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The COVID-19 pandemic pushed some households in India into difficult and often unsustainable coping strategies, forcing trade-offs between immediate survival and long-term stability, according to new research by Lancaster University and the Indian Institute of Technology, Kanpur (IITK).

The study documents how vulnerable families in India coped with food insecurity during the pandemic. It highlights how interviewed families sometimes went without food, medicine, and other essentials to cope with the fallout of the pandemic.

The research draws particular attention to how circular/recent migrant workers were most at risk among those interviewed, with limited alternative support systems available. The study examines how vulnerable households that depended on daily wages coped when COVID-19 disrupted their livelihoods.

Findings underscore the importance of local social networks and government support in coping with crisis.

COVID-19 Forced Indian Families Into Impossible Choices

The study highlights how additional government entitlements, particularly through the Public Distribution System (PDS), proved to be a critical lifeline for households with limited access to alternate income sources.

The research team spoke with 86 families between December 2022 to March 2023. Families spoke of 'impossible choices' they faced during the pandemic. These ranged from limiting food diversity to taking loans, delaying non-critical medical expenses and temporarily withdrawing children from school to facilitate everyday food expenses.

The new study, 'Diverse coping strategies for food security: A qualitative study of economically precarious households in India in the context of COVID-19' is published today in PLOS One.

The research team carried out 343 interviews in Uttar Pradesh and Goa. From these interviews, a subset of households experiencing severe and continued COVID-related adversities were chosen to understand the impact of the pandemic on different members of the household including men, women and children aged seven years and older.

The study found that migration status and existing structural inequalities, such as poverty, critically shaped families' resilience.

Coping capacity during COVID-19 depended less on income loss than on access to government support and social networks, both of which were rarely available for migrant workers, especially the more recent migrants.

Stressing the inter-dependence of rural and urban economies, the study discusses how COVID-19 triggered a wave of reverse migration (migrants returning to their native places) to rural areas. This created intense pressure on already stressed rural economies and worsening inequalities.

As employment became irregular, the first strategies adopted by the interviewed households were to 'smooth consumption'. This meant shifting to less preferred foods, reducing expensive items, like dairy and meat, and limiting portion size with potatoes and cereals becoming primary fallback options. This, says the research, can raise serious concerns about the nutritional impacts of the pandemic.

Women, who often enacted 'maternal buffering', were especially likely to absorb impacts of food scarcity themselves by cutting down on their own meals to ensure children and men had 'enough'. Families sharing homes began cooking jointly to conserve cooking fuel to ensure children did not go hungry. Some children were sent to live with grandparents/relatives when managing finances became difficult.

As lockdowns further compromised livelihoods, more severe strategies such as borrowing money for food, skipping meals, selling assets, and reverse migration to rural areas were adopted. Some urban migrants within the study settings assumed they would have easier access to food in their rural homes due to agricultural stocks and established social networks. However, for those with more limited resources, reverse migration placed additional pressure on single earning members, making it more difficult to provide for larger households.

Local social networks embedded in hierarchies of caste and class also proved essential when livelihood opportunities were scarce. During the COVID-19 pandemic, the Indian Government expanded support under the Public Distribution System (PDS) - a key food security scheme providing subsidized cereals and other staples to eligible households.

Cereal allocations were doubled, and additional items such as oil and chickpeas were introduced to promote dietary diversity. Complementary schemes were also launched to address heightened food insecurity amid livelihood disruptions.

These allocations, says the research, were crucial for maintaining access to food among vulnerable families in this period of crisis, highlighting the value of government support. However, as PDS entitlements are typically tied to place of registration, many migrant workers were unable to access rations at their destination, reflecting longstanding challenges around portability.

Households without valid local PDS registrations, particularly recent migrants, remained highly vulnerable during disruptions. One household of seasonal migrant brick kiln workers reported that their registration was linked to their home state, rendering them ineligible for local allocations at their place of work. In the absence of formal support, they relied on daily meals provided by a local hospital in partnership with a non-governmental organization.

According to the research:

"The study underscores the importance of understanding context-specific household strategies to inform policies that aim to build long-term resilience. Conflicts, disease outbreaks and global inter-dependencies that disrupt global supply chains are becoming increasingly common. In this context, it is imperative for governments, communities and households to be better prepared for crisis events like COVID-19."

Lead author Dr Charumita Vasudev said:

"In an increasingly uncertain world, it is important to understand that household responses to global threats are not just about the crisis itself, but the existing structural inequalities and vulnerabilities that people are already coping with. Public policies like the PDS form the backbone of household's resilience strategies. They, thus need to account for contextual vulnerabilities to ensure that short-term coping during crisis does not risk deepening of inequalities in the longer term."

Bundibugyo virus is a zoonotic Orthoebolavirus species, with fruit bats suspected as the natural reservoir, that spreads person-to-person through contact with bodily fluids and is amplified in healthcare settings and during unsafe burials. Its two-to-21-day incubation period and non-specific early symptoms make it hard to distinguish from illnesses like malaria without lab confirmation, and there are currently no approved vaccines or specific treatments, so control depends on rapid detection, isolation, contact tracing, and community engagement.

Risk to the U.S.

On May 18, CDC and DHS announced enhanced travel screening, entry restrictions, and public health measures to prevent Ebola disease from entering the United States amid outbreaks in East and Central Africa. To date, no Ebola cases associated with this outbreak have been reported in the United States, and the risk to the general public remains low.

Symptoms of Ebola Image

Ebola Outbreak Updates - 2026

8th June, 2026 - Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo and Uganda

The WHO Disease Outbreak News page reports on a rapidly escalating outbreak of Bundibugyo virus disease, a severe form of Ebola, spreading across the Democratic Republic of the Congo and Uganda. As of 6 June 2026, the two countries had reported a combined 534 confirmed cases and 93 deaths, giving a case fatality rate of around 17%, with at least 17 people recovered. Case numbers have climbed sharply since the previous update on 29 May, driven partly by expanded testing that cleared a backlog of previously collected samples.

The bulk of the outbreak is in the DRC, which accounts for 515 confirmed cases and 91 deaths across 25 health zones in Ituri, North Kivu, and South Kivu provinces. Ituri Province is the epicenter, holding the vast majority of cases, though North Kivu shows a far higher fatality rate. Uganda has reported 19 confirmed cases and several deaths, all epidemiologically linked to travelers from the DRC, with no documented community transmission. One notable case involved a Congolese national who traveled through Uganda to the United Arab Emirates and back, prompting cross-border contact tracing, though no secondary spread was identified in the UAE. Security incidents affecting health facilities in the DRC are complicating surveillance and response efforts.

On the response side, authorities in both countries, working with WHO and partners, are coordinating field teams, strengthening surveillance and laboratory capacity, and setting up treatment centers. On 5 June, Africa CDC and WHO launched a joint continental preparedness and response plan seeking US$518 million. WHO assesses the risk as very high in the DRC, high in Uganda and neighboring border countries, and low for the rest of Africa and globally, while advising against any travel or trade restrictions on the affected countries.

Full report from WHO: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON606

29th May, 2026 - Ebola Disease Caused by Bundibugyo Virus, Democratic Republic of the Congo and Uganda

The BVD outbreak in the Democratic Republic of the Congo and Uganda continued to evolve rapidly, with rising case numbers, wider geographic spread, and ongoing cross-border transmission. As of 27 May, the DRC had reported 906 suspected cases and 223 deaths among suspected cases. As of 29 May, a total of 134 confirmed cases - including nine in Uganda - and 18 deaths among confirmed cases had been reported across both countries, giving a case fatality rate of about 14 percent. This represented an additional 49 confirmed cases, eight confirmed deaths, 160 suspected cases, and 47 suspected deaths since the 21 May update. Separately, a medical doctor from the United States, who had been exposed while caring for patients in the DRC, tested positive on 17 May and was transported to Germany for treatment and care.

In the DRC, transmission remained concentrated in Ituri Province, which accounted for 88 percent of confirmed cases, along with North Kivu and South Kivu provinces. The highest case numbers in Ituri were reported from the Bunia, Rwampara, Mongbwalu, and Nyankunde Health Zones, and 16 confirmed cases had been reported among health and care workers. Security incidents against health facilities and community resistance emerged as major operational challenges, with recent incidents in the Mongbwalu and Rwampara Health Zones creating additional risks of undetected transmission. In Uganda, the nine confirmed cases were reported in Kampala and Wakiso, with exposure risks linked to health-care settings and cross-border movement.

On 22 May 2026, WHO assessed the risk of the outbreak as very high at the national level in the DRC, high at the regional level, and low at the global level. WHO Director-General Dr Tedros Adhanom Ghebreyesus traveled to the DRC on 28 May to support the response. WHO advised against any restriction of travel to, or trade with, the DRC or Uganda based on the information available. National authorities, working with WHO and partners, continued to deploy rapid response teams, deliver medical supplies, strengthen surveillance and laboratory confirmation, reinforce infection prevention and control, establish safe and optimized treatment centers, and prioritize community engagement.

Full report from WHO: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON605

21st May, 2026 - Ebola Disease Caused by Bundibugyo Virus, Democratic Republic of the Congo

Following the declarations of 15 May 2026, when the DRC Ministry of Public Health, Hygiene and Social Welfare and the Uganda Ministry of Health declared an Ebola Disease outbreak after BVD was confirmed in both countries, and the 17 May 2026 PHEIC determination by the WHO Director-General, the response continued to expand. On 19 May 2026, the Director-General convened the first meeting of the IHR Emergency Committee, and temporary recommendations were issued to States Parties.

As of 21 May, the DRC had reported 746 suspected cases and 176 deaths among those suspected cases. Across both countries, 85 confirmed cases - including two in Uganda - and 10 deaths among confirmed cases, one of them in Uganda, had been reported. In the DRC, transmission was concentrated in Ituri, North Kivu, and South Kivu provinces, with challenges in contact follow-up, insecure conditions, and inadequate isolation and referral systems complicating response efforts. Uganda reported two imported cases with no confirmed local transmission. An American national who had been working in the DRC was also confirmed positive and transferred to Germany for care.

National authorities, in collaboration with WHO and partners, continued to implement response measures including the deployment of rapid response teams, delivery of medical supplies, strengthened surveillance, laboratory confirmation, infection prevention and control assessments, the set-up of safe and optimized treatment centers, and community engagement.

Full report from WHO: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON603

16th May, 2026 - Ebola Disease Caused by Bundibugyo Virus, Democratic Republic of the Congo and Uganda

On 5 May 2026, the World Health Organization (WHO) was alerted to a high-mortality outbreak of an unknown illness in the Mongbwalu Health Zone, Ituri Province, in the Democratic Republic of the Congo (DRC), including deaths among health workers. On 14 May 2026, the Institut national de recherche biomédicale (INRB) in Kinshasa analyzed 13 blood samples drawn from the Rwampara Health Zone in Ituri Province. The following day, 15 May, laboratory analysis confirmed Bundibugyo virus disease (BVD), a species of Ebola, in eight of those samples.

Case fatality rates in the past two BVD outbreaks have ranged from 30 percent to 50 percent. Unlike Ebola virus disease, there is no licensed vaccine or specific therapeutic against Bundibugyo virus, although early supportive care can be lifesaving. On 15 May 2026, the Ministry of Public Health, Hygiene and Social Welfare in the DRC officially declared the country's 17th Ebola Disease outbreak. At the same time, the Uganda Ministry of Health confirmed an outbreak of BVD after identifying one imported case from the DRC - a Congolese man who died in the capital city of Kampala.

On 17 May 2026, after consulting the States Parties where the event was known to be occurring, the WHO Director-General determined that the Ebola disease caused by Bundibugyo virus in the DRC and Uganda constituted a public health emergency of international concern (PHEIC), as defined under the International Health Regulations (IHR). Response measures at this stage included the deployment of rapid response teams, delivery of medical supplies, strengthened surveillance, laboratory confirmation, infection prevention and control assessments, the establishment of safe treatment centers, and community engagement. WHO supported the coordination of the response, case management, and cross-border preparedness, and issued advice to countries.

Full report from WHO: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON602

Ketone bodies are among the most misunderstood molecules in human metabolism. For decades they were viewed mainly as a warning sign - something to watch for in a diabetic emergency or a sample of starvation chemistry. More recent research paints a richer picture. Ketone bodies are an elegant backup fuel system, a set of signaling molecules, and in several disabling conditions, a genuine therapeutic tool. This paper explains what ketone bodies are, how the liver produces them, why the brain depends on them during food scarcity, and how they connect to a range of disabilities, from drug resistant epilepsy to rare inherited metabolic disorders.

The Three Ketone Bodies

Despite the plural name, there are only three ketone bodies, and one of them is not chemically a ketone at all:

• Acetoacetate - the first ketone body produced and the central molecule from which the other two are derived.
• Beta-hydroxybutyrate, sometimes written as 3-hydroxybutyrate - the most abundant ketone body in the blood. In strict chemistry terms it is a hydroxy acid rather than a true ketone, but it is grouped with the others because of how the body handles it.
• Acetone - formed when acetoacetate breaks down on its own. The body cannot use acetone for energy, so it is exhaled through the lungs. This is the source of the faint, sweet, nail polish like smell sometimes noticed on the breath of people in deep ketosis or diabetic crisis.

Beta-hydroxybutyrate and acetoacetate are water soluble, which is important. Fats themselves do not dissolve in blood and cannot easily cross into the brain, but ketone bodies travel freely in the bloodstream and pass into the brain through dedicated transport proteins [Puchalska and Crawford, 2017].

How the Body Makes Ketone Bodies

The production of ketone bodies is called ketogenesis, and it happens almost entirely inside liver cells. The process switches on when glucose is in short supply - during fasting, prolonged exercise, very low carbohydrate eating, or in poorly controlled diabetes.

When blood sugar and insulin fall, the body begins releasing stored fat. Fatty acids are shuttled into the liver and broken down through a process called beta-oxidation, which generates large amounts of a molecule called acetyl-CoA. Normally acetyl-CoA feeds into the cell's energy producing cycle, but when fat is being burned faster than that cycle can handle, the surplus is redirected into making ketone bodies instead. A liver enzyme often abbreviated as HMG-CoA synthase governs this step and acts as the gatekeeper of ketone production.

There is an interesting quirk here. The liver manufactures ketone bodies but cannot use them, because it lacks a specific enzyme needed to convert them back into usable energy. In effect, the liver behaves like a factory that ships its entire product to other organs and keeps none for itself [Cahill, 2006].

Ketone Bodies as an Alternative Fuel

Most tissues prefer glucose, but the brain has a particular dependence on it and cannot burn fatty acids directly. This poses a survival problem during a long fast, when glucose runs low. Ketone bodies solve it. They cross the blood-brain barrier and supply energy that fat alone never could.

Classic metabolic studies showed that during prolonged starvation the human brain can draw the majority of its energy - well over half - from ketone bodies rather than glucose [Owen et al., 1967]. The heart, kidneys, and resting muscle also use them readily. This adaptation is one reason humans can survive weeks without food: ketone bodies spare the limited glucose supply for the few tissues that truly require it.

Ketosis Versus Ketoacidosis

The two terms sound alike but describe very different states, and confusing them causes a great deal of needless worry.

Nutritional ketosis

This is a controlled, healthy state in which ketone levels rise modestly, typically somewhere in the range of half a millimole to three millimoles per litre of blood. It occurs naturally during fasting or a carbohydrate restricted diet. Blood acidity remains normal because the body regulates the process carefully.

Diabetic ketoacidosis

This is a medical emergency seen mainly in people with type 1 diabetes and occasionally type 2. Without enough insulin, the body cannot signal that fuel is available, so it produces ketone bodies relentlessly. Levels climb far higher than in nutritional ketosis, the blood turns dangerously acidic, and the result can be life threatening without prompt treatment. The key difference is control: nutritional ketosis is regulated, while ketoacidosis is the system running away unchecked.

Ketone Bodies and Disability

For people living with certain disabilities and chronic conditions, ketone bodies are far more than a textbook curiosity. In some cases they are the basis of established treatment, and in others a disorder in how the body makes or uses them is the cause of disability itself.

Drug resistant epilepsy and the ketogenic diet

The most well documented disability link is epilepsy. The ketogenic diet - very high in fat, very low in carbohydrate, designed to keep the body producing ketone bodies - was developed in the 1920s specifically to control seizures, and the name itself dates to that era [Wheless, 2008]. It fell out of fashion once anti-seizure medications arrived, then returned to mainstream use when doctors recognized that a meaningful share of patients do not respond to drugs.

A landmark randomized controlled trial found that children with hard to treat epilepsy had significantly fewer seizures on a ketogenic diet than children receiving usual care, with some becoming seizure free [Neal et al., 2008]. The diet is now a recognized option for drug resistant epilepsy, particularly in children, and is used in conditions such as Dravet syndrome and Lennox-Gastaut syndrome. Researchers continue to debate exactly how ketone bodies calm an overactive brain, with theories pointing to steadier energy supply, changes in brain chemistry, and reduced inflammation.

Glucose transporter type 1 deficiency syndrome

In this rare genetic disorder, the protein that carries glucose into the brain does not work properly. The brain is effectively starved of its usual fuel, leading to seizures, movement problems, and developmental delay. Because ketone bodies enter the brain through a completely different doorway, a ketogenic diet can bypass the faulty glucose transport and feed the brain directly. For this condition the diet is considered a primary treatment rather than a last resort [Veech, 2004].

Inherited disorders of ketone metabolism

Some children are born unable to make or break down ketone bodies correctly. Defects in the enzymes responsible for ketogenesis, or in those that convert ketone bodies back into energy, can trigger dangerous metabolic crises during illness or fasting. Repeated or severe episodes may cause lasting neurological injury and intellectual disability if not managed. These conditions are usually identified in infancy and managed by avoiding long gaps without food and treating illness aggressively.

Fatty acid oxidation disorders

This group deserves special mention because it highlights an important caution. People with disorders that block the breakdown of fat - such as medium chain acyl-CoA dehydrogenase deficiency - cannot generate ketone bodies during fasting. Instead of switching to ketones when glucose runs low, their blood sugar simply falls, which can cause seizures, coma, and brain damage. For these individuals a ketogenic diet is not just unhelpful but actively dangerous, illustrating that ketone based therapy must always be matched to the specific diagnosis.

Neurological and neurodegenerative conditions

A growing body of research is examining whether ketone bodies might help in conditions where brain energy use is impaired, including Alzheimer's disease, Parkinson's disease, and traumatic brain injury. The reasoning is that aging or injured brain cells often struggle to use glucose efficiently, and ketone bodies may offer a fuel they can still process. Beyond fuel, beta-hydroxybutyrate appears to act as a signaling molecule that can dampen inflammation and reduce cellular stress [Puchalska and Crawford, 2017]. This work is promising but still developing, and ketone based approaches are not yet established treatments for these conditions. People should be cautious of overstated claims and discuss any dietary change with their medical team.

Measuring Ketone Bodies

There are three practical ways to measure ketone bodies, each reflecting a different molecule. Blood meters measure beta-hydroxybutyrate and give the most accurate, real time reading. Urine strips detect acetoacetate and are cheaper but less reliable, especially once the body adapts to ketosis. Breath analysers estimate acetone. For anyone managing diabetes, monitoring matters because a rapid rise in blood ketones can be an early warning of developing ketoacidosis.

Conclusion

Ketone bodies began their scientific career as a danger signal and have since been recognized as one of the body's most resourceful survival tools. They keep the brain running when food is scarce, and in carefully chosen conditions they form the basis of real medical therapy. They are not a cure all, and the same molecules that protect one patient can endanger another with a different diagnosis. Understanding what ketone bodies are, and respecting the difference between controlled ketosis and dangerous ketoacidosis, is the foundation for using them safely.

References:

Cahill, G. F. (2006). Fuel metabolism in starvation. Annual Review of Nutrition, 26, 1-22.

Neal, E. G., Chaffe, H., Schwartz, R. H., Lawson, M. S., Edwards, N., Fitzsimmons, G., Whitney, A., and Cross, J. H. (2008). The ketogenic diet for the treatment of childhood epilepsy: A randomized controlled trial. The Lancet Neurology, 7(6), 500-506.

Owen, O. E., Morgan, A. P., Kemp, H. G., Sullivan, J. M., Herrera, M. G., and Cahill, G. F. (1967). Brain metabolism during fasting. The Journal of Clinical Investigation, 46(10), 1589-1595.

Puchalska, P., and Crawford, P. A. (2017). Multi-dimensional roles of ketone bodies in fuel metabolism, signaling, and therapeutics. Cell Metabolism, 25(2), 262-284.

Veech, R. L. (2004). The therapeutic implications of ketone bodies. Prostaglandins, Leukotrienes and Essential Fatty Acids, 70(3), 309-319.

Wheless, J. W. (2008). History of the ketogenic diet. Epilepsia, 49(Suppl. 8), 3-5.

The story goes: archaeologists discover the ancient bones of a disabled person who would have needed the people around them to take care of them. Modern humans see this as proof of that group's capacity for human empathy and compassion. They focus on what it means for these humans or pre-humans to have to care for someone who cannot add to the resources of their community and would not survive without help. But why do we always focus on the stories of the caretakers rather than the experience of the disabled person?

When physically disabled people's remains are found in archaeological digs, this is often presented as a way to show that humans have always cared for others. However, these stories are colored by our modern beliefs about the worth of people. People are only worthy if they can produce something every hour of the day. People are seen as less worthy when they are unable to work at all, as much, or in the ways that society expects them to work. We put our current system of value onto people of the past.

When physically disabled people's remains are found, we assume that they could not produce value; therefore, only other people's compassion would lead to their survival. This is a problematic way to view disabled people. First, it focuses on the realities of people living with disabled people, not on the disabled person themselves. Second, it ties a person's worth exclusively to what they can produce, rather than recognizing that everyone has worth. The third problem is that it acts as if only these physically disabled people in the past required compassion, and not that every community is full of people with different limitations and skills, who work together to raise up the entire community, regardless of what each individual can do. We see disabled people as a problem, and focus on what resources they take away from a community, rather than recognizing them as part of the community.

This is not a problem that is only seen in our discussions of early humans. This is also seen in how we discuss disability today. Many parents use social media to tell stories about their disabled children. They focus on how difficult it is to be a parent of a disabled child and ignore the stories of the children. There is more focus on how these disabilities disrupt other people's lives than on the life of the disabled person at the center of the story.

Even though anyone can be disabled, people often view the disabled as uncomfortable to see or interact with, taking advantage of the system or other people, lazy, or annoying. Stories about disabled people are often about the people burdened with their care, rather than the experiences of that person. When there are stories that focus on disabled people, they are often about people who overcome their disabilities. People don't want to hear stories about disabled people who are unable to achieve their goals because they are disabled. People don't want to hear about how disabled people can be an important part of their community, even when they are unable to produce what our system considers valuable.

These disability narratives focus on non-disabled people, othering those with disabilities. They say that disabled people have no worth because of their disability, that they can add nothing to their community, and that they only exist to help other people be more human through compassion. However, disabled people are never seen through that lens of humanity. Many times, we focus on these stories as proof of the long history of human compassion, while only thinking about the experiences of the people who take care of someone who is disabled. When you look at disabled people as proof of ancient compassion, you ignore their lives.

Rather than dehumanizing disabled people and seeing them as something requiring empathy and compassion, we should be able to present them as people who also lived and had worth despite what they could and could not do. While their disabilities may have been a major part of their lives, we need to stop looking at them simply as living obstacles that affect the people around them. Recognizing the humanity of disabled people means thinking about their experiences, not just those who lived beside them. It is recognizing that everyone has worth, regardless of whether or not they match our cultural ideas of success.

The word comes from the Latin efficientia, rooted in efficere - ex (out) and facere (to make). In its earliest philosophical sense, it referred to causation itself. An "efficient cause," in Aristotelian thought, was not the fastest or cheapest actor in a system. It was simply the one that made something happen. The potter shaping clay was an efficient cause not because she minimized effort, but because she turned possibility into form.

Efficiency, in that older world, was not about trimming excess but about the mystery of making.

That meaning didn't survive the modern world intact.

By the late 19th and early 20th centuries, the Efficiency Movement in the United States and Europe reframed the term entirely. What had once described the act of creation itself was gradually narrowed into something more mechanical: the reduction of waste and the optimization of output.

It is a subtle shift in language, but not in consequence. Efficiency stops being about making and becomes about minimizing. It no longer asks what comes into being, only how quickly and cheaply it can be produced.

Frederick Winslow Taylor gave this new definition its most influential form. In The Principles of Scientific Management (1911), he argued that work could be broken down, measured, and reconstructed into a single optimal sequence. Every task, he believed, contained a "one best way" to perform it, discoverable through observation and analysis.

Work becomes legible only when it is fragmented.

Time-and-motion studies reduced labor to sequences of measurable gestures. Management became planning and calculation. Labor became execution. The worker's body shifted from a site of meaning and skill to a unit of output.

The Gilbreths extended this logic by filming workers' movements, treating human gesture as analyzable data. Henry Gantt translated production into charts that mapped time against output. Henry Ford's assembly line turned industrial production into synchronized motion, aligning human bodies with machine rhythm and dramatically increasing output while narrowing the experience of work itself.

What emerged was not only a more productive industrial system. It was a new assumption about reality: that what matters most is what can be measured.

Over time, efficiency moved beyond factories entirely. It entered universities, government agencies, and corporate governance. Business schools expanded to train managers in optimization. Industrial engineering became a profession. Consulting firms emerged to locate inefficiency anywhere it might hide.

Efficiency stopped being a tool and became a way of seeing.

In the mid-20th century, that way of seeing entered one of the most powerful institutions in modern life: the United States Department of Defense.

Robert McNamara, former president of Ford Motor Company, became Secretary of Defense in 1961. He brought with him a belief that systems analysis could rationalize even the most complex human conflicts. Surrounded by economists and statisticians known as the "Whiz Kids," McNamara tried to render war legible through data.

Under his leadership, the Pentagon adopted Planning, Programming, Budgeting, and Execution systems. Military strategy increasingly depended on cost-benefit modeling. Decisions that once involved judgment and experience were reframed as problems of optimization.

But war does not behave like a production line.

During Vietnam, the reliance on quantifiable metrics produced a narrowing of attention. Without clear territorial markers of success, outcomes were measured through what could be counted: enemy casualties, sorties flown, tonnage of bombs dropped.

Over time, this produced what came to be known as the McNamara fallacy: the belief that what can be measured is what matters most. It is not simply a technical error. It is a shift in perception itself, where measurement begins to replace judgment.

Efficiency, in this form, no longer helps us understand reality. It begins to define what reality is allowed to be.

Nowhere is this tension more visible than in disability advocacy and the nonprofit sector.

Here, efficiency arrives as structure: grant applications, reporting requirements, and evaluation frameworks that translate human experience into numerical outputs. Cost per service. Number of clients served. Percentage of funds directed to programming versus administration.

What resists measurement becomes harder to sustain.

But disability advocacy is precisely the kind of work that does not compress cleanly into metrics. Accessibility is not a single intervention but an ongoing negotiation with environments, institutions, and assumptions. Legal advocacy can take years. Independent living support unfolds in uneven, deeply personal trajectories that rarely align with fiscal reporting cycles.

This creates a distortion. Work that is easiest to measure often becomes easiest to fund. Work that is hardest to measure, even when more transformative, becomes structurally fragile.

As organizations adapt, leadership often shifts toward those fluent in administrative systems: grant writing, compliance, and data reporting. These skills are necessary for survival, but they can also move authority away from lived experience.

The disability rights principle often summarized as "Nothing About Us Without Us" becomes harder to sustain when legitimacy is defined through paperwork rather than participation.

In conversations with disability rights advocates in upstate New York, this tension becomes concrete. There is a recurring concern that systems designed to provide support can, over time, begin to structure dependency. Agencies become gateways to essential resources, but also gatekeepers of access. Housing, healthcare, and assistance are routed through layers of eligibility and approval that must be continuously navigated.

Over time, navigating the system itself becomes its own form of labor.

In that arrangement, the identity of "client" can harden into something more permanent than intended. What begins as support risks becoming a long-term administrative position within a system that defines both need and response.

What many advocates are pushing toward is not only better services, but a shift in authorship. The question is not just how efficiently support is delivered, but who gets to design the systems that define what support even is. Leadership becomes central. Who sets the terms. Who builds the pathways. Who decides what counts as success.

From this perspective, efficiency is not only about optimization. It is about power. It shapes who designs systems and who must move through them.

At the same time, efficiency is not only constraint.

Data has also become a tool of advocacy. Statistical documentation of employment disparities, accessibility gaps, and healthcare inequities allows disability organizations to make injustice visible at scale. What is difficult to hold in individual experience can sometimes become undeniable in aggregate form.

There is also a growing movement toward trust-based philanthropy, which reduces rigid outcome tracking and gives organizations more autonomy over how they define success. These approaches do not abandon accountability, but they loosen the grip of constant quantification.

Across this long arc - from Aristotle's potter to Taylor's stopwatch, from Ford's assembly line to McNamara's systems analysis, from grant reporting to disability advocacy frameworks - a single tension keeps returning.

What happens when the systems designed to measure reality begin to define it?

Efficiency has created enormous capacity. It has shaped modern industry, governance, and institutional life. But in moving from efficientia, the act of bringing something into being, it has also narrowed the range of what counts as meaningful making.

Efficiency meets real human needs: for clarity, for standards, for speed, for accomplishment, for frugality, for control. When those needs are met, systems feel coherent and people often feel effective within them. But when efficiency becomes the dominant logic, other needs are pushed aside: choice, exploration, creativity, expression, patience. When those needs are neglected, the result is not abstract failure but lived experience. People feel stifled, unheard, and compressed by systems that no longer register the fullness of what they are trying to express.

The question is not whether efficiency is useful. The question is whether, in centering efficiency so completely, we still recognize what it means to make anything at all.

About the Author

George Cassidy Payne is a freelance journalist, poet, and educator based in Rochester, New York. He writes on topics ranging from social justice and disability advocacy to art, culture, and nature. George has published in both local and national outlets, and he brings a keen eye for storytelling that illuminates lived experience. In addition to his work as a journalist, he serves as a 988 Suicide Prevention Counselor and engages with communities through nonprofit leadership, teaching, and public speaking.

The Record-Breaking Canvas

Over an intense 48-hour period at Potters Fields Park, celebrated muralist Luke Embden and 23-year-old autistic artist Alex the Doodler (@alexthedoodler) worked tirelessly to create a massive 5-meter by 3-meter live portrait installation.

The duo successfully captured the likenesses of 800 participants, officially securing the world record for the Most participants featured on a live portrait installation in 48 hours.94 Members of the public had their Polaroid photos taken, which the artists then vividly illustrated onto the mural. Each of the 800 faces on the canvas represents 1,000 of the estimated 800,000 people with learning disabilities in the UK who live with sight problems.

From Total Blur to Clarity: Terence's Story

At the absolute center of this record-breaking artwork is the face of Terence, a 20-year-old Londoner whose life was completely transformed by SeeAbility's Special Schools Eye Care team.

Terence, who is autistic and non-verbal, had gone his entire life without ever having a sight test. Because he could not communicate his struggle, no one knew that he was living with a severe -19 eye vision prescription. Without glasses, Terence's world was a complete blur; he was unable to see further than just two inches (five centimeters) in front of his face.

"When SeeAbility fitted Terence's glasses I was so happy, I was in tears of joy! This is life-changing for Terence. With his glasses he can see the world clearly. He is smiling all the time!" Chantal Panzu, Terence's mother

Shining a Light on Hidden Sight Loss

Children with learning disabilities are 28 times more likely to suffer from serious sight complications than other children, yet tens of thousands pass through the special education system without basic eye care.

The Tower Bridge event was organized not just to break records, but to raise urgent funds and awareness for SeeAbility's campaign to ensure specialize d sight tests and glasses are readily available in special schools. Thanks to the collaboration of Luke Embden, Alex the Doodler, and hundreds of everyday Londoners, Terence and the thousands of children like him are finally being seen.

Life is not easy for people with disabilities in New York City. However, among other challenges, such as expensive mortgages ⁽¹⁾ and unaffordable housing,⁽²⁾ people with disabilities in New York City face a problem that directly threatens their lives: food insecurity. In New York City, 19% of people with disabilities experience food insecurity at any given year. By comparison, only 6% of non-disabled New Yorkers experience this problem. Among all individual challenges (food, housing, bills, financial and medical), this is the largest gap between people with disabilities and non-disabled New Yorkers.

Food problems for people with disabilities in New York City are caused by several factors. For example, approximately 400,000 people with disabilities have difficulty shopping independently. These people are classified as "with an independent living difficulty." This represents slightly less than half of the total number of people with disabilities in the city. However, a significantly greater obstacle is a lack of money. After all, food is not provided free of charge to people with disabilities, even if they can get to the store or order food delivery. Money is considered the main barrier to accessing food for people with disabilities.

There are, as always, three ways to solve the money shortage problem. Move from New York to a more comfortable place to live. Incidentally, between 50,000 and 310,000 people, including those with disabilities, do this every year. Earn more money. Get food more efficiently. Of the last two options, the second is the most realistic: get food more efficiently. And here's why.

The lack of income for people with disabilities is a systemic problem throughout the United States, and New York City in particular. Most people with disabilities are condemned to low wages from a young age. Because the education of people with disabilities is lower than that of people without disabilities. And average wages rise in tandem with educational attainment. Educational challenges for people with disabilities begin during school age. In 2025, only 59% of students with disabilities graduated from NYC public schools. Among students without disabilities, this figure was 81%. Unsurprisingly, only 20% of people with disabilities in New York City hold a bachelor's degree or higher. Meanwhile, among people without disabilities, 41.6% hold a similar degree. This is very bad for wages. After all, the average weekly wage in New York City depended on education in the following way in 2025.

• All Workers - $1,350.
• Less than High School or High School Diploma/GED - $880.
• Some College or Associate Degree - $1,096.
• Bachelor's Degree - $1,690.
• Master's Degree or Higher - $1,980.

Breaking the vicious cycle of poor education and low wages is very difficult. This requires work not only from childhood but also with parental support. After all, the education of children with disabilities depends largely on parents.

Therefore, it's much more realistic to improve your nutrition by spending your money more efficiently. Fortunately, New York City offers many opportunities for this. The most common way is through government support. New York City has 11 citywide food programs targeting various population groups. These include Catholic Charities, Farmers Market Nutrition Program, FoodHelp NYC, Foodbank NYC, NYC Neighborhood Food Resource Guides (Hunter College NYC Food Policy Center), Neighborhood Opportunity Network (NeON), NYC Department for the Aging, Citymeals on Wheels, God's Love We Deliver, ACCESS HRA, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

In addition to citywide programs, there are local food programs. For example, Long Island Harvest (Long Island) and Feeding Westchester (Westchester). In addition, New York City has at least 10 Regional Food Banks that can also be used by people with disabilities.

It also makes sense to draw on the survival experience of people living in various extreme conditions. For example, people living in war zones and constantly experiencing financial shortages organize their grocery shopping and meal preparation in a completely different way than most people. The main saving methods are:

1. Avoid street food and cafes.

2. Cook at home.

3. Buy groceries only after checking market prices.

For example, home-baked bread is usually 2-3 times cheaper than store-bought bread. Buying in bulk with friends and neighbors can also help you save a lot. Buying a whole bag of pasta (55 pounds) and splitting it among several people is much cheaper than buying the same amount of pasta packaged in attractive factory packaging. You can even make ice cream at home for a fraction of the cost of buying it at the supermarket. Many people share their survival experiences with recipes. Therefore, learning to save money won't be difficult. The main thing is to understand that proper food savings don't reduce the quality of your diet, but rather help you eat well while saving money.

