Journal articles on the topic 'National Health Care Expenditures Study (U.S.)'

Relevance of the research topic. In the context of the COVID-19 pandemic, the health care financing system is an important tool for regulating social processes. Accordingly, the assessment of its institutional components, financial and economic risks in this area is an important condition for the formation and implementation of sound public policy in the field of health. Formulation of the problem. In the context of deteriorating trends in national economic development, important tasks are: substantiation of priority areas of state policy in the field of health care, in particular to strengthen the funding system in this area, ensuring an economically sound level of social standards. At the same time, the basis for the quality level of implementation of state policy in the field of health care is its coherence with the strategic directions of socio-economic development of the country in the short, medium and long term. Analysis of recent research and publications. The issue of formation and implementation of state policy in the field of health care, financing of health care is quite common in research. These are the works of foreign and domestic scientists: Barrow H., Bella P., Gupta S., Dali Eyu, Dzhigira I., Matnonnat J., Mainzyuk K., Sparkes S., Adamenko I., Lysyak L., Chugunova I. and others. Selection of unexplored parts of the general problem. The above issues are relevant in connection with the deteriorating trend of economic development, the pandemic COVID-19, which requires a number of specific tasks related to strengthening the health care financing system. Problem statement, research goals. The objectives of the study are: to reveal the role of the health care financing system in the regulation of socio-economic processes; substantiate the features of the system of financing the health care sector in modern conditions; to analyze and estimate health care expenditures of the State Budget of Ukraine. The purpose of the study is to reveal the directions of state policy on the development of the health care financing system. Method or methodology of the study. The article uses a set of research methods: a systematic approach, statistical analysis, structuring, synthesis, etc. Presentation of the main material (results of work). The role of the health care financing system in the regulation of socio-economic processes is revealed. The peculiarities of the system of financing the sphere of health care in modern conditions are substantiated. The analysis and assessment of health care expenditures of the State Budget of Ukraine was carried out. The directions of the state policy on the development of the system of financing the sphere of health care are substantiated. Field of application of results. The results of the study can be used in the process of forming and implementing public policy in the field of health care. Conclusions in accordance with the article. The validity of the implementation of state policy in the field of health care is an important condition for social development. In order to improve the quality of the health care financing system, at this stage, it is advisable to: take measures to reduce the risk of violation of the sustainability of the financial security system in the field of health care, which involves the modernization of system infrastructure. Stabilization of the level of financial support for health care involves improving budget policy in terms of planning budget expenditures for health care. An important condition for the formation of an effective state policy in the field of health care is to improve the interaction of public administration in terms of informatization of this area. Solving these problems will help create conditions for sustainable social development, the introduction of modern financial tools in the field of health.

SummaryBackground: Since the introduction of exogenous factor VIII therapy, several studies have explored the clinical benefits of prophylactic use of factor VIII. Little research, though, has focused on the economic aspects of this regimen. We conducted a cost analysis using data from the Orthopedic Outcomes Study, a prospective, cross-national study of the clinical outcomes associated with different patterns of factor VIII utilization to examine the health care costs incurred and expenditures averted in patients receiving on-demand versus prophylactic use of factor VIII in hemophilia. Methods and Analysis: 831 patients with severe hemophilia aged 1 to 31 years, from 19 centers around the world were included in the cost analysis. Patients were categorized into three groups according to the number of weeks during the study years in which they received prophylactic regimens of factor VIII. For each subject, we estimated the costs of hospitalization, surgery, days lost from school or work, and factor VIII utilization. Costs were then stratified by age and by joint score to assess confounding, and a multivariate model developed to determine the relationship between use of factor VIII prophylaxis and total costs, while controlling for potential confounders.Results: Patients who received factor VIII episodically incurred substantially greater disability-related costs (days lost from school or work, days hospitalized due to hemophilia, surgery) than patients who received factor VIII prophylactically for some or all of the study period. For all treatment regimens, most disability-related costs were accounted for by hospitalization for hemophilia-related conditions. The cost of factor VIII itself was substantial in all treatment categories but was highest among patients who received year-round prophylaxis, exceeding the savings resulting from reduced disability and other health care expenditures.Conclusions: Reductions in non-factor health care costs and disability associated with prophylactic use of factor VIII in hemophilia were substantial and helped somewhat to offset the much higher costs of this regimen. For certain subgroups, frequent episodic treatment may be more expensive than full-time prophylaxis. However, because of the very high cost of year-round prophylactic use of factor VIII, total health care expenditures were highest among patients receiving this therapeutic regimen. However, because prophylaxis clearly offers important clinical benefits, this approach may be warranted on medical rather than economic grounds.

Abstract Introduction Despite the wide usage of U.S. News & World Report (U.S. News) rankings of ophthalmology hospitals among the public, residency applicants, and ophthalmologists, there is disagreement in the literature on the role of quality of care, research productivity, and other factors in the ranking system. This study investigated the association of U.S. News ranking of ophthalmology hospitals and objective measures of research productivity. Methods The 2020 U.S. News “Best Hospitals for Ophthalmology” ranking lists 38 hospitals by reputation score and numerically ranks the top 12 institutions. For our analysis, top 12 hospitals were classified as group A and the remaining 26 as group B. The Clinicaltrials.gov, National Institutes of Health (NIH) Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER), and NIH Research Portfolio Online Reporting Tools (RePORT) were systematically searched for total clinical trials, NIH funding, and the National Eye Institute (NEI) funding for fiscal years 2017, 2018, and 2019. Faculty size and the number of publications by ophthalmology faculty per hospital were recorded from a previous study in 2016. Results Independent measures of research productivity significantly associated with group A status after multivariate logistic regression analysis were mean faculty Hirsch's index (h-index) over 15 (odds ratio [OR]: 6.13, 95% confidence interval [CI]: [1.14–32.94]) and conducting five or more total clinical trials (OR: 8.77, 95% CI: [1.39–55.16]). Conclusion This study suggests that the reputation-based U.S. News ranking may serve as a proxy for an ophthalmology department's contribution to research measured by mean faculty h-index and number of clinical trials.

Expanding the sphere of interaction between the state and the medical business is one of the priorities for the development of the medical services market in the Russian Federation. The healthcare reform, based on the principles of evidence-based medicine, digital healthcare, and high medical technologies, is primarily aimed at improving the quality of medical services and the availability of highly qualified medical care for all segments of the population. Accessibility, quality and timeliness of medical care are the main postulates of the daily activities of a private medical institution. during the period of increasing crisis phenomena in the economy and social sphere, private medicine can provide significant assistance to the state health service, become the “lifesaver” for the domestic health protection system, which today is mostly represented by the public sector. One of the most effective mechanisms of interaction between the state and private business, adopted all over the world, is the system of public-private partnership. The purpose of the study is to analyze possible forms and mechanisms of interaction between the medical business and the state within the framework of public-private partnership. M a t e r i a l s a n d m e t h o d s . The assessment of the current regulatory framework was carried out, a significant volume of domestic and foreign literary publications was analyzed, the main theoretical hypothesis was formulated on the basis of the systematic scientific method and a research plan was built. R e s u l t s . In the course of the conducted research, objective main cause-and-effect factors affecting the development of an adequate system of public-private partnership in the field of medicine and healthcare have been identified and analyzed, in terms of the distribution of benefits, costs and risks carried out on the principles of long-term, voluntary, manageability, legal validity between a private medical organization and federal and/or municipal executive authorities. The main causal factors include insufficient funding, an unfavorable demographic situation, low efficiency of using the resource base, a reduction in the bed fund under the guise of “optimization”, a decrease in the social level of the population and the redistribution of the medical and diagnostic structure due to the COVID‑19 infection pandemic. It should be recognized that the state system of medical care is not always able to fully meet the needs of societies for high-quality qualified medical care. The analysis of foreign literature has shown that medical services abroad successfully use the principle of public-private partnership, redistributing efforts to form the necessary institutional environment in healthcare between private business and the state. Such a form of interaction as concession, leasing, franchise, outsourcing, aufstaffing allows us to optimally balance the interests of the medical business and public health, significantly optimize the budget costs for health protection, especially in a difficult epidemiological period. The result of the research was the development of a conceptual and theoretical model of various forms of interaction between private medical business and government agencies within the framework of public-private partnership programs. C o n c l u s i o n s . Thus, public-private partnership is an effective economic tool that ensures the coincidence of the interests of private medical business and the state, allowing to make a profit for both subjects of medical activity, with a reduction in state budget expenditures for healthcare purposes, but with the preservation of high quality medical services and resource provision.

Abstract Objective The study aims to determine the effects of implementing stroke unit (SU) care in a remote hospital in North-East India. Materials and Methods This before-and-after implementation study was performed at the Baptist Christian Mission Hospital, Tezpur, Assam between January 2015 and December 2017. Before the implementation of stroke unit care (pre-SU), we collected information on usual stroke care and 1-month outcome of 125 consecutive stroke admissions. Staff was then trained in the delivery of SU care for 1 month, and the same information was collected in a second (post-SU) cohort of 125 patients. Statistical Analysis Chi-square and Mann–Whitney U test were used to compare group differences. The loss to follow-up was imputed by using multiple imputations using the Markov Chain Monto Carlo method. The sensitivity analysis was also performed by using propensity score matching of the groups for baseline stroke severity (National Institute of Health Stroke Scale) using the nearest neighbor approach to control for confounding, and missing values were imputed by using multiple imputations. The adjusted odds ratio was calculated in univariate and multivariate regression analysis after adjusting for baseline variables. All the analysis was done by using SPSS, version 21.0., IBM Corp and R version 4.0.0., Armonk, New York, United States. Results The pre-SU and post-SU groups were age and gender matched. The post-SU group showed higher rates of swallow assessment (36.8 vs. 0%, p < 0.001), mobility assessment, and re-education (100 vs. 91.5%, p = 0.037). The post-SU group also showed reduced complications (28 vs. 45%, p = 0.006) and a shorter length of hospital stay (4 ± 2.16 vs. 5 ± 2.68 days, p = 0.026). The functional outcome (modified ranking scale) at 1-month showed no difference between the groups, good outcome in post-SU (39.6%) versus pre-SU (35.7%), p = 0.552. Conclusion The implementation of this physician-based SU care model in a remote hospital in India shows improvements in quality measures, complications, and possibly patient outcomes.

Purpose. Policies that address the food environment at the population level may help prevent chronic disease, but their value to society is still uncertain. Dietary sodium is linked to increased prevalence of hypertension, a primary risk factor for cardiovascular and renal diseases. This study calculates the potential societal savings of reducing hypertension and related cardiovascular disease via a reduction in population-level sodium intake. On average, U. S. adults consume almost twice the recommended maximum of dietary sodium, most of it from processed foods. Design. This study modeled sodium-reduction scenarios by using a cross-sectional simulation approach. The model used population-level data on blood pressure, antihypertensive medication use, and sodium intake from the National Health and Nutrition Examination Survey (1999–2004). This data was then combined with parameters from the literature on sodium effects, disease outcomes, costs, and quality of life to yield model outcomes. Measures. This study calculated the following outcome measures: hypertension prevalence, direct health care costs, and quality-adjusted life years for noninstitutionalized U.S. adults. Analysis. The simulation was conducted with STATA 9.2 and Microsoft Excel. Survey weights were used to calculate population averages. Results. Reducing average population sodium intake to 2300 mg per day, the recommended maximum for adults, may reduce cases of hypertension by 11 million, save $18 billion health care dollars, and gain 312,000 QALYs that are worth $32 billion annually. Greater reductions in population sodium consumption bring even greater savings to society. Conclusions. Large benefits to society may result from efforts to lower sodium consumption on a population level by modest amounts over time. Although savings in direct health care costs are likely to be quite high, they could easily be matched or exceeded by the value of quality-of-life improvements.

BACKGROUND: The health care workers are considered as vulnerable people who had higher infecting dose of SARS-CoV-2 infection compared to other society. Among more than 500 deaths of Indonesians physicians, obstetrics and gynecologist (OBGYN) has become the most specialists who died in this pandemic. AIM: The objective of our study is to evaluate the antibodies of SARS-CoV-2 in serum OBGYN residents post-vaccination as well as the presence of infection 3 months after the vaccination. METHODS: A prospective cohort study was conducted in OBGYN residents Universitas Indonesia. Serum antibodies SARS-CoV-2 spike (S) protein receptor-binding domain (RBD) was measured using electrochemiluminescence immunoassay, 21 days after Sinovac vaccination, with basic characteristics being recorded. Within 3 months follow-up, the participants were monthly checked related to post-vaccination infection. RESULTS: The median antibodies SARS-CoV-2 for all participants were 50.72 (19.09–98.57) U/mL. There were 20 residents (24.1%) who had post-vaccination infection within 3 months and dominated by asymptomatic to mild symptoms. Body mass index (r = –0.221, p = 0.044) and sleep hours (r = –0.225, p = 0.041) were found to be inversely correlated with antibodies SARS-CoV-2 S RBD. CONCLUSION: Antibodies SARS-CoV-2 S RBD found to be correlated with BMI and sleep hours. The 3-month post-vaccine infection among OBGYN residents was almost similar to Jakarta’s positivity rate and the efficacy rate was higher than expected by National Agency of Drug and Food Control.

Abstract Introduction Management of scalp pressure ulcers (SPU) in patients admitted to intensive care units (ICU) remains a challenge. The impossibility of freely moving the head due to different factors such as the intubation, enteral nutrition, dialysis and use of extracorporeal membrane oxygenation among others, makes the management of these wounds problematic. Herein, we present our early clinical experience in the treatment of SPU with a novel aerosol formulation of silver sulfadiazine. Methods A prospective study including all patients with SPU who were treated with an aerosol formula that includes silver sulfadiazine, lidocaine and vitamin A was carried out. Wound dressings were changed every 12h and consisted in wound cleansing, aerosol application and occlusion with sterile gauze. Evolution of each SPU was controlled with pictures and measures on the affected area every 48 hours. In order to determine the total wound area, pictures were analyzed using the Informatics Image System from the U.S National Institute of Health. Results Six patients were prospectively followed and were included in this study. There were 2 females and 4 males. Average age was 70.8 years (range 41–99), while average hospital stay in the ICU was 14 days (range 5–22). None of these patients experienced wound progression to a more critical stage. One patient had a favorable evolution from stage IV to stage II. Also, none of them showed clinical signs of a local infection of the SPU. The average quantity of aerosol used per dressing was 1.3 ml which represents 2,6 mm/day and a cost of A$106,16 (U$S 1,45). As the cost of hydrocolloid dressings, at our institution, is A$602 per dressing (U$S 8,24), this represented an important saving in costs. Conclusions In this case series, the use of this novel aerosol formulation of silver sulfadiazine has shown promising results in the treatment of SPU in patients admitted to ICU, facilitating the application and saving costs. Further and larger studies to confirm our encouraging preliminary results are warranted.

Background Female Genital Schistosomiasis (FGS) is most often caused by presence of Schistosoma haematobium eggs lodged in the female reproductive tract which results in chronic fibrosis and scarring. In Cameroon, despite high community prevalences of urine-patent S. haematobium infections, FGS has yet to be studied in depth. To shed light on the clinical prevalence and socioeconomic effects of FGS, we undertook a formative community-based epidemiological and qualitative survey. Method A cross sectional multidisciplinary study of 304 girls and women from 11 remote rural fishing communities in Cameroon was undertaken using parasitological sampling, clinical colposcopy, and interviews. The lived experiences of those with FGS were documented using a process of ethnography with participant observation and in-depth interviews. Result Amongst 304 women and girls aged >5 years (Median age: 18; Interquartile range: 9.6–28), 198 females were eligible for FGS testing and 58 adult women were examined by clinical colposcopy. Of these, 34 were positive for FGS (proportion: 58.6%; 95% CI: 45.8–70.4), younger girls showing a higher FGS prevalence, and older women not shedding eggs showing a pattern for cervical lesions from earlier infection. In a subset of women with FGS selected purposively (12/58), in-depth interviews with participant observation revealed out-of-pocket expenditures of up to 500USD related health spending for repeated diagnosis and treatment of gynecological illnesses, and 9 hours daily lost reproductive labour. Psychosocial unrest, loss in social capital, and despair were linked with sub-fertility and persistent vaginal itch. Conclusion With our first formative evidence on prevalence, socioeconomic effects and experiences of FGS amongst women and girls in Cameroon, we have clarified to a new level of detail the deficit in provision of and access to peripheral health services in remote areas of Cameroon. Using this information, there is now strong evidence for national programs and services on women’s health and schistosomiasis to update and revise policies targeted on prevention and management of FGS. We therefore stress the need for regular provision of Praziquantel treatment to adolescent girls and women in S. haematobium endemic areas, alongside better access to tailored diagnostic services that can detect FGS and appropriately triage care at primary health level.

<p><strong>1. How can we maintain a sustainable private practice in the current political and economic climate?</strong></p><p>Eugene Allers</p><p><strong>2. SASOP Clinical guidelines, protocols and algorithms: Development of treatment guidelines for bipolar mood disorder and major depression</strong></p><p> Eugene Allers, Margaret Nair, Gerhard Grobler</p><p><strong>3. The revolving door phenomenon in psychiatry: Comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country</strong></p><p>U A Botha, P Oosthuien, L Koen, J A Joska, J Parker, N Horn</p><p><strong>4. Neurophysiology of emotion and senses - The interface between psyche and soma</strong></p><p>Eugene Allers</p><p><strong>5. Suicide prevention: From and beyond the psychiatrist's hands</strong></p><p>O Alonso Betanourt, M Morales Herrera</p><p><strong>6. Treatment of first-episod psychosis: Efficacy and toleabilty of a long-acting typical antipsychotic </strong></p><p>B Chiliza, R Schoeman, R Emsey, P Oosthuizen, L KOen, D Niehaus, S Hawkridge</p><p><strong>7. Treatment of attention deficit hyperactivity disorder in the young child</strong></p><p>Helen Clark</p><p><strong>8. Holistic/ Alternative treatment in psychiatry: The value of indigenous knowledge systems in cllaboration with moral, ethical and religious approaches in the military services</strong></p><p>J Dill</p><p><strong>9. Treating Schizophrenia: Have we got it wrong?</strong></p><p>Robin Emsley</p><p><strong>10.Terminal questions in the elderly</strong></p><p>Mike Ewart Smith</p><p><strong>11. Mental Health Policy development and implementation in Ghana, South Africa, Uganda and Zambia</strong></p><p>Alan J Flisher, Crick Lund, Michelle Frank, Arvin Bhana, Victor Doku, Natalie Drew, Fred N Kigozi, Martin Knapp, Mayeh Omar, Inge Petersen, Andrew Green andthe MHaPP Research Programme Consortium</p><p><strong>12. What indicators should be used to monitor progress in scaling uo services for people with mental disorders?</strong></p><p>Lancet Global Mental Health Group (Alan J Flisher, Dan Chisholm, Crick Lund, Vikram Patel, Shokhar Saxena, Graham Thornicroft, Mark Tomlinson)</p><p><strong>13. Does unipolar mania merit research in South Africa? A look at the literature</strong></p><p>Christoffel Grobler</p><p><strong>14. Revisiting the Cartesian duality of mind and body</strong></p><p>Oye Gureje</p><p><strong>15. Child and adolescent psychopharmacology: Current trends and complexities</strong></p><p>S M Hawkridge</p><p><strong>16. Integrating mental illness, suicide and religion</strong></p><p>Volker Hitzeroth</p><p><strong>17. Cost of acute inpatient mental health care in a 72-hour assessment uniy</strong></p><p>A B R Janse van Rensburg, W Jassat</p><p><strong>18. Management of Schizophrenia according to South African standard treatment guidelines</strong></p><p>A B R Janse van Rensburg</p><p><strong>19. Structural brain imaging in the clinical management of psychiatric illness</strong></p><p>F Y Jeenah</p><p><strong>20. ADHD: Change in symptoms from child to adulthood</strong></p><p>S A Jeeva, A Turgay</p><p><strong>21. HIV-Positive psychiatric patients in antiretrovirals</strong></p><p>G Jonsson, F Y Jeenah, M Y H Moosa</p><p><strong>22. A one year review of patients admitted to tertiary HIV/Neuropsychiatry beds in the Western Cape</strong></p><p>John Joska, Paul Carey, Ian Lewis, Paul Magni, Don Wilson, Dan J Stein</p><p><strong>23. Star'd - Critical review and treatment implications</strong></p><p>Andre Joubert</p><p><strong>24. Options for treatment-resistent depression: Lessons from Star'd; an interactive session</strong></p><p>Andre Joubert</p><p><strong>25. My brain made me do it: How Neuroscience may change the insanity defence</strong></p><p>Sean Kaliski</p><p><strong>26. Child andadolescent mental health services in four African countries</strong></p><p>Sharon Kleintjies, Alan Flisher, Victoruia Campbell-Hall, Arvin Bhana, Phillippa Bird, Victor Doku, Natalie, Drew, Michelle Funk, Andrew Green, Fred Kigozi, Crick Lund, Angela Ofori-Atta, Mayeh Omar, Inge Petersen, Mental Health and Poverty Research Programme Consortium</p><p><strong>27. Individualistic theories of risk behaviour</strong></p><p>Liezl Kramer, Volker Hitzeroth</p><p><strong>28. Development and implementation of mental health poliy and law in South Africa: What is the impact of stigma?</strong></p><p>Ritsuko Kakuma, Sharon Kleintjes, Crick Lund, Alan J Flisher, Paula Goering, MHaPP Research Programme Consortium</p><p><strong>29. Factors contributing to community reintegration of long-term mental health crae users of Weskoppies Hospital</strong></p><p>Carri Lewis, Christa Kruger</p><p><strong>30. Mental health and poverty: A systematic review of the research in low- and middle-income countries</strong></p><p>Crick Lund, Allison Breen, Allan J Flisher, Ritsuko Kakuma, Leslie Swartz, John Joska, Joanne Corrigall, Vikram Patel, MHaPP Research Programe Consortium</p><p><strong>31. The cost of scaling up mental health care in low- and middle-income countries</strong></p><p>Crick Lund, Dan Chishlom, Shekhar Saxena</p><p><strong>32. 'Tikking'Clock: The impact of a methamphetamine epidemic at a psychiatric hospital in the Western Cape</strong></p><p>P Milligan, J S Parker</p><p><strong>33. Durban youth healh-sk behaviour: Prevalence f Violence-related behaviour</strong></p><p>D L Mkize</p><p><strong>34. Profile of morality of patients amitted Weskoppies Psychiatric Hospital in Sout frican over a 5-Year period (2001-2005)</strong></p><p>N M Moola, N Khamker, J L Roos, P Rheeder</p><p><strong>35. One flew over Psychiatry nest</strong></p><p>Leverne Mountany</p><p><strong>36. The ethical relationship betwe psychiatrists and the pharmaceutical indutry</strong></p><p>Margaret G Nair</p><p><strong>37. Developing the frameor of a postgraduate da programme in mental health</strong></p><p>R J Nichol, B de Klerk, M M Nel, G van Zyl, J Hay</p><p><strong>38. An unfolding story: The experience with HIV-ve patients at a Psychiatric Hospital</strong></p><p>J S Parker, P Milligan</p><p><strong>39. Task shifting: A practical strategy for scalingup mental health care in developing countries</strong></p><p>Vikram Patel</p><p><strong>40. Ethics: Informed consent and competency in the elderly</strong></p><p>Willie Pienaar</p><p><strong>41. Confronting ommonmoral dilemmas. Celebrating uncertainty, while in search patient good</strong></p><p>Willie Pienaar</p><p><strong>42. Moral dilemmas in the treatment and repatriation of patients with psychtorders while visiting our country</strong></p><p>Duncan Ian Rodseth</p><p><strong>43. Geriatrics workshop (Psegal symposium): Medico-legal issuess in geriatric psyhiatry</strong></p><p>Felix Potocnik</p><p><strong>44. Brain stimulation techniques - update on recent research</strong></p><p>P J Pretorius</p><p><strong>45. Holistic/Alternative treatments in psychiatry</strong></p><p>T Rangaka, J Dill</p><p><strong>46. Cognitive behaviour therapy and other brief interventions for management of substances</strong></p><p>Solomon Rataemane</p><p><strong>47. A Transtheoretical view of change</strong></p><p>Nathan P Rogerson</p><p><strong>48. Profile of security breaches in longerm mental health care users at Weskoppies Hospital over a 6-month period</strong></p><p>Deleyn Rema, Lindiwe Mthethwa, Christa Kruger</p><p><strong>49. Management of psychogenic and chronic pain - A novel approach</strong></p><p>M S Salduker</p><p><strong>50. Childhood ADHD and bipolar mood disorders: Differences and similarities</strong></p><p>L Scribante</p><p><strong>51. The choice of antipsychotic in HIV-infected patients and psychopharmacocal responses to antipsychotic medication</strong></p><p>Dinesh Singh, Karl Goodkin</p><p><strong>52. Pearls in clinical neuroscience: A teaching column in CNS Spectrums</strong></p><p><strong></strong>Dan J Stein</p><p><strong>53. Urinary Cortisol secretion and traumatics in a cohort of SA Metro policemen A longitudinal study</strong></p><p>Ugash Subramaney</p><p><strong>54. Canabis use in Psychiatric inpatients</strong></p><p><strong></strong>M Talatala, G M Nair, D L Mkize</p><p><strong>55. Pathways to care and treatmt in first and multi-episodepsychosis: Findings fm a developing country</strong></p><p>H S Teh, P P Oosthuizen</p><p><strong>56. Mental disorders in HIV-infected indivat various HIV Treatment sites in South Africa</strong></p><p>Rita Thom</p><p><strong>57. Attendanc ile of long-term mental health care users at ocupational therapy group sessions at Weskoppies Hospital</strong></p><p>Ronel van der Westhuizen, Christa Kruger</p><p><strong>58. Epidemiological patterns of extra-medical drug use in South Africa: Results from the South African stress and health study</strong></p><p>Margaretha S van Heerden, Anna Grimsrud, David Williams, Dan Stein</p><p><strong>59. Persocentred diagnosis: Where d ps and mental disorders fit in the International classificaton of diseases (ICD)?</strong></p><p>Werdie van Staden</p><p><strong>60. What every psychiatrist needs to know about scans</strong></p><p>Herman van Vuuren</p><p><strong>61. Psychiatric morbidity in health care workers withle drug-resistant erulosis (MDR-TB) A case series</strong></p><p>Urvashi Vasant, Dinesh Singh</p><p><strong>62. Association between uetrine artery pulsatility index and antenatal maternal psychological stress</strong></p><p>Bavanisha Vythilingum, Lut Geerts, Annerine Roos, Sheila Faure, Dan J Stein</p><p><strong>63. Approaching the dual diagnosis dilemma</strong></p><p>Lize Weich</p><p><strong>64. Women's mental health: Onset of mood disturbance in midlife - Fact or fiction</strong></p><p>Denise White</p><p><strong>65. Failing or faking: Isses in the fiagnosis and treatment of adult ADHD</strong></p><p>Dora Wynchank</p>

Background: Globally, surgical site infections (SSIs) not only complicate the surgeries but also lead to $5–10 billion excess health expenditures, along with the increased length of hospital stay. SSI rates have become a universal measure of quality in hospital-based surgical practice because they are probably the most preventable of all healthcare-associated infections. Although, many national regulatory bodies have made it mandatory to report SSI rates, the burden of SSI is still likely to be significant underestimated due to truncated SSI surveillance as well as underestimated postdischarge SSIs. A WHO survey found that in low- to middle-income countries, the incidence of SSIs ranged from 1.2 to 23.6 per 100 surgical procedures. This contrasted with rates between 1.2% and 5.2% in high-income countries. Objectives: We aimed to leverage the existing surveillance capacities at our tertiary-care hospital to estimate the incidence of SSIs in a cohort of trauma patients and to develop and validate an indigenously developed, electronic SSI surveillance system. Methods: A prospective cohort study was conducted at a 248-bed apex trauma center for 18 months. This project was a part of an ongoing multicenter study. The demographic details were recorded, and all the patients who underwent surgery (n = 770) were followed up until 90 days after discharge. The associations of occurrence of SSI and various clinico-microbiological variables were studied. Results: In total, 32 (4.2%) patients developed SSI. S. aureus (28.6%) were the predominant pathogen causing SSI, followed by E. coli (14.3%) and K. pneumoniae (14.3%). Among the patients who had SSI, higher SSI rates were associated in patients who were referred from other facilities (P = .03), had wound class-CC (P < .001), were on HBOT (P = .001), were not administered surgical antibiotics (P = .04), were not given antimicrobial coated sutures (P = .03) or advanced dressings (P = .02), had a resurgery (P < .001), had a higher duration of stay in hospital from admission to discharge (P = .002), as well as from procedure to discharge (P = .002). SSI was cured in only 16 patients (50%) by 90 days. SSI data collection, validation, and analyses are essential in developing countries like India. Thus, it is very crucial to implement a surveillance system and a system for reporting SSI rates to surgeons and conduct a robust postdischarge surveillance using trained and committed personnel to generate, apply, and report accurate SSI data.Funding: NoneDisclosures: None

<p><strong>List of abstracts and authors:</strong></p><p><strong>1. Antipsychotics in anxiety disorders</strong></p><p>Christer Allgulander</p><p><strong>2. Anxiety in somatic disorders</strong></p><p>Christer Allgulander</p><p><strong>3. Community rehabilitation of the schizophrenic patient</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera</p><p><strong>4. Dual diagnosis: A theory-driven multidisciplinary approach for integrative care</strong></p><p>David Blackbeard</p><p><strong>5. The emotional language of the gut - when 'psyche' meets 'soma'</strong></p><p>Helen Clark</p><p><strong>6. The Psychotherapy of bipolar disorder</strong></p><p>Franco Colin</p><p><strong>7. The Psychotherapy of bipolar disorder</strong></p><p>Franco Colin</p><p><strong>8. Developing and adopting mental health policies and plans in Africa: Lessons from South Africa, Uganda and Zambia</strong></p><p>Sara Cooper, Sharon Kleintjes, Cynthia Isaacs, Fred Kigozi, Sheila Ndyanabangi, Augustus Kapungwe, John Mayeya, Michelle Funk, Natalie Drew, Crick Lund</p><p><strong>9. The importance of relapse prevention in schizophrenia</strong></p><p>Robin Emsley</p><p><strong>10. Mental Health care act: Fact or fiction?</strong></p><p>Helmut Erlacher, M Nagdee</p><p><strong>11. Does a dedicated 72-hour observation facility in a district hospital reduce the need for involuntary admissions to a psychiatric hospital?</strong></p><p>Lennart Eriksson</p><p><strong>12. The incidence and risk factors for dementia in the Ibadan study of ageing</strong></p><p>Oye Gureje, Lola Kola, Adesola Ogunniyi, Taiwo Abiona</p><p><strong>13. Is depression a disease of inflammation?</strong></p><p><strong></strong>Angelos Halaris</p><p><strong>14. Paediatric bipolar disorder: More heat than light?</strong></p><p>Sue Hawkridge</p><p><strong>15. EBM: Anova Conundrum</strong></p><p>Elizabeth L (Hoepie) Howell</p><p><strong>16. Tracking the legal status of a cohort of inpatients on discharge from a 72-hour assessment unit</strong></p><p>Bernard Janse van Rensburg</p><p><strong>17. Dual diagnosis units in psychiatric facilities: Opportunities and challenges</strong></p><p>Yasmien Jeenah</p><p><strong>18. Alcohol-induced psychotic disorder: A comparative study on the clinical characteristics of patients with alcohol dependence and schizophrenia</strong></p><p>Gerhard Jordaan, D G Nel, R Hewlett, R Emsley</p><p><strong>19. Anxiety disorders: the first evidence for a role in preventive psychiatry</strong></p><p>Andre F Joubert</p><p><strong>20. The end of risk assessment and the beginning of start</strong></p><p>Sean Kaliski</p><p><strong>21. Psychiatric disorders abd psychosocial correlates of high HIV risk sexual behaviour in war-effected Eatern Uganda</strong></p><p>E Kinyada, H A Weiss, M Mungherera, P Onyango Mangen, E Ngabirano, R Kajungu, J Kagugube, W Muhwezi, J Muron, V Patel</p><p><strong>22. One year of Forensic Psychiatric assessment in the Northern Cape: A comparison with an established assessment service in the Eastern Cape</strong></p><p>N K Kirimi, C Visser</p><p><strong>23. Mental Health service user priorities for service delivery in South Africa</strong></p><p>Sharon Kleintjes, Crick Lund, Leslie Swartz, Alan Flisher and MHaPP Research Programme Consortium</p><p><strong>24. The nature and extent of over-the-counter and prescription drug abuse in cape town</strong></p><p>Liezl Kramer</p><p><strong>25. Physical health issues in long-term psychiatric inpatients: An audit of nursing statistics and clinical files at Weskoppies Hospital</strong></p><p>Christa Kruger</p><p><strong>26. Suicide risk in Schizophrenia - 20 Years later, a cohort study</strong></p><p>Gian Lippi, Ean Smit, Joyce Jordaan, Louw Roos</p><p><strong>27.Developing mental health information systems in South Africa: Lessons from pilot projects in Northern Cape and KwaZulu-Natal</strong></p><p>Crick Lund, S Skeen, N Mapena, C Isaacs, T Mirozev and the Mental Health and Poverty Research Programme Consortium Institution</p><p><strong>28. Mental health aspects of South African emigration</strong></p><p>Maria Marchetti-Mercer</p><p><strong>29. What services SADAG can offer your patients</strong></p><p>Elizabeth Matare</p><p><strong>30. Culture and language in psychiatry</strong></p><p>Dan Mkize</p><p><strong>31. Latest psychotic episode</strong></p><p>Povl Munk-Jorgensen</p><p><strong>32. The Forensic profile of female offenders</strong></p><p>Mo Nagdee, Helmut Fletcher</p><p><strong>33. The intra-personal emotional impact of practising psychiatry</strong></p><p>Margaret Nair</p><p><strong>34. Highly sensitive persons (HSPs) and implications for treatment</strong></p><p>Margaret Nair</p><p><strong>35. Task shifting in mental health - The Kenyan experience</strong></p><p>David M Ndetei</p><p><strong>36. Bridging the gap between traditional healers and mental health in todya's modern psychiatry</strong></p><p>David M Ndetei</p><p><strong>37. Integrating to achieve modern psychiatry</strong></p><p>David M Ndetei</p><p><strong>38. Non-medical prescribing: Outcomes from a pharmacist-led post-traumatic stress disorder clinic</strong></p><p>A Parkinson</p><p><strong>39. Is there a causal relationship between alcohol and HIV? Implications for policy, practice and future research</strong></p><p>Charles Parry</p><p><strong>40. Global mental health - A new global health discipline comes of age</strong></p><p>Vikram Patel</p><p><strong>41. Integrating mental health into primary health care: Lessons from pilot District demonstration sites in Uganda and South Africa</strong></p><p>Inge Petersen, Arvin Bhana, K Baillie and MhaPP Research Programme Consortium</p><p><strong>42. Personality disorders -The orphan child in axis I - Axis II Dichotomy</strong></p><p><strong></strong>Willie Pienaar</p><p><strong>43. Case Studies in Psychiatric Ethics</strong></p><p>Willie Pienaar</p><p><strong>44. Coronary artery disease and depression: Insights into pathogenesis and clinical implications</strong></p><p>Janus Pretorius</p><p><strong>45. Impact of the Mental Health Care Act No. 17 of 2002 on designated hospitals in KwaZulu-Natal: Triumphs and trials</strong></p><p>Suvira Ramlall, Jennifer Chipps</p><p><strong>46. Biological basis of addication</strong></p><p>Solomon Rataemane</p><p><strong>47. Genetics of Schizophrenia</strong></p><p>Louw Roos</p><p><strong>48. Management of delirium - Recent advances</strong></p><p>Shaquir Salduker</p><p><strong>49. Social neuroscience: Brain research on social issues</strong></p><p>Manfred Spitzer</p><p><strong>50. Experiments on the unconscious</strong></p><p>Manfred Spitzer</p><p><strong>51. The Psychology and neuroscience of music</strong></p><p>Manfred Spitzer</p><p><strong>52. Mental disorders in DSM-V</strong></p><p>Dan Stein</p><p><strong>53. Personality, trauma exposure, PTSD and depression in a cohort of SA Metro policemen: A longitudinal study</strong></p><p>Ugashvaree Subramaney</p><p><strong>54. Eating disorders: An African perspective</strong></p><p>Christopher Szabo</p><p><strong>55. An evaluation of the WHO African Regional strategy for mental health 2001-2010</strong></p><p>Thandi van Heyningen, M Majavu, C Lund</p><p><strong>56. A unitary model for the motor origin of bipolar mood disorders and schizophrenia</strong></p><p>Jacques J M van Hoof</p><p><strong>57. The origin of mentalisation and the treatment of personality disorders</strong></p><p>Jacques J M Hoof</p><p><strong>58. How to account practically for 'The Cause' in psychiatric diagnostic classification</strong></p><p>C W (Werdie) van Staden</p><p><strong>POSTER PRESENTATIONS</strong></p><p><strong>59. Problem drinking and physical and sexual abuse at WSU Faculty of Health Sciences, Mthatha, 2009</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera, E, N Kwizera, J L Bernal Munoz</p><p><strong>60. Prevalence of alcohol drinking problems and other substances at WSU Faculty of Health Sciences, Mthatha, 2009</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera, E, N Kwizera, J L Bernal Munoz</p><p><strong>61. Lessons learnt from a modified assertive community-based treatment programme in a developing country</strong></p><p>Ulla Botha, Liezl Koen, John Joska, Linda Hering, Piet Ooosthuizen</p><p><strong>62. Perceptions of psychologists regarding the use of religion and spirituality in therapy</strong></p><p>Ottilia Brown, Diane Elkonin</p><p><strong>63. Resilience in families where a member is living with schizophreni</strong></p><p>Ottilia Brown, Jason Haddad, Greg Howcroft</p><p><strong>64. Fusion and grandiosity - The mastersonian approach to the narcissistic disorder of the self</strong></p><p>William Griffiths, D Macklin, Loray Daws</p><p><strong>65. Not being allowed to exist - The mastersonian approach to the Schizoid disorder of the self</strong></p><p>William Griffiths, D Macklin, Loray Daws</p><p><strong>66. Risky drug-injecting behaviours in Cape Town and the need for a needle exchange programme</strong></p><p>Volker Hitzeroth</p><p><strong>67. Neuroleptic malignant syndrome in adolescents in the Western Cape: A case series</strong></p><p>Terri Henderson</p><p><strong>68. Experience and view of local academic psychiatrists on the role of spirituality in South African specialist psychiatry, compared with a qualitative analysis of the medical literature</strong></p><p>Bernard Janse van Rensburg</p><p><strong>69. The role of defined spirituality in local specialist psychiatric practice and training: A model and operational guidelines for South African clinical care scenarios</strong></p><p>Bernard Janse van Rensburg</p><p><strong>70. Handedness in schizophrenia and schizoaffective disorder in an Afrikaner founder population</strong></p><p>Marinda Joubert, J L Roos, J Jordaan</p><p><strong>71. A role for structural equation modelling in subtyping schizophrenia in an African population</strong></p><p>Liezl Koen, Dana Niehaus, Esme Jordaan, Robin Emsley</p><p><strong>72. Caregivers of disabled elderly persons in Nigeria</strong></p><p>Lola Kola, Oye Gureje, Adesola Ogunniyi, Dapo Olley</p><p><strong>73. HIV Seropositivity in recently admitted and long-term psychiatric inpatients: Prevalence and diagnostic profile</strong></p><p>Christina Kruger, M P Henning, L Fletcher</p><p><strong>74. Syphilis seropisitivity in recently admitted longterm psychiatry inpatients: Prevalence and diagnostic profile</strong></p><p>Christina Kruger, M P Henning, L Fletcher</p><p><strong>75. 'The Great Suppression'</strong></p><p>Sarah Lamont, Joel Shapiro, Thandi Groves, Lindsey Bowes</p><p><strong>76. Not being allowed to grow up - The Mastersonian approach to the borderline personality</strong></p><p>Daleen Macklin, W Griffiths</p><p><strong>77. Exploring the internal confirguration of the cycloid personality: A Rorschach comprehensive system study</strong></p><p>Daleen Macklin, Loray Daws, M Aronstam</p><p><strong>78. A survey to determine the level of HIV related knowledge among adult psychiatric patients admitted to Weskoppies Hospital</strong></p><p><strong></strong> T G Magagula, M M Mamabolo, C Kruger, L Fletcher</p><p><strong>79. A survey of risk behaviour for contracting HIV among adult psychiatric patients admitted to Weskoppies Hospital</strong></p><p>M M Mamabolo, T G Magagula, C Kruger, L Fletcher</p><p><strong>80. A retrospective review of state sector outpatients (Tara Hospital) prescribed Olanzapine: Adherence to metabolic and cardiovascular screening and monitoring guidelines</strong></p><p>Carina Marsay, C P Szabo</p><p><strong>81. Reported rapes at a hospital rape centre: Demographic and clinical profiles</strong></p><p>Lindi Martin, Kees Lammers, Donavan Andrews, Soraya Seedat</p><p><strong>82. Exit examination in Final-Year medical students: Measurement validity of oral examinations in psychiatry</strong></p><p>Mpogisheng Mashile, D J H Niehaus, L Koen, E Jordaan</p><p><strong>83. Trends of suicide in the Transkei region of South Africa</strong></p><p>Banwari Meel</p><p><strong>84. Functional neuro-imaging in survivors of torture</strong></p><p>Thriya Ramasar, U Subramaney, M D T H W Vangu, N S Perumal</p><p><strong>85. Newly diagnosed HIV+ in South Africa: Do men and women enroll in care?</strong></p><p>Dinesh Singh, S Hoffman, E A Kelvin, K Blanchard, N Lince, J E Mantell, G Ramjee, T M Exner</p><p><strong>86. Diagnostic utitlity of the International HIC Dementia scale for Asymptomatic HIV-Associated neurocognitive impairment and HIV-Associated neurocognitive disorder in South Africa</strong></p><p>Dinesh Singh, K Goodkin, D J Hardy, E Lopez, G Morales</p><p><strong>87. The Psychological sequelae of first trimester termination of pregnancy (TOP): The impact of resilience</strong></p><p>Ugashvaree Subramaney</p><p><strong>88. Drugs and other therapies under investigation for PTSD: An international database</strong></p><p>Sharain Suliman, Soraya Seedat</p><p><strong>89. Frequency and correlates of HIV Testing in patients with severe mental illness</strong></p><p>Hendrik Temmingh, Leanne Parasram, John Joska, Tania Timmermans, Pete Milligan, Helen van der Plas, Henk Temmingh</p><p><strong>90. A proposed mental health service and personnel organogram for the Elizabeth Donkin psychiatric Hospital</strong></p><p>Stephan van Wyk, Zukiswa Zingela</p><p><strong>91. A brief report on the current state of mental health care services in the Eastern Cape</strong></p><p>Stephan van Wyk, Zukiswa Zingela, Kiran Sukeri, Heloise Uys, Mo Nagdee, Maricela Morales, Helmut Erlacher, Orlando Alonso</p><p><strong>92. An integrated mental health care service model for the Nelson Mandela Bay Metro</strong></p><p>Stephan van Wyk, Zukiswa Zingela, Kiran Sukeri</p><p><strong>93. Traditional and alternative healers: Prevalence of use in psychiatric patients</strong></p><p>Zukiswa Zingela, S van Wyk, W Esterhuysen, E Carr, L Gaauche</p>

The patient registration service is the starting gate for the health center services. In implementing BPJS, the community expects to get satisfactory health services. Patients will feel or not depends on the quality of registration services provided. If the patient feels satisfied the he will come back to get health care. However, if the patient is not satisfied, there will be many complaints that will not only be delivered face-to-face but more than that it can occur the complaint is submitted thorugh print media, visual media, and even social media. The purpose of study was to determine the comparative satisfaction of BPJS and non BPJS patients on the quality of registration services at the Johar Baru Health Center in Central Jakarta.riptive method with a Cross Sectional Comparative approach in the registration section at Johar Baru Health Center, Central Jakarta Research methods. This research was conducted with a descriptive method with a Cross Sectional Comparative approach in the registration section at Johar Baru Health Center, Central Jakarta. The population in this study were BPJS and Non BPJS patients who registered at the outpatient Registration in October-December 2019. The method of selecting samples was used with probability sampling whie to take samples using the proportionate stratified random sampling technique. The tool used for research with Questionnaire/Questionnaire. With a Likert scale measurement scale. For data analysis techniques using the Vality Test used is the product moment correlation which results in that the whoe question items are valid, which decision considerations are based on the r table for N = 30 at a significance of 5%, amounting to 0.361.Realibility Tests are used to show the extent to which a measurement result is relatively consistent if our measuring instrument repeatedly. Based on the reliability test, for the item questionnaire, the decision consideration is based on Cronbach’salfa value>0.60, the questionnaire is declared reliable or consistent. In this study the Cronvachs’s Alfa Value of 0.699 ‘s was rounded to 0.70, the cronbanch Alfa Value of 0.70>0.60, the questionnaire was declared reliable or consistent. With cross sectional time approach. The Mann Whitney U test was used to prove the hypothesis with the SPSS For Windows 25 software version, the significance value or Symp was obtained. Sig, (2 tailed) of 0.001. Therefore the value of Symp. Sig, (2 tailed) of 0.001>from the probability of 0.0f, the hypothesis “Ha is a accepted” or there is a difference. Based on the average value in the level of BPJS patient satisfaction obtained an average of 79.96 for Non BPJS patients obtained an average of 76.13 while the difference between the two amounted to 3.83. Targeted Output. Is a scientific publication in the National Journal of ISSN submitted, speakers in scientific meetings are registered, teaching material (ISBN) draft newspapaer articles are published. The proposed TKT research is TKT 1 The patient registration service is the starting gate for the health center services. In implementing BPJS, the community expects to get satisfactory health services. Patients will feel or not depends on the quality of registration services provided. If the patient feels satisfied the he will come back to get health care. However, if the patient is not satisfied, there will be many complaints that will not only be delivered face-to-face but more than that it can occur the complaint is submitted thorugh print media, visual media, and even social media. The purpose of study was to determine the comparative satisfaction of BPJS and non BPJS patients on the quality of registration services at the Johar Baru Health Center in Central Jakarta.riptive method with a Cross Sectional Comparative approach in the registration section at Johar Baru Health Center, Central JakartaResearch methods. This research was conducted with a descriptive method with a Cross Sectional Comparative approach in the registration section at Johar Baru Health Center, Central Jakarta. The population in this study were BPJS and Non BPJS patients who registered at the outpatient Registration in October-December 2019. The method of selecting samples was used with probability sampling whie to take samples using the proportionate stratified random sampling technique. The tool used for research with Questionnaire/Questionnaire. With a Likert scale measurement scale. For data analysis techniques using the Vality Test used is the product moment correlation which results in that the whoe question items are valid, which decision considerations are based on the r table for N = 30 at a significance of 5%, amounting to 0.361.Realibility Tests are used to show the extent to which a measurement result is relatively consistent if our measuring instrument repeatedly. Based on the reliability test, for the item questionnaire, the decision consideration is based on Cronbach’salfa value>0.60, the questionnaire is declared reliable or consistent. In this study the Cronvachs’s Alfa Value of 0.699 ‘s was rounded to 0.70, the cronbanch Alfa Value of 0.70>0.60, the questionnaire was declared reliable or consistent. With cross sectional time approach. The Mann Whitney U test was used to prove the hypothesis with the SPSS For Windows 25 software version, the significance value or Symp was obtained. Sig, (2 tailed) of 0.001. Therefore the value of Symp. Sig, (2 tailed) of 0.001>from the probability of 0.0f, the hypothesis “Ha is a accepted” or there is a difference. Based on the average value in the level of BPJS patient satisfaction obtained an average of 79.96 for Non BPJS patients obtained an average of 76.13 while the difference between the two amounted to 3.83.Targeted Output. Is a scientific publication in the National Journal of ISSN submitted, speakers in scientific meetings are registered, teaching material (ISBN) draft newspapaer articles are published. The proposed TKT research is TKT 1

ABSTRAKPasien pasca operasi katarak, perlu tahu bagaimana cara perawatan luka pasca operasi yang benar, agarmeminimalisir terjadinya resiko infeksi. Perawatan luka harus sesuai teknik aseptik untuk mengurangimikroorganisme sebagai salah satu faktor penyebab infeksi luka. Khususnya pada pasien dengan riwayatpenyakit diabetes mellitus, mereka membutuhkan pengetahuan dan keterampilan dalam merawat luka,dikarenakan memiliki gula darah yang rentan meningkat disetiap waktunya. Masalah ini menjadi salah satufaktor penghambat proses penyembuhan luka. Penelitian ini mengunakan metode kuantitatif dengan desainpre-eksperimen one group pretest–post test menggunakan nonprobablity sampling metode purposivesampling jumlah sampel 30 responden. Hasil penelitian menggunakan uji statistik Wilcoxon yangmenunjukan bahwa signifikan (p), sebesar 0,000 lebih kecil dari 0,05 (α), yaitu (p < α), artinya terdapatefektivitas yang signifikan antara health education pada pasien diabetes melitus terhadap pencegahan risikoinfeksi pasca operasi katarak. Penelitian ini menunjukkan bahwa perlu adanya kesadaran perawat untukmemberikan health education pasca operasi katarak pada pasien dan terlebih lagi, khususnya kepada pasiendengan riwayat penyakit diabetes melitus. Pihak rumah sakit perlu memasukan tindakan ini kedalam SOPpelayanan pasca operasi katarak agar bisa dijadikan tugas mutlak yang wajib dikerjakan, supaya terbinasaling kerjasama dalam meminimalisir kejadian infeksi luka, kecacatan dan mampu meningkatkan kualitashidup serta mengurangi biaya pasien untuk berobat ke rumah sakit. Kata Kunci: Health education, Pencegahan Risiko Infeksi, Diabetes Melitus, Perawatan Luka Operasi Katarak. Daftar Rujukan Beyene, A. M., Eshetie, A., Tadesse, Y., & Getnet, M. G. (2021). Time to recovery from cataract and its predictors among eye cataract patients treated with cataract surgery: A retrospective cohort study in Ethiopia. Annals of Medicine and Surgery, 65(102275), 1–5. https://doi.org/10.1016/j.amsu.2021.102275 Chiu, T. H. T., Chang, C. C., Lin, C. L., & Lin, M. N. (2021). A Vegetarian Diet Is Associated with a Lower Risk of Cataract, Particularly Among Individuals with Overweight: A Prospective Study. Journal of the Academy of Nutrition and Dietetics, 121(4), 669-677.e1. https://doi.org/10.1016/j.jand.2020.11.003 Chua, S. Y. L., Luben, R. N., Hayat, S., Broadway, D. C., Khaw, K. T., Warwick, A., Britten, A., Day, A. C., Strouthidis, N., Patel, P. J., Khaw, P. T., Foster, P. J., & Khawaja, A. P. (2021). Alcohol Consumption and Incident Cataract Surgery in Two Large UK Cohorts. Ophthalmology, 128(6), 837–847. https://doi.org/10.1016/j.ophtha.2021.02.007 Dede Achmad Basofi, Wilson, M. A. (2016). Hubungan Jenis Kelamin, Pekerjaan Dan Status Pernikahan Dengan Tingkat Kecemasan Pada Pasien Operasi Katarak Di Rumah Sakit Yarsi Pontianak. Dewanti Widya Astari, S. R. (2021). STRATEGI PENANGANAN ASUHAN KEPERAWATAN TERKAIT ENDOFTALMITIS: A LITERATURE REVIEW. Jurnal Ilmiah Permas, 11(4), 705– 718. Dian Sukma Dewi Arimbi, Lita, R. L. I. (2020). Pengaruh Health education terhadap Motivasi Mengontrol Kadar Gula Darah pada Pasien DM Tipe II. Jurnal Keperawatan Abdurrab, 4(1), 66–76. Febri Nadyati, Rani Himayani, Giska Tri Putri, M. Y. (2019). Hubungan Durasi Menderita Diabetes Melitus Tipe 2 dengan Kejadaian Katarak di RSUD DR.H.Abdul Moeloek Provinsi Lampung. ESSENTIAL:Essence of Scientific Medical Journal, 17(1), 1–4. Gülşen, M., & Akansel, N. (2020). Effects of Discharge Education and Telephone Followup on Cataract Patients’ Activities According to the Model of Living. Journal of Perianesthesia Nursing, 35(1), 67–74. https://doi.org/10.1016/j.jopan.2019.04.010 Harun, H. M., Abdullah, Z., & Salmah, U. (2020). Pengaruh Diabetes, Hipertensi, Merokok dengan Kejadian Katarak di Balai Kesehatan Mata Makassar. Jurnal Kesehatan Vokasional, 5(1), 45. https://doi.org/10.22146/jkesvo.52528 Jeong, I. S., & Lee, E. J. (2021). Current Status and Associated Factors of Annual Eye Examination Among People with Type 2 Diabetes Mellitus: Using the 7th National Health and Nutrition Examination Survey. Asian Nursing Research, 15(4), 239–246. https://doi.org/10.1016/j.anr.2021.07.003 Maryati Tombokan, sukma saini, Masdiana AR, M. R. N. A. (2017). HUBUNGAN DUKUNGAN KELUARGA DENGAN MOTIVASI DALAM MENGONTROL KADAR GULA DARAH PADA PENDERITA DIABETES MELITUS DI WILAYAH KERJA PUSKESMAS PAMPANG KECAMATAN PANAKKUKANG KOTA MAKASSAR. Jurnal Media Keperawatan, 08(02), 39–45. Qurrat, D., & Silvia, M. (2018). Hubungan Pengetahuan Dan Sikap Keluarga Dengan Perawatan Post Operasi Katarak Di Poli Mata Rsud Pariaman. Jurnal Kesehatan Medika Saintika, 09(2), 108–113. Rahani Ayu Amalia, Dwi Utari Widyastuti, P. (2019). PENGETAHUAN DAN KEPATUHAN KLIEN TENTANG PERAWATAN POST OPERASI KATARAK. Jurnal Keperawatan, XII(2), 115–120. Sitompul, R. (2015). Perawatan Lensa Kontak untuk Mencegah Komplikasi Ratna Sitompul. EJournal Kedokteran Indonesia, 3(1), 77–85. https://doi.org/10.23886/ejki.3.4811. Thompson, J., & Lakhani, N. (2015). Cataracts. Primary Care - Clinics in Office Practice, 42(3), 409–423. https://doi.org/10.1016/j.pop.2015.05.012 Torabi, H., Sadraei, M., Jadidi, K., & Alishiri, A. A. (2019). Choroidal thickness changes following cataract surgery in patients with type 2 diabetes mellitus. Journal of Current Ophthalmology, 31(1), 49–54. https://doi.org/10.1016/j.joco.2018.07.004

Este trabalho apresenta valores da variação de concentração, caracterização elementar e avaliação da toxidade in vitro no material particulado 10 μm (MP10) coletado em dois sítios na área urbana de Catalão-GO. O período amostrado foi entre 05/08/17 a 28/03/18. Os valores de concentração de MP10 estavam em conformidade com a legislação do CONAMA. A espectrometria de fluorescência de raios X identificou a presença majoritária de ferro e menores quantidades de fósforo e enxofre, caracterizando o MP10como resultado da ressuspenção de solo, emissão veicular e emissões do setor industrial. No estudo de toxidade verificou-se que o MP10 não inibiu o desenvolvimento de culturas bacterianas. Referências 1. Queiroz, P. G. M.; Jacomino, V. M. F.; Menezes, M. A. B.; Composição elementar do material particulado presente no aerossol atmosférico do município de Sete Lagoas, Minas Gerais. Química Nova, 2007, 30, 1233.2. Kim, K. H; Jahan, S. A.; Kabir, E. A review on human health perspective of air pollution with respect to allergies and asthma. Environment International, 2013, 59, 41. 3. Padula, A.; Yang, W.; Lurmann, F.; Balmes, J.; Hammond, S.; Shaw, G.; Prenatal exposure to air pollution, maternal diabetes and preterm birth, Environmental Research, 2019, 170, 160. 4. Binaku, K.; O’Brien, T.; Schmeling, M.; Fosco, T.; Statistical analysis of aerosol species, trace gasses, and meteorology in Chicago, Environmental Monitoring and Assessment, 2013, 185, 7295. 5. Almeida-Silva, M.; Canha, N.; Freitas, M. C.; Dung, H. M.; Dionísio, I.; Air pollution at an urban traffic tunnel in Lisbon, Portugal-an INNA study. Applied Radiation and Isotopes, 2011, 69, 1586.6. Marloes, E.; Gerard, H.; Olena, G. Molter, A.; Agius, Raymond.; Beelen, R.; Brunekreef, B.; Custovic, A.; Cyrys, J.; Fuertes, E.; Heinrich, J. Hoffmann, B.; Hoogh, K.; Jedynska, A.; Keuken, M.; Klumper, C.; Kooter, I.; Kramer, U.; Korek, M.; Koppelman, G. H.; Kuhlbusch, T. A. J.; Simpson, A.; Smit, H.A.; Tsai, M.; Wang, M.; Wolf, K.; Pershagen, G.; Gehring, U.; Elemental Composition of Particulate Matter and the Association with Lung Function. Empidemiology, 2014, 25, 648. 7. Baird, C.; Química Ambiental, Bookman: Porto Alegre, 2002.8. Ruckerl, R.; Schneider, A.; Breitner, S,; et. al. Health effects of particulate air pollution: A review of epidemiological evidence. Inhal Toxicol, 2011, 23, 555.9. Gavinier S, Nascimento L. Particulate matter and hospital admissions due to ischemic heart disease in Sorocaba, SP. Rev. Ambient. Água. 2014, 8, 228. 10. Nascimento, L. Air pollution and cardiovascular hospital admissions in a medium-sized city in São Paulo State, Brazil. Braz J Med Biol Res. 2011, 44, 720.11. Machin, A.; Nascimento L. Effects of exposure to air pollutants on children’s health in Cuiabá, Mato Grosso State, Brazil. Cad Saúde Pública [online], 2018, 34. 12. Liu, H.; Dunea, D.; Iordache, S.; Pohoata, A. A Review of Airborne Particulate Matter Effects on Young Children’s Respiratory Symptoms and Diseases. Atmosphere, 2018, 9, 150. 13. Grineski, S.; Collins, T.; Morales, D.; Asian Americans and disproportionate exposure to carcinogenic hazardous air pollutants: A national study, Social Science e Medicine, 2017, 185, 71. 14. Mutlu, E.; Comba, I.; Cho, T.; Engen, P.; Yazici, C.; Soberanes, S.; Hamanaka, R.; Nigdelioglu, R.; Meliton, A.; Ghio, A.; Budinger, S.; Mutlu, G.; Inhalational exposure to particulate matter air pollution alters the composition of the gut microbiome, Environmental Pollution, 2018, 240, 817. 15. Shah, M.; Shaheen-Nazir, R. Assessment of the trace elements level in urban atmospheric particulate matter and source apportionment Islamabad, Pakistan. Atmospheric Pollution Research, 2012, 3, 39.16. Vellingiri, K.; Kim, K.; Ma, C.; Kang, C.; Lee, J.; Kim, I.; Brown, R.; Ambient particulate matter in a central urban area of Seoul, Korea. Chemosphere, 2015, 119, 812.17. Hassan, H.; Kumar, P.; Kakosimos, K.; Flux estimation of fugitive particulate matter emissions from loose Calcisols at construction sites, Atmospheric Environment, 2016, 141, 96. 18. Caixeta, D.; Silva T.; Santana, F.; Almeida, W.; Quality monitoring indoor air of a school of public network located in the city of Cuiaba-MT. Engineering and Science, 2016, 1, 20.19. Smets, W.; Moretti, S.; Denys, S. Airborne bacteria in the atmosphere: Presence, purpose, and potential. Atmospheric Environment, 2016, 139, 214. 20. Maki, T.; Hara, K.; Kobayashi, F. et al. Vertical distribution of airborne bacterial communities in an Asian-dust downwind area, Noto Peninsula. Atmospheric Environment, 2015, 119, 282. 21. Maki, T.; Kakikawa, M.; Kobayashi, F; Yamada, M.; Atsushi, M.; Hasegawa, H.; Iwasaka, Y.; Assessment of composition and origin of airborne bacteria in the free troposphere over Japan. Atmospheric Environment, 2013, 74, 73. 22. Pereira, P.; Lopes, W.; Carvalho, L.; Rocha, G.; Bahia, N.; Loyola, J.; Quiterio, S.; Escaleira, V.; Arbilla, G.; Andrade, J.; Atmospheric concentrations and dry deposition fluxes of particulate trace metals in Salvador, Bahia, Brazil, Atmospheric Environment, 2007, 41, 7837. 23. Romualdo, L.; Santos, R.; Lima, F.; Andrade, L.; Ferreira, I.; Pozza, S.; Environmental Impact Monitoring of a Minero-Chemical Complex in Catalão Urban Area of PTS, PM10 and PM2.5 by EDX Characterization, Chemical Engineering transactions, 2015, 43, 1909.24. Sousa, N.; Análise físico-química e toxicidade do material particulado (MP10) no ar atmosférico em Catalão – GO, Dissertação (Mestrado) - Curso de Química, Universidade Federal de Goiás, Catalão, 2018, 87.25. SILVA, A. C. N.; BERNARDES, R. S.; MORAES, L. R. S.; DOS REIS, J. D. P. “Critérios adotados para seleção de indicadores de contaminação ambiental relacionados aos resíduos sólidos de serviços de saúde: uma proposta de avaliação”. Cad. Saúde Pública, 18:1401-1409, 2002.26. Morris, A.; Beck, J.; Schloss, P.; Campbell, T.; Crothers, K.; Curtis, J.; Flores, S.; Fontenot, A.; Ghedin, E.; Huang, L.; Jabloski, K.; Kleerup, E.; Lynch, S.; Sodergreen, E.; Twigg, H.; Young, V.; Bassis, C.; Venkataraman, A.; Schmidt, T.; Weinstock, G.;. Comparison of the respiratory microbiome in healthy nonsmokers and smokers, American Jounal Respiratory and Critical Care Medicine, 2013, 15, 1067.

Introduction. According to the WHO, about 3 % of infants worldwide are born with a congenital malformation (CM). The aim of the study. To conduct a retrospective analysis of the spectrum of congenital malformations diagnosed during pregnancy based on the Lviv Medical Genetics Center during 2018-2020 yy. Materials and methods. Clinical and epidemiological, as well as medical and statistical data on CM diagnosed prenatally between 2018-2020 were collected from primary source documents (Form No. 49) and then analyzed at the Lviv Medical Genetics Center ʺInstitute of Hereditary Pathology, National Academy of Medical Sciences of Ukraineʺ, Lviv. The Student’s t-test was used to determine the difference between the arithmetic means. The null hypotheses were tested using a t-test at the significance level of p-value less than 0.05. Results. A total of 11062 pregnant women were examined between 2018-2020: CM at different stages of pregnancy were diagnosed in 454 cases, which accounted for 4.1 % of cases and did not exceed the population value. There was a 2.3-fold reduction in the number of pregnant women presented to the Medical Genetics Center in 2020, probably due to the global coronavirus pandemic – from 5007 women in 2018 to 2212 females in 2020. However, the number of CM diagnosed prenatally in 2020 was not statistically significant (p-value more than 0.05) as compared to the average value for these years and 2018. In 2018, a total of 5007 pregnant women were examined at the Lviv Medical Genetics Center. In 136 (4.8 %) cases, fetal malformations were diagnosed before 22 weeks of gestation, while in 26 (1.2 %) cases, pregnancy was affected by congenital anomaly in its second half. In 2019, there were examined 3843 pregnant women. In169 (7.8 %) cases, CM were diagnosed before 22 weeks of gestation, that was statistically significant as compared to 2018 (p-value less than 0.05) and in 20 (1.2 %) cases, fetal anomalies were detected in the second half of pregnancy, that was not statistically significant as compared to the previous year (p-value more than 0.05). In 2020, we examined 2212 pregnant women. Reducing the number of visits to our medical center was probably due to the coronavirus pandemic. There were95 (5.0 %) cases of fetal malformations diagnosed before 22 weeks of gestation and 8 (2.5 %) cases of congenital anomalies detected in the second half of pregnancy. The number of CM diagnosed prenatally was the highest in 2019 – 4.9 %; however, there was no statistically significant difference (p-value more than 0.05) in the average values for these years – 4.1 % and 3.2 % in 2020 and 2018, respectively. In 2020, the incidence of congenital malformations diagnosed after 22 weeks of gestation was significantly higher (p-value less than 0.05) than in other years – 2.5 % and 1.2 %, respectively. Conclusions. Between 2018-2020, the incidence of congenital malformations diagnosed at different stages of pregnancy was 4.1 %. Congenital malformation s of the nervous system (Q00-Q07) were the most common anomalies diagnosed before 22 weeks of gestation, while after 22 weeks, the most common malformations were congenital malformations of the urinary system (Q60-Q64). Qualified timely diagnosis of correctable developmental deficiencies, as well as team efforts of obstetricians, neonatologists, pediatric neurologists, pediatricians, and other health care professionals to ensure normal childbirth and provide a baby with specialized care, followed by life-time rehabilitation are the main tasks of prenatal medicine.

