Journal articles on the topic 'Knee Grand Challenge'

Ballet deep squat with legs rotated externally (grand plié) is a fundamental movement for dancers. However, performing this task is a challenge to ankle control, particularly for those with ankle injury. Thus, the purpose of this study was to investigate how ankle sprains affect the ability of postural and muscular control during grand plié in ballet dancers. Thirteen injured dancers and 20 uninjured dancers performed a 15 second grand plié consisting of lowering, squatting, and rising phases. The lower extremity motion patterns and muscle activities, pelvic orientation, and center of pressure (COP) excursion were measured. In addition, a principal component analysis was applied to analyze waveforms of muscle activity in bilateral medial gastrocnemius, peroneus longus, and tibialis anterior. Our findings showed that the injured dancers had smaller pelvic motions and COP excursions, greater maximum angles of knee flexion and ankle dorsiflexion as well as different temporal activation patterns of the medial gastrocnemius and tibialis anterior. These findings suggested that the injured dancers coped with postural challenges by changing lower extremity motions and temporal muscle activation patterns.

A musculoskeletal model of the right lower limb was developed to estimate 3D tibial contact forces in high knee flexion postures. This model determined the effect of intersegmental contact between thigh–calf and heel–gluteal structures on tibial contact forces. This model includes direct tracking and 3D orientation of intersegmental contact force, femoral translations from in vivo studies, wrapping of knee extensor musculature, and a novel optimization constraint for multielement muscle groups. Model verification consisted of calculating the error between estimated tibial compressive forces and direct measurements from the Grand Knee Challenge during movements to ∼120° of knee flexion as no high knee flexion data are available. Tibial compression estimates strongly fit implant data during walking (R2 = .83) and squatting (R2 = .93) with a root mean squared difference of .47 and .16 body weight, respectively. Incorporating intersegmental contact significantly reduced model estimates of peak tibial anterior–posterior shear and increased peak medial–lateral shear during the static phase of high knee flexion movements by an average of .33 and .07 body weight, respectively. This model supports prior work in that intersegmental contact is a critical parameter when estimating tibial contact forces in high knee flexion movements across a range of culturally and occupationally relevant postures.

The purpose of this study was to determine what differences exist when performing grand plié with and without the barre. Differences in center of pressure (COP) sway, trunk kinematics, and lower extremity kinematics were used in this analysis for both first (P1) and fifth positions (P5). It was hypothesized that use of the barre would result in decreased COP sway, but increased asymmetries in trunk and lower extremity kinematics would be seen compared with the same movements performed without the barre in both positions. Sixteen collegiate dancers (1 male, 15 female) performed three trials of grand plié in P1 and P5 (right leg crossed in front) with or without the barre, for a total of 12 trials. For the barre condition (BC), participants demonstrated less time to complete grand plié, slightly less depth in grand plié, and decreased anterior-posterior (AP) sway compared to the without barre condition (WBC). The BC condition showed increased peak left trunk rotation, right knee flexion, decreased right and left peak hip flexion, and increased right hip abduction in both P1 and P5. Comparing P1 to P5, there was decreased AP sway, decreased peak left trunk rotation, decreased peak right and left hip flexion, increased left hip abduction, and decreased right knee flexion in both BC and WBC conditions. For the BC, there was increased right hip abduction in P1 compared to P5. Our results indicate that while use of the barre provides proprioceptive information, which helps dancers to control balance and learn a motor control strategy, grand plié should also be taught without the barre to challenge the dancer's balance control with different movement patterns in space.

Background: Ligaments and cartilage contact contribute to the mechanical constraints in the knee joints. However, the precise influence of these structural components on joint movement, especially when the joint constraints are computed using inverse dynamics solutions, is not clear. Methods: We present a mechanical characterization of the connections between the infinitesimal twist of the tibia and the femur due to restraining forces in the specific tissue components that are engaged and responsible for such motion. These components include the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments and cartilage contact surfaces in the medial and lateral compartments. Their influence on the bony rotation about the instantaneous screw axis is governed by restraining forces along the constraints explored using the principle of reciprocity. Results: Published kinetic and kinematic joint data (American Society of Mechanical Engineers Grand Challenge Competition to Predict In Vivo Knee Loads) are applied to define knee joint function for verification using an available instrumented knee data set. We found that the line of the ground reaction force (GRF) vector is very close to the axis of the knee joint. It aligns the knee joint with the GRF such that the reaction torques are eliminated. The reaction to the GRF will then be carried by the structural components of the knee instead. Conclusions: The use of this reciprocal system introduces a new dimension of foot loading to the knee axis alignment. This insight shows that locating knee functional axes is equivalent to the static alignment measurement. This method can be used for the optimal design of braces and orthoses for conservative treatment of knee osteoarthritis. (J Am Podiatr Med Assoc 103(2): 126–135, 2013)

Unicompartmental knee arthroplasty has been shown to provide superior functional outcomes compared to total knee arthroplasty and have motivated development of advanced implant designs including bicruciate retaining knee arthroplasty. However, few validated frameworks are available to directly compare the effect of implant design and surgical techniques on ligament function and joint kinematics. In the present study, the subject-specific lower extremity models were developed based on musculoskeletal modeling framework using force-dependent kinematics method, and validated against in vivo telemetric data. The experiment data of two subjects who underwent TKA were obtained from the SimTK “Grand Challenge Competition” repository, and integrated into the subject-specific lower extremity model. Five walking gait trials and three different knee implant models for each subject were used as partial inputs for the model to predict knee biomechanics for unicompartmental, bicruciate retaining, and total knee arthroplasty. The results showed no significant differences in the tibiofemoral contact forces or angular kinematic parameters between three groups. However, unicompartmental knee arthroplasty demonstrated significantly more posterior tibial location between 0% and 40% of the gait cycle ( p < 0.017). Significant differences in range of tibiofemoral anterior/posterior translation and medial/lateral translation were also observed between unicompartmental and bicruciate retaining arthroplasty ( p < 0.017). Peak values of anterior cruciate ligament forces differed between unicompartmental and bicruciate retaining arthroplasty from 10% to 30% of the gait cycle. Findings of this study indicate that unicompartmental and bicruciate retaining arthroplasty do not have identical biomechanics and point to the complementary role of anterior cruciate ligament and articular geometry in guiding knee function. Further, the patient-specific musculoskeletal model developed provides a reliable framework for assessing new implant designs, and effect of surgical techniques on knee biomechanics following arthroplasty.

Bi-cruciate retaining total knee arthroplasty has several potential advantages including improved anteroposterior knee stability compared to contemporary posterior cruciate-retaining total knee arthroplasty. However, few studies have explored whether there is significant differences of knee biomechanics following bi-cruciate retaining total knee arthroplasty compared to posterior cruciate-retaining total knee arthroplasty. In the present study, subject-specific lower extremity musculoskeletal multi-body dynamics models for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty were developed based on the musculoskeletal modeling framework using force-dependent kinematics method and validated against in vivo telemetric data. The experiment data of two subjects who underwent total knee arthroplasty were obtained for the SimTK “Grand Challenge Competition” repository, and integrated into the musculoskeletal model. Five walking gait trials for each subject were used as partial inputs for the model to predict the knee biomechanics for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty. The results revealed significantly greater range of anterior/posterior tibiofemoral translation, and significantly more posterior tibial location during the early phase of gait and more anterior tibial location during the late phase of gait were found in bi-cruciate retaining total knee arthroplasty without anterior cruciate ligament when compared to the bi-cruciate retaining total knee arthroplasty. No significant differences in tibiofemoral contact forces, rotations, translations, and ligament forces between bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty during normal walking gait, albeit slight differences in range of tibiofemoral internal/external rotation and anterior/posterior translation were observed. The present study revealed that anterior cruciate ligament retention has a positive effect on restoring normal knee kinematics in bi-cruciate retaining total knee arthroplasty. Preservation of anterior cruciate ligament in total knee arthroplasty and knee implant designs interplay each other and both contribute to restoring normal knee kinematics in different types of total knee arthroplasty. Further evaluation of more demanding activities and subject data from patients with bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty via musculoskeletal modeling may better highlight the role of the anterior cruciate ligament and its stabilizing influence.

Background:Osteoarthritis (OA) is a degenerative joint disease involving structural pathology of all joint tissues, and most commonly affecting the knee, hip and hand. Degradation of the cartilage extracellular matrix represents a central feature of OA and is widely thought to be mediated by proteinases that degrade primarily aggrecan and collagen. ADAMTS-5, a Disintegrin And Metalloproteinase with ThromboSpondin-motif-5, is a key aggrecan-cleaving enzyme involved in cartilage degradation. S201086/GLPG1972, a potent and highly selective inhibitor of ADAMTS-5, is an oral Disease-Modifying OsteoArthritis Drug (DMOAD) candidate.Objectives:The primary objective of the ROCCELLA phase 2 clinical trial (NCT03595618) is to evaluate the effect of S201086/GLPG1972 over 52 weeks of treatment (3 dose groups compared to placebo) in reducing cartilage loss. Cartilage thickness of the knee is being measured quantitatively by Magnetic Resonance Imaging. Here, we describe the baseline characteristics of patients included in the ROCCELLA clinical trial.Methods:The main inclusion criteria were: male or female, aged 40 to 75, with a diagnosis of knee OA according to the clinical and radiological criteria of the American College of Rheumatology. The target knee had to meet a pain score between 40 and 90 mm on a 100 mm Visual Analog Scale (VAS), and the following radiographic feature upon central radiographic readings: Kellgren/Lawrence (KL) 2 or 3 and OARSI medial joint space narrowing (JSN) 1 or 2 (for more details see Deckxet al. OARSI 2020). The rationale for these specific radiographic inclusion criteria was to ensure sufficient cartilage loss over 12 months to assess the efficacy of S201086/GLPG1972.Results:Across 12 countries, 3319 patients were screened and 932 were finally included in the study. The screen failure of 72% is mainly due to the radiological criteria. The age of the patients was 62.9 ± 7.3 years (mean ± SD) with a majority of women (69.3%). The BMI was 30.5 ± 4.7 kg/m2. The duration of knee OA was 7.2 ± 6.9 years. Five hundred and one (53.8%) patients reported a medical history of musculoskeletal and connective tissue disorders, mainly osteoarthritis in other sites (20.2%), back pain (13.6%), and arthralgia (9.8%). At inclusion, 97.2% of the patients were taking different types of drug treatments, mainly anti-inflammatory and anti-rheumatic products (69.4%) and analgesics (42%). At baseline, 11% of the target knees were KL2 and 89% were KL3; 32% were OARSI medial JSN grade 1 and 68% grade 2. Target knees at inclusion had a pain score on the VAS of 63.5 ± 11.4 mm (range 0-100, with 0 for no and 100 for extreme pain) and a total WOMAC (Likert 3.1) score of 48.0 ± 15.0 (range 0-96). The WOMAC subscores for pain, stiffness and physical function were 10.0 ± 3.2 (range 0-20), 4.2 ± 1.6 (range 0-8) and 33.8 ± 11.2 (range 0-68, indicating functional limitation), respectively.Conclusion:For this clinical trial, patients were selected to present radiological criteria (i.e.OARSI JSN 1 and 2) to ensure sufficient structural progression (cartilage loss) over 12 months, as well as clinical symptoms. These stringent selection criteria were the main cause for the high screen failure rate. These baseline characteristics should warrant the ability to evaluate the efficacy of S201086/GLPG1972 as a DMOAD candidate. The search for an effective pharmacological treatment that can prevent or cure OA remains a major challenge and unmet medical need.Disclosure of Interests:Katy Bernard Employee of: Institut de Recherches Internationales Servier, Sergey GRANKOV Employee of: Institut de Recherches Internationales Servier, Marjolijne van der Stoep Employee of: Galapagos, Agnès Lalande Employee of: Institut de Recherches Internationales Servier, Olivier Imbert Employee of: Institut de Recherches Internationales Servier, De Phung Employee of: Galapagos, Damien Chimits Employee of: Institut de Recherches Internationales Servier, Karine Muller Employee of: Galapagos, Ellen van der Aar Employee of: Galapagos, Henri Deckx Employee of: Galapagos, Maria Pueyo Employee of: Institut de Recherches Internationales Servier, Felix Eckstein Grant/research support from: Merck, Orthotrphix, Servier, Galapagos, Kolon Tissuegene, Samumed, Novartis, Consultant of: Merck, Bioclinica, Servier, Samumed, Roche, Kolon Tissuegene, Galapagos and Novartis, Employee of: co-owner and employment with Chondrometrics

Background:The role of nurses in managing painful knee OA has been advocated but whether nurses can deliver such interventions as a package of care is unknown.The overall aim of this research is to develop and test a nurse-led complex intervention for knee pain comprising non-pharmacological and pharmacological components. In the first study phase, we report on fidelity and acceptability of a non-pharmacological intervention, to resolve possible challenges to delivery.Objectives:To evaluate fidelity of delivery and acceptability of non-pharmacological components of a complex intervention.Methods:This was a mixed-methods study. Participants with chronic knee pain were recruited from the community to receive the intervention, delivered in 4-sessions over a 5-week period by a trained research nurse. The intervention consisted of holistic assessment, patient education and advice, aerobic and strengthening exercise and weight-loss advice if required. All sessions were video-recorded. Fidelity checklists were completed by the nurse (nurse-rated) and two researchers from the video-recordings (video-rated). Median fidelity scores (%) and interquartile ranges (IQR) were calculated for each component and each session. Semi-structured interviews were conducted with participants. These were audio recorded, transcribed and analysed following the framework approach.Results:18 participants (34% women), with a mean (SD) age and BMI of 68.7 (9.0) years and 31.2 (8.4) kg/m2, took part in the study. Of these, 14 completed all visits. In total, 62 intervention sessions were assessed for fidelity. Overall fidelity was rated high by both nurse-rated scores (97.7%) and video-rated scores (84.2%). The level of agreement between nurse-rated and video-recorded methods was 73.3% (CI 71.3, 75.3) and the inter-rater agreement was 65.5% (CI 60.3, 70.5). Fidelity of delivery was lower for advice on footwear modification and walking aids in all sessions and moderate for education in session 1 and for exercise in session 4 (Table 1).Table 1.Fidelity scores of the components of the intervention for each session,Intervention componentsSession 1*Session 2*Session 3*Session 4*Education78.1 (74.1, 93.7)87.5 (50, 100)87.5 (50, 100)100 (93.7, 100)Exercise94.4 (88.9, 100)88.9 (75, 94)86.1 (72, 100)75 (67.6, 82.8)Adjunctive treatments50 (45.83, 100)0 (0, 50)50 (0, 100)-*median (IQR)17 participants were interviewed. Most found advice supplied straightforward. They were satisfied with the package, which changed their perception of managing knee pain, understanding it can be improved though self-management. However, too much information was provided in a short time-span and it was difficult to fit exercises into their daily routine.Conclusion:Delivery of a non-pharmacological intevention by a nurse is feasible within a research setting. Most components of the intervention were delivered as intended, except for advice about the use of adjunctive treatment.Acknowledgments:This research was funded by the NIHR Nottingham BRC and Pain Centre Versus ArthritisDisclosure of Interests:Polykarpos Angelos Nomikos: None declared, Amy Fuller: None declared, Michelle Hall: None declared, Bonnie Millar: None declared, Reuben Ogollah: None declared, Michael Doherty: None declared, Roshan Nair Speakers bureau: Financial support from pharmaceutical companies (Biogen and Novartis) to present lectures at events related to psychological support for people with multiple sclerosis (Speaker’s bureau)., David Walsh Grant/research support from: 2016: Investigator-led grant from Pfizer Ltd (ICRP) on Pain Phenotypes in RA; non-personal financial disclosure (payment to University)., Consultant of: DAW has undertaken paid consultancy to Pfizer Ltd, Eli Lilly and Company and GSK Consumer Healthcare., Paid instructor for: 2019: Consultancy to Love Productions; consultancy on programme design, contribution to programme content on self-management of chronic pain (payments to University)2019: Consultancy to AbbVie Ltd; 13.06.19; presentation on RA pain at EULAR, Madrid, and webinar (payments to University).2019: Consultancy to Eli Lilly and Company Ltd. 06.06.19 Centre for Collaborative Neuroscience, Windlesham, Surrey, UK (payment to University).2019: Consultancy to Pfizer (payment to University).2018: Consultancy to Pfizer. 07.12.18. USA. 1 day. Tanezumab (payment to University).2018: Consultancy to Pfizer. 23.11.18. Manchester UK. 1 day. Tanezumab (payment to University).2018: Consultancy to Pfizer. 1.11.18. Skype. 4h. Tanezumab (payment to University).2018: Consultancy to GlaxoSmithKline Plc. 1 day. Pain in RA and anti-GM-CSF (payment to University).2018: Consultancy to Pfizer Ltd; Presentation at OARSI; non-personal financial disclosure (payment to University)2018: Consultancy to Pfizer Ltd; Patient preference study; non-personal financial disclosure (payment to University)2017: Consultancy to Pfizer Ltd; personal financial disclosure2017: Consultancy to Pfizer Ltd through Nottingham University; non-personal financial disclosure (payment to University).2015: Consultancy to GSK Consumer Healthcare; personal financial disclosure., Speakers bureau: 2019: Irish Society of Rheumatology: speaker fees (personal pecuniary), Ana Valdes Grant/research support from: Awarded a grant from Pfizer, Abhishek Abhishek: None declared

A survey of gardeners in Minnesota found they get their information from friends and garden centers. Older gardeners were less likely to use the Internet. The highest interest was indicated for annuals, perennials, and containers, followed by trees and shrubs. Most participants had not attended a gardening class in the past year and indicated they learn best from talking with friends. Publications are of interest to gardeners, and they highly value color photos and illustrations. The University of Minnesota and Minnesota Landscape Arboretum were perceived as significantly more credible and trustworthy than garden centers, and participants felt these institutions should provide educational programs, even if survey respondents were not participating in these programs. About half the participants were not able to comment on the level of bias of the university and arboretum, and other traits (credible, trustworthy, expert, and knowledgeable) were unknown to one-third to one-half of the participants. Participants knew more about these traits for garden centers and home stores. Participants in this survey indicated they look for convenient sources of gardening information and, although many felt the land-grant university and arboretum were highly credible and knowledgeable, they were still more likely to use other sources for their gardening information. This poses a challenge to universities and arboreta to use new ways to reach gardeners.

In researching life and career of Nguyen Hoang, it is apparent to realize that he was a prominent politician as well as a military genius. In his over 60 years in the military, Nguyen Hoang won numerous battles without a single defeat. His victories were acknowledged by the Le Emperor and the Trinh lords of Kiem and Tac, and conferred to the title of Right hand General (18), Grand Duke Doan (Hữu tướng Đoan Quốc công). Right from the very first battles, his military ability was proven. That Talent was increasingly being challenged, trained, and made him the best general overtime. He mastered both naval and army warfare. His fought on diverse battle sites with enemies ranging from Vietnamese to Westerners. All of the victories earned him the fame of “invincible hero”. Nguyen Hoang was not merely a field general but also a military thinker. He knew how to maximize the advantages including natural landscapes and his troops’ spirit. He also used psychological techniques and exploited divisions among the enemies in order to skillfully escape from the Trinh’s control. Nguyen Hoang’s Southward territorial expansions proved himself a military man with strategic vision as well. Nguyen Hoang’s vision can be observed clearly in his consideration of his headquarters’ locations so that it could be well defended against rivals’ attacks. The headquarters’ Southward relocations reflect his gradual awareness of local strategic landscapes as well as the possibility of the Trinh’s invasion from the North, which he thought of very much ahead in time. Nguyen Hoang’s testament to his heir served as a guideline for the rule of the Nguyen in the South. The Nguyen lords put much effort on the early settlements, sustained with the Trinh in the North, and expanded Dai Viet frontier further Southward as far as Ca Mau.

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 53-year-old healthy man presented with recurrent in-transit melanoma of the right lower extremity. Eight years prior he had undergone wide local excision and sentinel lymph node biopsy for invasive melanoma of the anteromedial aspect of the distal right thigh. Pathology revealed an ulcerated melanoma, Breslow depth 3.5 mm, and with one involved micrometastatic inguinal lymph node. Staging studies did not demonstrate distant metastases. Superficial inguinal node dissection was performed and did not identify any additional metastatic nodes of 14 retrieved for a final pathologic staging of T3bN1aM0 (stage IIIB) cutaneous melanoma. He received 12 months of adjuvant high-dose interferon alfa-2b. Two years later, he developed a 1.2-cm subcutaneous focus of in-transit recurrence approximately 4 cm proximal to the original melanoma site in the right thigh, which was treated with surgical resection followed by adjuvant radiotherapy. Over the next 4 years, he underwent six additional surgeries for isolated in-transit recurrences affecting the same limb. He was referred for therapeutic options at the time of his latest in-transit recurrence. Examination revealed three palpable subcutaneous nodules in the right thigh in the setting of lymphedema. A core biopsy confirmed recurrent melanoma (Fig 1). Whole-body fluorodeoxyglucose positron emission tomography imaging revealed at least 17 hypermetabolic cutaneous and subcutaneous nodules in the right thigh, four fluorodeoxyglucose-avid nodules below the right knee, but no distant metastases (Fig 2A). Brain magnetic resonance imaging was normal. His serum chemistry profile, including lactate dehydrogenase, was normal. Molecular analysis demonstrated presence of BRAF V600E mutation in the tumor. After multidisciplinary evaluation, an isolated limb infusion procedure of the right lower extremity was not believed to be feasible, secondary to the proximal extent of the recurrence. Therapy was initiated with pembrolizumab at 2 mg/kg intravenously every 3 weeks.

Background:Mevalonate Kinase Deficiency (MKD) is an autosomal recessive autoinflammatory syndrome. Diagnostic criteria are based in clinical and genetic features (mutations in MVK gene) and its main treatment consists of blocking IL-11-5.Objectives:To describe a case-series of a rare bleated cutaneous feature.Methods:From January 2004 to September 2019, all cases diagnosed of MKD have been reviewed.Results:15 patients had MKD diagnosis (11 pathogenic mutations, homozygosis or double heterozygosis). Most common symptoms were oral and genital aphthous, abdominal pain, adenopathies and recurrent fever. Mean age of diagnosis was 10,67 years old (8,67 years later from the beginning of symptoms). Mean time of follow-up was 10 years. 3 patients developed this rare bleated cutaneous feature: suppurative hydrosadenitis. When the first injury appeared, all were at treatment with Canakinumab (mean time of treatment 4 years) and had 7,67 years of MKD course. This comorbidity began as repeating abscesses in folds with apocrine glands and hair follicles (armpits, inguinal, anal and genital folds). 2 patients continued Canakinumab and 1 switched to Adalimumab because of severity of cutaneous involvement.Conclusion:This is the first case-series showing suppurative hydrosadenitis associated to MKD that has not been described in literature. Both theories have been found: as immune-mediated disease partnering this autoinflammatory syndrome (MKD) or as adverse event of treatment (anti-IL-1, less presumable).References:[1]Van der Meer JW, Simon A. The challenge of autoinflammatory síndromes: with an emphasis on hyper-IgD syndrome. Rheumatology 2016;55:23-29.[2]Arnal C, Modesto C. Sídnromes febriles periódicos hereditarios: nuevas perspectivas sobre su conocimiento clínico y genético. 2003;30(2):45-48.[3]Mulders-Manders C, Simon A. Hyper-IgD syndrome/mevalonate kinase deficiency: what is knew? Semin Immunopathol 2015;37:371-376.[4]Cush, J. Autoinflammatory Syndromes. Dermatol Clin 2013;31(3):471-480.[5]Moreira A, Torres B, Peruzzo J, et al. Skin symptoms as diagnostic clue for autoinflammatory diseases. An Bras Dermatol 2017;92(1):72-80.Disclosure of Interests:Raquel Dos Santos Sobrín: None declared, B Lopez-Montesinos: None declared, Miguel Martí Masanet: None declared, Lucía Lacruz Pérez: None declared, Inmaculada Calvo Grant/research support from: Bristol-Myers Squibb, Clementia, GlaxoSmithKline, Hoffman-La Roche, Merck Sharpe & Dohme, Novartis, Pfizer, Sanofi, Speakers bureau: AbbVie, GlaxoSmithKline, Hoffman-La Roche, Novartis

Background:Bone formation in spondyloarthritis (SpA) is presumably related to local enthesitis/peri-articular inflammation and ultimately may lead to functional limitation (1,2). X-rays only allow long-term monitoring of bone formation (≥2 years) (3). Imaging techniques that can visualize bone formation at an early stage would therefore be valuable. Positron Emission Tomography (PET) using [18F]Fluoride can visualize and quantify (early changes in) bone formation at molecular level (4).Objectives:To investigate the feasibility of [18F]Fluoride to assess new bone formation at axial and peripheral enthesial sites in SpA patients.Methods:Thus far, 5 of the total of 15 patients with clinically active ankylosing spondylitis (AS) (according to modified New York criteria and BASDAI ≥4) and 8 of the 25 patients with active psoriatic arthritis (PsA) (according to CASPAR criteria and ≥1 clinically active enthesitis) were included. Of each patient, a whole body [18F]Fluoride PET-CT scan was performed. All scans were visually judged and scored dichotomously by one reader (blinded for clinical data) for PET-positive lesions in the spine, peripheral enthesis sites and joints. Low dose CT was used for anatomical reference.Results:The study is ongoing, with whole body [18F]Fluoride PET-CT scans available in five AS patients and eight PsA patients. In 4/5 AS scans, at least (≥1) PET positive lesions were found in the cervical, thoracic and/or lumbar vertebrae. These were mainly found in anterior corners of vertebrae and bridging syndesmophytes (Fig. 1A). In all eight PsA patients, at least 1 PET positive lesion was visualized, projected either at the site of a tendon attachment (fascia plantaris, achilles- and patella tendon (Fig 1B)) or peri-articularly (in the ankle or wrist).Fig 1.[18F]Fluoride uptake in the cervical, thoracic and lumbar spine in a clinically active AS patient (A) and in the patella tendon of the right knee in a clinically active PsA patient (B)Conclusion:[18F]Fluoride PET uptake, reflecting new bone formation, can be visualized at heterogeneously distributed enthesis and (peri-)articular sites in AS- and PsA patients. The technique therefore is sensitive to visualize new bone formation and may reflect local disease activity. Additional scans will be collected and analyzed quantitatively, also after anti-TNF or Secukinumab treatment, to further investigate the applicability of [18F]Fluoride PET for monitoring of therapeutic effects on bone formation in SpA.References: :[1]Maksymowych WP, Mallon C, Morrow S, Shojania K, Olszynski WP, Wong RL, et al. Development and validation of the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index. Ann Rheum Dis. 2009;68(6):948-53.[2]Rezvani A, Bodur H, Ataman S, Kaya T, Bugdayci DS, Demir SE, et al. Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis. Mod Rheumatol. 2014;24(4):651-6.[3]Rudwaleit M, Khan MA, Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum 2005;52:1000-8..[4]Bruijnen ST, Verweij NJF, van Duivenvoorde L, Bravenboer N, Baeten D, van Denderen JC, et al. [18F]Fluoride PET-CT imaging of bone formation in ankylosing spondylitis before and after 12 weeks of anti-TNF treatment. 2017.Acknowledgments:We thank EULAR Foreum, Pfizer and Novartis for financial support of this investigator initiated study.Disclosure of Interests:Jerney de Jongh: None declared, Robert Hemke: None declared, Gerben C.J. Zwezerijnen: None declared, Maqsood Yaqub: None declared, Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Marleen G.H. van de Sande Grant/research support from: Novartis, Eli lily, UCB, Jansen, Consultant of: Abbvie, Novartis, Eli lily, MSD, Arno Van Kuijk: None declared, Irene Bultink: None declared, Lot Burgemeister: None declared, Nancy M.A. van Dillen: None declared, Alexandre Voskuyl: None declared, Conny J. van der Laken: None declared

Purpose This paper is a “Q&A interview” conducted by Joanne Pransky of Industrial Robot Journal as a method to impart the combined technological, business and personal experience of a prominent, robotic industry engineer-turned successful innovator and leader regarding the challenges of bringing technological discoveries to fruition. This paper aims to discuss these issues. Design/methodology/approach The interviewee is Dr Robin R. Murphy, Raytheon Professor of Computer Science and Engineering, Texas A&M University; Co-lead, Emergency Informatics EDGE Innovation Network Center, Texas A&M, Director of the Humanitarian Robotics and AI Laboratory and Vice President of the Center for Robot-Assisted Search and Rescue (CRASAR) http://crasar.org. In this interview, Dr Murphy provides answers to questions regarding her pioneering experiences in rescue robotics. Findings As a child, Dr Murphy knew she wanted to be a mechanical engineer and obtained her BME degree from Georgia Institute of Technology (Georgia Tech). While working in industry after her BME, she fell in love with computer science and received an MS and PhD in Computer Science at Georgia Tech where she was a Rockwell International Doctoral Fellow. In the mid-1990s, while teaching at the Colorado School of Mines, she pioneered rescue robots after one of her graduate students returned from the Oklahoma City bombing and suggested that small rescue robots should be developed for future disasters. The National Science Foundation awarded Murphy and her students the first grant for search-and-rescue robots. She has since assisted in responses at more than 20 worldwide disasters, including Hurricane Katrina, the Crandall Canyon Mine collapse, the Tohoku Tsunami and the Fukushima Daiichi nuclear accident. Originality/value The response to the World Trade Center attacks after September 11, 2001 by Dr Murphy’s team from the University of South Florida (the only academic institution), along with four other teams brought together by CRASAR, marked the first recorded use of a rescue robot at a disaster site. In addition to being a founder in the field of rescue robots, she is also a founder in the field of human–robot interaction and the Roboticists Without Borders. She has written over 100 publications and three books: the best-selling textbook, Introduction to AI Robotics, Disaster Robotics and Robotics-Through-Science-Fiction: Artificial Intelligence Explained Six Classic Robot Short Stories. Dr Murphy has received approximately 20 national awards and honors including: the AUVSI’s Al Aube Outstanding Contributor Award, the Eugene L. Lawler Award for Humanitarian Contributions within Computer Science and Informatics, CMU Field Robotics Institute “Pioneer in Field Robotics” and TIME Magazine, Innovators in Artificial Intelligence. She is an IEEE Fellow.

