Artigos de revistas sobre o tema "Association of Universalist Women of New York State"

AbstractThis paper explores the movement of the New York City Interborough Association of Women Teachers (IAWT) for “equal pay for equal work” in teaching salaries, which it won in 1911. The IAWT’s success sheds light on the possibilities and limits of women teachers advocating for change within a feminized profession. Leading the movement were of a group of women teachers, organizing before woman’s suffrage and in an era of sex-differentiated work and pay, who convinced the city’s public and state’s legislators that they deserved pay equal to what men teachers received. They did so by strategic maneuvering in city and state politics and making equal pay look reasonable. And they did so by narrowly defining their goals and leaning on their identities as women to push a theoretically sex-neutral claim of justice. Their success, though limited, was nonetheless a victory in shifting ideas about women’s societal and professional status in New York City and the state.

The New York State Angler Study will evaluate the association between past and current consumption of contaminated fish from Lake Ontario and both short- and long-term health effects in a population-based cohort. It will measure fish consumption and reproductive and developmental health among 10,518 male anglers and 6,651 of their wives or partners, as well as among 913 female anglers. To characterize exposure among subgroups of the cohort, further analytical methods were developed and implemented to measure specific polychlorinated biphenyls (PCB) congeners, methylmercury, and other substances in biological samples. Exposure assessment has been completed for a stratified random sample of 321 anglers. In addition, analyses for 79 congeners of PCBs are complete for 177 anglers. A special study of duck andturtle consumers currently is underway. Telephone interviews have been completed with 2,454 of the 2,999 women who planned a pregnancy between 1991 and 1994. The entire cohort of male anglers, partners of male anglers, and female anglers has been submitted for matching with the New York State live birth and fetal death registries to obtain lifetime reproductive histories. A medical record abstraction study will assess perinatal and developmental outcomes among the 3,442 births that occurred between 1986 and 1991. Finally, a study of breast milk from currently lactating women is underway, and 215 breast milk samples have been collected from the planned pregnancy subcohort. Progress on each of the study components is discussed herein.

OBJECTIVE: To assess the relative associations of individual race and hospital racial composition on the likelihood of undergoing minimally invasive hysterectomy for the treatment of uterine leiomyomas in New York State. METHODS: We performed a retrospective cohort study that used the New York SPARCS (Statewide Planning and Research Cooperative System) database to identify women with uterine leiomyomas who underwent hysterectomy from 2000 to 2018. Hospitals were grouped by racial composition into quartiles based on the proportion of non-Hispanic Black (Black) patients, with quartile 1 corresponding to the lowest proportion of Black patients and quartile 4 corresponding to the greatest proportion of Black patients. Surgical route was characterized as minimally invasive (laparoscopic, vaginal, or robot-assisted) or abdominal hysterectomy. The contributions of individual race and hospital racial composition on route of hysterectomy were assessed with a series of logistic regression models accounting for patient and hospital characteristics. RESULTS: A total of 259,161 women with leiomyomas who underwent hysterectomies at 215 hospitals were identified. The rate of minimally invasive hysterectomy increased from 20.2% in 2000 to 65.7% in 2018. From 2000 to 2009, 29.6% of White patients underwent minimally invasive hysterectomy compared with 12.3% of Black women (P<.001). Minimally invasive hysterectomy was performed in 34.4% of patients in hospitals that served the lowest percentage of Black patients, compared with 15.9% in centers serving the highest percentage of Black patients (P<.001). Similar trends were noted for the 2010–2018 time period. In a series of models, both individual race (odds ratio [OR] 0.52; 95% CI, 0.48–0.56) and hospital racial quartile (OR 0.43; 95% CI, 0.32–0.58) remained associated with performance of minimally invasive hysterectomy. CONCLUSION: Black women and women who receive care at hospitals that serve a greater proportion of Black patients are less likely to receive minimally invasive surgery when undergoing definitive surgical management for uterine leiomyomas. These disparities are worsening.

AbstractIn 1870, the New York State Suffrage Association published a pamphlet titled “Woman as Inventor.” White suffragists distributed this history of female invention to prove women's inventiveness, countering arguments that biological disabilities justified women's legal disabilities. In the United States, inventiveness was linked to the capacity for original thought considered crucial for voters, making female inventiveness relevant to the franchise. As women could and did receive patents, activists used them as government certification of female ability. By publicizing female inventors, counting patents granted to women, and displaying women's inventions, they sought to overturn the common wisdom that women could not invent and prove that they had the ability to vote. Although partially successful, these efforts left undisturbed the equally common assertion that African Americans could not invent. White suffragists kept the contemporary Black woman inventor invisible, relegating the technological creations of women of color to a primitive past. White suffragists created a feminist history of invention, in words and objects, that reinforced white supremacy—another erasure of Black women, whose activism white suffragists were eager to harness, yet whose public presence they sought to minimize in order to keep the woman voter, like the woman inventor, presumptively white.

ABSTRACTTo assess whether treatment with metronidazole during pregnancy is associated with preterm birth, low birth weight, or major congenital anomalies, we conducted chart reviews and an analysis of electronic data from a cohort of women delivering at an urban New York State hospital. Of 2,829 singleton/mother pairs, 922 (32.6%) mothers were treated with metronidazole for clinical indications, 348 (12.3%) during the first trimester of pregnancy and 553 (19.5%) in the second or third trimester. There were 333 (11.8%) preterm births, 262 (9.3%) infants of low birth weight, and 52 infants (1.8%) with congenital anomalies. In multivariable analysis, no association was found between metronidazole treatment and preterm birth (odds ratio [OR], 1.02 [95% confidence interval [CI], 0.80 to 1.32]), low birth weight (OR, 1.05 [95% CI, 0.77 to 1.43]), or treatment in the first trimester and congenital anomalies (OR, 0.86 [0.30 to 2.45]). We found no association between metronidazole treatment during the first or later trimesters of pregnancy and preterm birth, low birth weight, or congenital anomalies.

Background: Growing evidence suggests an association between adolescent obesity and increased risk of multiple sclerosis (MS). Objective: The objective of this paper is to investigate whether weight or body mass index (BMI) in adolescence and young adulthood was associated with age at MS symptom onset. Methods: Our cohort is comprised of a sub-group of 184 women enrolled in the New York State MS Consortium registry. Individuals were asked to recall their weight at the time of first menstruation and at age 25. BMI was calculated accordingly for age 25. Regression analyses were carried out to investigate the association between weight or BMI and age at onset. Results: Weight at menarche was significantly related to younger age at symptom onset (β = −0.073, p = 0.001). These results were also found at age 25 for weight (β = −0.080, p < 0.001) and BMI (β = −0.448, p = 0.001). Significantly earlier disease onset (26.9 years ±9.9) was observed in individuals who were overweight at 25 compared to those who were not overweight (32.1 years ±9.2, p = 0.006). Conclusions: Women who reported higher weight in adolescence and BMI in early adulthood were younger at MS onset. Future research should investigate whether there is a causal link between body weight and MS, as prevention lifestyle and dietary interventions could be implemented.

In her pivotal work on Kuwaiti politics, Mary Ann Tétreault provides an “insider's guide” to the private and public spaces in which struggles over communal power are pursued by the government, the Parliament, and the people of Kuwait. Tétreault is careful to call her text “Stories of Democracy,” as she realizes the reflexive nature of what democracy means at different periods in history (before oil, after oil, under Iraqi occupation, in post-Liberation Kuwait); for different people in Kuwait (women, the merchants, government officials, tribal leaders, service politicians, opposition leaders); and in different contexts (the mosque, the diwaniyya or men's social club, the civic association, Parliament, the government). With this in mind, she argues that “democracy” is a “concept that ‘moves' depending on one's assumptions” (p. 3). Her basic message is that Kuwaiti politics resembles the politics of the Greek city-state, and she relies on various forms of Aristotelian comparison to explore this concept. Moreover, Tétreault illustrates that much of Kuwaiti politics resembles a high-stakes soap opera. For example, she calls the bad debt crisis “one of the longest running soap operas in Kuwaiti politics” (p. 164). In Chapter 4, she labels Kuwaiti politics “a family romance, whose grip on political actors constrains their choices” (p. 67). Toward the end of her text in chapter 8, Tétreault combines these metaphors when she observes that in the city-state that is Kuwait, politics are “the product of a domestic public life that seems all too often like life in a large and contentious family” (p. 206).

Edna Lomsky-Feder and Orna Sasson-Levy, Women Soldiers and Citizenship in Israel: Gendered Encounters with the State (New York: Routledge, 2017), 178 pp. Hardback, $149.95.Aviva Halamish, Kibbutz: Utopia and Politics. The Life and Times of Meir Yaari, 1897–1987 (Brighton, MA: Academic Studies Press, 2017), 496 pp. Hardback, $119. Paperback, $45.Eliezer Ben-Rafael, Julius H. Schoeps, Yitzhak Sternberg, and Olaf Glöckner, eds., Handbook of Israel: Major Debates (Berlin: De Gruyter Oldenbourg, 2016), 1,304 pp. Hardback, $165.00. Paperback, $81.00.Uri Ram, Israeli Sociology: Text in Context (Basingstoke: Palgrave Macmillan, 2017), 174 pp. e-Book: $54.99.Herbert C. Kelman, Transforming the Israeli-Palestinian Conflict: From Mutual Negation to Reconciliation (London: Routledge, 2018), 248 pp. Hardback, $112.00. eBook, $27.48.Charles D. Freilich, Israeli National Security: A New Strategy for an Era of Change (New York: Oxford University Press, 2018), 496 pp. Hardback, $39.95. Kindle, $14.57.David Rosenberg, Israel’s Technology Economy: Origins and Impact (New York: Palgrave Macmillan, 2018), 275 pp. Hardback, $84.95. eBook, $64.95.Lee Perlman, But Abu Ibrahim, We’re Family! (Tel Aviv: Tami Steinmetz Center for Peace Research, 2017), 198 pp. Paperback, $20.00. Shapiro Prize WinnersThis new feature of ISR will present the report of the committee choosing the recipient of the Yonathan Shapiro Prize for the best book in Israel Studies, to be awarded at the annual meeting of the Association for Israel Studies. In 2018, there was a tie, and two books received the prize. The committee members were Raphael Cohen-Almagor, Mikhal Dekel, Tamar Hermann, Sam Lehman-Wilzig, and Ruvi Ziegler.Alona Nitzan-Shiftan, Seizing Jerusalem: The Architecture of Unilateral Unification (Minneapolis: University of Minnesota Press, 2017), 376 pp. Hardback, $160.00. Paperback, $39.95.Kimmy Caplan, Amram Blau [in Hebrew] (Jerusalem: Yad Ben Zvi and the Ben-Gurion Institute, 2017), 588 pp. Paperback, NIS116.

It is with the deepest humility that I accept the Abraham Jacobi Award from the American Medical Association (AMA) and the American Academy of Pediatrics. Dr Jacobi represented the best in pediatrics, a practitioner in New York in 1853, Professor of Diseases of Children at New York Medical College in 1859, Chairman of the AMA Section Council on Pediatrics, founder and president of the American Pediatrics Society, and president of the American Medical Association. He was perhaps best known as a child advocate. Dr Jacobi believed that physicians should take an active interest in public policy. At an early age he was, and remained throughout his life, what would now be termed a "troublemaker." He actively pursued legislation for women and children in Albany, the state capitol, and in Washington, DC. Throughout his long and productive life, he felt comfortable only when championing a good cause.1-4 It is truly an honor to receive an award bearing his name. Before I begin my address, I would like to pay personal tribute to my dear wife Kathie, who has stood by me for 40 years throughout my shortcomings as a husband and father, as I pursued my interest in organized medicine as a child advocate. She has suffered through long waits for late dinners because of my practice or meetings, the yardwork that was never done because of office or hospital emergencies, and cared for our family alone while I attended meetings on the mainland. I would also like to honor my mentor, the late Dr Irvine McQuarrie, who "fathered" me during my first year of pediatrics residency in Hawaii.

Martin K. Sorge. The Other Price of Hitler's War. German Military and Civilian Losses Resulting from World War II. Westport, CT: Greenwood Press, 1986. Pp. xx, 175. Cloth, $32.95; M. K. Dziewanowski. War At Any Price: World War II in Europe, 1939-1945. Englewood Cliffs, NJ: Prentice-Hall, 1987. Pp. xiv, 386. Paper, $25.67. Review by Lawrence S. Rines of Quincy Community College. David Goldfield. Promised Land: The South Since 1945. Arlington Heights, IL: Harlan Davidson, Inc., 1987. Pp. xiii, 262. Cloth, $19.95, Paper, $9.95; Alexander P. Lamis. The Two Party South. New York: Oxford University Press, 1984. Pp. x, 317. Cloth, $25.00; Paper, $8.95. Review by Ann W. Ellis of Kennesaw College. Walter J. Fraser, Jr., R. Frank Saunders, Jr., and Jon L. Wakelyn, eds. The Web of Southern Social Relations: Women, Family, and Education. Athens: University of Georgia Press, 1985. Pp. XVII, 257. Paper, $12.95. Review by Thomas F. Armstrong of Georgia College. William H. Pease and Jane H. Pease. The Web of Progress: Private Values and Public Styles in Boston and Charleston, 1828-1842. New York and Oxford: Oxford University Press, 1985. Pp. xiv, 334. Paper, $12.95. Review by Peter Gregg Slater of Mercy College. Stephen J. Lee. The European Dictatorships, 1918-1945. London and New York: Methuen, 1987. Pp. xv, 343. Cloth, $47.50; Paper, $15.95. Review by Brian Boland of Lockport Central High School, Lockport, IL. Todd Gitlin. The Sixties: Days of Hope, Days of Rage. New York: Bantam, 1987. Pp. 483. Cloth, $19.95; Maurice Isserman. IF I HAD A HAMMER... : The Death of the Old Left and the Birth of the New Left. New York: Basic Books, 1987. Pp. xx, 244. Cloth, $18.95. Review by Charles T. Banner-Haley of Martin Luther King, Jr. Center for Nonviolent Social Change, Inc. Donald Alexander Downs. Nazis in Skokie: Freedom, Community, and the First Amendment. Notre Dame IN: Notre Dame Press, 1985. Pp. 227. Paper, $9.95. Review by Benjamin Tate of Macon Junior College. Paul Preston, The Triumph of Democracy in Spain. London and New York: Methuen, 1986. Pp. 227. Cloth, $32.00. Review by Victoria L. Enders of Northern Arizona University. Robert B. Downs. Images of America: Travelers from Abroad in the New World. Urbana and Chicago: University of Illinois Press, 1987. Pp. 232. Cloth, $24.95. Review by James F. Marran of New Trier Township High School, Winnetka, IL. Joel H. Silbey. The Partisan Imperative: The Dynamics of American Politics Before the Civil War. New York and Oxford: Oxford University Press, 1985. Pp. viii, 234. Paper, $8.95. Review by John T. Reilly of Mount Saint Mary College. Barbara J. Howe, Dolores A. Fleming, Emory L. Kemp, and Ruth Ann Overbeck. Houses and Homes: Exploring Their History. Nashville: The American Association for State and Local History, 1987. Pp. xii, 168. Paper, $13.95; $11.95 to AASLH members. Review by Marsha L. Frey of Kansas State University. Thomas C. Cochran. Challenges to American Values: Society, Business and Religion. New York and Oxford: Oxford University Press, 1987. Pp. 147. Paper, $6.95. Review by H. Roger Grant of University of Akron. M.S. Anderson. Europe in the Eighteenth Century, 1713-1783. London and New York: Longman, 1987. Third Edition. Pp. xii, 539. Cloth, $34.95. Review by Robert Lindsay of the University of Montana.

e13157 Background: National guidelines recommend genetic testing for women at increased risk for pathogenic mutations, however insurance coverage is a commonly cited barrier to test completion. The major provisions of the Affordable Care Act (ACA) became available in New York State (NYS) in January 2014. We sought to evaluate the effect of insurance status on genetic testing patterns following introduction of the ACA. Methods: Insurance status and genetic testing patterns at the hereditary breast and ovarian cancer center at a single institution were reviewed between 1/1/2013 and 12/31/2016. Insurance status and association with testing type and clinical outcomes were evaluated before and after January 2014. Results: During the study period, 1535 women underwent genetic counseling and genetic assessment. When comparing the cohort of women undergoing genetic testing prior to and following January 2014, significant increases in patients undergoing multigene panel testing were observed across all insurance types (6.3% vs. 40.6%, p < 0.001). While a significant increase in the number of patients with private insurance or Medicaid as primary coverage was seen, the increase in insured women was largely attributed to insurance polices through the ACA exchange (p < 0.001), with the majority being Medicaid ACA plans (80.3%). Conclusions: Since expansion of health insurance through the ACA in NYS, there has been a shift in the demographics of women undergoing genetic testing at a hereditary breast and ovarian cancer center with significantly more insured women and a rise in multigene panel testing. With insurance expansion and improved access to comprehensive genetic testing, insurance status should not be an obstacle for genetic testing.

Ovarian cancer is the fifth leading cause of female cancer mortality in the U.S. and accounts for five percent of all cancer deaths among women. No environmental risk factors for ovarian cancer have been confirmed. We previously reported that ovarian cancer incidence rates at the state level were significantly correlated with the extent of pulp and paper manufacturing. We evaluated that association using county-level data and advanced geospatial methods. Specifically, we investigated the relationship of spatial patterns of ovarian cancer incidence rates with toxic emissions from pulp and paper facilities using data from the Environmental Protection Agency’s Toxic Release Inventory (TRI). Geospatial analysis identified clusters of counties with high ovarian cancer incidence rates in south-central Iowa, Wisconsin, New York, Pennsylvania, Alabama, and Georgia. A bivariate local indicator of spatial autocorrelation (LISA) analysis confirmed that counties with high ovarian cancer rates were associated with counties with large numbers of pulp and paper mills. Regression analysis of state level data indicated a positive correlation between ovarian cancer and water pollutant emissions. A similar relationship was identified from the analysis of county-level data. These data support a possible role of water-borne pollutants from pulp and paper mills in the etiology of ovarian cancer.

BackgroundPolycystic ovarian syndrome (PCOS) is the most common cause of female infertility and is associated with higher levels of circulating androgens. Exposure to higher levels of androgens in utero may be a risk factor for obesity among children of women with PCOS.MethodsWe examined whether maternal PCOS was associated with differences in offspring growth and obesity in the Upstate KIDS study, a prospective cohort study of infants born in New York State (excluding New York City) oversampled for fertility treatments and multiple births. Measurements of offspring length/height and weight were recorded at doctor’s visits through 3 years of age. PCOS diagnosis was self-reported by mothers at baseline. We used linear mixed models with robust SEs to estimate differences in growth by maternal PCOS exposure. We used logistic regression to examine whether infants experienced rapid weight gain at 4, 9 and 12 months. Growth measures were reported by 4098 mothers for 4949 children (1745 twins). Of these, 435 mothers (10.6%) had a diagnosis of PCOS.ResultsCompared with children born to mothers without PCOS, children of mothers with PCOS did not have significant differences in weight (4.81 g, 95% CI −95.1 to 104.7), length/height (0.18 cm, 95% CI −0.16 to 0.52) and body mass index (−0.14 kg/m2, 95% CI −0.30 to 0.01) through 3 years of age. We also observed no association between maternal PCOS and offspring rapid weight gain.ConclusionsOverall, we found little evidence to suggest that maternal PCOS influences early childhood growth in this large, prospective cohort study.

Background There is strong evidence that pain is undertreated in black and Hispanic patients. The association between race and ethnicity and the use of epidural analgesia for labor is not well described. Methods Using the New York State Perinatal Database, the authors examined whether race and ethnicity were associated with the likelihood of receiving epidural analgesia for labor after adjusting for clinical characteristics, demographics, insurance coverage, and provider effect. This retrospective cohort study was based on 81,883 women admitted for childbirth between 1998 and 2003. Results Overall, 38.3% of the patients received epidural analgesia for labor. After adjusting for clinical risk factors, socioeconomic status, and provider fixed effects, Hispanic and black patients were less likely than non-Hispanic white patients to receive epidural analgesia: The adjusted odds ratio was 0.85 (95% CI, 0.78-0.93) for white/Hispanic and 0.78 (0.74-0.83) for blacks compared with non-Hispanic whites. Compared with patients with private insurance, patients without insurance were least likely to receive epidural analgesia (adjusted odds ratio, 0.76; 95% CI, 0.64-0.89). Black patients with private insurance had similar rates of epidural use to white/non-Hispanic patients without insurance coverage: The adjusted odds ratio was 0.66 (95% CI, 0.53-0.82) for white/non-Hispanic patients without insurance versus 0.69 (0.57-0.85) for black patients with private insurance. Conclusion Black and Hispanic women in labor are less likely than non-Hispanic white women to receive epidural analgesia. These differences remain after accounting for differences in insurance coverage, provider practice, and clinical characteristics.

In order to supplement the literature that describes individual injuries of the shoulder, carpal tunnel, and back in golfers, we administered a survey to demonstrate the incidence of golfers' injuries and describe the most frequent types. A questionnaire was administered to 1,790 members of the New York State Golf Association (amateur) under age 21. Three hundred sixty-eight players responded. Half of those responding had been struck by a golf ball at least on one occasion (47.6%), and 23% of the injuries were to the head or neck. Male golfers were 2.66 times more likely to be struck by a golf ball than females. Women and golfers with a higher handicap were at an increased risk for upper extremity problems, whereas younger and overweight golfers were more likely to have golf-related back problems. We concluded that golf is associated with a significant morbidity. Repetitious trunk and upper limb motions probably contribute to musculoskeletal disorders. However, an unexpectedly high incidence of trauma from projectile golf balls leads to the conclusion that no amount of stretching or muscular exercise is as important as increased alertness by golfers to decrease this hazard.

Athena Athanasiou, Agonistic Mourning: Political Dissidence and the Women in Black, Edinburgh: Edinburgh University Press, 2017, xii + 348 pp., £19.99 (paperback), ISBN 978-1-4744-2015-0.Maria Bucur and Mihaela Miroiu, Birth of Democratic Citizenship: Women and Power in Modern Romania, Bloomington: University of Indiana Press, 2018, 189 pp., $35.00 (рaperback), ISBN 978-0-25302-564-7.Katherina Dalakoura and Sidiroula Ziogou-Karastergiou, Hē ekpaideusē tôn gynaikôn, gynaikes stēn ekpaideusē: Koinônikoi, ideologikoi, ekpaideutikoi metaschēmatismoi kai gynaikeia paremvasē (18os–20os ai.) (Women’s education, women in education: Social, ideological, educational transformations, and women’s interventions [18th–20th centuries]), Athens: Greek Academic Electronic Manuals/Kallipos Repository, 2015, 346 pp., e-book: http://hdl.handle.net/11419/2585, ISBN: 978-960-603-290-5. Provided free of charge by the Association of Greek Academic Libraries.Melissa Feinberg, Curtain of Lies: The Battle over Truth in Stalinist Eastern Europe, New York: Oxford University Press, 2017, 232 pp., $74.00 (hardback), ISBN 978-0-19-064461-1.Christa Hämmerle, Oswald Überegger, and Birgitta Bader Zaar, eds., Gender and the First World War, Basingstoke, UK: Palgrave Macmillan, 2014, 276 pp., £69.99 (paperback), ISBN 978-1-349-45379-5.Oksana Kis, Ukrayinky v Hulahu: Vyzhyty znachyt’ peremohty (Ukrainian women in the Gulag: Survival means victory), Lvіv: Institute of Ethnology, 2017, 288 pp., price not listed (paperback), ISBN: 978-966-02-8268-1.Ana Kolarić, Rod, modernost i emancipacij a: Uredničke politike u časopisima “Žena” (1911–1914) i “The Freewoman” (1911–1912) (Gender, modernity, and emancipation: Editorial politics in the journals “Žena” [The woman] [1911–1914] and “The Freewoman” [1911–1912]), Belgrade: Fabrika knjiga, 2017, 253 pp., €14 (paperback), ISBN 978-86-7718-168-0.Agnieszka Kościańska, Zobaczyć łosia: Historia polskiej edukacji seksualnej od pierwszej lekcji do internetu (To see a moose: The history of Polish sex education from the first lesson to the internet), Wołowiec: Czarne, 2017, 424 pp., PLN 44.90 (hardback), ISBN 978-83-8049-545-6.Irina Livezeanu and Árpád von Klimó, eds., The Routledge History of East Central Europe since 1700, New York: Routledge, 2017, 522 pp., GBP 175 (hardback), ISBN 978-0-415-58433-3.Zsófia Lóránd, The Feminist Challenge to the Socialist State in Yugoslavia, Basingstoke, UK: Palgrave Macmillan 2018, 270 pp., €88.39 (hardback), €71.39 (e-book), ISBN 978-3-319-78222-5.Marina Matešić and Svetlana Slapšak, Rod i Balkan (Gender and the Balkans), Zagreb: Durieux, 2017, 333 pp., KN 168 (hardback), ISBN 978-953-188-425-9.Ana Miškovska Kajevska, Feminist Activism at War: Belgrade and Zagreb Feminists in the 1990s, London: Routledge, 2017, 186 pp., £105.00 (hardback), ISBN 978-1-138-69768-3.Ivana Pantelić, Uspon i pad “prve drugarice” Jugoslavij e: Jovanka broz i srpska javnost, 1952–2013 (The rise and fall of the “first lady comrade” of Yugoslavia: Jovanka Broz and Serbian public, 1952–2013), Belgrade: Službeni glasnik, 2018, 336 pp., RSD 880 (paperback), ISBN 978-86-519-2251-3.Fatbardha Mulleti Saraçi, Kalvari i grave në burgjet e komunizmit (The cavalry of women in communist prisons), Tirana: Instituti i Studimit të Krimeve dhe Pasojave të Komunizmit; Tiranë: Kristalina-KH, 2017, 594 pp., 12000 AL Lek (paperback), ISBN 978-9928-168-71-9.Žarka Svirčev, Avangardistkinje: Ogledi o srpskoj (ženskoj) avangardnoj književnosti (Women of the avant-garde: Essays on Serbian (female) avant-garde literature), Belgrade, Šabac: Institut za književnost i umetnost, Fondacij a “Stanislava Vinaver,” 2018, 306 pp., RSD 800 (paperback), ISBN 978-86-7095259-1.Şirin Tekeli, Feminizmi düşünmek (Thinking feminism), İstanbul: Bilgi University, 2017, 503 pp., including bibliography, appendices, and index, TRY 30 (paperback), ISBN: 978-605-399-473-2.Zafer Toprak, Türkiye’de yeni hayat: Inkılap ve travma 1908–1928 (New life in Turkey: Revolution and trauma 1908–1928), Istanbul: Doğan Kitap, 2017, 472 pp., TRY 40 (paperback), ISBN 978-605-09-4721-2.Wang Zheng, Finding Women in the State: A Socialist Feminist Revolution in the People’s Republic of China, 1949–1964, Berkeley: University of California Press, 2016, 380 pp., 31.45 USD (paperback), ISBN 978-0-520-29229-1.