The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. Available at: https://covid19.who.int/ [Accessed on 23 August 2020] Sim K, Chua HC. The psychological impact of SARS: a matter of heart and mind. CMAJ. 2004; 170:811e2. https://doi.org/10.1503/cmaj.1032003. Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatr. 2009; 54:302e11. https://doi.org/10.1177/070674370905400504. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020; 395:912e20. https://doi.org/10.1016/S0140-6736(20)30460-8. Robertson E, Hershenfield K, Grace SL, Stewart DE. The psychosocial effects of being quarantined following exposure to SARS: a qualitative study of Toronto health care workers. Can J Psychiatr. 2004; 49:403e7. https://doi.org/10.1177/070674370404900612. Barbisch D, Koenig KL, Shih FY. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Med Public Health Prep. 2015; 9:547e53. https://doi.org/10.1017/dmp.2015.38. Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health. 2016;38: e2016048. https://doi.org/10.4178/epih.e2016048. Liu X, Kakade M, Fuller CJ, Fan B, Fang Y, Kong J, et al. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatr. 2012; 53:15e23. https://doi.org/10.1016/j.comppsych.2011.02.003 Chadda RK, Deb KS. Indian family systems, collectivistic society and psychotherapy. Indian J Psychiatry. 2013;55: S299‑ https://dx.doi.org/10.4103%2F0019-5545.105555. Grover S, Sahoo S, Mehra A, Avasthi A, Tripathi A, Subramanyan A, et al. Psychological impact of COVID‑19 lockdown: An online survey from India. Indian J Psychiatry. 2020; 62:354-62. https://doi.org/ 10.4103/psychiatry.IndianJPsychiatry _427_20. Hawkley LC, Cacioppo JT. Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Ann Behav Med. 2010; 40: 218–27. https://dx.doi.org/10.1007%2Fs12160-010-9210-8. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/10.1016/S0140-6736(20)30211-7. Bhandari S, Sharma R, Singh Shaktawat A, Banerjee S, Patel B, Tak A, et al. COVID-19 related mortality profile at a tertiary care centre: a descriptive study. Scr Med. 2020;51(2):69-73. https://doi.org/10.5937/scriptamed51-27126. Baumeister RF, Leary MR. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull. 1995; 117: 497–529. https://doi.org/10.1037/0033-2909.117.3.497. Caspi A, Harrington H, Moffitt TE, Milne BJ, Poulton R. Socially isolated children 20 years later: risk of cardiovascular disease. Arch Pediatr Adolesc Med. 2006; 160(8):805-11. https://doi.org/10.1001/archpedi.160.8.805. Eaker ED, Pinsky J, Castelli WP. Myocardial infarction and coronary death among women: psychosocial predictors from a 20-year follow-up of women in the Framingham Study. Am J Epidemiol. 1992; 135(8):854-64. https://doi.org/10.1093/oxfordjournals.aje.a116381. Luo Y, Hawkley LC, Waite LJ, Cacioppo JT. Loneliness, health, and mortality in old age: a national longitudinal study. Soc Sci Med. 2012 Mar; 74(6):907-14. https://dx.doi.org/10.1016%2Fj.socscimed.2011.11.028. Olsen RB, Olsen J, Gunner-Svensson F, Waldstrøm B. Social networks and longevity. A 14-year follow-up study among elderly in Denmark. Soc Sci Med. 1991; 33(10):1189-95. https://doi.org/10.1016/0277-9536(91)90235-5. Patterson AC, Veenstra G. Loneliness and risk of mortality: a longitudinal investigation in Alameda County, California. Soc Sci Med. 2010; 71(1):181-6. https://doi.org/10.1016/j.socscimed.2010.03.024. Savikko N, Routassalo P, Tilvis RS, Strandberg TE, Pitkalla KH. Predictors and subjective causes of loneliness in an aged population. Arch Gerontol Geriatrics. 2005; 41:3;223-33. https://doi.org/10.1016/j.archger.2005.03.002. Health Advisory for Elderly Population of India during COVID19. Available at: https://www.mohfw.gov.in/pdf/AdvisoryforElderlyPopulation.pdf [Accessed on 13 August 2020]. Dicks D, Myers R, Kling A. Uncus and amygdala lesions: effects on social behavior in the free-ranging rhesus monkey. Science. 1969; 165:69–71. https://doi.org/10.1126/science.165.3888.69. Kanai R, Bahrami B, Duchaine B, Janik A, Banissy MJ, Rees G. Brain structure links loneliness to social perception. Curr Biol. 2012; 22(20):1975-9. https://dx.doi.org/10.1016%2Fj.cub.2012.08.045. Bender AR, Daugherty A, Raz N. Vascular risk moderates associations between hippocampal subfield volumes and memory. J Cogn Neurosci. 2013; 25:1851–62. https://doi.org/10.1162/jocn_a_00435. Raz N. Diabetes: brain, mind, insulin–what is normal and do we need to know? Nat Rev Endocrinol. 2011; 7:636–7. https://doi.org/10.1038/nrendo.2011.149. Colcombe SJ, Erickson KI, Naftali R, Andrew GW, Cohen NJ, McAuley E, et al. Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol A Biol Sci Med Sci. 2003; 58:176–80. https://doi.org/10.1093/gerona/58.2.m176. Maass A, Düzel S, Goerke M, Becke A, Sobieray U, Neumann K, et al. Vascular hippocampal plasticity after aerobic exercise in older adults. Mol Psychiatry. 2015; 20, 585–93. https://doi.org/10.1038/mp.2014.114. Wilson RS, Krueger KR, Arnold SE, Schneider JA, Kelly JF, Barnes LL, et al. Loneliness and Risk of Alzheimer Disease. Arch Gen Psychiatry. 2007;64(2):234–240. https://doi.org/10.1001/archpsyc.64.2.234. Kogan JH, Frankland PW, Silva AJ. Long-term memory underlying hippocampus-dependent social recognition in mice. Hippocampus. 2000;10(1):47-56. https://doi.org/10.1002/(sici)1098-1063(2000)10:1%3C47::aid-hipo5%3E3.0.co;2-6. Yorgason JT, España RA, Konstantopoulos JK, Weiner JL, Jones SR. Enduring increases in anxiety-like behavior and rapid nucleus accumbens dopamine signaling in socially isolated rats. Eur J Neurosci. 2013;37(6):1022-31. https://doi.org/10.1111/ejn.12113. Bledsoe AC, Oliver KM, Scholl JL, Forster GL. Anxiety states induced by post-weaning social isolation are mediated by CRF receptors in the dorsal raphe nucleus. Brain Res Bull. 2011;85(3-4):117-22. https://dx.doi.org/10.1016%2Fj.brainresbull.2011.03.003. Lukkes JL, Engelman GH, Zelin NS, Hale MW, Lowry CA. Post-weaning social isolation of female rats, anxiety-related behavior, and serotonergic systems. Brain Res. 2012; 1443:1-17. https://dx.doi.org/10.1016%2Fj.brainres.2012.01.005. Ago Y, Araki R, Tanaka T, Sasaga A, Nishiyama S, Takuma K, et al. Role of social encounter-induced activation of prefrontal serotonergic systems in the abnormal behaviors of isolation-reared mice. Neuropsychopharmacology. 2013; 38(8):1535-47. https://doi.org/10.1038/npp.2013.52. Veenema AH. Early life stress, the development of aggression and neuroendocrine and neurobiological correlates: what can we learn from animal models? Front Neuroendocrinol. 2009;30(4):497-518. https://doi.org/10.1016/j.yfrne.2009.03.003. Zhao X, Sun L, Jia H, Meng Q, Wu S, Li N, et al. Isolation rearing induces social and emotional function abnormalities and alters glutamate and neurodevelopment-related gene expression in rats. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33(7):1173-1177. https://doi.org/10.1016/j.pnpbp.2009.06.016. Sciolino NR, Bortolato M, Eisenstein SA, Fu J, Oveisi F, Hohmann AG, et al. Social isolation and chronic handling alter endocannabinoid signaling and behavioral reactivity to context in adult rats. Neuroscience. 2010;168(2):371-86. https://dx.doi.org/10.1016%2Fj.neuroscience.2010.04.007. Ghasemi M, Phillips C, Trillo L, De Miguel Z, Das D, Salehi A. The role of NMDA receptors in the pathophysiology and treatment of mood disorders. Neurosci Biobehav Rev. 2014; 47:336-358. https://doi.org/10.1016/j.neubiorev.2014.08.017. Olivenza R, Moro MA, Lizasoain I, Lorenzo P, Fernández AP, Rodrigo J, et al. Chronic stress induces the expression of inducible nitric oxide synthase in rat brain cortex. J Neurochem. 2000;74(2):785-791. https://doi.org/10.1046/j.1471-4159.2000.740785.x. Maeng S, Zarate CA Jr, Du J, Schloesser RJ, McCammon J, Chen G, et al. Cellular mechanisms underlying the antidepressant effects of ketamine: role of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptors. Biol Psychiatry. 2008;63(4):349-352. https://doi.org/10.1016/j.biopsych.2007.05.028. Kalia LV, Kalia SK, Salter MW. NMDA receptors in clinical neurology: excitatory times ahead. Lancet Neurol. 2008;7(8):742-755. https://dx.doi.org/10.1016%2FS1474-4422(08)70165-0. Waxman EA, Lynch DR. N-methyl-D-aspartate Receptor Subtypes: Multiple Roles in Excitotoxicity and Neurological Disease. The Neuroscientist. 2005; 11(1), 37–49. https://doi.org/10.1177/1073858404269012. Hermes G, Li N, Duman C, Duman R. Post-weaning chronic social isolation produces profound behavioral dysregulation with decreases in prefrontal cortex synaptic-associated protein expression in female rats. Physiol Behav. 2011;104(2):354-9. https://dx.doi.org/10.1016%2Fj.physbeh.2010.12.019. Sestito RS, Trindade LB, de Souza RG, Kerbauy LN, Iyomasa MM, Rosa ML. Effect of isolation rearing on the expression of AMPA glutamate receptors in the hippocampal formation. J Psychopharmacol. 2011;25(12):1720-1729. https://doi.org/10.1177/0269881110385595. Toua C, Brand L, Möller M, Emsley RA, Harvey BH. The effects of sub-chronic clozapine and haloperidol administration on isolation rearing induced changes in frontal cortical N-methyl-D-aspartate and D1 receptor binding in rats. Neuroscience. 2010;165(2):492-499. https://doi.org/10.1016/j.neuroscience.2009.10.039. Alò R, Avolio E, Mele M, Storino F, Canonaco A, Carelli A et al. Excitatory/inhibitory equilibrium of the central amygdala nucleus gates anti-depressive and anxiolytic states in the hamster. Pharmacol Biochem Behav. 2014; 118:79-86. https://doi.org/10.1016/j.pbb.2014.01.007. St JP, Petkov VV. Changes in 5-HT1 receptors in different brain structures of rats with isolation syndrome. General pharmacology. 1990;21(2):223-5. https://doi.org/10.1016/0306-3623(90)90905-2. Miachon S, Rochet T, Mathian B, Barbagli B, Claustrat B. Long-term isolation of Wistar rats alters brain monoamine turnover, blood corticosterone, and ACTH. Brain Res Bull. 1993;32(6):611-614. https://doi.org/10.1016/0361-9230(93)90162-5. Van den Berg CL, Van Ree JM, Spruijt BM, Kitchen I. Effects of juvenile isolation and morphine treatment on social interactions and opioid receptors in adult rats: behavioural and autoradiographic studies. Eur J Neurosci. 1999;11(9):3023-3032. https://doi.org/10.1046/j.1460-9568.1999.00717.x. Vanderschuren LJ, Stein EA, Wiegant VM, Van Ree JM. Social play alters regional brain opioid receptor binding in juvenile rats. Brain Res. 1995;680(1-2):148-156. https://doi.org/10.1016/0006-8993(95)00256-p. Moles A, Kieffer BL, D'Amato FR. Deficit in attachment behavior in mice lacking the mu-opioid receptor gene. Science. 2004;304(5679):1983-1986. https://doi.org/10.1126/science.1095943. Panksepp J, Herman BH, Vilberg T, Bishop P, DeEskinazi FG. Endogenous opioids and social behavior. Neurosci Biobehav Rev. 1980;4(4):473-487. https://doi.org/10.1016/0149-7634(80)90036-6. Gong JP, Onaivi ES, Ishiguro H, Liu Q, Tagliaferro PA, Brusco A, et al. Cannabinoid CB2 receptors: immunohistochemical localization in rat brain. Brain Res. 2006;1071(1):10-23. https://doi.org/10.1016/j.brainres.2005.11.035. Breivogel CS, Sim-Selley LJ. Basic neuroanatomy and neuropharmacology of cannabinoids. Int Rev Psychiatry 2009; 21:2:113-121. https://doi.org/10.1080/09540260902782760. Haj-Mirzaian A, Amini-Khoei H, Haj-Mirzaian A, Amiri S, Ghesmati M, Zahir M, et al. Activation of cannabinoid receptors elicits antidepressant-like effects in a mouse model of social isolation stress. Brain Res Bull. 2017; 130:200-210. https://doi.org/10.1016/j.brainresbull.2017.01.018. Banach M, Piskorska B, Czuczwar SJ, Borowicz KK. Nitric Oxide, Epileptic Seizures, and Action of Antiepileptic Drugs. CNS & Neurological Disorders - Drug Targets 2011;10: 808. https://doi.org/10.2174/187152711798072347. Förstermann U, Sessa WC. Nitric oxide synthases: regulation and function. Eur Heart J. 2012;33(7):829-37, 837a-837d. https://dx.doi.org/10.1093%2Feurheartj%2Fehr304. Hu Y, Wu D, Luo C, Zhu L, Zhang J, Wu H, et al. Hippocampal nitric oxide contributes to sex difference in affective behaviors. PNAS. 2012, 109 (35) 14224-14229. https://doi.org/10.1073/pnas.1207461109. Khan MI, Ostadhadi S, Zolfaghari S, Mehr SE, Hassanzadeh G, Dehpour, A et al. The involvement of NMDA receptor/NO/cGMP pathway in the antidepressant like effects of baclofen in mouse force swimming test. Neuroscience Letters. 2016; 612:52-61. https://doi.org/10.1016/j.neulet.2015.12.006. Matsumoto K, Puia G, Dong E, Pinna G. GABAA receptor neurotransmission dysfunction in a mouse model of social isolation-induced stress: Possible insights into a non-serotonergic mechanism of action of SSRIs in mood and anxiety disorders. Stress. 2007; 10:1:3-12. https://doi.org/10.1080/10253890701200997. Zlatković J, Filipović D. Chronic social isolation induces NF-κB activation and upregulation of iNOS protein expression in rat prefrontal cortex. Neurochem Int. 2013;63(3):172-179. https://doi.org/10.1016/j.neuint.2013.06.002. Haj-Mirzaian A, Amiri S, Kordjazy N, Momeny M, Razmi A, Balaei MR, et al. Lithium attenuated the depressant and anxiogenic effect of juvenile social stress through mitigating the negative impact of interlukin-1β and nitric oxide on hypothalamic-pituitary-adrenal axis function. Neuroscience. 2016; 315:271-285. https://doi.org/10.1016/j.neuroscience.2015.12.024. Larson HJ. The biggest pandemic risk? Viral misinformation. Nature 2018; 562:309. https://doi.org/10.1038/d41586-018-07034-4. Zarocostas J. How to fight an infodemic. Lancet 2020; 395:676. https://doi.org/10.1016/S0140-6736(20)30461-X. World Health Organization, 2019. Ebola Virus Disease – Democratic Republic of the Congo. Geneva, Switzerland: WHO. Available at: https://www.who.int/csr/don/28-november-2019-ebola-drc/en/ [Accessed on August 8, 2020] Times of India. Covid-19: doctors gone to collect samples attacked in Indore. Available at: https://timesofindia.indiatimes.com/videos/news/covid-19-doctors-goneto- collect-samples-attacked-in-indore/videoshow/74942153.cms; 2020 [Accessed on August 8, 2020]. Withnall A. Coronavirus: why India has had to pass new law against attacks on healthcare workers. The Independent. April 23, 2020. Semple K. “Afraid to be a nurse”: health workers under attack. The New York Times. 2020 Apr 27. The Economist. Health workers become unexpected targets during COVID-19. The Economist. May 11, 2020. Turan B, Budhwani H, Fazeli PL, Browning WR, Raper JL, Mugavero MJ, et al. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS Behav. 2017; 21: 283–291. https://doi.org/10.1007/s10461-016-1451-5. James PB, Wardle J, Steel A, Adams J. An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross sectional study. BMC Public Health. 2020; 20: 182. https://doi.org/10.1186/s12889-020-8279-7. Aljazeera, 2020. Iran: Over 700 Dead after Drinking Alcohol to Cure Coronavirus. Aljazeera. Available at: https://www.aljazeera.com/ news/2020/04/iran-700-dead-drinking-alcohol-cure-coronavirus200427163529629.html. (Accessed June 4, 2020) Delirrad M, Mohammadi AB, 2020. New methanol poisoning outbreaks in Iran following COVID-19 pandemic. Alcohol Alcohol. 55: 347–348. https://doi.org/10.1093/alcalc/agaa036. Hassanian-Moghaddam H, Zamani N, Kolahi A-A, McDonald R, Hovda KE. Double trouble: methanol outbreak in the wake of the COVID-19 pandemic in Iran-a cross-sectional assessment. Crit Care. 2020; 24: 402. https://doi.org/10.1186/s13054-020-03140-w. Soltaninejad K. Methanol Mass Poisoning Outbreak: A Consequence of COVID-19 Pandemic and Misleading Messages on Social Media. Int J Occup Environ Med. 2020;11(3):148-150. https://dx.doi.org/10.34172%2Fijoem.2020.1983. Islam MS, Sarkar T, Khan SH, Kamal AM, Hasan SMM, Kabir A, et al. COVID-19–Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis. Am J Trop Med Hyg. 2020; 00(0):1–9. https://doi.org/10.4269/ajtmh.20-0812. Hawryluck L, Gold W, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis. 2004;10(7):1206–1212. https://dx.doi.org/10.3201%2Feid1007.030703. Lee S, Chan LYY, Chau AAM, Kwok KPS, Kleinman A. The experience of SARS-related stigma at Amoy Gardens. Soc Sci Med. 2005; 61(9): 2038-2046. https://doi.org/10.1016/j.socscimed.2005.04.010. Yoon MK Kim SY Ko HS Lee MS. System effectiveness of detection, brief intervention and refer to treatment for the people with post-traumatic emotional distress by MERS: a case report of community-based proactive intervention in South Korea. Int J Ment Health Syst. 2016; 10: 51. https://doi.org/10.1186/s13033-016-0083-5. Reynolds DL, Garay JR, Deamond SL, Moran MK, Gold W, Styra R. Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiol Infect. 2008; 136: 997-1007. https://dx.doi.org/10.1017%2FS0950268807009156. Marjanovic Z, Greenglass ER, Coffey S. The relevance of psychosocial variables and working conditions in predicting nurses' coping strategies during the SARS crisis: an online questionnaire survey. Int J Nurs Stud. 2007; 44(6): 991-998. https://doi.org/10.1016/j.ijnurstu.2006.02.012. Bai Y, Lin C-C, Lin C-Y, Chen J-Y, Chue C-M, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv. 2004; 55: 1055-1057. https://doi.org/10.1176/appi.ps.55.9.1055. Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/Guidelinesforhomequarantine.pdf [Accessed on 25 August 2020]. Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/RevisedguidelinesforHomeIsolationofverymildpresymptomaticCOVID19cases10May2020.pdf [Accessed on 25 August 2020]. Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/AdvisoryformanagingHealthcareworkersworkinginCOVIDandNonCOVIDareasofthehospital.pdf (Accessed on 25 August 2020). Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/RevisedguidelinesforInternationalArrivals02082020.pdf [Accessed on 25 August 2020]. Cost of the lockdown? Over 10% of GDP loss for 18 states. Available at: https://timesofindia.indiatimes.com/india/cost-of-the-lockdown-over-10-of-gdp-loss-for-18-states/articleshow/76028826.cms [Accessed on 21 August 2020]. Jorda O, Singh SR, Taylor AM. Longer-Run Economic Consequences of Pandemics. Federal Reserve Bank of San Francisco Working Paper. 2020-09. https://doi.org/10.24148/wp2020-09. Firdaus G. Mental well‑being of migrants in urban center of India: Analyzing the role of social environment. Indian J Psychiatry. 2017; 59:164‑ https://doi.org/10.4103/psychiatry.indianjpsychiatry_272_15. National Crime Record Bureau. Annual Crime in India Report. New Delhi, India: Ministry of Home Affairs; 2018. 198 migrant workers killed in road accidents during lockdown: Report. Available at: https://www.hindustantimes.com/india-news/198-migrant-workers-killed-in-road-accidents-during-lockdown-report/story-hTWzAWMYn0kyycKw1dyKqL.html [Accessed on 25 August 2020]. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020; 20:689-96. https://doi.org/10.1016/S1473-3099(20)30198-5. Dalton L, Rapa E, Stein A. Protecting the psychological health of through effective communication about COVID-19. Lancet Child Adolesc Health. 2020;4(5):346-347. https://doi.org/10.1016/S2352-4642(20)30097-3. Centre for Disease Control. Helping Children Cope with Emergencies. Available at: https://www.cdc.gov/childrenindisasters/helping-children-cope.html [Accessed on 25 August 2020]. Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. Lancet Child & Adolesc Health. 2020; 4(5):347-349. https://doi.org/10.1016/S2352-4642(20)30096-1. Sprang G, Silman M. Posttraumatic Stress Disorder in Parents and Youth After Health-Related Disasters. Disaster Med Public Health Prep. 2013;7(1):105-110. https://doi.org/10.1017/dmp.2013.22. Rehman U, Shahnawaz MG, Khan NH, Kharshiing KD, Khursheed M, Gupta K, et al. Depression, Anxiety and Stress Among Indians in Times of Covid-19 Lockdown. Community Ment Health J. 2020:1-7. https://doi.org/10.1007/s10597-020-00664-x. Cao W, Fang Z, Hou, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research. 2020; 287:112934. https://doi.org/10.1016/j.psychres.2020.112934. Wang C, Zhao H. The Impact of COVID-19 on Anxiety in Chinese University Students. Front Psychol. 2020; 11:1168. https://dx.doi.org/10.3389%2Ffpsyg.2020.01168. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry 2020;7(3): e14. https://doi.org/10.1016/s2215-0366(20)30047-x. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3(3): e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976. Lancee WJ, Maunder RG, Goldbloom DS, Coauthors for the Impact of SARS Study. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv. 2008;59(1):91-95. https://dx.doi.org/10.1176%2Fps.2008.59.1.91. Tam CWC, Pang EPF, Lam LCW, Chiu HFK. Severe acute respiratory syndrome (SARS) in Hongkong in 2003: Stress and psychological impact among frontline healthcare workers. Psychol Med. 2004;34 (7):1197-1204. https://doi.org/10.1017/s0033291704002247. Lee SM, Kang WS, Cho A-R, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018; 87:123-127. https://dx.doi.org/10.1016%2Fj.comppsych.2018.10.003. Koh D, Meng KL, Chia SE, Ko SM, Qian F, Ng V, et al. Risk perception and impact of severe acute respiratory syndrome (SARS) on work and personal lives of healthcare workers in Singapore: What can we learn? Med Care. 2005;43(7):676-682. https://doi.org/10.1097/01.mlr.0000167181.36730.cc. Verma S, Mythily S, Chan YH, Deslypere JP, Teo EK, Chong SA. Post-SARS psychological morbidity and stigma among general practitioners and traditional Chinese medicine practitioners in Singapore. Ann Acad Med Singap. 2004; 33(6):743e8. Yeung J, Gupta S. Doctors evicted from their homes in India as fear spreads amid coronavirus lockdown. CNN World. 2020. Available at: https://edition.cnn.com/2020/03/25/asia/india-coronavirus-doctors-discrimination-intl-hnk/index.html. [Accessed on 24 August 2020] Violence Against Women and Girls: the Shadow Pandemic. UN Women. 2020. May 3, 2020. Available at: https://www.unwomen.org/en/news/stories/2020/4/statement-ed-phumzile-violence-against-women-during-pandemic. [Accessed on 24 August 2020]. Gearhart S, Patron MP, Hammond TA, Goldberg DW, Klein A, Horney JA. The impact of natural disasters on domestic violence: an analysis of reports of simple assault in Florida (1999–2007). Violence Gend. 2018;5(2):87–92. https://doi.org/10.1089/vio.2017.0077. Sahoo S, Rani S, Parveen S, Pal Singh A, Mehra A, Chakrabarti S, et al. Self-harm and COVID-19 pandemic: An emerging concern – A report of 2 cases from India. Asian J Psychiatr 2020; 51:102104. https://dx.doi.org/10.1016%2Fj.ajp.2020.102104. Ghosh A, Khitiz MT, Pandiyan S, Roub F, Grover S. Multiple suicide attempts in an individual with opioid dependence: Unintended harm of lockdown during the COVID-19 outbreak? Indian J Psychiatry 2020; [In Press]. The Economic Times. 11 Coronavirus suspects flee from a hospital in Maharashtra. March 16 2020. Available at: https://economictimes.indiatimes.com/news/politics-and-nation/11-coronavirus-suspects-flee-from-a-hospital-in-maharashtra/videoshow/74644936.cms?from=mdr. [Accessed on 23 August 2020]. Xiang Y, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry 2020;(3):228–229. https://doi.org/10.1016/S2215-0366(20)30046-8. Van Bortel T, Basnayake A, Wurie F, Jambai M, Koroma A, Muana A, et al. Psychosocial effects of an Ebola outbreak at individual, community and international levels. Bull World Health Organ. 2016;94(3):210–214. https://dx.doi.org/10.2471%2FBLT.15.158543. Kumar A, Nayar KR. COVID 19 and its mental health consequences. Journal of Mental Health. 2020; ahead of print:1-2. https://doi.org/10.1080/09638237.2020.1757052. Gupta R, Grover S, Basu A, Krishnan V, Tripathi A, Subramanyam A, et al. Changes in sleep pattern and sleep quality during COVID-19 lockdown. Indian J Psychiatry. 2020; 62(4):370-8. https://doi.org/10.4103/psychiatry.indianjpsychiatry_523_20. Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry. 2020;7(4): P300-302. https://doi.org/10.1016/S2215-0366(20)30073-0. Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr. 2020; 14(5): 779–788. https://dx.doi.org/10.1016%2Fj.dsx.2020.05.035. Wright R. The world's largest coronavirus lockdown is having a dramatic impact on pollution in India. CNN World; 2020. Available at: https://edition.cnn.com/2020/03/31/asia/coronavirus-lockdown-impact-pollution-india-intl-hnk/index.html. [Accessed on 23 August 2020] Foster O. ‘Lockdown made me Realise What’s Important’: Meet the Families Reconnecting Remotely. The Guardian; 2020. Available at: https://www.theguardian.com/keep-connected/2020/apr/23/lockdown-made-me-realise-whats-important-meet-the-families-reconnecting-remotely. (Accessed on 23 August 2020) Bilefsky D, Yeginsu C. Of ‘Covidivorces’ and ‘Coronababies’: Life During a Lockdown. N. Y. Times; 2020. Available at: https://www.nytimes.com/2020/03/27/world/coronavirus-lockdown-relationships.html [Accessed on 23 August 2020]

Eating habits develop during the first years of a child's life, children learn what, when, and how much to eat through direct experience with food and by observing the eating habits of others. The aim of this study is to get a clear picture of the Eating program Healthy, starting from the planning, implementation, supervision, and evaluation as a case study of nutrition education; to get information about the advantages, disadvantages and effects of implementing a healthy eating program for children. This research was conducted through a case study with qualitative data analysed using Miles and Huberman techniques. Sample of children in Ananda Islāmic School Kindergarten. The results showed the Healthy Eating program could be implemented well, the diet was quite varied and could be considered a healthy and nutritious food. The visible impact is the emotion of pleasure experienced by children, children become fond of eating vegetables, and make children disciplined and responsible. Inadequate results were found due to the limitations of an adequate kitchen for cooking healthy food, such as cooking activities still carried out by the cook himself at the Foundation's house which is located not far from the school place; use of melamine and plastic cutlery for food; the spoon and fork used already uses aluminium material but still does not match its size; does not involve nutritionists. Keywords: Early Childhood, Eating Healthy Program References: Bandura, A. (1977). Social learning theory. Englewood Cliffs: Prentice-Hall. Bandura, Albert. (2004). Health promotion by social cognitive means. Health Education and Behavior, 31(2), 143–164. https://doi.org/10.1177/1090198104263660 Battjes-Fries, M. C. E., Haveman-Nies, A., Renes, R. J., Meester, H. J., & Van’T Veer, P. (2015). Effect of the Dutch school-based education programme “Taste Lessons” on behavioural determinants of taste acceptance and healthy eating: A quasi-experimental study. Public Health Nutrition, 18(12), 2231–2241. https://doi.org/10.1017/S1368980014003012 Birch, L., Savage, J. S., & Ventura, A. (2007). Influences on the Development of Children’s Eating Behaviours: From Infancy to Adolescence. Canadian Journal of Dietetic Practice and Research : A Publication of Dietitians of Canada = Revue Canadienne de La Pratique et de La Recherche En Dietetique : Une Publication Des Dietetistes Du Canada, 68(1), s1– s56. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19430591%0Ahttp://www.pubmedcentral.nih.gov/a rticlerender.fcgi?artid=PMC2678872 Coulthard, H., Williamson, I., Palfreyman, Z., & Lyttle, S. (2018). Evaluation of a pilot sensory play intervention to increase fruit acceptance in preschool children. Appetite, 120, 609–615. https://doi.org/10.1016/j.appet.2017.10.011 Coulthard, Helen, & Sealy, A. (2017). Play with your food! Sensory play is associated with tasting of fruits and vegetables in preschool children. Appetite, 113, 84–90. https://doi.org/10.1016/j.appet.2017.02.003 Crain, W. C. (2005). Theories of development: Concepts and applications. Upper Saddle River: Pearson Prentice Hall. Dazeley, P., Houston-Price, C., & Hill, C. (2012). Should healthy eating programmes incorporate interaction with foods in different sensory modalities? A review of the evidence. British Journal of Nutrition, 108(5), 769–777. https://doi.org/10.1017/S0007114511007343 Derscheid, L. E., Umoren, J., Kim, S. Y., Henry, B. W., & Zittel, L. L. (2010). Early childhood teachers’ and staff members’ perceptions of nutrition and physical activity practices for preschoolers. Journal of Research in Childhood Education, 24(3), 248–265. https://doi.org/10.1080/02568543.2010.487405 Eliassen, E. K. (2011). The impact of teachers and families on young children’s eating behaviors. YC Young Children, 66(2), 84–89. Elliott, E., Isaacs, M., & Chugani, C. (2010). Promoting Self-Efficacy in Early Career Teachers: A Principal’s Guide for Differentiated Mentoring and Supervision. Florida Journal of Educational Administration & Policy, 4(1), 131–146. Emm, S., Harris, J., Halterman, J., Chvilicek, S., & Bishop, C. (2019). Increasing Fruit and Vegetable Intake with Reservation and Off-reservation Kindergarten Students in Nevada. Journal of Agriculture, Food Systems, and Community Development, 9, 1–10. https://doi.org/10.5304/jafscd.2019.09b.014 Flynn, M. A. T. (2015). Empowering people to be healthier: Public health nutrition through the Ottawa Charter. Proceedings of the Nutrition Society, 74(3), 303–312. https://doi.org/10.1017/S002966511400161X Franciscato, S. J., Janson, G., Machado, R., Lauris, J. R. P., de Andrade, S. M. J., & Fisberg, M. (2019). Impact of the nutrition education Program Nutriamigos® on levels of awareness on healthy eating habits in school-aged children. Journal of Human Growth and Development, 29(3), 390–402. https://doi.org/10.7322/jhgd.v29.9538 Froehlich Chow, A., & Humbert, M. L. (2014). Perceptions of early childhood educators: Factors influencing the promotion of physical activity opportunities in Canadian rural care centers. Child Indicators Research, 7(1), 57–73. https://doi.org/10.1007/s12187-013-9202-x Graham, H., Feenstra, G., Evans, A. M., & Zidenberg-Cherr, S. (2002). Healthy Eating Habits in Children. California Agriculture, 58(4), 200–205. Gucciardi, E., Nagel, R., Szwiega, S., Chow, B. Y. Y., Barker, C., Nezon, J., ... Butler, A. (2019). Evaluation of a Sensory-Based Food Education Program on Fruit and V egetable Consumption among Kindergarten Children. Journal of Child Nutrition & Management, 43(1). Holley, C. E., Farrow, C., & Haycraft, E. (2017). A Systematic Review of Methods for Increasing Vegetable Consumption in Early Childhood. Current Nutrition Reports, 6(2), 157–170. https://doi.org/10.1007/s13668-017-0202-1 Hoppu, U., Prinz, M., Ojansivu, P., Laaksonen, O., & Sandell, M. A. (2015). Impact of sensory- based food education in kindergarten on willingness to eat vegetables and berries. Food and Nutrition Research, 59, 1–8. https://doi.org/10.3402/fnr.v59.28795 Jarpe-Ratner, E., Folkens, S., Sharma, S., Daro, D., & Edens, N. K. (2016). An Experiential Cooking and Nutrition Education Program Increases Cooking Self-Efficacy and Vegetable Consumption in Children in Grades 3–8. Journal of Nutrition Education and Behavior, 48(10), 697-705.e1. https://doi.org/10.1016/j.jneb.2016.07.021 Jones, A. M., & Zidenberg-Cherr, S. (2015). Exploring Nutrition Education Resources and Barriers, and Nutrition Knowledge in Teachers in California. Journal of Nutrition Education and Behavior, 47(2), 162–169. https://doi.org/10.1016/j.jneb.2014.06.011 Jung, T., Huang, J., Eagan, L., & Oldenburg, D. (2019). Influence of school-based nutrition education program on healthy eating literacy and healthy food choice among primary school children. International Journal of Health Promotion and Education, 57(2), 67–81. https://doi.org/10.1080/14635240.2018.1552177 Lwin, M. O., Malik, S., Ridwan, H., & Sum Au, C. S. (2017). Media exposure and parental mediation on fast-food consumption among children in metropolitan and suburban Indonesian. Asia Pacific Journal of Clinical Nutrition, 26(5), 899–905. https://doi.org/10.6133/apjcn.122016.04 Mc Kenna, & L, M. (2010). Policy Options to Support Healthy Eating in Schools. Canadian Journal of Public Health, 101(2), S14–S18. https://doi.org/10.1007/BF03405619 Menkes, R. PERATURAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR 41 TAHUN 2014. , Menteri Kesehatan Republik Indonesia § (2014). Mitsopoulou, A. V., Magriplis, E., Dimakopoulos, I., Karageorgou, D., Bakogianni, I., Micha, R., ... Zampelas, A. (2019). Association of meal and snack patterns with micronutrient intakes among Greek children and adolescents: data from the Hellenic National Nutrition and Health Survey. Journal of Human Nutrition and Dietetics, 32(4), 455–467. https://doi.org/10.1111/jhn.12639 Moffitt, A. (2019). Early Childhood Educators and the Development of Family Literacy Programs: A Qualitative Case Study. ProQuest Dissertations and Theses, 96. Retrieved from http://proxy.mul.missouri.edu/login?url=https://search.proquest.com/docview/2242479347 ?accountid=14576%0Ahttps://library.missouri.edu/findit?genre=dissertations+%26+theses &title=Early+Childhood+Educators+and+the+Development+of+Family+Literacy+Progra ms%3A+ Mustonen, S., & Tuorila, H. (2010). Sensory education decreases food neophobia score and encourages trying unfamiliar foods in 8-12-year-old children. Food Quality and Preference, 21(4), 353–360. https://doi.org/10.1016/j.foodqual.2009.09.001 Myszkowska-Ryciak, J., & Harton, A. (2019). Eating healthy, growing healthy: Outcome evaluation of the nutrition education program optimizing the nutritional value of preschool menus, Poland. Nutrients, 11(10), 1–17. https://doi.org/10.3390/nu11102438 Nekitsing, C., Hetherington, M. M., & Blundell-Birtill, P. (2018). Developing Healthy Food Preferences in Preschool Children Through Taste Exposure, Sensory Learning, and Nutrition Education. Current Obesity Reports, 7(1), 60–67. https://doi.org/10.1007/s13679- 018-0297-8 Noura, M. S. pd. (2018). Child nutrition programs in kindergarten schools implemented by the governmental sector and global nutrition consulting companies: A systematic review. Current Research in Nutrition and Food Science, 6(3), 656–663. https://doi.org/10.12944/CRNFSJ.6.3.07 Oh, S. M., Yu, Y. L., Choi, H. I., & Kim, K. W. (2012). Implementation and Evaluation of Nutrition Education Programs Focusing on Increasing Vegetables, Fruits and Dairy Foods Consumption for Preschool Children. Korean Journal of Community Nutrition, 17(5), 517. https://doi.org/10.5720/kjcn.2012.17.5.517 Osera, T., Tsutie, S., & Kobayashi, M. (2016). Using Soybean Products in School Lunch for Health Education may improve Children’s Attitude and Guardians’ Knowledge in Kindergarten. Journal of Child and Adolescent Behaviour, 04(05). https://doi.org/10.4172/2375-4494.1000310 Park, B. K., & Cho, M. S. (2016). Taste education reduces food neophobia and increases willingness to try novel foods in school children. Nutrition Research and Practice, 10(2), 221–228. https://doi.org/10.4162/nrp.2016.10.2.221 Pendidikan, K., & Kebudayaan, D. A. N. Menteri Pendidikan Dan Kebudayaan Republik Indonesia Nomor 137 Tahun 2013 Tentang Standar Nasional Pendidikan Anak Usia Dini. , (2015). Prima, E., Yuliantina, I., Nurfadillah, Handayani, I., Riana, & Ganesa, R. eni. (2017). Layanan Kesehatan,Gizi dan Perawatan. Jakarta: Direktorat Pembinaan Pendidikan Anak Usia Dini Direktorat Jenderal Pendidikan Anak Usia Dini dan Pendidikan Masyarakat Kementerian Pendidikan dan Kebudayaan. Resor, J., Hegde, A. V., & Stage, V. C. (2020). Pre-service early childhood educators’ perceived barriers and supports to nutrition education. Journal of Early Childhood Teacher Education, 00(00), 1–17. https://doi.org/10.1080/10901027.2020.1740841 Rizqie Aulianaca5804p200-169314. (2011). Gizi Seimbang Dan Makanan Sehat Untuk Anak Usia Dini. Journal of Nutrition and Food Research, 2(1), 1–12. Retrieved from http://staff.uny.ac.id/sites/default/files/pengabdian/rizqie-auliana-dra-mkes/gizi-seimbang- dan-makanan-sehat-untuk-anak-usia-dini.pdf Sandell, M., Mikkelsen, B. E., Lyytikäinen, A., Ojansivu, P., Hoppu, U., Hillgrén, A., & Lagström, H. (2016). Future for food education of children. Futures, 83, 15–23. https://doi.org/10.1016/j.futures.2016.04.006 Schanzenbach, D. W., & Thorn, B. (2019). Food Support Programs and Their Impacts on Young Children. Health Affairs, (march). Retrieved from https://www.healthaffairs.org/briefs Schmitt, S. A., Bryant, L. M., Korucu, I., Kirkham, L., Katare, B., & Benjamin, T. (2019). The effects of a nutrition education curriculum on improving young children’s fruit and vegetable preferences and nutrition and health knowledge. Public Health Nutrition, 22(1), 28–34. https://doi.org/10.1017/S1368980018002586 Sekiyama, M., Roosita, K., & Ohtsuka, R. (2012). Snack foods consumption contributes to poor nutrition of rural children in West Java, Indonesia. Asia Pacific Journal of Clinical Nutrition, 21(4), 558–567. https://doi.org/10.6133/apjcn.2012.21.4.11 Sepp, H., & Ho, K. (2016). Food as a tool for learning in everyday activities at preschool exploratory study from Sweden. Food & Nurtition Research, 1, 1–7. Shor, R., & Friedman, A. (2009). Integration of nutrition-related components by early childhood education professionals into their individual work with children at risk. Early Child Development and Care, 179(4), 477–486. https://doi.org/10.1080/03004430701269218 Taylor, C. M., & Emmett, P. M. (2019). Picky eating in children: Causes and consequences. Proceedings of the Nutrition Society, 78(2), 161–169. https://doi.org/10.1017/S0029665118002586 Taylor, C. M., Steer, C. D., Hays, N. P., & Emmett, P. M. (2019). Growth and body composition in children who are picky eaters: a longitudinal view. European Journal of Clinical Nutrition, 73(6), 869–878. https://doi.org/10.1038/s41430-018-0250-7 Unusan, N. (2007). Effects of a food and nutrition course on the self-reported knowledge and behavior of preschool teacher candidates. Early Childhood Education Journal, 34(5), 323– 327. https://doi.org/10.1007/s10643-006-0116-9 Usfar, A. A., Iswarawanti, D. N., Davelyna, D., & Dillon, D. (2010). Food and Personal Hygiene Perceptions and Practices among Caregivers Whose Children Have Diarrhea: A Qualitative Study of Urban Mothers in Tangerang, Indonesia. Journal of Nutrition Education and Behavior, 42(1), 33–40. https://doi.org/10.1016/j.jneb.2009.03.003 Witt, K. E., & Dunn, C. (2012). Increasing Fruit and V egetable Consumption among Preschoolers: Evaluation of Color Me Healthy. Journal of Nutrition Education and Behavior, 44(2), 107–113. https://doi.org/10.1016/j.jneb.2011.01.002

Background: Although sleep has been identified as an important modifiable risk factor for sports injury, the effect of decreased sleep on sports injuries in adolescents is poorly studied. Purpose: To systematically review published literature to examine if a lack of sleep is associated with sports injuries in adolescents and to delineate the effects of chronic versus acute lack of sleep. Methods: PubMed and EMBASE databases were systematically searched for studies reporting statistics regarding the relationship between sleep and sports injury in adolescents aged <19 years published between 1/1/1997 and 12/21/2017. From included studies, the following information was extracted: bibliographic and demographic information, reported outcomes related to injury and sleep, and definitions of injury and decreased sleep. Additionally, a NOS (Newcastle-Ottawa Scale) assessment and an evaluation of the OCEM (Oxford Center for Evidence-Based Medicine) level of evidence for each study was conducted to assess each study’s individual risk of bias, and the risk of bias across all studies. Results: Of 907 identified articles, 7 met inclusion criteria. Five studies reported that adolescents who chronically slept poorly were at a significantly increased likelihood of experiencing a sports or musculoskeletal injury. Two studies reported on acute sleep behaviors. One reported a significant positive correlation between acutely poor sleep and injury, while the other study reported no significant correlation. In our random effects model, adolescents who chronically slept poorly were more likely to be injured than those who slept well (OR 1.58, 95% CI 1.05 to 2.37, p = 0.03). OCEM criteria assessment showed that all but one study (a case-series) were of 2b level of evidence—which is the highest level of evidence possible for studies which were not randomized control trials or systematic reviews. NOS assessment was conducted for all six cohort studies to investigate each study’s individual risk of bias. Five out of six of these studies received between 4 to 6 stars, categorizing them as having a moderate risk of bias. One study received 7 stars, categorizing it as having a low risk of bias. NOS assessment revealed that the most consistent source of bias was in ascertainment of exposure: all studies relied on self-reported data regarding sleep hours rather than a medical or lab record of sleep hours. Conclusions: Chronic lack of sleep in adolescents is associated with greater risk of sports and musculoskeletal injuries. Current evidence cannot yet definitively determine the effect of acute lack of sleep on injury rates. Our results thus suggest that adolescents who either chronically sleep less than 8 hours per night, or have frequent night time awakenings, are more likely to experience sports or musculoskeletal injuries. [Figure: see text][Figure: see text][Table: see text][Table: see text][Table: see text] References used in tables and full manuscript Barber Foss KD, Myer GD, Hewett TE. Epidemiology of basketball, soccer, and volleyball injuries in middle-school female athletes. Phys Sportsmed. 2014;42(2):146-153. Adirim TA, Cheng TL. Overview of injuries in the young athlete. Sports Med. 2003;33(1):75-81. Valovich McLeod TC, Decoster LC, Loud KJ, et al. National Athletic Trainers’ Association position statement: prevention of pediatric overuse injuries. J Athl Train. 2011;46(2):206-220. Milewski MD, Skaggs DL, Bishop GA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014;34(2):129-133. Wheaton AG, Olsen EO, Miller GF, Croft JB. Sleep Duration and Injury-Related Risk Behaviors Among High School Students--United States, 2007-2013. MMWR Morb Mortal Wkly Rep. 2016;65(13):337-341. Paruthi S, Brooks LJ, D’Ambrosio C, et al. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine. 2016;12(11):1549-1561. Watson NF, Badr MS, Belenky G, et al. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion. Sleep. 2015;38(8):1161-1183. Juliff LE, Halson SL, Hebert JJ, Forsyth PL, Peiffer JJ. Longer Sleep Durations Are Positively Associated With Finishing Place During a National Multiday Netball Competition. J Strength Cond Res. 2018;32(1):189-194. Beedie CJ, Terry PC, Lane AM. The profile of mood states and athletic performance: Two meta- analyses. Journal of Applied Sport Psychology. 2000;12(1):49-68. Panic N, Leoncini E, de Belvis G, Ricciardi W, Boccia S. Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses. PLoS One. 2013;8(12): e83138. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS medicine. 2009;6(7): e1000100. Watson A, Brickson S, Brooks A, Dunn W. Subjective well-being and training load predict in- season injury and illness risk in female youth soccer players. Br J Sports Med. 2016. Alricsson M, Domalewski D, Romild U, Asplund R. Physical activity, health, body mass index, sleeping habits and body complaints in Australian senior high school students. Int J Adolesc Med Health. 2008;20(4):501-512. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Luke A, Lazaro RM, Bergeron MF, et al. Sports-related injuries in youth athletes: is overscheduling a risk factor? Clin J Sport Med. 2011;21(4):307-314. University of Oxford Center for Evidence-Based Medicine. Oxford Centre for Evidence-based Medicine – Levels of Evidence. 2009; https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/ . von Rosen P, Frohm A, Kottorp A, Friden C, Heijne A. Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes. Scand J Med Sci Sports. 2017;27(11):1364-1371. von Rosen P, Frohm A, Kottorp A, Friden C, Heijne A. Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective. Scand J Med Sci Sports. 2017;27(12):2059-2069. Picavet HS, Berentzen N, Scheuer N, et al. Musculoskeletal complaints while growing up from age 11 to age 14: the PIAMA birth cohort study. Pain. 2016;157(12):2826-2833. Kim SY, Sim S, Kim SG, Choi HG. Sleep Deprivation Is Associated with Bicycle Accidents and Slip and Fall Injuries in Korean Adolescents. PLoS One. 2015;10(8): e0135753. Stare J, Maucort-Boulch D. Odds Ratio, Hazard Ratio and Relative Risk. Metodoloski Zvezki. 2016;13(1):59-67. Watson AM. Sleep and Athletic Performance. Curr Sports Med Rep. 2017;16(6):413-418. Stracciolini A, Stein CJ, Kinney S, McCrystal T, Pepin MJ, Meehan Iii WP. Associations Between Sedentary Behaviors, Sleep Patterns, and BMI in Young Dancers Attending a Summer Intensive Dance Training Program. J Dance Med Sci. 2017;21(3):102-108. Stracciolini A, Shore BJ, Pepin MJ, Eisenberg K, Meehan WP, 3 rd. Television or unrestricted, unmonitored internet access in the bedroom and body mass index in youth athletes. Acta Paediatr. 2017;106(8):1331-1335. Snyder Valier AR, Welch Bacon CE, Bay RC, Molzen E, Lam KC, Valovich McLeod TC. Reference Values for the Pediatric Quality of Life Inventory and the Multidimensional Fatigue Scale in Adolescent Athletes by Sport and Sex. Am J Sports Med. 2017;45(12):2723-2729. Simpson NS, Gibbs EL, Matheson GO. Optimizing sleep to maximize performance: implications and recommendations for elite athletes. Scand J Med Sci Sports. 2017;27(3):266-274. Liiv H, Jurimae T, Klonova A, Cicchella A. Performance and recovery: stress profiles in professional ballroom dancers. Med Probl Perform Art. 2013;28(2):65-69. Van Der Werf YD, Van Der Helm E, Schoonheim MM, Ridderikhoff A, Van Someren EJ. Learning by observation requires an early sleep window. Proc Natl Acad Sci U S A. 2009;106(45):18926- 18930. Lee AJ, Lin WH. Association between sleep quality and physical fitness in female young adults. J Sports Med Phys Fitness. 2007;47(4):462-467. Mejri MA, Yousfi N, Hammouda O, et al. One night of partial sleep deprivation increased biomarkers of muscle and cardiac injuries during acute intermittent exercise. J Sports Med Phys Fitness. 2017;57(5):643-651. Mejri MA, Yousfi N, Mhenni T, et al. Does one night of partial sleep deprivation affect the evening performance during intermittent exercise in Taekwondo players? Journal of exercise rehabilitation. 2016;12(1):47-53. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep health. 2015;1(4):233-243. Dennis J, Dawson B, Heasman J, Rogalski B, Robey E. Sleep patterns and injury occurrence in elite Australian footballers. J Sci Med Sport. 2016;19(2):113-116. Bergeron MF, Mountjoy M, Armstrong N, et al. International Olympic Committee consensus statement on youth athletic development. Br J Sports Med. 2015;49(13):843-851. Riley M, Locke AB, Skye EP. Health maintenance in school-aged children: Part II. Counseling recommendations. Am Fam Physician. 2011;83(6):689-694. Spector ND, Kelly SF. Sleep disorders, immunizations, sports injuries, autism. Curr Opin Pediatr. 2005;17(6):773-786. Asarnow LD, McGlinchey E, Harvey AG. The effects of bedtime and sleep duration on academic and emotional outcomes in a nationally representative sample of adolescents. J Adolesc Health. 2014;54(3):350-356. Dahl RE, Lewin DS. Pathways to adolescent health sleep regulation and behavior. J Adolesc Health. 2002;31(6 Suppl):175-184. School start times for adolescents. Pediatrics. 2014;134(3):642-649. Bland JM, Altman DG. The odds ratio. BMJ. 2000;320(7247):1468.

Background: The COVID-19 pandemic has various unfavorable effects on individuals and the community. This study aims to assess the psychological impact of the COVID-19 epidemic and the subsequent social isolation on the general population of Karnataka, India. Methods: A web-based cross-sectional survey was conducted in Karnataka from 8 to 14 April 2020 using the snowball technique. The psychological impact was assessed with the help of the nine-item Patient Health Questionnaire-9 (PHQ-9) and seven-item General Anxiety Disorder-7 (GAD-7) questionnaires. IBM SPSS Statistics Subscription version 16.0 was recruited to analyze the data. Descriptive (Mean + Standard Deviation) and bivariate (Pearson chi-square and ANOVA tests) analysis used to present data with the significance level set at less than 0.05. Results: This study included 1537 participants from 26 cities in Karnataka. About two-thirds of the respondents were undergraduate students (951, 61.9%), females (768, 50.0%), and 40.1% stayed about 15-20 days in social isolation. The prevalence of depression was 47.0%, and anxiety was 41.5%, respectively, among the surveyed sample. After the analysis, the age group 21-30 year old (P < 0.001), females P < 0.001), urban residents (P = 0.021), and the students (P p < 0.001) were significant for depression. However, only the age group 31-40 years was found to be more susceptible to anxiety. Conclusion: As important as addressing the psychological effects, knowing people at risk of developing mental illnesses will contribute effectively to providing appropriate psychological rehabilitation programs at the right time. References World Health Organization, Novel Coronavirus (2019-nCoV) Situation Report –1, 21 January 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf, [Accessed on 30 August 2020]. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020 Mar 6;17(5):1729. https://doi.org/10.3390/ijerph17051729. World Health Organization, WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 [Accessed on 13 April 2020] Coronavirus in India: Latest Map and Case Count. Available from: https://www.covid19india.org/ [Accessed 13 April 2020]. Arakal RA. First COVID-19 case in Karnataka: Techie who returned to Bengaluru from US tests positive, (9 March2020). Available from: https://indianexpress.com/article/cities/bangalore/coronavirus-karnataka-first-case-covid-19-bengaluru-6307223/ [Accessed on 13 April 2020] India Today on 24 March 2020. Modi announces lockdown Updates: No panic buying please. Stay indoors, tweets PM. Available from: https://www.indiatoday.in/india/story/pm-modi-address-the-nation-at-8-pm-today-speech-covid-19-coronavirus-live-updates-1659215-2020-03-24 [Accessed on 13 April 2020] Ali Jadoo SA. Was the world ready to face a crisis like COVID-19? Journal of Ideas in Health2020;3(1):123-4. https://doi.org/10.47108/jidhealth.Vol3.Iss1.45 Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci U S A. 2013;110(15):5797-5801. https://doi.org/10.1073/pnas.1219686110 Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020; 287:112934. https://doi.org/10.1016/j.psychres.2020.112934 Taylor HO, Taylor RJ, Nguyen AW, Chatters L. Social Isolation, Depression, and Psychological Distress Among Older Adults. Journal of Aging and Health2018; 30(2): 229–246. https://doi.org/10.1177/0898264316673511 Sim K, Huak Chan Y, Chong PN, Chua HC, Wen Soon S. Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease. J Psychosom Res. 2010;68(2):195-202. https://doi.org/10.1016/j.jpsychores.2009.04.004 Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatr. 2020; 51:102083. https://doi.org/10.1016/j.ajp.2020.102083. Karnataka Population. Available from: http://www.populationu.com/in/karnataka-population [Accessed on 8 April 2020] Sample Size Calculator: Understanding Sample Sizes. Available from: https://www.surveymonkey.com/mp/sample-size-calculator/ [Accessed on 5 March 2020] Toussaint A, Hüsing P, Gumz A, Wingenfeld K, Härter M, Schramm E, Löwe B. Sensitivity to change and minimal clinically important difference of the 7-item generalized anxiety disorder questionnaire (GAD-7). J Affect Disord. 2020; 265:395–401. https://doi.org/10.1016/j.jad.2020.01.032 Williams N. The GAD-7 Questionnaire [Review of the test Generalized anxiety disorder (gad-7) Questionnaire, by R. L. Spitzer]. Occupational Medicine2014; 64(3): 224. https://doi.org/10.1093/occmed/kqt161 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606. Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci. 2015;40(4):219-221. https://doi.org/10.1503/jpn.150205 Patten SB, Wang JL, Williams JV, Wang JL, McDonald K, Bulloch ACM. Descriptive epidemiology of major depression in Canada. Can J Psychiatry. 2006; 51:84–90. https://doi.org/10.1177/070674371506000106 Jones C. Student anxiety, depression increasing during school closures, survey finds. EdSorce, 13 May 2020. Available from: https://edsource.org/2020/student-anxiety-depression-increasing-during-school-closures-survey-finds/631224 [Accessed on 29 August 2020]. Frasquilho D, Matos MG, Salonna F, Guerreiro D, Storti CC, Gaspar T, Caldas-de-Almeida JM. Mental health outcomes in times of economic recession: a systematic literature review. BMC Public Health2015; 16:115. https://doi.org/10.1186/s12889-016-2720-y. Ali Jadoo SA. COVID -19 pandemic is a worldwide typical Biopsychosocial crisis. Journal of Ideas in Health2020;3(2):152-4. https://doi.org/10.47108/jidhealth.Vol3.Iss2.58 Prabhu N. Bengaluru urban tops state in per capita income, Kalaburagi last, (20 March 2016). Available from: https://www.thehindu.com/news/cities/bangalore/bengaluru-urban-tops-state-in-per-capita-income-kalaburagi-last/article8376124.ece [Accessed 13 April 2020].

<p><strong>List of abstracts and authors:</strong></p><p><strong>1. Bipolar disorder not otherwise specified -overdiagnosed or underdiagnosed?</strong></p><p>E Allers</p><p><strong>2. The prognosis of major depression untreated and treated: Does the data reflect the true picture of the prognosis of this very common disorder?</strong></p><p>E Allers</p><p><strong>3. Can we prolong our patients' life expectancy? Providing a better quality of life for patients with severe mental illness</strong></p><p>O A Betencourt</p><p><strong>4. The scope of ECT practice in South Africa</strong></p><p>J Benson-Martin, P Milligan</p><p><strong>5. Biomarkers for schizophrenia: Can we evolve like cancer therapeutics?</strong></p><p>P Buckley<strong></strong></p><p><strong>6. Relapse in schizophrenis: Major challenges in prediction and prevention</strong></p><p>P Buckley</p><p><strong>7. Informed consent in biological treatments: The right to know the duty to inform</strong></p><p><strong></strong>I Chetty</p><p><strong>8. Effectiveness of a long-acting injectable antipsychotic plus an assertive monitoring programme in first-episode schizophrenia</strong></p><p><strong></strong>B Chiliza, L Asmal, O Esan, A Ojagbemi, O Gureje, R Emsley</p><p><strong>9. Name, shame, fame</strong></p><p>P Cilliers</p><p><strong>10. Can we manage the increasing incidence of violent raging children? We have to!</strong></p><p>H Clark</p><p><strong>11. Serotonin, depression and antidepressant action</strong></p><p>P Cowen</p><p><strong>12. Prevalence and correlates of comorbid psychiatris illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit</strong></p><p>L Dannatt, K J Cloete, M Kidd, L Weich</p><p><strong>13. Investigating the association between diabetes mellitus, depression and psychological distress in a cohort of South African teachers</strong></p><p>A K Domingo, S Seedat, T M Esterhuizen, C Laurence, J Volmink, L Asmal</p><p><strong>14. Neuropeptide S -emerging evidence for a role in anxiety</strong></p><p>K Domschke</p><p><strong>15. Pathogenetics of anxiety</strong></p><p>K Domschke</p><p><strong>16. The effects of HIV on the fronto-striatal system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>17. Effects of acute antipsychotic treatment on brain morphology in schizophrenia</strong></p><p>R Emsley, L Asmal, B Chiliza, S du Plessis, J Carr, A Goosen, M Kidd, M Vink, R Kahn</p><p><strong>18. Development of a genetic database resource for monitoring of breast cancer patients at risk of physical and psychological complications</strong></p><p>K Grant, F J Cronje, K Botha, J P Apffelstaedt, M J Kotze</p><p><strong>19. Unipolar mania reconsidered: Evidence from a South African study</strong></p><p><strong></strong>C Grobler</p><p><strong>20. Antipsychotic-induced movement disorders: Occurence and management</strong></p><p>P Haddad</p><p><strong>21. The place of observational studies in assessing the effectiveness of long-acting injectable antipsychotics</strong></p><p>P Haddad</p><p><strong>22. Molecular mechanisms of d-cycloserine in fear extinction: Insights from RNS sequencing</strong></p><p>S Hemmings, S Malan-Muller, L Fairbairn, M Jalali, E J Oakeley, J Gamieldien, M Kidd, S Seedat</p><p><strong>23. Schizophrenia: The role of inflammation</strong></p><p>DC Henderson</p><p><strong>24. Addictions: Emergent trends and innovations</strong></p><p>V Hitzeroth</p><p><strong>25. The socio-cultural-religious context of biological psychiatric practice</strong></p><p>B Janse van Rensburg</p><p><strong>26. Biochemical markers for identifying risk factors for disability progression in multiple sclerosis</strong></p><p><strong></strong>S Janse van Rensburg, M J Kotze, F J Cronje, W Davis, K Moremi, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>27. Alcohol-induced psychotic disorder: Brain perfusion and psychopathology - before and after antipsychotic treatment</strong></p><p>G Jordaan, J M Warwick, D G Nel, R Hewlett, R Emsley</p><p><strong>28.'Pump and dump': Harm reduction strategies for breastfeeding while using substances</strong></p><p>L Kramer</p><p><strong>29. Adolescent neuropsychiatry - an emerging field in South African adolescent psychiatric services</strong></p><p>A Lachman</p><p><strong>30. Recovery versus remission, or what it means to be healthy for a psychiatric patient?</strong></p><p>B Latecki</p><p><strong>31. Holistic methods utilised to normalise behaviours in youth diagnosed with neuro-biochemical disorders</strong></p><p>P Macqueen</p><p><strong>32. Candidate genes and novel polymorphisms for anxiety disorder in a South African cohort</strong></p><p>N McGregor, J Dimatelis, S M J Hemmings, C J Kinnear, D Stein, V Russel, C Lochner</p><p><strong>33. Higher visual functioning</strong></p><p>A Moodley</p><p><strong>34. The effects of prenatal methylmercury exposure on trace element and antioxidant levels in rat offspring following 6-hydroxydopamine-induced neuronal insult</strong></p><p>Z M Moosa, W M U Daniels, M V Mabandla</p><p><strong>35. Paediatric neuropsychiatric movement disorders</strong></p><p>L Mubaiwa</p><p><strong>36. The South African national female offenders study</strong></p><p>M Nagdee, L Artz, C de Clercq, P de Wet, H Erlacher, S Kaliski, C Kotze, L Kowalski, J Naidoo, S Naidoo, J Pretorius, M Roffey, F Sokudela, U Subramaney</p><p><strong>37. Neurobiological consequences of child abuse</strong></p><p>C Nemeroff</p><p><strong>38. What do Stellenbosch Unviversity medical students think about psychiatry - and why should we care?</strong></p><p>G Nortje, S Suliman, K Seed, G Lydall, S Seedat</p><p><strong>39. Neurological soft skins in Nigerian Africans with first episode schizophrenia: Factor structure and clinical correlates</strong></p><p><strong></strong>A Ojagbemi, O Esan, O Gureje, R Emsley</p><p><strong>40. Should psychiatric patients know their MTHFR status?</strong></p><p>E Peter</p><p><strong>41. Clinical and functional outcome of treatment refractory first-episode schizophrenia</strong></p><p>L Phahladira, R Emsley, L Asmal, B Chiliza</p><p><strong>42. Bioethics by case discussion</strong></p><p>W Pienaar</p><p><strong>43. Reviewing our social contract pertaining to psychiatric research in children, research in developing countries and distributive justice in pharmacy</strong></p><p>W Pienaar</p><p><strong>44. The performance of the MMSE in a heterogenous elderly South African population</strong></p><p>S Ramlall, J Chipps, A I Bhigjee, B J Pillay</p><p><strong>45. Biological basis addiction (alocohol and drug addiction)</strong></p><p>S Rataemane</p><p><strong>46. Volumetric brain changes in prenatal methamphetamine-exposed children compared with healthy unexposed controls</strong></p><p><strong></strong>A Roos, K Donald, G Jones, D J Stein</p><p><strong>47. Single voxel proton magnetic resonance spectroscopy of the amygdala in social anxiety disorder in the context of early developmental trauma</strong></p><p>D Rosenstein, A Hess, S Seedat, E Meintjies</p><p><strong>48. Discussion of HDAC inhibitors, with specific reference to supliride and its use during breastfeeding</strong></p><p>J Roux</p><p><strong>49. Prevalence and clinical correlates of police contact prior to a first diagnosis of schizophrenia</strong></p><p>C Schumann, L Asmal, K Cloete, B Chiliza, R Emsley</p><p><strong>50. Are dreams meaningless?</strong></p><p>M Solms</p><p><strong>51. The conscious id</strong></p><p>M Solms<strong></strong></p><p><strong>52. Depression and resilience in HIV-infected women with early life stress: Does trauma play a mediating role?</strong></p><p>G Spies, S Seedat</p><p><strong>53. State of affairs analysis for forensic psychiatry in SA</strong></p><p>U Subramaney</p><p><strong>54. Escitalopram in the prevention of post-traumatic stress disorder: A pilot randomised controlled trial</strong></p><p>S Suliman, S Seedat, J Pingo, T Sutherland, J Zohar, D J Stein</p><p><strong>55. Epigenetic consequences of adverse early social experiences in primates</strong></p><p>S Suomi</p><p><strong>56. Risk, resilience, and gene x environment interactions in primates</strong></p><p>S Suomi</p><p><strong>57. Biological aspects of anorexia nervosa</strong></p><p>C Szabo</p><p><strong>58. Agents used and profiles of non-fatal suicidal behaviour in East London</strong></p><p>H Uys</p><p><strong>59. The contributions of G-protein coupled receptor signalling to opioid dependence</strong></p><p>J van Tonder</p><p><strong>60. Emerging trend and innovation in PTSD and OCD</strong></p><p>J Zohar</p><p><strong>61. Making the SASOP treatment guidelines operational</strong></p><p>E Allers</p><p><strong>Poster Presentations</strong></p><p><strong>62. Neuropsychological deficits in social anxiety disorder in the context of early developmental trauma</strong></p><p><strong></strong>S Bakelaar, D Rosenstein, S Seedat</p><p><strong>63.Social anxiety disorder in patients with or without early childhood trauma: Relationship to behavioral inhibition and activation and quality of life</strong></p><p><strong></strong>S Bakelaar, C Bruijnen, A Sambeth, S Seedat</p><p><strong>64. Exploring altered affective processing in obssessive compulsive disorder symptom subtypes</strong></p><p>E Breet, J Ipser, D Stein, C Lochner<strong><br /></strong></p><p><strong>65. To investigate the bias toward recognising the facial expression of disgust in obsessive compulsive disorder as well as the effect of escitalopram</strong></p><p>E Breet, J Ipser, D Stein, C Lochner</p><p><strong>66. A fatal-case of nevirapine-induced Stevens-Johnson's syndrome in HIV mania</strong></p><p>A Bronkhorst, Z Zingela, W M Qwesha, B P Magigaba<strong></strong></p><p><strong>67. Association of the COMT G472A (met/met) genotype with lower disability in people diagnosed with multiple sclerosis</strong></p><p>W Davis, S J van Rensburg, L Fisher, F J Cronje, D Geiger, M J Kotze</p><p><strong>68. Homocycsteine levels are associated with the fat mass and obesity associated gene FTO(intron 1 T&gt;A) polymorphism in MS patients</strong></p><p>W Davis, S J Van Rensburg, M J Kotze, L Fisher, M Jalali, F J Cronje, K Moremi, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>69. Analysis of the COMT 472 G&gt;A (rs4680) polymorphism in relation to environmental influences as contributing factors in patients with schizophrenia</strong></p><p>D de Klerk, S J van Rensburg, R A Emsley, D Geiger, M Rensburg, R T Erasmus, M J Kotze</p><p><strong>70. Dietary folate intake, homocysteine levels and MTHFR mutation detection in South African patients with depression: Test development for clinical application </strong></p><p>D Delport, N vand der Merwe, R Schoeman, M J Kotze</p><p><strong>71. The use ofexome sequencing for antipsychotic pharmacogenomic applications in South African schizophrenia patients</strong></p><p>B Drogmoller, D Niehaus, G Wright, B Chiliza, L Asmal, R Emsley, L Warnich</p><p><strong>72. The effects of HIV on the ventral-striatal reward system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>73. Xenomelia relates to asymmetrical insular activity: A case study of fMRI</strong></p><p>S du Plessis, M Vink, L Asmal</p><p><strong>74. Maternal mental helath: A prospective naturalistic study of the outcome of pregancy in women with major psychiatric disorders in an African country</strong></p><p>E du Toit, L Koen, D Niehaus, B Vythilingum, E Jordaan, J Leppanen</p><p><strong>75. Prefrontal cortical thinning and subcortical volume decrease in HIV-positive children with encephalopathy</strong></p><p>J P Fouche, B Spottiswoode, K Donald, D Stein, J Hoare</p><p><strong>76. H-magnetic resonance spectroscopy metabolites in schizophrenia</strong></p><p>F Howells, J Hsieh, H Temmingh, D J Stein</p><p><strong>77. Hypothesis for the development of persistent methamphetamine-induced psychosis</strong></p><p><strong></strong> J Hsieh, D J Stein, F M Howells</p><p><strong>78. Culture, religion, spirituality and psychiatric practice: The SASOP Spirituality and Psychiatry Special Interest Group Action Plan for 2012-2014</strong></p><p>B Janse van Rensburg</p><p><strong>79. Cocaine reduces the efficiency of dopamine uptake in a rodent model of attention-deficit/hyperactivity disorder: An <em>in vivo</em> electrochemical study</strong></p><p><strong></strong>L Kellaway, J S Womersley, D J Stein, G A Gerhardt, V A Russell</p><p><strong>80. Kleine-Levin syndrome: Case in an adolescent psychiatric unit</strong></p><p>A Lachman</p><p><strong>81. Increased inflammatory stress specific clinical, lifestyle and therapeutic variables in patients receiving treatment for stress, anxiety or depressive symptoms</strong></p><p>H Luckhoff, M Kotze, S Janse van Rensburg, D Geiger</p><p><strong>82. Catatonia: An eight-case series report</strong></p><p>M Mabenge, Z Zingela, S van Wyk</p><p><strong>83. Relationship between anxiety sensitivity and childhood trauma in a random sample of adolescents from secondary schools in Cape Town</strong></p><p>L Martin, M Viljoen, S Seedat</p><p><strong>84. 'Making ethics real'. An overview of an ethics course presented by Fraser Health Ethics Services, BC, Canada</strong></p><p>JJ McCallaghan</p><p><strong>85. Clozapine discontinuation rates in a public healthcare setting</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>86. Retrospective review of clozapine monitoring in a publica sector psychiatric hospital and associated clinics</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>87. Association of an iron-related TMPRSS6 genetic variant c.2007 C&gt;7 (rs855791) with functional iron deficiency and its effect on multiple sclerosis risk in the South African population</strong></p><p>K Moremi, S J van Rensburg, L R Fisher, W Davis, F J Cronje, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus, M Kidd, M J Kotze</p><p><strong>88. Identifying molecular mechanisms of apormophine-induced addictive behaviours</strong></p><p>Z Ndlazi, W Daniels, M Mabandla</p><p><strong>89. Effects of lifestyle factors and biochemistry on the major neck blood vessels in patients with mutiple sclerosis</strong></p><p>M Nelson, S J van Rensburg, M J Kotze, F Isaacs, S Hassan</p><p><strong>90. Nicotine protects against dopamine neurodegenration and improves motor deficits in a Parkinsonian rat model</strong></p><p>N Ngema, P Ngema, M Mabandla, W Daniels</p><p><strong>91. Cognition: Probing anatomical substrates</strong></p><p>H Nowbath</p><p><strong>92. Chronic exposure to light reverses the effects of maternal separation on the rat prefrontal cortex</strong></p><p>V Russel, J Dimatelis</p><p><strong>93. Evaluating a new drug to combat Alzheimer's disease</strong></p><p>S Sibiya, W M U Daniels, M V Mabandla</p><p><strong>94. Structural brain changes in HIV-infected women with and without childhood trauma</strong></p><p>G Spies, F Ahmed, C Fennema-Notestine, S Archibald, S Seedat</p><p><strong>95. Nicotine-stimulated release of hippocampal norepinephrine is reduced in an animal model of attention-deficit/ hyperactivity disorder: the spontaneously hypertensive rat</strong></p><p>T Sterley</p><p><strong>96. Brain-derive neurotrophic factor (BDNF) protein levels in anxiety disorders: Systematic review and meta-regression analysis</strong></p><p>S Suliman, S M J Hemmings, S Seedat</p><p><strong>97. A 12-month retrospective audit of the demographic and clinical profile of mental healthcare users admitted to a district level hospital in the Western Cape, South Africa</strong></p><p>E Thomas, K J Cloete, M Kidd, H Lategan</p><p><strong>98. Magnesium recurarization: A comparison between reversal of neuromuscular block with sugammadex v. neostigmine/ glycopyrrolate in an <em>in vivo</em> rat model</strong></p><p><strong></strong>M van den Berg, M F M James, L A Kellaway</p><p><strong>99. Identification of breast cancer patients at increased risk of 'chemobrain': Case study and review of the literature</strong></p><p>N van der Merwe, R Pienaar, S J van Rensburg, J Bezuidenhout, M J Kotze</p><p><strong>100. The protective role of HAART and NAZA in HIV Tat protein-induced hippocampal cell death</strong></p><p>S Zulu, W M U Daniels, M V Mabandla</p>

