title: Mutual assured destruction

text: Mutual assured destruction (MAD) is a doctrine of military strategy and national security policy which posits that a full-scale use of nuclear weapons by an attacker on a nuclear-armed defender with second-strike capabilities would cause the complete annihilation of both the attacker and the defender. It is based on the theory of rational deterrence, which holds that the threat of using strong weapons against the enemy prevents the enemy's use of those same weapons. The strategy is a form of Nash equilibrium in which, once armed, neither side has any incentive to initiate a conflict or to disarm.


title: Mutual assured destruction

text: The term "mutual assured destruction", commonly abbreviated "MAD", was coined by Donald Brennan, a strategist working in Herman Kahn's Hudson Institute in 1962. However, Brennan came up with this acronym ironically, spelling out the English word "mad" to argue that holding weapons capable of destroying society was irrational.


title: Mutual assured destruction

text: Under MAD, each side has enough nuclear weaponry to destroy the other side. Either side, if attacked for any reason by the other, would retaliate with equal or greater force. The expected result is an immediate, irreversible escalation of hostilities resulting in both combatants' mutual, total, and assured destruction. The doctrine requires that neither side construct shelters on a massive scale. If one side constructed a similar system of shelters, it would violate the MAD doctrine and destabilize the situation, because it would have less to fear from a second strike. The same principle is invoked against missile defense.


title: Mutual assured destruction

text: The doctrine further assumes that neither side will dare to launch a first strike because the other side would launch on warning (also called fail-deadly) or with surviving forces (a second strike), resulting in unacceptable losses for both parties. The payoff of the MAD doctrine was and still is expected to be a tense but stable global peace. However, many have argued that mutually assured destruction is unable to deter conventional war that could later escalate. Emerging domains of cyber-espionage, proxy-state conflict, and high-speed missiles threaten to circumvent MAD as a deterrent strategy.


title: Mutual assured destruction

text: The primary application of this doctrine started during the Cold War (1940s to 1991), in which MAD was seen as helping to prevent any direct full-scale conflicts between the United States and the Soviet Union while they engaged in smaller proxy wars around the world. It was also responsible for the arms race, as both nations struggled to keep nuclear parity, or at least retain second-strike capability. Although the Cold War ended in the early 1990s, the MAD doctrine continues to be applied.


title: Mutual assured destruction

text: Proponents of MAD as part of the US and USSR strategic doctrine believed that nuclear war could best be prevented if neither side could expect to survive a full-scale nuclear exchange as a functioning state. Since the credibility of the threat is critical to such assurance, each side had to invest substantial capital in their nuclear arsenals even if they were not intended for use. In addition, neither side could be expected or allowed to adequately defend itself against the other's nuclear missiles. This led both to the hardening and diversification of nuclear delivery systems (such as nuclear missile silos, ballistic missile submarines, and nuclear bombers kept at fail-safe points) and to the Anti-Ballistic Missile Treaty.


title: Mutual assured destruction

text: When the possibility of nuclear warfare between the United States and Soviet Union started to become a reality, theorists began to think that mutual assured destruction would be sufficient to deter the other side from launching a nuclear weapon. Kenneth Waltz, an American political scientist, believed that nuclear forces were in fact useful, but even more useful in the fact that they deterred other nuclear threats from using them, based on mutually assured destruction. The theory of mutually assured destruction being a safe way to deter continued even farther with the thought that nuclear weapons intended on being used for the winning of a war, were impractical, and even considered too dangerous and risky. Even with the Cold War ending in 1991, about 30 years ago, deterrence from mutually assured destruction is still said to be the safest course to avoid nuclear warfare.


title: Mutual assured destruction

text: The concept of MAD had been discussed in the literature for nearly a century before the invention of nuclear weapons. One of the earliest references comes from the English author Wilkie Collins, writing at the time of the Franco-Prussian War in 1870: "I begin to believe in only one civilizing influence—the discovery one of these days of a destructive agent so terrible that War shall mean annihilation and men's fears will force them to keep the peace." The concept was also described in 1863 by Jules Verne in his novel "Paris in the Twentieth Century", though it was not published until 1994. The book is set in 1960 and describes "the engines of war", which have become so efficient that war is inconceivable and all countries are at a perpetual stalemate.


title: Mutual assured destruction

text: MAD has been invoked by more than one weapons inventor. For example, Richard Jordan Gatling patented his namesake Gatling gun in 1862 with the partial intention of illustrating the futility of war. Likewise, after his 1867 invention of dynamite, Alfred Nobel stated that "the day when two army corps can annihilate each other in one second, all civilized nations, it is to be hoped, will recoil from war and discharge their troops." In 1937, Nikola Tesla published "The Art of Projecting Concentrated Non-dispersive Energy through the Natural Media", a treatise concerning charged particle beam weapons. Tesla described his device as a "superweapon that would put an end to all war."


title: Mutual assured destruction

text: The March 1940 Frisch–Peierls memorandum, the earliest technical exposition of a practical nuclear weapon, anticipated deterrence as the principal means of combating an enemy with nuclear weapons.


title: Mutual assured destruction

text: In August 1945, the United States became the first nuclear power after the nuclear attacks on Hiroshima and Nagasaki. Four years later, on August 29, 1949, the Soviet Union detonated its own nuclear device. At the time, both sides lacked the means to effectively use nuclear devices against each other. However, with the development of aircraft like the American Convair B-36 and the Soviet Tupolev Tu-95, both sides were gaining a greater ability to deliver nuclear weapons into the interior of the opposing country. The official policy of the United States became one of "Instant Retaliation", as coined by Secretary of State John Foster Dulles, which called for massive atomic attack against the Soviet Union if they were to invade Europe, regardless of whether it was a conventional or a nuclear attack.


title: Mutual assured destruction

text: By the time of the 1962 Cuban Missile Crisis, both the United States and the Soviet Union had developed the capability of launching a nuclear-tipped missile from a submerged submarine, which completed the "third leg" of the nuclear triad weapons strategy necessary to fully implement the MAD doctrine. Having a three-branched nuclear capability eliminated the possibility that an enemy could destroy all of a nation's nuclear forces in a first-strike attack; this, in turn, ensured the credible threat of a devastating retaliatory strike against the aggressor, increasing a nation's nuclear deterrence.


title: Mutual assured destruction

text: Campbell Craig and Sergey Radchenko argue that Nikita Khrushchev (Soviet leader 1953 to 1964) decided that policies that facilitated nuclear war were too dangerous to the Soviet Union. His approach did not greatly change his foreign policy or military doctrine but is apparent in his determination to choose options that minimized the risk of war.


title: Mutual assured destruction

text: Beginning in 1955, the United States Strategic Air Command (SAC) kept one-third of its bombers on alert, with crews ready to take off within fifteen minutes and fly to designated targets inside the Soviet Union and destroy them with nuclear bombs in the event of a Soviet first-strike attack on the United States. In 1961, President John F. Kennedy increased funding for this program and raised the commitment to 50 percent of SAC aircraft.


title: Mutual assured destruction

text: During periods of increased tension in the early 1960s, SAC kept part of its B-52 fleet airborne at all times, to allow an extremely fast retaliatory strike against the Soviet Union in the event of a surprise attack on the United States. This program continued until 1969. Between 1954 and 1992, bomber wings had approximately one-third of their assigned aircraft on quick reaction ground alert and were able to take off within a few minutes. SAC also maintained the National Emergency Airborne Command Post (NEACP, pronounced "kneecap"), also known as "Looking Glass", which consisted of several EC-135s, one of which was airborne at all times from 1961 through 1990. During the Cuban Missile Crisis the bombers were dispersed to several different airfields, and also were sometimes airborne. For example, some were sent to Wright Patterson, which normally did not have B-52s.


title: Mutual assured destruction

text: During the height of the tensions between the US and the USSR in the 1960s, two popular films were made dealing with what could go terribly wrong with the policy of keeping nuclear-bomb-carrying airplanes at the ready: "Dr. Strangelove" (1964) and "Fail Safe" (1964).


title: Mutual assured destruction

text: The strategy of MAD was fully declared in the early 1960s, primarily by United States Secretary of Defense Robert McNamara. In McNamara's formulation, there was the very real danger that a nation with nuclear weapons could attempt to eliminate another nation's retaliatory forces with a surprise, devastating first strike and theoretically "win" a nuclear war relatively unharmed. The true second-strike capability could be achieved only when a nation had a "guaranteed" ability to fully retaliate after a first-strike attack.


title: Mutual assured destruction

text: The United States had achieved an early form of second-strike capability by fielding continual patrols of strategic nuclear bombers, with a large number of planes always in the air, on their way to or from fail-safe points close to the borders of the Soviet Union. This meant the United States could still retaliate, even after a devastating first-strike attack. The tactic was expensive and problematic because of the high cost of keeping enough planes in the air at all times and the possibility they would be shot down by Soviet anti-aircraft missiles before reaching their targets. In addition, as the idea of a missile gap existing between the US and the Soviet Union developed, there was increasing priority being given to ICBMs over bombers.


title: Mutual assured destruction

text: It was only with the advent of ballistic missile submarines, starting with the " George Washington" class in 1959, that a genuine survivable nuclear force became possible and a retaliatory second strike capability guaranteed.


title: Mutual assured destruction

text: The deployment of fleets of ballistic missile submarines established a guaranteed second-strike capability because of their stealth and by the number fielded by each Cold War adversary—it was highly unlikely that all of them could be targeted and preemptively destroyed (in contrast to, for example, a missile silo with a fixed location that could be targeted during a first strike). Given their long-range, high survivability and ability to carry many medium- and long-range nuclear missiles, submarines were credible and effective means for full-scale retaliation even after a massive first strike.


title: Mutual assured destruction

text: This deterrence strategy and the program have continued into the 21st century, with nuclear submarines carrying Trident II ballistic missiles as one leg of the US strategic nuclear deterrent and as the sole deterrent of the United Kingdom. The other elements of the US deterrent are intercontinental ballistic missiles (ICBMs) on alert in the continental United States, and nuclear-capable bombers. Ballistic missile submarines are also operated by the navies of China, France, India, and Russia.


