Journal articles on the topic 'Lego Media International'

Dall'inaugurazione del governo Berlusconi (maggio 1994) al giuramento della compagine guidata da Prodi intercorrono solo ventiquattro mesi. Ma sono due anni caratterizzati da una densa e convulsa vicenda politica nel corso della quale si verificano tutta una serie di episodi di rilievo. Tra i più salienti spiccano: la rottura dell'alleanza di centro-destra nata alla vigilia del 27 marzo 1994 (il cosiddetto «ribaltone»); il ricorso ad un governo «tecnico» che doveva costituire una soluzione provvisoria ma finisce col durare più del previsto; la nuova spaccatura che si produce nella maggior formazione di centro (il Ppi) nella primavera del 1995 e che porta alla nascita del Cdu e fa quindi salire a tre gli eredi della vecchia Dc; una ulteriore modifica delle regole del gioco con l'adozione di un nuovo sistema per le elezioni dei consigli regionali; e, infine, lo svolgimento di ben tre consultazioni elettorali a carattere nazionale (le elezioni per il Parlamento europeo 1994, le elezioni regionali ed amministrative dell'aprile 1995, la tornata referendaria del giugno dello stesso anno).Gli avvenimenti del biennio segnalano le evidenti difficoltà di un processo di transizione per il quale non si riesce a trovare una via di uscita. Dopo la fase di destrutturazione del periodo 1992-1993, con le elezioni del 1994 il sistema dei partiti pareva avviato ad assumere una configurazione di tipo (quasi) bipolare, accompagnata da una significativa riduzione del grado di frammentazione. Ma la dinamica della vita politica nei mesi successivi alla formazione del governo Berlusconi smentiva entrambe le ipotesi. Essa dimostrava, in primo luogo, che la doppia e anomala alleanza risultata vincente il 27 marzo era solo un precario cartello elettorale destinato a dissolversi nel breve periodo. In secondo luogo, risultava evidente che nonostante la prevalenza della quota maggioritaria e la clausola di sbarramento, il nuovo meccanismo elettorale non era riuscito ad incidere in maniera significativa sul numero delle formazioni politiche presenti nell'arena parlamentare e nel paese. Infine, che si trattasse di un bi-polarismo assai imperfetto risultava chiaro dal fatto che, caduto il governo di centro-destra per la defezione della Lega, risultava impraticabile la formazione di una maggioranza alternativa. In sostanza, le nuove regole e gli assetti usciti dalla consultazione e dai successivi rimescolamenti degli schieramenti e dell'offerta elettorale non avevano prodotto né un governo destinato a durare, né una opposizione pienamente in grado di sostituirlo.

To investigate the quality of sleep and the presence of Restless Legs Syndrome (RLS) in the Turkish population with β-thalassemia major (TM). The second aim was to assess the risk factors of RLS in TM adults. The study sample comprised of 121 patients at least 18 years old with TM. The patients’ socio-demographic information, body mass indexes (BMI), current medications, laboratory data were recorded. The patients were asked if they had a history of chronic kidney disease, diabetes mellitus (DM), and polyneuropathy. Restless legs syndrome was diagnosed according to the International Restless Legs Syndrome Study Group criteria. The sleep quality of the patients was assessed using the Pittsburgh Sleep Quality Index (PSQI) scale. The Epworth Sleepiness Scale (ESS) was used to assess excessive daytime sleepiness in the patients. The median age of the patients was 25 years (range 18-52). The mean BMI was 21.49±2.5 (R 14-26.5) for all patients. The prevalence of RLS was 5% in TM adult patients. The TM patients with RLS had no major complications of TM. The median PSQI global score of all patients was 3. Twenty-two (18.1%) patients had poor sleep quality. The reason for poor sleep quality was RLS symptoms in four patients (18%). There was no significant association between PSQI total score and blood parameters of the patients. Twelve (9.9%) patients had ESS scores greater than 10, which indicates excessive daytime sleepiness. The prevalence of RLS in TM patients was similar to that of the general Turkish adult population. These results indicate that RLS may occur in patients with TM, although they had a high level of serum ferritin.

Zusammenfassung Hintergrund Das Restless-Legs-Syndrom (RLS) ist eine häufige neurologische Erkrankung, die durch einen starken Bewegungsdrang der Beine und Missempfindungen einen hohen Leidensdruck auf die betroffenen Patienten ausübt. Die in der Regel medikamentöse Therapie ist mit zahlreichen Nebenwirkungen verbunden. Über die Wirkung körperlichen Trainings als risikoarme Alternative existiert bisher nur wenig Forschung. Ziel Diese Übersichtsarbeit untersuchte die Effekte körperlichen Trainings auf den Schweregrad des RLS. Methode Die systematische Literaturrecherche in den Datenbanken PubMed, PEDro, The Cochrane Library und Embase schloss kontrollierte Studien über Ausdauer- oder Krafttraining zur Verbesserung der Erkrankungsschwere von RLS. Die interne Validität der Studien wurde mit der PEDro-Skala bewertet und die Effekte der Trainingsverfahren auf den Schweregrad des RLS metaanalytisch zusammengefasst. Ergebnisse In die Arbeit wurden 5 Studien mit insgesamt 124 Teilnehmern eingeschlossen. Basierend auf der Metaanalyse verbesserte körperliches Training im Vergleich zur Kontrollintervention signifikant die Symptomatik von RLS auf der International RLS Severity Scale (durchschnittliche Verbesserung: 8,53 Punkte; 95 %-Konfidenzintervall: 10,42 bis 6,63 Punkte). Es fand sich kein signifikanter Publikationsbias. Die methodische Qualität der Studien war gering (Median PEDro-Score: 5). Schlussfolgerung Die Ergebnisse weisen auf die Verringerung des Schweregrads des RLS durch körperliches Training hin. Da die aktuell schwache Studienlage jedoch die Übertragbarkeit limitiert, sind weitere klinische Studien erforderlich.

Water polo is a full body contact sport. It is the combination of swimming, rugby, soccer, and basketball. The basic skills to be mastered in water polo are swimming, water trapping, and ball controlling using hands while floating in the water supported by egg-beater foot movement, where the leg endurance is the main point to perfect this technique. Athletes need leg endurance to float and swim during the game. This study is a literature review aimed at analyzing water polo athletes’ training using weighted jacket and weighted belt in water on their strength and leg endurance. The data were collected from research results published in national and international journals from 1991 to 2019. Therefore, the data were analyzed using content analysis. The review result revealed that the strategy to combine weighted jacket and weighted belt to train water polo athletes’ leg endurance was more effective. Weighted belts were worn around the athlete's waist, and heavy objects that were generally used for scuba diving were placed on belts. On the other hand, weighted jackets must be placed directly below the waist and the weight is suspended between the legs. The jacket with soft, durable, and waterproof material can be adjusted to the athlete's body size. The use of weighted jacket and weighted belt training media in water polo affected the strength and leg endurance of water polo athletes directly.

SummaryThis article discusses some of the distinguishing features of the debate over national identity that took place in Italy in the 1990s. Reacting against the threats of the Lega Nord and in response to the new ideological and political landscape of the post-Cold War order, a number of Italian intellectuals rediscovered the value of patriotism. Searching for the origins of the Italians' allegedly weak sense of national identity, some questioned the Resistance and the party system that originated from it. While this historical revisionism has been the object of well-deserved criticism, there is another type of thematization of identity which has received less attention: it deploys the old notion of an ‘Italian character’, which appears frequently in the press and the media. The article shows that this discourse, too, is a way of articulating patriotism, and then reflects on the meaning that this reconfiguration of ideologies and identities acquires in the new context, both domestic and international.

Abstract The relative effectiveness of 6 selective plating media were compared for effectiveness in recovery of Salmonella spp. from selected high-moisture foods. Three new plating agars (EF-18, Rambach, and xylose lysine Tergitol-4) and 3 selective plating agars (bismuth sulfite, Hektoen enteric, and xylose lysine desoxycholate) recommended by AOAC INTERNATIONAL and the Bacteriological Analytical Manual (BAM) were compared. The agars were streaked from cultures selectively enriched in selenite cystine broth, tetrathionate broth, and Rappaport–Vassiliadis medium. The high-moisture foods studied were naturally contaminated pork sausage, chicken parts, turkey parts, and frog legs and artificially contaminated shrimp, oysters, egg yolks, and lettuce. The relative effectiveness of each selective plating agar was determined by recovery of Salmonella spp. and enumeration of false-positive and false-negative reactions. Although the new selective plating agars compared favorably with the AOAC/BAM-recom mended agars, they offered no advantage. Incubation of selective enrichment broths at elevated temperatures decreased the numbers of false-positive and falsenegative reactions for all 6 selective plating agars.

Abstract Purpose Infusate osmolarity, pH, and cytotoxicity were investigated as risk factors for midline catheter failure. Methods An experimental, randomized, controlled, blinded trial was conducted using an ovine model. Two 10-cm, 18-gauge single-lumen midline catheters were inserted into the cephalic veins of sheep. The animals were divided into 6 study arms and were administered solutions of vancomycin 4 mg/mL (a low-cytotoxicity infusate) or 10 mg/mL (a high-cytotoxicity infusate), doxycycline 1 mg/mL (an acidic infusate), or acyclovir 3.5 mg/mL (an alkaline infusate) and 0.9% sodium chloride injection; or 1 of 2 premixed Clinimix (amino acids in dextrose; Baxter International) products with respective osmolarities of 675 mOsm/L (a low-osmolarity infusate) and 930 mOsm/L (a mid-osmolarity infusate). Contralateral legs were infused with 0.9% sodium chloride injection for control purposes. Catheter failure was evaluated by assessment of adverse clinical symptoms (swelling, pain, leakage, and occlusion). A quantitative vessel injury score (VIS) was calculated by grading 4 histopathological features: inflammation, mural thrombus, necrosis, and perivascular reaction. Results Among 20 sheep included in the study, the overall catheter failure rate was 95% for test catheters (median time to failure, 7.5 days; range, 3–14 days), while 60% of the control catheters failed before or concurrently (median time to failure, 7 days; range, 4.5–14 days). Four of the 6 study arms (all but the Clinimix 675-mOsm/L and acyclovir 3.5-mg/mL arms) demonstrated an increase in mean VIS of ≥77% in test vs control legs (P ≤ 0.034). Both pain and swelling occurred at higher rates in test vs control legs: 65% vs 10% and 70% vs 50%, respectively. The mean difference in rates of occlusive pericatheter mural thrombus between the test and control arms was statistically significant for the vancomycin 10-mg/mL (P = 0.0476), Clinimix 930-mOsm/L (P = 0.0406), and doxycycline 1-mg/mL (P = 0.032) arms. Conclusion Administration of infusates of varied pH, osmolarity, and cytotoxicity via midline catheter resulted in severe vascular injury and premature catheter failure; therefore, the tested infusates should not be infused via midline catheters.

Abstract Background and aims Restless Legs Syndrome (RLS) is characterised by unusual sensations in the legs which can be described as painful in up to 60% of RLS patients. The purpose of this study was to characterise and examine whether the presence of pain influenced the words used to describe the sensations of RLS in an English speaking population. Methods RLS participants (n=55) were divided according to whether or not painful RLS sensations were reported upon questioning. They completed the McGill Pain Questionnaire (MPQ), the International Restless Legs Syndrome Severity Scale (IRLS) and selected descriptors from a list of previously published RLS terms. Results Thirty-five percent of the RLS patients had painful sensations. The participants with painful RLS had higher Pain Rating Index (PRI) scores [median (interquartile range) 21 (17–28) vs. 14 (7.5–21) p=0.0008] and IRLS scores [23 (17–28) vs. 18 (11.5–22.5) p=0.0175] than the participants with non-painful RLS. Patients with painful RLS symptoms selected more pain-related literature terms, chose significantly different words in eight of the MPQ subclasses (both sensory and affective) and selected more intense descriptors from certain MPQ subclasses than the non-painful RLS group. The terms that characterised painful RLS were “aching”, “painful”, “cramping” and “unbearable”. Conclusions Descriptors of RLS sensations are changed by the presence of pain, which may indicate an aetiological difference in the patients who have painful RLS. Clinically, patients complaining of cramping and painful sensations may be diagnosed with a condition that mimics RLS. Thus, it is important that the most accurate set of descriptors for RLS are used to enable recognition of RLS and optimised treatment according to the RLS phenotype. Implications The diagnosis of RLS may be improved by overcoming language and cultural barriers and obtaining differential diagnostic terms for painful conditions mimicking RLS.

Abstract Background: Asparaginase-associated pancreatitis (AAP) is a well-known and frequent toxicity of childhood acute lymphoblastic leukemia (ALL) therapy. Diagnostic criteria have varied among international ALL study groups, impairing international comparison of incidence, severity and complications, and limiting the knowledge on the risk of re-exposure to asparaginase. Objectives and Methods: This questionnaire study reports AAP data from 19 collaborative groups on children (1.0-17.9 years) treated with ALL from 1/2000-4/2015. To define AAP, the Ponte di Legno toxicity working group (PTWG) consensus definition was used: At least two of i) amylase, pancreatic amylase, or pancreatic lipase >3x upper normal limit (UNL), ii) abdominal pain, iii) imaging compatible with AAP (Lancet Oncology, 2016; 6: 231-239). AAP was graded as mild or severe (persisting abdominal pain and pancreatic enzymes ≥3xUNL more than 72 hours after AAP diagnosis and/or pseudocyst, abscess, or hemorrhagic APP at imaging). Results: Of 633 patients registered with AAP, 459 patients fulfilled the PTWG criteria for AAP; 96% had abdominal pain, 92% had a rise in at least one pancreatic enzyme >3xUNL, and 75% had imaging (72 MRI, 239 CT, 320 ultrasound) compatible with AAP. Of the remaining 174 patients, 29 had >35 days from injection of asparaginase to diagnosis of pancreatitis, 41 fulfilled only one diagnostic criteria, and 104 had insufficient data in the groups' registries. The median age was 8.3 years (75%-range: 4.2-13.3), 53% were male, and 80% had B-cell precursor ALL. At AAP diagnosis, 41% presented with fever, 68% had tachycardia, 29% had hypotension, and 77% presented with systemic inflammatory response syndrome (SIRS) defined as fulfilling a minimum of two of four criteria: i) body temperature >38 ◦C or <36 ◦C; ii) heart rate >90 beats per minute; iii) respiratory rate >20 breaths per minute or PaCO2 <4.2 kPa; iv) white blood cell count >12 x 109/L or <4 x 109/L. Seven percent required mechanical ventilation, including 5 of the 7 patients who died due to AAP. Twenty-six percent of the 459 study patients developed pseudocysts. These patients were older than those who did not (median age 10.8 years vs 7.1 years; p=0.0003), and more frequently presented with SIRS (30% with SIRS vs 16% without SIRS; p=0.015). Five percent of patients with abdominal pain that ceased within 72 hours developed pseudocysts vs 33% of patients with pain persisting >72 hours (p<0.0001). Twenty percent required insulin within ten days of AAP diagnosis, and 6% still received insulin at last follow-up (median: 5 years from diagnosis of AAP). Persisting need of insulin therapy was associated with older age (median: 13 years vs 7.6 years; P=0.001) and presence of pseudocysts (13% vs 3% for those without pseudocysts; p=0.0001). Five percent of all patients had recurrent abdominal pain at last follow-up. 103 patients (22%) were re-exposed to asparaginase, and 45% of these developed a second AAP. 24% were re-exposed after a mild AAP, and no difference in risk of second AAP was found among mild and severe first AAP episodes (47% vs 45%, P=1). Risk of a second AAP was not significantly associated with presence of SIRS at first AAP episode (56% vs 30%; P=0.1), CRP level, or pancreatic enzyme levels at diagnosis of first AAP. Of the 43 patients who developed a second AAP, this was graded as a mild second AAP in 48%. Severity of second AAP was not associated to SIRS or severity of first AAP. Conclusion: AAP is associated with a high frequency of both acute and persisting complications. The risk of complications was associated with older age and presence of SIRS at diagnosis of AAP. Almost half of those re-exposed to asparaginase developed a second episode of AAP, however the risk of recurrent AAP was not predictable based on characteristics of the first episode. To improve prediction of AAP, exploration of other risk factors, including host genome variants, is indicated. Disclosures Inaba: Arog: Research Funding. Moricke:JazzPharma: Honoraria, Other: financial support of travel costs.

Non solo un correttivoLa riforma elettorale del 1993, pur nella sua architettura bifronte e ambigua1, modifica in maniera decisiva il sistema elettorale in senso maggioritario. La quota di seggi assegnata con il sistema proporzionale, pensata per attutire i verdetti, prevedibilmente perentori, della competizione maggioritaria a turno unico, rispetto a quest'ultima assume un peso numericamente subordinato.In conformità allo spirito e alla lettera della legge sia nel 1994 sia nel 1996 il confronto elettorale è stato centrato sulla competizione maggioritaria, in cui le coalizioni e i candidati nei collegi uninominali hanno giocato il ruolo degli attori principali. Nel 1996, poi, il rilievo della competizione maggioritaria è stato ulteriormente accresciuto in virtù del processo di apprendimento istituzionale degli attori2. In particolare, nel 1996 un adeguamento decisivo al formato maggioritario è passato attraverso la contrapposizione di due leader di coalizione, designati come capi del futuro esecutivo. Questa personalizzazione dello scontro, così congeniale alle esigenze di semplificazione e drammatizzazione dei media, ha di conseguenza accentuato il rilievo delle due coalizioni principali, che hanno allargato la loro ombra sugli altri attori (la Lega, i candidati di collegio, ecc.), e soprattutto a danno dei contendenti dell'arena proporzionale.

Management of lower extremity venous trauma using repair or ligation has been an area of controversy during the past decades. However, in unstable patients or if primary repair is technically impossible as a result of extensive disruption of the vein, ligation is recommended. This study investigated the effects of venous ligation on major veins in the lower extremities when primary repair is impossible as a result of extensive laceration of the vein. Between January 2001 and April 2004, 63 patients with Grade III and IV venous injuries were observed prospectively. Compression ultrasonography was performed postoperatively on the fifth day, once before discharge, and at the 3-month visit to assess deep vein thrombosis (DVT) and the patency of arterial repair. If DVT was present, the patient was given an oral anticoagulant (warfarin Na) for 3 months (international normalized ratio, 2.0–3.0), and Class II compression stockings (Sigvaris-212, Ganzoni, Switzerland) were used for 1 year. Follow-up visits occurred at 1, 3, 6, and 12 months and at 6-month intervals thereafter. Combined arterial and venous injuries were present in 50 (79.4%) patients and pure venous injuries were present in 13 (20.6%) patients. DVT developed in 49 patients (77.7%; postoperative n = 37 [58.7%], late n = 12 [19%]). Three arterial restenoses (4.7%) and one pseudoaneurysm (1.6%) of the superficial femoral artery developed. Five early (prophylactic) and two late (compartment syndrome) fasciotomies were performed. Postoperative edema was seen in 56 (88.8%) patients and wound infection was seen in 19 patients (30.1%; n = 18 superficial, n = 1 deep). Two amputations (3.2%) were performed. One patient (1.7%) died as a result of irreversible shock. After a median of 18 months, 25 patients were classified with Clinical Etiology, Anatomy, Pathology classification: 10 legs C-0, seven legs C-2, and eight legs C-3. No severe postthrombophlebitic syndrome was observed. Early leg swelling after venous ligation was the most common morbidity. We observed no significant sequelae of chronic venous insufficiency, and venous ligation had no detrimental effect on associated arterial repair. In cases of DVT, anticoagulation with low-molecular-weight heparin and oral anticoagulants should begin immediately and continue for 3 months along with compression stocking support for 1 year.

Background and Aims A novel genetic subtype of B cell precursor acute lymphoblastic leukemia (B-ALL) is characterized by rearrangement of NUTM1 (NUTM1r) on 15q14 resulting in fusion of NUTM1 to one of several partner genes such as CUX1, ACIN1, BRD9, and IKZF1. The downstream effects of NUTM1r include upregulation of the proto-oncogene BMI1 and specific fusions also induce transcription of the HOXA gene cluster (Hormann et al. Haematologica 2019; Li et al. PNAS 2018). This novel subtype is rare in children, but appears to be more prevalent among infants negative for KMT2A rearrangement (KMT2Ar) based on the frequency of karyotypic 15q aberrations (De Lorenzo et al. Leukemia 2014). This international collaborative study aimed to determine the frequency of NUTM1r in infant and pediatric cohorts, and to characterize the demographic, clinical and molecular features of NUTM1r-positive B-ALL. Patients and Methods Interfant-related study groups provided NUTM1 screening results for KMT2Ar-negative Interfant-99 and -06 cases with karyotypic 15q aberration, normal karyotype, or missing karyotype. Additionally, NUTM1r-positive cases of any age were collected from the study groups united in the Ponte di Legno consortium. The identified NUTM1r-positive children were diagnosed between 1995-2019, infants (≤365 days of age) included in the Interfant-99 or 06 trials were diagnosed between 2000-2016, and remaining infants between 1986-2019. The techniques used for the detection of NUTM1r were break-apart FISH, RNA sequencing, and RT-PCR. Event-free survival (EFS) and overall survival (OS) were estimated according to Kaplan-Meier, standard error according to Greenwood, and the curves were compared by log-rank test. Results We identified 81 NUTM1r cases, including 35 Interfant-enrolled infants, 10 other infants and 36 children. NUTM1r was reported to be rare among pediatric B-ALL with an estimated frequency range of 0.28-0.86%. The median age among NUTM1r-positive children was 4.5 years (range 1-15). Among KMT2Ar-negative infants the frequency of NUTM1r was 21.7%. Of NUTM1r-positive infants, 54% were <6 months at diagnosis (median 5.6, range 0.4-11.0 months) compared with 16% in the remaining KMT2Ar-negative infants (median 9.3, range 0.1-11.9; p<0.0001). Other baseline characteristics (WBC, gender, prednisone poor response) were similar between NUTM1r-positive and -negative infants. Of the NUTM1r-positive cases, all achieved complete remission, 82% had minimal residual disease <10e-4 at the end of induction, and no patient received stem cell transplant in first remission. The 4-year EFS was 100% in Interfant-enrolled NUTM1r-positive patients versus 74% (95% CI 65.1-81.0, p=0.001) in the remaining KMT2Ar-negative cases (n=126). The better outcome was confirmed also after adjusting for WBC, gender and prednisone response (p=0.0001). The 4-year OS were 100% and 88.0% (95% CI 80.5-92.7) for NUTM1r-positive and other KMT2Ar-negative infant cases, respectively (p-value=0.04). Children and non-Interfant-enrolled infants treated on different treatment protocols showed 89.4% (95% CI 78.6-1) 4-year EFS and 100% 4-year OS. In order of frequency, NUTM1 fusion partners were ACIN1 (30.4%), CUX1 (21.7%), BRD9 (17.4%), ZNF618 (13%), AFF1 (4.3%), SLC12A6 (4.3%), IKZF1 (2.9%), and three novel partners: ATAD5 (2.9%), CHD4 (1.4%) and RUNX1 (1.4%). Infants mainly showed fusions with ACIN1, CUX1, BRD9 and AFF1, associated with HOXA9 upregulation. Older infants and children showed both HOXA-upregulating and non-HOXA-upregulating fusions. Epigenetic profiling showed a distinct pattern of DNA methylation and histone modification of the HOXA gene cluster region in leukemic cells of an ACIN1-NUTM1 pediatric case compared with KMT2Ar-positive and KMT2Ar/NUTM1r-negative pediatric cases. Conclusions NUTM1r ALL was identified as the second largest subtype in infants, found in 21.7% of KMT2Ar-negative infant B-ALL, representing 5-7% of total infant ALL, and associated with excellent outcome on Interfant standard risk protocols. The favorable outcome was confirmed in the Ponte di Legno cohort of infant and pediatric NUTM1r-positive patients enrolled on different treatment protocols over more than two decades. We conclude that NUTM1r ALL is a favorable genetic subtype in infants and children and possibly eligible for treatment reduction. Disclosures No relevant conflicts of interest to declare.

Abstract The May Measurement Month (MMM) 2019 campaign aimed to raise awareness of the health issues surrounding raised blood pressure (BP) among the general public. It also sought to identify and facilitate reduction of BPs of participants who require intervention to lower their BP according to current country treatment guidelines. Participants aged ≥18 years were recruited on site through interactions with the study team, educational fliers, and as voluntary walk-ins in response to the media engagement prior to the campaign. Blood pressures were measured using validated upper-arm cuff electronic devices provided by Omron Healthcare in partnership with International Society of Hypertension. With the participant seated, their back supported and legs resting uncrossed on the ground, three BP and heart rate readings were taken and recorded, 1 min apart. Participants’ basic demographic data were also collected. Hypertension was defined as being on treatment for hypertension, or a systolic BP ≥140 mmHg and/or a diastolic BP ≥90 mmHg (based on the mean of the last two of three readings). Of the 5459 screened participants, 1750 (32.1%) had hypertension, of whom 784 (44.8%) were aware they were hypertensive and 726 (41.5%) were on antihypertensive medication. Among those on antihypertensive treatment, 47.0% had their BP controlled (<140/90 mmHg). Only 19.5% of all those with hypertension had their BP controlled. A total of 1024 (21.6%) of the 4733 participants not on antihypertensive treatment were hypertensive. Intensified preventive and treatment measures to control BP at the health system, individual and population levels remain a critical requirement for Botswana.

Abstract Abstract 293 Intrachromosomal amplification of chromosome 21 (iAMP21) is a distinct cytogenetic subgroup of childhood BCP-ALL, characterised by older age, low white cell count (WCC) and poor outcome on standard therapy. It is identified by a complex structure of one copy of chromosome 21, highly variable between patients, with a common 5.1Mb region of amplification within which the RUNX1 gene is located. Thus FISH, using probes directed to RUNX1 provides a reliable detection method, defining iAMP21 as ≥5 copies of RUNX1 ≥4 on the abnormal chromosome 21. The Ponte di Legno International Childhood ALL Workshop has collected data from 513 iAMP21 patients from 15 international study groups in order to further characterise this subgroup and improve identification. iAMP21 was mutually exclusive of ETV6-RUNX1 fusion (509 tested), MLL rearrangement (391 tested), TCF3-PBX1/TCF3-HLF (151 tested). There was evidence of classical high hyperdiploidy in two of the 428 patients with a successful cytogenetic result. Four patients (393 tested) were positive for the BCR-ABL1 fusion. In addition to iAMP21 all patients had one normal chromosome 21, apart from 10 patients with two copies of normal 21 in addition to iAMP21, and 4 patients with an additional iAMP21. Other whole chromosomes commonly gained or lost among the 398 patients with abnormal karyotypes were: +X (21%, n=85), −7 (5%, n=19), +10 (4%, n=17), +14 (4%, n=17), and −15 (3%, n=11). Abnormalities of 11q (14%, n=57), 7q (9%, n=35), 9p (9%, n=36) and 12p (6%, n=24) were the most frequent visible chromosomal imbalances. Deletions of CDKN2A/B and ETV6 occurred in 16% and 34% cases, respectively, suggesting that these genes were the targets of 9p and 12p abnormalities. The incidences of deletions of ETV6 (34% vs 22%) and RB1 (40% vs 6%), as well the CRLF2 rearrangement, P2RY8-CRLF2 (19% vs 4%), were significantly higher among the iAMP21 patients than a comparator cohort of 1427 children with BCP-ALL. There were a number of patients with constitutional abnormalities involving chromosome 21: Down syndrome (n=1), ring chromosome 21, r(21)c (n=3) and Robertsonian translocation between chromosomes 15 and 21, rob(15;21)(q10;q10)c (n=4). It was intriguing that in the one case with r(21)c and those with rob(15;21)(q10;q10)c, in which an acquired abnormal karyotype was present, it was the chromosome with the constitutional abnormality which gave rise to the abnormal iAMP21 chromosome. In terms of the demographic profile of iAMP21 patients, 52% were female and 48% were male, median age was 9 years (range 2–23). Patients <10 and ≥10 years old were equally distributed (51% vs 49%). The median WCC was 5×109/L, range (<1–900×109/L), with only 3% having a high WCC >50 x109/L (n=13). The NCI Risk status was standard risk (SR) in 48% and high risk (HR) in 52%. Follow-up data were available for 283 patients diagnosed before 01/01/2009. Complete remission (CR) was achieved in 280/283 (99%) of which 90 (32%) suffered a relapse and 47 (17%) patients died. In total 43% were treated as HR, with the remainder (57%) treated as SR. There was a significant improvement in event free survival (EFS) (Figure) for patients treated as HR compared to SR. After a median follow-up time of 3.4 years, the 5 year EFS rates were 70% (95% CI 59–78) and 50% (30–59), respectively, hazard ratio 0.73 (95% CI 0.59–0.91) (p=0.005). Patients with iAMP21 display a unique spectrum of genetic abnormalities, which may be useful for improving identification of iAMP21: gain of chromosomes X, 10 or 14 in the absence of high hyperdiploidy, or monosomy 7/deletion of 7q, deletions of 11q, including MLL and ATM genes, P2RY8-CRLF2, deletions of ETV6 and RB1. These characteristic abnormalities provide useful data to ascertain the presence of iAMP21 when no metaphases are available to visualise the abnormal chromosome 21, or in the rare cases where the abnormal chromosome 21 has atypical rearrangements with other chromosomes. In rare cases, iAMP21 is associated with BCR-ABL1 and high hyperdiploidy, but is exclusive of other chromosomal abnormalities of prognostic significance. Although Down syndrome was rare, other constitutional abnormalities of chromosome 21 may be related to iAMP21 in these patients. Accurate identification of this abnormality is important due to the treatment implications. This study has shown that treatment of iAMP21 patients as HR provides a significant improvement in outcome. Figure: EFS for iAMP21 patients treated as HR and SR Figure:. EFS for iAMP21 patients treated as HR and SR Disclosures: No relevant conflicts of interest to declare.

ObjectiveTo study the clinical and epidemiological characteristics of complex regional pain syndrome (CRPS) in children.Patients and methodsAll children and adolescents under 16 years of age with a new diagnosis of CRPS who were reported to the Scottish Paediatric Surveillance Unit were included. Patients’ recruitment ran between 1 November 2011 and 31 October 2015. Information was collected on patients’ demography, clinical features, investigations, management and impact of disease on child and family. The diagnosis of CRPS was made on fulfilling the clinical criteria of the International Association for the Study of Pain.Results26 cases of CRPS were reported over 4 years, giving a minimum estimated incidence of 1.16/100 000 (95% CI 0.87 to 1.44/100 000) children 5–15 years of age. Nineteen patients were female (73%) and mean age at diagnosis was 11.9 (range 5.5–15.4 years). The median interval between onset of symptoms and diagnosis was 2 months (range 1–12). The majority of children have single site involvement, with legs been more often affected than arms and the right side is more often affected than the left. There was a clear trauma at onset of the illness in 19 children and possible nerve injury in one. All investigations were normal and several treatment modalities were used with variable success. The disease had significant impacts on the patients’ education and family lives.ConclusionsThe estimated incidence of CRPS is 1.2/100 000 children 5–15 years old. The diagnosis of CRPS is often delayed. CRPS has a significant impact on children and their families.

STEAM-based learning is a global issue in early-childhood education practice. STEAM content becomes an integrative thematic approach as the main pillar of learning in kindergarten. This study aims to develop a conceptual and practical approach in the implementation of children's education by applying a modification from STEAM Learning to R-SLAMET. The research used a qualitative case study method with data collection through focus group discussions (FGD), involving early-childhood educator's research participants (n = 35), interviews, observation, document analysis such as videos, photos and portfolios. The study found several ideal categories through the use of narrative data analysis techniques. The findings show that educators gain an understanding of the change in learning orientation from competency indicators to play-based learning. Developing thematic play activities into continuum playing scenarios. STEAM learning content modification (Science, Technology, Engineering, Art and Math) to R-SLAMETS content (Religion, Science, Literacy, Art, Math, Engineering, Technology and Social study) in daily class activity. Children activities with R-SLAMETS content can be developed based on an integrative learning flow that empowers loose part media with local materials learning resources.
 Keyword: STEAM to R-SLAMETS, Early Childhood Education, Integrative Thematic Learning
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B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is a heterogeneous disease that can be subdivided according to primary recurrent genetic abnormalities that are strongly associated with characteristic biological and clinical features. The first few cases with ZNF384-related rearrangements were described as early as 2002. The leukemic phenotype of these cases was not only BCP-ALL but also mixed phenotype acute leukemia (MPAL) and acute myeloid leukemia (AML) switched from ALL. The number of patients was small because this type of leukemia is rare and many of the fusions are cytogenetically cryptic. RNA sequencing revealed that 1% to 6% of childhood BCP-ALL cases, 5% to 15% of adult BCP-ALL cases and 48% of B/Myeloid MPAL cases harbored ZNF384 rearrangements. Of note, ZNF384 has a variety of partner genes such as TCF3, EP300 and TAF15. Their biological characteristics showed distinct expression profiles, and the cell origin might arise from primitive hematopoietic cells. The clinical features associated with ZNF384-related rearrangements have not been analyzed in a large cohort of patients. To identify the clinical characteristics of ZNF384-related rearrangements in childhood BCP-ALL (MPAL was excluded), we studied a total with 226 cases of ZNF384-related rearrangements from 15 international consortia who participate in the Ponte di Legno study group registered between 1987 and 2018. We analyzed the impact of outcome in association with clinical and biological characteristics. ZNF384-related rearrangements were detected by fluorescence in situ hybridization (FISH), reverse transcription polymerase chain reaction (RT-PCR) and/or next generation sequencing (NGS), according to local selection policies, or because of poor response to therapy. Additional genetic abnormalities were detected by multiplex ligation-dependent probe amplification (MLPA), single nucleotide polymorphism array (SNP array) and/or NGS. The median age of presentation was 9 years old (range, 1 - 25 years old). The female and male ratio was 1:1. Immunophenotypic characteristics were classified as BCP-ALL exclusively In addition, 33% were CD10 negative cases (cutoff 20%); 71% were CD13 positive; and 86% were CD33 positive. Complete hematological remission was achieved in 99% of cases. One third (31%) of patients were treated as high risk and one quarter (23%) of patients received a stem cell transplant in first remission. After a median follow-up of 5.3 years, the 5-year event free survival (EFS) rate was 84% (95%CI, 77 to 89%), and the 5-year overall survival (OS) rate was 91% (95% CI, 85 to 94%). There was no difference in survival rate by treatment era or by country or region of origin. The proportion of partner genes with ZNF384 was as follows: EP300 (37%, n=84), TCF3 (27%, n=60), TAF15 (8%, n=17), CREBBP (7%, n=16), others (8%, n=18) of identifiable partners, and unknown (14%, n=31), although a prospective unselected analysis is needed for an appropriate estimate of the partners distribution. Patients with an EP300-ZNF384 fusion had a significantly lower relapse rate at 5 years compared with the remaining patients: 5% (95% CI 2-14) versus 20% (12-32), hazard ratio 4.58 (1.56-13.45), p=0.006), respectively. The corresponding EFS and OS rates were 91% (81-96) vs. 76% (64-85), p=0.024 and 92% (81-96) vs. 90% (80-95), p=0.3, suggesting that the non-EP300 relapses were salvageable (Figure). Multivariate analysis adjusting for sex, age, WBC and treatment era did not alter these results. Of note, in cases of TCF3 and TAF15, relapse occurred very late even after 5 years from diagnosis. Additional genetic abnormalities such as IKZF1, PAX5, CDKN2A/2B deletions were also analyzed. The distribution of deletions by partner genes was different between fusion partners but were not significant as prognostic factors. We confirm that ZNF384 rearrangement is a biologically and clinically distinct subtype of BCP-ALL. Immunophenotype abnormalities imply that ZNF384 rearrangements arise from primitive hematopoietic cells. Even considering a potential selection bias for the retrospective nature of the study, the OS was excellent in this subtype, although, relapse events did not reach a plateau among patients with TCF3-ZNF384 and TAF15-ZNF384. On the other hand, EP300-ZNF384 showed good prognosis with a low relapse rate. The biological background in each fusion partner warrants further investigation. Disclosures Loh: Medisix Therapeutics, Inc.: Membership on an entity's Board of Directors or advisory committees.