ABSTRAK Kemisikinan merupakan suatu permasalahan yang harus ditemukan cara mengentaskannya. Islam agama yang sempurna telah memberikan solusi melalui instrument zakat, infak, dan sedekah. Tujuan dari penelitian ini adalah untuk menilai dampak zakat, infak, sedekah di LAZNAS LMI (Lembaga Manajemen Infaq) dengan Pendekatan CIBEST. Metode penelitian yang digunakan adalah kuantitatif dengan uji beda antara kondisi material dan spiritual mustahik sebelum dibantu dengan setelah disalurkan dana ZIS. Hasil analisis dari 355 penerima manfaat menunjukkan bahwa pada kuadran I, penerima manfaat yang dikategorikan sejahtera bertambah 28% sesudah dibantu. Pada kuadran II, penerima manfaat yang dikategorikan miskin secara material menurun sebesar 27,7%. Selain itu pada kuadran IV penerima manfaat yang dikategorikan miskin secara absolut, juga ikut menurun sebesar 0,3%. Hasil Uji Beda juga menunjukan ada perbedaan indeks spiritual maupun indeks material penerima manfaat antar sebelum dan sesudah pemberian dana ZIS dibuktikan dengan Uji Beda Wilcoxon untuk indeks material value, dan Uji T berpasangan untuk indeks spiritual value.. Dengan adanya hasil penilaian kaji dampak ini diharapkan dampak dari bantuan yang diberikan bisa terukur dan juga menjadi bahan evaluasi serta perencanaan untuk program-program yang akan datang. Implikasi temuan penelitian ini dapat memberikan refrensi terkait manfaat zakat, infak, sedekah dalam membantu mengetaskan kemiskinan yang dilakukan oleh lembaga amil zakat nasional. Secara praktik, Lembaga Manajemen Infaq perlu memberikan perhatian khusus kepada mustahik yang berada di kategori miskin absolut, dengan memberikan intervensi ekonomi dan pembinaan secara spiritual. Kata Kunci: Kaji Dampak, ZIS, Kemiskinan, CIBEST, Lemabga Amil Zakat, Lembaga Manajemen Infaq. ABSTRACT Poverty is a problem that must find a way to eradicate. Islam, the perfect religion, has provided a solution through the instruments of zakat, infaq, and shadaqah. The purpose of this study was to assess the impact of Zakat, Sedekah, and Infaq in Lembaga Manajemen Infaq with the CIBEST Approach. The method used is quantitative by distributing questionnaires and testing the difference between the material and spiritual conditions of the mustahik before being assisted with after the ZIS funds are distributed. The results of the analysis of 355 beneficiaries showed that in quadrant I, beneficiaries categorized as prosperous increased by 28% after being assisted. In quadrant II, beneficiaries categorized as materially poor decreased by 27.7%. In addition, in quadrant IV, beneficiaries who are categorized as absolute poor also decreased by 0.3%. The results of the Difference Test also show that there are differences in the spiritual index and material index of beneficiaries between before and after the provision of ZIS funds, as evidenced by the Wilcoxon Difference Test for the material value index, and the paired T-test for the spiritual value index. The assistance provided can be measured and can also be used as material for evaluation and planning for future programs. The implications of the findings of this study can provide a reference regarding the benefits of zakat, shadaqah, and infaq in helping to alleviate poverty carried out by the national amil zakat institution. In practice, Amil Zakat Organization needs to pay special attention to mustahik who are in the absolute poor category, by providing economic intervention and spiritual guidance. Keywords: Assessment of Impact, ZIS, Poverty, CIBEST, Amil Zakat Organization, Lembaga Manajemen Infaq. DAFTAR PUSTAKA Ahmed, B. O., Johari, F., & Wahab, K. A. (2017). Identifying the poor and the needy among the beneficiaries of zakat Need for a zakat-based poverty threshold in Nigeria. International Journal of Social Economics, 44(4), 446–458. https://doi.org/10.1108/IJSE-09-2015-0234 Amalia, & Mahalli, K. (2012). Analisis peran zakat dalam mengurangi kemiskinan: Studi kasus dompet dhuafa republika. Jurnal Ekonomi dan Keuangan. Andam, A. C., & Osman, A. Z. (2019). Determinants of intention to give zakat on employment income: Experience from Marawi City, Philippines. Journal of Islamic Accounting and Business Research, 10(4), 528–545. https://doi.org/10.1108/JIABR-08-2016-0097 Ashar, M. A., & Nafik, M. (2019). Implementasi metode CIBEST (Center of Islamic business and economic studies) dalam mengukur peran zakat produktif terhadap pemberdayaan mustahiq di lembaga yayasan dana sosial al-falah (ydsf) Surabaya. Jurnal Ekonomi Syariah Teori dan Terapan, 6(5). 1057-1071. https://doi.org/10.20473/vol6iss20195pp1057-1071 Asian Development Bank. (2021). Daftar negara dengan penduduk hidup di bawah garis kemiskinan terbanyak di Asia Tenggara. Retrieved from https://databoks.katadata.co.id/datapublish/2021/11/19/daftar-negara-dengan-penduduk-hidup-di-bawah-garis-kemiskinan-terbanyak-di-asia-tenggara Asmalia, S., Kasri, R. A., & Ahsan, A. (2018). Exploring the potential of zakah for supporting realization of sustainable development Goals (SDGs) in Indonesia. International Journal of Zakat, 3(4), 51–69. https://doi.org/10.37706/IJAZ.V3I4.106 Ayuniyyah, Q., Pramanik, A. H., Md Saad, N., & Ariffin, M. I. (2022). The impact of zakat in poverty alleviation and income inequality reduction from the perspective of gender in West Java, Indonesia. International Journal of Islamic and Middle Eastern Finance and Management. Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/IMEFM-08-2020-0403 Ayyubi, S. el, & Saputri, H. E. (2018). Analysis of the impact of zakat, infak, and sadaqah distribution on poverty alleviation based on the CIBEST model (Case study: Jogokariyan baitul maal mosque, Yogyakarta). In International Journal of Zakat, 3(2), 85-97. https://doi.org/10.37706/ijaz.v3i2.80 Beik, I. S., & Arsyianti, L. D. (2015). Construction of CIBEST model as measurement of poverty and welfare indices from Islamic perspective. Al-Iqtishad: Jurnal Ilmu Ekonomi Syariah, 7(1), 87–104. https://doi.org/10.15408/AIQ.V7I1.1361 Beik, I. S., & Arsyianti, L. D. (2016). Measuring zakat impact on poverty and welfare using Cibest model. Journal of Islamic Monetary Economics and Finance, 1(2), 141–160. https://doi.org/10.21098/JIMF.V1I2.524 Beik, I. S., & Arsyianti, L. D. (2017). Ekonomi pembangunan syariah. Surabaya: Rajagrafindo Persada. BPS. (2022). Persentase penduduk miskin September 2021 turun menjadi 9,71 persen. Retrieved from https://www.bps.go.id/pressrelease/2022/01/17/1929/persentase-penduduk-miskin-september-2021-turun-menjadi-9-71-persen.html Efendi, M. S., & Fathurrohman, M. S. (2021). Dampak zakat terhadap kesejahteraan material dan spiritual mustahik (Studi kasus baznas microfinance desa sawojajar). Jurnal Ekonomi Syariah Teori dan Terapan, 8(6), 686-695. https://doi.org/10.20473/VOL8ISS20216PP686-695 Ghahari, S., Khademolreza, N., Ghasemnezhad, S., Babagholzadeh, H., & Ghayoomi, R. (2018). Comparison of anxiety and depression in victims of spousal abused and non-abused women in primary health care (PHC) in Babol-Iran. UCT Journal of Social Science and Humanities Research, 6(2), 14-18. https://doi.org/10.24200/jsshr.vol6iss02pp14-18 Halimatussakdiyah, & Nurlaily. (2021). Analisis pendayagunaan zakat produktif dalam mengurangi kemiskinan berdasarkan model Cibest (Studi kasus badan amil zakat nasional Prov Sumut). At-Tawassuth: Jurnal Ekonomi Islam, 1(Januari –Juni 2021), 12–25. Handayani, R. (2020). Model Cibest terhadap pengelolaan zakat produktif untuk mengukur kesejahteraan mustahik (Studi kasus Lazisnu Kota Metro). Skripsi tidak dipublikasikan. Lampung: IAIN Metro. Hayakawa, H., & Venieris, Y. P. (2019). Duality in human capital accumulation and inequality in income distribution. Eurasian Economic Review, 9(3), 285–310. https://doi.org/10.1007/S40822-018-0110-8 Indriastuti, H. (2019). Entrepreneurial innovativeness, relational capabilities, and value co-creation to enhance marketing performance. Humanities & Social Sciences Reviews, 7(3), 181–188. https://doi.org/10.18510/hssr.2019.7328 Istikoma. (2017). Asesmen kesejahteraan model Cibest (Centre of Islamic Business and Economic Studies): Studi pada nelayan di Kecamatan Kandanghaur Kabupaten Indramayu. Skripsi tidak dipublikasikan. Bandung: Universitas Pendidikan Indonesia. Kailani, N., & Slama, M. (2019). Accelerating Islamic charities in Indonesia: Zakat, sedekah and the immediacy of social media. South East Asia Research, 28(1), 70–86. https://doi.org/10.1080/0967828X.2019.1691939 Kasri, R. A. (2013). Giving behaviors in Indonesia: Motives and marketing implications for Islamic charities. Journal of Islamic Marketing, 4(3), 306–324. https://doi.org/10.1108/JIMA-05-2011-0044 Kasri, R. A., & Ramli, U. H. (2019). Why do Indonesian muslims donate through mosques?: A theory of planned behaviour approach. International Journal of Islamic and Middle Eastern Finance and Management, 12(5), 663–679. https://doi.org/10.1108/IMEFM-11-2018-0399 Kementrian Agama Republik Indonesia. (2019). Al-Quran dan terjemahannya. Jakarta: Kemenag RI. Kurbanov, R. A., Afad Oglu Gurbanov, R., Belyalova, A. M., Maksimova, E. v, Leonteva, I. A., & Sharonov, I. A. (2017). Practical advice for teaching of university students the mechanisms of self-government of safe behavior. Electronic Journal of Mathematics Education, 12(1), 35-42. https://doi.org/10.29333/iejme/596 Mulyani, E. F. (2018). Analisis dampak pendistribusian dana zakat terhadap tingkat kemiskinan mustahik dengan menggunakan model Cibest (Studi kasus: LAZ dompet dhuafa daerah istimewa Yogyakarta). Skripsi tidak dipublikasikan. Yogyakarta: UIN Sunan Kalijaga. Nisa, N. I. (2022). Penerapan model CIBEST dalam pengentasan kemiskinan di Indonesia. Retrieved from https://kumparan.com/naylazzatnsa/penerapan-model-cibest-dalam-pengentasan-kemiskinan-di-indonesia-1xkNF2L43tu/full Obaidullah, M. (2008). Introduction to Islamic microfinance. India: IBF Net (P) Limited. Owoyemi, M. Y. (2020). Zakat management: The crisis of confidence in zakat agencies and the legality of giving zakat directly to the poor. Journal of Islamic Accounting and Business Research, 11(2), 498–510. https://doi.org/10.1108/JIABR-07-2017-0097 Pistrui, D., & Fahed-Sreih, J. (2010). Islam, entrepreneurship and business values in the Middle East. International Journal of Entrepreneurship and Innovation Management, 12(1), 107–118. https://doi.org/10.1504/IJEIM.2010.033170 Puskas BAZNAS. (2016). Kaji dampak penyaluran zakat baznas terhadap kesejahteraan mustahik tahun 2016. Jakarta: Puskas BAZNAS. Putri, O. R. (2020). Hubungan antara spiritualitas dengan kebermaknaan hidup pada remaja di panti asuhan budi mulya sukarame Bandar Lampung. Skripsi tidak dipublikasikan. Lampung: UIN Raden Intan. Rahmat, R. S., & Nurzaman, M. S. (2019). Assesment of zakat distribution: A case study on zakat community development in Bringinsari village, Sukorejo district, Kendal. International Journal of Islamic and Middle Eastern Finance and Management, 12(5), 743–766. https://doi.org/10.1108/IMEFM-12-2018-0412 Reza Dasangga, D. G., & Cahyono, E. F. (2020). Analisis peran zakat terhadap pengentasan kemiskinan dengan model Cibest (Studi kasus rumah gemilang Indonesia kampus Surabaya. Jurnal Ekonomi Syariah Teori dan Terapan, 7(6), 1060-1073. https://doi.org/10.20473/vol7iss20206pp1060-1073 Rijal, K., Zainuri, A., & Azwari, P. C. (2020). Impact analysis of the zakat, infaq and shadaqah funds distribution to the poverty level of mustahik by using Cibest method Indonesia. Fikri: Jurnal Kajian Agama,Sosial dan Budaya, 5(1), 145-158. https://doi.org/10.25217/jf.v5i1.982 Rozalinda. (2014). Ekonomi Islam: Teori dan aplikasinya pada aktivitas ekonomi. Jakarta: Rajagrafindo. Saad, R. A. J., Farouk, A. U., & Abdul Kadir, D. (2020). Business zakat compliance behavioral intention in a developing country. Journal of Islamic Accounting and Business Research, 11(2), 511–530. https://doi.org/10.1108/JIABR-03-2018-0036 Saad, R. A. J., & Haniffa, R. (2014). Determinants of (Islamic tax) compliance behavior. Journal of Islamic Accounting and Business Research, 5(2), 182–193. https://doi.org/10.1108/JIABR-10-2012-0068 Salam, A., & Nisa, R. (2021). Analisis pengaruh pendistribusian dana zakat terhadap mustahik ditinjau dengan menggunakan metode CIBEST. Jurnal Ekonomi Syariah Indonesia, 9(1), 67–73. https://doi.org/10.21927/jesi.2021.11(1).67-73 Sanrego, & Taufik. (2016). Fiqih tamkin (Fiqih pemberdayaan). Jakarta: QisthiPress. Sudarmanto, E., Revida, E., Zaman, N., Simarmata, M. M. T., Purba, S., Syafrizal, S., Bachtiar, E., Faried, A. I., Nasrullah, N., Marzuki, I., Hastuti, P., Jamaludin, J., Kurniawan, I., Mastutie, F., Susilawaty, A. (2020). Konsep Dasar Pengabdian Kepada Masyarakat: Pembangunan dan Pemberdayaan. Medan: Yayasan Kita Menulis. Sugiyono. (2015). Metode penelitian pendidikan (Pendekatan kuantitatif, kualitatif, dan R&D). Bandung: CV. Alfabeta. Suharto, E. (2005). Membangun masyarakat memberdayakan rakyat kajian strategis pembangunan kesejahteraan sosial dan pekerja sosial. Bandung: PT. Revika Aditama. Sumantri, R., Iswati, S., & Mufrodi, A. (2019). The effectiveness of distribution of zakat funds on ZDC South Sumatra. Opción, Año 35(20), 1572–1588. Widyaningsih, N., Hafidhuddin, D., & Beik, I. S. (2016). Studi dampak zakat di Sulawesi Selatan dengan model CIBEST. Jurnal Ekonomi Islam Republika, 28. Retrieved from https://fem.ipb.ac.id/d/iqtishodia/2016/Iqtishodia_20160128.pdf Yacoub, Y. (2012). Pengaruh tingkat pengangguran terhadap tingkat kemiskinan kabupaten/kota di Provinsi Kalimantan Barat. Jurnal Eksos, 8(3), 176-185.

ABSTRAK Kemisikinan merupakan suatu permasalahan yang harus ditemukan cara mengentaskannya. Islam agama yang sempurna telah memberikan solusi melalui instrument zakat, infak, dan sedekah. Tujuan dari penelitian ini adalah untuk menilai dampak zakat, infak, sedekah di LAZNAS LMI (Lembaga Manajemen Infaq) dengan Pendekatan CIBEST. Metode penelitian yang digunakan adalah kuantitatif dengan uji beda antara kondisi material dan spiritual mustahik sebelum dibantu dengan setelah disalurkan dana ZIS. Hasil analisis dari 355 penerima manfaat menunjukkan bahwa pada kuadran I, penerima manfaat yang dikategorikan sejahtera bertambah 28% sesudah dibantu. Pada kuadran II, penerima manfaat yang dikategorikan miskin secara material menurun sebesar 27,7%. Selain itu pada kuadran IV penerima manfaat yang dikategorikan miskin secara absolut, juga ikut menurun sebesar 0,3%. Hasil Uji Beda juga menunjukan ada perbedaan indeks spiritual maupun indeks material penerima manfaat antar sebelum dan sesudah pemberian dana ZIS dibuktikan dengan Uji Beda Wilcoxon untuk indeks material value, dan Uji T berpasangan untuk indeks spiritual value.. Dengan adanya hasil penilaian kaji dampak ini diharapkan dampak dari bantuan yang diberikan bisa terukur dan juga menjadi bahan evaluasi serta perencanaan untuk program-program yang akan datang. Implikasi temuan penelitian ini dapat memberikan refrensi terkait manfaat zakat, infak, sedekah dalam membantu mengetaskan kemiskinan yang dilakukan oleh lembaga amil zakat nasional. Secara praktik, Lembaga Manajemen Infaq perlu memberikan perhatian khusus kepada mustahik yang berada di kategori miskin absolut, dengan memberikan intervensi ekonomi dan pembinaan secara spiritual. Kata Kunci: Kaji Dampak, ZIS, Kemiskinan, CIBEST, Lemabga Amil Zakat, Lembaga Manajemen Infaq. ABSTRACT Poverty is a problem that must find a way to eradicate. Islam, the perfect religion, has provided a solution through the instruments of zakat, infaq, and shadaqah. The purpose of this study was to assess the impact of Zakat, Sedekah, and Infaq in Lembaga Manajemen Infaq with the CIBEST Approach. The method used is quantitative by distributing questionnaires and testing the difference between the material and spiritual conditions of the mustahik before being assisted with after the ZIS funds are distributed. The results of the analysis of 355 beneficiaries showed that in quadrant I, beneficiaries categorized as prosperous increased by 28% after being assisted. In quadrant II, beneficiaries categorized as materially poor decreased by 27.7%. In addition, in quadrant IV, beneficiaries who are categorized as absolute poor also decreased by 0.3%. The results of the Difference Test also show that there are differences in the spiritual index and material index of beneficiaries between before and after the provision of ZIS funds, as evidenced by the Wilcoxon Difference Test for the material value index, and the paired T-test for the spiritual value index. The assistance provided can be measured and can also be used as material for evaluation and planning for future programs. The implications of the findings of this study can provide a reference regarding the benefits of zakat, shadaqah, and infaq in helping to alleviate poverty carried out by the national amil zakat institution. In practice, Amil Zakat Organization needs to pay special attention to mustahik who are in the absolute poor category, by providing economic intervention and spiritual guidance. Keywords: Assessment of Impact, ZIS, Poverty, CIBEST, Amil Zakat Organization, Lembaga Manajemen Infaq. DAFTAR PUSTAKA Ahmed, B. O., Johari, F., & Wahab, K. A. (2017). Identifying the poor and the needy among the beneficiaries of zakat Need for a zakat-based poverty threshold in Nigeria. International Journal of Social Economics, 44(4), 446–458. https://doi.org/10.1108/IJSE-09-2015-0234 Amalia, & Mahalli, K. (2012). Analisis peran zakat dalam mengurangi kemiskinan: Studi kasus dompet dhuafa republika. Jurnal Ekonomi dan Keuangan. Andam, A. C., & Osman, A. Z. (2019). Determinants of intention to give zakat on employment income: Experience from Marawi City, Philippines. Journal of Islamic Accounting and Business Research, 10(4), 528–545. https://doi.org/10.1108/JIABR-08-2016-0097 Ashar, M. A., & Nafik, M. (2019). Implementasi metode CIBEST (Center of Islamic business and economic studies) dalam mengukur peran zakat produktif terhadap pemberdayaan mustahiq di lembaga yayasan dana sosial al-falah (ydsf) Surabaya. Jurnal Ekonomi Syariah Teori dan Terapan, 6(5). 1057-1071. https://doi.org/10.20473/vol6iss20195pp1057-1071 Asian Development Bank. (2021). Daftar negara dengan penduduk hidup di bawah garis kemiskinan terbanyak di Asia Tenggara. Retrieved from https://databoks.katadata.co.id/datapublish/2021/11/19/daftar-negara-dengan-penduduk-hidup-di-bawah-garis-kemiskinan-terbanyak-di-asia-tenggara Asmalia, S., Kasri, R. A., & Ahsan, A. (2018). Exploring the potential of zakah for supporting realization of sustainable development Goals (SDGs) in Indonesia. International Journal of Zakat, 3(4), 51–69. https://doi.org/10.37706/IJAZ.V3I4.106 Ayuniyyah, Q., Pramanik, A. H., Md Saad, N., & Ariffin, M. I. (2022). The impact of zakat in poverty alleviation and income inequality reduction from the perspective of gender in West Java, Indonesia. International Journal of Islamic and Middle Eastern Finance and Management. Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/IMEFM-08-2020-0403 Ayyubi, S. el, & Saputri, H. E. (2018). Analysis of the impact of zakat, infak, and sadaqah distribution on poverty alleviation based on the CIBEST model (Case study: Jogokariyan baitul maal mosque, Yogyakarta). In International Journal of Zakat, 3(2), 85-97. https://doi.org/10.37706/ijaz.v3i2.80 Beik, I. S., & Arsyianti, L. D. (2015). Construction of CIBEST model as measurement of poverty and welfare indices from Islamic perspective. Al-Iqtishad: Jurnal Ilmu Ekonomi Syariah, 7(1), 87–104. https://doi.org/10.15408/AIQ.V7I1.1361 Beik, I. S., & Arsyianti, L. D. (2016). Measuring zakat impact on poverty and welfare using Cibest model. Journal of Islamic Monetary Economics and Finance, 1(2), 141–160. https://doi.org/10.21098/JIMF.V1I2.524 Beik, I. S., & Arsyianti, L. D. (2017). Ekonomi pembangunan syariah. Surabaya: Rajagrafindo Persada. BPS. (2022). Persentase penduduk miskin September 2021 turun menjadi 9,71 persen. Retrieved from https://www.bps.go.id/pressrelease/2022/01/17/1929/persentase-penduduk-miskin-september-2021-turun-menjadi-9-71-persen.html Efendi, M. S., & Fathurrohman, M. S. (2021). Dampak zakat terhadap kesejahteraan material dan spiritual mustahik (Studi kasus baznas microfinance desa sawojajar). Jurnal Ekonomi Syariah Teori dan Terapan, 8(6), 686-695. https://doi.org/10.20473/VOL8ISS20216PP686-695 Ghahari, S., Khademolreza, N., Ghasemnezhad, S., Babagholzadeh, H., & Ghayoomi, R. (2018). Comparison of anxiety and depression in victims of spousal abused and non-abused women in primary health care (PHC) in Babol-Iran. UCT Journal of Social Science and Humanities Research, 6(2), 14-18. https://doi.org/10.24200/jsshr.vol6iss02pp14-18 Halimatussakdiyah, & Nurlaily. (2021). Analisis pendayagunaan zakat produktif dalam mengurangi kemiskinan berdasarkan model Cibest (Studi kasus badan amil zakat nasional Prov Sumut). At-Tawassuth: Jurnal Ekonomi Islam, 1(Januari –Juni 2021), 12–25. Handayani, R. (2020). Model Cibest terhadap pengelolaan zakat produktif untuk mengukur kesejahteraan mustahik (Studi kasus Lazisnu Kota Metro). Skripsi tidak dipublikasikan. Lampung: IAIN Metro. Hayakawa, H., & Venieris, Y. P. (2019). Duality in human capital accumulation and inequality in income distribution. Eurasian Economic Review, 9(3), 285–310. https://doi.org/10.1007/S40822-018-0110-8 Indriastuti, H. (2019). Entrepreneurial innovativeness, relational capabilities, and value co-creation to enhance marketing performance. Humanities & Social Sciences Reviews, 7(3), 181–188. https://doi.org/10.18510/hssr.2019.7328 Istikoma. (2017). Asesmen kesejahteraan model Cibest (Centre of Islamic Business and Economic Studies): Studi pada nelayan di Kecamatan Kandanghaur Kabupaten Indramayu. Skripsi tidak dipublikasikan. Bandung: Universitas Pendidikan Indonesia. Kailani, N., & Slama, M. (2019). Accelerating Islamic charities in Indonesia: Zakat, sedekah and the immediacy of social media. South East Asia Research, 28(1), 70–86. https://doi.org/10.1080/0967828X.2019.1691939 Kasri, R. A. (2013). Giving behaviors in Indonesia: Motives and marketing implications for Islamic charities. Journal of Islamic Marketing, 4(3), 306–324. https://doi.org/10.1108/JIMA-05-2011-0044 Kasri, R. A., & Ramli, U. H. (2019). Why do Indonesian muslims donate through mosques?: A theory of planned behaviour approach. International Journal of Islamic and Middle Eastern Finance and Management, 12(5), 663–679. https://doi.org/10.1108/IMEFM-11-2018-0399 Kementrian Agama Republik Indonesia. (2019). Al-Quran dan terjemahannya. Jakarta: Kemenag RI. Kurbanov, R. A., Afad Oglu Gurbanov, R., Belyalova, A. M., Maksimova, E. v, Leonteva, I. A., & Sharonov, I. A. (2017). Practical advice for teaching of university students the mechanisms of self-government of safe behavior. Electronic Journal of Mathematics Education, 12(1), 35-42. https://doi.org/10.29333/iejme/596 Mulyani, E. F. (2018). Analisis dampak pendistribusian dana zakat terhadap tingkat kemiskinan mustahik dengan menggunakan model Cibest (Studi kasus: LAZ dompet dhuafa daerah istimewa Yogyakarta). Skripsi tidak dipublikasikan. Yogyakarta: UIN Sunan Kalijaga. Nisa, N. I. (2022). Penerapan model CIBEST dalam pengentasan kemiskinan di Indonesia. Retrieved from https://kumparan.com/naylazzatnsa/penerapan-model-cibest-dalam-pengentasan-kemiskinan-di-indonesia-1xkNF2L43tu/full Obaidullah, M. (2008). Introduction to Islamic microfinance. India: IBF Net (P) Limited. Owoyemi, M. Y. (2020). Zakat management: The crisis of confidence in zakat agencies and the legality of giving zakat directly to the poor. Journal of Islamic Accounting and Business Research, 11(2), 498–510. https://doi.org/10.1108/JIABR-07-2017-0097 Pistrui, D., & Fahed-Sreih, J. (2010). Islam, entrepreneurship and business values in the Middle East. International Journal of Entrepreneurship and Innovation Management, 12(1), 107–118. https://doi.org/10.1504/IJEIM.2010.033170 Puskas BAZNAS. (2016). Kaji dampak penyaluran zakat baznas terhadap kesejahteraan mustahik tahun 2016. Jakarta: Puskas BAZNAS. Putri, O. R. (2020). Hubungan antara spiritualitas dengan kebermaknaan hidup pada remaja di panti asuhan budi mulya sukarame Bandar Lampung. Skripsi tidak dipublikasikan. Lampung: UIN Raden Intan. Rahmat, R. S., & Nurzaman, M. S. (2019). Assesment of zakat distribution: A case study on zakat community development in Bringinsari village, Sukorejo district, Kendal. International Journal of Islamic and Middle Eastern Finance and Management, 12(5), 743–766. https://doi.org/10.1108/IMEFM-12-2018-0412 Reza Dasangga, D. G., & Cahyono, E. F. (2020). Analisis peran zakat terhadap pengentasan kemiskinan dengan model Cibest (Studi kasus rumah gemilang Indonesia kampus Surabaya. Jurnal Ekonomi Syariah Teori dan Terapan, 7(6), 1060-1073. https://doi.org/10.20473/vol7iss20206pp1060-1073 Rijal, K., Zainuri, A., & Azwari, P. C. (2020). Impact analysis of the zakat, infaq and shadaqah funds distribution to the poverty level of mustahik by using Cibest method Indonesia. Fikri: Jurnal Kajian Agama,Sosial dan Budaya, 5(1), 145-158. https://doi.org/10.25217/jf.v5i1.982 Rozalinda. (2014). Ekonomi Islam: Teori dan aplikasinya pada aktivitas ekonomi. Jakarta: Rajagrafindo. Saad, R. A. J., Farouk, A. U., & Abdul Kadir, D. (2020). Business zakat compliance behavioral intention in a developing country. Journal of Islamic Accounting and Business Research, 11(2), 511–530. https://doi.org/10.1108/JIABR-03-2018-0036 Saad, R. A. J., & Haniffa, R. (2014). Determinants of (Islamic tax) compliance behavior. Journal of Islamic Accounting and Business Research, 5(2), 182–193. https://doi.org/10.1108/JIABR-10-2012-0068 Salam, A., & Nisa, R. (2021). Analisis pengaruh pendistribusian dana zakat terhadap mustahik ditinjau dengan menggunakan metode CIBEST. Jurnal Ekonomi Syariah Indonesia, 9(1), 67–73. https://doi.org/10.21927/jesi.2021.11(1).67-73 Sanrego, & Taufik. (2016). Fiqih tamkin (Fiqih pemberdayaan). Jakarta: QisthiPress. Sudarmanto, E., Revida, E., Zaman, N., Simarmata, M. M. T., Purba, S., Syafrizal, S., Bachtiar, E., Faried, A. I., Nasrullah, N., Marzuki, I., Hastuti, P., Jamaludin, J., Kurniawan, I., Mastutie, F., Susilawaty, A. (2020). Konsep Dasar Pengabdian Kepada Masyarakat: Pembangunan dan Pemberdayaan. Medan: Yayasan Kita Menulis. Sugiyono. (2015). Metode penelitian pendidikan (Pendekatan kuantitatif, kualitatif, dan R&D). Bandung: CV. Alfabeta. Suharto, E. (2005). Membangun masyarakat memberdayakan rakyat kajian strategis pembangunan kesejahteraan sosial dan pekerja sosial. Bandung: PT. Revika Aditama. Sumantri, R., Iswati, S., & Mufrodi, A. (2019). The effectiveness of distribution of zakat funds on ZDC South Sumatra. Opción, Año 35(20), 1572–1588. Widyaningsih, N., Hafidhuddin, D., & Beik, I. S. (2016). Studi dampak zakat di Sulawesi Selatan dengan model CIBEST. Jurnal Ekonomi Islam Republika, 28. Retrieved from https://fem.ipb.ac.id/d/iqtishodia/2016/Iqtishodia_20160128.pdf Yacoub, Y. (2012). Pengaruh tingkat pengangguran terhadap tingkat kemiskinan kabupaten/kota di Provinsi Kalimantan Barat. Jurnal Eksos, 8(3), 176-185.

Hamsters were exposed to sodium arsenite (173 mg As/L) in drinking water for 6 days. Equal amounts of proteins from urinary bladder or liver extracts of control and arsenic-treated hamsters were labeled with Cy3 and Cy5 dyes, respectively. After differential in gel electrophoresis and analysis by the DeCyder software, several protein spots were found to be down-regulated and several were up regulated. Our experiments indicated that in the bladder tissues of hamsters exposed to arsenite, transgelin was down-regulated and GST-pi was up-regulated. The loss of transgelin expression has been reported to be an important early event in tumor progression and a diagnostic marker for cancer development [29-32]. Down-regulation of transgelin expression may be associated with the carcinogenicity of inorganic arsenic in the urinary bladder. In the liver of arsenite-treated hamsters, ornithine aminotransferase was up-regulated, and senescence marker protein 30 and fatty acid binding protein were down-regulated. The volume ratio changes of these proteins in the bladder and liver of hamsters exposed to arsenite were significantly different than that of control hamsters. Introduction Chronic exposure to inorganic arsenic can cause cancer of the skin, lungs, urinary bladder, kidneys, and liver [1-6]. The molecular mechanisms of the carcinogenicity and toxicity of inorganic arsenic are not well understood [7-9). Humans chronically exposed to inorganic arsenic excrete MMA(V), DMA(V) and the more toxic +3 oxidation state arsenic biotransformants MMA(III) and DMA (III) in their urine [10, 11], which are carcinogen [12]· After injection of mice with sodium arsenate, the highest concentrations of the very toxic MMA(III) and DMA(III) were in the kidneys and urinary bladder tissue, respectively, as shown by experiments of Chowdhury et al [13]. Many mechanisms of arsenic toxicity and carcinogenicity have been suggested [1, 7, 14] including chromosome abnormalities [15], oxidative stress [16, 17], altered growth factors [18], cell proliferation [19], altered DNA repair [20], altered DNA methylation patterns [21], inhibition of several key enzymes [22], gene amplification [23] etc. Some of these mechanisms result in alterations in protein expression. Methods for analyzing multiple proteins have advanced greatly in the last several years. In particularly, mass spectrometry (MS) and tandem MS (MS/MS) are used to analyze peptides following protein isolation using two-dimensional (2-D) gel electrophoresis and proteolytic digestion [24]. In the present study, Differential In Gel Electrophoresis (DIGE) coupled with Mass Spectrometry (MS) has been used to study some of the proteomic changes in the urinary bladder and liver of hamsters exposed to sodium arsenite in their drinking water. Our results indicated that transgelin was down-regulated and GST-pi was up-regulated in the bladder tissues. In the liver tissues ornithine aminotransferase was up-regulated, and senescence marker protein 30, and fatty acid binding protein were down-regulated. Materials and Methods Chemicals Tris, Urea, IPG strips, IPG buffer, CHAPS, Dry Strip Cover Fluid, Bind Silane, lodoacetamide, Cy3 and Cy5 were from GE Healthcare (formally known as Amersham Biosciences, Uppsala, Sweden). Thiourea, glycerol, SDS, DTT, and APS were from Sigma-Aldrich (St. Louis, MO, USA). Glycine was from USB (Cleveland, OH, USA). Acrylamide Bis 40% was from Bio-Rad (Hercules, CA, USA). All other chemicals and biochemicals used were of analytical grade. All solutions were made with Milli-Q water. Animals Male hamsters (Golden Syrian), 4 weeks of age, were purchased from Harlan Sprague Dawley, USA. Upon arrival, hamsters were acclimated in the University of Arizona animal care facility for at least 1 week and maintained in an environmentally controlled animal facility operating on a 12-h dark/12-h light cycle and at 22-24°C. They were provided with Teklad (Indianapolis, IN) 4% Mouse/Rat Diet # 7001 and water, ad libitum, throughout the acclimation and experimentation periods. Sample preparation and labelling Hamsters were exposed to sodium arsenite (173 mg) in drinking water for 6 days and the control hamsters were given tap water. On the 6th day hamsters were decapitated rapidly by guillotine. Urinary bladder tissues and liver were removed, blotted on tissue papers (Kimtech Science, Precision Wipes), and weighed. Hamster urinary bladder or liver tissues were homogenized in lysis buffer (30mMTris, 2M thiourea, 7M urea, and 4% w/w CHAPS adjusted to pH 8.5 with dilute HCI), at 4°C using a glass homogenizer and a Teflon coated steel pestle; transferred to a 5 ml acid-washed polypropylene tube, placed on ice and sonicated 3 times for 15 seconds. The sonicate was centrifuged at 12,000 rpm for 10 minutes at 4°C. Small aliquots of the supernatants were stored at -80°C until use (generally within one week). Protein concentration was determined by the method of Bradford [25] using bovine serum albumin as a standard. Fifty micrograms of lysate protein was labeled with 400 pmol of Cy3 Dye (for control homogenate sample) and Cy5 Dye (for arsenic-treated urinary bladder or liver homogenate sample). The samples containing proteins and dyes were incubated for 30 min on ice in the dark. To stop the labeling reaction, 1uL of 10 mM lysine was added followed by incubation for 10 min on ice in the dark. To each of the appropriate dye-labeled protein samples, an additional 200 ug of urinary bladderor liver unlabeled protein from control hamster sample or arsenic-treated hamster sample was added to the appropriate sample. Differentially labeled samples were combined into a single Microfuge tube (total protein 500 ug); protein was mixed with an equal volume of 2x sample buffer [2M thiourea, 7M urea, pH 3-10 pharmalyte for isoelectric focusing 2% (v/v), DTT 2% (w/v), CHAPS 4% (w/v)]; and was incubated on ice in the dark for 10 min. The combined samples containing 500 ug of total protein were mixed with rehydration buffer [CHAPS 4% (w/v), 8M urea, 13mM DTT, IPG buffer (3-10) 1% (v/v) and trace amount of bromophenol blue]. The 450 ul sample containing rehydration buffer was slowly pipetted into the slot of the ImmobilinedryStripReswelling Tray and any large bubbles were removed. The IPG strip (linear pH 3-10, 24 cm) was placed (gel side down) into the slot, covered with drystrip cover fluid (Fig. 1), and the lid of the Reswelling Tray was closed. The ImmobillineDryStrip was allowed to rehydrate at room temperature for 24 hours. First dimension Isoelectric focusing (IEF) The labeled sample was loaded using the cup loading method on universal strip holder. IEF was then carried out on EttanIPGphor II using multistep protocol (6 hr @ 500 V, 6 hr @ 1000 V, 8 hr @ 8000 V). The focused IPG strip was equilibrated in two steps (reduction and alkylation) by equilibrating the strip for 10 min first in 10 ml of 50mM Tris (pH 8.8), 6M urea, 30% (v/v) glycerol, 2% (w/v) SDS, and 0.5% (w/v) DTT, followed by another 10 min in 10 ml of 50mM Tris (pH 8.8), 6M urea, 30% (v/v) glycerol, 2% (w/v) SDS, and 4.5% (w/v) iodoacetamide to prepare it for the second dimension electrophoresis. Second dimension SDS-PAGE The equilibrated IPG strip was used for protein separation by 2D-gel electrophoresis (DIGE). The strip was sealed at the top of the acrylamide gel for the second dimension (vertical) (12.5% polyacrylamide gel, 20x25 cm x 1.5 mm) with 0.5% (w/v) agarose in SDS running buffer [25 mMTris, 192 mM Glycine, and 0.1% (w/v) SDS]. Electrophoresis was performed in an Ettan DALT six electrophoresis unit (Amersham Biosciences) at 1.5 watts per gel, until the tracking dye reached the anodic end of the gel. Image analysis and post-staining The gel then was imaged directly between glass plates on the Typhoon 9410 variable mode imager (Sunnyvale, CA, USA) using optimal excitation/emission wavelength for each DIGE fluor: Cy3 (532/580 nm) and Cy5 (633/670 nm). The DIGE images were previewed and checked with Image Quant software (GE Healthcare) where all the two separate gel images could be viewed as a single gel image. DeCyde v.5.02 was used to analyze the DIGE images as described in the Ettan DIGE User Manual (GE Healthcare). The appropriate up-/down regulated spots were filtered based on an average volume ratio of ± over 1.2 fold. After image acquisition, the gel was fixed overnight in a solution containing 40% ethanol and 10% acetic acid. The fixed gel was stained with SyproRuby (BioRad) according to the manufacturer protocol (Bio-Rad Labs., 2000 Alfred Nobel Drive, Hercules, CA 94547). Identification of proteins by MS Protein spot picking and digestion Sypro Ruby stained gels were imaged using an Investigator ProPic and HT Analyzer software, both from Genomic Solutions (Ann Arbor, MI). Protein spots of interest that matched those imaged using the DIGE Cy3/Cy5 labels were picked robotically, digested using trypsin as described previously [24] and saved for mass spectrometry identification. Liquid chromatography (LC)- MS/MS analysis LC-MS/MS analyses were carried out using a 3D quadrupole ion trap massspectrometer (ThermoFinnigan LCQ DECA XP PLUS; ThermoFinnigan, San Jose, CA) equipped with a Michrom Paradigm MS4 HPLC (MichromBiosources, Auburn, CA) and a nanospray source, or with a linear quadrupole ion trap mass spectrometer (ThermoFinnigan LTQ), also equipped with a Michrom MS4 HPLC and a nanospray source. Peptides were eluted from a 15 cm pulled tip capillary column (100 um I.D. x 360 um O.D.; 3-5 um tip opening) packed with 7 cm Vydac C18 (Vydac, Hesperia, CA) material (5 µm, 300 Å pore size), using a gradient of 0-65% solvent B (98% methanol/2% water/0.5% formic acid/0.01% triflouroacetic acid) over a 60 min period at a flow rate of 350 nL/min. The ESI positive mode spray voltage was set at 1.6 kV, and the capillary temperature was set at 200°C. Dependent data scanning was performed by the Xcalibur v 1.3 software on the LCQ DECA XP+ or v 1.4 on the LTQ [27], with a default charge of 2, an isolation width of 1.5 amu, an activation amplitude of 35%, activation time of 50 msec, and a minimal signal of 10,000 ion counts (100 ion counts on the LTQ). Global dependent data settings were as follows: reject mass width of 1.5 amu, dynamic exclusion enabled, exclusion mass width of 1.5 amu, repeat count of 1, repeat duration of a min, and exclusion duration of 5 min. Scan event series were included one full scan with mass range of 350-2000 Da, followed by 3 dependent MS/MS scans of the most intense ion. Database searching Tandem MS spectra of peptides were analyzed with Turbo SEQUEST, version 3.1 (ThermoFinnigan), a program that allows the correlation of experimental tandem MS data with theoretical spectra generated from known protein sequences. All spectra were searched against the latest version of the non redundant protein database from the National Center for Biotechnology Information (NCBI 2006; at that time, the database contained 3,783,042 entries). Statistical analysis The means and standard error were calculated. The Student's t-test was used to analyze the significance of the difference between the control and arsenite exposed hamsters. P values less than 0.05 were considered significant. The reproducibility was confirmed in separate experiments. Results Analysis of proteins expression After DIGE (Fig. 1), the gel was scanned by a Typhoon Scanner and the relative amount of protein from sample 1 (treated hamster) as compared to sample 2 (control hamster) was determined (Figs. 2, 3). A green spot indicates that the amount of protein from sodium arsenite-treated hamster sample was less than that of the control sample. A red spot indicates that the amount of protein from the sodium arsenite-treated hamster sample was greater than that of the control sample. A yellow spot indicates sodium arsenite-treated hamster and control hamster each had the same amount of that protein. Several protein spots were up-regulated (red) or down-regulated (green) in the urinary bladder samples of hamsters exposed to sodium arsenite (173 mg As/L) for 6 days as compared with the urinary bladder of controls (Fig. 2). In the case of liver, several protein spots were also over-expressed (red) or under-expressed (green) for hamsters exposed to sodium arsenite (173 mg As/L) in drinking water for 6 days (Fig. 3). The urinary bladder samples were collected from the first and second experiments in which hamsters were exposed to sodium arsenite (173 mg As/L) in drinking water for 6 days and the controls were given tap water. The urinary bladder samples from the 1st and 2nd experiments were run 5 times in DIGE gels on different days. The protein expression is shown in Figure 2 and Table 1. The liver samples from the 1st and 2nd experiments were also run 3 times in DIGE gels on different days. The proteins expression were shown in Figure 3 and Table 2. The volume ratio changed of the protein spots in the urinary bladder and liver of hamsters exposed to arsenite were significantly differences than that of the control hamsters (Table 1 and 2). Protein spots identified by LC-MS/MS Bladder The spots of interest were removed from the gel, digested, and their identities were determined by LC-MS/MS (Fig. 2 and Table 1). The spots 1, 2, & 3 from the gel were analyzed and were repeated for the confirmation of the results (experiments; 173 mg As/L). The proteins for the spots 1, 2, and 3 were identified as transgelin, transgelin, and glutathione S-transferase Pi, respectively (Fig. 2). Liver We also identified some of the proteins in the liver samples of hamsters exposed to sodium arsenite (173 mg As/L) in drinking water for 6 days (Fig. 3). The spots 4, 5, & 6 from the gels were analyzed and were repeated for the confirmation of the results. The proteins for the spots 4, 5, and 6 were identified as ornithine aminotransferase, senescence marker protein 30, and fatty acid binding protein, respectively (Fig. 3) Discussion The identification and functional assignment of proteins is helpful for understanding the molecular events involved in disease. Weexposed hamsters to sodium arsenite in drinking water. Controls were given tap water. DIGE coupled with LC-MS/MS was then used to study the proteomic change in arsenite-exposed hamsters. After electrophoresis DeCyder software indicated that several protein spots were down-regulated (green) and several were up-regulated (red). Our overall results as to changes and functions of the proteins we have studied are summarized in Table 3. Bladder In the case of the urinary bladder tissue of hamsters exposed to sodium arsenite (173 mg As/L) in drinking water for 6 days, transgelin was down-regulated and GST-pi was up-regulated. This is the first evidence that transgelin is down-regulated in the bladders of animals exposed to sodium arsenite. Transgelin, which is identical to SM22 or WS3-10, is an actin cross linking/gelling protein found in fibroblasts and smooth muscle [28, 29]. It has been suggested that the loss of transgelin expression may be an important early event in tumor progression and a diagnostic marker for cancer development [30-33]. It may function as a tumor suppressor via inhibition of ARA54 (co-regulator of androgen receptor)-enhanced AR (androgen receptor) function. Loss of transgelin and its suppressor function in prostate cancer might contribute to the progression of prostate cancer [30]. Down-regulation of transgelin occurs in the urinary bladders of rats having bladder outlet obstruction [32]. Ras-dependent and Ras-independent mechanisms can cause the down regulation of transgelin in human breast and colon carcinoma cell lines and patient-derived tumorsamples [33]. Transgelin plays a role in contractility, possibly by affecting the actin content of filaments [34]. In our experiments loss of transgelin expression may be associated or preliminary to bladder cancer due to arsenic exposure. Arsenite is a carcinogen [1]. In our experiments, LC-MS/MS analysis showed that two spots (1 and 2) represent transgelin (Fig. 2 and Table 1). In human colonic neoplasms there is a loss of transgelin expression and the appearance of transgelin isoforms (31). GST-pi protein was up-regulated in the bladders of the hamsters exposed to sodium arsenite. GSTs are a large family of multifunctional enzymes involved in the phase II detoxification of foreign compounds [35]. The most abundant GSTS are the classes alpha, mu, and pi classes [36]. They participate in protection against oxidative stress [37]. GST-omega has arsenic reductase activity [38]. Over-expression of GST-pi has been found in colon cancer tissues [39]. Strong expression of GST-pi also has been found in gastric cancer [40], malignant melanoma [41], lung cancer [42], breast cancer [43] and a range of other human tumors [44]. GST-pi has been up-regulated in transitional cell carcinoma of human urinary bladder [45]. Up-regulation of glutathione – related genes and enzyme activities has been found in cultured human cells by sub lethal concentration of inorganic arsenic [46]. There is evidence that arsenic induces DNA damage via the production of ROS (reactive oxygen species) [47]. GST-pi may be over-expressed in the urinary bladder to protect cells against arsenic-induced oxidative stress. Liver In the livers of hamsters exposed to sodium arsenite, ornithine amino transferase was over-expressed, senescence marker protein 30 was under-expressed, and fatty acid binding protein was under-expressed. Ornithine amino transferase has been found in the mitochondria of many different mammalian tissues, especially liver, kidney, and small intestine [48]. Ornithine amino transferase knockdown inhuman cervical carcinoma and osteosarcoma cells by RNA interference blocks cell division and causes cell death [49]. It has been suggested that ornithine amino transferase has a role in regulating mitotic cell division and it is required for proper spindle assembly in human cancer cells [49]. Senescence marker protein-30 (SMP30) is a unique enzyme that hydrolyzes diisopropylphosphorofluoridate. SMP30, which is expressed mostly in the liver, protects cells against various injuries by stimulating membrane calcium-pump activity [50]. SMP30 acts to protect cells from apoptosis [51]. In addition it protects the liver from toxic agents [52]. The livers of SMP30 knockout mice accumulate phosphatidylethanolamine, cardiolipin, phosphatidyl-choline, phosphatidylserine, and sphingomyelin [53]. Liver fatty acid binding protein (L-FABP) also was down- regulated. Decreased liver fatty acid-binding capacity and altered liver lipid distribution hasbeen reported in mice lacking the L-FABP gene [54]. High levels of saturated, branched-chain fatty acids are deleterious to cells and animals, resulting in lipid accumulation and cytotoxicity. The expression of fatty acid binding proteins (including L-FABP) protected cells against branched-chain saturated fatty acid toxicity [55]. Limitations: we preferred to study the pronounced spots seen in DIGE gels. Other spots were visible but not as pronounced. Because of limited funds, we did not identify these others protein spots. In conclusion, urinary bladders of hamsters exposed to sodium arsenite had a decrease in the expression of transgelin and an increase in the expression of GST-pi protein. Under-expression of transgelin has been found in various cancer systems and may be associated with arsenic carcinogenicity [30-33). Inorganic arsenic exposure has resulted in bladder cancer as has been reported in the past [1]. Over-expression of GST-pi may protect cells against oxidative stress caused by arsenite. In the liver OAT was up regulated and SMP-30 and FABP were down regulated. These proteomic results may be of help to investigators studying arsenic carcinogenicity. The Superfund Basic Research Program NIEHS Grant Number ES 04940 from the National Institute of Environmental Health Sciences supported this work. Additional support for the mass spectrometry analyses was provided by grants from NIWHS ES06694, NCI CA023074 and the BIOS Institute of the University of Arizona. Acknowledgement The Author wants to dedicate this paper to the memory of his former supervisor Dr. H. VaskenAposhian who passed away in September 6, 2019. He was an emeritus professor of the Department of Molecular and Cellular Biology at the University of Arizona. This research work was done under his sole supervision and with his great contribution.I also would like to thanks Dr. George Tsapraills, Center of Toxicology, The University of Arizona for identification of proteins by MS. References NRC (National Research Council), Arsenic in Drinking Water, Update to the 1999 Arsenic in Drinking Water Report. National Academy Press, Washington, DC 2001. Hopenhayn-Rich, C.; Biggs, M. L.; Fuchs, A.; Bergoglio, R.; et al. Bladder cancer mortality with arsenic in drinking water in Argentina. Epidemiology 1996, 7, 117-124. Chen, C.J.; Chen, C. W.; Wu, M. M.; Kuo, T. L. Cancer potential in liver, lung, bladder, and kidney due to ingested inorganic arsenic in drinking water. J. Cancer. 1992, 66, 888-892. IARC (International Agency for Research on Cancer), In IARC monograph on the evaluation of carcinogenicity risk to humans? Overall evaluation of carcinogenicity: an update of IARC monographs 1-42 (suppl. 7), International Agency for Research on Cancer, Lyon, France, 1987, pp. 100-106. Rossman, T. G.; Uddin, A. N.; Burns, F. J. Evidence that arsenite acts as a cocarcinogen in skin cancer. Appl. Pharmacol. 2004, 198, 394 404. Smith, A. H.; Hopenhayn-Rich, C.; Bates, M. N.; Goeden, H. M.; et al. Cancer risks from arsenic in drinking water. Health Perspect. 1992, 97, 259-267. Aposhian, H. V.; Aposhian, M. M. Arsenic toxicology: five questions. Res. Toxicol. 2006, 19, 1-15. Goering, P. L.; Aposhian, H. V.; Mass, M. J.; Cebrián, M., et al. The enigma of arsenic carcinogenesis: role of metabolism. Sci. 1999, 49, 5-14. Waalkes, M. P.; Liu, J.; Ward, J. M.; Diwan, B. A. Mechanisms underlying arsenic carcinogenesis: hypersensitivity of mice exposed to inorganic arsenic during gestation. 2004, 198, 31-38. Aposhian, H. V.; Gurzau, E. S.; Le, X. C.; Gurzau, A.; et al. Occurrence of monomethylarsonous acid in urine of humans exposed to inorganic arsenic. Res. Toxicol. 2000, 13, 693-697. Del Razo, L. M.; Styblo, M.; Cullen, W. R.; Thomas, D. J. Determination of trivalent methylated arsenicals in biological matrices. Appl. Pharmacol. 2001, 174, 282-293. Styblo, M.; Drobna, Z.; Jaspers, I.; Lin, S.; Thomas, D. J.; The role of biomethylation in toxicity and carcinogenicity of arsenic: a research update. Environ. Health Perspect. 2002, 5, 767-771. Chowdhury, U. K.; Zakharyan, R. A.; Hernandez, A.; Avram, M. D.; et al. Glutathione-S-transferase-omega [MMA(V) reductase] knockout mice: Enzyme and arsenic species concentrations in tissues after arsenate administration. Appl. Pharmaol. 2006, 216, 446-457. Kitchin, K. T. Recent advances in arsenic carcinogenesis: modes of action, animal model systems, and methylated arsenic metabolites. Appl. Pharmacol. 2001, 172, 249-261. Beckman, G.; Beckman, L.; Nordenson, I. Chromosome aberrations in workers exposed to arsenic. Health Perspect. 1977, 19, 145-146. Yamanaka, K.; Hoshino, M.; Okanoto, M.; Sawamura, R.; et al. Induction of DNA damage by dimethylarsine, a metabolite of inorganic arsenics, is for the major part likely due to its peroxyl radical. Biophys. Res. Commun. 1990, 168, 58-64. Yamanaka, K.; Okada, S. Induction of lung-specific DNA damage by metabolically methylated arsenics via the production of free radicals. Health Perspect. 1994, 102, 37-40. Simeonova, P. P.; Luster, M. I. Mechanisms of arsenic carcinogenicity:Genetic or epigenetic mechanisms? Environ. Pathol. Toxicol. Oncol. 2000, 19, 281-286. Popovicova, J.; Moser, G. J.; Goldsworthy, T. L.; Tice, R. R, Carcinogenicity and co-carcinogenicity of sodium arsenite in p53+/- male mice. 2000, 54, 134. Li, J. H.; Rossman, T. G. Mechanism of co-mutagenesis of sodium arsenite with N-methyl-N-nitrosourea. Trace Elem. 1989, 21, 373-381. Zhao, C. Q.; Young, M. R.; Diwan, B. A.; Coogan, T. P.; et al. Association of arsenic-induced malignant transformation with DNA hypomethylation and aberrant gene expression. Proc. Natl. Acad. Sci. USA, 1997, 94, 10907-10912. Abernathy, C. O.; Lui, Y. P.; Longfellow, D.; Aposhian, H. V.; et al. Arsenic: Health effects, mechanisms of actions and research issues. Health Perspect. 1999, 107, 593-597. Lee, T. C.; Tanaka, N.; Lamb, P. W.; Gilmer, T. M.; et al. Induction of gene amplification by arsenic. 1988, 241, 79-81. Lantz, R. C.; Lynch, B. J.; Boitano, S.; Poplin, G. S.; et al. Pulmonary biomarkers based on alterations in protein expression after exposure to arsenic. Health Perspect. 2007, 115, 586-591. Bradford, M.M. A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of protein-dye binding. Biochem. 1976, 72, 248-254. Chowdhury, U. K.; Aposhian, H. V. Protein expression in the livers and urinary bladders of hamsters exposed to sodium arsenite. N. Y. Acad. Sci. 2008, 1140, 325-334. Andon, N. L.; Hollingworth, S.; Koller, A.; Greenland, A. J.; et al. Proteomic characterization of wheat amyloplasts using identification of proteins by Tandem Mass Spectrometry. 2002, 2, 1156-1168. Shapland, C.; Hsuan, J. J.; Totty, N. F.; Lawson, D. Purification and properties of transgelin: a transformation and shape change sensitive actin-gelling protein. Cell Biol. 1993, 121, 1065-1073. Lawson, D.; Harrison, M.; Shapland, C. Fibroblast transgelin and smooth muscle SM22 alpha are the same protein, the expression of which is down-regulated in may cell lines. Cell Motil. Cytoskeleton. 1997, 38, 250-257. Yang, Z.; Chang, Y- J.; Miyamoto, H.; Ni, J.; et al. Transgelin functions as a suppressor via inhibition of ARA54-enhanced androgen receptor transactivation and prostate cancer cell grown. Endocrinol. 2007, 21, 343-358. Yeo, M.; Kim, D- K.; Park, H. J.; Oh, T. Y.; et al. Loss of transgelin in repeated bouts of ulcerative colitis-induced colon carcinogenesis. 2006, 6, 1158-1165. Kim, H- J.; Sohng, I.; Kim, D- H.; Lee, D- C.; et al. Investigation of early protein changes in the urinary bladder following partial bladder outlet obstruction by proteomic approach. Korean Med. Sci. 2005, 20, 1000-1005. Shields, J. M.; Rogers-Graham, K.; Der, C. J. Loss of transgelin in breast and colon tumors and in RIE-1 cells by Ras deregulation of gene expression through Raf-independent pathways. Biol. Chem. 2002, 277, 9790-9799. Zeiden, A.; Sward, K.; Nordstrom, J.; Ekblad, E.; et al. Ablation of SM220c decreases contractility and actin contents of mouse vascular smooth muscle. FEBS Lett. 2004, 562, 141-146. Hoivik, D.; Wilson, C.; Wang, W.; Willett, K.; et al. Studies on the relationship between estrogen receptor content, glutathione S-transferase pi expression, and induction by 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin and drug resistance in human breast cancer cells. Biochem. Biophys. 1997, 348, 174-182. Hayes, J. D.; Pulford. D. J. The glutathione S-transferase super gene family: regulation of GST and the contribution of the isoenzymes to cancer chemoprotection and drug resistance. Critical Rev. Biochem. Mol. Biol. 1995, 30, 445-600. Zhao, T.; Singhal, S. S.; Piper, J. T.; Cheng, J.; et al. The role of human glutathione S-transferases hGSTA1-1 and hGSTA2-2 in protection against oxidative stress. Biochem. Biophys. 1999, 367, 216-224. Zakharyan, R. A.; Sampayo-Reyes, A.; Healy, S. M.; Tsaprailis, G.; et al. Human monomethylarsonic acid (MMA) reductase is a member of the glutathione-S-transferase superfamily. Res. Toxicol. 2001, 14, 1051-1057. Tsuchida, S.; Sekine, Y.; Shineha, R.; Nishihira, T.; et al. Elevation of the placental glutathione S-transferase form (GST-PI) in tumor tissues and the levels in sera of patients with cancer. Cancer Res. 1989, 43, 5225-5229. Tsutsumi, M.; Sugisaki, T.; Makino, T.; Miyagi, N.; et al. Oncofetal expression of glutathione S-transferase placental form in human stomach carcinomas. Gann. 1987, 78, 631-633. Mannervik, B.; Castro, V. M.; Danielson, U. H.; Tahir, M. K.; et al. Expression of class Pi glutathione transferase in human malignant melanoma cells. Carcinogenesis (Lond.). 1987, 8, 1929-1932. Di llio, C.; Del Boccio, G.; Aceto, A.; Casaccia, R.; et al. Elevation of glutathione transferase activity in human lung tumor. Carcinogenesis (Lond.). 1988, 9, 335-340. Sreenath, A. S.; Ravi, K. K.; Reddy, G. V.; Sreedevi, B.; et al. Evidence for the association of synaptotagmin with glutathione S- transferase: implications for a novel function in human breast cancer. Clinical Biochem. 2005, 38, 436-443. Shea, T. C.; Kelley S. L.; Henner, W. D. Identification of an anionic form ofglutathione transferase present in many human tumors and human tumor cell lines. Cancer Res. 1988, 48, 527-533. Simic, T.; Mimic-Oka, J.; Savic-Radojevic, A.; Opacic, M.; et al. Glutathione S- transferase T1-1 activity upregulated in transitional cell carcinoma of urinary bladder. 2005, 65, 1035-1040. Schuliga, M.; Chouchane, S.; Snow, E. T. Up-regulation of glutathione - related genes and enzyme activities in cultured human cells by sub-lethal concentration of inorganic arsenic. Sci. 2002, 70, 183-192. Matsui, M.; Nishigori, C.; Toyokuni, S.; Takada, J.; et al. The role of oxidative DNA damage in human arsenic carcinogenesis: detection of 8 hydroxy-2'-deoxyguanosine in arsenic-related Bowen's disease. Invest. Dermatol. 1999, 113, 26-31. Sanada, Y.; Suemori, I.; Katunuma, N. Properties of ornithine aminotransferase from rat liver, kidney, and small intestine. Biophys. Acta. 1970, 220, 42-50. Wang, G.; Shang, L.; Burgett, A. W. G.; Harran, P. G.; et al. Diazonamide toxins reveal an unexpected function for ornithine d-amino transferase in mitotic cell division. PNAS, 2007, 104, 2068-2073. Fujita, T.; Inoue, H.; Kitamura, T.; Sato, N.; et al. Senescence marker protein-30 (SMP30) rescues cell death by enhancing plasma membrane Caat-pumping activity in hep G2 cells. Biophys. Res. Commun. 1998, 250, 374-380. Ishigami, A.; Fujita, T.; Handa, S.; Shirasawa, T.; et al. Senescence marker protein-30 knockout mouse liver is highly susceptible to tumors necrosis factor-∞ and fas-mediated apoptosis. J. Pathol. 2002, 161, 1273-1281. Kondo, Y.; Ishigami, A.; Kubo, S.; Handa, S.; et al. Senescence marker protein-30is a unique enzyme that hydrolyzes diisopropylphosphorofluoridate in the liver. FEBS Letters. 2004, 570, 57-62. Ishigami, A.; Kondo, Y.; Nanba, R.; Ohsawa, T.; et al. SMP30 deficiency in mice causes an accumulation of neutral lipids and phospholipids in the liver and shortens the life span. Biophys. Res. Commun. 2004, 315, 575-580. Martin, G. G.; Danneberg, H.; Kumar, L. S.; Atshaves, B. P.; et al. Decreased liver fatty acid binding capacity and altered liver lipid distribution in mice lacking the liver fatty acid binding protein gene. Biol. Chem. 2003, 278, 21429-21438. Atshaves, B. P.; Storey, S. M.; Petrescu, A.; Greenberg, C. C.; et al. Expression of fatty acid binding proteins inhibits lipid accumulation and alters toxicity in L cell fibroblasts. J. Physiol. Cell Physiol. 2002, 283, C688-2703.

