Journal articles on the topic 'Whitaker College of Health Sciences, Technology, and Management'

A Review of: Reed, J. B., & Carroll, A. J. (2020). Roles for health sciences librarians at college and university libraries. Issues in Science and Technology Librarianship, (94). https://doi.org/10.29173/istl42 Abstract Objective – To examine job postings for academic health sciences libraries to determine if they reflect the changing research needs of institutions of higher education and to compare these postings to similar, existing positions. Design – Mixed methods data analysis of job advertisements collected through relevant job boards and mailing lists. The authors conducted qualitative content analysis using a modified grounded theory approach, completed two cycles of coding using NVivo 12, and calculated statistical significance using Fisher’s exact test. Setting – College and university library and Association of Academic Health Sciences Libraries job boards and mailing lists between September 1, 2018 and March 1, 2019. Subjects – 104 unique posted job descriptions. Methods – The authors conducted a thorough search of posted position descriptions (PPDs) for academic health sciences librarians across a number of job boards and mailing lists between September 1, 2018 and March 1, 2019. In addition to searching ALA JobLIST, MLA Find a Job, Association of College & Research Libraries Health Sciences Interest Group (ACRL HSIG), MEDLIB-L, and ACRL Science and Technology Section (STS), the authors also hand searched alumni and general library job electronic mailing lists using relevant keyword searching. Inclusion criteria for PPDs included research support and other research-related responsibilities for the health sciences. The authors excluded any PPDs describing administrative or non-professional positions. Following review, the IRB determined that the research design did not qualify as human subjects research. After data collection, the authors categorized the PPDs using the National Network of Libraries of Medicine (NNLM) geographic regions and by the type of institution—college and university libraries (C&UL) or Association of Academic Health Sciences Libraries (AAHSL). Using modified grounded theory, the authors identified emergent themes from the PPDs and applied descriptive coding. Then, the authors merged categories to create overall themes. Using NVivo 12 to facilitate the mixed methods content analysis, the authors ran text queries to identify major themes in the position roles and responsibilities, required and preferred education, and required and preferred qualifications sections. They also noted themes they expected to see that did not emerge in the PPDs, as well as emerging roles for health sciences libraries that are identified in the literature but did not appear as major themes in the included PPDs. Finally, the authors utilized Fisher’s exact test to calculate statistical significance. Main Results – In the quantitative analysis, the authors identified 60 AAHSL and 44 C&UL PPDs out of the 104 total job postings. Positions were available from all 8 NNLM Regions and across 32 states, though they were not all equally distributed. Most of the positions (64 of the 104) were located in the NNLM Middle Atlantic, Southeastern/Atlantic, and Greater Midwest regions. The Southeastern/Atlantic and Greater Midwest regions made up nearly half of the included PPDs. However, the New England region had the most postings per capita. In the qualitative analysis, an ALA-accredited MLIS or equivalent degree emerged as a near-universal requirement across all PPDs. The authors noted that the few PPDs that did not require this degree typically referenced it in the preferred education section or described a proxy to the MLIS. Furthermore, 57% of C&UL positions compared to 27% of AAHSL positions listed preferred education (p=0.0004) that was usually related to health and science disciplines that the position supported. There was significant overlap of required qualifications for AAHSL and C&UL postings. The authors also identified a list of hard and soft skills noted in the PPDs’ required qualifications sections, including experience with specific tools, expertise in library services, and interpersonal skills. However, reportedly emerging skills in data sciences, open science, grant experience, and research impact assessment were absent in many PPDs. The authors found statistically significant differences between two themes in the PPD roles and responsibilities including collection management (p=0.0004) and systematic reviews (p=0.03). Additionally, the authors found no statistically significant differences for required qualifications between AAHLS and C&UL PPDs. They did find statistically significant differences for two preferred qualifications including the Academic of Health Information Professionals (AHIP) credential (p=0.0042) and experience with systematic reviews (p=0.0009). The AHIP credential and experience with systematic reviews were absent in the C&UL PPDs and referenced rarely in AAHSL postings. Though diversity, equity, and inclusion (DEI) qualifications were frequently referenced in C&UL PPD requirements, the authors noted that research libraries have failed to make meaningful change in diverse candidate hiring and retention, but also pointed to the rapid adoption of DEI qualifications in PPDs within a short period of time. The authors highlighted that the roles and responsibilities reflected traditional librarian duties and referenced more emerging skills and research needs than any other section of the PPD. Assessment and systematic reviews appeared more often in the roles and responsibilities sections of AAHSL and C&UL PPDs in comparison to the combined required and preferred qualifications sections of all the PPDs. A more traditional responsibility, collection management, also appeared more frequently in the roles and responsibilities section of PPDs than in the experience section, suggesting that most hiring committees feel confident that librarians who fill positions will be successful in performing collection management tasks despite experience. The authors noted that collection management, one of the most common themes that emerged from the data analysis, appeared more frequently in C&UL PPDs and theorize that AAHLS may have dedicated collection management departments. Conclusions – While the research literature documents new roles and emerging skills for academic health sciences librarian positions, the authors noted that PPDs do not frequently reflect those emerging roles and skills, and maintain traditional health sciences librarian skillsets. The authors concluded that library administrators should design position descriptions that are user centred and match the changing research needs of the local community. PPDs should reflect changing priorities by including less weight towards the MLIS degree, shifting traditional skillsets from required experience sections to preferred experience sections, adapting the language of PPDs to be more inclusive and welcoming for a diverse pool of candidates, and adding an emphasis on DEI responsibilities. By creating position descriptions that are user focused, library administrators and hiring committees make meaningful investments for their communities and their strategic priorities.

Purpose Information literacy skills (ILSs) and information-seeking behavior (ISB) is a widespread topic that needs modern technologies to improve the technical skills of the students. The purpose of this study is to assess the usage of library resources for medical college students. To explore and understand the student’s level of satisfaction, learning and seeking behavior by efficient information retrieval systems. Design/methodology/approach The study is based on a quantitative research method and data was collected from the undergraduate students of medical colleges Islamabad Pakistan. The data were analyzed by Statistical Package for Social Science (SPSS) version 25 using Pearson correlation statistical test to identify the level of proficiency of correlation of variables and testing of the proposed hypothesis. Findings The finding of the study shows that the medical students can enhance their IT skills to seek the information in this technology era. The medical institutional administration can develop the education development policy, traditional health education policy, funds allocating policy, health information literacy and collaborate with library staff for enhancing the services and to meet the information need of medical students. Practical implications The conclusion of this study is very helpful to reduce the barriers between the students and the library staff. The findings of the study are also beneficial for the administration to improve and develop the strategies for enhancing the ILSs of medical students to achieve medical educational information in the age of technology. Therefore, all significant structures want to improve and to develop the environment of information seeking by medical students to achieve medical educational information. Social implications Medical college library administrative management must be design useful a durable policy to come up with the technology development for digital literacy. The study reduces the barriers between the students and the library staff. Originality/value The study is based on quantitative research method to find out ISB of medical students.

Purpose Vocational courses in England support the progression to higher education (HE) of large numbers of young people from disadvantaged backgrounds, yet there is little research exploring the college experiences of these young people prior to entering university. The purpose of this paper is to consider the experiences of young people on Level 3 Business and Technology Education Council (BTEC) vocational courses in their progression to HE from differently positioned post-16 colleges in England. Design/methodology/approach A qualitative study was undertaken into the experiences of students on BTEC courses in four subject clusters (science, technology, engineering and maths, arts and humanities, social sciences and health) at both a Further Education College and a Sixth Form College in an area of multiple deprivation and low HE participation. Young people’s experiences of BTEC courses and the support and guidance they receive are explored through the conceptual lens of “possible selves” and using Bourdieu’s ideas of capital, habitus and field. Findings Pedagogies and practices on BTEC courses are found to support the development of relevant social and cultural capital and help young people formulate well-articulated “possible selves” as university students, even amongst students who previously had not considered university as an option. The findings illustrate how differently positioned colleges support students’ progression and identify challenges presented by an increasingly stratified and marketised system. Originality/value The study highlights the transformative potential of BTEC courses and their role in supporting progression to HE amongst young people from economically disadvantaged backgrounds. The current emphasis on standardisation and rigour as mechanisms to better equip students for HE neglects the unique contribution BTEC pedagogies and practices make to encouraging HE participation. A Bourdieusian and “possible selves” theoretical framework has provided new insights into these valuable learning processes.

Higher Education Studies wishes to acknowledge the following individuals for their assistance with peer review of manuscripts for this issue. Their help and contributions in maintaining the quality of the journal are greatly appreciated.Higher Education Studies is recruiting reviewers for the journal. If you are interested in becoming a reviewer, we welcome you to join us. Please find the application form and details at http://recruitment.ccsenet.org and e-mail the completed application form to hes@ccsenet.org.Reviewers for Volume 8, Number 3Ana-Cornelia Badea, Technical University of Civil Engineering Bucharest, RomaniaAntonina Lukenchuk, National Louis University, USAArbabisarjou Azizollah, Zahedan University of Medical Sciences, IranAusra Kazlauskiene, Siauliai University, LithuaniaÇelebi Uluyol, Gazi University, Turkey, TurkeyDonna Harp Ziegenfuss, The University of Utah, USADonna.Smith, The Open University, UKFirouzeh Sepehrian Azar, Orumieh University, IranGerard Hoyne, School of Health Sciences, University of Notre Dame Australia, AustraliaGregory S. Ching, Fu Jen Catholic University, TaiwanHermes Loschi, University of Campinas, Braziljames badger, University of North Georgia, USAJisun Jung, University of Hong Kong, Hong KongJohn Cowan, Edinburgh Napier University, United KingdomJohn Lenon Ednave Agatep, AMA Computer College, PhilippinesLaid Fekih, University of Tlemcen Algeria, AlgeriaMichael John Maxel Okoche, Uganda Management Institute, UgandaNajia Sabir, Indiana University Bloomington, USANicos Souleles, Cyprus University of Technology, CyprusQing Xie, Jiangnan University, ChinaRanjit Kaur Gurdial Singh, The Kilmore International School, AustraliaSakiru Abiodun, Adeniran Ogunsanya College of Education, NigeriaSandhya Rao Mehta, Sultan Qaboos University, IndiaSavitri Bevinakoppa, Melbourne Institute of Technology, AustraliaTeguh Budiharso, Center of Language and Culture Studies, IndonesiaVasiliki Brinia, Athens University of Economic and Business, GreeceYi Luo, University of Illinois at Urbana- Champaign, USA

