Journal articles on the topic 'Super Pitfall'

Dual-energy computed tomography (DECT) has been reported to successfully identify bone marrow oedema (BME) in various traumatic settings. DECT has multiple strengths, including the availability of both a 3D view of the anatomical area studied and of high-resolution dual energy specific maps super-imposed onto conventional grayscale morphological images. Windowing can be used to enhance the visualization of BME by increasing the level of the super-imposed images. Conversely, by decreasing the level of the super-imposition of color-coded images, it is possible to progressively enhance the visualization of fine anatomical details, which is useful for diagnosing associated imaging findings. Importantly, bone sclerosis may represent an important pitfall for DECT, potentially generating both false positive and false negative findings by locally altering CT numbers. The aim of this paper was to evaluate the strengths and limitations of DECT in accurately detecting traumatic BME, by considering practical approaches to imaging at several anatomical sites.

Land type changes in the super wet tropical rain forest area caused fluctuations in the diversity of soil fauna which caused disruption of ecosystem balance. This research was conducted for four months, in November 2017-February 2018. Data on soil fauna was taken using pitfall traps and hand sorting. Furthermore, the soil fauna data obtained were identified and calculated the value of the diversity index, evenness and dominance on each type of land for four months. The results showed that forests had a high diversity index of soil fauna, which were 3,134, 3,313 and 3,314 in the first to the third month. While in the 4th month the forest diversity index decreased to 2,981. In open land, the soil fauna diversity index value is moderate, which is 2.631, 2.998, 2.782 and the diversity index increases in the fourth month, is 3.084. Mixed gardens have a value of the fauna diversity index of 2,728, 3,113, 2,870 and increased in the fourth month of 3,084. Whereas monoculture gardens have diversity index values of 2,527, 3,214, 2,935 and 2,927. Changes in land types of super wet tropical rainforests have an effect on changes in the level of diversity of soil fauna and not always these changes reduce the level of diversity of soil fauna.

As glaciers retreat, their forelands represent “natural laboratories” for the study of primary succession. This review describes how certain arthropods conquer pristine ground and develop food webs before the establishment of vascular plants. Based on soil samples, pitfall traps, fallout and sticky traps, gut content studies, and some unpublished data, we compare early arthropod succession on glacial forelands of northern Europe (Iceland, Norway including Svalbard, and Sweden) and of the Alps (Austria, Italy). While macroarthropod predators like ground beetles (Coleoptera: Carabidae), harvestmen (Arachnida: Opiliones), and spiders (Arachnida: Araneae) have usually been considered as pioneers, assumed to feed on airborne prey, this review explains a different pattern. Here, we highlight that springtails (Collembola), probably feeding on biofilm made up of algae or cyanobacteria, are super-pioneers, even at high altitudes and under arctic conditions. We also point out that macroarthropod predators can use locally available prey, such as springtails or non-biting midges (Diptera: Chironomidae). Pioneer arthropod communities vary under different biogeographical and climatic conditions. Two pioneer food webs, from northern Europe and the Alps, respectively, differed in structure and function. However, certain genera and orders were common to both. Generalists and specialists live together in a pioneer community. Cold-adapted specialists are threatened by glacier melting.

AbstractBeginning 1 year after an intense forest fire in the Interlace region of Manitoba, carabid beetles were sampled by pitfall trapping in two burned sites and two unburned control sites. Before the tire, one burned site had been dominated by aspen, Populus tremuloides Michx,, and the other by conifers (mostly Picea spp.). During the 11-year study, burned sites became dominated by aspen saplings. Three carabid species were caught significantly more frequently in burned sites than in control sites. Two of these, Harpalus laticeps LeConte and H. egregius Casey, invaded soon after the fire and were caught in the burned sites for several years after the fire. Seventeen species were caught significantly less often in burned than in control sites; catches of another 13 common species were not significantly affected by burning of the site. Burning influenced the seasonal patterns of catches of Carabus taedatus F. and Pterostichus adstrictus Eschscholtz; this was attributed to higher litter and soil temperatures in burned sites. Seasonal patterns of other common species were not markedly affected by burning. In burned sites, the incidence of brachypterous species and the size of beetles increased with time after the fire. In control sites, the incidence of brachyptery was independent of time, but the percentage of brachypterous species was significantly higher in the conifer site than in the aspen site. Trends of brachyptery and size are those expected if early colonizers are super-tramp r-strategists and later invaders are K-strategists. Patterns of species occurrence during forest regeneration can be explained in terms of dispersal and competitive abilities, preference for physical attributes of the habitat, and responses to prey availability.

In order to contribute to the myrmecological fauna knowledg of the Guerrouche forest massif based in northeastern Algeria. A study was conducted on three oak groves (Quercus suber, Q. canariensis and Q.afares). A total of 60 plots were surveyed by using four sampling methods (manual capture, bait, pitfall and Winkler). The inventory revealed 34 ants species belonging to 15 genus and 4 sub-families; Dolichoderinae, Formicinae, Myrmicinae and Ponerinae. Dispatch as follow, 22 species for Cork oak, 14 for Algerian oak and 17 for Afares oak. Myrmicinae dominate in Cork oak and in Algerian oak (82.83 and 81.23% respectively) while in the Afares oak, Formicinae are largely in the lead (68.54%). This study revealed an endemic species to Algeria (Aphaenogaster testaceo-pilosa ssp canescens), three endemic’ species to Algeria and Morocco (Camponotus laurenti, Messor antennatus ans Aphaenogaster foreli) and one endemic to Algeria and Tunisia (Bothriomymrmex decapitans). Comparison of the four sampling methods effectiveness, used reveals that it’s the bait (80.7% of the species total number harvested in the all stations) and manual capture (49.69% of the species total number harvested in the all stations), which allowed the capture of the largest number of species followed by pitfalls traps (31.64% of the species total number harvested in the all stations). The Winkler was much less effective (5.55% of the species total number harvested in the all stations).

The Competition Tribunal recently found Mittal Steel SA guilty of abusing its super-dominant position by charging excessive prices to the detriment of consumers of flat carbon steel products. This article assesses the economic tests to be used for excessive pricing in light of the case and reviews the lessons that can be learned from the evidence required for the different tests. It discusses issues related to using profitability as a test and points out problems and pitfalls in profitability measures.

Duplex stainless steels (DSS, including super duplex stainless steels {SDSS}) have proven to be very useful engineering materials, albeit with somewhat different welding requirements than those of the more familiar austenitic stainless steels. Despite a generally good track record in welding of duplex stainless steels, certain pitfalls have been encountered with enough frequency that they deserve review. Inappropriate base metal specification often leads to unsuitable heat affected zone (HAZ) properties. Autogenous fusion zones are also of concern. This issue centers around nitrogen limits. The most frequently encountered is applying the UNS S31803 composition for 2205 DSS, instead of the S32205 composition. Inappropriate welding heat input arises most frequently with SDSS. While 0.5 to 1.5 kJ/mm is a normal heat input recommendation for SDSS, either a root pass or many small beads towards the low end of this heat input range tends to result in precipitation and/or secondary austenite formation in weld metal subjected to repeated thermal cycles from multiple weld passes. Inappropriate PWHT occurs when the enhanced nickel filler metals (typically 9% Ni) are used. DSS are not normally given PWHT, but extensive forming of heads, for example, or repair welding of castings, may require a postweld anneal. Specifications such as ASTM A790 and A890 call for annealing at 1040ºC minimum, and the fabricator tends to use temperatures close to that minimum. However, the enhanced nickel filler metals require higher temperatures to dissolve sigma phase that forms during heating to the annealing temperature.

