Journal articles on the topic 'Regional Studies Association (Seaford, England)'

Objective. Few orofacial cleft (OFC) studies have examined the severity of clefts of the lip or palate. This study examined associations between the severity of cleft of the lip with cleft type, laterality, and sex in four regional British Isles cleft registers whilst also looking for regional variations. Design. Retrospective analysis of cleft classification in the data contained in these four cleft registers. Sample. Three thousand and twelve patients from cleft registers based in Scotland, East England, Merseyside, and Belfast were sourced from the period 2002–2010. Submucous clefts and syndromic clefts were included whilst stillbirths, abortuses, and atypical orofacial clefts were excluded. Results. A cleft of the lip in CLP patients is more likely to be complete in males. A cleft of the lip in isolated CL patients is more likely to be complete in females. Variation in the proportion of cleft types was evident between Scotland and East England. Conclusions. Association between severity of cleft of the lip and sex was found in this study with females having a significantly greater proportion of more severe clefts of the lip (CL) and CLP males being more severe . This finding supports a fundamental difference between cleft aetiology between CL and CLP.

Eastern white pine (Pinus strobus) is considered a signature species in eastern North America, particularly in New England. In recent years, however, white pine has experienced increased damage due to native pathogens that reduce the species’ growth, productivity, and economic value. One disease of concern is Caliciopsis canker, caused by the fungal pathogen Caliciopsis pinea, which is associated with excessive resin production, cankers, rough bark, bark fissures/cracks, and reduced growth in white pine. Recent studies have documented the extent of Caliciopsis canker in New England and its association with soil and stocking conditions, yet few studies have focused on the biological impacts of the disease. This study used dendrochronology and whole-tree dissections to reconstruct Caliciopsis canker history in three New England white pine sites, quantify its impact on tree growth and vigor, identify pre-disposing factors, and assess potential silvicultural management options. Dendrochronology and whole-tree dissections provided a unique insight into canker damage throughout trees’ development. Canker damage was first reported in New Hampshire in the mid-1990s, yet cankers were present as far back as 1967 and have steadily increased since the mid-1980s. Increased canker damage was significantly associated with decreased live crown ratios and declining tree growth. Trees maintaining a 30% live crown ratio or greater generally experienced the least canker damage. Furthermore, peaks in canker occurrence were consistent across sites, indicating a regional synchronization of infection and damage. Canker damage was closely associated with climatic events such as droughts and a New England hurricane. The results suggest that Caliciopsis canker has been affecting white pine health over the last 40 years, and that the disease has become more prevalent in the past 20–30 years. Yet, our results suggest that if silvicultural prescriptions target low density thinnings that favor trees with higher live crown ratios (>30%) and low Caliciopsis symptom severity ratings, the risk of canker damage can be reduced in white pine stands.

The role of clusters and clustering in economic development is of current policy interest, in part because of analyses and studies that have associated these forms of collaboration with regional and local prosperity and development. Although some of the literature supports or starts from this association, there are also critiques of the clusters concept and its feasibility as a policy development and intervention strategy. Intrinsic to part of these concerns has been a view that clusters cannot be created without business involvement and input at the heart of the process. The paper addresses this issue via an examination of four cases of potential clusters development from the perspectives of the businesses involved. Although clear evidence for the existence of a cluster could only be established definitively in one of the four cases, there were extensive indications of clustering as a collaborative activity across all four cases. Based on this, a process of clusters formation and emergence was developed that applied to the cases. This process consists of several phases of clusters emergence and points to three stages of clusters development: potential, emerging, and established. A key implication is that processes of clusters formation may provide an opportunity for the formulation of ‘bottom-up’, contextually sensitive clusters development strategies for groups of businesses.

In this paper we are concerned with the nature and extent of product and process innovation and adoption of information and communications technologies (ICTs) in manufacturing plants and SMEs. The paper is based on extensive postal surveys conducted in southeast (SE) England, Northern Ireland (NI), and the Republic of Ireland (RoI) with a harmonised survey instrument. We confirm the findings of a number of previous studies by demonstrating a positive association between product and process innovation and business performance. Data collected from all three surveys show that sales growth, employment growth, and profit margins were higher for innovators than growth, for noninnovators. It also appears that although foreign-owned plants show a higher propensity for innovation than indigenously owned plants, the latter grew faster than their foreign owned counterparts in all three regions. This suggests that a targeting strategy focused on innovative, indigenously owned SMEs may be particularly rewarding. With regard to the nature and extent of the use of ICT and electronic business (e-business), the survey found a higher level of adoption of nearly all ICT facilities in SE England compared with the levels in NI and the RoI. Differences in ICT capability between the regions are greatest in the case of smaller plants, with the adoption of various ICT facilities being particularly favoured amongst the smallest plants in SE England, most of which are indigenously owned. However, there is evidence to suggest that the technology may be underutilised in each region, possibly reflecting a lack of in-house knowledge and resources in some applications and external barriers in others. SE England was found to have the highest proportion of plants engaged in some R&D compared with the two Irish regions, particularly NI. Unsurprisingly, there is a tendency for the propensity of a firm to be engaged in R&D to increase with firm size. The surveys also underlined sectoral differences in explaining the relative importance of R&D. ‘Technology transfer’ was significantly more common in the two Irish regions, reflecting the higher proportion of externally controlled plants. With respect to the role of external linkages in innovation, links with customers and suppliers were the ones most commonly identified in all three regions. In SE England there is a particularly low propensity to engage in collaboration with external agencies and research institutions, indicating scope here for further policy intervention. We conclude with a number of suggestions for the agenda of the new regional centre of manufacturing excellence in SE England.

Meeting Centres (MC) are a flexible, hyper-local model for dementia post-diagnostic support, which create engaging, enabling, and empowering spaces for families affected by dementia. MCs offer ongoing warm and friendly expert assistance, including peer support, for people and families affected by dementia. The model originated in the Netherlands, led by Professor Rose-Marie Dröes at the Amsterdam University Medical Centers. Meeting Centres UK was established in 2018 and led by the Association for Dementia Studies (ADS), University of Worcester. In 2019 Kirrie Connections set up the first Scottish MC. Prior to the COVID-19 pandemic, there were 13 MCs in the UK. Despite the pandemic, there are now 32 funded MCs in England and Wales and 14 in Scotland with the likelihood of another 10 being funded before the end of 2023. Significant national and regional developments have taken place over the last three years. This has been driven by different policy decisions and funding opportunities across the three nations and has involved a variety of partnership working between academic, local authority, third sector, government and lived experience partners. The Scottish Government is supporting the development of a national MC network because of the recognition that capacity can be built, best practice shared, and communities empowered. In addition, the involvement of people affected by dementia is of paramount importance. In Scotland, this is being driven forward with a strategy board made up of a third people living with dementia, a third family carers and a third dementia professionals. This is being replicated in the new UK National MC Consortium. In the presentation, the different contexts and approaches to MCs will be described and compared. The audience will gain an understanding of the flexibility of the MC model in meeting the needs of people affected by dementia in different communities; the MC grassroots community development approach; and the impact of the involvement of people affected by dementia in the meaningful ongoing coproduction of MCs. Brooker, D., Evans, S., Dröes, R. M., (2016), Framing outcomes of post-diagnostic psychosocial interventions in dementia: The Adaptation-Coping Model and Adjusting to Change. Working with Older People. Vol 21: Issue 1 Evans, S., Bray, J. and Brooker, D. (2021), ""How Meeting Centres continue to support people affected by dementia: report on UK COVID-19 impact"", Working with Older People, Vol. 25 No. 4, pp. 283-293. https://doi.org/10.1108/WWOP-12-2020-0060 Evans, S., Bray, J., Brooker, D. and Stephens, N. (2022), ""The essential features of Meeting Centres: development of the UK criteria for community support for people affected by dementia"", Working with Older People, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/WWOP-03-2022-0009

REVIEWS OF BOOKSTHE IRISH LANDSCAPE, by Frank Mitchell. London: Collins, 1976. 240 pp. £5.50. Reviewed by: T. J. HughesTHE LAND AND PEOPLE OF NINETEENTH CENTURY CORK: THE RURAL ECONOMY AND THE LAND QUESTION, by James S. Donnelly, Jr. London and Boston: Routledge & Kegan Paul, 1975. 440 pp. £9.95. Reviewed by: William J. SmythIRISH SETTLEMENTS IN EASTERN CANADA: A STUDY OF CULTURAL TRANSFER AND ADAPTATION, by John J. Mannion. University of Toronto Press, 1974. 219 pp. $5.00. Reviewed by: T. J. HughesREGIONAL PHYSICAL DEVELOPMENT STRATEGY 1975–95. Department of Housing, Local Government and Planning, Northern Ireland, Discussion Paper. Belfast: Her Majesty's Stationery Office, 1975. 39 pp. £0.30.; REGIONAL POLICY IN IRELAND: A REVIEW. National Economic and Social Council Report No. 4. Dublin: Stationery Office, 1975. 86 pp. £0.25.Reviewed by: A. A. HornerCARTON, CO. KILDARE: A CASE STUDY OF THE MAKING OF AN IRISH DEMESNE, by Arnold Horner. Dublin: Quarterly Bulletin of the Irish Georgian Society, Vol. 18, Nos. 2 and 3, 1975. 57 pp. £ 1 .Reviewed by: R. A. ButlinTHE CLIMATE OF IRELAND, by P. K. Rohan, Dublin: Stationery Office, 1975–112 pp. £1.50.Reviewed by: J. P. HaughtonDINNSEANCHAS. Baile Atha Cliath: An Cumann Logainmneacha. Vol. 3, No. 4, December 1969 - Vol. 6, No. 2, December 1974. Current price, £1.50 per annum.Reviewed by: Breandán S. Mac AodhaLOGAINMNEACHA AS PAROlSTE NA RINNE CO. PHORT LAlRGE. Baile Atha Cliath: An Cumann Logainmneacha, 1975. 43 pp. Reviewed by: Breandán S. Mac AodhaTHE JEWS OF IRELAND, by Louis Hyman. London: Jewish Historical Society of England; Jerusalem: Israel Universities Press, 1972. xix + 403 pp. Reviewed by: Stanley WatermanTHE CAVES OF FERMANAGH AND CAVAN, by G. L. Jones. Enniskillen: Watergate Press, 1974. 117 pp.Reviewed by: D. P. DrewARCHITECTURAL CONSERVATION - AN IRISH VIEWPOINT. Dublin: the Architectural Association of Ireland, 1975. 95 pp. £3.75.Reviewed by: J. A. K. GrahameHOW TO USE THE RECORD OFFICE: MAPS AND PLANS. NO. 11, CO. ANTRIM, C.1570–C.1830, 31 pp. NO. 12, CO. ARMAGH, c. 1600–c. 1830, 36 pp. NO. 13, CO. DOWN, c. 1600-c. 1830,39 pp. NO. 14, CO. FERMANAGH, C.1590-C.1830, 16pp. NO. 15, CO. LONDONDERRY, c. 1600–c. 1830, 23 pp. NO. 16, CO. TYRONE, C.1580–C.1830, 34 pp. NO. 17, BELFAST, c.1570– c.1860, 19 pp. NO. 18, GENERAL MAPS OF IRELAND AND ULSTER, C.1538–C.1830, 15 pp. Belfast: Public Record Office of Northern Ireland, n.d. £0.05 each.; NORTHERN IRELAND TOWN PLANS, 1828–1966. A CATALOGUE OF LARGE SCALE TOWN PLANS PREPARED BY THE ORDNANCE SURVEY AND DEPOSITED IN P.R.O.N.I. Belfast, Public Record Office of Northern Ireland, n.d. 20 pp. £0.20. Reviewed by: J. H. AndrewsANGLO-IRISH STUDIES. Chalfont St Giles: Alpha Academic Books. Volume i, 1975, 118 pp. £4.Reviewed by: J. H. AndrewsA GEOGRAPHY OF TOWNS AND CITIES, by A. J. Parker. Dublin: the Educational Company, 1976. 117 pp.Reviewed by: James E. KillenMAP REVIEWOILEÁlN ÁRANN. 1:25,344. Kilronan, Aran Islands: T. D. Robinson, 1975.Reviewed by: J. P. Haughton

Introduction The academic area known as food studies—incorporating elements from disciplines including anthropology, folklore, history, sociology, gastronomy, and cultural studies as well as a range of multi-disciplinary approaches—asserts that cooking and eating practices are less a matter of nutrition (maintaining life by absorbing nutrients from food) and more a personal or group expression of various social and/or cultural actions, values or positions. The French philosopher, Michel de Certeau agrees, arguing, moreover, that there is an urgency to name and unpick (what he identifies as) the “minor” practices, the “multifarious and silent reserve of procedures” of everyday life. Such practices are of crucial importance to all of us, as although seemingly ordinary, and even banal, they have the ability to “organise” our lives (48). Within such a context, the following aims to consider the influence and significance of an important (although largely unstudied) professional figure in rural and regional economic life: the country food preparer variously known as the local chef or cook. Such an approach is obviously framed by the concept of “cultural economy”. This term recognises the convergence, and interdependence, of the spheres of the cultural and the economic (see Scott 335, for an influential discussion on how “the cultural geography of space and the economic geography of production are intertwined”). Utilising this concept in relation to chefs and cooks seeks to highlight how the ways these figures organise (to use de Certeau’s term) the social and cultural lives of those in their communities are embedded in economic practices and also how, in turn, their economic contributions are dependent upon social and cultural practices. This initial mapping of the influence and significance of the rural and regional chef in one rural and regional area, therefore, although necessarily different in approach and content, continues the application of such converged conceptualisations of the cultural and economic as Teema Tairu’s discussion of the social, recreational and spiritual importance of food preparation and consumption by the unemployed in Finland, Guy Redden’s exploration of how supermarket products reflect shared values, and a series of analyses of the cultural significance of individual food products, such as Richard White’s study of vegemite. While Australians, both urban and rural, currently enjoy access to an internationally renowned food culture, it is remarkable to consider that it has only been during the years following the Second World War that these sophisticated and now much emulated ways of eating and cooking have developed. It is, indeed, only during the last half century that Australian eating habits have shifted from largely Anglo-Saxon influenced foods and meals that were prepared and eaten in the home, to the consumption of a wider range of more international and sophisticated foods and meals that are, increasingly, prepared by others and eaten outside the consumer’s residence. While a range of commonly cited influences has prompted this relatively recent revolution in culinary practice—including post-war migration, increasing levels of prosperity, widespread international travel, and the forces of globalisation—some of this change owes a debt to a series of influential individual figures. These tastemakers have included food writers and celebrity chefs; with early exponents including Margaret Fulton, Graham Kerr and Charmaine Solomon (see Brien). The findings of this study suggests that many restaurant chefs, and other cooks, have similarly played, and continue to take, a key role in the lives of not only the, necessarily, limited numbers of individuals who dine in a particular eatery or the other chefs and/or cooks trained in that establishment (Ruhlman, Reach), but also the communities in which they work on a much broader scale. Considering Chefs In his groundbreaking study, A History of Cooks and Cooking, Australian food historian Michael Symons proposes that those who prepare food are worthy of serious consideration because “if ‘we are what we eat’, cooks have not just made our meals, but have also made us. They have shaped our social networks, our technologies, arts and religions” (xi). Writing that cooks “deserve to have their stories told often and well,” and that, moreover, there is a “need to invent ways to think about them, and to revise our views about ourselves in their light” (xi), Symons’s is a clarion call to investigate the role and influence of cooks. Charles-Allen Baker-Clark has explicitly begun to address this lacunae in his Profiles from the Kitchen: What Great Cooks Have Taught Us About Ourselves and Our Food (2006), positing not only how these figures have shaped our relationships with food and eating, but also how these relationships impact on identities, culture and a range of social issues including those of social justice, spirituality and environmental sustainability. With the growing public interest in celebrities, it is perhaps not surprising that, while such research on chefs and/or cooks is still in its infancy, most of the existing detailed studies on individuals focus on famed international figures such as Marie-Antoine Carême (Bernier; Kelly), Escoffier (James; Rachleff; Sanger), and Alexis Soyer (Brandon; Morris; Ray). Despite an increasing number of tabloid “tell-all” surveys of contemporary celebrity chefs, which are largely based on mass media sources and which display little concern for historical or biographical accuracy (Bowyer; Hildred and Ewbank; Simpson; Smith), there have been to date only a handful of “serious” researched biographies of contemporary international chefs such as Julia Child, Alice Waters (Reardon; Riley), and Bernard Loiseux (Chelminski)—the last perhaps precipitated by an increased interest in this chef following his suicide after his restaurant lost one of its Michelin stars. Despite a handful of collective biographical studies of Australian chefs from the later-1980s on (Jenkins; O’Donnell and Knox; Brien), there are even fewer sustained biographical studies of Australian chefs or cooks (Clifford-Smith’s 2004 study of “the supermarket chef,” Bernard King, is a notable exception). Throughout such investigations, as well as in other popular food writing in magazines and cookbooks, there is some recognition that influential chefs and cooks have worked, and continue to work, outside such renowned urban culinary centres as Paris, London, New York, and Sydney. The Michelin starred restaurants of rural France, the so-called “gastropubs” of rural Britain and the advent of the “star-chef”-led country bed and breakfast establishment in Australia and New Zealand, together with the proliferation of farmer’s markets and a public desire to consume locally sourced, and ecologically sustainable, produce (Nabhan), has focused fresh attention on what could be called “the rural/regional chef”. However, despite the above, little attention has focused on the Australian non-urban chef/cook outside of the pages of a small number of key food writing magazines such as Australian Gourmet Traveller and Vogue Entertaining + Travel. Setting the Scene with an Australian Country Example: Armidale and Guyra In 2004, the Armidale-Dumaresq Council (of the New England region, New South Wales, Australia) adopted the slogan “Foodies thrive in Armidale” to market its main city for the next three years. With a population of some 20,000, Armidale’s main industry (in economic terms) is actually education and related services, but the latest Tourist Information Centre’s Dining Out in Armidale (c. 2006) brochure lists some 25 restaurants, 9 bistros and brasseries, 19 cafés and 5 fast food outlets featuring Australian, French, Italian, Mediterranean, Chinese, Thai, Indian and “international” cuisines. The local Yellow Pages telephone listings swell the estimation of the total number of food-providing businesses in the city to 60. Alongside the range of cuisines cited above, a large number of these eateries foreground the use of fresh, local foods with such phrases as “local and regional produce,” “fresh locally grown produce,” “the finest New England ingredients” and locally sourced “New England steaks, lamb and fresh seafood” repeatedly utilised in advertising and other promotional material. Some thirty kilometres to the north along the New England highway, the country town of Guyra, proclaimed a town in 1885, is the administrative and retail centre for a shire of some 2,200 people. Situated at 1,325 metres above sea level, the town is one of the highest in Australia with its main industries those of fine wool and lamb, beef cattle, potatoes and tomatoes. Until 1996, Guyra had been home to a large regional abattoir that employed some 400 staff at the height of its productivity, but rationalisation of the meat processing industry closed the facility, together with its associated pet food processor, causing a downturn in employment, local retail business, and real estate values. Since 2004, Guyra’s economy has, however, begun to recover after the town was identified by the Costa Group as the perfect site for glasshouse grown tomatoes. Perfect, due to its rare combination of cool summers (with an average of less than two days per year with temperatures over 30 degrees celsius), high winter light levels and proximity to transport routes. The result: 3.3 million kilograms of truss, vine harvested, hydroponic “Top of the Range” tomatoes currently produced per annum, all year round, in Guyra’s 5-hectare glasshouse: Australia’s largest, opened in December 2005. What residents (of whom I am one) call the “tomato-led recovery” has generated some 60 new local jobs directly related to the business, and significant flow on effects in terms of the demand for local services and retail business. This has led to substantial rates of renovation and building of new residential and retail properties, and a noticeably higher level of trade flowing into the town. Guyra’s main street retail sector is currently burgeoning and stories of its renewal have appeared in the national press. Unlike many similar sized inland towns, there are only a handful of empty shops (and most of these are in the process of being renovated), and new commercial premises have recently been constructed and opened for business. Although a small town, even in Australian country town terms, Guyra now has 10 restaurants, hotel bistros and cafés. A number of these feature local foods, with one pub’s bistro regularly featuring the trout that is farmed just kilometres away. Assessing the Contribution of Local Chefs and Cooks In mid-2007, a pilot survey to begin to explore the contribution of the regional chef in these two close, but quite distinct, rural and regional areas was sent to the chefs/cooks of the 70 food-serving businesses in Armidale and Guyra that I could identify. Taking into account the 6 returns that revealed a business had closed, moved or changed its name, the 42 replies received represented a response rate of 65.5per cent (or two thirds), representatively spread across the two towns. Answers indicated that the businesses comprised 18 restaurants, 13 cafés, 6 bistro/brasseries, 1 roadhouse, 1 takeaway/fast food and 3 bed and breakfast establishments. These businesses employed 394 staff, of whom 102 were chefs and/cooks, or 25.9 per cent of the total number of staff then employed by these establishments. In answer to a series of questions designed to ascertain the roles played by these chefs/cooks in their local communities, as well as more widely, I found a wide range of inputs. These chefs had, for instance, made a considerable contribution to their local economies in the area of fostering local jobs and a work culture: 40 (95 per cent) had worked with/for another local business including but not exclusively food businesses; 30 (71.4 per cent) had provided work experience opportunities for those aspiring to work in the culinary field; and 22 (more than half) had provided at least one apprenticeship position. A large number had brought outside expertise and knowledge with them to these local areas, with 29 (69 per cent) having worked in another food business outside Armidale or Guyra. In terms of community building and sustainability, 10 (or almost a quarter) had assisted or advised the local Council; 20 (or almost half) had worked with local school children in a food-related way; 28 (two thirds) had helped at least one charity or other local fundraising group. An extra 7 (bringing the cumulative total to 83.3 per cent) specifically mentioned that they had worked with/for the local gallery, museum and/or local history group. 23 (more than half) had been involved with and/or contributed to a local festival. The question of whether they had “contributed anything else important, helpful or interesting to the community” elicited the following responses: writing a food or wine column for the local paper (3 respondents), delivering TAFE teacher workshops (2 respondents), holding food demonstrations for Rotary and Lions Clubs and school fetes (5 respondents), informing the public about healthy food (3 respondents), educating the public about environmental issues (2 respondents) and working regularly with Meals on Wheels or a similar organisation (6 respondents, or 14.3 per cent). One respondent added his/her work as a volunteer driver for the local ambulance transport service, the only non-food related response to this question. Interestingly, in line with the activity of well-known celebrity chefs, in addition to the 3 chefs/cooks who had written a food or wine column for the local newspaper, 11 respondents (more than a quarter of the sample) had written or contributed to a cookbook or recipe collection. One of these chefs/cooks, moreover, reported that he/she produced a weblog that was “widely read”, and also contributed to international food-related weblogs and websites. In turn, the responses indicated that the (local) communities—including their governing bodies—also offer some support of these chefs and cooks. Many respondents reported they had been featured in, or interviewed and/or photographed for, a range of media. This media comprised the following: the local newspapers (22 respondents, 52.4 per cent), local radio stations (19 respondents, 45.2 per cent), regional television stations (11 respondents, 26.2 per cent) and local websites (8 respondents, 19 per cent). A number had also attracted other media exposure. This was in the local, regional area, especially through local Council publications (31 respondents, 75 per cent), as well as state-wide (2 respondents, 4.8 per cent) and nationally (6 respondents, 14.3 per cent). Two of these local chefs/cooks (or 4.8 per cent) had attracted international media coverage of their activities. It is clear from the above that, in the small area surveyed, rural and regional chefs/cooks make a considerable contribution to their local communities, with all the chefs/cooks who replied making some, and a number a major, contribution to those communities, well beyond the requirements of their paid positions in the field of food preparation and service. The responses tendered indicate that these chefs and cooks contributed regularly to local public events, institutions and charities (with a high rate of contribution to local festivals, school programs and local charitable activities), and were also making an input into public education programs, local cultural institutions, political and social debates of local importance, as well as the profitability of other local businesses. They were also actively supporting not only the future of the food industry as a whole, but also the viability of their local communities, by providing work experience opportunities and taking on local apprentices for training and mentorship. Much more than merely food providers, as a group, these chefs and cooks were, it appears, also operating as food historians, public intellectuals, teachers, activists and environmentalists. They were, moreover, operating as content producers for local media while, at the same time, acting as media producers and publishers. Conclusion The terms “chef” and “cook” can be diversely defined. All definitions, however, commonly involve a sense of professionalism in food preparation reflecting some specialist knowledge and skill in the culinary arts, as well as various levels of creativity, experience and responsibility. In terms of the specific duties that chefs and professional cooks undertake every day, almost all publications on the subject deal specifically with workplace related activities such as food and other supply ordering, staff management, menu planning and food preparation and serving. This is constant across culinary textbooks (see, for instance, Culinary Institute of America 2002) and more discursive narratives about the professional chef such as the bestselling autobiographical musings of Anthony Bourdain, and Michael Ruhlman’s journalistic/biographical investigations of US chefs (Soul; Reach). An alternative preliminary examination, and categorisation, of the roles these professionals play outside their kitchens reveals, however, a much wider range of community based activities and inputs than such texts suggest. It is without doubt that the chefs and cooks who responded to the survey discussed above have made, and are making, a considerable contribution to their local New England communities. It is also without doubt that these contributions are of considerable value, and valued by, those country communities. Further research will have to consider to what extent these contributions, and the significance and influence of these chefs and cooks in those communities are mirrored, or not, by other country (as well as urban) chefs and cooks, and their communities. Acknowledgements An earlier version of this paper was presented at the Engaging Histories: Australian Historical Association Regional Conference, at the University of New England, September 2007. I would like to thank the session’s participants for their insightful comments on that presentation. A sincere thank you, too, to the reviewers of this article, whose suggestions assisted my thinking on this piece. Research to complete this article was carried out whilst a Visiting Fellow with the Research School of Humanities, the Australian National University. References Armidale Tourist Information Centre. Dining Out in Armidale [brochure]. Armidale: Armidale-Dumaresq Council, c. 2006. Baker-Clark, C. A. 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Abstract Cancer registries help us to understand skin cancer cause, prevalence, treatment and prevention. They provide evidence to gain new healthcare resources. This paper studies the evolution of cancer registries and their relevance to dermatology. In the 16th century, ‘Bills of Mortality’, the first English healthcare registry, catalogued the number and causes of death in London parishes. Originally set up to track bubonic plague, it expanded to cover other diseases, including cancer. The 1728 London ‘General Census of Cancer’ was an early systemic study of cancer. In the 19th and early 20th centuries, hospital censuses often monitored cancers. These were superseded by population-based cancer registries, allowing continuous data collection. An early example is the Hamburg Cancer Registry (1926), which recorded names on a card-based registry and compared them with death certificates. The first national cancer registry was the Danish national cancer registry, formed in 1942. In the UK, the Scottish Cancer Registry was formed in 1958, the Welsh Cancer Intelligence & Surveillance Unit in 1972 and the Northern Ireland Cancer Registry in 1994. In England, eight regional registries were created, with the South West being the first in 1945. The Calman–Hine report (1995) highlighted a desire for a national cancer registry. In 2008, the National Cancer Intelligence Network enabled the assimilation and analysis of data sets from English registries. They merged in 2013, forming the National Cancer Registry and Analysis Service (NCRAS), England. Critically, the 2006 National Health Service act (section 251) allowed cancer data collection without formal consent. Although melanoma data were generally good quality, the inclusion and quality of nonmelanoma skin cancers (NMSCs) were historically less reliable, with improvement since 2013. Historically, the exclusion of NMSCs from published cancer data is common. Wales is the last UK registry to not routinely report NMSC. However, this is due to change in 2024. The ‘global burden of disease tool’ (1990) utilizes various sources, including cancer registry data, to model incidence, mortality and health implications of disease globally, including melanoma and NMSCs. In 2022, the British Association of Dermatologists joined with the NCRAS to develop the Get Data Out skin tool, an annually updated website featuring more granular epidemiological data on skin cancers. High-quality epidemiological data are essential to understanding skin cancer’s regional and chronological variations, and to ensure that resources for healthcare and research are allocated appropriately.

