Innovation in family firms is still a controversial issue within the academic community and poses some unique challenges for family business owners and managers. This special issue on innovation in family firms results from the cooperation of both academic and business guest editors, in a pioneering initiative that is not usual in academic journals. Indeed, a key feature of this Special Issue has been the collaboration with two family business leaders, who have been involved in the editorial process together with the academics. The two business editors that we involved are Antonio Gallardo, Vicepresident of Almirall and former director of FBN-Family Business Network, and Ignacio Osborne, CEO of the Osborne Group and Chairman of the Spanish Family Firm Institute. In order to introduce the six papers that make up this special issue on innovation in family firms, we as academic editors are pleased to include some comments from the business editors that emerged during our interactions with the aim to make a step forward toward bridging the gap between research and practice on family business innovation, acknowledging the different perspectives and approaches adopted by academics and practitioners. As the business editor Mr. Osborne points: "Innovation issues in family firms are nowadays more important than ever, due to the rapid developments that are occurring in the business world and its corresponding technologies". Despite being a topic analyzed by a number of authors over time (Feranita, Kotlar and De Massis, 2017; Aparicio, Iturralde and Sánchez-Famoso, 2020 in this issue; Chrisman, Chua, De Massis, Frattini and Wright, 2015), the study of innovation in family business still requires a greater volume of research to provide answers to the needs of family businesses. The distinctive nature of family firms results in a complex influence on the innovation process (De Massis, Frattini and Lichtenthaler, 2013), which is reflected in mixed research findings. For instance, the conclusions of the published research offer sometimes contradictory results, since family businesses can be considered innovative (Aronoff, 1998; Craig and Moores, 2006) or conservative (Sharma, Chrisman, y Chua, 1997; Zahra, Hayton y Salvato, 2004; Gómez-Mejía et al., 2007), with several studies that can support whatever of the two options. Family businesses present a number of characteristics that, a priori, seem to favor innovation, such as long-term orientation (Tagiuri and Davis, 1996; Ward and Aronoff, 1994), the desire for continuity through the following generations (Miroshnychenko et al., 2020; Gallo, 1995), patient capital (De Massis, Audretsch, Uhlaner and Kammerlander, 2018; Sirmon and Hitt, 2003), and the long tenure of their main leaders (Lorenzo, 2020). The replacement of the prior generation by the next generation implies the access of younger people to the leadership of the company, who also often present a greater level of qualification (De Massis et al., 2008; Cabrera-Suárez, 2011). Young and qualified leaders would provide a new momentum to the firm, by means of the renewal of the firm (Núñez-Cacho and Lorenzo, 2020). Likewise, the successors receive an important legacy by means of the values of the family business (Erdogan et al., 2020), such as effort, perseverance, austerity, excellence, long-term orientation and entrepreneurial spirit, as basic foundations of their way of understanding business activity (Bermejo, 2008). Accordingly, the new generation managers could be in the best conditions to reinvent the company, since they know the business from within and they also provide the new vision of a person with a working life ahead. Another factor that favors the renewal impulse of the next generation is the familial support to carry out a prolonged tenure over time, which will not be as conditioned by short-term results as in other types of companies, by the so-called patient capital (Sirmon and Hitt, 2003) of the family business (Lorenzo, 2020). But, even if these ideal conditions are met in a specific family firm, it is not guaranteed that the company realizes the innovation it needs. Therefore, it is needed to shed more light about the determinants and conditions for innovation. The editors of this special issue selected a number of papers to reflect the state-of-the-art on this topic, indicating some of the most promising research lines on innovation. According to the business editor Mr. Gallardo, "A very important aspect emerging from this special issue is that the papers published in it reveal that external contributions to the internal know-how of the family and the business are often vital to help produce the changes needed by a family firm for innovation to take place". Innovation in the family business has been a phenomenon of great interest to researchers, especially in the last decade. This is highlighted in the article that opens this special issue by presenting a complete bibliometric review of the literature on innovation in family businesses. Generally, researchers have noted that the influence of the family is the factor that makes this type of businesses different from the other ones (Habbershon and Williams, 1999; Lorenzo and Núñez-Cacho, 2012). However, in order to conclude that this is really true, it is necessary to identify the nature of these differences and determine how and why they affect the innovative behavior of the family business. The paper Innovation on family businesses: A holistic bibliometric(Aparicio, Iturralde and Sánchez-Famoso, 2020) offers an overview of the research field through an analysis of 207 articles that were published between 1994 and 2017. The authors complement other recent reviews such as those by Feranita, Kotlar and De Massis (2017) and Calabrò, Vecchiarini, Gast, Campopiano, De Massis and Kraus (2019), and reflect about the take-off of research on innovation that takes place since 2009. In the study two differentiated periods are highlighted: An initial one that covers the years 1994 to 2009, and one of expansion from 2010 to 2017. In addition, they identify the most influential journals, the most referenced articles, the most productive scholars -namely, De Massis, Frattini, Craig, Chrisman, Fang, Kotlar and Nordqvist appear as the most productive and referenced ones- and the main lines of research developed, providing a clear and synthetic map of innovation research in family businesses today. This paper approaches innovation from a more theoretical perspective, and also presents the lines of research that are currently being developed. These lines include the internal factors of the family business and its influence on innovation, as well as external factors, among others advances in research in the subject. The paper An Analysis of Open Innovation Determinants: The Case Study of Singapore based Family owned Enterprises, by Koh, Kong and Timperio (2020, this issue) analyzes the drivers of open innovation by studying cases of family businesses in Singapore. The authors highlight the external determinants and catalysts of innovation projects, such as family and business culture, access to external funds, government support for initiatives, market dynamics and partnership between companies. In addition to these six external determinants, there are two other factors that have a great influence on open innovation. First, family capital, which is the main source of financing for innovative initiatives. Second, a strong external network, supported by Singapore's legal and regulatory framework that fosters innovation, promotes the development of an enabling business environment so that the spirit of innovation can truly thrive. Most of the surveyed companies' managers mentioned process innovation as the most critical aspect, and also organizational innovation. Process innovation is considered superior by the companies included in the sample due to their capabilities to drive product innovation, marketing and organizational structure (and people). Organizational innovation is also considered of utmost importance, due to the need to adopt technologies such as digitalization, robotics or automation, which require an adequate organizational structure. Some ideas from the surveyed managers highlight these statements, like: "The correct processes create the necessary conditions to shape the products, as well as the marketing and organization structures," as well as "Having cutting-edge processes underway is a key differentiator." This study also reflects the need to establish new financing mechanisms adapted to the peculiarities of innovation processes. External capital injection and stimulus policies are necessary, although not sufficient, since they must be combined with the determinants of the internal functioning of family businesses. The relevance of the external network is also highlighted in the paper Collaborative innovation in the family SME: conceptualization, goals, and success factors, by Arzubiaga, Maseda, Uribarri and Palma Ruiz (2020, this issue), which analyzes the strategy of collaborative innovation that seeks the creation of knowledge, new product designs and Improving the efficiency of the production process. Among the conditions of collaborative innovation, four groups stand out: The composition of the management team (in terms of family members percentage and number of generations involved in management), abilities (cognitive factors, absorption capacity and trajectory in innovation), attitudes, and legacy preservation, (referring to socio-emotional wealth and internal behavior). These factors of small and medium family businesses play a crucial role in the successful design and implementation of collaborative innovation. The main contributions of this paper can be summarized in the need for establish solid bases to deepen in the future the study of collaborative innovation. Moreover, a second contribution refers to the identification of the distinguishing characteristics of family SMEs. Arzubiaga, Maseda, Uribarri and Palma Ruiz (2020, this issue) also propose the analysis of the possible moderating effects of firm size and the sector to refine the impact of the variables in this model, looking to achieve excellence in collaborative innovation. As business reviewer, Mr. Osbornehave highlighted collaborative innovation as one of the relevant issues in order to reinforce the role of innovation in their companies. Absorptive capacity is another aspect of great interest to researchers. There are numerous factors that condition it, some of them are features of the family character that make the behavior of family businesses paradoxical (Kotlar et al. 2020). The paper titled A mediating model of innovative capacity between absorptive capacity and family business performanceby Hernández-Perlines, Ariza-Montes and Araya-Castillo (2020, this issue) addresses the issue about absorptive capacity. Absorptive capacity is related to the identification, assimilation and exploitation of new knowledge by the company. Those family businesses that have these capabilities improve their performance. In addition, this effect is enhanced by the innovative capacity of the company, which acts as a mediator between absorption capacity and the company's performance, reinforcing this relationship. Thus, family business managers should focus their efforts on providing their organizations with the necessary skills to absorb and exploit knowledge. This will be easier if the company has developed innovative capabilities. In this sense, the business editor Mr. Gallardo points that: "There is also the possibility of establishing an advisory council with external collaborators that serves as a contrast to the company's board, in which oftentimes the weight of the family is too decisive." The last two papers in this special issue address the role of family involvement in relation to innovation. Does too much love hinder innovation? Family involvement and firms' innovativeness in family-owned Small Medium Enterprises (SMEs), by Filippo Ferrari (2020, this issue) reflects on the role of family cohesion and its flexibility in the process of innovation, drawing upon the Olson Circumplex model (Olson, 2000) which is applied in a sample of Italian family businesses. The study indicates that unbalanced families show the lowest levels of innovation, although family cohesion and flexibility do not show a significant correlation with the overall level of organizational innovation. Flexibility shows a positive correlation with the process and behavioral innovation, which can be explained by the demand for new forms and