Journal articles on the topic '"Brought to you by a team of medical experts'

Aim/Purpose: The complexity of scientific problems has spurred the development of transdisciplinary science, in which experts are brought together to collaborate across disciplinary and practice boundaries. These knowledge diverse teams can produce novel solutions, but they often fail to achieve their potential. Background: Leaders have a crucial role to play in enabling effective collaboration among these diverse experts. We propose that a critical predictor of whether a newly formed interdisciplinary team will perform well is the leader’s multidisciplinary breadth of experience, which we define as a leader’s possession of significant experience in multiple areas of research and practice. We suggest that these leaders will have the capability to skillfully manage the interactions within the team. Methodology: We test our prediction in a sample of 52 newly formed interdisciplinary medical research teams. We also observe and examine the communication patterns in a subset of these teams. Contribution: There is a lack of systematic study of the impact leaders have on newly formed interdisciplinary science teams whose members have little or no prior collaborative experience with each other, possess specialized knowledge, and have limited overlapping expertise. This study combines quantitative and qualitative methods to examine the effect of leader multidisciplinary experience on team communication patterns and innovation. Findings: Our study finds that teams are more innovative when their leader has a moderate breadth of multidisciplinary expertise. Exploration of team communication patterns suggests that leaders with moderate multidisciplinary breadth of experience actively stimulated information sharing across expert domains by choosing cross-cutting topics and drew individuals’ attention to the knowledge and approaches of others in the team. Recommendations for Practitioners: Insights from this work can have practical implications regarding how to best select and train leaders to facilitate cross-boundary collaboration in transdisciplinary science. This study elucidates a variety of communication strategies that leaders can to enhance the team innovativeness. Recommendation for Researchers: Further investigation into the underlying psychological states that these communication strategies elicit is needed. Future research should investigate psychological mediators such as knowledge consideration, perspective taking, and cognitive flexibility. Impact on Society: Transdisciplinary science is needed to solve society’s most complex problems. The more insight we gather about factors that can help these knowledge diverse teams to be successful, but more society will benefit. Future Research: More research is needed on team formation, leader experience, and team outcomes in transdisciplinary science teams in a variety of contexts.

Background: This study is based on the tragic firework accident, with the highest death toll in India, that occurred in Puttingal Devi Temple, Kollam District, Kerala, at 3.30 am on 10/04/2016. Around 1500 people were injured. On the spot death toll was 109 and 12 others died in hospitals later. 1039 were treated as OP case and 410 as inpatients in various secondary and tertiary care hospitals in Kollam and Thiruvananthapuram with the help of the team of experts from AIIMS, Delhi. The aim was to study the clinical profile of inpatients admitted with trauma and/or burns following the incident and to formulate a Medical action- plan of in such eventualities.Methods: The present study is descriptive in nature with study setting in secondary and tertiary care hospitals in Kollam and Thiruvananthapuram districts. The study subjects were all the inpatient victims of the firework tragedy. The study method used analysis of relevant patient details collected from hospitals records. Results: 410 inpatients of various hospitals were analysed. Majority of the victims were males. (95.6%) Major age group affected is 20-50 years (66.1%). 79.5% of patients were treated in wards and 20.5% in various ICUs. 54.4% in secondary care centres and 45.6% in tertiary care centres. 78.2% of patients had traumatic injuries alone, 19.8% had trauma and burn injuries and 2% had burn injuries alone. 37.3% had major injuries, 21.5% had multiple fractures and 39.1% had minor injuries. 29% of patients had to undergo various surgeries. Hospital stay -76.4% of patients <2 weeks, 16.6% 2-4 weeks and 7.1% more than 30 days. Outcome: 70.7% were completely cured, 21.5% had temporary disability, 4.9% developed permanent disability. Mortality was 2.9%.Conclusions: Dedicated team work and inter-disciplinary care at Secondary and tertiary care centres of Kollam and Trivandrum districts with the timely help of medical team from Delhi has brought down the mortality rate to 2.9% in a major firework disaster with 1500 victims, which is comparable with the international standards.

In its 2017 guideline, ASCO challenged members to integrate palliative care into their standard oncology practices for all patients, throughout their cancer trajectory. However, partnering with palliative care experts alone will not be enough to achieve that goal; there are too few experts now, and there will not be enough in the future to meet the needs of patients with cancer and their families. Other strategies are required. Oncologists can develop new communication skills that were not included in their fellowship curricula, skills that integrate into their visits the subjects that palliative care clinicians discuss routinely with patients referred to them. In this review, Dr. Back offers three questions matched to communication skills that can help oncologists explore key areas: (1) What is happening? (2) How do you (and I) feel? and (3) What is important? and discusses the “REMAP” strategy for making urgent medical decisions. Dr. Friedman reviews the impact of community-based palliative care resources and telehealth on care quality, patient centeredness, and reducing costs. Community-based palliative care services and telehealth are available to patients and families at home, during active treatment. Dr. Abrahm reviews how patient-reported outcomes (PROs) completed at home can enhance patients’ symptom control, quality of life, and toleration of treatment and decrease unplanned emergency visits by alerting clinicians to patients’ severe symptoms, making appropriate referrals, or suggesting patients contact their oncology team. She also provides an update on using PROs and natural language processing with clinical decision support to create sophisticated palliative care assessments and treatment options in the electronic health record during patients’ office visits.

‘Some editors are failed writers, but so are most writers.’ TS Eliot (1888–1965) Have you ever wondered what medical journal editors do? Most editors in the medical field are unpaid and the work is part of the wider culture of service provided by so many in the medical profession. Together with the editorial board and the publisher, an editor will decide the direction of the journal. For instance, decisions are made about what sort of material should be published. One of the most common tasks, however, is the daily screening of manuscripts submitted for publication, many of which are rejected without peer review owing to poor quality, redundant material or the subject of the article being beyond the scope of the journal. After deciding which peer reviewers to send an article to, the editor must make a final decision on a manuscript, which may not necessarily concur with the advice given by the reviewers. With this comes a huge amount of personal responsibility and one to the organisation the editor represents. Take the example of George Lundberg, the editor of JAMA: The Journal of the American Medical Association, who was fired from his position after 17 years with the alleged faux pas of rushing to publish an article to coincide with the Clinton impeachment hearings ‘to extract political leverage.’ Lundberg published research showing that 60% of college students surveyed in 1991 did not think that engaging in oral sex was classed as actually ‘having sex.’ 1 While neither the methods used in the survey nor the results were disputed, the timing of the publication at an awkward political juncture was. Extrapolating this, editors are therefore not just responsible for the content of what is published but also the impact of publications in the wider arena. Editors must also handle a great deal of correspondence, including author queries and complaints, and respond to them in a timely manner. Communication with the team, the publisher, authors and readers is a vital skill. Finally, the editor needs to deal with the journal’s ethical policy when examples of plagiarism, author disputes or other forms of misconduct are evident. Breaches of publication ethics are forms of scientific misconduct that can undermine science and challenge editors, many of whom have little formal training in this field. In this respect, the Committee on Publication Ethics (COPE), founded in 1997 as a voluntary body, has become a central player. COPE provides a discussion forum and advice as well as guidelines for scientific editors with the aim of finding practical ways to deal with forms of misconduct. The Annals is a member of COPE and follows its code of conduct for journal editors. 2 It is a privilege that the current chair of COPE, Dr Barbour, and her colleagues have written this final article in the medical publishing series about challenges in publication ethics. I hope you have found this series useful and enjoyed reading the range of articles we have published from many experts in their fields. JYOTI SHAH Commissioning Editor References 1. Sanders SA , Reinisch JM . Would you say you ‘had sex’ if…? JAMA 1999 ; 281 : 275 – 277 . 2. Committee on Publication Ethics . Code of Conduct and Best Practice Guidelines for Journal Editors . Harleston, UK : COPE ; 2011 .

Background Biopharmaceutical products have become an important sector of the pharmaceutical industry in the United States (U.S.). This fast-growing sector is in a critical position in which therapeutic biological products represent over a third of all new drugs in clinical trials or awaiting approval from the U.S. Food and Drug Administration (FDA) (International Trade Administration, n.d.). The development and review of a new therapeutic biological product is a complex process that requires considerable monetary and time investment. This process takes, on average, twelve years, and the estimated average cost of taking a new drug from concept to market exceeds $1 billion (Van Norman, 2016a). After the significant expenditure of manufacturer time and resources, many drugs fail to achieve FDA approval late in the process. Criticism has arisen from the fact that the increasingly complex regulatory environment and expense associated with drug development have caused a lag in the release of new pharmaceuticals to the drug market. Advocacy groups and experts in the area are demanding a more rapid approval and release of new products because they consider the current process to be risk averse, slow, and inefficient (Ty Williams, 2016; Van Norman, 2016a). The FDA has created programs to expedite the approval of drugs and biological products (FDA, 2018). Despite all of these efforts, FDA scrutiny remains a long, costly, and risky process. The goal of this work is the exploration of the factors and gaps relevant to the FDA review and approval process which contribute to process inefficiencies, as well as proposed methods and solutions to address such gaps. Review Findings Researchers who investigated the FDA review and approval operations have identified challenges and constraints in the process (e.g. Baylor, 2014; Conner et al., 2014; Kinch, 2016; Ty Williams, 2016; Van Norman, 2016a, 2016b). Van Norman (2016a) and Ty Williams (2016) emphasizes that the main challenges for the pharmaceuticals are in terms of cost and time. Complexities in the flow of information and the communications network have been identified due to the fact that the process involves multiple FDA resources and constant communication with the applicant. Additionally, complexities could arise from the review team not only having to deal with the flow of new submissions but also with the flow of resubmitted applications, which puts a strain on FDA normal operations by having to share resources between both types of submissions. Other relevant challenges are in terms of bias due to the user fees collected from sponsors and drug manufacturers to support the drug approval process (Ty Williams, 2016) and lack of transparency of non-published drug trial data (Van Norman, 2016b). The review of methods and solutions to address such challenges and constraints has identified a lack of research activity in studying the approval process from the regulatory agency point of view (i.e. from FDA internal operations). Most research efforts are directed toward the incorporation of modeling tools to the drugs development and production practices (e.g. Gernaey & Gani, 2010; Horner, Joshi, & Waghmare, 2017). Reform models to the current FDA review and approval process have been published with the purpose of providing flexible approaches to change the way medical products are brought to market (Thierer & Wilt, 2016; Williams, Joffe, & Slonim, 2016; Klein & Tabarrok, 2016; Conko & Madden, 2000; Gulfo, Briggeman, & Roberts, 2016). The implementation of any of these reform models may imply a shift in the responsibilities of the FDA and therefore may change the organizational structure of the regulatory agency – something that must be addressed and measured for effectiveness. Conclusions Suggesting changes to the review and approval of therapeutic biological products is a challenging task. To the best of our knowledge, none of the academic articles identified in this scoping review have modeled the FDA review and approval process to address issues related to the robustness, reliability and efficiency of its operations from an internal point of view. The reform models identified in the literature are limited in several aspects. For example, there is a general lack of application of scientific methodologies and modeling techniques in understanding FDA as a complex sociotechnical system. In addition, tools and methods to assess their efficacy before implementation are largely absent. Findings from this scoping review suggest an opportunity to employ Model-Based Systems Engineering (MBSE) approaches to provide a systems-oriented descriptive model of the FDA approval process for therapeutic biological products as a service network, with the objective of providing a method to support individual, team, and organizational decision-making to balance the process structure in terms of enforcement and in-formation. This holistic approach will serve several investigative purposes: (1) identify influential sources of variability that cause major delays including individual, team, and organiza-tional decision-making, (2) identify the human-system bottle-necks, (3) identify areas of opportunity for design-driven im-provements, (4) study the effect of induced changes in the sys-tem, and (5) assess the robustness of the structure of the FDA approval process in terms of enforcement and information sym-metry.

[Formula: see text] There is a growing desire amongst space-faring nations to venture beyond the Van Allen radiation belts to a variety of intriguing locations in our inner solar system. Mars is the ultimate destination. In two decades, we hope to vicariously share in the adventure of an intrepid crew of international astronauts on the first voyage to the red planet. This will be a daunting mission with an operational profile unlike anything astronauts have flown before. A flight to Mars will be a 50-million-kilometre journey. Interplanetary distances are so great that voice and data communications between mission control on Earth and a base on Mars will feature latencies up to 20 min. Consequently, the ground support team will not have real-time control of the systems aboard the transit spacecraft nor the surface habitat. As cargo resupply from Earth will be impossible, the onboard inventory of equipment and supplies must be planned strategically in advance. Furthermore, the size, amount, and function of onboard equipment will be constrained by limited volume, mass, and power allowances. With less oversight from the ground, all vehicle systems will need to be reliable and robust. They must function autonomously. Astronauts will rely on their own abilities and onboard resources to deal with urgent situations that will inevitably arise. The deep space environment is hazardous. Zero- and reduced-gravity effects will trigger deconditioning of the cardiovascular, musculoskeletal, and other physiological systems. While living for 2.5 years in extreme isolation, Mars crews will experience psychological stressors such as loss of privacy, reduced comforts of living, and distant relationships with family members and friends. Beyond Earth’s protective magnetosphere, the fluence of ionising radiation will be higher. Longer exposure of astronauts to galactic cosmic radiation could result in the formation of cataracts, impaired wound healing, and degenerative tissue diseases. Genetic mutations and the onset of cancer later in life are also possible. Acute radiation sickness and even death could ensue from a large and unpredictable solar particle event. There are many technological barriers that prevent us from carrying out a mission to Mars today. Before launching the first crew, we will need to develop processes for in-situ resource utilisation. Rather than bringing along large quantities of oxygen, water, and propellant from Earth, future astronauts will need to produce some of these consumables from local space-based resources. Ion propulsion systems will be needed to reduce travel times to interplanetary destinations, and we will need systems to land larger payloads (up to 40 tonnes of equipment and supplies for a human mission) on planetary surfaces. These and other innovations will be needed before humans venture into deep space. However, it is the delivery of health care that is regarded as one of the most important obstacles to be overcome. Physicians, biomedical engineers, human factors specialists, and radiation experts are re-thinking operational concepts of health care, crew performance, and life support. Traditional oversight of astronaut health by ground-based medical teams will no longer be possible, particularly in urgent situations. Aborting a deep space mission to medically evacuate an ill or injured crew member to Earth will not be an option. Future crews must have all of the capability and responsibility to monitor and manage their own health. Onboard medical resources must include imaging, surgery, and emergency care, as well as laboratory analysis of blood, urine, and other biospecimens. At least one member of the crew should be a broadly trained physician with experience in remote medicine. She/he will be supported by an onboard health informatics network that is artificial intelligence enabled to assist with monitoring, diagnosis, and treatment. In other words, health care in deep space will become more autonomous, intelligent, and point of care. The International Commission on Radiological Protection (ICRP) has dedicated a day of its 5th International Symposium in Adelaide to the theme of Mars exploration. ICRP has brought global experts together today to consider the pressing issues of radiation protection. There are many issues to be addressed: Can the radiation countermeasures currently used in low Earth orbit be adapted for deep space? Can materials of low atomic weight be integrated into the structure of deep space vehicles to shield the crew? In the event of a major solar particle event, could a safe haven shelter the crew adequately from high doses of radiation? Could Martian regolith be used as shielding material for subterranean habitats? Will shielding alone be sufficient to minimise exposure, or will biological and pharmacological countermeasures also be needed? Beyond this symposium, I will value the continued involvement of ICRP in space exploration. ICRP has recently established Task Group 115 to examine radiation effects on the health of astronaut crew and to recommend exposure limits. This work will be vital. Biological effects of radiation could not only impact the health, well-being, and performance of future explorers, but also the length and quality of their lives. While humanity has dreamed of travel to the red planet for decades, an actual mission is finally starting to feel like a possibility. How exciting! I thank ICRP for its ongoing work to protect radiation workers on Earth. In the future, we will depend on counsel from ICRP to protect extraterrestrial workers and to enable the exploration of deep space.

Perfect vision for the path ahead? As I write this editorial it seems that once again, we stand on the threshold of yet another significant date. The fortieth anniversary of ISCPES and also that of this journal, that has been the voice of the society’s contribution over that period, has been and gone. This time it is 2020 that looms on the near horizon. It is a date that has long been synonymous with perfect vision. Many may perhaps see this as somewhat ironic, given the themes surrounding change and the directions it has taken, that have been addressed previously in these pages. Perfect vision and the clarity it can bring seem a far cry away from the turbulent world to which we seem to be becoming accustomed. So many of the divisions that we are facing today seem to be internal in nature and far different from the largely: nation against nation; system against system strife, we can remember from the cold war era. The US, for example, seems to be a nation perpetually at war with itself. Democrats v Republicans, deplorables v elites - however you want to label the warring sides - we can construct a number of divisions which seem to put 50% of Americans implacably opposed to the other 50%. In the UK, it has been the divide around the referendum to leave the European Union – the so-called Brexit debate. Nationally the division was 52% to 48% in favour of leaving. Yet the data can be reanalysed in, it seems, countless ways to show the splits within a supposedly ‘United’ Kingdom. Scotland v England, London and the South East v the English regions, young v old are just some of the examples. Similar splits seem to be increasing within many societies. Hong Kong has recently been the focus of world interest We have watched this erstwhile model of an apparently successful and dynamic compromise between two ‘diverse’ systems, appear to tear itself apart on our television screens. Iran, Brazil, Venezuela are just three further examples of longstanding national communities where internal divisions have bubbled to the surface in recent times. These internal divisions frequently have no simple and single fault line. In bygone times, social class, poverty, religion and ethnicity were simple universal indicators of division. Today ways of dividing people have become far more complex and often multi-dimensional. Social media has become a means to amplify and repeat messages that have originated from those who have a ‘gripe’ based in identity politics or who wish to signal to all and sundry how extremely ‘virtuous’ and progressive they are. The new technologies have proved effective for the distribution of information but remarkably unsuccessful in the promotion of communication. This has been exemplified by the emergence and exploitation of Greta Thunberg a sixteen-year-old from Sweden as a spokesperson for the ‘Extinction Rebellion’ climate change lobby. It is a movement that has consciously eschewed debate and discussion in favour of action. Consequently, by excluding learning from its operation, it is cutting itself off from the possibility of finding out what beneficial change will look like and therefore finding a way by which to achieve it. Put simply, it has predetermined its desired goal and defined the problem in inflexible terms. It has ignored a basic tenet of effective problem solving, namely that the key lies in the way you actually frame the problem. Unfortunately, the movement has adopted the polarised labelling strategies that place all humans into the category of either ‘believers’ or ‘deniers’. This fails to acknowledge and deal with the depth and complexity of the problem and the range of our possible responses to it. We are all the losers when problems, particularly given their potential significance, become addressed in such a way. How and where can human behaviour learn to rise above the limits of the processes we see being followed all around us? If leadership is to come, it must surely come from and through a process of education. All of us must assume some responsibility here – and certainly not abdicate it to elite and powerful groups. In other words, we all have a moral duty to educate ourselves to the best of our ability. An important part of the process we follow should be to remain sceptical of the limits of human knowledge. In addition, we need to be committed to applying tests of truth and integrity to the information we access and manage. This is why we form and support learned societies such as ISCPES. Their duty is to test, debate and promote ideas and concepts so that truth and understanding might emerge from sharing and exploring information, while at the same time applying the criteria developed by the wisdom and experience of those who have gone before. And so, we come to the processes of change and disruption as we are currently experiencing them at International Sports Studies. Throughout our history we have followed the traditional model of a scholarly journal. That is, our reason for existence is to provide a scholarly forum for colleagues who wish to contribute to and develop understanding within the professional and academic field of Comparative Physical Education and Sport. As the means of doing this, we encourage academics and professionals in our field to submit articles which are blind reviewed by experts. They then advise the editor on their quality and suitability for publication. As part of our responsibility we particularly encourage qualified authors from non-English speaking backgrounds to publish with us, as a means of providing a truly international forum for ideas and development. Where possible the editorial team works with contributors to assist them with this process. We have now taken a step further by publishing the abstracts in Portuguese, Spanish and Chinese on the website, in order to spread the work of our contributors more widely. Consistent with international changes in labelling and focus over the years, the title of the society’s journal was changed from the Journal of Comparative Physical Education and Sport to International Sports Studies in 1989. However, our aim has remained to advance understanding and communication between members of the global community who share a professional, personal or scholarly interest in the state and development of physical education and sport around the world. In line with the traditional model, the services of our editorial and reviewing teams are provided ex gratia and the costs of publication are met by reader and library subscriptions. We have always offered a traditional printed version but have, in recent years, developed an online version - also as a subscription. Over the last few years we have moved to online editorial support. From 2020 will be adopting the practice of making articles available online immediately following their acceptance. This will reduce the wait time experienced by authors in their work becoming generally available to the academic community. Readers will no doubt be aware of the current and recent turbulence within academic publishing generally. There has been a massive increase in the university sector globally. As a result, there has been an increasing number of academics who both want to and need to publish, for the sake of advancement in their careers. A number of organisations have seen this as providing a business opportunity. Consequently, many academics now receive daily emails soliciting their contributions to various journals and books. University libraries are finding their budgets stretched and while they have been, up until now, the major funders of scholarly journals through their subscriptions, they have been forced to limit their lists and become much more selective in their choices. For these reasons, open access has provided a different and attractive funding model. In this model, the costs of publication are effectively transferred to the authors rather than the readers. This works well for those authors who may have the financial support to pursue this option, as well as for readers. However, it does raise a question as to the processes of quality control. The question arises because when the writer becomes the paying customer in the transaction, then the interests of the merchant (the publisher) can become more aligned to ensuring the author gets published rather than guaranteeing the reader some degree of quality control over the product they are receiving. A further confounding factor in the scenario we face, is the issue of how quality is judged. Universities have today become businesses and are being run with philosophies similar to those of any business in the commercial world. Thus, they have ‘bought into’ a series of key performance indicators which are used to compare institutions one with another. These are then added up together to produce summative scores by which universities can be compared and ranked. There are those of us that believe that such a process belittles and diminishes the institutions and the role they play in our societies. Nonetheless it has become a game with which the majority appear to have fallen in line, seeing it as a necessary part of the need to market themselves. As a result, very many institutions now pay their chief executives (formerly Vice-Chancellors) very highly, in order to for them to optimise the chosen metrics. It is a similar process of course with academic journals. So it is, that various measures are used to categorise and rank journals and provide some simplistic measure of ‘quality’. Certain fields and methodologies are inherently privileged in these processes, for example the medical and natural sciences. As far as we are concerned, we address a very significant element in our society – physical education and sport - and we address it from a critical but eclectic perspective. We believe that this provides a significant service to our global community. However, we need to be realistic in acknowledging the limited and restricted nature of that community. Sport Science has become dominated by physiology, data analytics, injury and rehabilitation. Courses and staff studying the phenomenon of sport and physical education through the humanities and social sciences, seem to be rarer and rarer. This is to the great detriment of the wellbeing and development of the phenomenon itself. We would like to believe that we can make an important difference in this space. So how do we address the question of quality? Primarily through following our advertised processes and the integrity and competence of those involved. We believe in these and will stick with them. However, we appreciate that burying our heads in the sand and remaining ‘king of the dinosaurs’ does not provide a viable way forward. Therefore, in our search for continuing strategy and clear vision in 2020, we will be exploring ways of signalling our quality better, while at the same time remaining true to our principles and beliefs. In conclusion we are advising you, as our readers, that changes may be expected as we, of necessity, adapt to our changing environment while seeking sustainability. Exactly what they will be, we are not certain at the time of going to press. We believe that there is a place, even a demand for our contribution and we are committed to both maintaining its standard and improving its accessibility. Comments and advice from within and outside of our community are welcome and we remain appreciative, as always, of the immense contribution of our international review board members and our supportive and innovative publisher. So, to the contributors to our current volume. Once again, we would point with some pride to the range of articles and topics provided. Together, they provide an interesting and relevant overview of some pertinent current issues in sport and physical education, addressed from the perspectives of different areas across the globe. Firstly, Pill and Agnew provide an update to current pedagogical practices in physical education and sport, through their scoping review of findings related to the use of small-sided games in teaching and coaching. They provide an overview of the empirical research, available between 2006 and 2016, and conclude that the strategy provides a useful means of achieving a number of specific objectives. From Belgium, Van Gestel explores the recent development of elite Thai boxing in that country. He draws on Elias’ (1986) notion of ‘sportization’ which describes the processes by which various play like activities have become transformed into modern sport. Thai boxing provides an interesting example as one of a number of high-risk combat sports, which inhabit an ambiguous area between the international sports community and more marginalised combat activities which can be brutal in nature. Van Gestel expertly draws out some of the complexities involved in concluding that the sport has experienced some of the processes of sportization, but in this particular case they have been ‘slight’ in impact rather than full-blown. Abdolmaleki, Heidari, Zakizadeh XXABSTRACT De Bosscher look at a topic of considerable contemporary interest – the management of a high-performance sport system. In this case their example is the Iranian national system and their focus is on the management of some of the resources involved. Given that the key to success in high performance sport systems would appear to lie in the ability to access and implement some of the latest and most effective technological information intellectual capital would seem to be a critical component of the total value of a competitive high performance sport system Using a model developed by a Swedish capital services company Skandia to model intangible assets in a service based organisation, Abdolmaleki and his associates have argued for the contribution of human, relational and structural capital to provide an understanding of the current place of intellectual capital in the operations of the Iranian Ministry of Sport and Youth. An understanding of the factors contributing to the development of these assets, contributes to the successful operation of any organisation in such a highly competitive and fast changing environment. Finally, from Singapore, Chung, Sufri and Wang report on some of the exciting developments in school based physical education that have occurred over the last decade. In particular they identify the increase in the placement of qualified physical education teachers as indicative of the progress that has been made. They draw on Foucault’s strategy of ‘archaeological analysis’ for an explanation of how these developments came to be successfully put in place. Their arguments strongly reinforce the importance of understanding the social and political context in order to achieve successful innovation and development. May I commend the work of our colleagues to you and wish you all the best in the attempt to achieve greater clarity of vision for 2020!

Introduction Such symptoms as hard, complex, bodily or mental feelings, that turn our everyday life into a hell, at first, lead us to a doctor, and then - to a psychotherapist. A sick man is keen to get rid of a symptom. A doctor prescribes medication, that is ought to eliminate a symptom. A psychotherapist searches for a reason of the problem that needs to be removed. There is such an idea that a neurotic symptom, in particular, an anxiety - is a pathological (spare or extra) response of a body. It is generally believed that such anxiety doesn’t have some real, objective reasons and that it is the result of a nervous system disorder, or some disruption of a cognitive sphere etc. Meanwhile, it is known that in the majority of cases, medical examinations of anxious people show that they don’t have any organic damages, including nervous system. It often happens that patients even wish doctors have found at least any pathology and have begun its treatment. And yet - there is no pathology. All examinations indicate a high level of functionality of a body and great performance of the brain's work. Doctors throw their hands up, as they can't cure healthy people. One of my clients told me her story of such medical examinations (which I’ll tell you with her permission). She said that it was more than 10 years ago. So, when she told her doctor all of her symptoms - he seemed very interested in it. He placed a helmet with electrodes on her head and wore some special glasses, when, according to her words, he created some kind of stressful situation for her brain, as she was seeing some flashings of bright pictures in her eyes. She said that he had been bothered with her for quite a long time, and at the end of it he had told her that her brain had been performing the best results in all respects. He noted that he’d rarely got patients with such great health indicators. My client asked the doctor how rare that was. And he answered: “one client in two or three months.” At that moment my client didn’t know whether to be relieved, flattered or sad. But since then, when someone told her that anxiety was a certain sign of mental problems, or problems with the nervous system, or with a body in general, she answered that people who had anxiety usually had already got all the required medical examinations sufficiently, and gave them the advice to go through medical screening by themselves before saying something like that. Therefore, we see a paradoxical situation, when some experts point to a neurotic anxiety as if it is a kind of pathology, in other words - some result of a nervous system disorder. Other specialists in the same situation talk about cognitive impairments. And some, after all the examinations, are ready to send such patients into space Main text I don’t agree with the statement that any neurotic anxiety that happens is excessive and unfounded. It often happens that there is objective, specific and real causes for appearance of anxiety conditions. And these causes require solutions. And it’s not about some organic damages of the brain or nervous system. The precondition that may give a rise to anxiety disorder is the development of such a life story that at some stage becomes too toxic - when, on the one hand, a person interacts with the outside world in a way that destroys his or her personality, and, on the other hand, this person uses repression and accepts such situation as common and normal. Repression - is an essential condition for the development of a neurotic symptom. Sigmund Freud was the first who pointed this out. Repression is such a defense mechanism that helps people separate themselves from some unpleasant feelings of discomfort (pain) while having (external or internal) irritations. It is the situation when, despite the presence of irritations and painful feelings, a person, however, doesn't feel any of it and is not aware of them in his or her conscious mind. Repression creates the situation of so-called emotional anesthesia. As a result, a displacement takes place, so a body starts to signal about the existing toxic life situation via a symptom. Anxiety disorder is usually an appropriate response (symptom) of a healthy body to an unhealthy life situation, which is seen by a person as normal. And it’s common when such a person is surrounded by others (close people), who tend to benefit from such situation, and so they actively maintain this state of affairs, whether it is conscious for them or not. At the beginning of a psychotherapy almost all clients insist that everything is good in their lives, even great, as it is like in everyone else’s life. They say that they have only one problem, which is that goddamn symptom. So they focus all of their attention on that symptom. They are not interested in all the other aspects of their life, and they show their irritation when it comes to talking about it. People want to get rid of it, whatever it takes, but they often tend to keep their lives the way that it was. In such cases a psychotherapist is dealing with the resistance of clients, trying to turn their attention from a symptom to their everyday situation that includes their way of thinking, interactions with themselves and with others and with the external world in order to have the opportunity to see the real problem, to live it through, to rethink and to change the story of their lives. For better understanding about how it works I want to tell you three allegorical tales. The name of the first tale is “A frog in boiling water”. There is one scientific anecdote and an assumption (however, it is noted that such experiments were held in 19 century), that if we put a frog in a pot with warm water and start to slowly heat the water, then this frog get used to the temperature rise and stays in a hot water, the frog doesn’t fight the situation, slowly begins to lose its energy and at the last moment it couldn’t find enough strength and energy to get out of that pot. But if we throw a frog abruptly in hot water - it jumps out very quickly. It is likely that a frog, that is seating in boiling water, will have some responses of the body (symptoms). For example, the temperature of its body will rise, the same as the color of it, etc., that is an absolutely normal body response to the existing situation. But let us keep fantasizing further. Imagine a cartoon where such a frog is the magical cartoon hero, that comes to some magical cartoon doctor, shows its skin, that has changed the color, to the doctor, and asks to change the situation by removing this unpleasant symptom. So the doctor prescribes some medication to return the natural green color of the frog’s skin back. The frog gets back in its hot water. For some period of time this medication helps. But then, after a while, the frog’s body gets over the situation, and the redness of the frog's skin gets back. And the magical cartoon doctor states that the resistance of the body to this medication has increased, and each time prescribes some more and more strong drugs. In this example with the frog it is perfectly clear that the true solution of the problem requires the reduction of the water temperature in that pot. We could propose that magical cartoon frog to think and try to realize that: 1) the water in that pot is hot, and that is the reason why the skin is red; 2) the frog got used to this situation and that is why it is so unnoticeably for this frog; 3) if the temperature of the water in the pot still stay so hot, without any temperature drop, then all the medication works only temporarily; 4) if we lower the temperature in that pot - the redness disappears on its own, automatically and without any medication. Also this cartoon frog, that will go after the doctor to some cartoon physiotherapist, will face the necessity to give itself some answers for such questions as: 1) What is going on? Who has put this frog in that pot? Who is raising the temperature progressively? Who needs it? And what is the purpose or benefit for this person in that? Who benefits? 2) Why did the frog get into the pot? What are the benefits in it for the frog? Or why did the frog agree to that? 3) What does the frog lose when it gets out of this pot? What are the consequences of it for the frog? What does the frog have to face? What are the possible difficulties on the way? Who would be against the changes? With whom the frog may confront? 4) Is the frog ready to take control over its own pot in its own hands and start to regulate the temperature of the water by itself, so to make this temperature comfortable for itself? Is this frog ready to influence by itself on its own living space, to take the responsibility for it to itself? The example “A frog in boiling water” is often used as a metaphorical portrayal of the inability of people to respond (or fight back) to significant changes that slowly happen in their lives. Also this tale shows that a body, while trying to adjust to unfavorable living conditions, will react with a symptom. And it is very important to understand this symptom. Symptom - is the response of a body, it’s a way a body adjusts to some unfriendly environment. Symptom, on the one hand, informs about the existence of a problem, and from the other hand - tries to regulate this problem, at least in some way (like, to remove or reduce), at the level on which it can do it. The process is similar to those when, for example, in a body, while it suffers from some infectious disease, the temperature rises. Thus, on the one hand, the temperature informs about the existence of some infection. On the other hand, the temperature increase creates in a body the situation that is damaging for the infection. So, it would be good to think about in what way does an anxiety symptom help a body that is surrounded by some toxic life situation. And this is a good topic for another article. Here I want to emphasize that all the attempts to remove a symptom without a removal of a problem, without changing the everyday life story, may lead to strengthening of the symptom in the body. Even though the removal of a symptom without elimination of its cause has shown success, it only means that the situation was changed into the condition of asymptomatic existence of a problem. And it is, in its essence, a worse situation. For example, it can cause an occurrence of cancer. The tale “A frog in boiling water” is about the tendency of people to treat a symptom, instead of seeing their real problems, as its cause, and trying to solve it. People don’t want to see their problems, but it doesn’t mean that the problem doesn’t exist. The problem does exist and it continues to destroy a person, unnoticeably for him or her. A person with panic disorder could show us anxiety that is out of control (fear, panic), which, by its essence, seems to exist without any logical reason. Meanwhile the body of such a person could be in such processes that are similar to those that occur in the conditions of some real dangers, when the instinct for self-preservation is triggered and an automatic response of a body to fight or flight implements for its full potential. We can see or feel signs of this response, for example, in cases when some person tries to avoid some real or imaginary danger via attempts to escape (the feeling of fear), or tries to handle the situation by some attempts to fight (the feeling of anger). As I mentioned before, many doctors believe that such fear is pathological, as there is no real reason for such intense anxiety. They may see the cause of the problem in worrisome temper, so they try to remove specifically anxiety rather than help such patients to understand specific reason of their anxiety, they use special psychotherapeutic methods that are designed to help clients to develop logical thinking, so it must help them to realize the groundlessness of their anxiety. In my point of view, such anxiety often has specific, real reasons, when this response of a body, fight or flight, is absolutely appropriate, but not excessive or pathological. Inadequacy, in fact, is in the unconsciousness, but not in the reactions of a body. For a better understanding of the role of anxiety in some toxic environment, that isn’t realized, I want to tell you another allegorical tale called “The wolf and the hare”. Let us imagine that two cages were brought together in one room. The wolf was inside one cage and the hare was in another. The cages were divided by some kind of curtain that makes it impossible for them to see each other. At this point a question arises whether the animals react to each other in some way in such a situation, or not? I think that yes, they will. Since there are a lot of other receptors that participate in the receiving and processing of the sensory information. As well as sight and hearing, we have of course a range of other senses. For example, animals have a strong sense of smell. It is well known that people, along with verbal methods of communicating information, like language and speaking, also have other means of transmitting information - non-verbal, such as tone of voice, intonation, look, gestures, body language, facial expressions etc., that gives us the opportunity to receive additional information from each other. The lie detector works by using this principle: due to detecting non-verbal signals, it distinguishes the level of the accuracy of information that is transmitted. It is assumed, that about 30% of information, that we receive from the environment, comes through words, vision, hearing, touches etc. This is the information that we are aware of in our consciousness, so we could consciously (logically) use it to be guided by. And approximately 70% of everyday information about the reality around us we receive non-verbally, and this information in the majority of cases could remain in us without any recognition. It is the situation when we’ve already known something, and we even have already started to respond to it via our body, but we still don’t know logically and consciously that we know it. We can observe the responses of our own body without understanding what are the reasons for such responses. We can recognize this unconscious information through certain pictures, associations, dreams, or with the help of psychoanalysis. Psychoanalysis is a great tool that can help to recognize the information from the unconscious mind, so that it can be logically processed further on, in other words, a person then receives the opportunity to indicate the real problems and to make right decisions. But let us return to the tale where the hare and the wolf stay in one room and don’t see each other, and, maybe, don’t hear, though - feel. These feelings (in other words - non-verbal information that the hare receives) activate a certain response in the hare’s body. And it reacts properly and adequately to the situation, for instance, the body starts to produce adrenaline and runs the response “fight or flight”. So the hare starts to behave accordingly and we could see the following symptoms: the hare is running around his cage, fussing, having some tremor and an increased heart rate, etc.. And now let us imagine this tale in some cartoon. The hare stays in its house, and the wolf wanders about this house. But the hare doesn’t see the wolf. Though the body of the hare gives some appropriate responses. And then that cartoon hare goes to a cartoon doctor and asks that doctor to give it some pill from its tremor and the increased heart rate. And in general asks to treat in some way this incomprehensible, confusing, totally unreasonable severe anxiety. If we try to replace the situation from this fairy-tale to a life story, we could see that it fits well to the script of interdependent relationships, where there are a couple “a victim and an aggressor”, and where such common for our traditional families’ occurrences as a domestic family violence, psychological and physical abuse take place. Only in 2019 a law was passed that follows the European norms and gives a legislative definition of such concepts as psychological domestic abuse, sexual abuse, physical abuse, bullying, that criminalizes all of these occurrences, establishes the punishment and directly points to people that could be a potential abuser. Among them are: a husband towards his wife, parents towards their children, a wife towards her husband, a superior towards a subordinate, a teacher towards his or her students, children towards each other etc.. When it comes to recognition of something as unacceptable, it seems more easy to put to that category such occurrences as physical and sexual abuse, as we could see here some obvious events. For example, beating or sexual harassment. Our society is ready to respond to these incidents in more or less adequate way, and to recognize them as a crime. But it is harder to deal with the recognition of psychological abuse as an offence. Psychological abuse in our families is common. Psychological abuse occurs through such situations, when one person, while using different psychological manipulations, such as violation of psychological borders, imposition of feeling of guilty or shame, etc., force another person to give up his or her needs and desires, and so in such a way make this person live another’s life. Such actions have an extremely negative effect on the mental health of these people, just as much as physical abuse. It can destroy a person from the inside, ruin self-esteem and a feeling of self-worth, create the situation of absolute dependence such victim from an abuser, including financial dependence etc.. It often happens that psychological abuse takes place against the backdrop of demonstrations of care and love. So you've got this story about the wolf and the hare, that are right next to each other, and the shield between two of them is a repression - a psychological defense mechanism, when a person turns a blind eye to such offences, that take place in his or her own life and towards him or her. And this person considers this as normal, doesn't realize, doesn't have a resource to realize, that it is a crime. Most importantly - doesn’t feel anything, as a repression takes place. But a body responds in a right way - from a certain point of the existence of such a toxic situation the response “fight or flight” is launched in a body at full, in other words - the fear and anxiety with the associated symptoms. The third allegorical tale I called “Defective suit”, which I read in the book of Clarissa Pinkola Estés with the name “Running With the Wolves". “Once one man came to a tailor and started to try on a suit. When he was standing in front of a mirror, he saw that the costume had uneven edges. - Don’t worry, - said the tailor. - If you hold the short edge of the suit by your left hand - nobody notices it. But then the man saw that a lapel of a jacket folded up a little bit. - It's nothing. You only need to turn your head and to nail it by your chin. The customer obeyed, but when he put on trousers, he saw that they were pulling. - All right, so just hold your trousers like this by your right hand - and everything will be fine, - the tailor comforts him. The client agreed with him and took the suit. The next day he put on his new suit and went for a walk, while doing everything exactly in the way that the tailor told him to. He waddled in a park, while holding the lapel by his chin, and holding the short edge of the suit by his left hand, and holding his trousers by his right hand. Two old men, who were playing checkers, left the game and started to watch him. - Oh, God! - said one of them. - Look at that poor cripple. - Oh, yes - the limp - is a disaster. But I'm wondering, where did he get such a nice suit?” Clarissa wrote: “The commentary of the second old man reflects the common response of the society to a woman, who built a great reputation for herself, but turned into a cripple, while trying to save it. “Yes, she is a cripple, but look how great her life is and how lovely she looks.” When the “skin” that we put on ourselves towards society is small, we become cripples, but try to hide it. While fading away, we try to waddle perky, so everyone could see that we are doing really well, everything is great, everything is fine”. As for me, this tale is also about the process of forming a symptom in a situation when one person tries very hard to match to another one, whether it is a husband, a wife or parents. It’s about a situation when such a person always tries to support the other one, while giving up his or her own needs and causing oneself harm in such a way by feeling a tension every day, that becomes an inner normality. And so this person doesn’t give oneself a possibility to relax, to be herself (or himself), to be spontaneous, free. As a result, in this situation the person, who was supported, looks perfect from the outside, but those who tried to match, arises some visible defect, like a limp - a symptom. And so this person lives like a cripple, under everyday stress and tension, trying to handle it, while sacrificing herself (or himself) and trying to maintain this situation, so not to lose the general picture of a beautiful family and to avoid shame. The tailor, who made this defective suit and tells how to wear the suit properly, in order to keep things going as they are going, often is a mother who raised a problematic child and then tells another person how to deal with her child in the right way. It is the situation when a mother-in-law tells her daughter-in-law how to treat her son properly. In other words, how to support him, when to keep silent, to handle, how to fit in, so that her problematic son and this relationship in general looks perfect. Or vice versa, when a mother-in-law tells her son-in-law how to support her problematic daughter, how to fit in etc.. When, for example, a woman acts like this in her marriage and with her husband, with these excessive efforts to fit in - then after a while everybody will talk like: “Look at this lovely man: he lives with his sick wife, and their family seems perfect!”. But when such a woman becomes brave enough to relax and to just let the whole thing go, everybody will see that the relationship in her marriage isn’t perfect, and it is the other one who has problems. Each time when someone tries excessively to match up to another one, while turning oneself in some kind of a cripple, - he or she, on the one hand, supports the comfort of that person, to whom he or she tries to match up, and on the other hand - such a situation always arises in that person such conditions as a continuous tension, anxiety, fear to act spontaneously. A symptom - is like a visible defect, that shows itself through the body (and may look like some kind of injury). It is the result of a hidden inner prison. As a result of evolution, a pain tells us about a problem that is needed to be solved. When we repress our pain we can’t see our needs and our problems at full. And then a body starts to talk to us via a symptom. Psychotherapy aims for providing a movement from a symptom to a resumption of sensitivity to feelings, a resumption of the ability to feel your psychological pain, so you can realize your own toxic story. In this perspective another fairy-tale looks interesting to analyze - it is Andersen's fairytale “Princess and the Pea”. In the tale a prince wanted to find a princess to marry. There was one requirement for women candidates, so the prince could select her among commoner - high level of sensitivity, as the real princess would feel a pea through the mountain of mattresses, and so she could have the ability to feel discomfort, to be in a good contact with her body, to tell about her discomfort without such feeling as shame and guilt, and to refuse that discomfort, so to have the readiness to solve her problems and to demand from others the respect for her needs. It is common for our culture that the expression “a princess on a pea” very often uses for a negative meaning. So people who are in good contact with their body and who can demand comfort for themselves are often called capricious. At the same time the heroes who are ready to suffer and to tolerate their pain, who are able to repress (stop to feel) their pain represents a good example to be followed in our society. So, we may see the next algorithm in cases of various anxiety disorders: the existence of some toxic situation that brings some danger to a person. And we need not to be confused: a danger exists not for a body, but for a personality. A toxic live situation as well as having a panic attack is not a threat for the health of a body (that is what medical examinations show), and vice versa - it’s like every day intensive sport training, that could be good for your health only to some degree. A toxic situation destroys a person as a personality, who longs for one self’s expression; the existence of such a defense mechanism as repression - it’s a life with closed eyes, in pink glasses, when there is inability (or the absence of the desire) to see its own toxic story; 3.the presence of a symptom - a healthy response of a body “fight or flight” to some toxic situation; displacement - it’s replacement of the attention from the situation to a symptom, when a person starts to see and search for the problem in some other place, not where it really is. A symptom takes as some spare, pathological reaction that we need to get rid of. The readiness to fight the symptom arises, and that is the goal of such methods of therapy as pharmacological therapy, CBT and many others; the absence of adequate actions that are directed towards the change of a toxic situation itself. The absence of the readiness to show aggression when it comes to protect its space. All of it is a mechanism of formation of primary anxiety and preparation for launch of secondary anxiety. A complete anxiety disorder is the interaction between a primary and a secondary anxiety.

