This dataset contains replication files for "The Fading American Dream: Trends in Absolute Income Mobility Since 1940" by Raj Chetty, David Grusky, Maximilian Hell, Nathaniel Hendren, Robert Manduca, and Jimmy Narang. For more information, see https://opportunityinsights.org/paper/the-fading-american-dream/. A summary of the related publication follows. One of the defining features of the “American Dream” is the ideal that children have a higher standard of living than their parents. We assess whether the U.S. is living up to this ideal by estimating rates of “absolute income mobility” – the fraction of children who earn more than their parents – since 1940. We measure absolute mobility by comparing children’s household incomes at age 30 (adjusted for inflation using the Consumer Price Index) with their parents’ household incomes at age 30. We find that rates of absolute mobility have fallen from approximately 90% for children born in 1940 to 50% for children born in the 1980s. Absolute income mobility has fallen across the entire income distribution, with the largest declines for families in the middle class. These findings are unaffected by using alternative price indices to adjust for inflation, accounting for taxes and transfers, measuring income at later ages, and adjusting for changes in household size. Absolute mobility fell in all 50 states, although the rate of decline varied, with the largest declines concentrated in states in the industrial Midwest, such as Michigan and Illinois. The decline in absolute mobility is especially steep – from 95% for children born in 1940 to 41% for children born in 1984 – when we compare the sons’ earnings to their fathers’ earnings. Why have rates of upward income mobility fallen so sharply over the past half-century? There have been two important trends that have affected the incomes of children born in the 1980s relative to those born in the 1940s and 1950s: lower Gross Domestic Product (GDP) growth rates and greater inequality in the distribution of growth. We find that most of the decline in absolute mobility is driven by the more unequal distribution of economic growth rather than the slowdown in aggregate growth rates. When we simulate an economy that restores GDP growth to the levels experienced in the 1940s and 1950s but distributes that growth across income groups as it is distributed today, absolute mobility only increases to 62%. In contrast, maintaining GDP at its current level but distributing it more broadly across income groups – at it was distributed for children born in the 1940s – would increase absolute mobility to 80%, thereby reversing more than two-thirds of the decline in absolute mobility. These findings show that higher growth rates alone are insufficient to restore absolute mobility to the levels experienced in mid-century America. Under the current distribution of GDP, we would need real GDP growth rates above 6% per year to return to rates of absolute mobility in the 1940s. Intuitively, because a large fraction of GDP goes to a small fraction of high-income households today, higher GDP growth does not substantially increase the number of children who earn more than their parents. Of course, this does not mean that GDP growth does not matter: changing the distribution of growth naturally has smaller effects on absolute mobility when there is very little growth to be distributed. The key point is that increasing absolute mobility substantially would require more broad-based economic growth. We conclude that absolute mobility has declined sharply in America over the past half-century primarily because of the growth in inequality. If one wants to revive the “American Dream” of high rates of absolute mobility, one must have an interest in growth that is shared more broadly across the income distribution.

This interview is part of the Women, Risk and Aids Project (1989-90) archive which was created as part of the Reanimating Data Project (2018-20).Original transcript of interview with Catherine, an aspiring fashion designer. Her sex education was very basic, reproductive and biological, and it was only through her friends that she actually discovered what sex is. She did get a lot of information on AIDS prevention from a teacher, which she found more useful than the adverts on television. She also thinks that youth clubs would be a good place for young people to get their sex education from. Catherine is aware of gendered double standards surrounding permissive sexualities and sexual reputation, but her and her friends are not the type to engage in casual sex or one night stands. She describes herself as 'a bit of an angel' - she doesn't partake in any 'risky' behaviours, like drinking alcohol or cigarettes. Her family is from West Africa, and though she is keen to learn about her cultural heritage she is very used to her Westernised lifestyle.

