Schools are increasingly using online pre-order systems for children to select school meals in advance. This study aimed to explore how children use and interact with these systems. Using a combination of direct observation and an online questionnaire, the operation of these systems in four UK primary schools was examined. This included how the menu options were displayed, how these were selected by children (4–11 years), and the interactions between children and others when making food selections. Where possible, most children pre-ordered their school lunch in the classroom, and differences in the food choice process among children were observed. These apparently related to children’s ages; older children (8–11 years) showed more independence when making food selections, whereas younger children were often supported by others. Most parents reported that their child was the decision maker when pre-ordering the school lunch, and the role of children in the selection of school lunches was evident. This may be accentuated by the online pre-order systems, and given the likely expansion of these systems in schools, there is an opportunity to implement interventions to influence children towards specific or different meal options from the school menu. The prevalence of global childhood obesity has increased substantially in the last forty-five years . In EnglExcess weight gain in children has been reported to be associated with the intake of foods, such as potatoes cooked in oil , processed meats, coated poultry and fish, milk, sugar-sweetened beverages, desserts, and sweets . Both inSeveral theoretical models are relevant to understanding children’s food choice behaviour. The Socio-ecological Model  describeThe school environment provides important opportunities to improve children’s diet and health behaviours . Food-baSchool lunches in England may be provided through local authority catering providers, in-house services, or private contracted companies. Schools generally operate a three-week menu cycle, with several meal options available every day, from which pupils make their selection. Primary schools are increasingly using online pre-order systems (OPSs) for pupils (and their parents) to choose their school lunches. A better understanding of these systems in operation will provide the necessary foundation for potential OPS-based interventions, to support children’s food decisions and, ultimately, to contribute towards improving dietary intake. This study aimed to explore how OPSs are used within a school food environment, and to examine how pupils interact with these systems to select their school lunches, and what this reveals regarding children’s food choices. This cross-sectional study was designed employing both direct observation and questionnaire survey methods. Ethical approval was granted by the University of Leeds Faculty Research Ethics Committee (ethics reference MEEC 18-017). All primary schools, within a local authority, that used OPSs were invited to participate in this study, i.e., schools that offered selection by an OPS of school lunch . Schools were initially contacted by email, followed up by a telephone call and an initial school visit. Four out of the nine primary schools invited agreed to participate. These schools varied in size from the average size of a primary school in England (with approximately 280 pupils) to the largest with almost 500 pupils. The free school meal (FSM) profiles of the schools varied; three schools had a lower percentage of pupils eligible for free school meals than the national average for primary schools (21.6%)  and one Reconnaissance visits were conducted at recruited schools, to understand how the schools managed school food and the lunch service, and specifically how the OPS was utilised. A drop-in session with parents was held at one school, to meet parents, answer questions, and informally collect data on parents’ thoughts on their children’s school lunch selections. Field notes from reconnaissance activities were written up by the researchers upon return, alongside reflections, and then discussed. Initial findings from these reconnaissance visits  further informed the study design.For the first component (non-participant direct observation), pupils’ processes for selecting school lunches using the OPS, as well as their mealtimes in the dining areas, were observed directly and systematically. Direct observations can offer rich insights into what people do in public and capture people’s behaviours in different social contexts . They prA bespoke observation form was developed to capture basic details and to note pupils’ apparent behaviours and experiences when selecting and consuming school lunches. The form was developed based on the aims of the observation, i.e., to capture: (1) how pupils chose their school lunches using the OPS; (2) how the school lunch options were displayed on the OPS; and (3) pupils’ interactions with others  within the school food environment. The design of the observation form was informed by previous research  and was The final observation form was made up of two parts. First, observations in the classroom related to (a) pupils selecting a school lunch, e.g., number of pupils, when and where lunch was selected, i.e., during registration or outside school; (b) menu options on offer; (c) how pupils selected their school lunch, e.g., independently, with help from teachers or parents; and (d) the classroom environment, e.g., health promotion posters. Second, observations in the dining area related to (a) the availability and presentation of food; (b) interactions with catering staff, e.g., verbal prompts to pupils; and (c) dining area environment, e.g., information on school meals. The form was designed in a tick box style (wherever possible) to facilitate data collection, although some sections were ‘open’ to consider the potential heterogeneity of observations. During each observation session, the observation form was completed, while the researcher watched and listened. Clear and detailed descriptions of what had been observed were noted, and reflections on these notes and what had been observed were added as soon as possible after the session. Photographs of specific aspects  and the setting in general  were also taken during visits. The researchers strove for discretion, limited their interaction with staff and pupils, and positioned themselves in an inconspicuous location.Following each observation visit, data were collated and observation notes written up. The researchers reviewed all data and highlighted key aspects and discussed emergent issues; points of discussion were written up and reviewed. The researchers also discussed potential sources of bias and the importance of reflexivity, paying attention to how their own experiences and characteristics might influence their conclusions. Furthermore, throughout the observation period, a daily reflection log that referred to the notes and photographs was kept. This regular process of data collection, note-taking, daily reflection, and discussion amongst the research team helped to provide valuable and robust insights from the observation.An online questionnaire was developed to collect data on parents’ perspectives on their children’s food choices in school, factors affecting these choices, and the OPS. Of particular interest was how the OPS was used, including potential factors influencing food choice, related to the OPS. Insights from the observation visits, informal discussions with catering staff and teachers, discussion among the research team, and previous research ,35,36,37Attention was paid to the wording and language in the items and literacy difficulty levels were assessed for the questionnaire, to check for appropriate readability scores ,39 (FlesThe platform used to host the questionnaire was Online Surveys (formerly Bristol Online Surveys). All parents were invited to complete the questionnaire. Introductory information was sent home via the schools’ communication systems , with a hyperlink to the questionnaire. Leaflets (including a QR code to link to the questionnaire) were given to the schools for pupils to take home. In addition, researchers visited three schools at morning drop-off and afternoon pick-up times with a tablet device and approached parents at the school gates to invite them to complete the questionnaire. The questionnaire was live from November 2019 through February 2020.The data collected via the online questionnaire were downloaded and screened for missing values, inconsistencies, or anomalies. Statistical analysis was completed using SPSS statistical software . Fisher’s exact tests were conducted to investigate associations between child characteristics  and outcomes related to school food choice . For all analyses relating to key stage, there were two groups; reception and key stage 1 were collapsed into one group , with the remainder being key stage 2 . The Index of Multiple Deprivation (IMD) was derived from postcodes provided by participants ,41.For open-ended questions, parents’ responses were collated, reviewed, and analysed using a thematic approach. Coding was done manually and iteratively; codes and themes were considered and discussed and then the data were reconsidered until a final set of themes emerged that were agreed on by the research team as representative of the data.Observation visits were conducted from April through June 2019. Across all schools, 12 h of direct observation in classrooms were conducted, and 682 children  were observed during registration when selecting their school meals using the OPS . This corresponded to approximately half of pupils (46%) attending the four schools. In addition, 8 h of direct observation in the dining areas were conducted to observe pupils (Reception–Year 6) across the four recruited primary schools. Findings from the observation visits were grouped into three distinct categories: (1) the online pre-order systems; (2) children’s school lunch selection using the OPS; and (3) the school dining areas. Key findings are described below with respect to these categories, and include: the food options displayed on the boards and how they differed depending upon the OPS; differences in the food choice process between children of different ages including the influence of others within the school environment; and the influence of the catering staff in the dining area. Meal options were displayed on the OPS and reflected the daily options for schools’ respective menu cycles. The schools operated a 3-week menu cycle. They offered daily options of: meat/fish-based meals, ; vegetarian meals, ; and jacket potatoes . School C also offered a fourth option of a sandwich . Additionally, vegetable side dishes were served with the meat/fish-based meals and with the vegetarian meals, and each child chose one or two of the vegetables available that day . This set up for school lunches is common in primary schools in England. Likewise, many schools adjust provision according to the pupil body, e.g., offering a halal meal option where there are a substantial number of Muslim children—this was the case in Schools B and D. Pre-orders for school lunches using OPSs were done at school, through an interactive whiteboard or a tablet device during registration at the start of the school day. Pre-orders were also made outside school via a parent’s online account. Importantly, these systems enabled parents to pre-select meals for their children and to know their children’s choices. The presentation and implementation of the OPS differed across the four schools, and two different OPSs from two different companies were observed. Schools A, B, and C used the same OPS (referred here as System 1); School D used a different system (System 2) .In Schools A and B, parents and children could choose a school lunch remotely (outside school) in advance via an online account (with any orders placed at home not being able to be changed in the classroom) or alternatively, choose in the classroom during morning registration, which was the more popular option. In School C, the lunch choice could only be done remotely in advance. Where children pre-ordered during morning registration (Schools A and B), children chose their school lunch using an interactive whiteboard or a laptop/tablet device. The whiteboard had a list of children’s names on it, and when a child pressed on their name, the meal options appeared on the board for them to choose from. In some classes with younger children, one pupil stayed at the board and helped others choose their meals or would take a tablet device around the classroom and ask the pupils to choose their meals. The meals were shown by name, with different background colours based on meal type . Some meals had descriptive words  or detailed descriptions , but there were no pictures or photographs of the meals. At lunch time in the dining area, two touchscreen monitors (one for pupils and one for catering staff) were used. Each child approached the ‘pupil’ touchscreen and selected their name to reveal their pre-selected school lunch option on both pupil and staff touchscreens. The ‘staff’ touchscreen was also used by catering