References

1. https://www.disabled-world.com/disability/finance/ny-mortgage.php

2. https://www.disabled-world.com/disability/housing/ny-housing.php

Some people find the sound annoying but can live with it. Others can get sick from this low-frequency sound, which is often also experienced as a vibration.

The humming sound isn't easy to hear outdoors, but it often appears indoors - and is most noticeable when you've gone to sleep at night. If you look out the window to see if there is something with a motor in the neighborhood, there's nothing to see. And others who are in the same place hear nothing.

First discovered in coastal cities

The phenomenon was first recorded and discussed in the city of Bristol, England in the mid-1970s. Suddenly, the Bristol Evening Post began receiving letter after letter from people who heard an inexplicable sound, and wondered where it came from.

One theory was that the humming sound came from large, industrial fans that were located inside the warehouse of a large department store. However, when the warehouse was closed down a few years later, people continued to hear the sound.

Since then, the sound has been recorded in several places in the United Kingdom, mainly in coastal cities such as Hythe, Plymouth, Southampton, and Swansea, but also in London. The sound is called The Hum phenomenon, or simply The Hum.

In the 1990s, it cropped up in the United States, first in the city of Taos, New Mexico and in the city of Kokomo, Indiana. The phenomenon has since been recorded worldwide: in Canada, Australia, New Zealand, South Africa, and several European cities. The sound is typically reported in relatively densely populated areas.

A couple of years ago, people in the Oslo area also reported an unexplained humming sound, according to the Norwegian Broadcasting Corporation.

Canadian Glen MacPherson began hearing the humming sound when he lived and worked as a teacher on Canada's west coast. When he moved to another city in the same area, the sound disappeared. He became so interested in the sound phenomenon that he started the interactive World Hum Map and Database Project in 2012, which collects data from places and people where the sound has been noted.

Many different theories

Many different theories have been offered to explain the cause of the phenomenon; everything from acoustic pollution from human-made sources to sounds that nature itself makes - as well as conspiracy theories that the sound is produced by the CIA or even aliens.

There are many human sources of low-frequency sound. These can include ventilation systems, heat pumps, traffic noise, windmills, and more. Examples of natural sources include the sounds of waves crashing along the coast and wind sweeping through the landscape.

The Hum has attracted the interest of hearing and audiology researchers worldwide. Markus Drexl, a professor at the Norwegian University of Science and Technology, is among this self-selected group. He and two PhD research fellows and a postdoc have conducted a study of 28 people in Germany who experience hearing an unexplained buzzing or humming.

Sounds that can be measured

The researchers tested two hypotheses. One was that The Hum can be measured, both from human-made infrastructure and industry and also from nature itself, which creates low-frequency sounds.

"We know that there are people who hear low-frequency sounds that can actually be measured, even if other people don't hear them. But it's not so easy to find the source of these sound waves, because it's a struggle to localize low-frequency sounds," Drexl said. These sounds have long wavelengths that can travel over great distances.

Extra good hearing?

The first thing the researchers did was test whether the participants had particularly good hearing for low-frequency sounds that are actually known to exist. Most did not, except for two participants who had better hearing than average at certain low frequencies.

"Even though the group we tested was small, it still means that the hypothesis of having especially good hearing for low-frequency sounds does not hold for most people," Drexl said.

He adds a small caveat: There are differences in hearing thresholds (microstructures) that make it possible for some people to hear sensitively in a very narrow frequency range, for example between 50 and 51 Hertz. These nuances are not captured by conventional hearing tests.

The ear can produce sounds itself

The cochlea in the inner ear itself produces weak sounds with different frequencies, typically between about 500 and 5000 Hertz. These sounds have no function of their own, but are a by-product of a physiological sound amplification process.

"Most of us don't hear these sounds. However, a few people can actually hear the sounds that the ear itself produces. And these sounds can be measured objectively," Drexl said.

These particular sounds are called oto-acoustic emissions and can be detected by placing a sensitive microphone in the ear canal. In some people, these spontaneous oto-acoustic emissions can be experienced as troublesome tinnitus.

"One hypothesis was that the participants in our group could hear oto-acoustic emissions at low frequencies. That's why we tested whether they had them," says Drexl. But the answer was no.

Sounds that cannot be measured

"Then there are people who hear something that cannot be measured objectively. We believe people in this category have a form of low-frequency tinnitus," Drexl said.

Tinnitus or ringing in the ears is when you hear a sound in the ear or in the head, which is not caused by an external sound source. Many people experience tinnitus, either permanently or for shorter periods. These individuals first experience the sounds in their ears as a sound coming from outside. But as the sound persists, even when they move to other places, they gradually become aware that the source of the sound is not external.

Drexl says that based on what is known about hearing and the tests they conducted on study participants, the best explanation is twofold. A few people who hear The Hum actually have particularly good low-frequency hearing. However, for most people, it may be a form of tinnitus, meaning a sound that originates from inside the auditory system.

"Based on our results, although we haven't ruled out cases of physical external sound sources, we suggest that subjective tinnitus in the low-frequency range is often the cause of hearing pulsations of low-frequency sound perceptions," he said.

Must understand the entire auditory system

Markus Drexl became interested in The Hum phenomenon because he studies low-frequency sounds.

"What we know about the hearing system is mainly based on how we capture and process sound with higher frequencies. We know less about how the auditory system handles and processes low-frequency sound, or infrasound," he said.

Drexl says that over the past decade there has been a growing concern about noise from technical sources in the low-frequency range (between about 20 and 250 Hz) and the infrasound range (below 20 Hz).

"If we want to conduct a thorough assessment of low-frequency sounds and infrasound, we first need a better understanding of how sensory systems process low-frequency sound and infrasound," he said.

Reference:

On the potential sources of a low-frequency sound percept that only a few can perceive, Plos One, March 2026.

For most of its sixty-year history, Medicaid eligibility has rested on who a person is and how much they earn, not on whether they hold a job. That long-standing approach changed with the 2025 budget reconciliation law, known as H.R. 1, which was signed on July 4, 2025. The law creates, for the first time, a nationwide work requirement - often called a community engagement requirement - that ties continued Medicaid coverage to participation in approved activities (Center for Health Care Strategies, 2025). For people with disabilities, many of whom rely on Medicaid for the everyday supports that make work and independent living possible, the details of this shift carry real weight.

The requirement applies to adults aged 19 to 64 who are enrolled through the Affordable Care Act's Medicaid expansion or through a comparable Section 1115 waiver that provides what the law calls minimum essential coverage. In states that adopted expansion, this group generally includes adults earning between the traditional Medicaid income cutoff and 138 percent of the Federal Poverty Level. As of mid-2025, 41 states had adopted Medicaid expansion, and more than 20 million adults were covered through it (Center for Health Care Strategies, 2025).

States That Have Adopted Medicaid Expansion: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Virginia, Washington, West Virginia.

States That Have Not Adopted Expansion as of 2026: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.

What Counts as a Qualifying Activity

To keep coverage, an affected enrollee must complete at least 80 hours per month of one or more qualifying activities. These include paid employment, participation in a work program such as job training, enrollment in an educational program on at least a half-time basis, community service, or any combination of these (Center for Health Care Strategies, 2025). Eighty hours a month works out to roughly 20 hours a week - a meaningful commitment for someone managing a fluctuating health condition, an unpredictable work schedule, or limited transportation.

One feature stands out: the requirement is non-waivable. States cannot use a Section 1115 demonstration waiver to set it aside, which removes a flexibility that states have historically used to tailor Medicaid rules to local conditions (Center for Health Care Strategies, 2025).

The Implementation Timeline

The rollout follows a staged schedule. The U.S. Department of Health and Human Services (HHS) must provide implementation guidance to states by June 1, 2026, clarifying definitions and standards left open in the statute. The Centers for Medicare and Medicaid Services (CMS) issued initial guidance on December 8, 2025, with more expected through 2026. States must put the requirements in place by January 1, 2027, though they may act sooner through waivers. States that show a good-faith effort can receive an extension as late as December 31, 2028 (Center for Health Care Strategies, 2025).

The Exemptions, and Why Disability Sits at the Center of Them

The law spells out several groups that are not subject to the requirement. These include foster youth and former foster youth under age 26; American Indians and Alaska Natives eligible for Indian Health Service care; caregivers of a dependent child aged 13 or under or of a disabled individual; veterans with a disability rated as total; pregnant and postpartum individuals; people meeting work rules under other programs such as the Supplemental Nutrition Assistance Program; those in qualifying substance use disorder treatment; people who are incarcerated or were released within the prior three months; and individuals facing short-term hardships such as a federally declared disaster or residence in a county with very high unemployment (Center for Health Care Strategies, 2025).

The Medically Frail Exemption

The exemption with the broadest reach for the disability community is the one for people who are medically frail. Federal rules define this group to include those who are blind or disabled, people with a serious mental disorder or substance use disorder, those with a physical, intellectual, or developmental disability that significantly limits daily activities, and people with a serious or complex medical condition (Center for Health Care Strategies, 2025). On paper, this category appears to protect anyone whose health makes consistent work difficult. In practice, how a state defines and verifies medical frailty determines whether that protection actually reaches the people it names.

The Disability Gap That Makes This Policy Complicated

A central misunderstanding about the new rules is the assumption that people with disabilities are automatically safe because Medicaid already has disability-based eligibility. The data tell a more complicated story. Although about 34 percent of Medicaid enrollees report having a disability, only around 10 percent qualify for coverage through a formal disability determination (Commonwealth Fund, 2025). The rest are enrolled through income-based pathways, most often the expansion group - precisely the population the work requirement targets.

Why do so many people with disabilities enroll through income rather than disability? Income-based determinations are faster and far less burdensome than the disability determination process, which often relies on Supplemental Security Income criteria. Those criteria are strict and do not always reflect current medical understanding of how conditions limit a person's capacity to work. Research suggests that nearly two-thirds of Medicaid enrollees with self-reported disabilities would not qualify under the narrow SSI-based definition (State Health and Value Strategies, 2025). When Arkansas implemented its earlier work requirement, only about 45 percent of the state's disabled Medicaid enrollees were eligible through the main disability-specific category (National Health Law Program, 2025).

The consequence is that a large share of enrollees who genuinely cannot work, or can work only intermittently, are not shielded by an automatic disability label. Instead, they must affirmatively claim an exemption and prove they qualify - and that is where coverage is most often lost.

Lessons From Arkansas and New Hampshire

The country has already run two real-world tests of Medicaid work requirements, and both offer cautionary lessons. Arkansas put its requirement into effect from June 2018 through March 2019, the only instance in which a state disenrolled people for noncompliance before a federal court halted the policy. In just seven months, more than 18,000 people - roughly one in four of those subject to the rule - lost coverage, mostly because they failed to report their work status or document an exemption rather than because they were not working (KFF, 2025).

Studies of the Arkansas experience found that the policy increased the uninsured rate while producing no measurable increase in employment (Urban Institute, 2025). The reason is straightforward. As one analysis summarized, about 64 percent of adults on Medicaid nationally already work, and another 28 percent are disabled, in school, or caring for a family member, leaving only a small remainder who could work but do not (Tradeoffs, 2025). A requirement aimed at that small group ends up creating paperwork hurdles for everyone, and the people most likely to stumble over those hurdles are often those with health conditions.

New Hampshire's brief 2019 implementation reinforced the point. The state received only 1,951 medical frailty exemption requests, even though more than 10,700 enrollees had previously self-attested to that status. The gap shows how many eligible people with disabilities can be left unprotected when the exemption process itself becomes a barrier (State Health and Value Strategies, 2025).

How Exemptions Are Verified, and Where People Fall Through the Cracks

Under the new law, states must first use available data - such as payroll records or Medicaid claims and encounter data - to confirm compliance or eligibility for an exemption before asking applicants for more information (Center for Health Care Strategies, 2025). Automatic, data-driven verification is the best protection for people with disabilities, because it does not depend on someone understanding the rules and filing the right form at the right time.

The difficulty is that data matching only works when the right information exists in a database. A person whose disability is documented in claims data may be flagged automatically, but someone newly diagnosed, recently enrolled, or treated outside the Medicaid system may not appear. In those cases, the state may turn to health screeners or ask for confirmation from a treating provider. Each added step introduces friction. Requiring a physician's attestation, for example, places a burden on clinicians who serve large numbers of Medicaid patients and can create an impossible situation for the patient (KFF, 2025).

Consider a hypothetical enrollee with a serious chronic illness who has not seen a doctor recently because she has been managing symptoms at home. If her state requires medical documentation to grant the medically frail exemption, she cannot prove her condition without first obtaining care - yet she may need coverage to obtain that care in the first place. Advocates have urged states to accept a person's own declaration for the medically frail and caregiver exemptions, and to renew those exemptions automatically when a condition is unlikely to improve, precisely to avoid this kind of trap (Justice in Aging, 2026; Commonwealth Fund, 2025).

Outreach, Reporting, and Disenrollment

The law builds in communication requirements. State Medicaid agencies must conduct member outreach between June 30 and August 31, 2026, using regular mail plus at least one other method such as phone, text message, or email, and must repeat outreach at least every six months after implementation. That outreach must explain how to comply, who is exempt, the consequences of noncompliance, and how to report (Center for Health Care Strategies, 2025).

Verification also follows a rhythm. At application, states perform a look-back review covering one to three months, and they must confirm compliance for at least one month within each six-month renewal period. If verification fails, the state issues a notice of noncompliance through mail and one other channel, after which the member has 30 days to demonstrate compliance before being disenrolled (Center for Health Care Strategies, 2025). For someone with a cognitive disability, a sensory impairment, or unstable housing, a single missed notice or a confusing online portal can be the difference between keeping and losing coverage - which is exactly what happened to many enrollees in Arkansas who said they never learned the rule applied to them (KFF, 2025).

Projected Impact on Coverage and Spending

The Congressional Budget Office projects that the work requirement provision will reduce federal Medicaid spending by 344 billion dollars over ten years. It also estimates that H.R. 1 as a whole will lead 11.8 million people to lose Medicaid coverage over the next decade, with about 4.8 million of those losses attributable to the work requirements specifically (Center for Health Care Strategies, 2025; Congressional Budget Office, 2025). To support the transition, the law appropriates 200 million dollars to CMS in fiscal year 2026 and directs HHS to distribute another 200 million dollars to states (Center for Health Care Strategies, 2025).

What This Means for People With Disabilities Going Forward

The practical effect of the new requirements on the disability community will depend less on the statute's text than on the choices states make as they build their systems. States that lean on automatic data matching, accept self-declaration for the medically frail and caregiver exemptions, renew long-term exemptions without repeated paperwork, and provide accessible reporting options stand to protect far more eligible people than states that require fresh documentation at every step. Federal disability law adds another layer here, since states remain obligated to offer reasonable accommodations to applicants and enrollees with disabilities throughout the process (Commonwealth Fund, 2025).

For enrollees and the people who assist them, three steps matter most in the near term: confirming whether the requirement applies to a person's eligibility category, identifying which exemption fits and what proof a given state will accept, and watching closely for outreach notices once states begin contacting members in the summer of 2026. The history of Arkansas and New Hampshire shows that coverage is most often lost not because people are unwilling to work, but because the process for proving an exemption is hard to navigate. Understanding that process early is the surest way to keep coverage intact.

References:

• Center for Health Care Strategies. (2025). A summary of federal Medicaid work requirements.
• Commonwealth Fund. (2025). How medical frailty exemption policies can offer a lifeline to people with disabilities and chronic conditions.
• Congressional Budget Office. (2025). Estimated budgetary effects of Medicaid provisions.
• Justice in Aging. (2026). Mitigating the harms of Medicaid work requirements for older adults: Tools for state advocates.
• KFF. (2025). 5 key facts about Medicaid work requirements.
• KFF. (2025). The medical frailty exemption from Medicaid work requirements: Key issues to watch for in upcoming CMS guidance.
• National Health Law Program. (2025). How Medicaid work requirements hurt people with disabilities.
• State Health and Value Strategies. (2025). The disability gap in Medicaid: Implications for the federal work requirement proposal.
• Tradeoffs. (2025). Medicaid work requirements are back: What you need to know.
• Urban Institute. (2025). New evidence confirms Arkansas's Medicaid work requirement did not boost employment.

Whatever the reason, my expectations when I recently had an opportunity to visit and ascend in the world-famous structure were high. That may have been why the experience was somewhat of a disappointment.

It's not that the well-known landmark, which towers over the city's skyline, isn't impressive. At 630 feet tall, it lays claim to the title of the highest man-made national monument in the United States. It weighs over 17,000 tons and was built to withstand both earthquakes and strong winds.

Planners of the Arch had those with a physical disability in mind when they designed it. Designated accessible parking spaces are located nearby, and access is available via ramps and elevators designed for wheelchair users. The accessible tram service reaches the top of the Arch, and people may request assistance from staff if needed. The museum has wheelchair-friendly pathways and exhibits.

Why didn't the site live up to the hype for me? For starters, the trip to the top is made in a somewhat cramped tram car. Those who suffer from claustrophobia may experience a bit of it on the way up. Once there, they peer out narrow slit windows for views of the city as far as 30 miles away, and of boat and barge traffic making its way along the Mississippi River.

If you wish to avoid the journey, or don't enjoy being crammed into a sardine-like setting, I found the Gateway Arch Museum at the base of the span to be inviting and interesting. It focuses upon the history and significance of the namesake above with interactive exhibits about the westward expansion, the Lewis and Clark Expedition, and the role played by St. Louis in the history of the United States since the city's founding in 1764.

It served as a hub for trade with regional American Indian tribes, the political capital of the region, and a center of commerce along waterways. Arrival of the first steamboat in 1817 changed the city forever. Steamboats opened the area to the West and St. Louis morphed into a major manufacturing city.

Among reminders of the Indigenous culture is Sugarloaf Mound, the sole remaining Mississippian culture mound in present-day St. Louis. Some 40 of these earthen knolls were built within present-day St. Louis by the Native Americans who thrived in the area from about 600 to1300 AD.

Another architectural gem in town is the Climatron, which houses the Geodesic Dome Conservatory. It incorporates the principles of R. Buckmaster Fuller, the architect, systems theorist, author, designer, inventor and futurist. It was the first geodesic dome to be used for that purpose and has been named one of the 100 most significant architectural achievements in United States history.

Contrasting with the colorless aluminum of which the dome is made are plantings in the 79-acre Missouri Botanical Garden. It includes a Japanese Garden, one of the largest in North America; exhibits some of the most distinctive examples of garden sculpture in the country, and displays results of sustainability practices throughout its operation.

Dwarfing that spread in size is Forest Park, a1,326-acre enclave of meadows and trees, prairie wetland, lakes and ponds. Opened in 1876, it has hosted significant events like the1904 World's Fair and Summer Olympics. Known as the "Heart of St. Louis," it's home to the city zoo, art and history museums, science center and opera theater.

Music lovers are likely to find venues in St. Louis where they may hear their favorite sounds. The city has long been a hopping hub of musical activity, and both local artists and visiting performers have been responsible for that. From jazz to blues, soul to hip-hop, the list of something-for-everyone sounds is long and varied.

When it's time to dine in St. Louis, the city offers a choice of local specialties which, if they may sound quirky, I found to be worth introducing to my taste buds. Beginning with breakfast, I quickly came to appreciate an early morning cake fix with a favorite local recipe.

Gooey butter cake is practically a rite of passage. The story about this concoction is that a baker accidentally doubled the butter in a cake recipe, resulting in a deliciously gooey custard atop a coffee cake base, all dusted with powdered sugar.

While there is a distinct difference between the St. Louis and Kansas City styles of barbecue, both include a generous quantity of barbecue sauce. The St. Louis version is a pork steak which is seasoned, smoked and slathered in tangy, tomato-based BBQ sauce.

Whether brunching on butter cake or munching on barbecue, admiring a soaring arch or strolling among a collection of garden sculptures, the choice of things to taste, see and do in St. Louis is likely to fulfill any visitor's wish list. After experiencing much that the city has to offer, I would suggest: Come for the Arch, stay for the rest.

Visiting St. Louis Arch: Tips for People with Disability

• Utilize designated accessible parking spaces near the Arch.
• Access the Arch via ramps and elevators designed for wheelchair users.
• Take advantage of the accessible tram service to reach the top of the Arch.
• Explore the museum with wheelchair-friendly pathways and exhibits.
• Request assistance from staff if needed for navigation or services.

Hello Robot envisions a future where a general-purpose robot can enhance life for everyone, including children, older adults, and people with disabilities, at home and on the job.

They've worked with patients with Parkinson's, severe disabilities (quadriplegics) and older adults with dementia, and have teamed up with a number of researchers at the university level to really understand the best way to bring adaptive technology into the home.

They are tackling the hardest use cases in order to build a robot that eventually can help the growing older population age in place. Some consider caring for the aging population a humanitarian crisis in the making. In the U.S. by 2030, 21% of the population will be older than 65; by 2060, nearly one in four Americans will be 65 or older.

Because of their open-source approach, they arguably have the world's largest developer community working on indoor mobile manipulation.

New Robot Puts Physical AI to Work - Actively Assisting People at Home and on the Job

Hello Robot, the team behind the Stretch mobile manipulation platform, today announced the release of Stretch 4. Available now for $29,950, Stretch 4 is an open-source robotics platform designed for researchers, developers, and application engineers building the next wave of Physical AI applications for general purpose robotics.

"In the last few years, Physical AI has brought us videos of robots doing amazing stunts. But these videos are missing something critical - the people the robots are meant to benefit," says Aaron Edsinger, co-founder and CEO of Hello Robot. "With Stretch 4, Hello Robot is delivering a robot designed specifically to operate safely shoulder-to-shoulder with people. It is compact, lightweight, ready to work, and a delight to use."

A Pathway to Robots in Everyday Life

From the beginning, Hello Robot has worked toward a future in which robots enhance life for everyone, including children, older adults, and people with disabilities. To this end, Hello Robot has been piloting Stretch to support individuals with severe mobility impairments. Controlling the robot through a mobile phone app, users have increased agency, accomplishing tasks such as fetching a drink of water, closing the blinds, and feeding themselves.

In developing Stretch 4 to meet the needs of these users, Hello Robot also is tackling some of the most difficult challenges in robotics: safe, reliable, and intuitive human-robot interaction. Their practical approach - rejecting the complexity of humanoid forms in favor of functional, lightweight, and safe design - positions Stretch to become a pathway to robots becoming a welcome part of everyday life.

"Designing Stretch 4 to meet real needs in homes has resulted in a platform with unprecedented potential," according to Charlie Kemp, CTO and co-founder of Hello Robot. "With Stretch 4, developers can confidently target new applications in which robots closely collaborate with people. People are not an afterthought; they are the primary reason for Stretch 4's design."

Working Safely, Shoulder to Shoulder

Stretch 4 is a distinctive robot featuring a telescoping arm, an omnidirectional base, and a sophisticated sensor array - including two hemispherical 3D LiDAR sensors, three high-resolution cameras, and six laser line sensors. The architecture follows the "sensor-rich" philosophy utilized by Waymo to achieve high-fidelity safety in autonomous driving, standing in contrast to the more minimalist, vision-only approaches seen elsewhere in the industry.

"You can't cheat physics when it comes to robot safety," added Edsinger. "The inherent physical properties of full-size humanoids means they can become potentially dangerous in the event of a system failure. In contrast, Stretch 4 has a unique, compact, and low-potential-energy design. It is intrinsically much safer when things don't go as expected - as they invariably will."

Stretch 4 is a major redesign based on customer feedback, resulting in a versatile and easy-to-use platform for developers. Notable features include:

Wide-angle 3D Sensing Head

• The sensor head is fully-calibrated and rigidly fixed with respect to the arm and mobile base, simplifying autonomy.
• Two hemispherical 3D LiDAR and global-shutter fisheye RGB cameras observe the surroundings, dramatically reducing blind spots even when the arm is in use.
• One central, high-resolution RGB camera observes the gripper's workspace, supporting dexterous manipulation.

Omnidirectional Mobile Base

• The mobile base provides quick and smooth motion in any direction.
• The large 20 cm wheels let the robot traverse indoor terrain, including carpets, rugs, and thresholds.
• Six laser-line sensors ring the base, sensing small hazards on the floor such as cords, rugs, and drop-offs.

Greater Speed, Reach and End-of-arm Options

• The arm, lift, and base operate at twice the speed of Stretch 3, while the total reach has been extended by 10%.
• The robot features 8 redundant degrees of freedom plus the gripper, including an ambidextrous wrist with an integrated depth camera that can be configured for either left- or right-handed operation.
• A new quick-release mechanism allows users to efficiently swap between a compliant gripper, parallel jaw gripper, and a tablet interface.

New Power and Compute System

• An NVIDIA Jetson Orin NX runs Physical AI models on the robot.
• An all-new power system enables up to eight hours of runtime.
• A docking station now supports autonomous self charging, enabling long-duration deployments.

A Capable Platform that is Ready to Work

Hello Robot launched the first Stretch robot in 2020. Since then, more than a thousand users from 23 countries have pioneered the future of mobile manipulation with Stretch. Stretch is an adaptable platform that can be used in unique ways. Henry Evans, a non-verbal person with quadriplegia, had this reaction:

"I've had the privilege of working with the Hello Robot team for some time, and what strikes me about Stretch 4 is its versatility. It has an omnidirectional base, which gives it the freedom to move effortlessly, in any direction, and it has simple, intuitive controls, which make it feel like an extension of my body. For me that is particularly important, because Stretch 4 represents my only means of interacting with my physical environment. Stretch 4 gives me greater confidence, deeper independence, and a life with more possibility." Henry Evans, Co-Founder, Robots for Humanity.

Berkeley Artificial Intelligence Research (BAIR) Lab is a leading academic research center advancing the foundations and real-world applications of artificial intelligence, with work spanning robotics, computer vision, machine learning, and human-centered AI systems.

"During graduate school, I spent nearly five years bringing robots into homes for experiments and demos. At that time, the only mobile robot I'd trust in my parents' home was Stretch. When it comes to living and working alongside humans, safety-first design will win. To get there, we need more robots that prioritize people above all else. I'm glad Hello Robot continues its invaluable work in this direction, and I hope Stretch 4 helps users and researchers move closer to a world where everyday home-helper robots are no longer a dream, but a reality." Nur Muhammad "Mahi" Shafiullah, Postdoctoral Researcher, Berkeley AI Research (BAIR), UC Berkeley.

University of Illinois Urbana-Champaign is home to a cutting-edge research center focused on how to develop next-generation smart homes that would allow people of all ages and abilities to live fuller, healthier, and autonomous lives.

"We are exploring the potential of Stretch to enable independence for older adults with a range of abilities and limitations; how a robot can support that in practical, everyday ways. Our research with Stretch is advancing understanding of how robots can and should function in home environments, with consideration for user needs and preferences." Wendy Rogers, Khan Professor of Applied Health Sciences, University of Illinois Urbana-Champaign.

Available Now for Developers

Stretch 4 is available for purchase today for $29,950 at www.hello-robot.com The Stretch platform empowers developers with open-source code, excellent support, and a global community.

About Hello Robot

Hello Robot was founded in 2017 by veteran roboticists Aaron Edsinger and Charlie Kemp, who collectively bring more than 50 years of experience from Massachusetts Institute of Technology, Google, and Georgia Institute of Technology. Their flagship robotic platform, Stretch, is one of the world's most popular open-source platforms for mobile manipulation.

A validation and consultation workshop on the "Knowledge, Attitude, Practice and Accessibility (KAP+A) Audit of Thematic Rights-Based Organizations in Nepal" was successfully organized by Prayatna Nepal on Monday in Kathmandu. The program brought together representatives from mainstream human rights organizations, women's rights groups, youth-led organizations, disability rights activists, and civil society stakeholders to discuss the draft findings of the KAP+A audit and identify pathways for strengthening disability inclusion within Nepal's civil society mechanism.

The program was moderated by Ms. Sarita Lamichhane, while the draft report and major findings were presented by disability rights activist and lead researcher Mr. Maheshwor Ghimire.

During the workshop, organizers highlighted that while the Knowledge, Attitude and Practice (KAP) approach has long been used in social research and institutional assessments, this study is the first of its kind in Nepal to systematically integrate "Accessibility" alongside KAP, forming the KAP+A framework. The study assessed not only institutional understanding and practices related to disability inclusion, but also physical, digital, informational, and procedural accessibility within thematic rights-based organizations.

The draft report revealed significant gaps between policy commitments and institutional practices. Findings indicated that disability inclusion within many mainstream organizations continues to be treated as a secondary or peripheral issue under broader GESI or GEDSI frameworks, rather than being institutionalized through dedicated mechanisms and practical accessibility measures. The study identified major barriers in physical infrastructure, digital accessibility, inclusive hiring, disability-disaggregated data collection, budgeting for reasonable accommodation, and organizational policy commitments.

The assessment further showed that while many organizations publicly advocate for inclusion and human rights, accessibility remains structurally weak. Toilets, internal mobility systems, and digital communication platforms were identified as some of the least accessible areas. The report also highlighted that many organizations still rely on temporary consultation with persons with disabilities rather than ensuring meaningful participation in governance, employment, leadership, and program design processes.

Sharing the rationale behind the study, the organizers stated that the audit aimed to examine why disability continues to remain outside the core institutional structure of many mainstream organizations despite progressive legal and constitutional commitments in Nepal. The assessment also explored the intersectional exclusion faced by women, girls, LGBTQI+ persons, and individuals from marginalized communities with disabilities.

During the discussion session, one organizational representative suggested that instead of developing separate disability inclusion policies alone, organizations should strengthen disability inclusion through a broader GEDSI quality approach integrated into institutional systems and governance structures. Another participant emphasized the need for the report to include more practical and actionable recommendations that organizations can realistically implement to strengthen disability-inclusive initiatives.

Participants also appreciated the roadmap proposed in the draft report, particularly its focus on long-term institutional transformation, accessibility audits, inclusive procurement systems, disability representation, and evidence-based policy reform. One participant acknowledged that the research document could serve as an important reference point for future institutional reforms within Nepal's civil society sector.

Speaking during the workshop, Ms. Sarita Lamichhane clarified that the objective of the study was not to single out or criticize any thematic mainstream organization. She emphasized that the purpose of the audit is to encourage collective reflection, collaboration, and shared responsibility for building disability-inclusive civil society mechanisms in Nepal.

"We are not here to point fingers at any organization. Our intention is to build collective efforts toward meaningful disability inclusion within civil society structures," she stated.

The organizers also shared that the initial plan was to conduct the KAP+A audit with at least 15 organizations. However, due to difficulties in securing sufficient time and institutional ownership from organizations during the assessment process, the study was ultimately completed with 10 participating organizations.

The workshop concluded with a collective commitment from participants to strengthen accessibility, institutional accountability, and inclusive participation within Nepal's civil society sector. Participants stressed the importance of moving beyond symbolic inclusion and ensuring that persons with disabilities are meaningfully engaged in decision-making, leadership, advocacy, and organizational systems.

The organizers informed that the recommendations and feedback collected during the validation workshop will be incorporated into the final version of the KAP+A assessment report before publication.

Speech Central, a text-to-speech application designed for long-form reading and accessibility, has introduced a series of school-focused deployment and accessibility improvements during the 2024/25 and 2025/26 academic seasons. The changes are intended to better support K12 environments using managed iPads, Chromebooks, and Android devices while maintaining accessibility for blind, low-vision, dyslexic, and ADHD users.

Originally launched in 2014, Speech Central has gradually expanded across Apple and Android platforms. In recent months, development has increasingly focused on how assistive reading tools operate inside managed educational environments where privacy, safety, deployment simplicity, and accessibility all need to work together.

The application now supports automated deployment through Apple School Manager with MDM solutions as well as Managed Google Play environments commonly used on Chromebooks and Android school devices. Schools do not need to request special access, licenses, or accessibility approvals. Features intended for educational deployments activate automatically when the managed environment is detected. A practical recommendation for Apple deployments is distributing an empty configuration .plist file through MDM systems, allowing the application to recognize school-managed environments and enable its school-specific behavior automatically.

Unlike many educational software rollouts that require separate student registrations or cloud onboarding procedures, Speech Central's school mode is designed to work with minimal setup requirements. The application is also declared as collecting no analytics, crash reporting, or user tracking data.

One of the major changes introduced for schools is a more restrictive default configuration intended to reduce unnecessary risks in K12 environments. Internet-related features that are less relevant in classroom settings are limited or reorganized, while still preserving practical reading workflows already controlled through school-managed systems. For example, importing content through Safari sharing remains supported because browsing permissions are generally regulated at the device-management level by schools themselves.

Other adjustments are smaller but intended to simplify student use and reduce distraction. Certain features that are less relevant in classroom contexts, such as sleep timer controls, are moved deeper into settings rather than appearing prominently in the primary configuration screens.

The application also changes behavior depending on accessibility needs. Speech Central includes separate accessibility profiles for blind and low-vision users, dyslexia, and ADHD. Each profile automatically applies different sets of defaults and interface accommodations intended to reduce the amount of manual configuration required from students or teachers.

For blind and low-vision users, the application automatically detects when Apple VoiceOver is active and enables accommodations optimized for screen-reader interaction. The low-vision profile is activated automatically without requiring separate setup steps from the user.

Dyslexia and ADHD modes focus on different reading behaviors and interaction patterns. Rather than expecting users to individually configure large numbers of settings, the profiles apply tailored defaults designed to better support concentration, pacing, readability, and navigation during extended reading sessions.

Speech Central also defaults to offline voices in school environments. This decision was made to reduce privacy and compliance concerns that may arise when third-party cloud voice services are involved in educational deployments. On Android devices, Google online voices remain available but are not configured as the default option in school mode.

The application supports reading from PDFs, EPUB books, web articles, scanned documents through on-device OCR, and Microsoft Office documents. OCR processing uses platform-native on-device APIs rather than cloud processing services.

Financial accessibility has also been a significant part of the project's direction. Speech Central is fully free for blind users when VoiceOver is active, with the accessibility detection process handled automatically by the application itself.

The application is also fully free when distributed to managed school devices through Apple School Manager or Managed Google Play deployments. According to Icin, this model was designed to reduce barriers for schools while also allowing students to continue using familiar tools outside educational environments. If students later want to continue using the same reading tools on personal devices, there is still an affordable one-time purchase option available instead of requiring ongoing subscriptions.

Data available through Apple deployment statistics indicates that Speech Central has been deployed on well over 100,000 managed iPads, with usage patterns suggesting broader district-level adoption in some U.S. school systems.

As schools continue expanding the use of managed tablets and Chromebooks in classrooms, accessibility-focused reading tools increasingly need to address not only assistive features themselves, but also deployment simplicity, student privacy, offline operation, and long-term continuity for students who depend on those tools daily.

More information about Speech Central is available at: https://speechcentral.net

Apple App Store: https://apps.apple.com/us/app/id1127349155

Google Play: https://play.google.com/store/apps/details?id=com.labsiisoftware.speechcentral

For many patients with disabilities, older adults, and family caregivers, the hard part doesn't always begin with the medical visit.

It begins with getting there.