Abstract Background Early life environmental exposures are linked with intestinal inflammation and inflammatory bowel disease (IBD) later in life. Per- and poly-fluoroalkyl substances (PFAS) are a large class of fluorinated organic chemicals used widely in consumer products that may be risk factors for IBD; however, the association between exposure to PFAS in early life and intestinal inflammation has not yet been studied. Dried blood spots (DBS) are archived neonatal capillary blood samples collected and stored as part of the New York State neonatal screening program and a cost-effective early life environmental exposure screening resource. Methods We measured 135 PFAS in DBS collected at birth from offsprings of women with and without IBD [n=37 (44%) and 47 (56%), respectively] enrolled in the MEChanisms Of disease traNsmission In Utero through the Microbiome (MECONIUM) cohort between January 2015 and November 2020, using untargeted metabolomics with liquid chromatography high-resolution mass spectrometry. In a subsample (n = 46), we also measured offspring fecal calprotectin (FC) at one year. We fitted exposome-wide regression models to estimate the association between each PFAS signal in the DBS and continuous FC at one year of age. For the significant associations (nominal p-value &lt;0.05), we further explored potential effect modification by stratifying by maternal IBD status. All models were adjusted for relevant confounders. Results The mean (SE) of FC at age one year was 213.9 (23.8) ug/gm. The PFAS chemicals perfluoroundecanoic acid (PFUnDA) and N-ethyl-perfluorooctane sulfonamido acetic acid (N-Et-FOSAA) were significantly associated with increased scaled and log-transformed FC per decile increase in exposures [estimate (95% CI) = 0.52 (0.13,0.91) and 0.34 (0.05,0.63), Figure A]. Associations tended to be stronger in offspring of women with IBD relative to offspring of women without IBD (Figure B). estimate (95% CI) for the associations between PFUnDA and FC were 0.86 (0.34,1.39) and 0.12 (-0.47,0.71), respectively, and between N-Et-FOSAA and FC, these were 0.54 (-0.01,1.08) and 0.31(-0.07,0.68), respectively. Conclusion DBS can be used to measure early life exposure to toxins, and prenatal PFAS exposure is associated with elevated FC, with a slightly stronger effect in the offspring of women with IBD. Larger prospective studies are needed to validate these associations and understand potential underlying mechanisms through which early life PFAS exposures may contribute to IBD etiology.

Pregnancy is a common decompensation factor for women with post-rheumatic mitral disease. However, valvular heart diseases causing severe acute respiratory distress are rare. Use of extracorporeal membrane oxygenation (ECMO) early in the event of cardiorespiratory failure after cardiac surgery may be of benefit. Indeed, ECMO cardiopulmonary bypass (CPB) support could help pulmonary recovery if the mitral pathology is involved. A 31-year-old female patient at 30 weeks of amenorrhea was admitted to the obstetrics department with 40°C hyperthermia and New York Heart Association (NYHA) class 4 dyspnea. The patient’s medical history included a post-rheumatic mitral stenosis. Blood gases showed severe hypoxemia associated with hypocapnia. The patient needed to be rapidly intubated and was placed on ventilatory support because of acute respiratory failure. Transesophageal echocardiography showed a severe mitral stenosis, mild mitral insufficiency, and diminished left ventricular function, hypokinetic, dilated right ventricle, and a severe tricuspid regurgitation. An urgent cesarean section was performed. Because of the persistent hemodynamic instability, a mitral valvular replacement and tricuspid valve annuloplasty were performed. In view of the preoperative acute respiratory distress, we decided, at the beginning of the operation, to carry on circulatory support with oxygenation through an ECMO-type CPB at the end of the operation. This decision was totally justified by the unfeasible CPB weaning off. ECMO use led to an efficient hemodynamic state without inotropic drug support. The surgical post-operative course was uneventful. Early use of cardiorespiratory support with veno-arterial ECMO allows pulmonary and right heart recovery after cardiac surgery, thus avoiding the use of inotropic drugs and complex ventilatory support.

BackgroundIn peritoneal dialysis (PD), a standard therapy for patients with end-stage renal disease (ESRD), the effects of using the peritoneum as an exchange membrane and of dialysate dwelling within the peritoneal cavity creates some mechanical changes, including an increase in intraperitoneal pressure (IPP) that might lead to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The diagnosis of IAH and ACS depend on intra-abdominal measurement of IAP by an indirect technique. There is no clear distinction between IPP and intra-abdominal pressure (IAP). Our objective in this study was to find if there is real difference between IPP and IAP.MethodsThis study was conducted at the PD unit of King Fahd Hospital of the University, Al-Khobar, between July 2008 and January 2009. To be included, patients had to have known ESRD for at least 5 years, to be 18 years of age or older at enrollment, with stable body weight and blood pressure, and with no clinical signs of overhydration. Patients with congestive heart failure III and IV (New York Heart Association criteria) and severe pulmonary disease, psychiatric illnesses, neurogenic bladder, known history of peritonitis, or medical or surgical abdominal intervention in the preceding 3 months were excluded. We measured IAP by the direct technique through the peritoneal catheter and by an indirect technique using an intravesical catheter.ResultsThe 25 patients who met the inclusion criteria included 13 men and 12 women, with a mean age of 53 ± 2 years (range: 18 – 76 years). The predominant causes of ESRD were diabetes mellitus and glomerulonephritis. Mean IPP in the dry state (supine) was 9.49 ± 5 mmHg, and mean IAP was 9.4 ± 5.4 mmHg ( p = 0.9). In the dry state (erect), the mean IPP increased to 16.9 ± 7.2 mmHg, and the mean IAP, to 16.4 ± 6.9 mmHg ( p = 0.8). In the filled state (supine), mean IPP was 12.6 ± 4.7 mmHg, and mean IAP, 12.8 ± 4.8 mmHg ( p = 0.88); the erect pressures were 21.4 ± 7 mmHg and 21.6 ± 6.9 mmHg respectively ( p = 0.9).ConclusionsOur findings indicate that there is no statistical difference between IPP and IAP in either the erect or the supine position.

The article deals with the educational project «American Talks», implemented during 2018-2019 by the non-governmental organization Ukrainian Association for American Studies and the Department of Modern and Contemporary History of Foreign Countries of the Faculty of History, Taras Shevchenko National University of Kyiv. A series of meetings, lectures, discussions on topical issues of American history and politics, Ukrainian-American relations, the place of personality in the modern world, the formation of leaders and their role in American society are covered. Lecture-discussion «Education at American Universities» by Associate Professor Alexander Komarenko was devoted to discussing opportunities for Ukrainian youth to study at American universities, financing American university education, system of management and coordination of educational projects, correlation of local and federal educational systems. The event in the Framework event within the American Talks project, organized by the Chairman of the Board of NGOs Ukrainian Association for American Studies, Associate Professor Makar Taran, on «The USA and China in the 21st Century: Global Competition of the Superpower of the Present and the Superpower of the Future», was devoted to the most important aspects of the current relations between the two superpowers, prospects for their development and the implications of these processes for international relations. It was emphasized that the US-China relations are the most important bilateral relations of global importance and their significance for the whole world, and for Ukraine in particular, will only grow. An opportunity to become a woman in the American society as an individual, her prospects for education and professional development, and family attitudes toward women who have a successful career was addressed by an event titled «Women’s Careers in the United States: Benefits, Challenges, Opportunities» with American filmmaker, lawyer Sharon Rowven, and producer, director and screenwriter Andrea Blaugrund Nevins. In May 2019, at the Faculty of History of Taras Shevchenko National University of Kyiv, a lecture-discussion was held by a well-known American journalist, a civil servant of Ukrainian descent, ex-director of the Ukrainian Voice of America service, Adrian Karmazin. This meaningful event was attended by students, studying under the American and European Studies program, as well as alumni, teachers of History Faculty, representatives of the Ukrainian Association for American Studies, specialists in international relations and counteraction to Russian hybrid information warfare against Ukraine. Ukrainian-American Educational Dialogue – a discussion about university-based humanitarian education in Ukraine and the USA between students and teachers of the American and European Studies program at the Taras Shevchenko National University and Nazareth College (State of New York, USA), aimed at informing US colleagues about the history and current development of Ukrainian university education, sharing experience in higher education in the humanities and discussing prospects for cooperation.

Heart failure (HF) is characterized by a progressive clinical course marked by frequent exacerbations and repeated hospitalizations, leading to considerably high morbidity and mortality rates. Patients with HF present with a constellation of bothersome symptoms, which range from physical to psychological and mental manifestations. With the transition to more advanced HF stages, symptoms become increasingly more debilitating, interfere with activities of daily living and disrupt multiple domains of life, including physical functioning, psychological status, emotional state, cognitive function, intimate relationships, lifestyle status, usual role activities, social contact and support. By inflicting profuse limitations in numerous aspects of life, HF exerts a profoundly negative impact on health-related quality of life (HRQOL). It is therefore not surprising that patients with HF display lower levels of HRQOL compared not only to the general healthy population but also to patients suffering from other chronic diseases. On top of this, poor HRQOL in patients with HF becomes an even greater concern considering that it has been associated with unfavorable long-term outcomes and poor prognosis. Nevertheless, HRQOL may differ significantly among patients with HF. Indeed, it has consistently been reported that women with HF display poorer HRQOL compared to men, while younger patients with HF tend to exhibit lower levels of HRQOL than their older counterparts. Moreover, patients presenting with higher New York Heart Association (NYHA) functional class (III–IV) have significantly more impaired HRQOL than those in a better NYHA class (I–II). Furthermore, most studies report worse levels of HRQOL in patients suffering from HF with preserved ejection fraction (HFpEF) compared to patients with HF with reduced ejection fraction (HFrEF) or HF with mildly reduced ejection fraction (HFmrEF). Last, but not least, differences in HRQOL have been noted depending on geographic location, with lower HRQOL levels having been recorded in Africa and Eastern Europe and higher in Western Europe in a recent large global study. Based on the observed disparities that have been invariably reported in the literature, this review article aims to provide insight into the underlying differences in HRQOL among patients with HF. Through an overview of currently existing evidence, fundamental differences in HRQOL among patients with HF are analyzed based on sex, age, NYHA functional class, ejection fraction and geographic location or ethnicity.

Цель. Провести оценку почечного кровотока методом ультразвуковой визуализации у пациентов пожилого возраста с хронической ишемической болезнью сердца. Материалы и методы. В исследование включено 100 пациентов с хронической ишемической болезнью сердца (ХИБС) в возрасте 70,2±4,1 года, из них 45 (45%) мужчин, 55 (55%) женщин. Все пациенты имели сердечную недостаточность не выше второго функционального класса по классификации Нью-Йоркской Ассоциации сердца (NYHA), с отсутствием диагностированных структурных и функциональных изменений почек (ХБП) в анамнезе. Коморбидная патология была представлена сахарным диабетом, артериальной гипертензией, ожирением, заболеваниями щитовидной железы. Результаты. Выявлена взаимосвязь умеренной силы между некоторыми показателями, характеризующими функциональное состояние сердечно-сосудистой системы (диастолическая функция миокарда, индекс Агатсона), функциональное состояние почек (цистатин С и расчетная скорость клубочковой фильтрации (СКФ) по цистатину С, суточная протеинурия, микроальбуминурия, индекс резистентности почечных сосудов по данным ультразвуковой доплерографии), что свидетельствует о наличии тесной взаимосвязи между наличием и степенью выраженности ХИБС и ХБП. Заключение. Расширение стандартного ультразвукового протокола исследования почек у пациентов с ХИБС за счет диагностически значимых доплерографических показателей, определяемых в ходе исследования, позволит проводить ранний отбор пациентов, имеющих высокий риск развития ХБП и гемодинамически значимого стенозирующего атеросклеротического повреждения почечных артерий, для возможности предупреждения развития/прогрессирования ХБП посредством рационального назначения лекарственных средств или своевременной хирургической коррекции выявленных атеросклеротических изменений. Purpose. To assess renal blood flow using ultrasound imaging in elderly patients with chronic coronary heart disease. Materials and methods. The study included 100 patients with chronic ischemic heart disease aged 70.2±4.06 years, of which 45 (45%) were men, 55 (55%) were women. All patients had heart failure no higher than the second functional class according to the New York Heart Association (NYHA) classification, with no history of diagnosed structural and functional kidney changes. Comorbid pathology was represented by diabetes mellitus, arterial hypertension, obesity, thyroid diseases. Results. When analyzing data from patient studies, a moderate correlation was revealed between some indicators of diastolic myocardial function, multislice computed tomography of the heart (Agatson index determination), the main biochemical markers of renal damage (cystatin C content and calculated glomerular filtration rate based on cystatin C, the content of daily protein and microalbumin in urine and Doppler ultrasound indicators of the renal vessels. Conclusion. A relationship of moderate strength was revealed between some indicators characterizing the functional state of the cardiovascular system (myocardial diastolic function, Agatson index), the functional state of the kidneys (cystatin C, and estimated glomerular filtration rate by cystatin C, daily proteinuria, microalbuminuria, resistance index renal vessels according to Doppler ultrasound), which indicates a close relationship between the presence and severity of chronic ischemic heart disease and chronic kidney disease.

Cristina A. Bejan, Intellectuals and Fascism in Interwar Romania: The Criterion Association, Cham, Switzer land: Palgrave, 2019, 323 pp., €74.89 (hardback), ISBN 978-3-030-20164-7.Chiara Bonfiglioli, Women and Industry in the Balkans: The Rise and Fall of the Yugoslav Textile Sector, London: I. B. Tauris, 2020, 232 pp., £85 (hardback), ISBN: 978-1-78533-598-3.Aslı Davaz, Eşitsiz kız kardeşlik, uluslararası ve Ortadoğu kadın hareketleri, 1935 Kongresi ve Türk Kadın Birliği (Unequal sisterhood, international and Middle Eastern women’s movements, 1935 Congress and the Turkish Women’s Union), İstanbul: Türkiye İş Bankası, 2014, 892 pp., with an introduction by Yıldız Ecevit, pp. xxi–xxviii; preface by the author, pp. xxix–xlix, TL 42 (hardcover), ISBN: 978-605-332-296-2.Biljana Dojčinović and Ana Kolarić, eds., Feministički časopisi u Srbiji: Teorija, aktivizam i umetničke prakse u 1990-im i 2000-im (Feminist periodicals in Serbia: Theory, activism, and artistic practice in the 1990s and 2000s), Belgrade: Faculty of Philology, University of Belgrade, 2018, 370 pp., price not listed (paperback), ISBN: 978-86-6153-515-4.Melanie Ilic, ed., The Palgrave Handbook of Women and Gender in Twentieth-Century Russia and the Soviet Union, London: Palgrave Macmillan, 2018, 572 pp., $239 (e-book) ISBN: 978-1-137-54904-4; ISBN: 978-1-137-54905-1.Luciana M. Jinga, ed., The Other Half of Communism: Women’s Outlook, in History of Communism in Europe, vol. 8, Bucharest: Zeta Books, 2018, 348 pp., USD 40 (paperback), ISBN: 978-606-697-070-9.Teresa Kulawik and Zhanna Kravchenko, eds., Borderlands in European Gender Studies: Beyond the East-West Frontier, New York: Routledge, 2020, 264 pp., $140.00 (hardback), ISBN: 978-0-367-25896-2.Jill Massino, Ambiguous Transitions: Gender, the State, and Everyday Life in Socialist and Postsocialist Romania, New York: Berghahn Books, 2019, 466 pp., USD 122 (hardback), ISBN: 978-1-785-33598-3.Gergana Mircheva, (A)normalnost i dostap do publichnostta: Socialnoinstitucionalni prostranstva na biomedicinskite discursi v Bulgaria (1878–1939) ([Ab]normality and access to publicity: Social-institutional spaces of biomedicine discourses in Bulgaria [1878–1939]), Sofia: St. Kliment Ohridski University Press, 2018, 487 pp., BGN 16 (paperback), ISBN: 978-954-07-4474-2.Milutin A. Popović, Zatvorenice, album ženskog odeljenja Požarevačkog kaznenog zavoda sa statistikom (1898) (Prisoners, the album of the women’s section of Požarevac penitentiary with statistics, 1898), edited by Svetlana Tomić, Belgrade: Laguna , 2017, 333 pp., RSD 894 (paperback), ISBN: 978-86-521-2798-6.Irena Protassewicz, A Polish Woman’s Experience in World War II: Conflict, Deportation and Exile, edited by Hubert Zawadzki, with Meg Knott, translated by Hubert Zawadzki, London: Bloomsbury Academic, 2019, xxv pp. + 257 pp., £73.38 (hardback), ISBN: 978-1-3500-7992-2.Zilka Spahić Šiljak, ed., Bosanski labirint: Kultura, rod i liderstvo (Bosnian labyrinth: Culture, gender, and leadership), Sarajevo and Zagreb: TPO Fondacija and Buybook, 2019, xii + 213 pp., no price listed (paperback), ISBN: 978-9926-422-16-5.Gonda Van Steen, Adoption, Memory and Cold War Greece: Kid pro quo?, University of Michigan Press, 2019, 350 pp., $85.00 (hardback), ISBN: 978-0-472-13158-7.D imitra Vassiliadou, Ston tropiko tis grafi s: Oikogeneiakoi desmoi kai synaisthimata stin astiki Ellada (1850–1930) (The tropic of writing: Family ties and emotions in modern Greece [1850–1930]), Athens: Gutenberg, 2018, 291 pp., 16.00 € (paperback), ISBN: 978-960-01-1940-4.Radina Vučetić, Coca-Cola Socialism: Americanization of Yugoslav Culture in the Sixties, English translation by John K. Cox, Budapest: Central European University Press, 2018, 334 pp., €58.00 (paperback), ISBN: 978-963-386-200-1.Nancy M. Wingfield, The World of Prostitution in Late Imperial Austria, Oxford: Oxford University Press, 2017, xvi + 272 pp., $80 (hardback), ISBN: 978-0-19880-165-8.Anastasia Lakhtikova, Angela Brintlinger, and Irina Glushchenko, eds., Seasoned Socialism: Gender and Food in Late Soviet Everyday Life, Bloomington: Indiana University Press, 2019, xix + 373 pp., $68.41(hardback), ISBN: 978-0-253-04095-4.

Professor Carol Collins graduated in Chemistry from Bates College (1952) and obtained her PhD in Organic Physical Chemistry from Iowa State University of Science and Technology (1958), when she was introduced to the recently developed gas–liquid chromatography. She conducted postdoctoral research at the University of Wisconsin and later worked on radiochemistry and nuclear medicine at the Brookhaven National Laboratory and the Western New York Nuclear Research Center in Louvain (Belgium) and Southwest Asia. Professor Collins came to the State University of Campinas (Unicamp) with her husband, Kenneth Collins, in July 1974, during the university’s first decade, and played a leading role in consolidation of the Institute of Chemistry at Unicamp and in the growth of chemistry and analytical chemistry in Brazil. Her first line of research in Brazil was radioanalytical chemistry, later focusing on chromatographic techniques, initially applied to the products of radiochemical reactions and radiation chemistry. Subsequently, her attention was directed to the preparation of stationary phases for liquid chromatography. She gained remarkable achievement in the area of chromatography that allowed her to publish two books that are very popular in Brazil: "Introduction to Chromatographic Methods" (1987) and "Fundamentals of Chromatography" (2006). Her scientific and technological contributions have been recognized through several awards, including the “Marie Curie Award” from the American Association of University Women and the “Simão Mathias Medal” from the Brazilian Chemical Society (SBQ). She also received honors in recognition of the contributions of Unicamp's 40th anniversary, SBQ's 30th anniversary, a tribute from the Journal of the Brazilian Chemical Society, the National Meeting of Analytical Chemistry, the School of Separations and the Brazilian Symposium on Chromatography and Related Techniques (SIMCRO) Medal. For her outstanding performance and leadership in the creation and consolidation of the Analytical Chemistry Division of the Brazilian Chemical Society, her name was recognized in the Carol Collins Medal given to each National Meeting of Analytical Chemistry since the 2018 edition. Professor Collins was also a full member of the Brazilian Academy of Sciences and the Academy of Sciences of São Paulo, and received the title of Professor Emerita of Unicamp on 14 May 2012, in addition to being Emeritus Researcher at the National Council for Scientific and Technological Development (CNPq). Apart from her scientific competence, some characteristics shaped her personality and made her very popular among her colleagues and students: her vast gourmet knowledge, keen taste for caipirinha and coffee, infallible memory, great love for her work and for Brazil, dedication to science, analytical chemistry/chromatography, kindness as a person and her incessant search for justice. She was always receptive to clarifying the doubts of students, teachers and interested parties, which she did with great pleasure, characteristic of those who like to teach and transmit knowledge. The contributions of Professor Collins to the training of human resources, the consolidation and development of the Institute of Chemistry at Unicamp and the analytical chemistry/chromatography sector in Brazil and abroad are immeasurable. Her brilliant trajectory will leave a huge legacy that is difficult to measure and she will remain forever in the memory of those who were fortunate enough to live with her.

Aim. To assess the effects of acquired social status, neurotic conditions, type D personality, cognitive functions, quality of life and adherence to treatment on psychosocial adaptation of patients with coronary heart disease (IHD) to chronic heart failure (CHF), depending on the severity of decompensation. Methods. 87 patients with coronary artery disease and chronic heart failure aged between 55 and 72 years were examined. All patients were divided into two groups depending on the functional class of chronic heart failure [New York Heart Association (NYHA) class IIV]. The first group included 41 patients with NYHA functional class III, the second group 46 patients with NYHA functional class IIIIV. For a comprehensive study of the psychosocial adaptation of patients, a set of standardized questionnaires was used: the abridged variant of the Minnesota Multiphasic Personality Inventory (SMOL), a clinical questionnaire for identifying and assessing neurotic condition, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the 36-Item Short Form Health Survey Questionnaire (SF-36), the Mini Mental State Examination (MMSE), 14-question test Type D Scale-14 (DS14), MoriskyGreen test, the short version of the AUDIT questionnaire (AUDIT-C). We collected data on the patient's social status: gender, education, income level. The results obtained were analyzed. Results. Based on the SMOL personality profiles, patients of the second group were classified as neurotic an increase was noted in three neurotic scales: hypochondria (U=541; p=0.030), hysteria (U=579; p=0.048), and autism/schizoid (U=577.5; p=0.047) compared with patients of the first group. According to the results of the clinical questionnaire for the identification and assessment of neurotic condition, the greatest differences were found between patients of first and second groups on the scale of autonomic disorders (U=571; p=0.039) and neurotic depression (U=576; p=0.046). Comparing the groups according to the MLHFQ score, quality of life in patients of the second group was markedly reduced (U=447.5; p 0.001). According to the SF-36 questionnaire, a decrease in the quality of life was also found in patients of the second group on the scale Physical functioning (U=554; p=0.032) and Physical component of health (U=573.5; p=0.044). The cognitive status in patients of the second group was significantly decreased compared with the first group (U=427; p 0.001). No significant differences were found in adherence to treatment between the two groups (U=757; p=0.666). Also, there were no patients with type D personality on both subscales (U=717.5; p=0.483, U=784; p=0.933) and according to the AUDIT-C scores, there are no significant differences between men (U=681.5; p=0.257) and women (U=728.5; p=0.425) in both groups of patients. Conclusion. Signs of social maladjustment in patients with more severe NYHA functional class of the disease are expressed by significantly more pronounced social isolation (autism), a tendency to avoid communicating with others, isolation on their own problems and hypochondriacal attention to the somatic manifestations of chronic heart failure; probably, the main reason that reduces the level of social adaptation is a high score in neuroticism, which leads to a functional decrease in cognitive abilities and a significant deterioration in quality of life.

La pandemia asociada al covid-19 acentúa las crisis de modelos y programas basados en una pedagogía que no responde a la complejidad de los conflictos y contextos de estudiantes y profesores, sobre todo en países latinoamericanos como México. Recuperar esta complejidad demanda tanto la revisión crítica de los conocimientos y estructuras disciplinares de los currículos como el ejercicio continuo de politizar los supuestos, y el sentido histórico y local de las instituciones y prácticas situadas de educación. En este trabajo se analizan algunas notas de los discursos sobre la complejidad biocultural como respuestas a ciencias y modelos que colapsaron las realidades de los educadores y educandos en conocimientos descontextualizados y despolitizados. Para superar algunos de estos constreñimientos, en este trabajo se analizan bases teóricas y experiencias educativas situadas para una pedagogía de la complejidad que articula a las ciencias de la complejidad, los estudios interseccionales y una didáctica decolonial. Abstract The pandemic associated with covid-19 accentuates the crisis of models and programs based on a pedagogy that does not respond to the complexity of conflicts and contexts of students and teachers, especially in Latin American countries such as Mexico. Recovering this complexity includes both the critical review of the knowledge and disciplinary structures of the curricula, as well as the continuous exercise of politicizing the assumptions and the historical and local meaning of educational institutions and practices. 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- M.A. van Bakel, H. Esen-Baur, Untersuchungen über den vogelmann-kult auf der Osterinsel, 1983, Franz Steiner Verlag GmbH, 399 pp. - Leen Boer, Bronislaw Malinowski, Malinowski in Mexico. The economics of a Mexican market system, edited and with an introduction by Susan Drucker-Brown, London: Routledge and Kegan Paul, 1982 (International Library of Anthropology)., Julio de la Fuente (eds.) - A.P. Borsboom, Betty Meehan, Shell bed to shell midden, Australian Institute of Aboriginal Studies, Canberra, 1982. - H.J.M. Claessen, Peter Geschiere, Village communities and the state. Changing relations among the Maka of Southeastern Cameroon since the colonial conquest. Monographs of the African Studies Centre, Leiden. London: Routledge and Kegan Paul Ltd. 1982. 512 pp. Appendices, index, bibliography, etc. - H.J.M. Claessen, Jukka Siikala, Cult and conflict in tropical Polynesia; A study of traditional religion, Christianity and Nativistic movements, Helsinki: Academia Scientiarum Fennica, 1982, 308 pp. Maps, figs., bibliography. - H.J.M. Claessen, Alain Testart, Les Chasseurs-Cueilleurs ou l’Origine des Inégalités, Mémoires de la Sociéte d’Ethnographie 26, Paris 1982. 254 pp., maps, bibliography and figures. - Walter Dostal, Frederik Barth, Sohar - Culture and society in an Omani town. Baltimore - London: The Johns Hopkins University Press, 1983, 264 pp., ill. - Benno Galjart, G.J. Kruyer, Bevrijdingswetenschap. Een partijdige visie op de Derde Wereld [Emancipatory Science. A partisan view of the Third World], Meppel: Boom, 1983. - Sjaak van der Geest, Christine Okali, Cocoa and kinship in Ghana: The matrilineal Akan of Ghana. London: Kegan Paul International (in association with the International African Institute), 1983. 179 pp., tables, index. - Serge Genest, Claude Tardits, Contribution de la recherche ethnologique à l’histoire des civilisations du Cameroun / The contribution of enthnological research to the history of Cameroun cultures. Paris, CNRS, 1981, two tomes, 597 pp. - Silvia W. de Groot, Sally Price, Co-wives and calabashes, Ann Arbor, The University of Michigan Press, 1984, 224 p., ill. - N.O. Kielstra, Gene R. Garthwaite, Khans and Shahs. A documentary analysis of the Bakhtiary in Iran, Cambridge University Press, Cambridge, 1983. 213 pp. - G.L. Koster, Jeff Opland, Xhosa oral poetry. Aspects of a black South African tradition, Cambridge Studies in oral and literate culture 7, Cambridge University Press, Cambridge , London, New York, New Rochelle, Melbourne, Sydney, 1983, XII + 303 pp. - Adam Kuper, Hans Medick, Interest and emotion: Essays on the study of family and kinship, Cambridge University Press, 1984., David Warren Sabean (eds.) - C.A. van Peursen, Peter Kloos, Antropologie als wetenschap. Coutinho, Muidenberg 1984 (204 p.). - Jerome Rousseau, Jeannine Koubi, Rambu solo’: “la fumée descend”. Le culte des morts chez les Toradja du Sud. Paris: Editions du CNRS, 1982. 530 pages, 3 maps, 73 pictures. - H.C.G. Schoenaker, Miklós Szalay, Ethnologie und Geschichte: zur Grundlegung einer ethnologischen geschichtsschreibung; mit beispielen aus der Geschichte der Khoi-San in Südafrika. Dietrich Reimer Verlag, Berlin 1983, 292 S. - F.J.M. Selier, Ghaus Ansari, Town-talk, the dynamics of urban anthropology, 170 pp., Leiden: E.J. Brill, 1983., Peter J.M. Nas (eds.) - A.A. Trouwborst, Serge Tcherkézoff, Le Roi Nyamwezi, la droite et la gauche. Revision comparative des classifications dualistes. Cambridge: Cambridge University Press, Paris:Éditions de la Maison des sciences de l’homme, 1983, 154 pp. - Pieter van der Velde, H. Boekraad, Te Elfder Ure 32: Verwantschap en produktiewijze, Jaargang 26 nummer 3 (maart 1983)., G. van den Brink, R. Raatgever (eds.) - E.Ch.L. van der Vliet, Sally Humphreys, The family, women and death. Comparative studies. London, Boston etc.: Routledge & Kegan Paul, 1983 (International Library of Anthropology). xiv + 210 pp. - W.F. Wertheim, T. Svensson, Indonesia and Malaysia. Scandinavian Studies in Contemporary Society. Scandinavian Institute of Asian Studies: Studies on Asian Topics no. 5. London and Malmö: Curzon Press, 1983, 282 pp., P. Sørensen (eds.) - H.O. Willems, Detlef Franke, Altägyptische verwandtschaftsbezeichnungen im Mittleren Reich, Hamburg, Verlag Born GmbH, 1983.

