Objective − to present the experience with providing specialized medical care during mass hospitalization of victims of an industrial accident at the Listvyazhnaya mine in conditions of limited capacity of medical institutions due to the next wave of the COVID-19 pandemic.Materials and methods. November 25, 2021 at 8:30 local time at the Listvyazhnaya mine (Belovo, Kemerovo region) at a depth of 250 meters in the ventilation drift No. 823, there was an explosion of mine gases and smoke in all underground workings of the mine for 40 km. At 09:00, a message about the industrial accident was received by the unified dispatching service of the Ministry of Emergency Situations (MES). Brigades of the militarized mountain rescue unit (VGSCh) and employees of the nearest ambulance service in Belovo immediately left for the accident site.Of the 285 employees of the mine, 197 miners came to the surface on their own, of which 12 victims with mild to moderate carbon monoxide poisoning were taken to the Belovo City Hospital No. 8, a level II trauma center 10 km from the mine; 39 victims needed help from the VGSCh staff. Within 72 hours from the moment of the accident, 35 victims with the main diagnosis "Carbon monoxide poisoning" were evacuated to the Kuzbass Clinical Center for Miners' Health named after the Holy Great Martyr Barbara (Leninsk-Kuznetsky, level I trauma center, 30 km from the mine); 11 victims with the same diagnosis were taken to the acute poisoning department of the Kuzbass Clinical Emergency Hospital named after. M. A. Podgorbunsky (Kemerovo, level I trauma center, 110 km from the mine).Demographic data (age), circumstances and mechanism of injury, organizational features of receiving and providing assistance to victims, heart rate (HR), systolic blood pressure (SBP), level of consciousness and severity of injuries (Glasgow coma scale (GCS), Injury Severity Scale (ISS), Abbreviated Injury Scale (AIS)) and the severity of carbon monoxide poisoning (CO) were analyzed.Analysis of the acid-base state and blood gases with the measurement of the levels of carboxyhemoglobin (COHb) and methemoglobin (MetHb) in whole venous blood was performed on a critical state analyzer "Cobas 221 S" (Roche Diagnostics, Germany).Statistical processing of the obtained data was carried out using the software package for processing statistical data of social sciences version 21 "IBM SPSS Statistics" (Statistical Product and Service Solutions − SPSS). Qualitative features are presented as absolute and relative (%) values. Quantitative variables are presented as arithmetic means (M) and the standard deviation of arithmetic means (SD), as Me (LQ–UQ), where Me is the median, (LQ–UQ) is the interquartile range (IQR) (LQ − 23 %, UQ − 75 % of the quartile).Results. Despite the difficult situation due to the re-profiling of 80 beds for the treatment of patients with the new coronovirus infection, at the time of the mass admission of victims from the internal reserves of Kuzbass Clinical Center of Miners' Health Protection named after The Holy Great Martyr Barbara, Leninsk-Kuznetsky, 10 beds were prepared in the intensive care unit (ICU), 40 beds in the departments of traumatology, surgery and neurosurgery. Additionally, 40 employees of the clinic were involved: 4 traumatologists, 3 surgeons, 3 anesthesiologist-resuscitators, neurologist, otolaryngologist, therapist, radiologist, functional diagnostics doctor, nurses of the operating unit and anesthetists, nurses.On the basis of Kuzbass Clinical Center of Miners' Health Protection named after The Holy Great Martyr Barbara, 30 victims were provided with medical care in accordance with previously developed protocols. Within 1 hour after the accident, 4 victims in serious condition were taken to the medical center and hospitalized to the intensive care unit. After 2-3 hours, another 26 people were delivered with barotrauma, carbon monoxide poisoning of moderate severity, bruises, abrasions of soft tissues. 26 % of the victims had lacerations of the head, trunk and limbs. The severity of the injury according to ISS was: M (SD) 6.2 (2) points. The severity of the condition of the victims was due to carbon monoxide poisoning. COHb levels within 0-3 % were recorded in 23.3 % of victims, within 4-10 % − in 63.3 % of victims, and a high level ≥ 11 % − in 13.4 % of victims. This made it possible to objectively assess the condition of the victims, clarify the diagnosis and conduct adequate treatment. The duration of non-invasive ventilation was Me (IQR) 1.4 (0.4-2.2) hours, the length of stay in the ICU Me (IQR) − 2.6 (0.5-2.6) hours, the duration of hospitalization in the clinic Me (IQR) − 6 (3.1-7.2) bed days.On the afternoon of November 25, 2021, 49 miners remained in the mine, as well as 6 mine rescuers, who did not return from search and rescue operations from a remote part of the mine. One victim was saved: he came to the surface on his own in more than 12 hours. The victim has poisoning and hypothermia of moderate severity. Despite the developed complication and acute renal failure due to reperfusion syndrome, this patient managed to be helped: like everyone else, he was discharged from the hospital with recovery.51 people died in the mine, including 5 people from the mine rescue team. The main reason is carbon monoxide poisoning.Conclusion. With a mass admission of victims, when there is a shortage of medical personnel involved in the provision of assistance, the issues of medical triage of victims, the targeted use of internal reserves and the potential of medical institutions to ensure the continuity of specialized medical care in the general health care system come to the fore.The unity of standards of diagnostics and treatment at all stages becomes the leading principle, which makes it possible to ensure the principle of continuity. In case of mass carbon monoxide poisoning, in order to assess the severity of the damage to the victims, it is necessary to correctly assess the acid-base state of the blood. The results of pulse oximetry in this situation, as a rule, are uninformative, they do not reflect the total oxygen content in the blood, which is accompanied by subsequent tissue hypoxia.It is necessary to improve the development of organizational technologies, operational management and personnel management, integrative management of forces and means in the context of ongoing innovative activities of medical institutions in the region. ; Цель работы — представить опыт оказания специализированной медицинской помощи при массовой госпитализации пострадавших в результате техногенной аварии на шахте «Листвяжная» в условиях ограниченных возможностей лечебных учреждений из-за очередной волны пандемии COVID-19.Материал и методы. 25 ноября 2021 года в 8 часов 30 минут по местному времени на шахте «Листвяжная» (г. Белово, Кемеровская область) на глубине 250 метров в вентиляционном штреке № 823 произошел взрыв шахтовых газов и задымление по всем подземным выработкам шахты на протяжении 40 км. В 09:00 сообщение о техногенной аварии поступило в единую диспетчерскую службу министерства по чрезвычайным ситуациям (МЧС). На место аварии сразу же выехали бригады военизированной горноспасательной части (ВГСЧ) и сотрудники ближайшей службы скорой помощи г. Белово.Из 285 сотрудников шахты на поверхность самостоятельно вышли 197 горняков, из них 12 пострадавших с отравлением угарным газом легкой и средней степени тяжести были доставлены в Беловскую городскую больницу № 8, травмоцентр II уровня в 10 км от шахты; 39 пострадавшим понадобилась помощь сотрудников ВГСЧ. В течение 72 часов с момента аварии 35 пострадавших с основным диагнозом «Отравление угарным газом» были эвакуированы в Кузбасский клинический центр охраны здоровья шахтеров имени святой великомученицы Варвары (ГБУЗ ККЦОЗШ, г. Ленинск-Кузнецкий, травмоцентр I уровня в 30 км от шахты); 11 пострадавших с аналогичным диагнозом были доставлены в отделение острых отравлений Кузбасской клинической больницы скорой медицинской помощи им. М. А. Подгорбунского (г. Кемерово, травмоцентр I уровня в 110 км от шахты).Анализировались демографические данные (возраст), обстоятельства и механизм травмы, организационные особенности приема и оказания помощи пострадавшим, частота сердечных сокращений (ЧСС), систолическое артериальное давление (САД), уровень сознания и тяжести полученных травм (шкала ком Глазго — GCS, шкала тяжести травмы — ISS, сокращенная шкала травмы — AIS) и степень тяжести отравления угарным газом (СО).Анализ кислотно-основного состояния и газов крови с измерением уровней карбоксигемоглобина (СOHb) и метгемоглобина (MetHb) в цельной венозной крови проводили на анализаторе критических состояний «Cobas 221 S» (Roche Diagnostics, Германия).Статистическую обработку полученных данных проводили с использованием пакета программ обработки статистических данных общественных наук версии 21 «IBM SPSS Statiatics» (Statistical Product and Service Solutions — SPSS). Качественные признаки представлены в виде абсолютных и относительных (%) значений. Количественные переменные представлены в виде средних арифметических величин (М) и квадратичного отклонения средних арифметических величин (SD), в виде Me (LQ–UQ), где ME — медиана, (LQ–UQ) — интерквартильный разброс (IQR) (LQ — 23%, UQ — 75% квартили). Результаты. Несмотря на сложную обстановку в связи с перепрофилированием 80 коек для лечения пациентов с новой короновирусной инфекцией, на момент массового поступления пострадавших из внутренних резервов ГБУЗ ККЦОЗШ были подготовлены 10 коек в отделении реанимации и интенсивной терапии (ОРИТ), 40 коек в отделениях травматологии, хирургии и нейрохирургии. Дополнительно были привлечены 40 сотрудников клиники: 4 травматолога, 3 хирурга, 3 анестезиолога-реаниматолога, невролог, ЛОР-врач, терапевт, врач рентгенолог, врач функциональной диагностики, медицинские сестры операционного блока и анестезисты, санитарки.На базе ГБУЗ ККЦОЗШ 30 пострадавшим была оказана медицинская помощь в соответствии с ранее разработанными протоколами. В течение 1 часа после аварии 4 пострадавших в тяжелом состоянии были доставлены в центр и госпитализированы в ОРИТ. Через 2–3 часа были доставлены еще 26 человек с баротравмой, отравлением угарным газом средней степени тяжести, ушибами, ссадинами мягких тканей. У 26 % пострадавших были рвано-ушибенные раны головы, туловища, конечностей. Тяжесть травмы по ISS составила: М (SD) 6,2 (2) балла. Тяжесть состояния пострадавших была обусловлена отравлением угарным газом. Уровень СOHb в пределах 0–3 % регистрировали у 23,3 % пострадавших, в пределах 4–10% — у 63,3 % пострадавших и высокий уровень ≥ 11 % – у 13,4 % пострадавших. Это позволило объективно оценить состояние пострадавших, уточнить диагноз и проводить адекватное лечение. Длительность неинвазивной вентиляции легких составила Me (IQR) 1,4 (0,4–2,2) часа, продолжительность пребывания в ОРИТ Me (IQR) 2,6 (0,5–2,6) часа, сроки госпитализации в клинике Me (IQR) 6 (3,1–7,2) койко-дней.Во второй половине дня 25 ноября 2021 г. в шахте оставались 49 шахтеров и 6 горноспасателей, которые не вернулись с поисково-спасательных работ из отдаленной части шахты. Одного пострадавшего удалось спасти: он вышел самостоятельно на поверхность более чем через 12 часов. У пострадавшего отравление и переохлаждение средней степени тяжести. Несмотря на развившееся осложнение, острую почечную недостаточность вследствие реперфузионного синдрома, этому больному удалось помочь: как и все остальные, он был выписан из стационара с выздоровлением.В шахте погиб 51 человек, в том числе 5 — из группы горноспасателей. Основная причина — отравление угарным газом.Заключение. При массовом поступлении пострадавших, когда наблюдается дефицит медицинского персонала, участвующего в оказании помощи, на первое место выступают вопросы медицинской сортировки пострадавших, целенаправленного использования внутренних резервов и потенциала лечебных учреждений для обеспечения непрерывности специализированной медицинской помощи в общей системе здравоохранения.Ведущим принципом становится единство стандартов диагностики, лечения на всех этапах, что позволяет обеспечить принцип преемственности. При массовом отравлении угарным газом для оценки степени тяжести поражения пострадавших необходимо обязательно правильно оценивать кислотно-основное состояние крови. Результаты пульсоксиметрии в данной ситуации, как правило, являются малоинформативными, они не отражают общего содержания кислорода в крови, что сопровождается последующей тканевой гипоксией.Необходимо совершенствовать разработку организационных технологий, оперативного управления и кадрового менеджмента, интегративного управления силами и средствами в условиях проводимой инновационной деятельности медицинских учреждений области.
Publisher's version (útgefin grein). ; Background: Genome-wide association studies conducted on QRS duration, an electrocardiographic measurement associated with heart failure and sudden cardiac death, have led to novel biological insights into cardiac function. However, the variants identified fall predominantly in non-coding regions and their underlying mechanisms remain unclear. Results: Here, we identify putative functional coding variation associated with changes in the QRS interval duration by combining Illumina HumanExome BeadChip genotype data from 77,898 participants of European ancestry and 7695 of African descent in our discovery cohort, followed by replication in 111,874 individuals of European ancestry from the UK Biobank and deCODE cohorts. We identify ten novel loci, seven within coding regions, including ADAMTS6, significantly associated with QRS duration in gene-based analyses. ADAMTS6 encodes a secreted metalloprotease of currently unknown function. In vitro validation analysis shows that the QRS-associated variants lead to impaired ADAMTS6 secretion and loss-of function analysis in mice demonstrates a previously unappreciated role for ADAMTS6 in connexin 43 gap junction expression, which is essential for myocardial conduction. Conclusions: Our approach identifies novel coding and non-coding variants underlying ventricular depolarization and provides a possible mechanism for the ADAMTS6-associated conduction changes. ; Funding This work was funded by a grant to YJ from the British Heart Foundation (PG/12/38/29615). AGES: This study has been funded by NIH contracts N01-AG-1-2100 and 271201200022C, the NIA Intramural Research Program, Hjartavernd (the Icelandic Heart Association), and the Althingi (the Icelandic Parliament). The study is approved by the Icelandic National Bioethics Committee, VSN: 00–063. The researchers are indebted to the participants for their willingness to participate in the study. ARIC: The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C), R01HL087641, R01HL59367, and R01HL086694; National Human Genome Research Institute contract U01HG004402; and National Institutes of Health contract HHSN268200625226C. The authors thank the staff and participants of the ARIC study for their important contributions. Infrastructure was partly supported by Grant Number UL1RR025005, a component of the National Institutes of Health and NIH Roadmap for Medical Research. Funding support for "Building on GWAS for NHLBI-diseases: the U.S. CHARGE consortium" was provided by the NIH through the American Recovery and Reinvestment Act of 2009 (ARRA) (5RC2HL102419). BRIGHT: The Exome Chip genotyping was funded by Wellcome Trust Strategic Awards (083948 and 085475). This work was also supported by the Medical Research Council of Great Britain (Grant no. G9521010D); and by the British Heart Foundation (Grant no. PG/02/128). AFD was supported by the British Heart Foundation (Grant nos. RG/07/005/23633 and SP/08/005/25115); and by the European Union Ingenious HyperCare Consortium: Integrated Genomics, Clinical Research, and Care in Hypertension (grant no. LSHM-C7–2006-037093). The BRIGHT study is extremely grateful to all the patients who participated in the study and the BRIGHT nursing team. We would also like to thank the Barts Genome Centre staff for their assistance with this project. CHS: This Cardiovascular Health Study (CHS) research was supported by NHLBI contracts HHSN268201800001C, HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086; and NHLBI grants R01HL068986, U01HL080295, R01HL087652, R01HL105756, R01HL103612, R01HL120393, and U01HL130114 with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided through R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. The provision of genotyping data was supported in part by the National Center for Advancing Translational Sciences, CTSI grant UL1TR001881, and the National Institute of Diabetes and Digestive and Kidney Disease Diabetes Research Center (DRC) grant DK063491 to the Southern California Diabetes Endocrinology Research Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. ERF: The ERF study as a part of EUROSPAN (European Special Populations Research Network) was supported by European Commission FP6 STRP grant number 018947 (LSHG-CT-2006-01947) and also received funding from the European Community's Seventh Framework Programme (FP7/2007–2013)/grant agreement HEALTH-F4–2007-201413 by the European Commission under the programme "Quality of Life and Management of the Living Resources" of 5th Framework Programme (no. QLG2-CT-2002-01254). The ERF study was further supported by ENGAGE consortium and CMSB. High-throughput analysis of the ERF data was supported by joint grant from Netherlands Organization for Scientific Research and the Russian Foundation for Basic Research (NWO-RFBR 047.017.043). We are grateful to all study participants and their relatives, general practitioners, and neurologists for their contributions to the ERF study and to P Veraart for her help in genealogy, J Vergeer for the supervision of the laboratory work, and P Snijders for his help in data collection. FHS: The Framingham Heart Study (FHS) research reported in this article was supported by a grant from the National Heart, Lung, and Blood Institute (NHLBI), HL120393. Generation Scotland: Generation Scotland received core support from the Chief Scientist Office of the Scottish Government Health Directorates (CZD/16/6) and the Scottish Funding Council (HR03006). Genotyping of the Generation Scotland and Scottish Family Health Study samples was carried out by the Genetics Core Laboratory at the Clinical Research Facility, Edinburgh, Scotland and was funded by the UK's Medical Research Council. GOCHA: The Genetics of Cerebral Hemorrhage with Anticoagulation was carried out as a collaborative study supported by grants R01NS073344, R01NS059727, and 5K23NS059774 from the NIH–National Institute of Neurological Disorders and Stroke (NIH-NINDS). GRAPHIC: The GRAPHIC Study was funded by the British Heart Foundation (BHF/RG/2000004). NJS and CPN are supported by the British Heart Foundation and is a NIHR Senior Investigator. This work falls under the portfolio of research supported by the NIHR Leicester Cardiovascular Biomedical Research. INGI-FVG: This study has been funded by Regione FVG (L.26.2008). INTER99: The Inter99 was initiated by Torben Jørgensen (PI), Knut Borch-Johnsen (co-PI), Hans Ibsen and Troels F. Thomsen. The steering committee comprises the former two and Charlotta Pisinger. The study was financially supported by research grants from the Danish Research Council, the Danish Centre for Health Technology Assessment, Novo Nordisk Inc., Research Foundation of Copenhagen County, Ministry of Internal Affairs and Health, the Danish Heart Foundation, the Danish Pharmaceutical Association, the Augustinus Foundation, the Ib Henriksen Foundation, the Becket Foundation, and the Danish Diabetes Association. The Novo Nordisk Foundation Center for Basic Metabolic Research is an independent Research Center at the University of Copenhagen partially funded by an unrestricted donation from the Novo Nordisk Foundation (www.metabol.ku.dk). JHS: We thank the Jackson Heart Study (JHS) participants and staff for their contributions to this work. The JHS is supported by contracts HHSN268201300046C, HHSN268201300047C, HHSN268201300048C, HHSN268201300049C, HHSN268201300050C from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities. Dr. Wilson is supported by U54GM115428 from the National Institute of General Medical Sciences. KORA: The KORA study was initiated and financed by the Helmholtz Zentrum München – German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. Furthermore, KORA research was supported within the Munich Center of Health Sciences (MC-Health), Ludwig-Maximilians-Universität, as part of LMUinnovativ. Korcula: This work was funded by the Medical Research Council UK, The Croatian Ministry of Science, Education and Sports (grant 216–1080315-0302), the Croatian Science Foundation (grant 8875), the Centre of Excellence in Personalized health care, and the Centre of Competencies for Integrative Treatment, Prevention and Rehabilitation using TMS. LifeLines: The LifeLines Cohort Study and generation and management of GWAS genotype data for the LifeLines Cohort Study are supported by The Netherlands Organization of Scientific Research NWO (grant 175.010.2007.006), the Economic Structure Enhancing Fund (FES) of the Dutch government, the Ministry of Economic Affairs, the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the Northern Netherlands Collaboration of Provinces (SNN), the Province of Groningen, University Medical Center Groningen, the University of Groningen, Dutch Kidney Foundation, and Dutch Diabetes Research Foundation. Niek Verweij is supported by NWO-VENI (016.186.125) and Marie Sklodowska-Curie GF (call: H2020-MSCA-IF-2014, Project ID: 661395). UHP: Folkert W. Asselbergs is supported by UCL Hospitals NIHR Biomedical Research Centre. Ilonca Vaartjes is supported by a Dutch Heart Foundation grant DHF project "Facts and Figures." MGH-CAMP: Dr. Patrick Ellinor is funded by NIH grants (2R01HL092577, 1R01HL128914, R01HL104156, and K24HL105780) and American Heart Association Established Investigator Award 13EIA14220013 (Ellinor). Dr. Steve Lubitz is funded by NIH grants K23HL114724 and a Doris Duke Charitable Foundation Clinical Scientist Development Award 2014105. NEO: The authors of the NEO study thank all individuals who participated in the Netherlands Epidemiology in Obesity study, all participating general practitioners for inviting eligible participants, and all research nurses for collection of the data. We thank the NEO study group, Pat van Beelen, Petra Noordijk, and Ingeborg de Jonge for the coordination, lab, and data management of the NEO study. We also thank Arie Maan for the analyses of the electrocardiograms. The genotyping in the NEO study was supported by the Centre National de Génotypage (Paris, France), headed by Jean-Francois Deleuze. The NEO study is supported by the participating Departments, the Division and the Board of Directors of the Leiden University Medical Center, and by the Leiden University, Research Profile Area Vascular and Regenerative Medicine. Dennis Mook-Kanamori is supported by Dutch Science Organization (ZonMW-VENI Grant 916.14.023). RS-I: The generation and management of the Illumina Exome Chip v1.0 array data for the Rotterdam Study (RS-I) was executed by the Human Genotyping Facility of the Genetic Laboratory of the Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands. The Exome chip array dataset was funded by the Genetic Laboratory of the Department of Internal Medicine, Erasmus MC, from the Netherlands Genomics Initiative (NGI)/Netherlands Organization for Scientific Research (NWO)-sponsored Netherlands Consortium for Healthy Aging (NCHA; project nr. 050–060-810); the Netherlands Organization for Scientific Research (NWO; project number 184021007); and by the Rainbow Project (RP10; Netherlands Exome Chip Project) of the Biobanking and Biomolecular Research Infrastructure Netherlands (BBMRI-NL; www.bbmri.nl). We thank Ms. Mila Jhamai, Ms. Sarah Higgins, and Mr. Marijn Verkerk for their help in creating the exome chip database, and Carolina Medina-Gomez, MSc, Lennard Karsten, MSc, and Linda Broer PhD for QC and variant calling. Variants were called using the best practice protocol developed by Grove et al. as part of the CHARGE consortium exome chip central calling effort. The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. The authors are grateful to the study participants, the staff from the Rotterdam Study, and the participating general practitioners and pharmacists. The work of Bruno H. Stricker is supported by grants from the Netherlands Organization for Health Research and Development (ZonMw) (Priority Medicines Elderly 113102005 to ME and DoelmatigheidsOnderzoek 80–82500–98-10208 to BHS). The work of Mark Eijgelsheim is supported by grants from the Netherlands Organization for Health Research and Development (ZonMw) (Priority Medicines Elderly 113102005 to ME and DoelmatigheidsOnderzoek 80–82500–98-10208 to BHS). SHIP: SHIP is supported by the BMBF (grants 01ZZ9603, 01ZZ0103, and 01ZZ0403) and the German Research Foundation (Deutsche Forschungsgemeinschaft [DFG]; grant GR 1912/5–1). SHIP and SHIP-TREND are part of the Community Medicine Research net (CMR) of the Ernst-Moritz-Arndt University Greifswald (EMAU) which is funded by the BMBF as well as the Ministry for Education, Science and Culture and the Ministry of Labor, Equal Opportunities, and Social Affairs of the Federal State of Mecklenburg-West Pomerania. The CMR encompasses several research projects that share data from SHIP. The EMAU is a member of the Center of Knowledge Interchange (CKI) program of the Siemens AG. SNP typing of SHIP and SHIP-TREND using the Illumina Infinium HumanExome BeadChip (version v1.0) was supported by the BMBF (grant 03Z1CN22). We thank all SHIP and SHIP-TREND participants and staff members as well as the genotyping staff involved in the generation of the SNP data. TWINSUK: TwinsUK is funded by the Wellcome Trust, Medical Research Council, European Union, the National Institute for Health Research (NIHR)-funded BioResource, Clinical Research Facility and Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London. UKBB: This research has been conducted using the UK Biobank Resource (application 8256 - Understanding genetic influences in the response of the cardiac electrical system to exercise) and is supported by Medical Research Council grant MR/N025083/1. We also wish to acknowledge the support of the NIHR Cardiovascular Biomedical Research Unit at Barts and Queen Mary University of London, UK. PD Lambiase acknowledges support from the UCLH Biomedicine NIHR. MO is supported by an IEF 2013 Marie Curie fellowship. JR acknowledges support from the People Programme (Marie Curie Actions) of the European Union's Seventh Framework Programme (FP7/2007–2013) under REA grant agreement no. 608765. YFS: The Young Finns Study has been financially supported by the Academy of Finland: grants 286284, 134309 (Eye), 126925, 121584, 124282, 129378 (Salve), 117787 (Gendi), and 41071 (Skidi); the Social Insurance Institution of Finland; Competitive State Research Financing of the Expert Responsibility area of Kuopio, Tampere and Turku University Hospitals (grant X51001); Juho Vainio Foundation; Paavo Nurmi Foundation; Finnish Foundation for Cardiovascular Research; Finnish Cultural Foundation; Tampere Tuberculosis Foundation; Emil Aaltonen Foundation; Yrjö Jahnsson Foundation; Signe and Ane Gyllenberg Foundation; and Diabetes Research Foundation of Finnish Diabetes Association. The expert technical assistance in the statistical analyses by Irina Lisinen is gratefully acknowledged. Cell culture and biochemistry: Funding was provided by the National Institutes of Health (Program of Excellence in Glycoscience award HL107147 to SSA and F32AR063548 to TJM) and the David and Lindsay Morgenthaler Postdoctoral Fellowship (to TJM) and by the Allen Distinguished Investigator Program, through support made by The Paul G. Allen Frontiers Group and the American Heart Association (to SSA). Mutant mouse model: Adamts6 mutant mice were generated and further propagated and analyzed by funding provided by NIH grants HL098180 and HL132024 (to CWL) and by the Allen Distinguished Investigator Program, through support made by The Paul G. Allen Frontiers Group and the American Heart Association (to SSA). ; Peer Reviewed
The PGC was funded by National Institute of Mental Health (NIMH) Grant Nos. MH085520 (to PFS) and MH080403. Statistical analyses were carried out on the Genetic Cluster Computer (http://www. geneticcluster.org) hosted by SURFsara and financially supported by the Netherlands Scientific Organization Grant No. NWO 480-05-003 (to D. Posthuma) and the department of Psychology, Vrije Universiteit Amsterdam along with a supplement from the Dutch Brain Foundation. The Bonn/Mannheim GWAS was supported by the German Federal Ministry of Education and Research (BMBF) through the Integrated Genome Research Network Systematic Investigation of the Molecular Causes of Major Mood Disorders and Schizophrenia Grant Nos. 01GS08144 and 01GS08147, under the auspices of the National Genome Research Network plus, and through the Integrated Network Integrated Understanding of Causes and Mechanisms in Mental Disorders, under the auspices of the e:Med Programme Grant Nos. 01ZX1314A and 01ZX1314G. The Bonn/Mannheim GWAS was also supported by the German Research Foundation (DFG) Grant Nos. FOR2107, RI908/11-1, and NO246/10-1. The GenRED GWAS project was supported by NIMH R01 Grant Nos. MH061686 (to DFL), MH059542 (to W.H. Coryell), MH075131 (W.B. Lawson), MH059552 (JBP), MH059541 (W.A. Scheftner), and MH060912 (MMW). Max Planck Institute of Psychiatry MARS study was supported by the BMBF Program Molecular Diagnostics: Validation of Biomarkers for Diagnosis and Outcome in Major Depression by Grant No. 01ES0811. Genotyping was supported by the Bavarian Ministry of Commerce, and the BMBF in the framework of the National Genome Research Network by Grant Nos. NGFN2 and NGFN-Plus, FKZ 01GS0481 and 01GS08145. The Netherlands Study of Depression and Anxiety and the Netherlands Twin Register contributed to Genetic Association Information Network (GAIN)-MDD and to MDD2000. Funding for NTR/NESDA was from the following: the Netherlands Organization for Scientific Research (MagW/ZonMW Grant Nos. 904-61-090, 985-10-002, 904-61-193, 480-04004, 400-05-717, 912-100-20; Spinozapremie Grant No. 56-464-14192; Geestkracht program Grant No. 10-000-1002); the Center for Medical Systems Biology (NWO Genomics), Biobanking and Biomolecular Resources Research Infrastructure, Vrije Universiteit's Institutes for Health and Care Research and Neuroscience Campus Amsterdam, BIC/BioAssist/RK (Grant No. 2008.024); the European Science Foundation (Grant No. EU/QLRT-200101254); the European Community's Seventh Framework Program (Grant No. FP7/2007-2013); ENGAGE (Grant No. HEALTH-F4-2007-201413); and the European Science Council (Grant No. ERC 230374). Genotyping was funded in part by the GAIN of the Foundation for the US National Institutes of Health, and analysis was supported by grants from GAIN and the NIMH (Grant No. MH081802). Funding for the QIMR samples was provided by the Australian National Health and Medical Research Council (Grant Nos. 241944, 339462, 389927, 389875, 389891, 389892, 389938, 442915, 442981, 496675, 496739, 552485, 552498, 613602, 613608, 613674, 619667), the Australian Research Council (Grant Nos. FT0991360, FT0991022), the FP-5 GenomEUtwin Project (Grant No. QLG2-CT-2002-01254), and the US National Institutes of Health (Grant Nos. AA07535, AA10248, AA13320, AA13321, AA13326, AA14041, MH66206, DA12854, DA019951), and the Center for Inherited Disease Research (Baltimore, MD). RADIANT was funded by the following: a joint grant from the UK Medical Research Council and GlaxoSmithKline (Grant No. r G0701420); the National Institute for Health Research Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley National Health Service Foundation Trust and the Institute of Psychiatry, King's College London; the UK Medical Research Council (Grant No. G0000647), and the Marie Curie Industry-Academia Partnership and Pathways (Grant No. 286213). The GENDEP study was funded by a European Commission Framework 6 grant (EC Contract Ref.: LSHB-CT2003- 503428). Genotyping of STAR* D was supported by NIMH Grant No. MH072802 (to SPH). STAR* D was funded by NIMH Grant No. N01MH90003 to the University of Texas Southwestern Medical Center at Dallas (to A.J. Rush). The CoLaus/PsyCoLaus study was supported by research grants from GlaxoSmithKline, the Faculty of Biology and Medicine of Lausanne, and the Swiss National Science Foundation (Grant Nos. 3200B0-105993, 3200B0-118308, 33CSCO-122661, 33CS30-139468, 33CS30-148401) and two grants from GlaxoSmithKline Clinical Genetics. SHIP is part of the Community Medicine Research net of the University of Greifswald, Germany, which is funded by the Federal Ministry of Education and Research (Grant Nos. 01ZZ9603, 01ZZ0103, 01ZZ0403), the Ministry of Cultural Affairs, and the Social Ministry of the Federal State of Mecklenburg-West Pomerania. Genome-wide data have been supported by the Federal Ministry of Education and Research (Grant No. 03ZIK012) and a joint grant from Siemens Healthcare, Erlangen, Germany, and the Federal State of Mecklenburg-West Pomerania. SHIP-LEGEND is funded by the DFG (Grant No. GR 1912/5-1). The TwinGene study was supported by the Swedish Ministry for Higher Education, the Swedish Research Council (Grant No. M-2005-1112), GenomEUtwin (Grant Nos. EU/QLRT2001-01254,QLG2-CT-2002-01254), the Swedish Foundation for Strategic Research and the US National Institutes of Health (Grant No. U01 DK066134). The collection of PRISME control subjects and genotyping of the 883 Danish control subjects was supported by grants from The Danish Strategic Research Council, The Stanley Research Foundation, and H. Lundbeck A/S. The Muenster Depression cohorts were supported by the European Union (Grant No. N Health-F2-2008-222963) and by grants from the DFG (Grant Nos. FOR 2107 and DA1151/5-1 [ to UD]), Innovative Medizinische Forschung of the Medical Faculty of Munster (Grant Nos. DA120903, DA111107, and DA211012 [ all to UD]). Generation Scotland is supported by a Wellcome Trust Strategic Award "Stratifying Resilience and Depression Longitudinally" (Reference No.: 104036/Z/14/Z) and core support from the Chief Scientist Office of the Scottish Government Health Directorates (Grant No. CZD/16/6) and the Scottish Funding Council (Grant No. HR03006).r The NIMH Cell Repository at Rutgers University and the NIMH Center for Collaborative Genetic Studies on Mental Disorders made essential contributions to this project. Genotyping was carried out by the Broad Institute Center for Genotyping and Analysis with support from Grant No. U54 RR020278 (which partially subsidized the genotyping of the GenRED cases). Collection and quality control analyses of the control dataset were supported by grants from NIMH and the National Alliance for Research on Schizophrenia and Depression.r We acknowledge the contributions of Dr. George S Zubenko and Dr. Wendy N Zubenko, Department of Psychiatry, University of Pittsburgh School of Medicine, to the GenRED I project. We are grateful to Knowledge Networks (Menlo Park, CA) for assistance in collecting the control dataset. We express our profound appreciation to the families who participated in this project, and to the many clinicians who facilitated the referral of participants to the study. We thank the twins and their families registered at the Australian Twin Registry for their participation in the many studies that have contributed to this research. We thank V. Mooser, G. Weaber, and P. Vollenweider who initiated the CoLaus project. We express our gratitude to the Lausanne inhabitants who volunteered to participate in the PsyCoLaus study. We would like to acknowledge the PRISME-study group, Denmark, for collection of the PRISME samples. We thank David M. Hougaard, Section of Neonatal Screening and Hormones, Statens Serum Institute, Copenhagen, Denmark; Preben Bo Mortensen, National Centre for Register-based Research, Aarhus University, Denmark; Merete Nordentoft, Mental Health Centre, Copenhagen, Denmark; and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark. Funding from the BBSRC and MRC is gratefully acknowledged.r Data used in the preparation of this article were obtained from the Genetic and Environmental Risk for Alzheimer's disease (GERAD1) Consortium. As such, the investigators within the GERAD1 consortia contributed to the design and implementation of GERAD1 and/or provided data but did not participate in analysis or writing of this report.r SS, HS, KS, and TET are employees of deCODE Genetics/Amgen. VA received funds from the German Federal Ministry of Education and Research, from the European Union (FP 7), and from the Interdisciplinary Center for Clinical Research Munster, and he has served on the advisory boards of, or has given presentations on behalf of the following companies: Astra-Zeneca, Janssen-Organon, Lilly, Lundbeck, Servier, Pfizer, Otsuka, and Trommsdorff. BTB has received funding from the National Health and Medical Research Council Australia and honoraria from Lundbeck, BristolMeyers Squibb, Sanofi, Servier, Astra-Zeneca, Pfizer. IJD is supported by the MRC-BBSRC, Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative (Grant No. MR/K026992/1). HJG has received funding from German Research Foundation and Federal Ministry of Education and Research Germany and speakers honoraria from Eli Lilly and Servier. CH acknowledges support from the Medical Research Council (MRC) and the Biotechnology and Biological Sciences Research Council (BBSRC). DJM is supported by an , funded by the Chief Scientist Office. AMM is supported by a Scottish Funding Council Senior Clinical Fellowship and by the Dame Theresa and Mortimer Sackler Foundation and has received research support from Pfizer, Janssen, and Lilly. CMM was supported by the Netherlands Organization for Scientific Research (Grant No. NOW VENI 916-76-125). BM- M has consulted for Affectis Pharmaceuticals. MP has served on the advisory boards of Lundbeck and Eli Lilly ; BACKGROUND: Major depressive disorder (MDD) is a disabling mood disorder, and despite a known heritable component, a large meta-analysis of genome-wide association studies revealed no replicable genetic risk variants. Given prior evidence of heterogeneity by age at onset in MDD, we tested whether genome-wide significant risk variants for MDD could be identified in cases subdivided by age at onset. METHODS: Discovery case-control genome-wide association studies were performed where cases were stratified using increasing/decreasing age-at-onset cutoffs; significant single nucleotide polymorphisms were tested in nine independent replication samples, giving a total sample of 22,158 cases and 133,749 control subjects for subsetting. Polygenic score analysis was used to examine whether differences in shared genetic risk exists between earlier and adult-onset MDD with commonly comorbid disorders of schizophrenia, bipolar disorder, Alzheimer's disease, and coronary artery disease. RESULTS: We identified one replicated genome-wide significant locus associated with adult-onset (.27 years) MDD (rs7647854, odds ratio: 1.16, 95% confidence interval: 1.11–1.21, p 5 5.2 3 10-11). Using polygenic score analyses, we show that earlier-onset MDD is genetically more similar to schizophrenia and bipolar disorder than adult-onset MDD. CONCLUSIONS: We demonstrate that using additional phenotype data previously collected by genetic studies to tackle phenotypic heterogeneity in MDD can successfully lead to the discovery of genetic risk factor despite reduced sample size. Furthermore, our results suggest that the genetic susceptibility to MDD differs between adult- and earlier-onset MDD, with earlier-onset cases having a greater genetic overlap with schizophrenia and bipolar disorder. ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) MH085520 MH080403 ; SURFsara ; Netherlands Scientific Organization NWO 480-05-003 ; Department of Psychology, Vrije Universiteit Amsterdam ; Dutch Brain Foundation ; Federal Ministry of Education & Research (BMBF) 01GS08144 01GS08147 ; National Genome Research Network plus, and through the Integrated Network Integrated Understanding of Causes and Mechanisms in Mental Disorders ; e:Med Programme 01ZX1314A 01ZX1314G ; German Research Foundation (DFG) FOR2107 RI908/11-1 NO246/10-1 ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) MH061686 MH059542 MH075131 MH059552 MH059541 MH060912 ; Federal Ministry of Education & Research (BMBF) 01ES0811 ; Bavarian Ministry of Commerce ; Federal Ministry of Education & Research (BMBF) NGFN2 NGFN-Plus FKZ 01GS0481 01GS08145 ; Netherlands Organization for Scientific Research (MagW/ZonMW) 904-61-090 985-10-002 904-61-193 480-04004 400-05-717 912-100-20 ; Spinozapremie 56-464-14192 ; Geestkracht program 10-000-1002 ; Center for Medical Systems Biology (NWO Genomics) ; Biobanking and Biomolecular Resources Research Infrastructure ; Vrije Universiteit's Institutes for Health and Care Research and Neuroscience Campus Amsterdam ; BIC/BioAssist/RK 2008.024 ; European Science Foundation (ESF) EU/QLRT-200101254 ; European Union (EU) FP7/2007-2013 ; ENGAGE HEALTH-F4-2007-201413 ; European Science Council ERC 230374 ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA ; GAIN ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) MH081802 MH072802 N01MH90003 ; National Health and Medical Research Council of Australia 241944 339462 389927 389875 389891 389892 389938 442915 442981 496675 496739 552485 552498 613602 613608 613674 619667 ; Australian Research Council FT0991360 FT0991022 ; FP-5 GenomEUtwin Project QLG2-CT-2002-01254 ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA AA07535 AA10248 AA13320 AA13321 AA13326 AA14041 MH66206 DA12854 DA019951 U01 DK066134 ; Center for Inherited Disease Research (Baltimore, MD) ; UK Medical Research Council and GlaxoSmithKline G0701420 ; National Institute for Health Research (NIHR) ; Maudsley National Health Service Foundation Trust ; Institute of Psychiatry, King's College London ; Medical Research Council UK (MRC) G0000647 ; European Union (EU) 286213 ; European Commission Framework 6 grant (EC) LSHB-CT2003- 503428 ; GlaxoSmithKline ; Faculty of Biology and Medicine of Lausanne ; Swiss National Science Foundation (SNSF) 3200B0-105993 3200B0-118308 33CSCO-122661 33CS30-139468 33CS30-148401 ; GlaxoSmithKline Clinical Genetics ; Federal Ministry of Education & Research (BMBF) 01ZZ9603 01ZZ0103 01ZZ0403 03ZIK012 ; Ministry of Cultural Affairs ; Social Ministry of the Federal State of Mecklenburg-West Pomerania ; Siemens Healthcare, Erlangen, Germany ; German Research Foundation (DFG) GR 1912/5-1 FOR 2107 DA1151/5-1 ; Swedish Ministry for Higher Education ; Swedish Research Council M-2005-1112 ; GenomEUtwin QLG2-CT-2002-01254 EU/QLRT2001-01254 ; Swedish Foundation for Strategic Research ; Danske Strategiske Forskningsrad (DSF) ; Stanley Research Foundation ; European Union (EU) N Health-F2-2008-222963 ; Innovative Medizinische Forschung of the Medical Faculty of Munster DA120903 DA111107 DA211012 ; Wellcome Trust Strategic Award "Stratifying Resilience and Depression Longitudinally" 104036/Z/14/Z ; Chief Scientist Office of the Scottish Government Health Directorates CZD/16/6 ; Scottish Funding Council HR03006 ; Broad Institute Center for Genotyping and Analysis U54 RR020278 ; NARSAD ; Biotechnology and Biological Sciences Research Council (BBSRC) ; Medical Research Council UK (MRC) ; Federal Ministry of Education & Research (BMBF) ; Interdisciplinary Center for Clinical Research Munster ; National Health and Medical Research Council of Australia ; MRC-BBSRC, Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative MR/K026992/1 ; German Research Foundation (DFG) ; Federal Ministry of Education ; Research Germany and speakers honoraria from Eli Lilly and Servier ; Medical Research Council UK (MRC) ; Biotechnology and Biological Sciences Research Council (BBSRC) ; NRS Career Fellowship - Chief Scientist Office ; Scottish Funding Council Senior Clinical Fellowship ; Dame Theresa and Mortimer Sackler Foundation ; Netherlands Organization for Scientific Research (NWO) NOW VENI 916-76-125 ; Lundbeckfonden R155-2014-1724 ; Medical Research Council UK (MRC) MR/K026992/1 MC_PC_U127561128 1292844 ; Chief Scientist Office CZD/16/6/4
