciplines related to bioethics, or its capacity to combat and avoid misinformation and epistemic distortion; (iii) and, intellectual exchange, by exercising awareness that it is necessary to work with specialists from different backgrounds to achieve its goals.[34] All of those suggest the need for bioethics to improve its dialogue with CSR and business and human rights. Both CSR and business and human rights have been the arena of political disputes over the role of regulations and corporations themselves, and the absence of strong stances by bioethicists risks deepening their exclusion from the public arena. Furthermore, CSR and business and human rights are at the forefront of contemporary issues, such as the limits to sustainable development and appropriate governance structures, which may lead to the acceptance of values and accomplishment of goals cherished by bioethics. However, a gap in identifying the role and nature of bioethics and CSR may also be an obstacle for bridging the chasm between bioethics and CSR. III. From Substance to Form: Philosophical Groundings of CSR and Bioethics As mentioned earlier, CSR is, to some extent, a byproduct of institutionalism. Institutional economics has a philosophical footprint in the pragmatic tradition[35], which has implications for the purpose of the movement and the typical course of the debate. The effectiveness of regulatory measures is often at the center of CSR and business and human rights debates: whatever the regulatory proposal may be, compliance, feasibility, and effectiveness are the kernel of the discussion. The axiological foundation is often the protection of human rights. But discussions over the prioritization of some human rights over others or the specific characteristics of the community to be protected are often neglected.[36] It is worth reinforcing that adopting human rights as an ethical standard presents problems to bioethics, given its grounding in the recognition of ethical pluralism. Pragmatism adopts an anti-essentialist view, arguing that concepts derive from their practical consequences instead of aprioristic elements.[37] Therefore, truth is transitory and context dependent. Pragmatism embraces a form of moral relativism and may find itself in an impasse in the context of political economy and policymaking due to its tendency to be stuck between the preservation of the status quo and the defense of a technocratic perspective, which sees technical and scientific progress as the solution to many of society’s issues.[38] These characteristics mean that bioethics has a complicated relationship with pragmatism. Indeed, there are connections between pragmatism and the bioethics discourse. Both can be traced back to American naturalism.[39] The early effort in bioethics to make it ecumenical, thus building on a common but transitory morality,[40] sounds pragmatic. Therefore, scholars suggest that bioethics should rely on pragmatism's perks and characteristics to develop solutions to new ethical challenges that emerge from scientific and technological progress. Nonetheless, ethical relativism is a problem for bioethics when it bleeds from a metaethical level into the subject matters themselves. After all, the whole point of bioethics is either descriptive, where it seeks to understand social values and conditions that pertain to its scope, or normative, where it investigates what should be done in matters related to medicine, life sciences, and social and technological change. It is a “knowledge of how to use knowledge.” Therefore, bioethics is a product of disillusionment regarding science and technology's capacity to produce exclusively good consequences. It was built around an opposition to ethical relativism—even though the field is aware of the particularity of its answers. This is true not only for the scholarly arena, where the objective is to produce ethically sound answers but also for bioethics governance, where relativism may induce decision paralysis or open the way to points of view disconnected from facts.[41] But there might be a point for more pragmatic bioethics. Bioethics has become an increasingly public enterprise which seeks political persuasion and impact in the regulatory sphere. When bioethics is seen as an enterprise, achieving social transformation is its main goal. In this sense, pragmatism can provide critical tools to identify idiosyncrasies in regulation that prove change is needed. An example of how this may play out is the abortion rights movement in the global south.[42] Despite barriers to accessing safe abortion, this movement came up with creative solutions and a public discourse focused on the consequences of its criminalization rather than its moral aspects. IV. Bridging the Divide: Connections Between Bioethics and CSR There have been attempts to bring bioethics and CSR closer to each other. Corporate responsibility can be a supplementary strategy for achieving the goals of bioethics. The International Bioethics Committee (IBC), an institution of the United Nations Educational, Scientific and Cultural Organization (UNESCO), highlights the concept that social responsibility regarding health falls under the provisions of the Universal Declaration on Bioethics and Human Rights (UDBHR). It is a means of achieving good health (complete physical, mental, and social well-being) through social development.[43] Thus, it plays out as a condition for actualizing the goals dear to bioethics and general ethical standards,[44] such as autonomy and awareness of the social consequences of an organization’s governance. On this same note, CSR is a complementary resource for healthcare organizations that already have embedded bioethics into their operations[45] as a way of looking at the social impact of their practices. And bioethics is also an asset of CSR. Bioethics can inform the necessary conditions for healthcare institutions achieving a positive social impact. When taken at face value, bioethics may offer guidelines for ethical and socially responsible behavior in the industry, instructing how these should play out in a particular context such as in research, and access to health.[46] When considering the relevance of rewarding mechanisms,[47] bioethics can guide the establishment of certification measures to restore lost trust in the pharmaceutical sector.[48] Furthermore, recognizing that the choice is a more complex matter than the maximization of utility can offer a nuanced perspective on how organizations dealing with existentially relevant choices understand their stakeholders.[49] However, all of those proposals might come with the challenge of proving that something can be gained from its addition to self-regulatory practices[50] within the scope of a dominant rights-based approach to CSR and global and corporate law. It is evident that there is room for further collaboration between bioethics and CSR. Embedding either into the corporate governance practices of an organization tends to be connected to promoting the other.[51] While there are some incompatibilities, organizations should try to overcome them and take advantage of the synergies and similarities. CONCLUSION Despite their common interests and shared history, bioethics and corporate social responsibility have not produced a mature exchange. Jurisdictional issues and foundational incompatibilities have prevented a joint effort to establish a model of social responsibility that addresses issues particular to the healthcare sector. Both bioethics and CSR should acknowledge that they hold two different pieces of a cognitive competence necessary for that task: CSR offers experience on how to turn corporate ethical obligations operational, while bioethics provides access to the prevailing practical and philosophical problem-solving tools in healthcare that were born out of social movements. Reconciling bioethics and CSR calls for greater efforts to comprehend and incorporate the social knowledge developed by each field reflexively[52] while understanding their insights are relevant to achieving some common goals. - [1]. Fritz Jahr, “Bio-Ethik: Eine Umschau Über Die Ethischen Beziehungen Des Menschen Zu Tier Und Pflanze,” Kosmos - Handweiser Für Naturfreunde 24 (1927): 2–4. [2]. Van Rensselaer Potter, “Bioethics, the Science of Survival,” Perspectives in Biology and Medicine 14, no. 1 (1970): 127–53, https://doi.org/10.1353/pbm.1970.0015. [3]. Maximilian Schochow and Jonas Grygier, eds., “Tagungsbericht: 1927 – Die Geburt der Bioethik in Halle (Saale) durch den protestantischen Theologen Fritz Jahr (1895-1953),” Jahrbuch für Recht und Ethik / Annual Review of Law and Ethics 21 (June 11, 2014): 325–29, https://doi.org/10.3726/978-3-653-02807-2. [4] George J. Annas, American Bioethics: Crossing Human Rights and Health Law Boundaries (Oxford ; New York: Oxford University Press, 2005). [5] Philip L. Cochran, “The Evolution of Corporate Social Responsibility,” Business Horizons 50, no. 6 (November 2007): 449–54, https://doi.org/10.1016/j.bushor.2007.06.004. p. 449. [6] Mauricio Andrés Latapí Agudelo, Lára Jóhannsdóttir, and Brynhildur Davídsdóttir, “A Literature Review of the History and Evolution of Corporate Social Responsibility,” International Journal of Corporate Social Responsibility 4, no. 1 (December 2019): 23, https://doi.org/10.1186/s40991-018-0039-y. [7] Potter, “Bioethics, the Science of Survival.” p. 129. [8] Latapí Agudelo, Jóhannsdóttir, and Davídsdóttir, “A Literature Review of the History and Evolution of Corporate Social Responsibility.” p. 4. [9] Albert R. Jonsen, The Birth of Bioethics (New York: Oxford University Press, 2003). p. 368-371. [10] Jonsen. p. 372. [11] Jonathan Montgomery, “Bioethics as a Governance Practice,” Health Care Analysis 24, no. 1 (March 2016): 3–23, https://doi.org/10.1007/s10728-015-0310-2. [12]. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, “The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research” (Washington: Department of Health, Education, and Welfare, April 18, 1979), https://www.hhs.gov/ohrp/sites/default/files/the-belmont-report-508c_FINAL.pdf. [13] Shana Alexander, “They Decide Who Lives, Who Dies,” in LIFE, by Time Inc, 19th ed., vol. 53 (Nova Iorque: Time Inc, 1962), 102–25. [14]. Latapí Agudelo, Jóhannsdóttir, and Davídsdóttir, “A Literature Review of the History and Evolution of Corporate Social Responsibility.” [15]. Boaventura de Sousa Santos, “Por Uma Concepção Multicultural Dos Direitos Humanos,” Revista Crítica de Ciências Sociais, no. 48 (June 1997): 11–32. [16] Latapí Agudelo, Jóhannsdóttir, and Davídsdóttir, “A Literature Review of the History and Evolution of Corporate Social Responsibility.” [17]. Anita Ramasastry, “Corporate Social Responsibility Versus Business and Human Rights: Bridging the Gap Between Responsibility and Accountability,” Journal of Human Rights 14, no. 2 (April 3, 2015): 237–59, https://doi.org/10.1080/14754835.2015.1037953. [18]. Kenneth W Abbott et al., “The Concept of Legalization,” International Organization, Legalization and World Politics, 54, no. 3 (2000): 401–4019. [19]. Jens Holst, “Global Health – Emergence, Hegemonic Trends and Biomedical Reductionism,” Globalization and Health 16, no. 1 (December 2020): 42–52, https://doi.org/10.1186/s12992-020-00573-4. [20]. Albert R. Jonsen, “Social Responsibilities of Bioethics,” Journal of Urban Health: Bulletin of the New York Academy of Medicine 78, no. 1 (March 1, 2001): 21–28, https://doi.org/10.1093/jurban/78.1.21. [21]. Solomon R Benatar, Abdallah S Daar, and Peter A Singer, “Global Health Challenges: The Need for an Expanded Discourse on Bioethics,” PLoS Medicine 2, no. 7 (July 26, 2005): e143, https://doi.org/10.1371/journal.pmed.0020143. [22]. Márcio Fabri dos Anjos and José Eduardo de Siqueira, eds., Bioética No Brasil: Tendências e Perspectivas, 1st ed., Bio & Ética (São Paulo: Sociedade Brasileira de Bioética, 2007). [23]. Montgomery, “Bioethics as a Governance Practice.” p. 8-9. [24]. Aline Albuquerque S. de Oliveira, “A Declaração Universal Sobre Bioética e Direitos Humanos e a Análise de Sua Repercussão Teórica Na Comunidade Bioética,” Revista Redbioética/UNESCO 1, no. 1 (2010): 124–39. [25] John R. Commons, “Law and Economics,” The Yale Law Journal 34, no. 4 (February 1925): 371, https://doi.org/10.2307/788562; Robert L. Hale, “Bargaining, Duress, and Economic Liberty,” Columbia Law Review 43, no. 5 (July 1943): 603–28, https://doi.org/10.2307/1117229; Karl N. Llewellyn, “The Effect of Legal Institutions Upon Economics,” The American Economic Review 15, no. 4 (1925): 665–83; Carlos Portugal Gouvêa, Análise Dos Custos Da Desigualdade: Efeitos Institucionais Do Círculo Vicioso de Desigualdade e Corrupção, 1st ed. (São Paulo: Quartier Latin, 2021). p. 84-94. [26] Milton Friedman, “A Friedman Doctrine‐- The Social Responsibility of Business Is to Increase Its Profits,” The New York Times, September 13, 1970, sec. Archives, https://www.nytimes.com/1970/09/13/archives/a-friedman-doctrine-the-social-responsibility-of-business-is-to.html. [27] Montgomery, “Bioethics as a Governance Practice.” p. 8. [28] John Hyde Evans, The History and Future of Bioethics: A Sociological View, 1st ed. (New York: Oxford University Press, 2012). [29] David J. Rothman, Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making, 2nd pbk. ed, Social Institutions and Social Change (New York: Aldine de Gruyter, 2003). p. 3. [30] Volnei Garrafa, Thiago Rocha Da Cunha, and Camilo Manchola, “Access to Healthcare: A Central Question within Brazilian Bioethics,” Cambridge Quarterly of Healthcare Ethics 27, no. 3 (July 2018): 431–39, https://doi.org/10.1017/S0963180117000810. [31] Jonsen, “Social Responsibilities of Bioethics.” [32] Evans, The History and Future of Bioethics. p. 75-79, 94-96. [33] Julian Savulescu, “Bioethics: Why Philosophy Is Essential for Progress,” Journal of Medical Ethics 41, no. 1 (January 2015): 28–33, https://doi.org/10.1136/medethics-2014-102284. [34] Silvia Camporesi and Giulia Cavaliere, “Can Bioethics Be an Honest Way of Making a Living? A Reflection on Normativity, Governance and Expertise,” Journal of Medical Ethics 47, no. 3 (March 2021): 159–63, https://doi.org/10.1136/medethics-2019-105954; Jackie Leach Scully, “The Responsibilities of the Engaged Bioethicist: Scholar, Advocate, Activist,” Bioethics 33, no. 8 (October 2019): 872–80, https://doi.org/10.1111/bioe.12659. [35] Philip Mirowski, “The Philosophical Bases of Institutionalist Economics,” Journal of Economic Issues, Evolutionary Economics I: Foundations of Institutional Thought, 21, no. 3 (September 1987): 1001–38. [36] David Kennedy, “The International Human Rights Movement: Part of the Problem?,” Harvard Human Rights Journal 15 (2002): 101–25. [37] Richard Rorty, “Pragmatism, Relativism, and Irrationalism,” Proceedings and Addresses of the American Philosophical Association 53, no. 6 (August 1980): 717+719-738. [38]. Mirowski, “The Philosophical Bases of Institutionalist Economics.” [39]. Glenn McGee, ed., Pragmatic Bioethics, 2nd ed, Basic Bioethics (Cambridge, Mass: MIT Press, 2003). [40]. Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 7th ed (New York: Oxford University Press, 2013). [41]. Montgomery, “Bioethics as a Governance Practice.” [42]. Debora Diniz and Giselle Carino, “What Can Be Learned from the Global South on Abortion and How We Can Learn?,” Developing World Bioethics 23, no. 1 (March 2023): 3–4, https://doi.org/10.1111/dewb.12385. [43]. International Bioethics Committee, On Social Responsibility and Health Report (Paris: Unesco, 2010). [44]. Cristina Brandão et al., “Social Responsibility: A New Paradigm of Hospital Governance?,” Health Care Analysis 21, no. 4 (December 2013): 390–402, https://doi.org/10.1007/s10728-012-0206-3. [45] Intissar Haddiya, Taha Janfi, and Mohamed Guedira, “Application of the Concepts of Social Responsibility, Sustainability, and Ethics to Healthcare Organizations,” Risk Management and Healthcare Policy Volume 13 (August 2020): 1029–33, https://doi.org/10.2147/RMHP.S258984. [46]The Biopharmaceutical Bioethics Working Group et al., “Considerations for Applying Bioethics Norms to a Biopharmaceutical Industry Setting,” BMC Medical Ethics 22, no. 1 (December 2021): 31–41, https://doi.org/10.1186/s12910-021-00600-y. [47] Anne Van Aaken and Betül Simsek, “Rewarding in International Law,” American Journal of International Law 115, no. 2 (April 2021): 195–241, https://doi.org/10.1017/ajil.2021.2. [48] Jennifer E. Miller, “Bioethical Accreditation or Rating Needed to Restore Trust in Pharma,” Nature Medicine 19, no. 3 (March 2013): 261–261, https://doi.org/10.1038/nm0313-261. [49] John Hardwig, “The Stockholder – A Lesson for Business Ethics from Bioethics?,” Journal of Business Ethics 91, no. 3 (February 2010): 329–41, https://doi.org/10.1007/s10551-009-0086-0. [50] Stefan van Uden, “Taking up Bioethical Responsibility?: The Role of Global Bioethics in the Social Responsibility of Pharmaceutical Corporations Operating in Developing Countries” (Mestrado, Coimbra, Coimbra University, 2012). [51] María Peana Chivite and Sara Gallardo, “La bioética en la empresa: el caso particular de la Responsabilidad Social Corporativa,” Revista Internacional de Organizaciones, no. 13 (January 12, 2015): 55–81, https://doi.org/10.17345/rio13.55-81. [52] Teubner argues that social spheres tend to develop solutions autonomously, but one sphere interfering in the way other spheres govern themselves tends to result in ineffective regulation and demobilization of their autonomous rule-making capabilities. These spheres should develop “reflexion mechanisms” that enable the exchange of their social knowledge and provide effective, non-damaging solutions to social issues. See Gunther Teubner, “Substantive and Reflexive Elements in Modern Law,” Law & Society Review 17, no. 2 (1983): 239–85, https://doi.org/10.2307/3053348.

