Journal articles on the topic 'Norwood (Mass.)'

Background: Multi-component interventions in large communities such as Philadelphia can effectively lower childhood obesity rates. It is less clear whether this type of intervention can be successful in smaller communities with more limited resources. Norwood, Ohio is a small Midwestern city with a population of 19,207. In 2010, Ohio passed a school health law requiring Body Mass Index (BMI) screening of students in kindergarten and grades 3, 5 and 9 along with restrictions on competitive foods and vending machine products and a physical education requirement of 30 min per day. In 2014, Norwood implemented a multi-component childhood obesity prevention and treatment bundle of interventions. Our objective was to describe the effects if this bundle on childhood overweight/obesity (OW/OB) rates. We hypothesized that implementation of the bundle would lower the prevalence of OW/OB in Norwood school children. Methods: In 2012, the Healthy Kids Ohio Act was fully implemented in the Norwood City School District (NCSD). In 2014 a comprehensive bundle was implemented that included: 1. A student gardening program; 2. Supplementation of fresh produce to a local food pantry and a family shelter; 3. A farmers market; 4. A health newsletter; 5. Incentives in the school cafeterias to promote healthy food selection; 6. A 100-mile walking club; 7. “Cook for America” (a “cooked from scratch” intervention for school cafeterias); 8. A school-based obesity treatment clinic; Results: The OW/OB rate in the NCSD was 43% at the time of the Bundle implementation in 2014 and 37% in 2016 (p = 0.029). Conclusions: A childhood OW/OB prevention bundle can be implemented in a small city and is associated with a favorable change in BMI.

Aim: To explore the prevalence of hair loss and its relation to men’s stress and smoking, Methodology: A cross sectional study attempts to explore the prevalence of baldness among the male residents of Lahore. For this purpose, a randomized sample of the male population was taken into consideration. The socio-demographic details, along with the smoking status of the sample were determined. Moreover, the body mass index (BMI) was also determined by referring to a prefixed formula. Baldness and stress levels were also quantified by taking into account the Norwood Hamilton categorical scale, and the perceived stress scale, respectively. A total of 250 male members were invited to participate in the research. Results: The study results showed that 51.2%, 41.2% and 7.6%of male experienced moderate, high and low level of stress respectively. When taking the Norwood Hamilton categorical scale into account, the results revealed that most prevalent type of baldness was Type II, which is the fronto-temporal hairline recession, with 19.2% of the individuals experiencing it. Age was significantly associated with baldness. Similarly a higher frequency of baldness was recorded in those men who lived in a nuclear family arrangement. Conclusion: No association was found between the type of baldness, stress level and smoking status. Keyword: Alopecia, Baldness, Norwood Hamilton categorical scale, Perceived stress scale, smoking

Hypoplastic left heart syndrome is a congenital heart disease that affects the normal blood flow through the heart and it characterized by a critical underdevelopment of the left heart. Hypoplastic left heart syndrome is 1.43.8% among all congenital heart defects and 16% among critical congenital heart disease. Mortality in large cardiac surgery centers currently does not exceed 15%. However, mortality among patients with low body mass is up to 51% after the first stage of palliative surgery. In our clinical case, we describe hemodynamic surgery in neonatal with left-heart hypoplasia syndrome and low body weight (Norwood procedure with Sano shunt), postoperative case management inter-stage period and bidirectional cavopulmonary anastomosis procedure (second stage of hemodynamic correction).

AbstractObjectiveHyperglycaemia has been identified as a risk factor for adverse outcomes in critically ill patients, including those who have undergone cardiopulmonary bypass. Tight glucose control with insulin therapy has been shown to improve outcomes, but is not common practice for children following cardiopulmonary bypass. We examined the relationship between blood glucose level and systemic and cerebral oxygen transport in a uniform group of neonates after the Norwood procedure.MethodsSystemic oxygen consumption was measured using respiratory mass spectrometry in 17 neonates for 72 hours postoperatively. Cardiac output, systemic and total pulmonary vascular resistances – including the Blalock–Taussig shunt, systemic oxygen delivery and oxygen extraction ratio, as well as arterial lactate and glucose, were measured at 2- to 4-hour intervals. Cerebral oxygen saturation was measured by near-infrared spectroscopy.ResultsBlood glucose levels ranged from 2.8 to 24.6 millimoles per litre. Elevated glucose level showed a significant negative correlation with cardiac output (p = 0.02) and cerebral oxygen saturation (p = 0.03), and a positive correlation with oxygen extraction ratio (p = 0.03). It tended to correlate positively with systemic vascular resistance (p = 0.09) and negatively with oxygen delivery (p = 0.09), but did not correlate with oxygen consumption (p = 0.13).ConclusionsHyperglycaemia is negatively associated with systemic haemodynamics, oxygen transport, and cerebral oxygenation status in neonates after the Norwood procedure. Further study is warranted to examine tight glucose control with insulin therapy on postoperative systemic and cerebral oxygen transport and functional outcomes in neonates after cardiopulmonary bypass.

Introduction: Androgenetic alopecia (AGA) is associated with increased risk of several systemic diseases and some environmental factors, however, controversies exist. Since AGA and Benign Prostatic Hyperplasia (BPH) share common pathogenesis and AGA manifests some decades before BPH onset, it may serve as an early marker of BPH.Objective: This study was conducted to know AGA and its association with BPH in men ≥20 years of age.Materials and Methods: Clinically diagnosed cases of AGA (n=176) and 117 age matched healthy controls were enrolled. All cases and controls were subjected for abdomino-pelvic ultrasonography, urinary flowmetry, fasting lipid profiles, glycemic index and body mass index. International Prostate Symptom Score (IPSS) was also assessed.Results: Among 176 patients, 120 (68.18%) had Hamilton-Norwood grade III AGA and 56 (31.82%) had grade IV-VII AGA. In both groups, 140 (79.55%) cases and 93 (79.49%) controls were aged <35 years respectively. Family history of AGA was present in 108 (61.36%) cases and 2 (1.71%) controls. This observation was statistically significant with OR= 89.61 (95%CI 23.67-339.29). Three (1.7%) cases and none of the controls had prostate volume >30ml. Seventeen(9.66%) cases and 4 (3.42%) controls were graded as moderately/severely symptomatic IPSS. Statistically significant association was seen between family history and early onset of hair loss (<35 years) in a male sibling or parent.Conclusion: Although positive family history was associated with early onset of AGA, no association between AGA and BPH could be elicited in our study.

Cisplatin (CDDP) was combined with floxuridine (FUDR) and delivered into the hepatic arteries of 29 patients as induction therapy for colorectal cancer metastatic to the liver. Mitomycin C and FUDR combination was substituted after progression or when response had peaked. Chemotherapy was delivered with an Infusaid pump (Infusaid Corp; Norwood, Mass; 14 patients), Medtronic programmable drug administration device (Medtronic, Inc, Minneapolis; two patients), or percutaneously placed catheters (13 patients). Complete disappearance of liver metastases was observed in four patients and 11 additional patients had a partial remission as determined by computed tomography (CT) scan and substantiated at times by angiography, for a total response rate of 52%. Response as determined by imaging techniques coincided with a concurrent decrease in carcinoembryonic antigen (CEA) and improvement in performance status. The severity of tumor burden was correlated with the response to therapy and survival. Among those patients who responded to arterial chemotherapy, differences in disease severity did not significantly influence survival. Median survival among responders with greater than 25% liver replacement by tumor was 14 months (P = .28), compared with 28 months for those patients with less than 25% liver replacement. In contrast, differences in tumor burden significantly affected survival among patients who failed to respond to chemotherapy; median survival among nonresponding patients with greater than 25% liver replacement was 4 months, compared with 8 months for those who had less than 25% liver replacement (P = .01). The presence of minimal extrahepatic disease at the time of initiation of intraarterial treatment did not seem to have a significant detrimental effect on survival. The study suggests that hepatic tumor response to arterial administration of CDDP and FUDR and mitomycin C and FUDR is clinically significant because it overrides the effect of tumor burden on survival among patients who have colorectal cancer with liver metastases and may offer effective palliation.

255 Background: Early onset of puberty, resulting in more prolonged exposure to higher androgen levels, has been hypothesized to be a risk factor for more aggressive prostate cancer (PCa) later in life. We sought to determine whether earlier age of first shave and height, as surrogates of pubertal onset, were associated with worsening PCa characteristics. Methods: A prospectively collected registry of patients presenting for a prostate biopsy at the Charlie Norwood Veterans Affairs Medical Center in Augusta, GA between July 1995 and June 2016 was utilized. Age of first shave and height were compared to the risk of cancer on prostate biopsy, high grade cancer (i.e. Gleason score 8 or higher), and high volume disease (i.e. at least 50% of total cores were positive) using univariable and multivariable logistic regression analysis, controlling for patient age, race, prostate specific antigen, percent free prostate specific antigen, clinical stage, prostate volume, body mass index, family history. Statistical significance was set at p < 0.05 and all statistical analyses were performed using R version 3.6.1. Results: Of the 1,176 patients analyzed, 599 (50.9%) had a cancer on prostate biopsy, of which 141 (23.5%) and 194 (32.4%) had high grade and volume disease, respectively. Median age of first shave was 17.0 years (interquartile range 16.0-19.0) and height was 177.8 cm (172.7-182.9). On multivariable analysis, later age of first shave was significantly associated with increased odds of a positive prostate biopsy (odds ratio for > 18 years versus < 16 years: 5.36, p = 0.03) and taller patients had significantly increased odds of high-grade cancer (odds ratio for 175-180 cm versus < 175 cm 7.41, p = 0.038). Conclusions: Among patients presenting for a prostate biopsy, those with a later age of first shave and taller height had an increased risk of a positive prostate biopsy and high-grade PCa, respectively. This suggests that patients with later age of puberty, and thus later testosterone surges, are at increased risk of overall and high-grade PCa. [Table: see text]

The article focuses on Modlitwa [Prayer], a short prose piece written by Cyprian Norwid towards the end of his life. The phrase “pod wrażeniem Teatru wiedeńskiego” [“under the impression of the Viennese theatre”] is read here as an indication that, despite the Arab setting, the plot and other elements of this piece draw on three tragic events directly preceding its composition in January 1882: the fire at the Ringtheater on 8 December 1881 and two events in Warsaw: the panic in the Holy Cross Church during Christmas Mass on 25 December, and the three-day-long pogrom of the Jewish community on 25–27 December. Uncovering these contexts, as suggested by Norwid, makes it possible to interpret Modlitwa as a parable which, by criticizing secularization, shows the way towards God and the fullness of prayer.