To make a summary of a book that contains so many different threads is no easy task. One should, on the one hand, refer to its conceptual contribution to the paradigm of sustainable agriculture, and on the other hand, consider the conclusions drawn from the studies conducted at international, national and regional level. It is clear that changing the paradigm of agricultural development from an industrial to a sustainable one will be neither easy nor quick. Agriculture must satisfy the demand for food products while lowering the pressure on the environment, providing for technological and biological progress, meeting the need to ensure a secure supply of food, and ensuring global economic, social and environmental rationality. The discussion in this book has concentrated chiefly on the last two questions. This is because certain dimensions of environmental and social rationality have so far been poorly researched. Environmental rationality means not only protecting the natural environment and reducing the pressure placed on it by agricultural production. The authors have pointed out that the assumption of an intrinsic value of land changes the expected productivity of capital in the sectors which utilise that production factor, namely in agriculture. This has far-reaching theoretical and practical consequences. The statistical data that have been presented demonstrate that utilities are discounted in Polish land prices to a much greater degree than would result from the agricultural functions of land. A similar situation is found in other EU countries. Where does this excess value of land come from? It is undoubtedly a result of the expectations of political rents, of speculative motives, and also of non-agricultural amenities provided by land. However, it is hard to determine the proportions of these factors. Moreover, new utilities of land have the nature of public goods, which further complicates the problem of seeking a market equilibrium. Similarly, recognition of the fact of the absolute and relative deprivation of farmers in the long term changes the balance of intersectoral flows, because it means a drainage of surplus from agriculture to other branches of agribusiness. This drainage is understood as a permanent mechanism by which economic rent flows out of agriculture as a result of market imperfections, in particular the flexible prices of agricultural products. More space should be given to studies of this problem in the world literature. 135 Poznan University of Economics and Business, anna.matuszczak@ue.poznan.pl Summary: Political Rents and the European Model of Agriculture 239 The second thread of the theoretical considerations relates to the problem of whether the concept of political rent, as found in the literature, fits the processes taking place in European agriculture. A review of the literature on rent seeking suggests that these theories provide only a partial explanation of the level of political rents and lobbying actions in European agriculture. Although there is a vast theoretical literature on rent seeking and collective action at global level, there is not much empirical work done with regard to these problems relating to the Common Agricultural Policy. Particularly problematic is the question of measuring political rents in particular EU member states. It has been found that, on a global level, it is European agriculture that best meets the criteria of viability and sustainability. Viewed against the backdrop of global agriculture, it is economically effective (in the institutional conditions guaranteed by the CAP), satisfies a variety of economic and social needs, and is developing in a way that reduces the burden on the environment. In 2012, based on the results of social consultations, the European Commission published a strategy and plan of action relating to the bioeconomy in Europe. The strategy creates a cohesive framework for a comprehensive approach to the solution of complex social problems (challenges) in Europe and worldwide. The measures undertaken with respect to the bioeconomy are focused on three pillars: investment in research, innovations and skills; strengthening the impact of the policy and engagement of interested parties; and strengthening competitiveness in sectors of the bioeconomy. The bioeconomy strategy represents an important step towards solving contemporary economic and social problems. The model of the development of agriculture in the EU can thus be considered an appropriate path to be followed in relatively densely populated countries, in which food producing area per capita is small. However, does this model require institutional support and the payment of political rents? The question arises as to whether these are in fact political rents, if in return society receives a package of specified benefits, and there is a net increase in social well-being. Empirical analyses have shown that up to the mid 1980s the level of support for agriculture in the EU (measured by the NRA indicator) was constantly increasing. The decline in support in subsequent years was maintained by payments of the decoupled type. Based on NRA values it can be concluded that nominal support in 2011 was at a level comparable to that recorded prior to the creation of an organisation of agricultural markets, that is, before 1962. This means that the CAP is distorting world prices to an ever smaller degree, and agricultural producers are losing their competitive advantages (although to differing extents). An important observation is the fact that, although the CAP applies to all member states, the level of support varies between those countries. In 2005-2011 it was the highest in Ireland, Slovenia, Poland, Belgium and the UK, and the lowest in Italy and Bulgaria. This observation 240 Summary: Political Rents and the European Model of Agriculture is confirmed by a second indicator constructed for the purposes of this research by the authors of Chapter 2.3 – the Farm Receipts Gap Estimate (FRGE). Despite the fact that in principle agricultural policy has a universal application, the amount of financial support given to agricultural producers measured as a percentage of gross farm receipts is not uniform between countries, with differences as high as 17 percentage points in 2012136 (cf. Table 2.4.). We should add that, according to the OECD, the value of the PSE for the whole of the European Union is 22.6% (of gross receipts). The differences between the PSE and the FRGE result partly from the methodology used for calculation. Most importantly, however, the FRGE shows how little uniformity there is across the EU in terms of support for agricultural producers in different countries. The differences are even more marked when we consider the contribution of pure political rent137 to the revenue of producers in various countries. In the Netherlands this contribution is just 4.3%, while for Ireland it is 25.8% (although the highest value, 28.7%, is recorded in Finland; cf. Table 3.12.). These data also demonstrate one more thing: that the PSE should not be used as a measure of political rents, because it significantly overstates them. The mechanisms shaping the structure of transfers in the selected countries also exhibited clear differences. This applies in particular to the two main streams of transfers: from taxpayers to producers and from consumers to producers. There has also been a gradual change in the structure of support, away from consumer transfers towards taxpayer transfers. This has resulted both from changes taking place in the global economy and the rise in prices of agricultural products, as well as from transformations in agriculture's role in the economy. A key part of the book proved to be Part 3, which presents the concept and the effects of long-term surplus drainage from agriculture under the various support models applied in the EU as regards equivalent payments (for specific public goods) and the different models for the taxation of agriculture. The analysis leads to what are called pure political rents, being what remains when the value of the aforementioned flows (drainage and net subsidies for public goods) is deducted from the sum of CAP subsidies. It should be noted that only rents calculated in this way meet the definition of political rent found in the public choice theory. Another important thread in this discussion concerns price fluctuations and their consequences. Agriculture is characterised by a high variability of prices in particular markets, which leads to adjustments of supply. This reaction is not always as described by neo-classical concepts – the spider's web and King's effects. Farmers' expectations in different countries may be more or less adaptive, and are sometimes 136 From 19.99% in the Netherlands to 36.96% in Ireland. 137 After adjusting the support by that part the receipt of which is conditional on the supply of specified public goods, and by the value of long-term drainage resulting from market failures. Summary: Political Rents and the European Model of Agriculture 241 rational. This depends on the degree of horizontal and vertical integration of sale channels, and on access to information. This price variability leads to unexpected flows of economic surplus into and out of agriculture, and in the authors' view, this produces a drainage effect in the long term. In response, there is a fluctuation in economic activity and in the economic situation in agriculture. This process is not uniform, however, and varies between different EU countries, as the authors observe. They propose an economic indicator based on surplus flows as a result of price fluctuations, based on an input-output table. The largest fluctuations were recorded in such countries as Germany, Denmark, the Czech Republic, Slovakia, Estonia and Lithuania. At the other extreme (with the smallest amplitudes of variation) are Portugal, Greece, Cyprus and Malta. At the same time, the value of the computed indicator determined the changes in farms' output and receipts, although in some countries this was a concurrent response, while in others it was delayed. This partly confirms the hypothesis that the outflow of economic rent from agriculture means a drop in productive activity, and vice versa (in some cases, however, such as in Poland, the response was delayed – recalling the spider's web theory). It was also shown that the relationship between the economic indicator and the production of agricultural raw materials differs between countries. In Germany, for example, the variation in output as a response to price changes is relatively low. Even in the most difficult period for agriculture (2009) production fell there by just 1%, compared with 15% in Portugal and as much as 30% in Poland, despite a smaller drop in the economic indicator. The authors believe this to be a result of the different agrarian structure, scale and technology of production, differences in the functioning of market institutions (integrative links, contracting systems), and the reactions of the producers themselves to the situation. To sum up, drawing conclusions about the general economic situation based on flows of economic rents is an atypical approach, but one that can identify the causes of variation in the productive activity on farms and help compare the scale of such variation between countries. This approach may also be a useful analytical tool for agricultural policy, which becomes particularly important in conditions of the intensification of processes of globalisation. In generalising the conclusions drawn from the analysis of the structure of CAP support in selected EU countries, three different models were identified138. Only 138 The structure of support is described based on the contribution of the following variables to total variable subsidies: X1 – the value of payments for public goods, being the sum of set-aside, agri-environmental and less favoured area payments and other subsidies for the development of rural areas; X2 – the value of subsidies for plant and animal production (the sum of other payments to plant and animal production plus the balance of subsidy and penalties for milk production, subsidy for other cattle production and subsidy for sheep and goat production); X3 – the value of single farm and area payments; X4 – the value of subsidies for indirect consumption; X5 – the value of investment subsidies. 242 Summary: Political Rents and the European Model of Agriculture two of them – model A (dominated by single farm and area payments, and with payments for the supply of public goods making up 17% of the total) and model C (combining different mechanisms of support for farms, with the highest contribution from payments for public goods, 33%) – were in accordance with the development priorities of the European agricultural model as defined in the new programming period of 2014-2020. These operated throughout most of the area of the EU in 2012, particularly in the new member states (cf. Figure 3.3.). Nonetheless, in most regions of the "old" EU-15 member states, the model in operation in 2012 was model B, oriented exclusively towards direct payments, which are treated as a substitute for support for production and produce a relatively weak stimulus for sustainable development. Further calculations showed that these countries receive more than 80% of the pure political rents derived from the CAP. There is also a large variation between EU countries as regards agricultural income. The tax systems applied to agriculture, however, are very similar (with certain exceptions, such as the case of Poland). They incorporate taxes on income, assets and consumption (VAT). The Polish system is different in that it does not include a tax on income from agricultural production. Based on an evaluation of the tax systems applied to agriculture in selected EU countries, it is possible to identify countries having the most restrictive tax policies towards agriculture (Belgium, Portugal, Ireland, Spain) and those where such policies are less restrictive (the UK, Germany, Italy, the Netherlands). Taking account of the long-term surplus drainage from agriculture and the net equivalent subsidies (in exchange for specific actions relating to public goods), an estimate was made of the value of "pure" political rents for individual countries of the EU-27. The analysis carried out here points to the conclusion that agricultural interventionism in the EU requires a special conceptual approach, since it is not sufficient to simply treat all subsidies as political rents. The new approach proposed by the authors is necessary, as it provides an indication of how to improve the effectiveness of allocation of support for agriculture in individual EU countries. Quantification of the political rent in agriculture enables a more rational and socially appropriate distribution of assistance from the CAP in accordance with the goals set for agricultural policy in the new financial framework after 2014. Although the division of payment envelopes between member states has already been decided, since 2014 the CAP has gained flexibility in terms of the structure of both pillars and transfers between them. These matters remain in the hands of the governments of member states. Another issue is the aforementioned contribution of political rents to the gross receipts from agriculture in a given country (cf. Tables 3.12. and 3.13.). On average in the EU-27 this contribution is 13.63%, and although in the EU-12 it is slightly Summary: Political Rents and the European Model of Agriculture 243 higher, and in the EU-15 somewhat lower than average, there are countries in which that value is exceeded almost twofold. Redefinition is required as regards the issue of social fairness in the determination of the sizes of national CAP envelopes. The calculations of political rents show that historical payments are neither a rational nor a just solution, because the structurally low profitability of agriculture in certain countries should be compensated for by a higher supply of public goods, and this is not happening. Perhaps countries with structurally inefficient agriculture should supply more public goods than they do at present, if they wish to maintain their current ratio of political rents to gross added value, or else subsidise their agriculture to a greater degree out of national funds. Part 4 of the book contains case studies. These demonstrate the applicative dimension of the paradigm of sustainable development and methods of evaluating the effectiveness of agricultural policy in supporting such development in rural areas. Naturally, the results of these studies are not representative for agriculture as a whole (at national or EU level). Nonetheless, they indicate a direction for discussion concerning the development of sustainable agriculture in theory and in practice, and provide methodological guidance. They develop a methodology for examining regional sustainable development, which enables not only a sustainability assessment, but also a comparison of synthetic indicators over the whole of the analysed period. Also a set of analytical models is proposed, which make possible not only a better management of human and material capital in firms in agricultural and food sectors, but also the identification of areas that need to be improved to enable these resources to be used more competitively. Among the detailed findings, the following are particularly striking: • The location-specific factor "type of rural area", based on land functions, is of key importance for land value in the SAPS. The area type determines whether particular use values, such as area or shape coefficient, and amenities, such as the possibility of building, as well as payments under agricultural policy, affect the land price. • There is a very large variation in land prices in the SAPS, and prices are strongly affected by speculation, which has driven the upward trend since the introduction of area payments in 2004. However, the impact of speculation is relatively small in areas with agrotouristic features. • Agricultural policy, in particular payments for public goods, has a very large significance (marginal effects) for the value of agricultural land compared with other parcel-level attributes of properties. • Payments for public goods are however capitalised in land prices only in peripheral areas. Elsewhere they fail to perform their role, and are even associated with the decapitalisation of the value of land. In particular, in 244 Summary: Political Rents and the European Model of Agriculture agrotouristic areas these schemes should be complementary and not substitutive with respect to the multifunctional development of the countryside. Therefore, in most places at present, single area payment support is not a differentiating factor for land value, in view of its general availability and low requirements, and the other payments do not compensate for the opportunity costs related to alternative ways of deriving rent from land. • Similarly, support for agrotouristic activity did not have a significant effect on the level of income from agrotourism among the analysed farms. This was because interest in such support came from those farms that did not yet obtain relatively high amounts of income from agrotourism; and moreover the instrument was not of a universal nature, but required the fulfilment of specified conditions. It can be expected that the situation was similar throughout Poland. • The relationships between agriculture and agrotourism are symbiotic in nature. Their common plane includes both the income of farms engaged in agricultural and agrotouristic activity, and the support provided by CAP instruments. In consequence, the preliminary conclusion can be reached that direct subsidies favour the economic activation of farms in non-agricultural activity. • The instruments of the CAP can be expected to evolve to favour the creation of public goods at local authority level rather than the development of agrotouristic activity itself at farm level. A particularly striking aspect of the findings of these case studies is that they point towards a common problem: the idea of payments for public goods under agricultural policy is set forth as a leitmotif of the European agricultural model, but in practice the CAP does not succeed in valuing these goods accurately. Perhaps this value is too low compared with the funds allocated indirectly to support production and efficiency, perversely given the name "decoupled"? Hence, the idea remains more a declaration than reality. This conclusion is confirmed by the variation in pure political rents obtained by agriculture (one might say non-equivalent rents) between EU countries in 2004-2012: ranging from approximately 9% of value added by agriculture in the Netherlands, to over 95% in Ireland. Are such disproportions, which it is hard to justify by any objective criteria, acceptable from the point of view of social justice and common community ideology? Alluding to the hypothesis put forward at the outset: there is something called the European model for the development of agriculture, but it is implemented in a minority of EU countries. Their common denominator is that pure political rent, after taking account of public goods and market corrections, accounts for a similar proportion of agricultural income. ; National Science Centre ; Bazyli Czyżewski
Córdoba es la segunda ciudad más poblada de la Argentina, y posee el ejido municipal más extenso del país, siendo un importante centro industrial y de servicios del centro del país. Es además la cabecera de la segunda región metropolitana argentina, el Área Metropolitana de Córdoba (AMCBA). Si bien el desarrollo de sus áreas centrales y periurbanas es un tema bastante desarrollado académicamente, actualmente hay un vacío de conocimiento en la situación actual de las áreas pericentrales e intermedias de esta ciudad -aun cuando ocupan más del 30% del área urbanizada y donde habita la mayor parte de su población-. Es en estas áreas donde se ubica el objeto de estudio de esta tesis: los barrios pericentrales que forman un anillo alrededor del área central. Originados como extensiones suburbanas alrededor de 1940, y consolidados como barrios residenciales de clase media y media alta de baja densidad antes de 1970, ocupan lo que son hoy algunas de las áreas con mejor calidad ambiental y urbana de la ciudad. Los barrios pericentrales son considerados generalmente consolidados y estables; sin embargo, analizados en detalle, muestran complejas transformaciones: un vaciamiento poblacional constante, a pesar del crecimiento demográfico en general de Córdoba y el AMCBA; aumento de inmuebles abandonados; y a diferencia de sectores en una similar posición, no son objeto de grandes inversiones inmobiliarias de renovación urbana. Esta situación es invisibilizada, en parte por ser resultado de procesos con poco impacto relativo en la ciudad, y en parte porque estos procesos no están contemplados por los modelos urbanos locales vigentes –basados en la teoría racionalista y determinista de principios del siglo XX-, que conceptualizan a los barrios pericentrales como una "panacea urbana". Esta tesis puso en disputa estos modelos, partiendo de la discusión sobre un fenómeno informal detectado indefectiblemente (aunque no exclusivamente) en estos barrios pericentrales: la microdensificación emergente. La imposibilidad de colocar los inmuebles existentes en el mercado hace que los propietarios busquen nuevas formas de valorizar sus propiedades, de facilitar el acceso a la vivienda a sus hijos o de invertir sus ahorros de forma segura, obteniendo una fuente adicional de ingresos: en cada parcela edificada se aumenta la cantidad de unidades funcionales, aprovechando la superficie construible vacante o refuncionalizando las construcciones obsoletas, aunque manteniendo el grano y la escala de intervención respecto al tejido existente. La oferta de hábitat en estos barrios se diversifica, y no sólo evita la expulsión de población, sino que también atrae a nuevos habitantes. Además, en un tejido originalmente sólo residencial, incorpora actividades de comercio y servicios que enriquecen el tejido funcional. El proceso se realiza sin planificación general (y por supuesto fuera del marco legal): es la suma de acciones individuales que se reconstruyen como una "tendencia" o "patrón emergente", revitalizando el tejido urbano de forma sutil pero definitiva. Se planteó como hipótesis que la microdensificación emergente es un proceso de revitalización que aprovecha el potencial del tejido de estos barrios de forma más sostenible y eficiente que el modelo impuesto formalmente. 10 La tesis se encuadró bajo el enfoque sistémico de la complejidad. Este enfoque entiende a la ciudad como un sistema complejo y dinámico, en desarrollo constante; determinado más por las interrelaciones entre sus componentes y entre esos componentes y el contexto, que por las condiciones de cada elemento individualmente. La calidad y cantidad de estas interacciones es primordial, al punto de definir la condición urbana de una aglomeración. Según estas premisas, un sistema urbano sostenible y eficiente será aquel que, maximizando recursos materiales y humanos (y de acuerdo a la capacidad de carga del sistema) desarrolle de redes de intercambio múltiples, diversas y descentralizadas, que generen procesos de sinergia y desarrollo inclusivos. La investigación se estructuró entonces de forma tal de responder las siguientes preguntas: • En primer lugar, ¿cuáles son las condiciones específicas que catalizan la microdensificación en los barrios pericentrales de Córdoba? • Siendo la microdensificación una respuesta a una situación particular dentro del sistema urbano, ¿Cuál es el grado de sostenibilidad y eficiencia que aporta a los barrios pericentrales (en particular) y a Córdoba (en general)? • Y tras haber identificado su impacto en la estructura urbana, su potencial transformador y organizativo, ¿puede el estudio de los procesos emergentes hacer un aporte conceptual e instrumental a los modelos locales de planeamiento urbano? Primeramente, un análisis documental reconstruyó la condición específica de los barrios pericentrales, y el escenario actual de Córdoba con respecto a la producción y acceso al hábitat urbano. Luego se infirió un escenario tendencial a corto y mediano plazo, que sirvió para definir distintos patrones de territorialización, incluyendo el patrón "formal" de los barrios pericentrales. Se continuó con el análisis específico de la microdensificación, proponiendo un escenario posible a mediano plazo donde el patrón de microdensificación ha sido plenamente desarrollado, transformando cuali y cuantitativamente el tejido espacio-funcional y socioeconómico. A partir de estos resultados, se realizó un análisis comparativo de los distintos patrones de desarrollo urbano de Córdoba en cuanto a su sostenibilidad y eficiencia. Se demostró que el patrón de microdensificación en los barrios pericentrales es mucho más sostenible y eficiente que los patrones formales existentes, y se abrió la discusión que se desarrolla en la última parte de esta tesis: El argumento desarrollado en esta investigación y los resultados que de él se desprenden tienen un carácter analítico y explicativo útil para el análisis de otros escenarios en el contexto urbano argentino y latinoamericano. En primer lugar, sobre preferir la revitalización progresiva frente a la renovación total o la creación de nuevo suelo urbano en la periferia; promover una ciudad compacta, diversa e inclusiva tanto social como funcionalmente; basada en la multiplicación y diversificación de los agentes productores de ciudad; que considera estos procesos, así como los mecanismos de empoderamiento, participación y gobernanza como instrumentos para lograr mayor sostenibilidad y eficiencia en el desarrollo urbano. Por otro lado, esta tesis puso en relevancia el rol de los procesos emergentes en un sistema urbano como mecanismo vital para generar esta revitalización. Finalmente, se discute el aporte del enfoque sistémico para comprender, explicar y proponer intervenciones a la disciplina. ; Córdoba ist die Hauptstadt der gleichnamigen Provinz im Nordosten Argentiniens. Sie ist der Mittelpunkt der zweitgrößten Metropolregion des Landes (bekannt unter der spanischen Abkürzung AMCBA) und ein wichtiges kulturelles und wirtschaftliches Zentrum des Landes. Derzeit scheint die Stadt durch zwei gegensätzlichen Prozesse geprägt, die zeitgleich von statten gehen: Einerseits die Erneuerung des Zentralbereichs und der Umgebung durch Hyperverdichtung, mit dem damit verbundenen Verlust des sozialen und architektonischen Erbes und dem Zusammenbruch der vorhandenen Infrastruktur-Netzwerke. Anderseits die Expansion der gebauten Stadt auf ländliche und industrielle Gebiete der städtischen Peripherie, was aufgrund einer abnehmenden Belegungsdichte immer mehr zu einer Verdünnung der Stadtstruktur führt. Darüber hinaus konzentriert sich der Wohnungsbau auf immer kleinere Gruppen und dies obwohl sich sowohl der Wohnungsbau beschleunigt als auch das Angebot an urbanen Wohnräumen erhöht: Während private Immobilienprojekte fast ausschließlich auf Bevölkerungsgruppen mit hohem Einkommen und Investoren, die nicht in der Stadt wohnen, ausgerichtet sind, sind die staatlichen Investitionen im sozialen Wohnungsbau ausschließlich für die Bevölkerungsgruppen mit den niedrigsten Einkommen bestimmt. Dadurch entsteht ein Defizit an Wohnangeboten für die Mittelschicht Córdobas, die fast 45% der Stadtbevölkerung ausmacht. Diese Schwerpunktsetzung ist auch bei lokalen Stadtforschern und Stadtplanern zu erkennen. Die aktuelle Situation der perizentralen Gebiete und Zwischenbereiche der Stadt sind weniger präsent, obgleich diese mehr als 30 % der urbanisierten Stadtfläche einnehmen und von der Mehrheit der Stadtbevölkerung bewohnt werden. Um diese Wissenslücke zu schließen, stehen die perizentralen Stadtviertel, die das Stadtzentrum umschließen, im Mittelpunkt dieser Arbeit. Sie sind ab 1940 als Erweiterungen der Vorstadt entstanden und etablierten sich im Laufe der 1960er Jahre als Wohngebiete mit einer geringen Bevölkerungsdichte, die heute von der Mittelschicht bewohnt werden und die höchste Umweltqualität und urbane Qualität der Stadt aufweisen. Die Gesetzgebung begrenzt dabei die Bebauung der Grundstücke auf Einfamilienhäusern, um die gewünschte geringe Bevölkerungsdichte beizubehalten. Man könnte die Untersuchung von bereits konsolidierten und stabilen urbanen Sektoren als sinnlos betrachten. Doch, wenn sie im Detail analysiert werden, zeigen sich komplexe demografische, räumliche und funktionale Transformationen, die von Interesse sind. Obwohl sich über die Jahre hinweg in diesen Stadtvierteln das bis zu diesem Moment angeblich "perfekteste" Wohnmodell materialisiert hat, nämlich ein Modell, welches "alle möglichen städtischen Wohnbedürfnisse erfüllt", leidet das soziale Gefüge und die bebaute Umwelt darunter. Das aktuelle Szenario zeigt, trotz des demografischen Wachstums von Cordoba und der Metropolregion AMCBA, einen konstanten Bevölkerungsrückgang in diesen Stadtvierteln: Junge Leute verlassen die Wohngegenden, während die zurückbleibende Bevölkerung altert und die Anzahl an verlassenen Gebäude stetig steigt. Für die auf dem Immobilienmarkt angebotenen Gebäude ist es schwierig, den Immobilienwert zu halten geschweige denn Käufer zu finden. Im Gegensatz zu anderen Bereichen der Stadt, die sich in einer ähnlichen Position befinden, sind diese Stadtviertel nicht im Fokus großer Immobilienaktivitäten. Dies widerspricht ihrer privilegierten Lage innerhalb der Stadtstruktur. 2 Diese Entwicklungen wurden lange Zeit übersehen. Zum einen da sie das Ergebnis von Prozessen sind, die wenig Auswirkungen auf die Stadt haben und zum anderen weil diese Prozesse in den heutigen lokalen städtischen Wohnmodellen nicht berücksichtigt werden, welche auf rationalistischen und deterministischen Theorien aus dem Anfang des 20. Jahrhunderts basieren und diese perizentralen Stadtviertel als städtisches Allheilmittel betrachten. Es ist unmöglich eine Hypothese abzuleiten, die aktuelle oder zukünftige Szenarios der perizentralen Stadtviertel in Córdoba unter diesen Rahmenbedingungen erklärt. Daher stellt diese Arbeit solche Modelle und ihre Fähigkeit, die Entwicklung der Stadt zu erklären oder in ihr effektiv zu arbeiten, in Frage und schlägt einen theoretischen Rahmen vor, der zum Verständnis, zur Erklärung und zur effektiven Umsetzung in der Stadt beitragen soll. Dies erfolgt auf Grundlage der Auseinandersetzung mit einem informellen Phänomen, welches deutlich (aber nicht ausschließlich) in diesen perizentralen Stadtvierteln erkennbar ist: die aufkommende Mikroverdichtung. Aufgrund der bereits genannten Unmöglichkeit, existierende Immobilien gewinnbringend auf den Markt zu bringen, suchen Eigentümer neue Wege, um ihr Wohneigentum aufzuwerten, ihren Kindern den Zugang zu einer Wohnung zu erleichtern oder ihre Ersparnisse sicher zu investieren und sich dadurch eine zusätzliche Einnahmequelle außerhalb des traditionellen Immobilienmarktes zu sichern. Aus diesem Grund erhöhen die Eigentümer die Anzahl der funktionalen Einheiten auf ihrem Grundstück, indem sie freie Fläche bebauen oder veraltete Konstruktionen renovieren. Das Stadtgefüge wird dabei durch diese Eingriffe nicht tiefgreifend verändert. Des Weiteren wird das Wohnraumangebot in diesen Stadtvierteln umfangreicher und verhindert nicht nur die Verdrängung der alten Bewohner, sondern zieht auch neue an. Auch werden dem ursprünglichen Wohngebiet zusätzliche nicht-residentielle Nutzungen hinzugefügt, die das Stadtgefüge bereichern. Letztendlich hat die Mikroverdichtung der perizentralen Nachbarschaften eine spezielle Eigenschaft, und zwar seinen emergenten / aufkommenden Zustand: Der Prozess erfolgt ohne allgemeine Planung (und auch außerhalb des rechtlichen Rahmens). Hauptakteure dieses Wandels sind die Eigentümer selbst, die ohne jegliche vorherige Absprachen agieren. Ob aus Notwendigkeit oder aus Opportunismus heraus, es handelt sich dabei um einen fragmentierten Prozess. Es beinhaltet eine Vielzahl individueller Aktionen, die als ein "Trend" oder "neu aufkommendes Muster" innerhalb der allgemeinen Organisation der perizentralen Stadtviertel zu begreifen sind und das Stadtgefüge auf subtile aber endgültige Art und Weise erneuern. Die vorliegende Arbeit stellt die Hypothese auf, dass die aufkommende Mikroverdichtung in diesen Stadtvierteln von Córdoba ein Revitalisierungsprozess ist, der das Potenzial des Stadtgefüges nachhaltiger und effizienter nutzt als das formell auferlegte Stadtentwicklungsmodell. Aufgrund des offenkundigen Gegensatzes zwischen dieser Hypothese und den aktuellen Rahmenbedingungen der lokalen Stadtentwicklung, ist es notwendig, einen theoretischen Rahmen zu schaffen, der die offensichtlichen Widersprüche auflöst und die Arbeitshypothese einrahmt. Diese These ordnet sich dem systemischen Ansatz der Komplexität zu, der analytischen Erforschung von komplexen Systemen. Dieser theoretische Rahmen ermöglicht, die aufkommenden Prozesse als integraler Bestandteil einer Stadt (ein "urbanes System"), seine Entwicklung im Laufe der Zeit, seine Komplexität und die Faktoren, von denen die urbane Nachhaltigkeit und Effizienz abhängen, zu erklären. Der systemische Ansatz begreift die Stadt als ein komplexes und dynamisches System in ständiger Entwicklung; ein System, das eher durch die Wechselbeziehungen zwischen seinen Komponenten und zwischen diesen und dem Kontext bestimmt wird, als durch den einzelnen Zustand jedes Elements. Die Qualität und Quantität dieser Interaktionen steht dabei an erster Stelle und definiert sogar den urbanen Zustand eines Ballungsgebietes. Urbanität ist nicht allein durch ihre Größe oder ihre Dichte gegeben, sondern ist gemäß der Synergie definiert, die durch eine Vielzahl an verschiedenen Interaktionen und Wech3 selwirkungen zwischen unterschiedlichen Akteuren produziert wird. Dieser Prozess heißt Synoikismos. Die Entfaltung der technologischen, sozialen und politischen Entwicklungen und Innovationen, die den städtischen Zustand charakterisieren, ist das inhärente Ergebnis dieser Interaktionen und eine direkte Funktion ihrer Intensität, Vielfalt und Redundanz, sowohl räumlich als auch zeitlich. Laut diesen Voraussetzungen ist ein nachhaltiges und effizientes Städtesystem eines, das durch die Maximierung der menschlichen und materiellen Ressourcen (und der Systembelastbarkeit entsprechend) mehrere unterschiedliche und dezentrale Austauschnetzwerke entwickelt, die inklusive Synergie- und Entwicklungsprozesse erzeugen. Dies bedeutet zum einen eine energieeffiziente Stadt, auch effizient im Konsum jeglicher Ressourcen und zum anderen eine kompakte Stadt, welche mehrere Begegnungen zwischen verschiedenen Akteuren ermöglicht, die Beteiligung an politischen Mechanismen und die intensive Nutzung des öffentlichen Raums, die Fußgängermobilität und eine funktionale und soziale Vielfalt in der Stadt fördert. Dies schließt auch Flexibilität und Anpassungsfähigkeit an Veränderungen durch Widerstands- oder Transformationsprozesse ein. Laut den lokalen Stadtentwicklungsmodellen, sind aufkommende und informelle Prozesse, wie die Mikroverdichtung, ein Zeichen der Krise im städtischen System: Anomalien, die durch die Entwicklung von schädlichen Prozessen im Konflikt mit dem Rest der Stadtstruktur entstanden sind. Konflikte, die sogar zum Zusammenbruch führen können. Laut dem theoretischen Ansatz dieser Arbeit jedoch, können diese Prozesse auch als Versuch des Systems verstanden werden, sich selbst zu regulieren und sich an neue Situationen anzupassen: Als Antwort auf ein ungelöstes Spannungsszenario; eine Art und Weise, in der das System sich selbst organisiert, um auf diese Spannung zu reagieren, indem ein neues Gleichgewicht gesucht wird. Die Arbeit strukturiert sich anhand von diesem theoretischen Rahmen, um die folgenden Fragen beantworten zu können: • Erstens, welche besonderen Rahmenbedingungen führen zu der aufkommenden Mikroverdichtung in den perizentralen Stadtvierteln in Córdoba? • Begreift man die Mikroverdichtung als Antwort auf eine bestimmte Situation innerhalb des städtischen Systems, stellt sich folgende zweite Frage: Welches Ausmaß an Nachhaltigkeit und Effizienz ermöglichen die Prozesse der Mikroverdichtung in den perizentralen Stadtvierteln im Speziellen und in Córdoba im Allgemeinen? • Nach der Identifizierung der Auswirkungen dieser Prozesse auf die Stadtstruktur, sowie des damit einhergehenden transformativen und organisatorischen Potenzials steht die dritte Frage im Raum: Kann die Erforschung von aufkommenden Prozessen dieser Art einen konzeptionellen und instrumentellen Beitrag zur lokalen Stadtplanung leisten? Um diesen Fragen nachzugehen wurde im weiteren Verlauf der Forschung eine Dokumentenanalyse durchgeführt, um den spezifischen Zustand der perizentralen Stadtviertel, der das Phänomen der aufkommenden Mikroverdichtung ermöglicht, zu rekonstruieren. Diese Analyse vollzog sich in zwei Schritten: Als Erstes wurden die perizentralen Stadtviertel und der Grund für ihr besonderes Urbanisierungsmuster historisch rekonstruiert und dadurch als (nahezu) monofunktionelle Wohnviertel mit einer geringen Bevölkerungsdichte identifiziert. Als Zweites wurde das aktuelle urbane Szenario Córdobas hinsichtlich der Produktion von und dem Zugang zu städtischem Habitat analysiert, um urbane, regionale und globale Variablen zu entwickeln, die die Entwicklungstrends der Stadt bestimmen. Dieses Vorgehen ermöglichte die Formulierung eines umfassendes Arguments, das alle Prozesse erklärt, die bisher als "gleichzeitig aber widersprüchlich" erfasst wurden. Darüber hinaus erklärt und prognostiziert dieses Argument die "undenkbare" Situation von perizentralen Stadtvierteln. Nach der Rekonstruktion des aktuellen Szenarios wurde ein kurzes und mittelfristiges (10 Jahren) Trendszenario des Phänomens abgeleitet. Dies diente dazu, die unterschiedlichen 4 Entwicklungsmuster in Córdoba zu vergleichen und deren Auswirkungen auf die Stadtstruktur zu bewerten. Im weiteren Verlauf der Arbeit wurde die Analyse der Mikroverdichtung hinsichtlich der Veränderungen im sozialen, funktionalen und räumlichen Stadtgefüge fortgeführt. Als Ergebnis wurde ein mögliches Zukunftsszenario vorgeschlagen, bei dem das Muster der Mikroverdichtung formalisiert und somit das räumlich-funktionale und sozioökonomische Gefüge der Stadtviertel transformiert wurde. Anschließend wurden das Potenzial und die Stärken (und Schwächen) gegenüber dem mittelfristigen Trendszenario von Córdoba und den perizentralen Stadtvierteln spezifiziert. Basierend auf diesen Ergebnissen wurden verschiedene Stadtentwicklungsmuster von Córdoba mithilfe der Variablen analysiert, die als strukturelle Bedingungen für Nachhaltigkeit und Effizienz definiert waren. Mit dem Ergebnis, dass die Nachhaltigkeit und die Effizienz der Mikroverdichtungsszenarien deutlich größer war als in den aktuellen Trendszenarien. Die vorliegende Analyse konnte somit die Hypothese dieser Arbeit belegen. Im letzten Abschnitt der Arbeit wurde der Diskussionsteil eröffnet. Die erste Diskussion befasste sich mit der Entwicklung, die eine progressive Revitalisierung fördert anstatt einer vollständigen Erneuerung des Stadtgefüges oder der Schaffung von neuem städtischem Land in der ruralen Peripherie der Stadt. Zudem fördert sie sowohl auf soziale, räumliche als auch funktionale Art und Weise eine kompakte, vielfältige und integrative Stadt. Diese Entwicklung beruht auf der Multiplikation und Diversifizierung der Akteure, die im Städtebau involviert sind, und betrachtet diese Prozesse, sowie die Ermächtigungs-, Beteiligungs- und Staatsführungsmechanismen als Instrumente zur Erlangung einer größeren Nachhaltigkeit und Effizienz in der Stadtentwicklung. Das bedeutet, eine Stadt, die in der Lage ist, kreativere Synergien zu schaffen und so zu sozialen, technologischen und wirtschaftlichen Vorteilen kommt. Des Weiteren betonte diese Arbeit die Rolle der aufkommenden Prozesse in einem städtischen System. Die aufkommende Mikroverdichtung hat wenig Einfluss auf die städtische Struktur von Córdoba. Jedoch ist es ein wichtiger Mechanismus, um die Verarmung und den Verlust von Ressourcen in perizentralen Bereichen und Zwischengebieten zu verhindern, d.h. um den partiellen Zusammenbruch der städtischen Struktur zu vermeiden und gleichzeitig Urbanität in Gebieten zu schaffen, die als bloße Wohnungsviertel charakterisiert sind. In der Stadtplanung ist es wichtig, auf aufkommende Prozesse in der Stadtentwicklung und auf die Erzeugung von Synergien Wert zu legen. Ihre Einbeziehung in die kritische Analyse beinhaltet die Entwicklung von Planungsinstrumenten, die nicht nur die Notwendigkeit der Dezentralisierung der Stadtentwicklung und der Entscheidungsfindung erkennen können, sondern die auch in der Lage sind, die Ungewissheit als Variable zu integrieren. Darüber hinaus müssen sie flexibel genug sein, um Veränderungen und die Notwendigkeit für Korrekturen und Anpassungen im Laufe der Zeit zu erkennen. Das Argument dieser Arbeit hat einen analytischen und erklärenden Charakter, der für die Analyse von anderen urbanen Szenarien in Argentinien und Lateinamerika nützlich ist. Dies ermöglicht die Verallgemeinerung sowohl der Ergebnisse als auch der theoretischen Annäherung an städtische Phänomene, basierend auf dem Stadt-Verständnis als komplexes, für ihre Umgebung offenes System, welches weit entfernt vom Gleichgewicht ist. Der größte Beitrag dieser Arbeit zur Urbanistik ist das Verständnis der Rolle der aufkommenden Phänomene und die Analyse der Widersprüche und Spannungen innerhalb der traditionellen lokalen Stadtmodelle, die auch Ausgrenzungen und Ungerechtigkeit im Zugang zu Stadt hervorhebt. Die Rolle des Staates und des Immobilienmarktes in der Stadtentwicklung von Cordoba wurde denaturiert und eine dialektische Artikulation der Logik des territorialen Lebensraumes in der Stadt, die sowohl Produktions- und Zugangsstrategien als auch die scheinbaren Widersprüche in der Stadtentwicklung der lateinamerikanischen mittelgroßen Städten erklärt, wurde vorgeschlagen. ; Córdoba is the capital of the province of Córdoba, in Argentina. It is also the principal city of the second-most populous metropolitan area of the country, the Greater Córdoba Metropolitan Area (AMCBA according to its acronym in Spanish), with strengths in business, automotive industry, culture, education, and research. Currently, the city seems to develop in two simultaneous and opposing processes: On the one hand, renovation by densification of the central area and its extensions, with losses of social and built heritage, and the collapse of infrastructure networks that this entails. On the other hand, extension of the urbanized area over rural and industrial periphery, with dwindling occupancy densities that dilute the urban structure more and more in the territory. Besides that, although housing production accelerates -increasing its supply-, it is concentrated in ever smaller groups: while real estate projects are targeted almost exclusively at high-income sectors and investors who do not live in the city, State investment in social housing is allocated exclusively to lower income sectors. This situation produces a deficit in proposals aimed at the so-called "middle class", even though it makes up of almost 45% of the city´s population. In addition, these processes concentrate the interest of the greater part of both local academics and urban planners. This situation produces a knowledge gap in the current situation of Córdoba´s pericentral and intermediate areas, which occupy more than 30% of the city´s urbanized land (and where the majority of this city´s inhabitants reside). It is there where this thesis´ case study is located: the pericentral districts that surround the central area. They originated as suburban extensions around 1940, and consolidated as middle-class/low-density residential neighborhoods before 1970. Today, they occupy some of the best environmental and urban quality areas of the city. Even land-use regulation specifically limits occupancy to single-family dwellings on individual plots to maintain the desired low-density residential neighborhood pattern. We can discuss the futility of studying urban sectors considered already consolidated and stable; however, when analyzed in detail, pericentral areas show complex demographic, spatial, and functional transformations that contradict this characterization: Despite the fact that these neighborhoods materializes the supposedly "most perfect" residential model known until now, a model "that solves each and every one of the urban-life needs", its social and built fabric resents. The current scenario shows a constant population-shrinking process, in spite of the demographic growth of both Córdoba and the AMCBA. Young people leaves these neighborhoods, while the remaining population ages. Abandoned buildings constantly increase; the ones offered in the real estate market have difficulties to find buyers, or even to maintain their price, which contradicts its privileged status within the city. At the same time -and unlike areas in a similar position- these neighborhoods are not the object of major real estate investments. Local academics and urban planners overlook this situation, in part because it is the result of processes with relative less impact in the city, and in part because these processes are not covered by current local urban models -based on the rationalist and deterministic urban theory of early 20th century-, which conceptualize suburban neigh6 borhoods as an urban panacea. It is impossible to deduce a hypothesis that explains the current nor the trend scenario of pericentral neighborhoods of Córdoba in terms of that framework. Therefore, this thesis discussed those theoretical models, and its capacity to explain Córdoba´s development. It proposed a theoretical framework that allowed understanding, explaining, and operating effectively in the city. It did so based on the discussion of an informal phenomenon unfailingly (but not exclusively) detected in pericentral neighborhoods: the emergent micro-densification. Given the impossibility of advantageously placing their properties in the housing market -due to factors such as land-use restrictions, and specific conditions of the local real estate market-, the landowners seek new ways to valorize their properties, facilitate access to housing for their children, or profitably invest their savings, obtaining an additional income outside the "traditional" real estate market. They increase the number of functional units in their plots, occupying the vacant building area or refurbishing obsolete constructions, while maintaining the intervention scale in relation to the existing urban fabric. These neighborhoods´ housing supply diversifies; and it not only prevents the expulsion of population, but it also attracts new inhabitants. In addition, in an originally residential fabric, it incorporates non-residential activities that enrich the urban fabric. Finally, micro-densification in pericentral neighborhoods presents a differential quality: its "emergent" condition. The process carries out without general planning (and of course outside the legal framework); inhabitants/landowners decide to do so, without any prior agreement. It is an atomized and fragmented process, result of necessity or opportunism. It is the sum of individual actions reconstructed as a "trend", or an "emerging pattern" within the general organization of pericentral neighborhoods, revitalizing the urban fabric in a subtle but definitive way. This research hypothesized that emergent micro-densification in these neighborhoods is a process of revitalization that harnesses the potential of their urban fabric; it does so in a more sustainable and efficient way than the current urban development patterns. Faced with the manifest opposition between this hypothesis and the current local urFaced with the manifest opposition between this hypothesis and the current local urban development framework, it was necessary to construct a theoretical framework able to solve the apparent contradictions detected -that the latter cannot explain-, and frame the working hypothesis. Therefore, this thesis is framed under the systemic complexity approach, that is, the analytical study of complex systems. This theoretical framework has the capacity to explain emergent processes as integral part of a city, its development over time, its complexity, and the factors on which urban sustainability and efficiency depend. The systemic approach understands the city as a complex and dynamic system, in constant development; a system determined more by interrelationships between its components, and between those components and the context, than by the individual conditions of each component. The quality and quantity of these interactions is paramount, to the point of defining the urban condition of a human agglomeration in the territory: urbanity is not given merely by the size or density of a human agglomeration; it is defined in terms of the synergy produced by a large number of different interactions between different agents; a process called synekism. The generation of innovation, and technological/social/political development that characterize the urban condition is an inherent result of these interactions, and a direct function of the intensity, diversity, and redundancy of them in the territory, over time. 7 A sustainable and efficient urban system will be one that, by maximizing material and human resources (and according to the system´s load capacity), develops decentralized, multi-exchange networks; one capable of generating synergy and inclusive development. This implies an energy efficient city, but also efficient in the consumption of any type of resources; a compact city, which prioritizes participatory political mechanisms and intensive use of public spaces, but also pedestrian mobility, and functional and social diversity. It also implies flexibility and adaptability in the face of changes, through processes of resilience or transformation. According to local urban development models, emergent and informal processes such as micro-densification are a sign of crisis within the urban system: anomalies due to the development of harmful processes, in conflict with the rest of the urban structure; conflicts that may even lead to the city´s collapse. But according to the theoretical approach proposed in this thesis, these processes can also be identified as an attempt by the system to self-regulate and adapt to new situations: as a response to a scenario of tension; a way in which the system self-organizes, and responds to that tension seeking a new equilibrium. The research is then structured in order to answer the following questions: • First, what are the specific conditions that catalyze micro-densification in the pericentral neighborhoods of Córdoba? • Second, since micro-densification is a response to a particular situation within the urban system, what is the degree of sustainability and efficiency that transformations through micro-densification provides to pericentral neighborhoods (in particular) and to Córdoba (in general)? • Finally, having identified the impact of such processes on the urban structure, and its transformative and organizational potential, can the study of emergent processes make a conceptual or instrumental contribution to local urban planning? The research continued with a document analysis that reconstructs the specific condition of pericentral neighborhoods of Córdoba -which catalyzes the phenomenon of emergent micro-densification-. This stage developed in two parts: In the first place, we historically reconstruct pericentral neighborhoods of Córdoba, and the reasons for their urbanization pattern, which consolidates them as residential, (virtually) mono-functional, low-density, middle-class neighborhoods. Secondly, we analyzed Córdoba´s current scenario -with respect to the production and access to urban habitat- establishing urban, regional, and global variables that determine the city´s current development trends. This analysis allowed us to develop a comprehensive argument that explains all the processes that until now were conceptualized as "simultaneous but contradictory". It also explains and predicts the "unthinkable" situation of pericentral neighborhoods. After reconstructing the current scenario and defining different development patterns in Córdoba (including the "formal" pericentral neighborhoods´ pattern), we inferred a trend scenario in the short and medium term (10 years). We continued analyzing the micro-densification phenomenon, in terms of its social, functional, and spatial urban fabric transformations. As a result, a possible future scenario was proposed in which the micro-densification pattern has been formalized, transforming qualitatively and quantitatively the spatial-functional and socio-economic fabric. We specified their potential and strengths (as well as their weaknesses), against the future trend scenario of Córdoba and the pericentral neighborhoods. 8 Based on these results, we analyzed the different urban development patterns in Córdoba according to the variables defined as structural conditions of sustainability and efficiency: The sustainability and efficiency of the micro-densification scenario are much greater than those of the current trends scenario. Therefore, we verified the working hypothesis, and opened the discussion of this thesis. A first line of discussion dealt with development that fosters progressive revitalization, instead of complete renewal of urban fabric, or creation of new urban land on city´s rural periphery. Development that promotes a compact, diverse, and inclusive city, both socially, spatially and functionally; based on the multiplication and diversification of city-building agents. Development that considers these processes, as well as the mechanisms of empowerment, participation, and governance as instruments to achieve greater sustainability and efficiency in urban development. A city capable of generating more creative synergy, which translates into social, technological, and economic benefits. We denatured both the role of the State and the real estate market in the urban development of Córdoba; we proposed a dialectical articulation of different logics of urban development, explaining both the production and access strategies to habitat, and the apparent contradictions in urban development of Latin American middle cities. This thesis´ argument has an analytical and explanatory character, useful for analyzing other urban systems in Argentina and Latin America. It allows the generalization of both the results and the theoretical approach to urban phenomena, understanding the city as a complex system open to its surroundings and far from equilibrium. On the other hand, this thesis emphasized the role of emergent processes in an urban system. So far, emergent micro-densification has little impact on Córdoba´s urban structure. However, it is a vital mechanism to prevent pauperization and loss of resources in pericentral and intermediate urban areas -that is to say, to avoid the partial collapse of the urban structure-, while generating urbanity in areas characterized as mere residential fragments. It is essential to give importance in urban development and in generation of synergy to emergent processes. Incorporating them into critical analysis and diagnosis involves developing planning tools capable not only of recognizing the need to decentralize urban development and sharing decision-making, but also capable of incorporating uncertainty as a variable. In addition, they must be flexible enough to detect changes and the need for adjustment and adaptation over time. This thesis makes its greatest contribution to urban studies by helping to understand the role of emergent phenomena, highlighting contradictions and tensions within the traditional local urban models, and exclusions and inequities driven by those models.