Abstract Introduction: Pain and functional impairment associated with joint disease are major problems affecting adults with congenital hemophilia. Various standardized and disease-specific patient-reported outcome (PRO) instruments have been used in clinical studies of PWH or other diseases, but the use of these tools in the hemophilia comprehensive care setting for individual patient assessment or overall outcome tracking is limited and inconsistent. P-FiQ was designed to assess the impact of pain on functional impairment and quality of life (QoL) in adult PWH. Objectives: To assess pain and functional impairment in nonbleeding adult PWH through 5 PRO instruments and a clinical joint health evaluation. Methods: Adult males with mild to severe hemophilia and a history of joint pain or bleeding were enrolled from 15 US sites between October 2013 and October 2014. During routine clinical care visits, participants completed a pain history and 5 PROs (EQ-5D-5L with visual analog scale [VAS], Brief Pain Inventory v2 Short Form [BPI], International Physical Activity Questionnaire [IPAQ], SF-36v2, Hemophilia Activities List [HAL]) and underwent a Hemophilia Joint Health Score v2.1 (HJHS) evaluation completed by a trained physical therapist. Results: Overall 381 patients were enrolled, with a median age of 34.0 years. PRO and HJHS summary scores are presented in the table below. On EQ-5D-5L, most participants reported problems with mobility, usual activities, and pain/discomfort. On BPI, median worst pain was 6.0, least pain 1.0, average pain 3.0, and current pain 2.0. Ankles were most frequently reported as the joints with the most pain (37.4%), followed by knees (23.7%) and elbows (18.9%). On IPAQ, approximately half of participants (51.0%) reported no physical activity in the prior week. Median SF-36v2 subscores were lower for the 4 physical health domains than for the 4 mental health domains. Among HAL domains, self-care was the least impacted (median, 100.0) and functions of the legs (median, 66.7) and lying/sitting/kneeling/standing (median, 67.5) were the most impacted. On HJHS, elbow, knee, and ankle scores did not differ appreciably (median, 4.0, 4.0, and 6.0, respectively). Table. Assessment Tool Median (Q1, Q3) Range EQ-5D-5LVAS Health index 80.0 (66.0, 90.0) 0.796 (0.678, 0.861) 0 to 100a-0.11 to 1.0a BPIPain severity Pain interference 3.3 (1.3, 5.0) 2.7 (0.6, 5.4) 0 to 10b IPAQTotal physical activity 530.2 (264.0, 1039.5) Metabolic equivalents of task (MET)/minutes per week: Walking = 3.3 METs Moderate activities = 4.0 METs Vigorous activities = 8.0 METs SF-36v2Physical functioning Role physical Bodily pain General health Vitality Social functioning Role emotional Mental health Physical health summary Mental health summary Overall health 44.4 (29.7, 52.8) 44.6 (32.4, 56.9) 41.8 (37.2, 51.1) 45.8 (35.3, 52.9) 49.0 (42.7, 55.2) 45.6 (34.9, 56.4) 55.9 (36.4, 55.9) 52.8 (41.6, 58.5) 39.2 (29.5, 49.4) 50.7 (41.4, 55.7) 3.0 (2.0, 4.0) 0 to 100a1 to 5a HALUpper extremity activities Basic lower extremity activities Complex lower extremity activities Overall sum score 88.9 (73.3, 97.8) 73.3 (46.7, 96.7) 55.6 (30.0, 88.9) 76.6 (58.0, 94.3) 0 to 100a HJHSElbow Knee Ankle Global gait Total score 4.0 (0.0, 11.0) 4.0 (0.0, 10.0) 6.0 (1.0, 15.0) 3.0 (0.0, 4.0) 19.5 (6.0, 36.0) 0 to 40c0 to 124c aHigher scores indicate better QoL or functional status bLower scores indicate less pain severity cLower scores indicate better function Conclusions: Results of this analysis demonstrated challenges of lower extremity pain and functional impairment in US adult PWH. Pain was frequently observed, and it impacted physical function and quality of life across PROs and HJHS. Further analyses are underway to correlate assessments of pain and function across different PROs and with the exam-based HJHS. Disclosures Kempton: CSL Behring: Consultancy; Biogen: Consultancy; Baxter: Consultancy. Recht:Baxalta: Research Funding; Kedrion: Consultancy. Neff:Novo Nordisk: Other: Advisory Board; Kedrion: Other: Advisory Board. Wang:Biogen: Membership on an entity's Board of Directors or advisory committees; CSL Behring: Membership on an entity's Board of Directors or advisory committees; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees; Baxalta: Membership on an entity's Board of Directors or advisory committees. Buckner:Novo Nordisk: Consultancy; Baxalta, Inc. US: Consultancy. Soni:Bayer: Other: member of the Global Emerging HEmophilia Panel (GEHEP); Novo Nordisk: Speakers Bureau. Quon:Bayer: Other: Advisory Board; Grifols: Speakers Bureau; Novo Nordisk: Other: Advisory Board, Speakers Bureau; Biogen: Other: Advisory Board, Speakers Bureau; Baxter: Other: Advisory Board, Speakers Bureau. Witkop:Pfizer: Other: Advisory Board, Research Funding; Baxter Bioscience: Other: Advisory Board; Novo Nordisk: Other: Advisory Board, Speakers Bureau. Boggio:Baxter: Consultancy, Research Funding; OctaPharma: Consultancy, Research Funding; OPKO: Research Funding; CSL Behring: Consultancy, Research Funding; Novo Nordisk: Consultancy, Research Funding; Selexys: Research Funding; Bayer: Consultancy, Research Funding. Cooper:Novo Nordisk: Employment.

Abstract Retrospective analysis to correlate Impact of Symptom Burden and Quality of life to treatment outcome with Tyrosine kinase inhibitors in chronic myeloid Leukemia chronic phase Binsah George, Lori Williams, Quiling Shi, Talha Badar, Susan O'Brien, Elias Jabbour, Guillermo Garcia-Manero, Nitin Jain, Farhad Ravandi, Gautam Borthakur, William Wierda, Charles Cleeland, Hagop Kantarjian and Jorge Cortes Department of Leukemia, MD Anderson Cancer Center, Houston, Texas; Department of Symptom Research, MD Anderson Cancer Center Background: With the advent of Tyrosine kinase inhibitors (TKI) in the treatment of Chronic Myeloid Leukemia chronic phase (CML-CP), patients (pts) live longer emphasizing the importance of symptom burden control to improve quality of life for these patients. The objectiveof this study isto analyze the symptom burden with different TKIs used as initial therapy for CML-CP and their impact on outcome Methods: We analyzed a total of 200 patients with CP-CML enrolled in prospective clinical trials with frontline TKI therapy; ponatinib [PONA]=33, dasatinib [DASA]=85, nilotinib [NILO]=82 between the years of 2005-2013. At time points including baseline, 3months, 6 months, 12months, 18months, 24 months pts symptom burden was assessed by the MD Andersron Symptom Inventory for CML (MDASI-CML) (Blood 2013; 122: 641). Results: The overall median age was 48 years (range, 22-76) and the median follow up was 24 months (range, 11-31months). The entire cohort of 200 patients reached a complete cytogenetic response (CCyR) at 3 months, all with reverse-transcriptase (RT)-polymerase chain reaction (PCR) for the BCR-ABL fusion transcript of <10 percent (%) by international Scale (IS). At 6 months 184/200 pts (92%), 12 months 160/189 (84%), 18 months 129/181 (71%), and 24 months 125/173 (72%) had reached PCR BCR-ABL of <1%, <0.1%, <0.01%, and <0.0035%, respectively. The mean worst symptom over 24 months of treatment with NILO and DASA was fatigue while for ponatinib was skin rash. The mean top 5 worst symptoms for DASA were (figure 1) fatigue (p=0.001 compared to baseline), drowsiness, memory loss, skin rash and sleep disturbance; for NILO (figure 2) top 5 were fatigue, sleep disturbance, memory loss, drowsiness, and skin rash; for patients treated with PONA (figure 3) top 5 symptoms were skin rash, fatigue, drowsiness, generalized muscle soreness, dry mouth. Mean overall symptom scores were 1.45 for DASA, 1.63 for NILO and 2.83 for PONA. Work was the aspect of daily life most interfered with by symptoms for the whole cohort at baseline and over the 24 month treatment period (mean DASA=1.11, NILO=1.95 and PONA=2.43). By individual TKI, the top mean aspects of daily life (after work) interfered with in order of severity were, for PONA, activities (2.12), mood (2.11) and ability to enjoy life (2.09); for DASA, ability to enjoy life (1.07), activities (0.99) and mood (0.98); and for NILO, mood (1.05), ability to enjoy life (0.99), and activities (0.93). The mean overall impact of function scores were 1.74 for DAS, 1.29 for NILO and 2.18 for PONA. In the DASA and NILO cohort who completed the MDASI-CML at 24 months, 6 of 19 (31%) did not reach MR4.5 (%BCR-ABL <0.0032%) while 13 (68%) achieved this response at 24 months (PONA cohort not included as most patients had not reached a 24 month treatment follow up at the time of this report). The top 5 significant symptom mean scores in the cohort who did not reach MR4.5 were fatigue (1.67), pain (1.33), memory loss (1.33), and drowsiness (1.17) and swelling of hands and legs (1.17) while for patients who reached MR4.5, fatigue (2.38), drowsiness (1.62), swelling of hands and legs (1.46), memory loss (1.46), and generalized pain (1.33) were the top mean symptoms. Patients that reached MR4.5 in this cohort had a higher mean symptom burden (1.65) in comparison to those not reaching MR4.5 (1.33) Conclusions: Symptom burden is affected in different ways by different TKI used as initial therapy for CML. The NILO and DASA cohort that had MR4.5 at 24 months had a worse symptomatology mean in comparison to the cohort that did not reach MR4.5. Figure: (1) Top 5 symptoms with Dastinib treatment over time Figure: (1). Top 5 symptoms with Dastinib treatment over time Figure: (2) Top 5 symptom with Nilotinib treatment over time Figure: (2). Top 5 symptom with Nilotinib treatment over time Figure: (3) Top 5 symptoms with ponatinib time over time Figure: (3). Top 5 symptoms with ponatinib time over time Disclosures Cortes: Ariad, BMS, Novartis, Pfizer, Teva: Consultancy, Research Funding.

Abstract Primary cutaneous B-cell lymphomas (PCBCL) are a distinct group of primary cutaneous lymphomas with few and controversial reports on their treatment and prognostic factors. The aim of this retrospective study of a large international series of PCBCL patients was to analyze the patient and lymphoma characteristics as well as treatment-related variables associated with clinical outcome. From 1980 to 2006, 507 patients were referred to 19 cancer centers of 6 countries all over the world. The median age was 55 years (range,16–92 years) and the M/F ratio was 1.4. According to the WHO-EORTC classification indolent lymphomas included 341 FCL and 122 MZL, while aggressive NHL were represented by DLBCL, leg type (n=44). Sixty patients (12%) had stage II. The majority of cases was diagnosed in trunk/arms (52%), while in 29% in head/neck and in 13% in the legs; 7% of patients had a generalized disease (>1 site). The maximal lesion diameter was >4 cm in 21% of cases and ≥2 lesions were recorded in 39%. The prevailing type of lesions were nodules (74%), while only a minority of patients (6%) were affected by tumors. Few patients had B symptoms (5%), poor ECOG-PS (9%) or elevated LDH (7%). Two hundred eighty-four out of 446 patients (64%) were treated only with surgery (n=86) or chemotherapy (n=95), mostly consisting of a short course of anthracyclin containing regimens, or radiotherapy (30–50 Gy) (n=103). One hundred sixty two cases (36%) received combined therapy, mostly including surgery or chemotherapy, followed by radiotherapy. A small subgroup of 35 patients were given rituximab alone (n=19) or in combination with other treatments. The remaining 26 patients did not receive any therapy. The response rate of 446 patients was the following: 402 achieved CR (86%), 38 PR and 6 were in SD. Neither histology nor treatment significantly influenced CR rate. Among 402 responders, 128 (32%) eventually relapsed, 86% in the skin, 10% in extracutaneous sites and 4% in both. The relapse rate varied according to histology, ranging from 52% in DLBCL leg-type to 29% in MZL and 28% in FL. Moreover, combined treatments significantly reduced relapse rate (24% vs. 37%; p=0.008). The achievement and maintenance of CR significantly influenced the long-term disease specific survival (at 20 year 99 % vs. 45%; p=0.0001). The CR rate of subgroup of 35 patients treated with rituximab, was 74%, while the relapse rate was 35%. These results were not influenced by the addition of other therapies to rituximab. After a median follow-up of 53 months (range, 2–333 months), 5 and 10-year estimate of OS, disease-specific survival, PFS and DFS were 91%, 92%, 61%, 65% and 82%, 88%, 49% and 56%, respectively. Cox multivariate analysis, stratified for age with a stepwise selection of the significant variables, identified DLBCL, leg-type histology, elevated LDH, type of lesion (nodules and tumors), B symptoms and female gender, as significant predictors of a poor OS. In conclusion this retrospective analysis confirms, on a large series of cases, that patients with PCBCL belong to different risk categories requiring a tailored treatment approach. These data can be usefully taken into account for an adequate management strategy of PCBCL patients.

Abstract Background: Lower extremity ulcers are one of the most common skin manifestation in patients (pts) with APS, observed in 20-30% of pts. These skin ulcers typically respond poorly to conventional treatment. Although incompletely understood, the pathogenesis of the skin ulcers (and most of the clinical manifestations of APS) appears to be the result of vascular endothelial damage at the microcirculation level, leading to intracapillary thrombosis and focal inflammation. Systemic treatments with immunomodulatory agents such as glucocorticoids, intravenous immunoglobulin (IVIG) and immunosuppressants have been reported to improve outcomes, but typically carry substantial side-effects, and may not be available outside specialized referralcenters. The use of anticoagulation, with or without immunosuppression, in pts with APS and skin ulcers has been reported with variable results. Our group and others have documented an excellent safety profile with the combination of ASA 81 mg orally and enoxaparin 40 mg subcutaneously given to pregnant patients with APS and recurrent pregnancy loss. Patient with APS appear to share similar microcirculatory changes in the organs involved. Methods: Case report. Results: A 72 year-old gentleman was diagnosed with APS in 2000, when he was evaluated for recurrent deep venous thrombosis in the lower extremities, and was found to have a positive lupus anticouagulant serum test. He received anticoagulation with warfarin, with a target International Normalized Ratio (INR) of 2.5-3.5. In 2011, the patient was evaluated for full-thickness ulceration of the bilateral medial distal legs. He had been treated years earlier with venous ablation, and screening for lower extremity arterial insufficiency showed adequate peripheral circulation. The ulcers were treated with moist antimicrobial wound dressings, serial wound debridement, ongoing compression therapy, and a course of skin substitute therapy. After over one year of treatment the ulcers healed. Over the next several years the patient experienced several episodes of re-ulceration of the lower extremity ulcers despite continued use of compression stockings. He was treated in the same fashion, and each episode of re-ulceration required months of therapy to achieve healing. In mid-2017 he developed another episode of re-ulceration. Similar treatment was again initiated, with little improvement over the first several months of therapy. Physical findings and the recalcitrant nature of the ulcers suggested a direct casual relation with his underlying APS. Since our pt was not a candidate for any form of immunosuppression, he was started on daily subcutaneous enoxaparin 1 mg/kg and daily oral ASA 81 mg. A complete healing of the skin ulcers was noted three months after initiation of the above therapy. He continues on this treatment without any side-effects. Conclusion: A multidisciplinary approach allows for a more detailed evaluation of these challenging cases and helps to improve clinical outcomes. Disclosures No relevant conflicts of interest to declare.

IntroductionPharmacologic measures to prevent venous thromboembolism were first routinely incorporated into the practice of general surgeons, urologists, and orthopedic surgeons in 1975, after the landmark International Multicentre Trial was published.1 This randomized trial allocated 4,121 surgical patients either to unfractionated heparin 5,000 U, beginning 2 hours preoperatively and continuing every 8 hours for 7 days, or to no heparin. Among the heparin-treated group, two patients had massive pulmonary embolism (PE) verified upon autopsy, compared with 16 among the no heparin group.These dramatic differences were reinforced by a subsequent meta-analysis of 15,598 surgical patients in randomized trials of venous thromboembolism prevention with low fixed dose (“minidose”) heparin.2 Those assigned to heparin prophylaxis had a two-thirds reduction in predominantly asymptomatic deep vein thrombosis (DVT), a one-third reduction in nonfatal pulmonary embolism, and a marked reduction in fatal PE (19 in heparin patients compared with 55 among controls). Based upon the results of these studies, unfractionated heparin in a dose of 5,000 U twice or three times daily, beginning 2 hours preoperatively, became the standard pharmacologic approach to perioperative prevention of DVT and PE.Despite the intensive study of venous thromboembolism in thousands of surgical patients, the investigation of DVT and PE developing as a complication among medical patients hospitalized for other primary conditions has languished, except for in stroke and myocardial infarction patients. Several fundamental issues are apparent. First, the incidence of venous thromboembolism among hospitalized patients has not been precisely elucidated. Second, subsets of patients with potentially the greatest risk, such as those in medical intensive care units, warrant special attention. Third, the failure rates of conventional low-dose heparin prophylaxis and mechanical prophylaxis with intermittent pneumatic compression boots have not been adequately defined among contemporary hospitalized medical patients. Fourth, the Food and Drug Administration has not approved low molecular weight heparin (LMWH) for prophylaxis against venous thromboembolism in medical patients. Such approval awaits the design, execution, and analysis of appropriate clinical trials in this understudied population.An Israeli study undertaken more than two decades ago provided intriguing evidence to support the concept that mortality reduction could be achieved in hospitalized general medical patients with low-dose heparin prophylaxis.3 This hypothesis was tested in 1,358 consecutive patients greater than 40 years of age who were admitted through the emergency department to the medical wards of an acute care hospital. Eligible patients with even numbered hospital records were assigned to receive 5,000 U low-dose heparin twice daily. Those with odd numbered records served as controls. Among patients allocated to heparin, there was a 31% reduction in mortality from 10.9% in the control group to 7.8% in the heparin group. The reduction in mortality in the heparin-treated group was evident from the first day, and the difference increased significantly and consistently with time until the end of the study period. Because the death rate was highest in the first 2 days in both groups, the reduction in mortality in absolute numbers was greatest on those 2 days. However, the relative mortality reduction remained stable throughout the study period.While low-dose heparin was demonstrated in the 1970s to be effective and safe for the prevention of venous thromboembolism in many thousands of surgical patients, only miniscule studies were carried out among medical patients during that era. For example, the Royal Infirmary in Glasgow studied 100 medical patients hospitalized with heart failure or chest infection.4 Patients were randomized to receive either heparin 5,000 U every 8 hours or to receive no specific prophylaxis measures. The diagnosis of DVT was established by iodine-125 fibrinogen leg scanning, which was undertaken in all study patients within 24 hours of hospitalization and repeated every other day for 14 days or until hospital discharge. The results in this group of hospitalized medical patients were dramatic. Among controls, 26% developed DVT, whereas the rate was only 4% among those receiving low-dose heparin.In a trial in 1986 that focused on octogenarian medical inpatients, a placebo-controlled, randomized, double-blind study5 utilized a once daily low molecular weight heparin (Pharmuka 10169, subsequently renamed enoxaparin). The dose was 60 mg injected subcutaneously once daily. The potential development of DVT was assessed by iodine-125 fibrinogen leg scanning in all patients. The trial lasted 10 days, and 270 patients were enrolled. The majority of subjects suffered from heart failure, respiratory diseases, stroke, or cancer. Of 263 evaluable patients, 9% in the placebo group developed DVT, compared with 3% of those receiving LMWH prophylaxis. Except for injection site hematomas, bleeding complications were not appreciably increased in the LMWH group.A trial involving 11,693 medical patients with infectious diseases randomized patients to receive either 5,000 U of heparin every 12 hours or no prophylaxis.6 Although patients were treated for a maximum of 3 weeks, follow-up was carried out for a maximum of 2 months. Heparin prophylaxis delayed the occurrence of fatal PE from a median of 12 days to a median of 28 days. Far more nonfatal thromboembolic complications in the control group (116 vs. 70, p = 0.0012). However, the prespecified primary endpoint was clinically relevant, autopsy-verified PE. In this respect, there was virtually no difference between the two groups: 15 heparin treated and 16 control group patients had autopsy-verified fatal PEs. This large trial, which yielded disappointing results, may have been flawed had the following study design flaws: 1) a lack of statistical power to detect a difference between the two groups in the primary endpoint, 2) the restriction of heparin prophylaxis to 3 weeks, and 3) an inadequate dose of heparin. (Keep in mind that the International Multicentre trial1 used low-dose heparin every 8 hours, not every 12 hours.)In the past decade, low molecular weight heparin has supplanted unfractionated heparin for prophylaxis against venous thromboembolism in total hip replacement7 and has proved superior both to warfarin8,9 and to graduated compression stockings10 for total knee replacement. This does not necessarily mean, however, that low molecular weight heparin will prove superior to unfractionated heparin, warfarin, or graduated compression stockings for prophylaxis of hospitalized medical patients.The MEDENOX trial of enoxaparin prophylaxis in medical patients completed enrollment of approximately 1,100 subjects in July 1998. Patients were randomized to one of three groups in a double-blind controlled trial: enoxaparin 20 mg once daily, enoxaparin 40 mg once daily, or placebo. The principal endpoint is the incidence of DVT as assessed by contrast venography on approximately day 10 of hospitalization. The results of this crucially important trial which favored enoxaparin 40 mg once daily, will be presented at the August 1999 XVII Congress of the International Society on Thrombosis and Haemostasis.Also, the Veterans Affairs Cooperative Studies Program has organized a randomized trial to study the effect of low-dose heparin prophylaxis on mortality among hospitalized general medical patients.11 Results will be available in about 5 years.Intermittent pneumatic compression devices constitute an alternative, nonpharmacologic approach to prevent PE and DVT. Though effective, special care must be taken to ensure that these devices are worn as prescribed.12 Frequent removal and nonuse can be problematic, especially in patients outside of an intensive care unit. In addition to the mechanical effect of increasing venous blood flow in the legs, these devices appear to cause an increase in endogenous fibrinolysis, due to stimulation of the vascular endothelial wall.13-15 It is possible that for hospitalized medical patients, combined mechanical and pharmacologic prophylaxis will find a special niche. For example, in certain surgical subspecialties, combined prophylaxis modalities are routinely used. Urologists combine intermittent pneumatic compression boots and adjusted-dose warfarin following radical prostatectomy.16 Neurosurgeons employ compression boots plus fixed, low-dose heparin in craniotomy patients with malignancies.17 The medical intensive care unit setting remains one of the last frontiers where the culture of routine venous thromboembolism prophylaxis is not well developed. Prophylaxis should be part of the standard admission orders, just like H2-blockers or carafate are almost always ordered routinely to prevent stress ulcers. Intensive care unit patients pose special challenges when planning prophylaxis strategies. First, these patients are often bleeding overtly or are admitted with thrombocytopenia. Accordingly, heparin or warfarin are often contraindicated. Second, leg ulcers, wounds, or peripheral arterial occlusive disease will preclude the use of intermittent pneumatic compression devices. With these problems in mind, it is useful to examine the current state of prophylaxis among intensive care unit patients.In 1994, the Venous Thromboembolism Research Group at Brigham and Women’s Hospital found that only one-third of consecutive patients admitted to the Medical Intensive Care Unit received prophylaxis against PE and DVT.18 In a subsequent survey of this population, one-third of patients developed DVT, and half of these were proximal leg DVTs. Overall, 56% received prophylaxis.19 Surprisingly, prophylaxis appeared to have little impact on DVT rates. The overall DVT rate in patients who had received either heparin or pneumatic compression prophylaxis was 34%, compared with 32% in patients who did not receive any prophylaxis. This observation should be interpreted cautiously because these patients were not randomly allocated to prophylaxis.There is currently no consensus on optimal prophylaxis for medical intensive care unit patients.20 Two prior trials have failed to show the superiority of low molecular weight heparin compared with unfractionated low-dose heparin among hospitalized medical patients.21,22 These two trials may have administered subtherapeutic doses of LMWH.We have just completed a multicenter, randomized, controlled trial of heparin 5,000 U twice daily (“miniheparin”) versus enoxaparin 30 mg twice daily among Medical Intensive Care Unit patients. This multicentered study has the principal endpoint of venous thrombosis proven by ultrasound examination. Approximately, almost 300 patients have been enrolled. We expect to present the results of this trial at the August 1999 XVII Congress of the International Society on Thrombosis and Haemostasis.

ANALISIS POLA HIDUP DAN DUKUNGAN KELUARGA PADA PASIEN DIABETES MELITUS TIPE 2 DI WILAYAH KERJA PUSKESMAS PAYUNG SEKAKI
 
 1Iis Dian Saviqoh, 2Yesi Hasneli, 3Nopriadi
 1Fakultas Keperawatan Universitas Riau
 Email : iisdians@gmail.com
 2 Fakultas Keperawatan Universitas Riau
 Email : yesi_zahra@yahoo.com 
 3 Fakultas Keperawatan Universitas Riau
 Email : nopriadi_dhs@yahoo.com
 
 ABSTRAK
 
 Diabetes Melitus (DM)adalah penyakit metabolik dengan ciri kadar gula darah yang tinggi. DM tipe 2 paling sering diderita. Peyebabnya karena pola hidup yang tidak sehat, beberapa upaya untuk mengurangi faktor pemicu seperti mengatur pola makan, kontrol berat badan, berolahraga, pantau gula darah, diet yang terarah, gizi sehat dan seimbang. Selain itu, dukungan keluarga juga mempengaruhi kualitas hidup pasien DM. Tujuan penelitian ini untuk mengetahui gambaran pola hidup (pola makan, aktivitas fisik) dan dukungan keluarga pada penderita DM tipe 2. Metode penelitian ini menggunakan deskriptif analitik dengan rancangan cross sectional. Sampel penelitian ini 131 orang penderita yang diambil berdasarakan kriteria inklusi menggunakan purposive sampling. Hasil: Penderita terbanyak umur yaitu 56-65 tahun (36,6%) dan banyak diderita laki-laki yaitu (52,7%), responden yang mengalami komplikasi (91,6%) dan banyak diderita oleh laki-laki (99,9%) sedangkan jenis komplikasi yaitu kebas (nefrophaty perifer) (69,5%). pola hidup penderita menunjukkan pola hidup baik (81,7) dan dukungan keluarga menunjukkan dukungan keluarga baik (98,5). Kesimpulan: Pola hidup yang baik dapat juga dipengaruhi oleh dukungan keluarga yang baik sehingga membuat penderita semakin bersemangat untuk menerapkan pola sehat dalam kehidupan sehari-hari.
 
 Kata Kunci:Diabetes Melitus, Pola Hidup, Dukungan Keluarga
 
 ABSTRACT
 
 Diabetes Mellitus (DM) is a metabolic disease characterized by high blood sugar levels. Type 2 DM is the most common. The reason is due to an unhealthy lifestyle, several attempts to reduce trigger factors such as regulating diet, weight control, exercising, monitoring blood sugar, directed diet, healthy and balanced nutrition. In addition, family support also affects the quality of life of DM patients. The purpose of this study was to describe the pattern of life (diet, physical activity) and family support in patients with type 2 diabetes. This research method used descriptive analytic with cross sectional design. The sample of this study was 131 patients who were taken based on the inclusion criteria using purposive sampling. Results: Most patients were aged 56-65 years (36.6%) and mostly suffered by men (52.7%), respondents who experienced complications (91.6%) and most suffered by men (99, 9%) while the type of complication is numbness (peripheral nephropathy) (69.5%). The patient's lifestyle showed a good lifestyle (81.7) and family support showed good family support (98.5). Conclusion: A good lifestyle can also be influenced by good family support so that it makes sufferers more enthusiastic to apply healthy patterns in daily life.
 
 Keywords: Diabetes Mellitus, Lifestyle, Family Support
 Referensi: 54 (2010-2020)
 
 PENDAHULUAN 
 Diabetes Melitus (DM) merupakan sekelompok penyakit metabolik dengan ciri kadar gula darah yang tinggi (hiperglikemik) (Pramukamto et al., 2018). Tanda dan gejala yang umum sering dirasakan pada penderita dengan gula darah tinggi adalah banyak kencing (polyuria), mudah haus (polydipsia) dan mudah lapar (polyphagia). Bila ini dibiarkan dapat menimbulkan komplikasi baik secara akut maupun kroik, yaitu timbul beberapa bulan atau beberapa tahun sesudah mengidap DM. Komplikasi DM yang paling sering adalah hiperglikemia dan koma diabetik (Susilo & Wulandari, 2011).
 Menurut Sutedjo (2016) Kematian penderita DM lebih banyak disebabkan oleh komplikasi daripada oleh penyakitnya sendiri sehingga, Diabetes melitus merupakan salah satu dari empat penyakit tidak menular prioritas yang menjadi target tindak lanjut oleh para pemimpin dunia. Jumlah kasus dan prevalensi diabetes terus meningkat selama beberapa dekade terakhir (WHO Global Report, 2016).
 WHO (World Health Organitation) memprediksi kenaikan jumlah penyandang DM di dunia dari 463 juta pada tahun 2019 menjadi 700 juta juta pada tahun 2045 naik menjadi 51% (WHO, 2019). International Diabetes Federation (IDF) memprediksi adanya kenaikan jumlah penyandang DM di Indonesia dari 9,1 juta pada tahun 2014 menjadi 14,1 juta pada tahun 2035. Dengan angka tersebut Indonesia menempati peringkat ke-5 di dunia, atau naik dua peringkat dibandingkan data IDF tahun 2013 yang menempati peringkat ke-7 dunia ( PERKENI, 2015).
 Berdasarkan Riset Kesehatan Dasar (Riskesdas, 2018) yang menunjukkan prevalensi diabetes melitus pada penduduk dewasa Indonesia sebesar 6,9% di tahun 2013, dan melonjak pesat ke angka 8,5% di tahun 2018. Diabetes melitus di Provinsi Riau berada di urutan 15 untuk penyakit tidak menular (PTM) dengan kenaikan 1,0 persen (2013) menjadi 1,9 persen (2018). Sedangkan pada tahun 2019 terjadi peningkatan pravelensi DM menjadi urutan ketiga dari 10 penyakit terbesar di Kota Pekanbaru setelah Hipertensi.
 Data terbaru yang didapatkan dari Dinas Kota Pekanbaru 2019, distribusi kasus diabetes melitus di Puskesmas se-kota Pekanbaru berdasarkan tempat diabetes melitus Tipe 2 tertinggi terdapat di Puskesmas Payung Sekaki sebesar 207 penderita. Jumlah distribusi kunjungan di puskesmas payung sekaki dari bulan Agustus 2019 sampai Agustus 2020 sebesar 540 penderita diabetes melitus.
 Secara umum Diabetes melitus dibagi menjadi tiga, yaitu tipe 1, 2 dan gestasional (terjadi saat kehamilan). DM tipe 1 dulu disebut Insulin Dependent Diabetes Melitus (IDDM), diabetes yang bergantung pada insulin. Faktor penyebabnya adalah virus atau reaksi auto-imun (rusaknnya sistem kekebalan tubuh) yang merusak sel-sel penghasil insulin, yaitu sel beta penghasil insulin pada pulau-pulau langerhans pankreas sehingga terjadi kekurangan insulin. Diabetes tipe ini biasanya mengenai anak-anak dan remaja. Sedangkan, DM tipe 2 disebut diabetes life style karena selain faktor keturunan, disebabkan oleh gaya hidup yang tidak sehat. Diabetes tipe 2 tidak bergantung insulin karena pankreas masih menghasilkan insulin tetapi insulin yang diproduksi, jumlahnya tidak mencukupi dan kerja insulin tidak efektif karena adanya hambatan pada insulin yang disebut resistensi insulin (Nurrahmani, 2015).
 Sebenarnya resistensi insulin mendahului terjadinya penurunan produksi insulin. Selama resistensi insulin belum diperbaiki pankreas harus bekerja keras menghasilkan insulin sebanyak-banyaknya untuk dapat menggempur resistensi tersebut agar gula juga bisa masuk. Namun karena gejalanya minim, maka semakin lama pankreas tidak mampu memproduksi insulin. Faktor pemicu resistensi insulin adalah kegemukan, kurang bergerak, dan terlalu banyak makan dengan gizi yang tidak seimbang (Nurrahmani, 2015).
 Upaya untuk mengurangi faktor pemicu tersebut diperlukan pencegahan seperti mengatur pola makan, kontrol berat badan, tidur cukup, berolahraga, pantau gula darah, manajemen stress, batasi komsumsi garam, berhenti kebiasaan merokok, diet yang terarah, gizi sehat dan seimbang (Susilo Y, Wulandari A. 2011).
 Hal diatas sesuai dengan penelitian Dafriani (2017), di Poliklinik Penyakit Dalam RSUD dr. Rasidin Padang diketahui bahwa kejadian DM lebih tinggi pada responden dengan pola makan yang tidak baik yaitu 27 responden (51,9%) dibandingkan yang memiliki pola makan yang baik yaitu 12 responden (29,3%). Sedangkan, pada aktivitas fisik diketahui bahwa kejadian DM lebih tinggi pada responden dengan aktifitas fisik yang ringan yaitu 26 responden (53,1%) dibandingkan yang memiliki aktifitas fisik berat yaitu 13 responden (29,5%).
 Selain itu, dukungan keluarga juga mempengaruhi kualitas hidup penderita DM tipe 2 ini sesuai dengan penelitian Retnowati et.al (2015) di Puskesmas Tanah Kalikedinding didapatkan bahwa mayoritas responden yang menyatakan puas terhadap kualitas hidupnya adalah responden yang memperoleh dukungan baik dari keluarga sebesar 85,2%.
 Hasil survey awal di Puskemas Sidomulyo dari 5 penderita di dapatkan bahwa 2 penderita mengatakan dapat mengatur pola makan dan rutin berolahraga seperti jalan pagi bersama keluaga di sekitaran komplek perumahan, 1 penderita mengatakan tidak mampu mengatur pola makan karena karena istrinya selalu masak makanan kesukaannya tetapi selalu berolahraga di sore hari bersama anaknya, 2 penderita mengatakan tidak mampu mengatur pola makan dan jarang melakukan aktivitas fisik seperti jalan pagi ataupun sore hari.
 Sehubungan hal di atas dapat diketahui bahwa pola hidup dan dukungan keluarga sangat berpengaruh terhadap kondisi fisik. Perubahan pola hidup dan dukungan keluarga dalam perilaku hidup sehat seperti pola makan yang tidak baik, kurang olahraga, serta kebiasaan-kebiasaan tidak sehat merupakan penyebab diabetes melitus. Usia subjek berada dalam rentang usia dewasa madya pada umumnya selalu mengikuti setiap adanya perubahan terutama perubahan mengenai pola hidup. Langkah tersebut dapat dimulai dengan menggali permasalahan penelitian tentang pola hidup penderita Diabetes Melitus tipe 2 dengan judul yaitu “Analisis pola hidup dan dukungan keluarga pada penderita DM tipe 2 di wilayah kerja puskesmas payung sekaki” yang mencangkup pola makan, aktivitas fisik seperti olahraga dan dukungan keluarga yang sangat membantu penderita untuk hidup sehat.
 
 TUJUAN PENELITIAN
 Untuk mengetahui gambaran pola hidup (pola makan, aktivitas fisik) dan dukungan keluarga pada penderita DM tipe 2.
 