This literature review addresses five themes that inform the faculty adequacy standards established by U.S. regional accreditation commissions and provides information about faculty credentials, the relationship between institutional missions and faculty responsibilities; full-time, part-time and contingent faculty; faculty responsibilities, and faculty in disciplinary-based accreditation. This review of literature supports institutions’ responses to the standards for adequacy of full-time faculty in six U.S. regional accreditation commissions. The study’s findings may provide common themes related to faculty adequacy to facilitate the institutions’ definitions and standards for faculty adequacy. The results might inform regional accreditors as they evaluate institutions on this standard. Finally, this study may be of interest to accreditors in other countries as they develop and revise their standards related to faculty adequacy. Keywords Faculty adequacy, accreditation standards, U.S. regional accreditation commissions References [1] Middaugh, M. F. (2002). Faculty productivity: Different strategies for different audiences. Planning For Higher Education, 30(3), 34-43[2] Tincher-Ladner, L., & King, S. (2014). Effects of regional accreditation of full-time faculty on community college graduation rates. Community College Journal of Research and Practice, 38, 947-950.[3] Northwest Commission on Colleges and Universities (NWCCU) (2012). Accreditation standards. Retrieved from http://www.nwccu.org/accreditation/standards-policies/standards/[4] Middle States Commission on Higher Education (MSCHE) (2015). Standards for accreditation and requirements of affiliation ( 13th ed). [5] North Central Association of Colleges and Schools-The Higher Learning Commission (NCA-HLC) (2015). Resource guide: Criteria for accreditation and assumed practices.[6] New England Association of Schools and Colleges Commission on Institutions of Higher Education (NEASC-CIHE) (2011). The standards for accreditation. [7] Southern Association of Colleges and Schools Commission on Colleges (2011). Faculty roster: Instructions for reporting the qualifications of full-time and part-time faculty. [8] WASC Senior College and University Commission (WSCUC) (2013). Handbook of Accreditation. Retrieved at https://www.wscuc.org/book/export/html/924[9] Cohen, A. & Kisker C. (2010). The shaping of American higher education (2nd ed.). San Francisco, CA: Jossey-Bass.[10] Faireweather.J. (2002). The mythologies of faculty productivity. The Journal of Higher Education. 73(1). 26-48[11] Townsend, B. K. (2008). Community college faculty what we know and need to know. Community College Review. 36 (1). 5-24. [12] National Center for Education Statistics, U.S. Department of Education. (2003). Federal programs for education and related activities. In Digest of Education Statistics (Chap. 4). Retrieved from the National Center for Education Statistics Web site: http://nces.ed.gov/programs/digest/d10/tables/dt10_261.asp[13] Middaugh, M. F.(2001). Understanding faculty productivity: Standards and benchmarks for colleges and universities. San Francisco: Jossey-Bass Publishers.[14] Texas Tech University (2006). Faculty responsibility (OP 32.06). Retrieved from http://www.depts.ttu.edu/opmanual/OP32.06.pdf[15] South Plains College (2015). Faculty Handbook. Retrieved from http://www.southplainscollege.edu/employees/manualshandbooks/facultyhandbook.php[16] North Central Association of Colleges and Schools-The Higher Learning Commission (HLC) (2015). Determining qualified faculty through HLC’s criteria for accreditation and assumed practices. Retrieved at https://www.lssu.edu/hlc/documents/QualifiedFacultyGuidelines_2015-08_OPB.pdf[17] Chaden, C. (2013). Engaging faculty in retention: Finding traction through accreditation. New Directions for Higher Education, (161), 91-100. doi: 10.1002/he.20049[18] Williams, T. S. (2011). The unknowning knowers: Faculty and the accreditation process. (Doctoral Dissertation). Available from ProQuest Dissertations & Theses Full Text (Order No. 3476398).[19] Townsend, B.K & Rosser, V.J (2007). Workload issues and measures of faculty productivities. The NEA Higher Education Journal. 7-19[20] Middaugh, M. F. (2011). Measuring faculty productivity: Let's get it right. Chronicle of Higher Education, 58(2), A43-A44.[21] Middaugh, M. F., Kelly, H. A., & Walters, A. M. (2008). The role of institutional research in understanding and describing faculty work. New Directions for Higher Education, (141), 41-56. doi:10.1002/he.292[22] Maxey, D. D., & Kezar, A. K. (2015). Revealing opportunities and obstacles for changing non-tenure-track faculty practices: An examination of stakeholders' awareness of institutional contradictions. Journal of Higher Education, 86(4), 564-594.[23] Marsh, F. K. (2010). High performance team: Building a business program with part- and full-time faculty. Journal of Education for Business, 85(4), 187-194. doi:10.1080/08832320903252421[24] Elman, S. E. (2003). A regional accreditation perspective on contingent faculty appointments. New Directions for Higher Education, (123), 71.[25] Gerlich, R. N., & Sollosy, M. (2010). Predicting assessment outcomes: The effect of full-time and part-time faculty. Journal of Case Studies in Accreditation and Assessment, 1-9[26] Speer, C. N. (2013). Perceptions of employment and use of part-time faculty among chief instructional officers at southern association of colleges and schools-accredited public associate's colleges. (Doctoral Dissertation). Available from ProQuest Dissertations & Theses Full Text. (Order No. 3612131)[27] Hedrick, D. D., Henson, S. E., Krieg, J. M., & Wassell Jr., C. S. (2010). The effects of AACSB accreditation on faculty salaries and productivity. Journal of Education for Business, 85(5), 284-291. doi:10.1080/08832320903449543[28] Bell, R. L., & Joyce, M. P. (2011). Comparing business faculty's salaries by rank and gender: Does AACSB accreditation really make a difference? Academy of Educational Leadership Journal, 15(2), 19-40.[29] Koys, D. J. (2008). Judging academic qualifications, professional qualifications, and participation of faculty using AACSB guidelines. Journal of Education for Business, 83(4), 207-213.[30] Boronico, J., Murdy, J., & Kong, X. (2014). Faculty sufficiency and AACSB accreditation compliance within a global university: A mathematical modeling approach. American Journal of Business Education, 7(3), 213-218. [31] Bộ Giáo dục và Đào tạo (2014). Thông thư số 36/2014/TTLT-BGDĐT-BNV ngày 28/11/2014 về Quy định mã số và tiêu chuẩn chức danh nghề nghiệp viên chức giảng dạy trong các cơ sở giáo dục đại học công lập. [32] Chính Phủ (2015). Nghị định chính phủ số 73/2015/NĐ-CP ngày 08/09/2015 về Quy định tiêu chuẩn phân tầng, khung xếp hạng và tiêu chuẩn xếp hạng cơ sở giáo dục đại học. [33] Cục quản lý chất lượng (2018). Thông thư số 768/QLCL-KĐCLGD ngày 20/04/2018 về Hướng dẫn đánh giá theo bộ tiêu chuẩn đánh giá chất lượng cơ sỏ giáo dục đại học.

It is widely recognised that multidisciplinary team meetings (MDTMs) are the cornerstone of cancer practice in the United Kingdom and many countries around the world. While MDTMs offer several key benefits to patients, healthcare professionals and cancer registration, data and audit services, in the United Kingdom they have over time become too large, onerous and ‘transactional’ often discussing cases that have a pre-determined management plan. In response to this growing problem, National Health Service (NHS) England and NHS Improvement produced an multidisciplinary team (MDT) streamlining document as a guide to encourage MDTM to consider a ‘Standard of Care’ (SoC) approach to conditions with a predictable agreed management plan based on national, regional cancer network or local cancer unit protocols. This would then enable more meaningful discussion of complex cases with in the MDT. This document did not gain much traction and had little impact on UK urological cancer MDTM. As a result, The British Association of Urological Surgeons (BAUS) was approached by the NHS Getting It Right First Time (GIRFT) Leads in 2021 to promote an SoC-based streamlining to urological cancer MDT working. Having consulted widely with colleagues, cancer networks and cancer delivery teams, the BAUS Section of Oncology sought views from its membership during a dedicated MDTM session in the Sections of Oncology Meeting, December 2021. From this extensive engagement with stakeholders, we have put together the following guidance for use as a framework to facilitate the agreement of local policies in the interests of supporting the needs of patients and MDTs. Level of evidence: level 5 (Expert opinions based on non-systematic reviews of results or mechanistic studies)