organizational routines to deal with process innovation. Here the author suggests some human resources practices that promote flexibility, such as labor rotation (Ortega, 2001), or the development of a horizontal internal career (Ichniowsky et al. 1996, 1997, 1999). Families that lack cohesion show a negative correlation with strategic innovation and process innovation. Ferrari (2020, this issue) considers as disconnected family systems those in which family members are not cohesive and have little family loyalty. On the other hand, innovation in processes is encouraged with new ideas through contributions in terms of new ways of doing things. According to the authors, the Olson Circumplex model (Olson, 2000) offers a framework that can diagnose the extent to which family systems are balanced and how the effects of balanced or unbalanced family dynamics can affect the family business (Daspit et al. 2018). Business reviewers were especially interested on the conclusions of this paper, and also pointed that it would be necessary more research on that kind of negative influences stemmed from lack of cohesion within the business family. Entrepreneurial orientation and product innovation: The moderating role of family involvement in management, by Fredyma, Ruiz Palomo and Diéguez (2020, this issue) addresses a classic concept closely linked to the study of innovation such as entrepreneurial orientation. The relationships between this variable and product innovation, incremental innovation and radical innovation are examined. The influence of family performance on the company is also analyzed. In their conclusions, Fredyma, Ruiz Palomo and Diéguez (2020, this issue) point out that family involvement weakens the positive effect of entrepreneurial orientation in product innovation, especially in case of radical innovation. Therefore, the family business must be aware of these weaknesses to correct them, professionalizing with non-family managers and including their participation in innovation decisions. This conclusion is stressed by both business editors, Mr. Osborne and Mr. Gallardo, who point out that: "Having a network of external collaborators, some of them generalists and others specialized in specific problems, is nowadays practically indispensable." Finally, the academic editors sincerely appreciate the contributions of two prominent Spanish businessmen, who have contributed to enrich this special issue with a business perspective, which helps to overcome the division that is sometimes perceived between the academic world and the business one. Both Antonio Gallardo and Ignacio Osborne represent the entrepreneurial vision that they have been able to maintain in their families and in their companies for generations. We all know how challenging it is for a family business to be entrepreneurial across generations (e.g., De Massis, Eddleston and Rovelli, 2020). Last but now least, we want to express our gratitude to the editor of the European Journal of Family Business, Professor Vanesa Guzmán for her collaboration and contributions. The Osborne Group, founded in 1772, is one of the oldest family businesses in Europe. The group evolved from the original business of raising and exporting wines from Jerez to a wider food and beverage group which includes quality wines from various Spanish designations of origin, premium spirits, and products derived from Iberian pork, with a growing international acceptance, entering markets as demanding as China. Ignacio Osborne, a member of the sixth family generation, is the current president of the company since 2017, after 21 years as CEO. The company has been especially innovative in marketing, creating the symbol of the bull in the 50s, which has become a symbol that identifies the Spanish, transcending its initial origin as a reference for the winery. Almirall is a pharmaceutical company founded in 1943. It is currently run by the second generation, which are giving way to the third. Although innovation is an essential requirement to compete in pharmaceutics, Almirall has managed to develop some well-known products in Spain, as Almax and Cleboril, becoming one of most innovative companies in the industry. Antonio Gallardo is honorary vice president of his company, which he chaired for 26 years. In addition, he was also president of the Family Council and the Family Office, as well as a member of the Executive Committee of the Family Business Network and vice president of the Family Business Institute.
The impact of infectious diseases on populations all over the world has long been recognized as an imminent global crisis.[1]The 21st century has seen an increase in outbreaks of emerging infectious diseases ("EIDs"), which threaten the health and safety of citizens all over the globe.[2]EIDs are diseases that have "recently appeared in a population or have already existed but are rapidly increasing in incidence or geographic range,"[3]which explains the widespread fear such disease outbreaks can incite. However, despite how many times EID outbreaks have made global news headlines in contemporary history, the international community has struggled to adequately respond, leaving vulnerable populations at risk. Many factors contribute to the disproportionate impact of EIDs on vulnerable populations, including those stemming from disparities regarding poverty and gender. Socioeconomic status influences health, to the point where "poverty breeds disease and ill health leads to poverty."[4]Data on gender differences in infectious disease outbreaks also show that disease does not affect everyone equally.[5]Although both men and women suffer from different diseases due to biological inequalities and social differences,[6]women are particularly vulnerable due to the lack of attention and integration of women in global health policies and management strategies of EID outbreaks. One case study that demonstrates the disparate impact on vulnerable populations during EID outbreaks is the current Ebola Virus Disease ("EVD") outbreak in the eastern region of the Democratic Republic of the Congo ("DRC"). This outbreak began in August 2018 and has grown to become the second largest EVD outbreak on record.[7]As observed in the 2014–2016 West African EVD outbreak and other large-scale EID outbreaks such as Zika or SARS,[8]the 2018 Eastern DRC EVD outbreak has had a significant impact on women. While research has been conducted on "diseases of poverty" and the vulnerability of women in EID outbreaks, the preference to deal with the immediate outbreak instead of addressing more systemic societal concerns forgoes the focus on the individual and their human rights. As a result, little has been done to bring in a human rights perspective to the management and response mechanisms of such outbreaks. A human rights perspective not only brings to the forefront these core issues of inequality, but also introduces supplemental and useful tools for considering how to achieve the most effective response to these emergencies. The first section of this paper provides an important background to the relationship between poverty, women, and EIDs by considering both legal and public health perspectives. The second section analyzes the role of women in global health, particularly in responses to EIDs, by examining how women have been impacted in past EID outbreaks and the current 2018 Eastern DRC EVD outbreak as a case study. Finally, this paper concludes with a discussion of how global health policymakers and healthcare professionals can address this gap by applying a gendered lens to EID outbreak management. Background The human right to health as a foundation for addressing inequality in poverty and gender As human rights have developed throughout history, the issue of health has consistently been regarded as a core, fundamental human right.[9]Beginning with the United Nations ("UN") Charter (1945), this emphasized the need for international cooperation in Chapter IX, particularly for finding solutions to health problems.[10]In 1946, the World Health Organization ("WHO") Constitution declared that the objective of the WHO is the "attainment by all peoples of the highest possible level of health."[11]In 1948, the Universal Declaration of Human Rights ("UDHR") referenced this same objective for health in Article 25(1): "everyone has the right to a standard of living adequate for the health of himself and his family, including food, clothing, housing and medical care, and necessary social services . . . ."[12]In 1966, the International Covenant on Economic, Social and Cultural Rights ("ICESCR") stated in Article 12: "The States Parties . . . recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health"[13]and to achieve this, highlighted the "prevention, treatment and control of epidemic, endemic, occupational and other diseases"[14]as a vital prerequisite for success. The drafting history of this provision demonstrates that the object and purpose of this provision was to obligate States to address the prevention of disease and malnutrition, two major factors which pose obstacles for achieving health for all.[15]Additionally, the Committee on Economic, Social and Cultural Rights ("CESCR") General Comment 14 further explained ICESCR Article 12(2)(c), stating that "The right to treatment includes the creation of a system of urgent medical care in cases of accidents, epidemics and similar health hazards, and the provision of disaster relief and humanitarian assistance in emergency situations"[16]and "[t]he control of diseases refers to States' individual and joint efforts to . . . make available relevant technologies, using and improving epidemiological surveillance and data collection on a disaggregated basis, the implementation or enhancement of immunization programmes and other strategies of infectious disease control."[17]With these core international instruments, basic standards of health, treatment, and particularly disease management all set the stage for a baseline of States' obligations to respect, protect, and fulfill the right to health. Currently, the Sustainable Development Goals ("SDG") also highlight the right to health. In SDG 3.3, States' target to end "the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases . . . ."[18]is particularly relevant because neglected tropical diseases ("NTDs") are a subset of EIDs and mainly affect the poorest populations in the world.[19]SDG 3.c to "substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries . ." and 3.d to "strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks"[20]are both also important goals for addressing the disproportionate disease burden on States that currently lack the capacity to respond to health crises such as EIDs. These goals, voluntarily assumed by States, continue to build upon the human rights foundation of the right to health and further solidify the importance of addressing health through a human rights framework. Just as the right to health has been established through international treaties, women's rights have also been protected through Article 12 of the Convention on the Elimination of All Forms of Discrimination Against Women ("CEDAW"), which "obligates States Parties to eliminate discrimination against women in the field of health care and to ensure women access to appropriate services in connection with pregnancy."[21]Like the CESCR, the CEDAW Committee further explained the importance of protections for women's health through its General Recommendation regarding CEDAW Article 12, stating that the "duty of States parties to ensure . . . access to health care services, information and education implies an obligation to respect, protect and fulfill women's rights to health care."[22]Additionally, another CESCR General Comment addresses women's health in particular by articulating "State obligations as including identifying how gender roles affect health and removing legal restrictions on reproductive health, among other things."[23]These international treaty provisions demonstrate the importance of protecting the right to health especially as it applies to women. Poverty as a determining factor of health outcomes in EIDs Poverty is a main determining factor of EIDs in communities[24]because "poor health and poverty are intertwined in developing countries. Poverty breeds disease and ill health leads to poverty."[25]With almost 900 million people living in extreme poverty[26]across the globe, understanding how poverty and disease are related is urgent.[27]Poverty is an important factor which contributes to more opportunities for infectious diseases to impact humans.