The cognitive specificity of social pedagogy is its interest in the issues related to social conditionings of human development and, respectively, the specific social conditionings of the upbringing process. The notion has been developed in various directions since the very beginning of the discipline, yet the most clearly visible area seems to be the functioning of individuals, families and broader environment. Simultaneously, it is possible to observe that the issues have been entangled in certain socio-political conditions, the knowledge of which is substantial for the reconstruction and identification of the research heritage of social pedagogy. All these interrelationships allowed to distinguish particular stages of development of social pedagogy. Contemporarily, it is a discipline with descent scientific achievements which marks out and indicates new perspectives both in the field of educational practice and the theory of social activity. Social pedagogy, similarly to other areas (subdisciplines) of pedagogy, deals with the notion of upbringing in a certain aspect – in a certain problem inclination. It specializes in social and environmental conditionings of the upbringing process. It is the thread of the social context of upbringing what proves to be the crucial, basic and fundamental determinant of upbringing and, thus, decisive factor for human development. This notion was always present in the general pedagogical thought however, its organized and rationalized character surfaced only when the social pedagogy was distinguished as a separate, systematic area of pedagogy. It occurred in Poland only at the beginning of the 19th century. From the very beginning the creators and precursors of this subdiscipline pointed out its relatively wide range. It has been the notion of individual – social conditionings of human development, yet, social pedagogists were interested in human at every stage of their lives i.e. childhood, adolescence, adulthood and old age. Another area of interest were the issues related to family as the most important “place” of human development and, in this respect, the issues connected with institutions undertaking various activities: help, care, support and animation. Finally, the scope of interest included issues related to the environment as the place where the upbringing process is supposed to realize and realizes. Since the very beginning of social pedagogy these have been the prominent threads for exploration. At the same time it ought to be stated that these threads have always been interwoven with various social-political conditions both with regards to their interpretation as well as possible and planned educational practice. Therefore social pedagogy and its findings must be always “read” in the context of social-political conditions which accompanied the creation of a given thought or realization of some educational practice. As these conditions have constantly been undergoing certain transformations one may clearly distinguish particular stages of development of social pedagogy. The stages reflect various approaches to exploring and describing the above-mentioned areas of this discipline. Following the assumptions regarding the chronology of social pedagogy development and the three distinguished stages of development, it seems worthwhile to study how the issues related to an individual, family and environment were shaped at these stages. The first stage when the social psychology was arising was mainly the time of Helena Radlińska’s activities as well as less popular and already forgotten Polish pedagogists – precursors of this discipline such as: Anna Chmielewska, Irena Jurgielewiczowa, Zofia Gulińska or Maria Korytowska. In that period social pedagogists mainly dealt with individuals, families and the functioning of environments in the context of educational activities aimed at arousing national identity and consciousness. However, their work did no focus on indicating the layers of threats and deficits in functioning of individuals, social groups or families but on the possibilities to stimulate their development and cultural life. Therefore social pedagogy of those times was not as strongly related to social work as it currently is but dealt mainly with educational work. The classic example of such approach in the research carried out in the social pedagogy of that time may be the early works by Helena Radlińska who undertook the narrow field of cultural-educational work targeted to all categories of people. The works described such issues as the organization of libraries, organizing extra-school education (H. Orsza, 1922, H. Orsza-Radlińska, 1925). It ought to be stated that this kind of work was regarded as public and educational work, whereas currently it exists under the name of social work. Frequently quoted works related to the issues of arising social pedagogy were also the works by Eustachy Nowicki e.g. “Extra-school education and its social-educational role in the contemporary Polish life” from 1923 or the works by Stefania Sempołowska, Jerzy Grodecki or Jadwiga Dziubińska. Such an approach and tendencies are clearly visible in a book from 1913 (a book which has been regarded by some pedagogists as the first synthetic presentation of social pedagogy). It is a group work entitled “Educational work – its tasks, methods and organization” (T. Bobrowski, Z. Daszyńska-Golińska, J. Dziubińska, Z. Gargasa, M. Heilperna, Z. Kruszewska, L. Krzywicki, M. Orsetti, H. Orsza, St. Posner, M. Stępkowski, T. Szydłowski, Wł. Weychert-Szymanowska, 1913). The problem of indicated and undertaken research areas and hence, the topics of works realized by the social pedagogists of that times changed immediately after regaining independence and before World War II. It was the time when the area of social pedagogists interests started to include the issues of social inequality, poverty and, subsequently, the possibility of helping (with regards to the practical character of social pedagogy). The research works undertaken by social pedagogists were clearly of diagnostic, practical and praxeological character. They were aimed at seeking the causes of these phenomena with simultaneous identification and exploration of certain environmental factors as their sources. A classic example of such a paper – created before the war – under the editorial management of H. Radlińska was the work entitled “Social causes of school successes and failures” from 1937 (H. Radlińska, 1937). Well known are also the pre-war works written by the students of H. Radlińska which revealed diagnostic character such as: “The harm of a child” by Maria Korytowska (1937) or “A child of Polish countryside” edited by M. Librachowa and published in Warsaw in 1934 (M. Librachowa, 1934). Worthwhile are also the works by Czesław Wroczyński from 1935 entitled “Care of an unmarried mother and struggle against abandoning infants in Warsaw” or the research papers by E. Hryniewicz, J. Ryngmanowa and J. Czarnecka which touched upon the problem of neglected urban and rural families and the situation of an urban and rural child – frequently an orphaned child. As it may be inferred, the issues of poverty, inefficient families, single-parent families remain current and valid also after the World War II. These phenomena where nothing but an outcome of various war events and became the main point of interest for researchers. Example works created in the circle of social pedagogists and dealing with these issues may be two books written in the closest scientific environment of Helena Radlińska – with her immense editorial impact. They are “Orphanage – scope and compensation” (H. Radlińska, J. Wojtyniak, 1964) and “Foster families in Łódź” (A. Majewska, 1948), both published immediately after the war. Following the chronological approach I adopted, the next years mark the beginning of a relative stagnation in the research undertaken in the field of social pedagogy. Especially the 50’s – the years of notably strong political indoctrination and the Marxist ideological offensive which involved building the so called socialist educational society – by definition free from socio-educational problems in public life. The creation and conduction of research in this period was also hindered due to organizational and institutional reasons. The effect of the mentioned policy was also the liquidation of the majority of social sciences including research facilities – institutes, departments and units. An interesting and characteristic description of the situation may be the statement given by Professor J. Auletner who described the period from the perspective of development of social policy and said that: “During the Stalinist years scientific cultivation of social policy was factually forbidden”. During the period of real socialism it becomes truly difficult to explore the science of social policy. The name became mainly the synonym of the current activity of the state and a manifestation of struggles aimed at maintaining the existing status quo. The state authorities clearly wanted to subdue the science of social activities of the state […]. During the real socialism neither the freedom for scientific criticism of the reality nor the freedom of research in the field of social sciences existed. It was impossible (yet deliberated) to carry out a review of poverty and other drastic social issues” (J. Auletner, 2000). The situation changes at the beginning of the 60’s (which marks the second stage of development of social pedagogy) when certain socio-political transformations – on the one hand abandoning the limitation of the Stalinist period (1953 – the death of Stalin and political thaw), on the other – reinforcement of the idea of socialist education in social sciences lead to resuming environmental research. It was simultaneously the period of revival of Polish social pedagogy with regards to its institutional dimension as well as its ideological self-determination (M. Cichosz, 2006, 2014). The issues of individuals, families and environments was at that time explored with regards to the functioning of educational environments and in the context of exploring the environmental conditionings of the upbringing process. Typical examples here may be the research by Helena Izdebska entitled “The functioning of a family and childcare tasks” (H. Izdebska, 1967) and “The causes of conflicts in a family” (H. Izdebska, 1975) or research conducted by Anna Przecławska on adolescents and their participation in culture: “Book, youth and cultural transformations” (A. Przecławska, 1967) or e.g. “Cultural diversity of adolescents against upbringing problems” (A. Przecławska, 1976). A very frequent notion undertaken at that time and remaining within the scope of the indicated areas were the issues connected with organization and use of free time. This may be observed through research by T. Wujek: “Homework and active leisure of a student” (T. Wujek, 1969). Another frequently explored area was the problem of looking after children mainly in the papers by Albin Kelm or Marian Balcerek. It is worthwhile that the research on individuals, families or environments were carried out as part of the current pedagogical concepts of that time like: parallel education, permanent education, lifelong learning or the education of adults, whereas, the places indicated as the areas of human social functioning in which the environmental education took place were: family, school, housing estate, workplace, social associations. It may be inferred that from a certain (ideological) perspective at that time we witnessed a kind of modeling of social reality as, on the one hand particular areas were diagnosed, on the other – a desired (expected) model was built (designed) (with respect to the pragmatic function of practical pedagogy). A group work entitled “Upbringing and environment” edited by B. Passini and T. Pilch (B. Passini, T. Pilch, 1979) published in 1979 was a perfect illustration of these research areas. It ought to be stated that in those years a certain model of social diagnosis proper for undertaken social-pedagogical research was reinforced (M. Deptuła, 2005). Example paper could be the work by I. Lepalczyk and J. Badura entitled: “Elements of pedagogical diagnostics” (I. Lepalczyk, J. Badura, 1987). Finally, the social turning point in the 80’s and 90’s brought new approaches to the research on individuals, families and environments which may be considered as the beginning of the third stage of the development of social pedagogy. Breaking off the idea of socialist education meant abandoning the specific approach to research on the educational environment previously carried out within a holistic system of socio-educational influences (A. Przecławska, w. Theiss, 1995). The issues which dominated in the 90’s and still dominate in social pedagogy with regards to the functioning of individuals, families and local environments have been the issues connected with social welfare and security as well as education of adults. Research papers related to such approach may be the work by Józefa Brągiel: “Upbringing in a single-parent family” from 1990; the work edited by Zofia Brańka “The subjects of care and upbringing” from 2002 or a previous paper written in 1998 by the same author in collaboration with Mirosław Szymański “Aggression and violence in modern world” published in 1999 as well as the work by Danuta Marzec “Childcare at the time of social transformations” from 1999 or numerous works by St. Kawula, A. Janke. Also a growing interest in social welfare and social work is visible in the papers by J. Brągiel and P. Sikora “Social work, multiplicity of perspectives, family – multiculturalism – education” from 2004, E. Kanwicz and A. Olubiński: “Social activity in social welfare at the threshold of 21st century” from 2004 or numerous works on this topic created by the circles gathered around the Social Pedagogy Faculty in Łódź under the management of E. Marynowicz-Hetka. Current researchers also undertake the issues related to childhood (B. Smolińska-Theiss, 2014, B. Matyjas, 2014) and the conditionings of the lives of seniors (A. Baranowska, E. Kościńska, 2013). Ultimately, among the presented, yet not exclusive, research areas related to particular activities undertaken in human life environment (individuals, families) and fulfilled within the field of caregiving, social welfare, adult education, socio-cultural animation or health education one may distinguish the following notions:  the functioning of extra-school education institutions, most frequently caregiving or providing help such as: orphanage, residential home, dormitory, community centre but also facilities aimed at animating culture like youth cultural centres, cultural centres, clubs etc.,  the functioning of school, the realization of its functions (especially educational care), fulfilling and conditioning roles of student/teacher, the functioning of peer groups, collaboration with other institutions,  the functioning (social conditionings) of family including various forms of families e.g. full families, single-parent families, separated families, families at risk (unemployment) and their functioning in the context of other institutions e.g. school,  social pathologies, the issues of violence and aggression, youth subcultures,  participation in culture, leisure time, the role of media,  the functioning of the seniors – animation of activities in this field,  various dimensions of social welfare, support, providing help, the conditionings of functioning of such jobs as the social welfare worker, culture animator, voluntary work. It might be concluded that the issues connected with individuals, families and environment have been the centre of interest of social pedagogy since the very beginning of this discipline. These were the planes on which social pedagogists most often identified and described social life – from the perspective of human participation. On the course of describing the lives of individuals, families and broader educational environments social pedagogists figured out and elaborated on particular methods and ways of diagnosing social life. Is it possible to determine any regularities or tendencies in this respect? Unquestionably, at the initial stage of existence of this discipline, aimed at stimulating national consciousness and subsequent popularization of cultural achievements through certain activities – social and educational work, social pedagogists built certain models of these undertakings which were focused on stimulating particular social activity and conscious participation in social life. The issues concerning social diagnosis, though not as significant as during other stages, served these purposes and hence were, to a certain extent, ideologically engaged. The situation changed significantly before and shortly after the World War II. Facing particular conditions of social life – increase in many unfavourable phenomena, social pedagogists attempted to diagnose and describe them. It seems to have been the period of clear shaping and consolidation of the accepted model of empirical research in this respect. The model was widely accepted as dominating and has been developed in Polish social pedagogy during the second and subsequent stages of developing of this discipline. Practical and praxeological character of social pedagogy became the main direction of this development. Consequently, social diagnosis realized and undertaken with regard to social pedagogy was associated with the idea of a holistic system of education and extra-school educational influences and related educational environments. Therefore, the more and more clearly emphasized goal of environmental research – forecasting, was associated with the idea of building holistic, uniform educational impacts. After the systemic transformation which occurred in Poland in the 90’s, i.e. the third stage of social pedagogy development, abandoning the previous ideological solutions, environmental research including diagnosis was reassociated with social life problems mainly regarding social welfare and security. Individuals, families and environment have been and still seem to be the subject of research in the field of social pedagogy in Poland. These research areas are structurally bound with its acquired paradigm – of a science describing transformations of social life and formulating a directive of practical conduct regarding these transformations. A question arouses about the development of social pedagogy as the one which charts the direction of transformations of practices within the undertaken research areas. If it may be considered as such, then it would be worthwhile to enquire about the directions of the accepted theoretical acknowledgments. On the one hand we may observe a relatively long tradition of specifically elaborated and developed concepts, on the other – there are still new challenges ahead. Observing the previous and current development of Polish social pedagogy it may be inferred that its achievements are not overextensive with regards to the described and acquired theoretical deliberations. Nevertheless, from the very beginning, it has generated certain, specific theoretical solutions attempting to describe and explain particular areas of social reality. Especially noteworthy is the first period of the existence of this discipline, the period of such social pedagogists like i.a. J.W. Dawid, A. Szycówna, I. Moszczeńska or Helena Radlińska. The variety of the reflections with typically philosophical background undertaken in their works (e.g. E. Abramowski) is stunning. Equally involving is the second stage of development of social pedagogy i.e. shortly after the World War II, when Polish social pedagogy did not fully break with the heritage of previous philosophical reflections (A. Kamiński, R. Wroczyński) yet was developed in the Marxist current. A question arouses whether the area of education and the projects of its functioning of that time were also specific with regards to theory (it seems to be the problem of the whole Socialist pedagogy realised in Poland at that time). The following years of development of this discipline, especially at the turn of 80’s and 90’s was the period of various social ideas existing in social pedagogy – the influences of various concepts and theories in this field. The extent to which they were creatively adapted and included in the current of specific interpretations still requires detailed analysis, yet remains clearly visible. Another important area is the field of confronting the theories with the existing and undertaken solutions in the world pedagogy. A. Radziewicz-Winnicki refers to the views of the representatives of European and world social thought: P. Bourdieu, U. Beck, J. Baudrillard, Z. Bauman and M. Foucault, and tries to identify possible connections and relationships between these ideas and social pedagogy: “the ideas undertaken by the mentioned sociologists undoubtedly account for a significant source of inspiration for practical reflection within social pedagogy. Therefore, it is worthwhile to suggest certain propositions of their application in the field of the mentioned subdiscipline of pedagogy” (Radziewicz-Winnicki 2008). The contemporary social pedagogy in Poland constantly faces numerous challenges. W. Theiss analysed the contemporary social pedagogy with regards to its deficiencies but also the challenges imposed by globalisation and wrote: “Modern social pedagogy focuses mainly on the narrow empirical research and narrow practical activity and neglects research in the field of theory functioning separately from the realms of the global (or globalising) world or pays insufficient attention to these problems. It leads to a certain self-marginalisation of our discipline which leaves us beyond the current of main socio-educational problems of modern times. In this respect, it seems worthwhile and necessary to carry out intensive conceptual and research work focused on e.g. the following issues:  metatheory of social pedagogy and its relationship with modern trends in social sciences;  the concepts of human and the world, the concepts of the hierarchy of values;  the theory of upbringing, the theory of socialization, the theory of educational environment;  a conceptual key of the modern reality; new terms and new meanings of classical concepts;  socio-educational activities with direct and indirect macro range e.g. balanced development and its programmes, global school, intercultural education, inclusive education, professional education of emigrants”. Considering the currently undertaken research in this field and the accepted theoretical perspectives it is possible to indicate specific and elaborated concepts. They fluctuate around structural spheres of social pedagogy on the axis: human – environment – environmental transformations. It accounts for an ontological sphere of the acknowledged concepts and theories. Below, I am enumerating the concepts which are most commonly discussed in social pedagogy with regards to the acquired and accepted model. Currently discussed theoretical perspectives (contexts) in social pedagogy and the concepts within. I. The context of social personal relationships  social participation, social presence;  social communication, interaction;  reciprocity. II. The context of social activities (the organization of environment)  institutionalisation;  modernization;  urbanization. III. The context of environment  space;  place;  locality. The socially conditioned process of human development is a process which constantly undergoes transformations. The pedagogical description of this process ought to include these transformations also at the stage of formulating directives of practical activities – the educational practice. It is a big challenge for social pedagogy to simultaneously do not undergo limitations imposed by current social policy and response to real social needs. It has been and remains a very important task for social pedagogy.

Objective This study aimed to assess trends and correlates of severe maternal morbidity at delivery among active duty women in the U.S. military, all of whom are guaranteed health care and full employment. Study Design Linked military personnel and medical encounter data from the Department of Defense Birth and Infant Health Research program were used to identify a cohort of delivery hospitalizations among active duty military women from January 2003 through August 2015. Cases of severe maternal morbidity were identified by applying 21- and 20-condition algorithms (with and without blood transfusion) developed by the Centers for Disease Control and Prevention. Rates (per 10,000 delivery hospitalizations) were reported overall and by specific condition. Multivariable Poisson regression models estimated associations with demographic, clinical, and military characteristics. Results Overall, 187,063 hospitalizations for live births were included for analyses. The overall 21- and 20-condition severe maternal morbidity rates were 111.7 (n = 2089) and 37.4 (n = 699) per 10,000 delivery hospitalizations, respectively. The 21-condition rate increased by 184% from 2003 to 2015; the 20-condition rate increased by 40%. Compared with non-Hispanic White women, the adjusted 21-condition rate of severe maternal morbidity was higher for Hispanic (adjusted rate ratio [aRR] = 1.28, 95% confidence interval [CI]: 1.13–1.46), non-Hispanic Black (aRR = 1.34, 95% CI: 1.21–1.49), Asian/Pacific Islander (aRR = 1.35, 95% CI: 1.13–1.61), and American Indian/Alaska Native (aRR = 1.39, 95% CI: 1.06–1.82) women. Rates also varied by age, clinical factors, and deployment history. Conclusion Active duty U.S. military women experienced an increase in severe maternal morbidity from 2003 to 2015 that followed national trends, despite protective factors such as stable employment and universal health care. Similar to other populations, military women of color were at higher risk for severe maternal morbidity relative to non-Hispanic White military women. Continued surveillance and further investigation into maternal health outcomes are critical for identifying areas of improvement in the Military Health System. Key Points

AbstractEarly extubation (EE) in pediatric cardiac surgery has demonstrated important benefits. However, ventilating them for 24 hours or more (delayed decannulation, DD) is an enduring practice. The objectives of this study were to describe the clinical profiles of EE in our setting and analyze its impact and the factors that prolong mechanical ventilation. Children operated on for cardiac surgery from 2016 to 2017 were included. The information was obtained from an electronic database. Comparisons were performed with Pearson's chi-square test, Student's t-test, or Mann–Whitney U test. Multivariate logistic regression was used to evaluate factors associated with DD. Of 649 cases, 530 were extubated on one occasion. EE was performed in 305 children (57.5%): 97 (31.8%) in the operating room and 208 (68.2%) in the intensive care unit (ICU). Reintubation (RI) occurred in 7.5% with EE and 16.9% with DD (p = 0.001). Fewer complications and ventilation time and decreased ICU and hospital length of stay resulted with EE. Age, presurgical ventilation, emergency surgery, pump time, attempts to weaning from cardiopulmonary bypass, bleeding greater than usual, and CPR in surgery were associated with DD. EE in the National Institute of Cardiology (INC; Spanish acronym) is in the middle category and has shown benefits without compromising the patient; the fear of further complications, RI, or death is unfounded. Although not all children at the INC can be decannulated early, if there are no or minimal risk factors, it should be a priority.

Background: Multimorbidity is defined as the existence of two or more chronic health conditions in the same individual. While patients with tuberculosis commonly have multiple conditions at diagnosis, such as HIV, diabetes, and depression, to the authors' knowledge, there is limited information on the patterns of multimorbidity, and how the types and combinations of conditions could impact the healthcare utilization, expenditure, and TB outcomes.Methods: An observational cohort study of adult patients diagnosed with tuberculosis was conducted using the Chinese Center for Disease Control and Prevention (CDC)'s National TB Information System (NTBIS) linked to the Ningbo Regional Health Care Database (NRHCD) (2015–2020). Latent class analysis was used to identify comorbidity groups among the subset with ≥2 conditions including TB. Group-level health care use, expenditure, and treatment outcomes were compared with patients without chronic conditions using multivariate regression models.Results: A total of 9,651 patients with TB were identified, of whom approximately 61.4% had no chronic conditions, 17.4% had 1 chronic condition, and 21.3% had ≥2 chronic conditions. Among those with ≥1 chronic condition other than TB, 4 groups emerged: (1) general morbidity (54.4%); (2) cardiovascular morbidity without complications (34.7%); (3) cardiovascular morbidity with complications (5.0%); (4) respiratory morbidity (5.9%). The respiratory morbidity group experienced the highest expenditures, at 16,360 CNY more overall (95% CI, CNY 12,615–21,215) after adjustment compared with TB patients without chronic conditions. The respiratory morbidity and cardiovascular morbidity with complications group also had the lowest odds of favorable TB outcomes [adjusted odds ratio (aOR), 0.68; 95% CI, 0.49–0.93] and (aOR 0.59, 95% CI 0.42–0.83), respectively. The cardiovascular morbidity without complications group had the highest odds of successful TB treatment (aOR, 1.40; 95% CI, 1.15–1.71).Conclusions: Multimorbidity is common among patients with TB. The current study identified four distinct comorbidity subgroups, all of which experienced high, yet differential, rates of health care use. These findings highlight the need for urgent reforms to transform current fragmented TB care delivery and improve access to other specialists and financial assistance.

Abstract Background Cancer Care Delivery (CCD) research studies often require practice-level interventions that pose challenges in the clinical trial setting. The SWOG Cancer Research Network (SWOG) conducted S1415CD, one of the first pragmatic cluster-randomized CCD trials to be implemented through the National Cancer Institute (NCI) Community Oncology Program (NCORP), to compare outcomes of primary prophylactic colony stimulating factor (PP-CSF) use for an intervention of automated PP-CSF standing orders to usual care. The introduction of new methods for study implementation created challenges and opportunities for learning that can inform the design and approach of future CCD interventions. Methods The order entry system intervention was administered at the site level; sites were affiliated NCORP practices that shared the same chemotherapy order system. 32 sites without existing guideline-based PP-CSF standing orders were randomized to the intervention (n = 24) or to usual care (n = 8). Sites assigned to the intervention participated in tailored training, phone calls and onboarding activities administered by research team staff and were provided with additional funding and external IT support to help them make protocol required changes to their order entry systems. Results The average length of time for intervention sites to complete reconfiguration of their order sets following randomization was 7.2 months. 14 of 24 of intervention sites met their individual patient recruitment target of 99 patients enrolled per site. Conclusions In this paper we share seven recommendations based on lessons learned from implementation of the S1415CD intervention at NCORP community oncology practices representing diverse geographies and patient populations across the U. S. It is our hope these recommendations can be used to guide future implementation of CCD interventions in both research and community settings. Trial Registration NCT02728596, registered April 5, 2016.

Holistic approach to nursing care is a comprehensive model which involves all facets of care which involves mental, spiritual, and social needs of patients. However, studies have shown that most nurses are not familiar with this model of caring and only considers the corporeal needs of the patient. Thus, the aim of the study was to assess the caring behaviors, spiritual and cultural competencies of nurses. Also, the extent of influence of cultural and spiritual competencies to the caring behaviors of Filipino nurses were determine. The study utilized a causal research design and a purposive sample of 124 Filipino medical-surgical nurses who were employed in Level 3 hospitals were included. The data were collected through survey using three (3) questionnaires which includes Nurse Cultural Competence Scale developed by Perng and Watson (2012), the Nurse Spiritual Care Therapeutic Scale developed by Mamier and Taylor(2014) and the Caring Nurse Patient Interaction Scale developed by Cossette et al. (2006). The data collected was analyzed using frequency, percentage, mean, standard deviation and univariate linear regression analysis. The findings revealed that Filipino nurses rated themselves good in terms of spiritual and cultural competencies. Specifically, the subscales of cultural competencies which includes cultural skills, cultural knowledge and cultural sensitivity were also rated as good. On the other hand, the caring behaviors of Filipino nurses were rated as excellent. The same findings were also noted for two of its subscales, the clinical care and comforting care while both relational and humanistic care were rated as very good. Spiritual competencies showed a significant influence in the caring behaviors of nurses, however, no significant influence was noted between the cultural competencies and caring behaviors of nurses. References Atashzadeh-Shoorideh F, Abdoljabbari M, Karamkhani M, Shokri Khubestani M, Pishgooie S. (2017). The relationship between nurses’ spiritual health and their caring behaviors. Journal of Research on Religion & Health.. 3(1), 5-15.Bachman, R. (2007). The practice of research in criminology and criminal justice. Chapter 5, Causation and Research Designs. (3rd ed.) Thousand Oaks, CA: Pine Forge Press.Bakar, A. Nursalam, Adriani, M., Kusnanto, Qomariah, S., Hidayati, L. Pratiwi, I., Ni’mah, L. (2017). Nurses’ spirituality improves caring behavior. International Journal of Evaluation and Research in Education. 6(1), 23-30.Bunjitpimol, P., Somronghtong, R. & Kumar, R. (2016). Factors affecting nursing cultural competency in private hospitals at Bangkok, Thailand. International Journal of Health Care. 2(1), 5-11Burkhardt, M., & Jacobson, M. (2002). Spirituality: living our connectedness. (1st ed.) New York: Delmar Thomson LearningCalong Calong, K. & Soriano, G. (2018). Caring behavior and patient satisfaction. Merging for satisfaction. International Journal of Caring Sciences. 11(2), 697-703Canadian Nurses Association (2010). Position statement on spirituality, health and nursing practice. Ottawa: AuthorCossette S., Cote J., Pepin J., Ricard N., & D’Aoust L. (2006). A dimensional structure of nurse-patient interaction from a caring perspective: Refinement of the caring nurse-patient interaction scale (CNPI-Short Scale). Journal of Advance Nursing. 55(2), 198-214Creswell, J. (2003). Research design: Qualitative, quantitative and mixed methods approaches (2nd ed.). Thousand Oaks, CA: SAGE Publications doi:10.20467/1091-5710-20.3.134. Cruz, J., Estacio, J., Bgatang, C. & Colet, P. (2016). Predictors of cultural competence among nursing students in the Philippines: A crosssectional study. Nurse Education Today. 46, 121-126. doi: 10.1016/j.nedt.2016.09.001de Beer, J. & Chipps, J. (2014). A survey of cultural competence of critical care nurses’ in KwaZulu-Natal. Southern African Journal of Critical Care. 30(2), 50-54Department of Health Administrative Order No. 012. (2012). Rules and regulations governing the new classification of hospitals and other health facilities in the Philippines. Retrieved from: https://www.doh.gov.ph/sites/default/files/publications/DOH_Annual_ Report_2015_07132016.compressed.pdfHellman, A. N., Williams, W. E., Jr., & Hurley, S. (2015). Meeting spiritual needs: A study using the spiritual care competence scale. Journal of Christian Nursing, 32, 236-241. doi:10.1097/CNJ.0000000000000207Kawashima, A. (2008). Study on cultural competency of japanese nurses. Unpublished Manuscript. George Mason University.Khorrami-Markani, A., Yaghmaie, F., Khodayarifard, M., & Alavimajd, H. (2012). Oncology nurses spiritual health experience: A qualitative content analysis. Basic & Clinical Cancer Research. 4(2&3), 28.Kolcaba, R. (1997). The primary holisms in nursing. Journal of Advance Nursing. 25(2), 290-296.Kuan, L. (1993). Essence of caring. National teacher Training Center for the Health Professions. University of the Philippines Manila. Learning Resources Unit.Larson, P. J. (1984). Important nurse caring behaviors perceived by patients with cancer. Oncology Nursing Forum. 11(6), 46–50.Lin, M., Wu, C., & Hsu, H. (2019). Exploring the experiences of cultural competence among clinical nurses in Taiwan. Applied Nursing Research. 45, 6-11. doi: 10.1016/j.apnr.2018.11.001Mamier, I., Taylor, E. & Wisnlow, B. (2018). Nurse spiritual care: prevalence and correlates. Western Journal of Nursing Research. doi: 10.1177/0193945918776328McSherry, W. (2006) The principal components model: a model for advancing spirituality and spiritual care within nursing and health care practice. Journal of Clinical Nursing, 15 (7), 905–917.McSherry, W. & Jamieson, S. (2011) An online survey of nurses’ perceptions of spirituality and spiritual care. Journal of Clinical Nursing, 20 (11–12), 1757–1767.Meyer, C. (2003). How effectively are nurse educators preparing students to provide spiritual care?. Nurse Education. 28(4), 185-190.Mizock L., Millner U., & Russinova Z. (2012). Spiritual and religious issues in psychotherapy with schizophrenia: cultural implications and implementation. Religions. 3(1), 82–98. doi: 10.3390/rel3010082Musa, A. (2017). Spiritual care intervention and spiritual well-being Jordanian Muslim nurses’ perspectives. Journal of Holistic Nursing, 35, 53-61. doi:10.1177/0898010116644388Olive, P. (2003). The holistic nursing care of patients with minor injuries attending the A&E department. Accident and Emergency Nursing. 11(1), 27-32. Polit, D. & Beck, C. (2014). Essentials of nursing research: Appraising evidence for nursing practice. Philadelphia: Wolters Kluwer Health /Lippincott Williams & Wilkins. Porter, S. (1997). The patient and power: Sociological perspectives on the consequences of holistic care. Health & Social Care in the Community. 5:17–20 Priambodo, Galih. Caring in nursing practice: Caring category based on culture. Unpublished Master’s Thesis. Yogyakarta University.Retrieved from: http://thesis.umy.ac.id/data publik/t34187.pdf, 2014. Saha, S., Beach, M. & Cooper, L. (2008). Patient centeredness, cultural competence and healthcare quality. Journal of the National Medical Association, 100(11), 1275-1285. doi: 10.1016/S0027-9684(15)31505-4Selimen, D., & Andsoy, I. (2011). The Importance of a holistic approach during the perioperative period. AORN Journal. 94(4), 482-490. doi: 10.1016/j.aorn.2010.09.029 Tang, C., Tian, B., Zhang, X., Zhang, K., Xiao, X., Simonu, J., & Wang, H. (2018). The influence of cultural competence of nurses on patient satisfaction and the mediating effect of patient trust. Journal of Advanced Nursing. doi: 10.1111/jan.13854 Tjale, A., & Bruce, J. (2007). A concept analysis of holistic nursing care in pediatric nursing. Curationis. 30(4), 45-52. Watson J. (1985). Nursing: Human science and human care. A theory of nursing. Norwalk, Connecticut: Appleton-Century-Crofts. Wintz, S., & Cooper, E. (2009). Cultural & spiritual sensitivity - A learning module for health care professionals and dictionary of patients' spiritual & cultural values for health care professionals. New York: Author Wolf, Z., Dillon, P., Townsend, A., & Glasofer, A. (2017). Caring behaviors inventory-24 Revised: CBI-16 validation and psychometric properties. International Journal for Human Caring. 21(4), 185-192 Wolf, Z. R., Giardino, E. R., Osborne, P. A., & Ambrose, M. S. (1994). Dimensions of nurse caring. Image: Journal of Nursing Scholarship. 26, 107–111. Wong K., Lee L., Lee J. (2008). Hong Kong enrolled nurses' perceptions of spirituality and spiritual care. International Nursing Review. 55(3), 333-340. doi: 10.1111/j.1466-7657.2008.00619.x Yılmaz, M., & Okyay, N. (2009). Views related to spiritual care and spirituality of nurses. HEMAR

Hypoglycemia limits the glycemic control that can be achieved with insulin and sulfonylureas (SUs) , but we lack evidence from head-to-head studies to guide management. In the GRADE comparative effectiveness study, 5,047 patients with type 2 diabetes (T2DM) of &lt;years’ duration, on metformin monotherapy with HbA1c 6.8-8.5%, were randomized to addition of the SU glimepiride, insulin glargine U-100, sitagliptin, or liraglutide, permitting a direct comparison over 5.0 ± 1.3 (mean ± SD) years of follow-up. Glimepiride was initiated at 1-2 mg/day, glargine at 10-20 units/day, and both were titrated according to algorithms based on self-monitored blood glucose levels. Over 4 years, adjudicated severe hypoglycemia occurred in 2.3% of those randomized to glimepiride vs. 1.4% with glargine, but was less frequent with liraglutide (0.9%) and sitagliptin (0.7%) , p=0.003. During GRADE, HbA1c was measured every 3 months, and if a HbA1c &gt;7.5% was confirmed, “rescue treatment” with glargine and/or aspart was added. We examined management in participants who were unable to keep HbA1c ≤7.5% - whose primary study drug was insufficient - prior to their “rescue”. At 3 mo after randomization, hypoglycemic symptoms or a measured glucose &lt;70 mg/dl within the previous 30 d was reported by 33% of those using glimepiride vs. 15% with glargine (p &lt;0.001) . The mean dose of glimepiride at 3 mo (n=627) and 12 mo (n=337) was 3.4 and 4.2 mg/day, respectively [a 24% increase but considerably submaximal (8 mg) ]. In contrast, the dose of glargine at 3 mo (n=487) and 12 mo (n=337) was 26 and 37 units/day, respectively (a 44% increase, p &lt;0.0vs. glimepiride) . The outcome of a confirmed HbA1c &gt;7.5% was reached in 50% of those using glimepiride, vs. 39% with glargine (p&lt;0.001) . Conclusions: In metformin-treated patients with T2DM, there was more hypoglycemia, less increase in drug dose, and less preservation of glycemic control, with addition of the SU glimepiride compared to glargine; increases in glimepiride dose might have been limited by hypoglycemia. Disclosure L.S. Phillips: Research Support; Abbott Diabetes, AbbVie Inc., Janssen Pharmaceuticals, Inc., Janssen Scientific Affairs, LLC, Pfizer Inc. Other Relationship; Cystic Fibrosis Foundation, Diasyst Inc. E.R. Seaquist: None. C. Baker: None. R.M. Bergenstal: Advisory Panel; Hygieia, Medtronic, Roche Diabetes Care, Zealand Pharma A/S. Consultant; Abbott Diabetes, Ascensia Diabetes Care, Bigfoot Biomedical, Inc., CeQur SA, Dexcom, Inc., Eli Lilly and Company, Novo Nordisk, Onduo LLC, Sanofi, United HealthCare Services, Inc. Research Support; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk, Sanofi. N.M. Butera: None. J.P. Crandall: Research Support; Abbott. R. Goland: None. S.H. Hox: None. D.S. Hsia: None. M.L. Johnson: Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Jaeb Center for Health Research, Lilly, Medtronic, Novo Nordisk, Sanofi. P. Raskin: None. W. Valencia: None. A.H. Waltje: None. N. Younes: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (U01DK098246, U34-DK-088043)

Photo by National Cancer Institute on Unsplash ABSTRACT The COVID-19 pandemic has brought about the advent of many new telehealth technologies as providers have been forced to shift their practice from the clinic to the cloud. Perhaps, none of these fields has been as widely advertised and expanded as telemental health. While many have lauded this change, it is important to question whether this method of practice is truly beneficial for patients, and further whether it benefits all patients. This paper critically examines the current structure of telemental health interventions and compares them to more traditional in-person interactions, reflecting on the unique benefits and challenges of each method, and ultimately concluding that telemental health is the wrong modality for certain patients and modalities. INTRODUCTION As the e-health revolution rapidly progresses, scientists, healthcare professionals, and technology experts are attempting to determine which areas of medical practice will best adapt to changing dynamics. Two key professions that are ripe for this kind of disruption are psychiatry and psychology. The American Psychiatric Association, along with its partners in the American Telemedicine Association, states that “telemental health in the form of interactive videoconferencing has become a critical tool in the delivery of mental health care. It has demonstrated its ability to increase access and quality of care, and, in some settings, to do so more effectively than treatment delivered in-person.”[1] This claim, though appearing bombastic, is also reflected, though with more nuance, by the American Psychological Association. For its part, the American Psychological Association states that “the expanding role of technology and the continuous development of new technologies that may be useful in the practice of psychology present unique opportunities, considerations, and challenges to practice.”[2] Thus, the point of this paper will be to examine whether the rapidly expanding system of telemental health is ethical based on its adherence to accepted standards of care, privacy concerns, and concerns about the boundaries of the patient-provider relationship. l. Standard of Care Concerns One of the most considerable objections to the broader implementation of telemental health services is the speculation that it is less effective than in-person treatment. It would follow that a system that is broadly implemented would not only fail to be beneficent, but it would also fail to be non-maleficent. Providers would be knowingly providing an ineffective treatment. Some may argue that such a system would also violate the principle of justice. It would create an unequal system of care in which those patients who could afford to see their therapist in person would benefit more than those who could not. However, data from a wide variety of sources at first glance, would seem to contradict these fears.[3] A review of the literature regarding the implementation of telemental health in geriatric patients, for example, showed that telemental health was as good as in-patient psychiatric care in several areas, including the diagnosis of dementia, nursing home consultations, and in conducting psychotherapy for geriatric patients and their caregivers.[4] On the other end of the age spectrum, a review of nineteen randomized controlled trials and one clinical trial demonstrated high comparative effectiveness between telemental health interventions in children and adolescents.[5] Hailey et al. found that telemental health interventions were effective in over half of the 65 studies reviewed. These studies encompassed a diverse and wide-ranging number of psychiatric disciplines, including child psychiatry, post-traumatic stress disorder, dementia, cognitive decline, smoking cessation, and eating disorders. Methods included phone- and web-based interventions.[6] Indeed, the data is not just limited to outpatient settings. For example, Reinhardt et al. conducted a literature review of studies about telemental health visits for psychiatric emergencies and crises. They found that no studies reported a significant statistical difference in diagnosis or disposition among psychiatric patients who presented to the Emergency Department. In addition, their review demonstrated a reduction in length of stay, reduction in time to care, and decreased costs among these patients. The authors also reviewed literature pertaining to crisis response teams and patients with severe mental illness. Both studies demonstrated that telemental health visits for these patients were similar, if not better, than face-to-face visits. In addition, both patients and practitioners showed high satisfaction with these services.[7] Thus, the implementation of telemental health is limited to out-patient settings and could feasibly be implemented in the in-patient and emergency settings. There is, however, one particularly glaring gap in telemental health services: group therapy. Perhaps the most famous example of group therapy is Alcoholics Anonymous, but group therapy has expanded to include many different modalities. Group therapy is a common intervention for many mental illnesses and can be incredibly effective in treating diseases ranging from PTSD to borderline personality disorder.[8] In a pilot study comparing a video teleconference based Dialectical Behavioral Therapy (DBT) group to an in-person DBT group, Lopez et al. found that while patients had similar levels of cohesion with the facilitator, participants in the video teleconference group saw less group cohesion than their peers in the in-person group. Further, while many patients in the video teleconference group believed that the convenience offset the adverse effects, many also wished for an in-person group. Attendance was also significantly higher in the video teleconference group.[9] Thus, while the video teleconference group did report some positives, some significant differences raise ethical questions. How well does a group do without cohesion? For example, if a person needing to be consoled breaks down and cries in front of the group, the in-person response may be different from the video conference. In the in-person group, other group members may place a gentle hand on the shoulder of the grieving person or maybe even hug them. The group facilitator or group members in the video conference group could say the same words of consolation as those in the in-person group. However, there still seems to be some missing action. The idea of physical touch, in this way, can mean a lot more than just a small action. Van Wynsberghe and Gastmans argue that this kind of deprivation may lead to feelings of depersonalization.[10] And, to an extent, their supposition is supported by the data presented by Lopez et.al. The low level of group cohesion in the video conference group could suggest that other group members seem unimportant to the participants. They are simply things on a screen, not real people. Dr. Thomas Insel, former National Institute of Mental Health Director writes that while technology may hold the key to improving mental health on the population level, there is a human-sized piece of the puzzle missing from these interventions. The solution, he asserts, lies somewhere in the integration of these two types of experiences, one that he terms “high-tech and high-touch.”[11] The lack of touch and physical presence is an obstacle for both patients and providers. At best this may lead to a slightly poorer provider-patient relationship and at worst may result in poorer quality care. ll. Privacy & Confidentiality Concerns Privacy and confidentiality are among the most serious concerns for practitioners and patients, made more complex by the advent of e-health. Major news outlets provide plenty of examples of breaches of confidentiality of people’s electronic records. Even significant systems, often thought to be secure, used to facilitate direct contact between people in the wake of COVID-19, like Zoom, have been breached. Not too long ago, "Zoom Bombing” was a national phenomenon, appearing in online classrooms, often sharing explicit or politically motivated content. Psychiatric patients are susceptible to issues surrounding privacy and confidentiality, and they may even come from communities that ostracize and stigmatize mental illness. These concerns must be taken seriously. Of course, both the American Psychiatric Association and the American Psychological Association address privacy concerns. Both organizations note in their guidelines that relevant HIPAA regulations apply to telehealth and doctors must use apps and videoconferencing tools with the highest levels of security.[12] Interestingly, the American Psychiatric Association takes these instructions one step further. It requires providers to be in a private room during telehealth videoconferences or calls and that people seeking care also have a private space so that any conversations are not overheard. This not only prevents violations of privacy but reassures the therapeutic relationship between provider and patient.[13] While providers can take these steps to ensure their patients’ privacy, an internet connection may not guarantee privacy. Many privacy issues are more easily mitigated in a clinical space. For example, walls and doors can be soundproofed, or white noise can be played in the waiting room to ensure that therapeutic conversations are not overheard. And while the American Psychiatric Association asks providers to mitigate these risks as they would in their respective clinics, there is another layer to online privacy. Providers should be concerned about telecommunications providers, how they collect information, and what types of information they collect.[14] If, for example, the patient must navigate to the practitioner’s webpage to enter into the therapy portal, that information might be tracked and used to generate personalized ads for the patient. If a person suffering from severe paranoia started receiving ads for psychiatric medication, they may react negatively to the invasion of privacy. That type of targeted advertising could even exacerbate a mental health condition. The scandals surrounding the National Security Administration (NSA) in recent years have added another layer of complexity to the issue of privacy. Whistleblowers like Edward Snowden, revealed that the government was collecting metadata from text messages, videos, and social media. Government surveillance is an added risk of mental health videoconferencing.[15] The government would not be bound by the rules that require privacy with few exceptions like the Tarasoff law, which could require disclosure to stop a violent act as a clinical care provider. The government might judge someone a risk-based on ill-gotten surveillance data, wrongly add a person to a watch list, or engage in further surveillance of a patient whom non-clinicians working in government assess to be a potential danger. Protection from government surveillance is a fundamental ethical endeavor. Yet government as a collector of data without a warrant or with easily attained FISA and other warrants is problematic. Scenarios may seem far-fetched but are within the realm of possibility. Secondly, the provider must envision how this might hinder care. For example, patients aware of the possibility of government surveillance may be reluctant to show up to online meetings if they show up at all. Perhaps they are so sensitive to these issues that they stop checking with their therapist altogether. It is easy to see how a person who has schizophrenia and shows signs of paranoia may avoid telehealth for fear of being tracked. Of course, one could also have privacy concerns about a therapist’s office. Perhaps patients are nervous about being seen in the office or parking lot. They might worry about being overheard. These concerns, however, can be mitigated fairly simply, for example, patients could find anonymous means of transportation and practitioners can soundproof their offices. Thus, in both the office and the videoconference, concerns can be mitigated easily and tangibly, but not eliminated entirely. Mental health providers should use the highest quality communication services with end-to-end encryption to bolster online privacy. lll. Boundary Issues and Professionalism The boundaries here are philosophical, not physical. Both the American Psychiatric Association and the American Psychological Association work to ensure that the patient-professional boundaries are kept as close to normal as possible. Both organizations expect practitioners to maintain the highest levels of professionalism when dealing with patients using telemental health services.[16] Practitioners are responsible for enforcing boundaries through informing their patients about appropriate behavior so that patients are discouraged from calling at inappropriate times absent an emergency. Videoconferencing systems and multi-layered protections like passwords and gatekeeping would prevent patients from logging into another patient’s appointment. These boundaries exist for a good reason. A 2017 report demonstrated that there is an escalating shortage of psychiatrists.[17] Nearly 1 in 5 people in the US has a mental health condition.[18] Mental health providers are nearly overwhelmed, therefore inappropriate, frequent, and unnecessary contact adds another level of complexity to treating patients. Mental health providers need to be stewards of the resource they provide. They must concentrate on the patient they are with. They also must guard themselves against burnout, because dealing with patients too often, even though technology allows for it, will lead to them being less effective for the rest of their patients. While these professional boundaries must be policed carefully, practitioners should also be careful of having boundaries that are too high. Thus, providers must balance between too much intimacy and too little.[19] Presence and physical touch have symbolic meaning. Being with a person reaffirms their personhood, and both provider and patient can feel that. Humans are relational beings, and a physical relationship often comforts people. It may also legitimize and reinforce the patient through sensation and perception. There may be something inherently missing from the practice of telemental health, as exemplified by the group members’ inability to console others in group therapy sessions over teleconference.[20] The screen may also be an agent of depersonalization. It may make the patient’s complaints seem less real. Or perhaps the patient may feel as though they are not being heard. Although the evidence of telemedicine’s successes above may seem to contradict this, none of the studies that extoll the benefits of telemental health have follow-up periods greater than one year. And while many studies show that patients are highly satisfied with telemental health, measurements of satisfaction are not standardized. It remains unclear whether patients benefit enough from their telemental sessions or whether they require more regular sessions to stay as satisfied as they were with in-person mental health care. Perhaps as time goes on, patients become more frustrated with telemental health. The research must answer these questions, but currently, it does not sufficiently address metaphysical arguments against telemental health. CONCLUSION Privacy is a key practical issue that remains. Although providers try to combat issues of privacy by using high-level conferencing software, which has end-to-end encryption,[21] surveillance and breaches may occur. While not suitable for all kinds of patients, telemental health services prove to be effective for groups of people that otherwise may not have been able to receive care over the past two years. There are some settings, such as group therapies, that are best suited for in-person meetings. Although online sessions encourage individuals to show up regularly, their downsides are not yet known. There is incredible power in the idea of presence, and humans are inherently relational beings. For some, a lack of contact is unwelcomed and makes therapy less satisfying. Opportunities to use in-person clinical care remain a priority for some patients, and healthcare providers should further investigate prioritizing in-person care for those who want it. Telemental health could be beneficial for emergencies, natural disasters, vulnerable groups, or when patients cannot get to their provider's office. However, for now, telemental health should not take a leading role in providing mental health treatment. - [1] Chiauzzi E, Clayton A, Huh-Yoo J. Videoconferencing-Based Telemental Health: Important Questions for the COVID-19 Era from Clinical and Patient-Centered Perspectives. JMIR Ment Health, 2020. doi:10.2196/24021 [2] Joint Task Force for the Development of Telepsychology Guidelines for Psychologists. Guidelines for the practice of telepsychology. American Psychologist, 2020. 791–800. doi.org/10.1037/a0035001 [3] Gentry MT, Lapid MI, Rummans TA. Geriatric Telepsychiatry: Systematic Review and Policy Considerations. Am J Geriatr Psychiatry. 2019 doi: 10.1016/j.jagp.2018.10.009; Campbell R, O'Gorman J, Cernovsky ZZ. Reactions of Psychiatric Patients to Telepsychiatry. Ment Illn. 2015;7(2):6101, 2015. doi:10.4081/mi.2015.6101; Malhotra S, Chakrabarti S, Shah R. Telepsychiatry: Promise, potential, and challenges. Indian J Psychiatry, 2013. doi: 10.4103/0019-5545.105499; Reinhardt I, Gouzoulis-Mayfrank E, Zielasek J. Use of Telepsychiatry in Emergency and Crisis Intervention: Current Evidence. Curr Psychiatry Rep, 2019. doi: 10.1007/s11920-019-1054-8 [4] Gentry, Lapid, and Rummans, Geriatric Telepsychiatry [5] Abuwalla, Zach & Clark, Maureen & Burke, Brendan & Tannenbaum, Viktorya & Patel, Sarvanand & Mitacek, Ryan & Gladstone, Tracy & Voorhees, Benjamin. Long-term Telemental health prevention interventions for youth: A rapid review, 2017. Internet Interventions. Doi.11. 10.1016/j.invent.2017.11.006. [6]Hailey D, Roine R, Ohinmaa A. The effectiveness of telemental health applications: a review, 2008. Can J Psychiatry. doi:10.1177/070674370805301109. [7] Reinhardt, Gouzoulis-Mayfrank, and Zielasek, Use of Telepsychiatry in Emergency and Crisis Intervention [8] Kealy, David & Piper, William & Ogrodniczuk, John & Joyce, Anthony & Weideman, Rene. Individual goal achievement in group psychotherapy: The roles of psychological mindedness and group process in interpretive and supportive therapy for complicated grief, 2018. Clinical Psychology & Psychotherapy. doi:10.1002/cpp.2346. Schwartze D, Barkowski S, Strauss B, Knaevelsrud C, Rosendahl J. Efficacy of group psychotherapy for posttraumatic stress disorder: Systematic review and meta-analysis of randomized controlled trials. Psychother Res, 2019. doi: 10.1080/10503307.2017.1405168; Wetzelaer P, Farrell J, Evers SM, Jacob GA, Lee CW, Brand O, van Breukelen G, Fassbinder E, Fretwell H, Harper RP, Lavender A, Lockwood G, Malogiannis IA, Schweiger U, Startup H, Stevenson T, Zarbock G, Arntz A. Design of an international multicentre RCT on group schema therapy for borderline personality disorder. BMC Psychiatry, 2014. doi: 10.1186/s12888-014-0319-3 [9] Lopez, Amy et al. “Therapeutic groups via video teleconferencing and the impact on group cohesion.” mHealth, 2020. doi:10.21037/mhealth.2019.11.04 [10] Van Wynsberghe A, Gastmans C. Telepsychiatry and the meaning of in-person contact: a preliminary ethical appraisal. Med Health Care Philos, 2009. doi: 10.1007/s11019-009-9214-y. [11]Thomas Insel, “Tech Can Help Solve Our Mental Health Crisis. But We Can’t Forget The Human Element.,” Substack newsletter, Big Technology (blog), January 27, 2022, https://bigtechnology.substack.com/p/tech-can-help-solve-our-mental-health. [12] Armstrong, C. M., Ciulla, R. P., Edwards-Stewart, A., Hoyt, T., & Bush, N. Best practices of mobile health in clinical care: The development and evaluation of a competency-based provider training program, 2018. Professional Psychology: Research and Practice. doi.org/10.1037/pro0000194 [13] Armstrong, C. M., Ciulla, R. P., Edwards-Stewart, A., Hoyt, T., & Bush, N. Best practices of mobile health in clinical care: The development and evaluation of a competency-based provider training program [14] Sabin JE, Skimming K. A framework of ethics for telepsychiatry practice. Int Rev Psychiatry, 2015. doi:10.3109/09540261.2015.1094034 [15] Lustgarten, S. D., & Colbow, A. J. Ethical concerns for telemental health therapy amidst governmental surveillance, 2017. American Psychologist. doi.org/10.1037/a0040321 [16] Armstrong, C. M., Ciulla, R. P., Edwards-Stewart, A., Hoyt, T., & Bush, N. Best practices of mobile health in clinical care: The development and evaluation of a competency-based provider training program [17] Merritt Hawkins. An Overview of the Salaries, Bonuses, and Other Incentives Customarily Used to Recruit Physicians, Physician Assistants and Nurse Practitioners, 2018. http://physicianresourcecenter.com/wp-content/uploads/2018/09/Merritt-Hawkins-2018-Review-of-Physician-and-Advanced-Practitioner-Incentives.pdf [18] Bose, J., Hedden, S., Lipari, R., Park-Lee, E. Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health, 2015. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf [19] Sabin and Skimming. A Framework of Ethics for Telepsychiatry Practice [20] Van Wynsberghe and Gastmans, Telepsychiatry and the Meaning of In-Person Contact [21] Lustgarten and Colbow, Ethical Concerns for Telemental Health Therapy amidst Governmental Surveillance

Insulin exposure and action are known to differ on each of 3 days of infusion set wear during CSII. We extend these observations to 1 week in a pilot phase study comparing conventional Teflon angled infusion sets to a prototype extended wear set using Capillary Biomedical SteadiFlow™ technology. Participants with T1DM for &gt;12 months, A1C &lt;8.5%, c-peptide &lt;0.6 nmol/L, and ≥6 months use of Medtronic model 530G or higher were enrolled in a 2-period crossover euglycemic clamp study; clamps were performed after fasting overnight stabilization with IV insulin. Five men and 2 women, mean duration of diabetes 22.5 (16.6 SD) years and mean BMI 27.6 (3.8 SD) kg/m2 were enrolled; 4 completed all 8 clamps, 2 completed 7 clamps and 1 completed 1 clamp. We present the pharmacokinetic profiles of insulin lispro, 0.15 U/kg delivered by bolus infusion on Days 0, 3, 5 and 7 of infusion set wear. The Figure shows aggregate results from Control and Investigational infusion sets for insulin concentration (mean±SEM) vs. time by day of set wear. Statistically significant decreases from Day 0 to Day 7 were seen for tmax (p≤0.001) , t50% (early) (p&lt;0.002) , t50% (late) (p&lt;0.001) , and Mean Residence Time (p&lt;0.001) . AUC0-300 declined by approximately 20% from Day 0 to Day 7 (p&lt;0.11) . These results confirm and extend previous observations showing significant progressive acceleration of insulin exposure as a function of duration of infusion set wear time. Disclosure T.S.Bailey: Advisory Panel; Abbott Diabetes, CeQur SA, MannKind Corporation, Medtronic, Novo Nordisk, Consultant; LifeScan, Sanofi, Research Support; Abbott Diabetes, Abbott Diagnostics, Biolinq, Capillary Biomedical, Inc., Dexcom, Inc., Eli Lilly and Company, Kowa Research Institute, Inc., Livongo, MannKind Corporation, Medtronic, Novo Nordisk, REMD Biotherapeutics, Sanofi, Sanvita Medical, Senseonics, ViaCyte, Inc., vTv Therapeutics, Zealand Pharma A/S, Speaker's Bureau; Becton, Dickinson and Company, Medtronic, Sanofi. J.R.Kastner: Consultant; Capillary Biomedical, Inc. P.Strange: Other Relationship; Capillary Biomedical, Inc., Stock/Shareholder; Capillary Biomedical, Inc. L.Shi: None. K.A.Oberg: Consultant; Beta Bionics, Inc., Companion Medical, Tandem Diabetes Care, Inc. J.I.Joseph: Advisory Panel; Capillary Biomedical, Inc., Stock/Shareholder; Capillary Biomedical, Inc. P.J.Strasma: Board Member; Capillary Biomedical, Inc., Employee; Capillary Biomedical, Inc., Stock/Shareholder; Capillary Biomedical, Inc. D.B.Muchmore: Consultant; Capillary Biomedical, Inc., Diasome, Zucara Therapeutics, Stock/Shareholder; Capillary Biomedical, Inc., Diasome. Funding National Institutes of Health (2R44DK110969-02)

Abstract Study question Is serum homocysteine combined with uterine-artery Doppler were effective in predicting preeclampsia (≥140mmHg/≥90mmHg blood pressure) in singleton pregnancy during 11–15 weeks of gestation? Summary answer Combination of serum homocysteine levels with uterine-artery Doppler is superior to individual presence of biochemical/ultrasound marker/s making the duo effective for early screening in preeclampsia. What is known already American College of Obstetricians and Gynecologists and National Institute for Care and Health Excellence recommend identifying patients who are at high risk of developing preeclampsia based on medical history. Recently, biochemical and ultrasound markers were investigated for prediction of preeclampsia, but none of them were predictably reliable, valid, and suitable for routine clinical use. Increased levels of homocysteine in 1st-trimester, seems to signal onset of preeclampsia later in pregnancy portraying severity of the disease as well. We aimed to identify predictive value of serum homocysteine combined with uterine-artery Doppler in singleton pregnancy during 11–15 weeks of gestation for preeclampsia. Study design, size, duration One hundred forty-two consented singleton pregnant women (28-45 years) at gestational age of 11–15 weeks, recruited between January to December 2021 from Institute of Reproductive Medicine, Kolkata were enrolled in the study. Women who used aspirin as a prophylaxis for preeclampsia or were diagnosed to have fetal, structural or chromosomal abnormalities were excluded from the study (n = 7). Maternal age, weight and height, mean arterial pressure, parity, and obstetric history were documented. Participants/materials, setting, methods Uterine-artery Doppler ultrasound and serum homocysteine levels were performed transabdominally and using ELISA respectively. Pregnancy outcomes were recorded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at optimal cut-off values were determined to predict preeclampsia. Optimal cut-off values for homocysteine levels were calculated using receiver operator characteristic curve (ROC). Chi-square test, Fisher’s exact test, unpaired t test, and Mann–Whitney U test were used when appropriate. P-value &lt;0.05 was considered statistically significant. Main results and the role of chance 16 cases had preeclampsia (11.26%) of whom 9 had early-onset preeclampsia (6.33%). Baseline characteristics including maternal-age (&gt;35 or&lt;), parity, body-mass- index, and gestational-age at measurement were not significantly different between two groups excepting higher (p &lt; 0.001) mean arterial blood pressure (mmHg) at first trimester (97.2±6.4 vs. 81.1±7.2) in preeclampsia. Preeclamptic women had significantly higher (p &lt; 0.001) serum homocysteine levels (μmol/l) (26.1±3.5 vs 10.2± 5.6) than normotensive pregnant women (n = 119). No difference in mean pulsatility (PI) of uterine-artery was observed (1.78±0.64 vs. 1.72±0.48) excluding significantly high (p &gt; 0.02) in women with early-onset preeclampsia than control (2.11±0.81 vs. 1.39±0.92). However, lower (p &lt; 0.01) gestational age (weeks) (35.4±2.1 vs. 37.6±1.4), and neonatal birth weight (gms) (2937.3±578.2 vs. 3227.6±421.5) with higher (p &lt; 0.001) preterm delivery (25% vs 5.04%), low birth weight (25% vs 5.04%) and neonatal respiratory distress syndrome (12.5% vs. 0.84%) was documented in preeclampsia than control/s. The optimal cut-off value of serum homocysteine with PI levels, from ROC (AUC=0.735, p &lt; 0.001) was superior to individual ROC (AUC=0.451; AUC=0.268). The sensitivity, specificity, PPV, and NPV were 67.7%, 70.5%, 1.7%, and 98.5%, respectively using a combination of abnormal serum homocysteine levels with abnormal uterine artery Doppler PI (above 95th percentile) and used as a predictive value for preeclampsia. Limitations, reasons for caution The limitation of this study was that there were small cases of early-onset preeclampsia. Additional studies with a larger sample size of early-onset preeclampsia and other models using serum homocysteine, combined with uterine artery Doppler, and maternal characteristic risk factors should be conducted. Wider implications of the findings Early screening of preeclampsia by using combination of serum homocysteine and uterine artery Doppler during first trimester (11–15 weeks) at the same visit may be more effective and allows the timing for using early low-dose aspirin prophylaxis in order to prevent preeclampsia. Trial registration number Not applicable

Abstract STUDY QUESTION What are the roles of individual and interpersonal factors in couples’ decision-making regarding preimplantation genetic testing for monogenic disorders (PGT-M)? SUMMARY ANSWER Couples’ decision-making regarding PGT-M was associated with individual and interpersonal factors, that is the perceived consistency of information received, satisfaction with information, self-efficacy (individuals’ beliefs in their ability to make decisions), actual knowledge about PGT-M and social support from the partner. WHAT IS KNOWN ALREADY Various factors have been shown to be associated with decision-making regarding PGT-M. However, PGT-M is experienced at an individual level, and to date, no studies have investigated the roles of the above-mentioned individual and interpersonal factors. STUDY DESIGN, SIZE, DURATION This is a cross-sectional study with 279 participants. Participants were recruited through IVFAustralia, Sydney Children’s Hospital and support groups from May 2020 to November 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were women who had undergone or were considering PGT-M and their partners. Participants were recruited through IVFAustralia, Sydney Children’s Hospital and support groups to complete online questionnaires. Decisional regret, decisional satisfaction and decisional conflict were measured as outcome variables. Multiple linear regressions were performed to examine the association between factors and outcome variables. Mann–Whitney U tests were performed to test the differences between participants who had undergone PGT-M and those who were considering PGT-M. MAIN RESULTS AND THE ROLE OF CHANCE For couples who had undergone PGT-M, decisional regret was significantly negatively associated with perceived consistency of information received (β = −0.26, P &lt; 0.01), self-efficacy (β = −0.25, P &lt; 0.01) and actual knowledge about PGT-M (β = −0.30, P &lt; 0.001), while decisional satisfaction had positive association with satisfaction with information received (β = 0.37, P &lt; 0.001) and self-efficacy (β = 0.24, P &lt; 0.05). For couples who were considering PGT-M, decisional conflict was negatively associated with satisfaction with information received (β = −0.56, P &lt; 0.001). For females who had undergone PGT-M, decisional regret was negatively associated with social support from the partner (β = −0.35, P &lt; 0.05) in addition to perceived consistency of information received (β = −0.24, P &lt; 0.05). In this group, decisional satisfaction was positively associated with women’s satisfaction with the information received (β = 0.34, P &lt; 0.01), social support from the partner (β = 0.26, P &lt; 0.05) and self-efficacy (β = 0.25, P &lt; 0.05). For females who were considering PGT-M, decisional conflict was negatively associated with satisfaction with the information received (β = −0.43, P &lt; 0.01) and social support from the partner (β = −0.30, P &lt; 0.05). This study also identified those aspects of PGT-M that couples felt most concerned about in relation to their decision-making, in particular safety issues such as short- or long-term health problems for the baby and potential harms to the embryos and the mother’s health. The likelihood of getting pregnant and having a baby with a genetic condition being tested for were also important in couples’ decision-making. LIMITATIONS, REASONS FOR CAUTION This study assessed the concerns of couples about having a baby with a variety of genetic conditions. However, condition-specific issues might not be covered. Furthermore, social support from the partner was assessed among females only. Male participants’ perceived social support from their partner and the association between mutual support and decision-making were not assessed due to the absence of dyadic data. WIDER IMPLICATIONS OF THE FINDINGS Results highlight the importance of effective patient education on PGT-M and the need to provide high-quality and consistent information in the context of patient-centred care. Patients are likely to benefit from information that addresses their specific concerns in relation to PGT-M. From females’ perspective, support from partners is essential, and partners should, therefore, be encouraged to participate in all stages of the decision-making process. Suggestions for future studies were made. STUDY FUNDING/COMPETING INTEREST(S) B.M. was funded through a Senior Research Fellowship Level B (ID 1078523) from the National Health and Medical Research Council of Australia. L.C. was supported by a University International Postgraduate Award under the Australian Government Research Training Program (RTP) scholarship. No other funding was received for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.