Abstract The author of the article claims that masterpieces need invisible translation. In order to “measure” the quality of a translation of a literary masterpiece, a critic has to compare the translation with its original and choose the best method of evaluating the translated text. The method which she proposed in this article was based on the attempt to discover the signifi cant and the most significant features of the orginal (by means of katena adapted from bibliology) and finding these features in its translations. The original was the starting-point of her analysis and she demanded as much faithfulness as possible to the original. Thus she began her analysis with the examination of Norwid’s poem: Fatum using (as katena demands) its interpretations and critics’ commentaries. She pointed out six features which constituted the specific quality of Norwid’s poem and therefore should be conveyed in its translation. Then she analysed Jerzy Peterkiewicz and Burns Singer’s translation of Fatum. She noticed that these translators made the assumption that the structure of the poem was most important. They maintained the rhymes of the original, but at the same time forfeited its brevity. In her opinion the failure of Peterkiewicz and Singer’s translation is attributable to their lack of knowledge of Norwid’s text and its interpretations. Peterkiewicz and Singer did not convey in depth any of the six features which constitute the specific quality of Norwid’s poem. Thus the readers of their translation of Fate will never realize that they are dealing with a masterpiece of Polish poetry. Résumé L’auteur de cet article estime que les chefs-d’oeuvre nécessitent une traduction invisible. Pour «mesurer» la qualité de la traduction d’un chef-d’oeuvre littéraire, un critique doit comparer la traduction à son original et choisir la meilleure méthode pour évaluer le texte traduit. La méthode qu’elle proposait dans cet article était basée sur la tentative de découvrir les traits significatifs et les traits les plus significatifs de l’original (au moyen de katena adapté de la bibliologie) et sur la présence de ces traits dans ses traductions. L’original constituait le point de départ de son analyse et elle exigeait de l’original la plus grande fidélité possible. Elle a donc commencé son analyse en examinant le poème de Norwid : Fatum, en utilisant (comme l’exige katena) ses interprétations et ses commentaires critiques. Elle a relevé six éléments qui composaient la qualité spécifique du poème de Norwid et qui devaient, par conséquent, apparaître dans sa traduction. Puis, elle a analysé la traduction de Fatum par Jerzy Peterkiewicz et Burns Singer. Elle a remarqué que ces traducteurs avaient supposé que la structure du poème était ce qui importait le plus. Ils ont conservé les rimes de l’original mais, en même temps, ont perdu sa concision. À son avis, l’échec de la traduction de Peterkiewicz et de Singer était dû au manque de connaissance du texte de Norwid et de ses interprétations. Peterkiewicz et Singer n’ont rendu en profondeur aucun des six éléments qui constituent la qualité spécifi que du poème de Norwid. Aussi les lecteurs de leur traduction de Fate ne se rendront-ils jamais compte qu’il s’agit d’un chef-d’oeuvre de la poésie polonaise.

AbstractBackground and aimsSeveral years ago, one of us described the difference in attitude to patients with hypoplastic left heart syndrome in the United States of America and Europe as similar to that between Mars and Venus. Uncertainty remains with regard to the long-term prognosis for patients with hypoplastic left heart syndrome. This prognosis may be considered in terms of survival, functional performance, including exercise capacity and neurodevelopment, as well as psychosocial effects on the patient, family, and siblings. Counselling parents where either an antenatal or postnatal diagnosis of hypoplastic left heart syndrome has been made requires practitioners to give information on these prognostic aspects. We wanted to see how attitudes among European surgeons have changed over the last few years.MethodsWe performed a review of recent European data for hypoplastic left heart syndrome and conducted a survey among surgeons in major European centres to ascertain key aspects of their attitudes to the management of patients with hypoplastic left heart syndrome and how they counsel parents.Results and conclusionsAs of January, 2011, 2392 citations in the PubMed database were available for the search string “hypoplastic left heart”. The majority of these were from the centres from the United States of America and Europe. The European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Database shows an annual increase in the number of Norwood (Stage I) operations for hypoplastic left heart syndrome from 2003 to 2009, with a corresponding reduction in mortality. European rates of antenatal detection vary widely between centres, as do the rates of termination for a prenatal diagnosis of hypoplastic left heart syndrome. We observed a wide variation in the estimates of surgeons for survival and quality of life for surgical palliation of hypoplastic left heart syndrome, as well as in their estimates for actual rates of termination of pregnancy in their centres. Further, there was marked inconsistency in the information given to parents as part of the process of counselling. These issues remain to be resolved if parents are to make a fully informed decision for their child.

2018 was marked by a variety of celebrations of the 100th anniversary of Poland’s independence. Therefore, it was impossible to ignore this great event also in terms of scientific reflection. We decided to include into this and the next issue a few interesting cultural studies on various aspects of the regained independence. The first mini cycle is comprised of three ar­ticles is dominated by research on the prefiguration of what happened in 1918. Włodzimierz Toruń (KUL) analyzes a few sketches, or rather, liter­ary essays by Cyprian Norwid, written after the fall of the January Upris­ing (1864), expressing the poet’s critical views on the Polish roads to na­tional sovereignty. The Poles “know how combat” but they “do not know how to fight,” Norwid writes, at the same time pointing to the importance of spiritual independence, which in his opinion is more meaningful than the political one. Wilhelm Coindre (UKSW) turns toward interesting in­dependence themes in the works of Maria Dąbrowska. The school strike in Kalisz in 1905 became an inspiration for that writer to undertake deep reflection about what the coming independence is to be like. The triptych is closed by the article by Karol Samsel (UW) on a little-known “post-ro­manticistally entangled” intellectual independence journalism of Joseph Conrad, providing a very interesting analysis from the perspective of the intertextual method, as a precise deconstruction of a highly sophisticated, elegant “literary game.” The second part of the issue consists of a number of highly diverse, but in any case interesting essays. The team of five authors (a setting to which we are not accustomed to in the humanities): Aleksandra Smołka- Majchrzak, Jakub Lickiewicz, Thomas Nag, Conrad Ravnanger, and Marta Makara-Studzińska present the results of their research combining clinical medicine and cultural studies, analyzing the effectiveness of tools to evaluate training geared to prevent aggressive behavior towards medi­cal staff from an intercultural perspective. Further, we include a cross-sec­tional, historical-cultural analysis of the significance of church music in the history of the Church by Fr. Robert Tyrała (UPJPII). An interesting proposal for interpretation of contemporary marketing strategies of book promotion, and more broadly, the “celebritization” of authors, was stud­ied by Edyta Żyrek-Horodyska (Jagiellonian University) on the example of a journalist and writer-reporter Mariusz Szczygieł, who perfectly illus­trates these transformations in the space of media activity (especially so­cial media), where the writer becomes not only an author but also a pro­tagonist of their work. The media study by Olga Białek-Szwed (KUL), in which the author aims to present correlations between contemporary civi­lization and cultural transformations and the situation of the human be­ing as a consumer of the mass media in the 21st century, shows the speci­ficity of some mechanisms governing contemporary media, such as media voyeurism, the so-called online living, or the metaphor of the synopticon. The issue closes with a text by Paweł Krokosz (UPJPII), under the in­triguing title Od przedawcy pierożków do generalissimusa [From pie seller to the generalissimo], bringing closer the little-known figure of Alexander Mienshykov, a man from the social lowlands, who made friends with Tsar Peter I and managed to achieve considerable wealth, prominent state posi­tions and the highest ranks of command in the Russian army and war fleet. He even tried unsuccessfully, after the tsar’s death, to take over the leader­ship of all state affairs. In 1727, he was arrested and convicted to exile in Berezovo, Siberia, with his family. As always, we wish you a pleasant and useful scientific reading!

Introduction: Low birth and procedure weight have been identified as risk factors for mortality after the Norwood operation. There are no strong data to show that growth during the interstage period is associated with interstage survival. Hypothesis: We hypothesize that positive growth trajectory following the Norwood operation is associated with improved interstage transplant-free survival. Methods: We conducted a retrospective cohort study using the National Pediatric Cardiology Quality Improvement Database. The exposure, growth trajectory, was the slope of the least-squares regression line of body mass index-for-age Z-scores over time. The outcome was interstage transplant-free survival. We constructed a multivariable logistic regression model to examine the association between interstage growth trajectory and interstage transplant-free survival. Results: The study population included 1501 infants who were discharged alive from the Norwood operation between June 2008 and January 2015. The most common diagnosis was hypoplastic left heart syndrome with aortic and mitral atresia (34%). The most common operation was the Norwood procedure with a right ventricle to pulmonary artery shunt (55%). Interstage survival was 89%. Growth trajectory was positive in 945/1392 (68%) for whom sufficient data were available. The occurrence of at least one post-operative complication was identified as an effect measure modifier (p=0.02). When adjusted for sex, birth weight, presence of a secondary cardiac diagnosis, type of operation and post-operative arrhythmia, positive growth trajectory was significantly associated with interstage survival in the absence (OR=3.7, 95% CI 1.7, 8.0) but not in the presence (OR=1.1, 95% CI 0.7, 1.7) of post-operative complications. Conclusions: Positive interstage growth trajectory is significantly associated with transplant-free interstage survival in the absence of post-operative complications.

Introduction: Plostagrandin E 1 (PGE 1 ) is essential for maintaining the ductus arteriosus (DA) in ductal-dependent congenital heart disease. Recently, relatively long-term administration of PGE 1 became common, especially in patient with hypoplastic left heart syndrome (HLHS) . Staged Norwood approach which consists of bilateral pulmonary artery banding, PGE 1 infusion, and Norwood procedure beyond newborn period provided excellent survival benefit. However, microstructural changes of DA after long-term PGE 1 administration remain unknown. Therefore, we sought to investigate their features of DA after long-term PGE 1 administration using synchrotron based X-ray phase-contrast tomography (XPCT), a novel modality to inspect biological soft tissue, and pathological scrutiny including DA specific immunostaining. Methods: Seventeen DA tissues of HLHS were obtained during Norwood procedure. The median duration of PGE 1 was 48 days (Range 3-123). Radiographic microstructural analysis of DA was performed using X-ray phase contrast tomography at SPring-8 (Hyogo, Japan). Histological changes focused on elastic fiber and smooth muscle formation were evaluated by Elastica van Gieson staining, and expression of prostaglandin E2 receptor EP4 was evaluated by immunohistochemical analysis. Results: XPCT study showed a sclerotic changes of ductal media. There was a significant correlation between the duration of PGE 1 infusion and the mass density of ductal media (R: 0.723, p=0.001). Histological study showed that the duration of PGE1 infusion was positively correlated with the elastic fiber formation (R: 0.795, P=0.002), and negatively correlated with smooth muscle formation (R: -0.83, P<0.001). The EP4 expression was disappeared in all DA. Conclusion: Long-term administration of PGE 1 induced elastogenesis and density growth of the ductal media. In addition, downregulation of EP4 was observed. These results suggested that dosage of PGE 1 could be decreased after definite period of administration.

