Suchergebnisse

The proposed national model described in this report has been developed by a working group comprised of staff from the National Board of Health and Welfare, the National Centre for Priority Setting in Health Care, and other organisations involved in vertical prioritisation – including the Östergötland County Council, Stockholm County Council, Västra Götaland, the Health Services Region of Southern Sweden, the Swedish Society of Medicine, the Swedish Society of Nursing, and the Swedish Association of Health Professionals. Throughout the process of designing the model, the Swedish Federation of Occupational Therapists and the Swedish Association of Registered Physiotherapists were regularly informed and given opportunities to review and comment on the proposal. Furthermore, the report was reviewed and discussed at a meeting with invited representatives from the other county councils, the Pharmaceutical Benefits Board, and several professional interest groups. Viewpoints were also obtained at a seminar arranged by PrioNet, a network of individuals interested in prioritisation. Potentially, the working model described in Chapter 4 could be used in any context where vertical prioritisation takes place, e.g. activities arranged by the state, county councils, municipalities, hospital departments, and professional groups. This report is designed to be a useful tool for those working on development projects in priority setting. We believe that the contents must be adapted, with the help of relevant examples and some simplifications; to fit the specific needs of different projects or groups. The text must also be adapted to a target group's knowledge and previous experience in dealing with transparent priority setting. It must be the responsibility of each provider and other affected organisation to adapt the material to the given situation and project. The National Centre for Priority Setting in Health Care, the National Board of Health and Welfare, and others who have participated actively in this effort can be helpful to various target groups in adapting this report. When and how to engage in practically implementing vertical prioritisation are questions that need to be answered at the local level. Primarily, it is the duty of the local authorities/providers to take responsibility for implementation. Professional organisations also play an important role. Public agencies, universities, and knowledge centres should be sources of support for the local authorities/providers. The Riksdag's resolution on prioritisation served as the foundation for developing the model. Where there are areas of uncertainty in how to translate these guidelines in practice, or where practical implementation might conflict with the principles, we have pointed this out. Our conclusions and proposals are the following: When facing a choice – regardless of whether it involves allocating new resources for different purposes, or to implement cutbacks – it can be advantageous to rank the possible choices in order of priority. In our model, only the relevant options can be ranked by priority. The consequences of this ranking are not obvious at the outset, but can serve as a basis either to allocate more resources or ration by some means. In vertical prioritisation, it is advantageous to organise the prioritization process starting from a general categorisation of health problems/disease groups. As a rule, these categories cover many organisational units/clinical departments, specialties, or professional groups, thus providing a more multidimensional view of the problem. Furthermore, this allows the process to start from a patient/population perspective, which appears to be more goal-oriented than an organisational/staff perspective. That which is ranked, i.e. one of the choices, we refer to as a prioritization object. We suggest that prioritisation objects consist of different combinations of health conditions and interventions.1 When deciding on the appropriate level of detail, the decision must be based on the context in which prioritisation is carried out. A starting point would be to focus on typical cases, large-volumes services, and controversial care. All forms of vertical prioritisation should be based on the ethical principles that the Riksdag decided should apply in prioritising health services. However, these ethical principles must be made known, clarified, and perhaps complemented before they can be applied to practical priority setting. Furthermore, we believe that the Riksdag's four so-called priority groups should not be part of the model. The human dignity principle, i.e. that all people should have equal value and equal rights to care irrespective of their personal characteristics and function in society, is the undisputed cornerstone in priority setting. When personal characteristics such as age, gender, lifestyle, or function of a group are expressions of the presence of special needs, so that benefits of the interventions are different, these personal characteristics could be addressed in a priority at the group level. Further discussion is needed regarding the question of how external effects (i.e. the effects of an intervention on families and groups other than the individual directly affected by the intervention) should be valued in priority setting. The concept of need in health care includes both the severity level of the condition and the expected benefits of intervention. As a patient, one needs only those interventions that can be expected to yield benefits. Based on this definition of need, a person does not need an intervention that does not improve health and quality of life, i.e. an intervention with no benefit. In such cases, health services have a responsibility to refer people who seek care for some type of problem, to other appropriate services. The Riksdag's guidelines regarding the cost-effectiveness principle (applied to individual patients) are too limited to provide guidance for vertical prioritisation at the group level. From the outset, the Government's bill (Priority Setting in Health Care) highlighted the importance of differentiating a cost-effectiveness principle that applied to choices among various interventions for the individual patient (where the principle can be applied as the Commission of Inquiry proposed) and the aim of health services to achieve high cost-effectiveness in health care generally. Here we also refer to the Riksdag's directive to the Pharmaceutical Benefits Board. In its decisions on subsidising (prioritising) a drug, the Board should determine, e.g. whether the drug is cost effective from a societal perspective, which requires comparing the patient benefits of the drug to its cost. In such decisions, the cost effectiveness should be considered along with the needs and solidarity principle and the human dignity principle. The proposed working model essentially concurs with the working model used by the National Board of Health and Welfare in developing national guidelines. In describing a national working model, it is not possible to include every aspect that might be considered. Hence, one must start from the model and decide which other relevant aspects should be included. For instance, the International Classification on Functioning, Disability, and Health (ICF) can be used as guidance to describe the severity of health conditions. Due to the wealth of variety in outcome measures for different activities, and the limited experience in working with explicit threshold values, we believe would be premature to recommend standardised categories, e.g. risk levels. However, it is important that those working with prioritization describe their reasoning. Primarily, the categories applied by the Swedish Council on Technology Assessment in Health Care (SBU) to grade the scientific evidence of an intervention's effects should be used. Local prioritisation projects with limited resources at their disposal should describe (text) their appraisal of the scientific evidence and reference the scientific sources used. The strength of evidence should be expressed in numbers only when supporting a conclusion of a systematic review by SBU, or other literature reviews of good quality. Prioritisation projects having access to health economic evaluation should, until further notice, adhere to the approach used by the National Board of Health and Welfare and present cost-effectiveness on a scale from low to very high cost per life-year gained or cost per quality-adjusted life-year. Economic evidence should be presented according to the principles applied by the National Board of Health and Welfare. In local projects with limited resources, or problems in consistently acquiring information on cost effectiveness, we recommend that the authors at least discuss cost effectiveness in cases where the priority ranking would be decisively affected when costs are weighed in. A 10-level ranking list should be used. The ranking list should be complemented by a "don't do" list for methods that should not be used at all, or not used routinely, and a research and development (R&D) list for methods where the evidence still insufficient to motivate their use in standard practice. In the absence of an objective quantitative/mathematical method, a qualitative method should be used in the appraisal. Here too, we believe that it is not yet possible to establish standard criteria to determine within which ranking level a prioritisation object should fall. Results should be presented as a ranking list. The parameters used as a basis for prioritisation should also be presented in a uniform manner in ranking lists that are shared with other parties. For pedagogic reasons, details concerning language and format need to be adapted to the respective target groups. Thresholds for what constitutes an acceptable coverage of need (care quality, volume, and percentage of the patient group with access to services) are regional and local issues, and hence are not included in the national model.

Executive summary Introduction CTA works primarily through intermediary organisations and partners (non-governmental organisations, farmers' organisations, regional organisations) to promote agriculture and rural development and to deliver its various information products and capacity building services. By partnering with these organisations, CTA seeks to increase the number of ACP organisations capable of generating and managing information and developing their own information and communication management strategies. In the period 2003 – 2005, CTA undertook a series of needs assessment studies in 21 countries in the ACP Pacific and Caribbean. As a continuation of this process, CTA have now commissioned assessments of the agricultural information needs of 6 countries emerging from prolonged conflict situations in ACP Africa, including Mozambique, which forms the focus of this report. Objectives of the Study The objectives of this study are to develop a strategy for CTA's approach to post-conflict countries, to improve the effectiveness of CTA's support for post-conflict countries and to compile baseline data on the status of ICM and ICTs in agriculture and rural development in Mozambique. Methodology The country profile was produced through a desk study. This study relied heavily on information available on the internet and additional information was obtained from various institutions in Mozambique, internationally and from key informants. Through the desk study we were able to identify a list of nine key institutions. This list was discussed with CTA and informants in Mozambique and face to face interviews were requested with each institution. Of these, seven of the institutions agreed, whilst one indicated that it would be closing its operations within a year and was therefore removed from the list. Expected results This study will provide: 1) an inventory of the status of agricultural information services, institutions and other actors and their needs as their relate to physical infrastructure, information availability and access and human capacity development; 2) an assessment of the current and / or planned interventions of the government and bi- or multilateral agencies in the field of information for agriculture and rural development; 3) an overview of the needs of potential partners for CTA activities and services in terms of building capacity for information and communication management; 4) a short-list of potential partners / beneficiaries for CTA activities and services; 5) baseline data to facilitate subsequent monitoring activities. The study will also provide a framework for CTA to develop a framework for action and fashion a strategy aimed at institutions in countries emerging from conflict situations and provide input into its 2006 – 2010 strategic plan. Findings Following the signing of a peace agreement in 1992 to end 16 years of conflict, Mozambique has achieved impressive economic growth and lowered its prevalence of poverty. Sustained by strong foreign investment, real GDP in Mozambique has been growing at rates in excess of 7 percent for the last 4 consecutive years, and per capita income in US dollars has increased by nearly 50 percent between 2001 and 2004. Mozambique's economic growth, however, implies an important transformation in the composition of its GDP, although services remain the dominant sector. The share of industry in total GDP increased to 27 percent in 2004 from about 16 percent in 1996, whereas the share of agriculture decreased to 23 percent from about 30 percent in the same period. The agricultural sector, however, still supports 80 percent of the economically active population, and agriculture still provides major export earnings from commodities such as prawns and fish, cotton, sugar, timber and cashew nuts. The forestry sector also has an important role in the country, contributing 4 percent of gross domestic product and supplying about 80 percent of the energy used. There is no unified policy or strategy in Mozambique with regard to the management of agricultural information and broad dissemination networks are not well developed. Institutions that fall outside of the state or donor worlds often find it difficult to get hold of information. Information exchange between institutions tends to be informal rather than structured. Agricultural research generally is restricted by the insufficient number of scientists who can formulate and carry out studies relevant to Mozambican needs. Budgets for information management tend to be a low priority. In-house capacity for maintaining and troubleshooting computer networks is a constraint; reliance is made upon private companies specialised in IT. Retention of staff at the centre with IT skills, in the face of competition from the private sector, was cited as a problem by all of the state agencies. Building the capacities of in-house staff was therefore felt to be important. Existing websites, maintained by some of the key institutions vary in their effectiveness as publishing outlets and often tend to be reflections of the institution, its structure and its work programme, rather than being designed specifically to disseminate information, reports, studies, etc. that are produced, or to act as advocacy tools. Use of radio as a means of disseminating information in vernacular languages is still rather limited. Problems in this respect are the costs of translation and payments for the transmissions. Training in how to pass information on to low literacy groups was also indicated by several agencies. This included training in more effective writing skills and training in how to compile radio programmes and audio visual materials. There is a general lack of metadata; documentation on who is doing what and types of available information is generally poor. This has a double negative effect. On one hand, potential data and information users have difficulties finding or getting access to relevant information and on the other hand, information suppliers do not know what they have, which prevents better organisation of information for dissemination. Conclusions Most of the institutions which we interviewed have fairly well-developed links to relevant sources of information; data on the functioning of markets, prices and production levels in the agriculture and fisheries sectors has vastly improved in recent years. Some of these agencies need information on regional and international markets and production levels. Technical data is still harder to source, particularly in Portuguese. There are information needs regarding developments in thinking on food security, forms and means of supporting organisations at community level, participatory approaches to resource management, information on low cost technologies for increasing production and conserving produce, on gender, on HIV/AIDS prevention and mitigation strategies and on general rural development issues. Respondents requested capacity building in information management to increase the effectiveness of their organisations. Government services and NGO staff indicated the importance of training in the analysis of socio-economic data. Training in the use of the internet to obtain information and in the targeting of information by library and documentation services was also a broad need. The design and development of web sites was indicated by many respondents, but it is felt that there is a particular need for support in how to conceptualise these as sources of information rather than just 'publicity'. Training in effective communication to low literacy target audiences, in the development of extension materials and the use of radio and audio-visual materials is also important. Recommendations We recommend that CTA provide support to the development of a national IMC strategy for agricultural information that takes full advantage of the opportunities offered by the new GovNet infrastructure. The ICM strategy should ensure that information is easily available to all stakeholders in rural development. Furthermore, the ICM strategy should prevent a gap from evolving between organisations connected to GovNet and those that are not. Finally, the ICM should provide for communication channels from the rural poor to research organisations and policy makers, to ensure that research and policies are guided by the needs of poor rural households. We recommend that CTA attempts to increase the amount of information disseminated in Portuguese language, particularly in regard to food security, forms and means of supporting organisations at community level, participatory approaches to resource management, information on low cost technologies for increasing production and conserving produce, on gender, on HIV/AIDS prevention and mitigation strategies and on general rural development issues. We recommend that CTA support short term research activities targeted at Mozambican-specific issues in relation to agricultural production and the conservation of produce. Links should be set up to inform IIAM and DNER about the information needs of poor farmers, women and PLWHA. These links can be set up through members organisations such as ORAM and UNAC, through Farmer Field Schools and through NGOs to which DNER has outsourced extension activities. We recommend that CTA investigate ways of supporting exchange of experience between organisations involved in training through associations and support to the development of training packages for associations. These should be provided to increase the effectiveness and efficiency of extension efforts in the field. In the long term, the required technical information can be provided to associations through newly developed training packages. ; The objectives of this study are to develop a strategy for CTA's approach to post-conflict countries, to improve the effectiveness of CTA's support for post-conflict countries and to compile baseline data on the status of ICM and ICTs in agriculture.

During the last five years, Bolivia received more than $US 3,000 million in foreign aid and more than $US 3,500 million in Foreign Direct Investment (FDI). The country also received debt relief with a net present value of $US 1,300 million and implemented a National Poverty Reduction Strategy. During the same period, however, the GDP growth rate fell from an average level of 4.7% between 1993 and 1998 to an average level of 1.7% between 1999 and 2002, relative and absolute poverty increased, and the fiscal deficit increased to 8.7% of GDP in 2002. These numbers suggest that neither foreign aid, nor debt relief, nor FDI has the capacity to increase growth rates and reduce poverty in Bolivia. This, however, is not necessarily true. It could be the case that without these positive shocks, the situation would have been even worse due to other negative shocks. The only way to separate the effects of different shocks is to use a Computable General Equilibrium (CGE) model, where the effects of changes in one variable can be analyzed while holding all other exogenous variables constant. The model used for this project contains a variety of sectors and household types which permits the analysis of aggregate effects on the GDP growth rate, the balance of payments, the fiscal deficit, etc, as well as distributional effects indicating who benefits and who is hurt by different policies. The distributional analysis is of particular importance when poverty is a main concern since aggregate GDP growth does not necessarily reduce poverty. Estimations by UDAPE indicate that the elasticities of poverty with respect to changes in GDP are extremely low in Bolivia: Only 0.3% in rural areas and 0.6% in urban areas[1]. This means that during the last decade, growth in Bolivia has clearly not been pro-poor, despite the stated emphasis on poverty reduction. During the period 1998-2002, Bolivia received on average $614 million in foreign aid per year. For the period 2003-2006, there are commitments implying that this amount will increase to $872 million per year, which means an increase in the level of annual foreign aid of $258 million. This report used the CGE model to simulate the effect of additional foreign donations of $258 million per year for four years, after which the level of aid returns to its "normal" level. Such a simulation allows us to see the effects of the initial expansion, the effect of the subsequent contraction, as well as the long run effects after the temporary increase in foreign aid.The effects of this extra aid will obviously depend on how the money is used. Applying the combination of public spending and public investment that we consider most likely, the simulations show an increase in the GDP growth rate of approximately 1 percentage point per year during the four years of extra aid, but when the extra aid disappears, the growth rates return to their normal levels. It is important to stress that public investment in the model is assumed to produce public goods, which increase the productivity of everybody. The extra aid has a corresponding positive effect on average incomes of the households for four years, but those who benefit most are skilled workers who are already among the richest in Bolivia, while the biggest and poorest group in Bolivia, the rural small-holders, are worse off every year during and after the extra aid, compared to the base scenario (without extra aid). This means that foreign aid, despite the very best intentions, tends to increase inequality and deepen poverty. This is not due to project failure at the micro level, but rather to adverse secondary effects at the macro level. It is perfectly possible that all aid projects are successful at the micro level, while the impacts at the macro level remain very close to zero. This paradox between the success of projects at the micro level and the lack of success at the macro level can be explained by the following arguments: First, aid projects distract resources away from other activities. Even when projects are 100% funded by foreign donations (the assumption used in the simulations), the project will use human resources which, in the absence of the project, could have been applied elsewhere. Since foreign aid projects usually skim the cream in terms of local human resources, this may imply a large social opportunity cost. This effect is particularly important in Bolivia, where the public sector (with the heavy support of foreign aid) is so attractive that few professionals are interested in working in the private, productive sector. And since this system appears to be relatively permanent, the new generations of students are demanding education that qualifies them to be politicians and bureaucrats, while few students are planning on working in the private sector, and much less create their own enterprises. Besides, not all aid projects are fully financed by donations, the majority of projects are financed by loans, and those that include a donation component, usually requires counterpart financing. This means that aid projects not only distract scarce human resources away from other activities, but also scarce financial resources. The second adverse macroeconomic effect arises through the real appreciation of the exchange rate that invariably follows from a large influx of dollars into the economy. This negatively affects most exporting sectors as their products become relatively more expensive on the international markets, and it negatively affects domestic producers of tradable goods as they have to compete with cheaper imports. The result is a reduction in the domestic production of tradable goods. Theoretically, the Central Bank could neutralize this effect by increasing its reserves of dollars or by paying off foreign debt, but this is unlikely to happen as most aid is tied to specific projects. The fact that the macroeconomic effects of foreign aid on monetary indicators tend to be small and temporary does not imply that foreign aid is useless. Many non-monetary indicators of well-being have increased substantially during the period, especially the indicators related to school enrollment, health, water, and sanitation. The Bolivian government is well aware of the asymmetry between progress in the provision of basic services and the lack of progress in the capacity of the population to increase its incomes: The real per capita income in Bolivia is practically the same as it was 50 years ago, despite the advances in education, health and basic services. The government is therefore changing the focus of its Poverty Reduction Strategy, laying more emphasis on the productive sectors. Fourteen sub-sectors with a high employment generation capacity have been selected for particular interventions in terms of infrastructure, market access, technical assistance, training, etc. Ten of these sub-sectors are part of modern agriculture, a sector whose expansion, according to our CGE analysis, would be beneficial not only because it raises average incomes, but also because it improves the income distribution. This is in contrast to the hydrocarbon sector and the mining sector, whose expansions tend to worsen the income distribution. Another sector whose expansion is highly desirable from a poverty reduction viewpoint, is the one producing consumer goods, usually through small and medium sized enterprises. The expansion of this sector would benefit the two big groups of poor households in Bolivia: the rural small-holders and the urban informals, and thus have a beneficial effect on both rural and urban poverty. In order to generate the largest and most sustainable impact possible of future foreign aid, it is recommended that donors and the government revise projects in three dimensions: First, they should check to which extent the projects create true public goods that increase the productivity of large groups of people, and to which extent they just generate short run activities which substitute for other, and possibly more sustainable, activities. The larger the public good component, the better the long run impact. Second, they should evaluate whether the projects help reduce the scarcity of skilled workers. It is the scarcity of skilled workers and the abundance of unskilled workers that generate high inequality in Bolivia, and projects which improve the quality of unskilled workers would tend to have a positive effect on the distribution of income in Bolivia and thus a beneficial effect on poverty. Third, they should check which sectors are likely to benefit or suffer from different projects, as the expansion of the sectors modern agriculture, coca, and consumer goods will have a much better impact on poverty than the expansion of mining, hydrocarbons, and formal services. It is often difficult to predict the impact of specific projects, and particularly difficult to assess how big the public good component of the project is. In order to learn from the past, it would be interesting to make a detailed retrospective analysis of past aid projects in Bolivia, evaluating which public goods have been created and what has been their impact on productivity. Specifically, donor agencies could provide a complete list of projects completed during the year 2000, and an independent team could analyze the project documentation and visit the project site some years after conclusion in order to evaluate the impact of the project. With a sample of 60-100 projects, it would be possible to make a statistical analysis, identifying what kind of projects would be most likely to generate not only positive impacts at the micro level but also at the macro level.

This thesis consists of three chapters, each derived from an individual paper. Although each of these chapters deals with a unique research question, there are similarities that are strong between Chapters 1 and 2 and weak regarding the third. First, all chapters raise questions in the field of microeconomics and touch on the Swiss system of Vocational Education and Training (VET). Second, all chapters apply quantitative methods widely used in the field. And finally, all chapters are embedded in the Swiss context. Whereas this Swissness merely concerns the data in chapter three, it additionally includes the outcome of interest and the fundamentals of the empirical methodology in chapter one and two. Both Chapters 1 and 2 investigate firms' engagement in the Swiss VET system. Within this system firms' voluntary participation is crucial – they help design curricula, hire apprentices, pay their wages, and are responsible for most of their training – and remarkable: Setting a world record, Switzerland's dual VET system accepts around 60% of all pupils after compulsory schooling each year. It thus seems fair to say that Swiss firms bear a large proportion of the investments needed to secure their own future skill demand. Chapter 1, which is joint work with Andreas Kuhn, investigates what happens to this voluntary engagement in the skill formation process if firms are permitted to secure their skill demand from another source: we focus on immigration. In recent years, this channel has changed substantially, both quantitatively and qualitatively. Through mutual agreements, foremost the Agreement on the Free Movement of Persons implemented in 2002, the labor markets of Switzerland and the European Union have increasingly integrated, and the non-Swiss workforce has grown by roughly 50% or 600,000 workers since 1995. Meanwhile, most immigrant workers today hold a vocational or tertiary degree, whereas in the 1990s fewer reached educational attainments higher than compulsory schooling. Overall, we hypothesize that this enlargement of skills provided by the non-native to the Swiss labor market may incentivizes firms to substitute their investments in VET by hiring immigrant workers. To examine this claim empirically, Chapter 1 focuses on crossborder workers, who work in but live outside Switzerland. Today, crossborder workers account for 6% of the total Swiss workforce and 20% of the immigrant workforce. Moreover, their numbers doubled between 1995 and 2018, an increase twice as large in relative terms as the simultaneous increase in resident immigrant workers. To understand Switzerland's particular attraction for crossborder workers, it is first worth picturing a map of Switzerland's distinct language regions. The triangle on the left pointing towards France forms the French-speaking part. The much smaller triangle hanging upside down into Italy covers the Italian-speaking, and the rest, mostly bordering Germany and Austria, the German-speaking part. One notices that all three main Swiss language regions border countries in which they are the sole official language. Evidently, language is not a major barrier at the Swiss border within the institutionally relatively well integrated European labor market, which together with the comparatively high Swiss wages makes Switzerland attractive for workers from neighboring countries. Second, Switzerland's comparatively high cost of living together with assumed personal preferences for residing in one's country of origin makes it relatively unattractive to work and live in Switzerland. Quite obviously, the resulting high numbers of crossborder workers are not evenly distributed across Switzerland. Swiss firms' opportunities to employ them is substantially constrained by their distance from the border. The empirical approach presented in Chapter 1 exploits this setting by comparing firms close to the border with large and firms far from the border with limited access to crossborder workers that are otherwise similar. Overall, we find that the increase observed in crossborder workers between 1995 and 2008 led to a decrease of about 3,500 apprenticeship positions, corresponding to roughly 2% of the total number of apprentice positions. Although the exact channel through which this substitution works remains ambiguous, policy makers designing institutions in either immigration or VET might want to pay attention to this trade-off, especially because it involves two goods that are in general positively valued by many employers. Chapter 2, which is joint work with Andreas Kuhn and Jürg Schweri, sticks with firms' investments in VET and, moreover, also investigates the spatial distribution of it across Switzerland. The focus lies on the varying proportions of firms providing apprenticeship positions across Switzerland's language regions (that you remember when recalling the map pictured above). Note first that we do not claim there is any direct link between different languages and different levels of firm engagement in VET. However, the distinct languages in Switzerland also maintain cultural differences within a small country, despite the fact that national institutions are well accepted and people increasingly mobile. It may be due to exclusive communication with same-language peers, selective media consumption, or varying exposure to Switzerland's neighboring countries with whom each Swiss language region forms a distinct supranational linguistic region: French speakers are most open to immigration and international cooperation and eat more meat than their German-speaking counterparts. German speakers have a more traditional understanding of gender roles than their French-speaking counterparts and donate the most for charity of all linguistic groups. Italian speakers use public transport the least and value leisure more than their German-speaking counterparts. In Chapter 2, we focus on a clear discontinuity that analysis of voting results reveals among the language-cultural regions constituting Switzerland: Whereas French and Italian speakers approve of strong state involvement, for example in the health insurance sector, for pension schemes, and in the VET system, German speakers prefer private engagement over the states in the same domains. From this starting point, we ask whether a favorable attitude towards private engagement expressed at the ballot box is actually accompanied by higher levels of the privately provided good apprenticeship. Chapter 2 reveals the answer to be yes: firms located in German-speaking municipalities are about 10% more likely to train apprentices than firms in very nearby French- and Italian-speaking municipalities. Altogether, we argue that norm-guided behavior is a complementary explanation for why some firms train apprentices and others do not. One can draw two policy implications from this finding. First, persistent norms might strengthen the sustainability of the Swiss VET system against potential shocks to firms' cost-benefit ratio. Second, behavior bound by norms might hinder the export of a Swiss-style VET system with its strong focus on firm engagement to other countries even if they set up the institutional framework to foster it. Chapter 3 focuses on the adult labor market, where skills acquired, e.g. in the VET system, are applied. Many economists claim that recent rapid technological change penetrating the labor market has shifted firms' skill demand and altered the nature of jobs. Given individuals' skills, these demand shifts potentially foster horizontal skill mismatches, such that someone's acquired skills do not match the skills needed in their current occupation. In line with previous mismatch literature, Chapter 3 shows that such horizontal skill mismatches are a multi-faceted phenomenon. First, whereas only about half of all individuals work in exactly the occupations that they learned formally, the degree of mismatch among the other half varies widely. Second, many individuals actually realize wage gains when becoming mismatched; this suggests that objectively identified mismatches are not bad per se. Based on these general findings and on the task-based approach, I hypothesize that horizontal skill mismatches are harmful to the wages of individuals who mostly hold skills substitutable by new technology, whereas they are not harmful in general. I account for this heterogeneity of mismatches in the empirical analysis of Chapter 3 by exploiting detailed occupational task data to measure the strength of mismatches and to focus on mismatches presumably caused by skill demand shifts due to new technology. The main result yields a wage penalty of roughly 12% for mismatched individuals with high shares of substitutable skills. Applying other methods to the same dataset suggests that objectively identified horizontal mismatches have zero wage implications on average, even after accounting for unobservable individual characteristics. From a policy perspective, it thus seems important to bear the heterogeneity of the mismatch phenomena in mind; otherwise, revealed average effects might mask negative effects on certain subgroups. In this spirit, I estimate mismatch wage penalties for different educational subgroups including VET diploma holders. And in this sense, all chapters of this thesis deal with the Swiss system of vocational education and training, a system that is recognized by many as one of the key contributors to the country's economic success. However, as this thesis shows, it is also a system that contains frictions, even contradictions at first sight, a system regularly challenged by pupils entering it and labor markets demanding its outcomes, and therefore a system that must remain agile. Thus, the recognition that the Swiss VET system receives from inside and outside the country must motivate constant reflection, adjustment, and amelioration, and should never tempt to rest on its laurels. I hope this thesis plays its modest role in fulfilling this purpose.

After an initial boom in the early years of the millennium, global land-based investments, also called Large-Scale Land Acquisitions (LSLAs), have slowed in recent years, but their impact on local environments and human well-being still poses a challenge for fulfilling the 2030 Agenda for Sustainable Development. The debate on the effects of LSLAs lacks systematic assessment at the meso-level of spatial and administrative scale – a level that is critical for informing national policies. This research addresses that issue by first explaining how LSLAs entail differential impacts on local livelihoods, and second, by revealing how positive outcomes to these investments can be achieved in the context of the Global South. My analysis of the recent land concession inventory of the Lao PDR, including the scope, scale and socio-ecological context of LSLAs, reveals how land deals have impacted local livelihoods. They have transformed natural resources and labour relations by pushing former land users into precarious situations and onto pathways leading to different well-being outcomes. The affected villages have experienced different degrees of poverty increase or reduction. This research suggests that looking only at quantitative variables, especially the size of the land acquisitions, is a poor predictor of their socio-economic impacts. A better understanding of key variables is urgently needed to avoid both misinterpretations of the impact and misguided land-based investment policies. Using a methodological approach that includes an examination of monetary poverty, multiple dimensions of human well-being, primitive accumulation, and precarity, this research suggests that the pathway to improved human well-being in the context of LSLAs is very narrow. The decrease in monetary poverty in most villages has not resulted in positive human well-being outcomes. In terms of employment, which is the most important and immediate benefit that smallholders can enjoy, the findings reveal that in some cases, the peasants have experienced dispossession without proletarianization. In many cases, semi-proletarianization has occurred, but through adverse terms rather than could be part of a sustainable livelihood strategy. To avoid the negative impacts and ensure that land deals contribute to sustainable agricultural growth, this dissertation emphasizes four key points: 1) A comprehensive socio-environmental impact analysis and monitoring that includes natural resources such as non-timber forest products, timber and wild animals must be implemented rather than just focusing on the land itself. Implementation of the relevant accompanying measures must take place throughout the business cycle. Protecting access to the land and other resources is imperative as natural resources still play a significant role in rural resilience. This will ensure that smallholders, particularly women and vulnerable groups like ethnic minorities, can sustain their traditional livelihoods, especially during the transition period. 2) Adverse outcomes tend to occur in cases in which smallholders are dependent on natural resources for a living rather than already being engaged in the non-farm sector. Therefore, the development of LSAs must consider the socio-ecological heterogeneity of peasant livelihoods. 3) The International Code of Conduct (free, prior, and informed consent) per se does not guarantee positive well-being outcomes but it does provide space for consultation and negotiation. Thus, it is an important tool that should be applied by the investors, but should not be considered as the solution for safeguards. 4) Promoting land-based investments as a means of poverty reduction in rural areas by moving from the natural resource- to wage-based livelihoods is effective only with accompanying related measures. The national government should consider appropriate trade-offs among different development goals – for example, large-scale, labour-intensive investments may not significantly contribute to national growth but they may generate a higher number of jobs which may have a great positive impact on human well-being. ; ພາຍຫຼັງທີ ່ ໄດ້ມີການຂະຫຍາຍຕົວຢ່ າງໄວວາ ແລະ ກວ້າງຂວາງ, ການລົງທຶນໃນຂົງເຂດທີ ່ ດິນ ຫຼື ເອີ້ນ ວ່ າ ການເຊ່ າົ -ສໍາປະທານທ່ ດີ ນິ ຂະໜາດ ໃຫຍ່ (LSLAs) ຢ່ ູໃນໂລກໃນຊຸມປີມ່ ໆໍ ນ ີ້ ໄດມ້ ກີ ານຂະຫຍາຍຕວົ ຊາ້ ລງົ ແຕ່ ຜນົ ກະທບົ ຂອງມນັ ຕ່ ໍກບັ ສ່ ງິ ແວດລອ້ ມ ແລະ ການມຊີ ວີ ດິ ການ ເປັນຢູ ່ ທີ ່ ດີ (Human well-being) ຂອງທ້ອງຖິ ່ ນ ຍັງເປັນສິ ່ ງທ້າທາຍໜຶ ່ ງ ຕໍ ່ ກັບການບັນລຸເປົ້າໝາຍການພດັ ທະນາແບບຍນື ຍງົ ປີ 2030. ການຖົກຖຽງ ກ່ ຽວກັບ ຜົນກະທົບຂອງ LSLAs ແມ່ ນຍັງຂາດຂໍ້ມູນຫຼັກຖານ ທີ ່ ໄດ້ຈາກການວິເຄາະຂໍ້ມູນຢ່ າງເປັນລະບບົ ໃນລະດບັ ຊາດ ຊ່ ງຶ ເຫັນວ່ າ ມີຄວາມສໍາຄັນຫຼາຍ ຕໍ ່ ກັບນະໂຍບາຍແຫ່ ງຊາດ. ການຄົ້ນຄວາ້ ນ ີ້ ໄດປ້ ະກອບສ່ ວນໃນການປິດຊ່ ອງຫວ່ າງດ່ ງັ ກ່ າວ ໂດຍ ທໍາອດິ ໄດວ້ ິ ເຄາະເຖິງ ບັນດາຜົນກະທົບ ຂອງ LSLAs ຕໍ ່ ກັບຊີວິດການເປັນຢູ ່ ຂອງທ້ອງຖິ ່ ນ ວ່ າເກີດຂຶ້ນແນວໃດ ແລະ ຈາກນັ້ນ ໄດວ້ ເິ ຄາະເຖງິ ແນວທາງ ທ່ ສີ າມາດເຮດັ ໃຫກ້ ານລງົ ທນຶ ດ່ ງັ ກ່ າວ ມຜີ ນົ ໄດຮ້ ບັ ດາ້ ນບວກຢ່ ູໃນປະເທດກໍາລງັ ພດັ ທະນາ. ຜົນໄດ້ຮັບຈາກການວິເຄາະຂໍ້ມູນ ການຂຶ້ນ ບັນຊີໂຄງການເຊົ ່ າ ແລະ ສໍາປະທານທີ ່ ດິນ ຂອງລັດຢູ ່ ສປປ ລາວ ທີ ່ ມີຢູ ່ ລ້າສຸດ ຊຶ ່ ງລວມມີຂໍ້ມູນກ່ຽວ ກບັ ປະເພດ ແລະ ຂະໜາດ ຂອງການລງົ ທນຶ ຢ່ ູໃນ ສະພາບແວດລອ້ ມດາ້ ນເສດຖະກດິ -ສງັ ຄມົ ແລະ ນເິ ວດວທິ ະຍາຕ່ າງໆ ໄດສ້ ະແດງເຖງິ ຂະ ບວນການ ທ່ ໂີ ຄງການລງົ ທນຶ ດ່ ງັ ກ່ າວ ໄດສ້ ່ ງົ ຜນົ ກະທບົ ຕ່ ໍກບັ ຊວີ ດິ ການເປັນຢ່ ູຂອງທອ້ ງຖ່ ນິ . ການລງົ ທນຶ ເຫ່ ຼາົ ນ ີ້ ໄດປ້ ່ ຽນແປງສດິ ທກິ ານຖຄື ອງ ທີ ່ ດິນ ແລະ ສາຍພົວພັນດ້ານກໍາລັງແຮງງານ ໂດຍໄດ້ເຮັດໃຫ້ ເຈົ້າ ຂອງທ່ ດີ ນິ ຕອ້ ງຕກົ ຢ່ ູໃນສະພາບຄວາມບ່ ໍແນ່ ນອນ ແລະ ມລີ ະດບັ ຊວີ ດິ ການ ເປັນຢູ ່ ທີ ່ ແຕກຕ່ າງກັນ. ນອກນັ້ນ , ບ້ານທີ ່ ໄດ້ຮັບຜົນກະທົບ ມີລະດັບຄວາມທຸກຍາກເພີ ່ ມຂຶ້ນ ຫຼ ື ຫຸຼດລງົ ໃນລະດບັ ທ່ ບີ ່ ໍຄກື ນັ . ຜນົ ຂອງການ ຄົ້ນ ຄວ້ານີ້ ແນະນໍາວ່ າ ການທີ ່ ນໍາເອົາແຕ່ ຂໍ້ມູນດາ້ ນປະລມິ ານ ໂດຍສະເພາະແມ່ ນ ຂະໜາດຂອງທ່ ດີ ນິ ມາເປັນເກນໃນການປະເມນີ ແມ່ ນບ່ ໍ ເປັນຕົວຊີ້ວັດທີ ່ ດີ ໃນການປະເມີນຜົນກະທົບທາງດ້ານເສດຖະກິດ-ສັງຄົມ ຂອງ LSLAs ຊຶ ່ ງອາດນໍາໄປສູ ່ ການເຂົ້າໃຈທີ ່ ຜິດພາດ ກ່ ຽວກັບ ຜນົ ກະທບົ ຂອງມນັ ແລະ ອາດນາໍ ໄປສ່ ູການກາໍ ນດົ ນະໂຍບາຍທ່ ບີ ່ ໍສອດຄ່ ອງ. ໂດຍການນໍາໃຊບ້ ນັ ດາວທິ ກີ ານຕ່ າງໆ ລວມມ ີ ການປະເມນີ ຄວາມທຸກຍາກໂດຍອງີ ໃສ່ ລາຍຮບັ ເປັນຫຼກັ , ການມຊີ ວີ ດິ ການເປັນຢ່ ູທ່ ດີ ,ີ ການ ຄອບຄອງກໍາລັງການຜະລິດ ເພື ່ ອເຮັດໃຫ້ເຈົ້າ ຂອງທ່ ດີ ນິ ກາຍເປັນແຮງງານຮບັ ຈາ້ ງຢ່ ູທ່ ດີ ນິ ຂອງຕນົ (primitive accumulation and proletarianization) ແລະ ຄວາມບໍ ່ໝັ້ນ ຄົງ ຂອງຊີວິດ (precarity), ບົດຄົ້ນ ຄວ້ານີ້ ຊີ້ໃ ຫເ້ ຫນັ ວ່ າ ການຫຸຼດລງົ ຂອງອດັ ຕາຄວາມທຸກຍາກ ໂດຍອີງໃສ່ລາຍຮັບເປັນຕົ້ນຕໍ ຢູ ່ ຫຼາຍບ້ານທີ ່ ໄດ້ຮັບຜົນກະທົບນັ້ນ ບໍ ່ ໄດ້ໝາຍຄວາມວ່ າ ຊາວບ້ານຈະມີຊີວິດການເປັນຢູ ່ ທີ ່ ດີຂຶ້ນ . ມບີ າງກໍລະ ນີ, ປະຊາຊົນສູນເສຍທີ ່ ດິນໃຫ້ແກ່ ໂຄງການລົງທຶນ ແຕ່ ບໍ ່ ໄດ້ຮັບໂອກາດເຂົ້າ ເປັນແຮງງານຮບັ ຈາ້ ງ ແລະ ໃນຫຼາຍກໍລະນ ີ ຊາວບາ້ ນໄດກ້ າຍເປັນ ເຄ່ ງິ -ແຮງງານຮບັ ຈາ້ ງ ໂດຍຢ່ ູພາຍໃຕເ້ ງ່ອື ນໄຂແບບຄວາມຈາໍ ເປັນ ແທນທ່ ຈີ ະເປັນຍຸດທະສາດ ສໍາລບັ ຊວີ ດິ ການເປັນຢ່ ູແບບຍນື ຍງົ . ເພ່ ອື ຫຼກີ ລຽ້ ງ ຜນົ ກະທບົ ດາ້ ນລບົ ຈາກ LSLAs ແລະ ຮບັ ປະກນັ ວ່ າ ການລງົ ທນຶ ດ່ ງັ ກ່ າວ ປະກອບສ່ ວນເຮດັ ໃຫ ້ ການເຕບີ ໂຕດາ້ ນການຜະ ລິດກະສິກໍາແບບຍືນຍົງນັ້ນ , ຜົນໄດ້ຮັບຈາກການຄົ້ນ ຄວາ້ ນ ີ້ ສະທອ້ ນເຖງິ ສ່ ບີ ນັ ຫາທ່ ສີ ໍາຄນັ ທ່ ຄີ ວນຈະພຈິ າລະນາ ໄດແ້ ກ່ : ໜ່ ງຶ , ຕອ້ ງມ ີ ກນົ ໄກໃນການປະເມນີ ແລະ ຕດິ ຕາມ ຜນົ ກະທບົ ດາ້ ນສງັ ຄມົ ແລະ ສ່ ງິ ແວດລອ້ ມ ແບບຄບົ ຊຸດ ໂດຍຄໍານງຶ ເຖງິ ບນັ ດາຊບັ ພະຍາ ກອນທໍາມະຊາດອື ່ ນໆ ເຊັ ່ ນ: ເຄື ່ ອງປ່ າຂອງດົງ, ໄມ້ທ່ ອນ ແລະ ສັດປ່ າ ແລະ ອື ່ ນໆ ແທນທີຈະເນັ້ນໃສ່ ແຕ່ ທີ ່ ດິນ ແລະ ລວມທັງການຈັດຕັ້ງ ປະຕິບັດ ບັນດາມາດຕະການທີ ່ ຈໍາເປັນ ແລະ ເໝາະສົມ. ພ້ອມກັນນັ້ນ ການປົກປອ້ ງສດິ ທກິ ານນໍາໃຊທ້ ່ ດີ ນິ ແລະ ຊບັ ພະຍາກອນທໍາມະຊາດ ຂອງປະຊາຊນົ ຈ່ ງຶ ເຫນັ ວ່ າມຄີ ວາມສໍາຄນັ ຫຼາຍ ເນ່ ອື ງຈາກວ່ າ ຊບັ ພະຍາກອນທໍາມະຊາດ ຍງັ ມບີ ດົ ບາດສໍາຄນັ ຫຼາຍໃນການຮບັ ມກື ບັ ເຫດສຸກ ເສນີ . ຊ່ ງຶ ມນັ ຈະສາມາດຮບັ ປະກນັ ວ່ າ ຊາວກະສກິ ອນ ໂດຍສະເພາະແມ່ ນ ແມ່ ຍງິ ແລະ ກ່ ຸມສ່ ຽງ ເຊ່ ນັ : ກ່ ຸມຊນົ ເຜ່ າົ ສ່ ວນນອ້ ຍ ສາມາດສບື ຕ່ ໍ ການດໍາລງົ ຊວີ ດິ ທ່ ເີ ຄຍີ ປະຕບິ ດັ ຜ່ ານມາໄດ ້ ໂດຍສະເພາະແມ່ ນ ໃນຊ່ ວງໄລຍະເວລາຂາ້ ມຜ່ ານ. ສອງ, ຜົນກະທົບດ້ານລົບຂອງການລົງທຶນມັກຈະເກີດຂຶ້ນ ໃນກໍລະນທີ ່ ີ ຊາວບາ້ ນຍງັ ອາໄສຊບັ ພະຍາກອນທໍາມະຊາດ ໃນການດໍາລງົ ຊວີ ດິ ເປັນຕົ້ນ ຕໍ ເມື ່ ອທຽບໃສ່ ກໍລະນີ ທີ ່ ຊາວບ້ານໄດ້ຫັນໄປສູ ່ ຂະແໜງການອື ່ ນທີ ່ ບໍ ່ ແມ່ ນການກະສິກໍາແລ້ວ. ສະນັ້ນ , ຈ່ ງຶ ແນະນໍາວ່ າ ຂະບວນການ ຕດັ ສນິ ໃຈ ຫຼ ື ວາງແຜນ ຄວນມກີ ານພຈິ າລະນາເຖງິ ຄວາມແຕກຕ່ າງຂອງປະຊາຊນົ ຢ່ ູໃນແຕ່ ລະເຂດ. ສາມ, ຫກຼັ ການ ກ່ ຽວກບັ ຄວາມສອດຄ່ ອງຂອງສາກນົ (Code of Conduct) ເຊ່ ນັ : ການເຫນັ ດ ີ ເຫນັ ພອ້ ມ ໂດຍມກີ ານຕດັ ສນິ ໃຈຢ່ າງ ອດິ ສະຫຼະ ແລະ ມກີ ານແຈງ້ ລ່ ວງໜາ້ ຢ່ າງດຽວ ແມ່ ນບ່ ໍສາມາດ ຮບັ ປະກນັ ຜນົ ໄດຮ້ ບັ ທາງດາ້ ນບວກໄດ ້ ແຕ່ ມນັ ຕອບສະໜອງ ໂອກາດ ໃນ ການປຶກສາຫາລື ແລະ ການເຈລະຈາໃຫ້ແກ່ ຊຸມຊົນ. ສະນັ້ນ , ຫຼກັ ການເຫ່ ຼາົ ນ ີ້ ແມ່ ນຄວນເປັນເຄ່ ອື ງມທື ່ ສີ ໍາຄນັ ທ່ ນີ ກັ ລງົ ທນຶ ຕອ້ ງນາໍ ໃຊ ້ ແຕ່ ບ່ ໍ ຄວນຖວື ່ າມນັ ເປັນທາງອອກ ສໍາລບັ ການປົກປອ້ ງຜນົ ກະທບົ ດາ້ ນສງັ ຄມົ . ສຸດທາ້ ຍ, ເຫນັ ວ່ າ ການສ່ ງົ ເສມີ ການລງົ ທນຶ ໃສ່ ທ່ ດີ ນິ ເພ່ ອື ເປັນເຄ່ ອື ງມໜື ່ ງຶ ໃນການຫຸຼດຜ່ ອນຄວາມທຸກຍາກຢ່ ູເຂດຊນົ ນະບດົ ໂດຍການຫນັ ຈາກ ການອາໄສຊບັ ພະຍາກອນທໍາມະຊາດ ໄປສ່ ູການເປັນແຮງງານຮບັ ຈາ້ ງ ແມ່ ນມປີ ະສດິ ທຜິ ນົ ຖາ້ ຫາກມ ີ ບນັ ດາມາດຕະການທ່ ຈີ າໍ ເປັນ. ສະນັ້ນ , ຈຶ ່ ງເຫັນວ່ າ ລັດຖະບານ ຈະຕ້ອງໄດ້ພິຈາລະນາເລືອກ (trade-offs) ລະຫວ່ າງ ເປົ້າ ໝາຍ ຂອງການພັດທະນາ - ຕົວຢ່າງ ໂຄງການ ລງົ ທນຶ ຂະໜາດໃຫຍ່ ແລະ ນໍາໃຊແ້ ຮງງານຄນົ ເປັນຫຼກັ ອາດບ່ ໍປະກອບສ່ ວນຫຼາຍປານໃດ ຕ່ ໍກບັ ການເຕບີ ໂຕແຫ່ ງຊາດ ແຕ່ ມນັ ອາດສາ້ ງວຽກ ເຮດັ ງານທໍາໄດຫ້ ຼາຍກວ່ າ.