[28]NTDs are a subset of EIDs which particularly thrive and persist under conditions of poverty.[29]One disease example is tuberculosis ("TB"), which is often described as a "disease of poverty" because it is "significantly associated with poor housing, low literacy and nutritional status, and lack of access to health services."[30]NTDs are often called infectious diseases of poverty and are the result of the "complex interaction of biological, social, and environmental factors [because they] disproportionately affect poor and disadvantaged populations in which the poverty context reinforces risk and vulnerability."[31]This is compounded by the fact that disease "control tools such as drugs, vaccines, and diagnostics often do not reach the populations that most need them because of social issues . or because they are ill adapted to the cultural, social, and economic realities in which people live."[32] Another connection between poverty and disease is that since EID outbreaks such as the 2014–2016 West African EVD outbreak, the 2015–2016 Zika outbreak, and the current 2018 Eastern DRC EVD outbreak can have a very significant impact on a community, they can essentially reach the level of a crisis or disaster. When disasters hit, people living in poverty are much more vulnerable.[33]On top of this, women make up approximately 70% of people living in poverty worldwide, so this indicates that overall, women are more likely to be affected by disasters in poverty-stricken areas.[34] Gender as a determining factor of health outcomes in EIDs Another key determinant of health is gender.[35]The term "gender" refers to societal and cultural factors that are different between traditional male and female roles.[36]Studies on the relationships between sex and gender to infectious diseases have been conducted across a variety of disciplines, which has actually acted as a barrier to application of this research in outbreak settings because each discipline tends to work in isolation.[37]Thus, to fill this gap, it is important to integrate a gendered lens into outbreak response and management. Disease does not affect men and women equally.[38]Women are a particularly vulnerable group because they "disproportionately bear the burden of poverty and disease."[39]Thus, vulnerability is deeply gendered.[40]Not only do over 80% of women in the world live in low- or middle-income countries,[41]putting them at higher risk for more EIDs, women also live longer in general. Over a lifetime, the "social context of women's lives place exceptional burdens on the quality of life lived." Understanding the pre-existing biological and socio-cultural conditions in which women live is an important foundation for understanding their vulnerability in crises and disasters. Risks related to health concerns from cooking fumes in the home and complications with pregnancy "overlap with developing countries and are exacerbated in the contexts of poverty combined with conflict . [and] such risks are further aggravated in situations of humanitarian crisis."[42] State and international core obligations to protect health for all Although there are international instruments protecting health, given the vulnerabilities of those living in poverty, especially women, it is not surprising that many States lack the capacity to "progressively realize and ensure that a minimum core of a properly functioning health system and infrastructure . exists for people to gain access to health services."[43]While States are required to "take all appropriate measures subject to available resources,"[44]to prevent diseases, the States that experience the most NTDs "are least able to counter the existing imbalance in disease prevention research and development."[45]The lack of capacity in many States in the Global South has been attributed to "historical vulnerability from slavery, colonialism, neocolonialism, bad governance, and neoliberal reform policies like structural adjustment."[46]In addition to States' obligations, there is also an "obligation of international co-operation under the right to health."[47]If a State lacks capacity, the international community is called upon to address this problem via a 'collective responsibility.'[48]The ICESCR addressed collective responsibility, stating that States should realize the rights in the Covenant "individually and through international assistance and co-operation, especially economic and technical."[49] Case study on the 2018 DRC EVD outbreak The most recent EVD outbreak began in August 2018 in the eastern region of the DRC, originally concentrated in North Kivu and Ituri provinces.[50]It has since grown to be the second largest EVD outbreak on record, the largest being the 2014–2016 West African EVD outbreak.[51]Although this is the tenth EVD outbreak to take place in the DRC, there are many factors which differentiate this outbreak from those in the past.[52] First, past outbreaks in the DRC have not been concentrated in the eastern region of the DRC. This region has been a conflict zone for decades and violence continues today.[53]Compared to the 2014–2016 West African EVD outbreak, North Kivu province houses an even denser population than Guinea, Liberia, and Sierra Leone combined, and also shares borders with four more provinces and two other countries.[54]This subregion of the DRC has a history of insecurity and presence of well over one hundred active non-state armed groups,[55]which still remain in the region after conflicts such as the DRC independence in 1960, the bordering 1994 Rwandan genocide, and the civil war that established the regime of recent President Joseph Kabila.[56] In the broader context, the history of the DRC has not provided a backdrop conducive to effective management of deadly EIDs. Centuries of colonialism led to decades of armed conflict, which continues today and has spread deep-rooted mistrust for the government across the country, especially in the Eastern DRC.[57]The DRC is also one of the three poorest countries in the world, despite its rich natural resources, so while colonialization may no longer be an issue, there is still an ongoing presence of exploitation.[58]These elements all contribute to the context in which the current 2018 Eastern DRC EVD outbreak is taking place, which is important to understand for the purposes of analyzing the impact of EIDs on women in poverty. Women play an integral role in global health and applying a gendered lens in all levels of EID responses provides better protections for women and more effective management strategies of EID outbreaks The role of women in global health Informal caregivers The 2014–2016 West African EVD outbreak began in December 2013, but in just eight months, data reported that "55-60% of all Ebola fatalities in Guinea, Liberia, and Sierra Leone were women."[59]Additionally, news headlines asking "Why Are So Many Women Dying from Ebola?" revealed that "women in Ebola-hit countries do not enjoy the promise of equality called for under human rights law."[60]Since increased risk in transmitting EVD comes from basic day-to-day interactions, traditional gender roles put women in especially vulnerable positions.[61] One role that women in many societies fill is that of the caregiver in the home. This societal expectation for women to care for the family greatly contributes to the disproportionate impact that EIDs such as EVD and HIV have on women.[62]For especially fatal diseases such as EVD, women are not only caring for more individuals, but the work is also laborious and dangerous because the disease is spread through direct contact with bodily fluids.[63]This is a particular challenge because often the intensity of the care given at home is equal to that given at a health care facility, yet not all women are formally trained health care professionals.[64]There is a gap in education and important information for women as informal caregivers, which further perpetuates the disparate impact of EIDs on women. As caregivers and due to traditional gender roles, women are also often heavily involved in the mourning and burial rituals once their loved ones have died and they are the "ones to perform funeral rites such as washing bodies and preparing them for burial."[65]During the 2014–2016 West African EVD outbreak, one area of Sierra Leone reported that as many as 365 deaths were connected to one funeral, and when the outbreak first began in Guinea, approximately 60% of all EVD cases were connected to traditional burial practices.[66]Since EVD is still transmissible after death and women play such a prominent role in these rituals, their gender role as caregiver and mourner puts them at a disproportionately higher risk of infection.[67] Additionally, while women in many societies are seen as the primary caregivers in the household, when they fall ill the roles are not reversed. Instead of the men taking care of the women, other women in the community are responsible for caring for each other.[68]This is partially due to socio-cultural aspects of what are appropriate roles for men and women, and also contributes to women being more vulnerable to EIDs. Nevertheless, while the role of women as caregivers is clear, in past EVD outbreaks it is shown that "men dominated informational meetings on the disease,"[69]leaving out the key voice of women and putting them in a vulnerable place without adequate information or agency to voice their concerns during these discussions. Health workers The healthcare workforce is also a vulnerable population during EID outbreaks due to the nature in which the disease is spread, such as EVD. Since EVD is spread through contact with bodily fluids once the patient has started to show symptoms and even after death during burial, the level of close contact that healthcare workers have to infected patients puts them higher risk of transmission. Healthcare workers are between 21 to 32 times more likely to be infected with EVD than the general adult population during an outbreak.[70]Especially in countries where the healthcare workforce is already scarce (i.e. West African countries during the 2014–2016 West African EVD outbreak), losing healthcare workers to EVD is especially challenging for effective management of the outbreak.[71] While men often perform higher-level healthcare positions such as doctors due to gendered differences in education levels, women also play a very important role in the healthcare workforce. In almost all countries, the nursing staff is predominately female, and nurses make up a considerable amount of the healthcare workforce.[72]For example, during the 2014–2016 EVD outbreak in Sierra Leone, 70% of the healthcare workers were nurses and midwives.[73]The work conducted by nurses differs from doctors because nurses are often the healthcare workers who are in direct contact with the most patients, making them more vulnerable to contracting diseases.[74]The WHO reports that "nurses and nurse aids account for more than half of all health worker infections."[75]As a result, since nurses are overwhelmingly female and the duties of nurses put them at higher risks of contracting diseases, "the occupational exposure of nurses can be considered a gender related exposure."[76] Another important consideration related to the high infection rates of healthcare workers is that a decrease in healthcare workers also results in a decrease in availability of health care services for women.[77]This is especially significant in States that already lack adequate health infrastructure and resources. Because women already experience many health inequalities, disasters such as EID outbreaks only exacerbate them further.[78]Especially given the specific provisions under international law to protect women's health, the lack of available health care services for women due to a decrease in healthcare workers is a serious concern. Global health security requires a gendered lens to adequately address the disparate impact of EIDs on women Global health security recently emerged in the 21st century. It expands upon the definition of public health security[79]and also includes "the health consequences of human behavior, weather-related events and infectious diseases, and natural catastrophes and man-made disasters . . . ."[80]Also, "public health emergency preparedness" brings in an additional legal aspect, in both a proactive and reactive manner to best prepare and respond to such emergencies.