Special Care NoticeThis article discusses trauma and violence inflicted upon the Indigenous peoples of Tasmania through the processes of colonisation. Content within this article may be distressing to some readers. IntroductionThis article looks briefly at the collection, consultation, and digital sharing of stories essential to the histories of the First Nations peoples of Australia. Focusing on materials held in Sydney, New South Wales two case studies—the object known as the Proclamation Board and the George Augustus Robinson Papers—explore how materials can be shared with Aboriginal peoples of the region now known as Tasmania. Specifically, the authors of this article (a Palawa man and an Australian woman of European descent) ask how can the idea of the privileging of Indigenous voices, within Eurocentric cultural collections, be transformed from rhetoric to reality? Moreover, how can we navigate this complex work, that is made even more problematic by distance, through the utilisation of knowledge networks which are geographically isolated from the collections holding stories crucial to Indigenous communities? In seeking to answer these important questions, this article looks at how cultural, emotional, and intellectual ownership can be divested from the physical ownership of a collection in a way that repatriates—appropriately and sensitively—stories of Aboriginal Australia and of colonisation. Holding Stories, Not Always Our OwnCultural institutions, including libraries, have, in recent years, been drawn into discussions centred on the notion of digital disruption and “that transformative shift which has seen the ongoing realignment of business resources, relationships, knowledge, and value both facilitating the entry of previously impossible ideas and accelerating the competitive impact of those same impossible ideas” (Franks and Ensor n.p.). As Molly Brown has noted, librarians “are faced, on a daily basis, with rapidly changing technology and the ways in which our patrons access and use information. Thus, we need to look at disruptive technologies as opportunities” (n.p.). Some innovations, including the transition from card catalogues to online catalogues and the provision of a wide range of electronic resources, are now considered to be business as usual for most institutions. So, too, the digitisation of great swathes of materials to facilitate access to collections onsite and online, with digitising primary sources seen as an intermediary between the pillars of preserving these materials and facilitating access for those who cannot, for a variety of logistical and personal reasons, travel to a particular repository where a collection is held.The result has been the development of hybrid collections: that is, collections that can be accessed in both physical and digital formats. Yet, the digitisation processes conducted by memory institutions is often selective. Limited resources, even for large-scale digitisation projects usually only realise outcomes that focus on making visually rich, key, or canonical documents, or those documents that are considered high use and at risk, available online. Such materials are extracted from the larger full body of records while other lesser-known components are often omitted. Digitisation projects therefore tend to be devised for a broader audience where contextual questions are less central to the methodology in favour of presenting notable or famous documents online only. Documents can be profiled as an exhibition separate from their complete collection and, critically, their wider context. Libraries of course are not neutral spaces and this practice of (re)enforcing the canon through digitisation is a challenge that cultural institutions, in partnerships, need to address (Franks and Ensor n.p.). Indeed, our digital collections are as affected by power relationships and the ongoing impacts of colonisation as our physical collections. These power relationships can be seen through an organisation’s “processes that support acquisitions, as purchases and as the acceptance of artefacts offered as donations. Throughout such processes decisions are continually made (consciously and unconsciously) that affect what is presented and actively promoted as the official history” (Thorpe et al. 8). While it is important to acknowledge what we do collect, it is equally important to look, too, at what we do not collect and to consider how we continually privilege and exclude stories. Especially when these stories are not always our own, but are held, often as accidents of collecting. For example, an item comes in as part of a larger suite of materials while older, city-based institutions often pre-date regional repositories. An essential point here is that cultural institutions can often become comfortable in what they collect, building on existing holdings. This, in turn, can lead to comfortable digitisation. If we are to be truly disruptive, we need to embrace feeling uncomfortable in what we do, and we need to view digitisation as an intervention opportunity; a chance to challenge what we ‘know’ about our collections. This is especially relevant in any attempts to decolonise collections.Case Study One: The Proclamation BoardThe first case study looks at an example of re-digitisation. One of the seven Proclamation Boards known to survive in a public collection is held by the Mitchell Library, State Library of New South Wales, having been purchased from Tasmanian collector and photographer John Watt Beattie (1859–1930) in May 1919 for £30 (Morris 86). Why, with so much material to digitise—working in a program of limited funds and time—would the Library return to an object that has already been privileged? Unanswered questions and advances in digitisation technologies, created a unique opportunity. For the First Peoples of Van Diemen’s Land (now known as Tasmania), colonisation by the British in 1803 was “an emotionally, intellectually, physically, and spiritually confronting series of encounters” (Franks n.p.). Violent incidents became routine and were followed by a full-scale conflict, often referred to as the Black War (Clements 1), or more recently as the Tasmanian War, fought from the 1820s until 1832. Image 1: Governor Arthur’s Proclamation to the Aborigines, ca. 1828–1830. Image Credit: Mitchell Library, State Library of New South Wales, Call No.: SAFE / R 247.Behind the British combatants were various support staff, including administrators and propagandists. One of the efforts by the belligerents, behind the front line, to win the war and bring about peace was the production of approximately 100 Proclamation Boards. These four-strip pictograms were the result of a scheme introduced by Lieutenant Governor George Arthur (1784–1854), on the advice of Surveyor General George Frankland (1800–38), to communicate that all are equal under the rule of law (Arthur 1). Frankland wrote to Arthur in early 1829 to suggest these Proclamation Boards could be produced and nailed to trees (Morris 84), as a Eurocentric adaptation of a traditional method of communication used by Indigenous peoples who left images on the trunks of trees. The overtly stated purpose of the Boards was, like the printed proclamations exhorting peace, to assert, all people—black and white—were equal. That “British Justice would protect” everyone (Morris 84). The first strip on each of these pictogram Boards presents Indigenous peoples and colonists living peacefully together. The second strip shows “a conciliatory handshake between the British governor and an Aboriginal ‘chief’, highly reminiscent of images found in North America on treaty medals and anti-slavery tokens” (Darian-Smith and Edmonds 4). The third and fourth strips depict the repercussions for committing murder (or, indeed, any significant crime), with an Indigenous man hanged for spearing a colonist and a European man hanged for shooting an Aboriginal man. Both men executed in the presence of the Lieutenant Governor. The Boards, oil on Huon pine, were painted by “convict artists incarcerated in the island penal colony” (Carroll 73).The Board at the State Library of New South Wales was digitised quite early on in the Library’s digitisation program, it has been routinely exhibited (including for the Library’s centenary in 2010) and is written about regularly. Yet, many questions about this small piece of timber remain unanswered. For example, some Boards were outlined with sketches and some were outlined with pouncing, “a technique [of the Italian Renaissance] of pricking the contours of a drawing with a pin. Charcoal was then dusted on to the drawing” (Carroll 75–76). Could such a sketch or example of pouncing be seen beneath the surface layers of paint on this particular Board? What might be revealed by examining the Board more closely and looking at this object in different ways?An important, but unexpected, discovery was that while most of the pigments in the painting correlate with those commonly available to artists in the early nineteenth century there is one outstanding anomaly. X-ray analysis revealed cadmium yellow present in several places across the painting, including the dresses of the little girls in strip one, uniform details in strip two, and the trousers worn by the settler men in strips three and four (Kahabka 2). This is an extraordinary discovery, as cadmium yellows were available “commercially as an artist pigment in England by 1846” and were shown by “Winsor & Newton at the 1851 Exhibition held at the Crystal Palace, London” (Fiedler and Bayard 68). The availability of this particular type of yellow in the early 1850s could set a new marker for the earliest possible date for the manufacture of this Board, long-assumed to be 1828–30. Further, the early manufacture of cadmium yellow saw the pigment in short supply and a very expensive option when compared with other pigments such as chrome yellow (the darker yellow, seen in the grid lines that separate the scenes in the painting). This presents a clearly uncomfortable truth in relation to an object so heavily researched and so significant to a well-regarded collection that aims to document much of Australia’s colonial history. Is it possible, for example, the Board has been subjected to overpainting at a later date? Or, was this premium paint used to produce a display Board that was sent, by the Tasmanian Government, to the 1866 Intercolonial Exhibition in Melbourne? In seeking to see the finer details of the painting through re-digitisation, the results were much richer than anticipated. The sketch outlines are clearly visible in the new high-resolution files. There are, too, details unable to be seen clearly with the naked eye, including this warrior’s headdress and ceremonial scarring on his stomach, scars that tell stories “of pain, endurance, identity, status, beauty, courage, sorrow or grief” (Australian Museum n.p.). The image of this man has been duplicated and distributed since the 1830s, an anonymous figure deployed to tell a settler-centric story of the Black, or Tasmanian, War. This man can now be seen, for the first time nine decades later, to wear his own story. We do not know his name, but he is no longer completely anonymous. This image is now, in some ways, a portrait. The State Library of New South Wales acknowledges this object is part of an important chapter in the Tasmanian story and, though two Boards are in collections in Tasmania (the Tasmanian Museum and Art Gallery, Hobart and the Queen Victoria Museum and Art Gallery, Launceston), each Board is different. The Library holds an important piece of a large and complex puzzle and has a moral obligation to make this information available beyond its metropolitan location. Digitisation, in this case re-digitisation, is allowing for the disruption of this story in sparking new questions around provenance and for the relocating of a Palawa warrior to a more prominent, perhaps even equal role, within a colonial narrative. Image 2: Detail, Governor Arthur’s Proclamation to the Aborigines, ca. 1828–1830. Image Credit: Mitchell Library, State Library of New South Wales, Call No.: SAFE / R 247.Case Study Two: The George Augustus Robinson PapersThe second case study focuses on the work being led by the Indigenous Engagement Branch at the State Library of New South Wales on the George Augustus Robinson (1791–1866) Papers. In 1829, Robinson was granted a government post in Van Diemen’s Land to ‘conciliate’ with the Palawa peoples. More accurately, Robinson’s core task was dispossession and the systematic disconnection of the Palawa peoples from their Country, community, and culture. Robinson was a habitual diarist and notetaker documenting much of his own life as well as the lives of those around him, including First Nations peoples. His extensive suite of papers represents a familiar and peculiar kind of discomfort for Aboriginal Australians, one in which they are forced to learn about themselves through the eyes and words of their oppressors. For many First Nations peoples of Tasmania, Robinson remains a violent and terrible figure, but his observations of Palawa culture and language are as vital as they are problematic. Importantly, his papers include vibrant and utterly unique descriptions of people, place, flora and fauna, and language, as well as illustrations revealing insights into the routines of daily life (even as those routines were being systematically dismantled by colonial authorities). “Robinson’s records have informed much of the revitalisation of Tasmanian Aboriginal culture in the twentieth century and continue to provide the basis for investigations of identity and deep relationships to land by Aboriginal scholars” (Lehman n.p.). These observations and snippets of lived culture are of immense value to Palawa peoples today but the act of reading between Robinson’s assumptions and beyond his entrenched colonial views is difficult work.Image 3: George Augustus Robinson Papers, 1829–34. Image Credit: Mitchell Library, State Library of New South Wales, A 7023–A 7031.The canonical reference for Robinson’s archive is Friendly Mission: The Tasmanian Journals and Papers of George Augustus Robinson, 1829–1834, edited by N.J.B. Plomley. The volume of over 1,000 pages was first published in 1966. This large-scale project is recognised “as a monumental work of Tasmanian history” (Crane ix). Yet, this standard text (relied upon by Indigenous and non-Indigenous researchers) has clearly not reproduced a significant percentage of Robinson’s Tasmanian manuscripts. Through his presumptuous truncations Plomley has not simply edited Robinson’s work but has, quite literally, written many Palawa stories out of this colonial narrative. It is this lack of agency in determining what should be left out that is most troubling, and reflects an all-too-familiar approach which libraries, including the State Library of New South Wales, are now urgently trying to rectify. Plomley’s preface and introduction does not indicate large tranches of information are missing. Indeed, Plomley specifies “that in extenso [in full] reproduction was necessary” (4) and omissions “have been kept to a minimum” (8). A 32-page supplement was published in 1971. A new edition, including the supplement, some corrections made by Plomley, and some extra material was released in 2008. But much continues to be unknown outside of academic circles, and far too few Palawa Elders and language revival workers have had access to Robinson’s original unfiltered observations. Indeed, Plomley’s text is linear and neat when compared to the often-chaotic writings of Robinson. Digitisation cannot address matters of the materiality of the archive, but such projects do offer opportunities for access to information in its original form, unedited, and unmediated.Extensive consultation with communities in Tasmania is underpinning the digitisation and re-description of a collection which has long been assumed—through partial digitisation, microfilming, and Plomley’s text—to be readily available and wholly understood. Central to this project is not just challenging the canonical status of Plomley’s work but directly challenging the idea non-Aboriginal experts can truly understand the cultural or linguistic context of the information recorded in Robinson’s journals. One of the more exciting outcomes, so far, has been working with Palawa peoples to explore the possibility of Palawa-led transcriptions and translation, and not breaking up the tasks of this work and distributing them to consultants or to non-Indigenous student groups. In this way, people are being meaningfully reunited with their own histories and, crucially, given first right to contextualise and understand these histories. Again, digitisation and disruption can be seen here as allies with the facilitation of accessibility to an archive in ways that re-distribute the traditional power relations around interpreting and telling stories held within colonial-rich collections.Image 4: Detail, George Augustus Robinson Papers, 1829–34. Image Credit: Mitchell Library, State Library of New South Wales, A 7023–A 7031.As has been so brilliantly illustrated by Bruce Pascoe’s recent work Dark Emu (2014), when Aboriginal peoples are given the opportunity to interpret their own culture from the colonial records without interference, they are able to see strength and sophistication rather than victimhood. For, to “understand how the Europeans’ assumptions selectively filtered the information brought to them by the early explorers is to see how we came to have the history of the country we accept today” (4). Far from decrying these early colonial records Aboriginal peoples understand their vital importance in connecting to a culture which was dismantled and destroyed, but importantly it is known that far too much is lost in translation when Aboriginal Australians are not the ones undertaking the translating. ConclusionFor Aboriginal Australians, culture and knowledge is no longer always anchored to Country. These histories, once so firmly connected to communities through their ancestral lands and languages, have been dispersed across the continent and around the world. Many important stories—of family history, language, and ways of life—are held in cultural institutions and understanding the role of responsibly disseminating these collections through digitisation is paramount. In transitioning from physical collections to hybrid collections of the physical and digital, the digitisation processes conducted by memory institutions can be—and due to the size of some collections is inevitably—selective. Limited resources, even for large-scale and well-resourced digitisation projects usually realise outcomes that focus on making visually rich, key, or canonical documents, or those documents considered high use or at risk, available online. Such materials are extracted from a full body of records. Digitisation projects, as noted, tend to be devised for a broader audience where contextual questions are less central to the methodology in favour of presenting notable documents online, separate from their complete collection and, critically, their context. Our institutions carry the weight of past collecting strategies and, today, the pressure of digitisation strategies as well. Contemporary librarians should not be gatekeepers, but rather key holders. In collaborating across sectors and with communities we open doors for education, research, and the repatriation of culture and knowledge. We must, always, remember to open these doors wide: the call of Aboriginal Australians of ‘nothing about us without us’ is not an invitation to collaboration but an imperative. Libraries—as well as galleries, archives, and museums—cannot tell these stories alone. Also, these two case studies highlight what we believe to be one of the biggest mistakes that not just libraries but all cultural institutions are vulnerable to making, the assumption that just because a collection is open access it is also accessible. Digitisation projects are more valuable when communicated, contextualised and—essentially—the result of community consultation. Such work can, for some, be uncomfortable while for others it offers opportunities to embrace disruption and, by extension, opportunities to decolonise collections. For First Nations peoples this work can be more powerful than any simple measurement tool can record. Through examining our past collecting, deliberate efforts to consult, and through digital sharing projects across metropolitan and regional Australia, we can make meaningful differences to the ways in which Aboriginal Australians can, again, own their histories.Acknowledgements The authors acknowledge the Palawa peoples: the traditional custodians of the lands known today as Tasmania. The authors acknowledge, too, the Gadigal people upon whose lands this article was researched and written. We are indebted to Dana Kahabka (Conservator), Joy Lai (Imaging Specialist), Richard Neville (Mitchell Librarian), and Marika Duczynski (Project Officer) at the State Library of New South Wales. Sincere thanks are also given to Jason Ensor of Western Sydney University.ReferencesArthur, George. “Proclamation.” The Hobart Town Courier 19 Apr. 1828: 1.———. Proclamation to the Aborigines. Graphic Materials. Sydney: Mitchell Library, State Library of New South Wales, SAFE R / 247, ca. 1828–1830.Australian Museum. “Aboriginal Scarification.” 2018. 11 Jan. 2019 <https://australianmuseum.net.au/about/history/exhibitions/body-art/aboriginal-scarification/>.Brown, Molly. “Disruptive Technology: A Good Thing for Our Libraries?” International Librarians Network (2016). 26 Aug. 2018 <https://interlibnet.org/2016/11/25/disruptive-technology-a-good-thing-for-our-libraries/>.Carroll, Khadija von Zinnenburg. Art in the Time of Colony: Empires and the Making of the Modern World, 1650–2000. Farnham, UK: Ashgate Publishing, 2014.Clements, Nicholas. The Black War: Fear, Sex and Resistance in Tasmania. St Lucia, U of Queensland P, 2014.Crane, Ralph. “Introduction.” Friendly Mission: The Tasmanian Journals and Papers of George Augustus Robinson, 1829-1834. 2nd ed. Launceston and Hobart: Queen Victoria Museum and Art Gallery, and Quintus Publishing, 2008. ix.Darian-Smith, Kate, and Penelope Edmonds. “Conciliation on Colonial Frontiers.” Conciliation on Colonial Frontiers: Conflict, Performance and Commemoration in Australia and the Pacific Rim. Eds. Kate Darian-Smith and Penelope Edmonds. New York: Routledge, 2015. 1–14.Edmonds, Penelope. “‘Failing in Every Endeavour to Conciliate’: Governor Arthur’s Proclamation Boards to the Aborigines, Australian Conciliation Narratives and Their Transnational Connections.” Journal of Australian Studies 35.2 (2011): 201–18.Fiedler, Inge, and Michael A. Bayard. Artist Pigments, a Handbook of Their History and Characteristics. Ed. Robert L. Feller. Cambridge: Cambridge UP, 1986. 65–108. Franks, Rachel. “A True Crime Tale: Re-Imagining Governor Arthur’s Proclamation Board for the Tasmanian Aborigines.” M/C Journal 18.6 (2015). 1 Feb. 2019 <http://journal.media-culture.org.au/index.php/mcjournal/article/view/1036>.Franks, Rachel, and Jason Ensor. “Challenging the Canon: Collaboration, Digitisation and Education.” ALIA Online: A Conference of the Australian Library and Information Association, 11–15 Feb. 2019, Sydney.Kahabka, Dana. Condition Assessment [Governor Arthur’s Proclamation to the Aborigines, ca. 1828–1830, SAFE / R247]. Sydney: State Library of New South Wales, 2017.Lehman, Greg. “Pleading Robinson: Reviews of Friendly Mission: The Tasmanian Journals and Papers of George Augustus Robinson (2008) and Reading Robinson: Companion Essays to Friendly Mission (2008).” Australian Humanities Review 49 (2010). 1 May 2019 <http://press-files.anu.edu.au/downloads/press/p41961/html/review-12.xhtml?referer=1294&page=15>. Morris, John. “Notes on A Message to the Tasmanian Aborigines in 1829, popularly called ‘Governor Davey’s Proclamation to the Aborigines, 1816’.” Australiana 10.3 (1988): 84–7.Pascoe, Bruce. Dark Emu. Broome: Magabala Books, 2014/2018.Plomley, N.J.B. Friendly Mission: The Tasmanian Journals and Papers of George Augustus Robinson, 1829–1834. Hobart: Tasmanian Historical Research Association, 1966.Robinson, George Augustus. Papers. Textual Records. Sydney: Mitchell Library, State Library of NSW, A 7023–A 7031, 1829–34. Thorpe, Kirsten, Monica Galassi, and Rachel Franks. “Discovering Indigenous Australian Culture: Building Trusted Engagement in Online Environments.” Journal of Web Librarianship 10.4 (2016): 343–63.

In early 1888, Miss Margaret Pearson arrived in Melbourne under engagement to the Working Men’s College there to give cookery lessons to young women. The College committee had applied to the National School of Cookery in London—an establishment effusively praised in the colonial press—for a suitable culinary educator, and Pearson, a graduate of that institute, was dispatched. After six months or so spent educating her antipodean pupils she published a cookbook, Cookery Recipes For The People, which she described in the preface as a handbook of “plain wholesome cookery” (Pearson 3). The book ran to three editions and sold more than 13,000 copies. A decade later, Hanna Maclurcan, co-proprietor of the popular Queen’s Hotel in Townsville, published Mrs Maclurcan’s Cookery Book: A Collection of Practical Recipes, Specially Suitable for Australia. A review of this work in the Brisbane Courier described it, positively, as a book of “good plain cooking”. Maclurcan had gained some renown as a cook after the Governor of Queensland, Lord Lamington, publicly praised the meals he had eaten at the Queen’s as “exceptionally good and above the average of Australian hotels” (Morning Bulletin 5). The first print run of Mrs Maclurcan’s Cookery Book sold out in weeks, and a second edition was swiftly produced. By 1903 there were 26,000 copies of Maclurcan’s book in print—one of which was deposited in the library of Queen Victoria. While the existence of any particular cookbook does not constitute evidence that any person ever reproduced a recipe from it, the not immodest sales enjoyed by Pearson and Maclurcan can, at the least, be taken to indicate a popular interest in the style of cookery, that is “plain cookery”, delineated in their respective works. If those who bought these books never actually turned them into working copies—that is, cooked from them—they likely aspired to do so. Practical classes in plain cookery were also popular in Australia in the latter part of the nineteenth century. The adjectival coupling of the word “plain” to “cookery” in colonial Australia can be seen then to have formed an appealing duet at that time If a modern author or reviewer described the body of recipes encapsulated in a cookbook as “plain cookery”, it would not serve to recommend it to the contemporary market—indeed it would likely condemn such a publication to pulping, rather than sales of many thousands—as the term would be understood by most modern cooks, and eaters, to describe food that was dull and lacking in flavour and cosmopolitan appeal. We now prefer cookery books that offer instruction on the preparation of dishes that are described as “exotic”, “global”, “ethnic”, “seasonal”, “local”, and “full of flavour”, and that lend those that prepare and consume the dishes they contain the “glamour of culinary ethnicity” (Appadurai 10). It would seem to be stating the obvious then to say that “plain cookery” meant something entirely different to colonial Australians, except that modern Australians commonly believe that their nineteenth century brethren ate an “abominable”, “monotonous”, “low standard” diet (Santich, The High and The Low 37), and therefore if they preferred their meals to be plain cooked, that these would have been exactly as our present-day interpretation would have them. Yet Pearson describes plain cookery as an “art” (3), arguably a rhetorical epithet, but she was a zealous educator and would not have used such a term to describe a style of cookery that she expected to turn out low quality dishes that were vile and dull. What Pearson and Maclurcan actually present in their respective books is English cookery: which was also known as plain cookery. The Anglo-Celtic population of Australia in the nineteenth century held varied opinions—ranging from obsequious to hateful—about England, depending on their background. The majority, however, considered it their natural home—including many who were colonial born—and the cultural model they reproduced, with local modifications, was that of the “mother country” (Abbott 10) some 10,000 long miles away. English political, legal, economic, and social systems were the foundation of white Australian society. In keeping with this, colonial cooks “perpetuated an English style of cookery, English food values, [and] an English meal structure” (Santich, Looking for Flavour 6) and English cookbooks were the models that colonial cooks and cookery writers drew upon. When Polly, the heroine of Henry Handel Richardson’s novel The Fortunes of Richard Mahoney, teaches herself to make pastry from a cookbook in her rudimentary kitchen on the Victorian goldfields circa 1853, historical accuracy requires her to have employed an imported publication to guide her. It was another decade before the first Australian cookbook, Edward Abbott’s The English And Australian Cookery Book, was published in 1864. Prior to the appearance of Abbott’s work, colonial cooks wanting the guidance of a culinary manual were reliant on the imported English titles stocked by Australian booksellers, such as Eliza Acton’s Modern Cookery for Private Families, Beeton’s Book of Household Management and William Kitchiner’s The Cook’s Oracle. These three particular cookbooks were amongst the most successful and influential works in the nineteenth century Anglo-sphere and were commonly considered as manuals of plain cookery: Acton’s particular work is also the source of the most commonly quoted definition of “plain cookery” as “the principles of roasting, boiling, stewing and baking” (Acton 167) and I am going let it stand as the model of such in this piece. If a curt literary catalogue, such as that used by Acton to delineate plain cookery, were used to describe any cuisine it would serve to make it seem austere, and the reputation of English food and cookery has likely suffered from a face value acceptance of it (and by association so has its Australian culinary doppelganger). A considered inspection of Acton’s work shows that her instructions for the plain methods of roasting, boiling, and stewing of food, cover 13 pages, followed by more than 100 pages of recipes for 19 different varieties of meat, poultry, and game that are further divided into numerous variant cuts. Three pages were dedicated to instruction for boiling potatoes properly. When preparing any of these dishes she enjoins her readers to follow the “slow methods of cooking recommended” (167) to ensure a superior end product. The principles of baking were elucidated across several chapters, taking under this classification the preparation of various types of pastry and a multitude of baked puddings, cakes and biscuits: all prepared from base ingredients—not a packet harmed in their production. We now venerate the taste of so-called “slow cooked” food, so to discover that this was the method prescribed for producing plain cooked dishes suggests that plain cookery potentially had more flavour than we imagine. Acton’s work also challenges the charge that the product of plain cookery was monotonous. We have developed a view that we must have a multitudinous array of different types of food available, all year round, for it to be satisfactory to us. Acton demonstrates that variety in cookery can be achieved in other ways such as in types and cuts of meat, and that “plain” was not necessarily synonymous with sameness. The celebrated twentieth century English food writer Elizabeth David says that Modern Cookery was the “most admired and copied English cookery book of the nineteenth century” (305). As the aspiration of most colonial cooks was the reproduction of English cookery it is not unreasonable to expect that Acton’s work might have had some influence on those that wrote cookery manuals for them. We know that Edward Abbott borrowed from her as he writes in his introduction that he has combined “the advantages of Acton’s work” (5) into this own. Neither Pearson or Maclurcan acknowledge any influence at all upon their works but their respective manuals are not particularly original in content—with the exception of some unique regional recipes in Maclurcan—and they must have drawn upon other cookery manuals of the same style to develop their repertoire. By the time they were writing, “large portions [of Acton’s] volume [had] been appropriated [by] contemporary [cookbook] authors [such as Abbott] without the slightest acknowledgment” (Acton 4): the famous Mrs. Beeton is generally considered to have borrowed heavily from Acton for the cookery section of her successful tome Household Management. If Pearson and Maclurcan did not draw directly on Acton—and they well might have—then they likely used culinary sources that had subsumed her influence as their inspiration. What was considered to constitute plain cookery was not as straightforward as Acton’s definition; it was also “generally understood” to be free of any French influence (David 35). It was a commonly held suspicion amongst nineteenth century English men and women that Gallic cooks employed sauces and strong flavourings such as garlic and other “low and treacherous devices” (Saunders 4), to disguise the fact that they had such poor quality ingredients to work with. On the other hand, the English “had such faith” in the superior quality of their native produce that they considered it only required treatment with plain cookery techniques to be rendered toothsome: this culinary Francophobia persisted in the colonies. In the novel, The Three Miss Kings, set in Melbourne in 1880, the trio of the title take lodgings with a landlady, who informs them from the outset that she is “only a plain cook, and can’t make them French things which spile [sic] the stomach” (Cambridge 36). While a good plain cook might have defined herself by the absence of any Gallic, or indeed any other “foreign”, influence in the meals she created, there had been a significant absorption of elements of both of these in the plain cookery she practised, but these had become so far embedded in English cookery that she was unaware of it. A telling example of this is the unremarked inclusion of curry in the plain cookery cannon. While the name and homogenised form of this dish is of British invention, it retained the varied spices, including pungent chillies, of the Indian cuisine it simulated. Pearson and Maclurcan, and Abbott, all included recipes for curries and curried dishes in their respective cookery books. Over time, plain cookery seems to have become conflated with “plain food”, but the latter was not necessarily the result of the former. There was little of Pearson’s “art” involved in creating plain food, except perhaps an ability to keep this style of food so flavourless and dull that it offered neither pleasure nor temptation to eat any more than that required to sustain life. This very real plainness was actively sought by some as “plain food was synonymous with moral rectitude […] and the plainer the food the more virtuous the eater” (Santich, Looking 28). A common societal appreciation of moral virtue is barely perceptible in modern Australian society but it was an attribute that was greatly valued in the nineteenth century Anglo-world and the consumption of plain food a necessary practice in the achievement of good character. (Our modern habit of labelling of foods “good” or “bad” shows that we continue to imbue food with moral overtones.) The list of “gustatory temptations” “proscribed by the plain food lobby” included “salt, spices, sauces and any flavourings that might have cheered the senses” (Santich, Looking 28). If this were the case then both Pearson and Maclurcan’s cookbooks would have dramatically failed to qualify as manuals of plain food. The recipes contained in their respective works feature a much greater use of components associated with flavour enhancement than we imagine to have been employed in plain cookery, particularly if we erroneously believe it to be analogous to plain food. Spices are used extensively in sweet and savoury dishes, as are various fresh green herbs and lemon juice and rind; homemade condiments such as mushroom ketchup (a type of essence pressed from a seasonal abundance of fungi), and a liberal employment of sherry, port, Madeira, and brandy that a “virtuous” plain food advocate would have considered most intemperate. Pearson and Maclurcan both give instructions for preparing rich stocks and gravies drawn from meat, bones and aromatic vegetables, and prescribe the end product of this process as the foundation for a variety of soups, sauces, and stews. Recipes are given for a greater diversity of vegetables than the stereotyped cabbage and potatoes of colonial culinary legend. Maclurcan displays a distinct tropical regionalism in her book providing recipes that use green bananas and pawpaw as vegetables, alongside other exotic species—for that time—such as eggplant, choko, mango, granadilla, passionfruit, rosella, prickly pear, and guava. Her distinct location, the coastal city of Townsville, is also reflected in the extensive selection of recipes for local species of fish and seafood such as beche-de-mer, prawns, and barramundi, which won Maclurcan a reputation as an expert on seafood. Ultimately, to gain a respectably informed understanding as to the taste, aroma, and texture of the plain cookery presented in the respective works of Pearson and Maclurcan one needs to prepare their recipes: I have done so, reproducing a wide selection of dishes from both books. Admittedly, I am a professionally trained cook with the skills to execute recipes to a high standard, but my practice is to scrupulously maintain the original listing of ingredients in the reproduction and follow the method as best I can. Through this practice I have made some delicious discoveries, which have helped inform my opinion that some colonial Australians, and perhaps significant numbers of them, must have been eating meals that were a long way from dull, flavourless and monotonous. It has been said that we employ our tongues for the “twin offices of rhetoric and taste” (Jaine 61). Words can exercise a significant influence on how we value the taste of—or actually taste—any particular food or indeed a cuisine. In the case of the popularly held opinion about the unappetizing state of colonial meals, it might be that the absence of rhetoric has contributed to this. Colonial food writers such as Pearson and Maclurcan did not “mince words” (Bannerman 166) and chose to use “plain titling” (David 306) and language that lacked the excessive adjectives and laudatory hyperbole typically employed by modern food writers. Perhaps if Pearson or Maclurcan had indulged in anointing their own works with enthusiastic recommendation and reference to international influences in their recipes, this might have contributed to a more positive impression of the food of our Anglo-Celtic ancestors. As an experiment with this idea I have taken a recipe from Cookery Recipes For The People and reframed its title and description in a modern food writing style. The recipe in question is titled “White Sauce” and Pearson writes that “this sauce will answer well for boiled fowl” (48): hardly language to make the dish sound appealing to the modern cook, and likely to confirm an expectation of plain cookery as tasteless and boring. But what if the recipe remained the same but the words used to describe it were changed, for example: the title to “Salsa Blanca” and the introductory remark to “this luxurious silky sauce infused with eschalot, mace, lemon, and sherry wine is perfect for perking up poached free-range chicken”. How much better might it then taste? References Abbott, Edward. The English And Australian Cookery Book: Cookery For The Many, As Well As The Upper Ten Thousand. London: Sampson Low, Son, & Marston, 1864. Acton, Eliza. Modern Cookery for Private Families. London: Longman, Brown, Green, Longmans, and Roberts, 1858. Appadurai, Arjun. “How to Make a National Cuisine: Cookbooks in Contemporary India”. Comparative Studies in Society and History 30 (1988): 3–24. Bannerman, Colin. A Friend In The Kitchen. Kenthurst NSW: Kangaroo Press, 1996. Brisbane Courier. “Mrs Maclurcan’s Cookery Book: A Collection of Practical Recipes, Specially Suitable for Australia [review].” Brisbane Courier c.1898. [Author’s manuscript collection.] Cambridge, Ada. The Three Miss Kings. London: Virago Press, 1987 (1st pub. Melbourne, 1891). David, Elizabeth. An Omelette and a Glass of Wine. London: Penguin, 1986. Freeman, Sarah. Mutton and Oysters: The Victorians and their Food. London: Victor Golllancz, 1989. Humble, Nicola. Culinary Pleasures. London, Faber & Faber, 2005. Jaine, Tom. “Banquets and Meals”. Pleasures of the Table: Proceedings of the Fifth Symposium of Australian Gastronomy (1991): 61–4. Jones, Shar, and Otto, Kirsten. Colonial Food and Drink 1788-1901. Sydney: Historic Houses Trust of New South Wales, 1985. Hartley, Dorothy. Food in England. London: Macdonald General, 1979. Hughes, Kathryn. The Short Life & Long Times of Mrs Beeton. London: Harper Perennial, 2006. Maclurcah, Hannah. Mrs Maclurcan’s Cookery Book: A Collection of Practical Recipes, Specially Suitable for Australia. Melbourne: George Robertson, 1905 (1st pub. Townsville, 1898). Morning Bulletin. “Gossip.” Morning Bulletin (Rockhampton) 10 May 1898: 5. Pearson, Margaret. Cookery Recipes for the People. Melbourne: Hutchinson, 1888. Richardson, Henry Handel. The Fortunes of Richard Mahony. London: Heinemann, 1954. Santich, Barbara. What the Doctors Ordered: 150 Years of Dietary Advice in Australia. Melbourne: Hyland House, 1995. ---. “The High and the Low: Australian Cuisine in the Late Nineteenth and Early Twentieth Centuries”. Journal of Australian Studies 30 (2006): 37–49. ---. Looking For Flavour. Kent Town: Wakefield, 1996 Saunders, Alan. “Why Do We Want An Australian Cuisine?”. Journal of Australian Studies 30 (2006): 1-17. Young, Linda. Middle-Class Culture in the Nineteenth Century: America, Australia and Britain. Basingstoke: Palgrave Macmilian, 2002.