The "Earthrise" photograph, taken on the 1968 Apollo 8 mission, became one of the most significant images of the 20th Century. It triggered a profound shift in environmental awareness and the potential for human unity—inspiring the first Earth Day in 1970. Taking inspiration from these events 50 years later, we initiated Project Earthrise at our 2020 annual conference of inVIVO Planetary Health. This builds on the emergent concept of planetary health, which provides a shared narrative to integrate rich and diverse approaches from all aspects of society towards shared solutions to global challenges. The acute catastrophe of the COVID-19 pandemic has drawn greater attention to many other interconnected global health, environmental, social, spiritual, and economic problems that have been underappreciated or neglected for decades. This is accelerating opportunities for greater collaborative action, as many groups now focus on the necessity of a "Great Transition". While ambitious integrative efforts have never been more important, it is imperative to apply these with mutualistic value systems as a compass, as we seek to make wiser choices. Project Earthrise is our contribution to this important process. This underscores the imperative for creative ecological solutions to challenges in all systems, on all scales with advancing global urbanization in the digital age—for personal, environmental, economic and societal health alike. At the same time, our agenda seeks to equally consider our social and spiritual ecology as it does natural ecology. Revisiting the inspiration of "Earthrise", we welcome diverse perspectives from across all dimensions of the arts and the sciences, to explore novel solutions and new normative values. Building on academic rigor, we seek to place greater value on imagination, kindness and mutualism as we address our greatest challenges, for the health of people, places and planet.

The potential for exemption from the European Union (EU) Common Fisheries Policy's (CFP) landing obligation (discard ban), where high discard survival can be demonstrated, has identified the need for scientific guidelines to conduct discard survival assessments. Robust estimates of discard survival can be used to justify exemptions from the landing obligation and inform on levels of post-release fishing mortality, which can then be accounted for in stock assessments. The Working Group on Methods for Estimating Discard Survival (WGMEDS) set out to review and update ICES guidance on Methods to Estimate Discard Survival and complete meta-analyses of discard survival evidence to investigate variables influencing survival, with a view to influencing survival through modified fishing practices. We also explored the demand for ongoing monitoring requirements to inform on discard survival and took a proactive approach to sharing discard survival estimates with those working in stock assessment so that new evidence could be applied more widely. In the past three years, the considerable investment in research in to discard survival, specifically from EU countries, has continued. The main outputs from WGMEDS include enhancements to the ICES guidance on how to quantify discard survival. This has supported the work of group members to estimate discard survival in a variety species-fishery combinations, including Nephrops, mackerel, plaice, common sole, eels, rays, much of which has been put forward as evidence to support exemptions from the EU discard ban. A critical review framework developed by WGMEDS has been used by the EU Scientific, Technical and Economic Committee for Fisheries (STECF) to assess the quality of discard survival evidence for proposed exemptions. There has been a high impact of work produced by the members of the group – specifically in multiple new EU regulated exemptions from the landing obligation. This has permitted fishers to continue discarding defined species and so assisting the implementation of the EU discard ban. Future work is expected to focus on applying discard survival estimates in stock assessments. This would include developing guidance to assist assessment expert groups to determine whether available survival studies can be applied. It would require reviewing and assessing the quality and confidence in available discard survival estimates and exploring the potential to combine the results of survival studies so the effect of different variables could be accounted for in estimating an overall best survival estimate. Ultimately, we would aim to include estimates of discard survival in catch scenarios in the ICES advice sheets.

The world's challenges of climate change, damage to ecosystems, and social and health inequalities require changes in human behaviours at every level of organisation, among governments, business, communities, and individuals. An important question is how behaviour change can be enabled and supported at the scale and speed required. The research reported in this paper describes important lessons for good practice in changing contexts to modify behaviours for a triple win for health, equity and environmental sustainability. Authors synthesised learning from qualitative, quantitative and cost benefit evaluations of 15 case studies conducted in 12 countries in Europe. The case studies address ways of living (green spaces and energy efficient housing), moving (active transport) and consuming (healthy and sustainable diets) that support the triple win. Ten lessons for good practice were identified. These include bringing a triple win mindset to policy and practice in planning interventions, with potential to improve environmental sustainability, health and equity at the same time. The lessons for good practice are intended to support governmental and non-governmental actors, practitioners and researchers planning to work across sectors to achieve mutual benefits for health and environmental sustainability and in particular to benefit poorer and more socio-economically disadvantaged groups.

Disc herniation is a major reason for lower back pain (LBP), a health issue that affects a very high proportion of the UK population and is costing the UK government over £1.3 million per day in health care cost. Currently, the process to diagnose the cause of LBP involves examining a large number of Magnetic Resonance Images (MRI) but this process is both expensive in terms time and effort. Automatic labeling of lumbar disc pixels in the MRI to detect the herniation area will reduce the time to diagnose and detect the cause of LBP by the physicians. In this paper, we present a method for automatic labeling of the lumbar spine disc pixels in axial view MRI using pixels locations and gray level as features. Clinical MRIs are used for the training and testing of the method. The pixel classification accuracy and the quality of the reconstructed disc images are used as the main performance indicators for our method. Our experiments show that high level of classification accuracy of 91.1% and 98.9% can be achieved using Weighted KNN and Fine Gaussian SVM classifiers respectively.

Issue 28.6 of the Review for Religious, 1969. ; EDITOR R. F. Smith, S.J. ASSOCIATE EDITORS Everett A. Diederich, S.J. Augustine G. Ellard. S.J. ASSISTANT EDITOR John L. Treloar, S.J. QUESTIONS AND ANSWERS EDITOR Joseph F. Gallen, S.J. Correspondence with the editor, the associate editors, and the assistant editor,.as well as books for review, should be sent to I~VIEW FOR RELIGIOUS; 612 Humboldt Building; 539 North Grand Boulevard; Saint Louis, Missouri 631o3. Questions for answering should be sent to Joseph F. Gallen, S.J.; St. Joseph's Church; 32~ Willings Alley; Philadelphia, Pennsylvania + + + REVIEW FOR RELIGIOUS Edited with ecclesiastical approval by faculty members of the School of Dt, imty of Saint Louis University, the editorial offices being located at 612 Humboldt Building, .539 North Grand Boulevard, Saint Lores, Missouri 63103. Owned by the Missouri Province Edu-cational Institute. 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Manuscripts, editorial cor-respondence, and books for review should be sent to REVIEW FOR RELIGIOUS; 612 Humboldt Building; 539 North Grand Boulevard; Saint Louis, Missouri 63103. Questions for answering should be sent to the address of the Questions and Answers editor. NOVEMBER 1969 VOLUME 28 NUMBER 6 BROTHERS THOMAS MORE, C.F.X:, AND LEO RYAN, C.S.V. Development: A New Challenge to Religious In a majority of the articles written these days in religious journals, the emphasis has been largely on areas which are of great concern for those seeking ways to achieve renewal and adaptation in the religious life. As a result, new and valuable insights have been gained in such areas as government, the evangelical counsels, prayer, community, personal responsibility, the aposto-late, secularization, and formation. There is, however, one significant movement which has yet to be fully treated in journals written for re-ligious. And because this movement could elicit from the religious families in the Church a response corre-sponding to that which characterized the great move-ments in the past, we want to draw the attention of religious to this phenomenon so that it" can become a + growing part of the literature on renewal and adapta- + tion. This movement can best be described as development. Because development is still more or less in its infancy stage, only gradually emerging into a full-blown move-ment in society and in the Church, it is not our in-tention to give here a definition of the term. Instead, we want to describe a number of events and programs which will illustrate not only the potential dynamism of de-velopment but also the implications which it has for religious institutes. On January 6, 1967, Paul VI issued the motu proprio Catholicam Christi Ecclesiam setting up the Pontifical Justice and Peace Commission. The objective of this Commission would be "to arouse the people of God to 869 Thomas More, C.F.X., is superior general of the Xa-verian Brother~; Antonio Bosio 5; 00161 Rome, Italy. Leo Ryan, C.$.V., is general councilor of the Viatorian Fath-ers and Brothers; Via Sierra Nevada 60; 00144 Rome, Italy. VOLUME 2B, 1969 + 4. 4. Brothers More and Ryan REVIEW FOR RELIGIOUS full awareness of its mission at the present time, in order on the one hand, to promote the progress of poor nations and encourage international social justice, and on the other, to help underdeveloped nations to work for their own development." 1 Shortly after establishing this new curial organ, Paul VI issued his famous encyclical, Populorum progressio, which is the charter of the Pontifical Commission and its basic text. The call of the encyclical is to all the Church, which is to be educated, stimulated, and in-spired to action by it. Cardinal Maurice Gilroy of Quebec, president of the Pontifical Commission, and Monsignor Joseph Gremil-lion, its secretary, set about the arduous task of travel-ing throughout the world to create national commis-sions for justice and peace witkin bishops' corr[erences. After this work had been completed, the commission turned to the Union of Superiors General in Rome to solicit its support. Monsignor Joseph Gremillion per-sonally addressed the Union, urging it to establish con-tact with the Commission and to take an active role in the promotion of the aims of development within all the religious families of the Church. in May, 1968, the Union unanimously approved the writers of this article as its official liaison with the Pontifical Commis-sion. Now that the liaison committee has been in existence for one year, it is in a position to discern a number of trends which indicate the response religious institutes will make to development in the immediate future. The remainder of this paper will be devoted to an elabora-tion of these trends and a brief description of the more important programs from which these trends have is-sued. At the present time we see four trends in development which have significant implications for religious insti-tutes. It is very dear now that development has an ecumenical character. Second, because of the nature of development, religious institutes will be looking for- 1Father. Arthur McCormack makes the following clarification: "The name Justice and Peace must be understood in the following way: Justice means social justice within and between nations so that every human being should have conditions of life in keeping with his human dignity, which will enable him to progress towards a fully human development--to the fullness of a more abundant life~ and enable him also to make his contribution to building a new and better world. Peace is to be understood, not in the sense of main-raining peace or working for peace in the political or diplomatic sense, but in the sense of building peace--the new name for peace is development--producing the conditions that are fundamental for peace, a more just, humane, better world in accordance with para. 76 of the Encyclical, Populorum Progressio" ("The Pontifical Com-mission Justice and Peace," World Justice, v. 8 (1967), pp. 435-55). ward to training specialists in planning, sociology, tech-nology, and social justice. Towards this end, some re-ligious institutes are establishing within their general administration a secretariat for development, Third, there is a growing spirit of collaboration within re-ligious institutes, since it is evident that no religious family can tackle the problems with its own resources. Finally, there is a search for a new theology of develop-ment. 1. Ecumenical Character oI Development In the spring of 1968, the Pontifical Commission of Justice and Peace, the Catholic .Rural Life Society, under the direction of Monsignor Luigi Liguitti, SEDOS, FERES, and ISS2 sponsored a two-day seminar on the Church in developing countries at the theologate of the Oblates of Mary, Rome. This seminar was arranged specifically for superiors general and their curias to acquaint them with development. However, interest in the meeting was so great that it turned out to be a cross-section of some of the most important European bodies having a Third World orientation. At the meet-ing were representatives from several Roman Congrega-tions, the German mission-sponsoring agencies Adveniat and Misereor, Caritas Internationalis, Protestant ~6b-servers, sociologists, and a number of developing organi-zations from Italy, France, Germany, Belgium, and Hol-land. The Catholic-Protestant team under the direction of Canon Houtart (FERES) and Professor Egbert de Vries (ISS) gave the audience a report of their three-year Ford-funded study of the Churches' work in the four developing countries of India, Brazil, Indonesia, and the Cameroons, in the areas of education, medicine, and social work.3 But of far greater importance than any of the socio-logical findings of the three-year study of FERES-ISS was the ecumenical character of the study and the seminar. The meeting was tangible evidence of the growing spirit of collaboration between the Catholic Church and the World Council of Churches, especially in an area which was once the most sensitive one in ~SEDOS (Servizio di Documentazione e Studi) is a cooperative documentation and research venture on the part of about thirty superiors general in Rome. FERES (Federation Internationale des Instituts Catholiques de Recherches Socio-religieuses) is the inter-nationally well-known research center in Brussels. ISS (Institute for Social Studies) is the Protestant counterpart of FERES and is lo-cated at The Hague. 8 A report of this seminar has been published by SEDOS under the title, The Church in Developing Countries;.Via dei Verbiti, 1; Rome, Italy. ÷ ÷ Development VOLUME 28, 1969 871 4" 4" Brothers More and Ryan REVIEW FOR RELIGIOUS the past--the developing countries. It is not surprising, then, that one of the most important conclusions ac-cepted by the superiors general was that cooperation between the different denominations be extended. Moving quickly from theory to action, the superiors general of several congregations devoted to medicine shortly after the seminar entered into discussions with the Christian Medical Commission, a semi-auton-omous organism related to the World Council of Churches. As a result of a number of meetings between Mr. J. McGilvray of the Executive Committee of the CMC, Geneva, and these religious congregations, the CMC Executive Committee reached the important con-sensus this past March that five Roman Catholic con-sultants would be appointed to the Commission after nomination by the Secretariat for the Promotion of Christian Unity. These consultants were present at the Commission's general assembly in August of this year. A third example of ecumenical cooperation in de-velopment is of far greater significance, since it was mounted on a larger international stage. In 1967 the World Council of Churches and the Pontifical Commission of Justice and Peace formed the E~ploratory Committee on Society, Development and Peace (SODEPAX) as an experimental instrument for ecumenical collaboration. Father George H. Dunne, S.J., formerly of Georgetown University, was appointed by Dr. Eugene Carson Blake and Cardinal Maurice Roy as joint secretary of this committee. SODEPAX held a conference in April, 1968 on world cooperation for development in Beirut, Lebanon, to which it invited sixty specialists from all over the world. The participants were Protestants, Orthodox, Catholics, observer-consultants from intergovernmen-tal bodies, and two participants from the Muslim com-munity of Lebanon.4 The conference was the first attempt on the part of the World Council of Churches and the Roman Catholic Church to jointly study and plan the involve-ment of the Christian bodies for the betterment of society. It is a concrete example of the way churches will unite their moral forces towards achieving human dig-nity and world peace. One of the conclusions of the meeting states this objective in terms which make an appeal to all religious: This Report has suggested many ways in which the Churches, acting together, can foster development programs both in ¯ A report of this conference has been published under the title, World Development, the Challenge to the Churches; Publications Department; The Ecumenical Center; 150 Route de Ferney; Geneva, Switzerland. the advanced and developing countries. Joint action for de-velopment will serve basic Christian aims. To work for devel-opment is to express in particular measures the aspiration for brotherhood and human dignity for every individual. And it can also be a significant contribution toward a more orderly and peaceful world. Development can gradually reduce the gross imbalances which promote instability; working together can encourage a wider sense of community among mankind; and the strengthening of international agencies will create structures for common effort and order. These three examples of ecumenical collaboration in the field of development are growing evidences of the need for all religious institutes to work together with other Christian bodies to concert their actions for play-ing their part in the long task of building a more stable international order of well-being and peace for the whole human family. This ecumenical spirit should be built into the thinking and planning of general and provincial chapters, constitutions, formation programs, and the apostolic work of religious families. It should also be the concern of national conferences of re-ligious institutes. The work is of too vast proportions to be left to the interest of those few religious who have up until now been involved in development. 2. Specialists and International Vocation The second trend in development in religious com-munities is the deployment of personnel to act as specialists in the Third World, along with the estab-lishment within general curias of a secretariat for de-velopment. Shortly after the seminar on the Church in develop-ing countries, Misereor approached the superiors general with an offer to provide funds for the training of some specialists who would assist bishops' conferences in de-veloping countries in setting up offices of trained experts in planning. The offer came as a result of the dis-cussions at the seminar concerning the lack of the skills of planning for the proper deployment of dwin-dling personnel, the retooling of personnel for meeting the new needs of the day, and the necessity for co-operating with governments in national planning. The time had come, it was agreed, for religious com-munities to become deeply involved in this modern approach and to train experts who would have com-petency as well as apostolic zeal. After many months of discussions with the superiors general, Misereor agreed early this year to provide funds for the training of highly qualified development experts for the countries of Indonesia, East Africa, and the Congo. Other countries would be added as the pool of experts becomes larger. As the agreement was finally 4, 4, Development VOLUME 28, 1969 873 Brothers More ¯ and Ryan REVIEW FOR ~ELIGIOUS worked out, the funds are in the form of a scholarship for 'the trairiing of experts in the fields of social ac-tion, science, communication, cooperatives, trade unions, medicine, agriculture, and technology. These experts would be seconded to central advisory and coordinat-ing bodies in the selected countries and would devote themselves specifically to the analysis of the problems, the planning of a strategy, and the coordination of pro-grams with national planning. This new type of service would be rendered by the religious ~ommunities only at the invitation of interested bishops' conferences of one of the three countries. This proposal clearly indicates that as the religious communities become more involved in social action, they will need more experts in this field. It also be-comes increasingly clear that religious congregations will now turn their efforts towards promoting and edu-cating a corps of highly qualified men and women who will act not for their individual communities alone but in teams for ihe good o[ society. This task force con-cept of highly competent religious from different in-stitutes could be the most dramatic response of religious congregations to the challenges provided in the Third World. From what we have just said, it is evident that re-ligious will have to respond more promptly and in-telligently to what we would call the apostolate of internationalism. To act as specialists in the Third World, to become globally involved in development, re-llgious will be entering more actively into what Barbara Ward calls our planetary community, a community which. cuts across all the lines and barriers of nations and races. In such a community, religious ought to feel very much at home, especially since the vision of all founders of religious communities extended beyond the hori-zons of a particular country or culture. That spirit which inspired founders to send their men and women to meet the needs of mankind in all parts of the world must now impel their followers to send trained and competent personnel to participate in international bodies which are working to achieve the humaniza-tion' of mankind. This apostolic thrust could be as dramatic and far-reaching as the missionary journey of Francis Xavier to the Indies. There are a number of religious currently engaged in this international apostblate. Those we have met or know of are: Father John Schutte, S.V.D., who was recently appointed by Pope Paul as assistant to Mon-signor Joseph Gremillion, Secretary of the Pontifical Commission of Justice and Peace; Father Arthur Mc- Cormack, M.H.M., special consultant to the same Com-mission; Father Philip Land, S.J., Gregorian University, Rome; Father George H. Dunne, s.J., SODEPAX Joint Secretary, Geneva; Father Thomas F. Stransky, C.S.P., Secretariat for Promotion of Christian Unity; Mother Jane Gates, Superior General of the Medical Missionary Sisters, who is working with the World Council of Churches in the field of medicine; and Father Theodore M. Hesburgh, C.S.C. The first indication we have of a religious institute becoming serious about development and the promo-tion of the international apostolate is the derision of Father Pedro Arrupe, superior general of the Jesuits, to establish a secretariat for development within the curia of his general administration. Father Francis Ivern has been appointed by Father Arrupe to head this secretariat. Similar offices could be set up in many of the larger congregations of men and women. In the case of smaller units, it is quite possible that interested and competent religious could be, as a matter of policy, trained to take their place in general curias. Others could be as-signed to work on task forces, national bishops' con-ferences, international or national research centers, na-tional conferences of religious, and the pontifical or the national conferences of justice and peace. 3. Spirit of Collaboration It is quite evident from what has been said above that there is growing within religious congregations and institutes a greater spirit of collaboration to make the response called for by Populorum progressio and the objectives of the Pontifical Commission of Justice and Peace. Since the work of development is of such gigantic proportions, no one rellgious institute can unilaterally plan its involvement in it. No one individual religious, or even a cadre of them, can shoulder the heavy re-sponsibility of this new apostolate. It must be the work of all religious, or the efforts for the humanization of mankind will be considerably weakened. One model of collaboration already exists in Rome. It is an organization to which we have already re-ferred many times, namely, SEDOS. This voluntary organization of a number of superiors general, formed only six years ago on the initiative of a few missionary congregations, has in a short time given proof of the results that can flow ~om the spirit of collaboration. Within a span of just one year, for imtance, SEDOS has held a seminar on development, a symposium on the theology of development and mission, and a con-÷ ÷ ÷ Developme~ VOLUME 28, 1969 875 Brotmheurl s. RM~oarne REVIEW FOR.RELIGIOUS terence on intermediate technology. As noted already, it has worked out an agreement with Misereor to finance the education of a number of specialists for developing countries. It is also actively engaged in es-tablishing guidelines for a mutual exchange of ideas between the World Council of Churches and medical missionary congregations in the field of medicine. SEDOS is unique in a number of ways. Its member-ship consists of both men and women religious. Its ex-ecutive secretary is Father Benjamin Tonna, a secular priest from Malta, who is a professional sociologist. The director is Miss Joan Overboss, a multilingual expert from Holland. But its uniqueness lies principally in its spirit of co-operation among the superiors general in facing the new problems evolving from the Third World. Since there was no structure among religious institutes or in any Roman curial congregation to help religious fami-lies prepare themselves for their involvement in the work of development, superiors general united their forces to establish a documentation and research center which would enable them to convert from a family business to a modern and efficient concern. Thus, for the first time in the Church's history, religious congre-gations have banded together at the highest level to make their contribution in an area in which the Church in recent years has focused its principal at-tention. This same spirit of collaboration is evident in such countries as the Congo and Indonesia, where religious are working together with bishops' conferences in es-tablishing planning secretariats. Quite recently we read an appeal by the East African conference of religious to its membership to turn itself to the question of de-velopment and to form a task force that would assist the bishops' conferences in establishing a secretariat for development. If religious congregations are to involve themselves in this apostolate, this spirit of cooperation must con-tinue to grow. Many religious want to see their in-stitutes take decisive measures to execute the social objectives of Populorum progressio and to work actively to achieve the goals of the Pontifical Commission of Justice and Peace. The younger generation of religious also want to become actively engaged in working to create conditions within and between nations that are in keeping with the human dignity of man. But they need some concrete programs to give them direction. As a step towards establishing some programs, con-ferences of religious and individual institutes could give attention to the following suggestions made by the Pontifical Commission of Justice and Peace at the end of its first plenary meeting of March, 1967: 1. That Bishops' Conferences, teaching orders and all those concerned with education should be encouraged to include the teaching of international social justice in the curricula of schools, seminaries, universities and all institutions of learn-ing. 2. That retreats, sermons and specifically religious instruc-tion should emphasize the discussion of world justice, ~. That such curricula should be, where possible and suit-able, worked out on an ecumenical basis. 4. That competent study groups, again when suitable on an ecumenical basis, should continue the work of elaborating a doctrine of world-wide development and justice. 5. That lay groups of all kinds be invited to include world justice in their programs of adult education and, when com-petent to do so, assist the Commission in suggesting programs for the mass media. 4. A New Theology ot Development A concern very often expressed at the seminar on de-velopment alluded to above was that what was needed was an honest exchange of views on the theological foundation of development. In fact, one of the prin-cipal resolutions of the seminar asked the Congregation for Evangelization to put the theology of development on its agenda for its next meeting and for eventual presentation to the Holy Father as agenda for the next Synod of Bishops. Another resolution requested a sym-p. osium on mission and development. These two actions reveal that a theology of develop-ment has become a matter of urgency for religious. So long as the effort of missionaries was expended 'within the limits of a parish or a diocese, no special problem presented itself. But today the organization of develop-ment has become a much more complex affair; it has assumed the dimensions of whole nations, of entire continents, of the planetary community itself. While such a task calls for specialists, the ordinary missionaries run the danger of no longer seeing and understanding the role they are called on to play in the task of de-velopment. They stand, then, in perplexity when faced with the contradictory opinions of theologians. If some theolo-gians insist on the irreplaceable character of the proc-lamation of God's word and of the sacramental ministry, missionaries taken up with the tasks of development be-cause of the demands of the situations in which they find themselves and the concrete needs they daily encounter are troubled by an uneasy conscience. If other theologians stress the primary role of development, then those mis-sionaries whose tasks are those which belong to the more + + + Developmem VOLUME 28, Z969 8?7 traditional patterns of the apostolate begin to question the value of what they are doing. It was in response to this perplexity that the superiors general of SEDOS held a mission theology symposium in Rome this past April. Theologians from Europe and other parts of the world were invited to tackle this prob-lem first among themselves, and second in open discus-sions with the generals and their staffs.~ This symposium's importance lies in the fact that it has brought before religious congregations the theologi-cal dimensions of development, while adding to the growing literature on tlfis subject. This hard confronta-tion with the realities of development is a hopeful sign of growth within the Church and religious institutes. And instead of standing before the reality with perplex-ity and bewilderment, religious institutes, with their sense of global dedication, ought to be in the vanguard of working out a new theology of development. This mission theology symposium should set the pace for all religious families of the church. It has been our intention in this paper to draw the attention of religious to the phenomenon of develop-ment so that it can become a growing part of the litera-ture on renewal and adaptation. As a contribution to this literature on renewal, we have pointed out four major trends we have noted over the past year in the field of development as they affect religious institutes. The contribution religious can make to development, we are convinced, is enormous. The single attempts being made here and there must spring into a massive effort that will engage religious in a venture that has taken the center stage of the Church. If development is the new word for peace, it is a new challenge to religious. ~ Preparations are being made for the publication of the pro-ceedings of this symposium in various languages. The English edi-tion will be published by Maryknoll Publications. Brothers More and R~an REVIEW FOR RELIGIOUS JAMES A. CLARK Placing U. S. Personnel in Latin America Once a bishop or provincial decides to give manpower assistance to Latin America, he quickly discovers the dif-ficulties of attempting to find the wisest way to assign priests, brothers, or nuns to projects in Latin America. Since few authorities can agree on proper priorities for such placements, a superior is wise to recognize im-mediately that optimum, effective assignment of per-sonnel throughout Latin America represents an unat-tainable goal. In the past, assignment of American religious in the southern half of the hemisphere resulted from acciden-tal factors. The high ratio of Americans in Peru derived from the efforts of a zealous nuncio who welcomed them warmly. The large numbers of Americans in Guatemala result from a statistic that indicated that Guatemala had the worst proportion of priests to peo.ple of any Latin American country. Bewildered superiors anxious to respond to appeals of the Vatican to send missionaries to Latin America seized on this fact as a reason to send their subjects to Guatemala. Localized concentrations of Americans usually can be traced to a friendship begun at the Vatican Council between North and Latin Ameri-can Church leaders or through the bonds of a religious community existing in both halves of the hemisphere. The complexity of properly placing people in Latin America appears as a new problem because previously the allocating of workers to missionary lands did not require any accommodation with a structured Church in the foreign situation as is the case now in Latin America. One locale appeared as needy and worthwhile as another for apostolic laborers. The presence of a viable and strong Church in Latin America demands :extreme delicacy in interposing foreigners to serve that Church. Yet the need is so general and widespread in Latin America that from a spiritual point of view it has be- 4- ÷ James A. Clark is a staff member of the apostolic delegation at The Manor House in Rockcliffe Park; Oto tawa 2, Canada. VOLUME 28, 1969 879 come impossible for even the indigenous Church to ar-rive at a generally satisfactory set of realistic and valid preferences. Priorities which have aided in the distribution of financial grants are applicable in part to the appoint-ment of people even. though this latter commodity, people, raises mnch more profound questions since it is so much more precious and scarce in Latin America. This dilemma especially concerns diocesan priests be-cause the international 'religious communities already have a functioning system for distribution of their mem-bers. This arrangement, made under the auspices of the Holy See, has served for generations and enables provincials to provide staff for missionary areas without an agonizing analysis in each case. Those communities without Latin American branches and bishops entering the field for the first time find the subject distressingly difficult. The. Most Reverend Marcos McGrath, Second Vice- .President of the Bishops' Council for Latin America (GELAM), has encouraged even the religious communi-ties to refuse to cling to traditional apostolates and to become open to new forms of ministry: Priorities of needs in the churches of Latin America can be determined most effectively when undertaken by a national episcopal conference. Deciding who comes first is a difficult exercise in the spirit of collegiality because each bishop would like to see his diocese at the top of the list. But it is a necessary exercise and is of great assistance to those from abroad who want to know what the bishops as a whole think about the needs of their country. A listing of priorities may indeed be prepared, by a special committee named by the local bishops. Such an arrangement has been requested in some instances by various organizations of assistance. CELAM's continental sec-retariat of the Latin American bishops may indicate some gen-eral priorities of needs through its specialized departments. ÷ ÷ REVIEW FOR RELIGIOUS Several complex plans have been proposed to resolve the problem of placement. The secretariat of the U.S. Bishops' Committee for Latin America once devised a coordinating committee of ten expert advisers to counsel bishops on the proper method of allocating personnel for Latin America. However since the ten could not agree among themselves on how to achieve best results the committee never met and the plan died. The secretariat received requests from most of the ecclesiastical jurisdictions in Latin America (more than 600) and circulated these to bishops and superiors of religious houses. However, no attempt to provide criteria for selecting one petition over another ever appeared. Standard policy urged superiors to.visit potential recipi- ¯ ent areas personally, a rather unrealistic suggestion for harried superiors already overstocked with requests for their manpower. Naturally, bishops prefer to retain jurisdiction over their priests. For this reason the concept of a military ordinariate type structure to recruit, train, and appoint personnel in Latin America failed to receive widespread acceptance, since experience .with military chaplains alerted bishops to the fear of losing control of their sub-jects for the major portion of their ministerial lives. Several prominent churchmen, support attempts to permit diocesan priests to serve in a religious community on the missions through a temporary connection with a religious order. Only diocesan priests who have lived for any length of time in the house of a religious society can foresee the difficulties of this plan. In spite of abundant good will on the part of all involved there is no escaping the feeling on the part of the secular priest that he is a "junior" or "non-incorporated" subject, without status and without the possibility of participation in decision making sessions. Likewise, this association causes the priest to lose identity both at home and abroad as a diocesan priest serving temporarily on the missions. The entry of diocesan priests with previous parish ex-perience into missionary areas revealed the value of these men over those who went directly to the missions upon ordination without any experience in a normal parish situation to use as a barometer for their missionary en-deavors. A diocese-to-diocese setup is not workable because one diocese in the States cannot properly provide for train-ing, support, leave time, illness, vacations, and so forth of overseas staff. Yet a method must be found which preserves the interest of the home diocese which usually provides the financial wherewithal enabling the Latin American mission to function. Other proposals include appointing men for a time to a national conference of bishaps in a given country, in-cardinating priests temporarily into a Latin American diocese, or assigning them to the U.S. Bishops' Com-mittee for Latin America, which, in conjunction with the U.S. and Latin American bishops involved, could arrange for training and distribution of priests. Two countries have established national offices to deal with this issue, and bishops assigning men to either Chile or Brazil need only refer to the national offices for ad-vice. Several methods of providing diocesan priests to Latin America have sprung up among the 76 dioceses involved in this effort. 24 dioceses merely permitted priests to go to Latin America. 17 assumed responsibility to support the volunteer priests during their term of Latin Ameri- 4- 4- 4- Latin America can service but they make no provisions for the assign-ment of these priests. 