 MANFAAT PENELITIAN
 Hasil penelitian ini dapat dijadikan sumber informasi dan pengembangan ilmu pengetahuan, khususnya pendidikan keperawatan mengenai analisis pola hidup dan dukungan keluarga pasien DM tipe 2.
 METODE PENELITIAN
 Jenis penelitian yang digunakan merupakan deskriptif analisis menggunakan cross sectional. Tempat penelitian dilakukan di Puskesmas Payung Sekaki Kota Pekanbaru pada tanggal 29 Januari-12Febaruari 2021. Populasi dalam penelitian ini adalah penderita Diabetes Melitus Tipe 2 di wilayah kerja Puskesmas Payung Sekaki Pekanbaru pada tanggal 1 Agustus 2019 sampai dengan 1 Agustus 2020 sebesar 205 penderita. Pengambilan sampel pada penelitian ini menggunakan tabel penentu sampel oleh Stepen Isaac Wiliam B. Michael dengan taraf kesalahan (significance level) sebesar 5%, maka jumlah sampel yang digunakan pada populasi 205 adalah 131 sampel.
 Kriteria inklusi adalah karakteristik umum subyek penelitian dari suatu populasi target yang terjangkau dan diteliti (Nursalam, 2013). Kriteria inklusi dalam penelitian ini adalah:
 
 Penderita DM Tipe II yang berada di Wilayah Kerja Puskesmas Payung Sekaki Pekanbaru dengan usia 40 tahun keatas.
 Penderita yang bersedia menjadi subyek dan menandatangani informend consent.
 Penderita yang tidak memiliki komplikasi.
 Penderita yang memiliki komplikasi akut (jangka pendek) yaitu hiperglikemia, diabetik ketoasidosis (DKA) dan komplikasi kronik (jangka panjang) yaitu hipertensi, penyakit arteri koroner, stroke, retinopati diabetik, nefropati diabetik.
 
 Kriteria ekslusi dalam penelitian ini adalah:
 
 Penderita yang tidak menjawab kuisioner dengan lengkap.
 
 
 HASIL PENELITIAN 
 
 Karateristik Responden
 
 Tabel 1.
 Distribusi karakteristik responden berdasarkan umur
 
 
 
 
 Umur
 
 
 Frekuensi (n)
 
 
 Persentase (%)
 
 
 
 
 36-45
 
 
 25
 
 
 19,1
 
 
 
 
 46-55
 
 
 29
 
 
 22,1
 
 
 
 
 56-65
 
 
 48
 
 
 36,6
 
 
 
 
 >65
 
 
 29
 
 
 22,1
 
 
 
 
 Total
 
 
 131
 
 
 100
 
 
 
 
 Berdasarkan tabel diatas menunjukkan bahwa 131 responden yang diteliti, distribusi responden terbanyak umur yaitu 56-65 tahun sebanyak 48 orang responden (36,6%).
 Tabel 2
 Distribusi karakteristik responden berdasarkan jenis kelamin
 
 
 
 
 Jenis Kelamin
 
 
 Frekuensi (n)
 
 
 Persentase (%)
 
 
 
 
 a. Laki-laki
 b. Perempuan
 
 
 69
 62
 
 
 52,7
 47,3
 
 
 
 
 Total
 
 
 131
 
 
 100
 
 
 
 
 Berdasarkan tabel diatas menunjuk bahwa 131 responden yang diteliti, distribusi responden terbanyak yaitu laki-laki sebanyak 69 responden (52,7%) sedangkan perempuan sebanyak 62 responden (47,3%).
 
 Tabel 3
 Distribusi karakteristik responden berdasarkan pendidikan
 
 
 
 
 Pendidikan Terakhir
 
 
 
 Frekuensi (n)
 
 
 
 Persentase (%)
 
 
 
 
 
 SD
 
 
 17
 
 
 13,0
 
 
 
 
 SMP
 
 
 16
 
 
 12,2
 
 
 
 
 SMA
 
 
 49
 
 
 37,4
 
 
 
 
 SMK
 
 
 4
 
 
 3,1
 
 
 
 
 D3
 
 
 17
 
 
 13,0
 
 
 
 
 S1
 
 
 26
 
 
 19,8
 
 
 
 
 S2
 
 
 2
 
 
 2
 
 
 
 
 Total
 
 
 131
 
 
 100
 
 
 
 
 Berdasarkan tabel diatas menunjukkan bahwa dari 131 responden yang diteliti pada karakteristik berdasarkan pendidikan paling tinggi adalah lulus SMA yaitu sebanyak 49 orang responden (37,4%).
 Tabel 4
 Distribusi frekuensi responden berdasarkan komplikasi DM
 
 
 
 
 Komplikasi DM
 
 
 Frekuensi (n)
 
 
 Persentase (%)
 
 
 
 
 Ya
 
 
 120
 
 
 91,6
 
 
 
 
 Tidak
 
 
 11
 
 
 8,4
 
 
 
 
 Total
 
 
 131
 
 
 100
 
 
 
 
 Berdasarkan tabel diatas menunjukkan bahwa dari 131 responden yang diteliti pada karakteristik berdasarkan komplikasi DM paling tinggi adalah responden yang mengalami komplikasi yaitu 120 orang responden (91,6%).
 Tabel 5
 Distribusi frekuensi komplikasi yang diderita responden
 
 
 
 
 Jenis Komplikasi
 
 
 Frekuensi (n)
 
 
 Persentase (%)
 
 
 
 
 Tidak ada
 
 
 11
 
 
 8,4
 
 
 
 
 Kebas
 
 
 91
 
 
 69,5
 
 
 
 
 Hipertensi
 
 
 20
 
 
 15,3
 
 
 
 
 Jantung
 
 
 2
 
 
 1,5
 
 
 
 
 Post Stroke
 
 
 1
 
 
 8
 
 
 
 
 Ginjal
 
 
 1
 
 
 8
 
 
 
 
 Mata Kabur
 
 
 5
 
 
 3,8
 
 
 
 
 Total
 
 
 131
 
 
 100
 
 
 
 
 Berdasarkan tabel diatas menunjukkan bahwa dari 131 responden yang diteliti pada karakteristik berdaarkan jenis komplikasi DM paling tinggi adalah kebas (nefrophaty perifer) sebesar 91 orang responden (69,5%).
 Tabel 6
 Distribusi Komplikasi diabetes melitus berdasarkan jenis kelamin 
 
 
 
 
 Komplikasi
 
 
 Jenis Kelamin
 
 
 
 
 Laki-laki
 
 
 Perempuan
 
 
 
 
 Tidak ada
 
 
 9
 
 
 2
 
 
 
 
 Kebas
 
 
 45
 
 
 46
 
 
 
 
 Hipertensi
 
 
 10
 
 
 10
 
 
 
 
 Jantung
 
 
 2
 
 
 0
 
 
 
 
 Post stroke
 
 
 0
 
 
 1
 
 
 
 
 Ginjal
 
 
 1
 
 
 0
 
 
 
 
 Mata kabur
 
 
 2
 
 
 3
 
 
 
 
 Frekuensi (n)
 
 
 69
 
 
 62
 
 
 
 
 Persentase (%)
 
 
 100
 
 
 100
 
 
 
 
 Berdasarkan tabel diatas menunjukkan bahwa dari 131 responden yang diteliti komplikasi DM banyak diderita laki-laki sebesar 69 (99,9%).
 Tabel 7
 Distribusi Pola Hidup pasien diabetes melitus tipe 2.
 
 
 
 
 Pola hidup (pola makan, aktivitas fisik)
 
 
 Frekuensi (n)
 
 
 Persentase %
 
 
 
 
 Baik
 
 
 107
 
 
 81,7
 
 
 
 
 Buruk
 
 
 24
 
 
 18,3
 
 
 
 
 Berdasarkan dari tabel diatas menunjukkan bahwa dari 131 responden yang diteliti pada pola hidup penderita menunjukkan pola hidup baik dengan jumlah 107 orang responden (81,7) sedangkan pola hidup buruk berjumlah 24 orang (18,3%).
 
 Tabel 8
 Distribusi dukungan keluarga pada pasien diabetes melitus tipe 2
 
 
 
 
 Dukungan keluarga
 
 
 Frekuensi (n)
 
 
 Persentase %
 
 
 
 
 Baik
 
 
 129
 
 
 98,5
 
 
 
 
 Buruk
 
 
 2
 
 
 1,5
 
 
 
 
 Berdasarkan dari tabel diatas menunjukkan bahwa dari 131 responden yang diteliti pada dukungan keluarga menunjukkan dukungan keluarga baik dengan 129 orang responden (98,5) sedangkan dukungan keluarga buruk dengan 2 responden (1,5).
 Tabel 9
 
 
 
 
 No
 
 
 Item Pertanyaan
 
 
 Kategori
 
 
 F (n)
 
 
 %
 
 
 
 
 A
 
 
 Sub Variabel : Metode
 
 
 
 
 1
 
 
 Saya menerapkan pola makan sehat dengan 3J: Jumlah kalori, jadwal makan, jenis makan
 
 
 Tidak pernah
 
 
 5
 
 
 3,8
 
 
 
 
 Jarang
 
 
 42
 
 
 32,1
 
 
 
 
 Sering
 
 
 73
 
 
 55,7
 
 
 
 
 Selalu
 
 
 11
 
 
 8,4
 
 
 
 
 2
 
 
 
 Saya makan dengan porsi cukup untuk mempertahankan berat badan ideal
 
 
 Tidak pernah
 
 
 41
 
 
 31,3
 
 
 
 
 Jarang
 
 
 48
 
 
 36,6
 
 
 
 
 Sering
 
 
 33
 
 
 25,2
 
 
 
 
 Selalu
 
 
 9
 
 
 6,9
 
 
 
 
 3
 
 
 Saya mengkonsumsinasi 2 ½ centong nasi setiap saya makan
 
 
 Tidak pernah
 
 
 73
 
 
 55,7
 
 
 
 
 Jarang
 
 
 38
 
 
 29,0
 
 
 
 
 Sering
 
 
 13
 
 
 9,9
 
 
 
 
 Selalu
 
 
 7
 
 
 5,3
 
 
 
 
 4
 
 
 Saya mengkonsumsi makanan yang banyak mengandung serat seperti buah dan sayur
 
 
 Tidak pernah
 
 
 3
 
 
 2,3
 
 
 
 
 Jarang
 
 
 4
 
 
 3,1
 
 
 
 
 Sering
 
 
 34
 
 
 26,0
 
 
 
 
 Selalu
 
 
 90
 
 
 68,7
 
 
 
 
 5
 
 
 Saya setiap hari mengkonsumsi makanan yang banyak mengandung protein. Seperti: telur dan daging
 
 
 Tidak pernah
 
 
 0
 
 
 0
 
 
 
 
 Jarang
 
 
 8
 
 
 6,1
 
 
 
 
 Sering
 
 
 104
 
 
 79,4
 
 
 
 
 Selalu
 
 
 19
 
 
 14,5
 
 
 
 
 6
 
 
 Saya membatasi makanan yag asin
 
 
 Tidak pernah
 
 
 3
 
 
 2,3
 
 
 
 
 Jarang
 
 
 16
 
 
 12,2
 
 
 
 
 Sering
 
 
 83
 
 
 63,4
 
 
 
 
 Selalu
 
 
 29
 
 
 22,1
 
 
 
 
 7
 
 
 Saya membatasi makanan yang banyak mengandunng lemak dan kolestrol tinggi. Seperti: santan, udang dan kepiting
 
 
 Tidak pernah
 
 
 3
 
 
 2,3
 
 
 
 
 Jarang
 
 
 20
 
 
 15,3
 
 
 
 
 Sering
 
 
 88
 
 
 67,2
 
 
 
 
 Selalu
 
 
 20
 
 
 15,3
 
 
 
 
 8
 
 
 Saya makan porsi cukup untuk mempertahankan gula darah
 
 
 Tidak pernah
 
 
 10
 
 
 7,4
 
 
 
 
 Jarang
 
 
 62
 
 
 47,3
 
 
 
 
 Sering
 
 
 51
 
 
 38,9
 
 
 
 
 Selalu
 
 
 8
 
 
 6,1
 
 
 
 
 9
 
 
 Saya olahraga 3-5 kali dalam seminggu
 
 
 Tidak pernah
 
 
 15
 
 
 11,5
 
 
 
 
 Jarang
 
 
 71
 
 
 54,2
 
 
 
 
 Sering
 
 
 28
 
 
 21,4
 
 
 
 
 Selalu
 
 
 17
 
 
 13,0
 
 
 
 
 10
 
 
 Saya melakukan jalan santai disekitaran komplek setiap pagi atau sore
 
 
 Tidak pernah
 
 
 9
 
 
 6,9
 
 
 
 
 Jarang
 
 
 20
 
 
 15,3
 
 
 
 
 Sering
 
 
 50
 
 
 38,2
 
 
 
 
 Selalu
 
 
 52
 
 
 39,7
 
 
 
 
 11
 
 
 Saya bersepedadi hari sabtu atau minggu
 
 
 Tidak pernah
 
 
 88
 
 
 67,2
 
 
 
 
 Jarang
 
 
 25
 
 
 19,1
 
 
 
 
 Sering
 
 
 12
 
 
 9,2
 
 
 
 
 Sering
 
 
 6
 
 
 4,6
 
 
 
 
 12
 
 
 Saya berenang di hari sabtu atau minggu
 
 
 Tidak pernah
 
 
 99
 
 
 75,6
 
 
 
 
 Jarang
 
 
 18
 
 
 13,7
 
 
 
 
 Sering
 
 
 11
 
 
 8,4
 
 
 
 
 Selalu
 
 
 3
 
 
 2,3
 
 
 
 
 13
 
 
 Saya olahraga waktu yang saya habiskan 30-60 menit
 
 
 Tidak pernah
 
 
 14
 
 
 10,7
 
 
 
 
 Jarang
 
 
 56
 
 
 42,7
 
 
 
 
 Sering
 
 
 49
 
 
 37,4
 
 
 
 
 Selalu
 
 
 12
 
 
 9,2
 
 
 
 
 
 Tabel 10
 
 
 
 
 No
 
 
 Item Pertanyaan
 
 
 Kategori
 
 
 F (n)
 
 
 %
 
 
 
 
 A 
 
 
 Sub Pertanyaan
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Dimensi Emosional
 
 
 
 
 
 
 
 
 
 
 
 
 
 1
 
 
 Keluarga mengerti saat saya mengalami masalah yang berhubungan dengan diabetes
 
 
 Tidak pernah
 
 
 0
 
 
 0
 
 
 
 
 Jarang
 
 
 13
 
 
 9,9
 
 
 
 
 Sering
 
 
 88
 
 
 67,2
 
 
 
 
 Selalu
 
 
 30
 
 
 22,9
 
 
 
 
 2
 
 
 Keluarga mendengarkan jika saya bercerita tentang diabetes
 
 
 Tidak pernah
 
 
 0
 
 
 0
 
 
 
 
 Jarang
 
 
 13
 
 
 9,9
 
 
 
 
 Sering
 
 
 91
 
 
 69,5
 
 
 
 
 Selalu
 
 
 27
 
 
 20,6
 
 
 
 
 3
 
 
 Keluarga memahami jika saya sedih dengan diabetes
 
 
 Tidak pernah
 
 
 0
 
 
 0
 
 
 
 
 Jarang
 
 
 8
 
 
 6,1
 
 
 
 
 Sering
 
 
 96
 
 
 73,3
 
 
 
 
 Selalu
 
 
 27
 
 
 20,6
 
 
 
 
 4
 
 
 Keluarga saya mengerti tentang bagaimana saya merasakan diabetes
 
 
 Tidak pernah
 
 
 0
 
 
 0
 
 
 
 
 Jarang
 
 
 14
 
 
 10,7
 
 
 
 
 Sering
 
 
 87
 
 
 66,4
 
 
 
 
 Selalu
 
 
 30
 
 
 22,9
 
 
 
 
 
 
 
 Dimensi Penghargaan
 
 
 
 
 
 
 
 
 
 
 
 
 
 5
 
 
 Keluarga mengingatkan saya tentang keteraturan diet
 
 
 Tidak pernah
 
 
 1
 
 
 0,8
 
 
 
 
 Jarang
 
 
 10
 
 
 7,6
 
 
 
 
 Sering
 
 
 99
 
 
 75,6
 
 
 
 
 Selalu
 
 
 21
 
 
 16,0
 
 
 
 
 6
 
 
 Keluarga mengigatkan saya untuk memesan obat diabetes
 
 
 Tidak pernah
 
 
 12
 
 
 9,2
 
 
 
 
 Jarang
 
 
 31
 
 
 23,7
 
 
 
 
 Sering
 
 
 49
 
 
 37,4
 
 
 
 
 Selalu
 
 
 39
 
 
 29,8
 
 
 
 
 
 
 
 Dimensi Instrumental
 
 
 
 
 
 
 
 
 
 
 
 
 
 7
 
 
 Keluarga mendukung usaha saya untuk olahraga
 
 
 Tidak pernah
 
 
 3
 
 
 2,3
 
 
 
 
 Jarang
 
 
 38
 
 
 29,0
 
 
 
 
 Sering
 
 
 43
 
 
 32,8
 
 
 
 
 Selalu
 
 
 47
 
 
 35,9
 
 
 
 
 8
 
 
 Keluarga membantu saya membayar pengobatan diabetes
 
 
 Tidak pernah
 
 
 0
 
 
 0
 
 
 
 
 Jarang
 
 
 10
 
 
 7,6
 
 
 
 
 Sering
 
 
 86
 
 
 65,6
 
 
 
 
 Selalu
 
 
 35
 
 
 26,7
 
 
 
 
 
 
 
 Dimensi Informasi
 
 
 
 
 
 
 
 
 
 
 
 
 
 9
 
 
 Keluarga memberi informasi baru tentang diabetes
 
 
 Tidak pernah
 
 
 0
 
 
 0
 
 
 
 
 Jarang
 
 
 32
 
 
 24,4
 
 
 
 
 Sering
 
 
 68
 
 
 51,9
 
 
 
 
 Selalu
 
 
 31
 
 
 23,7
 
 
 
 
 10
 
 
 Keluarga memberi saran agar saya kontrol ke dokter
 
 
 Tidak pernah
 
 
 11
 
 
 8,4
 
 
 
 
 Jarang
 
 
 58
 
 
 44,3
 
 
 
 
 Sering
 
 
 62
 
 
 47,3
 
 
 
 
 Selalu
 
 
 62
 
 
 47,3
 
 
 
 
 11
 
 
 Keluarga memberi saran agar saya menkuti edukasi diabetes
 
 
 Tidak pernah
 
 
 1
 
 
 0,8
 
 
 
 
 Jarang
 
 
 23
 
 
 17,6
 
 
 
 
 Sering
 
 
 72
 
 
 55,0
 
 
 
 
 Selalu
 
 
 35
 
 
 26,7
 
 
 
 
 12
 
 
 Saya merasakan kemudahan mendapatkan informasi dari keluarga tentang diabetes
 
 
 Tidak pernah
 
 
 0
 
 
 0
 
 
 
 
 Jarang
 
 
 25
 
 
 19,1
 
 
 
 
 Sering
 
 
 74
 
 
 56,5
 
 
 
 
 Selalu
 
 
 32
 
 
 24,4
 
 
 
 
 
 PEMBAHASAN 
 
 Karakteristik Responden
 Umur
 
 Penelitian yang telah dilakukan terhadap 131 responden didapatkan bahwa umur pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki yaitu masa dewasa akhir (36-45 tahun) 25 orang responden (19,1%), masa lansia awal (46-55 tahun) 29 orang responden (22,1%), masa lansia akhir (56-65) 48 orang responden (36,6%), masa lansia akhir 56-65, dan masa manula (>65 tahun) 29 orang responden (22,1%). Menurut penelitian Kurniati dan Yanita (2016) Diabetes melitus (DM) merupakan penyakit kronis yang ditandai dengan hiperglikemia dan intoleransi glukosa yang terjadi karena kelenjar pankreas tidak dapat memproduksi insulin secara adekuat yang atau karena tubuh tidak dapat menggunakan insulin yang diproduksi secara efektif atau kedua-duanya. Faktor risiko yang tidak dapat diubah adalah faktor umur. Menurut Dalimartha & Adrian (2012) umur >45 berisiko untuk menderita diabetes melitus.
 
 
 Jenis Kelamin
 
 Penelitian yang telah dilakukan terhadap 131 responden didapatkan bahwa pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki lebih banyak terjadi pada laki-laki sebanyak 69 orang responden (52,7%). Karakteristik ini tidak sesuai jika dibandingkan dengan data Riskesdas tahun 2018. Menurut data Riskesdas di Indonesia tahun 2018 penderita diabetes melitus banyak diderita oleh perempuan yaitu 1,8% sedangkan laki-laki sebesar 1,2%.
 
 
 Pendidikan Terakhir
 
 Penelitian yang telah dilakukan terhadap 131 responden didapatkan bahwa pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki didapatkan bahwa riwayat pendidikan terakhir sebagian besar responden tamatan SMA yaitu sebanyak 49 orang responden (37,4%). Hal ini didukung dengan penelitian Arimbi, Lita dan Indra (2020) menyatakan bahwa terdapat pengaruh faktor risiko tingkat pendidikan terhadap risiko terkena penyakit diabetes melitus tipe II, dan yang memiliki peluang yang paling besar terhadap penyakit diabetes melitus adalah tingkat pendidikan SMA atau yang sederajat (76.7%).
 Tingkat pendidikan seseorang memiliki pengaruh terhadap kejadian penyakit diabetes melitus tipe 2. Hal ini sesuai dengan penelitian Trisnadewi, Adiputra dan Mitayanti (2018) yang menyatakan rendahnya tingkat pendidikan dan pengetahuan merupakan salah satu penyebab tingginya angka kasus suatu penyakit. Pengetahuan bisa diperoleh melalui promosi kesehatan salah satunya pendidikan kesehatan.
 Meskipun demikian tidak dipungkiri masih ada orang yang berpendidikan tinggi mengabaikan kesehatan dengan berbagai alasan yang menyebabkannya, salah satunya berhubungan dengan pekerjaan dimana dengan adanya kesibukan yang tinggi sehingga pola hidup yang tidak teratur atau tidak teraturnya pola makan meyebabkan gangguan kesehatan. Biasanya orang dengan kegiatan yang padat sering lupa utuk makan namun lebih banyak makan cemilan. Dengan adanya perubahan gaya hidup dan kebiasaan makan, konsumsi makanan yang energi dan tinggi lemak selain aktivitas fisik yang rendah, akan mengubah keseimbangan energi dengan disimpannya energi sebagai lemak simpanan yang jarang digunakan (Rahmasari & Wahyuni, 2019)
 
 
 Komplikasi DM
 
 Penelitian yang telah dilakukan terhadap 131 responden didapatkan bahwa pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki lebih banyak komplikasi sebesar 120 orang responden (91,6%). Sedangkan, jenis komplikasi yang banyak diderita responden perempuan adalah neurophaty (kebas) sebesar 91 orang responden (69,5%). Hal ini sejalan dengan penelitian Suyanto dan Susanto (2016, dalam Booya, F., Bandarian, F., Larijani, B., Pajouhi, M., Noorei, M, dan Lotfi, 2005) Hasil ini sesuai dengan hasil penelitian terdahulu yang relevan yang menyatakan bahwa faktor resiko potensial neuropati diabetik lebih besar pada perempuan sebesar 78 % dibandingkan responden laki-laki 22 %.
 
 
 Pola Hidup
 
 Penelitian yang telah dilakukan terhadap 131 responden didapatkan bahwa pola hidup meliputi pola makan dan aktivitas fisik pada pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki didapatkan pola hidup baik dengan jumlah 107 orang responden (81,7%). Hal ini tidak sesuai dengan penelitian Heriawan, Fathony dan Purnawati (2019) dari 60 responden sebagian besar responden dikategorikan memiliki pola makan sehat sejumlah 31 responden pola makan pada pasien diabetes melitus sebagian besar didapatkan memiliki pola makan tidak sehat dengan 19 responden.
 Pada item 1, responden yang menerapkan pola makan sehat dengan 3J: jumlah kalori, jadwal makan, jenis makan yang menjawab sering sebanyak 73 orang responden (55,7%). Artinya kesadaran responden untuk menerapkan pola makan sehat dengan 3J cukup tinggi. Hal ini sesuai dengan wawancara peneliti dengan instalagi gizi di puskesmas dimana setiap hari sebelum dilakukan penyuluhan tentang diabetes minimal 1 kali seminggu.
 Pada item 2, 3, dan 8 responden yang menerapkan makan dengan porsi cukup untuk mempertahankan berat badan ideal yang menjawab jarang sebanyak 48 orang responden (36,6%), yang mengkonsumsi 2 ½ centong nasi setiap saya makan yang menjawab tidak pernah 73 orang responden (55,7%) dan yang makan porsi cukup untuk mempertahankan gula darah yang menjawab jarang sebesar 62 orang responden (47,3%). Artinya responden merasa jika makan sedikit kurang dari 2 ½ itu membantu dalam menurunkan gula darah dan berat badan menjadi ideal. Padahal, porsi cukup disini adalah cukup dalam jumlah kalori agar responden tidak merasa lemas diakibatkan kenaikan gula darah yang tidak terkontrol karena jumlah kalori responden yang tidak mencukupi tubuh. Jumlah kalori yang tidak cukup dapat mengakibatkan rsponden merasa lapar dan berkeinginan untuk makan lagi tanpa melihat jadwal makan, jumlah makan, dan jenis makanan. Bila dibiarkan, secara tidak sadar pasien sudah mengkonsumsi makanan yang melebihi jumlah kalori perhari. Jumlah kalori yang dianjurkan adalah 25-30 kalori per kilogram berat badan ideal. Hal ini sesuai dengan penelitian Baequny, Harnarni dan Rumimper (2015) yaitu sebagian besar responden mempunyai pola makan tinggi kalori sebanyak 43 responden (57%) dan sebagian kecil mempunyai pola makan tidak tinggi kalori yaitu sebanyak 32 responden (43%). Faktor yang bisa mempengaruhi pola makan yang salah pada responden adalah tingkat pengetahuan yang kurang baik tentang perencanaan makanan bagi penderita DM.
 Pada item 4, responden yang mengkonsumsi makanan yang banyak mengandung serat seperti buah dan sayur sebesar 90 responden (68,7%). Artinya kesadaran responden dalam mengkonsumsi serat seperti sayur dan buah sangat tinggi. Sayur dan buah yang dikonsumsi oleh penderita diabetes melitus mengandung serat yang dapat memperlambat proses perpidahan karbohidrat menjadi gula, sehingga peningkatan gula dalam darah meningkat secara perlahan, dan membantu mengontrol kadar gula darah dalam darah. Selain itu, serat dapat membuat kita merasa kenyang lebih lama, sehingga kita bisa makan lebih sedikit dan mencegah makan berlebihan. Hal ini tidak sesuai dengan penelitian Purnasari dan Maryato (2011) Pada penelitian ini diketahui asupan serat responden berkisar antara 15,7 gram sampai dengan 27,4 gram, dengan rata-rata asupan serat sebesar 21,57 gram. Sebanyak 77,1% responden mempunyai tingkat asupan serat <25 gr/hari. Pada penderita diabetes dianjurkan untuk mengkonsumsi serat sebanyak 25-35 gr/hari, terutama serat larut air. Berdasarkan data recall diketahui asupan serat responden hanya sedikit. Asupan serat yang kurang pada sampel terkait dengan pola kebiasaan makan yang mengkonsumsi sayuran dalam jumlah sedikit dibandingkan konsumsi karbohidratnya dan jarang menkonsumsi buah, padahal kandungan serat banyak terdapat pada sayur dan buah, hal ini dapat disebabkan karena kurangnya pengetahuan akan manfaat serat bagi kesehatan. Dari data recall hanya 22,9% responden yang memiliki asupan serat sesuai dengan yang dianjurkan pada penderita diabetes yaitu 25-35 gr/hari.
 Pada item 5, responden yang setiap hari mengkonsumsi makanan yang banyak mengandung protein. Seperti: telur dan daging sebesar 104 orang responden (79,4%). Protein dapat mengurangi kenaikan gula darah karena protein bersifat mengenyangkan dan lambat di cerna di dalam tubuh sehingga kalori tubuh pada pasien dm dapat terkontrol. Hal ini tidak sesuai dengan Idris, Jafar dan Indriasari (2014) hasil penelitian pada pasien diabetes melitus tipe 2 diketahui bahwa sebesar 69,6% pasien dengan konsumsi protein kurang sebagian besar yaitu 81,2% memiliki kadar gula darah tidak terkontrol dibandingkan pasien yang memiliki kadar gula darah terkontrol 18,8%. Hasil uji pearson chi square menunjukkan bahwa tidak ada hubungan bermakna antara asupan protein dengan kadar gula darah pasien diabetes mellitus tipe 2.. Tidak adanya hubungan yang bermakna tingkat asupan protein dengan kontrol kadar gula darah dikarenakan fungsi utama protein adalah untuk pertumbuhan dan mengganti sel-sel yang rusak. Protein akan digunakan sebagai sumber energi apabila ketersediaan energi dari sumber lain yaitu karbohidrat dan lemak tidak mencukupi melalui proses glikoneogenesis.
 Pada item 6 yang membatasi makanan asin yang menjawab sering sebesar 83 orang responden (63,4%) dan item 7 yang membatasi makanan yang banyak mengandunng lemak dan kolestrol tinggi. Seperti: santan, udang dan kepiting yang menjawab sering sebesar 88 orang responden (67,2%). Responden memiliki kesadaran tinggi dalam membatasi makanan yang banyak mengandung garam, lemak dan kolestrol tinggi. Banyak responden mengatakan bahwa makanan asin, lemak dan kolestrol tinggi dapat memperberat penyakit diabetes melitus yang diderita sehingga mereka selalu berusaha menjaga asupan yang dikonsumsi. Dari penyuluhan yang di dapat mereka mengatakan bahwa makanan yang asin akan menyebabkan hipertensi dan jika hipertensi tidak dapat di kontrol maka akan meyebabkan stroke. Sedangkan untuk lemak dan kolestrol tinggi, mereka lebih suka menjaga karena umur mereka rentan dengan penyakit stroke. Hal ini sesuai dengan penelitian Zainudin dan Yunawati (2012) Asupan garam yang berlebihan terus-menerus dapat memicu tekanan darah tinggi. Ginjal akan mengeluarkan kelebihan tersebut melalui urin. Apabila fungsi ginjal tidak optimal, kelebihan natrium tidak dapat dibuang dan menumpuk di dalam darah. Volume cairan tubuh akan meningkat dan membuat jantung dan pembuluh darah bekerja lebih keras untuk memompa darah dan mengalirkannya ke seluruh tubuh. Tekanan darah pun akan meningkat, inilah yang terjadi pada hipertensi. Selama konsumsi garam tidak berlebihan dan sesuai kebutuhan, kondisi pembuluh darah akan baik, ginjal pun akan berfungsi baik, serta proses kimiawi dan faal tubuh tetap berjalan normal tidak ada gangguan. Asupan lemak berfungsi sebagai sumber pembangun jika sesuai dengan kebutuhan asupan lemak yang di butuhkan tetapi asupan lemak akan menjadi masalah ketika asupan lemak yang masuk berlebih dari asupan lemak yang dibutuhkan. Konsumsi pangan sumber lemak yang tinggi terutama lemak jenuh membuat kolesterol low density lipoprotein (LDL) meningkat yang lama-kelamaan akan tertimbun dalam tubuh dan dapat membentuk plak di pembuluh darah. Plak tersebut akan menyumbat pembuluh darah sehingga mempengaruhi peningkatan tekanan darah. Membatasi konsumsi lemak dilakukan agar kadar kolesterol darah tidak terlalu tinggi. Kadar kolesterol darah yang tinggi dapat mengakibatkan terjadinya endapan kolesterol dalam dinding pembuluh darah. Apalabila dibiarkan maka akan menyumbat pembuluh nadi dan mengganggu sistem peredaran darah yang dapat memperberat kerja jantung dan secara tidak langsung memperparah tekanan darah
 Pada item 9, 10 dan 13 responden olahraga 3-5 kali dalam seminggu yang menjawab jarang 71 orang responden (54,2%), responden yang melakukan jalan santai disekitaran komplek setiap pagi atau sore yang menjawab selalu 52 orang responden (39,7%), dan waktu yang dihabiskan responden untuk olahraga adalah 30-60 menit yang menjawab jarang 56 orang responden (42,7%). Di musim pandemi seperti sekarang olahraga sangat di anjurkan dengan mematuhi protokol kesehatan. Kesadaran responden tentang pentingnya olahraga dengan berjalan santai di sekitaran komplek rumah merupakan aktivitas fisik sedang. Banyak manfaat yang didapatkan ketika melakukan jalan santai dengan waktu 30-60 menit yaitu ketika tubuh beraktivitas makan glukosa dalam tubuh akan diubah menjadi energi. Hal ini sesuai dengan WHO (2018) Pada kasus diabetes tipe 2 aktivitas fisik sangat membantu dalam penyerapan glukosa darah kedalam otot. Pada saat otot berkontraksi permeabilitas membran terhadap glukosa meningkat. Sehingga saat otot berkontaksi akan bertindak seperti insulin. Maka dari itu saat beraktivitas fisik, resistensi insulin berkurang.
 