[81] Because women play such an integral role in global health and are greatly and differentially impacted by EIDs, it is important to consider these issues with a gendered lens. The CESCR recognized this by recommending that States "integrate a gender perspective in their health-related policies, planning, programmes and research in order to promote better health for both women and men [because] a gender-based approach recognizes that biological and sociocultural factors play a significant role in influencing the health of men and women."[82]Thus, women are a key voice that should be "included at all levels of planning and operations to ensure the effectiveness and appropriateness of a response."[83] However, though these recommendations have been made by many international actors, little has been done to integrate women into global health security responses. During the 2014–2016 West African EVD outbreak, women were "invisible" at every point of international response.[84]It is clear how women are closely intertwined in EID responses, "yet they are invisible in global health strategy, policy or practice . [and] only made visible through motherhood."[85]When it comes to addressing gender during a disaster such as an EID outbreak like EVD, the tendency is to focus on "Ebola first, gender later," as if gender concerns are an optional add-on that others can address after the outbreak has ended.[86] However, not only do women play important roles in global health security, but particularly in societies like the DRC's North Kivu province, women are often leaders and heads of households. They are not only responsible for caring for their families, but their position gives them social power as well, and they care for entire communities.[87]This is especially important for EIDs like EVD because community fear and distrust of governmental and international actors in recent outbreaks have greatly complicated the EVD management response. In just seven months after the start of the 2018 Eastern DRC outbreak, studies reported "low levels of trust in government institutions and widespread belief in misinformation about EVD,"[88]which has led to "reduced adherence to EVD preventative behaviors" such as vaccinations.[89]To combat these challenges, it is vital to build up community trust by "engaging locally trusted leaders and service providers . . . to build trust with Ebola responders who are not from these communities."[90] One example of how the WHO has tapped into women as a resource[91]to address this is through a partnership with Mama Mwatatu, a woman so well known in her community in North Kivu she earned the nickname "Mother Counsellor of Beni."[92]Listeners of her radio show are mostly female, so the impact she has had on the EVD management efforts in Beni has been significant.[93]On her broadcast, she answers her listeners' questions about EVD, emphasizing the reality of the disease. If she is unable to answer a question, she "carefully notes it down and consults with WHO experts,"[94]thus forming an invaluable partnership between the WHO and the local female community. Julienne Anoko, a social anthropologist for the WHO has also proven the power of women by collaborating with the Collectif des Associations Feminines to educate 132 women leaders about EVD and send them out to their local communities to conduct a two-week information campaign, explaining EVD vaccines, treatment, contract tracing, and the vulnerability of women and children to EVD, ultimately reaching over 600,000 people that would not have otherwise been reached due to fear and stigma.[95]These are just a few examples of ways in which women can contribute to the management of an EID outbreak. They are a key connection to the local population, and at a time when trust of authority figures is low and belief in misinformation is high, it is vital to reach all corners of affected communities. Conclusion Gender might not be the first element global health policymakers and healthcare professionals responding to an EID consider, but it should be. Applying a gendered lens to EID outbreaks reveals the disproportionate impact of EIDs on women, due to their higher rate of living in poverty and susceptibility to disease as a result of gendered roles in many societies. Women's rights in health have been codified in many provisions in international law, but the connection between gender and EID response has not yet been developed. Due to women's heightened susceptibility and integrated role in EID management, empowering women to do global health work in their communities and supporting them is an extremely effective way to combat not just this current EVD outbreak, but to strengthen global health security as a whole.
Publisher's version (útgefin grein) ; Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd. ; Research reported in this publication was supported by the Bill & Melinda Gates Foundation; the University of Melbourne; Queensland Department of Health, Australia; the National Health and Medical Research Council, Australia; Public Health England; the Norwegian Institute of Public Health; St Jude Children's Research Hospital; the Cardiovascular Medical Research and Education Fund; the National Institute on Ageing of the National Institutes of Health (award P30AG047845); and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated, the National Health Service (NHS), the National Institute for Health Research (NIHR), the UK Department of Health and Social Care, or Public Health England; the United States Agency for International Development (USAID), the US Government, or MEASURE Evaluation; or the European Centre for Disease Prevention and Control (ECDC). This research used data from the Chile National Health Survey 2003, 2009-10, and 2016-17. The authors are grateful to the Ministry of Health, the survey copyright owner, for allowing them to have the database. All results of the study are those of the authors and in no way committed to the Ministry. The Costa Rican Longevity and Healthy Aging Study project is a longitudinal study by the University of Costa Rica's Centro Centroamericano de Poblacion and Instituto de Investigaciones en Salud, in collaboration with the University of California at Berkeley. The original pre-1945 cohort was funded by the Wellcome Trust (grant 072406), and the 1945-55 Retirement Cohort was funded by the US National Institute on Aging (grant R01AG031716). The principal investigators are Luis Rosero-Bixby and William H Dow and co-principal investigators are Xinia Fernandez and Gilbert Brenes. The accuracy of the authors' statistical analysis and the findings they report are not the responsibility of ECDC. ECDC is not responsible for conclusions or opinions drawn from the data provided. ECDC is not responsible for the correctness of the data and for data management, data merging and data collation after provision of the data. ECDC shall not be held liable for improper or incorrect use of the data. The Health Behaviour in School-Aged Children (HBSC) study is an international study carried out in collaboration with WHO/EURO. The international coordinator of the 1997-98, 2001-02, 2005-06, and 2009-10 surveys was Candace Currie and the databank manager for the 1997-98 survey was Bente Wold, whereas for the following surveys Oddrun Samdal was the databank manager. A list of principal investigators in each country can be found on the HBSC website. Data used in this paper come from the 2009-10 Ghana Socioeconomic Panel Study Survey, which is a nationally representative survey of more than 5000 households in Ghana. The survey is a joint effort undertaken by the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana and the Economic Growth Centre (EGC) at Yale University. It was funded by EGC. ISSER and the EGC are not responsible for the estimations reported by the analysts. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with license number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. Data for this research was provided by MEASURE Evaluation, funded by USAID. The authors thank the Russia Longitudinal Monitoring Survey, conducted by the National Research University Higher School of Economics and ZAO Demoscope together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology, Russia Academy of Sciences for making data available. This paper uses data from the Bhutan 2014 STEPS survey, implemented by the Ministry of Health with the support of WHO; the Kuwait 2006 and 2014 STEPS surveys, implemented by the Ministry of Health with the support of WHO; the Libya 2009 STEPS survey, implemented by the Secretariat of Health and Environment with the support of WHO; the Malawi 2009 STEPS survey, implemented by Ministry of Health with the support of WHO; and the Moldova 2013 STEPS survey, implemented by the Ministry of Health, the National Bureau of Statistics, and the National Center of Public Health with the support of WHO. This paper uses data from Survey of Health, Ageing and Retirement in Europe (SHARE) Waves 1 (DOI:10.6103/SHARE. w1.700), 2 (10.6103/SHARE.w2.700), 3 (10.6103/SHARE.w3.700), 4 (10.6103/SHARE.w4.700), 5 (10.6103/SHARE.w5.700), 6 (10.6103/SHARE.w6.700), and 7 (10.6103/SHARE.w7.700); see Borsch-Supan and colleagues (2013) for methodological details. The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N degrees 211909, SHARE-LEAP: GA N degrees 227822, SHARE M4: GA N degrees 261982) and Horizon 2020 (SHARE-DEV3: GA N degrees 676536, SERISS: GA N degrees 654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and from various national funding sources is gratefully acknowledged. This study has been realised using the data collected by the Swiss Household Panel, which is based at the Swiss Centre of Expertise in the Social Sciences. The project is financed by the Swiss National Science Foundation. The United States Aging, Demographics, and Memory Study is a supplement to the Health and Retirement Study (HRS), which is sponsored by the National Institute of Aging (grant number NIA U01AG009740). It was conducted jointly by Duke University and the University of Michigan. The HRS is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. This paper uses data from Add Health, a program project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website. No direct support was received from grant P01-HD31921 for this analysis. The data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government. Collection of data for the Mozambique National Survey on the Causes of Death 2007-08 was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00. This manuscript is based on data collected and shared by the International Vaccine Institute (IVI) from an original study IVI conducted. L G Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (Brazil; finance code 001) and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, a Brazilian funding agency). I N Ackerman was supported by a Victorian Health and Medical Research Fellowship awarded by the Victorian Government. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. A Agrawal acknowledges the Wellcome Trust DBT India Alliance Senior Fellowship. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. M Ausloos, C Herteliu, and A Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. A Badawi is supported by the Public Health Agency of Canada. D A Bennett was supported by the NIHR Oxford Biomedical Research Centre. R Bourne acknowledges the Brien Holden Vision Institute, University of Heidelberg, Sightsavers, Fred Hollows Foundation, and Thea Foundation. G B Britton and I Moreno Velasquez were supported by the Sistema Nacional de Investigacion, SNI-SENACYT, Panama. R Buchbinder was supported by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship. J J Carrero was supported by the Swedish Research Council (2019-01059). F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. A R Chang was supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant K23 DK106515. V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundacao para a Ciencia e Tecnologia, IP, under the Norma Transitaria DL57/2016/CP1334/CT0006. A Douiri acknowledges support and funding from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, and support from the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. B B Duncan acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. H E Erskine is the recipient of an Australian NHMRC Early Career Fellowship grant (APP1137969). A J Ferrari was supported by a NHMRC Early Career Fellowship grant (APP1121516). H E Erskine and A J Ferrari are employed by and A M Mantilla-Herrera and D F Santomauro affiliated with the Queensland Centre for Mental Health Research, which receives core funding from the Queensland Department of Health. M L Ferreira holds an NHMRC Research Fellowship. C Flohr was supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust. M Freitas acknowledges financial support from the EU (European Regional Development Fund [FEDER] funds through COMPETE POCI-01-0145-FEDER-029248) and National Funds (Fundacao para a Ciencia e Tecnologia) through project PTDC/NAN-MAT/29248/2017. A L S Guimaraes acknowledges support from CNPq. C Herteliu was partially supported by a grant co-funded by FEDER through Operational Competitiveness Program (project ID P_40_382). P Hoogar acknowledges Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education and Centre for Holistic Development and Research, Kalaghatagi. F N Hugo acknowledges the Visiting Professorship, PRINT Program, CAPES Foundation, Brazil. B-F Hwang was supported by China Medical University (CMU107-Z-04), Taichung, Taiwan. S M S Islam was funded by a National Heart Foundation Senior Research Fellowship and supported by Deakin University. R Q Ivers was supported by a research fellowship from the National Health and Medical Research Council of Australia. M Jakovljevic acknowledges the Serbian part of this GBD-related contribution was co-funded through Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. P Jeemon was supported by a Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust-Department of Biotechnology, India Alliance (2015-20). O John is a recipient of UIPA scholarship from University of New South Wales, Sydney. S V Katikireddi acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13, MC_UU_12017/15), and the Scottish Government Chief Scientist Office (SPHSU13, SPHSU15). C Kieling is a CNPq researcher and a UK Academy of Medical Sciences Newton Advanced Fellow. Y J Kim was supported by Research Management Office, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/00010). K Krishan is supported by UGC Centre of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar was supported by K43 TW 010716 FIC/NIMH. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. J V Lazarus was supported by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III [ISCIII]/ESF, the EU [CP18/00074]). K J Looker thanks the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England, for research support. S Lorkowski was funded by the German Federal Ministry of Education and Research (nutriCARD, grant agreement number 01EA1808A). R A Lyons is supported by Health Data Research UK (HDR-9006), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, NIHR (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. J J McGrath is supported by the Danish National Research Foundation (Niels Bohr Professorship), and the Queensland Health Department (via West Moreton HHS). P T N Memiah acknowledges support from CODESRIA. U O Mueller gratefully acknowledges funding by the German National Cohort Study BMBF grant number 01ER1801D. S Nomura acknowledges the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). A Ortiz was supported by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. S B Patten was supported by the Cuthbertson & Fischer Chair in Pediatric Mental Health at the University of Calgary. G C Patton was supported by an aNHMRC Senior Principal Research Fellowship. M R Phillips was supported in part by the National Natural Science Foundation of China (NSFC, number 81371502 and 81761128031). A Raggi, D Sattin, and S Schiavolin were supported by grants from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4-Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). P Rathi and B Unnikrishnan acknowledge Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. A L P Ribeiro was supported by Brazilian National Research Council, CNPq, and the Minas Gerais State Research Agency, FAPEMIG. D C Ribeiro was supported by The Sir Charles Hercus Health Research Fellowship (#18/111) Health Research Council of New Zealand. D Ribeiro acknowledges financial support from the EU (FEDER funds through the Operational Competitiveness Program; POCI-01-0145-FEDER-029253). P S Sachdev acknowledges funding from the NHMRC of Australia Program Grant. A M Samy was supported by a fellowship from the Egyptian Fulbright Mission Program. M M Santric-Milicevic acknowledges the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). R Sarmiento-Suarez received institutional support from Applied and Environmental Sciences University (Bogota, Colombia) and ISCIII (Madrid, Spain). A E Schutte received support from the South African National Research Foundation SARChI Initiative (GUN 86895) and Medical Research Council. S T S Skou is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council under the EU's Horizon 2020 research and innovation program (grant agreement number 801790). J B Soriano is funded by Centro de Investigacion en Red de Enfermedades Respiratorias, ISCIII. R Tabares-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. N Taveira was partially supported by the European & Developing Countries Clinical Trials Partnership, the EU (LIFE project, reference RIA2016MC-1615). S Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral programme (reference number CD15/00019 from ISCIII-FEDER). S B Zaman received a scholarship from the Australian Government research training programme in support of his academic career. ; "Peer Reviewed"
Susheel Kumar Sharma's Unwinding Self: A Collection of Poems. Cuttack: Vishvanatha Kaviraj Institute, 2020, ISBN: 978-81-943450-3-9, Paperback, pp. viii + 152. Like his earlier collection, The Door is Half Open, Susheel Kumar Sharma's Unwinding Self: A Collection of Poems has three sections consisting of forty-two poems of varied length and style, a detailed Glossary mainly on the proper nouns from Indian culture and tradition and seven Afterwords from the pens of the trained readers from different countries of four continents. The structure of the book is circular. The first poem "Snapshots" indicates fifteen kaleidoscopic patterns of different moods of life in about fifteen words each. It seems to be a rumination on the variegated images of everyday experiences ranging from individual concerns to spiritual values. Art-wise, they can be called mini-micro-poems as is the last poem of the book. While the character limit in a micro poem is generally 140 (the character limit on Twitter) Susheel has used just around 65 in each of these poems. Naturally, imagery, symbolism and cinematic technique play a great role in this case. In "The End of the Road" the poet depicts his individual experiences particularly changing scenario of the world. He seems to be worried about his eyesight getting weak with the passage of time, simultaneously he contrasts the weakness of his eyesight with the hypocrisy permeating the human life. He compares his diminishing eyesight to Milton and shows his fear as if he will get blind. He changes his spectacles six times to clear his vision and see the plurality of a reality in human life. It is an irony on the changing aspects of human life causing miseries to the humanity. At the end of the poem, the poet admits the huge changes based on the sham principles: "The world has lost its original colour" (4). The concluding lines of the poem make a mockery of the people who are not able to recognise reality in the right perspective. The poem "Durga Puja in 2013" deals with the celebration of the festival "Durga Puja" popular in the Hindu religion. The poet's urge to be with Ma Durga shows his dedication towards the Goddess Durga, whom he addresses with different names like 'Mai', 'Ma' and 'Mother'. He worships her power and expresses deep reverence for annihilating the evil-spirits. The festival Durga Puja also reminds people of victory of the goddess on the elusive demons in the battlefield. "Chasing a Dream on the Ganges" is another poem having spiritual overtones. Similarly, the poem "Akshya Tritya" has religious and spiritual connotations. It reflects curiosity of people for celebration of "Akshya Tritya" with enthusiasm. But the political and economic overtones cannot be ignored as the poem ends with the remarkable comments: The GDP may go up on this day; Even, Budia is able to Eat to his fill; Panditji can blow his Conch shell with full might. Outside, somebody is asking for votes; Somebody is urging others to vote. I shall vote for Akshya Tritya. (65-66) "On Reading Langston Hughes' 'Theme for English B'" is a long poem in the collection. In this poem, the poet reveals a learner's craving for learning, perhaps who comes from an extremely poor background to pursue his dreams of higher education. The poet considers the learner's plights of early childhood, school education and evolutionary spirit. He associates it with Dronacharya and Eklavya to describe the mythical system of education. He does not want to be burdened with the self-guilt by denying the student to be his 'guru' therefore, he accepts the challenge to change his life. Finally, he shows his sympathy towards the learner and decides to be the 'guru': "It is better to face/A challenge and change/Than to be burden with a life/Of self-guilt. /I put my signatures on his form willy-nilly" (11). The poem "The Destitute" is an ironical presentation of the modern ways of living seeking pleasure in the exotic locations all over the world. It portrays the life of a person who has to leave his motherland for earning his livelihood, and has to face an irreparable loss affecting moral virtues, lifestyle, health and sometimes resulting in deaths. The poem "The Black Experience" deals with the suppression of the Africans by the white people. The poem "Me, A Black Doxy", perhaps points out the dilemma of a black woman whether she should prostitute herself or not, to earn her livelihood. Perhaps, her deep consciousness about her self-esteem does not allow her to indulge in it but she thinks that she is not alone in objectifying herself for money in the street. Her voice resonates repeatedly with the guilt of her indulgence on the filthy streets: At the dining time Me not alone? In the crowded street Me not alone? They 'ave white, grey, pink hair Me 'ave black hair – me not alone There's a crowd with black hair. Me 'ave no black money Me not alone? (14) The poem "Thus Spake a Woman" is structured in five sections having expressions of the different aspects of a woman's love designs. It depicts a woman's dreams and her attraction towards her lover. The auditory images like "strings of a violin", "music of the violin" and "clinch in my fist" multiply intensity of her feelings. With development of the poem, her dreams seem to be shattered and sadness know the doors of her dreamland. Finally, she is confronted with sadness and is taken back to the past memories reminding her of the difficult situations she had faced. Replete with poetic irony, "Bubli Poems" presents the journey of a female, who, from the formative years of her life to womanhood, experienced gender stereotypes, biased sociocultural practices, and ephemeral happiness on the faces of other girls around her. The poem showcases the transformation of a village girl into a New Woman, who dreams her existence in all types of luxurious belongings rather than identifying her independent existence and finding out her own ways of living. Her dreams lead her to social mobility through education, friendships, and the freedom that she gains from her parents, family, society and culture. She attempts her luck in the different walks of human life, particularly singing and dancing and imagines her social status and wide popularity similar to those of the famous Indian actresses viz. Katrina and Madhuri Dixit: "One day Bubli was standing before the mirror/Putting on a jeans and jacket and shaking her hips/She was trying to be a local Katrina" (41). She readily bears the freakish behaviour of the rustic/uncultured lads, derogatory comments, and physical assaults in order to fulfil her expectations and achieves her individual freedom. Having enjoyed all the worldly happiness and fashionable life, ultimately, she is confronted with the evils designs around her which make her worried, as if she is ignorant of the world replete with the evils and agonies: "Bubli was ignorant of her agony and the lost calm" (42). The examples of direct poetic irony and ironic expressions of the socio-cultural evils, and the different governing bodies globally, are explicit in this poem: "Bubli is a leader/What though if a cheerleader./The news makes her family happy."