Córdoba es la segunda ciudad más poblada de la Argentina, y posee el ejido municipal más extenso del país, siendo un importante centro industrial y de servicios del centro del país. Es además la cabecera de la segunda región metropolitana argentina, el Área Metropolitana de Córdoba (AMCBA). Si bien el desarrollo de sus áreas centrales y periurbanas es un tema bastante desarrollado académicamente, actualmente hay un vacío de conocimiento en la situación actual de las áreas pericentrales e intermedias de esta ciudad -aun cuando ocupan más del 30% del área urbanizada y donde habita la mayor parte de su población-. Es en estas áreas donde se ubica el objeto de estudio de esta tesis: los barrios pericentrales que forman un anillo alrededor del área central. Originados como extensiones suburbanas alrededor de 1940, y consolidados como barrios residenciales de clase media y media alta de baja densidad antes de 1970, ocupan lo que son hoy algunas de las áreas con mejor calidad ambiental y urbana de la ciudad. Los barrios pericentrales son considerados generalmente consolidados y estables; sin embargo, analizados en detalle, muestran complejas transformaciones: un vaciamiento poblacional constante, a pesar del crecimiento demográfico en general de Córdoba y el AMCBA; aumento de inmuebles abandonados; y a diferencia de sectores en una similar posición, no son objeto de grandes inversiones inmobiliarias de renovación urbana. Esta situación es invisibilizada, en parte por ser resultado de procesos con poco impacto relativo en la ciudad, y en parte porque estos procesos no están contemplados por los modelos urbanos locales vigentes –basados en la teoría racionalista y determinista de principios del siglo XX-, que conceptualizan a los barrios pericentrales como una "panacea urbana". Esta tesis puso en disputa estos modelos, partiendo de la discusión sobre un fenómeno informal detectado indefectiblemente (aunque no exclusivamente) en estos barrios pericentrales: la microdensificación emergente. La imposibilidad de colocar los inmuebles existentes en el mercado hace que los propietarios busquen nuevas formas de valorizar sus propiedades, de facilitar el acceso a la vivienda a sus hijos o de invertir sus ahorros de forma segura, obteniendo una fuente adicional de ingresos: en cada parcela edificada se aumenta la cantidad de unidades funcionales, aprovechando la superficie construible vacante o refuncionalizando las construcciones obsoletas, aunque manteniendo el grano y la escala de intervención respecto al tejido existente. La oferta de hábitat en estos barrios se diversifica, y no sólo evita la expulsión de población, sino que también atrae a nuevos habitantes. Además, en un tejido originalmente sólo residencial, incorpora actividades de comercio y servicios que enriquecen el tejido funcional. El proceso se realiza sin planificación general (y por supuesto fuera del marco legal): es la suma de acciones individuales que se reconstruyen como una "tendencia" o "patrón emergente", revitalizando el tejido urbano de forma sutil pero definitiva. Se planteó como hipótesis que la microdensificación emergente es un proceso de revitalización que aprovecha el potencial del tejido de estos barrios de forma más sostenible y eficiente que el modelo impuesto formalmente. 10 La tesis se encuadró bajo el enfoque sistémico de la complejidad. Este enfoque entiende a la ciudad como un sistema complejo y dinámico, en desarrollo constante; determinado más por las interrelaciones entre sus componentes y entre esos componentes y el contexto, que por las condiciones de cada elemento individualmente. La calidad y cantidad de estas interacciones es primordial, al punto de definir la condición urbana de una aglomeración. Según estas premisas, un sistema urbano sostenible y eficiente será aquel que, maximizando recursos materiales y humanos (y de acuerdo a la capacidad de carga del sistema) desarrolle de redes de intercambio múltiples, diversas y descentralizadas, que generen procesos de sinergia y desarrollo inclusivos. La investigación se estructuró entonces de forma tal de responder las siguientes preguntas: • En primer lugar, ¿cuáles son las condiciones específicas que catalizan la microdensificación en los barrios pericentrales de Córdoba? • Siendo la microdensificación una respuesta a una situación particular dentro del sistema urbano, ¿Cuál es el grado de sostenibilidad y eficiencia que aporta a los barrios pericentrales (en particular) y a Córdoba (en general)? • Y tras haber identificado su impacto en la estructura urbana, su potencial transformador y organizativo, ¿puede el estudio de los procesos emergentes hacer un aporte conceptual e instrumental a los modelos locales de planeamiento urbano? Primeramente, un análisis documental reconstruyó la condición específica de los barrios pericentrales, y el escenario actual de Córdoba con respecto a la producción y acceso al hábitat urbano. Luego se infirió un escenario tendencial a corto y mediano plazo, que sirvió para definir distintos patrones de territorialización, incluyendo el patrón "formal" de los barrios pericentrales. Se continuó con el análisis específico de la microdensificación, proponiendo un escenario posible a mediano plazo donde el patrón de microdensificación ha sido plenamente desarrollado, transformando cuali y cuantitativamente el tejido espacio-funcional y socioeconómico. A partir de estos resultados, se realizó un análisis comparativo de los distintos patrones de desarrollo urbano de Córdoba en cuanto a su sostenibilidad y eficiencia. Se demostró que el patrón de microdensificación en los barrios pericentrales es mucho más sostenible y eficiente que los patrones formales existentes, y se abrió la discusión que se desarrolla en la última parte de esta tesis: El argumento desarrollado en esta investigación y los resultados que de él se desprenden tienen un carácter analítico y explicativo útil para el análisis de otros escenarios en el contexto urbano argentino y latinoamericano. En primer lugar, sobre preferir la revitalización progresiva frente a la renovación total o la creación de nuevo suelo urbano en la periferia; promover una ciudad compacta, diversa e inclusiva tanto social como funcionalmente; basada en la multiplicación y diversificación de los agentes productores de ciudad; que considera estos procesos, así como los mecanismos de empoderamiento, participación y gobernanza como instrumentos para lograr mayor sostenibilidad y eficiencia en el desarrollo urbano. Por otro lado, esta tesis puso en relevancia el rol de los procesos emergentes en un sistema urbano como mecanismo vital para generar esta revitalización. Finalmente, se discute el aporte del enfoque sistémico para comprender, explicar y proponer intervenciones a la disciplina. ; Córdoba ist die Hauptstadt der gleichnamigen Provinz im Nordosten Argentiniens. Sie ist der Mittelpunkt der zweitgrößten Metropolregion des Landes (bekannt unter der spanischen Abkürzung AMCBA) und ein wichtiges kulturelles und wirtschaftliches Zentrum des Landes. Derzeit scheint die Stadt durch zwei gegensätzlichen Prozesse geprägt, die zeitgleich von statten gehen: Einerseits die Erneuerung des Zentralbereichs und der Umgebung durch Hyperverdichtung, mit dem damit verbundenen Verlust des sozialen und architektonischen Erbes und dem Zusammenbruch der vorhandenen Infrastruktur-Netzwerke. Anderseits die Expansion der gebauten Stadt auf ländliche und industrielle Gebiete der städtischen Peripherie, was aufgrund einer abnehmenden Belegungsdichte immer mehr zu einer Verdünnung der Stadtstruktur führt. Darüber hinaus konzentriert sich der Wohnungsbau auf immer kleinere Gruppen und dies obwohl sich sowohl der Wohnungsbau beschleunigt als auch das Angebot an urbanen Wohnräumen erhöht: Während private Immobilienprojekte fast ausschließlich auf Bevölkerungsgruppen mit hohem Einkommen und Investoren, die nicht in der Stadt wohnen, ausgerichtet sind, sind die staatlichen Investitionen im sozialen Wohnungsbau ausschließlich für die Bevölkerungsgruppen mit den niedrigsten Einkommen bestimmt. Dadurch entsteht ein Defizit an Wohnangeboten für die Mittelschicht Córdobas, die fast 45% der Stadtbevölkerung ausmacht. Diese Schwerpunktsetzung ist auch bei lokalen Stadtforschern und Stadtplanern zu erkennen. Die aktuelle Situation der perizentralen Gebiete und Zwischenbereiche der Stadt sind weniger präsent, obgleich diese mehr als 30 % der urbanisierten Stadtfläche einnehmen und von der Mehrheit der Stadtbevölkerung bewohnt werden. Um diese Wissenslücke zu schließen, stehen die perizentralen Stadtviertel, die das Stadtzentrum umschließen, im Mittelpunkt dieser Arbeit. Sie sind ab 1940 als Erweiterungen der Vorstadt entstanden und etablierten sich im Laufe der 1960er Jahre als Wohngebiete mit einer geringen Bevölkerungsdichte, die heute von der Mittelschicht bewohnt werden und die höchste Umweltqualität und urbane Qualität der Stadt aufweisen. Die Gesetzgebung begrenzt dabei die Bebauung der Grundstücke auf Einfamilienhäusern, um die gewünschte geringe Bevölkerungsdichte beizubehalten. Man könnte die Untersuchung von bereits konsolidierten und stabilen urbanen Sektoren als sinnlos betrachten. Doch, wenn sie im Detail analysiert werden, zeigen sich komplexe demografische, räumliche und funktionale Transformationen, die von Interesse sind. Obwohl sich über die Jahre hinweg in diesen Stadtvierteln das bis zu diesem Moment angeblich "perfekteste" Wohnmodell materialisiert hat, nämlich ein Modell, welches "alle möglichen städtischen Wohnbedürfnisse erfüllt", leidet das soziale Gefüge und die bebaute Umwelt darunter. Das aktuelle Szenario zeigt, trotz des demografischen Wachstums von Cordoba und der Metropolregion AMCBA, einen konstanten Bevölkerungsrückgang in diesen Stadtvierteln: Junge Leute verlassen die Wohngegenden, während die zurückbleibende Bevölkerung altert und die Anzahl an verlassenen Gebäude stetig steigt. Für die auf dem Immobilienmarkt angebotenen Gebäude ist es schwierig, den Immobilienwert zu halten geschweige denn Käufer zu finden. Im Gegensatz zu anderen Bereichen der Stadt, die sich in einer ähnlichen Position befinden, sind diese Stadtviertel nicht im Fokus großer Immobilienaktivitäten. Dies widerspricht ihrer privilegierten Lage innerhalb der Stadtstruktur. 2 Diese Entwicklungen wurden lange Zeit übersehen. Zum einen da sie das Ergebnis von Prozessen sind, die wenig Auswirkungen auf die Stadt haben und zum anderen weil diese Prozesse in den heutigen lokalen städtischen Wohnmodellen nicht berücksichtigt werden, welche auf rationalistischen und deterministischen Theorien aus dem Anfang des 20. Jahrhunderts basieren und diese perizentralen Stadtviertel als städtisches Allheilmittel betrachten. Es ist unmöglich eine Hypothese abzuleiten, die aktuelle oder zukünftige Szenarios der perizentralen Stadtviertel in Córdoba unter diesen Rahmenbedingungen erklärt. Daher stellt diese Arbeit solche Modelle und ihre Fähigkeit, die Entwicklung der Stadt zu erklären oder in ihr effektiv zu arbeiten, in Frage und schlägt einen theoretischen Rahmen vor, der zum Verständnis, zur Erklärung und zur effektiven Umsetzung in der Stadt beitragen soll. Dies erfolgt auf Grundlage der Auseinandersetzung mit einem informellen Phänomen, welches deutlich (aber nicht ausschließlich) in diesen perizentralen Stadtvierteln erkennbar ist: die aufkommende Mikroverdichtung. Aufgrund der bereits genannten Unmöglichkeit, existierende Immobilien gewinnbringend auf den Markt zu bringen, suchen Eigentümer neue Wege, um ihr Wohneigentum aufzuwerten, ihren Kindern den Zugang zu einer Wohnung zu erleichtern oder ihre Ersparnisse sicher zu investieren und sich dadurch eine zusätzliche Einnahmequelle außerhalb des traditionellen Immobilienmarktes zu sichern. Aus diesem Grund erhöhen die Eigentümer die Anzahl der funktionalen Einheiten auf ihrem Grundstück, indem sie freie Fläche bebauen oder veraltete Konstruktionen renovieren. Das Stadtgefüge wird dabei durch diese Eingriffe nicht tiefgreifend verändert. Des Weiteren wird das Wohnraumangebot in diesen Stadtvierteln umfangreicher und verhindert nicht nur die Verdrängung der alten Bewohner, sondern zieht auch neue an. Auch werden dem ursprünglichen Wohngebiet zusätzliche nicht-residentielle Nutzungen hinzugefügt, die das Stadtgefüge bereichern. Letztendlich hat die Mikroverdichtung der perizentralen Nachbarschaften eine spezielle Eigenschaft, und zwar seinen emergenten / aufkommenden Zustand: Der Prozess erfolgt ohne allgemeine Planung (und auch außerhalb des rechtlichen Rahmens). Hauptakteure dieses Wandels sind die Eigentümer selbst, die ohne jegliche vorherige Absprachen agieren. Ob aus Notwendigkeit oder aus Opportunismus heraus, es handelt sich dabei um einen fragmentierten Prozess. Es beinhaltet eine Vielzahl individueller Aktionen, die als ein "Trend" oder "neu aufkommendes Muster" innerhalb der allgemeinen Organisation der perizentralen Stadtviertel zu begreifen sind und das Stadtgefüge auf subtile aber endgültige Art und Weise erneuern. Die vorliegende Arbeit stellt die Hypothese auf, dass die aufkommende Mikroverdichtung in diesen Stadtvierteln von Córdoba ein Revitalisierungsprozess ist, der das Potenzial des Stadtgefüges nachhaltiger und effizienter nutzt als das formell auferlegte Stadtentwicklungsmodell. Aufgrund des offenkundigen Gegensatzes zwischen dieser Hypothese und den aktuellen Rahmenbedingungen der lokalen Stadtentwicklung, ist es notwendig, einen theoretischen Rahmen zu schaffen, der die offensichtlichen Widersprüche auflöst und die Arbeitshypothese einrahmt. Diese These ordnet sich dem systemischen Ansatz der Komplexität zu, der analytischen Erforschung von komplexen Systemen. Dieser theoretische Rahmen ermöglicht, die aufkommenden Prozesse als integraler Bestandteil einer Stadt (ein "urbanes System"), seine Entwicklung im Laufe der Zeit, seine Komplexität und die Faktoren, von denen die urbane Nachhaltigkeit und Effizienz abhängen, zu erklären. Der systemische Ansatz begreift die Stadt als ein komplexes und dynamisches System in ständiger Entwicklung; ein System, das eher durch die Wechselbeziehungen zwischen seinen Komponenten und zwischen diesen und dem Kontext bestimmt wird, als durch den einzelnen Zustand jedes Elements. Die Qualität und Quantität dieser Interaktionen steht dabei an erster Stelle und definiert sogar den urbanen Zustand eines Ballungsgebietes. Urbanität ist nicht allein durch ihre Größe oder ihre Dichte gegeben, sondern ist gemäß der Synergie definiert, die durch eine Vielzahl an verschiedenen Interaktionen und Wech3 selwirkungen zwischen unterschiedlichen Akteuren produziert wird. Dieser Prozess heißt Synoikismos. Die Entfaltung der technologischen, sozialen und politischen Entwicklungen und Innovationen, die den städtischen Zustand charakterisieren, ist das inhärente Ergebnis dieser Interaktionen und eine direkte Funktion ihrer Intensität, Vielfalt und Redundanz, sowohl räumlich als auch zeitlich. Laut diesen Voraussetzungen ist ein nachhaltiges und effizientes Städtesystem eines, das durch die Maximierung der menschlichen und materiellen Ressourcen (und der Systembelastbarkeit entsprechend) mehrere unterschiedliche und dezentrale Austauschnetzwerke entwickelt, die inklusive Synergie- und Entwicklungsprozesse erzeugen. Dies bedeutet zum einen eine energieeffiziente Stadt, auch effizient im Konsum jeglicher Ressourcen und zum anderen eine kompakte Stadt, welche mehrere Begegnungen zwischen verschiedenen Akteuren ermöglicht, die Beteiligung an politischen Mechanismen und die intensive Nutzung des öffentlichen Raums, die Fußgängermobilität und eine funktionale und soziale Vielfalt in der Stadt fördert. Dies schließt auch Flexibilität und Anpassungsfähigkeit an Veränderungen durch Widerstands- oder Transformationsprozesse ein. Laut den lokalen Stadtentwicklungsmodellen, sind aufkommende und informelle Prozesse, wie die Mikroverdichtung, ein Zeichen der Krise im städtischen System: Anomalien, die durch die Entwicklung von schädlichen Prozessen im Konflikt mit dem Rest der Stadtstruktur entstanden sind. Konflikte, die sogar zum Zusammenbruch führen können. Laut dem theoretischen Ansatz dieser Arbeit jedoch, können diese Prozesse auch als Versuch des Systems verstanden werden, sich selbst zu regulieren und sich an neue Situationen anzupassen: Als Antwort auf ein ungelöstes Spannungsszenario; eine Art und Weise, in der das System sich selbst organisiert, um auf diese Spannung zu reagieren, indem ein neues Gleichgewicht gesucht wird. Die Arbeit strukturiert sich anhand von diesem theoretischen Rahmen, um die folgenden Fragen beantworten zu können: • Erstens, welche besonderen Rahmenbedingungen führen zu der aufkommenden Mikroverdichtung in den perizentralen Stadtvierteln in Córdoba? • Begreift man die Mikroverdichtung als Antwort auf eine bestimmte Situation innerhalb des städtischen Systems, stellt sich folgende zweite Frage: Welches Ausmaß an Nachhaltigkeit und Effizienz ermöglichen die Prozesse der Mikroverdichtung in den perizentralen Stadtvierteln im Speziellen und in Córdoba im Allgemeinen? • Nach der Identifizierung der Auswirkungen dieser Prozesse auf die Stadtstruktur, sowie des damit einhergehenden transformativen und organisatorischen Potenzials steht die dritte Frage im Raum: Kann die Erforschung von aufkommenden Prozessen dieser Art einen konzeptionellen und instrumentellen Beitrag zur lokalen Stadtplanung leisten? Um diesen Fragen nachzugehen wurde im weiteren Verlauf der Forschung eine Dokumentenanalyse durchgeführt, um den spezifischen Zustand der perizentralen Stadtviertel, der das Phänomen der aufkommenden Mikroverdichtung ermöglicht, zu rekonstruieren. Diese Analyse vollzog sich in zwei Schritten: Als Erstes wurden die perizentralen Stadtviertel und der Grund für ihr besonderes Urbanisierungsmuster historisch rekonstruiert und dadurch als (nahezu) monofunktionelle Wohnviertel mit einer geringen Bevölkerungsdichte identifiziert. Als Zweites wurde das aktuelle urbane Szenario Córdobas hinsichtlich der Produktion von und dem Zugang zu städtischem Habitat analysiert, um urbane, regionale und globale Variablen zu entwickeln, die die Entwicklungstrends der Stadt bestimmen. Dieses Vorgehen ermöglichte die Formulierung eines umfassendes Arguments, das alle Prozesse erklärt, die bisher als "gleichzeitig aber widersprüchlich" erfasst wurden. Darüber hinaus erklärt und prognostiziert dieses Argument die "undenkbare" Situation von perizentralen Stadtvierteln. Nach der Rekonstruktion des aktuellen Szenarios wurde ein kurzes und mittelfristiges (10 Jahren) Trendszenario des Phänomens abgeleitet. Dies diente dazu, die unterschiedlichen 4 Entwicklungsmuster in Córdoba zu vergleichen und deren Auswirkungen auf die Stadtstruktur zu bewerten. Im weiteren Verlauf der Arbeit wurde die Analyse der Mikroverdichtung hinsichtlich der Veränderungen im sozialen, funktionalen und räumlichen Stadtgefüge fortgeführt. Als Ergebnis wurde ein mögliches Zukunftsszenario vorgeschlagen, bei dem das Muster der Mikroverdichtung formalisiert und somit das räumlich-funktionale und sozioökonomische Gefüge der Stadtviertel transformiert wurde. Anschließend wurden das Potenzial und die Stärken (und Schwächen) gegenüber dem mittelfristigen Trendszenario von Córdoba und den perizentralen Stadtvierteln spezifiziert. Basierend auf diesen Ergebnissen wurden verschiedene Stadtentwicklungsmuster von Córdoba mithilfe der Variablen analysiert, die als strukturelle Bedingungen für Nachhaltigkeit und Effizienz definiert waren. Mit dem Ergebnis, dass die Nachhaltigkeit und die Effizienz der Mikroverdichtungsszenarien deutlich größer war als in den aktuellen Trendszenarien. Die vorliegende Analyse konnte somit die Hypothese dieser Arbeit belegen. Im letzten Abschnitt der Arbeit wurde der Diskussionsteil eröffnet. Die erste Diskussion befasste sich mit der Entwicklung, die eine progressive Revitalisierung fördert anstatt einer vollständigen Erneuerung des Stadtgefüges oder der Schaffung von neuem städtischem Land in der ruralen Peripherie der Stadt. Zudem fördert sie sowohl auf soziale, räumliche als auch funktionale Art und Weise eine kompakte, vielfältige und integrative Stadt. Diese Entwicklung beruht auf der Multiplikation und Diversifizierung der Akteure, die im Städtebau involviert sind, und betrachtet diese Prozesse, sowie die Ermächtigungs-, Beteiligungs- und Staatsführungsmechanismen als Instrumente zur Erlangung einer größeren Nachhaltigkeit und Effizienz in der Stadtentwicklung. Das bedeutet, eine Stadt, die in der Lage ist, kreativere Synergien zu schaffen und so zu sozialen, technologischen und wirtschaftlichen Vorteilen kommt. Des Weiteren betonte diese Arbeit die Rolle der aufkommenden Prozesse in einem städtischen System. Die aufkommende Mikroverdichtung hat wenig Einfluss auf die städtische Struktur von Córdoba. Jedoch ist es ein wichtiger Mechanismus, um die Verarmung und den Verlust von Ressourcen in perizentralen Bereichen und Zwischengebieten zu verhindern, d.h. um den partiellen Zusammenbruch der städtischen Struktur zu vermeiden und gleichzeitig Urbanität in Gebieten zu schaffen, die als bloße Wohnungsviertel charakterisiert sind. In der Stadtplanung ist es wichtig, auf aufkommende Prozesse in der Stadtentwicklung und auf die Erzeugung von Synergien Wert zu legen. Ihre Einbeziehung in die kritische Analyse beinhaltet die Entwicklung von Planungsinstrumenten, die nicht nur die Notwendigkeit der Dezentralisierung der Stadtentwicklung und der Entscheidungsfindung erkennen können, sondern die auch in der Lage sind, die Ungewissheit als Variable zu integrieren. Darüber hinaus müssen sie flexibel genug sein, um Veränderungen und die Notwendigkeit für Korrekturen und Anpassungen im Laufe der Zeit zu erkennen. Das Argument dieser Arbeit hat einen analytischen und erklärenden Charakter, der für die Analyse von anderen urbanen Szenarien in Argentinien und Lateinamerika nützlich ist. Dies ermöglicht die Verallgemeinerung sowohl der Ergebnisse als auch der theoretischen Annäherung an städtische Phänomene, basierend auf dem Stadt-Verständnis als komplexes, für ihre Umgebung offenes System, welches weit entfernt vom Gleichgewicht ist. Der größte Beitrag dieser Arbeit zur Urbanistik ist das Verständnis der Rolle der aufkommenden Phänomene und die Analyse der Widersprüche und Spannungen innerhalb der traditionellen lokalen Stadtmodelle, die auch Ausgrenzungen und Ungerechtigkeit im Zugang zu Stadt hervorhebt. Die Rolle des Staates und des Immobilienmarktes in der Stadtentwicklung von Cordoba wurde denaturiert und eine dialektische Artikulation der Logik des territorialen Lebensraumes in der Stadt, die sowohl Produktions- und Zugangsstrategien als auch die scheinbaren Widersprüche in der Stadtentwicklung der lateinamerikanischen mittelgroßen Städten erklärt, wurde vorgeschlagen. ; Córdoba is the capital of the province of Córdoba, in Argentina. It is also the principal city of the second-most populous metropolitan area of the country, the Greater Córdoba Metropolitan Area (AMCBA according to its acronym in Spanish), with strengths in business, automotive industry, culture, education, and research. Currently, the city seems to develop in two simultaneous and opposing processes: On the one hand, renovation by densification of the central area and its extensions, with losses of social and built heritage, and the collapse of infrastructure networks that this entails. On the other hand, extension of the urbanized area over rural and industrial periphery, with dwindling occupancy densities that dilute the urban structure more and more in the territory. Besides that, although housing production accelerates -increasing its supply-, it is concentrated in ever smaller groups: while real estate projects are targeted almost exclusively at high-income sectors and investors who do not live in the city, State investment in social housing is allocated exclusively to lower income sectors. This situation produces a deficit in proposals aimed at the so-called "middle class", even though it makes up of almost 45% of the city´s population. In addition, these processes concentrate the interest of the greater part of both local academics and urban planners. This situation produces a knowledge gap in the current situation of Córdoba´s pericentral and intermediate areas, which occupy more than 30% of the city´s urbanized land (and where the majority of this city´s inhabitants reside). It is there where this thesis´ case study is located: the pericentral districts that surround the central area. They originated as suburban extensions around 1940, and consolidated as middle-class/low-density residential neighborhoods before 1970. Today, they occupy some of the best environmental and urban quality areas of the city. Even land-use regulation specifically limits occupancy to single-family dwellings on individual plots to maintain the desired low-density residential neighborhood pattern. We can discuss the futility of studying urban sectors considered already consolidated and stable; however, when analyzed in detail, pericentral areas show complex demographic, spatial, and functional transformations that contradict this characterization: Despite the fact that these neighborhoods materializes the supposedly "most perfect" residential model known until now, a model "that solves each and every one of the urban-life needs", its social and built fabric resents. The current scenario shows a constant population-shrinking process, in spite of the demographic growth of both Córdoba and the AMCBA. Young people leaves these neighborhoods, while the remaining population ages. Abandoned buildings constantly increase; the ones offered in the real estate market have difficulties to find buyers, or even to maintain their price, which contradicts its privileged status within the city. At the same time -and unlike areas in a similar position- these neighborhoods are not the object of major real estate investments. Local academics and urban planners overlook this situation, in part because it is the result of processes with relative less impact in the city, and in part because these processes are not covered by current local urban models -based on the rationalist and deterministic urban theory of early 20th century-, which conceptualize suburban neigh6 borhoods as an urban panacea. It is impossible to deduce a hypothesis that explains the current nor the trend scenario of pericentral neighborhoods of Córdoba in terms of that framework. Therefore, this thesis discussed those theoretical models, and its capacity to explain Córdoba´s development. It proposed a theoretical framework that allowed understanding, explaining, and operating effectively in the city. It did so based on the discussion of an informal phenomenon unfailingly (but not exclusively) detected in pericentral neighborhoods: the emergent micro-densification. Given the impossibility of advantageously placing their properties in the housing market -due to factors such as land-use restrictions, and specific conditions of the local real estate market-, the landowners seek new ways to valorize their properties, facilitate access to housing for their children, or profitably invest their savings, obtaining an additional income outside the "traditional" real estate market. They increase the number of functional units in their plots, occupying the vacant building area or refurbishing obsolete constructions, while maintaining the intervention scale in relation to the existing urban fabric. These neighborhoods´ housing supply diversifies; and it not only prevents the expulsion of population, but it also attracts new inhabitants. In addition, in an originally residential fabric, it incorporates non-residential activities that enrich the urban fabric. Finally, micro-densification in pericentral neighborhoods presents a differential quality: its "emergent" condition. The process carries out without general planning (and of course outside the legal framework); inhabitants/landowners decide to do so, without any prior agreement. It is an atomized and fragmented process, result of necessity or opportunism. It is the sum of individual actions reconstructed as a "trend", or an "emerging pattern" within the general organization of pericentral neighborhoods, revitalizing the urban fabric in a subtle but definitive way. This research hypothesized that emergent micro-densification in these neighborhoods is a process of revitalization that harnesses the potential of their urban fabric; it does so in a more sustainable and efficient way than the current urban development patterns. Faced with the manifest opposition between this hypothesis and the current local urFaced with the manifest opposition between this hypothesis and the current local urban development framework, it was necessary to construct a theoretical framework able to solve the apparent contradictions detected -that the latter cannot explain-, and frame the working hypothesis. Therefore, this thesis is framed under the systemic complexity approach, that is, the analytical study of complex systems. This theoretical framework has the capacity to explain emergent processes as integral part of a city, its development over time, its complexity, and the factors on which urban sustainability and efficiency depend. The systemic approach understands the city as a complex and dynamic system, in constant development; a system determined more by interrelationships between its components, and between those components and the context, than by the individual conditions of each component. The quality and quantity of these interactions is paramount, to the point of defining the urban condition of a human agglomeration in the territory: urbanity is not given merely by the size or density of a human agglomeration; it is defined in terms of the synergy produced by a large number of different interactions between different agents; a process called synekism. The generation of innovation, and technological/social/political development that characterize the urban condition is an inherent result of these interactions, and a direct function of the intensity, diversity, and redundancy of them in the territory, over time. 7 A sustainable and efficient urban system will be one that, by maximizing material and human resources (and according to the system´s load capacity), develops decentralized, multi-exchange networks; one capable of generating synergy and inclusive development. This implies an energy efficient city, but also efficient in the consumption of any type of resources; a compact city, which prioritizes participatory political mechanisms and intensive use of public spaces, but also pedestrian mobility, and functional and social diversity. It also implies flexibility and adaptability in the face of changes, through processes of resilience or transformation. According to local urban development models, emergent and informal processes such as micro-densification are a sign of crisis within the urban system: anomalies due to the development of harmful processes, in conflict with the rest of the urban structure; conflicts that may even lead to the city´s collapse. But according to the theoretical approach proposed in this thesis, these processes can also be identified as an attempt by the system to self-regulate and adapt to new situations: as a response to a scenario of tension; a way in which the system self-organizes, and responds to that tension seeking a new equilibrium. The research is then structured in order to answer the following questions: • First, what are the specific conditions that catalyze micro-densification in the pericentral neighborhoods of Córdoba? • Second, since micro-densification is a response to a particular situation within the urban system, what is the degree of sustainability and efficiency that transformations through micro-densification provides to pericentral neighborhoods (in particular) and to Córdoba (in general)? • Finally, having identified the impact of such processes on the urban structure, and its transformative and organizational potential, can the study of emergent processes make a conceptual or instrumental contribution to local urban planning? The research continued with a document analysis that reconstructs the specific condition of pericentral neighborhoods of Córdoba -which catalyzes the phenomenon of emergent micro-densification-. This stage developed in two parts: In the first place, we historically reconstruct pericentral neighborhoods of Córdoba, and the reasons for their urbanization pattern, which consolidates them as residential, (virtually) mono-functional, low-density, middle-class neighborhoods. Secondly, we analyzed Córdoba´s current scenario -with respect to the production and access to urban habitat- establishing urban, regional, and global variables that determine the city´s current development trends. This analysis allowed us to develop a comprehensive argument that explains all the processes that until now were conceptualized as "simultaneous but contradictory". It also explains and predicts the "unthinkable" situation of pericentral neighborhoods. After reconstructing the current scenario and defining different development patterns in Córdoba (including the "formal" pericentral neighborhoods´ pattern), we inferred a trend scenario in the short and medium term (10 years). We continued analyzing the micro-densification phenomenon, in terms of its social, functional, and spatial urban fabric transformations. As a result, a possible future scenario was proposed in which the micro-densification pattern has been formalized, transforming qualitatively and quantitatively the spatial-functional and socio-economic fabric. We specified their potential and strengths (as well as their weaknesses), against the future trend scenario of Córdoba and the pericentral neighborhoods. 8 Based on these results, we analyzed the different urban development patterns in Córdoba according to the variables defined as structural conditions of sustainability and efficiency: The sustainability and efficiency of the micro-densification scenario are much greater than those of the current trends scenario. Therefore, we verified the working hypothesis, and opened the discussion of this thesis. A first line of discussion dealt with development that fosters progressive revitalization, instead of complete renewal of urban fabric, or creation of new urban land on city´s rural periphery. Development that promotes a compact, diverse, and inclusive city, both socially, spatially and functionally; based on the multiplication and diversification of city-building agents. Development that considers these processes, as well as the mechanisms of empowerment, participation, and governance as instruments to achieve greater sustainability and efficiency in urban development. A city capable of generating more creative synergy, which translates into social, technological, and economic benefits. We denatured both the role of the State and the real estate market in the urban development of Córdoba; we proposed a dialectical articulation of different logics of urban development, explaining both the production and access strategies to habitat, and the apparent contradictions in urban development of Latin American middle cities. This thesis´ argument has an analytical and explanatory character, useful for analyzing other urban systems in Argentina and Latin America. It allows the generalization of both the results and the theoretical approach to urban phenomena, understanding the city as a complex system open to its surroundings and far from equilibrium. On the other hand, this thesis emphasized the role of emergent processes in an urban system. So far, emergent micro-densification has little impact on Córdoba´s urban structure. However, it is a vital mechanism to prevent pauperization and loss of resources in pericentral and intermediate urban areas -that is to say, to avoid the partial collapse of the urban structure-, while generating urbanity in areas characterized as mere residential fragments. It is essential to give importance in urban development and in generation of synergy to emergent processes. Incorporating them into critical analysis and diagnosis involves developing planning tools capable not only of recognizing the need to decentralize urban development and sharing decision-making, but also capable of incorporating uncertainty as a variable. In addition, they must be flexible enough to detect changes and the need for adjustment and adaptation over time. This thesis makes its greatest contribution to urban studies by helping to understand the role of emergent phenomena, highlighting contradictions and tensions within the traditional local urban models, and exclusions and inequities driven by those models.