That sounds simple until a regular car is not safe. A wheelchair-accessible vehicle may be needed. In some cases, the patient needs stretcher transportation. Others need help getting out of a home, down stairs, into a vehicle, and safely into a clinic, hospital, dialysis center, rehabilitation facility, or specialist’s office.

When this kind of transportation is difficult to arrange, care becomes harder to access.

A recent family story shows how quickly the problem becomes serious. A woman in Ohio needed transportation for her husband to attend critical neurology treatment. She reportedly called around 15 transportation providers and struggled to get a clear answer. When she learned the ride could cost about $150 per day, and that treatment required four days of transportation, she began to question whether the treatment was financially possible.

That's the moment transportation stops being a convenience issue and becomes a healthcare access issue.

The data points in the same direction. In 2022, the CDC reported that 5.7% of U.S. adults lacked reliable transportation for daily living during the previous year. Among adults with disabilities, the percentage was much higher: 14.4%, compared with 4.9% among adults without disabilities. The difference was present across all age groups.

The problem also shows up directly in medical care. CMS has noted that transportation barriers are responsible for 25% or more of missed clinic appointments. It also describes reliable transportation as important for managing chronic conditions and attending recommended appointments. The American Hospital Association has similarly described transportation as a social determinant of health, noting that transportation barriers may lead to missed or delayed care, higher health expenditures, and poorer health outcomes.

For people who don't need specialized transportation, the problem may be invisible. The default assumption is that someone can call a taxi, open a rideshare app, ask a relative, or drive themselves. But disability-related medical transportation often requires specific equipment and trained handling. A wheelchair van is not the same as a stretcher vehicle. Curb-to-curb service is not the same as door-through-door assistance. A provider that can handle local dialysis transportation may not be able to manage stairs, bariatric support, hospital discharge, or long-distance travel.

Families often discover these differences only after making many calls.

One of the clearest examples is hospital discharge. Many people learn that a patient is being discharged the same day or one day before. At that point, the family is under pressure. The hospital wants to discharge the patient. The patient wants to go home. The family needs transportation quickly. If the patient can't sit in a regular car, the family must locate a provider with the right vehicle, staffing, timing, and service area.

That pressure can become expensive fast.

In one case seen by MedicalRide.org, a booking platform for non-emergency medical transport, a person was close to paying about $1,900 for a trip that could be arranged for closer to $400 after comparing options. This kind of price gap may not always be intentional exploitation. Medical transportation pricing can legitimately vary because of distance, vehicle type, assistance level, waiting time, same-day urgency, staffing, and local availability. But for families, the result is still the same: without comparison, they may not know whether a quote is reasonable.

The private-pay medical transportation market is fragmented. Prices are often not standardized. Capabilities are not always published. Some providers answer quickly. Others don't answer at all. Some can handle wheelchair transport but not stretcher transport. Some can manage local rides but not longer distances. Some may support recurring appointments, while others are better suited for one-time trips.

For a family already under stress, it can feel like a maze with a clock running.

There's also a common misconception about older adults and online forms. People often assume older people can't or won't use digital tools to arrange services. In practice, that assumption is not always accurate. Many older adults are fully capable of submitting clear online forms when the process is simple, respectful, and useful. In MedicalRide.org’s early experience, many requests have been submitted directly by older adults themselves, not just by adult children or caregivers.

That matters. It suggests the barrier is not always technology itself. The barrier is often poor design, unclear pricing, slow responses, and forcing people to repeat the same information to multiple providers.

A better system would respect both needs: phone support for people who prefer it, and simple digital intake for those who would rather submit details once.

That's the kind of gap resources like MedicalRide.org are trying to address. The platform focuses on private-pay medical transportation and helps families compare options for wheelchair, stretcher, hospital discharge, dialysis, bariatric, recurring, and long-distance rides. The goal is to reduce repeated phone calls, organize provider capability information, and help families avoid extreme last-minute quotes when they are already under pressure.

Transparency won't solve every problem. Even a fair price can still be unaffordable. A $150 ride may reflect real operating costs, but if a patient needs that ride four times in one week, the total becomes $600. For people on fixed incomes, caregivers already carrying financial strain, or families dealing with serious illness, transportation can become a deciding factor in whether treatment happens.

That's why funding remains essential. Communities need more transportation assistance for people with disabilities, older adults, and patients who fall outside public benefits or can't access them quickly enough. Some patients qualify for Medicaid non-emergency medical transportation or local programs, but many others don't. Some need urgent private-pay rides before public assistance can be arranged. Others need specialized transport across boundaries where local programs don't operate.

Medical transportation should not be treated as an afterthought. For many patients, the ride is part of the care plan.

Hospitals, clinics, discharge planners, aging agencies, disability organizations, funders, and community resource directories can all play a role. At minimum, families need better information about available providers, capabilities, price ranges, and realistic alternatives. Where possible, community organizations should also help identify funding options for people who can't afford necessary transportation.

The goal should be simple: no one should have to question needed medical care because they can't find or afford a safe ride.

A medical ride may look like a trip from one address to another. But for a person with a disability, a patient leaving the hospital, or a caregiver trying to keep treatment on schedule, it can be the bridge between a doctor’s recommendation and real access to care.

When the ride fails, care can fail too.

References

CDC / NCHS, "Lack of Reliable Transportation for Daily Living Among Adults: United States, 2022."

CDC MMWR QuickStats, "Percentage of Adults Aged ≥18 Years Who Lacked Reliable Transportation for Daily Living... by Disability Status and Age Group."

CMS Innovation Center, "Addressing Transportation Barriers."

American Hospital Association, "Transportation and the Role of Hospitals."

MedicalRide.org is an online booking and provider-matching platform for private-pay NEMT, wheelchair-accessible vans, stretcher rides, hospital discharge, dialysis, appointments, and long-distance medical transport.

One of the things she has made clear to me in our conversations about her work is this: Your environment is affecting you. Psychologically and physically. Be aware, purposeful, and willing to make big changes in the choosing and creation of your environment.

One of the things I find fascinating about this truth is that simply knowing and believing it gives you a most important tool to help yourself and your loved ones, regardless of your surroundings! You don't need to have overwhelming smarts or a fancy education to use this info. Just pay attention to yourself and your loved ones, and keep an eye open for clues, and be willing to make changes.

So, knowing that your environment plays a big role in your mental and physical health can help you get healthy, no matter your environment!

Funny, right? I mean, my mom works in homes of every style and culture, yet this important fact, that the world we immerse ourselves in matters to such a powerful degree, helps my mom effectively help her clients regardless of their environment.

So look around you, friends. Be willing to make big and small changes to your chosen environment of beliefs, friends, culture, and habits.

When us eight kids were small (my adopted siblings still multi-diagnosed and overwhelmingly challenged) my mom often moved towns, tweaked her belief systems, and changed professions in order to create a safe and healthy world for us kids. It always helped! Always, always! (Sometimes it helped lots of us and hurt some of us, in which case mom had real hard choices to make. Caring about a lot of kids is a lot of ... well, a lot.)

Regardless of where or how you live, you are able to help your family by being aware and purposeful of where and how you live while keeping an open eye on how it is affecting you and being willing to make changes.

That's some empowering stuff!

I encourage you to watch my mom's award winning international docu-series FIX IT IN FIVE with THE BRAIN BROAD in order to see how well she uses any and every environment - along with neurofeedback and behavior science - to point out problems, make changes, and begin healing. (I almost want to insist that you watch it, but you would probably feel like I was being bossy and then purposefully push back against my insistence to prove your independence, which is something I do far more often than I care to admit, push away from a good idea just because someone seemed to be acting like they know what's best for me and so I want to put my own adulthood on display while acting like a child and giving into a knee jerk reaction to be my own woman by saying no, and then making up some reason I pretend is smart about why I'm saying no... not that you would act that way just because I sometimes do but, you know, I don't want to risk it and then you don't watch the show and you miss out on amazing entertainment and learning.) Giggle!

The family we are given, the family we choose, and the family we build is complex and interwoven. We aren't responsible for making the world be the way we want it to be, and we shouldn't make the mistake of trying to make our family members be the way we imagine they should be, but we do want to take steps to build, discover, and allow for a world and family that is healthy for us at any given time in our lives.

There is a heavy responsibility in this knowledge. I know. But, along with that, there is freedom and potential in it! So try to accept the responsibility while focusing on the fun of the freedom! Build on that potential and discover the various environments and surroundings that suit you!

Our environment is affecting us. It is helping grow us, and our families, into who we are. Let's have fun and play the important role of being purposeful and open to change!

Orthostatic intolerance, often shortened to OI, is a clinical term used to describe a cluster of physical symptoms that develop when a person stands upright and that ease when the person sits or lies down. The word "orthostasis" simply means standing, and OI captures the body's struggle to maintain steady blood flow against gravity once a person is on their feet. While most people rarely think about what happens to circulation during a change in posture, the body must perform a rapid and coordinated set of cardiovascular adjustments every time someone stands. When these adjustments fail or fall short, the brain receives less oxygen-rich blood than it needs, and a recognizable set of symptoms follows.

OI is not a single disease but an umbrella term covering several distinct conditions, including orthostatic hypotension, postural orthostatic tachycardia syndrome (POTS), neurally mediated hypotension, and vasovagal syncope. Researchers estimate that chronic OI affects hundreds of thousands of people in the United States alone, and many more experience milder transient forms during illness, dehydration, or after extended bed rest (Stewart, 2013). Despite its prevalence, OI is frequently underdiagnosed, partly because its symptoms can mimic anxiety, deconditioning, or general fatigue, and partly because routine blood pressure checks taken while seated may miss the problem entirely.

How the Body Normally Responds to Standing

To understand why OI occurs, it helps to picture what happens during a routine stand-up. When a person rises from a seated or lying position, gravity pulls roughly 500 to 1,000 milliliters of blood downward into the abdomen and lower limbs. In a healthy circulatory system, baroreceptors in the carotid arteries and aortic arch detect the drop in pressure within seconds. They signal the autonomic nervous system to constrict blood vessels, increase heart rate slightly, and cue the skeletal and respiratory muscles to pump blood back toward the heart (Stewart, 2013).

This compensatory sequence is so quick that most people never notice it. In someone with OI, however, one or more steps in the sequence is impaired. Blood vessels may not constrict effectively, the heart rate response may overshoot or undershoot, blood volume may be abnormally low, or the autonomic nerves themselves may misfire. The result is that less blood returns to the heart, cardiac output falls, and the brain is briefly under-perfused. Because cerebral blood flow is so closely tied to alertness and balance, even modest reductions can produce noticeable symptoms.

Common Forms of Orthostatic Intolerance

Orthostatic Hypotension

Orthostatic hypotension (OH) is defined as a sustained drop in systolic blood pressure of 20 mmHg or more, or a fall in diastolic pressure of 10 mmHg or more, within three minutes of standing (Freeman et al., 2011). It is most common in older adults and in people with conditions that affect autonomic nerves, including Parkinson disease, diabetes, and multiple system atrophy. Initial orthostatic hypotension, a related variant, produces a sharp pressure drop within 15 seconds of standing and resolves quickly on its own.

Postural Orthostatic Tachycardia Syndrome (POTS)

POTS is characterized by a heart rate increase of at least 30 beats per minute (or 40 beats per minute in adolescents) within 10 minutes of standing, occurring without a significant drop in blood pressure (Sheldon et al., 2015). It tends to affect young adults, with women outnumbering men by roughly four or five to one, and it often follows a viral illness, surgery, pregnancy, or trauma. POTS has received increased clinical attention in recent years because of its overlap with Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Neurally Mediated Hypotension and Vasovagal Syncope

Also called neurocardiogenic syncope, this form of OI involves a reflex that causes blood pressure to drop and the heart rate to slow, sometimes producing fainting. Common triggers include prolonged standing, dehydration, the sight of blood, emotional distress, and warm environments. Vasovagal syncope is the most common cause of fainting in the general population, with a lifetime prevalence approaching 22 percent (Sun et al., 2008).

Low Orthostatic Tolerance

Some patients experience the typical orthostatic symptoms without meeting the heart rate or blood pressure criteria for the conditions above. Clinicians sometimes describe this as low orthostatic tolerance and treat it based on the underlying triggers and the impact on daily function rather than on a strict numerical threshold.

Symptoms and How They Present

Symptoms of OI vary widely from one person to the next, but they share a common thread: they appear or worsen with upright posture and ease with reclining. The most frequently reported symptoms include lightheadedness, dizziness, blurred vision, palpitations, weakness, fatigue, headache, brain fog, nausea, tremulousness, sweating, and in more severe cases, syncope (fainting). Many patients also experience exercise intolerance, gastrointestinal upset, and difficulty regulating body temperature (Low et al., 2009).

For example, a college student with POTS might feel fine while sitting in class but become dizzy and short of breath while waiting in line at a cafeteria. An older adult with orthostatic hypotension may rise from a chair, feel the room tilt, and need to sit back down to avoid falling. A teenager with vasovagal syncope might faint after standing in a hot shower or during a long school assembly. The setting changes, but the underlying pattern of upright trigger and recumbent relief stays the same.

Causes and Risk Factors

OI can arise from a wide range of underlying causes. Acute episodes are often linked to dehydration, blood loss, fever, or extended bed rest. Chronic OI, on the other hand, is more likely to involve dysautonomia, an umbrella term for disorders of the autonomic nervous system. Conditions associated with OI include diabetes, Parkinson disease, multiple sclerosis, Ehlers-Danlos syndrome, mast cell activation syndrome, amyloidosis, and several genetic disorders affecting nerve function (Mathias et al., 2012).

Several medications can produce or worsen OI as well, including diuretics, antihypertensives, tricyclic antidepressants, opioids, and some Parkinson drugs. Pregnancy, deconditioning following illness, and aging contribute to risk. Genetics likely plays a role in many cases, since OI conditions sometimes cluster within families. The pathway from cause to symptom is rarely a single line; in most patients, several contributing factors interact at once.

How Orthostatic Intolerance Is Diagnosed

Diagnosis begins with a careful medical history and physical examination, with particular attention to the timing of symptoms in relation to posture. Clinicians often perform an active stand test, in which heart rate and blood pressure are measured while a patient lies down and then again at intervals after standing. The tilt table test, considered a more controlled assessment, involves strapping the patient to a motorized table that gradually shifts from horizontal to nearly vertical while vital signs are continuously monitored.

Additional tests may include autonomic function studies, blood volume measurement, electrocardiography, echocardiography, and laboratory work to rule out anemia, thyroid disease, or adrenal dysfunction. Because symptoms overlap with anxiety disorders and ME/CFS, a thorough evaluation by a physician familiar with autonomic conditions is often necessary to reach a definitive diagnosis (Raj, 2013). Average time from symptom onset to diagnosis remains long, with surveys of POTS patients reporting waits of several years before correct identification (Shaw et al., 2019).

Orthostatic Intolerance and Disability

For many people with OI, the condition is more than an occasional inconvenience. Symptoms can be unpredictable and severe enough to limit education, employment, social participation, and routine self-care. In a large cross-sectional survey of POTS patients, only about a quarter were able to work or study full time, while a similar share reported being too unwell to work at all (Shaw et al., 2019). Chronic fatigue, brain fog, and the risk of falls all contribute to functional limitations that meet most legal definitions of disability.

Functional Limitations

People with OI may struggle with prolonged standing, walking long distances, working in warm environments, climbing stairs, lifting, or sitting upright for extended periods. Cognitive symptoms, often described as brain fog, can affect memory, concentration, and processing speed. Fainting episodes pose a real injury risk, particularly in occupations that involve heights, machinery, or driving. Some patients use mobility aids, including canes, rollators, shower chairs, or wheelchairs, especially during symptom flares.

Legal Recognition Under the Americans with Disabilities Act

The Americans with Disabilities Act (ADA) does not list specific medical conditions. Instead, it defines a person with a disability as someone who has a physical or mental impairment that substantially limits one or more major life activities. OI conditions, including POTS, can meet this definition when symptoms substantially limit activities such as standing, walking, concentrating, sleeping, or working (Job Accommodation Network, 2024). The ADA Amendments Act of 2008 broadened this interpretation to include conditions that remain limiting even when treated with medication or assistive devices, which is particularly relevant for patients who manage symptoms with daily compression garments, salt loading, or pharmacotherapy.

Workplace Accommodations

Reasonable workplace accommodations can help many people with OI remain employed. Common options include:

• Flexible scheduling and the option to work from home on bad days.
• Frequent rest breaks and access to water, salty snacks, and electrolyte drinks at the workstation.
• A stool, perch seat, or sit-stand desk to alternate between postures.
• Cooler ambient temperatures and access to a fan.
• Parking close to the building entrance or use of an elevator instead of stairs.
• Modified duties that reduce prolonged standing, lifting, or work in heat.
• Permission to recline briefly or lie down during a presyncopal episode.

Employers covered by the ADA are required to engage in an interactive process with the employee to identify accommodations that allow the worker to perform essential job functions.

Disability Benefits

In the United States, people with severe OI may apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Although OI is not separately listed in the Social Security Administration's Blue Book, applicants can qualify by demonstrating that their condition causes functional limitations severe enough to prevent substantial work for at least 12 months (Social Security Administration, 2023). Medical evidence typically includes tilt table results, autonomic function tests, treating physician statements, and a residual functional capacity assessment that documents specific limitations on standing, walking, lifting, and concentration. Long-term disability insurance policies may also cover OI when the condition prevents the policyholder from performing the duties of their own occupation or, after a defined period, any occupation.

Management and Treatment

There is no single cure for OI, but a combination of lifestyle measures, physical reconditioning, and medications can substantially reduce symptoms. First-line strategies focus on expanding blood volume and improving venous return. These include increasing fluid intake to two to three liters per day, raising salt intake under medical supervision, wearing compression garments such as waist-high stockings or abdominal binders, and elevating the head of the bed by a few inches.

Graded exercise is a cornerstone of long-term management, particularly for POTS. Recumbent or semi-recumbent exercise, such as cycling, rowing, and swimming, is generally better tolerated than upright walking in the early stages. Strength training of the lower body and core muscles helps the skeletal muscle pump return blood toward the heart and reduces the deconditioning that can perpetuate symptoms (Fu and Levine, 2018).

When lifestyle measures are not enough, clinicians may prescribe medications such as fludrocortisone, midodrine, pyridostigmine, beta-blockers, ivabradine, or droxidopa, depending on the underlying mechanism. Treatment of any contributing condition - thyroid disease, anemia, sleep apnea, iron deficiency, or mast cell activation - is also essential and often improves orthostatic symptoms in parallel.

Living with Orthostatic Intolerance

OI is often invisible to others, which can make daily life particularly difficult. A person who looks healthy may need to sit on the floor of a grocery store, leave a social event early, or pace themselves carefully through a workday. Educating family members, employers, teachers, and clinicians can reduce misunderstandings and improve support. Patient advocacy organizations such as Dysautonomia International, the POTS Foundation, and Standing Up to POTS provide educational resources, peer support groups, and updated research summaries.

For some people, symptoms improve significantly with treatment and time, particularly in adolescent-onset POTS, where many patients see partial or full recovery within several years. For others, OI is a long-term condition that requires ongoing management. In either case, recognizing OI as a legitimate medical and disability concern is the first step toward appropriate care, fair accommodations, and a workable quality of life.

References:

• Freeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., et al. (2011). Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clinical Autonomic Research, 21(2), 69-72.
• Fu, Q., and Levine, B. D. (2018). Exercise and non-pharmacological treatment of POTS. Autonomic Neuroscience, 215, 20-27.
• Job Accommodation Network. (2024). Accommodation and Compliance: Postural Orthostatic Tachycardia Syndrome (POTS). Office of Disability Employment Policy, U.S. Department of Labor.
• Low, P. A., Sandroni, P., Joyner, M., and Shen, W. K. (2009). Postural tachycardia syndrome (POTS). Journal of Cardiovascular Electrophysiology, 20(3), 352-358.
• Mathias, C. J., Low, D. A., Iodice, V., Owens, A. P., Kirbis, M., and Grahame, R. (2012). Postural tachycardia syndrome - current experience and concepts. Nature Reviews Neurology, 8(1), 22-34.
• Raj, S. R. (2013). Postural tachycardia syndrome (POTS). Circulation, 127(23), 2336-2342.
• Shaw, B. H., Stiles, L. E., Bourne, K., Green, E. A., Shibao, C. A., Okamoto, L. E., et al. (2019). The face of postural tachycardia syndrome: insights from a large cross-sectional online community-based survey. Journal of Internal Medicine, 286(4), 438-448.
• Sheldon, R. S., Grubb, B. P., Olshansky, B., Shen, W. K., Calkins, H., Brignole, M., et al. (2015). 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm, 12(6), e41-e63.
• Social Security Administration. (2023). Disability Evaluation Under Social Security (Blue Book). SSA Publication No. 64-039.
• Stewart, J. M. (2013). Common syndromes of orthostatic intolerance. Pediatrics, 131(5), 968-980.
• Sun, B. C., Emond, J. A., and Camargo, C. A. (2008). Direct medical costs of syncope-related hospitalizations in the United States. The American Journal of Cardiology, 95(5), 668-671.

For the first time since 2019, funding for the Office for People with Developmental Disabilities (OPWDD) has been significantly cut. Available FY 2026 amounts to only $6,260,000. A year earlier it was almost 1 billion more!

New York City isn't the most popular place to live for people with disabilities. The U.S. average is 28.7% of the population with disabilities. However, in New York City, only 11% of the population is disabled. Statewide, the figure is 22.8%. The low number of people with disabilities in New York City is due to economic factors. In 2023, the U.S. average was 24.2% of people with disabilities living below the poverty line. However, in New York State, the figure was 28.7%.

One of the reasons for the high poverty rate is the result of ineffective labor market policies. In New York City, the proportion of employed people with disabilities is consistently lower than the national average. According to the latest data for 2022, these figures were 34.7% and 26.1%, respectively. Interestingly, the proportion of employed people with disabilities is increasing nationally, while in New York City, it is decreasing. Unemployment among people with disabilities in New York City is also consistently higher than unemployment among people with disabilities in the United States. In 2022, both figures were 11.9% and 8.2%. Finally, the average wages of people with disabilities in New York City are unsustainable. Judge for yourself. In 2023, the median household expenditure in the New York Metropolitan Area was $91,520. During this same time, the median earnings of people with disabilities in New York City was $36,300. And the median household income of people with disabilities was $32,100.

In the current situation, people with disabilities survive primarily on budget support. But in 2026, disability support will be dealt a serious blow. New York State is in a budget crisis. Although the budget for the 2026 fiscal year is supposed to be adopted by April 1, it hasn't been passed even by May 1. Legislators can't decide how much money to spend and on what. Expenses are high, but revenues are low! The main disputes are over allocating funds for the state's car insurance laws, raising taxes on the wealthy, school aid, Tier 6 pension reform, and the creation of a 25-foot protest buffer around places of worship.

In the current situation, New York State Governor Kathy Hochul, a Democrat, is significantly cutting spending on disability support. For the first time since 2019, funding for the Office for People with Developmental Disabilities (OPWDD) has been significantly cut. See the table for data. Initially, the Recommended FY 2026 Appropriations for OPWDD was $10,116,918,000. However, the amount was ultimately reduced by almost a third. Available FY 2026 amounts to only $6,260,000. A year earlier it was almost 1 billion more!

Legislators and community organizations are trying to change the budget to benefit people with disabilities. In particular, labor unions representing direct care workers employed by non-profit agencies that contract with OPWDD and Disabilities Committee Chairs have joined forces to achieve this. The coalition is calling on lawmakers to include both a 4% cost-of-living adjustment (COLA) and Article VII language that guarantees funding is used to raise wages for direct care workers. The Governor's Executive Budget, which only allocated a 1.7% targeted inflationary increase - an amount that unions and their supporters say is too low.

Whether these efforts will be successful and what the final budget will be remains unclear. But it's clear that the lives of people with disabilities in New York City need to be improved. Increasing funding alone won't solve all the problems. A change in tactics and strategy is needed. This will be discussed in future articles.

This section of an otherwise unremarkable highway is one road, among many throughout the United States, which immerse travelers in a theme. Whatever your interest - driving historic routes or enjoying breathtaking views, passing through tiny towns or exploring large cities, following a culinary trail or checking out places where iconic scenes from movies or TV shows were shot - there’s likely to be a road trip that meets it.

Another benefit, for those with a physical handicap, is introductions to places that might present a challenge to people who walk with crutches or a cane, roll in a wheelchair or deal with other disabilities. They may enjoy much of what narrow streets, broad highways and other thoroughfares have to offer without having to leave their vehicle.

Streets can be more, much more, than just a way to get from here to there. They can lead you to new experiences filled with diversity and discovery. They can transport you to sites where a mixing bowl of people came together to establish a nation.

For example, they can include Lexington and Concord, Massachusetts, which share the honor of having opened the military phase of the American Revolution that ended British occupation of the Colonies. Following the initial skirmish at Lexington, British soldiers entered Concord on April 19, 1775, for the purpose of destroying arms and ammunition collected by the Americans. However, having been, forewarned by Paul Revere, the residents had already removed and hidden most of the supplies.

The Battle of Gettysburg was a turning point in the Civil War, the Union victory that ended General Robert E. Lee's most ambitious invasion of the North. Often referred to as the "High Water Mark of the Rebellion," its was the Civil War's bloodiest fray and it provided the inspiration for President Abraham Lincoln's immortal Gettysburg Address.

Fighting between Native Americans who occupied much of what was to become the United States, and European explorers who ventured upon the land, occupied important chapters of the country’s history. These conflicts occurred from the time of the earliest colonial settlements in the 17th century until the end of the 19th century.

The Indian Wars began the moment English colonists arrived in Jamestown, Virginia, in 1607, when the settlers started an uneasy relationship with Native Americans who had thrived on the land for thousands of years. In 1622, Powhatan Indians attacked and killed colonists in eastern Virginia, a bloodbath that gave the English government an excuse to justify their efforts to attack Native Americans and confiscate their land.

In 1636, the Pequot War broke out between Pequot Indians and English settlers at the Massachusetts Bay Colony. Driving to and through battlefields where these campaigns took place provides an introduction to other chapters of early American history.

Itineraries that include ghost towns allow people to step into the past and discover abandoned places that often have scintillating sagas to relate. Bodie, California became a boom town after a valuable vein of gold was discovered there in 1876. Then, following decades of decline, by 1915 it was described as a ghost town, one of the most authentic such relics in the West.

Calico, California, once a bustling silver mining enclave, today is a restored tourist attraction. The remains of Rhyolite, Nevada only hint at the humming mining camp which operated there after gold was found in 1905 in the surrounding hills.

Some gilt unearthed at those sites wound up as ornamentation in mansions and even castles built for wealthy people with a taste for showmanship. Boldt Castle, which occupies an island in the St. Lawrence River as it flows through New York State, is a romantic Rhineland-style structure built in the early 20^th century for German-American millionaire George Bold, a wealthy hotelier. The Biltmore Estate in North Carolina exemplifies the opulence of the Gilded Age in America.

And the list goes on. Does geological history told by underground caverns interest you? Do lighthouses shine a beam on an area of fascination? Are you drawn to star gazing away from the night light pollution of cities? These are among the countless road trips awaiting people ready to drive to new experiences.

Where the Term Comes From

The label purple washing belongs to a wider family of critiques that pair a color with the suffix "washing" to describe surface level allyship. The earliest and best known relative is greenwashing, a term popularized in the 1980s to describe corporate environmental claims that did not match operations. Pinkwashing followed, first in the breast cancer awareness context and later in critiques of LGBTQ+ branding. Rainbow washing now describes Pride month marketing without year round inclusion. Purple washing applies the same logic to disability (Haller, 2010).

Purple itself has multiple associations with disability. The disability pride flag uses a series of stripes that include lavender tones, and purple is widely adopted by disability charities, awareness campaigns, and advocacy organizations. The "Purple Pound" - a phrase coined in the United Kingdom to describe the collective spending power of households containing a disabled person - has been cited at roughly 274 billion pounds annually, a figure that has helped move disability from the margins of marketing strategy to its center (Purple Tuesday, 2020). When a corporation paints a logo purple for a day, it is borrowing from this established visual shorthand.

Common Forms of Purple Washing

Awareness Day Performance

The most visible form of purple washing tends to cluster around set dates: the International Day of Persons with Disabilities on 3 December, Global Accessibility Awareness Day in May, Disability Pride Month in July, and various national observances. A company may post a single graphic, change a profile photo, or release a statement, then return to inaccessible products, websites that fail basic Web Content Accessibility Guidelines, and physical premises without step-free entry. Disabled audiences have grown adept at spotting this pattern, sometimes called "ribbon allyship" (Pulrang, 2021).

Inspiration Porn and Charity Imagery

The late comedian and activist Stella Young coined the term "inspiration porn" to describe media that presents disabled people as inherently inspiring purely for living their lives, and that is consumed primarily by non disabled audiences for emotional uplift (Young, 2014). When organizations recycle this imagery in their marketing - the smiling child with a prosthetic, the wheelchair athlete framed as overcoming - they often do so without consulting disabled communities and without altering their underlying practice. The visual signals concern, but the relationship to disabled people remains charitable rather than equitable.

Tokenistic Hiring and Casting

A second pattern involves hiring or casting a single disabled person, often in a public facing role, while leaving recruitment pipelines, retention policies, and promotion practices unchanged. Sia's 2021 film Music, which cast a non autistic performer in a lead autistic role and depicted prone restraint techniques widely criticized by autistic advocates, became a reference point in debates about who is allowed to tell disability stories (Andrews et al., 2019). The pattern extends well beyond film. Industry surveys conducted by disability employment networks regularly find that visible disability representation in advertising outpaces actual representation in workforces.

Surface Level Accessibility Claims

Technology firms, hotels, retailers, and transport providers increasingly market themselves as accessible. Some claims are well founded. Others rest on a single accessible feature - a screen reader compatible page, one adapted hotel room, an automatic door - while the broader product remains difficult or impossible for many disabled users to navigate. Annual audits of the most visited websites have repeatedly found accessibility errors on the overwhelming majority of home pages, despite public commitments to inclusion (WebAIM, 2025).

Political and Institutional Washing

Governments and public institutions can also engage in purple washing. A ministry may announce a disability strategy, fund a single high visibility program, and reference the United Nations Convention on the Rights of Persons with Disabilities, while leaving benefits assessments, social care funding, or institutional living arrangements broadly unreformed. Disabled People's Organizations have cautioned that ratification of the Convention, without domestic implementation, can itself become a form of purple washing (United Nations, 2006; Shakespeare, 2014).

The Purple Pound and Commercial Incentives

Purple washing is not random. It responds to a clear commercial calculation. Disabled people and their families represent a substantial share of consumer spending, and surveys consistently show that disabled customers and their networks will switch providers when accessibility is poor or representation is absent. The Purple Pound figure, the World Health Organization estimate that roughly 1.3 billion people experience significant disability worldwide, and the aging of populations across high income economies all point in the same direction (World Health Organization, 2022). Brands that ignore disabled customers risk losing them. Brands that signal inclusion without delivering it can capture short term goodwill at low cost.

This commercial pressure is reinforced by reputational pressure. Investor frameworks increasingly include diversity, equity, and inclusion metrics. Procurement standards, particularly in the public sector, may require evidence of accessibility commitments. The combination creates an incentive to perform inclusion publicly even where internal capacity is limited. Purple washing is, in this sense, a rational if cynical response to misaligned incentives (Heiss, 2011).

Recognizing Purple Washing in Practice

Several markers help distinguish performance from substance. Among the more useful are:

• Awareness days messaging from organizations whose physical or digital products fail basic accessibility standards on other days of the year.
• Public commitments without published targets, timelines, or progress reports.
• Disability imagery in advertising without disabled people in senior roles, on advisory boards, or in product design teams.
• Accessibility framed as a feature for a separate user group rather than as a baseline for all users.
• Charity partnerships used to deflect from criticism of core operations or working conditions.
• The absence of disabled employees, contributors, or consultants from any visible part of the campaign.

None of these markers is conclusive in isolation. Together, they describe a recognizable pattern that disabled audiences and disability journalists have documented for years (Haller, 2010; Ellis and Goggin, 2015).

The Harms of Purple Washing

Purple washing is sometimes treated as harmless marketing. It is not. The first and most direct harm is that it absorbs attention, funding, and political will that might otherwise support substantive change. When a campaign performs inclusion convincingly, audiences and policymakers can come to believe that the underlying problem is being addressed. Second, it crowds out disabled led organizations, which often operate on smaller budgets and cannot match the visibility of corporate or government messaging. Third, it tends to reproduce ableist narratives - the inspirational individual, the deserving recipient, the grateful beneficiary - rather than the political and structural framing that disability rights movements have spent decades building (Charlton, 1998; Mitchell and Snyder, 2015).

There is also a slower harm. Disabled communities, like other groups subject to repeated performative gestures, become understandably sceptical of claims about inclusion. That scepticism is reasonable, but it complicates the work of organizations attempting to act in good faith. Trust, once eroded, is expensive to rebuild.

Purple Washing and Adjacent Critiques

Purple washing overlaps with several adjacent concepts without being interchangeable with any of them. Ableism describes the broader system of beliefs, practices, and policies that disadvantage disabled people; purple washing is one of its surface expressions, not its source. Performative allyship is a wider phenomenon that applies across marginalized communities, while purple washing is its disability specific instance. Inspiration porn, as defined by Young (2014), is a particular media trope that purple washing campaigns frequently rely upon, but the two are not the same: a campaign can avoid inspirational framing and still purple wash, and a piece of inspiration porn can circulate without any corporate sponsor behind it.

The distinctions matter because remedies differ. Reducing inspiration porn requires editorial and curatorial change in media organizations. Tackling othering and ableism requires legislative, educational, and cultural work across generations. Reducing purple washing specifically requires accountability mechanisms, inclusive procurement standards, and a willingness among disabled communities and their allies to publicly evaluate the gap between claim and reality (Goodley, 2014).

What Genuine Disability Inclusion Looks Like

The disability rights principle "Nothing about us without us," widely associated with the work of James Charlton and adopted by Disabled Peoples' International, offers the clearest test (Charlton, 1998). Genuine inclusion involves disabled people in setting priorities, designing solutions, and evaluating outcomes. Several practical markers tend to follow:

• Disabled people in governance and senior leadership, not only in front of cameras.
• Co-design processes that begin before specifications are drafted, rather than user testing added at the end.
• Accessibility treated as a baseline standard across all products, services, and communications, with measurable conformance to recognized guidelines.
• Procurement, recruitment, and retention practices audited and revised with input from disabled employees and consultants.
• Transparent reporting on workforce representation, pay, and accommodation rates, comparable to the reporting now common for gender.
• Funding relationships with disabled led organizations that are sustained rather than transactional.

The Social Model of Disability, developed primarily by British disabled scholars and activists in the 1970s and formalized in the work of Mike Oliver, frames disability as the product of social, environmental, and attitudinal barriers rather than individual deficit (Oliver, 1990). Organizations that take the model seriously tend to examine their own contribution to those barriers first, before turning to imagery and messaging.

Conclusion

Purple washing is best understood as the gap between disability messaging and disability practice. It is encouraged by real economic and reputational incentives, and it survives because the gap is often invisible to non disabled audiences. Closing the gap requires moving disability from the communications team to the boardroom, from the awareness day to the procurement contract, and from the campaign image to the hiring decision. The color is fine. What sits behind it is what matters.