Background:Ultrasound (US) is an imaging adjunct to clinical joint examination adding sensitivity and objectivity to the assessment of inflammation. Previous studies in PsA have shown disparity between ultrasound and clinical findings with significant subclinical joint inflammation. A clinical challenge in PsA is to interpret tender joints (TJ) that are not swollen (SJ). As US is not widely used, alignment of clinical with US assessment is needed to determine its future role.Objectives:To determine how joint clinical examination relates to US findings in very early DMARD naïve PsA.Methods:Newly diagnosed DMARD naïve PsA patients, fulfilling CASPAR criteria, were recruited into the Leeds Spondyloarthropathy Register for Research and Observation (SpARRO), a prospective observational cohort study. US examination of 48 joints per patient was conducted by trained ultra-sonographers, blinded to clinical details with semi-quantitative scoring (0-3) for gray scale (GS) and power Doppler (PD). TJ and SJ counts were independently recorded. Cross-sectional baseline analysis was performed. The prevalence-adjusted and bias-adjusted kappa (PABAK) was calculated to determine agreements between clinical and US parameters. Spearman’s rank correlation coefficient was calculated to identify permutations of TJ/SJ correlating with GS ≥2, PD≥1 or both.Results:A total 5927 joints were scanned in 155 PsA patients. The mean age was 44.4 years, (SD 12.8), median disease duration 5.1 weeks (0.4-13.1); median TJC=7 (3-14) and SJC=2 (1-7). Oligoarthritis was present in 63.9% (99/155). US GS≥2 was frequently detected in the feet at MTPs1-4 (37.4- 53.6 %) and wrists (26.5- 33.6%). PD was most prevalent at wrists (17.5%) and MTP1 (12.6%) but observed less in other joints. Erosions were less frequent, the commonest site being MTP5 (17/310, 5.4%).Overall, SJ demonstrated high agreement (p<0.001) with US synovitis (GS ≥2 and/or PD ≥1). High agreement was equivalent between combined GS ≥2 and PD ≥1 compared with PD ≥1 alone (p<0.001) indicating it was predominantly driven by PD. Agreement with TJ and US was consistently lower yet still significant (p<0.001). Combinations of TJ/SJ were explored with US synovitis (table 1). Correlation was significant for T+ S+ and PD≥1 at wrists, MCP1-5, PIP2-5, MCP3-4 (p<0.001); DIP2 (p<0.05), knees and ankles (p<0.01) but weaker correlation in MTP3,4. In contrast, poor correlation was observed in the T+ S- group for most joints.Table 1.Agreement between TJ or SJ with GS≥2 & PD ≥1 and correlations for tender with/ without swollen combinations for right sided hand/feet joints.TenderSwollenT+ S-T+ S+Joint (Right)A (%)PABAKA (%)PABAKrrWrist75.50.51*89.10.78*-0.090.35*MCP184.10.68*87.50.75*0.090.44*MCP277.70.55*83.10.66*0.080.35*MCP379.10.58*84.50.69*0.0050.50*MCP478.40.57*86.40.72*0.070.22†MCP587.80.76*95.60.91*-0.030.49*MTP169.80.40*83.90.68*-0.03-MTP279.10.58*90.50.81*0.060.11MTP377.00.54*88.50.77*0.050.22‡MTP477.70.55*87.20.74*-0.0020.23‡MTP579.90.60*89.90.80*0.150.09T+= tender, S+ =swollen, S- = not swollen, A=agreement (%), r =coefficient, † p<0.05, ‡ p<0.01, *p<0.001.Conclusion:Swollen joints demonstrate higher agreement with US synovitis (PD≥1 alone or GS ≥2 & PD ≥1 combined) than tender joints in early PsA. In addition, joints that are tender but not swollen have poor correlation with US synovitis at the individual joint level indicating that swelling is a better clinical discriminator of active synovitis, and factors other than synovial inflammation may drive tenderness in very early, DMARD naïve PsA. These results suggest re-appraisal of clinical joint counts is needed to refine treatment decision making in early PsA.Disclosure of Interests:Sayam Dubash: None declared, Oras Alabas: None declared, Xabier Michelena: None declared, Leticia Garcia-Montoya: None declared, Gabriele De Marco: None declared, Mira Merashli: None declared, Richard Wakefield Speakers bureau: Novartis, Janssen, GE, Philip Helliwell: None declared, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC, Ai Lyn Tan: None declared, Paul Emery Grant/research support from: AbbVie, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, Roche (all paid to employer), Consultant of: AbbVie (consultant, clinical trials, advisor), Bristol-Myers Squibb (consultant, clinical trials, advisor), Lilly (clinical trials, advisor), Merck Sharp & Dohme (consultant, clinical trials, advisor), Novartis (consultant, clinical trials, advisor), Pfizer (consultant, clinical trials, advisor), Roche (consultant, clinical trials, advisor), Samsung (clinical trials, advisor), Sandoz (clinical trials, advisor), UCB (consultant, clinical trials, advisor), Helena Marzo-Ortega Grant/research support from: Janssen, Novartis, Consultant of: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda, UCB

Validation is critical if clinicians are to use musculoskeletal models to optimize treatment of individual patients with a variety of musculoskeletal disorders. This paper provides an update on the annual Grand Challenge Competition to Predict in Vivo Knee Loads, a unique opportunity for direct validation of knee contact forces and indirect validation of knee muscle forces predicted by musculoskeletal models. Three competitions (2010, 2011, and 2012) have been held at the annual American Society of Mechanical Engineers Summer Bioengineering Conference, and two more competitions are planned for the 2013 and 2014 conferences. Each year of the competition, a comprehensive data set collected from a single subject implanted with a force-measuring knee replacement is released. Competitors predict medial and lateral knee contact forces for two gait trials without knowledge of the experimental knee contact force measurements. Predictions are evaluated by calculating root-mean-square (RMS) errors and R2 values relative to the experimentally measured medial and lateral contact forces. For the first three years of the competition, competitors used a variety of methods to predict knee contact and muscle forces, including static and dynamic optimization, EMG-driven models, and parametric numerical models. Overall, errors in predicted contact forces were comparable across years, with average RMS errors for the four competition winners ranging from 229 N to 312 N for medial contact force and from 238 N to 326 N for lateral contact force. Competitors generally predicted variations in medial contact force (highest R2 = 0.91) better than variations in lateral contact force (highest R2 = 0.70). Thus, significant room for improvement exists in the remaining two competitions. The entire musculoskeletal modeling community is encouraged to use the competition data and models for their own model validation efforts.

Segment-based musculoskeletal models allow the prediction of muscle, ligament, and joint forces without making assumptions regarding joint degrees-of-freedom (DOF). The dataset published for the “Grand Challenge Competition to Predict in vivo Knee Loads” provides directly measured tibiofemoral contact forces for activities of daily living (ADL). For the Sixth Grand Challenge Competition to Predict in vivo Knee Loads, blinded results for “smooth” and “bouncy” gait trials were predicted using a customized patient-specific musculoskeletal model. For an unblinded comparison, the following modifications were made to improve the predictions: further customizations, including modifications to the knee center of rotation; reductions to the maximum allowable muscle forces to represent known loss of strength in knee arthroplasty patients; and a kinematic constraint to the hip joint to address the sensitivity of the segment-based approach to motion tracking artifact. For validation, the improved model was applied to normal gait, squat, and sit-to-stand for three subjects. Comparisons of the predictions with measured contact forces showed that segment-based musculoskeletal models using patient-specific input data can estimate tibiofemoral contact forces with root mean square errors (RMSEs) of 0.48–0.65 times body weight (BW) for normal gait trials. Comparisons between measured and predicted tibiofemoral contact forces yielded an average coefficient of determination of 0.81 and RMSEs of 0.46–1.01 times BW for squatting and 0.70–0.99 times BW for sit-to-stand tasks. This is comparable to the best validations in the literature using alternative models.

This study presents a semi-automatic framework to create subject-specific total knee replacement finite element models, which can be used to analyze locomotion patterns and evaluate knee dynamics. In recent years, much scientific attention was attracted to pre-clinical optimization of customized total knee replacement operations through computational modeling to minimize post-operational adverse effects. However, the time-consuming and laborious process of developing a subject-specific finite element model poses an obstacle to the latter. One of this work's main goals is to automate the finite element model development process, which speeds up the proposed framework and makes it viable for practical applications. This pipeline's reliability was ratified by developing and validating a subject-specific total knee replacement model based on the 6th SimTK Grand Challenge data set. The model was validated by analyzing contact pressures on the tibial insert in relation to the patient's gait and analysis of tibial contact forces, which were found to be in accordance with the ones provided by the Grand Challenge data set. Subsequently, a sensitivity analysis was carried out to assess the influence of modeling choices on tibial insert's contact pressures and determine possible uncertainties on the models produced by the framework. Parameters, such as the position of ligament origin points, ligament stiffness, reference strain, and implant-bone alignment were used for the sensitivity study. Notably, it was found that changes in the alignment of the femoral component in reference to the knee bones significantly affect the load distribution at the tibiofemoral joint, with an increase of 206.48% to be observed at contact pressures during 5° internal rotation. Overall, the models produced by this pipeline can be further used to optimize and personalize surgery by evaluating the best surgical parameters in a simulated manner before the actual surgery.

Musculoskeletal (MS) models should be able to integrate patient-specific MS architecture and undergo thorough validation prior to their introduction into clinical practice. We present a methodology to develop subject-specific models able to simultaneously predict muscle, ligament, and knee joint contact forces along with secondary knee kinematics. The MS architecture of a generic cadaver-based model was scaled using an advanced morphing technique to the subject-specific morphology of a patient implanted with an instrumented total knee arthroplasty (TKA) available in the fifth “grand challenge competition to predict in vivo knee loads” dataset. We implemented two separate knee models, one employing traditional hinge constraints, which was solved using an inverse dynamics technique, and another one using an 11-degree-of-freedom (DOF) representation of the tibiofemoral (TF) and patellofemoral (PF) joints, which was solved using a combined inverse dynamic and quasi-static analysis, called force-dependent kinematics (FDK). TF joint forces for one gait and one right-turn trial and secondary knee kinematics for one unloaded leg-swing trial were predicted and evaluated using experimental data available in the grand challenge dataset. Total compressive TF contact forces were predicted by both hinge and FDK knee models with a root-mean-square error (RMSE) and a coefficient of determination (R2) smaller than 0.3 body weight (BW) and equal to 0.9 in the gait trial simulation and smaller than 0.4 BW and larger than 0.8 in the right-turn trial simulation, respectively. Total, medial, and lateral TF joint contact force predictions were highly similar, regardless of the type of knee model used. Medial (respectively lateral) TF forces were over- (respectively, under-) predicted with a magnitude error of M < 0.2 (respectively > −0.4) in the gait trial, and under- (respectively, over-) predicted with a magnitude error of M > −0.4 (respectively < 0.3) in the right-turn trial. Secondary knee kinematics from the unloaded leg-swing trial were overall better approximated using the FDK model (average Sprague and Geers' combined error C = 0.06) than when using a hinged knee model (C = 0.34). The proposed modeling approach allows detailed subject-specific scaling and personalization and does not contain any nonphysiological parameters. This modeling framework has potential applications in aiding the clinical decision-making in orthopedics procedures and as a tool for virtual implant design.

Joint contact forces measured with instrumented knee implants have not only revealed general patterns of joint loading but also showed individual variations that could be due to differences in anatomy and joint kinematics. Musculoskeletal human models for dynamic simulation have been utilized to understand body kinetics including joint moments, muscle tension, and knee contact forces. The objectives of this study were to develop a knee contact model which can predict knee contact forces using an inverse dynamics-based optimization solver and to investigate the effect of joint constraints on knee contact force prediction. A knee contact model was developed to include 32 reaction force elements on the surface of a tibial insert of a total knee replacement (TKR), which was embedded in a full-body musculoskeletal model. Various external measurements including motion data and external force data during walking trials of a subject with an instrumented knee implant were provided from the Sixth Grand Challenge Competition to Predict in vivo Knee Loads. Knee contact forces in the medial and lateral portions of the instrumented knee implant were also provided for the same walking trials. A knee contact model with a hinge joint and normal alignment could predict knee contact forces with root mean square errors (RMSEs) of 165 N and 288 N for the medial and lateral portions of the knee, respectively, and coefficients of determination (R2) of 0.70 and −0.63. When the degrees-of-freedom (DOF) of the knee and locations of leg markers were adjusted to account for the valgus lower-limb alignment of the subject, RMSE values improved to 144 N and 179 N, and R2 values improved to 0.77 and 0.37, respectively. The proposed knee contact model with subject-specific joint model could predict in vivo knee contact forces with reasonable accuracy. This model may contribute to the development and improvement of knee arthroplasty.

Detailed knowledge of knee kinematics and dynamic loading is essential for improving the design and outcomes of surgical procedures, tissue engineering applications, prosthetics design, and rehabilitation. This study used publicly available data provided by the “Grand Challenge Competition to Predict in-vivo Knee Loads” for the 2013 American Society of Mechanical Engineers Summer Bioengineering Conference (Fregly et al., 2012, “Grand Challenge Competition to Predict in vivo Knee Loads,” J. Orthop. Res., 30, pp. 503–513) to develop a full body, musculoskeletal model with subject specific right leg geometries that can concurrently predict muscle forces, ligament forces, and knee and ground contact forces. The model includes representation of foot/floor interactions and predicted tibiofemoral joint loads were compared to measured tibial loads for two different cycles of treadmill gait. The model used anthropometric data (height and weight) to scale the joint center locations and mass properties of a generic model and then used subject bone geometries to more accurately position the hip and ankle. The musculoskeletal model included 44 muscles on the right leg, and subject specific geometries were used to create a 12 degrees-of-freedom anatomical right knee that included both patellofemoral and tibiofemoral articulations. Tibiofemoral motion was constrained by deformable contacts defined between the tibial insert and femoral component geometries and by ligaments. Patellofemoral motion was constrained by contact between the patellar button and femoral component geometries and the patellar tendon. Shoe geometries were added to the feet, and shoe motion was constrained by contact between three shoe segments per foot and the treadmill surface. Six-axis springs constrained motion between the feet and shoe segments. Experimental motion capture data provided input to an inverse kinematics stage, and the final forward dynamics simulations tracked joint angle errors for the left leg and upper body and tracked muscle length errors for the right leg. The one cycle RMS errors between the predicted and measured tibia contact were 178 N and 168 N for the medial and lateral sides for the first gait cycle and 209 N and 228 N for the medial and lateral sides for the faster second gait cycle. One cycle RMS errors between predicted and measured ground reaction forces were 12 N, 13 N, and 65 N in the anterior-posterior, medial-lateral, and vertical directions for the first gait cycle and 43 N, 15 N, and 96 N in the anterior-posterior, medial-lateral, and vertical directions for the second gait cycle.

Model-based estimation of in vivo contact forces arising between components of a total knee replacement is challenging because such forces depend upon accurate modeling of muscles, tendons, ligaments, contact, and multibody dynamics. Here we describe an approach to solving this problem with results that are tested by comparison to knee loads measured in vivo for a single subject and made available through the Grand Challenge Competition to Predict in vivo Tibiofemoral Loads. The approach makes use of a “dual-joint” paradigm in which the knee joint is alternately represented by (1) a ball-joint knee for inverse dynamic computation of required muscle controls and (2) a 12 degree-of-freedom (DOF) knee with elastic foundation contact at the tibiofemoral and patellofemoral articulations for forward dynamic integration. Measured external forces and kinematics were applied as a feedback controller and static optimization attempted to track measured knee flexion angles and electromyographic (EMG) activity. The resulting simulations showed excellent tracking of knee flexion (average RMS error of 2.53 deg) and EMG (muscle activations within ±10% envelopes of normalized measured EMG signals). Simulated tibiofemoral contact forces agreed qualitatively with measured contact forces, but their RMS errors were approximately 25% of the peak measured values. These results demonstrate the potential of a dual-joint modeling approach to predict joint contact forces from kinesiological data measured in the motion laboratory. It is anticipated that errors in the estimation of contact force will be reduced as more accurate subject-specific models of muscles and other soft tissues are developed.

Computational models that predict internal joint forces have the potential to enhance our understanding of normal and pathological movement. Validation studies of modeling results are necessary if such models are to be adopted by clinicians to complement patient treatment and rehabilitation. The purposes of this paper are: (1) to describe an electromyogram (EMG)-driven modeling approach to predict knee joint contact forces, and (2) to evaluate the accuracy of model predictions for two distinctly different gait patterns (normal walking and medial thrust gait) against known values for a patient with a force recording knee prosthesis. Blinded model predictions and revised model estimates for knee joint contact forces are reported for our entry in the 2012 Grand Challenge to predict in vivo knee loads. The EMG-driven model correctly predicted that medial compartment contact force for the medial thrust gait increased despite the decrease in knee adduction moment. Model accuracy was high: the difference in peak loading was less than 0.01 bodyweight (BW) with an R2 = 0.92. The model also predicted lateral loading for the normal walking trial with good accuracy exhibiting a peak loading difference of 0.04 BW and an R2 = 0.44. Overall, the EMG-driven model captured the general shape and timing of the contact force profiles and with accurate input data the model estimated joint contact forces with sufficient accuracy to enhance the interpretation of joint loading beyond what is possible from data obtained from standard motion capture studies.

Total knee replacement (TKR) is one of the most performed orthopedic surgeries to treat knee joint diseases in the elderly population. Although the survivorship of knee implants may extend beyond two decades, the poor outcome rate remains considerable. A recent computational approach used to better understand failure modes and improve TKR outcomes is based on the combination of musculoskeletal (MSK) and finite element models. This combined multiscale modeling approach is a promising strategy in the field of computational biomechanics; however, some critical aspects need to be investigated. In particular, the identification and quantification of the uncertainties related to the boundary conditions used as inputs to the finite element model due to a different definition of the MSK model are crucial. Therefore, the aim of this study is to investigate this problem, which is relevant for the model credibility assessment process. Three different generic MSK models available in the OpenSim platform were used to simulate gait, based on the experimental data from the fifth edition of the “Grand Challenge Competitions to Predict in vivo Knee Loads.” The outputs of the MSK analyses were compared in terms of relative kinematics of the knee implant components and joint reaction (JR) forces and moments acting on the tibial insert. Additionally, the estimated knee JRs were compared with those measured by the instrumented knee implant so that the “global goodness of fit” was quantified for each model. Our results indicated that the different kinematic definitions of the knee joint and the muscle model implemented in the different MSK models influenced both the motion and the load history of the artificial joint. This study demonstrates the importance of examining the influence of the model assumptions on the output results and represents the first step for future studies that will investigate how the uncertainties in the MSK models propagate on disease-specific finite element model results.

Musculoskeletal models are powerful tools that allow biomechanical investigations and predictions of muscle forces not accessible with experiments. A core challenge modelers must confront is validation. Measurements of muscle activity and joint loading are used for qualitative and indirect validation of muscle force predictions. Subject-specific models have reached high levels of complexity and can predict contact loads with surprising accuracy. However, every deterministic musculoskeletal model contains an intrinsic uncertainty due to the high number of parameters not identifiable in vivo. The objective of this work is to test the impact of intrinsic uncertainty in a scaled-generic model on estimates of muscle and joint loads. Uncertainties in marker placement, limb coronal alignment, body segment parameters, Hill-type muscle parameters, and muscle geometry were modeled with a global probabilistic approach (multiple uncertainties included in a single analysis). 5–95% confidence bounds and input/output sensitivities of predicted knee compressive loads and varus/valgus contact moments were estimated for a gait activity of three subjects with telemetric knee implants from the “Grand Challenge Competition.” Compressive load predicted for the three subjects showed confidence bounds of 333 ± 248 N, 408 ± 333 N, and 379 ± 244 N when all the sources of uncertainty were included. The measured loads lay inside the predicted 5–95% confidence bounds for 77%, 83%, and 76% of the stance phase. Muscle maximum isometric force, muscle geometry, and marker placement uncertainty most impacted the joint load results. This study demonstrated that identification of these parameters is crucial when subject-specific models are developed.

Though walking impairments are prevalent in society, clinical treatments are often ineffective at restoring lost function. For this reason, researchers have begun to explore the use of patient-specific computational walking models to develop more effective treatments. However, the accuracy with which models can predict internal body forces in muscles and across joints depends on how well relevant model parameter values can be calibrated for the patient. This study investigated how knowledge of internal knee contact forces affects calibration of neuromusculoskeletal model parameter values and subsequent prediction of internal knee contact and leg muscle forces during walking. Model calibration was performed using a novel two-level optimization procedure applied to six normal walking trials from the Fourth Grand Challenge Competition to Predict In Vivo Knee Loads. The outer-level optimization adjusted time-invariant model parameter values to minimize passive muscle forces, reserve actuator moments, and model parameter value changes with (Approach A) and without (Approach B) tracking of experimental knee contact forces. Using the current guess for model parameter values but no knee contact force information, the inner-level optimization predicted time-varying muscle activations that were close to experimental muscle synergy patterns and consistent with the experimental inverse dynamic loads (both approaches). For all the six gait trials, Approach A predicted knee contact forces with high accuracy for both compartments (average correlation coefficient r = 0.99 and root mean square error (RMSE) = 52.6 N medial; average r = 0.95 and RMSE = 56.6 N lateral). In contrast, Approach B overpredicted contact force magnitude for both compartments (average RMSE = 323 N medial and 348 N lateral) and poorly matched contact force shape for the lateral compartment (average r = 0.90 medial and −0.10 lateral). Approach B had statistically higher lateral muscle forces and lateral optimal muscle fiber lengths but lower medial, central, and lateral normalized muscle fiber lengths compared to Approach A. These findings suggest that poorly calibrated model parameter values may be a major factor limiting the ability of neuromusculoskeletal models to predict knee contact and leg muscle forces accurately for walking.

The purpose of this study was to perform a blinded comparison of model predictions of total knee replacement contact forces to in vivo forces from an instrumented prosthesis during normal walking and medial thrust gait by participating in the “Third Grand Challenge Competition to Predict in vivo Knee Loads.” We also evaluated model assumptions that were critical for accurate force predictions. Medial, lateral, and total axial forces through the knee were calculated using a previously developed and validated parametric numerical model. The model uses equilibrium equations between internal and external moments and forces to obtain knee joint contact forces and calculates a range of forces at instances during the gait cycle through parametric variation of muscle activity levels. For 100 instances during a normal over-ground gait cycle, model root mean square differences from eTibia data were 292, 248, and 281 for medial, lateral, and total contact forces, respectively. For 100 instances during a medial thrust gait cycle, model root mean square differences from eTibia data were 332, 234, and 470 for medial, lateral, and total contact forces, respectively. The percent difference between measured and predicted peak total axial force was 2.89% at the first peak and 9.36% at the second peak contact force for normal walking and 3.94% at the first peak and 14.86% at the second peak contact force for medial thrust gait. After unblinding, changes to model assumptions improved medial and lateral force predictions for both gait styles but did not improve total force predictions. Axial forces computed with the model compared well to the eTibia data under blinded and unblinded conditions. Knowledge of detailed knee kinematics, namely anterior-posterior translation, appears to be critical in obtaining accurate force predictions.

Computational models that predict in vivo joint loading and muscle forces can potentially enhance and augment our knowledge of both typical and pathological gaits. To adopt such models into clinical applications, studies validating modeling predictions are essential. This study created a full-body musculoskeletal model using data from the “Sixth Grand Challenge Competition to Predict in vivo Knee Loads.” This model incorporates subject-specific geometries of the right leg in order to concurrently predict knee contact forces, ligament forces, muscle forces, and ground contact forces. The objectives of this paper are twofold: (1) to describe an electromyography (EMG)-driven modeling methodology to predict knee contact forces and (2) to validate model predictions by evaluating the model predictions against known values for a patient with an instrumented total knee replacement (TKR) for three distinctly different gait styles (normal, smooth, and bouncy gaits). The model integrates a subject-specific knee model onto a previously validated generic full-body musculoskeletal model. The combined model included six degrees-of-freedom (6DOF) patellofemoral and tibiofemoral joints, ligament forces, and deformable contact forces with viscous damping. The foot/shoe/floor interactions were modeled by incorporating shoe geometries to the feet. Contact between shoe segments and the floor surface was used to constrain the shoe segments. A novel EMG-driven feedforward with feedback trim motor control strategy was used to concurrently estimate muscle forces and knee contact forces from standard motion capture data collected on the individual subject. The predicted medial, lateral, and total tibiofemoral forces represented the overall measured magnitude and temporal patterns with good root-mean-squared errors (RMSEs) and Pearson's correlation (p2). The model accuracy was high: medial, lateral, and total tibiofemoral contact force RMSEs = 0.15, 0.14, 0.21 body weight (BW), and (0.92 < p2 < 0.96) for normal gait; RMSEs = 0.18 BW, 0.21 BW, 0.29 BW, and (0.81 < p2 < 0.93) for smooth gait; and RMSEs = 0.21 BW, 0.22 BW, 0.33 BW, and (0.86 < p2 < 0.95) for bouncy gait, respectively. Overall, the model captured the general shape, magnitude, and temporal patterns of the contact force profiles accurately. Potential applications of this proposed model include predictive biomechanics simulations, design of TKR components, soft tissue balancing, and surgical simulation.

Detailed knowledge of knee joint kinematics and dynamic loading is essential for improving the design and outcomes of surgical procedures, tissue engineering applications, prosthetics design, and rehabilitation. The need for dynamic computational models that link kinematics, muscle and ligament forces, and joint contacts has long been recognized but such body-level forward dynamic models do not exist in recent literature. A main barrier in using computational models in the clinic is the validation of the in vivo contact, muscle, and ligament loads. The purpose of this study was to develop a full body, muscle driven dynamic model with subject specific leg geometries and validate it during squat and toe-rise motions. The model predicted loads were compared to in vivo measurements acquired with an instrumented knee implant. Data for this study were provided by the “Grand Challenge Competition to Predict In-Vivo Knee Loads” for the 2012 American Society of Mechanical Engineers Summer Bioengineering Conference. Data included implant and bone geometries, ground reaction forces, EMG, and the instrumented knee implant measurements. The subject specific model was developed in the multibody framework. The knee model included three ligament bundles for the lateral collateral ligament (LCL) and the medial collateral ligament (MCL), and one bundle for the posterior cruciate ligament (PCL). The implanted tibia tray was segmented into 326 hexahedral elements and deformable contacts were defined between the elements and the femoral component. The model also included 45 muscles on each leg. Muscle forces were computed for the muscle driven simulation by a feedback controller that used the error between the current muscle length in the forward simulation and the muscle length recorded during a kinematics driven inverse simulation. The predicted tibia forces and torques, ground reaction forces, electromyography (EMG) patterns, and kinematics were compared to the experimentally measured values to validate the model. Comparisons were done graphically and by calculating the mean average deviation (MAD) and root mean squared deviation (RMSD) for all outcomes. The MAD value for the tibia vertical force was 279 N for the squat motion and 325 N for the toe-rise motion, 45 N and 53 N for left and right foot ground reaction forces during the squat and 94 N and 82 N for toe-rise motion. The maximum MAD value for any of the kinematic outcomes was 7.5 deg for knee flexion-extension during the toe-rise motion.

Abstract Because of its simplicity, static optimization (SO) is frequently used to resolve the muscle redundancy problem (i.e., more muscles than degrees-of-freedom (DOF) in the human musculoskeletal system). However, SO minimizes antagonistic co-activation and likely joint stiffness as well, which may not be physiologically realistic since the body modulates joint stiffness during movements such as walking. Knowledge of joint stiffness is limited due to the difficulty of measuring it experimentally, leading researchers to estimate it using computational models. This study explores how imposing a synergy structure on the muscle activations estimated by optimization (termed “synergy optimization,” or SynO) affects calculated lower body joint stiffnesses during walking. By limiting the achievable muscle activations and coupling all time frames together, a synergy structure provides a potential mechanism for reducing indeterminacy and improving physiological co-activation but at the cost of a larger optimization problem. To compare joint stiffnesses produced by SynO (2–6 synergies) and SO, we used both approaches to estimate lower body muscle activations and forces for sample experimental overground walking data obtained from the first knee grand challenge competition. Both optimizations used a custom Hill-type muscle model that permitted analytic calculation of individual muscle contributions to the stiffness of spanned joints. Both approaches reproduced inverse dynamic joint moments well over the entire gait cycle, though SynO with only two synergies exhibited the largest errors. Maximum and mean joint stiffnesses for hip and knee flexion in particular decreased as the number of synergies increased from 2 to 6, with SO producing the lowest joint stiffness values. Our results suggest that SynO increases joint stiffness by increasing muscle co-activation, and furthermore, that walking with a reduced number of synergies may result in increased joint stiffness and perhaps stability.