34 accept the task of supporting a parish or several parishes in Latin America. In Boston, Richard Cardinal Cushing founded in 1958 a society to bring these diocesan priests together. Currently this St. James (the Cardinal's middle name) Society counts slightly more than 100 members from 30 dioceses in the U.S. and several European countries. This corps pro-vides pastoral services to a half million people spread across Peru, Ecuador, and Bolivia. It represents the best vehicle currently available for sending diocesan priests to Latin America. A similar organization for pooling nuns going to Latin America received attention at an inter-American meeting of Bishops at Georgetown University in 1959 but has failed to be implemented. In attempting to establish priorities, the national conferences of Bishops in Latin America have proved to be a boon although usually the primatial archbishop in a country tends to see his own needs first and with good reason for he usually presides over the largest metropoli-tan portion of that country. But rural bishops complain about the criteria when they witness most foreign ar-rivals remaining in the capital city. Both CELAM and the Pontifical Commission for Latin America have sought to provide a solution in this sensitive area but without success, as most attempts at coordination cause disputes over the choice of one diocese over another as beneficiary of American clerics. Originally the Pontifical Commission offered the facili-ties of the nunciatures throughout Latin America as clearing houses, but a.fear of Roman control of the en-tire movement impelled both donor and petitioner dioceses to bypass quietly any Commission services. As a former nuncio in Panama, the late Archbishop Paul Bernier commented on this question during his tenure on the Canadian Bishops' Commission for Latin America: lames A. Clark REVIEW FOR'RELIGIOUS I think there is a strong feeling against forming a society of any kind. Most of the bishops, if I understand well, insist on having and keeping an effort of the secular clergy as such with no affiliation, neither to the diocese ad quam nor to any particular religious or semi-religious society but to keep all of them [the priests] incardinated in the diocese a qua. If they don't want to stay there for more than five years, or if for any other reason they cannot remain, they come back to their own diocese just as if they were never out of it. I think that in Canada at least the impression of the bishops would be rather contrary to affiliating or incorporating our diocesan ~nd secular priests to any particular society. Most bishops would be willing, however, to send according to their abilities one or two, five or ten priests, to some form of, not a society, but a responsible organization which in the last analysis would be in the hands of the Episcopal Committee for that. Whoever accepts responsibility for such appointments will have need of some priorities or guidelines since the priestly requirements of Latin America could not be fulfilled if every priest in. the United States went to Latin America. Some principles to follow in this area would include the following points. The i~rst choice to be made is a selection of a category of work for a religious volunteey, that is, shall I send my priest (or brother or sister) to work as a catechist, teacher, parish worker, or what? The departments of CELAM indicate the critical apostolates which normally will have first call on foreign services: education, medi-cine, social service, relief, charity, seminary/vocational work, catechetics, student/university apostolates, and service to laborers. Next the superior must choose a geographical classifi-cation, that is, shall I send him (her) to serve on the con-tinental level with CELAM, or on the regional or na-tional level with the conferences of bishops, or to the diocesan and local level. Foreigners often function best in posts removed from the intimate personal relation-ship of priest-to-parishioner which reqmres sensitive cul-tural perception. Usually their North American organi-zational talents achieve widest impact on a broader scale at the continental, regional, or diocesan levels. Also a decision must be made as to whether to send personnel to the rural or urban locations. Many Mary-knollers in Latin America have regretted the decision made many years ago to spread Society members across the mountain ranges. The impact of an individual is broader in the cities. On the other hand Cardinal Cush-ing says that the revolution in Latin America will be born in the mountains and the Church ought to be there. At one time it was thought preferable to assign North Americans to dioceses with North American bishops at the helm. This principle has been subsequently disre-garded since it leads to a danger of creating a church within a church, one foreign and one native. The monster parishes which have arisen in Latin America as a resuh of abundant American material and personnel aid have become a source of distress for Latin Americans and embarrassment for North Americans. Parish A flooded with American assistance can only re-flect poorly on parish B which is struggling along with local resources only. OccasionaIIy a choice arises between placing people in projects underwritten by private industry or govern-÷ ÷ ÷ Latin America VOLUM~ 28~ 1969 883 4- 4- REVIEW FOR,RELIGIOUS 884 ments, for example, a company hospital or a state nor-mal school. These opportunities sometimes permit the assure, ption of responsibilities which would otherwise be financially prohibitive; on the other hand, alliance with a government or industrial concern can be severely det-rimental to the Church image and impact. .One essential requirement demands that the project given help be integrated into the local church structure. For this reason each local request must be approved by the national conference of bishops to insure that it co-ordinates with the national pastoral plan. From the viewpoint of the candidate to be sent to Latin America, if he or she speaks one of the languages of Latin America or has studied or served in a particular country naturally it is logical to assign the person to that place. All attempts to satisfy reasonable personal preferences will reduce the inevitable cultural shock suffered by v, olunteers. A first principle of sending people into Latin America is that they be sent as members of a team effort and never individually. The ability of the subject offering his services will sometimes be the final determinant of assignment; a seminary professor will not serve best in a slum parish nor will a Trappist normally function well in a mass communications program. Due to the profound social division in Latin America there is a need to predetermine whether personnel are to be placed in projects serving the wealthy or the im-poverished. In the latter case a realistic plan for external financing will normally be required. Projects which provide some hope of eventual self-sufficiency in regard to their staffing needs should be selected rather than those which will require permanent foreign workers. Realistic approaches to provide new solutions to basic religious problems of Latin America deserve special con-sideration. For examples, the novel approach to slum parish work of Father Andres Godin, a Canadian Oblate, in Lima, Peru; or that of American Oblate Edmund Leising who has developed a remarkable program in Brazil for promoting parish self-support through Ameri-can fund raising procedures; or the renowned apostolate of Father Leo Mahon in San Miguelito parish in Pan-ama who has discovered an entirely new process for parish effectiveness. These offer novel and successful approaches to stubborn problems. Similar examples of projects managed by Latin American priests themselves could be cited. Most superiors have the background to recognize that adequate and detailed financial arrangements must be agreed upon in advance by both sides to prevent animos-ity from developing on obscure financial responsibilities. The overall plan an agency presents ought to be ex-amined carefully to learn if it is realistically conceived. Experience in Latin America reveals that ill.constructed, idealistic proposals soon collapse. Those of us familiar with the problem of positioning personnel in Latin America are aware of the difficulties superiors face in this field. Hopefully some of the above remarks will assist the ongoing dialogue in this area and be of some assistance to those who seek to serve the Church by releasing people for work on the only Catholic continent of the globe. + + ÷ Latin America VOLUME 28, 1969 885 JOSEPH F. GALLEN, S.J. Comments on tl e Instruction on Formation Joseph F. Gallen, S.J., writes from St. Joseph's Church; $21 Willings Alley; Philadelphia, Penn-sylvania 19106. REVIEW FOR RELIGIOUS Prepostulancy Nothing is said in the Instruction on a prepostulancy period. Number 4 states that it would be worthwhile to consider whether the practice of going directly to the novitiate from such places as aspirancies, apostolic schools, or minor seminaries should be continued or whether an interval of probation should be had to develop the human and emotional maturity of the candidate. In the case of those obliged to a postulancy by canon 539, § 1, this development can be taken care of during the postulancy, which can last up to two years and also be made while residing outside any house of the in-stitute (n. 12). There is nothing in the Instruction for or against such places as aspirancies but, as is clear from what was said above, number 4 presumes that they will continue to exist. Postulancy (nn. 4; 10-2; 33) Importance. "Hence it follows that all institutes, even those that do not prescribe the postulancy, must at-tach great importance to this preparation for the novice-ship" (n. 4). Purpose. This is to judge the suitability and aptitude of the candidate; to give a preparation that will enable the noviceship to be made more fruitfully; to provide a gradual transition from secular to religious life; and to verify and complete, if necessary, the religious knowledge of the candidate (nn. 11-2). "Tentative" in number 11 of the Vatican English translation is not in the Latin text and "to formulate a. judgment" is to form a judgment. Power of general chapter. In institutes in which the postulancy is of obligation by common law (in insti-tutes of perpetual vows: all women but in those of men only lay brothers) or by the constitutions, the gen-eral chapter may keep in mind, for a better adaptation of the postulancy~ the following norms (n. 12): Duration. In institutes in which the postulancy is not obligatory by common or constitutional law, the general chapter may determine its nature and duration, which can vary for different candidates but should not be too brief nor ordinarily longer than two years. In institutes in which the postulancy is obligatory from common law, it must last at least six full months (c. 589, § I), and this minimum time is more probably retained in the Instruction; but the general chapters of these institutes may also follow the two-year limit, the principle that the time may vary for different candi-dates, and probably that the minimum time may be less than six months (n. 12). 1 do not think the right of canon 539, § 2, to prolong the postulancy for six months extends to a postulancy of two years. A postu-lancy longer than two years would not be very rea-sonable, especially since it can be varied within that time for the individual. Place. Preferably not in the novitiate house, and it can be profitable for it to be made wholly or in part outside a house of the institute (n. 12). The postulancy may therefore be so organized that the postulants con-tinue to reside in their homes or in such another place as a college. See also numbers 4 and 11. The latter speaks of a "gradual transition from lay life to that proper to the noviceship." Director. The postulants, wherever the postulancy is made, are to be under the direction of qualified re-ligious, between whom and the master of novices there is to be sedulous cooperation (n. 12). Dross. The determination of the dress of the postu-lants appertains to the general chapter (n. 33). How-ever, canon 540, § 2, had required simply that the dress of the postulants be modest and different from that of the novices. It could therefore have been secular but modest; special and uniform, but this was not neces-sary; religious, but different from that of the novices. Noviceship (nn. 4-5; 13-33) Maturity requisite Ior beginning noviceship (n. 4). The noviceship should begin when the candidate is aware of God's call and has reached that degree of human and spiritual maturity which will allow him to decide to respond to this call with sufficient and proper knowledge and responsibility: "Most of the difficulties encountered today in the formation of novices are usually due to the fact that when they were admitted they did not have the required maturity., it must ÷ ÷ ÷ Formation VOLUME 28, 1969 887 ÷ ÷ ÷ $. F. Gallen, S.l. REVIEW FOR RELIGIOUS 888 be affirmed that the age required for admission to the noviceship should be higher than heretofore" (n. 4). Place. The noviceship for validity must be made in a house legitimately designated for this purpose (n. 15) by the superior general with the consent of his council and according to the constitutions (n. 16). The superior general with the consent of his council and after consultation with the interested provincial may in a case of necessity permit also many novitiates in the same province (n. 17). When the small number of novices is not sufficient to promote community life, the superior general should, if possible, establish the novitiate in a community of the institute capable of aiding the formation of such a small group of novices (n. 18). To better meet some demands of their formation, the superior general may authorize that the group of novices be transferred during certain periods to another house of the institute designated by himself (n. 16). In particular and exceptional cases, the superior gen-eral with the consent of his council may permit that a candidate validly make his noviceship in a house of the institute other than the novitiate house, under the direction of a qualified religious acting as a master of novices (n. 19). Duration. For validity the noviceship must last for twelve months (n. 21). A continuous or interrupted absence from the noviti-ate group and house that exceeds three months ren-ders the noviceship invalid (ft. 22). In lesser absences the higher superior, after consulting the novice master and considering the reason for the absence, may in individual cases command an extension of the noviceship and determine its length, and this matter may also be determined by the constitutions (n. 22). Formative activity periods outside the novitiate house must be added to the required twelve months, nor may they be begun before a novice has spent three months in the novitiate (if the contrary is done, the noviceship be-gins only on the completion of the formative activity period) and must be so arranged that the novice spends a minimum of six continuous months in the novitiate, re-turns there at least a month before the first vows or other temporary commitment, and the time of the whole novice-ship extended in this manner may not exceed two years (n. 24). The noviceship amplified by such formative activity periods may not exceed two years, but this does not abrogate the right given to higher superiors in canon 571, § 2, to prolong the noviceship up to six months in a doubt about the suitability of a candidate. Such a prolongation is permitted in a noviceship of two years without formative activity periods. A higher superior for a just cause may permit first profession or commitment to be anticipated but not beyond fifteen days (n. 26). Formative activity periods. The general chapter by at least a two-thirds vote may experimentally enact, in keeping with the nature of the institute, one or more periods of formative activity outside the novitiate house, the number to be determined in practice accord-ing to the judgment of the master of novices with the consent of the higher superior, for the formation of the novices or, in some cases, for a better judgment of their aptitude for the life of the institute. Such periods may be used for one, several, or the entire group of novices. If possible a novice should not be assigned alone to these periods. In these periods the novices are under the direction of the master of novices (nn. 23, 25). "It must be emphasized that this formative activ-ity, which complements novitiate teaching, is not in-tended to provide the novices with the technical or professional training required for certain apostolic ac-tivities, training which will be afforded to them later on, but rather to help them, in the very midst of these activities, to better discover the exigencies of their vocation as religious and how to remain.faithful to them" (n. 5; see also n. 25). Separation of novices. There must be some separation between the novices and the professed religious, with whom, however, and with other communities, the novices may have contact according to the judgment of the master of novices. It appertains to the general chapter to decide, according to the nature of the institute and particular circumstances, what contacts may be had between the novices and the professed of the institute (n. 28). The use of the term "professed re-ligious" in the second sentence makes it sufficiently clear that there is no prohibition of contact between the novices and the postulants, as might be feared from the word "members" in the other two sentences of number 28. Studies during the noviceship. The general chapter may permit or command certain studies during the nov-iceship for the better formation of the novices, but doctri-nal studies should be directed to the knowledge and love of God and to the development of a more profound life of faith. From the twelve months of noviceship of number 21 all studies, even theological and philosophi-cal, made for obtaining diplomas or for acquiring a formation directed to preparation for fulfilling future Formation VOLUME 28, 1969 889 REVIEW FOR RELIGIOUS 890 duties are forbidden (n. 29). Provided doctrinal studies are directed to the spiritual life, as prescribed in the first sentence, it is probably not forbidden to receive credits for such studies when these can be had but the studies are not to be directed to the attaining of credits. There is no doubt that the prescription on doctrinal studies in this first sentence also applies only to the twelve months of noviceship of number 21, as is also true of the canonical legislation in canon 565, § 3, on this point, "even though the Latin text says "during the time of the noviceship," not "during the regular novitiate year," as in the English translation. The latter also has "all formal study programs" in the second paragraph whereas the Latin reads "all studies." Dress o] the novices. It appertains to the general chapter to determine the dress of the novices (n. 33). Number 33 speaks of the "habit of the novices and of other candidates for the religious life." It certainly had not been the practice nor is there any tendency to give a religious habit to postulants, and the meaning here of "habit" is "dress." No limitation is placed on the power of the general chapter to determine the dress of the novices and postulants. Canon 557 commands the wear-ing of the habit during the whole time of the noviceship, but it has also been maintained that the noviceship is an uncertain time and that the habit, to retain all its significance, should not be given to the novices. Noviceship lot another class. Unless the constitutions determine otherwise, a noviceship made for one class is valid for another (n. 27). The constitutions may de-termine the conditions regulating a transfer from one class to another (n. 27), Novice master. The novices are under the direction of the novice master who may seek the aid of other skilled helpers (n. 30). This is to be kept in mind with regard to a formation team. See also numbers 5, 12, 15, 23, 31, 32. Temporary Bond (nn. 2, 6-9; 34-8) A different temporary bond may be established and ]or all. Number 34 gives a faculty, not a precept, but in general language: "The General Chapter, by a two-thirds majority, may decide to replace temporary vows with some other kind of commitment as, for example, a promise made to the institute." The same general lan-guage is found in numbers 2, 6, 10, 24,' 37-8. The pos-sibility of the extension to all in the probation after the noviceship is not certainly excluded by other num-bers of the Instruction. A dil~erent bond should be introduced only a]ter most careful thought. The reasons are (1) number 34 demands a two-thirds vote of the general chapter to in-troduce a different bond and (2) number 7 explidtly re-quires such careful thought: "No institute should de-cide to use the faculty granted by this Instruction to replace temporary vows by some other form of commit-ment without having clearly perceived and weighed the reasons for and the nature of this change." A different bond in fairness, prudence, and proper regard [or sound spirituality should be introduced only [or those in whom the special immaturity exists. The reasons are (1) by vows a special consecration is had according to number 2: "Thus it is that religious pro-fession is an act of religion ~nd a special consecration whereby a person dedicates himself to God." (2) Be-cause according to number 7 temporary vows are com-pletely in harmony with the greater response to God so important at the beginning of the religious life and also enable the candidate to make the consecration proper to the religious state: "For him who has heeded the call of Jesus to leave everything to follow Him there can be no question of how important it is to respond generously and wholeheartedly to this call £rom the very outset of his religious life; the making of temporary vows is completely in harmony with this requirement. For, while still retaining its probationary character by the fact that it is temporary, the profession of first vows makes the young religious share in the consecration proper to the religious state." (3) Because immaturity is the sole reason given (n. 7) for substituting another temporary commitment: "In fact, more fre-quently now than in the past, a certain number [quidam] of young candidates come to the end of their novitiate without having acquired the religious ma-turity sufficient to bind themselves immediately by re-ligious vows, although no prudent doubt can be raised regarding their generosity or their authentic vocation to the religious state. This hesitancy in pronbuncing vows is frequently accompanied by a great awareness of the exigencies and the importance of the perpetual religious profession to which they aspire and wish to prepare themselves." (4) Possibly also because the desire for the different commitment was true only of some institutes (n. 7): "Thus it has seemed desirable in a certain num-ber o[ institutes that at the end of their noviceship the novices should be able to bind themselves by a temporary commitment different from vows, yet answering their twofold desire to give themselves to God and the institute and to pledge themselves to a fuller preparation for perpetual profession." Since the Instruction describes temporary vows as a consecration that is special, proper to the religious state, and in harmony with the greater ÷ ÷ ÷ VOLUME 28. 1969 89! + ÷ .~. Fo Gallen, $J. REVIEW FOR RELIGIOUS 89~> response to God, it at least seems unfair, imprudent, and without regard for sound spirituality to deprive a novice of temporary vows when he has all the quali-ties requisite for making them, that is, when he is not affected by the special immaturity described in number 7. ¯ Some observations on this immaturity. Is this im-maturity proper to the young or is it the emotionalism that is today found in many older religious, and which the young often manifest only after continuous contact with such older religious? Isn't there a movement at this moment in the United States to give the vote to those who are eighteen years of age because the young are now more politically mature? In more than thirty states it has been the law that a girl of eighteen may marry without the consent of her parents. Is there any widespread tendency at present to change this very general law because of the immaturity of the ~young? Don't some hold that the greater physical development of modern youth argues to a greater psychological de-velopment? Does one frequently and without indoctri-nation encounter a novice who is judged to have a certain religious vocation (see also c. 571, § 2) but is too immature to take temporary vows? What factual and ob-jective investigations were made in the United States to prove the existence of such immaturity? Isn't it true that such immaturity would occur with regard to the temporary vow of chastity, not of poverty or obedience? Prescinding now from the obligation of the different commitment, don't the commandments of God still bind such a candidate and under serious sin in a violation of chastity? The simplest and most appropriate different com-mitment would be a promise to the institute to observe poverty, chastity, and obedience because (1) neither the form nor the object of the different commitment is determined in the Instruction (see n. 34) but (2) in numbers 7 and 35 the Instruction at least says it is fitting that the dit~erent commitment should in some way refer to the exercise of the three evangelical counsels, for example in number 7: "Whatever form such a temporary commitment may take, it is in keeping, with fidelity to a genuine religious vocation that it should in some way be based on the requirements of the three evangelical counsels." and (3) more directly and even categorically in number 13 the Instruction apparently says that the novice is to make profession of the evangeli-cal counsels at the end of the noviceship by temporary vows or other temporary commitment: ".that a novice.may implement the evangelical counsels of chastity, poverty, and obedience, the profession of which 'either by vows or by other sacred bonds that are like vows in their purpose' he will later make." This number of the Instruction is talking of a novice and therefore o[ the first consecration, which can be either vows or another temporary commitment. There is no alternative for the profession of perpetual vows. Other forms and objects of commitment are possible. The form and object of members in the strict sense of secular institutes is: "By making profession before God of celibacy and perfect chastity, which shall be confirmed by vow, oath, or consecration binding in conscience, according to the constitutions; by a vow or promise of obedience.by a vow or promise of poverty." (Provida Mater Ecclesia, February 2, 1947, Art. III). Some of the different forms of commitments in societies of common life without public vows are annual private vows of poverty, chastity, and obedience and the service of the poor; private perpetual vows of poverty, chastity, and obedience; promise of fidelity to the observance of the rule and constitutions; perpetual promise of observ-ance of common life and poverty; perpetual agreement to obey the rule of the institute; perpetual oath of perseverance and obedience; and perpetual oath and promise of perseverance and obedience,x The societies of common life more £requently encountered are the Daughters of Charity of St. Vincent de Paul, Eudists, Josephites, Maryknoll Missionaries, Oratorians, Pallot-tine Fathers, Paulists, Precigus Blood Fathers, Sulpicians, Vincentians, and White Fathers. Is one who makes a di1~erent temporary commitment in a state of perfection, in the religious state, a re-ligious, and a member of his institute? This is at least a very basic question and with wide implications. The negative arguments are that the Instruction nowhere says that one who makes a different temporary commit-ment is a religious and that canon 488, 7°, demands public vows to constitute a religious. On the other hand (1) vows are required only by canon law, not by divine law or the nature of the matter,2 to constitute a re-ligious, and the Instruction derogates from this canon law, as will be seen from the following arguments: (2) number 36 states absolutely that the subject is united with his institute and absolutely that he is obliged to observe its law; (3) the Instruction throughout does not differentiate between such a commitment and temporary vows (see nn. 2, 6, 10, 24, 34, 37-8); (4) num-ber 10 states explicitly that the temporary commitment is not the noviceship. If an entirely new state were being 1 See also Beste, lntroductio in Codicem, 497; Guti~rrez, Gora-mentarium pro religiosis, 38 (1959), 312-3. =See Goyeneche, De religiosis, 10-11; Guti~rrez, op.cit., 29 (1050), 72-3. ÷ ÷ ÷ VOU, JME 25, 89~ REV;EW FOR RELIGIOUS introduced distinct from that of the noviceship and temporary vows, this should have been dearly stated in the Instruction. (5) The probationary periods can last for thirteen years. This seems in itself to be un-reasonable if the subject does not become a member of the institute until the end of such time. The professed of temporary vows are members by first profession. The present canon law does not permit a duration of tempo-rary vows longer than six years, and canon 642, § 2, likens a professed of six years of temporary vows to one of perpetual vows. (6) During this prolonged time the institute would not be held in the case of such a subject to the norms of dismissal for professed but could dismiss him almost in the manner of a novice, whereas the pro-fessed of temporary vows would have also a right of sus-pensive recourse against his dismissal. Nor would canon 643, § 2, on the charitable subsidy apply, nor canon 646 on an automatic dismissal. (7) There would be an evident distinction in the rights and obligations of these subjects and the professed of temporary vows even though both would be in the same factual state of proba-tion. It is true, as number 7 states, tl~at "the profesz sion of first vows., makes the candidate share in the consecration proper to the religious state." Such a consecration, however, is required only by canon or human law, which can therefore enact that other suitable forms of commitment would also constitute a candidate in the religious state and make him a re-ligious, as also because such a candidate is always des-tined for this proper consecration in perpetual profes-sion. Religious women are nuns and their institutes are religious orders even though no one in fact has solemn vows provided at least some are destined for solemn vows from the particular law of the institute. Public vows would also remain proper to the religious state and to religious institutes since they are not had either in societies of common life nor in secular institutes. I therefore believe that the subject in a different temporary commitment is in a state of perfection, in the religious state, is a religious, and a member of his institute, but the question should be authoritatively serried by the Holy See. In the contrary opinion, those in a different temporary commitment are in a state that is neither noviceship nor profession, one also for which we have no parallel, and consequently a state of deep obscurity at least juridically. Determination o~ details b) the general chapter (n. 36). In virtue of canon 543 only a higher superior is competent to admit to the noviceship and to any re-ligious profession. The same canon demands a vote of the council or chapter for admission to the novice- ship, first temporary, and perpetual professions. The gen-eral chapter should require the deliberative vote for admission to the first temporary commitment and pre-scribe for renewals and prolongation of. such a com-mitment the same vote as is enacted in the constitutions for these acts with regard to temporary profession. The same policy should be observed concerning the superior competent for permitting an anticipated renewal of the temporary commitment, for exclusion from renewal or from the profession of perpetual vows (c. 637), and for the vote of the council in this case. The superior general with at least the advice of his council should be given the faculty of consenting to the dissolution of the com-mitment by the subject, to so consent to the request of the subject at any time during a commitment, who can then be immediately admitted to temporary vows, and with the consent of his council from the institute. Reception of ment is not necessary because it (c. 1308, § 1), and the consent of to dismiss a subject the different commit-is not a public vow the institute was suf-ficiently given and expressed in the admission to the commitment or its renewal. The general chapter could prescribe reception since such a repeated consent of the institute is not contrary to common law. The formula of the vows will have to be changed for a different commitment, for example, a promise will be to the institute, not to God as is a vow. Even if the new com-mitment does not have obedience as its express object and is therefore not productive of another obligation of obedience, superiors, as the head of the institute or of its parts, possess at least the same authority that they have over a novice and, if the Holy See decides that a different commitment is on the same juridical level as temporary vows, they possess the same authority as over a professed but without the added title to exact obedi-ence from the vow (c. 501, § 1; 502). Ganons whose application is obscure. The applica-tion of the following canons to those in a different temporary commitment should also be decided by the Holy See: responsibility for debts, 536, §§ 2-3; canonical examination, 552; dowry, 547-51; making of cession and disposition regarding personal patrimony and a civilly valid will, 569; retreat before first profession, 571, § 3; profession of a novice in danger of death. Requisites for a valid profession, exclusive of recep-tion, the necessity of three years of temporary vows, and understanding the derogations regarding a valid novice-ship in the Instruction, 572; age for profession, 573; deliberative vote for first profession, 575, § 2; written declaration of profession, 576, § 2; no intervals between renewals or perpetual profession, 577, § 1; 575, § 1; ÷ ÷ Formation VOLUME 28, 1969 895 ~. F. Gallen, S.]. REVIEW FOR RELIGIOUS 896 enjoyment of the same indulgences, privileges, spiritual favors, and suffrages, obligation of observing rules and constitutions, active and passive voice and computation of time for obtaining either, 578; illiceity and invalidity of acts contrary to the vows, 579. Acquisition of property by a professed of simple vows, change of cession and disposition, 580; renuncia-tion of personal patrimony, 581; 583, 1°; change of will, 583; 2°. Common obligations of clerics in canons 124-42, 592; obligation of common life, 594; obligation of wear-ing habit, 596; cloister, 597 ft.; religious duties, 595; right of exempt correspondence, 611; enjoyment of privileges of first order by nuns, 613, § 2; enjoyment of clerical privileges of canons 119-23, 614. Transfer to another religious institute or monastery, 632-5; 544, § 5; right of professed of temporary vows to leave at the end of a temporary profession, 637; ex-claustration, 638-9; effects of secularization, 640-3; compensation may not be sought for services given to the institute, 643, § 1; charitable subsidy, 643, § 2; laws on fugitives, 644, § 3; 645; 2386; automatic dismissal, 646; dismissal of a professed of temporary vows, 647-8; provisional return to secular life, 653. Six professed constitute a formal house, 488, 5°; precedence from first profession breaking a tie in elec-tions, 101, § 1, 1°; first profession as date of computing eligibility for office, 504; 559, §§ 1-2; prohibition of being members of third orders secular, 704; prohibi-tion of being a sponsor in baptism and confirmation, 766, 4°; 796, 3°; special jurisdiction necegsary for the confessions of religious women, 876; funerals of religious, 1221; 1124, 2°; permission for writings, 1386, § 1; punish-able for violations of common life, 2389. Obligation o[ observing the evangelical counsels. If the Holy See decides that a different temporary com-mitment is on the same juridical level as the profession of temporary vows, the evangelical counsels must be observed at least with the same obligation as the con-stitutions, no matter what be the object of the different temporary commitment because (1) not only does num-ber 36 impose after the new commitment "the obliga-tion of observing the Rule, constitutions and other regulations of the institute" and therefore a fortiori also the obligation of observing the evangelical coun-sels as more essential and important for a state of complete Christian perfection but also and more pro-foundly because (2) the observance of the evangelical counsels is necessary from the nature of a state of per-fection, as can be seen from the following direct and clear statements of only three Popes and Vatican II: "The religious orders, as everyone knows, have their origin and raison d'etre in those sublime evangelical counsels, of which our divine Redeemer spoke, for the course of all time, to those who desire to attain Christian perfection" (Leo XIII, December 23, 1900). "When the only-begotten Son of God came into the world to re-deem the human race, he gave the precepts of spiritual life by which all men were to be directed to their appointed end; in addition, he taught that all those who wished to follow more closely in His footsteps should embrace and follow the evangelical counsels" (Pius XI, March 19, 1924). "It is true that by the apostolic constitution Provida Mater Ecclesia we declared that the form of life, which is followed by secular institutes, is also to be accepted as a state of perfection publicly recognized, because the members are bound in some way to the observance of the evangelical counsels" (Pius XII, July 13, 1952).3 Vatican II affirmed: "Thus, although the religious state constituted by the profession of the evangelical counsels does not belong to the hierarchical structure of the Church, nevertheless it belongs in-separably to her life and holiness." 4 Moral obligation of a new temporary commitment. It might seem that a general chapter could also completely determine this (see n. 36), but number 34 gives a promise to the institute as an example of such a com-mitment. We are to presume words in such a document are being used in their proper sense, and in such a sense a promise produces a moral obligation. In a merely private promise to God or man, the one making the promise can oblige himself only to a light obliga-tion in light matter but in serious matter he can assume either a light or a grave obligation. May a general chapter, therefore, define the moral obligation of the new temporary commitment, for example, a promise to the institute, as only light? It could do so if it is decided by the Holy See that such a commitment is not on the same juridical level as temporary vows. Could it do so if the level is the same? Such a definition is not excluded by the nature of a commitment or promise purely in itself nor by the explicit wording of the Instruction. The light obligation can also be urged from the reason for permitting a different commitment, that is, the immaturity of a candidate. It would not 8Courtois, The States of Perfection, Dublin: 1961, M. H. Gill and Son, nn. 33, 130, 403, 474; see also Schaefer, De religiosis, n. 125; Beste, op.cit., 328; Padri Claretdani, II diritto dei religiosi, n. 3; Fanfani, II diritto delle religiose, n. 2; Bastien, Directoire canonique, nn. 9, 14; Creusen, Religious Men and Women in Church Law, nn. 4-5; Guti~rrez, ibid., 63-4, 67. ' Abbott-Gallagher, The Document~ of Vatican II, 75. 4" 4" 4" Formation VOLUME 28, 1969 89~ ]. F. Gallen, $.$. REVIEW FOR RELIGIOUS seem very practical to enact that such a candidate does not have to take the added serious obligation of a re-ligious vow if he must assume the added serious obli-gation of another form of commitment. On the opposite side it can be well maintained from the nature of the matter that it would be incongruous for the funda-mental obligations of a permanent state of life to be only light. Above all there is a reply given by the Sacred Congregation of Religious, May 19, 1949, in an entirely parallel case and in general language to the effect that the bonds assumed by the members of secular insti-tutes cannot be light in their general nature.~ The pur-pose and nature of secular institutes are given as the reason for this doctrine. A secular institute is an apos-tolic state of complete Christian perfection, and the reasoning of the Sacred Congregation appears to me to apply, at least equally, if not afortiori, to religious in-stitutes. In effect this would mean, in the promise we have advocated to the institute to observe poverty, chastity, and obedience, the same light or serious obliga-tion that is had in the religious vows. The document reads: 1. The obligations which are contracted by members in the strict sense (Art. III, §§ £ and 3) for the full pursuit of the juridical state of perfection in secular institutes (Art. III, § 2), if they are to correspond to the purpose and nature of the institute, cannot be light in their general nature and under every respect (ex genere suo atque ex omni parte). 2. On the other hand, the bonds on which this state of perfection rests, are considered so to oblige in conscience that the obligations thus produced must be called grave in their general nature (ex genere suo). 3. In individual cases, an obligation must be considered grave only when its matter must be considered as certainly grave according to the constitutions and the common teaching regarding equal or similar bonds. Moreov,er, according to the well-known rule of law (Reg. 30 in VI°), 'In obscure matters, one is obliged to Iollow only the least obligation," it cannot be affirmed in a doubtful case that an obligation is grave or more grave, for example, on the ground that an obligation arises from or is reinforced by the formal virtue of religion. 4. Just what is the nature of the bonds assumed in individual institutes and what is the precise mode of obligation---e.g., in addition to justice and fidelity, is there also and, if so, to what degree, an obligation from the virtue of religion--must be learned from the constitutions, which should give an accurate presentation of the matter, and from the formula of consecra-tion or incorporation in which the bonds are expressed. 5. Even when it is certain that there is a formal obligation arising from the virtue of religion, since there is question of vows or bonds which, although they are not fully private, nevertheless, in law, cannot be called public in the strict and specific sense and do not effect a public consecration of the' "Bouscaren-O'Connor, Canon Law Digest /or Religious, 167-8; see also Commentarium pro religiosis, 28 (1949): Larraona, 199-200; Fuertes, 292-8. person, the malice of sacrilege must not be attributed to their violation. Duration oI probation after the noviceship. The gen-eral chapter is to determine this but it is to be no less than three nor longer than nine years (n. 37). I find it difficult to see why a period longer than five years should be generally prescribed (n. 6). The total possible probationary period, that is, 2 years of postulancy, 2 of noviceship, and 9 of temporary commitment, can thus be 13 years. This would ordinarily mean perpetual profes-sion at the youngest only at the age of 30 or 31 years. Would we advise marriage only at 30 or 317 The gen-eral chapter may permit a prolongation in individual cases of a prescribed time, e.g., five years, up to the full nine years or may limit the power of prolonging, e.g., to only one year (n. 37). Precise length of dil~erent commitment. This may be made in the one act for the full length of the interval before perpetual profession, for example, five years; or for a briefer period, for example, three years, to be re-newed for two years on its expiration or to be followed by temporary vows (n. 34). The provision of canon 577, § 2, of permitting a renewal of temporary vows to be an-ticipated but not by more than a month may be also applied to the renewal of a different form of temporary commitment. Such an anticipation is permissible £rom the nature of a commitment and is not excluded by the Instruction. Must also a di~erent temporary commitment be ac-companied by the intention of renewing and of admit-ting to a renewal on its expiration? If the decision of the Holy See is that the juridical level of temporary vows and other temporary commitments is the same, the answer is in the affirmative. The explanation of the necessity of this intention in temporary vows has been the following. The religious life has ever and now de-mands stability or permanence. From its concept it is a state of life in the same way as the clerical or married state. A state of life is something that contains the note of stability or permanence. The exact permanence re-quired is defined by the Church as follows: solemn vows or simple perpetual vows are sufficient but not neces-sary; the minimum requisite is simple temporary vows. Therefore, an institute in which all the members make only annual professions of poverty, chastity, and obedi-ence fulfills this requisite. The Church further requires that temporary vows be renewed on their expiration (c. 488, 1°). This implies an intention on the part of both the religious making temporary profession and the superior admitting to this profession that, iI no obstacle ÷ ÷ ÷ Formation VOLUME 28, 1969 899 ]. F. Gallery, REVIEW FOR RELIGIOUS 900 occurs in the meantime, the vows will be renewed on their expiration. It is evident that the same necessity of this intention and its explanation apply to a different temporary commitment since the necessity of the inten-tion is required not from vows as such but from the fact that the religious state is 'a state of life and demands stability.6 Lastly, such an intention is required in secular institutes, in which the bond can be vow, oath, consecra-tion, or promise: "The bond by which the secular insti-tute and its members in the strict sense are to be united must be: 1o Stable, according to the constitutions, either perpetual or temporary but to be renewed at its expira-tion (c. 488, 1°) . ,, 7 ConIusion on temporary vows. Tkis is the appropriate place to mention the extensive confusion that has existed on temporary vows in this whole matter of a different commitment. Many talked as if a temporary vow were a most unusual and even a contradictory thing. Evidently they did not know that temporary vows were mentioned in canon law (c. 131.1) as also in practically any manual of moral theology and in canonical works that included the treatment of the vows. It was also frequently stated that the intention of renewing and of admitting to renewal on their expiration was a contra-diction of the temporary duration of such vows. This again was ignorance. The intention was not and could not have been absolute, which would have been clearly contrary to the probationary nature of the period of temporary vows. It was a conditional intention to renew the vows i[ no obstacle intervened in the meantime, S and this obstacle, if not always, would practically always have been the discovery by the institute or the subject that he or she had no vocation. There was almost an equal number of statements that a temporary profession was invalid if at the time a religious had the intention of not renewing or a superior of not admitting to a renewal on the expiration of a temporary profession. Canon 572 does not list such an intention among the requisites for a valid religious profession. Canon 488, 1°, does not append an invalidating clause to the necessity of this intention as required by canon 11. A requirement for liceity only will also sufficiently fulfill the required stability. An invalidating law according to canon 15 does not exist in a doubt of law, and there is certainly a doubt o See Larraona, op. cit., 2 (1921), 137, 209; 28 (1949), 205; Schaefer, op.ciL, n. 128; Jone, Commentarium in Codicem iuris canonici, I, 387; Padri Clarettiani, op.cit., nn. 3, 6; Vermeersch-Creusen, Epitome iuris canonici, I, n. 580; Goyeneche, op.cit., 9-10; De Carlo, Jus religiosorum, n. 2. ~ Provida Mater Ecclesia, Bouscaren-O'Connor, op.cit., 151. aSee Larraona, op.cit.o 2 (1921), 209 and note 81; 28 (1949)~ 205; Guti~rrez, ibid., 90. of law in the present caseP There was also a great deal of talk merely about promises, as if a vow were not a promise. Nor was there too much knowledge of sanctity of life and of the relation of the evangelical counsels and of vows to this sanctity. Sacred orders may not be conferred belore perpetual profession (n. 37; c. 964, 4°). For a just reason a higher superior may permit that a first profession be made outside the novitiate house (n. 20). The Instruction does not mention the commitment presumably because it is held that the prescription on place of canon 574, §1 applies only to vows. Readmission of one who legitimately left either after completing temporary vows or other commitment or a[ter being [reed from either. He may be readmitted by the superior general with the consent of his council, who is not obliged to prescribe another noviceship, nor an-other postulancy (c. 640, § 2), but is obliged to enjoin a previous period of probation and also a period of tem-porary vows or other commitment not less than a year nor less than the time that remained to be spent in this temporary probation before perpetual profession when the subject left. The superior general may prescribe a longer period of temporary vows or other commitment (n. 38). Immediate preparation for perpetual proIession and similar periods during tbmporary vows or other commit-ment. It is desirable that perpetual profession should be preceded by a sufficiently long immediate preparation something in the manner of a second noviceship. The duration and other aspects are to be determined by the general chapter (nn. 9, 35). It is also desirable that periods of withdrawing to prayer, meditation, and study be established during the time of temporary vows or other commitment (n. 25). Section IlL Application of the special norms. The par-ticular provisions axe called norms because they have been enacted for experimentation (VII). They are in effect from January 6, 1969 (VII). The norms and direc-tives of the Instruction appertain only to religious in-stitutes; other institutes of common life may but are not obliged to follow them (n. 3). Common law (canon law, laws enacted after the Code of Canon Law, laws of Vatican II, and postconciliar laws) remains in effect un-less derogated by this Instruction (I). The faculties granted by this Instruction may in no way be delegated g See Schaefer, op.cit., n. 128; Jone, op.cit., 387; Guti~rrez, ibid., note 65; Vermeersch, Periodica, 31 (1932), 122 ft.; Goyeneche, Corn. mentarium tyro religiosis, 16 (1935), 315-6; Vidal, De religiosis, n. 9, holds for invalidity. 