References:

Andrews, E. E., Forber-Pratt, A. J., Mona, L. R., Lund, E. M., Pilarski, C. R., and Balter, R. (2019). #SaytheWord: A disability culture commentary on the erasure of "disability." Rehabilitation Psychology, 64(2), 111-118.

Ellis, K., and Goggin, G. (2015). Disability and the media. Palgrave Macmillan.

Goodley, D. (2014). Dis/ability studies: Theorising disablism and ableism. Routledge.

Haller, B. A. (2010). Representing disability in an ableist world: Essays on mass media. Advocado Press.

Heiss, S. N. (2011). Locating the bodies of women and disability in definitions of beauty: An analysis of Dove's Campaign for Real Beauty. Disability Studies Quarterly, 31(1).

Langtree, I. C. (2025). Disability Rights: Nothing About Us, Without Us Examined. Disabled World.

Mitchell, D. T., and Snyder, S. L. (2015). The biopolitics of disability: Neoliberalism, ablenationalism, and peripheral embodiment. University of Michigan Press.

Oliver, M. (1990). The politics of disablement. Macmillan.

Pulrang, A. (2021). What disability community language tells us about ourselves. Forbes.

Purple Tuesday. (2020). The Purple Pound: Understanding the spending power of disabled consumers. Purple.

Shakespeare, T. (2014). Disability rights and wrongs revisited (2nd ed.). Routledge.

United Nations. (2006). Convention on the Rights of Persons with Disabilities. United Nations.

WebAIM. (2025). The WebAIM Million: An accessibility analysis of the top 1,000,000 home pages. WebAIM.

World Health Organization. (2022). Global report on health equity for persons with disabilities. World Health Organization.

Young, S. (2014). I'm not your inspiration, thank you very much. TED Talk.

I played sports, did well in school, and graduated. After school, in 1999, I went to study in the Russian Federation, entering a university in Krasnodar at the Faculty of Law, majoring in Jurisprudence. I studied quite well, continued playing sports, didn't drink, and didn't smoke. I had friends and a girlfriend whom I dated for about a year. I lived an ordinary life, made plans, and was finishing my studies.

On April 26, 2004, during my final year of study, my friends and I went to a sports stadium in the evening to work out on the horizontal bars. During a complex element - a somersault, a flip on the bar - I slipped and fell. I hit my head hard and broke my neck.

The fall was so severe that I lost consciousness and woke up only on the second day in intensive care. At that time, I was a student from Turkmenistan, and the Russian hospital was in no hurry to operate on me. The surgery was performed only two weeks after the fall, and time is crucial for spinal injuries. During this time, the damage became severe. I underwent two surgeries at the 1st Krasnodar Regional Hospital. I stayed in the hospital for six months. In October 2004, my sister and brother-in-law took me home to Ashgabat.

Primary diagnosis: Severe concomitant injury. Complicated fracture-dislocation of the C5 vertebra. Severe spinal cord contusion. In April 2004, as a result of the trauma, a fracture of the cervical spine with displacement occurred, which led to compression and severe damage to the spinal cord. Two complex surgeries were performed to decompress (free) the spinal cord and fix the vertebrae with metal structures and a bone graft.

Tetraplegia: Complete absence of active movements in all four limbs.

Pelvic organ dysfunction: Inability to urinate independently (neurogenic bladder, use of a catheter).

Muscle atrophy: Pronounced wasting of the muscle tissue in the limbs.

Spinal shock and its consequences: Loss of all types of sensation below the level of injury (from the level of C5 - C6 segments).

Concomitant complications: Chronic cystopyelonephritis (inflammation of the kidneys and bladder) and a tendency to form bedsores.

Summary for organizations: The patient is a disabled person with a complete loss of motor activity (paralysis of arms and legs) and pelvic organ functions due to critical damage to the spinal cord in the cervical region. The condition requires constant external care, medical observation, and regular rehabilitation.

Since then, I have had total paralysis of all four limbs - quadriplegia, tetraplegic paralysis. I am completely paralyzed from the neck down. I can feel and move my neck slightly, but I cannot move my shoulders, arms, legs, or body. I have been living with a Group 1 disability for over 22 years. I am a prisoner of my own body.

Right after the fall and the hospital, my girlfriend, whom I had been dating for a year, found another man and left me a few months later. It was very hard. I felt betrayed.

Then my father started drinking heavily, fell into depression, and died. My older biological sister called me a complete invalid, a useless creature, betrayed me, and left the family. I haven't seen or heard from her in over 15 years. Friends, relatives, and acquaintances gradually disappeared, stopped calling and visiting. Time erased all connections. I was left alone.

Out of my entire family, only my mother and two sisters remained by my side. My mother is 73 - 75 years old, she is a pensioner. My sisters are 43 - 50 years old. The older sister has a 9-year-old daughter. Only two of my sisters work: one is a gynecologist in a clinic, the other is a teacher. Their salary is about 110 dollars a month. My mother and I receive a pension of about 30 dollars. This money is catastrophically insufficient.

Over 20 years of illness, we have spent and exhausted all our resources, sold jewelry and belongings, and took out a loan for treatment, which we still cannot repay. All the money goes toward medicines and dressing materials. Sometimes neighbors bring food on holidays. No one has helped with money or medications.

I applied to foundations in America, Germany, and Russia, to the "Predanie" foundation, wrote to Beth Eisenbud, but received no help.

Long-term paralysis led to muscle atrophy and dystrophy. I have type 2 diabetes, asthma, frequent inflammations, and chronic infections. My wounds hardly heal.

I had three fistulas - one healed, but two have remained for 8 - 11 years: one at the bottom of the anus, the other higher up. They get inflamed, bleed, and fester. I have bedsores on my buttocks, shoulders, and knees, ulcers that have turned into open, purulent wounds. I had a phlegmon on my foot.

We treat the wounds 4 times a day: hydrogen peroxide, iodine, furacilin, alcohol spray, ointments, sterile bandages, adhesive plaster. We use anal suppositories. I constantly take antibiotics and vitamins. I take antidiabetic pills, follow a diet, and do not eat sweets. All of this is very expensive.

I live on the 4th floor of an old building without an elevator or ramps. The stairs are narrow. To bring me down or carry me up requires four strong men. I only have my mother and two sisters; they cannot lift me.

I have a wheelchair, but I cannot sit in it without being secured. I have to be tied down with belts and bandages. I only sit for a couple of hours a day - to eat and go online. The rest of the time I lie on an old mattress, turning only on my right and left sides.

I haven't left my room in 22 years. I have never been to rehabilitation centers. I haven't received any treatment other than medications at my own expense. I haven't seen or heard from Turkmen social services.

After the injury, my girlfriend leaving, my father's death, my sister's betrayal, and my friends disappearing, I grieved, wanted to die, and sought death. I felt like a ghost, lifeless. I drank. I had 4 suicide attempts. I tried to meet people online, to find a friend or a girlfriend, but with my disability, no one wanted to be friends or build a relationship. I was left alone in my room, existing in isolation for over 22 years.

My story is before and after. Today I have a kind of anniversary: 22 years since I broke and became paralyzed. I have complete paralysis, my arms and legs do not move. Before that, for 22 years I lived a full, fully functional, healthy life: I ran, jumped, was useful, and actively played sports. Those are my first 22 years. And for the second 22 years, I am completely paralyzed, motionless. I am inactive, defective, and non-functional; only my head works.

Over these 22 years, I rarely sought help and support. Except perhaps in critical moments, when it was scary, when panic set in that I would die and things would get worse. I tried to look for sponsors, patrons, investors, charitable foundations, organizations, and institutions that would help me get surgery, undergo treatment, rehabilitation, and now at least help with medications. But alas. Over the course of 20 years, I sought passive help very rarely, maybe 15 - 20 times, perhaps when my bedsores turned into a phlegmon and the wounds festered, and fistulas appeared. They had to be cut, opened, the pus pulled out, cleaned, and washed. All this was done at home, because there was no money, I had no trusted doctors, and there was no way to carry me downstairs, take me somewhere, and then bring me back and keep me there. To maintain me, two or three people need to be around at all times: my mother and two sisters. They have always done this and still do.

It was exactly in these moments of fear that I would look for help for maybe a week, but I always failed; no one responded. Everyone ignored it as always, no one replied, no one tried to help, no one answered letters and requests. I lived like this for 20 years, trying everything myself, coping with everything. I worked on myself, but alas, after 20 years of paralysis, I developed type 2 diabetes, and then very major complications began. All my bedsores, former phlegmons, and fistulas that I had started to fester and grow, and my body began to die off. I panicked; it was very scary.

For the last two years out of these 22, I have been desperately and furiously looking for help. I reached out to charitable foundations and wealthy people. I wrote to 500 foundations in America, 400 foundations in Germany, 200 foundations in Russia, 400 international charitable organizations, and about 200 rich, famous people: singers, billionaires from Forbes. I applied to international charitable organizations, funds, trusts, banks. During this time, I wrote and personally sent more than one and a half thousand applications, but received almost no replies. About 80 percent simply ignore my letters. Roughly 10 percent reply with a refusal because they only help people in their own country. The remaining 10 percent direct me to other charitable foundations, which, in turn, send me to yet other foundations again. So the help goes in circles between organizations, but it almost never reaches people, and no one provides real financial support. In the end, I realized that the majority simply do not care about my condition. Either my age isn't right, or my nationality didn't please them, maybe the illness isn't complex enough, or the region didn't suit them.

I have almost resigned myself to this. Now I am no longer looking for major help; I've given up, as they say. Disappointment, unfulfilled expectations, and, of course, pain and resentment. I thought I was different, I believed that my illness and my suffering were the most unique, that I had some kind of special case. It turned out nobody cares. There is no uniqueness in me or my situation. Just another sick disabled person out of many hundreds of thousands, millions around the world.

The only thing is, I am ashamed before the children. Children who haven't seen life, who don't know what a first kiss, football, running, or the sea is. How ashamed I am before them when I asked for help from charitable foundations and organizations that help the disabled. At that time, it hurt me to ask for money that could have helped children. But the fear of death, and that I would rot alive, that my arms and legs would fall off - is very terrifying. I pushed my conscience aside, although I felt guilty. I continued looking for help, but in the end, it all came to zero, nobody helped me with anything. I just went cold.

That's it, I realized that mercy, sympathy, compassion are empty words with no strength or meaning behind them. And good is just a candy wrapper without filling, which evil people forced us to believe in so that only others would do good. Good is also an empty word, there is no good in people. Over 22 years, I reached out to girls on many dating sites to chat, to meet - everyone avoided me. Apparently, the same story as with the foundations: either the illness is wrong, or the country is wrong. I tried to communicate in communities, but there are only evil people there: they either ignore you or gloat. They asked how I type. I had to explain to everyone that I type with a Chinese chopstick. No one understood, no one believed, and I had to prove it to everyone all over again. I thought that people with chronic diseases - oncology, cancer, paralysis - are kinder and more merciful to people like them. But I was deeply mistaken. Empathy is also just a fake.

People are ruled by self-interest, profit, greed, avarice, stinginess, and pride. Acting, hypocrisy, falsehood, and lies. Believe me, I know what I'm talking about. Over these 22 years, I have conducted many experiments on myself, on my body, consciousness, hearing, and vision. And I also observed the communication of people - sick and healthy. How the healthy treat the disabled and how the disabled treat the healthy. It's just a nightmare. Everything is the same, there is no difference. Everyone is looking for comfort, profit, and their own well-being. Nobody cares about everything else. I understood the true essence and the true meaning of the genius words: do not trust, do not fear, do not beg. I almost wrote a book and froze everything because I saw no prospect that it would be interesting to anyone and that it could be published.

Now I continue to rot, my wounds constantly torment me, bleed, fester, and die off. And in a fit of fear of death, I sometimes panic and, under the influence of fear, try to write to someone and ask for help. I just stupidly beg for alms and handouts, as much as anyone can give. I write: if you give 10 dollars - good, if you give 100 dollars - that will be super. For you, 100 dollars is a glass of wine, but for me, it is almost a month of life, it is two and a half of my pensions. With this money, I can live for a month, buying myself all the medicines. But in response, there is usually silence and being ignored. Nobody cares, especially about an old man. In a couple of months, I will turn 44, and my whole story is 22 years before and 22 years after. Such is my fate.

The insistence that not everyone is on the autism spectrum preserves a boundary that diagnosis requires. But it also raises a question that diagnosis cannot fully answer: what, exactly, is being separated from what?

The claim that autism is a distinct neurodevelopmental condition is clinically precise. Within the framework of the DSM-5-TR, Autism Spectrum Disorder is defined by persistent differences in social communication and interaction, alongside restricted or repetitive patterns of behavior. These traits must also be accompanied by clinically significant impairment in daily functioning.

That final requirement is decisive. Diagnosis is not simply a matter of identifying traits. It is a judgment about impact.

There is no blood test for autism. No brain scan confirms it. Clinicians rely instead on developmental history, behavioral observation, and structured instruments such as the ADOS-2 and ADI-R. Screening tools in childhood and adulthood may indicate likelihood, but they do not settle the question. They point toward a threshold at which variation becomes impairment.

A diagnosis is made when a configuration of traits crosses that threshold.

What complicates this picture is that the traits themselves are not confined to those who meet diagnostic criteria. They are widely distributed across the population. Sensory sensitivity, preference for routine, intense focus, and differences in social communication appear in many people who are never diagnosed. Others exhibit clusters of these traits at a level that produces significant functional disruption and therefore receives a clinical label.

The distinction, then, is not between presence and absence. It is between distribution and configuration.

Human traits vary continuously. Diagnosis does not.

It is here that a conceptual tension begins to emerge. If traits are continuous, it becomes tempting to imagine the spectrum as something that extends across everyone. But this is where clinical reasoning draws its necessary line. Continuity of traits does not imply continuity of impairment.

Still, the overlap is revealing. The same traits that are disabling in one environment may be neutral or even advantageous in another. Sensory sensitivity can become distress under overload. Intense focus can become liability in systems that demand constant task-switching. Differences in communication style can become barriers in environments that privilege rapid reciprocity.

This suggests that autism is not only a property of the individual, but a relationship between cognition and environment.

The boundary, then, is not purely biological. It is ecological.

And once that is seen clearly, the spectrum no longer appears as a line dividing two kinds of people. It appears as a distribution of human variation encountering the limits of a particular social world.

The difficulty is that diagnosis must still draw a line even when reality resists stable edges. Clinical systems require thresholds in order to allocate support, determine eligibility, and organize care. Without them, need becomes harder to name, not easier to address.

But the existence of a threshold does not settle what lies beneath it.

If anything, it clarifies the tension. Autism remains a clinically necessary category because some configurations of traits produce sustained difficulty that cannot be reduced to preference or personality. At the same time, those same traits do not appear out of nowhere at the moment of diagnosis. They exist along a wider continuum of human variation, only becoming visible as "disorder" when they encounter environments that cannot accommodate them.

This is where the idea of a "spectrum" becomes unstable in public discourse. It is often treated as a single line stretching from "not autistic" to "very autistic," as if the only question were degree. But clinically, it is not a scale of intensity. It is a description of how multiple traits cluster together across domains: communication, behavior, sensory processing, and flexibility. A person is not diagnosed because they have "more autism" than another person. They are diagnosed because a particular configuration of traits reaches a level of functional impact.

This distinction matters because it exposes a common misunderstanding. When people say "everyone is a little autistic," they are usually pointing to genuine human overlap: most people have moments of sensory overload, social awkwardness, or attachment to routine. But these isolated traits do not constitute the clinical condition. They do not, in most cases, organize into a stable pattern of impairment.

The clinical threshold, in other words, is not arbitrary. But neither is it purely natural. It is a negotiated boundary between human variation and the demands of specific environments.

Once that is recognized, the spectrum can no longer be understood as a simple medical ladder. It becomes something closer to a map of friction points between cognition and world.

This is where a second layer of interpretation becomes unavoidable.

If the same traits shift from neutral to disabling depending on context, then disability is not located solely inside the individual. It is produced in the interaction between the individual and the structures they must navigate. Fluorescent lighting, constant social signaling, open-plan offices, rapid conversational turn-taking, and implicit social norms all shape whether a given cognitive style becomes sustainable or exhausting.

Autism, in this sense, is not only a neurodevelopmental condition. It is also a diagnostic window into the relationship between human diversity and environmental design.

This does not dissolve the clinical category. It reinforces why it exists. A diagnosis marks those whose needs are consistent, significant, and not easily absorbed by existing environments. It identifies where support must be structured rather than improvised.

But it also raises an uncomfortable implication. If disability emerges at the point of mismatch between cognition and environment, then environments are not neutral backgrounds. They are active participants in producing or reducing disability.

This shifts the question. It is no longer only about how individuals are classified. It is about how systems are built.

Neurotypicality, from this perspective, is not a universal standard of cognition. It is a statistical center produced by environments that reward certain forms of communication and sensory tolerance. It is what emerges when a particular configuration of traits is most easily accommodated by prevailing social structures.

The spectrum, then, is not a line separating normal from abnormal minds. It is a distribution of human variation filtered through the constraints of a particular world.

And that world is not fixed.

What counts as "functional" cognition has always depended on historical and material conditions. In one context, sustained focus is essential. In another, rapid switching is rewarded. In one environment, sensory sensitivity is irrelevant. In another, it becomes a daily burden. The same human traits move in and out of alignment depending on how the environment is arranged.

Seen this way, autism does not reveal a deviation from nature. It reveals how tightly "normality" is bound to design.

The most persistent confusion arises when these two levels are collapsed into one. On one level, autism is a clinical category that identifies individuals with significant support needs. On another, it exposes the broader truth that human cognition is variable and only becomes "disordered" in relation to specific expectations.

Both levels are real. Neither replaces the other.

The clinical level is necessary for care, funding, education, and protection. Without it, those with high support needs would become harder to identify, not easier to include. The structural level is necessary for understanding why those needs arise in the first place, and why they vary so dramatically across environments.

Holding both together is difficult because each resists the logic of the other. Clinical systems require boundaries. Philosophical interpretation reveals continuities. One organizes care. The other destabilizes assumptions about where care is needed and why.

The spectrum sits precisely at this intersection.

Not as a line that divides humanity into categories, but as a structure that shows how categories are produced at all.

And what it shows, most consistently, is that the boundary between "autistic" and "not autistic" is not a line drawn through nature. It is a line drawn through human variation after the fact, when variation meets the limits of a particular social world.

The question is not whether the line exists.

It is what it becomes visible against.

Once this is clear, the ethical question shifts. It is no longer only about who qualifies for diagnosis. It is about what kind of society is built around this distribution of minds.

If traits associated with autism exist, in varying degrees, across the population, then the work of adaptation cannot be assigned to a single group. It cannot be framed as the task of "fixing" those who diverge most from the norm. It becomes a shared responsibility to build environments, habits, and institutions that support a wide range of cognitive styles.

This is where the universal intuition, properly understood, becomes constructive rather than reductive.

In early childhood, when the brain is most responsive to experience, inclusion can be treated not as an abstract value but as a set of practiced skills. Parents and teachers can cultivate what might be called empathy and flexibility as capacities that develop through repetition. Children can be guided to tolerate difference, adapt to changing expectations, and engage across styles of communication that are not identical to their own. These are not specialized interventions. They are foundational practices that benefit all children while making environments more navigable for those with greater support needs.

At the same time, the broader public can be taught to recognize moments of what might be called social overload. These are the points at which the brain defaults into defensiveness, tribal thinking, or withdrawal in response to difference. Learning to pause at that threshold, rather than react automatically, is a form of cognitive work that extends beyond any diagnostic category. It is a shared human task.

Research priorities could reflect this shift. Instead of focusing exclusively on deficits within individuals, greater attention could be directed toward the conditions under which diverse groups successfully collaborate. This would include studying interactions across different levels of support need and identifying the kinds of environmental and relational factors that allow understanding to emerge. The question would not only be what makes individuals struggle, but what enables connection.

Taken together, these approaches suggest a broader reorientation. Support would no longer be framed as a specialized service for a defined minority, but as a general standard for how people learn to live with one another. The goal would not be statistical normalcy, but functional flourishing across a wide range of cognitive profiles.

This does not eliminate the need for diagnosis. Clinical categories remain essential for organizing care, securing resources, and ensuring that those with the greatest needs are not overlooked. Nor does it erase the reality that individuals at higher levels of support requirement experience the world in ways that demand sustained, often intensive assistance.

What it does is redistribute responsibility.

Instead of locating the problem entirely within the individual who meets diagnostic criteria, it recognizes that the challenge of building a livable social world is shared. Some individuals require more support to navigate that world. But everyone participates in shaping the conditions that make navigation possible or impossible.

Seen this way, the spectrum is neither universal in the sense of collapsing all distinction nor bounded in the sense of separating entirely different kinds of minds. It is a layered model. Beneath the clinical threshold lies a continuous distribution of traits. Above that threshold lies the practical necessity of care.

The clarity comes from holding both at once. Human variation is continuous. Support is not.

And a society that understands that distinction can move beyond the false choice between pathologizing difference and dissolving it into abstraction. It can begin to ask a better question: not who belongs on the spectrum, but how we build a world in which more people, across that spectrum of traits, can actually thrive.

About the Author

George Cassidy Payne is a freelance journalist, poet, and community-based writer whose work moves between philosophy, mental health, and contemporary culture. He has worked for over two decades in social services, including suicide prevention and crisis counseling, and has served as a 988 Crisis Counselor since 2022.

Ben Tyers is the creator of TactivoPlay, a new collection of accessible audio-based games for Windows PCs and laptops. Instead of treating accessibility as an extra option added later, the games are being designed from the beginning around spoken instructions, clear sound cues, simple controls, and non-visual gameplay.

Gaming is often described as something for everyone, but for blind and low-vision players, many games still rely too heavily on screens, visual menus, fast reactions, and tiny on-screen details. TactivoPlay aims to change that by putting sound at the heart of play.

The Audio Games Collection

The collection will include 20 audio games in total. The first 10 are already in beta testing, with the remaining 10 planned to be shaped by feedback and suggestions from players. Current games include:

• Audio Racer
• Beat Tapper
• Black Jack
• Bug Basher
• General Knowledge Quiz
• Hi-Low Card Game
• Pizza Maker Plus
• Sequence Memory
• Soundcast Fishing
• Treasure Chest and the Ancients

Each game explores a different style of play. In Audio Racer, players listen for engine sounds, warning cues, and directional audio to stay on the track. In Bug Basher, players use stereo sound to locate bugs in an arena. Sequence Memory challenges players to remember and repeat patterns of sounds, while Soundcast Fishing uses splashes, movement, and bite cues to guide the player through each catch.

The idea is not simply to make games that can be played without sight, but to make games that feel natural, enjoyable, and rewarding when played through sound. Spoken instructions explain what is happening, audio feedback confirms actions, and selected games use stereo or positional audio to help players understand direction and distance.

TactivoPlay is especially aimed at blind and low-vision gamers, but the project also has wider appeal. It could be useful for families, schools, accessibility groups, support organizations, and anyone interested in inclusive game design. The games are intended to be easy to learn, quick to play, and friendly for players who may not use traditional visual interfaces.

At a time when accessibility in games is becoming an increasingly important topic, TactivoPlay offers a simple but powerful idea: games do not always need to be seen to be played. Sometimes, the adventure can begin by listening.

A Word from Ben Tyers, TactivoPlay Creator

My name is Ben Tyers, and I am the creator of TactivoPlay.

TactivoPlay grew from a long-standing passion for game design, accessibility, simple controls, and the idea that games should be enjoyable for as many people as possible. I have always loved making small, focused games that are quick to understand, fun to play, and built around clear feedback. Over the years, that interest has developed into a much bigger mission: creating games that do not depend entirely on sight, complex controls, or traditional game interfaces.

TactivoPlay is my latest accessible gaming project. It is a collection of audio-based games designed especially for blind and low-vision players, using spoken instructions, sound cues, simple controls, and clear audio feedback. Rather than taking existing visual games and trying to adapt them afterwards, TactivoPlay is being designed around sound from the beginning. The aim is to make games that feel natural to play without needing to rely on a screen.

My Background In Accessible Games

Over the years, I have created hundreds of mini games for PC, tablets, and phones. These have included puzzle games, reaction games, arcade games, memory games, card games, quiz games, racing games, and many other small game ideas.

One of my biggest accessible gaming projects before TactivoPlay was One Button Controlled Games, a collection of more than 50 accessible games that can be played using a single input. These games were designed so players could use a mouse button, spacebar, or accessible switch controller. The idea was simple: reduce the control barrier and make gameplay possible for people who may find standard keyboard, mouse, touchscreen, or controller layouts difficult to use.

That project taught me a huge amount about accessibility, game flow, player feedback, difficulty design, and the importance of keeping controls simple. It also showed me that accessible games do not need to be boring, limited, or treated as an afterthought. With the right design, a simple input method can still support a wide range of game types and experiences.

TactivoPlay builds on that same belief, but with a stronger focus on audio-first play. Instead of asking, "How can this visual game be made accessible?" the better question is, "What kind of game becomes possible when sound is the main way to play?"

Why I Created TactivoPlay

Many games still rely heavily on visuals. Menus, maps, enemies, scores, warnings, instructions, progress, and results are often shown on screen first, with accessibility added later if it is added at all. This can make many games difficult or impossible to enjoy for blind and low-vision players.

TactivoPlay was created to explore a different approach. The games are being designed around:

• Clear spoken instructions.
• Useful sound effects.
• Audio cues that help guide the player.
• Simple controls.
• Game ideas that work without needing visual reactions.
• Feedback that tells the player what happened, what is happening, and what to do next.
• Fun, repayable gameplay that can be understood through sound.
• The goal is not just to make games "accessible enough." The goal is to make games that are genuinely enjoyable as audio games.

TactivoPlay includes a range of different game types, including card games, racing games, memory challenges, music-based games, quizzes, adventures, and more. The first games are currently being shaped through testing and feedback, with the final collection planned to include 20 audio-based games.

Designed With Players, Not Just For Players

One of the most important parts of TactivoPlay is feedback.

The project is currently being developed with input from beta testers. This means players can help shape how the games work, what audio cues are needed, how instructions are delivered, how menus should behave, and what kinds of games should be added next.

This matters because accessibility is not something that should be guessed from a distance. The best ideas often come from the people who will actually use the games. By listening to players, TactivoPlay can become clearer, more useful, and more enjoyable.

The final 10 games in the collection will also be shaped by player suggestions, which means the project can grow in a direction that reflects what players actually want.

My GameMaker Experience

Alongside making games, I have also written several books about game programming and GameMaker.

I am the author of GameMaker Fundamentals: Learn GML Programming to Start Making Amazing Games, published by Apress. This book teaches the core programming skills needed to create games using GameMaker, including important topics such as variables, layers, sprites, levels, GUI design, and publishing games.

I also wrote GameMaker Programming Challenges, a book containing 500 programming challenges designed to help GameMaker users improve their GML knowledge. The challenges cover a wide range of game development topics, from simple beginner tasks to more advanced programming ideas.

Writing these books helped me think deeply about how games are built, how beginners learn programming, and how small game mechanics can be broken down into clear, understandable steps. That same approach is part of TactivoPlay. Each game needs to be simple enough to understand, but interesting enough to enjoy. Each sound needs a purpose. Each control needs to make sense. Each player action needs clear feedback.

My Design Philosophy

My approach to game design is based on a few simple ideas.

• Games should be easy to start. Players should not have to fight through confusing menus, unclear instructions, or complicated controls before they can enjoy the experience.
• Games should provide clear feedback. When a player presses a button, makes a choice, wins a round, loses a life, catches a fish, answers a question, crashes a car, or collects an item, the game should tell them clearly what happened.
• Games should respect different players. Not everyone plays in the same way, at the same speed, or with the same needs. Good design should make room for that.
• Games should be fun first. Accessibility should not remove the excitement, challenge, humor, surprise, or satisfaction of playing. It should help more people reach those experiences.

TactivoPlay is built around these ideas.

A Project Built Around Sound

Audio game design is an exciting challenge because sound can do so much more than simply replace visuals. Sound can create atmosphere, direction, tension, timing, rhythm, reward, danger, movement, space, and personality.

• A racing game can use engine sounds, lane cues, crashes, countdowns, and finish-line feedback.
• A fishing game can use water ambiance, splashes, casting sounds, bite alerts, reel tension, and catch sounds.
• A quiz game can use spoken questions, answer options, countdown cues, correct and incorrect sounds, and score announcements.
• A memory game can use patterns of tones, voices, instruments, or effects.
• An adventure game can use footsteps, doors, treasure sounds, character voices, environmental audio, and spoken narration.

This is what makes TactivoPlay exciting to develop. Each game is not just a visual game with the screen removed. Each game is an opportunity to design around listening, memory, timing, reaction, and imagination.

What I Hope TactivoPlay Will Achieve

My hope is that TactivoPlay becomes a fun, useful, and affordable collection of audio games for blind and low-vision players, families, schools, support organizations, accessibility groups, and anyone interested in non-visual play.

I want it to be something people can pick up, understand, enjoy, and share.

I also hope it encourages more discussion about accessible game design. Accessibility should not be treated as a small extra feature hidden in a settings menu. It can be a starting point for creative design. It can lead to new ideas, new mechanics, and new ways to play.

TactivoPlay is still growing, and player feedback will continue to shape the project. Every suggestion, test session, comment, and idea helps make the games better.

Thank You For Supporting TactivoPlay

TactivoPlay is a project built from years of making mini games, experimenting with accessible controls, writing about game development, and listening to what players need.

Thank you for visiting the site, supporting the project, sharing it with others, or becoming part of the beta testing process.

Whether you are a blind or low-vision player, a family member, teacher, accessibility supporter, game developer, or someone who simply believes games should be more inclusive, I hope TactivoPlay gives you something fun, useful, and different to explore.

TactivoPlay is about simple controls, clear sound, accessible fun, and games designed to be played by listening.

For more information visit: https://www.tactivoplay.com/about-me

GoFundMe link: https://www.gofundme.com/f/creating-a-collection-of-audio-based-accessible-games

Obesity care in the United States has been rewritten in less than a decade. The pharmacological treatment of obesity used to mean phentermine prescriptions and over-the-counter orlistat at the drugstore, with modest results that often vanished the moment a patient stopped taking the pill. That world still exists, but it now sits alongside a generation of injectable and oral medications that routinely produce double-digit percentage weight loss and are reshaping how physicians, insurers, and courts think about body weight itself (Obesity Medicine Association, 2026).

As of April 2026, the U.S. Food and Drug Administration has approved nine pharmacological options for long-term or short-term weight management in adults, along with one medical device classified as a prescription product and a single over-the-counter option. Two of those medications arrived within the last five months: the oral formulation of Wegovy in December 2025 and Foundayo (orforglipron) on April 1, 2026 (U.S. Food and Drug Administration, 2026a). A higher-dose injectable version of Wegovy, branded Wegovy HD, was approved on March 19, 2026 (U.S. Food and Drug Administration, 2026b). The pipeline behind these products is crowded. Analysts at Ozmosi have identified roughly three dozen GLP-1-related weight management candidates in development, with new launches expected every year for the foreseeable future.

How These Medications Actually Work

Most of the newer weight loss drugs belong to a class called incretin mimetics. They imitate hormones the gut releases after meals - glucagon-like peptide-1 (GLP-1) and, in some cases, glucose-dependent insulinotropic polypeptide (GIP). These hormones slow gastric emptying, blunt appetite signals in the brain, and improve insulin sensitivity. The older medications work differently: some are stimulants that suppress appetite (phentermine), some block fat absorption in the intestine (orlistat), and some combine neuromodulators that reduce reward-driven eating (Contrave).

The practical distinction that matters most to patients is simpler than the pharmacology. Some of these products are injected under the skin, usually once a week. Others are swallowed. Some require a prescription and physician supervision. Only one true anti-obesity drug is sold without a prescription in the United States.

Injectable Prescription Medications

Wegovy (semaglutide)

Manufactured by Novo Nordisk and approved in 2021 for chronic weight management, Wegovy delivers semaglutide once weekly by subcutaneous injection using a pre-filled pen. Phase 3 trials reported mean weight reduction of roughly 14.9% of body weight over 68 weeks at the 2.4 mg dose. The drug is approved for adults with a body mass index (BMI) of 30 or higher, or 27 or higher with at least one weight-related comorbid condition, and for adolescents 12 and older with a BMI at or above the 95th percentile. In March 2026 the FDA approved a higher 7.2 mg dose called Wegovy HD, which produced additional weight reduction beyond the standard dose in clinical testing (U.S. Food and Drug Administration, 2026b).

Zepbound (tirzepatide)

Eli Lilly's Zepbound, approved for obesity in late 2023, is currently the most effective weight loss medication on the U.S. market. It is a dual GLP-1 and GIP receptor agonist administered once weekly by injection. In the head-to-head SURMOUNT-5 trial published in The New England Journal of Medicine, tirzepatide produced a mean weight reduction of 20.2% at 72 weeks compared with 13.7% for semaglutide, the first direct clinical comparison of the two (Aronne et al., 2025). A separate phase 3 trial in participants with knee osteoarthritis and obesity found weight losses of up to 28.7% with the related triple-agonist retatrutide, which remains in development but signals where this class is heading.

Saxenda (liraglutide)

Liraglutide, marketed by Novo Nordisk as Saxenda, was the first GLP-1 receptor agonist approved for weight management in adults and is also approved for adolescents 12 and older. Unlike Wegovy and Zepbound, it must be injected daily rather than weekly. Its weight loss effect is more modest, typically 5% to 8% of body weight at 56 weeks, but it remains relevant for patients who cannot tolerate the newer agents or whose insurance favors it on formulary.

Oral Prescription Medications

Wegovy Pill (oral semaglutide for obesity)

In December 2025 the FDA approved an oral formulation of Wegovy, the first oral GLP-1 receptor agonist cleared specifically for chronic weight management. At the highest dose, trial participants lost an average of 16.6% of their body weight after 64 weeks, and roughly one in three lost at least 20% (AARP, 2026). The pill is taken once daily on an empty stomach with a small amount of water, a protocol some patients find inconvenient. A lower-dose oral semaglutide product called Rybelsus has been available since 2019 for type 2 diabetes and is sometimes prescribed off label.

Foundayo (orforglipron)

Approved on April 1, 2026, Foundayo is Eli Lilly's oral GLP-1 receptor partial agonist and the only weight loss pill of its class that can be taken any time of day without food or water restrictions. Its chemistry - a small-molecule nonpeptide rather than a peptide - makes it more stable in the stomach. In the ATTAIN-1 trial, adults taking the highest dose of 36 mg lost an average of 12.4% of body weight, about 27 pounds, after 72 weeks, compared with about 2 pounds for placebo (Eli Lilly and Company, 2026). Foundayo was the first new molecular entity approved under the FDA's Commissioner's National Priority Voucher program, which shortened the review timeline by several months (U.S. Food and Drug Administration, 2026a).

Qsymia (phentermine and topiramate)

Qsymia combines a controlled-substance appetite suppressant (phentermine) with the anticonvulsant topiramate in an extended-release capsule. It is approved for chronic weight management in adults and in pediatric patients 12 and older. Mean weight loss in trials runs about 8% to 10% at one year. It requires prescriber enrollment in a Risk Evaluation and Mitigation Strategy because of the teratogenic potential of topiramate.