The parliamentary elections in Kyrgyzstan in October 2015 garnered widespread approval from commentators for the level of fairness and freedom maintained throughout the campaign. However, the results of the vote do not provide a clear indication of the current state of affairs of parliamentarism in the republic. Focusing on the commercialization of party lists, we argue that neither identity politics nor the logic of neopatrimonialism adequately explain the dynamics of political competition in Kyrgyzstan. Instead, we see perpetual uncertainty emerging from contradicting yet increasing attempts to harness the capital of privatized party lists and to impose discipline. Eventually, and beyond short-term threats of an emerging super-presidentialism, Kyrgyzstan risks suffering from hollow parliamentarism, with political parties persistently failing to supply legislative initiatives with substantial agendas and adequate professionals. The weakly institutionalized political parties and their short-sighted electoral strategies undermine both the parliamentary system and its political pluralism.

Background: Status epilepticus (SE) carries an exceedingly high mortality and morbidity, often warranting an aggressive therapeutic approach. Recently, the implementation of a ketogenic diet (KD) in adults with refractory and super-refractory SE has been shown to be feasible and effective. Methods: We describe our experience, including the challenges of achieving and maintaining ketosis, in an adult with new onset refractory status epilepticus (NORSE). Case Vignette: A previously healthy 29-year-old woman was admitted with cryptogenic NORSE following a febrile illness; course was complicated by prolonged super-refractory SE. A comprehensive work-up was notable only for mild cerebral spinal fluid (CSF) pleocytosis, elevated nonspecific serum inflammatory markers, and edematous hippocampi with associated diffusion restriction on magnetic resonance imaging (MRI). Repeat CSF testing was normal and serial MRIs demonstrated resolution of edema and diffusion restriction with progressive hippocampal and diffuse atrophy. She required prolonged therapeutic coma with high anesthetic infusion rates, 16 antiseizure drug (ASD) trials, empiric immunosuppression and partial bilateral oophorectomy. Enteral ketogenic formula was started on hospital day 28. However, sustained beta-hydroxybutyrate levels >2 mmol/L were only achieved 37 days later following a comprehensive adjustment of the care plan. KD was challenging to maintain in the intensive care unit (ICU) and was discontinued due to poor nutritional state and pressure ulcers. KD was restarted again in a non-ICU unit facilitating ASD tapering without re-emergence of SE. Discussion: There are inconspicuous carbohydrates in commonly administered medications for SE including antibiotics, electrolyte repletion formulations, different preparations of the same drug (i.e., parenteral, tablet, or suspension) and even solutions used for oral care―all challenging the use of KD in the hospitalized patient. Tailoring comprehensive care and awareness of possible complications of KD are important for the successful implementation and maintenance of ketosis.

Multiparametric MRI (mpMRI) has superb sensitivity in prostate cancer detection. mpMRI is increasingly used not only for primary diagnostics, but for location of suspicious lesion before biopsy in case of targeted biopsy (TB). In many recent studies have been shown higher level of TB accuracy in prostate cancer detection in comparison with traditional systemic biopsy. In recent EAU, NICE, ACR recommendations mpMRI is indicated for men with high level of prostate cancer suspicion with previous negative results of systemic biopsy. However, it is not absolutely clear, whether mpMRI is indicated for biopsy-naïve men. This study is dedicated for prostate biopsy planning in the groups of biopsy-naïve men and with the history of previous biopsy.

This article explores the potential of real-world labs (RWLs) and real-world experiments (RWEs) to be a fruitful addition to established approaches in urban planning in Germany. While transdisciplinary and transformative RWLs rooted in socio-ecological sustainability studies have become an important tool for experimenting with innovative solutions for environmental challenges in cities, RWLs aimed at improving social cohesion in neighbourhoods and fostering a communal life characterised by dialogue and solidarity are rare. To this latter aim, this article contributes with research experience from a transdisciplinary RWL on cooperative urban open space development seeking to foster social cohesion in super-diverse neighbourhoods in Germany. This article analyses the contradictory perceptions of the local stakeholders involved as regards the potentials of RWEs to be a meaningful addition to established planning practices. This article makes it clear that there is greater proximity between urban planning theory, practice, and RWEs than initially assumed. Nevertheless, RWEs have considerable potential as a positive complement to established approaches to urban planning and as a means of experimenting with open-ended encounter formats in neighbourhoods.

One of the pitfalls on the road of any commentator on any author is that of seizing upon a single aspect of his work and developing this aspect to the exclusion of others equally important. What is said may then be true enough, yet the total picture becomes a distorted one. The danger of a selective reading pulling the whole critical super-structure awry is peculiarly evident in connection with John Updike. He is a comic writer, a fabulist, a poet, a moralist, an observer of social mores, a religious believer, a student of history, an “earnest meditator” on the ego, a critic of other authors—and sometimes all of these things at once. Those who would bake a critical cake must not only include all the ingredients he has supplied but also mix them in the right proportions. If they fail, the cake will turn out flat.

Embolotherapies used in the treatment of hepatocellular carcinoma (HCC) include bland embolization, conventional transarterial chemoembolization (cTACE) using ethiodol as a carrier, TACE with drug-eluting beads and super absorbent polymer microspheres (DEB-TACE), and selective internal radiation therapy (SIRT). Successfully treated HCC lesions undergo coagulation necrosis, and appear as nonenhancing hypoattenuating or hypointense lesions in the embolized region on computed tomography (CT) and magnetic resonance. Residual or recurrent tumours demonstrate arterial enhancement with portal venous phase wash-out of contrast, features characteristic of HCC, in and/or around the embolized area. Certain imaging features that result from the procedure itself may limit assessment of response. In conventional TACE, the high-attenuating retained ethiodized oil may obscure arterially-enhancing tumours and limit detection of residual tumours; thus a noncontrast CT on follow-up imaging is important post-cTACE. Hyperenhancement within or around the treated zone can be seen after cTACE, DEB-TACE, or SIRT due to physiologic inflammatory response and may mimic residual tumour. Recognition of these pitfalls is important in the evaluation embolotherapy response.

Abstract International relations (IR) has seen a proliferation of recent research on both international hierarchies as such and on historical IR in (often hierarchical) East Asia. This article takes stock of insights from East Asian hierarchies for the study of international hierarchy as such. I argue for and defend an explanatory approach emphasizing repertoires or toolkits of hierarchical super- and subordination. Historical hierarchies surrounding China took multiple dynastic forms. I emphasize two dimensions of variation. First, hierarchy-building occurs in dialogue between cores and peripheries. Variation in these relationships proliferated multiple arrangements for hierarchical influence and rule. Second, Sinocentric hierarchies varied widely over time, in ways that suggest learning. Successive Chinese dynasties both emulated the successes and avoided the pitfalls of the past, adapting their ideologies and strategies for rule to varying circumstances by recombining past political repertoires to build new ones. Taken together, these phenomena suggest new lines of inquiry for research on hierarchies in IR.

Abstract This paper presents the results of a comparative study with the objective of studying the spatio-temporal variation in the abundance and richness of scarab beetles in two oak biotopes (cork oak – Quercus suber and zeen oak – Q. canariensis) of the Ouled Bechih Forest in the Souk-Ahras region of north-eastern Algeria during 2017. Two sampling techniques were used: pitfall traps and bidirectional glass traps. During the study period 6022 individuals were collected and 17 species of the family Scarabaeidae were identified. The results of nonparametric tests (Mann-Whitney U-test and Kruskal-Wallis H-test) show that there is a significant difference in abundance and richness between the two biotopes and from March to August. These two biodiversity parameters were greater in the cork oak than in the zeen oak forests. The activity of the scarab beetles was much higher in the dry season, but lower in the rainy season. The phytophagous species were most influenced by seasonality, especially in the cork oak biotopes, whereas the coprophagous ones remained relatively constant in both habitats.