Abstract Background: Environmental risk factors for lymphoma are ill-defined and controversial. Epidemiologic studies have demonstrated an association between pesticide exposure and an increase in non-Hodgkin lymphomas (NHL), particularly those with a 14;18 translocation. However, in the absence of a mechanistic explanation for the effects of pesticide on lymphomagenesis, the data remain correlative and subject to alternative explanations. Mutagenesis due to activation-induced cytidine deaminase (AICDA) is key to lymphomagenesis, particularly in follicular lymphoma (FL). AICDA exerts physiologic effects by creating mutations in the immunoglobulin heavy locus (IGH) for somatic hypermutation in order to produce highly specific antibodies. AICDA's off-target genomic damage creates "driver" and "passenger" mutations, which can be used to quantify the subclonal evolution of each tumor specimen. Using deep sequencing (10000-fold) with appropriate error-thresholding, our lab previously demonstrated that the number of AICDA-mediated mutations in the 5' UTR of BCL2 is linearly related to the sum of AICDA-mediated mutations at other off-target sites, implying that mutations within the 5'UTR of BCL2 can function as a surrogate marker for the genome-wide aberrant targeting (Spence, J Immunology, 2014). We have also demonstrated that the number of mutations within IGHV is unrelated to the sum of genome-wide aberrant mutations. The sequencing data can thus be used to determine the minimum number of subclonal populations within a specimen as defined by each region (BCL2 and IGHV). We hypothesized that the number of AICDA-generated subclones would differ in patients with FL living in high and low pesticide use regions, elucidating whether pesticide-associated lymphomagenesis acts through AICDA or an alternative mechanism. We sought to assess the feasibility of demonstrating a difference in extent of AICDA-mediated subclonal evolution in patients with FL residing in regions with high and low pesticide usage by quantifying AICDA-mediated subclones in the 5' UTR of BCL2 and within IGHV. Methods: Using a state-wide database of pesticide application organized by ZIP code, we identified 35 patients with FL seen at our institution in Western New York in locales with high (N=19) and low (N=16) pesticide usage and quantified AICDA-mediated subclones in the 5' UTR of BCL2 and within IGHV for these patients' FL specimens. This sample size provided 75-92% power to detect a difference in the number of subclones by pesticide usage, using a 2-sided 0.05 level Wilcoxon test, assuming an effect size of 75-80% probability of more subclones in one pesticide usage group. Results: We identified 19 patients from high pesticide use (1000+ gigaliters (GL)) and 16 from low pesticide use ZIP codes (&lt;1000 GL). Pesticide volume use by ZIP code in the low group ranged from 10-664 GL with a median of 263 GL, and in the high group ranged from 1636 to 67,140 GL with a median of 4787 GL. Patients living in regions of high and low pesticide use were similar in terms of race and ethnicity. The proportion of women was also similar: 43% among high versus 50% among low. Mean age at diagnosis was 62 in the high versus 60 in the low group. Three patients were diagnosed at age &lt; 45 in the high group while no one in the low group was diagnosed at age &lt; 45. BCL2 subclone count was lower (p = 0.046) among those in high pesticide ZIP codes (median 3.0), compared with those in low pesticide ZIP codes (median 6.5). Although the median IGH subclone count was 278 among those in the high group versus 91.5 in the low group, there was insufficient evidence of an association between IGH subclone count and the level of pesticide usage (p = 0.36). Conclusions: The extent of subclonal evolution was significantly different between lymphoma specimens of patients residing in ZIP codes with high versus low pesticide usage. Our data suggest that AICDA-mediated subclonal evolution is negatively correlated with residence in a ZIP code with high pesticide use, raising the question of whether pesticides could induce lymphoma through an alternate mechanism. This observation calls for both corroboration and examination of alternative hypotheses. We demonstrate a feasible approach to assessing these questions in a larger dataset. Disclosures Peterson: Abbott: Consultancy. Casulo: Verastem: Research Funding; BMS: Research Funding; Genentech: Research Funding; Gilead: Research Funding.

The DebateQuestion 1: Various commentators have frequently invoked the importance of moderate Muslims and the role that they can play in fighting extremism in the Muslim world. But it is not clear who is a moderate Muslim. The recent cancellation of Tariq Ramadan’s visa to the United States, the raids on several American Muslim organizations, and the near marginalization of mainstream American Muslims in North America pose the following question: If moderate Muslims are critical to an American victory in the war on terror, then why does the American government frequently take steps that undermine moderate Muslims? Perhaps there is a lack of clarity about who the moderate Muslims are. In your view, who are these moderate Muslims and what are their beliefs and politics? JLE: Our human tendency is to define what is normal or moderate in terms of someone just like “us.” The American government, as well as many western and Muslim governments and experts, define moderate by searching for reflections of themselves. Thus, Irshad Manji or “secular” Muslims are singled out as self-critical moderate Muslims by such diverse commentators as Thomas Friedman or Daniel Pipes. In an America that is politicized by the “right,” the Republican and religious right, and post-9/11 by the threat of global terrorism and the association of Islam with global terrorism, defining a moderate Muslim becomes even more problematic. Look at the situations not only in this country but also in Europe, especially France. Is a moderate Muslim one who accepts integration, or must it be assimilation? Is a moderate Muslim secular, as in laic (which is really anti-religious)? Is a moderate Muslim one who accepts secularism, as in the separation of church and state, so that no religion is privileged and the rights of all (believer and nonbeliever) are protected? Is a moderate Muslim one who accepts a particular notion of gender relations, not simply the equality of women and men but a position against wearing hijab? (Of course let’s not forget that we have an analogous problem with many Muslims whose definition of being a Muslim, or of being a “good” Muslim woman, is as narrowly defined.) In today’s climate, defining who is a moderate Muslim depends on the politics or religious positions of the individuals making the judgment: Bernard Lewis, Daniel Pipes, Gilles Kepel, Stephen Schwartz, Pat Robertson, and Tom DeLay. The extent to which things have gotten out of hand is seen in attempts to define moderate Islam or what it means to be a good European or American Muslim. France has defined the relationship of Islam to being French, sought to influence mosques, and legislated against wearing hijab in schools. In the United States, non-Muslim individuals and organizations, as well as the government, establish or fund organizations that define or promote “moderate Islam,” Islamic pluralism, and so on, as well as monitor mainstream mosques and organizations. The influence of foreign policy plays a critical role. For some, if not many, the litmus test for a moderate Muslim is tied to foreign policy issues, for example, how critical one is of American or French policy or one’s position in regard to Palestine/Israel, Algeria, Kashmir, and Iraq. Like many Muslim regimes, many experts and ideologues, as well as publications like The Weekly Standard, National Review, The Atlantic, The New York Sun and media like Fox Television, portray all Islamists as being the same. Mainstream and extremist (they deny any distinction between the two) and indeed all Muslims who do not completely accept their notion of secularism, the absolute separation of religion and the state, are regarded as a threat. Mainstream Islamists or other Islamically oriented voices are dismissed as “wolves in sheep’s clothing.” What is important here is to emphasize that it is not simply that these individuals, as individual personalities, have influence and an impact, but that their ideas have taken on a life of their own and become part of popular culture. In a post-9/11 climate, they reinforce the worst fears of the uninformed in our populace. The term moderate is in many ways deceptive. It can be used in juxtaposition to extremist and can imply that you have to be a liberal reformer or a progressive in order to pass the moderate test, thus excluding more conservative or traditionalist positions. Moderates in Islam, as in all faiths, are the majority or mainstream in Islam. We assume this in regard to such other faiths as Judaism and Christianity. The Muslim mainstream itself represents a multitude of religious and socioeconomic positions. Minimally, moderate Muslims are those who live and work “within” societies, seek change from below, reject religious extremism, and consider violence and terrorism to be illegitimate. Often, in differing ways, they interpret and reinterpret Islam to respond more effectively to the religious, social, and political realities of their societies and to international affairs. Some seek to Islamize their societies but eschew political Islam; others do not. Politically, moderate Muslims constitute a broad spectrum that includes individuals ranging from those who wish to see more Islamically oriented states to “Muslim Democrats,” comparable to Europe’s Christian Democrats. The point here is, as in other faiths, the moderate mainstream is a very diverse and disparate group of people who can, in religious and political terms, span the spectrum from conservatives to liberal reformers. They may disagree or agree on many matters. Moderate Jews and Christians can hold positions ranging from reform to ultraorthodox and fundamentalist and, at times, can bitterly disagree on theological and social policies (e.g., gay rights, abortion, the ordination of women, American foreign and domestic policies). So can moderate Muslims.

The DebateQuestion 1: Various commentators have frequently invoked the importance of moderate Muslims and the role that they can play in fighting extremism in the Muslim world. But it is not clear who is a moderate Muslim. The recent cancellation of Tariq Ramadan’s visa to the United States, the raids on several American Muslim organizations, and the near marginalization of mainstream American Muslims in North America pose the following question: If moderate Muslims are critical to an American victory in the war on terror, then why does the American government frequently take steps that undermine moderate Muslims? Perhaps there is a lack of clarity about who the moderate Muslims are. In your view, who are these moderate Muslims and what are their beliefs and politics? JLE: Our human tendency is to define what is normal or moderate in terms of someone just like “us.” The American government, as well as many western and Muslim governments and experts, define moderate by searching for reflections of themselves. Thus, Irshad Manji or “secular” Muslims are singled out as self-critical moderate Muslims by such diverse commentators as Thomas Friedman or Daniel Pipes. In an America that is politicized by the “right,” the Republican and religious right, and post-9/11 by the threat of global terrorism and the association of Islam with global terrorism, defining a moderate Muslim becomes even more problematic. Look at the situations not only in this country but also in Europe, especially France. Is a moderate Muslim one who accepts integration, or must it be assimilation? Is a moderate Muslim secular, as in laic (which is really anti-religious)? Is a moderate Muslim one who accepts secularism, as in the separation of church and state, so that no religion is privileged and the rights of all (believer and nonbeliever) are protected? Is a moderate Muslim one who accepts a particular notion of gender relations, not simply the equality of women and men but a position against wearing hijab? (Of course let’s not forget that we have an analogous problem with many Muslims whose definition of being a Muslim, or of being a “good” Muslim woman, is as narrowly defined.) In today’s climate, defining who is a moderate Muslim depends on the politics or religious positions of the individuals making the judgment: Bernard Lewis, Daniel Pipes, Gilles Kepel, Stephen Schwartz, Pat Robertson, and Tom DeLay. The extent to which things have gotten out of hand is seen in attempts to define moderate Islam or what it means to be a good European or American Muslim. France has defined the relationship of Islam to being French, sought to influence mosques, and legislated against wearing hijab in schools. In the United States, non-Muslim individuals and organizations, as well as the government, establish or fund organizations that define or promote “moderate Islam,” Islamic pluralism, and so on, as well as monitor mainstream mosques and organizations. The influence of foreign policy plays a critical role. For some, if not many, the litmus test for a moderate Muslim is tied to foreign policy issues, for example, how critical one is of American or French policy or one’s position in regard to Palestine/Israel, Algeria, Kashmir, and Iraq. Like many Muslim regimes, many experts and ideologues, as well as publications like The Weekly Standard, National Review, The Atlantic, The New York Sun and media like Fox Television, portray all Islamists as being the same. Mainstream and extremist (they deny any distinction between the two) and indeed all Muslims who do not completely accept their notion of secularism, the absolute separation of religion and the state, are regarded as a threat. Mainstream Islamists or other Islamically oriented voices are dismissed as “wolves in sheep’s clothing.” What is important here is to emphasize that it is not simply that these individuals, as individual personalities, have influence and an impact, but that their ideas have taken on a life of their own and become part of popular culture. In a post-9/11 climate, they reinforce the worst fears of the uninformed in our populace. The term moderate is in many ways deceptive. It can be used in juxtaposition to extremist and can imply that you have to be a liberal reformer or a progressive in order to pass the moderate test, thus excluding more conservative or traditionalist positions. Moderates in Islam, as in all faiths, are the majority or mainstream in Islam. We assume this in regard to such other faiths as Judaism and Christianity. The Muslim mainstream itself represents a multitude of religious and socioeconomic positions. Minimally, moderate Muslims are those who live and work “within” societies, seek change from below, reject religious extremism, and consider violence and terrorism to be illegitimate. Often, in differing ways, they interpret and reinterpret Islam to respond more effectively to the religious, social, and political realities of their societies and to international affairs. Some seek to Islamize their societies but eschew political Islam; others do not. Politically, moderate Muslims constitute a broad spectrum that includes individuals ranging from those who wish to see more Islamically oriented states to “Muslim Democrats,” comparable to Europe’s Christian Democrats. The point here is, as in other faiths, the moderate mainstream is a very diverse and disparate group of people who can, in religious and political terms, span the spectrum from conservatives to liberal reformers. They may disagree or agree on many matters. Moderate Jews and Christians can hold positions ranging from reform to ultraorthodox and fundamentalist and, at times, can bitterly disagree on theological and social policies (e.g., gay rights, abortion, the ordination of women, American foreign and domestic policies). So can moderate Muslims.

NOTICIAS / NEWS (“Transfer”, 2015) 1) CONGRESOS / CONFERENCES: 1. First Forlì International Workshop – Corpus-based Interpreting Studies: The State of the Art University of Bologna at Forlì, 7-8 May 2015. http://eventi.sslmit.unibo.it/cis1/<file:///owa/redir.aspx 2. 5th IATIS Conference – Innovation Paths in Translation and Intercultural Studies, Belo Horizonte, Brazil, 7-10 July 2015. www.iatis.org/index.php/iatis-belo-horizonte-conference/itemlist/category/168-call-for-communication-proposals-within-the-general-conference 3. POETRY/TRANSLATION/FILM – POÉSIE/TRADUCTION/FILM PoeTransFi, Paul Valéry University, Montpellier, France, 18-19 June 2015. http://pays-anglophones.upv.univ-montp3.fr/?page_id=1795 4. 6th International Maastricht-Lodz Duo Colloquium on “Translation and Meaning”, Maastricht School of Translation & Interpre-ting, Zuyd University of Applied Sciences, Maastricht, Netherlands 21-22 May 2015. www.translation-and-meaning.nl 5. MiddleWOmen. Networking and cultural mediation with and between women (1850-1950). Centre for Reception Studies (CERES), HERA Travelling TexTs project and Huygens ING KU Leuven campus Brussels 7-8 May 2015. www.receptionstudies.be 6. 5th International Symposium: Respeaking, Live Subtitling and Accessibility, Università degli Studi Internazionali di Roma, Italy, 12 June 2015. www.unint.eu/it/component/content/article/8-pagina/494-respeaking-live-subtitling-and-accessibility.html 7. Conference on Law, Translation and Culture (LTC5) and Legal and Institutional Translation Seminar, University of Geneva, Switzerland 24-26 June 2015. www.unige.ch/traduction-interpretation/recherches/groupes/transius/conference2015_en.html 8. 6th International Conference Media for All – Audiovisual Translation and Media Accessibility: Global Challenges, University of Western Sydney, Australia, 16-18 September 2015. http://uws.edu.au/mediaforall 9. Translation in Exile, Vrije Universiteit Brussel, 10-11 December 2015. www.cliv.be 10. Literary Translation as Creation, Université d’Avignon et des Pays de Vaucluse, 20-21 May 2015. laurence.belingard@univ-avignon.fr marie-francoise.sanconie@univ-avignon.fr 11. 4th International Conference on Language, Medias and Culture (ICLMC 2015) 9-10 April 2015. Kyoto, Japan, www.iclmc.org 12. 9th International Colloquium on Translation Studies in Portugal – Translation & Revolution, Universidade Católica Portuguesa, Lisbon, 22-23 October 2015. ix.translation.revolution@gmail.com 13. Translation as Collaboration: Translaboration?, University of Westminster, London, 18 June 2015 Contact: Alexa Alfer (A.Alfer01@westminster.ac.uk), Steven Cranfield (S.Cranfield@westminster.ac.uk), Paresh Kathrani (P.Kathrani@westminster.ac.uk) 14. Translation/Interpreting Teaching and the Bologna Process: Pathways between Unity and Diversity, FTSK Germersheim, Germany 27–29 November 2015. www.fb06.uni-mainz.de/did2015/index_ENG.php 15. Atlantic Communities: Translation, Mobility, Hospitality, University of Vigo, Spain, 17-18 September 2015. http://translating.hypotheses.org/551 16. Exploring the Literary World III: Transgression and Translation in Literature Chulalongkorn University, Bangkok, Thailand 23-24 April 2015. www.arts.chula.ac.th/~complit/complite/?q=conference 17. Authenticity and Imitation in Translation and Culture, University of Social Sciences and Humanities, Warsaw, Poland, 7 – 9 May 2015. www.swps.pl/english-version/news/conferences/12164-authenticity-and-imitation-in-translation-and-culture 18. Translation in Transition, Barnard College, New York City, USA 1-2 May 2015. barnard.edu/translation/translation-in-transition 19. First Forlì International Workshop – Corpus-based Interpreting Studies: The state of the art, University of Bologna at Forlì, Italy, 7-8 May 2015. http://eventi.sslmit.unibo.it/cis1 20. Translation and Meaning. The Lodz Session of the 6th International Maastricht-Lodz Duo Colloquium, University of Lodz, Poland, 18-19 September 2015. http://duo.uni.lodz.pl 21. TAO-CAT-2015, Université Catholique de l’Ouest, Angers, France 28-30 May 2015. www.tao2015.org/home-new 22. English Language and Literary Studies (ELLS 2015), Chulalongkorn University, Bangkok, Thailand, 3-4 August 2015. http://ells2015.com 23. Talking to the World 2: The Relevance of Translation and Interpreting – Past, Present and Future, Newcastle University, UK, 10-11 September 2015. www.ncl.ac.uk/sml/study/postgraduate/T&I/2015conference/main.htm 24. 6th International Symposium for Young Researchers in Translation, Interpreting, Intercultural Studies and East Asian Studies Universitat Autònoma de Barcelona, Spain, 3 July 2015. www.fti.uab.es/departament/simposi-2015/en/index.htm 25. Portsmouth Translation Conference: Border Crossing or Border Creation?, University of Portsmouth, UK, 14 November 2015. www.port.ac.uk/translation/events/conference 26. New Perspectives in Assessment in Translation Training: Bridging the Gap between Academic and Professional Assessment, University of Westminster, London, UK, 4 September 2015. www.westminster.ac.uk/news-and-events/events/humanities/archive/2014/mlc/new-perspectives-in-assessment-in-translation-training-bridging-the-gap-between-academic-and-professional-assessment 27. III Congreso Internacional de Neología en las Lenguas Románicas University of Salamanca, 22-24 October 2015. http://diarium.usal.es/cineo2015 28. Some Holmes and Popovič in all of us? The Low Countries and the Nitra Schools in the 21st century, Constantine the Philosopher University, Nitra, Slovakia, 8-10 October 2015. Contact: igor.tyss@gmail.com 29. The Cultural Politics of Translation, Cairo, Egypt, 27-29 October 2015. https://culturalpoliticstranslation2015.wordpress.com 30. Journée d’étude « le(s) figure(s) du traducteur », Mount Royal University, Calgary, Canada, 30 April 2015. http://mrujs.mtroyal.ca/index.php/cf/index 31. Mediterranean Editors and Translators Annual Meeting —Versatility and readiness for new challenges, University of Coimbra, Portugal, 29-31 October 2015. www.metmeetings.org/en/preliminary-program:722 32. Lengua, Literatura y Traducción “liLETRAd”, University of Seville, Spain, 7-8 July 2015. http://congreso.us.es/liletrad. 33. Meta: Translators' Journal is celebrating its 60th anniversary in 2015! For the occasion, an anniversary colloquium will be held on August 19th to 21st, 2015 at the Université de Montréal (Montréal, Canada). Colloquium for the 60th Anniversary of META – 1955-2015: Les horizons de la traduction: retour vers le futur. Translation’s horizons: back to the future. Los horizontes de la traducción: regreso al futuro, August 19-21, 2015 – Université de Montréal. Please send your proposal to this address: meta60e@gmail.com, to the attention of Georges L. Bastin or Eve-Marie Gendron-Pontbrian 2) CURSOS DE POSGRADO / MASTERS: 1. Legal Translation, Master universitario di II livello in Traduzione Giuridica University of Trieste, Italy. http://apps.units.it/Sitedirectory/InformazioniSpecificheCdS/Default.aspx?cdsid=10374&ordinamento=2012&sede=1&int=web&lingua=15 2. Traducción Especializada, Universitat Oberta de Catalunya (UOC), Spain. http://estudios.uoc.edu/es/masters-posgrados-especializaciones/master/artes-humanidades/traduccion-especializada/presentacion 3. Online course: La Traducción Audiovisual y el Aprendizaje de Lenguas Extranjeras, Universidad Nacional de Educación a Distancia, Madrid, 1st December 2014 to 31st May 2015. http://formacionpermanente.uned.es/tp_actividad/idactividad/7385 https://canal.uned.es/mmobj/index/id/21174 Contact: Noa Talaván (ntalavan@flog.uned.es), José Javier Ávila (javila@flog.uned.es) 4. Online course: Audio Description and Its Use in the Foreign Language Classroom, UNED, Madrid, Spain http://formacionpermanente.uned.es/tp_actividad/idactividad/7492 5. Online course: Curso de Formación de Profesorado, La Traducción Audiovisual y el Aprendizaje de Lenguas Extranjeras UNED, Madrid, Spain. http://formacionpermanente.uned.es/tp_actividad/idactividad/7385 6. EST Training Seminar for Translation Teachers, Kraków, Poland 29 June – 3 July 2015. www.est-translationstudies.org/events/2015_seminar_teachers/index.html 7. Train the Trainer -Teaching MT: EAMT-funded Workshop, Dublin City University, 30 April- 1 May 2015. https://cttsdcu.wordpress.com/eamt-workshop-on-teaching-mt-to-translator-trainers-30-april-1-may 3) CURSOS DE VERANO / SUMMER COURSES: 1. 2015 Nida School of Translation Studies, Leading Edges in Translation: World Literature and Performativity, San Pellegrino University Foundation campus, Misano Adriatico, Italy, 18-29 may 2015. http://nsts.fusp.it/Nida-Schools/NSTS-2015 2. EMUNI Translation Studies Doctoral and Teacher Training Summer School, University of Turku, Finland, 1-12 June 2015. www.utu.fi/en/units/hum/units/languages/EASS/Pages/home.aspx 3. Chinese-English Translation and Interpretation, School of Translation and Interpretation, University of Ottawa, Canada, 13th July – 7th August 7 2015. http://arts.uottawa.ca/translation/summer-programs 4. Summer Program in Translation Pedagogy, University of Ottawa 13 July – 7 August 2015. http://arts.uottawa.ca/translation/summer-programs 4) LIBROS / BOOKS: 1. Audio Description: New Perspectives Illustrated, Edited by Anna Maszerowska, Anna Matamala and Pilar Orero, John Benjamins, 2014. https://benjamins.com/#catalog/books/btl.112/main 2. Call for papers: Translation Studies in Africa and beyond: Reconsidering the Postcolony, Editors: J Marais & AE Feinauer Contacts: Kobus Marais (jmarais@ufs.ac.za) or Ilse Feinauer (aef@sun.ac.za). 4. Measuring live subtitling quality: Results from the second sampling exercise, Ofcom, UK. http://stakeholders.ofcom.org.uk/consultations/subtitling/sampling-results-2 5. A Training Handbook for Legal and Court Interpreters in Australia by Mary Vasilakakos, ISBN 978-0-9925873-0-7, Publisher: Language Experts Pty Ltd. www.interpreterrevalidationtraining.com www.languageexperts.com.au 6. Call for papers: Opera and Translation: Eastern and Western Perspectives, Edited by Adriana Serban and Kelly Kar Yue Chan http://pays-anglophones.upv.univ-montp3.fr/?page_id=1908 7. The Known Unknowns of Translation Studies, Edited by Elke Brems, Reine Meylaerts and Luc van Doorslaer, Amsterdam/Philadelphia: John Benjamins, 2014. https://benjamins.com/#catalog/books/bct.69/main 8. Translating the Voices of Theory/ La traduction des voi de la théorie Edited by Isabelle Génin and Ida Klitgård, 2014. www.hf.uio.no/ilos/english/research/groups/Voice-in-Translation/ 9. Authorial and Editorial Voices in Translation 1 - Collaborative Relationships between Authors, Translators, and Performers, Eds. Hanne Jansen and Anna Wegener, 2014. http://editionsquebecoisesdeloeuvre.ca/data/documents/AEVA-Flyer-1-190895-Vita-Traductiva-Vol-2-Flyer-EN-100413.pdf 10. Authorial and Editorial Voices in Translation 2 - Editorial and Publishing Practices, Eds. Hanne Jansen and Anna Wegener, 2014. www.editionsquebecoisesdeloeuvre.ca/accueil 11. Call for papers: Achieving Consilience. Translation Theories and Practice. https://cfpachievingconsilience.wordpress.com 12. Framing the Interpreter. Towards a visual perspective. Anxo Fernández-Ocampo & Michaela Wolf (eds.), 2014, London: Routledge. http://routledge-ny.com/books/details/9780415712743 13. Multilingual Information Management: Information, Technology and Translators, Ximo Granell, 2014. http://store.elsevier.com/Multilingual-Information-Management/Ximo-Granell-/isbn-9781843347712/ 14. Writing and Translating Francophone Discourse: Africa, The Caribbean, Diaspora, Paul F. Bandia (ed.), 2014, Amsterdam, Rodopi www.brill.com/products/book/writing-and-translating-francophone-discourse 15. Call for papers (collective volumen): Translation studies in Africa and beyond: Reconsidering the postcolony www.facebook.com/notes/mona-baker/translation-studies-in-africa-and-beyond-reconsidering-the-postcolony/743564399051495 16. Audiovisual Translation in the Digital Age - The Italian Fansubbing Phenomenon, By Serenella Massidda, Palgrave Connect, 2015. www.palgrave.com/page/detail/audiovisual-translation-in-the-digital-age-serenella-massidda/?k=9781137470362 17. Video: First International SOS-VICS Conference - Building communication bridges in gender violence, University of Vigo, Spain 25-26 September 2014. http://cuautla.uvigo.es/CONSOS/ 18. Camps, Assumpta. Traducción y recepción de la literatura italiana, Publicacions i Edicions UB, 2014. ISBN: 978-84-475-3776-1. 19. Camps, Assumpta. Italia en la prensa periódica durante el franquismo, Publicacions i Edicions UB, 2014. ISBN: 978-84-475-3753-2. 5) REVISTAS / JOURNALS: Call for papers: “Altre Modernità – Rivista di studi letterarie e culturali” Special Issue: Ideological Manipulation in Audiovisual Translation, Contact: irene.ranzato@uniroma.it. http://riviste.unimi.it/index.php/AMonline/announcement/view/381 2. Call for papers: “Between, Journal of the Italian Association of Comparative Literature”. Special issue on censorship and self-censorship. http://ojs.unica.it/index.php/between/pages/view/CFP9_censura_auto-censura 3. Open access journal, “Hieronymus, A Journal of Translation Studies and Terminology”, Croatia. www.ffzg.unizg.hr/hieronymus 4. “DIE SCHNAKE. Zeitschrift für Sprachkritik, Satire, Literatur”, Number 39+40, Kleines ABC des Literaturübersetzens. www.rainer-kohlmayer.de 5. Call for papers: “MonTI” 8 (2016) - Economic, Financial and Business Translation: from Theory to Training and Professional Practice. http://dti.ua.es/es/monti-english/monti-authors.html daniel.gallego@ua.es 6. Call for papers: “LINGUISTICA ANTVERPIENSIA”, NEW SERIES -Themes in Translation Studies (15/2016). Interpreting in Conflict Situations and in Conflict Zones throughout History. https://lans.ua.ac.be/index.php/LANS-TTS/announcement 7. Call for papers: “CULTUS: The Journal of Intercultural Mediation and Communication” (8/2016). The Intercultural Question and the Interpreting Professions. www.cultusjournal.com 8. Call for papers: “The Journal of Specialised Translation” Non-thematic issue, Issue 26, July 2016. www.jostrans.org 9. “TranscUlturAl: A journal of Translation and Culture Studies”, Special issue Translating Street Art. http://ejournals.library.ualberta.ca/index.php/TC/issue/view/1634 10. “Przekładaniec 28: Audiodeskrypcja [Audio Description]”, edited by Anna Jankowska and Agnieszka Szarkowska. All papers are published in Polish, with English abstracts. www.ejournals.eu/Przekladaniec/zakladka/66/ 11. Call for papers: “Lingvisticæ Investigationes”, Special issue on Spanish Phraseology: Varieties and Variations. http://dti.ua.es/es/documentos/li-call-for-papers-spanish-phraseology-varieties-and-variations.pdf Further details: Pedro.mogorron@ua.es; xblancoe@gmail.com 13. Call for papers: “Revista de Lenguas para Fines Específicos”, Special issue on The Translation of Advertising. Contact: Laura Cruz (lcruz@dis.ulpgc.es). Deadline: 20th July 2015. www.webs.ulpgc.es/lfe 14. “The AALITRA Review”. www.nla.gov.au/openpublish/index.php/ALLITRA 15. “Current Trends in Translation Teaching and Learning E” www.cttl.org/cttl-e-2014.html 16. Call for papers: “Current Trends in Translation Teaching and Learning E”. www.cttl.org 18. Call for papers: “Translation and Translanguaging in Multilingual Contexts”, Volume 1, Number 2, 2015 Deadline: 10-Jan-2015. https://benjamins.com/#catalog/journals/ttmc/main 19. Call for book reviews: “TRANS. Revista de Traductología,” vol.19, 2015. Deadline: Friday, 30th January 2015. www.trans.uma.es trans@uma.es 20. Call for papers: “a journal of literature, culture and literary Translation”. Special volume – Utopia and Political Theology Today Deadline: 15th January 2015. Contact: sic.journal.contact@gmail.com https://owl.english.purdue.edu/owl/resource/747/01 21. “trans-kom”. www.trans-kom.eu 22. “Linguistica Antverpiensia” NS-TTS 13/2014: Multilingualism at the cinema and on stage: A translation perspective, Edited by Reine Meylaerts and Adriana Şerban. https://lans-tts.uantwerpen.be/index.php/LANS-TTS/issue/current 23. Call for papers: 5th issue (2015) of “Estudios de Traducción”, Deadline: 20 February 2015. www.ucm.es/iulmyt/revista 24. Call for papers: “Journal of Translation Studies” - special issue on Translator & Interpreter Education in East Asia. KATS (Korean Association of Translation Studies), www.kats.or.kr (Go to 'English' page). Contact: Won Jun Nam (wonjun_nam@daum.net, wjnam@hufs.ac.kr). 25. “The Journal of Specialised Translation”, 23, January 2015. www.jostrans.org 26. Call for papers: “TranscUlturAl: A Journal of Translation and Cultural Studies”. Deadline: 15 March 2015. http://ejournals.library.ualberta.ca/index.php/TC/announcement 27. “New Voices in Translation Studies”, Issue 11 (Fall 2014). www.iatis.org/index.php/publications/new-voices-in-translation-studies/item/1034-issue11-2014 28. “The Interpreter and Translator Trainer”, 8:3 (2014). Special issue: Dialogue Interpreting in practice: bridging the gap between empirical research and interpreter education E. Davitti and S. Pasquandrea (eds.) www.tandfonline.com/toc/ritt20/current#.VLQHuyvF-So 6) WEBS DE INTERÉS / WEBSITES OF INTEREST: 1. Support Spanish interpreters to secure the right to translation and interpreting in criminal proceedings: www.change.org/p/pablo-casado-retiren-el-proyecto-de-ley-org%C3%A1nica-que-modifica-la-lecrim