Following the global-level Ebola virus disease (EVD) outbreak during 2014–2016, international collaboration with multiorganizational participation has rapidly increased. Given the greater priorities for research and development (R&D) outcomes despite the quantitative and qualitative lack of high-containment laboratory facilities in low- and middle-income countries (LMICs), where biological targets for investigation are located near their natural habitats, occupational readiness for health workers' safety has not been well-addressed, where limited global expert human resources are being deployed to high-containment laboratories including biosafety level 4 (BSL-4) facilities for case management and medical investigations. Pursuing scientific and managerial success to make laboratories efficient and productive, most laboratory safety policies have focused on the functionality of technical skills or performance, procedural methodologies, and supervision over the employees to collaborate in LMICs. The experts dispatched from advanced countries bring a long list of scientific tasks with high-tech devices, supplies, and training programs to introduce their collaboration with local partners in LMICs. However, the dispatched experts would subsequently realize their list becomes endless to establish their basic functions required in high-containment laboratories to ensure qualified scientific outcomes in LMICs. Under such circumstances where dual or multiple policies and standards accommodated pose dilemmas for operational procedures to ensure biosafety and biosecurity, all the frontline experts from both LMICs and advanced countries may be exposed to significant risks of life-threating infection of highly pathogenic agents like EVD, without any pragmatic measures or road maps to establish valued international collaboration, pursuing its sustainability. Given the fact mentioned above, we conducted a quick review of the key biosafety and biosecurity management documents, relevant policy analyses, and research to understand the current status and, if any, measures to dissolve critical dilemmas mentioned above. As a result, we found that occupational safety and health (OSH) aspects had not been sufficiently addressed, particularly in the context of international BSL-4 collaboration in LMICs. Moreover, consideration of OSH can be one of the key drivers to make such collaborative interventions more pragmatic, safer to reorient, harness disease-based vertical approaches, and harmonize policies of biosafety and biosecurity, particularly for collaborations organized in resource-limited settings.

This statistic shows the results of a survey among American adults on their happiness with their current living standards, by social class. The survey was conducted in July 2012, shortly before the presidential election. 32 percent of Americans who define themselves as members of the middle class stated they were very happy with their life nowadays, while 20 percent of Americans belonging to the lower class stated the same.

K-12 International Schools Market Outlook

The global K-12 international schools market size was estimated at USD 60 billion in 2023, and it is projected to reach approximately USD 120 billion by 2032, growing at a CAGR of 7.5% during the forecast period. This remarkable growth is primarily fueled by a burgeoning demand for quality education and a growing expatriate population that values an international curriculum for their children. Additionally, increasing awareness about the benefits of global education and the rising disposable income of families in emerging economies are significant contributors to the market's expansion.

One of the major growth factors driving the K-12 international schools market is the rising demand for high-quality education that adheres to international standards. As globalization continues to shape the world, more parents are recognizing the advantages of enrolling their children in international schools that offer globally recognized curricula such as the International Baccalaureate (IB) and Cambridge International Examinations. These programs not only enhance students' academic prospects but also prepare them for higher education opportunities worldwide.

Moreover, the increase in expatriate communities across various regions is another vital driver of market growth. Many multinational corporations are expanding their operations globally, leading to a rise in the number of expatriates who seek international schooling options for their children. These schools cater to the diverse needs of expatriate families by offering a curriculum that is compatible with various educational systems worldwide, thereby ensuring a seamless transition for students moving between countries.

The growing emphasis on bilingual and multilingual education is also playing a significant role in the market's growth. Parents are increasingly valuing the importance of language acquisition from an early age, which is a common feature of many international schools. By offering bilingual programs and foreign language immersion, these schools equip students with the linguistic skills needed to thrive in a globalized world. This emphasis on language learning not only enhances cognitive abilities but also provides a competitive edge in future career prospects.

Regionally, the Asia Pacific region is anticipated to witness the highest growth rate during the forecast period. This can be attributed to the rapid economic development in countries like China and India, coupled with a growing middle-class population that is willing to invest in premium education for their children. Additionally, the presence of a large expatriate community in cities such as Hong Kong, Singapore, and Tokyo further boosts the demand for international schools. The strategic initiatives taken by governments in these countries to attract foreign investments also play a pivotal role in fostering the growth of the international school market in the region.