title: Mutual assured destruction

text: The US Department of Defense anticipates a continued need for a sea-based strategic nuclear force. The first of the current "Ohio"-class SSBNs are expected to be retired by 2029, meaning that a replacement platform must already be seaworthy by that time. A replacement may cost over $4 billion per unit compared to the USS "Ohio"s $2 billion. The USN's follow-on class of SSBN will be the Columbia class, which began construction in 2021 and enter service in 2031.


title: Mutual assured destruction

text: In the 1960s both the Soviet Union (A-35 anti-ballistic missile system) and the United States (LIM-49 Nike Zeus) developed anti-ballistic missile systems. Had such systems been able to effectively defend against a retaliatory second strike, MAD would have been undermined. However, multiple scientific studies showed technological and logistical problems in these systems, including the inability to distinguish between real and decoy weapons.


title: Mutual assured destruction

text: The multiple independently targetable re-entry vehicle (MIRV) was another weapons system designed specifically to aid with the MAD nuclear deterrence doctrine. With a MIRV payload, one ICBM could hold many separate warheads. MIRVs were first created by the United States in order to counterbalance the Soviet A-35 anti-ballistic missile systems around Moscow. Since each defensive missile could be counted on to destroy only one offensive missile, making each offensive missile have, for example, three warheads (as with early MIRV systems) meant that three times as many defensive missiles were needed for each offensive missile. This made defending against missile attacks more costly and difficult. One of the largest US MIRVed missiles, the LGM-118A Peacekeeper, could hold up to 10 warheads, each with a yield of around —all together, an explosive payload equivalent to 230 Hiroshima-type bombs. The multiple warheads made defense untenable with the available technology, leaving the threat of retaliatory attack as the only viable defensive option. MIRVed land-based ICBMs tend to put a premium on striking first. The START II agreement was proposed to ban this type of weapon, but never entered into force.


title: Mutual assured destruction

text: In the event of a Soviet conventional attack on Western Europe, NATO planned to use tactical nuclear weapons. The Soviet Union countered this threat by issuing a statement that any use of nuclear weapons (tactical or otherwise) against Soviet forces would be grounds for a full-scale Soviet retaliatory strike (massive retaliation). Thus it was generally assumed that any combat in Europe would end with apocalyptic conclusions.


title: Mutual assured destruction

text: MIRVed land-based ICBMs are generally considered suitable for a first strike (inherently counterforce) or a counterforce second strike, due to:


title: Mutual assured destruction

text: Unlike a decapitation strike or a countervalue strike, a counterforce strike might result in a potentially more constrained retaliation. Though the Minuteman III of the mid-1960s was MIRVed with three warheads, heavily MIRVed vehicles threatened to upset the balance; these included the SS-18 Satan which was deployed in 1976, and was considered to threaten Minuteman III silos, which led some neoconservatives to conclude a Soviet first strike was being prepared for. This led to the development of the aforementioned Pershing II, the Trident I and Trident II, as well as the MX missile, and the B-1 Lancer.


title: Mutual assured destruction

text: MIRVed land-based ICBMs are considered destabilizing because they tend to put a premium on striking first. When a missile is MIRVed, it is able to carry many warheads (up to eight in existing US missiles, limited by New START, though Trident II is capable of carrying up to 12) and deliver them to separate targets. If it is assumed that each side has 100 missiles, with five warheads each, and further that each side has a 95 percent chance of neutralizing the opponent's missiles in their silos by firing two warheads at each silo, then the attacking side can reduce the enemy ICBM force from 100 missiles to about five by firing 40 missiles with 200 warheads, and keeping the rest of 60 missiles in reserve. As such, this type of weapon was intended to be banned under the START II agreement; however, the START II agreement was never brought into force, and neither Russia nor the United States ratified the agreement.


title: Mutual assured destruction

text: The original US MAD doctrine was modified on July 25, 1980, with US President Jimmy Carter's adoption of "countervailing strategy" with Presidential Directive 59. According to its architect, Secretary of Defense Harold Brown, "countervailing strategy" stressed that the planned response to a Soviet attack was no longer to bomb Soviet population centers and cities primarily, but first to kill the Soviet leadership, then attack military targets, in the hope of a Soviet surrender before total destruction of the Soviet Union (and the United States). This modified version of MAD was seen as a winnable nuclear war, while still maintaining the possibility of assured destruction for at least one party. This policy was further developed by the Reagan administration with the announcement of the Strategic Defense Initiative (SDI, nicknamed "Star Wars"), the goal of which was to develop space-based technology to destroy Soviet missiles before they reached the United States.


title: Mutual assured destruction

text: SDI was criticized by both the Soviets and many of America's allies (including Prime Minister of the United Kingdom Margaret Thatcher) because, were it ever operational and effective, it would have undermined the "assured destruction" required for MAD. If the United States had a guarantee against Soviet nuclear attacks, its critics argued, it would have first-strike capability, which would have been a politically and militarily destabilizing position. Critics further argued that it could trigger a new arms race, this time to develop countermeasures for SDI. Despite its promise of nuclear safety, SDI was described by many of its critics (including Soviet nuclear physicist and later peace activist Andrei Sakharov) as being even more dangerous than MAD because of these political implications. Supporters also argued that SDI could trigger a new arms race, forcing the USSR to spend an increasing proportion of GDP on defense—something which has been claimed to have been an indirect cause of the eventual collapse of the Soviet Union. Gorbachev himself in 1983 announced that “the continuation of the S.D.I. program will sweep the world into a new stage of the arms race and would destabilize the strategic situation.”


title: Mutual assured destruction

text: Proponents of ballistic missile defense (BMD) argue that MAD is exceptionally dangerous in that it essentially offers a single course of action in the event of a nuclear attack: full retaliatory response. The fact that nuclear proliferation has led to an increase in the number of nations in the "nuclear club", including nations of questionable stability (e.g. North Korea), and that a nuclear nation might be hijacked by a despot or other person or persons who might use nuclear weapons without a sane regard for the consequences, presents a strong case for proponents of BMD who seek a policy which both protect against attack, but also does not require an escalation into what might become global nuclear war. Russia continues to have a strong public distaste for Western BMD initiatives, presumably because proprietary operative BMD systems could exceed their technical and financial resources and therefore degrade their larger military standing and sense of security in a post-MAD environment. Russian refusal to accept invitations to participate in NATO BMD may be indicative of the lack of an alternative to MAD in current Russian war-fighting strategy due to the dilapidation of conventional forces after the breakup of the Soviet Union.


title: Mutual assured destruction

text: Proud Prophet was a series of war games played out by various American military officials. The simulation revealed MAD made the use of nuclear weapons virtually impossible without total nuclear annihilation, regardless of how nuclear weapons were implemented in war plans. These results essentially ruled out the possibility of a limited nuclear strike, as every time this was attempted, it resulted in a complete expenditure of nuclear weapons by both the United States and USSR. Proud Prophet marked a shift in American strategy; following Proud Prophet, American rhetoric of strategies that involved the use of nuclear weapons dissipated and American war plans were changed to emphasize the use of conventional forces.


title: Mutual assured destruction

text: In 1983, a group of researchers including Carl Sagan released the TTAPS study (named for the respective initials of the authors), which predicted that the large scale use of nuclear weapons would cause a “nuclear winter”. The study predicted that the debris burned in nuclear bombings would be lifted into the atmosphere and diminish sunlight worldwide, thus reducing world temperatures by “-15° to -25°C”. These findings led to theory that MAD would still occur with many fewer weapons than were possessed by either the United States or USSR at the height of the Cold War. As such, nuclear winter was used as an argument for significant reduction of nuclear weapons since MAD would occur anyway.


title: Mutual assured destruction

text: After the fall of the Soviet Union, the Russian Federation emerged as a sovereign entity encompassing most of the territory of the former USSR. Relations between the United States and Russia were, at least for a time, less tense than they had been with the Soviet Union.


title: Mutual assured destruction

text: While MAD has become less applicable for the US and Russia, it has been argued as a factor behind Israel's acquisition of nuclear weapons. Similarly, diplomats have warned that Japan may be pressured to nuclearize by the presence of North Korean nuclear weapons. The ability to launch a nuclear attack against an enemy city is a relevant deterrent strategy for these powers.


title: Mutual assured destruction

text: The administration of US President George W. Bush withdrew from the Anti-Ballistic Missile Treaty in June 2002, claiming that the limited national missile defense system which they proposed to build was designed only to prevent nuclear blackmail by a state with limited nuclear capability and was not planned to alter the nuclear posture between Russia and the United States.


title: Mutual assured destruction

text: While relations have improved and an intentional nuclear exchange is more unlikely, the decay in Russian nuclear capability in the post–Cold War era may have had an effect on the continued viability of the MAD doctrine. A 2006 article by Keir Lieber and Daryl Press stated that the United States could carry out a nuclear first strike on Russia and would "have a good chance of destroying every Russian bomber base, submarine, and ICBM." This was attributed to reductions in Russian nuclear stockpiles and the increasing inefficiency and age of that which remains. Lieber and Press argued that the MAD era is coming to an end and that the United States is on the cusp of global nuclear primacy.


title: Mutual assured destruction

text: However, in a follow-up article in the same publication, others criticized the analysis, including Peter Flory, the US Assistant Secretary of Defense for International Security Policy, who began by writing "The essay by Keir Lieber and Daryl Press contains so many errors, on a topic of such gravity, that a Department of Defense response is required to correct the record." Regarding reductions in Russian stockpiles, another response stated that "a similarly one-sided examination of [reductions in] U.S. forces would have painted a similarly dire portrait".