staff to check which children had received or were yet to receive their meal, as well as any dietary requirements or allergies. Children who had not pre-ordered were also indicated; these children were able to choose an option during lunchtime from whatever food would be left. Observations in the dining areas highlighted how service could be reliant on the OPS. For example, longer queues and waiting time ensued when the touchscreen stopped working, or children found it difficult to find their name quickly on the small touchscreens.School D used System 2 where children selected their meals from an interactive white board showing their photos and names, and when a child has selected a meal, their photo is colour-highlighted to denote their selection. Before lunchtime, each child is given a coloured wristband corresponding to their pre-selected meal option, e.g., red wristband denoted the meat/fish-based meal option. At lunch, catering staff recognised which meal to serve to each pupil from the wristbands.Overall, just over half (52%) of the children observed during the visits chose a school lunch (as opposed to packed lunches). Variations were apparent, however; for example, at School B, the majority of the younger children in reception and key stage 1 chose a school lunch (86%), whereas in KS2, less than half of the children chose school lunches (49%). This reflects the UIFSM provision, nevertheless, across all schools, for some of the children who qualify for free school meals, their parents opted for them to bring packed lunches as opposed to a school lunch. Most children (70%) who had a school lunch used a classroom whiteboard or tablet during morning registration to select their school lunch option . Further, there was a higher number of remote selections for younger pupils  compared to other year groups. Across all schools, differences in how children chose a school lunch from the OPS were observed. Some children were fully independent when making food selections,  whereas other children received help from their parents or teachers. Generally, and as may be expected, the differences observed appeared to relate to children’s ages. More independent food selection was observed with older children in Years 4–6 (8–11 years), whereas younger children (4–8 years) were typically supported by their parents or teachers. Parental management of lunch selection was especially apparent in the Reception classes, where all the children chose their meals with a teacher’s or parent’s help. In some cases, parents were observed reading aloud specific options on offer that day and describing or explaining the menu to children. The extent of parental interaction over menu options varied, with the potential influence exemplified by one case when a child asked their parent, ‘What’s the green meal?’, the parent said, ‘It’s not very nice’. In another example, after a child chose a cheese sandwich, the parent responded, ‘But you had a cheese sandwich last night!’. In other cases, parents reminded their son or daughter that they were familiar with and ‘knew’ some options, to prompt them to choose specific meals, or provided encouragement such as ‘You’ll like that’. Whilst some parents engaged and involved their children in selecting the school lunch option, in contrast, some parents quickly read through the options available that day and chose on behalf of their children. The level of control exercised by parents varied, and in one instance, a parent changed the child’s meal choice on the OPS, but when the parent left the classroom, the child went back to the board and changed it back. Throughout all classes, there were a few instances of children needing help, for example, due to learning difficulties, or blurred screen on the whiteboard with unclear menu options. The relevance of peer influence was also evident during the observation. For example, school food selections were a topic of conversation among some children as they discussed what they wanted to eat and asked each other about their choices. Interestingly, across all classes, cases of peers influencing children’s choices were observed. This included, for example, children keen to see what their peers chose and allowing them to choose first or asking them about their choice, before then making theirs based on their friend’s (imitation of peers). In a minority of cases, children asked their friends to choose a meal for them if they were close to the board. In all schools, pupils entered the dining areas by year group (Reception to Year 6). Children received the school lunch that they had pre-ordered during registration that morning, or that had been pre-ordered remotely (outside school) by their parents or themselves. The school lunch included vegetable side dishes for pupils with a meat/fish-based/vegetarian meal. At all schools, there was also a separate salad bar where children could select and help themselves to salad items  and a separate table for desserts which held the one/two dessert options for the day .The importance of catering staff and in particular their interaction with children was apparent in the observations. Catering staff asked children about, for example, their choice of vegetable side dishes, and used verbal encouragement, such as ‘great choice’ or ‘good choice’. Sometimes, older children were asked about their portion size, e.g., if they would like more food or more sides. At the end of lunch, when pupils would bin their leftover food in the food waste bin, catering staff would, on occasion, encourage children to consume more of their lunch if they noticed that most was uneaten. A total of 125 parents completed the questionnaire in full, and n = 81, 65%) reported their children always had a school lunch, with the remainder taking a packed lunch . More younger children  had school lunches than older children , and to examine the relationship between the type of lunch and key stage, Fisher’s exact tests were conducted. These indicated that there was a significant moderate association between the type of lunch and key stage,  = 17.99, p < 0.001, Cramer’s V = 0.38); this reflects the Universal Infant Free School Meal programme for pupils in Reception and key stage 1. Most respondents  reporting their children enjoying them, and more than three quarters of parents (76%) reporting their children to be happy with the amount of food. Parents also reported that they were happy themselves with their child’s school lunch (89%) and the variety of food on the school menu (78%). Two-thirds, however, would prefer the school lunch menu to include healthier options (67%). Ultimately however, most parents (91%) would not prefer their child to have a packed lunch instead. 2  = 9.10, p = 0.026, Cramer’s V = 0.33 and χ2  = 6.92, p = 0.034, Cramer’s V = 0.30, respectively), with a moderate effect size.When asked about the reasons for their children having a school lunch, most parents thought it was ‘very important’ for their children to have a hot school lunch (62%), to have a healthy school lunch (58%), to have a freshly prepared school lunch (53%), and to have something different to eat each day (51%). Particularly for parents of younger children (R & KS1), value for money and a freshly prepared school lunch were important  with a significant association between responses and key stage  = 29.73, p = 0.007, Cramer’s V = 0.33) with a moderate effect size. In Schools A and B where parents and children could choose a school meal option remotely via an online account (as well as by using the boards in the classroom), many parents  reported choosing meals remotely using a device . This was not evident in the observation where most children chose their school lunch at school.More than half of parents whose children had a school lunch  reported that their child chose their own school lunch option, and most of these parents preferred their children to do so . More children in Years 2 and 3  chose their own lunch option, compared to other year groups (range 33–50%), and there was a significant association between year group and who chose the lunch option from the school menu  = 15.10, p = 0.008, Cramer’s V = 0.42) with a medium effect size.Regarding the school lunch options, more parents of R & KS1 children liked their children to eat a mix of meals (30%) or a meat/fish-based meal (13%) compared to parents of KS2 children . More KS2 parents (13%) also did not mind about the option chosen compared to R & KS1 parents (4%). Overall, there was a significant association between key stage and parents’ preferred meal options,  = 13.55, p = 0.027, Cramer’s V = 0.42). A minority of R & KS1 parents (10%) reported that ‘What my child’s friends choose’ is important to their children (no KS2 parents chose this reason), and a significant association with key stage was observed with a small effect size  = 5.72, p = 0.020, Cramer’s V = 0.26). Parents were also asked about the reasons that a specific lunch option is chosen . Most pa2  =12.89, p = 0.034, Cramer’s V = 0.40).Parents were asked about what might help their children to choose a different school lunch option from the school menu. Almost half (49%) of all parents felt that encouragement from themselves, more education on the importance of eating a variety of foods (40%), a photo of the food on the menu (35%), and children growing/cooking their own food were important (34%). There were 151 free text comments made by parents in response to open-ended questions. Analysis of the comments revealed three main themes, with component subthemes .Wanting children to eat betterWhile a few parents were ‘happy with my child’s diet’, many referred to wanting their children to ‘eat better’ or ‘eat healthier’. Specifically, parents commented about wanting their children to have a greater variety of foods, to try new foods (particularly fruit and vegetables), and to consume less sugar.‘I want my son to have a more varied diet. I would like to be able to offer a more interesting range of things to my child! He eats nothing!’(Reception parent)A few parents referred to their children as being ‘fussy’ or ‘picky eaters’, and wanting them ‘not to be so fussy and try new things’. Parents generally referred to wanting their children to try new foods and be ‘more adventurous’, particularly with fruit and vegetables, which was also highlighted by a few parents as a food group that they would like their children ‘to try a broader range of’.‘A greater variety of vegetable and willing to eat or try new things so the whole family could eat a more varied diet’(Reception parent)‘More fruit and vegetable, and would like him to have a more adventurous palate’(Year 1 parent)‘I would love for my son to trust food more and be less cautious. I wish my child would try new things’(Reception parent)reduce sugary foods such as Apple juice’ (Year 6 parent) in relation to improving children’s diets.Some parents also referred to wanting their children to ‘Children choosing school lunchTrust children to choose their school lunch’. The most striking comments related to giving children independence or control when choosing their school lunches.Overall, almost a quarter of comments related to children choosing their lunch and were positive, for example, relating to being able to ‘‘I think it’s important for them to be independent and she [daughter] always chooses different things to eat’(Reception parent)Other parents mentioned that their children preferred to choose by themselves from the school menu. ‘He [son] likes when he is given (a) few options and he can choose his favourite’(Year 2 parent)Parents also confirmed the value in their children choosing the school lunch from the school menu. ‘He [son] knows what he likes better than I do. If I chose for him, he would not eat it’(Year 3 parent)Improving the school lunchWanting improvements to the school lunch was also noted, this included more varied options, the ‘quality’, and portion size. Some parents commented on adding more varied options to the school menu.‘I would like to see a wider range of foods as the same meals appear on the menu too often’(Year 6 parent)Parents also suggested improving the quality of the school lunch and mentioned that vegetables can be overcooked ‘soggy’ or ‘like mush’.‘The quality is pretty poor, for instance over cooked vegetables’(Year 3 parent)Other parents referred to a need to increase school lunch portion sizes as their children are hungry when they arrive home from school. ‘Sometimes the portions are a bit small so he can come home very hungry!’