Aortic atresia (AA) has been identified as a risk factor for mortality after the Norwood procedure. We compared postoperative systemic and regional (cerebral and splanchnic) oxygen transport profiles in neonates with hypoplastic left heart syndrome with or without AA after the Norwood procedure. Systemic oxygen consumption (VO 2 ) was measured using respiratory mass spectrometry postoperatively for 72 hrs in 17 neonates (n=9 in AA group and 8 in non-AA group). Arterial, superior vena cava, and pulmonary venous blood gases and pressures were measured at 2– 4 hr intervals to calculate cardiac output (CO), systemic vascular resistance (SVR), oxygen delivery (DO 2 ) and oxygen extraction ratio (ERO 2 ). Cerebral (ScO 2 ) and splanchnic (SsO 2 ) oxygen saturations were measured using near infrared spectroscopy. The doses of dopamine, vasopressin (up to 0.0008 unit/kg/min), phenoxybenzamine and milrinone were noted. When compared to non-AA group, AA group had lower CO (p=0.03), higher systolic arterial blood pressure (p=0.01) and SVR (p=0.002), lower DO 2 (p=0.07), VO 2 (p=0.003) and ScO 2 during the first 30 to 40 hrs. There was no significant difference in SsO 2 (p=0.12, n=7 in AA group and 3 in non-AA group). Despite a similar ERO 2 (p=0.5), AA group had higher lactate over 72 hrs (p=0.01). AA group received higher doses of vasopressin (p=0.005) and milrinone (p<0.0001), lower doses of dopamine (p=0.07), with similar use of phenoxybenzamine. Furthermore, VO 2 negatively correlated with vasopressin (p=0.05), positively correlated with milrinone (p=0.03) and dopamine (p<0.0001). When including the drugs, the inferior status in all the oxygen transport variables remained, and additionally adversely correlated with vasopressin (p from <0.0001 to 0.06), except for ScO 2 that positively correlated with dopamine, but not with other drugs. Aortic atresia is associated with an inferior status of systemic, cerebral and splanchnic oxygen transport in neonates after the Norwood procedure. Aggressive use of vasopressin worsens systemic and splanchnic oxygen transport status. Postoperative management strategies should be directed to improve both systemic and regional oxygen transport in this special group of patients.

Abstract INTRODUCTION: Cyanotic heart disease and paragangliomas are two rare diagnosis. Co-occurrence of congenital cyanotic heart disease and pheochromocytomas/paragangliomas has been described, but the mechanism is unclear. In those patients where immediate cyanosis resulting from the congenital heart disease happens right after birth there is an association with an earlier detection of tumor compared to those with cyanotic heart disease later in life (26.6 years vs 46.3 years respectively) [1]. The objective of this case is to highlight this association, as a high degree of suspicion needs to be had when caring for individuals with cyanotic heart disease to pursue evaluation of these tumors. CASE: A 23-year-old man with a chief complaint of diffuse abdominal pain was found to have a 2.6 x 2.8 cm smoothly marginated soft tissue mass in the right lower quadrant on abdominal computed tomography. Patient had a known history of hypoplastic left heart syndrome (mitral atresia-aortic atresia) who had undergone a three-stage Norwood repair in childhood. In his adulthood was diagnosed with Central Adrenal Insufficiency, and Type 2 Diabetes Mellitus. At the time of presentation patient was short of breath, tachycardic (heart rate 115), and tender to palpation of his right lower quadrant. Plasma normetanephrines were 3.8 nmol/L (normal &lt; 0.9 nmol/L), 24-hour urinary excretion of normetanephrine was 1117 mcg/24h (normal 103-390 mcg/24h). Plasma metanephrine levels were normal. A nuclear medicine whole body scan with metaiodobenzylguanidine (MIBG) scan confirmed a MIBG avid tumor in the right lower quadrant. Preoperative management was initiated with oral doxazosin. He underwent laparoscopic surgery with removal of a 3 cm pelvis mass resected from the retroperitoneal tissue deep to the peritoneum along the gonadal vein and ureter. Final pathology confirmed the diagnosis of a paraganglioma. Postoperatively, plasma normetanephrines were corrected at 0.86 nmol/L. Patient underwent genetic testing that was negative for FH, MAX, MEN1, NF1, RET, SDHA, SDHAF2, SDHB, SDHC, SDHD, TMEM127 and VHL. CONCLUSION: Multidisciplinary approach to these patients is essential given their complex hemodynamics. Long term follow up is necessary to monitor for tumor recurrence, review of case reports may suggest a higher risk of recurrence [1]. Of these case reports there has been no strong genetic association found, the most popular theory is a causal relationship from their cyanotic heart disease. References: Zhao B, Zhou Y, Zhao Y et al (2018) Co-occurrence of pheochromocytoma-paraganglioma and cyanotic congenital heart disease: A case report and literature review. Front Endocrinol. https://doi.org/10.3389/fendo.2018.00165

Abstract Introduction: Association between male pattern baldness, also called androgenetic alopecia (AGA) and risk of coronary artery disease has been suggested by several epidemiological studies. Exogenous testosterone (T) therapy in transgender men (TM) promotes the development of alopecia in genetically susceptible individuals, and increases facial and body hair, muscle mass (MM) and visceral fat. The outcome of a long-term androgenic therapy over the functional properties of large arteries and the cardiovascular system of TM are not well stablished. Objective: To investigate the possible association between AGA and arterial stiffness assessed by measurement of carotid-femoral pulse wave velocity (VOPcf) and intima-media thickness carotid artery (cIMT) in TM receiving long-term T therapy. Methods: Forty-six TM (mean age: 43 ± 10 yo) undergoing T therapy (mean time of treatment duration: 13 ± 10 y; mean serum T levels: 611 ± 439 ng/dL) were evaluated in a cross-sectional study. Hair pattern (Ferriman & Gallway scale), grades of male pattern baldness (Hamilton-Norwood scale) and waist-hip ratio (WHR) were analyzed. Subjects were considered to have AGA if they have vertex alopecia (grade ≥ 3). Arterial Hypertension was defined as systolic blood pressure &gt; 140 and/or diastolic blood pressure &gt; 90mmHg or under pharmacological treatment, and dyslipidemia as total cholesterol ≥ 240 mg/dL and/or LDL-c≥ 160 mg/dL and/or HDL-c &lt; 40 mg/dL and/or triglycerides &gt; 200 mg/dL, or under pharmacological treatment. Current smoking has been investigated. The aortic stiffness, assessed by VOPcf and cIMT, was measured using the Complior® device and carotid ultrasound, respectively. Results: TM’s Ferriman degree was 21 ± 6 and AGA was identified in 70% of them. The WHR was 0.9 ± 0.1. TM with AGA showed higher cIMT than TM without AGA (0.66 ± 0.1mm vs. 0.54 ± 0.07mm, p = 0.001), as well as higher WHR (0.93 ± 0.08 vs.0.87 ± 0.04, p = 0.02), higher score in terminal body hair (Ferriman 23 ± 6 vs. 18 ± 6, p = 0.007) and higher frequency of hypertension (94% vs. 6%, p = 0.01). The cIMT positively correlated with age (p = 0.01) and WHR (p = 0.002). The VOPcf was positively correlated with the age (p = 0.0001), androgen treatment duration (p = 0.01) and WHR (p = 0.04). There was a positive correlation between androgen treatment duration and WHR (p = 0.01). There was no difference in the VOPcf values, age, T treatment duration, serum T levels, frequency of dyslipidemia and smoking between the groups. Conclusion: The severe vertex AGA pattern may be considered a possible marker of arterial stiffness in TM undergoing long-term testosterone therapy.

04–517Armand, Françoise (U. de Montréal, Canada; Email: Francoise.Armand@umontreal.ca), Lefrançoise, Pascale, Baron, Agnès, Gomez, Maria-Cécilia and Nuckle, Sylvie. Improving reading and writing learning in underprivileged pluri-ethnic settings. British Journal of Educational Psychology (Leicester, UK), 74 (2004), 437–459.04–518Cheng, Y-S. (National Taiwan Normal U., Taiwan; Email: t22035@cc.ntnu.edu.tw). A measure of second language writing anxiety: scale development and preliminary validation. Journal of Second Language Writing (New York, USA), 13, 4 (2004), 313–335.04–519de Jong, Maria T. and Bus, Adriana G. (Leiden U., Netherlands; Email: jongtm@fsw.leidenuniv.nl). The efficacy of electronic books in fostering kindergarten children's emergent story understanding. Reading Research Quarterly (Newark, USA), 39, 4 (2004), 378–393.04–520Dunsmuir, Sandra (U. College London, UK; Email: s.dunsmuir@ucl.ac.uk) and Blatchford, Peter. Predictors of writing competence in 4-to 7-year-old children. British Journal of Educational Psychology (Leicester, UK), 74 (2004), 461–483.04–521Forey, Gail (Hong Kong Polytechnic U.). Workplace texts: do they mean the same for teachers and business people?English for Specific Purposes (Oxford,UK), 23, 4 (2004), 447–469.04–522Harwood, Nigel and Hadley, Gregg (U. of Essex, UK). Pragmatism and the teaching of academic writing. English for Specific Purposes. (Oxford, UK), 23, 4 (2004), 355–379.04–523Heinz, Peter J. (Pikes Peak Community College, Colorado Springs, USA). Towards enhanced second language reading comprehension assessment: computerized versus manual scoring of written recall protocols. Reading in a Foreign Language (Hawai'i, USA), 16, 2 (2004), 97–124.04–524Huxford, L. (National Primary Strategy, England). Developing an understanding of the pedagogy of writing in the middle years (age 8–11). Australian Journal of Language and Literacy. (Norwood, South Australia), 27, 3 (2004), 234–244.04–525Hyland, Ken (Institute of Education, U. of London, UK; Email: k.hyland@ioe.ac.uk). Disciplinary interactions: metadiscourse in L2 postgraduate writing. Journal of Second Language Writing (New York, USA), 13, 2 (2004), 133–151.04–526Joh, Jeongsoon (Konkuk U., Korea; Email: johjs@konkuk.ac.kr). Interactions among the reader, text and task variables in EFL reading comprehension performance. English Teaching (Anseonggun, Korea), 59, 3 (2004) 115–143.04–527Lee, Icy (Hong Kong Baptist U., China; Email: icylee@hkbu.edu.hk). Error correction in L2 secondary writing classrooms: the case of Hong Kong. Journal of Second Language Writing (New York, USA), 13, 4 (2004), 285–312.04–528Makalela, Leketi (U. of Limpopo and Michigan State U.). Differential error types in second-language students' written and spoken texts: implications for instruction in writing. Written Communication (Thousand Oaks, CA, USA), 22, 4 (2004), 368–385.04–529McNaughton, S., Lai, M., MacDonald, S. and Farry, S. (Auckland U., Australia). Designing more effective teaching of comprehension in culturally and linguistically diverse classrooms in New Zealand. Australian Journal of Language and Literacy. (Norwood, South Australia), 27, 3 (2004), 184–197.04–530Moore, Tim (Monash U., Australia; Email: tim.moore@celts.monash.edu.au) and Morton, Janne. Dimensions of difference: a comparison of university writing and IELTS writing. Journal of English for Academic Purposes (Oxford, UK), 4, 1 (2005), 43–66.04–531Taguchi, Etsuo (Daito Bunka U., Tokyo; Email: taguchi@ic.daito.ac.jp), Takayasu-Maass, Miyoko and Gorsuch, Greta J. Developing reading fluency in EFL: How assisted repeated reading and extensive reading affect fluency development. Reading in a Foreign Language (Hawai'i, USA), 16, 2 (2004), 70–96.04–532Yoon, Hyunsook and Hirvela, Alan (The Ohio State U., USA; Email: yoon.98@osu.edu). ESL student attitudes toward corpus use in L2. Journal of Second Language Writing (New York, USA), 13, 4 (2004), 257–283.