ObjectiveMore women are obese at their first prenatal visit and then subsequently gain further weight throughout pregnancy than ever before. The impact on the infant’s development of neonatal hypoxic ischemic encephalopathy (HIE) has not been well studied. Using defined physiologic and neurologic criteria, our primary aim was to determine if maternal obesity conferred an additional risk of HIE.Study DesignData from the New York State Perinatal Data System of all singleton, term births in the Northeastern New York region were reviewed using the NIH obesity definition (Body Mass Index (BMI) ≥ 30 kg/m2). Neurologic and physiologic parameters were used to make the diagnosis of HIE. Physiologic criteria included the presence of an acute perinatal event, 10-min Apgar score ≤ 5, and metabolic acidosis. Neurologic factors included hypotonia, abnormal reflexes, absent or weak suck, hyperalert, or irritable state or evidence of clinical seizures. Therapeutic hypothermia was initiated if the infant met HIE criteria when assessed by the medical team. Logistic regression analysis was used to assess the effect of maternal body mass index on the diagnosis of HIE.ResultsIn this large retrospective cohort study we evaluated outcomes of 97,488 pregnancies. Infants born to obese mothers were more likely to require ventilatory assistance and have a lower 5-min Apgar score. After adjusting for type of delivery and maternal risk factors, infants of obese mothers were diagnosed with HIE more frequently than infants of non-obese mothers, OR 1.96 (1.33–2.89) (p = 0.001).ConclusionInfants of obese mothers were significantly more likely to have the diagnosis of HIE.

Introduction How do we measure intimacy? What are its impacts on our social, political and personal lives? Can we claim a politics to our intimate lives that escapes the normative confines of archaic institutions, while making social justice claims for relationship recognition? Negotiating some of these disparate questions requires us to think more broadly in contemporary public debates on equality and relationship recognition. Specifically, by outlining the impacts of the popular "gay marriage" debate, this paper examines the impacts of queer theory in association with public policy and community lobbying for relationship equality. Much of the debate remains polarised: eliminating discrimination is counterposed to religious or reproductive narratives that suggest such recognition undermines the value of the "natural" heterosexual family. Introducing queer theory into advocacy that oscillates between rights and reproduction problematises indexing intimacy against normative ideas of monogamy and family. While the arguments circulated by academics, lawyers, politicians and activists have disparate political and ethical impacts, when taken together, they continue to define marriage as a public regulation of intimacy and citizenship. Citizenship, measured in democratic participation and choice, however, can only be realised through reflexive politics that value difference. Encouraging critical dialogue across disparate areas of the marriage equality debate will have a significant impact on how we make ethical claims for recognising intimacy. (Re)defining Marriage In legislative terms, marriage remains the most fundamental means through which the relationship between citizenship and intimacy is crystallised in Australia. For example, in 2004 the Federal Liberal Government in Australia passed a legislative amendment to the Marriage Act 1961 and expressly defined marriage as a union between a man and a woman. By issuing a public legislative amendment, the Government intended to privilege monogamous (in this case understood as heterosexual) intimacy by precluding same-sex or polygamous marriage. Such an exercise had rhetorical rather than legal significance, as common law principles had previously defined the scope of marriage in gender specific terms for decades (Graycar and Millbank 41). Marriage as an institution, however, is not a universal or a-historical discourse limited to legal or political constructs. Socialist feminist critiques of marriage in the 1950s conceptualised the legal and gender specific constructs in marriage as a patriarchal contract designed to regulate female bodies (Hannam 146). However, Angela McRobbie notes that within a post-feminist context, these historical realities of gendered subjugation, reproduction or domesticity have been "disarticulated" (26). Marriage has become a more democratic and self-reflexive expression of intimacy for women. David Shumway elaborates this idea and argues that this shift has emerged in a context of "social solidarity" within a consumer environment of social fragmentation (23). What this implies is that marriage now evokes a range of cultural choices, consumer practices and affective trends that are incommensurable to a singular legal or historical term of reference. Debating the Politics of Intimacy and Citizenship In order to reflect on this shifting relationship between choice, citizenship and marriage as a concept, it is necessary to highlight that marriage extends beyond private articulations of love. It is a ritualised performance of heterosexual individual (or coupled) citizenship as it entrenches economic and civil rights and responsibilities. The private becomes public. Current neo-liberal approaches to same-sex marriage focus on these symbolic and economic questions of how recognising intimacy is tied to equality. In a legal and political context, marriage is defined in s5 Marriage Act as "the union between a man and a woman to the exclusion of all others, voluntarily entered into for life." While the Act does not imbue marriage with religious or procreative significance, such a gender dichotomous definition prevents same-sex and gender diverse partners from entering into marriage. For Morris Kaplan, this is a problem because "full equality for lesbian and gay citizens requires access to the legal and social recognition of our intimate associations" (201). Advocates and activists define the quest for equal citizenship by engaging with current religious dogma that situates marriage within a field of reproduction, whereby same-sex marriage is seen to rupture the traditional rubric of monogamous kinship and the biological processes of "gender complementarity" (Australian Christian Lobby 1). Liberal equality arguments reject such conservative assertions on the basis that desire, sexuality and intimacy are innate features of human existence and hence always already implicated in public spheres (Kaplan 202). Thus, legal visibility or state recognition becomes crucial to sustaining practices of intimacy. Problematising the broader social impact of a civil rights approach through the perspective of queer theory, the private/public distinctions that delineate citizenship and intimacy become more difficult to negotiate. Equality and queer theory arguments on same-sex marriage are difficult to reconcile, primarily because they signify the different psychic and cultural investments in the monogamous couple. Butler asserts that idealisations of the couple in legal discourse relates to norms surrounding community, family and nationhood (Undoing 116). This structured circulation of sexual norms reifies the hetero-normative forms of relationships that ought to be recognised (and are desired) by the state. Butler also interrogates this logic of marriage, as a heterosexual norm, and suggests it has the capacity to confine rather than liberate subjects (Undoing 118-20). The author's argument relies upon Michel Foucault's notion of power and subjection, where the subject is not an autonomous individual (as conceived in neo liberal discourses) but a site of disciplined discursive production (Trouble 63). Butler positions the heterosexuality of marriage as a "cultural and symbolic foundation" that renders forms of kinship, monogamy, parenting and community intelligible (Undoing 118). In this sense, marriage can be a problematic articulation of state interests, particularly in terms of perpetuating domesticity, economic mobility and the heterosexual family. As former Australian Prime Minister John Howard opines: Marriage is … one of the bedrock institutions of our society … marriage, as we understand it in our society, is about children … providing for the survival of the species. (qtd. in Wade) Howard's politicisation of marriage suggests that it remains crucial to the preservation of the nuclear family. In doing so, the statement also exemplifies homophobic anxieties towards non-normative kinship relations "outside the family". The Prime Ministers' words characterise marriage as a framework which privileges hegemonic ideas of monogamy, biological reproduction and gender dichotomy. Butler responds to these homophobic terms by alluding to the discursive function of a "heterosexual matrix" which codes and produces dichotomous sexes, genders and (hetero)sexual desires (Trouble 36). By refusing to accept the binary neo-liberal discourse in which one is either for or against gay marriage, Butler asserts that by prioritising marriage, the individual accepts the discursive terms of recognition and legitimacy in subjectifying what counts as love (Undoing 115). What this author's argument implies is that by recuperating marital norms, the individual is not liberated, but rather participates in the discursive "trap" and succumbs to the terms of a heterosexual matrix (Trouble 56). In contradistinction to Howard's political rhetoric, engaging with Foucault's broader theoretical work on sexuality and friendship can influence how we frame the possibilities of intimacy beyond parochial narratives of conjugal relationships. Foucault emphasises that countercultural intimacies rely on desires that are relegated to the margins of mainstream (hetero)sexual culture. For example, the transformational aesthetics in practices such as sadomasochism or queer polyamorous relationships exist due to certain prohibitions in respect to sex (Foucault, History (1) 38, and "Sex" 169). Foucault notes how forms of resistance that transgress mainstream norms produce new experiences of pleasure. Being "queer" (though Foucault does not use this word) becomes identified with new modes of living, rather than a static identity (Essential 138). Extending Foucault, Butler argues that positioning queer intimacies within a field of state recognition risks normalising relationships in terms of heterosexual norms whilst foreclosing the possibilities of new modes of affection. Jasbir Puar argues that queer subjects continue to feature on the peripheries of moral and legal citizenship when their practices of intimacy fail to conform to the socio-political dyadic ideal of matrimony, fidelity and reproduction (22-28). Puar and Butler's reluctance to embrace marriage becomes clearer through an examination of the obiter dicta in the recent American jurisprudence where the proscription on same-sex marriage was overturned in California: To the extent proponents seek to encourage a norm that sexual activity occur within marriage to ensure that reproduction occur within stable households, Proposition 8 discourages that norm because it requires some sexual activity and child-bearing and child-rearing to occur outside marriage. (Perry vs Schwarzenegger 128) By connecting the discourse of matrimony and sex with citizenship, the court reifies the value of marriage as an institution of the family, which should be extended to same-sex couples. Therefore, by locating the family in reproductive heterosexual terms, the court forecloses other modes of recognition or rights for those who are in non-monogamous relationships or choose not to reproduce. The legal reasoning in the case evinces the ways in which intimate citizenship or legitimate kinship is understood in highly parochial terms. As Kane Race elaborates, the suturing of domesticity and nationhood, with the rhetoric that "reproduction occur within stable households", frames heterosexual nuclear bonds as the means to legitimate sexual relations (98). By privileging a familial kinship aesthetic to marriage, the state implicitly disregards recognising the value of intimacy in non-nuclear communities or families (Race 100). Australia, however, unlike most foreign nations, has a dual model of relationship recognition. De facto relationships are virtually indistinguishable from marriage in terms of the rights and entitlements couples are able to access. Very recently, the amendments made by the Same-Sex Relationships (Equal Treatment in Commonwealth Laws - General Reform) Act 2008 (Cth) has ensured same-sex couples have been included under Federal definitions of de facto relationships, thereby granting same-sex couples the same material rights and entitlements as heterosexual married couples. While comprehensive de facto recognition operates uniquely in Australia, it is still necessary to question the impact of jurisprudence that considers only marriage provides the legitimate structure for raising children. As Laurent Berlant suggests, those who seek alternative "love plots" are denied the legal and cultural spaces to realise them ("Love" 479). Berlant's critique emphasises how current "progressive" legal approaches to same-sex relationships rely on a monogamous (heterosexual) trajectory of the "love plot" which marginalises those who are in divorced, single, polyamorous or multi-parent situations. For example, in the National Year of Action, a series of marriage equality rallies held across Australia over 2010, non-conjugal forms of intimacy were inadvertently sidelined in order to make a claim for relationship recognition. In a letter to the Sydney Star Observer, a reader laments: As a gay man, I cannot understand why gay people would want to engage in a heterosexual ritual called marriage … Why do gay couples want to buy into this ridiculous notion is beyond belief. The laws need to be changed so that gays are treated equal under the law, but this is not to be confused with marriage as these are two separate issues... (Michael 2) Marriage marks a privileged position of citizenship and consumption, to which all other gay and lesbian rights claims are tangential. Moreover, as this letter to the Sydney Star Observer implies, by claiming sexual citizenship through the rubric of marriage, discussions about other campaigns for legislative equality are effectively foreclosed. Melissa Gregg expands on such a problematic, noting that the legal responses to equality reiterate a normative relationship between sexuality and power, where only couples that subscribe to dyadic, marriage-like relationships are offered entitlements by the state (4). Correspondingly, much of the public activism around marriage equality in Australia seeks to achieve its impact for equality (reforming the Marriage Act) by positioning intimacy in terms of state legitimacy. Butler and Warner argue that when speaking of legitimacy a relation to what is legitimate is implied. Lisa Bower corroborates this, asserting "legal discourse creates norms which universalise particular modes of living…while suppressing other practices and identities" (267). What Butler's and Bower's arguments reveal is that legitimacy is obtained through the extension of marriage to homosexual couples. For example, Andrew Barr, the current Labor Party Education Minister in the Australian Capital Territory (ACT), noted that "saying no to civil unions is to say that some relationships are more legitimate than others" (quoted in "Legal Ceremonies"). Ironically, such a statement privileges civil unions by rendering them as the normative basis on which to grant legal recognition. Elizabeth Povinelli argues the performance of dyadic intimacy becomes the means to assert legal and social sovereignty (112). Therefore, as Jenni Millbank warns, marriage, or even distinctive forms of civil unions, if taken alone, can entrench inequalities for those who choose not to participate in these forms of recognition (8). Grassroots mobilisation and political lobbying strategies around marriage equality activism can have the unintentional impact, however, of obscuring peripheral forms of intimacy and subsequently repudiating those who contest the movement towards marriage. Warner argues that those who choose to marry derive pride from their monogamous commitment and "family" oriented practice, a privilege afforded through marital citizenship (82). Conversely, individuals and couples who deviate from the "normal" (read: socially palatable) intimate citizen, such as promiscuous or polyamorous subjects, are rendered shameful or pitiful. This political discourse illustrates that there is a strong impetus in the marriage equality movement to legitimate "homosexual love" because it mimics the norms of monogamy, stability, continuity and family by only seeking to substitute the sex of the "other" partner. Thus, civil rights discourse maintains the privileged political economy of marriage as it involves reproduction (even if it is not biological), mainstream social roles and monogamous sex. By defining social membership and future life in terms of a heterosexual life-narrative, same-sex couples become wedded to the idea of matrimony as the basis for sustainable intimacy and citizenship (Berlant and Warner 557). Warner is critical of recuperating discourses that privilege marriage as the ideal form of intimacy. This is particularly concerning when diverse erotic and intimate communities, which are irreducible to normative forms of citizenship, are subject to erasure. Que(e)rying the Future of Ethics and Politics By connecting liberal equality arguments with Butler and Warner's work on queer ethics, there is hesitation towards privileging marriage as the ultimate form of intimacy. Moreover, Butler stresses the importance of a transformative practice of queer intimacy: It is crucial…that we maintain a critical and transformative relation to the norms that govern what will not count as intelligible and recognisable alliance and kinship. (Undoing 117) Here the author attempts to negotiate the complex terrain of queer citizenship and ethics. On one hand, it is necessary to be made visible in order to engage in political activism and be afforded rights within a state discourse. Simultaneously, on the other hand, there is a need to transform the prevailing hetero-normative rhetoric of romantic love in order to prevent pathologising bodies or rendering certain forms of intimacy as aberrant or deviant because, as Warner notes, they do not conform to our perception of what we understand to be normal or morally desirable. Foucault's work on the aesthetics of the self offers a possible transformational practice which avoids the risks Warner and Butler mention because it eludes the "normative determinations" of moralities and publics, whilst engaging in an "ethical stylization" (qtd. in Race 144). Whilst Foucault's work does not explicitly address the question of marriage, his work on friendship gestures to the significance of affective bonds. Queer kinship has the potential to produce new ethics, where bodies do not become subjects of desires, but rather act as agents of pleasure. Negotiating the intersection between active citizenship and transformative intimacy requires rethinking the politics of recognition and normalisation. Warner is quite ambivalent as to the potential of appropriating marriage for gays and lesbians, despite the historical dynamism of marriage. Rather than acting as a progressive mechanism for rights, it is an institution that operates by refusing to recognise other relations (Warner 129). However, as Alexander Duttmann notes, recognition is more complex and a paradoxical means of relation and identification. It involves a process in which the majority neutralises the difference of the (minority) Other in order to assimilate it (27). However, in the process of recognition, the Other which is validated, then transforms the position of the majority, by altering the terms by which recognition is granted. Marriage no longer simply confers recognition for heterosexual couples to engage in reproduction (Secomb 133). While some queer couples may subscribe to a monogamous relationship structure, these relationships necessarily trouble conservative politics. The lamentations of the Australian Christian Lobby regarding the "fundamental (anatomical) gender complementarity" of same-sex marriage reflect this by recognising the broader social transformation that will occur (and already does with many heterosexual marriages) by displacing the association between marriage, procreation and parenting (5). Correspondingly, Foucault's work assists in broadening the debate on relationship recognition by transforming our understanding of choice and ethics in terms of "queer friendship." He describes it as a practice that resists the normative public distinction between romantic and platonic affection and produces new aesthetics for sexual and non-sexual intimacy (Foucault, Essential 170). Linnell Secomb argues that this "double potential" alluded to in Foucault and Duttman's work, has the capacity to neutralise difference as Warner fears (133). However, it can also transform dominant narratives of sexual citizenship, as enabling marriage equality will impact on how we imagine traditional heterosexual or patriarchal "plots" to intimacy (Berlant, "Intimacy" 286). Conclusion Making an informed impact into public debates on marriage equality requires charting the locus of sexuality, intimacy and citizenship. Negotiating academic discourses, social and community activism, with broader institutions and norms presents political and social challenges when thinking about the sorts of intimacy that should be recognised by the state. The civil right to marriage, irrespective of the sex or gender of one's partner, reflects a crucial shift towards important democratic participation of non-heterosexual citizens. However, it is important to note that the value of such intimacy cannot be indexed against a single measure of legal reform. While Butler and Warner present considered indictments on the normalisation of queer intimacy through marriage, such arguments do not account for the impacts of que(e)rying cultural norms and practices through social and political change. Marriage is not a singular or a-historical construction reducible to state recognition. Moreover, in a secular democracy, marriage should be one of many forms of diverse relationship recognition open to same-sex and gender diverse couples. In order to expand the impact of social and legal claims for recognition, it is productive to rethink the complex nature of recognition, ritual and aesthetics within marriage. In doing so, we can begin to transform the possibilities for articulating intimate citizenship in plural democracies. References Australian Christian Lobby. "Submission to the Senate Legal and Constitutional Affairs Legislation Committee Inquiry into the Marriage Equality Amendment Bill 2009." Deakin: ACL, 2009. Australian Government. "Sec. 5." Marriage Act of 1961 (Cth). 1961. ———. Same-Sex Relationships (Equal Treatment in Commonwealth Laws - General Reform) Act 2008 (Cth). 2008. Bell, David, and John Binnie. The Sexual Citizen: Queer Politics and Beyond. Oxford: Polity P, 2000. Berlant, Lauren. "Intimacy: A Special Issue." Critical Inquiry 24 (1998): 281-88. ———. "Love, a Queer Feeling." Homosexuality and Psychoanalysis. Eds. Tim Dean and Christopher Lane. Chicago: U of Chicago P, 2001:432-52. Berlant, Lauren, and Michael Warner. "Sex in Public." Ed. Lauren Berlant. Intimacy. Chicago and London: U of Chicago P, 2000: 311-30. Bower, Lisa. "Queer Problems/Straight Solutions: The Limits of a Politics of 'Official Recognition'" Playing with Fire: Queer Politics, Queer Theories. Ed. Shane Phelan. London and New York: Routledge, 1997: 267-91. Butler, Judith. Gender Trouble: Feminism and the Subversion of Identity. New York and London: Routledge, 1990. ———. Undoing Gender. New York: Routledge, 2004. Duttmann, Alexander. Between Cultures: Tensions in the Struggle for Recognition. London: Verso, 2000. Foucault, Michel. The History of Sexuality (1): The Will to Knowledge. London: Penguin Books, 1977. ———. "Sex, Power and the Politics of Identity." Ethics: Subjectivity and Truth. Ed. Paul Rabinow. London: Allen Lange/Penguin, 1984. 163-74. ———. Essential Works of Foucault: 1954-1984: Ethics, Vol. 1. London: Penguin, 2000. Graycar, Reg, and Jenni Millbank. "From Functional Families to Spinster Sisters: Australia's Distinctive Path to Relationship Recognition." Journal of Law and Policy 24. 2007: 1-44. Gregg, Melissa. "Normal Homes." M/C Journal 10.4 (2007). 27 Aug. 2007 ‹http://journal.media-culture.org.au/0708/02-gregg.php›. Hannam, Jane. Feminism. London and New York: Pearson Education, 2007. Kaplan, Morris. "Intimacy and Equality: The Question of Lesbian and Gay Marriage." Playing with Fire: Queer Politics, Queer Theories. Ed. Shane Phelan. London and New York: Routledge, 1997: 201-30. "Legal Ceremonies for Same-Sex Couples." ABC Online 11 Nov. 2009. 13 Dec. 2011 ‹http://www.abc.net.au/news/stories/2009/11/11/2739661.htm›. McRobbie, Angela. The Aftermath of Feminism: Gender, Culture and Social Change. London and New York: Sage, 2008. Michael. "Why Marriage?" Letter to the Editor. Sydney Star Observer 1031 (20 July 2010): 2. Millbank, Jenni. "Recognition of Lesbian and Gay Families in Australian Law - Part One: Couples." Federal Law Review 34 (2008): 1-44. Perry v. Schwarzenegger. 3: 09 CV 02292. United States District Court for the Northern District of California. 2010. Povinelli, Elizabeth. Empire of Love: Toward a Theory of Intimacy, Genealogy and Carnality. Durham: Duke UP, 2006. Puar, Jasbir. Terrorist Assemblages: Homonationalism in Queer Times. Durham: Duke UP, 2007. Race, Kane. Pleasure Consuming Medicine: The Queer Politics of Drugs. Durham and London: Duke UP, 2009. Secomb, Linnell. Philosophy and Love. Edinburgh: Edinburgh UP, 2007. Shumway, David. Modern Love: Romance, Intimacy and the Marriage Crisis. New York: New York UP, 2003. Wade, Matt. "PM Joins Opposition against Gay Marriage as Cleric's Election Stalls." The Sydney Morning Herald 6 Aug. 2003. Warner, Michael. The Trouble with Normal: Sex, Politics and the Ethics of Queer Life. Cambridge: Harvard UP, 1999.