The thesis of this paper is simple: we as critical readers of the New Testament often use John Rylands Greek Papyrus 3.457, also known as P52, ininappropriate ways, and we should stop doing so. A recent example will illustrate the problem. In what is on the whole a superb commentary on John's gospel, D. Moody Smith writes the following about the date of John:For a time, particularly in the early part of the twentieth century, the possibility that John was not written, or at least not published, until [the] mid-second century was a viable one. At that time Justin Martyr espoused a logos Christology, without citing the Fourth Gospel explicitly. Such an omission by Justin would seem strange if the Gospel of John had already been written and was in circulation. Then the discovery and publication in the1930s of two papyrus fragments made such a late dating difficult, if not impossible, to sustain. The first and most important is the fragment of John chapter 18 … [P52], dated by paleographers to the second quarter of the second century (125–150); the other is a fragment of a hithertounknown gospel called Egerton Papyrus 2 from the same period, which obviously reflects knowledge of the Gospel of John…. For the Gospel of Johnto have been written and circulated in Egypt, where these fragments were found, a date nolater than the first decade of the second century must be presumed.

Instagram is the fastest rising social medium used by young people in the United Arab Emirates (UAE) and therefore constitutes a superb means for companies to advertise their brands. To better inform the selection of the most well-targeted and effective models for advertising products, this research first analyzed UAE-based Instagram posts to explore the types of models used for different types of advertising content on Instagram. Individual interviews were then conducted with Emirati women consumers to determine the criteria they use when reviewing Instagram models in terms of the intention to purchase. Results reveal that there are three archetypal models connected with product ranges relating to (1) beauty, (2) health, and (3) fashion. Four determining factors in purchase decisions emerged, namely, (1) product effect, (2) product display, (3) the modesty of the models, and (4) the pose of the models. These last two, and most notably, the modesty of the model, is perhaps somewhat uniquely relevant to the region given the primacy of female modesty within the Islamic canon. Moreover, the majority of women interviewed stressed that they favor models who exemplify a realistic lifestyle and authentic beauty. While the goal of effortless perfection is a common one, this objective may be more dominant in this socio-cultural region, given the Islamic prescriptions on female modesty. Such a desire for an effortless perfection and authentic deception characterizes the essence of the ethos paradox of Instagram models. The value of this empirical investigation is that it highlights a potential pitfall for advertisers in making the assumption that featuring strong influencers in their advertising is necessarily an enhancement of sales potential. Moreover, it illustrates how Instagram endorsement functions in this geopolitical context and offers guidelines for optimizing Instagram advertising.

Abstract Abstract 1228 Due to a lack of standardized methodologies and reporting, results of BCR-ABL transcripts by quantitative real-time PCR (qPCR) are difficult to evaluate and compare between laboratories in molecular monitoring of BCR-ABL in CML. Although progress has been made in harmonization of reporting BCR-ABL quantification, such as the introduction of the International Scale, the standardization of each step in qPCR for BCR-ABL quantification is important. The majority of laboratories use an absolute approach with a standard curve to quantitate the transcript level of BCR-ABL. A number of sources are available for standards, such as RNA, cDNA, and plasmid. Among those, plasmid DNA is the most widely used. Since the standard is the most important factor in the absolute approach, in this study different preparations of plasmid DNA were investigated by qPCR with a TaqMan probe to evaluate their amplification rate. BCR-ABL b3a2 and ABL were individually cloned into pGEM-T Easy vector, and each plasmid DNA was isolated with Qiagen Plasmid Maxi kit. After quantification, DNA was diluted to obtain E6 copy number as templates for qPCR. For data comparison, a common threshhold was set in the middle of the exponential phase and Ct values were obtained. A small Ct value indicates a high amplification rate. Multiple preparations of purified completely linearized plasmid DNA for both b3a2 and ABL have the Ct values of 17.90 ± 0.19 and 17.94 ± 0.44 respectively. These values were very similar or equal to the Cts of purified b3a2 and ABL DNA fragments derived from RT-PCR. However, the non-linearized circular plasmid DNA only had 20.36 ± 0.08 for b3a2 and 20.31 ± 0.13 for ABL when the same number of templates was analyzed in the same qPCR indicating a 5.5 fold deficiency in amplification rate. Although the amplification efficiency obtained from both linearized and circular plasmids were very similar in the range of 3.3±0.3, a deficiency in the amplification rate from the circular plasmid indicates that the complicated super coiled structure in the circular plasmid DNA may interfere with the amplification. After plasmid DNA was completely linearized with three individual restriction enzymes, aliquots of known amounts of plasmid DNA were adjusted to E6 copy number and analyzed without further purification. Depending on the restriction enzyme the amplification rate of non-purified plasmid varied from 69 to almost 100% compared with purified linearized plasmid DNA. To mimic the purification procedure, Rnase A was added to the restriction digestion mixture to remove RNA contamination. Without purification, the addition of RNase A significantly inhibits the amplification rate. Furthermore, standards from Ipsogen were compared in the study. From multiple concentration points in comparison of the standards, Ipsogen standards had a Ct value of 1.43 more than the purified completely linearized plasmid DNA with 2.7 fold deficiency in amplification rate. Since the Ct value of the sample is the same, the standards with low amplification rate would over-estimate the copy number of the sample. In theory, the copy ratio of the fusion gene (b3a2) to the control gene (ABL) should be the same, independent on the amplification rate of the standards. However, in practical experiments with a high amplification rate of the standards, the copy ratio is more accurate and reproducible when the samples have a low copy number of BCR-ABL. The combination of incomplete linearization of plasmid DNA in restriction enzyme digestion, non-purification of the linearized plasmid and contamination of interfering substances may together decrease the amplification rate. The preparation of purified completely linearized plasmid provides a standard way to obtain standards for qPCR in molecular monitoring of the BCR-ABL transcript level in the management of CML patients as well as for qPCR in other usages. Disclosures: No relevant conflicts of interest to declare.

13014 Background: Growth factors are routine after systemic chemotherapy both as primary and secondary prophylaxis. Similarly PET scan is increasingly used for initial staging and follow-up of response. Timing of both is important since false positive results are noted due to high sensitivity of the test. Methods: Records of four patients with super positive PET scan with diffuse uptake in the axial skeleton were analyzed for the timing of administration of white cell growth factor before imaging and confirmation of bone finding with a follow- up bone scan to rule out mets. Results: Two patients were treated for stage IIIB/IV non-small cell lung cancer, one patient with breast cancer was receiving adjuvant treatment for stage IIIA breast cancer, and the last patient was treated for metastatic pancreatic cancer. All had negative scans for bone mets before the start of treatment. PET scan was done for staging in one patient and evaluation of abnormal CT scan in another, and follow-up of response in two patients. It was inadvertently obtained 10–14 days after the filgrastim/pefilgrastim administration. Based on the unusual uptake in bony skeleton, bone scan was ordered to rule out bone mets in all four patients. Since their bone scans were negative for metastatic disease they were continued on their treatment plan as scheduled. Conclusions: PET scan has been sparingly used until 1990’s due to high cost. Currently Medicare has approved it for wider indications. PET scan in general has high sensitivity and low specificity and false positive results are more common from metabolically active infection and inflammation. Granulocyte colony stimulating factor used with cancer treatments can increase the FDG uptake in PET scan. Diffuse increased uptake in bone marrow by PET scan can be seen in reactive marrow following growth factor therapy. Usually FDG uptake is modest with SUV of less than 3, uniform and diffuse if due to growth factor stimulation in contrast to greater intensity with SUV around 6 with non uniform distribution. Awareness of this pitfalls associated with PET scan allows image interpretation accurately. PET-CT fusion may increase the diagnostic specificity. However timing of the scan in relation to growth factor administration may also help to avoid the unnecessary anxiety and further follow up testing which adds to the health care costs. No significant financial relationships to disclose.