(40), "Others were blaming the Vice-Chancellor/ Some others the system;/ Some the freedom given to girls;"(45), and "Some blame poverty; some the IMF;/ Some the UN; some the environment;/ Some the arms race; some the crony's lust;/ Some the US's craving for power;/Some the UK's greed. (46-47). Finally, Bubli finds that her imaginative world is fragile. She gives up her corporeal dreams which have taken the peace of her mind away. She yearns for shelter in the temples and churches and surrenders herself before deities praying for her liberation: "Jai Kali,/ Jai Mahakali, Jai Ma, Jai Jagaddhatri,/ Save me, save the world." (47). In the poem "The Unlucky", the poet jibes at those who are lethargic in reading. He identifies four kinds of readers and places himself in the fourth category by rating himself a 'poor' reader. The first three categories remind the readers of William Shakespeare's statement "Some are born great, some achieve greatness, and some have greatness thrust upon them." At the end of the poem, the poet questions himself for being a poet and teacher. The question itself reflects on his ironic presentation of himself as a poor reader because a poet's wisdom is compared with that of the philosopher and everybody worships and bows before a teacher, a "guru", in the Indian tradition. The poet is considered the embodiment of both. The poet's unfulfilled wish to have been born in Prayagraj is indexed with compunction when the poem ends with the question "Why was I not born in Prayagraj?" (52). Ending with a question mark, the last line of the poem expresses his desire for perfection. The next poem, "Saying Goodbye", is elegiac in tone and has an allusion to Thomas Gray's "The Elegy Written in a Country Churchyard" in the line "When the curfew tolls the knell of the parting day"; it ends with a question mark. The poem seems to be a depiction of the essence and immortality of 'time'. Reflecting on the poet's consideration of the power and beauty of 'time', Pradeep Kumar Patra rightly points out, "It is such a phenomena that nobody can turn away from it. The moment is both beautiful as well as ferocious. It beautifies and showcases everything and at the same time pulls everything down when necessary" (146). Apparently, the poem "The Kerala Flood 2018"is an expression of emotions at the disaster caused by the flood in 2018. By reminding of Gandhi's tenets to be followed by people for the sake of morality and humankind, the poet makes an implicit criticism of the pretentions, and violation of pledges made by people to care of other beings, particularly, cow that is worshiped as "mother" and is considered to be a symbol of fertility, peace and holiness in Hinduism as well as the Buddhist culture. The poet also denigrates people who deliberately ignore the sanctity of the human life in Hinduism and slaughter the animal cow to satisfy their appetites. In the poem, the carnivorous are criticized explicitly, but those who pretend to be herbivorous are decried as shams: If a cow is sacrosanct And people eat beef One has to take a side. Some of the friends chose to Side with cow and others With the beef-eaters. Some were more human They chose both. (55) The poet infuses positivity into the minds of the Indian people. Perhaps, he thinks that, for Indians, poverty, ignorance, dirt and mud are not taboos as if they are habitual to forbear evils by their instincts. They readily accept them and live their lives happily with pride considering their deity as the preserver of their lives. The poem "A Family by the Road" is an example of such beliefs, in which the poet lavishes most of his poetic depiction on the significance of the Lord Shiva, the preserver of people in Hinduism: Let me enjoy my freedom. I am proud of my poverty. I am proud of my ignorance. I am proud of my dirt. I have a home because of these. I am proud of my home. My future is writ on the walls Of your houses My family shall stay in the mud. After all, somebody is needed To clean the dirt as well. I am Shiva, Shivoham. (73) In the poem "Kabir's Chadar", the poet invokes several virtues to back up his faith in spirituality and simplicity. He draws a line of merit and virtue between Kabir's Chadar which is 'white' and his own which is "thickly woven" and "Patterned with various beautiful designs/ In dark but shining colours" (50). The poet expresses his views on Kabir's 'white' Chadar symbolically to inculcate the sense of purity, fortitude, spirituality, and righteousness among people. The purpose of his direct comparison between them is to refute artificiality, guilt and evil intents of humanity, and propagate spiritual purity, the stark simplicities of our old way of life, and follow the patience of a saint like Kabir. The poem "Distancing" is a statement of poetic irony on the city having two different names known as Bombay and Mumbai. The poet sneers at its existence in Atlas. Although the poet portraits the historical events jeering at the distancing between the two cities as if they are really different, yet the poet's prophetic anticipation about the spread of the COVID-19 in India cannot be denied prima facie. The poet's overwhelming opinions on the overcrowded city of Bombay warn humankind to rescue their lives. Even though the poem seems to have individual expressions of the poet, leaves a message of distancing to be understood by the people for their safety against the uneven things. The poem "Crowded Locals" seems to be a sequel to the poem "Distancing". Although the poet's purpose, and appeal to the commonplace for distancing cannot be affirmed by the readers yet his remarks on the overcrowded cities like in Mumbai ("Crowded Locals"), foresee some risk to the humankind. In the poem "Crowded Locals", he details the mobility of people from one place to another, having dreams in their eyes and puzzles in their minds for their livelihood while feeling insecure especially, pickpockets, thieves and strangers. The poet also makes sneering comments on the body odour of people travelling in first class. However, these two poems have become a novel contribution for social distancing to fight against the COVID-19. In the poem "Buy Books, Not Diamonds" the poet makes an ironical interpretation of social anarchy, political upheaval, and threat of violence. In this poem, the poet vies attention of the readers towards the socio-cultural anarchy, especially, anarchy falls on the academic institutions in the western countries where capitalism, aristocracy, dictatorship have armed children not with books which inculcate human values but with rifles which create fear and cause violence resulting in deaths. The poet's perplexed opinions find manifestation in such a way as if books have been replaced with diamonds and guns, therefore, human values are on the verge of collapse: "Nine radiant diamonds are no match/ To the redness of the queen of spades. . . . / … holding/ Rifles is a better option than/ Hawking groundnuts on the streets?" (67).The poet also decries the spread of austere religious practices and jihadist movement like Boko Haram, powerful personalities, regulatory bodies and religious persons: "Boko Haram has come/Obama has also come/The UN has come/Even John has come with/Various kinds of ointments" (67). The poem "Lost Childhood" seems to be a memoir in which the poet compares the early life of an orphan with the child who enjoys early years of their lives under the safety of their parents. Similarly, the theme of the poem "Hands" deals with the poet's past experiences of the lifestyle and its comparison to the present generation. The poet's deep reverence for his parents reveals his clear understanding of the ways of living and human values. He seems to be very grateful to his father as if he wants to make his life peaceful by reading the lines of his palms: "I need to read the lines in his palm" (70). In the poem "A Gush of Wind", the poet deliberates on the role of Nature in our lives. The poem is divided into three sections, perhaps developing in three different forms of the wind viz. air, storm, and breeze respectively. It is structured around the significance of the Nature. In the first section, the poet lays emphasis on the air we breathe and keep ourselves fresh as if it is a panacea. The poet criticizes artificial and material things like AC. In the second section, he depicts the stormy nature of the wind scattering papers, making the bed sheets dusty affecting or breaking the different types of fragile and luxurious objects like Italian carpets and lamp shades with its strong blow entering the oriels and window panes of the houses. Apparently, the poem may be an individual expression, but it seems to be a caricature on the majesty of the rich people who ignore the use of eco-chic objects and disobey the Nature's behest. In the third and the last section of the poem, the poet's tone is critical towards Whitman, Pushkin and Ginsberg for their pseudoscientific philosophy of adherence to the Nature. Finally, he opens himself to enjoy the wind fearlessly. The poems like "A Voice" , "The New Year Dawn", "The New Age", "The World in Words in 2015", "A Pond Nearby", "Wearing the Scarlet Letter 'A'", "A Mock Drill", "Strutting Around", "Sahibs, Snobs, Sinners", "Endless Wait", "The Soul with a New Hat", "Renewed Hope", "Like Father, Unlike Son", "Hands", "Rechristening the City", "Coffee", "The Unborn Poem", "The Fountain Square", "Ram Setu", and "Connaught Place" touch upon the different themes. These poems reveal poet's creativity and unique features of his poetic arts and crafts. The last poem of the collection "Stories from the Mahabharata" is written in twenty-five stanzas consisting of three lines each. Each stanza either describes a scene or narrates a story from the Mahabharata, the source of the poem. Every stanza has an independent action verb to describe the actions of different characters drawn from the Mahabharata. Thus, each stanza is a complete miniscule poem in itself which seems to be a remarkable characteristic of the poem. It is an exquisite example of 'Micro-poetry' on paper, remarkable for its brevity, dexterity and intensity. The poet's conscious and brilliant reframing of the stories in his poem sets an example of a new type of 'Found Poetry' for his readers. Although the poet's use of various types images—natural, comic, tragic, childhood, horticultural, retains the attention of readers yet the abundant evidences of anaphora reflect redundancy and affect the readers' concentration and diminishes their mental perception, for examples, pronouns 'her' and 'we' in a very small poem "Lost Childhood", articles 'the' and 'all' in "Crowded Locals", the phrase 'I am proud of' in "A Family by the Road" occur many times. Svitlana Buchatska's concise but evaluative views in her Afterword to Unwinding Self help the readers to catch hold of the poet's depiction of his emotions. She writes, "Being a keen observer of life he vividly depicts people's life, traditions and emotions involving us into their rich spiritual world. His poems are the reflection on the Master's world of values, love to his family, friends, students and what is more, to his beloved India. Thus, the author reveals all his beliefs, attitudes, myths and allusions which are the patterns used by the Indian poets" (150). W. H. Auden defines poetry as "the clear expression of mixed feelings." It seems so true of Susheel Sharma's Unwinding Self. It is a mixture of poems that touch upon the different aspects of human life. It can be averred that the collection consists of the poet's seamless efforts to delve into the various domains of the human life and spot for the different places as well. It is a poetic revue in verse in which the poet instils energy, confidence, power and enthusiasm into minds of Indian people and touches upon all aspects of their lives. The poverty, ignorance, dirt, mud, daily struggle against liars, thieves, pickpockets, touts, politician and darkness have been depicted not as weaknesses of people in Indian culture but their strengths, because they have courage to overcome darkness and see the advent of a new era. The poems teach people morality, guide them to relive their pains and lead them to their salvation. Patricia Prime's opinion is remarkable: "Sharma writes about his family, men and women, childhood, identity, roots and rootlessness, memory and loss, dreams and interactions with nature and place. His poised, articulate poems are remarkable for their wit, conversational tone and insight" (138). Through the poems in the collection, the poet dovetails the niceties of the Indian culture, and communicates its beauty and uniqueness meticulously. The language of the poem is lucid, elevated and eloquent. The poet's use of diction seems to be very simple and colloquial like that of an inspiring teacher. On the whole the book is more than just a collection of poems as it teaches the readers a lot about the world around them through a detailed Glossary appended soon after the poems in the collection. It provides supplementary information about the terms used abundantly in Indian scriptures, myths, and other religious and academic writings. The Glossary, therefore, plays pivotal role in unfolding the layers of meaning and reaching the hearts of the global readers. The "Afterwords" appended at the end, enhances readability of poems and displays worldwide acceptability, intelligibility, and popularity of the poet. The Afterwords are a good example of authentic Formalistic criticism and New Criticism. They indirectly teach a formative reader and critic the importance of forming one's opinion, direct reading and writing without any crutches of the critics.