IntroductionBritish initiatives to manage both the number of arrivals of asylum seekers and the experiences of those who arrive have burgeoned in recent years. The budget dedicated to asylum seeker management increased from £357 million in 1998-1999 to £1.71 billion in 2004-2005, making the Immigration and Nationality Directorate (IND) the second largest concern of the Home Office behind the Prison Service in 2005 (Back et al). The IND was replaced in April 2007 by the Border and Immigration Agency (BIA), whose expenditure exceeded £2 billion in 2007-2008 (BIA). Perhaps as a consequence the number of asylum seekers applying to the UK has fallen dramatically, illustrating the continuing influence of exclusionary state policies despite the globalisation and transnationalisation of migrant flows (UNHCR; Koser).One of the difficulties with the study of asylum seekers is the persistent risk that, by employing the term ‘asylum seeker’, research conducted into their experiences will contribute towards the exclusion of a marginalised and abject group of people, precisely by employing a term that emphasises the suspended recognition of a community (Nyers). The ‘asylum seeker’ is a figure defined in law in order to facilitate government-level avoidance of humanitarian obligations by emphasising the non-refugeeness of asylum claimants (Tyler). This group is identified as supplicant to the state, positioning the state itself as a legitimate arbiter. It is in this sense that asylum seekers suffer a degree of cruel optimism (Berlant) – wishing to be recognised as a refugee while nevertheless subject to state-defined discourses, whatever the outcome. The term ‘forced migrant’ is little better, conveying a de-humanising and disabling lack of agency (Turton), while the terms ‘undocumented migrant’, ‘irregular migrant’ and ‘illegal migrant’ all imply a failure to conform to respectable, desirable and legitimate forms of migration.Another consequence of these co-opted and politically subjugating forms of language is their production of simple imagined geographies of migration that position the foreigner as strange, unfamiliar and incapable of communication across this divide. Such imaginings precipitate their own responses, most clearly expressed in the blunt, intrusive uses of space and time in migration governance (Lahav and Guiraudon; Cohen; Guild; Gronendijk). Various institutions exist in Britain that function to actually produce the imagined differences between migrants and citizens, from the two huge, airport-like ‘Asylum Screening Units’ in Liverpool and London where asylum seekers can lodge their claims, to the 12 ‘Removal Centres’ within which soon-to-be deported asylum seekers are incarcerated and the 17 ‘Hearing Centres’ at which British judges preside over the precise legal status of asylum applicants.Less attention, however, has been given to the tension between mobility and stillness in asylum contexts. Asylum seeker management is characterised by a complex combination of enforced stillness and enforced mobility of asylum seeking bodies, and resistance can also be understood in these terms. This research draws upon 37 interviews with asylum seekers, asylum activists, and government employees in the UK conducted between 2005 and 2007 (see Gill) and distils three characteristics of stillness. First, an association between stillness and safety is clearly evident, exacerbated by the fear that the state may force asylum seekers to move at any time. Second, stillness of asylum seekers in a physical, literal sense is intimately related to their psychological condition, underscoring the affectual properties of stillness. Third, the desire to be still, and to be safe, precipitates various political strategies that seek to secure stillness, meaning that stillness functions as more than an aspiration, becoming also a key political metric in the struggle between the included and excluded. In these multiple and contradictory ways stillness is a key factor that structures asylum seekers’ experiences of migration. Governing through Mobility The British state utilises both stillness and mobility in the governance of asylum seeking bodies. On the one hand, asylum seekers’ personal freedoms are routinely curtailed both through their incarceration and through the requirements imposed upon them by the state in terms of ‘signing in’ at local police stations, even when they are not incarcerated, throughout the time that they are awaiting a decision on their claim for asylum (Cwerner). This requirement, which consists of attending a police station to confirm the continuing compliance of the asylum seeker, can vary in frequency, from once every month to once every few days.On the other hand, the British state employs a range of strategies of mobility that serve to deprive asylum seeking communities of geographical stillness and, consequently, also often undermines their psychological stability. First, the seizure of asylum seekers and transportation to a Removal Centre can be sudden and traumatic, and incarceration in this manner is becoming increasingly common (Bacon; Home Office). In extreme cases, very little or no warning is given to asylum seekers who are taken into detention, and so-called ‘dawn raids’ have been organised in order to exploit an element of surprise in the introduction of asylum seekers to detention (Burnett). A second source of forced mobility associated with Removal Centres is the transfer of detainees from one Removal Centre to another for a variety of reasons, from the practical constraints imposed by the capacities of various centres, to differences in the conditions of centres themselves, which are used to form a reward and sanction mechanism among the detainee population (Hayter; Granville-Chapman). Intra-detention estate transfers have increased in scope and significance in recent years: in 2004/5, the most recent financial year for which figures are available, the British government spent over £6.5 million simply moving detainees from one secure facility to another within the UK (Hansard, 2005; 2006).Outside incarceration, a third source of spatial disruption of asylum seekers in the UK concerns their relationship with accommodation providers. Housing is provided to asylum seekers as they await a decision on their claim, but this housing is provided on a ‘no-choice’ basis, meaning that asylum seekers who are not prepared to travel to the accommodation that is allocated to them will forfeit their right to accommodation (Schuster). In other words, accommodation is contingent upon asylum seekers’ willingness to be mobile, producing a direct trade-off between the attractions of accommodation and stillness. The rationale for this “dispersal policy”, is to draw asylum seekers away from London, where the majority of asylum seekers chose to reside before 2000. The maintenance of a diverse portfolio of housing across the UK is resource intensive, with the re-negotiation of housing contracts worth over a £1 billion a constant concern (Noble et al). As these contracts are renegotiated, asylum seekers are expected to move in response to the varying affordability of housing around the country. In parallel to the system of deportee movements within the detention estate therefore, a comparable system of movement of asylum seekers around the UK in response to urban and regional housing market conditions also operates. Stillness as SanctuaryIn all three cases, the psychological stress that movement of asylum seekers can cause is significant. Within detention, according to a series of government reports into the conditions of removal centres, one of the recurring difficulties facing incarcerated asylum seekers is incomprehension of their legal status (e.g. HMIP 2002; 2008). This, coupled with very short warning of impending movements, results in widespread anxiety among detained asylum seekers that they may be deported or transferred imminently. Outside detention, the fear of snatch squads of police officers, or alternatively the fear of hate crimes against asylum seekers (Tyler), render movement in the public realm a dangerous practice in the eyes of many marginalised migrants. The degree of uncertainty and the mental and emotional demands of relocation introduced through forced mobility can have a damaging psychological effect upon an already vulnerable population. Expressing his frustration at this particular implication of the movement of detainees, one activist who had provided sanctuary to over 20 asylum seekers in his community outlined some of the consequences of onward movement.The number of times I’ve had to write panic letters saying you know you cannot move this person to the other end of the country because it destabilises them in terms of their mental health and it is abusive. […] Their solicitors are here, they’re in process, in legal process, they’ve got a community, they’ve got friends, they may even have a partner or a child here and they would still move them.The association between governance, mobility and trepidation highlights one characteristic of stillness in the asylum seeking field: in contra-distinction to the risk associated with movement, to be still is very often to be safe. Given the necessity to flee violence in origin countries and the tendency for destination country governments to require constant re-positioning, often backed-up with the threat of force, stillness comes to be viewed as offering a sort of sanctuary. Indeed, the Independent Asylum Commission charity that has conducted a series of reviews of asylum seekers’ treatment in the UK (Hobson et al.), has recently suggested dispensing with the term ‘asylum’ in favour of ‘sanctuary’ precisely because of the positive associations with security and stability that the latter provides. To be in one place for a sustained period allows networks of human trust and reciprocity to develop which can form the basis of supportive community relationships. Another activist who had accompanied many asylum seekers through the legal process spoke passionately about the functions that communities can serve in asylum seekers’ lives.So you actually become substitute family […] I think it’s what helps people in the midst of trauma when the future is uncertain […] to find a community which values them, which accepts them, which listens to them, where they can begin to find a place and touch a creative life again which they may not have had for years: it’s enormously important.There is a danger in romanticising the benefits of community (Joseph). Indeed, much of the racism and xenophobia directed towards asylum seekers has been the result of local community hostilities towards different national and ethnic groups (Boswell). For many asylum seekers, however, the reciprocal relations found in communities are crucially important to their well-being. What is more, the inclusion of asylum seekers into communities is one of the most effective anti-state and anti-deportation strategies available to activists and asylum seekers alike (Tyler), because it arrests the process of anonymising and cordoning asylum seekers as an homogenous group, providing instead a chance for individuals to cast off this label in favour of more ‘humane’ characteristics: families, learning, friendship, love.Strategies for StillnessFor this reason, the pursuit of stillness among asylum seekers is both a human and political response to their situations – stillness becomes a metric in the struggle between abject migrants and the state. Crucial to this political function is the complex relationship between stillness and social visibility: if an asylum seeker can command their own stillness then they can also have greater influence over their public profile, either in order to develop it or to become less conspicuous.Tyler argues that asylum seekers are what she calls a ‘hypervisible’ social group, referring to the high profile association between a fictional, dehumanised asylum seeking figure and a range of defamatory characteristics circulated by the popular printed press. Stillness can be used to strategically reduce this imposed form of hypervisibility, and to raise awareness of real asylum seeker stories and situations. This is achieved by building community coalitions, which require physically and socially settled asylum seeking families and communities. Asylum advocacy groups and local community support networks work together in the UK in order to generate a genuine public profile of asylum seekers by utilising local and national newspapers, staging public demonstrations, delivering speeches, attending rallies and garnering support among local organisations through art exhibitions, performances and debates. Some activist networks specialise explicitly in supporting asylum seekers in these endeavours, and sympathetic networks of journalists, lawyers, doctors and radio producers combine their expertise with varying degrees of success.These sorts of strategies can produce strong loyalties between local communities and the asylum seekers in their midst, precisely because, through their co-presence, asylum seekers cease to be merely asylum seekers, but become active and valued members of communities. One activist who had helped to organise the protection of an asylum seeker in a church described some of the preparations that had been made for the arrival of immigration task forces in her middle class parish.There were all sorts of things we practiced: if they did break through the door what would we do? We set up a telephone tree so that each person would phone two or three people. We had I don’t know how many cars outside. We arranged a safe house, where we would hide her. We practiced getting her out of the room into a car […] We were expecting them to come at any time. We always had people at the back […] guarding, looking at strangers who might be around and [name] was never, ever allowed to be on her own without a whole group of people completely surrounding her so she could feel safe and we would feel safe. Securing stillness here becomes more than simply an operation to secure geographic fixity: it is a symbolic struggle between state and community, crystallising in specific tactics of spatial and temporal arrangement. It reflects the fear of further forced movement, the abiding association between stillness and safety, and the complex relationship between community visibility and an ability to remain still.There are, nevertheless, drawbacks to these tactics that suggest a very different relationship between stillness and visibility. Juries can be alienated by loud tactics of activism, meaning that asylum seekers can damage their chances of a sympathetic legal hearing if they have had too high a profile. Furthermore, many asylum seekers do not have the benefits of such a dedicated community. An alternative way in which stillness becomes political is through its ability to render invisible the abject body. Invisibility is taken to mean the decision to ‘go underground’, miss the appointments at local police stations and attempt to anticipate the movements of immigration removal enforcement teams. Perversely, although this is a strategy for stillness at the national or regional scale, mobile strategies are often employed at finer scales in order to achieve this objective. Asylum seekers sometimes endure extremely precarious and difficult conditions of housing and subsistence moving from house to house regularly or sleeping and living in cars in order to avoid detection by authorities.This strategy is difficult because it involves a high degree of uncertainty, stress and reliance upon the goodwill of others. One police officer outlined the situation facing many ‘invisible’ asylum seekers as one of poverty and desperation:Immigration haven’t got a clue where they are, they just can’t find them because they’re sofa surfing, that’s living in peoples coffee shops … I see them in the coffee shop and they come up and they’re bloody starving! Despite the difficulties associated with this form of invisibility, it is estimated that this strategy is becoming increasingly common in the UK. In 2006 the Red Cross estimated that there were some 36 000 refused and destitute asylum seekers in England, up from 25 000 the previous year, and reported that their organisation was having to provide induction tours of soup kitchens and night shelters in order to alleviate the conditions of many claimants in these situations (Taylor and Muir). Conclusion The case of asylum seekers in the UK illustrates the multiple, contradictory and splintered character of stillness. While some forms of governance impose stillness upon asylum seeking bodies, in the form of incarceration and ‘signing in’ requirements, other forms of governance impose mobility either within detention or outside it. Consequently stillness figures in the responses of asylum seeking communities in various ways. Given the unwelcome within-country movement of asylum seekers, and adding to this the initial fact of their forced migration from their home countries, the condition of stillness becomes desirable, promising to bring with it stability and safety. These promises contrast the psychological disruption that further mobility, and even the threat of further mobility, can bring about. This illustrates the affectual qualities both of movement and of stillness in the asylum-seeking context. Literal stillness is associated with social and emotional stability that complicates the distinction between real and emotional spaces. While this is certainly not the case uniformly – incarceration and inhibited personal liberties have opposite consequences – the promises of stillness in terms of stability and sanctuary are clearly significant because this desirability leads asylum advocates and asylum seekers to execute a range of political strategies that seek to ensure stillness, either through enhanced or reduced forms of social visibility.The association of mobility with freedom that typifies much of the literature surrounding mobility needs closer inspection. At least in some situations, asylum seekers pursue geographical stillness for the political and psychological benefits it can offer, while mobility is both employed as a subjugating strategy by states and is itself actively resisted by those who constitute its targets.ReferencesBack, Les, Bernadette Farrell and Erin Vandermaas. A Humane Service for Global Citizens. London: South London Citizens, 2005.Bacon, Christine. The Evolution of Immigration Detention in the UK: The Involvement of Private Prison Companies. Oxford: Refugee Studies Centre, 2005.Berlant, Lauren. “Cruel Optimism.” differences : A Journal of Feminist Cultural Studies 17.3 (2006): 20—36.Border and Immigration Agency. Business Plan for Transition Year April 2007 – March 2008: Fair, Effective, Transparent and Trusted. London: Home Office, 2007.Boswell, Christina. “Burden-Sharing in the European Union: Lessons from the German and UK Experience.” Journal of Refugee Studies 16.3 (2003): 316—35.Burnett, Jon. Dawn Raids. PAFRAS Briefing Paper Number 4. Leeds: Positive Action for Refugees and Asylum Seekers, 2008. ‹http://www.statewatch.org/news/2008/apr/uk-patras-briefing-paper-4-%2Ddawn-raids.pdf›.Cohen, Steve. “The Local State of Immigration Controls.” Critical Social Policy 22 (2002): 518—43.Cwerner, Saulo. “Faster, Faster and Faster: The Time Politics of Asylum in the UK.” Time and Society 13 (2004): 71—88.Gill, Nick. "Presentational State Power: Temporal and Spatial Influences over Asylum Sector." Transactions of the Institute of British Geographers, 2009 (forthcoming).Granville-Chapman, Charlotte, Ellie Smith, and Neil Moloney. Harm on Removal: Excessive Force Against Failed Asylum Seekers. London: Medical Foundation for the Care of Victims of Torture, 2004.Groenendijk, Kees. “New Borders behind Old Ones: Post-Schengen Controls behind the Internal Borders and inside the Netherlands and Germany”. In Search of Europe's Borders. Eds. Kees Groenendijk, Elspeth Guild and Paul Minderhoud. The Hague: Kluwer International Law, 2003. 131—46.Guild, Elspeth. “The Europeanisation of Europe's Asylum Policy.” International Journal of Refugee Law 18 (2006): 630—51.Guiraudon, Virginie. “Before the EU Border: Remote Control of the 'Huddled Masses'.” In Search of Europe's Borders. Eds. Kees Groenendijk, Elspeth Guild and Paul Minderhoud. The Hague: Kluwer International Law, 2003. 191—214.Hansard, House of Commons. Vol. 440 Col. 972W. 5 Dec. 2005. 6 Mar. 2009 ‹http://www.publications.parliament.uk/pa/cm200506/cmhansrd/vo051205/text/51205w18.htm›.———. Vol. 441 Col. 374W. 9 Jan. 2006. 6 Mar. 2009 ‹http://www.publications.parliament.uk/pa/cm200506/cmhansrd/vo060109/text/60109w95.htm›.Hayter, Theresa. Open Borders: The Case against Immigration Controls. London: Pluto P, 2000.HM Inspectorate of Prisons. An Inspection of Campsfield House Immigration Removal Centre. London: HM Inspectorate of Prisons, 2002.———. Report on an Unannounced Full Follow-up Inspection of Campsfield House Immigration Removal Centre. London: HM Inspectorate of Prisons, 2008. Hobson, Chris, Jonathan Cox, and Nicholas Sagovsky. Saving Sanctuary: The Independent Asylum Commission’s First Report of Conclusions and Recommendations. London: Independent Asylum Commission, 2008.Home Office. “Record High on Removals of Failed Asylum Seekers.” Press Office Release, 27 Feb. 2007. London: Home Office, 2007. 6 Mar. 2009 ‹http://press.homeoffice.gov.uk/press-releases/asylum-removals-figures›. Joseph, Miranda. Against the Romance of Community. Minnesota: U of Minnesota P, 2002.Koser, Khalid. “Refugees, Trans-Nationalism and the State.” Journal of Ethnic and Migration Studies 33 (2007): 233—54.Lahav, Gallya, and Virginie Guiraudon. “Comparative Perspectives on Border Control: Away from the Border and outside the State”. Wall around the West: State Borders and Immigration Controls in North America and Europe. Eds. Gallya Lahav and Virginie Guiraudon. The Lanham: Rowman and Littlefield, 2000. 55—77.Noble, Gill, Alan Barnish, Ernie Finch, and Digby Griffith. A Review of the Operation of the National Asylum Support Service. London: Home Office, 2004. Nyers, Peter. "Abject Cosmopolitanism: The Politics of Protection in the Anti-Deportation Movement." Third World Quarterly 24.6 (2003): 1069—93.Schuster, Lisa. "A Sledgehammer to Crack a Nut: Deportation, Detention and Dispersal in Europe." Social Policy & Administration 39.6 (2005): 606—21.Taylor, Diane, and Hugh Muir. “Red Cross Aids Failed Asylum Seekers” UK News. The Guardian 9 Jan. 2006. 6 Mar. 2009 ‹http://www.guardian.co.uk/news/2006/jan/09/immigrationasylumandrefugees.uknews›.Turton, David. Conceptualising Forced Migration. University of Oxford Refugee Studies Centre Working Paper 12 (2003). 6 Mar. 2009 ‹http://www.rsc.ox.ac.uk/PDFs/workingpaper12.pdf›.Tyler, Imogen. “'Welcome to Britain': The Cultural Politics of Asylum.” European Journal of Cultural Studies 9.2 (2006): 185—202.United Nations High Commission for Refugees. Refugees by Numbers 2006 Edition. Geneva: UNHCR, 2006.