 
 Dukungan Keluarga
 
 Penelitian yang telah dilakukan terhadap 131 responden didapatkan bahwa dukungan keluarga pada pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki dukungan keluarga baik dengan jumlah 129 orang responden (98,5%). Penelitian ini didukung dengan penelitian Isfandiari dan Wardani (2014) yaitu responden yang mendapatkan dukungan keluarga melakukan pengendalian kadar gula darah kurang baik sebesar 23,5% (8 responden) dan melakukan pengendalian kadar gula darah dengan baik sebesar 32,4% (11 responden).
 Hal ini sejalan dengan penelitian Nuraisyah, Kusnanto dan Rahayujati (2017) yaitu adanya hubungan dukungan keluarga dengan kualitas hidup pasien DM II (p-value: 0,00). Untuk hasil analisis diperoleh bahwa adanya hubungan dukungan keluarga yang ditinjau dari empat dimensi yaitu dimensi emosional (p-value: 0,00), dimensi penghargaan (p-value: 0,00), dan dimensi instrumental (p-value: 0,00). Sementara untuk hasil nilai analisis diperoleh bahwa adanya hubungan variabel komplikasi dengan kualitas hidup pasien DM II (p-value: 0,02).
 Item 1,2,3 dan 4 merupakan dukungan emosional. Rata-rata responden menjawab sering mendapatkan dukungan emosional yang baik. Dengan jawaban tersebut maka keluarga bagi responden sangat dibutuhkan ketika responden mengalami kesulitan tentang diabetes yang dideritanya. Ketika seorang keluarga yang menderita diabetes sangat butuh tempat untuk bercerita, hal pertama yang akan dilakukan responden adalah bercerita dengan keluarga. Sedangkan respon keluarga yang menunjukkan rasa empati akan membuat responden semakin nyaman bercerita dan terasa lega setelah bercerita. Ini sangat membantu responden yang berkeinginan untuk sembuh ataupun untuk mempertahankan gula darah tetap terkontrol sehingga tidak menimbulkan komplikasi yang tidak diinginkan.
 Pada item 5 dan 6 merupakan dimensi penghargaan. Rata-rata responden menjawab sering pada item tersebut. Dengan jawaban tersebut, penghargaan yang diterima responden berupa dorongan agar tetap mempertahan kadar gula darah tetap normal dengan mengingatkan responden untuk tetap memesan obat diabetes dan menjaga keteraturan waktu diet. Hal ini dapat membuat responden sangat diperhatikan dan dihargai oleh keluarga sehingga mampu menambah semangat responden agar tetap menjaga kadar gula darah tetap normal dan menghindari komplikasi yang ditimbulkan oleh diabetes melitus.
 Pada item 7 dan 8 merupakan dimensi instrumental. Rata-rata responden menjawab selalu untuk item 7 dan sering untuk item 8. Dengan jawaban tersebut, dukungan keluarga berupa dimensi instrumental yaitu mengembalikan energi atau stamina dan semangat yang menurun serta memberi rasa perhatian dan kepedulian terhadap responden yang menderita diabetes melitus yang sedang berusaha untuk tetap menjaga dan mengontrol agar gula darahnya tetap normal.
 Pada item 9,10,11 dan 12 merupakan dimensi informasi. Rata-rata jawaban responden pada ke empat item tersebut adalah sering. Ini menunjukan bahwa keluarga mampu memberikan informasi yang baik untuk responden sehingga menekan stressor yang muncul akibat penyakit yang diderita. Sehingga responden mampu untuk mengolah informasi yang didapat agar diabetes yang diderita tidak dapat menimbulkan komplikasi dan tetap menjaga gula darah tetap normal.
 PENUTUPAN 
 Kesimpulan 
 Hasil penelitian menunjukkan bahwa karakteristik umur responden yang menderita diabetes melitus tipe 2 terjadi pada usia lansia akhir yaitu 56-65 tahun dan diabetes melitus tipe 2 banyak diderita oleh laki-laki sebanyak 69 orang responden. Rata- rata riwayat pendidikan terakhir responden sebagian besar adalah tamatan SMA sebanyak 49 orang responden. pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki lebih banyak mnderita komplikasi sebesar 120 orang responden. Sedangkan, jenis komplikasi yang banyak diderita responden perempuan adalah neurophaty (kebas) sebesar 91 orang responden.
 Hasil Penelitian menunjukkan bahwa pola hidup meliputi pola makan dan aktivitas fisik pada pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki didapatkan pola hidup baik dengan jumlah 107 orang responden (81,7%). Sedangkan, dukungan keluarga pada pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki dukungan keluarga baik dengan jumlah 129 orang responden (98,5%).
 Ini berarti pola hidup yang baik dapat juga dipengaruhi oleh dukungan keluarga yang baik sehingga membuat penderita semakin bersemangat untuk menerapkan pola sehat dalam kehidupan sehari-hari.
 Saran 
 Bagi Mahasiswa hasil penelitian ini dapat menjadi masukan, media pembelajaran dan referensi tambahan bagi profesi keperawatan dalam melakukan pengkajian pada pasien DM tipe 2 baik dari segi pola makan, aktivitas fisik dan dukungan keluarga.
 Bagi peneliti selanjutnya hasil penelitian ini diharapkan menjadi referensi untuk peneliti selanjutnya dan bahan perbandingan dan bahan pertimbangan untuk lebih memperdalam penelitian selanjutnya dengan desain berbeda.
 Bagi puskesmas hasil penelitian ini diharapkan menjadi masukan bagi puskesmas untuk melakukan penyuluhan tentang diabetes melitus minimal 2 kali bulan sekali khusus pada pasien diabetes melitus agar pasien yang belum sempat mendengarkan penyuluhan sebelum dilakukan pelayanan bisa mendengarkan kembali informasi terbaru seputar diabetes melitus.
 
 
 Iis Dian Saviqoh, Mahasiswa Program Studi Ilmu Keperawatan Universitas Riau, Indonesia
 Yesi Hasneli, Dosen Program Studi Ilmu Keperawatan Universitas Riau, Indonesia
 Nopriadi, Dosen Program Studi Ilmu Keperawatan Universitas Riau, Indonesia
 
 
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Introduction: Restless legs syndrome (RLS) is a common chronic disorder characterized by an irresistible need to move the lower limbs that is usually worse in the evening and is associated with sleep disturbances. RLS has been associated with hypertension and has been proposed as a marker for increased cardiovascular risk. Hypothesis: Individuals with RLS have an increased common carotid intima-media thickness (cIMT) relative to individuals without RLS. Methods: We evaluated cross-sectional relation of RLS and cIMT in 1,147 disease-free Mexican women of the Mexican Teachers’ Cohort. In 2011, participants responded to a follow-up questionnaire that included standardized questions addressing the four minimal diagnostic criteria of the International Restless Legs Study Group. Participants were asked: “Do you have unpleasant leg sensations (like crawling, loss of sensation or pain) combined with restlessness and an urge to move your legs?”, “Do these symptoms occur only at rest?”, “Does moving improve these symptoms?”, “Are these symptoms worse in the evening or at night compared with the morning?” Women who answered yes to all the four questions were defined as having RLS. Between 2012 and 2013, a subsample of participants were invited for a clinical visit where neurologists assessed cIMT with an ultrasound. cIMT measurements were found to be reproducible in a substudy in 52 participants (intra-class correlation=0.89). We defined subclinical atherosclerosis as a cIMT ≥0.8 mm or the presence of plaque. Results: Among women with a mean age of 48.2 (SD±4.3), the prevalence of RLS was 14.2% (cases, 163). The age-adjusted mean difference of cIMT comparing participants with RLS to those without RLS was 0.009mm (95%CI -0.004 to 0.023). After further adjustment for diabetes, hypercholesterolemia, migraine, oral contraceptive use, menopause, smoking, body mass index, physical activity and alcohol, the mean difference of cIMT comparing participants with and without RLS was not statistically different (0.007mm; 95%CI -0.007 to 0.021). The prevalence of subclinical atherosclerosis was 27% (n=44) in those with RLS and 21.9% (n=215) in those without RLS. The age-adjusted OR comparing women with RLS to those without RLS was 1.23 (95%CI 0.83-1.82). In the multivariable model the OR remained non-significant (1.16, 95%CI 0.77-1.74). Conclusions: In this cross-sectional study in middle-aged women, RLS was not associated to cIMT. Our results do not support the observation that individuals with RLS are at an increased risk for cardiovascular disease.

Perfume is a Japanese “techno-pop” idol trio formed in 2000 consisting of three women–Ayano Omoto, Yuka Kashino, and Ayaka Nishiwaki. Since 2007, when one of their songs was selected for a recycling awareness campaign by Japan's national public broadcaster, Perfume has been a consistent fixture in the Japanese pop music charts. They have been involved in the full gamut of typical idol activities, from television and radio shows to commercials for clothing brands, candy, and drinks. Their success reflects Japanese pop culture's long-standing obsession with pop idols, who once breaking into the mainstream, become ubiquitous cross-media presences. Perfume’s fame in Japan is due in large part to their masterful performance of traditional female idol roles, through which they assume the kaleidoscopic positions of daughter, sister, platonic friend, and heterosexual romantic partner depending on the standpoint of the beholder. In the lyrical content of their songs, they play the various parts of the cute but shy girl who loves from a distance, the strong compatriot that pushes the listener to keep striving for their dreams, and the kindred spirit with whom the listener can face life's ordinary challenges. Like other successful idols, their extensive lines of Perfume-branded merchandise and product endorsements make the exercise of consumer spending power by their fans a vehicle for them to approach the ideals and experiences that Perfume embodies. Yet, Perfume's videos, music, and stage performances are also replete with subversive images of machines, virtual cities and landscapes, and computer generated apparitions. In their works, the traditional idol as an object of consumer desire co-exists with images of the fragmentation of identity, distrust in the world and the senses, and the desire to escape from illusion, all presented in terms of encounters with technology. In what their fans call the "Near Future Trilogy", a set of three singles released soon after their major label debut (2005-06), lyrics refer to the artificiality and transience of virtual worlds ("Nothing I see or touch has any reality" from "Electro-World," or "I want to escape. I want to destroy this city created by immaculate computation" from "Computer City"). In their later work, explicit lyrical references to virtual worlds and machines largely disappear, but they are replaced with images and bodily performances of Perfume with robotic machinery and electronic information. Perfume is an idol group augmented by technology. In this paper, I explore the significance of these images of technological augmentation of the human body in the work of Perfume. I suggest that the ways these bodily encounters of the human body and technology are articulated in their work reflect broader social and economic anxieties and hopes in Japan. I focus in the first section of this paper on describing some of the recurring technological motifs in their works. Next, I show how their recent work is an experiment with the emergent possibilities of human-technology relationships for imagining Japan's future development. Not only in their visual and performance style, but in their modes of engagement with their fans through new media, I suggest that Perfume itself is attempting to seek out new forms of value creation, which hold the promise of pushing Japan out of the extended economic and social stagnation of its 1990s post-bubble "Lost Decade,” particularly by articulating how they connect with the world. The idol's technologically augmented body becomes both icon and experiment for rethinking Japan and staking out a new global position for it. Though I have referred above to Perfume as its three members, I also use the term to signify the broader group of managers and collaborating artists that surrounds them. Perfume is a creation of corporate media companies and the output of development institutions designed to train multi-talented entertainers from a young age. In addition to the three women who form the public face of Perfume, main figures include music producer Yasutaka Nakata, producer and choreographer MIKIKO, and more recently, the new media artist Daito Manabe and his company, Rhizomatiks. Though Perfume very rarely appear on stage or in their videos with any other identifiable human performers, every production is an effort involving dozens of professional staff. In this respect, Perfume is a very conventional pop idol unit. The attraction of these idols for their fans is not primarily their originality, creativity, or musicality, but their professionalism and image as striving servants (Yano 336). Idols are beloved because they "are well-polished, are trained to sing and act, maintain the mask of stardom, and are extremely skillful at entertaining the audience" (Iwabuchi 561). Moreover, their charisma is based on a relationship of omoiyari or mutual empathy and service. As Christine Yano has argued for Japanese Enka music, the singer must maintain the image of service to his or her fans and reach out to them as if engaged in a personal relationship with each (337). Fans reciprocate by caring for the singer, and making his or her needs their own, not the least of which are financial. The omoiyari relationship of mutual empathy and care is essential to the singer’s charismatic appeal (Yano 347). Thus it does not matter to their fans that Perfume do not play their own instruments or write their own songs. These are jobs for other professionals. However, mirroring the role of the employee in the Japanese company-as-family (see Kondo), their devotion to their jobs as entertainers, and their care and respect for their fans must be evident at all times. The tarnishing of this image, for instance through revelations of underage smoking or drinking, can be fatal, and has resulted in banishment from the media spotlight for some former stars. A large part of Japanese stars' conventional appeal is based on their appearance as devoted workers, consummate professionals, and partners in mutual empathy. As charismatic figures that exchange cultural ideals for fans’ disposable income, it is not surprising that many authors have tied the emergence of the pop idol to the height of Japan's economic prosperity in the 1970s and 1980s, when the social contract between labor and corporations that provided both lifelong employment and social identity had yet to be seriously threatened. Aoyagi suggests (82) that the idol system is tied to post-war consumerism and the increased importance of young adults, particularly women, as consumers. As this correlation between the health of idols and the economy might imply, there is a strong popular connection between concerns of social fission and discontent and economic stagnation. Koichi Iwabuchi writes that Japanese media accounts in the 1990s connected the health of the idol system to the "vigor of society" (555). As Iwabuchi describes, some Japanese fans have looked for their idols abroad in places such as Hong Kong, with a sense of nostalgia for a kind of stardom that has waned in Japan and because of "a deep sense of disillusionment and discontent with Japanese society" (Iwabuchi 561) following the collapse of Japan's bubble economy in the early 1990s. In reaction to the same conditions, some Japanese idols have attempted to exploit this nostalgia. During a brief period of fin-de-siècle optimism that coincided with neoliberal structural reforms under the government of Junichiro Koizumi, Morning Musume, the most popular female idol group at the time, had a hit single entitled "Love Machine" that ended the 1990s in Japan. The song's lyrics tie together dreams of life-long employment, romantic love, stable traditional families, and national resurgence, linking Japan's prosperity in the world at large to its internal social, emotional, and economic health. The song’s chorus declares, "The world will be envious of Japan's future!", although that future still has yet to materialize. In its place has appeared the "near-future" imaginary of Perfume. As mentioned above, the lyrics of some of their early songs referenced illusory virtual worlds that need to be destroyed or transcended. In their later works, these themes are continued in images of the bodies of the three performers augmented by technology in various ways, depicting the performers themselves as robots. Images of the three performers as robots are first introduced in the music video for their single "Secret Secret" (2007). At the outset of the video, three mannequins resembling Perfume are frozen on a futuristic TV soundstage being dressed by masked attendants who march off screen in lock step. The camera fades in and out, and the mannequins are replaced with the human members frozen in the same poses. Other attendants raise pieces of chocolate-covered ice cream (the music video also served as an advertisement for the ice cream) to the performers' mouths, which when consumed, activate them, launching them into a dance consisting of stilted, mechanical steps, and orthogonal arm positions. Later, one of the performers falls on stairs and appears to malfunction, becoming frozen in place until she receives another piece of ice cream. They are later more explicitly made into robots in the video for "Spring of Life" (2012), in which each of the three members are shown with sections of skin lifted back to reveal shiny, metallic parts inside. Throughout this video, their backs are connected to coiled cables hanging from the ceiling, which serve as a further visual sign of their robotic characters. In the same video, they are also shown in states of distress, each sitting on the floor with parts exposed, limbs rigid and performing repetitive motions, as though their control systems have failed. In their live shows, themes of augmentation are much more apparent. At a 2010 performance at the Tokyo Dome, which was awarded the jury selection prize in the 15th Japan Media Arts Festival by the Japanese Agency for Cultural Affairs, the centerpiece was a special performance entitled "Perfume no Okite" or "The Laws of Perfume." Like "Secret Secret," the performance begins with the emergence of three mannequins posed at the center of the stadium. During the introductory sequence, the members rise out of a different stage to the side. They begin to dance, synchronized to massively magnified, computer generated projections of themselves. The projections fluctuate between photorealistic representations of each member and ghostly CG figures consisting of oscillating lines and shimmering particles that perform the same movements. At the midpoint, the members each face their own images, and state their names and dates of birth before uttering a series of commands: "The right hand and right leg are together. The height of the hands must be precise. Check the motion of the fingers. The movement of the legs must be smooth. The palms of the hands must be here." With each command, the members move their own bodies mechanically, mirrored by the CG figures. After more dancing with their avatars, the performance ends with Perfume slowly lowered down on the platform at the center of the stage, frozen in the same poses and positions as the mannequins, which have now disappeared. These performances cleverly use images of robotic machinery in order to subvert Perfume's idol personas. The robotic augmentations are portrayed as vectors for control by some unseen external party, and each of the members must have their life injected into them through cables, ice cream, or external command, before they can begin to dance and sing as pop idols. Pop idols have always been manufactured products, but through such technological imagery Perfume make their own artificiality explicit, revealing to the audience that it is not the performers they love, but the emergent and contingently human forms of a social, technological, and commercial system that they desire. In this way, these images subvert the performers' charisma and idol fans' own feelings of adoration, revealing the premise of the idol system to have been manufactured to manipulate consumer affect and desire. If, as Iwabuchi suggests, some fans of idols are attracted to their stars by a sense of nostalgia for an age of economic prosperity, then Perfume's robotic augmentations offer a reflexive critique of this industrial form. In "The Laws of Perfume", the commands that comport their bodies may be stated in their own voices, yet they issue not from the members themselves, but their magnified and processed avatars. It is Perfume the commercial entity speaking. The malfunctioning bodies of Perfume depicted in "Secret Secret" and "Spring of Life" do not detract from their charisma as idols as an incident of public drunkenness might, because the represented breakdowns in their performances are linked not to the moral purity or professionalism of the humans, but to failures of the technological and economic systems that have supported them. If idols of a past age were defined by their seamless and idealized personas as entertainers and employees, then it is fitting that in an age of much greater economic and social uncertainty that they should acknowledge the cracks in the social and commercial mechanisms from which their carefully designed personas emerge. In these videos and performances, the visual trope of technological body augmentation serves as a means for representing both the dependence of the idol persona on consumer capitalism, and the fracturing of that system. However, they do not provide an answer to the question of what might lie beyond the fracturing. The only suggestions provided are the disappearance of that world, as in the end of "Computer City," or in the reproduction of the same structure, as when the members of Perfume become mannequins in "The Laws of Perfume" and "Secret Secret." Interestingly, it was with Perfume's management's decision to switch record labels and market Perfume to an international audience that Perfume became newly augmented, and a suggestion of an answer became visible. Perfume began their international push in 2012 with the release of a compilation album, "Love the World," and live shows and new media works in Asia and Europe. The album made their music available for purchase outside of Japan for the first time. Its cover depicts three posed figures computer rendered as clouds of colored dots produced from 3D scans of the members. The same scans were used to create 3D-printed plastic figures, whose fabrication process is shown in the Japanese television ad for the album. The robotic images of bodily augmentation have been replaced by a more powerful form of augmentation–digital information. The website which accompanied their international debut received the Grand Prix of the 17th Japan Media Arts Prize. Developed by Daito Manabe and Rhizomatiks, visitors to the Perfume Global website were greeted by a video of three figures composed of pulsating clouds of triangles, dancing to a heavy, glitch-laden electronic track produced by Nakata. Behind them, dozens of tweets about Perfume collected in real-time scroll across the background. Controls to the side let visitors change not only the volume of the music, but also the angle of their perspective, and the number and responsiveness of the pulsating polygons. The citation for the site's prize refers to the innovative participatory features of the website. Motion capture data from Perfume, music, and programming examples used to render the digital performance were made available for free to visitors, who were encouraged to create their own versions. This resulted in hundreds of fan-produced videos showing various figures, from animals and cartoon characters to swooshing multi-colored lines, dancing the same routine. Several of these were selected to be featured on the website, and were later integrated into the stage performance of the piece during Perfume's Asia tour. A later project extended this idea in a different direction, letting website visitors paint animations on computer representations of the members, and use a simple programming language to control the images. Many of these user creations were integrated into Perfume's 2013 performance at the Cannes Lions International Festival as advertising. Their Cannes performance begins with rapidly shifting computer graphics projected onto their costumes as they speak in unison, as though they are visitors from another realm: "We are Perfume. We have come. Japan is far to the east. To encounter the world, the three of us and everyone stand before you: to connect you with Japan, and to communicate with you, the world." The user-contributed designs were projected on to the members' costumes as they danced. This new mode of augmentation–through information rather than machinery–shows Perfume to be more than a representation of Japan's socio-economic transitions, but a live experiment in effecting these transitions. In their international performances, their bodies are synthesized in real-time from the performers' motions and the informatic layer generated from tweets and user-generated creations. This creates the conditions for fans to inscribe their own marks on to Perfume, transforming the emotional engagement between fan and idol into a technological linkage through which the idols’ bodies can be modified. Perfume’s augmented bodies are not just seen and desired, but made by their fans. The value added by this new mode of connection is imagined as the critical difference needed to transform Perfume from a local Japanese idol group into an entity capable of moving around the world, embodying the promise of a new global position for Japan enabled through information. In Perfume, augmentation suggests a possible answer to Japan’s economic stagnation and social fragmentation. It points past a longing for the past towards new values produced in encounters with the world beyond Japan. Augmentations newly connect Perfume and Japan with the world economically and culturally. At the same time, a vision of Japan emerges, more mobile, flexible, and connected perhaps, yet one that attempts to keep Japan a distinct entity in the world. Bodily augmentations, in media representations and as technological practices, do more than figuratively and materially link silicon and metal with flesh. They mark the interface of the body and technology as a site of transnational connection, where borders between the nation and what lies outside are made References Aoyagi, Hiroshi. Islands of Eight Million Smiles: Idol Performance and Symbolic Production in Contemporary Japan. Cambridge, Mass.: Harvard University Press, 2005. Iwabuchi, Koichi. "Nostalgia for a (Different) Asian Modernity: Media Consumption of "Asia" in Japan." positions: east asia cultures critique 10.3 (2002): 547-573. Kondo, Dorinne K. Crafting Selves: Power, Gender and Discourses of Identity in a Japanese Workplace. Chicago and London: University of Chicago Press, 1990. Morning Musume. “Morning Musume ‘Love Machine’ (MV).” 15 Oct. 2010. 4 Dec. 2013 ‹http://www.youtube.com/watch?v=6A7j6eryPV4›. Perfume. “[HD] Perfume Performance Cannes Lions International Festival of Creativity.” 20 June 2013. 11 Nov. 2013 ‹http://www.youtube.com/watch?v=gI0x5vA7fLo›. ———. “[SPOT] Perfume Global Compilation “LOVE THE WORLD.”” 11 Sep. 2012. 11 Nov. 2013 ‹http://www.youtube.com/watch?v=28SUmWDztxI›. ———. “Computer City.” 18 June 2013. 10 Oct. 2013 ‹http://www.youtube.com/watch?v=jOXGKTrsRNg›. ———. “Electro World.” 18 June 2013. 10 Oct. 2013 ‹http://www.youtube.com/watch?v=8zh0ouiYIZc›. ———. “Perfume no Okite.” 8 May 2011. 10 Oct. 2013 ‹http://www.youtube.com/watch?v=2EjOistJABM›. ———. “Perfume Official Global Website.” 2012. 11 Nov. 2013 ‹http://perfume-global.com/project.html›. ———. “Secret Secret.” 18 Jan. 2012. 10 Oct. 2013 ‹http://www.youtube.com/watch?v=birLzegOHyU›. ———. “Spring of Life.” 18 June 2013. 10 Oct. 2013 ‹http://www.youtube.com/watch?v=7PtvnaEo9-0›. Yano, Christine. "Charisma's Realm: Fandom in Japan." Ethnology 36.4 (1997): 335-49.

IntroductionWhen I saw Patriots Day (Berg 2016) at my local multiplex, a family entered the theatre and sat a few rows in front of me. They had a child with them, a boy who was perhaps nine or ten years old. Upon seeing the kid, I had a physical reaction. Not quite a knee-jerk, but more of an uneasy gut punch. ‘Don't you know what this movie is about?’ I wanted to ask his parents; ‘I’ve seen Jeff Bauman’s bones, and that is not something a child should see.’ I had lived through the 2013 Boston Marathon bombing and subsequent manhunt, and the memories were vivid in my mind as I waited for the movie to start, to re-present the memory on screen. Admittedly, I had lived through it from the other side of the world, watching through the mediated windows of the computer, smartphone, and television screen. Nevertheless, I remembered it in blood-soaked colour detail, brought to me by online photo galleries, social media updates, the failed amateur sleuths of Reddit, and constant cable news updates, breaking news even when the events had temporarily stalled. Alison Landsberg has coined the term “prosthetic memory” to describe how historical events are re-created and imbued with an affective experience through cinema and other sites of mass cultural mediation, allowing those who did not experience the past to form a personal connection to and subjective memory of history (2). For the boy in the cinema, Patriots Day would most likely be his first encounter with and memory of the Boston Marathon bombing. But how does prosthetic memory apply to audience members like me, who had lived through the Boston bombing from a great distance, with personalised memories mediated by the first-person perspective of social media? Does the ease of dissemination of information, particularly eyewitness photographs and videos, create possibilities for a prosthetic experience of the present? Does the online mediation of historical events of the present translate to screen dramatisations? These questions become particularly pertinent when the first-release audience of a film has recent, living memories of the real events depicted on screen.The time between when an event occurs and when it is brought to cinemas in a true-events adaptation is decreasing. Rebecca A. Sheehan argues that the cultural value of instant information has given rise to a trend in the contemporary biopic and historical film that sees our mediated world turned into a temporal "paradox in which the present is figured as both historical and ongoing" (36). Since 2005, Sheehan writes, biographical films that depict the lives of still-living public figures or in other ways comment on the ongoing history of the present have become increasingly frequent. Sheehan cites films such as The Social Network (Fincher 2010), The Queen (Frears 2006), W. (Stone 2008), and Game Change (Roach 2012) as examples of this growing biopic trend (35-36). In addition to the instantaneous remediation of public figures in the contemporary biopic, similarly there is a stable of contemporary historical films based on the true stories of ordinary people involved in extraordinary recent events. Films such as The Impossible (Bayona 2012), World Trade Center (Stone 2006), United 93 (Greengrass 2006), and Deepwater Horizon (Berg 2016) bring the death and destruction of real-world natural disasters or terrorist attacks to a sanitised but experiential cinematic event. The sensitive nature of some of the events in question often see the films labelled “too soon” and exploitative of recent tragedy. Films such as these typically do not have known public figures as their protagonists, but they arise from a similar climate of the demands of televisual and online mediation that Sheehan describes in the “instant biopics” of her study (36). Given this rise of brief temporal space between real events and their dramatisations, in this essay, I examine Patriots Day in light of the role digital experience plays in both its dramatisation and how the film's initial audience may remember the event. As Patriots Day replicates a kind of prosthetic memory of the present, it uses the first-instance digital mediation of the event to form prosthetic memories for future viewers. Through Patriots Day, I seek to gesture toward the possibilities of first-person digital mediation of major news events in shaping dramatisations of the recent past.Digital Memories of the Boston Marathon BombingTo examine the ways the Boston Marathon bombing circulated in online space, I look at the link- and image-based online discussion platform Reddit as an example of engagement with and recirculation of the event, particularly as a form of engagement defined by photographs and videos. Because the Boston Marathon is a televised and widely-reported event, professional videographers and photographers were present at the marathon’s finish line at the time of the first explosion. Thus, the first bomb and its immediate aftermath were captured in news footage and still images. The graphic nature of some of these images depicting the violence of the scene saw traditional print and television outlets cropping or otherwise editing the photographs to make them appropriate for mass broadcast (Hughney). Some online outlets, however, showed these pictures in their unedited form, often accompanied by warnings that required readers to scroll further down the page or click through the warning to see the photographs. These distinctive capabilities of the online environment allowed individuals to choose whether to view the image, while still allowing the uncensored image to circulate and be reposted elsewhere, such as on Reddit. In addition to photos and videos shot by professionals at the finish line, witnesses armed with smart phone cameras and access to social media posted their views of the aftermath to social media like Twitter, enabling the collation of both amateur and professionally shot photographs of the scene by online news aggregators such as Buzzfeed (Broderick). The Reddit community is seen as an essential part of the Boston Bombing story for the way some of its users participated in a form of ‘crowd-sourced’ investigation that resulted in the false identification of suspects (see: Nhan et al.; Tapia et al.; Potts and Harrison). There is another aspect to Reddit’s role in the circulation and mediation of the story, however, as online venues became a go-to source for news on the unfolding event, where information was delivered faster and with greater accuracy than the often-sensationalised television news coverage (Starbird et al. 347). In addition to its role in providing information that is a part of Reddit’s culture that “value[s] evidence of some kind” to support discussion (Potts and Harrison 144), Reddit played a number of roles in the sense-making process that social media can often facilitate during crisis situations (Heverin and Zach). Through its division into “subreddits,” the individual communities and discussion areas that make up the platform, Reddit accommodates an incredibly diverse range of topics and interests. Different areas of Reddit were able to play different roles in the process of sharing information and acting in a community sense-making capacity in the aftermath of the bombing. Among the subreddits involved in attempting to make sense of the event were those that served as appropriate places for posting image galleries of both professional and amateur photographs and videos, drawn from a variety of online sources. Users of subreddits such as /r/WTF and /r/MorbidReality, for example, posted galleries of “NSFL” (Not Safe For Life) images of the bombing and its aftermath (see: touhou_hijack, titan059, f00d4tehg0dz). Additionally, the /r/Boston subreddit issued calls for anyone with photographs or videos related to the attack to upload them to the thread, as well as providing an e-mail address to submit them to the FBI (RichardHerold). The /r/FindBostonBombers subreddit became a hub for analysis of the photographs. The subreddit's investigatory work was picked up by other online and traditional media outlets (including the New York Post cover photo which misidentified two suspects), bringing wider attention to Reddit’s unfolding coverage of the bombing (Potts and Harrison 148). Landsberg’s theory of prosthetic memory, and her application of it, largely relates to mass culture’s role in “the production and dissemination of memories that have no direct connection to a person’s lived past” (20). The possibilities for news events to be recorded and disseminated by smart phones and social media, however, help to create a deeper sense of affective engagement with a distant present, creating prosthetic memories out of the mediated first-hand experiences of others. The graphic nature of the photos and videos of the Boston bombing collected by and shared on sites like Reddit, the ongoing nature of the event (which, from detonation to the capture of Dzokhar Tsarnaev, spanned five days), and the participatory activity of scouring photographs for clues to the identity of the bombers all lend a sense of ongoing, experiential engagement with first-person, audiovisual mediations of the event. These prosthetic memories of the present are, as Landsberg writes of those created from dramatisations or re-creations of the past, transferable, able to belong to those who have no “natural” claim to them (18) with an experiential element that personalises history for those who do not directly experience it (33). If widely disseminated first-person mediations of events like the Boston bombing can be thought of as a prosthetic experience of present history, how will they play a part in the prosthetic memories of the future? How will those who did not live through the Boston bombing, either as a personal experience or a digitally mediated one, incorporate this digital memory into their own experience of its cinematic re-creation? To address this question, I turn to consider Patriots Day. Of particular note is the bombing sequence’s resemblance to digital mediations of the event as a marker of a plausible docudramatic resemblance to reality.The Docudramatic Re-Presentation of Digital MemoryAs a cinematic representation of recent history, Patriots Day sits at a somewhat uncomfortable intersection of fact and fiction, of docudrama and popcorn action movie, more so than an instant history film typically would. Composite characters or entirely invented characters and narratives that play out against the backdrop of real events are nothing out of the ordinary in the historical film. However, Patriots Day's use of real material and that of pure invention coincides, frequently in stark contrast. The film's protagonist, Boston Police Sergeant Tommy Saunders (played by Mark Wahlberg) is a fictional character, the improbable hero of the story who is present at every step of the attack and the manhunt. He is there on Boylston Street when the bombs go off. He is there with the FBI, helping to identify the suspects with knowledge of Boylston Street security cameras that borders on a supernatural power. He is there at the Watertown shootout among exploding cars and one-liner quips. When Dzokhar Tsarnaev is finally located, he is, of course, first on the scene. Tommy Saunders, as embodied by Wahlberg, trades on all the connotations of both the stereotypical Boston Southie and the action hero that are embedded in Wahlberg’s star persona. As a result, Patriots Day often seems to be a depiction of an alternate universe where Mark Wahlberg in a cop uniform almost single-handedly caught a terrorist. The improbability of Saunders as a character in a true-events drama, though, is thoroughly couched in the docudramatic material of historical depiction. Steven N. Lipkin argues that docudrama is a mode of representation that performs a re-creation of memory to persuade us that it is representing the real (1). By conjuring the memory of an event into being in ways that seem plausible and anchored to the evidence of actuality—such as integrating archival footage or an indexical resemblance to the actual event or an actual person—the representational, cinematic, or fictionalised elements of docudrama are imbued with a sense of the reality they claim to represent (Lipkin 3). Patriots Day uses real visual material throughout the film. The integration of evidence is particularly notable in the bombing sequence, which combines archival footage of the 2013 race, surveillance footage of the Tsarnaev brothers approaching the finish line, and a dramatic re-creation that visually resembles the original to such an extent that its integration with archival footage is almost seamless (Landler). The conclusion of the film draws on this evidential connection to the real as well, in the way that docudrama is momentarily suspended to become documentary, as interviews with some of the real people who are depicted as characters in the film close out the story. In addition to its direct use of the actual, Patriots Day's re-creation of the bombing itself bears an indexical resemblance to the event as seen by those who were not there and relies on memories of the bombing's initial mediation to vouch for the dramatisation's accuracy. In the moments before the bombing's re-creation, actual footage of the Tsarnaevs's route down Boylston Street plays, a low ominous tone of the score building over the silent security footage. The fictional Saunders’s fictional wife (Michelle Monaghan) has come to the finish line to bring him a knee brace, and she passes Tamerlan Tsarnaev as she leaves. This shot directly crosses a visual resemblance to the actual (Themo Melikidze playing Tsarnaev, resembling the bomber through physicality and costuming) with the fictional structuring device of the film in the form of Tommy Saunders. Next, in a long shot, we see Tsarnaev bump into a man wearing a grey raglan shirt. The man turns to look at Tsarnaev. From the costuming, it is evident that this man who is not otherwise named is intended to represent Jeff Bauman, the subject of an iconic photograph from the bombing. In the photo, Bauman is shown being taken from the scene in a wheelchair with both legs amputated from below the knee by the blast (another cinematic dramatisation of the Boston bombing, Stronger, based on Bauman’s memoir of the same name, will be released in 2017). In addition to the visual signifier of Bauman from the memorable photograph, reports circulated that Bauman's ability to describe Tsarnaev to the FBI in the immediate aftermath of the bombing was instrumental in identifying the suspects (Hartmann). Here, this digital memory is re-created in a brief but recognisable moment: this is the before picture of Jeff Bauman, this is the moment of identification that was widely circulated and talked about, a memory of that one piece of good news that helped satisfy public curiosity about the status of the iconic Man in the Wheelchair.When the bombs detonate, we are brought into the smoke and ash, closer access than the original mediation afforded by the videographers at the finish line. After the first bomb detonates, the camera follows Saunders as he walks toward the smoke cloud. As the second bomb explodes, we go inside the scene. The sequence cuts from actual security camera footage that captured the blast, to a first-person perspective of the explosion, the resulting fire and smoke, and a shot that resembles the point of view of footage captured on a smart phone. The frame shakes wildly, giving the viewer disorienting flashes of the victims, a sense of the chaos without seeing anything in lasting, specific detail, before the frame tips sideways onto the pavement, stained with blood and littered with debris. Coupled with this is a soundscape that resembles both the subjective experience of a bombing victim and what their smart phone video has captured. There is the rumble of the explosion and muffled sounds of debris hidden under the noise of shockwaves of air hitting a microphone, fading into an electronic whine and tinnitus ring. A later shot shows the frame obscured by smoke, slowly clearing to give us a high angle view of the aftermath, resembling photographs taken from a window overlooking the scene on Boylston Street (see: touhou_hijack). Archival footage of first responders and points of view resembling a running cell phone camera that captures flashes of blood and open wounds combine with shots of the actors playing characters (both fictional and based on real people) that were established at the beginning of the film. There is once again a merging of the re-created and the actual, bound together by a sense of memory that encourages the viewer to take the former as plausible, based on its resemblance to the latter.When Saunders runs for the second bombing site further down the street, he looks down at two bodies on the ground. Framed in close-up, the bloodless, empty expression and bright blue shirt of Krystle Campbell are recognisable. We can ignore the inaccuracies of this element of the digital memory amidst the chaos of the sequence. Campbell died in the first bombing, not the second. The body of a woman in a black shirt is between the camera's position on the re-created Boylston Street and the actor standing in for Campbell, the opposite of how Campbell and her friend Karen Rand lay beside each other in photographs of the bombing aftermath. The police officer who takes Krystle's pulse on film and shakes her head at Wahlberg's character is a brunette, not the blonde in the widely-circulated picture of a first responder at the actual bombing. The most visceral portion of the image is there, though, re-created almost exactly as it appeared at its first point of mediation: the lifeless eyes and gaping mouth, the bright blue t-shirt. The memory of the event is conjured into being, and the cinematic image resembles the most salient elements of the memory enough for the cinematic image to be a plausible re-creation. The cinematic frame is positioned at a lower level to the original still, as though we are on the ground beside her, bringing the viewer even closer to the event, even as the frame crops out her injuries as scene photographs did not, granting a semblance of respectful distance from the real death. This re-creation of Krystle Campbell’s death is a brief flash in the sequence, but a powerful moment of recognition for those who remember its original mediation. The result is a sequence that shows the graphic violence of the actuality it represents in a series of images that invite its viewer to expand the sequence with their memory of the event the way most of them experienced it: on other screens, at the site of its first instance of digital mediation.ConclusionThrough its use of cinematography that resembles actual photographic evidence of the Boston Marathon bombing or imbues the re-creation with a sense of a first-person, digitally mediated account of the event, Patriots Day draws on its audience's digital memory of recent history to claim accuracy in its fictionalisation. Not everyone who sees Patriots Day may be as familiar with the wealth of eyewitness photographs and images of the Boston Marathon bombing as those who may have experienced and followed the events in online venues such as Reddit. Nonetheless, the fact of this material's existence shapes the event's dramatisation as the filmmakers attempt to imbue the dramatisation with a sense of accuracy and fidelity to the event. The influence of digital memory on the film’s representation of the event gestures toward the possibilities for how online engagement with major news events may play a role in their dramatisation moving forward. Events that have had eyewitness visual accounts distributed online, such as the 2015 Bataclan massacre, the 2016 Pulse nightclub shooting, the 2017 Manchester Arena bombing and Westminster Bridge attack, or the 2016 police shooting of Philando Castile that was streamed on Facebook live, may become the subject of future dramatisations of recent history. The dramatic renderings of contemporary history films will undoubtedly be shaped by the recent memory of their online mediations to appeal to a sense of accuracy in the viewer's memory. As recent history films continue, digital memories of the present will help make the prosthetic memories of the future. ReferencesBroderick, Ryan. “Photos from the Scene of the Boston Marathon Explosion (Extremely Graphic).” Buzzfeed News, 16 Apr. 2013. 2 Aug. 2017 <https://www.buzzfeed.com/ryanhatesthis/first-photos-from-the-scene-of-the-boston-marathon-explosion?utm_term=.fw38Byjq1#.peNXWPe8G>.f00d4tehg0dz. “Collection of Photos from the Boston Marathon Bombing (NSFW) (NSFL-Gore).” Reddit, 16 Apr. 2013. 8 Aug. 2017 <https://www.reddit.com/r/WTF/comments/1cfhg4/collection_of_photos_from_the_boston_marathon/>.Hartmann, Margaret. “Bombing Victim in Iconic Photo Was Key to Identifying Boston Suspects.” New York Magazine, 18 Apr. 2013. 8 Aug. 2017 <http://nymag.com/daily/intelligencer/2013/04/bombing-victim-identified-suspects.html>.Heverin, Thomas, and Lisl Zach. “Use of Microblogging for Collective Sense-Making during Violent Crises: A Study of Three Campus Shootings.” Journal of the American Society for Information Science and Technology 63.1 (2012): 34-47. Hughney, Christine. “News Media Weigh Use of Photos of Carnage.” New York Times, 17 Apr. 2013. 2 Aug. 2017 <http://www.nytimes.com/2013/04/18/business/media/news-media-weigh-use-of-photos-of-carnage.html>.Landler, Edward. “Recreating the Boston Marathon Bombing in Patriots Day.” Cinemontage, 21 Dec. 2016. 8 Aug. 2017 <http://cinemontage.org/2016/12/recreating-boston-marathon-bombing-patriots-day/>.Landsberg, Alison. Prosthetic Memory: The Transformation of American Remembrance in the Age of Mass Culture. New York: Columbia U P, 2004. Lipkin, Steven N. Docudrama Performs the Past: Arenas of Argument in Films Based on True Stories. Newcastle upon Tyne: Cambridge Scholars, 2011. Nhan, Johnny, Laura Huey, and Ryan Broll. “Digilantism: An Analysis of Crowdsourcing and the Boston Marathon Bombing.” British Journal of Criminology 57 (2017): 341-361. Patriots Day. Dir. Peter Berg. CBS Films, 2016.Potts, Liza, and Angela Harrison. “Interfaces as Rhetorical Constructions. Reddit and 4chan during the Boston Marathon Bombings.” Proceedings of the 31st ACM International Conference on Design of Communication. Greenville, North Carolina, September-October 2013. 143-150. RichardHerold. “2013 Boston Marathon Attacks: Please Upload Any Photos in Relation to the Attacks That You Have.” Reddit, 15 Apr. 2013. 8 Aug. 2017 <https://www.reddit.com/r/boston/comments/1cf5wp/2013_boston_marathon_attacks_please_upload_any/>.Sheehan, Rebecca A. “Facebooking the Present: The Biopic and Cultural Instantaneity.” The Biopic in Contemporary Film Culture. Eds. Tom Brown and Bélen Vidal. New York: Routledge, 2014. 35-51. Starbird, Kate, Jim Maddock, Mania Orand, Peg Achterman, and Robert M. Mason. “Rumors, False Flags, and Digital Vigilantes: Misinformation on Twitter after the 2013 Boston Marathon Bombing.” iConference 2014 Proceedings. Berlin, March 2014. 654-662. Tapia, Andrea H., Nicolas LaLone, and Hyun-Woo Kim. “Run Amok: Group Crowd Participation in Identifying the Bomb and Bomber from the Boston Marathon Bombing.” Proceedings of the 11th International ISCRAM Conference. Eds. S.R. Hiltz, M.S. Pfaff, L. Plotnick, and P.C. Shih. University Park, Pennsylvania, May 2014. 265-274. titan059. “Pics from Boston Bombing NSFL.” Reddit, 15 Apr. 2013. 8 Aug. 2017 <https://www.reddit.com/r/WTF/comments/1cf0po/pics_from_boston_bombing_nsfl/>.touhou_hijack. “Krystle Campbell Died Screaming. This Sequence of Photos Shows Her Final Moments.” Reddit, 18 Apr. 2013. 8 Aug. 2017 <https://www.reddit.com/r/MorbidReality/comments/1cktrx/krystle_campbell_died_screaming_this_sequence_of/>.