title: Mutual assured destruction

text: A situation in which the United States might actually be expected to carry out a "successful" attack is perceived as a disadvantage for both countries. The strategic balance between the United States and Russia is becoming less stable, and the objective, the technical possibility of a first strike by the United States is increasing. At a time of crisis, this instability could lead to an accidental nuclear war. For example, if Russia feared a US nuclear attack, Moscow might make rash moves (such as putting its forces on alert) that would provoke a US preemptive strike.


title: Mutual assured destruction

text: An outline of current US nuclear strategy toward both Russia and other nations was published as the document "Essentials of Post–Cold War Deterrence" in 1995.


title: Mutual assured destruction

text: In November 2020, the US successfully destroyed a dummy ICBM outside the atmosphere with another missile. Bloomberg Opinion writes that this defense ability "ends the era of nuclear stability".


title: Mutual assured destruction

text: MAD does not entirely apply to all nuclear-armed rivals. India and Pakistan are an example of this; because of the superiority of conventional Indian armed forces to their Pakistani counterparts, Pakistan may be forced to use their nuclear weapons on invading Indian forces out of desperation regardless of an Indian retaliatory strike. As such, any large-scale attack on Pakistan by India could precipitate the use of nuclear weapons by Pakistan, thus rendering MAD inapplicable. However, MAD is applicable in that it may deter Pakistan from making a “suicidal” nuclear attack rather than a defensive nuclear strike.


title: Mutual assured destruction

text: Since the emergence of North Korea as a nuclear state, military action has not been an option in handling the instability surrounding North Korea because of their option of nuclear retaliation in response to any conventional attack on them, thus rendering non-nuclear neighboring states such as South Korea and Japan incapable of resolving the destabilizing effect of North Korea via military force. MAD may not apply to the situation in North Korea because the theory relies on rational consideration of the use and consequences of nuclear weapons, which may not be the case for potential North Korean deployment.


title: Mutual assured destruction

text: Whether MAD was the officially accepted doctrine of the United States military during the Cold War is largely a matter of interpretation. The United States Air Force, for example, has retrospectively contended that it never advocated MAD as a sole strategy, and that this form of deterrence was seen as one of numerous options in US nuclear policy. Former officers have emphasized that they never felt as limited by the logic of MAD (and were prepared to use nuclear weapons in smaller-scale situations than "assured destruction" allowed), and did not deliberately target civilian cities (though they acknowledge that the result of a "purely military" attack would certainly devastate the cities as well). However, according to a declassified 1959 Strategic Air Command study, US nuclear weapons plans specifically targeted the populations of Beijing, Moscow, Leningrad, East Berlin, and Warsaw for systematic destruction. MAD was implied in several US policies and used in the political rhetoric of leaders in both the United States and the USSR during many periods of the Cold War.


title: Mutual assured destruction

text: The doctrine of MAD was officially at odds with that of the USSR, which had, contrary to MAD, insisted survival was possible. The Soviets believed they could win not only a strategic nuclear war, which they planned to absorb with their extensive civil defense planning, but also the conventional war that they predicted would follow after their strategic nuclear arsenal had been depleted. Official Soviet policy, though, may have had internal critics towards the end of the Cold War, including some in the USSR's own leadership.


title: Mutual assured destruction

text: Other evidence of this comes from the Soviet minister of defense, Dmitriy Ustinov, who wrote that "A clear appreciation by the Soviet leadership of what a war under contemporary conditions would mean for mankind determines the active position of the USSR." The Soviet doctrine, although being seen as primarily offensive by Western analysts, fully rejected the possibility of a "limited" nuclear war by 1975.


title: Mutual assured destruction

text: Deterrence theory has been criticized by numerous scholars for various reasons. A prominent strain of criticism argues that rational deterrence theory is contradicted by frequent deterrence failures, which may be attributed to misperceptions. Scholars have also argued that leaders do not behave in ways that are consistent with the predictions of nuclear deterrence theory. For example, scholars have argued that it is inconsistent with the logics of rational deterrence theory why states that have achieved second-strike capabilities continue to build nuclear arsenals once they have reached the second-strike threshold.


title: Yumi's Cells

text: Yumi's Cells () is a 2021 South Korean television series directed by Lee Sang-yeob and starring Kim Go-eun, Ahn Bo-hyun, Jinyoung, Lee Yu-bi, and Park Ji-hyun. Based on the eponymous webtoon, it is a cell-based psychological romance that unravels the daily life of an ordinary office worker Yumi through the eyes of the cells in her head. The series premiered on tvN on September 17, 2021, and aired every Friday and Saturday at 22:50 (KST). It was also released simultaneously on both online streaming services TVING and iQIYI.


title: Yumi's Cells

text: On September 8, 2021, TVING announced that the drama had sold broadcast rights in more than 160 countries around the world, including Europe, North America and Southeast Asia.


title: Yumi's Cells

text: The second season premiered exclusively on TVING on June 10, 2022, releasing two episodes every Friday at 16:00 (KST). It was later aired on tvN from November 16, 2022, every Wednesday and Thursday at 22:30 (KST).


title: Yumi's Cells

text: On September 15, 2022, it was announced that season 2 had been sold to Japan's Amazon Prime Video. Season 2 were also available on Amazon Prime Video in Indonesia, Thailand and the Philippines.


title: Yumi's Cells

text: The drama tells the story of an ordinary office worker from the perspective of the brain cells in her head that control her every thought, feeling and action.


title: Yumi's Cells

text: Yumi (Kim Go-eun) is an ordinary woman. Her love-cell falls into a coma following the shock of a failed relationship. The drama will depict her growth and transformation as her cells work hard to wake up the love cell.


title: Yumi's Cells

text: Goo Woong (Ahn Bo-hyun) is a game developer who is an engineer to the core. Although he doesn't speak emotionally, he tries to wake up Yumi's love-cell with his simple and honest personality.


title: Yumi's Cells

text: After parting with Goo Woong, Yumi starts a new relationship with her co-worker Babi (Jinyoung) but they start to have issues after some time when he doesn't tell her the truth about certain things.


title: Yumi's Cells

text: On December 31, 2020, it was reported that webtoon "Yumi's Cells" published on Naver by Lee Dong-gun with 3.2 billion accumulated views was being made into a television series and Kim Go-eun was confirmed as the female lead. In April 2021, the lead cast line-up was announced as Kim Go-eun, Ahn Bo-hyun, Lee Yu-bi, and Park Ji-hyun.


title: Yumi's Cells

text: Filming of the series began in April 2021. On June 18, Ahn Bo-hyun revealed in an interview that he was currently filming "Yumi's Cells" and he has developed naturally tanned skin tone for the role of Goo Woong.


title: Yumi's Cells

text: "Yumi's Cells" is being produced using a new format which combines live-action and 3D animation. It is the first time in a Korean drama that such a format is used to produce a TV series while using the Unreal Engine as its source. The 3D animation is produced by Locus Corporation (also known as Sidus Animation Studios), the producer of "Red Shoes and the Seven Dwarfs", which is also producing an animated feature film based on the property with Studio N.


title: Yumi's Cells

text: The release of the second season on June 10 saw the number of TVING's paid subscribers increasing by more than 60% from the first to the second week, and the series took first place among all the platform original contents for five weeks in a row.


title: Will Peltz

text: William Peltz (born May 30, 1986) is an American actor, who is best known for his roles in "Unfriended" "Men, Women & Children" and "Manifest".


title: Will Peltz

text: Peltz was born in New York City, the son of Nelson Peltz, a billionaire businessman. Peltz's father is of Austrian Jewish and Russian Jewish descent, while his mother has German, Welsh, and English ancestry. Peltz celebrated his becoming a Bar Mitzvah. Among his siblings are actress Nicola Peltz and ice hockey defenceman Brad Peltz. He has seven siblings, and two half-siblings from his father's previous marriages.


title: Will Peltz

text: Peltz became interested in acting while reading scripts with his sister Nicola. In 2009, he moved to Los Angeles and secured his first roles in film productions. In 2014, he had his first major role in Jason Reitman's drama "Men, Women & Children". That same year, he starred in the horror film "Unfriended" as Adam Sewell.


title: Will Peltz

text: He and his sister actress Nicola Peltz have matching Hebrew tattoos on their ribs, that read: "family".


title: Clémence Poésy

text: Clémence Guichard (born 30 October 1982), known professionally as Clémence Poésy (), is a French actress and fashion model. After starting on the stage as a child, Poésy studied drama and has been active in both film and television since 1999, including some English-language productions. She is known for the roles of Fleur Delacour in the "Harry Potter" film series, Chloë in "In Bruges", Rana in "127 Hours", Natasha Rostova in "War and Peace", and the lead role as Elise Wassermann in the 24-episode series "The Tunnel".


title: Clémence Poésy

text: Born in L'Haÿ-les-Roses, a southern suburb of Paris, she is the daughter of actor-writer Étienne Guichard and a French teacher. Poésy took her mother's maiden name as her stage name. She was sent to an alternative school in Meudon.


title: Clémence Poésy

text: Her father gave Poésy her first acting job when she was a child; then she had two lines at age 14. She has a younger sister, Maëlle Poésy-Guichard, who is also an actress.


title: Clémence Poésy

text: After leaving "La Source", the bilingual, alternative school she attended until the age of 16, Poésy studied drama at the "Conservatoire National Supérieur d'Art Dramatique" (CNSAD, the French National Academy of Dramatic Arts), the "Atelier International de Blanche Salant et Paul Weaver", and Paris Nanterre University.


title: Clémence Poésy

text: Poésy's first English-speaking role was in the BBC mini-series "Gunpowder, Treason & Plot" (2004), in which she portrayed Mary, Queen of Scots, subsequently winning the 2005 Golden FIPA for actress in a TV Series and Serial.


title: Clémence Poésy

text: In 2005, Poésy appeared in the Harry Potter franchise as Fleur Delacour in "The Goblet of Fire". Between 2006 and 2007, she worked in a number of film and television productions, including the 2007 mini-series "War and Peace".