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

ABSTRACT This article examines the bioethical discourse on polygenic embryo screening (PES) in reproductive medicine in blogs and news stories published during 2021 in response to the first baby’s birth using polygenic risk scores (PRS) derived from genome-wide association studies. We further contextualize the findings by synthesizing the emerging peer-reviewed bioethics literature on the issue, which has emphasized considerations regarding the child-parent future relationship, equity of access, and the absence of professional guidelines. Our media content analysis has established that expert opinion was prominently featured in news coverage, with bioethicists and other academics contributing 38 percent of articles and providing extensive commentary on ethical, social, and policy implications in the articles written by journalists. The overall perspective towards the use of PES was primarily negative (59 percent of the articles), without significant differences in negativity and positivity between experts and science reporters. This indicates a shift from the predominantly neutral attitudes towards the technology in media discourse prior to its deployment in clinical settings. There is heightened awareness that offering these tests to prospective parents is unethical and can create unrealistic expectations, with the two most prominent arguments being uncertainty about the prediction accuracy of polygenic risk scores in this context (72 percent of the articles) and the potential of PES to lead to a eugenic future of human reproduction that normalizes the discrimination of people based on their genetics (59 percent of the articles). INTRODUCTION The possibility of using genetic technologies to engineer the perfect baby has long haunted the public imagination. While some techno-utopians have openly advocated for human genetic enhancement, many critics have warned that advances in DNA technology come with myriads of ethical dilemmas and potentially dangerous social consequences. Literary and cinematic works have offered dystopian visions of our genetic futures—from Aldous Huxley’s powerful socio-political fantasy in his book Brave New World (1932) to cult classics of sci-fi cinema, such as Blade Runner (1982) and Gattaca (1997), there has been no shortage of ominous predictions that genetic engineering would lead to a new form of eugenics, which would ultimately create new social hierarchies grounded on genetic discrimination. Moreover, concerns about the use of genetic and genomic technologies for social control have been entangled with deep philosophical questions about personal autonomy, the right of the child to an open future, and the morality of changing, improving, or redesigning human nature.1 The perennial debate on human enhancement was recently reignited with a new controversy over the use of pre-implantation screening of embryos using polygenic risk scores.2 While the profiling of IVF embryos to detect hereditary, monogenetic diseases has been widely accepted, some companies are now pushing the envelope with unrealistic promises of tests that can predict genetic possibilities for desirable traits such as a child’s intelligence, athletic ability, and physical appearance. One event that prompted a public outcry in late 2021 was news about the birth of the first baby from an embryo selected through polygenic testing, a girl named Aurea.3 Although the embryo screening in Aurea’s case was used to decrease the likelihood for certain health conditions, many commentators believed that it signaled a real possibility of embryo selection for non-medical reasons becoming a commercial procedure in the foreseeable future, especially in the largely unregulated US fertility market.4 In the past, there have been discrepancies in how ethical and policy issues arising from advances in reproductive medicine have been viewed by experts (e.g., bioethicists, philosophers, legal scholars) and presented in the news. Like other advances in medical genetics, gene editing and screening technologies have been frequently characterized by exaggeration, sensationalism, and hype around clinical possibilities.5 Moreover, news media have often amplified the anticipated health benefits of genetic testing while overlooking uncertainty associated with its clinical validity and emerging ethical concerns, as shown in a recent study of the media portrayal of non-invasive prenatal testing (NIPT).6 The issue of polygenic embryo screening (PES) initially gained traction in the media in 2017 when the New Jersey biotech startup Genomic Prediction made headlines with claims that its testing technology could identify and avoid implanting embryos with very low IQs.7 The company also claimed that it had the capability to identify embryos with high IQs, although it committed not to offer that procedure for ethical reasons.8 The media coverage of polygenic risk scoring of human embryos between 2017 and 2019 was previously analyzed in a study published in BMC Medical Ethics in September 2021.9 This media content analysis has established that while most news articles were neutral towards the technology, one of the most significant critiques raised by science reporters was the absence of solid scientific evidence for the technology’s predictive accuracy and its practical value in IVF settings. It has also identified five major ethical concerns articulated by science reporters that have also been addressed in the academic discourse and within broader policy debates on reproductive technologies: a slippery slope towards designer babies, well-being of the child and parents, impact on society, deliberate choice, and societal readiness. In this article, we examine the discourse on PES in bioethics blogs, opinion articles, and news stories published in 2021, with a specific focus on reactions to the birth of the first polygenic risk score baby. We compare the perspectives of experts and science reporters to establish their attitudes towards PES, the main ethical themes in press coverage, and the key issues highlighted for a future policy debate. We also juxtapose our findings to the previous study of media coverage to establish if the case of baby Aurea has raised any new issues and pressing ethical concerns. I. Polygenic Embryo Screening in Reproductive Medicine While complex diseases and human traits result from a combination of genetic, lifestyle, and environmental factors, genomic medicine is quickly gaining momentum, and demands for genetic tests in clinical practice have significantly increased. Scans and analyses of genomes from various populations, a research area known as genome-wide association studies, have enabled scientists and researchers to identify genetic differences or variants associated with a particular trait or medical condition. These variants can be combined into a polygenic risk score that predicts an individual’s traits or increased risk for a certain disease. For instance, PES have been used to predict a range of diverse common conditions, from diabetes and cancer to attention deficit issues10 and, in some cases, well-being in general.11 This testing modality relies on the probabilistic susceptibility of individuals to certain diseases to offer personalized medical treatments and inform therapeutic interventions. Polygenic embryo screening uses polygenic risk scores to assess an embryo’s statistical risks of developing diseases (e.g., cardiovascular diseases) and potentially traits (e.g., intelligence, athletic ability, among others) and is performed in an IVF setting. It is currently marketed by several US companies such as MyOme, OrchidHealth, and Genomic Prediction to prospective parents as a method to screen pre-implantation embryos for health and non-health related conditions and is accessible to those who can afford to pay for it. As stated in a recent report on companies bringing PES into reproductive medicine, Genomic Prediction has already made their test for polygenic disorders, LifeView, available to couples. In