Abstract Background Oral health is an essential component of a healthy pregnancy. While most women work full-time while pregnant, research has overlooked the impact of occupational status and job loss on oral health experiences during pregnancy. To examine the impact of employment status and job loss on oral health experiences during pregnancy in the United States. Data Data are from eight sites (Georgia, Massachusetts, Minnesota, Missouri, North Carolina, New York State, New York City, and Wisconsin) of the Pregnancy Risk Assessment Monitoring System (PRAMS) for the years 2016–2020 (n = 31,362). Multiple logistic regression is used to assess the relationship between occupational status (including employment status and unwanted job loss) during pregnancy and oral health. Findings Women who experienced an unwanted job loss in the prenatal period were at elevated risk of not having dental insurance, not receiving a dental cleaning during pregnancy, having an oral health problem, and having unmet dental care needs. Conclusion Experiencing unwanted job loss around the time of pregnancy is an important life event that corresponds to worse oral health experiences. There is a need for greater focus on adverse life events, such as job loss, especially during pregnancy, as a mechanism for oral health issues and challenges with proper access to dental health systems.

Introduction: The effect of pregnancy on the lifespan of prosthetic heart valves is an important consideration in valve selection for women with valvular heart disease who may desire future pregnancy. Current evidence is mixed and limited to small, single-center studies. Methods: Retrospective analysis of 11,930 women ≤50 years of age who underwent 14,017 valve replacements in California, New Jersey, and New York State between 1990 and 2015. Patient were identified using state-run mandatory administrative databases. Average follow-up time was 9.4 years (SD 6.7 years). To evaluate the association between pregnancy and time to reoperation, time-dependent propensity scoring was used to match women with pregnancy at the time of earliest delivery with controls at risk for pregnancy within the same year after valve implantation. Controls were any woman with valve implantation and without exposure to pregnancy during the study period that was free from reoperation, death, or censoring at the time of matching. Results: Pregnancies in 417 women with 241 biologic valves and 217 mechanical valves were identified. After propensity score matching, there were no significant differences between the pregnant and control groups for both the cohorts with biologic and mechanical valves. Pregnancy was a significant risk factor for reoperation for both biologic (HR 2.5, 95% CI 1.6-3.8 after time-dependent propensity matching) and mechanical (HR 2.3, 95% CI 1.3-4.1 after time-dependent propensity matching) prostheses. For women with mechanical valves who experienced pregnancy and subsequently required reoperation, almost half of reoperations occurred within one year of delivery. Almost all were performed on valves at the mitral position (84.6%) and had diagnosis codes for valve-related complications, including valve thrombosis (76.9%). Conclusion: Pregnancy accelerates time to reoperation for both biologic and mechanical prostheses. Mechanical valves, especially those in the mitral position, are at particular risk for near-term valve loss after delivery.

Background: We evaluate the association of migraine before and during pregnancy with the development of major adverse vascular events (MAVE) during an extended postpartum period of 24 weeks. Methods: We identified pregnant women aged between 12 and 44 years from the state inpatient databases of New York, Florida, Georgia, Maryland, and Washington (2016 - 2019). Patients were followed up for up to 24 weeks postpartum. Patients with migraine (ICD-10 code: G43) before or during pregnancy were considered to have a history of migraine. We fit multivariable logistic regression models to evaluate the association between the history of migraine and the development of MAVE (stroke, acute coronary syndrome, systemic thromboembolism, hypertensive encephalopathy, pulmonary heart disease, or death) up to 24 weeks after delivery. Patients with a history of MAVE before or during pregnancy were excluded. Adjusted odds ratios (aOR) and 95% confidence interval (CI) are reported. Results: Among 1,568,646 eligible participants (mean age [SD]: 29 [5.7] years), 43,840 (2.79%) had a documented history of migraine. Women with a history of migraine (vs. those without a history of migraine) had higher odds of experiencing MAVE (268/43840 [0.61%] vs. 4556/1524806 [0.3%], aOR, 95% CI: 1.47, 1.30 - 1.67). Also, older age (aOR, CI: 1.02, 1.02 - 1.03), smoking during pregnancy (2.14, 1.97 - 2.32), and pre-eclampsia (1.87, 1.72 - 2.03) were independently associated with a higher likelihood of developing postpartum MAVE. Additionally, those with a history of kidney failure (2, 1.76 - 2.27), liver disease (1.32, 1.11 - 1.56), and heart failure (1.59, 1.35 - 1.86) had higher odds of experiencing MAVE. Furthermore, those with a history of hypertension (1.23, 1.13 - 1.33), diabetes (1.30, 1.17 - 1.45), obesity (1.31, 1.22 - 1.41), and coagulopathy (2.36, 2.17 - 2.57) were more likely to experience MAVE. Conclusions: Migraine seems to be independently associated with a higher risk of post-partum MAVE. Further studies are needed to assess the utility of extended workup for evaluating the risk of MAVE among pregnant females with migraines.

BackgroundPrior studies on rupture risk of brain arteriovenous malformations (AVMs) in women undergoing pregnancy and delivery have reported conflicting findings, but also have not accounted for AVM morphology and heterogeneity. Here, we assess the association between pregnancy and the risk of intracranial hemorrhage (ICH) in women with AVMs using a cohort-crossover design in which each woman serves as her own control.MethodsWomen who underwent pregnancy and delivery were identified using DRG codes from the Healthcare Cost and Utilization Project State Inpatient Databases for California (2005–2011), Florida (2005–2014), and New York (2005–2014). The presence of AVM and ICH was determined using ICD 9 codes. Pregnancy was defined as the 40 weeks prior to delivery, and postpartum as 12 weeks after. We defined a non-exposure control period as a 52-week period prior to pregnancy. The relative risks of ICH during pregnancy were compared against the non-exposure period using conditional Poisson regression.ResultsAmong 4 022 811 women identified with an eligible delivery hospitalization (median age, 28 years; 7.3% with gestational diabetes; 4.5% with preeclampsia/eclampsia), 568 (0.014%) had an AVM. The rates of ICH during pregnancy and puerperium were 6355.4 (95% CI 4279.4 to 8431.5) and 14.4 (95% CI 13.3 to 15.6) per 100 000 person-years for women with and without AVM, respectively. In cohort-crossover analysis, in women with AVMs the risk of ICH increased 3.27-fold (RR, 95% CI 1.67 to 6.43) during pregnancy and puerperium compared with a non-pregnant period.ConclusionsAmong women with AVM, pregnancy and puerperium were associated with a greater than 3-fold risk of ICH.

Background The Medicare Merit-based Incentive Payment System (MIPS) ties reimbursement incentives to clinician performance to improve healthcare quality. It is unclear whether the MIPS quality score can accurately distinguish between high-performing and low-performing clinicians. Questions/purposes (1) What were the rates of unplanned hospital visits (emergency department visits, observation stays, or unplanned admissions) within 7, 30, and 90 days of outpatient orthopaedic surgery among Medicare beneficiaries? (2) Was there any association of MIPS quality scores with the risk of an unplanned hospital visit (emergency department visits, observation stays, or unplanned admissions)? Methods Between January 2018 and December 2019, a total of 605,946 outpatient orthopaedic surgeries were performed in New York State according to the New York Statewide Planning and Research Cooperative System database. Of those, 56,772 patients were identified as Medicare beneficiaries and were therefore potentially eligible. A further 34% (19,037) were excluded because of missing surgeon identifier, age younger than 65 years, residency outside New York State, emergency department visit on the same day as outpatient surgery, observation stay on the same claim as outpatient surgery, and concomitant high-risk or eye procedures, leaving 37,735 patients for analysis. The database does not include a list of all state residents and thus does not allow for censoring of patients who move out of state. We chose this dataset because it includes nearly all hospitals and ambulatory surgery centers in a large geographic area (New York State) and hence is not limited by sampling bias. We included 37,735 outpatient orthopaedic surgical encounters among Medicare beneficiaries in New York State from 2018 to 2019. For the 37,735 outpatient orthopaedic surgical procedures included in our study, the mean ± standard deviation age of patients was 73 ± 7 years, 84% (31,550) were White, and 59% (22,071) were women. Our key independent variable was the MIPS quality score percentile (0 to 19th, 20th to 39th, 40th to 59th, or 60th to 100th) for orthopaedic surgeons. Clinicians in the MIPS program may receive a bonus or penalty based on the overall MIPS score, which ranges from 0 to 100 and is a weighted score based on four subscores: quality, promoting interoperability, improvement activities, and cost. The MIPS quality score, which attempts to reward clinicians providing superior quality of care, accounted for 50% and 45% of the overall MIPS score in 2018 and 2019, respectively. Our main outcome measures were 7-day, 30-day, and 90-day unplanned hospital visits after outpatient orthopaedic surgery. To determine the association between MIPS quality scores and unplanned hospital visits, we estimated multivariable hierarchical logistic regression models controlling for MIPS quality scores; patient-level (age, race and ethnicity, gender, and comorbidities), facility-level (such as bed size and teaching status), surgery and surgeon-level (such as surgical procedure and surgeon volume) covariates; and facility-level random effects. We then used these models to estimate the adjusted rates of unplanned hospital visits across MIPS quality score percentiles after adjusting for covariates in the multivariable models. Results In total, 2% (606 of 37,735), 2% (783 of 37,735), and 3% (1013 of 37,735) of encounters had an unplanned hospital visit within 7, 30, or 90 days of outpatient orthopaedic surgery, respectively. Most hospital visits within 7 days (95% [576 of 606]), 30 days (94% [733 of 783]), or 90 days (91% [924 of 1013]) were because of emergency department visits. We found very small differences in unplanned hospital visits by MIPS quality scores, with the 20th to 39th percentile of MIPS quality scores having 0.71% points (95% CI -1.19% to -0.22%; p = 0.004), 0.68% points (95% CI -1.26% to -0.11%; p = 0.02), and 0.75% points (95% CI -1.42% to -0.08%; p = 0.03) lower than the 0 to 19th percentile at 7, 30, and 90 days, respectively. There was no difference in adjusted rates of unplanned hospital visits between patients undergoing surgery with a surgeon in the 0 to 19th, 40th to 59th, or 60th to 100th percentiles at 7, 30, or 90 days. Conclusion We found that the rates of unplanned hospital visits after outpatient orthopaedic surgery among Medicare beneficiaries were low and primarily driven by emergency department visits. We additionally found only a small association between MIPS quality scores for individual physicians and the risk of an unplanned hospital visit after outpatient orthopaedic surgery. These findings suggest that policies aimed at reducing postoperative emergency department visits may be the best target to reduce overall postoperative unplanned hospital visits and that the MIPS program should be eliminated or modified to more strongly link reimbursement to risk-adjusted patient outcomes, thereby better aligning incentives among patients, surgeons, and the Centers for Medicare ad Medicaid Services. Future work could seek to evaluate the association between MIPS scores and other surgical outcomes and evaluate whether annual changes in MIPS score weighting are independently associated with clinician performance in the MIPS and regarding clinical outcomes. Level of Evidence Level III, therapeutic study.

In this paper we explore the rise of anti-gambling apps in the context of the massive expansion of gambling in new spheres of life (online and offline) and an acceleration in strategies of anticipatory and individualised management of harm caused by gambling. These apps, and the techniques and forms of labour they demand, are examples of and a mechanism through which a mode of governance premised on ‘self-care’ and ‘self-control’ is articulated and put into practice. To support this argument, we explore two government initiatives in the Australian context. Quit Pokies, a mobile app project between the Moreland City Council, North East Primary Care Partnership and the Victorian Local Governance Association, is an example of an emerging service paradigm of ‘self-care’ that uses online and mobile platforms with geo-location to deliver real time health and support interventions. A similar mobile app, Gambling Terminator, was launched by the NSW government in late 2012. Both apps work on the premise that interrupting a gaming session through a trigger, described by Quit Pokies’ creator as a “tap on the shoulder” provides gamblers the opportunity to take a reflexive stance and cut short their gambling practice in the course of play. We critically examine these apps as self-disciplining techniques of contemporary neo-liberalism directed towards anticipating and reducing the personal harm and social risk associated with gambling. We analyse the material and discursive elements, and new forms of user labour, through which this consumable media is framed and assembled. We argue that understanding the role of these apps, and mobile media more generally, in generating new techniques and technologies of the self, is important for identifying emerging modes of governance and their implications at a time when gambling is going through an immense period of cultural normalisation in online and offline environments. The Australian context is particularly germane for the way gambling permeates everyday spaces of sociality and leisure, and the potential of gambling interventions to interrupt and re-configure these spaces and institute a new kind of subject-state relation. Gambling in Australia Though a global phenomenon, the growth and expansion of gambling manifests distinctly in Australia because of its long cultural and historical attachment to games of chance. Australians are among the biggest betters and losers in the world (Ziolkowski), mainly on Electronic Gaming Machines (EGM) or pokies. As of 2013, according to The World Count of Gaming Machine (Ziolkowski), there were 198,150 EGMs in the country, of which 197,274 were slot machines, with the rest being electronic table games of roulette, blackjack and poker. There are 118 persons per machine in Australia. New South Wales is the jurisdiction with most EGMs (95,799), followed by Queensland (46,680) and Victoria (28,758) (Ziolkowski). Gambling is significant in Australian cultural history and average Australian households spend at least some money on different forms of gambling, from pokies to scratch cards, every year (Worthington et al.). In 1985, long-time gambling researcher Geoffrey Caldwell stated thatAustralians seem to take a pride in the belief that we are a nation of gamblers. Thus we do not appear to be ashamed of our gambling instincts, habits and practices. Gambling is regarded by most Australians as a normal, everyday practice in contrast to the view that gambling is a sinful activity which weakens the moral fibre of the individual and the community. (Caldwell 18) The omnipresence of gambling opportunities in most Australian states has been further facilitated by the availability of online and mobile gambling and gambling-like spaces. Social casino apps, for instance, are widely popular in Australia. The slots social casino app Slotomania was the most downloaded product in the iTunes store in 2012 (Metherell). In response to the high rate of different forms of gambling in Australia, a range of disparate interest groups have identified the expansion of gambling as a concerning trend. Health researchers have pointed out that online gamblers have a higher risk of experiencing problems with gambling (at 30%) compared to 15% in offline bettors (Hastings). The incidence of gambling problems is also disproportionately high in specific vulnerable demographics, including university students (Cervini), young adults prone to substance abuse problems (Hayatbakhsh et al.), migrants (Tanasornnarong et al.; Scull & Woolcock; Ohtsuka & Ohtsuka), pensioners (Hing & Breen), female players (Lee), Aboriginal communities (Young et al.; McMillen & Donnelly) and individuals experiencing homelessness (Holsworth et al.). While there is general recognition of the personal and public health impacts of gambling in Australia, there is a contradiction in the approach to gambling at a governance level. On one hand, its expansion is promoted and even encouraged by the federal and state governments, as gambling is an enormous source of revenue, as evidenced, for example, by the construction of the new Crown casino in Barangaroo in Sydney (Markham & Young). Campaigns trying to limit the use of poker machines, which are associated with concerns over problem gambling and addiction, are deemed by the gambling lobby as un-Australian. Paradoxically, efforts to restrict gambling or control gambling winnings have also been described as un-Australian, such as in the Australian Taxation Office’s campaign against MONA’s founder, David Walsh, whose immense art collection was acquired with the funds from a gambling scheme (Global Mail). On the other hand, people experiencing problems with gambling are often categorised as addicts and the ultimate blame (and responsibility) is attributed to the individual. In Australia, attitudes towards people who are arguably addicted to gambling are different than those towards individuals afflicted by alcohol or drug abuse (Jean). While “Australians tend to be sympathetic towards people with alcohol and other drug addictions who seek help,” unless it is seen as one of the more socially acceptable forms of occasional, controlled gambling (such as sports betting, gambling on the Melbourne Cup or celebrating ANZAC Day with Two-Up), gambling is framed as an individual “problem” and “moral failing” (Jean). The expansion of gambling is the backdrop to another development in health care and public health discourse, which have for some time now been devoted to the ideal of what Lupton has called the “digitally engaged patient” (Lupton). Technologies are central to the delivery of this model of health service provision that puts the patient at the centre of, and responsible for, their own health and medical care. Lupton has pointed out how this discourse, while appearing new, is in fact the latest version of the 1970s emphasis on the ‘patient as consumer’, an idea given an extra injection by the massive development and availability of digital and interactive web-based and mobile platforms, many of these directed towards the provision of health and health-related information and services. What this means for patients is that, rather than relying solely on professional medical expertise and care, the patient is encouraged to take on some of this medical/health work to conduct practices of ‘self-care’ (Lupton). The Discourse of ‘Self-Management’ and ‘Self-Care’ The model of ‘self-care’ and ‘self-management’ by ‘empowering’ digital technology has now become a dominant discourse within health and medicine, and is increasingly deployed across a range of related sectors such as welfare services. In recent research conducted on homelessness and mobile media, for example, government department staff involved in the reform of welfare services referred to ‘self-management’ as the new service paradigm that underpins their digital reform strategy. Echoing ideas and language similar to the “digitally engaged patient”, customers of Centrelink, Medicare and other ‘human services’ are being encouraged (through planned strategic initiatives aimed at shifting targeted customer groups online) to transact with government services digitally and manage their own personal profiles and health information. One departmental staff member described this in terms of an “opportunity cost”, the savings in time otherwise spent standing in long queues in service centres (Humphry). Rather than view these examples as isolated incidents taking place within or across sectors or disciplines, these are better understood as features of an emerging ‘discursive formation’ , a term Foucault used to describe the way in which particular institutions and/or the state establish a regime of truth, or an accepted social reality and which gives definition to a new historical episteme and subject: in this case that of the self-disciplined and “digitally engaged medical/health patient”. As Foucault explained, once this subject has become fully integrated into and across the social field, it is no longer easy to excavate, since it lies below the surface of articulation and is held together through everyday actions, habits and institutional routines and techniques that appear to be universal, necessary and/normal. The way in which this citizen subject becomes a universal model and norm, however, is not a straightforward or linear story and since we are in the midst of its rise, is not a story with a foretold conclusion. Nevertheless, across a range of different fields of governance: medicine; health and welfare, we can see signs of this emerging figure of the self-caring “digitally engaged patient” constituted from a range of different techniques and practices of self-governance. In Australia, this figure is at the centre of a concerted strategy of service digitisation involving a number of cross sector initiatives such as Australia’s National EHealth Strategy (2008), the National Digital Economy Strategy (2011) and the Australian Public Service Mobile Roadmap (2013). This figure of the self-caring “digitally engaged” patient, aligns well and is entirely compatible with neo-liberal formulations of the individual and the reduced role of the state as a provider of welfare and care. Berry refers to Foucault’s definition of neoliberalism as outlined in his lectures to the College de France as a “particular form of post-welfare state politics in which the state essentially outsources the responsibility of the ‘well-being' of the population” (65). In the case of gambling, the neoliberal defined state enables the wedding of two seemingly contradictory stances: promoting gambling as a major source of revenue and capitalisation on the one hand, and identifying and treating gambling addiction as an individual pursuit and potential risk on the other. Risk avoidance strategies are focused on particular groups of people who are targeted for self-treatment to avoid the harm of gambling addiction, which is similarly framed as individual rather than socially and systematically produced. What unites and makes possible this alignment of neoliberalism and the new “digitally engaged subject/patient” is first and foremost, the construction of a subject in a chronic state of ill health. This figure is positioned as terminal from the start. They are ‘sick’, a ‘patient’, an ‘addict’: in need of immediate and continuous treatment. Secondly, this neoliberal patient/addict is enabled (we could even go so far as to say ‘empowered’) by digital technology, especially smartphones and the apps available through these devices in the form of a myriad of applications for intervening and treating ones afflictions. These apps range fromself-tracking programs such as mood regulators through to social media interventions. Anti-Pokie Apps and the Neoliberal Gambler We now turn to two examples which illustrate this alignment between neoliberalism and the new “digitally engaged subject/patient” in relation to gambling. Anti-gambling apps function to both replace or ‘take the place’ of institutions and individuals actively involved in the treatment of problem gambling and re-engineer this service through the logics of ‘self-care’ and ‘self-management’. Here, we depart somewhat from Foucault’s model of disciplinary power summed up in the institution (with the prison exemplifying this disciplinary logic) and move towards Deleuze’s understanding of power as exerted by the State not through enclosures but through diffuse and rhizomatic information flows and technologies (Deleuze). At the same time, we retain Foucault’s attention to the role and agency of the user in this power-dynamic, identifiable in the technics of self-regulation and in his ideas on governmentality. We now turn to analyse these apps more closely, and explore the way in which these articulate and perform these disciplinary logics. The app Quit Pokies was a joint venture of the North East Primary Care Partnership, the Victorian Local Governance Association and the Moreland City Council, launched in early 2014. The idea of the rational, self-reflexive and agentic user is evident in the description of the app by app developer Susan Rennie who described it this way: What they need is for someone to tap them on the shoulder and tell them to get out of there… I thought the phone could be that tap on the shoulder. The “tap on the shoulder” feature uses geolocation and works by emitting a sound alert when the user enters a gaming venue. It also provides information about each user’s losses at that venue. This “tap on the shoulder” is both an alert and a reprimand from past gambling sessions. Through the Responsible Gambling Fund, the NSW government also launched an anti-pokie app in 2013, Gambling Terminator, including a similar feature. The app runs on Apple and Android smartphone platforms, and when a person is inside a gambling venue in New South Wales it: sends reminder messages that interrupt gaming-machine play and gives you a chance to re-think your choices. It also provides instant access to live phone and online counselling services which operate 24 hours a day, seven days a week. (Google Play Store) Yet an approach that tries to prevent harm by anticipating the harm that will come from gambling at the point of entering a venue, also eliminates the chance of potential negotiations and encounters a user might have during a visit to the pub and how this experience will unfold. It reduces the “tap on the shoulder”, which may involve a far wider set of interactions and affects, to a software operation and it frames the pub or the club (which under some conditions functions as hubs for socialization and community building) as dangerous places that should be avoided. This has the potential to lead to further stigmatisation of gamblers, their isolation and their exclusion from everyday spaces. Moreland Mayor, Councillor Tapinos captures the implicit framing of self-care as a private act in his explanation of the app as a method for problem gamblers to avoid being stigmatised by, for example, publicly attending group meetings. Yet, curiously, the app has the potential to create a new kind of public stigmatisation through potentially drawing other peoples’ attention to users’ gambling play (as the alarm is triggered) generating embarrassment and humiliation at being “caught out” in an act framed as aberrant and literally, “alarming”. Both Quit Pokies and Gambling Terminator require their users to perform ‘acts’ of physical and affective labour aimed at behaviour change and developing the skills of self-control. After downloading Quit Pokies on the iPhone and launching the app, the user is presented an initial request: “Before you set up this app. please write a list of the pokies venues that you regularly use because the app will ask you to identify these venues so it can send you alerts if you spend time in these locations. It will also use your set up location to identify other venues you might use so we recommend that you set up the App in the location where you spend most time. Congratulation on choosing Quit Pokies.”Self-performed processes include installation, setting up, updating the app software, programming in gambling venues to be detected by the smartphone’s inbuilt GPS, monitoring and responding to the program’s alerts and engaging in alternate “legitimate” forms of leisure such as going to the movies or the library, having coffee with a friend or browsing Facebook. These self-performed labours can be understood as ‘technologies of the self’, a term used by Foucault to describe the way in which social members are obliged to regulate and police their ‘selves’ through a range of different techniques. While Foucault traces the origins of ‘technologies of the self’ to the Greco-Roman texts with their emphasis on “care of oneself” as one of the duties of citizenry, he notes the shift to “self-knowledge” under Christianity around the 8th century, where it became bound up in ideals of self-renunciation and truth. Quit Pokies and Gambling Terminator may signal a recuperation of the ideal of self-care, over confession and disclosure. These apps institute a set of bodily activities and obligations directed to the user’s health and wellbeing, aided through activities of self-examination such as charting your recovery through a Recovery Diary and implementing a number of suggested “Strategies for Change” such as “writing a list” and “learning about ways to manage your money better”. Writing is central to the acts of self-examination. As Jeremy Prangnell, gambling counsellor from Mission Australia for Wollongong and Shellharbour regions explained the app is “like an electronic diary, which is a really common tool for people who are trying to change their behaviour” (Thompson). The labours required by users are also implicated in the functionality and performance of the platform itself suggesting the way in which ‘technologies of the self’ simultaneously function as a form of platform work: user labour that supports and sustains the operation of digital systems and is central to the performance and continuation of digital capitalism in general (Humphry, Demanding Media). In addition to the acts of labour performed on the self and platform, bodies are themselves potentially mobilised (and put into new circuits of consumption and production), as a result of triggers to nudge users away from gambling venues, towards a range of other cultural practices in alternative social spaces considered to be more legitimate.Conclusion Whether or not these technological interventions are effective or successful is yet to be tested. Indeed, the lack of recent activity in the community forums and preponderance of issues reported on installation and use suggests otherwise, pointing to a need for more empirical research into these developments. Regardless, what we’ve tried to identify is the way in which apps such as these embody a new kind of subject-state relation that emphasises self-control of gambling harm and hastens the divestment of institutional and social responsibility at a time when gambling is going through an immense period of expansion in many respects backed by and sanctioned by the state. Patterns of smartphone take up in the mainstream population and the rise of the so called ‘mobile only population’ (ACMA) provide support for this new subject and service paradigm and are often cited as the rationale for digital service reform (APSMR). Media convergence feeds into these dynamics: service delivery becomes the new frontier for the merging of previously separate media distribution systems (Dwyer). Letters, customer service centres, face-to-face meetings and web sites, are combined and in some instances replaced, with online and mobile media platforms, accessible from multiple and mobile devices. These changes are not, however, simply the migration of services to a digital medium with little effective change to the service itself. Health and medical services are re-invented through their technological re-assemblage, bringing into play new meanings, practices and negotiations among the state, industry and neoliberal subjects (in the case of problem gambling apps, a new subjectivity, the ‘neoliberal addict’). These new assemblages are as much about bringing forth a new kind of subject and mode of governance, as they are a solution to problem gambling. This figure of the self-treating “gambler addict” can be seen to be a template for, and prototype of, a more generalised and universalised self-governing citizen: one that no longer needs or makes demands on the state but who can help themselves and manage their own harm. Paradoxically, there is the potential for new risks and harms to the very same users that accompanies this shift: their outright exclusion as a result of deprivation from basic and assumed digital access and literacy, the further stigmatisation of gamblers, the elimination of opportunities for proximal support and their exclusion from everyday spaces. References Albarrán-Torres, César. “Gambling-Machines and the Automation of Desire.” Platform: Journal of Media and Communication 5.1 (2013). Australian Communications and Media Authority. “Australians Cut the Cord.” Research Snapshots. Sydney: ACMA (2013) Berry, David. Critical Theory and the Digital. Broadway, New York: Bloomsbury Academic, 2014 Berry, David. Stunlaw: A Critical Review of Politics, Arts and Technology. 2012. ‹http://stunlaw.blogspot.com.au/2012/03/code-foucault-and-neoliberal.html›. Caldwell, G. “Some Historical and Sociological Characteristics of Australian Gambling.” Gambling in Australia. Eds. G. Caldwell, B. Haig, M. Dickerson, and L. Sylan. Sydney: Croom Helm Australia, 1985. 18-27. Cervini, E. “High Stakes for Gambling Students.” The Age 8 Nov. 2013. ‹http://www.theage.com.au/national/education/high-stakes-for-gambling-students-20131108-2x5cl.html›. Deleuze, Gilles. "Postscript on the Societies of Control." October (1992): 3-7. Foucault, Michel. “Technologies of the Self.” Eds. Luther H. Martin, Huck Gutman and Patrick H. Hutton. Boston: University of Massachusetts Press, 1988 Hastings, E. “Online Gamblers More at Risk of Addiction.” Herald Sun 13 Oct. 2013. ‹http://www.heraldsun.com.au/news/online-gamblers-more-at-risk-of-addiction/story-fni0fiyv-1226739184629#!›.Hayatbakhsh, Mohammad R., et al. "Young Adults' Gambling and Its Association with Mental Health and Substance Use Problems." Australian and New Zealand Journal of Public Health 36.2 (2012): 160-166. Hing, Nerilee, and Helen Breen. "A Profile of Gaming Machine Players in Clubs in Sydney, Australia." Journal of Gambling Studies 18.2 (2002): 185-205. Holdsworth, Louise, Margaret Tiyce, and Nerilee Hing. "Exploring the Relationship between Problem Gambling and Homelessness: Becoming and Being Homeless." Gambling Research 23.2 (2012): 39. Humphry, Justine. “Demanding Media: Platform Work and the Shaping of Work and Play.” Scan: Journal of Media Arts Culture, 10.2 (2013): 1-13. Humphry, Justine. “Homeless and Connected: Mobile Phones and the Internet in the Lives of Homeless Australians.” Australian Communications Consumer Action Network. Sep. 2014. ‹https://www.accan.org.au/grants/completed-grants/619-homeless-and-connected›.Lee, Timothy Jeonglyeol. "Distinctive Features of the Australian Gambling Industry and Problems Faced by Australian Women Gamblers." Tourism Analysis 14.6 (2009): 867-876. Lupton, D. “The Digitally Engaged Patient: Self-Monitoring and Self-Care in the Digital Health Era.” Social Theory & Health 11.3 (2013): 256-70. Markham, Francis, and Martin Young. “Packer’s Barangaroo Casino and the Inevitability of Pokies.” The Conversation 9 July 2013. ‹http://theconversation.com/packers-barangaroo-casino-and-the-inevitability-of-pokies-15892›. Markham, Francis, and Martin Young. “Who Wins from ‘Big Gambling’ in Australia?” The Conversation 6 Mar. 2014. ‹http://theconversation.com/who-wins-from-big-gambling-in-australia-22930›.McMillen, Jan, and Katie Donnelly. "Gambling in Australian Indigenous Communities: The State of Play." The Australian Journal of Social Issues 43.3 (2008): 397. Ohtsuka, Keis, and Thai Ohtsuka. “Vietnamese Australian Gamblers’ Views on Luck and Winning: Universal versus Culture-Specific Schemas.” Asian Journal of Gambling Issues and Public Health 1.1 (2010): 34-46. Scull, Sue, Geoffrey Woolcock. “Problem Gambling in Non-English Speaking Background Communities in Queensland, Australia: A Qualitative Exploration.” International Gambling Studies 5.1 (2005): 29-44. Tanasornnarong, Nattaporn, Alun Jackson, and Shane Thomas. “Gambling among Young Thai People in Melbourne, Australia: An Exploratory Study.” International Gambling Studies 4.2 (2004): 189-203. Thompson, Angela, “Live Gambling Odds Tipped for the Chop.” Illawarra Mercury 22 May 2013: 6. Metherell, Mark. “Virtual Pokie App a Hit - But ‘Not Gambling.’” Sydney Morning Herald 13 Jan. 2013. ‹http://www.smh.com.au/digital-life/smartphone-apps/virtual-pokie-app-a-hit--but-not-gambling-20130112-2cmev.html#ixzz2QVlsCJs1›. Worthington, Andrew, et al. "Gambling Participation in Australia: Findings from the National Household Expenditure Survey." Review of Economics of the Household 5.2 (2007): 209-221. Young, Martin, et al. "The Changing Landscape of Indigenous Gambling in Northern Australia: Current Knowledge and Future Directions." International Gambling Studies 7.3 (2007): 327-343. Ziolkowski, S. “The World Count of Gaming Machines 2013.” Gaming Technologies Association, 2014. ‹http://www.gamingta.com/pdf/World_Count_2014.pdf›.

