Journal articles on the topic 'La Colle Falls'

Purpose: To report a case of traumatic enucleation and Colles’ fracture in a 70-year-old male farmer following a fall from a height. Design: A case report. Findings: Enucleated right eye and bilateral Colles’ fracture. Practical implications: The attending health care personnel should do a complete assessment of a patient with a history of fall from a height to avoid missing important bodily injuries. Fall from height is a cause of avoidable blindness. Originality: Rare original case of traumatic enucleation after a fall.

Reflexionamos sobre las tesis de Fals Borda acerca del accionar político de los movimientos sociales en nuestros países, reflexión clave en este momento en que los canales de organización política están siendo interpelados. La democracia directa ejercida por los actores sociales movilizados cuestiona la democracia representativa. Proponemos una evolución del pensamiento de Fals, que si bien lo llevó en un momento de su reflexión a plantear que los movimientos sociales pudieran reemplazar a los partidos políticos y darle una nueva dinámica a la política que superara las deficiencias históricas de partidos oligárquicos, clientelistas y generadores de violencia, posteriormente desistió de dicho planteamiento, sólo que insistiendo en el papel político de los movimientos sociales.

ZusammenfassungBeschrieben werden die magnetresonanztomographischen Befunde bei einem 10 Jahre alten Border Collie mit operativ bestätigter isolierter Ruptur des hinteren Kreuzbandes. Die Befunde beinhalteten die komplette Ruptur des kaudalen Kreuzbandes, eine wahrscheinliche “Bone-Bruise”-Läsion in der proximolateralen Tibia und einen Muskelfaserriss im Ursprung des M. flexor digitorum lateralis. In der Humanmedizin werden “Bone-Bruise”-Läsionen herangezogen, um die Mechanismen von Bandschäden bei Traumata erklären zu können. Im beschriebenen Fall lässt sich anhand der magnetresonanztomographischen Befunde nachvollziehen, wie es zur seltenen isolierten Ruptur des kaudalen Kreuzbandes bei dem Hund kam.

Es gehört zur Natur eines philosophischen Klassikers, dass er immer wieder neu interpretiert werden muss. Im Fall von Nietzsche reichen die Revisionen aber weiter. Nicht nur die Bedeutung, sondern auch der Wortlaut seiner Philosophie ist umstritten, was dazu führt, dass neue Interpreationenen nach neuen Editionen verlangen - und umgekehrt. Zuletzt haben der Basler Stroemfeld und der Göttinger Seidl Verlag je eine weiter Nietzsche-Ausgabe angekündigt. Jedes Wort, das der Philosoph auf Papier hinterlassen hat, ist längst transkribiert, historisch-kritisch kommentiert und mehrfach editert worden. Und dennoch sind die Herausgeber der neuen Ausgaben der Meinung, der echte Nietzsche sei uns über hundert Jahre nach seinem Tod noch immer unbekannt.

As Coale notes, over the long run human societies have been successful at maintaining a balance between population growth rates and economic resources. This has not been easy: some societies became extinct through overwhelming mortality or by failing to reproduce themselves, while others have burgeoned and outstripped their territories. Even at the end of the twentieth century, a hundred years after the onset of the demographic transition in Europe which transformed human birth and death rates forever, achieving the balance which creates homeostasis remains problematic. In east Asia alone, while the People's Republic of China is trying to bring the expected number of births per woman below 2.0, Japan is attempting the opposite, to raise the total fertility rate above its current level of 1.6. The same contests are being played out in developing and developed societies throughout the world. Thus creating a balance between birth and death rates and linking it to economic conditions so that a society neither outruns its economic resources nor fails to exploit them is a perduring human problem.

1. The time-course of the age-related decline in specific muscle force (maximum voluntary force per cross-sectional area) in men and women was determined by measuring the maximum voluntary force and cross-sectional area of the adductor pollicis muscle in 273 subjects aged 17–90 years (176 men, 30 premenopausal women and 67 peri- or post-menopausal women who were not receiving hormone replacement therapy). 2. To determine whether the loss of specific muscle force is hormone-dependent in women, we studied a further 25 women, aged 42–72 years, who were receiving hormone replacement therapy. 3. There was no significant difference in specific force between young men and pre-menopausal women. Around the time of the menopause there was a dramatic decline in specific force in women which was prevented by the use of hormone replacement therapy. In men the weakness started later (around the age of 60 years) and the decline in specific force was more gradual, reaching the level seen in postmenopausal women after the age of 75 years. 4. The protective effect of hormone replacement therapy on muscle strength is likely to be an important contributory factor to its proven action in preventing osteoporotic fractures. The dramatic peri-menopausal decline in muscle strength is a likely explanation for the known increases in falls and Colles’ fractures around the time of the menopause.

ZusammenfassungEin 2-jähriger Bearded Collie wurde nach präskrotaler Kastration mit dem Verdacht auf ein Hämoabdomen vorgestellt. Zum Zeitpunkt der Vorstellung war der Zustand des Hundes stabil und der Hämatokrit befand sich im Referenzbereich. Die sonographische Untersuchung zeigte im Abdomen eine moderate Menge an freier korpuskulärer Flüssigkeit, weshalb der Hund für eine laparoskopische Operation vorbereitet wurde. Im Bereich des Nabels wurde ein sogenannter „Single Port Access” durchgeführt, gefolgt von der Insufflation mit CO2 bei einem initialen Druck von 8 mmHg. Nach der Entfernung von ca. einem Liter Blut aus dem Abdomen mittels einer laparoskopischen Absaugvorrichtung waren die Inguinalkanäle einsehbar. Die Laparoskopie ermöglichte hier eine exzellente Darstellung der Inguinalkanäle mit den entsprechenden Gefäßen, die mithilfe eines Instruments zur Gefäßversiegelung verschlossen wurden. Der Hund erholte sich problemlos von der Operation und der postoperative Verlauf war komplikationslos. Der Fallbericht zeigt, dass sich bei einem Rüden mit Hämoabdomen nach präskrotaler Kastration eine laparoskopische Therapie durchführen lässt und diese in den Händen eines Chirurgen mit Erfahrung in minimalinvasiver Chirurgie als alternative Behandlungsmethode angesehen werden kann. Mit der Erfahrung bei diesem Fall stellt sich die Frage, ob ein Hämoabdomen in Zukunft nicht mehr als absolute Kontraindikation für eine Laparoskopie angesehen werden sollte, sondern nur eine relative Kontraindikation darstellt.

Zusammenfassung: Gegenstand und Ziel: Es werden Symptomatik und Verlauf einer Ivermectin-Vergiftung bei Hunden beschrieben, die durch die Aufnahme von Pferde-Wurmpaste (Ivomec P®, Deutschland bzw. Eqvalan®, Schweiz) verursacht wurde. Material und Methode: Dokumentation von drei Fällen. Ergebnisse: Zwei Hunde besaßen ein intaktes MDR1-Gen, während ein Hund von dem MDR1-Gen-Defekt betroffen war. Dementsprechend entwickelte sich eine unterschiedliche Symptomatik. Das klinische Leitsymptom bei den Hunden mit intaktem MDR1-Gen war eine symmetrische Mydriasis verbunden mit einer Visuseinschränkung bzw. vorübergehendem Visusverlust. Daneben wurden unkontrollierte Muskelzuckungen im Kopfbereich beobachtet. Eine ähnliche Symptomatik würde man bei einer oralen Einzeldosis von etwa 2,5–5 mg Ivermectin/kg Körpergewicht erwarten. Ein homozygot von dem MDR1-Gen-Defekt betroffener Collie (Fall 3) zeigte eine wesentlich gravierendere Symptomatik: Mydriasis, Apathie, Tremor und Hypersalivation, Koma mit krampfartigen Phasen begleitet von Schreien. Ein derartiger Verlauf wäre bei einem Hund mit homozygotem MDR1-Defekt nach einer oralen Einzeldosis von etwa 150–300 µg/kg KM zu erwarten. Schlussfolgerung: Für Hunde mit intaktem MDR1-Gen verlaufen derartige Intoxikationen vergleichsweise harmlos und sind von kurzer Dauer, während Hunde mit homozygotem MDR1-Gen-Defekt bereits bei der Aufnahme geringer Mengen Ivermectin-Wurmpaste für Pferde in den letalen Dosisbereich (≥ 0,2 mg/kg KM) kommen. Klinische Relevanz: Vergiftungen mit Ivermectin-Pferdepaste beim Hund kommen gelegentlich vor und müssen bei auffälliger Mydriasis mit oder ohne Visuseinschränkung differenzialdiagnostisch in Betracht gezogen werden.

<p>Uscito a pezzi dalla pesante crisi finanziaria e industriale del 1907, che aveva messo a nudo i limiti della struttura economica del Paese, il capitalismo industriale italiano elaborò un programma, portato avanti fino al primo dopoguerra, che prevedeva l’instaurazione di un governo di tecnocrati. Questo avrebbe dovuto trainare il Paese fuori dalla crisi, pianificarne l’economia e trasformarlo in una grande potenza industriale, con forti connotazioni imperialistiche. Segnali in tale direzione si erano registrati anche nei decenni precedenti, tra fine Ottocento e inizi Novecento, quando ebbe inizio un processo di concentrazione nel settore siderurgico e meccanico. Un percorso peraltro stimolato dalle commesse statali sempre più consistenti (Galli Della Loggia, 1970; Battilossi, 1999; Amatori e Colli, 1999; Bolchini, 2002). La crisi industriale e finanziaria del 1907 e la recessione a livello mondiale che ne seguì, accelerarono la soluzione tecnocratica, che prevedeva un’alleanza, più o meno stretta, con una parte della classe politica e l’entrata in guerra. Negli anni immediatamente seguenti il conflitto, il potere dei tecnocrati sulla scena politica italiana sembrò accrescersi notevolmente, soprattutto quando il governo progettò un programma di espansione economica nelle regioni del Caucaso, nei Balcani e nel Levante ex ottomano, territori in grado di fornire materie prime e di assorbire la produzione italiana in eccesso rispetto alle richieste di un mercato interno asfittico. La collaborazione tra mondo imprenditoriale, bancario e politico non produsse il risultato sperato. La caduta del governo Nitti e il ruolo destabilizzante e filotedesco della Banca Commerciale Italiana nell’Est europeo e nel Caucaso furono tra le cause principali che impedirono il decollo del progetto tecnocratico,<strong> </strong>provocando una dura reazione da parte dei fratelli Perrone alla guida del gruppo Ansaldo.</p><p>Heavily Weakened by the financial and industrial crisis of 1907, which showed all the limits of the economic structure of Italy, the Italian industrial capitalism developed a program that continued until the early after World War, which was taking into account the establishment of a government of technocrats.</p><p>This should had to take the country out of crisis, establish an economical plan and turn it into a major industrial power, with strong imperialist characteristics. Signals in this direction were also recorded in the previous decades, from the late nineteenth and early twentieth century, when a process of concentration of the main groups of entrepreneurs and capitalists began in the steel and mechanical industry. A path anyway enhanced by more and more orders from the government (Galli Della Loggia, 1970; Battilossi, 1999; Amatori and Colli, 1999; Boldrini, 2002). The industrial and financial crisis of 1907 and the global recession that followed, accelerated the technocratic solution, which were looking for a more or less closer alliance, with a part of the political class and going into war. Soon after the war, the political power of the technocrats in Italy seemed to grow significantly, especially when the Government developed a program of economic expansion in the regions of the Caucasus, Balkans and on the countries of the ex East Ottoman, these territories could provide raw materials and, with respect of an internal market completely saturated, to absorb the exceeding Italian production. The collaboration within the world of business, banking and politics did not produce the desired result. The fall of the Nitti´s Government and the pro German and destabilizing role of the Italian Commercial Bank in Eastern Europe and on the Caucasus were the major drivers against the launch of the technocratic project, inducing a though reaction by the Perrone brothers leading the group Ansaldo.</p>