Photo by Clément Hélardot on Unsplash INTRODUCTION The history of biomedical research in the United States is both inspiring and haunting. From the first public demonstration of anesthesia in surgery at Massachusetts General Hospital to the infamous Tuskegee Experiment, we see the significant advances made for the medical field and the now exposed power dynamics that contribute to injustices when they are left unmonitored.[1] Over the past century, biomedical research led to positive change but also reinforced structural racism. Henrietta Lacks, whose tissue was used without her consent to generate HeLa cells, and the Tuskegee study research subjects, who were denied an existing treatment for syphilis, exemplify how biomedical research in the US has been a vector for exploiting minority groups in exchange for knowledge creation. As we usher in the age of computational medicine, leaders of the field must listen to calls from communities around the country and world to decrease the prevalence of structural racism in the next wave of medical advances.[2] We are vulnerable to perpetuating structural racism through algorithms and databases that will drive biomedical research and aid healthcare systems in developing new methods for diagnosing and treating illness. With guidelines from governmental funding agencies and inclusivity of racial and ethnic minorities in research and development communities, we can inch closer to a more just future for our nation's health. BACKGROUND Many health systems rely on commercial software to store and process their patient’s data. This software commonly comes with patented predictive algorithms that help providers assign a risk score to patients based on health needs. However, biases held by algorithm developers can reflect racial disparities and incorporate them in the algorithms if proper counterbalances are not in place to audit the work of algorithm designers.[3] Despite the recent digitization of healthcare data across the United States, racial bias has already found its way into healthcare algorithms that manage populations. ANALYSIS l. Use of Algorithms One landmark study that interrogated a widely used algorithm demonstrated that Black patients were considerably sicker than white patients at a given risk score, evidenced by signs of uncontrolled disease.[4] The algorithm predicted the need for additional help based on past expenditures, and we historically spend less on Black patients than white patients. Rectifying this bias would lead to three times as many Black patients receiving additional resources. The algorithm produces a treatment gap due to a history of unequal access to care and lower spending on people of color compared to white people in the healthcare system. The disconnect between the clinical situation and historical resource allocation exemplifies how certain predictors may produce an outcome that harms patients. The study shows that using a proxy measure for healthcare spending to quantify how sick a patient is instead of using physiologic data can amplify racial disparities. This example highlights the need for collaboration between clinicians, data scientists, ethicists, and epidemiologists of diverse backgrounds to ensure model parameters do not perpetuate racial biases. ll. Use of Big Data in Algorithm Creation In addition to eradicating algorithms that make decisions based on proxy measures encoding racial inequities, we must also be diligent about the content of databases employed in algorithm development. Racial disparities in a database may result from the intentional selection of a homogenous population or unintentional exclusion due to systemic issues such as unequal distribution of resources. For example, a genetic study conducted in a Scandinavian country is more likely to be racially homogenous and not generalizable to a broader population. Applying algorithms derived from homogenous populations to either diverse populations or to different homogenous populations would fail to account for biological differences and could result in a recess of care when used beyond the appropriate population. Additionally, companies like Apple or FitBit could de-identify consumer data collected using their wearable sensors and make it available in research. This is problematic because the demographic distribution of people who have access to their technology may not reflect the general population. To combat these potential disparities, we must construct freely accessible research databases containing patients with diverse demographic characteristics that better model the actual populations that a given model will serve. lll. Government-Based Safeguards Armed with an understanding of how systemic bias is integrated into algorithms and databases, we must strive to construct safeguards that minimize systemic racism in computational biomedical research. A potential way to step forward as a society would be aligning incentives to produce the desired results. Governmental agencies wield enormous power over the trajectory of publicly funded research. Therefore, it is crucial that computational biomedical research funding is regulated by procedures that encourage diverse researchers to investigate and develop healthcare algorithms and databases that promote our nation's health. For example, the National Institutes of Health (NIH) has set forth two large initiatives to catalyze equitable growth of knowledge and research in healthcare artificial intelligence (AI). The first initiative is the Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity (AIM-AHEAD), which focuses on increasing diversity in researchers and data within AI/machine learning (ML). The program states that “these gaps pose a risk of creating and continuing harmful biases in how AI/ML is used, how algorithms are developed and trained, and how findings are interpreted.” Increased participation of researchers and communities currently underrepresented in AI/ML modeling can prevent continued health disparities and inequities. Programs like AIM-AHEAD are crucial to reducing the risk of creating and continuing harmful biases in biomedical research. With the four key focus areas of partnerships, research, infrastructure, and data science training, AIM-AHEAD and its future incarnations can promote health equity for the next era of medicine and biomedical research. The second initiative announced by the NIH is known as the Bridge to Artificial Intelligence (Bridge2AI) program.[5] This program has a different approach to tackling systemic racism and bias by focusing on the content and process of AI/ML research. Two key components of AI/ML research are rich databases and algorithm development protocols. To develop reproducible and actionable algorithms, researchers must have access to large, well-labeled databases and follow best practices in their development of algorithms. However, large databases are not readily available across the healthcare research ecosystem. As a result, many investigators struggle to gain access to databases that would enable them to carry out AI/ML research at their home institution. A movement toward more freely available databases like the Medical Information Mart for Intensive Care (MIMIC) and electronic Intensive Care Unit (eICU) through the PhysioNet platform created at the Massachusetts Institute of Technology Laboratory for Computational Physiology can improve access to data for research.[6] By adopting the practice of freely available databases commonly used in the AI/ML research communities outside of medicine, MIMIC and eICU lowered the barrier to entry for data scientists interested in health care. The improved access from MIMIC and eICU has led to over 2,000 publications to date. While this is a solid foundational step for the healthcare AI/ML research community, it is essential to reflect on progress and ensure that freely accessible databases are racially and geographically diverse. In this manner, Bridge2AI will facilitate the expansion of healthcare databases that are ethically sourced, trustworthy, and accessible. Without government programs such as AIM-AHEAD and Bridge2AI, the US biomedical research community is at higher risk of perpetuating systemic racism and biases in how AI/ML is used, how algorithms are developed, and how clinical decision support results are interpreted when delivering patient care. lV. Private Sector Standards Even with the proper incentives delivered from governmental agencies, there can be a disconnect between the public and private sectors, leading to racial bias in algorithms used in patient care. Privately funded AI/ML algorithms used in care decision-making should be held to the same ethical standards as those developed by publicly funded research at academic institutions. Publicly funded research is usually peer-reviewed before publication, giving reviewers a chance to evaluate algorithmic bias or deficiencies. Algorithms used in care may have avoided similar scrutiny. Corporations have an inherent conflict between protecting intellectual property and providing transparency of algorithmic design and inputs. The Food and Drug Administration (FDA) is responsible for regulating AI/ML algorithms. It has classified them as Software as a Medical Device (SaMD), focusing on the development process and benchmarking.[7] The importance of holding privately funded algorithm development to the same standards as publicly funded research is highlighted in a September 2020 review of FDA-approved AI/ML algorithms. All SaMD approved by the FDA are registered by private companies.[8] Regulators must be well-versed in structural racism and equipped to evaluate proprietary algorithms for racial bias and maintain oversight as population data drifts occur and the algorithms continue to optimize themselves. The FDA role is crucial to clinical use of SaMD. CONCLUSION Computational decision support using algorithms and large databases has the potential to transform the way we deliver care. However, governments should plan how they will prevent structural racism and associated inequities from running rampant in the new systems. Racial bias and mistreatment are engrained in the history of medical research. In the newly formulated digital world, these biases are potentially even more dangerous. They now can propagate quietly in the background, masked under layers of computer code that very few people understand how to write and interpret. It will be possible for a doctor to unconsciously propagate bias because an algorithm is nudging the doctor’s behavior to make the best treatment decision for their patient. Healthcare leaders must be vigilant in guiding the development of algorithms and databases to minimize systemic racism. Guidance from funding agencies to uphold minimum quality standards, a transparent vetting process for algorithms by governing bodies like the FDA, and a diverse community of researchers and developers will allow us to curb the spread of structural racism in research and build equitable tools for diagnosing and treating illness. The real question is: will the age of digital medicine also lead to a more equitable healthcare system? - [1] About the USPHS Syphilis Study. Accessed August 18 2021. https://www.tuskegee.edu/about-us/centers-of-excellence/bioethics-center/about-the-usphs-syphilis-study; MGH. MGH Firsts. Accessed August 18 2021. https://libguides.massgeneral.org/mghhistory/firsts. [2] Geneviève LD, Martani A, Shaw D, Elger BS, Wangmo T. Structural racism in precision medicine: leaving no one behind. BMC medical ethics. 2020;21(1):1-13. [3] Barocas S, Selbst AD. Big data's disparate impact. Calif L Rev. 2016;104:671. [4] Obermeyer Z, Powers B, Vogeli C, Mullainathan S. Dissecting racial bias in an algorithm used to manage the health of populations. Science. 2019;366(6464):447-453. [5] NIH. Bridge to Artificial Intelligence. Accessed August 17 2021. https://commonfund.nih.gov/bridge2ai. [6] PhysioNet. PhysioNet: The Research Resource for Complex Physiologic Signals. Accessed August 17 2021. https://physionet.org. [7] FDA. Software as a Medical Device (SaMD). Accessed August 16 2021. https://www.fda.gov/medical-devices/digital-health-center-excellence/software-medical-device-samd. [8] Benjamens S, Dhunnoo P, Meskó B. The state of artificial intelligence-based FDA-approved medical devices and algorithms: an online database. npj Digital Medicine. 2020;3(1):1-8.

Photo by Ishan @seefromthesky on Unsplash ABSTRACT A strike to highlight the plight facing contract doctors which has been proposed has received mixed reactions from those within the profession and the public. This unprecedented nationwide proposal has the potential to cause real-world effects, posing an ethical dilemma. Although strikes are common, especially in high-income countries, these industrial actions by doctors in Malaysia are almost unheard of. Reviewing available evidence from various perspectives is therefore imperative to update the profession and the complexity of invoking this important human right. INTRODUCTION Contract doctors in Malaysia held a strike on July 26, 2021. COVID-19 cases are increasing in Malaysia. In June, daily cases ranged between 4,000 to 8,000 despite various public health measures. The R naught, which indicates the infectiousness of COVID-19, remains unchanged. During the pandemic, health care workers (HCWs) have been widely celebrated, resulting in a renewed appreciation of the risks that they face.[1] The pandemic has exposed flawed governance in the public healthcare system, particularly surrounding the employment of contract doctors. Contract doctors in Malaysia are doctors who have completed their medical training, as well as two years of internship, and have subsequently been appointed as medical officers for another two years. Contract doctors are not permanently appointed, and the system did not allow extensions after the two years nor does it offer any opportunity to specialize.[2] Last week, Parliament did decide to offer a two-year extension but that did not hold off the impending strike.[3] In 2016, the Ministry of Health introduced a contract system to place medical graduates in internship positions at government healthcare facilities across the country rather than placing them in permanent posts in the Public Service Department. Social media chronicles the issues that doctors in Malaysia faced. However, tensions culminated when and contract doctors called for a strike which ended up taking place in late July 2021. BACKGROUND Over the past decade, HCW strikes have arisen mostly over wages, work hours, and administrative and financial factors.[4] In 2012, the British Medical Association organized a single “day of action” by boycotting non-urgent care as a response to government pension reforms.[5] In Ireland, doctors went on strike for a day in 2013 to protest the austerity measures implemented by the EU in response to the global economic crisis. It involved a dispute over long working hours (100 hours per week) which violated EU employment laws and more importantly put patients’ lives at risk.[6] The strike resulted in the cancellation of 15,000 hospital appointments, but emergencies services were continued. Other major strikes have been organized in the UK to negotiate better pay for HCWs in general and junior doctors’ contracts specifically.[7] During the COVID-19 pandemic, various strikes have also been organized in Hong Kong, the US, and Bolivia due to various pitfalls in managing the pandemic.[8] A recent strike in August 2020 by South Korean junior doctors and medical students was organized to protest a proposed medical reform plan which did not address wage stagnation and unfair labor practices.[9] These demands are somewhat similar to the proposed strike by contract doctors in Malaysia. As each national health system operates within a different setting, these strikes should be examined in detail to understand the degree of self-interest involved versus concerns for patient’s welfare. l. The Malaysia Strike An anonymous group planned the current strike in Malaysia. The group used social media, garnering the attention of various key stakeholders including doctors, patients, government, and medical councils.[10] The organizers of the strike referred to their planned actions as a hartal. (Although historically a hartal involved a total shutdown of workplaces, offices, shops, and other establishments as a form of civil disobedience, the Malaysian contract doctors pledged no disturbance to healthcare working hours or services and intend a walk-out that is symbolic and reflective of a strike.)[11] The call to action mainly involved showing support for the contract doctors with pictures and placards. The doctors also planned the walk-out.[12] Despite earlier employment, contract medical doctors face many inequalities as opposed to their permanent colleagues. These include differences in basic salary, provisions of leave, and government loans despite doing the same job. The system disadvantages contract doctors offering little to no job security and limited career progression. Furthermore, reports in 2020 showed that close to 4,000 doctors’ contracts were expected to expire by May 2022, leaving their futures uncertain.[13] Some will likely be offered an additional two years as the government faces pressure from the workers. Between December 2016 and May 2021, a total of 23,077 contract doctors were reportedly appointed as medical officers, with only 789 receiving permanent positions.[14] It has been suggested that they are appointed into permanent positions based on merit but the criteria for the appointments remain unclear. Those who fail to acquire a permanent position inevitably seek employment elsewhere. During the COVID-19 pandemic, there have been numerous calls for the government to absorb contract doctors into the public service as permanent staff with normal benefits. This is important considering a Malaysian study that revealed that during the pandemic over 50 percent of medical personnel feel burned out while on duty.[15] This effort might be side-lined as the government prioritizes curbing the pandemic. As these issues remain neglected, the call for a strike should be viewed as a cry for help to reignite the discussions about these issues. ll. Right to strike The right to strike is recognized as a fundamental human right by the UN and the EU.[16] Most European countries also protect the right to strike in their national constitutions.[17] In the US, the Taft-Hartley Act in 1947 prohibited healthcare workers of non-profit hospitals to form unions and engage in collective bargaining. But this exclusion was repealed in 1947 and replaced with the requirement of a 10-day advanced written notice prior to any strike action.[18] Similarly, Malaysia also recognizes the right to dispute over labor matters, either on an individual or collective basis. The Industrial Relations Act (IRA) of 1967[19] describes a strike as: “the cessation of work by a body of workers acting in combination, or a concerted refusal or a refusal under a common understanding of a number of workers to continue to work or to accept employment, and includes any act or omission by a body of workers acting in combination or under a common understanding, which is intended to or does result in any limitation, restriction, reduction or cessation of or dilatoriness in the performance or execution of the whole or any part of the duties connected with their employment” According to the same act, only members of a registered trade union may legally participate in a strike with prior registration from the Director-General of Trade Unions.[20] Under Section 43 of the IRA, any strike by essential services (including healthcare) requires prior notice of 42 days to their employer.[21] Upon receiving the notice, the employer is responsible for reporting the particulars to the Director-General of Industrial Relations to allow a “cooling-off” period and appropriate action. Employees are also protected from termination if permitted by the Director-General and strike is legalized. The Malaysian contract healthcare workers’ strike was announced and transparent. Unfortunately, even after legalization, there is fear that the government may charge those participating in the legalized strike.[22] The police have announced they will pursue participants in the strike.[23] Even the Ministry of Health has issued a warning stating that those participating in the strike may face disciplinary actions from the ministry. However, applying these laws while ignoring the underlying issues may not bode well for the COVID-19 healthcare crisis. lll. Effects of a Strike on Health Care There is often an assumption that doctors’ strikes would unavoidably cause significant harm to patients. However, a systematic review examining several strikes involving physicians reported that patient mortality remained the same or fell during the industrial action.[24] A study after the 2012 British Medical Association strike has even shown that there were fewer in-hospital deaths on the day, both among elective and emergency populations, although neither difference was significant.[25] Similarly, a recent study in Kenya showed declines in facility-based mortality during strike months.[26] Other studies have shown no obvious changes in overall mortality during strikes by HCWs.[27] There is only one report of increased mortality associated with a strike in South Africa[28] in which all the doctors in the Limpopo province stopped providing any treatment to their patients for 20 consecutive days. During this time, only one hospital continued providing services to a population of 5.5 million people. Even though their data is incomplete, authors from this study found that the number of emergency room visits decreased during the strike, but the risks of mortality in the hospital for these patients increased by 67 percent.[29] However, the study compared the strike period to a randomly selected 20-day period in May rather than comparing an average of data taken from similar dates over previous years. This could greatly influence variations between expected annual hospital mortality possibly due to extremes in weather that may exacerbate pre-existing conditions such as heart failure during warmer months or selecting months with a higher incidence of viral illness such as influenza. Importantly, all strikes ensured that emergency services were continued, at least to the degree that is generally offered on weekends. Furthermore, many doctors still provide usual services to patients despite a proclaimed strike. For example, during the 2012 BMA strike, less than one-tenth of doctors were estimated to be participating in the strike.[30] Emergency care may even improve during strikes, especially those involving junior doctors who are replaced by more senior doctors.[31] The cancellation of elective surgeries may also increase the number of doctors available to treat emergency patients. Furthermore, the cancellation of elective surgery is likely to be responsible for transient decreases in mortality. Doctors also may get more rest during strike periods. Although doctor strikes do not seem to increase patient mortality, they can disrupt delivery of healthcare.[32] Disruptions in delivery of service from prolonged strikes can result in decline of in-patient admissions and outpatient service utilization, as suggested during strikes in the UK in 2016.[33] When emergency services were affected during the last strike in April, regular service was also significantly affected. Additionally, people might need to seek alternative sources of care from the private sector and face increased costs of care. HCWs themselves may feel guilty and demotivated because of the strikes. The public health system may also lose trust as a result of service disruption caused by high recurrence of strikes. During the COVID-19 pandemic, as the healthcare system remains stretched, the potential adverse effects resulting from doctor strikes remain uncertain and potentially disruptive. In the UK, it is an offence to “willfully and maliciously…endanger human life or cause serious bodily injury.”[34] Likewise, the General Medical Council (GMC) also requires doctors to ensure that patients are not harmed or put at risk by industrial action. In the US, the American Medical Association code of ethics prohibits strikes by physicians as a bargaining tactic, while allowing some other forms of collective bargaining.[35] However, the American College of Physicians prohibits all forms of work stoppages, even when undertaken for necessary changes to the healthcare system. Similarly, the Delhi Medical Council in India issued a statement that “under no circumstances doctors should resort to strike as the same puts patient care in serious jeopardy.”[36] On the other hand, the positions taken by the Malaysian Medical Council (MMC) and Malaysian Medical Association (MMA) on doctors’ strikes are less clear when compared to their Western counterparts. The MMC, in their recently updated Code of Professional Conduct 2019, states that “the public reputation of the medical profession requires that every member should observe proper standards of personal behavior, not only in his professional activities but at all times.” Strikes may lead to imprisonment and disciplinary actions by MMC for those involved. Similarly, the MMA Code of Medical Ethics published in 2002 states that doctors must “make sure that your personal beliefs do not prejudice your patients' care.”[37] The MMA which is traditionally meant to represent the voices of doctors in Malaysia, may hold a more moderate position on strikes. Although HCW strikes are not explicitly mentioned in either professional body’s code of conduct and ethics, the consensus is that doctors should not do anything that will harm patients and they must maintain the proper standard of behaviors. These statements seem too general and do not represent the complexity of why and how a strike could take place. Therefore, it has been suggested that doctors and medical organizations should develop a new consensus on issues pertaining to medical professional’s social contract with society while considering the need to uphold the integrity of the profession. Experts in law, ethics, and medicine have long debated whether and when HCW strikes can be justified. If a strike is not expected to result in patient harm it is perhaps acceptable.[38] Although these debates have centered on the potential risks that strikes carry for patients, these actions also pose risks for HCWs as they may damage morale and reputation.[39] Most fundamentally, strikes raise questions about what healthcare workers owe society and what society owes them. For strikes to be morally permissible and ethical, it is suggested that they must fulfil these three criteria:[40] a. Strikes should be proportionate, e., they ‘should not inflict disproportionate harm on patients’, and hospitals should as a minimum ‘continue to provide at least such critical services as emergency care.’ b. Strikes should have a reasonable hope of success, at least not totally futile however tough the political rhetoric is. c. Strikes should be treated as a last resort: ‘all less disruptive alternatives to a strike action must have been tried and failed’, including where appropriate ‘advocacy, dissent and even disobedience’. The current strike does not fulfil the criteria mentioned. As Malaysia is still burdened with a high number of COVID-19 cases, a considerable absence of doctors from work will disrupt health services across the country. Second, since the strike organizer is not unionized, it would be difficult to negotiate better terms of contract and career paths. Third, there are ongoing talks with MMA representing the fraternity and the current government, but the time is running out for the government to establish a proper long-term solution for these contract doctors. One may argue that since the doctors’ contracts will end in a few months with no proper pathways for specialization, now is the time to strike. However, the HCW right to strike should be invoked only legally and appropriately after all other options have failed. CONCLUSION The strike in Malaysia has begun since the drafting of this paper. Doctors involved assure that there will not be any risk to patients, arguing that the strike is “symbolic”.[41] Although an organized strike remains a legal form of industrial action, a strike by HCWs in Malaysia poses various unprecedented challenges and ethical dilemmas, especially during the pandemic. The anonymous and uncoordinated strike without support from the appropriate labor unions may only spark futile discussions without affirmative actions. It should not have taken a pandemic or a strike to force the government to confront the issues at hand. It is imperative that active measures be taken to urgently address the underlying issues relating to contract physicians. As COVID-19 continues to affect thousands of people, a prompt reassessment is warranted regarding the treatment of HCWs, and the value placed on health care. [1] Ministry of Health (MOH) Malaysia, “Current situation of COVID-19 in Malaysia.” http://covid-19.moh.gov.my/terkini (accessed Jul. 01, 2021). [2] “Future of 4,000 young doctors who are contract medical officers uncertain,” New Straits Times - November 26, 2020. https://www.nst.com.my/news/nation/2020/11/644563/future-4000-young-doctors-who-are-contract-medical-officers-uncertain [3] “Malaysia doctors strike, parliament meets as COVID strain shows,” Al Jazeera, July 26, 2021. https://www.aljazeera.com/news/2021/7/26/malaysia-doctors-strike-parliament-meets-as-covid-strains-grow [4] R. Essex and S. M. Weldon, “Health Care Worker Strikes and the Covid Pandemic,” N. Engl. J. Med., vol. 384, no. 24, p. e93, Jun. 2021, doi: 10.1056/NEJMp2103327; G. Russo et al., “Health workers’ strikes in low-income countries: the available evidence,” Bull. World Health Organ., vol. 97, no. 7, pp. 460-467H, Jul. 2019, doi: 10.2471/BLT.18.225755. [5] M. Ruiz, A. Bottle, and P. Aylin, “A retrospective study of the impact of the doctors’ strike in England on 21 June 2012,” J. R. Soc. Med., vol. 106, no. 9, pp. 362–369, 2013, doi: 10.1177/0141076813490685. [6] E. Quinn, “Irish Doctors Strike to Protest Work Hours Amid Austerity,” The Wall Street Journal, 2013. https://www.wsj.com/articles/no-headline-available-1381217911?tesla=y (accessed Jun. 29, 2021). [7] “NHS workers back strike action in pay row by 2-to-1 margin,” The Guardian, 2014. https://www.theguardian.com/society/2014/sep/18/nhs-workers-strike-pay-unison-england (accessed Jun. 29, 2021); M. Limb, “Thousands of junior doctors march against new contract,” BMJ, p. h5572, Oct. 2015, doi: 10.1136/bmj.h5572. [8] J. Parry, “China coronavirus: Hong Kong health staff strike to demand border closure as city records first death,” BMJ, vol. 368, no. February, p. m454, Feb. 2020, doi: 10.1136/bmj.m454; “MultiCare healthcare workers strike, urging need for more PPEs, staff support,” Q13 FOX, 2020. https://www.q13fox.com/news/health-care-workers-strike-urging-need-for-ppes-risks-on-patient-safety (accessed Jun. 29, 2021); “Bolivia healthcare workers launch strike in COVID-hit region,” Al Jazeera, 2021. https://www.aljazeera.com/news/2021/2/9/bolivia-healthcare-workers-strike-covid-hit-region (accessed Jun. 29, 2021). [9] K. Arin, “Why are Korean doctors striking?” The Korea Herald, 2020. http://www.koreaherald.com/view.php?ud=20200811000941 (accessed Jun. 29, 2021). [10] “Hartal Doktor Kontrak,” Facebook. https://www.facebook.com/hartaldoktorkontrak. [11] “Hartal,” Oxford Advanced Learner’s Dictionary. https://www.oxfordlearnersdictionaries.com/definition/english/hartal (accessed Jun. 29, 2021). [12] “Hartal Doktor Kontrak,” Facebook. https://www.facebook.com/hartaldoktorkontrak. [13] R. Anand, “Underpaid and overworked, Malaysia’s contract doctors’ revolt amid Covid-19 surge,” The Straits Times, 2021. [14] Anand. [15] N. S. Roslan, M. S. B. Yusoff, A. R. Asrenee, and K. Morgan, “Burnout prevalence and its associated factors among Malaysian healthcare workers during covid-19 pandemic: An embedded mixed-method study,” Healthc., vol. 9, no. 1, 2021, doi: 10.3390/healthcare9010090. [16] Maina Kiai, “Report by the Special Rapporteur on the Right to Freedom of Peaceful Assembly and Association,” 2016. [Online]. Available: http://freeassembly.net/wp-content/uploads/2016/10/A.71.385_E.pdf. [17] ETUI contributors, Strike rules in the EU27 and beyond. The European Trade Union Institute. ETUI, 2007. [18] National Labor Relations Board, National Labor Relations Act. 1935, pp. 151–169. [19] Ministry of Human Resources, Industrial Relations Act 1967 (Act 177), no. October. 2015, pp. 1–76. [20] Article 10 of the Federal Constitution states that all citizens have the right to form associations including registered trade or labor unions. A secret ballot with two-third majority will suffice to call for a strike required for submission to the DGTU within 7 days as stated in Section 25(A) of the Trade Union Act 1959. [21] Ministry of Human Resources Malaysia, Guidelines on Strikes, Pickets and Lockouts in Malaysia. Putrajaya, 2011. [22] Ordinance Emergency which was declared in Malaysia since 12 January 2021. Under the Ordinance Emergency, the king or authorized personnel may, as deemed necessary, demand any resources. [23] “Malaysia doctors strike, parliament meets as COVID strain shows,” Al Jazeera, July 26, 2021. https://www.aljazeera.com/news/2021/7/26/malaysia-doctors-strike-parliament-meets-as-covid-strains-grow [24] S. A. Cunningham, K. Mitchell, K. M. Venkat Narayan, and S. Yusuf, “Doctors’ strikes and mortality: A review,” Soc. Sci. Med., vol. 67, no. 11, pp. 1784–1788, Dec. 2008, doi: 10.1016/j.socscimed.2008.09.044. [25] M. Ruiz, A. Bottle, and P. Aylin, “A retrospective study of the impact of the doctors’ strike in England on 21 June 2012,” J. R. Soc. Med., vol. 106, no. 9, pp. 362–369, 2013, doi: 10.1177/0141076813490685. [26] G. K. Kaguthi, V. Nduba, and M. B. Adam, “The impact of the nurses’, doctors’ and clinical officer strikes on mortality in four health facilities in Kenya,” BMC Health Serv. Res., vol. 20, no. 1, p. 469, Dec. 2020, doi: 10.1186/s12913-020-05337-9. [27] G. Ong’ayo et al., “Effect of strikes by health workers on mortality between 2010 and 2016 in Kilifi, Kenya: a population-based cohort analysis,” Lancet Glob. Heal., vol. 7, no. 7, pp. e961–e967, Jul. 2019, doi: 10.1016/S2214-109X (19)30188-3. [28] M. M. Z. U. Bhuiyan and A. Machowski, “Impact of 20-day strike in Polokwane Hospital (18 August - 6 September 2010),” South African Med. J., vol. 102, no. 9, p. 755, Aug. 2012, doi: 10.7196/SAMJ.6045. [29] M. M. Z. U. Bhuiyan and A. Machowski, “Impact of 20-day strike in Polokwane Hospital (18 August - 6 September 2010),” South African Med. J., vol. 102, no. 9, p. 755, Aug. 2012, doi: 10.7196/SAMJ.6045. [30] M. Ruiz, A. Bottle, and P. Aylin, “A retrospective study of the impact of the doctors’ strike in England on 21 June 2012,” J. R. Soc. Med., vol. 106, no. 9, pp. 362–369, 2013, doi: 10.1177/0141076813490685. [31] D. Metcalfe, R. Chowdhury, and A. Salim, “What are the consequences when doctors strike?” BMJ, vol. 351, no. November, pp. 1–4, 2015, doi: 10.1136/bmj.h6231. [32] D. Waithaka et al., “Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County,” Int. J. Equity Health, vol. 19, no. 1, pp. 1–15, 2020, doi: 10.1186/s12939-020-1131-y. [33] The study has shown that there were 9.1% reduction in admissions and around 6% fewer emergency cases and outpatient appointments than expected. An additional 52% increase in expected outpatient appointments cancelations were made by hospitals during that period. D. Furnivall, A. Bottle, and P. Aylin, “Retrospective analysis of the national impact of industrial action by English junior doctors in 2016,” BMJ Open, vol. 8, no. 1, p. e019319, Jan. 2018, doi: 10.1136/bmjopen-2017-019319. [34] D. Metcalfe, R. Chowdhury, and A. Salim, “What are the consequences when doctors strike?” BMJ, vol. 351, no. November, pp. 1–4, 2015, doi: 10.1136/bmj.h6231. [35] R. Essex and S. M. Weldon, “Health Care Worker Strikes and the Covid Pandemic,” N. Engl. J. Med., vol. 384, no. 24, p. e93, Jun. 2021, doi: 10.1056/NEJMp2103327. [36] M. Selemogo, “Criteria for a just strike action by medical doctors,” Indian J. Med. Ethics, vol. 346, no. 21, pp. 1609–1615, Jan. 2014, doi: 10.20529/IJME.2014.010. [37] Malaysian Medical Association, “Malaysian Medical Association Official Website.” https://mma.org.my (accessed Jun. 29, 2021). [38] M. Toynbee, A. A. J. Al-Diwani, J. Clacey, and M. R. Broome, “Should junior doctors strike?” J. Med. Ethics, vol. 42, no. 3, pp. 167–170, Mar. 2016, doi: 10.1136/medethics-2015-103310. [39] R. Essex and S. M. Weldon, “Health Care Worker Strikes and the Covid Pandemic,” N. Engl. J. Med., vol. 384, no. 24, p. e93, Jun. 2021, doi: 10.1056/NEJMp2103327. [40] M. Selemogo, “Criteria for a just strike action by medical doctors,” Indian J. Med. Ethics, vol. 346, no. 21, pp. 1609–1615, Jan. 2014, doi: 10.20529/IJME.2014.010; A. J. Roberts, “A framework for assessing the ethics of doctors’ strikes,” J. Med. Ethics, vol. 42, no. 11, pp. 698–700, Nov. 2016, doi: 10.1136/medethics-2016-103395. [41] “Malaysia doctors strike, parliament meets as COVID strain shows,” Al Jazeera, July 26, 2021. https://www.aljazeera.com/news/2021/7/26/malaysia-doctors-strike-parliament-meets-as-covid-strains-grow

Introduction This paper explores some specific conjunctions that tie together two nations, Japan and the Philippines. Over the past 30 years both have become entwined as a transfer of people, cultures and societies have connected and formed some interesting developments. Relations between both countries have been highly influenced through the deployment of State intervention (historically colonial and post-colonial), as well as through actors’ initiatives, leading to the development of a complex network that links both countries. It is in these relations that I would like to locate a transition between two stages in Japan-Philippine relations. I argue, this is a transition, where marriages of one kind (international marriages), the bonding of social actors from two distinct cultural spheres, gives way to another form of marriage. This transition locates the term marriage as part of an ongoing process and a discursive realm in a larger ‘affective complex’ that has developed. In this paper, I focus on this term ‘affective complex’ as it offers some interesting avenues in order to understand the continuing development of relations between Japan and the Philippines. By ‘affective complex’ I refer to the ‘cultural responses’ that people use in reaction to situations in which they find themselves which are not mediated by language. I suggest that this complex is a product of a specific encounter that exists between two nations as understood and mediated by Japanese actors’ positionings vis-à-vis foreign resident Filipinos. In tracing a moment between Japan and the Philippines, I delineate emerging properties that currently allude to a transition in relations between both countries. I would like to show that the properties of this transition are creating an emergent phenomena, a complex? This is developing through interactions between human actors whose trajectories as transnational migrants and permanent foreign residents are coming under the scrutiny of Japanese State forces in a heavily contested discursive field. This paper focuses upon the nature of the complex that entwines both countries and examines Japan’s particular restructuring of parts of its workforce in an attempt to include foreign migrants. To do this I first offer an outline of my fieldwork and then delineate the complex that ties both countries within present theoretical boundaries. This paper is based on fieldwork which deals with the theme of International Marriages between Japanese and Filipino couples. In the field I have observed the different ways in which Filipinos or Japanese with a connection to the Philippines orientate themselves within Japanese society vis-à-vis the Philippines. For the purpose of this paper, I will focus exclusively on a particular moment in my field: a care-giver course run privately with approval and recognition from local government. This course was offered exclusively for Filipino nationals with permanent residency and a high level of Japanese. As part of a larger field, a number of overlapping themes and patterns were present within the attitudes of those participating in the course. These were cultural responses that social actors carry with them which constitute part of an ‘affective complex’, its gradual emergence and unfolding. To further locate this fieldwork and its theoretical boundaries, I also position this research within current understandings of complexity. Chesters and Welsh have referred to a complex system as being a non-linear, non-deterministic system. However, from my perspective, these parameters are insufficient if institutions, organisations and human actors exhibit linear and deterministic properties (properties that discursively capture, locate and define elements in a system). In my research, I am dealing with actors, in this case Filipinos who are seen first as recipients and then as providers of welfare services. Japanese actors act as suppliers of a service both to long-term residents and to the State. In this case the following question arises: whose ‘complexes’ may be defined by a mixture of both these parameters and how can it be possible to take into account relationships whose existence cuts across them? Could a complex not be any number of these terrains which have emerged through encounters between two countries? Marriage could be a starting point for complexes that can come under scrutiny at a higher level, that of the State forces. In addition, a study of complexity in the Social Sciences focuses on how structures form rather than by focusing on any prior structured existence. Any focus on a complex system is to analyze holistic multiple elements in order to descriptively locate structures, what they penetrate, and what they are penetrated by. Human actors’ actions, strategies and expectations merge under the influence of these structures, while simultaneously influencing them. As elements interact, emergent phenomena (properties that emerge at a higher level) show a system that is process dependent, organic, and always evolving (Arthur 109). Locating Affect Deleuze and Guattari refined the discursive realm to emphasise how spaces of creation, dialogue and the casting of influence are affective, institutional and State-influenced. Within these spaces I locate the existence of ‘affective complexes’ which are discursively constructed and deployed by local actors. I will to argue that international marriages have laid a groundwork in which ‘affect’ itself has become a catalyst, re-orientating perceptions of and toward Filipinos. Following Deleuze, we can understand ‘affect’ as an intensity which, to repeat, is an expression of human relationships not mediated directly through language (Rodriguez). However, I want to suggest ‘affect’ also comes under the scrutiny of, and is discursively appealed to by, State forces as ‘affective capital’. When I refer to ‘affective capital’ I mean the potential labour discursively constructed. This construction is then “projected and tapped” in response to the changing nature of Japan’s labour market – in particular, the shortage of care-givers. This construction itself exists as an ongoing management strategy that deals with certain foreign nationals in Japan. Here, in response to the transformations of service work, ‘affective capital’ is the commoditised value of care inherent the discourse. It is the kernel of ‘affective labour’. This was very clear in my fieldwork, wherein Filipinos were targeted exclusively as the recipients of training in the health-care sector based on an understanding of the form of ‘affect’ that they possess. In this context, ‘affect’ adds intensity to meaning and is used in a wide range of cultural contexts, yet its very essence eludes description, especially when that essence as used by ‘active agents’ may be misconstrued in its deployment or discursively captured. Returning to the Deleuzian interpretation of ‘affect’, it could be interpreted as the outcome of encounters between actors and as such, a ‘mode’ in which becoming can initiate possibilities. I refer to ‘affect’, the deployment of shared, performed, communicated non-verbal ‘content’, as a powerful tool and an essential component in everyday habituated practice. In other areas of my field (not included in this discussion), ‘affect’ deployed by both actors, husband and wife, within and beyond the family, manifests itself as a mode of being. This at times adds to the location of actors’ intentions, be they spoken or performative. In this sense, locating the ‘affect’ in my research has meant observing the way in which Filipinos negotiate the availability of life strategies and opportunities available to them. At the same time, ‘affect’ is also produced by Japanese actors realigning themselves vis-à-vis both foreign actors and social change, as well as by effectuating strategies to emergent situations in Japan such as care management. ‘Affective capital’ is an inherent long-term strategy which has its roots in the cultural resources at the disposal of non-Japanese partners who, over the years, in the short and long term put to use discursively produced ‘affect’. ‘Affect’, produced in reactions to situations, encounters and events, can work in favour of long-term residents who do not have access to the same conditions Japanese may find in the labour sector. From encounters in my fieldwork, the location of ‘affect’ is an asset not just within immediate relationships, but as a possible expression of strategies that have arisen in response to the recognition of reactionary elements in Japanese society. By reactionary elements I refer to the way in which a complex may realign itself when ‘interfered’ with at another level, that of the State. The Japanese State is facing labour shortages in certain sectors due to social change, therefore they must secure other potential sources of labour. Appropriation of human resources locally available has become one Japanese State solution for this labour shortage. As such, ‘affect’ is brought into the capitalist fold in response to labor shortages in the Health Sector. Background The Philippines is a prime example of a nomad nation, where an estimated eight million of the population currently work or live overseas while remitting home (Phillippines Overseas Employment Agency). Post-colonial global conditions in the Asia Pacific region have seen the Philippines cater to external national situations in order to participate in the global labour market. These have been in the form of flows of labour and capital outsourced to those economies which are entangled with the Philippines. In this context, marriage between both countries has come to be made up almost exclusively of Japanese men with Filipina women (Suzuki). These marriages have created nascent partnerships that have formed links within homes in both countries and supported the creation of a complex system tying together both nations. Yet, in the entanglement of what seems to be two economies of desire, some interesting observations can be drawn from what I consider to be the by-products of these marriages. Yet what does this have to do with a marriage? First, I would like to put forward that certain international marriages may have developed within the above discursive framework and, in the case of the Philippines and Japan, defined certain characteristics that I will explain in more detail. Over the past 20 years, Filipinos who came to Japan on entertainment visas or through encounters with Japanese partners in the Philippines have deployed discursively constructed ‘affective capital’ in strategies to secure relationships and a position in both societies. These strategies may be interpreted as being knowledgeable, creative and possessive of the language necessary for negotiating long-term dialogues, not only with partners and surrounding family, but also with Japanese society. These deployments also function as an attempt to secure additional long term benefits which include strengthening ties to the Philippines through increasing a Japanese spouse’s involvement and interest in the Philippines. It is here that Filipinos’ ‘affect’ may be traced back to a previous deployment of categories that influences local Japanese actors’ decisions in offering a course exclusively for Filipino residents. This offers the first hint as to why only Filipinos were targeted. In Japan, secure permanent work for resident Filipinos can be, at times, difficult even when married to a partner with a stable income. The reality of remitting home to support family members and raising a family in Japan is a double burden which cannot be met solely by the spouse’s salary. This is an issue which means actors (in this case, partners) recourse to their ‘affective capital’ in order to secure means towards a livelihood. In this context, marriages have acted as a primary medium entangling both countries. Yet changes in Japan are re-locating ‘possible’ resources that are rationalised as a surplus from these primary encounters. Shifts in Japan’s social landscape have over the past 10 years led to an increasing awareness of the high stakes involved in care for the ageing and invalid in Japanese society. With over 21% of the population now over 65, the care industry has seen a surge in demand for labour, of which there is currently a shortfall (Statistics Bureau Japan). With the Philippines having strategically relocated its economy to accommodate demands for the outsourcing of health care workers and nurses overseas, Japan, realigning its economy to domestic change, has shown a new type of interest (albeit reluctant) in the Philippines. In 2005, changes and reforms to Japan’s Immigration Control and Refugee Recognition Act successfully curtailed the flow of Filipinos applying to Japan to work as entertainers. This was in part due to pressure from the interventionary power of the U.S: in 2006 the U.S. State department published the Trafficking in Persons Report, which stipulated that Japan had yet to comply in improving the situation of persons trafficked to Japan (U.S. State Department). This watershed reform has become a precursor to the Philippines Economic Partnership Agreement ratified by Japan and the Philippines to promote the ‘trans-border flow of goods, person, services and capital between Japan and the Philippines (Ministry of Foreign Affairs) and has now temporarily realigned both economies into a new relationship. Under the terms ‘movement of natural persons’, Filipino candidates for qualified nurses and certified care workers would be allowed a stay of up to three years as nurses, or four for certified care workers (Ministry of Foreign Affairs). Nonetheless, this lip service in showing openness to admit a new category of Filipino is the continuation of a mode of ‘servicing’ within the Japanese nation, albeit under the guise of ‘care work’, and rests upon the capitalist rationalisation of hired workers for Japan’s tertiary sectors. The Philippines, a nation which is positively export-orientated in terms of its human resources in response to care inequalities that exist between nations at a global level (Parreñas 12-30), is now responding to the problematic issue of care that has become a serious concern in Japan. Fieldwork To place these issues in context I want to locate the above issues within a part of my present fieldwork. In 2006, I participated in a privately funded non-profit venture set up for Filipino residents with the aim of training them to be care-givers. The course was validated and acknowledged by the local prefectural government and primarily limited to a group of 20 participants who paid approximately sixty thousand yen ($485) for the three month course including training and text books. One Filipina acquaintance enthusiastically introduced me to the retired bank manager who had set up a fund for the three month care-giver course for Filipina residents. Through interviews with the course providers, one underlying theme in the planning of the course was clear: the core idea that Filipinos have a predisposition to care for the elderly, reflecting Filipino social values no longer existent in Japan. In particular, two Japanese words employed to reflect these views – ‘omoiyari’ (思いやり), meaning “compassion” or “considerateness” and ‘yasashisa’ (優しさ) meaning “kindness toward others” – were reiterated throughout the course as a requisite for dealing with the elderly or those in need of care. One core presupposition underlining the course was that the Philippines still cherishes values which are on the decline in Japan, offering a care ethos based on Christian values ready for deployment in such work. I believe this marks a transition point in how both countries’ relations are moving away from ‘entertainment-based’ care to ‘care within an institutional setting’, such as private nursing homes or hospitals. In both cases, ‘care’ (as it is ironically known in both industries, the deployment of hospitality and attendance), operates as a dynamic of desire within a social field which orientates how residents (i.e. foreign female residents with permanent residency) are used. Yet, why would the Philippines be such an attractor? It is not difficult to see how ‘affect’ is discursively rationalised and deployed and projected onto Philippine society. This ‘affect’ acts as an attractor and belongs to an ‘imagined’ cultural repertoire that Japan has created in response to its turbulent marriage to the Philippines. In this sense, the care course promoted this ‘caring affective side’ of Filipinas here in Japan, and provided a dynamic engagement for potential negotiation, persuasion and tension between ‘local actors’ (course providers and participants) who come under the direct remit of the Japanese State (care institutions, hospitals and nursing homes). I say “tension”, as to date only a handful (three women out of a total of sixty) of those who participated in the course have taken up employment in the care industry. As one participant, a divorcee, commented, the reluctance to seek work as a qualified care worker resided in an economic framework, she says: this is a useful investment, but I don’t know if I can do this work full time to live off and support my families…but it is another arrow in my bow if the situation changes. Yet, for another woman, care work was an extension of something that they were familiar with. She jokingly added with a sigh of resignation: Oh well, this is something we are used to, after all we did nothing but care for our papa-san (husband)! When I discussed these comments with an N.G.O. worker connected to the course she pessimistically summed up what she thought by saying: The problem of care in Japan was until very recently an issue of unpaid work that women have had to bear. In a sense, looking after the aged living at home has been a traditional way to treat people with respect. Yet, here in Japan we have experienced an excessively long period whereby it was de facto that when a woman married into someone’s family, she would care for the husband and his family. Now, this isn’t an individual problem anymore, it’s a societal one. Care is now becoming an institutional practice which is increasing paid work, yet the State works on the assumption that this is low paid work for people who have finished raising their children; hard labour for low wages. All the women have graduated and are licensed to work, yet at 1000 yen (U.S. $8) an hour for psychologically demanding hard labour they will not work, or start and finish realising the demands. Travelling between locations also is also unpaid, so at the most in one day they will work 2-3 hours. It is the worst situation possible for those who choose to work. The above opinion highlights the ambiguities that exist in the constant re-alignment of offering work to foreign residents in the effort to help integrate people into Japan’s tertiary ‘care sector’ in response to the crisis of a lack of manpower. To date most women who trained on this course have not pursued positions within the health sector. This indicates a resistance to the social beliefs that continue to categorise female foreign residents for gendered care work. Through three successive batches of students (sixty women in total) the president, staff and companies who participated in this pilot scheme have been introduced to Filipino residents in Japanese society. In one respect, this has been an opportunity for the course providers to face those who have worked, or continue to work at night. Yet, even this exposure does not reduce the hyper-feminisation of care; rather, it emphasises positions. One male coordinator brazenly mentioned the phrase ashi wo aratte hoshii, meaning ‘we want to give them a clean break’. This expression is pregnant with the connotation that these women have been involved in night work have done or still participate in. These categorisations still do not shake themselves free from previous classifications of female others located in Japanese society; the ongoing legacy that locates Filipinos in a feminised discursive space. As Butler has elucidated, ‘cultural inscriptions’ and ‘political forces with strategic interests’ work to keep the ‘body bounded and constituted’ (Butler 175). It is possible to see that this care course resides within a continuously produced genealogy that tries to constitute bodies. This resides under the rubric of a dominant fantasy that locates the Philippines in Japan as a source of caring and hospitality. Now, those here are relocated under a restructuring industry outsourcing work to those located in the lower tiers of the labour sector. Why other nationals have not been allowed to participate in the course is, I stress, a testimony to this powerful discourse. Major national and international media coverage of both the course and company and those women who found employment has also raised interest in the curious complex that has arisen from this dynamic, including a series of specials aired on Japanese television by NHK (NHK Kaigo no Jinzai ga Nigete iku). This is very reminiscent of a ‘citationary’ network where writings, news items and articles enter into a perpetuating relationship that foments and bolsters the building up of a body of work (Said) to portray Japan’s changing circumstances. As seen from a traced genealogy, initial entanglements between two nations, in conjunction with societal change in Japan, have created a specific moment in both countries’ trajectories. Here, we can see an emergent phenomena and the relocation of a discursive structure. An affective complex can be located that marks a shift in how foreign residents are perceived and on what terms they can participate or contribute to Japanese society. Within this structure, ‘care’ is relocated – or, rather, trapped – and extracted as labour surplus that resides in an antagonistic relationship of domination highlighting how a specific moment existing between two countries can be ‘structured’ by needs in the ‘engaging’ country, in this case Japan. Non-linear elements in a complex system that contest how discursive practices in Japanese society locate foreign residents, within the rubric of an ‘imagined’ ethos of compassion and kindness that emanates from outside of Japan, seem to display ‘affective’ qualities. Yet, are these not projected categories deployed to continue to locate migrant labour (be they permanent or temporary residents) within an ongoing matrix that defines what resources can be discursively produced? However, these categories do not take into account the diverse structures of experience that both Japanese nationals and Filipino nationals experience in Japan (Suzuki). Conclusion In this paper I have briefly delineated a moment which rests between specific trajectories that tie two nations. A complex of marriages brought about within a specific historic post-colonial encounter has contributed to feminising the Philippines: firstly, for women in marriages, and now secondly for ‘potential resources’ available to tackle societal problems in Japan. As I have argued a discursively produced ‘affective complex’ is an authorising source of otherness and could be part of a precursor complex which is now discursively relocating human resources within one country (Japan) as a ‘reluctant source’ of labour, while entering into a new discursive mode of production that shapes attitudes toward others. I also suggest that there is a very specific complex at work here which follows an as of yet faint trajectory that points to the re-organisation of a relationship between Japan and the Philippines. Yet, there are linear elements (macro-level forces rooted in the Japanese State’s approach to care vis-à-vis the Philippines) operating at the fundamental core of this care-giver course that are being constantly challenged and cut across by non-linear elements, that is, human actors and their ambivalence as the beneficiaries/practitioners of such practices. This is the continued feminisation of a highly gendered dynamic that locates labour as and when it sees fit, but through the willing coercion of local agents, with an interest in mediating services through and for the State, for the welfare of the Nation. The desiring-machine that brings together Japan and the Philippines is also one that continues to locate the potential in foreign actors located within Japan’s institutional interpellation for its care market. Within these newly emergent relationships, available political and social capital is being reshaped and imagined in reaction to social change in Japan. By exploring two entangled nations situated within global capitalist production in the twenty-first century, my research points towards new ways of looking at emerged complexes (international marriages) that precludes the reconfigurations of ongoing emerging complexes that discursively locate residents as caregivers, who fall under the jurisdiction and glare of political powers, government subjects and State forces. References Artur, W. Brian. “Complexity and the Economy.” Science 284.2 (1999): 107-109. Butler, Judith. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge, 2006. Chester, Graeme, and Ian Welsh. “Complexity and Social Movement(s): Process and Emergence in Planetary Action Systems.” Theory, Culture & Society 22.5 (2005): 187-211. Deleuze, Giles, and Felix Guattari. A Thousand Plateaus: Capitalism and Schizophrenia. Minnesota: U of Minnesota P, 1987. Ministry of Foreign Affairs (Japan). Japan-Philippines Economic Partnership Agreement Press Statement. 29 Nov. 2004. 29 Mar. 2007 http://www.mofa.go.jp/region/asia-paci/philippine/joint0411.html>. NHK Kaigo no Jinzai ga Nigete iku. 介護の人材が逃げて行く (“Care Workers Are Fleeing.”) Televised 11 Mar. 2007. 29 Mar. 2007 http://www.nhk.or.jp/special/onair/070311.html>. Parreñas, Rachel Salazar. Children of Global Migration: Transnational Families and Gendered Woes. Stanford: Stanford UP, 2005. Philippines Overseas Employment Agency. “Stock Estimates of Filipinos Overseas.” 2 May 2007 http://www.poea.gov.ph/html/statistics.html>. Rodriguez, Encarnación Gutiérrez. “Reading Affect – On the Heterotopian Spaces of Care and Domestic Work in Private Households.” Forum: Qualitative Social Research 8 (2007). 2 May 2007 http://www.qualitative-research.net/fqs-texte/2-07/07-2-11-e.pdf>. Said, Edward. Orientalism. London: Penguin, 1995. Statistics Bureau and Statistical Research and Training Institute. Ministry of Internal Affairs and Communications (Philippines). 2005. 2 May 2007 http://www.poea.gov.ph/docs/STOCK%20ESTIMATE%202004.xls>. Suzuki, Nobue. “Inside the Home: Power and Negotiation in Filipina-Japanese Marriages.” Women’s Studies: An Interdisciplinary Journal 33.4 (2004): 481-506. “Trafficking in Persons Report.” U.S. State Department. 2006. 29 Apr. 2007. http://www.state.gov/documents/organization/66086.pdf>. Citation reference for this article MLA Style Lopez, Mario. "From Bride to Care Worker?: On Complexes, Japan and the Philippines." M/C Journal 10.3 (2007). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0706/04-lopez.php>. APA Style Lopez, M. (Jun. 2007) "From Bride to Care Worker?: On Complexes, Japan and the Philippines," M/C Journal, 10(3). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0706/04-lopez.php>.

ObjectiveTo assess the relationship between seasonal increases in emergency department (ED) and urgent care center (UCC) visits for hand, foot, and mouth disease (HFMD) among children 0-4 years old and average dew point temperatures in Virginia. To determine if this relationship can be used to develop an early warning tool for high intensity seasons of HFMD, allowing for earlier targeted public health action and communication to the community and local childcare centers during these high intensity seasons.IntroductionHand, foot, and mouth disease is a highly infectious disease common among early childhood populations caused by human enteroviruses (Enterovirus genus).1 The enteroviruses responsible for HFMD generally cause mild illness among children in the United States with symptoms of fever and rash/blisters, but have also been linked to small outbreaks of severe neurological disease such as meningitis, encephalitis, and acute flaccid myelitis.2Enteroviruses circulate year-round but increase in the summer-fall months across much of the United States.3 The drivers of this seasonality are not fully understood, but research indicates climatic factors, rather than demographic ones, are most likely to drive the amplitude and timing of the seasonal peaks.3 A recent CDC study on nonpolio enteroviruses identified dew point temperature as a strong predictor of local enterovirus seasonality, explaining around 30% of the variation in intensity of transmission across the United States.3MethodsSyndromic surveillance data on ED and UCC visits among 0-4 year olds in Virginia were analyzed from January 1, 2012 to August 31, 2018. Visits for HFMD were identified using the following chief complaint and discharge diagnosis terms: hand, foot, and mouth; HFM; fever with rash, lesions, or blisters; ICD-10 code: B08.4; or SNOMED CT code: 266108008. Visits for HFMD among 0-4 year olds were aggregated by week and calculated as a proportion of all ED and UCC visits among this age group during the study period.Hourly dew point readings from the Richmond International Airport from January 1, 2012 to August 31, 2018 were obtained from the National Oceanic and Atmospheric Administration (NOAA), National Climatic Data Center (NCDC). NOAA readings were averaged by week to establish a mean dew point for each week during the study period. Correlation analyses were performed on weekly dew point temperatures and weekly percent of HFMD visits. Weekly dew point averages were used to determine low-activity weeks at which to measure baseline percentages of HFMD visits. A low-activity week was defined as periods of two or more consecutive weeks in which each week had an average dew point temperature of less than 55.4 degrees Fahrenheit.3 To assess if HFMD seasons varied in intensity from year to year, a Kruskal-Wallis test was used to assess significant differences by year among the mean weekly percent of HFMD visits during high-activity weeks.An early warning threshold for a high intensity season was developed by calculating the mean percent of HFMD visits during low-activity weeks for the previous three years and adding two standard deviations. Threshold rates were calculated for years 2015 through 2018 and compared to the percentage of 0-4 year old HFMD visits during high-activity weeks. The week where percent of HFMD visits crossed the early warning threshold in 2018 was assessed to determine when public health notifications could have been made to alert the community about a high intensity (above threshold) HFMD season if this early warning tool had been utilized.ResultsBetween January 1, 2012 and August 31, 2018, there were 27,181 visits for HFMD among children aged 0-4 years. Mean and median weekly percent of HFMD visits were 1.33% and 1.01% of total 0-4 year old visits, respectively, with a range from 0.18% to 5.32%. These visits were most prominent during the summer or fall each year, with annual peaks occurring between weeks 22-46.Weekly percent of HFMD visits and average weekly dew point temperatures were significantly correlated (r=0.562, p<.0001). The mean weekly dew point temperature for high-activity weeks was 67.2 degrees Fahrenheit, with a range between 49.3 and 73.5 degrees. A Kruskal-Wallis test showed a significant difference in the mean weekly percent of visits by year for high-activity weeks (p<.0001).Over the 4 years of data to which the threshold was applied, percent of HFMD visits crossed the threshold in 2016 and 2018, indicating both years experienced high intensity HFMD seasons (Fig. 1). Percent of HFMD visits never crossed the early warning threshold in 2015 nor 2017. In 2018, the threshold was met on Week 21 (week ending June 2, 2018) which was more than 3 weeks prior to when public health notifications were made using routine surveillance methods through ESSENCE.ConclusionsVisits for HFMD among the young childhood population (0-4 year olds) in Virginia exhibit annual summer-fall seasonality with significant differences between the percent of visits from year to year. Seasons exhibiting a significantly higher percent of HFMD visits during high-activity weeks warrant a greater level of public health communication and outreach to educate parents, physicians and childcare centers about the disease and prevention measures. It can be difficult to differentiate high intensity seasons from low intensity seasons in the early weeks of increasing disease activity. Traditional syndromic surveillance methods using ESSENCE identify significant increases in HFMD visits from the previous 90 days, but do not readily alert on differences in seasonality from year to year. These results support the use of dew point temperature data to develop an early warning tool for high intensity seasons of HFMD. This early warning tool will allow for more efficient use of resources and targeted outreach during years with particularly high HFMD activity within the young childhood population. This early warning tool will be implemented by the Virginia Department of Health in 2019 to evaluate its effectiveness at identifying high HFMD activity in real-time.References1. Khetsuriani N, Lamonte-Fowlkes A, Oberst S, Pallansch MA. Enterovirus surveillance—United States, 1970–2005. MMWR Surveill Summ 2006;55(No. SS-8). https://www.ncbi.nlm.nih.gov/pubmed/169718902. Centers for Disease Control and Prevention (2018). Hand, Foot, and Mouth Disease (HFMD). Retrieved Sept 25, 2018, from https://www.cdc.gov/hand-foot-mouth/about/complications.html.3. Pons-Salort M, Oberste MS, Pallansch MA, et al. The seasonality of nonpolio enteroviruses in the United States: patterns and drivers. Proc Natl Acad Sci U S A 2018;115:3078–83 http://doi.org/10.1073/pnas.1721159115

Introduction Most developed countries, including Australia, have a strong focus on national, state and local strategies for emergency management and response in the face of disasters and crises. This framework can include coping with catastrophic dislocation, service disruption, injury or loss of life in the face of natural disasters such as major fires, floods, earthquakes or other large-impact natural events, as well as dealing with similar catastrophes resulting from human actions such as bombs, biological agents, cyber-attacks targeting essential services such as communications networks, or other crises affecting large populations. Emergency management frameworks for crisis and disaster response are distinguished by their focus on the domestic context for such events; that is, how to manage and assist the ways in which civilian populations, who are for the most part inexperienced and untrained in dealing with crises and disasters, are able to respond and behave in such situations so as to minimise the impacts of a catastrophic event. Even in countries like Australia that demonstrate a strong public commitment to cultural pluralism and social cohesion, ethno-cultural diversity can be seen as a risk or threat to national security and values at times of political, natural, economic and/or social tensions and crises. Australian government policymakers have recently focused, with increasing intensity, on “community resilience” as a key element in countering extremism and enhancing emergency preparedness and response. In some sense, this is the result of a tacit acknowledgement by government agencies that there are limits to what they can do for domestic communities should such a catastrophic event occur, and accordingly, the focus in recent times has shifted to how governments can best help people to help themselves in such situations, a key element of the contemporary “resilience” approach. Yet despite the robustly multicultural nature of Australian society, explicit engagement with Australia’s cultural diversity flickers only fleetingly on this agenda, which continues to pursue approaches to community resilience in the absence of understandings about how these terms and formations may themselves need to be diversified to maximise engagement by all citizens in a multicultural polity. There have been some recent efforts in Australia to move in this direction, for example the Australian Emergency Management Institute (AEMI)’s recent suite of projects with culturally and linguistically diverse (CALD) communities (2006-2010) and the current Australia-New Zealand Counter-Terrorism Committee-supported project on “Harnessing Resilience Capital in Culturally Diverse Communities to Counter Violent Extremism” (Grossman and Tahiri), which I discuss in a longer forthcoming version of this essay (Grossman). Yet the understanding of ethno-cultural identity and difference that underlies much policy thinking on resilience remains problematic for the way in which it invests in a view of the cultural dimensions of community resilience as relic rather than resource – valorising the preservation of and respect for cultural norms and traditions, but silent on what different ethno-cultural communities might contribute toward expanded definitions of both “community” and “resilience” by virtue of the transformative potential and existing cultural capital they bring with them into new national and also translocal settings. For example, a primary conclusion of the joint program between AEMI and the Australian Multicultural Commission is that CALD communities are largely “vulnerable” in the context of disasters and emergency management and need to be better integrated into majority-culture models of theorising and embedding community resilience. This focus on stronger national integration and the “vulnerability” of culturally diverse ethno-cultural communities in the Australian context echoes the work of scholars beyond Australia such as McGhee, Mouritsen (Reflections, Citizenship) and Joppke. They argue that the “civic turn” in debates around resurgent contemporary nationalism and multicultural immigration policies privileges civic integration over genuine two-way multiculturalism. This approach sidesteps the transculturational (Ortiz; Welsch; Mignolo; Bennesaieh; Robins; Stein) aspects of contemporary social identities and exchange by paying lip-service to cultural diversity while affirming a neo-liberal construct of civic values and principles as a universalising goal of Western democratic states within a global market economy. It also suggests a superficial tribute to cultural diversity that does not embed diversity comprehensively at the levels of either conceptualising or resourcing different elements of Australian transcultural communities within the generalised framework of “community resilience.” And by emphasising cultural difference as vulnerability rather than as resource or asset, it fails to acknowledge the varieties of resilience capital that many culturally diverse individuals and communities may bring with them when they resettle in new environments, by ignoring the question of what “resilience” actually means to those from culturally diverse communities. In so doing, it also avoids the critical task of incorporating intercultural definitional diversity around the concepts of both “community” and “resilience” used to promote social cohesion and the capacity to recover from disasters and crises. How we might do differently in thinking about the broader challenges for multiculturalism itself as a resilient transnational concept and practice? The Concept of Resilience The meanings of resilience vary by disciplinary perspective. While there is no universally accepted definition of the concept, it is widely acknowledged that resilience refers to the capacity of an individual to do well in spite of exposure to acute trauma or sustained adversity (Liebenberg 219). Originating in the Latin word resilio, meaning ‘to jump back’, there is general consensus that resilience pertains to an individual’s, community’s or system’s ability to adapt to and ‘bounce back’ from a disruptive event (Mohaupt 63, Longstaff et al. 3). Over the past decade there has been a dramatic rise in interest in the clinical, community and family sciences concerning resilience to a broad range of adversities (Weine 62). While debate continues over which discipline can be credited with first employing resilience as a concept, Mohaupt argues that most of the literature on resilience cites social psychology and psychiatry as the origin for the concept beginning in the mid-20th century. The pioneer researchers of what became known as resilience research studied the impact on children living in dysfunctional families. For example, the findings of work by Garmezy, Werner and Smith and Rutter showed that about one third of children in these studies were coping very well despite considerable adversities and traumas. In asking what it was that prevented the children in their research from being negatively influenced by their home environments, such research provided the basis for future research on resilience. Such work was also ground-breaking for identifying the so-called ‘protective factors’ or resources that individuals can operationalise when dealing with adversity. In essence, protective factors are those conditions in the individual that protect them from the risk of dysfunction and enable recovery from trauma. They mitigate the effects of stressors or risk factors, that is, those conditions that predispose one to harm (Hajek 15). Protective factors include the inborn traits or qualities within an individual, those defining an individual’s environment, and also the interaction between the two. Together, these factors give people the strength, skills and motivation to cope in difficult situations and re-establish (a version of) ‘normal’ life (Gunnestad). Identifying protective factors is important in terms of understanding the particular resources a given sociocultural group has at its disposal, but it is also vital to consider the interconnections between various protective mechanisms, how they might influence each other, and to what degree. An individual, for instance, might display resilience or adaptive functioning in a particular domain (e.g. emotional functioning) but experience significant deficits in another (e.g. academic achievement) (Hunter 2). It is also essential to scrutinise how the interaction between protective factors and risk factors creates patterns of resilience. Finally, a comprehensive understanding of the interrelated nature of protective mechanisms and risk factors is imperative for designing effective interventions and tailored preventive strategies (Weine 65). In short, contemporary thinking about resilience suggests it is neither entirely personal nor strictly social, but an interactive and iterative combination of the two. It is a quality of the environment as much as the individual. For Ungar, resilience is the complex entanglements between “individuals and their social ecologies [that] will determine the degree of positive outcomes experienced” (3). Thinking about resilience as context-dependent is important because research that is too trait-based or actor-centred risks ignoring any structural or institutional forces. A more ecological interpretation of resilience, one that takes into a person’s context and environment into account, is vital in order to avoid blaming the victim for any hardships they face, or relieving state and institutional structures from their responsibilities in addressing social adversity, which can “emphasise self-help in line with a neo-conservative agenda instead of stimulating state responsibility” (Mohaupt 67). Nevertheless, Ungar posits that a coherent definition of resilience has yet to be developed that adequately ‘captures the dual focus of the individual and the individual’s social ecology and how the two must both be accounted for when determining the criteria for judging outcomes and discerning processes associated with resilience’ (7). Recent resilience research has consequently prompted a shift away from vulnerability towards protective processes — a shift that highlights the sustained capabilities of individuals and communities under threat or at risk. Locating ‘Culture’ in the Literature on Resilience However, an understanding of the role of culture has remained elusive or marginalised within this trend; there has been comparatively little sustained investigation into the applicability of resilience constructs to non-western cultures, or how the resources available for survival might differ from those accessible to western populations (Ungar 4). As such, a growing body of researchers is calling for more rigorous inquiry into culturally determined outcomes that might be associated with resilience in non-western or multicultural cultures and contexts, for example where Indigenous and minority immigrant communities live side by side with their ‘mainstream’ neighbours in western settings (Ungar 2). ‘Cultural resilience’ considers the role that cultural background plays in determining the ability of individuals and communities to be resilient in the face of adversity. For Clauss-Ehlers, the term describes the degree to which the strengths of one’s culture promote the development of coping (198). Culturally-focused resilience suggests that people can manage and overcome stress and trauma based not on individual characteristics alone, but also from the support of broader sociocultural factors (culture, cultural values, language, customs, norms) (Clauss-Ehlers 324). The innate cultural strengths of a culture may or may not differ from the strengths of other cultures; the emphasis here is not so much comparatively inter-cultural as intensively intra-cultural (VanBreda 215). A culturally focused resilience model thus involves “a dynamic, interactive process in which the individual negotiates stress through a combination of character traits, cultural background, cultural values, and facilitating factors in the sociocultural environment” (Clauss-Ehlers 199). In understanding ways of ‘coping and hoping, surviving and thriving’, it is thus crucial to consider how culturally and linguistically diverse minorities navigate the cultural understandings and assumptions of both their countries of origin and those of their current domicile (Ungar 12). Gunnestad claims that people who master the rules and norms of their new culture without abandoning their own language, values and social support are more resilient than those who tenaciously maintain their own culture at the expense of adjusting to their new environment. They are also more resilient than those who forego their own culture and assimilate with the host society (14). Accordingly, if the combination of both valuing one’s culture as well as learning about the culture of the new system produces greater resilience and adaptive capacities, serious problems can arise when a majority tries to acculturate a minority to the mainstream by taking away or not recognising important parts of the minority culture. In terms of resilience, if cultural factors are denied or diminished in accounting for and strengthening resilience – in other words, if people are stripped of what they possess by way of resilience built through cultural knowledge, disposition and networks – they do in fact become vulnerable, because ‘they do not automatically gain those cultural strengths that the majority has acquired over generations’ (Gunnestad 14). Mobilising ‘Culture’ in Australian Approaches to Community Resilience The realpolitik of how concepts of resilience and culture are mobilised is highly relevant here. As noted above, when ethnocultural difference is positioned as a risk or a threat to national identity, security and values, this is precisely the moment when vigorously, even aggressively, nationalised definitions of ‘community’ and ‘identity’ that minoritise or disavow cultural diversities come to the fore in public discourse. The Australian evocation of nationalism and national identity, particularly in the way it has framed policy discussion on managing national responses to disasters and threats, has arguably been more muted than some of the European hysteria witnessed recently around cultural diversity and national life. Yet we still struggle with the idea that newcomers to Australia might fall on the surplus rather than the deficit side of the ledger when it comes to identifying and harnessing resilience capital. A brief example of this trend is explored here. From 2006 to 2010, the Australian Emergency Management Institute embarked on an ambitious government-funded four-year program devoted to strengthening community resilience in relation to disasters with specific reference to engaging CALD communities across Australia. The program, Inclusive Emergency Management with CALD Communities, was part of a wider Australian National Action Plan to Build Social Cohesion, Harmony and Security in the wake of the London terrorist bombings in July 2005. Involving CALD community organisations as well as various emergency and disaster management agencies, the program ran various workshops and agency-community partnership pilots, developed national school education resources, and commissioned an evaluation of the program’s effectiveness (Farrow et al.). While my critique here is certainly not aimed at emergency management or disaster response agencies and personnel themselves – dedicated professionals who often achieve remarkable results in emergency and disaster response under extraordinarily difficult circumstances – it is nevertheless important to highlight how the assumptions underlying elements of AEMI’s experience and outcomes reflect the persistent ways in which ethnocultural diversity is rendered as a problem to be surmounted or a liability to be redressed, rather than as an asset to be built upon or a resource to be valued and mobilised. AEMI’s explicit effort to engage with CALD communities in building overall community resilience was important in its tacit acknowledgement that emergency and disaster services were (and often remain) under-resourced and under-prepared in dealing with the complexities of cultural diversity in emergency situations. Despite these good intentions, however, while the program produced some positive outcomes and contributed to crucial relationship building between CALD communities and emergency services within various jurisdictions, it also continued to frame the challenge of working with cultural diversity as a problem of increased vulnerability during disasters for recently arrived and refugee background CALD individuals and communities. This highlights a common feature in community resilience-building initiatives, which is to focus on those who are already ‘robust’ versus those who are ‘vulnerable’ in relation to resilience indicators, and whose needs may require different or additional resources in order to be met. At one level, this is a pragmatic resourcing issue: national agencies understandably want to put their people, energy and dollars where they are most needed in pursuit of a steady-state unified national response at times of crisis. Nor should it be argued that at least some CALD groups, particularly those from new arrival and refugee communities, are not vulnerable in at least some of the ways and for some of the reasons suggested in the program evaluation. However, the consistent focus on CALD communities as ‘vulnerable’ and ‘in need’ is problematic, as well as partial. It casts members of these communities as structurally and inherently less able and less resilient in the context of disasters and emergencies: in some sense, as those who, already ‘victims’ of chronic social deficits such as low English proficiency, social isolation and a mysterious unidentified set of ‘cultural factors’, can become doubly victimised in acute crisis and disaster scenarios. In what is by now a familiar trope, the description of CALD communities as ‘vulnerable’ precludes asking questions about what they do have, what they do know, and what they do or can contribute to how we respond to disaster and emergency events in our communities. A more profound problem in this sphere revolves around working out how best to engage CALD communities and individuals within existing approaches to disaster and emergency preparedness and response. This reflects a fundamental but unavoidable limitation of disaster preparedness models: they are innately spatially and geographically bounded, and consequently understand ‘communities’ in these terms, rather than expanding definitions of ‘community’ to include the dimensions of community-as-social-relations. While some good engagement outcomes were achieved locally around cross-cultural knowledge for emergency services workers, the AEMI program fell short of asking some of the harder questions about how emergency and disaster service scaffolding and resilience-building approaches might themselves need to change or transform, using a cross-cutting model of ‘communities’ as both geographic places and multicultural spaces (Bartowiak-Théron and Crehan) in order to be more effective in national scenarios in which cultural diversity should be taken for granted. Toward Acknowledgement of Resilience Capital Most significantly, the AEMI program did not produce any recognition of the ways in which CALD communities already possess resilience capital, or consider how this might be drawn on in formulating stronger community initiatives around disaster and threats preparedness for the future. Of course, not all individuals within such communities, nor all communities across varying circumstances, will demonstrate resilience, and we need to be careful of either overgeneralising or romanticising the kinds and degrees of ‘resilience capital’ that may exist within them. Nevertheless, at least some have developed ways of withstanding crises and adapting to new conditions of living. This is particularly so in connection with individual and group behaviours around resource sharing, care-giving and social responsibility under adverse circumstances (Grossman and Tahiri) – all of which are directly relevant to emergency and disaster response. While some of these resilient behaviours may have been nurtured or enhanced by particular experiences and environments, they can, as the discussion of recent literature above suggests, also be rooted more deeply in cultural norms, habits and beliefs. Whatever their origins, for culturally diverse societies to achieve genuine resilience in the face of both natural and human-made disasters, it is critical to call on the ‘social memory’ (Folke et al.) of communities faced with responding to emergencies and crises. Such wellsprings of social memory ‘come from the diversity of individuals and institutions that draw on reservoirs of practices, knowledge, values, and worldviews and is crucial for preparing the system for change, building resilience, and for coping with surprise’ (Adger et al.). Consequently, if we accept the challenge of mapping an approach to cultural diversity as resource rather than relic into our thinking around strengthening community resilience, there are significant gains to be made. For a whole range of reasons, no diversity-sensitive model or measure of resilience should invest in static understandings of ethnicities and cultures; all around the world, ethnocultural identities and communities are in a constant and sometimes accelerated state of dynamism, reconfiguration and flux. But to ignore the resilience capital and potential protective factors that ethnocultural diversity can offer to the strengthening of community resilience more broadly is to miss important opportunities that can help suture the existing disconnects between proactive approaches to intercultural connectedness and social inclusion on the one hand, and reactive approaches to threats, national security and disaster response on the other, undermining the effort to advance effectively on either front. This means that dominant social institutions and structures must be willing to contemplate their own transformation as the result of transcultural engagement, rather than merely insisting, as is often the case, that ‘other’ cultures and communities conform to existing hegemonic paradigms of being and of living. In many ways, this is the most critical step of all. A resilience model and strategy that questions its own culturally informed yet taken-for-granted assumptions and premises, goes out into communities to test and refine these, and returns to redesign its approach based on the new knowledge it acquires, would reflect genuine progress toward an effective transculturational approach to community resilience in culturally diverse contexts.References Adger, W. Neil, Terry P. Hughes, Carl Folke, Stephen R. Carpenter and Johan Rockström. “Social-Ecological Resilience to Coastal Disasters.” Science 309.5737 (2005): 1036-1039. ‹http://www.sciencemag.org/content/309/5737/1036.full> Bartowiak-Théron, Isabelle, and Anna Corbo Crehan. “The Changing Nature of Communities: Implications for Police and Community Policing.” Community Policing in Australia: Australian Institute of Criminology (AIC) Reports, Research and Policy Series 111 (2010): 8-15. Benessaieh, Afef. “Multiculturalism, Interculturality, Transculturality.” Ed. A. Benessaieh. Transcultural Americas/Ameriques Transculturelles. Ottawa: U of Ottawa Press/Les Presses de l’Unversite d’Ottawa, 2010. 11-38. Clauss-Ehlers, Caroline S. “Sociocultural Factors, Resilience and Coping: Support for a Culturally Sensitive Measure of Resilience.” Journal of Applied Developmental Psychology 29 (2008): 197-212. Clauss-Ehlers, Caroline S. “Cultural Resilience.” Encyclopedia of Cross-Cultural School Psychology. Ed. C. S. Clauss-Ehlers. New York: Springer, 2010. 324-326. Farrow, David, Anthea Rutter and Rosalind Hurworth. Evaluation of the Inclusive Emergency Management with Culturally and Linguistically Diverse (CALD) Communities Program. Parkville, Vic.: Centre for Program Evaluation, U of Melbourne, July 2009. ‹http://www.ag.gov.au/www/emaweb/rwpattach.nsf/VAP/(9A5D88DBA63D32A661E6369859739356)~Final+Evaluation+Report+-+July+2009.pdf/$file/Final+Evaluation+Report+-+July+2009.pdf>.Folke, Carl, Thomas Hahn, Per Olsson, and Jon Norberg. “Adaptive Governance of Social-Ecological Systems.” Annual Review of Environment and Resources 30 (2005): 441-73. ‹http://arjournals.annualreviews.org/doi/pdf/10.1146/annurev.energy.30.050504.144511>. Garmezy, Norman. “The Study of Competence in Children at Risk for Severe Psychopathology.” The Child in His Family: Children at Psychiatric Risk. Vol. 3. Eds. E. J. Anthony and C. Koupernick. New York: Wiley, 1974. 77-97. Grossman, Michele. “Resilient Multiculturalism? Diversifying Australian Approaches to Community Resilience and Cultural Difference”. Global Perspectives on Multiculturalism in the 21st Century. Eds. B. E. de B’beri and F. Mansouri. London: Routledge, 2014. Grossman, Michele, and Hussein Tahiri. Harnessing Resilience Capital in Culturally Diverse Communities to Counter Violent Extremism. Canberra: Australia-New Zealand Counter-Terrorism Committee, forthcoming 2014. Grossman, Michele. “Cultural Resilience and Strengthening Communities”. Safeguarding Australia Summit, Canberra. 23 Sep. 2010. ‹http://www.safeguardingaustraliasummit.org.au/uploader/resources/Michele_Grossman.pdf>. Gunnestad, Arve. “Resilience in a Cross-Cultural Perspective: How Resilience Is Generated in Different Cultures.” Journal of Intercultural Communication 11 (2006). ‹http://www.immi.se/intercultural/nr11/gunnestad.htm>. Hajek, Lisa J. “Belonging and Resilience: A Phenomenological Study.” Unpublished Master of Science thesis, U of Wisconsin-Stout. Menomonie, Wisconsin, 2003. Hunter, Cathryn. “Is Resilience Still a Useful Concept When Working with Children and Young People?” Child Family Community Australia (CFA) Paper 2. Melbourne: Australian Institute of Family Studies, 2012.Joppke, Christian. "Beyond National Models: Civic Integration Policies for Immigrants in Western Europe". West European Politics 30.1 (2007): 1-22. Liebenberg, Linda, Michael Ungar, and Fons van de Vijver. “Validation of the Child and Youth Resilience Measure-28 (CYRM-28) among Canadian Youth.” Research on Social Work Practice 22.2 (2012): 219-226. Longstaff, Patricia H., Nicholas J. Armstrong, Keli Perrin, Whitney May Parker, and Matthew A. Hidek. “Building Resilient Communities: A Preliminary Framework for Assessment.” Homeland Security Affairs 6.3 (2010): 1-23. ‹http://www.hsaj.org/?fullarticle=6.3.6>. McGhee, Derek. The End of Multiculturalism? Terrorism, Integration and Human Rights. Maidenhead: Open U P, 2008.Mignolo, Walter. Local Histories/Global Designs: Coloniality, Subaltern Knowledges, and Border Thinking. Princeton: Princeton U P, 2000. Mohaupt, Sarah. “Review Article: Resilience and Social Exclusion.” Social Policy and Society 8 (2009): 63-71.Mouritsen, Per. "The Culture of Citizenship: A Reflection on Civic Integration in Europe." Ed. R. Zapata-Barrero. Citizenship Policies in the Age of Diversity: Europe at the Crossroad." Barcelona: CIDOB Foundation, 2009: 23-35. Mouritsen, Per. “Political Responses to Cultural Conflict: Reflections on the Ambiguities of the Civic Turn.” Ed. P. Mouritsen and K.E. Jørgensen. Constituting Communities. Political Solutions to Cultural Conflict, London: Palgrave, 2008. 1-30. Ortiz, Fernando. Cuban Counterpoint: Tobacco and Sugar. Trans. Harriet de Onís. Intr. Fernando Coronil and Bronislaw Malinowski. Durham, NC: Duke U P, 1995 [1940]. Robins, Kevin. The Challenge of Transcultural Diversities: Final Report on the Transversal Study on Cultural Policy and Cultural Diversity. Culture and Cultural Heritage Department. Strasbourg: Council of European Publishing, 2006. Rutter, Michael. “Protective Factors in Children’s Responses to Stress and Disadvantage.” Annals of the Academy of Medicine, Singapore 8 (1979): 324-38. Stein, Mark. “The Location of Transculture.” Transcultural English Studies: Fictions, Theories, Realities. Eds. F. Schulze-Engler and S. Helff. Cross/Cultures 102/ANSEL Papers 12. Amsterdam and New York: Rodopi, 2009. 251-266. Ungar, Michael. “Resilience across Cultures.” British Journal of Social Work 38.2 (2008): 218-235. First published online 2006: 1-18. In-text references refer to the online Advance Access edition ‹http://bjsw.oxfordjournals.org/content/early/2006/10/18/bjsw.bcl343.full.pdf>. VanBreda, Adrian DuPlessis. Resilience Theory: A Literature Review. Erasmuskloof: South African Military Health Service, Military Psychological Institute, Social Work Research & Development, 2001. Weine, Stevan. “Building Resilience to Violent Extremism in Muslim Diaspora Communities in the United States.” Dynamics of Asymmetric Conflict 5.1 (2012): 60-73. Welsch, Wolfgang. “Transculturality: The Puzzling Form of Cultures Today.” Spaces of Culture: City, Nation World. Eds. M. Featherstone and S. Lash. London: Sage, 1999. 194-213. Werner, Emmy E., and Ruth S. Smith. Vulnerable But Invincible: A Longitudinal Study of\ Resilience and Youth. New York: McGraw Hill, 1982. NotesThe concept of ‘resilience capital’ I offer here is in line with one strand of contemporary theorising around resilience – that of resilience as social or socio-ecological capital – but moves beyond the idea of enhancing general social connectedness and community cohesion by emphasising the ways in which culturally diverse communities may already be robustly networked and resourceful within micro-communal settings, with new resources and knowledge both to draw on and to offer other communities or the ‘national community’ at large. In effect, ‘resilience capital’ speaks to the importance of finding ‘the communities within the community’ (Bartowiak-Théron and Crehan 11) and recognising their capacity to contribute to broad-scale resilience and recovery.I am indebted for the discussion of the literature on resilience here to Dr Peta Stephenson, Centre for Cultural Diversity and Wellbeing, Victoria University, who is working on a related project (M. Grossman and H. Tahiri, Harnessing Resilience Capital in Culturally Diverse Communities to Counter Violent Extremism, forthcoming 2014).