The rise of expertise in the lives of women is a complex and prolonged process that began when the old networks through which women had learned from each other were being discredited or destroyed (Ehrenreich and English). Enclosed spaces of expert power formed separately from political control, market logistics and the pressures exerted by their subjects (Rose and Miller). This, however, was not a question of imposing expertise on women and forcing them to adhere to expert proclamations: “the experts could not have triumphed had not so many women welcomed them, sought them out, and … organised to promote their influence” (Ehrenreich and English 28). Women’s continuing enthusiasm for self-help books – and it is mainly women who buy them (Wood) – attests to the fact that they are still welcoming expertise into their lives. This paper argues that a major factor in the popularity of self-help is the reversal of the conventional ‘priestly’ relationship and ethic of confession, in a process of conversion that relies on the enthusiasm and active participation of the reader.Miller and Rose outline four ways in which human behaviour can be transformed: regulation (enmeshing people in a code of standards); captivation (seducing people with charm or charisma); education (training, convincing or persuading people); and conversion (transforming personhood, and ways of experiencing the world so that people understand themselves in fundamentally new ways). Of these four ways of acting upon others, it is conversion that is the most potent, because it changes people at the level of their own subjectivity – “personhood itself is remade” (Miller and Rose 35). While theories of conversion cannot be adequately discussed here, one aspect held in common by theories of religious conversion as well as those from psychological studies of ‘brainwashing’ is enthusiasm. Rambo’s analysis of the stages of religious conversion, for example, includes ‘questing’ in an active and engaged way, and a probable encounter with a passionately enthusiastic believer. Melia and Ryder, in their study of ‘brainwashing,’ state that two of the end stages of conversion are euphoria and proselytising – a point to which I will return in the conclusion. In order for a conversion to occur, then, the reader must be not only intellectually convinced of the truth, but must feel it is an important or vital truth, a truth she needs – in short, the reader must be enthused. The popularity of self-help books coincides with the rise of psy expertise more generally (Rose, "Identity"; Inventing), but self-help putatively offers escape from the experts, whilst simultaneously immersing its readers in expertise. Readers of self-help view themselves as reading sceptically (Simonds), interpretively (Rosenblatt) and resistingly (Fetterly, Rowe). They choose to read books as an educational activity (Dolby), rather than attending counselling or psychotherapy sessions in which they might be subject to manipulation, domination and control by a therapist (Simonds). I have discussed the nature of the advice in relationship manuals elsewhere (Hazleden, "Relationship"; "Pathology"), but the intention of this paper is to investigate the ways in which the authors attempt to enthuse and convert the reader.Best-Selling ExpertiseIn common with other best-selling genres, popular relationship manuals begin trying to enthuse the reader on the covers, which are intended to attract the reader, to establish the professional – or ‘priestly’ – credentials of the author and to assert the merit of the book, presenting the authors as experienced professionally-qualified experts, and advertising their bestseller status. These factors form part of the marketing ‘buzz’ or collective enthusiasm about a particular author or book.As part of the process of establishing themselves in the priestly role, the authors emphasise their professional qualifications and experience. Most authors use the title ‘Dr’ on the cover (Hendrix, McGraw, Forward, Gray, Cowan and Kinder, Schlessinger) or ‘PhD’ after their names (Vedral, DeAngelis, Spezzano). Further claims on the covers include assertions of the prominence of the authors in their field. Typical are DeAngelis’s claim to being “America’s foremost relationships expert,” and Hendrix’s claim to being “the world’s leading marital therapist.” Clinical and professional experience is mentioned, such as Spezzano’s “twenty-three years of counseling experience” (1) and Forward’s experience as “a consultant in many southern California Medical and psychiatric facilities” (iii). The cover of Spezzano’s book claims that he is a “therapist, seminar leader, author, lecturer and visionary leader.” McGraw emphasises his formal qualifications throughout his book, saying, “I had more degrees than a thermometer” (McGraw 6), and he refers to himself throughout as “Dr. Phil,” much like “Dr Laura” (Schlessinger). Facts and SecretsThe authors claim their ideas are based on clinical practice, research, and evidence. One author claims, “In this book, there is a wealth of tried and accurate information, which has worked for thousands of people in my therapeutic practice and seminars over the last two decades” (Spezzano 1). Another claims that he “worked with hundreds of couples in private practice and thousands more in workshops and seminars” and subsequently based his ideas on “research and clinical observations” (Hendrix xviii). Dowling refers to “four years of research … interviewing professionals who work with and study women.” She went to all this trouble because, she assures us, “I wanted facts” (Dowling, dust-jacket, 30).All this is in order to assure the reader of the relevance and build her enthusiasm about the importance of the book. McGraw (226) says he “reviewed case histories of literally thousands and thousands of couples” in order “to choose the right topics” for his book. Spezzano (7) claims that his psychological exercises come from clinical experience, but “more importantly, I have tested them all personally. Now I offer them to you.” This notion of being in possession of important new knowledge of which the reader is unaware is common, and expressed most succinctly by McGraw (15): “I have learned what you know and, more important, what you don't know.” This knowledge may be referred to as ‘secret’ (e.g. DeAngelis), or ‘hidden’ (e.g. Dowling) or as a recent discovery. Readers seem to accept this – they often assume that self-help books spring ‘naturally’ from clinical investigation as new information is ‘discovered’ about the human psyche (Lichterman 432).The Altruistic AuthorOn the assumption that readers will be familiar with other self-help books, some authors find it necessary to explain why they felt motivated to write one themselves. Usually these take the form of a kind of altruistic enthusiasm to share their great discoveries. Cowan and Kinder (xiv) claim that “one of the wonderful, intrinsic rewards of working with someone in individual psychotherapy is the rich and intense relationship that is established, [but] one of the frustrations of individual work is that in a whole lifetime it is impossible to touch more than a few people.” Morgan (26) assures us that “the results of applying certain principles to my marriage were so revolutionary that I had to pass them on in the four lesson Total Woman course, and now in this book.”The authors justify their own addition to an overcrowded genre by delineating what is distinctive about their own book, or what other “books, articles and surveys missed” (Dowling 30) or misinterpreted. Beattie (98-102) devotes several pages to a discussion of Dowling to assert that Dowling’s ‘Cinderella Complex’ is more accurately known as ‘codependency.’ The authors of another book admit that their ideas are not new, but claim to make a unique contribution because they are “writing from a much-needed male point of view” (Cowan and Kinder, back cover). Similarly, Gray suggests “many books are one-sided and unfortunately reinforce mistrust and resentment toward the opposite sex.” This meant that “a definitive guide was needed for understanding how healthy men and women are different,” and he promises “This book provides that vision” (Gray 4,7).Some authors are vehement in attacking other experts’ books as “gripe sessions,” “gobbledegook” (Schlessinger 51, 87), or “ridiculous” (Vedral 282). McGraw (9) writes “it is amazing to me how this country is overflowing with marital therapists, psychiatrists and psychologists, counselors, healers, advice columnists, and self-help authors – and their approach to relationships is usually so embarrassing that I want to turn my head in shame.” His own book, by contrast, will be quite different from anything the reader has heard before, because “it differs from what relationship ‘experts’ tell you” (McGraw 45).Confessions of an Author Because the authors are writing about intimate relationships, they are also keen to establish their credentials on a more personal level. “Loving, losing, learning the lessons, and reloving have been my path” (Carter-Scott 247-248), says one, and another asserts that, “It’s taken me a long time to understand men. It’s been a difficult and often painful journey and I’ve made a lot of mistakes along the way in my own relationships” (DeAngelis xvi). The authors are even keen to admit the mistakes they made in their previous relationships. Gray says, “In my previous relationships, I had become indifferent and unloving at difficult times … As a result, my first marriage had been very painful and difficult” (Gray 2). Others describe the feelings of disappointment with their marriages: We gradually changed. I was amazed to realize that Charlie had stopped talking. He had become distant and preoccupied. … Each evening, when Charlie walked in the front door after work, a cloud of gloom and tension floated in with him. That cloud was almost tangible. … this tension cloud permeated our home atmosphere … there was a barrier between us. (Morgan 18)Doyle (14) tells a similar tale: “While my intentions were good, I was clearly on the road to marital hell. … I was becoming estranged from the man who had once made me so happy. Our marriage was in serious trouble and it had only been four years since we’d taken our vows.” The authors relate the bewilderment they felt in these failing relationships: “My confusion about the psychology of love relationships was compounded when I began to have problems with my own marriage. … we gave our marriage eight years of intensive examination, working with numerous therapists. Nothing seemed to help” (Hendrix xvii).Even the process of writing the relationship manual itself can be uncomfortable: This was the hardest and most painful chapter for me to write, because it hit so close to home … I sat down at my computer, typed out the title of this chapter, and burst into tears. … It was the pain of my own broken heart. (DeAngelis 74)The Worthlessness of ExpertiseThus, the authors present their confessional tales in which they have learned important lessons through their own suffering, through the experience of life itself, and not through the intervention of any form of external or professional expertise. Furthermore, they highlight the failure of their professional training. Susan Forward (4) draws a comparison between her professional life as a relationship counsellor and the “Susan who went home at night and twisted herself into a pretzel trying to keep her husband from yelling at her.” McGraw tells of a time when he was counselling a couple, and: Suddenly all I could hear myself saying was blah, blah, blah. Blah, blah, blah, blah. As I sat there, I asked myself, ‘Has anybody noticed over the last fifty years that this crap doesn’t work? Has it occurred to anyone that the vast majority of these couples aren’t getting any better? (McGraw 6)The authors go to some lengths to demonstrate that their new-found knowledge is unlike anything else, and are even prepared to mention the apparent contradiction between the role the author already held as a relationship expert (before they made their important discoveries) and the failure of their own relationships (the implication being that these relationships failed because the authors themselves were not yet beneficiaries of the wisdom contained in their latest books). Gray, for example, talking about his “painful and difficult” first marriage (2), and DeAngelis, bemoaning her “mistakes” (xvi), allude to the failure of their marriage to each other, at a time when both were already well-known relationship experts. Hendrix (xvii) says: As I sat in the divorce court waiting to see the judge, I felt like a double failure, a failure as a husband and as a therapist. That very afternoon I was scheduled to teach a course on marriage and the family, and the next day, as usual, I had several couples to counsel. Despite my professional training, I felt just as confused and defeated as the other men and women who were sitting beside me.Thus the authors present the knowledge they have gained from their experiences as being unavailable through professional marital therapy, relationship counselling, and other self-help books. Rather, the advice they impart is presented as the hard-won outcome of a long and painful process of personal discovery.Peace and PassionOnce the uniqueness of the advice is established, the authors attempt to enthuse the reader by describing the effects of following it. Norwood (Women 4) says her programme led to “the most rewarding years of my life,” and Forward (10) says she “discovered enormous amounts of creativity and