Encontramos al analizar la incidencia de los diferentes tipos de prolapso, la edad, paridad, asociación con I.U.E. y síntomas que en más de la mitad de los casos corresponden a prolapso grado II (50.4%); de ellos los que cursaron sin Elongation Colli constituían el 39%, tenían más de 51 años y eran grandes multíparas, con 7 partos en promedio y el síntoma predominante era la sensación de cuerpo extraño asociado a I.U.E. en el 72.4%.En el prolapso grado III persiste la sensación de cuerpo extraño en un alto porcentaje, 66%, pero disminuye la I.U.E. a un 28.5%, siempre en grandes multíparas, promedio de 8 y en edad post-menopáusica, 58 años de promedio. Consideramos que indudablemente la multiparidad asociada a las fallas tróficas que ocasiona el hipoestrogenismo de la postmenopausia juega papel importante en las fallas del soporte genitourinario.Se practicó histerectomía vaginal como la técnica más frecuente para tratar el prolapso genital, 58%. Esto está de acuerdo con lo analizado por los diferentes autores del tema. En todas las cirugías la morbilidad intra-operatoria fue del 7.4%; en su mayor parte, 77% constituido por el sangrado profuso. Debemos entender que la mayoría de los casos son practicados por personal en entrenamiento, además del hecho de que los plexos venosos de la región favorecen esta situación.Las complicaciones post-operatorias constituyeron el 48%, siendo la retención urinaria la mayor causa, 51.4%, por encima de la infección.La estancia post-operatoria la consideramos realmente alta y guarda relación directa con las complicaciones intra y post operatorias, dando el mayor promedio la histerectomía vaginal. Como explicación tenemos que dadas las condiciones socio económicas de nuestras pacientes hospitalarias, la retención urinaria que podría ser manejada ambulatoriamente, la tratamos en forma ¡ntrahospitalaria.El 82% de la patología encontrada al estudio A.P. fue benigna, constituida por cambios propios del prolapso en un 48%; cervicitis crónica en un 16.5% y miomatosis uterina un 8%. Esto está de acuerdo con lo ordinariamente informado. Sin embargo, se encontraron en 6 casos de prolapso III asociación con displasia leve y moderada y un caso más informado después del estudio A.P. de la pieza quirúrgica como C.A. infiltrante de cervix, lo cual no es frecuente verlo informado.El seguimiento postoperatorio fue inadecuado, consiguiéndose únicamente que el 59% de las pacientes regresaron cuando menos una vez después del egreso hospitalario.La persistencia de I.U.E. se observó en el 47% de las pacientes que regresaron al control, siendo de suponer que es bastante más alto. Esto es explicable dado el concepto actualmente más aceptado de que las técnicas para la corrección del prolapso uretrovesical por vía vaginal no llenan los requisitos para la cura de la I.U.E.El porcentaje de curación obtenido con el tratamiento quirúrgico del prolapso fue superior al 72%, a excepción de los casos en los cuales se empleó la operación de Kelly modificada donde se encontró un fracaso del 45%, dado especialmente por la persistencia del síntoma de I.U.E. ya explicado.

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Distal radius fracture is one of the most common fractures. It may be sustained due to low-energy trauma or high-energy trauma. Objectives: To compare the clinical effectiveness of Kirschner wire fixation with and plaster immobilization for patients with fracture of the distal radius.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Interventions Kirschner wire fixation: wires are passed through the skin over the dorsal aspect of the distal radius and into the bone to hold the fracture in the correct anatomical position. About 79 patients with Distal Radial Fractures presented to MGM Medical College and LSK Hospital, Kishanganj between November 2012 and June 2014 were included in the study</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The majority were men (60.4%). Majority of the patients (69.8%) sustained the injury due to fall. The side of involvement was nearly equal and that there was no predominance of the either sides. In our study, according to AO classification, 31 cases were of Type A, 17 were of Type B and 5 were of Type C. The Anatomical evaluation by Sarmiento’s Criteria showed 33 patients with excellent result, 15 patients with good result and 5 with a fair result. At final follow-up by ‘The Gartland and Werley criteria for functional outcome’ 37 patients had excellent result, 13 had good result, 2 had fair result and 1 had a poor result. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">This study demonstrates that percutaneous Kirschner<strong> </strong>wire pinning is a minimally invasive technique that provides an effective means of maintaining the anatomical<strong> </strong>fracture reduction. It does not required highly skilled<strong> </strong>personnel or sophisticated tools for application. It is a<strong> </strong>suitable method for fixation of displaced Colles fracture with minimal intra-articular involvement. The technique involves a minimal procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.</span></p>

Red soda apple (Solanum capsicoides All.), a member of the Solanaceae, is a weed originally from Brazil (3). It is a perennial in southern Florida and is characterized by abundant prickles on stems, petioles, and leaves. Prickles on stems are more dense than those on its larger, noxious weed relative, tropical soda apple (Solanum viarum Dunal), and the mature red soda apple fruits are bright red in contrast to the yellow fruits of tropical soda apple (2). Virus-like foliar symptoms of light and dark green mosaic were observed on the leaves of a red soda apple in a Lee County cow pasture during a tropical soda apple survey during the fall of 2004. The appearance of necrotic local lesions following inoculation of Nicotiana tabacum cv. Xanthi nc with sap from the symptomatic red soda apple leaves suggested the presence of a tobamovirus. Tropical soda apple mosaic virus (TSAMV), a recently described tobamovirus isolated from tropical soda apple in Florida, was specifically identified by a double-antibody sandwich-ELISA (1). An additional six similarly symptomatic red soda apple plants were later collected in the Devils Garden area of Hendry County. Inoculation of N. tabacum cv. Xanthi nc with sap from each of these symptomatic plants also resulted in necrotic local lesions. Sequence analysis of the TSAMV coat protein (CP) gene amplified from total RNA by reverse transcription (RT)-PCR with a mixture of upstream (SolA5′CPv = 5′-GAACTTWCAGAAGMAGTYGTTGATGAGTT-3′; SolB5′CPv = 5′-GAACTCACTGARRMRGTTGTTGAKGAGTT-3′) and downstream (SolA3′CPvc = 5′-CCCTTCGATTTAAGTGGAGGGAAAAAC-3′; SolB3′CPvc = 5′-CGTTTMKATTYAAGTGGASGRAHAAMCACT-3′) degenerate primers flanking the CP gene of Solanaceae-infecting tobamoviruses confirmed the presence of TSAMV in all plants from both locations. Nucleotide and deduced amino acid sequences of the 483-bp CP gene were both 98 to 99% identical to the original TSAMV CP gene sequences in GenBank (Accession No. AY956381). TSAMV was previously identified in tropical soda apple in these two locations in Lee and Hendry counties and three other areas in Florida (1). Sequence analysis of the RT-PCR products also revealed the presence of Tomato mosaic virus in the plant from Lee County. To our knowledge, this represents the first report of natural TSAMV infection of any host other than tropical soda apple and suggests that TSAMV may be more widely distributed in solanaceous weeds than initially reported. References: (1) S. Adkins et al. Plant Dis. 91:287, 2007. (2) N. Coile. Fla. Dep. Agric. Consum. Serv. Div. Plant Ind. Bot. Circ. 27, 1993. (3) U.S. Dep. Agric., NRCS. The PLANTS Database. National Plant Data Center. Baton Rouge, LA. Published online, 2006.

Abstract. A tephrostratigraphic record covering the Marine Isotope Stages (MIS) 1–15 was established for the DEEP site record of Lake Ohrid (Macedonia and Albania). Major element analyses (energy dispersive spectroscopy (EDS) and wavelength-dispersive spectroscopy (WDS)) were carried out on juvenile fragments extracted from 12 tephra layers (OH-DP-0115 to OH-DP-2060). The geochemical analyses of the glass shards of all of these layers suggest an origin in the Italian volcanic provinces. They include the Y-3 (OH-DP-0115, 26.68–29.42 ka cal BP), the Campanian Ignimbrite–Y-5 (OH-DP-0169, 39.6 ± 0.1 ka), and the X-6 (OH-DP-0404, 109 ± 2 ka) from the Campanian volcanoes, the P-11 of Pantelleria (OH-DP-0499, 133.5 ± 2 ka), the Vico B (OH-DP-0617, 162 ± 6 ka) from the Vico volcano, the Pozzolane Rosse (OH-DP-1817, 457 ± 2 ka) and the Tufo di Bagni Albule (OH-DP-2060, 527 ± 2 ka) from the Colli Albani volcanic district, and the Fall A (OH-DP-2010, 496 ± 3 ka) from the Sabatini volcanic field. Furthermore, a comparison of the Ohrid record with tephrostratigraphic records of mid-distal archives related to the Mediterranean area allowed the recognition of the equivalents of other less known tephra layers, such as the TM24a–POP2 (OH-DP-0404, 102 ± 2 ka) recognized in the Lago Grande di Monticchio and the Sulmona Basin, the CF-V5–PRAD3225 (OH-DP-0624, ca. 163 ± 22 ka) identified in the Campo Felice Basin and the Adriatic Sea, the SC5 (OH-DP-1955, 493.1 ± 10.9 ka) recognized in the Mercure Basin, and the A11/12 (OH-DP-2017, 511 ± 6 ka) sampled at the Acerno Basin, whose specific volcanic sources are still poorly constrained. Additionally, one cryptotephra (OH-DP-0027) was identified by correlation of the potassium X-ray flourescence (XRF) intensities from the DEEP site with those from a short core of a previous study from Lake Ohrid. In these cores, a maximum in potassium is caused by glass shards, which were correlated with the Mercato tephra (8.43–8.63 ka cal BP) from Somma–Vesuvius. The tephrostratigraphic work presented here allows, for the first time, the extension of a consistent part of the Middle Pleistocene tephrostratigraphy of Italian volcanoes as far as the Balkans. The establishment of the tephrostratigraphic framework for the Lake Ohrid record provides important, independent tie points for the age–depth model of the DEEP site sequence, which is a prerequisite for palaeoclimatic and palaeoenvironmental reconstructions. Furthermore, this age–depth model will help to improve and re-evaluate the chronology of other, both undated and dated tephra layers from other records. Thus, the Lake Ohrid record may potentially become the template for the central Mediterranean tephrostratigraphy, especially for the hitherto poorly known and explored lower Middle Pleistocene period.

Abstract. A~tephrostratigraphic record covering the Marine Isotope Stages (MIS) 1–15 was established for the DEEP site record of Lake Ohrid (Macedonia/Albania). Major element analyses (SEM-EDS/WDS) were carried out on juvenile fragments extracted from 12 tephra layers (OH-DP-0115 to OH-DP-2060). The geochemical analyses of the glass shards of all of these layers suggest an origin from the Italian Volcanic Provinces. They include: the Y-3 (OH-DP-0115, 26.68–29.42 cal ka BP), the Campanian Ignimbrite/Y-5 (OH-DP-0169, 39.6 ± 0.1 ka), and the X-6 (OH-DP-0404, 109 ± 2 ka) from the Campanian volcanoes, the P-11 of the Pantelleria Island (OH-DP-0499, 129 ± 6 ka), the Vico B (OH-DP-0617, 162 ± 6 ka) from the Vico volcano, the Pozzolane Rosse (OH-DP-1817, 457 ± 2 ka) and the Tufo di Bagni Albule (OH-DP-2060, 527 ± 2 ka) from the Colli Albani volcanic district, and the Fall A (OH-DP-2010, 496 ± 3 ka) from the Sabatini volcanic field. Furthermore, a comparison of the Ohrid record with tephrostratigraphic records of mid-distal archives related to the Mediterranean area, allowed the recognition of the equivalents of other less known tephra layers, such as the TM24-a/POP2 (OH-DP-0404, 101.8 ka) from the Lago Grande di Monticchio and the Sulmona basin, the CF-V5/PRAD3225 (OH-DP-0624, ca. 162 ka) from the Campo Felice basin/Adriatic Sea, the SC5 (OH-DP-1955, 493.1 ± 10.9 ka) from the Mercure basin, and the A11/12 (OH-DP-2017, 511 ± 6 ka) from the Acerno basin, whose specific volcanic sources are still poorly constrained. Additionally, one cryptotephra (OH-DP-0027) was identified by correlation of the potassium XRF intensities from the DEEP site with those from short cores of previous studies from Lake Ohrid. In these cores, a maximum in potassium is caused by glass shards, which were correlated with the Mercato tephra (8.43–8.63 cal ka BP) from Somma-Vesuvius. With the tephrostratigraphic work, a consistent part of the Middle Pleistocene tephrostratigraphic framework of Italian volcanoes was for the first time extended as far as to the Balkans. The establishment of the tephrostratigraphic framework for the Lake Ohrid record provides important, independent tie-points for the age-depth model of the DEEP site sequence, which is a prerequisite for paleoclimatic and -environmental reconstructions. Furthermore, this age-depth model will help to improve and re-evaluate the chronology of other, both undated and dated tephra layers from other records. Thus, the Lake Ohrid record is candidate to become the Rosetta stone for the central Mediterranean tephrostratigraphy, especially for the hitherto poorly known and explored lower Middle Pleistocene period.