title: Clémence Poésy

text: In 2008, Poésy starred in the Academy Award-nominated film "In Bruges", alongside Colin Farrell, and "Harry Potter" co-stars Ralph Fiennes and Brendan Gleeson. In 2009, Poésy appeared in "Heartless" opposite Jim Sturgess. She reprised her role as Fleur Delacour in both "Harry Potter and the Deathly Hallows" movies. She played Chuck Bass's new French girlfriend, Eva, in the fourth season of the CW hit show "Gossip Girl".


title: Clémence Poésy

text: In 2010, Poésy appeared alongside James Franco in "127 Hours", directed by Danny Boyle. "127 Hours" was screened at the Toronto International Film Festival on 12 September 2010, following its premiere at the 2010 Telluride Film Festival.


title: Clémence Poésy

text: In 2011, she appeared alongside Rupert Friend in "Lullaby for Pi", a romantic drama and Benoit Philippon's directorial debut. The film is about a jazz singer (Friend) whose wife has just died and who meets a mysterious woman (Poésy). Forest Whitaker also starred. She can be heard singing on the album "Colour of the Trap" by Miles Kane. She is featured on the track "Happenstance".


title: Clémence Poésy

text: She worked alongside Michael Caine in "Mr. Morgan's Last Love", and in 2012 made her Broadway debut in "Cyrano de Bergerac" as Roxane.


title: Clémence Poésy

text: In 2013, Poésy was the female lead in the Sky Atlantic/Canal+ series "The Tunnel", which comprised 24 episodes over three series. In 2019, she played the part of Yelena in Chekhov's "Uncle Vanya" at the Theatre Royal in Bath.


title: Clémence Poésy

text: Poésy has been featured in numerous magazines, including the covers of "i-D", on French magazine "Jalouse" twice, on Australia's "Yen", and on "Nylon". Since October 2007, Poésy has been one of three spokesmodels for the self-titled fragrance by Chloé, and has modelled in Gap's 2008 autumn advertising campaign.


title: Clémence Poésy

text: In December 2011, Poésy was chosen as the face of the designer clothing company G-Star Raw. In 2014, she became the poster girl for the "Love Story" fragrance from Chloé.


title: Clémence Poésy

text: Poésy is fluent in French and English, and speaks some Italian and Spanish. She divides her time between homes in Paris and London, and has spent some time in Eastern Europe. Politically, she identifies as "very clearly on the left".


title: Clémence Poésy

text: In early 2017, she gave birth to a son, Liam. In 2019, while filming "Tenet", she was pregnant with her second child. At the Deauville American Film Festival 2021 she was pregnant with her third child.


title: Strong Girl Bong-soon

text: Strong Girl Bong-soon () is a 2017 South Korean television series starring Park Bo-young in the title role as a woman with superhuman strength, with Park Hyung-sik and Ji Soo. It aired on JTBC from February 24 to April 15, 2017.


title: Strong Girl Bong-soon

text: The series was a commercial hit and became one of the highest-rated Korean dramas on cable television history.


title: Strong Girl Bong-soon

text: Do Bong-soon (Park Bo-young) was born with superhuman strength. Her strength is hereditary and passed along only to the women in her family. Her dream is to create a video game with herself as the main character. She desperately wants to become a delicate and elegant woman, which is the ideal type of her crush, In Guk-doo (Ji Soo), a police officer. Thanks to her strength, she gets a job as bodyguard to rich heir Ahn Min-hyuk (Park Hyung-sik), the CEO of a gaming company, Ainsoft.


title: Strong Girl Bong-soon

text: A series of kidnapping cases happen in Dobong-dong, the district Bong-soon lives in, and she is determined to catch the culprit, who targeted her best friend. With help and training from Min-hyuk, she manages to control her strength to use it for good causes. Min-hyuk and Bong-soon find their relationship growing into something more. Their relationship at work and in pursuit of the kidnapper creates comical and dangerous situations, which bring them closer.


title: Strong Girl Bong-soon

text: The drama is written by Baek Mi-kyung who previously wrote "Beloved Eun-dong" and directed by Lee Hyung-min of "Ms. Temper and Nam Jung-gi". Filming started in October 2016 and finished on April 11, 2017.


title: Strong Girl Bong-soon

text: The drama serves as a reunion between Park Hyung-sik and Yoo Jae-myung who previously worked together in the KBS2 drama "". As well as Kim Won-Hae.


title: Strong Girl Bong-soon

text: On November 9, 2018, it was announced that an adaptation of the series was in development at The CW from CBS Television Studios and writer Melissa Scrivner-Love, with Ronda Rousey and Ben Silverman also set to executive produce. The project, titled "Strong Girl", would have followed "a former war photographer named Rayna who discovers she is indestructible and potentially the strongest woman in the world. Ghosted by [her Special Operations fiancé] when she reveals her newfound power to him, Rayna is hired as a bodyguard by a billionaire named Oliver, who sees her true potential." On February 8, 2019, it was revealed that the script was not picked up to pilot.


title: Strong Girl Bong-soon

text: A sequel of the series titled "Strong Woman Gang Nam-soon" (), starring Kim Jung-eun, Kim Hae-sook, Lee Yoo-mi, Ong Seong-wu and Byeon Woo-seok, is set to air in the first half of 2023.


title: Macular degeneration

text: Macular degeneration, also known as age-related macular degeneration (AMD or ARMD), is a medical condition which may result in blurred or no vision in the center of the visual field. Early on there are often no symptoms. Over time, however, some people experience a gradual worsening of vision that may affect one or both eyes. While it does not result in complete blindness, loss of central vision can make it hard to recognize faces, drive, read, or perform other activities of daily life. Visual hallucinations may also occur.


title: Macular degeneration

text: Macular degeneration typically occurs in older people. Genetic factors and smoking also play a role. It is due to damage to the macula of the retina. Diagnosis is by a complete eye exam. The severity is divided into early, intermediate, and late types. The late type is additionally divided into "dry" and "wet" forms with the dry form making up 90% of cases.


title: Macular degeneration

text: The difference between the two forms is the change of macula. Those with dry form AMD have drusen, cellular debris in their macula that gradually damages light-sensitive cells and leads to vision loss. In wet form AMD, blood vessels grow under the macula, causing blood and fluid to leak into the retina.


title: Macular degeneration

text: Exercising, eating well, and not smoking may reduce the risk of macular degeneration. There is no cure or treatment that returns vision already lost. In the wet form, anti-VEGF medication injected into the eye or less commonly laser coagulation or photodynamic therapy may slow worsening. Dietary antioxidant vitamins, minerals, and carotenoids do not appear to affect the onset. However, dietary supplements may slow the progression in those who already have the disease.


title: Macular degeneration

text: Age-related macular degeneration is a main cause of central blindness among the working-aged population worldwide. As of 2020, it affects more than 190 million people globally with the prevalence expected to increase to 288 million people by 2040 as the proportion of elderly persons in the population increases. It is equally seen in males and females and it is more common in those of European or North American ancestry. In 2013, it was the fourth most common cause of blindness after cataracts, preterm birth, and glaucoma. It most commonly occurs in people over the age of fifty and in the United States is the most common cause of vision loss in this age group. About 0.4% of people between 50 and 60 have the disease, while it occurs in 0.7% of people 60 to 70, 2.3% of those 70 to 80, and nearly 12% of people over 80 years old.


title: Macular degeneration

text: Early or intermediate AMD may be asymptomatic, or it may present with blurred or decreased vision in one or both eyes. This may manifest initially as difficulty with reading or driving (especially in poorly lit areas). Other symptoms of AMD include distortion of vision and blind spots (especially in and around the central visual field).


title: Macular degeneration

text: Macular degeneration by itself will not lead to total blindness. For that matter, only a small number of people with visual impairment are totally blind. In almost all cases, some vision remains, mainly peripheral. Other complicating conditions may lead to such an acute condition (severe stroke or trauma, untreated glaucoma, etc.), but few macular degeneration patients experience total visual loss.


title: Macular degeneration

text: The area of the macula constitutes only about 2.1% of the retina, and the remaining 97.9% (the peripheral field) remains unaffected by the disease. Even though the macula provides such a small fraction of the visual field, almost half of the visual cortex is devoted to processing macular information.


title: Macular degeneration

text: In addition, people with dry macular degeneration often do not experience any symptoms but can experience gradual onset of blurry vision in one or both eyes. People with wet macular degeneration may experience acute onset of visual symptoms.


title: Macular degeneration

text: Key risk factors are age, race/ethnicity, smoking, and family history. Advanced age is the strongest predictor of AMD, particularly over 50.


title: Macular degeneration

text: As illustrated by the Figure in this section, derived from data presented by the National Eye Institute of the United States, among those over 80 years of age, White individuals are more than 6-fold more likely to develop AMD than Black or Hispanic individuals. Thus, white background is a major risk factor for AMD.


title: Macular degeneration

text: In Caucasian (White) skin, there is a specific group of polymorphic genes (with single nucleotide alterations) that encode for enzymes and transcription factors responsible for the early steps (including the first step, formation of L-DOPA from the amino acid tyrosine) of the melanin synthesis pathway. Many of these enzymes and transcription factors are reviewed by Markiewicz and Idowu. Also, as reviewed by Sturm et al. “increasing intracellular concentrations of either tyrosine or L-DOPA both result in an increase in melanogenesis” or formation of the black pigment melanin. Thus there appears to be an association between reduced L-DOPA production and white skin. As suggested by the Figure and information in this section, reduced L-DOPA, resulting in white skin, appears to be associated with an increased risk of macular degeneration for white individuals over the age of 80.


title: Macular degeneration

text: AMD is a highly heritable condition. Recurrence ratios for siblings of an affected individual are three- to six-fold higher than in the general population. Genetic linkage analysis has identified 5 sets of gene variants at three locations on different chromosomes (1, 6 and 10) as explaining at least 50% of the risk. These genes have roles regulating the immune response, inflammatory processes and homeostasis of the retina. Variants of these genes give rise to different kinds of dysfunction in these processes. Over time, this results in accumulation of intracellular and extracellular metabolic debris. This can cause scarring of the retina or breakdown of its vascularization.