4- 4- ÷ VOLUME 901 ~. F. Gallen, $.]. 902 to another (II), but they may be used by those who legiti-mately take the place of the superior general when there is no superior general or he is legitimately prevented from acting (IV). The same principle is true of the vicars of other higher superiors since they are actually exercising the office of the higher superior when accord-ing to the constitutions they take the place of a higher superior, such as a provincial, in the vacancy of the office, in his absence, or when he is otherwise impeded from fulfilling the duties of his office. There is nothing of such importance in the faculties granted in the Instruc-tion to higher superiors that would merit the exclusion of vicars from the exercise of such faculties. An abbot at the head of a monastic congregation is also to be understood under the name of superior general in this Instruction (III). In the case of nuns dedicated exclu-sively to the contemplative life, special norms shall be inserted into the constitutions and submitted for ap-proval, but the norms in numbers 22, 26-7 may be ap-plied to them (V). I[ the special general chapter has already been held, the superior general and his council acting collegially,x° after a careful study of all circumstances, are to decide whether a general chapter should be convoked to deliber-ate on the faculties granted to it or whether it would be preferable to await the next general chapter (VI). If they decide against the above convocation but also that the use of the faculties granted to the general chapter is urgent for the good of the institute, they, again acting collegially, have the power of putting all or some of the same faculties in use until the next gen-eral chapter provided they have previously consulted all other higher superiors and their councils and have ob-tained their two-thirds affirmative vote. These other higher superiors should have it at heart to consult previ-ously the professed of perpetual vows. In institutes with no provinces, the superior general must consult the l~rofessed of perpetual vows and obtain the affirmative vote of two-thirds OgI). The following appertain to the general chapter: with a two-thirds vote: to introduce periods of formative ac-tivity in the noviceship (n. 23) and a different tempo-rary commitment (n. 34); with the vote prescribed by the constitutions: to make determinations for the pos-tulancy (n. 12); to decide on the permissible contacts of the novices (n. 28); to permit or command studies during the noviceship (n. 29); to determine the dress of the novices and other candidates (n. 33); to determine the duration of the probation between the noviceship See REVIEW FOR RELIGIOUS, 19 (1960), 131-2. and perpetual profession and other aspects of the same probation (nn. 35-6-7); and experimentally to enact other matters that imply a change in the constitutions, for example, in numbers 16, 22, and 27. The following appertain to the superior general: with the consent of his council: the institution of a novitiate (n. 16) and of many novitiates in the same province, having consulted the interested provincial (n. 17); the making of the noviceship in a house that is not a noviti-ate house (n. 19); the readmission of one who legiti-mately left either after completing temporary vows or other commitment or after being freed from either (n. 38); alone: to permit the group of novices to reside for a time in another house designated by him (n. 16); to per-mit a small group of novices to make their noviceship in a house more suitable for community life (n. 18); with the council acting collegially: to decide on the calling of a general chapter to implement the Instruction or to permit, without a general chapter, the use of the facul-ties granted in the Instruction, after consulting all other higher superiors and their councils and having obtained the affirmative vote of two-thirds of them or of the pro-fessed of perpetual vows when the institute does not have provinces (VI). The following appertain to higher superiors: alone: to permit first profession outside the novitiate house (n: 20); to permit that first profession be anticipated but not beyond fifteen days (n. 26); after consulting the master of novices: to decide on a supplying of absence of a novice of less than three months (n. 22); and it is rec-ommended that higher superiors below the superior general previously consult the professed of perpetual vows on the use of faculties of the Instruction without having a general chapter (VI). Spiritual principles of the Instruction. In the intro-duction to the Instruction, the Sacred Congregation for Religious and Secular Institutes stated that the reason Vatican II gave no small measure of attention to reli-gious was that the Church might have a greater abun-dance of spiritual strength and be better prepared to proclaim the message of salvation to the men of our age; quoted Lumen gentium, numbers 44-5, to the effect that the state of the evangelical counsels appertains to the sanctity of the Church and that the practice of these counsels is uniquely effective for the perfection of the love of God and of the neighbor; spoke of the duty of religious institutes to renew their spiritual, evangelical, and apostolic lives; recalled that no loss was to be per-mitted in the basic values of the religious life; and de-clared the necessity of defining again the principal as-pects of this life. Formation VO'LUME 28, 1969 9O3 I. F. Ga//en,~$.l. REVIEW FOR REI.~G~OU$ 90; In the first section, which treats of principles and criteria, the Sacred Congregation reaffirmed that pro-fession of the evangelical counsels is a total consecration of one's person to God; that both from the teaching of the Church and the nature of this consecration the vow of obedience appertains to the essence of religious pro-fession; that by this consecration the religious exercises the perfection of apostolic charity, even though the apostolate is not the primary purpose of religious pro-fession; and that it may not be said that the nature of religious profession is to be changed or its proper de-mands lessened. The Sacred Congregation stated that the noviceship retains its irreplaceable role in formation; that novices are to be taught the cohesive unity that should link contemplation and apostolic activity; and that this unity is one of the fundamental and primary values of apostolic institutes. The achievement of this unity requires a~proper un-derstanding of the realities of the supernatural life and of the paths leading to a deepening of union with God in the unity of the one supernatural love for God and for man, finding expression at times in the solitude of inti-mate communing with the Lord and at others in the generous giving of self to apostolic activity. Young reli-gious must be taught that this unity, so eagerly sought and toward which all life tends in order to find its full development, cannot be attained on the level of activity alone, or even be psychologically experienced, for it resides in that divine love which is the bond of perfec-tion and which surpasses all understanding. The attainment of this unity, which cannot be achieved without long exercise of self-denial or without persevering efforts toward purity of intention in action, demands in those institutes faithful compliance with the law inherent in the spiritual life itself, which con-sists in arranging a proper balance of periods set aside for solitude with God and others devoted to various activities and to the human contacts which these in-volve (n. 5). The Sacred Congregation maintained that suitable maturity was required that the religious state be a means of perfection and not a burden too heavy to carry, as also the desirability that the perpetual con-secration to God of perpetual vows be preceded by a sufficiently long immediate preparation spent in recol-lection and prayer that could be like a second novice-ship. The second section of the Instruction is on special or particular norms and contains the following spiritual ideas and principles. The novices are to develop that union with Christ which is to be the source of all their apostolic activity; conformably to the teaching of our Lord in the gospel, the formation of the noviceship con-sists especially in initiating the novices gradually into detachment from everything not connected with the kingdom of God; that they learn to practice humility, obedience, poverty, to be instant in prayer, to maintain union with God, along with a soul receptive to the inspirations of the Holy Spirit, and to be mutually and spiritually helpful to one another in a sincere and un-feigned charity; they are to study and meditate on Holy Scripture; to be formed in the spiritual doctrine and practice required for the development of a supernatural life, union with God, and the understanding of the re-ligious state; they are to be initiated into the liturgical life and the spiritual discipline proper to their own in-stitute; they are to be given the occasions for striving to preserve faithful union with God in the active life; for the novices there is to be a balancing of periods of ac-tivity and of those given to recollection in prayer, medi-tation, and study to stimulate them to remain faithful to it throughout life, and a similar balancing is desirable during the years of formation before perpetual profes-sion. The Instruction reaffirmed the principle of the spiritual life and of Perfectae caritatis, number 8, that apostolic activity must have its source in intimate union with Christ and that therefore all the members should seek God only and above all, and unite contemplation by which they adhere to Him in mind and heart with apostolic love, in which they are associated with the work of redemption and strive to spread the kingdom of God; that novices are likewise to be formed in purity of intention and love for God and man; to learn to use this world as if they did not use it; realize that devotion to God and man demands a humble control of self; culti-vate the necessary human and spiritual balancing of the times given to the apostolate and the service of men and of the properly prolonged periods, in solitude or in com-munity, dedicated to prayer and to the meditative read-ing of the Sacred Scriptures. By fidelity to this most necessary and important program in all such institutes, the novices will gradually develop a peaceful union with God, which comes from conformity to the will of God. They must learn to discern the divine inspirations in the duties of their state, especially those of justice and charity. A mutual confidence, docility, and openness are to be fostered between superiors, the master of novices, and the novices that the master may be able to direct the generosity of the novices to a complete gift of themselves to God and lead them gradually to discern in the mys-tery of Christ crucified the demands of true religious + + + Formation VOLUME 28, 1969 905 obedience, and in this manner inspire them to an active and responsible obedience. The Instruction affirms with sufficient emphasis that the religious s~ate is different from secular institutes and from the state of the laity. ~. F. Gall~, $.1. REVIEW FOR RELIGIOUS SISTER MARY PATRICIA NORTON A New Form Community oJ Religious Government The custom that has been traditionally followed in women's religious communities of focusing all authority, responsibility, and decision-making in one person at the local, regional, and generalate level has, we believe, been a custom that grew up as a result of historical circumstances. When some of the original women's re-ligious communities were founded, there was a com-paratively small number of the members that were well educated. There has, of course, always been a local, regional, and general council to assist and advise the superior; but in actual practice the superior has gen-erally led an overburdened existence, weighed down by the responsibility of major decisions. Since the founding of the early communities, the pic-ture has changed dramatically. The rank and file sisters are no longer uneducated followers. Vatican Council II has told us that the Holy Spirit breathes up ~rom below, that is, He speaks and points out the way through the person of each and every member of the community. In the summer of 1967, the 48 Maryknoll Sisters working in Korea, considering the problems of the past, the directions of the future, and the urgings of Vatican Council II (that "all members of the community have a share in the welfare of the whole community and a responsibility for it"--~om the Decree on Ap-propriate Renewal o[ Religious Life, n. 14), began to draw up a new plan for regional government. This plan was to provide for sharing more broadly the burdens of responsibility, participation of every member in the decision-making and planning of community affairs, and to foster in each member a mature spirit of initiative and involvement. The experiment is at present under way with three elected members now jointly sharing the responsibilities that had previously belonged to the regional superior. 4, 4, Siste~ Patricia Norton is missioned at the Maryknoll Hospital; P.O. Box 77; Pusan, Korea. VOLUME 28, 1969 907 REVIEW FOR RELIGIOU$ (Note: The work of the Maryknoll Sisters in Korea is designated as a regional unit.) No one of these is superior to the others in authority or responsibility. Each one is responsible in the area that has been allotted to her: Personnel, Administration-finance, and Planning-research respectively. These three sisters are known as the Regional Team. Although each one has her area of responsibility, she does not bear this burden alone. Each of these team members has a corresponding committee of 4 regular members and one alternate member. Each committee meets once a month and the results of these meetings constitute the agenda for the meeting of the Regional Team (the three team leaders). The Regional Team also aims at meeting monthly as high priority has been placed on the value of close and frequent communications. It is felt that real participation of each and every mem-ber of the region is dependent on the thoroughness of these communications. In addition to the monthly meetings of both team and committees, good communications are fostered by availa-bility of the minutes of the Regional Team, of each of the three committees, and the publication of the agenda before each meeting. With the publishing of the agenda, each sister is invited to respond with her ideas, sugges-tions, objections, and so forth to any item on the agenda. This is one technique to insure participation by every individual. Furthermore, all those sisters who are neither mem-bers of the team nor of one of the committees become members of an interest area. The latter means that the sister has indicated her interest in one of the areas, follows the activities of that committee in par-ticular, and is ready at any time to fully participate. The Maryknoll Sisters are divided among six houses in Korea. In the event that one of these houses does not have a particular committee member, one of the in-terest area members acts as contact person for that house. Planning for this experiment began in early Fall of 1967. It was formally inaugurated at a regionwide work-shop in October of that year. Since that time it has undergone several evaluations resulting in both minor and major changes. What so far have been the advantages and disad-vantages in regard to this experiment? Some of the disadvantages: ---outsiders who have contacts with the Maryknoll Sisters do not understand it; --it is expensive (train travel and postage) and time consuming; ---it deprives the other sisters of that leisure they used to have while the superior did all the work. Some of the advantages: --it takes the heavy, burden from the shoulders of one person and spreads it" out over the shoulders of all; --it provides for the utilization of the ideas, inspira-tions, and talents of each person rather than just two or three; --it provides for decisions to be made at the level at which they are carried out; --it helps to uncover and develop leadership qualities in a wider spectrum O[ persons; ---it allows for a more truly Christian li[e [or each sister as a completely participating person, con-scious of her own role of responsibility for the success or failure of Maryknoll works in Korea; ---it cuts down dissatisfaction and provides a channel for rectifying any dissatis[actions that may occur. The comment was made by one observer: "It deprives the religious of that necessary sacrifice involved in obedience to a superior." Those who have been living ¯ this experiment would strongly differ. Obedience is not a vanished thing. It is merely the focus that has changed. Decisions are made through group-to-group or individ-ual- to-group dialogue and the individual remains open and ready to obey the results of this dialogue. It is now two years since the initial idea for this type of government was discussed. Since that time there have been many pros and cons, many wrinkles to be ironed out. It has been said by informed sources that such an arrangement Without ultimate responsibility resting in one person can never be a success. The Maryknoll Sisters are willing to concede that this may be true. But they are not willing to concede without an earnest trial. ÷ ÷ ÷ VOLUME 28, 1969 9O9 WILLIAM A. HINNEBUSCH, O.P. Origins and Development oJ Religious Orders William A. Hin-nebusch, O.P., teaches ecclesiastical history at the Do-minican House of Studies; 487 Michi-gan Avenue, Waahington, D.C. REVIEW FOR RELIGIOUS 910 An# attentive study of the origins and history of reli-gious orders reveals that there are two primary currents in religious life--contemplative and apostolic. Vatican II gave clear expression to this fact when it called on the members of every community to "combine contem-plation with apostolic love." It went on to say: "By the former they adhere to God in mind and heart; by the latter they strive to associate themselves with the work of redemption and to spread the Kingdom of God" (PC, 5). The orders1 founded before the 16th century, with the possible exception of the military orders, recognized clearly the contemplative element in their lives. Many of them, however, gave minimum recognition to the apos-tolic element, if we use the word "apostolic" in its pres-ent- day meaning, but not if we understand it as they did. In their thinking, the religious life was the Apos-tolic life. It reproduced and perpetuated the way of living learned by the Apostles from Christ and taught by them to the primitive Church of Jerusalem. Since it was lived by the "Twelve," the Apostolic life included preaching and the other works of the ministry. The pas-sage describing the choice of the seven deacons in the Acts of the Apostles clearly delineates the double ele-ment in the Apostolic life and underlines the contem-plative spirit of the Apostles. The deacons were to wait on tables; the Apostles were to be free to devote them-selves "to prayer and the ministry of the word" (Acts 6:~4~). ¯ This is the text of an address given to the annual meeting of United States major superiors of men religious held in June, 1968, at Mundelein, Illinois. x I use the words, "order," "monasticism," and their derivatives in a wide sense to include all forms of the religious life. In its strict sense "monasticism" applies only to the monks and does not extend to the friars and the clerks regular. There were, however, exceptions to the general rule that monks did not engage in the ministry. An Eastern current of monasticism, influenced by John Chrysostom, viewed missionary work as a legitimate activity of the monk; and, as we shall see, many Western monks shared this conviction. Nevertheless, missionary activity did not become an integral part of monasticism. Even after most monks became priests, they considered their vocation to lie within the monastery where they could contemplate and dedicate themselves to the service of God. Since the clergy did not embrace the religious life, with the ex-ception of those of Eusebius of Vercelli and Augustine of Hippo, the ministerial element remained generally absent from the religious life until the development of the canons regular. In itself the life of the monks was exclusively contemplative. "Tradition assigns no other end to the life of a monk than to 'seek God' or 'to live for God alone,' an ideal that can be attained only by life of penance and .prayer. The first and fundamental manifestation of such a vocation is a real separation from the world." Yet in the thinking of the monks and of the friars, who integrated apostolic activity into the religious life, their prayer, contemplation, and example were mighty forces working for the upbuilding of the Body of Christ. Foundation o[ Monasticism Though other Scriptural elements contributed to the origin of monasticism, the concept of the Apostolic life was the decisive force. This truth has been demon-strated by historians who have been studying this point for over half a century; it has recently been dis-cussed scripturally by Heinz Schiirmann, professor of New Testament exegesis at Erfurt. The historians show how the life of the Apostles and the primitive Christians influenced the origins and growth of monasticism; Schiirmann makes clear that the constitutive elements of the religious life were taught to and demanded of the Apostles by Christ. Religious life is rooted in the key Biblical texts that record the calling and formation of the Apostles. These passages determine the character of the Apostolic office and the relationship of the Apostles to Jesus. They are to be with Him, listen to Him, and follow Him. His call is rigorous and imperious. He demands commitment without reserve. Negatively, this requires a complete break with one's previous life: family, wife, home, and oc-cupation; positively, it establishes the Apostles in a state of total availability. Abandoning their possessions, their means of livelihood and, like the lily and raven, trusting completely in divine providence, they follow Christ, + ÷ ÷ Religious Orders VOLUME 28, 1969 9]] W. A. Hinnebusch, 0~. REVIEW FOR RELIGIOUS 912 putting themselves in a student-teacher, servant-master relationship to Him. All .the features of their new life with Him are already conveyed in brief in Mark's ac-count of their call: And going up a mountain, he called to him men of his own choosing, and they came to him. And he appointed twelve that they might be with him and that he might send them forth to preach (3:13-5). In this text, too, we find the first s~atement of the contemplative and apostolic elements that reappear in the religious life. They are "to be with him." Here is the contemplative element. They are "with him," devoting themselves to the "one thing necessary"--listening to His word. Yet in hearing and learning .they are made ready so "that he might send them forth to preach." As Schiirmann summarizes it: First they hear and learn, then they teach and act: "Preaching isonly one part of their life and its follows from the other." The Apostles enter irrevocably into a community of life with Jesus. They share His life and destiny: eat with Him, walk the dusty roads with Him, serve the people with Him, undergo His trials, conflicts, persecu-tions. They must be ready to hate and even to lose their lives for His sake. He wants total obedience, one based on their "faith in Him who calls and proposes the word of God in an entirely unique fashion. Their following of Christ becomes understandable only as a permanent state of profession of faith., fit] opens up a new pos-sibility of existence, a new manner of being-in-the-world, a new 'state' of life." Though the Apostles take no vows, their life is that of the three counsels. Christ imposes no greater moral de-mands on them than on all the other believers, but they alone live this close community life with Him. Not all who declare for Christ are chosen by Him to follow Him in this intimate, permanent way. Obviously Mary, Martha, and Lazarus do not. Others asked to be ad-mitted into the group of disciples but were not accepted. Mark (5:18-19) describes one case: As Jesus was getting into the boat, the man who had been afflicted by the devil began to entreat him that he might re-main with him. And he did not allow him, but said to him, "Go home to thy relatives, and tell them all that the Lord has done for thee, and how he has had mercy on thee." (See also Mt 11:28, Mk 3:35, Lk 12:8-9, 10:38-42, 9:61-2.) Being with Christ constantly, hearing His word, com-pletely obedient to His wishes, separated from family, home, and occupation, the Apostles enter a new form of existence that signifies. The prime purpose of their spe-cialized following is to declare themselves openly for Him, so that all might come to believe in Him. In a strikingly visible way their intimate following pro-claims to the Jewish world that the one thing necessary is to hear the word of Christ and to keep it. Their visi-ble, stable following becomes a sign to the world. Only after they have made this permanent commitment are they sent out to preach and to act. At every step in monastic history, whether in its ori-gins, renewals, or creation of new forms, the Apostolic life taught by Christ to the Twelve, and by them to the primitive Christian community of Jerusalem, was the leading and most powerful influence. The Gospel texts and those in the Acts of the Apostles that describe the primitive community were decisive in creating the con-cept of monasticism and in fashioning its life and usages. In the Jerusalem community we find fraternal unanim-ity, common ownership of possessions, fidelity to the teachings of Christ, common public prayer, intense pri-vate prayer. The following passages embody all these features: Now the multitude of the believers were of one heart and soul, and not one of them said anything he possessed was his own, but they had all things in common (Acts 4:32). And they continued steadfastly in the teaching of the apostles, and in the communion of the breaking of bread and in the prayers. And all who believed were together and held all things in common. And continuing daily with one accord in the temple, and breaking bread in. their houses, they took their food with gladness and simplicity of heart, praising God and being in favor with all people (Acts 2:42-7; see also 1:14, 3:1, 6:4,34; Mt 10:gff). The ministry of the word, evangelical preaching of salvation, was c~irried out by the Apostles (Mk 6:6-13; Acts 6:4), a mission that entailed indefatigable journey-ing (Mt 10:7if; Mk 6:6-13; Acts 6:4). Only the pre-dominately lay character of early monasticism delayed the full realization of the ministerial mendicant orders. For centuries monks examined and lovingly scruti-nized the texts. The power that they exercised over monastic founders is illustrated by the passage where Athanasius describes the origin of Antony's vocation in his Life of Antony: As he was walking along on his way to Church, he col-lected his thoughts and reflected how the Apostles left every-thing and followed the Savior; also how the people in Acts sold what they had and laid it at the feet of the Apostles for distribution among the needy; and what great hope is laid up in Heaven for such as these. With these thoughts in his mind he entered the church. And it so happened that the Gospel was being read at that moment and he heard the passage in which the Lord says to the rich man: "If thou wilt be perfect, ¯ go sell all that thou hast, and give it to the poor; and come, follow me and thou shalt have treasures in heaven," 4- 4- Religious Orders VOLUME 28~ 1969 W. A. Hinnebusch, O.P. REVIEW FOR RELIGIOUS As though God had been speaking directly to him, An-tony left the church, sold what he had, gave it to the poor, and went into the desert. During subsequent centuries the Scriptures lost none of their influence over monasticism. The Apostolic texts led to much more than the abandonment of riches and fleeing the world; they provided a complete program of life in community. Explaining the origins of monasti-cism about 1122 A.D., Abbot William of Saint-Thierry shows how the meditation of hundreds of years had sys-tematized the Scriptural influence: We come to this spiritual sbciety of which the Apostle Paul spoke to the Philippians (2:1-5; 3:17) in praise of the regular discipline and of the sublime joy of brothers living together in unanimity. To do justice to this discipline it is necessary to return to its beginning in the time of the Apostles, since it was the Apostles themselves who instituted it as their own way of life, according to the teaching of the Lord. Unless it was the grace of the Holy Spirit which gave them power from above to live together in such a way that all would have but one heart and one soul, so that everything would be held in common, and all would be continually in the temple in a spirit of harmony. Animated by a great !ove for this form of life instituted by the Apostles, certain men wished no longer to have any other house or any other lodging than the hbuse of God, the house of prayer. All that they did they did according to a common program, under a common rule. In the name of the Lord they lived together, possessing nothing of their own, not even their bodily strength, nor were they even masters of their own will. They lay down to sleep at the same time, they rose up together, they prayed, they sang Psalms, they studied together. They showed the fixed and changeless will of being obedient to their superiors and of being entirely submissive to them. They kept their needs to a minimum and lived with very little; they had poor clothes, a mean diet, and limited everything according to a very precise rule. Influence o[ Cassian Soon after Antony went into the desert, the influence of the Scriptures on monastic origins was enhanced by a misconception of Eusebius and Jerome, who mistakenly believed that the Apostolic life of the primitive Jerusa-lem community was followed in Alexandria, Rome, and other centers. Writing a century later, Cassian developed this misconception and found in it th~ explanation of the rise of monasticism: The conversion of the Gentiles forced an abandonment of the Apostolic way by the ma-jority of Christians, even by the clergy. More zealous souls refused to give it up and founded communities to perpetuate it. This theory was very fruitful in its effects when it was coupled with the example of Antony and Pachomius, the founder of the cenobitic life, who were inspired by the Scriptures alone. This fusion constituted a powerful op- erative force in the development of monasticism for many centuries. Scarcely any monastic 'author was read so continuously as Cassian. As late as the thirteenth cen-tury, St. Dominic was reading his Conferences. Con-stantly read and reread, Cassian's books [ashioned the medieval--and our ownnmonastic life. The Holy Spirit at Work in the Church The truth underlying Cassian's error is the almost simultaneous appearance of the religious life everywhere that the Church took root. The origin of the monastic life was a spontaneous manifestation of the Holy Spirit impelling Christians to live the life of the counsels taught by Jesus. Antony was merely the first to emerge, thanks to Athanasius, from the anonymity that conceals the virgins, celibates, and ascetics who preceded him. The impetus of the Spirit is seen particularly in the early acceptance of the virginal life by both men and women as a prime means of following the Master. From the end of the first century there are references to ascetics who lived continently "in honor of the flesh of Christ." After the third century virgins were looked upon as "the most illustrious portion of the flock of Christ" and were considered the spouses of Christ. Perfect continence, to-gether with voluntary poverty and austerity of life, was a constitutive element of the ascetical life that began to develop in the second century. Though these ascetics lived in their homes, sometimes holy women, widows, and virgins formed small communities that were marked by considerable personal freedom. The general reverence of the Church for chastity when Antony became a hermit about 300 A.D. accounts in large measure for the immediate wide diffusion of the eremitic and cenobitic forms of monasticism throughout the Christian world. The dynamic power of the Holy Spirit has been con-stantly operative during the history of the religious life. Here again there is a link with the early community of Jerusalem. These Christians, as we find their record in Acts, were very conscious of the action of the Spirit in their lives and apostolic works. Theirs was a life lived in the ~lan of the Spirit, as Vicaire remarks. ImmediateIy after describing the primitive community, the Acts of the Apostles goes on to say: "And great grace was upon them all" (4:33). This grace made itself visible even by miracles: "And many wonders and signs were done through the apostles" (2:43). When William of Saint-Thierry, whom I quoted a few pages back, described monastic origins, he manifested the awareness the monks had that the charismatic power of the Spirit was at work among them. In William's think-ing it was the "grace of the Holy Spirit which gave [the ÷ ÷ 4. Religious Orders VOLUME 28, 1969 W. A o Hinnebusch~ O.P. REVIEW FOR RELIGIOUS Apostles] power from above to live together in such a way that all would have but one heart and one soul, so that everything would be held in common . '~ Cen-turies before, Gregory the Great, writing his Dialogues within fifty years of the death of Benedict, described the great patriarch of Western monasticism as the ideal "man of God," the spiritual father who was entirely under the guidance of the Holy Spirit. The attention paid to the miracles worked by the founders and great figtires of monastic history is not merely a thoughtless emphasis on the secondary but was motivated by. the belief that the true monk, living in community, possesses an extraordinary grace for radiat-ing sanctity and contributing to the upbuilding of the B6dy of Christ. He can even receive from the Spirit the power of working miracles. The present-day interest in the charismatic character of the religious life and the charismatic founders is a legitimate, more explicit, recognition of the power of the Spirit working through all the years of monastic history. His role in the religious life deserves more attention and should awaken in us a great hope in the future of the religious life. Antony the Hermit Monasticism entered the pages of history close to the year 300 A.D. when Antony, the great hermit, gave away his possessions and retired to the Egyptian desert. The holiness and ordered discipline of his life, characterized by solitary contemplation and a severe but lofty and well-balanced asceticism soon brought other hermits to him for direction. Great colonies of solitaries arose under Antony's direction, especially at Pispir, where he lived, and at Nitria and Scete. These disciples lived alone like their master. Antony found so many imitators because of his moral greatness at a time of growing wickedness in the contemporary world. When Constantine ended the per-secutions and began to favor Christianity, the consequent lowering of the moral level of Christian life stimulated the development of a powerful ascetical movement, in-spired by the Gospels, on the ~ringes of the populated world. Antony became the model of the movement, especially after the appearance of his Life, written by Athanasius in 357 A.D., a year after Antony died. Gre-gory of Nazianzen called it "a rule of monastic life in the form of a narrative." Athanasius, who had known Antony personally and had seen him often, considered "the life of Antony an ideal pattern of the ascetical life." He intended to hold up Antony as the exemplar of the consecrated life and induce his readers to imitate what they saw. The work enjoyed a~tonishing success and was shortly translated into various languages. Antony, earnestly desiring to die the death of a martyr, went to Alexandria in 311 A.D., when the persecution of Maximin Daja broke out, to minister to the confessors in the mines and prisons, not thinking it justified to turn himself over to the authorities. When his hopes were dis-appointed, Antony returned to his desert cell where "he was a daily martyr to his conscience, ever fighting the battles of the faith. For he practiced a zealous and more intense ascetic life." With this short passage Athanasius enriched monasticism at its very birth with a positive view of asceticism and the renunciations involved in the life of the counsels. Antony's life in the desert was a substitute martyrdom and the monk the successor to the . martyr, a concept that remains alive to this day. Pachomius the Cenobite The weakness of the ei:emitical life lay in the minimal opportunity for practicing charity. Pachomius remedied this defect when he formed a genuine fellowship based on the communal charity inherent in Christianity. He composed the first monastic Rule, in it establishing the economic and spiritual bases for the common life and providing for community government. A younger con-temporary of Antony, Pachomius first served an appren-ticeship under the hermit Palaemon. Then about the year 320 A.D. he established a monastery at Tabennisi on the right bank of the Nile. Other monasteries soon followed, so that when he died, nine for men and two for women were under his guidance. These foundations were large settlements of monks who were organized into smaller groups according to the kind of agricultural work they did or the crafts they practiced. They lived a disciplined life, practiced individual poverty and de-tachment in essential matters, supported themselves by remunerative work, gathered for prayers morning and evening, and observed the three counsels, though they took no vows. Numerous biographies testify to the esteem in which Pachomius was held and the extent of his in- ~uence. Basil the Great The eremitical and cenobitic types of monasticism spread quickly both in East and West. Basil the Great, who benefited from the experience of the previous half century bf monastic experience, became the lawgiver of Eastern monasticism when he wrote his Longer R