Once again, 12 months seem to have f lown by and we find ourselves at the end of this journal’s 10th Anniversary year. So what will 2012 have in store for us? Will financial chaos send us spiralling into the abyss or will the Olympics and Diamond Jubilee bring back the long-awaited ‘feel good factor’? Maybe the England football team will finally win a trophy, and surely we are due for some decent weather. I prefer to stay optimistic, and believe predictions of ‘barbeque summers’, rather than those of Nostradamus! One thing we can certainly look forward to in 2012 is a ‘silver’ anniversary for SAM – as well as the first to be held overseas, the spring meeting in Dublin will be the 25th held by the Society. I hope that many UK readers will be able to make the short trip across the Irish Sea to attend this special event. The year’s end also brings the cluster of festive bank holidays – 3 in England and 4 for those North of the border, each co-inciding with weekends. Some will take this opportunity to recharge the batteries before the onslaught of January; for others the challenge of 7 day working will be brought back into sharp focus. Many readers will be familiar with the aftermath of these long holiday weekends when it often feels like the whole hospital has ground to a halt. Higher weekend mortality has attracted some Press attention during the past year; this has added weight to those arguing for greater levels of consultant cover outside of traditional working hours. The paper from Dublin, published in this edition, suggests that higher illness severity might contribute to this weekend mortality. The model of medical service is a little different to that which operates in most UK hospitals, but the findings are still of interest. Does this diminish the need to expand consultant cover? Absolutely not, in my view – sicker patients require more senior care, not less; whether this will inf luence outcome for these patients is yet to be proven, but the principle remains clear. We should strive to provide the same level of care for patients, irrespective of the day on which they are admitted. Achieving this is a bigger challenge – particularly in the current financial climate – which will require close cooperation between SAM and the Royal Colleges. Acute physicians will need to continue on rotas working alongside ‘general’ physicians to achieve this as the numbers gradually expand. Mark Temple, recently appointed as Acute Care Fellow at the Royal College of Physicians of London and writing in this edition, has reiterated the RCPL’s line on this issue; a ‘toolkit’ is being produced in collaboration with SAM to provide practical solutions to this problem. On a lighter note, I hope readers will enjoy the series of clinical articles to be found in this issue. Case reports from both sides of the world document some unusual causes of ‘collapse’, a common reason for admission on the AMU, requiring a broad differential. Serotonin syndrome and thyrotoxic periodic paralysis may not be top of the list of causes, but these articles highlight the need to keep an open mind in such cases. Our problem-based review series continues, with paracetamol overdose and pleural effusions being the subjects on this occasion. Although forming part of the ‘trainee’ section, I am certain that the content will also provide a useful insight into these topics for our many ‘trained’ readers. Finally, I would like to take this opportunity to thank all those who have contributed to the journal over this ‘anniversary’ year – and the previous nine. I am particularly grateful for the efforts of the editorial board in helping to make this a ‘quarterly’ publication in 2011. The numbers of contributions continues to rise, as does the quality of submissions, no doubt fuelled by the recent listing of the journal in Medline. As a consequence we are still looking to expand our pool of expert referees, so please contact me at the email address on this page, indicating any specific areas of interest / expertise, if you are able to help. Wishing all readers a happy Christmas and New Year

The requirements of state-of-the-art curricula and teaching processes in medical education have brought both new and improved the existing assessment methods. Recently, several promising methods have emerged, among them the Comprehensive Integrative Puzzle (CIP), which shows great potential. However, the construction of such questions requires high efforts of a team of experts and is time-consuming. Furthermore, despite the fact that English language is accepted as an international language, for educational purposes there is also a need for representing data and knowledge in native language. In this paper, we present an approach for automatic generation of CIP assessment questions based on using ontologies for knowledge representation. In this way, it is possible to provide multilingual support in the teaching and learning process because the same ontological concept can be applied to corresponding language expressions in different languages. The proposed approach shows promising results indicated by dramatic speeding up of construction of CIP questions compared to manual methods. The presented results represent a strong indication that adoption of ontologies for knowledge representation may enable scalability in multilingual domain-specific education regardless of the language used. High level of automation in the assessment process proven on the CIP method in medical education as one of the most challenging domains, promises high potential for new innovative teaching methodologies in other educational domains as well.

Abstract Funding Acknowledgements Non funded project Background Early mobilization as a multidisciplinary team approach in cardiac High Dependency Unit-B (HDU B) helps to reduce loss of muscle strength, decrease hospital length of stay, improve functional capacity, cognitive levels, enhances the quality of care, and helps to decrease the hospitals costs. Purpose Early mobilization means reducing the time of bed rest from admission to first activity. Based on this definition the project aimed to mobilize more than 95% of cardiac patients within 24 hours of admission by September 2019 in HDU B unit. Methods HDU B Initiated Early mobilization program as a part of Value improvement project (VIP). Experts from multidisciplinary team (MDT) worked together to improve the functional mobility of patients. A cross section survey was conducted to identify barriers for early mobility in the unit followed by analyzing barriers through Pareto chart. An early mobility flow chart (Level1-Passive, Level 2-Active assisted, Level 3-Active) framed in order to standardize the practice of mobilizing patients in HDU B. New changes were tested by using methodology of Plan Do Study Act. Staff education, training given regarding the implementation of early mobility protocol. Patients with mobility level 1 and 2 were identified by nurses, requested for Physiotherapy referral by Physicians. Nursing staff education on mobility assessment given an easy access of data about mobility level of patients in handoff communication, which guided the staff to decide on the need of PT consultation for each patient. In coordination with MDT team referral were also given even during weekend for the patients with mobility level 2. To engage patient and family in the early mobility program a new concept of END PYJAMA PARALYSIS was introduced. Patients with mobility level 3 were identified and encouraged to wear their own dress and move outside their room under supervision.This concept aims to build confidence in patients making them feel that they are ready to go home. Results With support and co-operation of the MDT, this project became a highly successful project in VIP. Initially 50% of the patients has been mobilized when the program was introduced in the ward during March 2019 which increased gradually to 90% at the end of the month. After introducing the flow chart, there was increase in 93.3% by April 2019. In addition to Physio referral it went to 100% at the end April 2019. End pyjama paralysis and weekend physio referral sustained the 100% compliance to Early mobility till the end of July 2019. Active interventions of the team helped to early mobilize by 100% till the end of September 2019 and currently it is in sustainable phase. Conclusion Early mobilization in HDU-B brought significant change in the culture of mobilization. Commitment, cooperation of MDT, a structural system and End pyjamas paralysis program are key factors of the success for the program that promoted patient safety and prevented adverse events.

IntroductionThis article addresses the experience of designing and conducting life-writing workshops for a group of clients with severe mental illness; the aim of this pilot study was to begin to determine whether such writing about the self can aid in individual ‘recovery’, as that term is understood by contemporary health professionals. A considerable amount has been written about the potential of creative writing in mental health therapy; the authors of this article provide a brief summary of that literature, then of the concept of ‘recovery’ in a psychology and arts therapy context. There follows a first-hand account by one of the authors of being an arts therapy workshop facilitator in the role of a creative practitioner. This occurred in consultation with, and monitored by, experienced mental health professionals. Life-Writing as ‘Therapeutic’ Life-story or life-writing can be understood in this context as involving more than disclosure or oral expression of a subject’s ‘story’ as in psycho-therapy – life-story is understood as a written, structured narrative. In 2001, Wright and Chung published a review of the literature in which they claimed that writing therapy had been “restimulated by the development of narrative approaches” (278). Pennebaker argues that “catharsis or the venting of emotions” without “cognitive processing” has little therapeutic value and people need to “build a coherent narrative that explains some past experience” in order to benefit from writing” (Pennebaker, Telling Stories 10–11). It is claimed in the Clinical Psychology Review that life-writing has the therapeutic benefits of, for example, “striking physical health and behaviour change” (Esterling et al. 84). The reasons are still unclear, but it is possible that the cognitive and linguistic processing of problematic life-events through narrative writing may help the subject assimilate such problems (Alschuler 113–17). As Pennebaker and Seagal argue in the Journal of Clinical Psychology, the life-writing processallows one to organise and remember events in a coherent fashion while integrating thoughts and feelings ... This gives individuals a sense of predictability and control over their lives. Once an experience has structure and meaning, it would follow that the emotional effects of that experience are more manageable. (1243)It would seem reasonable to suggest that life-writing which constructs a positive recovery narrative can have a positive therapeutic effect, providing a sense of agency, connectedness and creativity, in a similar, integrating manner. Humans typically see their lives as stories. Paul Eakin stresses the link between narrative and identity in both this internal life-story and in outwardly constructed autobiography:narrative is not merely a literary form but a mode of phenomenological and cognitive self-experience, while self – the self of autobiographical discourse - does not necessarily precede its constitution in narrative. (Making Selves 100)So both a self-in-time and a socially viable identity may depend on such narrative. The term ‘dysnarrativia’ has been coined to describe the documented inability to construct self-narrative by those suffering amnesia, autism, severe child abuse or brain damage. The lack of ability to achieve narrative construction seems to be correlated with identity disorders (Eakin, Fictions in Autobiography 124). (For an overview of the current literature on creative and life-writing as therapy see Murphy & Neilsen). What is of particular relevance to university creative writing practitioners/teachers is that there is evidence, for example from Harvard psychiatrist Judith Herman and creative writing academic Vicki Linder, that life-narratives are more therapeutically effective if guided to be written according to fundamental ‘effective writing’ aesthetic conventions – such as having a regard to coherent structure in the narrative, the avoidance of cliché, practising the ‘demonstrate don’t state’ dictum, and writing in one’s own voice, for example. Defining ‘Recovery’There remains debate as to the meaning of recovery in the context of mental health service delivery, but there is agreement that recovery entails significantly more than symptom remission or functional improvement (Liberman & Kopelowicz). In a National Consensus Statement, the Substance Abuse and Mental Health Services Administration (SAMHSA) unit of the US Department of Health and Human Services in 2005 described recovery (in general terms) as being achieved by the enabling of a person with a mental illness to live meaningfully in a chosen community, while also attempting to realize individual potential. ‘Recovery’ as a central concept behind rehabilitation can be understood both as objective recovery – that is, in terms of noting a reduction in objective indicators of illness and disability (such as rates of hospital usage or unemployment) and a greater degree of social functioning – and also as subjective recovery. Subjective recovery can be ascertained by listening closely to what clients themselves have said about their own experiences. It has been pointed out (King, Lloyd & Meehan 2) that there is not always a correspondence between objective indicators of recovery and the subjective, lived experience of recovery. The experience of mental illness is not just one of symptoms and disability but equally importantly one of major challenge to sense of self. Equally, recovery from mental illness is experienced not just in terms of symptoms and disability but also as a recovery of sense of self … Recovery of sense of self and recovery with respect to symptoms and disability may not correspond. (King, Lloyd & Meehan; see also Davidson & Strauss)Symptoms of disability can persist, but a person can have a much stronger sense of self or empowerment – that is still recovery. Illness dislocates the sense of self as part of a community and of a self with skills and abilities. Restoring this sense of empowerment is an aim of arts therapy. To put it another way, recovery is a complex process by which a client with a mental illness develops a sense of identity and agency as a citizen, as distinct from identification with illness and disability and passivity as a ‘patient’. The creative arts have gone well beyond being seen as a diversion for the mentally ill. In a comprehensive UK study of creative arts projects for clients with mental illness, Helen Spandler et al. discovered strong evidence that participation in creative activity promoted a sense of purpose and meaning, and assisted in “rediscovering or rebuilding an identity within and beyond that of someone with mental health difficulties” (795). Recovery is aided by people being motivated to achieve self-confidence through mastery and competence; by learning and achieving goals. Clearly this is where arts therapy could be expected or hoped to be effective. The aim of the pilot study was not to measure ‘creativity’, but whether involvement in what is commonly understood as a creative process (life-writing) can have flow-on benefits in terms of the illness of the workshop participant. The psychologists involved, though more familiar with visual arts therapy (reasonably well-established in Australia – in 2006, the ANZAT began publishing the Australian and New Zealand Journal of Art Therapy), thought creative writing could also be valuable. Preparation for and Delivery of the Workshops I was acutely aware that I had no formal training in delivering a program to clients with mental health illness. I was counselled during several meetings with experienced psychologists and a social worker that the participants in the three workshops over two weeks would largely be people who had degrees of difficulty in living independently, and could well have perceptual problems, could misjudge signals from outside and inside the group, and be on medication that could affect their degree of engagement. Some clients could have impaired concentration and cognition, and a deficit in volition. Participants needed to be free to leave and rejoin the workshops during the afternoon sessions. Attendance might well fall as the workshops progressed. Full ethical clearance was attained though the University of Queensland medical faculty (after detailed description of the content and conduct of the proposed workshops) and consent forms prepared for participants. My original workshop ‘kit’ to be distributed to participants underwent some significant changes as I was counselled and prepared for the workshops. The major adjustment to my usual choice of material and approach was made in view of the advice that recounting traumatic events can have a negative effect on some patients – at least in the short term. For the sake of both the individuals and the group as a whole this was to be avoided. I changed my initial emphasis on encouraging participants to recount their traumatic experiences in a cathartic way (as suggested by the narrative psychology literature), to encouraging them to recount positive narratives from their lives – narratives of ‘recovery’ – as I explain in more detail below. I was also counselled that clients with mental health problems might dwell on retelling their story – their case history – rather than reflecting upon it or using their creative and imaginative ability to shape a life-story that was not a catalogue of their medical history. Some participants did demonstrate a desire to retell their medical history or narrative – including a recurring theme of the difficulty in gaining continuity with one trusted medical professional. I gently guided these participants back to fashioning a different and more creative narrative, with elements of scene creation, description and so on, by my first listening intently to and acknowledging their medical narrative for a few minutes and then suggesting we try to move beyond that. This simple strategy was largely successful; several participants commented explicitly that they were tired of having to retell their medical history to each new health professional they encountered in the hospital system, for example. My principal uncertainty was whether I should conduct the workshops at the same level of complexity that I had in the past with groups of university students or community groups. While in both of those cohorts there will often be some participants with mental health issues, for the most part this possibility does not affect the level or kind of content of material discussed in workshops. However, within this pilot group all had been diagnosed with moderate to severe mental illness, mostly schizophrenia, but also bipolar disorder and acute depression and anxiety disorders. The fact that my credentials were only as a published writer and teacher of creative writing, not as a health professional, was also a strong concern to me. But the clients readily accepted me as someone who knew the difficulty of writing well and getting published. I stressed to them that my primary aim was to teach effective creative writing as an end in itself. That it might be beneficial in health terms was secondary. It was a health professional who introduced me and briefly outlined the research aims of the workshop – including some attempt to measure qualitatively any possible benefits. It was my impression that the participants did not have a diminished sense of my usefulness because I was not a health professional. Their focus was on having the opportunity to practice creative writing and/or participate in a creative group activity. As mentioned above, I had prepared a workshop ‘kit’ for the participants of 15 pages. It contained the usual guidelines for effective writing – extracts from professional writers’ published work (including an extract from my own published work – a matter of equity, since they were allowing me to read their work), and a number of writing exercises (using description, concrete and abstract words, narrative point of view, writing in scenes, show don’t tell). The kit contained extracts from memoirs by Hugh Lunn and Bill Bryson, as well as a descriptive passage from Charles Dickens. An extract from Inga Clendinnen’s 2006 account in Agamemnon’s Kiss: selected essays of her positive interaction with fellow cancer patients (a narrative with the underlying theme of recovery) was also valuable for the participants. I stressed to the group that this material was very similar to that used with beginning writers among university students. I described the importance of life-writing as follows: Life-writing is simply telling a story from your life and perhaps musing or commenting on it at the same time. When you write a short account of something chosen from your life, you are making a pattern, using your memory, using your powers of description – you are being creative. You are being a story-teller. And story-telling is one very important thing that makes us humans different from all other animals – and it is a way in which we find a lot of meaning in our lives.My central advice in the kit was: “Just try to be as honest as you can – and to remember as well as you can … being honest and direct is both the best and the easiest way to write memoir”. The only major difference between my approach with these clients and that with a university class was in the selection of possible topics offered. In keeping with the advice of the psychologists who were experts in the theory of ‘recovery’, the topics were predominantly positive, though one or two topics gave the opportunity to recount and/or explore a negative experience if the participant wanted to do so: A time when I was able to help another personA time when I realised what really mattered in lifeA time when I overcame a major difficultyA time when I felt part of a group or teamA time when I knew what I wanted to do with my lifeA time when someone recognised a talent or quality of mineA time I did something that I was proud of A time when I learned something important to meA memorable time when I lived in a certain house or suburbA story that begins: “Looking back, I now understand that …”The group expressed satisfaction with these topics, though they had the usual writing students’ difficulty in choosing the one that best suited them. In the first two workshops we worked our way through the kit; in the third workshop, two weeks later, each participant read their own work to the group and received feedback from their peers and me. The feedback was encouraged to be positive and constructive, and the group spontaneously adopted a positive reinforcement approach, applauding each piece of writing. Workshop DynamicsThe venue for the workshops was a suburban house in the Logan area of Brisbane used as a drop-in centre for those with mental illness, and the majority of the participants would be familiar with it. It had a large, breezy deck on which a round-table configuration of seating was arranged. This veranda-type setting was sheltered enough to enable all to be heard easily and formal enough to emphasise a learning event was taking place; but it was also open enough to encourage a relaxed atmosphere. The week before the first workshop I visited the house to have lunch with a number of the participants. This gave me a sense of some of the participants’ personalities and degree of engagement, the way they related to each other, and in turn enabled them to begin to have some familiarity with me and ask questions. As a novice at working with this kind of client, I found this experience extremely valuable, especially as it suggested that a relatively high degree of communication and cognition would be possible, and it reduced the anxiety I had about pitching the workshops at an appropriate level. In the course of the first workshop, the most initially sceptical workshop participant ended up being the most engaged contributor. A highly intelligent woman, she felt it would be too upsetting to write about negative events, but ultimately wrote a very effective piece about the empowerment she gained from caring for a stray cat and locating the owner. Her narrative also expressed her realisation that the pet was partly a replacement for spending time with her son, who lived interstate. Another strong participant previously had written a book-length narrative of her years of misdiagnoses and trauma in the hospital system before coming under the care of her present health professionals. The participant who had the least literacy skills was accepted by the group as an equal and after a while contributed enthusiastically. Though he refused to sign the consent form at the outset, he asked to do so at the close of the first afternoon. The workshop was comprised of clients from two health provider organisations; at first the two groups tended to speak with those they already knew (as in any such situation in the broader community), but by the third workshop a sense of larger group identity was being manifested in their comments, as they spoke of what ‘the group’ would like in the future – such as their work being published in some form. It was clear that, as in a university setting, part of the beneficial effect of the workshops came from group and face to face interaction. It would be more difficult to have this dimension of benefit achieved via a web-based version of the workshops, though a chat room scenario would presumably go some way towards establishing a group feeling. Web-based delivery would certainly suit participants who lacked mobility or who lived in the regions. Clearly the Internet is a vital social networking tool, and an Internet-based version of the workshops could well be attempted in the future. My own previous experience of community digital storytelling workshops (Neilsen, Digital Storytelling as Life-writing) suggests that a high degree of technical proficiency can not be expected across such a cohort; but with adequate technical support, a program (the usual short, self-written script, recorded voice-over and still images scanned from the participants’ photo albums, etc) could make digital storytelling a further dimension of therapeutic life-writing for clients with mental illness. One of the most useful teaching techniques in a class room setting is the judicious use of humour – to create a sense of sharing a perspective, and simply to make material more entertaining. I tested the waters at the outset by referring to the mental health worker sitting in the background, and declaring (with some comic exaggeration) my concern that if I didn’t run the workshop well he would report adversely on me. There was general laughter and this expression of my vulnerability seemed to defuse anxiety on the part of some participants. As the workshop progressed I found I could use both humorous extracts of life-writing and ad hoc comic comments (never at the expense of a participant) as freely as in a university class. Participants made some droll comments in the overall context of encouraging one another in their contributions, both oral and written. Only one participant exhibited some temporary distress during one of the workshops. I was allowing another participant the freedom to digress from the main topic and the participant beside me displayed agitation and sharply demanded we get back to the point. I apologised and acknowledged I had not stayed as focused as I should and returned to the topic. I suspect I had a fortunate first experience of such arts therapy workshops – and that this was largely due to the voluntary nature of the study and that most of the participants brought a prior positive experience of the workshop scenario, and prior interest in creative writing, to the workshops. Outcomes A significantly positive outcome was that only one of the nine participants missed a session (through ill-health) and none left during workshops. The workshops tended to proceed longer than the three hours allotted on each occasion. Post-workshop interviews were conducted by a psychologist with the participants. Detailed data is not available yet – but there was a clear indication by almost all participants that they felt the workshops were beneficial and that they would like to participate in further workshops. All but one agreed to have their life-writing included in a newsletter produced by one of the sponsors of the workshops. The positive reception of the workshops by the participants has encouraged planning to be undertaken for a wide-ranging longitudinal study by means of a significant number of workshops in both life-writing and visual arts in more than one city, conducted by a team of health professionals and creative practitioners – this time with sophisticated measurement instruments to gauge the effectiveness of art therapy in aiding ‘recovery’. Small as the workshop group was, the pilot study seems to validate previous research in the UK and US as we have summarised above. The indications are that significant elements of recovery (in particular, feelings of enhanced agency and creativity), can be achieved by life-writing workshops that are guided by creative practitioners; and that it is the process of narrative construction within life-writing that engages with or enhances a sense of self and identity. NoteWe are indebted, in making the summary of the concept of ‘recovery’ in health science terms, to work in progress by the following research team: Robert King, Tom O'Brien and Claire Edwards (School of Medicine, University of Queensland), Margot Schofield and Patricia Fenner (School of Public Health, Latrobe University). We are also grateful for the generous assistance of both this group and Seiji Humphries from the Richmond Queensland Fellowship, in providing preparation for the workshops. ReferencesAlschuler, Mari. “Lifestories – Biography and Autobiography as Healing Tools for Adults with Mental Illness.” Journal of Poetry Therapy 11.2 (1997): 113–17.Davidson, Larry and John Strauss. “Sense of Self in Recovery from Severe Mental Illness.” British Journal of Medical Psychology 65 (1992): 31–45.Eakin, Paul. Fictions in Autobiography: Studies of the Art of Self-Invention. Princeton: Princeton UP, 1985.———. How Our Lives Become Stories: Making Selves. Ithaca: Cornell UP, 1999.Esterling, B.A., L. L’Abate., E.J. Murray, and J.W. Pennebaker. “Empirical Foundations for Writing in Prevention and Psychotherapy: Mental and Physical Health Outcomes.” Clinical Psychology Review 19.1 (1999): 79–96.Herman, Judith. Trauma and Recovery: The Aftermath of Violence - from Domestic Abuse to Political Terror. New York: Basic Books, 1992.King, Robert, Chris Lloyd, and Tom Meehan. Handbook of Psychosocial Rehabilitation. Oxford: Blackwell Publishing, 2007.Liberman, Robert, and Alex Kopelowicz. “Recovery from Schizophrenia: A Criterion-Based Definition.” In Ralph, R., and P. Corrigan (eds). Recovery in Mental Illness: Broadening Our Understanding of Wellness. Washington, DC: APA, 2005.Linder, Vicki. “The Tale of two Bethanies: Trauma in the Creative Writing Classroom.” New Writing: The International Journal for the Practice and Theory of Creative Writing 1.1 (2004): 6–14Murphy, Ffion, and Philip Neilsen. “Recuperating Writers – and Writing: The Potential of Writing Therapy.” TEXT 12.1 (Apr. 2008). ‹http://www.textjournal.com.au/april08/murphy_neilsen.htm›.Neilsen, Philip. “Digital Storytelling as Life-Writing: Self-Construction, Therapeutic Effect, Textual Analysis Leading to an Enabling ‘Aesthetic’ for the Community Voice.” ‹http://www.speculation2005.qut.edu.au/papers/Neilsen.pdf›.Pennebaker, James W., and Janel D. Seagal. “Forming a Story: The Health Benefits of Narrative.” Journal of Clinical Psychology, 55.10 (1999): 1243–54.Pennebaker, James W. “Telling Stories: The Health Benefits of Narrative.” Literature and Medicine 19.1 (2000): 3–18.Spandler, H., J. Secker, L. Kent, S. Hacking, and J. Shenton. “Catching Life: The Contribution of Arts Initiatives to ‘Recovery’ Approaches in Mental Health.” Journal of Psychiatric and Mental Health Nursing 14.8 (2007): 791–799.Wright, Jeannie, and Man Cheung Chung. “Mastery or Mystery? Therapeutic Writing: A Review of the Literature.” British Journal of Guidance and Counselling, 29.3 (2001): 277–91.

Abstract Introduction Kashmir is a resource limited, region of India having its own distinctive regional challenges, operational limitations and poor accessibility of remote areas to health care. Utilizing smart phones as a medium for providing access to the optimum cardiac care in the remotest of the areas of our region served as a platform for SAVE HEART INITIATIVE (SHI) launched in the form of Social Media Whatsapp Group connecting peripheral hospitals (spokes) in the Kashmir region to experts (Hub). Material and methods SHI, a novel initiative was started voluntarily by a team of cardiologists and physicians. All the government hospitals along with their Emergency (ER) teams were roped in, integrated with expert physicians and cardiologists via whats app based technology creating a virtual cardiac ER facility and a CYBER HUB where teams of experts lended optimum support to all the peripheral hospitals of the region which acted as CYBER SPOKES of the initiative. Simultaneously all the peripheral hospitals upgraded to a functional Emergency room with all the emergency drugs available including the clot busters as streptokinase and vital anti arrhythmic drugs free of cost. Emergency room proformas, algorithms, protocols were created and standardized to aid in management. CME's regarding cardiac emergencies and response workshops were organized at regional institutes regularly for capacity building locally. The decision to use whatsapp as technology in medical care was taken due to its unique features of being readily available, handy technology, and as it could transfer all data in form of text, images, audios, visuals to and from the cyber spokes and cyber hubs respectively. Results Within 500 days of the initiative about 130 hospitals and 1200 doctors were taken on board. A total of 38000 ECGs were analyzed till date wherein the average response time in this social media group to any case was 1–2 minutes mostly and the diagnostic delays decreased to minimum. This initiative managed 950 STEMI's with thrombolysis, 2723 NSTEMI, 5320 arrhythmias, 345 heart blocks, 16 pulmonary thrombo-embolisms, 53 PCI decisions. Conclusion Our experiment demonstrated the feasibility of the approach adopted for better cardiac care that reached the poorest living in far flung area without any extra burden to the state exchequer. SHI reduced morbidity, mortality; CCU occupancy rate in tertiary care brought down undue referrals and established a vibrant patient tracking system in the region depicting its success. Using Smartphone based technology in time sensitive cardiac events seems to be the most vibrant, novel and viable option being available, portable, efficient, and cost-effective, with least technical glitches. It seems to be the way forward in providing optimum and timely treatment in all acute cardiac emergencies in resource deficient regions as Kashmir. Funding Acknowledgement Type of funding source: None

This special issue of the Deakin Review of Children’s Literature is dedicated to health fiction. The concept for the special issue grew out of an interest in using fiction as a tool in health literacy and healing. Many of us have had the experience of escaping in to a book as a place of refuge when the real world seems too tough or being moved and inspired by a story about someone coping with illness, injury, or disability. We wondered whether or not fictional works that offer children similar benefits are readily available? The answer is ‘Yes’, to a large extent. But as we started to read our way through the books in local libraries, we realized that a number of the books may be of questionable benefit. Many had flaws, from obvious content errors to subtle issues that you might not recognize unless you read the book closely or someone brought them to your attention. We wanted to take the opportunity to use this issue of Deakin to showcase some of the high quality fiction that we would recommend to libraries and parents. The authors of the reviews are librarians or other information professionals, with strengths in children's literature, health librarianship, or both. Many have children. Most are experienced reviewers. Even though we had done some pre-screening, several of the reviewers started reviews and then discarded them when they found that upon close examination, they could not recommend the books. The accompanying article describes the larger study that we undertook to thoroughly review current children's health fiction. The end products of this research were: 1) a checklist for selection of children's health fiction; 2) a list of readily available works in the area; 3) this special theme issue of the Deakin, and; 4) a joint exhibit of the reviewed books, at the University of Alberta’s Education and Health Sciences libraries, to complement the publication of this issue. In addition to the outcomes mentioned above, it is our hope that an additional benefit of this project will be an increased community awareness of the value of children’s health fiction and the knowledge that sometimes a good story is good medicine. Sandy Campbell and Maria TanSandy is a Health Sciences Librarian at the University of Alberta, who has written hundreds of book reviews across many disciplines. Sandy thinks that sharing books with children is one of the greatest gifts anyone can give. Maria C. Tan is a medical librarian at the Abdul Khaliq Library in Alberta Health Services’ Cross Cancer Institute and a former editorial team member of the Deakin Review. She firmly believes that children's literature is an essential component in the fountain of youth.

Dear Colleagues, Erciyes University Faculty of Medicine, Department of Pediatrics has been serving with great enthusiasm and success to protect Child Health and treat pediatric diseases in our country for half a century. We are proud to have raised a great number of pediatricians and sub-specialists serving as physicians, physician-scientists and academics all over our country and across the globe. We proudly present our newly established journal, The Journal of Pediatric Academy (JPA). We would like to share our scientific experiences with the national and international medical experts through JPA. Our aim is to be a permanent publication indexed in National and International indexes without sacrificing the quality, ethical and scientific principles. The Journal of Pediatric Academy aims to be publish novel articles in general pediatrics and pediatric subspecialties (Emergency Medicine, Allergy and Immunology, Endocrinology, Gastroenterology, Hepatology and Nutrition, Genetics, Cardiology, Hematology-Oncology, Infectious Diseases, Metabolism, Nephrology, Neurology, Rheumatology, Pulmonology, Social Pediatrics, Newborn, Critical Care Medicine, Ethics and Health Service Research), as well as relevant specialties such as Pediatric Surgery, Child and Adolescent Psychiatry, Pedodontics, Pediatric Nursing and Family Physicians. We are aware that we started our publishing life during these difficult times due to COVID 19 pandemic. However, having a highly motivated and diligent team in the kitchen of the magazine helped us overcome these difficulties. In our first issue, we come before you with articles of great importance and original topics and case reports in pediatrics field. Drs. Çicek & Kisaarslan (1) reviewed the clinical guidelines for rheumatic COVID-19 children in their review article. In this issue, Kurtoğlu et al (2) reported the first study that show body mass index (BMI), fat mass (FM), fat free mass (FFM), and body fat % in Turkish children and adolescents. Their study sample has consisted of more than 4 000 children and adolescent. The result of this study can be regarded as a base the final product of the data of Determination of Anthropometric Measures of Turkish Children and Adolescents (DAMTCA II) study. Beside reference values, they also checked the age specific contribution of fat mass index (FMI), fat free mass index (FFMI) to BMI and fat % with Hattori chart. Both in screening and clinical practice use of FMI and FFMI together with BMI would significantly contribute to detection and follow-up of adiposity rebound, puberty precious, delayed puberty, overweight and obesity. Dr. Çıraklı et al (3) reported the clinical and electrophysiological features, treatment, and outcome of 15 children with hot water epilepsy. Dr. Vatansever et al. (4) reported their experience of 126 critically ill children with hyperglycemia in pediatric intensive care unit. The effect of thiamine pyrophosphate level on mortality and morbidity in patients with hyperglycemia at the time of application was evaluated. Dr. Yel et al. (5) determined the etiological reasons and frequency of prenatal determined hydronephrosis and evaluated the renal functions in 48 patients. In addition, two interesting case reports by Dr. Kara (6), Dr. Aydın (7) were also included in the first issue of the JPA. We wish best of luck to JPA family and looking forward to the valuable contributions of our colleagues in the coming period.