The ribs show a wide range of normal and pathologic radiographic appearences as well as congenital variations. Intrathoracic ribs are isolated and rare anomalies. They are usually super-numerary, more often right-sided, and involve the middle part of the thorax. We describe a case with intrathorasic rib abnormality mimicking a peripheral metastatic lung nodule in the plain chest x-ray and emphasize the use of coronal and sagittal reformatted images in thorasic imaging. Utilisation of multiplanar reformatted images in chest computerised tomography increase diagnostic quality.

The move from analog distribution to online digital delivery is common in the contemporary mediascape. Music is in the midst of an ipod driven paradigm shift (Levy), television and movie delivery is being reconfigured (Johnson), and newspaper and magazines are confronting the reality of the world wide web and what it means for business models and ideas of journalism (Beecher). In the midst of this change, the book publishing industry remains defiant. While embracing digital production technologies, the vast majority of book content is still delivered in material form, printed and shipped the old-fashioned way—despite the efforts of many technology companies over the last decade. Even the latest efforts from corporate giants such as Sony and Amazon (who appear to have solved many of the technical hurdles of electronic reading devices) have had little visible impact. The idea of electronic books, or e-books, remains the domain of geeky early adopters (“Have”). The reasons for this are manifold, but, arguably, a broader uptake of e-books has not occurred because cultural change is much more difficult than technological change and book readers have yet to be persuaded to change their cultural habits. Electronic reading devices have been around for as long as there have been computers with screens, but serious attempts to replicate the portability, readability, and convenience of a printed book have only been with us for a decade or so. The late 1990s saw the release of a number of e-book devices. In quick succession, the likes of the Rocket e-Book, the SoftBook and the Franklin eBookman all failed to catch on. Despite this lack of market penetration, software companies began to explore the possibilities—Microsoft’s Reader software competed with a similar product from Adobe, some publishers became content providers, and a niche market of consumers began reading e-books on personal digital assistants (PDAs). That niche was sufficient for e-reading communities and shopfronts to appear, with a reasonable range of titles becoming available for purchase to feed demand that was very much driven by early adopters. But the e-book market was and remains small. For most people, books are still regarded as printed paper objects, purchased from a bookstore, borrowed from a library, or bought online from companies like Amazon.com. More recently, the introduction of e-ink technologies (EPDs) (DeJean), which allow for screens with far more book-like resolution and contrast, has provided the impetus for a new generation of e-book devices. In combination with an expanded range of titles (and deals with major publishing houses to include current best-sellers), there has been renewed interest in the idea of e-books. Those who have used the current generation of e-ink devices are generally positive about the experience. Except for some sluggishness in “turning” pages, the screens appear crisp, clear and are not as tiring to read as older displays. There are a number of devices that have embraced the new screen technologies (mobileread) but most attention has been paid to three devices in particular—mainly because their manufacturers have tried to create an ecosystem that provides content for their reading devices in much the same way that Apple’s itunes store provides content for ipods. The Sony Portable Reader (Sonystyle) was the first electronic ink device to be produced by a mainstream consumers electronics company. Sony ties the Reader to its Connect store, which allows the purchase of book titles via a computer; titles are then downloaded to the Reader in the same way that an mp3 player is loaded with music. Sony’s most prominent competition in the marketplace is Amazon’s Kindle, which does not require users to have a computer. Instead, its key feature is a constant wireless connection to Amazon’s growing library of Kindle titles. This works in conjunction with US cellphone provider Sprint to allow the purchase of books via wireless downloads wherever the Sprint network exists. The system, which Amazon calls “whispernet,” is invisible to readers and the cost is incorporated into the price of books, so Kindle users never see a bill from Sprint (“Frequently”). Both the Sony Reader and the Amazon Kindle are available only in limited markets; Kindle’s reliance on a cellphone network means that its adoption internationally is dependent on Amazon establishing a relationship with a cellphone provider in each country of release. And because both devices are linked to e-bookstores, territorial rights issues with book publishers (who trade publishing rights for particular global territories in a colonial-era mode of operation that seems to ignore the reality of global information mobility (Thompson 74–77)) contribute to the restricted availability of both the Sony and Amazon products. The other mainstream device is the iRex Iliad, which is not constrained to a particular online bookstore and thus is available internationally. Its bookstore ecosystems are local relationships—with Dymocks in Australia, Borders in the UK, and other booksellers across Europe (iRex). All three devices use EPDs and share similar specifications for the actual reading of e-books. Some might argue that the lack of a search function in the Sony and the ability to write on pages in the Iliad are quite substantive differences, but overall the devices are distinguished by their availability and the accessibility of book titles. Those who have used the devices extensively are generally positive about the experience. Amazon’s Customer Reviews are full of positive comments, and the sense from many commentators is that the systems are a viable replacement for old-fashioned printed books (Marr). Despite the good reviews—which suggest that the technology is actually now good enough to compete with printed books—the e-book devices have failed to catch on. Amazon has been hesitant to state actual sales figures, leaving it to so-called analysts to guess with the most optimistic suggesting that only 30 to 50,000 have sold since launch in late 2007 (Sridharan). By comparison, a mid-list book title (in the US) would expect to sell a similar number of copies. The sales data for the Sony Portable Reader (which has been on the market for nearly two years) and the iRex iliad are also elusive (Slocum), suggesting that they have not meaningfully changed the landscape. Tellingly, despite the new devices, the e-book industry is still tiny. Although it is growing, the latest American data show that the e-book market has wholesale revenues of around $10 million per quarter (or around $40 million per year), which is dwarfed by the $35 billion in revenues regularly earned annually in the US printed book industry ("Book"). It’s clear that despite the technological advances, e-books have yet to cross the chasm from early adopter to mainstream usage (see IPDF). The reason for this is complex; there are issues of marketing and distribution that need to be considered, as well as continuing arguments about screen technologies, appropriate publishing models, and digital rights management. It is beyond the scope of this article to do justice to those issues. Suffice to say, the book industry is affected by the same debates over content that plague other media industries (Vershbow). But, arguably, the key reason for the minimal market impact is straightforward—technological change is relatively easy, but cultural change is much more difficult. The current generation of e-book devices might be technically very close to being a viable replacement for print on paper (and the next generation of devices will no doubt be even better), but there are bigger cultural hurdles to be overcome. For most people, the social practice of reading books (du Gay et al 10) is inextricably tied with printed objects and a print culture that is not yet commonly associated with “technology” (perhaps because books, as machines for reading (Young 160), have become an invisible technology (Norman 246)). E. Annie Proulx’s dismissive suggestion that “nobody is going to sit down and read a novel on a twitchy little screen. Ever” (1994) is commonly echoed when book buyers consider the digital alternative. Those thoughts only scratch the surface of a deeply embedded cultural practice. The centuries since Gutenberg’s printing press and the vast social and cultural changes that followed positioned print culture as the dominant cultural mode until relatively recently (Eisenstein; Ong). The emerging electronic media forms of the twentieth century displaced that dominance with many arguing that the print age was moved aside by first radio and television