Background The cost of university presents various challenges with regards to students’ daily learning activities. This is particularly evident in developing countries, where higher education students face acute financial problems that greatly affect their daily educational activities. In Ethiopia, public university students do benefit from governmental cost-sharing programs. Moreover, health sciences students have additional costs during their clinical placements that are above the common expenses for university students. Objectives Authors aim to explore the challenges that undergraduate health sciences students in their clinical year face with limited pocket money, as well as how students perceive these limited funds affecting their learning activities and their ability to meet challenges. Methods This descriptive qualitative study was conducted at the Department of Medical Radiologic Technology, College of Health Sciences, at Addis Ababa University in Ethiopia. Interviews were conducted between January 28, 2019 and February 1, 2019 with twelve students; and only ten participants were included in the study. The semi-structured questions explored participants’ experiences and perceptions regarding the challenges of a lack of pocket money and its impacts on their learning activities. Their reaction to financial challenges was assessed. Results Four themes that are related to the impact of a lack of money on learning activities emerged from our interviews. First, students believed that their difficulty in obtaining pocket money from family or other funding sources contributed to their financial stress, which negatively impacted their learning. Moreover, their difficulty in affording the basic needs for a student greatly affected their learning abilities in the classroom as well as in their clinical placements. The ability to self-manage was also a significant concern for students, with the pressure to use self-control and proper money management adding to their financial stress. Lastly, students observed that the lack of pocket money affected their ability to make social connections at university, which they saw as negatively impacting their learning abilities. Conclusion Ethiopian undergraduate health sciences students faced many challenges due to the lack of pocket money and these challenges affected student learning both directly or indirectly. Based on our data, we believe that the underlying causes of student financial hardship can be addressed by increasing public awareness of university expenses, clarifying the cost-sharing system to the public, redesigning the cost-sharing policy, and improving university services. Additionally, teaching students self-management skills is also another area that could increase student success.

Higher Education Studies wishes to acknowledge the following individuals for their assistance with peer review of manuscripts for this issue. Their help and contributions in maintaining the quality of the journal are greatly appreciated.Higher Education Studies is recruiting reviewers for the journal. If you are interested in becoming a reviewer, we welcome you to join us. Please find the application form and details at http://recruitment.ccsenet.org and e-mail the completed application form to hes@ccsenet.org.Reviewers for Volume 8, Number 2Abdelaziz Mohammed, Albaha University, Saudi ArabiaAlina Mag, University Lucian Blaga of Sibiu, RomaniaAnna Liduma, Riga Teacher Training and Educational Management Academy, LatviaAntonina Lukenchuk, National Louis University, USAArbabisarjou Azizollah, Zahedan University of Medical Sciences, IranAynur Yürekli, İzmir University of Economics, TurkeyCarmen P. Mombourquette, University of Lethbridge, CanadaDibakar Sarangi, Directorate of Teacher Education and State Council for Educational research and Training, IndiaGerard Hoyne, School of Health Sciences, University of Notre Dame Australia, AustraliaGregory S. Ching, Fu Jen Catholic University, TaiwanHermes Loschi, University of Campinas, BrazilHuda Fadhil Halawachy, University of Mosul, IraqHüseyin Serçe, Selçuk University, TurkeyJayanti Dutta, Panjab University, IndiaJohn Cowan, Edinburgh Napier University, United KingdomKholood Moustafa Alakawi, Al-Imam Muhammad Ibn Saud Islamic University, Saudi ArabiaLung-Tan Lu, Fo Guang University, Taiwan, TaiwanMehmet Ersoy, Lecturer-Department of Computer Education and Instructional Technologies, TurkeyMei Jiun Wu, Faculty of Education, University of Macau, ChinaMeric Ozgeldi, Mersin University, TurkeyMichael John Maxel Okoche, Uganda Management Institute, UgandaNancy Maynes, Nipissing University, Schulich School of Education, Canada, CanadaNicos Souleles, Cyprus University of Technology, CyprusQing Xie, Jiangnan University, ChinaRanjit Kaur Gurdial Singh, The Kilmore International School, AustraliaSahar Ahadi, Islamic Azad University of Mashhad, IranSakiru Abiodun, Adeniran Ogunsanya College of Education, NigeriaSandhya Rao Mehta, Sultan Qaboos University, IndiaTeguh Budiharso, Center of Language and Culture Studies, IndonesiaVasiliki Brinia, Athens University of Economic and Business, GreeceWaldiney Mello, Universidade do Estado do Rio de Janeiro, Brazil

Introduction: Rural populations have many barriers to quality health care including lack of access to primary care and specialty care and a greater likelihood to be underinsured or uninsured. They are also less likely to use preventive screening, or to participate in self-care and engage in their health when compared to urban residents. The purpose of this paper was to describe patients’ healthcare experiences in a rural western state focusing on their healthcare expectations and engagement. Methods: This qualitative study was conducted using a focus group protocol to elicit rural patients’ healthcare experiences. A purposeful sample of English speaking adult residents from a single county who were willing to discuss their healthcare experiences was included. Patients and community members (21 years and older) were recruited through a local hospital as well as via flyers posted throughout the community. Each audio-recorded group took about two hours. A total of 15 focus groups were conducted to obtain sufficient text for theoretical saturation and thematic analysis. Each group had a range of 3-8 participants. A $25 visa gift card and lunch were provided for each participant as an incentive. Results: ‘Encounters with Healthcare Professionals’ and ‘Engagement in Health’ were the two dominant dimensions with two themes each. Themes centered around what characterized the best or worst encounters. Trust and Communication - both were based on time spent with the provider and establishment of rapport with the providers. The best encounters were those with health care providers or pharmacists who had sufficient time, adequately explained a diagnosis and new medications did not dismiss patient concerns, and treated individuals with respect. Typical responses describing the worst encounters included examples of misdiagnosis, dismissing patient’s symptoms, healthcare professionals whose attention was not focused on the patient, pushing too many medications, rushed encounters, and providers with poor bedside manner. ‘Engagement in Health’ dimension included the theme of Self-management Process such as taking things one day at a time, taking medication daily, and good stress management. The second theme was Barriers to Engagement and included issues regarding inclement weather, lack of sidewalks, stress, lack of time and the financial constraints for eating healthy, going to a gym, and/or problems with payer source. Participants also described a number of technological tools they utilized to engage with their healthcare including appointment reminders, health-based websites, symptom trackers, online portal systems for health care records, and online bill pay. Many used apps on smart phones to track calories and exercise as well as online community groups to encourage fitness. Conclusions: The results from this study highlighted some of the gaps in healthcare for rural areas. A large number of participants indicated a lack of trust of their providers and only a few had any communicative interaction with their pharmacist. Future studies could evaluate training designed to teach healthcare providers and pharmacists how to engage patients in their own care. Use of technology by healthcare providers might be another way to improve healthcare engagement. Conflict of Interest "We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties". Acknowledgements: This study was funded by the University of Wyoming College of Health Sciences (UW CHS) Faculty Seed Grant awarded to first author Dr. Singh in April 2015. Interim results of this study have been presented at the Health Literacy Research Conference (HARC) in November 2015. Treatment of Human Subjects: IRB review/approval required and obtained Type: Original Research

The knowledge of the science of human body parts for early childhood is very important so that children have the ability to recognize and support the cleanliness and health of members of the body, as well as so that they recognize their identity. In addition, introducing environmentally friendly material for early childhood teachers to enrich learning media. This study aims to improve student learning outcomes in science using environmentally friendly media. The topic raised in this search was about recognizing body parts and their benefits and treatments. This type of research is action research. Respondents involved 19 early childhood students. The results showed that there was an increase in subjects' understanding of swallowing extremities and treatment 60% in the pre-cycle phase, 80% in the first cycle and 93% in the second cycle. The findings show that the use of happy body media has a positive effect on limb recognition. 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This study aimed to explore the perceived barriers to physical activity among college students Study Design: Qualitative research design Eight focus group discussions on 67 college students aged 18-24 years (48 females, 19 males) was conducted on College premises. Data were analysed using inductive approach. Participants identified a number of obstacles to physical activity. Perceived barriers emerged from the analysis of the data addressed the different dimensions of the socio-ecological framework. The result indicated that the young adults perceived substantial amount of personal, social and environmental factors as barriers such as time constraint, tiredness, stress, family control, safety issues and much more. Understanding the barriers and overcoming the barriers at this stage will be valuable. Health professionals and researchers can use this information to design and implement interventions, strategies and policies to promote the participation in physical activity. This further can help the students to deal with those barriers and can help to instil the habit of regular physical activity in the later adult years.

Every test designed for purposes of admission is expected to possess psychometric properties of a test in order to address the social implications of tests. This study was aimed to determine the predictive validity of College Entrance Examination Questions (CEEQ) for 2014/2015 academic session. An expos-facto research design was used on a sample of 105 candidate entrance scores and Cumulative Grade Point Averages (CGPA) from seven programs of study. Data were obtained from the College Registry and various departments running the programs. Data collected were analyzed, using Microsoft Excel 2010 and Statistical Package for Social Sciences (SPSS) 20. Result of analysis showed that CEEQ score could predict students’ CGPA by 2.8% only. It was also determined that CEEQ has a weak but positive relationship with CGPAs (16.7%). On running the data on simple regression statistics revealed that the CEEQ do not predict CGPAs significantly as p =.089 (P>.05). It was concluded that CEEQ was not valid hence recommendation was made that College management should look forward to develop a standardized test for admission purposes. KEY WORDS: Psychometric properties, predictive validity, questions, test, entrance, academic performance.