(Year 3 parent)‘The portion of food may not be enough for most of the children as they are seemed to be starving after school’(Reception parent)This study revealed insights into online pre-order systems in primary schools, specifically, how pupils interacted with others when choosing their school lunch, differences in the food choice process, as well as how menu options were displayed. The analyses also highlighted parents’ perspectives on their children as decision makers when it came to choosing the school lunches–with many parents preferring this. Further, comments from parents cited children’s independence when choosing school lunches as a part of the independence of growing older. Findings from the observation indicated that most children chose their school lunch during morning registration. The role of children in food decisions corresponds with previous research, which has highlighted children’s influence on food at home ,43,44, fIn this study, distinct differences between older and younger children were found. This related to how children themselves were observed to select their school lunches, as well as parents’ perspectives of their children. For example, younger children tended to need support in choosing their lunches; this is as might be expected and consistent with, for example, their younger age and relative literacy skills. Their reliance on others, however, introduced the potential influence of their parents or teachers. There also appeared to be a continuum of parental support and control . More parents of KS2 children reported not minding which school lunch option their child chose compared to parents with younger children, pointing to a loosening of parental control over food choice with age. Likewise, whilst only a minority of pupils had lunches that had been selected remotely (outside school), a greater number of remote selections was evident for younger pupils—this may be a reflection of parents’ greater input/level of responsibility. A previous study on the perspectives of parents and children (5–12 years) found that, generally, with out of home food choice, children exerted the most control over the final food and that parental input depended upon the child’s age, with younger children being given less control to choose their food . Other wIn the present study, parents with younger children held whether their children’s friends chose a meal as an important factor for their children choosing a specific lunch option. This supported findings from the observation where incidences of peers influencing children’s choices were evident. This concurs with previous Australian research which found that parents considered peers to be an important influence on children’s food preferences and intake . LikewisThe influence of parents and peers and the related social aspects are relevant to the Socio-ecological Model , along wThe direct observation of children’s food selections was useful in capturing children’s behaviour in the school environment. As well as providing a basic understanding of the practical aspects of how children are interacting with the OPS, it also provided insights into how children choose what to eat at school, and the potential of others affecting their choices within the school environment. This study is unique in that it observed the pre-ordering within a school environment, and also demonstrates the utility of the observational method for examining children’s food choices and environmental effects that influence them. Previous research has captured children’s food selections at schools by recording the food components on children’s trays , and frun = 2714 children, aged 5–12 years) and found these to be effective in improving food selection [With OPSs, particularly with pre-selection at school, it is proposed that children themselves are likely to be making their choices. This highlights the importance of the presentation of options on the digital screens, and also the relevance of others influencing them . Indeed, the results of the observation indicated that children interacted with the OPS and the offering of school meals on the boards. The extent to which the OPS influenced the selection by children, however, is unclear. Given the relevance of the framing of food choice, factors related to how the food options are presented , i.e., the choice architecture , within election . Anotherelection .It is clear that there are opportunities with OPSs and, more generally, with pre-ordering school lunches. Potential disadvantages, however, should not be overlooked. A previous study on UK employees who used a pre-ordering website to select their lunches found that participants valued seeing the foods before selecting and some reported that not being able to view the foods on offer was a weakness of pre-ordering . It is uLimitations of this study should be acknowledged, including the limited number of schools, all within the same local authority. The observation form was specifically developed for this study, however, it may not have captured all pertinent information. Likewise, data collected during observation were limited and subject to interactions happening around the researcher. Additionally, although researchers strived for discretion, the researchers’ presence may have affected how pupils chose their school lunches. Parents self-selected for the questionnaire and sample bias should be acknowledged as a limitation, as well as the relatively low number of responses. When considering findings, attention should be paid to the schools’ characteristics , and further studies to examine other schools (including those with pupils from different socio-economic backgrounds) would be valuable, especially given the anticipated rise in the use of OPSs in primary schools. Pupils using an online pre-order system were observed to be the primary decision makers when choosing their options for school meals. Differences in levels of external control and influence were evident and these generally varied according to age. Online pre-order systems offer the potential of intervention, including targeted and age-differentiated strategies, to influence food choice and promote specific or different meal options from the school menu. They also provide valuable food choice datasets for the exploration of children’s meal choices.


This commentary offers a response to the call to improve family planning language that describes “need” and “demand” and proposes a set of recommendations to add precision, improve measurement, and foster shared understanding in family planning. Speizer et al.See related article by GHSP, 2 terms, in particular, are frequently misused and misinterpreted: “demand” and “need.” Speizer et. al.Jargon—the specialized language used by people in the same work or profession—is only communicative if the people working in that profession have a common understanding of its meaning. As with most fields, family planning (FP) has its share of jargon and its own debates about the meaning of various pieces of jargon. As Speizer et al.,One of the initial areas of confusion in FP jargon is the field’s frequent use of economic terms. Borrowed language includes “desire,” “want,” “need,” and “demand.” According to many economists,One of the initial areas of confusion in FP jargon is the field’s frequent use of economic terms.BOX 1Desire: A wish.Want: A nonessential desire.Need: An essential desire, a necessity, essential for life.Demand: Desire plus ability and willingness to enact that desire.Also crucial is having a shared definition of “family planning.” FP generally supports the goal that anyone and everyone who has a desire to avoid pregnancy can be protected by voluntary, safe, and effective contraception . FP is aBOX 2Family planning: The services, policies, information, attitudes, practices, and commodities, including contraceptives, that give individuals who desire to avoid pregnancy the ability to do so.a Adapted from Starbird et al.Because FP is focused on meeting the pregnancy prevention needs of individuals who desire to limit or avoid pregnancy, FP aims to transform need into demand. In this context, “demand” means that individuals who express the need to prevent pregnancy are willing and able to achieve that need, typically by using modern contraceptive methods. FP then sets out to meet demand with adequate supply .Reflecting on definitions and meanings, using the term “need” here, rather than “want,” represents an important linguistic nuance. The need to avoid unwanted or unplanned pregnancy is essential. An individual’s ability to prevent pregnancy is not something “nice to have,” it is necessary—necessary for health, empowerment, education, wealth, and beyond.In addition to the need and demand to prevent pregnancy, there are other types of desires, wants, needs, and demands related to FP, including demand to have reproductive autonomy, to use contraception, and to choose a specific contraceptive method . These vBOX 3Desire/Demand for Reproductive Autonomy: “Having the power to decide and control contraceptive use, pregnancy, and childbearing. For example, people with reproductive autonomy can control whether and when to become pregnant, whether and when to use contraception, which method to use, and whether and when to continue a pregnancy.”Desire/Demand to Delay or Limit Pregnancy: In the case of desire, it is an individual’s stated preference to avoid pregnancy/childbearing in the near-term  and/or long-term . An individual’s desire to limit or delay pregnancy transforms into demand when the individual is willing and able to enact that desire—through prolonged abstinence, breastfeeding, or contraception .aDesire/Demand for Contraception: Similar to, but not to be confused with “demand for family planning,”b this concept refers to an individual’s desire to use a method or device that prevents pregnancy. Desire becomes demand when that individual is willing and able to use contraception.Desire/Demand for a Specific Contraceptive Method: An individual’s desire for a specific contraceptive method. An individual’s desire transforms into demand when that individual is willing and able to use their preferred method.a Abortion serves to limit or delay childbearing but does not delay or limit pregnancy. If the focus were on the demand to delay or limit childbearing, rather than demand to delay or limit pregnancy, abortion would be included in this list.b “Demand for family planning” is a common family planning indicator. It is defined as the sum of (a) the number of women of reproductive age who are currently using (or whose partner is currently using) contraception and (b) the number of women of reproductive age who are classified as having unmet need for family planning.FP measurement usually categorizes an individual’s fertility desires as a binary . This concept is typically measured through direct questions to individuals about their fertility desires. For example, the Demographic and Health Surveys Program asks women aged 15–49 years, “Would you like to have (a/another) child, or would you prefer not to have any (more) children?” and “How long would you like to wait from now before the birth of (a/another) child?”,FP characterizes individuals who express the need to limit or delay pregnancy, but who are lacking the willingness and/or ability to enact that need as having “unmet need for family planning” and having “demand for family planning.” These characterizations have several problems. First, “unmet need for family planning” is a misnomer. Based on a literal interpretation of needs expressed by individuals, the accurate framing is “unmet need for pregnancy prevention.” Second, the need for pregnancy prevention is not equivalent to the need for contraception. For example, pregnancy prevention methods include not only contraception  but also prolonged abstinence and breastfeeding, however, FP characterizes individuals who are using prolonged abstinence or breastfeeding to prevent pregnancy as having “unmet need for family planning.”FP assumes everyone who is using contraception has “met demand for family planning.” This assumption also has several problems. First, not all contraceptive users are using them for FP purposes. For example, individuals may demand contraception for nonpregnancy-related reasons, including to protect against sexually transmitted infections and/or for other health-related reasons, such as to reduce the severity of menstrual-related cramping and bleeding. Second, some individuals may be contraceptive users despite wanting to become pregnant. For example, individuals who have been unable to access implant removal services would be captured as having “met demand” when, in fact, they have no demand for contraception and their reproductive autonomy has been curtailed. Finally, some individuals may be dissatisfied with their contraceptive method. These individuals would be classified as having “met demand for family planning,” without regard to their desire for other contraceptive method(s).FP tends to conflate these 4 types of desires and demands, which creates some challenges for the field, especially for indicator development and measurement.Ideally, the FP field would aim to measure and understand all 4 types of interrelated, yet distinct desires, wants, needs, and demands. This requires more indicators that are more precise, which requires more complex data collection. To start, FP measurement can focus on answering a set of questions  and deveIdeally, the FP field would aim to measure and understand all 4 types of interrelated, yet distinct desires, wants, needs, and demands.By using shared definitions, recognizing a common demand typology, and addressing known measurement issues (language and beyond), FP can recapture shared meaning, understanding, and purpose. FP jargon can once again be communicative rather than obscuring.