and now computers and the Internet (McLuhan; Postman). Indeed, there is a subtext in that line of thought, one that situates electronic media forms (particularly screen-based ones) as the antithesis of print and book culture. Current e-book reading devices attempt to minimise the need for cultural change by trying to replicate a print culture within an e-print culture. For the most part, they are designed to appeal to book readers as a replacement for printed books. But it will take more than a perfect electronic facsimile of print on paper to persuade readers to disengage with a print culture that incorporates bookshops, bookclubs, writing in the margins, touching and smelling the pages and covers, admiring the typesetting, showing off their bookshelves, and visibly identifying with their collections. The frequently made technical arguments (about flashing screens and reading in the bath (Randolph)) do not address the broader apprehension about a cultural experience that many readers do not wish to leave behind. It is in that context that booklovers appear particularly resistant to any shift from print to a screen-based format. One only has to engage in a discussion about e-books (or lurk on an online forum where one is happening) to appreciate how deeply embedded print culture is (Hepworth)—book readers have a historical attachment to the printed object and it is this embedded cultural resistance that is the biggest barrier for e-books to overcome. Although e-book devices in no way resemble television, print culture is still deeply suspicious of any screen-based media and arguments are often made that the book as a physical object is critical because “different types of media function differently, and even if the content is similar the form matters quite a lot” (Weber). Of course, many in the newspaper industry would argue that long-standing cultural habits can change very rapidly and the migration of eyeballs from newsprint to the Internet is a cautionary tale (see Auckland). That specific format shift saw cultural change driven by increased convenience and a perception of decreased cost. For those already connected to the Internet, reading newspapers online represented zero marginal cost, and the range of online offerings dwarfed that of the local newsagency. The advantage of immediacy and multimedia elements, and the possibility of immediate feedback, appeared sufficient to drive many away from print towards online newspapers.For a similar shift in the e-book realm, there must be similar incentives for readers. At the moment, the only advantages on offer are weightlessness (which only appeals to frequent travellers) and convenience via constant access to a heavenly library of titles (Young 150). Amazon’s Kindle bookshop can be accessed 24/7 from anywhere there is a Sprint network coverage (Nelson). However, even this advantage is not so clear-cut—there is a meagre range of available electronic titles compared to printed offerings. For example, Amazon claims 130,000 titles are currently available for Kindle and Sony has 50,000 for its Reader, figures that are dwarfed by Amazon’s own printed book range. Importantly, there is little apparent cost advantage to e-books. The price of electronic reading devices is significant, amounting to a few hundred dollars to which must be added the cost of e-books. The actual cost of those titles is also not as attractive as it might be. In an age where much digital content often appears to be free, consumers demand a significant price advantage for purchasing online. Although some e-book titles are priced more affordably than their printed counterparts, the cost of many seems strangely high given the lack of a physical object to print and ship. For example, Amazon Kindle titles might be cheaper than the print version, but the actual difference (after discounting) is not an order of magnitude, but of degree. For example, Randy Pausch’s bestselling The Last Lecture is available for $12.07 as a paperback or $9.99 as a Kindle edition (“Last”). For casual readers, the numbers make no sense—when the price of the reading device is included, the actual cost is prohibitive for those who only buy a few titles a year. At the moment, e-books only make sense for heavy readers for whom the additional cost of the reading device will be amortised over a large number of books in a reasonably short time. (A recent article in the Wall Street Journal suggested that the break-even point for the Kindle was the purchase of 61 books (Arends).) Unfortunately for the e-book industry, not is only is that particular market relatively small, it is the one least likely to shift from the embedded habits of print culture. Arguably, should e-books eventually offer a significant cost benefit for consumers, uptake would be more dramatic. However, in his study of cellphone cultures, Gerard Goggin argues against purely fiscal motivations, suggesting that cultural change is driven by other factors—in his example, new ways of communicating, connecting, and engaging (205–211). The few market segments where electronic books have succeeded are informative. For example, the market for printed encyclopedias has essentially disappeared. Most have reinvented themselves as CD-ROMs or DVD-ROMs and are sold for a fraction of the price. Although cost is undoubtedly a factor in their market success, added features such as multimedia, searchability, and immediacy via associated websites are compelling reasons driving the purchase of electronic encyclopedias over the printed versions. The contrast with the aforementioned e-book devices is apparent with encyclopedias moving away from their historical role in print culture. Electronic encyclopedias don’t try to replicate the older print forms. Rather they represent a dramatic shift of book content into an interactive audio-visual domain. They have experimented with new formats and reconfigured content for the new media forms—the publishers in question simply left print culture behind and embraced a newly emerging computer or multimedia culture. This step into another realm of social practices also happened in the academic realm, which is now deeply embedded in computer-based delivery of research and pedagogy. Not only are scholarly journals moving online (Thompson 320–325), but so too are scholarly books. For example, at the Macquarie University Library, there has been a dramatic increase in the number of electronic books in the collection. The library purchased 895 e-books in 2005 and 68,000 in 2007. During the same period, the number of printed books purchased remained relatively stable with about 16,000 bought annually (Macquarie University Library). The reasons for the dramatic increase in e-book purchases are manifold and not primarily driven by cost considerations. Not only does the library have limited space for physical storage, but Macquarie (like most other Universities) emphasises its e-learning environment. In that context, a single e-book allows multiple, geographically dispersed, simultaneous access, which better suits the flexibility demanded of the current generation of students. Significantly, these e-books require no electronic reading device beyond a standard computer with an internet connection. Users simply search for their required reading online and read it via their web browser—the library is operating in a pedagogical culture that assumes that staff and students have ready access to the necessary resources and are happy to read large amounts of text on a screen. Again, gestures towards print culture are minimal, and the e-books in question exist in a completely different distributed electronic environment. Another interesting example is that of mobile phone novels, or “keitai” fiction, popular in Japan. These novels typically consist of a few hundred pages, each of which contains about 500 Japanese characters. They are downloaded to (and read on) cellphones for about ten dollars apiece and can sell in the millions of copies (Katayama). There are many reasons why the keitai novel has achieved such popularity compared to the e-book approaches pursued in the West. The relatively low cost of wireless data in Japan, and the ubiquity of the cellphone are probably factors. But the presence of keitai culture—a set of cultural practices surrounding the mobile phone—suggests that the mobile novel springs not from a print culture, but from somewhere else. Indeed, keitai novels are written (often on the phones themselves) in a manner that lends itself to the constraints of highly portable devices with small screens, and provides new modes of engagement and communication. Their editors attribute the success of keitai novels to how well they fit into the lifestyle of their target demographic, and how they act as community nodes around which readers and writers interact (Hani). Although some will instinctively suggest that long-form narratives are doomed with such an approach, it is worthwhile remembering that, a decade ago, few considered reading long articles using a web browser and the appropriate response to computer-based media was to rewrite material to suit the screen (Nielsen). However, without really noticing the change, the Web became mainstream