contrast, Orchid Health has only recently invited couples to an early-access program for their testing technology, and MyOme is still in the process of launching its own test.12 In September 2021, Bloomberg first reported the birth of baby Aurea using screening conducted by Genomic Prediction. She was born after her parents used IVF and subsequently PES to select from 33 candidate pre-implantation embryos in 2020.13 Aurea’s embryo was deemed to have the best genetic odds of avoiding conditions such as breast cancer, diabetes, heart disease, and schizophrenia in adulthood. It is worth noting that Genomic Prediction made the announcement almost one year following Aurea’s birth, thus delaying the media’s reaction to this development and the ensuing bioethical and policy debates. II. Ethical, Social, and Policy Implications Some important ethical, social, and regulatory considerations regarding the development and clinical use of PES have been raised within the academic community. The bioethics literature on the issue, however, appears rather thin, which is not surprising given that prior to 2021, the possibility of using this screening method in clinical practice was largely hypothetical. Other genomic technologies that have enabled polygenic embryo selection, such as whole-genome sequencing and pre-implantation genetic diagnosis, have received more attention from bioethicists, legal scholars, and Ethical, Legal, and Social Implications (ELSI) researchers. Our analysis of the emerging literature has shown that some proponents of PES advocate its current use and go as far as to suggest a permissive regulatory environment for the purpose of outpacing the ethical concerns and potential restrictions once the technology becomes widely available. This approach suggests that embryo selection should be allowed for or against any trait associated with higher odds for better health and well-being in general, often without further discussion of what accounts for wellbeing.14 Scholars applying the principle of procreative beneficence to defend the use of PES have also argued for regulation that addresses issues of justice and equality and expands access to the procedure for those who are currently unable to afford it. By contrast, opponents have argued that the clinical utility of this embryo selection method is yet to be proven, and its current use may create unrealistic expectations in parents, making it an unethical practice to offer the procedure as part of IVF treatments.15 They state that predictive models from PRS have been developed with data from genomes of adult populations. Therefore, extrapolating results for embryo screening, along with the absence of a research protocol to validate its diagnostic effectiveness, is dangerous and misleading.16 Another layer of complexity is added because PRS already faces many translational hurdles that would undermine its predictive value assessment for certain traits or diseases. Scientists have noted that PRS take into consideration the genetic component of a particular trait putting aside the effects of other non-genetic factors, such as lifestyle and environment, which might interfere and influence the calculation of these scores.17 Discussions on the ethics and societal implications of PES in the bioethics literature can be grouped into three distinct categories: 1) relational issues between parents and the future child (e.g., selection as identity-determining, concerns about the instrumentalization of children and the child’s right to an open future); 2) concerns about social justice and equality (e.g., fears about a new eugenics that establishes new social hierarchy, limited access to the technology due to its cost); and 3) implementation and regulatory concerns (e.g., lack of professional guidelines and advertising of PES by private companies). An important ethical implication of PES relates to the well-being of the future child and the way that selecting children based on their genetic make-up might negatively affect the parent-child relationship. This is in line with previously raised ethical concerns in the literature around cloning and pre-implantation genetic diagnosis that by choosing a child’s genetic predisposition, we are limiting to and, in some cases, denying their right to an open future. For instance, the future child’s options would be restricted if parents chose a genetic predisposition to musicality that might interfere with the child’s ability to make certain life choices.18 On a societal level, there are concerns PES may alter social perceptions of what is “normal” and “healthy,” resulting in discrimination and stigmatization of certain conditions.19 Related to this are fears about encouraging eugenic attitudes that can exacerbate discrimination against people with disabilities. Furthermore, one of the main ethical concerns raised is that the growing use of PES might exacerbate societal pressure to use this technology, influencing parents’ decisions to select the embryo with the “best” genetics giving rise to a generation of “designer babies.” 20 Finally, direct-to-consumer marketing and clinical introduction of the technology prior to the publication of professional guidelines and in the absence of scientific validity for its use, as well as without appropriate regulatory oversight, is seen as a premature step that might erode public trust.21 III. News Stories and Expert Commentary on Polygenic Embryo Screening in 2021 We conducted searches on google news using keywords such as “polygenic embryo screening,” “polygenic risk scores,” “baby Aurea,” and “embryo selection” and selected blogs and articles from major news sources (e.g., Washington Post, New York Times, Wall Street Journal, LA Times, Guardian, The Times, etc.). An additional effort was made to collect all relevant articles from prominent bioethics blogs such as the Hastings Center Bioethics Forum, Impact Ethics, Bioethics.net, Biopolitical Times (Center for Genetics and Society), among others. The time period for the study was one year, from January 1 to December 31, 2021. While most coverage occurred after the Bloomberg report on the birth of the first baby using PES, there were a number of news stories and blogs in response to a special report on embryo selection based on polygenic risk scores published in the New England Journal of Medicine on July 1, 2020.22 This report, which has received significant attention in the press, warns that companies that offer genetic services can create unrealistic expectations in health providers and prospective parents through their marketing practices. It has further emphasized the scientific uncertainty around the predictive results of PRS in the context of embryo selection. In general, our search has established that the news media coverage on PES over the past year has revolved around these two events – the NEJM Report and the announcement about the first baby born after PES. In total, we collected 29 publications, of which 12 were blog posts and 17 publications under the general category of “news,” including ten news articles, three opinion pieces/perspective articles, two press releases, and one radio broadcast transcript (see Supplementary Material). IV. Methods for content analysis We utilized an inductive-deductive process to develop coding categories for a systematic content analysis of the blogs and new articles. The first author undertook a close reading of the entire dataset to derive inductively recurrent themes and ethical arguments in the media representations of PES. Based on this preliminary analysis, both authors agreed on the categories for textual analysis. The coding book was further refined by using a deductive approach that incorporates themes that have been previously articulated in the scholarly literature on the issue, particularly questions about the perceived attributes of the test, ethical concerns, and emerging policy considerations. The following categories were used to analyze key issues and attitudes towards PES expressed by experts and science journalists: a. Claims that PES is unethical because it violates the future child’s autonomy. b. Concerns about PES as a step towards eugenics and/or genetic discrimination. c. Defenses of PES with arguments that parents have a duty to give the child the healthiest possible start in life (and reduce public health burden). d. Claims that the science behind PRS-based diagnostics is uncertain, and it will take some time to prove its clinical validity. e. Concerns about the equality of access to PES. f. Arguments that PES can exacerbate ethnic and racial inequality (e.g., that most polygenic scores are