We evaluated animal-based biomedical ‘breakthroughs’ reported in the UK national press in 1995 (25 years prior to the conclusion of this study). Based on evidence of overspeculative reporting of biomedical research in other areas , we specifically examined animal research in the media, asking, ‘In a given year, what proportion of animal research “breakthroughs”’ published in the UK national press had translated, more than 20 years later, to approved interventions?’We searched the Nexis media database (LexisNexis.com) for animal-based biomedical reports in the UK national press. The only restrictions were that the intervention should be specific, such as a named drug, gene, biomedical pathway, to facilitate follow-up, and that there should be claims of some clinical promise.Were any interventions approved for human use? If so, when and by which agency? If not, why, and how far did development proceed? Were any other, directly related interventions approved? Did any of the reports overstate human relevance?Overspeculation and exaggeration of human relevance was evident in all the articles examined. Of 27 unique published ‘breakthroughs’, only one had clearly resulted in human benefit. Twenty were classified as failures, three were inconclusive and three were partially successful.The results of animal-based preclinical research studies are commonly overstated in media reports, to prematurely imply often-imminent ‘breakthroughs’ relevant to human medicine. This study investigates exaggeration in the media of the significance and human relevance of animal research.The study focuses on articles in the UK national press in a particular year, and specifically follows up the fate of forecasted ‘breakthroughs’, to see if they had resulted in human benefit >20 years later.This study was comprehensive, objective and detailed.Significant research was conducted for each media-reported breakthrough, and all its findings have been made available in this report.One limitation is that the focus was on one calendar year (1995).However, there is no reason to believe that analyses of other years would lead to significantly different conclusions, with regard to the overspeculation and overstatement of potential human benefits from animal-based research in the media.et alet alAnimal experiments remain controversial, with issues including the welfare of the animals involved, and the questionable human relevance of animal data.et al11Exaggeration of animal-based findings has also been noted in online and other media. Haneef et alet al15Exaggeration is also evident in scientific publications. Contopoulos-Ioannidis In summary, in the past approximately 15 years, various efforts have been made to assess the outcomes and human benefits of scientific breakthroughs, and how accurately and speculatively these were reported. Overstatement, overspeculation and exaggeration were highly prevalent. We sought to explore these issues further, and uniquely, by examining reports of animal-based biomedical ‘breakthroughs’ in UK national newspapers in 1995, 25 years prior to the conclusion of this study in 2020. Our aim was to determine whether any of these biomedical ‘breakthroughs’ had resulted in clinical benefit, and to what degree their clinical impact had been exaggerated. This period provides ample time for the apparent ‘breakthroughs’ to be developed, tested and ultimately translated into clinical benefit, and is a similar time span to that used in a comparable study.only mechanisms of action, pathophysiology or diagnosis, or in which the intervention was not of a specific named procedure or compound, or was not speculated to be associated with a specific gene/molecule/pathway, were excluded. For each report, the associated academic publication(s) were obtained, where available, and as much of the following data that were available were extracted: title, news media source, publishing journal, date of publication, author name(s), PubMed ID and links, animal species and numbers used, intervention, preventive/therapeutic in nature, expected clinical benefit and years to expected benefit, relevant text and summary of findings, disease in question, institution, funding body, harms to animals, any salient quotes from authors, any obvious related material, etc.The ‘Nexis’ database is an archive of more than 40 000 information sources of various types, including news content, provided by the international company, LexisNexis (lexisnexis.com). Media sources were selected to include ‘UK national newspapers’, in the calendar year 1995. The search strategy involved selecting the ‘Medical research’ index term, then adding the following animal terms to identify news items based on animal research: ‘animal OR mouse OR mice OR rodent OR rat OR dog OR cat OR monkey OR primate OR guinea pig OR rabbit’. Articles that did not describe a clear, direct clinical promise, or that described a non-clinical application , or that described To investigate whether clinical benefit transpired within 20-plus years, the following websites and sources were consulted: PubMed, the European Medicines Agency, the UK Medicines and Healthcare Regulatory Agency, the US Food and Drug Administration (FDA), clinicaltrials.gov, Medscape.com, the National Institute for Health and Care Excellence, the British National Formulary, Centers for Disease Control and Prevention, the WHO and the US National Library of Medicine’s TOXNET. Data obtained from thorough searches of these sources were collated, and used to determine the outcome of each ‘breakthrough’ with regard to any further studies that were conducted; whether these were human, animal or both; if clinical trials were conducted, and what the results of these were with respect to efficacy and adverse drug reactions; if the drug/intervention reached the market, and if so, if it had been relabelled or recalled. Based on the above, a decision was made, in consultation with colleagues, about whether the 1995 media report had been accurate in reporting the research as a ‘breakthrough’. For clarity: if the intervention in question had not been approved at the time of writing, >20 years after the media report, it was classified as ‘failed’. Some were classified as a ‘partial success’, if, for example, use was restricted clinically and/or geographically; any use was specific to particular, rather than general, circumstances ; an approved therapy was of questionable efficacy; evidence from other, non-animal research data (including human data) suggested the animal data were not crucial to the ‘breakthrough’; there was an indirect relation between the ‘breakthrough’ and the successful intervention; there was questionable clinical relevance of the animal data and so on.The initial search produced 229 articles, and the removal of 16 duplicates left 213 for consideration according to the selection criteria. Forty individual articles  met these inclusion criteria. Some of these breakthroughs were (not surprisingly) reported in more than one article: grouping duplicates together resulted in 27 unique ‘breakthroughs’. These involved a variety of diseases, conditions and biomedical areas, including HIV/AIDS, malaria, allergies, Alzheimer’s disease (AD), multiple sclerosis, deafness, cancers, obesity, pain, organ transplantation, ageing and others. Each newspaper article reporting breakthroughs in these areas contained speculative claims, from scientists undertaking the research, as well as from the reporters and others involved: in other words, overstatement of the potential relevance of the breakthroughs came from scientists as well as the journalists involved. These are some of the more speculative examples, to illustrate what was found. With regard to an anti-allergy vaccination, ‘This is potentially one of the biggest-selling drugs ever…the company estimates that the vaccine will be available in the UK in five years’. In cancer gene therapy, ‘It is hoped that by giving the correct version of the gene to lung cancer patients, normal apoptosis will resume and the tumours will shrink. Experiments carried out on animals are encouraging’. With regard to obesity treatments, ‘There seems no doubt that this new technology will appear: the only question is when…within a few years a fat reducing injection could make liposuction a thing of the past…the fact that it has been seen to work in several animal species shows that it is very likely to work in humans, too’, and ‘This is a major breakthrough in obesity research…We have every reason to believe this could become a treatment for obesity in humans’. In organ transplantation, ‘The first organ transplants from pigs to humans are expected to begin next year in a move that could signal an end to the global shortage of human donors…rejection problems involved in xenotransplantation are being solved’, and in ageing research, “Researchers have discovered a natural hormone produced by the body that could delay the effects of ageing…the hormone could help to defer such characteristic problems of old age as wrinkles, muscle fatigue, rheumatism, bone fragility, memory loss and some cancers…the results so far in animals had been “spectacular”’.These examples—one from each of the main classifications —are included here, to illustrate the detailed and comprehensive investigation and follow-up conducted by the authors, to ensure that the classifications are as accurate as possible. They were selected subjectively by the authors, as being particularly illustrative and of interest.11. Mending broken bones with injectable ‘Skeletal Repair System’—Succeeded (with caveats)The Times, April 25 1995Cast Away Your Plaster Cast—The Times reported the development of an injectable paste that can be introduced—‘like toothpaste’—into broken or fractured bones, or bones affected by osteoporosis.This bone substitute—Skeletal Repair System (SRS)—was invented by Norian Corporation (USA). It was not the first bone substitute intended to replace metal implants, but was claimed to be a better match for real bone than anything that had gone before it.Science, stating ‘Experiments with animals have given good results, and the first tests on human patients…have produced good repairs of broken wrists’.The report cited a paper in The Times report, between 1996 and 2000,A 2003 paper discussing the background to SRSMore recently (2012–2013): Ozer and Chung28The Times article and the associated paper.29A 2010 meta-analysis noted bone cements were first introduced in ceramic form in 1992not been approved for use in certain spinal surgeries, such as the treatment of vertebral compression fractures—a common consequence of osteoporosis. This was due to concerns over Norian cement leaking into blood vessels—numerous in the spine—which, it was known, could cause blood clotting, with severe or lethal consequences.Norian was bought by Synthes in 1999, when SRS had been approved for use in the arm, and another version, Craniofacial Repair System (CRS), for use in the skull. Ten years later, Synthes was accused of ‘running illegal clinical trials—essentially, experimenting on humans’. They had mixed SRS with barium sulphate, in a new formulation known as XR, to facilitate visualisation on X-rays. Although XR had been approved by the US FDA in 2002, it had expressly In 2009, Norian wanted to begin using a new formulation—XR—in spinal surgeries, as they considered it would be lucrative, but the US FDA ordered them to conduct lengthy and expensive clinical trials. Instead, they persuaded ‘a few sites’ to perform 60–80 