The depiction of alcohol is the focus of a growing number of content analyses in the field of social media research. Typically, the occurrence and nature of alcohol representations are coded to measure the prevalence, normalization, or even glorification of alcohol and its consumption on different social media platforms (Moreno et al., 2016; Westgate & Holliday, 2016) and smartphone apps (Ghassemlou et al., 2020). But social media platforms and smartphone apps also play a role in the prevention of alcohol abuse when they disseminate messages about alcohol risks and foster harm reduction, abstinence, and sobriety (Davey, 2021; Döring & Holz, 2021; Tamersoy et al., 2015; Westgate & Holliday, 2016). Field of application/theoretical foundation: Social Cognitive Theory (SCT; Bandura 1986, 2009) as the dominant media effects theory in communication science, is applicable and widely applied to social media representations of alcohol: According to SCT, positive media portayals of alcohol and attractive role models consuming alcohol can influence the audience’s relation to alcohol. That’s why positive alcohol portayals in the media are considered a public health threat as they can foster increased and risky alcohol consumption among media users in general and young people in particular. The negative health impact predicted by SCT depends on different aspects of alcohol portrayals on social media that have been traditionally coded in manual content analyses (Beullens & Schepers, 2013; Mayrhofer & Naderer, 2019; Moreno et al., 2010) and most recently by studies relying on computational methods for content analysis (e.g. Ricard & Hassanpour, 2021). Core aspects of alcohol representations on social media are: a) the type of communicator / creator of alcohol-related social media content, b) the overall valence of the alcohol portrayal, c) the people consuming alcohol, d) the alcohol consumption behaviors, e) the social contexts of alcohol consumption, f) the types and brands of consumed alcohol, g) the consequences of alcohol consumption, and h) alcohol-related consumer protection messages in alcohol marketing (Moreno et al., 2016; Westgate & Holliday, 2016). For example, a normalizing portrayal shows alcohol consumption as a regular and normal behavior of diverse people in different contexts, while a glorifying portrayal shows alcohol consumption as a behavior that is strongly related to positive effects such as having fun, enjoying social community, feeling sexy, happy, and carefree (Griffiths & Casswell, 2011). While criticism of glorifying alcohol portrayals in entertainment media (e.g., music videos; Cranwell et al., 2015), television (e.g., Barker et al., 2021), and advertising (e.g., Curtis et al., 2018; Stautz et al., 2016) has a long tradition, the concern about alcohol representations on social media is relatively new and entails the phenomenon of alcohol brands and social media influencers marketing alcohol (Critchlow & Moodie, 2022; Turnwald et al., 2022) as well as ordinary social media users providing alcohol-related self-presentations (e.g., showing themselves partying and drinking; Boyle et al., 2016). Such alcohol-related self-presentations might elicit even stronger identification and imitation effects among social media audiences compared to regular advertising (Griffiths & Casswell, 2011). Because of its psychological and health impact, alcohol-related social media content – and alcohol marketing in particular – is also an issue of legal regulation. The World Health Organization states that “Europe is the heaviest-drinking region in the world” and strongly advocates for bans or at least stricter regulations of alcohol marketing both offline and online (WHO, 2020, p. 1). At the same time, the WHO points to the problem of clearly differentiating between alcohol marketing and other types of alcohol representations on social media. Apart from normalizing and glorifying alcohol portayals, there are also anti-alcohol posts and comments on social media. They usually point to the health risks of alcohol consumption and the dangers of alcohol addiction and, hence, try to foster harm reduction, abstincence and sobriety. While such negative alcohol portayals populate different social media platforms, an in-depth investigation of the spread, scope and content of anti-alcohol messages on social media is largely missing (Davey, 2021; Döring & Holz, 2021; Tamersoy et al., 2015). References/combination with other methods of data collection: Manual and computational content analyses of alcohol representations on social media platforms can be complemented by qualitative interview and quantitative survey data addressing alcohol-related beliefs and behaviors collected from social media users who a) create and publish alcohol-related social media content and/or b) are exposed to or actively search for and follow alcohol-related social media content (e.g., Ricard & Hassanpour, 2021; Strowger & Braitman, 2022). Furthermore, experimental studies are helpful to directly measure how different alcohol-related social media posts and comments are perceived and evaluated by recipients and if and how they can affect their alcohol-related thoughts, feelings, and behaviors (Noel, 2021). Such social media experiments can build on respective mass media experiments (e.g., Mayrhofer & Naderer, 2019). Insights from content analyses help to select or create appropriate stimuli for such experiments. Last but not least, to evaluate the effectiveness of alcohol marketing regulations, social media content analyses conducted within a longitudinal or trend study design (including measurements before and after new regulations came into effect) should be preferred over cross-sectional studies (e.g., Chapoton et al., 2020). Example Studies for Manual Content Analyses: Coding Material Measure Operationalization (excerpt) Reliability Source a) Creators of alcohol-related social media content Extensive explorations on Facebook, Instagram and TikTok Creators of alcohol-related social media content on Facebook, Instagram and TikTok Polytomous variable “Type of content creator” (1: alcohol industry; 2: media organization/media professional; 3: health organization/health professional; 4: social media influencer; 5: ordinary social media user; 6: other) Not available Döring & Tröger (2018) Döring & Holz (2021) b) Valence of alcohol-related social media content N = 3 015 Facebook comments N = 100 TikTok videos Valence of alcohol-related social media content (posts or comments) Binary variable “Valence of alcohol-related social media content” (1: positive/pro-alcohol sentiment; 2: negative/anti-alcohol sentiment) Cohen’s Kappa average of .72 for all alcohol-related variables in codebook* Döring & Holz (2021) *Russell et al. (2021) c) People consuming alcohol N = 160 Facebook profiles (profile pictures, personal photos, and text) Portrayal of people consuming alcohol on Facebook profiles Binary variable “Number of persons on picture” (1: alone; 2: with others) Cohen’s Kappa > .90 Beullens & Schepers (2013) d) Alcohol consumption behaviors N = 160 Facebook profiles (profile pictures, personal photos, and text) Type of depicted alcohol use/consumption Polytomous variable “Type of depicted alcohol use/consumption” (1: explicit use such as depiction of person drinking alcohol; 2: implicit use such as depiction of alcohol bottle on table; 3: alcohol logo only) Cohen’s Kappa = .89 Beullens & Schepers (2013) N = 100 TikTok videos Multiple alcoholic drinks consumed per person Binary variable “Multiple alcoholic drinks consumed per person” as opposed to having only one drink or no drink per person (1: present; 2: not present) Cohen’s Kappa average of .72 for all alcohol-related variables in codebook Russell et al. (2021) N = 100 TikTok videos Alcohol intoxication Binary variable “Alcohol intoxication” (1: present; 2: not present) Cohen’s Kappa average of .72 for all alcohol-related variables in codebook Russell et al. (2021) N = 4 800 alcohol-related Tweets Alcohol mentioned in combination with other substance use Binary variable “Alcohol mentioned in combination with tobacco, marijuana, or other drugs” (1: yes; 2: no) Cohen’s Kappa median of .73 for all pro-drinking variables in codebook Cavazos-Rehg et al. (2015) e) Social contexts of alcohol consumption N = 192 Facebook and Instagram profiles (profile pictures, personal photos, and text) Portrayal of social evaluative contexts of alcohol consumption on Facebook and Instagram profiles Polytomous variable “Social evaluative context” (1: negative context such as someone looking disapprovingly at a drunk person; 2: neutral context such as no explicit judgment or emotion is shown; 3: positive context such as people laughing and toasting with alcoholic drinks) Cohen’s Kappa ranging from .68 to .91 for all variables in codebook Hendriks et al. (2018), based on previous work by Beullens & Schepers (2013) N = 51 episodes with a total of N = 1 895 scenes of the American adolescent drama series “The OC” Portrayal of situational contexts of alcohol consumption in scenes of a TV series Polytomous variable “Setting of alcohol consumption” (1: at home; 2: at adult / youth party; 3: in a bar; 4: at work; 5: at other public place) Polytomous variable “Reason of alcohol consumption” (1: celebrating/partying; 2: habit; 3: stress relief; 4: social facilitation) Cohen’s Kappa for setting of alcohol consumption .90 Cohen’s Kappa for reason of alcohol consumption .71 Van den Bulck et al. (2008) f) Types and brands of consumed alcohol N = 17 800 posts of Instagram influencers and related comments Portrayal of different alcohol types and alcohol brands in Instagram posts Polytomous variable “Alcohol type” (1: wine; 2: beer; 3: cocktails; 4: spirits; 5: non-alcoholic drinks/0% alcohol) Binary variable “Alcohol brand visibility” (1: present if full brand name, recognizable logo, or brand name in header or tag are visible; 2: non-present) String variable “Alcohol brand name” (open text coding) Krippendorff’s Alpha ranging from .69 to 1.00 for all variables in codebook Hendriks et al. (2019) g) Consequences of alcohol consumption N = 400 randomly selected public MySpace profiles Portayal of consequences of alcohol consumption on MySpace profiles Five individually coded binary variables for different consequences associated with alcohol use (1: present; 2: not present): a) “Positive emotional consequence highlighting positive mood, feeling or emotion associated with alcohol use” b) “Negative emotional consequence highlighting negative mood, feeling or emotion associated with alcohol use” c) “Positive social consequences highlighting perceived social gain associated with alcohol use” d) “Negative social consequences highlighting perceived poor social outcomes associated with alcohol use” e) “Negative physical consequences describing adverse physical consequences or outcomes associated with alcohol use” Cohen’s Kappa ranging from 0.76 to 0.82 for alcohol references and alcohol use Moreno et al. (2010) h) Alcohol-related consumer protection messages in alcohol marketing N = 554 Tweets collected from 13 Twitter accounts of alcohol companies in Ireland Alcohol-related consumer protection messages in alcohol marketing (covers both mandatory and voluntary messages depending on national legislation) Four individually coded binary variables for different alcohol-related consumer protection messages in alcohol marketing (1: present; 2: not present): a) “Warning about the risks/danger of alcohol consumption” b) “Warning about the risks/danger of alcohol consumption when pregnant” c) “Warning about the link between alcohol consumption and fatal cancers” d) “Link/reference to website with public health information about alcohol” Not available Critchlow & Moodie (2022) The presented measures were developed for specific social media platforms, but are so generic that they can be used across different social media platforms and even across mass media channels such as TV, cinema, and advertisement. The presented measures cover different aspects of media portrayals of alcohol and can be used individually or in combination. Depending on the research aim, more detailed measures can be developed and added: for example, regarding the media portrayal of people consuming alcohol, additional measures can code people’s age, gender, ethnicity and further characteristics relevant to the respective research question. In the course of a growing body of content analyses addressing alcohol-related prevention messages on social media, respective measures can be added as well. References Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall. Bandura, A. (2009). Social cognitive theory of mass communication. In J. Bryant & M. B. Oliver (Eds.), Communication series. Media effects: Advances in theory and research (3rd ed., pp. 94–124). Routledge. Barker, A. B., Britton, J., Thomson, E., & Murray, R. L. (2021). Tobacco and alcohol content in soap operas broadcast on UK television: A content analysis and population exposure. Journal of Public Health (Oxford, England), 43(3), 595–603. https://doi.org/10.1093/pubmed/fdaa091 Boyle, S. C., LaBrie, J. W., Froidevaux, N. M., & Witkovic, Y. D. (2016). Different digital paths to the keg? How exposure to peers' alcohol-related social media content influences drinking among male and female first-year college students. Addictive Behaviors, 57, 21–29. https://doi.org/10.1016/j.addbeh.2016.01.011 Beullens, K., & Schepers, A. (2013). Display of alcohol use on Facebook: A content analysis. Cyberpsychology, Behavior and Social Networking, 16(7), 497–503. https://doi.org/10.1089/cyber.2013.0044 Cavazos-Rehg, P. A., Krauss, M. J., Sowles, S. J., & Bierut, L. J. (2015). "Hey everyone, I'm drunk." An evaluation of drinking-related Twitter chatter. 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Meta-analysis of the association of alcohol-related social media use with alcohol consumption and alcohol-related problems in adolescents and young adults. Alcoholism, Clinical and Experimental Research, 42(6), 978–986. https://doi.org/10.1111/acer.13642 Davey, C. (2021). Online sobriety communities for women's problematic alcohol use: A mini review of existing qualitative and quantitative research. Frontiers in Global Women's Health, 2, 773921. https://doi.org/10.3389/fgwh.2021.773921 Döring, N., & Tröger, C. (2018). Zwischenbericht: Durchführung und Ergebnisse der summativen Evaluation des Facebook-Kanals „Alkohol? Kenn dein Limit.“ [Intermediate report: Implementation and results of the summative evaluation of the Facebook channel "Alcohol? Know your limit."]. Döring, N., & Holz, C. (2021). Alkohol in sozialen Medien: Wo ist der Platz für Prävention? [Alcohol in social media: Where is the space for prevention?]. 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Photo by Adhy Savala on Unsplash ABSTRACT During a crisis, when healthcare capacity becomes overwhelmed and cannot meet regular standards of patient care, crisis standards of care are invoked to distribute scarce hospital space, staff, and supplies. When transitioning between conventional standards of care and crisis standards, hospitals may have to manage resources under scarcity constraints in an intermediate phase defined as the contingency phase. While much attention has been paid to the ethics of crisis standard of care protocols, contingency measures were more widely implemented, though little exists within the literature on the ethics of contingency measures or a clearly explicated contingency standard of care. This paper addresses three ethical issues with the current contingency response to COVID-19: the lack of formalization, the risks of using short-term solutions for prolonged contingency shortages, and the danger of exacerbating health disparities through hospital-level resource allocation. To mitigate these ethical issues, I offer recommendations for reimagining resource allocation during contingency standards of care. INTRODUCTION When transitioning between conventional standards of care and crisis standards, or in situations where shortages do not immediately threaten care delivery, hospitals may have to manage scarce resources in an intermediate phase, known as the “contingency” phase.[1] While much attention has been paid to the ethics of crisis standards, less literature covers the ethics of contingency measures or a clearly explicated contingency standard of care. Many states and hospital systems do not have contingency standards of care to dictate allocation absent an event triggering crisis standards. Crisis standards of care, used when healthcare capacity becomes overwhelmed and cannot meet regular standards of patient care, reflect ethical priorities relevant in times of shortage or other emergencies. These priorities include saving the most lives, the stewardship of scarce resources, and justice relating to equitable resource distribution.[2] Crisis standards of care delineate specialized allocation protocols and triage decision-making bodies at the institutional or state levels. Crisis standards of care require formal activation at the state level, and in the absence of clear triggers or governmental willingness to use them, hospitals may adopt informal strategies to manage allocation in the form of contingency measures. The contingency phase is defined by two simultaneous goals: prevent or stall crisis-level scarcity by managing limited resources and providing patient care that is functionally equivalent to usual care.[3] In other words, allocate scarce resources with no significant health consequences to patients. However, this is an unrealistic expectation: meeting a patient’s medical needs and allocating resources on the basis of scarcity instead of medical indications can be at odds, creating ethical tension. This paper addresses three ethical issues with the current contingency response stemming from this tension: the lack of formalization, the risk of using short-term solutions for prolonged contingency shortages, and the danger of exacerbating health disparities through hospital-level resource allocation. To mitigate these ethical issues, I offer recommendations for reimagining resource allocation during contingency standards of care. l. Lack of Formalization One shortcoming of current contingency measures is that they fail to meet the same level of procedural detail and clarity as crisis standards. The early COVID-19 surges in Italy and France demonstrated the pitfalls of bedside allocation in the absence of procedural guidance. The acute scarcity of critical care resources forced doctors in these countries to make allocation decisions at the bedside, which often resulted in de facto age-based allocation as well as experiences of moral distress and shame among providers.[4] In France, medical allocation guidelines and statistics were never released to the public, raising concerns over the role of transparency in implementing crisis standards and triage guidelines and causing the public to question the trustworthiness of provider triage.[5] Though many states in the US have crisis standards of care that can be implemented in the case of a large-scale triage event, these measures vary widely. A 2020 review of 31 crisis standards of care in the US found that only 18 contained strong “ethical grounding,” 28 used “evidence-based clinical processes and operations,” 21 included “ongoing community and provider engagement, education, and communication,” and 16 had “clear indicators, triggers, and lines of responsibility.”[6] The need for standardization, public transparency, and guidelines for crisis standards of care to prevent bedside allocation has been widely recognized. However, these issues remain unresolved by public policy or legislative efforts during the contingency period before (or after) crisis standards apply. A recent public health study that observed triage team members in a high-fidelity triage simulation highlighted the challenges of making equitable frontline allocation decisions.[7] In the simulation, participants nudged patient priority status up or down depending on what they subjectively identified as morally relevant factors. Through the simulation, participants reported difficulty separating implicit biases about patient characteristics from their clinical judgment. In the absence of formal institutional or regional guidelines for allocation during contingency-level shortages, there are few to no procedural safeguards against biased, ad hoc, and non-transparent rationing. Without formalized or standardized contingency allocation guidance, providers are left to make bedside allocation decisions that are susceptible to individual biases and patterns of unintended discrimination. An example of this susceptibility is seen when hospitals allow patients who no longer benefit from ICU resources to continue occupying ICU beds. This is based on a first-come-first-served (FCFS) approach to bed allocation. FCFS is often a default for patient intake, which led to disparities in care access during the early COVID-19 pandemic. Media reports of hospitals with “plenty of space” being unwilling to accept patients from overwhelmed, lower-income hospitals illustrate that the FCFS default advantages those who could show up first to a particular hospital: often privileged, well-funded healthcare systems that were inaccessible to low-income communities.[8] FCFS is blind to several morally relevant factors, including the likelihood of survival to discharge, reciprocity (i.e. prioritizing healthcare workers), and varying degrees of access to healthcare. Therefore, it inappropriately privileges those in proximity to healthcare systems or with social connections enabling greater initial access to care.[9] During crisis standards of care, excessive mortality that would result from FCFS is mitigated through formalized system-wide triage protocols based on current patient health status and potential benefit from resources. Crisis and contingency standards may provide liability coverage for providers who reallocate critical care beds away from those who no longer benefit during periods of scarcity. This liability coverage shifts bed allocation away from an FCFS model, but only if the policy is well-defined, clearly established, and known to providers. Without a formal system to guide the process or transition from the usual method of allocation to the contingency period, contingency decisions about who gets a scarce resource may continue to operate on an implicit FCFS basis, even when approaching crisis levels of scarcity. Additionally, these decisions will fall unsustainably on individual providers or transfer center workers, leading to moral distress on the frontlines when hospitals are already strained. Lessons from the crisis and contingency responses during COVID-19 can improve future contingency responses. There are multiple ways of achieving equity during contingency allocation, ranging from hospital-level to state-level policy changes. State-wide policies and interventions to facilitate resource-sharing can relieve some of the scarcity burdens that hospitals may face during the contingency period. For example, moving ICU patients to lower levels of care once they have sufficiently recovered is a challenge for doctors, who often call other hospitals to find open beds. In these situations, providers who do not move patients who no longer benefit from ICU beds unknowingly reinforce the FCFS system in which those who arrive first keep the scarce beds, while those who arrive later or wait for one are disadvantaged by having limited access to them. State-wide patient transfer centers, often facilitated by state public health departments, present an alternative by balancing patient needs and bed distribution more equitably and efficiently than individual physicians do, as demonstrated following COVID-19 surges in hospitalization.[10] These centers aid not only in allocating open tertiary care beds, but also in identifying open beds at lower levels of care and assisting physicians with transferring out patients who can be safely downgraded and no longer benefit from tertiary care resources. However, the simplest solution is to encourage the creation of ethics guidance or protocols for contingency allocation at the hospital level. In hospitals, institutional ethics guidance can help providers navigate difficult decisions and conversations with patients. When providers face time-sensitive allocation decisions, like the allocation of open ICU beds, the guidance would be a useful tool for making transparent, principled, and ethically justified allocation decisions in real-time to mitigate the risk of ad hoc or implicit rationing. ll. Unsuited for Prolonged Resource Shortages Secondly, neither contingency nor crisis standards are currently designed to respond to prolonged strains on the healthcare system. Since the start of the pandemic, a prolonged period of staffing shortages began and is projected to persist.[11] However, both crisis and contingency standards assume that the system will eventually return to conventional standards of care. For example, as a contingency or crisis standard, many hospitals deferred elective surgeries to preserve limited resources for emergency and life-saving procedures. Massachusetts, for instance, issued a public health emergency order that required hospitals to defer 50 percent of all non-essential and non-urgent (elective) surgeries. This order demonstrates the use of this contingency measure in response to prolonged staffing and bed shortages.[12] However, the deferral of elective procedures can result in adverse long-term community health consequences. Medical conditions typically addressed through elective surgery, such as joint replacement surgeries for osteoarthritis patients, may worsen if delayed. This can result in greater numbers of acute emergencies, the need for more complex surgical procedures later, increased reliance on pain medications, and longer recovery times.[13] Without a greater understanding of long-term complications in community health, existing contingency strategies, such as the deferral of elective surgeries, may be unsuitable for prolonged shortages. This becomes a greater threat to patient safety when contingency measures inappropriately take the place of crisis standards, risking the long-term implementation of emergency measures designed for temporary use. Although some state emergency planning documents identify indicators and triggers for activating contingency and crisis operations,[14] this transition is not always clear in action. For example, New York did not implement crisis standards of care during the early COVID-19 pandemic despite being one of the hardest-hit cities in the US.[15] Other states, including California, Texas, and Florida, did not activate crisis standards of care, leaving hospitals to implement informal contingency measures that ultimately required allocation strategies very similar or identical to many crisis standards of care protocols.[16] Due to the hesitance to activate crisis standards, ad hoc contingency measures and bedside decision-making prevailed over formal triage protocols. If contingency measures are not set forth in objective documents and are inappropriately used in the place of crisis standards, these short-term measures may result in an unfair or non-transparent distribution of scarce resources. When shortages in space, staff, or supplies jeopardize the ability to provide necessary care for critically ill patients under a conventional standard of care, failures to activate crisis standards risk the inappropriate use of ad hoc contingency measures in their place. With clear contingency standards of care, the duration of an ad hoc approach could be limited. Crisis standards are defined and activated at the regional or state-wide level, but outside of hospital-specific resource limitations, there are generally no standardized indications or triggers for transitioning into and out of contingency measures. Leaving contingency needs to individual hospitals may seem beneficial but defining the contingency period at the hospital level and the crisis period at the state or regional level blurs the line about when it is appropriate for decision makers to activate crisis standards, risking delayed activation or failure to activate them at all. Therefore, it is important that state policies implement automatic triggers for activation that clearly delineate between contingency and crisis responses.[17] Automatic triggers based on validated metrics like remaining available resources can inform the appropriate decision makers about when they must activate crisis standards. These triggers should be transparent to the public, validated, and updated over time with evolving data. These automatic triggers would prevent confusion, inconsistent guidelines, and inequitable contingency allocation at the hands of distressed providers when crisis standards are needed. Defining when to begin crisis standards could help limit the length of the contingency period. This would protect against the inappropriate application of contingency measures to crisis-level scarcity and prolonged shortages that they could not sustainably ameliorate. lll. Potential to Exacerbate Health Disparities Inconsistencies in contingency allocation open the door to disparities in care and unequal distribution of scarcity burdens among different communities based on their location or health needs. This is a concern because it is unclear whether contingency measures can meet their goal of achieving functionally equivalent patient outcomes when resource allocation must be balanced with patient-centered care.[18] The care under contingency standards is meant to be functionally equivalent to regular care. The definition assumes (or may wrongly suggest) that any contingency strategy in place to avoid critical scarcity has no significant impact on patient outcomes. While functional equivalence is attainable, there is currently little research into which contingency measures achieve functionally equivalent outcomes and which patient groups may be disproportionately affected by harmful resource allocation strategies. Although the transition from contingency standards to crisis standards is defined by the inability to provide functionally equivalent care, the difference in practice may merely be a distinction between visible, immediate sacrifices to patient well-being during crises and less-obvious, long-term decrements in community health due to protracted contingency care alterations. Two common contingency measures are cause for concern over disparate patient outcomes and the attainability of functional equivalence. First, restricting emergency room visits by the patient’s degree of need has worrying consequences. In late 2021 and early 2022, hospitals in Massachusetts faced widespread staffing shortages, leading to an emergency order that restricted emergency visits to emergency needs.[19] While this order is a reasonable method of allocating limited staff in the emergency department during severe shortages, it is doubtful that the outcomes of this restriction were equivalent to usual care. Health issues that are soon-to-be emergencies are filtered out until they worsen, resulting in patients overflowing to urgent care clinics or presenting to ERs with more severe forms of sicknesses later on. Given the empirical evidence demonstrating ER treatment and admission disparities that disadvantage Black and Hispanic patients, such a measure would only exacerbate these disparities by further limiting access to needed care.[20] Second, altered staffing ratios, which stretch a limited number of providers to meet patient needs during a staffing shortage, are another concerning yet common contingency measure. Staffing allocation is often viewed similarly to the allocation of space and medical equipment, such that contingency alterations to staffing operations may not seem like they significantly jeopardize patient care quality and outwardly appear functionally equivalent.[21] However, lower ratios of qualified nurses are associated with poor outcomes such as higher inpatient mortality[22] and lower survival rates of in-hospital cardiac arrest for Black patients.[23] These examples highlight the strong potential for contingency measures to amplify social health disparities, particularly when adopted over a prolonged time frame. Lowered standards of care in crisis allocation disproportionately impact racial and ethnic minorities.[24] For example, crisis standards of care used clinical scoring systems that were not developed or validated for crisis triage to prioritize access to life-saving treatments during the COVID-19 pandemic. This practice actively gives rise to racial health disparities and discrimination against disabled patients.[25] Not only were the standards inequitable in practice, but they varied widely from state to state and sometimes even from hospital to hospital, creating disparities across and within geographic regions.[26] If contingency measures are similarly implemented across hospitals or hospital departments without standardization or advance planning to ensure equitable outcomes, it is likely that the burden of a lower standard of care will fall primarily on disadvantaged patient groups and racial minorities. However, standardization alone may be insufficient. Other factors like varying levels of details on patients’ charts between hospitals could produce unfair outcomes if used to determine patient admission or transfer priority, even if the criteria for admissions and transfers are consistent. Thus, ongoing monitoring for unintended patterns of disparity must accompany standardization to ensure that blind spots in the allocation process are identified and corrected. Bioethics has long been preoccupied with the micro-allocation of limited resources within hospitals instead of confronting the structural inequities that underlie broader scarcity and patient needs. The traditional dilemma of allocating limited hospital resources among a certain number of patients overlooks questions about how other resources have already been allocated, which patients were present at the hospital in the first place, where hospitals have (and have not) been built, and whether previous allocation strategies created bias in the broader distribution of resources. Therefore, to achieve fairness, bioethicists must pay attention to aspects of the broader distribution of resources, such as social determinants of health and the allocation of preventative resources at the public health level. One strategy for measuring and addressing these disparities is the Area Deprivation Index (ADI). The ADI quantifies the effects of race, class, and socioeconomic background by geographic region for use in public health research and the prioritization of resources.[27] It has shown promise in identifying geographic regions in need of targeted community health efforts for diabetes management based on electronic patient health records.[28] The ADI and similar tools would be useful in proactively deciding how to allocate public health resources when hospitals are strained. Moreover, through using population health and resource data, public health organizations may forecast contingency shortages allowing for the adoption of early measures to mitigate health disparities that might otherwise be amplified from hospital-level contingency allocation decisions. CONCLUSION Meeting community health needs during periods of contingency scarcity, both before and after crisis standards of care apply, will require contingency standards of care rather than a bedside ad hoc distribution of scarce resources. While it is not inherently ethically unjustifiable for hospitals to adopt measures that may lower the standard of care during contingency standards, the necessity of these measures requires that bioethicists consider how equity, transparency, and the overall aim of functional equivalence can best be achieved under conditions of scarcity. The long-term health consequences of existing contingency measures, the potential for ad hoc and inconsistent allocation of scarce resources, and the need for consensus about when it becomes appropriate to make the formal transition to crisis standards of care demand further consideration. Because contingency measures will likely amplify existing disparities as crisis standards have, hospital-level management of scarcity is inadequate. Public health measures should be adopted in parallel to anticipate and manage health needs at the community or state level when resources are strained. - [1] Altevogt, B. M., Stroud, C., Hanson, S. L., Hanfling, D., & Gostin, L. O. (2009). Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. The National Academies Press. https://doi.org/10.17226/12749 [2] Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A., Zhang, C., Boyle, C., Smith, M., & Phillips, J. P. (2020). Fair Allocation of Scarce Medical Resources in the Time of Covid-19. New England Journal of Medicine, 382(21), 2049–2055. https://doi.org/10.1056/NEJMsb2005114 [3] Alfandre, D., Sharpe, V. A., Geppert, C., Foglia, M. B., Berkowitz, K., Chanko, B., & Schonfeld, T. (2021). Between Usual and Crisis Phases of a Public Health Emergency: The Mediating Role of Contingency Measures. The American Journal of Bioethics, 21(8), 4–16. https://doi.org/10.1080/15265161.2021.1925778 [4] Rosenbaum, L. (2020). Facing Covid-19 in Italy—Ethics, Logistics, and Therapeutics on the Epidemic’s Front Line. New England Journal of Medicine, 382(20), 1873–1875. https://doi.org/10.1056/NEJMp2005492 [5] Orfali, K. (2020). What Triage Issues Reveal: Ethics in the COVID-19 Pandemic in Italy and France. Journal of Bioethical Inquiry, 17(4), 675–679. https://doi.org/10.1007/s11673-020-10059-y [6] Romney, D., Fox, H., Carlson, S., Bachmann, D., O’Mathuna, D., & Kman, N. (2020). Allocation of Scarce Resources in a Pandemic: A Systematic Review of US State Crisis Standards of Care Documents. Disaster Medicine and Public Health Preparedness, 14(5), 677–683. https://doi.org/10.1017/dmp.2020.101 [7] Butler, C. R., Webster, L. B., Diekema, D. S., Gray, M. M., Sakata, V. L., Tonelli, M. R., & Vranas, K. C. (2022). Perspectives of Triage Team Members Participating in Statewide Triage Simulations for Scarce Resource Allocation During the COVID-19 Pandemic in Washington State. JAMA Network Open, 5(4), e227639. https://doi.org/10.1001/jamanetworkopen.2022.7639 [8] Dwyer, J. (2020, May 14). One Hospital Was Besieged by the Virus. Nearby Was ‘Plenty of Space.’—The New York Times. The New York Times. https://www.nytimes.com/2020/05/14/nyregion/coronavirus-ny-hospitals.html [9] Persad, G., Wertheimer, A., & Emanuel, E. J. (2009). Principles for allocation of scarce medical interventions. Lancet (London, England), 373(9661), 423–431. https://doi.org/10.1016/S0140-6736(09)60137-9 [10] Mitchell, S. H., Rigler, J., & Baum, K. (2022). Regional Transfer Coordination and Hospital Load Balancing During COVID-19 Surges. JAMA Health Forum, 3(2), e215048. https://doi.org/10.1001/jamahealthforum.2021.5048 [11] ASPE. (2022, May 3). Impact of the COVID-19 Pandemic on the Hospital and Outpatient Clinician Workforce: Challenges and Policy Responses. ASPE. https://aspe.hhs.gov/reports/covid-19-health-care-workforce [12] Executive Office of Health and Human Services. (2021). Baker-Polito Administration Provides COVID-19 Update on Mask Advisory, Hospital Support | Mass.gov. https://www.mass.gov/news/baker-polito-administration-provides-covid-19-update-on-mask-advisory-hospital-support [13] The Lancet Rheumatology. (2021). Too long to wait: The impact of COVID-19 on elective surgery. The Lancet Rheumatology, 3(2), e83. https://doi.org/10.1016/S2665-9913(21)00001-1 [14] For an example of transition planning between crisis and contingency standards, see Minnesota Department of Health. (2021). Ethical Framework for Transitions Between Conventional, Contingency, and Crisis Conditions in Pervasive or Catastrophic Public Health Events with Medical Surge Implications (Minnesota Crisis Standards of Care). https://www.health.state.mn.us/communities/ep/surge/crisis/framework_transitions.pdf [15] Powell, T., & Chuang, E. (2020). COVID in NYC: What We Could Do Better. The American Journal of Bioethics, 20(7), 62–66. https://doi.org/10.1080/15265161.2020.1764146 [16] Persoff, J., & Wynia, M. K. (2021). Ethically Navigating the Murky Waters of “Contingency Standards of Care.” The American Journal of Bioethics, 21(8), 20–21. https://doi.org/10.1080/15265161.2021.1939810 [17] Board on Health Sciences Policy & Institute of Medicine. (2013). Indicators and Triggers. In Crisis Standards of Care: A Toolkit for Indicators and Triggers. National Academies Press (US). http://www.ncbi.nlm.nih.gov/books/NBK202381/ [18] Frith, L., Draper, H., Fovargue, S., Baines, P., Redhead, C., & Chiumento, A. (2021). Neither ‘Crisis Light’ nor ‘Business as Usual’: Considering the Distinctive Ethical Issues Raised by the Contingency and Reset Phases of a Pandemic. The American Journal of Bioethics, 21(8), 34–37. https://doi.org/10.1080/15265161.2021.1940363 [19] Rosseau, M. (2022, January 14). New emergency orders issued to help understaffed Mass. Hospitals. Boston.Com. https://www.boston.com/news/coronavirus/2022/01/14/new-emergency-orders-issued-to-help-understaffed-mass-hospitals/ [20] Zhang, X., Carabello, M., Hill, T., Bell, S. A., Stephenson, R., & Mahajan, P. (2020). Trends of Racial/Ethnic Differences in Emergency Department Care Outcomes Among Adults in the United States From 2005 to 2016. Frontiers in Medicine, 7. https://www.frontiersin.org/articles/10.3389/fmed.2020.00300 [21] Hick, J. L., Hanfling, D., & Wynia, M. (2022). Hospital Planning for Contingency and Crisis Conditions: Crisis Standards of Care Lessons from COVID-19. The Joint Commission Journal on Quality and Patient Safety. https://doi.org/10.1016/j.jcjq.2022.02.003 [22] Musy, S. N., Endrich, O., Leichtle, A. B., Griffiths, P., Nakas, C. T., & Simon, M. (2021). The association between nurse staffing and inpatient mortality: A shift-level retrospective longitudinal study. International Journal of Nursing Studies, 120, 103950. https://doi.org/10.1016/j.ijnurstu.2021.103950 [23] Brooks Carthon, M., Brom, H., McHugh, M., Sloane, D. M., Berg, R., Merchant, R., Girotra, S., & Aiken, L. H. (2021). Better Nurse Staffing Is Associated With Survival for Black Patients and Diminishes Racial Disparities in Survival After In-Hospital Cardiac Arrests. Medical Care, 59(2), 169–176. https://doi.org/10.1097/MLR.0000000000001464 [24] Annas, G. J., & Crosby, S. S. (2021). Standard Racism: Trying to Use “Crisis Standards of Care” in the COVID-19 Pandemic. The American Journal of Bioethics, 21(8), 1–3. https://doi.org/10.1080/15265161.2021.1941424 [25] Wynia, M. K., & Sottile, P. D. (2020). Ethical Triage Demands a Better Triage Survivability Score. The American Journal of Bioethics, 20(7), 75–77. https://doi.org/10.1080/15265161.2020.1779412 [26] Fink, S. (2020). Ethical Dilemmas in Covid-19 Medical Care: Is a Problematic Triage Protocol Better or Worse than No Protocol at All? The American Journal of Bioethics, 20(7), 1–5. https://doi.org/10.1080/15265161.2020.1788663 [27] Knighton, A. J., Savitz, L., Belnap, T., Stephenson, B., & VanDerslice, J. (2016). Introduction of an Area Deprivation Index Measuring Patient Socioeconomic Status in an Integrated Health System: Implications for Population Health. EGEMS (Washington, DC), 4(3), 1238. https://doi.org/10.13063/2327-9214.1238 [28] Kurani, S. S., Lampman, M. A., Funni, S. A., Giblon, R. E., Inselman, J. W., Shah, N. D., Allen, S., Rushlow, D., & McCoy, R. G. (2021). Association Between Area-Level Socioeconomic Deprivation and Diabetes Care Quality in US Primary Care Practices. JAMA Network Open, 4(12), e2138438. https://doi.org/10.1001/jamanetworkopen.2021.38438