created using DNA samples from individuals of European ancestries and predictions may not be accurate in other populations). g. Arguments that PES provides health benefits and can help overcome genetic and health inequalities. h. Concerns about the negative impact that PES may have on the child-parent relationship. i. Arguments about the need for better regulatory oversight of PES. j. Suggestions that there is an urgent need for deliberation and debate on the societal and ethical implications of PES. k. Concerns that patients and clinicians may get the impression that the procedure is more effective and less risky than it is. l. Assessment of whether the article’s perspective towards the use of PES is positive, negative, or neutral. We used yes/no questions to detect the frequencies of mentions in each category, except on the last question, which required a more nuanced, qualitative assessment of the overall tone of the articles. We coded articles as “positive” when the authors viewed the technology favorably and emphasized its potential health benefits over its negative implications. Articles that did not condone the current use of PES and expressed strong concerns about the predictive accuracy of this testing method, its readiness for clinical use, and highlighted its controversial ethical and social implications were coded as “negative.” Finally, articles that simply presented information about the topic and quoted experts on the advantages and disadvantages of using PRS for embryo selection without taking a side or expressing value judgments were coded as “neutral.” Acknowledging the complex polysemic nature of media texts, we took into consideration that support or disapproval of PES may be implicit and expressed by giving credence to some experts’ opinions over others. Therefore, we coded articles that mostly cited expert opinion favorable to PES, or alternatively, presented such views as more credible, as “positive”, while we coded articles that emphasized critical perspectives as “negative.” V. Media Discourse and Expert Opinion On PES We found out that perspectives and opinions by experts were prominently featured in both news (17 articles) and blogs (12 articles). The blog posts in our dataset were written by university professors in bioethics (four articles), academics from other disciplines such as medicine, political science, psychology, human genetics, and neurobiology (four articles), and science journalists and editors (four articles). Furthermore, three of the news articles in influential newspapers and magazines such as The Wall Street Journal, The Washington Post, and The Scientific American were opinion articles or commentaries contributed by academics (e.g., a psychology professor, specializing in personality, individual differences, and behavior genetics, a sociology professor, and a director of research in a graduate program in human genetics). The remaining 14 news articles in our dataset were written by science reporters, editors, or other staff writers. Altogether, experts contributed 38 percent of the media coverage (11 articles) on the issue of PES and its wider societal implications. Experts’ comments were also heavily featured in the 18 articles written by science reporters and other media professionals, which accounted for 68 percent of the dataset. Of these articles, 17 extensively cited experts with academic and research backgrounds (professors and research scientists), seven articles quoted industry representatives (e.g., CEOs and spokespersons of Genomic Prediction and Orchid, other commercial developers), and four articles included opinions by parents seeking PES, particularly Aurea’s father, North Carolina neurologist Rafal Smigrodzki, who argued that a parent’s duty is to prevent disease in their child.23 The overall perspective towards the use of PES was mostly negative – 59 percent (17 articles) expressed negative attitudes, while 24 percent (seven articles) were positive and 17% (five articles) were neutral in tone and did not advance arguments in favor or against the technology and its adoption. However, we did not establish significant differences in negativity and positivity between experts and science reporters. For instance, 49 percent of the articles with negative attitudes were written by experts, while 53 percent were authored by science reports. Similarly, the articles by experts with positive perspectives on PES accounted for 13 percent of the dataset, while science reporters contributed 11 percent of the positive articles. VI. Major Themes and Issues The most discussed issue in media coverage was the prediction accuracy of polygenic risk scores and the uncertainties regarding the utility of these tests in embryo screening. Our analysis has established that 72 percent of the articles (21 out of 29) argued that the science behind PES-based diagnostics is uncertain, and it will take some time to prove its clinical validity. The second most frequently mentioned issue was the potential of PES to lead to a eugenic future of human reproduction. More than half of the articles (59 percent or 17 out of 29) raised concerns that PES could become a step towards a new form of eugenics that could eventually normalize the discrimination of people based on their genetics. Despite concerns about the accuracy of PES testing, many articles gave extensive attention to problems concerning equality of access to PES and related diagnostic services, with 49 percent of the articles (13 out of 29) expressing concerns that the procedure is currently offered at a high cost, it is not covered by health insurance plans, and people of lower socioeconomic status cannot afford it. Furthermore, 41 percent of the articles (12 out of 29) raise concern that the current use of PES reflects the existing ethnic and racial inequalities since most PES are created using DNA samples from individuals of European ancestries, and predictions may not be accurate in other populations. Although it has been reported that Genomic Prediction considers offering the procedure to parents of non-European ancestries, their messaging has suggested it would take a significant time to provide them with predictive models that are as relevant as those for European populations.24 The health benefits of this testing technology, its regulation, and the need for a wider debate on how to realize its promise in a responsible manner were also addressed, albeit to a lesser extent. The potential to overcome genetic and health inequalities by selecting healthy embryos with the best odds against diseases and chronic conditions was emphasized in 41 percent of the articles (12 out of 29). The regulation was a topic covered in 38 percent of the articles (11 out of 29), in which the authors argued that better regulatory oversight of PES is needed, especially in the present condition of an unregulated US market for genetic testing. Additionally, 38 percent suggested that there is an urgent need for deliberation and public debate on the societal and ethical implications of PES. Finally, the issue that patients and clinicians may get the wrong impression that the procedure is more effective and less risky was addressed in 31 percent (nine out of 29). We have established that critical issues about how PES may affect the well-being of the future child and the child-parent relationship have received less attention. For instance, only 17 percent of the articles (five out of 29) supported the clinical use of PES with arguments that parents have a moral obligation to give the child the healthiest possible start in life, a line of thought that is prominent in the bioethics literature on procreative beneficence and procreative autonomy.25 These authors also maintained that the technology has the potential to provide benefits to individuals and reduce the burden of disease and public health expenditure. Similarly, just 10 percent of the articles (three out of 29) expressed concerns about the negative impact that PES may have on the child-parent relationship by causing relational asymmetries between generations and limiting the autonomy of the future child. CONCLUSION Our content analysis has shown that the media discourse on PES and the birth of baby Aurea has been highly influenced by expert opinion. In fact, leading experts from bioethics and a range of other academic disciplines contributed 38 percent of the content in the form of blogs, opinion articles, and commentaries, published on prestigious bioethics fora and in the popular press. Furthermore, as our analysis has shown, science reporters have heavily relied on expert opinion in writing stories about the