In the 15-years I have served in the United States Army, the focal point of my tactical and academic study has been almost entirely centered on the Middle East and its unique cultural complexities. As an Infantryman, I was embroiled in the early efforts to prevent a Sunni-Shia civil war in post-invasion Iraq, while also hunting down al-Qaeda operatives under the leadership of Abu Musab al-Zarqawi. A year later, during General Patraeus's troop surge, I was in the urban sprawl of Northwest Baghdad fighting not only a Sunni insurgency, but also the Iranian-backed Jaysh al-Mahdi, comprised of local Shia militia groups. In 2010, I led a battalion reconnaissance team in the Arghandab River Valley of Afghanistan against the Taliban near the very birthplace of their Salafi-jihadist movement. In subsequent years, following my graduation from the Special Forces Qualification Course, I served in the 5th Special Forces Group (SFG) on a variety of missions in support of Operation Inherent Resolve in Turkey and Syria. As a fluent Arabic speaker, I was heavily involved in early efforts to train and equip the Free Syrian Army for its fight against the Islamic State. Following this deployment, I served as a liaison officer to the United States Embassy and Turkish General Staff in Ankara, having daily interaction with foreign dignitaries, defense attachés, and military officials in strategic level planning and coordination efforts. I culminated my time with 5th SFG as the assistant operations sergeant of a detachment fighting the Islamic State in Syria. My understanding of the culture of jihad, the various jihadist groups operating throughout the Central Command (CENTCOM) area of responsibility, and the intricacy of Middle Eastern problem sets as a whole, has come from years of dedicated cultural analysis, in-depth study of Sunni and Shia Islam, and field experience from the strategic to the tactical level. It is because of this experience that I am compelled to discuss the culture of jihad in the 21st Century. ; Winner of the 2020 Friends of the Kreitzberg Library Award for Outstanding Research in the College of Graduate and Continuing Studies Degree Completion category. ; 1 The Culture of Jihad in the 21st Century Michael J. Bearden Norwich University SOCI401: Cultural and Anthropology Studies Dr. Timothy Maynard April 30, 2020 2 The Culture of Jihad in the 21st Century In the 15-years I have served in the United States Army, the focal point of my tactical and academic study has been almost entirely centered on the Middle East and its unique cultural complexities. As an Infantryman, I was embroiled in the early efforts to prevent a Sunni-Shia civil war in post-invasion Iraq, while also hunting down al-Qaeda operatives under the leadership of Abu Musab al-Zarqawi. A year later, during General Patraeus's troop surge, I was in the urban sprawl of Northwest Baghdad fighting not only a Sunni insurgency, but also the Iranian-backed Jaysh al-Mahdi, comprised of local Shia militia groups. In 2010, I led a battalion reconnaissance team in the Arghandab River Valley of Afghanistan against the Taliban near the very birthplace of their Salafi-jihadist movement. In subsequent years, following my graduation from the Special Forces Qualification Course, I served in the 5th Special Forces Group (SFG) on a variety of missions in support of Operation Inherent Resolve in Turkey and Syria. As a fluent Arabic speaker, I was heavily involved in early efforts to train and equip the Free Syrian Army for its fight against the Islamic State. Following this deployment, I served as a liaison officer to the United States Embassy and Turkish General Staff in Ankara, having daily interaction with foreign dignitaries, defense attachés, and military officials in strategic level planning and coordination efforts. I culminated my time with 5th SFG as the assistant operations sergeant of a detachment fighting the Islamic State in Syria. My understanding of the culture of jihad, the various jihadist groups operating throughout the Central Command (CENTCOM) area of responsibility, and the intricacy of Middle Eastern problem sets as a whole, has come from years of dedicated cultural analysis, in-depth study of Sunni and Shia Islam, and field experience from the strategic to the tactical level. It is because of this experience that I am compelled to discuss the culture of jihad in the 21st Century. 3 Since its beginning in circa 610 CE, when the prophet Muhammad ibn Abdullah was visited by the angel Gabriel in a cave near Mecca, Islam has shaken the foundations of the Middle East and remained in a state of near-perpetual conflict with the Western world. Islam is an Arabic term most closely relating to the English words submission or surrender. Mujahedeen, or holy warriors, spread this new religion by the sword throughout Asia, forcing the "submission" of thousands, and have hardly been at peace with their neighbors since. Centuries later, in the two decades following the attacks on the World Trade Center and Pentagon in the United States, radical Islam's stance against the West has altered the diplomatic landscape between the world's great powers, fundamentally changed the United States' national strategic direction, and caused youth from all walks of life to sacrifice the best years of their lives in holy war to protect the supra-national community of Islam. From the invasion of Afghanistan to the subsequent invasions of Iraq and Syria to the ongoing peace talks with the Taliban, diplomatic and military efforts to eradicate jihadists from the Middle East have to-date been nearly ineffectual. Not only have these efforts failed to contain or defeat jihad, but at times have served to strengthen Islamic extremists' resolve in their call to arms against the West. Because jihad is such a fundamental part of the Islamic faith, it can never be "defeated" in the sense of traditional military eradication of an enemy force, but it can be confronted, contained, or refocused, as this paper will address. I argue that enabling local solutions and promoting education, alongside tailored surgical strike and security cooperation operations where necessary, are the keys to confronting, containing, and countering jihad. 4 Background Defining Jihad and Salafism Jihad is a transliterated form of the Arabic word meaning to struggle or to strive. In the traditional teachings of the Islamic faith, jihad is broken into two distinct categories: Greater jihad and lesser jihad. Greater jihad includes the personal struggle against selfish desires, emphasizing discipline and morality, as well as the struggle against Satan and the forces of evil. It includes jihad of the heart, jihad of the mind, and jihad of the tongue, involving praise for those who follow the will of Allah and correction for those who have gone astray (Gorka, 2016). The second category, lesser jihad, is viewed as the struggle against the enemies of Islam and the defense of its people. Lesser jihad is commonly referred to as Jihad of the Sword. Gorka (p. 60) reveals that, over time, this category of jihad has been used as justification for at least seven different subsets of holy war: 1. Using holy war to build an empire 2. Going after apostate regimes or individuals 3. Revolting against non-pious Muslim leaders 4. Fighting against the forces of imperialism in Muslim lands 5. Countering the West's pagan influence 6. Guerrilla warfare against a foreign invader 7. Using jihad as justification for terrorist attacks against civilian targets In a broad sense, lesser jihad can be viewed as offensive or defensive martial action. On the offensive side, jihadists use religion to justify building an empire, such as the Islamic State, attack apostate regimes, like those of the Taliban against Afghan government forces, and use terrorism against civilians, like the attacks on the World Trade Center. This offensive action 5 often takes jihadists beyond the borders of the ummah, or the people of Islam, striking fear into hearts of unbelievers around the globe. The defensive variety, especially in recent history, has most often correlated directly with the use of guerrilla warfare against foreign invaders, such as al-Qaeda's attacks on the international military coalitions that invaded Afghanistan and Iraq. This radical view of Islam is mostly practiced by those who follow the way of the Salafi, or the pious predecessors from the time of Muhammad, who experienced Islam in its purest form. It is believed that the first three generations who practiced the teachings of the prophet Muhammad are the ones who all Muslims thereafter should try to emulate. Themes of Salafism focus on complete adherence to sharia law, the fight against apostate Muslim regimes, and the spread and protection of Islam and its followers. At its core, Salafism is a very traditionalist view of Islam and has been practiced by multiple 21st Century terrorist organizations. The terms jihad and Salafi have shared such a close relationship in the last few decades that they have become nearly synonymous, at times described as Salafi-Jihadism or Jihadi-Salafism (Gorka, 2016; Nilsson, 2019) What Cultural Influences Lead One to the Path of Jihad? Before the attacks on 9/11, the largest call to jihad answered by the international Muslim community was in response to the Soviet invasion of Afghanistan in 1979. Stopping the spread of communism and defending the ummah against the atrocities of Russian ground forces was seen as a noble and just cause for young Muslim men, and not just among Muslims (Gorka, 2016; Nilsson, 2019). Many nations, including the United States, funded, equipped, and trained the Afghan mujahedeen (those who conduct jihad) for the fight against the Soviet empire. Jihad in the 21st Century has been viewed in a much different light, as it is most closely associated with acts of extreme violence against Western nations. While the piles of rubble that used to be the 6 World Trade Center smoldered, and a gaping hole scarred the wall of the Pentagon, people of the world were forced to ask themselves, "How could a person do this? Why would someone take their own lives and thousands of others in the name of Allah?" Religious Justification for Jihad. Though jihad has become almost entirely associated with Islamic holy war, the term itself is still simply the Arabic word for striving. Struggling against one's selfish desires, striving to maintain traditional values, and defending a community against a common enemy are not just Islamic concepts, they are universal to most tightly-knit cultures. Similarly, Christians and Jews are taught self-discipline, adherence to moral codes, and defending their belief against enemies of their faith. So, why has the Islamic flavor of this common cultural theme become so violent, causing deep unrest around the world in our modern era? Verses from the Qur'an can begin to unpack why horrific public executions, suicide bombings, and advocating for generalized violence against non-Muslims may be justifiable in jihadist culture. The Qur'an (2015) lays out the following decree in chapter 9, verse 29: Fight those from among the People of the Book who believe not in Allah, nor in the Last Day, nor hold as unlawful what Allah and His Messenger have declared to be unlawful, nor follow the true religion, until they pay the tax with their own hand and acknowledge their subjection (p. 208). My personal study of Islam and conversations with Muslims in the field revealed that this bit of prose has been used as motivation and justification for jihad by groups like al-Qaeda, the Taliban, the Islamic State, and Hay'at Tahrir al-Sham of our modern age. Some of the following themes are evident in the translation: 7 • Jews and Christians are recognized as People of the Book, but are required to accept the following—Allah as the one true god, sharia as the acceptable law, and Islam as the one true religion. • If Jews and Christians refuse to accept these statutes, they must pay a tax called the jizyah to show their subjugation. • If they refuse to do either of these, they are to be put to the sword (p. 208). Salafi-jihadist groups such as the Taliban and Islamic State have tried to revive the jizyah tax in areas under their control. Likewise, hundreds of Christians, Jews, and even Muslims who refuse to adhere to strict sharia law have been publicly executed. This vehement enforcement of arcane Islamic law is seen as a return to the purest form of Islam, as pious as the first few generations who followed the Prophet Muhammad. Another common religious cultural theme that ties these jihadist organizations together is a message of religious oppression. They preach to young Muslims that the Islamic world is under siege by the West and that their god, their value systems, and their way of life are being threatened by the evils of capitalism and democracy (Venhaus, 2010). In joining organizations like al-Qaeda or the Islamic State, young men from across the globe find a sense of purpose and direction in their cause to protect the ummah. This theme is manifested in the teachings of Anwar al-Awlaki, the spiritual leader of al-Qaeda and the father of home-grown terrorism in the United States. He calls on Muslims living among those in the West: How can your conscience allow you to live in peaceful coexistence with a nation that is responsible for the tyranny and crimes committed against your own brothers and sisters? How can you have your loyalty to a government that is leading the war against Islam and Muslims? Hence, my advice to you is this, you have two choices: either hijra [migration 8 to an Islamic land] or jihad. You either leave or you fight. You leave and live among Muslims or you stay behind and fight with your hand, your wealth, and your word. I specifically invite the youth to either fight in the West or join their brothers on the fronts of jihad: Afghanistan, Iraq, and Somalia (as cited in Gorka, 2016). This way of thinking is also captured in chapter 9, verse 5 of the Qur'an (2015): Kill the idolaters wherever you find them and take them prisoners, and beleaguer them, and lie in wait for them at every place of ambush. But if they repent and observe Prayer and pay the Zakat, then leave their way free (p. 204). When taken literally, as they are by followers of Salafi-jihad, scriptures such as these leave no choice. To these men who have committed themselves fully to the ways of the pious ones, they are compelled to become shahid, or martyrs in the protection of the ummah. The Qur'an promises paradise for those who do: Surely, Allah has purchased of the believers their persons and their property in return for the Garden they shall have; they fight in the cause of Allah, and they slay and are slain—a promise the He has made incumbent on Himself in the Torah, and the Gospel, and the Qur'an. And who is more faithful to his promise than Allah? Rejoice, then, in your bargain which you have made with Him; and that it is which is the supreme triumph (p. 222). The concept of becoming a martyr in the struggle for Islam is romanticized by jihadist groups, like al-Qaeda and the Islamic State, and even state governments in local programming. In Lebanon, Mothers of Martyrs are interviewed to share the stories of their sons' glorious end while fighting abroad against the infidels (Venhaus, 2010). The Qur'an itself calls this sacrifice the supreme triumph for a jihadist, striving for the glory of Allah. 9 Though enforcing the jizyah, publicly executing those who do not follow sharia law, and seeking opportunities to kill infidels through suicide attacks represent a very small, extremist cultural sect of Islam, each of these practices is still justifiable if one looks to the Qur'an. This could be viewed as no different than a rural Pentecostal church in the Deep South who maintains strict standards for how women must dress and act: it all comes down to interpretation and a community's willingness to subjugate themselves to these standards. Spiritual leaders of jihadist groups in the 21st Century have used the Qur'an as continued justification for a variety of cruel, inhumane, and brutal actions that served to shock the West. The holy book of Islam acts as the essential glue, binding together all facets of Arab and Islamic culture. Artistic Inspiration for Jihad. A far cry from the harsh proclamations of the Qur'an, Arabic poetry predates Islam by centuries and serves as a bedrock of Arabic culture across the Middle East. Early desert nomads composed poems mostly in mono-rhyme and in one of sixteen standard canonical measures, which made them easy to commit to memory (Creswell & Haykel, 2015). Naturally, this beautiful form of cultural expression has found a home in the modern jihadist movement, where it has become an inspiration for new recruits to join the cause and crucial in the sustainment of those already fighting infidels abroad. Creswell and Haykel assert that although analysts have generally ignored this facet of jihadist culture, it is woven deeply into the fabric of modern Islamic extremism. Osama bin Laden, most recognized as the former head of al-Qaeda, was also a highly-celebrated jihadist poet. Without question, his lyrical genius inspired young Arabs with stories of a return to the heroic and chivalrous past of Islam. One of his most famous works celebrates the martyrdom of the 9/11 hijackers. This is a theme among modern jihadist poetry, which preserves the tales of suicide bombers, the conquered apostate regimes of Iraq and Syria, and the glories of jihadist heroes (Creswell & Haykel). Likewise, in a 10 group of individuals who have each traveled far from home to defend Islam against the kuffar, these poems help to establish a sense of cultural identity, strengthening their wartime bond and solidifying their resolve. In seeing the videos of the Islamic State as they carved a path of destruction across large swathes of Iraq in early 2014, it may be difficult for one to believe that its members were motivated by the rhythmic lines of jihadist poetry. It is hard to accept that the same young fighter who is willing to behead an infidel for all the free world to see, could also be found passionately reciting lines celebrating the glorious return of an Islamic caliphate. During its rise, the Islamic State capitalized on the lyrical talent of a Damascus-born woman named Ahlam al-Nasr. In her first broadcast, called the Blaze of Truth, she sang each one of her 107 works a cappella, in accordance with the Islamic State's ban on musical instruments. The video was uploaded to Youtube, receiving thousands of views and further shares on multiple social media platforms (Creswell & Haykel, 2015). In the early days of the group's brutal campaign in Iraq, al-Nasr celebrated victory in Mosul as a new dawn for the country: "Ask Mosul, city of Islam, about the lions— how their fierce struggle brought liberation. The land of glory has shed its humiliation and defeat and put on the raiment of splendor" (as cited in Creswell & Haykel, 2015). Her choice of words helps one sense her deep passion for jihad, hidden within the lines. Mujahedeen are called lions and liberators. Mosul is called both a city of Islam and a land of 11 glory that, because of its liberation, has been released from the chains of shame and can now live in the splendor and pride of its former renown. Poetry has succored those serving in times of war for hundreds, even thousands of years. In the same manner, this key element of artistic cultural expression has helped bind together the modern jihadi movement, capturing the heroic deeds of martyrs who would otherwise remain nameless and unrecognized by the outside world. Serving in lands far away from home, young jihadists find inspiration, strength, and a renewed sense of identity in these haunting bits of rhyme. Social Pressure to Join Jihad. Abdullah Anas was an Algerian who served as one of the mujahedeen in Afghanistan in the 1980s and spent several years studying under Abdullah Azzam, the Palestinian "Father of Resistance to the Soviets" (Gall, 2020). Working to help Algerians achieve nonviolent change in their government, Anas, now in his 60s, has spent a life living and working among jihadists. To Anas, jihad is a fundamental principle of Muslim culture through which mujahedeen receive rewards in heaven: "I will never denounce jihad. As a Muslim, I know this to be a noble deed—where man can be the most beastly" (Gall). In a study of three Swedish jihadists, with experiences ranging from 1980s Afghanistan to the modern fight in Syria, Nilsson (2019) suggests that one of the fundamental social justifications for joining jihad is the sense that Islam and Muslims are collectively under attack. This, again, is a theme that applies to more than just the modern jihadist movement: Americans lined up in droves outside recruiting stations following the attacks on Pearl Harbor and decades later after September 11, 2001. Following the invasion of Afghanistan and Iraq, many Muslims from around the world began to see this not as just the West going after the 9/11 conspirators, but as a global attack on Islam. Each day, fresh news stories of coalition soldiers' crimes against 12 Muslim civilians and pictures of burning villages continued to motivate men to join the fight to protect the ummah from the foreign invaders. Nilsson contends that since most jihadists are very young, in their teens and early twenties, they are very susceptible to the influences of close friends and social groups. Safet, a young Muslim living in Sweden, was pressured by a friend to join the Islamic State in Syria, saying that he became convinced by his friend Ahmed that the group was fighting to protect Muslims (Nilsson). However, after realizing that the Islamic State was actually killing other Muslims in a practice called takfir, or excommunication, Safet became disillusioned and returned to Sweden (Nilsson). From the fight against the foreign invaders in the early 2000s in Afghanistan and Iraq, to the struggle for the establishment of an Islamic caliphate in 2015, it seems jihadists have most often been motivated by the need to protect the international Muslim community. Aside from the social responsibility of defending their faith and people, the need for adventure also seems to permeate the ideations of young men seeking to join a jihadist group. One of Nilsson's (2019) most interesting theories is that jihad is not the radicalization of Islam, but rather the Islamization of radicalism. Individuals who are already naturally predisposed to such adventurous or nihilistic behavior get caught up in the social dynamics of their time, ending up in a jihadist movement. Venhaus (2010) explains that in interviews with over 2,000 al-Qaeda prisoners from Iraq to Guantanamo Bay, he found that young Muslim men sought the cause of jihad for a number of normal social pressures felt by normal teens worldwide: "Revenge seekers need an outlet for their frustration, status seekers need recognition, identity seekers need a group to join, and thrill seekers need adventure" (Venhaus). The Effects of Social Media and Technology on Jihad. In the modern era, news is no longer bound by the time it takes for an article to be published, printed, and distributed across 13 great distance in a community. Social media platforms like Facebook, Youtube, Twitter, and Instagram have made sharing news instantaneous. Additionally, the advent of the smartphone, which acts simultaneously as a hand-held computer, high definition camera, and telephone with nearly world-wide coverage has forever changed the media landscape. In the era of modern jihad, one can post a single video that moves the minds of thousands in a matter of seconds. Following the 2003 invasion of Iraq to topple Saddam Hussein's regime, news stories of atrocity among the efforts of coalition troops over the next decade served to further the cause of local and foreign jihadists to protect the ummah from these invaders. Accidental bombing of civilians, mistreatment of the prisoners at Abu Ghraib, and a general ignorance toward Muslim culture were fueled by social media and smartphone technology. Venhaus (2010) claims that throughout this early phase of the war in Iraq, al-Qaeda very rarely had to actively recruit, their global brand was aggressively promoted through satellite television, internet chat rooms, and social media platforms; willing candidates sought them out. This use of media continued to be perfected by jihadist organizations like the Islamic State, who published a digital magazine called Dabiq, named for the ideological capital of the proposed caliphate, which rallied Muslims to jihad through stories of glory and heroism in the cause for Islam. The Islamic State also posted grisly execution videos, with stunning music and production value, including super high-definition shots of their brutality. Publications and videos such as these could be copied, saved, shared, and re-shared before any sort of government intervention could stop them. Creswell and Haykel (2015) reveal that jihadists were running a massive, secret network of social media websites and fake accounts that could be rapidly assembled and dissembled by hackers. The effects of social media and technology on modern jihadist culture are easy to understand, but challenging to measure in scope and reach. Just as easily as videos of Islamic 14 State propaganda or poetry can be shared, so too can stories of coalition force atrocities in Afghanistan and Iraq. This has put strategists in a unique position, where it is nearly impossible to control the narrative. Unfortunately, the story that breaks first is still the one that is liked and shared the most, even if the truth comes out after. Effects of Western Culture on Jihad. Rapid globalization, including the widespread diffusion of the internet and technology into the Middle East in the last two decades has continued to foment jihadist hatred for the West. Personal conversations with multiple Muslims in Iraq and Afghanistan revealed that the decadence, lavish richness, and sinful lifestyles portrayed by Western movies and media served to fuel the fires of disdain among the pious Salafi-jihadists. Additionally, Muslim men living in Western nations following the attacks on the World Trade Center were ostracized and feared by society, often leading them to an eventual radicalization process. Being denied a peaceful coexistence because of continued Western misperception, caused many young Muslims to become angry and seek community and brotherhood among other Muslims experiencing the same problems. Venhaus (2010) notes that out of the over 2,000 captured jihadists interviewed, more than 30 per cent of them sought al-Qaeda because they were angry. Under the tutelage of local al-Qaeda mentors, the frustrations of these young men were then turned upon their neighbors through careful instruction and manipulation. They were taught to see the West as the enemy of Islam, with hundreds of the ummah being harmed by their military coalitions in Afghanistan and Iraq each day. They were instructed in the ways of the pious ones who came before them, inspiring them to turn from the sinfulness of their Western neighbors and take pride in their newfound self-discipline and righteousness in the eyes of Allah. Eventually, many of these young men would travel to their 15 ancestral homelands to join the struggle, or conduct terrorist attacks on their own Western communities. Analysis A Unique Challenge Given the litany of reasons one might join jihad, the incredibly complex cultural and social environment, and the fluidity of the modern jihadist movement, how can the United States begin to contain this problem? The reasons one individual might join a jihadist cause are as various and sundry as why one might choose to join any movement or profession over another. As Nilsson (2019) and Venhaus (2010) have detailed, there appears to be no singular marker: one could be an extremely religious or a passive Muslim, rich or poor, single or married with a family, have a completely stable social life or be isolated with no friends. Jihadists can be from any country, any walk of life, and usually do not widely broadcast their intentions prior to taking part in acts of violence for the cause of Islam. It is because of the near-impossibility of clearly identifying a pattern of distinguishable cultural markers that make it such a challenge for the United States government and its allies to address the threat of jihad. Targeting an individual before they become a jihadist or before they commit a terrorist act has been one of the most formidable challenges of our time for military and law enforcement professionals alike. Usually, the much simpler job is finding a jihadist who has allowed their communications discipline to slip before an act, or catching them in a pitched battle on foreign soil. In order to protect citizens of the West and East alike against jihadists' aims, the United States Government must be prepared to confront, contain, and counter the jihadist narrative "left of bang," before an attack occurs. 16 The Global War on Terrorism: Taking the Fight to the Jihadists. In the months that followed September 11, 2001, President George W. Bush deployed Central Intelligence Agency (CIA) paramilitary officers and US Special Operations Forces (SOF) to find, fix, and finish pockets of al-Qaeda militants being harbored by the Taliban in Afghanistan. A fierce campaign of relentless aerial bombardment and mounted assaults by the forces of the Afghan Northern Alliance led to a swift and decisive defeat of al-Qaeda and the Taliban. With Kabul and Kandahar in allied hands, and an interim government established under the leadership of the Pashtun Hamid Karzai, the future of a free and prosperous Afghanistan seemed assured, but what came to be known as The Long War had only just begun. Trillions of dollars, thousands of lives, and 19 years later, the United States and its allies have been forced to the negotiating table with the Salafi-jihadist Taliban. Likewise, after Saddam Hussein's continued disregard for international law, threats against the United States, and open violence against his own people, the administration of President Bush decided again to pursue a military option. Much like Afghanistan, the coalition was led by CIA operatives and SOF operators, coordinating airstrikes on key positions in a tactical display of American firepower affectionately titled Shock and Awe. However, unlike Afghanistan, a massive conventional invasion followed the bombing campaign, bent on toppling the Baathist regime and finding Saddam's chemical weapons stockpiles. What followed was a series of policy failures, leading to a steady influx of jihadists partnering with local insurgents seeking to oust the foreign invaders and protect the ummah from the atrocities of the kuffar. In my professional opinion, Iraq is still recovering from the decade-long military occupation, cleaning up the destruction left by the Islamic State, and on the brink of civil war due to concerns about being an Iranian puppet state. 17 Ineffective Military Methods to Combat Jihad Operation Iraqi Freedom. During my first combat rotation as an Infantryman in the Triangle of Death in southern Iraq in 2005-2006, I experienced the initial rumblings of a civil war between the Sunni and Shia Muslims in Iraq, each wrestling for power in a post-Saddam world. I was also witness to the inundation of foreign jihadists, joining the ranks of al-Qaeda in Iraq under the leadership of Abu Musab al-Zarqawi, who at times headquartered in my area of operations. As I analyze our highly-kinetic and aggressive initial campaigns years later, I can see that the coalition's fight, first against Saddam, then against al-Qaeda, only bolstered jihadist motivation. In being a foreign invader, we inadvertently created a jihadist resistance movement, bent on the removal of their occupiers. Kilcullen (2010) explains this dilemma by explaining that focusing on the wrong metrics in a fight against insurgents can be deceptive: If you kill 20 insurgents, they may have 40 relatives who are now in a blood feud with your unit and are compelled to take revenge. Again in 2007-2008, I was deployed to Iraq as an Infantry squad leader to the sacred city of Khadimiyah in Northwest Baghadad. This was during the famous troop surge, meant to fix the ongoing problems with stability throughout the country. Being in the home of the beautiful Shrine of the Seventh Imam, it was a predominantly Shia area. Over the course of 15 months, my unit fought several engagements against Iranian-backed Shia militias and worked on project after project to strengthen local civil infrastructure, all while maintaining the utmost discretion against damaging homes or creating civilian casualties. Yet again, although we had conducted a nearly perfect counterinsurgency fight, it seemed that Kilcullen's insurgent math still applied: Fighting the jihadists only served to create more unrest within the population, no matter if we were restoring essential services and reducing damage to homes or not. 18 Operation Enduring Freedom. Nearly a decade after the fall of al-Qaeda and its Taliban hosts, I was deployed to the mountains of Afghanistan from 2010-2011. Stationed along the Arghandab River, just north of Kandahar, we were in the heart of the Pashtun Taliban. Again, the same story remained true: We fought the Taliban jihadists almost daily, but could not seem to win over the true key terrain in a counterinsurgency fight: The hearts and minds of the people. The Taliban would harass our unit's base of operations with a few pop shots as we called them, which would unleash a massive response in firepower and resources. Thousands of rounds of machine gun ammunition would be fired into the farm fields surrounding our Combat Out Post (COP), squads would be sent in pursuit of the attackers, and helicopters would spend hours scouring the terrain in an attempt to heap justice on the insurgents. This massive effort against so few served to erode the unit's motivation, exhaust our supplies, and alienate the civilian population whose homes and fields had been damaged in the process. Reflections on Personal Combat Experience. After years of combat experience and deeply studying Muslim culture, I can now see how the mistakes the coalitions made early-on in both operations only fueled the fires of insurgency, resistance to foreign occupiers, and generalized hatred for the West. Porch (2013) argues brilliantly that US counterinsurgency doctrine made the same mistake as its imperialistic predecessors of centuries before: Believing that military action was a proper vehicle for providing Middle Easterners with Western values, as well as a foundation for governance, social programs, and economic transformation in a region. This became evident in my own experience, realizing that no matter what sort of social, infrastructure, or economic programs ran alongside our military efforts, the people of both Afghanistan and Iraq felt the enormous social weight of being occupied by a foreign power, rendering these efforts nearly ineffectual. On the contrary, local and foreign jihadist movements 19 capitalized on each and every mistake of coalition forces, increasing their recruitment and resolve against the West. Though our military may have been winning every major battle against the jihadists, our policy makers and field commanders made the fundamental mistake of believing that these non-Western nations lived in some sort of time-warp, in which the adoption of Western democracy, rule of law, and capitalism would allow them to thrive as a nation (Porch). Effective Military Methods to Combat Jihad Surgical Strike and Precision Targeting. A unique feature of the Global War on Terrorism was the US military's continued perfection of covert strike operations with surgical precision deep into enemy safe havens. This was put on display in the rout of al-Qaeda by CIA and SOF in Afghanistan, in the kill/capture missions against the Baathists in the deck of cards in Iraq, and later in the killing of Osama bin Laden in Pakistan and Sheik Abu Bakr al-Baghdadi in Iraq. Having the ability to appear out of nowhere in the middle of the night, kill or capture an intended target with zero damage to infrastructure or civilian casualties, and leave within minutes of arrival struck fear into the hearts and minds of jihadists across the globe. The success and efficacy of this type of operation was acknowledged in the 2015 National Military Strategy, which stated: "The best way to counter VEOs [violent extremist organizations] is by way of.military strengths such as ISR, precision strike [emphasis added], training, and logistical support" (p.11). Likewise, President Obama's massive expansion of the use of drones, which could watch individuals for days and execute a precise strike that only touched the intended target, has continued to sow fear and deny jihadists' freedom of maneuver on a global scale. The US military and its allies have only continued to master these types of operations throughout the 20 fights in Afghanistan, Iraq, Syria, and other locations. The jihadists know this, and realize that one wrong move at any time could mean disaster. Security Cooperation. An additional theme that has spelled the end for jihadists throughout the globe has been the training, advising, and equipping of security forces and partners within Afghanistan, Iraq, Syria, and other nations. Enabling the host-nation military to handle jihadist movements on their own helps the United States military work itself out of a job. US Army Special Forces are uniquely suited to accomplish this mission: With specialized training, language capability, and cultural understanding, they are able to train foreign security forces through a variety of Principle Tasks. These tasks include Foreign Internal Defense, which focuses on a holistic approach to internal security and protection of citizens against lawlessness and insurgency, and Security Force Assistance, which can be focused internally or externally against threats to a nation's stability and security. The success of these mission sets was evident in 2014, during my own experience with the Afghan Commando Kandaks' continued fight against the Taliban and in closely following the Iraqi Counterterrorism Service's efforts against the Islamic State. Both of these forces, built from the ground-up by US Army Special Forces have continually fortified weak conventional military force operations against jihadist groups in their respective nations. Muslim Youth Efforts Against Jihad Globalization, though it has been proven to bolster the jihadists' narrative against the West, has also been beneficial to the movement against jihad itself. Because youth of the world have access to technology that allows them to see the atrocities and lies associated with global jihadist organizations, they are beginning to turn the tide. During the Islamic State's rise to power in Iraq and Syria, Muslim youth from across Europe travelled to join the jihadists in their 21 fight against the West. However, groups of Muslim youth also spoke up to counter this narrative. In 2015 the Muslim Youth League, an anti-Islamic State cultural movement, declared a holy war against all extremist organizations (Dearden, 2015). The group called on all Muslims to stand united against those who have hijacked Islam and misrepresented the faith. Through engagement work in schools and communities, as well as a robust online campaign, the Muslim Youth League is fighting back against jihadist propaganda that bids young Muslims join the Islamic State and other extremist groups (Dearden). Since the time of this publication, the Muslim Youth League has spread to several countries throughout the Middle East, Asia, and Europe, each with their own social media presence, outreach programs, community events, and websites. Local Government Efforts Against Jihad In the years following the Islamic State's spread across Iraq and Syria, the United Kingdom has developed a robust strategy to help at-risk Muslims avoid the radicalization process. The program itself is called Contest, and includes four distinct categories: Prevent, Prepare, Protect, and Pursue (British Broadcasting Corporation [BBC], 2017). Police departments and social organizations have built relationships with doctors, faith leaders, teachers and others, who are required to report suspicious persons to the proper authorities. In response to these reporting requirements and recommendations, over 7,500 reports were filed between 2015-2016, with one in 10 being actionable intelligence for government and police forces (BBC). In 2015 alone, over 150 people, including 50 children, were kept from traveling to conflict zones in Iraq and Syria (BBC). The strategy has of course drawn criticism, for fear that it will further alienate Muslims from their local communities, but it presents as an excellent plan of action for identifying individuals who are at risk beyond just using traditional signals intelligence and 22 surveillance techniques. It does more than just target the individual, it also seeks to reform them through education, outreach, and community programs. Counterarguments You Can Kill an Idea. I have heard the opinion throughout my time in the military that jihad and the idea of Islamic supremacy can be completely eradicated. The example most often given is that Nazism, including the idea that the Aryan race was superior to all others, was effectively destroyed by a global military campaign. This argument is weak. The Nazis represented a very small portion of German culture, including among those serving in the military, so it was relatively easy to contain once there was an overwhelming military victory by the Allies. However, although the German Army of the 1940s was defeated militarily, the idea of white supremacy lives on in small social groups throughout the world to this day. The Ongoing Taliban Peace Talks. I have colleagues throughout the military who are convinced that the current negotiations with the Taliban are a key indicator of success in our two decades at war against the Salafi-jihadist group. The issue with this is that temporary cease fires have already been violated several times, leading one to believe that the strategic level leadership's messages are simply not reaching their subordinates or that local factions are not adhering to the agreement. Trusting that radical Muslim extremists will not allow Afghanistan to become a future safe haven for other jihadists, as it has in the past, is simply unrealistic. Believing some sort of quasi peace deal is going to miraculously pacify an organization that hates everything the West stands for is misguided. My own experiences throughout the Middle East have proven that the spirit of jihad and hatred will live on in Afghanistan. The Islamic State is Nearly Defeated. Multiple global media outlets continue to run stories about the dismantling of the Islamic State, as though the battle is won. Though Sheik Abu 23 Bakr al-Baghdadi has been killed, and the proposed Islamic caliphate was never fully realized, it would be naïve to think that the Islamic State's jihad is over. The movement will metastasize and take on new forms in other parts of the globe: It is already happening. Jihadists are continually leaving the battlefields of Iraq and Syria, headed back to their former homes in mainland Europe. As these individuals reenter the diaspora, the concern is that they will radicalize other individuals and conduct terrorist attacks within the continent. Conclusion The reasons an individual seeks to join a jihadist movement are deeply rooted in personal social dynamics, the security situation of their country, and a multitude of other religious, cultural, and economic factors. I agree with Venhaus (2010) and Gorka (2016) who assert that there is no singular military operation or strategy that can bring about a decisive victory against something so intangible as why one might join the modern jihadist movement. Use of the US military as a vehicle for the establishment of Western democracy and nation-building efforts in tribal nations like Afghanistan and Iraq only served to invigorate the jihadists' call to arms. Jihad is not something that can be eradicated completely by military force. Jihad must be confronted, contained, and countered through a comprehensive approach that empowers state and non-state actors to develop local solutions and directs expeditious military applications only where completely necessary. Recommendations Promote and Protect the Muslim Youth Leagues In order to truly create a cultural paradigm shift in Muslim youth at risk of radicalization, groups like the Muslim Youth League (BBC, 2017) should be promoted by governments worldwide as a bastion of true and peaceful Islam. While they should no doubt be supported, 24 governments must also protect these organizations from becoming targets for violent acts of terrorism or influence operations by jihadists. Through a combination of deep cultural understanding and positive messaging, the Muslim Youth League has already shown its effectiveness in the United Kingdom and beyond. Because the youth of each nation understand the social pressures and cultural influences that may lead one to seek jihad, they can effectively develop tailored, local solutions to persuade at-risk individuals. The Muslim Youth Leagues are on the front lines of countering the jihadist worldview, taking a stand and declaring war on jihad and its misrepresentations of Islam. Enable Local Solutions for Local Problems This should be accomplished through unified government action that involves all the United States' instruments of national power including diplomacy, information sharing, military action where necessary, and economic stimulus as needed. The specific issue with efforts like these, is that they cannot be accomplished during what is perceived by locals as a military occupation. This was proven true in Afghanistan and later in Iraq. Despite massive efforts to rebuild infrastructure, aid in agricultural processes, build schools, and organize community projects, the United States and its allies were still viewed as pushing Western values and democracy on nations through military occupation. As much as possible, we must limit our military presence in areas that are ripe for developing a jihadist movement, or in ones that are recovering. I have seen firsthand that government efforts against jihadist organizations or at-risk communities have often been fragmented, poorly staffed, and uncoordinated. Venhaus (2010) suggests the creation of an agency that is staffed, trained, funded, enabled, and equipped for strategic communications, calling it the United States Strategic Communications Agency. An 25 agency like this could ensure that a comprehensive national communications strategy is developed and achieved, with a focus on enabling local community efforts to counter the jihadist narrative. By promoting social outreach, religious education, and community programs, this agency could bolster the efforts of community leaders and stifle jihadist aims in their areas. Support Religious Education and Reintegration Reintegration programs in Saudi Arabia, Indonesia, Singapore and elsewhere have successfully rehabilitated former jihadists through religious education (Venhaus, 2010). Countering the apocalyptic world view of jihadist groups like al-Qaeda and the Islamic State requires local religious leaders who understand their community's issues to band together and refute the extremist narrative. Through careful, patient, and individually-tailored instruction, Muslim religious leaders can invalidate each and every one of the extremists' claims. Individuals who turn to jihad are often seeking this type of direction, they just find it in the wrong places. Counter Threats with Tailored Military Force Packages Continued themes among the military failures in counterinsurgency and counterterrorism operations during the early years of the Global War on Terrorism are indiscriminate use of force, lack of cultural understanding, and hyper-focus on tactical gains while failing at the strategic level. US government nation-building efforts on the backs of the military cost our country trillions of dollars, thousands of lives, and years of frustration, bogged-down in an endless quagmire of misunderstanding. US Army Special Forces are selected, trained, equipped, and enabled to clandestinely handle complex problem sets in denied or politically-sensitive environments. Each Special Forces Group is regionally-aligned, with Operational Detachments developing deep cultural understanding through Area Studies and continuous relationship-building with regional state and 26 non-state actors. Special Forces operators understand the complex cultural and security situations in their areas of responsibility and have the language capability and strategic understanding to operate with complete independence of outside support. Frankly, if given the authority and autonomy to do their jobs, Special Forces can coerce, disrupt, or overthrow jihadist organizations unilaterally, or train, advise, and equip foreign security forces to accomplish this task on their own. This can all be done independent of a large, slow, and expensive conventional military occupation. Organizations like al-Qaeda must be kept in a state of constant fear and uncertainty. US Special Operations Forces are uniquely suited to this task. Through structured, rapid application of military force, SOF can find, fix, and finish intended targets with surgical precision. This has proven true in the capture of Saddam Hussein and the elimination of Osama bin Laden and Abu Bakr al-Baghdadi, among numerous other targets throughout the Global War on Terrorism. Continuing to deny safe havens through short, precise applications of combat power is crucial and does not rely on a conventional military occupation of the target area. Operations such as these, characterized by discriminate use of force and strategic impact, should be the main avenue for denying the relative safety, security, and freedom of maneuver of jihadist organizations. 27 References British Broadcasting Corporation (2017, June 4). Reality check: What is the prevent strategy? Reality Check. https://www.bbc.com/news/election-2017-40151991. Creswell, R., & Haykel, B. (2015, June 1). Battle lines: Want to understand the jihadis? Read their poetry. The New Yorker. https://www.newyorker.com/magazine/2015/06/08/battle-lines-jihad-creswell-and-haykel. Dearden, L. (2015, March 21). Young British Muslims declare own jihad against ISIS and other terrorists who 'hijack' Islam. Independent. https://www.independent.co.uk/news/uk/home-news/young-british-muslims-declare-own-jihad-against-isis-and-other-terrorists-who-hijack-islam-10146534.html. Dempsey, M. (2015). The national military strategy of the United States of America 2015: The United States military's contribution to national security. The Joint Staff. https://www.jcs.mil/Portals/36/Documents/Publications/UNCLASS_2018_National_Military_Strategy_Description.pdf. Gall, C. (2020, January 31). From armed struggle to peaceful protest, a road still to travel: A veteran of the Afghan jihad working for nonviolent change in Algeria. The New York Times. https://www.nytimes.com/2020/01/31/world/middleeast/from-armed-struggle-to-peaceful-protest-a-road-still-to-travel.html. Gorka, S. L. (2016). Defeating jihad: The winnable war. Regnery Publishing. Kilcullen, D. J. (2010). Counterinsurgency. Oxford University Press. Nilsson, M. (2019, 18 June) Motivations for jihad and cognitive dissonance: A qualitative analysis of former Swedish jihadists. Studies in Conflict and Terrorism. https://doi.org/10.1080/1057610X.2019.1626091. 28 Porch, D. (2013). Counterinsurgency: Exposing the myths of the new way of war. Cambridge University Press. Qur'an (M. Ali, Trans.; 7th ed.) (2015). Islam International Publications. (Original work published ca. 1537). Venhaus, J. (2010). Why youth join al-Qaeda. Special Report, 236(1), 1-12. https://www.usip. org/sites/default/files/SR236Venhaus.pdf.