The rise of expertise in the lives of women is a complex and prolonged process that began when the old networks through which women had learned from each other were being discredited or destroyed (Ehrenreich and English). Enclosed spaces of expert power formed separately from political control, market logistics and the pressures exerted by their subjects (Rose and Miller). This, however, was not a question of imposing expertise on women and forcing them to adhere to expert proclamations: “the experts could not have triumphed had not so many women welcomed them, sought them out, and … organised to promote their influence” (Ehrenreich and English 28). Women’s continuing enthusiasm for self-help books – and it is mainly women who buy them (Wood) – attests to the fact that they are still welcoming expertise into their lives. This paper argues that a major factor in the popularity of self-help is the reversal of the conventional ‘priestly’ relationship and ethic of confession, in a process of conversion that relies on the enthusiasm and active participation of the reader.Miller and Rose outline four ways in which human behaviour can be transformed: regulation (enmeshing people in a code of standards); captivation (seducing people with charm or charisma); education (training, convincing or persuading people); and conversion (transforming personhood, and ways of experiencing the world so that people understand themselves in fundamentally new ways). Of these four ways of acting upon others, it is conversion that is the most potent, because it changes people at the level of their own subjectivity – “personhood itself is remade” (Miller and Rose 35). While theories of conversion cannot be adequately discussed here, one aspect held in common by theories of religious conversion as well as those from psychological studies of ‘brainwashing’ is enthusiasm. Rambo’s analysis of the stages of religious conversion, for example, includes ‘questing’ in an active and engaged way, and a probable encounter with a passionately enthusiastic believer. Melia and Ryder, in their study of ‘brainwashing,’ state that two of the end stages of conversion are euphoria and proselytising – a point to which I will return in the conclusion. In order for a conversion to occur, then, the reader must be not only intellectually convinced of the truth, but must feel it is an important or vital truth, a truth she needs – in short, the reader must be enthused. The popularity of self-help books coincides with the rise of psy expertise more generally (Rose, "Identity"; Inventing), but self-help putatively offers escape from the experts, whilst simultaneously immersing its readers in expertise. Readers of self-help view themselves as reading sceptically (Simonds), interpretively (Rosenblatt) and resistingly (Fetterly, Rowe). They choose to read books as an educational activity (Dolby), rather than attending counselling or psychotherapy sessions in which they might be subject to manipulation, domination and control by a therapist (Simonds). I have discussed the nature of the advice in relationship manuals elsewhere (Hazleden, "Relationship"; "Pathology"), but the intention of this paper is to investigate the ways in which the authors attempt to enthuse and convert the reader.Best-Selling ExpertiseIn common with other best-selling genres, popular relationship manuals begin trying to enthuse the reader on the covers, which are intended to attract the reader, to establish the professional – or ‘priestly’ – credentials of the author and to assert the merit of the book, presenting the authors as experienced professionally-qualified experts, and advertising their bestseller status. These factors form part of the marketing ‘buzz’ or collective enthusiasm about a particular author or book.As part of the process of establishing themselves in the priestly role, the authors emphasise their professional qualifications and experience. Most authors use the title ‘Dr’ on the cover (Hendrix, McGraw, Forward, Gray, Cowan and Kinder, Schlessinger) or ‘PhD’ after their names (Vedral, DeAngelis, Spezzano). Further claims on the covers include assertions of the prominence of the authors in their field. Typical are DeAngelis’s claim to being “America’s foremost relationships expert,” and Hendrix’s claim to being “the world’s leading marital therapist.” Clinical and professional experience is mentioned, such as Spezzano’s “twenty-three years of counseling experience” (1) and Forward’s experience as “a consultant in many southern California Medical and psychiatric facilities” (iii). The cover of Spezzano’s book claims that he is a “therapist, seminar leader, author, lecturer and visionary leader.” McGraw emphasises his formal qualifications throughout his book, saying, “I had more degrees than a thermometer” (McGraw 6), and he refers to himself throughout as “Dr. Phil,” much like “Dr Laura” (Schlessinger). Facts and SecretsThe authors claim their ideas are based on clinical practice, research, and evidence. One author claims, “In this book, there is a wealth of tried and accurate information, which has worked for thousands of people in my therapeutic practice and seminars over the last two decades” (Spezzano 1). Another claims that he “worked with hundreds of couples in private practice and thousands more in workshops and seminars” and subsequently based his ideas on “research and clinical observations” (Hendrix xviii). Dowling refers to “four years of research … interviewing professionals who work with and study women.” She went to all this trouble because, she assures us, “I wanted facts” (Dowling, dust-jacket, 30).All this is in order to assure the reader of the relevance and build her enthusiasm about the importance of the book. McGraw (226) says he “reviewed case histories of literally thousands and thousands of couples” in order “to choose the right topics” for his book. Spezzano (7) claims that his psychological exercises come from clinical experience, but “more importantly, I have tested them all personally. Now I offer them to you.” This notion of being in possession of important new knowledge of which the reader is unaware is common, and expressed most succinctly by McGraw (15): “I have learned what you know and, more important, what you don't know.” This knowledge may be referred to as ‘secret’ (e.g. DeAngelis), or ‘hidden’ (e.g. Dowling) or as a recent discovery. Readers seem to accept this – they often assume that self-help books spring ‘naturally’ from clinical investigation as new information is ‘discovered’ about the human psyche (Lichterman 432).The Altruistic AuthorOn the assumption that readers will be familiar with other self-help books, some authors find it necessary to explain why they felt motivated to write one themselves. Usually these take the form of a kind of altruistic enthusiasm to share their great discoveries. Cowan and Kinder (xiv) claim that “one of the wonderful, intrinsic rewards of working with someone in individual psychotherapy is the rich and intense relationship that is established, [but] one of the frustrations of individual work is that in a whole lifetime it is impossible to touch more than a few people.” Morgan (26) assures us that “the results of applying certain principles to my marriage were so revolutionary that I had to pass them on in the four lesson Total Woman course, and now in this book.”The authors justify their own addition to an overcrowded genre by delineating what is distinctive about their own book, or what other “books, articles and surveys missed” (Dowling 30) or misinterpreted. Beattie (98-102) devotes several pages to a discussion of Dowling to assert that Dowling’s ‘Cinderella Complex’ is more accurately known as ‘codependency.’ The authors of another book admit that their ideas are not new, but claim to make a unique contribution because they are “writing from a much-needed male point of view” (Cowan and Kinder, back cover). Similarly, Gray suggests “many books are one-sided and unfortunately reinforce mistrust and resentment toward the opposite sex.” This meant that “a definitive guide was needed for understanding how healthy men and women are different,” and he promises “This book provides that vision” (Gray 4,7).Some authors are vehement in attacking other experts’ books as “gripe sessions,” “gobbledegook” (Schlessinger 51, 87), or “ridiculous” (Vedral 282). McGraw (9) writes “it is amazing to me how this country is overflowing with marital therapists, psychiatrists and psychologists, counselors, healers, advice columnists, and self-help authors – and their approach to relationships is usually so embarrassing that I want to turn my head in shame.” His own book, by contrast, will be quite different from anything the reader has heard before, because “it differs from what relationship ‘experts’ tell you” (McGraw 45).Confessions of an Author Because the authors are writing about intimate relationships, they are also keen to establish their credentials on a more personal level. “Loving, losing, learning the lessons, and reloving have been my path” (Carter-Scott 247-248), says one, and another asserts that, “It’s taken me a long time to understand men. It’s been a difficult and often painful journey and I’ve made a lot of mistakes along the way in my own relationships” (DeAngelis xvi). The authors are even keen to admit the mistakes they made in their previous relationships. Gray says, “In my previous relationships, I had become indifferent and unloving at difficult times … As a result, my first marriage had been very painful and difficult” (Gray 2). Others describe the feelings of disappointment with their marriages: We gradually changed. I was amazed to realize that Charlie had stopped talking. He had become distant and preoccupied. … Each evening, when Charlie walked in the front door after work, a cloud of gloom and tension floated in with him. That cloud was almost tangible. … this tension cloud permeated our home atmosphere … there was a barrier between us. (Morgan 18)Doyle (14) tells a similar tale: “While my intentions were good, I was clearly on the road to marital hell. … I was becoming estranged from the man who had once made me so happy. Our marriage was in serious trouble and it had only been four years since we’d taken our vows.” The authors relate the bewilderment they felt in these failing relationships: “My confusion about the psychology of love relationships was compounded when I began to have problems with my own marriage. … we gave our marriage eight years of intensive examination, working with numerous therapists. Nothing seemed to help” (Hendrix xvii).Even the process of writing the relationship manual itself can be uncomfortable: This was the hardest and most painful chapter for me to write, because it hit so close to home … I sat down at my computer, typed out the title of this chapter, and burst into tears. … It was the pain of my own broken heart. (DeAngelis 74)The Worthlessness of ExpertiseThus, the authors present their confessional tales in which they have learned important lessons through their own suffering, through the experience of life itself, and not through the intervention of any form of external or professional expertise. Furthermore, they highlight the failure of their professional training. Susan Forward (4) draws a comparison between her professional life as a relationship counsellor and the “Susan who went home at night and twisted herself into a pretzel trying to keep her husband from yelling at her.” McGraw tells of a time when he was counselling a couple, and: Suddenly all I could hear myself saying was blah, blah, blah. Blah, blah, blah, blah. As I sat there, I asked myself, ‘Has anybody noticed over the last fifty years that this crap doesn’t work? Has it occurred to anyone that the vast majority of these couples aren’t getting any better? (McGraw 6)The authors go to some lengths to demonstrate that their new-found knowledge is unlike anything else, and are even prepared to mention the apparent contradiction between the role the author already held as a relationship expert (before they made their important discoveries) and the failure of their own relationships (the implication being that these relationships failed because the authors themselves were not yet beneficiaries of the wisdom contained in their latest books). Gray, for example, talking about his “painful and difficult” first marriage (2), and DeAngelis, bemoaning her “mistakes” (xvi), allude to the failure of their marriage to each other, at a time when both were already well-known relationship experts. Hendrix (xvii) says: As I sat in the divorce court waiting to see the judge, I felt like a double failure, a failure as a husband and as a therapist. That very afternoon I was scheduled to teach a course on marriage and the family, and the next day, as usual, I had several couples to counsel. Despite my professional training, I felt just as confused and defeated as the other men and women who were sitting beside me.Thus the authors present the knowledge they have gained from their experiences as being unavailable through professional marital therapy, relationship counselling, and other self-help books. Rather, the advice they impart is presented as the hard-won outcome of a long and painful process of personal discovery.Peace and PassionOnce the uniqueness of the advice is established, the authors attempt to enthuse the reader by describing the effects of following it. Norwood (Women 4) says her programme led to “the most rewarding years of my life,” and Forward (10) says she “discovered enormous amounts of creativity and energy in myself that hadn't been available to me before.” Gray (268) asserts that, following his discoveries “I personally experienced this inner transformation,” and DeAngelis (126) claims “I am compassionate where I used to be critical; I am patient where I used to be judgmental.” Doyle (23) says, “practicing the principles described in this book has transformed my marriage into a passionate, romantic union.” Similarly, in discussing the effects of her ideas on her marriage, Morgan (26) speaks of “This brand new love between us” that “has given us a brand new life together.” Having established the success of their ideas and techniques on their own lives, the authors go on to relate stories about their successful application to the lives and relationships of their clients. One author writes that “When I began implementing my ideas … The divorce rate in my practice sharply declined, and the couples … reported a much deeper satisfaction in their marriages” (Hendrix xix). Another claims “Repeatedly I have heard people say that they have benefited more from this new understanding of relationships than from years of therapy” (Gray 7). Morgan, describing the effects of her ‘Total Woman’ classes, says: Attending one of the first classes in Miami were wives of the Miami Dolphin football players … it is interesting to note that their team won every game that next season and became the world champions! … Gals, I wouldn’t dream of taking credit for the Superbowl … (Morgan 188)In case we are still unconvinced, the authors include praise and thanks from their inspired clients: “My life has become exciting and wonderful. Thank you,” writes one (Vedral 308). Gray (6) talks of the “thousands of inspirational comments that people have shared” about his advice. Vedral (307) says “I have received thousands of letters from women … thanking me for shining a beam of light on their situations.” If these clients have transformed their lives, the authors claim, so can the reader. They promise that the future will be “exceptional” (Friedman 242) and “wonderful” (Norwood, Women 257). It will consist of “self fulfilment, love, and joy” (Norwood, Women 26), “peace and joy” (Hendrix xx), “freedom and a lifetime of healing, hope and happiness” (Beattie), “peace, relief, joy, and passion that you will never find any other way” (Doyle 62) – in short, “happiness for the rest of your life” (Spezzano 77).SummaryIn order to effect the conversion of their readers, the authors seek to create enthusiasm about their books. First, they appeal to the modern tradition of credentialism, making claims about their formal professional qualifications and experience. This establishes them as credible ‘priests.’ Then they make calculable, factual, evidence-based claims concerning the number of books they have sold, and appeal to the epistemological authority of the methodology involved in establishing the findings of their books. They provide evidence of the efficacy of their own unique methods by relating the success of their ideas when applied to their own lives and relationships, and those of their clients and their readers. The authors also go to some lengths to establish that they have personal experience of relationship problems, especially those the reader is currently presumed to be experiencing. This establishes the ‘empathy’ essential to Rogerian therapy (Rogers), and an informal claim to lay knowledge or insight. In telling their own personal stories, the authors establish an ethic of confession, in which the truth of oneself is sought, unearthed and revealed in “the infinite task of extracting from the depths of oneself, in between the words, a truth which the very form of the confession holds out like a shimmering mirage” (Foucault, History 59). At the same time, by claiming that their qualifications were not helpful in solving these personal difficulties, the authors assert that much of their professional training was useless or even harmful, suggesting that they are aware of a general scepticism towards experts (cf. Beck, Giddens), and share these doubts. By implying that it is other experts who are perhaps not to be trusted, they distinguish their own work from anything offered by other relationship experts, thereby circumventing “the paradox of self-help books’ existence” (Cheery) and proliferation. Thus, the authors present their motives as altruistic, whilst perhaps questioning the motives of others. Their own book, they promise, will be the one (finally) that brings a future of peace, passion and joy. Conversion, Enthusiasm and the Reversal of the Priestly RelationshipAlthough power relations between authors and readers are complex, self-help is evidence of power in one of its most efficacious forms – that of conversion. This is a relationship into which one enters voluntarily and enthusiastically, in the name of oneself, for the benefit of oneself. Such power enthuses, persuades, incites, invites, provokes and entices, and it is therefore a strongly subjectifying power, and most especially so because the relationship of the reader to the author is one of choice. Because the reader can choose between authors, and skip or skim sections, she can concentrate on the parts of the therapeutic diagnosis that she believes specifically apply to her. For example, Grodin (414) found it was common for a reader to attach excerpts from a book to a bathroom mirror or kitchen cabinet, and to re-read and underline sections of a book that seemed most relevant. In this way, through her enthusiastic participation, the reader becomes her own expert, her own therapist, in control of certain aspects of the encounter, which nonetheless must always take place on psy terms.In many conversion studies, the final stage involves the assimilation and embodiment of new practices (e.g. Paloutzian et al. 1072), whereby the convert employs or utilises her new truths. I argue that in self-help books, this stage occurs in the reversal of the ‘priestly’ relationship. The ‘priestly’ relationship between client and therapist, is one in which in which the therapist remains mysterious while the client confesses and is known (Rose, "Power"). In the self-help book, however, this relationship is reversed. The authors confess their own ‘sins’ and imperfections, by relating their own disastrous experiences in relationships and wrong-thinking. They are, of course, themselves enthusiastic converts, who are enmeshed within the power that they exercise (cf. Foucault History; Discipline), as these confessions illustrate. The reader is encouraged to go through this process of confession as well, but she is expected to do so privately, and to play the role of priest and confessor to herself. Thus, in a reversal of the priestly relationship, the person who ‘is knowledge’ within the book itself is the author. It is only if the reader takes up the invitation to perform for herself the priestly role that she will become an object of knowledge – and even then, only to herself, albeit through a psy diagnostic gaze provided for her. Of course, this instance of confession to the self still places the individual “in a network of relations of power with those who claim to be able to extract the truth of these confessions through their possession of the keys to interpretation” (Dreyfus and Rabinow 174), but the keys to interpretation are provided to the reader by the author, and left with her for her own safekeeping and future use. As mentioned in the introduction, conversion involves questing in an active and engaged way, and may involve joy and proselytising. Because the relationship must be one of active participation, the enthusiasm of the reader to apply these truths to her own self-understanding is critical. Indeed, the convert is, by her very nature, an enthusiast.ConclusionSelf-help books seek to bring about a transformation of subjectivity from powerlessness to active goal-setting, personal improvement and achievement. This is achieved by a process of conversion that produces particular choices and types of identity, new subjectivities remade through the production of new ethical truths. Self-help discourses endow individuals with new enthusiasms, aptitudes and qualities – and these can then be passed on to others. Indeed, the self-help reader is invited, by means of the author’s confessions, to become, in a limited way, the author’s own therapist – ie, she is invited to perform an examination of the author’s (past) mistakes, to diagnose the author’s (past) condition and to prescribe an appropriate (retrospective) cure for this condition. Through the process of diagnosing the author and the author’s clients, using the psy gaze provided by the author, the reader is rendered an expert in therapeutic wisdom and is converted to a new belief system in which she will become an enthusiastic participant in her own subjectification. ReferencesBeattie, M. 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Women Who Love Too Much: When You Keep Wishing and Hoping He’ll Change. New York: Pocket Books, 1986.Paloutzian, R., J. Richardson, and L. Rambo. “Religious Conversion and Personality Change.” Journal of Personality 67.6 (1999).Ricoeur, P. Oneself as Another. Trans. K. Blamey. Chicago: Chicago UP, 1990.Rambo, L. Understanding Conversion. Yale UP, 1993.Rogers, C. On Becoming a Person. Boston: Houghton Mifflin, 1961.Rosenblatt, L. Literature as Exploration. 5th ed. New York: MLA, 1995.Rose, N. “Identity, Genealogy, History.” In S. Hall and Paul du Gay, eds. Questions of Cultural Identity. London: Sage, 1995.———. Inventing Our Selves: Psychology, Power and Personhood. Cambridge: Cambridge UP, 1998.———. “Power and Subjectivity: Critical History and Psychology.” Academy for the Study of the Psychoanalytic Arts. 2000. < http://www.academyanalyticarts.org >.———., and P. Miller. “Political Power beyond the State: Problematics of Government.” British Journal of Sociology 43.2 (1992): 173-205.Rowe, Y. “Beyond the Vulnerable Self: The 'Resisting Reader' of Marriage Manuals for Heterosexual Women.” In Kate Bennett, Maryam Jamarani, and Laura Tolton. Rhizomes: Re-Visioning Boundaries conference papers, University of Queensland, 24-25 Feb. 2006.Schlessinger, L. The Proper Care and Feeding of Husbands. New York, HarperCollins, 2004.Simonds, W. Women and Self-Help Culture: Reading between the Lines. New Jersey: Rutgers UP, 1992.Spezzano, C. 30 Days to Find Your Perfect Mate: The Step by Step Guide to Happiness and Fulfilment. London: Random House, 1994.Starker, S. Oracle at the Supermarket: The American Preoccupation with Self-Help Books. Oxford: Transaction, 1989.Vedral, J. Get Rid of Him! New York: Warner Books, 1994.Wood, L. “The Gallup Survey: Self-Help Buying Trends.” Publishers Weekly 234 (1988): 33.

The latest reality program about weight loss makeover, Australian Channel Seven’s Bringing Sexy Back maintained the dominant frame of fat as bad, shameful and unsexy. Similar to other programs’ point of view, only slim bodies could claim to be healthy and sexy. Conversely the Fat Acceptance movement presents fat as beautiful, sexy, and healthy. But what did online audiences in 2014 think about Bringing Sexy Back? In this article online-viewer-generated comments are analysed to find out: a) whether audiences challenged and contested the dominant framing; and b) what phrases did they use to do this. The research task is a discourse analysis in which key words and phrases are highlighted and colour coded as categories and patterns begin to emerge. My intention is to represent the expressions of the participants responding to the articles and or online forums about the program. The focus is on the ‘language-in-use’ (Gee 34), in particular their gut reactions to the idea of whether only slim people can be sexy and their experience of viewing the program. Selected television websites, online television forums and blogs will be analysed. Introduction The latest makeover television program drawing on the obesity-epidemic discourse Bringing Sexy Back (BSB) promises the audience that by the end of the program participants will have bought their sexy back. Sexy in the program is equated with one’s younger and slimmer self; the program host Samantha Armytage (from Sunrise the national Australian morning show) tells viewers sexy can be reclaimed if participants (from their late 30s and up to 51 years) drop kilos, commit to a strenuous exercise regime, and re-style their wardrobe. Experts, the usual suspects, are bought in—the medical machinery, the personal trainer, the stylist, and the hairdresser etc.—to assess, admonish, advise and appraise the participants. At the final reveal the audience—made up of family, friends and the local community—show enthusiasm for the aesthetic desirability of the participants slimmer sexier body as evidenced by descriptors such as “wow”, and “oh my God” as well as an outpouring of emotion such as crying and squeals of delight. Previous researchers of fat-shaming television programs have found audience’s reactions divided: some audience members see it as motivating; others see it as humiliating; and others see it as what the contestants deserve (Holland, Blood and Thomas; Rodan, Ellis and Lebeck; Sender and Sullivan)! I want to find out if online and social media audiences of the relatively tame makeover program BSB, which features individual Australians and couples who are overweight and obese, challenge and contest the dominant framing. In my analysis of the phrases online audiences’ have used about BSB, posters mostly found the program inspiring and motivating. From this inauspicious first strike, I will push onto examine the phrases posters have used to respond to the program. The paper begins with a short background about the program. The key elements of the makeover television genre are then discussed. Following this, I provide an analysis of the program’s official BSB Facebook site, and unofficial viewer-generated sites, such as the bubhub, TVTONIGHT, MamaMia, The Hoopla and the hashtag #sexybackau on Twitter. Posters to these sites were regular, infrequent or intermittent viewers. My approach to the analysis of these online forums and social media sites is a discourse analysis that examines “language-in-use”—as well as other elements such as values, symbols, tools and thinking styles—so as to identify and track tacit knowledge—that is, meanings emerging from obesity-epidemic discourse (Gee 34, 40–41). Such a method is apt given its capacity to analyse contributors’ spontaneous statements of their feelings—in particular their gut reactions to the program and the participants. The paper ends with my findings and conclusions. Bringing Sexy Back: Background Information Screened in 2014, season one of BSB format consists of a host Samantha Armytage, fitness trainer Cameron Byrnes and stylist Jules Sebastian and her team of hairdresser, groomers etc. Undoubtedly, part of the program’s construction is to select participants who appeal to a broad range of viewers. Participants’ ages range from 21 years (Courney Gollings) to 51 years (Vicki Gollings). The individuals or couples who make up the series include: Ned (truck driver), Sam and Gary (parents of two boys), Lisa Wilson (single mother and hairdresser), Vicki and Courtney Golling (mother and daughter), Livio Caldarone (pizza/small restaurant owner), and Paula Beckton (mother of four), The first episode was aired on Australia’s Channel Seven on 12 August 2014 and the final episode on 13 January 2015. This particular series consisted of 9 episodes. In this paper I focus on the six episodes that were aired in 2014. Generally each individual episode consisted of: the intervention, presenting medical facts about participant’s weight; the helper figures setting training and diet regimes; the trials leading to transformation; and the happy ending evident in the reveal. Essentially, these segments illustrate that the program series is highly contrived and they also demonstrate the program’s method of challenging participants to lose weight. Makeover Television I now provide a further construct to assist the reader’s understanding of ‘what is going on’ in the BSB program, which fits within the genre of makeover program. As reflected in the literature, makeover television has some or all of the following ingredients: personal fitness trainer as expertstylist and grooming expertsfamily members and contestant’s reflexivity (reflect on their own behaviour)new self-celebrated photo shootscontestant winning challengessymbols, such as the dream outfit, and before and after photographstransformation before the ‘big reveal’ Moreover, makeover programs are about the ordinary person on television. According to Redden, identities on these programs are individual rather than collective in that they serve to show a type of “individuality” as if it exists irrespective of any social or cultural group (156). And what is the role of the expert? Redden points out the expert on makeover programs interprets the “life situation of the given person, who may represent a certain social category of ordinary person” (153). So while makeover programs purport to be about the ordinary person and make claims about the actuality of the ordinary person’s life (Skeggs and Wood 559; Stagi 138), they also depict a hierarchy of social categories. The participants’ class also features in makeover programs like BSB. Class is evident in that participants who are selected to be on the program are often from lower-middle class backgrounds. Most participants have non-professional occupations—truck driver (Ned), hairdresser (Lisa), pizza/small restaurant owner (Livio), body caster, a person who makes body casts (Paula). Similar to The Biggest Loser (2004–2014) on American NBC, and Australia Network Ten, the participants in BSB were also mainly from lower–middle class backgrounds (Rodan; Sender and Sullivan 575) Several researcher’s show that makeover television promises advancement for lower–middle class citizens (Fraser 188–189; Miller 589; Redden 155; Skeggs and Wood 561) based on the proposition that contestants have the power to transform themselves (Bratich 17; Ouellette and Hay 471–472; Lewis 443; Sender and Sullivan 581). Like other makeover programs BSB takes advantage of the aspirations of working and lower-middle class participants. And, not surprisingly, the desired transcendence is something most participants/viewers from lower-middle and working class backgrounds cannot strive to achieve without participating in the program (Miller 589). Transcendence in BSB comes from losing weight, and acquiring new gym equipment, gym clothing, access to a personal trainer, gym membership, holiday at a health retreat, new wardrobe, new haircut, and new gym clothes. These acts to transform oneself are often “presented” as the middle class “standard,” taste and specific ongoing “intimate practices” of the “middle class” (Skeggs and Wood 561; Redden 155). But clearly much of the sprucing up (such as a private gym at home, personal trainers) are expensive and beyond the budget of even an Australian middle-class family. Analysis Posters on the official BSB Channel Seven Facebook forum overall were the most positive about the program—they found the program motivating and inspiring. Several posters on Facebook asked how they might apply to be on the program. After the airing of the reveal, posters on all the online forums and social media analysed consistently used adjectives such as fantastic, awesome, congratulations, stunning, amazing, gorgeous, wow, incredible, look sensational, look hot, look great, champion effort, fabulous, impressive, beautiful, inspirational. Fat-Shaming In BSB fat-shaming works through the use of medical machines and imagery, which measure weight and body fat percentage (BMI) using the DXA scanner and X-ray machine. Even though many physicians object to BMI measurement, it has become an “infallible marker of dangerous risk-saturated obesity” (Morgan 205) in Health Department campaigns, insurance company policies and on makeover television. Participants’ current weight is compared to the weight of their 20 year-old self. The program also induces fat-shaming through visuals of food and drink stashes found in participant’s bedroom cupboards (Ned), remnants of take-away packaging in rubbish bins (Lisa), processed foods in pantry cupboards (Vicki and Courtney), and pizza cartons at work (Livio). Here food amounts are quantified for audiences to gasp with shock and horror reinforcing the stereotype that people are fat because they have insufficient willpower and overeat (Farrell 34), thus perpetuating the view that obese people are undisciplined, sloppy and “less likely to do productive work” (Greenberg et al.). Banners are produced of participants’ photographs in their 20s; the photographs chosen have been taken when participants were slim and looked hot at the beach or night clubbing. These banners are juxtaposed with a banner of participant’s current self—appearing overweight in unflattering short crop top and underwear. Both banners are flashed onto the screen during the program especially in the final reveal presumably as a visual measurement to shame participants for “letting themselves go”. Even though host Samantha provides reasons for participants gaining weight—such as the stress of being a single parent, having a busy life as a mother of four, work commitments etc—the visual banners powerfully signify more than the presenter’s dialogue. Katrina Dowd on Facebook suggests it is the banners that signified the truth about participants’ lifestyles when she comments: Absolutely. Amazing how people whom follow unhealthy eating patterns for years with lack of exercise get congratulated because they’ve lost weight. Should never have let yourself get to that stage. Using your children and work commitments as excuses for why you got that way is a big “fail”. Some social media participants on Twitter and online forum posters saw the participants as “Bogan” ( a white working-class person who lacks fashion sense, is uncouth unsophisticated and invokes disgust), lazy, slobs as represented in the following comments: “Bogan Hunters Makeover” (tvaddict); “STILL A FUCKING FAT BOGAN […] JUST STOP EATING” (Al_Mack); “Stop being a lazy bitch […] Seriously lazy slobs” (Dutchess of Tweet St); “learn to cook lazy cow” (Gidgit VonLaRue). Thus, for Katrina and the posters above, it is the “fat body” that is seen as the “uncivilized body” that lacks the self-control of the thin body (Richardson 80). Inspirational and Motivational I discovered that many online forum and social media participants found the program BSB inspiring and motivating. A similar finding to my study of The Biggest Loser online viewers (Rodan), as well as other researchers who interviewed audiences about The Biggest Loser (Readdy and Ebbeck). For instance, Twitter posters said the BSB inspires “everyday women” (Sharon@Shar0n) and “inspires me that I can do the same” (Sharon@KeepitRealV), “another great show #inspiring” (miss shadow). On Facebook most of the posters talked about how inspired they were by the show and or by the individual participants, for instance: Hi Lisa, I think I see a lot of me in you, I pretty much cried through the whole show. You have inspired me, much admiration for sharing your story with Australia. (Haigh) Many posters on Facebook identified with Lisa as a single mother (Jenkins) and her declaration that she was “an emotional eater” (McTavish). This may account for Lisa Wilson (5,824 likes) receiving the most likes on Facebook. There were those who identified with individual participants, such as Paula, who were attempting to lose weight. On the forum the bubhub, a forum for parents established in 2002, the administrator BH-bubhub started a thread titled “Need some motivation to shift those kilos? Our pal Paula is here to help hubbers!” Paula was the participant on BSB who lost the most weight, and was invited onto the forum to answer forum members’ questions. On this forum, disparaging, negative, demotivating comments were removed from public viewing (see caveat BH-bubhub). Overall, online forum posters on the bubhub expressed positive feelings about BSB as a weight loss program. Participants comments included “Awesome work Paula, I have no doubt you will inspire many and I look forward to hearing all your tips” (Mod-Uniquey) “and … you look fabulous” (BH-KatiesMum), “Wow, you must be so proud of yourself! That is an amazing effort and you look great” (Curby), “What an inspirational story!” (Mod-Nomsie). Facebook posters on the BSB official forum found the show motivating and evidence of others finding the same are: “I feel great after watching #sexybackau” (Freeburn), “an uplifting hour” (Hustwaite), “feeling motivated now to change a lot of things about myself” (McDonald). However, online posters rarely commented that the program inspired or motivated them to take specific actions about their own body size or lifestyle. For some, as other researchers have found about makeover programs, it is a form of televisual escapism (Holland, Blood and Thomas; Readdy and Ebbeck 585)—that is, the pleasure of watching others’ emotions in achieving their goal. For many others, identifying with the participants’ struggle, and seeing them overcome daily challenges and obstacles to losing weight, gave posters insights about themselves and how to change their own lifestyle. But maintaining weight-loss and a lifestyle that supports it—as Facebook posters frequently suggest—is very challenging for most people who are overweight. The transformations and reveals make for fairy-tale endings (the essence of makeover television), but the reality of losing weight is persistence, perseverance and hard work. Criticisms of the Program Posters on Facebook were censored more than some of the other online forums and social media. Facebook criticisms about the program BSB were dealt with swiftly by other posters—that is, posters were pressured to only express positive feelings about the program. For instance, Lynne Nicholas in response to Peter Thomson’s criticism that the program is “exploiting these people for cheap television entertainment” (Facebook, 14 August 2014) posted on Facebook: If you don’t like the show then don’t come on the page and comment. Channel 7 gives these people a chance to change their life and inspire others to do the same. (Facebook, 14 Aug. 2014) And in response to criticisms about the amount of processed food Cam discarded from participants Vicki and Courtney’s cupboard, Emily McCabe commented: If you don’t enjoy the concept of the program, feel free to change the channel and keep your negative comments to yourself. (Facebook, 2 Sep. 2014) Nevertheless, a lot of criticism appeared on the various online and social media outlets ranging from: the commercial aspects (matúš; Hales); the constant use of the word “fat” by the host (Spencer); the sponsorship and advertisements by a take-away food company (Daisy Murray; Patriot); the “irresponsible/unsafe training!” (M_Gardner; Ashton); the insufficient number of “diet tips” (Pedron-Peggs); and “sick of seeing all that food thrown away!!” (Barkla; Dunell; Robbie; Martin; Coupland). As noted above, some of the sites were censored. Criticisms of the program were only aired if the online forum and social media allowed people to vent their feelings and express their opinion. Allowing viewers to express their concerns about mainstream television programs such as BSB counters the argument made by other researchers suggesting that makeover programs do the work of audiences becoming “self-managing” and self-governing citizens (see Stagi; Ouellette and Hay 471-472; Sender and Sullivan 581; Ringrose and Walkerdine); and makeover programs perpetuate the myth that obesity is solely an individual behavioural problem (Yoo). Such critical comments (above) reveal that some viewers do question the show’s premises, and as a consequence they do not accept the dominant framing. Thus the hypothesis that all viewers of makeover programs are pliable and docile cannot be supported in my analysis. Findings and Conclusion Most BSB posters said they found the program inspiring and motivating. It seems many of the online posters identified with the participants’ struggle to lose their weight, and stay motivated to keep it off. So there was little fat-shaming from posters on Facebook and the online forums. The posters on Facebook expressed the most positive comments about the BSB program and the participants; however, the Facebook site was the official BSB social media site. It seems that many of the Facebook and online forum discussants were makeover television fans who had acquired a taste for the makeover genre – that is the transformation and the big reveal at the end, the re-styled self, the symbols as well as the tips, information and ideas about how to lose weight and change their lifestyle. Questions were often asked by posters about the participants’ eating plan, exercise regime, maintenance program etc., as well as how they (the posters) could apply to be on the show. Very few social media or online posters questioned and challenged the makeover genre, the advertising during the program, the quality and number of diet and nutrition tips, and the time as well as financial cost required to maintain the new self. References Al_Mack. “STILL A FUCKING FAT BOGAN.” 26 Aug. 2014, no time. Tweet. Al_Mack. “JUST STOP EATING.” 26 Aug. 2014, no time. Tweet. Ashton, Susan. “Bringing Sexy Back.” 13 Jan. 2015, 17:56. Facebook comment. Barkla, Michelle. “Bringing Sexy Back.” 9 Sep. 2014, 18:39. Facebook comment. BH-bubhub Administrator. “Need Some Motivation to Shift Those Kilos? Our Pal Paula Is Here to Help Hubbers!” The Bubhub 3 March 2015. 15:27. BH-KatiesMum. “Need Some Motivation to Shift Those Kilos? Our Pal Paula Is Here to Help Hubbers!” The Bubhub 3 Mar. 2015 19:26. Bratich, Jack Z. “Programming Reality: Control Societies, New Subjects and the Powers of Transformation.” Ed. Dana Heller. Makeover Television: Realities Remodelled. London: I.B. Tauris, 2007. 6-22. Coupland, Allison. “Bringing Sexy Back.” 2 Sep. 2014, 17:55. Facebook comment. Curby. “Need Some Motivation to Shift Those Kilos? Our Pal Paula Is Here to Help Hubbers!” The Bubhub 3 Mar. 2015, 19.30. Dowd, Katrina. “Bringing Sexy Back.” 19 Aug. 2014, 21:07. Facebook comment. Dunell, Meredith. “Bringing Sexy Back.” 9 Sep. 2014, 17:54pm. Facebook comment. Dutchess of Tweet St (Appy_Dayz). “Seriously lazy slobs feeling sorry for themselves on #SexyBackAu are just bloody annoying.” 19 Aug. 2014, no time. Tweet. Farrell, Amy E. Fat Shame: Stigma and the Fat Body in American Culture. New York: New York University Press, 2011. Fraser, Kathryn. “‘Now I Am Ready to Tell How Bodies Are Changed into Different Bodies…’ Ovid, The Metamorphoses.” Ed. Dana Heller. Makeover Television: Realities Remodelled. London: I.B. Tauris, 2007. 177-92. Freeburn, Tim (TimBurna). “I feel great after watching #sexybackau I would’ve felt better if I didn’t eat all that Lindt chocolate while watching it though.” 19 Aug. 2014, no time. Tweet. Gee, James Paul. An Introduction to Discourse Analysis: Theory and Method. 3rd ed. New York: Routledge, 2010. Gidgit VonLaRue. “You want to eat crap nightly fine, it’s your body – but not fair to your poor kid. Learn to cook lazy cow.” 19 Aug. 2014, no time. Tweet. Greenberg, B., M. Eastin, L. Hofschire, K. Lachlan, and K.D. Brownell. “Portrayals of Overweight and Obese Individuals on Commercial Television.” American Journal of Public Health 93.8 (2003): 1324–48. Haigh, Renee J. “Bringing Sexy Back.” 26 Aug. 2014, 18:47. Facebook comment. Hales, Wendy. “Bringing Sexy Back.” 26 Aug. 2014, 18:38. Facebook comment. Holland, Kate, R., Warwick Blood, and Samantha Thomas. “Viewing The Biggest Loser: Modes of Reception and Reflexivity among Obese People.” Social Semiotics 25.1 (2015): 16-32. Hustwaite, Megan. “What an uplifting hour @BSBon7 is! @sam_armytage shines and @julessebastian is a talent #sexybackau.” 19 Aug. 2014, no time. Tweet. Jenkins, Yohti. “Bringing Sexy Back.” 26 Aug. 2014, 18:45. Facebook comment. Lewis, Tanya. “Introduction: Revealing the Makeover Show.” Continuum: Journal of Media and Cultural Studies 22.4 (2008): 441-46. M_Gardner (MSGardner_1). “This show has just trumped biggestloser for irresponsible/unsafe training! Do not try at home people #SexyBackAu.” 12 Aug. 2014, no time. Tweet. Martin, Tania. “Bringing Sexy Back.” 2 Sep. 2014, 18:41. Facebook comment. matúš (MattLXS). “Sales are going to increase now for the fit bit flex thanks to #sexybackau sorry jaw bone up.” 19 Aug. 2014, no time. Tweet. McCabe, Emily. “Bringing Sexy Back.” 2 Sep. 2014, 21:01. Facebook comment. McDonald, Christine (Clubby_R8). “Watching #sexyback I’m really feeling motivated now to change a lot of things about myself. Although the smoking thing is a tough call.” 26 Aug. 2014, no time. Tweet. McTavish, Karen. “Bringing Sexy Back.” 26 Aug. 2014, 18:51. Facebook comment. Miller, Toby. “Afterword: The New World Makeover.” Continuum: Journal of Media and Cultural Studies 22.4 (2008): 585-90. miss shadow (Miss_Shadow). “another great show #inspiring.” 26 Aug. 2014, no time. Tweet. Mod-Nomsie. “Need Some Motivation to Shift Those Kilos? Our Pal Paula Is Here to Help Hubbers!” The Bubhub 4 Mar. 2015. 11:47. Mod-Uniquey. “Need Some Motivation to Shift Those Kilos? Our Pal Paula Is Here to Help Hubbers!” The Bubhub 3 Mar. 2015, 17:46. Morgan, Kathryn Pauly. “Foucault, Ugly Ducklings, and Technoswans: Analyzing Fat Hatred, Weight-Loss Surgery, and Compulsory Biomedicalized Aesthetics in America.” Journal of Feminist Approaches to Bioethics 4.1 (2011): 188-220. Murray, Daisy. “Bringing Sexy Back.” 2 Sep. 2014, 18:27. Facebook comment. Nicholas, Lynne. “Bringing Sexy Back.” 14 Aug. 2014, 20:08. Facebook comment. Ouellette, Laurie, and James Hay. “Makeover Television, Governmentality and the Good Citizen.” Continuum: Journal of Media and Cultural Studies 22.4 (2008): 471-84. Patriot (THEbitchiestgay). “Why is a weight loss show sponsored by a chicken company? Chicken is fattening.” 12 Aug. 2014, no time. Tweet. Pedron-Peggs, Peta. “Bringing Sexy Back.” 16 Sep. 2014, 17:38. Facebook comment. Readdy, Tucker, and Vicki Ebbeck. “Weighing In on NBC’s The Biggest Loser: Governmentality and Self-Concept on the Scale.” Research Quarterly for Exercise and Sport 83.4 (2012): 579-86. Redden, Guy. “Makeover Morality and Consumer Culture.” Ed Dana Heller. Makeover Television: Realities Remodelled. London: I.B. Tauris, 2007. 150-64. Richardson, Niall. Transgressive Bodies: Representations in Film and Popular Culture. Farnham, UK: Ashgate Publishing, 2010. Ringrose, Jessica, and Valerie Walkerdine. “The TV Make-Over as Site of Neo-Liberal Reinvention toward Bourgeois Femininity.” Feminist Media Studies 8.3 (2008): 227-46. Robbie, Tina. “Bringing Sexy Back.” 5 Sep. 2014, 16:46. Facebook comment. Rodan, Debbie. “Technologies of the Self: Remaking the Obese ‘Self’ in The Biggest Loser: Couples (Australia).” Proceedings of the Australian and New Zealand Communication Association on Media Democracy and Change Conference. Ed. K. McCallum. Canberra, 2010. Rodan, Debbie, Katie Ellis, and Pia Lebeck. Disability, Obesity and Ageing: Popular Media Identifications. London: Ashgate, 2014. Sender, Katherine, and Margaret Sullivan. “Epidemics of Will, Failures of Self Esteem: Responding to Fat Bodies in The Biggest Loser and What Not to Wear.” Continuum: Journal of Media and Cultural Studies 22.4 (2008): 573-84. Sharon (Shar0n). “Watched #SexyBackAu for the first time tonight; a top show to motivate and inspire everyday women to be healthier and set achievable goals.” 26 Aug. 2014, no time. Tweet. Sharon (KeepitRealV). “#SexyBackAu watching another single mum challenge herself and change her life really inspires me that I can do the same!” 26 Aug. 2014, no time. Tweet. Skeggs, Beverley, and Helen Wood. “The Labour of Transformation and Circuits of Value ‘around’ Reality Television.” Continuum: Journal of Media and Cultural Studies 22.4 (2008): 559-72. Spencer, Amby. “Bringing Sexy Back.” 17 Aug. 2014, 13:55. Facebook comment. Stagi, Luisa. “Lifestyle Television and Diet: Body Care as a Duty.” Italian Journal of Sociology of Education 6.3 (2014): 130-52. Thomson, Peter. “Bringing Sexy Back.” 14 Aug. 2014, 20:03. Facebook comment. Tvaddict. “Bringing Sexy Back.” TV Tonight 13 Aug. 2014, 18:17. Yoo, Jina. “No Clear Winner: Effects of The Biggest Loser on Stigmatization of Obese Persons. Health Communication 28 (2013): 294-303.