Contrave (naltrexone and bupropion)

Contrave pairs a low-dose opioid antagonist with an antidepressant to reduce appetite and cravings. It produces roughly 5% to 6% mean weight loss at one year. The combination can raise blood pressure and is contraindicated in patients taking opioids, so clinician selection matters.

Phentermine (Adipex-P, Lomaira)

Phentermine is the oldest and cheapest prescription weight loss medication still in wide use, originally approved in 1959. It is a sympathomimetic amine sold as Adipex-P, Lomaira, and under its generic name. It is FDA approved only for short-term use, generally up to 12 weeks, because of its stimulant profile and potential for tolerance. Many clinicians prescribe it in cycles or alongside topiramate. It remains popular in part because generic monthly costs can fall below $15 without insurance.

Xenical (prescription orlistat)

Orlistat, marketed at the 120 mg prescription strength as Xenical, inhibits pancreatic lipase and blocks absorption of about 30% of dietary fat. Average weight loss is 3% to 5% at one year. Its gastrointestinal side effects - oily stools, flatulence, fecal urgency when patients eat high-fat meals - are well known and are the reason many patients discontinue it.

Over-the-Counter and Device-Based Options

Alli (orlistat 60 mg)

Alli is the only over-the-counter weight loss medication approved by the FDA. It contains orlistat at half the prescription strength and is available on drugstore shelves for adults 18 and older with a BMI of 25 or higher. Its efficacy and side effect profile mirror those of Xenical at a smaller magnitude. Alli remains useful for patients who want a nonprescription option and are willing to maintain a low-fat diet during treatment.

Plenity (prescription, not an OTC drug)

Plenity is often mentioned alongside medications but is technically a prescription medical device rather than a drug. It is a hydrogel made of carboxymethylcellulose and citric acid that expands in the stomach to create a feeling of fullness. Patients take three capsules with water before lunch and dinner. Mean weight loss in the gateway trial was about 6.4%. Because it is classified as a device, it is regulated and reimbursed differently than the GLP-1 products.

How the Medications Compare for Efficacy

Ranked roughly by average percent body weight loss at one year or longer, the current options fall into three tiers. At the top sit Zepbound at about 20% mean loss, followed by injectable Wegovy at about 15% and the Wegovy pill at about 17% at the highest dose (Aronne et al., 2025; AARP, 2026). Foundayo sits near the middle at 12.4%, a meaningful but smaller effect than the injectables (Eli Lilly and Company, 2026). Qsymia, Saxenda, and Plenity land in the 5% to 10% range. Contrave, Xenical, and Alli typically produce 3% to 6%.

These numbers are averages. Individual response varies widely. Roughly one in five patients on GLP-1 drugs is a low responder, and up to a third lose more than 20% of their starting weight. Weight regain after discontinuation is common and often substantial, which is why most clinicians frame these medications as chronic therapies for a chronic disease rather than short courses.

The Overlap Between Weight Loss and Disability

Weight enters disability law through several doors, and none of them are wide. The Americans with Disabilities Act (ADA) does not list obesity as a protected condition, and federal courts have been reluctant to treat body weight alone as a qualifying disability.

Obesity Under the Americans with Disabilities Act

The ADA defines disability as a physical or mental impairment that substantially limits one or more major life activities. The implementing regulations of the Equal Employment Opportunity Commission specifically exclude physical characteristics within a normal range, including weight, unless they result from a physiological disorder. Four federal circuit courts - the Second, Sixth, Seventh, and Eighth - have held that obesity is not an ADA impairment unless it is caused by an underlying physiological condition (Richardson v. Chicago Transit Authority, 2019). The most cited case, Richardson, involved a Chicago bus driver whose weight rose above 550 pounds; the court declined to recognize his obesity as a disability because he produced no evidence of a physiological cause.

State and municipal law fills some of the gap. New York City banned weight-based employment discrimination outright in 2023. Michigan and a handful of cities including San Francisco, Washington D.C., and Binghamton maintain similar protections. Courts in Texas, Louisiana, Mississippi, California, New Jersey, New York state, Washington, and Oregon have been more willing than their federal counterparts to recognize obesity, or perceived obesity, as a qualifying condition in disability discrimination claims (Ogletree, 2023).

Weight-Related Comorbidities That Do Qualify

Where weight itself falls outside the ADA, the conditions that commonly accompany it often do not. Type 2 diabetes, obstructive sleep apnea, severe osteoarthritis of the knees or hips, congestive heart failure, lymphedema, and chronic kidney disease can each independently meet the ADA definition of disability when they substantially limit a major life activity. A warehouse worker with knee osteoarthritis severe enough to limit standing or walking is protected under the statute regardless of the number on the scale. This distinction is legally important and, in practice, is how many large employees pursue accommodation rather than arguing obesity on its own terms.

How Weight Loss Medication Can Change the Disability Picture

The new generation of GLP-1 medications is starting to alter the clinical calculus around weight-related disability. Beyond weight reduction, semaglutide has demonstrated improved cardiovascular outcomes and reduced progression of diabetic kidney disease, and tirzepatide has been shown to reduce liver fat, improve metabolic dysfunction-associated steatohepatitis, and decrease the severity of obstructive sleep apnea (American Diabetes Association, 2024). The TRIUMPH-4 trial of retatrutide reported substantial reduction in knee osteoarthritis pain alongside weight loss. As these indications expand, more patients may find that the underlying impairments limiting their work lives - joint pain, apnea-driven fatigue, uncontrolled diabetes - respond to a weekly injection. That does not make the medications a substitute for reasonable accommodation. It does mean the clinical picture of a disabled worker with obesity is less static than it was five years ago.

Access, Insurance, and the Practical Barriers

Coverage is the quiet crisis underneath the excitement about these drugs. List prices for Wegovy and Zepbound run roughly $1,000 to $1,350 per month before rebates. Medicare Part D historically excluded weight loss drugs by statute, though that has begun to shift for obesity-related conditions such as cardiovascular disease. Commercial coverage is uneven. Manufacturer self-pay programs have narrowed the gap: Foundayo launched at $149 per month for its lowest dose on self-pay and $25 per month with the manufacturer savings card for those with commercial insurance (Eli Lilly and Company, 2026). A FAIR Health analysis published in May 2025 reported that more than 2% of U.S. adults had filled a prescription for a GLP-1 weight loss medication in the preceding year, a share that has since grown.

For patients who qualify as disabled under state law or the ADA through an underlying condition, the calculus shifts again. Some state Medicaid programs now cover anti-obesity medications when a comorbid disability is documented, and several federal accommodations claims have successfully argued that denial of effective weight management treatment constitutes a failure to accommodate a physiological condition.

Risks and Realistic Expectations

None of these medications is benign. Gastrointestinal side effects - nausea, vomiting, constipation, diarrhea - are the most common reason patients discontinue GLP-1 drugs. Rarer but serious risks include pancreatitis, gallbladder disease, and a boxed warning for thyroid C-cell tumors observed in rodent studies. Orlistat can cause liver injury in rare cases and interferes with absorption of fat-soluble vitamins. Phentermine carries the cardiovascular risks typical of stimulants. Qsymia requires pregnancy prevention counseling due to topiramate. Contrave is contraindicated in patients with seizure disorders or eating disorders.

Muscle loss during rapid weight reduction is a concern specific to the GLP-1 class. Clinicians now routinely recommend resistance training and a minimum of 30 grams of protein per meal during active treatment (American Diabetes Association, 2024). The combination of an amylin analog, cagrilintide, with semaglutide - known as CagriSema - is in late-stage development and has reported mean weight loss of 20.4% at 68 weeks with less muscle loss than semaglutide alone in early results (Obesity Medicine Association, 2026).

Weight loss medication works best when patients, physicians, and payers treat obesity as what the American Medical Association has called it since 2013: a chronic disease. That framing has not yet fully reached the courts, and it has only partly reached the insurance market. But it is the clinical reality the next decade of these products will be built on.

References:

AARP. (2026, April 2). FDA approves new weight loss pills: Costs and results. AARP Health.

American Diabetes Association. (2024). Starting FDA-approved weight management medications. Professional Resources.

Aronne, L. J., Horn, D. B., le Roux, C. W., Ho, W., Falcon, B. L., Gomez Valderas, E., Das, S., Lee, C. J., Glass, L. C., Senyucel, C., and Dunn, J. P. (2025). Tirzepatide as compared with semaglutide for the treatment of obesity. The New England Journal of Medicine, 393(16), 1543 - 1554.

Eli Lilly and Company. (2026, April 1). FDA approves Lilly's Foundayo (orforglipron), the only GLP-1 pill for weight loss that can be taken any time of day without food or water restrictions [Press release]. PR Newswire.

Ghusn, W., De La Rosa, A., Sacoto, D., Cifuentes, L., Campos, A., Feris, F., Hurtado, M. D., and Acosta, A. (2022). Weight loss outcomes associated with semaglutide treatment for patients with overweight or obesity. JAMA Network Open, 5(9), e2231982.

Obesity Medicine Association. (2026, April 2). Top weight loss medications. OMA Clinical Resources.

Ogletree Deakins. (2023). Obesity as a disability under the Americans with Disabilities Act. Employment Law Insights.

Richardson v. Chicago Transit Authority, 926 F.3d 881 (7th Cir. 2019).

U.S. Equal Employment Opportunity Commission. (2008). Enforcement guidance on the Americans with Disabilities Act and the ADA Amendments Act. Washington, DC: EEOC.

U.S. Food and Drug Administration. (2026a, April 1). FDA approves first new molecular entity under National Priority Voucher program [Press release].

U.S. Food and Drug Administration. (2026b, March 19). FDA approves fourth product under National Priority Voucher program, higher dose semaglutide [Press release].

University of Chicago Law Review. (2024). Weighing in: Why obesity should be considered a qualifying disability under the Americans with Disabilities Act. The University of Chicago Law Review, 91(3), 789 - 828.

Pesticide residue may play a role in increased rates of lung cancer in non-smokers under age 50.

A diet rich in fruit, vegetables and whole grains is generally recommended for better health and to lower the risk of cancer and other diseases. However, new research from USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC, presented at the annual meeting of the American Association for Cancer Research suggests that this type of diet may put non-smoking Americans under the age of 50 at greater risk of developing lung cancer.

"Our research shows that younger non-smokers who eat a higher quantity of healthy foods than the general population are more likely to develop lung cancer," said Jorge Nieva, MD, a medical oncologist and lung cancer specialist with USC Norris and lead investigator of the study. "These counter-intuitive findings raise important questions about an unknown environmental risk factor for lung cancer related to otherwise beneficial food that needs to be addressed."

Nieva and his fellow researchers speculate that this risk factor may be the pesticides used to keep crops pest-free. Commercially produced (non-organic) fruits, vegetables and whole grains are more likely to be associated with a higher residue of pesticides than dairy, meat and many processed foods, according to Nieva. He also notes that agricultural workers exposed to pesticides typically have higher rates of lung cancer, which adds credence to the theory.

The study also showed that young women who don't smoke have a higher incidence of lung cancer than men, and that women tended to also have a diet higher in produce and whole grains than men.

A New Epidemic of Lung Cancer

Lung cancer has typically been a disease that affects older adults (the average age of lung cancer onset is 71), men more than women, and smokers. Smoking rates have fallen since the mid-1980s, which has led to fewer lung cancer cases across the United States, except for one unique group - non-smokers age 50 and younger, especially women, who are now more likely to get lung cancer than men.

To investigate this trend, researchers launched the Epidemiology of Young Lung Cancer Project, which surveyed 187 patients who were diagnosed with lung cancer by age 50. Patients provided details on demographics, diet, smoking history and lung cancer diagnosis. Most patients had never smoked and had a form of lung cancer biologically different from lung cancer caused by smoking.

A 2021 study from the Epidemiology of Young Lung Cancer Project, the Genomics of Young Lung Cancer Project, found that the subtypes of lung cancer seen in people under 40 were distinct from lung cancer in older adults.

Researchers used the Healthy Eating Index (HEI), a ranking of the overall quality of Americans' diet on a scale of 1-100, to compare patients' diets with the broader United States population. Young non-smoking lung cancer patients had an average HEI score of 65 out of 100, compared to the national average of 57. Among participants in the study, women had higher HEI scores than men.

On average, the young lung cancer patients ate more daily servings of fruit, vegetables and whole grains than the general population. For example, participants averaged 4.3 servings of dark green vegetable and legumes and 3.9 servings of whole grains per day, while the average U.S. adult eats 3.6 servings of dark green vegetables and legumes and 2.6 servings of whole grains per day.

More Research Needed

The link between pesticides and lung cancer in young people, especially women, needs more research, said Nieva. In the study, researchers did not test specific foods for pesticides. Instead, they used published data on average pesticide levels for food categories such as fruits, vegetables and grains to estimate exposure. The next step, said Nieva, is to confirm the link by directly measuring pesticide levels in blood or urine samples from patients. This could also help reveal whether or not some pesticides increase lung cancer risk more than others.

"This work represents a critical step toward identifying modifiable environmental factors that may contribute to lung cancer in young adults," said Nieva. "Our hope is that these insights can guide both public health recommendations and future investigation into lung cancer prevention."

The research is supported by the Addario Lung Cancer Medical Institute, a nonprofit focused on advancing lung cancer research and care, as well as AstraZeneca, the Beth Longwell Foundation, Genentech, GO2 for Lung Cancer and Upstage Lung Cancer. Researchers also received funding from the National Institutes of Health, grant number R25CA225513 and the National Cancer Institute, grant number P30CA014089.

Disclosure: Dr. Nieva has received consulting payments from AstraZeneca and Genentech.

The eco-retreat focused on fostering an environment where persons with disabilities could connect meaningfully with others, promoting inclusivity and challenging societal stereotypes about disability. The initiative successfully showcased how tourism professionals, community leaders, and organizations can re-imagine travel experiences to be accessible for all individuals, regardless of ability.

A Vision for Inclusivity in Tourism

The core objective of the retreat was clear: to create an inclusive environment where persons with disabilities could actively participate and contribute to the tourism experience. The event underscored that persons with disabilities are not just recipients of tourism services, but vital contributors to the industry. This philosophy echoed through personal stories and presentations that highlighted the potential of persons with disabilities in the tourism sector.

Suraj Silwal, one of the event organizers, emphasized the importance of rebranding Nepal as a destination that values culture, nature, and accessibility. said Silwal. He also urged Disability Coordination Committees to step up as advocates for inclusive tourism, promoting the idea that persons with disabilities can be active participants in the tourism sector.

Empowering Persons with Disabilities

The retreat also featured powerful testimonials from disability rights activists, including Arjun Bohara, who shared his vision for an inclusive tourism industry:

"We, too, are travelers. Our active participation is key to making sure that all people, regardless of ability, can experience the beauty and culture our country has to offer."

Similarly, Chiranjivi Poudel, Founder and CEO of Seeing Hands Nepal, and World Blind Idol 2025, called for a shift in how society views persons with disabilities in the tourism industry. "It's time we recognize them as professionals and partners, not just beneficiaries," Poudel stated.

Chiran, an internationally renowned and his team of Seeing Hands Blind massage Clinc were limited to providing professional massage which was limited to foreign guest within the 4 walled rooms of thamel, provided massage to people in community next to a river for the first time in his professional life which spanned since their founding in 2010

Breaking Stereotypes and Building Awareness

One of the significant successes of the retreat was its ability to challenge and dismantle the harmful stereotypes that often limit the roles of person with disabilities. Rikesh Koirala, an organizer and participant, noted the common misconception of visually impaired individuals being limited to roles like "street singers" or "beggars."

"This retreat has given us the chance to show that we have valuable skills and can contribute meaningfully to the tourism and recreation industries," Koirala said.

Participants also shared how the event helped them break personal biases and expand their perspectives. One visually impaired participant noted:

"I've always associated the Trishuli River with tragedy, but after rafting, I now see it as a place of adventure and joy." Another shared, "This is my first time interacting with someone who is visually impaired, and I've realized how much strength and resilience they have."

A Living Model for Inclusive Tourism

The retreat, hosted at Motel Du Muglin, featured over 100 attendees, including visually impaired therapists, activists, tourism professionals, and creatives. Activities such as wellness services, rafting, and swimming were specifically designed to be accessible for all, offering a blend of adventure and wellness facilitated by experts with disabilities.

Organized by organizations such as Wandering Trail Adventure, Art & Soul Foundation Nepal, Project Uddeshya, Escapade Nepal, Seeing Hands Nepal and JCI International Ichchhakamana Chapter, the event demonstrated how inclusive tourism is not just about integration, but about re-imagining the entire system to ensure accessibility, equality, and representation.

A Movement, Not Just a Trend

Jiwan KC, an organizer of the retreat, summed up the core philosophy of the event:

"Inclusive tourism isn't about simply adding people with disabilities to the existing system. It's about redesigning the system so everyone feels they belong."

This initiative signifies not only the importance of including persons with disabilities in tourism, but also the need to overhaul the entire system to ensure that everyone has equal access to opportunities in the sector.

The Far-Reaching Impact of Inclusive Tourism

The eco-retreat also highlighted the broader impact of inclusive tourism, proving that it is more than a moral imperative—it is an opportunity for substantial economic, social, and systemic change. Some of the benefits of inclusive tourism include:

• Economic Impact: Expanding the tourism market by attracting a diverse group of travelers and creating employment opportunities for persons with disabilities.
• Social Impact: Promoting dignity, respect, and understanding while challenging harmful stereotypes about person with disabilities.
• Systemic Change: Encouraging the adoption of universal design principles and accessibility standards across the tourism industry.
• Local Development: Strengthening community-based tourism initiatives and promoting sustainable, inclusive practices that benefit both travelers and local communities.

A Future of Inclusive Tourism in Nepal

This eco-retreat marks a crucial step in positioning Nepal as a global leader in inclusive, accessible, and socially responsible tourism. By re-imagining Muglin as a destination that celebrates diversity and inclusion, the retreat has set a powerful example of how tourism can foster deeper connections, elevate dignity, and drive systemic change.

For more information, please contact: projectuddeshya@gmail.com

Is social media addictive? Why a formal diagnosis is still out of reach.

On March 25, a California trial awarded $6 million to a plaintiff who argued that the addictive qualities of social media had caused her harm. Google and Meta, which were the companies that were found liable, disagree with the verdict and intend to appeal.

Dar Meshi, an associate professor of advertising and public relations at the Michigan State University College of Communication Arts and Sciences, studies the psychology of technology use, including social media. He recently authored a commentary for the journal Nature about social media addiction and can discuss what an addictive behavior is, whether or not social media is addictive, and if social media addiction should be taken more seriously.

Answers are excerpts from Meshi's Nature commentary.

What are the impacts of excessive social media use?

Case-based evidence has linked excessive social media use to psychological distress and impaired functioning in some people, for example, through job loss, relationship problems and academic failure. This use has been associated with differences in the structure and activity of reward-related brain regions and with impaired decision-making. Such features are observed in substance-use disorders too.

But the issue is complex. Outcomes associated with social media use vary widely, depending on how and why people use the platforms. 'Active' habits such as posting, commenting and messaging have been linked to positive well-being - unlike passive scrolling. And social media can provide social support to marginalized groups, such as young people from sexual and gender minorities.

What's more, the field's literature is dominated by research that is correlational, not causal - mine included. Another issue is that researchers are still debating how to measure social media addiction, including the threshold at which social media becomes problematic.

Do these impacts mean that social media is addictive?

Despite more than two decades of study on social media use, many researchers like me are wary of using the label of 'addiction.' That's because there is no general agreement on whether social media use can meet current standards for addictive disorders. More rigorous research is needed, along with guidance from professional bodies such as the American Psychiatric Association, or APA. This could help to establish whether social media addiction is a clinical phenomenon - and, if so, which criteria could be used to diagnose it.

What makes a behavior a clinical addiction?

In the United States, a formal designation of social media addiction as a clinical disorder can only come from the APA. Its Diagnostic and Statistical Manual of Mental Disorders, also commonly referred to as DSM, defines these conditions and guides clinical assessment and research. The fifth, and most recent, edition of the DSM was published in 2013, before much of the evidence around problematic social media use had accumulated.

For the APA to categorize a behavior phenomenon as an addictive disorder, the phenomenon has to meet a range of benchmarks. These include showing that the behavior causes real harm in a person's life, that it is linked to an underlying biological process and that the benefits of labeling it as a disorder outweigh potential harms such as stigma.

In 2013, the APA considered social media addiction to be part of general internet addiction, which did not meet these criteria.

Could social media become classified as an addiction in the future?

No new diagnostic guidance was provided in a 2022 update to the DSM-V, nor could I find any mention of social media or addictive behaviors in plans for the future of the DSM, which were published in January. Yet the APA's website has educational information on "social media addiction," showing a lack of alignment with its diagnostic guidance.

What is the issue with the misuse of the term 'addiction'?

Wrong use of the term addiction could lead to everyday behaviors being pathologized. Medicalizing an intense behavior because of poor methods and measures - in effect, lowering the threshold for what counts as addiction - could waste medical resources and strain health care systems. Wrongly diagnosed people could experience stigma and be prescribed unnecessary medication.

By contrast, formally designating social media use as an addiction would provide mental health practitioners with standard diagnostic criteria, thus improving screening and the development of treatments. It would also give researchers guidelines for categorizing study participants, making addiction research more robust.

Should social media be taken seriously as an addiction?

The APA must engage with the current research around social media use. Its future plans include establishing subcommittees that will focus on various aspects of mental disorders - biomarkers, socio-economic determinants, impaired functioning and more. It is crucial that each subcommittee includes experts in behavioral addictive disorders. Current evidence can then be used to determine whether problematic social media use should be defined as addictive and - if so - to delineate clear criteria for diagnosis, with decisions being revisited over time.

Knowing what users do and see on platforms would improve researchers' understanding of individual differences in social media use and its impacts. Policymakers could require social media companies to provide secure access to anonymized behavioral data, or identifiable data with user consent, under strict privacy safeguards.

There's an urgent need for better information about what constitutes social media addiction. Its existence should not be debated in the courts and by jurors, but by trained experts, determined by data.

Even when people with incomplete spinal cord injuries can walk, everyday functions like standing, balancing or producing steady force may remain difficult. A new study shows why.

Using surface skin electrical sensors, a research team in Sweden identified previously unseen changes in motor coordination that result from incomplete spinal cord injuries (SCI). The study is the first to examine how individual motor units - that is, nerve-to-muscle connections that create movement - work together in people with SCI.

"Our study reveals, at the cellular level, how the central nervous system adapts to the injury to control movement," says Ruoli Wang, associate professor in biomechanics at Promobilia MoveAbility lab, KTH Royal Institute of Technology. She says the researchers' approach was completely non-invasive.

The results were published in the Journal of NeuroEngineering and Rehabilitation.

Adaptation of Motor Unit Synergies In The Synergetic Ankle Plantarflexors In Ambulatory Persons With Incomplete Spinal Cord Injury

The study's lead author, PhD student Zhihao Duan, says the researchers found the nervous system struggles to spread signals smoothly across muscles at low levels of exertion after the injury. And it appears to overcompensate at higher levels of exertion, sending "louder", less refined signals.

A single muscle moves through hundreds of motor units, each turning on and off precisely to create smooth force. Composed of a single motor neuron and its connecting muscle fibers, these motor units respond to shared signals from the nervous system, much like different sections of musicians led by an orchestra conductor. That shared input is what allows them to act in coordinated patterns.

To explore how well these units coordinate under the control of the central nervous system the team examined 25 people (including 10 control participants). They used high density electromyography (HD-EMG) to measure electrical activity in the functionally similar calf muscles - soleus and gastrocnemius - while volunteers pushed lightly or moderately against a force measurement device.

Duan says that at 20 percent effort, fewer of the motor units in the two calf muscles were working in a shared, coordinated way compared with people without injury. Their movements as a result were shaky and unstable.

"They were much less being driven by the same coordinated signal from the nervous system," he says.

At a higher level of effort - 50 percent - the SCI group showed stronger low-frequency synchronization between the two muscles. The body loses flexibility and precision in control of the movement.

"This could be a sign of the nervous system compensating by sending louder, less refined signals," Duan says.

"One interesting finding is that after spinal cord injury the nervous system becomes more rigid and less able to change its approach as the muscles work harder. A healthy nervous system on the other hand is able to adapt its strategy as force demands, to adjust the shared neural drive level," Wang says.

Although the study was limited by a small sample size and challenges in identifying enough motor units per muscle from the skin surface, Wang says the results offer unique insight into how SCI reshapes motor control.

"This finding may open the door to a new rehabilitation biomarker, helping clinicians and researchers design new neurorehabilitation strategies to re-tune the spinal cord control and to restore coordinated neural input," she says.

The study was a collaboration with Aleris Rehab Station and was funded by the Swedish Research Council and Promobilia Foundation.

COI Statement

The authors declare no competing interests.

The scene was different for Sam and Judy Crawford. While they also lolled on chaise lounges to soak up the sun’s rays and cooled off in clear water, they ended their relaxing afternoon silt and sting free. That’s because they were replicating a visit to a beach on the roof of the inner-city hotel where they were staying.

Fortunately for Dan, who uses a wheelchair, an elevator reached the roof, its surface was level and smooth, and an ADA compliant swimming pool lift made it easy for him to get into, and out of, the water.Rooftop swimming pools occupy the tops of a number of lodgings throughout the country. They provide people with added appeal and places to replicate a seaside sojourn without having to travel from their place of accommodation. Many make up in attractions and ambiance anything they might lack in ocean views, and a number of them are accessible to people with a physical handicap.

With gas prices rising and airport congestion still unpredictable, many folks are rethinking long-haul trips in favor of closer-to-home escapes. Some are opting for a "staycation" summer right where they live.

For residents of the Nation’s Capital, and those who visit it, that can include the hidden rooftop pool at the Arlo hotel. Framed by plush loungers and set against a bold, colorful wall mural, it offers sweeping panoramic views of the U.S. Capitol Building and city skyline.

Art also enhances the experience for guests atop the Arlo Wynwood in Miami, Florida. Along with a 360-degree view of the city below, the heated swim bath is overlooked by a larger-than-life mural which was created by an acclaimed graffiti artist.

It’s oversize chess pieces that greet those enjoying the Ara Rooftop and Pool Lounge at Hotel Effie in Sandestin, Florida. It’s the only such installation along the self-proclaimed Emerald Coast, which stretches about 100 miles along the Gulf of Mexico. If they’re not relaxing in a private cabana or enjoying breathtaking views that stretch to the horizon, guests may participate in wine tastings, yoga, bingo nights and other activities.

People travel far to gaze in awe at the New York City skyline and there are few more dramatic views than that from the rooftop pool deck at the Arlo Williamsburg Hotel in Brooklyn. A dramatic Water Tower Bar overlooks the pool and poolside cabanas. Guests of the property may book a complementary pool time slot, and others can make a reservation.

For a classic yet unexpected location, look no further than the rooftop’s Water Tower. These kinds of structures are an iconic sight throughout the city, but at Arlo Williamsburg, the Water Tower can serve as your very own private event venue. Perfect for gatherings, photo shoots, weddings, cocktail parties and other occasions, the Water Tower has a private bar, can be furnished for your event, and is accessible by elevator.

Have you ever surfed on a rooftop? You can at the FlowRider Wave Ride at Caesars Palace in Las Vegas. Its advanced waveform technology provides a safe, yet thrilling, environment where people may "hang ten" and test their boarding talents. The innovative design gently absorbs impacts, allowing everyone to master the waves with confidence and enjoy a unique experience right on the Las Vegas Strip.

Another thrill awaits those checking out the rooftop pool at the Joule Hotel in Dallas. It’s cantilevered over the streets below, and the clear walled edge gives the fortunately false impression that swimmers could plunge off the top of the building.

Worrying that you may fall to your death, or trying to surf high above city streets, may not be on your bucket list. However, they’re among unusual, and unexpected, activities that swimming pools perched on the rooves of some buildings offer, and are available to those who wish to take part in them.

Disability is one of the most important public health topics in the United States, yet it remains one of the most misunderstood. Tens of millions of Americans - adults and children alike - navigate daily life with conditions that affect how they move, think, see, hear, or care for themselves. While conversations about disability have gained visibility in recent years, the actual numbers behind these experiences are often overlooked or poorly understood. This paper draws on the most current federal data available to present a clear picture of disability prevalence across the U.S. population, broken down by age group, type of disability, and demographic characteristics.

Understanding the Numbers: Two Major Federal Data Sources

Before diving into specific figures, it helps to understand why disability statistics sometimes look different depending on where you find them. Two of the most widely cited federal sources are the U.S. Census Bureau's American Community Survey (ACS) and the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS). Both surveys ask a similar set of six questions about difficulty with hearing, seeing, walking, cognition, self-care, and independent living. However, differences in how the surveys are conducted - including sample size, response rates, and whether interviews happen by phone, mail, or online - lead to different prevalence estimates (Centers for Disease Control and Prevention [CDC], 2024a).

The ACS, which surveys approximately 4.7 million people annually with a response rate near 85 percent, reported a disability prevalence of 13.5 percent in 2023 (Erickson et al., 2025). The BRFSS, a phone-based survey with about 400,000 respondents and a lower response rate, reported 28.7 percent for 2022 (CDC, 2024b). According to researchers at Cornell University and the Northeast ADA Center, part of this gap may also come from a "priming" effect - people responding to a health-focused survey like the BRFSS may be more inclined to think about their limitations than those answering a broad demographic survey like the ACS (Northeast ADA Center, 2025). Both figures are legitimate, and together they offer a fuller picture of disability in America.

Adults Living With Disabilities in the United States

Overall Adult Prevalence

According to the CDC's most recent BRFSS data, more than 1 in 4 adults in the United States - approximately 28.7 percent, or an estimated 70 million people - reported having some type of functional disability in 2022 (CDC, 2024b). That makes disability one of the most common health-related experiences in American life. To put that number in perspective, the total civilian noninstitutionalized adult population in the United States was approximately 260 million during that period.

The ACS provides a somewhat lower but still substantial figure. Based on 2023 ACS data, approximately 44.68 million civilians of all ages in the community reported one or more disabilities, representing 13.5 percent of the noninstitutionalized population (Erickson et al., 2025). When the ACS sample is adjusted to focus only on adults aged 18 and older - to better match the BRFSS population - the prevalence rises to approximately 16 percent, which narrows some of the gap between the two surveys (Northeast ADA Center, 2025).

Disability by Type Among Adults

The BRFSS breaks disability down into six functional categories, each reflecting a different dimension of daily life. The most commonly reported disability type among adults in 2022 was cognitive disability, defined as serious difficulty concentrating, remembering, or making decisions, at 13.9 percent. This figure increased noticeably from 12.8 percent in 2021, a trend that some researchers have linked to the lingering effects of COVID-19 on brain health (CDC, 2024b).

Mobility disability - serious difficulty walking or climbing stairs - was the second most prevalent at 12.2 percent. Independent living disability, meaning difficulty running errands alone, affected 7.7 percent of adults. Hearing disability, defined as deafness or serious difficulty hearing, was reported by 6.2 percent. Vision disability, meaning blindness or serious difficulty seeing even with corrective lenses, affected 5.5 percent. And self-care disability, which involves difficulty dressing or bathing, was reported by 3.7 percent of adults (CDC, 2024b).

From the ACS perspective, using 2023 data for the entire population, ambulatory disability was the most commonly reported type at 6.3 percent (about 20.78 million people), followed by cognitive disability at 5.4 percent (about 17.97 million), independent living disability at 4.8 percent (about 15.79 million), hearing disability at 3.7 percent (about 12.07 million), vision disability at 2.5 percent (about 8.29 million), and self-care disability at 2.4 percent (about 8.02 million) (Erickson et al., 2025).

Disability by Age

Disability prevalence rises substantially with age. Among adults aged 18 to 29, approximately 8.7 percent reported a disability in the 2023 ACS. That figure held relatively steady through the 30 to 39 age group at 8.2 percent, then climbed to 9.5 percent for those aged 40 to 49 and 14.5 percent for those aged 50 to 59. By ages 60 to 64, nearly one in five adults - 19.4 percent - reported a disability (AskEARN, 2025). Among people aged 65 and older, the BRFSS found that 43.9 percent reported a disability, making this the age group with the highest prevalence by a wide margin (CDC, 2024b).

Disability by Race and Ethnicity

Disability does not affect all racial and ethnic groups equally. According to ACS estimates, American Indian and Alaska Native populations had the highest disability prevalence at approximately 18 percent. White and Black Americans both reported disability at around 14 percent. Hispanic Americans reported disability at roughly 10 percent, and Asian Americans at about 8 percent (Pew Research Center, 2023). These disparities reflect a combination of factors including differences in occupational risk, access to healthcare, socioeconomic conditions, and historical patterns of environmental exposure.

Long COVID and Disability

The 2022 BRFSS was the first time the survey collected data on Long COVID - symptoms lasting three months or longer after an initial COVID-19 infection. The results revealed a significant connection between disability and Long COVID: 10.8 percent of adults with disabilities reported experiencing Long COVID symptoms, compared to 6.6 percent of adults without disabilities (CDC, 2024b). While the exact mechanisms behind this association are still being studied, the finding reinforced concerns that the pandemic may have both created new disabilities and worsened existing ones.

Employment and Education Among Adults With Disabilities

Working-age adults with disabilities face significant gaps in both employment and education compared to their nondisabled peers. According to 2023 ACS data, people with disabilities accounted for 6.8 percent of all employees aged 18 to 64. Employment rates varied dramatically by disability type: 59.4 percent of people with hearing disabilities were employed, compared to just 17.9 percent of those with self-care disabilities (AskEARN, 2025).

Education gaps are also stark. In 2024, 16.4 percent of individuals aged 25 and over with disabilities had less than a high school education, compared to 8.8 percent of those without disabilities - making people with disabilities 1.9 times more likely to lack a high school diploma. At the other end, just 13.4 percent of adults with disabilities held a four-year college degree, compared to 24 percent of adults without disabilities (Center for Research on Disability, 2026).

Children Living With Disabilities in the United States

Overall Prevalence Among Children

Estimating the number of children with disabilities in the United States is complicated by the fact that different surveys use different definitions and age ranges. The National Health Interview Survey (NHIS), conducted by the CDC's National Center for Health Statistics, reported in its 2020-2021 data that approximately 13 percent of children aged 5 to 17 had a disability. Rates were slightly higher for boys (14 percent) than for girls (12 percent) (Federal Interagency Forum on Child and Family Statistics, 2023).

The ACS provides estimates for younger age groups as well, though children under age 5 are only asked about vision and hearing difficulties. For children aged 5 to 15, the 2023 ACS found a disability prevalence in line with the roughly 6 percent figure seen in prior years, while the rate for those aged 16 to 20 was somewhat higher, consistent with the broader challenges of adolescence and early adulthood (Erickson et al., 2025).

A peer-reviewed study published in Scientific Reports using NHIS data from 2018 to 2021 estimated that 16.65 percent of children and adolescents aged 3 to 17 had a developmental disability of some kind, including ADHD, learning disabilities, autism, intellectual disability, and other developmental delays (Li et al., 2023).

Children With Developmental Disabilities

Developmental disabilities represent the largest category of childhood disability in the United States. According to the NHIS data analyzed by Li et al. (2023), ADHD was the most commonly identified developmental disability among children aged 3 to 17, with a prevalence of 9.57 percent. Learning disabilities followed at 7.45 percent, other developmental delays at 5.24 percent, autism spectrum disorder at 2.94 percent, and intellectual disability at 1.72 percent.