energy in myself that hadn't been available to me before.” Gray (268) asserts that, following his discoveries “I personally experienced this inner transformation,” and DeAngelis (126) claims “I am compassionate where I used to be critical; I am patient where I used to be judgmental.” Doyle (23) says, “practicing the principles described in this book has transformed my marriage into a passionate, romantic union.” Similarly, in discussing the effects of her ideas on her marriage, Morgan (26) speaks of “This brand new love between us” that “has given us a brand new life together.” Having established the success of their ideas and techniques on their own lives, the authors go on to relate stories about their successful application to the lives and relationships of their clients. One author writes that “When I began implementing my ideas … The divorce rate in my practice sharply declined, and the couples … reported a much deeper satisfaction in their marriages” (Hendrix xix). Another claims “Repeatedly I have heard people say that they have benefited more from this new understanding of relationships than from years of therapy” (Gray 7). Morgan, describing the effects of her ‘Total Woman’ classes, says: Attending one of the first classes in Miami were wives of the Miami Dolphin football players … it is interesting to note that their team won every game that next season and became the world champions! … Gals, I wouldn’t dream of taking credit for the Superbowl … (Morgan 188)In case we are still unconvinced, the authors include praise and thanks from their inspired clients: “My life has become exciting and wonderful. Thank you,” writes one (Vedral 308). Gray (6) talks of the “thousands of inspirational comments that people have shared” about his advice. Vedral (307) says “I have received thousands of letters from women … thanking me for shining a beam of light on their situations.” If these clients have transformed their lives, the authors claim, so can the reader. They promise that the future will be “exceptional” (Friedman 242) and “wonderful” (Norwood, Women 257). It will consist of “self fulfilment, love, and joy” (Norwood, Women 26), “peace and joy” (Hendrix xx), “freedom and a lifetime of healing, hope and happiness” (Beattie), “peace, relief, joy, and passion that you will never find any other way” (Doyle 62) – in short, “happiness for the rest of your life” (Spezzano 77).SummaryIn order to effect the conversion of their readers, the authors seek to create enthusiasm about their books. First, they appeal to the modern tradition of credentialism, making claims about their formal professional qualifications and experience. This establishes them as credible ‘priests.’ Then they make calculable, factual, evidence-based claims concerning the number of books they have sold, and appeal to the epistemological authority of the methodology involved in establishing the findings of their books. They provide evidence of the efficacy of their own unique methods by relating the success of their ideas when applied to their own lives and relationships, and those of their clients and their readers. The authors also go to some lengths to establish that they have personal experience of relationship problems, especially those the reader is currently presumed to be experiencing. This establishes the ‘empathy’ essential to Rogerian therapy (Rogers), and an informal claim to lay knowledge or insight. In telling their own personal stories, the authors establish an ethic of confession, in which the truth of oneself is sought, unearthed and revealed in “the infinite task of extracting from the depths of oneself, in between the words, a truth which the very form of the confession holds out like a shimmering mirage” (Foucault, History 59). At the same time, by claiming that their qualifications were not helpful in solving these personal difficulties, the authors assert that much of their professional training was useless or even harmful, suggesting that they are aware of a general scepticism towards experts (cf. Beck, Giddens), and share these doubts. By implying that it is other experts who are perhaps not to be trusted, they distinguish their own work from anything offered by other relationship experts, thereby circumventing “the paradox of self-help books’ existence” (Cheery) and proliferation. Thus, the authors present their motives as altruistic, whilst perhaps questioning the motives of others. Their own book, they promise, will be the one (finally) that brings a future of peace, passion and joy. Conversion, Enthusiasm and the Reversal of the Priestly RelationshipAlthough power relations between authors and readers are complex, self-help is evidence of power in one of its most efficacious forms – that of conversion. This is a relationship into which one enters voluntarily and enthusiastically, in the name of oneself, for the benefit of oneself. Such power enthuses, persuades, incites, invites, provokes and entices, and it is therefore a strongly subjectifying power, and most especially so because the relationship of the reader to the author is one of choice. Because the reader can choose between authors, and skip or skim sections, she can concentrate on the parts of the therapeutic diagnosis that she believes specifically apply to her. For example, Grodin (414) found it was common for a reader to attach excerpts from a book to a bathroom mirror or kitchen cabinet, and to re-read and underline sections of a book that seemed most relevant. In this way, through her enthusiastic participation, the reader becomes her own expert, her own therapist, in control of certain aspects of the encounter, which nonetheless must always take place on psy terms.In many conversion studies, the final stage involves the assimilation and embodiment of new practices (e.g. Paloutzian et al. 1072), whereby the convert employs or utilises her new truths. I argue that in self-help books, this stage occurs in the reversal of the ‘priestly’ relationship. The ‘priestly’ relationship between client and therapist, is one in which in which the therapist remains mysterious while the client confesses and is known (Rose, "Power"). In the self-help book, however, this relationship is reversed. The authors confess their own ‘sins’ and imperfections, by relating their own disastrous experiences in relationships and wrong-thinking. They are, of course, themselves enthusiastic converts, who are enmeshed within the power that they exercise (cf. Foucault History; Discipline), as these confessions illustrate. The reader is encouraged to go through this process of confession as well, but she is expected to do so privately, and to play the role of priest and confessor to herself. Thus, in a reversal of the priestly relationship, the person who ‘is knowledge’ within the book itself is the author. It is only if the reader takes up the invitation to perform for herself the priestly role that she will become an object of knowledge – and even then, only to herself, albeit through a psy diagnostic gaze provided for her. Of course, this instance of confession to the self still places the individual “in a network of relations of power with those who claim to be able to extract the truth of these confessions through their possession of the keys to interpretation” (Dreyfus and Rabinow 174), but the keys to interpretation are provided to the reader by the author, and left with her for her own safekeeping and future use. As mentioned in the introduction, conversion involves questing in an active and engaged way, and may involve joy and proselytising. Because the relationship must be one of active participation, the enthusiasm of the reader to apply these truths to her own self-understanding is critical. Indeed, the convert is, by her very nature, an enthusiast.ConclusionSelf-help books seek to bring about a transformation of subjectivity from powerlessness to active goal-setting, personal improvement and achievement. This is achieved by a process of conversion that produces particular choices and types of identity, new subjectivities remade through the production of new ethical truths. Self-help discourses endow individuals with new enthusiasms, aptitudes and qualities – and these can then be passed on to others. Indeed, the self-help reader is invited, by means of the author’s confessions, to become, in a limited way, the author’s own therapist – ie, she is invited to perform an examination of the author’s (past) mistakes, to diagnose the author’s (past) condition and to prescribe an appropriate (retrospective) cure for this condition. Through the process of diagnosing the author and the author’s clients, using the psy gaze provided by the author, the reader is rendered an expert in therapeutic wisdom and is converted to a new belief system in which she will become an enthusiastic participant in her own subjectification. ReferencesBeattie, M. Codependent No More: How to Stop Controlling Others and Start Caring for Yourself. Minnesota: Hazelden, 1992.Beck, U. Risk Society: Towards a New Modernity. Trans. M. Ritter. London: Sage, 1992.Carter-Scott, C. If Love Is a Game, These Are the Rules. London: Vermilion, 2000.Cheery, S. "The Ontology of a Self-Help Book: A Paradox of Its Own Existence." Social Semiotics 18.3 (2008): 337-348.Cowan, C., and M. Kinder. Smart Women, Foolish Choices: Finding the Right Men and Avoiding the Wrong Ones. New York: Signet, 1986.DeAngelis, B. Secrets about Men Every Woman Should Know. London: Thirsons, 1990.Dolby, S. Self-Help Books: Why Americans Keep Reading Them. Chicago: U of Illinois P, 2005.Dowling, C. The Cinderella Complex: Women’s Hidden Fear of Independence. New York: Summit Books, 1981.Doyle, L. The Surrendered Wife: A Step by Step Guide to Finding Intimacy, Passion and Peace with a Man. London: Simon and Schuster, 2000.Dreyfus, H.L., and P. Rabinow. Beyond Structuralism and Hermeneutics. Chicago: U of Chicago P, 1982.Ehrenreich, B., and D. English. For Her Own Good: 150 Years of the Experts’ Advice to Women. London: Pluto, 1988.Foucault, M. Discipline and Punish: The Birth of the Prison. Trans. A. Sheridan. New York: Vintage, 1979.———. The History of Sexuality Volume 1: An Introduction. Trans. R. Hurley. Harmondsworth: Penguin, 1978.Giddens, A. Modernity and Self-Identity: Self and Society in the Late Modern Age. Oxford: Polity, 1991.Gray, J. Men Are from Mars, Women Are from Venus: A Practical Guide for Improving Communication and Getting What You Want in Your Relationships. London: HarperCollins, 1993.Grodin, D. “The Interpreting Audience: The Therapeutics of Self-Help Book Reading.” Critical Studies in Mass Communication 8.4 (1991): 404-420.Hamson, S. “Are Men Really from Mars and Women From Venus?” In R. Francoeur and W. Taverner, eds. Taking Sides: Clashing Views on Controversial Issues in Human Sexuality. 7th ed. Conneticut: McGraw-Hill, 2000.Hazleden, R. “The Pathology of Love in Contemporary Relationship Manuals.” Sociological Review 52.2 (2004). ———. “The Relationship of the Self with Itself in Contemporary Relationship Manuals.” Journal of Sociology 39.4 (Dec. 2003). Hendrix, H. Getting the Love You Want: A Guide for Couples. New York: Pocket Books, 1997.Lichterman, Paul. "Self-Help Reading as a Thin Culture." Media, Culture and Society 14.3 (1992): 421-447. Melia, T., and N. Ryder. Lucifer State: A Novel Approach to Rhetoric. Kendall/Hunt Publishing, 1983.Miller, P., and N. Rose. “On Therapeutic Authority: Psychoanalytical Expertise under Advanced Liberalism.” History of the Human Sciences 7.3 (1994): 29-64. McGraw, P. Relationship Rescue: Don’t Make Excuses! Start Repairing Your Relationship Today. London: Vermilion, 2001.Morgan, M. The Total Woman. London: Harper Collins, 1973.Norwood, R. Letters From Women Who Love Too Much. New York: Pocket Books, 1988. ———. Women Who Love Too Much: When You Keep Wishing and Hoping He’ll Change. New York: Pocket Books, 1986.Paloutzian, R., J. Richardson, and L. Rambo. “Religious Conversion and Personality Change.” Journal of Personality 67.6 (1999).Ricoeur, P. Oneself as Another. Trans. K. Blamey. Chicago: Chicago UP, 1990.Rambo, L. Understanding Conversion. Yale UP, 1993.Rogers, C. On Becoming a Person. Boston: Houghton Mifflin, 1961.Rosenblatt, L. Literature as Exploration. 5th ed. New York: MLA, 1995.Rose, N. “Identity, Genealogy, History.” In S. Hall and Paul du Gay, eds. Questions of Cultural Identity. London: Sage, 1995.———. Inventing Our Selves: Psychology, Power and Personhood. Cambridge: Cambridge UP, 1998.———. “Power and Subjectivity: Critical History and Psychology.” Academy for the Study of the Psychoanalytic Arts. 2000. < http://www.academyanalyticarts.org >.———., and P. Miller. “Political Power beyond the State: Problematics of Government.” British Journal of Sociology 43.2 (1992): 173-205.Rowe, Y. “Beyond the Vulnerable Self: The 'Resisting Reader' of Marriage Manuals for Heterosexual Women.” In Kate Bennett, Maryam Jamarani, and Laura Tolton. Rhizomes: Re-Visioning Boundaries conference papers, University of Queensland, 24-25 Feb. 2006.Schlessinger, L. The Proper Care and Feeding of Husbands. New York, HarperCollins, 2004.Simonds, W. Women and Self-Help Culture: Reading between the Lines. New Jersey: Rutgers UP, 1992.Spezzano, C. 30 Days to Find Your Perfect Mate: The Step by Step Guide to Happiness and Fulfilment. London: Random House, 1994.Starker, S. Oracle at the Supermarket: The American Preoccupation with Self-Help Books. Oxford: Transaction, 1989.Vedral, J. Get Rid of Him! New York: Warner Books, 1994.Wood, L. “The Gallup Survey: Self-Help Buying Trends.” Publishers Weekly 234 (1988): 33.