The purpose of this paper is to investigate the impact of credit card knowledge and financial self-efficacy toward credit card misuse and intention to reuse credit card. The technological breakthroughs and regulatory reforms of the past decades have brought payment media to the forefront of business, social and political interest. This research is a survey research that is conducted to understand the causal relationships between variables with the use of questionnaire as the instrument to obtain data. The questionnaire is distributed to 100 sample who fulfill the requirements. The sample of this research are adults in Pontianak that are at least 21 years old. In this research, the data analysis method used is Structural Equation Model Partial Least Square (SEMPLS) method. To conduct analysis using PLS method, this research is using smartPLS 3.0 software. The hypothesis of the research is H1 : Credit card knowledge have significant influence on credit card misuse, H2: Financial self-efficacy have significant influence on credit cards misuse, H3: Credit card knowledge have significant influence on intention to reuse credit cards, H4: Financial self-efficacy have signficant influence on intention to reuse credit cards, H5: Credit card misuse have significant influence on intention to reuse credit cards. The result of this research shows that H1, H4 and H5 are accepted but H2 and H3 are rejected.References A, F. (1984). "Many sides of the coin: The psychology of money usage. Personality and Individual Differences. 501-509.Ackert, L., & Church, B. (2015). Credit cards, financial responsibility, and college students: an experimental study. International Journal of Behavioural Accounting and Finance, Vol. 5 No. 1, 1-26.Aghazadeh, H., & Esfidani, M. R. (2007). Internet Marketing Strategies. 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Quantifying the genetic correlation between cancers can provide important insights into the mechanisms driving cancer etiology. Using genome-wide association study summary statistics across six cancer types based on a total of 296,215 cases and 301,319 controls of European ancestry, here we estimate the pair-wise genetic correlations between breast, colorectal, head/neck, lung, ovary and prostate cancer, and between cancers and 38 other diseases. We observed statistically significant genetic correlations between lung and head/neck cancer (rg = 0.57, p = 4.6 × 10-8), breast and ovarian cancer (rg = 0.24, p = 7 × 10-5), breast and lung cancer (rg = 0.18, p =1.5 × 10-6) and breast and colorectal cancer (rg = 0.15, p = 1.1 × 10-4). We also found that multiple cancers are genetically correlated with non-cancer traits including smoking, psychiatric diseases and metabolic characteristics. Functional enrichment analysis revealed a significant excess contribution of conserved and regulatory regions to cancer heritability. Our comprehensive analysis of cross-cancer heritability suggests that solid tumors arising across tissues share in part a common germline genetic basis. ; he authors in this manuscript were working on behalf of BCAC, CCFR, CIMBA, CORECT, GECCO, OCAC, PRACTICAL, CRUK, BPC3, CAPS, PEGASUS, TRICL- ILCCO, ABCTB, APCB, BCFR, CONSIT TEAM, EMBRACE, GC-HBOC, GEMO, HEBON, kConFab/AOCS Mod SQuaD, and SWE-BRCA. The breast cancer genome-wide association analyses: BCAC is funded by Cancer Research UK [C1287/A16563, C1287/ A10118], the European Union ' s Horizon 2020 Research and Innovation Programme (grant numbers 634935 and 633784 for BRIDGES and B-CAST, respectively), and by the European Community's Seventh Framework Programme under grant agreement number 223175 (grant number HEALTH-F2-2009-223175) (COGS). The EU Horizon 2020 Research and Innovation Programme funding source had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Genotyping of the OncoArray was funded by the NIH Grant U19 CA148065, and Cancer UK Grant C1287/ A16563 and the PERSPECTIVE project supported by the Government of Canada through Genome Canada and the Canadian Institutes of Health Research (grant GPH-129344) and, the Ministère de lÉconomie, Science et Innovation du Québec through Genome Québec and the PSR-SIIRI-701 grant, and the Quebec Breast Cancer Foundation. Funding for the iCOGS infrastructure came from: the European Community 's Seventh Framework.Programme under grant agreement n° 223175 (HEALTH-F2-2009-223175) (COGS), Cancer Research UK (C1287/A10118, C1287/A10710, C12292/A11174, C1281/A12014, C5047/A8384, C5047/A15007, C5047/A10692, C8197/A16565), the National Institutes of Health (CA128978), and Post-Cancer GWAS initiative (1U19 CA148537, 1U19 CA148065, and 1U19 CA148112 — the GAME-ON initiative), the Department of Defence (W81XWH-10-1-0341), the Canadian Institutes of Health Research (CIHR) for the CIHR Team in Familial Risks of Breast Cancer, and Komen Foundation for the Cure, the Breast Cancer Research Foundation, and the Ovarian Cancer Research Fund. The DRIVE Consortium was funded by U19 CA148065. The Australian Breast Cancer Family Study (ABCFS) was supported by grant UM1 CA164920 from the National Cancer Institute (USA). The content of this manuscript does not necessarily re fl ect the views or policies of the National Cancer Institute or any of the collaborating centers in the Breast Cancer Family Registry (BCFR), nor does mention of trade names, commercial products, or organizations imply endorsement by the USA Government or the BCFR. The ABCFS was also supported by the National Health and Medical Research Council of Australia, the New South Wales Cancer Council, the Victorian Health Promotion Foundation (Aus- tralia), and the Victorian Breast Cancer Research Consortium. J.L.H. is a National Health and Medical Research Council (NHMRC) Senior Principal Research Fellow. M.C.S. is a NHMRC Senior Research Fellow. The ABCS study was supported by the Dutch Cancer Society [grants NKI 2007-3839; 2009 4363]. The Australian Breast Cancer Tissue Bank (ABCTB) is generously supported by the National Health and Medical Research Council of Australia, The Cancer Institute NSW and the National Breast Cancer Foundation. The ACP study is funded by the Breast Cancer Research Trust, UK. The AHS study is supported by the intramural research program of the National Institutes of Health, the National Cancer Institute (grant number Z01-CP010119), and the National Institute of Environmental Health Sciences (grant number Z01-ES049030). The work of the BBCC was partly funded by ELAN-Fond of the University Hospital of Erlangen. The BBCS is funded by Cancer Research UK and Breast Cancer Now and acknowledges NHS funding to the NIHR Biomedical Research Centre, and the National Cancer Research Network (NCRN). The BCEES was funded by the National Health and Medical Research Council, Australia and the Cancer Council Western Australia and acknowledges funding from the National Breast Cancer Foundation (JS). For the BCFR-NY, BCFR-PA, and BCFR-UT this work was supported by grant UM1 CA164920 from the National Cancer Institute. The content of this manuscript does not necessarily re fl ect the views or policies of the National Cancer Institute or any of the collaborating centers in the Breast Cancer Family Registry (BCFR), nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or the BCFR. For BIGGS, ES is supported by NIHR Comprehensive Biomedical Research Centre, Guy ' s & St. Thomas ' NHS Foundation Trust in partnership with King ' s College London, United Kingdom. IT is supported by the Oxford Biomedical Research Centre. BOCS is supported by funds from Cancer Research UK (C8620/A8372/A15106) and the Institute of Cancer Research (UK). BOCS acknowledges NHS funding to the Royal Marsden/Institute of Cancer Research NIHR Specialist Cancer Biomedical Research Centre. The BREast Oncology GAlician Network (BREOGAN) is funded by Acción Estratégica de Salud del Instituto de Salud Carlos III FIS PI12/02125/Co fi nanciado FEDER; Acción Estratégica de Salud del Instituto de Salud Carlos III FIS Intrasalud (PI13/01136); Programa Grupos Emergentes, Cancer Genetics Unit, Instituto de Investigacion Biomedica Galicia Sur. Xerencia de Xestion Integrada de Vigo-SERGAS, Instituto de Salud Carlos III, Spain; Grant 10CSA012E, Consellería de Industria Programa Sectorial de Investigación Aplicada, PEME I + DeI + D Suma del Plan Gallego de Investigación, Desarrollo e Innovación Tecnológica de la Consellería de Industria de la Xunta de Galicia, Spain; Grant EC11-192. Fomento de la Investigación Clínica Independiente, Ministerio de Sanidad, Servicios Sociales e Igualdad, Spain; and Grant FEDER-Innterconecta. Ministerio de Economia y Competitividad, Xunta de Gali- cia, Spain. The BSUCH study was supported by the Dietmar-Hopp Foundation, the Helmholtz Society and the German Cancer Research Center (DKFZ). The CAMA study was funded by Consejo Nacional de Ciencia y Tecnología (CONACyT) (SALUD-2002- C01-7462). Sample collection and processing was funded in part by grants from the National Cancer Institute (NCI R01CA120120 and K24CA169004). CBCS is funded by the Canadian Cancer Society (grant # 313404) and the Canadian Institutes of Health Research. CCGP is supported by funding from the University of Crete. The CECILE study was supported by Fondation de France, Institut National du Cancer (INCa), Ligue Nationale contre le Cancer, Agence Nationale de Sécurité Sanitaire, de l ' Alimentation, de l ' Environnement et du Travail (ANSES), Agence Nationale de la Recherche (ANR). The CGPS was supported by the Chief Physician Johan Boserup and Lise Boserup Fund, the Danish Medical Research Council, and Herlev and Gentofte Hospital. The CNIO-BCS was supported by the Instituto de Salud Carlos III, the Red Temática de Investigación Cooperativa en Cáncer and grants from the Asociación Española Contra el Cáncer and the Fondo de Investigación Sanitario (PI11/00923 and PI12/00070). COLBCCC is sup- ported by the German Cancer Research Center (DKFZ), Heidelberg, Germany. D.T. was in part supported by a postdoctoral fellowship from the Alexander von Humboldt Foundation. The American Cancer Society funds the creation, maintenance, and updating of the CPS-II cohort. The CTS was initially supported by the California Breast Cancer Act of 1993 and the California Breast Cancer Research Fund (contract 97-10500) and is currently funded through the National Institutes of Health (R01 CA77398, UM1 CA164917, and U01 CA199277). Collection of cancer incidence data was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885. H.A.C eceives support from the Lon V Smith Foundation (LVS39420). The University of Westminster curates the DietCompLyf database funded by Against Breast Cancer Registered Charit.No. 1121258 and the NCRN. The coordination of EPIC is fi nancially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by: Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l ' Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), Federal Ministry of Education and Research (BMBF) (Germany); the Hellenic Health Foundation, the Stavros Niarchos Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Neth- erlands); Health Research Fund (FIS), PI13/00061 to Granada, PI13/01162 to EPIC- Murcia, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, ISCIII RETIC (RD06/0020) (Spain); Cancer Research UK (14136 to EPIC- Norfolk; C570/A16491 and C8221/A19170 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk, MR/M012190/1 to EPIC-Oxford) (United Kingdom). The ESTHER study was supported by a grant from the Baden Württemberg Ministry of Science, Research and Arts. Additional cases were recruited in the context of the VERDI study, which was supported by a grant from the German Cancer Aid (Deutsche Kreb- shilfe). FHRISK is funded from NIHR grant PGfAR 0707-10031. The GC-HBOC (Ger- man Consortium of Hereditary Breast and Ovarian Cancer) is supported by the German Cancer Aid (grant no 110837, coordinator: Rita K. Schmutzler, Cologne). This work was also funded by the European Regional Development Fund and Free State of Saxony, Germany (LIFE - Leipzig Research Centre for Civilization Diseases, project numbers 713- 241202, 713-241202, 14505/2470, and 14575/2470). The GENICA was funded by the Federal Ministry of Education and Research (BMBF) Germany grants 01KW9975/5, 01KW9976/8, 01KW9977/0, and 01KW0114, the Robert Bosch Foundation, Stuttgart, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, the Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, as well as the Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany. The GEPARSIXTO study was conducted by the German Breast Group GmbH. The GESBC was supported by the Deutsche Krebshilfe e. V. [70492] and the German Cancer Research Center (DKFZ). GLACIER was supported by Breast Cancer Now, CRUK and Biomedical Research Centre at Guy ' s and St Thomas ' NHS Foundation Trust and King ' s College London. The HABCS study was supported by the Claudia von Schilling Foundation for Breast Cancer Research, by the Lower Saxonian Cancer Society, and by the Rudolf- Bartling Foundation. The HEBCS was fi nancially supported by the Helsinki University Central Hospital Research Fund, Academy of Finland (266528), the Finnish Cancer Society, and the Sigrid Juselius Foundation. The HERPACC was supported by MEXT Kakenhi (No. 170150181 and 26253041) from the Ministry of Education, Science, Sports, Culture and Technology of Japan, by a Grant-in-Aid for the Third Term Comprehensive 10-Year Strategy for Cancer Control from Ministry Health, Labour and Welfare of Japan, by Health and Labour Sciences Research Grants for Research on Applying Health Technology from Ministry Health, Labour and Welfare of Japan, by National Cancer Center Research and Development Fund, and " Practical Research for Innovative Cancer Control (15ck0106177h0001) " from Japan Agency for Medical Research and develop- ment, AMED, and Cancer Bio Bank Aichi. The HMBCS was supported by a grant from the Friends of Hannover Medical School and by the Rudolf Bartling Foundation. The HUBCS was supported by a grant from the German Federal Ministry of Research and Education (RUS08/017), and by the Russian Foundation for Basic Research and the Federal Agency for Scienti fi c Organizations for support the Bioresource collections and RFBR grants 14-04-97088, 17-29-06014, and 17-44-020498. ICICLE was supported by Breast Cancer Now, CRUK, and Biomedical Research Centre at Guy ' s and St Thomas ' NHS Foundation Trust and King ' s College London. Financial support for KARBAC was provided through the regional agreement on medical training and clinical research (A.L. F.) between Stockholm County Council and Karolinska Institutet, the Swedish Cancer Society, The Gustav V Jubilee foundation and Bert von Kantzows foundation. The KARMA study was supported by Märit and Hans Rausings Initiative Against Breast Cancer. The KBCP was fi nancially supported by the special Government Funding (E.V. O.) of Kuopio University Hospital grants, Cancer Fund of North Savo, the Finnish Cancer Organizations, and by the strategic funding of the University of Eastern Finland. kConFab is supported by a grant from the National Breast Cancer Foundation, and previously by the National Health and Medical Research Council (NHMRC), the Queensland Cancer Fund, the Cancer Councils of New South Wales, Victoria, Tasmania and South Australia, and the Cancer Foundation of Western Australia. Financial support for the AOCS was provided by the United States Army Medical Research and Materiel Command [DAMD17-01-1-0729], Cancer Council Victoria, Queensland Cancer Fund, Cancer Council New South Wales, Cancer Council South Australia, The Cancer Foundation of Western Australia, Cancer Council Tasmania and the National Health and Medical Research Council of Australia (NHMRC; 400413, 400281, 199600). G.C.-T. and P.W. are supported by the NHMRC. RB was a Cancer Institute NSW Clinical Research Fellow. The KOHBRA study was partially supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), and the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (HI16C1127; 1020350; 1420190). LAABC is supported by grants (1RB-0287, 3PB- 0102, 5PB-0018, 10PB-0098) from the California Breast Cancer Research Program. Incident breast cancer cases were collected by the USC Cancer Surveillance Program (CSP) which is supported under subcontract by the California Department of Health. TheCSP is also part of the National Cancer Institute ' s Division of Cancer Prevention and Control Surveillance, Epidemiology, and End Results Program, under contract number N01CN25403. L.M.B.C. is supported by the ' Stichting tegen Kanker ' . D.L. is supported by the FWO. The MABCS study is funded by the Research Centre for Genetic Engineering and Biotechnology " Georgi D. Efremov " and supported by the German Academic Exchange Program, DAAD. The MARIE study was supported by the Deutsche Krebshilfe e.V. [70-2892-BR I, 106332, 108253, 108419, 110826, 110828], the Hamburg Cancer Society, the German Cancer Research Center (DKFZ) and the Federal Ministry of Edu- cation and Research (BMBF) Germany [01KH0402]. MBCSG is supported by grants from the Italian Association for Cancer Research (AIRC) and by funds from the Italian citizens who allocated the 5/1000 share of their tax payment in support of the Fondazione IRCCS Istituto Nazionale Tumori, according to Italian laws (INT-Institutional strategic projects " 5 × 1000 " ). The MCBCS was supported by the NIH grants CA192393, CA116167, CA176785 an NIH Specialized Program of Research Excellence (SPORE) in Breast Cancer [CA116201], and the Breast Cancer Research Foundation and a generous gift from the David F. and Margaret T. Grohne Family Foundation. MCCS cohort recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further supported by Australian NHMRC grants 209057 and 396414, and by infrastructure provided by Cancer Council Victoria. Cases and their vital status were ascertained through the Victorian Cancer Registry (VCR) and the Australian Institute of Health and Welfare (AIHW), including the National Death Index and the Australian Cancer Database. The MEC was support by NIH grants CA63464, CA54281, CA098758, CA132839, and CA164973. The MISS study is supported by funding from ERC-2011-294576 Advanced grant, Swedish Cancer Society, Swedish Research Council, Local hospital funds, Berta Kamprad Foun- dation, Gunnar Nilsson. The MMHS study was supported by NIH grants CA97396, CA128931, CA116201, CA140286, and CA177150. MSKCC is supported by grants from the Breast Cancer Research Foundation and Robert and Kate Niehaus Clinical Cancer Genetics Initiative. The work of MTLGEBCS was supported by the Quebec Breast Cancer Foundation, the Canadian Institutes of Health Research for the " CIHR Team in Familial Risks of Breast Cancer " program – grant # CRN-87521 and the Ministry of Economic Development, Innovation and Export Trade – grant # PSR-SIIRI-701. MYBRCA is funded by research grants from the Malaysian Ministry of Higher Education (UM.C/HlR/MOHE/ 06) and Cancer Research Malaysia. MYMAMMO is supported by research grants from Yayasan Sime Darby LPGA Tournament and Malaysian Ministry of Higher Education (RP046B-15HTM). The NBCS has been supported by the Research Council of Norway grant 193387/V50 (to A.-L. Børresen-Dale and V.N. Kristensen) and grant 193387/H10 (to A.-L. Børresen-Dale and V.N. Kristensen), South Eastern Norway Health Authority (grant 39346 to A.-L. Børresen-Dale and 27208 to V.N. Kristensen) and the Norwegian Cancer Society (to A.-L. Børresen-Dale and 419616 - 71248 - PR-2006-0282 to V.N. Kristensen). It has received funding from the K.G. Jebsen Centre for Breast Cancer Research (2012-2015). The NBHS was supported by NIH grant R01CA100374. Biological sample preparation was conducted the Survey and Biospecimen Shared Resource, which is supported by P30 CA68485. The Northern California Breast Cancer Family Registry (NC- BCFR) and Ontario Familial Breast Cancer Registry (OFBCR) were supported by grant UM1 CA164920 from the National Cancer Institute (USA). The content of this manu- script does not necessarily re fl ect the views or policies of the National Cancer Institute or any of the collaborating centers in the Breast Cancer Family Registry (BCFR), nor does mention of trade names, commercial products, or organizations imply endorsement by the USA Government or the BCFR. The Carolina Breast Cancer Study was funded by Komen Foundation, the National Cancer Institute (P50 CA058223, U54 CA156733, and U01 CA179715), and the North Carolina University Cancer Research Fund. The NGOBCS was supported by Grants-in-Aid for the Third Term Comprehensive Ten-Year Strategy for Cancer Control from the Ministry of Health, Labor and Welfare of Japan, and for Scienti fi c Research on Priority Areas, 17015049 and for Scienti fi c Research on Innovative Areas, 221S0001, from the Ministry of Education, Culture, Sports, Science, and Technology of Japan. The NHS was supported by NIH grants P01 CA87969, UM1 CA186107, and U19 CA148065. The NHS2 was supported by NIH grants UM1 CA176726 and U19 CA148065. The OBCS was supported by research grants from the Finnish Cancer Foundation, the Academy of Finland (grant number 250083, 122715 and Center of Excellence grant number 251314), the Finnish Cancer Foundation, the Sigrid Juselius Foundation, the University of Oulu, the University of Oulu Support Foundation, and the special Governmental EVO funds for Oulu University Hospital-based research activities. The ORIGO study was supported by the Dutch Cancer Society (RUL 1997- 1505) and the Biobanking and Biomolecular Resources Research Infrastructure (BBMRI- NL CP16). The PBCS was funded by Intramural Research Funds of the National Cancer Institute, Department of Health and Human Services, USA. Genotyping for PLCO was supported by the Intramural Research Program of the National Institutes of Health, NCI, Division of Cancer Epidemiology and Genetics. The PLCO is supported by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics and supported by contracts from the Division of Cancer Prevention, National Cancer Institute, National Institutes of Health. The POSH study is funded by Cancer Research UK (grants C1275/ A11699, C1275/C22524, C1275/A19187, C1275/A15956, and Breast Cancer Campaign 2010PR62, 2013PR044. PROCAS is funded from NIHR grant PGfAR 0707-10031. The RBCS was funded by the Dutch Cancer Society (DDHK 2004-3124, DDHK 2009-4318). The SASBAC study was supported by funding from the Agency for Science, Technology and Research of Singapore (A*STAR), the US National Institute of Health (NIH) and the Susan G. Komen Breast Cancer Foundation. The SBCGS was supported primarily by NIH grants R01CA64277, R01CA148667, UMCA182910, and R37CA70867. Biological sample preparation was conducted the Survey and Biospecimen Shared Resource, which is supported by P30 CA68485. The scienti fi c development and funding of this project were, in part, supported by the Genetic Associations and Mechanisms in Oncology (GAME- ON) Network U19 CA148065. The SBCS was supported by Shef fi eld Experimental Cancer Medicine Centre and Breast Cancer Now Tissue Bank. The SCCS is supported by a grant from the National Institutes of Health (R01 CA092447). Data on SCCS cancer cases used in this publication were provided by the Alabama Statewide Cancer Registry; Kentucky Cancer Registry, Lexington, KY; Tennessee Department of Health, Of fi ce of Cancer Surveillance; Florida Cancer Data System; North Carolina Central Cancer Registry, North Carolina Division of Public Health; Georgia Comprehensive Cancer Registry; Louisiana Tumor Registry; Mississippi Cancer Registry; South Carolina Central Cancer Registry; Virginia Department of Health, Virginia Cancer Registry; Arkansas Department of Health, Cancer Registry, 4815 W. Markham, Little Rock, AR 72205. The Arkansas Central Cancer Registry is fully funded by a grant from National Program of Cancer Registries, Centers for Disease Control and Prevention (CDC). Data on SCCS cancer cases from Mississippi were collected by the Mississippi Cancer Registry which participates in the National Program of Cancer Registries (NPCR) of the Centers for Disease Control and Prevention (CDC). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the of fi cial views of the CDC or the Mississippi Cancer Registry. SEARCH is funded by Cancer Research UK [C490/A10124, C490/ A16561] and supported by the UK National Institute for Health Research Biomedical Research Centre at the University of Cambridge. The University of Cambridge has received salary support for PDPP from the NHS in the East of England through the Clinical Academic Reserve. SEBCS was supported by the BRL (Basic Research Laboratory) program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2012-0000347). SGBCC is funded by the NUS start- up Grant, National University Cancer Institute Singapore (NCIS) Centre Grant and the NMRC Clinician Scientist Award. Additional controls were recruited by the Singapore Consortium of Cohort Studies-Multi-ethnic cohort (SCCS-MEC), which was funded by the Biomedical Research Council, grant number: 05/1/21/19/425. The Sister Study (SIS- TER) is supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01-ES044005 and Z01-ES049033). The Two Sister Study (2SISTER) was supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01-ES044005 and Z01-ES102245), and, also by a grant from Susan G. Komen for the Cure, grant FAS0703856. SKKDKFZS is supported by the DKFZ. The SMC is funded by the Swedish Cancer Foundation. The SZBCS was supported by Grant PBZ_KBN_122/P05/2004. The TBCS was funded by The National Cancer Institute, Thailand. The TNBCC was supported by a Specialized Program of Research Excellence (SPORE) in Breast Cancer (CA116201), a grant from the Breast Cancer Research Foundation, a generous gift from the David F. and Margaret T. Grohne Family Foundation. The TWBCS is supported by the Taiwan Biobank project of the Institute of Biomedical Sciences, Academia Sinica, Taiwan. The UCIBCS component of this research was supported by the NIH [CA58860, CA92044] and the Lon V Smith Foundation [LVS39420]. The UKBGS is funded by Breast Cancer Now and the Institute of Cancer Research (ICR), London. ICR acknowledges NHS funding to the NIHR Bio- medical Research Centre. The UKOPS study was funded by The Eve Appeal (The Oak Foundation) and supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. The US3SS study was supported by Massachusetts (K.M.E., R01CA47305), Wisconsin (P.A.N., R01 CA47147) and New Hampshire (L.T.-E., R01CA69664) centers, and Intramural Research Funds of the National Cancer Institute, Department of Health and Human Services, USA. The USRT Study was funded by Intramural Research Funds of the National Cancer Institute, Department of Health and Human Services, USA. The WAABCS study was supported by grants from the National Cancer Institute of the National Institutes of Health (R01 CA89085 and P50 CA125183 and the D43 TW009112 grant), Susan G. Komen (SAC110026), the Dr. Ralph and Marian Falk Medical Research Trust, and the Avon Foundation for Women. The WHI program is funded by the National Heart, Lung, and Blood Institute, the US National Institutes of Health and the US Department of Health and Human Services (HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C). This work was also funded by NCI U19 CA148065-01. D.G.E. is supported by the all Manchester NIHR Biomedical research center Manchester (IS-BRC- 1215-20007). HUNBOCS, Hungarian Breast and Ovarian Cancer Study was supported by Hungarian Research Grant KTIA-OTKA CK-80745, NKFI_OTKA K-112228. C.I. received support from the Nontherapeutic Subject Registry Shared Resource at George- town University (NIH/NCI P30-CA-51008) and the Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research. K.M. is supported by CRUK C18281/ A19169. City of Hope Clinical Cancer Community Research Network and the Hereditary Cancer Research Registry, supported in part by Award Number RC4CA153828 (PI: J Weitzel) from the National Cancer Institute and the of fi ce of the Directory, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the of fi cial views of the National Institutes of Health. The colorectal cancer genome-wide association analyses: Colorectal Transdisciplinary Study (CORECT): The content of this manuscript does not necessarily re fl ect the views or policies of the National Cancer Institute or any of the collaborating centers in the CORECT Consortium, nor does mention of trade names, commercial products or organizations imply endor- sement by the US Government or the CORECT Consortium. We are incredibly grateful for the contributions of Dr. Brian Henderson and Dr. Roger Green over the course of this study and acknowledge them in memoriam. We are also grateful for support from Daniel and Maryann Fong. ColoCare: we thank the many investigators and staff who made thisHHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN26 8201600004C. The head and neck cancer genome-wide association analyses: The study was supported by NIH/NCI: P50 CA097190, and P30 CA047904, Canadian Cancer Society Research Institute (no. 020214) and Cancer Care Ontario Research Chair to R.H. The Princess Margaret Hospital Head and Neck Cancer Translational Research Program is funded by the Wharton family, Joe ' s Team, Gordon Tozer, Bruce Galloway and the Elia family. Geoffrey Liu was supported by the Posluns Family Fund and the Lusi Wong Family Fund at the Princess Margaret Foundation, and the Alan B. Brown Chair in Molecular Genomics. This publication presents data from Head and Neck 5000 (H&N5000). H&N5000 was a component of independent research funded by the UK National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10034). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Human papillomavirus (HPV) in H&N5000 serology was supported by a Cancer Research UK Programme Grant, the Integrative Cancer Epidemiology Programme (grant number: C18281/A19169). National Cancer Institute (R01-CA90731); National Institute of Environmental Health Sciences (P30ES10126). The authors thank all the members of the GENCAPO team/The Head and Neck Genome Project (GENCAPO) was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (Grant numbers 04/12054-9 and 10/51168-0). CPS-II recruitment and maintenance is supported with intramural research funding from the American Cancer Society. Genotyping per- formed at the Center for Inherited Disease Research (CIDR) was funded through the U.S. National Institute of Dental and Craniofacial Research (NIDCR) grant 1 × 01HG007780- 0. The University of Pittsburgh head and neck cancer case-control study is supported by National Institutes of Health grants P50 CA097190 and P30 CA047904. The Carolina Head and Neck Cancer Study (CHANCE) was supported by the National Cancer Institute (R01-CA90731). The Head and Neck Genome Project (GENCAPO) was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (Grant numbers 04/ 12054-9 and 10/51168-0). The authors thank all the members of the GENCAPO team. The HN5000 study was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10034), the views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The Toronto study was funded by the Canadian Cancer Society Research Institute (020214) and the National Cancer Institute (U19-CA148127) and the Cancer Care Ontario Research Chair. The alcohol-related cancers and genetic susceptibility study in Europe (ARCAGE) was funded by the Eur- opean Commission ' s 5th Framework Program (QLK1-2001-00182), the Italian Associa- tion for Cancer Research, Compagnia di San Paolo/FIRMS, Region Piemonte, and Padova University (CPDA057222). The Rome Study was supported by the Associazione Italiana per la Ricerca sul Cancro (AIRC) IG 2011 10491 and IG2013 14220 to S.B., and Fon- dazione Veronesi to S.B. The IARC Latin American study was funded by the European Commission INCO-DC programme (IC18-CT97-0222), with additional funding from Fondo para la Investigacion Cienti fi ca y Tecnologica (Argentina) and the Fundação de Amparo à Pesquisa do Estado de São Paulo (01/01768-2). We thank Leticia Fernandez, Instituto Nacional de Oncologia y Radiobiologia, La Habana, Cuba and Sergio and Rosalina Koifman, for their efforts with the IARC Latin America study São Paulo center. The IARC Central Europe study was supported by European Commission ' s INCO- COPERNICUS Program (IC15- CT98-0332), NIH/National Cancer Institute grant CA92039, and the World Cancer Research Foundation grant WCRF 99A28. The IARC Oral Cancer Multicenter study was funded by grant S06 96 202489 05F02 from Europe against Cancer; grants FIS 97/0024, FIS 97/0662, and BAE 01/5013 from Fondo de Investigaciones Sanitarias, Spain; the UICC Yamagiwa-Yoshida Memorial International Cancer Study; the National Cancer Institute of Canada; Associazione Italiana per la Ricerca sul Cancro; and the Pan-American Health Organization. Coordination of the EPIC study is fi nancially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The lung cancer genome-wide association analyses: Transdisciplinary Research for Cancer in Lung (TRICL) of the International Lung Cancer Consortium (ILCCO) was supported by (U19-CA148127, CA148127S1, U19CA203654, and Cancer Prevention Research Institute of Texas RR170048). The ILCCO data harmonization is supported by Cancer Care Ontario Research Chair of Population Studies to R. H. and Lunenfeld-Tanenbaum Research Institute, Sinai Health System. The TRICL-ILCCO OncoArray was supported by in-kind genotyping by the Centre for Inherited Disease Research (26820120008i-0-26800068-1). The CAPUA study was supported by FIS-FEDER/Spain grant numbers FIS-01/310, FIS-PI03-0365, and FIS- 07-BI060604, FICYT/Asturias grant numbers FICYT PB02-67 and FICYT IB09-133, and the University Institute of Oncology (IUOPA), of the University of Oviedo and the Ciber de Epidemiologia y Salud Pública. CIBERESP, SPAIN. The work performed in the CARET study was supported by the National Institute of Health/National Cancer Insti- tute: UM1 CA167462 (PI: Goodman), National Institute of Health UO1-CA6367307 (PIs Omen, Goodman); National Institute of Health R01 CA111703 (PI Chen), National Institute of Health 5R01 CA151989-01A1(PI Doherty). The Liverpool Lung project is supported by the Roy Castle Lung Cancer Foundation. The Harvard Lung Cancer Study was supported by the NIH (National Cancer Institute) grants CA092824, CA090578, CA074386. The Multi-ethnic Cohort Study was partially supported by NIH Grants CA164973, CA033619, CA63464, and CA148127. The work performed in MSH-PMH study was supported by The Canadian Cancer Society Research Institute (020214), Ontario Institute of Cancer and Cancer Care Ontario Chair Award to R.J.H. and G.L. and the Alan Brown Chair and Lusi Wong Programs at the Princess Margaret Hospital Foundation. NJLCS was funded by the State Key Program of National Natural Science ofChina (81230067), the National Key Basic Research Program Grant (2011CB503805), the Major Program of the National Natural Science Foundation of China (81390543). The Norway study was supported by Norwegian Cancer Society, Norwegian Research Council. The Shanghai Cohort Study (SCS) was supported by National Institutes of Health R01 CA144034 (PI: Yuan) and UM1 CA182876 (PI: Yuan). The Singapore Chinese Health Study (SCHS) was supported by National Institutes of Health R01 CA144034 (PI: Yuan) and UM1 CA182876 (PI: Yuan). The work in TLC study has been supported in part the James & Esther King Biomedical Research Program (09KN-15), National Institutes of Health Specialized Programs of Research Excellence (SPORE) Grant (P50 CA119997), and by a Cancer Center Support Grant (CCSG) at the H. Lee Mof fi tt Cancer Center and Research Institute, an NCI designated Comprehensive Cancer Center (grant number P30- CA76292). The Vanderbilt Lung Cancer Study — BioVU dataset used for the analyses described was obtained from Vanderbilt University Medical Center ' s BioVU, which is supported by institutional funding, the 1S10RR025141-01 instrumentation award, and by the Vanderbilt CTSA grant UL1TR000445 from NCATS/NIH. Dr. Aldrich was supported by NIH/National Cancer Institute K07CA172294 (PI: Aldrich) and Dr. Bush was sup- ported by NHGRI/NIH U01HG004798 (PI: Crawford). The Copenhagen General Population Study (CGPS) was supported by the Chief Physician Johan Boserup and Lise Boserup Fund, the Danish Medical Research Council and Herlev Hospital. The NELCS study: Grant Number P20RR018787 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH). The Kentucky Lung Cancer Research Initiative was supported by the Department of Defense [Congressionally Directed Medical Research Program, U.S. Army Medical Research and Materiel Com- mand Program] under award number: 10153006 (W81XWH-11-1-0781). Views and opinions of, and endorsements by the author(s) do not re fl ect those of the US Army or the Department of Defense. This research was also supported by unrestricted infrastructure funds from the UK Center for Clinical and Translational Science, NIH grant UL1TR000117 and Markey Cancer Center NCI Cancer Center Support Grant (P30 CA177558) Shared Resource Facilities: Cancer Research Informatics, Biospecimen and Tissue Procurement, and Biostatistics and Bioinformatics. The M.D. Anderson Cancer Center study was supported in part by grants from the NIH (P50 CA070907, R01 CA176568) (to X.W.), Cancer Prevention & Research Institute of Texas (RP130502) (to X. W.), and The University of Texas MD Anderson Cancer Center institutional support for the Center for Translational and Public Health Genomics. The deCODE study of smoking and nicotine dependence was funded in part by a grant from NIDA (R01- DA017932). The study in Lodz center was partially funded by Nofer Institute of Occupational Med- icine, under task NIOM 10.13: Predictors of mortality from non-small cell lung cancer — fi eld study. Genetic sharing analysis was funded by NIH grant CA194393. The research undertaken by M.D.T., L.V.W., and M.S.A. was partly funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. M.D.T. holds a Medical Research Council Senior Clinical Fellowship (G0902313). The work to assemble the FTND GWAS meta-analysis was supported by the National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA) grant number R01 DA035825 (Prin- cipal Investigator [PI]: DBH). The study populations included COGEND (dbGaP phs000092.v1.p1 and phs000404.v1.p1), COPDGene (dbGaP phs000179.v3.p2), deCODE Genetics, EAGLE (dbGaP phs000093.vs.p2), and SAGE. dbGaP phs000092.v1.p1). See Hancock et al. Transl Psychiatry 2015 (PMCID: PMC4930126) for the full listing of funding sources and other acknowledgments. The Resource for the Study of Lung Cancer Epidemiology in North Trent (ReSoLuCENT)study was funded by the Shef fi eld Hospitals Charity, Shef fi eld Experimental Cancer Medicine Centre and Weston Park Hospital Cancer Charity. The ovarian cancer genome-wide association analysis: The Ovarian Cancer Association Consortium (OCAC) is supported by a grant from the Ovarian Cancer Research Fund thanks to donations by the family and friends of Kathryn Sladek Smith (PPD/RPCI.07). The scienti fi c development and funding for this project were in part supported by the US National Cancer Institute GAME-ON Post-GWAS Initiative (U19-CA148112). This study made use of data generated by the Wellcome Trust Case Control consortium that was funded by the Wellcome Trust under award 076113. The results published here are in part based upon data generated by The Cancer Genome Atlas Pilot Project established by the National Cancer Institute and National Human Genome Research Institute (dbGap accession number phs000178.v8.p7). The OCAC OncoArray genotyping project was funded through grants from the U.S. National Institutes of Health (CA1X01HG007491-01 (C.I.A.), U19-CA148112 (T.A.S.), R01-CA149429 (C.M.P.), and R01-CA058598 (M.T.G.); Canadian Institutes of Health Research (MOP-86727 (L.E.K.) and the Ovarian Cancer Research Fund (A.B.). The COGS project was funded through a European Commission ' s Seventh Framework Programme grant (agreement number 223175 - HEALTH-F2-2009-223175) and through a grant from the U.S. National Insti- tutes of Health (R01-CA122443 (E.L.G)). Funding for individual studies: AAS: National Institutes of Health (RO1-CA142081); AOV: The Canadian Institutes for Health Research (MOP-86727); AUS: The Australian Ovarian Cancer Study Group was supported by the U.S. Army Medical Research and Materiel Command (DAMD17-01-1-0729), National Health & Medical Research Council of Australia (199600, 400413 and 400281), Cancer Councils of New South Wales, Victoria, Queensland, South Australia and Tas- mania and Cancer Foundation of Western Australia (Multi-State Applications 191, 211, and 182). The Australian Ovarian Cancer Study gratefully acknowledges additional support from Ovarian Cancer Australia and the Peter MacCallum Foundation; BAV: ELAN Funds of the University of Erlangen-Nuremberg; BEL: National Kankerplan; BGS: Breast Cancer Now, Institute of Cancer Research; BVU: Vanderbilt CTSA grant from the National Institutes of Health (NIH)/National Center for Advancing Translational SciencesNCATS) (ULTR000445); CAM: National Institutes of Health Research Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Cancer Centre; CHA: Innovative Research Team in University (PCSIRT) in China (IRT1076); CNI: Instituto de Salud Carlos III (PI12/01319); Ministerio de Economía y Competitividad (SAF2012); COE: Department of Defense (W81XWH-11-2-0131); CON: National Institutes of Health (R01-CA063678, R01-CA074850; and R01-CA080742); DKE: Ovarian Cancer Research Fund; DOV: National Institutes of Health R01-CA112523 and R01-CA87538; EMC: Dutch Cancer Society (EMC 2014-6699); EPC: The coordination of EPIC is fi nancially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l ' Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), Federal Ministry of Education and Research (BMBF) (Germany); the Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway); Health Research Fund (FIS), PI13/00061 to Granada, PI13/01162 to EPIC-Murcia, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, ISCIII RETIC (RD06/0020) (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC- Norfolk; C570/A16491 and C8221/A19170 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk, MR/M012190/1 to EPIC-Oxford) (United Kingdom); GER: German Federal Ministry of Education and Research, Programme of Clinical Biomedical Research (01 GB 9401) and the German Cancer Research Center (DKFZ); GRC: This research has been co- fi nanced by the European Union (European Social Fund — ESF) and Greek national funds through the Operational Program " Education and Lifelong Learn- ing " of the National Strategic Reference Framework (NSRF) — Research Funding Program of the General Secretariat for Research & Technology: SYN11_10_19 NBCA. Investing in knowledge society through the European Social Fund; GRR: Roswell Park Cancer Institute Alliance Foundation, P30 CA016056; HAW: U.S. National Institutes of Health (R01- CA58598, N01-CN-55424, and N01-PC-67001); HJO: Intramural funding; Rudolf- Bartling Foundation; HMO: Intramural funding; Rudolf-Bartling Foundation; HOC: Helsinki University Research Fund; HOP: Department of Defense (DAMD17-02-1-0669) and NCI (K07-CA080668, R01-CA95023, P50-CA159981 MO1-RR000056 R01- CA126841); HUO: Intramural funding; Rudolf-Bartling Foundation; JGO: JSPS KAKENHI grant; JPN: Grant-in-Aid for the Third Term Comprehensive 10-Year Strategy for Cancer Control from the Ministry of Health, Labour and Welfare; KRA: This study (Ko-EVE) was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), and the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (HI16C1127; 0920010); LAX: American Cancer Society Early Detection Professorship (SIOP-06-258-01-COUN) and the National Center for Advancing Translational Sciences (NCATS), Grant UL1TR000124; LUN: ERC-2011-AdG 294576-risk factors cancer, Swedish Cancer Society, Swedish Research Council, Beta Kamprad Foundation; MAC: National Institutes of Health (R01-CA122443, P30-CA15083, P50-CA136393); Mayo Foundation; Minnesota Ovarian Cancer Alliance; Fred C. and Katherine B. Andersen Foundation; Fraternal Order of Eagles; MAL: Funding for this study was provided by research grant R01- CA61107 from the National Cancer Institute, Bethesda, MD, research grant 94 222 52 from the Danish Cancer Society, Copenhagen, Denmark; and the Mer- maid I project; MAS: Malaysian Ministry of Higher Education (UM.C/HlR/MOHE/06) and Cancer Research Initiatives Foundation; MAY: National Institutes of Health (R01- CA122443, P30-CA15083, and P50-CA136393); Mayo Foundation; Minnesota Ovarian Cancer Alliance; Fred C. and Katherine B. Andersen Foundation; MCC: Cancer Council Victoria, National Health and Medical Research Council of Australia (NHMRC) grants number 209057, 251533, 396414, and 504715; MDA: DOD Ovarian Cancer Research Program (W81XWH-07-0449); MEC: NIH (CA54281, CA164973, CA63464); MOF: Mof fi tt Cancer Center, Merck Pharmaceuticals, the state of Florida, Hillsborough County, and the city of Tampa; NCO: National Institutes of Health (R01-CA76016) and the Department of Defense (DAMD17-02-1-0666); NEC: National Institutes of Health R01- CA54419 and P50-CA105009 and Department of Defense W81XWH-10-1-02802; NHS: UM1 CA186107, P01 CA87969, R01 CA49449, R01-CA67262, UM1 CA176726; NJO: National Cancer Institute (NIH-K07 CA095666, R01-CA83918, NIH-K22-CA138563, and P30-CA072720) and the Cancer Institute of New Jersey; If Sara Olson and/or Irene Orlow is a co-author, please add NCI CCSG award (P30-CA008748) to the funding sources; NOR: Helse Vest, The Norwegian Cancer Society, The Research Council of Norway; NTH: Radboud University Medical Centre; OPL: National Health and Medical Research Council (NHMRC) of Australia (APP1025142) and Brisbane Women ' s Club; ORE: OHSU Foundation; OVA: This work was supported by Canadian Institutes of Health Research grant (MOP-86727) and by NIH/NCI 1 R01CA160669-01A1; PLC: Intramural Research Program of the National Cancer Institute; POC: Pomeranian Medical Uni- versity; POL: Intramural Research Program of the National Cancer Institute; PVD: Canadian Cancer Society and Cancer Research Society GRePEC Program; RBH: National Health and Medical Research Council of Australia; RMH: Cancer Research UK, Royal Marsden Hospital; RPC: National Institute of Health (P50-CA159981, R01-CA126841); SEA: Cancer Research UK (C490/A10119 C490/A10124); UK National Institute forHealth Research Biomedical Research Centres at the University of Cambridge; SIS: NIH, National Institute of Environmental Health Sciences, Z01-ES044005 and Z01-ES049033; SMC: The bbSwedish Research Council-SIMPLER infrastructure; the Swedish Cancer Foundation; SON: National Health Research and Development Program, Health Canada, grant 6613-1415-53; SRO: Cancer Research UK (C536/A13086, C536/A6689) and Imperial Experimental Cancer Research Centre (C1312/A15589); STA: NIH grants U01 CA71966 and U01 CA69417; SWE: Swedish Cancer foundation, WeCanCureCancer and VårKampMotCancer foundation; SWH: NIH (NCI) grant R37-CA070867; TBO: National Institutes of Health (R01-CA106414-A2), American Cancer Society (CRTG-00-196-01- CCE), Department of Defense (DAMD17-98-1-8659), Celma Mastery Ovarian Cancer Foundation; TOR: NIH grants R01-CA063678 and R01 CA063682; UCI: NIH R01- CA058860 and the Lon V Smith Foundation grant LVS39420; UHN: Princess Margaret Cancer Centre Foundation-Bridge for the Cure; UKO: The UKOPS study was funded by The Eve Appeal (The Oak Foundation) and supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre; UKR: Cancer Research UK (C490/A6187), UK National Institute for Health Research Biomedical Research Centres at the University of Cambridge; USC: P01CA17054, P30CA14089, R01CA61132, N01PC67010, R03CA113148, R03CA115195, N01CN025403, and Cali- fornia Cancer Research Program (00-01389V-20170, 2II0200); VAN: BC Cancer Foun- dation, VGH & UBC Hospital Foundation; VTL: NIH K05-CA154337; WMH: National Health and Medical Research Council of Australia, Enabling Grants ID 310670 & ID 628903. Cancer Institute NSW Grants 12/RIG/1-17 & 15/RIG/1-16; WOC: National Science Centren (N N301 5645 40). The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland. The University of Cambridge has received salary support for PDPP from the NHS in the East of England through the Clinical Academia Reserve. The prostate cancer genome-wide association analyses: we pay tribute to Brian Henderson, who was a driving force behind the OncoArray project, for his vision and leadership, and who sadly passed away before seeing its fruition. We also thank the individuals who participated in these studies enabling this work. The ELLIPSE/ PRACTICAL (http//:practical.icr.ac.uk) prostate cancer consortium and his collaborating partners were supported by multiple funding mechanisms enabling this current work. ELLIPSE/PRACTICAL Genotyping of the OncoArray was funded by the US National Institutes of Health (NIH) (U19 CA148537 for ELucidating Loci Involved in Prostate Cancer SuscEptibility (ELLIPSE) project and X01HG007492 to the Center for Inherited Disease Research (CIDR) under contract number HHSN268201200008I). Additional analytical support was provided by NIH NCI U01 CA188392 (F.R.S.). Funding for the iCOGS infrastructure came from the European Community ' s Seventh Framework Pro- gramme under grant agreement n° 223175 (HEALTH-F2-2009-223175) (COGS), Cancer Research UK (C1287/A10118, C1287/A 10710, C12292/A11174, C1281/A12014, C5047/ A8384, C5047/A15007, C5047/A10692, and C8197/A16565), the National Institutes of Health (CA128978) and Post-Cancer GWAS initiative (1U19 CA148537, 1U19 CA148065, and 1U19 CA148112; the GAME-ON initiative), the Department of Defense (W81XWH-10-1-0341), the Canadian Institutes of Health Research (CIHR) for the CIHR Team in Familial Risks of Breast Cancer, Komen Foundation for the Cure, the Breast Cancer Research Foundation, and the Ovarian Cancer Research Fund. This work was supported by the Canadian Institutes of Health Research, European Commission ' s Seventh Framework Programme grant agreement n° 223175 (HEALTH-F2-2009-223175), Cancer Research UK Grants C5047/A7357, C1287/A10118, C1287/A16563, C5047/ A3354, C5047/A10692, C16913/A6135, C5047/A21332 and The National Institute of Health (NIH) Cancer Post-Cancer GWAS initiative grant: No. 1 U19 CA148537-01 (the GAME-ON initiative). We also thank the following for funding support: The Institute of Cancer Research and The Everyman Campaign, The Prostate Cancer Research Founda- tion, Prostate Research Campaign UK (now Prostate Action), The Orchid Cancer Appeal, The National Cancer Research Network UK, and The National Cancer Research Institute (NCRI) UK. We are grateful for support of NIHR funding to the NIHR Biomedical Research Centre at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust. The Prostate Cancer Program of Cancer Council Victoria also acknowledge grant support from The National Health and Medical Research Council, Australia (126402, 209057, 251533, 396414, 450104, 504700, 504702, 504715, 623204, 940394, and 614296), VicHealth, Cancer Council Victoria, The Prostate Cancer Foun- dation of Australia, The Whitten Foundation, PricewaterhouseCoopers, and Tattersall ' s. E.A.O., D.M.K., and E.M.K. acknowledge the Intramural Program of the National Human Genome Research Institute for their support. The BPC3 was supported by the U.S. National Institutes of Health, National Cancer Institute (cooperative agreements U01- CA98233 to D.J.H., U01-CA98710 to S.M.G., U01-CA98216 to E.R., and U01-CA98758 to B.E.H., and Intramural Research Program of NIH/National Cancer Institute, Division of Cancer Epidemiology and Genetics). CAPS GWAS study was supported by the Swedish Cancer Foundation (grant no 09-0677, 11-484, 12-823), the Cancer Risk Prediction Center (CRisP; www.crispcenter.org ), a Linneus Centre (Contract ID 70867902) fi nanced by the Swedish Research Council, Swedish Research Council (grant no K2010-70 × - 20430-04-3, 2014-2269). The Hannover Prostate Cancer Study was supported by the Lower Saxonian Cancer Society. PEGASUS was supported by the Intramural Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health. RAPPER was supported by the NIHR Manchester Bio- medical Research Center, Cancer Research UK (C147/A25254, C1094/A18504) and the EUs7Framework Programme Grant/Agreement no 60186. Overall: this research has been conducted using the UK Biobank Resource (application number 16549). NHS is supported by UM1 CA186107 (NHS cohort infrastructure grant), P01 CA87969, and R01 CA49449. NHSII is supported by UM1 CA176726 (NHSII cohort infrastructure grant),and R01-CA67262. A.L.K. is supported by R01 MH107649. We would like to thank the participants and staff of the NHS and NHSII for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data. ; Sí