title: Macular degeneration

text: The list of genetic variations association with AMD include complement factors, apolipoprotein E, fibroblast growth factor 2, DNA excision repair protein, and age-related maculopathy susceptibility protein 2.


title: Macular degeneration

text: Although genetic testing can lead to the identification of genetic variation which can predispose to AMD, the complex pathogenesis of the condition prevents the use of these tests in routine practice. Nevertheless, they can be useful in selecting patients for clinical trials and analysing their response to treatment. The three loci where identified gene variants are found are designated:


title: Macular degeneration

text: The pathogenesis of age-related macular degeneration is not well known, although some theories have been put forward, including oxidative stress, mitochondrial dysfunction, and inflammatory processes.


title: Macular degeneration

text: The imbalance between the production of damaged cellular components and degradation leads to the accumulation of harmful products, for example, intracellular lipofuscin and extracellular drusen. Incipient atrophy is demarcated by areas of retinal pigment epithelium (RPE) thinning or depigmentation that precede geographic atrophy in the early stages of AMD. In advanced stages of AMD, atrophy of the RPE (geographic atrophy) and/or development of new blood vessels (neovascularization) result in the death of photoreceptors and central vision loss.


title: Macular degeneration

text: In the dry (nonexudative) form, drusen accumulates between the retina and the choroid, causing atrophy and scarring to the retina. In the wet (exudative) form, which is more severe, blood vessels grow up from the choroid (neovascularization) behind the retina which can leak exudate and fluid and also cause hemorrhaging.


title: Macular degeneration

text: Early work demonstrated a family of immune mediators was plentiful in drusen. Complement factor H (CFH) is an important inhibitor of this inflammatory cascade, and a disease-associated polymorphism in the CFH gene strongly associates with AMD. Thus an AMD pathophysiological model of chronic low grade complement activation and inflammation in the macula has been advanced. Lending credibility to this has been the discovery of disease-associated genetic polymorphisms in other elements of the complement cascade including complement component 3 (C3).


title: Macular degeneration

text: A powerful predictor of AMD is found on chromosome "10q26" at LOC 387715. An insertion/deletion polymorphism at this site reduces expression of the "ARMS2" gene though destabilization of its mRNA through deletion of the polyadenylation signal. ARMS2 protein may localize to the mitochondria and participate in energy metabolism, though much remains to be discovered about its function.


title: Macular degeneration

text: Other gene markers of progression risk includes tissue inhibitor of metalloproteinase 3 (TIMP3), suggesting a role for extracellular matrix metabolism in AMD progression. Variations in cholesterol metabolising genes such as the hepatic lipase, cholesterol ester transferase, lipoprotein lipase and the ATP-binding cassette A1 correlate with disease progression. The early stigmata of disease, drusen, are rich in cholesterol, offering face validity to the results of genome-wide association studies.


title: Macular degeneration

text: In AMD there is a progressive accumulation of characteristic yellow deposits, called drusen (buildup of extracellular proteins and lipids), in the macula (a part of the retina), between the retinal pigment epithelium and the underlying choroid. This accumulation is believed to damage the retina over time. Amyloid beta, which builds up in Alzheimer's disease brains, is one of the proteins that accumulate in AMD, which is a reason why AMD is sometimes called "Alzheimer's of the eye" or "Alzheimer's of the retina".


title: Macular degeneration

text: AMD can be divided into 3 stages: early, intermediate, and late, based partially on the extent (size and number) of drusen.


title: Macular degeneration

text: AMD-like pathology begins with small yellow deposits (drusen) in the macula, between the retinal pigment epithelium and the underlying choroid. Most people with these early changes (referred to as age-related maculopathy) still have good vision. People with drusen may or may not develop AMD. In fact, the majority of people over age 60 have drusen with no adverse effects. The risk of developing symptoms is higher when the drusen are large and numerous, and associated with the disturbance in the pigmented cell layer under the macula. Large and soft drusen are thought to be related to elevated cholesterol deposits.


title: Macular degeneration

text: Early AMD is diagnosed based on the presence of medium-sized drusen, about the width of an average human hair. Early AMD is usually asymptomatic.


title: Macular degeneration

text: Intermediate AMD is diagnosed by large drusen and/or any retinal pigment abnormalities. Intermediate AMD may cause some vision loss, but, like early AMD, it is usually asymptomatic.


title: Macular degeneration

text: Recently, subgroups of intermediate AMD have been identified, which have a very high risk of progression toward late AMD. This subgroup (depending on the precise definitions) is termed nascent GA and/or iRORA (incomplete retinal pigment epithelium and outer retinal atrophy). These 'high-risk' subgroups of intermediate AMD can be used to inform patients of theirs prognosis. In addition, these can be applied in clinical trials as endpoints.


title: Macular degeneration

text: In late AMD, enough retinal damage occurs that, in addition to drusen, people will also begin to experience symptomatic central vision loss. The damage can either be the development of atrophy or the onset of neovascular disease. Late AMD is further divided into two subtypes based on the types of damage: Geographic atrophy and Wet AMD (also called Neovascular AMD).


title: Macular degeneration

text: Dry AMD (also called nonexudative AMD) is a broad designation, encompassing all forms of AMD that are not neovascular (wet AMD). This includes early and intermediate forms of AMD, as well as the advanced form of dry AMD known as geographic atrophy. Dry AMD patients tend to have minimal symptoms in the earlier stages; visual function loss occurs more often if the condition advances to geographic atrophy. Dry AMD accounts for 80–90% of cases and tends to progress slowly. In 10–20% of people, dry AMD progresses to the wet type.


title: Macular degeneration

text: Geographic atrophy (also called atrophic AMD) is an advanced form of AMD in which progressive and irreversible loss of retinal cells leads to a loss of visual function. There are multiple layers that make up the retina, and in geographic atrophy, there are three specific layers that undergo atrophy: the choriocapillaris, retinal pigment epithelium, and the overlying photoreceptors.


title: Macular degeneration

text: The three layers that undergo atrophy in geographic atrophy are all adjacent to each other. The photoreceptors are the most superficial and they are the cells that are responsible for converting energy from the light from the outside world, into an electrical signal to be sent to the brain. There are several functions of the retinal pigment epithelium. One of the main functions of the retinal pigment epithelium is to minimize oxidative stress. It does so by absorbing light, and thus preventing it from getting to the underlying layers. The layers underlying the retinal pigment epithelium are very vascularlized so they have very high oxygen tension. Thus, if light was to get to those layers, many free radicals would form and cause damage to nearby tissues. The deepest layer that undergoes atrophy in geographic atrophy is called the choriocappilaris. It is a capillary network that provides nutrients to the retinal pigment epithelium.


title: Macular degeneration

text: The pathophysiology of geographic atrophy is still uncertain. Some studies questioned whether it was due to a deficient retinal pigment epithelium, leading to increased oxidative stress. Other studies have looked for inflammatory causes of damage. Thus far, the medical community is still not certain. Recent studies have begun to look at each layer individually. They found that decrease blood flow in the choriocapillaris precedes atrophy of the retinal pigment epithelium and the overlying photoreceptors. Since the choriocapillaris is a vascular layer, this may be used as an argument for why geographic atrophy could be a disease due to decreased blood flow.


title: Macular degeneration

text: Neovascular or exudative AMD, the "wet" form of advanced AMD, causes vision loss due to abnormal blood vessel growth (choroidal neovascularization) in the choriocapillaris, through Bruch's membrane. It is usually, but not always, preceded by the dry form of AMD. The proliferation of abnormal blood vessels in the retina is stimulated by vascular endothelial growth factor (VEGF). Because these blood vessels are abnormal, these are also more fragile than typical blood vessels, which ultimately leads to blood and protein leakage below the macula. Bleeding, leaking, and scarring from these blood vessels eventually cause irreversible damage to the photoreceptors and rapid vision loss if left untreated.


title: Macular degeneration

text: Diagnosis of age-related macular degeneration depends on signs in the macula, not necessarily vision. Early diagnosis of AMD can prevent further visual deterioration and potentially improve vision.


title: Macular degeneration

text: Diagnosis of dry (or early stage) AMD may include the following clinical examinations as well as procedures and tests:


title: Macular degeneration

text: Treatment of AMD varies depending on the category of the disease at the time of diagnosis. In general, treatment is aimed at slowing down the progression of AMD. As of 2018, there are no treatments to reverse the effects of AMD. Early-stage and intermediate-stage AMD is managed by modifying known risk factors such as smoking cessation, management of hypertension and atherosclerosis and making dietary modifications. For intermediate-stage AMD, management also includes antioxidant and mineral supplementation. Advanced-stage AMD is managed based on the presence of choroidal neovascularization (CNV): dry AMD (no CNV present) or wet AMD (CNV present). No effective treatments exist for dry AMD. The CNV present in wet AMD is managed with vascular endothelial growth factor (VEGF) inhibitors. Daily use of an Amsler grid or other home visual monitoring tools can be used to monitor for development of distorted vision, which may be a sign of disease progression.


title: Macular degeneration

text: The age related eye disease studies 1 and 2 (AREDS) showed that those with bilateral early or intermediate AMD, or intermediate AMD in one eye and advanced AMD in the other eye may benefit from specific vitamin and mineral supplementation. The specific vitamins and minerals in AREDS-1 are vitamin C (500 mg), zinc (80 mg), vitamin E (400 IU), copper (2 mg) and beta-carotene (15 mg). In the AREDS-2 formulation, lutein (10 mg) and zeaxanthin (2 mg) replaced beta-carotene due to the risk of lung cancer in smokers taking beta-carotene. These specific micronutrient supplementations were associated with a lower risk of progression to more severe forms of AMD and greater visual acuity at 5 years. There is no evidence that micronutrient supplementation prevents AMD progression in those with severe disease or prevents disease onset in those without AMD.