Photo by Matteo Vistocco on Unsplash ABSTRACT This paper explores a way to ensure a person’s autonomy and legacy are preserved during the experience of dementia due to Alzheimer’s disease. Due to the profound effect the disease has on memory, the “person of the lifetime” (the person’s past experiences and their future aspirations prior to disease progression) becomes seemingly disconnected from the “person of the moment,” or the person experiencing memory loss. Thus, directives are important to recognize and maintain continuity of person. Yet, a person’s “legacy,” based on the person’s values and philosophy, can serve as a bridge between those two identities. Ultimately, people with significant memory loss from Alzheimer’s disease are unable to secure their own legacy due to the diminishing ability to make autonomous decisions as the disease progresses. A legal system that codifies the ability to create a requirement to honor ADs and research advance directives (RADs) can best secure the autonomy of the person of the lifetime, and thus the person’s legacy, of the person Alzheimer’s disease. INTRODUCTION At present, there is no effective treatment or cure for Alzheimer’s disease’s cognitive decline and ensuing dementia. While the definitive diagnosis is confirmed only after death via brain autopsy, Alzheimer’s is diagnosed by symptoms and scans.[1] Over the course of an eight-to-twelve-year post-diagnosis period, people progressively lose memory and cognitive functions in an irreversible pattern.[2] Because Alzheimer’s disease remains incurable despite significant scientific research into its causes, its biological qualities,[3] and its symptoms, many people with Alzheimer’s disease may wish to document care choices in advance while they have capacity to do so. Those experiencing early-stage Alzheimer’s disease or mild cognitive impairment wanting to determine the best path for their private and public future life’s agenda must have the legal tools needed to make sound plans for their future. l. Preserving Legacy: The Benefits of Advance Directives for People with Alzheimer’s Disease A legacy is the part of a patient that will persist into the future, even after death. Autonomy can be increased by permitting Alzheimer’s patients to document their legacy and wishes prior to significant cognitive impairment. Whether a legacy is in others’ memories of personality traits or is something concrete like a business, named building, charity, or a cookie recipe, many people with Alzheimer’s disease wish their person of a lifetime to be remembered. Many do not want to be remembered only as they are in the end of life, or as the cognitively impaired person of the moment. I argue that the best legacy for oneself is defined by one’s own autonomy and his or her most personal, private philosophy and values. When third-party caregivers or healthcare workers seek to impose their views of the best interests on the person of the moment, they may be disrespecting that person’s legacy interests. Having an AD that the caregivers must respect can help all stakeholders make decisions with moral legitimacy. The preservation of the person of the lifetime can be maximized by focusing on both past and present life experiences. Significant memory loss from Alzheimer’s disease interrupts the usual relationship between the person of the lifetime and the person of the moment, who may understand the present but may experience near-complete short- and long-term memory loss.[4] Reconciling these two “personhoods” in one person in a formal process best serves the legacy for Alzheimer’s patients by assessing various perspectives and providing a decision-making framework for caregivers and stakeholders. I assert that the autonomy of the person of the lifetime deserves equal or more weight than a decision-making third party when the person of the moment lacks capacity to make a healthcare decision. This argument is compatible with Samuel Dale’s argument that “precedent autonomy morally authorizes ADs when dementia renders patients medically incompetent because it respects their dignity as persons, not merely pleasure-seeking creatures.”[5] Dale relies on Dworkin’s view that critical interests should carry more weight than “experiential interests.”[6] The pursuit of critical interests gives meaning to human life and is encoded in ADs to represent the whole person.[7] Nevertheless, the person of the moment has value and can enjoy the pursuit of happiness. Treatment for Alzheimer’s disease focuses on comfort and happiness as a driver for the patient’s best interests, thus attending to the needs of the person of the moment while balanced with the interests in an AD if it conflicts, to not damage the legacy. The person of the moment needs care to avoid pain and arguably to achieve some happiness, while simultaneously relying, insofar as still possible, on the person of the lifetime to obtain peace and contentment.[8] Respecting Alzheimer’s ADs is consistent with the strong individualism inherent in the US. The rule of law attempts to maximize autonomy and theoretically to ensure individual rights.[9] In the US and other liberal democracies, recognizing the power and inalienable rights of the individual involves securing the right to make one’s own decisions. Yet, as with other individual rights, there are situations where ADs are not absolute and where laws limit their full effect. Some statutory and regulatory restrictions make it legally difficult to honor ADs, especially with respect to nutrition and hydration directives.[10] Arguably that is a poorly considered approach; notably, at least one scholar, Corinna Porteri, argues that “statutes that disregard or invalidate ADs are discriminatory against the life lived.”[11] ll. The Benefits of Research Advance Directives for People with Alzheimer’s Disease The scientific research necessary to better treat people who have Alzheimer’s disease requires engaging patients in research. A major bioethical question immediately arises: how can we obtain informed consent from a person unable to weigh different options and risks/rewards properly? Research advance directives (RADs) could allow advanced consent for participation in research and could place limits on the consent.[12] People who have Alzheimer’s disease should be able to express their desires in ADs during the early stages or before diagnosis. Directives must be able to allow people to express a desire to join clinical trials. The National Bioethics Advisory Committee in the US recommended RADs,[13] which allow people to join studies when the treatment or medicine would benefit them, and possibly when it would benefit the larger public and has some potential to benefit the person.[14] Porteri asserts that RADs should include consent based on the type and degree of risk, as it is impossible to predict the types of treatment or the anticipated side effects in future studies.[15] Ultimately, the person’s autonomy of a lifetime should take precedence because further research offers patients hope for both their legacy and the legacies of others. Still, there may be cases in which the societal interest in protecting the person takes precedence. Societal interests may include preserving dignity and avoiding suffering. It may be necessary to safeguard people by limiting participation to low-risk studies and requiring additional consent from a proxy or caregiver. RADs are appealing because they guide decisions, as do ADs; their unique appeal that is specific to RAD as part of AD is that the certainty of a permanently preserved legacy of valuing medical research in writing could take precedence over the uncertainty facing the person of the moment. At present, these are still tenuous grounds, requiring philosophical and other solutions. A moral question arises regarding the ability to change one’s mind after the threshold established for ADs and RADs takes effect. How can it be known if patients would have changed their minds given current circumstances and the often-lengthy progress of Alzheimer’s disease? If a person wanted to withdraw an AD or RAD and expressed an unwillingness to engage in research, there is a moral argument that the person of the moment must not be deprived of a right to withdraw. By limiting the AD and RAD to treatment and research decisions after significant memory loss occurs, those with mild cognitive impairment certainly would decide about research for themselves, possibly with the input of family, friends, or doctors. Early diagnosis permits time for the patient to alter ADs before they develop significant memory loss. When patients understand the progression of the disease, their autonomous decisions regarding their care should be honored. Porteri asserts the ADs are the necessary proof of the person’s desires and thus should govern when capacity is lost.[16] Bodily integrity, philosophical belief, and autonomy must be respected once the capacity to make decisions is lost. lll. Recommendations Capacity is task-specific; therefore, determining when the healthcare AD should be implemented must be based on capacity testing.[17] This process turns ADs into a framework for interpreting the person of the lifetime’s wishes as applied to the person of the moment. For example, dying in battle is quite a different memorial outcome compared to experiencing a vegetative state while fed artificial hydration and nutrition through a feeding tube. Establishing the desired legacy of the person with Alzheimer’s disease in an AD allows the patient more autonomy to choose how they wish to be remembered.[18] One problem with our current system for ADs is that it deviates substantially from state to state. The Patient Self Determination Act does not prescribe how state laws should address significant memory loss.[19] Therefore continuity of person is not assumed in all state laws. A federal law that supports the acknowledgment of ADs would be preferable. The right to determine how you live and die is a fundamental choice and should not depend on the state in which one lives. Fortunately, perspectives between stakeholders and other parties align in many cases, and their expressed wishes respect the person of a lifetime. To maintain the patient’s dignity during disease progression for a greater proportion of Alzheimer’s patients, states should honor ADs and RADs. Currently, ADs offer an unpredictable degree of protection, especially as patients move from state to state. Unpredictable factors include judicial discretion, shifts of thinking within the body politic, and the power of stakeholders with interests at odds with those of the person of the lifetime. Judicial discretion should be limited to invalidating only those ADs that were based on fraud, undue influence, or incapacity at their inception. Administrative personnel and other stakeholders should not have authority to redefine a person’s legacy once the person reaches the stage at which they no longer have capacity. ADs and RADs could include dispute resolution mechanisms as well as directives with respect to those persons the person of the moment does not want involved in their care. In declaring the continuity of person yet acknowledging the differences due to significant memory loss, Giovanni Boniolo concludes, “We have to respect them and their choices and decisions as long as they are capable of choosing and deciding. Then, when this capacity has vanished, we must continue respecting not only them, but also the choices and decisions they made.”[20] Boniolo is absolutely correct; one is capable of creating AD until they are not. A sharper scientific approach would base the point at which one no longer has capability to make decisions on biological or clinical markers. The law should ensure that ADs and RADs made prior to that point govern care and research decisions. CONCLUSION Permitting an unfaithful surrogate or an administrator with a different philosophy to reinterpret patient desires based on current circumstances would create a “slippery slope,” compromising the known wishes of a person with Alzheimer’s disease as preserved in writing. ADs and RADs are the best opportunities for people with early Alzheimer’s disease, or those who recognize the risk of dementia, to preserve their legacy and to use their autonomy to govern care of the significantly memory-impaired person of the moment. Preserving the legacy of patients in binding documents avoids the quagmire of courts, doctors, surrogates, and caregivers. Ultimately, ADs and RADs can maintain continuity of the person of a lifetime’s dignity even when that person experiences cognitive impairment, evolving into the person of the moment. [1] Weller J, Budson A. Current Understanding of Alzheimer's Disease Diagnosis and Treatment. F1000Res. 2018;7:F1000 Faculty Rev-1161. Published 2018 Jul 31. doi:10.12688/f1000research.14506.1 [2] Gauthier S, Leuzy A, Racine E, Rosa-Neto P. Diagnosis and management of Alzheimer's disease: Past, present and future ethical issues. Progress in Neurobiology. 2013;110:102-113; Naylor M, Karlawish J, Arnold S et al. Advancing Alzheimer's disease diagnosis, treatment, and care: Recommendations from the Ware Invitational Summit. Alzheimer's & Dementia. 2012;8(5):445-452. [3] The combination of Tau proteins becoming defective, creating neurofibrillary tangles, and β amyloid plaques building up in the neural connections of the brain prevents neural functioning, resulting in brain cell incapacity and death; Zetterberg H, Schott J. Biomarkers for Alzheimer’s disease beyond amyloid and tau. Nat Med. 2019;25(2):201-203.; Qin K, Zhao L, Gregory C, Solanki A, Mastrianni J. “Dual Disease” TgAD/GSS mice exhibit enhanced Alzheimer’s disease pathology and reveal PrPC-dependent secretion of Aβ. Sci Rep. 2019;9(1). doi:10.1038/s41598-019-44317-w; Qin K, Zhao L, Gregory C, Solanki A, Mastrianni J. “Dual Disease” TgAD/GSS mice exhibit enhanced Alzheimer’s disease pathology and reveal PrPC-dependent secretion of Aβ. Sci Rep. 2019;9(1). [4] Kitwood T. Dementia Reconsidered, Revisited: The Person Still Comes First. 2nd ed. New York: Open University Press; 2019. [5] Dale S. Personhood, Critical Interests, and the Moral Imperative of Advances Directives in Alzheimer's Cases. Voices in Bioethics. 2021;7:1-6. [6] Dale S. Personhood, Critical Interests, and the Moral Imperative of Advances Directives in Alzheimer's Cases. Voices in Bioethics. 2021;7:1-6, citing Dworkin R. (1994) Life’s Dominion; An Argument About Abortion, Euthanasia, And Individual Freedom. 1st ed. New York: Vintage Books. [7] Dale S., 2021. [8] Person M, Hanssen I. Joy, Happiness, and Humor in Dementia Care: A Qualitative Study. Creative Nursing. 2015;21(1):47-52.; Yeaman P, Ford J, Kim K. Providing Quality Palliative Care in End-Stage Alzheimer Disease. American Journal of Hospice and Palliative Medicine®. 2012;30(5):499-502. [9] Kim S. The Ethics of Informed Consent in Alzheimer Disease Research. Nature Reviews Neurology. 2011;7(7):410-414.; Porteri C. Advance Directives as A Tool to Respect Patients’ Values and Preferences: Discussion on The Case Of Alzheimer’s Disease. BioMed Central Medical Ethics. 2018;19(1).; Naue U. ‘Self-care without a self’: Alzheimer’s Disease and The Concept of Personal Responsibility for Health. Medicine, Health Care and Philosophy. 2008;11(3):315-324. [10] Sieger CE, Arnold JF, Ahronheim JC. Refusing artificial nutrition and hydration: does statutory law send the wrong message?. J Am Geriatr Soc. 2002;50(3):544-550. doi:10.1046/j.1532-5415.2002.50124.x [11] Porteri C. Advance Directives as A Tool to Respect Patients’ Values And Preferences: Discussion On The Case Of Alzheimer’s Disease. BioMed Central Medical Ethics. 2018;19(1). [12] Buller T. Advance Consent, Critical Interests and Dementia Research. Journal of Medical Ethics. 2014;41(8):701-707.; Jongsma K, van de Vathorst S. Dementia Research and Advance Consent: It Is Not About Critical Interests. Journal of Medical Ethics. 2014;41(8):708-709.; Jongsma K, Perry J, Schicktanz S, Radenbach K. Motivations for people with cognitive impairment to complete an advance research directive – a qualitative interview study. BioMed Central Psychiatry. 2020;20(1). [13] National Bioethics Advisory Commission (NBAC) Research Involving Persons with Mental Disorders That May Affect Decision-making Capacity. Rockville: National Bioethics Advisory Commission; 1998. https://pubmed.ncbi.nlm.nih.gov/12747354/ [14] Porteri C. Advance Directives as A Tool to Respect Patients’ Values and Preferences: Discussion on The Case Of Alzheimer’s Disease. BioMed Central Medical Ethics. 2018;19(1). https://pubmed.ncbi.nlm.nih.gov/29458429/ ; Jongsma K, van de Vathorst S. Dementia Research and Advance Consent: It Is Not About Critical Interests. Journal of Medical Ethics. 2014;41(8):708-709. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.997.8037&rep=rep1&type=pdf [15] Porteri C. Advance directives as a tool to respect patients’ values and preferences: discussion on the case of Alzheimer’s disease. BioMed Central Medical Ethics. 2018;19(1). https://pubmed.ncbi.nlm.nih.gov/29458429/ [16] Porteri C. Advance directives as a tool to respect patients’ values and preferences: discussion on the case of Alzheimer’s disease. BioMed Central Medical Ethics. 2018;19(1). [17] McDonald A, D'Arcy R, Song X. Functional MRI On Executive Functioning in Aging and Dementia: A Scoping Review Of Cognitive Tasks. Aging Medicine. 2018;1(2):209-219; Sclan S, Reisberg B. Functional Assessment Staging (FAST) in Alzheimer's Disease: Reliability, Validity, and Ordinality. Int Psychogeriatr. 1992;4(3):55-69; Appelbaum P, Grisso T. Assessing Patients' Capacities to Consent to Treatment. New England Journal of Medicine. 1988;319(25):1635-1638; Fisher C, Appelbaum P. Diagnosing Consciousness: Neuroimaging, Law, and the Vegetative State. Journal of Law, Medicine & Ethics. 2010;38(2):374-385. [18] Menzel P. Ethical Perspectives on Advance Directives for Dementia - The Hastings Center. The Hastings Center; 2018. https://www.thehastingscenter.org/ethical-perspectives-advance-directives-dementia. Accessed December 8, 2018. [19] HR 5835 Omnibus Budget Reconciliation Act of 1990, Title IV, Section 4206. US Congress. [20] Boniolo, G. Demented Patients and The Quandaries of Identity: Setting the Problem, Advancing A Proposal. HPLS 43, 21 (2021). https://doi.org/10.1007/s40656-021-00365-y

Pentingnya membangun OCB tidak lepas dari komitmen karyawan dalam organisasi. Komitmen karyawan akan mendorong terciptanya OCB dan tanpa adanya kontrol yang baik dalam pemberian kompensasi yang sesuai dengan hasil kerja tentunya memperlambat kerja pegawai. Penelitian ini bertujuan untuk menguji dan menganalisis pengaruh kompensasi dan komitmen organisasi terhadap kepuasan kerja dan OCB. Jumlah responden dalam penelitian ini berjumlah 86 orang. Pengumpulan data diperoleh dengan kuesioner menggunakan skala likert. Metode analisis data menggunakan Path Analysis. Hasil penelitian diperoleh bahwa kompensasi berpengaruh positif dan signifikan terhadap kepuasan kerja dan Kepuasan kerja berpengaruh positif dan signifikan terhadap OCB. Kata Kunci : Komitmen Organisasi, Kompensasi, Kepuasan kerja dan OCBDAFTAR PUSTAKA Bangun, Wilson. (2012). Manajemen Sumber Daya Manusia. Erlangga. Jakarta. Bernardin, H. John, & Joyce E.A Russel. (2003). Human resource management(An Experimental Approach International Edition). Mc. Graw-Hill Inc. Singapore. Baedhowi. (2007). Manajemen Sumber Daya Manusia. Pelita Insani. Semarang Bigliardi, Barbara & Albert, Ivo Dormio. (2012). The Impact of Organizational Culture on The Job Satisfaction of Knowledge Workers. Emerald Group. Vol.2 No.1, 36-51.Blau, P.M. (1964). Exchange and Power in Social Life. Transaction Publishers. Wiley, New York, NY.Bohlander, George, & Snell, Scott. (2010). Principles of Human Resource. Management, 15th ed. Mason, OH: South Western – Cengage Learning Boon, C. & Hartog, D.D. (2014). Human Resource Management and Organizational Citizenship Behavior The Mediating Role of Job Satisfaction. Netherland: Scriptiesonline.uba.uva.nl Cassio, Wayne F. (1997). Managing Human Resources, Productivity, Quality of Work Life Product Fourth Edition, New York: McGraw Hill International. Chinyere N. I. (2013). Job Satisfaction and Organizational Citizenship Behavior of Library Personnel in Selected Nigerian Universities. International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Colquitt, Jason A., Jeffery A. LePine., Michael J. Wesson. (2011). Organizational Behaviour. New York: McGraw-Hill International Companies. Delery, E. J. & Doty, H. D. (1996). Modes of Theorizing in Strategic Human ResourcecManagement: Tests of Universalistic, Contingency, and Configurationally PerformancecPredictions, Academy of Management Journal, 39(4), 802–35. Dewi, S., Suwandana, Made. (2016). Pengaruh Kepuasan Kerja Terhadap Organizational Citizenship Behavior (OCB) Dengan Komitmen Organisasional Sebagai Variabel Mediasi. E-Jurnal Manajemen Unud, Vol. 5 No.9 : 5643-5670. Darma, P.S & Supryanto, Achmad.S. (2017). The effect of compensation on satisfaction and employe performance. Management and Economics Journal. E-ISSN: 2598-9537 P-ISSN: 2599-3402. Journal Home Page: http://ejournal.uin-malang.ac.id/index.php/mec. De Saa-Perez, P. & JM. Garcia-Falcon. (2002). A Resource-based View of Human Resource Management & Organizational Capabilities Development. International Journal of Human Resource Management. Vol. 13. 123–40. Dewanggana, B.D., Paramita, P.D. & Haryono, A.T. (2016). Pengaruh Komitmen Organisasi, Kepuasan Kerja, Budaya Organisasi Terhadap Organizational Citizenship Behavior (OCB) Yang Berdampak Pada Prestasi Kerja Karyawan (Studi Pada PT. PLN App Semarang). Journal Of Management, Vol. 2 No. 2 Edy Sutrisno, (2014). Manajemen Sumber Daya Manusia. Cetak Ke Enam. Pranada Media Group. Jakarta. Fahmi, Irham. (2014). Analisa kinerja keuangan. Alfabeta. Bandung. Fitrianasari,D.,Nimran,U.,&Utami,H.,N. (2013).Pengaruh Kompensasi DanKepuasanKerja Terhadap OrganizationalCitizenship Behavior(OCB)dan Kinerja Karyawan. (Studi pada Perawat Rumah SakitUmum “Darmayu”di KabupatenPonorogo”). Jurnal ProfitVol.7 No.1Flippo, Edwin B (1997). Manajemen Personalia, Edisi Indonesia. ErlangaJakarta. Guest, D. (1997). Human Resource Management and Performance: A Review and Research Agenda. The International Journal of Human Resource Management. Vol. 8 (3). 263-76. Hartono, B & Setiawan, R. (2013). Judul penelitian Pengaruh Komitmen Organisasional Terhadap Kepuasan Kerja Karyawan Paparon’s Pizza City Of Tomorrow. AGORAVol.1, No.1, 1-8. Hasibuan, Malayu. (2012). Manajemen Sumber Daya Manusia dan Kunci Keberhasilan. Haji Mas Agung. Jakarta. Handoko,THani.(2014).Manajemen Personalia &SumberdayaManusia.Edisi Kedua.Cetakan Ke-21. BPFE-Yogyakarta. Yogyakarta. Indrawati, Endang Sri. dan Nafi’, C. (2017). Hubungan Antara Kepuasan Kerja Dengan Organizational Citizenship Behavior Pada Karyawan CV. Elfa’s Kudus. Jurnal Empati. Vol. 7 No. 3, 134 – 145. Joarder, M. H. R., Sharif, M. Y., & Ahmmed, K. (2011). Mediating role of affectivecommitment in hrm practices and turnover intention. relationship: a study in adeveloping context. Business and Economics Research Journal, Vol 2 (4), 135–158. Kamel B., El Amine M.B., and Abdeljalil M., (2015). Relationship between Job Satisfaction and Organizational Citizenship Behavior in the National Company for Distribution of Electricity and Gas.European Journal of Business and Management Vol.7, No.30 1-6 Khan, A.H.,Muhammad M.N., Muhammad A &Wasim, H. (2012). Impact ofJob Satisfaction onEmployee Performance:An Empirical Study of Autonomous MedicalInstitutions of Pakistan.African Journalof Business Management,Vol. 6, 2697-2705 Kreitner, R &Kinicki, A. (2014). Perilaku Organisasi. Salemba Empat. Jakarta. Kurniawan, A. (2015). Pengaruh Komitmen Organisasi Terhadap Organizational Citizenship Behavior (OCB) PT X Bandung. Jurnal Manajemen, Vol.15 No.1, 95-118. Kwantes, Karam, Kuo, & Towson. (2009). Culture's influence on the perception of OCB as in-role or extra-role. Kanada. International Journal of Intercultural Relations Luthans, Fred. (2006). Perilaku Organisasi edisi 10. Penerbit ANDI. Yogyakarta. Mangkunegara, A.A. Anwar Prabu. 2013.Manajemen Sumber Daya ManusiaPerusahaan.RemajaRosdakarya. Bandung. Mathis, R.L. & J.H. Jackson. (2006). Human Resource Management: Manajemen Sumber Daya Manusia. Terjemahan Dian Angelia. Salemba Empat. Jakarta. ----------------------------------. (2011). Human Resource Management: Manajemen Sumber Daya Manusia. Terjemahan Dian Angelia. Salemba Empat. Jakarta. Mehboob & Bhutto. (2012). Job Satisfaction as a Predictor of Organizational Citizenship Behavior A Study of Faculty Members at Business Institutes. Jurnal Ilmu Pendidikan, (Online) Vol. 3, No 9(http://www.journal-archieves14.webs.com/1447-1455.pdf) Mondy,R Wayne. (2008).ManajemenSumberDaya Manusia. Jilid 2Edisi 10. PenerbitErlangga. Jakarta. Muguongo, Muguna,, Muriithi. (2015). Effects of Compensation on Job Satisfaction Among Secondary School Teachers in Maara Sub - County o Tharaka Nithi County, Kenya”, Published online October 10, 2015 (http://www.sciencepublishinggroup.com/j/jhrm) ISSN: 2331-0707 (Print); ISSN: 2331-0715 (Online) Nazar, Omer Abdallah Ahmed. (2016). Impact of Human Resource Management Practices on Organizational Citizenship Behavior: An Empirical Investigation from Banking Sector of Sudan. International Review of Management and Marketing. Vol. 6(4), 964-973. Nursyamsi. (2013). Organizational Citizenship Behavior dan Pemberdayaan terhadap Komitmen Organisasi serta Dampaknya terhadap Kinerja Karyawan. Jurnal Keuangan dan Perbankan Vol. 17 No 3, 488-498. Nurandini, A & Lataruva, E. (2014). Judul penelitian Analisis Pengaruh Komitmen Organisasi Terhadap Kinerja Karyawan (Studi Pada Pegawai Perum PERUMNAS Jakarta). JurnalStudiManajemen& Organisasi Vol 11, 78–91. Omer, N. & Ahmed, A. (2017). Impact of Human Resource Management Practices on Organizational Citizenship Behavior: An Empirical Investigation from Banking Sector of Sudan. International Review of Management and Marketing. Vol. 6(4), 964-973. Oyeniyi, K.O, Afolabi, M.A, Olayanju, Mufutau (2014). Effect of Human Resource Management Practices on Job Satisfaction: An Empirical Investigation of Nigeria Banks. International Journal of Academic Research in Business and Social Sciences, Vol. 4, No. 8, 243-251. Organ, D. W. (1990). The motivational basis of organizational citizen ship behavior. In B. M. Staw, & L. L. Cummings (Eds.), Research in organizational behavior (pp. 43-72). Greenwich, CT: JAI Press. Organ, D. W., Podsakoff, P. M., & MacKenzie, S. B. (2006). Organizational citizenship behavior: Its nature, antecedents, and consequences. Thousand Oaks, CA: SAGE. Pala, Fikri. Eker, Semith dkk.2008. The effect of demographic characteristic on organizational commitment and job satisfaction : An Empirical study on Turkish health care staff. The journal of industrial relations and human resources Vol. 10 No. 2 Purwanto, A.H. (2011). Pengaruh Kualitas Layanan Internal dan Orientasi Pemberi Layanan Terhadap Kinerja Pegawai di Kantor Perijinan Kabupaten Lamongan. Jurnal Psikosains. Vol. 3(1) : 55-72. Priyatno, Duwi. (2011). Buku Saku Analisis Statistik Data. Penerbit Media Kom. Yogyakarta. Prowse, Peter & Prowse, Julie. (2009). The dilemma of performance appraisal. Measuring Business Excellence, 13 (4) : 69 – 77. Podsakoff P.M, Michae Ahearne, MacKenzie S.B (1997). Organizational Citizenship Behavior and the Quantity of Work Group Perpormance. American Psychological Association. Vol. 82 No. 2, 262-270. Rahayu, N.M.N & Riana, I.G. (2017). Pengaruh Kompensasi Terhadap Kepuasan Kerja dan Keinginan Keluar Pada Hotel Amaris Legian. E-JurnalManajemen Unud, Vol. 6,No. 11, 5804-5833 Ramadhani, A.A (2013). Pengaruh Kompensasi Terhadap Motivasi Kerja Di PT. Pos Indonesia (Persero) Bandung. Skripsi: Program Studi Manajemen, Universitas Pendidikan Indonesia. (http://repository.upi.edu/1299/ [16 November 2013]Rahmayanti, Febriana, dan Dewi. (2014). Faktor-Faktor yang MempengaruhiOrganizationalCitizenshipBehavior(OCB).JurnalEcopsyVol.1No.3 Retnoningsih, T., Sunuharjo, B.S & Ruhana, I. 2015. Pengaruh Kompensasi Terhadap Kepuasan Kerja Dan Kinerja Karyawan (Studi Pada Karyawan PT PLN (Persero) Distribusi Jawa Timur Area Malang). Richard L. Hughes, Robert C. Ginnett, and Gordon J. Curphy. (2012). Leadership, Enhancing the Lessons of Experience, Alih Bahasa: Putri Izzati. Salemba Humanika. Jakarta. Robbins, S.P., & Judge, T.A. (2008). Perilaku organisasi. organizational behavior. buku 1. edisi 12. Penerjemah: Angelica, D., Cahyani, R., dan Rosyid, A. Salemba Empat. Jakarta. Robbins, S. P. & Coulter, M. (2012). Management (11th ed.). Prentice Hall: River, N.J. Robbins, S.P dan Judge T.A. (2015).Perilaku Organisasi.SalembaEmpat. Jakarta. Rozzaid, Y., Toni Herlambang, T & dan Devi, A.M. (2015). Pengaruh Kompensasi Dan Motivasi Terhadap Kepuasan Kerja Karyawan (Studi Kasus Pada PT. Nusapro Telemedia Persada Cabang Banyuwangi). Jurnal ManajemenDanBisnis IndonesiaVol. 1No. 2, 201-220. Saleem, Sharjeel & Saba, Amin. (2013). The Impact of Organizational Support for Career Development and Supervisory Suppoert on Employee Performance : An Emperical Study From Pakistani Academic Sector. Europen Journal of Business and Management. 5 (5) : 194-207. Samsudin, Sadili. (2010). Manajemen Sumber Daya Manusia. Pustaka Setia. Bandung. Sasilu, J.B, Chinyio & Sures, S. (2015). The impact of compensation on the job satisfaction of public sector construction workers of jigawa state of Nigeria. The Business and Management Review. Vol. 6 No. 4.Schneider, B., dan Bowen, D.E. (1985). Employee and customer perceptions of service in bank: Replication and extension. Journal of Applied Psychology. Vol 70, 423-433. Sekaran, Uma. (2014). Metodologi Penelitian untuk Bisnis (Research Methods for Business). Salemba Empat. Jakarta. Siagian, Sondang., P. (2013). Manajemen Sumber Daya Manusia. Binapura Aksara. Jakarta. --------------------------, (2008). Manajemen Sumber Daya Manusia (EdisiPertama). Binapura Aksara. Jakarta. Siregar, S & Prasetio, A.P. (2015). Pengaruh Kepuasan Kerja dan Komikmen Organisasi Terhadap Organizational Citizenship Behavior (Prilaku OCB) Karyawan Kantor Distribusi PT. PLN (Persero) Distribusi Jawa Barat Dan Banten. E-Proceeding ofManagement.Vol.2 no.3Society for Human Resource Management. (2012). EmployeeJob Satisfaction and Engagement. A research report by SHRM. Retrieved from www.shrmstore. shrm.org. Solihin, Dadang. (2013). Optimalisasi Otonomi Daerah Kebijakan, Strategi dan Upaya. Yayasan Empat Sembilan. Jakarta. Srimulyani, V. A. (2009). Tipilogi dan Anteseden Komitmen Organisasi. Jurnal Ilmiah Widya Wana. Vol. 33 (1), 1-20. Steven, H Appelbaum, Michel Roy & Terry Gilliland. (2011). Globalization of performance appraisals: theory and applications. Management Decision, Vol. 49 (4) : 570-585. Subekhi, A. (2012). Pengantar Manajemen Sumber DayaManusia.PrestasiPustakaJakarta. Jakarta. Sugiyono. (2013). Metode Penelitian Kuantitatif Kualitatif dan R&D. Alfabeta. Bandung. Sutrisno,E. (2011).ManajemenSumberDayaManusia. PrenadaMediaGroup.Jakarta. Tan, R&Tarigan, Z.J.H. (2017). PengaruhKompensasiDanKepuasanKerjaTerhadap OrganizationalCitizenshipBehavior(OCB)MelaluiMotivasi KerjaSebagaiVariabelInterveningPada3HMotosport. AGORAVol. 5,No. 1 Titisari, Purnamie. (2014). Peranan Organizational Citizenship Behaviour (OCB) dalam Meningkatkan Kinerja Karyawan. Mitra Wacana Media. Jakarta. Uma Sankar Mishra, Aurolipy, Madhusmita Dash. (2017). Impact of HRM Practices on Job Satisfaction and Performance: An Empirical Study in Health Care Sector. International journal of economic research. Vol. 14, No. 1 Umar, Husein. (2003). Riset Sumber Daya Manusia Dalam Organisasi. Penerbit Gramedia Pustaka Utama. Jakarta. Wexley, Kenneth. & Gary Yukl. (2003). Perilaku organisasi dan psikologi personalia. Rineka Cipta. Jakarta. Wibowo. (2016). Manajemen Kinerja. PT. Rajagrafindo Persada. Jakarta. Widodo, SE. (2015). Manajemen Pengembangan Sumber Daya Manusia. Pustaka Pelajar. Yogyakarta. Yani. (2012). Manajemen Sumber Daya Manusia. Mitra Wacana Media. Jakarta.Zaenabadi, H. (2010). Job satisfaction and organizational commitment as antecedents of Organizational Citizenship Behavior (OCB) of teachers. Procedia Social and Behavioral Sciences Vol. 5 : 998–1003.

Background “The sense of taste,” write Nelson and colleagues in a 2002 issue of Nature, “provides animals with valuable information about the nature and quality of food. Mammals can recognize and respond to a diverse repertoire of chemical entities, including sugars, salts, acids and a wide range of toxic substances” (199). The authors go on to argue that several amino acids—the building blocks of proteins—taste delicious to humans and that “having a taste pathway dedicated to their detection probably had significant evolutionary implications”. They imply, but do not specify, that the evolutionary implications are positive. This may be the case with some amino acids, but contemporary tastes, and changes in them, are far from universally beneficial. Indeed, this article argues that modern food production shapes and distorts human taste with significant implications for health and wellbeing. Take the western taste for fried chipped potatoes, for example. According to Schlosser in Fast Food Nation, “In 1960, the typical American ate eighty-one pounds of fresh potatoes and about four pounds of frozen french fries. Today [2002] the typical American eats about forty-nine pounds of fresh potatoes every year—and more than thirty pounds of frozen french fries” (115). Nine-tenths of these chips are consumed in fast food restaurants which use mass-manufactured potato-based frozen products to provide this major “foodservice item” more quickly and cheaply than the equivalent dish prepared from raw ingredients. These choices, informed by human taste buds, have negative evolutionary implications, as does the apparently long-lasting consumer preference for fried goods cooked in trans-fats. “Numerous foods acquire their elastic properties (i.e., snap, mouth-feel, and hardness) from the colloidal fat crystal network comprised primarily of trans- and saturated fats. These hardstock fats contribute, along with numerous other factors, to the global epidemics related to metabolic syndrome and cardiovascular disease,” argues Michael A. Rogers (747). Policy makers and public health organisations continue to compare notes internationally about the best ways in which to persuade manufacturers and fast food purveyors to reduce the use of these trans-fats in their products (L’Abbé et al.), however, most manufacturers resist. Hank Cardello, a former fast food executive, argues that “many products are designed for ‘high hedonic value’, with carefully balanced combinations of salt, sugar and fat that, experience has shown, induce people to eat more” (quoted, Trivedi 41). Fortunately for the manufactured food industry, salt and sugar also help to preserve food, effectively prolonging the shelf life of pre-prepared and packaged goods. Physiological Factors As Glanz et al. discovered when surveying 2,967 adult Americans, “taste is the most important influence on their food choices, followed by cost” (1118). A person’s taste is to some extent an individual response to food stimuli, but the tongue’s taste buds respond to five basic categories of food: salty, sweet, sour, bitter, and umami. ‘Umami’ is a Japanese word indicating “delicious savoury taste” (Coughlan 11) and it is triggered by the amino acid glutamate. Japanese professor Kikunae Ikeda identified glutamate while investigating the taste of a particular seaweed which he believed was neither sweet, sour, bitter, or salty. When Ikeda combined the glutamate taste essence with sodium he formed the food additive sodium glutamate, which was patented in 1908 and subsequently went into commercial production (Japan Patent Office). Although individual, a person’s taste preferences are by no means fixed. There is ample evidence that people’s tastes are being distorted by modern food marketing practices that process foods to make them increasingly appealing to the average palate. In particular, this industrialisation of food promotes the growth of a snack market driven by salty and sugary foods, popularly constructed as posing a threat to health and wellbeing. “[E]xpanding waistlines [are] fuelled by a boom in fast food and a decline in physical activity” writes Stark, who reports upon the 2008 launch of a study into Australia’s future ‘fat bomb’. As Deborah Lupton notes, such reports were a particular feature of the mid 2000s when: intense concern about the ‘obesity epidemic’ intensified and peaked. Time magazine named 2004 ‘The Year of Obesity’. That year the World Health Organization’s Global Strategy on Diet, Physical Activity and Health was released and the [US] Centers for Disease Control predicted that a poor diet and lack of exercise would soon claim more lives than tobacco-related disease in the United States. (4) The American Heart Association recommends eating no more than 1500mg of salt per day (Hamzelou 11) but salt consumption in the USA averages more than twice this quantity, at 3500mg per day (Bernstein and Willett 1178). In the UK, a sustained campaign and public health-driven engagement with food manufacturers by CASH—Consensus Action on Salt and Health—resulted in a reduction of between 30 and 40 percent of added salt in processed foods between 2001 and 2011, with a knock-on 15 percent decline in the UK population’s salt intake overall. This is the largest reduction achieved by any developed nation (Brinsden et al.). “According to the [UK’s] National Institute for Health and Care Excellence (NICE), this will have reduced [UK] stroke and heart attack deaths by a minimum of 9,000 per year, with a saving in health care costs of at least £1.5bn a year” (MacGregor and Pombo). Whereas there has been some success over the past decade in reducing the amount of salt consumed, in the Western world the consumption of sugar continues to rise, as a graph cited in the New Scientist indicates (O’Callaghan). Regular warnings that sugar is associated with a range of health threats and delivers empty calories devoid of nutrition have failed to halt the increase in sugar consumption. Further, although some sugar is a natural product, processed foods tend to use a form invented in 1957: high-fructose corn syrup (HFCS). “HFCS is a gloopy solution of glucose and fructose” writes O’Callaghan, adding that it is “as sweet as table sugar but has typically been about 30% cheaper”. She cites Serge Ahmed, a French neuroscientist, as arguing that in a world of food sufficiency people do not need to consume more, so they need to be enticed to overeat by making food more pleasurable. Ahmed was part of a team that ran an experiment with cocaine-addicted rats, offering them a mutually exclusive choice between highly-sweetened water and cocaine: Our findings clearly indicate that intense sweetness can surpass cocaine reward, even in drug-sensitized and -addicted individuals. We speculate that the addictive potential of intense sweetness results from an inborn hypersensitivity to sweet tastants. In most mammals, including rats and humans, sweet receptors evolved in ancestral environments poor in sugars and are thus not adapted to high concentrations of sweet tastants. The supranormal stimulation of these receptors by sugar-rich diets, such as those now widely available in modern societies, would generate a supranormal reward signal in the brain, with the potential to override self-control mechanisms and thus lead to addiction. (Lenoir et al.) The Tongue and the Brain One of the implications of this research about the mammalian desire for sugar is that our taste for food is about more than how these foods actually taste in the mouth on our tongues. It is also about the neural response to the food we eat. The taste of French fries thus also includes that “snap, mouth-feel, and hardness” and the “colloidal fat crystal network” (Rogers, “Novel Structuring” 747). While there is no taste receptor for fats, these nutrients have important effects upon the brain. Wang et al. offered rats a highly fatty, but palatable, diet and allowed them to eat freely. 33 percent of the calories in the food were delivered via fat, compared with 21 percent in a normal diet. The animals almost doubled their usual calorific intake, both because the food had a 37 percent increased calorific content and also because the rats ate 47 percent more than was standard (2786). The research team discovered that in as little as three days the rats “had already lost almost all of their ability to respond to leptin” (Martindale 27). Leptin is a hormone that acts on the brain to communicate feelings of fullness, and is thus important in assisting animals to maintain a healthy body weight. The rats had also become insulin resistant. “Severe resistance to the metabolic effects of both leptin and insulin ensued after just 3 days of overfeeding” (Wang et al. 2786). Fast food restaurants typically offer highly palatable, high fat, high sugar, high salt, calorific foods which can deliver 130 percent of a day’s recommended fat intake, and almost a day’s worth of an adult man’s calories, in one meal. The impacts of maintaining such a diet over a comparatively short time-frame have been recorded in documentaries such as Super Size Me (Spurlock). The after effects of what we widely call “junk food” are also evident in rat studies. Neuroscientist Paul Kenny, who like Ahmed was investigating possible similarities between food- and cocaine-addicted rats, allowed his animals unlimited access to both rat ‘junk food’ and healthy food for rats. He then changed their diets. “The rats with unlimited access to junk food essentially went on a hunger strike. ‘It was as if they had become averse to healthy food’, says Kenny. It took two weeks before the animals began eating as much [healthy food] as those in the control group” (quoted, Trivedi 40). Developing a taste for certain food is consequently about much more than how they taste in the mouth; it constitutes an individual’s response to a mixture of taste, hormonal reactions and physiological changes. Choosing Health Glanz et al. conclude their study by commenting that “campaigns attempting to change people’s perception of the importance of nutrition will be interpreted in terms of existing values and beliefs. A more promising strategy might be to stress the good taste of healthful foods” (1126). Interestingly, this is the strategy already adopted by some health-focused cookbooks. I have 66 cookery books in my kitchen. None of ten books sampled from the five spaces in which these books are kept had ‘taste’ as an index entry, but three books had ‘taste’ in their titles: The Higher Taste, Taste of Life, and The Taste of Health. All three books seek to promote healthy eating, and they all date from the mid-1980s. It might be that taste is not mentioned in cookbook indexes because it is a sine qua non: a focus upon taste is so necessary and fundamental to a cookbook that it goes without saying. Yet, as the physiological evidence makes clear, what we find palatable is highly mutable, varying between people, and capable of changing significantly in comparatively short periods of time. The good news from the research studies is that the changes wrought by high salt, high sugar, high fat diets need not be permanent. Luciano Rossetti, one of the authors on Wang et al’s paper, told Martindale that the physiological changes are reversible, but added a note of caution: “the fatter a person becomes the more resistant they will be to the effects of leptin and the harder it is to reverse those effects” (27). Morgan Spurlock’s experience also indicates this. In his case it took the actor/director 14 months to lose the 11.1 kg (13 percent of his body mass) that he gained in the 30 days of his fast-food-only experiment. Trivedi was more fortunate, stating that, “After two weeks of going cold turkey, I can report I have successfully kicked my ice cream habit” (41). A reader’s letter in response to Trivedi’s article echoes this observation. She writes that “the best way to stop the craving was to switch to a diet of vegetables, seeds, nuts and fruits with a small amount of fish”, adding that “cravings stopped in just a week or two, and the diet was so effective that I no longer crave junk food even when it is in front of me” (Mackeown). Popular culture indicates a range of alternative ways to resist food manufacturers. In the West, there is a growing emphasis on organic farming methods and produce (Guthman), on sl called Urban Agriculture in the inner cities (Mason and Knowd), on farmers’ markets, where consumers can meet the producers of the food they eat (Guthrie et al.), and on the work of advocates of ‘real’ food, such as Jamie Oliver (Warrin). Food and wine festivals promote gourmet tourism along with an emphasis upon the quality of the food consumed, and consumption as a peak experience (Hall and Sharples), while environmental perspectives prompt awareness of ‘food miles’ (Weber and Matthews), fair trade (Getz and Shreck) and of land degradation, animal suffering, and the inequitable use of resources in the creation of the everyday Western diet (Dare, Costello and Green). The burgeoning of these different approaches has helped to stimulate a commensurate growth in relevant disciplinary fields such as Food Studies (Wessell and Brien). One thing that all these new ways of looking at food and taste have in common is that they are options for people who feel they have the right to choose what and when to eat; and to consume the tastes they prefer. This is not true of all groups of people in all countries. Hiding behind the public health campaigns that encourage people to exercise and eat fresh fruit and vegetables are the hidden “social determinants of health: The conditions in which people are born, grow, live, work and age, including the health system” (WHO 45). As the definitions explain, it is the “social determinants of health [that] are mostly responsible for health iniquities” with evidence from all countries around the world demonstrating that “in general, the lower an individual’s socioeconomic position, the worse his or her health” (WHO 45). For the comparatively disadvantaged, it may not be the taste of fast food that attracts them but the combination of price and convenience. If there is no ready access to cooking facilities, or safe food storage, or if a caregiver is simply too time-poor to plan and prepare meals for a family, junk food becomes a sensible choice and its palatability an added bonus. For those with the education, desire, and opportunity to break free of the taste for salty and sugary fats, however, there are a range of strategies to achieve this. There is a persuasive array of evidence that embracing a plant-based diet confers a multitude of health benefits for the individual, for the planet and for the animals whose lives and welfare would otherwise be sacrificed to feed us (Green, Costello and Dare). Such a choice does involve losing the taste for foods which make up the lion’s share of the Western diet, but any sense of deprivation only lasts for a short time. The fact is that our sense of taste responds to the stimuli offered. It may be that, notwithstanding the desires of Jamie Oliver and the like, a particular child never will never get to like broccoli, but it is also the case that broccoli tastes differently to me, seven years after becoming a vegan, than it ever did in the years in which I was omnivorous. When people tell me that they would love to adopt a plant-based diet but could not possibly give up cheese, it is difficult to reassure them that the pleasure they get now from that specific cocktail of salty fats will be more than compensated for by the sheer exhilaration of eating crisp, fresh fruits and vegetables in the future. Conclusion For decades, the mass market food industry has tweaked their products to make them hyper-palatable and difficult to resist. They do this through marketing experiments and consumer behaviour research, schooling taste buds and brains to anticipate and relish specific cocktails of sweet fats (cakes, biscuits, chocolate, ice cream) and salty fats (chips, hamburgers, cheese, salted nuts). They add ingredients to make these products stimulate taste buds more effectively, while also producing cheaper items with longer life on the shelves, reducing spoilage and the complexity of storage for retailers. Consumers are trained to like the tastes of these foods. Bitter, sour, and umami receptors are comparatively under-stimulated, with sweet, salty, and fat-based tastes favoured in their place. Western societies pay the price for this learned preference in high blood pressure, high cholesterol, diabetes, and obesity. Public health advocate Bruce Neal and colleagues, working to reduce added salt in processed foods, note that the food and manufacturing industries can now provide most of the calories that the world needs to survive. “The challenge now”, they argue, “is to have these same industries provide foods that support long and healthy adult lives. And in this regard there remains a very considerable way to go”. If the public were to believe that their sense of taste is mutable and has been distorted for corporate and industrial gain, and if they were to demand greater access to natural foods in their unprocessed state, then that journey towards a healthier future might be far less protracted than these and many other researchers seem to believe. References Bernstein, Adam, and Walter Willett. “Trends in 24-Hr Sodium Excretion in the United States, 1957–2003: A Systematic Review.” American Journal of Clinical Nutrition 92 (2010): 1172–1180. Bhaktivedanta Book Trust. The Higher Taste: A Guide to Gourmet Vegetarian Cooking and a Karma-Free Diet, over 60 Famous Hare Krishna Recipes. Botany, NSW: Bhaktivedanta Book Trust, 1987. Brinsden, Hannah C., Feng J. He, Katharine H. Jenner, & Graham A. MacGregor. “Surveys of the Salt Content in UK Bread: Progress Made and Further Reductions Possible.” British Medical Journal Open 3.6 (2013). 2 Feb. 2014 ‹http://bmjopen.bmj.com/content/3/6/e002936.full›. Coughlan, Andy. “In Good Taste.” New Scientist 2223 (2000): 11. Dare, Julie, Leesa Costello, and Lelia Green. “Nutritional Narratives: Examining Perspectives on Plant Based Diets in the Context of Dominant Western Discourse”. Proceedings of the 2013 Australian and New Zealand Communication Association Conference. Ed. In Terence Lee, Kathryn Trees, and Renae Desai. Fremantle, Western Australia, 3-5 Jul. 2013. 2 Feb. 2014 ‹http://www.anzca.net/conferences/past-conferences/159.html›. Getz, Christy, and Aimee Shreck. “What Organic and Fair Trade Labels Do Not Tell Us: Towards a Place‐Based Understanding of Certification.” International Journal of Consumer Studies 30.5 (2006): 490–501. Glanz, Karen, Michael Basil, Edward Maibach, Jeanne Goldberg, & Dan Snyder. “Why Americans Eat What They Do: Taste, Nutrition, Cost, Convenience, and Weight Control Concerns as Influences on Food Consumption.” Journal of the American Dietetic Association 98.10 (1988): 1118–1126. Green, Lelia, Leesa Costello, and Julie Dare. “Veganism, Health Expectancy, and the Communication of Sustainability.” Australian Journal of Communication 37.3 (2010): 87–102 Guthman, Julie. Agrarian Dreams: the Paradox of Organic Farming in California. Berkley and Los Angeles, CA: U of California P, 2004 Guthrie, John, Anna Guthrie, Rob Lawson, & Alan Cameron. “Farmers’ Markets: The Small Business Counter-Revolution in Food Production and Retailing.” British Food Journal 108.7 (2006): 560–573. Hall, Colin Michael, and Liz Sharples. Eds. Food and Wine Festivals and Events Around the World: Development, Management and Markets. Oxford, UK: Routledge, 2008. Hamzelou, Jessica. “Taste Bud Trickery Needed to Cut Salt Intake.” New Scientist 2799 (2011): 11. Japan Patent Office. History of Industrial Property Rights, Ten Japanese Great Inventors: Kikunae Ikeda: Sodium Glutamate. Tokyo: Japan Patent Office, 2002. L’Abbé, Mary R., S. Stender, C. M. Skeaff, Ghafoorunissa, & M. Tavella. “Approaches to Removing Trans Fats from the Food Supply in Industrialized and Developing Countries.” European Journal of Clinical Nutrition 63 (2009): S50–S67. Lenoir, Magalie, Fuschia Serre, Lauriane Cantin, & Serge H. Ahmed. “Intense Sweetness Surpasses Cocaine Reward.” PLOS One (2007). 2 Feb. 2014 ‹http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0000698›. Lupton, Deborah. Fat. Oxford, UK: Routledge, 2013. MacGregor, Graham, and Sonia Pombo. “The Amount of Hidden Sugar in Your Diet Might Shock You.” The Conversation 9 January (2014). 2 Feb. 2014 ‹http://theconversation.com/the-amount-of-hidden-sugar-in-your-diet-might-shock-you-21867›. Mackeown, Elizabeth. “Cold Turkey?” [Letter]. New Scientist 2787 (2010): 31. Martindale, Diane. “Burgers on the Brain.” New Scientist 2380 (2003): 26–29. Mason, David, and Ian Knowd. “The Emergence of Urban Agriculture: Sydney, Australia.” The International Journal of Agricultural Sustainability 8.1–2 (2010): 62–71. Neal, Bruce, Jacqui Webster, and Sebastien Czernichow. “Sanguine About Salt Reduction.” European Journal of Preventative Cardiology 19.6 (2011): 1324–1325. Nelson, Greg, Jayaram Chandrashekar, Mark A. Hoon, Luxin Feng, Grace Zhao, Nicholas J. P. Ryba, & Charles S. Zuker. “An Amino-Acid Taste Receptor.” Nature 416 (2002): 199–202. O’Callaghan, Tiffany. “Sugar on Trial: What You Really Need to Know.” New Scientist 2954 (2011): 34–39. Rogers, Jenny. Ed. The Taste of Health: The BBC Guide to Healthy Cooking. London, UK: British Broadcasting Corporation, 1985. Rogers, Michael A. “Novel Structuring Strategies for Unsaturated Fats—Meeting the Zero-Trans, Zero-Saturated Fat Challenge: A Review.” Food Research International 42.7 August (2009): 747–753. Schlosser, Eric. Fast Food Nation. London, UK: Penguin, 2002. Super Size Me. Dir. Morgan Spurlock. Samuel Goldwyn Films, 2004. Stafford, Julie. Taste of Life. Richmond, Vic: Greenhouse Publications Ltd, 1983. Stark, Jill. “Australia Now World’s Fattest Nation.” The Age 20 June (2008). 2 Feb. 2014 ‹http://www.theage.com.au/news/health/australia-worlds-fattest-nation/2008/06/19/1213770886872.html›. Trivedi, Bijal. “Junkie Food: Tastes That Your Brain Cannot Resist.” New Scientist 2776 (2010): 38–41. Wang, Jiali, Silvana Obici, Kimyata Morgan, Nir Barzilai, Zhaohui Feng, & Luciano Rossetti. “Overfeeding Rapidly Increases Leptin and Insulin Resistance.” Diabetes 50.12 (2001): 2786–2791. Warin, Megan. “Foucault’s Progeny: Jamie Oliver and the Art of Governing Obesity.” Social Theory & Health 9.1 (2011): 24–40. Weber, Christopher L., and H. Scott Matthews. “Food-miles and the Relative Climate Impacts of Food Choices in the United States.” Environmental Science & Technology 42.10 (2008): 3508–3513. Wessell, Adele, and Donna Lee Brien. Eds. Rewriting the Menu: the Cultural Dynamics of Contemporary Food Choices. Special Issue 9, TEXT: Journal of Writing and Writing Programs October 2010. World Health Organisation. Closing the Gap: Policy into Practice on Social Determinants of Health [Discussion Paper]. Rio de Janeiro, Brazil: World Conference on Social Determinants of Health, World Health Organisation, 19–21 October 2011.