human procedures and publish the results—quicker and cheaper, but at least five people died. This had taken place despite data highlighting its risk: small amounts of XR had caused human blood to form clots in test tubes, suggesting blood vessels in patients’ hearts or lungs could also be blocked. In addition, the injection of XR into a pig’s vein had caused clots in its lungs that killed it within seconds. The company pleaded guilty to dozens of felonies and misdemeanours, was fined US$23 million, and four of its executives were imprisoned.It must be concluded, therefore, that even though SRS was approved for human use, the animal data did not predict many of the major complications of SRS use that were revealed by research with humans. While SRS remains in use, it is used with caution and only for particular purposes, and certain caveats must be borne in mind—all as a result of human studies.16b, 19 and 30. Treatment for Alzheimer’s Disease with Extract of Daffodils —Partly successful, with caveatsThe Independent, May 23 1995Try a little flower power; Long dismissed as unscientific, plants are making a pharmaceutical comeback, says Roger Dobson—The Times, June 12 1995The Brain’s Messenger—The Independent, September 3 1995Drug Hopes Rest on a Host of Daffodils; A Bulb Extract May Alleviate Alzheimer's - and Boost East Anglia Growers—The Independent briefly discussed the progression of galanthamine into clinical trials, which had reached phase III, involving 560 patients across Europe.An extract of daffodil and snowdrop bulbs was proposed to slow the progress of AD. Brain-damaged rats, deficient in the neurotransmitter acetylcholine (ACh), showed a slower rate of learning to navigate through water mazes. This is consistent with poorer memory in patients with AD, whose brains show a deficiency in ACh, although there remains controversy over whether this is cause or effect. Rats genetically modified (GM) with cells that replaced the lost ACh could navigate mazes better than those who had not: ACh replacement appeared to restore memory function and learning deficits. It was hoped that this would lead to drugs designed to halt the decline of ACh associated with AD. However, a drug to do this was already in clinical trials , and another—Tacrine—had already been licensed in some countries. A subsequent article in proved that regional ACh is causally required for learning and memory’. Furthermore, drugs to address this issue were already in use and in clinical development, so in no way could have depended on these particular animal experiments. This was tacitly acknowledged by the authors.The paper described how rats had their brains damaged via direct injections of ibotenic acid, causing ‘permanently and selectively damaged learning and memory’.It is worth examining the path of galanthamine to clinical trials, particularly for the contribution (or lack of) of animal experiments. It was discovered accidentally in the early 1950s, and used for various purposes since then, including nerve pain, polio and in anaesthesiology.There was extensive, promising, human research preceding the 1995 ‘breakthrough’, in both patients with AD and healthy volunteers.Clinical development progressed throughout the 1990s; and it was first licensed for AD treatment in 2000 in Iceland, Ireland, Sweden and the UK, followed by the USA and other countries in the early 2000s. There have been significant issues, however. While some trials showed it to be well tolerated and to improve cognitive function in patients with AD,47In summary, there was substantial, significant weight of evidence of the role and ACh in AD prior to the 1995 rat experiments; much of this was human specific and much of this was acknowledged by the authors themselves. Drugs targeting this pathway were already in clinical development, and so it cannot be claimed that galanthamine development depended on animal research—and certainly not on this particular research—due to the extensive human data relating to it, which go back hundreds of years, and which include detailed pharmacodynamic and pharmacokinetic data preceding 1995. Human trials are still ongoing, and it is they that will clarify issues regarding safety and efficacy.23b, 31, 32, 33. Genetically modified pig organs will successfully address the shortage of organs for human transplant—FailedDaily Mail, July 28 1995 Could these mice help women to look like this; forget that diet: a daily jab may soon be enough—The Times, September 14 1995Pig Hearts Could End Fatal Lack of Transplant Organs—Daily Mail, September 14 1995The moral implications of animal transplants will disturb many. But an eminent Cambridge don says we should rejoice; ‘Pigs will be tailored for each of us so we have organs for emergencies. Godparents may give children their own pigs, bred on a scientific farm’—The Independent, September 17 1995Pioneer spurned by Britain—The Times reported the expected commencement of clinical trials of pig-to-human organ transplants—xenotransplantation (XTP).In the main article, These trials would be based on experiments in which hearts from GM pigs survived for up to 60 days in monkeys who had received transplants, supported by immunosuppressive drugs to help prevent rejection—a perennial issue with organ transplantation, but particularly with transplantation between different species. The article was optimistic: the director of the company directing the experiments, Imutran, claimed ‘a big hurdle in the development of transplants between species known as xenotransplantation had been overcome’; ‘the rejection problems involved in xenotransplantation are being solved’ and that they had ‘found a way to trick the immune system of a primate into accepting a pig organ’, while the director of transplant services at Papworth Hospital stated, “If progress continues the way it is, we intend to start human clinical trials in 1996”', and that it would be at least 5 years before animal transplants were generally available. At the same time, the article noted the urgent need for organs for transplantation, stating that ‘The first organ transplants from pigs to humans are expected to begin next year in a move that could signal an end to the global shortage of human donors’, and ‘If successful, the technique could open up the prospect of animal transplants to thousands more patients who are denied treatment because of a shortage of human organs’.Nature carried an associated report.sic) the timeframe of our experiments”.A paper in Building on this: GM pigs were created, with genes for two regulators of complement activity.54Additionally, issues with the transfer of pathogenic microorganisms from the donor pigs to organ recipients continue, despite significant efforts to combat them. Other variables affecting survival include immune suppression, donor genetics, recipient species , viral status, the level of pre-existing antipig antibody, prophylactic antiviral and antibacterial therapy and postoperative care.55Ongoing work towards human trials centres around increasing ‘tolerance’ via multiple genetic modifications of pigs, targeting the many (and increasing) antigens involved in organ rejection. The current level of immunosuppression required to prolong survival post-XTP is still unacceptably high, and so even greater genetic modification of pig donors is necessary.55It therefore must be asked; how much genetic modification might permit an adequate level of survival? And, even if it were possible, could it ever be enough? This may be illustrated by the identification of another crucial antigen involved in rejection, B4GALNT2.58 59The Times, two other articles were printed. One in the Daily Mail was an overly speculative positive spin on results from Imutran, in which quotes illustrated comprehensively the issue of exaggeration and embellishment. The other, in The Independent, focused on why British venture capitalists failed to back Imutran, and was also replete with positive spin. In it, a major financial backer appreciated that ‘These things take between 6 and 10 years to mature’—but a quarter of a century later, we are still waiting.Within a few days of the article in Our analysis demonstrates that the relevance and impact of animal-based findings to human health are frequently overstated in the UK national press—findings that are consistent with similar reports of exaggeration in institutional press releases, online news, etc,61 62et al highlighted serious omissions in the way that research using animals is reported , recommending that authors should explicitly comment on limitations of animal data and their relevance to humans.et al examined publication bias in animal research, revealing that ‘negative’ animal results were rarely published, leading to a publication bias that ‘will impede the performance of valid literature syntheses’, as this invariably must lead to an inflated view of the success of animal studies.67Similar observations have also been made for publications in scientific journals (see ‘Introduction’).We found that only one of 27 original breakthroughs reported in the UK national press in 1995 had led unambiguously to clinical benefit >20 years later. This result carries more weight than it might have, because we made attempts, where no direct breakthrough was evident, to determine whether any related breakthroughs had resulted from the animal experiments, and if so, whether the animal research had been essential. Even if any of the six ‘breakthroughs’ currently classified as ‘inconclusive’ or a ‘partial success’ are reclassified as a success in the future, the degree of successful translation—and therefore exaggeration—are still disappointing, especially given the high ethical and economic costs of animal research.Classifying some of the ‘breakthroughs’, for example, as ‘partial successes’ or as ‘failures’, was not straightforward. Some areas of research had taken a related, but different, direction; some results effectively duplicated, or at least were strongly underpinned by, previous human research and/or animal research; some interventions had complex and changing nomenclatures; some were broad in nature ; some had gone on to clinical trials with unpublished results and so on.In terms of limitations, our study focused on one calendar year. While there may be some degree of variability from year to year with regard to the areas of animal research and the degree of the translation to human benefit reported in the media, we employed broad selection criteria, reflected in a wide variety of research topics, and are therefore confident that these particular aspects of our findings can be generalised. We accept that our analyses could not include animal research that was not expressly reported as animal research, that is, that was conveyed as if it already applied to humans. Our search strategy could not identify such reports, but it was not the aim of our work to do this; however, our goal was to examine research clearly done in animals, as reported in the UK national media.Our findings, along with the observations of the other authors cited, should encourage media reports of animal research ‘breakthroughs’ that forecast benefits to human health to be viewed with caution. This is of crucial importance, as widespread and high-profile dissemination of exaggerated and overspeculative claims will lead to general overconfidence among the public—as well as the research community—of animal research as an approach, and an overly optimistic assumption of eventual clinical benefits.