This book offers a contrastive, corpus-illustrated study of modal adverbs in English and Polish. It adopts a functional perspective on modal adverbs, and focuses on their interpersonal, textual and rhetorical functions in the two languages. The items under analysis (e.g. certainly, probably, evidently, clearly) are categorised differently in Anglophone and Polish linguistics, which is why this book also provides some insights into the treatment of modality and modal adverbs in English and Polish studies, thus contributing to the discussion of the ways in which such concepts as modal adverb, modal particle and discourse marker are understood across different languages and different linguistic traditions. It draws its examples from two monolingual corpora (the British National Corpus and the National Corpus of Polish), and the English-Polish parallel corpus Paralela. ; This project is financed from the grant received from the Polish Ministry of Science and Higher Education under the Regional Initiative of Excellence programme for the years 2019-2022; project number 009/RID/2018/19, the amount of funding: PLN 10 947.15. It has also received financial support from the Polish Ministry of Science and Higher Education under subsidy for maintaining the research potential of the Faculty of Philology, University of Białystok. ; a.rozumko@uwb.edu.pl ; Agata Rozumko is an Assistant Professor of English and English-Polish Contrastive Linguistics in the Institute of Modern Languages at the University of Bialystok. 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Quantifying the genetic correlation between cancers can provide important insights into the mechanisms driving cancer etiology. Using genome-wide association study summary statistics across six cancer types based on a total of 296,215 cases and 301,319 controls of European ancestry, here we estimate the pair-wise genetic correlations between breast, colorectal, head/neck, lung, ovary and prostate cancer, and between cancers and 38 other diseases. We observed statistically significant genetic correlations between lung and head/neck cancer (rg = 0.57, p = 4.6 × 10-8), breast and ovarian cancer (rg = 0.24, p = 7 × 10-5), breast and lung cancer (rg = 0.18, p =1.5 × 10-6) and breast and colorectal cancer (rg = 0.15, p = 1.1 × 10-4). We also found that multiple cancers are genetically correlated with non-cancer traits including smoking, psychiatric diseases and metabolic characteristics. Functional enrichment analysis revealed a significant excess contribution of conserved and regulatory regions to cancer heritability. Our comprehensive analysis of cross-cancer heritability suggests that solid tumors arising across tissues share in part a common germline genetic basis. ; he authors in this manuscript were working on behalf of BCAC, CCFR, CIMBA, CORECT, GECCO, OCAC, PRACTICAL, CRUK, BPC3, CAPS, PEGASUS, TRICL- ILCCO, ABCTB, APCB, BCFR, CONSIT TEAM, EMBRACE, GC-HBOC, GEMO, HEBON, kConFab/AOCS Mod SQuaD, and SWE-BRCA. The breast cancer genome-wide association analyses: BCAC is funded by Cancer Research UK [C1287/A16563, C1287/ A10118], the European Union ' s Horizon 2020 Research and Innovation Programme (grant numbers 634935 and 633784 for BRIDGES and B-CAST, respectively), and by the European Community's Seventh Framework Programme under grant agreement number 223175 (grant number HEALTH-F2-2009-223175) (COGS). The EU Horizon 2020 Research and Innovation Programme funding source had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Genotyping of the OncoArray was funded by the NIH Grant U19 CA148065, and Cancer UK Grant C1287/ A16563 and the PERSPECTIVE project supported by the Government of Canada through Genome Canada and the Canadian Institutes of Health Research (grant GPH-129344) and, the Ministère de lÉconomie, Science et Innovation du Québec through Genome Québec and the PSR-SIIRI-701 grant, and the Quebec Breast Cancer Foundation. Funding for the iCOGS infrastructure came from: the European Community 's Seventh Framework.Programme under grant agreement n° 223175 (HEALTH-F2-2009-223175) (COGS), Cancer Research UK (C1287/A10118, C1287/A10710, C12292/A11174, C1281/A12014, C5047/A8384, C5047/A15007, C5047/A10692, C8197/A16565), the National Institutes of Health (CA128978), and Post-Cancer GWAS initiative (1U19 CA148537, 1U19 CA148065, and 1U19 CA148112 — the GAME-ON initiative), the Department of Defence (W81XWH-10-1-0341), the Canadian Institutes of Health Research (CIHR) for the CIHR Team in Familial Risks of Breast Cancer, and Komen Foundation for the Cure, the Breast Cancer Research Foundation, and the Ovarian Cancer Research Fund. The DRIVE Consortium was funded by U19 CA148065. The Australian Breast Cancer Family Study (ABCFS) was supported by grant UM1 CA164920 from the National Cancer Institute (USA). The content of this manuscript does not necessarily re fl ect the views or policies of the National Cancer Institute or any of the collaborating centers in the Breast Cancer Family Registry (BCFR), nor does mention of trade names, commercial products, or organizations imply endorsement by the USA Government or the BCFR. The ABCFS was also supported by the National Health and Medical Research Council of Australia, the New South Wales Cancer Council, the Victorian Health Promotion Foundation (Aus- tralia), and the Victorian Breast Cancer Research Consortium. J.L.H. is a National Health and Medical Research Council (NHMRC) Senior Principal Research Fellow. M.C.S. is a NHMRC Senior Research Fellow. The ABCS study was supported by the Dutch Cancer Society [grants NKI 2007-3839; 2009 4363]. The Australian Breast Cancer Tissue Bank (ABCTB) is generously supported by the National Health and Medical Research Council of Australia, The Cancer Institute NSW and the National Breast Cancer Foundation. The ACP study is funded by the Breast Cancer Research Trust, UK. The AHS study is supported by the intramural research program of the National Institutes of Health, the National Cancer Institute (grant number Z01-CP010119), and the National Institute of Environmental Health Sciences (grant number Z01-ES049030). The work of the BBCC was partly funded by ELAN-Fond of the University Hospital of Erlangen. The BBCS is funded by Cancer Research UK and Breast Cancer Now and acknowledges NHS funding to the NIHR Biomedical Research Centre, and the National Cancer Research Network (NCRN). The BCEES was funded by the National Health and Medical Research Council, Australia and the Cancer Council Western Australia and acknowledges funding from the National Breast Cancer Foundation (JS). For the BCFR-NY, BCFR-PA, and BCFR-UT this work was supported by grant UM1 CA164920 from the National Cancer Institute. The content of this manuscript does not necessarily re fl ect the views or policies of the National Cancer Institute or any of the collaborating centers in the Breast Cancer Family Registry (BCFR), nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or the BCFR. For BIGGS, ES is supported by NIHR Comprehensive Biomedical Research Centre, Guy ' s & St. Thomas ' NHS Foundation Trust in partnership with King ' s College London, United Kingdom. IT is supported by the Oxford Biomedical Research Centre. BOCS is supported by funds from Cancer Research UK (C8620/A8372/A15106) and the Institute of Cancer Research (UK). BOCS acknowledges NHS funding to the Royal Marsden/Institute of Cancer Research NIHR Specialist Cancer Biomedical Research Centre. The BREast Oncology GAlician Network (BREOGAN) is funded by Acción Estratégica de Salud del Instituto de Salud Carlos III FIS PI12/02125/Co fi nanciado FEDER; Acción Estratégica de Salud del Instituto de Salud Carlos III FIS Intrasalud (PI13/01136); Programa Grupos Emergentes, Cancer Genetics Unit, Instituto de Investigacion Biomedica Galicia Sur. Xerencia de Xestion Integrada de Vigo-SERGAS, Instituto de Salud Carlos III, Spain; Grant 10CSA012E, Consellería de Industria Programa Sectorial de Investigación Aplicada, PEME I + DeI + D Suma del Plan Gallego de Investigación, Desarrollo e Innovación Tecnológica de la Consellería de Industria de la Xunta de Galicia, Spain; Grant EC11-192. Fomento de la Investigación Clínica Independiente, Ministerio de Sanidad, Servicios Sociales e Igualdad, Spain; and Grant FEDER-Innterconecta. Ministerio de Economia y Competitividad, Xunta de Gali- cia, Spain. The BSUCH study was supported by the Dietmar-Hopp Foundation, the Helmholtz Society and the German Cancer Research Center (DKFZ). The CAMA study was funded by Consejo Nacional de Ciencia y Tecnología (CONACyT) (SALUD-2002- C01-7462). Sample collection and processing was funded in part by grants from the National Cancer Institute (NCI R01CA120120 and K24CA169004). CBCS is funded by the Canadian Cancer Society (grant # 313404) and the Canadian Institutes of Health Research. CCGP is supported by funding from the University of Crete. The CECILE study was supported by Fondation de France, Institut National du Cancer (INCa), Ligue Nationale contre le Cancer, Agence Nationale de Sécurité Sanitaire, de l ' Alimentation, de l ' Environnement et du Travail (ANSES), Agence Nationale de la Recherche (ANR). The CGPS was supported by the Chief Physician Johan Boserup and Lise Boserup Fund, the Danish Medical Research Council, and Herlev and Gentofte Hospital. The CNIO-BCS was supported by the Instituto de Salud Carlos III, the Red Temática de Investigación Cooperativa en Cáncer and grants from the Asociación Española Contra el Cáncer and the Fondo de Investigación Sanitario (PI11/00923 and PI12/00070). COLBCCC is sup- ported by the German Cancer Research Center (DKFZ), Heidelberg, Germany. D.T. was in part supported by a postdoctoral fellowship from the Alexander von Humboldt Foundation. The American Cancer Society funds the creation, maintenance, and updating of the CPS-II cohort. The CTS was initially supported by the California Breast Cancer Act of 1993 and the California Breast Cancer Research Fund (contract 97-10500) and is currently funded through the National Institutes of Health (R01 CA77398, UM1 CA164917, and U01 CA199277). Collection of cancer incidence data was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885. H.A.C eceives support from the Lon V Smith Foundation (LVS39420). The University of Westminster curates the DietCompLyf database funded by Against Breast Cancer Registered Charit.No. 1121258 and the NCRN. The coordination of EPIC is fi nancially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by: Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l ' Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), Federal Ministry of Education and Research (BMBF) (Germany); the Hellenic Health Foundation, the Stavros Niarchos Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Neth- erlands); Health Research Fund (FIS), PI13/00061 to Granada, PI13/01162 to EPIC- Murcia, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, ISCIII RETIC (RD06/0020) (Spain); Cancer Research UK (14136 to EPIC- Norfolk; C570/A16491 and C8221/A19170 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk, MR/M012190/1 to EPIC-Oxford) (United Kingdom). The ESTHER study was supported by a grant from the Baden Württemberg Ministry of Science, Research and Arts. Additional cases were recruited in the context of the VERDI study, which was supported by a grant from the German Cancer Aid (Deutsche Kreb- shilfe). FHRISK is funded from NIHR grant PGfAR 0707-10031. The GC-HBOC (Ger- man Consortium of Hereditary Breast and Ovarian Cancer) is supported by the German Cancer Aid (grant no 110837, coordinator: Rita K. Schmutzler, Cologne). This work was also funded by the European Regional Development Fund and Free State of Saxony, Germany (LIFE - Leipzig Research Centre for Civilization Diseases, project numbers 713- 241202, 713-241202, 14505/2470, and 14575/2470). The GENICA was funded by the Federal Ministry of Education and Research (BMBF) Germany grants 01KW9975/5, 01KW9976/8, 01KW9977/0, and 01KW0114, the Robert Bosch Foundation, Stuttgart, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, the Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, as well as the Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany. The GEPARSIXTO study was conducted by the German Breast Group GmbH. The GESBC was supported by the Deutsche Krebshilfe e. V. [70492] and the German Cancer Research Center (DKFZ). GLACIER was supported by Breast Cancer Now, CRUK and Biomedical Research Centre at Guy ' s and St Thomas ' NHS Foundation Trust and King ' s College London. The HABCS study was supported by the Claudia von Schilling Foundation for Breast Cancer Research, by the Lower Saxonian Cancer Society, and by the Rudolf- Bartling Foundation. The HEBCS was fi nancially supported by the Helsinki University Central Hospital Research Fund, Academy of Finland (266528), the Finnish Cancer Society, and the Sigrid Juselius Foundation. The HERPACC was supported by MEXT Kakenhi (No. 170150181 and 26253041) from the Ministry of Education, Science, Sports, Culture and Technology of Japan, by a Grant-in-Aid for the Third Term Comprehensive 10-Year Strategy for Cancer Control from Ministry Health, Labour and Welfare of Japan, by Health and Labour Sciences Research Grants for Research on Applying Health Technology from Ministry Health, Labour and Welfare of Japan, by National Cancer Center Research and Development Fund, and " Practical Research for Innovative Cancer Control (15ck0106177h0001) " from Japan Agency for Medical Research and develop- ment, AMED, and Cancer Bio Bank Aichi. The HMBCS was supported by a grant from the Friends of Hannover Medical School and by the Rudolf Bartling Foundation. The HUBCS was supported by a grant from the German Federal Ministry of Research and Education (RUS08/017), and by the Russian Foundation for Basic Research and the Federal Agency for Scienti fi c Organizations for support the Bioresource collections and RFBR grants 14-04-97088, 17-29-06014, and 17-44-020498. ICICLE was supported by Breast Cancer Now, CRUK, and Biomedical Research Centre at Guy ' s and St Thomas ' NHS Foundation Trust and King ' s College London. Financial support for KARBAC was provided through the regional agreement on medical training and clinical research (A.L. F.) between Stockholm County Council and Karolinska Institutet, the Swedish Cancer Society, The Gustav V Jubilee foundation and Bert von Kantzows foundation. The KARMA study was supported by Märit and Hans Rausings Initiative Against Breast Cancer. The KBCP was fi nancially supported by the special Government Funding (E.V. O.) of Kuopio University Hospital grants, Cancer Fund of North Savo, the Finnish Cancer Organizations, and by the strategic funding of the University of Eastern Finland. kConFab is supported by a grant from the National Breast Cancer Foundation, and previously by the National Health and Medical Research Council (NHMRC), the Queensland Cancer Fund, the Cancer Councils of New South Wales, Victoria, Tasmania and South Australia, and the Cancer Foundation of Western Australia. Financial support for the AOCS was provided by the United States Army Medical Research and Materiel Command [DAMD17-01-1-0729], Cancer Council Victoria, Queensland Cancer Fund, Cancer Council New South Wales, Cancer Council South Australia, The Cancer Foundation of Western Australia, Cancer Council Tasmania and the National Health and Medical Research Council of Australia (NHMRC; 400413, 400281, 199600). G.C.-T. and P.W. are supported by the NHMRC. RB was a Cancer Institute NSW Clinical Research Fellow. The KOHBRA study was partially supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), and the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (HI16C1127; 1020350; 1420190). LAABC is supported by grants (1RB-0287, 3PB- 0102, 5PB-0018, 10PB-0098) from the California Breast Cancer Research Program. Incident breast cancer cases were collected by the USC Cancer Surveillance Program (CSP) which is supported under subcontract by the California Department of Health. TheCSP is also part of the National Cancer Institute ' s Division of Cancer Prevention and Control Surveillance, Epidemiology, and End Results Program, under contract number N01CN25403. L.M.B.C. is supported by the ' Stichting tegen Kanker ' . D.L. is supported by the FWO. The MABCS study is funded by the Research Centre for Genetic Engineering and Biotechnology " Georgi D. Efremov " and supported by the German Academic Exchange Program, DAAD. The MARIE study was supported by the Deutsche Krebshilfe e.V. [70-2892-BR I, 106332, 108253, 108419, 110826, 110828], the Hamburg Cancer Society, the German Cancer Research Center (DKFZ) and the Federal Ministry of Edu- cation and Research (BMBF) Germany [01KH0402]. MBCSG is supported by grants from the Italian Association for Cancer Research (AIRC) and by funds from the Italian citizens who allocated the 5/1000 share of their tax payment in support of the Fondazione IRCCS Istituto Nazionale Tumori, according to Italian laws (INT-Institutional strategic projects " 5 × 1000 " ). The MCBCS was supported by the NIH grants CA192393, CA116167, CA176785 an NIH Specialized Program of Research Excellence (SPORE) in Breast Cancer [CA116201], and the Breast Cancer Research Foundation and a generous gift from the David F. and Margaret T. Grohne Family Foundation. MCCS cohort recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further supported by Australian NHMRC grants 209057 and 396414, and by infrastructure provided by Cancer Council Victoria. Cases and their vital status were ascertained through the Victorian Cancer Registry (VCR) and the Australian Institute of Health and Welfare (AIHW), including the National Death Index and the Australian Cancer Database. The MEC was support by NIH grants CA63464, CA54281, CA098758, CA132839, and CA164973. The MISS study is supported by funding from ERC-2011-294576 Advanced grant, Swedish Cancer Society, Swedish Research Council, Local hospital funds, Berta Kamprad Foun- dation, Gunnar Nilsson. The MMHS study was supported by NIH grants CA97396, CA128931, CA116201, CA140286, and CA177150. MSKCC is supported by grants from the Breast Cancer Research Foundation and Robert and Kate Niehaus Clinical Cancer Genetics Initiative. The work of MTLGEBCS was supported by the Quebec Breast Cancer Foundation, the Canadian Institutes of Health Research for the " CIHR Team in Familial Risks of Breast Cancer " program – grant # CRN-87521 and the Ministry of Economic Development, Innovation and Export Trade – grant # PSR-SIIRI-701. MYBRCA is funded by research grants from the Malaysian Ministry of Higher Education (UM.C/HlR/MOHE/ 06) and Cancer Research Malaysia. MYMAMMO is supported by research grants from Yayasan Sime Darby LPGA Tournament and Malaysian Ministry of Higher Education (RP046B-15HTM). The NBCS has been supported by the Research Council of Norway grant 193387/V50 (to A.-L. Børresen-Dale and V.N. Kristensen) and grant 193387/H10 (to A.-L. Børresen-Dale and V.N. Kristensen), South Eastern Norway Health Authority (grant 39346 to A.-L. Børresen-Dale and 27208 to V.N. Kristensen) and the Norwegian Cancer Society (to A.-L. Børresen-Dale and 419616 - 71248 - PR-2006-0282 to V.N. Kristensen). It has received funding from the K.G. Jebsen Centre for Breast Cancer Research (2012-2015). The NBHS was supported by NIH grant R01CA100374. Biological sample preparation was conducted the Survey and Biospecimen Shared Resource, which is supported by P30 CA68485. The Northern California Breast Cancer Family Registry (NC- BCFR) and Ontario Familial Breast Cancer Registry (OFBCR) were supported by grant UM1 CA164920 from the National Cancer Institute (USA). The content of this manu- script does not necessarily re fl ect the views or policies of the National Cancer Institute or any of the collaborating centers in the Breast Cancer Family Registry (BCFR), nor does mention of trade names, commercial products, or organizations imply endorsement by the USA Government or the BCFR. The Carolina Breast Cancer Study was funded by Komen Foundation, the National Cancer Institute (P50 CA058223, U54 CA156733, and U01 CA179715), and the North Carolina University Cancer Research Fund. The NGOBCS was supported by Grants-in-Aid for the Third Term Comprehensive Ten-Year Strategy for Cancer Control from the Ministry of Health, Labor and Welfare of Japan, and for Scienti fi c Research on Priority Areas, 17015049 and for Scienti fi c Research on Innovative Areas, 221S0001, from the Ministry of Education, Culture, Sports, Science, and Technology of Japan. The NHS was supported by NIH grants P01 CA87969, UM1 CA186107, and U19 CA148065. The NHS2 was supported by NIH grants UM1 CA176726 and U19 CA148065. The OBCS was supported by research grants from the Finnish Cancer Foundation, the Academy of Finland (grant number 250083, 122715 and Center of Excellence grant number 251314), the Finnish Cancer Foundation, the Sigrid Juselius Foundation, the University of Oulu, the University of Oulu Support Foundation, and the special Governmental EVO funds for Oulu University Hospital-based research activities. The ORIGO study was supported by the Dutch Cancer Society (RUL 1997- 1505) and the Biobanking and Biomolecular Resources Research Infrastructure (BBMRI- NL CP16). The PBCS was funded by Intramural Research Funds of the National Cancer Institute, Department of Health and Human Services, USA. Genotyping for PLCO was supported by the Intramural Research Program of the National Institutes of Health, NCI, Division of Cancer Epidemiology and Genetics. The PLCO is supported by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics and supported by contracts from the Division of Cancer Prevention, National Cancer Institute, National Institutes of Health. The POSH study is funded by Cancer Research UK (grants C1275/ A11699, C1275/C22524, C1275/A19187, C1275/A15956, and Breast Cancer Campaign 2010PR62, 2013PR044. PROCAS is funded from NIHR grant PGfAR 0707-10031. The RBCS was funded by the Dutch Cancer Society (DDHK 2004-3124, DDHK 2009-4318). The SASBAC study was supported by funding from the Agency for Science, Technology and Research of Singapore (A*STAR), the US National Institute of Health (NIH) and the Susan G. Komen Breast Cancer Foundation. The SBCGS was supported primarily by NIH grants R01CA64277, R01CA148667, UMCA182910, and R37CA70867. Biological sample preparation was conducted the Survey and Biospecimen Shared Resource, which is supported by P30 CA68485. The scienti fi c development and funding of this project were, in part, supported by the Genetic Associations and Mechanisms in Oncology (GAME- ON) Network U19 CA148065. The SBCS was supported by Shef fi eld Experimental Cancer Medicine Centre and Breast Cancer Now Tissue Bank. The SCCS is supported by a grant from the National Institutes of Health (R01 CA092447). Data on SCCS cancer cases used in this publication were provided by the Alabama Statewide Cancer Registry; Kentucky Cancer Registry, Lexington, KY; Tennessee Department of Health, Of fi ce of Cancer Surveillance; Florida Cancer Data System; North Carolina Central Cancer Registry, North Carolina Division of Public Health; Georgia Comprehensive Cancer Registry; Louisiana Tumor Registry; Mississippi Cancer Registry; South Carolina Central Cancer Registry; Virginia Department of Health, Virginia Cancer Registry; Arkansas Department of Health, Cancer Registry, 4815 W. Markham, Little Rock, AR 72205. The Arkansas Central Cancer Registry is fully funded by a grant from National Program of Cancer Registries, Centers for Disease Control and Prevention (CDC). Data on SCCS cancer cases from Mississippi were collected by the Mississippi Cancer Registry which participates in the National Program of Cancer Registries (NPCR) of the Centers for Disease Control and Prevention (CDC). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the of fi cial views of the CDC or the Mississippi Cancer Registry. SEARCH is funded by Cancer Research UK [C490/A10124, C490/ A16561] and supported by the UK National Institute for Health Research Biomedical Research Centre at the University of Cambridge. The University of Cambridge has received salary support for PDPP from the NHS in the East of England through the Clinical Academic Reserve. SEBCS was supported by the BRL (Basic Research Laboratory) program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2012-0000347). SGBCC is funded by the NUS start- up Grant, National University Cancer Institute Singapore (NCIS) Centre Grant and the NMRC Clinician Scientist Award. Additional controls were recruited by the Singapore Consortium of Cohort Studies-Multi-ethnic cohort (SCCS-MEC), which was funded by the Biomedical Research Council, grant number: 05/1/21/19/425. The Sister Study (SIS- TER) is supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01-ES044005 and Z01-ES049033). The Two Sister Study (2SISTER) was supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01-ES044005 and Z01-ES102245), and, also by a grant from Susan G. Komen for the Cure, grant FAS0703856. SKKDKFZS is supported by the DKFZ. The SMC is funded by the Swedish Cancer Foundation. The SZBCS was supported by Grant PBZ_KBN_122/P05/2004. The TBCS was funded by The National Cancer Institute, Thailand. The TNBCC was supported by a Specialized Program of Research Excellence (SPORE) in Breast Cancer (CA116201), a grant from the Breast Cancer Research Foundation, a generous gift from the David F. and Margaret T. Grohne Family Foundation. The TWBCS is supported by the Taiwan Biobank project of the Institute of Biomedical Sciences, Academia Sinica, Taiwan. The UCIBCS component of this research was supported by the NIH [CA58860, CA92044] and the Lon V Smith Foundation [LVS39420]. The UKBGS is funded by Breast Cancer Now and the Institute of Cancer Research (ICR), London. ICR acknowledges NHS funding to the NIHR Bio- medical Research Centre. The UKOPS study was funded by The Eve Appeal (The Oak Foundation) and supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. The US3SS study was supported by Massachusetts (K.M.E., R01CA47305), Wisconsin (P.A.N., R01 CA47147) and New Hampshire (L.T.-E., R01CA69664) centers, and Intramural Research Funds of the National Cancer Institute, Department of Health and Human Services, USA. The USRT Study was funded by Intramural Research Funds of the National Cancer Institute, Department of Health and Human Services, USA. The WAABCS study was supported by grants from the National Cancer Institute of the National Institutes of Health (R01 CA89085 and P50 CA125183 and the D43 TW009112 grant), Susan G. Komen (SAC110026), the Dr. Ralph and Marian Falk Medical Research Trust, and the Avon Foundation for Women. The WHI program is funded by the National Heart, Lung, and Blood Institute, the US National Institutes of Health and the US Department of Health and Human Services (HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C). This work was also funded by NCI U19 CA148065-01. D.G.E. is supported by the all Manchester NIHR Biomedical research center Manchester (IS-BRC- 1215-20007). HUNBOCS, Hungarian Breast and Ovarian Cancer Study was supported by Hungarian Research Grant KTIA-OTKA CK-80745, NKFI_OTKA K-112228. C.I. received support from the Nontherapeutic Subject Registry Shared Resource at George- town University (NIH/NCI P30-CA-51008) and the Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research. K.M. is supported by CRUK C18281/ A19169. City of Hope Clinical Cancer Community Research Network and the Hereditary Cancer Research Registry, supported in part by Award Number RC4CA153828 (PI: J Weitzel) from the National Cancer Institute and the of fi ce of the Directory, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the of fi cial views of the National Institutes of Health. The colorectal cancer genome-wide association analyses: Colorectal Transdisciplinary Study (CORECT): The content of this manuscript does not necessarily re fl ect the views or policies of the National Cancer Institute or any of the collaborating centers in the CORECT Consortium, nor does mention of trade names, commercial products or organizations imply endor- sement by the US Government or the CORECT Consortium. We are incredibly grateful for the contributions of Dr. Brian Henderson and Dr. Roger Green over the course of this study and acknowledge them in memoriam. We are also grateful for support from Daniel and Maryann Fong. ColoCare: we thank the many investigators and staff who made thisHHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN26 8201600004C. The head and neck cancer genome-wide association analyses: The study was supported by NIH/NCI: P50 CA097190, and P30 CA047904, Canadian Cancer Society Research Institute (no. 020214) and Cancer Care Ontario Research Chair to R.H. The Princess Margaret Hospital Head and Neck Cancer Translational Research Program is funded by the Wharton family, Joe ' s Team, Gordon Tozer, Bruce Galloway and the Elia family. Geoffrey Liu was supported by the Posluns Family Fund and the Lusi Wong Family Fund at the Princess Margaret Foundation, and the Alan B. Brown Chair in Molecular Genomics. This publication presents data from Head and Neck 5000 (H&N5000). H&N5000 was a component of independent research funded by the UK National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10034). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Human papillomavirus (HPV) in H&N5000 serology was supported by a Cancer Research UK Programme Grant, the Integrative Cancer Epidemiology Programme (grant number: C18281/A19169). National Cancer Institute (R01-CA90731); National Institute of Environmental Health Sciences (P30ES10126). The authors thank all the members of the GENCAPO team/The Head and Neck Genome Project (GENCAPO) was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (Grant numbers 04/12054-9 and 10/51168-0). CPS-II recruitment and maintenance is supported with intramural research funding from the American Cancer Society. Genotyping per- formed at the Center for Inherited Disease Research (CIDR) was funded through the U.S. National Institute of Dental and Craniofacial Research (NIDCR) grant 1 × 01HG007780- 0. The University of Pittsburgh head and neck cancer case-control study is supported by National Institutes of Health grants P50 CA097190 and P30 CA047904. The Carolina Head and Neck Cancer Study (CHANCE) was supported by the National Cancer Institute (R01-CA90731). The Head and Neck Genome Project (GENCAPO) was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (Grant numbers 04/ 12054-9 and 10/51168-0). The authors thank all the members of the GENCAPO team. The HN5000 study was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10034), the views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The Toronto study was funded by the Canadian Cancer Society Research Institute (020214) and the National Cancer Institute (U19-CA148127) and the Cancer Care Ontario Research Chair. The alcohol-related cancers and genetic susceptibility study in Europe (ARCAGE) was funded by the Eur- opean Commission ' s 5th Framework Program (QLK1-2001-00182), the Italian Associa- tion for Cancer Research, Compagnia di San Paolo/FIRMS, Region Piemonte, and Padova University (CPDA057222). The Rome Study was supported by the Associazione Italiana per la Ricerca sul Cancro (AIRC) IG 2011 10491 and IG2013 14220 to S.B., and Fon- dazione Veronesi to S.B. The IARC Latin American study was funded by the European Commission INCO-DC programme (IC18-CT97-0222), with additional funding from Fondo para la Investigacion Cienti fi ca y Tecnologica (Argentina) and the Fundação de Amparo à Pesquisa do Estado de São Paulo (01/01768-2). We thank Leticia Fernandez, Instituto Nacional de Oncologia y Radiobiologia, La Habana, Cuba and Sergio and Rosalina Koifman, for their efforts with the IARC Latin America study São Paulo center. The IARC Central Europe study was supported by European Commission ' s INCO- COPERNICUS Program (IC15- CT98-0332), NIH/National Cancer Institute grant CA92039, and the World Cancer Research Foundation grant WCRF 99A28. The IARC Oral Cancer Multicenter study was funded by grant S06 96 202489 05F02 from Europe against Cancer; grants FIS 97/0024, FIS 97/0662, and BAE 01/5013 from Fondo de Investigaciones Sanitarias, Spain; the UICC Yamagiwa-Yoshida Memorial International Cancer Study; the National Cancer Institute of Canada; Associazione Italiana per la Ricerca sul Cancro; and the Pan-American Health Organization. Coordination of the EPIC study is fi nancially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The lung cancer genome-wide association analyses: Transdisciplinary Research for Cancer in Lung (TRICL) of the International Lung Cancer Consortium (ILCCO) was supported by (U19-CA148127, CA148127S1, U19CA203654, and Cancer Prevention Research Institute of Texas RR170048). The ILCCO data harmonization is supported by Cancer Care Ontario Research Chair of Population Studies to R. H. and Lunenfeld-Tanenbaum Research Institute, Sinai Health System. The TRICL-ILCCO OncoArray was supported by in-kind genotyping by the Centre for Inherited Disease Research (26820120008i-0-26800068-1). The CAPUA study was supported by FIS-FEDER/Spain grant numbers FIS-01/310, FIS-PI03-0365, and FIS- 07-BI060604, FICYT/Asturias grant numbers FICYT PB02-67 and FICYT IB09-133, and the University Institute of Oncology (IUOPA), of the University of Oviedo and the Ciber de Epidemiologia y Salud Pública. CIBERESP, SPAIN. The work performed in the CARET study was supported by the National Institute of Health/National Cancer Insti- tute: UM1 CA167462 (PI: Goodman), National Institute of Health UO1-CA6367307 (PIs Omen, Goodman); National Institute of Health R01 CA111703 (PI Chen), National Institute of Health 5R01 CA151989-01A1(PI Doherty). The Liverpool Lung project is supported by the Roy Castle Lung Cancer Foundation. The Harvard Lung Cancer Study was supported by the NIH (National Cancer Institute) grants CA092824, CA090578, CA074386. The Multi-ethnic Cohort Study was partially supported by NIH Grants CA164973, CA033619, CA63464, and CA148127. The work performed in MSH-PMH study was supported by The Canadian Cancer Society Research Institute (020214), Ontario Institute of Cancer and Cancer Care Ontario Chair Award to R.J.H. and G.L. and the Alan Brown Chair and Lusi Wong Programs at the Princess Margaret Hospital Foundation. NJLCS was funded by the State Key Program of National Natural Science ofChina (81230067), the National Key Basic Research Program Grant (2011CB503805), the Major Program of the National Natural Science Foundation of China (81390543). The Norway study was supported by Norwegian Cancer Society, Norwegian Research Council. The Shanghai Cohort Study (SCS) was supported by National Institutes of Health R01 CA144034 (PI: Yuan) and UM1 CA182876 (PI: Yuan). The Singapore Chinese Health Study (SCHS) was supported by National Institutes of Health R01 CA144034 (PI: Yuan) and UM1 CA182876 (PI: Yuan). The work in TLC study has been supported in part the James & Esther King Biomedical Research Program (09KN-15), National Institutes of Health Specialized Programs of Research Excellence (SPORE) Grant (P50 CA119997), and by a Cancer Center Support Grant (CCSG) at the H. Lee Mof fi tt Cancer Center and Research Institute, an NCI designated Comprehensive Cancer Center (grant number P30- CA76292). The Vanderbilt Lung Cancer Study — BioVU dataset used for the analyses described was obtained from Vanderbilt University Medical Center ' s BioVU, which is supported by institutional funding, the 1S10RR025141-01 instrumentation award, and by the Vanderbilt CTSA grant UL1TR000445 from NCATS/NIH. Dr. Aldrich was supported by NIH/National Cancer Institute K07CA172294 (PI: Aldrich) and Dr. Bush was sup- ported by NHGRI/NIH U01HG004798 (PI: Crawford). The Copenhagen General Population Study (CGPS) was supported by the Chief Physician Johan Boserup and Lise Boserup Fund, the Danish Medical Research Council and Herlev Hospital. The NELCS study: Grant Number P20RR018787 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH). The Kentucky Lung Cancer Research Initiative was supported by the Department of Defense [Congressionally Directed Medical Research Program, U.S. Army Medical Research and Materiel Com- mand Program] under award number: 10153006 (W81XWH-11-1-0781). Views and opinions of, and endorsements by the author(s) do not re fl ect those of the US Army or the Department of Defense. This research was also supported by unrestricted infrastructure funds from the UK Center for Clinical and Translational Science, NIH grant UL1TR000117 and Markey Cancer Center NCI Cancer Center Support Grant (P30 CA177558) Shared Resource Facilities: Cancer Research Informatics, Biospecimen and Tissue Procurement, and Biostatistics and Bioinformatics. The M.D. Anderson Cancer Center study was supported in part by grants from the NIH (P50 CA070907, R01 CA176568) (to X.W.), Cancer Prevention & Research Institute of Texas (RP130502) (to X. W.), and The University of Texas MD Anderson Cancer Center institutional support for the Center for Translational and Public Health Genomics. The deCODE study of smoking and nicotine dependence was funded in part by a grant from NIDA (R01- DA017932). The study in Lodz center was partially funded by Nofer Institute of Occupational Med- icine, under task NIOM 10.13: Predictors of mortality from non-small cell lung cancer — fi eld study. Genetic sharing analysis was funded by NIH grant CA194393. The research undertaken by M.D.T., L.V.W., and M.S.A. was partly funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. M.D.T. holds a Medical Research Council Senior Clinical Fellowship (G0902313). The work to assemble the FTND GWAS meta-analysis was supported by the National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA) grant number R01 DA035825 (Prin- cipal Investigator [PI]: DBH). The study populations included COGEND (dbGaP phs000092.v1.p1 and phs000404.v1.p1), COPDGene (dbGaP phs000179.v3.p2), deCODE Genetics, EAGLE (dbGaP phs000093.vs.p2), and SAGE. dbGaP phs000092.v1.p1). See Hancock et al. Transl Psychiatry 2015 (PMCID: PMC4930126) for the full listing of funding sources and other acknowledgments. The Resource for the Study of Lung Cancer Epidemiology in North Trent (ReSoLuCENT)study was funded by the Shef fi eld Hospitals Charity, Shef fi eld Experimental Cancer Medicine Centre and Weston Park Hospital Cancer Charity. The ovarian cancer genome-wide association analysis: The Ovarian Cancer Association Consortium (OCAC) is supported by a grant from the Ovarian Cancer Research Fund thanks to donations by the family and friends of Kathryn Sladek Smith (PPD/RPCI.07). The scienti fi c development and funding for this project were in part supported by the US National Cancer Institute GAME-ON Post-GWAS Initiative (U19-CA148112). This study made use of data generated by the Wellcome Trust Case Control consortium that was funded by the Wellcome Trust under award 076113. The results published here are in part based upon data generated by The Cancer Genome Atlas Pilot Project established by the National Cancer Institute and National Human Genome Research Institute (dbGap accession number phs000178.v8.p7). The OCAC OncoArray genotyping project was funded through grants from the U.S. National Institutes of Health (CA1X01HG007491-01 (C.I.A.), U19-CA148112 (T.A.S.), R01-CA149429 (C.M.P.), and R01-CA058598 (M.T.G.); Canadian Institutes of Health Research (MOP-86727 (L.E.K.) and the Ovarian Cancer Research Fund (A.B.). The COGS project was funded through a European Commission ' s Seventh Framework Programme grant (agreement number 223175 - HEALTH-F2-2009-223175) and through a grant from the U.S. National Insti- tutes of Health (R01-CA122443 (E.L.G)). Funding for individual studies: AAS: National Institutes of Health (RO1-CA142081); AOV: The Canadian Institutes for Health Research (MOP-86727); AUS: The Australian Ovarian Cancer Study Group was supported by the U.S. Army Medical Research and Materiel Command (DAMD17-01-1-0729), National Health & Medical Research Council of Australia (199600, 400413 and 400281), Cancer Councils of New South Wales, Victoria, Queensland, South Australia and Tas- mania and Cancer Foundation of Western Australia (Multi-State Applications 191, 211, and 182). The Australian Ovarian Cancer Study gratefully acknowledges additional support from Ovarian Cancer Australia and the Peter MacCallum Foundation; BAV: ELAN Funds of the University of Erlangen-Nuremberg; BEL: National Kankerplan; BGS: Breast Cancer Now, Institute of Cancer Research; BVU: Vanderbilt CTSA grant from the National Institutes of Health (NIH)/National Center for Advancing Translational SciencesNCATS) (ULTR000445); CAM: National Institutes of Health Research Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Cancer Centre; CHA: Innovative Research Team in University (PCSIRT) in China (IRT1076); CNI: Instituto de Salud Carlos III (PI12/01319); Ministerio de Economía y Competitividad (SAF2012); COE: Department of Defense (W81XWH-11-2-0131); CON: National Institutes of Health (R01-CA063678, R01-CA074850; and R01-CA080742); DKE: Ovarian Cancer Research Fund; DOV: National Institutes of