School Type Analysis

When analyzing the K-12 international schools market by school type, it is essential to consider the primary, middle, and high school segments. Each of these segments caters to different age groups and educational needs, thereby shaping the overall dynamics of the market. Primary schools typically cater to younger students, emphasizing foundational skills in literacy, numeracy, and social development. The demand for primary international schools has seen a substantial increase, driven by parents' desire to provide their children with a strong educational foundation from an early age.

Middle schools, which serve students in the transitional phase between primary and high school, focus on a more comprehensive curriculum that includes a broader range of subjects and extracurricular activities. The middle school segment is witnessing significant growth as parents recognize the importance of this transitional period in shaping their children's future academic and personal development. International middle schools are particularly valued for their holistic approach to education, which includes a strong emphasis on critical thinking, problem-solving, and emotional intelligence.

High schools, catering to older students preparing for higher education, are another crucial segment within the K-12 international schools market. The high school segment is experiencing robust growth due to the increasing number of students seeking globally recognized qualifications such as the International Baccalaureate (IB) Diploma or A-levels. These qualifications are highly regarded by unive

This interview is part of the Women, Risk and Aids Project (1989-90) archive which was created as part of the Reanimating Data Project (2018-20).Original transcript of an interview with Teresa, who is at university studying languages. She would like a career in this field, but needs more business experience and would like to go into higher education. She has travelled a lot through Asia and Europe with her dad's job. Her twin sister is more 'feminine' than her, and Teresa doesn't find any interest in traditionally feminine things, like sewing or cooking. Her comprehensive secondary school provided limited sex education, a book that her mum had already given her. Teresa's mum told her about periods and she learnt about sex through the playground. Contraception was taught in school in one assembly, but only to the girls - it was considered their responsibility. AIDS was learnt about through media and the news. She had her first sexual intercourse at age 17, but had had some sexual relationships before then. Her first sex was with a male she had met on holiday, and they used a condom. She didn't enjoy it physically, but had learnt about female sexual pleasure and orgasms through reading magazines. She notes that her male peers would think a girl was a 'slag' if she asserted her dominance and right to pleasure within a sexual relationship. There is contradiction among her peer group around sexuality and reputation, where there was stigma around being a virgin in her later teens, but also a risk of being labelled as a 'slag'. She is on the pill and finds it convenient, but has used condoms inconsistently in her sexual relationships. Teresa doesn't consider herself as at risk of AIDS, but thinks that bisexuals and those who sleep around would be. She would be adamant on condom use in the future as she is starting to worry about risk of disease. She is happy to engage in casual sex, but recognises that there are gendered double standards in terms of sexual reputation.

Abstract copyright UK Data Service and data collection copyright owner.

The broad aim of the research is to investigate the social and economic consequences of the middle class settlement of inner London in recent decades in order to assess whether there are variations between different areas. A subsidiary aim will be to investigate the relationships between the middle class and other social groups in these neighbourhoods and whether, if these differ, the quality of these relationships can be related to the area and the social composition of the groups involved. Have the middle class exacerbated social exclusion in the city as some claim (Smith 1996)? At the heart of the research proposal is the assumption is that it is no longer possible to identify a single middle class and that different groups will have different social, economic, political and cultural interests and, for this reason, will have different relationships to their localities and populations.
More specific objectives are:
to identify what are the dominant patterns of middle-class settlement in inner London and how these are differentiated - by occupational characteristics, by social background, or by age-cohort;
to identify the consequences of middle class settlement particularly in terms of networks, patterns of sociation, the relations between work and non work associations;
to investigate to what extent these social and possibly economic interactions involve other social groups and if so how these variations might be explained;
to identify if possible what one area might learn from another - in other words, are there policy recommendations that can be made to improve the attractiveness of some areas and minimize their negativities?
Main Topics:

The research was centred on the ways in which inner London has changed over recent years and in particular on the process of gentrification. It did this by investigating the consequences of the middle classes upgrading different areas of inner London since the 1970s and examining the consequences of this both for the neighbourhoods concerned and in relation to other non middle class groups. Fieldwork was conducted between 1998 and 2000 in six areas: three south of the river Thames and two north, a sixth area comprised the London Docklands which was subdivided into three. These areas were:
'Telegraph Hill' (New Cross in the London Borough of Lewisham)
Brixton (Herne Hill and Tulse Hill in the London Borough of Brixton)
'Between the Commons' (Battersea in the London Borough of Wandsworth)
'Barnsbury' (in the London Borough of Islington)
'London Fields' (Dalston in the London Borough of Hackney)
Docklands:
'The Isle of Dogs' (in the London Borough of Tower Hamlets)
'Surrey Quays' (in the London Borough of Southwark)
'Britannia Village' (in the London Borough of Newham)
The dataset contains the results of interviews undertaken with respondents drawn from these areas.

Standard Measures
ONS Social Class classification was used.

According to a survey conducted in South Korea in May 2025, about ** percent of respondents who considered their living standards to be lower-middle class supported the Democratic Party. In contrast, about ** percent of respondents with high or upper-middle living standards supported the People Power Party.

Supplementary Material containing List of Reviewed Policy Reports by International Organizations (IOs), Codebook and Table on Intercoder Reliability showing: Comparison between Human-Coded and Automated Sentiment Analysis

Children's Beds Market Outlook

In 2023, the global children's beds market size was estimated at approximately USD 25 billion, projected to reach around USD 40 billion by 2032, growing at a compound annual growth rate (CAGR) of 5.5%. The market's consistent growth is driven by several factors, including the increasing awareness of child safety, the rise in disposable incomes, and the growing trend of nuclear families that necessitates separate spaces for children.

One of the primary growth drivers for the children's beds market is the heightened awareness and emphasis on child safety and comfort. Parents are increasingly investing in high-quality, ergonomically designed beds that ensure the physical well-being of their children. The growing trend of customization has also significantly contributed to market growth. Parents today are more inclined to choose beds that not only cater to the functional needs but also match the aesthetic preferences of their children, spurring demand for themed and personalized beds.

Another major growth factor is the rising disposable income among the middle and upper-middle-class population. As economic conditions improve, families have more spending power, allowing them to invest in premium furniture for their children. Moreover, the surge in nuclear families has created a need for dedicated children's rooms, further driving the demand for specialized children's beds. Additionally, the increasing birth rates in developing regions and the urbanization trends contribute positively to the market's expansion.

The influence of e-commerce and online retail platforms cannot be overlooked as a critical factor boosting market growth. The convenience of browsing a wide variety of products, reading reviews, and making purchases from the comfort of home has led to a significant rise in online sales of children's beds. Furthermore, online platforms often offer competitive prices and discounts, incentivizing parents to choose online over traditional brick-and-mortar stores. The integration of augmented reality (AR) in online shopping experiences also allows parents to visualize the beds in their home settings, making the decision-making process easier and boosting market growth.

Regionally, North America and Europe hold significant shares in the market due to the high standard of living and the greater emphasis on child development. These regions also have a well-established retail infrastructure and a higher adoption rate of new and innovative products. Asia Pacific is expected to witness the fastest growth during the forecast period, driven by the rising middle class, increasing urbanization, and significant improvements in living standards. Latin America and the Middle East & Africa are also poised for growth, albeit at a slower pace, as they continue to develop their retail sectors and improve economic conditions.

Product Type Analysis

The children's beds market is segmented into various product types, including bunk beds, loft beds, trundle beds, standard beds, and others. Bunk beds are particularly popular among families with multiple children sharing a room due to their space-saving design. These beds are designed to maximize vertical space, making them ideal for small apartments and houses. Safety features such as guardrails and sturdy ladders are paramount in bunk beds, and manufacturers are continually innovating to enhance these aspects, ensuring the well-being of children.