Publisher's version (útgefin grein). ; Quantifying the genetic correlation between cancers can provide important insights into the mechanisms driving cancer etiology. Using genome-wide association study summary statistics across six cancer types based on a total of 296,215 cases and 301,319 controls of European ancestry, here we estimate the pair-wise genetic correlations between breast, colorectal, head/neck, lung, ovary and prostate cancer, and between cancers and 38 other diseases. We observed statistically significant genetic correlations between lung and head/neck cancer (rg = 0.57, p = 4.6 × 10−8), breast and ovarian cancer (rg = 0.24, p = 7 × 10−5), breast and lung cancer (rg = 0.18, p =1.5 × 10−6) and breast and colorectal cancer (rg = 0.15, p = 1.1 × 10−4). We also found that multiple cancers are genetically correlated with non-cancer traits including smoking, psychiatric diseases and metabolic characteristics. Functional enrichment analysis revealed a significant excess contribution of conserved and regulatory regions to cancer heritability. Our comprehensive analysis of cross-cancer heritability suggests that solid tumors arising across tissues share in part a common germline genetic basis. ; The authors in this manuscript were working on behalf of BCAC, CCFR, CIMBA, CORECT, GECCO, OCAC, PRACTICAL, CRUK, BPC3, CAPS, PEGASUS, TRICL-ILCCO, ABCTB, APCB, BCFR, CONSIT TEAM, EMBRACE, GC-HBOC, GEMO, HEBON, kConFab/AOCS Mod SQuaD, and SWE-BRCA. The breast cancer genome-wide association analyses: BCAC is funded by Cancer Research UK [C1287/A16563, C1287/A10118], the European Union's Horizon 2020 Research and Innovation Programme (grant numbers 634935 and 633784 for BRIDGES and B-CAST, respectively), and by the European Community's Seventh Framework Programme under grant agreement number 223175 (grant number HEALTH-F2-2009-223175) (COGS). The EU Horizon 2020 Research and Innovation Programme funding source had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Genotyping of the OncoArray was funded by the NIH Grant U19 CA148065, and Cancer UK Grant C1287/A16563 and the PERSPECTIVE project supported by the Government of Canada through Genome Canada and the Canadian Institutes of Health Research (grant GPH-129344) and, the Ministère de l'Économie, Science et Innovation du Québec through Genome Québec and the PSR-SIIRI-701 grant, and the Quebec Breast Cancer Foundation. Funding for the iCOGS infrastructure came from: the European Community's Seventh Framework Programme under grant agreement n° 223175 (HEALTH-F2-2009-223175) (COGS), Cancer Research UK (C1287/A10118, C1287/A10710, C12292/A11174, C1281/A12014, C5047/A8384, C5047/A15007, C5047/A10692, C8197/A16565), the National Institutes of Health (CA128978), and Post-Cancer GWAS initiative (1U19 CA148537, 1U19 CA148065, and 1U19 CA148112—the GAME-ON initiative), the Department of Defence (W81XWH-10-1-0341), the Canadian Institutes of Health Research (CIHR) for the CIHR Team in Familial Risks of Breast Cancer, and Komen Foundation for the Cure, the Breast Cancer Research Foundation, and the Ovarian Cancer Research Fund. The DRIVE Consortium was funded by U19 CA148065. The Australian Breast Cancer Family Study (ABCFS) was supported by grant UM1 CA164920 from the National Cancer Institute (USA). The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in the Breast Cancer Family Registry (BCFR), nor does mention of trade names, commercial products, or organizations imply endorsement by the USA Government or the BCFR. The ABCFS was also supported by the National Health and Medical Research Council of Australia, the New South Wales Cancer Council, the Victorian Health Promotion Foundation (Australia), and the Victorian Breast Cancer Research Consortium. J.L.H. is a National Health and Medical Research Council (NHMRC) Senior Principal Research Fellow. M.C.S. is a NHMRC Senior Research Fellow. The ABCS study was supported by the Dutch Cancer Society [grants NKI 2007-3839; 2009 4363]. The Australian Breast Cancer Tissue Bank (ABCTB) is generously supported by the National Health and Medical Research Council of Australia, The Cancer Institute NSW and the National Breast Cancer Foundation. The ACP study is funded by the Breast Cancer Research Trust, UK. The AHS study is supported by the intramural research program of the National Institutes of Health, the National Cancer Institute (grant number Z01-CP010119), and the National Institute of Environmental Health Sciences (grant number Z01-ES049030). The work of the BBCC was partly funded by ELAN-Fond of the University Hospital of Erlangen. The BBCS is funded by Cancer Research UK and Breast Cancer Now and acknowledges NHS funding to the NIHR Biomedical Research Centre, and the National Cancer Research Network (NCRN). The BCEES was funded by the National Health and Medical Research Council, Australia and the Cancer Council Western Australia and acknowledges funding from the National Breast Cancer Foundation (JS). For the BCFR-NY, BCFR-PA, and BCFR-UT this work was supported by grant UM1 CA164920 from the National Cancer Institute. The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in the Breast Cancer Family Registry (BCFR), nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or the BCFR. For BIGGS, ES is supported by NIHR Comprehensive Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust in partnership with King's College London, United Kingdom. IT is supported by the Oxford Biomedical Research Centre. BOCS is supported by funds from Cancer Research UK (C8620/A8372/A15106) and the Institute of Cancer Research (UK). BOCS acknowledges NHS funding to the Royal Marsden/Institute of Cancer Research NIHR Specialist Cancer Biomedical Research Centre. The BREast Oncology GAlician Network (BREOGAN) is funded by Acción Estratégica de Salud del Instituto de Salud Carlos III FIS PI12/02125/Cofinanciado FEDER; Acción Estratégica de Salud del Instituto de Salud Carlos III FIS Intrasalud (PI13/01136); Programa Grupos Emergentes, Cancer Genetics Unit, Instituto de Investigacion Biomedica Galicia Sur. Xerencia de Xestion Integrada de Vigo-SERGAS, Instituto de Salud Carlos III, Spain; Grant 10CSA012E, Consellería de Industria Programa Sectorial de Investigación Aplicada, PEME I + D e I + D Suma del Plan Gallego de Investigación, Desarrollo e Innovación Tecnológica de la Consellería de Industria de la Xunta de Galicia, Spain; Grant EC11-192. Fomento de la Investigación Clínica Independiente, Ministerio de Sanidad, Servicios Sociales e Igualdad, Spain; and Grant FEDER-Innterconecta. Ministerio de Economia y Competitividad, Xunta de Galicia, Spain. The BSUCH study was supported by the Dietmar-Hopp Foundation, the Helmholtz Society and the German Cancer Research Center (DKFZ). The CAMA study was funded by Consejo Nacional de Ciencia y Tecnología (CONACyT) (SALUD-2002-C01-7462). Sample collection and processing was funded in part by grants from the National Cancer Institute (NCI R01CA120120 and K24CA169004). CBCS is funded by the Canadian Cancer Society (grant # 313404) and the Canadian Institutes of Health Research. CCGP is supported by funding from the University of Crete. The CECILE study was supported by Fondation de France, Institut National du Cancer (INCa), Ligue Nationale contre le Cancer, Agence Nationale de Sécurité Sanitaire, de l'Alimentation, de l'Environnement et du Travail (ANSES), Agence Nationale de la Recherche (ANR). The CGPS was supported by the Chief Physician Johan Boserup and Lise Boserup Fund, the Danish Medical Research Council, and Herlev and Gentofte Hospital. The CNIO-BCS was supported by the Instituto de Salud Carlos III, the Red Temática de Investigación Cooperativa en Cáncer and grants from the Asociación Española Contra el Cáncer and the Fondo de Investigación Sanitario (PI11/00923 and PI12/00070). COLBCCC is supported by the German Cancer Research Center (DKFZ), Heidelberg, Germany. D.T. was in part supported by a postdoctoral fellowship from the Alexander von Humboldt Foundation. The American Cancer Society funds the creation, maintenance, and updating of the CPS-II cohort. The CTS was initially supported by the California Breast Cancer Act of 1993 and the California Breast Cancer Research Fund (contract 97-10500) and is currently funded through the National Institutes of Health (R01 CA77398, UM1 CA164917, and U01 CA199277). Collection of cancer incidence data was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885. H.A.C eceives support from the Lon V Smith Foundation (LVS39420). The University of Westminster curates the DietCompLyf database funded by Against Breast Cancer Registered Charity No. 1121258 and the NCRN. The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by: Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), Federal Ministry of Education and Research (BMBF) (Germany); the Hellenic Health Foundation, the Stavros Niarchos Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Health Research Fund (FIS), PI13/00061 to Granada, PI13/01162 to EPIC-Murcia, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, ISCIII RETIC (RD06/0020) (Spain); Cancer Research UK (14136 to EPIC-Norfolk; C570/A16491 and C8221/A19170 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk, MR/M012190/1 to EPIC-Oxford) (United Kingdom). The ESTHER study was supported by a grant from the Baden Württemberg Ministry of Science, Research and Arts. Additional cases were recruited in the context of the VERDI study, which was supported by a grant from the German Cancer Aid (Deutsche Krebshilfe). FHRISK is funded from NIHR grant PGfAR 0707-10031. The GC-HBOC (German Consortium of Hereditary Breast and Ovarian Cancer) is supported by the German Cancer Aid (grant no 110837, coordinator: Rita K. Schmutzler, Cologne). This work was also funded by the European Regional Development Fund and Free State of Saxony, Germany (LIFE - Leipzig Research Centre for Civilization Diseases, project numbers 713-241202, 713-241202, 14505/2470, and 14575/2470). The GENICA was funded by the Federal Ministry of Education and Research (BMBF) Germany grants 01KW9975/5, 01KW9976/8, 01KW9977/0, and 01KW0114, the Robert Bosch Foundation, Stuttgart, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, the Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, as well as the Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany. The GEPARSIXTO study was conducted by the German Breast Group GmbH. The GESBC was supported by the Deutsche Krebshilfe e. V. [70492] and the German Cancer Research Center (DKFZ). GLACIER was supported by Breast Cancer Now, CRUK and Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London. The HABCS study was supported by the Claudia von Schilling Foundation for Breast Cancer Research, by the Lower Saxonian Cancer Society, and by the Rudolf-Bartling Foundation. The HEBCS was financially supported by the Helsinki University Central Hospital Research Fund, Academy of Finland (266528), the Finnish Cancer Society, and the Sigrid Juselius Foundation. The HERPACC was supported by MEXT Kakenhi (No. 170150181 and 26253041) from the Ministry of Education, Science, Sports, Culture and Technology of Japan, by a Grant-in-Aid for the Third Term Comprehensive 10-Year Strategy for Cancer Control from Ministry Health, Labour and Welfare of Japan, by Health and Labour Sciences Research Grants for Research on Applying Health Technology from Ministry Health, Labour and Welfare of Japan, by National Cancer Center Research and Development Fund, and "Practical Research for Innovative Cancer Control (15ck0106177h0001)" from Japan Agency for Medical Research and development, AMED, and Cancer Bio Bank Aichi. The HMBCS was supported by a grant from the Friends of Hannover Medical School and by the Rudolf Bartling Foundation. The HUBCS was supported by a grant from the German Federal Ministry of Research and Education (RUS08/017), and by the Russian Foundation for Basic Research and the Federal Agency for Scientific Organizations for support the Bioresource collections and RFBR grants 14-04-97088, 17-29-06014, and 17-44-020498. ICICLE was supported by Breast Cancer Now, CRUK, and Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London. Financial support for KARBAC was provided through the regional agreement on medical training and clinical research (A.L.F.) between Stockholm County Council and Karolinska Institutet, the Swedish Cancer Society, The Gustav V Jubilee foundation and Bert von Kantzows foundation. The KARMA study was supported by Märit and Hans Rausings Initiative Against Breast Cancer. The KBCP was financially supported by the special Government Funding (E.V.O.) of Kuopio University Hospital grants, Cancer Fund of North Savo, the Finnish Cancer Organizations, and by the strategic funding of the University of Eastern Finland. kConFab is supported by a grant from the National Breast Cancer Foundation, and previously by the National Health and Medical Research Council (NHMRC), the Queensland Cancer Fund, the Cancer Councils of New South Wales, Victoria, Tasmania and South Australia, and the Cancer Foundation of Western Australia. Financial support for the AOCS was provided by the United States Army Medical Research and Materiel Command [DAMD17-01-1-0729], Cancer Council Victoria, Queensland Cancer Fund, Cancer Council New South Wales, Cancer Council South Australia, The Cancer Foundation of Western Australia, Cancer Council Tasmania and the National Health and Medical Research Council of Australia (NHMRC; 400413, 400281, 199600). G.C.-T. and P.W. are supported by the NHMRC. RB was a Cancer Institute NSW Clinical Research Fellow. The KOHBRA study was partially supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), and the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (HI16C1127; 1020350; 1420190). LAABC is supported by grants (1RB-0287, 3PB-0102, 5PB-0018, 10PB-0098) from the California Breast Cancer Research Program. Incident breast cancer cases were collected by the USC Cancer Surveillance Program (CSP) which is supported under subcontract by the California Department of Health. The CSP is also part of the National Cancer Institute's Division of Cancer Prevention and Control Surveillance, Epidemiology, and End Results Program, under contract number N01CN25403. L.M.B.C. is supported by the 'Stichting tegen Kanker'. D.L. is supported by the FWO. The MABCS study is funded by the Research Centre for Genetic Engineering and Biotechnology "Georgi D. Efremov" and supported by the German Academic Exchange Program, DAAD. The MARIE study was supported by the Deutsche Krebshilfe e.V. [70-2892-BR I, 106332, 108253, 108419, 110826, 110828], the Hamburg Cancer Society, the German Cancer Research Center (DKFZ) and the Federal Ministry of Education and Research (BMBF) Germany [01KH0402]. MBCSG is supported by grants from the Italian Association for Cancer Research (AIRC) and by funds from the Italian citizens who allocated the 5/1000 share of their tax payment in support of the Fondazione IRCCS Istituto Nazionale Tumori, according to Italian laws (INT-Institutional strategic projects "5 × 1000"). The MCBCS was supported by the NIH grants CA192393, CA116167, CA176785 an NIH Specialized Program of Research Excellence (SPORE) in Breast Cancer [CA116201], and the Breast Cancer Research Foundation and a generous gift from the David F. and Margaret T. Grohne Family Foundation. MCCS cohort recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further supported by Australian NHMRC grants 209057 and 396414, and by infrastructure provided by Cancer Council Victoria. Cases and their vital status were ascertained through the Victorian Cancer Registry (VCR) and the Australian Institute of Health and Welfare (AIHW), including the National Death Index and the Australian Cancer Database. The MEC was support by NIH grants CA63464, CA54281, CA098758, CA132839, and CA164973. The MISS study is supported by funding from ERC-2011-294576 Advanced grant, Swedish Cancer Society, Swedish Research Council, Local hospital funds, Berta Kamprad Foundation, Gunnar Nilsson. The MMHS study was supported by NIH grants CA97396, CA128931, CA116201, CA140286, and CA177150. MSKCC is supported by grants from the Breast Cancer Research Foundation and Robert and Kate Niehaus Clinical Cancer Genetics Initiative. The work of MTLGEBCS was supported by the Quebec Breast Cancer Foundation, the Canadian Institutes of Health Research for the "CIHR Team in Familial Risks of Breast Cancer" program – grant # CRN-87521 and the Ministry of Economic Development, Innovation and Export Trade – grant # PSR-SIIRI-701. MYBRCA is funded by research grants from the Malaysian Ministry of Higher Education (UM.C/HlR/MOHE/06) and Cancer Research Malaysia. MYMAMMO is supported by research grants from Yayasan Sime Darby LPGA Tournament and Malaysian Ministry of Higher Education (RP046B-15HTM). The NBCS has been supported by the Research Council of Norway grant 193387/V50 (to A.-L. Børresen-Dale and V.N. Kristensen) and grant 193387/H10 (to A.-L. Børresen-Dale and V.N. Kristensen), South Eastern Norway Health Authority (grant 39346 to A.-L. Børresen-Dale and 27208 to V.N. Kristensen) and the Norwegian Cancer Society (to A.-L. Børresen-Dale and 419616 - 71248 - PR-2006-0282 to V.N. Kristensen). It has received funding from the K.G. Jebsen Centre for Breast Cancer Research (2012-2015). The NBHS was supported by NIH grant R01CA100374. Biological sample preparation was conducted the Survey and Biospecimen Shared Resource, which is supported by P30 CA68485. The Northern California Breast Cancer Family Registry (NC-BCFR) and Ontario Familial Breast Cancer Registry (OFBCR) were supported by grant UM1 CA164920 from the National Cancer Institute (USA). The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in the Breast Cancer Family Registry (BCFR), nor does mention of trade names, commercial products, or organizations imply endorsement by the USA Government or the BCFR. The Carolina Breast Cancer Study was funded by Komen Foundation, the National Cancer Institute (P50 CA058223, U54 CA156733, and U01 CA179715), and the North Carolina University Cancer Research Fund. The NGOBCS was supported by Grants-in-Aid for the Third Term Comprehensive Ten-Year Strategy for Cancer Control from the Ministry of Health, Labor and Welfare of Japan, and for Scientific Research on Priority Areas, 17015049 and for Scientific Research on Innovative Areas, 221S0001, from the Ministry of Education, Culture, Sports, Science, and Technology of Japan. The NHS was supported by NIH grants P01 CA87969, UM1 CA186107, and U19 CA148065. The NHS2 was supported by NIH grants UM1 CA176726 and U19 CA148065. The OBCS was supported by research grants from the Finnish Cancer Foundation, the Academy of Finland (grant number 250083, 122715 and Center of Excellence grant number 251314), the Finnish Cancer Foundation, the Sigrid Juselius Foundation, the University of Oulu, the University of Oulu Support Foundation, and the special Governmental EVO funds for Oulu University Hospital-based research activities. The ORIGO study was supported by the Dutch Cancer Society (RUL 1997-1505) and the Biobanking and Biomolecular Resources Research Infrastructure (BBMRI-NL CP16). The PBCS was funded by Intramural Research Funds of the National Cancer Institute, Department of Health and Human Services, USA. Genotyping for PLCO was supported by the Intramural Research Program of the National Institutes of Health, NCI, Division of Cancer Epidemiology and Genetics. The PLCO is supported by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics and supported by contracts from the Division of Cancer Prevention, National Cancer Institute, National Institutes of Health. The POSH study is funded by Cancer Research UK (grants C1275/A11699, C1275/C22524, C1275/A19187, C1275/A15956, and Breast Cancer Campaign 2010PR62, 2013PR044. PROCAS is funded from NIHR grant PGfAR 0707-10031. The RBCS was funded by the Dutch Cancer Society (DDHK 2004-3124, DDHK 2009-4318). The SASBAC study was supported by funding from the Agency for Science, Technology and Research of Singapore (A*STAR), the US National Institute of Health (NIH) and the Susan G. Komen Breast Cancer Foundation. The SBCGS was supported primarily by NIH grants R01CA64277, R01CA148667, UMCA182910, and R37CA70867. Biological sample preparation was conducted the Survey and Biospecimen Shared Resource, which is supported by P30 CA68485. The scientific development and funding of this project were, in part, supported by the Genetic Associations and Mechanisms in Oncology (GAME-ON) Network U19 CA148065. The SBCS was supported by Sheffield Experimental Cancer Medicine Centre and Breast Cancer Now Tissue Bank. The SCCS is supported by a grant from the National Institutes of Health (R01 CA092447). Data on SCCS cancer cases used in this publication were provided by the Alabama Statewide Cancer Registry; Kentucky Cancer Registry, Lexington, KY; Tennessee Department of Health, Office of Cancer Surveillance; Florida Cancer Data System; North Carolina Central Cancer Registry, North Carolina Division of Public Health; Georgia Comprehensive Cancer Registry; Louisiana Tumor Registry; Mississippi Cancer Registry; South Carolina Central Cancer Registry; Virginia Department of Health, Virginia Cancer Registry; Arkansas Department of Health, Cancer Registry, 4815 W. Markham, Little Rock, AR 72205. The Arkansas Central Cancer Registry is fully funded by a grant from National Program of Cancer Registries, Centers for Disease Control and Prevention (CDC). Data on SCCS cancer cases from Mississippi were collected by the Mississippi Cancer Registry which participates in the National Program of Cancer Registries (NPCR) of the Centers for Disease Control and Prevention (CDC). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or the Mississippi Cancer Registry. SEARCH is funded by Cancer Research UK [C490/A10124, C490/A16561] and supported by the UK National Institute for Health Research Biomedical Research Centre at the University of Cambridge. The University of Cambridge has received salary support for PDPP from the NHS in the East of England through the Clinical Academic Reserve. SEBCS was supported by the BRL (Basic Research Laboratory) program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2012-0000347). SGBCC is funded by the NUS start-up Grant, National University Cancer Institute Singapore (NCIS) Centre Grant and the NMRC Clinician Scientist Award. Additional controls were recruited by the Singapore Consortium of Cohort Studies-Multi-ethnic cohort (SCCS-MEC), which was funded by the Biomedical Research Council, grant number: 05/1/21/19/425. The Sister Study (SISTER) is supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01-ES044005 and Z01-ES049033). The Two Sister Study (2SISTER) was supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01-ES044005 and Z01-ES102245), and, also by a grant from Susan G. Komen for the Cure, grant FAS0703856. SKKDKFZS is supported by the DKFZ. The SMC is funded by the Swedish Cancer Foundation. The SZBCS was supported by Grant PBZ_KBN_122/P05/2004. The TBCS was funded by The National Cancer Institute, Thailand. The TNBCC was supported by a Specialized Program of Research Excellence (SPORE) in Breast Cancer (CA116201), a grant from the Breast Cancer Research Foundation, a generous gift from the David F. and Margaret T. Grohne Family Foundation. The TWBCS is supported by the Taiwan Biobank project of the Institute of Biomedical Sciences, Academia Sinica, Taiwan. The UCIBCS component of this research was supported by the NIH [CA58860, CA92044] and the Lon V Smith Foundation [LVS39420]. The UKBGS is funded by Breast Cancer Now and the Institute of Cancer Research (ICR), London. ICR acknowledges NHS funding to the NIHR Biomedical Research Centre. The UKOPS study was funded by The Eve Appeal (The Oak Foundation) and supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. The US3SS study was supported by Massachusetts (K.M.E., R01CA47305), Wisconsin (P.A.N., R01 CA47147) and New Hampshire (L.T.-E., R01CA69664) centers, and Intramural Research Funds of the National Cancer Institute, Department of Health and Human Services, USA. The USRT Study was funded by Intramural Research Funds of the National Cancer Institute, Department of Health and Human Services, USA. The WAABCS study was supported by grants from the National Cancer Institute of the National Institutes of Health (R01 CA89085 and P50 CA125183 and the D43 TW009112 grant), Susan G. Komen (SAC110026), the Dr. Ralph and Marian Falk Medical Research Trust, and the Avon Foundation for Women. The WHI program is funded by the National Heart, Lung, and Blood Institute, the US National Institutes of Health and the US Department of Health and Human Services (HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C). This work was also funded by NCI U19 CA148065-01. D.G.E. is supported by the all Manchester NIHR Biomedical research center Manchester (IS-BRC-1215-20007). HUNBOCS, Hungarian Breast and Ovarian Cancer Study was supported by Hungarian Research Grant KTIA-OTKA CK-80745, NKFI_OTKA K-112228. C.I. received support from the Nontherapeutic Subject Registry Shared Resource at Georgetown University (NIH/NCI P30-CA-51008) and the Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research. K.M. is supported by CRUK C18281/A19169. City of Hope Clinical Cancer Community Research Network and the Hereditary Cancer Research Registry, supported in part by Award Number RC4CA153828 (PI: J Weitzel) from the National Cancer Institute and the office of the Directory, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The colorectal cancer genome-wide association analyses: Colorectal Transdisciplinary Study (CORECT): The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in the CORECT Consortium, nor does mention of trade names, commercial products or organizations imply endorsement by the US Government or the CORECT Consortium. We are incredibly grateful for the contributions of Dr. Brian Henderson and Dr. Roger Green over the course of this study and acknowledge them in memoriam. We are also grateful for support from Daniel and Maryann Fong. ColoCare: we thank the many investigators and staff who made this research possible in ColoCare Seattle and ColoCare Heidelberg. ColoCare was initiated and developed at the Fred Hutchinson Cancer Research Center by Drs. Ulrich and Grady. CCFR: the Colon CFR graciously thanks the generous contributions of their study participants, dedication of study staff, and financial support from the U.S. National Cancer Institute, without which this important registry would not exist. Galeon: GALEON wishes to thank the Department of Surgery of University Hospital of Santiago (CHUS), Sara Miranda Ponte, Carmen M Redondo, and the staff of the Department of Pathology and Biobank of CHUS, Instituto de Investigación Sanitaria de Santiago (IDIS), Instituto de Investigación Sanitaria Galicia Sur (IISGS), SERGAS, Vigo, Spain, and Programa Grupos Emergentes, Cancer Genetics Unit, CHUVI Vigo Hospital, Instituto de Salud Carlos III, Spain. MCCS: this study was made possible by the contribution of many people, including the original investigators and the diligent team who recruited participants and continue to work on follow-up. We would also like to express our gratitude to the many thousands of Melbourne residents who took part in the study and provided blood samples. SEARCH: We acknowledge the contributions of Mitul Shah, Val Rhenius, Sue Irvine, Craig Luccarini, Patricia Harrington, Don Conroy, Rebecca Mayes, and Caroline Baynes. The Swedish low-risk colorectal cancer study: we thank Berith Wejderot and the Swedish low-risk colorectal cancer study group. Genetics & Epidemiology of Colorectal Cancer Consortium (GECCO): we thank all those at the GECCO Coordinating Center for helping bring together the data and people that made this project possible. ASTERISK: we are very grateful to Dr. Bruno Buecher without whom this project would not have existed. We also thank all those who agreed to participate in this study, including the patients and the healthy control persons, as well as all the physicians, technicians and students. DACHS: we thank all participants and cooperating clinicians, and Ute Handte-Daub, Renate Hettler-Jensen, Utz Benscheid, Muhabbet Celik, and Ursula Eilber for excellent technical assistance. HPFS, NHS and PHS: we acknowledge Patrice Soule and Hardeep Ranu of the Dana-Farber Harvard Cancer Center High-Throughput Polymorphism Core who assisted in the genotyping for NHS, HPFS, and PHS under the supervision of Dr. Immaculata Devivo and Dr. David Hunter, Qin (Carolyn) Guo, and Lixue Zhu who assisted in programming for NHS and HPFS and Haiyan Zhang who assisted in programming for the PHS. We thank the participants and staff of the Nurses' Health Study and the Health Professionals Follow-Up Study, for their valuable contributions as well as the following state cancer registries for their help: A.L., A.Z., A.R., C.A., C.O., C.T., D.E., F.L., G.A., I.D., I.L., I.N., I.A., K.Y., L.A., M.E., M.D., M.A., M.I., N.E., N.H., N.J., N.Y., N.C., N.D., O.H., O.K., O.R., P.A., R.I., S.C., T.N., T.X., V.A., W.A., W.Y. In addition, this study was approved by the Connecticut Department of Public Health (DPH) Human Investigations Committee. Certain data used in this publication were obtained from the DPH. We assume full responsibility for analyses and interpretation of these data. PLCO: we thank Drs. Christine Berg and Philip Prorok, Division of Cancer Prevention, National Cancer Institute, the Screening Center investigators and staff or the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, Mr. Tom Riley and staff, Information Management Services Inc., Ms. Barbara O'Brien and staff, Westat Inc. and Drs. Bill Kopp, Wen Shao and staff, SAIC-Frederick. Most importantly, we acknowledge the study participants for their contributions for making this study possible. The statements contained herein are solely those of the authors and do not represent or imply concurrence or endorsement by NCI. PMH: we thank the study participants and staff of the Hormones and Colon Cancer study. WHI: we thank the WHI investigators and staff for their dedication, and the study participants for making the program possible. A full listing of WHI investigators can be found at https://cleo.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Short20List.pdf. CORECT: The CORECT Study was supported by the National Cancer Institute, National Institutes of Health (NCI/NIH), U.S. Department of Health and Human Services (grant numbers U19 CA148107, R01 CA81488, P30 CA014089, R01 CA197350; P01 CA196569; and R01 CA201407) and National Institutes of Environmental Health Sciences, National Institutes of Health (grant number T32 ES013678). The ATBC Study was supported by the US Public Health Service contracts (N01-CN-45165, N01-RC-45035, N01-RC-37004, and HHSN261201000006C) from the National Cancer Institute. The Cancer Prevention Study-II Nutrition Cohort is funded by the American Cancer Society. ColoCare: This work was supported by the National Institutes of Health (grant numbers R01 CA189184, U01 CA206110, 2P30CA015704-40 (Gilliland)), the Matthias Lackas-Foundation, the German Consortium for Translational Cancer Research, and the EU TRANSCAN initiative. Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO): funding for GECCO was provided by the National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services (grant numbers U01 CA137088, R01 CA059045, and U01 CA164930). This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA015704. The Colon Cancer Family Registry (CFR) Illumina GWAS was supported by funding from the National Cancer Institute, National Institutes of Health (grant numbers U01 CA122839, R01 CA143247). The Colon CFR/CORECT Affymetrix Axiom GWAS and OncoArray GWAS were supported by funding from National Cancer Institute, National Institutes of Health (grant number U19 CA148107 to S.G.). The Colon CFR participant recruitment and collection of data and biospecimens used in this study were supported by the National Cancer Institute, National Institutes of Health (grant number UM1 CA167551) and through cooperative agreements with the following Colon CFR centers: Australasian Colorectal Cancer Family Registry (NCI/NIH grant numbers U01 CA074778 and U01/U24 CA097735), USC Consortium Colorectal Cancer Family Registry (NCI/NIH grant numbers U01/U24 CA074799), Mayo Clinic Cooperative Family Registry for Colon Cancer Studies (NCI/NIH grant number U01/U24 CA074800), Ontario Familial Colorectal Cancer Registry (NCI/NIH grant number U01/U24 CA074783), Seattle Colorectal Cancer Family Registry (NCI/NIH grant number U01/U24 CA074794), and University of Hawaii Colorectal Cancer Family Registry (NCI/NIH grant number U01/U24 CA074806), Additional support for case ascertainment was provided from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute to Fred Hutchinson Cancer Research Center (Control Nos. N01-CN-67009 and N01-PC-35142, and Contract No. HHSN2612013000121), the Hawai'i Department of Health (Control Nos. N01-PC-67001 and N01-PC-35137, and Contract No. HHSN26120100037C, and the California Department of Public Health (contracts HHSN261201000035C awarded to the University of Southern California, and the following state cancer registries: A.Z., C.O., M.N., N.C., N.H., and by the Victoria Cancer Registry and Ontario Cancer Registry. ESTHER/VERDI was supported by grants from the Baden–Württemberg Ministry of Science, Research and Arts and the German Cancer Aid. MCCS cohort recruitment was funded by VicHealth and Cancer Council Victoria. GALEON: FIS Intrasalud (PI13/01136). The MCCS was further supported by Australian NHMRC grants 509348, 209057, 251553, and 504711 and by infrastructure provided by Cancer Council Victoria. Cases and their vital status were ascertained through the Victorian Cancer Registry (VCR) and the Australian Institute of Health and Welfare (AIHW), including the National Death Index and the Australian Cancer Database. MSKCC: the work at Sloan Kettering in New York was supported by the Robert and Kate Niehaus Center for Inherited Cancer Genomics and the Romeo Milio Foundation. Moffitt: This work was supported by funding from the National Institutes of Health (grant numbers R01 CA189184, P30 CA076292), Florida Department of Health Bankhead-Coley Grant 09BN-13, and the University of South Florida Oehler Foundation. Moffitt contributions were supported in part by the Total Cancer Care Initiative, Collaborative Data Services Core, and Tissue Core at the H. Lee Moffitt Cancer Center & Research Institute, a National Cancer Institute-designated Comprehensive Cancer Center (grant number P30 CA076292). SEARCH: Cancer Research UK (C490/A16561). The Spanish study was supported by Instituto de Salud Carlos III, co-funded by FEDER funds –a way to build Europe– (grants PI14-613 and PI09-1286), Catalan Government DURSI (grant 2014SGR647), and Junta de Castilla y León (grant LE22A10-2). The Swedish Low-risk Colorectal Cancer Study: the study was supported by grants from the Swedish research council; K2015-55 × -22674-01-4, K2008-55 × -20157-03-3, K2006-72 × -20157-01-2 and the Stockholm County Council (ALF project). CIDR genotyping for the Oncoarray was conducted under contract 268201200008I (to K.D.), through grant 101HG007491-01 (to C.I.A.). The Norris Cotton Cancer Center - P30CA023108, The Quantitative Biology Research Institute - P20GM103534, and the Coordinating Center for Screen Detected Lesions - U01CA196386 also supported efforts of C.I.A. This work was also supported by the National Cancer Institute (grant numbers U01 CA1817700, R01 CA144040). ASTERISK: a Hospital Clinical Research Program (PHRC) and supported by the Regional Council of Pays de la Loire, the Groupement des Entreprises Françaises dans la Lutte contre le Cancer (GEFLUC), the Association Anne de Bretagne Génétique and the Ligue Régionale Contre le Cancer (LRCC). COLO2&3: National Institutes of Health (grant number R01 CA060987). DACHS: This work was supported by the German Research Council (BR 1704/6-1, BR 1704/6-3, BR 1704/6-4, CH 117/1-1, HO 5117/2-1, HE 5998/2-1, KL 2354/3-1, RO 2270/8-1, and BR 1704/17-1), the Interdisciplinary Research Program of the National Center for Tumor Diseases (NCT), Germany, and the German Federal Ministry of Education and Research (01KH0404, 01ER0814, 01ER0815, 01ER1505A, and 01ER1505B). DALS: National Institutes of Health (grant number R01 CA048998 to M.L.S). HPFS is supported by National Institutes of Health (grant numbers P01 CA055075, UM1 CA167552, R01 137178, and P50 CA127003), NHS by the National Institutes of Health (grant numbers UM1 CA186107, R01 CA137178, P01 CA087969, and P50 CA127003), NHSII by the National Institutes of Health (grant numbers R01 050385CA and UM1 CA176726), and PHS by the National Institutes of Health (grant number R01 CA042182). MEC: National Institutes of Health (grant numbers R37 CA054281, P01 CA033619, and R01 CA063464). OFCCR: National Institutes of Health, through funding allocated to the Ontario Registry for Studies of Familial Colorectal Cancer (grant number U01 CA074783); see Colon CFR section above. As subset of ARCTIC, OFCCR is supported by a GL2 grant from the Ontario Research Fund, the Canadian Institutes of Health Research, and the Cancer Risk Evaluation (CaRE) Program grant from the Canadian Cancer Society Research Institute. T.J.H. and B.W.Z. are recipients of Senior Investigator Awards from the Ontario Institute for Cancer Research, through generous support from the Ontario Ministry of Research and Innovation. PLCO: Intramural Research Program of the Division of Cancer Epidemiology and Genetics and supported by contracts from the Division of Cancer Prevention, National Cancer Institute, NIH, DHHS. Additionally, a subset of control samples was genotyped as part of the Cancer Genetic Markers of Susceptibility (CGEMS) Prostate Cancer GWAS, Colon CGEMS pancreatic cancer scan (PanScan), and the Lung Cancer and Smoking study. The prostate and PanScan study datasets were accessed with appropriate approval through the dbGaP online resource (http://cgems.cancer.gov/data/) accession numbers phs000207.v1.p1 and phs000206.v3.p2, respectively, and the lung datasets were accessed from the dbGaP website (http://www.ncbi.nlm.nih.gov/gap) through accession number phs000093.v2.p2. Funding for the Lung Cancer and Smoking study was provided by National Institutes of Health (NIH), Genes, Environment and Health Initiative (GEI) Z01 CP 010200, NIH U01 HG004446, and NIH GEI U01 HG 004438. For the lung study, the GENEVA Coordinating Center provided assistance with genotype cleaning and general study coordination, 23 and the Johns Hopkins University Center for Inherited Disease Research conducted genotyping. PMH: National Institutes of Health (grant number R01 CA076366). VITAL: National Institutes of Health (grant number K05-CA154337). WHI: The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C. The head and neck cancer genome-wide association analyses: The study was supported by NIH/NCI: P50 CA097190, and P30 CA047904, Canadian Cancer Society Research Institute (no. 020214) and Cancer Care Ontario Research Chair to R.H. The Princess Margaret Hospital Head and Neck Cancer Translational Research Program is funded by the Wharton family, Joe's Team, Gordon Tozer, Bruce Galloway and the Elia family. Geoffrey Liu was supported by the Posluns Family Fund and the Lusi Wong Family Fund at the Princess Margaret Foundation, and the Alan B. Brown Chair in Molecular Genomics. This publication presents data from Head and Neck 5000 (H&N5000). H&N5000 was a component of independent research funded by the UK National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10034). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Human papillomavirus (HPV) in H&N5000 serology was supported by a Cancer Research UK Programme Grant, the Integrative Cancer Epidemiology Programme (grant number: C18281/A19169). National Cancer Institute (R01-CA90731); National Institute of Environmental Health Sciences (P30ES10126). The authors thank all the members of the GENCAPO team/The Head and Neck Genome Project (GENCAPO) was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (Grant numbers 04/12054-9 and 10/51168-0). CPS-II recruitment and maintenance is supported with intramural research funding from the American Cancer Society. Genotyping performed at the Center for Inherited Disease Research (CIDR) was funded through the U.S. National Institute of Dental and Craniofacial Research (NIDCR) grant 1 × 01HG007780-0. The University of Pittsburgh head and neck cancer case-control study is supported by National Institutes of Health grants P50 CA097190 and P30 CA047904. The Carolina Head and Neck Cancer Study (CHANCE) was supported by the National Cancer Institute (R01-CA90731). The Head and Neck Genome Project (GENCAPO) was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (Grant numbers 04/12054-9 and 10/51168-0). The authors thank all the members of the GENCAPO team. The HN5000 study was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10034), the views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The Toronto study was funded by the Canadian Cancer Society Research Institute (020214) and the National Cancer Institute (U19-CA148127) and the Cancer Care Ontario Research Chair. The alcohol-related cancers and genetic susceptibility study in Europe (ARCAGE) was funded by the European Commission's 5th Framework Program (QLK1-2001-00182), the Italian Association for Cancer Research, Compagnia di San Paolo/FIRMS, Region Piemonte, and Padova University (CPDA057222). The Rome Study was supported by the Associazione Italiana per la Ricerca sul Cancro (AIRC) IG 2011 10491 and IG2013 14220 to S.B., and Fondazione Veronesi to S.B. The IARC Latin American study was funded by the European Commission INCO-DC programme (IC18-CT97-0222), with additional funding from Fondo para la Investigacion Cientifica y Tecnologica (Argentina) and the Fundação de Amparo à Pesquisa do Estado de São Paulo (01/01768-2). We thank Leticia Fernandez, Instituto Nacional de Oncologia y Radiobiologia, La Habana, Cuba and Sergio and Rosalina Koifman, for their efforts with the IARC Latin America study São Paulo center. The IARC Central Europe study was supported by European Commission's INCO-COPERNICUS Program (IC15- CT98-0332), NIH/National Cancer Institute grant CA92039, and the World Cancer Research Foundation grant WCRF 99A28. The IARC Oral Cancer Multicenter study was funded by grant S06 96 202489 05F02 from Europe against Cancer; grants FIS 97/0024, FIS 97/0662, and BAE 01/5013 from Fondo de Investigaciones Sanitarias, Spain; the UICC Yamagiwa-Yoshida Memorial International Cancer Study; the National Cancer Institute of Canada; Associazione Italiana per la Ricerca sul Cancro; and the Pan-American Health Organization. Coordination of the EPIC study is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The lung cancer genome-wide association analyses: Transdisciplinary Research for Cancer in Lung (TRICL) of the International Lung Cancer Consortium (ILCCO) was supported by (U19-CA148127, CA148127S1, U19CA203654, and Cancer Prevention Research Institute of Texas RR170048). The ILCCO data harmonization is supported by Cancer Care Ontario Research Chair of Population Studies to R. H. and Lunenfeld-Tanenbaum Research Institute, Sinai Health System. The TRICL-ILCCO OncoArray was supported by in-kind genotyping by the Centre for Inherited Disease Research (26820120008i-0-26800068-1). The CAPUA study was supported by FIS-FEDER/Spain grant numbers FIS-01/310, FIS-PI03-0365, and FIS-07-BI060604, FICYT/Asturias grant numbers FICYT PB02-67 and FICYT IB09-133, and the University Institute of Oncology (IUOPA), of the University of Oviedo and the Ciber de Epidemiologia y Salud Pública. CIBERESP, SPAIN. The work performed in the CARET study was supported by the National Institute of Health/National Cancer Institute: UM1 CA167462 (PI: Goodman), National Institute of Health UO1-CA6367307 (PIs Omen, Goodman); National Institute of Health R01 CA111703 (PI Chen), National Institute of Health 5R01 CA151989-01A1(PI Doherty). The Liverpool Lung project is supported by the Roy Castle Lung Cancer Foundation. The Harvard Lung Cancer Study was supported by the NIH (National Cancer Institute) grants CA092824, CA090578, CA074386. The Multi-ethnic Cohort Study was partially supported by NIH Grants CA164973, CA033619, CA63464, and CA148127. The work performed in MSH-PMH study was supported by The Canadian Cancer Society Research Institute (020214), Ontario Institute of Cancer and Cancer Care Ontario Chair Award to R.J.H. and G.L. and the Alan Brown Chair and Lusi Wong Programs at the Princess Margaret Hospital Foundation. NJLCS was funded by the State Key Program of National Natural Science of China (81230067), the National Key Basic Research Program Grant (2011CB503805), the Major Program of the National Natural Science Foundation of China (81390543). The Norway study was supported by Norwegian Cancer Society, Norwegian Research Council. The Shanghai Cohort Study (SCS) was supported by National Institutes of Health R01 CA144034 (PI: Yuan) and UM1 CA182876 (PI: Yuan). The Singapore Chinese Health Study (SCHS) was supported by National Institutes of Health R01 CA144034 (PI: Yuan) and UM1 CA182876 (PI: Yuan). The work in TLC study has been supported in part the James & Esther King Biomedical Research Program (09KN-15), National Institutes of Health Specialized Programs of Research Excellence (SPORE) Grant (P50 CA119997), and by a Cancer Center Support Grant (CCSG) at the H. Lee Moffitt Cancer Center and Research Institute, an NCI designated Comprehensive Cancer Center (grant number P30-CA76292). The Vanderbilt Lung Cancer Study—BioVU dataset used for the analyses described was obtained from Vanderbilt University Medical Center's BioVU, which is supported by institutional funding, the 1S10RR025141-01 instrumentation award, and by the Vanderbilt CTSA grant UL1TR000445 from NCATS/NIH. Dr. Aldrich was supported by NIH/National Cancer Institute K07CA172294 (PI: Aldrich) and Dr. Bush was supported by NHGRI/NIH U01HG004798 (PI: Crawford). The Copenhagen General Population Study (CGPS) was supported by the Chief Physician Johan Boserup and Lise Boserup Fund, the Danish Medical Research Council and Herlev Hospital. The NELCS study: Grant Number P20RR018787 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH). The Kentucky Lung Cancer Research Initiative was supported by the Department of Defense [Congressionally Directed Medical Research Program, U.S. Army Medical Research and Materiel Command Program] under award number: 10153006 (W81XWH-11-1-0781). Views and opinions of, and endorsements by the author(s) do not reflect those of the US Army or the Department of Defense. This research was also supported by unrestricted infrastructure funds from the UK Center for Clinical and Translational Science, NIH grant UL1TR000117 and Markey Cancer Center NCI Cancer Center Support Grant (P30 CA177558) Shared Resource Facilities: Cancer Research Informatics, Biospecimen and Tissue Procurement, and Biostatistics and Bioinformatics. The M.D. Anderson Cancer Center study was supported in part by grants from the NIH (P50 CA070907, R01 CA176568) (to X.W.), Cancer Prevention & Research Institute of Texas (RP130502) (to X.W.), and The University of Texas MD Anderson Cancer Center institutional support for the Center for Translational and Public Health Genomics. The deCODE study of smoking and nicotine dependence was funded in part by a grant from NIDA (R01- DA017932). The study in Lodz center was partially funded by Nofer Institute of Occupational Medicine, under task NIOM 10.13: Predictors of mortality from non-small cell lung cancer—field study. Genetic sharing analysis was funded by NIH grant CA194393. The research undertaken by M.D.T., L.V.W., and M.S.A. was partly funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. M.D.T. holds a Medical Research Council Senior Clinical Fellowship (G0902313). The work to assemble the FTND GWAS meta-analysis was supported by the National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA) grant number R01 DA035825 (Principal Investigator [PI]: DBH). The study populations included COGEND (dbGaP phs000092.v1.p1 and phs000404.v1.p1), COPDGene (dbGaP phs000179.v3.p2), deCODE Genetics, EAGLE (dbGaP phs000093.vs.p2), and SAGE. dbGaP phs000092.v1.p1). See Hancock et al. Transl Psychiatry 2015 (PMCID: PMC4930126) for the full listing of funding sources and other acknowledgments. The Resource for the Study of Lung Cancer Epidemiology in North Trent (ReSoLuCENT)study was funded by the Sheffield Hospitals Charity, Sheffield Experimental Cancer Medicine Centre and Weston Park Hospital Cancer Charity. The ovarian cancer genome-wide association analysis: The Ovarian Cancer Association Consortium (OCAC) is supported by a grant from the Ovarian Cancer Research Fund thanks to donations by the family and friends of Kathryn Sladek Smith (PPD/RPCI.07). The scientific development and funding for this project were in part supported by the US National Cancer Institute GAME-ON Post-GWAS Initiative (U19-CA148112). This study made use of data generated by the Wellcome Trust Case Control consortium that was funded by the Wellcome Trust under award 076113. The results published here are in part based upon data generated by The Cancer Genome Atlas Pilot Project established by the National Cancer Institute and National Human Genome Research Institute (dbGap accession number phs000178.v8.p7). The OCAC OncoArray genotyping project was funded through grants from the U.S. National Institutes of Health (CA1X01HG007491-01 (C.I.A.), U19-CA148112 (T.A.S.), R01-CA149429 (C.M.P.), and R01-CA058598 (M.T.G.); Canadian Institutes of Health Research (MOP-86727 (L.E.K.) and the Ovarian Cancer Research Fund (A.B.). The COGS project was funded through a European Commission's Seventh Framework Programme grant (agreement number 223175 - HEALTH-F2-2009-223175) and through a grant from the U.S. National Institutes of Health (R01-CA122443 (E.L.G)). Funding for individual studies: AAS: National Institutes of Health (RO1-CA142081); AOV: The Canadian Institutes for Health Research (MOP-86727); AUS: The Australian Ovarian Cancer Study Group was supported by the U.S. Army Medical Research and Materiel Command (DAMD17-01-1-0729), National Health & Medical Research Council of Australia (199600, 400413 and 400281), Cancer Councils of New South Wales, Victoria, Queensland, South Australia and Tasmania and Cancer Foundation of Western Australia (Multi-State Applications 191, 211, and 182). The Australian Ovarian Cancer Study gratefully acknowledges additional support from Ovarian Cancer Australia and the Peter MacCallum Foundation; BAV: ELAN Funds of the University of Erlangen-Nuremberg; BEL: National Kankerplan; BGS: Breast Cancer Now, Institute of Cancer Research; BVU: Vanderbilt CTSA grant from the National Institutes of Health (NIH)/National Center for Advancing Translational Sciences (NCATS) (ULTR000445); CAM: National Institutes of Health Research Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Cancer Centre; CHA: Innovative Research Team in University (PCSIRT) in China (IRT1076); CNI: Instituto de Salud Carlos III (PI12/01319); Ministerio de Economía y Competitividad (SAF2012); COE: Department of Defense (W81XWH-11-2-0131); CON: National Institutes of Health (R01-CA063678, R01-CA074850; and R01-CA080742); DKE: Ovarian Cancer Research Fund; DOV: National Institutes of Health R01-CA112523 and R01-CA87538; EMC: Dutch Cancer Society (EMC 2014-6699); EPC: The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), Federal Ministry of Education and Research (BMBF) (Germany); the Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway); Health Research Fund (FIS), PI13/00061 to Granada, PI13/01162 to EPIC-Murcia, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, ISCIII RETIC (RD06/0020) (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C570/A16491 and C8221/A19170 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk, MR/M012190/1 to EPIC-Oxford) (United Kingdom); GER: German Federal Ministry of Education and Research, Programme of Clinical Biomedical Research (01 GB 9401) and the German Cancer Research Center (DKFZ); GRC: This research has been co-financed by the European Union (European Social Fund—ESF) and Greek national funds through the Operational Program "Education and Lifelong Learning" of the National Strategic Reference Framework (NSRF)—Research Funding Program of the General Secretariat for Research & Technology: SYN11_10_19 NBCA. Investing in knowledge society through the European Social Fund; GRR: Roswell Park Cancer Institute Alliance Foundation, P30 CA016056; HAW: U.S. National Institutes of Health (R01-CA58598, N01-CN-55424, and N01-PC-67001); HJO: Intramural funding; Rudolf-Bartling Foundation; HMO: Intramural funding; Rudolf-Bartling Foundation; HOC: Helsinki University Research Fund; HOP: Department of Defense (DAMD17-02-1-0669) and NCI (K07-CA080668, R01-CA95023, P50-CA159981 MO1-RR000056 R01-CA126841); HUO: Intramural funding; Rudolf-Bartling Foundation; JGO: JSPS KAKENHI grant; JPN: Grant-in-Aid for the Third Term Comprehensive 10-Year Strategy for Cancer Control from the Ministry of Health, Labour and Welfare; KRA: This study (Ko-EVE) was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), and the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (HI16C1127; 0920010); LAX: American Cancer Society Early Detection Professorship (SIOP-06-258-01-COUN) and the National Center for Advancing Translational Sciences (NCATS), Grant UL1TR000124; LUN: ERC-2011-AdG 294576-risk factors cancer, Swedish Cancer Society, Swedish Research Council, Beta Kamprad Foundation; MAC: National Institutes of Health (R01-CA122443, P30-CA15083, P50-CA136393); Mayo Foundation; Minnesota Ovarian Cancer Alliance; Fred C. and Katherine B. Andersen Foundation; Fraternal Order of Eagles; MAL: Funding for this study was provided by research grant R01- CA61107 from the National Cancer Institute, Bethesda, MD, research grant 94 222 52 from the Danish Cancer Society, Copenhagen, Denmark; and the Mermaid I project; MAS: Malaysian Ministry of Higher Education (UM.C/HlR/MOHE/06) and Cancer Research Initiatives Foundation; MAY: National Institutes of Health (R01-CA122443, P30-CA15083, and P50-CA136393); Mayo Foundation; Minnesota Ovarian Cancer Alliance; Fred C. and Katherine B. Andersen Foundation; MCC: Cancer Council Victoria, National Health and Medical Research Council of Australia (NHMRC) grants number 209057, 251533, 396414, and 504715; MDA: DOD Ovarian Cancer Research Program (W81XWH-07-0449); MEC: NIH (CA54281, CA164973, CA63464); MOF: Moffitt Cancer Center, Merck Pharmaceuticals, the state of Florida, Hillsborough County, and the city of Tampa; NCO: National Institutes of Health (R01-CA76016) and the Department of Defense (DAMD17-02-1-0666); NEC: National Institutes of Health R01-CA54419 and P50-CA105009 and Department of Defense W81XWH-10-1-02802; NHS: UM1 CA186107, P01 CA87969, R01 CA49449, R01-CA67262, UM1 CA176726; NJO: National Cancer Institute (NIH-K07 CA095666, R01-CA83918, NIH-K22-CA138563, and P30-CA072720) and the Cancer Institute of New Jersey; If Sara Olson and/or Irene Orlow is a co-author, please add NCI CCSG award (P30-CA008748) to the funding sources; NOR: Helse Vest, The Norwegian Cancer Society, The Research Council of Norway; NTH: Radboud University Medical Centre; OPL: National Health and Medical Research Council (NHMRC) of Australia (APP1025142) and Brisbane Women's Club; ORE: OHSU Foundation; OVA: This work was supported by Canadian Institutes of Health Research grant (MOP-86727) and by NIH/NCI 1 R01CA160669-01A1; PLC: Intramural Research Program of the National Cancer Institute; POC: Pomeranian Medical University; POL: Intramural Research Program of the National Cancer Institute; PVD: Canadian Cancer Society and Cancer Research Society GRePEC Program; RBH: National Health and Medical Research Council of Australia; RMH: Cancer Research UK, Royal Marsden Hospital; RPC: National Institute of Health (P50-CA159981, R01-CA126841); SEA: Cancer Research UK (C490/A10119 C490/A10124); UK National Institute for Health Research Biomedical Research Centres at the University of Cambridge; SIS: NIH, National Institute of Environmental Health Sciences, Z01-ES044005 and Z01-ES049033; SMC: The bbSwedish Research Council-SIMPLER infrastructure; the Swedish Cancer Foundation; SON: National Health Research and Development Program, Health Canada, grant 6613-1415-53; SRO: Cancer Research UK (C536/A13086, C536/A6689) and Imperial Experimental Cancer Research Centre (C1312/A15589); STA: NIH grants U01 CA71966 and U01 CA69417; SWE: Swedish Cancer foundation, WeCanCureCancer and VårKampMotCancer foundation; SWH: NIH (NCI) grant R37-CA070867; TBO: National Institutes of Health (R01-CA106414-A2), American Cancer Society (CRTG-00-196-01-CCE), Department of Defense (DAMD17-98-1-8659), Celma Mastery Ovarian Cancer Foundation; TOR: NIH grants R01-CA063678 and R01 CA063682; UCI: NIH R01-CA058860 and the Lon V Smith Foundation grant LVS39420; UHN: Princess Margaret Cancer Centre Foundation-Bridge for the Cure; UKO: The UKOPS study was funded by The Eve Appeal (The Oak Foundation) and supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre; UKR: Cancer Research UK (C490/A6187), UK National Institute for Health Research Biomedical Research Centres at the University of Cambridge; USC: P01CA17054, P30CA14089, R01CA61132, N01PC67010, R03CA113148, R03CA115195, N01CN025403, and California Cancer Research Program (00-01389V-20170, 2II0200); VAN: BC Cancer Foundation, VGH & UBC Hospital Foundation; VTL: NIH K05-CA154337; WMH: National Health and Medical Research Council of Australia, Enabling Grants ID 310670 & ID 628903. Cancer Institute NSW Grants 12/RIG/1-17 & 15/RIG/1-16; WOC: National Science Centren (N N301 5645 40). The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland. The University of Cambridge has received salary support for PDPP from the NHS in the East of England through the Clinical Academia Reserve. The prostate cancer genome-wide association analyses: we pay tribute to Brian Henderson, who was a driving force behind the OncoArray project, for his vision and leadership, and who sadly passed away before seeing its fruition. We also thank the individuals who participated in these studies enabling this work. The ELLIPSE/PRACTICAL (http//:practical.icr.ac.uk) prostate cancer consortium and his collaborating partners were supported by multiple funding mechanisms enabling this current work. ELLIPSE/PRACTICAL Genotyping of the OncoArray was funded by the US National Institutes of Health (NIH) (U19 CA148537 for ELucidating Loci Involved in Prostate Cancer SuscEptibility (ELLIPSE) project and X01HG007492 to the Center for Inherited Disease Research (CIDR) under contract number HHSN268201200008I). Additional analytical support was provided by NIH NCI U01 CA188392 (F.R.S.). Funding for the iCOGS infrastructure came from the European Community's Seventh Framework Programme under grant agreement n° 223175 (HEALTH-F2-2009-223175) (COGS), Cancer Research UK (C1287/A10118, C1287/A 10710, C12292/A11174, C1281/A12014, C5047/A8384, C5047/A15007, C5047/A10692, and C8197/A16565), the National Institutes of Health (CA128978) and Post-Cancer GWAS initiative (1U19 CA148537, 1U19 CA148065, and 1U19 CA148112; the GAME-ON initiative), the Department of Defense (W81XWH-10-1-0341), the Canadian Institutes of Health Research (CIHR) for the CIHR Team in Familial Risks of Breast Cancer, Komen Foundation for the Cure, the Breast Cancer Research Foundation, and the Ovarian Cancer Research Fund. This work was supported by the Canadian Institutes of Health Research, European Commission's Seventh Framework Programme grant agreement n° 223175 (HEALTH-F2-2009-223175), Cancer Research UK Grants C5047/A7357, C1287/A10118, C1287/A16563, C5047/A3354, C5047/A10692, C16913/A6135, C5047/A21332 and The National Institute of Health (NIH) Cancer Post-Cancer GWAS initiative grant: No. 1 U19 CA148537-01 (the GAME-ON initiative). We also thank the following for funding support: The Institute of Cancer Research and The Everyman Campaign, The Prostate Cancer Research Foundation, Prostate Research Campaign UK (now Prostate Action), The Orchid Cancer Appeal, The National Cancer Research Network UK, and The National Cancer Research Institute (NCRI) UK. We are grateful for support of NIHR funding to the NIHR Biomedical Research Centre at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust. The Prostate Cancer Program of Cancer Council Victoria also acknowledge grant support from The National Health and Medical Research Council, Australia (126402, 209057, 251533, 396414, 450104, 504700, 504702, 504715, 623204, 940394, and 614296), VicHealth, Cancer Council Victoria, The Prostate Cancer Foundation of Australia, The Whitten Foundation, PricewaterhouseCoopers, and Tattersall's. E.A.O., D.M.K., and E.M.K. acknowledge the Intramural Program of the National Human Genome Research Institute for their support. The BPC3 was supported by the U.S. National Institutes of Health, National Cancer Institute (cooperative agreements U01-CA98233 to D.J.H., U01-CA98710 to S.M.G., U01-CA98216 to E.R., and U01-CA98758 to B.E.H., and Intramural Research Program of NIH/National Cancer Institute, Division of Cancer Epidemiology and Genetics). CAPS GWAS study was supported by the Swedish Cancer Foundation (grant no 09-0677, 11-484, 12-823), the Cancer Risk Prediction Center (CRisP; www.crispcenter.org), a Linneus Centre (Contract ID 70867902) financed by the Swedish Research Council, Swedish Research Council (grant no K2010-70 × -20430-04-3, 2014-2269). The Hannover Prostate Cancer Study was supported by the Lower Saxonian Cancer Society. PEGASUS was supported by the Intramural Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health. RAPPER was supported by the NIHR Manchester Biomedical Research Center, Cancer Research UK (C147/A25254, C1094/A18504) and the EU's 7th Framework Programme Grant/Agreement no 60186. Overall: this research has been conducted using the UK Biobank Resource (application number 16549). NHS is supported by UM1 CA186107 (NHS cohort infrastructure grant), P01 CA87969, and R01 CA49449. NHSII is supported by UM1 CA176726 (NHSII cohort infrastructure grant), and R01-CA67262. A.L.K. is supported by R01 MH107649. We would like to thank the participants and staff of the NHS and NHSII for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data. ; Peer Reviewed
Issue 48.2 of the Review for Religious, March/April 1989. ; Ministry and Ministries On Becoming An Apostolic °Hermit Mid-Life Divorce And Alienation The Readmission of Former Members Volume 48 Number 2 March/April 1989 Revn~w t:or Rt~LIGIOUS (ISSN 0034-639X) is published bi-monthly at St. Louis University by the Mis-souri Province Educational Institute of the Soi:icty of Jesus; Editorial Office; 3601 Lindcll Blvd. Rm. 428: St. Louis. MO 63108-3393. Second-class postage paid at St. Louis MO. Single copies $3.00. Subscriptions: $12.00 per year: $22.00 for two years. Other countries: for surface mail. add U,S. $5.00 per year: for airmail, add U.S. $20.00 per year. For subscription orders or change of address, write: R~v~w t:oR Rt~t.~GOUS; P.O. Box 6070; Duluth. MN 55806. POSTMASTER: Send address changes to R~:v~:w ~'o~ R~:t.t~no~s; P.O. Box 6070; Duluth, MN 55806. David L. Fleming, S.J. Iris Ann Ledden, S.S.N.D. Richard A. Hill, S.J. Jean Read Mary Ann Foppe Editor Associate Editor "~"~ Contributing Editor ~% ~,~,¢~ Assistant Editors °"'~ March/April 1989 Volume 48 Number 2 Manuscripts, books for review and correspundence with the editor should be sent to R~:\'~:w ~'o~ R~:~.t~aot~s; 3601 Lindell Blvd.; SI. [a~uis, MO 63108-3393. Cnrrespondence about the department "Canonical Counsel" should be addressed to Rich-ard A. Hill, S.J.; J.S.T.B.; 1735 LeRoy Ave.; Berkeley, CA 94709-1193. Back issues and reprints should be ordered from R~:v~:w ~'on R~:t.~aot~s; 3601 Lindell Blvd.; St. la~uis, MO 63108-3393. "Out of print" issues are available from University Microfilms International; 300 N. Zeeb Rd.; Ann Arbor, MI 48106. A major portion of each issue is also available on cassette recordings as a service for the visually impaired. Write Io the Xavier Society for the Blind; 154 East 23rd Street; New York, NY 10010. PRISMS . Computers easily make available various readouts of statistical in-formation. While I was perusing the printout listings of our January- February 1989 issue, 1 began, to realize how much I take for granted the exchange of information in our contemporary world. This international exchange of information through a journal like REVIEW FOR REL~C~OtJS pro-vides one of the most valuable prisms which exist for expanding our worldview and our unders.tanding of religious life. I want to share with you a few of the statistics about the interriational readership. First, I should call attention to the fact that REVIEW has sub-scribers in all fifty states, the District of Columbia, and the U.S. territo-ries, such as Puerto Rico, the Virgin Islands, Guam, American Samoa, the North Mariana Islands, and the Canal Zone. Roughly this grouping takes in about sixty per cent of our subscription list. Our readers are also from all ten provinces of Canada, including the Yukon and the North-west Territories. Subscribers are also present throughout Mexico, six countries of Central America, ten countries of South America, and throughout the West Indies. REWEff FOR REt.~C~OUS has large numbers of subscribers in the English-speaking countries of Europe, such as England, Ireland, Northern Ire-. land, Scotland, and Wales. But its readership is spread throughout Aus-tria, Belgium, Denmark, France, Italy, Malta, Netherlands, Norway, Po-land, Portugal, Switzerland, Spain, Sweden, and West Germany. The subscription lists are large for India, the Philippines, Australia, and New Zealand, with a widespread distribution throughout the coun-tries. Africa, too, is well-represented, with subscribers from some twenty-two countries, such as Republic of Ivory Coast, Egypt, Ethiopia, Ghana, Kenya, Lesotho, South Africa, Liberia~ Zimbabwe, Nigeria, Uganda, Zambia, Sudan, Tanzania, Swaziland, Sierra Leone, Malawi, Cameroun, and Mauritania. REVIEW also serves readers in Indonesia, Bangladesh, Thailand, Ma-laysia, Pakistan, Sri Lanka, Israel, Jordan, Korea, Japan, Taiwan, Sin-gapore, and Hong Kong. As editor, I think that I may want to take a win-ter trip to visit our subscribers from Fiji, Papua New Guinea, Gilbert Is-lands, Solomon Islands, and Western Samoa. These listings do not exhaust all the places R~:w~:w FOR reaches, but perhaps this kind of enumeration can give all of us a greater 161 Review for Religious, March-April 1989 appreciation of the catholicity of the articles we read and the religious life we try better to understand and live. Of course, this international dimension is reflected in the authors who submit manuscripts and in the content matter of the articles submit-ted. For example, in this issue, Father Donald Macdonald, writing from England, reflects upon the situation of Church members in some com-munist- dominated countries of Eastern Europe. Brother Martin O'Reilly shares with us his vocation director's experience, working in Liberia and Sierra Leone in Africa. Father Robert Maloney calls our attention to an impressive lay-movement of young people who serve the poor in Italy. Reverend Paul Casper, who first went to Burma as missionary in 1952 and later served as the first American Dean of St. John's Cathedral in Hong Kong from 1982-1986, reflects on the influence of his fellow An-glican, C.S. Lewis, upon his experience of spiritual direction. As editor, I want to continue to welcome readers and writers from all over the world. REVIEW FOR RELigiOUS will continue to be enriched by the .reflections of people who come from different community, mission, and cultural life-experiences. Through this journal, we are being given a new window--varied prisms--upon our world and upon our religious iives.~ David L. Fleming, S.J. Ministry and Ministries John R. Sheets, S.J. Father John Sheets, S.J. is well known to our readers. His last article, "Spiritual Direction in the Church," appeared in the issue of July/August, 1987. Father Sheets may be addressed at Creighton University; California at 24th Street; Omaha, Ne-braska 68178. In the remarks which follow, I try to distinguish two related but radically different forms of ministry: that which is primordial, the ministry of pres-ence, and that which is functional, activities, some of which are institu-tionalized, others not, which serve to constitute and build up the Church. The ministry of presence is overlooked today. When people speak of ministry they tend to speak only of functional ministry, various ac-tivities which in one way or another build up the Church. However, they forget that the functional ministry is always built on and presupposes a primordial, or deeper form of ministry, the ministry of presence. Though it is risky to use masculine-feminine analogies today, I think that those who can bypass the loaded nature of such language, and re-gain a certain direct vision of those realities, without the prejudices of our times, can spontaneously recognize in the ministry of presence quali-ties which are feminine, and in the mini~stry of function, masculine char-acteristics. I do not mean, of course, that functional ministries belong only to men, and not to women, or that men cannot exercise qualities of presence. The distinction is aimed at calling attention to two related but different modalities of ministry: a mode of being in and with, which is presence; and a mode of being for, which is function. We live in an age which is centrifugal. The self is caught in a kind of cyclotron that empties the inner self as it pours itself into more and more things to do. For this reason in the remarks which follow there is an attempt to recapture the primordial ministry of presence, which alone 163 164 / Review for Religious,. March-April 1989 can vitalize, energize, the ministries of function. In a sense it is an at-tempt to see how the feminine principle of presence lies beneath all other activ.ities within the Church, providing the presence of the Spirit, who alone breathes life into those activities which are ordinarily called min-istry. Without the presence of the breath of the Spirit, ministry in the sense of activity is like those dry bones Ezekiel describes (Ezk 37), strewn about in a valley, lifeless skeletons that have a faint resemblance to a living person. Hans Urs von Balthasar in Elucidations (London: S.P.C.K., 1975, p. 70) describes what I have just spoken of as a kind of "masculiniza-tion" of the Church. "The Church since the Council has to a large ex-tent put off its mystical characteristics. It has become a Church of per-manent conversations, organizations, advisory commissions, congresses, synods, commissions, academies, parties, pressure groups, functions, structures and restructurings, sociological experiments, statistics; that is to say, more than ever a male Church . " General Reflections on the Meaning of Ministry Before going into some specifics in regard to ministry, I would like to give a working description of ministry that will include everything pre-sented in this article about various ways of speaking of ministry. Most of the time discussions on ministry begin with a description of various activities in the Church that are exercised for the good of others, either as individuals or as :a community. This approach is a valid one. But it also tends to play into models which belong to other forms of hu-man activity for the good of any society, not specifically the society we call the Church. Hence, it is possible that, without realizing it, what is secretly at work in discussion of ministry are models coming from hu-man social structures, such as civil society, instead of those that respect the uniqueness of the ministries that belong to the Church. One has to see Christian. ministry in terms of the complete newness of the forms of activity that the Christian calls ministry. The Church, on the other hand, does not exist only as a heavenly city coming downfrom above. It exists in the world in interaction with other societies. It also has similarities with other societies, especially the state, But the danger is to lose sight of the uniqueness of Christian ministry, and to reduce it to secular models. I want to speak of Christian ministry, then, by beginning from a slightly different perspective than is customary. Ordinarily discussion of ministry begins by talking about different activities in the Church as they are exercised by different members. But it might be more helpful to ap- Ministry and Ministries / 165 proach ministry in a reverse direction. Ministries come from awareness of needs that have to be taken care of within the Church. Ministries are always a response to specific kinds of needs. Ministries in the Church then are those activities which are generated within the Church in re-sponse to the needs of the community. In somewhat the same way, all "secular ministries," such as schools, hospitals, civil authority have to be understood primarily as response to needs within the community. There are no ministries that are simply there, self-evident, self-explanatory. Ministries.exist only because they are called forth as a re-sponse to certain needs. They are essentially relative then to the need that calls them forth. They come, go, remain as the needs either remain or come and go. Their importance ranges from fulfilling needs which are essential to the existence of the Church (for example, the ministry of holy ordi~rs), to those which are i, mportant for'its well-being, but not essen-tial tbqts very existence. This,is true both forthe secular notion of ministry, as well as the ec-clesial. But the needs in each case are radically different. Hence, the re-sponse, or the ministry will be radically different. To understand minis-try, then, one has, so to speak, to work backwards, from need to re-sponse. The respbnse in turn depends upon the particular gift, whether of grace or nature, to respond to the need. St. Paul always sees the gifts of ministry in this sense, as Spirit-evoked responses to community needs. Ministry t.hen is called forth by the particular needs of the organiza-tion as social whether the social body is sec.ular or religious. Some of these needs are practically identified.with the continued existence and Well-functioning of the.body; for example, in the state, different levels of auihority are 'called forth from the need to preserve the society so that it keeps its identity and reaches its goals. The importance of the minis-try varies. Its importance is relative to the nature of the need that has to be taken care of. But our question is concernedowith the society called the Church, not secular societies. Ministry in the Church is the Spirit-created response to the unique needs of the new kind of society' that came into the world-through the institutiofi' of Christ and the outpouring of the Spirit at Pen-tecost. The basic needs.to be responded to are those to which Jesus him-self responded. The Church exists only to carry out what Jesus intended in his life and redemptive death. The deepest need of humankind, then, is the.need for redemption. This is the need that Jesus came to fulfill. He had no other purpose. All ministries in the Church are relative to the one basic need, the need for redemption. "166 / Review for Religious, March-April 1989 The primary ministry in the Church, then, is that which he commu-nicated to his,,apostles. He breathed into them his own mission or his own ministry. " 'As the Father sent me, so I send you.' He then breathed on them saying, 'Receive the.Holy Spirit. If you forgive anyone's sins, they stand forgiven; if you pronounce them unforgiven, unforgiven th.ey remain' " (Jn 20:21-23). He creates a correlation between his ministry which comes from the Father, and the mission of the apostles, which comes from Jesus. They are to minister to the fundamental need of hu-mankind, reconciliation with God and with one. another. Thus th+ fundamental ministry of the Church which is poured into the Church is to respond to a need at the heart of the whole of humanity and even of the universe itself. If this ministry fails, then the mission of Ctiiist is aborted. The raw fundamental need of humankind remains un-touched. "We are still in our.sins" (see 1 Co 15:17). Within that fun-damental ministry, which makes die mission of Christ present, ,there are other subordinate ministries, each of them in one way or another a par-ticipation in the fundamental response to the need for redemption. All forms of ministry in the Church, therefore, are responses to the radical need of humankind, the need f+r redemption. They are not self-actuated responses like those belonging to other socie.ties. They are di-rectly evoked and sustained by the Spirit ~vhose intention is to carry out in the Church what he initiated in the life and death of Christ. St. Paul uses a striking metaphor to bring out ministry as response to need. He calls himself a debtor to everyone. What he owes them is the Gospel. This is the Spirit-evoked gift to answer the radical need in the human heart. M6re than health, money, food, or anything else, the radical need is for Christ. "I am in debt to Greek and to non-Greek, to learned and Simple" (Rm i : 14). The Need for the Presence of Christ: Ministry as a Mode of Being Present As I mentioned in the beginning, it i~ important at the outset to dis-tinguish, ministry according to two different modalities: (a) ministry as presence,, which is a mode of being-with, what I called above, the pri-mordial form of ministry, and (b) ministry as partiizular activities which are ways of doing that flow from being-for others. The latter has to do with activities which flow from and presuppose ministry in the first sense. Most often when people talk about ministry they refer only to doing something. They forget that ministry as we find it in the Church is situ-ated within what is deeper, the mystery of an existence that has been trans- Ministry and Ministries / 167 formed through grace. This transformed existence brings a new mode of presence into the world. I spoke above of ministry as the Spirit-created response to need. The great absence, and therefore, the deepest need, is that of the absence of God in the hearts of individuals and society. The first mode of "minis-try" then is not some particular kind of activity. Rather it is a mode of presence that penetrates a person's whole being. It is a kind of "glory," or radiance that end/elopes a person's whole life. It cannot be located within any one particular kind of activity. "We all reflect as in a mirror the glory of the Lord" (1 Co 3:18). Like a mirror, Christian existence reflects tothe world the presence of Christ. This is the primary mode of ministry. This "presence" or glory comes from the fact that, as Paul says, we are a "new creation." "When anyone is united to Christ, there is a new creation; the old order has gone, and a new order has already be-gun" (2 Co 5:17). He tells the Christians that in the midst of an evil world they are to "shine like stars in a dark world, and proffer the word of life" (Ph 2:13). All of Paul's exhortations about what to do as Chris-tians flow as corollaries from the mystery of their transformed existence as a new creation. The images that Jesus uses to describe the primary ministry of the Christian do not concern specific activities. He calls the Christian salt, light, leaven for the world. The Christian's pri(nary ministry to the world, then, is not some particular activity, but a kind of epiphany of the presence of the New Creation. The most fundamental ministry then is to live the Christian life in its fullness. It is a doing that is identified with their very being. How they live flows from who they are. Very sim-ply it is the call to be holy. It helps us understand this primary form of ministry if we reflect on the fact that all Christian ministry receives its meaning insofar as it takes on the.pattern of Christ's ministry. In Christ, we see the perfect expres-sion of "ministry." All that he does flows from who he is. The myste-rious interaction of Jesus with everyone came.from an awareness of a pres-ence in him Which eluded all categories and particular activities. Similarly his primary activity in the Church is not through specific ministries, for example, orders,.charisms, and so forth. It is the fullness of his presence filling the whole Church. "He put everything in subjec-tion beneath his feet, and appointed him as supreme head to the Church, which is his body and as such holds within it the fullness of him who himself receives the entire fullness of God" (Ep 1:22-23). "Be assured. Review for Religious, March-April 1989 I amowith you always, to the end of time" (Mt 28:20). At center of all particular ministries in the Church, then, is the mystery ~f presence. Christ's own ministry is the Si~irit-evoked response to the most radi-cal needs of humankind redemption, salvation, atonement. "I have a ba, ptism wherewith I am to be baptized, and how I am straitened until it be accomplished" (Lk, 12:50). His fundamental ministry then is to re-veal the Father's love. This love is not only an affective, but also an ef-fective love. The Father shows his love through the redemptive gift of his Son. Hence, the mode of being of Christ is a redemptive mode of being. He is from the beginning the? ',Lamb of God who takes away the sins of the world." His ministry then is identified with his whole being. No matter what he says or does, it is always the expression of his gift of himself: "This is my body given for you. This is my blood poured out for you." Christ's presence then is a special mode of presence: a re-demptive presence. All particular activities flow from his pervasive pres-ence as the Suffering Servant. The Church itself has only one primary ministry. It is the sacrament of the presence of Christ. It exists only to bring to the world what Christ accomplished through his ministry, to bring.~the world in touch with the mystery of Christ. All of the various particular ministries in the Church, ways of doing, flow from the primary ministry which is a mode of being present. Similarly, the primary mimstry of the Christian is that of pres-ence where God is absent, to be light in the darkness, leaven in a dead world, salt in a world which has lost its savor. The failure to recognize the primary ministry as that of presence has led to many ambiguities, in discussion of ministry today. One gets the im-pression that greater participation in ministry is only (or mainly) being able to participate in many activities which were closed to a person up to the present. But in reality the primary ministry is to respond by pres-ence to what is absence, or anti-presence. This has always been the pri-mary ministry of the saints, canonized and uncanonized. The m.inistry of presence creates an atmosphere that is broader, deeper, more pene-trating, both stronger and more delicate, and more effective while it is more self-effacing than what is brought about by particular ministries. Yet it has to be admitted that this primary notion of ministry is often neglected~ The activistic mentality that pervades our society sees minis-try mainly as involvement in more activities, o~ in activities associated with one form of ministry, that of Orders. But the ministry of presence is not a matter of this ministry or that. It takes in a whole constellation of activities that identify the New Creation. Th.ey are not so much spe- Ministry and Ministries cific activities as Christian modes of being. St. Paul describes this min-istry Of presence as the harvest of the Spirit: "lbve, joy, peace, patience, kindness, goodness, trustfulness, gentleness and self-control" (Ga 5:22). The ministry of presence, then, takes in all of those activities which are gr0upe~d under the names of the spiritual and corporal works of mercyL''When I was hungry., thirsty., a stranger., naked. ill . in prison" (Mt 25:31f). In particular, it takes on Christ's minis-try as the Suffering Servant. "I have set you an example: you are to do as I have done for you. In truth I tell you, a servant is not greater than his master, nor a messenger than the one who sent him" (Jn 13:!5-16). As Paul says, "Let your bearing toward one another arise out of your life in Christ" (Ph 2:5). All of these activities belong to the Christian qua Christian, not to the Christian as having a particular form of ministry. They are insepara-ble from the Christian identity itself. These activities form the primary ministry of,the Christian. I have spoken, then, of ministry as the Spirit-evoked response to needs. The primary ministry is the response to the need for the presence of Christ through the Christian in the world which still needs to be touched by the redemption. This is the ministry that flows from the pres-ence of the New Creation. Presence in torn is not one or other specific activity. It is a kind of epiphany that shows itself in the constellation of activities that irradiates from the New Creation. Ministry on this foundational level is related to specific forms of min-istry as the atmosphere is to thir~gs that breathe. The specific forms of ministry are lifeless unless they live out of this atmosphere that identi-fies the Neff Creation. Yet it has to be. admitted that popular ways of speal(ing of particular ministries in the Church isolate them from their roots in the primary form of ministry, which is a mode of being present as the New Creature to the Church and to the world. It is on the level of the ministry of presence that really important but unheralded ministry takes place in the Church. It is that which belongs to states of life, such as, for example, marriage. The "ministry" of ¯ mother or father is not this or that particular activity. It is a mode of lov-ing presence that creates a kind of a cosmos of relationships which we call the family. Others, for example, a baby sitter, can carry out particu-lar activities that a mother or father also do. But it is only when such particular activities are rfianifestation of the mystery of presence, the mys-tery of motherhood and fatherhood, that such activities create the mys-tery that we call the family. 170 / Review for Religious, March-April 1989 The Catholic lay person, like every other Christian, exercises the min-istry of presence. This presence obviously comes to the fore in ways of acting that are spe~:ifically Christian. But those particular activities have their power because they are witness to a presence that makes Christ pre-sent in the whole of one"s life. The p~resence is that of the New Crea-tion, in a quiet hut powerful way emitting signals that show the 'presence of Christ in the secular world. They are like beacohs of light sending rays out into the night, both illumining the darkness an~! attracting people to the light of Christ. Particular Ministries in the Church Finally, after this long buildup, we come to the place where most people usually begin discussions about ministry. They mean particular activities in the Church directed to building up the Church that have ec-clesial recognition. "Above we spoke mainly of ministry as the manifold group of activi-ties that flow from the new mod~ of being which St. Paul calls the New Creation. They are not activities in the same sense as the particularized m~nistries. In the particularized ministries one does something to accom-plish something else. But in the foundational ministry one is not "'do-ing" one thing to accomplish something else. Rather it is a ministry of transforming presence. "To crown all, there must be love to bind all to-gether and complete the whole" (Col 3: 14). "'I may dole out all I pos-sess, or even give my body to be burnt, but if I have no love, I am none the better" (1 Co 13:3). Ministry as a particular activity ~n the.Church presupposes and lives off the foundational ministry which is presence, the presence of the Holy Spirit in individuals making them the New Creation: The Holy Spirit, then, draws individuals into the love of Christ by givingthem gifts to respond to particular needs in the Church. St. Paul's description of.min-istry always presupposes the presence of the Holy Spirit in the individ-ual not simply as an individual but as a member of the Church. Gifts are given to individuals to enable them to fulfill a need within the Church. Presupposing, then, the fundamental ministry of presence, St. Paul speaks of various ministries which the Holy Spirit calls forth to respond to various needs. While each is izalled to the primary ministry of radiat-ing the presence of Christ to the whole (the fundamenthl ministry), there are particular functional-roles within the community called forth to re-spond to a whole range of different needs, some more essential than oth-ers. Paul describes some of these. "And these were his gif!s: some to be apostles, some prophets, some evangelists, some pastors and teach- Ministry and Ministries / .17"1 ers, to the building up of the Body of Christ" (Ep 4:1 !