title: Macular degeneration

text: There is no cure for dry AMD. While there is increasing academic and pharmaceutical interest in developing complement inhibitors to treat ophthalmic inflammation, with several clinical trials underway for dry AMD, the first such agent to complete Phase 3 trials in AMD (the anti-factor D agent, lampalizumab) did not significantly improve the rate of disease progression. Nevertheless, strategies targeting different aspects of the complement system are ongoing.


title: Macular degeneration

text: Ranibizumab, aflibercept, brolucizumab and faricimab are approved VEGF inhibitors for the treatment of CNV in wet AMD. All three drugs are administered via intravitreal injection, meaning they are injected directly into the eye. Bevacizumab is another VEGF inhibitor that has been shown to have similar efficacy and safety as the previous two drugs, however, is not currently indicated for AMD. AMD can also be treated with laser coagulation therapy.


title: Macular degeneration

text: A randomized control trial found that bevacizumab and ranibizumab had similar efficacy, and reported no significant increase in adverse events with bevacizumab. A 2014 Cochrane review found that the systemic safety of bevacizumab and ranibizumab are similar when used to treat neovascular AMD, except for gastrointestinal disorders. Bevacizumab however is not FDA approved for treatment of macular degeneration. A controversy in the UK involved the off-label use of cheaper bevacizumab over the approved, but expensive, ranibizumab. Ranibizumab is a smaller fragment, Fab fragment, of the parent bevacizumab molecule specifically designed for eye injections. Other approved antiangiogenic drugs for the treatment of neo-vascular AMD include pegaptanib and aflibercept.


title: Macular degeneration

text: These anti-VEGF agents may be administered monthly or adaptively. For adaptive anti-VEGF treatment, two approaches are conventionally applied. In the case of pro re nata, the patient comes at fixed intervals, but treatment is only administered if an activity is detected (i.e., presence of fluid). In the case of "treat-and-extend", the patients always receive treatment, but the interval to the next visit is extended if the lesion was inactive.


title: Macular degeneration

text: Recently, researchers have started to apply AI algorithms to predict the future need for treatment. But these approaches have not been validated for clinical use as of today.


title: Macular degeneration

text: The American Academy of Ophthalmology practice guidelines do not recommend laser coagulation therapy for macular degeneration, but state that it may be useful in people with new blood vessels in the choroid outside of the fovea who don't respond to drug treatment. There is strong evidence that laser coagulation will result in the disappearance of drusen but does not affect choroidal neovascularisation. A 2007 Cochrane review on found that laser photocoagulation of new blood vessels in the choroid outside of the fovea is effective and economical method, but that the benefits are limited for vessels next to or below the fovea.


title: Macular degeneration

text: Photodynamic therapy has also been used to treat wet AMD. The drug verteporfin is administered intravenously; light of a certain wavelength is then applied to the abnormal blood vessels. This activates the verteporfin destroying the vessels.


title: Macular degeneration

text: Cataract surgery could improve visual outcomes for people with AMD, though there have been concerns about surgery increasing the progression of AMD. A randomized controlled trial found that people who underwent immediate cataract surgery (within two weeks) had improved visual acuity and better quality of life outcomes than those who underwent delayed cataract surgery (6 months).


title: Macular degeneration

text: Radiotherapy has been proposed as a treatment for wet AMD but the evidence to support the use of modern stereotactic radiotherapy combined with anti-VEGF is currently uncertain and is awaiting the results of ongoing studies.


title: Macular degeneration

text: Nucleoside reverse transcription inhibitors like they are used in anti-HIV therapy was associated with a reduced risk of developing atrophic macular degeneration. This is because Alu elements undergo L1 (protein)-mediated reverse transcription in the cytoplasm resulting in DNA synthesis. First clinical trials are being prepared as of January 2021.


title: Macular degeneration

text: Because peripheral vision is not affected, people with macular degeneration can learn to use their remaining vision to partially compensate. Assistance and resources are available in many countries and every state in the U.S. Classes for "independent living" are given and some technology can be obtained from a state department of rehabilitation.


title: Macular degeneration

text: Adaptive devices can help people read. These include magnifying glasses, special eyeglass lenses, computer screen readers, electronic glasses, and TV systems that enlarge the reading material.


title: Macular degeneration

text: Video cameras can be fed into standard or special-purpose computer monitors, and the image can be zoomed in and magnified. These systems often include a movable table to move the written material.


title: Macular degeneration

text: Accessible publishing provides larger fonts for printed books, patterns to make tracking easier, audiobooks and DAISY books with both text and audio.


title: Macular degeneration

text: The prevalence of any age-related macular degeneration is higher in Europeans than in Asians and Africans. There is no difference in prevalence between Asians and Africans. The incidence of age-related macular degeneration and its associated features increases with age and is low in people <55 years of age. Smoking is the strongest modifiable risk factor. As of 2008, age-related macular degeneration accounts for more than 54% of all vision loss in the white population in the US. An estimated 8 million Americans are affected with early age-related macular degeneration, of whom over 1 million will develop advanced age-related macular degeneration within the next 5 years. In the UK, age-related macular degeneration is the cause of blindness in almost 42% of those who go blind aged 65–74 years, almost two-thirds of those aged 75–84 years, and almost three-quarters of those aged 85 years or older.


title: Macular degeneration

text: Studies indicate drusen associated with AMD are similar in molecular composition to amyloid beta (Aβ) plaques and deposits in other age-related diseases such as Alzheimer's disease and atherosclerosis. This suggests that similar pathways may be involved in the etiologies of AMD and other age-related diseases.


title: Macular degeneration

text: Genetic testing can help identify whether a patient with AMD is at a greater risk of developing the condition and can inform disease progression. Genetic testing can also allow researchers to identify whether patients are more or less likely to respond to treatments, such anti-VEGF medication or complement inhibitors. However, there remain several challenges to using predictive tools which incorporate genetic variation in clinical practice. As well as our limited understanding of the way that different genetic variants and environmental factors interact to influence AMD risk, the single nucleotide polymorphisms which are common in the population have small effects on individual patients with AMD. Therefore, there is increasing interest in understanding the functional consequences of rare mutations, which often have more pronounced effects. Genetic testing to guide clinical management is not currently recommended.


title: Macular degeneration

text: Cell based therapies using bone marrow stem cells as well as retinal pigment epithelial transplantation are being studied. A number of trials have occurred in humans with encouraging results.


title: Macular degeneration

text: CRISPR-Cas9 genome editing may be used to treat wet age-related macular degeneration caused by "VEGFA". Scientists described an approach in which engineered lentiviruses are injected into the affected anatomical regions for transient editing that could reduce the area of choroidal neovascularization by 63% without inducing undesired off-target edits or anti-Cas9 immune responses.


title: Macular degeneration

text: The retinal pigment epithelium (RPE) (see diagram) has an essential role in the eye. It secretes a large variety of factors including at least 22 proteins important in maintaining the structure, function and micro-environments on the two sides of the RPE. (The two sides of the RPE include the choroid side, where blood vessels form and bring nourishment to the eye, and the photoreceptor side, with rods and cones that receive light signals.) In particular, the RPE secretes vascular endothelial growth factor (VEGF) at its basement membrane, with the VEGF reaching the choriocapillaris to maintain proper blood vessel formation in the choroid region.


title: Macular degeneration

text: Many factors, including genetic factors, hypoxia, oxidative stress and inflammatory stressors, may cause pathologic over-production of VEGF by the RPE. This over-production causes excess blood vessel formation in the choroid region (the choriocapillaris), which is a major cause of wet AMD.


title: Macular degeneration

text: Research is exploring if artificial intelligence can help in predicting wet AMD early enough to make prevention possible. A study tested an AI model for predicting whether people with wet AMD in one eye would develop it in the other within six months. Compared to doctors and optometrists the AI model predicted the development more accurately.


title: Macular degeneration

text: There are a few other (rare) kinds of macular degeneration with similar symptoms but unrelated in etiology to Wet or Dry age-related macular degeneration. They are all genetic disorders that may occur in childhood or middle age.


title: Macular degeneration

text: Similar symptoms with a very different etiology and different treatment can be caused by epiretinal membrane or macular pucker or any other condition affecting the macula, such as central serous retinopathy.


title: Consumer price index

text: A consumer price index (CPI) is a price index, the price of a weighted average market basket of consumer goods and services purchased by households. Changes in measured CPI track changes in prices over time.


title: Consumer price index

text: A CPI is a statistical estimate constructed using the prices of a sample of representative items whose prices are collected periodically. Sub-indices and sub-sub-indices can be computed for different categories and sub-categories of goods and services, being combined to produce the overall index with weights reflecting their shares in the total of the consumer expenditures covered by the index. It is one of several price indices calculated by most national statistical agencies. The annual percentage change in a CPI is used as a measure of inflation. A CPI can be used to index (i.e. adjust for the effect of inflation) the real value of wages, salaries, and pensions; to regulate prices; and to deflate monetary magnitudes to show changes in real values. In most countries the CPI is one of the most closely watched national economic statistics.


title: Consumer price index

text: The index is usually computed monthly, or quarterly in some countries, as a weighted average of sub-indices for different components of consumer expenditure, such as food, housing, shoes, clothing, each of which is, in turn, a weighted average of sub-sub-indices. At the most detailed level, the elementary aggregate level, (for example, men's shirts sold in department stores in San Francisco), detailed weighting information is unavailable, so indices are computed using an unweighted arithmetic or geometric mean of the prices of the sampled product offers. (However, the growing use of barcode scanner data is gradually making weighting information available even at the most detailed level.) These indices compare prices each month with prices in the price-reference month. The weights used to combine them into the higher-level aggregates, and then into the overall index, relate to the estimated expenditures during a preceding whole year of the consumers covered by the index on the products within its scope in the area covered. Thus the index is a fixed-weight index, but rarely a true Laspeyres index, since the weight-reference period of a year and the price-reference period, usually a more recent single month, do not coincide.