The outbreak of coronavirus has caused widespread global havoc, and the implementation of lockdown to contain the spread of the virus has caused increased levels of online healthcare services. Upgraded network technology gives birth to a new interface “telecare medicine information systems” in short TMIS. In this system, a user from a remote area and a server located at the hospital can establish a connection to share the necessary information between them. But, it is very clear that all the information is always being transmitted over a public channel. Chaotic map possesses a dynamic structure and it plays a very important role in the construction of a secure and efficient authentication protocols, but they are generally found vulnerable to identity-guess, password-guess, impersonation, and stolen smart-card. We have analyzed  and found that Bergamo’s attack (IEEE Trans Circ Syst 52(7):1382–1393, 2005) cannot be resisted by the protocol. Although few of the protocols ensures efficient computations but they cannot ensure an anonymous and secure communication. Therefore, we have proposed a secure and efficient chaotic map based authentication protocol that can be used in telecare medicine information system. This protocol supports verified session keys with only two messages of exchange. Moreover, we have analysed the performance of proposed protocol with relevant protocols and it is being implemented in “Automated Validation of Internet Security Protocols and Applications” respectively. The adoption of advanced health care “Telemedicne Information System” and “Telematics” applications in health care needs an integrated strategy to the different social, financial, cultural and political impacts and hurdles of information and communication technologies. Both security and privacy –39, 42 aPatients can be benefited with online health care services via their smart phones, i-pads, and other smart sensors, but their security and privacy are two very important components during communication on public channel. In 2012, Wu et al.  designedIn 2013, Lin et al.   observedIn the year 2016, Li et al.  designedIn the Table mentclass2pt{minimmentclass2pt{minimSimilarly, in the design , we haveSimilarly, in the design , we haveSimilarly, in the design , we havex that results from different x for each of the user. Now, the x will plays the role in place of master secret that is different for each of the user. Therefore, we have designed a new authentication protocol possessing both security and efficiency using the dynamic Chaos theory. The security of the presented scheme have been analyzed in random Oracle with this we also use the tool for authentication called “Automated Validation of Internet Security Protocols and Applications” respectively. Moreover, the presented protocol resists session key violation problem, that is proposed by Bergamo et al. [To handle the issues in , 25, 35,o et al.  and estaIn this section, we will discuss some of the basic notations, terminologies and basic properties of conformal Chaos maps used in the proposed protocol. A conformal map is an angle-preserving transformation that preserves local angles. A brief review of some of the useful notations are also given in Table As seen in Fig. A polynomial The set of Chebyshev polynomials on Chebyshev polynomials given in variable x is u such that y and x are known to the adversary. Then this problem is know as Discrete Logarithm Problem (DLP).If it is asked to find Computational Diffie-Hellman Problem (CDHP) can be stated to find I(.) and R(.). I(.) is a probabilistic algorithm that produced two strings R(.) is an algorithm that is used to regenerate the private key A fuzzy extractor registration-phase, (2) login-phase, (3) authentication-phase and (4) password-update-phase.After getting the information Finally, Using The choose If After receiving the information To update password At first, we have to define a framework Security-model Suppose the Extract: With the help of extract query, Sendm, to random oracle then in response of m, random oracle have to reply with a computational output.Hash(m): In this query m to H(.), then oracle select s, after storing it into hash list m. Initially RevealCorruptTestSuppose a bit b is selected from corrupt query phase and Chaotic based assumption: Suppose pneg(n) such that:Collision resistance attack(CRA) algorithm: If for h(.), CRA problem, together with Suppose CRA, At first, Hash query: When Extract: In extract query Send-queries: In send query there are three phases discussed as below, first Mo is supposed to reply a login message to Mo computes j, y and r is chosen arbitrarily, then check the equation AnalysisIf  If without any knowledge about privet key, CRA. As CRA problem The protocol is secured against chosen massage attack in RO model, if Chaotic discrete logarithm problem (CDLP) holds.mo that violates the discrete logarithm presumption based on the Chaotic map (CDLP), which implies that mo breaches the proposed system as well, which means Game 1: Suppose that Mo tries to breach the assumptions. Since CDLP says challenger can obtain Gen(.) algorithm and returns . It makes proposed scheme secure against privileged insider attack.Since in registration phase user If s. So above discussion suggest that proposed scheme is secure against impersonation attack.Again if y for every session in proposed scheme where session key depends upon y, with this we also use time stamp, to avoid this type of attacks. For every session, the timestamp is uniquely chosen. The timestamp uniqueness property limits the duplication of log-in messages. This indicates that the proposed system is responsive to replay attacks.Since we use different random number s is compromised, suggested scheme is secure. Because to create session key x and for this Even if long term secret key If any adversary If adversary get access to the smart card of a user and extract In this subsection, we simulate the scheme using “Automated Validation of Internet Security Protocols and Applications” in short AVISPA tool to analyse formal security  . We haveIn this section, we have analyzed the performance of the proposed protocol and the performance of the proposed protocol has been compared with the related chaotic map based authentication scheme in the Table We have analysed the performance of chaotic map based authentication protocols , 24, 25 or as in  with thiIn addition, Liu et al.  runs wit et al.  , at user et al.   at user  et al.  , at the  et al.   runs wit et al.   at user mentclass2pt{minimIn this article, we have considered the cost of communication in the form of hashing, chaotic operation, and time-stamp as 160-bits, and symmetric encryption outputs standard 256 bits, whereas total cost of communication is given in the Fig. This article provides a review on the security of recently proposed chaotic map based authentication protocol. The suggested design is free from most of the existing vulnerabilities such as password-guess, identity-guess, impersonations, replaying of messages, and stolen smart cards attacks and it also gives the idea how a poor verification results vulnerabilities. Furthermore, we have observed that the proposed design fulfills the requirement of session key verification in just two message exchange. In future, we can implement the protocol in vehicular communications, and digital rights management system etc.