While recent literature has clearly demonstrated that an extensive personalization of the musculoskeletal models was necessary to reach high accuracy, several components of the generic models may be further investigated before defining subject-specific parameters. Among others, the choice in muscular geometry and thus the level of muscular redundancy in the model may have a noticeable influence on the predicted musculotendon and joint contact forces. In this context, the aim of this study was to investigate if the level of muscular redundancy can contribute or not to reduce inaccuracies in tibiofemoral contact forces predictions. For that, the dataset disseminated through the Sixth Grand Challenge Competition to Predict In Vivo Knee Loads was applied to a versatile 3D lower limb musculoskeletal model in which two muscular geometries (i.e., two different levels of muscular redundancy) were implemented. This dataset provides tibiofemoral implant measurements for both medial and lateral compartments and thus allows evaluation of the validity of the model predictions. The results suggest that an increase of the level of muscular redundancy corresponds to a better accuracy of total tibiofemoral contact force whatever the gait pattern investigated. However, the medial and lateral contact forces ratio and accuracy were not necessarily improved when increasing the level of muscular redundancy and may thus be attributed to other parameters such as the location of contact points. To conclude, the muscular geometry, among other components of the generic model, has a noticeable impact on joint contact forces predictions and may thus be correctly chosen even before trying to personalize the model.

There are days when having a child with Down syndrome can mean losing all hope of being an ordinary mother: a mother with run of the mill concerns, a mother with run of the mill routines. I know. I’ve had such days. I’ve also found that sharing these feelings with other mothers, even those who have a child with a disability, isn’t always easy. Or straightforward. In part I believe my difficulty sharing my experience with other mothers is because the motherhood issues surrounding the birth of a child with Down syndrome are qualitatively different to those experienced by mothers who give birth to children with other disabilities. Disabilities such as autism or cerebral palsy. The mother who has a child with autism or cerebral palsy is usually viewed as a victim - as having had no choice – of life having dealt her a cruel blow. There are after all no prenatal tests that can currently pick up these defects. That she may not see herself as a victim or her child as a victim often goes unreported, instead in the eyes of the popular media to give birth to a child with a disability is seen as a personal tragedy – a story of suffering and endurance. In other words disability is to be avoided if at all possible and women are expected to take advantage of the advances in reproductive medicine – to choose a genetically correct pregnancy – thus improving their lives and the lives of their offspring. Within this context it is not surprising then that the mother of a child with Down syndrome is likely to be seen as having brought the suffering on herself – of having had choices – tests such as amniocentesis and CVS – but of having failed to take control, failed to prevent the suffering of her child. But how informative are tests such as pre-implantation diagnosis, CVS or amniocentesis? How meaningful? More importantly, how safe is it to assume lives are being improved? Could it be, for example, that some lives are now harder rather than easier? As one mother who has grappled with the issues surrounding prenatal testing and disability I would like to share with you our family’s experience and hopefully illuminate some of the more complex and troubling issues these technological advances have the capacity to create. Fraser’s Pregnancy I fell pregnant with Fraser in 1995 at the age of thirty-seven. I was already the mother of a fifteen-month old and just as I had during his pregnancy – I took the routine maternal serum alpha-fetoprotein blood screen for chromosomal abnormalities at sixteen weeks. It showed I was at high risk of having a child with Down syndrome. However as I’d had a similarly high-risk reading in my first pregnancy I wasn’t particularly worried. The risk with Fraser appeared slightly higher, but other than knowing we would have to find time to see the genetic counsellor again, I didn’t dwell on it. As it happened Christopher and I sat in the same office with the same counsellor and once again listened to the risks. A normal foetus, as you both know, has 46 chromosomes in each cell. But given your high AFP reading Fiona, there is a significant risk that instead of 46 there could be 47 chromosomes in each cell. Each cell could be carrying an extra copy of chromosome 21. And as you both know, she continued her voice deepening; Trisomy 21 is associated with mild to severe intellectual disability. It also increases the risk of childhood leukaemia; certain cardiac disorders and is associated with other genetic disorders such as Hirschsprung’s disease. We listened and just as we’d done the first time – decided to have a coffee in the hospital café. This time for some reason the tone was different, this time we could feel the high-octane spiel, feel the pressure pound through our bodies, pulsate through our veins – we should take the test, we should take the test, we should take the test. We were, were we not, intelligent, well-educated and responsible human beings? Surely we could understand the need to invade, the need to extract a sample of amniotic fluid? Surely there were no ifs and buts this time? Surely we realised we had been very lucky with our first pregnancy; surely we understood the need for certainty; for reliable and accurate information this time? We did and we didn’t. We knew for example, that even if we ruled out the possibility of Down syndrome there was no guarantee our baby would be normal. We’d done our research. We knew that of all the children born with an intellectual disability only twenty five percent have a parentally detectable chromosomal disorder such as Down syndrome. In other words, the majority of mothers who give birth to a child with an intellectual disability will have received perfectly normal, utterly reassuring amniocentesis results. They will have put themselves at risk and will have been rewarded with good results. They will have been expecting a baby they could cherish, a baby they could feel proud of – a baby they could love. Our Decision Should we relent this time? Should we accept the professional advice? We talked and we talked. We knew if we agreed to the amniocentesis it would only rule out Down syndrome – or a less common chromosomal disorder such as Trisomy 18 or Trisomy 13. But little else. Four thousand other known birth defects would still remain. Defects such as attention deficit disorder, cleft lip, cleft palate, clubfoot, congenital cardiac disorder, cystic fibrosis, epilepsy, ... would not magically disappear by agreeing to the test. Neither would the possibility of giving birth to a child with autism or cerebral palsy. Or a child with vision, hearing or speech impairment. Neurological problems, skin problems or behavioural difficulties... We were however strongly aware the drive to have a normal child was expected of us. That we were making our decision at a time when social and economic imperatives dictated that we should want the best. The best partner, the best career, the best house ... the best baby. I had already agreed to a blood test and an ultrasound, so why not an amniocentesis? Why stop now? Why not proceed with a test most women over the age of thirty-five consider essential? What was wrong with me? Put simply, the test didn’t engage me. It seemed too specific. Too focused. Plus there was also a far larger obstacle. I knew if I agreed to the test and the words chromosomal disorder were to appear – a certain set of assumptions, an as yet unspoken trajectory would swiftly emerge. And I wasn’t sure I would be able to follow its course. Beyond the Test I knew if the test results came back positive I would be expected to terminate immediately. To abort my affected foetus. The fact I could find it difficult to fall pregnant again after the termination or that any future foetus may also be affected by a birth defect would make little difference. Out the four thousand known birth defects it would be considered imperative not to proceed with this particular one. And following on from that logic it would be assumed that the how – the business of termination – would be of little importance to me given the perceived gravity of the situation. I would want to solve the problem by removing it. No matter what. Before the procedure (as it would be referred to) the staff would want to reassure me, would want to comfort me – and in soothing voices tell me that yes; yes of course this procedure is in your best interests. You and your baby shouldn’t be made to suffer, not now or ever. You’re doing the right thing, they would reassure me, you are. But what would be left as unsaid would be the unavoidable realities of termination. On the elected day, during what would be the twenty-second week of my pregnancy, I would have to consent to the induction of labour. Simultaneously, I would also be expected to consent to a foetal intra-cardiac injection of potassium chloride to ensure the delivery of a dead baby. I would be advised to give birth to a dead baby because it would be considered better if I didn’t hear the baby cry. Better if I didn’t see the tiny creature breathe. Or try to breathe. The staff would also prefer I consent, would prefer I minimised everyone else’s distress. Then after the event I would be left alone. Left alone to my own devices. Left alone with no baby. I would be promised a tiny set of foot and handprints as a memento of my once vibrant pregnancy. And expected to be grateful, to be thankful, for the successful elimination of a pending disaster. But while I knew the staff would mean well, would believe they were doing the right thing for me, I knew it wasn’t the road for me. That I just couldn’t do it. We spent considerably longer in the hospital café the second time. And even though we tried to keep things light, we were both subdued. Both tense. My risk of having a baby with Down syndrome had come back as 1:120. Yes it was slightly higher than my first pregnancy (1:150), but did it mean anything? Our conversation was full of bumps and long winding trails. My Sister’s Experience of Disability Perhaps the prospect of having a child with Down syndrome didn’t terrify me because my sister had a disability. Not that we ever really referred to it as such, it was only ever Alison’s epilepsy. And although it was uncontrollable for most of her childhood, my mother tried to make her life as normal as possible. She was allowed to ride a bike, climb trees and swim. But it wasn’t easy for my mother because even though she wanted my sister to live a normal life there were no support services. Only a somewhat pessimistic neurologist. No one made the link between my sister’s declining school performance and her epilepsy. That she would lose the thread of a conversation because of a brief petit mal, a brief moment when she wouldn’t know what was going on. Or that repeated grand mal seizures took away her capacity for abstract thought and made her more and more concrete in her thinking. But despite the lack of support my mother worked long and hard to bring up a daughter who could hold down a full time job and live independently. She refused to let her use her epilepsy as an excuse. So much so that even today I still find it difficult to say my sister had a disability. I didn’t grow up with the word and my sister herself rarely used it to describe herself. Not surprisingly she went into the field herself working at first as a residential worker in a special school for disabled children and later as a rehabilitation counsellor for the Royal Blind Society. Premature Babies I couldn’t understand why a baby with Down syndrome was something to be avoided at all costs while a baby who was born prematurely and likely to emerge from the labour-intensive incubator process with severe life-long disabilities was cherished, welcomed and saved no matter what the expense. Other than being normal to begin with – where was the difference? Perhaps it was the possibility the premature baby might emerge unscathed. That hope remained. That there was a real possibility the intense and expensive process of saving the baby might not cause any damage. Whereas with Down syndrome the damage was done. The damage was known. I don’t know. Perhaps even with Down syndrome I felt there could be hope. Hope that the child might only be mildly intellectually disabled. Might not experience any of the serious medical complications. And that new and innovative treatments would be discovered in their lifetime. I just couldn’t accept the conventional wisdom. Couldn’t accept the need to test. And after approaching the decision from this angle, that angle and every other angle we could think of we both felt there was little more to say. And returned to our genetic counsellor. The Pressure to Conform Welcome back, she smiled. I’d like to introduce you to Dr M. I nodded politely in the doctor’s direction while immediately trying to discern if Christopher felt as caught off guard as I did. You’ll be pleased to know Dr M can perform the test today, she informed us. Dr M nodded and reached out to shake my hand. It’s a bit of a squeeze, she told me, but I can fit you in at around four. And don’t worry; she reassured me, that’s what we’re here for. I was shocked the heavy artillery had been called in. The pressure to conform, the pressure to say yes had been dramatically heightened by the presence of a doctor in the room. I could also sense the two women wanted to talk to me alone. That they wanted to talk woman to woman, that they thought if they could get me on my own I would agree, I would understand. That it must be the male who was the stumbling block. The problem. But I could also tell they were unsure; Christopher was after all a doctor, a member of the medical profession, one of them. Surely, they reasoned, surely he must understand why I must take the test. I didn’t want to talk to them alone. In part, because I felt the decision was as much Christopher’s as it was mine. Perhaps a little more mine, but one I wanted to make together. And much to their dismay I declined both the talk and the amniocentesis. Well, if you change your mind we’re here the counsellor reassured me. I nodded and as I left I made a point of looking each woman in the eye while shaking her hand firmly. Thank you, but no thank you, I reassured them. I wanted the baby I’d felt kick. I wanted him or her no matter what. After that day the whole issue pretty much faded, in part because soon after I developed a heart problem, a tachycardia and was fairly restricted in what I could do. I worried about the baby but more because of the medication I had to take rather than any genetic issue to do with its well being. The Birth Despite my heart condition the birth went well. And I was able to labour naturally with little intervention. I knew however, that all was not right. My first glimmer of recognition happened as I was giving birth to Fraser. He didn't push against me, he didn't thrust apart the walls of my birth canal, didn’t cause me to feel as though I was about to splinter. He was soft and floppy. Yet while I can tell you I knew something was wrong, knew instinctively – at another level I didn't have a clue. So I waited. Waited for his Apgar score. Waited to hear what the standard assessment of newborn viability would reveal. How the individual scores for activity (muscle tone), pulse (heart rate), grimace (reflex response), appearance (colour) and respiration (breathing) would add up. I knew the purpose of the Apgar test was to determine quickly whether or not Fraser needed immediate medical care – with scores below 3 generally regarded as critically low, 4 to 6 fairly low, and over 7 generally normal. Fraser scored 8 immediately after birth and 9 five minutes later. His markers of viability were fine. However all was not fine and within minutes he received a tentative diagnosis – whispers and murmurs placing a virtual sticker on his forehead. Whispers and murmurs immediately setting him apart from the normal neonate. Whispers and murmurs of concern. He was not a baby they wanted anything to do with – an experience they wanted anything to do with. In a very matter of fact voice the midwife asked me if I had had an amniocentesis. I said no, and thankfully because I was still feeling the effects of the gas, the bluntness and insensitivity of her question didn't hit me. To tell the truth it didn't hit me until years later. At the time it registered as a negative and intrusive question – certainly not the sort you want to be answering moments after giving birth – in the midst of a time that should be about the celebration of a new life. And while I can remember how much I disliked the tenor of her voice, disliked the objectifying of my son, I too had already begun a process of defining, of recognising. I had already noted he was floppy and too red. But I guess the real moment of recognition came when he was handed to me and as a way of making conversation I suggested to Christopher our baby had downsy little eyes. At the time Christopher didn’t respond. And I remember feeling slightly miffed. But it wasn’t until years later that I realised his silence had been not because he hadn’t wanted to chat but because at that moment he’d let his dread, fear and sadness of what I was suggesting go straight over my head. Unconsciously though – even then – I knew my son had Down syndrome, but I couldn't take it in, couldn't feel my way there, I needed time. But time is rarely an option in hospital and the paediatrician (who we knew from the birth of our first son) was paged immediately. Disability and the Medical Paradigm From the perspective of the medical staff I was holding a neonate who was displaying some of the 50 signs and symptoms suggestive of Trisomy 21. Of Down syndrome. I too could see them as I remembered bits and pieces from my 1970s nursing text Whaley and Wong. Remembered a list that now seems so de-personalised, so harsh and objectifying. Flat faceSmall headFlat bridge of the noseSmaller than normal, low-set noseSmall mouth, causing the tongue to stick out and look unusually largeUpward slanting eyesExtra folds of skin at the inside corner of each eyeRounded cheeksSmall, misshapened earsSmall, wide handsA deep crease across the center of each palmA malformed fifth fingerA wide space between the big and second toesUnusual creases on the soles of the feetOverly-flexible joints (as in people who are double-jointed)Shorter than normal height Christopher and I awaited the arrival of the paediatrician without the benefits of privacy, only able to guess at what the other was thinking. We only had the briefest of moments alone when they transferred me to my room and Christopher was able to tell me that the staff thought our son had what I had blurted out. I remember being totally devastated and searching his face, trying to gauge how he felt. But there was no time for us to talk because as soon as he had uttered the words Down syndrome the paediatrician entered the room and it was immediately apparent he perceived our birth outcome a disaster. You’re both professionals he said, you both know what we are thinking. But he couldn’t bring himself to say the words, say Down syndrome, and instead went on about the need for chromosomal testing and the likelihood of a positive result. The gist, the message about our son was that while he would walk, might even talk, he would never cook, never understand danger and never live independently, never, never, never... Fraser was only an hour or so old and he’d already been judged, already been found wanting. Creating Fraser’s Cultural Identity The staff wanted me to accept his diagnosis and prognosis. I on the other hand wanted to de-medicalise the way in which his existence was being shaped. I didn’t want to know right then and there about the disability services to which I would be entitled, the possible medical complications I might face. And in a small attempt to create a different kind of space, a social space that could afford my son an identity that wasn’t focused on his genetic make-up, I requested it not be assumed by the staff that he had Down syndrome until the results of the blood tests were known – knowing full well they wouldn’t be available until after I’d left hospital. Over the next few days Fraser had to spend some time in the neonatal intensive care unit because of an unrelated medical problem. His initial redness turning out to be a symptom of polycythemia (too many red blood cells). And in many ways this helped me to become his mother – to concentrate on looking after him in the same way you would any sick baby. Yet while I was deeply confident I was also deeply ashamed. Deeply ashamed I had given birth to a baby with a flaw, a defect. And processing the emotions was made doubly difficult because I felt many people thought I should have had prenatal testing – that it was my choice to have Fraser and therefore my fault, my problem. Fortunately however these feelings of dejection were equally matched by a passionate belief he belonged in our family, and that if he could belong and be included in our lives then there was no reason why he couldn’t be included in the lives of others. How Prenatal Testing Shapes Our Lives It is now twelve years since I gave birth to Fraser yet even today talking about our lives can still mean having to talk about the test – having to explain why I didn’t agree to an amniocentesis. Usually this is fairly straightforward, and fairly painless, but not always. Women have and still do openly challenge my decision. Why didn’t I take control? Aren’t I a feminist? What sort of a message do I think I am sending to younger women? Initially, I wasn’t able to fathom how anyone could perceive the issue as being so simple – take test, no Down syndrome. And it wasn’t until I saw the film Gattaca in 1997 that I began to understand how it could seem such a straightforward issue. Gattaca explores a world in which genetic discrimination has been taken to its logical conclusion – a world in which babies are screened at birth and labeled as either valids or in-valids according to their DNA status. Valids have every opportunity open to them while in-valids can only do menial work. It is a culture in which pre-implantation screening and prenatal testing are considered givens. Essential. And to challenge such discrimination foolish – however in the film the main character Vincent does just that and despite his in-valid status and its inherent obstacles he achieves his dream of becoming an astronaut. The film is essentially a thriller – Vincent at all times at risk of his true DNA status being revealed. The fear and loathing of imperfection is palpable. For me the tone of the film was a revelation and for the first time I could see my decision through the eyes of others. Feel the shock and horror of what must appear an irrational and irresponsible decision. Understand how if I am not either religious or anti-abortion – my objection must seem all the more strange. The film made it clear to me that if you don’t question the genes as destiny paradigm, the disability as suffering paradigm then you probably won’t think to question the prenatal tests are routine and essential paradigm. That you will simply accept the conventional medical wisdom – that certain genetic configurations are not only avoidable, but best avoided. Paradoxically, this understanding has made mothering Fraser, including Fraser easier and more enjoyable. Because I understand the grounds on which he was to have been excluded and how out of tune I am with the conventional thinking surrounding pregnancy and disability – I am so much freer to mother and to feel proud of my son. I Would Like to Share with You What Fraser Can Do He canget dressed (as long as the clothes are already turned the right side out and have no buttons!) understand most of what mum and dad sayplay with his brothers on the computermake a cup of coffee for mumfasten his own seatbeltwait in the car line with his brothersswim in the surf and catch waves on his boogie boardcompete in the school swimming carnivaldraw for hours at a time (you can see his art if you click here) Heis the first child with Down syndrome to attend his schoolloves the Simpsons, Futurama and Star Wars begs mum or dad to take him to the DVD store on the weekendsloves sausages, Coke and salmon rissottoenjoys life is always in the now Having fun with Photo Booth His brothers Aidan and Harrison Brotherly Love – a photo taken by Persia (right) and exhibited in Local Eyes. It also appeared in The Fitz Files (Sun-Herald 30 Mar. 2008) What Excites Me Today as a Mother I love that there is now hope. That there is not just hope of a new test, a reliable non-invasive prenatal test, but hope regarding novel treatments – of medications that may assist children with Down syndrome with speech and memory. And an increasingly vocal minority who want to talk about how including children in mainstream schools enhances their development, how children with Down syndrome can, can, can … like Persia and Tyler for example. That perhaps in the not too distant future there will be a change in the way Down syndrome is perceived – that if Fraser can, if our family can – then perhaps mothering a child with Down syndrome will be considered culturally acceptable. That the nexus between genetics and destiny will be weakened in the sense of needing to choose one foetus over another, but strengthened by using genetic understandings to enhance and assist the lives of all individuals no matter what their genetic make-up. And perhaps one day Down syndrome will be considered a condition with which you can conceive. Can imagine. Can live. And not an experience to be avoided at all costs.