Cognitive biases, or systematic errors in cognition, are important contributors to diagnostic error in medicine. In our review, we explore the psychological underpinnings of cognitive bias and highlight several common biases using clinical cases. We conclude by reviewing strategies to improve diagnostic accuracy and by discussing controversies and future research directions.RésuméLes préjugés cognitifs, ou les erreurs systématiques dans la cognition, sont des contributeurs importants à l'erreur diagnostique dans la médecine. Dans notre examen, nous explorons les fondements psychologiques du biais cognitif et soulignons plusieurs préjugés communs en utilisant des cas cliniques. Nous concluons en examinant les stratégies visant à améliorer la précision diagnostique et en discutant des controverses et des futures orientations de recherche.Research in the field of behavioural psychology and its application to medicine has been ongoing for several decades in an effort to better understand clinical decision making.1 Cognitive biases (systematic errors in cognition) are increasingly recognized in behavioural economics2 and more recently have been shown to affect medical decision making.3 Over 100 such cognitive biases have been identified and several dozen are postulated to play a major role in diagnostic error.4 Cognitive errors can take many forms and in one study contributed to as many as 74% of diagnostic errors by internists. 5 Most of these errors were due to “faulty synthesis” of information, including premature diagnostic closure and failed use of heuristics.5 Inadequate medical knowledge, on the other hand, was rare and mostly identified in cases concerning rare conditions. 5 Professional organizations such as the Royal College of Physicians and Surgeons of Canada and the Canadian Medical Protective Association have since been working to raise awareness of cognitive bias in clinical practice.6In our review, we explore the role of cognitive bias in diagnostic error through the use of clinical cases. We also review the literature on de-biasing strategies and comment on limitations and future directions of research.The Dual Process TheoryA prevailing theory to explain the existence of cognitive bias is the dual process theory, which asserts that two cognitive systems are used in decision making, herein called System 1 and System 2 (Table 1). 2,7System 1 can be thought of as our intuitive mode of thinking. It generates hypotheses rapidly, operates beneath our perceptible consciousness and makes judgments that are highly dependent on contextual clues. System 1 is characterized by heuristics (short cuts, or “rules of thumb”) and is an important component of clinical judgment or expertise. In contrast, System 2 is slow, deliberate, analytical and more demanding on cognition. It applies rules that are acquired through learning and it can play a “monitoring role” over System 1, and thus overrides heuristics when their use is inappropriate. The dual process theory implies that errors result when inappropriate judgments generated by System 1 fail to be recognized and corrected by System 2. Maintaining constant vigilance over System 1 would be both impractical and time consuming for routine decisions and would diminish the value of intuition. It follows that a more practical way of improving reasoning is to identify the most common biases of System 1 and to recognize situations when mistakes are most likely to occur.2Alternative Theories of CognitionVariations of dual process theory have further refined our understanding of medical decision making. Fuzzy trace theory, for example, proposes that individuals process information through parallel gist and verbatim representations.8 The “gist” is analogous to System 1 and represents the bottom-line “meaning” of information. This representation is subject to an individual’s worldview, emotions and experiences. In contrast, verbatim representations are precise, literal and analogous to System 2. Fuzzy trace theory is particularly useful in explaining how patients might interpret health information. Proponents of this theory contend that in order for information to lead to meaningful behavioural change, physicians must appeal to both gist and verbatim representations when communicating with patients.8 Other models, such as dynamic graded continuum theory, do away with the dichotomy of System 1 and System 2 and instead represent implicit, automatic and explicit cognitive processes on a continuous scale.9 These single system models are useful to compare against dual process theory but have not replaced it as a well-established framework for understanding and mitigating cognitive bias in clinical decision making.7Case 1: A 55-Year-Old Male with Retrosternal Chest PainA 55year-old non-smoking male was assessed in a busy Emergency Department (ED) for retrosternal chest pain. Past medical history is significant for osteoarthritis for which he takes naproxen. On review of his history, the patient has had multiple visits for retrosternal chest pain in the previous two months. At each encounter, he was discharged home after a negative cardiac workup.Vital signs in the ED were within normal limits except for sinus tachycardia at 112 beats per minute. On exam, the patient was visibly distressed. Cardiac and respiratory exams were normal. There was mild tenderness in the epigastrium. Basic blood-work revealed leukocytosis (16.0 × 109/L), a mildly elevated high sensitivity cardiac troponin, and no other abnormalities. An ECG revealed T wave flattening in leads V3-V4.The patient was referred to the internal medicine service with a diagnosis of non-ST-elevation myocardial infarction and treated with aspirin, clopidogrel, and fondaparinux. Several hours later, the patient became more agitated and complained of worsening retrosternal and epigastric pain. On re-examination, heart rate had increased to 139 beats per minute, blood pressure dropped to 77/60 and he had a rigid abdomen. Abdominal radiography revealed free air under the right hemi-diaphragm and the patient was rushed to the operating room where a perforated gastric ulcer was detected and repaired. The case above illustrates numerous cognitive biases, including:1. Premature diagnostic closure: the tendency to accept a diagnosis before it is fully verified.42. Anchoring: the tendency to over-emphasize features in the patient’s initial presentation and failing to adjust the clinical impression after learning new information.43. Confirmation bias: the tendency to look for confirming evidence to support a diagnosis, rather than to look for (or explain) evidence which puts the diagnosis in question.4In this case, the physician based the diagnosis of myocardial infarction primarily on symptoms of chest pain and an elevated cardiac troponin. However, several other objective findings were present and when taken together, suggested a diagnosis other than myocardial infarction. These included a tender epigastrium, leukocytosis, and resting sinus tachycardia. These symptoms/signs were not explicitly explained or investigated before a treatment decision was made. Premature diagnostic closure is one of the most common cognitive biases underlying medical errors5 and it affects clinicians at all levels of training.10 It is multifactorial in origin5 and is especially common in the face of other cognitive biases such as anchoring and confirmation bias.The physician in this case “anchored” to a diagnosis of cardiac chest pain given the patient’s previous ED visit history and his/her best intentions of ruling out a “worst case scenario.” Anchoring can be especially powerful in the face of abnormal screening investigations that have been reviewed even before the physician has acquired a history or performed a physical examination. If the physician had reviewed the screening investigations before seeing the patient, he/she might have narrowed the differential diagnosis prematurely, failed to gather all the relevant information and failed to adjust the clinical impression based on new information.The physician demonstrated confirmation bias by failing to explain the abnormalities that put the diagnosis of myocardial infarction in question (e.g. tender epigastrium, leukocytosis). Confirmation bias arises from an attempt to avoid cognitive dissonance, a distressing psychological conflict which occurs when inconsistent beliefs or theories are held simultaneously.11 In one study evaluating clinical decision making amongst 75 psychiatrists and 75 medical students,12 13% of psychiatrists and 25% of medical students demonstrated confirmation bias when searching for information after having made a preliminary diagnosis. In this study, confirmation bias resulted in more frequent diagnostic errors and predictably impacted subsequent treatment decisions.An appropriate consideration of all diagnostic possibilities is the first step in avoiding diagnostic error. While acquiring information, physicians should step back and consolidate new data with the working diagnosis, as failure to do so can result in confirmation bias.13 All abnormal findings and tests, especially if considered clinically relevant should be explained by the most probable diagnosis. An alternate diagnosis or the possibility of more than one diagnosis should be considered when an abnormal finding or test cannot reasonably be explained by the working diagnosis.Tschen et al observed a team of physicians working through a simulated scenario which had diagnostic ambiguity.14 Two approaches were found to be effective in reducing the effect of confirmation bias: explicit reasoning and talking to the room. Explicit reasoning involves making causal inferences when interpreting and communicating information. Talking to the room is a process whereby diagnostic reasoning is explained in an unstructured way to a team member or colleague in the room. This allows the clinician the opportunity to elaborate on their thoughts and observers to point out errors or suggest alternate diagnoses in a shared mental model.Case 2: A 30-Yearold Male with Confusion and SeizuresA 30-year-old homeless male is found confused on the street by paramedics and brought to the ED for assessment. Empty bottles of alcohol were noted at the scene. The CIWA (Clinical Institute Withdrawal Assessment for Alcohol) protocol is initiated and he is given several doses of lorazepam to minimal effect. Several hours after the patient is admitted, a resident on-call is paged for elevated CIWA scores on the basis of diaphoresis and agitation. Several additional doses of lorazepam are ordered which fail to completely resolve the symptoms. Gradually, the patient becomes more obtunded. The on-call resident orders a capillary blood glucose and it measures 1.1 mmol/L. Intravenous D50W is promptly administered, the blood glucose normalizes and the patient’s level of consciousness improves.The case above illustrates the following biases:1. Availability bias: the tendency to weigh a diagnosis as being more likely if it comes to mind more readily.42. Diagnostic momentum: the tendency for labels to “stick” to patients and become more definite with time.4Although the symptoms of diaphoresis and agitation are not specific to alcohol withdrawal, this diagnosis was deemed most likely based on how readily it came to mind, the empty alcohol bottles at the scene, and potentially on the patient’s demographics. The unproven diagnosis of alcohol withdrawal “stuck” with the patient despite minimal improvement after a therapeutic trial of benzodiazepines.Availability bias has been shown to affect internal medicine residents. In one single-centre study,15 18 first-year and 18 second-year residents were exposed to case descriptions with associated diagnoses as part of an exercise. They were then asked to diagnose a series of new cases, some of which appeared similar to those they had previously encountered but with pertinent differences that made an alternate diagnosis more likely. Second year residents had lower diagnostic accuracy on these similar-appearing cases; a result consistent with availability bias. First year residents were less prone to this bias because of their limited clinical experience. Most importantly, subsequent reflective diagnostic reasoning countered the bias and improved accuracy.General Strategies to Avoid Cognitive BiasInterventions aimed at mitigating diagnostic error due to cognitive bias take several approaches.1. Improving clinical reasoning2. Reducing cognitive burden3. Improving knowledge and experienceDespite a large number of proposed interventions, there is a lack of empirical evidence supporting the efficacy of many de-biasing strategies. 16 What follows is a brief review of the current evidence.Improving Clinical ReasoningSeveral “de-biasing” strategies have been proposed to improve clinical reasoning. De-biasing strategies assume that System 1 processes are more prone to bias due to their heavy reliance on heuristics and therefore the solution is to activate System 2 at critical points in decision making. De-biasing occurs in several stages: at first an individual is educated about the presence of a cognitive bias, they then employ strategies to eliminate that bias and finally they maintain those strategies in the long term.17Metacognition, or “thinking about thinking,” involves reflecting on one’s own diagnostic reasoning. Internal reflection along with awareness of potential biases should allow the clinician to identify faulty reasoning. However, the evidence underlying reflective practice is mixed.16 Several studies have tried to encourage reflective practice and System 2 processes by instructing participants to proceed slowly through their reasoning18 or by giving participants the opportunity to review their diagnoses.19 These studies have found minimal or no impact on reducing the rate of diagnostic error. On the other hand, some studies have shown improved diagnostic accuracy when physicians are asked to explicitly state their differential diagnoses along with features that are consistent or inconsistent with each diagnosis.20 These results suggest that if reflective practice is to be effective, it must involve a thorough review of the differential diagnosis as opposed to simply taking additional time.Reducing Cognitive BurdenTools that reduce the cognitive burden placed on physicians may reduce the frequency of diagnostic errors. One suggestion has been to incorporate the use of checklists in the diagnostic process. These checklists would be matched to common presenting symptoms and include a list of possible diagnoses. One randomized controlled trial failed to show a statistically significant reduction in the diagnostic error rate with the use of checklists, except in a small subgroup of patients treated in the ED. 21 These findings challenge the results of two other studies that found checklists to be effective in improving scrutiny22 and diagnostic accuracy23 when interpreting electrocardiograms. More advanced forms of clinician decision support systems have also been studied.24 Software programs such as DXplain generate a list of potential diagnoses based on a patient’s chief complaint. In one study, when the software provided physicians a list of possible diagnoses before evaluating patients, diagnoses were 1.31 times more likely to be correct. 25 The use of diagnostic support tools may grow in the future as they are integrated into electronic medical record systems.Improving Knowledge and ExperienceA combination of experience, knowledge and feedback are integral in developing a clinician’s intuition to produce the best hypotheses. Experience without feedback can lead to overconfidence, which itself is a cognitive bias. The evidence supporting feedback is strong. Fridriksson et al showed a significant reduction in diagnostic error when referring doctors were provided feedback on the identification of subarachnoid hemorrhage.26 A systematic review of 118 randomized trials concluded that feedback was effective in improving professional practice.27 The specific characteristics of the best feedback were elusive. In general, however, feedback was thought to be most effective when it was explicit and delivered close to the time of decision making. ConclusionsIn our review, we explore clinical decision making through the lens of dual-process theory. However, multiple different dual-processing models are still being explored and fundamental questions are still under debate. For example, some experts believe that instead of focusing on de-biasing strategies, the key to improving intuitive (System 1) processes is simply to acquire more formal and experiential knowledge.19 Other unanswered questions include: the impact and magnitude of cognitive bias in actual clinical practice, which biases are most prevalent in each medical specialty and which strategies are the most effective in mitigating bias. Further study is also needed to assess the impact of novel educational methods, such as case-based and simulation-based learning, which are promising venues where trainees may identify and correct cognitive biases in a directly observed setting. References 1. Norman G. Research in clinical reasoning: past history and current trends. Med Educ 2005;39:418–27.2. Kahneman D. Thinking, fast and slow. Farrar, Straus and Giroux; 2011.3. Croskerry P. From mindless to mindful practice — cognitive bias and clinical decision making. N Engl J Med 2013;368:2445–8.4. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Academic Medicine 2003;78:775–80.5. Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med 2005;165:1493–9.6. Parush A, Campbell C, Hunter A, et al. Situational awareness and patient safety - a short primer. Ottawa ON: The Royal College of Physicians and Surgeons of Canada; 2011.7. Pelaccia T, Tardif J, Triby E, Charlin B. An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory. Med Educ Online 2011;16.8. Reyna VF. A theory of medical decision making and health: fuzzy trace theory. Med Decis 2008;28:850–65.9. Osman M. An evaluation of dual-process theories of reasoning. Psychonom Bull review 2004;11:988–1010.10. Dubeau CE, Voytovich AE, Rippey RM. Premature conclusions in the diagnosis of iron-deficiency anemia: cause and effect. Med Dec Mak 1986;6:169–73.11. Nickerson RS. Confirmation bias: A ubiquitous phenomenon in many guises. Rev Gen Psychol 1998;2:175.12. Mendel R, Traut-Mattausch E, Jonas E, et al. Confirmation bias: why psychiatrists stick to wrong preliminary diagnoses. Psychol Med 2011;41:2651–9.13. Pines JM. Profiles in patient safety: confirmation bias in emergency medicine. Acad Emerg Med 2006;13:90–4.14. Tschan F, Semmer NK, Gurtner A, et al. Explicit reasoning, confirmation bias, and illusory transactive memory: a simulation study of group medical decision making. Small Group Res 2009;40:271–300.15. Mamede S, van Gog T, van den Berge K, et al. Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA 2010;304:1198–203.16. Graber ML, Kissam S, Payne VL, et al. Cognitive interventions to reduce diagnostic error: a narrative review. BMJ Qual Safe 2012;21:535–57.17. Croskerry P, Singhal G, Mamede S. Cognitive debiasing 2: impediments to and strategies for change. BMJ Qual Saf 2013.18. Norman G, Sherbino J, Dore K, et al. The etiology of diagnostic errors: a controlled trial of system 1 versus system 2 reasoning. Acad Med 2014;89:277–84.19. Monteiro SD, Sherbino J, Patel A, Mazzetti I, Norman GR, Howey E. Reflecting on diagnostic errors: taking a second look is not enough. J Gen Intern Med 2015;30:1270–4.20. Bass A, Geddes C, Wright B, Coderre S, Rikers R, McLaughlin K. Experienced physicians benefit from analyzing initial diagnostic hypotheses. Can Med Educ J 2013;4:e7–e15.21. Ely JW, Graber MA. Checklists to prevent diagnostic errors: a pilot randomized controlled trial. Diagnosis 2015;2.22. Sibbald M, de Bruin ABH, Yu E, van Merrienboer JJG. Why verifying diagnostic decisions with a checklist can help: insights from eye tracking. Adv Health Sci Educ Theory Pract 2015;20:1053–60.23. Sibbald M, de Bruin ABH, van Merrienboer JJG. Checklists improve experts' diagnostic decisions. Med Educ 2013;47:301–8.24. Garg AX, Adhikari NKJ, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005;293:1223–38.25. Kostopoulou O, Rosen A, Round T, et al. Early diagnostic suggestions improve accuracy of GPs: a randomised controlled trial using computer-simulated patients. Br J Gen Pract 2015;65:e49–54.26. Fridriksson S, Hillman J, Landtblom AM, Boive J. Education of referring doctors about sudden onset headache in subarachnoid hemorrhage. A prospective study. Acta Neurol Scand 2001;103:238–42.27. Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD. Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. Qual Saf Health Care 2006;15:433–6.

SCULLY: I said, I got the lab to rush the results of the Szczesny autopsy, if you're interested.MULDER: I heard you, Scully.SCULLY: And Szczesny did indeed drown, but not as the result of the inhalation of ectoplasm as you so vehemently suggested.MULDER: Well, what else could she possibly have drowned in?SCULLY: Margarita mix, upchucked with about 40 ounces of Corcovado Gold tequila which, as it turns out, she and her friends rapidly consumed in the woods while trying to reenact the Blair Witch Project.MULDER: Well, I think that demands a little deeper investigation, don't you?SCULLY: No, I don't.— The X-Files, “All Things” (0717) IntroductionMikel J. Koven argues that “The X-Files [1993-2002, films 2005, 2010, revived 2016-2018] was the American television series that defined the zeitgeist of the 1990s” (337) by tapping into “pre-millenium paranoia and the collapse of traditional beliefs” (338). In each episode, “True Believer” and FBI agent Fox Mulder (David Duchovny) and his partner, the skeptical and rational Dr Dana Scully (Gillian Anderson), travel through a post-Cold War American landscape that is manifesting varying levels of anxiety about the century to come. The series is preoccupied with a series of questions that have, by the second decade of the twenty-first century, come to be answered fairly definitively. Have aliens visited Earth? (Well, if you believe a team of Harvard scientists, maybe [see Freeman], but there is no evidence of alien colonisation just yet.) Does the US government have its citizens’ best interests at heart? (In its current incarnation, no.) Will climate change have monstrous consequences? (Yes, we’re seeing them.) What do we do about the shady forces operating in post-Soviet Union Russia? (God knows, but they seem to be doing a good job of changing the shape of “democracy” in an increasing number of countries.)These broader socio-political aspects of The X-Files have been explored in a number of studies (see Koven; Moses; Wildermuth). In this article, I focus in more closely on some of the ways in which the character of Scully can be read as a complex engagement with a particularly 1990s version of third-wave feminism. I suggest that the type of feminism embodied in the character of Scully taps into the zeitgeist of the 1990s, a decade characterised not only by a growing media-driven “backlash” against feminism (see Faludi), but also by emergent third wave of feminism driven by movements such as “Riot Grrrl” (centred on openly feminist bands like Bikini Kill and Huggy Bear) and the various, and often contested, feminisms endorsed by a new generation of writers like Susan Faludi, Naomi Wolf, and even Katie Roiphe. Part of Scully’s longevity as a feminist icon can be attributed to the fact that while she is not without her own contradictions and complexities, she emerged from a televisual landscape dominated by particularly insipid representations of professional women. Scully, with her combination of lively wit and serious scientific mind, represented a radical imagining of professional femininity in the 1990s.Working against the Backlash: Scully and the Power of ProfessionalismBy the late 1980s, the political gains made by the second-wave feminism in the 1960s and early 1970s had come increasingly under fire in a “backlash” that “worked to revoke the gains made by the feminist movement” (Genz and Brabon 53). L.S. Kim argues this backlash is reflected in the fact that while strong female characters had always been a feature of US television (e.g. Mary Tyler Moore), in the 1990s televisual landscape feminism was often made popular in a type of “postfeminist discourse in which it is acceptable to be pro-woman but not to be feminist” (319). The quintessential example of this trend was David E. Kelley’s series about a Boston lawyer, Ally McBeal (1997-2002), in which McBeal’s primary dilemma is presented as being that she has “too many choices, too much freedom, and too much desire” which leads to “never-ending searching and even to depression and dysfunction” (Kim 319). McBeal’s professional success never seems to compensate for her various romantic disappointments and these remain the focal point of Kelley’s series.Part of what sets Scully apart from a character like McBeal is her unerring professionalism, and her strong commitment to equality in her relationship with Mulder. Scully displays none of McBeal’s neuroses, and she is unapologetically feminist in her disposition. She also understands implicitly the pivotal role she plays in the partnership at the heart of the X-Files. Scully is, then, a capable, professional woman who not only remains professional at all times, but who also works as a powerful grounding force to her partner’s more outlandish approaches and theories. As series creator Chris Carter has been forced to concede on numerous occasions, without the rational and practical figure of Scully in the morgue to (usually) prove and (sometimes) disprove Mulder’s theories, The X-Files as we know them would cease to exist. In fact, and somewhat paradoxically, in order to best understand Scully as a character, one needs to recognise the significance of the relationship between Scully and Mulder that lies at the heart of the series. The sheer force of Scully’s professionalism, and its resistance to being conscripted straightforwardly into a traditional romantic plot, becomes an important contributor to the powerful sexual tension between Mulder and Scully that came to define the series. Scully also, as critics and commentators were quick to point out, takes on the traditionally masculine role of skeptical scientist on the series, with Mulder positioned in the typically feminine role of intuitive “believer” (in, among other things, aliens, Chupacabra, big foot, and psychic powers). There are, of course, problems with this approach, but for now it is enough to simply point out that this positioning of Mulder and Scully is an important feature of the internal structure of The X-Files and speaks to an awareness of, and desire to challenge, the traditional association of women with intuition and men with rationality. Indeed, Linda Badley points out that the relationship between the two agents is “remarkably egalitarian, challenging traditional gender roles as portrayed on television” (63).Scully and Mulder’s relationship, a relationship that is at once personal and professional, is also grounded in genuine equality and respect. Mulder never undermines Scully, he (occasionally) knows when to bow to her superior scientific reasoning, and his eventual love for his partner is based in his understanding that Scully’s skepticism offers the perfect counterpart to his openness to the paranormal. In fact, one might say that Mulder, at least in part, falls in love with Scully’s professionalism and with her commitment to scientific reasoning. Mulder admits as much himself in the film The X-Files: Fight the Future (1998): “as difficult and frustrating as it’s been sometimes, your goddamn strict rationalism and science have saved me a thousand times over. You kept me honest. You made me a whole person.” In this calculation, Scully is not only Mulder’s equal, she is his missing piece. While she might sometimes grumble about merely playing Watson to Mulder’s Holmes (see “Fight Club” [0720]), Scully’s role is much more important than this, and Mulder (and the viewer) knows it.In the context of the televisual landscape of the 1990s, this representation of Scully as a character who is every bit as intelligent and as integral to the action of the series as her male partner, was incredibly powerful. It marked Scully as a third-wave feminist character in an era dominated by women who seemed to conform to the kind of problematic post-feminism embodied by Ally McBeal. In a recent interview, Gillian Anderson acknowledged the significant role Scully played in opening up possibilities for the representation of women on television in the 1990s. She observed, “a lot of women felt that they saw something recognisable for the first time [in Scully and] there were a lot of young women whose eyes were opened to feeling like they were finally represented in some way on television” (Anderson in Idato n.p.) Many women saw themselves in this character, and there can be little doubt The X-Files spearheaded a shift towards a more representative approach to the writing of female roles in US television in which layered and complex characters such as Scully became the norm rather than the exception. Rosalind Gill, for example, notes that “quality television” has “evolved since the 1990s into a site of rich and complex representations of gender including Homeland, Veep, House of Cards, Orange is the New Black, Transparent, and The Good Wife” (620).One of the other pervasive positive effects associated with the character of Scully is that she functioned, and indeed continues to function, as a role model for women in STEM (Science, Technology, Engineering and Mathematics). A recent report commissioned by 21st Century Fox, the Geena Davis Institute on Gender in Media, and J. Walter Thompson Intelligence found that “Scully’s media depiction of a high-achieving woman in STEM asked a generation of girls and women to imagine new professional options… Scully also influenced a generation of young women to study and pursue careers in STEM” (3). Although this report is not entirely impartial (21th Century Fox owns The X-Files), it found that “among women who are familiar with Scully’s character, 91% say she is a role model for girls and women” (5). This finding tallies with those of a variety of earlier online observers who noticed Scully had become a touchstone character “who inspired an entire generation of young women to pursue medical, scientific, and law enforcement degrees as positions” (Consalvi). To an extent not seen before in the history of television, Scully became an important role model for young women in the STEM professions. Scully’s fictional professionalism helped to create a new generation of real-life female STEM professionals.But it is worth remembering that in other respects, Scully is a complicated feminist heroine. This is largely because The X-Files’ production team’s own feminist credentials were often less-than-inspiring. The series was created by a man, and was written and directed predominantly by men in all of its various filmic and televisual incarnations. As Anderson herself pointed out on her Twitter feed for 29 June 2017, of the 207 episodes of X-Files produced, only 2 were directed by women (fig. 1). Famously, when the X-Files began in the early 1990s, Anderson was paid far less than her co-star Duchovny and was even asked to stand behind him on camera. The actor agitated successfully for equal pay after three years in the role, and for the right to stand beside her televisual partner, rather than behind him, even if, somewhat astonishingly, Twenty First Century Fox also offered Anderson less than Duchovny to reprise her famous role in 2016. (Anderson eventually received equal pay for equal billing.)Fig. 1: Gillian Anderson tweet, 29 June 2017.It ought to be remembered, then, that Scully’s feminism is predominantly a construction of men, overlaid with the undoubted feminine empowerment brought to the role by Anderson. As far back as 1998, Linda Badley noticed that for Scully/Anderson “the transference of ‘feminist’ characteristics between character and star is unusually strong—to the extent that a discussion of one must refer to the other. And Anderson/Scully is instantly recognisable as an icon of popular feminism” (62). But in more recent years, Anderson has made even clearer her own feminist leanings. She has done this through the publication (with Jennifer Nadel) of the explicitly feminist We: The Uplifting Manuel for Women Seeking Happiness (2017); by taking up more explicitly feminist roles, such as that of Stella Gibson in the acclaimed BBC series The Fall (2013-present); and through her Twitter feed. The significance of Anderson’s online feminist presence is highlighted by Lauren Modery, who notes: “the next time you’re having a day where you’re not sure if you’re being the best feminist you can be, just ask yourself “what would Gillian Anderson do?” and go to her Twitter account” (Modery). Scully’s 1990s Feminism in a Twenty-First Century ContextFor much of the series, Scully’s feminism can be viewed as a form of the “New Feminism” that Stephanie Genz and Benjamin Brabon associate with the late 1990s and with Natasha Walter’s book The New Feminism (1998). This “New Feminism” attempts to break from second-wave feminism by decoupling the personal from the political (64). Badley, for example, points out that Scully’s feminism is strictly based on individual empowerment: “rather than challenge patriarchy directly or join forces with women activists, Scully channels her anger/ambition into fitting into the system” (70). But equally, Scully’s feminism could be seen as a prototype of the kind of “neo-liberal” feminism that theorists such as Angela McRobbie associate with the present moment, a feminism which “discards the older, welfarist and collectivist feminism of the past, in favour of individualist striving” (4). Certainly, over the course of the 25 years, The X-Files has been in existence, we have seen little evidence that Scully has female friends (or indeed, that she interacts with anyone much outside of Mulder and her family).When other women do enter the picture, such as when Mulder’s one-time lover and co-founder of the X-Files, Diana Fowley appears in the fifth season of the series (see “The End” [0520]), Scully is often positioned in an antagonistic relationship with them. In this context, it is notable that “All Things,” a seventh-season episode directed and written by Anderson, places Scully’s interaction with Colleen Azar, a woman from the American Taoist Healing Centre, at the centre of the narrative. Azar’s exhortations to Scully to “slow down” are presented as the wise words of a female ally in this episode, and Scully does well to heed them. This episode, consciously I think, works as a counter to the more typical representation of Scully as being in competition with women for Mulder’s interest, evident in episodes like “Alpha” (0616) and “Syzygy” (0313). In this respect, Anderson appears to be aligning Scully with a feminism that is much more inclusive than it appears in other, male-written, episodes.From the vantage point of the second decade of the twenty-first century, one of the more problematic elements The X-Files has to do with its representation of sex and sexuality. Sex, in the world of The X-Files, is very 1990s in orientation. In fact, it echoes the way in which sex operated in the Clinton impeachment: denial, denial, denial, even in the face of clear evidence it took place. We see this most obviously in “All Things,” which begins with a shot of Scully getting dressed in front of a mirror, that pans to a shot of an undressed Mulder in bed. This opening seems to suggest the two had spent the night together, but nothing overtly sexual actually takes place in the episode. Indeed, any sexual activity that ever takes place in the X-Files happens off camera, but it is nonetheless worth pointing out that while the equally solitary Mulder is repeatedly characterised in the series by his porn fetish, Scully’s sexuality is repeatedly denied or diminished in the series. Moreover, any overt expression of Scully’s sexuality (such as in “Milagro,” [0618] where she falls for a writer living next door to Mulder) typically ends badly, with Scully placed in peril by her sexual desires.Scully’s continued presence in the twenty-first century, however, means that while her character is rooted in what we might call a “1990s feminist disposition” (she prides herself on being a “woman in a man’s world”; she demonstrates little interest in stereotypically feminine pursuits such as shopping or make up; her focus is on work, rather than romance), she has also been allowed the room to grow and develop. Perhaps most notably, the 2018 Scully is allowed to embrace her sexuality. Sexual activity still appears off screen, of course, but in “Plus One” (1103), we see her actively pursue sex with Mulder (twice!), while her vibrator makes an unapologetic cameo appearance in “Rm9sbG93ZXJz” (1107). Given that we live in a decade saturated in sexual imagery, it makes no sense for 2018 Scully to be as chaste and buttoned up as she was in the 1990s.Finally, in a series in which the wild speculation of the conspiracy theories is almost always true, Scully’s feminist commitment to rationality, science and the power of logic might appear to be undermined at every turn. Badley, for example, reminds us that while Scully may “have medicine and the law on her side ... Mulder’s vision is validated by Chris Carter, as the prologue to nearly every episode reminds us” (67). This is highlighted in “Field Trip” (0621) when Scully wonders, “Mulder, can’t you just for once, just ... for the novelty of it, come up with the simplest explanation, the most logical one instead of automatically jumping to UFOs or Bigfoot or…” Mulder simply counters with:Scully, in six years, how … how often have I been wrong? No seriously, I mean, every time I bring you a case we go through this perfunctory dance. You tell me that I’m not being scientifically rigorous and that I’m off my nut, and then in the end who turns out to be right like 98.95 of the time? I just think I’ve ... earned the benefit of the doubt here.Interestingly enough, however, it is Scully who solves the mystery at the heart of this particular episode of X-Files—Mulder and Scully are indeed trapped inside a giant fungus, being slowly digested by its gooey secretions.And while Mulder’s viewpoint is most often endorsed in the series, the chaos of the Trump administration illustrates perfectly the dangers behind the valorisation of the irrational over the rational. In a decade in which rationality itself is coming under increasing threat—by “fake news”; through a hostility towards the science of climate change; in the desire to wind back further the gains of the feminist movement—we need to remember the importance of the strong and abiding relationship between rationality and feminism. This is a relationship that goes at least as far back as Mary Wollstonecraft’s (1759-1797) Vindication of the Rights of Woman (1792), is at the heart of the feminist gothic writings of women like Ann Radcliffe (1764-1823) and Mary Shelley (1797-1851). This commitment to the power of rationality lives on in the character of Dana Scully.Conclusion: Scully as Twenty-First-Century Feminist IconI have argued throughout this article that there are limitations of the kind of feminism embodied in Scully, but it is clear that she has come to represent a type of woman who refuses to let men dictate her behaviour, and who maintains her professionalism even under the most difficult of circumstances. A host of Scully memes now circulating on the web celebrate the character’s competence, intelligence, and compassion (figs. 2, 3, and 4). The character of Scully now exists far beyond the confines of the television screen and the imaginations of her predominantly male authors. Scully’s continuing relevance to twenty-first century feminists is reflected in this meme recently placed by Anderson on her Twitter account in response to the allegations of sexual misconduct directed at US Supreme Court nominee Brett Kavanagh (fig. 5). Rarely have the 1990s seemed so relevant to the present moment.Fig. 2: Scully meme, Meme Generator.Fig. 3: Rustnsplinters, “Scully Motivational.” Deviant Art.Fig. 4: E.H. Redlum, “Scully: Meme Style.” Deviant Art.Fig. 5: Gillian Anderson tweet.ReferencesBadley, Linda. “Scully Hits the Glass Ceiling: Postmodernism, Postfeminism, Posthumanism, and The X-Files.” Fantasy Girls: Gender in the New Universe of Science Fiction and Fantasy Television. Ed. Elyce Rae Helford. Lanham: Rowman & Littlefield, 2000. 61-90.Consalvi, Sydney. “The Scully Effect Continues: How The X-Files’ Dana Scully Changed Television Forever.” Odyssey. 9 Aug. 2016. 1 Dec. 2018 <https://www.theodysseyonline.com/scully-effect>.Faludi, Susan. Backlash: The Undeclared War against Women. London: Vintage, 1991.Freeman, David. “Scientists Say Mysterious ‘Oumuamua’ Object Could Be an Alien Spacecraft: Harvard Researchers Raise the Possibility That It’s a Probe Sent by Extraterrestrials.” NBCNews.com. 6 Nov. 2018. 1 Dec. 2018 <https://www.nbcnews.com/mach/science/scientists-say-mysterious-oumuamua-object-could-be-alien-spacecraft-ncna931381>.Genz, Stéphanie, and Benjamin A. Brabon. Postfeminism: Cultural Texts and Theories. Edinburgh: Edinburgh UP, 2009.Gill, Rosalind. “Post-Postfeminism? New Feminist Visibilities in Postfeminist Times.” Feminist Media Studies 16.4 (2016): 610-30.Idato, Michael. “Gillian Anderson on Why She’s Closing The X-Files after 25 Years.” The Sydney Morning Herald. 15 Jan. 2018. 1 Dec. 2018 <https://www.smh.com.au/entertainment/tv-and-radio/times-up-gillian-anderson-on-why-shes-closing-the-xfiles-after-25-years-20180115-h0iapf.html>.Kim, L.S. “‘Sex and the Single Girl’ in Postfeminism: The F Word on Television.” Television and New Media 2.4 (Nov. 2001): 319-334.Koven, Mikel J. “The X-Files.” Essential Cult TV Reader. Ed. David Lavery. Lexington: University of Kentucky Press, 2010. 337-343.McRobbie, Angela. “Notes on the Perfect: Competitive Femininity in Neoliberal Times.” Australian Feminist Studies 30:83 (2015): 3-20.Modery, Lauren. “Gillian Anderson Is the Feminist Twitter Hero We Need Right Now.” Birth. Movies. Death. 25 Jan. 2018. 1 Dec. 2018 <https://birthmoviesdeath.com/2018/01/25/gillian-anderson-is-the-feminist-twitter-hero-we-need-right-now>.Moses, Michael Valdez. “Kingdom of Darkness: Autonomy and Conspiracy in The X-Files and Millenium.” The Philosophy of TV Noir. Eds. Steven M. Sanders and Aeon J. Skoble. Lexington: U. of Kentucky P., 2008. 203-228.21stCentury Fox, the Geena Davis Institute on Gender in Media, and J. Walter Thompson Intelligence. The ‘Scully Effect’: I Want to Believe… in STEM. 2018. <https://impact.21cf.com/wp-content/uploads/sites/2/2018/03/ScullyEffectReport_21CF_1-1.pdf>.Wildermuth, Mark E. Gender, Science Fiction Television, and the American Security State: 1958-Present. London: Palgrave Macmillan, 2014.X-Files: Fight the Future. Dir. Rob Bowman. Perf. Gillian Anderson and David Duchovny. 20th Century Fox. 1998.