Population aging will be one of humanity’s major challenges in the decades to come. In addition to focusing on the pathologies causing the greatest mortality and morbidity in this population, such as dementia, health research in elderly people must consider a myriad of other interlinked factors, such as geriatric syndromes, social aspects, and factors related to preserving quality of life and promoting healthy aging. This study aims to identify the main subject areas attracting research attention with regard to very old (≥ 80 years) populations.Documents assigned with the medical subject heading “Aged, 80 and over” were retrieved from MEDLINE and the Web of Science. This dataset was used to determine publication output by disease, geographic region, country, and discipline. A co-word analysis was undertaken to identify thematic research clusters.Since the mid-2000s, there has been a boom in scientific output focusing specifically on very old populations, especially in Europe (43.7% of the documents) but also in North America (30.5%) and Asia (26%); other regions made only nominal contributions (0.5 to 4.4%). The USA produced the most research, while the most growth over the study period occurred in Japan, Spain, and China. Four broad thematic clusters were identified: a) geriatric diseases, health services for the aged, and social and psychological issues of aging; b) cardiovascular diseases; c) neoplasms, and d) bacterial infections & anti-bacterial agents.Scientific research in very old populations covers a wide variety of interrelated topics. In quantitative terms, the top subject areas have to do with cardiovascular and cerebrovascular diseases , dementia, and neoplasms. However, other degenerative pathologies, geriatric syndromes, and different social and psychosocial aspects also attract considerable interest. It is necessary to promote more equal participation in global research on pathologies and topics related to very elderly populations, as the highest rates of population aging and the largest numbers of elderly people in the next decades will be in low- and middle-income countries.The online version contains supplementary material available at 10.1186/s12877-021-02209-7. The World Health Organization (WHO) estimates that the proportion of inhabitants aged over 60 years will double between 2000 and 2050, from 11 to 22% of the world population (roughly 2 billion people). The most significant rise, moreover, will be in the most elderly people, with the proportion of octogenarians quadrupling in the same period of time, reaching a figure of 395 million people. About 80% of older people will be in low- and middle-income countries, which will experience the highest rates of population aging over the coming decades [Apart from the main causes of death  –4, olderDifferent bibliometric studies have taken “aging” as the topic of reference to analyze scientific literature, which has considered this variable in association with “healthy aging,” a concept describing optimal physical, mental and social well-being –10. SomeIn very old populations, it is essential to consider these medical aspects hand in hand with social factors, including people’s family and living environment along with their overall well-being , 23. HowThe overarching aim of this study is to characterize international scientific research in very old people over the last two decades, identifying the main topics addressed in research and the geographic distribution of the resulting publications.The methods applied in the study followed the steps described below.Documents indexed in the MEDLINE database. The indicators obtained from this dataset enabled a general vision of the scientific output and subject areas in the biomedical literature with regard to this age group.Next, we generated a new dataset, excluding the retrieved documents that had also been assigned to other age groups  in order to specifically analyze the literature focusing exclusively on very old people, as a high number of publications jointly consider very old populations along with people from other age groups. Thus, epidemiological studies, basic research and other documents in which advanced age was not an exclusive key variable were excluded. To calculate the indicators, we opted to include only the documents in the Web of Science-Core Collection (WoS-CC). Although this database does not encompass all of the documents indexed in MEDLINE, it does offer some additional functionalities that are relevant to the study aims. For example, it classifies documents into areas of knowledge or disciplines, based on the subject area focus of the journals in which they were published. The WoS-CC also records all authors’ institutional affiliations and their corresponding countries, along with the number of citations that the documents receive. Figure We used the National Library of Medicine’s MeSH thesaurus to identify documents  that had been assigned the descriptor “Aged, 80 and over” (“a person 80 years of age and older”) between 2000 and 2019. The results comprised two groups of documents:Searches were undertaken using the Web of Science , which includes the MEDLINE database, on 24 June 2020.All bibliographic data were downloaded in order to review and standardize them prior to quantitative analysis. Multiple entries in some fields  were individualized, and information on authors’ countries was extracted based on institutional affiliations, unifying all documents assigned to Scotland, England, Wales, and Northern Ireland as originating in the UK.The WoS-CC databases include subject categories for both “Geriatrics & Gerontology” (in the case of the Science Citation Index Expanded (SCIE), which “includes the clinical, biochemical, histological, and psychological aspects of aging”) and “Gerontology,” linked to the Social Sciences Citation Index (SSCI) and covering “resources that are concerned with the sociological and psychological issues of aging.” For journals assigned to both categories, and generally for all journals assigned to more than one subject category, we made fractional assignments for the documents, proportional to the number of subject categories pertaining to the journal of publication.We analyzed the number of documents published per year and the frequency of the MeSH terms assigned to them, both for all documents retrieved and for the subset limited to the ≥80-year age group. With regard to the documents in the WoS-CC focusing exclusively on the very old population, we categorized them by geographic region , country , and thematic category of the publishing journals.To specifically identify the main subject areas attracting the most research attention, beyond the broader disciplines in which the documents were published, we carried out a co-word analysis to determine the frequency and co-occurrence of the MeSH terms assigned to them. First, a matrix was generated to quantify the joint appearances of 11,285 MeSH terms, and then a co-occurrence network was generated to show the relationships between high-frequency MeSH terms (> 30 documents). Next, to focus the analysis on the most relevant MeSH terms, we excluded from the analysis the generic descriptors referring to sex , epidemiological aspects, countries, diagnostic procedures and techniques, study designs, and statistical methods. Finally, Persson’s Party Clustering algorithm [As this was an analysis of available published research, no ethics approval was required. No authors were contacted for further information regarding their publications.We identified 707,175 documents that had been assigned the “Aged, 80 and over” descriptor in MEDLINE and 22,043 documents referring exclusively to this age group and published in journals included in the WoS-CC. The dataset included 16,383 articles (74.3%), 4456 letters (20.2%), 843 reviews (3.8%), and 361 proceedings papers (1.6%).The annual evolution in the number of documents published Fig.  shows thThe distribution of documents by geographic region Table  shows thWith regard to research participation by country Table , the USAThe analysis of disciplines in which the documents were published Table  reveals The co-word analysis of MeSH descriptors showed four prominent clusters, that bring together 77.5% of the documents, reflecting the main topic areas attracting the most research interest in relation to very old populations.Neurocognitive disorders , cognitive dysfunction, and depression all have a prominent presence in this cluster, as do descriptors referring to different tools for diagnosing dysfunctions, brain damage, and central nervous system disorders, and for assessing the severity of mental illnesses and measuring pain.Another area of research interest is fractures  caused by accidental falls. Papers focus on the procedures for their treatment, including orthopedic surgery using bone fixation devices to maintain proper fracture alignment.Numerous descriptors refer to the study of nutritional physiological phenomena associated with nutrient absorption and the assessment of nutritional status.The loss of skeletal muscle mass, especially in relation to sarcopenia, represents another specific area of research identified.Other descriptors have to do with the study of genetic factors associated with longevity, genetic predisposition, and conditions that can trigger the activation of disease.Finally, another thematic area concerns health services for the aged in the hospital setting as well as in institutional care and home care and social and psychological issues of aging.There is a heterogeneous cluster covering closely interrelated disorders and diseases that have a particularly strong impact on people of very advanced age (cluster A). The concepts are linked to diagnosis and treatment of the diseases as well as social and psychological aspects related to aging. The following topics stand out:Heart diseases. Different diseases and pathologies associated with heart valves and conditions linked to “myocardial ischemia” stand out among this cluster.Vascular diseases. This cluster also features different vascular diseases, like “aortic aneurysm,” both abdominal and thoracic; “iliac aneurysm”; and “carotid stenosis.”Cerebrovascular disorders. Finally, cerebrovascular disorders, especially “stroke” and “brain ischemia,” comprise a prominent area of study with its own specific lines of research.Another cluster with a high density of interlinking terminology revolves around heart diseases and the surgical procedures used to address them (cluster B).A large set of terms linked to neoplasms, tumors, and carcinomas make up another cluster (cluster C), in which aspects such as pharmacological and surgical treatments, biomarkers, and antineoplastic agents are considered. This cluster also shows a specific line of research into “anti- vascular endothelial growth factor A” as a strategy to limit the angiogenesis associated with the use of drugs like bevacizumab, for treating both different cancers and age-related macular degeneration.Management of infections associated with “staphylococcal infections,” “prosthesis-related infections,” “urinary tract infections,” “klebsiella infections,” “gram-positive bacterial infections,” and “endocarditis, bacterial” are the main research topics in this cluster (cluster D), which covers topics like the combination of drugs, the sensitivity of microbial tests, and bacterial resistance.Table Additional file Some descriptors for age-related pathologies are more likely to be associated with descriptors like “aged” (“a person 65 through 79 years of age”) than exclusively “aged, 80 and over,” so they do not appear in the clusters described above. This is the case of “diabetes mellitus,” “osteoporosis,” “pulmonary disease, chronic obstructive,” “depression,” and “Parkinson’s disease.” Some significant differences between men and women have also been observed for certain diseases , confirming the results reported by Serrano-Pozo et al. [n = 44; “Lewy Body Disease” n = 44; and negligible research in other pathologies) shows the need to promote research focusing on dementias other than Alzheimer’s in very old people. The scant research identified on “Frontotemporal dementia,” which is the second cause of dementia, is probably due to its earlier onset compared to Alzheimer’s [Alzheimer’s disease is positioned as the main entity studied in research on age-associated dementias  in people aged 80 years or older. Clinical manifestations include muscle