and users began reading everything on their computers, including much longer pieces of text. Apart from the examples cited, the wider book trade has largely approached e-books by trying to replicate print culture, albeit with an electronic reading device. Until there is a significant cost and convenience benefit for readers, this approach is unlikely to be widely successful. As indicated above, those segments of the market where e-books have succeeded are those whose social practices are driven by different cultural motivations. It may well be that the full-frontal approach attempted to date is doomed to failure, and e-books would achieve more widespread adoption if the book trade took a different approach. The Amazon Kindle has not yet persuaded bookloving readers to abandon print for screen in sufficient numbers to mark a seachange. Indeed, it is unlikely that any device positioned specifically as a book replacement will succeed. Instead of seeking to make an e-book culture a replacement for print culture, effectively placing the reading of books in a silo separated from other day-to-day activities, it might be better to situate e-books within a mobility culture, as part of the burgeoning range of social activities revolving around a connected, convergent mobile device. Reading should be understood as an activity that doesn’t begin with a particular device, but is done with whatever device is at hand. In much the same way that other media producers make content available for a number of platforms, book publishers should explore the potential of the new mobile devices. Over 45 million smartphones were sold globally in the first three months of 2008 (“Gartner”)—somewhat more than the estimated shipments of e-book reading devices. As well as allowing a range of communications possibilities, these convergent devices are emerging as key elements in the new digital mediascape—one that allows users access to a broad range of media products via a single pocket-sized device. Each of those smartphones makes a perfectly adequate e-book reading device, and it might be useful to pursue a strategy that embeds book reading as one of the key possibilities of this growing mobility culture. The casual gaming market serves as an interesting example. While hardcore gamers cling to their games PCs and consoles, a burgeoning alternative games market has emerged, with a different demographic purchasing less technically challenging games for more informal gaming encounters. This market has slowly shifted to convergent mobile devices, exemplified by Sega’s success in selling 300,000 copies of Super Monkey Ball within 20 days of its release for Apple’s iphone (“Super”). Casual gamers do not necessarily go on to become hardcore games, but they are gamers nonetheless—and today’s casual games (like the aforementioned Super Monkey Ball) are yesterday’s hardcore games of choice. It might be the same for reading. The availability of e-books on mobile platforms may not result in more people embracing longer-form literature. But it will increase the number of people actually reading, and, just as casual gaming has attracted a female demographic (Wallace 8), the instant availability of appropriate reading material might sway some of those men who appear to be reluctant readers (McEwan). Rather than focus on printed books, and book-like reading devices, the industry should re-position e-books as an easily accessible content choice in a digitally converged media environment. This is more a cultural shift than a technological one—for publishers and readers alike. Situating e-books in such a way may alienate a segment of the bookloving community, but such readers are unlikely to respond to anything other than print on paper. Indeed, it may encourage a whole new demographic—unafraid of the flickering screen—to engage with the manifold attractions of “books.” References Arends, Brett. “Can Amazon’s Kindle Save You Money?” The Wall St Journal 24 June 2008. 25 June 2008 ‹http://online.wsj.com/article/SB121431458215899767.html? mod=rss_whats_news_technology>. Auckland, Steve. “The Future of Newspapers.” The Independent 13 Nov. 2008. 24 June 2008 ‹http://news.independent.co.uk/media/article1963543.ece>. Beecher, Eric. “War of Words.” The Monthly, June 2007: 22–26. 25 June 2008 . “Book Industry Trends 2006 Shows Publishers’ Net Revenues at $34.59 Billion for 2005.” Book Industry Study Group. 22 May 2006 ‹http://www.bisg.org/news/press.php?pressid=35>. DeJean, David, “The Future of e-paper: The Kindle is Only the Beginning.” Computerworld 6 June 2008. 12 June 2008 ‹http://www.computerworld.com/action/article .do?command=viewArticleBasic&articleId=9091118>. du Gay, Paul, Stuart Hall, Linda Janes, Hugh Mackay, and Keith Negus. Doing Cultural Studies: The Story of the Sony Walkman. Thousand Oaks: Sage, 1997. Eisenstein, Elizabeth. The Printing Press as an Agent of Change. Cambridge: Cambridge UP, 1997. “Frequently Asked Questions about Amazon Kindle.” Amazon.com. 12 June 2008 ‹http://www.amazon.com/gp/help/customer/display.html?nodeId=200127480&#whispernet>. “Gartner Says Worldwide Smartphone Sales Grew 29 Percent in First Quarter 2008.” Gartner. 6 June 2008. 20 June 2008 ‹http://www.gartner.com/it/page.jsp?id=688116>. Goggin, Gerard. Cell Phone Cultures. London: Routledge, 2006. Hani, Yoko. “Cellphone Bards Make Bestseller Lists.” Japan Times Online Sep. 2007. 20 June 2008 ‹http://search.japantimes.co.jp/cgi-bin/fl20070923x4.html>. “Have you Changed your mind on Ebook Readers?” Slashdot. 25 June 2008 ‹http://ask.slashdot.org/article.pl?sid=08/05/08/2317250>. Hepworth, David. “The Future of Reading or the Sinclair C5.” The Word 17 June 2008. 20 June 2008 ‹http://www.wordmagazine.co.uk/content/future-reading-or-sinclair-c5>. IPDF (International Digital Publishing Forum) Industry Statistics. 24 June 2008 ‹http://www.openebook.org/doc_library/industrystats.htm>. iRex Technologies Press. 12 June 2008 ‹http://www.irextechnologies.com/about/press>. Johnson, Bobbie. “Vince Cerf, AKA the Godfather of the Net, Predicts the End of TV as We Know It.” The Guardian 27 Aug. 2008. 24 June 2008 ‹http://www.guardian.co.uk/technology/2007/aug/27/news.google>. Katayama, Lisa. “Big Books Hit Japan’s Tiny Phones.” Wired Jan. 2007. 24 June 2008 ‹http://www.wired.com/culture/lifestyle/news/2007/01/72329>. “The Last Lecture.” Amazon.com. 24 June 2008 ‹http://www.amazon.com/gp/product/1401323251/ref=amb_link_3359852_2? pf_rd_m=ATVPDKIKX0DER&pf_rd_s=right-1&pf_rd_r=07NDSWAK6D4HT181CNXD &pf_rd_t=101&pf_rd_p=385880801&pf_rd_i=549028>.Levy, Steven. The Perfect Thing. London:Ebury Press, 2006. Macquarie University Library Annual Report 2007. 24 June 2008 ‹http://senate.mq.edu.au/ltagenda/0308/library_report%202007.doc>. Marr, Andrew. “Curling Up with a Good EBook.” The Guardian 11 May 2007. 23 May 2007 ‹http://technology.guardian.co.uk/news/story/0,,2077278,00.html>. McEwan, Ian. “Hello, Would you Like a Free Book?” The Guardian 20 Sep. 2005. 28 June 2008 ‹http://www.guardian.co.uk/books/2005/sep/20/fiction.features11>. McLuhan, Marshall. The Gutenberg Galaxy. Toronto: U of Toronto P, 1962. Mobileread. E-book Reader Matrix, Mobileread Wiki. 30 May 2008 ‹http://wiki.mobileread.com/wiki/E-book_Reader_Matrix>. Nelson, Sara. “Warming to Kindle.” Publishers Weekly 10 Dec. 2007. 31 Jan. 2008 ‹http://www.publishersweekly.com/article/CA6510861.htm.html>. Nielsen, Jakob. “Concise, Scannable and Objective, How to Write for the Web.” 1997. ‹20 June 2008 ‹http://www.useit.com/papers/webwriting/writing.html>. Norman, Don. The Invisible Computer: Why Good Products Can Fail. Cambridge, MA: MIT P, 1998. Ong, Walter. Orality & Literacy: The Technologizing of the Word. New York: Methuen, 1988. Postman, Neil. Amusing Ourselves to Death. New York: Penguin, 1986. Proulx, E. Annie. “Books on Top.” The New York Times 26 May 1994. 28 June 2008 ‹http://www.nytimes.com/books/99/05/23/specials/proulx-top.html>. Randolph, Eleanor. “Reading into the Future.” The New York Times 18 June 2008. 19 June 2008 ‹http://www.nytimes.com/2008/06/18/opinion/18wed3.html?>. Slocum, Mac. “The Pitfalls of Publishing’s E-Reader Guessing Game.” O’Reilly TOC. June 2006. 24 June 2008 ‹http://toc.oreilly.com/2008/06/the-pitfalls-of-publishings-er.html>. Sridharan, Vasanth. “Goldman: Amazon Sold up to 50,000 Kindles in Q1.” Silicon Alley Insider 19 May 2008. 25 June 2008 ‹http://www.alleyinsider.com/2008/5/how_many_kindles_sold_last_quarter_>. “Super Monkey Ball iPhone's Super Sales.” Edge OnLine. 24 Aug. 2008 ‹http://www.edge-online.com/news/super-monkey-ball-iphones-super-sales>. Thompson, John B. Books in the Digital Age. London: Polity, 2005. Vershbow, Ben. “Self Destructing Books.” if:book. May 2005. 4 Oct. 2006 ‹http://www.futureofthebook.org/blog/archives/2005/05/selfdestructing_books.html>. Wallace, Margaret, and Brian Robbins. 2006 Casual Games White Paper. IDGA. 24 Aug. 2008 ‹http://www.igda.org/casual/IGDA_CasualGames_Whitepaper_2006.pdf>. Weber, Jonathan. “Why Books Resist the Rise of Novel Technologies.” The Times Online 23 May 2006. 25 June 2008 ‹http://entertainment.timesonline.co.uk/tol/arts_and_entertainment/books/article724510.ece> Young, Sherman. The Book is Dead, Long Live the Book. Sydney: UNSW P, 2007.