ethical challenges and societal implications of PES. One important finding of our study is the prevalence of negative attitudes towards the technology, as opposed to past media representations of PES, which had been neutral towards the technology.26 This change in attitudes is likely caused by the amplified voices of bioethics experts reacting to the first clinical use of the technology, which made hypothetical ethical dilemmas a very real possibility. As far as the thematic focus of media representations is concerned, the birth of the first baby using PES has raised ethical concerns similar to those highlighted in the literature on PES and embryo selection through pre-implantation genetic diagnosis, with the most prominent issue being the absence of robust scientific evidence for the predictive accuracy of PRS modeling and its practical value in IVF settings. Although the critical nature of media discourse can contribute to raising public awareness about the ethical acceptability of the technology, bioethicists should also examine the effect of economic forces and societal pressures to have a perfect child that may be driving prospective parents to seek such unproven genetic interventions. PES is an emerging niche in a large, unregulated market for genetic testing services that has the potential to shape the future of reproductive medicine, and there is an urgent need for a policy debate on how it can be developed responsibly and ethically. 1 J. Habermas, "The Debate on the Ethical self-Understanding of the Species," The Future of Human Nature (Oxford, UK: Blackwell Publishing, 2003): p. 16-100. 2 Polygenic risk scores (PRS) are used in personalized medicine to predict disease risk in different human populations, not necessarily for risk modelling in embryos. Polygenic embryo screening (PES), on the other hand, involves the clinical use of PRS modelling from genome-wide association studies of adult populations for selecting embryos with the lowest probability of developing certain health conditions in adulthood. It could potentially be used to select embryos with a higher probability for inheritance of certain physical traits or complex characteristics. 3 C. Goldberg, "Picking Embryos With Best Health Odds Sparks New DNA Debate," Bloomberg September 17, 2021. 4 D. Conley, "A new age of genetic screening is coming — and we don’t have any rules for it," The Washington Post June 14, 2021. 5 K. Kamenova, A. Reshef, and T. Caulfield, "Angelina Jolie's faulty gene: newspaper coverage of a celebrity's preventive bilateral mastectomy in Canada, the United States, and the United Kingdom," Genetics in Medicine 16, no. 7 (2014): 522-28. 6 K. Kamenova et al., "Media portrayal of non-invasive prenatal testing: a missing ethical dimension," Journals of Science Communication 15, no. 2 (2016): 1-19. 7 B. Talat, Choosing the "Smartest" Embryo: Embryo Profiling and the Future of Reproductive Technology, (Canadian Institute for Genomics and Society, March 14, 2019), https://www.genomicsandsociety.com/post/choosing-the-smartest-embryo-embryo-profiling-and-the-future-of-reproductive-technology8 E. Parens, S. P. Applebaum, and W. Chung, "Embryo editing for higher IQ is a fantasy. Embryo profiling for it is almost here.," Statnews, February 12, 2019. 9 T. Pagnaer et al., "Polygenic risk scoring of human embryos: a qualitative study of media coverage," BMC Medical Ethics 22, no. 1 (2021): 1-8. 10 E. L. de Zeeuw et al., "Polygenic scores associated with educational attainment in adults predict educational achievement and ADHD symptoms in children," American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 165b, no. 6 (2014): 51020. 11 A. Okbay et al., "Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses," Nature Genetics 48, no. 6 (2016): 624-33. 12 F. Ray, "Embryo Selection From Polygenic Risk Scores Enters Market as Clinical Value Remains Unproven," (December 22, 2021). https://www.genomeweb.com/sequencing/embryo-selection-polygenic-risk-scores-enters-market-clinical-value-remainsunproven#.YeVWzvhOk2w13 J. Savulescu, "The moral case for eugenics?," IAI News, September 28, 2021, https://iai.tv/articles/the-moral-case-for-eugenicsauid-1916. 14 S. Munday and J. Savulescu, "Three models for the regulation of polygenic scores in reproduction," Journal of Medical Ethics 47, no. 12 (2021): 1-9. 15 F. Forzano et al., "The use of polygenic risk scores in pre-implantation genetic testing: an unproven, unethical practice," European Journal of Human Genetics (2021). 16 Forzano et al., 1-3.; P. Turley et al., "Problems with Using Polygenic Scores to Select Embryos," The New England Jourmal of Medicine 385, no. 1 (2021): 78-86. 17 N. J. Wald and R. Old, "The illusion of polygenic disease risk prediction," Genetics in Medicine 21, no. 8 (2019): 1705-7. 18 M. J. Sandel, "The case against perfection: what's wrong with designer children, bionic athletes, and genetic engineering," Atlantic Monthly 292, no. 3 (2004): 50-4, 56-60, 62. 19 H. Haidar, "Polygenic Risk Scores to Select Embryos: A Need for Societal Debate," Impact Ethics (blog), November 3, 2021, https://impactethics.ca/2021/11/03/polygenic-risk-scores-to-select-embryos-a-need-for-societal-debate/. 20 Pagnaer et al., " 1-8. 21 Forzano et al., 1-8. 22 Turley et al., 78-86. 23 P. Ball, "Polygenic screening of embryos is here, but is it ethical?," The Guardian, October 17, 2021. 24 W. K. Davis, "A New Kind of Embryo Genetics Screening Makes Big Promises on Little Evidence," Slate, July 23, 2021, https://slate.com/technology/2021/07/prs-model-snp-genetic-screening-counseling.html. 25 J. Savulescu, "Procreative beneficence: why we should select the best children," Bioethics 15, no. 5-6 (2001): 413-26. 26 Pagnaer et al., 1-8.

Introduction Toys and games are important elements of child growth and development. When children play, they have fun. They also learn to perform and contest ideas making up their culture. The potential professional affiliations and skills offer an illustration of the roles that children learn about in the early years of their lives. Therefore, toys may serve as a site to research professional aspirations. In light of this, a question emerges: what do toys teach about professions and professionalism? As a feminist communication researcher, I study toys primarily intended for girls – the dolls in the American Girl collection. Even though the doll sets demand an excessively high price, this brand has a cultural significance for the girls and women growing up in the United States because of the historical and contemporary connections found in deeply researched stories and intricately designed accessories (Solly). The American Girl brand started in 1986. Mattel, the American toy conglomerate, has owned the American Girl brand since 1998 and describes the brand as helping "generations of girls find courage, build confidence, and spread kindness" ("American Girl"). The original American Girl dolls represented historical figures: for example, Melody Ellison from the era of the Civil Rights Movement of the 1960s and Kit Kittredge from the time of the Great Depression in 1934. In addition to historical personalities, the American Girl depicts contemporary girls, including the Girl of the Year line introduced annually. These dolls portray modern girls who have special talents or hobbies and who navigate their lives and experience adventures through the prism of their talents. For example, Joss Kendrick’s passion is surfing, Gabriela McBride loves dancing and poetry, and Grace Thomas is interested in baking. As a rule, the talents of the Girls of the Year align with professional work and can inspire future generations to choose specific professions or develop professional qualities. To narrow the subject, this essay examines the professional aspirations presented in the stories and media associated with the American Girl doll, Luciana Vega, released in 2018. Luciana is an aspiring 10-year-old astronaut and scientist who dreams to be the first person to walk on Mars. Luciana is unique because she is the first doll among contemporary characters to exclusively engage in science, technology, engineering, and math, or STEM (Strickland). This doll marks an attempt to address the high barrier for women and underrepresented groups to enter and remain in science, technology, engineering, and math fields. The former NASA chief scientist Ellen Stofan reflects on the importance of Luciana, saying that "a lot of girls are sometimes intimidated by STEM careers" and that characters like Luciana can let "girls of color around the world know they can be astronauts" (Strickland). Therefore, Luciana Vega contributes