Theme:Transformational Learning Campuswide: Insights to Enhance Student EngagementSeptember 20, 2013 Conference Director:Kimberly Eby (Center for Teaching & Faculty Excellence) Conference Coordinator:Ashleen Gayda (Center for Teaching & Faculty Excellence) (Retroactive) Conference Proceedings:Laura Lukes (Center for Teaching & Faculty Excellence)Chyna Staten (Center for Teaching & Faculty Excellence) Logistical Coordination:Karen Tai (Office of Events Management) Logistical Support:Events productionShannon DavisRebecca JonesLisa ListerSamira LloydLindsey LowenbergDenise NazaireHermoine PickettShawn Lee’s Tourism StudentsThe Writing Center Tutors Co-Sponsors: Blackboard, Inc.; 4-VA; Cengage Learning; Center for the Arts; College of Education and Human Development; College of Health and Human Services; College of Humanities and Social Sciences; College of Science; College of Visual and Performing Arts; Division of Instructional Technology; GMU Bookstore; Graduate Student Life; Higher Education Program; Mason Inn Conference Center & Hotel; Of ce of Student Scholarship, Creative Activities, and Research; Online Education; School for Con ict Analysis and Resolution; School of Management; School of Public Policy; University Libraries; University Life; Volgenau School of Engineering; Writing Across the Curriculum; and The Writing Center.

Theme: Signature Learning ExperiencesSeptemer 19, 2014 Conference Director:Laura Lukes (Center for Teaching & Faculty Excellence) Advisory & Selection Committee:Jan ArminioKimberly EbyKat HithcockMichelle LaFranceSusan LawrenceJessica MatthewsJanette MuirSteve NodineDiane SmithJoy TaylorBethany Usher Logistical Coordination:Ashleen Gayda (Center for Teaching and Faculty Excellence)Tamara Day (Office of Events Management) Logistical Support:Events ProductionSamira LloydLindsey LowenburgDenise Nazaire Conference Proceedings:Laura LukesEmily LambackChyna Staten (Retroactive) Sponsors: Blackboard, Inc.; 4-VA; University Libraries; Cengage Learning; Center for the Arts; College of Education and Human Development; College of Health and Human Services; College of Humanities and Social Sciences; College of Science; College of Visual and Performing Arts; Division of Instructional Technology; Graduate Student Life; Higher Education Program; Hylton Performing Arts Center; Mason Athletics; Mason Bookstore; O ce of Distance Education; Office of Student Scholarship, Creative Activities, and Research; School for Confiict Analysis and Resolution; School of Business; School of Policy, Government, and International Affairs; University Life; Volgenau School of Engineering; Writing Across the Curriculum; and The Writing Center. Session Hosts & Volunteers: Sarah Davis Randy Gabel Ariel Goldenthal Caitlin HolmesMichelle Hughes David KravitzMichelle LaFrance Shawn Lee Jamie LesterLindsey LowenbergJames Merrifield Janette MuirJeff OffuttJulie Owen PsycheReadyEsperanza Roman-MendozaDanielle RudesBob Sachs Lesley Smith Christine SpillsonJoy TaylorBethany UsherShannon Williams

Theme:The Science of Learning: Using Research to Improve Teaching7th Annual ConferenceSeptember 18, 2015 Conference Director:Laura Lukes (Center for Teaching & Faculty Excellence) Advisory & Selection Committee: Boicu, MihaiBoyette, JoannaClare, KatieCressman, RobEby, KimEdwards, CodyGeorge, ChristianGliozzi, MarioGoldman, JonathanHannan, HeatherKoch, LisaKravitz, DavidLawrence, SusanLukes, LauraMallett, KarynOffutt, JeffOlesova, LarisaOwen, JuliePettigrew, KathyReid, ShelleyRogers, PaulSaleem, RajaSaunders, CathyScott Constantine, LynneUsher, BethanyWarren, JohnWest, PatriciaWillis, OdetteWolf, PaigeYigit, Erdal Logistical Coordination:Ashleen Gayda (Center for Teaching & Faculty Excellence)Tamara Day (Events Management) Logistical Support:Office of Events ManagementEvents ProductionMason CateringAndrew Cote (OSCAR)Samira Lloyd (OSCAR)Denise Nazaire (OSCAR) Conference Proceedings:John WarrenJeri WieringaLaura LukesAshleen GaydaEmily LambackChyna Staten (Retroactive) Sponsors: BlackboardGeorge Mason University LibrariesGeorge Mason Publishing GroupProQuestUPCEABarnes & Noble College: George Mason Bookstore4-VAThe New York Times in Education Supporters:College of Education and Human Development; College of Health and Human Services; College of Humanities and Social Sciences; College of Science; College of Visual and Performing Arts; Graduate Student Life; Higher Education Program; Information Technology Services; Office of Distance Education; Office of Student Scholarship, Creative Activities, and Research; School for Conflict Analysis and Resolution; School of Business; School of Policy, Government, and International A airs; University Life; Volgenau School of Engineering; Writing Across the Curriculum; and The Writing Center.Volunteers:Dorothy Amoah-Darko, Sam Ashworth, Jesse Capobianco, Cameron Carter, Andrew Cartwright, Zella Christensen, Lynne Scott Constantine, Svetlana Filiatreau, Andrew Finn, Darcy Gagnon, Liesel Hamilton, Caitlin Holmes, Tabine Kamaleddine, Mills Kelly, Joey Kuhn, Ying-Ying Kuo, Shawn Lee, Jaime Lester, Jessica Matthews, Je O utt, Larisa Olesova, Julie Owen, Nathalia Peixoto, Richena Purnell-Sayle, Esperanza Roman-Mendoza, Robert Sachs, Catherine Saunders, Linda Sheridan, Darlene Smucny, Debra Sprague, Carol Stiller, Bethany Usher, John Warren, Gerald Weatherspoon, Margaret Weiss, and the students of TOUR 440. of Engineering; Writing Across the Curriculum; and The Writing Center.

Republic Act 11223, known as the Universal Health Care (UHC) Act, has a triple goal of providing quality healthcare services that are equitable, accessible and cost-effective for all Filipinos. At long last, no longer would health care reform have to be re-invented as new DOH Administrative Orders or Executive Orders, which changes not only with every new Presidency, but in fact with every new Secretary of Health (recall the “Integrated Public Health System of 1983”, “Health Sector Reform Agenda of 1999”, the “FOURmula ONE for Health of 2005”, the “FOURmula ONE Plus for Health of 2019” programs). Finally, we now have a law that mandates lasting health care reform which are multi-administration in length, and multi-sectoral in scope. With this new law, however, we now have to accept the dirty little secrets that all past health care reform programs have learned. That medical science alone is not enough to bring about lasting improvements in the mortalities and morbidities for every Filipino man, woman, and child. That every new advancement in medicine, vaccination, therapy, or diagnostics, have actually been met with: new schemes for fraud; new opportunities for program failures due to increasing infrastructure demands including more electricity, more expensive machines, faster internet access, and others; and new healthcare workers who become overworked, under-compensated, and even under-protected from politicians and patients who attack the new advances due to ignorance or unfounded fears. As the old adage goes, the correct naming of a problem is 50% of the solution. Fortunately, just as the dirty little secret have metamorphosed with each medical science improvement, so have Information Technology, Behavior Science, Management Science, Economic Evaluation science, and Criminology also improved. Thus, the modern Evidence-Based Policy (EBP) development must actively supplement medical science with these other sciences to ensure that the promise of better, safer, and more cost-effective improvements in mortality and morbidity is actually enjoyed by all beneficiaries. As the main steward of health, the Department of Health (DOH) takes the lead in detailing the operationalization of the Law, hence, formulating the prescribed provisions of the Implementing Rules and Regulations (IRR). Because we need to ensure the success of this Law, it is imperative for DOH to use evidence-based policy tools and papers, and to yield consensus recommendations from all involved stakeholders. Hence, the UP Manila Health Policy Development Hub, having the special niche as a multi-science policy research group, was granted the AHEAD-HPSR funding to generate evidences as inputs in crafting the UHC Act IRR. The 15 policy papers in this issue formed part of the expected products from a research grant on “Development of Policy Notes or Evidence Summaries” submitted by the University of the Philippines Manila Health Policy Development Hub (UPM HPDH), otherwise known as Policy Hub, to the AHEAD-HPSR program of DOH in 2018. Created in 2015, UPM HPDH is a think tank and network of health policy advocates, analysts, and multidisciplinary researchers under the Office of the Chancellor of the University of the Philippines Manila and aims to be a national leader in formulating policy statements based on empirical, unbiased data, and appropriate statistical and policy analysis, to aid in the implementation of policy in different local settings. Since its establishment, the Policy Hub has conducted policy round table discussions on high impact and controversial health policies, provided trainings for policy makers and students, held special mentoring sessions with policy analysts, formed technical working groups for policy analysis that included critical assessment of evidence, dissemination and publication, among others. With the ubiquitous presence of fake news and other unreliable health information accessible to the public in the internet and social media, the Policy Hub aims to provide reliable and evidence-based health policy analyses and statements as an act of responsive public service and advocacy. This special issue of the journal contains position papers and policy statements that generated evidence summaries and consensus recommendations as inputs for the IRR of the UHC Act of 2020. These 15 policy papers focus on salient features of the UHC Act that revolve on the following: addressing primary care inequities; contracting out of health services for province-level integration of healthcare system; determining hospital bed capacity; gaps and gray areas identified in the IRR; criteria for population versus Individual-based health services; rationalizing health personnel financing schemes; third party accreditation; equitable health investment; return service agreement; and, include vital health concerns drawn from other health-related laws such as mental health and oral health that are integral part of the healthcare services in the UHC Act. Producing evidence-based data and information in aid of legislation is evolving as a standard in developing sound health policy and decision.1 We all know the power that a state-sponsored health policy exudes. It significantly influences how health is distributed, accessed, and acquired. Thus, a health policy evidenced by the sciences, if deployed properly with strong political will, certainly leads to healthy and happy citizens. The policy papers in this special issue embody a collaboration between UP Manila and DOH. A collaboration that could serve as a model wherein a health sciences academic institution and a national health agency of the government worked in synergy towards a public health policy that balances population health, scientific evidences, and fiscal and risk management. This was the first formal application of evidence-based policy (EBP) development between DOH, UP Manila, and stakeholders for evidence-informed and unbiased policy making. Evidence-based policy (EBP) development “refers to an approach that levers the best available objective evidence from research to identify and understand issues so that policies can be crafted by decision makers that will deliver desired outcomes effectively, with a minimal margin of error and reduced risk of unintended consequences.”2 The rationale therefore for EBP, is to advocate a more systematic approach that is both rigorous and encompassing to inform the policy process.3 Its objective consequently is not to produce the solutions; rather it is to utilize the best evidences, to provide credible information and analysis as a tool in policy making.2 As it uses these clear, unbiased and objective EBP policies, front line implementers can better contextualize, augment and deliver the intended health and health related improvements, by reducing uncertainty, increasing consistency, and providing accountability. We assert that the 15 policy papers contained in this special issue are products of EBP development and were meant to produce grounded data and information from the best scientific evidences and actual stakeholder experiences, that minimize and even prevent fraud, program failures, and worker fatigue and demoralization, so that we will finally attain true universal health care for all Filipinos in all stages and walks of life. Leonardo R. Estacio, Jr., MCD, MPH, PhD Dean College of Arts and Sciences University of the Philippines Manila Hilton Y. Lam, MHA, PhD Director Institute of Health Policy and Development Studies National Institutes of Health University of the Philippines Manila REFERENCES Brownson RC, Chriqui JF, Stamatakis KA. Understanding evidence-based public health policy. Am J Public Health. 2009 Sep; 99(9):1576-83.doi:10.2105/AJPH.2008.156224. Townsend T, Kunimoto B. Capacity, Collaboration and Culture: The Future of the Policy Research Function in the Government of Canada [Internet]. 2014 [cited 2020 Nov]. Available from: Sutcliffe S, Court J. Evidence-Based Policy Making. Overseas Development Institute. November 2005 [cited 2020 Nov]. Available from: https://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion- files/3683.pdf