title: Consumer price index

text: Ideally, the weights would relate to the composition of expenditure during the time between the price-reference month and the current month. There is a large technical economics literature on index formulas which would approximate this and which can be shown to approximate what economic theorists call a true cost-of-living index. Such an index would show how consumer expenditure would have to move to compensate for price changes so as to allow consumers to maintain a constant standard of living. Approximations can only be computed retrospectively, whereas the index has to appear monthly and, preferably, quite soon. Nevertheless, in some countries, notably in the United States and Sweden, the philosophy of the index is that it is inspired by and approximates the notion of a true cost of living (constant utility) index, whereas in most of Europe it is regarded more pragmatically.


title: Consumer price index

text: The coverage of the index may be limited. Consumers' expenditure abroad is usually excluded; visitors' expenditure within the country may be excluded in principle if not in practice; the rural population may or may not be included; certain groups such as the very rich or the very poor may be excluded. Saving and investment are always excluded, though the prices paid for financial services provided by financial intermediaries may be included along with insurance.


title: Consumer price index

text: The index reference period, usually called the base year, often differs both from the weight-reference period and the price-reference period. This is just a matter of rescaling the whole time series to make the value for the index reference-period equal to 100. Annually revised weights are a desirable but expensive feature of an index, for the older the weights the greater is the divergence between the current expenditure pattern and that of the weight reference-period.


title: Consumer price index

text: It is calculated and reported on a per region or country basis on a monthly and annual basis. International organizations like the Organisation for Economic Co-operation and Development (OECD) report statistical figures like the consumer price index for many of its member countries. In the US the CPI is usually reported by the Bureau of Labor Statistics.


title: Consumer price index

text: An English economist by the name of Joseph Lowe first proposed the theory of price basket index in 1822. His fixed basket approach was relatively simple as Lowe computed the price of a list of goods in period 0 and compared the price of that same basket of goods in period 1. Since his proposed theories however were elementary, later economists built on his ideas to form our modern definition.


title: Consumer price index

text: Alternatively, the CPI can be performed as formula_3. The "updated cost" (i.e. the price of an item at a given year, e.g.: the price of bread today) is divided by that of the initial year (the price of bread in 1970), then multiplied by one hundred.


title: Consumer price index

text: Example: The prices of 85,000 items from 22,000 stores, and 35,000 rental units are added together and averaged. They are weighted this way: housing 41.4%; food and beverages 17.4%; transport 17.0%; medical care 6.9%; apparel 6.0%; entertainment 4.4%; other 6.9%. Taxes (43%) are not included in CPI computation.


title: Consumer price index

text: By convention, weights are fractions or ratios summing to one, as percentages summing to 100 or as per mille numbers summing to 1000.


title: Consumer price index

text: On the European Union's Harmonized Index of Consumer Prices (HICP), for example, each country computes some 80 prescribed sub-indices, their weighted average constituting the national HICP. The weights for these sub-indices will consist of the sum of the weights of a number of component lower level indices. The classification is according to use, developed in a national accounting context. This is not necessarily the kind of classification that is most appropriate for a consumer price index. Grouping together of substitutes or of products whose prices tend to move in parallel might be more suitable.


title: Consumer price index

text: For some of these lower-level indices detailed reweighing to make them be available, allowing computations where the individual price observations can all be weighted. This may be the case, for example, where all selling is in the hands of a single national organisation which makes its data available to the index compilers. For most lower level indices, however, the weight will consist of the sum of the weights of a number of elementary aggregate indices, each weight corresponding to its fraction of the total annual expenditure covered by the index. An 'elementary aggregate' is a lowest-level component of expenditure: this has a weight, but the weights of each of its sub-components are usually lacking. Thus, for example: Weighted averages of elementary aggregate indices (e.g. for men's shirts, raincoats, women's dresses, etc.) make up low-level indices (e.g. outer garments).


title: Consumer price index

text: Weight averages of these, in turn, provide sub-indices at a higher, more aggregated level (e.g. clothing) and weighted averages of the latter provide yet more aggregated sub-indices (e.g. Clothing and Footwear).


title: Consumer price index

text: Some of the elementary aggregate indices and some of the sub-indices can be defined simply in terms of the types of goods and/or services they cover. In the case of such products as newspapers in some countries and postal services, which have nationally uniform prices. But where price movements do differ or might differ between regions or between outlet types, separate regional and/or outlet-type elementary aggregates are ideally required for each detailed category of goods and services, each with its own weight. An example might be an elementary aggregate for sliced bread sold in supermarkets in the Northern region.


title: Consumer price index

text: Most elementary aggregate indices are necessarily 'unweighted' averages for the sample of products within the sampled outlets. However, in cases where it is possible to select the sample of outlets from which prices are collected so as to reflect the shares of sales to consumers of the different outlet types covered, self-weighted elementary aggregate indices may be computed. Similarly, if the market shares of the different types of products represented by product types are known, even only approximately, the number of observed products to be priced for each of them can be made proportional to those shares.


title: Consumer price index

text: The outlet and regional dimensions noted above mean that the estimation of weights involves a lot more than just the breakdown of expenditure by types of goods and services, and the number of separately weighted indices composing the overall index depends upon two factors:


title: Consumer price index

text: How the weights are calculated, and in how much detail, depends upon the availability of information and upon the scope of the index. In the UK the retail price index (RPI) does not relate to the whole of consumption, for the reference population is all private households with the exception of pensioner households that derive at least three-quarters of their total income from state pensions and benefits, and "high income households" whose total household income lies within the top four per cent of all households. The result is that it is difficult to use data sources relating to total consumption by all population groups.


title: Consumer price index

text: The situation in most countries comes somewhere between these two extremes. The point is to make the best use of whatever data are available.


title: Consumer price index

text: No firm rules can be suggested on this issue for the simple reason that the available statistical sources differ between countries. However, all countries conduct periodical household-expenditure surveys and all produce breakdowns of consumption expenditure in their national accounts. The expenditure classifications used there may however be different. In particular:


title: Consumer price index

text: Even with the necessary adjustments, the national-account estimates and household-expenditure surveys usually diverge.


title: Consumer price index

text: The "statistical sources" required for regional and outlet-type breakdowns are usually weak. Only a large-sample Household Expenditure survey can provide a regional breakdown. Regional population data are sometimes used for this purpose, but need adjustment to allow for regional differences in living standards and consumption patterns. Statistics of retail sales and market research reports can provide information for estimating outlet-type breakdowns, but the classifications they use rarely correspond to COICOP categories.


title: Consumer price index

text: The increasingly widespread use of bar codes, scanners in shops has meant that detailed cash register printed receipts are provided by shops for an increasing share of retail purchases. This development makes possible improved Household Expenditure surveys, as Statistics Iceland has demonstrated. Survey respondents keeping a diary of their purchases need to record only the total of purchases when itemized receipts were given to them and keep these receipts in a special pocket in the diary. These receipts provide not only a detailed breakdown of purchases but also the name of the outlet. Thus response burden is markedly reduced, accuracy is increased, product description is more specific and point of purchase data are obtained, facilitating the estimation of outlet-type weights.


title: Consumer price index

text: There are only two general principles for the estimation of weights: use all the available information and accept that rough estimates are better than no estimates.


title: Consumer price index

text: Ideally, in computing an index, the weights would represent current annual expenditure patterns. In practice, they necessarily reflect past using the most recent data available or, if they are not of high quality, some average of the data for more than one previous year. Some countries have used a three-year average in recognition of the fact that household survey estimates are of poor quality. In some cases, some of the data sources used may not be available annually, in which case some of the weights for lower-level aggregates within higher-level aggregates are based on older data than the higher level weights.


title: Consumer price index

text: Infrequent reweighing saves costs for the national statistical office but delays the introduction into the index of new types of expenditure. For example, subscriptions for Internet service entered index compilation with a considerable time lag in some countries, and account could be taken of digital camera prices between re-weightings only by including some digital cameras in the same elementary aggregate as film cameras.


title: Consumer price index

text: The way in which owner-occupied dwellings should be dealt with in a consumer price index has been, and remains, a subject of heated controversy in many countries. Various approaches have been considered, each with their advantages and disadvantages.


title: Consumer price index

text: Leaving aside the quality of public services, the environment, crime and so forth, and regarding the standard of living as a function of the level and composition of individuals' consumption, this standard depends upon the amount and range of goods and services they consume. These include the service provided by rented accommodation, which can readily be priced, and the similar services yielded by a flat or house owned by the consumer who occupies it. Its cost to a consumer is, according to the economic way of thinking, an "opportunity cost", namely what he or she sacrifices by living in it. This cost, according to many economists, is what should form a component of a consumer price index.


title: Consumer price index

text: Opportunity cost can be looked at in two ways, since there are two alternatives to continuing to live in an owner-occupied dwelling. One – supposing that it is one year's cost that is to be considered – is to sell it, earn interest on the owner's capital thus released, and buy it back a year later, making an allowance for its physical depreciation. This can be called the "alternative cost" approach. The other, the "rental equivalent" approach, is to let it to someone else for the year, in which case the cost is the rent that could be obtained for it.


title: Consumer price index

text: There are practical problems in implementing either of these economists' approaches. Thus, with the alternative cost approach, if house prices are rising fast the cost can be negative and then become sharply positive once house prices start to fall, so such an index would be very volatile. On the other hand, with the rental equivalent approach, there may be difficulty in estimating the movement of rental values of types of property that are not actually rented. If one or other of these measures of the consumption of the services of owner-occupied dwellings is included in consumption, then it must be included in income too, for income equals consumption plus saving. This means that if the movement of incomes is to be compared with the movement of the consumer price index, incomes must be expressed as money income plus this imaginary consumption value. That is logical, but it may not be what users of the index want.