To listen to them talk, you'd think most Americans hate television. Everyday discourse about television abounds with condemnation of television content. Television is a wasteland, a stream of idiotic material insulting to the intelligence of the viewer. When people deem a particular program worth watching, they often articulate it in contradistinction to the vast majority of awful stuff out there. This almost universal discourse of condemnation does not mean Americans do not watch television, of course. They do, and they watch a great deal of it. Thus we have a conundrum. If it is so awful, why do people watch television? When Americans construct stories about themselves, they construct themselves as choice--making individuals (Polanyi). Sane, mature Americans are expected to be able to make intelligent choices and to live with the consequences of their choices. How, then, can Americans articulate themselves as television viewers, as individuals who choose to view what is clearly awful stuff? In this paper, I want to discuss 'veging out' as an American category of media viewing that resolves this conundrum. In framing their discourse about watching television in terms of 'veging out,' Americans are able to construct themselves as sensible, choice--making persons, and yet explain why they watch large amounts of television. I want to use this example to explore ways that media scholars might supplement explorations of the self as mediated by texts with attention to the ways the viewing self is articulated in everyday discourses about television by viewers. An American Folk Category of Pleasure I said I'm sorry this is late. I just couldn't work on it over the weekend. I just veged out in front of the TV the whole weekend. I realise that's not much of an excuse…but…I had my Arabic test Thursday and I was too burned out afterward to do anything. I had to let my brain recharge. [text one] Let's just veg out tonight. We both had a big lunch, let's just make some popcorn and watch whatever stupid stuff is on TV. Unless you want to get a video. [text two] God, we didn't do anything this weekend. We just sat in front of the TV. (laughs) It was a total veg out weekend, we ordered out every night. John was on the rig for two weeks and then he's had to work late every night since he's been back, and I've had this activity and that activity with the kids, and girl scouts and soccer... We really needed the break. [text three] In the interest of brevity, I offer only three texts here.1 Anyone who has listened to Americans talk about television can probably multiply these examples many times; most Americans of my generation or later have almost certainly been producers of such discourse at one time or another. Each of these examples is drawn from a different context: a student's explanation for handing in a late paper [text one], a wife's suggestion for evening plans [text two], a friend sharing information about her family [text three]. And each is part of the language of experience – the language people use to describe emotions, sensations, and thoughts and, in so doing, articulate a self. 'Veging out' -- the 'veg--' prefix is borrowed from the word 'vegetable' and pronounced with a soft g -- is a nice example of a local taxonomic category of pleasure and the way it is embedded in more complex discursive formations, which it both replicates and refracts. In American society, where sitting in front of the television when there are other things to do is condemned as a waste of time that makes one a 'couch potato,' 'veging out' allows actors to reconstitute 'being a vegetable' as an empowering choice, an intentional and temporary vegetative state one escapes into as a means to relax, reduce stress and 'get away' from one's troubles. Veging out involves escape but specifies that one is escaping to nowhere, that an avoidance of critical mental activity is precisely what is sought. The claim to be veging out thus accepts the general American public discourse of television as a wasteland – the 'waste' in particular involving waste of time -- and simultaneously challenges it by claiming, in essence, that one has a right to do nothing if one has been working 'too hard'. There is nothing fanciful or even insightful in this analysis; discourses in which Americans talk about their television viewing activity tend to be both straightforward and redundant. Americans who say they spent an evening veging out are likely to follow the statement with an explanation of why they are entitled to veg out -- a litany of stresses or labours -- and sometimes also assertions to confirm that the world they escaped to was indeed a place that involved minimal mental activity. For example, the student in Text One quoted above followed it up with the comment, 'There was absolutely nothing on worth watching'. The woman who produced Text Three commented a few lines later, 'It was practically all commercials, nothing could hold my interest because it was always being interrupted. I hardly ever watch TV, I hadn't realised how many commercials there are'. This latter comment also positions the activity as a rare one for this person, emphasising the strategic nature of veging out as a life choice and hence acceptable within American understandings of choice.2 People's own modes of articulation may thus even deny their motivations involve pleasure.3 Choosing to enter the wasteland of television certainly can be, and often is, constructed as a bad choice. As Beeman demonstrates in his analysis of the language of choice in American advertising, making a choice is often constituted as not enough -- one must make the 'right' choice. Discourse about 'veging out' partly forecloses the possibility of the instance described being a bad choice by embedding the choice in the matrix of suffering. Yet as Carbaugh discovers in his sociolinguistic appraisal of TV talk shows, doing something 'wrong' can nonetheless be valorised in America by its formulation as a deliberate exercise of one's right to choose. The moral wrongness of the particular choice is redeemed by the articulation of a self exercising its right to make its own choices, and taking responsibility for those choices. The power of 'veging out' as a representation of social action thus lies in its ability to simultaneously embrace the widespread discourse that 'television is a wasteland' while at the same time subsuming it under the important American discourse of choice. In so doing, it allows Americans to construct themselves as hard--working individuals who choose to waste time as a strategy for resolving the stresses and discomforts of hard work. One articulates a viewing self, that is, which is consonant with the fundamental values of American culture. The Viewing Self The 'viewing self' is that self, or that aspect of the self, constructed through experiences of viewing events and activities in which the person is not a participant. In the contemporary world, such viewing has increased as an activity, accommodated and mediated by film, television, video and other technologies. These technologies offer, among other things, the opportunity for virtual experiences, events and activities that we do not experience with our bodies but which nonetheless offer us comparable fodder for our cognitive processes (Drummond). Studies of the self as viewer have long been dominated in media studies by attention to these virtual experiences as internal. From the early argument that the self is 'interpellated' by the culture industry (Adorno), to the argument that the self is socially and politically positioned in dominated, negotiating or resistant ways (Hall), to the idea of the self as simultaneously occupying multiple (and shifting) spectator positions (Modleski, Williams, Clover, Caton), emphasis has long been on how the viewer experiences structured sets of symbols, appropriates them at various levels of cohesion, cognitively and affectively orders them with regard to pre--existing understandings of and feelings about the world, and uses them in the ongoing construction of the self. I am suggesting here the utility of turning our attention from internal to external articulations of self as viewer. I want to argue that in addition to engaging with the content of the viewing experience, people usually engage with the meaning of the viewing experience as an activity. The viewing experience is never just about engagement with content about what one watches. It is also about the activities of 'watching TV,' 'renting a video,' and 'going to the movies.' Each of these is an experience that must be internally evaluated with regard to one's pre--existing sense of self, and which may have to be verbally articulated in interaction with others. In the latter case, it provides yet more fodder for the construction of the self, as we see versions of ourselves mirrored in the responses of the other to our own self--performance. Given the plethora of media, genres, places and events in which visual media are watched, speaking with others about one's television viewing maps one onto a complex terrain of distinctions about one's taste. One's 'taste' is never innocent, because it ties in to a complex social code that relates it to class, gender, ethnicity, education, and other social categories (Bourdieu). To represent ourselves to others as viewers of any particular kind of media is to position ourselves as particular kinds of persons in relation to others. One can use this code to articulate oneself as a particular kind of person vis--à--vis those with whom one is interacting: an equal who shares common tastes, a superior who enjoys more refined discernment, a populist who revels in his or her common tastes. To speak of our viewing allows us to generate social contact on grounds of shared experience. It allows us to confirm our tastes with regard to the social others who serve as mirrors to our selves. Of course, persons are never omnicompetent in their self--presentations, and efforts to present the self in particular ways can backfire, so that instead of appearing as a woman of discernment one appears pompous; and instead of appearing as a common Joe, one comes across as vulgar. Talking about viewing, in other words, always involves risk. In examining how people manage this risk in their social interactions, as through framing their experience as 'veging out,' we can learn much about how people construct themselves as viewers. Conclusion 'Veging out' is not the only verbal strategy by means of which Americans solve the conundrum of the viewing self. Nor is there anything unique in this American conundrum. Ethnographic accounts clearly demonstrate that many societies offer public condemnatory discourses about television that are at odds with actual viewing practices. The content of television in Belize is 'destroying a whole generation' (Wilk), in Egypt it's a flood of 'moral pollution' (Armbrust), in the Netherlands it's 'an embarrassment' (Alasuutaari). People's ways of speaking about themselves as viewers are clearly often a result of an ambivalence born of their pleasure, on the one hand, and their understanding that one should not be getting pleasure from such stuff, on the other. The result is often discourse that expresses guilt, or embarrassment, as summed up by Alasuutari's informant who said 'I'm ashamed to admit it, but I watch Dallas.' Alasuutari's reliance on interviewing, though, captures the conundrum but not the cultural solutions. An interview with a sociologist is a very different kind of speech act from the quotidian contexts in which people construct themselves as television viewers in interaction with friends, family, the person sitting next to you at the bar, and so forth (Briggs). My objective in this brief exercise is to draw our attention away from interviewing toward ethnography, and away from attention to internal subjectivities to the interactive contexts in which the self is constructed in everyday life. Notes 1 These three examples were all collected among American expatriates while I was teaching at the American University in Cairo. 2 Individual performances of this discourse are always strategic, of course; their articulation shaped by the speakers understanding of the speech event in which they take place. 3 The American discomfort with spending one's leisure pleasurably has been long chronicled. As early as the 1920s the Lynds found the people of Middletown uncomfortable with talking about reading for pleasure rather than instruction and profit. People did not want to articulate themselves as persons who wasted time (Lynd and Lynd 1929: 225) References Adorno, Theodor. 'The Culture Industry Reconsidered.' The Adorno Reader. Ed. Brian O'Connor. Oxford: Blackwell, 2000. 230-38. Alasuutari, Pertti. ''I'm Ashamed to Admit it, but I have Watched Dallas:' The Moral Hierarchy of Television Programmes.' Media, Culture and Society 14 (1992): 561-582. Armbrust, Walter. Mass Culture and Modernisation in Egypt. Cambridge: University Press, 1996. Beeman, William O. 'Freedom to Choose: Symbolic Values in American Advertising.' The Symbolisation of America. Ed. Herve Varenne. Omaha: University of Nebraska Press, 1986 Bourdieu, Pierre. Distinction: A Social Critique of the Judgment of Taste. Trans. Richard Nice. Harvard: Harvard University Press, 1984. Briggs, Charles. Learning How to Ask: A Sociolinguistic Appraisal of the Role of the Interview in Social Science Research. Cambridge: Cambridge University Press, 1986. Carbaugh, Donal. Talking American: Cultural Discourses on Donahue. Norwood, NJ: Ablex, 1989. Caton, Steven C. Lawrence of Arabia: a Film's Anthropology. Berkeley: University of California Press, 1999. Clover, Carol. Men, Women, and Chain Saws: Gender in the Modern Horror Film. Princeton, NJ: Princeton University Press, 1992. Drummond, Lee. American Dreamtime: A Cultural Analysis of Popular Movies and Their Implications for a Science of Humanity. Lanham, MD: Littlefield Adams, 1995. Hall, Stuart. 'Culture, the Media and the 'Ideological Effect.' ' Mass Communication and Society. Ed. James Curran, Michael Gurevitch and Janet Woolacott. London: Edward Arnold, 1977. - - - . 'The Rediscovery of 'Ideology:' The Return of the Repressed in Media Studies. Culture, Society and the Media. Ed. Michael Gurevitch, T. Bennett, James Curran and Janet Woolacott. London: Methuen, 1982. Modleski, Tania. The Women Who Knew Too Much: Hitchcock and Feminist Analysis. New York: Routledge, 1988 Polanyi, Livia. Telling the American Story. Cambridge, Mass: MIT Press, 1989 Wilk, Richard. ''It's Destroying a Whole Generation:' Television and Moral Discourse in Belize.' Visual Anthropology 5 (1995): 229-44. Williams, Linda. Hard Core: Power, Pleasure and the Frenzy of the Visible. Berkeley, CA: University of California Press, 1989. Citation reference for this article Substitute your date of access for Dn Month Year etc... MLA Style Peterson, Mark Allen. "Choosing the Wasteland" M/C: A Journal of Media and Culture 5.5 (2002). [your date of access] < http://www.media-culture.org.au/mc/0210/Peterson.html &gt. Chicago Style Peterson, Mark Allen, "Choosing the Wasteland" M/C: A Journal of Media and Culture 5, no. 5 (2002), < http://www.media-culture.org.au/mc/0210/Peterson.html &gt ([your date of access]). APA Style Peterson, Mark Allen. (2002) Choosing the Wasteland. M/C: A Journal of Media and Culture 5(5). < http://www.media-culture.org.au/mc/0210/Peterson.html &gt ([your date of access]).