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Translational Medicine and Exercise Prescription (TMEP): Advancing the Era of Exercise Medicine Sulin Cheng1,2,3,4, Moritz Schumann()2,4 and Wilhelm Bloch4 1Exercise, Health and Technology Center, Department of Physical Education, Shanghai Jiao Tong University, Shanghai, China 2Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China 3Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland 4Department of Molecular and Cellular Sport Medicine, German Sport University, Cologne, Germany © The Authors "Exercise is medicine" has gained popularity worldwide after the American Medical Association and the American College of Sports Medicine co-launched their ground-breaking health initiative in 20071 . This initiative was aimed at improving population health and well-being, mainly by raising the awareness of healthcare providers to regard performing physical activity (PA) as one of the vital signs. Ever since, this concept has spread worldwide and PA has been proposed as an essential part of treatment for chronic diseases2 . In their pioneering work, Pedersen and Saltin provided compelling evidence for the role of exercise as the first- or second-line therapy for at least 26 diseases2 . These findings are further corroborated by meta-epidemiological data, indicating exercise interventions to be as effective as drug interventions, such as during rehabilitation after stroke and for the treatment of heart failure3 . However, the overall effect appears to be strongly correlated with important determinants of the exercise program performed (i.e. dose of training [frequency, volume, intensity], type of exercise and adherence to the training program) and disease-related specifics4 , thus requiring not only clinical expertise but also an in-depth understanding of exercise physiology and biology. In this new journal-Translational Medicine and Exercise Prescription (TMEP), we are aiming to bring together the fields of exercise physiology and biology, sports medicine and the science of physical training and testing to bridge the gap between mechanistic research and clinical practice. The journal covers nine sections, including obesity, diabetes, cancer, cardiovascular diseases, neurological and psychiatric diseases, pulmonary diseases, musculoskeletal diseases, endocrine disorders as well as advanced exercise prescription and health maintenance. In this first issue of TMEP, we are delighted to present seven papers from different areas of translational research performed in humans on specific themes related to the treatment and prevention of chronic diseases. Appropriate selection of primary and secondary endpoints is critical for successfully designing translational studies. In the first paper of this issue, TMEP Section Editor, Jörn Rittweger provides his thoughts on "What Are Good Muscle Endpoints for Translational Studies?". In his important work, he highlights the importance of muscles for our health because of their size, their involvement in energy metabolism and their relevance for locomotion. He further suggests that at least eight different muscle functions are important to health. Well accepted methods exist for three relevant muscular endpoints, namely for power, strength and muscle mass, and these endpoints are utilized in clinical studies. However, such validated methods lack a number of additional muscle functions that are not yet fully scientifically explored. This applies foremost to not only the metabolic functions of muscles, but also to their role in storage and dissipation of mechanical energy. His work concludes by emphasizing how physiological knowledge can be an important base for the guidance of clinical diagnostics. Following this important message, the group of TMEP Section Editor Pieter de Lange shares their work entitled "Exercise with Energy Restriction as a Means of Losing Body Mass While Preserving Muscle Quality and Ameliorating Comorbidities: Towards A Therapy for Obesity?". Obesity and related comorbidities have reached pandemic proportions worldwide, particularly during the past decade. Therefore, finding effective intervention strategies not only requires scientific focus but these strategies are also of public interest. Based on both human and animal studies, this narrative review summarizes the effects of dietary and exercise-based programs on loss of different body mass components. Furthermore, both the gain and lack of loss of lean mass in view of muscle quality maintenance are discussed and data related to the mechanisms underlying the conservation of functional muscle mass provided. They also provide evidence of the interaction between energy restriction by diet and exercise-induced metabolic demands at the molecular level. This insight into the mechanisms underlines the relevance of translational considerations for personalized exercise prescription. Obesity and an unhealthy lifestyle are also known to be among the risk factors for type 2 diabetes (T2DM). The research group of TMEP Section Editor Thomas Yates highlights research opportunities and challenges for combining exercise and medical therapies by means of a narrative review entitled "Exercise, Pharmaceutical Therapies and Type 2 Diabetes: Looking beyond Glycemic Control to Whole Body Health and Function". The authors provide evidence on newer generations of glucose-lowering therapies that also induce concomitant weight loss, particularly on glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is). Based on current knowledge, they stress the importance of investigating the interaction or synergy between exercise and other glucose-lowering or weight loss therapies, to make exercise a tailored therapy rather than a generic treatment in the management of T2DM. This review, therefore, clearly highlights the need of precise exercise prescription, originating from an in-depth mechanistic understanding of the effects of exercise. Cancer is another important metabolic and chronic inflammatory disease that may also be associated with obesity. TMEP Section Editor Jesper F Christensen and Associate Editor Ciaran M Fairman provide a very interesting viewpoint in their article,"Targeted Exercise Training for Cancer Patients: Moving beyond Generic Exercise Guidelines in Clinical Oncology". This paper aims to update the current knowledge and the clinical rationale for targeted exercise interventions in exercise oncology. Moreover, a framework for systematic guidance of the design and execution of targeted exercise interventions in oncology is presented. The authors hope that their framework can encourage further research into targeted exercise interventions in oncology and may also be used as a guideline for the design of future trials to increase quality and impact. The group of TMEP Section Editor Helen Dawes, shares their original data in the context of neurological and psychiatric diseases in the article entitled "Physical Activity and Fatigue in Multiple Sclerosis: Secondary Outcomes from a Double-blinded Randomized Controlled Trial of Cocoa Flavonoid Drinks". In this study, they performed intensive phenotyping of the inter-relationships of the time of day, physical activity levels and fatigue to determine exercise prescription in a group of people with multiple sclerosis (MS) participating in a six-week randomized controlled trial of morning flavonoid intake. It was found that fatigue levels increased during the day and higher levels of fatigue reduced physical activity; yet physical activity itself did not lead to increased fatigue. Additionally, morning cocoa intake reduced daytime fatigue and fatigue related to subsequent physical activity. Therefore, combined prescription of morning exercise and dietary flavonoids may optimize the exercise and physical activity potential in people with MS. This study nicely demonstrates the importance of understanding and considering possible covariants such as nutrition and chronobiology to determine an optimal exercise prescription model. TMEP Section Editor Jonathan Myers and colleague Baruch Vainshelboim present a narrative review on "Resistance Training for Rehabilitation of Patients with Idiopathic Pulmonary Fibrosis". In this paper, the pathophysiology and clinical manifestations of Idiopathic Pulmonary Fibrosis (IPF) are summarized with an emphasis on the numerous health and clinical benefits of resistance training among older adults and patients with this respiratory disease. This article effectively explores the potential mechanisms by which systematic resistance training may help overcome exercise limitations in IPF, providing a therapeutic opportunity for rehabilitation. Furthermore, the authors provide important recommendations for pulmonary rehabilitation programs that are based on resistance training for patients with IPF. With this paper, the authors highlight that disease-adapted exercise prescription requires a pathophysiological understanding to justify the inclusion of specific exercise regimens. In the final paper of this special issue, the research group of Section Editor Anthony C Hackney shares their original data on the "Energy Availability and RED-S Risk Factors in Competitive, Non-elite Male Endurance Athletes". This paper particularly emphasizes the entire spectrum of TMEP, that is more than just the most common types of non-communicable diseases, but also includes chronic conditions that may be for example induced by athletic training. In this study, the authors assessed the associations of energy availability and risk factors of relative energy deficiency in sport (RED-S) in 60 competitive, recreationally trained male endurance athletes. They found that hormonal and bone biomarkers were within normal clinical ranges, even when the energy availability was low. The authors further state that athletes are considered at a high risk for RED-S if their energy availability is low (<30 kcal/kg FFM), which is based primarily upon research in women. However, the included recreationally trained male endurance athletes were below this criterion but displayed no RED-S symptomology. Thus, the authors suggest that the <30 kcal/kg FFM criterion may not be a valid categorization for a high risk of RED-S in non-elite male endurance athletes, highlighting the importance of using other criteria. While the purpose of this first issue is to stimulate further discussion on the topic of translational medicine and exercise prescription from different disciplines, we wish to highlight that these topics are not exhaustive and there are many more questions that must be addressed. With TMEP, we aim to introduce a platform for the transparent dissemination of research findings, where special consideration will be given to novel types of exercise prescriptions, including technology-based intervention approaches as well as mechanism-driven studies with translation to exercise prescription. Moreover, TMEP encourages submissions of "negative findings" and/or possible reports of harmful adverse events (e.g. if trials are terminated prematurely) as long as the quality of the study can be assured (i.e. indicated by relevance/novelty of the question, rigorous methodology, transparency and reproducibility). We strongly encourage submissions from all parts of the world to further improve our understanding on exercise prescription based on mechanistic approaches and by that commence a new era of evidence-based precision exercise medicine.