Health R01-CA112523 and R01-CA87538; EMC: Dutch Cancer Society (EMC 2014-6699); EPC: The coordination of EPIC is fi nancially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l ' Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), Federal Ministry of Education and Research (BMBF) (Germany); the Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway); Health Research Fund (FIS), PI13/00061 to Granada, PI13/01162 to EPIC-Murcia, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, ISCIII RETIC (RD06/0020) (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC- Norfolk; C570/A16491 and C8221/A19170 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk, MR/M012190/1 to EPIC-Oxford) (United Kingdom); GER: German Federal Ministry of Education and Research, Programme of Clinical Biomedical Research (01 GB 9401) and the German Cancer Research Center (DKFZ); GRC: This research has been co- fi nanced by the European Union (European Social Fund — ESF) and Greek national funds through the Operational Program " Education and Lifelong Learn- ing " of the National Strategic Reference Framework (NSRF) — Research Funding Program of the General Secretariat for Research & Technology: SYN11_10_19 NBCA. Investing in knowledge society through the European Social Fund; GRR: Roswell Park Cancer Institute Alliance Foundation, P30 CA016056; HAW: U.S. National Institutes of Health (R01- CA58598, N01-CN-55424, and N01-PC-67001); HJO: Intramural funding; Rudolf- Bartling Foundation; HMO: Intramural funding; Rudolf-Bartling Foundation; HOC: Helsinki University Research Fund; HOP: Department of Defense (DAMD17-02-1-0669) and NCI (K07-CA080668, R01-CA95023, P50-CA159981 MO1-RR000056 R01- CA126841); HUO: Intramural funding; Rudolf-Bartling Foundation; JGO: JSPS KAKENHI grant; JPN: Grant-in-Aid for the Third Term Comprehensive 10-Year Strategy for Cancer Control from the Ministry of Health, Labour and Welfare; KRA: This study (Ko-EVE) was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), and the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (HI16C1127; 0920010); LAX: American Cancer Society Early Detection Professorship (SIOP-06-258-01-COUN) and the National Center for Advancing Translational Sciences (NCATS), Grant UL1TR000124; LUN: ERC-2011-AdG 294576-risk factors cancer, Swedish Cancer Society, Swedish Research Council, Beta Kamprad Foundation; MAC: National Institutes of Health (R01-CA122443, P30-CA15083, P50-CA136393); Mayo Foundation; Minnesota Ovarian Cancer Alliance; Fred C. and Katherine B. Andersen Foundation; Fraternal Order of Eagles; MAL: Funding for this study was provided by research grant R01- CA61107 from the National Cancer Institute, Bethesda, MD, research grant 94 222 52 from the Danish Cancer Society, Copenhagen, Denmark; and the Mer- maid I project; MAS: Malaysian Ministry of Higher Education (UM.C/HlR/MOHE/06) and Cancer Research Initiatives Foundation; MAY: National Institutes of Health (R01- CA122443, P30-CA15083, and P50-CA136393); Mayo Foundation; Minnesota Ovarian Cancer Alliance; Fred C. and Katherine B. Andersen Foundation; MCC: Cancer Council Victoria, National Health and Medical Research Council of Australia (NHMRC) grants number 209057, 251533, 396414, and 504715; MDA: DOD Ovarian Cancer Research Program (W81XWH-07-0449); MEC: NIH (CA54281, CA164973, CA63464); MOF: Mof fi tt Cancer Center, Merck Pharmaceuticals, the state of Florida, Hillsborough County, and the city of Tampa; NCO: National Institutes of Health (R01-CA76016) and the Department of Defense (DAMD17-02-1-0666); NEC: National Institutes of Health R01- CA54419 and P50-CA105009 and Department of Defense W81XWH-10-1-02802; NHS: UM1 CA186107, P01 CA87969, R01 CA49449, R01-CA67262, UM1 CA176726; NJO: National Cancer Institute (NIH-K07 CA095666, R01-CA83918, NIH-K22-CA138563, and P30-CA072720) and the Cancer Institute of New Jersey; If Sara Olson and/or Irene Orlow is a co-author, please add NCI CCSG award (P30-CA008748) to the funding sources; NOR: Helse Vest, The Norwegian Cancer Society, The Research Council of Norway; NTH: Radboud University Medical Centre; OPL: National Health and Medical Research Council (NHMRC) of Australia (APP1025142) and Brisbane Women ' s Club; ORE: OHSU Foundation; OVA: This work was supported by Canadian Institutes of Health Research grant (MOP-86727) and by NIH/NCI 1 R01CA160669-01A1; PLC: Intramural Research Program of the National Cancer Institute; POC: Pomeranian Medical Uni- versity; POL: Intramural Research Program of the National Cancer Institute; PVD: Canadian Cancer Society and Cancer Research Society GRePEC Program; RBH: National Health and Medical Research Council of Australia; RMH: Cancer Research UK, Royal Marsden Hospital; RPC: National Institute of Health (P50-CA159981, R01-CA126841); SEA: Cancer Research UK (C490/A10119 C490/A10124); UK National Institute forHealth Research Biomedical Research Centres at the University of Cambridge; SIS: NIH, National Institute of Environmental Health Sciences, Z01-ES044005 and Z01-ES049033; SMC: The bbSwedish Research Council-SIMPLER infrastructure; the Swedish Cancer Foundation; SON: National Health Research and Development Program, Health Canada, grant 6613-1415-53; SRO: Cancer Research UK (C536/A13086, C536/A6689) and Imperial Experimental Cancer Research Centre (C1312/A15589); STA: NIH grants U01 CA71966 and U01 CA69417; SWE: Swedish Cancer foundation, WeCanCureCancer and VårKampMotCancer foundation; SWH: NIH (NCI) grant R37-CA070867; TBO: National Institutes of Health (R01-CA106414-A2), American Cancer Society (CRTG-00-196-01- CCE), Department of Defense (DAMD17-98-1-8659), Celma Mastery Ovarian Cancer Foundation; TOR: NIH grants R01-CA063678 and R01 CA063682; UCI: NIH R01- CA058860 and the Lon V Smith Foundation grant LVS39420; UHN: Princess Margaret Cancer Centre Foundation-Bridge for the Cure; UKO: The UKOPS study was funded by The Eve Appeal (The Oak Foundation) and supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre; UKR: Cancer Research UK (C490/A6187), UK National Institute for Health Research Biomedical Research Centres at the University of Cambridge; USC: P01CA17054, P30CA14089, R01CA61132, N01PC67010, R03CA113148, R03CA115195, N01CN025403, and Cali- fornia Cancer Research Program (00-01389V-20170, 2II0200); VAN: BC Cancer Foun- dation, VGH & UBC Hospital Foundation; VTL: NIH K05-CA154337; WMH: National Health and Medical Research Council of Australia, Enabling Grants ID 310670 & ID 628903. Cancer Institute NSW Grants 12/RIG/1-17 & 15/RIG/1-16; WOC: National Science Centren (N N301 5645 40). The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland. The University of Cambridge has received salary support for PDPP from the NHS in the East of England through the Clinical Academia Reserve. The prostate cancer genome-wide association analyses: we pay tribute to Brian Henderson, who was a driving force behind the OncoArray project, for his vision and leadership, and who sadly passed away before seeing its fruition. We also thank the individuals who participated in these studies enabling this work. The ELLIPSE/ PRACTICAL (http//:practical.icr.ac.uk) prostate cancer consortium and his collaborating partners were supported by multiple funding mechanisms enabling this current work. ELLIPSE/PRACTICAL Genotyping of the OncoArray was funded by the US National Institutes of Health (NIH) (U19 CA148537 for ELucidating Loci Involved in Prostate Cancer SuscEptibility (ELLIPSE) project and X01HG007492 to the Center for Inherited Disease Research (CIDR) under contract number HHSN268201200008I). Additional analytical support was provided by NIH NCI U01 CA188392 (F.R.S.). Funding for the iCOGS infrastructure came from the European Community ' s Seventh Framework Pro- gramme under grant agreement n° 223175 (HEALTH-F2-2009-223175) (COGS), Cancer Research UK (C1287/A10118, C1287/A 10710, C12292/A11174, C1281/A12014, C5047/ A8384, C5047/A15007, C5047/A10692, and C8197/A16565), the National Institutes of Health (CA128978) and Post-Cancer GWAS initiative (1U19 CA148537, 1U19 CA148065, and 1U19 CA148112; the GAME-ON initiative), the Department of Defense (W81XWH-10-1-0341), the Canadian Institutes of Health Research (CIHR) for the CIHR Team in Familial Risks of Breast Cancer, Komen Foundation for the Cure, the Breast Cancer Research Foundation, and the Ovarian Cancer Research Fund. This work was supported by the Canadian Institutes of Health Research, European Commission ' s Seventh Framework Programme grant agreement n° 223175 (HEALTH-F2-2009-223175), Cancer Research UK Grants C5047/A7357, C1287/A10118, C1287/A16563, C5047/ A3354, C5047/A10692, C16913/A6135, C5047/A21332 and The National Institute of Health (NIH) Cancer Post-Cancer GWAS initiative grant: No. 1 U19 CA148537-01 (the GAME-ON initiative). We also thank the following for funding support: The Institute of Cancer Research and The Everyman Campaign, The Prostate Cancer Research Founda- tion, Prostate Research Campaign UK (now Prostate Action), The Orchid Cancer Appeal, The National Cancer Research Network UK, and The National Cancer Research Institute (NCRI) UK. We are grateful for support of NIHR funding to the NIHR Biomedical Research Centre at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust. The Prostate Cancer Program of Cancer Council Victoria also acknowledge grant support from The National Health and Medical Research Council, Australia (126402, 209057, 251533, 396414, 450104, 504700, 504702, 504715, 623204, 940394, and 614296), VicHealth, Cancer Council Victoria, The Prostate Cancer Foun- dation of Australia, The Whitten Foundation, PricewaterhouseCoopers, and Tattersall ' s. E.A.O., D.M.K., and E.M.K. acknowledge the Intramural Program of the National Human Genome Research Institute for their support. The BPC3 was supported by the U.S. National Institutes of Health, National Cancer Institute (cooperative agreements U01- CA98233 to D.J.H., U01-CA98710 to S.M.G., U01-CA98216 to E.R., and U01-CA98758 to B.E.H., and Intramural Research Program of NIH/National Cancer Institute, Division of Cancer Epidemiology and Genetics). CAPS GWAS study was supported by the Swedish Cancer Foundation (grant no 09-0677, 11-484, 12-823), the Cancer Risk Prediction Center (CRisP; www.crispcenter.org ), a Linneus Centre (Contract ID 70867902) fi nanced by the Swedish Research Council, Swedish Research Council (grant no K2010-70 × - 20430-04-3, 2014-2269). The Hannover Prostate Cancer Study was supported by the Lower Saxonian Cancer Society. PEGASUS was supported by the Intramural Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health. RAPPER was supported by the NIHR Manchester Bio- medical Research Center, Cancer Research UK (C147/A25254, C1094/A18504) and the EUs7Framework Programme Grant/Agreement no 60186. Overall: this research has been conducted using the UK Biobank Resource (application number 16549). NHS is supported by UM1 CA186107 (NHS cohort infrastructure grant), P01 CA87969, and R01 CA49449. NHSII is supported by UM1 CA176726 (NHSII cohort infrastructure grant),and R01-CA67262. A.L.K. is supported by R01 MH107649. We would like to thank the participants and staff of the NHS and NHSII for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data. ; Sí

Abstract Aim: This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Methods: This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. Results: From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS-CoV-2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age >70 years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). Conclusion: Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks. ; Appendix 1 Writing group (*denotes joint first authors) Elizabeth Li*, James C. Glasbey*, Dmitri Nepogodiev*, Joana F. F. Simoes*, Omar M. Omar, Mary L. Venn, Jonathan P. Evans, Kaori Futaba, Charles H. Knowles, Ana Minaya-Bravo, Helen Mohan, Manish Chand, Peter Pockney, Salomone Di Saverio, Neil Smart, Abigail Vallance, Dale Vimalachandran, Richard J. W. Wilkin, Aneel Bhangu (Overall guarantor). 2 Statistical analysis Omar M. Omar (Lead statistician), Elizabeth Li, James C. Glasbey, Aneel Bhangu. 3 CovidSurg Operations Committee Kwabena Siaw-Acheampong, Ruth A. Benson, Edward Bywater, Daoud Chaudhry, Brett E. Dawson, Jonathan P. Evans, James C. Glasbey, Rohan R. Gujjuri, Emily Heritage, Conor S. Jones, Sivesh K. Kamarajah, Chetan Khatri, Rachel A. Khaw, James M. Keatley, Andrew Knight, Samuel Lawday, Elizabeth Li, Harvinder S. Mann, Ella J. Marson, Kenneth A. McLean, Siobhan C. Mckay, Emily C. Mills, Dmitri Nepogodiev, Gianluca Pellino, Maria Picciochi, Elliott H. Taylor, Abhinav Tiwari, Joana F. F. Simoes, Isobel M. Trout, Mary L. Venn, Richard J. W. Wilkin, Aneel Bhangu. 4 International Cancer Leads (*denotes specialty principal Investigator) James C. Glasbey (Chair); Colorectal: Neil J. Smart*, Ana Minaya-Bravo*, Jonathan P. Evans, Gaetano Gallo, Susan Moug, Francesco Pata, Peter Pockney, Salomone Di Saverio, Abigail Vallance, Dale Vimalchandran. 5 Dissemination Committee Joana F. F. Simoes (Chair); Tom E. F. Abbott, Sadi Abukhalaf, Michel Adamina, Adesoji O. Ademuyiwa, Arnav Agarwal, Murat Akkulak, Ehab Alameer, Derek Alderson, Felix Alakaloko, Markus Albertsmeiers, Osaid Alser, Muhammad Alshaar, Sattar Alshryda, Alexis P. Arnaud, Knut Magne Augestad, Faris Ayasra, José Azevedo, Brittany K. Bankhead-Kendall, Emma Barlow, David Beard, Ruth A. Benson, Ruth Blanco-Colino, Amanpreet Brar, Ana Minaya-Bravo, Kerry A. Breen, Chris Bretherton, Igor Lima Buarque, Joshua Burke, Edward J. Caruana, Mohammad Chaar, Sohini Chakrabortee, Peter Christensen, Daniel Cox, Moises Cukier, Miguel F. Cunha, Giana H. Davidson, Anant Desai, Salomone Di Saverio, Thomas M. Drake, John G. Edwards, Muhammed Elhadi, Sameh Emile, Shebani Farik, Marco Fiore, J. Edward Fitzgerald, Samuel Ford, Tatiana Garmanova, Gaetano Gallo, Dhruv Ghosh, Gustavo Mendonça Ataíde Gomes, Gustavo Grecinos, Ewen A. Griffiths, Madalegna Gründl, Constantine Halkias, Ewen M. Harrison, Intisar Hisham, Peter J. Hutchinson, Shelley Hwang, Arda Isik, Michael D. Jenkinson, Pascal Jonker, Haytham M. A. Kaafarani, Debby Keller, Angelos Kolias, Schelto Kruijff, Ismail Lawani, Hans Lederhuber, Sezai Leventoglu, Andrey Litvin, Andrew Loehrer, Markus W. Löffler, Maria Aguilera Lorena, Maria Marta Madolo, Piotr Major, Janet Martin, Hassan N. Mashbari, Dennis Mazingi, Symeon Metallidis, Ana Minaya-Bravo, Helen M. Mohan, Rachel Moore, David Moszkowicz, Susan Moug, Joshua S. Ng-Kamstra, Mayaba Maimbo, Ionut Negoi, Milagros Niquen, Faustin Ntirenganya, Maricarmen Olivos, Kacimi Oussama, Oumaima Outani, Marie Dione Parreno-Sacdalanm, Francesco Pata, Carlos Jose Perez Rivera, Thomas D. Pinkney, Willemijn van der Plas, Peter Pockney, Ahmad Qureshi, Dejan Radenkovic, Antonio Ramos-De la Medina, Keith Roberts, April C. Roslani, Martin Rutegård, Irène Santos, Sohei Satoi, Raza Sayyed, Andrew Schache, Andreas A Schnitzbauer, Justina O. Seyi-Olajide, Neil Sharma, Richard Shaw, Sebastian Shu, Kjetil Soreide, Antonino Spinelli, Grant D Stewart, Malin Sund, Sudha Sundar, Stephen Tabiri, Philip Townend, Georgios Tsoulfas, Gabrielle H. van Ramshorst, Raghavan Vidya, Dale Vimalachandran, Oliver J. Warren, Duane Wedderburn, Naomi Wright, EuroSurg, European Society of Coloproctology (ESCP), Global Initiative for Children's Surgery (GICS), GlobalSurg, GlobalPaedSurg, ItSURG, PTSurg, SpainSurg, Italian Society of Colorectal Surgery (SICCR), Association of Surgeons in Training (ASiT), Irish Surgical Research Collaborative (ISRC), Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG), Italian Society of Surgical Oncology (SICO). 6 Collaboratoring authors (*denotes site principal investigators) Argentina: Alurralde C., Caram E. L., Eskinazi D* (Sanatorio 9 De Julio Sa); Badra R., García J.S., Lucchini S.M.* (Sanatorio Allende). Australia: Cecire J., Salindera S.*, Sutherland A. (Coffs Harbour Health Campus); Ahn J.H., Chen S., Gauri N., Jang S., Jia F., Mulligan C., Yang W., Ye G., Zhang H. (Concord Repatriation General Hospital); Moss J.*, Richards T., Thian A., Vo U. G. (Fiona Stanley Hospital); Bagraith K., Chan E., Ho D., Jeyarajan E., Jordan S., Nolan G. J., Von Papen M., Wullschleger M. (Gold Coast University Hospital); Egoroff N., Gani J., Lott N., Pockney P.* (John Hunter Hospital); Phan D., Townend D.* (Lismore Base Hospital); Bong C., Gundara J.* (Logan Hospital); Bowman S.*, Guerra G. R. (Queen Elizabeth II Jubilee Hospital); Dudi-Venkata N. N., Kroon H. M.*, Sammour T. (Royal Adelaide Hospital); Mitchell D.*, Swinson B. (Royal Brisbane and Women's Hospital). Austria: Messner F., Öfner D.* (Medical University of Innsbruck); Emmanuel K., Grechenig M., Gruber R., Harald M., Öhlberger L., Presl J.*, Wimmer A. (Paracelsus Medical University Salzburg). Barbados: Barker D., Boyce R., Doyle A., Eastmond A., Gill R., O'Shea M., Padmore G.*, Paquette N., Phillips E., St John S., Walkes K. (Queen Elizabeth Hospital). Belgium: Flamey N., Pattyn P.* (Az Delta); Oosterlinck W.*, Van den Eynde J., Van den Eynde R. (Uz Leuven). Bulgaria: Sokolov M.* (University Hospital Alexandrovska). Canada: Boutros M.*, Caminsky N. G., Ghitulescu G. (Jewish General Hospital); Boutros M.*, Demyttenaere S.*, Garfinkle R. (St Mary's Hospital); Nessim C.*, Stevenson J. (The Ottawa Hospital). Croatia: Bačić G., Karlović D., Kršul D., Zelić M.* (University Hospital Center Rijeka); Bakmaz B., Ćoza I., Dijan E., Katusic Z., Mihanovic J.*, Rakvin I. (Zadar General Hospital). Cyprus: Frantzeskou K., Gouvas N.*, Kokkinos G., Papatheodorou P., Pozotou I., Stavrinidou O., Yiallourou A.* (Nicosia General Hospital). Czechia: Martinek L., Skrovina M.*, Szubota I. (Hospital and Oncological Centre Novy Jicin). Denmark: Ebbehøj A. L., Krarup P., Schlesinger N., Smith H.* (Bispebjerg Hospital). Egypt: Al Sayed M., Ashoush F.*, Elazzazy E., Essam E., Eweda M., Hassan E., Metwalli M., Mourad M., Qatora M. S., Sabry A.*, Samih A., Samir Abdelaal A., Shehata S.*, Shenit K. (Alexandria Main University Hospital); Attia D., Kamal N., Osman N.* (Alexandria Medical Research Institute); Alaa S., Hamza H. M., M. elghazaly S., Mohammed M. M.*, Nageh M. A., Saad M. M.*, Yousof E. A. (Assiut University Hospital); Eldaly A. S.* (El-Menshawy Hospital); Amira G., Sallam I.*, Sherief M., Sherif A. (Misr Cancer Center); Ghaly G.*, Hamdy R., Morsi A., Salem H.*, Sherif G. (National Cancer Institute); Abdeldayem H., Abdelkader Salama I.*, Balabel M., Fayed Y., Sherif A. E.* (National Liver Institute, Menoufia University). Finland: Kauppila J. H.*, Sarjanoja E. (Länsi-Pohja Central Hospital); Helminen O., Huhta H., Kauppila J. H.* (Oulu University Hospital). France: Beyrne C., Jouffret L.*, Marie-Macron L. (Centre Hospitalier Avignon); Lakkis Z.*, Manfredelli S. (CHU Besançon); Chebaro A.*, El Amrani M., Lecolle K., Piessen G.*, Pruvot F. R., Zerbib P. (CHU Lille); Ballouhey Q.*, Barrat B., Taibi A. (Chu Limoges); Bergeat D., Merdrignac A. (CHU Rennes – General Surgery); Le Roy B., Perotto L. O., Scalabre A.* (Chu Saint Etienne); Aimé A., Ezanno A.*, Malgras B. (Hia Begin); Bouche P. A.*, Tzedakis S.* (Hôpital Cochin – APHP); Cotte E., Glehen O., Kepenekian V., Passot G. (Hopital Lyon Sud); D'Urso A., Mutter D., Seeliger B.* (Strasbourg University Hospitals/IHU-Strasbourg); Bonnet S., Denet C., Fuks D., Laforest A., Pourcher G., Seguin-Givelet A.*, Tribillon E. (Institut Mutualiste Montsouris); Duchalais E.* (Nantes University Hospital). Germany: Bork U.*, Fritzmann J., Praetorius C., Weitz J., Welsch T. (Carl-Gustav-Carus University Hospital, TU Dresden); Beyer K., Kamphues C.*, Lauscher J. C., Loch F. N., Schineis C. (Charité University Medicine, Campus Benjamin Franklin); Becker R.*, Jonescheit J. (Heilig-Geist Hospital Bensheim); Pergolini I., Reim D.* (Klinikum Rechts der Isar TUM School of Medicine); Boeker C., Hakami I.*, Mall J.* (KRH Nordstadt-Siloah Hospitals); Albertsmeier M.*, Kappenberger A., Schiergens T., Werner J. (LMU Klinikum Campus Innenstadt); Nowak K.*, Reinhard T.* (Romed Klinikum Rosenheim); Kleeff J., Michalski C., Ronellenfitsch U.* (University Hospital Halle (Saale)); Bertolani E., Königsrainer A.*, Löffler M. W., Quante M.*, Steidle C., Überrück L., Yurttas C. (University Hospital Tuebingen); Izbicki J., Nitschke C., Perez D., Uzunoglu F. G.* (University Medical Center Hamburg–Eppendorf). Greece: Antonakis P., Contis I., Dellaportas D., Gklavas A., Konstadoulakis M., Memos N.*, Papaconstantinou I.*, Polydorou A., Theodosopoulos T., Vezakis A. (Aretaieion Hospital); Antonopoulou M. I., Manatakis D. K.*, Tasis N. (Athens Naval and Veterans Hospital); Arkadopoulos N., Danias N., Economopoulou P., Frountzas M., Kokoropoulos P., Larentzakis A., Michalopoulos N.*, Parasyris S., Selmani J., Sidiropoulos T., Vassiliu P. (Attikon University General Hospital); Bouchagier K.*, Klimopoulos S., Paspaliari D., Stylianidis G. (Evaggelismos General Hospital); Baxevanidou K., Bouliaris K., Chatzikomnitsa P., Efthimiou M., Giaglaras A., Kalfountzos C.*, Koukoulis G., Ntziovara A. M., Petropoulos K., Soulikia K., Tsiamalou I., Zervas K., Zourntou S. (General Hospital of Larissa 'Koutlimpaneio and Triantafylleio'); Baloyiannis I., Diamantis A., Perivoliotis K., Tzovaras G.* (General University Hospital of Larissa); Christidis P., Ioannidis O.*, Loutzidou L. (George Papanikolaou General Hospital of Thessaloniki); Karaitianos I.*, Tsirlis T. (Henry Dunant Hospital Center); Charalabopoulos A., Liakakos T., Baili E., Schizas D.*, Spartalis E., Syllaios A., Zografos C. (Laiko University Hospital); Athanasakis E., Chrysos E., Tsiaoussis I., Xenaki S.*, Xynos E.* (University Hospital of Heraklion Crete and Interclinic Hospital of Crete). Hong Kong: Futaba K.*, Ho M. F., Hon S. F., Mak T. W. C., Ng S. S. M. (Prince of Wales Hospital); Foo C. C.* (Queen Mary Hospital). Hungary: Banky B.*, Suszták N. (Szent Borbála Kórház). India: Bhat G. A., Chowdri N. A., Mehraj A.*, Parray F., Shah Z. A., Wani R. (Sher-I-Kashmir Institute of Medical Sciences); Ahmed Z., Bali R., Bhat M. A., Laharwal A., Mahmood M., Mir I., Mohammad Z., Muzamil J., Rashid A.* (SMHS Hospital, Government Medical College). Ireland: Aremu M.*, Canas-Martinez A., Cullivan O., Murphy C., Owens P., Pickett L. (Connolly Hospital Blanchardstown); Corrigan M.*, Daly A., Fleming C.*, Jordan P., Killeen S., Lynch N., O'Brien S., Syed W. A. S., Vernon L. (Cork University Hospital); Fahey B. A., Larkin J. O.*, McCormick P., Mehigan B. J., Mohan H., Shokuhi P., Smith. J (St James's Hospital); Bashir Y., Bass G. A., Connelly T. M., Creavin B., Earley H., Elliott J. A.*, Gillis A. E., Kavanagh D. O., Neary P. C., O'Riordan J. M., Reynolds I. S., Rice D., Ridgway P. F., Umair M., Whelan M. (Tallaght University Hospital); Corless K., Finnegan L., Fowler A., Hogan A., Lowery A.*, McKevitt K.*, Ryan É. (University Hospital Galway); Coffey J. C., Cunningham R. M., Devine M., Nally D.*, Peirce C. (University Hospital Limerick); Hardy N. P., Neary P. M., O'Malley S.*, Ryan M. (University Hospital Waterford/University College Cork). Italy: Macina S.* (ASST Mantua); Mariani N. M.*, Opocher E., Pisani Ceretti A. (ASST Santi Paolo E. Carlo); Bianco F.* (ASST Papa Giovanni XXIII – Bergamo); Marino M. V.*, Mirabella A., Vaccarella G. (Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello); Agostini C., Alemanno G., Bartolini I., Bergamini C., Bruscino A., De Vincenti R., Di Bella A., Fortuna L., Maltinti G., Muiesan P.*, Prosperi P.*, Ringressi M. N., Risaliti M., Taddei A.*, Tucci R. (Azienda Ospedaliera Universitaria Careggi); Campagnaro T.*, Guglielmi A., Pedrazzani C., Rattizzato S., Ruzzenente A., Turri G. (Azienda Ospedaliera Universitaria Integrata di Verona); Bellora P., D'Aloisio G., Ferrari M., Francone E., Gentilli S.*, Nikaj H. (Azienda Ospedaliero Universitaria Maggiore della Carità); Bianchini M., Chiarugi M., Coccolini F., Di Franco G., Furbetta N., Gianardi D., Guadagni S., Morelli L.*, Palmeri M., Tartaglia D.* (Azienda Ospedaliero Universitaria Pisana); Anania G.*, Carcoforo P.*, Chiozza M., De Troia A., Koleva Radica M., Portinari M., Sibilla M. G., Urbani A. (Azienda Ospedaliero Universitaria San'anna); Fabbri N., Feo C. V.*, Gennari S., Parini S., Righini E. (Azienda Unità Sanitaria Locale di Ferrara, Università di Ferrara); Annessi V., Castro Ruiz C., Montella M. T., Zizzo M.* (Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia); Grossi U., Novello S., Romano M., Rossi S., Zanus G.* (Ca' Foncello Treviso – DISCOG – Università di Padova); Esposito G., Frongia F., Pisanu A., Podda M.* (Cagliari University Hospital); Belluco C., Lauretta A.*, Montori G., Moras L., Olivieri M.; Feo C. F., Perra T.*, Porcu A.*, Scanu A. M. (Cliniche San Pietro, Aou Sassari); Aversano A., Carbone F., Delrio P.*, Di Lauro K., Fares Bucci A., Rega D.*, Spiezio G. (Colorectal Surgical Oncology Unit – Istituto Nazionale Tumori Fondazione, Pascale IRCCS); Calabrò M.*, Farnesi F., Lunghi E. G., Muratore A.*, Pipitone Federico N. S. (Edoardo Agnelli); De Palma G. D., Luglio G.*, Pagano G., Tropeano F. P. (Federico II University Hospital); Baldari L.*, Boni L.*, Cassinotti E.* (Fondazione IRCCS Ca' Granda – Ospedale Maggiore Policlinico di Milano); Cosimelli M., Fiore M.*, Guaglio M.*, Sorrentino L. (Fondazione IRCCS Istituto Nazionale dei Tumori, Milano); Agnes A., Alfieri S., Belia F., Biondi A., Cozza V., D'Ugo D., De Simone V., Litta F., Lorenzon L., Marra A. A., Marzi F., Parello A., Persiani R., Ratto C., Rosa F., Scrima O., Sganga G. (Fondazione Policlinico Universitario Agostino Gemelli IRCCS); Belli A.*, Izzo F., Patrone R. (HPB Surgical Oncology Unit – Istituto Nazionale Tumori Fondazione, Pascale IRCCS); Carrano F. M., Carvello M. M., Di Candido F., Maroli A., Spinelli A.* (Humanitas Clinical and Research Center IRCCS, Rozzano (Mi) and Humanitas University, Department of Biomedical Sciences, Pieve Emanuele (Mi)); Aprile A., Batistotti P., Massobrio A., Pertile D., Scabini S.*, Soriero D. (IRCCS Ospedale Policlinico San Martino); De Manzoni Garberini A.* (Ospedale Civile Spirito Santo); Federico P., Maida P., Marra E., Marte G., Petrillo A., Tammaro P., Tufo A.* (Ospedale del Mare); Berselli M.*, Borroni G.*, Cocozza E., Conti L., Desio M., Rizzi A. (ASST Sette Laghi-Varese); Baldi C.*, Corbellini C., Sampietro G. M. (Ospedale di Rho – ASST Rhodense); Baldini E.*, Capelli P., Conti L., Isolani S. M., Ribolla M. (Ospedale Guglielmo da Saliceto Piacenza); Bondurri A., Colombo F.*, Ferrario L., Guerci C., Maffioli A. (Ospedale Luigi Sacco Milano); Armao T., Ballabio M.*, Bisagni P., Gagliano A., Longhi M., Madonini M., Pizzini P. (Ospedale Maggiore di Lodi); Mochet S.*, Usai A. (Ospedale Regionale Umberto Parini); Bianco F.*, Incollingo P. (Ospedale S. Leonardo – Asl Napoli 3 Sud, Castellammare di Stabia); Mancini S., Marino Cosentino L.*, Sagnotta A.* (Ospedale San Filippo Neri); Nespoli L. C., Tamini N.* (Ospedale San Gerardo); Anastasi A., Bartalucci B., Bellacci A., Canonico G.*, Capezzuoli L., Di Martino C., Ipponi P., Linari C., Montelatici M., Nelli T., Spagni G., Tirloni L., Vitali A. (Ospedale San Giovanni di Dio); Abate E., Casati M.*, Casiraghi T., Laface L., Schiavo M. (Ospedale Vittorio Emanuele III – Carate Brianza); Arminio A., Cotoia A., Lizzi V.*, Vovola F. (Ospedali Riuniti Azienda Ospedaliera Universitaria Foggia); Vergari R.* (Ospedali Riuniti di Ancona); D'Ugo S.*, Depalma N., Spampinato M. G. (Vito Fazzi, Leece); Brachini G., Chiappini A., Cicerchia P. M., Cirillo B., De Toma G., Fiori E., Fonsi G. B., Iannone I., La Torre F., Lapolla P.*, Meneghini S., Mingoli A., Sapienza P., Zambon M. (Policlinico Umberto I Sapienza University of Rome); Capolupo G. T.*, Mazzotta E. (Policlinico Universitario Campus Bio Medico of Rome); Gattolin A., Migliore M., Rimonda R., Sasia D.*, Travaglio E. (Regina Montis Regalis Hospital, Mondovì); Cervellera M., Gori A., Sartarelli L., Tonini V.* (S. Orsola-Malpighi Hospital); Chessa A.*, Fiorini A., Norcini C. (San Giovanni di Dio); Colletti G., Confalonieri M., Costanzi A.*, Frattaruolo C., Mari G., Monteleone M. (San Leopoldo Mandic); De Nardi P.*, Parise P., Vignali A. (San Raffaele Scientific Institute, Milan); Belvedere A., Bernante P., Jovine E., Neri J., Parlanti D., Pezzuto A. P., Poggioli G., Rottoli M.*, Tanzanu M., Violante T. (IRCCS Azienda Ospedaliero – Universitaria di Bologna; Alma Mater Studiorum University of Bologna); Borghi F., Cianflocca D., Di Maria Grimaldi S., Donati D., Gelarda E., Giraudo G., Giuffrida M. C., Marano A.*, Palagi S., Pellegrino L., Peluso C., Testa V.* (Santa Croce E. Carle Hospital, Cuneo); Agresta F.*, Prando D.*, Zese M.* (Santa Maria degli Angeli Hospital ULSS 5 – Adria); Armatura G.*, Frena A., Scotton G.* (St Moritz Hospital); Gallo G.*, Sammarco G., Vescio G. (University 'Magna Graecia' of Catanzaro); Di Marzo F.* (Valtiberina); Fontana T.* ('Vittorio Emanuele' – Gela). Japan: Kanemitsu Y.*, Moritani K. (National Cancer Center Hospital). Jordan: Al Abdallah M.*, Ayasra F., Ayasra Y., Qasem A. (Al-Basheer Hospital); Fahmawee T., Hmedat A., Obeidat K.* (King Abdullah University Hospital); Abou Chaar M. K., Al-Masri M.*, Al-Najjar H., Alawneh F. (King Hussein Cancer Center). Libya: Alkadeeki G.*, Al Maadany F. S. (Al-Jalaa Hospital); Aldokali N., Senossi O., Subhi M. T. (Alkhadra Hospital); Burgan D.*, Kamoka E., Kilani A. I. (National Cancer Institute, Sabratha); Ellojli I.*, Kredan A. (Tripoli University Hospital). Lithuania: Bradulskis S., Dainius E., Kubiliute E., Kutkevičius J., Parseliunas A., Subocius A., Venskutonis D.* (Lithuanian University of Health Sciences Kaunas Clinical Hospital). Madagascar: Rasoaherinomenjanahary F.*, Razafindrahita J. B., Samison L. H. (Joseph Ravoahangy Andrianavalona Hospital). Malaysia: Hamdan K. H., Ibrahim M. R., Tan J. A., Thanapal M. R.* (Hospital Kuala Lumpur); Amin Sahid N., Hayati F.*, Jayasilan J., Sriram R. K.*, Subramaniam S. (Queen Elizabeth Hospital and Universiti Malaysia Sabah, Kota Kinabalu, Sabah); Che Jusoh M. A., Hussain A. H., Mohamed Sidek A. S., Mohd Yunus M. F., Soh J. Y., Wong M., Zakaria A. D.*, Zakaria Z. (School of Medical Sciences and Hospital, Universiti Sains Malaysia); Fathi N. Q., Xavier R. G., Roslani A. C.* (University Malaya Medical Centre). Mexico: Buerba G. A., Mercado M. Á.*, Posadas-Trujillo O. E., Salgado-Nesme N., Sarre C. (Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán'). Morocco: Amrani L., El Ahmadi B., El Bouazizi Y., Majbar A. M., Benkabbou A., Mohsine R., Souadka A.* (Institut National d'Oncologie, Université Mohammed V Rabat). Netherlands: Hompes R.*, Meima-van Praag E. M., Pronk A. J. M., Sharabiany S. (Amsterdam UMC, University of Amsterdam); Grotenhuis B.*, Hartveld L. (Antoni Van Leeuwenhoek Ziekenhuis); Posma-Bouman L.* (Slingeland Ziekenhuis); Derksen T., Franken J., Oosterling S.* (Spaarne Gasthuis); Konsten J.*, Van Heinsbergen M. (Viecuri Medisch Centrum). Nigeria: Olaogun J.* (Ekiti State University Teaching Hospital); Abdur-Rahman L.*, Adeyeye A.*, Bello J., Olasehinde O., Popoola A. (University of Ilorin Teaching Hospital). Pakistan: Jamal A., Kerawala A. A.* (Cancer Foundation Hospital); Memon A. S.*, Nafees Ahmed R., Rai .L* (Dr Ruth K. M. Pfau Civil Hospital); Ayub B., Ramesh P., Sayyed R.* (Patel Hospital); Butt U. I.*, Kashif M., Qureshi A.*, Farooka M. W.*, Ayyaz M.* (Services Hospital Lahore); Ayubi A., Waqar S. H.* (Pakistan Institute of Medical Sciences). Poland: Major P. (Jagiellonian University Medical College). Portugal: Azevedo C., Machado D., Mendes F.* (Centro Hospitalar Cova da Beira); De Sousa X.* (Centro Hospitalar de Setúbal); Fernandes U., Ferreira C.*, Guidi G., Marçal A., Marques R., Martins D., Vaz Pereira R., Vieira B. (Centro Hospitalar de Trás-Os-Montes e Alto Douro, EPE); Afonso J., Almeida J. I., Almeida-Reis R.*, Correia de Sá T., Costa M. J. M. A., Fernandes V., Ferraz I., Lima da Silva C., Lopes L., Machado N., Marialva J., Nunes Coelho M., Pereira C., Ribeiro A., Ribeiro C. G., Santos R., Saraiva P., Silva R., Tavares F., Teixeira M. (Centro Hospitalar do Tamega e Sousa); Almeida A. C., Amaral M. J., Andrade R., Camacho C., Costa M., Lázaro A.*, Nogueira O., Oliveira A., Ruivo A., Silva M., Simões J. (Centro Hospitalar e Universitário de Coimbra); Devezas V., Jácome F., Nogueiro J., Pereira A., Santos-Sousa H.*, Vaz S. (Centro Hospitalar e Universitário de São João); Pinto J., Tojal A.* (Centro Hospitalar Tondela-Viseu); Cardoso P.*, Cardoso N., Domingos J. C., Henriques P., Manso M. I., Martins dos Santos G., Martins R., Morais H.*, Pereira R., Revez T., Ribeiro R., Ribeiro V. I., Soares A. P., Sousa S., Teixeira J. (Centro Hospitalar Universitário do Algarve – Unidade de Faro); Amorim E., Baptista V. H., Cunha M. F.*, Sampaio da Nóvoa Gomes Miguel I. I. (Centro Hospitalar Universitário do Algarve – Unidade de Portimão); Bandovas J. P., Borges N.*, Chumbinho B., Figueiredo de Barros I., Frade S., Gomes J., Kam da Silva Andrade A., Pereira Rodrigues A., Pina S., Silva N.*, Silveira Nunes I., Sousa R. (Centro Hospitalar Universitário Lisboa Central); Azevedo P., Costeira B., Cunha C., Garrido R.*, Miranda P., Peralta Ferreira M., Sousa Fernandes M. (Hospital Beatriz Angelo); Galvão D., Vieira A.* (Hospital de Santo Espirito da Ilha Terceira); Patrício B., Santos P. M. D. D.*, Vieira Paiva Lopes A. C. (Hospital de Torres Vedras – Centro Hospitalar do Oeste); Cunha R., Faustino A., Freitas A., Mendes J. R.*, Parreira R. (Hospital do Divino Espírito Santo); Abreu da Silva A.*, Claro M., Costa Santos D., Deus A. C., Grilo J. V. (Hospital do Litoral Alentejano); Borges F.*, Corte Real J., Henriques S., Lima M. J., Matos Costa P. (Hospital Garcia de Orta); Brito da Silva F., Caiado A.*, Fonseca F. (Instituto Português de Oncologia de Lisboa Francisco Gentil); Ângelo M., Baiao J. M., Martins Jordão D.*, Vieira Caroço T. (IPO Coimbra); Baía C., Canotilho R., Correia A. M., Ferreira Pinto A. P., Peyroteo M., Videira J. F.* (IPO Porto). Réunion: Kassir R.*, Sauvat F. (CHU Réunion). Romania: Bezede C., Chitul A., Ciofic E., Cristian D., Grama F.* (Coltea Clinical Hospital); Bonci E.*, Gata V.*, Titu S.* (Prof. Dr. Ion Chiricuta Institute of Oncology). Russia: Garmanova T., Kazachenko E., Markaryan D., Rodimov S., Tsarkov P.*, Tulina I. (Clinic of Coloproctology and Minimally Invasive Surgery, Sechenov Medical State University); Litvina Y., Provozina A. (Immanuel Kant Baltic Federal University, Regional Clinical Hospital); Agapov M.*, Galliamov E., Kakotkin V., Kubyshkin V., Kamalov A., Semina E. (Moscow Research and Educational Center, Lomonosov Moscow State University). Saudi Arabia: Alshahrani M.*, Alsharif F., Eskander M. (Aseer Central Hospital); Alharthi M., Aljiffry M., Basendowah M., Malibary N.*, Nassif M., Saleem A., Samkari A., Trabulsi N.* (King Abdulaziz University Hospital); Al Awwad S.*, Alghamdi M.*, Alnumani T.* (King Fahad General Hospital); Al Habes H., Alqannas M.*, Alyami M.*, Alzamanan M., Cortés Guiral D.*, Elawad A. (King Khalid Hospital); AlAamer O., Alselaim N.* (King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard, Health Affairs, General Surgery Department); Al-Khayal K., Alhassan N., Alobeed O., Alshammari S., Bin Nasser A.*, Bin Traiki T., Nouh T.*, Zubaidi A. M. (King Saud University). Serbia: Aleksić L., Antic A., Barisic G.*, Ceranic M., Grubač Ž., Jelenkovic J., Kecmanović D., Kmezić S., Knezevic D.*, Krivokapic Z.*, Latinčić S., Markovic V.*, Matić S.*, Miladinov M., Pavlov M.*, Pejovic I., Tadic B., Vasljević J., Velickovic D. (Clinic for Digestive Surgery, Clinical Centre of Serbia); Buta M., Cvetkovic A., Gacic S., Goran M., Jeftic N., Markovic I.*, Milanović M., Nikolic S., Pejnovic L., Savković N., Stevic D., Vucic N., Zegarac M. (Institute for Oncology and Radiology of Serbia); Karamarkovic A., Kenic M., Kovacevic B., Krdzic I.* (Zvezdara University Medical Center). Singapore: Lieske B.* (National University Hospital). South Africa: Almgla N.*, Boutall A., Herman A., Kloppers C.*, Nel D., Rayamajhi S. (Groote Schuur Hospital). Spain: Paniagua García Señorans M.*, Vigorita V. (Álvaro Cunqueiro Hospital); Acrich E., Baena Sanfeliu E., Barrios O., Golda T.*, Santanach C., Serrano-Navidad M., Sorribas Grifell M., Vives R. V. (Bellvitge University Hospital); Escolà D., Jiménez A.* (Comarcal Alt Penedés); Cayetano Paniagua L., Gómez Fernández L.* (Consorci Sanitari de Terrassa); Collera P., Diaz Del Gobbo R., Farre Font R., Flores Clotet R., Gómez Díaz C. J.*, Guàrdia N., Guariglia C. A., Osorio A., Sanchez Jimenez R., Sanchon L., Soto Montesinos C. (Fundació Althaia – Xarxa Assistencial Universitària de Manresa); Alonso-Lamberti L., García-Quijada J., Jimenez Miramón J., Jimenez V.*, Jover J. M., Leon R., Rodriguez J. L., Salazar A., Valle Rubio A. (Getafe University Hospital); Aguado H.* (Hellín Hospital); Bravo Infante R., De Lacy F. B., Lacy A. M.*, Otero A., Turrado-Rodriguez V.*, Valverde S. (Hospital Clinic Barcelona); Anula R., Cano-Valderrama O., Del Campo Martín M., Díez-Valladares L., Domínguez I., Dziakova J., García Alonso M., García Romero E., Gómez Latorre L., Muguerza J.M.*, Pizarro M. J., Saez Carlin P., Sánchez del Pueblo C., Sánchez-Pernaute A., Sanz Ortega G., Sanz-Lopez R., Torres A. (Hospital Clínico de Madrid); Garcés-Albir M.*, Lopez F.*, Martín-Arévalo J., Moro-Valdezate D.*, Pla Marti V. (Hospital Clínico Universitario de Valencia); Beltrán de Heredia J., De Andrés Asenjo B.*, Gómez Sanz T., Jezieniecki C., Nuñez del Barrio H., Ortiz de Solórzano Aurusa F. J., Romero de Diego A., Ruiz Soriano M., Trujillo Díaz J., Vázquez Fernández A. (Hospital Clínico Universitario de Valladolid); Lora-Cumplido P., Sosa M. V.* (Hospital de Cabueñes); Gonzalez-Gonzalez E., Minaya Bravo A. M.* (Hospital del Henares); Alonso de la Fuente N., Jimenez Toscano M.* (Hospital del Mar); Grau-Talens E. J., Martin-Perez B.* (Hospital Don Benito-Villanueva); Benavides Buleje J. A., Carrasco Prats M.*, Giménez Francés C.*, Muñoz Camarena J. M., Parra Baños P. A., Peña Ros E., Ramirez Faraco M., Ruiz-Marín M.*, Valero Soriano M. (Hospital General Reina Sofía); Estaire Gómez M.*, Fernández Camuñas Á., Garcia Santos E. P., Jimenez Higuera E., Martínez-Pinedo C., Muñoz-Atienza V., Padilla-Valverde D.*, Picón Rodríguez R., Sánchez-García S., Sanchez-Pelaez D. (Hospital General Universitario de Ciudad Real); Colombari R. C., del Valle E., Fernández M., Lozano Lominchar P.*, Martín L., Rey Valcarcel C., Zorrilla Ortúzar J. (Hospital General Universitario Gregorio Marañón); Alcaide Matas F., García Pérez J. M., Troncoso Pereira P.* (Hospital Mateu Orfila); Mora-Guzmán I.* (Hospital Santa Bárbara); Achalandabaso Boira M.*, Sales Mallafré R. (Hospital Universitari de Tarragona Joan XXIII); Marín H., Prieto Calvo M., Villalabeitia Ateca I.* (Hospital Universitario Cruces); De Andres Olabarria U., Durán Ballesteros M., Fernández Pablos F. J., Ibáñez-Aguirre F. J., Sanz Larrainzar A., Ugarte-Sierra B.* (Hospital Universitario de Galdakao); Correa Bonito A., Delgado Búrdalo L., Di Martino M.*, García Septiem J.*, Maqueda González R., Martin-Perez E. (Hospital Universitario de la Princesa); Calvo Espino P.*, Guillamot Ruano P. (Hospital Universitario de Móstoles); Colao García L., Díaz Pérez D.*, Esteban Agustí E., Galindo Jara P., Gutierrez Samaniego M.*, Hernandez Bartolome M. A.*, Serrano González J. (Hospital Universitario de Torrejón de Ardoz); Alonso Poza A., Diéguez B., García-Conde M., Hernández-García M., Losada M.* (Hospital Universitario del Sureste); Alvarez E., Chavarrias N., Gegúndez Simón A., Gortázar S., Guevara J., Prieto Nieto M. I., Ramos-Martín P., Rubio-Perez I.*, Saavedra J., Urbieta A. (Hospital Universitario la Paz); Cantalejo Diaz M., De Miguel Ardevines M. D. C., Duque-Mallén V.*, Gascon Ferrer I., González-Nicolás Trébol M. T., Gracia-Roche C., Herrero Lopez M., Martinez German A., Matute M., Sánchez Fuentes N., Sánchez-Rubio M., Santero-Ramirez M. S., Saudí S. (Hospital Universitario Miguel Servet); Blazquez Martin A., Diez Alonso M.*, Hernandez P., Mendoza-Moreno F., Ovejero Merino E., Vera Mansilla C. (Hospital Universitario Principe de Asturias); Acebes García F., Bailón M., Bueno Cañones A. D., Choolani Bhojwani E., Marcos-Santos P., Miguel T., Pacheco Sánchez D., Pérez-Saborido B., Sanchez Gonzalez J., Tejero-Pintor F. J.* (Hospital Universitario Río Hortega); Cano A., Capitan-Morales L., Cintas Catena J., Gomez-Rosado J.*, Oliva Mompean F., Pérez Sánchez M. A., Río Lafuente F. D., Torres Arcos C., Valdes-Hernandez J. (Hospital Universitario Virgen Macarena); Cholewa H., Frasson M., Martínez Chicote C., Sancho-Muriel J.* (Hospital Universitario Y Politécnico la Fe); Abad Gurumeta A., Abad-Motos A., Martínez-Hurtado E., Ripollés-Melchor J.*, Ruiz Escobar A. (Infanta Leonor University Hospital); Cuadrado-García A.*, Garcia-Sancho Tellez L.*, Heras Aznar J.*, Maté P., Ortega Vázquez I.*, Picardo A. L., Rojo López J. A., Sanchez Cabezudo Noguera F.*, Serralta de Colsa D.* (Infanta Sofía University Hospital); Cagigas Fernandez C., Caiña Ruiz R., Gomez Ruiz M., Martínez-Pérez P., Poch C., Santarrufina Martinez S.*, Valbuena Jabares V. (Marqués de Valdecilla University Hospital); Blas Laina J. L., Cros B., Escartin J.*, Garcia Egea J., Nogués A., Talal El-Abur I., Yánez C. (Royo Villanova); Cagigal Ortega E. P., Cervera I., Díaz Peña P., Gonzalez J., Marqueta De Salas M., Perez Gonzalez M.