BackgroundRoe was overturned in 2022. No peer-reviewed evidence exists for the indirect spillover effects of overturning Roe on non-abortion reproductive care access for diverse patient populations.MethodsNational data were from 2013–2023 HHS Title X Directory, 2013–2020 CDC Artificial Reproductive Technologies (ART) Surveillance and 2021–2023 manual collection, and Guttmacher Institute. Outcome measures included numbers of ART clinics and Title X entities. Title X entities are those that receive federal funds to establish and operate voluntary family planning projects, especially for low-income patients. We reported pre-and post-Roe changes, associations between changes in measures and abortions, and characteristics of changed measures by region and political geography.ResultsPost-Roe America witnessed national declines of 1.03% in ART clinics and 18.34% in Title X entities, and average state decreases of 0.08 ART clinics (p &lt; 0.05) and 18 Title X entities (p &lt; 0.001). State-level ART clinic closures and abortion reductions had little association except for Texas, Oklahoma, Arizona, New York, and California. Plummets in Title X entities and abortions were positively associated: Reducing 100 abortions was associated with defunding two Title X entities (p &lt; 0.05). The South experienced the largest losses of both, while 83.39% of lost Title X entities were in states that voted Republican in the 2020 presidential election, disproportionate to the 49.02% of states that voted Republican and the 42.52% of US population residing in these states.ConclusionWe provide one of the first few evidence of spillover impacts of overturning Roe on non-abortion care access for diverse populations: low-income men and women, single parents by choice, and biologically and socially infertile patients. Early evidence warns of worsening challenges of inequities and calls for immediate policy actions.

Photo by Hédi Benyounes on Unsplash ABSTRACT The current incarceration facilities for the growing number of women are depriving expecting mothers of adequate care crucial for the child’s mental and physical development. Programs need to be established to counteract this. INTRODUCTION Currently, Diana Sanchez was eight months pregnant when she was arrested for identity theft and put in a prison cell in Denver. At five a.m., two weeks after being incarcerated, she announced to a deputy outside her cell that she was going into labor. Footage from a camera in her cell shows her pacing anxiously or writhing in her bed for the five hours preceding the arrival of her son. She banged on the door and begged for help. All she received was an absorbent pad. She gave birth alone in her prison cell on July 31, 2015, around 10:45 am. At 11:00 am, a prison nurse walked in to cut the umbilical cord and take Sanchez’s newborn baby without offering postnatal care. Sanchez was later sent to a hospital, and her baby was separated from her until she was put on probation. In 2018, on behalf of her three-year-old son, Sanchez sued Denver Health and Denver Sheriff Department and won a $480,000 settlement.[1] Though many more men are incarcerated than women, the rate of growth of female incarceration has exceeded that of male incarceration for decades. One study estimated that 231,000 women are currently incarcerated in the US,[2] 80 percent of whom are mothers, and 150,000 pregnant.[3] Another recent study of 1,396 incarcerated pregnant women found that 92 percent had live births, 6.5 percent had stillbirths or miscarriages, and 4 percent terminated the pregnancy. The authors found that there is no system of reporting pregnancy outcomes in US prisons. There is a noteworthy ethical lapse in mental, emotional, and medical care that threatens the well-being of pregnant women in prison. According to Carolyn Sufrin, “Pregnant incarcerated people are one of the most marginalized and forgotten groups in our country… and women who don't get counted don't count.” [4] Poor documentation, visibility, and transparency contribute to the systemic abuse of incarcerated women. Studies document women giving birth alone in cells and shackles in solitary confinement. Their complaints regarding contractions, bleeding, and other pains of labor are often ignored.[5] l. Prenatal Care in American Prisons Diana Sanchez was not offered any prenatal care after she was incarcerated. And neither she nor her son received appropriate postnatal care.[6] Sanchez was on medication for opioid withdrawal while pregnant, which could have been detrimental to her baby’s health.[7] There is an unacceptable absence of pre- and postnatal care in most US prisons. A lack of regulation makes the availability of perinatal care unpredictable and unreliable. Several studies confirmed that there is not a standard for prenatal care for women incarcerated during pregnancy. [8] Knowledge of the appropriate mental and physical care pregnant women require, addiction support, and support for maternal-infant bonding all exists outside the prison system and ought to be used as a benchmark. At the very least, pregnant women, birthing women, and new mothers should not be placed in solitary confinement or shackled.[9] In the prenatal arena, depriving an individual of adequate healthcare is not appropriate and could be cruel and unusual. Only 18 percent of funding in prisons goes to health care for the prisoners. That is roughly $5.7 thousand per prisoner, according to an NIH study done in 2015.[10] There should be an adequate amount of funding for the health needs of incarcerated pregnant women. By depriving pregnant women of healthcare, the prisons are depriving the fetus of adequate care. ll. Respect for Autonomy During Incarceration Women maintain healthcare autonomy even when incarcerated. The purpose of a prison sentence is retribution for crimes and rehabilitation to prevent reoffending.[11] The separation of a mother and newborn causes significant developmental and psychological harm to the child and the parent. Parent-child separation does not serve the purpose of retribution or rehabilitation and is authorized only due to prisons’ limited space and resources that make it difficult to accommodate children, as well as a state interest in children’s best interests or the custody rights of the other parent. When it is possible to keep a family together, prisons should make every effort to do so for the health of the mother-child relationship. Incarcerated people may become a burden to family or society due to prison medical neglect. For example, diabetes and hypertension, which can occur during pregnancy, can worsen without treatment. The inability to access the care they would otherwise want and need endangers women and poses a burden to the healthcare system after incarceration, Depersonalizing individuals convicted of crimes must be placed in the context of historical eugenics practices. State-sanctioned sterilization and efforts to prevent women from reproducing were widespread during the early 20th century.[12] Cases of coerced and nonconsensual sterilization of incarcerated women and men evidence the history of eugenics.[13]Abortions are offered to some incarcerated women.[14] However, many incarcerated women are denied the right to see healthcare providers to thoroughly discuss abortion or other options.[15] Although the abortions are consensual, the quality of consent is questionable. lll. Prison Nursery Programs, “I need something to live for…” Indiana Women’s Prison (IWP), a max security female prison, has a program called Wee Ones that enables women convicted of nonviolent crimes to spend 30 months bonding with their newborn child. It is one of eight programs in the country that allows pregnant mothers to spend the last few months of their sentence with their children. It is a voluntary program that allows pregnant offenders a private room in a housing unit. It offers parent education, resources that are accessible after release, and career education. The program application process and the rules to which women must adhere to remain in the program are stringent. The programs generally have a zero-tolerance policy. Even simply sleeping in the same bed as the child or arguing with other mothers can result in termination from the program. Kara, a pregnant woman incarcerated for drug possession, had a history of abuse in her family and tended to act out in anger against her peers in the program. She was learning how to have healthy reactions to anger when handling her child, but her temper ultimately led to her removal from the program. Her son was placed in foster care, and Kara returned to the regular cells. In an interview before her transfer, she told the camera that Charlie gave her a purpose. With tears in her eyes, she said, “Charlie was my way of life here [...] I need something to live for [,] and I screwed up.”[16] Pregnancy in prison can be a way to improve quality of life for some women. Studies demonstrate that nursery programs improve mental health of the incarcerated women.[17] The secure attachment of the infant to its primary caregiver promotes healthy development in the child and a bonded relationship with the mother.[18] The close bond between mother and child in prisons has been shown to decrease recidivism and to reduce the burden on the foster care system.[19] Women who do not qualify for these programs, or are incarcerated in prisons without them, are separated from their newborn babies and their other children. The disconnect can lead to the child rejecting the incarcerated mother once she is released.[20] Programs like Wee Ones honor women’s autonomy while they are incarcerated. During interviews, the women expressed that although raising a child in that environment is difficult, it was better than not being with their children. While rocking a baby in her lap, one inmate expressed her frustrations with Wee Ones but then paused to express gratitude and said, “After all, it’s prison. And prison ain’t supposed to be nice.”[21] The ethical issue of autonomy reflects a more difficult dilemma in the prison landscape. lV. Counter Arguments: Do the Nursery Programs Work for the Children and the Women Typically, newborns are taken from their incarcerated mothers within two to three days of birth and sent to live with a relative or placed in foster care. Many women are never reunited with their babies. There is much debate over whether the programs are beneficial to the children. One ethical issue is whether children, as innocents, are being punished either by being in the prison system or by being separated from their mothers. Skeptics, like James Dwyer, have argued against keeping innocent babies in the custody of incarcerated mothers asserting that there is little evidence demonstrating that the programs rehabilitate the women.[22] Dwyer commented on the “reckless” hopefulness the programs provide: "It might, in fact, be the babies distract them from rehabilitation they should be doing instead. […] They're so focused on childcare and have this euphoria — they think they'll be just fine when they get out of prison and they're not. We just don't know."[23] One study showed that 58 percent of incarcerated women are arrested again after release, 38 percent are reconvicted, and 30 percent return to prison within three years.[24] Dwyer uses this data to argue that the programs are not worthwhile. However, the data is not limited to the special population that had the prison nursery experience. The data applies to all incarcerated women limiting its applicability. More importantly, there is compelling evidence to support prison nursery programs.[25] The programs do decrease recidivism[26] and prison misconduct,[27] and they allow women to create stronger bonds with their children.[28] Bev Little argues that allowing mothers to bond with their babies only delays the inevitable separation and will cause trauma and have other ill effects on the baby. [29] But others feel that stronger maternal-fetal attachment is best for both parties. There is evidence that the bond, once formed, is long-lasting. Later in life, there is less drug addiction among children who stayed in the nursery rather than being separated from their mothers.[30] Another counterargument is that the policies in prison nurseries are not as useful for motherhood outside of the facility; thus, an issue with recidivism occurs because the women are less prepared for motherhood upon release from prison. Prison nursery programs establish methods and procedures for successful motherhood that are unique to operation within correctional environments. Yet, fortunately, parenting classes offered by prisons and jails emphasize sacrifice, self-restraint, and dedicated attention to the baby. These classes aptly apply to motherhood outside of prison.[31] One incarcerated mother experiencing addiction, Kima, was described as ambivalent toward her pregnancy. “It’s something about knowing but not knowing that makes me not accountable or makes me think I’m not accountable,” Kima shared.[32] After the nurse confirmed her pregnancy, she acknowledged fear and knew she would be held accountable to the baby. The occurrence of pregnancy ambivalence is common.[33] A study of a population of prisoners from Rhode Island found that 41 percent of the women expressed ambivalent attitudes about pregnancy. 70 of the women from a population in San Francisco expressed ambivalent or negative attitudes towards pregnancy.[34] But the ambivalence of some women toward pregnancy is not a reason to prevent women who feel differently from reaping the full benefits of programs that support them during pregnancy. Another counterargument is that prison is becoming a comfort that women might seek if they are homeless or housing insecure. For example, Evelyn was released from a San Francisco jail after being arrested for using cocaine. She was 26 weeks pregnant and had a four-year-old son in the custody of her aunt. Following her release, she was homeless and using drugs in the streets. She felt that her only hope of keeping her baby safe was to go back to jail. Like Kima, she had been in and out of jail from a young age. She grew accustomed to and dependent on the care provided there. While incarceration can provide a home and a nursery, there is no ethical reason to argue for making prison less comfortable by separating babies and children from incarcerated women. Instead, these facts suggest we are not doing enough for women outside prisons either. CONCLUSION Many experts stress the dearth of research and information on these women and their babies. There is no empirical data to show how big the problem is, but there is evidence that programs providing nursery care for the children of incarcerated women have many benefits. Because the research is not largescale enough, many pregnant women in the prison system are ignored. Many women give birth in unacceptable conditions, and their children are taken from them the moment the umbilical cord is cut. While the US incarcerates too many women, a movement to expand prison nurseries could help new mothers bond with their children. Strong educational programs could aid in lowering the rates of recidivism by providing therapeutic resources for mothers.[35] There is a growing problem of mass incarceration in the US as many women are placed in correctional facilities. Most of these women are convicted of possession or use of illegal substances.[36] Many women come from disadvantaged backgrounds, poverty, and have experienced addiction. Depriving an expectant mother of adequate care is cruel and irresponsible both to the mother and her innocent child. The criminal justice system is harming children both mentally and physically. Reform of the system is needed to provide the basic care those children need. Programs like IWP’s Wee Ones are necessary for physical, psychological, and social development. A program that offers a place for mothers to raise their babies in the community of other mothers would incentivize and facilitate healthy parental habits. Further programs for mothers who are released from prison would give them valuable resources to keep them from returning and encourage healthy relationships between the mother and the baby. - [1] Li, D. K. Video allegedly shows woman giving birth in Denver jail cell alone, with no assistance. Denver: NBC News, 2019. [2] Kajstura, Aleks. “Women's Mass Incarceration: The Whole Pie 2019.” Prison Policy Initiative, 29 Oct. 2019, https://www.prisonpolicy.org/reports/pie2019women.html. (“Including those in prisons, jails, and other correctional facilities.”) [3] Swavola, E, K Riley and R Subramanian. "Overlooked: Women and Jails in an Era of Reform." Vera Institute of Justice August 2016. [4] Sufrin, C. Pregnant Behind Bars: What We Do and Don't Know About Pregnancy and Incarceration Allison Chang. 21 March 2019. Transcript. [5] Sufrin, C., 2019. (Suffrin expressed that she had seen such practices firsthand working as an OB/GYN for incarcerated women.) [6] Padilla, M. “Woman Gave Birth in Denver Jail Cell Alone, Lawsuit Says,” New York Times, Sep. 1, 2019. [7] Li, D. “Video allegedly shows woman giving birth in Denver jail cell alone, with no assistance,” NBC U.S. News, Apr. 29. 2019. [8] Knittel, A. and C. Sufrin. "Maternal Health Equity and Justice for Pregnant Women Who Experience Incarceration." JAMA Network Open 3.8 (2020). A study in Ontario, Canada, coincided with a study done in Australia. [9] Sufrin, C., et al. "Pregnancy Outcomes in US Prisons, 2016–2017." p. 803-804. [10] Sridhar, S., R. Cornish and S. Fazel. "The Costs of Healthcare in Prison and Custody: Systematic Review of Current Estimates and Proposed Guidelines for Future Reporting." Frontiers in Psychiatry 9.716 (2018). [11] Kifer, M., Hemmens, C., Stohr, M. K. “The Goals of Corrections: Perspectives from the Line” Criminal Justice Review. 1 May 2003 [12] Perry, D. M. "Our Long, Troubling History of Sterilizing the Incarcerated." The Marshall Project: Sterilization of Women in Prison 26 July 2017. [13] Rachel Roth & Sara L. Ainsworth, If They Hand You a Paper, You Sign It: A Call to End the Sterilization of Women in Prison, 26 Hastings WOMEN's L.J. 7 (2015); See Skinner v. Oklahoma ex rel. Williamson, 316 U.S. 535 (1942) (procreation considered a fundamental right; fact pattern of male sterilization in prison based on type of crime.) [14] Sufrin, C., M. D. Creinin, J. C. Chang. “Incarcerated Women and Abortion Provision: A Survey of Correctional Health Providers.” Perspectives on Sexual and Reproductive Health. p. 6-11. 23 March 2009. [15] Kasdan, D. “Abortion Access for Incarcerated Women: Are Correctional Health Practices in Conflict with Constitutional Standards?” Guttmacher Institute. 26 March 2009. [16] Born Behind Bars. Season 1, Episode 5, “They Can Take Your Baby Away,” produced by Luke Ellis, Francis Gasparini, & Jen Wise, aired on 15 Nov. 2017 A&E Networks [17] Bick, J., & Dozier, M. (2008). Helping Foster Parents Change: The Role of Parental State of Mind. In H. Steele & M. Steele (Eds.), Clinical applications of the Adult Attachment Interview (pp. 452–470). New York: Guilford Press. [18]Sroufe, L. A., B. Egeland, E. A. Carlson, W. A. Collins. (2005). The Development of the Person: The Minnesota Study of Risk and Adaptation from Birth to Adulthood. New York: Guilford Press. [19] Goshin, L. S., & Byrne, M. W. “Converging Streams of Opportunity for Prison Nursery Programs in the United States.” Journal of Offender Rehabilitation. 15 Apr 2009. [20] Babies Behind Bars. Dirs. W. Serrill and S. O'Brien. 2015. Another IWP pregnant woman is Taylor. At the time of the show, she was pregnant and expecting twins. In interviews throughout the episode, she expressed how her pregnancies in prison had put her in a better mood and felt beneficial to her. She had tried to sign up for the nursery program for her previous pregnancy, but her sentence was too long to get it. Her child was sent to live with a caregiver, and when Taylor was on probation, Taylor’s daughter didn’t want to be around Taylor. Taylor was so distraught that she messed up and went back, this time, pregnant with twins. After she was reincarcerated, she was able to be accepted into Wee Ones. She expressed to the camera man that the program might help her feel more like a mother so that when she gets out, she will have someone to care for. Taylor, Kara, and many other women depend on their children or their pregnancy for a purpose while behind bars. They relied on their babies to be a boon for them. [21] Babies Behind Bars. Dirs. W. Serrill and S. O'Brien. 2015. [22] Corley, C. "Programs Help Incarcerated Moms Bond with Their Babies in Prison." Criminal Justice Collaborative (2018). [23] Corley, C. "Programs Help Incarcerated Moms Bond with Their Babies in Prison." Criminal Justice Collaborative (2018). [24] Owen, B. & Crow, J. “Recidivism among Female Prisoners: Secondary Analysis of the 1994 BJS Recidivism Data Set” Department of Criminology California State University (2006) p. 28 [25] Prison Nursery Programs: Literature Review and Fact Sheet for CT. Diamond Research Consulting, 2012, www.cga.ct.gov/2013/JUDdata/tmy/2013HB-06642-R000401-Sarah Diamond - Director, Diamond Research Consulting-TMY.PDF. [26] New York Department of Correction Services (NYDOCS). (1993). Profile of Participants: The Bedford and Taconic Nursery Program in 1992. Albany, NY. Department of Correction Services.Rowland, M., & Watts, A. (2007). Washington State’s effort to the generational impact on crime. Corrections Today. Retrieved September 12, 2007, from http://www. aca.org/publications/pdf/Rowland_Watts_Aug07.pdf. [27] Carlson, J. R. (2001). Prison nursery 2000: A five-year review of the prison nursery at the Nebraska Correctional Center for Women. Journal of Offender Rehabilitation, 33, 75–97. [28] Carlson, J.R. [29] Little, B. "What Happens When a Woman Gives Birth Behind Bars?" A+E Networks, 29 October 2019. <https://www.aetv.com/real-crime/what-happens-when-a-woman-gives-birth-in-jail-or-prison>. [30] Margolies, J. K., & Kraft-Stolar, T. When “Free” Means Losing Your Mother: The Collision of Child Welfare and the Incarceration of Women in New York State 1, 9 (Correctional Association of N.Y. Women in Prison Project 2006) [31] Sufrin, C. Jailcare: Finding the Safety Net for Women Behind Bars. Berkeley: University of California Press, 2017. [32] Sufrin, C. Jailcare: p. 155. [33] Peart, M. S. & Knittel, A. K. “Contraception need and available services among incarcerated women in the United States: a systematic review.” Contraception and Reproductive Medicine. 17 March 2020 [34] LaRochelle, F., C. Castro, J. Goldenson, J. P. Tulsky, D.L. Cohan, P. D. Blumenthal, et al. “Contraceptive use and barriers to access among newly arrested women.” J Correct Health Care. (2012) p. 111–119. [35] Goshin, L., & Byrne, M. (2009). “Converging streams of opportunity for prison nursery programs in the United States.” Journal of Offender Rehabilitation. 2009. p.271–295. [36] Elizabeth Swavola, Kristine Riley, Ram Subramanian. Overlooked: Women and Jails in an Era of Reform. New York: Vera Institute of Justice, 2016.