The Alt Right Are Not Alright Academic explorations complicating both the Internet and whiteness have often focussed on the rise of the “alt-right” to examine the co-option of digital technologies to extend white supremacy (Daniels, “Cyber Racism”; Daniels, “Algorithmic Rise”; Nagle). The term “alt-right” refers to media organisations, personalities, and sarcastic Internet users who promote the “alternative right”, understood as extremely conservative, political views online. The alt-right, in all of their online variations and inter-grouping, are infamous for supporting white supremacy online, “characterized by heavy use of social media and online memes. Alt-righters eschew ‘establishment’ conservatism, skew young, and embrace white ethnonationalism as a fundamental value” (Southern Poverty Law Center). Theoretical studies of the alt-right have largely focussed on its growing presence across social media and websites such as Twitter, Reddit, and notoriously “chan” sites 4chan and 8chan, through the political discussions referred to as “threads” on the site (Nagle; Daniels, “Algorithmic Rise”; Hawley). As well, the ability of online users to surpass national boundaries and spread global white supremacy through the Internet has also been studied (Back et al.). The alt-right have found a home on the Internet, using its features to cunningly recruit members and to establish a growing community that mainstream politically extreme views (Daniels, “Cyber Racism”; Daniels, “Algorithmic Rise; Munn). This body of knowledge shows that academics have been able to produce critically relevant literature regarding the alt-right despite the online anonymity of the majority of its members. For example, Conway et al., in their analysis of the history and social media patterns of the alt-right, follow the unique nature of the Christchurch Massacre, encompassing the use and development of message boards, fringe websites, and social media sites to champion white supremacy online. Positioning my research in this literature, I am interested in contributing further knowledge regarding the alt-right, white supremacy, and the Internet by exploring the sinister conducting of Zoom-bombing anti-racist events. Here, I will investigate how white supremacy through the Internet can lead to violence, abuse, and fear that “transcends the virtual world to damage real, live humans beings” via Zoom-bombing, an act that is situated in a larger co-option of the Internet by the alt-right and white supremacists, but has been under theorised as a hate crime (Daniels; “Cyber Racism” 7). Shitposting I want to preface this chapter by acknowledging that while I understand the Internet, through my own external investigations of race, power and the Internet, as a series of entities that produce racial violence both online and offline, I am aware of the use of the Internet to frame, discuss, and share anti-racist activism. Here we can turn to the work of philosopher Michel de Certeau who conceived the idea of a “tactic” as a way to construct a space of agency in opposition to institutional power. This becomes a way that marginalised groups, such as racialised peoples, can utilise the Internet as a tactical material to assert themselves and their non-compliance with the state. Particularly, shitposting, a tactic often associated with the alt-right, has also been co-opted by those who fight for social justice and rally against oppression both online and offline. As Roderick Graham explores, the Internet, and for this exploration, shitposting, can be used to proliferate deviant and racist material but also as a “deviant” byway of oppositional and anti-racist material. Despite this, a lot can be said about the invisible yet present claims and support of whiteness through Internet and digital technologies, as well as the activity of users channelled through these screens, such as the alt-right and their digital tactics. As Vikki Fraser remarks, “the internet assumes whiteness as the norm – whiteness is made visible through what is left unsaid, through the assumption that white need not be said” (120). It is through the lens of white privilege and claims to white supremacy that online irony, by way of shitposting, is co-opted and understood as an inherently alt-right tool, through the deviance it entails. Their sinister co-option of shitposting bolsters audacious claims as to who has the right to exist, in their support of white identity, but also hides behind a veil of mischief that can hide their more insidious intention and political ideologies. The alt-right have used “shitposting”, an online style of posting and interacting with other users, to create a form of online communication for a translocal identity of white nationalist members. Sean McEwan defines shitposting as “a form of Internet interaction predicated upon thwarting established norms of discourse in favour of seemingly anarchic, poor quality contributions” (19). Far from being random, however, I argue that shitposting functions as a discourse that is employed by online communities to discuss, proliferate, and introduce white supremacist ideals among their communities as well as into the mainstream. In the course of this article, I will introduce racist Zoom-bombing as a tactic situated in shitposting which can be used as a means of white supremacist discourse and an attempt to block anti-racist efforts. By this line, the function of discourse as one “to preserve or to reproduce discourse (within) a closed community” is calculatingly met through shitposting, Zoom-bombing, and more overt forms of white supremacy online (Foucault 225-226). Using memes, dehumanisation, and sarcasm, online white supremacists have created a means of both organising and mainstreaming white supremacy through humour that allows insidious themes to be mocked and then spread online. Foucault writes that “in every society the production of discourse is at once controlled, selected, organised and redistributed according to a certain number of procedures, whose role is to avert its powers and danger, to cope with chance events, to evade ponderous, awesome materiality” (216). As Philippe-Joseph Salazar recontextualises to online white supremacists, “the first procedure of control is to define what is prohibited, in essence, to set aside that which cannot be spoken about, and thus to produce strategies to counter it” (137). By this line, the alt-right reorganises these procedures and allocates a checked speech that will allow their ideas to proliferate in like-minded and growing communities. As a result, online white supremacists becoming a “community of discourse” advantages them in two ways: first, ironic language permits the mainstreaming of hate that allows sinister content to enter the public as the severity of their intentions is doubted due to the sarcastic language employed. Second, shitposting is employed as an entry gate to more serious and dangerous participation with white supremacist action, engagement, and ideologies. It is important to note that white privilege is embodied in these discursive practices as despite this exploitation of emerging technologies to further white supremacy, there are approaches that theorise the alt-right as “crazed product(s) of an isolated, extremist milieu with no links to the mainstream” (Moses 201). In this way, it is useful to consider shitposting as an informal approach that mirrors legitimised white sovereignties and authorised white supremacy. The result is that white supremacist online users succeed in “not only in assembling a community of actors and a collective of authors, on the dual territory of digital communication and grass-roots activism”, but also shape an effective fellowship of discourse that audiences react well to online, encouraging its reception and mainstreaming (Salazar 142). Continuing, as McBain writes, “someone who would not dream of donning a white cap and attending a Ku Klux Klan meeting might find themselves laughing along to a video by the alt-right satirist RamZPaul”. This idea is echoed in a leaked stylistic guide by white supremacist website and message board the Daily Stormer that highlights irony as a cultivated mechanism used to draw new audiences to the far right, step by step (Wilson). As showcased in the screen capture below of the stylistic guide, “the reader is at first drawn in by curiosity or the naughty humor and is slowly awakened to reality by repeatedly reading the same points” (Feinburg). The result of this style of writing is used “to immerse recruits in an online movement culture built on memes, racial panic and the worst of Internet culture” (Wilson). Figure 1: A screenshot of the Daily Stormer’s playbook, expanding on the stylistic decisions of alt-right writers. Racist Zoom-Bombing In the timely text “Racist Zoombombing”, Lisa Nakamura et al. write the following: Zoombombing is more than just trolling; though it belongs to a broad category of online behavior meant to produce a negative reaction, it has an intimate connection with online conspiracy theorists and white supremacy … . Zoombombing should not be lumped into the larger category of trolling, both because the word “trolling” has become so broad it is nearly meaningless at times, and because zoombombing is designed to cause intimate harm and terrorize its target in distinct ways. (30) Notwithstanding the seriousness of Zoom-bombing, and to not minimise its insidiousness by understanding it as a form of shitposting, my article seeks to reiterate the seriousness of shitposting, which, in the age of COVID-19, Zoom-bombing has become an example of. I seek to purport the insidiousness of the tactical strategies of the alt-right online in a larger context of white violence online. Therefore, I am proposing a more critical look at the tactical use of the Internet by the alt-right, in theorising shitposting and Zoom-bombing as means of hate crimes wherein they impose upon anti-racist activism and organising. Newlands et al., receiving only limited exposure pre-pandemic, write that “Zoom has become a household name and an essential component for parties (Matyszczyk, 2020), weddings (Pajer, 2020), school and work” (1). However, through this came the strategic use of co-opting the application by the alt-right to digitise terror and ensure a “growing framework of memetic warfare” (Nakamura et al. 31). Kruglanski et al. label this co-opting of online tools to champion white supremacy operations via Zoom-bombing an example of shitposting: Not yet protesting the lockdown orders in front of statehouses, far-right extremists infiltrated Zoom calls and shared their screens, projecting violent and graphic imagery such as swastikas and pornography into the homes of unsuspecting attendees and making it impossible for schools to rely on Zoom for home-based lessons. Such actions, known as “Zoombombing,” were eventually curtailed by Zoom features requiring hosts to admit people into Zoom meetings as a default setting with an option to opt-out. (128) By this, we can draw on existing literature that has theorised white supremacists as innovation opportunists regarding their co-option of the Internet, as supported through Jessie Daniels’s work, “during the shift of the white supremacist movement from print to digital online users exploited emerging technologies to further their ideological goals” (“Algorithmic Rise” 63). Selfe and Selfe write in their description of the computer interface as a “political and ideological boundary land” that may serve larger cultural systems of domination in much the same way that geopolitical borders do (418). Considering these theorisations of white supremacists utilising tools that appear neutral for racialised aims and the political possibilities of whiteness online, we can consider racist Zoom-bombing as an assertion of a battle that seeks to disrupt racial justice online but also assert white supremacy as its own legitimate cause. My first encounter of local Zoom-bombing was during the Institute for Culture and Society (ICS) Seminar titled “Intersecting Crises” by Western Sydney University. The event sought to explore the concatenation of deeply inextricable ecological, political, economic, racial, and social crises. An academic involved in the facilitation of the event, Alana Lentin, live tweeted during the Zoom-bombing of the event: Figure 2: Academic Alana Lentin on Twitter live tweeting the Zoom-bombing of the Intersecting Crises event. Upon reflecting on this instance, I wondered, could efforts have been organised to prevent white supremacy? In considering who may or may not be responsible for halting racist shit-posting, we can problematise the work of R David Lankes, who writes that “Zoom-bombing is when inadequate security on the part of the person organizing a video conference allows uninvited users to join and disrupt a meeting. It can be anything from a prankster logging on, yelling, and logging off to uninvited users” (217). However, this beckons two areas to consider in theorising racist Zoom-bombing as a means of isolated trolling. First, this approach to Zoom-bombing minimises the sinister intentions of Zoom-bombing when referring to people as pranksters. Albeit withholding the “mimic trickery and mischief that were already present in spaces such as real-life classrooms and town halls” it may be more useful to consider theorising Zoom-bombing as often racialised harassment and a counter aggression to anti-racist initiatives (Nakamura et al. 30). Due to the live nature of most Zoom meetings, it is increasingly difficult to halt the threat of the alt-right from Zoom-bombing meetings. In “A First Look at Zoom-bombings” a range of preventative strategies are encouraged for Zoom organisers including “unique meeting links for each participant, although we acknowledge that this has usability implications and might not always be feasible” (Ling et al. 1). The alt-right exploit gaps, akin to co-opting the mainstreaming of trolling and shitposting, to put forward their agenda on white supremacy and assert their presence when not welcome. Therefore, utilising the pandemic to instil new forms of terror, it can be said that Zoom-bombing becomes a new means to shitpost, where the alt-right “exploits Zoom’s uniquely liminal space, a space of intimacy generated by users via the relationship between the digital screen and what it can depict, the device’s audio tools and how they can transmit and receive sound, the software that we can see, and the software that we can’t” (Nakamura et al. 29). Second, this definition of Zoom-bombing begs the question, is this a fair assessment to write that reiterates the blame of organisers? Rather, we can consider other gaps that have resulted in the misuse of Zoom co-opted by the alt-right: “two conditions have paved the way for Zoom-bombing: a resurgent fascist movement that has found its legs and best megaphone on the Internet and an often-unwitting public who have been suddenly required to spend many hours a day on this platform” (Nakamura et al. 29). In this way, it is interesting to note that recommendations to halt Zoom-bombing revolve around the energy, resources, and attention of the organisers to practically address possible threats, rather than the onus being placed on those who maintain these systems and those who Zoom-bomb. As Jessie Daniels states, “we should hold the platform accountable for this type of damage that it's facilitated. It's the platform's fault and it shouldn't be left to individual users who are making Zoom millions, if not billions, of dollars right now” (Ruf 8). Brian Friedberg, Gabrielle Lim, and Joan Donovan explore the organised efforts by the alt-right to impose on Zoom events and disturb schedules: “coordinated raids of Zoom meetings have become a social activity traversing the networked terrain of multiple platforms and web spaces. Raiders coordinate by sharing links to Zoom meetings targets and other operational and logistical details regarding the execution of an attack” (14). By encouraging a mass coordination of racist Zoom-bombing, in turn, social justice organisers are made to feel overwhelmed and that their efforts will be counteracted inevitably by a large and organised group, albeit appearing prankster-like. Aligning with the idea that “Zoombombing conceals and contains the terror and psychological harm that targets of active harassment face because it doesn’t leave a trace unless an alert user records the meeting”, it is useful to consider to what extent racist Zoom-bombing becomes a new weapon of the alt-right to entertain and affirm current members, and engage and influence new members (Nakamura et al. 34). I propose that we consider Zoom-bombing through shitposting, which is within “the location of matrix of domination (white supremacy, heteropatriarchy, ableism, capitalism, and settler colonialism)” to challenge the role of interface design and Internet infrastructure in enabling racial violence online (Costanza-Chock). Conclusion As Nakamura et al. have argued, Zoom-bombing is indeed “part of the lineage or ecosystem of trollish behavior”, yet these new forms of alt-right shitposting “[need] to be critiqued and understood as more than simply trolling because this term emerged during an earlier, less media-rich and interpersonally live Internet” (32). I recommend theorising the alt-right in a way that highlights the larger structures of white power, privilege, and supremacy that maintain their online and offline legacies beyond Zoom, “to view white supremacy not as a static ideology or condition, but to instead focus on its geographic and temporal contingency” that allows acts of hate crime by individuals on politicised bodies (Inwood and Bonds 722). This corresponds with Claire Renzetti’s argument that “criminologists theorise that committing a hate crime is a means of accomplishing a particular type of power, hegemonic masculinity, which is described as white, Christian, able-bodied and heterosexual” – an approach that can be applied to theorisations of the alt-right and online violence (136). This violent white masculinity occupies a hegemonic hold in the formation, reproduction, and extension of white supremacy that is then shared, affirmed, and idolised through a racialised Internet (Donaldson et al.). Therefore, I recommend that we situate Zoom-bombing as a means of shitposting, by reiterating the severity of shitposting with the same intentions and sinister goals of hate crimes and racial violence. References Back, Les, et al. “Racism on the Internet: Mapping Neo-Fascist Subcultures in Cyber-Space.” Nation and Race: The Developing Euro-American Racist Subculture. Eds. Jeffrey Kaplan and Tore Bjørgo. Northeastern UP, 1993. 73-101. Bonds, Anne, and Joshua Inwood. “Beyond White Privilege: Geographies of White Supremacy and Settler Colonialism.” Progress in Human Geography 40 (2015): 715-733. Conway, Maura, et al. “Right-Wing Extremists’ Persistent Online Presence: History and Contemporary Trends.” The International Centre for Counter-Terrorism – The Hague. Policy Brief, 2019. Costanza-Chock, Sasha. “Design Justice and User Interface Design, 2020.” Proceedings of the 33rd Annual ACM Symposium on User Interface Software and Technology. Association for Computing Machinery, 2020. Daniels, Jessie. “The Algorithmic Rise of the ‘Alt-Right.’” Contexts 17 (2018): 60-65. ———. “Race and Racism in Internet Studies: A Review and Critique.” New Media & Society 15 (2013): 695-719. ———. Cyber Racism: White Supremacy Online and the New Attack on Civil Rights. Rowman and Littlefield, 2009. De Certeau, Michel. The Practice of Everyday Life. First ed. U of California P, 1980. Donaldson, Mike. “What Is Hegemonic Masculinity?” Theory and Society 22 (1993): 643-657. Feinburg, Ashley. “This Is The Daily Stormer’s Playbook.” Huffington Post 13 Dec. 2017. <http://www.huffpost.com/entry/daily-stormer-nazi-style-guide_n_5a2ece19e4b0ce3b344492f2>. Foucault, Michel. “The Discourse on Language.” The Archaeology of Knowledge and the Discourse on Language. Ed. A.M. Sheridan Smith. Pantheon, 1971. 215-237. Fraser, Vicki. “Online Bodies and Sexual Subjectivities: In Whose Image?” The Racial Politics of Bodies, Nations and Knowledges. Eds. Barbara Baird and Damien W. Riggs. Newcastle: Cambridge Scholars Publishing, 2015. 116-132. Friedberg, Brian, Gabrielle Lim, and Joan Donovan. “Space Invaders: The Networked Terrain of Zoom Bombing.” Harvard Shorenstein Center, 2020. Graham, Roderick. “Race, Social Media and Deviance.” The Palgrave Handbook of International Cybercrime and Cyberdeviance. Eds. Thomas J. Holt and Adam M. Bossler, 2019. 67-90. Hawley, George. Making Sense of the Alt-Right. Columbia UP, 2017. Henry, Matthew G., and Lawrence D. Berg. “Geographers Performing Nationalism and Hetero-Masculinity.” Gender, Place & Culture 13 (2006): 629-645. Kruglanski, Arie W., et al. “Terrorism in Time of the Pandemic: Exploiting Mayhem.” Global Security: Health, Science and Policy 5 (2020): 121-132. Lankes, R. David. Forged in War: How a Century of War Created Today's Information Society. Rowman & Littlefield, 2021. Ling, Chen, et al. “A First Look at Zoombombing, 2021.” Proceedings of the 42nd IEEE Symposium on Security and Privacy. Oakland, 2021. McBain, Sophie. “The Alt-Right, and How the Paranoia of White Identity Politics Fuelled Trump’s Rise.” New Statesman 27 Nov. 2017. <http://www.newstatesman.com/culture/books/2017/11/alt-right-and-how-paranoia-white-identity-politics-fuelled-trump-s-rise>. McEwan, Sean. “Nation of Shitposters: Ironic Engagement with the Facebook Posts of Shannon Noll as Reconfiguration of an Australian National Identity.” Journal of Media and Communication 8 (2017): 19-39. Morgensen, Scott Lauria. “Theorising Gender, Sexuality and Settler Colonialism: An Introduction.” Settler Colonial Studies 2 (2012): 2-22. Moses, A Dirk. “‘White Genocide’ and the Ethics of Public Analysis.” Journal of Genocide Research 21 (2019): 1-13. Munn, Luke. “Algorithmic Hate: Brenton Tarrant and the Dark Social Web.” VoxPol, 3 Apr. 2019. <http://www.voxpol.eu/algorithmic-hate-brenton-tarrant-and-the-dark-social-web>. Nagle, Angela. Kill All Normies: Online Culture Wars from 4chan and Tumblr to Trump and the Alt-Right. Zero Books, 2017. Nakamura, Lisa, et al. Racist Zoom-Bombing. Routledge, 2021. Newlands, Gemma, et al. “Innovation under Pressure: Implications for Data Privacy during the COVID-19 Pandemic.” Big Data & Society July-December (2020): 1-14. Perry, Barbara, and Ryan Scrivens. “White Pride Worldwide: Constructing Global Identities Online.” The Globalisation of Hate: Internationalising Hate Crime. Eds. Jennifer Schweppe and Mark Austin Walters. Oxford UP, 2016. 65-78. Renzetti, Claire. Feminist Criminology. Routledge, 2013. Ruf, Jessica. “‘Spirit-Murdering' Comes to Zoom: Racist Attacks Plague Online Learning.” Issues in Higher Education 37 (2020): 8. Salazar, Philippe-Joseph. “The Alt-Right as a Community of Discourse.” Javnost – The Public 25 (2018): 135-143. Selfe, Cyntia L., and Richard J. Selfe, Jr. “The Politics of the Interface: Power and Its Exercise in Electronic Contact Zones.” College Composition and Communication 45 (1994): 480-504. Southern Poverty Law Center. “Alt-Right.” <http://www.splcenter.org/fighting-hate/extremist-files/ideology/alt-right>. 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Unlike some current discourse on automediality, this essay eschews most of the analysis concerning the adoption or modification of avatars to deliberately enhance, extend or distort the self. Rather than the automedial enabling of alternative, virtual selves modified by playful, confronting or disarming avatars we concentrate instead on emerging efforts to present the self in hyper-realist, interactive modes. In doing so we ask, what is the relationship between traumatic forms of automediation and the affective impact on and response of the audience? We argue that, while on the one hand there are promising avenues for valuable individual and social engagements with traumatic forms of automediation, there is an overwhelming predominance of suffering as a theme in such virtual depictions, comingled with uncritically asserted promises of empathy, which are problematic as the technology assumes greater mainstream uptake.As Smith and Watson note, embodiment is always a “translation” where the body is “dematerialized” in virtual representation (“Virtually” 78). Past scholarship has analysed the capacity of immersive realms, such as Second Life or online games, to highlight how users can modify their avatars in often spectacular, non-human forms. Critics of this mode of automediality note that users can adopt virtually any persona they like (racial, religious, gendered and sexual, human, animal or hybrid, and of any age), behaving as “identity tourists” while occupying virtual space or inhabiting online communities (Nakamura). Furthermore, recent work by Jaron Lanier, a key figure from the 1980s period of early Virtual Reality (VR) technology, has also explored so-called “homuncular flexibility” which describes the capacity for humans to seemingly adapt automatically to the control mechanisms of an avatar with multiple legs, other non-human appendages, or for two users to work in tandem to control a single avatar (Won et. al.). But this article is concerned less with these single or multi-player online environments and the associated concerns over modifying interactive identities. We are principally interested in other automedial modes where the “auto” of autobiography is automated via Artificial Intelligences (AIs) to convincingly mimic human discourse as narrated life-histories.We draw from case studies promoted by the 2017 season of ABC television’s flagship science program, Catalyst, which opened with semi-regular host and biological engineer Dr Jordan Nguyen, proclaiming in earnest, almost religious fervour: “I want to do something that has long been a dream. I want to create a copy of a human. An avatar. And it will have a life of its own in virtual reality.” As the camera followed Nguyen’s rapid pacing across real space he extolled: “Virtual reality, virtual human, they push the limits of the imagination and help us explore the impossible […] I want to create a virtual copy of a person. A digital addition to the family, using technology we have now.”The troubling implications of such rhetoric were stark and the next third of the program did little to allay such techno-scientific misgivings. Directed and produced by David Symonds, with Nguyen credited as co-developer and presenter, the episode “Meet the Avatars” immediately introduced scenarios where “volunteers” entered a pop-up inner city virtual lab, to experience VR for the first time. The volunteers were shown on screen subjected to a range of experimental VR environments designed to elicit fear and/or adverse and disorienting responses such as vertigo, while the presenter and researchers from Sydney University constantly smirked and laughed at their participants’ discomfort. We can only wonder what the ethics process was for both the ABC and university researchers involved in these broadcast experiments. There is little doubt that the participant/s experienced discomfort, if not distress, and that was televised to a national audience. Presenter Nguyen was also shown misleading volunteers on their way to the VR lab, when one asked “You’re not going to chuck us out of a virtual plane are you?” to which Nguyen replied “I don't know what we’re going to do yet,” when it was next shown that they immediately underwent pre-programmed VR exposure scenarios, including a fear of falling exercise from atop a city skyscraper.The sweat-inducing and heart rate-racing exposures to virtual plank walks high above a cityscape, or seeing subjects haptically viewing spiders crawl across their outstretched virtual hands, all elicited predictable responses, showcased as carnivalesque entertainment for the viewing audience. As we will see, this kind of trivialising of a virtual environment’s capacity for immersion belies the serious use of the technology in a range of treatments for posttraumatic stress disorder (see Rizzo and Koenig; Rothbaum, Rizzo and Difede).Figure 1: Nguyen and researchers enjoying themselves as their volunteers undergo VR exposure Defining AutomedialityIn their pioneering 2008 work, Automedialität: Subjektkonstitution in Schrift, Bild und neuen Medien, Jörg Dünne and Christian Moser coined the term “automediality” to problematise the production, application and distribution of autobiographic modes across various media and genres—from literary texts to audiovisual media and from traditional expression to inter/transmedia and remediated formats. The concept of automediality was deployed to counter the conventional critical exclusion of analysis of the materiality/technology used for an autobiographical purpose (Gernalzick). Dünne and Moser proffered a concept of automediality that rejects the binary division of (a) self-expression determining the mediated form or (b) (self)subjectivity being solely produced through the mediating technology. Hence, automediality has been traditionally applied to literary constructs such as autobiography and life-writing, but is now expanding into the digital domain and other “paratextual sites” (Maguire).As Nadja Gernalzick suggests, automediality should “encourage and demand not only a systematics and taxonomy of the constitution of the self in respectively genre-specific ways, but particularly also in medium-specific ways” (227). Emma Maguire has offered a succinct working definition that builds on this requirement to signal the automedial universally, noting it operates asa way of studying auto/biographical texts (of a variety of forms) that take into account how the effects of media shape the kinds of selves that can be represented, and which understands the self not as a preexisting subject that might be distilled into story form but as an entity that is brought into being through the processes of mediation.Sidonie Smith and Julia Watson point to automediality as a methodology, and in doing so emphasize how the telling or mediation of a life actually shapes the kind of story that can be told autobiographically. They state “media cannot simply be conceptualized as ‘tools’ for presenting a preexisting, essential self […] Media technologies do not just transparently present the self. They constitute and expand it” (Smith and Watson “Virtually Me” 77).This distinction is vital for understanding how automediality might be applied to self-expression in virtual domains, including the holographic avatar dreams of Nguyen throughout Catalyst. Although addressing this distinction in relation to online websites, following P. David Marshall’s description of “the proliferation of the public self”, Maguire notes:The same integration of digital spaces and platforms into daily life that is prompting the development of new tools in autobiography studies […] has also given rise to the field of persona studies, which addresses the ways in which individuals engage in practices of self-presentation in order to form commoditised identities that circulate in affective communities.For Maguire, these automedial works operate textually “to construct the authorial self or persona”.An extension to this digital, authorial construction is apparent in the exponential uptake of screen mediated prosumer generated content, whether online or theatrical (Miller). According to Gernalzick, unlike fictional drama films, screen autobiographies more directly enable “experiential temporalities”. Based on Mary Anne Doane’s promotion of the “indexicality” of film/screen representations to connote the real, Gernalzick suggests that despite semiotic theories of the index problematising realism as an index as representation, the film medium is still commonly comprehended as the “imprint of time itself”:Film and the spectator of film are said to be in a continuous present. Because the viewer is aware, however, that the images experienced in or even as presence have been made in the past, the temporality of the so-called filmic present is always ambiguous” (230).When expressed as indexical, automedial works, the intrinsic audio-visual capacities of film and video (as media) far surpass the temporal limitations of print and writing (Gernalzick, 228). One extreme example can be found in an emergent trend of “performance crime” murder and torture videos live-streamed or broadcast after the fact using mobile phone cameras and FaceBook (Bender). In essence, the political economy of the automedial ecology is important to understand in the overall context of self expression and the governance of content exhibition, access, distribution and—where relevant—interaction.So what are the implications for automedial works that employ virtual interfaces and how does this evolving medium inform both the expressive autobiographical mode and audiences subjectivities?Case StudyThe Catalyst program described above strove to shed new light on the potential for emerging technology to capture and create virtual avatars from living participants who (self-)generate autobiographical narratives interactively. Once past the initial gee-wiz journalistic evangelism of VR, the episode turned towards host Nguyen’s stated goal—using contemporary technology to create an autonomous virtual human clone. Nguyen laments that if he could create only one such avatar, his primary choice would be that of his grandfather who died when Nguyen was two years old—a desire rendered impossible. The awkward humour of the plank walk scenario sequence soon gives way as the enthusiastic Nguyen is surprised by his family’s discomfort with the idea of digitally recreating his grandfather.Nguyen next visits a Southern California digital media lab to experience the process by which 3D virtual human avatars are created. Inside a domed array of lights and cameras, in less than one second a life-size 3D avatar is recorded via 6,000 LEDs illuminating his face in 20 different combinations, with eight cameras capturing the exposures from multiple angles, all in ultra high definition. Called the Light Stage (Debevec), it is the same technology used to create a life size, virtual holocaust survivor, Pinchas Gutter (Ziv).We see Nguyen encountering a life-size, high-resolution 2D screen version of Gutter’s avatar. Standing before a microphone, Nguyen asks a series of questions about Gutter’s wartime experiences and life in the concentration camps. The responses are naturalistic and authentic, as are the pauses between questions. The high definition 4K screen is photo-realist but much more convincing in-situ (as an artifact of the Catalyst video camera recording, in some close-ups horizontal lines of transmission appear). According to the project’s curator, David Traum, the real Pinchas Gutter was recorded in 3D as a virtual holograph. He spent 25 hours providing 1,600 responses to a broad range of questions that the curator maintained covered “a lot of what people want to say” (Catalyst).Figure 2: The Museum of Jewish Heritage in Manhattan presented an installation of New Dimensions in Testimony, featuring Pinchas Gutter and Eva SchlossIt is here that the intersection between VR and auto/biography hybridise in complex and potentially difficult ways. It is where the concept of automediality may offer insight into this rapidly emerging phenomenon of creating interactive, hyperreal versions of our selves using VR. These hyperreal VR personae can be questioned and respond in real-time, where interrogators interact either as casual conversers or determined interrogators.The impact on visitors is sobering and palpable. As Nguyen relates at the end of his session, “I just want to give him a hug”. The demonstrable capacity for this avatar to engender a high degree of empathy from its automedial testimony is clear, although as we indicate below, it could simply indicate increased levels of emotion.Regardless, an ongoing concern amongst witnesses, scholars and cultural curators of memorials and museums dedicated to preserving the history of mass violence, and its associated trauma, is that once the lived experience and testimony of survivors passes with that generation the impact of the testimony diminishes (Broderick). New media modes of preserving and promulgating such knowledge in perpetuity are certainly worthy of embracing. As Stephen Smith, the executive director of the USC Shoah Foundation suggests, the technology could extendto people who have survived cancer or catastrophic hurricanes […] from the experiences of soldiers with post-traumatic stress disorder or survivors of sexual abuse, to those of presidents or great teachers. Imagine if a slave could have told her story to her grandchildren? (Ziv)Yet questions remain as to the veracity of these recorded personae. The avatars are created according to a specific agenda and the autobiographical content controlled for explicit editorial purposes. It is unclear what and why material has been excluded. If, for example, during the recorded questioning, the virtual holocaust survivor became mute at recollecting a traumatic memory, cried or sobbed uncontrollably—all natural, understandable and authentic responses given the nature of the testimony—should these genuine and spontaneous emotions be included along with various behavioural ticks such as scratching, shifting about in the seat and other naturalistic movements, to engender a more profound realism?The generation of the photorealist, mimetic avatar—remaining as an interactive persona long after the corporeal, authorial being is gone—reinforces Baudrillard’s concept of simulacra, where a clone exists devoid of its original entity and unable to challenge its automedial discourse. And what if some unscrupulous hacker managed to corrupt and subvert Gutter’s AI so that it responded antithetically to its purpose, by denying the holocaust ever happened? The ethical dilemmas of such a paradigm were explored in the dystopian 2013 film, The Congress, where Robyn Wright plays herself (and her avatar), as an out of work actor who sells off the rights to her digital self. A movie studio exploits her screen persona in perpetuity, enabling audiences to “become” and inhabit her avatar in virtual space while she is limited in the real world from undertaking certain actions due to copyright infringement. The inability of Wright to control her mimetic avatar’s discourse or action means the assumed automedial agency of her virtual self as an immortal, interactive being remains ontologically perplexing.Figure 3: Robyn Wright undergoing a full body photogrammetry to create her VR avatar in The Congress (2013)The various virtual exposures/experiences paraded throughout Catalyst’s “Meet the Avatars” paradoxically recorded and broadcast a range of troubling emotional responses to such immersion. Many participant responses suggest great caution and sensitivity be undertaken before plunging headlong into the new gold rush mentality of virtual reality, augmented reality, and AI affordances. Catalyst depicted their program subjects often responding in discomfort and distress, with some visibly overwhelmed by their encounters and left crying. There is some irony that presenter Ngyuen was himself relying on the conventions of 2D linear television journalism throughout, adopting face-to-camera address in (unconscious) automedial style to excitedly promote the assumed socio-cultural boon such automedial VR avatars will generate.Challenging AuthenticityThere are numerous ethical considerations surrounding the potential for AIs to expand beyond automedial (self-)expression towards photorealist avatars interacting outside of their pre-recorded content. When such systems evolve it may be neigh impossible to discern on screen whether the person you are conversing with is authentic or an indistinguishable, virtual doppelganger. In the future, a variant on the Turning Test may be needed to challenge and identify such hyperreal simulacra. We may be witnessing the precursor to such a dilemma playing out in the arena of audio-only podcasts, with some public intellectuals such as Sam Harris already discussing the legal and ethical problems from technology that can create audio from typed text that convincingly replicate the actual voice of a person by sampling approximately 30 minutes of their original speech (Harris). Such audio manipulation technology will soon be available to anybody with the motivation and relatively minor level of technological ability in order to assume an identity and masquerade as automediated dialogue. However, for the moment, the ability to convincingly alter a real-time computer generated video image of a person remains at the level of scientific innovation.Also of significance is the extent to which the audience reactions to such automediated expressions are indeed empathetic or simply part of the broader range of affective responses that also include direct sympathy as well as emotions such as admiration, surprise, pity, disgust and contempt (see Plantinga). There remains much rhetorical hype surrounding VR as the “ultimate empathy machine” (Milk). Yet the current use of the term “empathy” in VR, AI and automedial forms of communication seems to be principally focused on the capacity for the user-viewer to ameliorate negatively perceived emotions and experiences, whether traumatic or phobic.When considering comments about authenticity here, it is important to be aware of the occasional slippage of technological terminology into the mainstream. For example, the psychological literature does emphasise that patients respond strongly to virtual scenarios, events, and details that appear to be “authentic” (Pertaub, Slater, and Barker). Authentic in this instance implies a resemblance to a corresponding scenario/activity in the real world. This is not simply another word for photorealism, but rather it describes for instance the experimental design of one study in which virtual (AI) audience members in a virtual seminar room designed to treat public speaking anxiety were designed to exhibit “random autonomous behaviours in real-time, such as twitches, blinks, and nods, designed to encourage the illusion of life” (Kwon, Powell and Chalmers 980). The virtual humans in this study are regarded as having greater authenticity than an earlier project on social anxiety (North, North, and Coble) which did not have much visual complexity but did incorporate researcher-triggered audio clips of audience members “laughing, making comments, encouraging the speaker to speak louder or more clearly” (Kwon, Powell, and Chalmers 980). The small movements, randomly cued rather than according to a recognisable pattern, are described by the researchers as creating a sense of authenticity in the VR environment as they seem to correspond to the sorts of random minor movements that actual human audiences in a seminar can be expected to make.Nonetheless, nobody should regard an interaction with these AIs, or the avatar of Gutter, as in any way an encounter with a real person. Rather, the characteristics above function to create a disarming effect and enable the real person-viewer to willingly suspend their disbelief and enter into a pseudo-relationship with the AI; not as if it is an actual relationship, but as if it is a simulation of an actual relationship (USC). Lucy Suchman and colleagues invoke these ideas in an analysis of a YouTube video of some apparently humiliating human interactions with the MIT created AI-robot Mertz. Their analysis contends that, while it may appear on first glance that the humans’ mocking exchange with Mertz are mean-spirited, there is clearly a playfulness and willingness to engage with a form of AI that is essentially continuous with “long-standing assumptions about communication as information processing, and in the robot’s performance evidence for the limits to the mechanical reproduction of interaction as we know it through computational processes” (Suchman, Roberts, and Hird).Thus, it will be important for future work in the area of automediated testimony to consider the extent to which audiences are willing to suspend disbelief and treat the recounted traumatic experience with appropriate gravitas. These questions deserve attention, and not the kind of hype displayed by the current iteration of techno-evangelism. Indeed, some of this resurgent hype has come under scrutiny. From the perspective of VR-based tourism, Janna Thompson has recently argued that “it will never be a substitute for encounters with the real thing” (Thompson). Alyssa K. Loh, for instance, also argues that many of the negatively themed virtual experiences—such as those that drop the viewer into a scene of domestic violence or the location of a terrorist bomb attack—function not to put you in the position of the actual victim but in the position of the general category of domestic violence victim, or bomb attack victim, thus “deindividuating trauma” (Loh).Future work in this area should consider actual audience responses and rely upon mixed-methods research approaches to audience analysis. In an era of alt.truth and Cambridge Analytics personality profiling from social media interaction, automediated communication in the virtual guise of AIs demands further study.ReferencesAnon. “New Dimensions in Testimony.” Museum of Jewish Heritage. 15 Dec. 2017. 19 Apr. 2018 <http://mjhnyc.org/exhibitions/new-dimensions-in-testimony/>.Australian Broadcasting Corporation. “Meet The Avatars.” Catalyst, 15 Aug. 2017.Baudrillard, Jean. “Simulacra and Simulations.” Jean Baudrillard: Selected Writings. Ed. Mark Poster. Stanford: Stanford UP, 1988. 166-184.Bender, Stuart Marshall. Legacies of the Degraded Image in Violent Digital Media. Basingstoke: Palgrave Macmillan, 2017.Broderick, Mick. “Topographies of Trauma, Dark Tourism and World Heritage: Hiroshima’s Genbaku Dome.” Intersections: Gender and Sexuality in Asia and the Pacific. 24 Apr. 2010. 14 Apr. 2018 <http://intersections.anu.edu.au/issue24/broderick.htm>.Debevec, Paul. “The Light Stages and Their Applications to Photoreal Digital Actors.” SIGGRAPH Asia. 2012.Doane, Mary Ann. The Emergence of Cinematic Time: Modernity, Contingency, the Archive. Cambridge: Harvard UP, 2002.Dünne, Jörg, and Christian Moser. “Allgemeine Einleitung: Automedialität”. Automedialität: Subjektkonstitution in Schrift, Bild und neuen Medien. Eds. Jörg Dünne and Christian Moser. München: Wilhelm Fink, 2008. 7-16.Harris, Sam. “Waking Up with Sam Harris #64 – Ask Me Anything.” YouTube, 16 Feb. 2017. 16 Mar. 2018 <https://www.youtube.com/watch?v=gMTuquaAC4w>.Kwon, Joung Huem, John Powell, and Alan Chalmers. “How Level of Realism Influences Anxiety in Virtual Reality Environments for a Job Interview.” International Journal of Human-Computer Studies 71.10 (2013): 978-87.Loh, Alyssa K. "I Feel You." Artforum, Nov. 2017. 10 Apr. 2018 <https://www.artforum.com/print/201709/alyssa-k-loh-on-virtual-reality-and-empathy-71781>.Marshall, P. David. “Persona Studies: Mapping the Proliferation of the Public Self.” Journalism 15.2 (2014): 153-170.Mathews, Karen. “Exhibit Allows Virtual ‘Interviews’ with Holocaust Survivors.” Phys.org Science X Network, 15 Dec. 2017. 18 Apr. 2018 <https://phys.org/news/2017-09-virtual-holocaust-survivors.html>.Maguire, Emma. “Home, About, Shop, Contact: Constructing an Authorial Persona via the Author Website” M/C Journal 17.9 (2014).Miller, Ken. More than Fifteen Minutes of Fame: The Evolution of Screen Performance. Unpublished PhD Thesis. Murdoch University. 2009.Milk, Chris. “Ted: How Virtual Reality Can Create the Ultimate Empathy Machine.” TED Conferences, LLC. 16 Mar. 2015. <https://www.ted.com/talks/chris_milk_how_virtual_reality_can_create_the_ultimate_empathy_machine>.Nakamura, Lisa. “Cyberrace.” Identity Technologies: Constructing the Self Online. Eds. Anna Poletti and Julie Rak. Madison, Wisconsin: U of Wisconsin P, 2014. 42-54.North, Max M., Sarah M. North, and Joseph R Coble. "Effectiveness of Virtual Environment Desensitization in the Treatment of Agoraphobia." International Journal of Virtual Reality 1.2 (1995): 25-34.Pertaub, David-Paul, Mel Slater, and Chris Barker. “An Experiment on Public Speaking Anxiety in Response to Three Different Types of Virtual Audience.” Presence: Teleoperators and Virtual Environments 11.1 (2002): 68-78.Plantinga, Carl. "Emotion and Affect." The Routledge Companion to Philosophy and Film. Eds. Paisley Livingstone and Carl Plantinga. New York: Routledge, 2009. 86-96.Rizzo, A.A., and Sebastian Koenig. “Is Clinical Virtual Reality Ready for Primetime?” Neuropsychology 31.8 (2017): 877-99.Rothbaum, Barbara O., Albert “Skip” Rizzo, and JoAnne Difede. "Virtual Reality Exposure Therapy for Combat-Related Posttraumatic Stress Disorder." Annals of the New York Academy of Sciences 1208.1 (2010): 126-32.Smith, Sidonie, and Julia Watson. Reading Autobiography: A Guide to Interpreting Life Narratives. 2nd ed. Minneapolis: U of Minnesota P, 2010.———. “Virtually Me: A Toolbox about Online Self-Presentation.” Identity Technologies: Constructing the Self Online. Eds. Anna Poletti and Julie Rak. Madison: U of Wisconsin P, 2014. 70-95.Suchman, Lucy, Celia Roberts, and Myra J. Hird. "Subject Objects." Feminist Theory 12.2 (2011): 119-45.Thompson, Janna. "Why Virtual Reality Cannot Match the Real Thing." The Conversation, 14 Mar. 2018. 10 Apr. 2018 <http://theconversation.com/why-virtual-reality-cannot-match-the-real-thing-92035>.USC. "Skip Rizzo on Medical Virtual Reality: USC Global Conference 2014." YouTube, 28 Oct. 2014. 2 Apr. 2018 <https://www.youtube.com/watch?v=PdFge2XgDa8>.Won, Andrea Stevenson, Jeremy Bailenson, Jimmy Lee, and Jaron Lanier. "Homuncular Flexibility in Virtual Reality." Journal of Computer-Mediated Communication 20.3 (2015): 241-59.Ziv, Stan. “How Technology Is Keeping Holocaust Survivor Stories Alive Forever”. Newsweek, 18 Oct. 2017. 19 Apr. 2018 <http://www.newsweek.com/2017/10/27/how-technology-keeping-holocaust-survivor-stories-alive-forever-687946.html>.