Smoking is a major heritable and modifiable risk factor for many diseases, including cancer, common respiratory disorders and cardiovascular diseases. Fourteen genetic loci have previously been associated with smoking behaviour-related traits. We tested up to 235,116 single nucleotide variants (SNVs) on the exome-array for association with smoking initiation, cigarettes per day, pack-years, and smoking cessation in a fixed effects meta-analysis of up to 61 studies (up to 346,813 participants). In a subset of 112,811 participants, a further one million SNVs were also genotyped and tested for association with the four smoking behaviour traits. SNV-trait associations with P < 5 × 10-8 in either analysis were taken forward for replication in up to 275,596 independent participants from UK Biobank. Lastly, a meta-analysis of the discovery and replication studies was performed. Sixteen SNVs were associated with at least one of the smoking behaviour traits (P < 5 × 10-8) in the discovery samples. Ten novel SNVs, including rs12616219 near TMEM182, were followed-up and five of them (rs462779 in REV3L, rs12780116 in CNNM2, rs1190736 in GPR101, rs11539157 in PJA1, and rs12616219 near TMEM182) replicated at a Bonferroni significance threshold (P < 4.5 × 10-3) with consistent direction of effect. A further 35 SNVs were associated with smoking behaviour traits in the discovery plus replication meta-analysis (up to 622,409 participants) including a rare SNV, rs150493199, in CCDC141 and two low-frequency SNVs in CEP350 and HDGFRP2. Functional follow-up implied that decreased expression of REV3L may lower the probability of smoking initiation. The novel loci will facilitate understanding the genetic aetiology of smoking behaviour and may lead to the identification of potential drug targets for smoking prevention and/or cessation. ; The authors would like to thank the many colleagues who contributed to collection and phenotypic characterisation of the clinical samples, as well as genotyping and analysis of the GWA data. Special mentions are as follows: CGSB participating cohorts: Some of the data utilised in this study were provided by the Understanding Society: The UK Household Longitudinal Study, which is led by the Institute for Social and Economic Research at the University of Essex and funded by the Economic and Social Research Council. The data were collected by NatCen and the genome wide scan data were analysed by the Wellcome Trust Sanger Institute. The Understanding Society DAC have an application system for genetics data and all use of the data should be approved by them. The application form is at: https://www.understandingsociety.ac.uk/about/health/data. The Airwave Health Monitoring Study is funded by the UK Home Office, (Grant number 780-TETRA) with additional support from the National Institute for Health Research Imperial College Health Care NHS Trust and Imperial College Biomedical Research Centre. We thank all participants in the Airwave Health Monitoring Study. This work used computing resources provided by the MRC- funded UK MEDical Bioinformatics partnership programme (UK MED-BIO) (MR/L01632X/1). Paul Elliott wishes to acknowledge the Medical Research Council and Public Health England (MR/L01341X/1) for the MRC-PHE Centre for Environment and Health; and the NIHR Health Protection Research Unit in Health Impact of Environmental Hazards (HPRU-2012-10141). Paul Elliott is supported by the UK Dementia Research Institute which receives its funding from UK DRI Ltd funded by the UK Medical Research Council, Alzheimer's Society and Alzheimer's Research UK. Paul Elliott is associate director of the Health Data Research UK London funded by a consortium led by the UK Medical Research Council. SHIP (Study of Health in Pomerania) and SHIP-TREND both represent population-based studies. SHIP is supported by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung (BMBF); grants 01ZZ9603, 01ZZ0103, and 01ZZ0403) and the German Research Foundation (Deutsche Forschungsgemeinschaft (DFG); grant GR 1912/5-1). SHIP and SHIP-TREND are part of the Community Medicine Research net (CMR) of the Ernst-Moritz-Arndt University Greifswald (EMAU) which is funded by the BMBF as well as the Ministry for Education, Science and Culture and the Ministry of Labor, Equal Opportunities, and Social Affairs of the Federal State of Mecklenburg-West Pomerania. The CMR encompasses several research projects that share data from SHIP. SNP typing of SHIP and SHIP-TREND using the Illumina Infinium HumanExome BeadChip (version v1.0) was supported by the BMBF (grant 03Z1CN22). LifeLines authors thank Behrooz Alizadeh, Annemieke Boesjes, Marcel Bruinenberg, Noortje Festen, Ilja Nolte, Lude Franke, Mitra Valimohammadi for their help in creating the GWAS database, and Rob Bieringa, Joost Keers, René Oostergo, Rosalie Visser, Judith Vonk for their work related to data-collection and validation. The authors are grateful to the study participants, the staff from the LifeLines Cohort Study and Medical Biobank Northern Netherlands, and the participating general practitioners and pharmacists. LifeLines Scientific Protocol Preparation: Rudolf de Boer, Hans Hillege, Melanie van der Klauw, Gerjan Navis, Hans Ormel, Dirkje Postma, Judith Rosmalen, Joris Slaets, Ronald Stolk, Bruce Wolffenbuttel; LifeLines GWAS Working Group: Behrooz Alizadeh, Marike Boezen, Marcel Bruinenberg, Noortje Festen, Lude Franke, Pim van der Harst, Gerjan Navis, Dirkje Postma, Harold Snieder, Cisca Wijmenga, Bruce Wolffenbuttel. The authors wish to acknowledge the services of the LifeLines Cohort Study, the contributing research centres delivering data to LifeLines, and all the study participants. Niek Verweij was supported by NWO VENI (016.186.125). Fenland authors thank Fenland Study volunteers for their time and help, Fenland Study general Practitioners and practice staff for assistance with recruitment, and Fenland Study Investigators, Co-ordination team and the Epidemiology Field, Data and Laboratory teams for study design, sample/data collection and genotyping. We thank all ASCOT trial participants, physicians, nurses, and practices in the participating countries for their important contribution to the study. In particular we thank Clare Muckian and David Toomey for their help in DNA extraction, storage, and handling. We would also like to acknowledge the Barts and The London Genome Centre staff for genotyping the Exome Chip array. The BRIGHT study is extremely grateful to all the patients who participated in the study and the BRIGHT nursing team. We would also like to thank the Barts Genome Centre staff for their assistance with this project. Patricia B. Munroe, Mark J. Caulfield, and Helen R. Warren wish to acknowledge the NIHR Cardiovascular Biomedical Research Unit at Barts and The London, Queen Mary University of London, UK for support. Mark J. Caulfield are Senior National Institute for Health Research Investigators. EMBRACE Collaborating Centres are: Coordinating Centre, Cambridge: Daniel Barrowdale, Debra Frost, Jo Perkins. North of Scotland Regional Genetics Service, Aberdeen: Zosia Miedzybrodzka, Helen Gregory. Northern Ireland Regional Genetics Service, Belfast: Patrick Morrison, Lisa Jeffers. West Midlands Regional Clinical Genetics Service, Birmingham: Kai-ren Ong, Jonathan Hoffman. South West Regional Genetics Service, Bristol: Alan Donaldson, Margaret James. East Anglian Regional Genetics Service, Cambridge: Joan Paterson, Marc Tischkowitz, Sarah Downing, Amy Taylor. Medical Genetics Services for Wales, Cardiff: Alexandra Murray, Mark T. Rogers, Emma McCann. St James's Hospital, Dublin & National Centre for Medical Genetics, Dublin: M. John Kennedy, David Barton. South East of Scotland Regional Genetics Service, Edinburgh: Mary Porteous, Sarah Drummond. Peninsula Clinical Genetics Service, Exeter: Carole Brewer, Emma Kivuva, Anne Searle, Selina Goodman, Kathryn Hill. West of Scotland Regional Genetics Service, Glasgow: Rosemarie Davidson, Victoria Murday, Nicola Bradshaw, Lesley Snadden, Mark Longmuir, Catherine Watt, Sarah Gibson, Eshika Haque, Ed Tobias, Alexis Duncan. South East Thames Regional Genetics Service, Guy's Hospital London: Louise Izatt, Chris Jacobs, Caroline Langman. North West Thames Regional Genetics Service, Harrow: Huw Dorkins. Leicestershire Clinical Genetics Service, Leicester: Julian Barwell. Yorkshire Regional Genetics Service, Leeds: Julian Adlard, Gemma Serra-Feliu. Cheshire & Merseyside Clinical Genetics Service, Liverpool: Ian Ellis, Claire Foo. Manchester Regional Genetics Service, Manchester: D Gareth Evans, Fiona Lalloo, Jane Taylor. North East Thames Regional Genetics Service, NE Thames, London: Lucy Side, Alison Male, Cheryl Berlin. Nottingham Centre for Medical Genetics, Nottingham: Jacqueline Eason, Rebecca Collier. Northern Clinical Genetics Service, Newcastle: Alex Henderson, Oonagh Claber, Irene Jobson. Oxford Regional Genetics Service, Oxford: Lisa Walker, Diane McLeod, Dorothy Halliday, Sarah Durell, Barbara Stayner. The Institute of Cancer Research and Royal Marsden NHS Foundation Trust: Ros Eeles, Nazneen Rahman, Elizabeth Bancroft, Elizabeth Page, Audrey Ardern-Jones, Kelly Kohut, Jennifer Wiggins, Jenny Pope, Sibel Saya, Natalie Taylor, Zoe Kemp and Angela George. North Trent Clinical Genetics Service, Sheffield: Jackie Cook, Oliver Quarrell, Cathryn Bardsley. South West Thames Regional Genetics Service, London: Shirley Hodgson, Sheila Goff, Glen Brice, Lizzie Winchester, Charlotte Eddy, Vishakha Tripathi, Virginia Attard. Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton: Diana Eccles, Anneke Lucassen, Gillian Crawford, Donna McBride, Sarah Smalley. Understanding Society Scientific Group is funded by the Economic and Social Research Council (ES/H029745/1) and the Wellcome Trust (WT098051). Paul D.P. Pharoah is funded by Cancer Research UK (C490/A16561). SHIP is funded by the German Federal Ministry of Education and Research (BMBF) and the German Research Foundation (DFG); see acknowledgements for details. F.W. Asselbergs is funded by the Netherlands Heart Foundation (2014T001) and supported by UCL Hospitals NIHR Biomedical Research Centre. The LifeLines Cohort Study, and generation and management of GWAS genotype data for the LifeLines Cohort Study is supported by the Netherlands Organization of Scientific Research NWO (grant 175.010.2007.006), the Economic Structure Enhancing Fund (FES) of the Dutch government, the Ministry of Economic Affairs, the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the Northern Netherlands Collaboration of Provinces (SNN), the Province of Groningen, University Medical Center Groningen, the University of Groningen, Dutch Kidney Foundation and Dutch Diabetes Research Foundation. Niek Verweij is supported by Horizon 2020, Marie Sklodowska-Curie (661395) and ICIN-NHI. Phenotype collection in the Lothian Birth Cohort 1921 was supported by the UK's Biotechnology and Biological Sciences Research Council (BBSRC), The Royal Society and The Chief Scientist Office of the Scottish Government. Phenotype collection in the Lothian Birth Cohort 1936 was supported by Age UK (The Disconnected Mind project). Genotyping was supported by Centre for Cognitive Ageing and Cognitive Epidemiology (Pilot Fund award), Age UK, and the Royal Society of Edinburgh. The work was undertaken by The University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative (MR/K026992/1). Funding from the BBSRC and Medical Research Council (MRC) is gratefully acknowledged. Paul W. Franks is supported by Novo Nordisk, the Swedish Research Council, Påhlssons Foundation, Swedish Heart Lung Foundation (2020389), and Skåne Regional Health Authority. Nicholas J Wareham, Claudia