Loft beds, another significant segment, are designed not only to save space but also to provide additional functionality. These beds are elevated to create usable space underneath, which can be used for studying, playing, or storage. The multifunctional nature of loft beds makes them highly attractive to parents who are looking to optimize space in their children’s rooms. Moreover, the versatility and modern designs of loft beds cater to the aesthetic preferences of the older children and teenagers.

Trundle beds have gained popularity due to their dual functionality. These beds come with an additional pull-out bed underneath, making them perfect for sleepovers or accommodating guests. Trundle beds are especially useful for families who frequently host other children without compromising on space and comfort. The practicality of trundle beds for small living spaces has driven their demand significantly.

Standard beds, which are the traditional single or twin beds, still hold a substantial market share. These beds are preferred for thei

Thailand’s middle class is currently emerging, and it is forecasted that around ** percent of the households will earn at least *** thousand Thai Baht by 2020. And yet, Thailand is seen as a country with huge income inequality. By 2020 the number of millionaires (in U.S. dollars) will reach ** thousand . The development of income inequality in ThailandThe differences in income seen in Thailand today are the result of a long-term political and economic process from which, until recently, only leading households in urban areas benefited from. However, in doing so, the government was highly successful in continuously fueling economic growth. Even though the banking- and export sectors developed and grew from the 1960s up to the early 1990s, the majority of the population was still working in agriculture. In 1997, however, Thailand was badly hit by the Asian crisis, resulting in a further rise of the poverty rate. Political leaders were thus forced to implement reforms supporting the low-income households, and a series of social reforms such as the introduction of a healthcare plan and affordable housing followed. While these reforms sometimes resulted in an improvement of living standards, most had the unfortunate consequence of increasing corruption in the public sector.

In 2023, the median household disposable income in South Korea amounted to around ***** million South Korean won, showing a steady increase over the past few years. The median disposable income of South Korean households has steadily increased over the past few years.

Real Estate Agency and Brokerage Service Market Outlook

The global Real Estate Agency and Brokerage Service market size was estimated to be approximately USD 1.2 trillion in 2023, with an anticipated growth to USD 2.1 trillion by 2032, reflecting a Compound Annual Growth Rate (CAGR) of 6.2%. The primary growth factor driving this market is the increasing urbanization and infrastructural development worldwide, paired with the rising demand for residential and commercial properties. This growth is supported by technological advancements and the digital transformation of real estate services, as well as the increasing disposable income among middle-class populations in emerging economies.

One of the most significant growth factors for the Real Estate Agency and Brokerage Service market is the technological advancements in property management and brokerage services. The integration of Artificial Intelligence (AI), Big Data, and Blockchain technology has revolutionized how real estate transactions are conducted. AI and machine learning algorithms are being used to predict market trends, automate processes, and provide personalized property recommendations. Blockchain technology, on the other hand, ensures transparency and security in transactions, reducing the risk of fraud. These technological advancements have not only enhanced the efficiency of real estate services but have also attracted tech-savvy customers, thereby driving market growth.

Another key growth factor is the increasing urbanization and infrastructural development across the globe. As more people migrate to urban areas in search of better job opportunities and living standards, the demand for residential and commercial properties is on the rise. Governments in various countries are also investing heavily in infrastructure projects, such as the construction of smart cities and transportation networks, which further boosts the real estate market. This trend is particularly evident in emerging economies where rapid urbanization is accompanied by economic growth, leading to a surge in real estate investments.

Additionally, the rising disposable income and improving living standards among middle-class populations in emerging markets have significantly contributed to the growth of the Real Estate Agency and Brokerage Service market. With more disposable income at their disposal, individuals and families are increasingly investing in real estate, either for residential purposes or as a form of financial security. This trend is particularly strong in countries like India, China, and Brazil, where economic growth has created a burgeoning middle class with a growing appetite for property ownership. The increasing number of high-net-worth individuals (HNWIs) in these regions also presents lucrative opportunities for real estate brokers and agencies.