I A sense of in-between shapes contemporary theoretical perspectives on identity through concepts such as fluidity, hybridity and diaspora. These concepts have traction when theorising global social and cultural orders characterised by ‘a delocalized transnation’. In this formation, Appadurai argues, ‘the formula of hyphenation (as in Italian-Americans, Asian-Americans, and African-Americans) is reaching the point of saturation, and the right-hand side of the hyphen can barely contain the unruliness of the left-hand side’ (803). Yet in the relatively monocultural space of Anglo-Celtic rural Australia, delocalised and hyphenated transnational identities tend to make their presence felt most strongly on television. Rather than fluidity, rigidity appears to be a more appropriate metaphor for reading the divisions in rural settler-Australian identity that function as ‘uneven, local attempts to make sense of the world’ (Gilroy 98). In Lismore on the north coast of NSW, for example, the relatively fixed notion of being “a local” maintains its power. Since returning to my home-town of Lismore in 1999 I have become particularly fascinated by the constant use of the word “local” in everyday conversation and in the local newspapers. When I share my fascination with students and colleagues, I am struck by the emotive engagement, both positive and negative, that the idea of being “a local” stimulates. That these students and colleagues have local knowledge of what it means to be “a local” is no doubt a factor in this emotion and engagement: being “a local” marks a divide in belonging and in the local social order. While there is ample literature regarding “the local” within the context of globalisation, “the local” in place-based and regional research, “local knowledges” in anthropology, or “the local” as metaphor for issues of subjectivity and self in feminism and postcolonial theory, literature on being “a local” is curiously sparse. A strong thread of scholarship comes from Hawai’i (for an example see Ohnuma). Conversely, in the Australian context I am aware of only one publication dealing specifically with the idea of being a local. In Ronnie’s Story, Richard Woolley analyses the performance of being a local at a pub in the Sydney suburb of Redfern. By telling first-person anecdotes about a long-term Redfern local, Ronnie, more recent arrivals position themselves in a local order of being local. Woolley’s analysis indicates the power and significance that the idea of being a local has in Australian society, even in places where populations are relatively fluid. Yet while performance may be one strategy for creating a local order, the key to a successful performance in Woolley’s analysis is a relation with an “authentic” local who has qualities not of fluidity, but of routine and rootedness. It is this latter sense of being local that has salience in Lismore. It functions as a benchmark for authenticity and acceptance. This sense of being “a local” deserves scrutiny because it carries the full weight of traditional settler belonging. In addition, being “a local” deserves careful unpacking because it is a category that excludes. Concealed within the idea is a racial and colonial discourse. An analysis of being local in Lismore reveals that not everyone can be a local and the conditions of acceptance are obscured. One criterion is, however, clear and discussable: if there is a question of one’s status as a local, conversation typically and quickly moves to duration of personal and ancestral residence. II “When I first came to Lismore twenty-five years ago, people told me it takes 25 years to become a local […]. My time’s up. I think I can safely say I’ve made it.” (Nora Vidler-Blanksby qtd. in Satherley) “All [the people I just mentioned were] born and bred in the area, plus John Chant, who has been here for 40 years, which makes him a local.” (Baxter) “[…W]hat I’ve come to understand is that you are never a local unless you are born here. […] I mean even after twenty-odd years people say [to me], well, you’re not a local.” (Irwin) Becoming local takes time: routine every day time spent on the ground. There is a notion here of connection between identity and a “patch of dirt”, of authenticity through autochthony, of a seed planted, of being a child of the soil, of coming from a place as distinct from a womb. Being local weaves identity and place together in this most intimate fashion. A local’s sense of identity emerges through time from a developing everyday personal relationship to place through a meld of history, community and geography (Miller 217). To come from outside Lismore, and move beyond being “just a blow-in” — an unannounced stranger blown off-course — the honorific must be earned through an infusion of soil into one’s blood. The period required for this metamorphosis is clearly open to question: 25 years, 40 years, forever. In a sense, locals were never not there. History begins with their arrival. III The stability of this reading of the local order rests on the concealment of an anxiety: an anxiety that settler autochthony is a fiction. Diffusion of settlers and dispersal of Aborigines was the reality of locals’ “settling”. Aborigines upset the signifying chain of local settler belonging at its source because a straightforward appeal to duration of residence is quickly undermined by 40,000 years of Indigenous tenure. This challenge to autochthony initiates a pre-emptive strategy of avoidance and concealment. The language of the settler “local”, articulated through history, community and geography of necessity excludes Aborigines. In de Certeau’s words “locals” define themselves within a ‘proper place’ — ‘a place appropriated as one’s own’ — ‘in a world bewitched by the invisible powers of the Other’ (1984: 36). An analysis of the use of the word “local” reveals how the idea of being “a local” stabilises local settler belonging through concealment. Local, in this usage, is an adjective doing the work of a noun. By becoming a substitute for the noun, the actual noun which “local” modifies is understood, elided, concealed. ‘So you’re “a local”, huh? A local what?’ we might ask. Turning to local newspapers reveals what the concealed noun is not. Within everyday settler discourse Aborigines cannot be noun-locals. To do so would pollute the proper place of “the local” with the Other. Instead, Aborigines are adjective-locals. In The Northern Star, Lismore’s daily paper, Digby Moran is described as a ‘local […] indigenous artist’ (Redmond). Bill Walker, the co-ordinator of the Bundjalung Nation Aboriginal Cultural Heritage Committee, is a ‘respected local identity’ (“Co-ordinator named”). These instances are illustrative of the repeated use of the term “local” as a regular adjective in reference to Aborigines. Local is a modifier of the nouns “artist” and “identity”, indeed a modifier that refers to an imagined boundary rather than to the land itself. Now and then there is a subversion of this order and someone will refer to an Aborigine as a ‘fair dinkum local’ (Opit). Nevertheless, a qualifier is required. Supporting evidence is needed for the Aboriginal claim to status as “a local” – a fair-dinkum local as opposed to a no-need-to-explain local. If there was a class of nouns to which “local” belonged, we would be justified in labelling them “dispossessives”. IV Being a local is a valued aspect of Australian culture and identity — an embodiment of care for community and place for the long term. In the contemporary moment, characterised in the media by accelerating cultural change and personal and national threat, the local represents tradition through apparently unchanging repetition that tourists, sea-changers and tree-changers seek as a refuge and solace. The locals might be said to offer a community of resistance and trust. The local stands within a clearing in a cluttered and threatening world. As I have attempted to argue, however, the local that is revealed in the light of the clearing contains concealment. As an adjective masquerading as a noun, “local” silences talk of the clearing of Aborigines and in the Aborigines’ place it silently installs the settler as original and autochthonous. As Heidegger writes, the ‘clearing in which beings stand is in itself at the same time concealment. […C]oncealment […] occurs within what is lighted. One being places itself in front of another being, the one helps to hide the other, the former obscures the latter, a few obstruct many, one denies all. […A] being […] presents itself as other than it is.’ (Heidegger 54) While there is much to value in being local, as an everyday contemporary practice of colonialism and exclusion it deserves careful attention and transformation. The transformation is clearly more than a task of defining and reinstating the noun that follows the adjective “local,” and instead requires an ontological earthquake of sorts for settler locals. How could the local order in Australia be otherwise than colonial? How might settler Australians be able to imagine the clearing they inhabit in a way that does not clear the land of Aborigines? Within these questions lies a possible ethics of location for settler Australians. References Appadurai, Arjun. “The Heart of Whiteness.” Callaloo 16 (1993): 796-807. Baxter, Reg. “Six Pack Not So Bad”. The Northern Star 17 Mar. 2004: 11. “Co-ordinator Named”. The Northern Star 18 Feb. 2004: 3. De Certeau, Michel. The Practice of Everyday Life. Trans. Steven Rendall. Berkeley: University of California Press, 1984. Gilroy, Paul. Between Camps: Race, Identity and Nationalism at the End of the Colour Line. Harmondsworth: Allen Lane, 2000. Heidegger, Martin. Poetry, Language, Thought. Trans. Albert Hofstadter. New York: Harper & Row, 1975. Irwin, Ros. Personal communication with author [transcript from tape]. 26 Aug. 2003. Miller, Linn. “Belonging to Country — A Philosophical Anthropology.” Voicing Dissent, New Talents 21C: Next Generation Australian Studies 76 (2003): 215-23, 257-8. Ohnuma, Keiko. “Local Haole – A Contradiction in Terms? The Dilemma of Being White, Born and Raised in Hawai’i.” Cultural Values 6 (2002): 273-85. Opit, G. “Stand Up for the Fair Dinkum Local.” Byron Shire Echo 18 Nov. 2003: 9. Redmond, Renee. “The Perfect Backdrop for Local Artist.” The Northern Star 11 Jul. 2003: 5. Satherley, Zoe “Look Who Wants to Be Mayor.” The Northern Star 30 Jan. 2004: 3. Woolley, Richard. “Ronnie’s Story: Narrative and Belonging to Place.” TASA 2003 Conference. The Australian Sociological Association. University of New England, Armidale. 4-6 December 2003. Citation reference for this article MLA Style Garbutt, Rob. "Local Order." M/C Journal 7.6 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0501/08-garbutt.php>. APA Style Garbutt, R. (Jan. 2005) "Local Order," M/C Journal, 7(6). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0501/08-garbutt.php>.