Lorenzo Colli and Tim Jones will receive the 2017 Study of the Earth’s Deep Interior Focus Group Award for Graduate Research at the 2017 American Geophysical Union Fall Meeting, to be held 11–15 December in New Orleans, La. This award is given annually “in recognition of advances that contribute to the understanding of the deep interior of the Earth or other planetary bodies using a broad range of observational, experimental, and/or theoretical approaches.”

Distal forearm fracture is one of the most frequently observed osteoporotic fractures, which may occur as a result of low energy falls such as falls from a standing height and may be linked to the osteoporotic nature of the bone, especially in the elderly. In order to prevent the occurrence of radius fractures and their adverse outcomes, understanding the effect of both extrinsic and intrinsic contributors to fracture risk is essential. In this study, a nonlinear fracture mechanics-based finite element model is applied to human radius to assess the influence of extrinsic factors (load orientation and load distribution between scaphoid and lunate) and intrinsic bone properties (age-related changes in fracture properties and bone geometry) on the Colles’ fracture load. Seven three-dimensional finite element models of radius were created, and the fracture loads were determined by using cohesive finite element modeling, which explicitly represented the crack and the fracture process zone behavior. The simulation results showed that the load direction with respect to the longitudinal and dorsal axes of the radius influenced the fracture load. The fracture load increased with larger angles between the resultant load and the dorsal axis, and with smaller angles between the resultant load and longitudinal axis. The fracture load also varied as a function of the load ratio between the lunate and scaphoid, however, not as drastically as with the load orientation. The fracture load decreased as the load ratio (lunate/scaphoid) increased. Multiple regression analysis showed that the bone geometry and the load orientation are the most important variables that contribute to the prediction of the fracture load. The findings in this study establish a robust computational fracture risk assessment method that combines the effects of intrinsic properties of bone with extrinsic factors associated with a fall, and may be elemental in the identification of high fracture risk individuals as well as in the development of fracture prevention methods including protective falling techniques. The additional information that this study brings to fracture identification and prevention highlights the promise of fracture mechanics-based finite element modeling in fracture risk assessment.

The focus of this paper is on the description of progressive fracture in distal radius in the event of a fall onto an outstretched hand. The inception of fracture, which involves formation of a macrocrack in the cortical tissue, is defined by invoking a macroscopic failure criterion that accounts for inherent anisotropy of the material. The subsequent propagation of damage is described by employing a homogenization procedure in which the average properties of cortical tissue intercepted by a macrocrack are established. The framework is verified by performing a series of nonlinear finite element analyses. In particular, the experimental tests recently conducted by the authors and their colleagues on a number of cadaver radii under boundary conditions leading to Colles’ fracture are simulated, and the results are compared with the experimental outcome.

A two-stage experimental program was conducted, which was aimed at examining the process of initiation/propagation of fracture in human radii under the conditions simulating a fall onto an outstretched hand. It involved a number of destructive tests on dried cadaver bones. The bones were first subjected to DXA as well as spiral CT measurements to establish the density properties and the details of geometry. Subsequently, the specimens were tested under controlled boundary conditions, to induce Colles’ type of fracture. Following these tests, samples of cortical bone tissue were extracted at different orientations with respect to the direction of osteons and tested in axial tension. The results of material tests were used to verify the performance of an anisotropic fracture criterion for the cortical tissue. It has been demonstrated that the proposed criterion can reproduce the basic trends in the directional dependence of the tensile strength characteristics. For the structural tests, a correlation was established between the geometric characteristics of the cortex, the strength properties and the fracture load for individual radii that were tested. It was shown that the morphological traits and/or the strength properties alone are not adequate predictors of the fracture load of intact radii. A rational assessment of the fracture load requires a mechanical analysis that incorporates the key elements of the experimental program outlined here, i.e., the information on bone geometry, material properties of the bone tissue, and the static/kinematic boundary conditions. A preliminary example of a finite element analysis, for one of the radii bones tested, has been provided.

Critical as they are for humans and nature, freshwater ecosystems are threatened—but the extent and depth of these threats are not well understood, especially if essential biodiversity data are lacking. Any policy aimed at protecting such ecosystems must first assess the threat factors and the potential harm, well before proposing conservation measures such as the creation and development of Protected Areas (PAs). These assessments must be done using a deep and sound knowledge of the actual and potential biodiversity variables. Freshwater ecosystems have been largely neglected in traditional PA design and management (Abell et al. 2007), be it for scarcity of biodiversity data, or for more perception-related reasons such as visibility and accessibility driving the allocation of conservation resources to more data-rich environments. In an effort to contribute to shifting this state of affairs, we have developed an irreplaceability index to identify the most relevant places to achieve conservation aims for freshwater fish, based on the International Union for the Conservation of Nature (IUCN) Red List, which, in turn, should be founded on available biodiversity data upon which expert knowledge is based (Le Saout 2013). However, we found large assessment gaps in the IUCN Red List for freshwater fish. These gaps may result from the non-systematic acquisition of primary biodiversity data, which could eventually be alleviated by coordinated policies promoting ecosystem surveys tailored at increasing the availability and spread of such data, while identifying, targeting and prioritizing hotspots. Obtaining valid conclusions from low-assessment areas such as South America, which are simultaneously biodiversity and endangerment hotspots (Collen 2014), is particularly troublesome. Building an irreplaceability index requires access to abundant, fine-scale biodiversity data. When combined with the assessment information available in the IUCN Red List, we can identify those areas where low assessment rates for highly irreplaceable rivers become keystones to protect freshwater biodiversity, and can therefore suggest actions for policy makers to take at both regional and local scales. In particular, we have thus identified those irreplaceable rivers that fall outside the current net of PAs. In a context of inadequate investment in biodiversity conservation (Juffe-Bignoli et al. 2016), our findings and the informatics-powered methods we propose, will hopefully help decision makers establish conservation priorities and allocate funds to preserve irreplaceable rivers and their fish fauna. Furthermore, the necessity of improving the IUCN Red List in low-assessed areas, requires synergies among IUCN, Global Biodiversity Information Facility (GBIF) and conservation scientists to achieve accurate and reliable assessments.