Broker Affiliate Programs have emerged as a strategic avenue for real estate agencies and brokers looking to expand their reach and enhance their service offerings. These programs allow brokers to partner with other businesses or individuals, creating a network of affiliates who promote their services in exchange for a commission. This model not only helps in increasing the visibility of brokerage services but also taps into new customer bases that might have been inaccessible otherwise. By leveraging these partnerships, brokers can offer a wider range of services and properties, catering to diverse client needs. Additionally, broker affiliate programs provide an opportunity for real estate professionals to collaborate with tech companies, financial institutions, and other sectors, fostering innovation and enhancing the overall customer experience.

From a regional perspective, North America dominates the Real Estate Agency and Brokerage Service market, followed by Europe and the Asia Pacific. North America's dominance can be attributed to the well-established real estate market, high disposable income, and advanced technological adoption in the region. Europe also holds a significant share due to the presence of a mature real estate market and favorable government policies. Meanwhile, the Asia Pacific region is expected to witness the highest growth rate during the forecast period, driven by rapid urbanization, economic growth, and increasing foreign investments in countries like China and India.

Service Type Analysis

The Real Estate Agency and Brokerage Service market is segmented by service type into residential brokerage, commerci

India Laundry Appliances Market size was valued at USD 2.72 Billion in 2024 and is projected to reach USD 5.25 Billion by 2032, growing at a CAGR of 8.6% from 2026 to 2032.

India Laundry Appliances Market Dynamics

The key market dynamics that are shaping the India laundry appliances market include:

Key Market Drivers

Rising Disposable Income and Middle-Class Growth: The rising disposable income and expanding middle class in India are significant drivers of the laundry appliance market. According to MOSPI, per capita net national income increased from ₹1,26,521 in 2019-20 to ₹1,72,000 in 2022-23, indicating greater purchasing power for household appliances. The Boston Consulting Group predicts that India's middle class will number between 550 and 600 million individuals by 2025, accounting for roughly 40% of the population. This expansion increases demand for time-saving equipment as middle-class households seek efficiency and modern living standards.

This interview is part of the Women, Risk and Aids Project (1989-90) archive which was created as part of the Reanimating Data Project (2018-20).Original transcript of interview with Jill, who is working towards a career in information technology. Most of her sex education came from magazines and chats with friends. Her school didn't teach them about periods until they were around age fifteen, which was much too late - they already knew about them, and one of her peers had already fallen pregnant. Jill describes her first sexual experience as boring, though she had been curious to see what all the fuss was about. She's a bit fed up with boys at the moment, but seems to garner a lot of male attention. She would prefer to use condoms as her main method of contraception in the future, as she believes they are the safest and some of her friends have gained a lot of weight using the pill. Jill is more worried about the risk of pregnancy than AIDS, but would like children in the future, once she has established a career for herself.

With few dissenting voices, the historiography of twentieth-century British civil society has been relayed through a prism of continuing and escalating elite disengagement. Within a paradigm of declinism, academics, politicians, and social commentators have contrasted a nineteenth and early twentieth century past, offering a richness of social commitment, against a present characterized by lowering standards in urban governance and civic disengagement. Put simply, as we entered the twentieth century the right sorts of people were no longer volunteering. Yet the data for such claims is insubstantial for we lack detailed empirical studies of social trends of urban volunteering across the first fifty years of the twentieth century. This dataset fills that void. It offers details of those involved in local politics, who were magistrates or poor law guardians, or who helped manage or represent one of 34 voluntary associations serving one ‘typical’ large city - Nottingham - and the surrounding county between 1900 and 1950. The sample covers a range of voluntary activities from the smallest to the largest of charities and associations. Three quarters of people captured by the data set lived within the city boundary. The clear majority of those sampled were middle class, only 10 per cent being working class, and 1.5 per cent upper class. Within this middle class there were major disparities in wealth, income, status, lifestyle, and self-view. Broken down, about 29 per cent of the sample overall were upper middle class, 43 per cent middle middle class, and 17 per cent lower middle class. Middle-class numbers in Nottingham, at about 22.5 per cent of the population, were roughly comparable with other Northern or Midland industrial cities. Its occupational distribution also approximately mirrored that of England.