to the discourse about professions for contemporary girls and women. The focus on professional aspirations represented in toys stems from the research about professionalism, which implies a set of assumptions that are taken for granted yet ambiguous, conflicted – and rarely questioned (Cheney and Ashcraft). The criticism of neoliberalism from the feminist perspective helps examine professionalism critically. Neoliberal feminism celebrates the achievements of individual women in the format of corporate and personal enterprises at the expense of confirming privileges based on race, class, and sexuality (Rottenberg). The essay argues that the lessons about professions and professionalism offered by the American Girl focus on establishing only a symbolic association with professional engagement. The emphasis on personal development through teamwork, leadership, and creativity promotes gendered professional capital that has limited resources to address potential imposter phenomenon and workplace harassment. Dolls and Professional Aspirations Scholars who study toys and playthings associate them with opportunities to display and obtain social rules and cultural values. Gender, race, and class norms are part of cultural production in toys (Foss; Rosner, Playing). As a product of culture, toys and texts associated with them represent professional futures and offer lessons about organisational life, professional identities, and work relations. Kuhn and Wolter report that young people tend to follow gender stereotypes in professional planning even in progressive locations, yet this connection between professional aspirations, career choices, and existing expectations is rather weak, suggesting that parental influence, regional or local specificities, educational programming, and other social factors, such as toys and games, may impact individual choices. The American Girl brand promotes an active lifestyle, teaching children to understand who they are and to bring positive changes to their communities. The company does not explicitly mention preparation for careers and professional education. The company emphasises holistic development for girls, where professionalism and career aspirations may serve as implied targets. Barbour, Rolison, and Jensen argue that “individuals construct professional selves that originate in the early socialisation phases of professional training and are further developed as they are immersed in the rules, language, skills, and work of the profession” (137). As such, playing with dolls and engaging with the issues suggested by the toy brand may have an impact on future generations as they explore potential professions and careers and learn what it means to be a professional. The academic research about the American Girl has not discussed professionalism yet. Scholars focus on exploring historic representations to argue that the company romanticises nostalgia to foster consumerism (Rosner, “The American Girl”) or presents a simplified and whitewashed version of history (Marcus; Valdivia). Marshall argues that the American Girl version of girlhood “reflects a gendered pedagogy of consumption rather than any lessons about empowerment or US history” (95). Scholars nevertheless have already noted the affiliations of the American Girl doll characters with neoliberalism. Neoliberalism refers to an approach to political economy that favours free market, economic growth, and capital accumulation. In feminist research, neoliberalism can be understood as “a sensibility or set of themes that privilege market-friendly notions of individualism, responsibility, and capitalization” (Thornton 273). The American Girl brand strives to empower girls, yet the empowerment offered by the brand is wrapped in a neoliberal frame of thinking, calling for girl power, self-determination, and femininity without changing the system that supports gender and other forms of discrimination and inequality (Rybas and Rybas; Zaslow). The criticism of neoliberal feminism provides a framework to examine professional belonging projected for future iterations of work, professions, and talents. Reading Professions in the American Girl Texts If Luciana Vega’s character offers lessons about professions and professionalism for the fans who play with the doll and engage with her story, it is important to explore these texts. The texts associated with the American Girl brand range from books that have traditionally defined the brand to mobile apps, short videos, feature or animated movies, and social media snippets that have appeared in recent years. The books create narratives about the characters, while multimedia texts offer alternative formats for the narratives as well as promote activities and engagements inspired by the characters. These texts offer rich data to examine the implications of the character for professionalism and being a professional. Further analysis draws from the content created for the 2018 Doll of the Year: the book Luciana by Erin Teagan and videos on the official American Girl YouTube channel and collected into a playlist. Material objects and discursive constructions of practices associated with work produce professional identification and belonging. Being a professional relies on demonstrating special skills and knowledge in work contexts and maintaining professional identities (Caza and Creary; Caza, Vough, and Puranik). As with other professionals, the character experiences contradictions and dilemmas embedded in the tasks (Ahuja). She evokes professional skills and grows her professional potential through the problems and struggles that she deals with. Based on how the character and spokespersons address situations associated with work and how they communicate about their experiences, the analysis identifies lessons about professions and professionalism. Lessons about Professions and Professionalism First, the discussion of lessons about professionalism focusses on the material markers of being a scientist. How do the professionally defined objects, places, and activities signify Luciana’s belonging to the STEM sphere? At the Space Camp, the kids wear space and science clothes, and Luciana receives an official Space Camp flight suit upon check-in. The camp participants move from their habitats, with bunk beds for six campers, to the habitat common area, with screens streaming news from the international space station, and to the mission floor, with spacecrafts, greenhouses, and training equipment. Luciana finds her sense of belonging to the Space Camp through items signifying connections to space explorations. She wears a dress of “the colors of the nighttime sky—blue, red, purple, orange” (Teagan 4) and the star-shaped necklace. She also packs her “favorite pajamas from the planetarium” (Teagan 11) and “a pillow with the solar-system pillowcase” (Teagan 2). The items make her feel comfortable upon her arrival at the camp. The STEM-style objects can stimulate desires to purchase the toys and outfits, such as the lunar habitat, space suit, galaxy-patterned dress for the doll, or science kit, available from the American Girl brand. In addition to the merchandise and branded items, the projects completed by the camp participants are indicative of their professional belonging: The campers perform soil experiments and design robots. The narrative refers to specialised terms (types of rocks and rockets), equipment (goggles, beakers), and scientific routines (wearing safety goggles, labelling samples) to create a world focussed on science. These details show Luciana’s familiarity with the camp space and speak to her abilities needed to complete the activities. The videos posted on YouTube provide additional illustration to the narrative. The spokespersons in the promotional videos as well as guests and hosts in the TV studio during the reveal wear blue overalls and walk through the NASA Centre (“A Day in the Life of Luciana”; “Meet American Girl’s 2018”). These descriptions and demonstrations create excitement about space exploration and make the STEM fields seem attractive and available. However, the price tag of almost $1,500 in 2023 (“Space Camp”) for camp participation keeps the dream of flying to Mars a distant reality for families. The financial barrier, obviously, does not appear in the texts promoted by the American Doll brand. Such silence indicates that each family needs to decide for themselves to what extent they can participate in the world of STEM, and such considerations reinforce class-based stratifications. Further, the discussion focusses on the ways of thinking associated with professionalism. Adams argues