IntroductionA catastrophe is often considered to be a final decisive event, resulting in a disastrous end. Two recent examples of catastrophes satisfying this definition were the 2012 super storm Sandy in the United States of America and the 2011 floods in Brisbane, Australia. The progress of these disasters was reported worldwide, yet coverage soon disappeared from the headlines, leaving people to deal with the aftermath of rebuilding homes, businesses and lives. The diagnosis of breast cancer is an individual’s catastrophic event. While not on the community-wide scale of the disasters mentioned previously, it can have disastrous effects on the individual as well as their family and friends. At the moment 1 in 8 women can expect to have a breast cancer diagnosis. In Australia alone this means approximately 1,375,000 people are likely to receive this diagnosis in the course of their lifetime. This article addresses how breast cancer can and does prompt women and their supportive friends, families and partners to become more creative as a result of the breast cancer (BC) diagnosis. In these cases, creativity—defined as doing something a little differently or thinking outside the square—can offer some remedy for catastrophe. Becoming totally involved in the creative moment, so as to lose all track of time and forget the trials and worries of BC, is referred to as flow. Flow is an “optimal experience” in which “people become so involved in what they are doing that the activity becomes spontaneous, almost automatic; they stop being aware of themselves as separate from the actions they are performing” (Csikszentmihalyi 53). This is one fruit of the creative process. This article refers to women as having breast cancer because the majority of people diagnosed with BC are women. However it is acknowledged that men constitute 0.8% of the total number of people diagnosed with BC (Breast Cancer in Australia). Responding to public concern, a range of charities has been formed to support people with breast cancer. One such charity is Breast Cancer Care WA (BCCWA). Together with the Australian Research Council (ARC) and Edith Cowan University (ECU), BCCWA supports an online community for people with breast cancer, Breast Cancer Click (Click). The membership of Click includes several male Clickers who are partners and supporters of Click members with BC. The Click online community consists of people with BC and their supporters, as well as health care practitioners and researchers. Those members with breast cancer are very interested in learning more about BC and supporting others in a similar situation whereas the health care practitioners and researchers are both supporting those with breast cancer and exploring the possibilities offered by online communities, to enhance their professional skills. Members of Click could be described as a community of practice, “groups of people informally bound together by shared expertise and passion for a joint enterprise” (Wenger and Snyder 139), in this case a passion for responding positively to a BC diagnosis. Wenger and Snyder go on to say: “People in communities of practice share their experiences and knowledge in free-flowing, creative ways that foster new approaches to problems” (140). The Click community helps foster creativity.Many of the verbatim quotes used in this article are taken from the www.breastcancerclick.com.au (Click) website. Instead of identifying a speaker with a personal attribution the term “Clicker” is used, and then qualified as a Clicker with breast cancer (BC) to differentiate the author from a Clicker who supports someone with breast cancer (Supporter). The Click website provides every member with an opportunity to express themselves and they often respond creatively to the challenges that confront them. The Chaos and Catastrophe of a Breast Cancer Diagnosis When a woman is first diagnosed with breast cancer, it is often as a result of her bi-annual mammogram. She expects a routine visit but is advised instead that she requires further investigation because abnormalities have been detected. This is not what she expected. Probably all previous mammograms have been normal. The personal catastrophe occurs when the woman receives a definitive diagnosis of breast cancer. Chaos is added to catastrophe as the patient and her family struggle to grasp the meaning of the diagnosis and the multiplicity of treatment options. For some, the diagnosis is quickly followed by another catastrophic event, the removal of one or both breasts. For others the catastrophe occurs by increments. This is evident in a member’s blog on the Click website,More surgery [...] dammit!!!!!!!!!! I just want this over NOW. The whole lot. I want my hair back, I want my working life back, I want the smile back on my man's face. I want ME back. I want to dance again. I want to have a conversation with friends that doesn't include my diagnosis or prognosis [...] short term, long term [...] any bloody term!!!! (Clicker BC) People with a breast cancer diagnosis do not always have an endpoint in sight, or an acceptable endpoint at all, and the chaos of treatment and recovery is focused on coping with the present and the next treatment on the horizon. This Clicker uses her blog to help her deal with the next stage of a seemingly interminable round of surgical and chemotherapeutic procedures which have thrown herself, her family, her friends and her work life into chaos. Other Clickers immediately responded to her angst with messages of support and understanding. Had this clicker not written a blog, she would not have received this support and consequently she may have coped less successfully with her treatment. Given the chaos and catastrophe inherent in a breast cancer diagnosis, what else can individuals do that makes a positive difference to their lives as they deal with the “treatment, wait, check” cycle that is the medical response to breast cancer? Creativity Arising from Chaos When people receive a life threatening diagnosis such as breast cancer, they sometimes choose to think outside the square, to do things a little differently, to change the way they relate to others, to learn a new art or craft or to take up a musical instrument. Being creative seems to provide distraction from the treatment, and may be something to look forward to when the treatment is over. Some choose to participate in a formal creative therapy program, others seek out a creative pursuit which they can do at home. For some women with a breast cancer diagnosis, joining the Click website is itself a creative act. Contributing to an online community with a common interest in BC which gives them unconditional support, such as Click, also provides them with new skills and allows other people to benefit from their advice and experience: Hi everyone. I know we all have different ways of dealing with our cancer. Mine has been to be more mindful of the wonders around me and savour every possible moment of joy. I have decided to start my own Blog to give myself a creative outlet and share my experiences. (Clicker BC) There may be a number of reasons for participating in an online community of people with breast cancer and their supporters. Whatever the motivation, it requires a person to think laterally and learn new skills in how to navigate and post to a website. A newbie member enters a relationship with people she hasn’t met. She can choose to create a new persona using an avatar, or simply devise a username which represents her online. Creativity, Click and Flow Susan Nesbit, an Associate Professor in the University of Manitoba’s occupational therapy department, was diagnosed with BC in 2000. She used “everyday creativity to maintain a good attitude and positive spirits” and refers to Csikszentmihalyi’s concept of “flow” to explain the gratifying experience which occurs when someone fully participates in an activity:that I am doing it for its own sake, and when I become so involved […] that I become spontaneous and almost automatic, I am experiencing flow. My energy flows smoothly, I feel relaxed, comfortable, energetic and totally absorbed, losing track of time. (Nesbit 63) Richards (489) describes creativity as having two conditions: one is originality and the other is meaningfulness. She argues that everyday creativity “in the multitudinous activities of day-to-day life […] has been conceptualised as a survival capability” (489). Click allows members to share this everyday creativity, inspiring a creative