When George Orwell encountered ideas of a technological utopia sixty-five years ago, he acted the grumpy middle-aged man Reading recently a batch of rather shallowly optimistic “progressive” books, I was struck by the automatic way in which people go on repeating certain phrases which were fashionable before 1914. Two great favourites are “the abolition of distance” and “the disappearance of frontiers”. I do not know how often I have met with the statements that “the aeroplane and the radio have abolished distance” and “all parts of the world are now interdependent” (1944). It is worth revisiting the old boy’s grumpiness, because the rhetoric he so niftily skewers continues in our own time. Facebook features “Peace on Facebook” and even claims that it can “decrease world conflict” through inter-cultural communication. Twitter has announced itself as “a triumph of humanity” (“A Cyber-House” 61). Queue George. In between Orwell and latter-day hoody cybertarians, a whole host of excitable public intellectuals announced the impending end of materiality through emergent media forms. Marshall McLuhan, Neil Postman, Daniel Bell, Ithiel de Sola Pool, George Gilder, Alvin Toffler—the list of 1960s futurists goes on and on. And this wasn’t just a matter of punditry: the OECD decreed the coming of the “information society” in 1975 and the European Union (EU) followed suit in 1979, while IBM merrily declared an “information age” in 1977. Bell theorized this technological utopia as post-ideological, because class would cease to matter (Mattelart). Polluting industries seemingly no longer represented the dynamic core of industrial capitalism; instead, market dynamism radiated from a networked, intellectual core of creative and informational activities. The new information and knowledge-based economies would rescue First World hegemony from an “insurgent world” that lurked within as well as beyond itself (Schiller). Orwell’s others and the Cold-War futurists propagated one of the most destructive myths shaping both public debate and scholarly studies of the media, culture, and communication. They convinced generations of analysts, activists, and arrivistes that the promises and problems of the media could be understood via metaphors of the environment, and that the media were weightless and virtual. The famous medium they wished us to see as the message —a substance as vital to our wellbeing as air, water, and soil—turned out to be no such thing. Today’s cybertarians inherit their anti-Marxist, anti-materialist positions, as a casual glance at any new media journal, culture-industry magazine, or bourgeois press outlet discloses. The media are undoubtedly important instruments of social cohesion and fragmentation, political power and dissent, democracy and demagoguery, and other fraught extensions of human consciousness. But talk of media systems as equivalent to physical ecosystems—fashionable among marketers and media scholars alike—is predicated on the notion that they are environmentally benign technologies. This has never been true, from the beginnings of print to today’s cloud-covered computing. Our new book Greening the Media focuses on the environmental impact of the media—the myriad ways that media technology consumes, despoils, and wastes natural resources. We introduce ideas, stories, and facts that have been marginal or absent from popular, academic, and professional histories of media technology. Throughout, ecological issues have been at the core of our work and we immodestly think the same should apply to media communications, and cultural studies more generally. We recognize that those fields have contributed valuable research and teaching that address environmental questions. For instance, there is an abundant literature on representations of the environment in cinema, how to communicate environmental messages successfully, and press coverage of climate change. That’s not enough. You may already know that media technologies contain toxic substances. You may have signed an on-line petition protesting the hazardous and oppressive conditions under which workers assemble cell phones and computers. But you may be startled, as we were, by the scale and pervasiveness of these environmental risks. They are present in and around every site where electronic and electric devices are manufactured, used, and thrown away, poisoning humans, animals, vegetation, soil, air and water. We are using the term “media” as a portmanteau word to cover a multitude of cultural and communications machines and processes—print, film, radio, television, information and communications technologies (ICT), and consumer electronics (CE). This is not only for analytical convenience, but because there is increasing overlap between the sectors. CE connect to ICT and vice versa; televisions resemble computers; books are read on telephones; newspapers are written through clouds; and so on. Cultural forms and gadgets that were once separate are now linked. The currently fashionable notion of convergence doesn’t quite capture the vastness of this integration, which includes any object with a circuit board, scores of accessories that plug into it, and a global nexus of labor and environmental inputs and effects that produce and flow from it. In 2007, a combination of ICT/CE and media production accounted for between 2 and 3 percent of all greenhouse gases emitted around the world (“Gartner Estimates,”; International Telecommunication Union; Malmodin et al.). Between twenty and fifty million tonnes of electronic waste (e-waste) are generated annually, much of it via discarded cell phones and computers, which affluent populations throw out regularly in order to buy replacements. (Presumably this fits the narcissism of small differences that distinguishes them from their own past.) E-waste is historically produced in the Global North—Australasia, Western Europe, Japan, and the US—and dumped in the Global South—Latin America, Africa, Eastern Europe, Southern and Southeast Asia, and China. It takes the form of a thousand different, often deadly, materials for each electrical and electronic gadget. This trend is changing as India and China generate their own media detritus (Robinson; Herat). Enclosed hard drives, backlit screens, cathode ray tubes, wiring, capacitors, and heavy metals pose few risks while these materials remain encased. But once discarded and dismantled, ICT/CE have the potential to expose workers and ecosystems to a morass of toxic components. Theoretically, “outmoded” parts could be reused or swapped for newer parts to refurbish devices. But items that are defined as waste undergo further destruction in order to collect remaining parts and valuable metals, such as gold, silver, copper, and rare-earth elements. This process causes serious health risks to bones, brains, stomachs, lungs, and other vital organs, in addition to birth defects and disrupted biological development in children. Medical catastrophes can result from lead, cadmium, mercury, other heavy metals, poisonous fumes emitted in search of precious metals, and such carcinogenic compounds as polychlorinated biphenyls, dioxin, polyvinyl chloride, and flame retardants (Maxwell and Miller 13). The United States’ Environmental Protection Agency estimates that by 2007 US residents owned approximately three billion electronic devices, with an annual turnover rate of 400 million units, and well over half such purchases made by women. Overall CE ownership varied with age—adults under 45 typically boasted four gadgets; those over 65 made do with one. The Consumer Electronics Association (CEA) says US$145 billion was expended in the sector in 2006 in the US alone, up 13% on the previous year. The CEA refers joyously to a “consumer love affair with technology continuing at a healthy clip.” In the midst of a recession, 2009 saw $165 billion in sales, and households owned between fifteen and twenty-four gadgets on average. By 2010, US$233 billion was spent on electronic products, three-quarters of the population owned a computer, nearly half of all US adults owned an MP3 player, and 85% had a cell phone. By all measures, the amount of ICT/CE on the planet is staggering. As investigative science journalist, Elizabeth Grossman put it: “no industry pushes products into the global market on the scale that high-tech electronics does” (Maxwell and Miller 2). In 2007, “of the 2.25 million tons of TVs, cell phones and computer products ready for end-of-life management, 18% (414,000 tons) was collected for recycling and 82% (1.84 million tons) was disposed of, primarily in landfill” (Environmental Protection Agency 1). Twenty million computers fell obsolete across the US in 1998, and the rate was 130,000 a day by 2005. It has been estimated that the five hundred million personal computers discarded in the US between 1997 and 2007 contained 6.32 billion pounds of plastics, 1.58 billion pounds of lead, three million pounds of cadmium, 1.9 million pounds of chromium, and 632000 pounds of mercury (Environmental Protection Agency; Basel Action Network and Silicon Valley Toxics Coalition 6). The European Union is expected to generate upwards of twelve million tons annually by 2020 (Commission of the European Communities 17). While refrigerators and dangerous refrigerants account for the bulk of EU e-waste, about 44% of the most toxic e-waste measured in 2005 came from medium-to-small ICT/CE: computer monitors, TVs, printers, ink cartridges, telecommunications equipment, toys, tools, and anything with a circuit board (Commission of the European Communities 31-34). Understanding the enormity of the environmental problems caused by making, using, and disposing of media technologies should arrest our enthusiasm for them. But intellectual correctives to the “love affair” with technology, or technophilia, have come and gone without establishing much of a foothold against the breathtaking flood of gadgets and the propaganda that proclaims their awe-inspiring capabilities.[i] There is a peculiar enchantment with the seeming magic of wireless communication, touch-screen phones and tablets, flat-screen high-definition televisions, 3-D IMAX cinema, mobile computing, and so on—a totemic, quasi-sacred power that the historian of technology David Nye has named the technological sublime (Nye Technological Sublime 297).[ii] We demonstrate in our book why there is no place for the technological sublime in projects to green the media. But first we should explain why such symbolic power does not accrue to more mundane technologies; after all, for the time-strapped cook, a pressure cooker does truly magical things. Three important qualities endow ICT/CE with unique symbolic potency—virtuality, volume, and novelty. The technological sublime of media technology is reinforced by the “virtual nature of much of the industry’s content,” which “tends to obscure their responsibility for a vast proliferation of hardware, all with high levels of built-in obsolescence and decreasing levels of efficiency” (Boyce and Lewis 5). Planned obsolescence entered the lexicon as a new “ethics” for electrical engineering in the 1920s and ’30s, when marketers, eager to “habituate people to buying new products,” called for designs to become quickly obsolete “in efficiency, economy, style, or taste” (Grossman 7-8).