Economic evaluation is a methodological framework that evaluates the clinical, economic and humanistic aspects of pharmaceutical products, services and programs, as well as other health care interventions. An Economic Evaluation Guideline (EEG) is a country-specific guideline which can be used as a standard for the preparation of studies to be included in application for reimbursement. This systematic review is a broad review about EEGs key features and characteristics with the addition of their development process and the team composition involved in this development in low- and middle-income countries (LMICs). It will examine the variation across different EEGs in LMICs. We will focus on LMICs as classified by the World Bank Atlas method for the 2020 fiscal year.

Apnea of prematurity (AOP) is a common complication among preterm infants (<37 weeks gestation), globally. However, access to caffeine citrate (CC) that is a proven safe and effective treatment in high income countries is largely unavailable in low-and-middle income countries, where most preterm infants are born. Therefore, the overall aim of this study was to describe the demand, policies, and supply factors affecting the availability and clinical use of CC in LMICs. A mixed methods approach was used to collect data from diverse settings in LMICs including Ethiopia, Kenya, Nigeria, South Africa, and India. Qualitative semi-structured interviews and focus group discussions were conducted with different health care providers, policymakers, and stakeholders from industry. Additional data was collected using standard questionnaires. A thematic framework approach was used to analyze the qualitative data and descriptive statistics were used to summarize the quantitative data. The findings indicate that there is variation in in-country policies on the use of CC in the prevention and treatment of AOP and its availability across the LMICs. As a result, the knowledge and experience of using CC also varied with clinicians on Ethiopia having no experience of using it while those in India have greater knowledge and experience of using it. The in turn influenced the demand and our findings show that only 29% of eligible preterm infants are receiving CC in these countries. There is an urgent need to address the multilevel barriers to accessing CC for management of AOP in Africa. These include cost, lack of national policies and therefore lack of demand stemming from its clinical equivalency with aminophylline. Practical ways to reduce the cost of CC in LMICs could potentially increase its availability and use. Methods Study design, setting, population, sampling We conducted a landscape evaluation involving stakeholders in Africa (Ethiopia, Kenya, Nigeria, South Africa) and South Asia (India – five states of Delhi; Bihar, Uttar Pradesh, Telangana and Madhya Pradesh) on CC availability and use from 1 July 2022 to 31 December 2022. We used a mixed methods study design to understand the complexity of CC availability and use across these LMICs. We selected a geographically and culturally diverse countries with high annual preterm births (~200,000). The selection of stakeholders within each focus country was by convenience and/or purposive sampling. We selected health facilities providing care for preterm infants and were able to provide the data required to achieve the study’s objectives. Proximity and ease of data collection was also factored into selection by research teams. Data collection Qualitative The research teams conducted key informant interviews and focus group discussions (FGD’s) with stakeholders in newborn health. The interviews with healthcare providers sought to explore their experience of using CC as a treatment for AOP. Interviews with WHO and Ministry of Health officials sought to understand current global and national health policies and CC’s inclusion in the essential drug list for using CC to treat AOP. Interviews with major drug suppliers and distributors of CC aimed to determine the current local market pricing of CC and its alternatives within and between countries. Also, to evaluate the factors determining the end-customer price of CC. The available average end-customer price per country was used to determine the daily cost of managing AOP for aminophylline and CC. We compared the average daily cost between aminophylline and cc for both public and private hospitals in each country. The dosing regimen for CC was a loading dose of 20 mg/kg/dose and a daily maintenance dose of between 5 to 10 mg/kg/day. The dosing regimen for aminophylline was a loading dose of 6 mg/kg administered intravenously (IV), followed by a maintenance dose of 2.5 mg/kg/dose/IV administered every 8 hours. Interviews and FGD’s were done in person or virtually over video or audio teleconferencing based on the preferences of the participants. All interviews were conducted in English. teams were situated in each country of focus and had previous training and experience conducting qualitative interviews and FGDs and in qualitative data analysis. The interviews and FGDs were semi structured using guide with a set of open-ended questions, in a set order and allowing for in-depth insights into the subject area. These guides were pilot tested across the 3 countries prior to data collection. Quantitative Additional interviews were conducted using standard questionnaires and had been piloted and refined in these settings prior to being used for data collection.The research team surveyed 107 providers: 20 from Ethiopia, 18 from India, 23 from Kenya, 28 from Nigeria, and 18 from South Africa. Providers were from 45 private or public health facilities across the five study countries. Of these, 12 (27%) were primary or secondary public, 7 (16%) were primary or secondary private, 25 (56%) were tertiary public, and 1 (2%) tertiary private Demand forecast for caffeine citrate. A demand forecast was conducted to determine the amount of CC needed per country. Using data from demographic health survey data from each country, we estimated the proportion of infants who would be eligible for CC treatment. Given AOP risk can be as high as 80% in preterm infants with birthweight ≤1500g (very low birth weight (VLBW)), we estimated that all VLBW infants met eligibility criteria for treatment with CC. We limited this forecast to public facilities where limited government funding constrains drug availability. We applied country-specific policies and assumptions to determine the percentage of VLBW infants who received or had a missed opportunity for CC treatment. These assumptions included, availability of CC, VLBW infants born in secondary facilities will be transferred to a tertiary center capable of providing AOP treat; some transfers will be unsuccessful and even when successful, AOP treatment will be unavailable. Data management and analysis All interviews were transcribed verbatim by an experienced transcriber. Authors reviewed the interview transcripts for errors. A coding framework was generated, and an emergent thematic analysis approach was used to analyze the data, to identify patterns and themes. Descriptive statistics were used to summarize the quantitative data.