Cyborgs already walk among us. (“Cures to Come” 76) This essay was begun as a reaction to a Hallmark Hall of Fame television movie called Sweet Nothing in My Ear (2008), which follows the lives of two parents, Dan, who is hearing (played by Jeff Daniels), and Laura, who is deaf (Marlee Matlin), as they struggle to make a decision about whether or not to give their 11-year-old son, Adam (late-deafened), a cochlear implant. Dan and Laura represent different perspectives, hearing and deaf perspectives. The film dramatizes the parents’ conflict and negotiation, exposing audiences to both sides of the cochlear implant debate, albeit in a fairly simplistic way. Nevertheless, it represents the lives of deaf people and gives voice to debates about cochlear implants with more accuracy and detail than most film and television dramas. One of the central scenes in the film is what I call the “activation scene”, quite common to cochlear implant narratives. In the scene, the protagonists witness a child having his implant activated or turned on. The depiction is reminiscent of the WATER scene in the film about Helen Keller, The Miracle Worker, employing a sentimental visual rhetoric. First, the two parents are shown seated near the child, clasping their hands as if in prayer. The audiologist, wielder of technology and therefore clearly the authority figure in the scene, types away furiously on her laptop. At the moment of being “turned on,” the child suddenly “hears” his father calling “David! David!” He gazes angelically toward heaven as piano music plays plaintively in the background. The parents all but fall to their knees and the protagonist of the film, Dan, watching through a window, weeps. It is a scene of cure, of healing, of “miracle,” a hyper-sentimentalised portrait of what is in reality often a rather anti-climactic event. It was certainly anti-climactic in my son, Michael’s case. I was taken aback by how this scene was presented and dismayed overall at some of the inaccuracies, small though they were, in the portrayal of cochlear implants in this film. It was, after all, according to the Nielsen ratings, seen by 8 million people. I began to wonder what kinds of misconceptions my son was going to face when he met people whose only exposure to implants was through media representations. Spurred by this question, I started to research other recent portrayals of people with implants on U.S. television in the past ten years, to see how cochlear implant (hereafter referred to as CI) identity has been portrayed by American media. For most of American history, deaf people have been portrayed in print and visual media as exotic “others,” and have long been the subject of an almost morbid cultural fascination. Christopher Krentz suggests that, particularly in the nineteenth century, scenes pairing sentimentality and deafness repressed an innate, Kristevan “abject” revulsion towards deaf people. Those who are deaf highlight and define, through their ‘lack’, the “unmarked” body. The fact of their deafness, understood as lack, conjures up an ideal that it does not attain, the ideal of the so-called “normal” or “whole” body. In recent years, however, the figure of the “deaf as Other” in the media, has shifted from what might be termed the “traditionally” deaf character, to what Brenda Jo Brueggeman (in her recent book Deaf Subjects: Between Identities and Places), calls “the new deaf cyborg” or the deaf person with a cochlear implant (4). N. Katharine Hailes states that cyborgs are now “the stage on which are performed contestations about the body boundaries that have often marked class, ethnic, and cultural differences” (85). In this essay, I claim that the character with a CI, as portrayed in the media, is now not only a strange, “marked” “Other,” but is also a screen upon which viewers project anxieties about technology, demonstrating both fascination fear. In her book, Brueggeman issues a call to action, saying that Deaf Studies must now begin to examine what she calls “implanting rhetorics,” or “the rhetorical relationships between our technologies and our identity” and therefore needs to attend to the construction of “the new deaf cyborg” (18). This short study will serve, I hope, as both a response to that injunction and as a jumping-off point for more in-depth studies of the construction of the CI identity and the implications of these constructions. First, we should consider what a cochlear implant is and how it functions. The National Association of the Deaf in the United States defines the cochlear implant as a device used to help the user perceive sound, i.e., the sensation of sound that is transmitted past the damaged cochlea to the brain. In this strictly sensorineural manner, the implant works: the sensation of sound is delivered to the brain. The stated goal of the implant is for it to function as a tool to enable deaf children to develop language based on spoken communication. (“NAD Position”) The external portion of the implant consists of the following parts: a microphone, which picks up sound from the environment, which is contained in the behind-the-ear device that resembles the standard BTE hearing aid; in this “hearing aid” there is also a speech processor, which selects and arranges sounds picked up by the microphone. The processor transmits signals to the transmitter/receiver, which then converts them into electric impulses. Part of the transmitter sits on the skin and attaches to the inner portion of the transmitter by means of a magnet. The inner portion of the receiver/stimulator sends the impulses down into the electrode array that lies inside the cochlea, which in turn stimulates the auditory nerve, giving the brain the impression of sound (“Cochlear Implants”). According to manufacturer’s statistics, there are now approximately 188,000 people worldwide who have obtained cochlear implants, though the number of these that are in use is not known (Nussbaum). That is what a cochlear implant is. Before we can look at how people with implants are portrayed in the media, before we examine constructions of identity, perhaps we should first ask what constitutes a “real” CI identity? This is, of course, laughable; pinning down a homogeneous CI identity is no more likely than finding a blanket definition of “deaf identity.” For example, at this point in time, there isn’t even a word or term in American culture for someone with an implant. I struggle with how to phrase it in this essay - “implantee?” “recipient?” - there are no neat labels. In the USA you can call a person deaf, Deaf (the “D” representing a specific cultural and political identity), hearing impaired, hard of hearing, and each gradation implies, for better or worse, some kind of subject position. There are no such terms for a person who gets an implant. Are people with implants, as suggested above, just deaf? Deaf? Are they hard of hearing? There is even debate in the ASL community as to what sign should be used to indicate “someone who has a cochlear implant.” If a “CI identity” cannot be located, then perhaps the rhetoric that is used to describe it may be. Paddy Ladd, in Understanding Deaf Culture, does a brilliant job of exploring the various discourses that have surrounded deaf culture throughout history. Stuart Blume borrows heavily from Ladd in his “The Rhetoric and Counter-Rhetoric of a 'Bionic' Technology”, where he points out that an “essential and deliberate feature” of the history of the CI from the 60s onward, was that it was constructed in an overwhelmingly positive light by the mass media, using what Ladd calls the “medical” rhetorical model. That is, that the CI is a kind of medical miracle that promised to cure deafness. Within this model one may find also the sentimental, “missionary” rhetoric that Krentz discusses, what Ladd claims is a revival of the evangelism of the nineteenth-century Oralist movement in America. Indeed, newspaper articles in the 1980s and 90s hailed the implant as a “breakthrough”, a “miracle”; even a quick survey of headlines shows evidence of this: “Upton Boy Can Hear at Last!”, “Girl with a New Song in Her Heart”, “Children Head Queue for Bionic Ears” (Lane). As recently as January 2010, an issue of National Geographic featured on its cover the headline Merging Man and Machine: The Bionic Age. Sure enough, the second photograph in the story is of a child’s bilateral cochlear implant, with the caption “within months of the surgery (the child) spoke the words his hearing parents longed for: Mama and Dada.” “You’re looking at a real bionic kid,” says Johns Hopkins University surgeon John Niparko, proudly (37). To counter this medical/corporate rhetoric of cure, Ladd and Blume claim, the deaf community devised a counter-rhetoric, a discourse in which the CI is not cast in the language of miracle and life, but instead in terms of death, mutilation, and cultural oppression. Here, the implant is depicted as the last in a long line of sadistic experiments using the deaf as guinea pigs. Often the CI is framed in the language of Nazism and genocide as seen in the title of an article in the British Deaf News: “Cochlear Implants: Oralism’s Final Solution.” So, which of these two “implanting rhetorics” is most visible in the current construction of the CI in American television? Is the CI identity presented by rendering people with CIs impossibly positive, happy characters? Is it delineated using the metaphors of the sentimental, of cure, of miracle? Or is the CI identity constructed using the counter-rhetorical references to death, oppression and cultural genocide? One might hypothesize that television, like other media, cultivating as it does the values of the hearing hegemony, would err on the side of promulgating the medicalised, positivist rhetoric of the “cure” for deafness. In an effort to find out, I conducted a general survey of American television shows from 2000 to now that featured characters with CIs. I did not include news shows or documentaries in my survey. Interestingly, some of the earliest television portrayals of CIs appeared in that bastion of American sentimentality, the daytime soap opera. In 2006, on the show “The Young and the Restless”, a “troubled college student who contracted meningitis” received an implant, and in 2007 “All My Children” aired a story arc about a “toddler who becomes deaf after a car crash.” It is interesting to note that both characters were portrayed as “late-deafened”, or suddenly inflicted with the loss of a sense they previously possessed, thus avoiding any whiff of controversy about early implantation. But one expects a hyper-sentimentalised portrayal of just about everything in daytime dramas like this. What is interesting is that when people with CIs have appeared on several “reality” programs, which purport to offer “real,” unadulterated glimpses into people’s lives, the rhetoric is no less sentimentalized than the soaps (perhaps because these shows are no less fabricated). A good example of this is the widely watched and, I think, ironically named show “True Life” which appears on MTV. This is a series that claims to tell the “remarkable real-life stories of young people and the unusual subcultures they inhabit.” In episode 42, “ True Life: I’m Deaf”, part of the show follows a young man, Chris, born deaf and proud of it (his words), who decides to get a cochlear implant because he wants to be involved in the hearing world. Through an interpreter Chris explains that he wants an implant so he can communicate with his friends, talk with girls, and ultimately fulfill his dreams of having a job and getting married (one has to ask: are these things he can’t do without an implant?). The show’s promo asks “how do you go from living a life in total silence to fully understanding the spoken language?” This statement alone contains two elements common to the “miracle” rhetoric, first that the “tragic” deaf victim will emerge from a completely lonely, silent place (not true; most deaf people have some residual hearing, and if you watch the show you see Chris signing, “speaking” voluminously) to seamlessly, miraculously, “fully” joining and understanding the hearing world. Chris, it seems, will only come into full being when he is able to join the hearing world. In this case, the CI will cure what ails him. According to “True Life.” Aside from “soap opera” drama and so-called reality programming, by far the largest dissemination of media constructions of the CI in the past ten years occurred on top-slot prime-time television shows, which consist primarily of the immensely popular genre of the medical and police procedural drama. Most of these shows have at one time or another had a “deaf” episode, in which there is a deaf character or characters involved, but between 2005 and 2008, it is interesting to note that most, if not all of the most popular of these have aired episodes devoted to the CI controversy, or have featured deaf characters with CIs. The shows include: CSI (both Miami and New York), Cold Case, Law and Order (both SVU and Criminal Intent), Scrubs, Gideon’s Crossing, and Bones. Below is a snippet of dialogue from Bones: Zach: {Holding a necklace} He was wearing this.Angela: Catholic boy.Brennan: One by two forceps.Angela {as Brennan pulls a small disc out from behind the victim’s ear} What is that?Brennan: Cochlear implant. Looks like the birds were trying to get it.Angela: That would set a boy apart from the others, being deaf.(Bones, “A Boy in the Tree”, 1.3, 2005) In this scene, the forensics experts are able to describe significant points of this victim’s identity using the only two solid artifacts left in the remains, a crucifix and a cochlear implant. I cite this scene because it serves, I believe, as a neat metaphor for how these shows, and indeed television media in general, are, like the investigators, constantly engaged in the business of cobbling together identity: in this particular case, a cochlear implant identity. It also shows how an audience can cultivate or interpret these kinds of identity constructions, here, the implant as an object serves as a tangible sign of deafness, and from this sign, or clue, the “audience” (represented by the spectator, Angela) immediately infers that the victim was lonely and isolated, “set apart from the others.” Such wrongheaded inferences, frivolous as they may seem coming from the realm of popular culture, have, I believe, a profound influence on the perceptions of larger society. The use of the CI in Bones is quite interesting, because although at the beginning of the show the implant is a key piece of evidence, that which marks and identifies the dead/deaf body, the character’s CI identity proves almost completely irrelevant to the unfolding of the murder-mystery. The only times the CI character’s deafness is emphasized are when an effort is made to prove that the he committed suicide (i.e., if you’re deaf you are therefore “isolated,” and therefore you must be miserable enough to kill yourself). Zak, one of the forensics officers says, “I didn’t talk to anyone in high school and I didn’t kill myself” and another officer comments that the boy was “alienated by culture, by language, and by his handicap” (odd statements, since most deaf children with or without implants have remarkably good language ability). Also, in another strange moment, the victim’s ambassador/mother shows a video clip of the child’s CI activation and says “a person who lived through this miracle would never take his own life” (emphasis mine). A girlfriend, implicated in the murder (the boy is killed because he threatened to “talk”, revealing a blackmail scheme), says “people didn’t notice him because of the way he talked but I liked him…” So at least in this show, both types of “implanting rhetoric” are employed; a person with a CI, though the recipient of a “miracle,” is also perceived as “isolated” and “alienated” and unfortunately, ends up dead. This kind of rather negative portrayal of a person with a CI also appears in the CSI: New York episode ”Silent Night” which aired in 2006. One of two plot lines features Marlee Matlin as the mother of a deaf family. At the beginning of the episode, after feeling some strange vibrations, Matlin’s character, Gina, checks on her little granddaughter, Elizabeth, who is crying hysterically in her crib. She finds her daughter, Alison, dead on the floor. In the course of the show, it is found that a former boyfriend, Cole, who may have been the father of the infant, struggled with and shot Alison as he was trying to kidnap the baby. Apparently Cole “got his hearing back” with a cochlear implant, no longer considered himself Deaf, and wanted the child so that she wouldn’t be raised “Deaf.” At the end of the show, Cole tries to abduct both grandmother and baby at gunpoint. As he has lost his external transmitter, he is unable to understand what the police are trying to tell him and threatens to kill his hostages. He is arrested in the end. In this case, the CI recipient is depicted as a violent, out of control figure, calmed (in this case) only by Matlin’s presence and her ability to communicate with him in ASL. The implication is that in getting the CI, Cole is “killing off” his Deaf identity, and as a result, is mentally unstable. Talking to Matlin, whose character is a stand-in for Deaf culture, is the only way to bring him back to his senses. The October 2007 episode of CSI: Miami entitled “Inside-Out” is another example of the counter-rhetoric at work in the form of another implant corpse. A police officer, trying to prevent the escape of a criminal en route to prison, thinks he has accidentally shot an innocent bystander, a deaf woman. An exchange between the coroner and a CSI goes as follows: (Alexx Woods): “This is as innocent as a victim gets.”(Calleigh Duquesne): “How so?”AW: Check this out.”CD: “I don’t understand. Her head is magnetized? Steel plate?”AW: “It’s a cochlear implant. Helps deaf people to receive and process speech and sounds.”(CSI dramatization) AW VO: “It’s surgically implanted into the inner ear. Consists of a receiver that decodes and transmits to an electrode array sending a signal to the brain.”CD: “Wouldn’t there be an external component?”AW: “Oh, she must have lost it before she was shot.”CD: “Well, that explains why she didn’t get out of there. She had no idea what was going on.” (TWIZ) Based on the evidence, the “sign” of the implant, the investigators are able to identify the victim as deaf, and they infer therefore that she is innocent. It is only at the end of the program that we learn that the deaf “innocent” was really the girlfriend of the criminal, and was on the scene aiding in his escape. So she is at first “as innocent” as they come, and then at the end, she is the most insidious of the criminals in the episode. The writers at least provide a nice twist on the more common deaf-innocent stereotype. Cold Case showcased a CI in the 2008 episode “Andy in C Minor,” in which the case of a 17-year-old deaf boy is reopened. The boy, Andy, had disappeared from his high school. In the investigation it is revealed that his hearing girlfriend, Emma, convinced him to get an implant, because it would help him play the piano, which he wanted to do in order to bond with her. His parents, deaf, were against the idea, and had him promise to break up with Emma and never bring up the CI again. His body is found on the campus, with a cochlear device next to his remains. Apparently Emma had convinced him to get the implant and, in the end, Andy’s father had reluctantly consented to the surgery. It is finally revealed that his Deaf best friend, Carlos, killed him with a blow to the back of the head while he was playing the piano, because he was “afraid to be alone.” This show uses the counter-rhetoric of Deaf genocide in an interesting way. In this case it is not just the CI device alone that renders the CI character symbolically “dead” to his Deaf identity, but it leads directly to his being literally executed by, or in a sense, excommunicated from, Deaf Culture, as it is represented by the character of Carlos. The “House Divided” episode of House (2009) provides the most problematic (or I should say absurd) representation of the CI process and of a CI identity. In the show, a fourteen-year-old deaf wrestler comes into the hospital after experiencing terrible head pain and hearing “imaginary explosions.” Doctors Foreman and Thirteen dutifully serve as representatives of both sides of the “implant debate”: when discussing why House hasn’t mocked the patient for not having a CI, Thirteen says “The patient doesn’t have a CI because he’s comfortable with who he is. That’s admirable.” Foreman says, “He’s deaf. It’s not an identity, it’s a disability.” 13: “It’s also a culture.” F: “Anything I can simulate with $3 earplugs isn’t a culture.” Later, House, talking to himself, thinks “he’s going to go through life deaf. He has no idea what he’s missing.” So, as usual, without permission, he orders Chase to implant a CI in the patient while he is under anesthesia for another procedure (a brain biopsy). After the surgery the team asks House why he did it and he responds, “Why would I give someone their hearing? Ask God the same question you’d get the same answer.” The shows writers endow House’s character, as they usually do, with the stereotypical “God complex” of the medical establishment, but in doing also they play beautifully into the Ladd and Blume’s rhetoric of medical miracle and cure. Immediately after the implant (which the hospital just happened to have on hand) the incision has, miraculously, healed overnight. Chase (who just happens to be a skilled CI surgeon and audiologist) activates the external processor (normally a months-long process). The sound is overwhelming, the boy hears everything. The mother is upset. “Once my son is stable,” the mom says, “I want that THING out of his head.” The patient also demands that the “thing” be removed. Right after this scene, House puts a Bluetooth in his ear so he can talk to himself without people thinking he’s crazy (an interesting reference to how we all are becoming cyborgs, more and more “implanted” with technology). Later, mother and son have the usual touching sentimental scene, where she speaks his name, he hears her voice for the first time and says, “Is that my name? S-E-T-H?” Mom cries. Seth’s deaf girlfriend later tells him she wishes she could get a CI, “It’s a great thing. It will open up a whole new world for you,” an idea he rejects. He hears his girlfriend vocalize, and asks Thirteen if he “sounds like that.” This for some reason clinches his decision about not wanting his CI and, rather than simply take off the external magnet, he rips the entire device right out of his head, which sends him into shock and system failure. Ultimately the team solves the mystery of the boy’s initial ailment and diagnoses him with sarcoidosis. In a final scene, the mother tells her son that she is having them replace the implant. She says it’s “my call.” This show, with its confusing use of both the sentimental and the counter-rhetoric, as well as its outrageous inaccuracies, is the most egregious example of how the CI is currently being constructed on television, but it, along with my other examples, clearly shows the Ladd/Blume rhetoric and counter rhetoric at work. The CI character is on one hand portrayed as an innocent, infantilized, tragic, or passive figure that is the recipient of a medical miracle kindly urged upon them (or forced upon them, as in the case of House). On the other hand, the CI character is depicted in the language of the counter-rhetoric: as deeply flawed, crazed, disturbed or damaged somehow by the incursions onto their Deaf identity, or, in the worst case scenario, they are dead, exterminated. Granted, it is the very premise of the forensic/crime drama to have a victim, and a dead victim, and it is the nature of the police drama to have a “bad,” criminal character; there is nothing wrong with having both good and bad CI characters, but my question is, in the end, why is it an either-or proposition? Why is CI identity only being portrayed in essentialist terms on these types of shows? Why are there no realistic portrayals of people with CIs (and for that matter, deaf people) as the richly varied individuals that they are? These questions aside, if these two types of “implanting rhetoric”, the sentimentalised and the terminated, are all we have at the moment, what does it mean? As I mentioned early in this essay, deaf people, along with many “others,” have long helped to highlight and define the hegemonic “norm.” The apparent cultural need for a Foucauldian “marked body” explains not only the popularity of crime dramas, but it also could explain the oddly proliferant use of characters with cochlear implants in these particular shows. A person with an implant on the side of their head is definitely a more “marked” body than the deaf person with no hearing aid. The CI character is more controversial, more shocking; it’s trendier, “sexier”, and this boosts ratings. But CI characters are, unlike their deaf predecessors, now serving an additional cultural function. I believe they are, as I claim in the beginning of this essay, screens upon which our culture is now projecting repressed anxieties about emergent technology. The two essentialist rhetorics of the cochlear implant, the rhetoric of the sentimental, medical model, and the rhetoric of genocide, ultimately represent our technophilia and our technophobia. The CI character embodies what Debra Shaw terms a current, “ontological insecurity that attends the interface between the human body and the datasphere” (85). We are growing more nervous “as new technologies shape our experiences, they blur the lines between the corporeal and incorporeal, between physical space and virtual space” (Selfe). Technology either threatens the integrity of the self, “the coherence of the body” (we are either dead or damaged) or technology allows us to transcend the limitations of the body: we are converted, “transformed”, the recipient of a happy modern miracle. In the end, I found that representations of CI on television (in the United States) are overwhelmingly sentimental and therefore essentialist. It seems that the conflicting nineteenth century tendency of attraction and revulsion toward the deaf is still, in the twenty-first century, evident. We are still mired in the rhetoric of “cure” and “control,” despite an active Deaf counter discourse that employs the language of the holocaust, warning of the extermination of yet another cultural minority. We are also daily becoming daily more “embedded in cybernetic systems,” with our laptops, emails, GPSs, PDAs, cell phones, Bluetooths, and the likes. We are becoming increasingly engaged in a “necessary relationship with machines” (Shaw 91). We are gradually becoming no longer “other” to the machine, and so our culturally constructed perceptions of ourselves are being threatened. In the nineteenth century, divisions and hierarchies between a white male majority and the “other” (women, African Americans, immigrants, Native Americans) began to blur. Now, the divisions between human and machine, as represented by a person with a CI, are starting to blur, creating anxiety. Perhaps this anxiety is why we are trying, at least in the media, symbolically to ‘cure’ the marked body or kill off the cyborg. Future examinations of the discourse should, I believe, use these media constructions as a lens through which to continue to examine and illuminate the complex subject position of the CI identity, and therefore, perhaps, also explore what the subject position of the post/human identity will be. References "A Boy in a Tree." Patrick Norris (dir.), Hart Hanson (by), Emily Deschanel (perf.). Bones, Fox Network, 7 Sep. 2005. “Andy in C Minor.” Jeannete Szwarc (dir.), Gavin Harris (by), Kathryn Morris (perf.). Cold Case, CBS Network, 30 March 2008. Blume, Stuart. “The Rhetoric and Counter Rhetoric of a “Bionic” Technology.” Science, Technology and Human Values 22.1 (1997): 31-56. Brueggemann, Brenda Jo. Deaf Subjects: Between Identities and Places. New York: New York UP, 2009. “Cochlear Implant Statistics.” ASL-Cochlear Implant Community. Blog. Citing Laurent Le Clerc National Deaf Education Center. Gallaudet University, 18 Mar. 2008. 29 Apr. 2010 ‹http:/ /aslci.blogspot.com/2008/03/cochlear-implant-statistics.html›. “Cures to Come.” Discover Presents the Brain (Spring 2010): 76. Fischman, Josh. “Bionics.” National Geographic Magazine 217 (2010). “House Divided.” Greg Yaitanes (dir.), Matthew V. Lewis (by), Hugh Laurie (perf.). House, Fox Network, 22 Apr. 2009. “Inside-Out.” Gina Lamar (dir.), Anthony Zuiker (by), David Caruso (perf.). CSI: Miami, CBS Network, 8 Oct. 2007. Krentz, Christopher. Writing Deafness: The Hearing Line in Nineteenth-Century American Literature. Chapel Hill: UNC P, 2007. Ladd, Paddy. Understanding Deaf Culture: In Search of Deafhood. Clevedon, UK: Multilingual Matters Limited, 2002. Lane, Harlan. A Journey Into the Deaf-World. San Diego: DawnSignPress, 1996. “NAD Position Statement on the Cochlear Implant.” National Association of the Deaf. 6 Oct. 2000. 29 April 2010 ‹http://www.nad.org/issues/technology/assistive-listening/cochlear-implants›. Nussbaum, Debra. “Manufacturer Information.” Cochlear Implant Information Center. National Deaf Education Center. Gallaudet University. 29 Apr. 2010 < http://clerccenter.gallaudet.edu >. Shaw, Debra. Technoculture: The Key Concepts. Oxford: Berg, 2008. “Silent Night.” Rob Bailey (dir.), Anthony Zuiker (by), Gary Sinise (perf.). CSI: New York, CBS Network, 13 Dec. 2006. “Sweet Nothing in My Ear.” Joseph Sargent (dir.), Stephen Sachs (by), Jeff Daniels (perf.). Hallmark Hall of Fame Production, 20 Apr. 2008. TWIZ TV scripts. CSI: Miami, “Inside-Out.” “What Is the Surgery Like?” FAQ, University of Miami Cochlear Implant Center. 29 Apr. 2010 ‹http://cochlearimplants.med.miami.edu/faq/index.asp›.

IntroductionThe tagline for the 2008 Game On exhibition at the Australian Centre for the Moving Image in Melbourne invites visitors to “play your way through the history of videogames.” The Melbourne hosting follows on from exhibitions that have included the Barbican (London), the Royal Museum (Edinburgh) and the Science Museum (London). The Game On exhibition presents an exemplary instance of how digital games and digital games culture are recovered, organised and presented. The Science Museum exhibition offered visitors a walkthrough from the earliest to the latest consoles and games (Pong to Wii Sports) with opportunities for game play framed by curatorial plaques. This article will explore some of the themes and narratives embodied within the exhibition that see digital games technologies enrolled within a media teleology that emphasises technological advancement and upgrade. Narratives of Technological Upgrade The Game On exhibition employed a “social contextualisation” approach, connecting digital gaming developments with historical events and phenomena such as the 1969 moon landing and the Spice Girls. Whilst including thematic strands such as games and violence and games in education, the exhibition’s chronological ordering highlighted technological advancement. In doing so, the exhibition captured a broader tension around celebrating past technological advancement in gaming, whilst at the same time emphasising the quaint shortfalls and looking to future possibilities. That technological advancements stand out, particularly as a means of organising a narrative of digital gaming, resonates with Stephen Kline, Nick Dyer-Withford and Greig de Peuter’s analysis of digital gaming as a “perpetual innovation economy.” For Kline et al., corporations “devote a growing share of their resources to the continual alteration and upgrading of their products” (66). Technological upgrade and advancement were described by the Game On curator as an engaging aspect of the exhibition: When we had a BBC news presenter come in, she was talking about ‘here we have the PDP 1 and here I have the Nintendo DS’. She was just sort of comparing and contrasting. I know certainly that journalists were very keen on: ‘yeah, but how much processing power does the PDP 1 have?’, ‘what does it compare to today?’ – and it is very hard to compare. How do you compare Space War on the PDP 1 with something that runs on your mobile phone? They are very different systems. (Lee)This account of journalistic interest in technological progression and the curator’s subsequent interpretation raise a significant tension around understanding digital gaming. The concern with situating past gaming technologies and comparing capacities and capabilities, emphasises both the fascination with advancement and technological progress in the field and how the impressiveness of this advancement depends on remembering what has come before. Questions of remembering, recovering and forgetting are clear in the histories that console manufacturers offer when they describe past innovation and pioneering developments. For example, the company history provided by Nintendo on its website is exclusively a history of games technologies with no reference to the proceeding business of playing-card games from the late nineteenth century. Its website-published history only starts with the 1985 release of the NES (Nintendo Entertainment System), “an instant hit [that] over the course of the next two years, it almost single-handedly revitalized the video game industry” (Nintendo, ‘History’), and thereby overlooks the earlier 1983 less successful Famicom system. Past technologies are selectively remembered and recovered as part of the foundations for future success. This is a tension, that can be unpacked in a number of ways, across current industry transformations and strategies that potentially erase the past whilst simultaneously seeking to recover it as part of an evidence-base for future development. The following discussion develops an analysis of how digital gaming history is recovered and constructed.Industry Wind Change and Granny on the WiiThere is “unease, almost embarrassment”, James Newman suggests, “about the videogames industry within certain quarters of the industry itself” (6). Newman goes on to suggest:Various euphemisms have passed into common parlance, all seemingly motivated by a desire to avoid the use of the word ‘game’ and perhaps even ‘computer’, thereby adding a veneer of respectability, distancing the products and experiences from the childish pursuits of game, play and toys, and downplaying the technology connection with its unwanted resonances of nerds in bedrooms hunched over ZX Spectrums and Commodore 64s and the amateurism of hobbyist production. (6-7) The attempted move away from the resonances of “nerds in bedrooms” has been a strategic decision for Nintendo especially. This is illustrated by the naming of consoles: ‘family’ in Famicom, ‘entertainment’ in NES and, more recently, the renaming of the Wii from ‘Revolution’. The seventh generation Nintendo Wii console, released in November and December 2006, may be been seen as industry leading in efforts to broaden gaming demographics. In describing the console for instance, Satoru Iwata, the President of Nintendo, stated, “we want to appeal to mothers who don't want consoles in their living rooms, and to the elderly and to young women. It’s a challenge, like trying to sell cosmetics to men” (Edge Online). This position illustrates a digital games industry strategy to expand marketing to demographic groups previously marginalised.A few examples from the marketing and advertising campaigns for the Nintendo Wii help to illustrate this strategy. The marketing associated with the Wii can be seen as part of a longer lineage of Nintendo marketing with Kline et al. suggesting, “it was under Nintendo’s hegemony that the video game industry began to see the systematic development of a high-intensity marketing apparatus, involving massive media budgets, ingenious event marketing, ground breaking advertising and spin off merchandising” (118). The “First Experiences” show on the Wii website mocks-up domestic settings as the backdrop to the Wii playing experience to present an ideal, potential Wii-play scenario. These advertisements can be seen to position the player within an imagined home and game-play environment and speak for the Wii. As Keith Grint and Steve Woolgar suggest, “technology does not speak for itself but has to be spoken for” (32). As part of their concern with addressing, “the particular regime of truth which surrounds, upholds, impales and represents technology” (32), Grint and Woolgar “analyse the way certain technologies gain specific attributes” (33). Across advertisements for the Wii there are a range of domestic environments and groups playing. Of these, the power to bring the family together and facilitate ease of game-play for the novice is most noticeable. David Morley’s comment that, “‘hi-tech’ discourse is often carefully framed and domesticated by a rather nostalgic vision of ‘family values’” (438) is borne out here.A television advertisement aired on Nickelodeon illustrates the extent to which the Wii was at the forefront in motioning forward a strategy of industry and gaming inclusiveness around the family: “the 60-second spot shows a dad mistaking the Wii Remote for his television remote control. Dad becomes immersed in the game and soon the whole family joins in” (Nintendo World Report). From confused fathers to family bonding, the Wii is presented as the easy-to-use and accessible device that brings the family together. The father confusing the Wii remote with a television remote control is an important gesture to foreground the accessibility of the Wii remotes compared to previous “joypads”, and emphasize the Wii as an accessible device with no bedroom, technical wizardry required. Within the emerging industry inclusivity agenda, the ‘over technological’ past of digital gaming is something to move away from. The forms of ‘geek’ or ‘hardcore’ that epitomise previous dominant representations of gaming have seemingly stood in the way of the industry reaching its full market potential. This industry wind change is captured in the comments of a number of current industry professionals.For Matthew Jeffrey, head of European Recruitment for Electronic Arts (EA), speaking at the London Games Week Career Fair, the shift in the accessibility and inclusivity of digital gaming is closely bound up with Nintendo’s efforts and these have impacted upon EA’s strategy: There is going to be a huge swathe of new things and the great thing in the industry, as you are all easy to identify, is that Nindento DS and the Wii have revolutionised the way we look at the way things are going on.Jeffrey goes on to add, “hopefully some of you have seen that your eighty year old grandparent is quite happy to play a game”, pointing to the figure of the grandparent as a game-player to emphasise the inclusivity shift within gaming.Similarly, at Edinburgh Interactive Festival 2007, the CEO of Ubisoft Yves Guillemot in his “The New Generation of Gaming: Facing the Challenges of a Changing Market” speech outlined the development of a family friendly portfolio to please a new, non-gamer population that would include the recruitment of subject experts for “non-game” titles. This instance of the accessibility and inclusivity strategy being advocated is notable for it being part of a keynote speech at the Edinburgh Interactive Festival, an event associated with the Edinburgh festival that is both an important industry gathering and receives mainstream press coverage. The approaches taken by the other leading console manufacturers Sony and Microsoft, illustrate that whilst this is by no means a total shift, there is nevertheless an industry-wide engagement. The ‘World of Playstation: family and friends’ for example suggests that, “with PlayStation, games have never been more family-friendly” and that “you can even team up as a family to challenge your overseas relatives to a round of online quizzing over the PLAYSTATION Network” (Playstation).What follows from these accounts and transformations is a consideration of where the “geeky” past resides in the future of gaming as inclusive and accessible. Where do these developments leave digital gaming’s “subcultural past” (“subcultural” as it now becomes even within the games industry), as the industry forges on into mainstream culture? Past digital games technologies are clearly important in indicating technological progression and advancement, but what of the bedroom culture of gaming? How does “geek game culture” fit within a maturing future for the industry?Bedroom Programmers and Subcultural Memories There is a tension between business strategy directed towards making gaming accessible and thereby fostering new markets, and the games those in industry would design for people like themselves. This is not to deny the willingness or commitment of games developers to work on a variety of games, but instead to highlight transformation and tension. In their research into games development, Dovey and Kennedy suggest that, the “generation, now nearing middle-age and finding themselves in the driving seat of cultures of new media, have to reconcile a subcultural history and a dominant present” (145). Pierre Bourdieu’s account of symbolic capital is influential in tracing this shift, and Dovey and Kennedy note Bourdieu’s comment around, “the subjective image of the occupational project and the objective function of the occupation” (145). This shift is highly significant for ways of understanding maturation and inclusivity strategies within digital gaming.Bourdieu’s account of the “conservative functions attached” to an occupation for Dovey and Kennedy: Precisely describes the tensions between designers’ sense of themselves as ‘outsiders’ and rebels (‘the subjective image of the occupational project’) on the one hand and their position within a very tight production machine (‘the objective function of the occupation’) on the other. (145) I would suggest the “production machine”, that is to say the broader corporate management structures by which games development companies are increasingly operated, has a growing role in understandings of the industry. This approach was implicit in Iwata’s comments on selling cosmetics to men and broadening demographics, and Jeffrey’s comments pointing to how EA’s outlook would be influenced by the accessibility and inclusivity strategy championed by Nintendo. It may be suggested that as the occupational project of gaming is negotiated and shifts towards an emphasis on accessibility and inclusivity, the subjective image must be similarly reoriented. That previous industry models are being replaced, is highlighted in this excerpt from a Managing Director of a ‘leisure software’ company in the Staying ahead report on the creative industries by the Work Foundation:The first game that came from us was literally two schoolchildren making a game in their bedroom … the game hadn’t been funded, but made for fun … As those days are gone, the biggest challenges nowadays for game developers are finding funding that doesn’t impinge on creativity, and holding onto IP [intellectual property], which is so important if you want a business that is going to have any value. (27)This account suggests a hugely important transition from bedroom production, the days that ‘are gone’, towards Intellectual Property-aware production. The creative industries context for these comments should not be overlooked and is insightful for further recognising the shifts and negotiations taking place in digital gaming, notably, around the maturation of the games industry. The creative industries context is made explicit in creative industries reports such as Staying ahead and in the comments of Shaun Woodward (former Parliamentary Under-Secretary of State at the Department for Culture, Media and Sport) in a keynote speech at the 2006 British Video Games Academy Awards, in which he referred to the games industry as “one of our most important creative industries”. The forms of collaboration between, for instance, The Independent Games Developers Association (TIGA) and the Department of Culture, Media and Sport (see Gamasutra), further indicate the creative industries context to the maturation of the UK games industry.The creative industries context also presents the anchor through which tensions between a subcultural history and professional future and the complex forms of recovery can be more fully engaged with. The Game On curator’s indication that making comparisons between different games technologies systems was a delicate balance insightfully provides cautions to any attempt to mark out a strict departure from the ‘subcultural’ to the ‘professional’. Clearly put, the accessibility and inclusivity strategy that shifts away from geek culture and technical wizardry remains in conversation with geek elements as the foundation for the future. As technologies are recovered within a lineage of technological development and upgrade, the geek bedroom culture of gaming is almost mythologized to offer the industry history creative credentials and future potential. Recovering and Combining: Technologies and Memories for a Professional Future Emphasised thus far has been a shift from the days gone by of bedroom programming towards an inclusive and accessible professional and mature future. This is a teleological shift in the sense that the latest technological developments can be located within a past replete with innovation and pioneering spirit. In relation to the Wii for example, a Nintendo employee states:Nintendo is a company where you are praised for doing something different from everyone else. In this company, when an individual wants to do something different, everyone else lends their support to help them overcome any hurdles. I think this is how we made the challenge of Wii a possibility. (Nintendo)Nintendo’s history, alluded to here and implicit throughout the interviews with Nintendo staff from which this comment is taken, and previous and existing ‘culture’ of experimentation is offered here as the catalyst and enabler of the Wii. A further example may be offered in relation to Nintendo’s competitor Sony.A hugely significant transformation in digital gaming, further to the accessibility and inclusivity agenda, is the ability of players to develop their own games using games engines. For Phil Harrison (Sony), gaming technology is creating a, “‘virtual community’ of collaborative digital production, marking a return to the ‘golden age of video game development, which was at home, on your own with a couple of friends, designing a game yourself’” (Kline et al., 204). Bedroom gaming that in the earlier comments was regarded as days gone by for professionals, takes on a new significance as a form of user-engagement. The previous model of bedroom production, now outmoded compared to industry production, is relocated as available for users and recovered as the ‘golden age of gaming’. It is recovered as a model for users to aspire to. The significance of this for business strategy is made clear by Kline et al. who suggest that, “thousands of bright bulbs have essentially become Sony’s junior development community” (204). An obsolete model of past production is recovered and deployed within a future vision of the games industry that sees users participating and extending forms of games engagement and consumption. Similarly, the potential of ‘bedroom’ production and its recovery in relation to growth areas such as games for mobile phones, is carefully framed by Intellectual Property Rights (Edwards and Coulton). In this respect, forms of bedroom production are carefully situated in terms of industry strategies.The “Scarce Talent Seminars” as part of the London Games Week 2008 “Skills Week” further illustrate this continual recovery of ‘past’, or more accurately alternative, forms of production in line with narratives of professionalisation and industry innovation. The seminars were stated as offering advice on bridging the gap between the “bedroom programmer” and the “professional developer”. The discourse of ‘talent’ framed this seminar, and the bedroom programmer is held up as being (not having) raw talent with creative energies and love and commitment for gaming that can be shaped for the future of the industry. This discourse of bedroom programmers as talent emphasises the industry as an enabler of individual talent through access to professional development and technological resources. This then sits alongside the recovery of historical narratives in which bedroom gaming culture is celebrated for its pioneering spirit, but is ultimately recovered in terms of current achievements and future possibilities. “Skills Week” and guidance for those wanting to work in the industry connects with the recovery of past technologies and ways of making games visible amongst the potential industry workers of the future – students. The professional future of the industry is intertwined with graduates with professional qualifications. Those qualifications need not be, and sometimes preferably should not be, in ‘gaming’ courses. What is important is the love of games and this may be seen through the appreciation of gaming’s history. During research conducted with games design students in higher education courses in the UK, many students professed a love of games dating back to the Spectrum console in the 1980s. There was legitimacy and evidence of professing long-seated interests in consoles. At the same time as acknowledging the significant, embryonic power these consoles had in stimulating their interests, many students engaged in learning games design skills with the latest software packages. Similarly, they engaged in bedroom design activities themselves, as in the days gone by, but mainly as training and to develop skills useful to securing employment within a professional development studio. Broadly, students could be said to be recovering both technologies and ways of working that are then enrolled within their development as professional workers of the future. The professional future of the gaming industry is presented as part of a teleological trajectory that mirrors the technological progression of the industry’s upgrade culture. The days of bedroom programming are cast as periods of incubation and experimentation, and part of the journey that has brought gaming to where it is now. Bedroom programming is incorporated into the evidence-base of creative industries policy reports. Other accounts of bedroom programming, independent production and attempts to explore alternative publishing avenues do not feature as readily.In the 2000 Scratchware Manifesto for example, the authors declare, “the machinery of gaming has run amok”, and say, “Basta! Enough!” (Scratchware). The Scratchware Manifesto puts forward Scratchware as a response: “a computer game, created by a microteam, with pro-quality art, game design, programming and sound to be sold at paperback prices” (Scratchware). The manifesto goes on to say, “we need Scratchware because there is more than one way to develop good computer games” (Scratchware, 2000). Using a term readily associated with the Zapatista Army of National Liberation, the Scratchware Manifesto called for a revolution in gaming and stated, “we will strive for […] originality over the tried and tested” (Scratchware). These are the experiences and accounts of the games industry that seem to fall well outside of the technological and upgrade focused agenda of professional games development.The recovery and framing of past technologies and industry practices, in ways supportive to current models of technological upgrade and advancement, legitimises these models and marginalizes others. A eulogized and potentially mythical past is recovered to point to cultures of innovation and creative vibrancy and to emphasize current and future technological prowess. We must therefore be cautious of the instrumental dangers of recovery in which ‘bright bulbs’ are enrolled and alternative forms of production marginalised.As digital gaming establishes a secure footing with increased markets, the growing pains of the industry can be celebrated and recovered as part of the ongoing narratives of the industry. Recovery is vital to make sense of both the past and future. Within digital gaming, the PDP-1 and the bedroom geek both exist in the past, present and future as part of an industry strategy and trajectory that seeks to move away from them but also relies on them. They are the legitimacy, the evidence and the potential for affirming industry models. The extent to which other narratives can be told and technologies and memories recovered as alternative forms of evidence and potential is a question I, and hopefully others, will leave open.ReferencesDovey, John, and Helen W. Kennedy. Game Cultures. Maidenhead: Open University Press, 2006.Edge-Online. "Iwata: Wii Is 'Like Selling Make-Up to Men.'" Edge-Online 19 Sep. 2006. 29 Sep. 2006 ‹http://www.edge-online.com/news/iwata-wii-like-selling-make-up-men›.Edwards, Reuben, and Paul Coulton. "Providing the Skills Required for Innovative Mobile Game Development Using Industry/Academic Partnerships." Italics e journal 5.3 (2006). ‹http://www.ics.heacademy.ac.uk/italics/vol5iss3/edwardscoulton.pdf›.Gamasutra. "TIGA Pushing for Continued UK Industry Government Support." Gamasutra Industry News 3 July 2007. 8 July 2007 ‹http://www.gamasutra.com/php-bin/news_index.php?story=14504›Grint, Keith, and Steve Woolgar. The Machine at Work. London: Blackwell, 1997.Jeffrey, Matthew. Transcribed Speech. 24 October 2007.Kline, Stephen, Nick Dyer-Witheford, and Greig De Peuter. Digital Play. London: McGill-Queen’s University Press, 2003.Lee, Gaetan. Personal Interview. 27 July 2007.Morley, David. "What’s ‘Home’ Got to Do with It? Contradictory Dynamics in the Domestication of Technology and the Dislocation of Domesticity." European Journal of Cultural Studies 6.4 (2003): 435-458.Newman, James. Videogames. London: Routledge, 2004.Nintendo. "Company History." Nintendo. 2007. 3 Nov. 2008 ‹http://www.nintendo.com/corp/history.jsp›.Nintendo. "Wii Remote." Nintendo. 2006. 29 Sep. 2008 ‹http://wiiportal.nintendo-europe.com/97.html›.Nintendo World Report. "Nintendo’s Marketing Blitz: Wii Play for All!" Nintendo World Report 13 Nov. 2006. 29 Sep. 2008 ‹http://www.nintendoworldreport.com/newsArt.cfm?artid=12383›.Playstation. "World of Playstation: Family and Friends." Sony Playstation. 3 Nov. 2008 ‹http://uk.playstation.com/home/news/articles/detail/item103208/World-of-PlayStation:-Family-&-Friends/›.Scratchware. "The Scratchware Manifesto." 2000. 14 June 2006 ‹http://www.the-underdogs.info/scratch.php›.Work Foundation. Staying Ahead: The Economic Performance of the UK’s Creative Industries. London: Department of Culture, Media and Sport, 2007.