En 1990, l'historien Eric Hobsbawm prophétisait la fin des nations et nationalismes. Pourtant, jamais autant d'États-nations n’ont vu le jour que dans le dernier quart du vingtième siècle. Leur importance dans le monde contemporain est telle qu’elle évoque un « système mondial ». Plus : nombre de conflits politiques aujourd’hui mobilisent des pulsions nationalistes qui soit président à la fondation d’un État-nation, soit en dérivent. La volonté de (re-)créer une communauté nationale y est portée par une espérance et un désir de vivre ensemble fondé sur la redéfinition de bases communes (langue, religion, etc.). Voici vingt ans, le nationalisme constituait un pré carré de l’histoire et de la science politique. À présent, il occupe une place centrale dans les travaux d’anthropologie politique. « Nationalisme », « national », « nationaliste » – Ajustements sémantiques. Le nationalisme se définit comme principe ou idéologie supposant une correspondance entre unités politique et nationale. La nation n'est cependant pas « chose » mais abstraction, construction idéologique dans laquelle est postulé un lien entre un groupe culturel auto-défini et un État. L’implication émotionnelle qu’elle suscite est, elle, bien concrète. Plus qu’une idéologie, d’aucuns considèrent le nationalisme comme sentiment et mouvement : de colère suscitée par la violation de l'intégrité politique et nationale, ou de satisfaction mû par sa défense.[1] Sentiment et mouvement, le nationalisme produit, entretient et transmet une implication émotionnelle autour de l'abstraction de la nation, potentiellement productrice de violence. La distinction entre « national » et « nationaliste » est ténue, davantage une question de perspective que de science objective. On oppose souvent le « simplement national », entendez « qui relève d’un intérêt légitime pour la nation », au « condamnable nationaliste », à savoir ressort de passions irrationnelles. Or, il s’agit davantage d’une question de point de vue. Importante pour l’analyse anthropologique, cette relativité permet de transcender les distinctions infructueuses entre « nations établies » (censées appartenir à la première catégorie) et « nations plus récentes » (reléguées à la seconde) qui balisent les réflexions les plus éclairées sur le nationalisme. Nationalisme, nationalisation et éducation. Le nationalisme a partie liée avec la nationalisation comme mise en œuvre d’un régime d’identification nationale. Celle-ci fut longtemps associée à des modèles de modernisation où la scolarisation était prépondérante. Le modèle sociologique universaliste d’Ernest Gellner (1983) au début des années 1980 a encadré maints programmes éducatifs, des appareils d’État comme des agences d’aide internationale. Dans cette perspective associant modernisation, industrialisation et nationalisme laïque, opèrent une division industrielle du travail et une culture partagée du nationalisme tenant ensemble les éléments d’une société atomisée par le procès d’industrialisation. Cette culture, homogène, doit être produite par la scolarisation, notamment primaire. Si la perspective gellnérienne est depuis longtemps disputée au vu du nombre de contre-exemples, où nationalisme exacerbé accompagne industrialisation faible ou, inversement, industrialisation poussée voisine avec nationalisme religieux, la plupart des États-nations aujourd’hui retiennent la corrélation entre scolarisation de masse et culture de sentiments d’appartenance nationale. En concevant l’éducation comme stratégie stato-centrée d’ingénierie sociale servant les structures hiérarchiques de la reproduction sociale (Bourdieu et Passeron 1990), cette perspective omet l'agency des citoyens ordinaires, autant que la contextualisation historique des conditions de production des mouvements nationalistes en contexte colonial, d’où sont issus maints État-nation récents. Nationalisme, colonialisme et catégories vernaculaires. Le cas des nations plus récentes appelle clarification concernant le legs des structures politiques européennes. Dans les sociétés autrefois sous le joug colonial, l’émergence d’une conscience nationaliste et la mobilisation contre les dirigeants coloniaux furent des processus concomitants. Citoyenneté et nationalisme furent étroitement associés, puisque la lutte pour l'indépendance assistait celle pour l’acquisition de droits fondamentaux. La conscience d’un sujet national libre s’est forgée de pair avec l'établissement de droits (et devoirs) de citoyen. Elle a aussi nécessité une accommodation vernaculaire de concepts initialement étiques. La sensibilité des anthropologues à l’égard des catégories vernaculaires opérantes dans les idiomes rituels, culturels et linguistiques et les pratiques de socialisation afférentes, contraste fortement avec leur faible investissement, de longues années durant, dans l’étude de sujets entretenant rapport avec une modernité politique, tels nationalisme, société civile ou citoyenneté. Philosophie et science politiques, aux instruments théoriques fondés sur une tradition européenne à valeur universelle, conservèrent longtemps l’exclusive. Or, même les perspectives les plus critiques vis-à-vis des Lumières ont négligé les langues vernaculaires dans leurs réflexions sur les modalités d’accueil en contextes non-européens de ces notions politiques (Kaviraj 1992; Burghart 1998; Rajagopal 2001 sont de notables exceptions). Pourtant, travailler avec les catégories vernaculaires illumine les répertoires sociaux et culturels et leurs négociations locales, favorisant une meilleure intelligibilité des ressorts culturels des processus, formes et modèles d’affects politiques et nationalistes. Ils déplacent aussi la focale, souvent portée sur l’éruption occasionnelle ou répétée de la violence nationaliste, vers l’analyse des procès de « naturalisation quotidienne de la nation ». Nouvelles approches (1) - Nationalisme banal et théologies du nationalisme. Mûris au long cours dans les multiples plis de la vie ordinaire, ces processus alimentent les « sentiments d’appartenance », piliers de l’identité en apparence naturels et évidents, vecteurs de la production journalière du « nationalisme banal ». Empruntée à Michael Billig (1995) en écho aux réflexions d’Hannah Arendt sur la « banalité du mal » (1963), l’expression réfère à l’expérience du nationalisme si parfaitement intégrée à la vie ordinaire qu’elle en passe inaperçue. Documenter la fabrique du nationalisme banal implique d’examiner les processus, d’apparence bénigne et anodine, d’identification nationale et de formation d’un attachement précoce à la nation. Ainsi s’éclairent la constitution de sens-/-timents d’appartenance dans la banalité quotidienne de la nation et la distinction ténue entre nationalisme religieux, sécularisme et patriotisme. Dans tout État-nation, les liturgies nationalistes se déroulant quotidiennement et périodiquement (par exemple, dans l’espace scolaire), sont fondées sur des rituels et procédures participant d’une « théologie du nationalisme ». Celle-ci peut dépendre d’une conception explicite de la fabrique de la nation comme projet théologique. Elle est alors informée par des principes d’adhésion à une doctrine ou à un dogme religieux. Tels sont les projets hindutva de construction nationale en Inde, où les partis d’extrême-droite hindoue prétendent édifier le royaume et le gouvernement du dieu Rama (Ramrajya) sur la base des écritures hindoues anciennes. Mais une théologie du nationalisme peut aussi s’arc-bouter sur des procédures rituelles promues par des idéologues et autres « constructeurs de la nation », nationalisme séculaire inclus. Dans l’après-coup de la Révolution française, par exemple, les parangons du sécularisme dur s’efforcèrent d’installer « une nation laïque » par l’emprunt massif des formes d’un catholicisme populaire (Ozouf 1988). Le cas français, bien qu'extrême, n’est nullement exceptionnel. Il souligne la troisième acception, plus générale, de la notion de théologie nationaliste en insistant sur l'élément sacré sous-jacent à maints projets d’édification nationale. Explicitement conceptualisées comme religieuses ou laïques, les production et sustentation de la nation sont dotées d'une inévitable sacralité (Anderson 1983). Ainsi apparaissent les similitudes habituellement méconnues entre différentes formes de nationalisme, y compris entre sécularisme, nationalisme religieux et confessionnalisme (Hansen 2001, Benei 2008). Nouvelles approches (2) - Sens, sentiments et ressentis d’appartenance nationale/nationaliste. Aujourd’hui, l’intérêt d’une perspective anthropologique sur le nationalisme tient au renouvellement du champ disciplinaire au croisement de recherches sur le corps*, les émotions et le sensible (Benei 2008). Celles-ci montrent comment les programmes nationalistes de formation du soi reposent sur la constitution d’un « sensorium national primaire », notamment dans un contexte national-étatique. À travers son appropriation préemptive de l’univers sensoriel de la population, l’État s’efforce de mobiliser les niveaux des sensoriums développés par les acteurs sociaux —dans l’intimité de la petite enfance, les traditions musicales recomposées, les liturgies dévotionnelles, les transformations culturelles et sensorielles engendrées par les nouvelles technologies et l’industrialisation, etc.— non seulement lors de rencontres périodiques, mais aussi dans l’union quotidienne de différentes couches de stimulations entrant dans la fabrique d’une allégeance nationale. Ces procès sont simultanément liés à une incorporation émotionnelle produite au long cours. Celle-ci repose la question de la « fin des méta-récits » —nationalisme inclus—, prophétisée par Jean-François Lyotard voici trente ans comme la marque distinctive de la postmodernité. L’époque était alors traversée par courants et discours contraires, aux plans régional, international et transnational. Depuis, on l’a vu, l’histoire a eu raison de ces prédictions. La forme « nation » et ses émanations nationalistes se sont manifestées concrètement dans la vie d'un nombre toujours croissant d'acteurs sociaux du monde contemporain. Comment, alors, expliquer le caractère désuet, voire acquis, de la notion aujourd’hui chez maints universitaires? Par la naturalisation de l’attachement national à une mesure sans précédent. Il ne s’agit plus de partager une communauté de nation avec des lecteurs de journaux (Anderson 1983) ou de « signaler banalement » le national (Billig 1995) : la naturalisation de l'idée et de l'expérience de la nation implique son « incorporation ». C'est par l'incorporation de la nation en nous-mêmes en tant que personnes sociales incarnées, sujets et citoyens, que nous entretenons un sentiment d'appartenance nationale, aussi éphémère et vague soit-il parfois. Conclusion : L’incorporation du nationalisme et ses limites. Un avertissement s’impose : loin de subir le projet étatique, les acteurs sociaux sont doués d’agency sociale et politique. Ils exercent plus d’autonomie que généralement concédé dans les analyses du nationalisme. La compréhension et la représentation des acteurs sociaux sont toujours le produit négocié de processus advenant en divers espaces, du foyer familial jusqu’à l’école et d’autres lieux dits « publics ». Par-delà visions et programmes étatiques relayés par des institutions-clés, l’intérêt d’une approche anthropologique faisant la part belle au corps, aux sens et aux émotions est sa mise en lumière de cette négociation toujours fragmentaire. Lesdits processus n’appartiennent pas à une unité d’analyse totale, État, “sphère publique” ou autre. Pour les acteurs sociaux « au ras du sol », l’État-nation n’est pas nécessairement un objet phénoménologiquement cohérent. Ce dont ils font l’expérience et qu’ils négocient, c’est le caractère incomplet et fragmentaire d’un projet politique de formation du soi, adossé à une toile historique et culturelle de « structures de ressenti » (Raymond Williams 1958). Également, les sens-/-timents d’appartenance sont protéiformes jusque dans leur construction dialogique avec les institutions étatiques, mass media et autres lieux de culture publique. Leur incorporation n’est un procès ni exhaustif ni final. Différents moments peuvent être convoqués dans une infinité de situations. Ce caractère labile rend l’issue de tout programme nationaliste imprévisible. Suite à ces constantes tension et incomplétude, aucun processus de nationalisme, pas même étatique, ne peut prévenir l’irruption de l’imprévisible, dans la routine quotidienne comme en des circonstances extra-ordinaires. En définitive, les programmes étatiques les mieux conçus, qui viseraient à capturer les expériences sensorielles et phénoménologiques que font les citoyens des réalités sociales, culturelles et politiques, ne peuvent en maîtriser la nature contingente.

Lincolnshire, England. The crowd cheer when the ball breaks loose. From one end of the field to the other, the players chase, their snouts hovering just above the grass. It’s not a case of four legs being better, rather a novel way to attract customers to the Woodside Wildlife and Falconry Park. During the matches, volunteers are drawn from the crowd to hold goal posts at either end of the run the pigs usually race on. With five pigs playing, two teams of two and a referee, and a ball designed to leak feed as it rolls (Stevenson) the ten-minute competition is fraught with tension. While the pig’s contributions to “the beautiful game” (Fish and Pele 7) have not always been so obvious, it could be argued that specific parts of the animal have had a significant impact on a sport which, despite calls to fall into line with much of the rest of the world, people in Australia (and the US) are more likely to call soccer. The Football Precursors to the modern football were constructed around an inflated pig’s bladder (Price, Jones and Harland). Animal hide, usually from a cow, was stitched around the bladder to offer some degree of stability, but the bladder’s irregular and uneven form made for unpredictable movement in flight. This added some excitement and affected how ball games such as the often violent, calico matches in Florence, were played. In the early 1970s, the world’s oldest ball was discovered during a renovation in Stirling Castle, Scotland. The ball has a pig’s bladder inside its hand-stitched, deer-hide outer. It was found in the ceiling above the bed in, what was then Mary Queens of Scots’ bedroom. It has since been dated to the 1540s (McGinnes). Neglected and left in storage until the late 1990s, the ball found pride of place in an exhibition in the Smiths Art Gallery and Museum, Stirling, and only gained worldwide recognition (as we will see later) in 2006. Despite confirmed interest in a number of sports, there is no evidence to support Mary’s involvement with football (Springer). The deer-hide ball may have been placed to gather and trap untoward spirits attempting to enter the monarch’s sleep, or simply left by accident and forgotten (McGinnes in Springer). Mary, though, was not so fortunate. She was confined and forgotten, but only until she was put to death in 1587. The Executioner having gripped her hair to hold his prize aloft, realised too late it was a wig and Mary’s head bounced and rolled across the floor. Football Development The pig’s bladder was the central component in the construction of the football for the next three hundred years. However, the issue of the ball’s movement (the bounce and roll), the bladder’s propensity to burst when kicked, and an unfortunate wife’s end, conspired to push the pig from the ball before the close of the nineteenth-century. The game of football began to take its shape in 1848, when JC Thring and a few colleagues devised the Cambridge Rules. This compromised set of guidelines was developed from those used across the different ‘ball’ games played at England’s elite schools. The game involved far more kicking, and the pig’s bladders, prone to bursting under such conditions, soon became impractical. Charles Goodyear’s invention of vulcanisation in 1836 and the death of prestigious rugby and football maker Richard Lindon’s wife in 1870 facilitated the replacement of the animal bladder with a rubber-based alternative. Tragically, Mr Lindon’s chief inflator died as a result of blowing up too many infected pig’s bladders (Hawkesley). Before it closed earlier this year (Rhoads), the US Soccer Hall of Fame displayed a rubber football made in 1863 under the misleading claim that it was the oldest known football. By the late 1800s, professional, predominantly Scottish play-makers had transformed the game from its ‘kick-and-run’ origins into what is now called ‘the passing game’ (Sanders). Football, thanks in no small part to Scottish factory workers (Kay), quickly spread through Europe and consequently the rest of the world. National competitions emerged through the growing need for organisation, and the pig-free mass production of balls began in earnest. Mitre and Thomlinson’s of Glasgow were two of the first to make and sell their much rounder balls. With heavy leather panels sewn together and wrapped around a thick rubber inner, these balls were more likely to retain shape—a claim the pig’s bladder equivalent could not legitimately make. The rubber-bladdered balls bounced more too. Their weight and external stitching made them more painful to header, but also more than useful for kicking and particularly for passing from one player to another. The ball’s relatively quick advancement can thereafter be linked to the growth and success of the World Cup Finals tournament. Before the pig re-enters the fray, it is important to glance, however briefly, at the ball’s development through the international game. World Cup Footballs Pre-tournament favourites, Spain, won the 2010 FIFA World Cup, playing with “an undistorted, perfectly spherical ball” (Ghosh par. 7), the “roundest” ever designed (FIFA par.1). Their victory may speak to notions of predictability in the ball, the tournament and the most lucrative levels of professional endeavour, but this notion is not a new one to football. The ball’s construction has had an influence on the way the game has been played since the days of Mary Queen of Scots. The first World Cup Final, in 1930, featured two heavy, leather, twelve-panelled footballs—not dissimilar to those being produced in Glasgow decades earlier. The players and officials of Uruguay and Argentina could not agree, so they played the first half with an Argentine ball. At half-time, Argentina led by two goals to one. In the second half, Uruguay scored three unanswered goals with their own ball (FIFA). The next Final was won by Italy, the home nation in 1934. Orsi, Italy’s adopted star, poked a wildly swerving shot beyond the outstretched Czech keeper. The next day Orsi, obligated to prove his goal was not luck or miracle, attempted to repeat the feat before an audience of gathered photographers. He failed. More than twenty times. The spin on his shot may have been due to the, not uncommon occurrence, of the ball being knocked out of shape during the match (FIFA). By 1954, the Federation Internationale de Football Association (FIFA) had sought to regulate ball size and structure and, in 1958, rigorously tested balls equal to the demands of world-class competition. The 1950s also marked the innovation of the swerving free kick. The technique, developed in the warm, dry conditions of the South American game, would not become popular elsewhere until ball technology improved. The heavy hand-stitched orb, like its early counterparts, was prone to water absorption, which increased the weight and made it less responsive, particularly for those playing during European winters (Bray). The 1970 World Cup in Mexico saw football progress even further. Pele, arguably the game’s greatest player, found his feet, and his national side, Brazil, cemented their international football prominence when they won the Jules Rimet trophy for the third time. Their innovative and stylish use of the football in curling passes and bending free kicks quickly spread to other teams. The same World Cup saw Adidas, the German sports goods manufacturer, enter into a long-standing partnership with FIFA. Following the competition, they sold an estimated six hundred thousand match and replica tournament footballs (FIFA). The ball, the ‘Telstar’, with its black and white hexagonal panels, became an icon of the modern era as the game itself gained something close to global popularity for the first time in its history. Over the next forty years, the ball became incrementally technologically superior. It became synthetic, water-resistant, and consistent in terms of rebound and flight characteristics. It was constructed to be stronger and more resistant to shape distortion. Internal layers of polyutherane and Syntactic Foam made it lighter, capable of greater velocity and more responsive to touch (FIFA). Adidas spent three years researching and developing the 2006 World Cup ball, the ‘Teamgeist’. Fourteen panels made it rounder and more precise, offering a lower bounce, and making it more difficult to curl due to its accuracy in flight. At the same time, audiences began to see less of players like Roberto Carlos (Brazil and Real Madrid CF) and David Beckham (Manchester United, LA Galaxy and England), who regularly scored goals that challenged the laws of physics (Gill). While Adidas announced the 2006 release of the world’s best performing ball in Berlin, the world’s oldest was on its way to the Museum fur Volkerkunde in Hamburg for the duration of the 2006 FIFA World Cup. The Mary Queen of Scot’s ball took centre spot in an exhibit which also featured a pie stand—though not pork pies—from Hibernian Football Club (Strang). In terms of publicity and raising awareness of the Scots’ role in the game’s historical development, the installation was an unrivalled success for the Scottish Football Museum (McBrearty). It did, however, very little for the pig. Heads, not Tails In 2002, the pig or rather the head of a pig, bounced and rolled back into football’s limelight. For five years Luis Figo, Portugal’s most capped international player, led FC Barcelona to domestic and European success. In 2000, he had been lured to bitter rivals Real Madrid CF for a then-world record fee of around £37 million (Nash). On his return to the Catalan Camp Nou, wearing the shimmering white of Real Madrid CF, he was showered with beer cans, lighters, bottles and golf balls. Among the objects thrown, a suckling pig’s head chimed a psychological nod to the spear with two sharp ends in William Golding’s story. Play was suspended for sixteen minutes while police tried to quell the commotion (Lowe). In 2009, another pig’s head made its way into football for different reasons. Tightly held in the greasy fingers of an Orlando Pirates fan, it was described as a symbol of the ‘roasting’ his team would give the Kaiser Chiefs. After the game, he and his friend planned to eat their mascot and celebrate victory over their team’s most reviled competitors (Edwards). The game ended in a nil-all draw. Prior to the 2010 FIFA World Cup, it was not uncommon for a range of objects that European fans might find bizarre, to be allowed into South African league matches. They signified luck and good feeling, and in some cases even witchcraft. Cabbages, known locally for their medicinal qualities, were very common—common enough for both sets of fans to take them (Edwards). FIFA, an organisation which has more members than the United Nations (McGregor), impressed their values on the South African Government. The VuVuZela was fine to take to games; indeed, it became a cultural artefact. Very little else would be accepted. Armed with their economy-altering engine, the world’s most watched tournament has a tendency to get what it wants. And the crowd respond accordingly. Incidentally, the ‘Jabulani’—the ball developed for the 2010 tournament—is the most consistent football ever designed. In an exhaustive series of tests, engineers at Loughborough University, England, learned, among other things, the added golf ball-like grooves on its surface made the ball’s flight more symmetrical and more controlled. The Jabulani is more reliable or, if you will, more predictable than any predecessor (Ghosh). Spanish Ham Through support from their Governing body, the Real Federación Española de Fútbol, Spain have built a national side with experience, and an unparalleled number of talented individuals, around the core of the current FC Barcelona club side. Their strength as a team is founded on the bond between those playing on a weekly basis at the Catalan club. Their style has allowed them to create and maintain momentum on the international stage. Victorious in the 2008 UEFA European Football Championship and undefeated in their run through the qualifying stages into the World Cup Finals in South Africa, they were tournament favourites before a Jabulani was rolled into touch. As Tim Parks noted in his New York Review of Books article, “The Shame of the World Cup”, “the Spanish were superior to an extent one rarely sees in the final stages of a major competition” (2010 par. 15). They have a “remarkable ability to control, hold and hide the ball under intense pressure,” and play “a passing game of great subtlety [ ... to] patiently wear down an opposing team” (Parks par. 16). Spain won the tournament having scored fewer goals per game than any previous winner. Perhaps, as Parks suggests, they scored as often as they needed to. They found the net eight times in their seven matches (Fletcher). This was the first time that Spain had won the prestigious trophy, and the first time a European country has won the tournament on a different continent. In this, they have broken the stranglehold of superpowers like Germany, Italy and Brazil. The Spanish brand of passing football is the new benchmark. Beautiful to watch, it has grace, flow and high entertainment value, but seems to lack something of an organic nature: that is, it lacks the chance for things to go wrong. An element of robotic aptitude has crept in. This occurred on a lesser scale across the 2010 FIFA World Cup finals, but it is possible to argue that teams and players, regardless of nation, have become interchangeable, that the world’s best players and the way they play have become identikits, formulas to be followed and manipulated by master tacticians. There was a great deal of concern in early rounds about boring matches. The world’s media focused on an octopus that successfully chose the winner of each of Germany’s matches and the winner of the final. Perhaps, in shaping the ‘most’ perfect ball and the ‘most’ perfect football, the World Cup has become the most predictable of tournaments. In Conclusion The origins of the ball, Orsi’s unrepeatable winner and the swerving free kick, popular for the best part of fifty years, are worth remembering. These issues ask the powers of football to turn back before the game is smothered by the hunt for faultlessness. The unpredictability of the ball goes hand in hand with the game. Its flaws underline its beauty. Football has so much more transformative power than lucrative evolutionary accretion. While the pig’s head was an ugly statement in European football, it is a symbol of hope in its South African counterpart. Either way its removal is a reminder of Golding’s message and the threat of homogeneity; a nod to the absence of the irregular in the modern era. Removing the curve from the free kick echoes the removal of the pig’s bladder from the ball. The fun is in the imperfection. Where will the game go when it becomes indefectible? Where does it go from here? Can there really be any validity in claiming yet another ‘roundest ball ever’? Chip technology will be introduced. The ball’s future replacements will be tracked by satellite and digitally-fed, reassured referees will determine the outcome of difficult decisions. Victory for the passing game underlines the notion that despite technological advancement, the game has changed very little since those pioneering Scotsmen took to the field. Shouldn’t we leave things the way they were? Like the pigs at Woodside Wildlife and Falconry Park, the level of improvement seems determined by the level of incentive. The pigs, at least, are playing to feed themselves. Acknowledgments The author thanks editors, Donna Lee Brien and Adele Wessell, and the two blind peer reviewers, for their constructive feedback and reflective insights. The remaining mistakes are his own. References “Adidas unveils Golden Ball for 2006 FIFA World Cup Final” Adidas. 18 Apr. 2006. 23 Aug. 2010 . Bray, Ken. “The science behind the swerve.” BBC News 5 Jun. 2006. 19 Aug. 2010 http://news.bbc.co.uk/2/hi/uk_news/magazine/5048238.stm>. Edwards, Piers. “Cabbage and Roasted Pig.” BBC Fast Track Soweto, BBC News 3 Nov. 2009. 23 Aug. 2010 . FIFA. “The Footballs during the FIFA World Cup™” FIFA.com. 18 Aug. 2010 .20 Fish, Robert L., and Pele. My Life and the Beautiful Game. New York: Bantam Dell, 1977. Fletcher, Paul. “Match report on 2010 FIFA World Cup Final between Spain and Netherlands”. BBC News—Sports 12 Jul. 2010 . Ghosh, Pallab. “Engineers defend World Cup football amid criticism.” BBC News—Science and Environment 4 Jun. 2010. 19 Aug. 2010 . Gill, Victoria. “Roberto Carlos wonder goal ‘no fluke’, say physicists.” BBC News—Science and Environment 2 Sep. 2010 . Hawkesley, Simon. Richard Lindon 22 Aug. 2010 . “History of Football” FIFA.com. Classic Football. 20 Aug. 2010 . Kay, Billy. The Scottish World: A Journey into the Scottish Diaspora. London: Mainstream, 2008. Lowe, Sid. “Peace for Figo? And pigs might fly ...” The Guardian (London). 25 Nov. 2002. 20 Aug. 2010 . “Mary, Queen of Scots (r.1542-1567)”. The Official Website of the British Monarchy. 20 Jul. 2010 . McBrearty, Richard. Personal Interview. 12 Jul. 2010. McGinnes, Michael. Smiths Art Gallery and Museum. Visited 14 Jul. 2010 . McGregor, Karen. “FIFA—Building a transnational football community. University World News 13 Jun. 2010. 19 Jul. 2010 . Nash, Elizabeth. “Figo defects to Real Madrid for record £36.2m." The Independent (London) 25 Jul. 2000. 20 Aug. 2010 . “Oldest football to take cup trip” 25 Apr. 2006. 20 Jul. 2010 . Parks, Tim. “The Shame of the World Cup”. New York Review of Books 19 Aug. 2010. 23 Aug. 2010 < http://nybooks.com/articles/archives/2010/aug/19/shame-world-cup/>. “Pig football scores a hit at centre.” BBC News 4 Aug. 2009. August 20 2010 . Price, D. S., Jones, R. Harland, A. R. “Computational modelling of manually stitched footballs.” Proceedings of the Institution of Mechanical Engineers, Part L. Journal of Materials: Design & Applications 220 (2006): 259-268. Rhoads, Christopher. “Forget That Trip You Had Planned to the National Soccer Hall of Fame.” Wall Street Journal 26 Jun. 2010. 22 Sep. 2010 . “Roberto Carlos Impossible Goal”. News coverage posted on You Tube, 27 May 2007. 23 Aug. 2010 . Sanders, Richard. Beastly Fury. London: Bantam, 2009. “Soccer to become football in Australia”. Sydney Morning Herald 17 Dec. 2004. 21 Aug. 2010 . Springer, Will. “World’s oldest football – fit for a Queen.” The Scotsman. 13 Mar. 2006. 19 Aug. 2010 < http://heritage.scotsman.com/willspringer/Worlds-oldest-football-fit.2758469.jp >. Stevenson, R. “Pigs Play Football at Wildlife Centre”. Lincolnshire Echo 3 Aug. 2009. 20 Aug. 2010 . Strang, Kenny. Personal Interview. 12 Jul. 2010. “The Execution of Mary Queen of Scots February 8, 1857”. Tudor History 21 Jul. 2010 http://tudorhistory.org/primary/exmary.html>. “The History of the FA.” The FA. 20 Jul. 2010 “World’s Oldest Ball”. World Cup South Africa 2010 Blog. 22 Jul. 2010 . “World’s Oldest Soccer Ball by Charles Goodyear”. 18 Mar. 2010. 20 Jul. 2010 .