Wearing clothing from the past is all the rage now. Different styles and aesthetics of vintage and historical clothing, original or appropriated, are popular with fashion wearers and home sewers. Social media is rich with images of anachronistic clothing and the major pattern companies have a large range of historical sewing patterns available. Butterick McCall, for example, have a Making History range of patterns for sewers of clothing from a range of historical periods up to the 1950s. The 1950s styled fashion is particularly popular with pattern producers. Yet little research exists that explains why anachronistic clothing is all the rage. Drawing on 28 interviews conducted by the author with women who wear/make 1950s styles clothing and a survey of 229 people who wear/make historical clothing, this article outlines four key reasons that help explain the popularity of wearing/making anachronistic clothing: It argues that there exists rage against four ‘fast fashion’ practices: environmental disregard, labour breaches, poor quality, and poor fit. Ethical consumption practices such as home sewing quality clothes that fit, seeks to ameliorate this rage. That much of what is being made is anachronistic speaks to past sewing techniques that were ethical and produced quality fitting garments rather than fashion today that doesn’t fit, is of poor quality, and it unethical in its production. Fig. 1: Craftivist Collective Rage: Protesting Fast FashionRage against Fast Fashion Rage against fast fashion is not new. Controversies over Disney and Nike’s use of child labour in the 1990s, the anti-fur campaigns of the 1980s, the widespread condemnation of factory conditions in Bangladesh in the wake of the 2016 Rana Plaza collapse and Tess Holiday’s Eff Your Beauty Standards campaign, are evidence of this. Fast fashion is “cheap, trendy clothing, that samples ideas from the catwalk or celebrity culture and turns them into garments … at breakneck speed” (Rauturier). It is produced cheaply in short turnarounds, manufactured offshore by slave labour, with the industry hiding these exploitative practices behind, and in, complex supply chains. The clothing is made from poor quality material, meaning it doesn’t last, and the material is not environmentally sustainable. Because of this fast fashion is generally not recycled and ends up as waste in landfills. This for Rauturier is what fast fashion is: “cheap, low quality materials, where clothes degrade after just a few wears and get thrown away”. The fast fashion industry engages in two discrete forms of obsolescence; planned and perceived. Planned obsolescence is where clothes are designed to have a short life-span, thus coercing the consumer into buying a replacement item sooner than intended. Claims that clothes now last only a few washes before falling apart are common in the media (Dunbar). This is due to conscious manufacturing techniques that reduce the lifespan of the clothes including using mixed fibres, poor-quality interfacing, and using polyester threads, to name a few. Perceived obsolescence is where the consumer believes an otherwise functioning item of clothing to no longer to be valued. This is borne out in the idea that an item is deemed to be “in vogue” or “in fashion” and its value to the consumer is thus embedded in that quality. Once it falls out of fashion is deemed worthless. Laver’s “fashion cycle” elucidated this idea over eighty years ago. Since the 1980s the fashion industry has sped up, moving from the traditional twice annual fashion seasons to the fast fashion system of constantly manufacturing new styles, sometimes weekly. The technologies that have allowed the rapid manufacturing of fast fashion mean that the clothes are cheaper and more readily available. The average price of clothing has dropped accordingly. An item that cost US$100 in 1993 only cost US$59.10 in 2013, a drop of 41 per cent (Perry, Chart). The average person in 2014 bought 60 per cent more clothing that they did in 2000. Fast fashion is generally unsaleable in the second-hand market, due to its volume and poor design and manufacture. Green notes that many charity clothing stores bin a large percentage of the fast fashion items they receive. Environmental Rage Consumers are increasingly expressing rage about the environmental impact of fast fashion. The production of different textiles places different stresses on the environment. Cotton, for example, accounts for one third of the fibres found in all textiles, yet it requires high levels of water. A single cotton shirt needs 2,700 litres of water alone, the equivalent to “what one person drinks in two-and-a-half years” (Drew & Yehounme). Synthetics don’t represent an environmentally friendly alternative. While they may need less water, they are more carbon-intensive and polyester has twice the carbon footprint of cotton (Drew & Yehounme). Criticisms of fast fashion also include “water pollution, the use of toxic chemicals and increasing levels of textile waste”. Textile dyeing is the “second largest polluter of clean water globally.” The inclusion of chemical in the manufacturing of textiles is “disruptive to hormones and carcinogenic” (Perry, Cost). Naomi Klein’s exposure of the past problems of fast fashion, and revelations such as these, inform why consumers are enraged by the fast fashion system. The State of Fashion 2019 Report found many of the issues Klein interrogated remain of concern to consumers. Consumers continue to feel enraged at the industry’s disregard for the environment (Shaw et al.) any many are seeking alternative sources of sustainable fashion. For some consumers, the ethical dilemmas are overcome by purchasing second-hand or recycled clothing, or participate in Clothing Exchanges. Another alternative to ameliorating the rage is to stop buying new clothes and to make and wear their own clothes. A recent article in The Guardian, “’Don’t Feed the Monster!’ The People Who Have Stopped Buying New Clothes” highlights the “growing movement” of people seeking to make a “personal change” in response to the ethical dilemmas fast fashion poses to the environment. While political groups like Fashion of Tomorrow argue for collective legislative changes to ensure environmental sustainability in the industry, consumers are also finding their own individual ways of ameliorating their rage against fast fashion. Over recent decades Australians have consistently shown concern over environmental issues. A 2016 national survey found that 63 per cent of Australians considered themselves to be environmentalists and this is echoed in the ABC’s War on Waste programme which examined attitudes to and effects of clothing waste in Australia. In my interviews with women wearing 1950s style clothing, almost 65 per cent indicated a distinct dissatisfaction with mainstream fashion and frustration particularly with pernicious ‘fast fashion’. One participant offered, “seeing the War on Waste and all the fast fashion … I really like if I can get it second hand … you know I feel like I am helping a little bit” [Gabrielle]. Traid, a network of UK charity clothes shops diverts 3 000 tonnes of clothes from landfill to the second-hand market annually, reported for 2017-18 a 30 per cent increase in its second-hand clothes sales (Coccoza). The Internet has helped expand the second-hand clothing market. Two participants offered these insights: “I am completely addicted to the Review Buy Swap and Sell Page” [Anna] and “Instagram is huge for girls like us to communicate and get ideas” [Ashleigh]. Slave Rage The history of fashion is replete with examples of exploitation of workers. From the seamstresses of France in the eighteenth century who had to turn to prostitution to supplement their meagre wages (Jones 16) to the twenty-first century sweatshop workers earning less than a living wage in developing nations, poor work conditions have plagued the industry. For Karl Marx fashion represented a contradiction within capitalism where labour was exploited to create a mass-produced item. He lambasted the fashion industry and its “murderous caprices”, and despite his dream that the invention of the sewing machine would alleviate the stress placed on garment workers, technology has only served to intensify its demands on its poor workers (Sullivan 36-37). The 2013 Rena Plaza factory disaster shows just how far some sections of the industry are willing to go in their race to the bottom.In the absence of enforceable, global fair-trade initiatives, it is hard for consumers to purchase goods that reflect their ethos (Shaw et al. 428). While there is much more focus on better labour practices in the fashion industry, as the Baptist World Aid Australia’s annual Ethical Fashion Report shows, consumers are still critical of the industry and its labour practices.A significant number of participants in my research indicated that they actively sought to purchase products that were produced free from worker exploitation. For some participants, the purchasing of second-hand clothing allowed them to circumnavigate the fast fashion system. For others, mid-century reproduction fashion was sourced from markets with strong labour laws and “ethically made” without the use of sweat shop labour” [Emma]. Alternatively, another participant rejected buying new vintage fashion and instead purchased originally made fashion, in this case clothing made 50 to 60 years ago. This was one was of ensuring “some poor … person has [not] had to work really hard for very little money … [while the] shop is gaining all the profits” [Melissa]. Quality Rage Planned obsolescence in fashion has existed at least since the 1940s when Dupont ensured their nylon stockings were thin enough to ladder to ensure repeat custom (Meynen). Since then manufacturers have deliberately used poor techniques and poor material – blended fabrics, unfinished seams, unfixed dyes, for example – to ensure that clothes fail quickly. A 2015 UK Barnardo’s survey found clothes were worn an average of just seven times, which is not surprising given that clothes can last as little as two washes before being worn out (Dunbar). Extreme planned obsolescence in concert with perceived obsolescence can lead to clothes being discarded before their short lifespan had expired. The War on Waste interviewed young women who wore clothes sometimes only once before discarding them.Not all women are concerned with keeping up to date with fashion, instead wanting to create their own identify though clothes and are therefore looking for durability in their clothes. Many of the women interviewed for this research were aware of the declining quality of clothes, often referring to those made before the fast fashion era as evidence of quality clothing. For many in this study, manufacturing of classically styled clothing was of higher concern than mimicking the latest fashion trend. Some indicated their “disgust” at the poor quality of fast fashion [Gabrielle]. Others has specific outrage at the cost of poorly made fast fashion: “I don’t like spending a lot of money on clothing that I know may not necessarily be well made” [Skye] and “I got sick of dresses just being see through … you know, seeing my bras under things” [Becky]. For another: “I don’t like the whole mass-produced thing. I don’t think that they are particularly well made … Sometimes they are made with a tiny waist but big boobs, there’s no seams on them, they’re just overlocked together …” [Vicky]. For other participants in this research fast fashion produced items were considered inferior to original items. One put it is this way: “[On using vintage wares] If something broke, you fixed it. You didn’t throw it away and go down to [the shop] and buy a new one ... You look at stuff from these days … you could buy a handbag today and you are like “is this going to be here in two years? Or is it going to fall apart in my hands?” … there’s that strength and durability that I do like” [Ashleigh]. For another, “vintage reproduction stuff is so well made, it’s not like fast fashion, like Vivien of Holloway and Pin Up Girl Clothing, their pieces last forever, they don’t fall apart after five washes like fast fashion” [Emma]. The following encapsulates the rage felt in response to fast fashion. I think a lot of people are wearing true vintage clothing more often as a kind of backlash to the whole fast fashion scene … you could walk into any shop and you could see a lot of clothing that is very, very cheap, but it’s also very cheaply made. You are going to wear it and it’s going to fall apart in six months and that is not something that I want to invest in. [Melissa]Fit RageFit is a multi-faceted issue that affects consumers in several ways: body size; body shape; and height. Body size refers to the actual physical size of the body, whether one is underweight, slim, average, muscular or fat. Fast fashion body size labelling reflects what the industry considers to be of ‘normal sizes’, ranging from a size 8 through to a size 16 (Hackett & Rall). Body shape is a separate, if not entirely discrete issue. Women differ widely in the ratios between their hips, bust and waist. Body shape distribution varies widely within populations, for example, the ‘Size USA’ study identified 11 different female body shapes with wide variations between populations (Lee et al.). Even this doesn’t consider bodies with physical disabilities. Clothing is designed to fit women of ‘average’ height, thus bodies that are taller or shorter are often excluded from fast fashion (Valtonen). Even though Australian sizing practices are based on erroneous historical data (Hackett and Rall; Kennedy), the fast fashion system continues to manufacture for average body shapes and average body heights, to the exclusion of others. Discrimination through clothing sizes represents one way in which social norms are reinforced. Garments for larger women are generally regarded as less fashionable (Peters 48). Enraged consumers label some of the offerings ‘fat sacks’, ‘tents’ and ‘camouflage wear’ (Colls 591-592). Further, plus size is often more expensive and having been ‘sized up’ from smaller sizes, the result is poor fit. Larger body’s therefore have less autonomy in fashioning their identity (Peters 45). Size restrictions can lead to consumers having to choose between going without a desired item or wearing a size too small for them as no larger alternative is available (Laitala et al. 33-34).The ideology behind the thin aesthetic is that it is framed as aspirational (Barry) and thus consumers are motivated to purchase clothes based upon a desire to fit in with this beauty ideal. This is a false dichotomy (Halliwell and Dittmar 105; Bian and Wang). For participants in this research rage at fashion fashions persistance in producing for ‘average’ sized women was clearly evident. For a plus-size participant: “I don’t suit modern stuff. I’m a bigger girl and that’s not what style is these days. And so, I find it just doesn’t work for me” [Ashleigh]. For non-plus participants, sizing rage was also evident: I’m just like a praying mantis, a long string bean. I’m slim, tall … I do have the body shape … that fast fashion catered for, and I can still dress in fast fashion, but I think the idea that so many women feel excluded by that kind of fashion, I just want to distance myself from it. So, so many women have struggles in the change rooms in shopping centres because things don’t fit them nicely. [Emma] For this participant reproduction fashion wasn’t vanity sized. That is, a dress from the 1950s had the body measurements on the label rather than a number reflecting an arbitrary and erroneous sizing system. Some noted their disregard for standardised sizing systems used exclusively for fast fashion: “I have very non-standard measurements … I don’t buy dresses for that reason … My bust and my waist and my hips don’t fit a standard. You know I can’t go “ooh that’s a 12, that’s an 18”. You know, I don’t believe in standard sizing basically” [Skye]. Variations of sizing by brands adds to the frustration of fashion consumers: “if someone says 'I’m a size 16' that means absolutely nothing. If you go between brands … [shop A] XXL to a [shop B] to a [shop C] XXL to a [shop D] XXL, you know … they’re not the same. They won’t fit the same, they don’t have the same fit” [Skye]. These women recognise that their body shape, size and/or height is not catered for by fast fashion. This frees them to look for alternatives beyond the product offerings of the mainstream fashion industry. Although the rage against aspects of fast fashion discussed here – environmental, labour, quality and fit – is not seeing people in the streets protesting, people are actively choosing to find alternatives to the problem of sourcing clothes that fit their ethos. ReferencesABC Television. "Coffee Cups and Fast Fashion." War on Waste. 30 May 2017. Barnardo's. "Once Worn, Thrice Shy – British Women’s Wardrobe Habits Exposed!" 11 June 2015. 1 Mar. 2019 <http://www.barnardos.org.uk/news/press_releases.htm?ref=105244http://www.barnardos.org.uk/news/press_releases.htm?ref=105244>.Barry, Ben. "Selling Whose Dream? A Taxonomy of Aspiration in Fashion Imagery." Fashion, Style & Popular Culture 1.2 (2014): 175-92.Cocozza, Paula. “‘Don’t Feed The Monster!’ The People Who Have Stopped Buying New Clothes”. The Guardian 19 Feb. 2019. 20 Feb. 2019 <http://www.theguardian.com/fashion/2019/feb/19/dont-feed-monster-the-people-who-have-stopped-buying-new-clothes#comment-126048716>.Colls, Rachel. "‘Looking Alright, Feeling Alright’: Emotions, Sizing and the Geographies of Women's Experiences of Clothing Consumption." Social & Cultural Geography 5.4 (2004): 583-96.Drew, Deborah, and Genevieve Yehounme. "The Apparel Industry’s Environmental Impact in 6 Graphics." World Resources Institute July 2005. 24 Feb. 2018 <http://www.wri.org/blog/2017/07/apparel-industrys-environmental-impact-6-graphics>.Dunbar, Polly. "How Your Clothes Are Designed to Fall Apart: From Dodgy Stitching to Cheap Fabrics, Today's Fashions Are Made Not to Last – So You Have to Buy More." Daily Mail 18 Aug. 2016. 25 Feb. 2018 <http://www.dailymail.co.uk/femail/article-3746186/Are-clothes-fall-apart-dodgy-stitching-cheap-fabrics-today-s-fashions-designed-not-buy-more.htmlhttp://www.dailymail.co.uk/femail/article-3746186/Are-clothes-fall-apart-dodgy-stitching-cheap-fabrics-today-s-fashions-designed-not-buy-more.html>.Hackett, Lisa J., and Denise N. Rall. "The Size of the Problem with the Problem of Sizing: How Clothing Measurement Systems Have Misrepresented Women’s Bodies from the 1920s – Today." Clothing Cultures 5.2 (2018): 263-83.Kennedy, Kate. "What Size Am I? Decoding Women's Clothing Standards." Fashion Theory 13.4 (2009): 511-30.Klein, Naomi. No Logo, No Space, No Choice, No Jobs: Taking Aim at the Brand Bullies. London: Flamingo, 2000.Laitala, Kirsi, Ingun Grimstad Klepp, and Benedict Hauge. "Materialised Ideals Sizes and Beauty." Culture Unbound: Journal of Current Cultural Research 3 (2011): 19-41.Laver, James. Taste and Fashion. London: George G. Harrap, 1937.Lee, Jeong Yim, Cynthia L. Istook, Yun Ja Nam, Sun Mi Pak. "Comparison of Body Shape between USA and Korean Women." International Journal of Clothing Science and Technology 19.5 (2007): 374-91.Perry, Mark J. "Chart of the Day: The CPI for Clothing Has Fallen by 3.3% over the Last 20 Years, while Overall Prices Increased by 63.5%." AEIdeas 12 Oct. 2013. 4 Jan. 2019 <http://www.aei.org/publication/chart-of-the-day-the-cpi-for-clothing-has-fallen-by-3-3-over-the-last-20-years-while-overall-prices-increased-by-63-5/http://www.aei.org/publication/chart-of-the-day-the-cpi-for-clothing-has-fallen-by-3-3-over-the-last-20-years-while-overall-prices-increased-by-63-5/>. Perry, Patsy. “The Environmental Cost of Fast Fashion.” Independent 8 Jan. 2018. 1 Mar. 2019 <https://www.independent.co.uk/life-style/fashion/environment-costs-fast-fashion-pollution-waste-sustainability-a8139386.html>.Peters, Lauren Downing. "You Are What You Wear: How Plus-Size Fashion Figures in Fat Identity Formation." Fashion Theory 18.1 (2014): 45-71.Rauturier, Solene. “What Is Fast Fashion?” 1 Aug. 2010. 1 Mar. 2019 <https://goodonyou.eco/what-is-fast-fashion/>.Shaw, Deirdre, Gillian Hogg, Edward Shui, and Elaine Wilson. "Fashion Victim: The Impact of Fair Trade Concerns on Clothing Choice." Journal of Strategic Marketing 14.4 (2006): 427-40.Sullivan, Anthony. "Karl Marx: Fashion and Capitalism." Thinking through Fashion. Eds. Agnès Rocamora and Anneke Smelik. London: I.B. Tauris, 2016. 28-45. Valtonen, Anu. "Height Matters: Practicing Consumer Agency, Gender, and Body Politics." Consumption Markets & Culture 16.2 (2013): 196-221.