If I find out that you have bought a $90 red light sabre, Tara, well there's going to be trouble. -- Kevin Brabazon A few Saturdays ago, my 71-year old father tried to convince me of imminent responsibilities. As I am considering the purchase of a house, there are mortgages, bank fees and years of misery to endure. Unfortunately, I am not an effective Big Picture Person. The lure of the light sabre is almost too great. For 30 year old Generation Xers like myself, it is more than a cultural object. It is a textual anchor, and a necessary component to any future history of the present. Revelling in the aura of the Australian release for Star Wars: The Phantom Menace, this paper investigates popular memory, an undertheorised affiliation between popular culture and cultural studies.1 The excitement encircling the Star Wars prequel has been justified in terms of 'hype' or marketing. Such judgements frame the men and women cuing for tickets, talking Yodas and light sabres as fools or duped souls who need to get out more. My analysis explores why Star Wars has generated this enthusiasm, and how cultural studies can mobilise this passionate commitment to consider notions of popularity, preservation and ephemerality. We'll always have Tattooine. Star Wars has been a primary popular cultural social formation for a generation. The stories of Luke Skywalker, Princess Leia, Han Solo, Chewbacca, Darth Vader, Yoda, C-3PO and R2D2 offer an alternative narrative for the late 1970s and 1980s. It was a comfort to have the Royal Shakespearian tones of Alec Guinness confirming that the Force would be with us, through economic rationalism, unemployment, Pauline Hanson and Madonna discovering yoga. The Star Wars Trilogy, encompassing A New Hope, The Empire Strikes Back and Return of the Jedi, was released between 1977 and 1983. These films have rarely slipped from public attention, being periodically 'brought back' through new cinematic and video releases. The currency of Star Wars is matched with the other great popular cultural formations of the post-war period: the James Bond series and Star Trek. One reason for the continued success of these programmes is that other writers, film makers and producers cannot leave these texts alone. Bond survives not only through Pierce Brosnan's good looks, but the 'Hey Baby' antics of Austin Powers. Star Trek, through four distinct series, has become an industry that will last longer than Voyager's passage back from the Delta Quadrant. Star Wars, perhaps even more effectively than the other popular cultural heavyweights, has enmeshed itself into other filmic and televisual programming. Films like Spaceballs and television quizzes on Good News Week keep the knowledge system and language current and pertinent.2 Like Umberto Eco realised of Casablanca, Star Wars is "a living example of living textuality" (199). Both films are popular because of imperfections and intertextual archetypes, forming a filmic quilt of sensations and affectivities. Viewers are aware that "the cliches are talking among themselves" (Eco 209). As these cinematic texts move through time, the depth and commitment of these (con)textual dialogues are repeated and reinscribed. To hold on to a memory is to isolate a moment or an image and encircle it with meaning. Each day we experience millions of texts: some are remembered, but most are lost. Some popular cultural texts move from ephemera to popular memory to history. In moving beyond individual reminiscences -- the personal experiences of our lifetime -- we enter the sphere of popular culture. Collective or popular memory is a group or community experience of a textualised reality. For example, during the Second World War, there were many private experiences, but certain moments arch beyond the individual. Songs by Vera Lynn are fully textualised experiences that become the fodder for collective memory. Similarly, Star Wars provides a sense-making mechanism for the 1980s. Like all popular culture, these texts allow myriad readership strategies, but there is collective recognition of relevance and importance. Popular memory is such an important site because it provides us, as cultural critics, with a map of emotionally resonant sites of the past, moments that are linked with specific subjectivities and a commonality of expression. While Star Wars, like all popular cultural formations, has a wide audience, there are specific readings that are pertinent for particular groups. To unify a generation around cultural texts is an act of collective memory. As Harris has suggested, "sometimes, youth does interesting things with its legacy and creatively adapts its problematic into seemingly autonomous cultural forms" (79). Generation X refers to an age cohort born between the mid-1960s and the mid-1970s. Finally cultural studies theorists have found a Grail subculture. Being depthless, ambivalent, sexually repressed and social failures, Xers are a cultural studies dream come true. They were the children of the media revolution. Star Wars is integral to this textualised database. A fan on the night of the first screening corrected a journalist: "we aren't Generation X, we are the Star Wars generation" (Brendon, in Miller 9). An infatuation and reflexivity with the media is the single framework of knowledge in which Xers operate. This shared understanding is the basis for comedy, and particularly revealed (in Australia) in programmes like The Panel and Good News Week. Television themes, lines of film dialogue and contemporary news broadcasts are the basis of the game show. The aesthetics of life transforms television into a real. Or, put another way, "individual lives may be fragmented and confused but McDonald's is universal" (Hopkins 17). A group of textual readers share a literacy, a new way of reading the word and world of texts. Nostalgia is a weapon. The 1990s has been a decade of revivals: from Abba to skateboards, an era of retro reinscription has challenged linear theories of history and popular culture. As Timothy Carter reveals, "we all loved the Star Wars movies when we were younger, and so we naturally look forward to a continuation of those films" (9). The 1980s has often been portrayed as a bad time, of Thatcher and Reagan, cold war brinkmanship, youth unemployment and HIV. For those who were children and (amorphously phrased) 'young adults' of this era, the popular memory is of fluorescent fingerless gloves, Ray Bans, 'Choose Life' t-shirts and bubble skirts. It was an era of styling mousse, big hair, the Wham tan, Kylie and Jason and Rick Astley's dancing. Star Wars action figures gave the films a tangibility, holding the future of the rebellion in our hands (literally). These memories clumsily slop into the cup of the present. The problem with 'youth' is that it is semiotically too rich: the expression is understood, but not explained, by discourses as varied as the educational system, family structures, leisure industries and legal, medical and psychological institutions. It is a term of saturation, where normality is taught, and deviance is monitored. All cultural studies theorists carry the baggage of the Birmingham Centre into any history of youth culture. The taken-for-granted 'youth as resistance' mantra, embodied in Resistance through Rituals and Subculture: The Meaning of Style, transformed young people into the ventriloquist's puppet of cultural studies. The strings of the dancing, smoking, swearing and drinking puppet took many years to cut. The feminist blade of Angela McRobbie did some damage to the fraying filaments, as did Dick Hebdige's reflexive corrections in Hiding in the Light. However, the publications, promotion and pedagogy of Gen X ended the theoretical charade. Gen X, the media sophisticates, played with popular culture, rather than 'proper politics.' In Coupland's Generation X, Claire, one of the main characters believed that "Either our lives become stories, or there's just no way to get through them." ... We know that this is why the three of us left our lives behind us and came to the desert -- to tell stories and to make our own lives worthwhile tales in the process. (8) Television and film are part of this story telling process. This intense connection generated an ironic and reflexive literacy in the media. Television became the basis for personal pleasures and local resistances, resulting in a disciplined mobilisation of popular cultural surfaces. Even better than the real thing. As the youngest of Generation Xers are now in their late twenties, they have moved from McJobs to careers. Robert Kizlik, a teacher trainer at an American community college expressed horror as the lack of 'commonsensical knowledge' from his new students. He conducted a survey for teachers training in the social sciences, assessing their grasp of history. There was one hundred percent recognition of such names as Madonna, Mike Tyson, and Sharon Stone, but they hardly qualify as important social studies content ... . I wondered silently just what it is that these students are going to teach when they become employed ... . The deeper question is not that we have so many high school graduates and third and fourth year college students who are devoid of basic information about American history and culture, but rather, how, in the first place, these students came to have the expectations that they could become teachers. (n. pag.) Kizlik's fear is that the students, regardless of their enthusiasm, had poor recognition of knowledge he deemed significant and worthy. His teaching task, to convince students of the need for non-popular cultural knowledges, has resulted in his course being termed 'boring' or 'hard'. He has been unable to reconcile the convoluted connections between personal stories and televisual narratives. I am reminded (perhaps unhelpfully) of one of the most famous filmic teachers, Mr Holland. Upon being attacked by his superiors for using rock and roll in his classes, he replied that he would use anything to instil in his students a love of music. Working with, rather than against, popular culture is an obvious pedagogical imperative. George Lucas has, for example, confirmed the Oprahfied spirituality of the current age. Obviously Star Wars utilises fables, myths3 and fairy tales to summon the beautiful Princess, the gallant hero and the evil Empire, but has become something more. Star Wars slots cleanly into an era of Body Shop Feminism, John Gray's gender politics and Rikki Lake's relationship management. Brian Johnson and Susan Oh argued that the film is actually a new religion. A long time ago in a galaxy far far away -- late 1970s California -- the known universe of George Lucas came into being. In the beginning, George created Star Wars. And the screen was without form, and void. And George said, 'Let there be light', and there was Industrial Light and Magic. And George divided the light from the darkness, with light sabres, and called the darkness the Evil Empire.... And George saw that it was good. (14) The writers underestimate the profound emotional investment placed in the trilogy by millions of people. Genesis narratives describe the Star Wars phenomenon, but do not analyse it. The reason why the films are important is not only because they are a replacement for religion. Instead, they are an integrated component of popular memory. Johnson and Oh have underestimated the influence of pop culture as "the new religion" (14). It is not a form of cheap grace. The history of ideas is neither linear nor traceable. There is no clear path from Plato to Prozac or Moses to Mogadon. Obi-Wan Kenobi is not a personal trainer for the ailing spirituality of our age. It was Ewan McGregor who fulfilled the Xer dream to be the young Obi Wan. As he has stated, "there is nothing cooler than being a Jedi knight" (qtd. in Grant 15). Having survived feet sawing in Shallow Grave and a painfully large enema in Trainspotting, there are few actors who are better prepared to carry the iconographic burden of a Star Wars prequel. Born in 1971, he is the Molly Ringwall of the 1990s. There is something delicious about the new Obi Wan, that hails what Hicks described as "a sense of awareness and self- awareness, of detached observation, of not taking things seriously, and a use of subtle dry humour" (79). The metaphoric light sabre was passed to McGregor. The pull of the dark side. When fans attend The Phantom Menace, they tend to the past, as to a loved garden. Whether this memory is a monument or a ruin depends on the preservation of the analogue world in the digital realm. The most significant theoretical and discursive task in the present is to disrupt the dual ideologies punctuating the contemporary era: inevitable technological change and progress.4 Only then may theorists ponder the future of a digitised past. Disempowered groups, who were denied a voice and role in the analogue history of the twentieth century, will have inequalities reified and reinforced through the digital archiving of contemporary life. The Web has been pivotal to the new Star Wars film. Lucasfilm has an Internet division and an official Website. Between mid November and May, this site has been accessed twenty million times (Gallott 15). Other sites, such as TheForce.net and Countdown to Star Wars, are a record of the enthusiasm and passion of fans. As Daniel Fallon and Matthew Buchanan have realised, "these sites represent the ultimate in film fandom -- virtual communities where like-minded enthusiasts can bathe in the aura generated by their favourite masterpiece" (27). Screensavers, games, desktop wallpaper, interviews and photo galleries have been downloaded and customised. Some ephemeral responses to The Phantom Menace have been digitally recorded. Yet this moment of audience affectivity will be lost without a consideration of digital memory. The potentials and problems of the digital and analogue environments need to be oriented into critical theories of information, knowledge, entertainment and pleasure. The binary language of computer-mediated communication allows a smooth transference of data. Knowledge and meaning systems are not exchanged as easily. Classifying, organising and preserving information make it useful. Archival procedures have been both late and irregular in their application.5 Bocher and Ihlenfeldt assert that 2500 new web sites are coming on-line every day ("A Higher Signal-to-Noise Ratio"). The difficulties and problems confronting librarians and archivists who wish to preserve digital information is revealed in the Australian government's PADI (Preserving Access to Digital Information) Site. Compared with an object in a museum which may lie undisturbed for years in a storeroom, or a book on a shelf, or even Egyptian hieroglyd on the wall of a tomb, digital information requires much more active maintenance. If we want access to digital information in the future, we must plan and act now. (PADI, "Why Preserve Access to Digital Information?") phics carve The speed of digitisation means that responsibility for preserving cultural texts, and the skills necessary to enact this process, is increasing the pressure facing information professionals. An even greater difficulty when preserving digital information is what to keep, and what to release to the ephemeral winds of cyberspace. 'Qualitative criteria' construct an historical record that restates the ideologies of the powerful. Concerns with quality undermine the voices of the disempowered, displaced and decentred. The media's instability through technological obsolescence adds a time imperative that is absent from other archival discussions.6 While these problems have always taken place in the analogue world, there was a myriad of alternative sites where ephemeral material was stored, such as the family home. Popular cultural information will suffer most from the 'blind spots' of digital archivists. While libraries rarely preserve the ephemera of a time, many homes (including mine) preserve the 'trash' of a culture. A red light sabre, toy dalek, Duran Duran posters and a talking Undertaker are all traces of past obsessions and fandoms. Passion evaporates, and interests morph into new trends. These objects remain in attics, under beds, in boxes and sheds throughout the world. Digital documents necessitate a larger project of preservation, with great financial (and spatial) commitments of technology, software and maintenance. Libraries rarely preserve the ephemera -- the texture and light -- of the analogue world. The digital era reduces the number of fan-based archivists. Subsequently forfeited is the spectrum of interests and ideologies that construct the popular memory of a culture. Once bits replace atoms, the recorded world becomes structured by digital codes. Only particular texts will be significant enough to store digitally. Samuel Florman stated that "in the digital age nothing need be lost; do we face the prospect of drowning in trivia as the generations succeed each other?" (n. pag.) The trivia of academics may be the fodder (and pleasures) of everyday life. Digitised preservation, like analogue preservation, can never 'represent' plural paths through the past. There is always a limit and boundary to what is acceptable obsolescence. The Star Wars films suggests that "the whole palette of digital technology is much more subtle and supple; if you can dream it, you can see it" (Corliss 65). This film will also record how many of the dreams survive and are archived. Films, throughout the century, have changed the way in which we construct and remember the past. They convey an expressive memory, rather than an accurate history. Certainly, Star Wars is only a movie. Yet, as Rushkoff has suggested, "we have developed a new language of references and self-references that identify media as a real thing and media history as an actual social history" (32). The build up in Australia to The Phantom Menace has been wilfully joyful. This is a history of the present, a time which I know will, in retrospect, be remembered with great fondness. It is a collective event for a generation, but it speaks to us all in different ways. At ten, it is easy to be amazed and enthralled at popular culture. By thirty, it is more difficult. When we see Star Wars, we go back to visit our memories. With red light sabre in hand, we splice through time, as much as space. Footnotes The United States release of the film occurred on 19 May 1999. In Australia, the film's first screenings were on 3 June. Many cinemas showed The Phantom Menace at 12:01 am, (very) early Thursday morning. The three main players of the GNW team, Paul McDermott, Mikey Robbins and Julie McCrossin, were featured on the cover of Australia's Juice magazine in costumes from The Phantom Menace, being Obi-Wan, Yoda and Queen Amidala respectively. Actually, the National Air and Space Museum had a Star Wars exhibition in 1997, titled "Star Wars: The Magic of Myth". For example, Janet Collins, Michael Hammond and Jerry Wellington, in Teaching and Learning with the Media, stated that "the message is simple: we now have the technology to inform, entertain and educate. Miss it and you, your family and your school will be left behind" (3). Herb Brody described the Net as "an overstuffed, underorganised attic full of pictures and documents that vary wildly in value", in "Wired Science". The interesting question is, whose values will predominate when the attic is being cleared and sorted? This problem is extended because the statutory provision of legal deposit, which obliges publishers to place copies of publications in the national library of the country in which the item is published, does not include CD-ROMs or software. References Bocher, Bob, and Kay Ihlenfeldt. "A Higher Signal-to-Noise Ratio: Effective Use of WebSearch Engines." State of Wisconsin Department of Public Instruction Website. 13 Mar. 1998. 15 June 1999 <http://www.dpi.state.wi.us/dpi/dlcl/lbstat/search2.php>. Brody, Herb. "Wired Science." Technology Review Oct. 1996. 15 June 1999 <http://www.techreview.com/articles/oct96/brody.php>. Carter, Timothy. "Wars Weary." Cinescape 39 (Mar./Apr. 1999): 9. Collins, Janet, Michael Hammond, and Jerry Wellington. Teaching and Learning with Multimedia. London: Routledge, 1997. Corliss, Richard. "Ready, Set, Glow!" Time 18 (3 May 1999): 65. Count Down to Star Wars. 1999. 15 June 1999 <http://starwars.countingdown.com/>. Coupland, Douglas. Generation X. London: Abacus, 1991. Eco, Umberto. Travels in Hyper-Reality. London: Picador, 1987. Fallon, Daniel, and Matthew Buchanan. "Now Screening." Australian Net Guide 4.5 (June 1999): 27. Florman, Samuel. "From Here to Eternity." MIT's Technology Review 100.3 (Apr. 1997). Gallott, Kirsten. "May the Web Be with you." Who Weekly 24 May 1999: 15. Grant, Fiona. "Ewan's Star Soars!" TV Week 29 May - 4 June 1999: 15. Hall, Stuart, and Tony Jefferson, eds. Resistance through Rituals. London: Hutchinson, 1976. Harris, David. From Class Struggle to the Politics of Pleasure: the Effects of Gramscianism on Cultural Studies. London: Routledge, 1992. Hebdige, Dick. Hiding in the Light. London: Routledge, 1988. Hopkins, Susan. "Generation Pulp." Youth Studies Australia Spring 1995. Johnson, Brian, and Susan Oh. "The Second Coming: as the Newest Star Wars Film Illustrates, Pop Culture Has Become a New Religion." Maclean's 24 May 1999: 14-8. Juice 78 (June 1999). Kizlik, Robert. "Generation X Wants to Teach." International Journal of Instructional Media 26.2 (Spring 1999). Lucasfilm Ltd. Star Wars: Welcome to the Official Site. 1999. 15 June 1999 <http://www.starwars.com/>. Miller, Nick. "Generation X-Wing Fighter." The West Australian 4 June 1999: 9. PADI. "What Digital Information Should be Preserved? Appraisal and Selection." Preserving Access to Digital Information (PADI) Website. 11 March 1999. 15 June 1999 <http://www.nla.gov.au/padi/what.php>. PADI. "Why Preserve Access to Digital Information?" Preserving Access to Digital Information (PADI) Website. <http://www.nla.gov.au/padi/why.php>. Rushkoff, Douglas. Media Virus. Sydney: Random House, 1994. Citation reference for this article MLA style: Tara Brabazon. "A Red Light Sabre to Go, and Other Histories of the Present." M/C: A Journal of Media and Culture 2.4 (1999). [your date of access] <http://www.uq.edu.au/mc/9906/sabre.php>. Chicago style: Tara Brabazon, "A Red Light Sabre to Go, and Other Histories of the Present," M/C: A Journal of Media and Culture 2, no. 4 (1999), <http://www.uq.edu.au/mc/9906/sabre.php> ([your date of access]). APA style: Tara Brabazon. (1999) A red light sabre to go, and other histories of the present. M/C: A Journal of Media and Culture 2(4). <http://www.uq.edu.au/mc/9906/sabre.php> ([your date of access]).