*, Ramos Bonilla A., Rodríguez Gómez L. (Severo Ochoa University Hospital); Blanco-Colino R., Espin-Basany E.*, Pellino G. (Vall d'Hebron University Hospital). Sri Lanka: Arulanantham A., Bandara G. B. K. D., Jayarajah U.*, Ravindrakumar S., Rodrigo V. S. D. (District General Hospital Chilaw); Srishankar S.* (Teaching Hospital Anuradhapura). Sudan Ali Adil A. K. (Al-Rajhi). Sweden: Älgå A.*, Heinius G., Nordberg M., Pieniowski E. (Stockholm South General Hospital); Löfgren N., Rutegård M.* (Umea University Hospital). Switzerland: Arigoni M., Bernasconi M., Christoforidis D.*, Di Giuseppe M., La Regina D., Mongelli F. (Ente Ospedaliero Cantonale); Chevallay M., Dwidar O., Gialamas E., Sauvain M. (Pourtales Neuchatel Hospital); Adamina M.*, Crugnale A. S., Guglielmetti L., Peros G. (Kantonsspital Winterthur). Turkey: Aghayeva A.*, Hamzaoglu I., Sahin I. (Acibadem Altunizade Hospital); Akaydin E., Aliyeva Z., Aytac E., Baca B., Ozben V.*, Ozmen B. B. (Acibadem Atakent Hospital); Arikan A. E.*, Bilgin I. A.*, Kara H., Karahasanoğlu T., Uras C. (Acibadem Maslak Hospital); Dincer H. A., Erol T. (Hacettepe University Hospital); Alhamed A., Ergün S.*, Özçelık M. F., Sanli A. N., Uludağ S. S.*, Velidedeoglu M.*, Zengin A. K. (Istanbul Universty – Cerrahpaşa Medical Faculty); Bozkurt M. A., Kara Y.*, Kocataş A. (Kanuni Sultan Suleyman Training and Research Hospital); Azamat İ. F., Balik E.*, Buğra D., Kulle C. B. (Koç University Medical School); Gözal K., Güler S. A., Köken H., Tatar O. C.*, Utkan N. Z., Yıldırım A., Yüksel E. (Kocaeli University Teaching Hospital); Akin E., Altintoprak F.*, Cakmak G., Çelebi F., Demir H., Dikicier E., Firat N., Gönüllü E., Kamburoğlu M. B., Küçük I. F., Mantoglu B. (Sakarya University Faculty of Medicine); Çolak E.*, Kucuk G. O., Uyanik M. S. (Samsun Training and Research Hospital); Göksoy B.* (Sehit Prof. Dr. İlhan Varank Training and Research Hospital); Bozkurt E., Mihmanli M., Tanal M.*, Yetkin S. G. (Sisli Hamidiye Etfal Training and Research Hospital); Akalin M., Arican C., Avci E. K., Aydin C., Demirli Atıcı S.*, Emiroglu M., Kaya T.*, Kebabçı E., Kilinc G., Kirmizi Y., Öğücü H., Salimoğlu S., Sert İ., Tugmen C., Tuncer K., Uslu G., Yeşilyurt D. (University of Health Sciences Tepecik Training and Research Hospital); Yildiz A.* (Yildirim Beyazit University Yenimahalle Training and Research Hospital). Uganda: Lule H.*, Oguttu B.* (Kampala International University Teaching Hospital). UK: Agilinko J., Ahmeidat A., Bekheit M.*, Cheung L. K., Kamera B. S., Mignot G., Shaikh S.*, Sharma P. (Aberdeen Royal Infirmary); Al-Mohammad A., Ali S., Ashcroft J., Baker O., Coughlin P., Davies R. J.*, Kyriacou H., Mitrofan C. G., Morris A., Raby-Smith W., Rooney S., Singh A., Tan X. S., Townson A., Tweedle E. (Addenbrooke's Hospital); Angelou D., Choynowski M., McAree B.*, McCanny A., Neely D. (Antrim Area Hospital – Northern Health and Social Care Trust); Mosley F.* (Bradford Royal Infirmary); Arrowsmith L.*, Campbell W.* (Causeway Hospital); Grove T., Kontovounisios C., Warren O.* (Chelsea and Westminster Hospital); Clifford R., Eardley N., Krishnan E., Manu N., Martin E., Roy Mahapatra S., Serevina O. L., Smith C., Vimalachandran D.* (Countess of Chester Hospital); Emslie K.*, Labib P.*, Minto G., Natale J., Panahi P., Rogers L.* (Derriford Hospital); Abubakar A.*, Akhter Rahman M. M., Chan E., O'Brien H., Sasapu K.* (Diana Princess of Wales Hospital Grimsby); Ng H. J.* (Dumfries and Galloway Royal Infirmary); Day A.* (East Surrey Hospital); Hunt A., Laskar N.* (East Sussex Healthcare (Conquest Hospital and Eastbourne District General Hospital)); Gupta A.*, Steinke J., Thrumurthy S. (Epsom and St Helier University Hospitals NHS Trust); Massie E., McGivern K., Rutherford D., Wilson M.* (Forth Valley Royal Hospital); Handa S., Kaushal M., Kler A., Patel P.*, Redfern J., Tezas S. (Furness General Hospital); Aawsaj Y., Barry C., Blackwell L., Emerson H., Fisher A.*, Katory M., Mustafa A. (Gateshead Health NHS Foundation Trust); Kretzmer L.*, Lalou L., Manku B., Parwaiz I., Stafford J. (George Eliot Hospital); Abdelkarim M., Asqalan A., Gala T., Ibrahim S., Maw A.*, Mithany R., Morgan R.*, Sundaram Venkatesan G. (Glan Clwyd Hospital); Boulton A. J. (Good Hope Hospital); Hardie C., McNaught C.* (Harrogate District Hospital); Karandikar S.*, Naumann D. (Heartlands Hospital); Ayorinde J., Chase T., Cuming T., Ghanbari A., Humphreys L., Tayeh S.* (Homerton University Hospital); Aboelkassem Ibrahim A., Evans C., Ikram H., Loubani M.*, Nazir S., Robinson A., Sehgal T., Wilkins A. (Hull University Teaching Hospitals NHS Trust); Dixon J.*, Jha M., Thulasiraman S. V., Viswanath Y. K. S.* (James Cook University Hospital); Curl-Roper T., Delimpalta C., Liao C. C. L.*, Velchuru V., Westwood E. (James Paget University NHS Foundation Trust Hospital); Bond-Smith G.*, Mastoridis S., Tebala G. D., Verberne C. (John Radcliffe Hospital); Bhatti M. I., Boyd-Carson H., Elsey E., Gemmill E., Herrod P.*, Jibreel M., Lenzi E., Saafan T., Sapre D., Sian T., Watson N. (King's Mill Hospital); Athanasiou A.*, Burke J., Costigan F., Elkadi H., Johnstone J., Nahm C. (Leeds Teaching Hospitals Trust); Annamalai S., Ashmore C., Kourdouli A. (Leicester Royal Infirmary); Askari A., Cirocchi N., Kudchadkar S., Patel K., Sagar J.*, Talwar R.* (Luton and Dunstable University Hospital); Abdalla M., Ismail O., Newton K., Stylianides N.* (Manchester Royal Infirmary); Aderombi A., Bajomo O., Beatson K., Garrett W.*, Ng V. (Medway Hospital); Al-Habsi R., Divya G S., Keeler B.* (Milton Keynes University Hospital); Egan R., Fabre I., Harries R.*, Li Z., Parkins K., Spencer N., Thompson D. (Morriston Hospital Swansea); Gemmell C., Grieco C., Hunt L.* (Musgrove Park Hospital); Mahmoud Ali F. (Newcastle Upon Tyne Hospitals NHS Foundation Trust.); Seebah K., Shaikh I.*, Sreedharan L., Youssef M.* (Norfolk and Norwich University Hospital); Shah J.* (North Manchester General Hospital); McLarty N., Mills S.*, Shenfine A. (Northumbria NHS Hospital Trust); Sahnan K. (Northwick Park Hospital); Michel M., Patil S., Ravindran S., Sarveswaran J.*, Scott L. (Pinderfields Hospital); Bhangu A.*, Cato L. D., Kamal M., Kulkarni R., Parente A., Saeed S., Vijayan D. (Queen Elizabeth Hospital Birmingham); Kaul S., Khan A. H., Khan F., Mukherjee S.*, Patel M., Sarigul M., Singh S. (Queen's Hospital Romford); Adiamah A., Brewer H., Chowdhury A.*, Evans J., Humes D.*, Jackman J., Koh A., Lewis-Lloyd C., Oyende O., Reilly J., Worku D. (Queens Medical Centre); Bisset C., Moug S. J.* (Royal Alexandra Hospital); Math S., Sarantitis I., Timbrell S., Vitone L.* (Royal Blackburn Hospital); Faulkner G.* (Royal Bolton Hospital); Brixton G., Findlay L., Majkowska A., Manson J.*, Potter R. (Royal Bournemouth Hospital); Bhalla A.*, Chia Z., Daliya P., Grimley E., Malcolm F. L., Theophilidou E. (Royal Derby Hospital); Daniels I. R., Fowler G., Massey L., McDermott F.*, Rajaretnam N. (Royal Devon and Exeter Hospital); Beamish A., Magowan D., Nassa H., Price C., Smith L., Solari F., Tang A. M., Williams G.* (Royal Gwent Hospital); Davies E.*, Hawkin P., Raymond T., Ryska O. (Royal Lancaster Infirmary); Baron R. D.*, Gahunia S., McNicol F.*, Russ J., Szatmary P., Thomas A. (Royal Liverpool University Hospital); Jayasinghe J. D., Knowles C., Ledesma F. S., Minicozzi A.*, Navaratne L., Ramamoorthy R., Sohrabi C., Thaha M.*, Venn M. (Royal London Hospital); Atherton R.*, Brocklehurst M., McAleer J., Parkin E.* (Royal Preston Hospital); Aladeojebi A., Ali M., Gaunt A.* (Royal Stoke University Hospital); Hammer C., Stebbing J. (Royal Surrey County Hospital); Bhasin S., Bodla A. S., Burahee A., Crichton A., Fossett R., Yassin N.* (Royal Wolverhampton NHS Trust); Brown S.*, Lee M., Newman T., Steele C. (Sheffield Teaching Hospital NHS Foundation Trust); Baker A., Konstantinou C., Ramcharan S.*, Wilkin R. J. W. (South Warwickshire NHS Foundation Trust); Lawday S., Lyons A.* (Southmead Hospital); Chung E., Hagger R., Hainsworth A., Karim A., Owen H., Ramwell A., Williams K.* (St George's Hospital); Hall J. (Stepping Hill Hospital); Harris G., Royle T.*, Watson L. J. (Sunderland Royal Hospital); Asaad P., Brown B., Duff S.*, Khan A., Moura F., Wadham B. (The University Hospital of South Manchester); McCluney S., Parmar C.*, Shah S. (The Whittington Hospital); Babar M. S., Goodrum S., Whitmore H. (Torbay and South Devon NHS Trust); Balasubramaniam D.*, Jayasankar B.*, Kapoor S., Ramachandran A. (Tunbridge Wells Hospital); Beech N., Chand M.*, Green L., Kiconco H., McEwen R. (University College London Hospital); Pereca J.* (University Hospital Ayr); Gash K.*, Gourbault L., MacCabe T., Newton C.* (University Hospitals Bristol NHS Foundation Trust); Baig M., Bates H., Dunne N., Khajuria A., Ng V., Sarma D. R., Shortland T., Tewari N.* (University Hospitals Coventry and Warwickshire NHS Trusts); Akhtar M. A.*, Brunt A., McIntyre J., Milne K., Rashid M. M., Sgrò A., Stewart K. E., Turnbull A. (Victoria Hospital Kirkcaldy); Aguilar Gonzalez M.*, Talukder S.* (West Suffolk Hospital); Eskander P., Hanna M., Olivier J.* (Weston General Hospital); Magee C.*, Powell S.* (Wirral University Teaching Hospital); Flindall I., Hanson A., Mahendran V. (Worcestershire Royal Hospital); Green S., Lim M., MacDonald L., Miu V., Onos L., Sheridan K., Young R.* (York Teaching Hospitals NHS Trust); Alam F., Griffiths O., Houlden C., Kolli V. S., Lala A. K., Seymour Z.* (Ysbyty Gwynedd). USA: Haynes A.*, Hill C., Leede E., McElhinney K., Olson K. A., Riley C., Thornhill M. (Dell Seton Medical Center at the University of Texas); Etchill E., Gabre-Kidan A.*, Jenny H., Kent A., Ladd M. R., Long C., Malapati H., Margalit A., Rapaport S., Rose J., Stevens K., Tsai L., Vervoort D., Yesantharao P., Bigelow B. (Johns Hopkins Hospital); Klaristenfeld D.* (Kaiser Permanente San Diego Medical Center); Huynh K. (Kaiser Permanente West Los Angeles); Azam M., Choudhry A.*, Marx W. (SUNY Upstate University Hospital); Abel M. K., Boeck M., Chern H., Kornblith L.*, Nunez-Garcia B., Ozgediz D., Glencer A., Sarin A., Varma M. (University of California, San Francisco (UCSF)); Abbott D., Acher A., Aiken T., Barrett J., Foley E., Schwartz P., Zafar S. N.* (University of Wisconsin); Hawkins A.*, Maiga A. (Vanderbilt University Medical Center).

A STUDY ON THE RELEVANCE OF MATERIALS IN ENGLISH TEXTBOOK "BRIGHT" FOR SEVENTH GRADERS OF JUNIOR HIGH SCHOOL PUBLISHED BY ERLANGGA TO 2013 CURRICULUM Halimatul Kamila English Study Program, FBS, Surabaya State University halimatulkamila@gmail.com Ririn Pusparini, S.Pd., M.Pd. Lecturer of English Study Program, FBS, Surabaya State University rrn.puspa@gmail.com Abstract The Indonesia government has developed English standard competence which is stated in curriculum as the standard of teaching and learning English process. According to the curriculum, material is one of the important factors for determining the success of the teaching and learning process. The material which is usually used is in the form of textbook. Textbook must be in line with the components stated in curriculum. Although there are many textbooks that are claimed as a suitable material for 2013 Curriculum, it is not a guarantee that the textbook is relevant to the standard competences of the curriculum. An analysis to a textbook is needed, moreover after the new curriculum was launched. Based on the background of the case above, this study is conducted: 1) to analyze the relevance of the materials with the cognitive aspects which are contained in the 2013 English Standard Competence, 2) to analyze the relevance of the materials with the psychomotor aspects which are contained in the 2013 English Standard Competence. This study was designed in descriptive qualitative research because the object of the study was a documented book. Moreover, as the data was in the form of words and documents, so the data were analysed qualitatively. The instrument used to collect the data is observation in the form of checklists. After being analyzed, it is found that some of the materials are not relevant with the cognitive and psychomotor aspects which are contained in the 2013 English Standard Competence. However, there are more materials which relevant with with the 2013 English Standard Competence than the materials which not. Thus, it can be concluded that the materials in this textbook are quite relevant with 2013 curriculum, especially with the cognitive and the psychomotor aspects. Therefore, this textbook is appropriate with the 2013 curriculum and suitable to be used in order to help the teaching and learning process in the classroom. Keywords: analysis, relevance, materials, textbook, the 2013 Curriculum. Abstrak Pemerintah Indonesia telah mengembangkan standar kompetensi Bahasa Inggris yang disampaikan dalam kurikulum sebagai acuan dalam proses belajar mengajar. Berdasarkan kurikulum, bahan pelajaran adalah saah satu faktor penting untuk menentukan suksesnya proses belajar mengajar. Bahan pelajaran yang umum digunakan adalah buku teks. Buku teks yang digunakan harus sesuai dengan komponen-komponen yang disampaikan dalam kurikulum. Meski banyak buku teks yang telah dinyatakan sebagai bahan pelajaran yang sesuai dengan Kurikulum 2013, tidak menjadi jaminan bahwa buku teks tersebut relevan dengan standar kompetensi dalam kurikulum. Analisis terhadap buku teks sangat dibutuhkan, terutama setelah diluncurkannya kurikulum baru. Berdasarkan latar belakang tersebut, penelitian ini dilaksanakan: 1) untuk menganalisis kecocokan antara bahan pelajaran dalam buku teks "Bright" dengan aspek kognitif yang terdapat dalam Standar Kompetensi Bahasa Inggris 2013, 2) untuk menganalisis kecocokan antara bahan pelajaran dalam buku teks "Bright" dengan aspek psikomotor yang terdapat dalam Standar Kompetensi Bahasa Inggris 2013. Metode penelitian yang digunakan adalah deskriptif kualitatif karena objek yang menjadi bahan penelitian adalah buku. Selain itu, data penelitian dianalisis secara kualitatif karena data yang digunakan dalam penelitian ini berbentuk dokumen. Instrumen yang digunakan dalam penelitian ini adalah observasi dalam bentuk checklists. Setelah dianalisis, ditemukan bahwa beberapa bahan pelajaran di dalam buku teks tidak relevan dengan aspek kognitif dan psikomotor yang terdapat dalam Standar Kompetensi Bahasa Inggris 2013. Akan tetapi, lebih banyak bahan pelajaran yang sesuai dengan Standar Kompetensi Bahasa Inggris 2013 daripada yang tidak sesuai. Jadi, dapat disimpulkan bahwa bahan pelajaran dalam buku teks ini cukup relevan dengan kurikulum 2013, terutama dengan aspek kognitif dan psikomotor. Oleh karena itu, buku teks ini sesuai dengan kurikulum 2013 dan layak digunakan untuk membantu proses belajar mengajar di dalam kelas. Kata Kunci: analisis, relevansi, bahan pelajaran, buku teks, kurikulum 2013. INTRODUCTION English plays a very important role as a means of communication. It is because English is an international language that can be used for international communication. Knowing that English as an international language is necessary in facing globalization, English as a foreign language is being taught and learnt in many countries, included in Indonesia. As the main foreign language in this country, English has become a compulsory subject in Junior High School until Senior High School. Indonesia government has implemented English into the academic curriculum. The government has developed English standard competence which is stated in curriculum as the standard of teaching and learning English process. Curriculum is made based on the Indonesian learners' need and is developed to achieve the certain aim of education. Because of the development of the human needs, especially in education field, the Indonesian government always trying to make a better standard for teaching and learning process. As stated by Nunan (2003:5) that "For many years, the goal of language pedagogy was to find the right method." That is why, Indonesian government especially the National education department develops a new curriculum as the new standard for teaching and learning process. Recently, by Peraturan Pemerintah 32/2013, the educational system of Indonesia has launched Kurikulum 2013. Kurikulum 2013 is a school based curriculum, it is an operational curriculum which is constructed, developed, and implemented by each education unit (school). The purpose of the 2013 Curriculum is to draw up the next generations of Indonesia to be a religious, productive, creative, and innovative citizen who could contribute for the social life in the Indonesia and social life in all over the world (Permendikbud Nomor 68 Tahun 2013). The English standard competences in 2013 Curriculum are conducted in particular purposes, they are: the purpose of affective aspects, cognitive aspects, and psychomotor aspects (Amri, 2013:39). Affective is the aspect which related to emotion, feeling and attitude. Cognitive is the aspect which related to knowledge. While psychomotor aspect is related to motor skill. According to the curriculum, material is also important in creating a good teaching and learning process. Material is one of the factors for determining the success of the teaching and learning process. The material which is usually used is in the form of textbook. In fact, mostly Indonesian teachers use textbook in delivering the material. Textbook is one of the learning materials that can be used by teacher and students in order to help the teaching and learning process in the classroom (Tomlinson, 2003). Textbook is an important component in the process of teaching and learning. It is because textbook can be a main resource for the teachers in guiding them in the teaching and learning activity. Textbook must be in line with the components stated in curriculum. However, selecting a textbook is not an easy job for the teachers. They should be careful in choosing an appropriate textbook, it is a textbook which supports the implementation of the curriculum. As Byrd (2001) says, textbook evaluation should be viewed in terms of the relevance between the textbook and the curriculum. Although there are many textbooks that are claimed as a suitable material for 2013 Curriculum, it is not a guarantee that the textbook is relevant to the standard competences of the curriculum. Based on the explanation above, textbook analysis is one of the efforts that can be done in determining whether a textbook is appropriate with the curriculum or not. An analysis to a textbook is still needed, moreover after the new curriculum was launched. Thus, this study was conducted to analyse the materials in English textbook for seventh graders entitled "Bright" published by Erlangga. In this study, the researcher wanted to find out the relevance of the materials in the textbook to the 2013 English Standard Competence. Based on the elaboration above, the objectives of this study are formulated as follow: 1. To analyse the relevance of the materials with the cognitive aspects which are contained in the 2013 English Standard Competence. 2. To analyse the relevance of the materials with the psychomotor aspects which are contained in the 2013 English Standard Competence. Curriculum Teaching and learning process in a school is performed based on the curriculum. The curriculum is designed by the government, so that everyone could get same experience in education (Ali, 2009:1). The Indonesian government defines curriculum as a set of plan and systematization of aims, contents, materials as the guidance in the process of teaching and learning to achieve the certain goal (Permendikbud Nomor 68 Tahun 2013). According to Ali (2009:15), curriculum has a strong influence in the process of teaching and learning. The curriculum as the plan for learning contains of some aspects and purposes which are related to the teaching and learning activity. In the curriculum, also contain the objectives of the study which should be achieved by the learners. Therefore, the good teaching and learning process should be performed based on the curriculum. Oliver (1977:329) states that as the product of the thinking and action of human beings, curriculum should be improved. As the ideas of people change, as people's actions change, so does curriculum. Curriculum is developed based on the objectives and the learners' need. Therefore, the Indonesian government can change and improve the curriculum, if the previous curriculum is not suitable with the objectives and Indonesian learners' need. Recently, by Peraturan Pemerintah 32/2013, the educational system of Indonesia has launched Kurikulum 2013. The 2013 Curriculum The 2013 Curriculum is a school based curriculum, it is an operational curriculum which is constructed, developed, and implemented by each education unit (school) since 2013. The 2013 Curriculum is legalized by Ministry of National Education in 2013. The 2013 Curriculum contains of the plan for teaching and learning process, the rules of objectives and materials, and the method used in the process of teaching and learning (Permendikbud Nomor 68 Tahun 2013). The 2013 Curriculum is designed in three aspects, they are: affective, cognitive, and psychomotor. Affective aspects encourage students to; accept, perform, appreciate, and inspire. Cognitive aspects encourage students to; comprehend, apply, analyse, and evaluate. While psychomotor aspects encourage students to; observe, ask, try, find reasons, present, and compose (Permendikbud Nomor 65 Tahun 2013). The learning stages that are emphasized in the 2013 Curriculum are: 1) observing; the students collect the information, 2) questioning; the students are stimulated to question how the phenomena happen, 3) experimenting; the students try to apply the knowledge through some practice given by the teacher, 4) associating; the students try to relate the phenomena to the previous knowledge, and 5) communicating; the students tell others about their finding. The 2013 English Standard Competence contains some English basic competences which cover all of the English materials. According to the 2013 Curriculum, English Standard Competence contains two kinds of competences, they are: core competences and basic competences. Core competence is divided into four objectives. The first and second objectives emphasize on affective domain. The third objectives emphasize on cognitive domain, and the forth objectives emphasize on psychomotor domain. Each of the core competence is divided into basic competences which are used as a guideline in developing learning materials (Permendikbud Nomor 68 Tahun 2013). The Three Domains of Learning According to Krathwohl, Bloom and Masia (1973), objectives of study could be placed in one of three major domains, they are: cognitive, affective, and psychomotor. Bloom et al. (1956) in Ali (2009:78-81) explains about those three domains as follows: Cognitive Cognitive domain related to the learner's thinking. This objective emphasizes remembering or reproducing something which has been learned. Cognitive objectives vary from simple recall of material learned to highly original and creative ways of combining and synthesizing new ideas and materials. Bloom et al. (1956) states the learning level of cognitive domain, they are: knowledge, comprehension, application, analysis, synthesis, and evaluation. Anderson (2001) revises the cognitive domain in the learning taxonomy and made some changes. The most prominent changes are: 1) the names in the six categories from noun to verb forms, and 2) slightly rearranging them. The revised cognitive domain are: remembering, understanding, applying, analysing, evaluating, and creating. Affective Affective domain related to the learner's attitude. This objective emphasizes a feeling, an emotion, or a degree of acceptance or rejection. Affective objectives vary from simple attention to selected phenomena to complex. Krathwohl et al. (1973) mentions the affective domain as: receive, respond, value, organise or conceptualize values, and internalize or characterise values. Psychomotor Psychomotor domain related to the learner's skill. This objective emphasizes some muscular or motor skill, some manipulation of material and objects, or some acts which requires a neuromuscular co-ordination. Dave (1975) mentions the psychomotor domain as: imitation, manipulation, precision, articulation, and naturalization. Textbook Textbook is an important component in the process of teaching and learning. It is because textbook can be a main resource for the teachers in guiding them in the teaching and learning activity. However, selecting a textbook is not an easy job for the teachers. They should be careful in choosing an appropriate textbook. Byrd (2001) explains the criteria that should be used in evaluating and choosing a good textbook. They are: 1. The fit between the material and the curriculum Curriculum is a guidance of teaching and learning process, including the purposes of the program and the teaching procedures. Therefore, the fit between the material and the curriculum would help the students to achieve the goal of the program. 2. The fit between the material and the students Textbook is used by the students. Therefore, the materials should be fit with the students' needs, so that they can learn the materials effectively. 3. The fit between the material and the teacher Textbook is used by the teacher. Therefore, the materials in the textbook should help the teacher in organizing the process of teaching and learning effectively. Textbook is often used in schools, and schools follow the curriculum designed by the government to guide the teachers in developing the objectives of teaching and learning activities. Therefore, Tarigan and Tarigan (1990:22) add that a good textbook should be relevant with the curriculum. Textbook is very important in supporting teaching and learning process. Therefore, a textbook must be in line with the components stated in the curriculum. The materials in the textbook should be designed based on the competences stated in curriculum. A textbook should support the curriculum to achieve the instructional objectives. A textbook should support the three domains that become the objectives of the 2013 English Standard Competence, they are: cognitive, affective, and psychomotor. RESEARCH METHOD This research is concerned in analysing the relevance of materials in the English textbook entitled "Bright" published by Erlangga to the 2013 Curriculum. Whether the textbook presents the purposes of the 2013 English standard competence or not. Since this study dealt with analysis of the content of textbook especially the materials, the data were analysed qualitatively, without any statistical calculation. As Ary et al. (2010:424) states that qualitative researcher deals with data that are in the form of words or pictures rather than numbers and statistics. Moreover, as the data was in the form of words and documents, so the data were analysed qualitatively. The data of this study is an English textbook entitled "Bright" for seventh graders of Junior High School published by Erlangga. The data are in the form of documented materials existing in the textbook. The materials are divided into some activities. The data were analysed in order to answer the research problems stated in Chapter I. There are several instruments which were needed to collect the data. According to Ary et al. (2010:421), the primary instrument used for collecting the data in qualitative research is the researcher him- or herself, often collecting the data through direct observation or interviews. So, the first instrument for this study is the researcher herself, and the second instrument is observation in the form of checklists. They are two kinds of checklist that were applied to answer the research questions. First, the checklist used to analyse the relevance of the materials with the cognitive aspects which are contained in the 2013 English Standard Competence. Second, the checklist used to analyse the relevance of the materials with the psychomotor aspects which are contained in the 2013 English Standard Competence. The technique used to collect the data in this study was by conducting an observation. The observation dealt with all of the materials in the textbook and the relevance of it based on 2013 Curriculum. The researcher observed the data by using observation checklist. The observation was done through several steps. First, the researcher determined the textbook which is going to be analysed. Second, the researcher read and observed the materials of the textbook carefully. Third, the researcher compared the materials in the textbook with the 2013 English Standard Competence using checklist in order to know the relevance between the materials on the textbook to the 2013 English Standard Competence. The last, the researcher collected the data then analysed them. The data of this study were collected from English textbook entitled "Bright" for seventh graders of Junior High School published by Erlangga. In analysing the data, some steps were taken, they are: The researcher analysed the relevance of the materials with the cognitive aspects which are contained in the 2013 English Standard Competence. The researcher analysed the relevance of the materials with the psychomotor aspects which are contained in the 2013 English Standard Competence. The researcher described and elaborated the findings of the analysis. The researcher determined the conclusion. RESULT AND DISCUSSION The Presentation of the textbook entitled "Bright" "Bright" is an English textbook designed for seventh graders of junior high school. This textbook also designed to support the process of teaching and learning and it is developed for the compatibility to the 2013 English Standard Competence. "Bright" is printed in 196 pages. These pages are added with the preface, table of contents, feature of the textbook, mini dictionary, appendix, bibliography, and spaces for students' notes. In total, there are 204 pages printed on this textbook. There are eight units presented in this textbook. In the first semester, the students will learn unit 1 to unit 4; and the rest of it will be taught for the next semester. On each unit, the textbook provides fun corner and reflection table. In the fun corner, the authors give riddle question. For the reflection table, the students could use it after learning each unit as the reflection what they are good at, what they are ok at, and what they are bad at. Furthermore, for each unit in this book is divided into two parts: Listening and Speaking Activities and Reading and Writing activities. The first part focuses on listening and speaking skills. The latter part focuses in reading and writing. Expressions, grammar, explanations, and specific vocabularies that the students need for each activity and the students need to know are introduced and presented at the beginning of the activities, so that the students could understand the materials better. The Relevance of the materials in the textbook entitled "Bright" with the 2013 English Standard Competences Here are the tables to present the final result of the analysis to check the relevance of the materials in this textbook with the 2013 English Standard Competence. The researcher analysed the relevance of the materials based on the third and fourth basic competences. The Relevance of the Materials with the Cognitive Aspects Table 1. The Conformity of Textbook Materials to the Third Basic Competence The Relevance The Third Basic Competence Relevant Sub-basic competence 3.1.1, 3.1.3, 3.1.4, 3.2.1, 3.2.2, 3.3.1, 3.3.2, 3.3.3, 3.3.4, 3.3.5, 3.4.2, 3.5.2, 3.6.1, 3.6.2 Partly relevant Sub-basic competence 3.1.2, and 3.4.1 Not relevant Sub-basic competence 3.5.1, and 3.5.3 According to the table above, it can be seen that there are some materials which are relevant, partly relevant, and not relevant with the third sub-basic competence. The materials which relevant with the sub-basic competence are be able to fulfil the purposes of the topic, language features, and social functions that are intended to be achieve by the students. While the materials which not relevant the sub-basic competence are not be able to fulfil all of the purposes of the topic, language features, and social functions that are stated in the third sub-basic competence. There are two materials which partly relevant with the third sub-basic competence, they are: the 3.2.1 and 3.4.1 sub-basic competence. The 3.1.2 sub-basic competence is comprehending social functions, text structures, and language features in leave taking expressions and the responses according to the contexts. Leave taking expression is becoming one part of the greeting material and not being explained in-depth. Only few examples of leave taking expression occur in the table of greeting and the responses. There are not exercises for the leave taking expression, so that the social functions cannot be achieved. Thus, the materials are partly relevant with the 3.1.2 sub-basic competence. The textbook does have material of personal informtion that is stated in the 3.4.1 sub-basic competence. The goal of the competence is the students will be able to comprehend social functions, text structures, and language features from spoken text to mention personal information, while the material of personal information in the textbook is presented in the form of written texts and examples. Therefore, the materials are partly relevant with the 3.1.2 sub-basic competence. The Relevance of the Materials with the Psychomotor Aspects Table 1. The Conformity of Textbook Materials to the Fourth Basic Competence The Relevance The Fourth Basic Competence Relevant Sub-basic competence 4.1.1, 4.1.3, 4.1.4, 4.2.1, 4.3.1, 4.3.2, 4.3.3, 4.3.4, 4.3.5, 4.4.2, 4.5.2, 4.6.2, 4.7.2 Partly relevant Sub-basic competence 4.1.2, 4.4.1, 4.5.1, 4.7.1 Not relevant Sub-basic competence 4.2.2, 4.6.1, 4.6.3 According to the table above, it can be seen that there are some materials which are relevant, partly relevant, and not relevant with the fourth sub-basic competence. The materials which relevant with the sub-basic competence are be able to fulfil the indicators that are intended to be done by the students. While the materials which not relevant the fourth sub-basic competence are not be able to fulfil all of the indicators that are stated in the fourth sub-basic competence. There are four materials which partly relevant with the fourth sub-basic competence, they are: the 4.1.2, 4.4.1, 4.5.1, and 4.7.1 sub-basic competence. The textbook does have material of personal informtion that is stated in the 4.1.2 sub-basic competence. The goal of the competence is the students will be able to constructing spoken text in the form of leave taking with the appropriate social functions, text structures, and language features according to the contexts. However, the material of leave taking expression in this textbook is becoming one part with the greeting material. So the leave taking material is not being explained in-depth. Thus, there is no exercise that could help the students to achieve the goal of 4.1.2 sub-basic competence. Therefore, the materials in the textbook are partly relevant with the sub-basic competence. The goal of the sub-basic competence 4.4.1 is the students will be able to comprehend the meaning of spoken information. While the exercise and the example of personal information in the textbook is in the form written text. Therefore, the indicators cannot be fulfilled and the materials in the textbook are partly relevant with the sub-basic competence. The goal of the sub-basic competence 4.5.1 is the students will be able to construct spoken text for mentioning personal information with the appropriate social functions, text structures, and language features according to the contexts. The textbook does have material of personal information in unit 1. While the exercise of personal information in the textbook is intended to make students be able to construct personal information in the form written text. Therefore, the indicators cannot be fulfilled and the materials in the textbook are partly relevant with the sub-basic competence. The textbook contains of the sub-basic competence 4.7.1. The purpose of the materials is to construct written text in the form of labels with the appropriate language features according to the contexts.This textbook provide exercises about labels. However, there is no activity that aims students to construct their own labels. The materials cannot fulfil the indicators stated. Thus, this textbook does not provide activity to construct written labels. Therefore, the material in the textbook is not relevant with the sub-basic competence and the materials in the textbook are partly relevant with the sub-basic competence. CONCLUSIONS AND SUGGESTIONS Conclusions This study is intended to analyse the relevance of materials in English textbook for seventh graders entitled "Bright" published by Erlangga to the 2013 English Standard Competence. The researcher analysed the materials relevance to the cognitive and the psychomotor domains. From the analysis, it can be concluded that the English textbook "Bright" is quite relevant with the 2013 English Standard Competence. The materials in the textbook are quite relevant with the cognitive aspects which are contained in the 2013 English Standard Competence. According to the tables presented in the chapter four, the third basic competences which objectives emphasize on cognitive domain are quite relevant with the 2013 English Standard Competence. There are sixteen tables for the third basic competences. There are twelve tables which show the materials are relevant with the basic competences, these materials could fulfil objectives of the main topics, language features, and social functions stated. There are two tables which show the materials partly relevant with the basic competences, these materials could only fulfil one objective or two objectives stated. There are only two tables that show the materials are not relevant with the competences stated, these materials cannot fulfil all of the objectives. The forth basic competences which objectives emphasize on psychomotor domain are also quite relevant with the 2013 English Standard Competence. There are eighteen tables for the fourth basic competences. There are eleven tables which show the materials are relevant with the basic competences, these materials could fulfil all of the indicators. There are four tables which show the materials partly relevant with the basic competences, these materials occur in the textbook but cannot fulfil the indicators stated. There are only three tables that shows the materials are not relevant with the basic competences stated in the 2013 curriculum, these materials do not occur in the textbook. According to the elaboration above, the materials in this textbook are quite relevant with 2013 curriculum, especially with the cognitive and the psychomotor aspects. There are more materials which relevant with the 2013 English Standard Competence than the materials which not. Therefore, this textbook is appropriate with the 2013 curriculum and suitable to be used in order to help the teaching and learning process in the classroom. Suggestions After finishing this research, the researcher would like to give suggestion for the teacher, the textbook writer, and the next researcher. The first suggestion is for the teachers, the teachers should be careful and selective in choosing the textbook to be used in helping them in the teaching and learning activities. They should choose textbooks that contain materials appropriate with the curriculum. The selected textbook should support the curriculum to achieve the instructional objectives. For the textbook writers, they have to follow certain criteria in developing the materials. The materials should be in line with the English Standard Competence stated in the curriculum. Moreover, the materials should be able to fulfil all of the indicators, the objective of the main topics, the objective of the language features, and the objective of the social functions related to the competences. Thus, the textbook will be relevant with the curriculum and appropriate to be used by teachers and students. For the next researcher, they can conduct the study which is intended to analyse the relevance of the materials of the same textbook to the 2013 curriculum and focuses on the activities that intended to be taught in the second semester. Otherwise, the next researcher can study other textbook with the different grade of the study and analyse the relevance of the materials to the 2013 curriculum. REFERENCES Ali, Muhammad. 2009. Pengembangan Kurikulum di Sekolah. Bandung: Sinar Baru Algensindo. Amri, Sofan. 2013. Pengembangan dan Model Pembelajaran dalam Kurikulum 2013. Jakarta: Prestasi Pustaka Publisher. Anderson, Lorin W. & Krathwohl, David R. 2001. A Taxonomy for Learning, Teaching and Assessing: a Revision of Bloom's Taxonomy. New York: Longman Publishing. Ary, Donald. et al. 2010. Introduction to Research in Education. Canada: Wadsworth, Cengage Learning. Bloom B. S. 1956. Taxonomy of Educational Objectives, Handbook I: The Cognitive Domain. New York: David McKay Co Inc. 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