Story spreads out through time the behaviors or bodies – the shapes – a self has been or will be, each replacing the one before. Hence a story has before and after, gain and loss. It goes somewhere…Moreover, shape or body is crucial, not incidental, to story. It carries story; it makes story visible; in a sense it is story. Shape (or visible body) is in space what story is in time. (Bynum, quoted in Garland Thomson, 113-114) Drawing on Goffman’s classic work on stigma, research documenting the existence of discrimination and bias against individuals classified as obese goes back five decades. Since Cahnman published “The Stigma of Obesity” in 1968, other researchers have well documented systematic and growing discrimination against fat people (cf. Puhl and Brownell; Puhl and Heuer; Puhl and Heuer; Fikkan and Rothblum). While weight-based stereotyping has a long history (Chang and Christakis; McPhail; Schwartz), contemporary forms of anti-fat stigma and discrimination must be understood within a social and economic context of neoliberal healthism. By neoliberal healthism (see Crawford; Crawford; Metzel and Kirkland), I refer to the set of discourses that suggest that humans are rational, self-determining actors who independently make their own best choices and are thus responsible for their life chances and health outcomes. In such a context, good health becomes associated with proper selfhood, and there are material and social consequences for those who either unwell or perceived to be unwell. While the greatest impacts of size-based discrimination are structural in nature, the interpersonal impacts are also significant. Because obesity is commonly represented (at least partially) as a matter of behavioral choices in public health, medicine, and media, to “remain fat” is to invite commentary from others that one is lacking in personal responsibility. Guthman suggests that this lack of empathy “also stems from the growing perception that obesity presents a social cost, made all the more tenable when the perception of health responsibility has been reversed from a welfare model” (1126). Because weight loss is commonly held to be a reasonable and feasible goal and yet is nearly impossible to maintain in practice (Kassierer and Angell; Mann et al.; Puhl and Heuer), fat people are “in effect, asked to do the impossible and then socially punished for failing” (Greenhalgh, 474). In this article, I explore how weight-based stigma shaped the decisions of bariatric patients to undergo weight loss surgery. In doing so, I underline the work that emotion does in circulating anti-fat stigma and in creating categories of subjects along lines of health and responsibility. As well, I highlight how fat bodies are lived and negotiated in space and place. I then explore ways in which participants take up notions of time, specifically in regard to risk, in discussing what brought them to the decision to have bariatric surgery. I conclude by arguing that it is a dynamic interaction between the material, social, emotional, discursive, and the temporal that produces not only fat embodiment, but fat subjectivity “failed”, and serves as an impetus for seeking bariatric surgery. Methods This article is based on 30 semi-structured interviews with American bariatric patients. At the time of the interview, individuals were between six months and 12 years out from surgery. After obtaining Intuitional Review Board approval, recruitment occurred through a snowball sample. All interviews were audio-taped with permission and verbatim interview transcripts were analyzed by means of a thematic analysis using Dedoose (www.dedoose.com). All names given in this article are pseudonyms. This work is part of a larger project that includes two additional interviews with bariatric surgeons as well as participant-observation research. Findings Navigating Anti-Fat Stigma In discussing what it was like to be fat, all but one of the individuals I interviewed discussed experiencing substantive size-based stigma and discrimination. Whether through overt comments, indirect remarks, dirty looks, open gawking, or being ignored and unrecognized, participants felt hurt, angry, and shamed by friends, family, coworkers, medical providers, and strangers on the street because of the size of their bodies. Several recalled being bullied and even physically assaulted by peers as children. Many described the experience of being fat or very fat as one of simultaneous hypervisibility and invisibility. One young woman, Kaia, said: “I absolutely was not treated like a person … . I was just like this object to people. Just this big, you know, thing. That’s how people treated me.” Nearly all of my participants described being told repeatedly by others, including medical professionals, that their inability to lose weight was effectively a failure of the will. They found these comments to be particularly hurtful because, in fact, they had spent years, even decades, trying to lose weight only to gain the weight back plus more. Some providers and family members seemed to take up the idea that shame could be a motivating force in weight loss. However, as research by Lewis et al.; Puhl and Huerer; and Schafer and Ferraro has demonstrated, the effect this had was the opposite of what was intended. Specifically, a number of the individuals I spoke with delayed care and avoided health-facilitating behaviors, like exercising, because of the discrimination they had experienced. Instead, they turned to health-harming practices, like crash dieting. Moreover, the internalization of shame and blame served to lower a sense of self-worth for many participants. And despite having a strong sense that something outside of personal behavior explained their escalating body weights, they deeply internalized messages about responsibility and self-control. Danielle, for instance, remarked: “Why could the one thing I want the most be so impossible for me to maintain?” It is important to highlight the work that emotion does in circulating such experiences of anti-fat stigma and discrimination. As Fraser et al have argued in their discussion on fat and emotion, the social, the emotional, and the corporeal cannot be separated. Drawing on Ahmed, they argue that strong emotions are neither interior psychological states that work between individuals nor societal states that impact individuals. Rather, emotions are constitutive of subjects and collectivities, (Ahmed; Fraser et al.). Negative emotions in particular, such as hate and fear, produce categories of people, by defining them as a common threat and, in the process, they also create categories of people who are deemed legitimate and those who are not. Thus following Fraser et al, it is possible to see that anti-fat hatred did more than just negatively impact the individuals I spoke with. Rather, it worked to produce, differentiate, and drive home categories of people along lines of health, weight, risk, responsibility, and worth. In this next section, I examine the ways in which anti-fat discrimination works at the interface of not only the discursive and the emotive, but the material as well. Big Bodies, Small Spaces When they discussed their previous lives as very fat people, all of the participants made reference to a social and built environment mismatch, or in Garland Thomson’s terms, a “misfit”. A misfit occurs “when the environment does not sustain the shape and function of the body that enters it” (594). Whereas the built environment offers a fit for the majority of bodies, Garland Thomson continues, it also creates misfits for minority forms of embodiment. While Garland Thomson’s analysis is particular to disability, I argue that it extends to fat embodiment as well. In discussing what it was like to navigate the world as fat, participants described both the physical and emotional pain entailed in living in bodies that did not fit and frequently discussed the ways in which leaving the house was always a potential, anxiety-filled problem. Whereas all of the participants I interviewed discussed such misfitting, it was notable that participants in the Greater New York City area (70% of the sample) spoke about this topic at length. Specifically, they made frequent and explicit mentions of the particular interface between their fat bodies and the Metropolitan Transit Authority (MTA), and the tightly packed spaces of the city itself. Greater New York City area participants frequently spoke of the shame and physical discomfort in having to stand on public transportation for fear that they would be openly disparaged for “taking up too much room.” Some mentioned that transit seats were made of molded plastic, indicating by design the amount of space a body should occupy. Because they knew they would require more space than what was allotted, these participants only took seats after calculating how crowded the subway or train car was and how crowded it would likely become. Notably, the decision to not take a seat was one that was made at a cost for some of the larger individuals who experienced joint pain. Many participants stated that the densely populated nature of New York City made navigating daily life very challenging. In Talia’s words, “More people, more obstacles, less space.” Participants described always having to be on guard, looking for the next obstacle. As Candice put it: “I would walk in some place and say, ‘Will I be able to fit? Will I be able to manoeuvre around these people and not bump into them?’ I was always self-conscious.” Although participants often found creative solutions to navigating the hostile environment of both the MTA and the city at large, they also identified an increasing sense of isolation that resulted from the physical discomfort and embarrassment of not fitting in. For instance, Talia rarely joined her partner and their friends on outings to movies or the theater because the seats were too tight. Similarly, Decenia would make excuses to her husband in order to avoid social situations outside of the home: “I’d say to my husband, ‘I don’t feel well, you go.’ But you know what? It was because I was afraid not to fit, you know?” The anticipatory scrutinizing described by these participants, and the anxieties it produced, echoes Kirkland’s contention that fat individuals use the technique of ‘scanning’ in order to navigate and manage hostile social and built environments. Scanning, she states, involves both literally rapidly looking over situations and places to determine accessibility, as well as a learned assessment and observation technique that allows fat people to anticipate how they will be received in new situations and new places. For my participants, worries about not fitting were more than just internal calculation. Rather, others made all too clear that fat bodies are not welcome. Nina recalled nasty looks she received from other subway riders when she attempted to sit down. Decenia described an experience on a crowded commuter train in which the woman next to her openly expressed annoyance and disgust that their thighs were touching. Talia recalled being aggressively handed a weight loss brochure by a fellow passenger. When asked to contrast their experiences living in New York City with having travelled or lived elsewhere, participants almost universally described the New York as a more difficult place to live for fat people. However, the experiences of three of the Latinas that I interviewed troubled this narrative. Katrina felt that the harassment she received in her country of origin, the Dominican Republic, was far worse than what she now experienced in the New York Metropolitan Area. Although Decenia detailed painful experiences of anti-fat stigma in New York City, she nevertheless described her life as relatively “easy” compared to what it was like in her home country of Brazil. And Denisa contrasted her neighbourhood of East Harlem with other parts of Manhattan: “In Harlem it's different. Everybody is really fat or plump – so you feel a bit more comfortable. Not everybody, but there's a mix. Downtown – there's no mix.” Collectively, their stories serve as a reminder (see Franko et al.; Grabe and Hyde) to be suspicious of over determined accounts that “Latino culture” is (or people of colour communities in general are), more accepting of larger bodies and more resistant to weight-based stigma and discrimination. Their comments also reflect arguments made by Colls, Grosz, and Garland Thomson, who have all pointed to the contingent nature between space and bodies. Colls argue that sizing is both a material and an emotional process – what size we take ourselves to be shifts in different physical and emotional contexts. Grosz suggests that there is a “mutually constitutive relationship between bodies and cities” – one that, I would add, is raced, classed, and gendered. Garland Thomson has described the relationship between bodies and space/place as “a dynamic encounter between world and flesh.” These encounters, she states, are always contingent and situated: “When the spatial and temporal context shifts, so does the fit, and with it meanings and consequences” (592). In this sense, fat is materialized differently in different contexts and in different scales – nation, state, city, neighbourhood – and the materialization of fatness is always entangled with raced, classed, and gendered social and political-economic relations. Nevertheless, it is possible to draw some structural commonalities between divergent parts of the Greater New York City Metropolitan Area. Specifically, a dense population, cramped physical spaces, inaccessible transportation and transportation funding cuts, social norms of fast paced life, and elite, raced, classed, and gendered norms of status and beauty work to materialize fatness in such a way that a ‘misfit’ is often the result for fat people who live and/or work in this area. And importantly, misfitting, as Garland Thomson argues, has consequences: it literally “casts out” when the “shape and function of … bodies comes into conflict with the shape and stuff of the built world” (594). This casting out produces some bodies as irrelevant to social and economic life, resulting in segregation and isolation. To misfit, she argues, is to be denied full citizenship. Responsibilising the Present Garland Thomson, discussing Bynum’s statement that “shape carries story”, argues the following: “the idea that shape carries story suggests … that material bodies are not only in the