Introduction Children are beginning to use digital technologies at younger and younger ages. The emerging trend of very young children (babies, toddlers and pre-schoolers) using Internet connected devices, especially touch screen tablets and smartphones, has elicited polarising opinions from early childhood experts. At present there is little actual research about the risks or benefits of tablet and smartphone use by very young children. Current usage recommendations, based on research into passive television watching which claims that screen time is detrimental, is in conflict with advice from education experts and app developers who commend interactive screen time as engaging and educational. Guidelines from the health professions typically advise strict time limits on very young children’s screen-time. Based for the most part on policy developed by the American Academy of Paediatrics, it is usually recommended that children under two have no screen time at all (Brown), and children over this age have no more than two hours a day (Strasburger, et al.). On the other hand, early childhood education guidelines promote the development of digital literacy skills (Department of Education). Further, education-based research indicates that access to computers and the Internet in the preschool years is associated with overall educational achievement (Bittman et al.; Cavanaugh et al; Judge et al; Neumann). The US based National Association for Education of Young Children’s position statement on technology for zero to eight year-olds declares that “when used intentionally and appropriately, technology and interactive media are effective tools to support learning and development” (NAEYC). This article discusses the notion of Digitods—a name for those children born since the introduction of the iPhone in 2007 who have ready access to touchscreen technologies since birth. It reports on the limited availability of evidence-based research about these children’s ICT use concluding that current research and recommendations are not grounded in the everyday life of very young children and their families. The article then reports on the beginnings of a research project funded by the Australian Research Council entitled Toddlers and Tablets: exploring the risks and benefits 0-5s face online. This research project recognises that at this stage it is parents who “are the real experts in their toddlers’ use of screen technologies. Accordingly, the project’s methodological approach draws on parents, pre-schoolers and their families as communities of practice in the construction of social meaning around toddlers’ use of touch screen technology. Digitods In 2000 Bill Gates introduced the notion of Generation I to describe the first cohort of children raised with the Internet as a reality in their lives. They are those born after the 1990s and will, in most cases; have no memory of life without the Net. [...] Generation I will be able to conceive of the Internet’s possibilities far more profoundly than we can today. This new generation will become agents of change as the limits of the Internet expand to include educational, scientific, and business applications that we cannot even imagine. (Gates)Digitods, on the other hand, is a term that has been used in education literature (Leathers et al.) to describe those children born after the introduction of the iPhone in 2007. These children often begin their lives with ready access to the Internet via easily usable touch screen devices, which could have been designed with toddlers’ touch and swipe movements in mind. Not only are they the youngest group of children to actively engage with the Internet they are the first group to grow up with a range of mobile Internet devices (Leathers et al.). The difference between Digitods and Gates’s Generation I is that Digitods are the first pre-verbal, non-ambulant infants to have ready access to digital technologies. Somewhere around the age of 10 months to fourteen months a baby learns to point with his or her forefinger. At this stage the child is ready to swipe and tap a touch screen (Leathers et al.). This is in contrast to laptops and PCs given that very young children often need assistance to use a mouse or keyboard. The mobility of touch screen devices allows very young children to play at the kitchen table, in the bedroom or on a car trip. These mobile devices have, of course, a myriad of mobile apps to go with them. These apps create an immediacy of access for infants and pre-schoolers who do not need to open a web browser to find their favourite sites. In the lives of these children it seems that it has always been possible to touch and swipe their way into games, books and creative and communicative experiences (Holloway et al. 149). The interactivity of most pre-school apps, as opposed to more passive screen activities such as watching television shows or videos (both offline or online), requires toddlers and pre-schoolers to pay careful attention, think about things and act purposefully (Leathers et al.). It is this interactivity which is the main point of difference, one which holds the potential to engage and educate our youngest children. It should be noted within this discussion about Digitods that, while the trope Digital Natives tends to homogenise an entire generation, the authors do not assume that all children born today are Digitods by default. Many children do not have the same privileged opportunities as others, or the (parental) cultural capital, to enable access, ease of use and digital skill development. In addition to this it is not implied that Digitods will be more tech savvy than their older siblings. The term is used more to describe and distinguish those children who have digital access almost since birth—in order to differentiate or tease out everyday family practices around these children’s ICT use and the possible risks and benefits this access affords babies, toddlers and pre-schoolers. While the term Digital Native has also been criticised as being a white middle class phenomenon this is not necessarily the case with Digitods. In the Southeast Asia and the Pacific region developed countries like Japan, Korea, New Zealand and Singapore have extremely high rates of touchscreen use by very young children (Child Sciences; Jie; Goh; Unantenne). Other countries such as the Philippines and Indonesia have moved to a high smart phone usage by very young children while at the same time have only nascent ICT access and instruction within their education systems (Unantenne). The Digitod Parent Parents of Digitods are usually experienced Internet users themselves, and many are comfortable with their children using these child-friendly touch screen devices (Findahl). Digital technologies are integral to their everyday lives, often making daily life easier and improving communication with family and friends, even during the high pressure parenting years of raising toddlers and pre-schoolers. Even though many parents and caregivers are enabling very young children’s use of touch screen technologies, they are also concerned about the changes they are making. This is because very young children’s use of touch screen devices “has become another area where they fear possible criticism and in which their parental practices risk negative evaluation by others” (Holloway et al). The tensions between expert advice regarding young children’s screen-time and parents’ and caregivers’ own judgments are also being played out online. Parenting blogs, online magazines and discussion groups are all joining in the debate: On the one hand, parents want their children to swim expertly in the digital stream that they will have to navigate all their lives; on the other hand, they fear that too much digital media, too early, will sink them. Parents end up treating tablets like precision surgical instruments, gadgets that might perform miracles for their child’s IQ and help him win some nifty robotics competition—but only if they are used just so. (Rosin)Thus, with over 80 000 children’s apps marketed as educational in the Apple App Store alone, parents can find it difficult to choose apps that are worth purchasing (Yelland). Nonetheless, recent research regarding Australian children shows that three to five year olds who access touch screen devices will typically have five or more specific apps to choose from (5.23 on average) (Neumann). With little credible evidence or considered debate, parents have been left to make their own choices about the pros and cons of their young children’s access to touch screens. Nonetheless, one immediate benefit that comes to mind is toddlers and pre-schoolers video chatting with dispersed family member—due to increased globalisation, guest worker arrangements, FIFO (fly-in fly-out) workforces and family separation or divorce. Such clear benefits around sociability and youngsters’ connection with significant others make previous screen-related guidelines out of date and no longer contextually relevant. Little Research Attention Family ownership of tablet devices as well as touch screen phones has risen dramatically in the last five years. With very young children being loaned these technologies by mum or dad, and a tendency in Australia to rely on market-orientated research regarding ownership and usage, there is very little knowledge about touch screen usage rates for very young Australian children. UK and US usage figures indicate that over the last few years there has been a five-fold increase in tablet uptake by zero to eight year olds (Ofcom; Rideout). Although large scale, comparative Australian data is not available, previous research regarding older children indicates that Australia is similar to high use countries like some Scandinavian nations and the UK (Green et al.). In addition to this, two small research projects in Australia, with under 160 participant families each, indicate that two thirds of these children (0-5) use touchscreen devices (Neumann; Coenenna et. al.). Beyond usage figures, there is also very limited evidence-based research about very young children’s app use. Interactive technologies available via touch screen technologies have been available domestically for a very short time. Consequently, “valid scientific research has not been completed and replicated due to [the lack of] available time” (Leathers el al. 129) and longitudinal studies which rely on an intervention group (in this case exposure to children’s apps) and a control group (no exposure) are even fewer and more time-consuming. Interestingly, researchers have revisited the issue of passive screen viewing. A recent 2015 review of previous 2007 research, which linked babies watching videos with poor language development, has found that there was statistical and methodological issues with the 2007 study and that there are no strong inferences to be drawn between media exposure and language development (Ferguson and Donellan). Thus, there seems to be no conclusive evidence-based research on which to inform parents and educators about the possible