Apart from its negative literary connotations, the notion of adaptation generally carries an optimistic connotation in the sense that it is most often associated with an improved outcome in the face of challenging circumstances. However, this is not an inevitable response to an adaptive imperative: there are often indicators of significant failure to adapt. In short, there is often evidence of maladaption. Examples include the spiralling rates of heart disease, obesity and adult-onset diabetes that have characterised richer western populations over the past half-century. Arguably, the West as a whole has failed to adapt to the health opportunities provided by plentiful food supplies. Instead, a growing dietary emphasis upon refined carbohydrates (including simple sugars) and animal-sourced protein (including dairy foods) is harming these populations. This paper applies the metaphors of adaptation and maladaptation to the development of a new sense of self following a diagnosis of heart disease. There is a range of evidence to suggest that newly-diagnosed heart patients resist accepting the implications of lifestyle-related heart disease. Such a lack of acceptance can impact upon short-term health, exercise and diet priorities, as well as upon long-term life expectancy. While this paper does not describe a medical, but a cultural approach to the well-adapted self as heart patient, it is also important to stress that there is a significant range of heart conditions that are not lifestyle related. Counterproductively, the links increasingly made between lifestyle choices and heart disease mean that many heart patients feel “punished” by people with healthy hearts who seem to assume that the patient is to “blame”. Nonetheless, there are few heart patients who cannot positively impact their health and recovery prospects by improving lifestyle choices. Ladwig and his research team argue that the challenge lies in getting heart patients to take their illness seriously without precipitating a traumatically negative view of the experience of illness. Such a negative view may, in itself, facilitate poor outcomes. These perspectives indicate that issues of communication and identity—that is, cultural imperatives—are important determinants of a healthy recovery. This paper records and analyses recent research relating to heart patients who are members of an online support community, HeartNET. HeartNET is an experimental Website funded by two Australian Research Council Linkage Grants (2004-10), with the National Heart Foundation (WA Division) as the industry partner. The authors/researchers speculate that engagement in the HeartNET online community enables the positive adaptation of an individual’s sense of self (rather than the fostering of a maladaptive identity, including a denial of the implications of heart disease that can lead to behaviours which promote morbidity). Early indications are that supportive online interactions can foster the development of a positive persona of a “heart patient“. At the optimistic end of the response-spectrum, a positive heart patient is a person who is keenly motivated to maximise their health and—if possible—halt or reverse (see, for example, Esselstyn) the progress of their disease. Such a response can be constituted and enhanced via supportive online interactions. Insofar as medical commentators theorise about reactions to a life-changing health diagnosis, this tends to be in terms of self-image (see, for example, Petrie et al.) and sometimes includes Kubler-Ross’s stages of grief: Denial, Anger, Bargaining, Depression and Acceptance. The results reported here look instead at issues of adapting to a new identity as “heart patient” that potentially involves positive commitment to improved health, partly as a result of giving and receiving social support. The rationale behind this perspective is influenced by significant evidence that compliance with the therapeutic regimes recommended and prescribed by physicians is lacking. It is speculated that patients are enacting a denial of the importance of the health challenges confronting them. For example, Hugtenburg et al. found that “of 232 first-time chronic medicine prescriptions [repeats], 132 were not collected at all (46.1%) or too late (11%).” Noting that 46% of the 232 prescriptions studied were for cardiovascular drugs (353), Hugtenburg et al. conclude that “This kind of non-compliance may result in an increased health risk as well as constituting a waste of a large amount of money” (352). Clearly, more emphasis needs to be placed on communicating constructively with patients and supporting the evolution and reconstitution of an identity that includes positive constructions of self-as-heart-patient and that works to facilitate recovery. The Website that enables the HeartNET community was developed by the National Heart Foundation (WA Branch: NHFWA) and Edith Cowan University (ECU) as part of an ARC-Linkage grant, 2004-6 “Evaluating the effectiveness of online support in building community, promoting healthy behaviours and supporting philanthropy”. The first three months of the Website’s operation (when the tiny number of postings trickled away and then dried up completely) are reported in Bonniface et al. (“Affect”) and graphed below (see Figure 1). They followed on from a careful process of recruitment via databases of existing heart patients that were held by the NHFWA and supportive cardiologists. Participants were approached to gain ethical consent, and would-be Website participants were matched with people who had equivalent heart illness, but who weren’t invited to join the HeartNET community, thus acting as comparisons. Baseline data was collected to compare “before” the HeartNET intervention with the yet-to-be collected “after” data. The idea was to see if there were differences between the online and offline groups that could be attributed to Website activity. Instead, the first version of the supposed-community remained stillborn, and it wasn’t until the Website was thrown open to all comers that it began to thrive. This was a preliminary indication that an invitation to participate in a therapeutic community was not effective, by itself, in encouraging communication with people who shared important health-related experiences. While Website engagement might have fitted comparatively well into a (Kubler-Ross) Bargaining approach to heart patients’ illnesses (“I’ll help others, and they’ll help me”) the default position appeared to be non-engagement, possibly an indication of the patients having become “stuck“ in the first stage of grief, Denial. Even though the initial HeartNET participants were well established as heart patients, and had all been diagnosed some time earlier, it is possible that they preferred to ignore the implications of this for their health. Figure 1 records the patterns of postings made by the 68 people who agreed to join the HeartNET Web community and who signed and returned the ethical consent forms. Of the 68 people recruited, only 53 logged on (despite phone calls to every individual) and of the 53 who logged into the site, only 22 posted (Bonniface et al. “Affect”). The heaviest week’s traffic was 40 postings in Week 4. By Week 12, activity had ceased entirely. The decision to relaunch had been taken a fortnight earlier and the first iteration of the Website was closed down. Figure 1, reprinted from Bonniface et al (“Affect”) The relaunch of the Website made it available for anyone interested in participating, and membership and traffic both grew exponentially. Amongst other innovations were “newbie” icons (to indicate new members to be welcomed and nurtured), guest status (to “try before you buy”), and symbols to indicate whether the member was a heart patient, a family member or supporter, or an administrator. In due course a “ratings system“ was added to indicate the total number of member-postings to date, so that people could gauge an individual’s commitment and contribution to the community. People contributing up to 150 posts to discussion boards were allotted from one to five stars, while Superstar status indicated 1000-plus posts. One of the major differences between the group of heart patients invited to participate in the site’s first iteration, and the group that ultimately launched the Website as a viable and vibrant community, is that the second-stage members were generally recently diagnosed. The research team speculate that they were actively reconstituting their identities as heart patients, and they and their families consequently had many matters and issues they wanted to discuss. In effect, the people who joined the relaunched site were “learning“ to be heart patients. Weis et al., investigating a pharmaceutically-sponsored Website for MS sufferers, argued that “users are diverse” and “communication needs change over time [as the disease progresses]” (146). They found that, of the 943 users who responded to their online survey, indications were that participants used “the website the most during early stages of the disease” (135). However, one area the HeartNET research is investigating is whether a community-member whose persona includes “care and support for my Web community“ will continue to participate even after the first information-seeking phase of their illness is over. Support offered for new heart patients by cardiologists, hospital staff, other specialists and general practitioners is an important part of the enculturation of the self-as-heart-patient, but it leaves unexplored the more personal work of reconstituting the individual’s identity as a person with heart disease (or as a supporter of such a person). It also leaves unaddressed the sense of “aloneness“ that HeartNET members say they feel until they are able to talk regularly with people who understand exactly what they are going through, as a result of having already “been there“ themselves. Although health professionals, family and friends are supportive, that support is only occasionally able to cut through the isolation. Extracts from two (separate) interviews are typical of the kinds of comments made: Murphy: I mean the support from Sandra and the family was all great but—to actually talk to other people who know what you’re feeling and … Yes, nothing against family and friends but they’re [other patients are] going through the same thing, they know what you’re feeling and … you know. Margo: I found friends were pains. It was like “well, okay, but you’re better now, they fixed you.” Well I looked at her and I said, ‘“You’re never fixed, but [it’s] something you live with for the rest of your life that doesn’t go away. …’ The implication is that heart patients have a differential need to communicate with others about their experience of heart disease, and that the communicative imperative is greatest in the first stages of being a heart patient, soon after diagnosis. For the well-established patients invited to contribute to the original HeartNET Website, their status as people-with-heart-disease was no longer problematic. Consequently, they had little to say and very few incentives to revisit the adaptive processes of personal identity construction. People who are used to their status as a heart patient may be theorised as having very different information needs and behaviours compared with the newly diagnosed. There is evidence that at least some of these well established patients were prompted to engage when new patients who needed support joined the site in the second iteration. However, those who are never given the opportunity to interact and learn from others may take longer to reach a level of adaptation. Even worse, they may adopt maladaptive behaviours encompassing issues of denial or self-sabotage—such as rejecting medications or increasing behaviours which progress morbidity, such as smoking and excessive alcohol consumption. Patients’ denial of the implications of heart disease is recognised as a major medical problem. Cooper et al. (234) cite evidence from Petrie et al. that “only a third of eligible patients under 65 years old attended cardiac rehabilitation” while noting that “Ades et al. showed uptake as low as 21% in eligible patients over 62 years”. In another study of patients who did/did not adhere to their pharmacological treatment regime, Horwitz et al. found that “Compared with patients with good adherence, patients with poor adherence were twice as likely to have died within a year of follow-up.” They argue that “adherence may need to be viewed more broadly as encompassing a cluster of health-related behaviours that may influence the outcome of treatment.” The argument advanced in our paper is that such a broader view should also encompass necessary adaptation strategies which introduce positive influences to the formation of patient identity. Compliance with therapeutic and medical regimes has been linked to increased self esteem (Burkhart and Rayens), and the combination of compliance with a positive patient identity may well multiply beneficial health outcomes. Whereas currently a majority of recovering heart patients may be inferred as resisting a revised self-identity that takes their diagnosis and health challenges seriously, the HeartNET Website may offer an effective enticement to positive behavioural change. Bonniface et al. (“Shuffling buddies”) have demonstrated that engagement with HeartNET can influence attitudes to (and involvement in) exercise. The hypothesis regarding identity adaptation is that active HeartNET members, through Website engagement, consistently indicate a willingness to acknowledge their changed health status and work to develop a reconstituted identity as a person with a heart condition who is proactively maximising positive outcomes (and helping others to do so at the same time). This is particularly the case where the online engagement feeds into the offline world: where “shuffling buddies“ have developed mutually supportive walking and exercise regimes, involving social events, consistent with their commitment to health-enhancing activity. Adaptation strategies delivered online offer new ways to counter the maladaptive processes which can follow diagnosis. By using the raw materials of social support and Website engagement, patients can chart new and positive ways in which they progress from denial and bargaining to health-promoting acceptance. For those established patients, online engagement may progress the stages of grief beyond the level of acceptance to the end goal of “support” as they pass on their knowledge, empathy and understanding of illness to the newly diagnosed. References Ades, Philip, M. L. Waldman, W. J. McCann, and S. O. Weaver. “Predictors of Cardiac Rehabilitation Participation in Older Coronary Patients.” Archives of Internal Medicine 152.2 (1992): 1033-5. Bonniface, Leesa, Lelia Green, and Maurice Swanson. “Affect and an Effective Online Therapeutic Community.” M/C Journal 8.6 (2005). 22 Apr. 2007 . Bonniface, Leesa, Arshad Omari, and Maurice Swanson. “Shuffling Buddies—How an Online Community Supports Healthier Lifestyle Choices: An Early Indication of Physical Activity and Exercise Outcomes from the HeartNET Intervention.” Proceedings of the Fifth International Conference on Cultural Attitudes towards Technology and Communication. Eds. F Sudweeks, H Hrachovec and C Ess. Estonia, Tartu: School of Information Technology, Murdoch University, 2006. 90-101. Burkhart, Patricia, and Mary Rayens. “Self-Concept and Health Locus of Control: Factors Related to Children’s Adherence to Recommended Asthma Regimen.” Pediatric Nursing 31.5 (2005): 404-9. Campbell, Colin, and Thomas Campbell. The China Study: Startling Implications for Diet, Weight Loss and Long-Term Health. Dallas, TX: Benbella Books, 2004. Cooper, A., G., Lloyd, J. Weinman, and G. Jackson. “Why Patients Do Not Attend Cardiac Rehabilitation: Role of Intentions and Illness Beliefs.” Heart 82.2 (1999): 234-6. Horwitz, Ralph, Catherine Viscoli, Lisa Berkman, Robert Donaldson, Sarah Horwitz, Carolyn Murray, David Ransohoff, and Jody Sindelar. “Treatment Adherence and Risk of Death after a Myocardial Infarction.” The Lancet 336 (1990): 542-5. Hugtenburg, J. G., A. T. G. Blom, and S. U. Kisoensingh. “Initial Phase of Chronic Medication Use; Patients’ Reasons for Discontinuation.” British Journal of Clinical Pharmacology 61.3 (2005): 352-4. Kubler-Ross, Elisabeth. On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families. New York: Macmillan, 1969. Ladwig, Karl-Heinz, Andreas Schoefinius, Gerhard Dammann, Reinhold Danner, Rolf Gurtler, and Robert Hermann. “Long-Acting Psychotraumatic Properties of a Cardiac Arrest Experience.” American Journal of Psychiatry 156.6 (1999): 912-9. Esselstyn, C.B. Jr. Prevent and Reverse Heart Disease. New York: Penguin Group, 2007. Petrie, Keith, John Weinman, Sharpe Norman, and Judith Buckley. “Role of Patients’ View of Their Illness in Predicting Return to Work and Functioning after Myocardial Infarction: Longitudinal Study.” British Medical Journal 312 (1996): 1191-4. Weis, Robert, Keith Stamm, Craig Smith, Michael Nilan, Fiona Clark, Joan Weis, and Kate Kennedy. “Communities of Care and Caring: The Case of Mswatch.Com.” Journal of Health Psychology 8.1 (2003): 135-48. Citation reference for this article MLA Style Green, Lelia, Leesa Bonniface, and Tami McMahon. "Adapting to a New Identity: Reconstituting the Self as a Heart Patient." M/C Journal 10.2 (2007). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0705/13-bonnifacegreenmcmahon.php>. APA Style Green, L., L. Bonniface, and T. McMahon. (May 2007) "Adapting to a New Identity: Reconstituting the Self as a Heart Patient," M/C Journal, 10(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0705/13-bonnifacegreenmcmahon.php>.

Editorial – Revista Ambiente Contábil – Volume 15 – Número 1 – Ano 2023 (Jan./Jun. 2023) A Revista Ambiente Contábil (Ambiente) apresenta na sua 29ª edição 18 (dezoito) artigos que tratam de assuntos relevantes para a área contábil e 12 (doze) artigos no idioma inglês (versões de artigos submetidos em português). Seção 1: Contabilidade Aplicada ao Setor Empresarial Artigo 1 - Desempenho das operadoras de planos de saúde: antes e durante a pandemia de Tâmara Ribeiro Rosa Marques, Elis Regina de Oliveira, Geovane Camilo dos Santos, Brasilino José Ferreira Neto e Ronivaldo Alcebíades Ferreira com o objetivo de analisar o desempenho econômico-financeiro e operacional das Operadoras de Planos de Saúde (OPS), antes (3T2018-4T2019) e durante a pandemia (1T2020-2T2021) à luz da teoria do isomorfismo institucional. Artigo 2 – A relevância dos fatos relevantes: um estudo das empresas do novo mercado que compõem o Índice Bovespa (IBOV [B]³) de Jéssika Vieira Gomes e Carlos Henrique Silva do Carmo com o objetivo de analisar como as divulgações das diferentes categorias de Fatos Relevantes (FRs) influenciam no retorno das companhias do Novo Mercado (NM) integrantes do IBOV no período de 2014 a 2017. Artigo 3 - Competências em tecnologia e sistema da informação demandadas em ciências contábeis: o exame nacional de desempenho dos estudantes (ENADE) de Roberto Fonseca de Aguiar, Paola Lomeu Ferreira e Monica Zaidan Gomes com o objetivo de identificar e analisar as habilidades e competências de Tecnologia da Informação [TI] e Sistemas de Informação [SI] que são objeto de avaliação do ENADE na área de Ciências Contábeis. Artigo 4 - Controller híbrido: principais competências e habilidades de Pedro Henrique Diehl Cabral e Wendy Beatriz Witt Haddad Carraro com o objetivo de identificar na literatura científica as principais competências técnicas e habilidades profissionais associadas aos perfis de controller técnico bean counter e gerencial business partner. Artigo 5 - Fatores que influenciam o nível de divulgação dos ativos intangíveis das empresas listadas no IBrX-50 de Aldir Dias de Amurim, Carla Renata Silva Leitão e José Jonas Alves Correia com o objetivo de identificar fatores financeiros e de governança que podem influenciar o nível de divulgação dos ativos intangíveis das empresas listadas no IBrX-50. Artigo 6 - Accrualls e risco sistemático nas empresas brasileiras de José Luciano de Oliveira Junior, Valcemiro Nossa, Silvania Neris Nossa e Edvan Soares Oliveira com o objetivo de investigar se o risco sistemático das empresas listadas na Bolsa de valores brasileira (B3) é afetado pela qualidade das informações contábeis. Artigo 7 - Análise dos indicadores de produção e distribuição do valor adicionado da Natura S. A. de Ana Paula Lemes da Silva, Renata Mendes de Oliveira, Thiago Alberto dos Reis Prado, Carlos Eduardo de Oliveira com o objetivo de analisar os indicadores de produção e distribuição do valor adicionado da Natura S.A, na busca por evidenciar o comportamento dos mesmos no período entre 2011 e 2020. Artigo 8 - Efeitos do CPC 47 no gerenciamento de resultados das empresas listadas na B3 de André Lamblet Dias, Ludmilla Gomes da Silva dos Anjos, Thiago de Abreu Costa e José Augusto Veiga da Costa Marques com o objetivo de analisar os efeitos da adoção do Pronunciamento Técnico CPC 47 no nível do gerenciamento de resultados das empresas listadas no mercado brasileiro de capitais. Seção 2: Contabilidade Aplicada ao Setor Público e ao Terceiro Setor Artigo 1 - Ciclos políticos e investimentos em infraestrutura: análise entre capitais brasileiras de Lorrany de Assis Oliveira, Vagner Alves Arantes e Rodrigo Silva Diniz Leroy com o objetivo de analisar os efeitos dos ciclos políticos nos investimentos em infraestrutura das capitais brasileiras, no horizonte de 2009 a 2019. Para tanto, adota-se como perspectiva de análise a Teoria dos Ciclos Políticos. Artigo 2 - A difícil construção da accountability pública perante os tribunais de contas brasileiros de Letícia Silva, Roberto Sérgio do Nascimento, Edson da Silva França e Ricardo Viotto com o objetivo de analisar se há evidências consistentes de que os tribunais de contas brasileiros estão utilizando as tecnologias da informação e comunicação (TICs) como instrumentos de melhoria da transparência, accountability e participação cidadã das ações que desempenham relativas ao controle das finanças públicas. Artigo 3 - Evidenciação de ativos imobilizados por parte dos governos subnacionais brasileiros de Eduardo Costa Brandão, Roberto Sérgio do Nascimento, Edson da Silva França e Ricardo Viotto com o objetivo de analisar a evolução do tratamento contábil dado aos ativos imobilizados por parte das entidades do setor público brasileiro ante ao processo de convergência das Normas Brasileiras de Contabilidade aos padrões internacionais. Artigo 4 - Eficiência dos gastos públicos com atenção básica à saúde: análise dos municípios de São Paulo de Sara Pereira da Silva e Jaime Crozatti com o objetivo de analisar a eficiência dos municípios paulistas com os gastos na subfunção Atenção Básica à Saúde no ano de 2018 e sua associação com a localização geográfica, o tamanho da população, a riqueza gerada no município (PIB - Produto Interno Bruto) e os gastos orçamentários com esta política pública. Seção 3: Pesquisas de Campo sobre Contabilidade (Survey) Artigo 1 - Análise do conhecimento dos discentes de ciências contábeis acerca dos red flags no processo investigativo da fraude de Meire Regina Oliveira Costa, Caritsa Scartaty Moreira, Jocykleber Meireles de Souza e Camilla Araújo Amaral Duarte com o objetivo de analisar as percepções dos discentes de Ciências Contábeis, das universidades públicas da cidade de Mossoró/RN, sobre os red flags no processo investigativo de fraude contábil. Artigo 2 - Práticas de gestão nas empresas de comércio varejista na região leste da cidade de Porto Alegre (RS) de George Wellingthon Ladvig Ribeiro, Márcia Bianchi e Lauren Dal Bem Venturini com o objetivo de identificar as práticas contábeis gerenciais utilizadas nas organizações de comércio varejista na Região Leste da cidade de Porto Alegre (RS). Artigo 3 - Análise de fatores contingenciais e sistemas de controles gerenciais associados às práticas de gestão sustentáveis de Thayná de Oliveira Fernandes, Renata Paes de Barros Câmara e Gilson Rodrigues da Silva com o objetivo de analisar como os fatores contingenciais e o uso de sistemas de controle gerencial estão associados às práticas de gestão sustentáveis em organizações. Artigo 4 - Ensinando sustentabilidade a estudantes de ciências contábeis: reduzindo sua pegada ecológica (PE) de Ane Karoline de Oliveira Mendes, Karine Bonfim da Silva, Franciele Machado de Souza e Rosaly Machado com o objetivo de analisar as mudanças na composição da pegada ecológica (PE) dos estudantes de ciências contábeis suscitadas pelo ensino da sustentabilidade. Artigo 5 - Os ativos intangíveis mais relevantes na geração de valor em empresas de economia criativa de Paulo Henrique Leite Valença e Adilson Celestino de Lima com o objetivo de identificar quais são variáveis que melhor explicam a geração de valor em empresas de economia criativa que apresentam alto investimento em ativos intangíveis. O estudo focou o setor de economia criativa do Porto Digital da cidade do Recife, Pernambuco, Brasil. Artigo 6 - Estilos de aprendizagem e técnicas de ensino: uma análise sobre seus efeitos no conhecimento adquirido de Cristiane Munhoz de Azevedo, Alexandre Costa Quintana e Marco Aurélio Gomes Barbosa com o objetivo de averiguar se os estilos de aprendizagem dos alunos impactam no conhecimento adquirido levando em consideração a aplicação de técnicas de ensino em sala de aula, buscando, especificamente, saber se os sujeitos estudados aprendem no decorrer da aplicação da técnica. Seção 4: Casos de Ensino Aplicados a Contabilidade Não houve submissão. Seção 5: Resenhas de Teses, Dissertações e Livros sobre Contabilidade Não houve submissão. Seção 6: Banco de Dados (Arquivos suplementares em Excel) Arquivos não incluídos. Seção 7: Internacional (S7) ENGLISH Section 1 Article 1 (Section 1) - Performance of health plan operators: before and during the pandemic of Tâmara Ribeiro Rosa Marques, Elis Regina de Oliveira, Geovane Camilo dos Santos, Brasilino José Ferreira Neto and Ronivaldo Alcebíades. To analyze the economic-financial and operational performance of Health Plan Operators (HPO), before (3Q2018-4Q2019) and during the pandemic (1Q2020-2Q2021) under the theory of institutional isomorphism. Article 3 (Section 1) - Competencies in technology and information system demanded in accounting sciences: the national student performance exam (ENADE) of Roberto Fonseca de Aguiar, Paola Lomeu Ferreira and Monica Zaidan Gomes. Identify and analyze the skills and competencies of Information Technology [IT] and Information Systems [IS] that are the object of evaluation of ENADE in Accounting Sciences. Article 4 (Section 1) - Hybrid controller: main competences and skills of Pedro Henrique Diehl Cabral and Wendy Beatriz Witt Haddad Carraro. To identify in the scientific literature the main technical competences and professional skills associated with the technical bean counter and managerial business partner controller profiles. Article 6 (Section 1) - Accrualls and systematic risk in Brazilian companies of José Luciano de Oliveira Junior, Valcemiro Nossa, Silvania Neris Nossa and Edvan Soares Oliveira. The objective of this study was to investigate whether the systematic risk of companies listed on the Brazilian Stock Exchange (B3) is affected by the quality of accounting information. Additionally, it was verified if the systematic risk was affected differently after the mandatory adoption of IFRS in Brazil. Article 8 (Section 1) - The effects of CPC 47 on earnings management in companies listed in B3 of André Lamblet Dias, Ludmilla Gomes da Silva dos Anjos, Thiago de Abreu Costa and José Augusto Veiga da Costa Marques. The objective of this study is to analyze the effects of adopting CPC 47 on the level of the earnings management of companies listed in the Brazilian capital market. Section 2 Article 2 (Section 2) - The difficult construction of public accountability before the Brazilian courts of accounts of Letícia Silva, Roberto Sérgio do Nascimento, Edson da Silva França and Ricardo Viotto. To analyze whether there is consistent evidence that Brazilian audit courts are using information and communication technologies (CITs) as instruments to improve transparency, accountability and citizen participation of actions related to the control of public finances. Article 3 (Section 2) - Evidence of fixed assets by Brazilian subnational governments of Eduardo Costa Brandão, Roberto Sérgio do Nascimento, Edson da Silva França e Ricardo Viotto. To analyze the evolution of the accounting treatment given to fixed assets by Brazilian public sector entities in the face of the process of convergence of Brazilian Accounting Standards to international standards. Article 4 (Section 2) - Efficiency of public spending on primary health care: analysis of São Paulo’s cities of Sara Pereira da Silva and Jaime Crozatti. To analyze the efficiency of São Paulo’s cities with spending on the Primary Health Care sub-function in the year of 2018 and its association with geographic location, population size, wealth generated in the city (GDP – Gross Domestic Product) and budget expenditures with this public policy. Section 3 Article 2 (Section 3) - Management practices in retail trade companies in the east region of the city of Porto Alegre (RS) of George Wellingthon Ladvig Ribeiro, Márcia Bianchi and Lauren Dal Bem Venturini. To identify the managerial accounting practices used in retail organizations in the Eastern Region of the city of Porto Alegre (RS). Moreover, study the effects of the Covid-19 pandemic and the importance attributed to financial reports and management instruments and data analysis systems for taking decisions. In a complementary way, the effect of the Covid-19 pandemic and the importance attributed to financial reports and management instruments and data analysis systems for decision making are investigated. Article 3 (Section 3) - Analysis of contingency factors and management control systems associated with sustainable management practices of Thayná de Oliveira Fernandes, Renata Paes de Barros Câmara and Gilson Rodrigues da Silva. The objective of this study was to analyze how contingency factors and the use of management control systems are associated with sustainable management practices in organizations. Article 4 (Section 3) – Teaching sustainability to accounting students: reducing their ecological footprint (EF) of Ane Karoline de Oliveira Mendes, Karine Bonfim da Silva, Franciele Machado de Souza and Rosaly Machado. To analyze the changes in ecological footprint (EF) composition of accounting students caused by the teaching of sustainability. Article 5 (Section 3) - The most relevant intangible assets in generating value in creative economy companies of Paulo Henrique Leite Valença and Adilson Celestino de Lima. This work seeks to identify which variables best explain the generation of value in creative economy companies that have high investment in intangible assets. The study focused on the creative economy sector of Porto Digital in the city of Recife, Pernambuco, Brazil. Boa leitura. Cordiais saudações! Prof. Dr. Maurício Corrêa da Silva Editor Gerente da Revista Ambiente Contábil

Taste and Lively Matter in the Anthropocene This paper is concerned with the role of taste in relation to food produced in backyard or community gardens. Taste, as outlined by Bourdieu, is constructed by many factors driven primarily by one’s economic position as well as certain cultural influences. Such arguments tend to work against a naïve reading of the “natural” attributes of food and the biological impulses and responses humans have to taste. Instead, within these frameworks, taste is positioned as a product of the machinations of human society. Along these lines, it is generally accepted that the economic and, consequently, the social shaping of tastes today have been significantly impacted on by the rise of international agribusiness throughout the twentieth century. These processes have greatly reduced the varieties of food commercially available due to an emphasis on economies of scale that require the production of food that can be grown in monocultures and which can withstand long transport times (Norberg-Hodge, Thrupp, Shiva). Of course, there are also other factors at play in relation to taste that give rise to distinction between classes. This includes the ways in which we perform our bodies and shape them in the face of our social and economic conditions. Many studies in this area focus on eating disorders and how control of food intake cannot be read simply as examples of disciplined or deviant bodies (Bordo, Probyn, Ferreday). Instead, the links between food and subjectivity are much more complex. However, despite the contradictions and nuance acknowledged in relation to understandings of food, it is primarily conceptualised as an economic and symbolic good that is controlled by humans and human informed processes. In line with the above observations, literature on food provisioning choices in the areas of food sociology and human geography tends to focus on efforts to understand food purchasing decisions and eating habits. There is a strong political-economic dimension to this research even when its cultural-symbolic value is acknowledged. This is highlighted by the work of Julie Guthman which, among other things, explores “the conversion of tastes into commodities (as well as the reverse)” (“Commodified” 296). Guthman’s analysis of alternative food networks, particularly the organic sector and farmers markets, has tended to reaffirm a Bourdieuan understanding of class and distinction whereby certain foods become appropriated by elites, driving up price and removing it from the reach of ordinary consumers (“Commodified”, “Fast Food”). There has also been, however, some recognition of the limits of such approaches and acknowledgement of the fragility and porous nature of boundaries in the food arena. For example, Jordan points out in her study of the heirloom tomato that, even when a food is appropriated by elites, thereby significantly increasing its cost, consumption of the food and its cultural-symbolic meaning can continue unchanged by those who have traditionally produced and consumed the food privately in their gardens. Guthman is quite right to highlight the presence of huge inequities in both mainstream and alternative food systems throughout the world. Food may, however, be able to disrupt the dominance of these economic and social representations through its very own agentic qualities. To explore this idea, this paper draws on the work of political theorist, Jane Bennett, and eco-feminist, Val Plumwood, and applies some of their key insights to data gathered through in-depth interviews with 20 community gardeners and 7 Canberra Show exhibitors carried out from 2009 to 2012. These interviews were approximately 1 to 2 hours long in duration and were carried out in, or following, an extensive tour of the gardens of the participants, during which tastings of the produce were regularly offered to the interviewers. Jane Bennett sets out to develop a theoretical approach which she names “thing-power materialism” which is grounded in the idea that objects, including food, have agency (354). Bennett conceptualises this idea through her notion of “lively matter” and the “thing power” of objects which she defines as “the curious ability of inanimate things to animate, to act, to produce effects dramatic and subtle” (“The force” 351, “Vibrant”). The basic idea here is that if we are willing to read agency into the nonhuman things around us, then we become forced to recognise that humans are simply one more element of a world of things which can act on, with or against others through various assemblages (Deleuze and Guatarri). These assemblages can be made, undone and rebuilt in multiple ways. The power of the elements to act within these may not be equal, but nor are they stable and static. For Bennett, this is not simply a return to previous materialist theories premised on naïve notions of object agency. It is, instead, a theory motivated by attempts to develop understandings and strategies that encourage engaged ecological living practices which seek to avoid ongoing human-inflicted environmental damage caused by the “master rationality” (Plumwood) that has fuelled the era of the anthropocene, the first geological era shaped by human action. Anthropocentric thinking and its assumptions of human superiority and separateness to other elements of our ecological mesh (Morton “Thinking”) has been identified as fuelling wasteful, exploitative, environmentally damaging practices. It acts as a key impediment to the embrace of attitudinal and behavioural changes that could promote more ecologically responsible and sustainable living practices. These ideas are particularly prominent in the fields of ecological humanities, ecological feminism and political theory (Bennett “The force”, “Vibrant”; Morton “Ecological”, “Thinking”, “Ecology”; Plumwood). To redress these issues and reduce further human-inflicted environmental damage, work in these spaces tends to highlight the importance of identifying the interconnections and mutual reliance between humans and nonhumans in order to sustain life. Thus, this work challenges the “master rationality” of the anthropocene by highlighting the agentic (Bennett “The force,” “Vibrant”) or actant (Latour) qualities of nonhumans. In this spirit, Plumwood writes that we need to develop “an environmental culture that values and fully acknowledges the nonhuman sphere and our dependency on it, and is able to make good decisions about how we live and impact on the nonhuman world” (3). Food, as a basic human need, and its very gustatory taste, is animated by nonhuman elements. The role of these nonhumans is particularly visible to those who engage in their own gardening practices. As such, the ways in which gardeners understand and speak of these processes may provide insights into how an environmental culture as envisaged by Plumwood could be supported, harnessed and shared. The brevity of this paper means only a quick skim of the murky ontological waters into which its wades can be provided. The overarching aim is to identify how the recent resurgence of cultural materiality can be linked to the ways in which everyday people conceptualise and articulate their food provisioning practices. In so doing, it demonstrates that gardeners can conceptualise their food, and the biological processes as well as the nonhuman labour which bring it to fruition, as having actant qualities. This is most overtly recognised through the gardeners’ discussions of how their daily habits and routines alter in response to the qualities and “needs” of their food producing gardens. The gardeners do not express this in a strict nature/culture binary. Instead, they indicate an awareness of the interconnectedness and mutual reliance of the human and nonhuman worlds. In this way, understandings of “taste,” as produced by human centred relations predicated on exchange of capital, are being rethought. This rethinking may offer ways of promoting a more sustainable engagement with ecological beliefs and behaviours which work against the very notion of human dominance that produced the era of the anthropocene. Local Food, Taste and Nonhuman Agency Recent years have seen an increase in the purchasing, sale and growing of local food. This has materialised in multiple forms from backyard, verge and community gardens to the significant growth of farmers markets. Such shifts are attributed to increasing resistance to the privileging of globalised and industrial-scale agri-business, practices which highlight the “master rationality” underpinning the anthropocene. This backlash has been linked to environmental motivations (Seyfang “Shopping,” “Ecological,” “Growing”); desires to support local economies (particularly the financial well-being of farmers) (Norberg-Hodge); and health concerns in relation to the use of chemicals in food production (Goodman and Goodman). Despite evidence that people grow or buy food based on gustatory taste, this has received less overt attention as a motivator for food provisioning practices in the literature (Hugner). Where it is examined, taste is generally seen as a social/cultural phenomenon shaped by the ideas related to the environmental, economic and health concerns mentioned above. However, when consumers discuss taste they also refer to notions of freshness, the varieties of food that are available, and nostalgia for the “way food used to be”. Taste in its gustatory sense and pleasure from food consumption is alluded to in all of the interviews carried out for this research. While the reasons for gardening are multiple and varied, there is a common desire to produce food that tastes better and, thus, induces greater pleasure than purchased food. As one backyard gardener and successful Royal Canberra Show exhibitor notes: “[e]verything that you put [grow] in the garden [has a] better taste than from the market or from the shop.” The extent of this difference was often a surprise for the gardeners: “I never knew a home grown potato could taste so different from a shop bought potato until I grew [my own] […] and I couldn’t believe the taste.” The gardeners in this research all agreed that the taste of commercially available fruit and vegetables was inferior to self-produced food. This was attributed to the multiple characteristics of industrialised food systems. Participants referred specifically to issues ranging from reduction in the varieties available to the chemical intensive practices designed to lead to high yields in short periods of time. The resulting poor taste of such foods was exemplified by comments such as shop bought tomatoes “don’t taste like tomatoes” and the belief that “[p]otatoes and strawberries from the shop taste the same as each other”. Even when gardeners raised health concerns about mainstream food, emphasising their delight in growing their own because they “knew what had gone into their food” (Turner, “Embodied”), the issue of taste continued to play an important role in influencing their gardening practices. One gardener stated: “I prefer more [food that] is tasty than one that is healthy for me”. The tastiest food for her came from her own community garden plot and this motivated her to travel across town most days to tend the garden. While tasty food was often seen as being more nutritious, this was not the key driver in food production. The superior taste of the fruit and vegetables grown by these gardeners in Canberra calls their bodies and minds into action to avoid poor tasting food. This desire for tasty food was viewed as common to the general population but was strongly identified as only being accessible to people who grow their own. A backyard gardener, speaking of the residents of an aged care facility where he volunteers observes: “[w]hen you…meet these people they've lost that ability to do any gardening and they really express it. They miss the taste, the flavours.” Another backyard gardener and Show exhibitor recounted a story from two years prior when he and his wife invited guests for a New Year’s Day lunch. While eating their meal, a guest asked “did you grow these carrots?” When he confirmed that he had, she declared: “I can taste it.” Others noted that many young people don’t know what they are missing out on because they have never tasted home-grown produce. Through the sense of taste, the tomatoes, potatoes and carrots and myriad of other foodstuffs grown at homes or in community gardens actively encourage resistance to, or questioning of, the industrial agricultural system and its outputs. The gardeners link poor tasting food to a loss of human responsiveness to plants resulting from the spatial characteristics of industrial agriculture. Modern agribusiness requires large-scale, global production and streamlined agricultural processes that aim to limit the need for producers to respond to unique climatic and soil conditions (through genetically modification technology, see Turner, “Reflections”) and removes the need, and capacity, for individual care of plants. This has led to heavy reliance on agricultural chemicals. The gardeners tend to link high-level usage of pesticides and herbicides with poor taste. One highly successful Show exhibitor, states that in his food, “There’s better taste …because they haven’t got the chemicals in them, not much spray, not much fertiliser, for that is better”. However, when chemical use is limited or removed, the gardeners acknowledge that food plants require more intensive and responsive human care. This involves almost daily inspection of individual plants to pick off and squash (or feed to chickens and birds) the harmful bugs. The gardeners need to be vigilant and capable of developing innovative techniques to ensure the survival of their plants and the production of tasty food. They are, of course, not always successful. One organic community gardener lamented the rising populations of slaters and earwigs which could decimate whole beds of newly sprouted seedlings overnight. This was a common issue and, in response, the gardeners research and trial new methods of control (including encouraging the introduction of “good” bugs into the ecosystem through particular plantings). Ultimately, however, the gardeners were resigned to “learn[ing] to live with them [the ‘bad’ bugs]” while exerting regular bodily and mental efforts to reduce their populations and maximise their own food production. The lack of ultimate control over their growing patch, and the food it could produce, was acknowledged by the gardeners. There was an awareness and understanding of the role nonhuman elements play in food production, ranging from weather conditions to soil microbes to bugs. The gardeners talk of how their care-giving is responsive to these elements. As one community gardener asserts: “…we prefer to … garden in a way that naturally strengthens the plant immune system.” This involves regular attention to soil microbes and the practice of what was referred to as “homeopathic” gardening. Through a responsive approach to the “needs” of plants, the soil, and other nonhuman elements, the plants then delivered “vitamins and minerals” to the gardeners, packaged in tasty food. The tastiest foods ensured their survival through seed-saving practices: “[i]f something tastes good, we’ll save the seed from it”. In this way, the plant’s taste encourages gardeners to invest their human labour to secure its future. The production of tasty food was understood to be reliant on collaborative, iterative and ongoing efforts between human and nonhuman elements. While gardening has often been represented as an attempt to bend nature to the will of humans (Power), the gardeners in this study spoke about working with nature in their quest to produce good tasting food. This was particularly evident in the interviews with gardeners who exhibit produce in the Canberra Show (see NMA for further details). However, despite the fact that taste is the key motivator for growing their own food, it is not a factor in Show judging. Instead, fruit and vegetable entries (those not turned into value added goods such as jams or relishes) are judged on appearance. While this focus on appearance tends to perpetuate the myth that the fruits and vegetables we consume should conform to an ideal type that are blemish free and uniform in size (just as is prized in industrialised agriculture), the act of gardening for the Show and the process of selecting produce to enter, contradicted this assumption. Instead, entering the Show seemed to reinforce awareness of the limits of human control over nature and emphasise the very agency of nonhuman elements. This is highlighted by one exhibitor and community gardener who states: I suppose you grow vegetables for the enjoyment of eating them, but there’s also that side of getting enough and perfecting the vegetables and getting… sometimes it’s all down to the day of whether you’ve got three of something, if it’s the right size and colour and so I’ll enter it [in the Show] on the day instead of putting an entry form in before …you just don’t know what you’re going to have, the bugs decide to eat this or the mice get it or something. There’s always something. In this way, where “there’s always something” waiting to disrupt a gardener’s best laid plans, the exhibitors involved in this project seem to be acutely aware of the agency of nonhumans. In these interviews there is evidence that nonhuman elements act on the gardeners, forcing them to alter their behaviours and engage with plants to meet both of their needs. While perfect specimens can sometimes be grown for the Show, the gardeners acknowledge that this can only be done with an element of luck and careful cultivation of the partnership between human and nonhuman elements in the garden. And, even then, you never know what might happen. This lack of ultimate control is part of the challenge and, thus, the appeal, of competing in the Show. Conclusion The era of the anthropocene demonstrates the consequences of human blindness to ecological matters. Myths of human supremacy and a failure to respect nonhuman elements have fuelled a destructive and wasteful mentality that is having serious consequences for our environment. This has prompted efforts to identify new environmental cultures to promote the adoption of more sustainable lifestyles. The resurgence of cultural materialism and the agentic capacity of objects is one key way in which this is being explored as a means of promoting new ethical approaches to how humans live their lives enmeshed with nonhumans. Food, as a basic necessity, provides a key way in which the interconnected relationships between humans and nonhumans can be brought to the fore. Taste, as a biological response and organic attribute of foodstuffs, can induce humans to act. It can cause us to alter our daily habits, behaviours and beliefs. Perhaps a more attentive approach to food, its taste and how it is produced could provide a framework for rethinking human/nature relations by emphasising the very limits of human control. References Bordo, Susan. Unbearable Weight: Feminism, Western Culture and the Body. Berkeley, CA: U of California P, 1993. Bourdieu, Pierre. Distinction: A Social Critique of the Judgement of Taste. Trans. R. Nice. Cambridge: Harvard UP, 1984. Bennett, Jane. “The Force of Things: Steps Toward an Ecology of Matter.” Political Theory 32.3 (2004): 347–372. ---. Vibrant Matter: A Political Ecology Of Things. Durham, NC: Duke UP, 2010. Deleuze, Gilles, and Felix Guattari. A Thousand Plateaus: Capitalism and Schizophrenia. Minneapolis: U of Minnesota P, 1993. Ferreday, Donna. “Unspeakable Bodies: Erasure, Embodiment and the Pro-Ana Community.” International Journal of Cultural Studies 6 (2003): 277–295. Goodman, David, and Michael Goodman. “Alternative Food networks.” International Encyclopedia of Human Geography. Ed. R. Kitchin and N. Thrift. Oxford: Elsevier, 2008. Guthman, Julie. “Commodified Meanings, Meaningful Commodities: Re–thinking Production–Consumption Links through the Organic System of Provision.” Sociologia Ruralis 42.4 (2002): 295–311. ---. “Fast Food/Organic Food: Reflexive Tastes and the Making of ‘Yuppie Chow’.” Social and Cultural Geography 4.1 (2003): 45–58. Hugner, Renee. S., Pierre McDonagh, Andrea Prothero, Clifford J. Scultz, and Julie Stanton. “Who Are Organic Food Consumers?: A Compilation And Review Of Why People Purchase Organic Food.” Journal of Consumer Behaviour 6.2–3 (2007): 94–110. Jordan, Jennifer A. “The Heirloom Tomato as Cultural Object: Investigating Taste and Space.” Sociologia Ruralis 47.1 (2007): 20–41. Latour, Bruno. Science in Action: How to Follow Scientists and Engineers Through Society. Milton Keynes: Open UP, 1987. Morton, Timothy. The Ecological Thought. Cambridge, MA: Harvard University Press, 2010. ---. “Thinking Ecology, the Mesh, the Strange Stranger and the Beautiful Soul.” Collapse VI (2010): 265–293. ---. Ecology without Nature. Cambridge, MA: Harvard UP, 2007. National Museum of Australia Urban Farming and the Agricultural Show. 12 Mar. 2014. ‹http://www.nma.gov.au/online_features/urban_farming_agricultural_show/home›. Norberg-Hodge, Helena. “Beyond the Monoculture: Strengthening Local Culture, Economy and Knowledge.” The Journal of Sustainability Education. 19 Mar. 2012. 13 Mar. 2014 ‹http://www.jsedimensions.org/wordpress/content/beyond-the-monoculture-strengthening-local-culture-economy-and-knowledge_2012_03›. Plumwood, Val. Environmental Culture: The Ecological Crisis of Reason. London and New York: Routledge, 2002. Power, Emma. “Human-Nature Relations in Suburban Gardens.” Australian Geographer 36.1 (2005): 39–53. Probyn, Elspeth. Carnal Appetites: Foodsexidentites. London: Routledge, 2000. Seyfang, Gil. “Shopping for Sustainability: Can Sustainable Consumption Promote Ecological Citizenship?”. Environmental Politics 14.2 (2005): 290–306. -----. “Ecological Citizenship and Sustainable Consumption: Examining Local Organic Food Networks.” Journal of Rural Studies 22 (2006): 383–395. -----. “Growing Sustainable Consumption Communities: The Case Of Local Organic Food Networks.” International Journal of Sociology and Social Policy 27.3/4 (2007): 120–134. Shiva, Vandana. Stolen Harvest: The Hijacking of the Global Food Supply. Cambridge, MA: South End P, 2000. Thrupp, Lori Ann. “Linking Agricultural Biodiversity and Food Security.” International Affairs 76.2 (2000): 265–282. Turner, Bethaney. “Embodied Connections: Sustainability, Food Systems And Community Gardens.” Local Environment: The International Journal of Justice and Sustainability 16.6 (2011): 509-522. ---. “Reflections On a New Technology”. National Museum of Australia 2012. 12 Mar. 2014. ‹http://www.nma.gov.au/history/pate/objects/collection_reflections/genetically_modified_food_and_farming›. Acknowledgements Thank you to the gardeners who volunteered to be part of this study. The interviews related to the Royal Canberra Show were carried out as part of a collaborative project between the Faculty of Arts and Design at the University of Canberra (Joanna Henryks and Bethaney Turner) and the People and the Environment team (George Main and Kirsten Wehner) at the National Museum of Australia.

Introduction The highly contagious COVID-19 virus has presented particularly difficult public policy challenges. The relatively late emergence of an effective treatments and vaccines, the structural stresses on health care systems, the lockdowns and the economic dislocations, the evident structural inequalities in effected societies, as well as the difficulty of prevention have tested social and political cohesion. Moreover, the intrusive nature of many prophylactic measures have led to individual liberty and human rights concerns. As noted by the Victorian (Australia) Ombudsman Report on the COVID-19 lockdown in Melbourne, we may be tempted, during a crisis, to view human rights as expendable in the pursuit of saving human lives. This thinking can lead to dangerous territory. It is not unlawful to curtail fundamental rights and freedoms when there are compelling reasons for doing so; human rights are inherently and inseparably a consideration of human lives. (5) These difficulties have raised issues about the importance of social or community capital in fighting the pandemic. This article discusses the impacts of social and community capital and other factors on the governmental efforts to combat the spread of infectious disease through the maintenance of social distancing and household ‘bubbles’. It argues that the beneficial effects of social and community capital towards fighting the pandemic, such as mutual respect and empathy, which underpins such public health measures as social distancing, the use of personal protective equipment, and lockdowns in the USA, have been undermined as preventive measures because they have been transmogrified to become a salient aspect of the “culture wars” (Peters). In contrast, states that have relatively lower social capital such a China have been able to more effectively arrest transmission of the disease because the government was been able to generate and personify a nationalist response to the virus and thus generate a more robust social consensus regarding the efforts to combat the disease. Social Capital and Culture Wars The response to COVID-19 required individuals, families, communities, and other types of groups to refrain from extensive interaction – to stay in their bubble. In these situations, especially given the asymptomatic nature of many COVID-19 infections and the serious imposition lockdowns and social distancing and isolation, the temptation for individuals to breach public health rules in high. From the perspective of policymakers, the response to fighting COVID-19 is a collective action problem. In studying collective action problems, scholars have paid much attention on the role of social and community capital (Ostrom and Ahn 17-35). Ostrom and Ahn comment that social capital “provides a synthesizing approach to how cultural, social, and institutional aspects of communities of various sizes jointly affect their capacity of dealing with collective-action problems” (24). Social capital is regarded as an evolving social type of cultural trait (Fukuyama; Guiso et al.). Adger argues that social capital “captures the nature of social relations” and “provides an explanation for how individuals use their relationships to other actors in societies for their own and for the collective good” (387). The most frequently used definition of social capital is the one proffered by Putnam who regards it as “features of social organization, such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit” (Putnam, “Bowling Alone” 65). All these studies suggest that social and community capital has at least two elements: “objective associations” and subjective ties among individuals. Objective associations, or social networks, refer to both formal and informal associations that are formed and engaged in on a voluntary basis by individuals and social groups. Subjective ties or norms, on the other hand, primarily stand for trust and reciprocity (Paxton). High levels of social capital have generally been associated with democratic politics and civil societies whose institutional performance benefits from the coordinated actions and civic culture that has been facilitated by high levels of social capital (Putnam, Democracy 167-9). Alternatively, a “good and fair” state and impartial institutions are important factors in generating and preserving high levels of social capital (Offe 42-87). Yet social capital is not limited to democratic civil societies and research is mixed on whether rising social capital manifests itself in a more vigorous civil society that in turn leads to democratising impulses. Castillo argues that various trust levels for institutions that reinforce submission, hierarchy, and cultural conservatism can be high in authoritarian governments, indicating that high levels of social capital do not necessarily lead to democratic civic societies (Castillo et al.). Roßteutscher concludes after a survey of social capita indicators in authoritarian states that social capital has little effect of democratisation and may in fact reinforce authoritarian rule: in nondemocratic contexts, however, it appears to throw a spanner in the works of democratization. Trust increases the stability of nondemocratic leaderships by generating popular support, by suppressing regime threatening forms of protest activity, and by nourishing undemocratic ideals concerning governance (752). In China, there has been ongoing debate concerning the presence of civil society and the level of social capital found across Chinese society. If one defines civil society as an intermediate associational realm between the state and the family, populated by autonomous organisations which are separate from the state that are formed voluntarily by members of society to protect or extend their interests or values, it is arguable that the PRC had a significant civil society or social capital in the first few decades after its establishment (White). However, most scholars agree that nascent civil society as well as a more salient social and community capital has emerged in China’s reform era. This was evident after the 2008 Sichuan earthquake, where the government welcomed community organising and community-driven donation campaigns for a limited period of time, giving the NGO sector and bottom-up social activism a boost, as evidenced in various policy areas such as disaster relief and rural community development (F. Wu 126; Xu 9). Nevertheless, the CCP and the Chinese state have been effective in maintaining significant control over civil society and autonomous groups without attempting to completely eliminate their autonomy or existence. The dramatic economic and social changes that have occurred since the 1978 Opening have unsurprisingly engendered numerous conflicts across the society. In response, the CCP and State have adjusted political economic policies to meet the changing demands of workers, migrants, the unemployed, minorities, farmers, local artisans, entrepreneurs, and the growing middle class. Often the demands arising from these groups have resulted in policy changes, including compensation. In other circumstances, where these groups remain dissatisfied, the government will tolerate them (ignore them but allow them to continue in the advocacy), or, when the need arises, supress the disaffected groups (F. Wu 2). At the same time, social organisations and other groups in civil society have often “refrained from open and broad contestation against the regime”, thereby gaining the space and autonomy to achieve the objectives (F. Wu 2). Studies of Chinese social or community capital suggest that a form of modern social capital has gradually emerged as Chinese society has become increasingly modernised and liberalised (despite being non-democratic), and that this social capital has begun to play an important role in shaping social and economic lives at the local level. However, this more modern form of social capital, arising from developmental and social changes, competes with traditional social values and social capital, which stresses parochial and particularistic feelings among known individuals while modern social capital emphasises general trust and reciprocal feelings among both known and unknown individuals. The objective element of these traditional values are those government-sanctioned, formal mass organisations such as Communist Youth and the All-China Federation of Women's Associations, where members are obliged to obey the organisation leadership. The predominant subjective values are parochial and particularistic feelings among individuals who know one another, such as guanxi and zongzu (Chen and Lu, 426). The concept of social capital emphasises that the underlying cooperative values found in individuals and groups within a culture are an important factor in solving collective problems. In contrast, the notion of “culture war” focusses on those values and differences that divide social and cultural groups. Barry defines culture wars as increases in volatility, expansion of polarisation, and conflict between those who are passionate about religiously motivated politics, traditional morality, and anti-intellectualism, and…those who embrace progressive politics, cultural openness, and scientific and modernist orientations. (90) The contemporary culture wars across the world manifest opposition by various groups in society who hold divergent worldviews and ideological positions. Proponents of culture war understand various issues as part of a broader set of religious, political, and moral/normative positions invoked in opposition to “elite”, “liberal”, or “left” ideologies. Within this Manichean universe opposition to such issues as climate change, Black Lives Matter, same sex rights, prison reform, gun control, and immigration becomes framed in binary terms, and infused with a moral sensibility (Chapman 8-10). In many disputes, the culture war often devolves into an epistemological dispute about the efficacy of scientific knowledge and authority, or a dispute between “practical” and theoretical knowledge. In this environment, even facts can become partisan narratives. For these “cultural” disputes are often how electoral prospects (generally right-wing) are advanced; “not through policies or promises of a better life, but by fostering a sense of threat, a fantasy that something profoundly pure … is constantly at risk of extinction” (Malik). This “zero-sum” social and policy environment that makes it difficult to compromise and has serious consequences for social stability or government policy, especially in a liberal democratic society. Of course, from the perspective of cultural materialism such a reductionist approach to culture and political and social values is not unexpected. “Culture” is one of the many arenas in which dominant social groups seek to express and reproduce their interests and preferences. “Culture” from this sense is “material” and is ultimately connected to the distribution of power, wealth, and resources in society. As such, the various policy areas that are understood as part of the “culture wars” are another domain where various dominant and subordinate groups and interests engaged in conflict express their values and goals. Yet it is unexpected that despite the pervasiveness of information available to individuals the pool of information consumed by individuals who view the “culture wars” as a touchstone for political behaviour and a narrative to categorise events and facts is relatively closed. This lack of balance has been magnified by social media algorithms, conspiracy-laced talk radio, and a media ecosystem that frames and discusses issues in a manner that elides into an easily understood “culture war” narrative. From this perspective, the groups (generally right-wing or traditionalist) exist within an information bubble that reinforces political, social, and cultural predilections. American and Chinese Reponses to COVID-19 The COVID-19 pandemic first broke out in Wuhan in December 2019. Initially unprepared and unwilling to accept the seriousness of the infection, the Chinese government regrouped from early mistakes and essentially controlled transmission in about three months. This positive outcome has been messaged as an exposition of the superiority of the Chinese governmental system and society both domestically and internationally; a positive, even heroic performance that evidences the populist credentials of the Chinese political leadership and demonstrates national excellence. The recently published White Paper entitled “Fighting COVID-19: China in Action” also summarises China’s “strategic achievement” in the simple language of numbers: in a month, the rising spread was contained; in two months, the daily case increase fell to single digits; and in three months, a “decisive victory” was secured in Wuhan City and Hubei Province (Xinhua). This clear articulation of the positive results has rallied political support. Indeed, a recent survey shows that 89 percent of citizens are satisfied with the government’s information dissemination during the pandemic (C Wu). As part of the effort, the government extensively promoted the provision of “political goods”, such as law and order, national unity and pride, and shared values. For example, severe publishments were introduced for violence against medical professionals and police, producing and selling counterfeit medications, raising commodity prices, spreading ‘rumours’, and being uncooperative with quarantine measures (Xu). Additionally, as an extension the popular anti-corruption campaign, many local political leaders were disciplined or received criminal charges for inappropriate behaviour, abuse of power, and corruption during the pandemic (People.cn, 2 Feb. 2020). Chinese state media also described fighting the virus as a global “competition”. In this competition a nation’s “material power” as well as “mental strength”, that calls for the highest level of nation unity and patriotism, is put to the test. This discourse recalled the global competition in light of the national mythology related to the formation of Chinese nation, the historical “hardship”, and the “heroic Chinese people” (People.cn, 7 Apr. 2020). Moreover, as the threat of infection receded, it was emphasised that China “won this competition” and the Chinese people have demonstrated the “great spirit of China” to the world: a result built upon the “heroism of the whole Party, Army, and Chinese people from all ethnic groups” (People.cn, 7 Apr. 2020). In contrast to the Chinese approach of emphasising national public goods as a justification for fighting the virus, the U.S. Trump Administration used nationalism, deflection, and “culture war” discourse to undermine health responses — an unprecedented response in American public health policy. The seriousness of the disease as well as the statistical evidence of its course through the American population was disputed. The President and various supporters raged against the COVID-19 “hoax”, social distancing, and lockdowns, disparaged public health institutions and advice, and encouraged protesters to “liberate” locked-down states (Russonello). “Our federal overlords say ‘no singing’ and ‘no shouting’ on Thanksgiving”, Representative Paul Gosar, a Republican of Arizona, wrote as he retweeted a Centers for Disease Control list of Thanksgiving safety tips (Weiner). People were encouraged, by way of the White House and Republican leadership, to ignore health regulations and not to comply with social distancing measures and the wearing of masks (Tracy). This encouragement led to threats against proponents of face masks such as Dr Anthony Fauci, one of the nation’s foremost experts on infectious diseases, who required bodyguards because of the many threats on his life. Fauci’s critics — including President Trump — countered Fauci’s promotion of mask wearing by stating accusingly that he once said mask-wearing was not necessary for ordinary people (Kelly). Conspiracy theories as to the safety of vaccinations also grew across the course of the year. As the 2020 election approached, the Administration ramped up efforts to downplay the serious of the virus by identifying it with “the media” and illegitimate “partisan” efforts to undermine the Trump presidency. It also ramped up its criticism of China as the source of the infection. This political self-centeredness undermined state and federal efforts to slow transmission (Shear et al.). At the same time, Trump chided health officials for moving too slowly on vaccine approvals, repeated charges that high infection rates were due to increased testing, and argued that COVID-19 deaths were exaggerated by medical providers for political and financial reasons. These claims were amplified by various conservative media personalities such as Rush Limbaugh, and Sean Hannity and Laura Ingraham of Fox News. The result of this “COVID-19 Denialism” and the alternative narrative of COVID-19 policy told through the lens of culture war has resulted in the United States having the highest number of COVID-19 cases, and the highest number of COVID-19 deaths. At the same time, the underlying social consensus and social capital that have historically assisted in generating positive public health outcomes has been significantly eroded. According to the Pew Research Center, the share of U.S. adults who say public health officials such as those at the Centers for Disease Control and Prevention are doing an excellent or good job responding to the outbreak decreased from 79% in March to 63% in August, with an especially sharp decrease among Republicans (Pew Research Center 2020). Social Capital and COVID-19 From the perspective of social or community capital, it could be expected that the American response to the Pandemic would be more effective than the Chinese response. Historically, the United States has had high levels of social capital, a highly developed public health system, and strong governmental capacity. In contrast, China has a relatively high level of governmental and public health capacity, but the level of social capital has been lower and there is a significant presence of traditional values which emphasise parochial and particularistic values. Moreover, the antecedent institutions of social capital, such as weak and inefficient formal institutions (Batjargal et al.), environmental turbulence and resource scarcity along with the transactional nature of guanxi (gift-giving and information exchange and relationship dependence) militate against finding a more effective social and community response to the public health emergency. Yet China’s response has been significantly more successful than the Unites States’. Paradoxically, the American response under the Trump Administration and the Chinese response both relied on an externalisation of the both the threat and the justifications for their particular response. In the American case, President Trump, while downplaying the seriousness of the virus, consistently called it the “China virus” in an effort to deflect responsibly as well as a means to avert attention away from the public health impacts. As recently as 3 January 2021, Trump tweeted that the number of “China Virus” cases and deaths in the U.S. were “far exaggerated”, while critically citing the Centers for Disease Control and Prevention's methodology: “When in doubt, call it COVID-19. Fake News!” (Bacon). The Chinese Government, meanwhile, has pursued a more aggressive foreign policy across the South China Sea, on the frontier in the Indian sub-continent, and against states such as Australia who have criticised the initial Chinese response to COVID-19. To this international criticism, the government reiterated its sovereign rights and emphasised its “victimhood” in the face of “anti-China” foreign forces. Chinese state media also highlighted China as “victim” of the coronavirus, but also as a target of Western “political manoeuvres” when investigating the beginning stages of the pandemic. The major difference, however, is that public health policy in the United States was superimposed on other more fundamental political and cultural cleavages, and part of this externalisation process included the assignation of “otherness” and demonisation of internal political opponents or characterising political opponents as bent on destroying the United States. This assignation of “otherness” to various internal groups is a crucial element in the culture wars. While this may have been inevitable given the increasingly frayed nature of American society post-2008, such a characterisation has been activity pushed by local, state, and national leadership in the Republican Party and the Trump Administration (Vogel et al.). In such circumstances, minimising health risks and highlighting civil rights concerns due to public health measures, along with assigning blame to the democratic opposition and foreign states such as China, can have a major impact of public health responses. The result has been that social trust beyond the bubble of one’s immediate circle or those who share similar beliefs is seriously compromised — and the collective action problem presented by COVID-19 remains unsolved. Daniel Aldrich’s study of disasters in Japan, India, and US demonstrates that pre-existing high levels of social capital would lead to stronger resilience and better recovery (Aldrich). Social capital helps coordinate resources and facilitate the reconstruction collectively and therefore would lead to better recovery (Alesch et al.). Yet there has not been much research on how the pool of social capital first came about and how a disaster may affect the creation and store of social capital. Rebecca Solnit has examined five major disasters and describes that after these events, survivors would reach out and work together to confront the challenges they face, therefore increasing the social capital in the community (Solnit). However, there are studies that have concluded that major disasters can damage the social fabric in local communities (Peacock et al.). The COVID-19 epidemic does not have the intensity and suddenness of other disasters but has had significant knock-on effects in increasing or decreasing social capital, depending on the institutional and social responses to the pandemic. In China, it appears that the positive social capital effects have been partially subsumed into a more generalised patriotic or nationalist affirmation of the government’s policy response. Unlike civil society responses to earlier crises, such as the 2008 Sichuan earthquake, there is less evidence of widespread community organisation and response to combat the epidemic at its initial stages. This suggests better institutional responses to the crisis by the government, but also a high degree of porosity between civil society and a national “imagined community” represented by the national state. The result has been an increased legitimacy for the Chinese government. Alternatively, in the United States the transformation of COVID-19 public health policy into a culture war issue has seriously impeded efforts to combat the epidemic in the short term by undermining the social consensus and social capital necessary to fight such a pandemic. Trust in American institutions is historically low, and President Trump’s untrue contention that President Biden’s election was due to “fraud” has further undermined the legitimacy of the American government, as evidenced by the attacks directed at Congress in the U.S. capital on 6 January 2021. As such, the lingering effects the pandemic will have on social, economic, and political institutions will likely reinforce the deep cultural and political cleavages and weaken interpersonal networks in American society. Conclusion The COVID-19 pandemic has devastated global public health and impacted deeply on the world economy. Unsurprisingly, given the serious economic, social, and political consequences, different government responses have been highly politicised. Various quarantine and infection case tracking methods have caused concern over state power intruding into private spheres. The usage of face masks, social distancing rules, and intra-state travel restrictions have aroused passionate debate over public health restrictions, individual liberty, and human rights. Yet underlying public health responses grounded in higher levels of social capital enhance the effectiveness of public health measures. In China, a country that has generally been associated with lower social capital, it is likely that the relatively strong policy response to COVID-19 will both enhance feelings of nationalism and Chinese exceptionalism and help create and increase the store of social capital. In the United States, the attribution of COVID-19 public health policy as part of the culture wars will continue to impede efforts to control the pandemic while further damaging the store of American community social capital that has assisted public health efforts over the past decades. References Adger, W. Neil. “Social Capital, Collective Action, and Adaptation to Climate Change.” Economic Geography 79.4 (2003): 387-404. Bacon, John. “Coronavirus Updates: Donald Trump Says US 'China Virus' Data Exaggerated; Dr. Anthony Fauci Protests, Draws President's Wrath.” USA Today 3 Jan. 2021. 4 Jan. 2021 <https://www.usatoday.com/story/news/health/2021/01/03/COVID-19-update-larry-king-ill-4-million-december-vaccinations-us/4114363001/>. Berry, Kate A. “Beyond the American Culture Wars.” Regions & Cohesion / Regiones y Cohesión / Régions et Cohésion 7.2 (Summer 2017): 90-95. Castillo, Juan C., Daniel Miranda, and Pablo Torres. “Authoritarianism, Social Dominance and Trust in Public Institutions.” Annual Scientific Meeting of the International Society of Political Psychology, Istanbul, 9-12 July 2011. 2 Jan. 2021 <https://pdfs.semanticscholar.org/>. Chapman, Roger. “Introduction, Culture Wars: Rhetoric and Reality.” Culture Wars: An Encyclopedia of Issues, Viewpoints, and Voices. Eds. Roger Chapman and M.E. Sharpe. 2010. 8-10. Chen, Jie, and Chunlong Lu. “Social Capital in Urban China: Attitudinal and Behavioral Effects on Grassroots Self-Government.” Social Science Quarterly 88.2 (June 2007): 422-442. China's State Council Information Office. “Fighting COVID-19: China in Action.” Xinhuanet 7 June 2020. 2 Sep. 2020 <http://www.xinhuanet.com/english/2020-06/07/c_139120424.htm?bsh_bid=551709954>. Fukuyama, Francis. Trust: The Social Virtues and the Creation of Prosperity. Hamish Hamilton, 1995. Kelly, Mike. “Welcome to the COVID-19 Culture Wars. Why Are We Fighting about Masks?’ Yahoo News 4 Dec. 2020 <https://www.msn.com/en-us/news/us/welcome-to-the-COVID-19-culture-wars-why-are-we-fighting-about-masks-mike-kelly/ar-BB1bCOHN>. Luigi Guiso, Paola Sapienza, and Luigi Zingales, “Social Capital as Good Culture.” National Bureau of Economic Research Working Paper No. 13712. 2007. 18 ct. 2017 <http://www.nber.org/papers/w13712.pdf>. Malik, Nesrine. “The Right's Culture War Is No Longer a Sideshow to Our Politics – It Is Our Politics.” The Guardian 31 Aug. 2020. 6 Jan. 2021 <https://www.theguardian.com/commentisfree/2020/aug/31/the-rights-culture-war-politics-rightwing-fantasy-elections>. Offe, Carl. “How Can We Trust Our Fellow Citizens?” Democracy and Trust. Ed. M.E. Warren. Cambridge University Press, 1999. 42-87. Ostrom, Elinor, and T.K. Ahn. “The Meaning of Social Capital and Its Link to Collective Action.” Handbook of Social Capital: The Troika of Sociology, Political Science and Economics. Eds. Gert Tinggaard Svendsen and Gunnar Lind Haase Svendsen. Edward Elgar, 2009. 17–35. Paxton, Pamela. “Is Social Capital Declining in the United States? A Multiple Indicator Assessment.” American Journal of Sociology 105.1 (1999): 88-127. People.cn. “Hubeisheng Huanggangshi chufen dangyuan ganbu 337 ren.” [“337 Party Cadres Were Disciplined in Huanggang, Hubei Province.”] 2 Feb. 2020. 10 Sep. 2020 <http://fanfu.people.com.cn/n1/2020/0130/c64371-31565382.html>. ———. “Zai yiqing fangkong douzheng zhong zhangxian weida zhongguo jingshen.” [“Demonstrating the Great Spirit of China in Fighting the Pandemic.”] 7 Apr. 2020. 9 Sep. 2020 <http://opinion.people.com.cn/n1/2020/0407/c1003-31663076.html>. Peters, Jeremy W. “How Abortion, Guns and Church Closings Made Coronavirus a Culture War.” New York Times 20 Apr. 2020. 6 Jan. 2021 <http://www.nytimes.com/2020/04/20/us/politics/coronavirus-protests-democrats-republicans.html>. Pew Research Center. “Americans Give the U.S. Low Marks for Its Handling of COVID-19, and So Do People in Other Countries.” 21 Sep. 2020. 15 Jan. 2021 <https://www.pewresearch.org/fact-tank/2020/09/21/americans-give-the-u-s-low-marks-for-its-handling-of-covid-19-and-so-do-people-in-other-countries/>. Putnam, Robert D. “Bowling Alone: America’s Declining Social Capital.” Journal of Democracy 6.1 (1995): 65-78. ———. Making Democracy Work: Civic Traditions in Modern Italy. Princeton University Press, 1993. Roßteutscher, Sigrid. “Social Capital Worldwide: Potential for Democratization or Stabilizer of Authoritarian Rule?” American Behavioural Scientist 53.5 (2010): 737–757. Russonello, G. “What’s Driving the Right-Wing Protesters Fighting the Quarantine?” New York Times 17 Apr. 2020. 2 Jan. 2021 <http://www.nytimes.com/2020/04/17/us/politics/poll-watch-quarantine-protesters.html>. Shear, Michael D., Maggie Haberman, Noah Weiland, Sharon LaFraniere, and Mark Mazzetti. “Trump’s Focus as the Pandemic Raged: What Would It Mean for Him?” New York Times 31 Dec. 2020. 2 Jan. 2021 <https://www.nytimes.com/2020/12/31/us/politics/trump-coronavirus.html>. Tracy, Marc. “Anti-Lockdown Protesters Get in Reporters’ (Masked) Faces.” New York Times 13 May 2020. 5 Jan. 2021 <https://www.nytimes.com/2020/05/13/business/media/lockdown-protests-reporters.html>. Victoria Ombudsman. “Investigation into the Detention and Treatment of Public Housing Residents Arising from a COVID-19 ‘Hard Lockdown’ in July 2020.” Dec. 2020. 8 Jan. 2021 <https://assets.ombudsman.vic.gov.au/>. Vogel, Kenneth P., Jim Rutenberg, and Lisa Lerer. “The Quiet Hand of Conservative Groups in the Anti-Lockdown Protests.” New York Times 21 Apr. 2020. 2 Jan. 2021 <http://www.nytimes.com/2020/04/21/us/politics/coronavirus-protests-trump.html>. Weiner, Jennifer. “Fake ‘War on Christmas’ and the Real Battle against COVID-19.” New York Times 7 Dec. 2020. 6 Jan. 2021 <https://www.nytimes.com/2020/12/07/opinion/christmas-religion-COVID-19.html>. White, Gordon. “Civil Society, Democratization and Development: Clearing the Analytical Ground.” Civil Society in Democratization. Eds. Peter Burnell and Peter Calvert. Taylor & Francis, 2004. 375-390. Wu, Cary. “How Chinese Citizens View Their Government’s Coronavirus Response.” The Conversation 5 June 2020. 2 Sep. 2020 <https://theconversation.com/how-chinese-citizens-view-their-governments-coronavirus-response-139176>. Wu, Fengshi. “An Emerging Group Name ‘Gongyi’: Ideational Collectivity in China's Civil Society.” China Review 17.2 (2017): 123-150. ———. “Evolving State-Society Relations in China: Introduction.” China Review 17.2 (2017): 1-6. Xu, Bin. “Consensus Crisis and Civil Society: The Sichuan Earthquake Response and State-Society Relations.” The China Journal 71 (2014): 91-108. Xu, Juan. “Wei yiqing fangkong zhulao fazhi diba.” [“Build a Strong Legal ‘Dam’ for Disease Control.”] People.cn 24 Feb. 2020. 10 Sep. 2020 <http://opinion.people.com.cn/n1/2020/0224/c1003-31600409.html>.