spaces of the world but that they are entwined with temporality as well” (596). In this section, I discuss how participants described their decisions to get weight loss surgery by making references to the need take responsibility for health now, in the present, in order to avoid further and future morbidity and mortality. Following Adams et al., I look at how the fat body is lived in a state of constant anticipation – “thinking and living toward the future” (246). All of the participants I spoke with described long histories of weight cycling. While many managed to lose weight, none were able to maintain this weight loss in the long term – a reality consistent with the medical fact that dieting does not produce durable results (Kassirer and Angell; Mann et al.; Puhl and Heuer). They experienced this inability as not only distressing, but terrifying, as they repeatedly regained the lost weight plus more. When participants discussed their decisions to have surgery, they highlighted concerns about weight related comorbidities and mobility limitations in their explanations. Consistent then with Boero, Lopez, and Wadden et al., the participants I spoke with did not seek out surgery in hopes of finding a permanent way to become thin, but rather a permanent way to become healthy and normal. Concerns about what is considered to be normative health, more than simply concerns about what is held to be an appropriate appearance, motivated their decisions. Significantly, for these participants the decision to have bariatric surgery was based on concerns about future morbidity (and mortality) at least as much, if not more so, than on concerns about a current state of ill health and impairment. Some individuals I spoke with were unquestionably suffering from multiple chronic and even life threatening illnesses and feared they would prematurely die from these conditions. Other participants, however, made the decision to have bariatric surgery despite the fact that they had no comorbidities whatsoever. Motivating their decisions was the fear that they would eventually develop them. Importantly, medial providers explicitly and repeatedly told all of these participants that lest they take drastic and immediate action, they would die. For example: Faith’s reproductive endocrinologist said: “you’re going to have diabetes by the time you’re 30; you’re going to have a stroke by the time you’re 40. And I can only hope that you can recover enough from your stroke that you’ll be able to take care of your family.” Several female participants were warned that without losing weight, they would either never become pregnant or they would die in childbirth. By contrast, participants stated that their bariatric surgeons were the first providers they had encountered to both assert that obesity was a medical condition outside of their control and to offer them a solution. Within an atmosphere in which obesity is held to be largely or entirely the result of behavioural choices, the bariatric profession thus positions itself as unique by offering both understanding and what it claims to be a durable treatment. Importantly, it would be a mistake to conclude that some bariatric patients needed surgery while others choose it for the wrong reasons. Regardless of their states of health at the time they made the decision to have surgery, the concerns that drove these patients to seek out these procedures were experienced as very real. Whether or not these concerns would have materialized as actual health conditions is unknown. Furthermore, bariatric patients should not be seen as having been duped or suffering from ‘false consciousness.’ Rather, they operate within a particular set of social, cultural, and political-economic conditions that suggest that good citizenship requires risk avoidance and personal health management. As these individuals experienced, there are material and social consequences for ‘failing’ to obtain normative conceptualizations of health. This set of conditions helps to produce a bariatric patient population that includes both those who were contending with serious health concerns and those who feared they would develop them. All bariatric patients operate within this set of conditions (as do medical providers) and make decisions regarding health (current, future, or both) by using the resources available to them. In her work on the temporalities of dieting, Coleman argues that rather than seeing dieting as a linear and progressive event, we might think of it instead a process that brings the future into the present as potential. Adams et al suggest concerns about potential futures, particularly in regard to health, are a defining characteristic of our time. They state: “The present is governed, at almost every scale, as if the future is what matters most. Anticipatory modes enable the production of possible futures that are lived and felt as inevitable in the present, rendering hope and fear as important political vectors” (249). The ability to act in the present based on potential future risks, they argue, has become a moral imperative and a marker of proper of citizenship. Importantly, however, our work to secure the ‘best possible future’ is never fully assured, as risks are constantly changing. The future is thus always uncertain. Acting responsibly in the present therefore requires “alertness and vigilance as normative affective states” (254). Importantly, these anticipations are not diagnostic, but productive. As Adams et al state, “the future arrives already formed in the present, as if the emergency has already happened…a ‘sense’ of the simultaneous uncertainty and inevitability of the future, usually manifest in entanglements of fear and hope” (250). It is in this light, then, that we might see the decision to have bariatric surgery. For these participants, their future weight-related morbidity and mortality had already arrived in the present and thus they felt they needed to act responsibly now, by undergoing what they had been told was the only durable medical intervention for obesity. The emotions of hope, fear, anxiety and I would suggest, hatred, were key in making these decisions. Conclusion Medical, public health, and media discourses frame obesity as an epidemic that threatens to bring untold financial disaster and escalating rates of morbidity and mortality upon the nation state and the world at large. As Fraser et al argue, strong emotions (such hatred, fear, anxiety, and hope), are at the centre of these discourses; they construct, circulate, and proliferate them. Moreover, they create categories of people who are deemed legitimate and categories of others who are not. In this context, the participants I spoke with were caught between a desire to have fatness understood as a medical condition needing intervention; the anti-fat attitudes of others, including providers, which held that obesity was a failure of the will and nothing more; their own internalization of these messages of personal responsibility for proper behavioural choices, and, the biologically intractable nature of fatness wherein dieting not only fails to reduce weight in the vast majority of cases but results, in the long term, in increased weight gain (Kassirer and Angell; Mann et al.; Puhl and Heuer). Widespread anxiety and embarrassment over and fear and hatred of fatness was something that the individuals I interviewed experienced directly and which signalled to them that they were less than human. Their desire for weight loss, therefore was partially a desire to become ‘normal.’ In Butler’s term, it was the desire for a ‘liveable life. ’A liveable life, for these participants, included a desire for a seamless fit with the built environment. The individuals I spoke with were never more ashamed of their fatness than when they experienced a ‘misfit’, in Garland Thomson’s terms, between their bodies and the material world. Moreover, feelings of shame over this disjuncture worked in tandem with a deeply felt, pressing sense that something must be done in the present to secure a better health future. The belief that bariatric surgery might finally provide a durable answer to obesity served as a strong motivating factor in their decisions to undergo bariatric surgery. By taking drastic action to lose weight, participants hoped to contest stigmatizing beliefs that their fat bodies reflected pathological interiors. Moreover, they sought to demonstrate responsibility and thus secure proper subjectivities and citizenship. In this sense, concerns, anxieties, and fears about health cannot be disentangled from the experience of anti-fat stigma and discrimination. Again, anti-fat bias, for these participants, was more than discursive: it operated through the circulation of emotion and was experienced in a very material sense. The decision to have weight loss surgery can thus be seen as occurring at the interface of emotion, flesh, space, place, and time, and in ways that are fundamentally shaped by the broader social context of neoliberal healthism. AcknowledgmentI am grateful to the anonymous reviewers of this article for their helpful feedback on earlier version. References Adams, Vincanne, Michelle Murphy, and Adele E. Clarke. “Anticipation: Technoscience, Life, Affect, Temporality.” Subjectivity 28.1 (2009): 246-265. Ahmed, Sara. “Affective Economies.” Social Text 22.2 (2004): 117-139 Boero, Natalie. Killer Fat: Media, Medicine, and Morals in the American "Obesity Epidemic". New Brunswick: Rutgers University Press, 2012. Butler, Judith. Undoing Gender. New York: Routledge, 2004. Bynum, Caroline Walker. 1999. Jefferson Lecture in the Humanities. National Endowment for the Humanities. Washington, DC, 1999. Cahnman, Werner J. “The Stigma of Obesity.” The Sociological Quarterly 9.3 (1968): 283-299. Chang, Virginia W., and Nicholas A. Christakis. “Medical Modeling of Obesity: A Transition from Action to Experience in a 20th Century American Medical Textbook.” Sociology of Health & Illness 24.2 (2002): 151-177. Coleman, Rebecca. “Dieting Temporalities: Interaction, Agency and the Measure of Online Weight Watching.” Time & Society 19.2 (2010): 265-285. Colls, Rachel. “‘Looking Alright, Feeling Alright:’ Emotions, Sizing, and the Geographies of Women’s Experience of Clothing Consumption.” Social & Cultural Geography 5.4 (2004): 583-596. Crawford, Robert. “You Are Dangerous to Your Health: The Ideology and Politics of Victim Blaming.” International Journal of Health Services 7.4 (1977): 663-680. ———. “Health as a Meaningful Social Practice.: Health 10.4 (2006): 401-20. Dedoose. Computer Software. n.d. Franko, Debra L., Emilie J. Coen, James P. Roehrig, Rachel Rodgers, Amy Jenkins, Meghan E. Lovering, Stephanie Dela Cruz. “Considering J. Lo and Ugly Betty: A Qualitative Examination of Risk Factors and Prevention Targets for Body Dissatisfaction, Eating Disorders, and Obesity in Young Latina Women.” Body Image 9.3 (2012), 381-387. Fikken, Janna J., and Esther D. Rothblum. “Is Fat a Feminist Issue? Exploring the Gendered Nature of Weight Bias.” Sex Roles 66.9-10 (2012): 575-592. Fraser, Suzanne, JaneMaree Maher, and Jan Wright. “Between Bodies and Collectivities: Articulating the Action of Emotion in Obesity Epidemic Discourse.” Social Theory & Health 8.2 (2010): 192-209. Garland Thomson, Rosemarie. “Misfits: A Feminist Materialist Disability Concept.” Hypatia 26.3 (2011): 591-609. Goffman, Erving. Stigma: Notes on the Management of Spoiled Identity. New York: Simon & Schuster, 1963. Grabe, Shelly, and Janet S. Hyde. “Ethnicity and Body Dissatisfaction among Women in the United States: A Meta-Analysis.” Psychological Bulletin 132.2 (2006): 622. Greenhalgh, Susan. “Weighty Subjects: The Biopolitics of the U.S. War on Fat.” American Ethnologist 39.3 (2012): 471-487. Grosz, Elizabeth A. “Bodies-Cities.” Feminist Theory and the Body: A Reader, eds. Janet Price and Margrit Shildrick. New York: Routledge, 1999. 381-387. Guthman, Julie. “Teaching the Politics of Obesity: Insights into Neoliberal Embodiment and Contemporary Biopolitics.” Antipode 41.5 (2009): 1110-1133. Kassirer, Jerome P., and M. Marcia Angell. “Losing Weight: An Ill-Fated New Year's Resolution.” The New England Journal of Medicine 338.1 (1998): 52. Kirkland, Anna. “Think of the Hippopotamus: Rights Consciousness in the Fat Acceptance Movement.” Law & Society Review 42.2 (2008): 397-432. Lewis, Sophie, Samantha L. Thomas, R. Warwick Blood, David Castle, Jim Hyde, and Paul A. Komesaroff. “How Do Obese Individuals Perceive and Respond to the Different Types of Obesity Stigma That They Encounter in Their Daily Lives? A Qualitative Study.” Social Science & Medicine 73.9 (2011): 1349-56. López, Julia Navas. “Socio-Anthropological Analysis of Bariatric Surgery Patients: A Preliminary Study.” Social Medicine 4.4 (2009): 209-217. McPhail, Deborah. “What to Do with the ‘Tubby Hubby?: ‘Obesity,’ the Crisis of Masculinity, and the Nuclear Family in Early Cold War Canada. Antipode 41.5 (2009): 1021-1050. Mann, Traci, A. Janet Tomiyama, Erika Westling, Ann-Marie Lew, Barbara Samuels, and Jason Chatman. “Medicare’s Search for Effective Obesity Treatments.” American Psychologist 62.3 (2007): 220-233. Metzl, Jonathan. “Introduction: Why ‘Against Health?’” Against Health: How Health Became the New Morality, eds. Jonathan Metzl and Anna Kirkland. New York: NYU Press, 2010. 1-14. Puhl, Rebecca M. “Obesity Stigma: Important Considerations for Public Health.” American Journal of Public Health 100.6 (2010): 1019-1028.———, and Kelly D. Brownell. “Psychosocial Origins of Obesity Stigma: Toward Changing a Powerful and Pervasive Bias.” Obesity Reviews 4.4 (2003): 213-227. ——— and Chelsea A. Heuer. “The Stigma of Obesity: A Review and Update.” Obesity 17.5 (2009): 941-964. Schafer, Markus H., and Kenneth F. Ferraro. “The Stigma of Obesity: Does Perceived Weight Discrimination Affect Identity and Physical Health?” Social Psychology Quarterly 74.1 (2011): 76-97. Schwartz, H. Never Satisfied: A Cultural History of Diets, Fantasies, and Fat. New York: Anchor Books, 1986. Wadden, Thomas A., David B. Sarwer, Anthony N. Fabricatore, LaShanda R. Jones, Rebecca Stack, and Noel Williams. “Psychosocial and Behavioral Status of Patients Undergoing Bariatric Surgery: What to Expect before and after Surgery.” The Medical Clinics of North America 91.3 (2007): 451-69. Wilson, Bianca. “Fat, the First Lady, and Fighting the Politics of Health Science.” Lecture. The Graduate Center of the City University of New York. 14 Feb. 2011.