downside or benefits of touch screen use. Nonetheless, early childhood experts have been quick to weigh in on the possible effects of screen usage, some providing restrictive guidelines and recommendations, with others advocating the use of interactive apps for very young children for their educational value. This knowledge-gap disguises what is actually happening in the lives of real Australian families. Due to the lack of local data, as well as worldwide research, it is essential that Australian researchers obtain a comprehensive understanding about actual behaviour around touch screen use in the lives of children aged between zero and five and their families. Beginning Research While research into very young children’s touch screen use is beginning to take place, few results have been published. When researching two to three year olds’ learning from interactive versus non-interactive videos Kirkorian, Choi and Pempek found that “toddlers may learn more from interactive media than from non-interactive video” (Kirkorian et al). This means that the use of interactive apps on touch screen devices may hold a greater potential for learning than passive video or television viewing for children in this age range. Another study considered the degree to which the young children could navigate to and use apps on touch screen devices by observing and analysing YouTube videos of infants and young children using touch screens (Hourcade et al.). It was found that between the ages of 12 months and 17 months the children filmed seemed to begin to “make meaningful use of the tablets [and] more than 90 per cent of children aged two [had] reached this level of ability” (1923). The kind of research mentioned above, usually the preserve of psychologists, paediatricians and some educators, does not, however, ground very young children’s use in their domestic context—in the spaces and with those people with whom most touch screen usage takes place. With funding from the Australian Research Council Australian, Irish and UK researchers are about to adopt a media studies (domestication) approach to comprehensively investigate digital media use in the everyday lives of very young children. This Australian-based research project positions very young children’s touch screen use within the family and will help provide an understanding of the everyday knowledge and strategies that this cohort of technology users (very young children and their parents) have already developed—in the knowledge vacuum left by the swift appropriation and incorporation of these new media technologies into the lives of families with very young children. Whilst using a conventional social constructionist perspective, the project will also adopt a co-creation of knowledge approach. The co-creation of knowledge approach (Fong) has links with the communities of practice literature (Wegner) and recognises that parents, care-givers and the children themselves are the current experts in this field in terms of the everyday uses of these technologies by very young children. Families’ everyday discourse and practices regarding their children’s touch screen use do not necessarily work through obvious power hierarchies (via expert opinions), but rather through a process of meaning making where they shape their own understandings and attitudes through experience and shared talk within their own everyday family communities of practice. This Toddlers and Tablets research is innovative in many ways. It seeks to capture the enthusiasm of young children’s digital interactions and to pioneer new ways of ‘beginnings’ researching with very young children, as well as with their parents. The researchers will work with parents and children in their broad domestic contexts (including in and out-of-home activities, and grandparental and wider-family involvement) to co-create knowledge about young children’s digital technologies and the social contexts in which these technologies are used. Aspects of these interactions, such as interviews and observations of everyday digital interactions will be recorded (audio and video respectively). In addition to this, data collected from media commentary, policy debates, research publications and learned articles from other disciplinary traditions will be interrogated to see if there are correlations, contrasts, trends or synergies between parents’ construction of meaning, public commentary and current research. Critical discourse tools and methods (Chouliaraki and Fairclough) will be used to analyse verbatim transcripts, video, and all written materials. Conclusion Very young children are uniquely dependent upon others for the basic necessities of life and for the tools they need, and will need to develop, to claim their place in the world. Given the ubiquitous role played by digital media in the lives of their parents and other caregivers it would be a distortion of everyday life for children to be excluded from the technologies that are routinely used to connect with other people and with information. In the same way that adults use digital media to renew and strengthen social and emotional bonds across distance, so young children delight in ‘Facetime’ and other technologies that connect them audio-visually with friends and family members who are not physically co-present. Similarly, a very short time spent in the company of toddlers using touch screens is sufficient to demonstrate the sheer delight that these young infants have in developing their sense of agency and autonomy (https://www.youtube.com/watch?v=aXV-yaFmQNk). Media, communications and cultural studies are beginning to claim a space for evidence based policy drawn from everyday activities in real life contexts. Research into the beginnings of digital life, with families who are beginning to find a way to introduce these technologies to the youngest generation, integrating them within social and emotional repertoires, may prove to be the start of new understandings into the communication skills of the preverbal and preliterate young people whose technology preferences will drive future development – with their parents likely trying to keep pace. Acknowledgment This research is supported under Australia Research Council’s Discovery Projects funding scheme (project number DP150104734). References Bittman, Michael, et al. "Digital Natives? New and Old Media and Children's Outcomes." Australian Journal of Education 55.2 (2011): 161-75. Brown, Ari. "Media Use by Children Younger than 2 Years." Pediatrics 128.5 (2011): 1040-45. Burr, Vivien. Social Constructionism. 2nd ed. London: Routledge, 2003. Cavanaugh, Cathy, et al. "The Effects of Distance Education on K–12 Student Outcomes: A Meta-Analysis." Naperville, Ill.: Learning Point Associates, 2004. 5 Mar. 2009 ‹http://www.ncrel.org/tech/distance/index.html›. Child Sciences and Parenting Research Office. Survey of Media Use by Children and Parents (Summary). Tokyo: Benesse Educational Research and Development Institute, 2014. Coenena, Pieter, Erin Howiea, Amity Campbella, and Leon Strakera. Mobile Touch Screen Device Use among Young Australian Children–First Results from a National Survey. Proceedings 19th Triennial Congress of the IEA. 2015. Chouliaraki, Lilie and Norman Fairclough. Discourse in Late Modernity: Rethinking Critical Discourse Analysis. Edinburgh: Edinburgh UP, 1999. Department of Education. "Belonging, Being and Becoming: The Early Years Learning Framework for Australia." Australian Government, 2009. Ferguson, Christopher J., and M. Brent Donnellan. "Is the Association between Children’s Baby Video Viewing and Poor Language Development Robust? A Reanalysis of Zimmerman, Christakis, and Meltzoff (2007)." Developmental Psychology 50.1 (2014): 129. Findahl, Olle. Swedes and the Internet 2013. Stockholm: The Internet Infrastructure Foundation, 2013. Fong, Patrick S.W. "Co-Creation of Knowledge by Multidisciplinary Project Teams." Management of Knowledge in Project Environments. Eds. E. Love, P. Fong, and Z. Irani. Burlington, MA: Elsevier, 2005. 41-56. Gates, Bill. "Enter 'Generation I': The Responsibility to Provide Access for All to the Most Incredible Learning Tool Ever Created." Instructor 109.6 (2000): 98. Goh, Wendy W.L., Susanna Bay, and Vivian Hsueh-Hua Chen. "Young School Children’s Use of Digital Devices and Parental Rules." Telematics and Informatics 32.4 (2015): 787-95. Green, Lelia, et al. "Risks and Safety for Australian Children on the Internet: Full Findings from the AU Kids Online Survey of 9-16 Year Olds and Their Parents." Cultural Science Journal 4.1 (2011): 1-73. Holloway, Donell, Lelia Green, and Carlie Love. "'It's All about the Apps': Parental Mediation of Pre-Schoolers' Digital Lives." Media International Australia 153 (2014): 148-56. Hourcade, Juan Pablo, Sarah Mascher, David Wu, and Luiza Pantoja. Look, My Baby Is Using an iPad! An Analysis of YouTube Videos of Infants and Toddlers Using Tablets. Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems. ACM, 2015. Jie S.H. "ICT Use Statistics of Households and Individuals in Korea." 10th World Telecommunication/ICT Indicators Meeting (WTIM-12). Korea Internet & Security Agency (KISA), 25-7 Sep. 2012.Judge, Sharon, Kathleen Puckett, and Sherry Mee Bell. "Closing the Digital Divide: Update from the Early Childhood Longitudinal Study." The Journal of Educational Research 100.1 (2006): 52-60. Kirkorian, H., K. Choi, and Pempek. "Toddlers' Word Learning from Contingent and Non-Contingent Video on Touchscreens." Child Development (in press). Leathers, Heather, Patti Summers, and Desollar. Toddlers on Technology: A Parents' Guide. Illinois: AuthorHouse, 2013. NAEYC. Technology and Interactive Media as Tools in Early Childhood Programs Serving Children from Birth through Age 8 [Position Statement]. Washington: National Association for the Education of Young Children, the Fred Rogers Center for Early Learning and Children’s Media at Saint Vincent College, 2012. Neumann, Michelle M. "An Examination of Touch Screen Tablets and Emergent Literacy in Australian Pre-School Children." Australian Journal of Education 58.2 (2014): 109-22. Ofcom. Children and Parents: Media Use and Attitudes Report. London, 2013. Rideout, Victoria. Zero to Eight: Children’s Media Use in America 2013. San Francisco: Common Sense Media, 2013. Rosin, Hanna. "The Touch-Screen Generation." The Atlantic, 20 Apr. 2013. Strasburger, Victor C., et al. "Children, Adolescents, and the Media." Pediatrics 132.5 (2013): 958-61. Unantenne, Nalika. Mobile Device Usage among Young Kids: A Southeast Asia Study. Singapore: The Asian Parent and Samsung Kids Time, 2014. Wenger, Etienne. Communities of Practice: Learning, Meaning, and Identity. New York: Cambridge University Press, 1998. Wenger, Etienne. "Communities of Practice and Social Learning Systems." Organization 7.2 (2000): 225-46. Yelland, Nicola. "Which Apps Are Educational and Why? It’s in the Eye of the Beholder." The Conversation 13 July 2015. 16 Aug. 2015 ‹http://theconversation.com/which-apps-are-educational-and-why-its-in-the-eye-of-the-beholder-37968›.