Although I'm a rich white guy, I'm also a feminist anti-racism activist who fights for the rights of the poor and oppressed. (Carl Kenner)Systemic bias is a scourge to the pillar of neutrality. (Cerejota)Count me in. Let's leave the bias to the mainstream media. (Orcar967)Because this is so important. (CuttingEdge)These are a handful of comments posted by online editors who have banded together in a virtual coalition to combat Western bias on the world’s largest digital encyclopedia, Wikipedia. This collective action by Wikipedians both acknowledges the inherent inequalities of a user-controlled information project like Wikpedia and highlights the potential for progressive change within that same project. These community members are taking the responsibility of social change into their own hands (or more aptly, their own keyboards).In recent years much research has emerged on Wikipedia from varying fields, ranging from computer science, to business and information systems, to the social sciences. While critical at times of Wikipedia’s growth, governance, and influence, most of this work observes with optimism that barriers to improvement are not firmly structural, but rather they are socially constructed, leaving open the possibility of important and lasting change for the better.WikiProject: Countering Systemic Bias (WP:CSB) considers one such collective effort. Close to 350 editors have signed on to the project, which began in 2004 and itself emerged from a similar project named CROSSBOW, or the “Committee Regarding Overcoming Serious Systemic Bias on Wikipedia.” As a WikiProject, the term used for a loose group of editors who collaborate around a particular topic, these editors work within the Wikipedia site and collectively create a social network that is unified around one central aim—representing the un- and underrepresented—and yet they are bound by no particular unified set of interests. The first stage of a multi-method study, this paper looks at a snapshot of WP:CSB’s activity from both content analysis and social network perspectives to discover “who” geographically this coalition of the unrepresented is inserting into the digital annals of Wikipedia.Wikipedia and WikipediansDeveloped in 2001 by Internet entrepreneur Jimmy Wales and academic Larry Sanger, Wikipedia is an online collaborative encyclopedia hosting articles in nearly 250 languages (Cohen). The English-language Wikipedia contains over 3.2 million articles, each of which is created, edited, and updated solely by users (Wikipedia “Welcome”). At the time of this study, Alexa, a website tracking organisation, ranked Wikipedia as the 6th most accessed site on the Internet. Unlike the five sites ahead of it though—Google, Facebook, Yahoo, YouTube (owned by Google), and live.com (owned by Microsoft)—all of which are multibillion-dollar businesses that deal more with information aggregation than information production, Wikipedia is a non-profit that operates on less than $500,000 a year and staffs only a dozen paid employees (Lih). Wikipedia is financed and supported by the WikiMedia Foundation, a charitable umbrella organisation with an annual budget of $4.6 million, mainly funded by donations (Middleton).Wikipedia editors and contributors have the option of creating a user profile and participating via a username, or they may participate anonymously, with only an IP address representing their actions. Despite the option for total anonymity, many Wikipedians have chosen to visibly engage in this online community (Ayers, Matthews, and Yates; Bruns; Lih), and researchers across disciplines are studying the motivations of these new online collectives (Kane, Majchrzak, Johnson, and Chenisern; Oreg and Nov). The motivations of open source software contributors, such as UNIX programmers and programming groups, have been shown to be complex and tied to both extrinsic and intrinsic rewards, including online reputation, self-satisfaction and enjoyment, and obligation to a greater common good (Hertel, Niedner, and Herrmann; Osterloh and Rota). Investigation into why Wikipedians edit has indicated multiple motivations as well, with community engagement, task enjoyment, and information sharing among the most significant (Schroer and Hertel). Additionally, Wikipedians seem to be taking up the cause of generativity (a concern for the ongoing health and openness of the Internet’s infrastructures) that Jonathan Zittrain notably called for in The Future of the Internet and How to Stop It. Governance and ControlAlthough the technical infrastructure of Wikipedia is built to support and perhaps encourage an equal distribution of power on the site, Wikipedia is not a land of “anything goes.” The popular press has covered recent efforts by the site to reduce vandalism through a layer of editorial review (Cohen), a tightening of control cited as a possible reason for the recent dip in the number of active editors (Edwards). A number of regulations are already in place that prevent the open editing of certain articles and pages, such as the site’s disclaimers and pages that have suffered large amounts of vandalism. Editing wars can also cause temporary restrictions to editing, and Ayers, Matthews, and Yates point out that these wars can happen anywhere, even to Burt Reynold’s page.Academic studies have begun to explore the governance and control that has developed in the Wikipedia community, generally highlighting how order is maintained not through particular actors, but through established procedures and norms. Konieczny tested whether Wikipedia’s evolution can be defined by Michels’ Iron Law of Oligopoly, which predicts that the everyday operations of any organisation cannot be run by a mass of members, and ultimately control falls into the hands of the few. Through exploring a particular WikiProject on information validation, he concludes:There are few indicators of an oligarchy having power on Wikipedia, and few trends of a change in this situation. The high level of empowerment of individual Wikipedia editors with regard to policy making, the ease of communication, and the high dedication to ideals of contributors succeed in making Wikipedia an atypical organization, quite resilient to the Iron Law. (189)Butler, Joyce, and Pike support this assertion, though they emphasise that instead of oligarchy, control becomes encapsulated in a wide variety of structures, policies, and procedures that guide involvement with the site. A virtual “bureaucracy” emerges, but one that should not be viewed with the negative connotation often associated with the term.Other work considers control on Wikipedia through the framework of commons governance, where “peer production depends on individual action that is self-selected and decentralized rather than hierarchically assigned. Individuals make their own choices with regard to resources managed as a commons” (Viegas, Wattenberg and McKeon). The need for quality standards and quality control largely dictate this commons governance, though interviewing Wikipedians with various levels of responsibility revealed that policies and procedures are only as good as those who maintain them. Forte, Larco, and Bruckman argue “the Wikipedia community has remained healthy in large part due to the continued presence of ‘old-timers’ who carry a set of social norms and organizational ideals with them into every WikiProject, committee, and local process in which they take part” (71). Thus governance on Wikipedia is a strong representation of a democratic ideal, where actors and policies are closely tied in their evolution. Transparency, Content, and BiasThe issue of transparency has proved to be a double-edged sword for Wikipedia and Wikipedians. The goal of a collective body of knowledge created by all—the “expert” and the “amateur”—can only be upheld if equal access to page creation and development is allotted to everyone, including those who prefer anonymity. And yet this very option for anonymity, or even worse, false identities, has been a sore subject for some in the Wikipedia community as well as a source of concern for some scholars (Santana and Wood). The case of a 24-year old college dropout who represented himself as a multiple Ph.D.-holding theology scholar and edited over 16,000 articles brought these issues into the public spotlight in 2007 (Doran; Elsworth). Wikipedia itself has set up standards for content that include expectations of a neutral point of view, verifiability of information, and the publishing of no original research, but Santana and Wood argue that self-policing of these policies is not adequate:The principle of managerial discretion requires that every actor act from a sense of duty to exercise moral autonomy and choice in responsible ways. When Wikipedia’s editors and administrators remain anonymous, this criterion is simply not met. It is assumed that everyone is behaving responsibly within the Wikipedia system, but there are no monitoring or control mechanisms to make sure that this is so, and there is ample evidence that it is not so. (141) At the theoretical level, some downplay these concerns of transparency and autonomy as logistical issues in lieu of the potential for information systems to support rational discourse and emancipatory forms of communication (Hansen, Berente, and Lyytinen), but others worry that the questionable “realities” created on Wikipedia will become truths once circulated to all areas of the Web (Langlois and Elmer). With the number of articles on the English-language version of Wikipedia reaching well into the millions, the task of mapping and assessing content has become a tremendous endeavour, one mostly taken on by information systems experts. Kittur, Chi, and Suh have used Wikipedia’s existing hierarchical categorisation structure to map change in the site’s content over the past few years. Their work revealed that in early 2008 “Culture and the arts” was the most dominant category of content on Wikipedia, representing nearly 30% of total content. People (15%) and geographical locations (14%) represent the next largest categories, while the natural and physical sciences showed the greatest increase in volume between 2006 and 2008 (+213%D, with “Culture and the arts” close behind at +210%D). This data may indicate that contributing to Wikipedia, and thus spreading knowledge, is growing amongst the academic community while maintaining its importance to the greater popular culture-minded community. Further work by Kittur and Kraut has explored the collaborative process of content creation, finding that too many editors on a particular page can reduce the quality of content, even when a project is well coordinated.Bias in Wikipedia content is a generally acknowledged and somewhat conflicted subject (Giles; Johnson; McHenry). The Wikipedia community has created numerous articles and pages within the site to define and discuss the problem. Citing a survey conducted by the University of Würzburg, Germany, the “Wikipedia:Systemic bias” page describes the average Wikipedian as:MaleTechnically inclinedFormally educatedAn English speakerWhiteAged 15-49From a majority Christian countryFrom a developed nationFrom the Northern HemisphereLikely a white-collar worker or studentBias in content is thought to be perpetuated by this demographic of contributor, and the “founder effect,” a concept from genetics, linking the original contributors to this same demographic has been used to explain the origins of certain biases. Wikipedia’s “About” page discusses the issue as well, in the context of the open platform’s strengths and weaknesses:in practice editing will be performed by a certain demographic (younger rather than older, male rather than female, rich enough to afford a computer rather than poor, etc.) and may, therefore, show some bias. Some topics may not be covered well, while others may be covered in great depth. No educated arguments against this inherent bias have been advanced.Royal and Kapila’s study of Wikipedia content tested some of these assertions, finding identifiable bias in both their purposive and random sampling. They conclude that bias favoring larger countries is positively correlated with the size of the country’s Internet population, and corporations with larger revenues work in much the same way, garnering more coverage on the site. The researchers remind us that Wikipedia is “more a socially produced document than a value-free information source” (Royal & Kapila).WikiProject: Countering Systemic BiasAs a coalition of current Wikipedia editors, the WikiProject: Countering Systemic Bias (WP:CSB) attempts to counter trends in content production and points of view deemed harmful to the democratic ideals of a valueless, open online encyclopedia. WP:CBS’s mission is not one of policing the site, but rather deepening it:Generally, this project concentrates upon remedying omissions (entire topics, or particular sub-topics in extant articles) rather than on either (1) protesting inappropriate inclusions, or (2) trying to remedy issues of how material is presented. Thus, the first question is "What haven't we covered yet?", rather than "how should we change the existing coverage?" (Wikipedia, “Countering”)The project lays out a number of content areas lacking adequate representation, geographically highlighting the dearth in coverage of Africa, Latin America, Asia, and parts of Eastern Europe. WP:CSB also includes a “members” page that editors can sign to show their support, along with space to voice their opinions on the problem of bias on Wikipedia (the quotations at the beginning of this paper are taken from this “members” page). At the time of this study, 329 editors had self-selected and self-identified as members of WP:CSB, and this group constitutes the population sample for the current study. To explore the extent to which WP:CSB addressed these self-identified areas for improvement, each editor’s last 50 edits were coded for their primary geographical country of interest, as well as the conceptual category of the page itself (“P” for person/people, “L” for location, “I” for idea/concept, “T” for object/thing, or “NA” for indeterminate). For example, edits to the Wikipedia page for a single person like Tony Abbott (Australian federal opposition leader) were coded “Australia, P”, while an edit for a group of people like the Manchester United football team would be coded “England, P”. Coding was based on information obtained from the header paragraphs of each article’s Wikipedia page. After coding was completed, corresponding information on each country’s associated continent was added to the dataset, based on the United Nations Statistics Division listing.A total of 15,616 edits were coded for the study. Nearly 32% (n = 4962) of these edits were on articles for persons or people (see Table 1 for complete coding results). From within this sub-sample of edits, a majority of the people (68.67%) represented are associated with North America and Europe (Figure A). If we break these statistics down further, nearly half of WP:CSB’s edits concerning people were associated with the United States (36.11%) and England (10.16%), with India (3.65%) and Australia (3.35%) following at a distance. These figures make sense for the English-language Wikipedia; over 95% of the population in the three Westernised countries speak English, and while India is still often regarded as a developing nation, its colonial British roots and the emergence of a market economy with large, technology-driven cities are logical explanations for its representation here (and some estimates make India the largest English-speaking nation by population on the globe today).Table A Coding Results Total Edits 15616 (I) Ideas 2881 18.45% (L) Location 2240 14.34% NA 333 2.13% (T) Thing 5200 33.30% (P) People 4962 31.78% People by Continent Africa 315 6.35% Asia 827 16.67% Australia 175 3.53% Europe 1411 28.44% NA 110 2.22% North America 1996 40.23% South America 128 2.58% The areas of the globe of main concern to WP:CSB proved to be much less represented by the coalition itself. Asia, far and away the most populous continent with more than 60% of the globe’s people (GeoHive), was represented in only 16.67% of edits. Africa (6.35%) and South America (2.58%) were equally underrepresented compared to both their real-world populations (15% and 9% of the globe’s population respectively) and the aforementioned dominance of the advanced Westernised areas. However, while these percentages may seem low, in aggregate they do meet the quota set on the WP:CSB Project Page calling for one out of every twenty edits to be “a subject that is systematically biased against the pages of your natural interests.” By this standard, the coalition is indeed making headway in adding content that strategically counterbalances the natural biases of Wikipedia’s average editor.Figure ASocial network analysis allows us to visualise multifaceted data in order to identify relationships between actors and content (Vego-Redondo; Watts). Similar to Davis’s well-known sociological study of Southern American socialites in the 1930s (Scott), our Wikipedia coalition can be conceptualised as individual actors united by common interests, and a network of relations can be constructed with software such as UCINET. A mapping algorithm that considers both the relationship between all sets of actors and each actor to the overall collective structure produces an image of our network. This initial network is bimodal, as both our Wikipedia editors and their edits (again, coded for country of interest) are displayed as nodes (Figure B). Edge-lines between nodes represents a relationship, and here that relationship is the act of editing a Wikipedia article. We see from our network that the “U.S.” and “England” hold central positions in the network, with a mass of editors crowding around them. A perimeter of nations is then held in place by their ties to editors through the U.S. and England, with a second layer of editors and poorly represented nations (Gabon, Laos, Uzbekistan, etc.) around the boundaries of the network.Figure BWe are reminded from this visualisation both of the centrality of the two Western powers even among WP:CSB editoss, and of the peripheral nature of most other nations in the world. But we also learn which editors in the project are contributing most to underrepresented areas, and which are less “tied” to the Western core. Here we see “Wizzy” and “Warofdreams” among the second layer of editors who act as a bridge between the core and the periphery; these are editors with interests in both the Western and marginalised nations. Located along the outer edge, “Gallador” and “Gerrit” have no direct ties to the U.S. or England, concentrating all of their edits on less represented areas of the globe. Identifying editors at these key positions in the network will help with future research, informing interview questions that will investigate their interests further, but more significantly, probing motives for participation and action within the coalition.Additionally, we can break the network down further to discover editors who appear to have similar interests in underrepresented areas. Figure C strips down the network to only editors and edits dealing with Africa and South America, the least represented continents. From this we can easily find three types of editors again: those who have singular interests in particular nations (the outermost layer of editors), those who have interests in a particular region (the second layer moving inward), and those who have interests in both of these underrepresented regions (the center layer in the figure). This last group of editors may prove to be the most crucial to understand, as they are carrying the full load of WP:CSB’s mission.Figure CThe End of Geography, or the Reclamation?In The Internet Galaxy, Manuel Castells writes that “the Internet Age has been hailed as the end of geography,” a bold suggestion, but one that has gained traction over the last 15 years as the excitement for the possibilities offered by information communication technologies has often overshadowed structural barriers to participation like the Digital Divide (207). Castells goes on to amend the “end of geography” thesis by showing how global information flows and regional Internet access rates, while creating a new “map” of the world in many ways, is still closely tied to power structures in the analog world. The Internet Age: “redefines distance but does not cancel geography” (207). The work of WikiProject: Countering Systemic Bias emphasises the importance of place and representation in the information environment that continues to be constructed in the online world. This study looked at only a small portion of this coalition’s efforts (~16,000 edits)—a snapshot of their labor frozen in time—which itself is only a minute portion of the information being dispatched through Wikipedia on a daily basis (~125,000 edits). Further analysis of WP:CSB’s work over time, as well as qualitative research into the identities, interests and motivations of this collective, is needed to understand more fully how information bias is understood and challenged in the Internet galaxy. The data here indicates this is a fight worth fighting for at least a growing few.ReferencesAlexa. “Top Sites.” Alexa.com, n.d. 10 Mar. 2010 ‹http://www.alexa.com/topsites>. Ayers, Phoebe, Charles Matthews, and Ben Yates. How Wikipedia Works: And How You Can Be a Part of It. San Francisco, CA: No Starch, 2008.Bruns, Axel. Blogs, Wikipedia, Second Life, and Beyond: From Production to Produsage. New York: Peter Lang, 2008.Butler, Brian, Elisabeth Joyce, and Jacqueline Pike. Don’t Look Now, But We’ve Created a Bureaucracy: The Nature and Roles of Policies and Rules in Wikipedia. Paper presented at 2008 CHI Annual Conference, Florence.Castells, Manuel. The Internet Galaxy: Reflections on the Internet, Business, and Society. Oxford: Oxford UP, 2001.Cohen, Noam. “Wikipedia.” New York Times, n.d. 12 Mar. 2010 ‹http://www.nytimes.com/info/wikipedia/>. Doran, James. “Wikipedia Chief Promises Change after ‘Expert’ Exposed as Fraud.” The Times, 6 Mar. 2007 ‹http://technology.timesonline.co.uk/tol/news/tech_and_web/article1480012.ece>. Edwards, Lin. “Report Claims Wikipedia Losing Editors in Droves.” Physorg.com, 30 Nov 2009. 12 Feb. 2010 ‹http://www.physorg.com/news178787309.html>. 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Kane, Gerald C., Ann Majchrzak, Jeremaih Johnson, and Lily Chenisern. A Longitudinal Model of Perspective Making and Perspective Taking within Fluid Online Collectives. Paper presented at the 2009 International Conference on Information Systems, Phoenix, AZ, 2009.Kittur, Aniket, Ed H. Chi, and Bongwon Suh. What’s in Wikipedia? Mapping Topics and Conflict Using Socially Annotated Category Structure. Paper presented at the 2009 CHI Annual Conference, Boston, MA.———, and Robert E. Kraut. Harnessing the Wisdom of Crowds in Wikipedia: Quality through Collaboration. Paper presented at the 2008 Association for Computing Machinery’s Computer Supported Cooperative Work Annual Conference, San Diego, CA.Konieczny, Piotr. “Governance, Organization, and Democracy on the Internet: The Iron Law and the Evolution of Wikipedia.” Sociological Forum 24 (2009): 162-191.———. “Wikipedia: Community or Social Movement?” Interface: A Journal for and about Social Movements 1 (2009): 212-232.Langlois, Ganaele, and Greg Elmer. “Wikipedia Leeches? The Promotion of Traffic through a Collaborative Web Format.” New Media & Society 11 (2009): 773-794.Lih, Andrew. The Wikipedia Revolution. New York, NY: Hyperion, 2009.McHenry, Robert. “The Real Bias in Wikipedia: A Response to David Shariatmadari.” OpenDemocracy.com 2006. 8 Mar. 2010 ‹http://www.opendemocracy.net/media-edemocracy/wikipedia_bias_3621.jsp>. Middleton, Chris. “The World of Wikinomics.” Computer Weekly, 20 Jan. 2009: 22-26.Oreg, Shaul, and Oded Nov. “Exploring Motivations for Contributing to Open Source Initiatives: The Roles of Contribution, Context and Personal Values.” Computers in Human Behavior 24 (2008): 2055-2073.Osterloh, Margit and Sandra Rota. “Trust and Community in Open Source Software Production.” Analyse & Kritik 26 (2004): 279-301.Royal, Cindy, and Deepina Kapila. “What’s on Wikipedia, and What’s Not…?: Assessing Completeness of Information.” Social Science Computer Review 27 (2008): 138-148.Santana, Adele, and Donna J. Wood. “Transparency and Social Responsibility Issues for Wikipedia.” Ethics of Information Technology 11 (2009): 133-144.Schroer, Joachim, and Guido Hertel. “Voluntary Engagement in an Open Web-Based Encyclopedia: Wikipedians and Why They Do It.” Media Psychology 12 (2009): 96-120.Scott, John. Social Network Analysis. London: Sage, 1991.Vego-Redondo, Fernando. Complex Social Networks. 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Photo ID 158378414 © Eduard Muzhevskyi | Dreamstime.com ABSTRACT There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities. INTRODUCTION Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve. BACKGROUND Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes.[1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research.[2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.”[3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops.[4] Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture. I. Global Cultural Perspective of Embryonic Stem Cells Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense,[5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research.[6] Consequently, global engagement in ESC research depends on social-cultural acceptability. a. US and Rights-Based Cultures In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism,[7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.”[8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed.[9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field.[10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture.[11] b. Ubuntu and Collective Cultures African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama, which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,”[12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth.[13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole. Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value.[14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society. Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.”[15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail. Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable.[16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus[17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines.[18] Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim.[19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research.[20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF. Their use is conditioned on consent, and available only to married couples.[21] The community's receptiveness to stem cell research depends on including communitarian African ethics. c. Asia Some Asian countries also have a collective model of ethics and decision making.[22] In China, the ethics model promotes a sincere respect for life or human dignity,[23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life.[25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research.[26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions.[27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency.[28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021.[29] However, issues still need to be addressed in implementing effective IRB review and approval procedures. The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy,[30] research ethics should also adapt to ensure respect for the values of its represented peoples. Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies.[31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells.[32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval,[33] and in another instance, the oocyte source was unclear and possibly violated ethical standards.[34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust. d. Middle East Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells,[35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research.[36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors.[37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so.[38] Jordan has a positive research ethics culture.[39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial.[40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation.[41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.”[42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes. e. Europe In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected.[43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44] For example, in Germany, Lebenzusammenhang, or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.”[45] Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount.[46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007.[47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization.[48] Spain’s approach differs still, with a comprehensive regulatory framework.[49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility.[50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices.[51] II. Religious Perspectives on ESC Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives. The Qur'an states: “And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.”[52] Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception.[53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible.[54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research.[55] In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided.[56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden.[57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all.[58] Acceptance varies on applied beliefs and interpretations. Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero,[59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all.[60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime.[61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit.[62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets.[63] Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life.[64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception:[65] “If she is found pregnant, until the fortieth day it is mere fluid,”[66] Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation.[67] Stem cell research is accepted due to application of these religious laws. We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory, which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions.[68] We only wish to show that the interaction with morality varies between cultures and countries. III. A Flexible Ethical Approach The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities. While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe.[69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation. For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent.[70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context,[71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders. This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research. Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values.[72] An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions.[73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion. IV. Concerns Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values.[74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions. Other concerns include medical tourism, which may promote health inequities.[75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments.[76] For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.”[77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices.[78] The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.”[79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds.[80] CONCLUSION While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research. For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society. This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model. - [1] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice. 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[14] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [15] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [16] Jackson, C.S., Pepper, M.S. Opportunities and barriers to establishing a cell therapy programme in South Africa. Stem Cell Res Ther 4, 54 (2013). https://doi.org/10.1186/scrt204; Pew Research Center. (2014, May 1). Public health a major priority in African nations. Pew Research Center’s Global Attitudes Project. https://www.pewresearch.org/global/2014/05/01/public-health-a-major-priority-in-african-nations/ [17] Department of Health Republic of South Africa. (2021). Health Research Priorities (revised) for South Africa 2021-2024. 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Middle East Fertil Soc J 24, 8 (2020). https://doi.org/10.1186/s43043-019-0011-0; Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [22] Pang M. C. (1999). Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Journal of medical ethics, 25(3), 247–253. https://doi.org/10.1136/jme.25.3.247 [23] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [24] Wang, Y., Xue, Y., & Guo, H. D. (2022). Intervention effects of traditional Chinese medicine on stem cell therapy of myocardial infarction. Frontiers in pharmacology, 13, 1013740. https://doi.org/10.3389/fphar.2022.1013740 [25] Li, X.-T., & Zhao, J. (2012). Chapter 4: An Approach to the Nature of Qi in TCM- Qi and Bioenergy. 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Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [30] Chen, H., Wei, T., Wang, H. et al. Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017. BMC Public Health 22, 434 (2022). https://doi.org/10.1186/s12889-022-12839-0 [31] Azuma, K. Regulatory Landscape of Regenerative Medicine in Japan. Curr Stem Cell Rep 1, 118–128 (2015). https://doi.org/10.1007/s40778-015-0012-6 [32] Harris, R. (2005, May 19). Researchers Report Advance in Stem Cell Production. NPR. https://www.npr.org/2005/05/19/4658967/researchers-report-advance-in-stem-cell-production [33] Park, S. (2012). South Korea steps up stem-cell work. Nature. https://doi.org/10.1038/nature.2012.10565 [34] Resnik, D. B., Shamoo, A. E., & Krimsky, S. (2006). Fraudulent human embryonic stem cell research in South Korea: lessons learned. Accountability in research, 13(1), 101–109. https://doi.org/10.1080/08989620600634193. [35] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [36]Association for the Advancement of Blood and Biotherapies. https://www.aabb.org/regulatory-and-advocacy/regulatory-affairs/regulatory-for-cellular-therapies/international-competent-authorities/saudi-arabia [37] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [38] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics, 23(3), 260–268. https://doi.org/10.1111/dewb.12355; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know. Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know [39] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [40] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [41] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [42] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France. Biotechnology Law Report, 32(6), 349–356. https://doi.org/10.1089/blr.2013.9865 [45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf [47] Regulation of Stem Cell Research in Germany. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany [48] Regulation of Stem Cell Research in Finland. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland [49] Regulation of Stem Cell Research in Spain. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain [50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered: Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110. Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ... Revista do Colegio Brasileiro de Cirurgioes, 41(5), 374–377. https://doi.org/10.1590/0100-69912014005013 Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India. Routledge. For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe [51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights. Cultura (Iasi, Romania), 14(2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent? Research Ethics, 13(1), 23-41. https://doi.org/10.1177/1747016116650235 [52] The Qur'an (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23 [53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life. Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/ [54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics, 31:399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386 [55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association, 12(4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf. [56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52. https://doi.org/10.5372/1905-7415.0801.260 [57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation. Journal of Religion and Health, 30(1), 35–41. http://www.jstor.org/stable/27510629; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva. A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm [59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. ((King James Bible. (1999). Oxford University Press. (original work published 1769)) Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…” In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David. Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…” These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth. [60] It should be noted that abortion is not supported as well. [61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day. Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html [62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells. Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology. Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf. [63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed. Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/ [64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. Journal of halacha and contemporary society, (43), 49–68.; Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [65] Schenker J. G. (2008). The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law). Journal of assisted reproduction and genetics, 25(6), 271–276. https://doi.org/10.1007/s10815-008-9221-6 [66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet). Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en [67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [68] Gert, B. (2007). Common morality: Deciding what to do. Oxford Univ. Press. [69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association.; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. U.S. Department of Health and Human Services. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html [70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes. Journal of assisted reproduction and genetics, 35(7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine, 10(12), 1715–1716. https://doi.org/10.1002/sctm.21-0234 [71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA. Reproductive biomedicine online, 18(5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8 [72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa. Clinical trials (London, England), 3(3), 306–313. https://doi.org/10.1191/1740774506cn150oa [73] Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Georgetown University Press, 2012. [74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity. Research Ethics, 14(3), 1-17. https://doi.org/10.1177/1747016117739939 [75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry. Voices in Bioethics, 8. https://doi.org/10.52214/vib.v8i.9894 [76] Stem Cell Tourism: False Hope for Real Money. Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism, See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis. Voices in Bioethics, 3. https://doi.org/10.7916/vib.v3i.6027 [77]Song, P. (2011) The proliferation of stem cell therapies in post-Mao China: problematizing ethical regulation, New Genetics and Society, 30:2, 141-153, DOI: 10.1080/14636778.2011.574375 [78] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [79] International Society for Stem Cell Research. (2024). Standards in stem cell research. International Society for Stem Cell Research. https://www.isscr.org/guidelines/5-standards-in-stem-cell-research [80] Benjamin, R. (2013). People’s science bodies and rights on the Stem Cell Frontier. Stanford University Press.