The old “Is the glass half empty or half full?” question does more than just illustrate a person’s proclivity for pessimism or for optimism. It alerts us to the possibility that the same real world phenomena may be interpreted in entirely different ways, with very real consequences. It is this notion that I apply to the way fat sex and thin sex are conceptualised in the larger social consciousness. While sexual, romantic and/or intimate acts between people where at least one individual is fat (Fat Sex) are deemed atypical, abnormal, fetishistic and even abusive (Saguy qtd. in Swami & Tovee 90; Schur qtd. in Prohaska 271; Gailey 119), such encounters between able-bodied individuals who are thin or of average weight (Thin Sex) are deemed normal and desirable. I argue in this article that this discrepancy in how we label and treat fat and thin sexuality is unjustified because the two domains are more similar than distinct. Given their similarity we should treat similar aspects of both domains in the same way, i.e. either as normal, or as fetishistic based on relevant criteria rather than body size. I also argue that fat prejudice and thin privilege underlie this discrepancy in modern western society. I finally conclude that this causes significant personal and social harm to both fat and thin individuals.Fat Sex – The Fetishized NormalHanne Blank, in writing of her foray into publishing body positive material exploring fat sexuality, speaks of the need for spaces that acknowledge the vitality and diversity of fat sex; not in fetishistic and pornographic portrayals of Big Beautiful Women offering themselves up as an object of desire but reflecting the desires and sexual experiences of fat people themselves (10). If there are a 100 million people in America who are obese according to BMI standards, she argues, they represent a whole array of body sizes and a lot of sexual activity, which she describes as follows:Fat people have sex. Sweet, tender, luscious sex. Sweaty, feral, sheet-ripping sex. Shivery, jiggly, gasping sex. Sentimental, slow, face-cradling sex. Even as you read these words, there are fat people out there somewhere joyously getting their freak on. Not only that, but fat people are falling in love, having hook-ups, being crushed-out, putting on sexy lingerie, being the objects of other people’s lust, flirting, primping before hot dates, melting a little as they read romantic notes from their sweeties, seducing and being seduced, and having shuddering, toe-curling orgasms that are as big as they are. It’s only natural. (15)Such normalcy and diverse expression, however, is not usually portrayed in popular media, nor even in much scholarly research. Apart from body positive spaces carved out by the fat acceptance movement online and the research of fat studies scholars, which, contextualises fat sexuality as healthy and exciting, in “the majority of scholarship on this topic, fat women’s sexual behaviors are never the result of women’s agency, are always the result of their objectification, and are never healthy” (Prohaska 271).This interpretation of fat sexuality, the assumptions associated with it and the reinforcement of these attitudes have much to do with the pervasiveness of fat prejudice in society today. One study estimates that the prevalence of weight based discrimination in the US increased by 66% between 1996 and 2006 (Andreyeva, Puhl and Brownell) and is now comparable to gender and race based discrimination (Puhl, Andreyeva and Brownell). This is not an isolated trend. An anthropological study analysing the globalisation of notions of fat being unhealthy and a marker of personal and social failing suggests that we have on our hands a rapidly homogenising global stigma associated with fat (Brewis, Wutich and Rodriguez-Soto), a climate of discrimination leading many fat people to what Goffman describes as a spoiled identity (3).Negative stereotypes affecting fat sexuality are established and perpetuated through a process of discursive constraint (Cordell and Ronai 30-31). “’No man will ever love you,’ Weinstein’s grandmother informs her (Weinstein, prologue), simultaneously offering her a negative category to define herself by and trying to coerce her into losing weight – literally constraining the discourse that Weinstein may apply to herself.Discursive constraint is created not only by individuals reinforcing cultural mores but also by overt and covert messages embedded in social consciousness: “fat people are unattractive”, “fat is ugly”, “fat people are asexual”, “fat sex is a fetish”, “no normal person can be attracted to a fat person”. Portrayals of fat individuals in mainstream media consolidate these beliefs.One of the most loved fat characters of 1990s, Fat Monica from the sitcom Friends is gluttonous, ungainly (rolling around in a bean bag, jolting the sofa as she sits), undesirable (Chandler says to Ross, “I just don’t want to be stuck here all night with your fat sister!”), and desperate for sex, affection and approval from the opposite sex: “the comedic potential of Fat Monica is premised on an understanding that her body is deviant or outside the norm” (Gullage 181).In Shallow Hal, a film in which a shallow guy falls in love with the inner beauty of a fat girl, Hal (Jack Black) is shown to be attracted to Rosemary (Gwyneth Paltrow) only after he can no longer see her real fat body and her “inner beauty” is represented by a thin white blond girl. All the while, the movie draws laughs from the audience at the fat jokes and gags made at the expense of Paltrow’s character.Ashley Madison, a website for married people looking to have an affair, used the image of a scantily clad fat model in an advertisement with the tagline “Did your wife scare you last night?”, implying that infidelity is justified if you’re not attracted to your partner, and fatness precludes attraction. And a columnist from popular magazine Marie Claire wrote about Mike and Molly, a sitcom about two fat people in a relationship:Yes, I think I'd be grossed out if I had to watch two characters with rolls and rolls of fat kissing each other ... because I'd be grossed out if I had to watch them doing anything. (Kelly)It is the prevalence of these beliefs that I call the fetishisation of fat sexuality. When fat bodies are created as asexual and undesirable, it gives rise to the rhetoric that to be sexually attracted to a fat body is unnatural, therefore making any person who is attracted to a fat body a fetishist and the fat person themselves an object of fetish.The internalisation of these beliefs is not only something that actively harms the self-esteem, sexual agency & health and happiness of fat individuals (Satinsky et al.), but also those who are attracted to them. Those who internalise these beliefs about themselves may be unable to view themselves as sexual and engage with their own bodies in a pleasurable manner, or to view themselves as attractive, perhaps discounting any assertions to the contrary. In a study designed to investigate the relationship between body image and sexual health in women of size, one participant revealed:I’ve had my issues with T as far as um, believing that T is attracted to me…because of my weight, my size and the way I look. (Satinsky et al. 717)Another participant speaks of her experience masturbating and her discomfort at touching her own flesh, leading her to use a vibrator and not her hands:Like, I don’t, I don’t look down. I look at the ceiling and I try to – it’s almost like I’m trying to imagine that I was thinner. Like, imagine that my stomach was flatter or something like that, which sounds bizarre, but I guess that’s what I’m trying to do. (Satinsky et al. 719)Others stay in bad marriages because they believe they wouldn’t find anyone else (Joanisse and Synnott 55) or tolerate abuse because of their low self-esteem (Hester qtd. in Prohaska 271).Similarly, men who internalise these attitudes about fat find it easier to dehumanise and objectify fat women, believe that they’d be desperate for sex and hence an easy target for a sexual conquest, and are less deserving of consideration (Prohaska and Gailey 19).On the other hand, many men who find fat women attractive (Fat Admirers or FA’s) remain closeted because their desire is stigmatised. Many do not make their preference known to their peer group and families, nor do they publicly acknowledge the woman they are intimate with. Research suggests that FA’s draw the same amount of stigma for being with fat women and finding them attractive, as they would for themselves being fat (Goode qtd. in Prohaska and Gailey).I do not argue here that all fat individuals have spoiled identities or that all expressions of fat sexuality operate from a place of stigma and shame, but that fat sexuality exists within a wider social fabric of fat phobia, discrimination and stigmatisation. Fulfilling sexual experience must therefore be navigated within this framework. As noted, the fat acceptance movement, body positive spaces online, and fat studies scholarship help to normalise fat sexuality and function as tools for resisting stigma and fetishisation.Resisting Stigma: Creating Counter NarrativesGailey, in interviews with 36 fat-identified women, found that though 34 of them (94%) had ‘experienced a life of ridicule, body shame and numerous attempts to lose weight’ which had an adverse effect on their relationships and sex life, 26 of them reported a positive change after having ‘embodied the size acceptance ideology’ (Gailey 118).Recently, Kristin Chirico, employee of Buzzfeed, released first an article and then a video titled My Boyfriend Loves Fat Women about her relationship with her boyfriend who loves fat women, her own discomfort with her fatness and her journey in embracing size acceptance ideologies: I will let him enjoy the thing he loves without tearing it down. But more importantly, I will work to earn love from me, who is the person who will always play the hardest to get. I will flirt as hard as I can, and I will win myself back.Books such as Wann’s Fat!So?, Blank’s Big Big Love: A Sex and Relationships Guide for People of Size (and Those Who Love Them), Chastain’s Fat: The Owner’s Manual and her blog Dances with Fat, Tovar’s Hot and Heavy: Fierce Fat Girls on Life, Love and Fashion, as well as Substantia Jones’s fat photography project called The Adipositivity Project are some examples of fat activism, size acceptance and body positive spaces and resources. The description on Jones’s site reads:The Adipositivity Project aims to promote the acceptance of benign human size variation and encourage discussion of body politics, not by listing the merits of big people, or detailing examples of excellence (these things are easily seen all around us), but rather through a visual display of fat physicality. The sort that's normally unseen. When fat individuals create personal narratives to resist stigmatisation of fat sexuality they confront the conundrum of drawing the line between sexual empowerment and glorifying fat fetishism. To see one’s own and other fat bodies as sexual, normal and worthy of pleasure is one way to subvert this fetishism. One would also take seriously any sexual advances, seeing oneself as desirable. The line between normal expression of fat sexuality and the wide spread belief that fat sex is fetishistic is so blurred however, that it becomes difficult to differentiate between them, so it is common to ask if one is being sexual or being an object of fetish. There is also the tension between the heady sense of power in being a sexual agent, and the desire to be wanted for more than just being a fat body.Modern burlesque stage is one arena where fat bodies are being recreated as sexy and desirable, offering a unique resource to ‘fat performers and audience members who want to experience their bodies in new and affirming ways’. Because burlesque is an erotic dance form, fat women on the burlesque stage are marked as ‘sexual, without question or challenge’. The burlesque stage has a great capacity to be a space for transforming sexual identity and driving changes in audience attitudes, creating a powerful social environment that is contrary to mainstream conditions in society (Asbill 300).The founder and creative director of “Big Burlesque” and “Fat-Bottom Revue” the world’s first all-fat burlesque troupe, however, notes that when she started Big Burlesque there were a couple of “bigger” performers on the neo-burlesque circuit, but they did not specifically advocate fat liberation. ‘Fat dance is rare enough; fat exotic/erotic dance is pretty much unheard of outside of “fetish” acts that alienate rather than normalise fat bodies’ (McAllister 305).In another instance, Laura writes that to most men her weight is a problem or a fetish, constraining the potential in relationships. Speaking of BBW (Big Beautiful Women) and BHM (Big Handsome Men) websites that cater to Fat Admirers she writes:As I’ve scrolled through these sites, I’ve felt vindicated at seeing women my size as luscious pinups. But, after a while, I feel reduced to something less than a person: just a gartered thigh and the breast-flesh offered up in a corset. I want to be lusted after. I want to be wanted. But, more than this, I want to love, and be loved. I want everything that love confers: being touched, being valued and being seen.That sexual attraction might rely wholly or partly on physical attributes, however, is hardly unfamiliar, and is an increasing phenomenon in the wider culture and popular media. Of course, what counts there is being thin and maintaining the thin state!Thin Sex: The Normalised FetishUnlike the fat body, the thin body is created as beautiful, sexually attractive, successful and overwhelmingly the norm (van Amsterdam). Ours is a culture fixated on physical beauty and sex, both of which are situated in thin bodies. Sexiness is a social currency that buys popularity, social success, and increasingly wealth itself (Levy). Like fat sex, thin sex operates on the stage set by the wider cultural ideals of beauty and attractiveness and that of the burden of thin privilege. Where stigma situates fat sexuality to abnormality and fetish, thin sexuality has to deal with the pressures of conforming to and maintaining the thin state (vam Amsterdam).Thin individuals also deal with the sexualisation of their bodies, confronting the separation of their personhood from their sexuality, in a sexual objectification of women that has long been identified as harmful. Ramsey and Hoyt explore how being objectified in heterosexual relationships might be related to coercion within those relationships. Their evidence shows that women are routinely objectified, and that this objectification becomes part of the schema of how men relate to women. Such a schema results in a fracturing of women into body parts dissociated from their personhood , making it easier to engage in violence with, and feel less empathy for female partners (in cases of rape or sexual assault). (Ramsey and Hoyt) What is interesting here is the fact that though aspects of thin sexuality are recognised as fetishistic (objectification of women), thin sex is still considered normal.Thin Sex, Fat Sex and 50 Shades of OverlapThe normalisation of sexual objectification -- society for the most part being habituated to the fetishistic aspects of thin sex, can be contrasted with attitudes towards comparable aspects of fat sex. In particular, Feederism, is generally viewed within scholarly discourse (and public attitudes) as ‘a consensual activity, a fetish, a stigmatised behaviour, and abuse’ (Terry & Vassey, Hester, Bestard, Murray as qtd. in Prohaska 281). Prohaska argues that Feederism and Diet Culture are broadly similar phenomena that elicit tellingly opposing judgements. She reports that the culture of feederism (as analysed on online forums) is a mostly consensual activity, where the community vocally dissuades non-consensual activities and any methods that may cause bodily harm (268). It is mostly a community of people who discuss measures of gradual weight gain and support and encourage each other in those goals. This, she argues, is very similar in tone to what appears on weight loss websites and forums (269). She contends, however that despite these parallels ‘the same scrutiny is not given to those who are attempting to lose weight as is placed upon those who do not diet or who try to gain weight’ (269).She notes that whereas in judging feederism emphasis is on fringe behaviours, in evaluating diet culture the focus is on behaviours deemed normal and healthy while only disorders like anorexia, bulimia, and pill using are judged fringe behaviours. This disparity, she claims, is rooted in fat phobia and prejudice (270).In comparing the dating sections of feederism websites with mainstream dating sites she notes that here too the nature of ads is similar, with the only difference being that in mainstream sites the body size preference is assumed. People seeking relationships on both kinds of sites look for partners who are ‘caring, intelligent and funny’ and consider ‘mutual respect’ as key (270).This is similar to what was revealed in an article by Camille Dodero, who interviewed a number of men who identify as fat admirers and delved into the myths and realities of fat admiration. The article covers stories of stigma that FA’s have faced and continue to face because of their sexual preference, and also of internalised self-hatred that makes it difficult for fat women to take their advances seriously. The men also create BBW/BHM dating websites as more than a fetish club. They experience these online spaces as safe spaces where they can openly meet people they would be interested in just as one would on a normal/mainstream dating site. Even if most women fit the type that they are attracted to in such spaces, it does not mean that they would be attracted to all of those women, just as on match.com one would look over prospective candidates for dating and that process would include the way they look and everything else about that person.Attempting to clear up the misconception that loving fat women is a fetish, one of the interviewees says,“Steve, over there, has a type,” gesturing wanly at a stranger in a hockey jersey probably not named Steve. “I have a type, too. Mine’s just bigger. He may like skinny blondes with bangs and long legs. I like pear shapes with brown hair and green eyes. I have a type—it just happens to be fat.” Besides, people aren’t fetish objects, they’re people. “It’s not like having a thing for leather.” (Dodero 3)ConclusionAnalysis of the domains of thin and fat sex shows that both have people engaging in sexual activity and romantic and intimate relationships with each other. Both have a majority of individuals who enjoy consensual, fulfilling sex and relationships, however these practices and desires are celebrated in one domain and stigmatised in the other. Both domains also have a portion of the whole that objectifies relationship partners with immense potential for harm, whether this involves sexualisation and objectification and its related harms in thin sex, objectification of fat bodies in some BBW and BHM circles, and the fringes of feederism communities, or non-body size specific fetish acts that individuals from both domains engage in. Qualitatively, since both domains significantly overlap, it is difficult to find the justification for the fetishisation of one and the normativity of the other. It seems plausible that this can be accounted for by the privilege associated with thin bodies and the prejudice against fat.Our failure to acknowledge such fetishisation of normal fat sex and normalisation of the fetishistic aspects of thin sex creates huge potential for harm for both groups, for it not only causes the fragmentation of effort when it comes to addressing these issues but also allows for the rich vitality and diversity of “normal” fat sex to wallow in obscurity and stigma.References Andreyeva, Tatiana, Rebecca M. Puhl, and Kelly D. Brownell. "Changes in Perceived Weight Discrimination among Americans, 1995–1996 through 2004–2006." Obesity 16 (2008): 1129-1134.Asbill, D. Lacy. "'I’m Allowed to Be a Sexual Being': The Distinctive Social Conditions of the Fat Burlesque Stage." The Fat Studies Reader, eds. Sondra Solovay and Esther Rothblum. New York: New York UP, 2009. 299.Blank, Hanne. Big Big Love, Revised, A Sex and Relationship Guide for People of Size (and Those Who Love Them). New York: Celestial Arts, 2011.Bogart, Laura. Salon 4 Aug. 2014.Brewis, A.A., A. Wutich and I. Rodriguez-Soto. "Body Norms and Fat Stigma in Global Perspective." Current Anthropology 52 (2011): 269-276.Chirico, Kristin. My Boyfriend Loves Fat Women. 25 Feb. 2015.Cordell, Gina, and Carol Rambo Ronai. "Identity Management among Overweight Women: Narrative Resistance to Stigma." Interpreting Weight: The Social Management of Fatness and Thinness, eds. Jeffery Sobal and Donna Maurer. Transaction Publishers, 1999. 29-48. Dodero, Camille. Guys Who Like Fat Chicks. 4 May 2011.Prohaska, Ariane, and Jeannine A. Gailey. "Achieving Masculinity through Sexual Predation: The Case of Hogging." Journal of Gender Studies 19.1 (2010): 13-25.Gailey, Jeannine A. “Fat Shame to Fat Pride: Fat Women’s Sexual and Dating Experiences.” Fat Studies: An Interdisciplinary Journal of Body Weight and Society 1.1 (2012). Goffman, Erving. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, N.J: Prentice-Hall, 1963.Gullage, Amy. "Fat Monica, Fat Suits and Friends." Feminist Media Studies 14.2 (2012): 178-89. Jacqueline. "I'm The 'Scary' Model in That Awful Ashley Madison Ad." 11 July 2011. Online. 24 May 2015.Jones, Substantia. The Adipositivity Project. n.d. Kelly, M. "Should 'Fatties' Get a Room? (Even on TV?)" 2010.Levy, Ariel. "Raunch Culture." Female Chauvinist Pigs: Women and the Rise of Raunch Culture. New York: Free Press, 2005. 7-45.McAllister, Heather. "Embodying Fat Liberation." The Fat Studies Reader, eds. Sondra Solovay and Esther Rothblum. New York: New York UP, 2009. 305.Prohaska, Ariane. “Help Me Get Fat! Feederism as Communal Deviance on the Internet.” Deviant Behaviour 35.4 (2014). Puhl, Rebecca M., Tatiana Andreyeva, and Kelly Brownell. "Perceptions of Weight Discrimination: Prevalence and Comparison to Race and Gender Discrimination in America." International Journal of Obesity 32 (2008): 992-1000.Ramsey, Laura R., and Tiffany Hoyt. "The Object of Desire: How Being Objectified Creates Sexual Pressure for Women in Heterosexual Relationships." Psychology of Women Quarterly (2014): 1-20.Satinsky, Sonya, et al. "'Fat Girl Complex': A Preliminary Investigation of Sexual Health and Body Image in Women of Size." Culture, Health and Sexuality: An International Journal for Research, Intervention and Care 15.6 (2013): 710-25.Swami, Viren, and Martin J. Tovee. “Big Beautiful Women: The Body Size Preferences of Male Fat Admirers.” The Journal of Sex Research 46.1 (2009): 89-86.Joanisse, Leanne, and Anthony Synnott. "Fighting Back: Reactions and Resistance to the Stigma of Obesity." Interpreting Weight: The Social Management of Fatness and Thinness, eds. Jeffery Sobal and Donna Maurer. New York: First Transaction Printing, 2013. 49-73.Van Amsterdam, Noortje. "Big Fat Inequalities, Thin Privilege: An Intersectional Perspective on 'Body Size'." European Journal of Women's Studies 20.2 (2013): 155-69.Weinstein, Rebecca Jane. “Fat Sex: The Naked Truth”. EBook, 2012.