Prelude: 2020 in Words Each year the Australian National Dictionary Centre, based at the Australian National University (ANU), selects “a word or expression that has gained prominence in the Australian social landscape”. In 2020, “iso” took out first place, with “bubble” following close behind. On the Centre’s website, Senior Researcher Mark Gywnn explains that “iso” was selected not only for its flexibility, merrily combining with other words to create new compound words (for instance “being in iso”, doing “iso baking” and putting on “iso weight”), but also because it “stood out as a characteristically Aussie abbreviation” (Australian National Dictionary Centre). Alongside the flexibility of the word “iso” and its affinity with the Australian English tradition of producing and embracing diminutives, iso’s appeal might well be that it does not carry the associations that the word “bubble” has acquired in the time of COVID. While COVID-19 has put many of us in various forms of “iso”, the media imagery—and indeed experiences—of many older people living in residential aged care during COVID has shifted some of the associations of the word “bubble”, heightening its associations with fragility and adding vulnerability and helplessness into the mix. 2020 was not the first time “bubble” has appeared in the Australian word of the year list. In 2018 “Canberra bubble” took out the first spot. What interests us about bubble’s runner-up position behind “iso” in 2020’s word of the year is what this might also reveal about the way ideas of independence vs dependence, and youthfulness vs aged underlie and inflect new usages of these words. In the era of COVID-19, the buoyancy of “iso” is tied to its association with a particular kind of Aussie-youth-speak, while the sense of heaviness and negative resonances that now accompany the word bubble are tied to its associations with the experiences of those in aged care. In 2020 “bubble”—a word that has primarily been associated with children and the child-like (bubble baths, bubble tea)—took on new associations and overtones. As the pandemic unfolded, “bubble” also became intertwined with media depictions of and popular discourses around those in later life, many of whom experienced “iso” much more brutally than the easy-Aussie-speak of “iso” would convey. There is much less play—and a lot less mingling—in the Australian National Dictionary Centre description of new uses of the word “bubble”: “a district, region, or a group of people viewed as a closed system, isolating from other districts, regions, or groups as a public health measure to limit the spread of Covid-19”. There have been various kinds of “closed system[s]”, isolated groups and regions constructed in the management of the pandemic, but there is one group—and one kind of location—that has been “bubbled” in quite specific ways. While the sectioning off and isolating of older age people in the name of protecting their health has often been ineffectively—and in some places, disastrously—managed in terms of disease prevention, it has been very effective in reducing the rights and voices of those it acts in the name of. Speaking from Ireland but commenting on the situation in the UK and parts of Europe, Anne Fuchs and colleagues write that “the discursive homogenization and ‘frailing’ of the over 65s meant that people in this category were an object of public discourse rather than participants in the debate” (2). In many instances the “bubbling” of older people, particularly those in aged care residences, has served to both isolate and render largely voiceless the residents of these care homes. Although the global impact of COVID-19 on the aged has been significant, including across many affluent societies, it has been particularly disastrous in Australia. At the time of writing (1 January 2021), of the 909 COVID-related deaths in Australia to date, 693 have been of people aged 80 or over: in other words, more than 75% of COVID-related deaths in Australia have been of people over 80. According to the federal government’s records of COVID-19 deaths by age group and sex, 685 of these deaths have been of aged care residents. It is not surprising therefore that many speak of the heavy impact of COVID-19 on older people as a form of genocide. Public discourse and government policies and priorities around COVID-19 have thrown into relief and exacerbated some of the deeply troubling ways that older people, particularly those living in aged care residences, are not recognised or treated as “equal partners in our future” (Royal Commission into Aged Care 1). Both the management of and public discourse around COVID-19 have highlighted and escalated the forms of ageism, especially ageism around later life, that have become embedded in Australian culture. In late 2019 the Royal Commission into Aged Care Quality and Safety released its Interim Report, titled simply Neglect. In the Foreword, the commissioners write: the Australian community generally accepts that older people have earned the chance to enjoy their later years, after many decades of contribution and hard work. Yet the language of public discourse is not respectful towards older people. Rather, it is about burden, encumbrance, obligation and whether taxpayers can afford to pay for the dependence of older people. (Royal Commission into Aged Care 1) Written and released before the COVID-19 pandemic, the Interim Report highlighted the “fundamental fact that our aged care system essentially depersonalises older people” (Royal Commission into Aged Care 6) and identified many ways “the aged care system fails to meet the needs of our older, often very vulnerable, citizens” (Royal Commission into Aged Care 1). In 2020 we saw some of the effects of these failures in the often disastrous mismanagement of disease transmission prevention in many aged care residences in Australia. Equally troubling, the resulting deaths have at times been accompanied by a general acceptance of the loss of so many in later life to COVID-19. The fact that these deaths are often regarded as somehow more inevitable, or as less significant than the deaths of others, is an indication of how deeply “Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities” (Royal Commission into Aged Care 1). It assumes that one’s later-life years are of less significance and value (to oneself, to the community) than one’s younger years. At various times in the pandemic, sizable parts of the global population have been variously asked, advised, or required by their governments to remain within their household or residential “bubble”. These COVID-related “bubbles” are more buoyant for some. Jackie Gulland has written a feminist analysis of the ways that the UK COVID-19 lockdown rules are premised on “neo-liberal assumptions about the family as autonomous and sufficient for the provision of reproductive labour” (330). In many places the requirement to stay within one’s “household bubble” both assumes that the home is safe for all, and that most care and dependency requirements are provided and received within a household. As Gulland’s essay demonstrates, the idea of the household bubble constructs an image or idea of who and what constitutes a household, and which relationships “count”. Drawing on critiques of neo-liberal and able-ist ideas about autonomy by feminist and disability scholars, Gulland “shows how the failure of policymakers to take account of interdependency has made lockdown more difficult for carers and those in receipt of care” (330). In this essay we look at some of the ways that the required and/or imagined COVID-19 bubbles for people in later life are thought of differently to the COVID-19 bubbles that younger, and mixed age, households are imagined as forming. This is particularly the case, we argue, for those in aged care residences. Younger and mixed age COVID bubbles often include extended or linked households (as we will discuss below in relation to the idea of the compassionate bubble) and function as a bubble that can link and enclose. In contrast, COVID bubbles in and for aged care and those in later life, work to isolate and separate. They function as bubbles that close off and shut out, as if placing the older person and older people behind glass (in some cases, quite literally). Likewise, while the COVID-19 bubbles for the “general” population (a category from which those in later life are often excluded) are regarded as temporary structures that will in time be dissolved to re-allow social movement and intermingling, the later life and aged care COVID-19 bubble is imagined very differently. This is because it is overlaid upon a pre-existing conception of later life—and in particular the fourth age—as itself a kind of bubbled existence, a fragile state held somewhat separate and apart from the general population and moving inexorably toward death—a bubble that pops. Bubbling the Fourth Age The idea that later life can be divided into different stages and ages has a long history, although the shape, meaning and valuing of different ages in later life is historically specific. Back in the late 1980s the Cambridge historian Peter Laslett proposed that rather than falling into three main stages—childhood, adulthood and old age—there are in fact four stages and that “later life can be divided into a ‘third age’ and a ‘fourth age’” (Gilleard and Higgs, “The Fourth Age” 368). Laslett’s distinction between a third age (active and characterised by personal fulfillment) and a fourth age (for Laslett an age of infirmity) has become increasingly significant in both age studies and in the provision and imagining of aged care. While the third age is increasingly depicted as something that, when managed “successfully”, can expand and fill with rich experiences and rewards (assuming one has the economic and social privilege and mobility to embrace these rich offerings—see Katz and McHugh cited in Zeilig, “Critical Use of Narrative”), the fourth age, on the other hand, is associated with frailty, increased dependence, vulnerability, precarity (see Lloyd; Gilleard and Higgs; and Morganroth Gullette on the fourth age). Of course, experiences of vulnerability, dependency and precarity run throughout the life course and cannot be reduced to chronological age. However, the distinction between a third and fourth age tends to assume that once one “leaves” the third age, it is a one-way path to “the three ‘Ds’: decrepitude, dependence, and death” (Laslett). The fourth age becomes associated with those aspects of ageing that are culturally rejected and pushed aside—in particular physical dependence which, as in much able-ist thinking, is rendered abject. As Morganroth Gullette has argued, a “savage contradiction” underlies and fuels this distinction, as “fantasies of the longevity bonanza proliferate alongside growing terrors of living too long” and becoming a “‘burden’” (21). In other words, those aspects of ageing—indeed those aspects of being human—that are seen as undesirable and/or abject are associated with the fourth age and imagined as somehow exclusive to it: they are placed elsewhere, contained in a fourth age “bubble”. The understanding of the fourth age as a kind of bubble is evident in and enabled by various kinds of cultural representations and institutional discourses around later life, including the kind of language used (particularly language connoting precarity and fragility and liminality) and recurrent media imagery in which people in their “fourth age” are depicted as mentally and physically out of reach (for instance isolated behind glass). Legislation around the movements of residents, visitors, and staff in aged care residence does not simply create “protective” bubbles around aged care residences but also constructs and imagines these residences and their inhabitants as “bubbled”, removed, and voiceless. Vulnerability, ephemerality, precarity and decline have become increasingly significant in representations of and discourses around ageing. Much of the media coverage of those in later life, particularly those living in aged care residences, has further fuelled what Sally Chivers has called the “nursing home specter” and delivered, in heightened and often spectacularised form, the “life-course narrative that dominant culture provides—an unliveable mind and unrecognizable body, mountainous expense” (Morganroth Gullette, 24). The discourse on ageing is characterised by the use of metaphor and metonymy, of which “the bubble” or “bubbling” is only one notable example. The culture of fear that surrounds the fourth age stems from the presumption that ageing inevitably leads to decay and decline in quality of life, and that the experience of ageing is characterised by various forms of physical and cognitive deterioration, such as dementia. Cultural gerontologist Hannah Zeilig has drawn attention to the pervasive use of metaphors—in both medical journals and mass media reports—to describe the experience of living with dementia. These metaphors attempt to capture and simplify the complexities of being, speaking, and knowing experienced by people with dementia. They are frequently used to communicate these experiences to people who do not live with dementia. The cultural metaphors of dementia are potent examples of ageism. They are not neutral in their connotations or implicit value judgements. These metaphors reveal wider social anxieties around ageing, despite the fact that people in their 40s and 50s can have dementia (Dementia Australia). As Zeilig has pointed out, many of these metaphors have presented a negative framing of dementia, describing the rising numbers of dementia diagnoses in apocalyptic, biblical terms such as “plague”, “crisis”, and “epidemic” (“Cultural Metaphor” 260). While this hyperbole may be grounded in statistics and the realities of an ageing population, it has nevertheless been alarming. This rhetoric has often been a necessary tactic for dementia organisations as part of their efforts to secure media coverage, raise public awareness of dementia, and lobby for increased government and private investment in funding research and support services. Despite these noble intentions, this rhetoric can risk excluding or marginalising the voices of people living with dementia. Some of the metaphors that have been used to describe dementia are particularly dehumanising and stigmatising, such as the perception of Alzheimer’s disease as a form of “living death”. This conception of Alzheimer’s, which Susan M. Behuniak has observed in