Photograph by Gonzalo Echeverria (2010)Declaring War Soon after Al Qaeda’s terrorist attacks on 11 September 2001, the Bush Administration described its new grand strategy: the “Global War on Terror”. This underpinned the subsequent counter-insurgency in Afghanistan and the United States invasion of Iraq in March 2003. Media pundits quickly applied the Global War on Terror label to the Madrid, Bali and London bombings, to convey how Al Qaeda’s terrorism had gone transnational. Meanwhile, international relations scholars debated the extent to which September 11 had changed the international system (Brenner; Mann 303). American intellectuals adopted several variations of the Global War on Terror in what initially felt like a transitional period of US foreign policy (Burns). Walter Laqueur suggested Al Qaeda was engaged in a “cosmological” and perpetual war. Paul Berman likened Al Qaeda and militant Islam to the past ideological battles against communism and fascism (Heilbrunn 248). In a widely cited article, neoconservative thinker Norman Podhoretz suggested the United States faced “World War IV”, which had three interlocking drivers: Al Qaeda and trans-national terrorism; political Islam as the West’s existential enemy; and nuclear proliferation to ‘rogue’ countries and non-state actors (Friedman 3). Podhoretz’s tone reflected a revival of his earlier Cold War politics and critique of the New Left (Friedman 148-149; Halper and Clarke 56; Heilbrunn 210). These stances attracted widespread support. For instance, the United States Marine Corp recalibrated its mission to fight a long war against “World War IV-like” enemies. Yet these stances left the United States unprepared as the combat situations in Afghanistan and Iraq worsened (Ricks; Ferguson; Filkins). Neoconservative ideals for Iraq “regime change” to transform the Middle East failed to deal with other security problems such as Pakistan’s Musharraf regime (Dorrien 110; Halper and Clarke 210-211; Friedman 121, 223; Heilbrunn 252). The Manichean and open-ended framing became a self-fulfilling prophecy for insurgents, jihadists, and militias. The Bush Administration quietly abandoned the Global War on Terror in July 2005. Widespread support had given way to policymaker doubt. Why did so many intellectuals and strategists embrace the Global War on Terror as the best possible “grand strategy” perspective of a post-September 11 world? Why was there so little doubt of this worldview? This is a debate with roots as old as the Sceptics versus the Sophists. Explanations usually focus on the Bush Administration’s “Vulcans” war cabinet: Vice President Dick Cheney, Secretary of Defense Donald Rumsfield, and National Security Advisor Condoleezza Rice, who later became Secretary of State (Mann xv-xvi). The “Vulcans” were named after the Roman god Vulcan because Rice’s hometown Birmingham, Alabama, had “a mammoth fifty-six foot statue . . . [in] homage to the city’s steel industry” (Mann x) and the name stuck. Alternatively, explanations focus on how neoconservative thinkers shaped the intellectual climate after September 11, in a receptive media climate. Biographers suggest that “neoconservatism had become an echo chamber” (Heilbrunn 242) with its own media outlets, pundits, and think-tanks such as the American Enterprise Institute and Project for a New America. Neoconservatism briefly flourished in Washington DC until Iraq’s sectarian violence discredited the “Vulcans” and neoconservative strategists like Paul Wolfowitz (Friedman; Ferguson). The neoconservatives' combination of September 11’s aftermath with strongly argued historical analogies was initially convincing. They conferred with scholars such as Bernard Lewis, Samuel P. Huntington and Victor Davis Hanson to construct classicist historical narratives and to explain cultural differences. However, the history of the decade after September 11 also contains mis-steps and mistakes which make it a series of contingent decisions (Ferguson; Bergen). One way to analyse these contingent decisions is to pose “what if?” counterfactuals, or feasible alternatives to historical events (Lebow). For instance, what if September 11 had been a chemical and biological weapons attack? (Mann 317). Appendix 1 includes a range of alternative possibilities and “minimal rewrites” or slight variations on the historical events which occurred. Collectively, these counterfactuals suggest the role of agency, chance, luck, and the juxtaposition of better and worse outcomes. They pose challenges to the classicist interpretation adopted soon after September 11 to justify “World War IV” (Podhoretz). A ‘Two-Track’ Process for ‘World War IV’ After the September 11 attacks, I think an overlapping two-track process occurred with the “Vulcans” cabinet, neoconservative advisers, and two “echo chambers”: neoconservative think-tanks and the post-September 11 media. Crucially, Bush’s “Vulcans” war cabinet succeeded in gaining civilian control of the United States war decision process. Although successful in initiating the 2003 Iraq War this civilian control created a deeper crisis in US civil-military relations (Stevenson; Morgan). The “Vulcans” relied on “politicised” intelligence such as a United Kingdom intelligence report on Iraq’s weapons development program. The report enabled “a climate of undifferentiated fear to arise” because its public version did not distinguish between chemical, biological, radiological or nuclear weapons (Halper and Clarke, 210). The cautious 2003 National Intelligence Estimates (NIE) report on Iraq was only released in a strongly edited form. For instance, the US Department of Energy had expressed doubts about claims that Iraq had approached Niger for uranium, and was using aluminium tubes for biological and chemical weapons development. Meanwhile, the post-September 11 media had become a second “echo chamber” (Halper and Clarke 194-196) which amplified neoconservative arguments. Berman, Laqueur, Podhoretz and others who framed the intellectual climate were “risk entrepreneurs” (Mueller 41-43) that supported the “World War IV” vision. The media also engaged in aggressive “flak” campaigns (Herman and Chomsky 26-28; Mueller 39-42) designed to limit debate and to stress foreign policy stances and themes which supported the Bush Administration. When former Central Intelligence Agency director James Woolsey’s claimed that Al Qaeda had close connections to Iraqi intelligence, this was promoted in several books, including Michael Ledeen’s War Against The Terror Masters, Stephen Hayes’ The Connection, and Laurie Mylroie’s Bush v. The Beltway; and in partisan media such as Fox News, NewsMax, and The Weekly Standard who each attacked the US State Department and the CIA (Dorrien 183; Hayes; Ledeen; Mylroie; Heilbrunn 237, 243-244; Mann 310). This was the media “echo chamber” at work. The group Accuracy in Media also campaigned successfully to ensure that US cable providers did not give Al Jazeera English access to US audiences (Barker). Cosmopolitan ideals seemed incompatible with what the “flak” groups desired. The two-track process converged on two now infamous speeches. US President Bush’s State of the Union Address on 29 January 2002, and US Secretary of State Colin Powell’s presentation to the United Nations on 5 February 2003. Bush’s speech included a line from neoconservative David Frumm about North Korea, Iraq and Iran as an “Axis of Evil” (Dorrien 158; Halper and Clarke 139-140; Mann 242, 317-321). Powell’s presentation to the United Nations included now-debunked threat assessments. In fact, Powell had altered the speech’s original draft by I. Lewis “Scooter” Libby, who was Cheney’s chief of staff (Dorrien 183-184). Powell claimed that Iraq had mobile biological weapons facilities, linked to Abu Musab al-Zarqawi. However, the International Atomic Energy Agency’s (IAEA) Mohamed El-Baradei, the Defense Intelligence Agency, the State Department, and the Institute for Science and International Security all strongly doubted this claim, as did international observers (Dorrien 184; Halper and Clarke 212-213; Mann 353-354). Yet this information was suppressed: attacked by “flak” or given little visible media coverage. Powell’s agenda included trying to rebuild an international coalition and to head off weather changes that would affect military operations in the Middle East (Mann 351). Both speeches used politicised variants of “weapons of mass destruction”, taken from the counterterrorism literature (Stern; Laqueur). Bush’s speech created an inflated geopolitical threat whilst Powell relied on flawed intelligence and scientific visuals to communicate a non-existent threat (Vogel). However, they had the intended effect on decision makers. US Under-Secretary of Defense, the neoconservative Paul Wolfowitz, later revealed to Vanity Fair that “weapons of mass destruction” was selected as an issue that all potential stakeholders could agree on (Wilkie 69). Perhaps the only remaining outlet was satire: Armando Iannucci’s 2009 film In The Loop parodied the diplomatic politics surrounding Powell’s speech and the civil-military tensions on the Iraq War’s eve. In the short term the two track process worked in heading off doubt. The “Vulcans” blocked important information on pre-war Iraq intelligence from reaching the media and the general public (Prados). Alternatively, they ignored area specialists and other experts, such as when Coalition Provisional Authority’s L. Paul Bremer ignored the US State Department’s fifteen volume ‘Future of Iraq’ project (Ferguson). Public “flak” and “risk entrepreneurs” mobilised a range of motivations from grief and revenge to historical memory and identity politics. This combination of private and public processes meant that although doubts were expressed, they could be contained through the dual echo chambers of neoconservative policymaking and the post-September 11 media. These factors enabled the “Vulcans” to proceed with their “regime change” plans despite strong public opposition from anti-war protestors. Expressing DoubtsMany experts and institutions expressed doubt about specific claims the Bush Administration made to support the 2003 Iraq War. This doubt came from three different and sometimes overlapping groups. Subject matter experts such as the IAEA’s Mohamed El-Baradei and weapons development scientists countered the UK intelligence report and Powell’s UN speech. However, they did not get the media coverage warranted due to “flak” and “echo chamber” dynamics. Others could challenge misleading historical analogies between insurgent Iraq and Nazi Germany, and yet not change the broader outcomes (Benjamin). Independent journalists one group who gained new information during the 1990-91 Gulf War: some entered Iraq from Kuwait and documented a more humanitarian side of the war to journalists embedded with US military units (Uyarra). Finally, there were dissenters from bureaucratic and institutional processes. In some cases, all three overlapped. In their separate analyses of the post-September 11 debate on intelligence “failure”, Zegart and Jervis point to a range of analytic misperceptions and institutional problems. However, the intelligence community is separated from policymakers such as the “Vulcans”. Compartmentalisation due to the “need to know” principle also means that doubting analysts can be blocked from releasing information. Andrew Wilkie discovered this when he resigned from Australia’s Office for National Assessments (ONA) as a transnational issues analyst. Wilkie questioned the pre-war assessments in Powell’s United Nations speech that were used to justify the 2003 Iraq War. Wilkie was then attacked publicly by Australian Prime Minister John Howard. This overshadowed a more important fact: both Howard and Wilkie knew that due to Australian legislation, Wilkie could not publicly comment on ONA intelligence, despite the invitation to do so. This barrier also prevented other intelligence analysts from responding to the “Vulcans”, and to “flak” and “echo chamber” dynamics in the media and neoconservative think-tanks. Many analysts knew that the excerpts released from the 2003 NIE on Iraq was highly edited (Prados). For example, Australian agencies such as the ONA, the Department of Foreign Affairs and Trade, and the Department of Defence knew this (Wilkie 98). However, analysts are trained not to interfere with policymakers, even when there are significant civil-military irregularities. Military officials who spoke out about pre-war planning against the “Vulcans” and their neoconservative supporters were silenced (Ricks; Ferguson). Greenlight Capital’s hedge fund manager David Einhorn illustrates in a different context what might happen if analysts did comment. Einhorn gave a speech to the Ira Sohn Conference on 15 May 2002 debunking the management of Allied Capital. Einhorn’s “short-selling” led to retaliation from Allied Capital, a Securities and Exchange Commission investigation, and growing evidence of potential fraud. If analysts adopted Einhorn’s tactics—combining rigorous analysis with targeted, public denunciation that is widely reported—then this may have short-circuited the “flak” and “echo chamber” effects prior to the 2003 Iraq War. The intelligence community usually tries to pre-empt such outcomes via contestation exercises and similar processes. This was the goal of the 2003 NIE on Iraq, despite the fact that the US Department of Energy which had the expertise was overruled by other agencies who expressed opinions not necessarily based on rigorous scientific and technical analysis (Prados; Vogel). In counterterrorism circles, similar disinformation arose about Aum Shinrikyo’s biological weapons research after its sarin gas attack on Tokyo’s subway system on 20 March 1995 (Leitenberg). Disinformation also arose regarding nuclear weapons proliferation to non-state actors in the 1990s (Stern). Interestingly, several of the “Vulcans” and neoconservatives had been involved in an earlier controversial contestation exercise: Team B in 1976. The Central Intelligence Agency (CIA) assembled three Team B groups in order to evaluate and forecast Soviet military capabilities. One group headed by historian Richard Pipes gave highly “alarmist” forecasts and then attacked a CIA NIE about the Soviets (Dorrien 50-56; Mueller 81). The neoconservatives adopted these same tactics to reframe the 2003 NIE from its position of caution, expressed by several intelligence agencies and experts, to belief that Iraq possessed a current, covert program to develop weapons of mass destruction (Prados). Alternatively, information may be leaked to the media to express doubt. “Non-attributable” background interviews to establishment journalists like Seymour Hersh and Bob Woodward achieved this. Wikileaks publisher Julian Assange has recently achieved notoriety due to US diplomatic cables from the SIPRNet network released from 28 November 2010 onwards. Supporters have favourably compared Assange to Daniel Ellsberg, the RAND researcher who leaked the Pentagon Papers (Ellsberg; Ehrlich and Goldsmith). Whilst Elsberg succeeded because a network of US national papers continued to print excerpts from the Pentagon Papers despite lawsuit threats, Assange relied in part on favourable coverage from the UK’s Guardian newspaper. However, suspected sources such as US Army soldier Bradley Manning are not protected whilst media outlets are relatively free to publish their scoops (Walt, ‘Woodward’). Assange’s publication of SIPRNet’s diplomatic cables will also likely mean greater restrictions on diplomatic and military intelligence (Walt, ‘Don’t Write’). Beyond ‘Doubt’ Iraq’s worsening security discredited many of the factors that had given the neoconservatives credibility. The post-September 11 media became increasingly more critical of the US military in Iraq (Ferguson) and cautious about the “echo chamber” of think-tanks and media outlets. Internet sites for Al Jazeera English, Al-Arabiya and other networks have enabled people to bypass “flak” and directly access these different viewpoints. Most damagingly, the non-discovery of Iraq’s weapons of mass destruction discredited both the 2003 NIE on Iraq and Colin Powell’s United Nations presentation (Wilkie 104). Likewise, “risk entrepreneurs” who foresaw “World War IV” in 2002 and 2003 have now distanced themselves from these apocalyptic forecasts due to a series of mis-steps and mistakes by the Bush Administration and Al Qaeda’s over-calculation (Bergen). The emergence of sites such as Wikileaks, and networks like Al Jazeera English and Al-Arabiya, are a response to the politics of the past decade. They attempt to short-circuit past “echo chambers” through providing access to different sources and leaked data. The Global War on Terror framed the Bush Administration’s response to September 11 as a war (Kirk; Mueller 59). Whilst this prematurely closed off other possibilities, it has also unleashed a series of dynamics which have undermined the neoconservative agenda. The “classicist” history and historical analogies constructed to justify the “World War IV” scenario are just one of several potential frameworks. “Flak” organisations and media “echo chambers” are now challenged by well-financed and strategic alternatives such as Al Jazeera English and Al-Arabiya. Doubt is one defence against “risk entrepreneurs” who seek to promote a particular idea: doubt guards against uncritical adoption. Perhaps the enduring lesson of the post-September 11 debates, though, is that doubt alone is not enough. What is needed are individuals and institutions that understand the strategies which the neoconservatives and others have used, and who also have the soft power skills during crises to influence critical decision-makers to choose alternatives. Appendix 1: Counterfactuals Richard Ned Lebow uses “what if?” counterfactuals to examine alternative possibilities and “minimal rewrites” or slight variations on the historical events that occurred. The following counterfactuals suggest that the Bush Administration’s Global War on Terror could have evolved very differently . . . or not occurred at all. Fact: The 2003 Iraq War and 2001 Afghanistan counterinsurgency shaped the Bush Administration’s post-September 11 grand strategy. Counterfactual #1: Al Gore decisively wins the 2000 U.S. election. Bush v. Gore never occurs. After the September 11 attacks, Gore focuses on international alliance-building and gains widespread diplomatic support rather than a neoconservative agenda. He authorises Special Operations Forces in Afghanistan and works closely with the Musharraf regime in Pakistan to target Al Qaeda’s muhajideen. He ‘contains’ Saddam Hussein’s Iraq through measurement and signature, technical intelligence, and more stringent monitoring by the International Atomic Energy Agency. Minimal Rewrite: United 93 crashes in Washington DC, killing senior members of the Gore Administration. Fact: U.S. Special Operations Forces failed to kill Osama bin Laden in late November and early December 2001 at Tora Bora. Counterfactual #2: U.S. Special Operations Forces kill Osama bin Laden in early December 2001 during skirmishes at Tora Bora. Ayman al-Zawahiri is critically wounded, captured, and imprisoned. The rest of Al Qaeda is scattered. Minimal Rewrite: Osama bin Laden’s death turns him into a self-mythologised hero for decades. Fact: The UK Blair Government supplied a 50-page intelligence dossier on Iraq’s weapons development program which the Bush Administration used to support its pre-war planning. Counterfactual #3: Rogue intelligence analysts debunk the UK Blair Government’s claims through a series of ‘targeted’ leaks to establishment news sources. Minimal Rewrite: The 50-page intelligence dossier is later discovered to be correct about Iraq’s weapons development program. Fact: The Bush Administration used the 2003 National Intelligence Estimate to “build its case” for “regime change” in Saddam Hussein’s Iraq. Counterfactual #4: A joint investigation by The New York Times and The Washington Post rebuts U.S. Secretary of State Colin Powell’s speech to the United National Security Council, delivered on 5 February 2003. Minimal Rewrite: The Central Intelligence Agency’s whitepaper “Iraq’s Weapons of Mass Destruction Programs” (October 2002) more accurately reflects the 2003 NIE’s cautious assessments. Fact: The Bush Administration relied on Ahmed Chalabi for its postwar estimates about Iraq’s reconstruction. Counterfactual #5: The Bush Administration ignores Chalabi’s advice and relies instead on the U.S. State Department’s 15 volume report “The Future of Iraq”. Minimal Rewrite: The Coalition Provisional Authority appoints Ahmed Chalabi to head an interim Iraqi government. Fact: L. Paul Bremer signed orders to disband Iraq’s Army and to De-Ba’athify Iraq’s new government. Counterfactual #6: Bremer keeps Iraq’s Army intact and uses it to impose security in Baghdad to prevent looting and to thwart insurgents. Rather than a De-Ba’athification policy, Bremer uses former Baath Party members to gather situational intelligence. Minimal Rewrite: Iraq’s Army refuses to disband and the De-Ba’athification policy uncovers several conspiracies to undermine the Coalition Provisional Authority. AcknowledgmentsThanks to Stephen McGrail for advice on science and technology analysis.References Barker, Greg. “War of Ideas”. PBS Frontline. Boston, MA: 2007. ‹http://www.pbs.org/frontlineworld/stories/newswar/video1.html› Benjamin, Daniel. “Condi’s Phony History.” Slate 29 Aug. 2003. ‹http://www.slate.com/id/2087768/pagenum/all/›. Bergen, Peter L. The Longest War: The Enduring Conflict between America and Al Qaeda. New York: The Free Press, 2011. Berman, Paul. Terror and Liberalism. 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No End in Sight, New York: Representational Pictures, 2007. Filkins, Dexter. The Forever War. New York: Vintage Books, 2008. Friedman, Murray. The Neoconservative Revolution: Jewish Intellectuals and the Shaping of Public Policy. New York: Cambridge UP, 2005. Halper, Stefan, and Jonathan Clarke. America Alone: The Neo-Conservatives and the Global Order. New York: Cambridge UP, 2004. Hayes, Stephen F. The Connection: How Al Qaeda’s Collaboration with Saddam Hussein Has Endangered America. New York: HarperCollins, 2004. Heilbrunn, Jacob. They Knew They Were Right: The Rise of the Neocons. New York: Doubleday, 2008. Herman, Edward S., and Noam Chomsky. Manufacturing Consent: The Political Economy of the Mass Media. Rev. ed. New York: Pantheon Books, 2002. Iannucci, Armando. In The Loop. London: BBC Films, 2009. Jervis, Robert. Why Intelligence Fails: Lessons from the Iranian Revolution and the Iraq War. Ithaca NY: Cornell UP, 2010. Kirk, Michael. “The War behind Closed Doors.” PBS Frontline. Boston, MA: 2003. ‹http://www.pbs.org/wgbh/pages/frontline/shows/iraq/›. Laqueur, Walter. No End to War: Terrorism in the Twenty-First Century. New York: Continuum, 2003. Lebow, Richard Ned. Forbidden Fruit: Counterfactuals and International Relations. Princeton NJ: Princeton UP, 2010. Ledeen, Michael. The War against The Terror Masters. New York: St. Martin’s Griffin, 2003. Leitenberg, Milton. “Aum Shinrikyo's Efforts to Produce Biological Weapons: A Case Study in the Serial Propagation of Misinformation.” Terrorism and Political Violence 11.4 (1999): 149-158. Mann, James. Rise of the Vulcans: The History of Bush’s War Cabinet. New York: Viking Penguin, 2004. Morgan, Matthew J. The American Military after 9/11: Society, State, and Empire. New York: Palgrave Macmillan, 2008. Mueller, John. Overblown: How Politicians and the Terrorism Industry Inflate National Security Threats, and Why We Believe Them. 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Introduction: Game Culture and GenderAs texts with the potential to help mediate specific forms of identity, video games are rich and complex sites for analysis. A tendency, however, still exists in scholarship to treat video games as just another kind of text, and work that explores the expression of masculine identity persists in drawing from cinematic analysis without proper consideration of game design and how these games are played (Triana). For example, insights from studies into horror cinema may illuminate the relationship between players and game systems in survival horror video games (Habel & Kooyman), but further study is needed to explore how people interact with the game.This article aims to build towards a scholarly definition of the term “Power Fantasy”, a concept that seems well established in wider discourse but is not yet well theorised in the scholarly literature. It does so through a case of the most recent reboot of Doom (2016), a game that in its original incarnation established an enduring tradition for high-action Power Fantasy. In the first-person shooter game Doom, the player fills the role of the “Doom Guy”, a faceless hero who shuttles between Earth and Hell with the sole aim of eviscerating demonic hordes as graphically as possible.How, then, do we begin to theorise the kind of automediation that an iconic game text like Doom facilitates? Substantial work has been done to explore player identification in online games (see Taylor; Yee). Shaw (“Rethinking”) suggests that single-player games are unexplored territory compared to the more social spaces of Massively Multiplayer Online games and other multiplayer experiences, but it is important to distinguish between direct identification with the avatar per se and the ways in which the game text mediates broader gender constructions.Abstract theorisation is not enough, though. To effectively understand this kind of automediation we also need a methodology to gain insights into its processes. The final part of this article, therefore, proposes the analysis of “Let’s Play” videos as a kind of gender identity performance which gives insight into the automediation of dominant masculine gender identities through Power Fantasy video games like Doom. This reflexive performance works to denaturalise gender construction rather than reinforce stable hegemonic identities.Power Fantasy and Gender IdentityPower Fantasy has become an established trope in online critiques and discussions of popular culture. It can be simply defined as “character imagines himself taking revenge on his bullies” (TVTropes). This trope takes on special resonance in video games, where the players themselves live out the violent revenge fantasy in the world of the game.The “power fantasy” of games implies escapism and meaninglessness, evoking outsize explosions and equally outsized displays of dominance. A “power gamer” is one who plays with a single-minded determination to win, at the expense of nuance, social relationships between players, or even their own pleasure in play. (Baker)Many examples apply this concept of Power Fantasy in video games: from God of War to Metroid: Prime and Grand Theft Auto, this prevalent trope of game design uses a kind of “agency mechanics” (Habel & Kooyman) to convince the player that they are becoming increasingly skilful in the game, when in reality the game is simply decreasing in difficulty (PBS Digital Studios). The operation of the Power Fantasy trope is also gendered; in a related trope known as “I Just Want To Be a Badass”, “males are somewhat more prone to harbour [the] wish” to feel powerful (TVTropes). More broadly, even though the game world is obviously not real, playing it requires “an investment in and commitment to a type of masculine performance that is based on the Real (particularly if one is interested in ‘winning’, pummelling your opponent, kicking ass, etc.)” (Burrill 2).Indeed, there is a perceived correlation (if not causation) between the widespread presence of Power Fantasy video games and how “game culture as it stands is shot through with sexism, racism, homophobia, and other biases” (Baker). Golding and van Deventer undertake an extended exploration of this disconcerting side of game culture, concluding that games have “become a venue for some of the more unsophisticated forms of patriarchy” (213) evidenced in the highly-publicised GamerGate movement. This saw an alignment between the label of “gamer” and extreme misogyny, abuse and harassment of women and other minorities in the industry.We have, then, a tentative connection between dominant gameplay forms based on high skill that may be loosely characterised as “Power Fantasy” and some of the most virulent toxic gender expressions seen in recent times. More research is needed to gain a clearer understanding of precisely what Power Fantasy is. Baker’s primary argument is that “power” in games can also be characterised as “power to” or “power with”, as well as the more traditional “power over”. Kurt Squire uses the phrase “Power Fantasy” as a castaway framing for a player who seeks an alternative reward to the usual game progression in Sid Meier’s Civilisation. More broadly, much scholarly work concerning gameplay design and gender identity has been focussed on the hot-button question of videogame violence and its connection to real-world violence, a question that this article avoids since it is well covered elsewhere. Here, a better understanding of the mediation of gender identity through Power Fantasy in Doom can help to illuminate how games function as automedia.Auto-Mediating Gender through Performance in Doom (2016) As a franchise, Doom commands near-incomparable respect as a seminal text of the first-person shooter genre. First released in 1993, it set the benchmark for 3D rendered graphics, energetic sound design, and high-paced action gameplay that was visceral and deeply immersive. It is impossible to mention more recent reboots without recourse to its first seminal instalment and related game texts: Kim Justice suggests a personal identification with it in a 29-minute video analysis entitled “A Personal History of Demon Slaughter”. Doom is a cherished game for many players, possibly because it evokes memories of “boyhood” gaming and all its attendant gender identity formation (Burrill).This identification also arises in livestreams and playthroughs of the game. YouTuber and game reviewer Markiplier describes nostalgically and at lengths his formative experiences playing it (and recounts a telling connection with his father who, he explains, introduced him to gaming), saying “Doom is very important to me […] this was the first game that I sat down and played over and over and over again.” In contrast, Wanderbots confesses that he has never really played Doom, but acknowledges its prominent position in the gaming community by designating himself outside the identifying category of “Doom fan”. He states that he has started playing due to “gushing” recommendations from other gamers. The nostalgic personal connection is important, even in absentia.For the most part, the critical and community response to the 2016 version of Doom was approving: Gilroy admits that it “hit all the right power chords”, raising the signature trope in reference to both gameplay and music (a power chord is a particular technique of playing heavy metal guitar often used in heavy metal music). Doom’s Metacritic score is currently a respectable 85, and, the reception is remarkably consistent between critics and players, especially for such a potentially divisive game (Metacritic). Commentators tend to cite its focus on its high action, mobility, immersion, sound design, and general faithfulness to the spirit of the original Doom as reasons for assessments such as “favourite game ever” (Habel). Game critic Yahtzee’s uncharacteristically approving video review in the iconic Zero Punctuation series is very telling in its assessment of the game’s light narrative framing:Doom seems to have a firm understanding of its audience because, while there is a plot going on, the player-character couldn’t give a half an ounce of deep fried shit; if you want to know the plot then pause the game and read all the fluff text in the character and location database, sipping daintily from your pink teacup full of pussy juice, while the game waits patiently for you to strap your bollocks back on and get back in the fray. (Yahtzee)This is a strident expression of the gendered expectations and response to Doom’s narratological refusal, which is here cast as approvingly masculine and opposed to a “feminine” desire for plot or narrative. It also feeds into a discourse which sees the game as one which demands skill, commitment, and an achievement orientation cast within an exclusivist ideology of “toxic meritocracy” (Paul).In addition to examining reception, approaches to understanding how Doom functions as a “Power Fantasy” or “badass” trope could take a variety of forms. It is tempting to undertake a detailed analysis of its design and gameplay, especially since these feed directly into considerations of player interaction. This could direct a critical focus towards gameplay design elements such as traversal and mobility, difficulty settings, “glory kills”, and cinematic techniques in the same vein as Habel and Kooyman’s analysis of survival horror video games in relation to horror cinema. However, Golding and van Deventer warn against a simplistic analysis of decontextualized gameplay (29-30), and there is a much more intriguing possibility hinted at by Harper’s notion of “Play Practice”.It is useful to analyse a theoretical engagement with a video game as a thought-experiment. But with the rise of gaming as spectacle, and particularly gaming as performance through “Let’s Play” livestreams (or video on demand) on platforms such as TwitchTV and YouTube, it becomes possible to analyse embodied performances of the gameplay of such video games. This kind of analysis allows the opportunity for a more nuanced understanding of how such games mediate gender identities. For Judith Butler, gender is not only performed, it is also performative:Because there is neither an “essence” that gender expresses or externalizes nor an objective ideal to which gender aspires, and because gender is not a fact, the various acts of gender create the idea of gender, and without those acts, there would be no gender at all. (214)Let’s Play videos—that show a player playing a game in real time with their commentary overlaying the on screen action—allow us to see the performative aspects of gameplay. Let’s Plays are a highly popular and developing form: they are not simple artefacts by any means, and can be understood as expressive works in their own right (Lee). They are complex and multifaceted, and while they do not necessarily provide direct insights into the player’s perception of their own identification, with sufficient analysis and unpacking they help us to explore both the construction and denaturalisation of gender identity. In this case, we follow Josef Nguyen’s analysis of Let’s Plays as essential for expression of player identity through performance, but instead focus on how some identity construction may narrow rather than expand the diversity range. T.L. Taylor also has a monograph forthcoming in 2018 titled Watch Me Play: Twitch and the Rise of Game Live Streaming, suggesting the time is ripe for such analysis.These performances are clear in ways we have already discussed: for example, both SplatterCat and Markiplier devote significant time to describing their formative experiences playing Doom as a background to their gameplay performance, while Wanderbots is more distanced. There is no doubt that these videos are popular: Markiplier, for example, has attracted nearly 5 million views of his Doom playthrough. If we see gameplay as automediation, though, these videos become useful artefacts for analysis of gendered performance through gameplay.When SplatterCat discovers the suit of armor for the game’s protagonist, Doom Guy, he half-jokingly remarks “let us be all of the Doom Guy that we can possibly be” (3:20). This is an aspirational mantra, a desire for enacting the game’s Power Fantasy. Markiplier speaks at length about his nostalgia for the game, specifically about how his father introduced him to Doom when he was a child, and he expresses hopes that he will again experience “Doom’s original super-fast pace and just pure unadulterated action; Doom Guy is a badass” (4:59). As the action picks up early into the game, Markiplier expresses the exhilaration and adrenaline that accompany performances of this fastpaced, highly mobile kind of gameplay, implying that he is becoming immersed in the character and, by performing Doom Guy, inhabiting the “badass” role and thus enacting a performance of Power Fantasy:Doom guy—and I hope I’m playing Doom guy himself—is just the embodiment of kickass. He destroys everything and he doesn’t give a fuck about what he breaks in the process. (8:45)This performance of gender through the skilled control of Doom Guy is, initially, unambiguously mediated as Power Fantasy: in control, highly skilled, suffused with Paul’s ‘toxic meritocracy. A similar sentiment is expressed in Wanderbots’ playthrough when the player-character dispenses with narrative/conversation by smashing a computer terminal: “Oh I like this guy already! Alright. Doom Guy does not give a shit. It’s like Wolf Blascowicz [sic], but like, plus plus” (Wanderbots). This is a reference to another iconic first-person shooter franchise, Wolfenstein, which also originated in the 1980s and has experienced a recent successful reboot, and which operates in a similar Power Fantasy mode. This close alignment between these two streamers’ performances suggests significant coherence in both genre and gameplay design and the ways in which players engage with the game as a gendered performative space.Nonetheless, there is no simple one-to-one relationship here—there is not enough evidence to argue that this kind of gameplay experience leads directly to the kind of untrammelled misogyny we see in game culture more broadly. While Gabbiadini et al. found evidence in an experimental study that a masculinist ideology combined with violent video game mechanics could lead to a lack of empathy for women and girls who are victims of violence, Ferguson and Donnellan dispute this finding based on poor methodology, arguing that there is no evidence for a causal relationship between gender, game type and lack of empathy for women and girls. This inconclusiveness in the research is mirrored by an ambiguity in the gendered performance of males playing through Doom, where the Power Fantasy is profoundly undercut in multiple ways.Wanderbots’ Doom playthrough is literally titled ‘I have no idea what I’m Dooming’ and he struggles with particular mechanics and relatively simple progression tools early in the game: this reads against masculinist stereotypes of superior and naturalised gameplay skill. Markiplier’s performance of the “badass” Doom Guy is undercut at various stages: in encountering the iconic challenge of the game, he mentions that “I am halfway decent… not that good at video games” (9:58), and on the verge of the protagonist’s death he admits “If I die this early into my first video I’m going to be very disappointed, so I’m going to have to kick it up a notch” (15:30). This suggests that rather than being an unproblematic and simple expression of male power in a fantasy video game world, the gameplay performances of Power Fantasy games are ambiguous and contested, and not always successfully performed via the avatar. They therefore demonstrate a “kind of gender performance [which] will enact and reveal the performativity of gender itself in a way that destabilizes the naturalized categories of identity and desire” (Butler 211). This cuts across the empowered performance of videogame mastery and physical dominance over the game world, and suggests that the automediation of gender identity through playing video games is a complex phenomenon urgently in need of further theorisation.ConclusionUltimately, this kind of analysis of the mediation of hegemonic gender identities is urgent for a cultural product as ubiquitous as video games. The hyper-empowered “badass” digital avatars of Power Fantasy video games can be expected to have some shaping effect on the identities of those who play them, evidenced by the gendered gameplay performance of Doom briefly explored here. This is by no means a simple or unproblematic process, though. Much further research is needed to test the methodological insights possible by using video performances of gameplay as explorations of the auto-mediation of gender identities through video games.ReferencesBaker, Meguey. “Problematizing Power Fantasy.” The Enemy 1.2 (2015). 18 Feb. 2018 <http://theenemyreader.org/problematizing-power-fantasy/>.Burrill, Derrick. Die Tryin’: Video Games, Masculinity, Culture. New York: Peter Lang, 2008.Butler, Judith. Gender Trouble. 10th ed. London: Routledge, 2002.Ferguson, Christopher, and Brent Donellan. “Are Associations between “Sexist” Video Games and Decreased Empathy toward Women Robust? A Reanalysis of Gabbiadini et al. 2016.” Journal of Youth and Adolescence 46.12 (2017): 2446–2459.Gabbiadini, Alessandro, Paolo Riva, Luca Andrighetto, Chiara Volpato, and Brad J. Bushman. “Acting like a Tough Guy: Violent-Sexist Video Games, Identification with Game Characters, Masculine Beliefs, & Empathy for Female Violence Victims.” PloS One 11.4 (2016). 14 Apr. 2018 <http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152121>.Gilroy, Joab. “Doom: Review.” IGN, 16 May 2016. 22 Feb. 2018 <http://au.ign.com/articles/2016/05/16/doom-review-2?page=1>.Golding, Dan, and Leena van Deventer. Game Changers: From Minecraft to Misogyny, the Fight for the Future of Videogames. South Melbourne: Affirm, 2016.Habel, Chad, and Ben Kooyman. “Agency Mechanics: Gameplay Design in Survival Horror Video Games”. Digital Creativity 25.1 (2014):1-14.Habel, Chad. “Doom: Review (PS4).” Game Truck Australia, 2017. 22 Feb. 2018 <http://www.gametruckaustralia.com.au/review-doom-2016-ps4/>.Harper, Todd. The Culture of Digital Fighting Games: Performance and Practice. London: Routledge, 2013.Kim Justice. “Doom: A Personal History of Demon Slaughter.” YouTube, 16 Jan. 2017. 22 Feb. 2018 <https://www.youtube.com/watch?v=JtvoENhvkys>.Lee, Patrick. “The Best Let’s Play Videos Offer More than Vicarious Playthroughs.” The A.V. Club, 24 Apr. 2015. 22 Feb. 2018 <https://games.avclub.com/the-best-let-s-play-videos-offer-more-than-vicarious-pl-1798279027>.Markiplier. “KNEE-DEEP IN THE DEAD | DOOM – Part 1.” YouTube, 13 May 2016. 21 Feb. 2018 <https://www.youtube.com/watch?v=pCygvprsgIk>.Metacritic. “Doom (PS4).” 22 Feb. 2018 <http://www.metacritic.com/game/playstation-4/doom>.Nguyen, Josef. “Performing as Video Game Players in Let’s Plays.” Transformative Works and Cultures 22 (2016). <http://journal.transformativeworks.org/index.php/twc/article/view/698>.Paul, Christopher. The Toxic Meritocracy of Video Games: Why Gaming Culture Is the Worst. Minneapolis: U of Minnesota P, 2018.PBS Digital Studios. “Do Games Give Us Too Much Power?” 2017. 18 Feb. 2018 <https://www.youtube.com/watch?v=9COt-_3C0xI>.Shaw, Adrienne. “Do You Identify as a Gamer? Gender, Race, Sexuality, and Gamer Identity.” New Media and Society 14.1 (2012): 28-44.———. “Rethinking Game Studies: A Case Study Approach to Video Game Play and Identification.” Critical Studies in Media Communication 30.5 (2013): 347-361.SplatterCatGaming. “DOOM 2016 PC – Gameplay Intro – #01 Let's Play DOOM 2016 Gameplay.” YouTube, 13 May 2016. 21 Feb. 2018 <https://www.youtube.com/watch?v=tusgsunWEIs>.Squire, Kurt. “Open-Ended Video Games: A Model for Developing Learning for the Interactive Age.” The Ecology of Games: Connecting Youth, Games, and Learning. Ed. Katie Salen. Cambridge, MA: MIT P, 2008. 167–198.Boellstorff, Tom, Bonnie Nardi, Celia Pearce, and T.L. Taylor. Ethnography and Virtual Worlds: A Handbook of Method. Princeton, NJ: Princeton UP, 2012.Triana, Benjamin. “Red Dead Maculinity: Constructing a Conceptual Framework for Analysing the Narrative and Message Found in Video Games.” Journal of Games Criticism 2.2 (2015). 12 Apr. 2018 <http://gamescriticism.org/articles/triana-2-2/>.TVTropes. Playing With / Power Fantasy. 18 Feb. 2018 <http://tvtropes.org/pmwiki/pmwiki.php/PlayingWith/PowerFantasy>.———. I Just Want to Be a Badass. 18 Feb. 2018 <http://tvtropes.org/pmwiki/pmwiki.php/Main/IJustWantToBeBadass>.Wanderbots. “Let’s Play Doom (2016) – PC Gameplay Part I – I Have No Idea What I’m Dooming!” YouTube, 18 June 2016. 14 Apr. 2018 <https://www.youtube.com/watch?v=AQSMNhWAf0o>.Yee, Nick. “Maps of Digital Desires: Exploring the Topography of Gender and Play in Online Games.” Beyond Barbie and Mortal Kombat: New Perspectives on Gender and Gaming. Eds. Yasmin B. Kafai, Carrie Heeter, Jill Denner, and Jennifer Sun. Cambridge, MA: MIT P, 2008. 83-96.Yahtzee. “Doom (2016) Review.” Zero Punctuation, 8 June 2016. 14 Apr. 2018 <https://www.youtube.com/watch?v=HQGxC8HKCD4>.