[iii] This defines the short lifespan deliberately constructed for computer systems (drives, interfaces, operating systems, batteries, etc.) by making tiny improvements incompatible with existing hardware (Science and Technology Council of the American Academy of Motion Picture Arts and Sciences 33-50; Boyce and Lewis). With planned obsolescence leading to “dizzying new heights” of product replacement (Rogers 202), there is an overstated sense of the novelty and preeminence of “new” media—a “cult of the present” is particularly dazzled by the spread of electronic gadgets through globalization (Mattelart and Constantinou 22). References to the symbolic power of media technology can be found in hymnals across the internet and the halls of academe: technologies change us, the media will solve social problems or create new ones, ICTs transform work, monopoly ownership no longer matters, journalism is dead, social networking enables social revolution, and the media deliver a cleaner, post-industrial, capitalism. Here is a typical example from the twilight zone of the technological sublime (actually, the OECD): A major feature of the knowledge-based economy is the impact that ICTs have had on industrial structure, with a rapid growth of services and a relative decline of manufacturing. Services are typically less energy intensive and less polluting, so among those countries with a high and increasing share of services, we often see a declining energy intensity of production … with the emergence of the Knowledge Economy ending the old linear relationship between output and energy use (i.e. partially de-coupling growth and energy use) (Houghton 1) This statement mixes half-truths and nonsense. In reality, old-time, toxic manufacturing has moved to the Global South, where it is ascendant; pollution levels are rising worldwide; and energy consumption is accelerating in residential and institutional sectors, due almost entirely to ICT/CE usage, despite advances in energy conservation technology (a neat instance of the age-old Jevons Paradox). In our book we show how these are all outcomes of growth in ICT/CE, the foundation of the so-called knowledge-based economy. ICT/CE are misleadingly presented as having little or no material ecological impact. In the realm of everyday life, the sublime experience of electronic machinery conceals the physical work and material resources that go into them, while the technological sublime makes the idea that more-is-better palatable, axiomatic; even sexy. In this sense, the technological sublime relates to what Marx called “the Fetishism which attaches itself to the products of labour” once they are in the hands of the consumer, who lusts after them as if they were “independent beings” (77). There is a direct but unseen relationship between technology’s symbolic power and the scale of its environmental impact, which the economist Juliet Schor refers to as a “materiality paradox” —the greater the frenzy to buy goods for their transcendent or nonmaterial cultural meaning, the greater the use of material resources (40-41). We wrote Greening the Media knowing that a study of the media’s effect on the environment must work especially hard to break the enchantment that inflames popular and elite passions for media technologies. We understand that the mere mention of the political-economic arrangements that make shiny gadgets possible, or the environmental consequences of their appearance and disappearance, is bad medicine. It’s an unwelcome buzz kill—not a cool way to converse about cool stuff. But we didn’t write the book expecting to win many allies among high-tech enthusiasts and ICT/CE industry leaders. We do not dispute the importance of information and communication media in our lives and modern social systems. We are media people by profession and personal choice, and deeply immersed in the study and use of emerging media technologies. But we think it’s time for a balanced assessment with less hype and more practical understanding of the relationship of media technologies to the biosphere they inhabit. Media consumers, designers, producers, activists, researchers, and policy makers must find new and effective ways to move ICT/CE production and consumption toward ecologically sound practices. In the course of this project, we found in casual conversation, lecture halls, classroom discussions, and correspondence, consistent and increasing concern with the environmental impact of media technology, especially the deleterious effects of e-waste toxins on workers, air, water, and soil. We have learned that the grip of the technological sublime is not ironclad. Its instability provides a point of departure for investigating and criticizing the relationship between the media and the environment. The media are, and have been for a long time, intimate environmental participants. Media technologies are yesterday’s, today’s, and tomorrow’s news, but rarely in the way they should be. The prevailing myth is that the printing press, telegraph, phonograph, photograph, cinema, telephone, wireless radio, television, and internet changed the world without changing the Earth. In reality, each technology has emerged by despoiling ecosystems and exposing workers to harmful environments, a truth obscured by symbolic power and the power of moguls to set the terms by which such technologies are designed and deployed. Those who benefit from ideas of growth, progress, and convergence, who profit from high-tech innovation, monopoly, and state collusion—the military-industrial-entertainment-academic complex and multinational commandants of labor—have for too long ripped off the Earth and workers. As the current celebration of media technology inevitably winds down, perhaps it will become easier to comprehend that digital wonders come at the expense of employees and ecosystems. This will return us to Max Weber’s insistence that we understand technology in a mundane way as a “mode of processing material goods” (27). Further to understanding that ordinariness, we can turn to the pioneering conversation analyst Harvey Sacks, who noted three decades ago “the failures of technocratic dreams [:] that if only we introduced some fantastic new communication machine the world will be transformed.” Such fantasies derived from the very banality of these introductions—that every time they took place, one more “technical apparatus” was simply “being made at home with the rest of our world’ (548). Media studies can join in this repetitive banality. Or it can withdraw the welcome mat for media technologies that despoil the Earth and wreck the lives of those who make them. In our view, it’s time to green the media by greening media studies. References “A Cyber-House Divided.” Economist 4 Sep. 2010: 61-62. “Gartner Estimates ICT Industry Accounts for 2 Percent of Global CO2 Emissions.” Gartner press release. 6 April 2007. ‹http://www.gartner.com/it/page.jsp?id=503867›. Basel Action Network and Silicon Valley Toxics Coalition. Exporting Harm: The High-Tech Trashing of Asia. Seattle: Basel Action Network, 25 Feb. 2002. Benjamin, Walter. “Central Park.” Trans. Lloyd Spencer with Mark Harrington. New German Critique 34 (1985): 32-58. Biagioli, Mario. “Postdisciplinary Liaisons: Science Studies and the Humanities.” Critical Inquiry 35.4 (2009): 816-33. Boyce, Tammy and Justin Lewis, eds. Climate Change and the Media. New York: Peter Lang, 2009. Commission of the European Communities. “Impact Assessment.” Commission Staff Working Paper accompanying the Proposal for a Directive of the European Parliament and of the Council on Waste Electrical and Electronic Equipment (WEEE) (recast). COM (2008) 810 Final. Brussels: Commission of the European Communities, 3 Dec. 2008. Environmental Protection Agency. Management of Electronic Waste in the United States. Washington, DC: EPA, 2007 Environmental Protection Agency. Statistics on the Management of Used and End-of-Life Electronics. Washington, DC: EPA, 2008 Grossman, Elizabeth. Tackling High-Tech Trash: The E-Waste Explosion & What We Can Do about It. New York: Demos, 2008. ‹http://www.demos.org/pubs/e-waste_FINAL.pdf› Herat, Sunil. “Review: Sustainable Management of Electronic Waste (e-Waste).” Clean 35.4 (2007): 305-10. Houghton, J. “ICT and the Environment in Developing Countries: Opportunities and Developments.” Paper prepared for the Organization for Economic Cooperation and Development, 2009. International Telecommunication Union. ICTs for Environment: Guidelines for Developing Countries, with a Focus on Climate Change. Geneva: ICT Applications and Cybersecurity Division Policies and Strategies Department ITU Telecommunication Development Sector, 2008. Malmodin, Jens, Åsa Moberg, Dag Lundén, Göran Finnveden, and Nina Lövehagen. “Greenhouse Gas Emissions and Operational Electricity Use in the ICT and Entertainment & Media Sectors.” Journal of Industrial Ecology 14.5 (2010): 770-90. Marx, Karl. Capital: Vol. 1: A Critical Analysis of Capitalist Production, 3rd ed. Trans. Samuel Moore and Edward Aveling, Ed. Frederick Engels. New York: International Publishers, 1987. Mattelart, Armand and Costas M. Constantinou. “Communications/Excommunications: An Interview with Armand Mattelart.” Trans. Amandine Bled, Jacques Guot, and Costas Constantinou. Review of International Studies 34.1 (2008): 21-42. Mattelart, Armand. “Cómo nació el mito de Internet.” Trans. Yanina Guthman. El mito internet. Ed. Victor Hugo de la Fuente. Santiago: Editorial aún creemos en los sueños, 2002. 25-32. Maxwell, Richard and Toby Miller. Greening the Media. New York: Oxford University Press, 2012. Nye, David E. American Technological Sublime. Cambridge, Mass.: MIT Press, 1994. Nye, David E. Technology Matters: Questions to Live With. Cambridge, Mass.: MIT Press. 2007. Orwell, George. “As I Please.” Tribune. 12 May 1944. Richtel, Matt. “Consumers Hold on to Products Longer.” New York Times: B1, 26 Feb. 2011. Robinson, Brett H. “E-Waste: An Assessment of Global Production and Environmental Impacts.” Science of the Total Environment 408.2 (2009): 183-91. Rogers, Heather. Gone Tomorrow: The Hidden Life of Garbage. New York: New Press, 2005. Sacks, Harvey. Lectures on Conversation. Vols. I and II. Ed. Gail Jefferson. Malden: Blackwell, 1995. Schiller, Herbert I. Information and the Crisis Economy. Norwood: Ablex Publishing, 1984. Schor, Juliet B. Plenitude: The New Economics of True Wealth. New York: Penguin, 2010. Science and Technology Council of the American Academy of Motion Picture Arts and Sciences. The Digital Dilemma: Strategic Issues in Archiving and Accessing Digital Motion Picture Materials. Los Angeles: Academy Imprints, 2007. Weber, Max. “Remarks on Technology and Culture.” Trans. Beatrix Zumsteg and Thomas M. Kemple. Ed. Thomas M. Kemple. Theory, Culture [i] The global recession that began in 2007 has been the main reason for some declines in Global North energy consumption, slower turnover in gadget upgrades, and longer periods of consumer maintenance of electronic goods (Richtel). [ii] The emergence of the technological sublime has been attributed to the Western triumphs in the post-Second World War period, when technological power supposedly supplanted the power of nature to inspire fear and astonishment (Nye Technology Matters 28). Historian Mario Biagioli explains how the sublime permeates everyday life through technoscience: "If around 1950 the popular imaginary placed science close to the military and away from the home, today’s technoscience frames our everyday life at all levels, down to our notion of the self" (818). [iii] This compulsory repetition is seemingly undertaken each time as a novelty, governed by what German cultural critic Walter Benjamin called, in his awkward but occasionally illuminating prose, "the ever-always-the-same" of "mass-production" cloaked in "a hitherto unheard-of significance" (48).