both scholarly and popular discourse, elicits strong negative emotional responses of revulsion and fear. It constructs people with Alzheimer’s as abject zombie-like figures living a half-life or twilight existence. These trends in dementia discourse that Zeilig and Behuniak identified in the first half of the 2010s are also apparent in media imagery and discourse about older people in the COVID-19 pandemic. Much like the cultural narratives of dementia, these representations often reinforce the fourth age’s association with forms of vulnerability, decline and decay that are rendered abject. In contrast to this negative framing of both dementia and the fourth age, the trope of “living in a bubble” can also present a more ambivalent conception of both living with dementia and, by extension, the sociocultural experience of living in the fourth age during the time of COVID-19. “Bubbling” can serve a protective function for the person living with dementia by reducing sensory overload and cognitive confusion that may lead to anxiety and emotional distress. In dementia care, bubble wands and bubble wrap are two of the most commonly used tools in sensory therapy for reducing anxiety and agitation, and providing comfort (DailyCaring). These examples remind us of the materiality of the bubble, which functions as both cultural trope and material condition that affects people’s lives (to borrow from Helen Deutsch and Felicity Nussbaum, cited in Vivian Sobchack’s essay on metaphor and materiality). Within the diversity and range of caring practices encompassed by the trope of “bubbling”, there is clear potential for the bubble to be enabling, rather than disabling, if it is used to enhance quality of life and wellbeing for older people, rather than to separate, marginalise and isolate. Despite the multivalent possibilities of the bubble for enhancing quality of life for people with dementia, the bubble’s association with precarity has been heightened by its deployment to protect older people during the COVID-19 pandemic. This is a source of ambivalence around the COVID-19 bubble, a public health response that is acknowledged as having both protective and harmful effects. It involves “bubbling” older people, especially those living in residential care, by physically isolating them and limiting their contact with family and friends to conversations mediated by digital technology or a windowpane. By restricting physical and direct contact with the outside world in order to reduce and contain transmission of the virus, the COVID-19 bubble is intended to protect the physical health of older adults. But as Karra Harrington and Martin J. Sliwinski caution, this can also risk the cognitive health and mental wellbeing of older people by creating social isolation. These concerns about the negative health impacts of the COVID-19 bubble compound the existing popular understanding of late life as isolated and isolating, perpetuating the ageist assumptions that characterise the social imaginary around the fourth age. Creating Compassionate Bubbles The distress of separation caused by COVID-19 lockdowns and restrictions is felt by all generations, not just older people. Recognising the costs to our emotional and mental wellbeing of living in isolation to protect our bodies and our communities from viral invasion, Australian epidemiologist Mary-Louise McLaws has called for “a compassionate germ bubble”, modelled on New Zealand’s concept of an extended bubble that allows close contacts beyond one household. This alternative approach to “bubbling” is designed to strike a better balance between physical and mental health. Writing during Melbourne’s strict and prolonged lockdown following a second wave of cases in the winter of 2020, McLaws argued that “a compassionate germ bubble may foster resilience by reducing a sense of isolation for people living alone and friends, extended family and partners distressed by the separation”. There have been a number of creative and compassionate responses to the necessity of the COVID-19 bubble for protecting those most vulnerable to the virus. Aged care residences have developed innovative ways to safely maintain in-person visits and provide opportunities for face-to-face contact between residents and their families and friends. One example reported in the Australian media (Steger) is “The Window of Love” in Perth, which demonstrates the positive potential of the bubble—represented here as a pane of glass bordered by a painted frame—for facilitating social connection and supporting wellbeing despite restrictions on physical contact. The media reporting of these innovations tends to spectacularise the residents of these homes, reinforcing their fragility and vulnerability as they are framed behind plastic or glass. In December 2020, international media outlets The Guardian, RTE News, and Star Media posted a Reuters video story on their respective YouTube channels about a “hug bubble” created in an aged care home in Jeumont, France. This inflatable plastic tunnel allows physical touch between those living in the home and those outside it through hermetically sealed sleeves. Separating the resident from their visitors is a clear plastic sheet, which is disinfected by staff in between each visit. Recognising the importance of physical contact for wellbeing, nursing staff reported that the hug bubble has brought comfort to the residents, whose previous contact with family and friends since the outbreak of COVID-19 in March 2020 had been limited to video calls or talking through a window. Viewer comments reveal divergent responses to this media story across all three YouTube channels. Some viewers applaud the innovation while others disparage the hug bubble as “cruel” and “disgraceful”. Other comments register viewers’ ambivalence, recognising the good intentions behind the idea while despairing at the need for it. Several comments offer a snapshot of the cynical, often incoherent views about the pandemic commonly found on social media platforms like Facebook and Twitter, while also demonstrating the persistence of ageist attitudes that regard the elderly as a burden. These negative responses are striking in contrast with the positive framing of the original media report, which is presented as a “feel good” human interest story through brief interviews with family members and nursing home staff, reflecting on the residents’ experiences using the hug bubble. This positive framing is reinforced by the gentle music track accompanying the video posted on the RTE News channel. Beyond the institutional context of aged care residences, many families and communities have also engineered solutions to reduce the stress of separation. Craving physical contact after months of isolation, they have embraced the materiality and tactility inherent in the bubble trope. People have improvised using household objects, such as plastic sleeves attached to transparent shower curtains, to build “cuddle curtains”, and “hug machines” to enable safe—and playful—physical contact. These innovations and adaptations tap into the bubble’s playful qualities, while also “going viral” as families document their creativity, delight and joy through their own video stories shared on YouTube. As we move into the second year of the COVID-19 pandemic, with case numbers and the death toll continuing to climb globally, the concept of the COVID-19 bubble and its role in protecting the community will continue to be debated, refined and reconfigured in both public health responses and media discourse. Despite Australia’s relatively good fortune in terms of total number of COVID-related deaths compared to other Western nations such as the US and the UK, the disproportionately high number of deaths among Australians in aged care is a sobering reminder of the systemic failures in Australia’s aged care residences. As we move in and out of periods of social isolation, restrictions and lockdowns, it will become increasingly important to address the mental health impacts of “living in a bubble” and to consider creative, compassionate alternatives that challenge ageism and maintain quality of life for fourth age Australians. *** As COVID-19 and its management continue to reshape our world(s) and our relations to each other, its impacts continue to be unevenly felt, particularly for those in later life. For this reason, it becomes increasingly important to be alert to the ways in which “bubbling” the fourth age in response to COVID-19 risks reinforcing a homogenising view of older people as vulnerable and isolated, defenceless against viral invasion and voiceless in expressing agency and maintaining social connection. This essay responds to Hannah Zeilig’s earlier call to “radically rethink the ways in which age and ageing have been culturally configured” (“Critical Use of Narrative” 16). One of the purposes of this essay has been to critically assess some of the ways that the relatively new discourse of a fourth age—as somehow both qualitatively and quantifiably different to and separate from the third age—entails a homogenising view of older people. This view has enabled forms of ageism that have often been particularly brutal in their impact during the pandemic. In this essay we have argued that popular conceptions of and public health discourse and policy around the fourth age have often enabled—or, at the very least, supported—forms of ageism. This ageism has been further heightened through both the discourse and the imagery of the COVID-19 bubble. The fourth age, we argued, has often been understood as bubble-like: as a “stage” of life when one is somehow separated from the larger community and culture. The fourth age is configured as physically fragile and precarious, transient and temporary, ephemeral, and enclosed in—and as—its own world. Created in the name of protecting “our most vulnerable”, the bubble in the time of COVID-19 has heightened these pre-existing social anxieties around the fourth age. The challenge, as we move into the second year of the pandemic in Australia, is to find new ways of protecting the health and wellbeing of people in later life, while creating opportunities for connection, agency and play that are supported, rather than hindered, by the COVID-19 bubble. References Australian National Dictionary Centre. “2020 Word of the Year.” Canberra: School of Literature, Languages and Linguistics, ANU College of Arts and Social Sciences, Australian National University. 17 Nov. 2020. 12 Jan. 2021 <https://slll.cass.anu.edu.au/centres/andc/news/2020-word-year>. Behuniak, Susan M. “The Living Dead? The Construction of People with Alzheimer’s Disease as Zombies.” Ageing & Society 21 (2011): 70–92. Chivers, Sally. “‘Blind People Don’t Run’: Escaping the ‘Nursing Home Specter’ in Children of Nature and Cloudburst.” Journal of Aging Studies 34 (2015): 134–41. “COVID-19 Deaths by Age Group and Sex.” Australian Government Department of Health: Coronovirus (COVID-19) Current Situation and Case Numbers. 1 Jan. 2021 <https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers#cases-and-deaths-by-age-and-sex>. DailyCaring. “6 Alzheimer’s Sensory Activities Reduce Anxiety without Medication.” 12 Jan. 2021 <https://dailycaring.com/6-alzheimers-sensory-activities-reduce-anxiety-without-medication/>. Dementia Australia. “What Is Dementia?” 12 Jan. 2021 <https://www.dementia.org.au/about-dementia/what-is-dementia>. Fuchs, Anne, Desmond O'Neill, Mary Cosgrove, and Julia Langbein. “Report on COVID-19 – Reframing Ageing Webinar 12 June 2020.” Preprint. Aug. 2020. DOI: 10.13140/RG.2.2.34508.44161. Gilleard, Chris, and Paul Higgs. “Aging without Agency: Theorizing the Fourth Age.” Aging and Mental Health 14.2 (2010): 121–28. Gilleard, Chris, and Paul Higgs. “Ageing Abjection and Embodiment in the Fourth Age.” Journal of Aging Studies 25.2 (2011): 135–42. Gilleard, Chris, and Paul Higgs. “The Fourth Age and the Concept of a ‘Social Imaginary’: A Theoretical Excursus.” Journal of Aging Studies 27 (2013): 368–76. Gulland, Jackie. “Households, Bubbles, and Hugging Grandparents: Caring and Lockdown Rules during COVID-19.” Feminist Legal Studies 28 (2020): 329–39. Harrington, Karra, and Martin J. Sliwinski. “The Loneliness of Social Isolation Can Affect Your Brain and Raise Dementia Risk in Older Adults.” The Conversation 4 Aug. 2020. 12 Jan. 2021 <https://theconversation.com/the-loneliness-of-social-isolation-can-affect-your-brain-and-raise-dementia-risk-in-older-adults-141752>. Laslett, Peter. A Fresh Map of Life: The Emergence of the Third Age. London: Weidenfeld and Nicolson, 1989. Lloyd, Liz. “The Fourth Age.” Routledge Handbook of Cultural Gerontology. Eds. Julia Twigg and Wendy Martin. London: Routledge, 2015. 20 Dec. 2020 <https://www.routledgehandbooks.com/doi/10.4324/9780203097090.ch33>. McLaws, Mary-Louise. “What Is the COVID ‘Bubble’ Concept, and Could It Work in Australia?” The Conversation 1 Sep. 2020. 12 Jan. 2021 <https://theconversation.com/what-is-the-covid-bubble-concept-and-could-it-work-in-australia-144938>. Morganroth Gullette, Margaret. “Aged by Culture.” Routledge Handbook of Cultural Gerontology. Eds. Julia Twigg and Wendy Martin. London: Routledge, 2015. 28 Dec. 2020 <https://www.routledgehandbooks.com/doi/10.4324/9780203097090.ch3>. Royal Commission into Aged Care Quality and Safety. Neglect. Interim Report Volume 1. Canberra: Commonwealth Government of Australia, 31 Oct. 2019. 12 Jan. 2021 <https://agedcare.royalcommission.gov.au/publications/interim-report>. Sobchack, Vivian. “A Leg to Stand On: Prosthetics, Metaphor, and Materiality.” In The Prosthetic Impulse: From a Posthuman Present to a Biocultural Future. Cambridge: MIT Press, 2006. 17–41. Steger, Sarah. “Coronavirus Crisis: Oryx Communities Aged Care Home Creates ‘Window of Love’ to Help Residents Stay Connected to Families.” The West Australian 5 Apr. 2020. 12 Jan. 2021 <https://thewest.com.au/news/coronavirus/coronavirus-crisis-oryx-communities-aged-care-home-creates-window-of-love-to-help-residents-stay-connected-to-families-ng-b881510245z>. Zeilig, Hannah. “The Critical Use of Narrative and Literature in Gerontology.” International Journal of Ageing and Later Life 6.2 (2011): 7-37. ———. “Dementia as a Cultural Metaphor.” The Gerontologist 54.2 (2013): 258–67. ———. “What Do We Mean When We Talk about Dementia? Exploring Cultural Representations of ‘Dementia’.” Working with Older People 19.1 (2015): 12–20.

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. 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