IntroductionClowns can be seen as enacting catastrophe with a small “c.” They are experts in “failing better” who perhaps live on the cusp of turning catastrophe into a metaphorical whirlwind while ameliorating the devastation that lies therein. They also have the propensity to succumb to the devastation, masking their own sense of the void with the gestures of play. In this paper, knowledge about clowns emerges from my experience, working with circus clowns in Circus Knie (Switzerland) and Circo Tihany (South America), observing performances and films about clowns, and reading, primarily in European fiction, of clowns in multiple guises. The exposure to a diverse range of texts, visual media and performance, has led me to the possibility that clowning is not only a conceptual discipline but also a state of being that is yet to be fully recognised.Diminutive CatastropheI have an idea (probably a long held obsession) of the clown as a diminutive figure of catastrophe, of catastrophe with a very small “c.” In the context of this incisive academic dialogue on relationships between catastrophe and creativity where writers are challenged with the horrendous tragedies that nature and humans unleash on the planet, this inept character appears to be utterly insignificant and, moreover, unworthy of any claim to creativity. A clown does not solve problems in the grand scheme of society: if anything he/she simply highlights problems, arguably in a fatalistic manner where innovation may be an alien concept. Invariably, as Eric Weitz observes, when clowns depart from their moment on the stage, laughter evaporates and the world settles back into the relentless shades of oppression and injustice. In response to the natural forces of destruction—earthquakes, tsunamis, cyclones, and volcanic eruptions—as much as to the forces of rage in war and ethnic cleansing that humans inflict on one another, a clown makes but a tiny gesture. Curiously, though, those fingers brushing dust off a threadbare jacket may speak volumes.Paradox is the crux of this exploration. Clowns, the best of them, project the fragility of human value on a screen beyond measure and across many layers and scales of metaphorical understanding (Big Apple Circus; Stradda). Why do odd tramps and ordinary inept people seem to pivot against the immense flows of loss and outrage which tend to pervade our understanding of the global condition today? Can Samuel Beckett’s call to arms of "failing better” in the vein of Charles Chaplin, Oleg Popov, or James Thiérrée offer a creative avenue to pursue (Bala; Coover; Salisbury)? Do they reflect other ways of knowing in the face of big “C” Catastrophes? Creation and CatastropheTo wrestle with these questions, I wish to begin by proposing a big picture view of earth-life wherein, across inconceivable aeons, huge physical catastrophes have wrought unimaginable damage on the ecological “completeness” of the time. I am not a palaeontologist or an evolutionary scientist but I suspect that, if human life is taken out of the equation, the planet since time immemorial has been battered by “disaster” which changed but ultimately did not destroy the earth. Evolution is replete with narratives of species wiped out by ice-ages, volcanoes, earthquakes, and meteors and yet the organism of this planet has survived and even regenerated. In metaphorical territory, the Sanskrit philosophers have a wise take on this process. Indian concepts are always multiple, crowded with possibilities, but I find there is something intriguing in the premise (even if it is impossible to tie down) of Shiva’s dance:Shiva Nataraja destroys creation by his Tandava Dance, or the Dance of Eternity. As he dances, everything disintegrates, apparently into nothingness. Then, out of the thin vapours, matter and life are recreated again. Shiva also dances in the hearts of his devotees as the Great Soul. As he dances, one’s egotism is consumed and one is rendered pure in soul and without any spiritual blemish. (Ghosh 109–10)For a dancer, the central location of dance in life’s creation forces is a powerful idea but I am also interested in how this metaphysical perspective aligns with current scientific views. How could these ancient thinkers predict evolutionary processes? Somehow, in the mix of experiential observation and speculation, they foresaw the complexity of time and, moreover, appreciated the necessary interdependence of creation and destruction (creativity and catastrophe). In comparison to western thought which privileges progression—and here evolution is a prime example—Hindu conceptualisation appears to prefer fatalism or a cyclical system of understanding that negates the potential of change to make things better. However, delving more closely into scientific narratives on evolution, the progression of life forms to the human species has involved the decimation of an uncountable number of other living possibilities. Contrariwise, Shiva’s Dance of Eternity is premised on endless diachronic change crossed vertically by reincarnation, through which progression and regression are equally expressed. I offer this simplistic view of both accounts of creation merely to point out that the interdependency of destruction and creation is deeply embodied in human knowledge.To introduce the clown figure into this idea, I have to turn to the minutiae of destruction and creation; to examples in the everyday nature of regeneration through catastrophe. I have memories of touring in the Northern Territory of Australia amidst strident green shoots bursting out of a fire-tortured landscape or, earlier in Paris, of the snow-crusted earth being torn asunder by spring’s awakening. We all have countless memories of such small-scale transformations of pain and destruction into startling glimpses of beauty. It is at this scale of creative wrestling that I see the clown playing his/her role.In the tension between fatalism and, from a human point of view, projections of the right to progression, a clown occupying the stage vacated by Shiva might stamp out a slight rhythm of his/her own with little or no meaning in the action. The brush on the sleeve might be hard to detect in an evolutionary or Hindu time scale but zoom down to the here and now of performance exchange and the scene may be quite different?Turning the Lens onto the Small-ScaleSmall-scale, clowns tend to be tiny bundles or, sometimes, gangly unbundles of ineptitude, careering through the simplest tasks with preposterous incompetence or, alternatively, imbibing complexity with the virtuosic delicacy—take Charles Chaplin’s shoe-lace spaghetti twirling and nibbling on nail-bones as an example. Clowns disrupt normalcy in small eddies of activity which often wreak paths of destruction within the tightly ordered rage of social formations. The momentum is chaotic and, not dissimilar to storms, clownish enactment bears down not so much to threaten human life but to disrupt what we humans desire and formulate as the natural order of decorum and success. Instead of the terror driven to consciousness by cyclones and hurricanes, the clown’s chaos is superficially benign. When Chaplin’s generous but unrealistic gesture to save the tightrope-act is thwarted by an escaped monkey, or when Thiérrée conducts a spirited debate with the wall of his abode in the midst of an identity crisis (Raoul), life is not threatened. Such incongruous and chaotic trajectories generate laughter and, sometimes, sadness. Moreover, as Weitz observes, “the clown-like imagination, unfettered by earthly logic, urges us to entertain unlikely avenues of thought and action” (87). While it may seem insensitive, I suggest that similar responses of laughter, sadness and unlikely avenues of thought and action emerge in the aftermath of cataclysmic events.Fear, unquestionably, saturates big states of catastrophe. Slide down the scale and intriguing parallels between fear and laughter emerge, one being a clown’s encapsulation of vulnerability and his/her stoic determination to continue, to persevere no matter what. There are many ways to express this continuity: Beckett’s characters are forever waiting, fearful that nothing will arrive, yet occupy themselves with variations of cruelty and amusement through the interminable passage of time. A reverse action occurs in Grock’s insistence that he can play his tiny violin, in spite of his ever-collapsing chair. It never occurs to him to find another chair or play standing up: that, in an incongruous way, would admit defeat because this chair and his playing constitute Grock’s compulsion to succeed. Fear of failure generates multiple innovations in his relationship with the chair and in his playing skills. Storm-like, the pursuit of a singular idea in both instances triggers chaotic consequences. Physical destruction may be slight in such ephemeral storms but the act, the being in the world, does leave its mark on those who witness its passage.I would like to offer a mark left in me by a slight gesture on the part of a clown. I choose this one among many because the singular idea played out in Circus Knie (Switzerland) back in the early 1970s does not conform to the usual parameters. This Knie season featured Dimitri, an Italian-Swiss clown, as the principal attraction. Following clown conventions, Dimitri appeared across the production as active glue between the various circus acts, his persona operating as an odd-jobs man to fix and clean. For instance, he intervened in the elephant act as a cleaner, scrubbing and polishing the elephant’s skin with little effect and tuned, with much difficulty, a tiny fiddle for the grand orchestration to come. But Dimitri was also given moments of his own and this is the one that has lodged in my memory.Dimitri enters the brightly lit and empty circus ring with a broom in hand. The audience at this point have accepted the signal that Dimitri’s interludes prepare the ring for the next attraction—to sweep, as it were, the sawdust back to neutrality. He surveys the circle for a moment and then takes a position on the periphery to begin what appears to be a regular clean-up. The initial brushes over the sawdust, however, produce an unexpected result—the light rather than the sawdust responds to his broom stokes. Bafflement swiftly passes as an idea takes hold: the diminutive figure trots off to the other side of the ring and, after a deep breath and a quick glance to see if anyone is looking (we all are), nudges the next edge of light. Triumphantly, the pattern is pursued with increasing nimbleness, until the figure with the broom stands before a pin-spot of light at the ring’s centre. He hesitates, checks again about unwanted surveillance, and then, in a single strike (poof), sweeps light and the world into darkness.This particular clown gesture contradicts usual commentaries of ineptitude and failure associated with clown figures but the incongruity of sweeping light and the narrative of the little man who scores a win lie thoroughly in the characteristic grounds of clownish behaviour. Moreover, the enactment of this simple idea illustrates for me today, as much as it did on its initial viewing, how powerful a slight clown gesture can be. This catastrophe with a very small “c:” the little man with nothing but a broom and an idea destroyed, like the great god Shiva, the world of light.Jesse McKnight’s discussion of the peculiar attraction of two little men of the 20th century, James Joyce’s Bloom and Charles Chaplin, could also apply to Dimitri:They are at sixes and sevens here on earth but in tune with the stars, buffoons of time, and heroes of eternity. In the petty cogs of the causal, they appear foolish; in the grand swirl of the universe, they are wise, outmaneuvering their assailants and winning the race or the girl against all odds or merely retaining their skins and their dignity by nightfall. (496) Clowning as a State of Mind/ConsciousnessAnother perspective on a clown’s relationship to ideas of catastrophe which I would like to examine is embedded in the discussion above but, at the same time, deviates by way of a harsh tangent from the beatitude and almost sacred qualities attributed by McKnight’s and my own visions of the rhythmic gestures of these diminutive figures. Beckett’s advice in Worstward Ho (1983) is a fruitful starting place wherein the directive is “to keep on trying even if the hope of success is dashed again and again by failure: ‘Ever tried. Ever failed. No matter. Try Again. Fail again. Fail better’” (Le Feuvre 13). True to the masterful wordsmith, these apparently simple words are not transparent; rather, they deflect a range of contradictory interpretations. Yes, failure can facilitate open, flexible and alternative thought which guards against fanatical and ultra-orthodox certitude: “Failure […] is free to honour other ways of knowing, other construals of power” (Werry & O’Gorman 107). On the other hand, failure can mask a horrifying realisation of the utter meaninglessness of human existence. It is as if catastrophe is etched lightly in external clown behaviour and scarred pitilessly deep in the psyches that drive the comic behaviour. Pupils of the pre-eminent clown teacher Jacques Lecoq suggest that theatrical clowning pivots on “finding that basic state of vulnerability and allowing the audience to exist in that state with you” (Butler 64). Butler argues that this “state of clowning” is “a state of anti-intellectualism, a kind of pure emotion” (ibid). From my perspective, there is also an emotional stratum in which the state or condition involves an adult anxiety desiring to protect the child’s view of the world with a fierceness equal to that of a mother hen protecting her brood. A clown knows the catastrophe of him/herself but refuses to let that knowledge (of failure) become an end. An obstinate resilience, even a frank acknowledgement of hopelessness, makes a clown not so much pure emotion or childlike but a kind of knowledgeable avenger of states of loss. Here I need to admit that I attribute the clowning state or consciousness to an intricate lineage inclusive of the named clowns, Grock, Chaplin, Popov, Dimitri, and Thiérrée, which extends to a whole host of others who never entered a circus or performance ring: Mikhail Dostoyevsky’s Mushkin (the holy Russian fool), Henry Miller’s Auguste, Salman Rushdie’s Saleem, Jacques Tati, Joan Miro, Marc Chagall, Jean Cocteau, Eric Satie’s sonic whimsy, and Pina Bausch’s choreography. In the following observation, the overlay of catastrophe and play is a crucial indication of this intricate lineage:Heiner Müller compared Pina Bausch's universe to the world of fairy tales. “History invades it like trouble, like summer flies [...] The territory is an unknown planet, an emerging island product of an ignored (forgotten or future) catastrophe [...] The whole is nothing but children's play”. (Biro 68)Bausch clearly recognises and is interested in the catastrophic moments or psychological wiring of life and her works are not exempt from comic (clownish) modulations in the play of violence and despair that often takes centre stage. In fact, Bausch probably plays on ambivalence between despair and play more explicitly than most artists. From one angle, this ambivalence is generational, as her adult performers bear the weight of oppression within the structures (and remembering of) childhood games. An artistic masterstroke in this regard is the tripling reproduction over many years of her work exploring gender negotiations at a social dance gathering: Kontakhof. Initially, the work was performed by Bausch’s regular company of mature, if diverse, dancers (Bausch 1977), then by an elderly ensemble, some of whom had appeared in the original production (Kontakhof), and, finally, by a group of adolescents in 2010. The latter version became the subject of a documentary film, Dancing Dreams (2010), which revealed the fidelity of the re-enactment, subtly transformed by the brashness and uncertainty of the teenage protagonists playing predetermined roles and moves. Viewing the three productions side-by-side reveals socialised relations of power and desire, resonant of Michel Foucault’s seminal observations (1997), and the catastrophe of gender relations subtly caught in generational change. The debility of each age group becomes apparent. None are able to engage in communication and free-play (dream) without negotiating an unyielding sexual terrain and, more often than not, the misinterpretation of one human to another within social conventions. Bausch’s affinity to the juxtaposition of childhood aspiration and adult despair places her in clown territory.Becoming “Inhuman” or SacrificialA variation on this condition of a relentless pursuit of failure is raised by Joshua Delpech-Ramey in an argument for the “inhuman” rights of clowns. His premise matches a “grotesque attachment to the world of things” to a clown’s existence that is “victimized by an excessive drive to exist in spite of all limitation. The clown is, in some sense, condemned to immortality” (133). In Delpech-Ramey’s terms:Chaplin is human not because his are the anxieties and frustrations of a man unable to realize his destiny, but because Chaplin—nearly starving, nearly homeless, a ghost in the machine—cannot not resist “the temptation to exist,” the giddiness of making something out of nothing, pancakes out of sawdust. In some sense the clown can survive every accident because s/he is an undead immortal, demiurge of a world without history. (ibid.)The play on a clown’s “undead” propensity, on his/her capacity to survive at all costs, provides a counterpoint to a tragic lens which has not been able, in human rights terms, to transcend "man’s inhumanity to man.” It might also be argued that this capacity to survive resists nature’s blindness to the plight of humankind (and visa versa). While I admire the skilful argument to place clowns as centrepieces in the formulation of alternative and possibly more potent human rights legislations, I’m not absolutely convinced that the clown condition, as I see it, provides a less mysterious and tragic state from which justice can be administered. Lear and his fool almost become interchangeable at the end of Shakespeare’s tragedy: both grapple with but cannot resolve the problem of justice.There is a little book written by Henry Miller, The Smile at the Foot of the Ladder (1948), which bears upon this aspect of a clown’s condition. In a postscript, Miller, more notorious for his sexually explicit fiction, states his belief in the unique status of clowns:Joy is like a river: it flows ceaselessly. It seems to me this is the message which the clown is trying to convey to us, that we should participate through ceaseless flow and movement, that we should not stop to reflect, compare, analyse, possess, but flow on and through, endlessly, like music. This is the gift of surrender, and the clown makes it symbolically. It is for us to make it real. (47)Miller’s fictional Auguste’s “special privilege [was] to re-enact the errors, the foibles, the stupidities, all the misunderstandings which plague human kind. To be ineptitude itself” (29). With overtones of a Christian resurrection, Auguste surrenders himself and, thereby, flows on through death, his eyes “wide open, gazing with a candour unbelievable at the thin sliver of a moon which had just become visible in the heavens” (40). It may be difficult to reconcile ineptitude with a Christ figure but those clowns who have made some sort of mark on human imagination tend to wander across territories designated as sacred and profane with a certain insouciance and privilege. They are individuals who become question marks: puzzles not meant to be solved. Maybe similar glimpses of the ineffable occur in tiny, miniscule shifts of consciousness, like the mark given to me by Dimitri and Chaplin and...—the unending list of clowns and clown conditions that have gifted their diminutive catastrophes to the problem of creativity, of rebirth after and in the face of destruction.With McKnight, I dedicate the last word to Chaplin, who speaks with final authority on the subject: “Be brave enough to face the veil and lift it, and see and know the void it hides, and stand before that void and know that within yourself is your world” (505).Thus poised, the diminutive clown figure may not carry the ferment of Shiva’s message of destruction and rebirth, he/she may not bear the strength to creatively reconstruct or re-birth normality after catastrophic devastation. But a clown, and all the humanity given to the collisions of laughter and tears, may provide an inept response to the powerlessness which, as humans, we face in catastrophe and death. Does this mean that creativity is inimical with catastrophe or that existing with catastrophe implies creativity? As noted at the beginning, these ruminations concern small “c” catastrophes. They are known otherwise as clowns.ReferencesBala, Michael. “The Clown.” Jung Journal: Culture & Psyche 4.1 (2010): 50–71.Bausch, Pina. Kontakthof. Wuppertal Dance Theatre, 1977.Big Apple Circus. Circopedia. 27 Feb. 2013 ‹http://www.circopedia.org/index.php/Main_Page›.Biro, Yvette. “Heartbreaking Fragments, Magnificent Whole: Pina Bausch’s New Minimyths.” PAJ: A Journal of Performance and Art 20.2 (1998): 68–72.Butler, Lauren. “Everything Seemed New: Clown as Embodied Critical Pedagogy.” Theatre Topics 22.1 (2012): 63–72.Coover, Robert. “Tears of a Clown.” Critique: Studies in Contemporary Fiction 42.1 (2000): 81–83.Dancing Dreams. Dirs. Anne Linsel and Rainer Hoffmann. First Run Features, 2010.Delpech-Ramey, Joshua. “Sublime Comedy: On the Inhuman Rights of Clowns.” SubStance 39.2 (2010): 131–41.Foucault, Michel. “The Ethics of the Concern for Self as Practice of Freedom.” Michel Foucault: Ethics: Subjectivity and Truth. Ed. Paul Rabinow. New York: The New Press, 1997. 281–302. Ghosh, Oroon. The Dance of Shiva and Other Tales from India. New York: New American Library, 1965.Kontakthof with Ladies and Gentlemen over ’65. Dir. Pina Bausch. Paris: L’Arche Editeur, 2007.Le Feuvre, Lisa. “Introduction.” Failure: Documents of Contemporary Art. Ed. Lisa Le Feuvre. London: Whitechapel Gallery, 2010. 12–21.McKnight, Jesse H. “Chaplin and Joyce: A Mutual Understanding of Gesture.” James Joyce Quarterly 45.3–4 (2008): 493–506.Miller, Henry. The Smile at the Foot of the Ladder. New York: New Directions Books, 1974.Raoul. Dir. James Thiérrée. Regal Theatre, Perth, 2012.Salisbury, Laura. “Beside Oneself Beckett, Comic Tremor and Solicitude.” Parallax 11.4 (2005): 81–92.Stradda. Stradda: Le Magazine de la Creation hors les Murs. 27 Feb. 2013 ‹http://www.horslesmurs.fr/-Decouvrez-le-magazine-.html›.Weitz, Eric. “Failure as Success: On Clowns and Laughing Bodies.” Performance Research: A Journal of the Performing Arts 17.1 (2012): 79–87.Werry, Margaret, and Róisín O'Gorman. “The Anatomy of Failure: An Inventory.” Performance Research: A Journal of the Performing Arts 17.1 (2012): 105–10.

The elaborate cross-media spectacle, ‘Australian Idol,’ ostensibly lays bare the process of creating a pop star. Yet with so much made visible, much is rendered opaque. Specifically, ‘Idol’ is defined by the use of carefully-tuned strategies of publicity and promotion that create, shape and reshape a series of ‘authentic celebrities’ – pop stars whose emergence is sanctified through a seemingly open process of public ratification. Yet, Idol’s main actor is the music industry itself which uses contestants as vehicles for crafting intimate, long-term relationships with consumers. Through an analysis of the process through which various contestants in ‘Australian Idol’ are promoted and sold, it becomes clear that these populist icons are emblematic of an industry reinventing itself in a media environment that presents remarkable challenges and surprising opportunities. Curiously, the debates, strategies and motivations of the public relations industry have received little sustained attention in popular music studies. While much has been written about the contradictions between the rhetoric of rebellion and the complicated realities of corporate success (Frank; Negus), less has been written about the evolution of specific kinds of publicity and the strategies that shape their use in the music industry. This is surprising given the foundational role of public relations strategies within the culture industries generally and the music industry in particular. Specifically, what Turner et. al. define as ‘the promotional culture’ is central to the production and marketing of mainstream popular music. The ‘Idol’ phenomenon offers a rich opportunity to examine how the mainstream of the popular music industry uses distinct and novel marketing strategies in the face of declining sales of compact discs, an advertising environment that is extraordinarily crowded with all manner of competing messages, a steady rate of trade in digital song files and ever more effective competition from video games and DVDs. The ‘Idol’ phenomenon has proved to be a bundle of highly successful strategies for making money from popular music. Selling CDs seems to be almost ancillary to the phenomenon, acting as only one profit centre among many. Indeed, we can track the progress and deployment of specific strategies for shaping the creation of what has become a series of musical celebrities from the start of the first series of ‘Australian Idol’ through a continuous process of strategic publicity. The Attention Economy It has been somewhat hysterically estimated that the average resident of Sydney might be presented with around 3000 commercial messages a day (Lee). It is this kind of communication environment that makes account planners go weak in the knees in both paralysing anxiety and genuine excitement. Many have taken to paying people to go to bars, cafes and clubs to talk up the relative merits of a product to complete strangers in the guise of casual conversation. Similarly, commercial buskers have recently appeared on City Trains to proclaim the virtues of the wares they’ve been contracted to hawk. One can imagine ‘Cockles and Mussels’ has been updated as ‘MP3 Players and Really Cool Footwear.’ These phenomena are variously referred to as ‘viral,’ ‘tipping point,’ ‘word of mouth’ or ‘whisper’ marketing. (Gladwell; Godin; Henry; Lee; Rosen) Regardless of what you call it, the problem inspiring these promotional chats and arias is the same: advertisers can no longer count on getting and holding our attention. As Davenport and Beck, Brody and even Nobel Prize winning economist Herbert Simon have noted, the more taxed public attention gets, the more valuable it becomes. By most industry accounts, the attention economy is an established reality. It represents a significant shift of emphasis away from traditional methods of reaching consumers, instead inspiring new thinking about how to create lasting, flexible and evolving relationships with target audiences. The attention economy is a complicated and often contradictory response to a media environment that appears less and less reliable and to consumers who behaviour is often poorly understood, even mysterious (Elliott and Jankel-Elliott). This challenging backdrop, however, is only the beginning for a seemingly beleaguered music industry. Wherever one looks, from the rise of the very real threat of global piracy to the expansion of the video game industry to mobile phones and hand held players to increasing amounts of money spent on DVDs and ring tones, selling CDs has become almost a sideline. The main event is the profitable use and reuse of the industry’s vast stores of intellectual property through all manner of media, most which didn’t exist ten years ago. Indeed, the ‘Idol’ phenomenon shows us how the music industry has been incorporating its jealously-guarded intellectual property and familiar modes of industrial self-presentation into existing media environments to build long-term relationships with consumers through television, radio, DVDs, CDs, the internet and mobile phones. Further, ‘Idol’s’ producers have supplemented more traditional models of communication by taking direct and explicit account of how and where audiences use a wide variety of media. The broad range of opportunities to participate in ‘Idol’ is central to its success. It demonstrates a willingness on the part of producers to accept the necessity of bending somewhat to the audience’s existing and evolving uses of the media. In short, they are simply not all that fussy about how participation actually happens so long as it does. Producers allow for many kinds of participation in order to constantly offer more specific and more active levels of involvement. ‘Idol’ has transformed consumer relationships within the music industry by coaxing into being ever more intimate, active and reciprocal relationships over the course of the contest by encouraging increasingly specific acts by consumers to complete a continual series of transactions. The Use and Reuse of Celebrity In many quarters, ‘Australian Idol’ has become a byword for bullshit. The competition seems rigged and the contestants are not seen as ‘real’ musicians in large part because their experience appears to be so transparent and so transparently commercial. As the mythology of the music industry has traditionally had it, deserving pop stars are established as celebrities through what is a more or less a linear progression. Early success is based on a carefully constructed sense of authentic cultural production. Credibility is established through a series of contestable affiliations to ostensibly organic music cultures, earned through artistic development and the hard slog of touring and practice (see Maxwell 118). The fraught possibilities of mainstream success continually beckon to ‘real’ musicians as they either ‘crossover’ or remain independent all the while trying to preserve some elusive measure of public honesty. As this mythology was implicitly unavailable to the producers of ‘Idol,’ a different kind of authenticity had to be constructed. Instead of a ‘battles of the bands’ (read: brands) contest, ‘Idol’ producers chose to present ‘unbranded’ aspirants (“Sydney Audition”). These hopefuls are presented as appealingly ambitious or merely optimistic individuals with varying degrees of talent. Those truly blessed, not only with talent but the drive to work it into saleable shape, would be carefully chosen from the multitude and offered an opportunity to make the most of their inherent yet unformed ability. Thus, their authenticity was assumed to be an implicit, inchoate presence, requiring the guiding hand of insiders to reach full flower. Through the facilitation of competition and direction provided in the form of knowledgeable music industry veterans who never tire of giving stern admonitions to indifferent performers who do not take full advantage of the opportunity presented to them, contestants are asked to prove themselves through an extended period of intense self-presentation and recreation. The lengthy televised, but tightly-edited auditions, complete with extensive commentary and the occasional gnashing of teeth on the part of the panel of experts and rejected contestants, demonstrate to us the earnest intent of those involved. Importantly, the authenticity of those proceeding through the contest is never firmly established, but has to be continually and strategically re-established. Each weighty choice of repertoire, wardrobe and performance style can only break them; each successful performance only raises the stakes. This tense maintenance of status as a deserving celebrity runs in tandem with the increasingly attentive and reciprocal relationship between the producers and the audience. The relationship begins with what has proved to be a compelling first act. Thousands of ‘ordinary’ Australians line up outside venues throughout the country, many sleeping in car parks and on footpaths, practising, singing and performing for the mobile camera crews. We are presented with their youthful vigour in all its varied guises. We cannot help but be convinced of the worth of those who survive such a process. The chosen few who are told with a flourish ‘You’re going to Sydney’ are then faced with what appears to be a daunting challenge, to establish themselves in short order as a performer with ‘the X factor’ (“Australian Idol” 14 July 2004). A fine voice and interesting look must be supplemented with those intangible qualities that result in wide public appeal. Yet these qualities are only made available to the public and the performer because of the contest itself. When the public is eventually asked to participate directly, it is to both produce and ratify exactly these ambiguous attributes. More than this, contestants need our help just to survive. Their celebrity is almost shockingly unstable, more fleeting than its surrounding rhetoric and context might suggest and under constant, expected threat. From round to round, favourites can easily become also rans–wild cards who limp out of one round, but storm through the next. The drama can only be heightened, securing our interest by requiring our input. As any advertiser can tell you, an effective campaign must end in action on our part. Through text message and phone voting as well as extensive ‘fan management’ through internet chat rooms and bulletin boards (see Stahl 228; http://au.messages.yahoo.com/australianidol/), our channelled ‘viral’ participation both shapes and completes the meanings of the contest. These active and often inventive relationships (http://au.australianidol.yahoo.com/fancentral/) allow the eventual ‘Idol’ to claim the credibility the means of their success otherwise renders suspect and these activities appear to consummate the relationship. However, the relationship continues well beyond the gala final. In a fascinating re-narration of the first series of ‘Australian Idol,’ Australian Idol: The Winner’s Story aired on the Friday following the final night of the contest. The story of the newly crowned Idol, Guy Sebastian, was presented in an hour long program that showed his home life, his life as a voice teacher in the Adelaide suburbs and his subsequent journey to stardom. The clips depicting his life prior to ‘Idol’ were of ambiguous vintage, cleverly silent on the exact date of production; somehow they were not quite in the past or the future, but floated in some eternal in-between. When his ‘Australian Idol’ experience was chronicled, after the second commercial break, we were allowed to see an intimate portrait of an anxious contestant transformed into ‘Your Australian Idol.’ There could be no doubt of the virtue of Sebastian’s struggles, nor of his well-earned victory. ‘New’ footage began with the sudden sensation reluctantly commenting on other contestants at the original Adelaide cattle call at the prompting of the mobile camera crew and ended with his teary-eyed mother exultant at the final decision as she stood in the front row at the Opera House. Further, not only is the entire run of the first series dramatically recounted in documentary format on the Australian Idol: Greatest Moments DVD, framed by Sebastian’s humble triumph, so are the stories of each member of the Final 12 and the paths they took through the contest. These reiterations serve to reinforce not only Sebastian’s status, but the status of the program itself. They confirm the benevolent success of the industry it so dutifully profiles. We are taken behind the curtain, allowed to see the machinery of stardom grind inevitably to a conclusion, knowing we will be allowed back again when the time is right. Whereas ‘Idol’ is routinely pilloried for its crass commercialism, it remains an unavoidable success. Viewers keep tuning in, advertisers still clamour to sponsor all aspects of the production and the CDs keep selling. Most importantly, the music industry has a showcase for its own operations. The structures of feeling it exists to produce take on a kind of subtle explicitness that ensures their perpetuation. Within an industry faced with threats perceived to be foundational, the creators of ‘Idol’ have produced an audacious and arrogant spectacle. They have made a profitable virtue out of an economic necessity. The expensive and unpredictable process of finding and nurturing new talent has not only been made more reliable, but ‘Idol’ has shown that it can actually turn a profit. The brand of celebrity produced by Idol possesses no mere sheen of populist approval, but embodies that more valuable commodity: popular attention, however reluctant or enthusiastic it may be. References “Australian Idol.” Ten Network, Sydney, 14 July 2004. “Australian Idol: The Winner’s Story.” Ten Network, Sydney, 21 November 2003. Australian Idol: Greatest Moments. Fremantle Media Operations, 2004. Brody, E.W. “The ‘Attention’ Economy.” Public Relations Quarterly 46.3 (2001): 18-21. Davenport, T., and J. Beck. “The Strategy and Structure of Firms in the Attention Economy.” Ivey Business Journal 66.4 (2002): 49–55. Elliott, R., and N. Jankel-Elliott. “Using Ethnography in Strategic Consumer Research.” Qualitative Market Research 6.4 (2003): 215-23. Frank, Thomas. The Conquest of Cool: Business Culture, Counterculture, and the Rise of Hip Consumerism. Chicago: U of Chicago P, 1997. Gladwell, Malcolm. The Tipping Point: How Little Things Can Make a Big Difference. Boston: Back Bay Books, 2002. Godin, Seth. Unleashing the Ideavirus. New York: Hyperion, 2001. Henry, Amy. “How Buzz Marketing Works for Teens.” Advertising and Marketing to Children April-June (2003): 3-10. Lee, Julian. “Stealth Marketers Ready to Railroad the Unsuspecting.” Sydney Morning Herald 24-5 July 2004: 3. Maxwell, Ian. “True to the Music: Authenticity, Articulation and Authorship in Sydney Hip-Hop Culture.” Social Semiotics 4.1-2 (1994): 117–37. Negus, Keith. Music Genres and Corporate Cultures. London: Routledge, 1999. Negus, Keith. Producing Pop: Culture and Conflict in the Popular Music Industry. London: Edward Arnold, 1992. Rosen, Emanuel. The Anatomy of Buzz: How to Create Word of Mouth Marketing. London: Harper Collins, 2000. Stahl, Matthew. “A Moment like This: American Idol and Narratives of Meritocracy.” Bad Music: Music We Love to Hate. Eds. C. Washburne and M. Derno. New York: Routledge, 2004. 212–32. “Sydney Auditions: Conditions of Participation in the Australian Idol Audition.” Australian Idol Website 10 June 2004. http://au.australianidol.com.au>. Turner, G., F. Bonner, and P.D. Marshall. Fame Games: The Production of Celebrity in Australia. Cambridge: Cambridge UP, 2000. Citation reference for this article MLA Style Fairchild, Charles. "'Australian Idol' and the Attention Economy." M/C Journal 7.5 (2004). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0411/09-fairchild.php>. APA Style Fairchild, C. (Nov. 2004) "'Australian Idol' and the Attention Economy," M/C Journal, 7(5). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0411/09-fairchild.php>.