Indigenous cross-cultural training has been around since the 1980s. It is often seen as a way to increase the skills and competency of staff engaged in providing service to Indigenous clients and customers, teaching Indigenous students within universities and schools, or working with Indigenous communities (Fredericks and Bargallie, “Indigenous”; “Which Way”). In this article we demonstrate how such training often exposes power, whiteness, and concepts of an Indigenous “other”. We highlight how cross-cultural training programs can potentially provide a setting in which non-Indigenous participants can develop a deeper realisation of how their understandings of the “other” are formed and enacted within a “white” social setting. Revealing whiteness as a racial construct enables people to see race, and “know what racism is, what it is not and what it does” (Bargallie, 262). Training participants can use such revelations to develop their racial literacy and anti-racist praxis (Bargallie), which when implemented have the capacity to transform inequitable power differentials in their work with Indigenous peoples and organisations.What Does the Literature Say about Cross-Cultural Training? An array of names are used for Indigenous cross-cultural training, including cultural awareness, cultural competency, cultural responsiveness, cultural safety, cultural sensitivity, cultural humility, and cultural capability. Each model takes on a different approach and goal depending on the discipline or profession to which the training is applied (Hollinsworth). Throughout this article we refer to Indigenous cross-cultural training as “cultural competence” or “cultural awareness” and discuss these in relation to their application within higher education institutions. While literature on health and human services programs in Australia, Canada, New Zealand, and other nation states provide clear definitions of terms such as “cultural safety”, cultural competence or cultural awareness is often lacking a concise and consistent definition.Often delivered as a half day or a one to two-day training course, it is unrealistic to think that Indigenous cultural competence can be achieved through one’s mere attendance and participation. Moreover, when courses centre on “cultural differences” and enable revelations about those differences they are in danger of presenting idealised notions of Indigeneity. Cultural competence becomes a process through which an Indigenous “other” is objectified, while very little is offered by way of translating knowledge and skills into practice when working with Indigenous peoples.What this type of learning has the capacity to do is oversimplify and reinforce racism and racist stereotypes of Indigenous peoples and Indigenous cultures. What is generally believed is that if non-Indigenous peoples know more about Indigenous peoples and cultures, relationships between Indigenous and non-Indigenous peoples will somehow improve. The work of Goenpul scholar Aileen Moreton-Robinson is vital to draw on here, when she asks, has the intellectual investment in defining our cultural differences resulted in the valuing of our knowledges? Has the academy become a more enlightened place in which to work, and, more important, in what ways have our communities benefited? (xvii)What is revealed in a range of studies – whether centring on racism and discrimination or the ongoing disparities across health, education, incarceration, employment, and more – is that despite forty plus years of training focused on understanding cultural differences, very little has changed. Indigenous knowledges continue to be devalued and overlooked. Everyday and structural racisms shape everyday experiences for Indigenous employees in Australian workplaces such as the Australian Public Service (Bargallie) and the Australian higher education sector (Fredericks and White).As the literature demonstrates, the racial division of labour in such institutions often leaves Indigenous employees languishing on the lower rungs of the employment ladder (Bargallie). The findings of an Australian university case study, discussed below, highlights how power, whiteness, and concepts of “otherness” are exposed and play out in cultural competency training. Through their exposure, we argue that better understandings about Indigenous Australians, which are not based on culture difference but personal reflexivity, may be gained. Revealing What Was Needed in the Course’s Foundation and ImplementationThis case study is centred within a regional Australian university across numerous campuses. In 2012, the university council approved an Aboriginal and Torres Strait Islander strategy, which included a range of initiatives, including the provision of cross-cultural training for staff. In developing the training, a team explored the evidence as it related to university settings (Anning; Asmar; Butler and Young; Fredericks; Fredericks and Thompson; Kinnane, Wilks, Wilson, Hughes and Thomas; McLaughlin and Whatman). This investigation included what had been undertaken in other Australian universities (Anderson; University of Sydney) and drew on the recommendations from earlier research (Behrendt, Larkin, Griew and Kelly; Bradley, Noonan, Nugent and Scales; Universities Australia). Additional consultation took place with a broad range of internal and external stakeholders.While some literature on cross-cultural training centred on the need to understand cultural differences, others exposed the problems of focusing entirely on difference (Brach and Fraser; Campinha-Bacote; Fredericks; Spencer and Archer; Young). The courses that challenged the centrality of cultural difference explained why race needed to be at the core of its training, highlighting its role in enabling discussions of racism, bias, discrimination and how these may be used as means to facilitate potential individual and organisational change. This approach also addressed stereotypes and Eurocentric understandings of what and who is an Indigenous Australian (Carlson; Gorringe, Ross and Forde; Hollinsworth; Moreton-Robinson). It is from this basis that we worked and grew our own training program. Working on this foundational premise, we began to separate content that showcased the fluidity and diversity of Indigenous peoples and refrained from situating us within romantic notions of culture or presenting us as an exotic “other”. In other words, we embraced work that responded to non-Indigenous people’s objectified understandings and expectations of us. For example, the expectation that Indigenous peoples will offer a Welcome to Country, performance, share a story, sing, dance, or disseminate Indigenous knowledges. While we recognise that some of these cultural elements may offer enjoyment and insight to non-Indigenous people, they do not challenge behaviours or the nature of the relationships that non-Indigenous people have with Aboriginal and Torres Strait Islander peoples (Bargallie; Fredericks; Hollinsworth; Westwood and Westwood; Young).The other content which needed separating were the methods that enabled participants to understand and own their standpoints. This included the use of critical Indigenous studies as a form of analysis (Moreton-Robinson). Critical race theory (Delgado and Stefancic) was also used as a means for participants to interrogate their own cultural positionings and understand the pervasive nature of race and racism in Australian society and institutions (McLaughlin and Whatman). This offered all participants, both non-Indigenous and Indigenous, the opportunity to learn how institutional racism operates, and maintains discrimination, neglect, abuse, denial, and violence, inclusive of the continued subjugation that exists within higher education settings and broader society.We knew that the course needed to be available online as well as face-to-face. This would increase accessibility to staff across the university community. We sought to embed critical thinking as we began to map out the course, including the theory in the sections that covered colonisation and the history of Indigenous dispossession, trauma and pain, along with the ongoing effects of federal and state policies and legislations that locates racism at the core of Australian politics. In addition to documenting the ongoing effects of racism, we sought to ensure that Indigenous resistance, agency, and activism was highlighted, showing how this continues, thus linking the past to the contemporary experiences of Indigenous peoples.Drawing on the work of Bargallie we wanted to demonstrate how Aboriginal and Torres Strait Islander peoples experience racism through systems and structures in their everyday work with colleagues in large organisations, such as universities. Participants were asked to self-reflect on how race impacts their day-to-day lives (McIntosh). The final session of the training focused on the university’s commitment to “Closing the Gap” and its Reconciliation Action Plan (RAP). The associated activity involved participants working individually and in small groups to discuss and consider what they could contribute to the RAP activities and enact within their work environments. Throughout the training, participants were asked to reflect on their personal positioning, and in the final session they were asked to draw from these reflections and discuss how they would discuss race, racism and reconciliation activities with the governance of their university (Westwood and Westwood; Young).Revelations in the Facilitators, Observers, and Participants’ Discussions? This section draws on data collected from the first course offered within the university’s pilot program. During the delivery of the in-person training sessions, two observers wrote notes while the facilitators also noted their feelings and thoughts. After the training, the facilitators and observers debriefed and discussed the delivery of the course along with the feedback received during the sessions.What was noticed by the team was the defensive body language of participants and the types of questions they asked. Team members observed how there were clear differences between the interest non-Indigenous participants displayed when talking about Aboriginal and Torres Strait Islander peoples and a clear discomfort when they were asked to reflect on their own position in relation to Indigenous people. We noted that during these occasions some participants crossed their arms, two wrote notes to each other across the table, and many participants showed discomfort. When the lead facilitator raised this to participants during the sessions, some expressed their dislike and discomfort at having to talk about themselves. A couple were clearly unhappy and upset. We found this interesting as we were asking participants to reflect and talk about how they interpret and understand themselves in relation to Indigenous people and race, privilege, and power.This supports the work of DiAngelo who explains that facilitators can spend a lot of time trying to manage the behaviour of participants. Similarly, Castagno identifies that sometimes facilitators of training might overly focus on keeping participants happy, and in doing so, derail the hard conversations needed. We did not do either. Instead, we worked to manage the behaviours expressed and draw out what was happening to break the attempts to silence racial discussions. We reiterated and worked hard to reassure participants that we were in a “safe space” and that while such discussions may be difficult, they were worth working through on an individual and collective level.During the workshop, numerous emotions surfaced, people laughed at Indigenous humour and cried at what they witnessed as losses. They also expressed anger, defensiveness, and denial. Some participants revelled in hearing answers to questions that they had long wondered about; some openly discussed how they thought they had discovered a distant Aboriginal relative. Many questions surfaced, such as why hadn’t they ever been told this version of Australian history? Why were we focusing on them and not Aboriginal people? How could they be racist when they had an Aboriginal friend or an Aboriginal relative?Some said they felt “guilty” about what had happened in the past. Others said they were not personally responsible or responsible for the actions of their ancestors, questioning why they needed to go over such history in the first place? Inter-woven within participants’ revelations were issues of racism, power, whiteness, and white privilege. Many participants took a defensive stance to protect their white privilege (DiAngelo). As we worked through these issues, several participants started to see their own positionality and shared this with the group. Clearly, the revelation of whiteness as a racial construct was a turning point for some. The language in the group also changed for some participants as revelations emerged through the interrogation and unpacking of stories of racism. Bargallie’s work exploring racism in the workplace, explains that “racism”, as both a word and theme, is primarily absent in conversations amongst non-Indigenous colleagues. Despite its entrenchment in the dialogue, it is rarely, if ever addressed. In fact, for many non-Indigenous people, the fear of being accused of racism is worse than the act of racism itself (Ahmed; Bargallie). We have seen this play out within the media, sport, news bulletins, and more. Lentin describes the act of denying racism despite its existence in full sight as “not racism”, arguing that its very denial is “a form of racist violence” (406).Through enhancing racial literacy, Bargallie asserts that people gain a better understanding of “what racism is, what racism is not and how race works” (258). Such revelations can work towards dismantling racism in workplaces. Individual and structural racism go hand-in-glove and must be examined and addressed together. This is what we wanted to work towards within the cultural competency course. Through the use of critical Indigenous studies and critical race theory we situated race, and not cultural difference, as central, providing participants with a racial literacy that could be used as a tool to challenge and dismantle racism in the workplace.Revelations in the Participant Evaluations?The evaluations revealed that our intention to disrupt the status quo in cultural competency training was achieved. Some of the discussions were difficult and this was reflected in the feedback. It was valuable to learn that numerous participants wanted to do more through group work, conversations, and problem resolution, along with having extra reading materials. This prompted our decision to include extra links to resource learning materials through the course’s online site. We also opted to provide all participants with a copy of the book Indigenous Australia for Dummies (Behrendt). The cost of the book was built into the course and future participants were thankful for this combination of resources.One unexpected concern raised by participants was that the course should not be “that hard”, and that we should “dumb down” the course. We were astounded considering that many participants were academics and we were confident that facilitators of other mandatory workplace training, for example, staff Equal Employment Opportunity (EEO), Fire Safety, Risk Management, Occupational Health and Safety, Discrimination and more, weren’t asked to “dumb down” their content. We explained to the participants what content we had been asked to deliver and knew their responses demonstrated white fragility. We were not prepared to adjust the course and dumb it down for white understandings and comfortabilities (Leonardo and Porter).Comments that were expected included that the facilitators were “passionate”, “articulate”, demonstrated “knowledge” and effectively “dealt with issues”. A couple of the participants wrote that the facilitators were “aggressive” or “angry”. This however is not new for us, or new to other Aboriginal women. We know Aboriginal women are often seen as “aggressive” and “angry”, when non-Indigenous women might be described as “passionate” or “assertive” for saying exactly the same thing. The work of Aileen Moreton-Robinson in Australia, and the works of numerous other Aboriginal women provide evidence of this form of racism (Fredericks and White; Bargallie; Bond). Internationally, other Indigenous women and women of colour document the same experiences (Lorde). Participants’ assessment of the facilitators is consistent with the racism expressed through racial microaggression outside of the university, and in other organisations. This is despite working in the higher education sector, which is normally perceived as a more knowledgeable and informed environment. Needless to say, we did not take on these comments.The evaluations did offer us the opportunity to adjust the course and make it stronger before it was offered across the university where we received further evaluation of its success. Despite this, the university decided to withdraw and reallocate the money to the development of a diversity training course that would cover all equity groups. This meant that Aboriginal and Torres Strait Islander peoples would be covered along with sexual diversity, gender, disability, and people from non-English speaking backgrounds. The content focused on Aboriginal and Torres Strait Islander peoples was reduced to one hour of the total course. Including Aboriginal and Torres Strait Islander peoples in this way is not based on evidence and works to minimise Indigenous Australians and their inherent rights and sovereignty to just another “equity group”. Conclusion We set out to develop and deliver a cross-cultural course that was based on evidence and a foundation of 40 plus years’ experience in delivering such training. In addition, we sought a program that would align with the university’s Reconciliation Action Plan and the directions being undertaken in the sector and by Universities Australia. Through engaging participants in a process of critical thinking centring on race, we developed a training program that successfully fostered self-reflection and brought about revelations of whiteness.Focusing on cultural differences has proven ineffective to the work needed to improve the lives of Indigenous Australian peoples. Recognising this, our discussions with participants directly challenged racist and negative stereotypes, individual and structural racism, prejudices, and white privilege. By centring race over cultural difference in cultural competency training, we worked to foster self-revelation within participants to transform inequitable power differentials in their work with Indigenous peoples and organisations. The institution’s disbandment and defunding of the program however is a telling revelation in and of itself, highlighting the continuing struggle and importance of placing additional pressure on persons, institutions, and organisations to implement meaningful structural change. ReferencesAhmed, Sara. On Being Included: Racism and Diversity in Institutional Life. Duke University Press, 2012.Anderson, Ian. “Advancing Indigenous Health through Medical Education”. 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In Cultural Competence and the Higher Education Sector: Perspectives, Policies and Practice, eds. Jack Frawley, Gabrielle Russell, and Juanita Sherwood, Springer Publications, 295-308. <https://link.springer.com/book/10.1007%2F978-981-15-5362-2>.Fredericks, Bronwyn, and Debbie Bargallie. “‘Which Way? Talking Culture, Talking Race’: Unpacking an Indigenous Cultural Competency Course”. International Journal of Critical Indigenous Studies 9.1 (2016): 1-14.Fredericks, Bronwyn, and Marlene Thompson. “Collaborative Voices: Ongoing Reflections on Cultural Competency and the Health Care of Australian Indigenous People”. Journal of Australian Indigenous Issues 13.3 (2010): 10-20.Fredericks, Bronwyn, and Nereda White. “Using Bridges Made by Others as Scaffolding and Establishing Footings for Those That Follow: Indigenous Women in the Academy”. Australian Journal of Education 62.3 (2018): 243–255.Gorringe, Scott, Joe Ross, and Cressida Fforde. Will the Real Aborigine Please Stand Up? 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Race Ethnicity and Education 13.2 (2010): 139-157.Lorde, Audrey. Sister Outsider: Essays and Speeches. Crossing Press, 1984.McIntosh, Peggy. White Privilege and Male Privilege: A Personal Account of Coming to See Correspondences through Work in Women's Studies. Wellesley College, Center for Research on Women, 1988.McLaughlin, Juliana, and Sue Whatman. “The Potential of Critical Race Theory in Decolonizing University Curricula”. Asia Pacific Journal of Education 31.4 (2011): 365-377.Moreton-Robinson, Aileen. The White Possessive: Property, Power, and Indigenous Sovereignty. University of Minnesota Press, 2015.Sargent, Sara E., Carol A. Sedlak, and Donna S. Martsolf. “Cultural Competence among Nursing Students and Faculty”. Nurse Education Today 25.3 (2005): 214-221.Sherwood, Juanita, and Tahnia Edwards. “Decolonisation: A Critical Step for Improving Aboriginal health”. Contemporary Nurse 22.2 (2016): 178-190.Spencer, Caroline, and Frances L. 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The debate on the social role of museums trundles along in an age where complex associations between community, collections, and cultural norms are highly contested (Silverman 3–4; Sandell, Inequality 3–23). This article questions whether, in the case of community groups whose aspirations often go unrecognised (in this case people with either blindness or low vision), there is a need to discuss and debate institutionalised approaches that often reinforce social exclusion and impede cultural access. If “access is [indeed] an entry point to experience” (Papalia), then the privileging of visual encounters in museums is clearly a barrier for people who experience sight loss or low vision (Levent and Pursley). In contrast, a multisensory aesthetic to exhibition display respects the gamut of human sensory experience (Dudley 161–63; Drobnick 268–69; Feld 184; James 136; McGlone 41–60) as do discursive gateways including “lectures, symposia, workshops, educational programs, audio guides, and websites” (Cachia). Independent access to information extends beyond Braille on toilet doors.Underpinning this article is an ongoing qualitative case study undertaken by the author involving participant observation, workshops, and interviews with eight adults who experience vision impairment. The primary research site has been the National Museum of Australia. Reflecting on the role of curators as storytellers and the historical development of museums and their practitioners as agents for social development, the article explores the opportunities latent in museum collections as they relate to community members with vision impairment. The outcomes of this investigation offer insights into emerging issues as they relate to the International Council of Museums (ICOM) definitions of the museum program. Curators as Storytellers“The ways in which objects are selected, put together, and written or spoken about have political effects” (Eilean Hooper-Greenhill qtd. in Sandell, Inequality 8). Curators can therefore open or close doors to discrete communities of people. The traditional role of curators has been to collect, care for, research, and interpret collections (Desvallées and Mairesse 68): they are characterised as information specialists with a penchant for research (Belcher 78). While commonly possessing an intimate knowledge of their institution’s collection, their mode of knowledge production results from a culturally mediated process which ensures that resulting products, such as cultural significance assessments and provenance determinations (Russell and Winkworth), privilege the knowing systems of dominant social groups (Fleming 213). Such ways of seeing can obstruct the access prospects of underserved audiences.When it comes to exhibition display—arguably the most public of work by museums—curators conventionally collaborate within a constellation of other practitioners (Belcher 78–79). Curators liaise with museum directors, converse with conservators, negotiate with exhibition designers, consult with graphics designers, confer with marketing boffins, seek advice from security, chat with editors, and engage with external contractors. I question the extent that curators engage with community groups who may harbour aspirations to participate in the exhibition experience—a sticking point soon to be addressed. Despite the team based ethos of exhibition design, it is nonetheless the content knowledge of curators on public display. The art of curatorial interpretation sets out not to instruct audiences but, in part, to provoke a response with narratives designed to reveal meanings and relationships (Freeman Tilden qtd. in Alexander and Alexander 258). Recognised within the institution as experts (Sandell, Inclusion 53), curators have agency—they decide upon the stories told. In a recent television campaign by the National Museum of Australia, a voiceover announces: a storyteller holds incredible power to connect and to heal, because stories bring us together (emphasis added). (National Museum of Australia 2015)Storytelling in the space of the museum often shares the histories, perspectives, and experiences of people past as well as living cultures—and these stories are situated in space and time. If that physical space is not fit-for-purpose—that is, it does not accommodate an individual’s physical, intellectual, psychiatric, sensory, or neurological needs (Disability Discrimination Act 1992, Cwlth)—then the story reaches only long-established patrons. The museum’s opportunity to contribute to social development, and thus the curator’s as the primary storyteller, will have been missed. A Latin-American PerspectiveICOM’s commitment to social development could be interpreted merely as a pledge to make use of collections to benefit the public through scholarship, learning, and pleasure (ICOM 15). If this interpretation is accepted, however, then any museum’s contribution to social development is somewhat paltry. To accept such a limited and limiting role for museums is to overlook the historical efforts by advocates to change the very nature of museums. The ascendancy of the social potential of museums first blossomed during the late 1960s at a time where, globally, overlapping social movements espoused civil rights and the recognition of minority groups (Silverman 12; de Varine 3). Simultaneously but independently, neighbourhood museums arose in the United States, ecomuseums in France and Quebec, and the integral museum in Latin America, notably in Mexico (Hauenschild; Silverman 12–13). The Latin-American commitment to the ideals of the integral museum developed out of the 1972 round table of Santiago, Chile, sponsored by the United Nations Educational, Scientific and Cultural Organization (Giménez-Cassina 25–26). The Latin-American signatories urged the local and regional museums of their respective countries to collaborate with their communities to resolve issues of social inequality (Round Table Santiago 13–21). The influence of Brazilian educator Paulo Freire should be acknowledged. In 1970, Freire ushered in the concept of conscientization, defined by Catherine Campbell and Sandra Jovchelovitch as:the process whereby critical thinking develops … [and results in a] … thinker [who] feels empowered to think and to act on the conditions that shape her living. (259–260)This model for empowerment lent inspiration to the ideals of the Santiago signatories in realising their sociopolitical goal of the integral museum (Assunção dos Santos 20). Reframing the museum as an institution in the service of society, the champions of the integral museum sought to redefine the thinking and practices of museums and their practitioners (United Nations Educational, Scientific and Cultural Organization 37–39). The signatories successfully lobbied ICOM to introduce an explicitly social purpose to the work of museums (Assunção dos Santos 6). In 1974, in the wake of the Santiago round table, ICOM modified their definition of a museum to “a permanent non-profit institution, open to the public, in the service of society and its development” (emphasis added) (Hauenschild). Museums had been transformed into “problem solvers” (Judite Primo qtd. in Giménez-Cassina 26). With that spirit in mind, museum practitioners, including curators, can develop opportunities for reciprocity with the many faces of the public (Guarini). Response to Social Development InitiativesStarting in the 1970s, the “second museum revolution” (van Mensch 6–7) saw the transition away from: traditional roles of museums [of] collecting, conservation, curatorship, research and communication … [and toward the] … potential role of museums in society, in education and cultural action. (van Mensch 6–7)Arguably, this potential remains a work in progress some 50 years later. Writing in the tradition of museums as agents of social development, Mariana Lamas states:when we talk about “in the service of society and its development”, it’s quite different. It is like the drunk uncle at the Christmas party that the family pretends is not there, because if they pretend long enough, he might pass out on the couch. (Lamas 47–48)That is not to say that museums have neglected to initiate services and programs that acknowledge the aspirations of people with disabilities (refer to Cachia and Krantz as examples). Without discounting such efforts, but with the refreshing analogy of the drunken uncle still fresh in memory, Lamas answers her own rhetorical question:how can traditional museums promote community development? At first the word “development” may seem too much for the museum to do, but there are several ways a museum can promote community development. (Lamas 52) Legitimising CommunitiesThe first way that museums can foster community or social development is to:help the community to over come [sic] a problem, coming up with different solutions, putting things into a new perspective; providing confidence to the community and legitimizing it. (Lamas 52)As a response, my doctoral investigation legitimises the right of people with vision impairment to participate in the social and cultural aspects of publicly funded museums. The Australian Government upheld this right in 2008 by ratifying the United Nations Convention on the Rights of Persons with Disabilities (and Optional Protocol), which enshrines the right of people with disability to participate in the cultural life of the nation (United Nations).At least 840,700 people in Australia (a minimum of four per cent of the population) experiences either blindness or low vision (Australian Bureau of Statistics 2009). For every one person in the Australian community who is blind, nearly five other people experience low vision. The medical model of disability identifies the impairment as the key feature of a person and seeks out a corrective intervention. In contrast, the social model of disability strives to remove the attitudinal, social, and physical barriers enacted by people or institutions (Landman, Fishburn, and Tonkin 14). Therein lies the opportunity and challenge for museums—modifying layouts and practices that privilege the visual. Consequently, there is scope for museums to partner with people with vision impairment to identify their aspirations rather than respond as a problem to be fixed. Common fixes in the museums for people with disabilities include physical alterations such as ramps and, less often, special tours (Cachia). I posit that curators, as co-creators and major contributors to exhibitions, can be part of a far wider discussion. In the course of doctoral research, I accompanied adults with a wide array of sight impairments into exhibitions at the Museum of Australian Democracy at Old Parliament House, the Australian War Memorial, and the National Museum of Australia. Within the space of the exhibition, the most commonly identified barrier has been the omission of access opportunities to interpreted materials: that is, information about objects on display as well as the wider narratives driving exhibitions. Often, the participant has had to work backwards, from the object itself, to understand the wider topic of the exhibition. If aesthetics is “the way we communicate through the senses” (Thrift 291), then the vast majority of exhibits have been inaccessible from a sensory perspective. For people with low vision (that is, they retain some degree of functioning sight), objects’ labels have often been too small to be read or, at times, poorly contrasted or positioned. Objects have often been set too deep into display cabinets or too far behind safety barriers. If individuals must use personal magnifiers to read text or look in vain at objects, then that is an indicator that there are issues with exhibition design. For people who experience blindness (that is, they cannot see), neither the vast majority of exhibits nor their interpretations have been made accessible. There has been minimal access across all museums to accessioned objects, handling collections, or replicas to tease out exhibits and their stories. Object labels must be read by family or friends—a tiring experience. Without motivated peers, the stories told by curators are silenced by a dearth of alternative options.Rather than presume to know what works for people with disabilities, my research ethos respects the “nothing about us without us” (Charlton 2000; Werner 1997) maxim of disability advocates. To paraphrase Lamas, we have collaborated to come up with different solutions by putting things into new perspectives. In turn, “person-centred” practices based on rapport, warmth, and respect (Arigho 206–07) provide confidence to a diverse community of people by legitimising their right to participate in the museum space. Incentivising Communities Museums can also nurture social or community development by providing incentives to “the community to take action to improve its quality of life” (Lamas 52). It typically falls to (enthusiastic) public education and community outreach teams to engage underserved communities through targeted programs. This approach continues the trend of curators as advocates for the collection, and educators as advocates for the public (Kaitavouri xi). If the exhibition briefs normally written by curators (Belcher 83) reinforced the importance of access, then exhibition designers would be compelled to offer fit-for-purpose solutions. Better still, if curators (and other exhibition team members) regularly met with community based organisations (perhaps in the form of a disability reference group), then museums would be better positioned to accommodate a wider spectrum of community members. The National Standards for Australian Museums and Galleries already encourages museums to collaborate with disability organisations (40). Such initiatives offer a way forward for improving a community’s sense of itself and its quality of life. The World Health Organization defines health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. While I am not using quality of life indicators for my doctoral study, the value of facilitating social and cultural opportunities for my target audience is evident in participant statements. At the conclusion of one sensory based workshop, Mara, a female participant who experiences low vision in one eye and blindness in the other, stated:I think it was interesting in that we could talk together about what we were experiencing and that really is the social aspect of it. I mean if I was left to go to a whole lot of museums on my own, I probably wouldn’t. You know, I like going with kids or a friend visiting from interstate—that sort of thing. And so this group, in a way, replicates that experience in that you’ve got someone else to talk about your impressions with—much better than going on your own or doing this alone.Mara’s statement was in response to one of two workshops I held with the support of the Learning Services team at the National Museum of Australia in May 2015. Selected objects from the museum’s accessioned collection and handling collection were explored, as well as replicas in the form of 3D printed objects. For example, participants gazed upon and handled a tuckerbox, smelt and tasted macadamia nuts in wattle seed syrup, and listened to a genesis story about the more-ish nut recorded by the Butchulla people—the traditional owners of Fraser Island. We sat around a table while I, as the workshop mediator, sought to facilitate free-flowing discussions about their experiences and, in turn, mused on the capacity of objects to spark social connection and opportunities for cultural access. While the workshop provided the opportunity for reciprocal exchanges amongst participants as well as between participants and me, what was highly valued by most participants was the direct contact with members of the museum’s Learning Services team. I observed that participants welcomed the opportunity to talk with real museum workers. Their experience of museum practitioners, to date, had been largely confined to the welcome desk of respective institutions or through special events or tours where they were talked at. The opportunity to communicate directly with the museum allowed some participants to share their thoughts and feelings about the services that museums provide. I suggest that curators open themselves up to such exchanges on a more frequent basis—it may result in reciprocal benefits for all stakeholders. Fortifying IdentityA third way museums can contribute to social or community development is by:fortify[ing] the bonds between the members of the community and reaffirm their identities making them feel more secure about who they are; and give them a chance to tell their own version of their history to “outsiders” which empowers them. (Lamas 52)Identity informs us and others of who we are and where we belong in the world (Silverman 54). However, the process of identity marking and making can be fraught: “some communities are ours by choice … [and] … some are ours because of the ways that others see us” (Watson 4). Communities are formed by identifying who is in and who is out (Francois Dubet qtd. in Bessant and Watts 260). In other words, the construction of collective identity is reinforced through means of social inclusion and social exclusion. The participants of my study, as members or clients of the Royal Society for the Blind | Canberra Blind Society, clearly value participating in events with empathetic peers. People with vision impairment are not a homogenous group, however. Reinforcing the cultural influences on the formation of identity, Fiona Candlin asserts that “to state the obvious but often ignored fact, blind people … [come] … from all social classes, all cultural, racial, religious and educational backgrounds” (101). Irrespective of whether blindness or low vision arises congenitally, adventitiously, or through unexpected illness, injury, or trauma, the end result is an assortment of individuals with differing perceptual characteristics who construct meaning in often divergent ways (De Coster and Loots 326–34). They also hold differing world views. Therefore, “participation [at the museum] is not an end in itself. It is a means for creating a better world” (Assunção dos Santos 9). According to the Australian Human Rights Commissioner, Professor Gillian Triggs, a better world is: a society for all, in which every individual has an active role to play. Such a society is based on fundamental values of equity, equality, social justice, and human rights and freedoms, as well as on the principles of tolerance and embracing diversity. (Triggs)Publicly funded museums can play a fundamental role in the cultural lives of societies. For example, the Powerhouse Museum (Museum of Applied Arts and Sciences) in Sydney partnered with Vision Australia to host an exhibition in 2010 titled Living in a Sensory World: it offered “visitors an understanding of the world of the blindness and low vision community and celebrates their achievements” (Powerhouse Museum). With similar intent, my doctoral research seeks to validate the world of my participants by inviting museums to appreciate their aspirations as a distinct but diverse community of people. ConclusionIn conclusion, the challenge for museum curators and other museum practitioners is balancing what Richard Sennett (qtd. in Bessant and Watts 265) identifies as opportunities for enhancing social cohesion and a sense of belonging while mitigating parochialism and community divisiveness. Therefore, curators, as the primary focus of this article, are indeed challenged when asked to contribute to serving the public through social development—a public which is anything but homogenous. Mindful of cultural and social differences in an ever-changing world, museums are called to respect the cultural and natural heritage of the communities they serve and collaborate with (ICOM 10). It is a position I wholeheartedly support. This is not to say that museums or indeed curators are capable of solving the ills of society. However, inviting people who are frequently excluded from social and cultural events to multisensory encounters with museum collections acknowledges their cultural rights. I suggest that this would be a seismic shift from the current experiences of adults with blindness or low vision at most museums.ReferencesAlexander, Edward, and Mary Alexander. Museums in Motion: An Introduction to the History and Functions of Museums. 2nd ed. Lanham, Maryland: AltaMira Press, 2008.Arigho, Bernie. “Getting a Handle on the Past: The Use of Objects in Reminiscence Work.” Touch in Museums: Policy and Practice in Object Handling. Ed. Helen Chatterjee. Oxford: Berg, 2008. 205–12.Assunção dos Santos, Paula. Introduction. Sociomuseology 4: To Think Sociomuseologically. Eds. Paula Assunção dos Santos and Judite Primo. Lisbon: Universidade Lusófona de Humanidades e Tecnologias, 2010. 5–12.Australian Bureau of Statistics. “National Health Survey: Summary of Results (2007- 2008) (Reissue), Cat. No. 4364.0. 2009.” Australian Bureau of Statistics. 12 Feb. 2015 ‹http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0›.Belcher, Michael. Exhibitions in Museums. Leicester: Leicester UP, 1991.Bessant, Judith, and Rob Watts. Sociology Australia. 3rd ed. Crows Nest: Allen & Unwin, 2007.Cachia, Amanda. “Talking Blind: Disability, Access, and the Discursive Turn.” Disability Studies Quarterly 33.3 (2013). 23 July 2015 ‹http://dsq-sds.org/article/view/3758›.Campbell, Catherine, and Sandra Jovchelovitch. "Health, Community and Development: Towards a Social Psychology of Participation." Journal of Community & Applied Social Psychology 10.4 (2000): 255–70.Candlin, Fiona. "Blindness, Art and Exclusion in Museums and Galleries." International Journal of Art & Design Education 22.1 (2003): 100–10.Charlton, James. Nothing about Us without Us: Disability Oppression and Empowerment. Berkeley: U of California P, 2000.De Coster, Karin, and Gerrit Loots. "Somewhere in between Touch and Vision: In Search of a Meaningful Art Education for Blind Individuals." International Journal of Art & Design Education 23.3 (2004): 32634.De Varine, Hugues. “Decolonising Museology.” ICOM News 58.3 (2005): 3.Desvallées, André, and François Mairesse. Key Concepts of Museology. Paris: Armand Colin, 2010. 16 Jun. 2015 ‹http://icom.museum/professional-standards/key-concepts-of-museology/›.Disability Discrimination Act 1992 (Cwlth). 14 June 2015 ‹https://www.comlaw.gov.au/Series/C2004A04426›.Drobnick, Jim. “Volatile Effects: Olfactory Dimensions of Art and Architecture.” Empire of the Senses: The Sensual Culture Reader. Ed. David Howes. New York: Berg, 2005. 265–80.Dudley, Sandra. “Sensory Exile in the Field.” Museums Objects: Experiencing the Properties of Things. Ed. Sandra H. Dudley. Abingdon, UK: Routledge, 2012. 161–63.Feld, Steven. “Places Sensed, Senses Placed: Toward a Sensuous Epistemology of Environments.” Empire of the Senses: The Sensual Culture Reader. Ed. David Howes. New York: Berg, 2005. 179–91.Fleming, David. “Positioning the Museum for Social Inclusion.” Museums, Society, Inequality. Ed. Richard Sandell. London: Routledge, 2002. 213–24.Giménez-Cassina, Eduardo. “Who Am I? An Identity Crisis. Identity in the New Museologies and the Role of the Museum Professional.” Sociomuseology 3: To Understand New Museology in the XXI Century. Eds. Paula Assunção dos Santos and Judite Primo. Lisbon: Universidade Lusófona de Humanidades e Tecnologias, 2010. 25–42. Guarini, Beaux. Up Close and Personal: Engaging Collections alongside Adults with Vision Impairment. 2015. 17 June 2015 ‹http://nma.gov.au/blogs/education/2015/06/17/4802/›.Hauenschild, Andrea. Claims and Reality of New Museology: Case Studies in Canada, the United States and Mexico. 1988. 21 June 2015 ‹http://museumstudies.si.edu/claims2000.htm›.Hoyt, Bridget O’Brien. “Emphasizing Observation in a Gallery Program for Blind and Low-Vision Visitors: Art beyond Sight at the Museum of Fine Arts, Houston.” Disability Studies Quarterly 33.3 (2013). 23 July 2015 ‹http://dsq-sds.org/article/view/3737›.International Council of Museums. ICOM Code of Ethics for Museums. Paris: International Council of Museums, 2013. 6 June 2015 ‹http://icom.museum/the-vision/code-of-ethics/›.James, Liz. “Senses and Sensibility in Byzantium.” Museums Objects: Experiencing the Properties of Things. Ed. Sandra H. Dudley. Abingdon, UK: Routledge, 2012. 134–149.Kaitavouri, Kaija. Introduction. It’s All Mediating: Outlining and Incorporating the Roles of Curating and Education in the Exhibit Context. Eds. Kaija Kaitavouri, Laura Kokkonen, and Nora Sternfeld. Newcastle upon Tyne: Cambridge Scholars Publishing, 2013. x–xxi.Lamas, Mariana. “Lost in the Supermarket – The Traditional Museums Challenges.” Sociomuseology 3: To Understand New Museology in the XXI Century. Eds. Paula Assunção dos Santos and Judite Primo. Lisbon: Universidade Lusófona de Humanidades e Tecnologias, 2010. 42–58. Landman, Peta, Kiersten Fishburn, Lynda Kelly, and Susan Tonkin. Many Voices Making Choices: Museum Audiences with Disabilities. Sydney: Australian Museum and National Museum of Australia, 2005. Levent, Nina, and Joan Muyskens Pursley. “Sustainable Museum Acess: A Two-Way Street.” Disability Studies Quarterly 33.3 (2013). 22 July 2015 ‹http://dsq-sds.org/article/view/3742›.McGlone, Francis. “The Two Sides of Touch: Sensing and Feeling.” Touch in Museums: Policy and Practice in Object Handling. Ed. Helen Chatterjee. Oxford: Berg, 2008. 41–60.National Museum of Australia. “Stories Can Unite Us as One.” YouTube 28 May 2015. 16 Jun. 2015 ‹https://www.youtube.com/watch?v=Qwxj_rC57zM›.National Standards Taskforce. National Standards for Australian Museums and Galleries (Version 1.4, October 2014). Melbourne: The National Standards Taskforce, 2014. 20 June 2015 ‹http://www.mavic.asn.au/assets/NSFAMG_v1_4_2014.pdf›.Papalia, Carmen. “A New Model for Access in the Museum.” Disability Studies Quarterly 33.3 (2013). 23 July 2015 ‹http://dsq-sds.org/article/view/3757›.Powerhouse Museum. 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"Social Inclusion, the Museum and the Dynamics of Sectoral Change." Museum and Society 1.1 (2003): 45–62.Silverman, Lois. The Social Work of Museums. London: Routledge, 2010.Thrift, Nigel. “Understanding the Material Practices of Glamour.” The Affect Theory Reader. Eds. Melissa Gregg and Gregory Seigworth. Durham: Duke UP, 2010. 289–308.Triggs, Gillian. Social Inclusion and Human Rights in Australia. 2013. 6 June 2015 ‹https://www.humanrights.gov.au/news/speeches/social-inclusion-and-human-rights-australia›. United Nations. Convention on the Rights of Persons with Disabilities. 2006. 16 Mar. 2015 ‹http://www.un.org/disabilities/default.asp?id=150?›.United Nations Educational Scientific and Cultural Organization. United Nations Educational Scientific and Cultural Organisation Round Table on the Development and the Role of Museums in the Contemporary World - Santiago de Chile, Chile 20-31 May 1972. 1973. 18 June 2015 ‹http://unesdoc.unesco.org/images/0002/000236/023679EB.pdf›.Van Mensch, Peter. Towards a Methodology of Museology. Diss. U of Zagreb, 1992. 16 June 2015 ‹http://www.muzeologie.net/downloads/mat_lit/mensch_phd.pdf›.Watson, Sheila. “Museum Communities in Theory and Practice.” Museums and Their Communities. Ed. Sheila Watson. Abingdon, UK: Routledge, 2007. 1–24.Werner, David. Nothing about Us without Us: Developing Innovative Technologies for, vy, and with Disabled Persons. Palo Alto, CA: Healthwrights, 1997.World Health Organization. Mental Health: Strengthening Our Response, Fact Sheet No. 220, Updated April 2014. 2014. 2 June 2015 ‹http://www.who.int/mediacentre/factsheets/fs220/en/›.

Since their first encounter with colonial administrators in 1963, approximately 2,000 indigenous people living in the Nimakot region of central New Guinea have been struggling with a tension between their indigenous way of life and the imperatives of the state. It is not just that they are on the international border between Papua New Guinea and Indonesia and therefore difficult to categorise into this or that country. It is that they do not habitually conceptualise themselves and others in categorical terms. They value and focus on relationships rather than categories. In their struggle to adapt the blooming buzzing complexities of their semi-nomadic lifestyle and relational logic to the strict and apparently static lines, grids, and coordinates of rationalistic statecraft they have become torn by duelling conceptions of “kantri” itself (Melanesian Tok Pisin for “country”). On the one hand, kantri invokes an unbroken rural landscape rich with personal and cultural memories that establish a firm and deep relationship with the land and the ancestors. Such a notion fits easily with local conceptions of kinship and land tenure. On the other hand, kantri is a bounded object, part of an often frustrating and mystifying system of categorization imposed by strict and rationalist mechanisms of statecraft. The following analyses this tension based on 22 months of intensive and intimate participant observation in the region from 1999-2006 with a special focus on the uses and impacts of writing and other new communication technologies. The categorical bias of statecraft is enabled, fostered, extended, and maintained by the technology of writing. Statecraft seeks (or makes) categories that are ideally stable, permanent, non-negotiable, and fit for the relative fixity of print, while the relationships emphasised by people of Nimakot are fluid, temporary, negotiable, contested and ambiguous. In contrast to the engaged, pragmatic, and personal view one finds in face-to-face relationships on the ground, the state’s knowledge of the local is ultimately mediated by what can be written into abstract categories that can be listed, counted and aggregated, producing a synoptic, distanced, and decontextualising perspective. By simplifying the cacophonous blooming buzzing complexities of life into legible categories, regularities, and rules, the pen and paper become both the eyes and the voice of the state (Scott 2). Even the writing of this paper is difficult. Many sentences would be easier to write if I could just name the group I am discussing. But the group of people I am writing about have no clear and uncontested name for themselves. More importantly, they do not traditionally think of themselves as a “group,” nor do they habitually conceptualise others in terms of bounded groups of individuals. The biggest challenge to statecraft’s attempts to create a sense of “country” here is the fact that most local people do not subjectively think of themselves in categorical terms. They do not imagine themselves to be part of “adjacent and competitive empires” (Strathern 102). This “group” is most widely known as the western “Atbalmin” though the name is not an indigenous term. “Atbalmin” is a word used by the neighbouring Telefol that means “people of the trees.” It was adopted by early patrol officers who were accompanied by Telefol translators. As these early patrols made their way through the “Atbalmin” region from east to west they frequently complained about names and their inability to pin or pen them down. Tribal names, clan names, even personal names seemed to change with each asking. While such flexibility and flux were perfectly at home in an oral face-to-face environment, it wasn’t suitable for the colonial administrators’ relatively fixed and static books. The “mysterious Kufelmin” (as the patrol reports refer to them) were even more frustrating for early colonial officers. Patrols heading west from Telefomin searched for decades for this mysterious group and never found them. To this day nobody has ever set foot in a Kufelmin village. In each valley heading west patrols were told that the Kufelmin were in the next valley to the west. But the Kufelmin were never there. They were always one more valley to the west. The problem was that the administrators wrongly assumed “Kufelmin” to be a tribal name as stable and categorical as the forms and maps they were using would accept. Kufelmin simply means “those people to the West.” It is a relational term, not a categorical one. The administration’s first contact with the people of Nimakot exposed even more fundamental differences and specific tensions between the local relational logic and the categorical bias of statecraft. Australian patrol officer JR McArthur crested the mountain overlooking Nimakot at precisely 1027 hours on 16 August 1963, a fact he dutifully recorded in his notebook (Telefomin Patrol Report 12 of 1962/63). He then proceeded down the mountain with pen and paper in hand, recording the precise moment he crossed the Sunim creek (1109 hours), came to Sunimbil (1117 hours), and likewise on and on to his final destination near the base of the present-day airstrip. Such recordings of precise times and locations were central to McArthur's main goal. Amidst the steep mountains painted with lush green gardens, sparkling waterfalls, and towering virgin rainforests McArthur busied himself examining maps and aerial photographs searching for the region’s most impressive, imposing, and yet altogether invisible feature: the 141st Meridian East of Greenwich, the international border. McArthur saw his work as one of fixing boundaries, taking names, and extending the great taxonomic system of statecraft that would ultimately “rationalise” and order even this remote corner of the globe. When he came to the conclusion that he had inadvertently stepped outside his rightful domain he promptly left, noting in his report that he purchased a pig just before leaving. The local understanding of this event is very different. While McArthur was busy making and obeying categories, the people of Nimakot were primarily concerned with making relationships. In this case, they hoped to create a relationship through which valuable goods, the likes of which they had never seen, would flow. The pig mentioned in McArthur's report was not meant to be bought or sold, but as a gift signifying the beginning of what locals hoped would be a long relationship. When McArthur insisted on paying for it and then promptly left with a promise that he would never return, locals interpreted his actions as an accusation of witchcraft. Witchcraft is the most visible and dramatic aspect of the local relational logic of being, what might be termed a relational ontology. Marilyn Strathern describes this ontology as being as much “dividual” as individual, pointing out that Melanesians tend to conceptualise themselves as defined and constituted by social relationships rather than independent from them (102). The person is conceptualised as socially and collectively constituted rather than individuated. A person’s strength, health, intelligence, disposition, and behaviour depend on the strength and nature of one’s relationships (Knauft 26). The impacts of this relational ontology on local life are far reaching. Unconditional kindness and sharing are constantly required to maintain healthy relations because unhealthy relations are understood to be the direct cause of sickness, infertility, and death. Where such misfortunes do befall someone, their explanations are sought in a complex calculus examining relational histories. Whoever has a bad relation with the victim is blamed for their misfortune. Modernists disparage such ideas as “witchcraft beliefs” but witchcraft accusations are just a small part of a much more pervasive, rich, and logical relational ontology in which the health and well-being of relations are conceptualised as influencing the health and well-being of things and people. Because of this logic, people of Nimakot are relationship experts who navigate the complex relational field with remarkable subtleness and tact. But even they cannot maintain the unconditional kindness and sharing that is required of them when their social world grows too large and complex. A village rarely grows to over 50 people before tensions lead to an irresolvable witchcraft accusation and the village splits up. In this way, the continuous negotiations inspired by the relational ontology lead to constant movement, changing of names, and shifting clan affiliations – nothing that fits very well on a static map or a few categories in a book. Over the past 45 years since McArthur first brought the mechanisms of statecraft into Nimakot, the tensions between this local relational ontology and the categorical logic of the state have never been resolved. One might think that a synthesis of the two forms would have emerged. Instead, to this day, all that becomes new is the form through which the tensions are expressed and the ways in which the tensions are exacerbated. The international border has been and continues to be the primary catalyst for these tensions to express themselves. As it turns out, McArthur had miscalculated. He had not crossed the international border before coming to Nimakot. It was later determined that the border runs right through the middle of Nimakot, inspiring one young local man to describe it to me as “that great red mark that cuts us right through the heart.” The McArthur encounter was a harbinger of what was to come; a battle for kantri as unbounded connected landscape, and a battle with kantri as a binding categorical system, set against a backdrop of witchcraft imagery. Locals soon learned the importance of the map and census for receiving state funds for construction projects, education, health care, and other amenities. In the early 1970s a charismatic local man convinced others to move into one large village called Tumolbil. The large population literally put Tumolbil “on the map,” dramatically increasing its visibility to government and foreign aid. Drawn by the large population, an airstrip, school, and aid post were built in the late 1970s and early 1980s. Locally this process is known as “namba tok,” meaning that “numbers (population, statistics, etc.) talk” to the state. The greater the number, the stronger the voice, so locals are now intent on creating large stable villages that are visible to the state and in line for services and development projects. Yet their way of life and relational cultural logics continue to betray their efforts to create such villages. Most people still navigate the complexities of their social relations by living in small, scattered, semi-nomadic hamlets. Even as young local men trained in Western schools become government officials in charge of the maps and census books themselves, they are finding that they are frustrated by the same characteristics of life that once frustrated colonial administrators. The tensions between the local relational ontology and the categorical imperatives of the state come to rest squarely on the shoulders of these young men. They want large stable villages that will produce a large number in the census book in order to bring development projects to their land. More importantly, they recognise that half of their land rests precariously west of that magical 141st Meridian. A clearly defined and distinct place on the map along with a solid number of names in the census book, have become essential to assuring their continued connection with their kantri. On several occasions they have felt threatened by the possibility that they would have to either abandon the land west of the meridian or become citizens of Indonesia. The first option threatens their sense of kantri as connection to their traditional land. The other violates their new found sense of kantri as nationalistic pride in the independent state of Papua New Guinea. In an attempt to resolve these increasingly pressing tensions, the officers designed “Operation Clean and Sweep” in 2003 – a plan to move people out of their small scattered hamlets and into one of twelve larger villages that had been recognised by Papua New Guinea in previous census and mapping exercises. After sending notice to hamlet residents, an operation team of over one hundred men marched throughout Nimakot, burning each hamlet along the way. Before each burning, officers gave a speech peppered with the phrase “namba tok.” Most people listened to the speeches with enthusiasm, often expressing their own eagerness to leave their hamlet behind to live in a large orderly village. In one hamlet they asked me to take a photo of them in front of their houses just before they cheerfully allowed government officers to enter their homes and light the thatch of their rooftops. “Finally,” the officer in charge exclaimed triumphantly, “we can put people where their names are.” If the tension between local relational logics and the categorical imperatives of the state had been only superficial, perhaps this plan would have ultimately resolved the tension. But the tension is not only expressed objectively in the need for large stable villages, but subjectively as well, in the state’s need for people to orient themselves primarily as citizens and individuals, doing what is best for the country as a categorical group rather than acting as relational “dividuals” and orienting their lives primarily towards the demands of kinship and other relations. This tension has been recognised in other contexts as well, and theorised in Craig Calhoun’s study of nationalism in which he marks out two related distinctions: “between networks of social relationships and categories of similar individuals, and between reproduction through directly interpersonal interactions and reproduction through the mediation of relatively impersonal agencies of large-scale cultural standardization and social organization” (29). The former in both of these distinctions make up the essential components of relational ontology, while the latter describe the mechanisms and logic of statecraft. To describe the form of personhood implicit in nationalism, Calhoun introduces the term “categorical identity” to designate “identification by similarity of attributes as a member of a set of equivalent members” (42). While locals are quick to understand the power of categorical entities in the cultural process of statecraft and therefore have eagerly created large villages on a number of occasions in order to “game” the state system, they do not readily assume a categorical identity, an identity with these categories, and the villages have consistently disintegrated over time due to relational tensions and witchcraft accusations born from the local relational ontology. Operation Clean and Sweep reached its crisis moment just two days after the burnings began. An influential man from one of the unmapped hamlets scheduled for burning came to the officers complaining that he would not move to the large government village because he would have to live too close to people who had bewitched and killed members of his family. Others echoed his fears of witchcraft in the large government villages. The drive for a categorical order came head to head with the local relational ontology. Moving people into large government villages and administering a peaceful, orderly, lawful society of citizens (a categorical identity) would take much more than eliminating hamlets and forced migration. It would require a complete transformation in their sense of being – a transformation that even the officers themselves have not fully undertaken. The officers did not see the relational ontology as the problem. They saw witchcraft as the problem. They announced plans to eradicate witchcraft altogether. For three months, witchcraft suspects were apprehended, interrogated, and asked to list names of other witches. With each interrogation, the list of witches grew longer and longer. The interrogations were violent at times, but not as violent or as devastating as the list itself. The violence of the list hid behind its simple elegance. Like a census book, it had a mystique of orderliness and rationality. It stripped away the ugliness and complexity of interrogations leaving nothing but pure categorical knowledge. In the interrogation room, the list became a powerful tool the officer in charge used to intimidate his suspects. He often began by reading from the list, as if to say, “we already have you right here.” But one might say it was the officer who was really trapped in the list. It ensnared him in its simple elegance, its clean straight lines and clear categories. He was not using the list as much as the list was using him. Traditionally it was not the witch that was of concern, but the act of witchcraft itself. If the relationship could be healed – thereby healing the victim – all was forgiven. The list transformed the accused from temporary, situational, and indefinite witches involved in local relational disputes to permanent, categorical witches in violation of state law. Traditional ways of dealing with witchcraft focused on healing relationships. The print culture of the state focuses on punishing the categorically “guilty” categorical individual. They were “sentenced” “by the book.” As an outsider, I was simply thought to be naïve about the workings of witchcraft. My protests were ignored (see Wesch). Ultimately it ended because making a list of witches proved to be even more difficult than making a list for the census. Along with the familiar challenges of shifting names and affiliations, the witch list made its own enemies. The moment somebody was listed all of their relations ceased recognising the list and those making it as authoritative. In the end, the same tensions that motivated Operation Clean and Sweep were only reproduced by the efforts to resolve them. The tensions demonstrated themselves to be more tenacious than anticipated, grounded as they are in pervasive self-sustaining cultural systems that do not overlap in a way that is significant enough to threaten their mutual existence. The relational ontology is embedded in rich and enduring local histories of gift exchange, marriage, birth, death, and conflict. Statecraft is embedded in a broader system of power, hierarchy, deadlines, roles, and rules. They are not simply matters of belief. In this way, the focus on witches and witchcraft could never resolve the tensions. Instead, the movement only exacerbated the relational tensions that inspire, extend, and maintain witchcraft beliefs, and once again people found themselves living in small, scattered hamlets, wishing they could somehow come together to live in large prosperous villages so their population numbers would be great enough to “talk” to the state, bringing in valuable services, and more importantly, securing their land and citizenship with Papua New Guinea. It is in this context that “kantri” not only embodies the tensions between local ways of life and the imperatives of the state, but also the persistent hope for resolution, and the haunting memories of previous failures. References Calhoun, Craig. Nationalism. Open UP, 1997. Knauft, Bruce. From Primitive to Postcolonial in Melanesia and Anthropology. Ann Arbor: U Michigan P, 1999. McArthur, JR. Telefomin Patrol Report 12 of 1962/63 Strathern, Marilyn. The Gender of the Gift. U California P, 1988. Scott, James. Seeing Like a State: How Certain Schemes to Improve the Human Condition Have Failed. Yale UP, 1998. Wesch, Michael. “A Witch Hunt in New Guinea: Anthropology on Trial.” Anthropology and Humanism 32.1 (2007): 4-17.