title: Consumer price index

text: Although the argument has been expressed in connection with owner-occupied dwellings, the logic applies equally to all durable consumer goods and services. Furniture, carpets and domestic appliances are not used up soon after purchase in the way that food is. Like dwellings, they yield a consumption service that can continue for years. Furthermore, since strict logic is to be adhered to, there are durable services as well that ought to be treated in the same way; the service consumers derive from appendectomies or crowned teeth continue for a long time. Since estimating values for these components of consumption has not been tackled, economic theorists are torn between their desire for intellectual consistency and their recognition that inclusion of the opportunity cost of the use of durables is impracticable.


title: Consumer price index

text: Another approach is to concentrate on spending. Everyone agrees that repairs and maintenance expenditure of owner-occupied dwellings should be covered in a consumer price index, but the spending approach would include mortgage interest too. This turns out to be quite complicated, conceptually as well as in practice.


title: Consumer price index

text: To explain what is involved, consider a consumer price index computed with reference to 2009 for just one sole consumer who bought her house in 2006, financing half of this sum by raising a mortgage. The problem is to compare how much interest such a consumer would now be paying with the interest that was paid in 2009. Since the aim is to compare like with like, that requires an estimate of how much interest would be paid now in the year 2010 on a similar house bought and 50% mortgage-financed three years ago, in 2007. It does not require an estimate of how much that identical person is paying now on the actual house she bought in 2006, even though that is what personally concerns her now.


title: Consumer price index

text: A consumer price index compares how much it would cost now to do exactly what consumers did in the reference-period with what it cost then. Application of the principle thus requires that the index for our one house owner should reflect the movement of the prices of houses like hers from 2006 to 2007 and the change in interest rates. If she took out a fixed-interest rate mortgage it is the change in interest rates from 2006 to 2007 that counts; if she took out a variable interest mortgage it is the change from 2009 to 2010 that counts. Thus her current index with 1999 as reference-period will stand at more than 100 if house prices or, in the case of a fixed-interest mortgage, interest rates rose between 2006 and 2007.


title: Consumer price index

text: The application of this principle in the owner-occupied dwellings component of a consumer price index is known as the "debt profile" method. It means that the current movement of the index will reflect past changes in dwelling prices and interest rates. Some people regard this as odd. Quite a few countries use the debt profile method, but in doing so most of them behave inconsistently. Consistency would require that the index should also cover the interest on consumer credit instead of the whole price paid for the products bought on credit if it covers mortgage interest payments. Products bought on credit would then be treated in the same way as owner-occupied dwellings.


title: Consumer price index

text: Variants of the debt profile method are employed or have been proposed. One example is to include down payments as well as interest. Another is to correct nominal mortgage rates for changes in dwelling prices or for changes in the rest of the consumer price index to obtain a "real" rate of interest. Also, other methods may be used alongside the debt profile method. Thus several countries include a purely notional cost of depreciation as an additional index component, applying an arbitrarily estimated, or rather guessed, depreciation rate to the value of the stock of owner-occupied dwellings. Finally, one country includes both mortgage interest and purchase prices in its index.


title: Consumer price index

text: The third approach simply treats the acquisition of owner-occupied dwellings in the same way as acquisitions of other durable products are treated. This means:


title: Consumer price index

text: Furthermore, expenditure on enlarging or reconstructing an owner-occupied dwelling would be covered, in addition to regular maintenance and repair. Two arguments of an almost theological character are advanced in connection with this transactions approach.


title: Consumer price index

text: One argument is that purchases of new dwellings are treated as 'investment' in the system of national accounts, so should not enter a consumption price index. It is said that this is more than just a matter of terminological uniformity. For example, it may be thought to help understanding and facilitate economic analysis if what is included under the heading of 'consumption' is the same in the consumer price index and in the national income and expenditure accounts. Since these accounts include the equivalent rental value of owner-occupied dwellings, the equivalent rental approach would have to be applied in the consumer price index too. But the national accounts do not apply it to other durables, so the argument demands consistency in one respect but accepts its rejection in another.


title: Consumer price index

text: The other argument is that the prices of new dwellings should exclude that part reflecting the value of the land, since this is an irreproducible and permanent asset that cannot be said to be consumed. This would presumably mean deducting site value from the price of a dwelling, site value presumably being defined as the price the site would fetch at auction if the dwelling were not on it. How this is to be understood in the case of multiple dwellings remains unclear.


title: Consumer price index

text: The merits of the different approaches are multidimensional, including feasibility, views on the way the index should and would move in particular circumstances, and theoretical properties of the index.


title: Consumer price index

text: Statisticians in a country lacking a good dwelling price index (which is required for all except the rental equivalent method) will go along with a proposal to use such an index only if they can obtain the necessary additional resources that will enable them to compile one. Even obtaining mortgage interest rate data can be a major task in a country with a multitude of mortgage lenders and many types of mortgage. Dislike of the effect upon the behavior of the consumer price index arising from the adoption of some methods can be a powerful, if sometimes unprincipled, argument.


title: Consumer price index

text: Dwelling prices are volatile and so, therefore, would be an index incorporating the current value of a dwelling price sub-index which, in some countries, would have a large weight under the third approach. Furthermore, the weight for owner-occupied dwellings could be altered considerably when reweighting was undertaken. (It could even become negative under the alternative cost approach if weights were estimated for a year during which house prices had been rising steeply).


title: Consumer price index

text: Then, there is the point that a rise in interest rates designed to halt inflation could paradoxically make inflation appear higher if current interest rates showed up in the index. Economists' principles are not acceptable to all; nor is insistence upon consistency between the treatment of owner-occupied dwellings and other durables.


title: Consumer price index

text: In the United States several different consumer price indices are routinely computed by the Bureau of Labor Statistics (BLS). These include the CPI-U (for all urban consumers), CPI-W (for Urban Wage Earners and Clerical Workers), CPI-E (for the elderly), and C-CPI-U (chained CPI for all urban consumers). These are all built over two stages. First, the BLS collects data to estimate 8,018 separate item–area indices reflecting the prices of 211 categories of consumption items in 38 geographical areas. In the second stage, weighted averages are computed of these 8,018 item–area indices. The different indices differ only in the weights applied to the different 8,018 item–area indices. The weights for CPI-U and CPI-W are held constant for 24 months, changing in January of even-numbered years. The weights for C-CPI-U are updated each month to reflecting changes in consumption patterns in the last month. Thus, if people on average eat more chicken and less beef or more apples and fewer oranges than the previous month, that change would be reflected in next month's C-CPI-U. However, it would not be reflected in CPI-U and CPI-W until January of the next even-numbered year.


title: Consumer price index

text: This allows the BLS to compute consumer price indices for each of the designated 38 geographical areas and for aggregates like the Midwest.


title: Consumer price index

text: In January of each year, Social Security recipients receive a cost-of-living adjustment (COLA) "to ensure that the purchasing power of Social Security and Supplemental Security Income (SSI) benefits is not eroded by inflation. It is based on the percentage increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W)". The use of CPI-W conflicts with this purpose, because the elderly consume substantially more health care goods and services than younger people. In recent years, inflation in health care has substantially exceeded inflation in the rest of the economy. Since the weight on health care in CPI-W is much less than the consumption patterns of the elderly, this COLA does not adequately compensate them for the real increases in the costs of the items they buy.


title: Consumer price index

text: The BLS does track a consumer price index for the elderly (CPI-E). It is not used, in part because the social security trust fund is forecasted to run out of money in roughly 40 years, and using the CPI-E instead of CPI-W would shorten that by roughly five years.


title: Consumer price index

text: The most recent December 2021 CPI reading hit 7%, the highest level in over 40 years. In response Jerome Powell, chair of the Federal Reserve has begun Quantitative tightening with rate hikes expected to begin in March 2022.


title: Consumer price index

text: Former White House Chief of Staff Erskine Bowles and former U.S. Senator Alan K. Simpson suggested a transition to using a "chained CPI" in 2010, when they headed the White House's deficit-reduction commission. They stated that it was a more accurate measure of inflation than the current system and switching from the current system could save the government more than $290 billion over the decade following their report. "The chained CPI is usually 0.25 to 0.30 percentage points lower each year, on average, than the standard CPI measurements".


title: Consumer price index

text: However, the National Active and Retired Federal Employees Associations said that the chained CPI does not account for seniors citizens' health care costs. Robert Reich, former United States Secretary of Labor under President Clinton, noted that typical seniors spend between 20 and 40 percent of their income on health care, far more than most Americans. "Besides, Social Security isn't in serious trouble. The Social Security trust fund is flush for at least two decades. If we want to ensure it's there beyond that, there's an easy fix – just lift the ceiling on income subject to Social Security taxes, which is now $113,700."


title: Consumer price index

text: Replacing the current cost-of-living adjustment calculation with the chained CPI was considered, but not adopted, as part of a deficit-reduction proposal to avert the sequestration cuts, or fiscal cliff, in January 2013, but President Obama included it in his April 2013 budget proposal.


title: Consumer price index

text: Because of some shortcomings of the CPI, notably that it uses static expenditure weighting and it does not account for the substitution effect, the PCEPI is an alternative price index used by the Federal Reserve, among others, to measure inflation. From January 1959 through July 2018, inflation measured by the PCEPI has averaged 3.3%, while it has averaged 3.8% using CPI.


title: And Just Like That...

text: And Just Like That... is an American comedy-drama streaming television series developed by Michael Patrick King for HBO Max. It is a revival and a sequel of the HBO television series "Sex and the City" created by Darren Star, which is based on Candace Bushnell's newspaper column and 1996 book anthology of the same name.


title: And Just Like That...

text: Development for the series began in December 2020, following the cancellation of a third film adaptation. It was given a straight-to-series order in January 2021 by HBO Max. Casting announcements were made throughout 2021 and filming started in July 2021 in New York City.


title: And Just Like That...

text: "And Just Like That..." premiered on HBO Max on December 9, 2021, with mixed reviews. The season finale was released on February 3, 2022. Originally billed as a miniseries, the series was renewed for a second season in March 2022.