Photo by niu niu on Unsplash ABSTRACT Shackling prisoners has been implemented as standard procedure when transporting prisoners in labor and during childbirth. This procedure ensures the protection of both the public and healthcare workers. However, the act of shackling pregnant prisoners violates the principles of ethics that physicians are supposed to uphold. This paper will explore how shackling pregnant prisoners violates the principle of justice and beneficence, making the practice unethical. INTRODUCTION Some states allow shackling of incarcerated pregnant women during transport and while in the hospital for labor and delivery. Currently, only 22 states have legislation prohibiting the shackling of pregnant women.[1] Although many states have anti-shackling laws prohibiting restraints, these laws also contain an “extraordinary circumstances” loophole.[2] Under this exception, officers shackle prisoners if they pose a flight risk, have any history of violence, and are a threat to themselves or others.[3] Determining as to whether a prisoner is shackled is left solely to the correctional officer.[4] Yet even state restrictions on shackling are often disregarded. In shackling pregnant prisoners during childbirth, officers and institutions are interfering with the ability of incarcerated women to have safe childbirth experiences and fair treatment. Moreover, physicians cannot exercise various ethical duties as the law constrains them. In this article, I will discuss the physical and mental harms that result from the use of restraints under the backdrop of slavery and discrimination against women of color particularly. I argue that stereotypes feed into the phenomenon of shackling pregnant women, especially pregnant women of color. I further assert that shackling makes it difficult for medical professionals to be beneficent and promote justice. BACKGROUND Female incarceration rates in the United States have been fast growing since the 1980s.[5] With a 498 percent increase in the female incarceration population between 1981 and 2021, the rates of pregnancy and childbirth by incarcerated people have also climbed.[6],[7] In 2021, over 1.2 million women were incarcerated in the United States.[8] An estimated 55,000 pregnant women are admitted to jails each year.[9],[10] Many remain incarcerated throughout pregnancy and are transported to a hospital for labor and delivery. Although the exact number of restrained pregnant inmates is unclear, a study found that 83 percent of hospital prenatal nurses reported that their incarcerated patients were shackled.[11] I. Harms Caused by Shackling Shackling has caused many instances of physical and psychological harm. In the period before childbirth, shackled pregnant women are at high risk for falling.[12] The restraints shift pregnant women’s center of gravity, and wrist restraints prevent them from breaking a fall, increasing the risk of falling on their stomach and harming the fetus.[13] Another aspect inhibited by using restraints is testing and treating pregnancy complications. Delays in identifying and treating conditions such as hypertension, pre-eclampsia, appendicitis, kidney infection, preterm labor, and especially vaginal bleeding can threaten the lives of the mother and the fetus.[14] During labor and delivery, shackling prevents methods of alleviating severe labor pains and giving birth.[15] Usually, physicians recommend that women in labor walk or assume various positions to relieve labor pains and accelerate labor.[16] However, shackling prevents both solutions.[17] Shackling these women limits their mobility during labor, which may compromise the health of both the mother and the fetus.[18] Tracy Edwards, a former prisoner who filed a lawsuit for unlawful use of restraints during her pregnancy, was in labor for twelve hours. She was unable to move or adjust her position to lessen the pain and discomfort of labor.[19] The shackles also left the skin on her ankles red and bruised. Continued use of restraints also increases the risk of potentially life-threatening health issues associated with childbirth, such as blood clots.[20] It is imperative that pregnant women get treated rapidly, especially with the unpredictability of labor. Epidural administration can also become difficult, and in some cases, be denied due to the shackled woman’s inability to assume the proper position.[21] Time-sensitive medical care, including C-sections, could be delayed if permission from an officer is required, risking major health complications for both the fetus and the mother.[22] After childbirth, shackling impedes the recovery process. Shackling can result in post-delivery complications such as deep vein thrombosis.[23] Walking prevents such complications but is not an option for mothers shackled to their hospital beds.[24] Restraints also prevent bonding with the baby post-delivery and the safe handling of the baby while breast feeding.[25] The use of restraints can also result in psychological harm. Many prisoners feel as though care workers treat them like “animals,” with some women having multiple restraints at once— including ankles, wrists, and even waist restraints.[26] Benidalys Rivera describes the feeling of embarrassment as she was walking while handcuffed, with nurses and patients looking on, “Being in shackles, that make you be in stress…I about to have this baby, and I’m going to go back to jail. So it’s too much.”[27] Depression among pregnant prisoners is highly prevalent. The stress of imprisonment and the anticipation of being separated from their child is often overwhelming for these mothers.[28] The inhumane action has the potential to add more stress, anxiety, and sadness to the already emotionally demanding process of giving birth. Shackling pregnant prisoners displays indifference to the medical needs of the prisoner.[29] II. Safety as a Pretense While public safety is an argument for using shackles, several factors make escape or violence extremely unlikely and even impossible.[30] For example, administering epidural anesthesia causes numbness and eliminates flight risk.[31] Although cited as the main reason for using shackles, public safety is likely just an excuse and not the main motivator for shackling prisoners. I argue that underlying the shackling exemplifies the idea that these women should not have become pregnant. The shackling reflects a distinct discrimination: the lawmakers allowing it perhaps thought that people guilty of crimes would make bad mothers. Public safety is just a pretense. The language used to justify the use of restraint of Shawanna Nelson, the plaintiff in Nelson v. Correctional Medical Services, discussed below, included the word “aggressive.”[32] In her case, there was no evidence that she posed any danger or was objectively aggressive. Officer Turnesky, who supervised Nelson, testified that she never felt threatened by Nelson.[33] The lack of documented attempts of escape and violence from pregnant prisoners suggests that shackling for flight risk is a false pretense and perhaps merely based on stereotypes.[34] In 2011, an Amnesty International report noted that “Around the USA, it is common for restraints to be used on sick and pregnant incarcerated women when they are transported to and kept in hospital, regardless of whether they have a history of violence (which only a minority have) and regardless of whether they have ever absconded or attempted to escape (which few women have).”[35] In a 2020 survey of correctional officers in select midwestern prisons, 76 percent disagreed or strongly disagreed with restraining pregnant women during labor and delivery.[36] If a correctional officer shackles a pregnant prisoner, it is not because they pose a risk but because of a perception that they do. This mindset is attributed to select law enforcement, who have authority to use restraints.[37] In 2022, the Tennessee legislature passed a bill prohibiting the use of restraints on pregnant inmates. However, legislators amended the bill due to the Tennessee Sherriff Association’s belief that even pregnant inmates could pose a “threat.”[38] Subjecting all prisoners to the same “precautions” because a small percentage of individuals may pose such risks could reflect stereotyping or the assumption that all incarcerated people pose danger and flight risk. To quell the (unjustified) public safety concern, there are other options that do not cause physical or mental harm to pregnant women. For example, San Francisco General Hospital does not use shackles but has deputy sheriffs outside the pregnant women’s doors.[39] III. Historical Context and Race A. Slavery and Post-Civil War The treatment of female prisoners has striking similarities to that of enslaved women. Originally, shackling of female slaves was a mechanism of control and dehumanization.[40] This enabled physical and sexual abuses. During the process of intentionally dehumanizing slaves to facilitate subordination, slave owners stripped slave women of their feminine identity.[41] Slave women were unable to exhibit the Victorian model of “good mothering” and people thought they lacked maternal feelings for their children.[42] In turn, societal perception defeminized slave women, and barred them from utilizing the protections of womanhood and motherhood. During the post-Civil War era, black women were reversely depicted as sexually promiscuous and were arrested for prostitution more often than white women.[43] In turn, society excluded black women; they were seen as lacking what the “acceptable and good” women had.[44] Some argue that the historical act of labeling black women sexually deviant influences today’s perception of black women and may lead to labeling them bad mothers.[45] Over two-thirds of incarcerated women are women of color.[46] Many reports document sexual violence and misconduct against prisoners over the years.[47] Male guards have raped, sexually assaulted, and inappropriately touched female prisoners. Some attribute the physical abuse of black female prisoners to their being depicted or stereotyped as “aggressive, deviant, and domineering.”[48] Some expect black women to express stoicism and if they do not, people label them as dangerous, irresponsible, and aggressive.[49] The treatment of these prisoners mirrors the historical oppression endured by black women during and following the era of slavery. The act of shackling incarcerated pregnant women extends the inhumane treatment of these women from the prison setting into the hospital. One prisoner stated that during her thirty-hour labor, while being shackled, she “felt like a farm animal.”[50] Another pregnant prisoner describes her treatment by a guard stating: “a female guard grabbed me by the hair and was making me get up. She was screaming: ‘B***h, get up.’ Then she said, ‘That is what happens when you are a f***ing junkie. You shouldn’t be using drugs, or you wouldn’t be in here.”[51] Shackling goes beyond punishing by isolation from society – it is an additional punishment that is not justified. B. Reproductive Rights and “Bad Mothers” As with slaves not being seen as maternal, prisoners are not viewed as “real mothers.” A female prison guard said the following: “I’m a mother of two and I know what that impulse, that instinct, that mothering instinct feels like. It just takes over, you would never put your kids in harm’s way. . . . Women in here lack that. Something in their nature is not right, you know?”[52] This comment implies that incarcerated women lack maternal instinct. They are not in line with the standards of what society accepts as a “woman” and “mother” and are thought to have abandoned their roles as caretakers in pursuit of deviant behaviors. Without consideration of racial discrimination, poverty issues, trauma, and restricted access to the child right after delivery, these women are stereotyped as bad mothers simply because they are in prison. Reminiscent of the treatment of female black bodies post-civil war and the use of reproductive interventions (for example, Norplant and forced sterilization) in exchange for shorter sentences, I argue that shackles are a form of reproductive control. Justification for the use of shackles even includes their use as a “punitive instrument to remind the prisoner of their punishment.”[53] However, a prisoner’s pregnancy should have no relevance to their sentence.[54] Using shackles demonstrates to prisoners that society tolerates childbirth but does not support it.[55] The shackling is evidence that women are being punished “for bearing children, not for breaking the law.”[56] Physicians and healthcare workers, as a result, are responsible for providing care for the delivery and rectifying any physical problems associated with the restraints. The issues that arise from the use of restraints place physicians in a position more complex than they experience with regular healthy pregnancies. C. Discrimination In the case of Ferguson v. City of Charleston, a medical university subjected black woman to involuntary drug testing during pregnancy. In doing so, medical professionals collaborated with law enforcement to penalize black women for their use of drugs during pregnancy.[57] The Court held the drug tests were an unreasonable search and violated the Fourth Amendment. Ferguson v. City of Charleston further reveals an unjustified assumption: the medical and legal community seemed suspicious of black women and had perhaps predetermined them more likely to use drugs while pregnant. Their fitness to become mothers needed to be proven, while wealthy, white women were presumed fit.[58] The correctional community similarly denies pregnant prisoners’ medical attention. In the case of Staten v. Lackawanna County, an African American woman whose serious medical needs were treated indifferently by jail staff was forced to give birth in her cell.[59] This woman was punished for being pregnant in prison through the withholding of medical attention and empathy. IV. Failure to Follow Anti-Shackling Laws Despite 22 states having laws against shackling pregnant prisoners, officers do not always follow these laws. In 2015, the Correctional Association of New York reported that of the 27 women who gave birth under state custody, officers shackled 23 women in violation of the anti-shackling laws.[60] The lawyer of Tracy Edwards, an inmate who officers shackled unlawfully during her twelve-hour labor stated, “I don’t think we can assume that just because there’s a law passed, that’s automatically going to trickle down to the prison.”[61] Even with more restrictions on shackling, it may still occur, partly due to the stereotype that incarcerated women are aggressive and dangerous. V. Constitutionality The Eighth Amendment protects people from cruel and unusual punishment. In Brown vs. Plata, the court stated, “Prisoners retain the essence of human dignity inherent in all persons.”[62] In several cases, the legal community has held shackling to be unconstitutional as it violates the Eighth Amendment unless specifically justified. In the case of Nelson v. Correctional Medical Services, a pregnant woman was shackled for 12 hours of labor with a brief respite while she pushed, then re-shackled. The shackling caused her physical and emotional pain, including intense cramping that could not be relieved due to positioning and her inability to get up to use a toilet.[63] The court held that a clear security concern must justify shackling. The court cited a similar DC case and various precedents for using the Eighth Amendment to hold correctional facilities and hospitals accountable.[64] An Arkansas law similarly states that shackling must be justified by safety or risk of escape.[65] If the Thirteenth Amendment applied to those convicted of crimes, shackling pregnant incarcerated people would be unconstitutional under that amendment as well as the Eighth. In the Civil Rights Cases, Congress upheld the right “to enact all necessary and proper laws for the obliteration and prevention of slavery with all its badges and incidents.”[66] Section two of the Thirteenth Amendment condemns any trace or acts comparable to that of slavery. Shackling pregnant prisoners, stripping them of their dignity, and justification based on stereotypes all have origins in the treatment of black female slaves. Viewed through the lens of the Thirteenth Amendment, the act of shackling would be unconstitutional. Nonetheless, the Thirteenth Amendment explicitly excludes people convicted of a crime. VI. Justice As a result of the unconstitutional nature of shackling, physicians should have a legal obligation, in addition to their ethical duty, to protect their patients. The principle of justice requires physicians to take a stand against the discriminatory treatment of their patients, even under the eye of law enforcement.[67],[68] However, “badge and gun intimidation,” threats of noncompliance, and the fear of losing one’s license can impede a physician’s willingness to advocate for their patients. The American College of Obstetricians and Gynecologists (ACOG) finds the use of physical restraints interferes with the ability of clinicians to practice medicine safely.[69] ACOG, The American Medical Association, the National Commission on Correctional Health Care, and other organizations oppose using restraints on pregnant incarcerated people.[70] Yet, legislators can adopt shackling laws without consultation with physicians. The ACOG argues that “State legislators are taking it upon themselves to define complex medical concepts without reference to medical evidence. Some of the penalties [faced by OBGYNs] for violating these vague, unscientific laws include criminal sentences.”[71] Legislation that does not consider medical implications or discourages physicians’ input altogether is unjust. In nullifying the voice of a physician in matters pertaining to the patient’s treatment, physicians are prevented from fulfilling the principle of justice, making the act of shackling patients unethical. VII. Principle of Beneficence The principle of beneficence requires the prevention of harm, the removal of harm, and the promotion of good.[72] Beneficence demands the physician not only avoid harm but benefit patients and promote their welfare.[73] The American Board of Internal Medicine Foundation states that physicians must work with other professionals to increase patient safety and improve the quality of care.[74] In doing so, physicians can adequately treat patients with the goal of prevention and healing. It is difficult to do good when law enforcement imposes on doctors to work around shackles during labor and delivery. Law enforcement leaves physicians and healthcare workers responsible not only to provide care for the delivery, but also rectify any ailments associated with the restraints. The issues arising from using restraints place physicians in a position more complex than they experience with other pregnancies. Doctors cannot prevent the application of the shackles and can only request officers to take them off the patient.[75] Physicians who simply go along with shackling are arguably violating the principle of beneficence. However, for most, rather than violating the principle of beneficence overtly, physicians may simply have to compromise. Given the intricate nature of the situation, physicians are tasked with minimizing potential harm to the best of their abilities while adhering to legal obligations.[76] It is difficult to pin an ethics violation on the ones who do not like the shackles but are powerless to remove them. Some do argue that this inability causes physicians to violate the principle of beneficence.[77] However, promoting the well-being of their patients within the boundaries of the law limits their ability to exercise beneficence. For physicians to fulfill the principle of beneficence to the fullest capacity, they must have an influence on law. Protocols and assessments on flight risks made solely by the officers and law enforcement currently undermine the physician’s expertise. These decisions do not consider the health and well-being of the pregnant woman. As a result, law supersedes the influence of medicine and health care. CONCLUSION People expect physicians to uphold the four major principles of bioethics. However, their inability to override restraints compromises their ability to exercise beneficence. Although pledging to enforce these ethical principles, physicians have little opportunity to influence anti-shackling legislation. Instead of being included in conversations regarding medical complexities, legislation silences their voices. Policies must include the physician's voice as they affect their ability to treat patients. Officers should not dismiss a physician's request to remove shackles from a woman if they are causing health complications. A woman's labor should not harm her or her fetus because the officer will not remove her shackles.[78] A federal law could end shackling pregnant incarcerated people. Because other options are available to ensure the safety of the public and the prisoner, there is no ethical justification for shackling pregnant prisoners. An incarcerated person is a human being and must be treated with dignity and respect. To safeguard the well-being of incarcerated women and the public, it is essential for advocates of individual rights to join forces with medical professionals to establish an all-encompassing solution. - [1] Ferszt, G. G., Palmer, M., & McGrane, C. (2018). Where does your state stand on shackling of Pregnant Incarcerated Women? Nursing for Women’s Health, 22(1), 17–23. https://doi.org/10.1016/j.nwh.2017.12.005 [2] S983A, 2015-2016 Regular Sessions (N.Y. 2015). https://legislation.nysenate.gov/pdf/bills/2015/S983A [3] Chris DiNardo, Pregnancy in Confinement, Anti-Shackling Laws and the “Extraordinary Circumstances” Loophole, 25 Duke Journal of Gender Law & Policy 271-295 (2018) https://scholarship.law.duke.edu/djglp/vol25/iss2/5 [4] Chris DiNardo (2018) [5] U.S. Bureau of Justice Statistics. 1980. " Prisoners in 1980 – Statistical Tables”. Retrieved April 20, 2023 (https://bjs.ojp.gov/content/pub/pdf/p80.pdf). [6] U.S. Bureau of Justice Statistics. 2022. " Prisoners in 2021 – Statistical Tables”. Retrieved April 20, 2023 (https://bjs.ojp.gov/sites/g/files/xyckuh236/files/media/document/p21st.pdf). [7] U.S. Bureau of Justice Statistics (1980) [8] Sufrin C, Jones RK, Mosher WD, Beal L. Pregnancy Prevalence and Outcomes in U.S. Jails. Obstet Gynecol. 2020;135(5):1177-1183. doi:10.1097/AOG.0000000000003834 [9] Kramer, C., Thomas, K., Patil, A., Hayes, C. M., & Sufrin, C. B. (2022). Shackling and pregnancy care policies in US prisons and jails. Maternal and Child Health Journal, 27(1), 186–196. https://doi.org/10.1007/s10995-022-03526-y [10] House, K. T., Kelley, S., Sontag, D. N., & King, L. P. (2021). Ending restraint of incarcerated individuals giving birth. AMA Journal of Ethics, 23(4). https://doi.org/10.1001/amajethics.2021.364 [11] Goshin, L. S., Sissoko, D. R., Neumann, G., Sufrin, C., & Byrnes, L. (2019). Perinatal nurses’ experiences with and knowledge of the care of incarcerated women during pregnancy and the postpartum period. Journal of Obstetric, Gynecologic &amp; Neonatal Nursing, 48(1), 27–36. https://doi.org/10.1016/j.jogn.2018.11.002 [12] Shackling and separation: Motherhood in prison. (2013). AMA Journal of Ethics, 15(9), 779–785. https://doi.org/10.1001/virtualmentor.2013.15.9.pfor2-1309 [13] King, L. (2018). Labor in chains: The shackling of pregnant inmates. Policy Perspectives, 25, 55–68. https://doi.org/10.4079/pp.v25i0.18348 [14] King, L. (2018). [15] AMA Journal of Ethics (2013) [16] Lawrence, A., Lewis, L., Hofmeyr, G. J., & Styles, C. (2013). Maternal positions and mobility during first stage labour. Cochrane database of systematic reviews, (8). [17] Association of Women’s Health, Obstetric and Neonatal Nurses. (2011). AWHONN position statement: Shackling incarcerated pregnant women. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 40(6), 817–818. doi:10.1111/j.1552-6909.2011.01300.x [18] Ferszt, G. G., Palmer, M., & McGrane, C. (2018). Where does your state stand on shackling of Pregnant Incarcerated Women? Nursing for Women’s Health, 22(1), 17–23. https://doi.org/10.1016/j.nwh.2017.12.005 [19] Thompson, E. (2022, August 30). Woman sues NC state prison system for mistreatment while pregnant. North Carolina Health News. Retrieved March 12, 2023, from https://www.northcarolinahealthnews.org/2022/05/25/woman-sues-nc-state-prison-system-for-mistreatment-while-pregnant/ [20] CBS Interactive. (2019, March 13). Shackling pregnant inmates is still a practice in many states. CBS News. Retrieved March 12, 2023, from https://www.cbsnews.com/news/shackling-pregnant-inmates-is-still-a-practice-in-many-states/ [21] Griggs, Claire Louise. "Birthing Barbarism: The Unconstitutionality of Shackling Pregnant Prisoners." American University Journal of Gender Social Policy and Law 20, no. 1 (2011): 247-271. [22] American Civil Liberties Union. (2012, October 12). ACLU briefing paper: The shackling of pregnant women & girls in U.S ... American Civil Liberties Union (ACLU). https://www.aclu.org/wp-content/uploads/legal-documents/anti-shackling_briefing_paper_stand_alone.pdf [23] King.L (2018) [24] Griggs, Claire Louise (2011) [25] American Civil Liberties Union. (2012) [26] Clarke, J. G., & Simon, R. E. (2013). Shackling and separation: Motherhood in prison. AMA Journal of Ethics, 15(9), 779–785. https://doi.org/10.1001/virtualmentor.2013.15.9.pfor2-1309 [27] Berg, M. D. (2014, April 18). Pregnant prisoners are losing their shackles - The Boston Globe. BostonGlobe.com. Retrieved March 12, 2023, from https://www.bostonglobe.com/magazine/2014/04/18/taking-shackles-off-pregnant-prisoners/7t7r8yNBcegB8eEy1GqJwN/story.html [28] Levi, R., Kinakemakorn, N., Zohrabi, A., Afanasieff, E., & Edwards-Masuda, N. (2010). Creating the bad mother: How the U.S. approach to pregnancy in prisons violates the right to be a mother. UCLA Women's Law Journal, 18(1). https://doi.org/10.5070/l3181017816 [29] Chris DiNardo (2018) [30] Griggs, Claire Louise (2011). [31] Allen, J. E. (2010, October 21). Shackled: Women Behind Bars Deliver in Chains. ABC News. https://abcnews.go.com/Health/WomensHealth/pregnant-shackled-women-bars-deliver-chains/story?id=11933376&page=1 [32] Nelson v. Correctional, 533 F.3d 958 (8th Cir. 2009) [33] Nelson v. Correctional(2009) [34] House, K. T., Kelley, S., Sontag, D. N., & King, L. P. (2021). Ending restraint of incarcerated individuals giving birth. AMA Journal of Ethics, 23(4). https://doi.org/10.1001/amajethics.2021.364 [35] Amnesty International USA. (1999, March). “Not part of my sentence” Violations of the Human Rights of Women in Custody. Amnesty International USA. Retrieved March 12, 2023, from https://www.amnestyusa.org/reports/usa-not-part-of-my-sentence-violations-of-the-human-rights-of-women-in-custody/ [36] Pendleton, V., Saunders, J. B., & Shlafer, R. (2020). Corrections officers' knowledge and perspectives of maternal and child health policies and programs for pregnant women in prison. Health & justice, 8(1), 1. https://doi.org/10.1186/s40352-019-0102-0 [37] Elizabeth Alexander, Unshackling Shawanna: The Battle Over Chaining Women Prisoners during Labor and Delivery, 32 U. ARK. LITTLE ROCK L. REV. 435 (2010). Available at: https://lawrepository.ualr.edu/lawreview/vol32/iss4/1 [38] Hernandez, J. (2022, April 22). More states are restricting the shackling of pregnant inmates, but it still occurs. NPR. Retrieved March 12, 2023, from https://www.npr.org/2022/04/22/1093836514/shackle-pregnant-inmates-tennessee [39] Sufrin, C. (2012, June 24). End practice of shackling pregnant inmates. SFGATE. Retrieved March 12, 2023, from https://www.sfgate.com/opinion/openforum/article/End-practice-of-shackling-pregnant-inmates-3176987.php [40] Mullings, L. (1997). On our own terms: Race, class, and gender in the lives of African American women. Routledge [41] Ocen, Priscilla A., (2011). [42] Ladd-Taylor, M. (1998). "Bad" mothers: The politics of blame in Twentieth-century America. New York Univ. Press. [43] Hine, D. C. (1998). Hine Sight: Black women and the re-construction of American history. Indiana University Press. [44] Baldwin, L. (2019). Excluded from good motherhood and the impact of prison: Motherhood and Social Exclusion, 129–144. https://doi.org/10.2307/j.ctvk12qxr.13 [45] Ocen, Priscilla A., Punishing Pregnancy: Race, Incarceration, and the Shackling of Pregnant Prisoners (October 3, 2011). California Law Review, Vol. 100, 2012, Available at SSRN: https://ssrn.com/abstract=1937872 [46] Johnson, P. C. (2004). Inner lives: Voices of african american women in prison. New York University Press. [47] Thomas, D. Q. (1996). All too familiar: Sexual abuse of women in U.S. state prisons. Human Rights Watch. [48] Ocen, Priscilla A., (2011). [49] Ashley W. 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Servs, 583 F.3d 522 (8th Cir. 2009) [64] Nelson citing Women Prisoners of D.C. Dep't of Corr. v. District of Columbia, 877 F.Supp. 634, 668-69 (D.D.C. 1994), modified in part on other grounds, 899 F.Supp. 659 (D.D.C. 1995). [65] Ark. Dep't of Corr. Admin. Reg. 403 § V (1992) [66] Civil Rights Cases, 109 U.S. 3 (1883) [67] Physician charter. ABIM Foundation. (2022, October 18). Retrieved March 10, 2023, from https://abimfoundation.org/what-we-do/physician-charter#:~:text=Principle%20of%20social%20justice.&text=Physicians%20should%20work%20actively%20to,or%20any%20other%20social%20category. [68] Riddick FA Jr. The code of medical ethics of the american medical association. Ochsner J. 2003 Spring;5(2):6-10. PMID: 22826677; PMCID: PMC3399321. [69] American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women (2021). Reproductive Health Care for Incarcerated Pregnant, Postpartum, and Nonpregnant Individuals: ACOG Committee Opinion, Number 830. 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(2010). The Birth of Bioethics. Oxford University Press. [77] Beauchamp, T. L., & Childress, J. F. (2019). [78] Amnesty International USA. (1999, March). “Not part of my sentence” Violations of the Human Rights of Women in Custody. Amnesty International USA. Retrieved March 12, 2023, from https://www.amnestyusa.org/reports/usa-not-part-of-my-sentence-violations-of-the-human-rights-of-women-in-custody/

Abstract Background Cognitive decline is highly prevalent in patients with heart failure (HF) and increases the risk of hospital readmission or mortality due to poor self-care ability. Although cognitive decline often coexists with physical frailty (PF) in HF, the clinical utility of combined assessment of both cognitive function and PF remains unclear. Purpose The aim of this study was to examine the prognostic value of assessing cognitive function and PF in patients with HF. Methods This prospective study was performed as a multicenter cohort study in Japan (FLAGSHIP). We enrolled 1611 patients admitted for acute HF or exacerbation of chronic HF and who were able to walk at discharge. Patients with severe dementia [Mini-Mental State Examination (MMSE) scores <18], severe psychological disorders or less than 6-month life expectancy were excluded. From data at discharge, we collected data on cognitive function, PF, age, gender, New York Heart Association class, left ventricular ejection fraction, brain natriuretic peptide, estimate glomerular filtration rate, hemoglobin, depression (5-item geriatric depression scale ≥2) and comorbidities, including atrial fibrillation, diabetes mellitus, stroke, and hyponatremia. PF was defined as ≥2 of the followings based on our previous publication: usual walking speed <0.8 m/s; grip strength <26 kg (men) or <17 kg (women); Performance Measure of Activity in Daily Living-8 ≥21; body mass index <20 kg/m2. Cognitive function was assessed by MMSE. We selected the optimal cutoff point of MMSE that predict a worse outcome by the receiver operating characteristic (ROC) curve analysis. Study outcome was a composite outcome of rehospitalization for worsening HF or all-cause mortality within 2 years after discharge. We used Cox proportional-hazard models to examine the association between the presence of cognitive decline and PF and 2-years prognosis, controlling for potential confound factors. Results A total of 507 events (31.5%) were observed (400 HF rehospitalization, 27 cardiac death, 80 non-cardiac death). The optimal cutoff point of MMSE was 28 (the area under the ROC curve: 0.58, p<0.01, sensitivity: 71.0%, specificity: 41.0%). There was a significant difference in event-free survival across the groups stratified by cognitive decline (MMSE <28) and PF (Figure). After adjusting for all variables, coexistence of both cognitive decline and PF was independently associated with 2-years prognosis (hazard ratio: 1.52, 95% confidence interval: 1.19–1.94). Conclusion Our data shows that even a slight decline in cognitive function leads to an increased risk of death or HF rehospitalization in frail patients with HF. Combined assessment both cognitive function and PF improves risk stratification for readmission and mortality in patients with HF. Acknowledgement/Funding This work was supported by a Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science [16H01862].

Abstract Background The role of yoga in paroxysmal atrial fibrillation (AF) is known. But its role in permanent AF has not been studied. Purpose The objectives of our study are to evaluate the effects of yoga on symptoms, heart rate, quality of life, hospitalisations, medication adherence and echocardiographic parameters in permanent AF. Methods We conducted a single centre, randomised, participant blinded, parallel group, sham-controlled study between October 2019 and September 2020. We included patients aged 18–65 years with permanent AF due to any cause. Patients in New York Heart Association (NYHA) class≥3, modified European Heart Rhythm Association (mEHRA) class ≥3 and left ventricular ejection fraction (LVEF)&lt;30% were excluded. Total of 84 patients underwent randomisation into two groups of 42 each. None of the participants had prior knowledge or contraindications to yoga. Subjects in yoga arm underwent supervised and self-performed yoga sessions consisting of various asanas, pranayamas and dhyana, while those in the sham arm underwent supervised and self-performed joint exercises, each session lasting for 60 minutes/day for 6 days a week along with guideline directed medical therapy in both arms. The primary endpoints were improvement in NYHA class, mEHRA class, heart rate at rest and after 6 minute walk test, 6 minute walk distance, quality of life, medication adherence, hospitalisations, LVEF and left atrial volume index at 3 months. The secondary endpoints included the same parameters assessed at 1month. Quality of life was assessed by the short form (SF)-36 questionnaire which has eight domains. Scores for each domain range from 0 to 100, with a higher score defining a more favourable health state. All analyses were based on intention to treat principle. Results The groups were well-matched at baseline. The mean age of study participants was 50.62±12.97 years, 56% were women and the most common risk factor was rheumatic heart disease found in 47.6% of the cases. Four patients in the yoga group and 3 in the sham group were lost to follow up. There was significant improvement in various parameters in the yoga arm at 1 and 3 months. (Figures 1 and 2). Hospitalisation at 3 months was lower in the yoga arm (0.73±0.81) versus sham arm (1.13±0.93); p=0.044. Out of 38 patients in the yoga arm, 6 patients had improvement in the medication adherence compared to 9 patients (out of 39) in the sham arm at 3 months, p=0.419, OR (95% CI) = 0.62 (0.19–1.96). Higher the compliance to yoga, defined by the number of sessions per week, more was the improvement in various parameters. No harms were noted. Conclusion Among patients of permanent AF already on medical therapy, yoga significantly improves symptoms, heart rate, functional capacity, quality of life and hospitalisations when compared to a sham procedure. Larger, multicentre, double blinded studies are required to generalise the results, though participant blinding cannot be 100% assured. Funding Acknowledgement Type of funding sources: None.