This essay originates out of our shared interest in genres and media forms used for identity practices that do not cohere into a narrative or a fixed representation of who someone is. It takes the current heightened visibility of drag as a mode of performance that explicitly engages with identity as a product materialized—but not completed—by the ongoing process of performance. We consider the new drag, which we define below, as a form of playing with identity that combines bodily practices (comportment and use of voice) and adornment (make-up, clothing, wigs, and accessories) with an array of media (photography, live performance, social media and television). Given the limited space available, we will not be engaging with the propositions made during earlier feminist and queer thinking that drag is not inherently subversive and may reinscribe gender and race norms through their hyperbolic recitation (Butler 230-37; hooks 145-56). While we think there is much to be gained from revisiting these critiques in light of the changes in conceptualisations of gender in queer subcultures, we are not interested in framing drag as subversive or resistant in relation to the norms of masculinity and femininity. Instead, we follow Eve Sedgwick’s interest in reparative practices adopted by queer-identified subjects who must learn to survive in a hostile culture (“Paranoid”) and trace two lines of analysis we identify in drag’s new found visibility that demonstrate the reparative potential of automedia.At time of writing, RuPaul’s Drag Race (RPDR) has truly hit the big time. Pop icon Christina Aguilera was a guest judge for the first episode of its tenth season (Daw “Christina”), and the latest episode of RuPaul’s All-Stars season three spin-off show was the most-watched of any show in its network’s history (Crowley). RuPaul Charles, the producer and star of RPDR, has just been honoured with a star on the Hollywood Walk of Fame, decades after he began his career as a drag performer (Daw “RuPaul”). Drag queens are finally becoming part of American mainstream media and drag as an art form and a cultural practice is on its way to becoming part of discourse about gender and identity around the world, via powerful systems of digital mediation and distribution. RPDR’s success is a good way to think about how drag, a long-standing performance art form, is having a “break out” moment in popular culture. We argue here that RPDR is doing this within an automedia framework.What does automedia mean in the context of drag on television and social media? We understand automedia to be about the mediation of identity when identity is both a product of representation and a process that is continually becoming, expressed in the double meaning of the word “life” as biography and as process (Poletti “Queer Collages” 362; Poletti and Rak 6-7). In this essay we build on our shared interest in developing a critical mode that can respond to forms of automedia that explore “the possibility of identity in the absence of narration” (Rak 172). What might artists who work with predominantly non-narrative forms such as drag performance show us about the ongoing interconnection between technologies and subjectivities as they represent and think through what “life” looks like, on stage and off?Automedia names life as a process and a product that has the potential to queer temporality and normative forms of identification, what Jack Halberstam has called “queer time” (1). We understand Halberstam’s evocation of queer time as suitable for being thought through automedia because of their characterisation of queer as “a form of self-description in the past decade or so … [that] has the potential to open up new life narratives and alternative relations to time and space” (2). Queer time, Halberstam explains, comes from the collapse of the past and shaky relation to futurity gay men experienced during the height of the American AIDs crisis, but they also see queer time, significantly, as exceeding the terms of its arrival. Queer time could be about the “potentiality of a life unscripted by the conventions of family, inheritance, and child rearing” (2). Queer time, then, evokes the possibility of making a life narrative that does not have to follow a straight line or stay “on script,” and does not have to feature conventional milestones or touchstones in its unfolding. If queer time can be thought alongside automedia, within drag performances that are not about straight lives, narrative histories and straight time can come into view.Much has been written about drag as a performance that creates a public, for example, as part of a queer world-building project that shoots unpredictably through spaces beyond performance locations (Berlant and Warner 558). Halberstam’s shift to thinking of queer time as an opening of new life narratives and a different relation to time has similar potential when considering the work of RPDR as automedia, because the shift of drag performance away from clubs, parades and other queer spaces to television and the internet is accompanied by a concern, manifested in the work of RuPaul himself, with drag history and the management of drag memory. We argue that a concern with the relationship between time and identity in RPDR is an attempt to open up, through digital networked media, a queer understanding of time that is in relation to drag of the past, but not always in a linear way. The performances of season nine winner Sasha Velour, and Velour’s own preoccupation with drag history in her performances and art projects, is an indicator of the importance of connecting the twin senses of “life” as process and product found in automedia to performance and narration.The current visibility of drag in popular culture is characterised by a shifting relationship between drag and media: what was once a location-based, temporally specific form of performance which occurred in bars, has been radically changed through the increased contact between the media forms of performance, television and social media. While local drag queens are often the celebrities (or “superstars”) of their local subcultural scene, reality television (in the form of RPDR) and social media (particularly Instagram) have radically increased the visibility of some drag queens, turning them into international celebrities with hundreds of thousands of fans. These queens now speak to audiences far beyond their local communities, and to audiences who may not have any knowledge of the queer subcultures that have nurtured generations of drag performers. Under the auspices of RPDR, drag queens have gained a level of cultural visibility that produces fascinating, and complex, encounters between subcultural identity practices and mainstream media tropes. Amongst her many tasks—being fierce, flawless, hilarious, and able to turn out a consummate lip sync performance—the newly visible drag queen is also a teacher. Enacting RuPaul’s theory of identity from his song title—“We’re all born naked and the rest is drag” (“Born”)—drag queens who in some way embody or make use of RuPaul’s ideas have the potential to advance a queer perspective on identity as a process in keeping with Judith Butler’s influential theory of identity performativity (Butler 7-16). In so doing they can provide fresh insights into the social function of media platforms and their genres in the context of queer lives. They are what we call “new” drag queens, because of their access to technology and digital forms of image distribution. They can refer to classic drag queen performance culture, and they make use of classic drag performance as a genre, but their transnational media presence and access to more recent forms of identification to describe themselves, such as trans, genderqueer or nonbinary, mark their identity presentations and performance presences as a departure from other forms of drag.While there is clearly a lot to be said about drag’s “break out,” in this essay we focus on two elements of the “new media” drag that we think speak directly, and productively, to the larger question of how cultural critics can understand the connection between identity and mediation as mutually emergent phenomena. As a particularly striking practitioner of automediality, the new drag queen draws our attention to the way that drag performance is an automedial practice that creates “queer time” (Halberstam), making use of the changing status of camp as a practice for constructing, and mediating identity. In what follows we examine the statements about drag and the autobiographical statements presented by RuPaul Charles and Sasha Velour (the winner of RPDR Season Nine) to demonstrate automediality as a powerful practice for queer world-making and living.No One Ever Wins Snatch Game: RuPaul and TimeAs we have observed at the opening of this essay, queer time is an oppositional practice, a refusal of those who belong to queer communities to fall into step with straight ideas about history, futurity, reproduction and the heteronormative idea of family, and a way to understand how communities mark occasions, conceptualize the history and traditions of subcultures. Queer time has the potential to rethink daily living and history differently and to tell accounts of lives in a different way, to “open up new life narratives,” as Halberstam says (2). RuPaul Charles’s own life story could be understood as a way to open up new life narratives literally by constructing what a queer life and career could mean in the aftermath of the AIDS epidemic in the United States. His 1995 memoir, Lettin It All Hang Out, details RuPaul’s early career in 1980s Atlanta, Georgia and in New York as an often-difficult search for what would make him a star. RuPaul did not at first conceptualize himself as a drag star, but as a punk musician in Atlanta and then as part of the New York Club Kid community, which developed when New York clubs were in danger of closing because of fear of the AIDS epidemic (Flynn). RuPaul became adept at self-promotion and image-building while he was part of these rebellious punk and dance club subcultures that refused gender and lifestyle norms (Lettin 62-5). It might seem to be an unusual beginning for a drag star, but as RuPaul writes, “I always knew I was going to be star [but] I never thought it was going to be as a drag queen” (Lettin 64). There was no narrative of mainstream success that RuPaul—a gay, gender non-binary African-American man from the American Midwest—could follow.Since he was a drag performer too, RuPaul eventually “had an epiphany. Why couldn’t I [he] become a mainstream pop star in drag? Who said it couldn’t be done?” (Workin’ It 159). And he decided that rather than look for a model of success to follow, he would queer the mainstream model for success. As he observes, “I looked around at my favorite stars and realized that they were drag queens too. In fact every celebrity is a drag queen” (Lettin 129). Proceeding from the idea that all people are in fact drag artists—the source of RuPaul’s aformentioned catch-phrase and song title “We’re all born naked and the rest is drag” (“Born”), RuPaul moved the show business trajectory into queer time, making the “formula” for success the labour required of drag queens to create personae, entertain, promote themselves and make a successful living (and a life) in dangerous work environments—a process presented in his song “Supermodel” and its widely-cited lyric “You better work!” (“Supermodel”). The video for “Supermodel” shows RuPaul in his persona as Supermodel of the World, “working” as a performer and a member of the public in New York to underscore the different kinds of labour that is involved, and that this labour is necessary for anyone to become successful (“Supermodel” video).When RuPaul’s Drag Race began in 2010, RuPaul modelled the challenges in the show on his own career in an instance of automedia, where the non-narrative aspects of drag performance and contest challenges were connected to the performance of RuPaul’s own story. According to one of RuPaul’s friends who produces the show: “The first season, all the challenges were ‘Ru did this, so you did this.’ It was Ru’s philosophy” (Snetiker). As someone who was without models for success, RuPaul intends for RPDR to provide a model for others to follow. The goal of the show is the replication of RuPaul’s own career trajectory: the winners of RPDR are each crowned “America’s Next Drag Superstar,” because they have successfully learned from RuPaul’s own experiences so that they too can develop their careers as drag artists. This pattern has persisted on RPDR, where the contestants are often asked to participate in challenges that reflect RuPaul’s own struggles to become a star as a way to “train” them to develop their careers. Contestants have, like RuPaul himself, starred in low-budget films, played in a punk band, marketed their own perfume, commemorated the work of the New York Club Kids, and even planned the design and marketing of their own memoirs.RPDR contestants are also expected to know popular culture of the past and present, and they are judged on how well they understand their own “herstory” of the drag communities and queer culture. Snatch Game, a popular segment where contestants have to impersonate celebrities on a queer version of the Match Game series, is a double test. To succeed, contestants must understand how to impersonate celebrities past and present within a camp aesthetic. But the segment also tests how well drag queens understand the genre of game show television, a genre that no longer exists on television (except in the form of Wheel of Fortune or Jeopardy), and that many of the RPDR contestants are not old enough to have seen, performing witty taglines and off-the-cuff jokes they hope will land in a very tight time frame. Sasha Velour, the winner of season nine, won praise for her work in the Snatch Game segment in episode six because, acting on advice from RuPaul, she played Marlene Dietrich and not her first choice, queer theorist Judith Butler (RuPaul’s). Sasha Velour was able to make Dietrich, a queer icon known for her film work in the 1920-1940s, humorous in the game show context, showing that she understands queer history, and that she is a skilful impersonator who understands how to navigate a genre that is part of RuPaul’s own life story. The queer time of RuPaul’s narrative is transmitted to a skill set future drag stars need to use: a narrative of a life becomes part of performance. RPDR is, in this sense, automedia in action as queens make their personae “live,” perform part of RuPaul’s “life” story, and get to “live” on the show for another week if they are successful. The point of Snatch Game is how well a queen can perform, how good she is at entertaining and educating audiences, and how well she deals with an archaic genre, that of the television game show. No one ever “wins” Snatch Game because that is not the point of it. But those who win the Snatch Game challenge often go on to win RPDR, because they have demonstrated improvisational skill, comic timing, knowledge of RuPaul’s own life narrative touchstones and entertained the audience.Performative Agency: The Drag Performance as Resource for Queer LivingVelour’s embodied performance in the Snatch Game of the love and knowledge of popular culture associated with camp, and its importance to the art of drag, highlights the multifaceted use of media as a resource for identity practices that characterizes drag as a form of automedia. Crucially, it exemplifies the complex way that media forms are heavily cited and replayed in new combinations in order to say something real about the ways of living of a specific artist or person. Sasha Velour’s impersonation of Dietrich is not one in which Velour’s persona disappears: indeed, she is highly commended by RuPaul, and fans, because her embodiment of Dietrich in the anachronous media environment of the Snatch Game works to further Velour’s unique persona and skill as a drag artist. Velour queers time with her Dietrich in order to demonstrate her unique sensibility and identity. Thus, reality TV, silent film, cabaret, improvisation and visual presentation are brought together in an embodied performance that advances Velour’s specific form of drag and is taken as a strong marker of who Sasha Velour is.But what exactly is Sasha Velour doing when she clarifies her identity by dressing as Marlene Dietrich and improvises the diva’s answers to questions on a game show? This element of drag is clearly connected to the aesthetics of camp that have a long tradition in gay and queer culture. Original theories of camp theorized it as a practice of taste and interpretation (Sontag)—camp described a relationship to the objects of popular culture that was subversive because it celebrated the artificiality of aesthetic forms, and was therefore ironizing. However, this understanding of camp does not adequately describe its role in postmodern culture or how some queer subcultures cultivate the use media forms for identity practices (O’Neill 21). In her re-casting of camp, Eve Kosofsky Sedgwick argues:we need to [think of camp] not in terms of parody or even wit, but with more of an eye of its visceral, operatic power: the startling outcrops of overinvested erudition; the prodigal production of alternative histories; the ‘over’-attachment to fragmentary, marginal, waste, lost, or leftover cultural products; the richness of affective variety; and the irrepressible, cathartic fascination with ventriloquist forms of relation. (Sedgwick The Weather 66)This reframing of camp emphasises affect, attachment and forms of relation as ongoing processes for the making of queer life (a process), rather than as elements of queer identity (a product). For Sedgwick camp is a practice or process that mediates queerness in the context of a hostile mainstream media culture that does not connect queer ways of living with flourishing or positive outcomes (Sedgwick “Paranoid Reading” 28). In O’Neill’s account, camp does not involve attachment to the diva as a fixed identity whose characteristics can be adopted in irony or impersonation in which the individual disappears (16). Rather, it is the diva’s labour—her way of marshalling her talent to produce compelling performances, which come to be the hallmark of her career and identity—that is the site of queer identification. What RuPaul wittily refers to as a drag queen’s “charisma, uniqueness, nerve and talent” (the acronym is important), O’Neill refers to as the diva’s “performative agency”—the primary “power to perform” (16, emphasis in original). This is the positive power of camp as form of automediation for queer world making: media forms provide resources that queer subjects can draw on in assembling a performance of identity as modes of embodiment and ways of being that can be cited (the specific posture of Dietrich, for example, which Velour mimics) and in terms of the affect required to marshal the performance itself.When she was crowned the winner of season nine of RPDR, Sasha Velour emphasised the drag queen’s performative agency itself as a resource for queer identity practices. After being announced the winner, Velour said: “Let’s change shit up. Let’s get all inspired by all this beauty, all this beauty, and change the motherfucking world” (Queentheban). This narrative of the world-changing power of the beauty of drag refers to the visibility of the new drag queens, who through television and social media now have thousands of fans across the world. Yet, this narrative of the collective potential of drag is accompanied by Velour presenting her own autobiographical narrative that posits drag as an automedial practice whose “richness of affective variety” has been central to her coming to terms with the death of her mother from cancer. In interviews and in her magazine about drag (Velour: The Drag Magazine) Velour narrates the evolution of her drag and her identity as a “bald queen” whose signature look includes a clean-shaven head which is often unadorned or revealed in her performances as directly linked to her mother’s baldness brought on by treatment for cancer (WBUR).In an autobiographical photo-essay titled “Gone” published in Velour, Velour poses in a series of eight photographs which are accompanied by handwritten text reflecting on the role of drag in Velour’s grieving for her mother. In the introduction, the viewer is told that the “books and clothes” used in the photos belonged to Velour’s mother, Jane. The penultimate image shows Velour lying on grass in drag without a wig, looking up at the camera and is accompanied by nineteen statements elucidating what drag is, all of which are in keeping with Sedgwick’s reframing of camp practices as reparative strategies for queer lives: “Drag is for danger / Drag is for safety / Drag is for remembering / Drag is for recovering.” Affect, catharsis, and operatic power are narrated and visually rendered in the photo-essay, presenting drag as a highly personal form of automediation for Velour. The twentieth line defining drag appears on the final page, accompanied by a photograph of Velour from behind, her arms thrown back and tensile: “Drag is for dressing up / And this is my mother’s dress.”Taken together, Velour’s generic and highly personal descriptions of drag as a process and product that empowers individual and collective queer lives define drag as a form of automedia in which identity and living are a constant process of creativity and invention “where ideas about the self and what it means to live are tested, played with, rejected, and embraced” (Rak 177).Velour’s public statements and autobiographical works foreground how the power, investment, richness and catharsis encapsulated in drag performance offers an important antidote to the hostility to queer ways of being embodied by an assimilationist gay politics. In a recent interview, Velour commented on the increased visibility of her drag beyond her localised performances in “dive bars” in New York:When Drag Race came on television I feel like the gay community in general was focussed on […] dare I say, a kind of assimilation politics, showing straight people and the world at large that we are just like everyone else and I think drag offered a radical different saying [sic] and reminded people that there’s been this grand tradition of queer people and gay people saying ‘actually we’re fabulously different and this is why.’ (PopBuzz)Velour suggests that in its newly visible forms outside localised queer cultures, drag as a media spectacle offers an important alternative to the pressure for queer people to assimilate to dominant forms of living, those practices, forms of attachment and relation Halberstam associates with straight time.ConclusionThe queer time and performative agency enacted in drag provides a compelling example of non-narrative forms of identity work in which identity is continuously emerging through labour, innovation, and creativity (or—in RuPaul’s formulation—charisma, uniqueness, nerve and talent). This creativity draws on popular culture as a resource and site of history for queer identities, an evocation of queer time. The queer time of drag as a performance genre has an increasing presence in media forms such as television, social media and print media, bringing autobiographical performances and narratives by drag artists into new venues. This multiple remediation of drag recasts queer cultural practices beyond localised subcultural contexts into the broader media cultures in order to amplify and celebrate queerness as a form of difference, and differing, as automediality.ReferencesBerlant, Lauren, and Michael Warner. “Sex in Public.” Critical Inquiry 24.2 (Winter 1998): 547-566.Butler, Judith. Bodies That Matter: On the Discursive Limits of Sex. New York and London: Routledge, 1993.Crowley, Patrick. “‘RuPaul’s Drag Race’ Sets New Franchise Ratings Records.” Billboard. 2 Mar. 2018 <https://www.billboard.com/articles/news/pride/8225839/rupauls-drag-race-sets-franchise-ratings-records>.Daw, Stephen. “Christina Aguilera Will Be First Guest Judge of ‘RuPaul's Drag Race’ Season 10.” Billboard. 1 Mar. 2018 <https://www.billboard.com/articles/news/pride/8223806/christina-aguilera-rupauls-drag-race-season-10>.———. “RuPaul to Receive a Star on the Hollywood Walk of Fame.” Billboard. 1 Mar. 2018 <https://www.billboard.com/articles/news/pride/8223677/rupaul-hollywood-walk-of-fame-star>.Flynn, Sheila. “Where Are New York’s Club Kids of the 80s and 90s Now?” Daily Mail. 4 Sep. 2017 <http://www.dailymail.co.uk/news/article-4851054/Where-New-York-s-Club-Kids-80s-90s-now.html>.Halberstam, J. Jack. “Queer Temporality and Postmodern Geographies.” In a Queer Time and Place. New York: NYU P, 2005. 1-21.hooks, bell. “Is Paris Burning?” Black Looks: Race and Representation. Boston: South End, 1992.O’Neill, Edward. “The M-m-mama of Us All: Divas and the Cultural Logic of Late Ca(m)pitalism.” Camera Obscura 65.22 (2007): 11–37. Poletti, Anna, and Julie Rak, eds. “Introduction: Digital Dialogues.” Identity Technologies: Constructing the Self Online. Madison, WI: U of Wisconsin P, 2014. 1-25.Poletti, Anna. “Periperformative Life Narrative: Queer Collages.” GLQ: A Journal of Lesbian and Gay Studies 22.3 (2016): 359-379.PopBuzz. “Sasha Velour Talks All Stars 3, Riverdale and Life after Winning RuPaul’s Drag Race.” 16 Feb. 2018 <https://youtu.be/xyl5PIRZ_Hw>.Queentheban. “Sasha Velour vs Peppermint | ‘It's Not Right But It's Okay’ & Winner Announcement.” 23 Jun. 2017 <https://youtu.be/8RqTzzcOLq4>.Rak, Julie. “Life Writing versus Automedia: The Sims 3 Game as a Life Lab.” Biography: An Interdisciplinary Quarterly 38.2 (Spring 2015): 155-180.RuPaul. “Born Naked.” Born Naked. RuCo, Inc., 2014.———. Lettin It All Hang Out: An Autobiography. New York: Hyperion Books, 1999.———. “Supermodel (You Better Work).” Supermodel of the World. Tommy Boy, 1993.———. “Supermodel (You Better Work).” Dir. Randy Barbato. MTV, 1993. <https://www.youtube.com/watch?v=Vw9LOrHU8JI>.———. Workin’ It!: RuPaul's Guide to Life, Liberty, and the Pursuit of Style. New York: HarperCollins, 2010.RuPaul’s Drag Race. RuPaul. World of Wonder Productions. Season 9, 2017.Sedgwick, Eve Kosofsky. The Weather in Proust. Durham and London: Duke UP, 2011.———. “Paranoid Reading and Reparative Reading; Or, You’re So Paranoid, You Probably Think This Introduction Is about You.” Novel Gazing: Queer Readings in Fiction. Ed. Eve Kosofsky Sedgwick. Durham: Duke UP, 1997. 1-37.Sontag, Susan. “Notes on ‘Camp’.” Camp: Queer Aesthetics and the Performing Subject: A Reader. Ed. Fabio Cleto. Edinburgh: Edinburgh UP, 1991. 53-65.Snetiker, Mark. “The Oral History of RuPaul.” Entertainment Weekly (2016). <http://rupaul.ew.com/>.WBUR. “Sasha Velour on Why Drag Is a ‘Political and Historical Art Form’.” 24 July 2017. <http://www.wbur.org/hereandnow/2017/07/24/sasha-velour>.Velour, Sasha. “Gone (with Daphne Chan).” sashavelour.com. <http://sashavelour.com/work/#/daphnechan/>.