IntroductionThe “North” is given explicitly “Nordic” value in extreme metal, as a vehicle for narratives of identity, nationalism and ideology. However, we also contend that “Nordicness” is articulated in diverse and contradictory ways in extreme metal contexts. We examine Nordicness in three key iterations: firstly, Nordicness as a brand tied to extremity and “authenticity”; secondly, Nordicness as an expression of exclusory ethnic belonging and ancestry; and thirdly, Nordicness as an imagined community of liberal democracy.In situating Nordicness across these iterations, we call into focus how the value of the “North” in metal discourse unfolds in different contexts with different implications. We argue that “Nordicness” as it is represented in extreme metal scenes cannot be considered as a uniform, essential category, but rather one marked by tensions and paradoxes that undercut the possibility of any singular understanding of the “North”. Deploying textual and critical discourse analysis, we analyse what Nordicness is made to mean in extreme metal scenes. Furthermore, we critique understandings of the “North” as a homogenous category and instead interrogate the plural ways in which “Nordic” meaning is articulated in metal. We focus specifically on Nordic Extreme Metal. This subgenre has been chosen with an eye to the regional complexities of the Nordic area in Northern Europe, the popularity of extreme metal in Nordic markets, and the successful global marketing of Nordic metal bands and styles.We use the term “Nordic” in line with Loftsdóttir and Jensen’s definition, wherein the “Nordic countries” encompass Norway, Sweden, Iceland, Denmark and Finland, and the autonomous regions of Greenland: the Faroe Islands and the Aland Islands (3). “Nordic-ness”, they argue, is the cultural identity of the Nordic countries, reified through self-perception, internationalisation and “national branding” (Loftsdóttir and Jensen 2).In referring to “extreme metal”, we draw from Kahn-Harris’s characterisation of the term. “Extreme metal” represents a cluster of heavy metal subgenres–primarily black metal, death metal, thrash metal, doom metal and grindcore–marked by their “extremity”; their impetus towards “[un]conventional musical aesthetics” (Kahn-Harris 6).Nonetheless, we remain acutely aware of the complexities that attend both terms. Just as extreme metal itself is “exceptionally diverse” (Kahn-Harris 6) and “constantly developing and reconfiguring” (Kahn-Harris 7), the category of the “Nordic” is also a site of “diverse experiences” (Loftsdóttir & Jensen 3). We seek to move beyond any essentialist understanding of the “Nordic” and move towards a critical mapping of the myriad ways in which the “Nordic” is given value in extreme metal contexts.Branding the North: Nordicness as Extremity and AuthenticityMetal’s relationship with the Nordic countries has become a key area of interest for both popular and scholarly accounts of heavy metal as the genre has rapidly expanded in the region. The Nordic countries currently boast the highest rate of metal bands per capita (Grandoni). Since the mid-2000s, metal scholars have displayed an accelerated interest in the “cultural aesthetics and identity politics” of metal in Northern Europe (Brown 261). Wider popular interest in Nordic metal has been assisted by the notoriety of the Norwegian black metal scene of the early 1990s, wherein a series of murders and church arsons committed by scene members formed the basis for popular texts such as Moynihan and Søderlind’s book Lords of Chaos and Aites and Ewell’s documentary Until the Light Takes Us.Invocations of Nordicness in metal music are not a new phenomenon, nor have such allusions been strictly limited to Northern European artists. Led Zeppelin and Iron Maiden displayed an interest in Norse mythology, while Venom and Manowar frequently drew on Nordic imagery in their performance and visual aesthetics.This interest in the North was largely ephemeral–the use of popular Nordic iconography stressed romanticised constructions of the North as a site of masculine liberty, rather than locating such archetypes in a historical context. Such narratives of Nordic masculinity, liberty and heathenry nevertheless become central to heavy metal’s contextual discourses, and point to the ways in which “Nordicness” becomes mobilised as a particular branded category.Whilst Nordic “branding” for earlier heavy metal bands was largely situated in romantic imaginings of the ancient North, in the late 1980s there emerged “a secondary usage” of Nordic identity and iconography by Northern European metal bands (Trafford & Pluskowski 58). Such “Nordicness” laid far more stress on historical context, national identity and notions of ancestry, and, crucially, a sense of extremity and isolation. This emphasis on metal’s extremity beyond the mainstream has long been a crucial component in the marketing of Nordic scenes.Such “extremity” is given mutually supportive value as “authenticity”, where the term is understood as a value judgement (Moore 209) applied by audiences to discern if music remains committed to its own premises (Frith 71). Such questions of sincerity and commitment to metal’s core continue to circulate in the discourses of Nordic extreme metal. Sweden’s death metal underground, for example, was considered at “the forefront of one of the most extreme varieties of music yet conceived” (Moynihan and Søderlind 32), with both the Stockholm and Gothenburg “sounds” proving influential beyond Northern Europe (Kahn-Harris 106).Situating Nordicness as a distinct identity beyond metal’s commercial appeal underscores much of the marketing of Nordic extreme metal to international audiences. Such discourses continue in contemporary contexts–Finland’s official website promotes metal as a form of Finnish art and culture: “By definition, heavy metal fans crave music from outside the mainstream. They champion material that boldly stands out against the normality of pop” (Weaver).The focus on Nordic metal existing “outside” the mainstream is commensurate with understandings of extreme metal as “on the edge of music” (Kahn-Harris 5). Such sentiments are situated in a wider regional narrative that sees the Nordic region at the geographic “edge” of Europe, as remote and isolated (Grimley 2). The apparent isolation that enables the distinctiveness of “Nordic” forms of extreme metal is, however, potentially undercut by the widespread circulation of “Nordicness” as a particular brand.“Nordic extreme metal” can be understood as both a generic and place-based scene, where genre and geography “cross cut and coincide in complex ways” (Kahn-Harris 99). The Bergen black metal sound, for example, much like the Gothenburg death metal sound, is both a geographic and stylistic marker that is replicated in different contexts.This Nordic branding of musical styles is further affirmed by the wider means through which “Nordic”, “Scandinavian” and the “North” become interchangeable frameworks for the marketing of particular styles of extreme metal. “Nordic metal”, Von Helden thus argues, “is a trademark and a best seller” (33).Nordicness as Exclusory Belonging and AncestryMarketing strategies that rely on constructions of Nordic metal as “beyond the mainstream” at once exotify and homogenise the “Nordic”. Sentiments of an “imagined community of Nordicness” (Lucas, Deeks and Spracklen 279) have created problematic boundaries of who, or what, may be represented in such categories.Understandings of “Nordicness” as a site of generic “purity” (Moynihan and Søderlind 32) are therefore both tacitly and explicitly underscored by projections of ethnic purity and “belonging”. As such, where we have previously considered the cultural capital of the “Nordic” as it emerges as a particular branding exercise, here we examine the exclusory impetus of homogenous understandings of the Nordic.Nordicness in this context connotes explicitly racialised value, which interpellates images of Viking heathenry to enable fantasies of the pure, white North. This phenomenon is particularly evident in the context of Norwegian black metal, which bases its own self-mythologising in explicitly Nordic parameters. Norwegian black metal bands and members of the broader scene have often taken steps to continually affirm their Nordicness through various representational strategies. The widespread church burnings associated with the early Norwegian black metal scene, for instance, can be framed as a radical rejection of Christianity and an embracing of Norway’s Viking, pagan past.The ethnoromanticisation of Nordic regions and landscapes is underscored by problematic projections of national belonging. An interest in pagan mythology, as Kahn-Harris notes, can easily become an interest in racism and fascism (41). The “uncritical celebration of pagan pasts, the obsession with the unpolluted countryside and the distrust of the cosmopolitan city” that mark much Norwegian black metal were also common features of early fascist and racist movements (Kahn-Harris 41).Norwegian black metal has thus been able to link the genre, as a global music commodity, to “the conscious revival of myths and ideologies of an ancient northern European history and nationalist culture” (Lucas, Deeks and Spracklen 279). The conscious revival of such myths materialised in the early Norwegian scene in deliberately racist sentiments. Mayhem drummer Jan Axel Blomberg (“Hellhammer”) demonstrates this in his brief declaration that “Black metal is for white people” (in Moynihan and Søderlind 305); similarly, Darkthrone’s original back cover of Transylvanian Hunger (1994) prominently featured the phrase “Norsk Arisk Black Metal” (“Norwegian Aryan Black Metal”). Nordicness as exclusory white, Aryan identity is further mobilised in the National Socialist Black Metal scene, which readily caters to ontological constructions of Nordic whiteness (Spracklen, True Aryan; Hagen).However, Nordicness is also given racialised value in more tacit, but nonetheless troubling ways in wider Nordic folk and Viking metal scenes. The popular association of Vikings with Nordic folk metal has enabled such figures to be dismissed as performative play or camp romanticism, ostensibly removed from the extremity of black metal. Such metal scenes and their appeals to ethnosymbolic patriarchs nevertheless remain central to the ongoing construction of Nordic metal as a site that enables the instrumentality of Northern European whiteness precisely through hiding such whiteness in plain sight (Spracklen, To Holmgard, 359).The ostensibly “camp” performance of bands such as Sweden’s Amon Amarth, Faroese act Týr, or Finland’s Korpiklaani distracts from the ways in which Nordicness, and its realisations through Viking and Pagan symbolism, emerges as a claim to ethnic exclusivity. Through imagining the Viking as an ancestral, genetic category, the “common past” of the Nordic people is constructed as a self-identity apart from other people (Blaagaard 11).Furthermore, the “Viking” itself has cultural capital that has circulated beyond Northern Europe in both inclusive and exclusive ways. Nordic symbolism and mythologies are invoked within the textual aesthetics of heavy metal communities across the globe–there are Viking metal bands in Australia, for instance. Further, the valorising of the “North” in metal discourse draws on the symbols of particular ethnic traditions to give historicity and local meaning to white identity.Lucas, Deeks and Spracklen map the rhetorical power of the “North” in English folk metal. However, the same international flows of Nordic cultural capital that have allowed for the success and distinctiveness of Nordic extreme metal have also enabled the proliferation of increasingly exclusionary practices. A flyer signed by the “Wiking Hordes” in May of 1995 (in Moynihan and Søderlind 327) warns that the expansion of black and death metal into Asia, Eastern Europe and South America posed a threat to the “true Aryan” metal community.Similarly, online discussions of the documentary Pagan Metal, in which an interviewee states that a Brazilian Viking metal band is “a bit funny”, shifted between assertions that enjoyment should not be restricted by cultural heritage and declarations that only Nordic bands could “legitimately” support Viking metal. Giving Nordicness value as a form of insular, ethnic belonging has therefore had exclusory and problematic implications for how metal scenes market their dominant symbols and narratives, particularly as scenes continue to grow and diversify across multiple national contexts.Nordicness as Liberal DemocracyNordicness in heavy metal, as we have argued, has been ascribed cultural capital as both a branded, generic phenomenon and as a marker of ancestral, ethnonational belonging. Understandings of “Nordic” as an exclusory ethnic category marked by strict boundaries however come into conflict with the Nordic region’s self-perceptions as a liberal democracy.We propose an additional iteration for “Nordicness” as a means of pointing to the tensions that emerge between particular metallic imaginings of the “North” as a remote, uncompromising site of pagan liberty, and the material realities of modern Nordic nation states. We consider some new parameters for articulations of “Nordicness” in metal scenes: Nordicness as material and political conditions that have enabled the popularity of heavy metal in the region, and furthermore, the manifestations of such liberal democratic discourses in Nordic extreme metal scenes.Nordicness as a cultural, political brand is based in perceptions of the Nordic countries as “global good citizens”, “peace loving”, “conflict-resolution oriented” and “rational” (Loftsdóttir and Jensen 2). This modern conception of Nordicness is grounded in the region’s current political climate, which took its form in the post-World War II rejection of fascism and the following refugee crisis.Northern Europe’s reputation as a “famously tolerant political community” (Dworkin 487) can therefore be seen, one on hand, as a crucial disconnect from the intolerant North mediated by factions of Nordic extreme metal scenes and on the other, a political community that provides the material conditions which allow extreme metal to flourish. Nordicness here, we argue, is a crucial form of scenic infrastructure–albeit one that has been both celebrated and condemned in the sites and spaces of Nordic extreme metal.The productivity and stability of extreme metal in the Nordic countries has been attributed to a variety of institutional factors: the general relative prosperity of Northern Europe (Terry), Scandinavian legal structures (Maguire 156), universal welfare, high levels of state support for cultural development, and a broad emphasis on musical education in schools.Kahn-Harris argues that the Swedish metal scene is supported by the strength of the Swedish music industry and “Swedish civil society in general” (108). Music education is strongly supported by the state; Sweden’s relatively generous welfare and education system also “provide [an] effective subsidy for music making” (108). Furthermore, he argues that the Swedish scene has benefited from being closer to the “cultural mainstream of the country than is the case in many other countries” (108). Such close relationships to the “cultural mainstream” also invite a critical backlash against the state. The anarchistic anti-government stance of Swedish hardcore bands or the radical individualism of Norwegian black metal embodies this backlash.Early black metal is seen as a targeted response to the “oppressive and numbing social democracy which dominated Norwegian political life” (Moynihan and Søderlind 32). This spurning of social democracy is further articulated by Darkthrone founder Fenriz, who states that black metal “…is every man for himself… It is individualism above all” (True Norwegian Black Metal). Nordic extreme metal’s emphasis on independence and anti-modernity is hence immediately troubled by the material reality of the conditions that allow it to flourish. Nordicness thus gains complex realisation as both radical individualism and democratic infrastructural conditions.In looking towards future directions for expressions of the “Nordic” in extreme metal scenes, we want to consider how Nordicness can be articulated not as exclusory ethnic belonging and individualist misanthropy, but rather illustrate how Nordic scenes have also proffered sites for progressive, anti-racist discourses that speak to the cultural branding of the North as a tolerant political community.Imaginings of the North as ethnically homogenous or pure are complicated by Nordic bands and fans who actively critique such racialised discourses, and instead situate “Nordic” metal as a site of heterogeneity and anti-racist activism. The liberal politics of the region are most clearly articulated in the music of Swedish hardcore and extreme metal bands, particularly those originating in the northern university town of Umeå. Like much of Europe’s underground music scene, Umeå hardcore bands are often aligned with the anti-fascist movement and its message of tolerance and active anti-racist, anti-homophobic and anti-sexist resistance and protest. Refused is the most well-known example, speaking out against capitalism and in favour of animal rights and civil liberties. Scandinavian DIY acts have also long played a crucial role in facilitating the global diffusion of anti-capitalist punk and hardcore music (Haenfler 287).Nonetheless, whilst such acts remain important sites of progressive discourses in homogenous constructions of Nordicness, such an argument for tolerance and diversity is difficult to maintain when the majority of the scene’s successful bands are made up of white, ethnically Scandinavian men. As such, in moving towards future considerations for Nordicness in extreme metal scenes, we thus call into focus a fragmentation of “Nordicness”, precisely to divorce it from homogenous constructions of the “Nordic”, and enable greater critical interrogation and plurality of the notion of the “North” in metal scholarship.ConclusionThis article has pointed towards a multiplicity of Nordic discourses that unfold in metal: Nordic as a marketing tool, Nordic as an ethnic signifier, and Nordic as the political reality of liberal democratic Northern Europe–and the tensions that emerge in their encounters and intersections. In arguing for multiple understandings of “Nordicness” in metal, we contend that the cultural capital that accompanies the “Nordic” actually emerges as a series of fragmented, often conflicting categories.In examining how images of the North as an isolated location at the edge of the world inform the branded construction of Nordic metal as sites of presumed authenticity, we considered how scenes such as Swedish death metal and Norwegian black metal were marketed precisely through their Nordicness, where their geographic isolation from the commercial centre of heavy metal was used to affirm their “Otherness” to their mainstream metal counterparts. This “otherness” has in turn enabled constructions of Nordic metal scenes as sites of not only metallic purity in their isolation from “commercial” metal scenes, but also ethnic homogeneity. Nordicness, in this instance, becomes inscribed with explicitly racialised value that interpellates images of Viking heathenry to bolster phantasmic imaginings of the pure, white North.However, as we argue in the third section, such exclusory narratives of Nordic belonging come into conflict with Northern Europe’s own self image as a site of progressive liberal democracy. We argue that Nordicness here can be taken as a political imperative towards socialist democracy, wherein such conditions have enabled the widespread viability of extreme metal; yet also invited critical backlashes against the modern political state.Ultimately, in responding to our own research question–what is the cultural capital of “Nordicness” in metal?–we assert that such capital is realised in multiple iterations, undermining any possibility of a uniform category of “Nordicness”, and exposing its political tensions and paradoxes. 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Rib Fractures are a common injury in trauma patients and affect 10% of all injured patients who require admission to the hospital. Currently, there is no consensus on the most efficacious treatment for rib fractures with the debate comparing non-surgical versus surgical management. Medical management of rib fractures often requires admission to the intensive care unit with a focus on pain control to allow good pulmonary hygiene. Pain control involved a multimodal approach with current techniques including epidural anesthesia and paravertebral blocks. Although many patients recover with medical management alone, some patients may benefit from surgical stabilization of rib fractures as a means of augmenting pain control. Flail chest is the most evidence-based indication for surgical stabilization of rib fractures SSRF with many studies showing decreased days on mechanical ventilation, risk of pneumonia, intensive care unit length of stay, and hospital length of stay. Additionally, in patients with non-flail chest and ventilator dependent respiratory failure, surgical stabilization of rib fractures may provide an advantage over medical management for pain control. There are relatively few contraindications and complications associated with surgical stabilization of rib fractures. Therefore, with proper patient selection, surgical stabilization of rib fractures can improve outcomes in patients with rib fractures. Medical management with or without surgical intervention requires a multidisciplinary approach to prevent adverse clinical outcomes. Keywords: Surgical stabilization of rib fractures, rib plating, rib fracture, flail chest, non-flail chest Article Details How to Cite RAFFA, Taylor et al. Surgical Stabilization of Rib Fractures: A Review of the Indications, Technique, and Outcomes. Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4694>. 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