Langenberg, Robert A Sacott, and Jian'an Luan are supported by the MRC (MC_U106179471 and MC_UU_12015/1). The BRIGHT study was supported by the Medical Research Council of Great Britain (Grant Number G9521010D); and by the British Heart Foundation (Grant Number PG/02/128). The BRIGHT study is extremely grateful to all the patients who participated in the study and the BRIGHT nursing team. The Exome Chip genotyping was funded by Wellcome Trust Strategic Awards (083948 and 085475). We would also like to thank the Barts Genome Centre staff for their assistance with this project. The ASCOT study and the collection of the ASCOT DNA repository was supported by Pfizer, New York, NY, USA, Servier Research Group, Paris, France; and by Leo Laboratories, Copenhagen, Denmark. Genotyping of the Exome Chip in ASCOT-SC and ASCOT-UK was funded by the National Institutes of Health Research (NIHR). Anna F. Dominiczak was supported by the British Heart Foundation (Grant Numbers RG/07/005/23633, SP/08/005/25115); and by the European Union Ingenious HyperCare Consortium: Integrated Genomics, Clinical Research, and Care in Hypertension (grant number LSHM-C7-2006-037093). Nilesh J. Samani is supported by the British Heart Foundation and is a Senior National Institute for Health Research Investigator. Panos Deloukas is supported by the British Heart Foundation (RG/14/5/30893), and NIHR, where his work forms part of the research themes contributing to the translational research portfolio of Barts Cardiovascular Biomedical Research Centre which is funded by the National Institute for Health Research (NIHR). The LOLIPOP study is supported by the National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre Imperial College Healthcare NHS Trust, the British Heart Foundation (SP/04/002), the Medical Research Council (G0601966, G0700931), the Wellcome Trust (084723/Z/08/Z, 090532 & 098381) the NIHR (RP-PG-0407-10371), the NIHR Official Development Assistance (ODA, award 16/136/68), the European Union FP7 (EpiMigrant, 279143) and H2020 programs (iHealth-T2D, 643774). We acknowledge support of the MRC-PHE Centre for Environment and Health, and the NIHR Health Protection Research Unit on Health Impact of Environmental Hazards. The work was carried out in part at the NIHR/Wellcome Trust Imperial Clinical Research Facility. The views expressed are those of the author(s) and not necessarily those of the Imperial College Healthcare NHS Trust, the NHS, the NIHR or the Department of Health. We thank the participants and research staff who made the study possible. JC is supported by the Singapore Ministry of Health's National Medical Research Council under its Singapore Translational Research Investigator (STaR) Award (NMRC/STaR/0028/2017). The research was supported by the National Institute for Health Research (NIHR) Exeter Clinical Research Facility and ERC grant 323195; SZ-245 50371-GLUCOSEGENES-FP7-IDEAS-ERC to T.M. Frayling. Hanieh Yaghootkar is funded by Diabetes UK RD Lawrence fellowship (grant:17/0005594) Anna Dominiczak was funded by a BHF Centre of Research Excellence Award (RE/13/5/30177) GSCAN participating cohorts: The Collaborative Study on the Genetics of Alcoholism (COGA), Principal Investigators: B. Porjesz, V. Hesselbrock, H. Edenberg, L. Bierut. The study includes eleven different centers: University of Connecticut (V. Hesselbrock); Indiana University (H.J. Edenberg, J. Nurnberger Jr., T. Foroud); University of Iowa (S. Kuperman, J. Kramer); SUNY Downstate (B. Porjesz); Washington University in St. Louis (L. Bierut, J. Rice, K. Bucholz, A. Agrawal); University of California at San Diego (M. Schuckit); Rutgers University (J. Tischfield, A. Brooks); Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia; Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA (L. Almasy), Virginia Commonwealth University (D. Dick), Icahn School of Medicine at Mount Sinai (A. Goate), and Howard University (R. Taylor). Other COGA collaborators include: L. Bauer (University of Connecticut); J. McClintick, L. Wetherill, X. Xuei, Y. Liu, D. Lai, S. O'Connor, M. Plawecki, S. Lourens (Indiana University); G. Chan (University of Iowa; University of Connecticut); J. Meyers, D. Chorlian, C. Kamarajan, A. Pandey, J. Zhang (SUNY Downstate); J.-C. Wang, M. Kapoor, S. Bertelsen (Icahn School of Medicine at Mount Sinai); A. Anokhin, V. McCutcheon, S. Saccone (Washington University); J. Salvatore, F. Aliev, B. Cho (Virginia Commonwealth University); and Mark Kos (University of Texas Rio Grande Valley). A. Parsian and M. Reilly are the NIAAA Staff Collaborators. COGA investigators continue to be inspired by their memories of Henri Begleiter and Theodore Reich, founding PI and Co-PI of COGA, and also owe a debt of gratitude to other past organizers of COGA, including Ting-Kai Li, P. Michael Conneally, Raymond Crowe, and Wendy Reich, for their critical contributions. COGA investigators are very grateful to Dr. Bruno Buecher without whom this project would not have existed. The authors also thank all those at the GECCO Coordinating Center for helping bring together the data and people that made this project possible. ASTERISK, a GECCO sub-study, also thanks all those who agreed to participate in this study, including the patients and the healthy control persons, as well as all the physicians, technicians and students. As part of the GECCO sub-studies, CPS-II authors thank the CPS-II participants and Study Management Group for their invaluable contributions to this research. The authors would also like to acknowledge the contribution to this study from central cancer registries supported through the Centers for Disease Control and Prevention National Program of Cancer Registries, and cancer registries supported by the National Cancer Institute Surveillance Epidemiology and End Results program. Another GECCO sub-study, HPFS and NHS investigators would like to acknowledge Patrice Soule and Hardeep Ranu of the Dana Farber Harvard Cancer Center High-Throughput Polymorphism Core who assisted in the genotyping for NHS, HPFS under the supervision of Dr. Immaculata Devivo and Dr. David Hunter, Qin (Carolyn) Guo and Lixue Zhu who assisted in programming for NHS and HPFS. HPFS and NHS investigators also thank the participants and staff of the Nurses' Health Study and the Health Professionals Follow-Up Study, 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. PLCO, a substudy within GECCO, was supported by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics, and additionally supported by contracts from the Division of Cancer Prevention, National Cancer Institute, NIH, DHHS. Additionally, a subset of control samples were genotyped as part of the Cancer Genetic Markers of Susceptibility (CGEMS) Prostate Cancer GWAS1, CGEMS pancreatic cancer scan (PanScan)2, 3, and the Lung Cancer and Smoking study4. The prostate and PanScan study datasets were accessed with appropriate approval through the dbGaP online resource (http://cgems.cancer.gov/data/) accession numbers phs000207.v1.p1 and phs000206.v3.p2, respectively, and the lung datasets were accessed from the dbGaP website (http://www.ncbi.nlm.nih.gov/gap) through accession number phs000093.v2.p2. For the lung study, the GENEVA Coordinating Center provided assistance with genotype cleaning and general study coordination, and the Johns Hopkins University Center for Inherited Disease Research conducted genotyping. The authors thank Drs. Christine Berg and Philip Prorok, Division of Cancer Prevention, National Cancer Institute, the Screening Center investigators and staff or the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, Mr. Tom Riley and staff, Information Management Services, Inc., Ms. Barbara O'Brien and staff, Westat, Inc., and Drs. Bill Kopp and staff, SAIC-Frederick. Most importantly, we acknowledge the study participants for their contributions to making this study possible. We also thank all participants and staff of the André and France Desmarais Montreal Heart Institute's (MHI) Biobank. The genotyping of the MHI Biobank was done at the MHI Pharmacogenomic Centre and funded by the MHI Foundation. HRS is supported by the National Institute on Aging (NIA U01AG009740). The genotyping was funded separately by the National Institute on Aging (RC2 AG036495, RC4 AG039029). Our genotyping was conducted by the NIH Center for Inherited Disease Research (CIDR) at Johns Hopkins University. Genotyping quality control and final preparation of the data were performed by the University of Michigan School of Public Health. CHDExome+ participating cohorts: BRAVE: The BRAVE study genetic epidemiology working group is a collaboration between the Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK, the Centre for Control of Chronic Diseases, icddr,b, Dhaka, Bangladesh and the National Institute of Cardiovascular Diseases, Dhaka, Bangladesh. CCHS, CIHDS, and CGPS collaborators thank participants and staff of the Copenhagen City Heart Study, Copenhagen Ischemic Heart Disease Study, and the Copenhagen General Population Study for their important contributions. EPIC-CVD: CHD case ascertainment and validation, genotyping, and clinical chemistry assays in EPIC-CVD were principally supported by grants awarded to the University of Cambridge from the EU Framework Programme 7 (HEALTH-F2-2012-279233), the UK Medical Research Council (G0800270) and British Heart Foundation (SP/09/002), and the European Research Council (268834). We thank all EPIC participants and staff for their contribution to the study, the laboratory teams at the Medical Research Council Epidemiology Unit for sample management and Cambridge Genomic Services for genotyping, Sarah Spackman for data management, and the team at the EPIC-CVD Coordinating Centre for study coordination and administration. MORGAM: The work by MORGAM collaborators has been sustained by the MORGAM Project's recent funding: European Union FP 7 projects ENGAGE (HEALTH-F4-2007-201413), CHANCES (HEALTH-F3-2010-242244) and BiomarCaRE (278913). This has supported central coordination, workshops and part of the activities of the The MORGAM Data Centre, at THL in Helsinki, Finland. MORGAM Participating Centres are funded by regional and national governments, research councils, charities, and other local sources. PROSPER: collaborators have received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° HEALTH-F2-2009-223004 PROMIS: The PROMIS collaborators are are thankful to all the study participants in Pakistan. Recruitment in PROMIS was funded through grants available to investigators at the Center for Non-Communicable Diseases, Pakistan (Danish Saleheen and Philippe Frossard) and investigators at the University of Cambridge, UK (Danish Saleheen and John Danesh). Field-work, genotyping, and standard clinical chemistry assays in PROMIS were principally supported by grants awarded to the University of Cambridge from the British Heart Foundation, UK Medical Research Council, Wellcome Trust, EU Framework 6-funded Bloodomics Integrated Project, Pfizer. We would like to acknowledge the contributions made by the following individuals who were involved in the field work and other administrative aspects of the study: Mohammad Zeeshan Ozair, Usman Ahmed, Abdul Hakeem, Hamza Khalid, Kamran Shahid, Fahad Shuja, Ali Kazmi, Mustafa Qadir Hameed, Naeem Khan, Sadiq Khan, Ayaz Ali, Madad Ali, Saeed Ahmed, Muhammad Waqar Khan, Muhammad Razaq Khan, Abdul Ghafoor, Mir Alam, Riazuddin, Muhammad Irshad Javed, Abdul Ghaffar, Tanveer Baig Mirza, Muhammad Shahid, Jabir Furqan, Muhammad Iqbal Abbasi, Tanveer Abbas, Rana Zulfiqar, Muhammad Wajid, Irfan Ali, Muhammad Ikhlaq, Danish Sheikh and Muhammad Imran. INTERVAL: Participants in the INTERVAL randomised controlled trial were recruited with the active collaboration of NHS Blood and Transplant England (www.nhsbt.nhs.uk), which has supported field work and other elements of the trial. DNA extraction and genotyping was funded by the National Institute of Health Research (NIHR), the NIHR BioResource (http://bioresource.nihr.ac.uk/) and the NIHR Cambridge Biomedical Research Centre (www.cambridge-brc.org.uk). The academic coordinating centre for INTERVAL was supported by core funding from: NIHR Blood and Transplant Research Unit in Donor Health and Genomics, UK Medical Research Council (MR/L003120/1), British Heart Foundation (RG/13/13/30194), and NIHR Research Cambridge Biomedical Research Centre. A complete list of the investigators and contributors to the INTERVAL trial is provided in reference.
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). 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