BackgroundIn the past twenty years the discourse of the weight-centred health paradigm (WCHP) has attained almost complete dominance in the sphere of public health policy throughout the developed English speaking world. The national governments of Australia and many countries around the world have responded to what is perceived as an ‘epidemic of obesity’ with public health policies and programs explicitly focused on reducing and preventing obesity through so called ‘lifestyle’ behaviour change. Weight-related public health initiatives have been subjected to extensive critique based on ideological, ethical and empirical grounds (Solovay; Oliver; Gaesser; Gard; Monaghan, Colls and Evans; Wright; Rothblum and Solovay; Saguy; Rich, Monaghan and Aphramor; Bacon and Aphramor; Brown). Many scholars have raised concerns about the stigmatising and harmful effects of the WCHP (Aphramor; Bacon and Aphramor; O'Dea; Tylka et al.), and in particular the inequitable distribution of such negative impacts on women, people who are poor, and people of colour (Campos). Weight-based stigma is now well recognised as a pervasive and insidious form of stigma (Puhl and Heuer). Weight-based discrimination (a direct result of stigma) in the USA has a similar prevalence rate to race-based discrimination, and discrimination for fatter and younger people in particular is even higher (Puhl, Andreyeva and Brownell). Numerous scholars have highlighted the stigmatising discourse evident in obesity prevention programs and policies (O'Reilly and Sixsmith; Pederson et al.; Nuffield Council on Bioethics; ten Have et al.; MacLean et al.; Carter, Klinner, et al.; Fry; O'Dea; Rich, Monaghan and Aphramor). The ‘war on obesity’ can therefore be regarded as a social determinant of poor health (O'Hara and Gregg). Focusing on overweight and obese people is not only damaging to people’s health, but is ineffective in addressing the broader social and economic issues that create health and wellbeing (Cohen, Perales and Steadman; MacLean et al.; Walls et al.). Analyses of the discourses used in weight-related public health initiatives have highlighted oppressive, stigmatizing and discriminatory discourses that position body weight as pathological (O'Reilly; Pederson et al.), anti-social and a threat to the viable future of society (White). There has been limited analysis of discourses in Australian social marketing campaigns focused on body weight (Lupton; Carter, Rychetnik, et al.).Social Marketing CampaignsIn 2006 the Australian, State and Territory Governments funded the Measure Up social marketing campaign (Australian Government Department of Health and Ageing "Measure Up"). As the name suggests Measure Up focuses on the measurement of health through body weight and waist circumference. Campaign resources include brochures, posters, a tape measure, a 12 week planner, a community guide and a television advertisement. Campaign slogans are ‘The more you gain, the more you have to lose’ and ‘How do you measure up?’Tomorrow People is the component of Measure Up designed for Indigenous Australians (Australian Government Department of Health and Ageing "Tomorrow People"). Tomorrow People resources focus on healthy eating and physical activity and include a microsite on the Measure Up website, booklet, posters, print and radio advertisements. The campaign slogan is ‘Tomorrow People starts today. Do it for our kids. Do it for our culture.’ In 2011, phase two of the Measure Up campaign was launched (Australian Government Department of Health and Ageing "Swap It, Don't Stop It"). The central premise of Swap It, Don’t Stop It is that you ‘can lose your belly without losing all the things you love’ by making ‘simple’ swaps of behaviours related to eating and physical activity. The campaign’s central character Eric is made from a balloon, as are all of the other characters and visual items used in the campaign. Eric claims thatover the years my belly has ballooned and ballooned. It’s come time to do something about it — the last thing I want is to end up with some cancers, type 2 diabetes and heart disease. That’s why I’ve become a Swapper! What’s a swapper? It’s simple really. It just means swapping some of the things I’m doing now for healthier choices. That way I can lose my belly, without losing all the things I love. It’s easy! The campaign has produced around 30 branded resource items including brochures, posters, cards, fact sheets, recipes, and print, radio, television and online advertisements. All resources include references to Eric and most also include the image of the tape measure used in the Measure Up campaign. The Swap It, Don’t Stop It campaign also includes resources specifically directed at Indigenous Australians including two posters from the generic campaign with a dot painting motif added to the background. MethodologyThe epistemological position in this project was constructivist (Crotty) and the theoretical perspective was critical theory (Crotty). Multimedia critical discourse analysis (Machin and Mayr) was the methodology used to examine the social marketing campaigns and identify the discourses within them. Critical discourse analysis (CDA) focuses on critiquing text for evidence of power and ideology. CDA is used to reveal the ideas, absences and assumptions, and therefore the power interests buried within texts, in order to bring about social change. As a method, CDA has a structured three dimensional approach involving textual practice analysis (for lexicon) at the core, within the context of discursive practice analysis (for rhetorical and lexical strategies particularly with respect to claims-making), which falls within the context of social practice analysis (Jacobs). Social practice analysis explores the role played by power and ideology in supporting or disturbing the discourse (Jacobs; Machin and Mayr). Multimodal CDA (MCDA) uses a broad definition of text to include words, pictures, symbols, ideas, themes or any message that can be communicated (Machin and Mayr). Analysis of the social marketing campaigns involved examining the vocabulary, grammar, sentence structure, visuals and overall structure of the text for textual, discursive and social practices.Results and DiscussionIndividual ResponsibilityThe discourse of individual responsibility is strongly evident in the campaigns. In this discourse, it is ultimately the individual who is held responsible for their body weight and their health. The individual responsibility discourse is signified by the discursive practice of using epistemic (related to the truth or certainty) and deontic (compelling or instructing) modality words, particularly modal verbs and modal adverbs. High modality epistemic words are used to convince the reader of the certainty of statements and to portray the statement-maker as authoritative. High modality deontic words are used to instil power and authority in the instructions.The extensive use of high modality epistemic and deontic words is demonstrated in the following paragraph assembled from various campaign materials: Ultimately (epistemic modality adverb) individuals must take responsibility (deontic modality verb) for their own health, including their and weight. Obesity is caused (epistemic modality verb) by an imbalance in energy intake (from diet) (epistemic modality verb) and expenditure (from activity) (epistemic modality verb). Individually (epistemic modality adverb) we make decisions (epistemic modality verb) about how much we eat (epistemic modality verb) and how much activity we undertake (epistemic modality verb). Each of us can control (epistemic modality) our own weight by controlling (deontic modality) what we eat (deontic modality verb) and how much we exercise (deontic modality verb). To correct (deontic modality verb) the energy imbalance, individuals need to develop (deontic modality verb) a healthy lifestyle by making changes (deontic modality verb) to correct (deontic modality verb) their dietary habits and increase (deontic modality verb) their activity levels. The verbs must, control, correct, develop, change, increase, eat and exercise are deontic modality verbs designed to instruct or compel the reader.These discursive practices result in the clear message that individuals can and must control, correct and change their eating and physical activity, and thereby control their weight and health. The implication of the individualist discourse is that individuals, irrespective of their genes, life-course, social position or environment, are charged with the responsibility of being more self-surveying, self-policing, self-disciplined and self-controlled, and therefore healthier. This is consistent with the individualist orientation of neoliberal ideology, and has been identified in various critiques of obesity prevention public health programs that centralise the self-responsible subject (Murray; Rich, Monaghan and Aphramor) and the concept of ‘healthism’, the moral obligation to pursue health through healthy behaviours or healthy lifestyles (Aphramor and Gingras; Mansfield and Rich). The hegemonic Western-centric individualist discourse has also been critiqued for its role in subordinating or silencing other models of health and wellbeing including Aboriginal or indigenous models, that do not place the individual in the centre (McPhail-Bell, Fredericks and Brough).Obesity Causes DiseaseEpistemic modality verbs are used as a discursive practice to portray the certainty or probability of the relationship between obesity and chronic disease. The strength of the epistemic modality verbs is generally moderate, with terms such as ‘linked’, ‘associated’, ‘connected’, ‘related’ and ‘contributes to’ most commonly used to describe the relationship. The use of such verbs may suggest recognition of uncertainty or at least lack of causality in the relationship. However this lowered modality is counterbalanced by the use of verbs with higher epistemic modality such as ‘causes’, ‘leads to’, and ‘is responsible for’. For example:The other type is intra-abdominal fat. This is the fat that coats our organs and causes the most concern. Even though we don’t yet fully understand what links intra-abdominal fat with chronic disease, we do know that even a small deposit of this fat increases the risk of serious health problems’. (Swap It, Don’t Stop It Website; italics added)Thus the prevailing impression is that there is an objective, definitive, causal relationship between obesity and a range of chronic diseases. The obesity-chronic disease discourse is reified through the discursive practice of claims-making, whereby statements related to the problem of obesity and its relationship with chronic disease are attributed to authoritative experts or expert organisations. The textual practice of presupposition is evident with the implied causal relationship between obesity and chronic disease being taken for granted and uncontested. Through the textual practice of lexical absence, there is a complete lack of alternative views about body weight and health. Likewise there is an absence of acknowledgement of the potential harms arising from focusing on body weight, such as increased body dissatisfaction, disordered eating, and, paradoxically, weight gain.Shame and BlameBoth Measure Up and Swap It, Don’t Stop It include a combination of written/verbal text and visual images that create a sense of shame and blame. In Measure Up, the central character starts out as young, slim man, and as he ages his waist circumference grows. When he learns that his expanding waistline is associated with an increased risk of chronic disease, his facial expression and body language convey that he is sad, dejected and fearful. In the still images, this character and a female character are positioned looking down at the tape measure as they measure their ‘too large’ waists. This position and the looks on their faces suggest hanging their heads in shame. The male characters in both campaigns specifically express shame about “letting themselves go” by unthinkingly practicing ‘unhealthy’ behaviours. The characters’ clothing also contribute to a sense of shame. Both male and female characters in Measure Up appear in their underwear, which suggests that they are being publicly shamed. The clothing of the Measure Up characters is similar to that worn by contestants in the television program The Biggest Loser, which explicitly uses shame to ‘motivate’ contestants to lose weight. Part of the public shaming of contestants involves their appearance in revealing exercise clothing for weigh-ins, which displays their fatness for all to see (Thomas, Hyde and Komesaroff). The stigmatising effects of this and other aspects of the Biggest Loser television program are well documented (Berry et al.; Domoff et al.; Sender and Sullivan; Thomas, Hyde and Komesaroff; Yoo). The appearance of the Measure Up characters in their underwear combined with their head position and facial expressions conveys a strong, consistent message that the characters both feel shame and are deserving of shame due to their self-inflicted ‘unhealthy’ behaviours. The focus on ‘healthy’ and ‘unhealthy’ behaviours contributes to accepted and contested health identities (Fry). The ‘accepted health identity’ is represented as responsible and aspiring to and pursuing good health. The ‘contested health identity’ is represented as unhealthy, consuming too much food, and taking health risks, and this identity is stigmatised by public health programs (Fry). The ‘contested health identity’ represents the application to public health of Goffman’s ‘spoiled identity’ on which much stigmatisation theorising and research has been based (Goffman). As a result of both lexical and visual textual practices, the social marketing campaigns contribute to the construction of the ‘accepted health identity’ through discourses of individual responsibility, choice and healthy lifestyle. Furthermore, they contribute to the construction of the spoiled or ‘contested health identity’ through discourses that people