These rates have been trending upward for years. The prevalence of any developmental disability among U.S. children rose from 16.22 percent during 2009-2011 to 17.76 percent during 2015-2017, reflecting a combination of improved screening, broadened diagnostic criteria, and greater awareness among both parents and clinicians (Li et al., 2023).

Autism Spectrum Disorder: A Rapidly Rising Diagnosis

No childhood disability statistic has drawn more public attention than autism. In April 2025, the CDC released updated data from its Autism and Developmental Disabilities Monitoring (ADDM) Network showing that approximately 1 in 31 eight-year-old children - or 3.2 percent - were identified with autism spectrum disorder (ASD) based on 2022 surveillance data. That represents a notable increase from the previously reported rate of 1 in 36 based on 2020 data, and a dramatic rise from 1 in 150 when the CDC first began tracking autism prevalence among children born in the early 1990s (Shaw et al., 2025).

The gender gap in autism identification remains significant: boys were 3.4 times more likely than girls to be identified with ASD, with a prevalence of 49.2 per 1,000 among boys compared to 14.3 per 1,000 among girls. Racial and ethnic patterns have also shifted in recent years. For the first time in the ADDM Network's history, Asian or Pacific Islander, Black, Hispanic, and multiracial children all had higher ASD prevalence than White children, suggesting that diagnostic access has expanded into communities that were historically underserved (Shaw et al., 2025).

Learning Disabilities

A 2025 study published in PLOS ONE using National Survey of Children's Health data from 2016 to 2023 found that 8.85 percent of U.S. children aged 6 to 17 had a parent-reported history of learning disability diagnosis. The study noted an upward trend in learning disability prevalence over the eight-year period, with notable variation by state (Weeks et al., 2025). Separately, the National Center for Learning Disabilities has estimated that as many as 20 percent of U.S. children have some type of learning or thinking difference, though not all of these meet the threshold for a clinical diagnosis (National Center for Learning Disabilities, 2024).

Children Served Under IDEA

Perhaps the most concrete measure of childhood disability comes from the Individuals with Disabilities Education Act (IDEA), which mandates free and appropriate public education for eligible students aged 3 to 21. According to the National Center for Education Statistics, approximately 7.5 million students were served under IDEA Part B during the 2022-23 school year, representing 15 percent of total public school enrollment. That number has grown steadily from 6.4 million students (13 percent of enrollment) in the 2012-13 school year (National Center for Education Statistics [NCES], 2024).

In the fall of 2022, approximately 67.76 million people aged 6 to 21 were enrolled in school in the United States. Of these, 7.08 million - or 10.5 percent - received special education services under IDEA Part B. The percentage varied considerably by state, from 7 percent in Hawaii to 13.9 percent in Maine (Center for Research on Disability, 2025).

Income and Childhood Disability

Family income plays a significant role in childhood disability prevalence. NHIS data show that children in families with incomes below the poverty level reported disability at a rate of 18 percent, compared to 15 percent for those at 100 to 199 percent of poverty and 11 percent for children in families at or above 200 percent of the poverty level (Federal Interagency Forum on Child and Family Statistics, 2023). This gradient likely reflects a combination of increased exposure to environmental risk factors, reduced access to prenatal and pediatric care, and the compounding effects of socioeconomic disadvantage on child development.

The Broader Picture: Disability as Part of American Life

Taken together, the data paint a clear picture: disability is woven into the fabric of American society. It touches every age group, every racial and ethnic community, and every income level. The CDC has noted that disability should not be viewed as a health outcome but rather as a part of how people experience life - encompassing the ways people hear, see, move, process information, and care for themselves (CDC, 2024a).

The numbers have been rising over time, driven in part by an aging population, improved diagnostic tools, greater public awareness of conditions like autism and ADHD, and the health consequences of COVID-19. Between the ACS estimate of 44.68 million civilians with disabilities and the BRFSS estimate of over 70 million adults alone, the scope of disability in America is enormous. Factor in the millions of children receiving special education services and the millions more with developmental disabilities, and it becomes clear that disability policy, accessibility, and inclusion are among the most consequential issues facing the nation.

References

• AskEARN. (2025). Statistics on disability. Employer Assistance and Resource Network on Disability Inclusion.
• Center for Research on Disability. (2025). 2025 annual disability statistics compendium. University of New Hampshire, Institute on Disability.
• Center for Research on Disability. (2026). 2026 annual disability statistics compendium. University of New Hampshire, Institute on Disability.
• Centers for Disease Control and Prevention. (2024a). Disability and health data now. National Center on Birth Defects and Developmental Disabilities.
• Centers for Disease Control and Prevention. (2024b). Disability impacts all of us [Infographic]. National Center on Birth Defects and Developmental Disabilities.
• Erickson, W., Lee, C., and von Schrader, S. (2025). 2023 disability status report: United States. Cornell University Yang-Tan Institute on Employment and Disability.
• Federal Interagency Forum on Child and Family Statistics. (2023). America's children: Key national indicators of well-being, 2023 - Disability. Childstats.gov.
• Li, Y., Wang, Y., and Chen, X. (2023). Prevalence and trends of developmental disabilities among US children and adolescents aged 3 to 17 years, 2018-2021. Scientific Reports, 13, 17562.
• National Center for Education Statistics. (2024). Students with disabilities. Condition of Education. U.S. Department of Education, Institute of Education Sciences.
• National Center for Learning Disabilities. (2024). The state of learning disabilities: Data, disparities, and directions for change. NCLD Research Report.
• Northeast ADA Center. (2025). How common is disability among adults in the US? Understanding survey differences.
• Pew Research Center. (2023). 8 facts about Americans with disabilities.
• Shaw, K. A., Williams, S., Patrick, M. E., et al. (2025). Prevalence and early identification of autism spectrum disorder among children aged 4 and 8 years - Autism and Developmental Disabilities Monitoring Network, 16 sites, United States, 2022. MMWR Surveillance Summaries, 74(SS-2), 1-22.
• Weeks, J. D., Madans, J. H., Black, L. I., Elgaddal, N., and Zablotsky, B. (2025). Difficulties in functioning among children in the United States: 2021-2023. National Health Statistics Reports, (218), 1-20.

Stromatolites - and their close relatives, microbial mats - could be mistaken for what seems like a bunch of old dark rocks. But instead, they are dense, layered communities of microbes. Long before complex life such as animals or plants existed, stromatolites breathed the first molecules of oxygen into Earth's atmosphere. Now, in a study published today, researchers say they may also hold insights into how complex life began.

An Asgard Archaeon From a Modern Analogue of Ancient Microbial Mats

Associate Professor Brendan Burns, an evolutionary microbiologist at UNSW Sydney, is part of a team that identified a previously unknown microbe living in close partnership with another organism inside these 'living fossils'. The work, co-led with researchers from the University of Technology Sydney and the University of Melbourne, could help solve one of life's biggest mysteries: how simple cells first combined to form more complex life.

"Stromatolites could be more than 'just' a cradle of life where early microbial life flourished," says A/Prof. Burns. "They could also tell us how complex life first emerged."

The 'Microbial Village that Helped Raise a Eukaryote'

Though they were first on Earth billions of years ago, stromatolites and mats continue to form in Shark Bay, which is a World Heritage-listed site in Western Australia. It was here that A/Prof. Burns and colleagues collected samples and eventually isolated a member of the Asgard archaea - a group of unique microbes thought to be closely related to the ancestors of eukaryotes, which are the cells that make up all plants and animals, including humans.

A long-standing theory in biology suggests the first eukaryote arose when an ancient archaeon and a bacterium formed a close partnership, with one eventually engulfing the other. This union gave rise to mitochondria - the powerhouse of cells. But what scientists have been missing is direct evidence of how such relationships might have looked in practice.

This study provides the first visual evidence of an Asgard archaeon physically interacting with a bacterium through fine, tube-like structures known as nanotubes.

"This could be a little model for how these kinds of partnerships started and ultimately formed eukaryotes," says A/Prof. Burns.

The Long Road of Discovery

While genetic sequencing revealed the organisms' DNA lurking within the samples, cultivating the microbes to observe them in action was difficult.

"It took four or five years in the lab," A/Prof. Burns says. "A lot of time, optimising and chasing different shadows."

Asgard archaea are notoriously difficult to cultivate outside their natural environment, so the team was unable to grow them in isolation. A/Prof. Burns says this is a finding that could also be significant.

"The fact that we could never get these organisms into pure culture is probably because they always depend on other organisms to survive," he says.

The breakthrough came with electron cryotomography, a high-resolution 3D imaging technique that allowed researchers to see structures at the scale of a millionth of a millimetre. The images revealed the two organisms physically linked by bacterial nanotubes. The archaeon also appeared to sprout chains of budded vesicles and elaborate tube-like structures. Each microbe made compounds that the other could use, including vitamins, nutrients and hydrogen.

Coauthor Associate Professor Debnath Ghosal from the University of Melbourne says capturing the first direct physical interaction between an Asgard archaeon and a bacterium is especially exciting.

"This discovery brings us a few steps closer towards understanding how complex cells evolved from relatively simpler microbial life forms," A/Prof. Ghosal says.

Coauthor Associate Professor Kate Mitchie from UNSW says the research included an element of deep learning - a type of machine learning.

"We used this to predict the structures of proteins in these microbes," A/Prof. Mitchie says. "And that's exciting because we can start to see ancient versions of the cellular machinery that later became central to complex life."

A/Prof. Burns likens archaea to 'companions'. Under the harsh conditions that batter microbial mats, this kind of cooperation, even at the microscale, could be vital for survival.

An Ancient but Living Story

Coauthor Associate Professor Iain Duggin from the University of Technology Sydney says it's amazing to imagine that these microbes could have been in partnership in these environments for millions of years, giving rise to complex life - including humans.

"It's as if we have slowly arisen from the bottom of the sea," A/Prof. Duggin says.

The newly identified archaeon was named Nerearchaeum marumarumayae after the ancient Greek sea god Nereus and the Malgana word marumarumayae, meaning 'ancient home'. Malgana is one of the traditional languages of the people of central Shark Bay, whose ties to country are recognised by Native Title. Malgana elders, rangers and community actively work in Shark Bay caring for country, protecting wildlife and restoring the land.

Shark Bay has a rich Indigenous history, with Indigenous people first inhabiting the area around 30,000 years ago. The naming process involved consultation with Kymberly Oakley, the world's foremost Malgana language expert. Malgana elders were also consulted for appropriate words that could be respectfully used in the naming of the new microbe. The elders granted permission to incorporate language that allowed the Malgana culture to be recognised and celebrated.

For scientists, these microbial communities offer a rare window into early Earth. For Traditional Owners, they are part of a cultural heritage that continues to be cared for and protected.

A/Prof. Burns hopes to uncover more microbial partnerships, expanding what he calls a "little primordial Asgard soup", to help scientists piece together the earliest chapters of complex life.

"But it's not just about the organisms," he says. "It's about people as well. A huge collaborative effort across disciplines with many graduate students being instrumental in building this story."

"Part of what makes this exciting is that it's not just discovery, but connection. Not just across many years, but at a time when these fragile ecosystems face mounting threats from climate change and human activity."

The microbes show how life depended on cooperation to survive - which A/Prof. Burns says is just as essential today.

"These microbes remind us that even the smallest partners can leave the deepest mark on our history."

Somewhere between biology and engineering, a strange new creation is quietly rewriting what we thought we knew about life, machines, and the line between the two. Xenobots are not the metallic, bolt-and-gear robots of science fiction. They are tiny, living organisms - less than a millimeter wide - assembled from the stem cells of the African clawed frog, Xenopus laevis. Since their debut in 2020, they have captured the imagination of scientists, ethicists, and the public alike. But beyond the headlines, xenobots carry real and tangible implications for medicine, environmental science, and perhaps most importantly, for the millions of people worldwide living with disabilities.

What Are Xenobots?

Xenobots are programmable, living organisms designed by artificial intelligence and built from biological cells. They were first created by a team of researchers at the University of Vermont and Tufts University, led by computer scientist Josh Bongard, roboticist Sam Kriegman, and biologist Douglas Blackiston, in collaboration with developmental biologist Michael Levin (Kriegman et al., 2020). Their name comes from the frog species whose cells are used - Xenopus laevis - combined with "bot," short for robot.

The process begins with harvesting stem cells from frog embryos at the blastula stage, when cells still retain the ability to develop into different tissue types. These cells are then separated, incubated, and carefully assembled under a microscope into configurations designed by AI-powered evolutionary algorithms running on supercomputers. The AI tests billions of possible cell arrangements in simulation, searching for body shapes that can perform specific tasks such as locomotion or object transport. Skin cells provide structural support, while heart muscle cells - or, in later versions, cilia - generate movement through rhythmic contraction or coordinated beating (Blackiston et al., 2021).

What makes xenobots distinct from traditional robots is that they are composed entirely of living, organic material. They require no batteries, no wiring, and no external power source. They run on energy stored naturally in their cells and, when their fuel is spent after roughly seven to ten days, they simply break down into dead skin cells and biodegrade harmlessly. They are not genetically modified organisms. Their DNA is entirely that of a normal frog. What changes is the architecture - the way those cells are organized and arranged to produce behaviors that no frog would ever naturally exhibit.

How Xenobots Work

The first generation of xenobots, introduced in a landmark 2020 paper published in the Proceedings of the National Academy of Sciences, moved by using contractions of cardiac muscle cells to propel themselves along the bottom of a petri dish. Researchers found these tiny organisms could push small objects, navigate aqueous environments, and even carry payloads within specially sculpted pouches in their bodies (Kriegman et al., 2020).

The second generation, sometimes called Xenobots 2.0, moved faster and lived longer. Instead of relying on heart muscle, these organisms grew patches of cilia - tiny hair-like structures - that acted as miniature oars, allowing them to swim. They could also self-assemble from single cells without the painstaking microsurgery required for the originals. Perhaps most remarkably, researchers demonstrated a basic form of recordable memory by introducing a fluorescent protein that changed color when exposed to a specific wavelength of blue light. This allowed scientists to track where individual xenobots had traveled during experiments (Blackiston et al., 2021).

In late 2021, the same research team revealed that xenobots could reproduce - but not through any method previously observed in nature. Rather than growing and dividing like cells or budding like some organisms, xenobots engaged in what the researchers called "kinematic self-replication." They gathered loose frog cells floating in their environment, compressed them into small clusters, and those clusters eventually matured into functional offspring capable of repeating the process. AI optimization of the parent xenobot's body shape - notably a C-shaped or Pac-Man-like form - dramatically improved the efficiency of this reproduction (Kriegman et al., 2021).

Why Xenobots Matter for Medicine

The medical possibilities of xenobots, while still largely theoretical, are genuinely compelling. Because they are made from living cells, xenobots are inherently biocompatible and biodegradable. They do not produce the toxic byproducts or pollution associated with synthetic materials like plastics or metals. This makes them attractive candidates for tasks inside the human body where traditional machines would cause immune reactions, contamination, or rejection.

One of the most discussed potential applications is targeted drug delivery. Conventional medications circulate throughout the entire bloodstream, affecting healthy and diseased tissue alike. A xenobot, by contrast, could theoretically be programmed to travel to a precise location within the body and release a therapeutic payload exactly where it is needed. Early experiments already demonstrated that xenobots can be sculpted with small pouches capable of carrying microscopic objects, suggesting a proof of concept for this kind of delivery system (Kriegman et al., 2020).

In a future clinical scenario, xenobots could be grown from a patient's own cells, virtually eliminating the risk of immune rejection. After completing their task, they would naturally degrade within days, leaving behind nothing harmful. Researchers have speculated about applications ranging from clearing arterial plaque to identifying and removing cancerous cells (Solanki et al., 2022).

Xenobots and Disability - A New Frontier

The relationship between xenobots and disability is not immediately obvious, but the connections run deep and have the potential to be transformative. Disabilities - whether physical, neurological, or sensory - frequently involve tissue damage, cellular dysfunction, or the failure of the body's own repair mechanisms. Xenobots, as living machines that interact directly with biological systems, could one day address several of these challenges in ways that current technologies cannot.

Targeted Therapy for Neurological Conditions

Neurodegenerative diseases like Parkinson's disease and Alzheimer's disease involve the progressive loss of specific types of brain cells. Current treatments often rely on systemic medications that come with significant side effects because they affect the entire body rather than just the affected regions. Xenobots, with their potential for precise navigation and targeted payload delivery, could theoretically carry therapeutic agents directly to damaged brain tissue. Because they are biological in nature, they may interact more safely with neural environments than synthetic nanoparticles or implanted devices (Solanki et al., 2022). For the millions of people whose daily lives are shaped by these conditions, the prospect of more effective and less invasive treatment is meaningful.

Regenerative Medicine and Tissue Repair

Many disabilities result from injuries or conditions that damage tissue beyond the body's natural ability to repair it - spinal cord injuries, severe burns, degenerative joint disease, or congenital defects in organ development. Xenobot research contributes directly to the broader field of regenerative medicine by advancing our understanding of how cells cooperate to build and rebuild complex structures. Michael Levin, one of the principal researchers behind xenobots, has described the work as part of a larger effort to crack the "morphogenetic code" - the set of rules that governs how cells organize themselves into functional tissues and organs (Levin, 2021). If researchers can learn to guide cellular self-organization the way they guide xenobot assembly, it could open doors to repairing damaged nerves, growing replacement tissues, or correcting developmental abnormalities.

Assistive Applications Inside the Body

Consider the challenges faced by someone with a chronic condition such as diabetes, where the body fails to properly regulate blood sugar. Future xenobots, equipped with molecular sensors and designed to respond to biochemical signals, might serve as internal monitors that detect dangerous changes in blood chemistry and deliver corrective agents automatically. Similar concepts could apply to autoimmune disorders, chronic pain conditions, or circulatory diseases that contribute to mobility impairments. The key advantage is that xenobots are not foreign objects - they are biological, temporary, and self-disposing, which reduces many of the complications associated with long-term implanted medical devices.

Reducing Barriers to Treatment

People with disabilities often face compounding barriers to medical care, including the physical demands of surgical recovery, the financial burden of repeated treatments, and the risks associated with invasive procedures. A xenobot-based approach to therapy - one that is minimally invasive, biodegradable, and potentially personalized from a patient's own cells - could reduce several of these barriers simultaneously. A treatment that requires no surgical implant, produces no lasting foreign material in the body, and degrades naturally after completing its task represents a fundamentally different model of medical intervention.

Environmental Remediation and Accessibility

Xenobots also have potential environmental applications that connect indirectly to disability. Researchers have observed that swarms of xenobots tend to collectively push loose particles into central piles, suggesting that future versions might be deployed to gather ocean microplastics or detect and aggregate radioactive contaminants (Ball, 2020). Environmental pollutants disproportionately affect people with disabilities and chronic health conditions. Cleaner environments mean fewer exacerbating factors for respiratory diseases, fewer neurotoxic exposures, and healthier communities overall. While this link is indirect, it is worth noting that advances in living-machine technology could have broad public health implications.

Self-Repair and What It Teaches Us

One of the most striking features of xenobots is their ability to heal themselves. When researchers cut a xenobot nearly in half, it stitched itself back together and continued functioning within minutes (Blackiston et al., 2021). This capacity for self-repair is something that no conventional machine can replicate and something that many human tissues struggle to achieve after injury. Studying how xenobots accomplish this repair at the cellular level may yield insights applicable to wound healing, nerve regeneration, and the recovery of function after traumatic injury. For people living with disabilities that result from tissue damage - whether from stroke, accident, or disease - understanding the mechanisms of biological self-repair is not an abstract academic exercise. It is directly relevant to their quality of life.

Ethical Considerations

Any discussion of xenobots would be incomplete without addressing the ethical questions they raise. Are xenobots alive? Are they machines? Do they have moral status? These are not settled questions, and researchers themselves disagree on the answers. The organisms are made entirely of living cells, they move autonomously, they can heal, and they can reproduce in a limited fashion. Yet they have no brain, no nervous system, and no capacity for sensation or experience as far as current science can determine.

There are also practical concerns. If xenobots were ever developed for use inside the human body, rigorous testing would be needed to ensure they behave predictably and safely. The use of frog embryos as source material raises questions about animal welfare. And as with any powerful new technology, there is the potential for misuse - applications in surveillance, biological weapons development, or unregulated experimentation. Researchers including the xenobot team have called for proactive ethical oversight, suggesting that applied ethicists should be involved in the development process from the outset (Kriegman et al., 2020).

For the disability community specifically, ethical considerations include ensuring equitable access to any therapies that emerge from this research, avoiding the framing of disability as something that universally requires a "fix," and centering the voices of disabled people in decisions about how these technologies are developed and deployed.

The Road Ahead

Xenobot research is still in its early stages. No xenobot has been tested inside a living animal, let alone a human patient. The organisms remain laboratory tools, primarily used to study how cells communicate, cooperate, and organize. But the trajectory of the research is clear: each successive generation of xenobots has been more capable, more autonomous, and more biologically sophisticated than the last.

The combination of AI-driven design and biological construction represents a genuinely new approach to engineering. It is not robotics in the traditional sense, and it is not genetic engineering either. It occupies a novel space - one that Michael Levin has described as the study of how "hardware enables cells to cooperate towards making functional anatomies under very different conditions" (Levin, 2021). The work is supported by institutions including DARPA's Lifelong Learning Machines program and the National Science Foundation, signaling that the research community and funding bodies take its potential seriously.

For people with disabilities, the most honest assessment is one of cautious optimism. The science is real, the potential applications are significant, and the underlying principles - biocompatibility, self-repair, targeted intervention, minimal invasiveness - align well with the needs of people who have historically been underserved by conventional medical technology. But timelines are uncertain, and translating laboratory findings into clinical treatments is a long and unpredictable process. What xenobots offer today is not a cure or a device but something equally important: a fundamentally new way of thinking about what biological materials can do when freed from their default programming and guided by intelligent design.

References

• Ball, P. (2020). Living robots. Nature Materials, 19, 265.
• Blackiston, D., Lederer, E., Kriegman, S., Garnier, S., Bongard, J., and Levin, M. (2021). A cellular platform for the development of synthetic living machines. Science Robotics, 6(52), eabf1571.
• Kriegman, S., Blackiston, D., Levin, M., and Bongard, J. (2020). A scalable pipeline for designing reconfigurable organisms. Proceedings of the National Academy of Sciences, 117(4), 1853-1859.
• Kriegman, S., Blackiston, D., Levin, M., and Bongard, J. (2021). Kinematic self-replication in reconfigurable organisms. Proceedings of the National Academy of Sciences, 118(49), e2112672118.
• Levin, M. (2021). Bioelectric signaling: Reprogrammable circuits underlying embryogenesis, regeneration, and cancer. Cell, 184(6), 1971-1989.
• Solanki, N., Mahant, S., Patel, S., Patel, M., Shah, U., Patel, A., Koria, H., and Patel, A. (2022). Xenobots: Applications in drug discovery. Current Pharmaceutical Biotechnology, 23(14), 1675-1690.

In New York City, the cost of living is higher than a standard police pension. Therefore, many police officers try to retire by receiving a disability pension. This pension is 25% higher than the standard pension. The disability pension is sufficient to live modestly in New York City. Frankly, police officers don't always receive their disability pension legally.

The average cost of living in New York City is 77% higher than the US average. To live comfortably, a single adult in New York City must earn $70,000-$100,000 per year. However, many people don't have that kind of income. Even police officers. A New York City police officer earns $60,884 for the first five and a half years of service. This is less than the amount needed to live comfortably in New York City. However, after that, the salary increases to $126,410. This allows officers to live comfortably for most of their careers. By law, a New York City police officer must work for 20 years to be eligible for retirement.

However, after 15 years of relative prosperity, police officers once again face poverty. A typical police officer's pension in New York City is 50% of their total earnings in their final year of service. If that earnings is the aforementioned $126,410, then the typical pension is only $63,000. This is less than the minimum subsistence level for a single adult in New York City.

However, a disability pension is 75% of the annual salary in the last year of service. This is almost $95,000, which is enough to live on in New York City. In the current situation, disability pensions are proving to be a lifeline for New York City police officers. This makes disability pensions notoriously popular among New York City police officers.

Between 33% and 50% of New York City police officers receive disability pensions. This represents at least 12,000 people. However, these individuals' records are not publicly available under a special law passed in New York State in 2009. This makes it difficult to identify cases of violations related to disability pensions. However, the press has repeatedly reported on numerous investigations into the illegal receipt of disability pensions by New York City police officers. These investigations involve dozens of suspects.

Police officers commonly falsify documents to obtain disability benefits. But sometimes they go further. One New York police officer received a disability pension, and there is no evidence that he obtained it illegally. He then moved to Florida and took a job with the police there. This allowed him to receive a New York pension and a Florida salary. It's a paradox. But the officer didn't break any laws by doing so. New York state law prohibits receiving a disability pension and working anywhere within the state. However, it is possible to receive a disability pension in New York and work outside of the state.

Let's be honest. The situation isn't always hopeless for police officers. Although the salary for the first five years of service and the pension based on the average salary are insufficient for a decent living in New York City, overtime pay is a lifesaver. Overtime pay is often very generous and provides the opportunity to increase the average salary, which in turn increases pensions. Overtime pay is so high that many officers choose to quit if they lose their overtime pay. Because without overtime, the salary is too low to provide a decent pension. For example, this trend is observed in 2026, when the city government is trying to reduce police overtime pay.

Overall, the situation with disability pensions in the NYPD is a classic example of how people strive to survive in difficult circumstances. It's unfortunate that honest work doesn't always guarantee a happy retirement. But even so, most New York City police officers receive their disability pensions legally. After all, being a police officer is a very dangerous and demanding profession. Forging documents to obtain a disability pension is certainly bad. But the fact that the disability pension is higher than a regular pension is a good thing!

My soulmate and I crawled into our big bed, the back elevated to perfect film watching position, and snuggled toward each other*. Within moments we were swept into Grace - a short film that felt effortlessly beautiful and moving.

The operative word there is "felt".

There is nothing effortless about telling a story well, casting a film perfectly, lighting scenes flawlessly, meaningfully inviting an audience along on an important journey that entertains while expanding empathy.

But by grace and goodness! This short film did all that and more for me.

Grace, written and directed by Anna Rodgers, is the eponymous story of a young woman testing the limits of her autonomy and expanding its edges. Grace has Down Syndrome and stays in an assisted living home, though the opening scene is of Grace sitting at the table in her family home. Her infant niece is placed in a high chair near her and while the two of them quietly spend time in each other's company, Grace's sister and mother are busily planning the sister's wedding in the background. Due to a mastery of acting, editing, and dialogue we quickly understand that Grace has a boyfriend, is thinking of long term life with him, and hoping to raise a family - and that this is a complication for those who love her.

The entire film unfolds with such beautiful brilliance, quietly inviting audiences into these moments. I hardly knew where my space ended and Grace's began.

Grace, played with subtle perfection by actress Fiadhnait Canning, is the sort of hero I crave in my stories. She is clear about what she wants, thoughtful toward people along the way, and courageous enough to insist on a life that is hers without being unreasonably self-centered.

Everyone in this film is beautiful. I sometimes tease media for all the beautiful people, but this is a film that gets it right. Yes, everyone is attractively lit and has an appearance that is lovely to look at, but more than that, it is the beauty of their character we are watching. The crux of the matter for each person in Grace's orbit - her carers, her boyfriend, her mother - is they care about her and feel a sense of obligation because of it. These people are all invested, they all care, but it is inside our caring we most struggle to agree on actions.

While watching this twenty-five minute film I hardly spoke. For me, this is unusual. My poor soulmate almost always has to endure the joy I get in treating all media as an interactive activity, my desire to follow a thought or add my two cents. To say, "this reminds me of the time..." or "that's what I was saying yesterday..." or "can you imagine? What would you do if..."

But while watching Grace's story unfold, I was mesmerized, drawn in.

It was only later all those thoughts came tumbling out.

A "this reminds me of the time..." thought I shared with my love: there was a lesbian couple with Down Syndrome who were regulars at the donut shop I worked at when I was a teen (1990). They were comfortable displaying their love in public, taking turns buying each other coffee, holding hands and giving each other little kisses, and they told me they liked the home they lived in but not the rules. They could not sleep in the same room and were considering getting their own apartment, but were consistently being told they could not.

A "that's like what I was saying yesterday..." moment sparked for me during a scene where residents are taking part in a class where the speaker asks them to practice saying no. Encouraged to role play, they're given a scenario where they are asked out on a date and they do not want to go. Grace and a male resident play the part with fun and flair. The man asks Grace out, she says no, he asks again, she again says no - no anger or apology, and we are reminded it is a skill worth practicing. Saying no. No explanation needed, just a knowledge that it is your right and responsibility.

I loved this scene so much! For people with disabilities this is such a valuable skill to both learn and practice. They are often at the mercy of carers, told they must comply for their own good and safety, and are not often enough given space to practice the skill of knowing when they aren't safer or expected to comply, or how to handle those moments.

Yet, it's true that we all need this space, for learning and practicing. For knowing how to comfortably and confidently say no. For knowing when complying is for our good and/or our safety and for knowing when it is not.

A "can you imagine? What would you do if..." moment for me was toward the end, when Grace is in the place of drastic decision making - I so badly don't want to spoil anything so suffice it to say, she and everyone who cares about her find themselves in a life-altering situation that needs to be addressed, yet all the players have different strongly held opinions, and every opinion is expressed with perceptive insight. What would I do? If I was Grace, if I was Grace's mom, if I was Grace's boyfriend? How would I step up? I don't have one clear answer, though I know which way I lean.

In my opinion this is not only a beautiful film, wonderfully executed, but a necessary one.

On a personal note: My mom raised eight of us kids. My four adopted brothers were on the autism spectrum, and she fought for them to be seen the way I feel the filmmakers see Grace: as someone with capabilities, requiring somewhat personalized teaching, and deserving of autonomy.

When I was growing up, mom was always fighting that fight. It was messy, heartbreaking, but ultimately victorious.

For me, watching this film felt like being given the gift of knowing mom's fight was not hers alone, it was known and understood by others.

But this film also felt lovely. Something that was lacking in the extremeness of my mom's fight for my brothers' rights, the loud clashing, the wild highs and lows, when I was growing up.

No, not lacking, simply harder to see.

On another personal note: I needed this. I needed this bit of Grace.

I suspect many of you do, too.

One last thought:

Grace is all of us. She is born into a preexisting system, as she grows people who love her find additional systems of support meant not for her for but for "people like her", she is encouraged to seek some independence and skills but as her adulthood blossoms, as she blossoms, she must navigate the world by deciding who she is, what she wants, which supports to break free from.

It is a powerful time in all our lives. Particularly, that first time.

One we hope to do with Grace.

*It was not lost on me that while my love and I were laying comfortably in our big bed, we were watching Grace fight for her right to lay in one with her boyfriend.

Screening

GRACE will screen at the 50th Cleveland International Film Festival in the Parability Shorts Program - premiering on April 12 at 2:30pm EDT, (More information here), Fiadhnait Canning will be in attendance thanks to the support of Culture Ireland.

Exposure to a chemical commonly used to make plastic more flexible may have contributed to about 1.97 million preterm births in 2018 alone, or more than 8 percent of the world's total, a new analysis of population surveys shows. The chemical was also linked to the deaths of 74,000 newborns, the researchers further estimate.

The toxin, di-2-ethylhexylphthalate (DEHP), is part of a group of chemicals called phthalates, which appear in cosmetics, detergents, bug repellents, and other household products. Experts have found that these substances can break down into microscopic particles and enter the body through food, air, and dust.

Global Study Puts a Number on Plastic's Pregnancy Risk - and It's Alarming

Led by NYU Langone Health researchers, the new study focused on preterm birth, which is a major risk factor for lasting learning and developmental issues and is a leading cause of infant death, according to the World Health Organization. The new analysis provides the first global estimate of preterm births connected to exposure to DEHP and explores which parts of the world are most affected, according to the authors. A report on the findings will be published online March 31 in the journal eClinicalMedicine.

"By estimating how much phthalate exposure may contribute to preterm birth worldwide, our findings highlight that reducing exposure, especially in vulnerable regions, could help prevent early births and the health problems that often follow," said study lead author Sara Hyman, MS.

Past studies have linked DEHP exposure to cancer, heart disease, and infertility, among many other health concerns, added Hyman, an associate research scientist at NYU Grossman School of Medicine. There is also a large body of research connecting the chemical to preterm birth.

According to the new work, DEHP exposure may have contributed to 1.2 million years lived with disability, a measure of all the years that people have lived or will live with illnesses, injuries, and other health issues caused by being born prematurely.

Hyman said that while the phthalate is in widespread use, certain regions are estimated to bear a much larger share of the health impacts than others, with the Middle East and South Asia representing 54 percent of estimated illness from preterm birth. These areas have rapidly growing plastics industries and high levels of global plastic waste. Africa, which accounted for 26 percent of health problems from DEHP-linked preterm birth, has a disproportionate share of deaths compared with its share of overall premature cases. The researchers said this reflects the region's higher underlying death toll from preterm birth.

How the Study Was Conducted

For the study, the research team estimated DEHP exposure in 2018 across 200 countries and territories by pulling data from large national surveys in the United States, Europe, and Canada. They also used estimates from earlier investigations to fill in regions that did not have their own data. The team then drew on earlier research that assessed how phthalate exposure may affect preterm birth and combined those findings with their global exposure estimates. Finally, they combined this information with worldwide figures on preterm births and deaths to gauge what share of these outcomes might be linked to DEHP.

The scientists repeated these steps for another phthalate called diisononyl phthalate (DiNP), a common replacement for DEHP. According to the results, DiNP may pose a similar risk as DEHP, having contributed to about 1.88 million preterm births around the world. The financial costs associated with newborn deaths ranged from millions to hundreds of billions of dollars for both phthalates.

A Call for Stronger Oversight

"Our analysis makes clear that regulating phthalates one at a time and swapping in poorly understood replacements is unlikely to solve the larger problem," said study senior author Leonardo Trasande, MD, MPP, the Jim G. Hendrick, MD, Professor of Pediatrics at NYU Grossman School of Medicine. "We are playing a dangerous game of Whac-A-Mole with hazardous chemicals, and these findings highlight the urgent need for stronger, class-wide oversight of plastic additives to avoid repeating the same mistakes."

Dr. Trasande, who is also a professor in the Department of Population Health and director of the Division of Environmental Pediatrics and the Center for the Investigation of Environmental Hazards, cautions that the investigation was not designed to establish that DEHP and DiNP directly or alone cause preterm birth, nor did it take into account other types of phthalates.

In addition, because there is some uncertainty in the data, the researchers looked at a range of possible values rather than just one estimate. This uncertainty range showed that the true impact of DEHP could be up to four times smaller than the main estimate or slightly higher. Even under the most conservative estimates, the results point to a substantial health burden, said Hyman.

Despite the limits of this kind of global modeling, added Hyman, the work lays important groundwork for future studies to confirm and refine these results and begins to fill a major gap in understanding the extent to which plastic chemicals affect preterm birth worldwide.

Funding and Disclosures

Funding for the study was provided by National Institutes of Health grant P2CES033423 and by Beyond Petrochemicals. Along with Hyman and Dr. Trasande, an NYU Langone co-investigator was Jonathan Acevedo, MPH.