-13). "Now you are Christ's body; but each of you is a different part of it. In the Church, God has given the first place to apostles, the second to prophets, the third to teachers. " (1 Co 12:18f). However, the primary ministry, the ministry of presence, with love as its animating principle, should animate all the particular ministries. "Be ambitious for the higher gifts. And I am going to show you a way that is better than any of them" (1 Co 12:31-13:1). Then he goes on to describe the ministry of all ministries, the mystery of love as the primary "ministry" to which we should aim. Ministries on this level have to do with the whole social unit, the whole Church. They reorientate a person's whole existence to take on a specific kind of relativity,from Chr.ist,for the Church. This reorienta-tion is such that it modifies in a new way the person's Christian iden-tity. There are three modes in which the presence of the New Creation is radicalized in an individual: the sacraments of baptism, confirmation, and holy orders. Theologically the term "character" describes what St. Paul calls the metamorphosis, the change in the inner structure of a per-son's life (2 Co 3:18). This is the radical reorientation of a person's whole being, first of all, through baptism to become the New Creation, to respond to one's own radical need--the need-for redemption; then, through confirmation which takes presence to a new dimension, orien-tating the baptized person to the needs of the whole Church; then, through holy orders which radicalizes in a person Christ's own gift-presence, making a person "steward of the mysteries of God" (I Co 4:1), a person whose presence is to draw forth the New Creation. The traditional theological term, "character," then, describes three modes of the presence of Christ in the New Creation. Flowing from these modes of presence are different kinds of activity. I have commented briefly above on the mode of presence that comes through baptism and confirmation. These are modes of presence and ac-tivity which belong to all Christians by virtue of their baptism and con-firmation. It is what is specifically called the mini~stry of the laity. Within that mode of presence there are many kinds of activities, as, for exam-ple, that which belongs to those who are married, or to those engaged in secular occupations in the world. I shall comment briefly on the kind of presen.ce that belongs to the priest. It has two sides. The priest mediates to the Church and the world the presence of Christ. On the other side, the priest draws the whole of Review for Religious, March-April 1989 the Church into the presence of Christ. Like John the Baptist the priest is to introduce the Bride to the Bridegroom, and the Bridegroom to the Bride. Priestly ministry has a.single purpose: to bring about the New Crea-tion- to nourish, sustain, and guide the New Creation by word and sac-rament. All of priestly activity then is some form of transubstantiation, that is, to change the old reality into the new. The priest's whole being is to transform the world by touching it with the redemptive event of Christ. The priest lives from Christ, for the Churchl' But at the heart of all ministries in the Church is the radicalization that takes place through baptism which brings into being the New Crea-tion. Confirmation and orders have their roots in the new mode of pres-ence of Christ in the individual and the Church through baptism. Con-firmation draws out another aspect of the giftedness of the New Crea-tion, that is, the apostolic dimension to "let your light shine before oth-ers . " Orders is a gift of the Spirit presupposing baptism which em-powers individuals to draw forth from the "old creation" the New Crea-tion, through word and sacrament, and to direct the community in the ways to live out the implications of the New Creation. Problems Associated With Ministry St. Paul describes ministries as the work of the Holy Spirit in call-ing responses from within the New Creation to particular needs within the Church. The images he uses always suggest harmonics or coordina-tion. In a sense, the Holy Spirit is like a conductor calling .forth from each individual player in the symphony that which leads to the harmon-ics of the whole piece of music. One of St. Paul's favorite images to bring out the .sense of harmonics of ministries is that of the body, where the whole exists for each part, and each part exists for every other part, as well as for the whole. "There is a variety of gifts but always the same Spirit; there are all sorts of service to be done, but always to the same Lord, working in all sorts of different people; it is the same God who is working in all of them" (1 Co 12:if). The words "same Spirit," or the "one Spirit" oc-cur about ten times in the passage to show that ministry is a Spirit-evoked response to different needs. The same emphasis is found in Ephe-sians 4: If. "Do all you can to preserve the unity of the Spirit. , there is one Body, one Spirit . . . one Lord, one faith~ one baptism, one God." It is interesting that Paul's extensive description of the interplay of the gifts of the Holy Spirit for the good of the whole Church is found mainly in a community where there was the greatest.disharmony, the Ministry and Ministries / "17'3 Church at Corinth. He is therefore calling attention to a special kind of sin, the obstruction of the power of the Holy Spirit in the very persons who are called to build up the body of Christ. But the situation at Corinth does point to what have always been three problems with ministry in the Church: (1) the failure to see minis-try as the Spirit-evoked response to different needs within the Church; (2) the failure to see that each ministry has its meaning not in itself, but only insofar as the foundational ministry of presence animates it; (3) the adaptation of the uniqueness of Christian ministry to secular models. I shall comment on these briefly. (1) The problems in the Corinthian community that turned the sym-phonic movements of the Holy Spirit into groups of warring factions have always been part of the sinfulness of the Church. Basically it is the problem of what in Jungian psychology is called the "persona," the pub-lic image a person seeks before the eyes of others. The symphonic na-ture of ministry becomes discordant when one's attention turns from the ministry in itself to an awareness of the public image associated with dif-ferent ministries. The attention then is not on what the Holy Spirit is do-ing through one's ministry, but on the way ttiat one's own glory appears before others. Some even felt they got a better public image by the fact that they were baptized by a person associated with such an image-creating personality, for example, the eloquent and gifted evangelist, Apollos, in contrast to someone like Paul who apparently did not pro-ject such an image. (2) The second problem which has plagued the Church in her past history, as well as at the present, is tile dissociation of the ministry of doing from the primary ministry of being or of presence. For this reason Paul insists that though the Corinthian Community exercise all of the other ministries, even to the point of giving all they have to the poor, or giving their bodies to be. burnt, yet if they are isolated from th~ min-istry of presence, of being, that is love, (hen all activities are like activi-ties of a corpse. There might be much activity, very busy people, but it does not carry the life-giving power of the Spirit. It is dead. The lack of holiness in those who are supposedly the New Creation has been the biggest obstacle to the work of the Spi.rit during the whole of the history of the Church. (3) The third problem, related to the first two, comes from a failure to recognize the uniqueness of ministry in the Church. Ministry in the Church is a reversal of all notions of service that we find in societies that owe their existence to some natural cause, for example, the state or the 174 / Review for Religious, March-April 1989 family. In these societies, a person enters at a certain level, then makes every effort to move to the top, with increase of salary, prestige, power, and the expansion of the "public image" as one works to the top. In the process, whoever is above is a threat because the one above stands in the way. Those who are below are looked on as inferior. Judgments about the importance of different "ministries" are always made accord-ing to the ladder\of the upward-bound movement and then more specifi-cally to what rung of the ladder one is on. This problem has always been with the Church. It was practically im-possible for the apostles to put this new wine into old wineskins. They argued who was the most important. Then Jesus taught them, "If any-one wants to be first, he must make himself last of all and the servant of all" (Mk 9:35). The sons of Zebedee asked Jesus, " 'Grant us the right to sit in state with you, one at your right and the other at your left.' Jesus said to them, 'You do not understand what you are ask!ng. Can you drink the cup that I drink, or be baptized with the baptism I am to be baptized with?' " Jesus tells them that if he as master and Lord has washed their feet, then they should wash one another's feet. This is a symbolic way of describing Christian ministry. Paul says, "Rivalry and personal vanity should have no place among you, but you should hum-bly reckon others better than yourselves" (Ph 2:3). I am sure there are many other problems that have to do with minis-try today. Some are organizational problems, others from many of the feminist questions. The ones I mentioned above are attitudinal. They have always been with us, and are with us today. They can be at work also in other problems such as organizational or the feminist issues. I can-not imagine people agitating for a job which, for example, would mean that they would take a salary cut, pay more taxes, have longer hou.rs, and work anonymously. The Christian notion of ministry~ is even more out-landish than that. Ministry and Religious Life In his Apostolic Exhortation on the religious life, The Gift of Redemp-tion (March 25, 1984), Pope John Paul II presents what is probably the most profound theology of religious life that has ever been thought out. He roots religious consecration in the New Creation that comes into be-ing through baptism. Religio6s life then has its primary ministry in what we spoke of above as the ministry of presence. It is foundational to all other particular forms of ministry. But the presence that forms the fundamental ministry of religious life takes on a particular paschal duality. It is to image forth the life of Jesus Ministry and Ministries as the Suffering Servant. It exists to show forth the duality that belongs to Christ's own paschal mystery. The paschal duality means that one and the same reality has two related aspects: the cross (sacrifice) and the res-urrection (the New Creation). The vowed life of the religious, then, is to bring into the world a particular modality of paschal presence. That is the fundamental ministry: the ministry of the paschal presence. But there are particular ministries which religious congregations ex-ercise for the good of the Church and society. When we look at the his-tory of the Church in our own country, these ministries are numerous. Some of the majors ones are education, hospitals, orphanages, care for the elderly, but there are many others, including the contemplative life of intercession for the Church. Other forms of particular ministries have emerged over the last twenty-five years. But it is the foundational ministry above all which must activate all particular ministries. To quote Pope John Paul: "It is precisely this wit-ness of love that the world today and all humanity need. They need this witness to the Redemption as this is imprinted upon the profession of the evangelical counsels" (no. 14). "From this witness of spousal love for Christ, through which the entire salvific truth of the Gospel becomes par-ticularly visible, there comes., as something proper to your vocation, a sharing in the Church's apostolate, in her universal mission . . ." (no. 15). He goes on to speak of the particular apostolates. Then, "And thus, even though the many different apostolic works that you perform are ex-tremely important, nevertheless the truly fundamental work of the apos-tolate remains always what (and at the same time who) you are in the Church. Of each one of you can be repeated, with special appropriate-ness, these words of Saint Paul: 'For you have died and your life is hid with Christ in God' " (no. 15). Conclusion Questions about ministry are very much with us today. Many of these questions were brought up in the recent synod on the laity. But the end results did not bring much clarification. Perhaps the most positive result was to bring an awareness of the need for a theology of ministry that relates ecclesiology, pneumatology, grace, sacraments, and voca-tion. I am sure that the synod wa~ an important step along the way to clarification. As the history of the theology and development of doctrine show, clarification of issues that touch the life of the Church very pro-foundly is a long process. .What I have tried to do above could be summed up as follows: (I) since ministry belongs to a unique reality, namely, the Church, which "176 / Review for Religious, March-April 1989 is, so to speak, held together 'from above,' through the Holy Spirit, min-istry in the Church is unique, and cannot be reduced to service as~we find it in any human society; (2) ministry is not self-initiated but originated by the Holy Spirit in order to respond to needs, some of which are con-stitutive of the Church, for example, sacrament of orders, and others which depend on historical, sociological factors; (3) the primordial min-istry is that of presence, which cannot be limited to presence of the Spirit "because God's love has flooded our inmost heart through the Holy Spirit he has given us" (Rm 5:5); (4) particular ministries address par-ticul~ ir needs within the Church or the w.ay the Church interfaces with the world; (5) three main problems were singled out: (a) the use of min-istry to glorify oneself; (b) the shift from primacy of presence ("the more excellent way" which Paul describes as love) to a primacy of par-ticular ministries; (c) the subtle adaptation of the gospel paradoxes about ministry ("Then if I, your Lord and Master, have washed your feet, you ought also to wash one another's feet" (Jn 13:14) to promotional mod-els taken from secular societies; (6) finally, I spoke of the particular min-istry of religious, whether active or contemplative: it is the ministry of a special mode of presence, a kenotic presence, which translates the words of Jesus, "this is my body given up for you . . . blood poured out for you" into the three evangelical counsels of chastity, poverty, obe-dience, creating a paschal presence which animates all particular minis-tries. Come and See: An Experiment in Vocation Discernment in Africa Martin O'Reilly, C.F.C. Brother Martin O'Reilly, C.F.C., does vocation counseling work in Liberia and Si-erra Leone. His address is Christian Brothers; P.O. Box,297; Monrovia, Liberia. ~lln unkind joke, certainly thought up with post-Vatican II religious life in mind, asks: how do you join a small religious congregation? Answer: join a big one and wait. It is, however, a joke that would not be under-stood in many parts of the Church, particularly in Africa. Let me explain. Between 1975 and 1985 the number of local priests rose in West Africa by a staggering 630%; local sisters increased by 280% and'brothers by 340% (Statistics compiled from L'Englise Catholique en Afrique, edited by Pere Perraud, Pontifical Missionary Union, France, 1987). T.he prob-lem for many seminaries and religious communities in the younger. churches is not so much trying to attract candidates, but to find ways in which to sort out the wheat from the chaff. This article will focus on the ways in which vocation counselors can effectively carry out their ministry in situations where the large numbers applying for entrance to religious communities, the newness of the ,~o-cation to many people, and the particular backgrounds of the applicants make it difficult to accurately assess the. seriousness of an application. If the postulancy is to really be a preparatory period for entry into the. novitiate, and not simply a sorting out of suitable candidates from the unsuitable, then there is need for some kind of system of deselection prior to that. A method for doing so is what is proposed here. It is the result of my own involvement over these past five years in vocation coun-seling in Liberia and Sierra Leone. 177 "17~1 / Review for Religious, March-April 1989 The Game Plan ~ Perhaps the best way to begin is by saying how I don't carry out my ministry: I don't advertise; I don't give talks in schools or churches; I don't have a telephone; I don't have my own means of transport; and I am not fulltime on the job. I prefer, rather, to spend a couple of weeks, five or six times a year on the road, covering some 3,000 miles or so, visiting those who have contacted me. I stay with them in their town or village, and meet their family and friends. Just as an ordinary friendship grows, so does mine with .those who have expressed interest in the life of a Brother. Through the people who have invited me to visit their homes, I have met others who want to know more about the religious vocation. Many people have joined our community through a friend or relative introducing them to me. Since b~ginning in my ministry in 1982 I have developed a network of contacts that r.uns into the hundreds. When my relationship with an applicant has developed past a cer-tain point, I then invite him to "come and see" where 1 live. I invite him to spend ten weeks with myself and the community. Apart from help-ing with his transport costs, he has to arrange his own travel documents and come under his own steam--just as any person would have to do, were he or she to travel and visit a friend in a far-off place. The idea behind the ten-week vocation discernment program is for candidates and the community to experience each other for a sufficient length of time, allowing both parties to get to know each other, and to see if they are compatible and willing to grow together in community, prayer, and service. :Who Is Invited? ~ There are fivemarkers I would look foi in a person suitable for ac-ceptance into the pre-postula.ncy program (I am presuming that an appli-cant is baptized and confirmed as a Catholic, has reasonable references and is in good health): (I) An applicant must have shown evidence of being able to commit him-self to a group within the Church (for example, The Legion of Mary, St. Vincent de Paul, Y.C.S., or a prayer group) for a substantial period of time. Simply "attending Mass'? regularly is not enough evidence of a commitment to the Church within the African context. (2) An applicant must have "nets to leave behind." The economic con-dition of many of the countries in West Africa is such that the vocation . of a priest or a religious can be a very attractive proposition. It offers a person security and status, to say nothing of sanctity! Those straight Come and See / "179 from school are not usually in a position to have ~proved their compe-tence in the art of living and providing for themselves. With few excep-tions school-leavers have the added problem of not seeing entrance to a religious community as anything more than pursuing "further stud-ies." Those who apply, and have no job, I advise to look elsewhere. (3) The family of an applicant must be able to understand what decision a young person is making in asking to join a religious community. There has to be some significant member of the family, not necessarily a par-ent, who supports his intention. The applicant, for his part, must explain to the family that all he is trying to do is to "find God's will." If he finds out that it is not God's intention forhim to be a religious, then he should tell them that he will return home a wiser person; but if it is, then he must explain thathe will be returning to join the community as a pos-tulant with, hopefully, the understanding and support of his family. (4) An applicant has to be able to see that there are difficulties for him in asking to join a religious community. His ability to talk of his'fears about the demands of a celibate life are as good an indicator as any of the degree of his seriousness. If he cannot see this as a tremendous chal-lenge, then I tell him that he probably has not thought enough about the vocation. (5) With regard to the intellectual ability of an applicant, it is essential that he be capable of tertiary education. A person's particular paper quali-fications do not always reflect his academic ability, so it is not appro-priate to apply the same rules for entry to everyone. A candidate should certainly have finished his secondary school education and not beqook-ing to resit exams at a later date. If I am unsure as to the suitability of a person applying for the pro-gram, I will give him the benefit of the doubt; but when it comes to en-try into the° six months postulancy, and I am s.t!ll unsure of his suitabil-ity, I give the benefit of the doubt to the community and ask him to look elsewhere for his vocation. The Rationale Behind The Program The pre-postulancy program, as outlined here, is conceived of as an extension of the vocation counselor work, .rather than the beginning of religious formation. Those selected for the prograrfi--never more than twelve--are fully aware of the temporary nature of the experience, and understand that at the end of the program they may, or may not, be in-vited to apply for admission to the postulancy program. For most of those entering the program, this will be their first expe-rience of living in a multi-cultural environment. Great care, therefore, 180 / Review for Religious, March-April 1989 is taken to make our candidates feel at home--if not, then they will prob-ably wish they were at home.! We have found that candidates, at this stage of the life in a religious community, prefer to share rooms and need ample opportunity for settling in ,and' being themselves. It goes without saying that the personnel involved in directing the program are comfort-able living with young people and are prepared to trust them. I have found that for a pre-postulancy program to work well, there must be a group of candidates with a specified program to follow. Sim-ply inviting young Africans to come and live with a religious commu-nity and to occupy themselves with some form of pastoral work is not a sufficient basis for helping them understand the meaning of religious life. Candidates need clear guidelines so as to help them negotiate the difficulties in living in a structured environment with others from differ-ent backgrounds and cultures. Growth in appreciation of the meaning of religious life will take place when candidates begin to experience the com-munity as sufficiently safe and supportive so that they can be themselves. However a person presents himself prior to joining the community, he cannot maintain a pretense for long when invited to participate in a strong community experience. Candidates, also, can be so concerned with try-ing to match our real or imagined expectations of them that they find it difficult not to think of themselves as playing the lead part in a drama scripted by others. As far as is possible I make the agenda of our daily living together the responsibility of all and try to foster a sense of ac-countability among them, a sense that "we are in this together." For people to encounter themselves, others, and God in a real way there has to be a ring of authenticity about the experience. I am espe-cially interested in exploring with those invited to join the program their notions about themselves, talents as well as weaknesses; the ways in which they handle questions relating to anger and misunderstanding~ sexu-ality and intimacy, and obligations towards family members--as well as the ways in which they enjoy praying. Matters spe(ifically related to the meaning of the vocation to the religious life, I leave for later on in the p6stulancy. Hopefully, as a result of this approach candidates come to build up their identity as members of the community and as people of prayer on more than the superficial foundations of rules and ritual. Sometimes formators can be afraid to get close to c.andidates, pre-ferring to treat them in h remote fashion. This is, 1 feel, wholly unac-ceptable within a cultural climate where tactile contact and verbal com-munication are so important.~Shaking hands, giving hugs and passing the time of day together are as natural to Africa as the sunshine. Most of Come and See 181 those applying to join us have encountered a good deal of opposition from their friends and family. They need to know from the outset that they are really welcome into the community, not simply for who they might become, (that is religious brothers), but for who.they actually are. That is not to say that there is no room for tough love, but simply that the most effective direction will be given by the formator who is capa-ble of sharing his or her affection for the candidates in concrete ways. A crucial element in thesuccess of the "Come and See" program has been the close presence of professed religious, actively involved in the mission of the congregation, and a novitiate community prepared to welcome candidates, albeit for only ten weeks, into the religious fam-ily. Both professed members and novices have provided a tangible ex-pression of the ideal and the possibility of becoming a religious candi-date. The director of the program is also supported by this in the com-plex business of evaluating applicants to the postulancy. Counseling and helping people discern their vocation is very much, at this stage, a group experience. The value of regular or weekly com-munity meetings, with the opportunity of bringing into the open any is-sue of concern to individuals or the group, cannot be overestimated. If something important to one or more of the candidates is being intention-ally avoided by the community, then nothing of importance will be ta~ked about either. Our weekly sessions start with a review of the pre-vious week and points arising from the reading of the community jour-nal take up the first part of the meeting. I have known that part of the meeting to go on for two hours. The principle of dialogue in Africa seems to be "to talk until you agree"! The length of the program--ten weeks--is long enough for both the candidates and the community to come to have a fair idea of one another, and yet short enough for a person to feel as though he has not burnt his boats by leaving home to enter into a religious community. Having a ter-mination point after ten weeks, instead of say six months, lessens the .chances of early drop-outs and an accompanying lowering of morale 'within the group. It also makes candidates feel free to reevaluate their own decision in the light of their experience of religious life and leave without recriminations, should they feel that such a life is not for them. Conclusion In the five years that the Brothers' Formation Center has been in op-eration in Gbarnga, Liberia, forty-two candidates have completed the "Come and See" program. To date, we have eight postulants, four nov-ices and ten junior professed. Most of those who have left us did so at 1~19 / Review for Religious, March-April 1989 the end of the pre-postulancy program, and left in good spirits. Those who entered the postulancy, and have stayed with the community, say thai the important thing about the pre-postulancy program was that it was religious life "small, small" and hence made them able to realize the importance of being themselves within a culture (religious life) vastly dif-ferent from the 6he they were used to. They were more able to relax and relate to the idea of becoming religious once they knew that they were accepted for who they were; and not who they might become. If those who enter the postulancy do so with some semblance of realism in terms of themselves, and the firm knowledge that "it. is indeed good when brothers dwell as one," then there is a reasonable chance that they can give themselves fully to the significant step of embarking upon the path of becoming members of the Congregation, and I as vocation counselor will have don~ my job. Assessing The "Moral Integrity" Of Candidates For Religious Life Charles Shelton, S.J. Father Charles Shelton, S.J., has a doctorate in clinica! psychology and is currently an Assistant Professor of psychology at Regis College in Denver, Colorado. A more detailed understanding of this theory of conscience is presented in his most recent book, Morality and the Adolescent: A Pastoral Psychology Approach. New York: Crossroad, 1989. His address is Regis College; 3539 West 50th Avenue; Denver, Colorado 8022 I. Over the past twenty years, it is safe to state that the application process for entering reli~ious life has radically changed. Gone are the days when a simple behavioral observation of the candidate's religious practice or the encouraging word of a religious who knows the candidate suffices for entrance. Instead, the application process for most orders and insti-tutes focuses on a thor~ough social history, detailed interviews, psycho-logical evaluations, and an overview of the candidate's sp!ritual life. Sur-prisingly, little has been written regarding one crucial aspect of the ap-plication process--that of the candidate's moral integrity. This article ad-dresses this issue by offering a theoretical yet practical view of the can-didate's capacity for moral growth. The linchpin which holds together the candidate's vocational aspirations with his or her moral integrity is "conscience." Accordingly, we will provide a model of conscience and suggest a practic,al approach which will be of use to vocation directors and interviewers of candidates. The thesis of this article is that the "moral integrity" of a candidate is a crucial area of assessment and that a perspective which utilizes an integrative understanding of conscience offers the best way for providing a thorough examination of the candi-date's capacity for living the moral life. 183 11~4 / Review for Religious,~ March-~April 1989 ,The Moral Life of the Candidate Perhaps one reason that little has been written about the candidate's moral life is that one simply "assumes" that anyone wishing to enter priestly ministry or a religious congregation possesses an upright moral character. Although understandable, such a position remains question-able. Any vocation director can readily provide stories about candidates who express interest .in religious life, many of whom are ill-suited for psychological reasons, as well as at times "moral" reasons, for proceed-ing with the application process. The question of the candidate's moral integrity, however, has taken on new significance over the past two decades. Several reasons can be offered why serious examination needs to be given in this area. First, many candidates seeking to enter religious life today are ~lder. This be-ing the case, the backgrounds and experience of the candidates provide an often admirable, yet at times puzzling, array of experiences. Many involved in the candidate selection process at times wonder what has re-ally gone on in the life history of the candidate. Secondly~ the psycho-logical nature of candidates often admits to a complex personality struc-ture which is threaded with a variety of motives and psychological ex-periences, not all of which are compatible with the demands of the re-ligious community.For example, I was once presented with a situation about a candidat~ to a diocesan seminary. The candid.at~e had. admitted to several questionable behaviors but now contended that a conversion experienc6 had resolved these issues. Since I did not know the candidate, I refused to offer an opinion regarding his suitability. I did suggest, though, that given the behaviors in question careful scrutiny must be given this person's motives. The capacity for rationalization is virtually limitless. Thirdly, the complexity of today's ministerial roles and struc-tures necessitates a well-developed and well-defined moral conscience Which allows flexibility, sustains insight, and fosters behaviOr~ which are~ healthy and which nurture moral integrity. The recent scandals surround~ ing sexual acting out among priests and religious necessitate a.well-integrated conscience which assists a person in reflecting 6n his or her own vocational commitment. All in all, conscience remains the single most vital human mechanism for assisting an individual's living of dis-cipleship. As a consequence, it becomes important to offer a view'of con- ~Cience that is'integrative and best captures the human desire to live the life of Christian discipleship. As a clinical psyChologiSt my own view is that for conscience to make sense it must be intimately rooted within the very human experience of life; indeed, conscience must arise from The "Moral Integrity" of Candidates / 185. the very depths of human experience as it responds to the self-commu-nicating presence of God's offer of grace. This perspective allows the very moral integrity of the person to be encapsulate~l within the reality of h.~uman life and surface in the very depths of human personhood. Ac-cordingly, I think that conscience is best explained as the decision for other-centered value in the concrete decision of everyday life. That is, conscience serves as the capacity to appropriate more and more the Chris-tian dynamic of love in the existential reality ot~ one's life. It is the one force .within life that serves to break through deceit and self-deception and challenges one to strive for a more authentic living of discipleship. In order to see this clearly, I would like to offer a model of con-science that incorporates seven dimensions. My thesis is that only an ex-amination of these seven features will allow a more complete and thor-ough understanding of a'person's capacity for moral int'egrity. As a way to assist the application process of candidates, I will offer specific com-ments and questions that are applicable for a candidate seeking to enter religious life. Through an eva, luation of these seven dimensions, a more adequate sense of the candidate's moral integrity can be ascertained.~ Evaluating for Moral Integrity Within a model of conscience, the following seven dimensions should be considered. Adaptive Psychic Energy. We are what we focus on and experience. Stated another way, what we give attention to offers insight into the type of person that we are. Psychic energy is required for all human endeav-ors. Indeed, perceptions, thoughts, emotions, attachments, and behav-iors ~all rely upon an adequate investment of psychic energy. At the same time, psychic energy is itself limited. One has only so much energy to invest. Thus, to tend to certain tasks and goals precludes, by necessity, investment in other ventures. Developmentally, psychic energy is best utilized in the successful resolution of developmental tasks. Applicants seeking to enter religious life require careful scrutiny of both their level of identity formation as well as their capacity for intimacy. Most likely, individuals who are without a sense of healthy identity or a balanced and mature sense of the demands, ambiguities, and feelings associated with intimacy are susceptible to the pull of a pervasive dependency or the un-due influence of others (or environmental situations) which deflect needed psychic energy for spiritual growth. Moral growth is most apt to take place when one can bring to one's evolving and (increasingly. con-solidated) ethical self the accumulated wisdom derived from a felt (yet evolving) sense of "who I am" and the felt attachment (yet continual 186 / Review for Religious, March-April 1989 self-discovery) that "I am loved and I do love." Some needed questions to consider in this regard include: To what extent does this ~:andidate know who he or sh~ is? How influenced is this candidate by his or her own needs or by the influence of others? With what degi'ee of self-awareness can the candidate speak of a sense of self-definitioh? Does there exist appropriate intimacy experiences in this per-son's life (or for yoUn(er candidates, the maturing capacity for inti-macy)? Has this candidate's sense of identity and intimacy allowed for greater self-awareness that is capable of dealing with increasing ambi-guity and the com, pl~xities of adult (and religious) life? Defensive Psychic Functioning. Healthy growth is dependent upon adap-tive psychic functioning which incorporates mature defense mechanisms. Defense mechanisms are psychic operations whose function is to allay anxiety and.p~rovide a more flexible and adal~table resPonse to reality. Healthy defenses include sublimation, a flexible and resourceful sense of humor, role flexibility, s~ppression's"(the conscious contro~l of im-pulses), and altruism. Needless to say, the living in community and the demands of the chaste life require wide use of these defenses in order that the religious might integrate and deal with sexual and aggressive urges. Community life, the constant demands of the apostolic life, and the need to continually appropriate the ideals of the vowed life require an adaptable and flexible approach to others. On the other hand, there exist a' wide variety of defense mechanisms which are apt to prove un-healthy for living and which in turn stunt moral growth. These include: projection (the attributing of unacceptable feelings to others); externali-zation (the blaming of one's difficulties on others); acting out (the ac-ceding to impulses); rationalization (the making of excuses); stereotyp-ing (theorefusal to allow and accept differences); and compartmentaliza-tion (the excluding of one area of life from self-examination). A classic example of this last defense is the person who lives a credible life as a religiousin most areas of life, yet refuses to look at one area such as sex-ual acting out. As the candidate becomes less able to marshal mature defenses, the inevitable result is a limit of self-knowledge and of reflective self-awareness needed for interior examination. Naturally, this form of lim-ited psychological functioning is bound to impact on the discerning of choices or a balanced and realistic reflection on personal life issues. Some pertinent questions are: Does the candidate rationalize'? exter-nalize? project? and so forth. What does personal responsibility mean for this candidate? How comfortable is the candidate with his or. her ira- The "Moral Integrity" of Candidates pulses? How does the candidate sublimate? How does the candidate deal with ambiguity? To what extent is creativity possible for this candidate? Empathy. Conscience is not only rational reflection; it includes emotional investment and attachment. Empathy best exemplifies this emotional ex-pression since it points to the capacity to bond and show sensitivity to others. Normally, empathic expression is not an issue for religious. How-ever, there exist several areas for scrutiny. Does the candidate overem-pathize? The person who cannot maintain healthy identity boundaries is apt to lose objectivity. Further, when empathizing how does the candi-date deal and integrate his or her empathic stirrings? How self-aware is he or she of emotional distress which arises from pastoral situations which often elicit intense internal feelings? This issue is critically im-portant because burnout (an ever present problem for members of caring professions such as those in religiousolife tend to be) often results from continual exposure of the self to empathic distress (experiencing the pain and hurt of others in pastoral situations) which, over time, wears down the religious both physically and emotionally. This burnout in turn less-ens the capacity for reflection, healthy objectivity, and discerning choice. Self~esteem. Adequate self-esteem is indispensable for maturation. S;~lf-esteem refers to a felt sense of inner goodness and a sense of self-competence. There are several ways self-esteem relates to the candidate's level of moral integrity. First, without a healthy sense Of Self-esteem, a person is psychologically limited in the capacity to admit personal fault and the seeking of forgiveness. Lack of self-esteem leads invariably to over-compensating behavior and desires for control; or, conversely, there exists denial~ of responsibility or rationalizations. Without self-esteem the religious who hurts a fellow community member is disinclined to view himself or herself as bearing responsibility for the hurtful action. An equally problematic behavior that is likely to surface from lack of self-esteem is over-dependency on the behaviors and thoughts of others. In other words, the religious who lacks a felt sense of "inner goodness" is vulnerable to being overly influenced by another. Consequently, such "neediness" is likely to evoke blindness regarding personal action and the rationalization of specific behaviors. Several questions come to mind that could be integrated into an as-sessment of the candidate. First, does the candidate genuinely "like" himself or herself? Is the candidate capable of independent and mature judgment which is open to input and guidance from others? At the same time, are there indications that this candidate is overly dependent on ob- Review for Religious, March-April 1989 taining a good impression from or the approval of others? Guilt. Feelfngs of guilt exact a tremendous toll on the psyche. They can be'the source of debilitation leading to weakened self-esteem, depres-sion, a sense of personal devaluation, and compensating behaviors which often take on a compulsive quality. Still, there is a vital, indeed neces-sary role for guilt in moral development. Healthy guilt serves as a vital linchpin'in orienting one to awareness of personal transgressions and the need for forgiveness. Furthermore, such guilt' experiences induce a re-sponse that is caring and sensitive to the concerns of others. Admittedly, the experience of guilt is one of the most difficult psychological tight-ropes to walk. If experienced too intensely, its effects can be crippling. On the other hand, to deny the experience of guilt deprives the self of' a naturally occurring psychic experience whose function nourishes increas-ing sensitivity and altruistic responding. My own impression is that many religious downplay the vital role that guilt exercisesin the experience of forgiveness, I suspect this is most likely due to many religious' own back-ground and difficult time with guilt feelings. Several questions are pertinent. How. has the candidate dealt with moral transgressions in his or her own life? Can he or she discuss them? Is there a sense of openness and also a healthy distance from these past experiences? What has the candidate learned from these experiences? Is the candidate still reacting to them? How does,the candidate speak of his. current limitatiohs? How does the ~candidate believe that he or she needs further growth? Note here the view of growth from a sense of positive integration as opposed to a compulsive sense of goals to be accom-plished. Idealization. The role of idealization is vital for the development of a healthy moral sell It is within our capacity for 'idealization that the can-didate 'is able to construct a view of the order or congregation and the personal desire"to enter religious life. Idealization speaks of dreams, hopes, desires and what the ca.ndidate wishes to become. It implies a mold~ ing process of gradual evolvement which is shaped from images and hopes yet to be realized. Idealizations indicate the quality of one's emo-tional investment and the underlying values to which the moral self is committed. Several questions are pertinent.~,How realistic is the candidate's view of self? religious life? It is to be expected th~at the view of both self and the order/congregation might be somewhat distorted; and the issue b'(- comes how open 'is the candidate to having his or her idealizations rfiodi-fled? A further question refers to the capacity of the candidate to deal The "Moral Integrity" of Candidates with disillusionment. Since idealizations are so valued, the failure of them to occur or be implemented can lead to tremendous hurt and an-ger. Behaviors emanating from such perceived slights and disappoint-ments include acting out, cynicism, passive-aggressive behavior, ration-alizations. In other words, the negative affect resulting from disil-lusionment can cloud healthy moral reflection and an authentic living of the vows. Teleology. A final dimension of the well-integrated conscience is a re-flective sense of purposive meaning. A teleological perspective is sim-ply one's capacity for rational reflection which provides reasons ("that for the sake of which") why one's behavior is carried out. Candidates to religious orders and congregations, of course, are capable of reasoned and reflective behaviors. The issue here is more the "style" of one's telic inclinations rather than the content of the reasoning. In other words, most people could give reasoned responses for their behaviors. The key for mature functioning, and most certainly for moral functioning, is the motivation behind such reflection. Tendencies to be observed include the following: Does the reasoning of this candidate contain a healthy per-sonal investment? Is there an emotional investment in his reasons? Con-victions are most apt to be lived out when they contain a mature blend-ing of reasoned reflection and emotional commitment. On the other hand, does the candidate isolate affect? Does he or she appear to sepa-rate reasons from the emotions which such content would naturally elicit? For example, a candidate who would,speak of a particularly disturbing experience in a cold and very intellectualized way might well not be aware of underlying emotional dynamics. On the other hand, the candi-date whose rationales are continually interspersed with an impulsive qual-ity or tinged with emotionally laden content might be too absorbed in de-veiopm+ ntal issues or underlying dynamic processes to offer healthy dis-tance and the requisite discerning that is needed for moral decision mak-ing. Conclusion This article has underscored the significance of exploring the moral integrity of applicants in any overall assessment of candidates. It is ar-gued that moral development is not simply a process of doing right or wrong. Rather, growth in the moral life is a complex event best exem-plified as an integrative process emanating within the rooted experiences of human living. In the assessment process itself, an exploration of the candidate's past life history is imperative. Equally important, though, is assessing some quality of the candidate's capacity for moral growth. This 190 / Review for Religious, March-April 1989 article argues that optimum moral growth for the candidate is most apt to take place when the following qualities are present: appropriate work-ing through of developmental issues, a realistic and adaptive view of self and others, a caring sensitivity, the capacity for admitting wrong, a healthy sense.of self-esteem, aspiring ideals that are realistic, and reflec-tive reasoning. Though no assessment procedure can accurately predict a candidate's ability to live consistently the moral life, it is well worth the efforts of those involved in the formation process to address every candidate's capacity for moral integrity. An Easter Prayer Love's force is stron.ger than the pull of dark: It can level mountains, raise the dead To a new life, and strengthen weary feet To walk on waters, piled rough waves of night. Its breath can blow the dying coals to light A tunnel black as pitch and radiate The way round pitfalls and sucking s~nds Even to the long, long corridor's end: Chain love's force in tomb with rock-seal tight, Beat it level on Friday's cross and still After three-days He rises above The morning sun in Tabor splendor. See how He moves unhindered through barred doors, All His glory sta.mped on hand and foot and side: Balm to festered sores of Calvary, Now free from binding shroud and fastening nails. Oh, Beacon Light at the end of the sea's corridor, Ointment spice for hurt eyes and wounded hands, Oh, Summoning Bell, buoyant to all our stumbling feet, Help us, Risen Christ, to walk life's dark waters! Marcella M. Holloway, C.S.J. 6400 Minnesota Avenue St. Louis, Mo. 63111 Comprehensive Counseling David Altman, O.C.S.O. Father David is a monk of Holy Trinity Abbey; Huntsville, Utah 84317. At one time or another during our lives, individuals will come to usfor the help they think we can give. Whether or not we find ourselves ex-pert in various kinds of problem-solving, we ought to be able to help them identify problems and be able to present recommendations. Perhaps the key to success in relating to and helping others is to see personal relationships as Christian ministry. The people we meet are, of course, Christ himself, in one of his many disguises. They are also our current pastoral assignments, to be met with faith and self-sacrifical love. Upwards of 85% of helping others consists.in listening: listening at-tentively with compassion and understanding. At times we will be called upon to respond, and this must not be done tritely, but intelligently and constructively. The Approach The secret, if there is one, of a good approach to solving personal problems is to meet each person-situation comprehensively, which is to say, completely. This simply means that we have to use a method which will ensure that problems are not permitted to get by undetected. We want to throw out a net, so to say, which will catch and identify all the difficulties from which a person is suffering. A way to do this is to realize that we human beings are basically three-fold in our makeup: we are physical beings, mental-psychologi~:al be-ings, and moral-spiritual beings, Obviously, then, we can have three gen-eral kinds of problems: physical, mental-psychological, and moral-spiritual. 