The first uncomfortable twinges started when I was a grad student, churning out my Master’s thesis on a laptop that I worked on at the library, in my bedroom, on the kitchen table, and at the coffee shop. By the last few months, typing was becoming uncomfortable for my arms, but as any thesis writer will tell you, your whole body is uncomfortable with the endless hours sitting, inputting, and revising. I didn’t think much of it until I moved on to a new city to start a PhD program. Now the burning that accompanied my essay-typing binges started to worry me more, especially since I noticed the twinges didn’t go away when I got up to chat with my roommate, or to go to bed. I finally mentioned the annoying arm to Sonja, a medical student friend of mine visiting me one afternoon. She asked me to pick up a chair in front of me, palms out. I did, and the attempt stabbed pain up my arm and through my elbow joint. The chair fell out of my hands. We looked at each other, eyebrows raised.Six months and much computer work later, I still hadn’t really addressed the issue. Who had time? Chasing mystery ailments around and more importantly, doing any less typing were not high on my likely list. But like the proverbial frog in slowly heated water, things had gotten much worse without my really acknowledging it. That is, until the day I got up from my laptop, stretched out and wandered into the kitchen to put some pasta on to boil. When the spaghetti was ready, I grabbed the pot to drain it and my right arm gave as if someone had just handed me a 200-pound weight. The pot, pasta and boiling water hit the floor with a scalding splash that nearly missed both me and the fleeing cat. Maybe there was a problem here.Both popular and critical understandings of the body have been in a great deal of flux over the past three or four decades as digital media technologies have become ever more pervasive and personal. Interfacing with the popular Internet, video games, mobile devices, wearable computing, and other new media technologies have prompted many to reflect on and reconsider what it means to be an embodied human being in an increasingly digitally determined era. As a result, the body, at various times in this recent history, has been theoretically disowned, disavowed, discarded, disdained, replaced, idealised, essentialised, hollowed out, re-occupied, dismembered, reconstituted, reclaimed and re-imagined in light of new media. Despite all of the angst over the relationships our embodied selves have had to digital media, of course, our embodied selves have endured. It remains true, that “even in the age of technosocial subjects, life is lived through bodies” (Stone 113).How we understand our embodiments and their entanglements with technologies matter deeply, moreover, for these understandings shape not only discourse around embodiment and media, but also the very bodies and media in question in very real ways. For example, a long-held tenet in both popular culture and academic work has been the notion that media technologies extend our bodies and our senses as technological prostheses. The idea here is that media technologies work like prostheses that extend the reach of our eyes, ears, voice, touch, and other bodily abilities through time and space, augmenting our abilities to experience and influence the world.Canadian media scholar Marshall McLuhan is one influential proponent of this notion, and claimed that, in fact, “the central purpose of all my work is to convey this message, that by understanding media as they extend man, we gain a measure of control over them” (McLuhan and Zingrone 265). Other more contemporary media scholars reflect on how “our prosthetic technological extensions enable us to amplify and extend ourselves in ways that profoundly affect the nature and scale of human communication” (Cleland 75), and suggest that a media technology such as one’s mobile device, can act “as a prosthesis that supports the individual in their interactions with the world” (Glitsos 161). Popular and commercial discourses also frequently make use of this idea, from the 1980’s AT&T ad campaign that nudged you to “Reach out and Touch Someone” via the telephone, to Texas Instruments’s claim in the 1990’s that their products were “Extending Your Reach”, to Nikon’s contemporary nudge to “See Much Further” with the prosthetic assistance of their cameras. The etymology of the term “prosthesis” reveals that the term evolves from Greek and Latin components that mean, roughly, “to add to”. The word was originally employed in the 16th century in a grammatical context to indicate “the addition of a letter or syllable to the beginning of a word”, and was adopted to describe “the replacement of defective or absent parts of the body by artificial substitutes” in the 1700’s. More recently the world “prosthesis” has come to be used to indicate more simply, “an artificial replacement for a part of the body” (OED Online). As we see in the use of the term over the past few decades, the meaning of the word continues to shift and is now often used to describe technological additions that don’t necessarily replace parts of the body, but augment and extend embodied capabilities in various ways. Technology as prosthesis is “a trope that has flourished in a recent and varied literature concerned with interrogating human-technology interfaces” (Jain 32), and now goes far beyond signifying the replacement of missing components. Although the prosthesis has “become somewhat of an all-purpose metaphor for interactions of body and technology” (Sun 16) and “a tempting theoretical gadget” (Jain 49), I contend that this metaphor is not often used particularly faithfully. Instead of invoking anything akin to the complex lived corporeal experiences and conundrums of prosthetic users, what we often get when it comes to metaphors of technology-as-prostheses is a fascination with the potential of technologies in seamlessly extending our bodies. This necessitates a fantasy version of both the body and its prostheses as interchangeable or extendable appendages to be unproblematically plugged and unplugged, modifying our capabilities and perceptions to our varying whims.Of course, a body seamlessly and infinitely extended by technological prostheses is really no body. This model forgoes actual lived bodies for a shiny but hollow amalgamation based on what I have termed the “disembodimyth” enabled by technological transcendence. By imagining our bodies as assemblages of optional appendages, it is not far of a leap to imagine opting out of our bodies altogether and using technological means to unfasten our consciousness from our corporeal parts. Alison Muri points out that this myth of imminent emancipation from our bodies via unity with technology is a view that has become “increasingly prominent in popular media and cultural studies” (74), despite or perhaps because of the fact that, due to global overpopulation and wasteful human environmental practices, “the human body has never before been so present, or so materially manifest at any time in the history of humanity”, rendering “contradictory, if not absurd, the extravagantly metaphorical claims over the past two decades of the human body’s disappearance or obsolescence due to technology” (75-76). In other words, it becomes increasingly difficult to speak seriously about the body being erased or escaped via technological prosthetics when those prosthetics, and our bodies themselves, continue to proliferate and contribute to the piling up of waste and pollution in the current Anthropocene. But whether they imply smooth couplings with alluring technologies, or uncoupling from the body altogether, these technology-as-prosthesis metaphors tell us very little about “prosthetic realities” (Sun 24). Actual prosthetic realities involve learning curves; pain, frustrations and triumphs; hard-earned remappings of mental models; and much experimentation and adaption on the part of both technology and user in order to function. In this vein, Vivian Sobchak has detailed the complex sensations and phenomenological effects that followed the amputation of her leg high above the knee, including the shifting presence of her “phantom limb” perceptions, the alignments, irritations, movements, and stabilities offered by her prosthetic leg, and her shifting senses of bodily integrity and body-image over time. An oversimplistic application of the prosthetic metaphor for our encounters with technology runs the risk of forgetting this wealth of experiences and instructive first-hand accounts from people who have been using therapeutic prosthetics as long as assistive devices have been conceived of, built, and used. Of course, prosthetics have long been employed not simply to aid function and mobility, but also to restore and prop up concepts of what a “whole,” “normal” body looks like, moves like, and includes as essential components. Prosthetics are employed, in many cases, to allow the user to “pass” as able-bodied in rendering their own technological presence invisible, in service of restoring an ableist notion of embodied normality. Scholars of Critical Disability Studies have pushed back against these ableist notions, in service of recognising the capacities of “the disabled body when it is understood not as a less than perfect form of the normative standard, but as figuring difference in a nonbinary sense” (Shildrick 14). Paralympian, actress, and model Aimee Mullins has lent her voice to this cause, publicly contesting the prioritisation of realistic, unobtrusive form in prosthetic design. In a TED talk entitled It’s Not Fair Having 12 Pairs of Legs, she showcases her collection of prosthetics, including “cheetah legs” designed for optimal running speed, transparent glass-like legs, ornately carved wooden legs, Barbie doll-inspired legs customised with high heel shoes, and beautiful, impractical jellyfish legs. In illustrating the functional, fashionable, and fantastical possibilities, she challenges prosthetic designers to embrace more poetry and whimsy, while urging us all to move “away from the need to replicate human-ness as the only aesthetic ideal” (Mullins). In this same light, Sarah S. Jain asks “how do body-prosthesis relays transform individual bodies as well as entire social notions about what a properly functioning physical body might be?” (39). In her exploration of how prostheses can be simultaneously wounding and enabling, Jain recounts Sigmund Freud’s struggle with his own palate replacement following surgery for throat cancer in 1923. His prosthesis allowed him to regain the ability to speak and eat, but also caused him significant pain. Nevertheless, his artificial palate had to be worn, or the tissue would shrink and necessitate additional painful procedures (Jain 31). Despite this fraught experience, Freud himself espoused the trope of technologically enhanced transcendence, pronouncing “Man has, as it were, become a prosthetic god. When he puts on all his auxiliary organs, he is truly magnificent.” However, he did add a qualification, perhaps reflective of his own experiences, by next noting, “but those organs have not grown on him and they still give him much trouble at times” (qtd. in Jain 31). This trouble is, I argue, important to remember and reclaim. It is also no less present in our interactions with our media prostheses. Many of our technological encounters with media come with unacknowledged discomforts, adjustments, lag, strain, ill-fitting defaults, and fatigue. From carpal tunnel syndrome to virtual reality vertigo, our interactions with media technologies are often marked by pain and “much trouble” in Freud’s sense. Computer Science and Cultural Studies scholar Phoebe Sengers opens a short piece titled Technological Prostheses: An Anecdote, by reflecting on how “we have reached the post-physical era. On the Internet, all that matters is our thoughts. The body is obsolete. At least, whoever designed my computer interface thought so.” She traces how concentrated interactions with computers during her graduate work led to intense tendonitis in her hands. Her doctor responded by handing her “a technological prosthesis, two black leather wrist braces” that allowed her to return to her keyboard to resume typing ten hours a day. Shortly after her assisted return to her computer, she developed severe tendonitis in her elbows and had to stop typing altogether. Her advisor also handed her a technological prosthesis, this time “a speech understanding system that would transcribe my words,” so that she could continue to work. Two days later she lost her voice. Ultimately she “learned that my body does not go away when I work. I learned to stop when it hurt […] and to refuse to behave as though my body was not there” (Sengers). My own experiences in grad school were similar in many ways to Sengers’s. Besides the pasta problem outlined above, my own computer interfacing injuries at that point in my career meant I could no longer turn keys in doors, use a screwdriver, lift weights, or play the guitar. I held a friend’s baby at Christmas that year and the pressure of the small body on my arm make me wince. My family doctor bent my arm around a little, then shrugging her shoulders, she signed me up for a nerve test. As a young neurologist proceeded to administer a series of electric shocks and stick pins into my arms in various places, I noticed she had an arm brace herself. She explained that she also had a repetitive strain injury aggravated by her work tasks. She pronounced mine an advanced repetitive strain injury involving both medial and lateral epicondylitis, and sent me home with recommendations for rest, ice and physiotherapy. Rest was a challenge: Like Sengers, I puzzled over how one might manage to be productive in academia without typing. I tried out some physiotherapy, with my arm connected to electrodes and currents coursing through my elbow until my arm contorted in bizarre ways involuntarily. I tried switching my mouse from my right side to my left, switching from typing to voice recognition software and switching from a laptop to a more ergonomic desktop setup. I tried herbal topical treatments, wearing an extremely ugly arm brace, doing yoga poses, and enduring chiropractic bone-cracking. I learned in talking with people around me at that time that repetitive strains of various kinds are surprisingly common conditions for academics and other computer-oriented occupations. I learned other things well worth learning in that painful process. In terms of my own writing and thinking about technology, I have even less tolerance for the idea of ephemeral, transcendent technological fusions between human and machine. Seductive slippages into a cyberspatial existence seem less sexy when bumping your body up against the very physical and unforgiving interface hurts more with each keystroke or mouse click. The experience has given me a chronic injury to manage carefully ever since, rationing my typing time and redoubling my commitment to practicing embodied theorising about technology, with attention to sensation, materiality, and the way joints (between bones or between computer and computant) can become points of inflammation. Although pain is rarely referenced in the myths of smooth human and technological incorporations, there is much to be learned in acknowledging and exploring the entry and exit wounds made when we interface with technology. The elbow, or wrist, or lower back, or mental health that gives out serves as an effective alarm, should it be ignored too long. If nothing else, like a crashed computer, a point of pain will break a flow of events typically taken for granted. Whether it is your screen or your pinky finger that unexpectedly freezes, a system collapse will prompt a step back to look with new perspective at the process you were engaged in. The lag, crash, break, gap, crack, or blister exposes the inherent imperfections in a system and offers up an invitation for reflection, critical engagement, and careful choice.One careful choice we could make would be a more critical engagement with technology-as-prosthesis by “re-membering” our jointedness with technologies. Of course, joints themselves are not distinct parts, but interesting articulated systems and relationships in the spaces in-between. Experiencing our jointedness with technologies involves recognising that this is not the smooth romantic union with technology that has so often been exalted. Instead, our technological articulations involve a range of pleasures and pain, flows and blockages, frictions and slippages, flexibilities and rigidities. I suggest that a new model for understanding technology and embodiment might employ “articulata” as a central figure, informed by the multiple meanings of articulation. At their simplest, articulata are hinged, jointed, plural beings, but they are also precarious things that move beyond a hollow collection of corporeal parts. The inspiration for an exploration of articulation as a metaphor in this way was planted by the work of Donna Haraway, and especially by her 1992 essay, “The Promises of Monsters: A Regenerative Politics for Inappropriate/d Others,” in which she touches briefly on articulation and its promise. Haraway suggests that “To articulate is to signify. It is to put things together, scary things, risky things, contingent things. I want to live in an articulate world. We articulate; therefore we are” (324). Following from Haraway’s work, this framework insists that bodies and technologies are not simply components cobbled together, but a set of relations that rework each other in complex and ongoing processes of articulation. The double-jointed meaning of articulation is particularly apt as inspiration for crafting a more nuanced understanding of embodiment, since articulation implies both physiology and communication. It is a term that can be used to explain physical jointedness and mobility, but also expressive specificities. We articulate a joint by exploring its range of motion and we articulate ideas by expressing them in words. In both senses we articulate and are articulated by our jointed nature. Instead of oversimplifying or idealising embodied relationships with prostheses and other technologies, we might conceive of them and experience them as part of a “joint project”, based on points of connexion that are not static, but dynamic, expressive, complex, contested, and sometimes uncomfortable. After all, as Shildrick reminds us, in addition to functioning as utilitarian material artifacts, “prostheses are rich in semiotic meaning and mark the site where the disordering ambiguity, and potential transgressions, of the interplay between the human, animal and machine cannot be occluded” (17). By encouraging the attentive embracing of these multiple meanings, disorderings, ambiguities, transgressions and interplays, my aim moving forward is to explore the ways in which we might all become more articulate about our articulations. After all, I too want to live in an articulate world.ReferencesAT&T. "AT&T Reach Out and Touch Someone Commercial – 1987." Advertisement. 13 Mar. 2014. YouTube. <http://www.youtube.com/watch?v=OapWdclVqEY>.Cleland, Kathy. "Prosthetic Bodies and Virtual Cyborgs." Second Nature 3 (2010): 74–101.Glitsos, Laura. "Screen as Skin: The Somatechnics of Touchscreen Music Media." Somatechnics 7.1 (2017): 142–165.Haraway, Donna. "Promises of Monsters: A Regenerative Politics for Inappropriate/d Others." Cultural Studies. Eds. Lawrence Grossberg, Cary Nelson and Paula A. Treichler. New York: Routledge, 1992. 295–337.Jain, Sarah S. "The Prosthetic Imagination: Enabling and Disabling the Prosthetic Trope." Science, Technology, & Human Values 31.54 (1999): 31–54.McLuhan, Eric, and Frank Zingrone, eds. Essential McLuhan. Concord: Anansi P, 1995.Mullins, Aimee. Aimee Mullins: It’s Not Fair Having 12 Pairs of Legs. TED, 2009. <http://www.ted.com/talks/aimee_mullins_prosthetic_aesthetics.html>.Muri, Allison. "Of Shit and the Soul: Tropes of Cybernetic Disembodiment in Contemporary Culture." Body & Society 9.3 (2003): 73–92.Nikon. "See Much Further! Nikon COOLPIX P1000." Advertisement. 1 Nov. 2018. YouTube. <http://www.youtube.com/watch?v=UtABWZX0U8w>.OED Online. "prosthesis, n." Oxford UP. June 2019. 1 Aug. 2019 <https://www-oed-com.proxy.hil.unb.ca/view/Entry/153069?redirectedFrom=prosthesis#eid>.Sengers, Phoebe. "Technological Prostheses: An Anecdote." ZKP-4 Net Criticism Reader. Eds. Geert Lovink and Pit Schultz. 1997.Shildrick, Margrit. "Why Should Our Bodies End at the Skin?: Embodiment, Boundaries, and Somatechnics." Hypatia 30.1 (2015): 13–29.Sobchak, Vivian. "Living a ‘Phantom Limb’: On the Phenomenology of Bodily Integrity." Body & Society 16.3 (2010): 51–67.Stone, Allucquere Roseanne. "Will the Real Body Please Stand Up? Boundary Stories about Virtual Cultures." Cyberspace: First Steps. Ed. Michael Benedikt. Cambridge: MIT P, 1991. 81–113.Sun, Hsiao-yu. "Prosthetic Configurations and Imagination: Dis/ability, Body and Technology." Concentric: Literacy and Cultural Studies 44.1 (2018): 13–39.Texas Instruments. "We Wrote the Book on Classroom Calculators." Advertisement. Teaching Children Mathematics 2.1 (1995): Back Matter. <http://www.jstor.org/stable/41196414>.

The Coming of Coffee Before World War II, Australians followed British tradition and largely drank tea. When coffee challenged the tea drinking habit in post-war Australia, the tea industry fought back using the most up-to-date marketing techniques imported from America. The shift to coffee drinking in post-war Australia is, therefore, explored through a focus on both the challenges faced by the tea industry and how that industry tackled the trend towards coffee. By focusing on the Australian Tea Council’s marketing campaign promoting tea as a fashionable drink and preferable to coffee, this article explores Australia’s cultural shift from tea drinking to coffee drinking. This complex and multi-layered transition, often simply explained by post-war migration, provides an opportunity to investigate other causal aspects of this shift. In doing so, it draws on oral histories—including of central figures working in the tea and coffee industries—as well as reports in newspapers and popular magazines, during this period of culinary transition. Australians always drank coffee but it was expensive, difficult and inconsistent to brew, and was regarded as a drink “for the better class of person” (P. Bennett). At the start of World War II, Australia was second only to Britain in terms of its tea consumption and maintaining Australia’s supply of tea was a significant issue for the government (NAA, “Agency Notes”). To guarantee a steady supply, tea was rationed, as were many other staples. Between 1941 and 1955, the tea supply was under government control with the Commonwealth-appointed Tea Control Board responsible for its purchase and distribution nationwide (Adams, “From Instant” 16). The influence of the USA on Australia’s shift from tea-drinking has been underplayed in narratives of the origins of Australia’s coffee culture, but the presence of American servicemen, either stationed in Australia or passing through during the war in the Pacific, had a considerable impact on what Australians ate and drank. In 2007, the late John Button noted that:It is when the countries share a cause that the two peoples have got to know each other best. Between 1942 and 1945, when Australia’s population was seven million, one million US service personnel came to Australia. They were made welcome, and strange things happened. American sporting results and recipes were published in the newspapers; ‘The Star-Spangled Banner’ was played at the start of theatre and concert performances. Australians were introduced to the hot dog; Americans, reluctantly, to the dim sim. 10 or 15 years after the war, there were stories of New York cab drivers who knew Australia well and spoke warmly of their wartime visits. For years, letters between Australia and the US went back and forth between pen friends […] following up friendships developed during the war. Supplying the daily ration of coffee to American servicemen was another concern for the Australian government as Australia had insufficient roasting capacity to supply this coffee—and so three roasting machines were shipped to Australia to help meet this new demand (NAA, MP5/45 a). To ensure a steady supply, coffee too came under the control of the Tea Controller and the Tea Control Board became the Tea and Coffee Control Board. At this time, civilians became more aware of coffee as newspapers raised its profile and Australian families invited American servicemen in their homes. Differences in food preferences between American servicemen and Australians were noticed, with coffee the most notable of these. The Argus reported that: “The main point of issue in these rival culinary fancies is the longstanding question of coffee” (“Yanks Differ” 8). It concluded that Australians and Americans ate the same foods, only prepared in different ways, but the most significant difference between them was the American “preference for coffee” (8). When Australian families invited hosted servicemen in their homes, housewives needed advice on how to make prepare coffee, and were told:One of the golden rules for hostesses entertaining American troops should be not to serve them coffee unless they know how to make it in the American fashion [...] To make coffee in the proper American fashion requires a special kind of percolating. Good results may be obtained by making coffee with strong freshly ground beans and the coffee should be served black with cream to be added if required (“Coffee for Americans” 5). Australian civilians also read reports of coffee, rather than tea, being served to Australian servicemen overseas, and the following report in The Argus in 1942 shows: “At Milne Bay 100 gallons of coffee were served to the men after pictures had been shown each night. Coffee was not the only comfort to be supplied. There were also chocolate, tobacco, toothpaste, and other articles appreciated by the troops” (“Untitled” 5). Due largely to tea rationing and the presence of American servicemen, Australia’s coffee consumption increased to 500 grams per person per annum between 1941 and 1944, but it also continued to rise in the immediate post-war period when the troops had departed (ABS). In May 1947, the Tea (and Coffee) Controller reported an increased consumption of 54 per cent in the two years after the war ended (NAA, MP5/45 b). Tea Loses Its Way Australian tea company and coffee roaster, Bushells, had an excellent roast and ground coffee—Bushells Pure Coffee—according to Bill Bennett who worked for the company from 1948 to 1950 (B. Bennett). It was sold freshly roasted in screw-top jars that could be re-used for storage in the kitchen or pantry. In 1945, in a series of cartoon-style advertisements, Bushells showed consumers how easy it was to make coffee using this ground beans, but the most significant challenge to tea’s dominance came not with this form of coffee, but in 1948 with the introduction of Nestlé instant coffee. Susie Khamis argues that “of all the coffee brands that vied for Australians’ attention, Nestlé was by far the most salient, by virtue of its frequency, timeliness and resonance” (218). With Nestlé instant coffee, “you use just the quantity you need for each cup and there are no grounds or sediment. Nescafé made perfect full-flavoured coffee in a matter of seconds” (Canberra Times). Figure 1. Advertisement for Nestlé Coffee. The Canberra Times 5 Aug. 1949: 2. Figure 2. Advertisement for Bushells Coffee. The Argus 22 Aug. 1945: 11. Instant coffee, as well as being relatively cheap, solved the “problem” of its brewing and was marketed as convenient, economical, and consistent. It also was introduced at a time when the price of tea was increasing and the American lifestyle had great appeal to Australians. Khamis argues that the discovery of instant coffee “spoke to changes in Australia’s lifestyle options”, noting that the “tea habit was tied to Australia’s development as a far-flung colonial outpost, a daily reminder that many still looked to London as the nation’s cultural capital; the growing appeal of instant coffee reflected a widening and more nuanced cultural palate” (218). Instant coffee, modernity, America, and glamour became thus entwined in a period when Australia’s cultural identity “was informed less by the staid conservatism of Britain than the heady flux of the new world glamour” (Khamis 219). In the 1950s, Australians were seduced by espresso coffee presented to them in imaginatively laid out coffee lounges featuring ultra modern décor and streamlined fittings. Customers were reportedly “seduced by the novelty of the impressive-looking espresso machines, all shining chrome and knobs and pressure gauges” (Australasian Confectioner and Restaurant Journal 61). At its best, espresso coffee is a sublime drink with a rich thick body and a strong flavour. It is a pleasure to look at and has about it an air of European sophistication. These early coffee lounges were the precursors of the change from American-style percolated coffee (Adams, “Barista” vi). According to the Australasian Confectioner and Restaurant Journal, in 1956 espresso coffee was changing the way people drank coffee “on the continent, in London and in other parts of the world,” which means that as well as starting a new trend in Australia, this new way of brewing coffee was making coffee even more popular elsewhere (61). The Connoisseurship of Coffee Despite the popularities of cafés, the Australian consumer needed to be educated to become a connoisseur, and this instruction was provided in magazine and newspaper articles. Rene Dalgleish, writing for Australian Home Beautiful in 1964, took “a look around the shops” to report on “a growing range of glamorous and complicated equipment designed for the once-simple job of brewing a cup of tea, or more particularly, coffee” (21). Although she included teapots, her main focus was coffee brewing equipment—what it looked like and how it worked. She also discussed how to best appreciate coffee, and described a range of home grinding and brewing coffee equipment from Turkish to percolation and vacuum coffee makers. As there was only one way of making tea, Dalgleish pays little attention to its method of brewing (21) and concludes the piece by referring only to coffee: “There are two kinds of coffee drinkers—those who drink it because it is a drink and coffee lovers. The sincere coffee lover is one who usually knows about coffee and at the drop of a hat will talk with passionate enthusiasm on the only way to make real coffee” (21). In its first issue in 1966, Australasian Gourmet Magazine reflected on the increased consumption and appreciation of coffee in a five-page feature. “More and more people are serving fine coffee in their homes,” it stated, “while coffee lounges and espresso bars are attracting the public in the city, suburbs and country towns” (Repin and Dressler 36). The article also noted that there was growing interest in the history and production of coffee as well as roasting, blending, grinding, and correct preparation methods. In the same year, The Australian Women’s Weekly acknowledged a growing interest in both brewing, and cooking with, coffee in a lift-out recipe booklet titled “Cooking with Coffee.” This, according to the Weekly, presented “directions that tell you how to make excellent coffee by seven different methods” as well as “a variety of wonderful recipes for cakes, biscuits, desserts, confectionary and drinks, all with the rich flavor of coffee” (AWW). By 1969, the topic was so well established that Keith Dunstan could write an article lampooning coffee snobbery in Australian Gourmet Magazine. He describes his brother’s attention to detail when brewing coffee and his disdain for the general public who were all drinking what he called “muck”. Coffee to the “coffee-olics” like his brother was, Dunstan suggested, like wine to the gourmand (5). In the early 1960s, trouble was brewing in the tea business. Tea imports were not keeping pace with population growth and, in 1963, the Tea Bureau conducted a national survey into the habits of Australian tea drinkers (McMullen). This found that although tea was the most popular beverage at the breakfast table for all socio-economic groups, 30 per cent of Australian housewives did not realise that tea was cheaper than coffee. 52 per cent of coffee consumed was instant and one reason given for coffee drinking between meals was that it was easier to make one cup (Broadcasting and Television “Tea Gains”). Marketing Tea against a Turning Tide Coffee enjoyed an advantage that tea was unlikely to ever have, as the margin between raw bean and landed product was much wider than tea. Tea was also traditionally subject to price-cutting by grocery chains who used it as a loss leader “to bring the housewife into the store” (Broadcasting and Television “Tea Battles”) and, with such a fine profit margin, the individual tea packer had little to allocate for marketing expenses. In response, a group of tea merchants, traders and members of tea growing countries formed The Tea Council of Australia in 1963 to pool their marketing funds to collectively market their product. With more funds, the Council hoped to achieve what individual companies could not (Adams “From Instant” 1-19). The chairman of the Tea Council, Mr. G. McMullan, noted that tea was “competing in the supermarkets with all beverages that are sold […]. All the beverages are backed by expensive marketing campaigns. And this is the market that tea must continue to hold its share” (McMullen 6). The Tea Council employed the services of Jackson Wain and Company for its marketing and public relations campaign. Australian social historian Warren Fahey worked for the company in the 1960s and described it in an interview. He recalled: Jackson Wain was quite a big advertising agency. Like a lot of these big agencies of the time it was Australian owned by Barry Wain and John Jackson. Jackson Wain employed some illustrious creative directors at that time and its clients were indeed big: they had Qantas, Rothmans, the Tea Council, White Wings—which was a massive client—and Sunbeam. And they are just some of the ones they had. Over the following eleven years, the Tea Council sought innovative ways to identify target markets and promote tea drinking. Much of this marketing was directed at women. Since women were responsible for most of the household shopping, and housewives were consuming “incidental” beverages during the day (that is, not with meals), a series of advertisements were placed in women’s magazines. Showing how tea could be enjoyed at work, play, in the home, and while shopping, these kick-started the Tea Council’s advertising campaign in 1964. Fahey remembers that: tea was seen as old-fashioned so they started to talk about different aspects of drinking tea. I remember the images of several campaigns that came through Jackson Wain of the Tea Board. The Women’s Weekly ones were a montage of images where they were trying to convince people that tea was refreshing […] invigorating […] [and] friendly. Figure 3. Tea Council Advertisement. The Australian Women’s Weekly 29 Jan. 1964, 57. Radio was the Tea Council’s “cup of tea”. Transistor and portable radio arrived in Australia in the 1950s and this much listened to medium was especially suited to the Tea Council’s advertising (Tea Council Annual Report 1964). Radio advertising was relatively low-cost and the Council believed that people thought aurally and could picture their cup of tea as soon as they heard the word “tea”. Fahey explains that although radio was losing some ground to the newly introduced television, it was still the premier media, largely because it was personality driven. Many advertisers were still wary of television, as were the agencies. Radio advertisements, read live to air by the presenter, would tell the audience that it was time for a cuppa—“Right now is the right time to taste the lively taste of tea” (Tea Council Annual Report 1964)—and a jingle created for the advertisement completed the sequence. Fahey explained that agencies “were very much tuned into the fact even in those days that women were a dominant fact in the marketing of tea. Women were listening to radio at home while they were doing their work or entertaining their friends and those reminders to have a cup of tea would have been quite useful triggers in terms of the marketing”. The radio jingle, “The taste of tea makes a lively you” (Jackson Wain, “Tea Council”) aired 21,000 times on 85 radio stations throughout Australia in 1964 (Tea Council of Australia Annual Report). In these advertisements, tea was depicted as an interesting, exciting and modern beverage, suitable for consumption at home as outside it, and equally, if not more, refreshing than other beverages. People were also encouraged to use more tea when they brewed a pot by adding “one [spoonful] for the pot” (Jackson Wain, “Tea Council”). These advertisements were designed to appeal to both housewives and working women. For the thrifty housewife, they emphasised value for money in a catchy radio jingle that contained the phrase “and when you drink tea the second cup’s free” (Jackson Wain “Tea Council”). For the fashionable, tea could be consumed with ice and lemon in the American fashion, and glamorous fashion designer Prue Acton and model Liz Holmes both gave their voices to tea in a series of radio advertisements (Tea Council of Australia, “Annual Reports”). This was supported with a number of other initiatives. With the number of coffee lounges increasing in cities, the Tea Council devised a poster “Tea is Served Here” that was issued to all cafes that served tea. This was strategically placed to remind people to order the beverage. Other print tea advertisements targeted young women in the workforce as well as women taking time out for a hot drink while shopping. Figure 4. “Tea Is Served Here.” Tea Council of Australia. Coll. of Andy Mac. Photo: Andy Mac. White Wings Bake-off The cookery competition known as the White Wings Bake-Off was a significant event for many housewives during this period, and the Tea Council capitalised on it. Run by the Australian Dairy Board and White Wings, a popular Australian flour milling company, the Bake-Off became a “national institution […] and tangible proof of the great and growing interest in good food and cooking in Australia” (Wilson). Starting in 1963, this competition sought original recipes from home cooks who used White Wings flour and dairy produce. Winners were feted with a gala event, national publicity and generous prizes presented by international food experts and celebrity chefs such as Graham Kerr. Prizes in 1968 were awarded at a banquet at the Southern Cross Hotel and the grand champion won A$4,750 and a Metters’ cooking range. Section winners received A$750 and the stove. In 1968, the average weekly wage in Australia was A$45 and the average weekly spend on food was $3.60, which makes these significant prizes (Talkfinancenet). In a 1963 television advertisement for White Wings, the camera pans across a table laden with cakes and scones. It is accompanied by the jingle, “White Wings is the Bake Off flour—silk sifted, silk sifted” (Jackson Wain, “Bake-Off”). Prominent on the table is a teapot and cup. Fahey noted the close “simpatico” relationship between White Wings and the Tea Council:especially when it came down to […] the White Wings Bake Off [...]. Tea always featured prominently because of the fact that people were still in those days baking once a week [...] having that home baking along side a cup of tea and a teapot was something that both sides were trying to capitalise on. Conclusion Despite these efforts, throughout the 1960s tea consumption continued to fall and coffee to rise. By 1969, the consumption of coffee was over a kilogram per person per annum and tea had fallen to just over two kilograms per person per year (ABS). In 1973, due to internal disputes and a continued decline in tea sales, the Tea Council disbanded. As Australians increasingly associated coffee with glamour, convenience, and gourmet connoisseurship, these trajectories continued until coffee overtook tea in 1979 (Khamis 230) and, by the 1990s, coffee consumption was double that of tea. Australia’s cultural shift from tea drinking to coffee drinking—easily, but too simplistically, explained by post-war migration—is in itself a complex and multi layered transition, but the response and marketing campaign by the Tea Council provides an opportunity to investigate other factors at play during this time of change. Fahey sums the situation up appropriately and I will conclude with his remarks: “Advertising is never going to change the world. It can certainly persuade a market place or a large percentage of a market place to do something but one has to take into account there were so many other social reasons why people switched over to coffee.” References Adams, Jillian. Barista: A Guide to Espresso Coffee. Frenchs Forest NSW: Pearson Education Australia, 2006. -----. “From Instant Coffee to Italian Espresso: How the Cuppa Lost its Way.” Masters Thesis in Oral History and Historical Memory. Melbourne: Monash University, 2009. Advertisement for Bushells Coffee. The Argus 22 Aug. (1945): 11. Australian Bureau of Statistics [ABS]. “4307.0 Apparent Consumption of Tea and Coffee, Australia 1969-1970.” Canberra: Australian Bureau of Statistics, 2000. Australasian Confectioner and Restaurant Journal. “Espresso Comes to Town.” Australian Confectioner and Restaurant Journal Feb. (1956): 61. Bennett, Bill. Interview. 22 Jun. 2007. Bennett, Peter. Interview. 10 Mar. 2010. Broadcasting and Television. “Tea Gains 98% Market Acceptance.” Broadcasting and Television 6 Jun. (1963): 16. -----. “Tea Battles Big Coffee Budgets.” Broadcasting and Television News 14 Oct. (1965): 16. Button, John. “America’s Australia: Instructions for a Generation.” The Monthly Feb. (2007) 28 Mar. 2012 ‹http://www.themonthly.com.au/monthly-essays-john-button-americas-australia-instructions-generation-456›. Canberra Times, The. Advertisement for Nestle Coffee. The Canberra Times 5 Aug. (1949): 2. “Coffee for Americans.” The Argus 20 Apr. (1942): 5.Dalgleish, Rene. “Better Tea and Coffee.” Australian Home Beautiful Jun. (1964): 21–5. Dunstan, Keith. “The Making of a Coffee-olic.” The Australian Gourmet Magazine Sep./Oct. (1969): 5. Fahey, Warren. Interview. 19 Aug. 2010. Howard, Leila. ‘Cooking with Coffee.” The Australian Women’s Weekly 6 Jul. (1966): 1–15. Jackson Wain. “The Bake-off Flour!” TV Commercial, 30 secs. Australia: Fontana Films for Jackson Wain, 1963. 1 Feb. 2012 ‹www.youtube.com/watch?v=1X50sCwbUnw›. -----. “Tea Council of Australia.” TV commercials, 30 secs. National Film and Sound Archive, 1964–1966. Khamis, Susie. “ It Only Takes a Jiffy to Make.” Food Culture and Society 12.2 (2009): 218–33. McMullen, G. F. The Tea Council of Australia Annual Report. Sydney, 1969. National Archives of Australia [NAA]. Agency Notes CP629/1. “History of the Tea Control and Tea Importation Board, January 1942–December 1956.” -----. Series MP5/45 a. Minutes of the Tea Control Board. 17 Aug. 1942. -----. Series MP5/45 b. Minutes of the Tea Control Board. 29 May 1947. Repin, J. D., and H. Dressler. “The Story of Coffee.” Australian Gourmet Magazine 1.1 (1966): 36–40. Talkfinance.net. “Cost of Living: Today vs. 1960.” 1 May 2012 ‹http://www.talkfinance.net/f32/cost-living-today-vs-1960-a-3941› Tea Council of Australia. Annual Reports Tea Council of Australia 1964–1973. ----- Advertisement. The Australian Women’s Weekly 3 Jul. (1968): 22.“Untitled.” The Argus 20 Apr. (1942): 5. Wilson, Trevor. The Best of the Bake-Off. Sydney: Ure Smith, 1969.“Yanks and Aussies Differ on ‘Eats’.” The Argus 4 Jul. (1942): 8.