Nearly 0.65 billion video views across the @Paralympics digital channels during 12 days of sporting competition.

The International Paralympic Committee's (IPC) digital channels enjoyed record breaking results during the Milano Cortina 2026 Paralympic Winter Games with the performance of some channels surpassing not just the Paris 2024 Paralympic Games but the whole year of 2024.

Across all @Paralympics channels, there were 648 million video views during 12 days of sporting competition, a staggering 3,144 percent increase on the Beijing 2022 Paralympic Winter Games. The number of video views is also more than two times the 305 million views across IPC channels during the Paris 2024 Paralympic Games which featured more sports and more days of competition.

Mike Peters PLY, IPC Chief Executive Officer, said:

"Milano Cortina 2026 was by some distance our most successful Paralympic Winter Games to date for digital content and engagement with both pre-Games and Games-time content achieving record numbers."

"For the Milano Cortina 2026 Paralympic Winter Games to outperform the record-breaking Paris 2024 Paralympic Games across some social media channels underlines the growing global interest in Paralympic sport among younger audiences, shows the value of working closely with the leading social media platforms, and the quality of talent within the IPC Content Team."

"Our pre-Games strategy focussed on educating audiences about the six Paralympic winter sports and the leading Para athletes in each sport. During the Games we switched to highlighting the best sporting moments and providing audiences with athlete and behind-the-scenes related content."

"Research from previous Paralympic Games has shown that witnessing Paralympic sport performances triggers massive shifts in attitudes and perceptions of viewers towards persons with disabilities. I am certain these record-breaking figures from Milano Cortina 2026 will have had a similar transformational impact."

YouTube Leads the Way

Working closely with YouTube, between the first day of competition on 4 March and the Closing Ceremony on 15 March 2026, there were 493.4 million videos views on the @Paralympics channel, with YouTube Shorts proving extremely popular. During this time, more than one million hours of content was consumed by viewers via the channel.

In terms of video views, the numbers recorded during Milano Cortina 2026 were 860 percent higher than for the Paris 2024 Paralympic Games and 97.6 percent greater than the whole year 2024.

The most popular YouTube short, involving a stunning shot by Canadian wheelchair curler Mark Ideson was viewed 46 million times.

With regards to pre-Games content, there were 1.2 million video views of content related to Milano Cortina 2026. This is 680 percent more than the 154,000 video views during a same pre-Games period for Beijing 2022. This content included the animated Allianz Sport Explainer films which serve as guides to each of the six Paralympic Winter sports; athlete profiles, and highlights from previous Games.

Meta Contributes 0.3 billion Content Views

Across Meta channels, there was more than 303 million impressions of content across @Paralympic channels.

On Facebook there were 169 million impressions of content on the @Paralympics page, including 44 million video views. Instagram accounted for more than 134 million impressions of content on the @Paralympics channel, with video content receiving more than 59 million views.

TikTok

On TikTok, the @Paralympics channel recorded 31.4 million video views and 1.2 million engagements. TikTok is the @Paralympics most popular channel with a regular audience of 4.7 million followers.

Douyin and Weibo

Across the Chinese social media channels of Douyin and Weibo there were nearly 21 million video views with one post - a video from the China's victory over Japan in wheelchair curling (mixed team or mixed doubles) attracting 9.65 million views. The majority of the most popular posts featured wheelchair curling as China won gold in the inaugural mixed doubles medal event and silver in the mixed team event.

Overall Audience Growth

Across all the social channels, the number of followers and subscribers to the IPC's @Paralympic social channels increased, with the number of YouTube subscribers growing by over 250,000. The IPC now has more than 10.2 million followers and subscribers across its @Paralympics network of channels.

Website Visitors

During the Games there were more than 3 million visitors to the IPC's official website, a growth of 43 per cent compared to the 2.1 million visitors during Beijing 2022.

Cosmopolitan Plated is based in Washington, DC and also offers its interactive lessons throughout the United States. Participants prepare and serve a meal chosen from a variety of themes and menu selections.

When they aren't in classrooms or kitchens, these folks turned their gastronomic gallivant into a sightseeing excursion. They combine a culinary learning experience with stimulating sightseeing.

Opportunities to do just that abound throughout the United States. After a search to find cooking classes which are of interest, people may hunt for things to see and do nearby.

For those with a physical disability, commercial galleys are very welcoming. They're flat, usually compact and utensils typically are in easy reach, including to those in a wheelchair or using crutches.

That is true at the Action Kitchen in Boston, where professional chefs conduct classes. Guests help to prepare a meal using regional ingredients, then enjoy what they have created. At the end of the exercise, participants receive a recipe book to take home.

Cosmopolitan Plated is based in Washington, DC and also offers its interactive lessons throughout the United States. Participants prepare and serve a meal chosen from a variety of themes and menu selections.

Among culinary course at Bossier Parish Community College in Louisiana are food basic skills, development and preparation principles. The region's relationship with food traces back to the 1830s, when the Elysian Groves Plantation grew corn, sweet potatoes and other crops which were shipped to markets in the south and east.

Meal time in Texas often means brisket, chicken fried steak and pecan pie. At the Spread Oaks Ranch in Markham selections include fresh-from-the gardens and greenhouse veggies, and learning to pair wines with food. When they're not preparing, or enjoying edibles, guests may select from a long list of activities including fresh and salt water fishing, hunting birds and stalking deer, wild hogs and alligators.

Agriculture has long shaped Idaho's identity and the state's food culture reflects a deep connection to locally grown ingredients and seasonal produce. Students at North Idaho College in Coeur d'Alene may study classical cooking techniques, nutrition and baking fundamentals.

Similar classes - Culinary Essentials, Nutrition, Bakeshop I and II - also are offered at the Danville Area Community College in Illinois. They're augmented by courses in salads, sandwiches, farm-to-fork and other topics, all taught by master chefs in a state-of-the-art kitchen.

The choices at Ivy Tech Community College in Indianapolis, Indiana are equally varied, and are available at nine locations. In addition to overall Culinary Arts classes they include baking and pastry, dietary administration and beverage management.

Hands-on experience is a focus of study at Edmonds Community College in Lynnwood, Washington. It blends classic cooking techniques with regional flavors. Students gain experience working in local kitchens, including the College Café.

Opportunities to cook in a college café, perfect your pastry prowess, broil brisket and try out regional recipes are just a few of countless approaching to upgrading one's culinary talents. Combining that learning experience with a sightseeing sojourn can offer benefits well beyond the plate, and palate.

One morning, during my recent visit there, I observed nattily dressed men and women playing the genteel game of croquet. That pastime traces its roots back to England in the 1860s, when it was promoted by the Earl of Essex and became a popular, socially accepted form of leisure.

In the afternoon, I watched a spirited polo match, a game which originated in ancient Persia more than 2,000 years ago and evolved over time to become known as "The Sport of Kings," popular in high society.

When evening arrived, I ate dinner during my month-long stay at a number of what can only be described as "dive bars" which are dotted throughout the community. They compete for customers with white tablecloth fine dining establishments that offer excellent food at sometimes excessive prices.

This diversity is, to me, one of the Palm Beach area's numerous inviting, and intriguing, traits. Walking or driving in the region introduces visitors to a smorgasbord of things to do and see which range from upscale to underprivileged, from interesting man-made attractions to some of Mother Nature's magnificent handiwork.

Adding to the appeal is the fact that many popular sites are welcoming to people with a handicap. For example, curb cuts along Worth Avenue are smooth and easy for wheelchairs to transit. Among welcoming beaches are those at DuBois Park, which has accessible picnic tables, ramped access and amphibious beach wheelchairs, and Ocean Reef Park, with ramped access to the sand and complimentary beach wheelchairs.

Mounts Botanical Garden is fully wheelchair accessible, as there are smooth paths throughout. That's also true for The Square in West Palm Beach, which is lined by dozens of shops and restaurants. Many businesses have an even entrance to get inside, and elevators are available to access the shops and restaurants on upper levels.

Visitors taking the drive-through experience at Lion Country Safari may see hundreds of animals from the comforts of their vehicle.

Of course, Florida means inviting seashores, and this location has its share of them. Those seeking a serene setting and calm waters often head for Sandy Point Beach. Trails meandering inland from the Riviera Municipal Beach cross dunes and coastal hammocks, and this stretch of sand offers excellent shelling. Ocean Reef Park is often pounded by powerful waves which can challenge all but the most accomplished swimmers.

The oceanfront location attracted Native Americans at least 3,000 years ago. Evidence of their habitation includes Pre-Colombian archaeological complexes consisting of a burial mound and cemeteries.

Early white settlers built the Jupiter Inlet Lighthouse around 1860. Twenty years later, Standard Oil tycoon Henry Fagler constructed three resort hotels which transformed the tropical landscape into a winter resort for the wealthy, then he extended the Florida East Coast Railway to the area.

In 1902, Flagler built a spectacular mansion as a gift for his bride, a beaux arts–styled modern manor adorned with pink aluminum-leaf wallpaper. The 4,750-square-foot Grand Hall, Library with its painted cast plaster ceiling and silk-and wood-lined Drawing Room give visitors a feel for the opulent lifestyle of the wealthy at that time. So vast is the castle-like structure that my first thought upon entering was if I had ever lived there, I'd have needed a map to find my way around.

Those who are there in mid-day may segue into a "Gilded Age Style" lunch in the Café des Beaux-Arts. It's housed in the Pavilion, a 19th-century, iron-and-glass railway palace which also displays Flagler's private railroad car.

Palm Beach continues to live up to its reputation as a retreat for the super-rich. Several years ago, Forbes magazine reported that the city was home to at least 30 billionaires – that's billion with a B. As I strolled along Worth Avenue, past high-end stores like Valentina, Versace and Ralph Lauren, I agreed with its description as one of the most beautiful shopping venues in the country. It combines classy European sophistication with elegant style and grace.

I also enjoyed the balance provided by stores, restaurants, bars and other establishments that cater largely to locals. Along with their touches of resident vibe, they offer opportunities to meet and mingle with folks who live in the area. Often, they can recommend below-the-radar places to see, and things to do, that visitors otherwise might miss.

In an area where Technicolor flowers and multi-hued foliage grow wild, gardens might seem redundant. However, formal plantings add an inviting painter's palette to the landscape.

Some, like the Ann Norton Sculpture Gardens, introduce human touches to Mother Nature's handiwork. Ann was a renowned sculpture whose works are displayed among some 250 species of rare tropical palms, cycads and native plants, as well as in her home.

Where there are sea, sand and soil there's likely to be wildlife, and it abounds at this destination. The John McArthur Beach State Park offers sightings of sea turtles, osprey and pelicans. Hikers in Phil Foster Park frequently encounter gopher, tortoise and herons. Droll-looking mammals referred to as sea cows congregate in large numbers in Manatee Lagoon, while in the visitor center there I enjoyed close-up views of animals of various sizes as they munched on a meal of lettuce and vegetables.

Getting close up and personal with those endearing creatures is one opportunity among many to meet and mingle with denizens of the Palm Beach area of Florida. Other experiences range from reliving the Gilded Age of high society to enjoying magnificent natural settings to checking out fun and funky places at which to sup and sip.

The NaviFut foot mouse is a new assistive device developed by an Italian engineer. The idea came directly from personal necessity. As he explains:

"I developed repetitive strain injury in both wrists due to continuous computer use. I tried every possible alternative - trackballs, vertical mice, pen tablets - but nothing really worked for me. That’s why I started experimenting with controlling the computer using my foot. After several iterations, I realized it was possible to build a device that could be fully controlled this way, both for cursor movement and for left and right clicking. I’m now making it available for everyone who may also benefit from it."

The device is designed with ergonomics and long-term use in mind. Its shape allows the foot to rest comfortably on top, with most of the weight supported by the heel. This makes it suitable for extended use without causing excessive strain.

Cursor movement works in a similar way to a traditional mouse. By gently sliding the device across the floor, the cursor moves accordingly on the screen. The device includes an integrated optical sensor with a resolution of up to 1600 DPI, ensuring a good level of precision (Figure 1). Sensitivity can also be adjusted through software, just like with a standard mouse.

Clicking is achieved through a controlled rolling motion of the foot. Starting from a relaxed position with the weight mainly on the heel, the user shifts the foot forward. A slight inward roll activates the left click, while a slight outward roll activates the right click. This motion becomes more natural with practice. Additionally, left and right click functions can be inverted directly in the operating system settings.

The device can be operated both with and without shoes. It is also compatible with different types of surfaces. On hard and smooth floors, such as wood or tiles, it can be used directly. In cases where the surface is softer or rougher, such as carpet, it is recommended to place a mouse mat underneath to improve movement, similar to a traditional mouse setup.

The learning curve is relatively short. Within a few days of use, most users can achieve a level of precision comparable to that of a hand-operated mouse. This makes it suitable for everyday computer use and work tasks, video editing and gaming.

The device can be used with either the left or right foot, depending on user preference.

The device outer case is manufactured using 3D printing with PLA, a biodegradable plastic material.

Who Can Benefit From This?

NaviFut has already started shipping internationally and has received positive feedback from users across different regions.

Some examples of people who have benefited from this technology include:

• Hand or upper limb amputees
• Individuals with limited hand mobility or paralysis
• People with conditions such as hemiparesis
• Users experiencing hand tremors
• Individuals suffering from long-term conditions such as repetitive strain injury or carpal tunnel syndrome.

In general, it can be a helpful alternative for anyone who struggles with traditional mouse use or is looking to reduce strain during prolonged computer work.

Where to Find Further Resources:

The device is currently available through the NaviFut website, with worldwide shipping options.

Via Kickstarter.

On Amazon for customers within the European Union.

More information on its operation and demo videos can also be found on NaviFut website and YouTube Channel at youtube.com/@NaviFutxStep

The phrase "cognitive debt" has surfaced in two very different fields over the past decade, yet the underlying concern is remarkably similar in both cases. Whether researchers are talking about the long-term brain health consequences of chronic negative thinking or the intellectual toll of outsourcing our reasoning to artificial intelligence, the core idea is the same: certain habits of mind - or the absence of them - can quietly erode our cognitive capacity over time. What makes the concept especially important right now is the speed at which AI tools are being adopted in workplaces, classrooms, and daily life, alongside an aging global population facing unprecedented rates of dementia. This paper examines cognitive debt from both angles, explores where the two interpretations overlap, and considers what the concept means for people living with disabilities or cognitive differences.

Origins of the Term

Cognitive debt did not begin as a technology buzzword. It was first proposed in a clinical context by Natalie Marchant and Robert Howard in a 2015 paper published in the Journal of Alzheimer's Disease. Marchant and Howard framed cognitive debt as the opposite of cognitive reserve - the well-established idea that education, intellectually stimulating work, and social engagement build a kind of neurological buffer that delays the onset of dementia symptoms. If cognitive reserve is the savings account, cognitive debt is the credit card bill. It represents the cumulative damage caused by psychological and behavioral patterns - depression, anxiety, chronic stress, sleep disorders, and neuroticism - that wear down the brain's resilience over time [Marchant and Howard, 2015].

The mechanism Marchant and Howard identified as the common thread running through all of these risk factors is repetitive negative thinking, or RNT. This is the clinical term for the kind of persistent rumination and worry that loops through the mind without resolution - rehashing past failures, anticipating future disasters, cycling through the same distressing scenarios again and again. RNT is not simply feeling sad or anxious. It is a measurable cognitive process that transcends the boundaries of any single diagnosis and appears across depression, generalized anxiety disorder, post-traumatic stress disorder, and insomnia alike [Ehring and Watkins, 2008].

Evidence from Brain Imaging Studies

The cognitive debt hypothesis gained significant empirical support in 2020, when Marchant and colleagues published the results of a study involving 360 older adults drawn from two cohort projects - PREVENT-AD in Canada and IMAP+ in France. Participants completed questionnaires measuring their levels of repetitive negative thinking, depression, and anxiety. A subset also underwent PET brain scans to measure deposits of amyloid beta and tau proteins, the biological hallmarks of Alzheimer's disease. The findings were striking. Individuals who scored higher on measures of RNT showed greater cognitive decline over a four-year period, with specific declines in memory - an early marker of Alzheimer's. They also had more amyloid and tau deposits in their brains. Notably, while depression and anxiety were associated with cognitive decline, they were not independently linked to amyloid or tau buildup in the same way that RNT was [Marchant et al., 2020].

This distinction matters because it suggests that the act of repetitive negative thinking itself - rather than the broader emotional state that accompanies it - may be the mechanism doing the most damage. As Marchant explained in a subsequent commentary, RNT could be the "active ingredient" within depression and anxiety that actually increases Alzheimer's risk [Marchant, 2020]. If that is the case, then interventions that specifically target repetitive thinking patterns, such as cognitive behavioral therapy and mindfulness-based approaches, could potentially reduce dementia risk even in people who continue to experience some level of depression or anxiety.

Cognitive Debt in the Age of AI

The second major use of "cognitive debt" emerged roughly a decade later, in an entirely different context. In 2025, researchers at the MIT Media Lab published a preprint titled "Your Brain on ChatGPT: Accumulation of Cognitive Debt when Using an AI Assistant for Essay Writing Task." Led by Nataliya Kosmyna, the study used electroencephalography to monitor the brain activity of 54 participants while they wrote essays under three conditions: using ChatGPT, using a search engine, or using no external tools at all. The results were dramatic. Participants who wrote without any tools showed the strongest and most broadly distributed neural connectivity, particularly in brain regions associated with critical thinking, creativity, and memory formation. Search engine users showed moderate engagement. ChatGPT users exhibited the weakest neural connectivity of the three groups - up to 55 percent lower than the no-tools group [Kosmyna et al., 2025].

Perhaps even more telling was what happened during the fourth session, when participants were switched. Those who had been writing with ChatGPT and were then asked to write without it struggled noticeably - their thinking had not been deeply engaged during the earlier sessions, so they had little to fall back on. Meanwhile, participants who had built up their own cognitive muscles by writing independently were able to transition smoothly to using ChatGPT as a complement rather than a replacement. The researchers also found that 83 percent of ChatGPT users could not accurately quote a single sentence from the essays they had just written, suggesting a profound absence of engagement with their own work [Kosmyna et al., 2025].

The MIT team used the term "cognitive debt" to describe how AI tools spare users mental effort in the short term but generate long-term costs including diminished critical thinking, reduced creativity, increased vulnerability to bias, and shallow information processing. The analogy to technical debt in software engineering is deliberate. Technical debt accumulates when developers take shortcuts that work in the moment but create maintenance problems later. Cognitive debt works the same way: each time a person lets an AI handle a thinking task they could have done themselves, they miss the neurological exercise that would have strengthened those capacities.

Where the Two Frameworks Converge

At first glance, the clinical model of cognitive debt and the technology model may seem to have little in common. One is about negative thought patterns eroding brain resilience. The other is about the atrophy of thinking skills through disuse. But both rest on the same neurological principle: cognitive capacity is not fixed. It is shaped by what we do with our minds over time. Just as physical muscles grow stronger with use and weaker with neglect, neural pathways are strengthened by effortful mental engagement and weakened by its absence.

In the clinical model, repetitive negative thinking consumes cognitive resources without producing adaptive outcomes - the mental equivalent of running a motor without ever engaging a gear. Over years and decades, this wasted effort depletes the brain's reserve capacity, leaving it more vulnerable to the effects of Alzheimer's pathology. In the technology model, the problem is not wasted effort but absent effort. When an AI system handles the reasoning, planning, synthesizing, and evaluating that a person's brain would otherwise perform, the brain simply does not get the workout it needs to maintain and develop those skills. The result in both cases is the same: a gradual erosion of cognitive function that may not be immediately apparent but compounds over time.

Cognitive Debt and Cognitive Disabilities

The relationship between cognitive debt and disability is complex and runs in multiple directions. For people with existing cognitive disabilities - whether resulting from intellectual disability, traumatic brain injury, neurodegenerative conditions like Alzheimer's, or developmental conditions affecting information processing - cognitive debt can be both a risk factor and a complicating element.

Consider the clinical model first. Individuals with cognitive disabilities are often more vulnerable to the conditions that generate cognitive debt. Depression, for instance, is significantly more common among people with intellectual disabilities, traumatic brain injuries, and neurological conditions than in the general population. Anxiety disorders and sleep disturbances are similarly elevated. If these conditions increase cognitive debt through repetitive negative thinking - and the research suggests they do - then people with existing cognitive vulnerabilities are at heightened risk of further decline. The concern is especially acute for older adults with ADHD, whose lifelong difficulties with executive function and emotional regulation already overlap with the cognitive profile associated with mild cognitive impairment. Researchers have noted that ADHD and mild cognitive impairment can look remarkably similar in older adults, creating diagnostic confusion that may delay appropriate intervention [Soff et al., 2021].

The technology model introduces a different set of concerns. For many people with cognitive and learning disabilities, AI tools are not a luxury - they are a necessity. A person with dyslexia may rely on AI to help organize and proofread written work. Someone with ADHD may use AI to break complex tasks into manageable steps. A person with a traumatic brain injury may depend on AI-powered reminders and planning tools to manage daily life. In these contexts, AI is not replacing effortful thinking so much as making effortful thinking possible in the first place. The question of cognitive debt becomes more nuanced when the alternative to AI assistance is not independent effort but rather exclusion from the task altogether.

The Disability Paradox of AI Offloading

This creates what might be called a disability paradox within the cognitive debt framework. The MIT study and similar research implicitly frame cognitive offloading as a choice - a shortcut taken by people who could do the work themselves but prefer to let the machine handle it. For many disabled individuals, however, offloading is not a shortcut. It is an accommodation. And drawing a sharp line between healthy effortful thinking and unhealthy reliance on tools ignores the reality that many people operate with cognitive budgets that are already stretched thin.

A writer and advocate who publishes under the name "Autside" made this point forcefully in a 2025 critique of the MIT study, noting that the research never asks why people offload cognitive work in the first place. The reasons can include executive functioning challenges, language processing differences, educational trauma, chronic fatigue, and the sheer cognitive load of navigating environments not designed for neurodivergent minds [Autside, 2025]. In these situations, cognitive offloading is not a failure of discipline. It is a rational adaptation to a mismatch between the person's cognitive profile and the demands placed on them.

This does not mean cognitive debt is irrelevant for disabled people. It means the concept needs to be applied with care. There is a meaningful difference between using AI to handle tasks that are genuinely inaccessible without support and using AI to avoid the kinds of cognitive effort that would build and maintain valuable skills. A person with dyslexia who uses voice-to-text software to draft ideas and then actively revises and refines the output is engaging in substantial cognitive work. A student who pastes a prompt into ChatGPT and submits whatever comes back without reading it closely is not - regardless of whether that student has a disability.

Cognitive Load, Masking, and the Hidden Costs

There is another dimension of cognitive debt that is specific to the disability experience and rarely discussed in the mainstream research. Many neurodivergent individuals - particularly autistic people and those with ADHD - engage in a process known as masking, in which they consciously suppress their natural behaviors and communication styles in order to fit into neurotypical environments. Masking is cognitively expensive. It requires constant self-monitoring, real-time behavioral adjustment, and sustained attention to social cues that neurotypical people process automatically. Over time, the cumulative cost of masking can lead to autistic burnout - a state of profound physical and emotional exhaustion that often includes significant cognitive regression [Raymaker et al., 2020].

This burnout could reasonably be understood as a form of cognitive debt. The person has been spending cognitive resources on performance rather than on genuine learning, problem-solving, and personal development. When those resources run out - and they eventually do - the person is left not only exhausted but also with a diminished capacity for the cognitive tasks they actually care about. In this sense, the societal expectation that neurodivergent people should conform to neurotypical norms is itself a generator of cognitive debt, one that the current research frameworks have largely failed to account for.

Cognitive Accessibility and the Prevention of Debt

The concept of cognitive accessibility offers a useful bridge between disability advocacy and the prevention of cognitive debt. Cognitive accessibility, as defined by the World Wide Web Consortium's Cognitive and Learning Disabilities Accessibility Task Force, refers to the design of information, environments, and tools so that they can be effectively used by people with a wide range of cognitive abilities. This includes simplifying language, reducing unnecessary complexity, providing clear navigation, offering multiple formats for information, and allowing users to control the pace at which they engage with content [W3C, 2021].

When environments are cognitively accessible, everyone - disabled or not - is freed from the unnecessary mental effort of decoding poor design, wrestling with confusing interfaces, or managing information overload. That freed-up cognitive capacity can then be directed toward the effortful, meaningful thinking that builds rather than depletes cognitive reserve. In other words, cognitive accessibility is not just about inclusion. It is about creating the conditions in which cognitive debt is less likely to accumulate for anyone.

Consider a practical example. A university student with a processing speed difference is given a timed exam with dense, jargon-heavy questions. Much of the student's cognitive effort goes toward managing anxiety about the time limit and parsing unnecessarily complicated language - neither of which has anything to do with the knowledge being tested. That wasted effort is a form of cognitive debt generated by poor design. If the same exam used clear language and provided extended time, the student could direct all of their cognitive resources toward demonstrating their actual understanding, and the experience would reinforce rather than deplete their knowledge.

Implications for Policy and Practice

If cognitive debt is a real and measurable phenomenon - and the evidence from both clinical and technology research suggests it is - then several practical implications follow for how we approach disability, education, and technology design.

First, mental health interventions for people with cognitive disabilities should pay specific attention to repetitive negative thinking as a modifiable risk factor. Cognitive behavioral therapy and mindfulness-based interventions have demonstrated effectiveness in reducing RNT, and there is growing evidence that these approaches can be adapted for people with intellectual disabilities and other cognitive differences [Marchant and Howard, 2015]. Reducing RNT in these populations could offer protective benefits against further cognitive decline.

Second, the integration of AI tools in educational and workplace settings should be guided by thoughtful policies that distinguish between assistive use and replacement use. For individuals who need AI as an accommodation, the goal should be to maximize the person's active engagement with the task while minimizing the barriers that would otherwise make the task impossible. This is not a binary choice between full independence and full automation. It is a spectrum, and the right balance will differ for every individual.

Third, designers and policymakers should recognize that cognitive debt is not purely an individual problem. It is shaped by environments, systems, and expectations. When workplaces demand more cognitive output than any person can sustainably produce, people will offload to survive - and some will accumulate cognitive debt as a result. When educational systems fail to accommodate cognitive differences, students will either mask their way through or disengage entirely, both of which carry cognitive costs. Addressing cognitive debt at a structural level means designing systems that support genuine cognitive engagement rather than merely demanding more output.

Looking Ahead

The concept of cognitive debt is still relatively young, and much remains to be understood. The clinical model proposed by Marchant and Howard has been supported by promising but preliminary evidence, and the researchers themselves note that the causal direction is not yet firmly established - it is possible that early Alzheimer's pathology contributes to increased repetitive negative thinking rather than the other way around [Marchant et al., 2020]. The MIT study, meanwhile, was a preprint with a small sample size that has not yet undergone peer review, and its authors have cautioned against overinterpreting their results [Kosmyna et al., 2025].

Still, the underlying principle is well supported by decades of neuroscience: the brain is shaped by what it does. Effortful cognitive engagement builds capacity. Chronic stress, rumination, and passive reliance on external systems can diminish it. For people with disabilities, these dynamics are amplified by environmental barriers, social expectations, and the daily costs of navigating a world not designed for cognitive difference. Any serious reckoning with cognitive debt must account for these realities - not to excuse disengagement, but to understand its causes and design better alternatives.

The conversation about cognitive debt is ultimately a conversation about what kind of thinking we want to protect and how we ensure that everyone - regardless of ability, diagnosis, or neurological profile - has the opportunity and the support to do it.

References

• Autside. (2025). The MIT AI brain study didn't measure what it thinks it measured. Autside Substack.
• Ehring, T., and Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192-205.
• Kosmyna, N., Hauptmann, E., Yuan, Y. T., Situ, J., Liao, X. H., Beresnitzky, A. V., Braunstein, I., and Maes, P. (2025). Your brain on ChatGPT: Accumulation of cognitive debt when using an AI assistant for essay writing task. arXiv preprint arXiv:2506.08872.
• Marchant, N. L. (2020). Dementia: Negative thinking linked with more rapid cognitive decline, study indicates. The Conversation.
• Marchant, N. L., and Howard, R. J. (2015). Cognitive debt and Alzheimer's disease. Journal of Alzheimer's Disease, 44(3), 755-770.
• Marchant, N. L., Lovland, L. R., Jones, R., Pichet Binette, A., Gonneaud, J., Arenaza-Urquijo, E. M., Chetelat, G., and Villeneuve, S. (2020). Repetitive negative thinking is associated with amyloid, tau, and cognitive decline. Alzheimer's and Dementia, 16(7), 1054-1064.
• Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., and Nicolaidis, C. (2020). "Having all of your internal resources exhausted beyond measure and being left with no clean-up crew": Defining autistic burnout. Autism in Adulthood, 2(2), 132-143.
• Soff, C., Sotnikova, A., Christiansen, H., Becker, K., and Siniatchkin, M. (2021). Mild cognitive impairment or attention-deficit/hyperactivity disorder in older adults? Overlapping cognitive profiles in clinical practice. Frontiers in Aging Neuroscience, 13, 737357.
• W3C. (2021). Cognitive accessibility at W3C. Web Accessibility Initiative.

I wrote my first story when I was six years old. I was too little to spell most of the words, so I told my mom the story and she wrote it down for me. It was about a little bear who wanders into the woods and gets lost. I illustrated the pages with colored pencils and stuck the whole thing in a three-ring binder - back when people still used those.

I always wanted to be a writer. When I got lost, words would come find me. Late at night, in journals, companions of insomnia, and later of pain, grief, and loss. Nothing made sense until I wrote it down.

So when I became disabled at the age of twenty-two, I did the only thing I knew how to do with that much pain: I wrote.

Pain kept me awake at night, so my fingers tapped the keyboard keys, twinges and needles pricking through my body: tiny insect stings, ant-stilettos tap-dancing across my skin, muscles, and nerves. Maybe you know that kind too.

I never intended for anyone to read those pages. They were just for me. It took weeks before I found the courage to type the word disabled even to myself.

I didn't want a cane but I needed one. I searched online for someone, anyone, who looked like me: a young person with a mobility aid. I found Selma Blair. A cane didn't look like a medical device in Selma's hands. It looked like style. Finesse. Beauty. Bravery. I wanted to be like that.

When I got my first cane (which I promptly named Jeeves) I took a couple of pictures and started sharing my thoughts online.

At the time, I almost didn't think my story was important enough to tell. I knew people who were suffering much more than I was. People who had more dramatic diagnoses, harder treatments, bigger obstacles. Sometimes the question still persists: who am I to talk about it?

But I think that's just another thing many of us share, that we think we're all alone in. We worry about complaining. We worry about being misunderstood. We worry about being too much. I never thought my words would get very far, but people resonate with pain.

If you live with a specific kind of suffering - disability, chronic illness, a neurological disorder, a genetic condition - it can be isolating in ways that are hard to explain. You start to wonder if anyone else experiences the strange symptoms you do, the awkward moments, the invisible grief that comes with a body that struggles to live.

Finding someone who shares your vulnerability is life-giving. The more I gave small pieces of my story, the more people gave theirs to me. What began as a few slightly ashamed posts quickly became an abundant and genuine community. Within a year, more than 10,000 people had joined the conversation. Five years later, that number is approaching 300,000.

But the numbers are not really the point.

The thing that really mattered were the messages: "I thought I was the only one."

If you have endured - or are enduring - a certain kind of suffering, and you wonder if you should share it, that might be a sign that you really should. That question mark in your mind, lingering over your silent thoughts and feelings and isolation, isn't something you feel unless you have something to say.

Don't worry about being clever. Or inspiring. Or even original.

You simply have to tell the truth.

The moments you think you alone struggle through - the strange symptoms, the embarrassing realities, the complicated emotions - are often the very moments that allow someone else to feel seen.

Share the moments you think you alone experience and you may find dozens - maybe hundreds, maybe thousands, maybe millions - of people who experience them too.

The book came naturally from those early works. Those insomniac scribblings. The posts I thought no one would read.

When HarperCollins Christian Publishing asked me what my first story was, I told them about the little bear that got lost in the woods.

That's where it all began. Maybe where it is right now.

My life wandered off the path I thought it was supposed to take. I've been tramping through the mud for a while now, and it's getting dark. I feel alone. But you're here too.

So if you are wondering whether your story matters, let me offer one encouragement: Don't despise small beginnings.

Tell the truth about your life. Get specific with your honesty. Tell it plainly, boldly (or shyly), and imperfectly. Write it for just one person. Write it for yourself.

That's really all it is - books, writing, storytelling. It's simply telling the truth to one person. And then hitting Post.

Author Bio:

Sydney Anne Bennett is a writer, disability advocate, and speaker who helps people struggling with chronic illness and pain find confidence and hope again - while pointing them to Jesus.

Two weeks after her honeymoon, Sydney became disabled and was later diagnosed with Functional Neurological Disorder (FND), a condition that disrupts the brain's ability to send correct signals to the body. She experiences daily seizures, chronic pain, and mobility loss - and often uses a wheelchair.

In 2022, Sydney began sharing her story on Instagram as a way of processing grief, faith, and the strange in-between of being both young and disabled. Today, she encourages a global audience of over 300,000 people with honesty, humor, and hope that leans hard on Jesus. She lives in Idaho with her husband, Colton, and their two daughters, Hadassah and Felicity. Her new book, Fearfully and Wonderfully Broken, releases April 28^th, 2026.

@theanne.girl on IG

Photograph by Sydney Anne Bennett. Used with permission.

As the Paralympic Winter Games celebrated its 50th anniversary, Milano Cortina 2026 broke multiple records, setting benchmarks for all future Games.

Key Milestones and Records

Unprecedented Athlete Participation

Milano Cortina 2026 welcomed 611 Para athletes from 55 National Paralympic Committees, marking the largest and most diverse field in Winter Paralympic history, including several debut nations.

Growth in Female Representation

Female participation reached new levels with 160 women competing across multiple sports, continuing a steady trend toward greater gender inclusion in elite winter competition.

Expanded Medal Distribution

A record 27 nations earned medals, underscoring the increasing competitiveness and global development of Paralympic winter sport.

Host Nation Performance

Italy achieved its strongest showing to date with 16 medals, including a record number of golds, highlighting the impact of hosting on national performance.

Audience and Engagement Records

Attendance milestones in Para ice hockey and significant growth in digital viewership demonstrate rising global interest and accessibility through media platforms.

Historic Firsts

Brazil secured its first Winter Paralympic medal, signaling continued expansion of the movement into new regions and climates.

Global Reach and Media Coverage

Record Broadcast Distribution

Coverage extended to 126 countries through multiple platforms, making Milano Cortina 2026 the most widely viewed Paralympic Winter Games to date.

Record After Record Broken

Record Number of Para Athletes and NPCs

A total of 611 Para athletes from 55 National Paralympic Committees (NPCs) competed in the Games. This was the most ever, surpassing the previous record high of 564 Para athletes from 48 NPCs at PyeongChang 2018.

Five NPCs made their Paralympic Winter Games debut with El Salvador, Haiti, Montenegro, North Macedonia, and Portugal all competing on snow and ice for the very first time.

More Female Competitors Than Ever Before

For the fourth successive Paralympic Winter Games, a record number of women competed. A total of 160 female competitors challenged for medals across six sports, an 18 per cent increase on the previous record high of 136 women set at Beijing 2022.