weakness, fatigue, and slow motor performance, among others, and these are often accompanied by social vulnerability and dependence  along wiThe mingled impacts of different clinical and social factors underline why clinical research in very old people must necessarily take into account other social and technological considerations in order to reduce disease incidence and associated harms, both in patients and in their family members and caregivers . Our finMore recently, Shi et al.  studied The development of research in the area of fracture surgery is also notable, showing substantial growth over the past several years. Hip fractures are the most relevant surgical pathology in people of advanced age, due both to the high incidence and the potential for negative effects on quality of life, autonomy, and level of frailty in this collective. These impacts have driven important advances in areas like minimally invasive surgery and complex fracture management .n = 121 or “exercise therapy” n = 57). Efforts to promote the integration of investigators from these areas into research on the pathologies identified could be warranted. Physical activity in relation to aging constitutes an area of active research, as Müller et al. [The descriptors referring to nutrition underscore the relevance of diet in relation with preventive and therapeutic treatments in very old people, as well as for addressing the deterioration of nutrition associated with factors like difficulty swallowing, loss of appetite, and reduced access to healthy diet . Conversr et al.  draw attTwo prominent research clusters, focused on pathologies that are not specifically associated with very old populations, are devoted to cardiovascular diseases and neoplasms. Coronary artery disease and stroke, in particular, are the main causes of death worldwide and in all regions except Africa, explaining the importance of these areas in research .Other cardiovascular diseases studied in very old patients are aneurysms and myocardial infarction, which follow stroke as the top cardiovascular diseases studied in this population. The rising prevalence of these diseases , along wLikewise, a substantial body of research revolves around rehabilitation and patients’ adaptation to their new health state and living conditions following a cardiovascular event. Chow et al.  points oThe presence of lung and colorectal cancer in the cluster on neoplasms responds to the fact that these are among the cancers causing the highest mortality in very old people , 4. On tThe cluster on neoplasms also includes an important line of research on anti-vascular endothelial growth factor A (anti-VEGF) treatments, both for different cancers and for age-related macular degeneration. Although the latter is not a neoplasm, it is the primary cause of vision loss in old people and is mediated by VEGF. In any case, there are still many unanswered questions along this research stream, for example related to the best anti-VEGF medications or the identification of biomarkers that would enable better assessment of treatment efficacy .Klebsiella spp., in very old people [Finally, the cluster around bacterial infections and anti-bacterial agents shows the importance of clinical entities like urinary tract infections and infections associated with the implantation of prostheses, especially those caused by staphylococci and d people . Urinaryd people —are the d people , and thed people .The main limitation of this analysis is that quantitative studies like ours provide a vision based on the research generating the most publications; however, they do not necessarily capture prominent lines of research on emerging or highly specific pathologies. Our results may also underestimate the body of research on diseases that generally develop before people reach such an advanced age, like diabetes, osteoporosis, chronic obstructive pulmonary disease, or Parkinson’s disease. The individual descriptors for these diseases all stand out as important, but they are not integrated in any of the thematic clusters we identified. Other highly prevalent conditions, for example eye diseases like glaucoma or cataracts, are underrepresented in our findings because there are already well-established pharmacological or surgical treatments available for them, so they attract less research interest. Our use of a descriptor for a human age group led to the exclusion of a large volume of literature that does not exclusively focus on the oldest age groups and probably most basic research that is not explicitly linked to studying very advanced age as a key variable. Finally, our analysis may not have picked up on the full body of research in some psychosocial areas, as it was based on terminology from the MeSH thesaurus, which is mainly rooted in biomedical fields.In addition, although we observed some very well-defined thematic clusters, multidisciplinary approaches to different pathologies remain vitally important in this population. Not only do a large proportion of very old people have multiple comorbidities, geriatric syndromes like sarcopenia or other conditions provoking the loss of skeletal mass can act as risk factors for pathologies like cardiovascular diseases. These associations are sometimes underrepresented in research .Despite the above limitations, this study contributes to advancing knowledge on the research performed in the context of population aging, helping to remedy the near-total absence of studies offering a comprehensive vision of the research panorama in this field. The main conclusions about the research related to the oldest population groups (≥ 80 years) are as follows:- The pace of scientific output began to speed up in the mid 2000s, although research is highly concentrated in the USA, Japan, and some European populations—settings where the greatest proportion of very old people live. Given that the highest rates of population aging in the coming decades will be in low- and middle-income countries, more balanced participation in this research should be promoted among different regions and countries.- Our results demonstrate the complexity of research in this area, which brings together numerous medical specialties and studies on different pathologies. In quantitative terms, the most prominent clusters focus on cardiovascular and cerebrovascular diseases, such as aortic valve stenosis and stroke; dementia— particularly Alzheimer’s disease; neoplasms with a higher incidence in the oldest populations; and bacterial infections in the urinary tract and prostheses. However, we also identified a number of other important clusters, focusing on a myriad of diseases, degenerative pathologies, and geriatric syndromes that need to be addressed in conjunction with social and psychosocial aspects related to aging.Additional file 1. Main terms referring to diseases linked with the MeSH descriptor “Aged, 80 and over”. Description of data: List of MeSH terms for diseases assigned to at least 50 of the documents on people aged 80 and over, with indicators for overall output and the number of documents that focus on the topic specifically for this age group.


Naunyn–Schmiedeberg’s Archives of Pharmacology is the oldest existing pharmacological journal, celebrating its 150th anniversary in 2023. In the journal, we place a lot of emphasis on good scientific traditions such as rigorous and fair peer review. We place science itself in the center and not its perceived “priority” or “impact”. We also encourage discussion of weaknesses of studies and do not expect authors to submit “perfect stories”.However, traditions can also be deleterious if they do not adapt to the progress in scientific knowledge. And we do have such a case now and must adapt: Pharmacological nomenclature, particularly designations of drug classes, have continuously evolved over decades and are deeply rooted in pharmacological textbooks, the scientific literature, and, most importantly, in scientific language. Most names of drug classes are rather descriptive and often focus on clinical indications. Thus, drug class names rarely describe the precise mechanisms of action of drugs which, when the terms were coined, were mostly unknown. Moreover, historically, very little thought was given on consistence of drug class designations among subfields. For example, the prefix “anti_” is used for multiple drug classes acting against a certain disease, without specifying the mechanism of action. In addition, receptor antagonists are inconsistently labeled as “anti_,” “_blockers,” or “_lytics.” Terminology was taken for granted. Three recent articles provide an overview of the problems associated with traditional drug class nomenclature Seifert , 2021.Over time, an increasing mismatch between terminology and scientific facts evolved. Firstly, in many cases, we now better understand the mechanisms of action of drugs Seifert , 2021. SNaunyn–Schmiedeberg’s Archives of Pharmacology . This change in nomenclature is now being taught in all medical schools in Germany and will be the basis for the federal medical exams effective spring 2022 . A textbook in German language fully adopting the nomenclature change has been recently published  in April 2021, the nomenclature issue was presented and positively received as well. In addition, among editors of Naunyn–Schmiedeberg’s Archives of Pharmacology, the nomenclature proposal received positive comments. It is agreed among authors and editors of Naunyn–Schmiedeberg’s Archives of Pharmacology that literature searches with traditional terms such as “antidepressants,” “antibiotics,” “antipsychotics,” and “non-steroidal anti-inflammatory drugs” become increasingly difficult and imprecise  abbreviated form. In general, readability of abbreviated drug class terms is better. In parentheses, authors are encouraged to use the traditional terms to avoid communication problems and ensure searchability of their papers in abstracting and indexing databases in the transition period. Most importantly, authors are not only required to implement the new nomenclature in the manuscript text but also in the abstract. Abstracts are globally and freely available to the scientific community in publication databases and not subject to subscription barriers. Thus, abstracts have great importance for global dissemination of knowledge, key concepts and terminology. It follows that use of modern drug nomenclature use will predominantly be propagated via abstracts. Manuscripts that do not abide to these new editorial guidelines will be administratively rejected and returned to authors for amendment.Specifically, we require that authors of all future submissions to Naunyn–Schmiedeberg’s Archives of Pharmacology is the first and currently only journal addressing this highly important topic. However, we are confident that our authors will soon appreciate that the precision and accuracy of their articles improve and that they can convey their scientific messages in a better and more precise manner.We realize that initially, it will require some work from the side of authors to implement the required nomenclature changes, specifically since IUPHAR and other pharmacological journals. In this way, these players will receive “real-world” feedback on which aspects of the nomenclature are good and practical and which aspects need revision.The pilot project-type implementation of the nomenclature change in this journal is also important for Below, authors will find a table Table  in whichIUPHAR rules . For more details, authors are referred to previous publications on terminology of drug classes (Seifert Authors should note that the list of traditional terms and translation into modern terminology and the list of problematic terms provided in Table  Seifert , 2021. ANaunyn–Schmiedeberg’s Archives of Pharmacology. Any suggestions for improvement of the nomenclature are most welcome. After all, it is a cultural process that must be accepted by the entire scientific and medical community to be effective.We encourage our authors and readers to provide feedback on the proposed nomenclature changes to the Editor-in-Chief of To conclude, your papers will become cutting-edge both scientifically and with respect to modern terminology if you follow our editorial guidelines. And your critical pharmacological thinking will be sharpened as well. Please keep in mind that language shapes thinking and vice versa. And for pharmacology, both aspects should be as precise as possible.