are naturally unhealthy and need to be frightened, guilted and shamed into stopping ‘unhealthy’ behaviours and adopting ‘healthy’ behaviours. The ‘contested health identity’ constructed through these discourses is in turn stigmatised by such discourses. Thus the campaigns not only risk perpetuating stigmatisation through the reinforcement of the health identities, but possibly extend it further by legitimising the stigma associated with such identities. Given that these campaigns are conducted by the Australian Government, the already deeply stigmatising social belief system receives a significant boost in legitimacy by being positioned as a public health belief system perpetrated by the Government. Fear and AlarmIn the Measure Up television advertisement the main male character’s daughter, who has run into the frame, abruptly stops and looks fearful when she hears about his increased risk of disease. Using the discursive practice of claims-making, the authoritative external source informs the man that the more he gains (in terms of his waist circumference), the more he has to lose. The clear implication is that he needs to be fearful of losing his health, his family and even his life if he doesn’t reduce his waist circumference. The visual metaphor of a balloon is used as the central semiotic trope in Swap It, Don’t Stop It. The characters and other items featuring in the visuals are all made from twisting balloons. Balloons themselves may not create fear or alarm, unless one is unfortunate to be afflicted with globophobia (Freed), but the visual metaphor of the balloon in the social marketing campaign had a range of alarmist meanings. At the population level, rates and/or costs of obesity have been described in news items as ‘ballooning’ (Body Ecology; Stipp; AFP; Thien and Begawan) with accompanying visual images of extremely well-rounded bodies or ‘headless fatties’ (Cooper). Rapid or significant weight gain is referred to in everyday language as ‘ballooning weight’. The use of the balloon metaphor as a visual device in Swap It, Don’t Stop It serves to reinforce and extend these alarmist messages. Further, there is no attempt in the campaigns to reduce alarm by including positive or neutral photographs or images of fat people. This visual semiotic absence – a form of cultural imperialism (Young) – contributes to the invisibilisation of ‘real life’ fat people who are not ashamed of themselves. Habermas suggests that society evolves and operationalises through rational communication which includes the capacity to question the validity of claims made within communicative action (Habermas The Structural Transformation of the Public Sphere; Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society). However the communicative action taken by the social marketing campaigns analysed in this study presents claims as uncontested facts and is therefore directorial about the expectations of individuals to take more responsibility for themselves, adopt certain behaviours and reduce or prevent obesity. Habermas argues that the lack or distortion of rational communication erodes relationships at the individual and societal levels (Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society; Habermas The Structural Transformation of the Public Sphere). The communicative actions represented by the social marketing campaigns represents a distortion of rational communication and therefore erodes the wellbeing of individuals (for example through internalised stigma, shame, guilt, body dissatisfaction, weight preoccupation, disordered eating and avoidance of health care), relationships between individuals (for example through increased blame, coercion, stigma, bias, prejudice and discrimination) and society (for example through stigmatisation of groups in the population on the basis of their body size and increased social and health inequity). Habermas proposes that power differentials work to distort rational communication, and that it is these distortions in communication that need to be the focal point for change (Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society; Habermas The Theory of Communicative Action: The Critique of Functionalist Reason; Habermas The Structural Transformation of the Public Sphere). Through critical analysis of the discourses used in the social marketing campaigns, we identified that they rely on the power, authority and status of experts to present uncontested representations of body weight and ‘appropriate’ health responses to it. In identifying the discourses present in the social marketing campaigns, we hope to focus attention on and thereby disrupt the distortions in the practical knowledge of the weight-centred health paradigm in order to contribute to systemic reorientation and change.ConclusionThrough the use of textual, discursive and social practices, the social marketing campaigns analysed in this study perpetuate the following concepts: everyone should be alarmed about growing waistlines and ‘ballooning’ rates of ‘obesity’; individuals are to blame for excess body weight, due to ignorance and the practice of ‘unhealthy behaviours’; individuals have a moral, parental, familial and cultural responsibility to monitor their weight and adopt ‘healthy’ eating and physical activity behaviours; such behaviour changes are easy to make and will result in weight loss, which will reduce risk of disease. These paternalistic campaigns evoke feelings of personal and parental guilt and shame, resulting in coercion to ‘take action’. They simultaneously stigmatise fat people yet serve to invisibilise them. Public health agencies must consider the harmful consequences of social marketing campaigns focused on body weight.ReferencesAFP. "A Ballooning Health Issue around the World." Gulfnews.com 29 May 2013. 17 Sep. 2013 ‹http://gulfnews.com/news/world/other-world/a-ballooning-health-issue-around-the-world-1.1189899›.Aphramor, Lucy. "The Impact of a Weight-Centred Treatment Approach on Women's Health and Health-Seeking Behaviours." Journal of Critical Dietetics 1.2 (2012): 3-12.Aphramor, Lucy, and Jacqui Gingras. "That Remains to Be Said: Disappeared Feminist Discourses on Fat in Dietetic Theory and Practice." The Fat Studies Reader, eds. Esther Rothblum and Sondra Solovay. New York: New York University Press, 2009. 97-105. Australian Government Department of Health and Ageing. "Measure Up." 2010. 3 Aug. 2011 ‹https://web.archive.org/web/20110817065823/http://www.measureup.gov.au/internet/abhi/publishing.nsf/Content/About+the+campaign-lp›.———. "Swap It, Don't Stop It." 2011. 20 Aug. 2011 ‹https://web.archive.org/web/20110830084149/http://swapit.gov.au›.———. "Tomorrow People." 2010. 3 Aug. 2011 ‹https://web.archive.org/web/20110821140445/http://www.measureup.gov.au/internet/abhi/publishing.nsf/Content/tp_home›.Bacon, Linda, and Lucy Aphramor. "Weight Science: Evaluating the Evidence for a Paradigm Shift." Nutrition Journal 10.9 (2011). Bacon, Linda, and Lucy Aphramor. Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight. Dallas: BenBella Books, 2014. Berry, Tanya R., et al. "Effects of Biggest Loser Exercise Depictions on Exercise-Related Attitudes." American Journal of Health Behavior 37.1 (2013): 96-103. Body Ecology. "Obesity Rates Ballooning – Here's What You Really Need to Know to Lose Weight and Keep It Off." 2009. 9 Jun. 2011 ‹http://bodyecology.com/articles/obesity-rates-ballooning.php›.Brown, Harriet. Body of Truth: How Science, History and Culture Drive Our Obsession with Weight – and What We Can Do about It. Boston: Da Capo Press, 2015. Campos, Paul. The Obesity Myth. New York: Gotham Books, 2004. Carter, Stacy M., et al. "The Ethical Commitments of Health Promotion Practitioners: An Empirical Study from New South Wales, Australia." Public Health Ethics 5.2 (2012): 128-39. Carter, Stacy M., et al. "Evidence, Ethics, and Values: A Framework for Health Promotion." American Journal of Public Health 101.3 (2011): 465-72. Cohen, Larry, Daniel P. Perales, and Catherine Steadman. "The O Word: Why the Focus on Obesity Is Harmful to Community Health." Californian Journal of Health Promotion 3.3 (2005): 154-61. Cooper, Charlotte. "Olympics/Uhlympics: Living in the Shadow of the Beast." thirdspace: a journal of feminist theory & culture 9.2 (2010). Crotty, Michael. The Foundations of Social Research: Meaning and Perspective in the Research Process. 1st ed. Crows Nest: Allen and Unwin, 1998. Domoff, Sarah E., et al. "The Effects of Reality Television on Weight Bias: An Examination of the Biggest Loser." Obesity 20.5 (2012): 993-98. Freed, Megan. "Uncommon Phobias: The Fear of Balloons." Yahoo Voices 2007. 17 Sep. 2013 ‹http://voices.yahoo.com/uncommon-phobias-fear-balloons-338043.html›.Fry, Craig L. "Ethical Issues in Obesity Interventions for Populations." New South Wales Public Health Bulletin 23.5-6 (2012): 116-19. Gaesser, Glenn A. "Is It Necessary to Be Thin to Be Healthy?" Harvard Health Policy Review 4.2 (2003): 40-47. Gard, Michael. The End of the Obesity Epidemic. Oxon: Routledge, 2011. Goffman, E. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice Hall, 1963.Habermas, Jürgen. The Theory of Communicative Action: Reason and the Rationalisation of Society. Vol. 1. Cambridge: Polity Press, 2004. ———. The Theory of Communicative Action: The Critique of Functionalist Reason. Vol. 2. Cambridge: Polity Press, 2004.———. The Structural Transformation of the Public Sphere. Cambridge: Polity Press, 2002.Jacobs, Keith. "Discourse Analysis." Social Research Methods: An Australian Perspective, ed. Maggie Walter. South Melbourne, Vic.: Oxford University Press, 2006. Lupton, Deborah. "'How Do You Measure Up?' Assumptions about 'Obesity' and Health-Related Behaviors and Beliefs in Two Australian 'Obesity' Prevention Campaigns." Fat Studies 3.1 (2014): 32-44. Machin, David, and Andrea Mayr. How to Do Critical Discourse Analysis: A Multimodal Introduction. London: Sage Publications 2012. MacLean, Lynne, et al. "Obesity, Stigma and Public Health Planning." Health Promotion International 24.1 (2009): 88-93. Mansfield, Louise, and Emma Rich. "Public Health Pedagogy, Border Crossings and Physical Activity at Every Size." Critical Public Health 23.3 (2013): 356-70. McPhail-Bell, Karen, Bronwyn Fredericks, and Mark Brough. "Beyond the Accolades: A Postcolonial Critique of the Foundations of the Ottawa Charter." Global Health Promotion 20.2 (2013): 22-29. Monaghan, Lee F., Rachel Colls, and Bethan Evans. "Obesity Discourse and Fat Politics: Research, Critique and Interventions." Critical Public Health 23.3 (2013): 249-62. Murray, Samantha. The 'Fat' Female Body. London: Palgrave Macmillan, 2008. Nuffield Council on Bioethics. Public Health: Ethical Issues. London: Nuffield Council on Bioethics, 2007. O'Dea, Jennifer A. "Prevention of Child Obesity: 'First, Do No Harm'." Health Education Research 20.2 (2005): 259-65. O'Hara, Lily, and Jane Gregg. "The War on Obesity: A Social Determinant of Health." Health Promotion Journal of Australia 17.3 (2006): 260-63. O'Reilly, Caitlin. "Weighing In on the Health and Ethical Implications of British Columbia's Weight Centered Health Paradigm." Simon Fraser University, 2011. O'Reilly, Caitlin, and Judith Sixsmith. "From Theory to Policy: Reducing Harms Associated with the Weight-Centered Health Paradigm." Fat Studies 1.1 (2012): 97-113. Oliver, J. "The Politics of Pathology: How Obesity Became an Epidemic Disease." Perspectives in Biology and Medicine 49.4 (2006): 611-27. Pederson, A., et al., eds. Rethinking Women and Healthy Living in Canada. Vancouver, BC: British Columbia Centre of Excellence for Women's Health, 2013. Puhl, Rebecca, and Chelsea Heuer. "Obesity Stigma: Important Considerations for Public Health." American Journal of Public Health 100.6 (2010): 1019. Puhl, Rebecca M., T. Andreyeva, and Kelly D. Brownell. "Perceptions of Weight Discrimination: Prevalence and Comparison to Race and Gender Discrimination in America." International Journal of Obesity 32 (2008): 992-1000.Rich, Emma, Lee Monaghan, and Lucy Aphramor, eds. Debating Obesity: Critical Perspectives. Basingstoke: Palgrave MacMillan, 2011. Rothblum, Esther, and Sondra Solovay, eds. The Fat Studies Reader. New York: New York University Press, 2009. Saguy, Abigail. What's Wrong with Fat? New York: Oxford University Press, 2013.Sender, Katherine, and Margaret Sullivan. "Epidemics of Will, Failures of Self-Esteem: Responding to Fat Bodies in The Biggest Loser and What Not to Wear." Continuum 22.4 (2008): 573-84. Solovay, Sondra. Tipping the Scales of Justice: Fighting Weight-Based Discrimination. New York: Prometheus Books, 2000.Stipp, David. "Obesity — Not Aging — Balloons Health Care Costs." Pacific Standard 2011. 17 Sep. 2013 ‹http://www.psmag.com/health/obesity-aging-cause-ballooning-health-care-costs-31879/›.Ten Have, M., et al. "Ethics and Prevention of Overweight and Obesity: An Inventory." Obesity Reviews 12.9 (2011): 669-79. Thien, Rachel, and Bandar Seri Begawan. "Obesity Balloons among Brunei Students." The Brunei Times 2010. 17 Sep. 2013 ‹http://www.bt.com.bn/news-national/2010/02/10/obesity-balloons-among-brunei-students›.Thomas, Samantha, Jim Hyde, and Paul Komesaroff. "'Cheapening the Struggle:' Obese People's Attitudes towards the Biggest Loser." Obesity Management 3.5 (2007): 210-15. Tylka, Tracy L., et al. "The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss." Journal of Obesity (2014): 18. Article ID 983495.Walls, Helen, et al. "Public Health Campaigns and Obesity – A Critique." BMC Public Health 11.1 (2011): 136. White, Francis Ray. "Fat, Queer, Dead: ‘Obesity’ and the Death Drive." Somatechnics 2.1 (2012): 1-17. Wright, Jan. "Biopower, Biopedagogies and the Obesity Epidemic." Biopolitics and the ‘Obesity Epidemic’: Governing Bodies. Ed. Jan Wright and Valerie Harwood. New York: Routledge, 2009. 1-14.Yoo, Jina H. "No Clear Winner: Effects of the Biggest Loser on the Stigmatization of Obese Persons." Health Communication 28.3 (2013): 294-303. Young, Iris Marion. "Five Faces of Oppression." The Philosophical Forum 19.4 (1988): 270-90.