Six NPCs boasted a record number of female competitors for the Paralympic Winter Games: Australia (5), Belarus (3), Brazil (3), Croatia (2), Korea (6), Latvia (4).

Five sports had a record number of female competitors: Para alpine skiing (57 women), Para biathlon (45), Para cross-country skiing (65), Para snowboard (15) and wheelchair curling (25).

Record Number of Medal Winning NPCs

Highlighting the growing strength of winter Paralympic sport across the world, 27 NPCs won medals across 79 medal events. This is the greatest number of NPCs to win at least one medal at a Paralympic Winter Games, beating the previous high of 25 from the Lillehammer 1994 Paralympic Winter Games.

Eighteen NPCs won gold medals a joint record high, equalling the record set at PyeongChang 2018.

Best Games Ever for Italy

Host nation Italy enjoyed their best ever Paralympic Winter Games winning 16 medals. Italy's previous highest number of medal wins was 13 at Lillehammer 1994. Italy's tally included a record seven gold medals, beating the previous highest number of three gold medals form Innsbruck 1988, Nagano 1988 and Salt Lake City 2002.

Biggest Para Ice Hockey Crowd

During the Games, the record for the biggest ever Para ice hockey crowd was broken not just once but twice. The record first fell on the first Saturday of the Games when 8,992 packed into the Santagiulia Arena in Milan to watch the Group A match between Italy and USA. The previous high hockey crowd for a Paralympic Winter Games was 8,462 set for the Salt Lake City 2002 gold medal match.

Sunday's gold medal match between USA and Canada was set to attract a bumper 11,000 crowd.

Historic First Paralympic Winter Medal for Brazil

Thanks to Christian Ribera in the Par cross-country sprint, Brazil won its first ever medal - a silver - at the Paralympic Winter Games. Ribera made his Paralympic debut as a 15-year-old at PyeongChang 2018.

Video Views Surpass Paris 2024

By Saturday (14 March) morning, there had been more than 414 million views of video content on the @Paralympics YouTube channel since competition began on 4 March. This number is 712.47 per cent more than the total number of video views for the Paris 2024 Paralympic Games and is 67.05 per cent greater than the whole of 2024, which was previously a record year for the IPC's channel.

Most Widespread Global Broadcast Coverage

Milano Cortina 2026 was the most widely broadcast Paralympic Winter Games in history with 20 Media Rights Holders broadcasting the Games to a record 126 countries on their linear free-to-air and Pay TV channels, and streaming, digital, social and audio platforms. In the remaining countries, the global stream will be available on the official Games digital platforms.

Strategic decision offers greater federal accountability and relief for states to focus on faster disability claim adjudication.

The Social Security Administration (SSA) has announced the agency will transition the processing of medical Continuing Disability Reviews (CDRs) from State Disability Determination Services (DDS) to its federal processing site called Disability Case Review (DCR). Bringing in-house CDRs will improve service to our most vulnerable Americans. CDRs are conducted as part of SSA's ongoing program integrity workload, supported by Congress, to determine whether a person receiving disability benefits is still eligible to receive them.

Aligning medical CDRs under SSA's direct oversight means all CDRs, including non-medical CDRs, are solely the agency's responsibility.

"By centralizing medical continuing disability reviews under Social Security, we are taking another important step towards operational excellence, reducing improper payments, and providing best-in-class service to Americans in critical need of support," said Commissioner Frank J. Bisignano.

"With complete ownership and accountability of CDRs and the proven track record of our DCR, our state disability determination service partners will be able to focus on the adjudication of initial disability claims and reconsideration cases, provide eligible individuals with expedited access to benefits, and further reduce initial disability claims backlogs, which are already reaching historic lows."

DDS can now focus their attention on expediting disability claims for residents of their state, which will enable efficient decisions for claimants, resulting in eligible individuals receiving the critical benefits they need in a timely manner.

In June of 2024, the DDS initial claims backlog was at an all-time high with over 1.26 million pending claims. With a focus on process improvement and operational excellence, the backlogs have been reduced by more than 33 percent to 831,000 as of February 2026. The shift in responsibilities and continued partnership between SSA and state DDSs will continue to significantly improve the processing times and reduce the initial claims backlog.

The agency's Disability Case Review, with its experience processing initial disability claims, reconsideration cases, and medical CDRs, will now handle medical CDRs for the entire country-allowing DDS sites to focus on reducing wait time on initial and reconsideration claims for citizens in their state citizens. Non-medical CDRs, which do not require the same expertise as medical CDRs to process, will continue to be handled by the agency's field offices and processing centers.

NOTE: SSA has stated that this operational change does not change the eligibility rules for disability benefits.

There's certainly a chance. But that's only true if you use federal aid.

In 2023, the median earnings of people with disabilities in New York City was $36,300. In the same year, the median household income of people with disabilities was $32,100. The median home price in New York City in 2023 was $675,000. To purchase this property with a mortgage, the median income required was $211,970. However, the number of people with disabilities in New York City earning such large sums is so small that it is not accounted for by the statistics. It is known for certain that only 23.1% of people with disabilities have median earnings of $75,000 or more. The $75,000 threshold is the maximum amount used to consider the income of people with disabilities.

An estimate of how many disabled people earn $211,000 or more can be made by examining New York City's overall income statistics. It is reliably known that in 2023, 16.8% of New York City households had an income of $200,000 or more. The proportion of disabled people in the city's total population is 11%. This suggests that approximately 1.6% of disabled people may earn more than $200,000 per year and could theoretically qualify for a mortgage to purchase a home.

This share may increase due to the lower income threshold required to qualify for a mortgage. After all, when purchasing a home that costs less than the market average, the required income level for a mortgage will also be lower than average. However, in this case, another study must be taken into account. It states that a significant portion of "recipients of Social Security Disability Insurance (SSDI) benefits pay 23 basis points more on 30-year mortgages than homeowners without a disability." This could significantly reduce access to mortgages for people with disabilities.

This means that the ability of disabled people to purchase housing with a mortgage on the same terms as non-disabled people is very limited. Probably no more than 2% of disabled people can take advantage of this opportunity.

However, it's not all bad. There are special federal programs offering preferential mortgages for people with disabilities. These programs vary greatly. Assistance is provided to people with disabilities nationwide, which means it may also be available to people with disabilities in New York. Since the programs are tailored to the individual borrower's needs, I won't provide a general description of each program. It's best for potential borrowers to research each program themselves and consult with a specialist who supports that program. These mortgage programs were available for people with disabilities as of January 2026: Fannie Mae HomeReady , VA home loans , USDA home loans, and Housing Choice Voucher Tenants.

What does New York City do? Let's be fair and honest. I couldn't find a special mortgage program specifically aimed at disabled borrowers created by the city. However, officials do do a lot to help people with disabilities in the housing market. For example, New York City has the Supportive Housing Loan Program (SHLP). This program is designed to assist non-profit and for-profit organizations developing housing for people with disabilities. Several alternative housing opportunities have also been created for people with disabilities, including lotteries. In addition, New York City provides financial support to disabled homeowners. Yes, such people exist in New York. We are talking about the Disabled Homeowners' Exemption (DHE), designed to reduce taxes for disabled homeowners. Numerous other supports are also provided to improve housing accessibility for people with disabilities and reduce rental costs. This was discussed in the article "Disability Housing in New York City - Costs and Barriers."

As we can see, there are problems. But the situation is not hopeless. There are many options. People with disabilities can try to resolve their housing issues in New York City with the help of the authorities. Or they can endure the current situation. Or they can leave New York for other cities where housing is more affordable and the job markets are more favorable. There are always options. The main thing is to believe in the best and not give up. And the right solution will be found sooner or later.

Walk into any grocery or produce store and you will encounter a pricing landscape far more engineered than most people realize. Behind the neat rows of cereal boxes, the colorful displays of bottled drinks, and the carefully arranged shelves of frozen meals lies a complex web of markups, slotting fees, and strategic product placement designed to maximize every square inch of retail space for profit. While all shoppers are affected by these practices, the consequences fall hardest on those who can least afford them - seniors on fixed incomes, people living with disabilities, and low-income households who may have limited options for where and how they shop.

How Grocery Store Markups Actually Work

The term "markup" in the grocery world refers to the percentage added to a product's wholesale cost before it reaches the shelf. This added margin pays for everything from rent and utilities to employee wages, refrigeration, and yes, the retailer's profit. In most conventional grocery chains, the average markup sits around 15 percent or less, though it varies wildly by product category (ECS Payments, 2024). Non-alcoholic packaged drinks like juices and iced teas carry markups as high as 72 percent, according to data published by the National Association of Convenience Stores. Bottled water - which costs manufacturers just pennies to produce - is often sold at markups exceeding 4,000 percent. On the other end, staples like bread might carry markups as low as 5 to 8 percent.

What makes grocery pricing so counterintuitive is that despite these sometimes enormous markups on individual items, the overall profit margin for grocery retailers remains remarkably thin. Industry data consistently shows that conventional grocery chains typically retain only about 1 to 3 percent of total revenue as actual profit after all operating costs are paid (Toast, 2025). In 2023, the grocery store profit margin fell to approximately 1.6 percent, marking its third straight year of decline (Griffith, as cited in River News Online, 2024). Natural, organic, and gourmet retailers tend to operate at somewhat higher margins in the 5 to 10 percent range, largely because their customers are willing to pay premium prices for specialty products.

The Hidden World of Slotting Fees

One of the least understood aspects of grocery pricing is the slotting fee - a payment that food manufacturers make to retailers simply for the privilege of having their product placed on store shelves. These fees, which emerged in the 1980s and have since become an entrenched part of the industry, can range from a few hundred dollars per product per store to hundreds of thousands of dollars for placement in a high-demand market or major retail chain (Federal Trade Commission, 2003). The total market for slotting fees in the United States has been estimated at roughly 9 billion dollars and continues to grow (University of Connecticut Food Marketing Policy Center, as cited in Observa, 2023).

A Federal Trade Commission study confirmed that slotting fees are "widespread" in the supermarket industry, and that many grocery retailers actually earn more revenue from the fees they charge manufacturers for shelf access than they do from selling products to customers. Freezer section placement alone in smaller chains can run up to 9,000 dollars per product, while the cost in larger chains can skyrocket far beyond that (Frozen and Refrigerated Foods, as cited in Observa, 2023). In addition to initial slotting fees, retailers commonly charge separate "pay-to-stay" fees for continued shelf presence, promotional fees for end-of-aisle displays, and stocking fees that cover warehouse and inventory management costs.

Who Really Pays for Shelf Space

The crucial question, of course, is who absorbs the cost of these fees. Manufacturers do not simply accept a thinner margin. They build slotting costs into their wholesale pricing, which means the fees are effectively passed along to the consumer through higher retail prices. When a cereal company pays tens of thousands of dollars to secure prime eye-level shelf placement at a national chain, that cost does not come out of the company's goodwill budget. It gets folded into the per-unit price of every box on the shelf.

This system creates a self-reinforcing dynamic that favors large, well-funded manufacturers over smaller producers. Established brands with deep marketing budgets can afford to pay top dollar for the best shelf positions - typically at eye level, sometimes referred to in the trade as the "strike zone" - while smaller or local brands are squeezed into bottom-shelf or peripheral placements where customers are far less likely to notice them (Pantry AI, 2024). The practical result for shoppers is a retail environment that systematically promotes higher-priced, heavily marketed products while making it harder to find potentially more affordable alternatives.

Shrinkflation - The Quiet Price Increase

Alongside traditional markups and shelf fees, consumers face another pricing pressure that is even harder to detect. Shrinkflation - the practice of reducing the size or quantity of a product while keeping the price the same or nearly the same - has become an increasingly common cost management strategy among food manufacturers. A 2024 analysis by LendingTree found that roughly one-third of common grocery items had been affected by shrinkflation, with household paper products showing the highest rates of downsizing at around 60 percent of tracked products (CBS News, 2024).

The U.S. Government Accountability Office confirmed that while shrinkflation's overall contribution to national inflation figures was small - less than one-tenth of a percentage point of the 34.5 percent increase in consumer prices from 2019 to 2024 - the per-unit price increases on individual downsized products were far more significant (GAO, 2025). Coffee saw average per-unit price increases of up to 32 percent due to downsizing. Research from the University of Massachusetts Amherst found that between 2012 and 2019, the average size of packaged food decreased by nearly 15 percent (Rojas, as cited in WBUR, 2026). Consumers typically do not notice subtle packaging changes, and in the United States, companies are not legally required to advertise that a product has been downsized, making it particularly difficult for budget-conscious shoppers to track.

How These Pricing Practices Affect Seniors

Older adults living on fixed incomes are among the most vulnerable to the cumulative effect of grocery markups, slotting-driven pricing, and shrinkflation. Many seniors rely on Social Security benefits, modest pensions, or limited retirement savings that do not adjust fast enough to keep pace with food price increases. The AARP reported that nearly 11.8 million Americans aged 50 and older faced food insecurity and the threat of hunger in 2022, representing a 25 percent increase from the previous year (AARP, 2022). The U.S. Department of Agriculture has documented that food prices in the United States rose by 25 percent between 2019 and 2023.

For a senior navigating the grocery store on a fixed monthly budget, the difference between a product at eye level - likely carrying a premium driven partly by slotting fees - and a cheaper alternative tucked away on a lower shelf can be both meaningful and invisible. Physical limitations such as reduced mobility, poor eyesight, or difficulty bending to reach bottom shelves mean that many older shoppers default to grabbing whatever is most easily accessible, which is almost always the higher-priced option. A survey by the Senior Citizens League found that 25 percent of senior respondents had skipped meals because of rising food costs (MetroHealth, 2022). When every dollar counts, the hidden architecture of grocery store pricing can force impossible choices between eating adequately and paying for medications or other essentials.

The Impact on People Living with Disabilities

People with disabilities face a unique and often compounding set of obstacles when it comes to grocery pricing. Research from Feeding America has shown that older adults with disabilities are twice as likely to be food insecure as their non-disabled peers (National Council on Aging, 2024). The reasons extend well beyond product prices themselves. Many individuals with physical or cognitive disabilities rely on caregivers, delivery services, or limited public transportation to access grocery stores, which can restrict the number and type of stores available to them.

When a person's mobility limits them to shopping at the nearest store rather than traveling to a less expensive one across town, they effectively become a captive consumer. If that nearest store happens to be a small neighborhood market or convenience store - common in many urban areas - they are likely paying significantly more for the same products. Studies cited by the Food Empowerment Project have found that urban residents who purchase groceries at small neighborhood stores pay between 3 and 37 percent more than suburban shoppers buying identical items at full-size supermarkets (Food Empowerment Project, 2025). For someone who cannot drive and depends on a nearby store, the shelf space dynamics of a large retailer are replaced by an even more constrained environment where healthy options are scarce and prices are inflated.

Low-Income Households and the Grocery Pricing Trap

For households with limited financial resources, grocery store pricing margins create what might fairly be called a structural disadvantage. While wealthier families spend more on food in absolute terms, lower-income households dedicate a disproportionately larger share of their total income to groceries. This means that every markup, every slotting-fee-driven price premium, and every shrinkflation-reduced package has a proportionally greater impact on a family operating near the poverty line.

The problem is worsened by geography. The USDA has identified that approximately 17.4 percent of the U.S. population - about 53.6 million people - live in low-income census tracts where they are more than half a mile from the nearest supermarket in urban areas or more than 10 miles in rural areas (USDA Economic Research Service, 2024). These areas, commonly referred to as food deserts or low-access communities, tend to be served primarily by convenience stores and small markets that stock fewer healthy items at higher prices. Research has shown that wealthy districts have roughly three times as many supermarkets as poor ones (Food Empowerment Project, 2025). When a low-income family's nearest shopping option is a small store with limited selection, they have no practical way to comparison-shop or seek out the lower-priced alternatives that full-size supermarkets may bury on a bottom shelf.

The Psychology Behind Store Layout and Product Placement

Grocery store layouts are not designed by accident. Retailers invest heavily in research on consumer behavior to arrange products in ways that encourage higher spending. The most profitable items are placed at eye level, where shoppers are most likely to reach for them without deliberation. Staples like milk and bread are often positioned at the back of the store, requiring shoppers to walk past aisle after aisle of impulse items. End-of-aisle displays - known in the industry as "endcaps" - command premium placement fees from manufacturers, sometimes ranging from 350 to 500 dollars per display per store (Trax Retail, 2025).

For seniors, people with disabilities, or anyone who finds lengthy shopping trips physically taxing, these layout strategies are more than an inconvenience. A shopper using a wheelchair or walker may find it impractical to navigate deep into the store for a basic staple, or to scan multiple shelf levels for the cheapest option. A shopper with cognitive challenges may struggle to compare unit prices across different package sizes, especially when shrinkflation has made those comparisons even more confusing. The entire store environment is calibrated for a shopper who has the time, energy, physical ability, and financial flexibility to hunt for value, and those who do not fit that profile end up paying more almost by default.

The Unit Price Problem

One of the most practical tools available to consumers who want to see through pricing complexity is the unit price - the cost per ounce, per count, or per other standard measure. Comparing unit prices across brands and sizes can reveal which products are genuinely better values, and it is particularly useful for spotting the effects of shrinkflation. The Food Marketing Institute has reported that 78 percent of consumers use unit prices when they are displayed (NPR, 2024).

The problem is that unit pricing regulations vary widely across the United States. Only some states require retailers to display unit prices, and even where laws exist, enforcement can be inconsistent. In 2024, the New Jersey Attorney General underscored the importance of accurate unit price labeling in helping shoppers make informed decisions (NPR, 2024). For consumers without access to clearly labeled unit prices - or without the visual acuity to read them on small shelf tags - the opacity of grocery pricing remains a significant barrier to smart shopping. Seniors with age-related vision loss, people with intellectual disabilities, and anyone unfamiliar with the concept of unit pricing are at a particular disadvantage.

What Can Be Done

Addressing the disparate impact of grocery pricing on vulnerable populations requires action at multiple levels. At the policy level, expanding and strengthening unit pricing requirements across all states would give every shopper a clearer picture of what they are actually paying. France has already moved in this direction by requiring retailers to disclose product downsizing through in-store labels, and Australia is considering similar measures (GAO, 2025). Federal proposals such as the Shrinkflation Prevention Act, introduced in the U.S. Congress, aim to increase transparency around product downsizing.

At the community level, programs such as SNAP (the Supplemental Nutrition Assistance Program), the Senior Farmers Market Nutrition Program, and initiatives like Meals on Wheels remain essential for bridging the gap between food costs and what vulnerable populations can actually afford. The expansion of mobile food pantries, community gardens with accessible raised beds, and partnerships between food banks and local organizations all represent practical efforts to bring affordable nutrition within reach of those who need it most.

For individual consumers, awareness is perhaps the most accessible form of protection. Understanding that eye-level placement often means higher prices, that the largest package is not always the best deal per unit, and that familiar packaging may be hiding reduced quantities can all contribute to more informed grocery shopping. Checking unit prices when they are available, buying store-brand alternatives when possible, and exploring local farmers markets for seasonal produce are small but meaningful strategies.

Conclusion

The modern grocery store is a far more complex commercial environment than it appears at first glance. Markups, slotting fees, pay-to-stay arrangements, shrinkflation, and strategic product placement all contribute to a pricing landscape that rewards manufacturers with the deepest pockets and penalizes shoppers with the fewest options. While these practices affect everyone, their impact is not distributed equally. Seniors, people with disabilities, and low-income households bear a disproportionate share of the burden - not because they shop recklessly, but because the system is not designed with their circumstances in mind. Greater transparency, stronger consumer protections, and continued investment in community food access programs are essential steps toward a grocery marketplace that treats all shoppers fairly.

References

• AARP. (2022). Food insecurity among older adults aged 50 and older. AARP Public Policy Institute.
• CBS News. (2024, October 16). Shrinkflation has affected one-third of grocery items, analysis finds. CBS News.
• Disabled World. (2025). Shrinkflation Decoded: Hidden Cost Increases in Everyday Products. Disabled-World.
• ECS Payments. (2024). 2024 sales strategy: Markups and margins. ECS Payments.
• Federal Trade Commission. (2003). Slotting allowances in the retail grocery industry. FTC Staff Report.
• Food Empowerment Project. (2025). Food deserts. Food Empowerment Project.
• Griffith, G. (2024). Food costs up but grocery profit margins down. River News Online.
• MetroHealth Inc. (2022). Seniors and the rising cost of food. MetroHealth Inc.
• National Council on Aging. (2024). Get the facts on food insecurity and older adults. NCOA.
• NPR. (2024, July 9). How to fight shrinkflation? Pay attention to grocery store unit prices. NPR Planet Money.
• Observa. (2023). Know your slotting fees. Observa.
• Pantry AI. (2024). Slotting fees in retail: Are they worth the investment? Pantry AI.
• Rojas, C. (2026). Shrinkflation and product downsizing trends. International Journal of Industrial Organization.
• Toast. (2025). How much do grocery stores make? Average grocery store revenue data 2025. Toast.
• Trax Retail. (2025). Retail shelf strategy: A guide to shelf space cost. Trax Retail.
• U.S. Department of Agriculture, Economic Research Service. (2024). Food Access Research Atlas. USDA ERS.
• U.S. Government Accountability Office. (2025). Consumer prices: Trends and policy options related to shrinking product sizes (GAO-25-107451). U.S. GAO.

As the Paralympic Winter Games celebrates a special milestone with its 50th anniversary, history will be made when 612 athletes from 56 NPCs will line-up in 79 medal events across six sports. The previous record was 564 athletes from 49 delegations at PyeongChang 2018. When the Winter Games began in Ornskoldsvik in 1976, there were 198 athletes from 16 countries.

Five Debutant NPCs

Amongst the 56 competing NPCs will be five Paralympic Winter Games debutants.

El Salvador has never competed at any Winter Games - Olympic or Paralympic - but will have two Para athletes competing in Para cross-country skiing - David Chavez and Jonathan Arias.

Haiti and North Macedonia will both make their Paralympic Winter Games debuts in Para alpine skiing courtesy of Ralf Etienne and Zoran Jovanovski respectively. Montenegro's Andrej Sibalic and Portugal's Diogo Carmona will both line-up in Para snowboard, ensuring representation of their respective countries for the first time at a Paralympic Winter Games.

The athletes from El Salvador, Haiti, Montenegro, and North Macedonia have all benefited from funding support from the IPC's Sport for Mobility program over the last 12 months to qualify for the Games. In total 39 athletes and four guides from 23 NPCs who will compete at the Games received sport development support through Sport for Mobility and other sport development programs for Milano Cortina 2026.

Record Female Participation

For the fourth successive Paralympic Winter Games, a record number of women will compete. A total of 160 female competitors will compete across all six sports, an 18 per cent increase on the previous record high of 136 women set at Beijing 2022.

Six NPCs will also have a record number of female competitors for the Paralympic Winter Games: Australia (5), Belarus (3), Brazil (3), Croatia (2), Korea (6), Latvia (4).

Five sports will have a record number of female competitors: Para alpine skiing (57 women), Para biathlon (45), Para cross-country skiing (65), Para snowboard (15) and wheelchair curling (25). In Para ice hockey a female athlete will compete for the second consecutive Games and the fourth-time ever since the sport was included in the Games.

Biggest Delegations

China, who topped the medals table for the first time at Beijing 2022, have the biggest delegation of all competing NPCs with 70 athletes, followed by USA with 68, and Canada with 46. Hosts Italy boast a team of 42 athletes.

Seven other NPCs will send their biggest ever delegations to a Paralympic Winter Games: Brazil (8 athletes), Czechia (24), Italy (42), Kazakhstan (7), Latvia (7), Slovakia (28) and Ukraine (25).

Highlighting the growth of the Paralympic Winter Games, a record number of NPCs will compete in the sports of Para alpine skiing, Para biathlon, Para cross-country skiing, Para snowboard and wheelchair curling.

Para athletes from 44 NPCs will contest 30 medal events in Para alpine skiing, surpassing the previous best of 37 NPCs from Beijing 2022.

In Para biathlon, 21 NPCs will contest 18 medal events. The previous highest was 16 NPCs from PyeongChang 2018.

Thirty-two NPCs will contest the 20 medal events in Para cross-country, one more than PyeongChang 2018.

In Para snowboard where there are eight medal events, Para athletes from 28 NPCs will compete, surpassing the previous high of 24 NPCs at PyeongChang 2018.

Colleen Wrenn, IPC Executive Director Paralympic Games, said:

"The number of records that Milano Cortina 2026 is setting in terms of competing athletes and delegations is a testament to the fantastic work of the NPCs and International Federations in the lead-up to the Games."

"While the number of competitors has increased, so has the intensity of competition with each medal event now boasting a depth of talent never seen to such a level before at Paralympic Winter Games."

"Across all six sports, we are set to witness incredible and historic performances. But the Games are more than just experiencing amazing sport - the power of the Paralympics is in its ability to also change attitudes towards persons with disabilities. It is this unique power that makes the Paralympic Games so transformational."

A total of 78 bipartite qualification slots were awarded to athletes spanning four sports - Para alpine skiing, Para biathlon, Para cross-country skiing and Para snowboard - and 36 NPCs.

The Milano Cortina 2026 Paralympic Winter Games will open on 6 March at the Arena di Verona.

Ticket prices for the Games start at EUR 10 for children under 14, with approximately 89 per cent of the tickets available for EUR 35 or less.

I am pleased to share a significant milestone in the New Mexico Postal Service's history. Jacob Sida, a dedicated postal worker living with acute scoliosis, has recently joined our team at the Alamogordo post office. Despite facing numerous challenges, including over thirty surgeries, medical retirement after 25 years as an Orthodox Charismatic Chaplain because of his disability. Jacob's perseverance and commitment have led to this groundbreaking achievement.

Jacob's journey to secure employment was not without obstacles, as he initially faced rejections from nearby offices. However, through collaborative efforts involving advocates of the Americans with Disabilities Act (ADA), the National Association of Letter Carriers, experienced colleagues, and the postmaster in Alamogordo, Jacob was ultimately hired. This hiring decision not only reflects the importance of inclusive practices but also highlights the positive impact of community support and reasonable accommodations.

While Jacob requires quite a bit of additional time, is slower and must take breaks to complete his mail routes, he is supported by most of his supervisors, coworkers and has adjusted workflows, and on-the-job assistance. This successful accommodation not only expands the Postal Service's hiring practices but also serves as a testament to the idea that severe disabilities should not hinder meaningful employment opportunities.

Beyond his postal responsibilities, Jacob demonstrates his determination by volunteering at the Grace Place Community Center in El Paso, where he provides and prepares a weekly meal for individuals experiencing homelessness and the disenfranchised.

Despite all odds at almost 51 years old Jacob is also recently engaged to the love of his life Jerekyn Ray a member of the Acoma Pueblo. His dedication to service, both as a carrier and a volunteer, serves as an inspiration for individuals with disabilities and community members alike.

Jacob's hiring exemplifies how reasonable accommodations and inclusive hiring practices can create pathways for individuals with disabilities. Despite the challenges he faces, Jacob's commitment and reliability ensure that mail is delivered and the community is well-served.

Disabled people and carers who move to Scotland from other parts of the UK must take action if they want to continue receiving certain benefits. From 23 February, people getting Attendance Allowance or Disability Living Allowance (DLA) who move to Scotland need to apply for the Scottish versions of those benefits. Pension Age Disability Payment and Scottish Adult DLA are the equivalents of Attendance Allowance and DLA in Scotland.

To minimize payment disruptions. people affected are being urged to tell the DWP about their change of address as soon as possible after they have moved, and before contacting Social Security Scotland.

Similar rules came into force on 6 November last year for people getting Disability Living Allowance for children, Personal Independence Payment and Carer's Allowance.

Deputy Director of Social Security Scotland Ally MacPhail said:

"The Scottish benefit system is built on the principles of dignity, fairness and respect, and we want disabled people and carers to get every penny they're entitled to."

"I urge everyone affected by these changes to ensure they apply for the equivalent benefits as soon as possible after they move."

"Our staff can answer questions and help people apply phone, through webchat or through a face-to-face appointment with one of our community-based advisors."

For more information including access to local support services call Social Security Scotland on 0800 182 2222.

Note:

The Department for Work and Pensions or Department of Communities in Northern Ireland will continue to pay impacted benefits to someone for 13 weeks after they move to Scotland

People who make a successful application for one of the impacted benefits within specific timescales may be entitled to have their payments backdated to the day after their Department for Work and Pensions benefit ended.

It took just a single word to ignite an international conversation, a word no one invited, no one expected, and that, for one man, came unbidden. At the 79th BAFTA Awards, John Davidson, a Scottish advocate for Tourette's syndrome and inspiration for the film I Swear, experienced a vocal tic that produced a racial slur as Michael B. Jordan and Delroy Lindo presented an award. What was meant to be a celebration of life and resilience suddenly became a lightning rod for debate about race, disability, and accountability.

For Davidson, the night was intended to honor his own life's journey, a story he has long shared to educate and advocate for the Tourette's community. Instead, a neurological condition, involuntary and largely misunderstood, became fodder for global scrutiny. Davidson later reflected on the night with both gratitude and mortification:

"I want to thank BAFTA and everyone involved for their support and understanding. I am, and always have been, deeply mortified if anyone considers my involuntary tics to be intentional or to carry any meaning. I attended to celebrate the film of my life, I Swear, which explains the origins, traits, and manifestations of Tourette syndrome. I left the auditorium early, aware of the distress my tics were causing."

Davidson's words highlight a rarely discussed reality. For people with Tourette's, participation in public life can come with constant, unchosen vulnerability. For those with coprolalia, a vocal tic involving involuntary utterances of socially unacceptable words, the stakes are even higher. Only a minority of people with Tourette's experience coprolalia, but it carries outsized social stigma. Each public appearance is fraught with uncertainty: how will people interpret something you cannot control, and what harm might your body inadvertently cause?

I spoke with Emauni Crawley, a Spelman College alumna, behavioral health coach, and Rising Leader Ambassador for the Tourette Association of America. Crawley works with Congress and elected officials to improve access to quality care, mentors youth ambassadors, and educates the community about Tourette's and Tic Disorders. She brings both personal and professional insight to these conversations, bridging disability advocacy with social justice and community education.

"Two things can be true at once," Crawley said, framing the incident within a broader social and historical context. "This situation is uncontrollable, he has coprolalia, but words carry weight, especially for the Black community. Coprolalia often picks up the worst words; he knows these words are derogatory. Not everyone experiences this the same way."

Crawley's perspective exposes the intersection of disability and racial trauma. While Davidson's tics were involuntary, the racial slur touched on centuries of oppression and violence.

"I do not think he should apologize for his condition," Crawley continued. "On the other hand, that word still hurts, especially when it is used by an outsider, someone from the white community. He did not acknowledge the pain in the room. His statement sounded like a marketing scheme, gloating about being an advocate for 25 years without acknowledging the feelings of Michael B. Jordan or Delroy Lindo. That was unacceptable."

This tension between involuntary neurological behavior and the historical weight of language lies at the heart of why the BAFTA incident became such a flashpoint. Coprolalia, while medically explained, cannot erase social consequence. For communities historically subjected to racialized slurs, even context cannot remove the sting. Crawley emphasizes that empathy and understanding must extend beyond the individual displaying the tic to the community affected.

"You can control responses afterward," Crawley said. "You don't apologize for your condition, but you can acknowledge the hurt. Sharing the space does not take away from your condition, but it does honor those affected. That is a critical lesson in accountability and leadership."

Crawley also noted a missed opportunity for broader advocacy.

"He had the opportunity after 24 hours. By being silent, he spoke many words. What about your TS siblings of color who may be affected? Only 10 percent of people with Tourette syndrome experience this type of tic. He could have taken time, gathered his thoughts, and responded, rather than leaving the burden on others. That is leadership in action."

Her observations highlight a broader social pattern: people of color often bear the emotional labor of incidents they did not cause. They are expected to manage their own trauma while maintaining composure in spaces that historically marginalize them. Crawley reflected on how Michael B. Jordan and Delroy Lindo handled the moment with poise.

"In that moment, another stereotype was projected - the angry Black woman, the angry Black man - when we are strong and resilient. I commend those two men for their composure that night."

The BAFTA episode is also a cautionary tale about public storytelling. In Tourette support groups and other forums, the focus shifted quickly to explaining Davidson's condition.

"People said, 'I just want to talk about the N-word used by Davidson; I want to educate that he could not control it.' I get that," Crawley said. "But that word goes deeper, especially for Black people, who are expected to hold their posture and heads high in moments of racism. We are living reminders of resilience, and that context matters."

Davidson's experience is emblematic of the complex space in which people with Tourette's navigate public life. Each interaction is an exercise in negotiation between the body and social perception, between involuntary behavior and moral responsibility, and between advocacy and humility. It also raises urgent questions for institutions hosting such events: how do you educate, support, and protect individuals while acknowledging the potential impact on audiences? How do you prevent harm without limiting participation?

Crawley believes these questions extend beyond a single incident. "This is a critical time for people with Tourette syndrome, especially those who are Black, to rise up and educate the public." She believes that by being silent, we forfeit a teachable moment.

The incident underscores the need for nuanced, intersectional public discourse. Coprolalia carries a social cost disproportionate to its prevalence, but that cost is compounded when words intersect with racial history. Discussions about Tourette's must educate without minimizing the lived experience of communities affected by language, and institutions must anticipate these dynamics to ensure equitable participation.

Davidson's BAFTA moment also offers an opportunity to reframe public understanding of Tourette syndrome. Too often, media coverage reduces coprolalia to shock value or humor, ignoring the broader human story. Davidson's advocacy, and Crawley's leadership, remind us that education, empathy, and accountability are not just abstract ideals - they are essential strategies for creating inclusive spaces.

For Crawley, the incident is a call to action. Moments like this can become lessons in empathy and shared responsibility. Understanding must go beyond explanation and extend into action: for communities living with disability, for communities confronting racism, and for all of us who share these spaces together.

The BAFTA incident demonstrates that public platforms are double-edged. They can amplify stories of resilience and advocacy, or they can expose fault lines in understanding and leadership. Davidson's tics revealed a neurological reality, but Crawley's critique reveals a social one: those with historical and systemic vulnerability often carry a disproportionate burden in moments of misunderstanding. Both realities demand attention.

Ultimately, the conversation extends far beyond one awards night. It is about how society understands disability, how we respond to the unexpected, and how we hold space for both individual realities and communal histories. It is about creating spaces where advocacy and accountability coexist, where people with Tourette syndrome can participate fully without forcing others to absorb harm, and where communities impacted by historical trauma are recognized and honored.

The BAFTA incident was a painful, complex moment. Within that complexity lies a lesson: true understanding is never passive. It requires education and courage to engage with discomfort. Moments like this can become a blueprint for better public discourse, one that values empathy, centers marginalized voices, and teaches us that responsibility extends beyond intent. In the end, the measure of leadership may not be in the absence of missteps, but in how we respond, learn, and move forward together.

About the Author

George Cassidy Payne is a freelance journalist, poet, and educator who writes on culture, education, and human potential. A 988 Suicide Prevention Counselor and community organizer, he brings curiosity and insight to stories that illuminate personal growth and social impact.

Famous People with Tourette’s Syndrome: Challenging Stereotypes: Discover famous people with Tourette's syndrome and learn how they have succeeded in diverse fields, helping to challenge stigma and promote understanding.