I wake up early, questions buzzing through my mind. While I sip my morning cup of tea and read The Guardian online, the writer, restless because I’m ignoring her, walks around firing questions.“Expecting the patriarchy to want to share its enormous wealth and power with women is extremely naïve.”I nod. Outside the window pieces of sky are framed by trees, fluffy white clouds alternate with bright patches of blue. The sweet, heady first wafts of lavender and citrus drift in through the open window. Spring has come to Hvar. Time to get to work.The more I understand about narcissism, the more I understand the world. I didn’t understand before. In the 1990s.“No—you knew, but you didn’t know at the same time.”I kept telling everybody The River Ophelia wasn’t about sex, (or the sex wasn’t about sex), it was about power. Not many people listened or heard, though. Only some readers.I’ve come here to get away. To disappear. To write.I can’t find the essay I want for my article about the 1990s. I consider the novel I’m reading, I Love Dick by Chris Kraus and wonder whether I should write about it instead? It’s just been reprinted, twenty years after its initial release. The back cover boasts, “widely considered to be the most important feminist novel of the past two decades.” It was first published in the 1990s. So far it’s about a woman named Chris who’s addictively obsessed with an unavailable man, though I’m yet to unravel Kraus’s particular brand of feminism—abjection? Maybe, maybe … while I think, I click through my storage folder. Half way through, I find a piece I wrote about Kathy Acker in 1997, a tribute of sorts that was never published. The last I’d heard from Kathy before this had been that she was heading down to Mexico to try shark cartilage for her breast cancer. That was just before she died.When I was first introduced to the work of Foucault and Deleuze, it was very political; it was about what was happening to the economy and about changing the political system. By the time it was taken up by the American academy, the politics had gone to hell. (Acker qtd. in Friedman 20)Looking back, I’d have to say my friendship with Kathy Acker was intense and short-lived.In the original I’d written “was a little off and on.” But I prefer the new version. I first met Kathy in person in Sydney, in 1995. We were at a World Art launch at Ariel bookshop and I remember feeling distinctly nervous. As it turned out, I needn’t have been. Nervous, that is.Reading this now brings it all back: how Kathy and I lost touch in the intervening two years and the sudden fact of her death. I turn to the end and read, “She died tragically, not only because she was much too young, but because American literature seems rather frumpy without her, of cancer on the 30th November 1997, aged 53.”The same age as I am now. (While some believe Kathy was 50 when she died, Kathy told me she lied about her age even to the point of changing her passport. Women who lie about their age tend to want to be younger than they are, so I’m sticking with 53.) This coincidence spooks me a little.I make a cup of tea and eat some chocolate.“This could work …” the writer says. My reasons for feeling nervous were historical. I’d spoken to Kathy once previously (before the publication of The River Ophelia on the phone from Seattle to San Francisco in 1993) and the conversation had ended abruptly. I’d wanted to interview Kathy for my PhD on American fiction but Kathy wouldn’t commit. Now I was meeting her face to face and trying to push the past to the back of my mind.The evening turned out to be a memorable one. A whole bunch of us—a mixture of writers, publishers, academics and literati—went out to dinner and then carried on drinking well into the night. I made plans to see Kathy again. She struck me as a warm, generous, sincere and intensely engaging person. It seemed we might become friends. I hesitated: should I include the rest? Or was that too much?The first thing Kathy had said when we were introduced was, “I loved your book, The River Ophelia. I found it as soon as I arrived. I bought it from the bookshop at the airport. I saw your amazing cover and then I read on the back that it was influenced by the work of Kathy Acker. I was like, wow, no one in America has ever put that on the back cover of a novel. So I read it immediately and I couldn’t put it down. I love the way you’ve deconstructed the canon but still managed to put a compelling narrative to it. I never did that.”Why didn’t I include that? It had given me more satisfaction than anything anyone else had said.I remember how quickly I abandoned my bestselling life in Sydney, sexual harassment had all but ruined my career, and exchanged it for an uncertain future in London. My notoriety as an author was damaging my books and my relationship with my publisher had become toxic. The first thing I did in London was hire a lawyer, break my contract with Picador and take both novels out of print.Reality intrudes in the form of a phone call from my mother. Terminally ill with cancer, she informs me that she’s off her food. For a retired chef, the loss of appetite is not inconsiderable. Her dying is a dull ache, a constant tiredness and sadness in me. She’s just arrived in London. I will go there next week to meet her.(1)I first came across Kathy’s work in 1991. I’d just finished my MA thesis on postmodernism and parody and was rewarding myself with some real reading (i.e. not related to my thesis) when I came across the novel Don Quixote. This novel had a tremendous impact on me. Those familiar with DQ may recall that it begins with an abortion that transforms its female narrator into a knight.When she was finally crazy because she was about to have an abortion, she conceived of the most insane idea that any woman can think of. Which is to love. How can a woman love? By loving someone other than herself. (Acker Quixote 9)Kathy’s opening sentences produced a powerful emotional response in me and her bold confronting account of an abortion both put me in touch with feelings I was trying to avoid and connected these disturbing feelings with a broader political context. Kathy’s technique of linking the personal and emotional with the political changed the way I worked as a writer.I’d submitted the piece as an obituary for publication to an Australian journal; the editor had written suggestions in the margin in red. All about making the piece a more conventional academic essay. I hadn’t been sure that was what I wanted to do. Ambitious, creative, I was trying to put poststructuralist theory into practice, to write theoretical fiction. It’s true, I hadn’t been to the Sorbonne, but so what? What was the point of studying theory if one didn’t put it into practice? I was trying to write like French theorists, not to write about them. The editor’s remarks would have made a better academic essay, it’s just I’m not sure that’s where I wanted to go. I never rewrote it and it was never published.I first encountered I Love Dick (2017) during a film course at the AFTVRS when the lecturer presented a short clip of the adaptation for the class to analyse. When I later saw the novel in a bookshop I bought a copy. Given my discovery of the unpublished obituary it is also a bit spooky that I’m reading this book as both Chris Kraus and Kathy Acker had relationships with academic and Semiotext(e) publisher Sylvère Lotringer. Chris as his wife, Kathy as his lover. Kraus wrote a biography of Acker called After Kathy Acker: A Biography, which seems fairly unsympathetic according to the review I read in The Guardian. (Cooke 2017) Intrigued, I add Kraus’s biography to my growing pile of Acker related reading, the Acker/Wark letters I’m Very Into You and Olivia Laing’s novel, Crudo. While I’ve not read the letters yet, Crudo’s breathless yet rhythmic layering of images and it’s fragmented reflections upon war, women and politics reminded me less of Acker and more of Woolf; Mrs Dalloway, in fact.(2)What most inspired me, and what makes Kathy such a great writer, is her manner of writing politically. For the purposes of this piece, when I say Kathy writes politically, I’m referring to what happens when you read her books. That is, your mind—fuelled by powerful feelings—makes creative leaps that link everyday things and ideas with political discourses and debates (for Kathy, these were usually critiques of bourgeois society, of oedipal culture and of the patriarchy).In the first pages of Don Quixote, for example, an abortion becomes synonymous with the process of becoming a knight. The links Kathy makes between these two seemingly unrelated events yields a political message for the creative reader. There is more at stake than just gender-bending or metamorphoses here: a reversal of power seems to have taken place. A relatively powerless woman (a female victim except for the fact that in having an abortion she’s exerting some measure of control over her life), far from being destroyed by the experience of aborting her foetus, actually gains power—power to become a knight and go about the world fulfilling a quest. In writing about an abortion in this way, Kathy challenges our assumptions about this controversial topic: beyond the moral debate, there are other issues at stake, like identity and power. An abortion becomes a birth, rather than a banal tragedy.When I think about the 1990s, I automatically think of shoulder pads, cocktails and expense accounts (the consumption of the former, in my case, dependent on the latter). But on reflection, I think about the corporatisation of the publishing industry, the Backlash and films like Thelma and Louise, (1991) Basic Instinct (1992) and Single White Female (1992). It occurs to me that the Hollywood movie star glamorous #MeToo has its origin in the turbulent 1990s Backlash. When I first saw each of these films I thought they were exciting, controversial. I loved the provocative stance they took about women. But looking back I can’t help wondering: whose stories were they really, why were we hearing them and what was the political point?It was a confusing time in terms of debates about gender equality.Excluding the premise for Thelma and Louise, all three films present as narrative truth scenarios that ran in stark contrast to reality. When it came to violence and women, most domestic homicide and violence was perpetrated by men. And violence towards women, in the 1990s, was statistically on the rise and there’s little improvement in these statistics today.Utter chaos, having a British passport never feels quite so wonderful as it does in the arrivals hall at Heathrow.“Perhaps these films allow women to fantasise about killing the men who are violent towards them?”Nyah, BI is chick killing chick … and think about the moral to the story. Fantasy OK, concrete action painful, even deadly.“Different story today …”How so?“Violent female protagonists are all the rage and definitely profitable. Killing Eve (2018) and A Simple Favour (2018).”I don’t have an immediate answer here. Killing Eve is a TV series, I think aloud, A Simple Favour structurally similar to Single White Female … “Why don’t you try self-publishing? It’ll be 20 years since you took The River Ophelia out of print, bit of an anniversary, maybe it’s time?”Not a bad idea. I’m now on the tube to meet mum at her bed and breakfast but the writer is impatient to get back to work. Maybe I should just write the screenplay instead?“Try both. If you don’t believe in your writing, who else will?”She has a point. I’m not getting anywhere with my new novel.A message pips through on Facebook. Want to catch up?What? Talk about out of the blue. I haven’t heard from Sade in twenty years … and how on earth did he get through my privacy settings?After meeting mum, the next thing I do is go to the doctor. My old doctor from West Kensington, she asks me how I’m going and I say I’m fine except that mum’s dying and this awful narcissistic ex-partner of mine has contacted me on Facebook. She recommends I read the following article, “The Highly Sensitive Person and the Narcissist” (Psychology Today).“Sometimes being a kind caring person makes you vulnerable to abusers.”After the appointment I can’t get her words out of my head.I dash into a Starbucks, I’m in Notting Hill just near the tube station, and read the article on my laptop on wifi. I highlight various sections. Narcissists “have a complete lack of empathy for others including their own family and friends, so that they will take advantage of people to get their own needs and desires met, even if it hurts someone.” That sounds about right, Sade could always find some way of masking his real motives in charm, or twisting reality around to make it look like things weren’t his fault, they were mine. How cleverly he’d lied! Narcissists, I read, are attracted to kind, compassionate people who they then use and lie to without remorse.But the bit that really makes me sit up is towards the end of the article. “For someone on the outside looking at a relationship between a highly sensitive person and a narcissist, it’s all too easy to blame the HSP. How and why would anyone want to stay in such a relationship?” Narcissists are incredibly good at making you doubt yourself, especially the part of you that says: this has happened before, it’ll happen again. You need to leave.The opening paragraph of the psychology textbook I read next uses Donald Trump as an example. Trump is also Patrick Bateman’s hero, the misogynistic serial killer protagonist of Bret Easton Ellis’s notorious American Psycho. Despite an earlier version that broadly focused on New York fiction of the 1990s, Ellis’s novel and the feminist outcry it provoked became the central topic of my PhD.“Are you alright mum?”I’ve just picked Mum up and I’m driving her to Paris for a night and then on to Switzerland where she’s going to have voluntary euthanasia. Despite the London drizzle and the horrific traffic the whole thing has a Thelma and Louise feel about it. I tell mum and she laughs.“We should watch it again. Have you seen it since it first came out?”“Sounds like a good idea.”Mum, tiny, pointy-kneed and wearing an out-of-character fluoro green beanie given to her at the oncology clinic in Sydney, is being very stoic but I can tell from the way she constantly wrings her hands that she’s actually quite terrified.“OK Louise,” she says as I unfold her Zimmer frame later that evening.“OK Thelma,” I reply as she walks off towards the hotel.Paris is a treat. My brother is waiting inside and we’re hoping to enjoy one last meal together.Mum didn’t want to continue with chemo at 83, but she’s frightened of dying a horrific death. As we approach hotel reception Mum can’t help taking a detour to inspect the dinner menu at the hotel restaurant.“Oysters naturel. That sounds nice.”I smile, wait, and take her by the elbow.I’ve completely forgotten. The interview/review I wrote of Acker’s Pussy, King of the Pirates, in 1995 for Rolling Stone. Where is it? I open my laptop and quickly click through the endless publicity and reviews of The River Ophelia, the interview/review came out around the same time the novel was published, but I can’t find it. I know I had it out just a few months ago, when I was chasing up some freelance book reviews.I make a fresh pot of tea from the mini bar, green, and return to my Acker tribute. Should I try to get it published? Here, or back in Australia? Ever the émigré’s dilemma. I decide I like the Parisian sense of style in this room, especially the cotton-linen sheets.Finally, I find it, it’s in the wrong folder. Printing it out, I remember how Kathy had called her agent and publisher in New York, and her disbelief when I’d told her the book hadn’t been picked up overseas. Kathy’s call resulted in my first New York agent. I scrutinise its pages.Kathy smiles benign childlike creativity in the larger photo, and gestures in passionate exasperation in the smaller group, her baby face framed by countless metal ear piercings. The interview takes place—at Kathy’s insistence—on her futon in her hotel room. My memories clarify. It wasn’t that we drifted apart, or rather we did, but only after men had come between us first. Neither of us had much luck in that department.(4)Kathy’s writing is also political because her characters don’t act or speak the way you’d expect them to. They don’t seem to follow the rules or behave in the way your average fictional character tends to do. From sentence to sentence, Kathy’s characters either change into different people, or live revolutionary lives, or even more radical still, live impossible lives.When the narrator of DQ transforms herself into a knight (and lives an impossible life); she turns a situation in which she is passive and relatively powerless—she is about to be operated on and drugged—into an empowering experience (and lives a creative revolutionary life). Ironically, getting power means she turns herself into a male knight. But Kathy gets around the problem that power is male by not letting things rest there. The female, aborting Kathy isn’t actually replaced by a male knight, bits of him are just grafted onto her. Sure, she sets out on a quest, but the other aspects of her empowerment are pretty superficial: she does adopt a new name (which is more like a disguise), and identity (appearance); and picks up a bad habit or two—a tendency to talk in the language used by knights.“But who’s the father?” the writer wants to know. “I mean isn’t that the real question here?”No, that is exactly not the real question here and not the point. It is not about who the father is—it’s about what happens to a woman who has an unwanted unplanned pregnancy.The phone rings. It’s my brother. Mum’s waiting for me downstairs and the oysters are beckoning.(5)The idea that writing could be political was very appealing. The transformation between my first novel, Marilyn’s Almost Terminal New York Adventure and my second, The River Ophelia (Picador insisted on publishing them in reverse chronology) was partly a result of my discovery of Kathy’s work and the ideas it set off in me. Kathy wasn’t the first novelist to write politically, but she was the first female novelist to do so in a way that had an immediate impact on me at an emotional level. And it was this powerful emotional response that inspired me as a writer—I wanted to affect my readers in a similar way (because reading Kathy’s work, I felt less alone and that my darkest experiences, so long silenced by shame and skirted around in the interests of maintaining appearances, could be given a voice).We’re driving through Switzerland and I’m thinking about narcissism and the way the narcissists in my personal and professional life overshadowed everything else. But now it’s time to give the rest of the world some attention. It’s also one way of pulling back the power from the psychopaths who rule the world.As we approach Zurich, my mother asks to pull over so she can use the ladies. When she comes out I can see she’s been crying. Inside the car, she reaches for my hand and clasps it. “I don’t know if I’m strong enough to say goodbye.”“It’s alright Mum,” I say and hold her while we both cry.A police car drives by and my mother’s eyes snag. Harassed by the police in Australia and unable to obtain Nembutal in the UK, Mum has run out of options.To be a woman in this society is to find oneself living outside the law. Maybe this is what Acker meant when she wrote about becoming a pirate, or a knight?Textual deconstruction can be a risky business and writers like Acker walk a fine line when it comes to the law. Empire of the Senseless ran into a plagiarism suit in the UK and her publishers forced Acker to sign an apology to Harold Robbins (Acker Hannibal Lecter 13). My third novel Dependency similarly fell foul of the law when I discovered that in deconstructing gossip and myths about celebrities, drawing on their lives and then making stuff up, the result proved prophetic. When my publisher, Harper Collins, refused to indemnify me against potential unintended defamation I pulled the book from its contract on the advice of a lawyer. I was worth seven million pounds on paper at that point, the internet travel site my then husband and I had founded with Bob Geldof had taken off, and the novel was a radical hybrid text comprised of Rupert Murdoch’s biography, Shakespeare’s King Lear and Hello Magazine and I was worried that Murdoch might come after me personally. I’d fictionalised him as a King Lear type, writing his Cordelia out of his will and leaving everything to his Goneril and Reagan.Recent theoretical studies argue that Acker’s appropriation and deconstruction constitute a feminist politics as “fragmentation” (June 2) and as “agency” (Pitchford 22). As Acker puts it. “And then it’s like a kid: suddenly a toy shop opens up and the toy shop was called culture.” (Acker Hannibal Lecter 11).We don’t easily fit in a system that wasn’t ever designed to meet our needs.(6)By writing about the most private parts of women’s lives, I’ve tried to show how far there is to go before women and men are equal on a personal level. The River Ophelia is about a young woman whose public life might seem a success from the outside (she is a student doing an honours year at university in receipt of a scholarship), but whose private life is insufferable (she knows nothing about dealing with misogyny on an intimate level and she has no real relationship-survival skills, partly as a result of her family history, partly because the only survival skills she has have been inscribed by patriarchy and leave her vulnerable to more abuse). When Justine-the-character learns how to get around sexism of the personal variety (by re-inventing her life through parodies of classic texts about oedipal society) she not only changes her life, but she passes on her new-found survival skills to the reader.A disturbing tale about a young university student who loses herself in a destructive relationship, The River Ophelia is a postmodern novel about domestic violence and sexual harassment in the academy, contrary to its marketing campaign at the time. It’s protagonist, Justine, loves Sade but Sade is only interested in sex; indeed, he’s a brutish sex addict. Despite this, Justine can’t seem to leave: for all her education, she’s looking for love and commitment in all the wrong places. While the feminist lore of previous generations seems to work well in theory, Justine can’t seem to make it work in practise. Owning her power and experimenting with her own sexuality only leaves her feeling more despairing than before. Unconventional, compelling and controversial, The River Ophelia became an instant best-seller and is credited with beginning the Australian literary movement known as grunge/dirty realism.But there is always the possibility, given the rich intertextuality and self referentiality, that The River Ophelia is Justine’s honours thesis in creative writing. In this case, Sade, Juliette, Ophelia, Hamlet, Bataille, Simone, Marcelle and Leopold become hybrids made up from appropriated canonical characters, fragments of Justine’s turbulent student’s world and invented sections. But The River Ophelia is also a feminist novel that partly began as a dialogue with Ellis whose scandalous American Psycho it parodies even as it reinvents. This creative activity, which also involves the reader by inviting her to participate in the textual play, eventually empowers Justine over the canon and over her perpetrator, Sade.Another hotel room. This one, just out of Zürich, is tiny. I place my suitcase on the rack beneath the window overlooking the narrow street and start to unpack.“Hasn’t this all been said before, about The River Ophelia?” The writer says, trying out the bed. I’m in the middle of an email about self-publishing a new edition of TRO.Some of it. While the grunge label has been refuted, Acker’s influence has been underplayed.Acker often named her protagonists after herself, so losing the Acker part of my textual filiation plays into the whole grunge/dirty realism marketing campaign. I’ve talked about how I always name protagonists after famous women but not linked this to Acker. Bohemia Beach has a protagonist named after Cathy as in Wuthering Heights. Justine of The River Ophelia was doubly an Acker trait: firstly, she was named Justine after De Sade’s character and is a deconstruction of that character, and secondly she was named Justine self-reflexively after me, as a tribute to Kathy as in Kathy Goes to Haiti.The other context for The River Ophelia that has been lost is to do with the early work of Mary Gaitskill, and Catherine Texier. The narcissists were so destructive and so powerful they left no time for the relatively more subtle Gaitskill or Texier. Prototypes for Sex in the City, the 1990s was also a time when Downtown New York women writers explored the idea that gender equality meant women could do anything men did sexually, that they deserved the full gamut of libertine sexual freedoms. Twenty years on it should also be said that women who push the envelope by writing women protagonists who are every bit as sexually transgressive as men, every bit as addictively self-destructive as male protagonists deserve not to be shamed for that experimentation. They deserve to be celebrated and read.AfterwordI’d like to remember Kathy as I knew her briefly in Sydney. A bottle-blonde with a number two haircut, a leopard-skin bikini and a totally tattooed body, she swam a surprisingly genteel breast-stroke in the next lane in one of the world’s most macho lap-swimming pools.ReferencesA Simple Favour. Dir. Paul Feig. Lionsgate, 2018.Acker, Kathy. Don Quixote. London: Collins, 1986.———. Empire of the Senseless. New York: Grove, 1988.———. Hannibal Lecter, My Father. New York: Semiotext(e), 1991.———. Kathy Goes to Haiti. New York: Grove Press/Atlantic Monthly, 1994.——— and McKenzie Wark. I’m Very into You: Correspondence 1995-1996. New York: Semiotext(e), 2015.Basic Instinct. Dir. Paul Verhoeven. TriStar Pictures, 1992.Brontë, Emily. Wuthering Heights. New York: Norton and Co, 2003.Bushnell, Candace. Sex in the City. United States: Grand Central Publishing, 1996.Cooke, Rachel. “Review of After Kathy Acker: A Biography by Chris Kraus—Baffling Life Study.” The Guardian 4 Sep. 2017. 4 Dec. 2018 <https://www.theguardian.com/books/2017/sep/04/after-kathy-acker-a-biography-chris-kraus-review>.Deleuze, Gilles, and Felix Guattari. A Thousand Plateaus: Capitalism and Schizophrenia. Minneapolis: University of Minnesota Press, 1987.Ellis, Bret Easton. American Psycho. New York: Vintage, 1991.Ettler, Justine. Bohemia Beach. Melbourne: Transit Lounge. 2018.———. “Kathy Acker: King of the Pussies.” Review of Pussy, King of the Pirates, by Kathy Acker. Rolling Stone. Nov. 1995: 60-61.———. Marilyn’s Almost Terminal New York Adventure. Sydney: Picador, 1996.———. “La Trobe University Essay: Bret Easton Ellis’s Glamorama, and Catherine Texier’s Break Up.” Australian Book Review, 1995.———. The Best Ellis for Business: A Re-Examination of the Mass Media Feminist Critique of “American Psycho.” PhD. Sydney: University of Sydney, 2013.———. The River Ophelia. Sydney: Picador, 1995.Faludi, Susan. Backlash: The Undeclared War against American Women. New York: Crown, 1991.Friedman, Ellen G. “A Conversation with Kathy Acker.” The Review of Contemporary Fiction 9.3 (Fall 1989): 20-21.Gaitskill, Mary. Bad Behaviour. New York: Random House, 1988.I Love Dick. Dir. Jill Soloway. Amazon Video, 2017.June, Pamela B. The Fragmented Female Body and Identity: The Postmodern Feminist and Multiethnic Writings of Toni Morrison, Therese Huk, Kyung Cha, Phyllis Alesia Perry, Gayl Jones, Emma Perez, Paula Gunn Allen, and Kathy Acker. New York: Peter Lang Publishing, 2010.Killing Eve. Dir. Phoebe Waller-Bridge. BBC America, 2018.Kraus, Chris. After Kathy Acker: A Biography. London: Penguin, 2017.———. I Love Dick. London: Serpent’s Tail, 2016.Laing, Olivia. Crudo. London: Picador, 2018.Lee, Bandy. The Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. New York: St Martin’s Press. 2017.Lombard, Nancy, and Lesley McMillan. “Introduction.” Violence against Women. Eds. Nancy Lombard and Lesley McMillan. London: Jessica Kingsley Publishers, 2013.Pitchford, Nicola. Tactical Readings: Feminist Postmodernism in the Novels of Kathy Acker and Angela Carter. London: Associated Uni Press, 2002.Schiffrin, André. The Business of Books: How International Conglomerates Took Over Publishing and Changed the Way We Read. London and New York: Verso, 2000.Shakespeare, William. King Lear. London: Penguin Classics, 2015.Siegle, Robert. Suburban Ambush: Downtown Writing and the Fiction of Insurgency. United States: John Hopkins Press, 1989.Single White Female. Dir. Barbet Schroeder. Columbia Pictures, 1992.Texier, Catherine. Panic Blood. London: Collins, 1991.Thelma and Louise. Dir. Ridley Scott. Metro-Goldwyn-Mayer, 1991.Ward, Deborah. “Sense and Sensitivity: The Highly Sensitive Person and the Narcissist.” Psychology Today (16 Jan. 2012). 4 Dec. 2018 <https://www.psychologytoday.com/us/blog/sense-and-sensitivity/201201/the-highly-sensitive-person-and-the-narcissist>.