191 Review for Religious, March-April 1989 These categories are not mutually exclusive since they all pertain to one human person in each case. I have found them useful in my own coun-seling experience because they are complete: they are the net from which no problem need escape, provided that each category is kept in mind dur-ing communication with the person who is seeking help. Competency Few of us are competent to handle difficult cases of pathological na-ture. Of course, those with severe illnesses are to be directed to pro-fessionals with the appropriate expertise. Psychotics need psychiatrists or psychologists; seriously sick bodies require medical attention; and mor-ally ill people need men and women who can show them God's healing ways. Because we presumably are these men and women of God, we ought also to have a certain competency in identifying problems in the other two areas of each person: the physical and the psychological. The body-soul unity is the temple of God's Spirit, sharing intimately in the spiri-tual life of each of us. Therefore our desire to, help the suffering Christ in others ought to carry us beyond spiritual and moral interests alone. Though we may not have the professional training by which we can solve a probiem fully, our working knowledge of various problems en-ables us to provide reasons to a person of his (or her) need for another with more expertise. Simply remarking, "You need a doctor" can be a slap in the face for one who is in pain. We should be able to convince another of his need for help, and perhaps even supply a good name for reference. Difficulties One of the greatest difficulties in attempting to solve individual prob-lems in any of the three areas is to give a suffering person What we want instead of what he needs. When a medical doctor sees a patient, the as-sumption is that the patient has a medical problem. Tunnel vision can take over, and physical medicine is all the doctor can see, whereas the patient's main difficulty may be in a quite different area. It is not un-usual for doctors to listen to remarks such as "I'm not feeling well" and respond with great pastoral concern: "Here, let me give you something for your nerves." This is treating the, sympto.m rather than attempting to identify the underlying cause, the root problem. When a person sees a psychologist with a problem, the psychologist will usually presume that the problem lies within the bounds of psycho-logical expertise. This too may not be the case at all. Remember the story Comprehensive Counseling / 193 of the man who went to a psychologist with a physical ailment that was impinging on his nervous system. "I feel terrible," was the complaint. The doctor responded unwaveringly with talk therapy and persevered in missing the mark. There is little sense and even less success realized in forcing one kind of solution on an entirely different kind of problem. Equally futile and costly is the failure to address real problems in favor of their symptoms. Worse still is the failure of the health-care specialist torecognize a ~prob-lem, then write off the patient as a hypochondriac. This is no solution, only an excuse. When religious or priests are approached for counseling, we nor-mally presume, in our turn, that the person is simply looking for a closer relationship with God, and we proceed accordingly and unfortunately. I remember a person coming to see a religious for years, feeling terrible for a great deal of her time. The counselor came across very generously with saccharine exhortations to a deeper relationship with the Lord. The individual responded with nodding smiles as tears of pain continued to roll down her cheeks. The religious was giving what he wanted, not what the person needed. As it was, the individual had developed a severe case of hypogly-cemia, diagnosed laterby a physician. And, as counselors should know, fluctuating blood-sugar levels have very much to do with a person's emo-tional dispositions. As soon as the suffering person said, "I feel terrible," that was the tip-off for aphysicai condition. After all, we can only feel, bodily, through our nervous-system cells. When they are offended, they are go-ing to let us know about it, one way or another, In addition to hypoglycemia and diabetes, people today are subject to stress situations--and with widely varying nutritional needs. Medical science today knows that under these stress conditions the body gobbles up vitamins and minerals to an enormous degree. Since the B vitamins, vitamin C, and calcium predominantly nourish the human nervous sys-tem, a deficiency is going to show up with contributions toward various kinds of problems: mood swings, nervousness, anxiety, anger, irritabil-ity, depression, compulsive sexual problems, insomnia. Any nervous-system- related problem can be caused or made more burdensome by the severely deficient diets that are practiced today throughout our junk-food land. One person complained of not feeling quite herself: irritable, even biting toward others. I learned that she had just recovered from the flu, Review for Religious, March-April 1989 which is just one of the stress factors we experience. I suggested a vita-min- mineral supplement on an as-needed basis, and the problem was cleared up. A third physical difficulty, also masked as spiritual or psychologi-cal, is the problem of intolerances. Pioneer medical research has shown that all kinds of personal difficulties are really the human body's reac-tion to ~,arious environmental factors: food intolerances certainly, but also paints, finishing substances, and other chemicals, even artificial light-ing. PhysiCal problems are the first options to explore in c~unseling. They are the most quantifiable, and perhaps the easiest to identify, if not to solve. Relationships People have trouble with relationships, and each of us has three re-lationships in life: a relationship with God, with others, and with one-self. Problem areas are identified by determining the quality of these three relationships, and there are many tip-off statements that come your way as a~counselor. They come voluntarily to the listening ear, and they can be elicited .by asking the right questions. For example, a counselor can determine the quality of someone's re-lationship with God by asking for details about private and communal prayer-lives and: about fidelity to known moral obligations :in 'marriage and work-commitments. Listening to descriptions of interpersonal rela-tionships can reveal much. On one occasion I heard, "They're pickin' on me." This could be true, or it could be a defense. In this particular case, "they" were not the problem. I was talking to the problem. We all enjoy the forbidden luxury of finger-pointing, but we should be mos'e aware that whatever we do, whatever~we say, whatever we wil.l-fully think, we are always saying something about ourselves. We behave out of what we are. Often individuals will present their relational difficulties in terms of an impossible situation with absolutely no way out. The answer is the awareness of the great difference between a real relational situation, and the particular way it is described. Simply reframe the problematic situ- ¯ ation. Discard the impossible description, redescribing the circumstances yourself, so as to provide as many solutions as you can. This takes imagi-nation, and first attempts will result in grasping at straws. But hold on to the straws, as they lead to stronger, more promising answers. It should also be clear that principles of good counseling are appli-cable not only to others,,but also to ourselves. In this connection there Comprehensive Counseling / 195 is a check on the judgments we must make in order to help others: the golden rule, the virtue of empathy, placing oneself in the other's shoes. These principles demand questions such as: Would I follow this advice myself? How would I feel were this advice given to me? Would I bene-fit from the behavior I am planning to recommend? The measure of the quality of any relationship--with God, others, or oneself--is the answer to this question: How does the individual han-dle conflict? We are all fair-weather friends of God, of others, especially of ourselves. But the true measure of a person's strength of character and personal integration is how one stands up in adversity. Do we respond to challenges with virtue and resultant, growth, or with vice and rebel-lion in its many forms? : We cannot give what we do not have; we can only give what we have, so the personal problems we carry around are going to show up in relationships with others. Do they handle re!ational conflicts with at-tempts at reconciliation and peace, or are they inclined to antagonism, revenge, and consequent alienation? Vices In the course of counseling experience, we come across the problem of evil: evil circumstances, evil behavior. We are all sinners before God, and before each other, a fact which ought never to be discounted in problematic relationships. We meet people who sin against God, against others, against them-selves. One of the best favors we can do for them is to help them admit and own their own evil. It is a mistake to try to identify every problem medically or psychologically. Wrongdoing must be identified, owned, and corrected. We are admittedly honest and generous in assigning praise for vir-tue and for any good act; we must be just as honest in recognizing and assigning vice (evil habits)and sinful acts. How we speak about this to others is important, but the honesty must be there, because the only way to solve a problem is to' face it. The love of Christ is a challenging love, because it is only through challenges that people grow. We must often challenge others' behavior, challenge their sin, challenge our own sin. It is these challenges which are the cross-experiences of our lives and the meaning of suffering. We grow through challenges into the strength of character that we need, to live life well, and to die well. These challenges or crosses hurt, because growing pains always do hurt. But the rewards are well worth the perse-vering effort. Review for Religious, March-April 1989 After the apparently innocuous complaint "My life seems to have no direction or purpose," aofew questions were able to uncover a some-what profligate sex life, little or no prayer, and a difficult family back~ ground. Well, we are all products of our background, but we never need be slaves of our backgrounds: Psychotherapy can be of great healing bene-fit; so can a humble confession of guilt with attendant petitions for for-giveness and :mercy; so can the healing power of prayer: holding up bad memories in prayer, exposing them to divine remedies. Whatever difficulties we:have had to endure, they tend to force upon us burdens and pressures which are often channeled compulsively as they please. Kn~owing that our two main emotion-vices are anger and lust, we see that compulsions can spell big trouble. As a result~ people gravitate toward giving up dominion over their own beings:~They become slaves of various emotions and habits. Indi-viduals abdicate the kingship or queenship of their beings in favor of an-ger, lust, drive for power, vain ambitiow, money, prestige, or another person. Taking steps to become one's own man, one's own woman, elimi-nates this slavery, and the first and most important step is fidelity to God ~nd his laws governing human living. This is i'eal love, which will in-variably be returned in greater measure, because w'e love a God who will not be outdone in generosity. Conclusion This contribution has also been called comprehensive because it is only an overview. There is no substitutefor common sense in counsel: ing, and no substitute for prayer. The Jesus Prayer o~: another prayer,of aspiration before, during, .and after the counseling session deepens the session in God, exposing both parties to divine healing power and spe-cial graces. We are ourselves healed as we heal others, because with our love, our desire to give.God to others,' we find that the same generous God gives to us in response to our needs. We offer the gift of our lives to the suffering Jesus in others,', and he returns this gift with his own life and gifts: the graces we need to accomplish our healing task well, and the grace to grow through our own physical, psychological, and moral prob-lems into the personal sanctity ordained for us. The Power of Romantic Love William F. Kraft, Ph.D. William Kraft, Ph.D., is well known to our readers. Dr. Kraft is on the faculty of th~ Psychology Department of Carlow College where he may be addressed: 3333 Fifth Avenue; Pittsburgh, Pennsylvania 15213. ~1 don't know what's gotten into me, but I do know that I'vemever felt like this. I never thought I could feel so alive, so open, so good. Since becoming friends with Sarah, I feel more confident; it's as though prob-lems don't bother me like they used to. I function better, I'm more open, and life just seems to finally make more sense. Especially when I'm with Sarah, I feel light, energetic,optimistic. It's as if almost anything is pos-sible. "Some sisters label our relationship as exclusive, or God forbid: par-ticular. In some ways, I guess it is. I know I can hardly wait to see her, to spend the weekend with her, to go on vacation with her. And some-times, I think I yearn too much to be with her. And yet, how could some-thing as wonderful and good be bad? True: sometimes we get a bit too physical, but never genital. We really strive to be chaste, but it's diffi-cult at times. I would like to be more physical, to give all, but I know that would be going out of bounds. "Before my friendship with Sarah, I was sort of happy. I was a good teacher and got along okay in the community. But ! always had the feel-ing that I was missing something important, that life should be more than getting by or maintaining the status quo. And I was always kind of shy or constricted. It was as if I had all these flashing red and yellow lights in my mind, and now there are more green lights." This sister has fallen romantically in love--one of our most invigo-rating and seductive modes of love. She has been lured into and is en- 197 Review for Religious, March-April 1989 joying the experience where almost anything seems possible and almost nothing seems impossible. Feeling more courage and confidence, old problems seemed to have changed and new possibilities have emerged. And her friend seems to be the center of her life, the source of her new vision and strength. Her life is so much more alive than her relatively constricted past. Understandably, she wants more of this new life. Such is romantic love. Listen to this male religious. "Something incredible happened to me this summer. While finishing my master's degree, I fell in love. I met. Carol, and my life changed. It wasn't as if I had a game plan; it wasn't even on my mind. It just happened. "It's great. I've never been so open in my life, especially with a woman. I share everything, and it feels so good. We hold nothing back, and we seem to know what each other is thinking and feeling without even saying anything. It's magic. She's on my mind and in my heart all the time, and I can't wait to see her or at least call her. Thank God she lives in the same city. When we are together, time goes so quickly. A few hours seem like a few minutes. "I think others would say that I've been a good religious. I've done well in my ministry and have gotten along in my community. I am grate-ful to my fellow brothers and priests. So it is difficult to think about leav-ing the religious life, and neither is it an easy question for Carol. We love each other very much, but we also love the religious life. And it has been good to us. "When you asked me what is wrong with Carol, I was stumped. I know she is not perfect, but I don't see or feel anything wrong with her. And I feel so much better myself. I'll take your advice to wait until life settles, and not make a hasty decision that would change my entire life. True, I have known Carol for only four months, but it seems like I have known her all my life. "Why shouldn't I leave. True, it would be difficult to find a good job, and family life would certainly be different. But I could still do much of what I do now, and I feel that being married to Carol, I could even be closer to God. I will, with the help of you, my friends, and God discern my experience. But why would God give me such a beautiful gift and then expect me to reject it?" Indeed, romantic love is wonderful. Although this man has been a very rational, successful, and good community religious, he finds him-self in a serious dilemma: to leave or stay in religious life. His past has been good to him, and he to it, but his future seems to offer an even bet- The Power of Romantic Love / 199 ter life. Being immersed in the magic of love, he feels strongly drawn to this land of apparently unlimited possibilities. Both of these religious are enjoying and being inspired and chal-lenged by romantic love. Their love consumes them, embracing all their senses, mind, and spirit. Radically new horizons of meaning have opened up, pressuring them to restructure their lives. What should they do? In this article I will discuss the nature and dynamics of romantic love, its positive and negative possibilities and consequences in religious life, and ways to cope with oneself and others in service of healthy and holy growth. The Nature and Dynamics of Romantic Love Romantic love lures us into a world where there is nothing dull and mundane, a world that promises a new and better life. It offers us an ex-hilarating and inspiring unity of feeling intensely and of being strongly involved with the ideal. To experience transcendence passionately can be awe-fully seductive. Romantic love offers us an exhilarating and inspiring unity of feel-ing intensely and of being strongly involved with the ideal. As romantic lovers we yearn to be with each other, constantly think about and feel for each other, and so it seems touch each other even when we are physi, cally absent. Being without each other, we feel an intense void as well as presence in absence, and being with each other brings warmth, secu-rity, and fulfillment along with this sensuous enrapture. We initially ide-alize each other, feeling that we can do and share anything, and be our most perfect selves. We feel what love can be without its limits, and we want to give, to be,and to receive all that is possible. There is a special magic--a passionate affair with the ideal, an experience of heaven. What happens when we fall romantically in love? Initially we prob-ably feel as though we are walking on clouds, and that everything is pos-sible. We experience each other in terms of perfection, while our imper-fections are denied, minimized or rationalized. We may feel thatwe want to live together, to capture this love forever. This romantic time is one of the most exciting, pleasurable, and satisfying experiences. In the in-itial stages of friendship we may experience new possibilities in testing our limits, risking our vulnerability, feeling more alive than ever before, and willing to do almost anything. We may feel that everything is possi-ble and all right, and that life is radiantly alive. Our romantic friendship usually inspires us to become our best selves, and often new energy and courage provide the way. We can have romantic experiences in solitude. For instance, we may 200 / Review for Religious, March-April 1989 intensely feel the spiritual possibilities of contemplation. We may expe-rience a world of meaning that is transcendent and permanent. To ask ultimate questions and to be confronted with mysterious issues can be a peak experience. T° hear silent music can include the romantic. Romantic lovers--religious, single, or married--initially experience the unlimited potential of each other and concretely celebrate each other's perfection. However, paradise does not last; our romantic time is usually followed by one of imperfection. Sometimes suddenly, instead of experiencing each other as unlimited, we intensely experience our limi-tations. We find ourselves criticizing, obsessed with the other's imper-fections, or perhaps withdrawing from each other. Think of a sister and priest (or lay couple) who fall in love and get married. At first, they radiate with love and cannot stand to be without each other. But sooner than later they begin to test and question their love, and at times cannot stand to be with each other. Instead of diviniz-ing each other, they now demonize each other. For instance, minor hab-its may become irritating. One squeezes the tooth paste from the middle and the other from the ind. His snoring upsets her, while her hair curl-ers upset him. More seriously, she becomes frustrated and angry because he no longer shows his feelings as he apparently once did. He becomes confused and angry with constant complaining about his overworking and in general his unavailability. Whatever the focus of criticism, they focus on eacffother's limits, as contrasted with their past when they en-joyed their unlimitedness. Instead of heavenly, being with each other feels more hellish. Their magic has disappeared. Consider a novice who experiences religious life as a perfect way of living. Particularly in early formation when there is considerable personal affirmation, exploration, and direction, religious life offers extraordinary opportunities for individual and communal growth. However, "reentry problems" may be experienced when a new religious moves from the no-vitiate to living in an ordinary community. Community living seems rnuch~different than it was in the novitiate, or how it was ideally de-scribed. The inevitable imperfection of living with others may feel more like a burden than a joy. A danger is to identify religious life (or any life form or person) with its perfections and possibilities, or with its limits and obstacles to growth. Like any personal (and professional) life, there are more or less problems and opportunities. Positive and Negative Seduction As its etymology indicates, seduction conveys a negative meaning, namely, some thing, activity, or person that leads us astray or into The Power of Romantic Love / 201 trouble. And indeed, this can be the case. However, seduction can also have positive meaning in luring us to a better life. One reason romantic love is important is that it can be a prelude and invitation to a more committed love. Its strong attraction, gentle excite-ment, and erotic idealism make it easier, more enjoyable, and exciting for us to enter love. Since love, especially intimate love, is a risky ven-ture, romantic love makes the entry into love relatively easier, safer, and moi'e fun. It is a delicious taste of heaven. But like food, its satisfaction is temporary, and if we eat too much of that elixir, we can get sick. Ro-mantic love is an intense promise of a more permanent love that is both ideal and limited, erotic and transcendent, for the moment and forever, pleasurable and painful, divine and demonic--a love that embraces and dignifies all of us. If some of us knew the total picture of religious life, especially its hard times, before entering religious life, we may have had second or third thoughts about making a life commitment. Strictly from a rational-istic view, religious life may not have been as appealing. Fortunately our Holy Spirit called us with an alluring voice. Likewise, some of our friend-ships may never have occurred without romantic love's promise of an even .more balanced, wholly, and permanent love. To be sure, not all men and women entered religious life or friendship in a romantic aura. But many did, and few people live without any romanticism. Our spiritual journey with and toward God can also include romantic times. It is not unusual to go through a time--or times--of being roman-tically in love with God. We may suddenly feel that anything is possi-ble, that everything will turn out all right, that everything makes sense. We may bask in a divine light while minimizing, forgetting, or even re-pressing darkness. Although there is much truth in the vision, dark nights will come in service of a deeper and more realistic presence to God. Romantic love is not only a means toward an end. When immersed in romantic love, it is good to celebrate and proclaim our romantic stand in the world. Our experience is a witness to love and often promotes hap-piness for others. We can also build a precious source of memories that can help us gain perspective when going through difficult times. And in-deed as authentic lovers we can, though not constantly, congistently cele-brate times of romantic love. Helping Oneself and Others Think of two religious who care for each other and become close friends. Initially, they may idealize their relationship so that it is basi-cally exclusive. At first, they may wonder how they ever li.ved without 202 /Review for Religious, March-April 1989 each other. Especially if one or both persons have had restricted feelings of affection, now they can feel free to express themselves without re-straint. They feel liberated and more wholly alive. Their "particular" friendship, however, soon incorporates limits and obstacles. For in-stance, they discover that they can irritate and confuse each other, and :they can become hurt, angry, jealous, and perhaps guilty and ashamed. Instead of harboring resentment, or ending the friendship, both persons can step back--physically, psychosocially, and spiritually--and listen to themselves and each other, and hopefully return to renew and deepen their friendship so that it includes both their positive and negative dimen-sions. The challenging ideal is that both the light and dark sides of life be integrated, rather than absolutizing one of them. In fact, these experi-ences point to and affirm what life is--both divine and demonic, light and dark, life and death. When we experience a person as perfect, it is helpful to keep in mind that every person is imperfect. When there are disagreements, past agreements can be remembered as well as agreeing. to disagree. Our challenge is to see potential virtue where there is vice, strength where there is weakness, joy where there is sadness, love where there is hate, life where there is death. Courage and commitment are needed to move with and grow from life's paradoxical rhythm. Although romantic love is particularly enjoyable, the genuine desire to give one's self totally to another p~'esents challenging difficulties. Be-cause of the affective and ideal qualities of romantic love, we may nei-ther want nor perhaps experience any limits, and consequently may yearn to give unconditionally in every way pogsible. As religious we may yearn to celebrate our love in genital experiences, but we can say "no" in serv-ice of a "yes" to our love. What can superiors, friends, or other community members do when they observe religious in romantic love. Particularly when the exclusivity is causing little community I~arm, the wisest approach may be to do noth-ing, that is, to let romantic love run its course from the divine to the de-monic. However, when infatuation occurs or the dark, limited phase ap-pears, interveution may be called for. What you d6 depends on the kind and amount of power and responsibility your superior and others in re-sponsible roles have, as well as what you are willing and able to do, par-ticularly in being willing and able to invest the time and energy on con-fronting, processing, and following through with consequences. A superior may choose to confront a priest with his infatuous friend-ship. Confrontation means to state assertively and with concern what you The Power of Romantic Love / 203. observe in the other's behavior. It does not mean to interpret or analyze a person's behavior, nor does it include verbal oppression or emotional rape. We give feedback, and depending on our authority, we state natu-ral and logical consequences of one's behavior. For instance, if you con-tinue to date this woman as well as isolate yourself from the community, then counseling must be pursued or you will be transferred to another city, or you will be asked/told to leave. It is important to remember that although we impact on one another more or less positively and negatively, we cannot change anyone. We can give others opportunities, feedback, advice, consequences, and so forth, but only they can change themselves. We can only change and con-trol ourselves, and this is accomplished within varying degrees of lim-its. Authoritarian, codependent, and other well-intentioned and overly responsible people may find this fact difficult to accept. Ideally, a radical decision (for example, leaving religious life) or a life commitment (for example, vowed religious life) should not be made in either the so-called divine or demonic phases of love. When we are madly in love and experience no imperfections whatsoever, a life com-mitment is precarious. And we should be equally as prudent about mak-ing radical decisions, those that significantly irnpact on our lives, while in a demonic phase. When life is overwhelmingly dark, any light or re-lief can be tempting. It is better to wait until light emerges in our pre-sent situation--to wait until we make more sense of our struggle and be freer to choose. To paraphrase an old saying: the darkest and coldest time is right before dawn. Ideally, we should also not make a decision for life only out of ro-manticism or infatuation--when there are no limits or imperfections, but rather when we can be open to both the positive and negative factors of our past, present, and future situations. For instance, a brother who falls in love with a sister may be in the divinizing stage of romantic love. When asked what is wrong with his beloved, he may say nothing con-crete. Until he can point out experientially what is positive and negative about her and himself, it is probably better for him to wait before mak-ing such a radical decision such as leaving religious life to get married. A decision to leave, not because of romantic involvement, but be-cause nothing seems right and satisfying is quite tempting. When under enormous stress, we can be duped into feeling that a change in lifestyle will solve personal and interpersonal problems. It is more likely that we will take our problems with us and unconsciously seek a similar situ-ation. It is wiser to look at and deal with the dark side in ourselves and 204 / Review for Religious, March-April 1989 then make decisions. In short, authentic committed love is never perfect or divine, and nei-ther is it always imperfect or demonic. It is a combination of both. When on earth, life and love are matters of heaven and hell. If authentic love were perfect, commitment would not be necessary, there would be heaven, not earth. Because we are a unity of perfection and imperfec-tion, commitment is called for. Seed I .know interpretation has rules, But they should not freeze mystery. Why can't metaphors step between parables, And people and plots mingle? The sower, for instance, and the birds on the wayside who fed, the birds Who never fall unknown any more Than the bum thrown out of the bar And the starving, potbellied African baby. How wide is the wayside'? Past oceans And deserts and ranges and space to Ultimate doing of truth in love? And the rocks (poor Peter), are they always shallow? Have you seen those rock walls on roads Where, in spite of technology, a stubborn Wild shoot adorns the crazy face of An impossible height? or the sturdy Root that splits concrete apart and Frees the seed of a water main (prodigal spill)? Then There's the child who patiently pulls the Tufts from the cracks between bricks And scatters the clumps for the wind To sow next season's crop and chore. But the thistles--I don't know about them. I cringe at the vision of crowns And wonder if scarlet hands too Can drip the seeds of the realm That the sower went out to sow. Clarita Felhoelter, O.S.U. 3105 Lexington Road Louisville, Kentucky 4020'6 The Experience of Mid-Life Divorce and AlienationI David J. Hassel, S.J. Father David Hassel, S.J., is currently Research Professor of Philosophy at Loyola University of Chicago. The contents of this article will be part of his forthcoming book called The Ache of Alienation. His address is Loyola University; 6525 N. Sheridan Road; Chicago, Illinois 60626, Helen,s husband had confronted her a year ago after a very quiet dinner. "Helen," he had said, "there is something we have to talk about in the living room while the kids are out." They had sat there through a long silence before he said in a rush of words: "I want a divorce; I cannot go on living as we have been--distant, on parallel courses, never really meeting. The kids already suspect something and are old enough to han-dle this now. I've made a decision and no talking will change it. I don't want to hurt you anymore than I've already done. My lawyer has drawn up the legal papers; you'll be taken care of financially." Helen, her voice sounding like cracking ice, had said to him: "Joe, it's Anita, isn't it. That day down at the office I saw the glance you gave her--like the one you had once given me." "Yes," he said, "but we are not going into that." Helen could recall herself slowly getting up, slowly going up the stairs to her room, throwing herself on the bed and beginning to shudder with great dry heaves. No tears, only a terrible emp-tiness. When during the course of the following weeks, she had been alone with each of the children, she had received some additional shocks. Jim, the twenty-two year old just finishing college, put it simply: "Look, Mom, where have you been the past two years? Dad has been home less and less, and telling less and less what he has been doing. What have 205 206 / Review for Religious, March-April 1989 you been thinking?" The twins, Edith and Carol, high school seniors, were rather casual: "Morn, this is the way things go these days; you have to be ready for the worst and this is the worst, no doubt about it." Timothy, the twelve-year old, was inconsolable: "Dad's leaving us be-hind and it's unfair; I hate him now. But what can we do? I guess we just get used to it the way Jerry Kanz did when his Dad moved out." Helen, like many another to-be-divorced woman, had looked back over her life and wondered bitterly: Where did it start to go wrong? Where did I fail? Except for Timmy, the children seemed so casual about it all. Were they simply ungrateful, without any affection for her and Joe or were they covering up their anger and disappointment? Her telephone call to her mother had caused a flood of tears and a scalding anger-- more at Helen's stupidity than at Joe's two-timing. Her favorite brother had only said, "Well, the bastard finally owned upto it, did he?" Women friends had been properly shocked and consoling for some weeks; then the telephone calls became less frequent and one friend fi-nally said to her: "Honey, you have to stop lamenting and get your life together--without Joe; the sooner the better." All her doings had be-come meaningless: cooking meals, house-cleaning, shopping, bridge-clubbing, fulfilling the immediate needs of her children, attending Mass, telephoning friends, volunteering at the hospital, watching TV late into the night. Then the depressing guilt-fits began. Why were her children so un-feeling unless she had failed badly in their upbringing? Why had she not noticed sooner her husband's wandering and done something to woo him back? Had she become an insensitive creature herself? Were all her friend-ships superficial, revealing her own lack of depth? Was all her busyness merely a way to hide from herself who she really was: an empty shell of a woman? How could even God find time for her anymore? Actually her past seemed gutted, her present confused and her future dark with anxiety. The Woman Religious' Parallel Experience of "Divorce" Helen's experience, in one form or another, is that of thousands of wives and mothers as divorces continue to multiply across America. But is it so very different from the experience of not a few women religious who at mid-life review the past ten or twenty years of their own lives and wonder where their prayer-union with Christ has gone? The woman religious has been living the regular routines of a life consecrated to Christ: spending some time with him before breakfast and before heading to bed; taking care of his people in hospital, school, day- Mid-Life Divorce and Alienation care center, parish, and social work office; making some friends along the, way; watching TV and going for occasional walks; attending family gatherings, and centering her life in daily Eucharists. But in everything she feels hardly any feedback of gratitude or joy. If she is a social worker, she may have been called a meddler by the fam-ily whose children she has seen through hospitals, remedial reading courses, and angry bouts with their parents. The high school teacher of twenty-five years' experience may have been told by a lay colleague that she is twenty years behind the times in her teaching techniques and thirty years behind in her understanding of today's high schoolers. The sister-nurse may be overwhelmed with the ugly fact that her order's hospitals are now big business and that she had better play it safe with charity cases lest the hospital's budget-report show red ink. An almost exhausted sister may be informed by her superior that if she cannot take this job of religious coordinator at the disorganized St. Dismas parish, she had better find another job.to earn her way. Meaning seems to have drained out of her work. The once beautiful routines connected with teaching, nursing, administrating, catechizing, parish organizing, and social work-ing feel drab, spiritless, and unending. Meanwhile, because of her busy dedication to her order and its works, she has allowed her own brothers and sisters to fade out of her life as they moved to the distant coasts and as she wrote less and less ¯ often. Her parents have become elder.ly, somewhat absent-minded, eager for her presence but hardly able to carry on a relaxing conversation, and evoking melancholy in her at their decline and helplessness. Her sister-friends are as busy as she; glad to see her and to chat for a time, but al-ways on the move to another appointment: little time for long leisurely conversations, not many fun times." Because she is one of the few younger sisters in tier older community, she may have to assume greater responsibilities without any contemporary nearby in whom to confide and with whom to laugh at life's crazy antics. This is a new aloneness never felt in her initial formation. The simple joys of life seem few and far between during these periods of intensely felt alienation. She wonders: is all my past life for nothing? Have I lost the respect of my own family; those who first gave me life and hope? Have I missed out on community life? Or did it never exist and I pretended, that it did? Why has my ministry lost its zest? Have I begun to give up on it and, if so, will I ever find a second ministry and trust myself to its demands for a disciplined life of sacrifice? Do my superiors and fellow religious value me for myself or only for what I can do? Are we all just worker- Review for Religious, March-April 1989 bees in the religious hive? Where is the reality of my prayer life? God seems so distant, so uninterested in me, so unlike the intimate friend of my early religious life. Around me I seem to find so many happy fami-lies and fulfilled career women. Or am I just romanticizing their lives out of my own drabness? Then begin the guilt-fits. Mow did my life dissipate into merely con-stant duties, deadlines, hurried moments of leisure with friends, commu-nity tensions, and superficial moments with Christ? How could I have ¯ let it happen? Does all this mean that I never had a vocation to religious life or that religious life in my particular group is now ,antiquated and no longer viable in ou~ present culture? What is my future--if anything? Who but a recently divorced iaywoman could Fully appreciate these questions and feelings 0f the woman religious. The divorced man, hear-ing a man,religious venice similar questions and feelings, would surely resonate to these pains of the heart and mind. The Feel of Alienation from the Church Among the Divorced and the Alienated The suffering asked of divorced men and women and of alienated re-ligious is scandalous not only to them but to the people who love them dearly. The shock felt by the "divorced" is such that at times they do feel isolated from their family (blood or religious) and perhaps even from Christ's Church. Their great temptation is to cut loose from past ties; to be free from all the b~aggage of the past~ They ask themselves: "Why not just leave the family or the religious order and forget any service of the Church?" It seems so much easier simply to concentrate on a career and, if the occasion offers, to form a small manageable group of new friends. Later some of these "divorced" will leave the Church deliber-ately and others will slowly drift away complaining: "'I'm tiredof fight-ing Church bureaucracy and small-mindedness." There is no denying that, in the twentieth-century Church, the petty pride of place, the drift towards disorder, the trickery practiced in the name of the kingdom, the mechanical use of the sacraments, the eloquent extolling of poverty by comfortable clerics, andthe depreciation of women's ministry are all very much alive. In fact, Christ found them quite active in his first century Church: the women's announcement that they had met the risen Christ was called "women's gossip"; John and James used their mother to agitate for their occupying the seats of power next to Christ; Paul had to confront Peter about using different standards for Jewish and gentile converts; Jerusalem converts tried to saddle all gen-tile converts with the hea~y apparatus of Judaic Law; Ananias and Sa- Mid-Life Divorce and Alienation / 209 phira embezzled the common holdings of the Christian community; some of the apostles, notably Judas, deplored Mary Magdalen's ministry to Christ as frivolous. This is the kingdom, God's people, as Christ de-scribed them in the parables where the net is thrown into the sea to haul in both good and bad fish or where the wheat field is sown with weeds by the enemy. The problem is not that scandal is always in the Church but that faith-fulness is needed to live through the scandalous events amid feelings of alienation. Men and women religious suffering alienation from their com-munities need to share their lives with divorced laymen and laywomen if they are all to remain faithful to the Church and to their families, lay and religious. The pooling of experience, the companioning in common sorrows, the cooperative attempt to let the Church know their agony, the working together to build better futures for each other and for the Church, enable the divorced lay people to take heart and the alienated religious to remain loyal. One woman religious who has been offering a program for divorced women in her motherhouse found that the prayers of the retired sisters gave solace to the divorced women, while the faith of the divorced women amid severe mental suffering proved encouraging to elderly sis-ters, some of whoin felt~ intensely their seeming uselessness to the world and to their Church. One of the divorced women approached this woman religious directing the program and said to her: "Were you divorced be-fore you entered religious life? You seem to read us so well." Aloud the sister said: "No, I've never b~een married," but whispered inside her-self "But I have experienced divorce--from my congregation." Recently women and men religious groups have been welcoming some divorced into their communities and finding that these women and men bring in a dimension of life much needed by the religious order. The divorced woman or man has gone through devastating bereavement from all that once gave meaning t,o her or his life. Through this stripping, they have rediscovered their own personal worth, having learned how to dis-tinguish life-roles (mother or father, wife or husband, secretary or car-penter, daughter or son, sister or brother) from their own selves which play out these roles. The divorced woman, for example, no longer de-fines herself merely by what she can do, but by what she can be--first in herself and then for others. This, of course, affects her relationship with Christ. She is devoted to him, first of all, for his own sake; and she expects his affection to be directed towards her for herself and not sim-ply for her accomplishments. Neither God nor herself is made out to be 210 / Review for Religious~ March-April 1989 an heroic workaholic. Such a mature attitude can be benevolently conta-gious. On the other hand, women and men religious have something to of-fer divorced laywomen and laymen. After all many religious have had to deal with the mid-life transition.2 They have come to see that the "yes-terdays outnumber the tomorrows" and that they have to trim their ap-ostolic sails accordingly. Their eqergy is less, their talents are not quite as rich as they first thought, they must drop some projects totally, oth-ers partially, in order to do the central works. At this point envy of the younger, the more energetic, and the more talented can creep in. Amid these tensions, one becomes more aware of personal shortcomings, pre-tenses, sins of revenge .and cattiness, and suddenly vehement sex-drives. This discouraging aspect of life is often allied with a sense of being enmeshed in a great bureaucratic machine (at the job or in the congrega-tion o~in work with the local government) with which one must battle for personal values without destroying oneself or the organization. At this same t~me friendships take on greater importance and one must re-order one's commitments to people, work, and God. Here the man and woman religious~face bereavement from parents and older friends who die. They have moved away from pet projects, from. former work that gave much satisfaction, and from favorite attitudes or ideas that no longer fit the times.' Death, including their own,.seems at times to totally sur-round them. But at the same time, if the man and woman religious can ride all these waves with some gratitude and graciousness, the slower pace al-lows them to have time for more care of others. A warm Wisdom, the fruit of keeping a sense of humor amid much suffering, can pervade their every day. A new stability may take shape at the center of their being. In their lasting friendships, they may rediscover their faithful God. And all this they can offer to divorced laymen and laywomen out of the very alienations which they had felt towards their own congregations. How bountiful the divorced lay people and alienated religious can be towards each other and thus towards the people of God--even though at times they feel so utterly empty and find themselves walking laboriously as though in desert sands. This desert experience has been chronicled and deserves our attention since out of it can come a conversion which will reveal a new self, a new God, and a new world. The Desert Experience of Transition Before Conversion Two women have given us brutally honest yet sensitive accounts of Mid-Life Divorce and Alienation their transitions from one congregation to another. The great change seemed to them like a lay person's divorce and remarriage with its awk-wardness, periods of loneliness, and rediscovery of self and life.3 Sr. Marie Conn found the loneliness of transfer to a new religious commu-nityunique in its roots and in its intensity. For she left behind a vibrantly rich past with only a vague future in mind. Besides, those with whom she would live her present and future had little idea of her past and she, of their past. When one starts all over with new and slowly developing friendships, with fresh routines, and with no one able to enter into one's more precious memories, one is thrust into a new relati