Introduction This paper offers a survey of familiar popular music performers and songwriters who reference coffee in their work. It examines three areas of discourse: the psychoactive effects of caffeine, coffee and courtship rituals, and the politics of coffee consumption. I claim that coffee carries a cultural and musicological significance comparable to that of the chemical stimulants and consumer goods more readily associated with popular music. Songs about coffee may not be as potent as those featuring drugs and alcohol (Primack; Schapiro), or as common as those referencing commodities like clothes and cars (Englis; McCracken), but they do feature across a wide range of genres, some of which enjoy archetypal associations with this beverage. m.o.m.m.y. Needs c.o.f.f.e.e.: The Psychoactive Effect of Coffee The act of performing and listening to popular music involves psychological elements comparable to the overwhelming sensory experience of drug taking: altered perceptions, repetitive grooves, improvisation, self-expression, and psychological empathy—such as that between musician and audience (Curry). Most popular music genres are, as a result, culturally and sociologically identified with the consumption of at least one mind-altering substance (Lyttle; Primack; Schapiro). While the analysis of lyrics referring to this theme has hitherto focused on illegal drugs and alcoholic beverages (Cooper), coffee and its psychoactive ingredient caffeine have been almost entirely overlooked (Summer). The most recent study of drugs in popular music, for example, defined substance use as “tobacco, alcohol, marijuana, cocaine and other stimulants, heroin and other opiates, hallucinogens, inhalants, prescription drugs, over-the-counter drugs, and nonspecific substances” (Primack 172), thereby ignoring a chemical stimulant consumed by 90 per cent of adult Americans every day (Lovett). The wide availability of coffee and the comparatively mild effect of caffeine means that its consumption rarely causes harm. One researcher has described it as a ubiquitous and unobtrusive “generalised public activity […] ‘invisible’ to analysts seeking distinctive social events” (Cooper 92). Coffee may provide only a relatively mild “buzz”—but it is now accepted that caffeine is an addictive substance (Juliano) and, due to its universal legality, coffee is also the world’s most extensively traded and enthusiastically consumed psychoactive consumer product (Juliano 1). The musical genre of jazz has a longstanding relationship with marijuana and narcotics (Curry; Singer; Tolson; Winick). Unsurprisingly, given its Round Midnight connotations, jazz standards also celebrate the restorative impact of coffee. Exemplary compositions include Burke/Webster’s insomniac torch song Black Coffee, which provided hits for Sarah Vaughan (1949), Ella Fitzgerald (1953), and Peggy Lee (1960); and Frank Sinatra’s recordings of Hilliard/Dick’s The Coffee Song (1946, 1960), which satirised the coffee surplus in Brazil at a time when this nation enjoyed a near monopoly on production. Sinatra joked that this ubiquitous drink was that country’s only means of liquid refreshment, in a refrain that has since become a headline writer’s phrasal template: “There’s an Awful Lot of Coffee in Vietnam,” “An Awful Lot of Coffee in the Bin,” and “There’s an Awful Lot of Taxes in Brazil.” Ethnographer Aaron Fox has shown how country music gives expression to the lived social experience of blue-collar and agrarian workers (Real 29). Coffee’s role in energising working class America (Cooper) is featured in such recordings as Dolly Parton’s Nine To Five (1980), which describes her morning routine using a memorable “kitchen/cup of ambition” rhyme, and Don't Forget the Coffee Billy Joe (1973) by Tom T. Hall which laments the hardship of unemployment, hunger, cold, and lack of healthcare. Country music’s “tired truck driver” is the most enduring blue-collar trope celebrating coffee’s analeptic powers. Versions include Truck Drivin' Man by Buck Owens (1964), host of the country TV show Hee Haw and pioneer of the Bakersfield sound, and Driving My Life Away from pop-country crossover star Eddie Rabbitt (1980). Both feature characteristically gendered stereotypes of male truck drivers pushing on through the night with the help of a truck stop waitress who has fuelled them with caffeine. Johnny Cash’s A Cup of Coffee (1966), recorded at the nadir of his addiction to pills and alcohol, has an incoherent improvised lyric on this subject; while Jerry Reed even prescribed amphetamines to keep drivers awake in Caffein [sic], Nicotine, Benzedrine (And Wish Me Luck) (1980). Doye O’Dell’s Diesel Smoke, Dangerous Curves (1952) is the archetypal “truck drivin’ country” song and the most exciting track of its type. It subsequently became a hit for the doyen of the subgenre, Red Simpson (1966). An exhausted driver, having spent the night with a woman whose name he cannot now recall, is fighting fatigue and wrestling his hot-rod low-loader around hairpin mountain curves in an attempt to rendezvous with a pretty truck stop waitress. The song’s palpable energy comes from its frenetic guitar picking and the danger implicit in trailing a heavy load downhill while falling asleep at the wheel. Tommy Faile’s Phantom 309, a hit for Red Sovine (1967) that was later covered by Tom Waits (Big Joe and the Phantom 309, 1975), elevates the “tired truck driver” narrative to gothic literary form. Reflecting country music’s moral code of citizenship and its culture of performative storytelling (Fox, Real 23), it tells of a drenched and exhausted young hitchhiker picked up by Big Joe—the driver of a handsome eighteen-wheeler. On arriving at a truck stop, Joe drops the traveller off, giving him money for a restorative coffee. The diner falls silent as the hitchhiker orders up his “cup of mud”. Big Joe, it transpires, is a phantom trucker. After running off the road to avoid a school bus, his distinctive ghost rig now only reappears to rescue stranded travellers. Punk rock, a genre closely associated with recreational amphetamines (McNeil 76, 87), also features a number of caffeine-as-stimulant songs. Californian punk band, Descendents, identified caffeine as their drug of choice in two 1996 releases, Coffee Mug and Kids on Coffee. These songs describe chugging the drink with much the same relish and energy that others might pull at the neck of a beer bottle, and vividly compare the effects of the drug to the intense rush of speed. The host of “New Music News” (a segment of MTV’s 120 Minutes) references this correlation in 1986 while introducing the band’s video—in which they literally bounce off the walls: “You know, while everybody is cracking down on crack, what about that most respectable of toxic substances or stimulants, the good old cup of coffee? That is the preferred high, actually, of California’s own Descendents—it is also the subject of their brand new video” (“New Music News”). Descendents’s Sessions EP (1997) featured an overflowing cup of coffee on the sleeve, while punk’s caffeine-as-amphetamine trope is also promulgated by Hellbender (Caffeinated 1996), Lagwagon (Mr. Coffee 1997), and Regatta 69 (Addicted to Coffee 2005). Coffee in the Morning and Kisses in the Night: Coffee and Courtship Coffee as romantic metaphor in song corroborates the findings of early researchers who examined courtship rituals in popular music. Donald Horton’s 1957 study found that hit songs codified the socially constructed self-image and limited life expectations of young people during the 1950s by depicting conservative, idealised, and traditional relationship scenarios. He summarised these as initial courtship, honeymoon period, uncertainty, and parting (570-4). Eleven years after this landmark analysis, James Carey replicated Horton’s method. His results revealed that pop lyrics had become more realistic and less bound by convention during the 1960s. They incorporated a wider variety of discourse including the temporariness of romantic commitment, the importance of individual autonomy in relationships, more liberal attitudes, and increasingly unconventional courtship behaviours (725). Socially conservative coffee songs include Coffee in the Morning and Kisses in the Night by The Boswell Sisters (1933) in which the protagonist swears fidelity to her partner on condition that this desire is expressed strictly in the appropriate social context of marriage. It encapsulates the restrictions Horton identified on courtship discourse in popular song prior to the arrival of rock and roll. The Henderson/DeSylva/Brown composition You're the Cream in My Coffee, recorded by Annette Hanshaw (1928) and by Nat King Cole (1946), also celebrates the social ideal of monogamous devotion. The persistence of such idealised traditional themes continued into the 1960s. American pop singer Don Cherry had a hit with Then You Can Tell Me Goodbye (1962) that used coffee as a metaphor for undying and everlasting love. Otis Redding’s version of Butler/Thomas/Walker’s Cigarettes and Coffee (1966)—arguably soul music’s exemplary romantic coffee song—carries a similar message as a couple proclaim their devotion in a late night conversation over coffee. Like much of the Stax catalogue, Cigarettes and Coffee, has a distinctly “down home” feel and timbre. The lovers are simply content with each other; they don’t need “cream” or “sugar.” Horton found 1950s blues and R&B lyrics much more sexually explicit than pop songs (567). Dawson (1994) subsequently characterised black popular music as a distinct public sphere, and Squires (2002) argued that it displayed elements of what she defined as “enclave” and “counterpublic” traits. Lawson (2010) has argued that marginalised and/or subversive blues artists offered a form of countercultural resistance against prevailing social norms. Indeed, several blues and R&B coffee songs disregard established courtship ideals and associate the product with non-normative and even transgressive relationship circumstances—including infidelity, divorce, and domestic violence. Lightnin’ Hopkins’s Coffee Blues (1950) references child neglect and spousal abuse, while the narrative of Muddy Waters’s scorching Iodine in my Coffee (1952) tells of an attempted poisoning by his Waters’s partner. In 40 Cups of Coffee (1953) Ella Mae Morse is waiting for her husband to return home, fuelling her anger and anxiety with caffeine. This song does eventually comply with traditional courtship ideals: when her lover eventually returns home at five in the morning, he is greeted with a relieved kiss. In Keep That Coffee Hot (1955), Scatman Crothers supplies a counterpoint to Morse’s late-night-abandonment narrative, asking his partner to keep his favourite drink warm during his adulterous absence. Brook Benton’s Another Cup of Coffee (1964) expresses acute feelings of regret and loneliness after a failed relationship. More obliquely, in Coffee Blues (1966) Mississippi John Hurt sings affectionately about his favourite brand, a “lovin’ spoonful” of Maxwell House. In this, he bequeathed the moniker of folk-rock band The Lovin’ Spoonful, whose hits included Do You Believe in Magic (1965) and Summer in the City (1966). However, an alternative reading of Hurt’s lyric suggests that this particular phrase is a metaphorical device proclaiming the author’s sexual potency. Hurt’s “lovin’ spoonful” may actually be a portion of his seminal emission. In the 1950s, Horton identified country as particularly “doleful” (570), and coffee provides a common metaphor for failed romance in a genre dominated by “metanarratives of loss and desire” (Fox, Jukebox 54). Claude Gray’s I'll Have Another Cup of Coffee (Then I’ll Go) (1961) tells of a protagonist delivering child support payments according to his divorce lawyer’s instructions. The couple share late night coffee as their children sleep through the conversation. This song was subsequently recorded by seventeen-year-old Bob Marley (One Cup of Coffee, 1962) under the pseudonym Bobby Martell, a decade prior to his breakthrough as an international reggae star. Marley’s youngest son Damian has also performed the track while, interestingly in the context of this discussion, his older sibling Rohan co-founded Marley Coffee, an organic farm in the Jamaican Blue Mountains. Following Carey’s demonstration of mainstream pop’s increasingly realistic depiction of courtship behaviours during the 1960s, songwriters continued to draw on coffee as a metaphor for failed romance. In Carly Simon’s You’re So Vain (1972), she dreams of clouds in her coffee while contemplating an ostentatious ex-lover. Squeeze’s Black Coffee In Bed (1982) uses a coffee stain metaphor to describe the end of what appears to be yet another dead-end relationship for the protagonist. Sarah Harmer’s Coffee Stain (1998) expands on this device by reworking the familiar “lipstick on your collar” trope, while Sexsmith & Kerr’s duet Raindrops in my Coffee (2005) superimposes teardrops in coffee and raindrops on the pavement with compelling effect. Kate Bush’s Coffee Homeground (1978) provides the most extreme narrative of relationship breakdown: the true story of Cora Henrietta Crippin’s poisoning. Researchers who replicated Horton’s and Carey’s methodology in the late 1970s (Bridges; Denisoff) were surprised to find their results dominated by traditional courtship ideals. The new liberal values unearthed by Carey in the late 1960s simply failed to materialise in subsequent decades. In this context, it is interesting to observe how romantic coffee songs in contemporary soul and jazz continue to disavow the post-1960s trend towards realistic social narratives, adopting instead a conspicuously consumerist outlook accompanied by smooth musical timbres. This phenomenon possibly betrays the influence of contemporary coffee advertising. From the 1980s, television commercials have sought to establish coffee as a desirable high end product, enjoyed by bohemian lovers in a conspicuously up-market environment (Werder). All Saints’s Black Coffee (2000) and Lebrado’s Coffee (2006) identify strongly with the culture industry’s image of coffee as a luxurious beverage whose consumption signifies prominent social status. All Saints’s promotional video is set in a opulent location (although its visuals emphasise the lyric’s romantic disharmony), while Natalie Cole’s Coffee Time (2008) might have been itself written as a commercial. Busting Up a Starbucks: The Politics of Coffee Politics and coffee meet most palpably at the coffee shop. This conjunction has a well-documented history beginning with the establishment of coffee houses in Europe and the birth of the public sphere (Habermas; Love; Pincus). The first popular songs to reference coffee shops include Jaybird Coleman’s Coffee Grinder Blues (1930), which boasts of skills that precede the contemporary notion of a barista by four decades; and Let's Have Another Cup of Coffee (1932) from Irving Berlin’s depression-era musical Face The Music, where the protagonists decide to stay in a restaurant drinking coffee and eating pie until the economy improves. Coffee in a Cardboard Cup (1971) from the Broadway musical 70 Girls 70 is an unambiguous condemnation of consumerism, however, it was written, recorded and produced a generation before Starbucks’ aggressive expansion and rapid dominance of the coffee house market during the 1990s. The growth of this company caused significant criticism and protest against what seemed to be a ruthless homogenising force that sought to overwhelm local competition (Holt; Thomson). In response, Starbucks has sought to be defined as a more responsive and interactive brand that encourages “glocalisation” (de Larios; Thompson). Koller, however, has characterised glocalisation as the manipulative fabrication of an “imagined community”—whose heterogeneity is in fact maintained by the aesthetics and purchasing choices of consumers who make distinctive and conscious anti-brand statements (114). Neat Capitalism is a more useful concept here, one that intercedes between corporate ideology and postmodern cultural logic, where such notions as community relations and customer satisfaction are deliberately and perhaps somewhat cynically conflated with the goal of profit maximisation (Rojek). As the world’s largest chain of coffee houses with over 19,400 stores in March 2012 (Loxcel), Starbucks is an exemplar of this phenomenon. Their apparent commitment to environmental stewardship, community relations, and ethical sourcing is outlined in the company’s annual “Global Responsibility Report” (Vimac). It is also demonstrated in their engagement with charitable and environmental non-governmental organisations such as Fairtrade and Co-operative for Assistance and Relief Everywhere (CARE). By emphasising this, Starbucks are able to interpellate (that is, “call forth”, “summon”, or “hail” in Althusserian terms) those consumers who value environmental protection, social justice and ethical business practices (Rojek 117). Bob Dylan and Sheryl Crow provide interesting case studies of the persuasive cultural influence evoked by Neat Capitalism. Dylan’s 1962 song Talkin’ New York satirised his formative experiences as an impoverished performer in Greenwich Village’s coffee houses. In 1995, however, his decision to distribute the Bob Dylan: Live At The Gaslight 1962 CD exclusively via Starbucks generated significant media controversy. Prominent commentators expressed their disapproval (Wilson Harris) and HMV Canada withdrew Dylan’s product from their shelves (Lynskey). Despite this, the success of this and other projects resulted in the launch of Starbucks’s in-house record company, Hear Music, which released entirely new recordings from major artists such as Ray Charles, Paul McCartney, Joni Mitchell, Carly Simon and Elvis Costello—although the company has recently announced a restructuring of their involvement in this venture (O’Neil). Sheryl Crow disparaged her former life as a waitress in Coffee Shop (1995), a song recorded for her second album. “Yes, I was a waitress. I was a waitress not so long ago; then I won a Grammy” she affirmed in a YouTube clip of a live performance from the same year. More recently, however, Crow has become an avowed self-proclaimed “Starbucks groupie” (Tickle), releasing an Artist’s Choice (2003) compilation album exclusively via Hear Music and performing at the company’s 2010 Annual Shareholders’s Meeting. Songs voicing more unequivocal dissatisfaction with Starbucks’s particular variant of Neat Capitalism include Busting Up a Starbucks (Mike Doughty, 2005), and Starbucks Takes All My Money (KJ-52, 2008). The most successful of these is undoubtedly Ron Sexsmith’s Jazz at the Bookstore (2006). Sexsmith bemoans the irony of intense original blues artists such as Leadbelly being drowned out by the cacophony of coffee grinding machines while customers queue up to purchase expensive coffees whose names they can’t pronounce. In this, he juxtaposes the progressive patina of corporate culture against the circumstances of African-American labour conditions in the deep South, the shocking incongruity of which eventually cause the old bluesman to turn in his grave. Fredric Jameson may have good reason to lament the depthless a-historical pastiche of postmodern popular culture, but this is no “nostalgia film”: Sexsmith articulates an artfully framed set of subtle, sensitive, and carefully contextualised observations. Songs about coffee also intersect with politics via lyrics that play on the mid-brown colour of the beverage, by employing it as a metaphor for the sociological meta-narratives of acculturation and assimilation. First popularised in Israel Zangwill’s 1905 stage play, The Melting Pot, this term is more commonly associated with Americanisation rather than miscegenation in the United States—a nuanced distinction that British band Blue Mink failed to grasp with their memorable invocation of “coffee-coloured people” in Melting Pot (1969). Re-titled in the US as People Are Together (Mickey Murray, 1970) the song was considered too extreme for mainstream radio airplay (Thompson). Ike and Tina Turner’s Black Coffee (1972) provided a more accomplished articulation of coffee as a signifier of racial identity; first by associating it with the history of slavery and the post-Civil Rights discourse of African-American autonomy, then by celebrating its role as an energising force for African-American workers seeking economic self-determination. Anyone familiar with the re-casting of black popular music in an industry dominated by Caucasian interests and aesthetics (Cashmore; Garofalo) will be unsurprised to find British super-group Humble Pie’s (1973) version of this song more recognisable. Conclusion Coffee-flavoured popular songs celebrate the stimulant effects of caffeine, provide metaphors for courtship rituals, and offer critiques of Neat Capitalism. Harold Love and Guthrie Ramsey have each argued (from different perspectives) that the cultural micro-narratives of small social groups allow us to identify important “ethnographic truths” (Ramsey 22). Aesthetically satisfying and intellectually stimulating coffee songs are found where these micro-narratives intersect with the ethnographic truths of coffee culture. 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As the ball dropped on 1999, is it any wonder that No Doubt played, “It’s the End of the World as We Know It” by R.E.M. live on MTV? Any discussion of the Nineties—and its pinnacle moment, Y2K—requires a discussion of both the cover and the glitch, two performative and technological enactments that fomented the collapse between author-reader and user-machine that has, twenty years later, become normalised in today’s Post Internet culture. By staging failure and inviting the audience to participate, the glitch and the cover call into question the original and the origin story. This breakdown of normative borders has prompted the convergence of previously demarcated media, genres, and cultures, a constellation from which to recognise a stochastic hybrid form. The Cover as a Revelation of Collaborative MurmurBefore Sean Parker collaborated with Shawn Fanning to launch Napster on 1 June 1999, networked file distribution existed as cumbersome text-based programs like Internet Relay Chat and Usenet, servers which resembled bulletin boards comprising multiple categories of digitally ripped files. Napster’s simple interface, its advanced search filters, and its focus on music and audio files fostered a peer-to-peer network that became the fastest growing website in history, registering 80 million users in less than two years.In harnessing the transgressive power of the Internet to force a new mode of content sharing, Napster forced traditional providers to rethink what constitutes “content” at a moment which prefigures our current phenomena of “produsage” (Bruns) and the vast popularity of user-generated content. At stake is not just the democratisation of art but troubling the very idea of intellectual property, which is to say, the very concept of ownership.Long before the Internet was re-routed from military servers and then mainstreamed, Michel Foucault understood the efficacy of anonymous interactions on the level of literature, imagining a culture where discourse would circulate without any need for an author. But what he was asking in 1969 is something we can better answer today, because it seems less germane to call into question the need for an author in a culture in which everyone is writing, producing, and reproducing text, and more effective to think about re-evaluating the notion of a single author, or what it means to write by yourself. One would have to testify to the particular medium we have at our disposal, the Internet’s ultimate permissibility, its provocations for collaboration and co-creation. One would have to surrender the idea that authors own anything besides our will to keep producing, and our desire for change; and to modulate means to resist without negating, to alter without omitting, to enable something new to come forward; the unfolding of the text into the anonymity of a murmur.We should remind ourselves that “to author” all the way down to its Latin roots signifies advising, witnessing, and transferring. We should be reminded that to author something means to forget the act of saying “I,” to forget it or to make it recede in the background in service of the other or others, on behalf of a community. The de-centralisation of Web development and programming initiated by Napster inform a poetics of relation, an always-open structure in which, as Édouard Glissant said, “the creator of a text is effaced, or rather, is done away with, to be revealed in the texture of his creation” (25). When a solid melts, it reveals something always underneath, something at the bottom, something inside—something new and something that was always already there. A cover, too, is both a revival and a reworking, an update and an interpretation, a retrospective tribute and a re-version that looks toward the future. In performing the new, the original as singular is called into question, replaced by an increasingly fetishised copy made up of and made by multiples.Authorial Effacement and the Exigency of the ErrorY2K, otherwise known as the Millennium Bug, was a coding problem, an abbreviation made to save memory space which would disrupt computers during the transition from 1999 to 2000, when it was feared that the new year would become literally unrecognisable. After an estimated $300 billion in upgraded hardware and software was spent to make computers Y2K-compliant, something more extraordinary than global network collapse occurred as midnight struck: nothing.But what if the machine admits the possibility of accident? Implicit in the admission of any accident is the disclosure of a new condition—something to be heard, to happen, from the Greek ad-cadere, which means to fall. In this drop into non-repetition, the glitch actualises an idea about authorship that necessitates multi-user collaboration; the curtain falls only to reveal the hidden face of technology, which becomes, ultimately, instructions for its re-programming. And even as it deviates, the new form is liable to become mainstreamed into a new fashion. “Glitch’s inherently critical moment(um)” (Menkman 8) indicates this potential for technological self-insurgence, while suggesting the broader cultural collapse of generic markers and hierarchies, and its ensuing flow into authorial fluidity.This feeling of shock, this move “towards the ruins of destructed meaning” (Menkman 29) inherent in any encounter with the glitch, forecasted not the immediate horror of Y2K, but the delayed disasters of 9/11, Hurricane Katrina, Deepwater Horizon Oil Spill, Indian Ocean tsunami, Sichuan Province earthquake, global financial crisis, and two international wars that would all follow within the next nine years. If, as Menkman asserts, the glitch, in representing a loss of self-control “captures the machine revealing itself” (30), what also surfaces is the tipping point that edges us toward a new becoming—not only the inevitability of surrender between machine and user, but their reversibility. Just as crowds stood, transfixed before midnight of the new millennium in anticipation of the error, or its exigency, it’s always the glitch I wait for; it’s always the glitch I aim to re-create, as if on command. The accidental revelation, or the machine breaking through to show us its insides. Like the P2P network that Napster introduced to culture, every glitch produces feedback, a category of noise (Shannon) influencing the machine’s future behaviour whereby potential users might return the transmission.Re-Orienting the Bizarre in Fantasy and FictionIt is in the fantasy of dreams, and their residual leakage into everyday life, evidenced so often in David Lynch’s Twin Peaks, where we can locate a similar authorial agency. The cult Nineties psycho-noir, and its discontinuous return twenty-six years later, provoke us into reconsidering the science of sleep as the art of fiction, assembling an alternative, interactive discourse from found material.The turning in and turning into in dreams is often described as an encounter with the “bizarre,” a word which indicates our lack of understanding about the peculiar processes that normally happen inside our heads. Dreams are inherently and primarily bizarre, Allan J. Hobson argues, because during REM sleep, our noradrenergic and serotonergic systems do not modulate the activated brain, as they do in waking. “The cerebral cortex and hippocampus cannot function in their usual oriented and linear logical way,” Hobson writes, “but instead create odd and remote associations” (71). But is it, in fact, that our dreams are “bizarre” or is it that the model itself is faulty—a precept premised on the normative, its dependency upon generalisation and reducibility—what is bizarre if not the ordinary modulations that occur in everyday life?Recall Foucault’s interest not in what a dream means but what a dream does. How it rematerialises in the waking world and its basis in and effect on imagination. Recall recollection itself, or Erin J. Wamsley’s “Dreaming and Offline Memory Consolidation.” “A ‘function’ for dreaming,” Wamsley writes, “hinges on the difficult question of whether conscious experience in general serves any function” (433). And to think about the dream as a specific mode of experience related to a specific theory of knowledge is to think about a specific form of revelation. It is this revelation, this becoming or coming-to-be, that makes the connection to crowd-sourced content production explicit—dreams serve as an audition or dress rehearsal in which new learning experiences with others are incorporated into the unconscious so that they might be used for production in the waking world. Bert O. States elaborates, linking the function of the dream with the function of the fiction writer “who makes models of the world that carry the imprint and structure of our various concerns. And it does this by using real people, or ‘scraps’ of other people, as the instruments of hypothetical facts” (28). Four out of ten characters in a dream are strangers, according to Calvin Hall, who is himself a stranger, someone I’ve never met in waking life or in a dream. But now that I’ve read him, now that I’ve written him into this work, he seems closer to me. Twin Peak’s serial lesson for viewers is this—even the people who seem strangers to us can interact with and intervene in our processes of production.These are the moments that a beginning takes place. And even if nothing directly follows, this transfer constitutes the hypothesised moment of production, an always-already perhaps, the what-if stimulus of charged possibility; the soil plot, or plot line, for freedom. Twin Peaks is a town in which the bizarre penetrates the everyday so often that eventually, the bizarre is no longer bizarre, but just another encounter with the ordinary. Dream sequences are common, but even more common—and more significant—are the moments in which what might otherwise be a dream vision ruptures into real life; these moments propel the narrative.Exhibit A: A man who hasn’t gone outside in a while begins to crumble, falling to the earth when forced to chase after a young girl, who’s just stolen the secret journal of another young girl, which he, in turn, had stolen.B: A horse appears in the middle of the living room after a routine vacuum cleaning and a subtle barely-there transition, a fade-out into a fade-in, what people call a dissolve. No one notices, or thinks to point out its presence. Or maybe they’re distracted. Or maybe they’ve already forgotten. Dissolve.(I keep hitting “Save As.” As if renaming something can also transform it.)C: All the guests at the Great Northern Hotel begin to dance the tango on cue—a musical, without any music.D: After an accident, a middle-aged woman with an eye patch—she was wearing the eye patch before the accident—believes she’s seventeen again. She enrolls in Twin Peaks High School and joins the cheerleading team.E: A woman pretending to be a Japanese businessman ambles into the town bar to meet her estranged husband, who fails to recognise his cross-dressing, race-swapping wife.F: A girl with blond hair is murdered, only to come back as another girl, with the same face and a different name. And brown hair. They’re cousins.G: After taking over her dead best friend’s Meals on Wheels route, Donna Hayward walks in to meet a boy wearing a tuxedo, sitting on the couch with his fingers clasped: a magician-in-training. “Sometimes things can happen just like this,” he says with a snap while the camera cuts to his grandmother, bed-ridden, and the appearance of a plate of creamed corn that vanishes as soon as she announces its name.H: A woman named Margaret talks to and through a log. The log, cradled in her arms wherever she goes, becomes a key witness.I: After a seven-minute diegetic dream sequence, which includes a one-armed man, a dwarf, a waltz, a dead girl, a dialogue played backward, and a significantly aged representation of the dreamer, Agent Cooper wakes up and drastically shifts his investigation of a mysterious small-town murder. The dream gives him agency; it turns him from a detective staring at a dead-end to one with a map of clues. The next day, it makes him a storyteller; all the others, sitting tableside in the middle of the woods become a captive audience. They become readers. They read into his dream to create their own scenarios. Exhibit I. The cycle of imagination spins on.Images re-direct and obfuscate meaning, a process of over-determination which Foucault says results in “a multiplication of meanings which override and contradict each other” (DAE 34). In the absence of image, the process of imagination prevails. In the absence of story, real drama in our conscious life, we form complex narratives in our sleep—our imaginative unconscious. Sometimes they leak out, become stories in our waking life, if we think to compose them.“A bargain has been struck,” says Harold, an under-5 bit player, later, in an episode called “Laura’s Secret Diary.” So that she might have the chance to read Laura Palmer’s diary, Donna Hayward agrees to talk about her own life, giving Harold the opportunity to write it down in his notebook: his “living novel” the new chapter which reads, after uncapping his pen and smiling, “Donna Hayward.”He flips to the front page and sets a book weight to keep the page in place. He looks over at Donna sheepishly. “Begin.”Donna begins talking about where she was born, the particulars of her father—the lone town doctor—before she interrupts the script and asks her interviewer about his origin story. Not used to people asking him the questions, Harold’s mouth drops and he stops writing. He puts his free hand to his chest and clears his throat. (The ambient, wind-chime soundtrack intensifies.) “I grew up in Boston,” he finally volunteers. “Well, actually, I grew up in books.”He turns his head from Donna to the notebook, writing feverishly, as if he’s begun to write his own responses as the camera cuts back to his subject, Donna, crossing her legs with both hands cupped at her exposed knee, leaning in to tell him: “There’s things you can’t get in books.”“There’s things you can’t get anywhere,” he returns, pen still in his hand. “When we dream, they can be found in other people.”What is a call to composition if not a call for a response? It is always the audience which makes a work of art, re-framed in our own image, the same way we re-orient ourselves in a dream to negotiate its “inconsistencies.” Bizarreness is merely a consequence of linguistic limitations, the overwhelming sensory dream experience which can only be re-framed via a visual representation. And so the relationship between the experience of reading and dreaming is made explicit when we consider the associations internalised in the reader/audience when ingesting a passage of words on a page or on the stage, objects that become mental images and concept pictures, a lens of perception that we may liken to another art form: the film, with its jump-cuts and dissolves, so much like the defamiliarising and dislocating experience of dreaming, especially for the dreamer who wakes. What else to do in that moment but write about it?Evidence of the bizarre in dreams is only the evidence of the capacity of our human consciousness at work in the unconscious; the moment in which imagination and memory come together to create another reality, a spectrum of reality that doesn’t posit a binary between waking and sleeping, a spectrum of reality that revels in the moments where the two coalesce, merge, cross-pollinate—and what action glides forward in its wake? Sustained un-hesitation and the wish to stay inside one’s self. To be conscious of the world outside the dream means the end of one. To see one’s face in the act of dreaming would require the same act of obliteration. Recognition of the other, and of the self, prevents the process from being fulfilled. Creative production and dreaming, like voyeurism, depend on this same lack of recognition, or the recognition of yourself as other. What else is a dream if not a moment of becoming, of substituting or sublimating yourself for someone else?We are asked to relate a recent dream or we volunteer an account, to a friend or lover. We use the word “seem” in nearly every description, when we add it up or how we fail to. Everything seems to be a certain way. It’s not a place but a feeling. James, another character on Twin Peaks, says the same thing, after someone asks him, “Where do you want to go?” but before he hops on his motorcycle and rides off into the unknowable future outside the frame. Everything seems like something else, based on our own associations, our own knowledge of people and things. Offline memory consolidation. Seeming and semblance. An uncertainty of appearing—both happening and seeing. How we mediate—and re-materialise—the dream through text is our attempt to re-capture imagination, to leave off the image and better become it. If, as Foucault says, the dream is always a dream of death, its purpose is a call to creation.Outside of dreams, something bizarre occurs. We call it novelty or news. We might even bestow it with fame. A man gets on the wrong plane and ends up halfway across the world. A movie is made into the moment of his misfortune. Years later, in real life and in movie time, an Iranian refugee can’t even get on the plane; he is turned away by UK immigration officials at Charles de Gaulle, so he spends the next sixteen years living in the airport lounge; when he departs in real life, the movie (The Terminal, 2004) arrives in theaters. Did it take sixteen years to film the terminal exile? How bizarre, how bizarre. OMC’s eponymous refrain of the 1996 one-hit wonder, which is another way of saying, an anomaly.When all things are counted and countable in today’s algorithmic-rich culture, deviance becomes less of a statistical glitch and more of a testament to human peculiarity; the repressed idiosyncrasies of man before machine but especially the fallible tendencies of mankind within machines—the non-repetition of chance that the Nineties emblematised in the form of its final act. The point is to imagine what comes next; to remember waiting together for the end of the world. There is no need to even open your eyes to see it. It is just a feeling. ReferencesBruns, Axel. “Towards Produsage: Futures for User-Led Content Production.” Cultural Attitudes towards Technology and Communication 2006: Proceedings of the Fifth International Conference, eds. Fay Sudweeks, Herbert Hrachovec, and Charles Ess. Murdoch: School of Information Technology, 2006. 275-84. <https://eprints.qut.edu.au/4863/1/4863_1.pdf>.Foucault, Michel. “Dream, Imagination and Existence.” Dream and Existence. Ed. Keith Hoeller. Pittsburgh: Review of Existential Psychology & Psychiatry, 1986. 31-78.———. “What Is an Author?” The Foucault Reader: An Introduction to Foucault’s Thought. Ed. Paul Rainbow. New York: Penguin, 1991.Glissant, Édouard. Poetics of Relation. Trans. Betsy Wing. Ann Arbor: U of Michigan P, 1997.Hall, Calvin S. The Meaning of Dreams. New York: McGraw Hill, 1966.Hobson, J. Allan. The Dream Drugstore: Chemically Altered State of Conscious­ness. Cambridge: MIT Press, 2001.Menkman, Rosa. The Glitch Moment(um). Amsterdam: Network Notebooks, 2011.Shannon, Claude Elwood. “A Mathematical Theory of Communication.” The Bell System Technical Journal 27 (1948): 379-423.States, Bert O. “Bizarreness in Dreams and Other Fictions.” The Dream and the Text: Essays on Literature and Language. Ed. Carol Schreier Rupprecht. Albany: SUNY P, 1993.Twin Peaks. Dir. David Lynch. ABC and Showtime. 1990-3 & 2017. Wamsley, Erin. “Dreaming and Offline Memory Consolidation.” Current Neurology and Neuroscience Reports 14.3 (2014): 433. “Y2K Bug.” Encyclopedia Britannica. 18 July 2018. <https://www.britannica.com/technology/Y2K-bug>.

Introduction In a 1984 New York Times interview, Germaine Greer discussed the quite different views that have surrounded her supposed attitude towards sex. As she put it, “People seem to think I'm Hugh Hefner and that the reason women started having sex is because I told them to” (qtd. in De Lacy). This view had, however, shifted by the 1980s. As she told reporter Justine De Lacy, “Now they are saying that I'm against sex.” In this article, I tease out Greer’s remarks about the supposed transformation of her political persona. I do so with reference to her work on Suck Magazine, which was billed by its editors as “The First European Sex Paper,” and which was first published in 1969 (cited in Gleeson 86). The article has two key aims. The first is to demonstrate that Greer has not (as it might seem) transformed from a sexual revolutionary to an anti-sex ideologue. This view is too simplistic. The article’s second aim is to explore Greer’s significant but under-acknowledged contribution to feminist debates about pornography. Far from being strictly anti- or pro-porn, Greer’s work on Suck actually aligns with both of these positions, and it appeared before the feminist porn debates really gained traction. Germaine Greer as Sexual Revolutionary and/or Anti-Sex Ideologue? The apparent political transformation that Greer mentioned in 1984 has been particularly apparent since the 1990s. Since that decade, she has criticised pornography on several occasions. For example, in her book The Whole Woman (1999), Greer argued, “Pornography is the flight from woman, men’s denial of sex as a medium of communication . . .” (181). In an article published in The Guardian in 2000, Greer wrote, “Can [pornography] go too far? No, it can't. As far as male sexual fantasy is concerned there is no too far.” In a 2012 episode of the Australian current affairs program Q&A, Greer argued, “Pornography is the advertisement of prostitution.”Greer’s stance on pornography, and particularly her invocation of female sexual subordination, might seem to represent a radical shift from the political persona that she cultivated during the 1960s and 1970s. During that earlier period, Greer was arguing for female sexual empowerment. She posed nude for Suck. In 1971, the US magazine Life described Greer as a “saucy feminist that even men like” (qtd. in Wallace, unpaginated photograph). There is nothing “saucy” about her more recent anti-porn posture; this posture is not concerned with “empowerment” in any obvious way. Yet I would suggest that Greer at least anticipated this posture in her work on Suck. In that magazine, she did not frame sex as being entirely emancipatory. Rather, Greer argued for sexual liberation (particularly for women), but (in doing so) she also invoked the hierarchical gender roles that would later be invoked in anti-porn feminist arguments. Examining some of Greer’s contributions to Suck will make clear the important contribution that she has made to feminist debates about pornography. These are debates which she has not generally been associated with, or at least not to the extent that Andrea Dworkin and Catharine A. MacKinnon (both US feminists who have very publicly remonstrated against porn) have (see Dworkin; MacKinnon and Dworkin). The feminist porn debates gained ascendance during the late 1970s and early 1980s, and seem to have been liveliest in North America (see Bronstein; Duggan and Hunter; MacKinnon and Dworkin). These debates are significant because of what they say about the truly complex and contentious relationship between sex, gender, power, and representation. The feminist porn debates have been broad-ranging (Sullivan and McKee 10), though they tend to have been framed as polarised conflicts between anti-pornography feminists and “sex-positive”/“anti-censorship” feminists. For anti-pornography feminists, pornography always symptomatises and perpetuates gender hierarchy. Andrea Dworkin famously defined “pornography” as the graphic, sexually explicit subordination of women in pictures and/or words that also includes women presented dehumanized as sexual objects, things, or commodities; or women presented as sexual objects who enjoy pain or humiliation; or women presented as sexual objects who experience sexual pleasure in being raped; or women presented as sexual objects tied up or cut up or mutilated or bruised or physically hurt; or women presented in postures or positions of sexual submission, servility, or display; or women’s body parts—including but not limited to vaginas, breasts, buttocks—exhibited such that women are reduced to those parts; or women presented as whores by nature . . . (xxxiii) Conversely, sex-positive/anti-censorship feminists tend to assess pornography “on a case by case basis”; porn can range from woman-hating to politically progressive (McKee, Albury, and Lumby 22). For these feminists, attempts to legislate against pornography (for example, via the anti-porn ordinance drawn up in the US during the 1980s by Dworkin and MacKinnon) amount to censorship, and are not in the interest of women, feminism, or sexual liberation (Duggan and Hunter 29–39; and see also MacKinnon and Dworkin). Among the most striking aspects of Greer’s work on Suck is that it actually mobilises aspects of both these (loosely-defined) feminist positions, and appeared almost a decade before pornography became an issue of contention amongst feminists. This work was published not in North America, but in Europe; the Australian-born Greer was living in the United Kingdom at the time of that magazine’s publication, and indeed she has been described as “Britain’s . . . most well-known feminist” (Taylor 759; and see also Gleeson). Does Porn Suck? Greer co-founded Suck in 1969, the year before The Female Eunuch was published. Greer had already established a minor public profile through her journalistic contributions to the London-based Oz Magazine. Several of those contributions were written under the guise of “Dr G—the only groupie with a Ph.D in captivity,” and featured references to “groupiedom” and “cunt power” (qtd. in Gleeson 86). Suck was published in Amsterdam to circumvent “British censorship laws” (Wallace 15). The magazine was very much a product of the then-current sexual revolution, as suggested by the following passage from a 1971 editorial: “Our cause is sexual liberation. Our tactic is the defiance of censorship” (University of Melbourne Archives). Suck comprised sexually-explicit imagery (for example, nudity and shots of (hetero)sexual penetration) and similarly explicit articles. These articles are furnished with the vivid, deliberately provocative prose for which Greer is renowned.In some articles, Greer argues that women’s acceptance of their bodies constitutes a rebellion against patriarchy. In a 1971 article, she writes, “Primitive man feared the vagina . . . as the most magical of magical orifices of the body” (University of Melbourne Archives). The title of this piece is “Lady Love Your Cunt,” and indicates Greer’s view that patriarchal fears—or, as she puts it, the fears of “primitive man”—have contributed to stigma that has surrounded the vagina. Greer concludes thus: “Why not send a photograph of your own cunt, with your names labelled on?” (Whether any readers responded to this invitation remains unclear.) In “Bounce Titty Bounce,” she describes a “Mafia that controls the shapes of [women’s] bodies” (University of Melbourne Archives). This control is particularly evident in the brassiere, which Greer calls “a muzzle, a mask, binding joys and desires with wire and rubber and nylon and clips and cotton.” In a 1970 article entitled “Ladies get on top for better orgasms,” Greer opens with the statement: “The prevalence of the missionary position of fucking in the Western World [sic] seems to mean a widespread unfairness in sex.” She elaborates: Even if women were not . . . slighter than men, the missionary position would have little to commend it. The hands of the man are not free to play with his lover’s breasts or clitoris . . . because he must support himself, at least partially by them . . . The male ismin [sic] full control. Greer concedes that the “female on top position is perhaps the least popular of the alternatives to the missionary position.” The “female on top” position does, however, have advantages for women, one being that a woman “can arrive at a position to accept the cock without having to take her weight on her hands.” Greer’s best-known contribution to Suck is a selection of nude photographs that were published in a 1971 edition. In one shot, Greer is lying on her back, her legs behind her ears, her anus directly in front of the camera. In another shot, she is positioned in the same manner, although her anus and vagina are more central within the frame. In both shots, Greer is gazing directly into the camera and smiling. On one level, the textual and photographic examples described above—and, in fact, the very publication of Suck—suggest a rebellion against sexual repression. This rebellion was characteristic of the sexual revolution (Gleeson 86). Yet, in advocating female sexual empowerment, Greer distanced herself from the masculine bias of that movement. In her 1984 New York Times interview, Greer was quoted as saying that “. . . the sexual revolution never happened. Permissiveness happened, and that’s no better than repressiveness, because women are still being manipulated by men” (qtd. in De Lacy). Here, she anticipates arguments (e.g. Jeffreys) that the sexual revolution of the 1960s and 1970s actually sanctioned (heterosexual) male desire and men’s sexual access to women. In Suck, then, Greer argued that women need to liberate themselves sexually, and not only be seen as instruments for male sexual liberation. Greer did pose nude, but, in doing so, she stared back into the camera/at the spectator—thus returning the gaze, rather than being objectified by this gaze (Mulvey). Greer has described her shots thus: “Face, pubes and anus, nothing decorative about it. Nothing sexy about it either. Confrontation was the name of the game” (qtd. in Gleeson 86). In 2013, Greer wrote of that photo shoot: “Women’s bodies were merchandised. Each week we saw a little more: nipples, then pussy . . . drip-feeding the masturbation fantasies of a [male] generation. My gesture aimed to short-circuit that process.” She has also been quoted as saying that she envisioned Suck as an “antidote to the exploitative papers like Screw and Hustler,” by “developing a new kind of erotic art, away from the tits ‘n’ ass and the peep show syndrome” (qtd. in Gleeson 86). Thus, Greer’s Suck contributions seem to foreshadow the “sex-positive” feminism that would emerge later in the 1970s in North America (e.g. Duggan and Hunter). Her work would also anticipate feminist uses of porn to explore female sexuality from specifically female and feminist perspectives (see Taormino et al.). A closer examination of these contributions, however, suggests a more complex picture. Witness Greer’s reference to the popularity of “missionary sex” as a reason for “widespread unfairness in sex,” or her description of a (presumably) male-dominated “Mafia” who control women’s bodies (for example, via the bra). In a newspaper interview that was published around the time of The Female Eunuch’s 1970 publication, Greer argued that sex needs to be “rescued” from the patriarchy by feminists. This is because sex under patriarchy has been characterised by the dichotomised positions of “powerful and powerless, masterful and mastered.” In this scenario, women are the ones who are “powerless” and “mastered.” The title of that interview is “Author Attacks Dominating Male” (University of Melbourne Archives).The above statements suggest a sexual landscape characterised by “potentially violent, dominant men and subordinated, silenced women” (Duggan and Hunter 7). In this landscape, sex is a site of gender inequality; and even something as apparently innocuous as underwear is used by men to control women. The pervasive sense of patriarchy invoked here would (as scholars such as Duggan and Hunter have argued) be invoked in much anti-pornography feminist writing. And Greer would go on to concur with the anti-porn stance, as the three pronouncements cited at the beginning of this article attest. (In Suck, Greer does not attempt to define “pornography,” and nor does she classify her contributions as being “pornography” or “anti-pornography.”)ConclusionI have argued that it is useful to revisit some of Germaine Greer’s contributions to Suck Magazine in order to reassess her apparent transformation from sexual revolutionary to anti-sex ideologue. These contributions (which include articles and photographs) are celebrations of female sexual empowerment and critiques of what Greer sees as a pervasive gender hierarchy. I have argued that this work is also useful in that it anticipates the feminist debates about pornography that would gain ascendance in North America almost a decade after Suck’s publication. Greer articulates arguments that would come to be aligned with both “sex-positive” and “anti-pornography” feminist discourses. To this extent, she has made an important and thus far largely unacknowledged contribution to these highly polarised feminist debates. ReferencesBronstein, Carolyn. Battling Pornography: The American Feminist Anti-Pornography Movement, 1976–1986. Cambridge: Cambridge UP, 2011.De Lacy, Justine. “Germaine Greer’s New Book Stirs a Debate.” The New York Times. 5 Mar. 1984. 21 Oct. 2015 <https://www.nytimes.com/books/99/05/09/specials/greer-debate.html>.Duggan, Lisa, and Nan D. Hunter, eds. “Introduction.” Sex Wars: Sexual Dissent and Political Culture. 10th Anniversary Edition. London: Routledge, 2006. 1–13.Dworkin, Andrea. Pornography: Men Possessing Women. New York: Plume, 1989. Gleeson, Kate. “From Suck Magazine to Corporate Paedophilia: Feminism and Pornograph—Remembering the Australian Way.” Women’s Studies International Forum 38 (2013): 83–96.Greer, Germaine. The Whole Woman. London: Transworld Publishers, 1999. ———. “Gluttons for Porn.” The Guardian 24 Sep. 2000. 21 Oct. 2015 <http://www.theguardian.com/books/2000/sep/24/society>.———. “As Women Bare All in Feminist Protest, Germaine Greer Asks: Is This Feminism?” News.com.au 17 Mar. 2013. 30 July 2016 <http://www.news.com.au/lifestyle/as-women-bare-all-in-feminist-protest-germaine-greer-asks-is-this-feminism/story-fneszs56-1226598414628>.Jeffreys, Sheila. Anticlimax: A Feminist Perspective on the Sexual Revolution. London: The Women’s Press, 1990. MacKinnon, Catharine A., and Andrea Dworkin, eds. In Harm’s Way: The Pornography Civil Rights Hearings. Massachusetts: Harvard UP, 1997. McKee, Alan, Katherine Albury, and Catharine Lumby. The Porn Report. Melbourne: Melbourne UP, 2008. 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