response in others. One Clicker (BC), who produces handmade cards at home, was inspired to hold a Skype card-making education session for rural and remote people (with and without BC).Today is a day of craft for me. I held my first remote workshop […] and it was a huge success. Just made a couple of Father's Day cards for a customer and decided to share some of my work with you all. I'd love you to take a peek at my album [...] doing what I love to do was and is my therapy to get me through each new crisis xxx. (Clicker BC) It seems this Clicker first achieved flow through the act of making cards for her own pleasure and then maintained that flow through the planning and execution of an online card making class, which was a great success. She found something that helped her to take control of her life and to live more fully and at the same time gave others the opportunity to do the same. The success of this session might inspire this Clicker to conduct more sessions for others, while those attending the session who may be battling a serious illness, might also achieve flow through absorption in the card-making process, then maintain flow through the positive responses they receive from recipients of these cards. Ripples in this online creative space reach out towards a widening pool of card makers, assisting them to cope with chaotic occurrences. Creative Therapy and Breast Cancer Some women may choose to participate in formal creative therapy programmes such as art therapy to help them deal with their cancer treatment. In general more women than men with cancer choose to use this creative response to help them cope (Geue et al. 168). This intervention when used with breast cancer patients has been shown to enhance psychological well-being by decreasing negative emotional states and enhancing positive ones (Puig et al. 224). For example, music therapy with a group of BC patients waiting for a chemotherapy cycle appeared to directly reduce patients’ anxiety and physiological arousal, while enhancing their sense of wellbeing and control (Bulfone et al. 241). Blogging and Breast Cancer The creative pursuit may already be part of woman’s “normal” or pre-diagnosis life, or may be identified and pursued as a result of the diagnosis and used as informal therapy to keep the chaos at bay, for example through joining a support website and blogging. Orgad’s research shows that when women write about their breast cancer story, “storytelling” online, it helps them cope with their disease. “The act of writing is seen as a crucial affirmation of living, a statement against fearfulness, invisibility and silence” (Lord qtd in. Orgad 67). The new ideas and direction for these women’s creativity may also be used to vent their feelings and to gain perspective on their breast cancer journey, or the story may be written to help others facing a similar journey. As evidenced by the collection of blogs at breastcancerblogs.org it seems a number of women find blogs offer a creative response to their breast cancer journey. The BC blogosphere is a vibrant record of resistance to the disease. Click members are encouraged to blog, and are given space on the site to do so, with full privacy if they choose. A study conducted by Chung and Kim (304) showed those cancer patients and their companions found blogging activity to be helpful in emotion management and for information sharing. The Clickers are also encouraged to complete a SWEE in their blog. SWEE stands for “structured written emotional expression” where a person writes about their breast cancer journey for 10-15 minutes each day for three to five days in a row. The Clicker has the opportunity to creatively express their positive and negative feelings about their breast cancer diagnosis. Research shows that writing a SWEE can be good for both physical and emotional health (Pennebaker 540; Lieberman, Morton and Goldstein 859; Butcher and Buckwalter 114; Stanton et al. 4165; Low, Stanton and Danoff-Burg 187). One Click member, the author of the Paw Paw Salad blog, received a top blog award from the breastcancerblogs website. She writes about her life with breast cancer and the stress of not knowing when or if she will ever be free of the disease. She is positive, however, about the Tamoxifen tablet she must take for another five years or more. She tries to only let the word “cancer” briefly enter her mind, once a day, when she takes her pill and to carry on as normal the rest of the time. On returning home from a camping trip, which she also described in her blog, she noted that her cancer medication bottle was looking battered and dirty.And for the first time, the sight of it made me smile. I've decided that this is just the way my Tamoxifen bottle should look. It’s not a bottle to be kept pristine in a medicine cabinet—I want it to be tossed into suitcases, kept cold in dust-covered eskies, dropped on the floor in the morning flurry. I'm hoping that my daily reminder of cancer will, as often as possible, be washed down with camp-stove coffee. And I’m thinking that the last pill of each year’s prescription demands a champagne and strawberry chaser (Paw Paw Salad). This post demonstrates the blogger’s ability to perceive and describe BC paraphernalia differently, and she uses this perspective to bolster her resilience in the face of the ongoing BC chaos in her life. Some Clickers express ambivalence towards taking Tamoxifen, a hormone based chemotherapeutic agent, because of its potentially deleterious side effects on their everyday sense of wellbeing. This blog entry may give them a new perspective on life, in spite of the possible side effects of the drug, and encourage them to celebrate the end of each year of taking the pill as one step towards being free of cancer. The fact that the writer can go camping while taking the Tamoxifen pill also demonstrates to others that life doesn’t have to stop. Mammoirs Some people with a BC diagnosis (non-Click members) have gone on to write what is affectionately called a “mammoir” a book which recounts their breast cancer journey or provides advice and information for those newly diagnosed with breast cancer. This is the term applied by Clickers even to established works of literature, such as Professor Brenda Walker’s award-winning “mammoir,” Reading by Moonlight: How Books Saved a Life. The book describes how Walker took refuge from the chaos of her breast cancer diagnosis in the books she’d always loved. Her experience of chaos prompted her to turn towards the creativity of others, which in turn triggered renewed creativity in the form of her memoir. Conclusion A diagnosis of breast cancer is for most women, a catastrophe. The newly diagnosed person is aware that this diagnosis may well be followed quite quickly by a mastectomy. Together with adjunct treatments, such as chemotherapy and/or radiotherapy, this causes chaos within the woman’s life, family and friendship networks. Each woman and her supporters deal with the catastrophe and ensuing chaos in their own individual creative way. Creative expressions include blogs, where women can tell their story; poetry, such as haikus and free verse; and simple venting of feelings about diagnosis and treatment. The SWEE technique seems to indicate that written engagement helps people cope with their diagnosis and illness. Attendance at art or music therapy sessions has been shown to be therapeutic and “mammoirs” have been written to help others to avoid the pitfalls of the health system or to deal with treatment and its side-effects. Both informal and formal or organised creative therapy appears to have positive psychological effects on the woman with breast cancer. Whether each individual with BC achieved flow, as described by Csikszentmihalyi, is not known, but it appears from the Click community that many do use everyday creative acts to help them deal with the ongoing chaos of their diagnosis and treatment. The Click was created to provide a blank canvas for those with breast cancer and their supporters to reach out to others in a similar situation. Through allowing people to respond creatively and to have those creative responses validated, this reaching out often also involves reaching in—and harnessing creativity. 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Acknowledgements A special thanks to all the people, women and men, who have shared their lives with the research team via the Breast Cancer Click website. Breast Cancer Care WA, our ARC Linkage Project industry partner.