that professionalism offers epistemologies that define "what is sayable, what is knowable, what is included, and what is excluded" (332). In other words, professionalism implies a system knowledge necessary for success in the neoliberal economy (Adams; Cheney and Ashcraft). What skills and epistemologies emerge in the texts associated with Luciana Vega? The set-up of Luciana’s story establishes her responsibility for the success. She participates in a week-long space camp without her parents and friends. Even though she has an opportunity to develop her interests and meet new friends, the narrative suggests that Luciana must push back her longing for her family and her worries about the adoption of her new sister to emphasise the camp projects and her dream to be an astronaut. The discourse about work and life balance is significant for the neoliberal feminist analysis because those who are successful can do it all (Rottberg; Thornton). Luciana takes responsibility for adapting to the camp environment and controlling her own development. Luciana’s competitive record illustrates her drive. She obtains an acceptance to join the camp after two rejections, and this achievement communicates her resilience and perseverance necessary for a neoliberal subject (Rottberg). Teamwork, leadership, and creativity are core skills expected from workers in the contemporary economy. Creativity defines neoliberal femininity as it aligns with passion, energy, and stamina (Rottberg; Thornton). Creativity is Luciana’s quality. Alex, one of the trainers, confirms her reputation by saying, "we need creative future astronauts just like you" (Teagan 6). Luciana’s ideas, however, may cause mistakes, as it happens during the building of a rover because she ignores the expectations about the rover’s weight. As the narrative develops, the team needs Luciana’s ideas, especially in designing a robot from junk parts, and the team acknowledges Luciana’s contributions. They note that Luciana has pretty good ideas and that making mistakes is normal. Ella, one of the teammates, concludes that "it’s the person who thinks a little differently from the rest who has the greatest chance of making a difference in this world" (Teagan 133). Even though Luciana’s creativity leads to various results, it is essential for her success as a professional. In addition to creativity, Luciana develops her teamwork and leadership skills. These qualities are required for the success of the camp mission and future professional endeavours. Alex, the camp trainer, says that "for an astronaut team is everything" (Teagan 118). To compete in the robotics challenge, Luciana becomes the captain of one of the teams, and she encourages her team to work in a cohesive and productive manner. The team chooses the name Red Rover by brainstorming and voting, yet the team fails to collaborate in the rover-building challenge because Luciana does not rely on the knowledge of her teammates. Red Rovers get disqualified from the competition, but Luciana leads her team in continuing their experiment, building a successful robot, and even helping the team whose project the girls have damaged. As a result, the team members develop a strong friendship bond and receive an award for building a unique robot. Luciana’s leadership is meaningful for professional aspirations in the neoliberal style because it juxtaposes her character against the other participants of the camp, which promotes the emphasis on taking responsibility for mistakes. Creativity, teamwork, and leadership permeate the simple activities inspired by the 2018 Doll of the Year: making star-shaped cookies, creating a purple hair streak, and organising a space-themed party (AG Life). The short episodes follow the style of videoblogs or reality TV shows created by and for teens and tweens. The five hosts are girls of Luciana’s age who perform activities and share knowledge in an easy-going manner imitating a conversation. Faber and Coulter critique girls’ digital production as an embodiment of neoliberal ideologies built on playful authenticity and the affective glamourisation of entrepreneurial logics. Making star-shaped cookies, creating a purple hair streak, and organising a space-themed party represent science and space exploration only by association, similar to the pyjamas from the planetarium or the star-shaped necklace. Together with the claims for expertise in the STEM sphere and the emerging skills required for success in professional spheres, Luciana experiences difficulties, such as the imposter phenomenon and work harassment. Imposters exhibit doubt in their achievements, think of their success as fraud, and diminish their success (Parkman). In the story, Luciana completes a difficult docking manoeuvre with her team successfully, yet she concludes that the task has been “barely” (Teagan 151) completed. She compares herself to other kids: “my belly was starting to turn. I hadn’t expected there to be so many genius kids here. Did they all want to be astronauts like I did?” (Teagan 29). Luciana doubts her leadership abilities and questions her creativity, suggesting that her existing skills are not enough. In one of the episodes, she almost gives up her captain role, hinting at a potential burn-out situation. She particularly struggles to build connections with Ella, one of her team members, yet she develops a relationship with her after a few trials. These experiences illustrate the challenging process of finding self and connecting with others in a professional context. The creators of Luciana Vega attempt to send a positive message to future experts in the field by welcoming diverse individuals. Luciana states that “astronauts come with hair in all shades and sizes and colors” (Teagan 32). However, the positive message is muffled because it serves as a reaction to a comment by another camp participant, James, who shares that he never saw astronauts with purple hair. The focus on the signature purple hair streak as a sign of diversity exemplifies a simplistic approach to intersectionality and diversity, a common criticism of the American Girl dolls (Marcus; Valdivia; Zaslow). In addition, the exchange about the purple streak in the girl’s hair highlights gender dynamics in the contemporary workplace, pointing at the possibility of workplace harassment. James adds that “it’s the like mom law” (Teagan 32), thus offending Luciana. In organisational contexts, harassers make offensive jokes and engage in insults, making the workplace environment hostile (Griffin), and Luciana encounters this experience. James clashes with Luciana and her team members throughout the narrative. What is important here is not only the professional rivalry that emerges in the narrative and is normalised in competitions, but the reactions that Luciana practices. She ignores the hurtful comments made by James during the spacewalk simulation exercise, yet she shares her resources to help him complete the task. Luciana’s team supports James’s team in the robot design task and transfers sponsorship to the boys’ team. Even though the story line introduces diversity to the workforce, it falls short of addressing instances of potential workplace harassment with force. Luciana seems not yet equipped to address the hostility exhibited by the fellow camp participant. She prioritises teamwork and camp mission at the expense of her own well-being. These emphases contributing to the gendered professional capital (Rottberg) essential for neoliberal progress. Conclusion The lessons about professions and professionalism offered by the American Girl are complex, if not contradictory. The presence of Luciana Vega in the competitively selected camp is promising, yet the STEM field remains difficult to access. The character experiences the imposter phenomenon even if she has extensive knowledge of science. Science-themed clothes, books, and accessories as well as science-inspired activities may promote an interest in the field. Teamwork, leadership, and creativity establish markers of professionalism and provide resources for cultivating professional epistemology. The current generation of girls and the future generations of women receive exposure to difficulties in developing leadership and teamwork skills and potential work harassment but may learn to address them through self-improvement or individual development. These lessons emphasise empowerment in the neoliberal frame of reference typical of the American Girl dolls. References “A Day in the Life of Luciana at Space Camp | Luciana Vega: Girl of the Year 2018.” American Girl. 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