This statistic shows the importance of ethical standards in retail to consumers in the United Kingdom, by social grade. The question posed in a survey conducted for the Department of Business, Innovation and Skills in June 2014, asked respondents to what extent are the ethical standards of retail companies and the products they sell important to them. Although the results are fairly similar across the social classes, those in the C1 grading (lower middle class) had the highest share of respondents believing ethical standards matter a great deal or a fair amount (57 percent). They mattered the least to those in the DE grade (working class and non working).

BackgroundA significant number of women in low and middle income countries (L-MICs) who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions from the published literatures and assess their implication for policy and future research.Study designA systematic review was performed in several electronic databases i.e Medline (Pubmed), Embase, Popline, The National Bureau of Economic Research (NBER), EBSCOHost, and The Cochrane Library. Articles reporting full economic evaluations of strategies to improve family planning interventions in one or more L-MICs, published between 1995 until 2015 were eligible for inclusion. Data was synthesized and analyzed using a narrative approach and the reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.ResultsFrom 920 references screened, 9 studies were eligible for inclusion. Six references assessed cost effectiveness of improving family planning interventions in one or more L-MICs, while the rest assessed costs and consequences of integrating family planning and HIV services, concerning sub-Saharan Africa. Assembled evidence suggested that improving family planning interventions is cost effective in a variety of L-MICs as measured against accepted international cost effectiveness benchmarks. In areas with high HIV prevalence, integrating family planning and HIV services can be efficient and cost effective; however the evidence is only supported by a very limited number of studies. The major drivers of cost effectiveness were cost of increasing coverage, effectiveness of the interventions and country-specific factors.ConclusionImproving family planning interventions in low and middle income countries appears to be cost-effective. Additional economic evaluation studies with improved reporting quality are necessary to generate further evidence on costs, cost-effectiveness, and affordability, and to support increased funding and investments in family planning programs.