Introduction Many destinations promote culinary encounters. Foods and beverages, and especially how these will taste in situ, are being marketed as niche travel motivators and used in destination brand building across the globe. While initial usage of the term culinary tourism focused on experiencing exotic cultures of foreign destinations by sampling unfamiliar food and drinks, the term has expanded to embrace a range of leisure travel experiences where the aim is to locate and taste local specialities as part of a pleasurable, and hopefully notable, culinary encounter (Wolf). Long’s foundational work was central in developing the idea of culinary tourism as an active endeavor, suggesting that via consumption, individuals construct unique experiences. Ignatov and Smith’s literature review-inspired definition confirms the nature of activity as participatory, and adds consuming food production skills—from observing agriculture and local processors to visiting food markets and attending cooking schools—to culinary purchases. Despite importing almost all of its foodstuffs and beverages, including some of its water, Singapore is an acknowledged global leader in culinary tourism. Horng and Tsai note that culinary tourism conceptually implies that a transferal of “local or special knowledge and information that represent local culture and identities” (41) occurs via these experiences. This article adds the act of reading to these participatory activities and suggests that, because food writing forms an important component of Singapore’s suite of culinary tourism offerings, taste contributes to the cultural experience offered to both visitors and locals. While Singapore foodways have attracted significant scholarship (see, for instance, work by Bishop; Duruz; Huat & Rajah; Tarulevicz, Eating), Singapore food writing, like many artefacts of popular culture, has attracted less notice. Yet, this writing is an increasingly visible component of cultural production of, and about, Singapore, and performs a range of functions for locals, tourists and visitors before they arrive. Although many languages are spoken in Singapore, English is the national language (Alsagoff) and this study focuses on food writing in English. Background Tourism comprises a major part of Singapore’s economy, with recent figures detailing that food and beverage sales contribute over 10 per cent of this revenue, with spend on culinary tours and cookery classes, home wares such as tea-sets and cookbooks, food magazines and food memoirs additional to this (Singapore Government). This may be related to the fact that Singapore not only promotes food as a tourist attraction, but also actively promotes itself as an exceptional culinary destination. The Singapore Tourism Board (STB) includes food in its general information brochures and websites, and its print, television and cinema commercials (Huat and Rajah). It also mounts information-rich campaigns both abroad and inside Singapore. The 2007 ‘Singapore Seasons’ campaign, for instance, promoted Singaporean cuisine alongside films, design, books and other cultural products in London, New York and Beijing. Touring cities identified as key tourist markets in 2011, the ‘Singapore Takeout’ pop-up restaurant brought the taste of Singaporean foods into closer focus. Singaporean chefs worked with high profile locals in its kitchen in a custom-fabricated shipping container to create and demonstrate Singaporean dishes, attracting public and media interest. In country, the STB similarly actively promotes the tastes of Singaporean foods, hosting the annual World Gourmet Summit (Chaney and Ryan) and Pacific Food Expo, both attracting international culinary professionals to work alongside local leaders. The Singapore Food Festival each July is marketed to both locals and visitors. In these ways, the STB, as well as providing events for visitors, is actively urging Singaporeans to proud of their food culture and heritage, so that each Singaporean becomes a proactive ambassador of their cuisine. Singapore Food Writing Popular print guidebooks and online guides to Singapore pay significantly more attention to Singaporean food than they do for many other destinations. Sections on food in such publications discuss at relative length the taste of Singaporean food (always delicious) as well as how varied, authentic, hygienic and suited-to-all-budgets it is. These texts also recommend hawker stalls and food courts alongside cafés and restaurants (Henderson et al.), and a range of other culinary experiences such as city and farm food tours and cookery classes. This writing describes not only what can be seen or learned during these experiences, but also what foods can be sampled, and how these might taste. This focus on taste is reflected in the printed materials that greet the in-bound tourist at the airport. On a visit in October 2013, arrival banners featuring mouth-watering images of local specialities such as chicken rice and chilli crab marked the route from arrival to immigration and baggage collection. Even advertising for a bank was illustrated with photographs of luscious-looking fruits. The free maps and guidebooks available featured food-focused tours and restaurant locations, and there were also substantial free booklets dedicated solely to discussing local delicacies and their flavours, plus recommended locations to sample them. A website and free mobile app were available that contain practical information about dishes, ingredients, cookery methods, and places to eat, as well as historical and cultural information. These resources are also freely distributed to many hotels and popular tourist destinations. Alongside organising food walks, bus tours and cookery classes, the STB also recommends the work of a number of Singaporean food writers—principally prominent Singapore food bloggers, reviewers and a number of memoirists—as authentic guides to what are described as unique Singaporean flavours. The strategies at the heart of this promotion are linking advertising to useful information. At a number of food centres, for instance, STB information panels provide details about both specific dishes and Singapore’s food culture more generally (Henderson et al.). This focus is apparent at many tourist destinations, many of which are also popular local attractions. In historic Fort Canning Park, for instance, there is a recreation of Raffles’ experimental garden, established in 1822, where he grew the nutmeg, clove and other plants that were intended to form the foundation for spice plantations but were largely unsuccessful (Reisz). Today, information panels not only indicate the food plants’ names and how to grow them, but also their culinary and medicinal uses, recipes featuring them and the related food memories of famous Singaporeans. The Singapore Botanic Gardens similarly houses the Ginger Garden displaying several hundred species of ginger and information, and an Eco(-nomic/logical) Garden featuring many food plants and their stories. In Chinatown, panels mounted outside prominent heritage brands (often still quite small shops) add content to the shopping experience. A number of museums profile Singapore’s food culture in more depth. The National Museum of Singapore has a permanent Living History gallery that focuses on Singapore’s street food from the 1950s to 1970s. This display includes food-related artefacts, interactive aromatic displays of spices, films of dishes being made and eaten, and oral histories about food vendors, all supported by text panels and booklets. Here food is used to convey messages about the value of Singapore’s ethnic diversity and cross-cultural exchanges. Versions of some of these dishes can then be sampled in the museum café (Time Out Singapore). The Peranakan Museum—which profiles the unique hybrid culture of the descendants of the Chinese and South Indian traders who married local Malay women—shares this focus, with reconstructed kitchens and dining rooms, exhibits of cooking and eating utensils and displays on food’s ceremonial role in weddings and funerals all supported with significant textual information. The Chinatown Heritage Centre not only recreates food preparation areas as a vivid indicator of poor Chinese immigrants’ living conditions, but also houses The National Restaurant of Singapore, which translates this research directly into meals that recreate the heritage kopi tiam (traditional coffee shop) cuisine of Singapore in the 1930s, purposefully bringing taste into the service of education, as its descriptive menu states, “educationally delighting the palate” (Chinatown Heritage Centre). These museums recognise that shopping is a core tourist activity in Singapore (Chang; Yeung et al.). Their gift- and bookshops cater to the culinary tourist by featuring quality culinary products for sale (including, for instance, teapots and cups, teas, spices and traditional sweets, and other foods) many of which are accompanied by informative tags or brochures. At the centre of these curated, purchasable collections are a range written materials: culinary magazines, cookbooks, food histories and memoirs, as well as postcards and stationery printed with recipes. Food Magazines Locally produced food magazines cater to a range of readerships and serve to extend the culinary experience both in, and outside, Singapore. These include high-end gourmet, luxury lifestyle publications like venerable monthly Wine & Dine: The Art of Good Living, which, in in print for almost thirty years, targets an affluent readership (Wine & Dine). The magazine runs features on local dining, gourmet products and trends, as well as international epicurean locations and products. Beautifully illustrated recipes also feature, as the magazine declares, “we’ve recognised that sharing more recipes should be in the DNA of Wine & Dine’s editorial” (Wine & Dine). Appetite magazine, launched in 2006, targets the “new and emerging generation of gourmets—foodies with a discerning and cosmopolitan outlook, broad horizons and a insatiable appetite” (Edipresse Asia) and is reminiscent in much of its styling of New Zealand’s award-winning Cuisine magazine. Its focus is to present a fresh approach to both cooking at home and dining out, as readers are invited to “Whip up the perfect soufflé or feast with us at the finest restaurants in Singapore and around the region” (Edipresse Asia). Chefs from leading local restaurants are interviewed, and the voices of “fellow foodies and industry watchers” offer an “insider track” on food-related news: “what’s good and what’s new” (Edipresse Asia). In between these publications sits Epicure: Life’s Refinements, which features local dishes, chefs, and restaurants as well as an overseas travel section and a food memories column by a featured author. Locally available ingredients are also highlighted, such as abalone (Cheng) and an interesting range of mushrooms (Epicure). While there is a focus on an epicurean experience, this is presented slightly more casually than in Wine & Dine. Food & Travel focuses more on home cookery, but each issue also includes reviews of Singapore restaurants. The bimonthly bilingual (Chinese and English) Gourmet Living features recipes alongside a notable focus on food culture—with food history columns, restaurant reviews and profiles of celebrated chefs. An extensive range of imported international food magazines are also available, with those from nearby Malaysia and Indonesia regularly including articles on Singapore. Cookbooks These magazines all include reviews of cookery books including Singaporean examples – and some feature other food writing such as food histories, memoirs and blogs. These reviews draw attention to how many Singaporean cookbooks include a focus on food history alongside recipes. Cookery teacher Yee Soo Leong’s 1976 Singaporean Cooking was an early example of cookbook as heritage preservation. This 1976 book takes an unusual view of ‘Singaporean’ flavours. Beginning with sweet foods—Nonya/Singaporean and western cakes, biscuits, pies, pastries, bread, desserts and icings—it also focuses on both Singaporean and Western dishes. This text is also unusual as there are only 6 lines of direct authorial address in the author’s acknowledgements section. Expatriate food writer Wendy Hutton’s Singapore Food, first published in 1979, reprinted many times after and revised in 2007, has long been recognised as one of the most authoritative titles on Singapore’s food heritage. Providing an socio-historical map of Singapore’s culinary traditions, some one third of the first edition was devoted to information about Singaporean multi-cultural food history, including detailed profiles of a number of home cooks alongside its recipes. Published in 1980, Kenneth Mitchell’s A Taste of Singapore is clearly aimed at a foreign readership, noting the variety of foods available due to the racial origins of its inhabitants. The more modest, but equally educational in intent, Hawkers Flavour: A Guide to Hawkers Gourmet in Malaysia and Singapore (in its fourth printing in 1998) contains a detailed introductory essay outlining local food culture, favourite foods and drinks and times these might be served, festivals and festive foods, Indian, Indian Muslim, Chinese, Nyonya (Chinese-Malay), Malay and Halal foods and customs, followed with a selection of recipes from each. More contemporary examples of such information-rich cookbooks, such as those published in the frequently reprinted Periplus Mini Cookbook series, are sold at tourist attractions. Each of these modestly priced, 64-page, mouthwateringly illustrated booklets offer framing information, such as about a specific food culture as in the Nonya kitchen in Nonya Favourites (Boi), and explanatory glossaries of ingredients, as in Homestyle Malay Cooking (Jelani). Most recipes include a boxed paragraph detailing cookery or ingredient information that adds cultural nuance, as well as trying to describe tastes that the (obviously foreign) intended reader may not have encountered. Malaysian-born Violet Oon, who has been called the Julia Child of Singapore (Bergman), writes for both local and visiting readers. The FOOD Paper, published monthly for a decade from January 1987 was, she has stated, then “Singapore’s only monthly publication dedicated to the CSF—Certified Singapore Foodie” (Oon, Violet Oon Cooks 7). Under its auspices, Oon promoted her version of Singaporean cuisine to both locals and visitors, as well as running cookery classes and culinary events, hosting her own television cooking series on the Singapore Broadcasting Corporation, and touring internationally for the STB as a ‘Singapore Food Ambassador’ (Ahmad; Kraal). Taking this representation of flavor further, Oon has also produced a branded range of curry powders, spices, and biscuits, and set up a number of food outlets. Her first cookbook, World Peranakan Cookbook, was published in 1978. Her Singapore: 101 Meals of 1986 was commissioned by the STB, then known as the Singapore Tourist Promotion Board. Violet Oon Cooks, a compilation of recipes from The FOOD Paper, published in 1992, attracted a range of major international as well as Singaporean food sponsors, and her Timeless Recipes, published in 1997, similarly aimed to show how manufactured products could be incorporated into classic Singaporean dishes cooked at home. In 1998, Oon produced A Singapore Family Cookbook featuring 100 dishes. Many were from Nonya cuisine and her following books continued to focus on preserving heritage Singaporean recipes, as do a number of other nationally-cuisine focused collections such as Joyceline Tully and Christopher Tan’s Heritage Feasts: A Collection of Singapore Family Recipes. Sylvia Tan’s Singapore Heritage Food: Yesterday’s Recipes for Today’s Cooks, published in 2004, provides “a tentative account of Singapore’s food history” (5). It does this by mapping the various taste profiles of six thematically-arranged chronologically-overlapping sections, from the heritage of British colonialism, to the uptake of American and Russia foods in the Snackbar era of the 1960s and the use of convenience flavoring ingredients such as curry pastes, sauces, dried and frozen supermarket products from the 1970s. Other Volumes Other food-themed volumes focus on specific historical periods. Cecilia Leong-Salobir’s Food Culture in Colonial Asia: A Taste of Empire discusses the “unique hybrid” (1) cuisine of British expatriates in Singapore from 1858 to 1963. In 2009, the National Museum of Singapore produced the moving Wong Hong Suen’s Wartime Kitchen: Food and Eating in Singapore 1942–1950. This details the resilience and adaptability of both diners and cooks during the Japanese Occupation and in post-war Singapore, when shortages stimulated creativity. There is a centenary history of the Cold Storage company which shipped frozen foods all over south east Asia (Boon) and location-based studies such as Annette Tan’s Savour Chinatown: Stories Memories & Recipes. Tan interviewed hawkers, chefs and restaurant owners, working from this information to write both the book’s recipes and reflect on Chinatown’s culinary history. Food culture also features in (although it is not the main focus) more general book-length studies such as educational texts such as Chew Yen Fook’s The Magic of Singapore and Melanie Guile’s Culture in Singapore (2000). Works that navigate both spaces (of Singaporean culture more generally and its foodways) such Lily Kong’s Singapore Hawker Centres: People, Places, Food, provide an consistent narrative of food in Singapore, stressing its multicultural flavours that can be enjoyed from eateries ranging from hawker stalls to high-end restaurants that, interestingly, that agrees with that promulgated in the food writing discussed above. Food Memoirs and Blogs Many of these narratives include personal material, drawing on the author’s own food experiences and taste memories. This approach is fully developed in the food memoir, a growing sub-genre of Singapore food writing. While memoirs by expatriate Singaporeans such as Cheryl Lu-Lien Tan’s A Tiger in the Kitchen: A Memoir of Food and Family, produced by major publisher Hyperion in New York, has attracted considerable international attention, it presents a story of Singapore cuisine that agrees with such locally produced texts as television chef and food writer Terry Tan’s Stir-fried and Not Shaken: A Nostalgic Trip Down Singapore’s Memory Lane and the food memoir of the Singaporean chef credited with introducing fine Malay dining to Singapore, Aziza Ali’s Sambal Days, Kampong Cuisine, published in Singapore in 2013 with the support of the National Heritage Board. All these memoirs are currently available in Singapore in both bookshops and a number of museums and other attractions. While underscoring the historical and cultural value of these foods, all describe the unique flavours of Singaporean cuisine and its deliciousness. A number of prominent Singapore food bloggers are featured in general guidebooks and promoted by the STB as useful resources to dining out in Singapore. One of the most prominent of these is Leslie Tay, a medical doctor and “passionate foodie” (Knipp) whose awardwinning ieatŸishootŸipost is currently attracting some 90,000 unique visitors every month and has had over 20,000 million hits since its launch in 2006. An online diary of Tay’s visits to hundreds of Singaporean hawker stalls, it includes descriptions and photographs of meals consumed, creating accumulative oral culinary histories of these dishes and those who prepared them. These narratives have been reorganised and reshaped in Tay’s first book The End of Char Kway Teow and Other Hawker Mysteries, where each chapter tells the story of one particular dish, including recommended hawker stalls where it can be enjoyed. Ladyironchef.com is a popular food and travel site that began as a blog in 2007. An edited collection of reviews of eateries and travel information, many by the editor himself, the site features lists of, for example, the best cafes (LadyIronChef “Best Cafes”), eateries at the airport (LadyIronChef “Guide to Dining”), and hawker stalls (Lim). While attesting to the cultural value of these foods, many articles also discuss flavour, as in Lim’s musings on: ‘how good can chicken on rice taste? … The glistening grains of rice perfumed by fresh chicken stock and a whiff of ginger is so good you can even eat it on its own’. Conclusion Recent Singapore food publishing reflects this focus on taste. Tay’s publisher, Epigram, growing Singaporean food list includes the recently released Heritage Cookbooks Series. This highlights specialist Singaporean recipes and cookery techniques, with the stated aim of preserving tastes and foodways that continue to influence Singaporean food culture today. Volumes published to date on Peranakan, South Indian, Cantonese, Eurasian, and Teochew (from the Chaoshan region in the east of China’s Guangdong province) cuisines offer both cultural and practical guides to the quintessential dishes and flavours of each cuisine, featuring simple family dishes alongside more elaborate special occasion meals. In common with the food writing discussed above, the books in this series, although dealing with very different styles of cookery, contribute to an overall impression of the taste of Singapore food that is highly consistent and extremely persuasive. This food writing narrates that Singapore has a delicious as well as distinctive and interesting food culture that plays a significant role in Singaporean life both currently and historically. It also posits that this food culture is, at the same time, easily accessible and also worthy of detailed consideration and discussion. 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Acknowledgements Research to complete this article was supported by Central Queensland University, Australia, under its Outside Studies Program (OSPRO) and Learning and Teaching Education Research Centre (LTERC). An earlier version of part of this article was presented at the 2nd Australasian Regional Food Networks and Cultures Conference, in the Barossa Valley in South Australia, Australia, 11–14 November 2012. The delegates of that conference and expert reviewers of this article offered some excellent suggestions regarding strengthening this article and their advice was much appreciated. All errors are, of course, my own.

Although I'm a rich white guy, I'm also a feminist anti-racism activist who fights for the rights of the poor and oppressed. (Carl Kenner)Systemic bias is a scourge to the pillar of neutrality. (Cerejota)Count me in. Let's leave the bias to the mainstream media. (Orcar967)Because this is so important. (CuttingEdge)These are a handful of comments posted by online editors who have banded together in a virtual coalition to combat Western bias on the world’s largest digital encyclopedia, Wikipedia. This collective action by Wikipedians both acknowledges the inherent inequalities of a user-controlled information project like Wikpedia and highlights the potential for progressive change within that same project. These community members are taking the responsibility of social change into their own hands (or more aptly, their own keyboards).In recent years much research has emerged on Wikipedia from varying fields, ranging from computer science, to business and information systems, to the social sciences. While critical at times of Wikipedia’s growth, governance, and influence, most of this work observes with optimism that barriers to improvement are not firmly structural, but rather they are socially constructed, leaving open the possibility of important and lasting change for the better.WikiProject: Countering Systemic Bias (WP:CSB) considers one such collective effort. Close to 350 editors have signed on to the project, which began in 2004 and itself emerged from a similar project named CROSSBOW, or the “Committee Regarding Overcoming Serious Systemic Bias on Wikipedia.” As a WikiProject, the term used for a loose group of editors who collaborate around a particular topic, these editors work within the Wikipedia site and collectively create a social network that is unified around one central aim—representing the un- and underrepresented—and yet they are bound by no particular unified set of interests. The first stage of a multi-method study, this paper looks at a snapshot of WP:CSB’s activity from both content analysis and social network perspectives to discover “who” geographically this coalition of the unrepresented is inserting into the digital annals of Wikipedia.Wikipedia and WikipediansDeveloped in 2001 by Internet entrepreneur Jimmy Wales and academic Larry Sanger, Wikipedia is an online collaborative encyclopedia hosting articles in nearly 250 languages (Cohen). The English-language Wikipedia contains over 3.2 million articles, each of which is created, edited, and updated solely by users (Wikipedia “Welcome”). At the time of this study, Alexa, a website tracking organisation, ranked Wikipedia as the 6th most accessed site on the Internet. Unlike the five sites ahead of it though—Google, Facebook, Yahoo, YouTube (owned by Google), and live.com (owned by Microsoft)—all of which are multibillion-dollar businesses that deal more with information aggregation than information production, Wikipedia is a non-profit that operates on less than $500,000 a year and staffs only a dozen paid employees (Lih). Wikipedia is financed and supported by the WikiMedia Foundation, a charitable umbrella organisation with an annual budget of $4.6 million, mainly funded by donations (Middleton).Wikipedia editors and contributors have the option of creating a user profile and participating via a username, or they may participate anonymously, with only an IP address representing their actions. Despite the option for total anonymity, many Wikipedians have chosen to visibly engage in this online community (Ayers, Matthews, and Yates; Bruns; Lih), and researchers across disciplines are studying the motivations of these new online collectives (Kane, Majchrzak, Johnson, and Chenisern; Oreg and Nov). The motivations of open source software contributors, such as UNIX programmers and programming groups, have been shown to be complex and tied to both extrinsic and intrinsic rewards, including online reputation, self-satisfaction and enjoyment, and obligation to a greater common good (Hertel, Niedner, and Herrmann; Osterloh and Rota). Investigation into why Wikipedians edit has indicated multiple motivations as well, with community engagement, task enjoyment, and information sharing among the most significant (Schroer and Hertel). Additionally, Wikipedians seem to be taking up the cause of generativity (a concern for the ongoing health and openness of the Internet’s infrastructures) that Jonathan Zittrain notably called for in The Future of the Internet and How to Stop It. Governance and ControlAlthough the technical infrastructure of Wikipedia is built to support and perhaps encourage an equal distribution of power on the site, Wikipedia is not a land of “anything goes.” The popular press has covered recent efforts by the site to reduce vandalism through a layer of editorial review (Cohen), a tightening of control cited as a possible reason for the recent dip in the number of active editors (Edwards). A number of regulations are already in place that prevent the open editing of certain articles and pages, such as the site’s disclaimers and pages that have suffered large amounts of vandalism. Editing wars can also cause temporary restrictions to editing, and Ayers, Matthews, and Yates point out that these wars can happen anywhere, even to Burt Reynold’s page.Academic studies have begun to explore the governance and control that has developed in the Wikipedia community, generally highlighting how order is maintained not through particular actors, but through established procedures and norms. Konieczny tested whether Wikipedia’s evolution can be defined by Michels’ Iron Law of Oligopoly, which predicts that the everyday operations of any organisation cannot be run by a mass of members, and ultimately control falls into the hands of the few. Through exploring a particular WikiProject on information validation, he concludes:There are few indicators of an oligarchy having power on Wikipedia, and few trends of a change in this situation. The high level of empowerment of individual Wikipedia editors with regard to policy making, the ease of communication, and the high dedication to ideals of contributors succeed in making Wikipedia an atypical organization, quite resilient to the Iron Law. (189)Butler, Joyce, and Pike support this assertion, though they emphasise that instead of oligarchy, control becomes encapsulated in a wide variety of structures, policies, and procedures that guide involvement with the site. A virtual “bureaucracy” emerges, but one that should not be viewed with the negative connotation often associated with the term.Other work considers control on Wikipedia through the framework of commons governance, where “peer production depends on individual action that is self-selected and decentralized rather than hierarchically assigned. Individuals make their own choices with regard to resources managed as a commons” (Viegas, Wattenberg and McKeon). The need for quality standards and quality control largely dictate this commons governance, though interviewing Wikipedians with various levels of responsibility revealed that policies and procedures are only as good as those who maintain them. Forte, Larco, and Bruckman argue “the Wikipedia community has remained healthy in large part due to the continued presence of ‘old-timers’ who carry a set of social norms and organizational ideals with them into every WikiProject, committee, and local process in which they take part” (71). Thus governance on Wikipedia is a strong representation of a democratic ideal, where actors and policies are closely tied in their evolution. Transparency, Content, and BiasThe issue of transparency has proved to be a double-edged sword for Wikipedia and Wikipedians. The goal of a collective body of knowledge created by all—the “expert” and the “amateur”—can only be upheld if equal access to page creation and development is allotted to everyone, including those who prefer anonymity. And yet this very option for anonymity, or even worse, false identities, has been a sore subject for some in the Wikipedia community as well as a source of concern for some scholars (Santana and Wood). The case of a 24-year old college dropout who represented himself as a multiple Ph.D.-holding theology scholar and edited over 16,000 articles brought these issues into the public spotlight in 2007 (Doran; Elsworth). Wikipedia itself has set up standards for content that include expectations of a neutral point of view, verifiability of information, and the publishing of no original research, but Santana and Wood argue that self-policing of these policies is not adequate:The principle of managerial discretion requires that every actor act from a sense of duty to exercise moral autonomy and choice in responsible ways. When Wikipedia’s editors and administrators remain anonymous, this criterion is simply not met. It is assumed that everyone is behaving responsibly within the Wikipedia system, but there are no monitoring or control mechanisms to make sure that this is so, and there is ample evidence that it is not so. (141) At the theoretical level, some downplay these concerns of transparency and autonomy as logistical issues in lieu of the potential for information systems to support rational discourse and emancipatory forms of communication (Hansen, Berente, and Lyytinen), but others worry that the questionable “realities” created on Wikipedia will become truths once circulated to all areas of the Web (Langlois and Elmer). With the number of articles on the English-language version of Wikipedia reaching well into the millions, the task of mapping and assessing content has become a tremendous endeavour, one mostly taken on by information systems experts. Kittur, Chi, and Suh have used Wikipedia’s existing hierarchical categorisation structure to map change in the site’s content over the past few years. Their work revealed that in early 2008 “Culture and the arts” was the most dominant category of content on Wikipedia, representing nearly 30% of total content. People (15%) and geographical locations (14%) represent the next largest categories, while the natural and physical sciences showed the greatest increase in volume between 2006 and 2008 (+213%D, with “Culture and the arts” close behind at +210%D). This data may indicate that contributing to Wikipedia, and thus spreading knowledge, is growing amongst the academic community while maintaining its importance to the greater popular culture-minded community. Further work by Kittur and Kraut has explored the collaborative process of content creation, finding that too many editors on a particular page can reduce the quality of content, even when a project is well coordinated.Bias in Wikipedia content is a generally acknowledged and somewhat conflicted subject (Giles; Johnson; McHenry). The Wikipedia community has created numerous articles and pages within the site to define and discuss the problem. Citing a survey conducted by the University of Würzburg, Germany, the “Wikipedia:Systemic bias” page describes the average Wikipedian as:MaleTechnically inclinedFormally educatedAn English speakerWhiteAged 15-49From a majority Christian countryFrom a developed nationFrom the Northern HemisphereLikely a white-collar worker or studentBias in content is thought to be perpetuated by this demographic of contributor, and the “founder effect,” a concept from genetics, linking the original contributors to this same demographic has been used to explain the origins of certain biases. Wikipedia’s “About” page discusses the issue as well, in the context of the open platform’s strengths and weaknesses:in practice editing will be performed by a certain demographic (younger rather than older, male rather than female, rich enough to afford a computer rather than poor, etc.) and may, therefore, show some bias. Some topics may not be covered well, while others may be covered in great depth. No educated arguments against this inherent bias have been advanced.Royal and Kapila’s study of Wikipedia content tested some of these assertions, finding identifiable bias in both their purposive and random sampling. They conclude that bias favoring larger countries is positively correlated with the size of the country’s Internet population, and corporations with larger revenues work in much the same way, garnering more coverage on the site. The researchers remind us that Wikipedia is “more a socially produced document than a value-free information source” (Royal & Kapila).WikiProject: Countering Systemic BiasAs a coalition of current Wikipedia editors, the WikiProject: Countering Systemic Bias (WP:CSB) attempts to counter trends in content production and points of view deemed harmful to the democratic ideals of a valueless, open online encyclopedia. WP:CBS’s mission is not one of policing the site, but rather deepening it:Generally, this project concentrates upon remedying omissions (entire topics, or particular sub-topics in extant articles) rather than on either (1) protesting inappropriate inclusions, or (2) trying to remedy issues of how material is presented. Thus, the first question is "What haven't we covered yet?", rather than "how should we change the existing coverage?" (Wikipedia, “Countering”)The project lays out a number of content areas lacking adequate representation, geographically highlighting the dearth in coverage of Africa, Latin America, Asia, and parts of Eastern Europe. WP:CSB also includes a “members” page that editors can sign to show their support, along with space to voice their opinions on the problem of bias on Wikipedia (the quotations at the beginning of this paper are taken from this “members” page). At the time of this study, 329 editors had self-selected and self-identified as members of WP:CSB, and this group constitutes the population sample for the current study. To explore the extent to which WP:CSB addressed these self-identified areas for improvement, each editor’s last 50 edits were coded for their primary geographical country of interest, as well as the conceptual category of the page itself (“P” for person/people, “L” for location, “I” for idea/concept, “T” for object/thing, or “NA” for indeterminate). For example, edits to the Wikipedia page for a single person like Tony Abbott (Australian federal opposition leader) were coded “Australia, P”, while an edit for a group of people like the Manchester United football team would be coded “England, P”. Coding was based on information obtained from the header paragraphs of each article’s Wikipedia page. After coding was completed, corresponding information on each country’s associated continent was added to the dataset, based on the United Nations Statistics Division listing.A total of 15,616 edits were coded for the study. Nearly 32% (n = 4962) of these edits were on articles for persons or people (see Table 1 for complete coding results). From within this sub-sample of edits, a majority of the people (68.67%) represented are associated with North America and Europe (Figure A). If we break these statistics down further, nearly half of WP:CSB’s edits concerning people were associated with the United States (36.11%) and England (10.16%), with India (3.65%) and Australia (3.35%) following at a distance. These figures make sense for the English-language Wikipedia; over 95% of the population in the three Westernised countries speak English, and while India is still often regarded as a developing nation, its colonial British roots and the emergence of a market economy with large, technology-driven cities are logical explanations for its representation here (and some estimates make India the largest English-speaking nation by population on the globe today).Table A Coding Results Total Edits 15616 (I) Ideas 2881 18.45% (L) Location 2240 14.34% NA 333 2.13% (T) Thing 5200 33.30% (P) People 4962 31.78% People by Continent Africa 315 6.35% Asia 827 16.67% Australia 175 3.53% Europe 1411 28.44% NA 110 2.22% North America 1996 40.23% South America 128 2.58% The areas of the globe of main concern to WP:CSB proved to be much less represented by the coalition itself. Asia, far and away the most populous continent with more than 60% of the globe’s people (GeoHive), was represented in only 16.67% of edits. Africa (6.35%) and South America (2.58%) were equally underrepresented compared to both their real-world populations (15% and 9% of the globe’s population respectively) and the aforementioned dominance of the advanced Westernised areas. However, while these percentages may seem low, in aggregate they do meet the quota set on the WP:CSB Project Page calling for one out of every twenty edits to be “a subject that is systematically biased against the pages of your natural interests.” By this standard, the coalition is indeed making headway in adding content that strategically counterbalances the natural biases of Wikipedia’s average editor.Figure ASocial network analysis allows us to visualise multifaceted data in order to identify relationships between actors and content (Vego-Redondo; Watts). Similar to Davis’s well-known sociological study of Southern American socialites in the 1930s (Scott), our Wikipedia coalition can be conceptualised as individual actors united by common interests, and a network of relations can be constructed with software such as UCINET. A mapping algorithm that considers both the relationship between all sets of actors and each actor to the overall collective structure produces an image of our network. This initial network is bimodal, as both our Wikipedia editors and their edits (again, coded for country of interest) are displayed as nodes (Figure B). Edge-lines between nodes represents a relationship, and here that relationship is the act of editing a Wikipedia article. We see from our network that the “U.S.” and “England” hold central positions in the network, with a mass of editors crowding around them. A perimeter of nations is then held in place by their ties to editors through the U.S. and England, with a second layer of editors and poorly represented nations (Gabon, Laos, Uzbekistan, etc.) around the boundaries of the network.Figure BWe are reminded from this visualisation both of the centrality of the two Western powers even among WP:CSB editoss, and of the peripheral nature of most other nations in the world. But we also learn which editors in the project are contributing most to underrepresented areas, and which are less “tied” to the Western core. Here we see “Wizzy” and “Warofdreams” among the second layer of editors who act as a bridge between the core and the periphery; these are editors with interests in both the Western and marginalised nations. Located along the outer edge, “Gallador” and “Gerrit” have no direct ties to the U.S. or England, concentrating all of their edits on less represented areas of the globe. Identifying editors at these key positions in the network will help with future research, informing interview questions that will investigate their interests further, but more significantly, probing motives for participation and action within the coalition.Additionally, we can break the network down further to discover editors who appear to have similar interests in underrepresented areas. Figure C strips down the network to only editors and edits dealing with Africa and South America, the least represented continents. From this we can easily find three types of editors again: those who have singular interests in particular nations (the outermost layer of editors), those who have interests in a particular region (the second layer moving inward), and those who have interests in both of these underrepresented regions (the center layer in the figure). This last group of editors may prove to be the most crucial to understand, as they are carrying the full load of WP:CSB’s mission.Figure CThe End of Geography, or the Reclamation?In The Internet Galaxy, Manuel Castells writes that “the Internet Age has been hailed as the end of geography,” a bold suggestion, but one that has gained traction over the last 15 years as the excitement for the possibilities offered by information communication technologies has often overshadowed structural barriers to participation like the Digital Divide (207). Castells goes on to amend the “end of geography” thesis by showing how global information flows and regional Internet access rates, while creating a new “map” of the world in many ways, is still closely tied to power structures in the analog world. The Internet Age: “redefines distance but does not cancel geography” (207). The work of WikiProject: Countering Systemic Bias emphasises the importance of place and representation in the information environment that continues to be constructed in the online world. This study looked at only a small portion of this coalition’s efforts (~16,000 edits)—a snapshot of their labor frozen in time—which itself is only a minute portion of the information being dispatched through Wikipedia on a daily basis (~125,000 edits). Further analysis of WP:CSB’s work over time, as well as qualitative research into the identities, interests and motivations of this collective, is needed to understand more fully how information bias is understood and challenged in the Internet galaxy. The data here indicates this is a fight worth fighting for at least a growing few.ReferencesAlexa. “Top Sites.” Alexa.com, n.d. 10 Mar. 2010 ‹http://www.alexa.com/topsites>. Ayers, Phoebe, Charles Matthews, and Ben Yates. How Wikipedia Works: And How You Can Be a Part of It. 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