Introduction Eating is one of the most quintessential activities of human life. Because of this primacy, eating is, as food anthropologist Sidney Mintz has observed, “not merely a biological activity, but a vibrantly cultural activity as well” (48). This article posits that the current awareness of climate change in the Western world is animating such cultural activity as the Slow Food movement and is, as a result, stimulating what could be seen as an evolutionary change in popular foodways. Moreover, this paper suggests that, in line with modelling provided by the Slow Food example, an increased awareness of the connections of climate change to the social injustices of food production might better drive social change in such areas. This discussion begins by proposing that contemporary foodways—defined as “not only what is eaten by a particular group of people but also the variety of customs, beliefs and practices surrounding the production, preparation and presentation of food” (Davey 182)—are changing in the West in relation to current concerns about climate change. Such modification has a long history. Since long before the inception of modern Homo sapiens, natural climate change has been a crucial element driving hominidae evolution, both biologically and culturally in terms of social organisation and behaviours. Macroevolutionary theory suggests evolution can dramatically accelerate in response to rapid shifts in an organism’s environment, followed by slow to long periods of stasis once a new level of sustainability has been achieved (Gould and Eldredge). There is evidence that ancient climate change has also dramatically affected the rate and course of cultural evolution. Recent work suggests that the end of the last ice age drove the cultural innovation of animal and plant domestication in the Middle East (Zeder), not only due to warmer temperatures and increased rainfall, but also to a higher level of atmospheric carbon dioxide which made agriculture increasingly viable (McCorriston and Hole, cited in Zeder). Megadroughts during the Paleolithic might well have been stimulating factors behind the migration of hominid populations out of Africa and across Asia (Scholz et al). Thus, it is hardly surprising that modern anthropogenically induced global warming—in all its’ climate altering manifestations—may be driving a new wave of cultural change and even evolution in the West as we seek a sustainable homeostatic equilibrium with the environment of the future. In 1962, Rachel Carson’s Silent Spring exposed some of the threats that modern industrial agriculture poses to environmental sustainability. This prompted a public debate from which the modern environmental movement arose and, with it, an expanding awareness and attendant anxiety about the safety and nutritional quality of contemporary foods, especially those that are grown with chemical pesticides and fertilizers and/or are highly processed. This environmental consciousness led to some modification in eating habits, manifest by some embracing wholefood and vegetarian dietary regimes (or elements of them). Most recently, a widespread awareness of climate change has forced rapid change in contemporary Western foodways, while in other climate related areas of socio-political and economic significance such as energy production and usage, there is little evidence of real acceleration of change. Ongoing research into the effects of this expanding environmental consciousness continues in various disciplinary contexts such as geography (Eshel and Martin) and health (McMichael et al). In food studies, Vileisis has proposed that the 1970s environmental movement’s challenge to the polluting practices of industrial agri-food production, concurrent with the women’s movement (asserting women’s right to know about everything, including food production), has led to both cooks and eaters becoming increasingly knowledgeable about the links between agricultural production and consumer and environmental health, as well as the various social justice issues involved. As a direct result of such awareness, alternatives to the industrialised, global food system are now emerging (Kloppenberg et al.). The Slow Food (R)evolution The tenets of the Slow Food movement, now some two decades old, are today synergetic with the growing consternation about climate change. In 1983, Carlo Petrini formed the Italian non-profit food and wine association Arcigola and, in 1986, founded Slow Food as a response to the opening of a McDonalds in Rome. From these humble beginnings, which were then unashamedly positing a return to the food systems of the past, Slow Food has grown into a global organisation that has much more future focused objectives animating its challenges to the socio-cultural and environmental costs of industrial food. Slow Food does have some elements that could be classed as reactionary and, therefore, the opposite of evolutionary. In response to the increasing homogenisation of culinary habits around the world, for instance, Slow Food’s Foundation for Biodiversity has established the Ark of Taste, which expands upon the idea of a seed bank to preserve not only varieties of food but also local and artisanal culinary traditions. In this, the Ark aims to save foods and food products “threatened by industrial standardization, hygiene laws, the regulations of large-scale distribution and environmental damage” (SFFB). Slow Food International’s overarching goals and activities, however, extend far beyond the preservation of past foodways, extending to the sponsoring of events and activities that are attempting to create new cuisine narratives for contemporary consumers who have an appetite for such innovation. Such events as the Salone del Gusto (Salon of Taste) and Terra Madre (Mother Earth) held in Turin every two years, for example, while celebrating culinary traditions, also focus on contemporary artisanal foods and sustainable food production processes that incorporate the most current of agricultural knowledge and new technologies into this production. Attendees at these events are also driven by both an interest in tradition, and their own very current concerns with health, personal satisfaction and environmental sustainability, to change their consumer behavior through an expanded self-awareness of the consequences of their individual lifestyle choices. Such events have, in turn, inspired such events in other locations, moving Slow Food from local to global relevance, and affecting the intellectual evolution of foodway cultures far beyond its headquarters in Bra in Northern Italy. This includes in the developing world, where millions of farmers continue to follow many traditional agricultural practices by necessity. Slow Food Movement’s forward-looking values are codified in the International Commission on the Future of Food and Agriculture 2006 publication, Manifesto on the Future of Food. This calls for changes to the World Trade Organisation’s rules that promote the globalisation of agri-food production as a direct response to the “climate change [which] threatens to undermine the entire natural basis of ecologically benign agriculture and food preparation, bringing the likelihood of catastrophic outcomes in the near future” (ICFFA 8). It does not call, however, for a complete return to past methods. To further such foodway awareness and evolution, Petrini founded the University of Gastronomic Sciences at Slow Food’s headquarters in 2004. The university offers programs that are analogous with the Slow Food’s overall aim of forging sustainable partnerships between the best of old and new practice: to, in the organisation’s own words, “maintain an organic relationship between gastronomy and agricultural science” (UNISG). In 2004, Slow Food had over sixty thousand members in forty-five countries (Paxson 15), with major events now held each year in many of these countries and membership continuing to grow apace. One of the frequently cited successes of the Slow Food movement is in relation to the tomato. Until recently, supermarkets stocked only a few mass-produced hybrids. These cultivars were bred for their disease resistance, ease of handling, tolerance to artificial ripening techniques, and display consistency, rather than any culinary values such as taste, aroma, texture or variety. In contrast, the vine ripened, ‘farmer’s market’ tomato has become the symbol of an “eco-gastronomically” sustainable, local and humanistic system of food production (Jordan) which melds the best of the past practice with the most up-to-date knowledge regarding such farming matters as water conservation. Although the term ‘heirloom’ is widely used in relation to these tomatoes, there is a distinctively contemporary edge to the way they are produced and consumed (Jordan), and they are, along with other organic and local produce, increasingly available in even the largest supermarket chains. Instead of a wholesale embrace of the past, it is the connection to, and the maintenance of that connection with, the processes of production and, hence, to the environment as a whole, which is the animating premise of the Slow Food movement. ‘Slow’ thus creates a gestalt in which individuals integrate their lifestyles with all levels of the food production cycle and, hence to the environment and, importantly, the inherently related social justice issues. ‘Slow’ approaches emphasise how the accelerated pace of contemporary life has weakened these connections, while offering a path to the restoration of a sense of connectivity to the full cycle of life and its relation to place, nature and climate. In this, the Slow path demands that every consumer takes responsibility for all components of his/her existence—a responsibility that includes becoming cognisant of the full story behind each of the products that are consumed in that life. The Slow movement is not, however, a regime of abstention or self-denial. Instead, the changes in lifestyle necessary to support responsible sustainability, and the sensual and aesthetic pleasure inherent in such a lifestyle, exist in a mutually reinforcing relationship (Pietrykowski 2004). This positive feedback loop enhances the potential for promoting real and long-term evolution in social and cultural behaviour. Indeed, the Slow zeitgeist now informs many areas of contemporary culture, with Slow Travel, Homes, Design, Management, Leadership and Education, and even Slow Email, Exercise, Shopping and Sex attracting adherents. Mainstreaming Concern with Ethical Food Production The role of the media in “forming our consciousness—what we think, how we think, and what we think about” (Cunningham and Turner 12)—is self-evident. It is, therefore, revealing in relation to the above outlined changes that even the most functional cookbooks and cookery magazines (those dedicated to practical information such as recipes and instructional technique) in Western countries such as the USA, UK and Australian are increasingly reflecting and promoting an awareness of ethical food production as part of this cultural change in food habits. While such texts have largely been considered as useful but socio-politically relatively banal publications, they are beginning to be recognised as a valid source of historical and cultural information (Nussel). Cookbooks and cookery magazines commonly include discussion of a surprising range of issues around food production and consumption including sustainable and ethical agricultural methods, biodiversity, genetic modification and food miles. In this context, they indicate how rapidly the recent evolution of foodways has been absorbed into mainstream practice. Much of such food related media content is, at the same time, closely identified with celebrity mass marketing and embodied in the television chef with his or her range of branded products including their syndicated articles and cookbooks. This commercial symbiosis makes each such cuisine-related article in a food or women’s magazine or cookbook, in essence, an advertorial for a celebrity chef and their named products. Yet, at the same time, a number of these mass media food celebrities are raising public discussion that is leading to consequent action around important issues linked to climate change, social justice and the environment. An example is Jamie Oliver’s efforts to influence public behaviour and government policy, a number of which have gained considerable traction. Oliver’s 2004 exposure of the poor quality of school lunches in Britain (see Jamie’s School Dinners), for instance, caused public outrage and pressured the British government to commit considerable extra funding to these programs. A recent study by Essex University has, moreover, found that the academic performance of 11-year-old pupils eating Oliver’s meals improved, while absenteeism fell by 15 per cent (Khan). Oliver’s exposé of the conditions of battery raised hens in 2007 and 2008 (see Fowl Dinners) resulted in increased sales of free-range poultry, decreased sales of factory-farmed chickens across the UK, and complaints that free-range chicken sales were limited by supply. Oliver encouraged viewers to lobby their local councils, and as a result, a number banned battery hen eggs from schools, care homes, town halls and workplace cafeterias (see, for example, LDP). The popular penetration of these ideas needs to be understood in a historical context where industrialised poultry farming has been an issue in Britain since at least 1848 when it was one of the contributing factors to the establishment of the RSPCA (Freeman). A century after Upton Sinclair’s The Jungle (published in 1906) exposed the realities of the slaughterhouse, and several decades since Peter Singer’s landmark Animal Liberation (1975) and Tom Regan’s The Case for Animal Rights (1983) posited the immorality of the mistreatment of animals in food production, it could be suggested that Al Gore’s film An Inconvenient Truth (released in 2006) added considerably to the recent concern regarding the ethics of industrial agriculture. Consciousness-raising bestselling books such as Jim Mason and Peter Singer’s The Ethics of What We Eat and Michael Pollan’s The Omnivore’s Dilemma (both published in 2006), do indeed ‘close the loop’ in this way in their discussions, by concluding that intensive food production methods used since the 1950s are not only inhumane and damage public health, but are also damaging an environment under pressure from climate change. In comparison, the use of forced labour and human trafficking in food production has attracted far less mainstream media, celebrity or public attention. It could be posited that this is, in part, because no direct relationship to the environment and climate change and, therefore, direct link to our own existence in the West, has been popularised. Kevin Bales, who has been described as a modern abolitionist, estimates that there are currently more than 27 million people living in conditions of slavery and exploitation against their wills—twice as many as during the 350-year long trans-Atlantic slave trade. Bales also chillingly reveals that, worldwide, the number of slaves is increasing, with contemporary individuals so inexpensive to purchase in relation to the value of their production that they are disposable once the slaveholder has used them. Alongside sex slavery, many other prevalent examples of contemporary slavery are concerned with food production (Weissbrodt et al; Miers). Bales and Soodalter, for example, describe how across Asia and Africa, adults and children are enslaved to catch and process fish and shellfish for both human consumption and cat food. Other campaigners have similarly exposed how the cocoa in chocolate is largely produced by child slave labour on the Ivory Coast (Chalke; Off), and how considerable amounts of exported sugar, cereals and other crops are slave-produced in certain countries. In 2003, some 32 per cent of US shoppers identified themselves as LOHAS “lifestyles of health and sustainability” consumers, who were, they said, willing to spend more for products that reflected not only ecological, but also social justice responsibility (McLaughlin). Research also confirms that “the pursuit of social objectives … can in fact furnish an organization with the competitive resources to develop effective marketing strategies”, with Doherty and Meehan showing how “social and ethical credibility” are now viable bases of differentiation and competitive positioning in mainstream consumer markets (311, 303). In line with this recognition, Fair Trade Certified goods are now available in British, European, US and, to a lesser extent, Australian supermarkets, and a number of global chains including Dunkin’ Donuts, McDonalds, Starbucks and Virgin airlines utilise Fair Trade coffee and teas in all, or parts of, their operations. Fair Trade Certification indicates that farmers receive a higher than commodity price for their products, workers have the right to organise, men and women receive equal wages, and no child labour is utilised in the production process (McLaughlin). Yet, despite some Western consumers reporting such issues having an impact upon their purchasing decisions, social justice has not become a significant issue of concern for most. The popular cookery publications discussed above devote little space to Fair Trade product marketing, much of which is confined to supermarket-produced adverzines promoting the Fair Trade products they stock, and international celebrity chefs have yet to focus attention on this issue. In Australia, discussion of contemporary slavery in the press is sparse, having surfaced in 2000-2001, prompted by UNICEF campaigns against child labour, and in 2007 and 2008 with the visit of a series of high profile anti-slavery campaigners (including Bales) to the region. The public awareness of food produced by forced labour and the troubling issue of human enslavement in general is still far below the level that climate change and ecological issues have achieved thus far in driving foodway evolution. This may change, however, if a ‘Slow’-inflected connection can be made between Western lifestyles and the plight of peoples hidden from our daily existence, but contributing daily to them. Concluding Remarks At this time of accelerating techno-cultural evolution, due in part to the pressures of climate change, it is the creative potential that human conscious awareness brings to bear on these challenges that is most valuable. Today, as in the caves at Lascaux, humanity is evolving new images and narratives to provide rational solutions to emergent challenges. As an example of this, new foodways and ways of thinking about them are beginning to evolve in response to the perceived problems of climate change. The current conscious transformation of food habits by some in the West might be, therefore, in James Lovelock’s terms, a moment of “revolutionary punctuation” (178), whereby rapid cultural adaption is being induced by the growing public awareness of impending crisis. It remains to be seen whether other urgent human problems can be similarly and creatively embraced, and whether this trend can spread to offer global solutions to them. References An Inconvenient Truth. Dir. Davis Guggenheim. Lawrence Bender Productions, 2006. Bales, Kevin. Disposable People: New Slavery in the Global Economy. Berkeley: University of California Press, 2004 (first published 1999). Bales, Kevin, and Ron Soodalter. The Slave Next Door: Human Trafficking and Slavery in America Today. Berkeley: University of California Press, 2009. Carson, Rachel. Silent Spring. Boston: Houghton Mifflin, 1962. Chalke, Steve. “Unfinished Business: The Sinister Story behind Chocolate.” The Age 18 Sep. 2007: 11. Cunningham, Stuart, and Graeme Turner. The Media and Communications in Australia Today. Crows Nest: Allen & Unwin, 2002. Davey, Gwenda Beed. “Foodways.” The Oxford Companion to Australian Folklore. Ed. Gwenda Beed Davey, and Graham Seal. Melbourne: Oxford University Press, 1993. 182–85. Doherty, Bob, and John Meehan. “Competing on Social Resources: The Case of the Day Chocolate Company in the UK Confectionery Sector.” Journal of Strategic Marketing 14.4 (2006): 299–313. Eshel, Gidon, and Pamela A. Martin. “Diet, Energy, and Global Warming.” Earth Interactions 10, paper 9 (2006): 1–17. Fowl Dinners. Exec. Prod. Nick Curwin and Zoe Collins. Dragonfly Film and Television Productions and Fresh One Productions, 2008. Freeman, Sarah. Mutton and Oysters: The Victorians and Their Food. London: Gollancz, 1989. Gould, S. J., and N. Eldredge. “Punctuated Equilibrium Comes of Age.” Nature 366 (1993): 223–27. (ICFFA) International Commission on the Future of Food and Agriculture. Manifesto on the Future of Food. Florence, Italy: Agenzia Regionale per lo Sviluppo e l’Innovazione nel Settore Agricolo Forestale and Regione Toscana, 2006. Jamie’s School Dinners. Dir. Guy Gilbert. Fresh One Productions, 2005. Jordan, Jennifer A. “The Heirloom Tomato as Cultural Object: Investigating Taste and Space.” Sociologia Ruralis 47.1 (2007): 20-41. Khan, Urmee. “Jamie Oliver’s School Dinners Improve Exam Results, Report Finds.” Telegraph 1 Feb. 2009. 24 Aug. 2009 < http://www.telegraph.co.uk/education/educationnews/4423132/Jamie-Olivers-school-dinners-improve-exam-results-report-finds.html >. Kloppenberg, Jack, Jr, Sharon Lezberg, Kathryn de Master, G. W. Stevenson, and John Henrickson. ‘Tasting Food, Tasting Sustainability: Defining the Attributes of an Alternative Food System with Competent, Ordinary People.” Human Organisation 59.2 (Jul. 2000): 177–86. (LDP) Liverpool Daily Post. “Battery Farm Eggs Banned from Schools and Care Homes.” Liverpool Daily Post 12 Jan. 2008. 24 Aug. 2009 < http://www.liverpooldailypost.co.uk/liverpool-news/regional-news/2008/01/12/battery-farm-eggs-banned-from-schools-and-care-homes-64375-20342259 >. Lovelock, James. The Ages of Gaia: A Biography of Our Living Earth. New York: Bantam, 1990 (first published 1988). Mason, Jim, and Peter Singer. The Ethics of What We Eat. Melbourne: Text Publishing, 2006. McLaughlin, Katy. “Is Your Grocery List Politically Correct? Food World’s New Buzzword Is ‘Sustainable’ Products.” The Wall Street Journal 17 Feb. 2004. 29 Aug. 2009 < http://www.globalexchange.org/campaigns/fairtrade/coffee/1732.html >. McMichael, Anthony J, John W Powles, Colin D Butler, and Ricardo Uauy. “Food, Livestock Production, Energy, Climate Change, and Health.” The Lancet 370 (6 Oct. 2007): 1253–63. Miers, Suzanne. “Contemporary Slavery”. A Historical Guide to World Slavery. Ed. Seymour Drescher, and Stanley L. Engerman. New York: Oxford University Press, 1998. Mintz, Sidney W. Tasting Food, Tasting Freedom: Excursions into Eating, Culture, and the Past. Boston: Beacon Press, 1994. Nussel, Jill. “Heating Up the Sources: Using Community Cookbooks in Historical Inquiry.” History Compass 4/5 (2006): 956–61. Off, Carol. Bitter Chocolate: Investigating the Dark Side of the World's Most Seductive Sweet. St Lucia: U of Queensland P, 2008. Paxson, Heather. “Slow Food in a Fat Society: Satisfying Ethical Appetites.” Gastronomica: The Journal of Food and Culture 5.1 (2005): 14–18. Pietrykowski, Bruce. “You Are What You Eat: The Social Economy of the Slow Food Movement.” Review of Social Economy 62:3 (2004): 307–21. Pollan, Michael. The Omnivore’s Dilemma: A Natural History of Four Meals. New York: The Penguin Press, 2006. Regan, Tom. The Case for Animal Rights. Berkeley: University of California Press, 1983. Scholz, Christopher A., Thomas C. Johnson, Andrew S. Cohen, John W. King, John A. Peck, Jonathan T. Overpeck, Michael R. Talbot, Erik T. Brown, Leonard Kalindekafe, Philip Y. O. Amoako, Robert P. Lyons, Timothy M. Shanahan, Isla S. Castañeda, Clifford W. Heil, Steven L. Forman, Lanny R. McHargue, Kristina R. Beuning, Jeanette Gomez, and James Pierson. “East African Megadroughts between 135 and 75 Thousand Years Ago and Bearing on Early-modern Human Origins.” PNAS: Proceedings of the National Academy of the Sciences of the United States of America 104.42 (16 Oct. 2007): 16416–21. Sinclair, Upton. The Jungle. New York: Doubleday, Jabber & Company, 1906. Singer, Peter. Animal Liberation. New York: HarperCollins, 1975. (SFFB) Slow Food Foundation for Biodiversity. “Ark of Taste.” 2009. 24 Aug. 2009 < http://www.fondazioneslowfood.it/eng/arca/lista.lasso >. (UNISG) University of Gastronomic Sciences. “Who We Are.” 2009. 24 Aug. 2009 < http://www.unisg.it/eng/chisiamo.php >. Vileisis, Ann. Kitchen Literacy: How We Lost Knowledge of Where Food Comes From and Why We Need to Get It Back. Washington: Island Press/Shearwater Books, 2008. Weissbrodt, David, and Anti-Slavery International. Abolishing Slavery and its Contemporary Forms. New York and Geneva: Office of the United Nations High Commissioner for Human Rights, United Nations, 2002. Zeder, Melinda A. “The Neolithic Macro-(R)evolution: Macroevolutionary Theory and the Study of Culture Change.” Journal of Archaeological Research 17 (2009): 1–63.

The Leichhardt Highway is a six hundred-kilometre stretch of sealed inland road that joins the Australian Queensland border town of Goondiwindi with the Capricorn Highway, just south of the Tropic of Capricorn. Named after the young Prussian naturalist Ludwig Leichhardt, part of this roadway follows the route his party took as they crossed northern Australia from Morton Bay (Brisbane) to Port Essington (near Darwin). Ignoring the usual colonial practice of honouring the powerful and aristocratic, Leichhardt named the noteworthy features along this route after his supporters and fellow expeditioners. Many of these names are still in use and a series of public monuments have also been erected in the intervening century and a half to commemorate this journey. Unlike Leichhardt, who survived his epic trip, some contemporary travellers who navigate the remote roadway named in his honour do not arrive at their final destinations. Memorials to these violently interrupted lives line the highway, many enigmatically located in places where there is no obvious explanation for the lethal violence that occurred there. This examination profiles the memorials along Leichhardt’s highway as Gothic practice, in order to illuminate some of the uncanny paradoxes around public memorials, as well as the loaded emotional terrain such commemorative practices may inhabit. All humans know that death awaits them (Morell). Yet, despite this, and the unprecedented torrent of images of death and dying saturating news, television, and social media (Duwe; Sumiala; Bisceglio), Gorer’s mid-century ideas about the denial of death and Becker’s 1973 Pulitzer prize-winning description of the purpose of human civilization as a defence against this knowledge remains current in the contemporary trope that individuals (at least in the West) deny their mortality. Contributing to this enigmatic situation is how many deny the realities of aging and bodily decay—the promise of the “life extension” industries (Hall)—and are shielded from death by hospitals, palliative care providers, and the multimillion dollar funeral industry (Kiernan). Drawing on Piatti-Farnell’s concept of popular culture artefacts as “haunted/haunting” texts, the below describes how memorials to the dead can powerfully reconnect those who experience them with death’s reality, by providing an “encrypted passageway through which the dead re-join the living in a responsive cycle of exchange and experience” (Piatti-Farnell). While certainly very different to the “sublime” iconic Gothic structure, the Gothic ruin that Summers argued could be seen as “a sacred relic, a memorial, a symbol of infinite sadness, of tenderest sensibility and regret” (407), these memorials do function in both this way as melancholy/regret-inducing relics as well as in Piatti-Farnell’s sense of bringing the dead into everyday consciousness. Such memorialising activity also evokes one of Spooner’s features of the Gothic, by acknowledging “the legacies of the past and its burdens on the present” (8).Ludwig Leichhardt and His HighwayWhen Leichhardt returned to Sydney in 1846 from his 18-month journey across northern Australia, he was greeted with surprise and then acclaim. Having mounted his expedition without any backing from influential figures in the colony, his party was presumed lost only weeks after its departure. Yet, once Leichhardt and almost all his expedition returned, he was hailed “Prince of Explorers” (Erdos). When awarding him a significant purse raised by public subscription, then Speaker of the Legislative Council voiced what he believed would be the explorer’s lasting memorial —the public memory of his achievement: “the undying glory of having your name enrolled amongst those of the great men whose genius and enterprise have impelled them to seek for fame in the prosecution of geographical science” (ctd. Leichhardt 539). Despite this acclaim, Leichhardt was a controversial figure in his day; his future prestige not enhanced by his Prussian/Germanic background or his disappearance two years later attempting to cross the continent. What troubled the colonial political class, however, was his transgressive act of naming features along his route after commoners rather than the colony’s aristocrats. Today, the Leichhardt Highway closely follows Leichhardt’s 1844-45 route for some 130 kilometres from Miles, north through Wandoan to Taroom. In the first weeks of his journey, Leichhardt named 16 features in this area: 6 of the more major of these after the men in his party—including the Aboriginal man ‘Charley’ and boy John Murphy—4 more after the tradesmen and other non-aristocratic sponsors of his venture, and the remainder either in memory of the journey’s quotidian events or natural features there found. What we now accept as traditional memorialising practice could in this case be termed as Gothic, in that it upset the rational, normal order of its day, and by honouring humble shopkeepers, blacksmiths and Indigenous individuals, revealed the “disturbance and ambivalence” (Botting 4) that underlay colonial class relations (Macintyre). On 1 December 1844, Leichhardt also memorialised his own past, referencing the Gothic in naming a watercourse The Creek of the Ruined Castles due to the “high sandstone rocks, fissured and broken like pillars and walls and the high gates of the ruined castles of Germany” (57). Leichhardt also disturbed and disfigured the nature he so admired, famously carving his initials deep into trees along his route—a number of which still exist, including the so-called Leichhardt Tree, a large coolibah in Taroom’s main street. Leichhardt also wrote his own memorial, keeping detailed records of his experiences—both good and more regretful—in the form of field books, notebooks and letters, with his major volume about this expedition published in London in 1847. Leichhardt’s journey has since been memorialised in various ways along the route. The Leichhardt Tree has been further defaced with numerous plaques nailed into its ancient bark, and the town’s federal government-funded Bicentennial project raised a formal memorial—a large sandstone slab laid with three bronze plaques—in the newly-named Ludwig Leichhardt Park. Leichhardt’s name also adorns many sites both along, and outside, the routes of his expeditions. While these fittingly include natural features such as the Leichhardt River in north-west Queensland (named in 1856 by Augustus Gregory who crossed it by searching for traces of the explorer’s ill-fated 1848 expedition), there are also many businesses across Queensland and the Northern Territory less appropriately carrying his name. More somber monuments to Leichhardt’s legacy also resulted from this journey. The first of these was the white settlement that followed his declaration that the countryside he moved through was well endowed with fertile soils. With squatters and settlers moving in and land taken up before Leichhardt had even arrived back in Sydney, the local Yeeman people were displaced, mistreated and completely eradicated within a decade (Elder). Mid-twentieth century, Patrick White’s literary reincarnation, Voss of the eponymous novel, and paintings by Sidney Nolan and Albert Tucker have enshrined in popular memory not only the difficult (and often described as Gothic) nature of the landscape through which Leichhardt travelled (Adams; Mollinson, and Bonham), but also the distinctive and contrary blend of intelligence, spiritual mysticism, recklessness, and stoicism Leichhardt brought to his task. Roadside Memorials Today, the Leichhardt Highway is also lined with a series of roadside shrines to those who have died much more recently. While, like centotaphs, tombstones, and cemeteries, these memorialise the dead, they differ in usually marking the exact location that death occurred. In 43 BC, Cicero articulated the idea of the dead living in memory, “The life of the dead consists in the recollection cherished of them by the living” (93), yet Nelson is one of very few contemporary writers to link roadside memorials to elements of Gothic sensibility. Such constructions can, however, be described as Gothic, in that they make the roadway unfamiliar by inscribing onto it the memory of corporeal trauma and, in the process, re-creating their locations as vivid sites of pain and suffering. These are also enigmatic sites. Traffic levels are generally low along the flat or gently undulating terrain and many of these memorials are located in locations where there is no obvious explanation for the violence that occurred there. They are loci of contradictions, in that they are both more private than other memorials, in being designed, and often made and erected, by family and friends of the deceased, and yet more public, visible to all who pass by (Campbell). Cemeteries are set apart from their surroundings; the roadside memorial is, in contrast, usually in open view along a thoroughfare. In further contrast to cemeteries, which contain many relatively standardised gravesites, individual roadside memorials encapsulate and express not only the vivid grief of family and friends but also—when they include vehicle wreckage or personal artefacts from the fatal incident—provide concrete evidence of the trauma that occurred. While the majority of individuals interned in cemeteries are long dead, roadside memorials mark relatively contemporary deaths, some so recent that there may still be tyre marks, debris and bloodstains marking the scene. In 2008, when I was regularly travelling this roadway, I documented, and researched, the six then extant memorial sites that marked the locations of ten fatalities from 1999 to 2006. (These were all still in place in mid-2014.) The fatal incidents are very diverse. While half involved trucks and/or road trains, at least three were single vehicle incidents, and the deceased ranged from 13 to 84 years of age. Excell argues that scholarship on roadside memorials should focus on “addressing the diversity of the material culture” (‘Contemporary Deathscapes’) and, in these terms, the Leichhardt Highway memorials vary from simple crosses to complex installations. All include crosses (mostly, but not exclusively, white), and almost all are inscribed with the name and birth/death dates of the deceased. Most include flowers or other plants (sometimes fresh but more often plastic), but sometimes also a range of relics from the crash and/or personal artefacts. These are, thus, unsettling sights, not least in the striking contrast they provide with the highway and surrounding road reserve. The specific location is a key component of their ability to re-sensitise viewers to the dangers of the route they are travelling. The first memorial travelling northwards, for instance, is situated at the very point at which the highway begins, some 18 kilometres from Goondiwindi. Two small white crosses decorated with plastic flowers are set poignantly close together. The inscriptions can also function as a means of mobilising connection with these dead strangers—a way of building Secomb’s “haunted community”, whereby community in the post-colonial age can only be built once past “murderous death” (131) is acknowledged. This memorial is inscribed with “Cec Hann 06 / A Good Bloke / A Good hoarseman [sic]” and “Pat Hann / A Good Woman” to tragically commemorate the deaths of an 84-year-old man and his 79-year-old wife from South Australia who died in the early afternoon of 5 June 2006 when their Ford Falcon, towing a caravan, pulled onto the highway and was hit by a prime mover pulling two trailers (Queensland Police, ‘Double Fatality’; Jones, and McColl). Further north along the highway are two memorials marking the most inexplicable of road deaths: the single vehicle fatality (Connolly, Cullen, and McTigue). Darren Ammenhauser, aged 29, is remembered with a single white cross with flowers and plaque attached to a post, inscribed hopefully, “Darren Ammenhauser 1971-2000 At Rest.” Further again, at Billa Billa Creek, a beautifully crafted metal cross attached to a fence is inscribed with the text, “Kenneth J. Forrester / RIP Jack / 21.10.25 – 27.4.05” marking the death of the 79-year-old driver whose vehicle veered off the highway to collide with a culvert on the creek. It was reported that the vehicle rolled over several times before coming to rest on its wheels and that Forrester was dead when the police arrived (Queensland Police, ‘Fatal Traffic Incident’). More complex memorials recollect both single and multiple deaths. One, set on both sides of the road, maps the physical trajectory of the fatal smash. This memorial comprises white crosses on both sides of road, attached to a tree on one side, and a number of ancillary sites including damaged tyres with crosses placed inside them on both sides of the road. Simple inscriptions relay the inability of such words to express real grief: “Gary (Gazza) Stevens / Sadly missed” and “Gary (Gazza) Stevens / Sadly missed / Forever in our hearts.” The oldest and most complex memorial on the route, commemorating the death of four individuals on 18 June 1999, is also situated on both sides of the road, marking the collision of two vehicles travelling in opposite directions. One memorial to a 62-year-old man comprises a cross with flowers, personal and automotive relics, and a plaque set inside a wooden fence and simply inscribed “John Henry Keenan / 23-11-1936–18-06-1999”. The second memorial contains three white crosses set side-by-side, together with flowers and relics, and reveals that members of three generations of the same family died at this location: “Raymond Campbell ‘Butch’ / 26-3-67–18-6-99” (32 years of age), “Lorraine Margaret Campbell ‘Lloydie’ / 29-11-46–18-6-99” (53 years), and “Raymond Jon Campbell RJ / 28-1-86–18-6-99” (13 years). The final memorial on this stretch of highway is dedicated to Jason John Zupp of Toowoomba who died two weeks before Christmas 2005. This consists of a white cross, decorated with flowers and inscribed: “Jason John Zupp / Loved & missed by all”—a phrase echoed in his newspaper obituary. The police media statement noted that, “at 11.24pm a prime mover carrying four empty trailers [stacked two high] has rolled on the Leichhardt Highway 17km north of Taroom” (Queensland Police, ‘Fatal Truck Accident’). The roadside memorial was placed alongside a ditch on a straight stretch of road where the body was found. The coroner’s report adds the following chilling information: “Mr Zupp was thrown out of the cabin and his body was found near the cabin. There is no evidence whatsoever that he had applied the brakes or in any way tried to prevent the crash … Jason was not wearing his seatbelt” (Cornack 5, 6). Cornack also remarked the truck was over length, the brakes had not been properly adjusted, and the trip that Zupp had undertaken could not been lawfully completed according to fatigue management regulations then in place (8). Although poignant and highly visible due to these memorials, these deaths form a small part of Australia’s road toll, and underscore our ambivalent relationship with the automobile, where road death is accepted as a necessary side-effect of the freedom of movement the technology offers (Ladd). These memorials thus animate highways as Gothic landscapes due to the “multifaceted” (Haider 56) nature of the fear, terror and horror their acknowledgement can bring. Since 1981, there have been, for instance, between some 1,600 and 3,300 road deaths each year in Australia and, while there is evidence of a long term downward trend, the number of deaths per annum has not changed markedly since 1991 (DITRDLG 1, 2), and has risen in some years since then. The U.S.A. marked its millionth road death in 1951 (Ladd) along the way to over 3,000,000 during the 20th century (Advocates). These deaths are far reaching, with U.K. research suggesting that each death there leaves an average of 6 people significantly affected, and that there are some 10 to 20 per cent of mourners who experience more complicated grief and longer term negative affects during this difficult time (‘Pathways Through Grief’). As the placing of roadside memorials has become a common occurrence the world over (Klaassens, Groote, and Vanclay; Grider; Cohen), these are now considered, in MacConville’s opinion, not only “an appropriate, but also an expected response to tragedy”. Hockey and Draper have explored the therapeutic value of the maintenance of “‘continuing bonds’ between the living and the dead” (3). This is, however, only one explanation for the reasons that individuals erect roadside memorials with research suggesting roadside memorials perform two main purposes in their linking of the past with the present—as not only sites of grieving and remembrance, but also of warning (Hartig, and Dunn; Everett; Excell, Roadside Memorials; MacConville). Clark adds that by “localis[ing] and personalis[ing] the road dead,” roadside memorials raise the profile of road trauma by connecting the emotionless statistics of road death directly to individual tragedy. They, thus, transform the highway into not only into a site of past horror, but one in which pain and terror could still happen, and happen at any moment. Despite their increasing commonality and their recognition as cultural artefacts, these memorials thus occupy “an uncomfortable place” both in terms of public policy and for some individuals (Lowe). While in some states of the U.S.A. and in Ireland the erection of such memorials is facilitated by local authorities as components of road safety campaigns, in the U.K. there appears to be “a growing official opposition to the erection of memorials” (MacConville). Criticism has focused on the dangers (of distraction and obstruction) these structures pose to passing traffic and pedestrians, while others protest their erection on aesthetic grounds and even claim memorials can lower property values (Everett). While many ascertain a sense of hope and purpose in the physical act of creating such shrines (see, for instance, Grider; Davies), they form an uncanny presence along the highway and can provide dangerous psychological territory for the viewer (Brien). Alongside the townships, tourist sites, motels, and petrol stations vying to attract customers, they stain the roadway with the unmistakable sign that a violent death has happened—bringing death, and the dead, to the fore as a component of these journeys, and destabilising prominent cultural narratives of technological progress and safety (Richter, Barach, Ben-Michael, and Berman).Conclusion This investigation has followed Goddu who proposes that a Gothic text “registers its culture’s contradictions” (3) and, in profiling these memorials as “intimately connected to the culture that produces them” (Goddu 3) has proposed memorials as Gothic artefacts that can both disturb and reveal. Roadside memorials are, indeed, so loaded with emotional content that their close contemplation can be traumatising (Brien), yet they are inescapable while navigating the roadway. Part of their power resides in their ability to re-animate those persons killed in these violent in the minds of those viewing these memorials. In this way, these individuals are reincarnated as ghostly presences along the highway, forming channels via which the traveller can not only make human contact with the dead, but also come to recognise and ponder their own sense of mortality. While roadside memorials are thus like civic war memorials in bringing untimely death to the forefront of public view, roadside memorials provide a much more raw expression of the chaotic, anarchic and traumatic moment that separates the world of the living from that of the dead. While traditional memorials—such as those dedicated by, and to, Leichhardt—moreover, pay homage to the vitality of the lives of those they commemorate, roadside memorials not only acknowledge the alarming circumstances of unexpected death but also stand testament to the power of the paradox of the incontrovertibility of sudden death versus our lack of ability to postpone it. In this way, further research into these and other examples of Gothic memorialising practice has much to offer various areas of cultural study in Australia.ReferencesAdams, Brian. Sidney Nolan: Such Is Life. Hawthorn, Vic.: Hutchinson, 1987. Advocates for Highway and Auto Safety. “Motor Vehicle Traffic Fatalities & Fatality Rate: 1899-2003.” 2004. Becker, Ernest. The Denial of Death. New York: Simon & Schuster, 1973. Bisceglio, Paul. “How Social Media Is Changing the Way We Approach Death.” The Atlantic 20 Aug. 2013. Botting, Fred. Gothic: The New Critical Idiom. 2nd edition. Abingdon, UK: Routledge, 2014. Brien, Donna Lee. “Looking at Death with Writers’ Eyes: Developing Protocols for Utilising Roadside Memorials in Creative Writing Classes.” Roadside Memorials. Ed. Jennifer Clark. Armidale, NSW: EMU Press, 2006. 208–216. Campbell, Elaine. “Public Sphere as Assemblage: The Cultural Politics of Roadside Memorialization.” The British Journal of Sociology 64.3 (2013): 526–547. Cicero, Marcus Tullius. The Orations of Marcus Tullius Cicero. 43 BC. Trans. C. D. Yonge. London: George Bell & Sons, 1903. Clark, Jennifer. “But Statistics Don’t Ride Skateboards, They Don’t Have Nicknames Like ‘Champ’: Personalising the Road Dead with Roadside Memorials.” 7th International Conference on the Social Context of Death, Dying and Disposal. Bath, UK: University of Bath, 2005. Cohen, Erik. “Roadside Memorials in Northeastern Thailand.” OMEGA: Journal of Death and Dying 66.4 (2012–13): 343–363. Connolly, John F., Anne Cullen, and Orfhlaith McTigue. “Single Road Traffic Deaths: Accident or Suicide?” Crisis: The Journal of Crisis Intervention and Suicide Prevention 16.2 (1995): 85–89. Cornack [Coroner]. Transcript of Proceedings. In The Matter of an Inquest into the Cause and Circumstances Surrounding the Death of Jason John Zupp. Towoomba, Qld.: Coroners Court. 12 Oct. 2007. Davies, Douglas. “Locating Hope: The Dynamics of Memorial Sites.” 6th International Conference on the Social Context of Death, Dying and Disposal. York, UK: University of York, 2002. Department of Infrastructure, Transport, Regional Development and Local Government [DITRDLG]. Road Deaths Australia: 2007 Statistical Summary. Canberra: Commonwealth of Australia, 2008. Duwe, Grant. “Body-count Journalism: The Presentation of Mass Murder in the News Media.” Homicide Studies 4 (2000): 364–399. Elder, Bruce. Blood on the Wattle: Massacres and Maltreatment of Aboriginal Australians since 1788. Sydney: New Holland, 1998. Erdos, Renee. “Leichhardt, Friedrich Wilhelm Ludwig (1813-1848).” Australian Dictionary of Biography Online Edition. Melbourne: Melbourne UP, 1967. Everett, Holly. Roadside Crosses in Contemporary Memorial Culture. Austin: Texas UP, 2002. Excell, Gerri. “Roadside Memorials in the UK.” Unpublished MA thesis. Reading: University of Reading, 2004. ———. “Contemporary Deathscapes: A Comparative Analysis of the Material Culture of Roadside Memorials in the US, Australia and the UK.” 7th International Conference on the Social Context of Death, Dying and Disposal. Bath, UK: University of Bath, 2005. Goddu, Teresa A. Gothic America: Narrative, History, and Nation. New York: Columbia UP, 2007. Gorer, Geoffrey. “The Pornography of Death.” Encounter V.4 (1955): 49–52. Grider, Sylvia. “Spontaneous Shrines: A Modern Response to Tragedy and Disaster.” New Directions in Folklore (5 Oct. 2001). Haider, Amna. “War Trauma and Gothic Landscapes of Dispossession and Dislocation in Pat Barker’s Regeneration Trilogy.” Gothic Studies 14.2 (2012): 55–73. Hall, Stephen S. Merchants of Immortality: Chasing the Dream of Human Life Extension. Boston: Houghton, Mifflin, Harcourt, 2003. Hartig, Kate V., and Kevin M. Dunn. “Roadside Memorials: Interpreting New Deathscapes in Newcastle, New South Wales.” Australian Geographical Studies 36 (1998): 5–20. Hockey, Jenny, and Janet Draper. “Beyond the Womb and the Tomb: Identity, (Dis)embodiment and the Life Course.” Body & Society 11.2 (2005): 41–57. Online version: 1–25. Jones, Ian, and Kaye McColl. (2006) “Highway Tragedy.” Goondiwindi Argus 9 Jun. 2006. Kiernan, Stephen P. “The Transformation of Death in America.” Final Acts: Death, Dying, and the Choices We Make. Eds. Nan Bauer-Maglin, and Donna Perry. Rutgers University: Rutgers UP, 2010. 163–182. Klaassens, M., P.D. Groote, and F.M. Vanclay. “Expressions of Private Mourning in Public Space: The Evolving Structure of Spontaneous and Permanent Roadside Memorials in the Netherlands.” Death Studies 37.2 (2013): 145–171. Ladd, Brian. Autophobia: Love and Hate in the Automotive Age. Chicago: U of Chicago P, 2008. Leichhardt, Ludwig. Journal of an Overland Expedition of Australia from Moreton Bay to Port Essington, A Distance of Upwards of 3000 Miles during the Years 1844–1845. London, T & W Boone, 1847. Facsimile ed. Sydney: Macarthur Press, n.d. Lowe, Tim. “Roadside Memorials in South Eastern Australia.” 7th International Conference on the Social Context of Death, Dying and Disposal. Bath, UK: University of Bath, 2005. MacConville, Una. “Roadside Memorials.” Bath, UK: Centre for Death & Society, Department of Social and Policy Sciences, University of Bath, 2007. Macintyre, Stuart. “The Making of the Australian Working Class: An Historiographical Survey.” Historical Studies 18.71 (1978): 233–253. Mollinson, James, and Nicholas Bonham. Tucker. South Melbourne: Macmillan Company of Australia, and Australian National Gallery, 1982. Morell, Virginia. “Mournful Creatures.” Lapham’s Quarterly 6.4 (2013): 200–208. Nelson, Victoria. Gothicka: Vampire Heroes, Human Gods, and the New Supernatural. Harvard University: Harvard UP, 2012. “Pathways through Grief.” 1st National Conference on Bereavement in a Healthcare Setting. Dundee, 1–2 Sep. 2008. Piatti-Farnell, Lorna. “Words from the Culinary Crypt: Reading the Recipe as a Haunted/Haunting Text.” M/C Journal 16.3 (2013). Queensland Police. “Fatal Traffic Incident, Goondiwindi [Media Advisory].” 27 Apr. 2005. ———. “Fatal Truck Accident, Taroom.” Media release. 11 Dec. 2005. ———. “Double Fatality, Goondiwindi.” Media release. 5 Jun. 2006. Richter, E. D., P. Barach, E. Ben-Michael, and T. Berman. “Death and Injury from Motor Vehicle Crashes: A Public Health Failure, Not an Achievement.” Injury Prevention 7 (2001): 176–178. Secomb, Linnell. “Haunted Community.” The Politics of Community. Ed. Michael Strysick. Aurora, Co: Davies Group, 2002. 131–150. Spooner, Catherine. Contemporary Gothic. London: Reaktion, 2006.

This article is about refugees’ and migrants’ dreams of home and family and stems from an Australian Research Council Linkage Grant, “A Hand Up: Disrupting the Communication of Intergenerational Welfare Dependency” (LP140100935), with Partner Organisation St Vincent de Paul Society (WA) Inc. (Vinnies). A Vinnies-supported refugee and migrant support centre was chosen as one of the hubs for interviewee recruitment, given that many refugee families experience persistent and chronic economic disadvantage. The de-identified name for the drop-in language-teaching and learning social facility is the Migrant and Refugee Homebase (MARH). At the time of the research, in 2018, refugee and forced migrant families from Syria, Iraq, and Afghanistan constituted MARH’s primary membership base. MARH provided English language classes alongside other educational and financial support. It could also organise provision of emergency food and was a conduit for furniture donated by Australian families. Crucially, MARH operated as a space in which members could come together to build shared community.As part of her role, the researcher was introduced to Sara (de-identified), a mother-tongue Arabic speaker and the centre’s coordinator. Sara had personal experience of being a refugee, as well as being MARH’s manager, and she became both a point of contact for the researcher team, an interpreter/translator, and an empathetic listener as refugees shared their stories. Dreams of home and family emerged throughout the interviews as a vital part of participants’ everyday lives. These dreams and hopes were developed in the face of what was, for some, a nightmare of adversity. Underpinning participants’ sense of agency, subjectivity and resilience, Badiou argues (93, as noted in Jackson, 241) that hope can appear as a basic form of patience or perseverance rather than a dream for justice. Instead of imagining an improvement in personal circumstances, the dream is one of simply moving forward rather than backward. While dreams of being reunited with family are rooted in the past and project a vision of a family which no longer exists, these dreams help fashion a future which once again contains a range of possibilities.Although Sara volunteered her time on the research project as part of her commitment to Vinnies, she was well-known to interviewees as a MARH staff member and, in many cases, a friend and confidante. While Sara’s manager role implies an imbalance of power, with Sara powerful and participants comparatively less so, the majority of the information explored in the interviews pertained to refugees’ experiences of life outside the sphere in which MARH is engaged, so there was limited risk of the data being sanitised to reflect positively upon MARH. The specialist information and understandings that the interviewees shared positions them as experts, and as co-creators of knowledge.Recruitment and Methodological ApproachThe project researcher (Jaunzems) met potential contributors at MARH when its members gathered for a coffee morning. With Sara’s assistance, the researcher invited MARH members to take part in the research project, giving those present the opportunity to ask and have answered any questions they deemed important. Coffee morning attendees were under no obligation to take part, and about half chose not to do so, while the remainder volunteered to participate. Sara scheduled the interviews at times to suit the families participating. A parent and child from each volunteer family was interviewed, separately. In all cases it was the mother who volunteered to take part, and all interviewees chose to be interviewed in their homes. Each set of interviews was digitally recorded and lasted no longer than 90 minutes. This article includes extracts from interviews with three mothers from refugee families who escaped war-torn homelands for a new life in Australia, sometimes via interim refugee camps.The project researcher conducted the in-depth interviews with Sara’s crucial interpreting/translating assistance. The interviews followed a traditional approach, except that the researcher deferred to Sara as being more important in the interview exchange than she was. This reflects the premise that meaning is socially constructed, and that what people do and say makes visible the meanings that underpin their actions and statements within a wider social context (Burr). Conceptualising knowledge as socially constructed privileges the role of the decoder in receiving, understanding and communicating such knowledge (Crotty). Respecting the role of the interpreter/translator signified to the participants that their views, opinions and their overall cultural context were valued.Once complete, the interviews were sent for translation and transcription by a trusted bi-lingual transcriber, where both the English and Arabic exchanges were transcribed. This was deemed essential by the researchers, to ensure both the authenticity of the data collected and to demonstrate “trust, understanding, respect, and a caring connection” (Valibhoy, Kaplan, and Szwarc, 23) with the participants. Upon completion of the interviews with volunteer members of the MARH community, and at the beginning of the analysis phase, researchers recognised the need for the adoption of an interpretive framework. The interpretive approach seeks to understand an individual’s view of the world through the contexts of time, place and culture. The knowledge produced is contextualised and differs from one person to another as a result of individual subjectivities such as age, race and ethnicity, even within a shared social context (Guba and Lincoln). Accordingly, a mother-tongue Arabic speaker, who identifies as a refugee (Al-Hameed), was added to the project. All authors were involved in writing up the article while authors two, three and four took responsibility for transcript coding and analysis. In the transcripts that follow, words originally spoken in Arabic are in intalics, with non-italcised words originally spoken in English.Discrimination and BelongingAya initially fled from her home in Syria into neighbouring Jordan. She didn’t feel welcomed or supported there.[00:55:06] Aya: …in Jordan, refugees didn’t have rights, and the Jordanian schools refused to teach them [the children…] We were put aside.[00:55:49] Interpreter, Sara (to Researcher): And then she said they push us aside like you’re a zero on the left, yeah this is unfortunately the reality of our countries, I want to cry now.[00:56:10] Aya: You’re not allowed to cry because we’ll all cry.Some refugees and migrant communities suffer discrimination based on their ethnicity and perceived legitimacy as members of the host society. Although Australian refugees may have had searing experiences prior to their acceptance by Australia, migrant community members in Australia can also feel themselves “constructed in the public and political spheres as less legitimately Australian than others” (Green and Aly). Jackson argues that both refugees and migrants experiencethe impossibility of ever bridging the gap between one’s natal ties to the place one left because life was insupportable there, and the demands of the nation to which one has travelled, legally or illegally, in search of a better life. And this tension between belonging and not belonging, between a place where one has rights and a place where one does not, implies an unresolved relationship between one’s natural identity as a human being and one’s social identity as ‘undocumented migrant,’ a ‘resident alien,’ an ‘ethnic minority,’ or ‘the wretched of the earth,’ whose plight remains a stigma of radical alterity even though it inspires our compassion and moves us to political action. (223)The tension Jackson refers to, where the migrant is haunted by belonging and not belonging, is an area of much research focus. Moreover, the label of “asylum seeker” can contribute to systemic “exclusion of a marginalised and abject group of people, precisely by employing a term that emphasises the suspended recognition of a community” (Nyers). Unsurprisingly, many refugees in Australia long for the connectedness of the lives they left behind relocated in the safe spaces where they live now.Eades focuses on an emic approach to understanding refugee/migrant distress, or trauma, which seeks to incorporate the worldview of the people in distress: essentially replicating the interpretive perspective taken in the research. This emic framing is adopted in place of the etic approach that seeks to understand the distress through a Western biomedical lens that is positioned outside the social/cultural system in which the distress is taking place. Eades argues: “developing an emic approach is to engage in intercultural dialogue, raise dilemmas, test assumptions, document hopes and beliefs and explore their implications”. Furthermore, Eades sees the challenge for service providers working with refugee/migrants in distress as being able to move beyond “harm minimisation” models of care “to recognition of a facilitative, productive community of people who are in a transitional phase between homelands”. This opens the door for studies concerning the notions of attachment to place and its links to resilience and a refugee’s ability to “settle in” (for example, Myers’s ground-breaking place-making work in Plymouth).Resilient PrecariousnessChaima: We feel […] good here, we’re safe, but when we sit together, we remember what we went through how my kids screamed when the bombs came, and we went out in the car. My son was 12 and I was pregnant, every time I remember it, I go back.Alongside the dreams that migrants have possible futures are the nightmares that threaten to destabilise their daily lives. As per the work of Xavier and Rosaldo, post-migration social life is recreated in two ways: the first through participation and presence in localised events; the second by developing relationships with absent others (family and friends) across the globe through media. These relationships, both distanced and at a distance, are dispersed through time and space. In light of this, Campays and Said suggest that places of past experiences and rituals for meaning are commonly recreated or reproduced as new places of attachment abroad; similarly, other recollections and experience can trigger a sense of fragility when “we remember what we went through”. Gupta and Ferguson suggest that resilience is defined by the migrant/refugee capacity to “reimagine and re-materialise” their lost heritage in their new home. This involves a sense of connection to the good things in the past, while leaving the bad things behind.Resilience has also been linked to the migrant’s/refugee’s capacity “to manage their responses to adverse circumstances in an interpersonal community through the networks of relationships” (Eades). Resilience in this case is seen through an intersubjective lens. Joseph reminds us that there is danger in romanticising community. Local communities may not only be hostile toward different national and ethnic groups, they may actively display a level of hostility toward them (Boswell). However, Gill maintains that “the reciprocal relations found in communities are crucially important to their [migrant/refugee] well-being”. This is because inclusion in a given community allows migrants/refugees to shrug off the outsider label, and the feeling of being at risk, and provides the opportunity for them to become known as families and friends. One of MAHR’s central aims was to help bridge the cultural divide between MARH users and the broader Australian community.Hope[01:06: 10] Sara (to interviewee, Aya): What’s the key to your success here in Australia?[01:06:12] Aya: The people, and how they treat us.[01:06:15] Sara (to Researcher): People and how they deal with us.[01:06:21] Aya: It’s the best thing when you look around, and see people who don’t understand your language but they help you.[01:06:28] Sara (to Researcher): She said – this is nice. I want to cry also. She said the best thing when I see people, they don’t understand your language, and I don’t understand theirs but they still smile in your face.[01:06:43] Aya: It’s the best.[01:06:45] Sara (to Aya): yes, yes, people here are angels. This is the best thing about Australia.Here, Sara is possibly shown to be taking liberties with the translation offered to the researcher, talking about how Australians “smile in your face”, when (according to the translator) Aya talked about how Australians “help”. Even so, the capacity for social connection and other aspects of sociality have been linked to a person’s ability to turn a negative experience into a positive cultural resource (Wilson). Resilience is understood in these cases as a strength-based practice where families, communities and individuals are viewed in terms of their capabilities and possibilities, instead of their deficiencies or disorders (Graybeal and Saleeby in Eades). According to Fozdar and Torezani, there is an “apparent paradox between high-levels of discrimination experienced by humanitarian migrants to Australia in the labour market and everyday life” (30) on the one hand, and their reporting of positive well-being on the other. That disparity includes accounts such as the one offered by Aya.As Wilson and Arvanitakis suggest,the interaction between negative experiences of discrimination and reports of wellbeing suggested a counter-intuitive propensity among refugees to adapt to and make sense of their migration experiences in unique, resourceful and life-affirming ways. Such response patterns among refugees and trauma survivors indicate a similar resilience-related capacity to positively interpret and derive meaning from negative migration experiences and associated emotions. … However, resilience is not expressed or employed uniformly among individuals or communities. Some respond in a resilient manner, while others collapse. On this point, an argument could be made that collapse and breakdown is a built-in aspect of resilience, and necessary for renewal and ongoing growth.Using this approach, Wilson and Arvanitakis have linked resilience to hope, as a “present- and future-oriented mode of situated defence against adversity”. They argue that the term “hope” is often utilised in a tokenistic way “as a strategic instrument in increasingly empty domestic and international political vocabularies”. Nonetheless, Wilson and Arvanitakis believe hope to be of vital academic interest due to the prevalence of war and suffering throughout the world. In the research reported here, the authors found that participants’ hopes were interwoven with dreams of being reunited with their families in a place of safety. This is a common longing. As Jackson states,so it is that migrants travel abroad in pursuit of utopia, but having found that place, which is also no-place (ou-topos), they are haunted by the thought that utopia actually lies in the past. It is the family they left behind. That is where they properly belong. Though the family broke up long ago and is now scattered to the four winds, they imagine a reunion in which they are together again. (223)There is a sense here that with their hopes and dreams lying in the past, refugees/migrants are living forward while looking backwards (a Kierkegaardian concept). If hope is thought to be key to resilience (Wilson and Arvanitakis), and key to an individual’s ability to live with a sense of well-being, then perhaps a refugee’s past relations (familial) impact both their present relations (social/community), and their ability to transform negative experiences into positive experiences. And yet, there is no readily accessible way in which migrants and refugees can recreate the connections that sustained them in the past. As Jackson suggests,the irreversibility of time is intimately connected with the irreversibility of one’s place of origin, and this entwined movement through time and across space proves perplexing to many migrants, who, in imagining themselves one day returning to the place from where they started out, forget that there is no transport which will convey them back into the past. … Often it is only by going home that is becomes starkly and disconcertingly clear that one’s natal village is no longer the same and that one has also changed. (221)The dream of home and family, therefore and the hope that this might somehow be recreated in the safety of the here and now, becomes a paradoxical loss and longing even as it is a constant companion for many on their refugee journey.Esma’s DreamAccording to author three, personal dreams are not generally discussed in Arab culture, even though dreams themselves may form part of the rich tradition of Arabic folklore and storytelling. Alongside issues of mental wellbeing, dreams are constructed as something private, and it generally breaks social taboos to describe them publicly. However, in personal discussions with other refugee women and men, and echoing Jackson’s finding, a recurring dream is “to meet my family in a safe place and not be worried about my safety or theirs”. As a refugee, the third author shares this dream. This is also the perspective articulated by Esma, who had recently had a fifth child and was very much missing her extended family who had died, been scattered as refugees, or were still living in a conflict zone. The researcher asked Sara to ask Esma about the best aspect of her current life:[01:17:03] Esma: The thing that comforts me here is nature, it’s beautiful.[01:17:15] Sara (to the Researcher): The nature.[01:17:16] Esma: And feeling safe.[01:17:19] Sara (to the Researcher): The safety. ...[01:17:45] Esma: Life’s beautiful here.[01:17:47] Sara (to the Researcher): Life is beautiful here.[01:17:49] Esma: But I want to know people, speak the language, have friends, life is beautiful here even if I don’t have my family here.[01:17:56] Sara (to the Researcher): Life is so pretty you only need to improve the language and have friends, she said I love my life here even though I don’t have any family or community here. (To Esma:) I am your family.[01:18:12] Esma: Bring me my siblings here.[01:18:14] Sara (to Esma): I just want my brothers here and my sisters.[01:18:17] Esma: It’s a dream.[01:18:18] Sara (to Esma): it’s a dream, one day it will become true.Here Esma uses the term dream metaphorically, to describe an imagined utopia: a dream world. In supporting Esma, who is mourning the absence of her family, Sara finds herself reacting and emoting around their shared experience of leaving siblings behind. In doing so, she affirms the younger woman, but also offers a hope for the future. Esma had previously made a suggestion, absorbed into her larger dream, but more achievable in the short term, “to know people, speak the language, have friends”. The implication here is that Esma is keen to find a way to connect with Australians. She sees this as a means of compensating for the loss of family, a realistic hope rather than an impossible dream.ConclusionInterviews with refugee families in a Perth-based migrant support centre reveals both the nightmare pasts and the dreamed-of futures of people whose lives have experienced a radical disruption due to war, conflict and other life-threatening events. Jackson’s work with migrants provides a context for understanding the power of the dream in helping to resolve issues around the irreversibility of time and circumstance, while Wilson and Arvanitakis point to the importance of hope and resilience in supporting the building of a positive future. Within this mix of the longed for and the impossible, both the refugee informants and the academic literature suggest that participation in local events, and authentic engagement with the broader community, help make a difference in supporting a migrant’s transition from dreaming to reality.AcknowledgmentsThis article arises from an ARC Linkage Project, ‘A Hand Up: Disrupting the Communication of Intergenerational Welfare Dependency’ (LP140100935), supported by the Australian Research Council, Partner Organisation St Vincent de Paul Society (WA) Inc., and Edith Cowan University. The authors are grateful to the anonymous staff and member of Vinnies’ Migrant and Refugee Homebase for their trust in and support of this project, and for their contributions to it.ReferencesBadiou, Alan. Saint Paul: The Foundation of Universalism. Trans. Ray Brassier. Stanford, CA: Stanford UP, 2003.Boswell, Christina. “Burden-Sharing in the European Union: Lessons from the German and UK Experience.” Journal of Refugee Studies 16.3 (2003): 316–35.Burr, Vivien. Social Constructionism. 2nd ed. Hove, UK & New York, NY: Routledge, 2003.Campays, Philippe, and Vioula Said. “Re-Imagine.” M/C Journal 20.4 (2017). Aug. 2017 <http://journal.media-culture.org.au/index.php/mcjournal/article/view/1250>.Crotty, Michael. The Foundations of Social Research: Meaning and Perspective in the Research Process. St Leonards: Allen & Unwin, 1998.Eades, David. “Resilience and Refugees: From Individualised Trauma to Post Traumatic Growth.” M/C Journal 16.5 (2013). Aug. 2013 <http://journal.media-culture.org.au/index.php/mcjournal/article/view/700>.Fozdar, Farida, and Silvia Torezani. “Discrimination and Well-Being: Perceptions of Refugees in Western Australia.” The International Migration Review 42.1 (2008): 1–34.Gill, Nicholas. “Longing for Stillness: The Forced Movement of Asylum Seekers.” M/C Journal 12.1 (2009). Mar. 2009 <http://journal.media-culture.org.au/index.php/mcjournal/article/view/123>.Graybeal, Clay. “Strengths-Based Social Work Assessment: Transforming the Dominant Paradigm.” Families in Society 82.3 (2001): 233–42.Green, Lelia, and Anne Aly. “Bastard Immigrants: Asylum Seekers Who Arrive by Boat and the Illegitimate Fear of the Other.” M/C Journal 17.5 (2014). Oct. 2014 <http://journal.media-culture.org.au/index.php/mcjournal/article/view/896>.Guba, Egon G., and Yvonna S. Lincoln. "Competing Paradigms in Qualitative Research." Handbook of Qualitative Research 2 (1994): 163-194.Gupta, Akhil, and James Ferguson. “Beyond ‘Culture’: Space, Identity, and the Politics of Difference.” Religion and Social Justice for Immigrants. Ed. Pierrette Hondagneu-Sotelo. New Jersey: Rutgers UP, 2006. 72-79.Jackson, Michael. The Wherewithal of Life: Ethics, Migration, and the Question of Well-Being. California: U of California P, 2013.Joseph, Miranda. Against the Romance of Community. Minnesota: University of Minnesota Press, 2002.Myers, Misha. “Situations for Living: Performing Emplacement." Research in Drama Education 13.2 (2008): 171-180. DOI: 10.1080/13569780802054828.Nyers, Peter. “Abject Cosmopolitanism: The Politics of Protection in the Anti-Deportation Movement.” Third World Quarterly 24.6 (2003): 1069–93.Saleeby, Dennis. “The Strengths Perspective in Social Work Practice: Extensions and Cautions.” Social Work 41.3 (1996): 296–305.Valibhoy, Madeleine C., Ida Kaplan, and Josef Szwarc. “‘It Comes Down to Just How Human Someone Can Be’: A Qualitative Study with Young People from Refugee Backgrounds about Their Experiences of Australian Mental Health Services.” Transcultural Psychiatry 54.1 (2017): 23-45.Wilson, Michael. Accumulating Resilience: An Investigation of the Migration and Resettlement Experiences of Young Sudanese People in the Western Sydney Area. Sydney: University of Western Sydney, 2012.Wilson, Michael John, and James Arvanitakis. “The Resilience Complex.” M/C Journal 16.5 (2013). <http://journal.media-culture.org.au/index.php/mcjournal/article/view/741>.Xavier, Johnathon, and Renato Rosaldo. “Thinking the Global.” The Anthropology of Globalisation. Eds. Johnathon Xavier and Renato Rosaldo. New Jersey: Wiley-Blackwell Publishers, 2002.