Fig. 1: Photo by Miguel Orós, from unsplash.comFeminism has stalled at the bedroom door. In the post-#metoo era, more than ever, we need intimate civil rights in our relationships to counter the worrisome prevailing trends: Intimate partner violence. Interpersonal abuse. Date rape. Sexual harassment. Online harassment. Bullying. Rage. Sexual Assault. Abusive relationships. Revenge porn. There’s a lot of damage done when we get up close and personal. In the 21st century, we have come far in terms of equality and respect between the genders, so there’s a lot to celebrate. We also note that the Australian government has stepped in recently with the theme ‘Keeping Australians safe and secure’, by pledging $78 million to combat domestic violence, much of which takes place behind closed doors (Morrison 2019). Herein lies the issue: while governments legislate to protect victims of domestic violence — out of the public eye, private behaviours cannot be closely monitored, and the lack of social enforcement of these laws threatens the safety of intimate relationships. Rather, individuals are left to their own devices. We outline here a guideline for intimate civility, an individually-embraced code of conduct that could guide interpersonal dynamics within the intimate space of relationships. Civility does not traditionally ‘belong’ in our most intimate relationships. Rather, it’s been presumed, even idealised, that intimacy in our personal lives transcends the need for public values to govern relationships between/among men and women (i.e., that romantic love is all you need). Civility developed as a public, gendered concept. Historically, a man’s home – and indeed, his partner – became his dominion, promoting hegemonic constructions of masculinity, and values that reflect competition, conquest, entitlement and ownership. Moreover, intimate relationships located in the private domain can also be considered for/by both men and women a retreat, a bastion against, or excluded from the controls and demands of the public or ‘polis’ - thus from the public requirement for civility, further enabling its breakdown. The feminist political theorist Carole Pateman situated this historical separation as an inheritance of Hegel’s double dilemma: first, a class division between civil society and the state (between the economic man/woman, or private enterprise and public power) and second, a patriarchal division between the private family (and intimate relationships) and civil society/the state. The private location, she argues, is “an association constituted by ties of love, blood … subjection and particularity” rather than the public sphere, “an association of free and equal individuals” (225). In Hegel’s dilemma, personal liberty is a dualism, only constructed in relation to a governed, public (patriarchal) state. Alternately, Carter depicts civility as a shared moral good, where civility arises not only because of concern over consequences, but also demonstrates our intrinsic moral obligation to respect people in general. This approach subsequently challenges our freedom to carry out private, uncivil acts within a truly civil society.Challenges to Gender EthicsHow can we respond to this challenge in gender ethics? Intimate civility is a term coined by Elizabeth Reid Boyd and Abigail Bray. It came out of their discussions proposing “a new poetics of romance” which called for rewritten codes of interpersonal conduct, an “entente cordiale; a cordial truce to end the sex wars”. Reid Boyd and Bray go further:Politeness is personal and political. We reclaim courtesy as applied sexual and social ethics, an interpersonal, intimate ethics, respectful and tolerant of difference. Gender ethics must be addressed, for they have global social and cultural ramifications that we should not underestimate. (xx)As researchers, we started to explore the idea of intimate civility in interpersonal violence, developing an analysis using social construction and attachment theory simultaneously. In defining the term, we soon realised the concept had wider applications that could change how we think about our most intimate relationships – and how we behave in them. Conceptualising intimate civility involves imagining rights and responsibilities within the private sphere, whether or not loving, familial and natural. Intimate civility can operate through an individually embraced code of conduct to guide interpersonal dynamics within the intimate space of relationships.Gringart, Grobbelaar, and Bender explored the concept of intimate civility by investigating women’s perspectives on what may harmonise their intimate relationships. Women’s most basic desires included safety, equality and respect in the bedroom. In other words, intimate civility is an enactment of human-rights, the embodiment of regard for another human being, insofar as it is a form of ensuring physical and mental integrity, life, safety and protection of all beings. Thus, if intimate civility existed as a core facet of each individual’s self-concept, the manifestation of intimate partner violence ideally would not occur. Rage, from an intimate civility perspective, rips through any civil response and generates misconduct towards another. When we hold respect for others as equal moral beings, civility is key to contain conflicts, which prevents the escalation of disagreements into rage. Intimate civility proposes that civility becomes the baseline behaviour that would be reciprocated between two individuals within the private domain of intimate relationships. Following this notion, intimate civility is the foremost casualty in many relationships characterised by intimate partner violence. The current criminalisation of intimate partner violence leaves unexplored the previously privatised property of the relational – including the inheritance of centuries of control of women’s bodies and sexuality – and how far, in this domain, notions of civility might liberate and/or oppress. The feminist philosopher Luce Irigaray argues that these kinds of ‘sexuate rights’ must apply to both men and women and the reality of their needs and desires. Equality, she argued, could not be achieved without a rewriting of the rights and obligations of each sex, qua different, in social rights and obligations (Yan).Synonyms for intimacy include, amongst others, closeness, attachment, togetherness, warmth, mutual affection, familiarity and privacy. Indirectly, sexual relations are also often synonymous with intimate relationships. However, sex is not intimacy, as both sex and intimacy both exist without the other. Bowlby proposed that throughout our lives we are attentive to the responsiveness and the availability of those that we are attached to, and suggested that “intimate attachments to other human beings are the hub around which a person’s life revolves, not only when he is an infant or a toddler, but throughout his adolescence and his years of maturity as well, and on into old age” (442). Although love is not by nature reciprocal, in intimacy we seek reciprocity – to love one another at the same time in a shared form of commitment. Kierkegaard hypothesised that genuine love is witnessed by one continuing to love another after their death as it obviates any doubt that the beloved was loved and was not merely instrumental (Soble).Intimate Civility as a Starting PointCivility includes qualities such as trust, duty, morality, sacrifice, self-restraint, respect, and fairness; a common standard allowing individuals to work, live and associate together. Intimacy encourages caring, loyalty, empathy, honesty, and self-knowledge. Thus, intimate civility should begin with those closest to us; being civil in our most intimate relationships. It advocates the genuine use of terms of endearment, not terms of abuse. We can only develop qualities such as morality and empathy, crucial for intimate relationships, if we have experienced secure, intimate relationships. Individuals reared in homes devoid of intimate civility will be challenged to identify and promote the interest or wellbeing of their intimate counterparts, and have to seek outside help to learn these skills: it is a learnt behaviour, both at an interpersonal and societal level. Individuals whose parents were insensitive to their childhood needs, and were unable to perceive, interpret and respond appropriately to their subtle communications, signals, wishes and mood will be flailing in this interpersonal skill (Holmes and Slade). Similarly, the individual’s inclusion in a civil society will only be achieved if their surrounding environment promotes and values virtues such as compassion, fairness and cooperation. This may be a challenging task. We envisage intimate civility as a starting point. It provides a focus to discuss and explore civil rights, obligations and responsibilities, between and among women and men in their personal relationships. As stated above, intimate civility begins with one's relationship with oneself and the closest relationships in the home, and hopefully reaches outwards to all kinds of relationships, including same sex, transgender, and other roles within non-specific gender assignment. Therefore, exploring the concept of intimate civility has applications in personal therapy, family counselling centres and relationship counselling environments, or schools in sexual education, or in universities promoting student safety. For example, the 2019 “Change the Course” report was recently released to augment Universities Australia’s 2016 campaign that raised awareness on sexual assault on campus. While it is still under development, we envision that intimate civility decalogue outlined here could become a checklist to assist in promoting awareness regarding abuse of power and gender roles. A recent example of cultural reframing of gender and power in intimate relationships is the Australian Government’s 2018 Respect campaign against gender violence. These recent campaigns promote awareness that intimate civility is integrated with a more functional society.These campaigns, as the images demonstrate, aim at quantifying connections between interactions on an intimate scale in individual lives, and their impacts in shaping civil society in the arena of gender violence. They highlight the elasticity of the bonds between intimate life and civil society and our collective responsibility as citizens for reworking both the gendered and personal civility. Fig. 2: Photo by Tyler Nix: Hands Spelling Out LOVE, from unsplash.comThe Decalogue of Intimate Civility Overall, police reports of domestic violence are heavily skewed towards male on female, but this is not always the case. The Australian government recently reported that “1 in 6 Australian women and 1 in 16 men have been subjected, since the age of 15, to physical and/or sexual violence by a current or previous cohabiting partner” (Australian Institutes of Health and Welfare). Rather than reiterating the numbers, we envisage the decalogue (below) as a checklist of concepts designed to discuss and explore rights, obligations and responsibilities, between and among both partners in their intimate relationships. As such, this decalogue forms a basis for conversation. Intimate civility involves a relationship with these ten qualities, with ourselves, and each other.1) Intimate civility is personal and political. Conceptualising intimate civility involves imagining rights and responsibilities within the private sphere. It is not an impingement on individual liberty or privacy but a guarantor of it. Civil society requires us not to defend private infringements of inter-personal respect. Private behaviours are both intimate in their performance and the springboard for social norms. In Geoffrey Rush’s recent defamation case his defence relied not on denying claims he repeatedly touched his fellow actor’s genitalia during their stage performance in a specific scene, despite her requests to him that he stop, but rather on how newspaper reporting of her statements made him out to be a “sexual pervert”, reflecting the complex link between this ‘private’ interaction between two people and its very public exposé (Wells). 2) Intimate civility is an enactment of a civil right, insofar as it is a form of ensuring physical and mental integrity, life, safety and protection. Intimate civility should begin with those closest to us. An example of this ethic at work is the widening scope of criminalisation of intimate partner abuse to include all forms of abusive interactions between people. Stalking and the pre-cursors to physical violence such as controlling behaviours, online bullying or any actions used to instil fear or insecurity in a partner, are accorded legal sanctions. 3) Intimate civility is polite. Politeness is more than manners. It relates to our public codes of conduct, to behaviours and laws befitting every civilian of the ‘polis’. It includes the many acts of politeness that are required behind closed doors and the recognition that this is the place from which public civility emerges. For example, the modern parent may hope that what they sanction as “polite” behaviour between siblings at home might then become generalised by the child into their public habits and later moral expectations as adults. In an ideal society, the micro-politics of family life become the blueprint for moral development for adult expectations about personal conduct in intimate and public life.4) Intimate civility is equitable. It follows Luce Irigaray’s call for ‘sexuate rights’ designed to apply to men and women and the reality of their needs and desires, in a rewriting of the social rights and obligations of each sex (Yan and Irigaray). Intimate civility extends this notion of rights to include all those involved in personal relations. This principle is alive within systemic family therapy which assumes that while not all members of the family system are always able to exert equal impacts or influence, they each in principle are interdependent participants influencing the system as a whole (Dallos and Draper). 5) Intimate civility is dialectical. The separation of intimacy and civility in Western society and thought is itself a dualism that rests upon other dualisms: public/private, constructed/natural, male/female, rational/emotional, civil/criminal, individual/social, victim/oppressor. Romantic love is not a natural state or concept, and does not help us to develop safe governance in the world of intimate relationships. Instead, we envisage intimate civility – and our relationships – as dynamic, dialectical, discursive and interactive, above and beyond dualism. Just as individuals do not assume that consent for sexual activity negotiated in one partnership under a set of particular conditions, is consent to sexual activity in all partnerships in any conditions. So, dialectics of intimate civility raises the expectation that what occurs in interpersonal relationships is worked out incrementally, between people over time and particular to their situation and experiences. 6) Intimate civility is humane. It can be situated in what Julia Kristeva refers to as the new humanism, emerging (and much needed) today. “This new humanism, interaction with others – all the others – socially marginalised, racially discriminated, politically, sexually, biologically or psychically persecuted others” (Kristeva, 2016: 64) is only possible if we immerse ourselves in the imaginary, in the experience of ‘the other’. Intimate civility takes on a global meaning when human rights action groups such as Amnesty International address the concerns of individuals to make a social difference. Such organisations develop globally-based digital platforms for interested individuals to become active about shared social concerns, understanding that the new humanism ethic works within and between individuals and can be harnessed for change.7) Intimate civility is empathic. It invites us to create not-yet-said, not-yet-imagined relationships. The creative space for intimate civility is not bound by gender, race or sexuality – only by our imaginations. “The great instrument of moral good is the imagination,” wrote the poet Shelley in 1840. Moral imagination (Reid Boyd) helps us to create better ways of being. It is a form of empathy that encourages us to be kinder and more loving to ourselves and each other, when we imagine how others might feel. The use of empathic imagination for real world relational benefits is common in traditional therapeutic practices, such as mindfulness, that encourages those struggling with self compassion to imagine the presence of a kind friend or ally to support them at times of hardship. 8) Intimate civility is respectful. Intimate civility is the foremost casualty in many relationships characterised by forms of abuse and intimate partner violence. “Respect”, wrote Simone Weil, “is due to the human being as such, and is not a matter of degree” (171). In the intimate civility ethic this quality of respect accorded as a right of beings is mutual, including ourselves with the other. When respect is eroded, much is lost. Respect arises from empathy through attuned listening. The RESPECT! Campaign originating from the Futures without Violence organisation assumes healthy relationships begin with listening between people. They promote the understanding that the core foundation of human wellbeing is relational, requiring inter-personal understanding and respect.9) Intimate civility is a form of highest regard. When we regard another we truly see them. To hold someone in high regard is to esteem them, to hold them above others, not putting them on a pedestal, or insisting they are superior, but to value them for who they are. To be esteemed for our interior, for our character, rather than what we display or what we own. It connects with the humanistic psychological concept of unconditional positive regard. The highest regard holds each other in arms and in mind. It is to see/look at, to have consideration for, and to pay attention to, recently epitomised by the campaign against human trafficking, “Can You See Me?” (Human Trafficking), whose purpose is to foster public awareness of the non-verbal signs and signals between individuals that indicate human trafficking may be taking place. In essence, teaching communal awareness towards the victimisation of individuals. 10) Intimate civility is intergenerational. We can only develop qualities such as morality and empathy, crucial for intimate relationships, if we have experienced (or imagined) intimate relationships where these qualities exist. Individuals reared in homes devoid of intimate civility could be challenged to identify and promote the interest or wellbeing of their intimate counterparts; it is a learnt behaviour, both at an interpersonal and societal level. Childhood developmental trauma research (Spinazzola and Ford) reminds us that the interaction of experiences, relational interactions, contexts and even our genetic amkeup makes individuals both vulnerable to repeating the behaviour of past generations. However, treatment of the condition and surrounding individuals with people in their intimate world who have different life experiences and personal histories, i.e., those who have acquired respectful relationship habits, can have a positive impact on the individuals’ capacity to change their learned negative behaviours. In conclusion, the work on intimate civility as a potential concept to alleviate rage in human relationships has hardly begun. The decalogue provides a checklist that indicates the necessity of ‘intersectionality’ — where the concepts of intimate civility connect to many points within the public/private and personal/political domains. Any analysis of intimacy must reach further than prepositions tied to social construction and attachment theory (Fonagy), to include current understandings of trauma and inter-generational violence and the way these influence people’s ability to act in healthy and balanced interpersonal relationships. While not condoning violent acts, locating the challenges to intimate civility on both personal and societal levels may leverage a compassionate view of those caught up in interpersonal violence. The human condition demands that we continue the struggle to meet the challenges of intimate civility in our personal actions with others as well as the need to replicate civil behaviour throughout all societies. ReferencesBowlby, John. Attachment and Loss. Vol. 3. New York: Basic Books, 1980.Carter, Stephen. Civility: Manners, Morals and the Etiquette of Democracy. New York: Basic Books, 1998.Dallos, Rudi, and Ros Draper. An Introduction to Family Therapy: Systemic Theory and Practice. 2nd ed. Open University Press: Berkshire, 2005.Australian Institutes of Health and Welfare, Australian Government. Family, Domestic and Sexual Violence in Australia. 2018. 6 Feb. 2019 <https://www.aihw.gov.au/reports/domestic-violence/family-domestic-sexual-violence-in-australia-2018/contents/summary>. Fonagy, Peter. Attachment Theory and Psychoanalysis. New York: Other Press, 2001.Gringart, Eyal, Madalena Grobbelaar, and Alise Bender. Intimate Civility: The Perceptions and Experiences of Women on Harmonising Intimate Relationships. Honours thesis, 2018.Holmes, Jeremy, and Arietta Slade. Attachment in Therapeutic Practice. Los Angeles: Sage, 2018. Human Trafficking, Jan. 2019. 14 Feb. 2019 <https://www.a21.org/content/can-you-see-me/gnsqqg?permcode=gnsqqg&site=true>.Kristeva, Julia. Teresa My Love: An Imagined Life of the Saint of Avila. New York: Columbia UP, 2016.Morrison, Scott. “National Press Club Address.” 11 Feb. 2019. 26 Feb. 2019 <https://www.pm.gov.au/media/national-press-club-address-our-plan-keeping-australians-safe-and-secure>.Pateman, Carole. “The Patriarchal Welfare State.” Defining Women: Social Institutions and Gender Divisions. Eds. Linda McDowell and Rosemary Pringle. London: Polity Press, 1994. 223-45.Reid Boyd, Elizabeth. “How Creativity Can Help Us Cultivate Moral Imagination.” The Conversation, 30 Jan. 2019. 11 Feb. 2019 <http://theconversation.com/how-creativity-can-help-us-cultivate-moral-imagination-101968>.Reid Boyd, Elizabeth, and Abigail Bray. Ladies and Gentlemen: Sex, Love and 21st Century Courtesy. Unpublished book proposal, 2005.Commonwealth of Australia. Respect Campaign. 2018, 9 Jan. 2019 <http://www.respect.gov.au/the-campaign/campaign-materials/>.Shelley, Percy Bysshe. A Defence of Poetry. London: Ginn and Company, 1840.Soble, Alan. Philosophy of Sex and Love. St Paul, MN: Paragon House, 1998.Weil, Simone. Waiting on God. London: Fontana Collins, 1968.Wells, Jamelle. “Geoffrey Rush, Erin Norvill and the Daily Telegraph: The Stakes Are High in This Defamation Trial.” ABC News 12 Nov. 2018. 23 Feb. 2019 <http://www.abc.net.au/news/2018-11-10/geoffrey-rush-defamation-trial-a-drama-with-final-act-to-come/10483944>.Yan, Liu, and Luce Irigaray. “Feminism, Sexuate Rights and the Ethics of Sexual Difference: An Interview with Luce Irigaray.” Foreign Literature Studies (2010): 1-9.

In the television series Sex and the City, there is a scene which illustrates a familiar contempt for suburban life as dull and boring. Implicit is the oppositional view that urban life by comparison, is the more exciting one. Charlotte (one of four women whose sexual and romantic relationships are the focus of the series), has spent time with her in-laws in an upper middle class suburban enclave, and is confessing to her three girl friends her fantasies and ultimate sexual encounter with her in-law's hunk of a gardener. She's racked with guilt over the incident, not least because she is married to the sexually non-performing Trey. At this point in the conversation, Samantha, whose voracious appetite for men is her hallmark, dismisses Charlotte's concerns with the retort: 'well honey really, what's the point of living in the suburbs if you can't fuck the gardener?' Ergo, a life of suburban mediocrity deserves some kind of compensation, preferably an exciting sexual antidote. Samantha's remark draws on a wealth of discourses which reinforce the opposition between the city and the suburbs, and the city and the country, where the city is the crucible for adventure, opportunity and sometimes danger. For these New York women, it is precisely excitement and the possibility of sex and romance that holds them to the metropolis. The association of sexual opportunity for women and the metropolis is something of a departure from earlier narratives of the city. Gender and sexual identity - through discourse, narrative, image and metaphor are inscribed in spatial landscapes, with a rich source to be found in articulations of the city. Inscriptions are contingent on social, economic and cultural forces which shift over time and place, often defining and redefining utopian and dystopian visions. The rise of the great nineteenth century European cities, for instance provoked both utopian and dystopian discourse. Industrialization, overcrowding and poverty were issues which provided representations of the city as menacing and deleterious (as represented in the writing of Charles Dickens, Edgar Allen Poe), while the practice of the flaneur--a nineteenth century male who observed and chronicled the new cities of nineteenth century Europe--confirmed the metropolis as a storehouse of aesthetic and experiential delights. The contemporary zeitgeist is largely utopian, the postmodern city is desirable, uber-cool: sexy. Look at any advertising for inner city apartment living to confirm this. The city's erotic potential is characterized by one of the fundamental conditions of urban life: the close proximity in which we all live among strangers (see also Patton 1995). On a psychic, if not material level, this might provide opportunity for reinvention and renewal of self, for an individual freedom and expression denied to those living in smaller and closer communities. This is the attraction and romanticism of the city. The proximity of strangers gives urban life its erotic possibilities, the capacity for anonymity, that chance meetings with strangers, who we so often live and work among. Lawrence Knopp (1995) describes this aspect of city life as: a world of strangers, a particular life space with a logic and sexuality of its own. The city's sexuality is described as an eroticisation of many of the characteristic experiences of modern urban life: anonymity, voyeurism, exhibitionism, consumption, authority (and challenges to it), tactility, motion danger, power, navigation and restlessness. (151) I've been collecting metaphors of the city and these reveal the congruence between eros and the city. I have yet to find one that is masculine. For instance, journalist Harold Nicholson summing up three European cities used woman as metaphor: 'London is an old lady - Paris is a woman - But Berlin is a girl in a pullover, not much powder on her face' (Petro 1989, 21). Jean Baudrillard's description of Las Vegas as 'that great whore' is similarly feminized and sexualized, and metropolises like New York where aggressive advertisements are like 'wall to wall prostitution.' For Baudrillard, in New York, the plumes of smoke are reminiscent of 'girls wringing out their hair after bathing' (in Docker 1995, 106). Author and journalist John Birmingham described Sydney as 'a tart, loud and brash'. I should add to the list a straw poll of metaphors I conducted for Brisbane, my favourite being Brisbane as a 'middle aged woman in resort wear' (thanks to Maureen Burns for this contribution). But maybe, with the focus on urban development, she might be getting younger. For a (heterosexual) man the city can be alluring, dangerous and feminine. Eros, the city, femininity and danger all collide in the film noir genre, in films such as Roman Polanski's Chinatown, Lawrence Kasden's Body Heat, where beautiful femme fatales lead men astray, or further down the path of corruption. Woman as stranger is alluring and seductive for men, but for woman the chance encounter with a male stranger might signal caution and fear. For women, the dangers are clear: the threat of sexual danger, the chance encounter with a male whose intentions may not be benign. `Reclaim the Night' marches are testament to women's concerns about safety and access to public space, particularly at night. Although research shows that the overwhelming majority of assaults upon women occur in the home, by a person known to the woman, this sober fact does not prevent the cautionary strategies most women employ while out at night. Nor does it diminish the fear and limitations which are the reality of women's experience in public space, particularly at night. Historically, women's role in the public space of the city has been an ambivalent one. A number of analyses of women's role in the nineteenth century city identify the ways in which women in public space were managed and regulated by social and economic interests. Courted on the one hand as consumers for the new department stores and a burgeoning capitalist economy, women were also subject to strict codes of conduct, lest their virtue be in question. Judith Walkowitz in The City of Dreadful Delights examined the ways in which public discourse of danger in nineteenth century London, including the account of Jack the Ripper, as malevolent male stranger, function as a form of moral regulation for women in these newly created city spaces. Both Walkowitz and cultural historian Elizabeth Wilson argue that the metropolis of the nineteenth century, eroded the boundaries between private and public spheres and divisions of labour between men and women. A disquiet and concern over women entering these new public spaces manifested in a discourse of danger and morality, underpinned by the idea that women were at the mercy of their passions and required control and guidance. Perhaps unsurprisingly, Freud had something to say about this. He speculated that the condition of agoraphobia, the fear of open spaces, (which for Freud was an intrinsically female neurosis), was linked to a repressed inner desire to walk the streets, to be streetwalkers (Vidler 1993, 35). But times have changed: the contemporary postmodern city, is celebrated, promoted and regulated as one of diversity, inclusivity and liveablity. Access and amenity are the buzzwords of local and state government policy. In the postmodern city everyone ostensibly is made welcome and a plethora of infrastructure support different interests and lifestyles. Cafés culture has provided a social space for women in particular, previously denied wholesale access to that other Australian social space, the pub. Women's earning capacity means that many of their interests are represented culturally and socially and that they are more firmly inserted into the fabric of city life. Television series and sit-coms located in the city, where groups of friends sometimes live together; Friends, Seinfeld, Sex and the City reinforce the perception of city living as a place of opportunity and fun for younger women and men. Promotional literature is quick to exploit this image. A tourism brochure for the inner city Sydney (non!) suburb of Newtown, describes the attractions of the area: `some cities are cursed with suburbs, but Sydney's blessed with Newtown, a cosmopolitan neighbourhood.' As if Cabramatta, Fairfield or Parramatta, all outer suburban areas of Sydney, weren't cosmopolitan. A billboard in Brisbane's urban renewal area of Newstead, advertises apartment living as 'Urban living NOT suburban'. Drawing upon the rhetoric of opposition and expressing the familiar anti-suburban sentiment which for Australia, originated in the bohemian movement of the late nineteenth century (see also Kinnane 1998). This tradition probably reached its apotheosis with Barry Humphries in the 1960s whose comedic alter ego, Edna Everage signified everything that was despicable and mindless about suburbia. Edna's obsession with housing décor, cooking and recipes, social status and the minutiae of domesticity was portrayed with a venomous satire that depended upon a trivialization of traditional feminine competencies. Is there a connection between the anti- suburban tradition of cultural elites and the suburbs' close association with the domestic and feminine sphere of life? Patrick White in describing the mythical suburb of Sarsaparilla claimed it as 'a geographical hell ruled by female demons' (in Duruz 1994). American historian Lewis Mumford in his seminal work The City in History wrote that the suburbs are not 'merely a child centred environment: it is based on a childish view of the world which is sacrificed to the pleasure principle' (1961). Little wonder that today, younger women are fleeing the suburbs and flocking to the city, attracted by its possibility of adventure and eros. The other day I picked up my teenage daughter from her school to which she had returned after a five day camp in the bush. 'Aaaagh', she sighed with a sense of relief, as we approached our densely populated inner city suburb, 'buildings again… and not too many trees'. The following morning we were out in the lush and fecund Samford Valley, this time at her first soccer match for the season. As we drove further into the bush she yelled out, 'Oh no, not all these trees again!' Is this the response of a typical twenty- first century urban woman? References Docker, John. (1995) Postmodernism and Popular Culture: A cultural history. Cambridge, Cambridge University Press. Duruz, Jean. (1994) 'Romancing the Suburbs?' in Katherine Gibson and Sophie Watson (eds) Metropolis Now. Sydney, Pluto Press. Kinnane, Gary. (1998) 'Shopping at Last!:History, Fiction and the Anti-Suburban Tradition.' Australian Literary Studies: Writing the Everyday, Australian Literature and the Limits of Suburbia, 18. 4: 41-55. Knopp, Lawrence. (1995) 'Sexuality and Urban Space: a framework for analysis' in David Bell and Gill Valentine (eds) Mapping Desire. London, Routledge. Mumford, Lewis. (1961) The City in History, Its Origins, Its Transformations and Its Prospects. London, Penguin. Patton, Paul. (1995) 'Imaginary Cities' in Sophie Watson and Katherine Gibson (eds) Postmodern Cities and Spaces. Cambridge, Blackwell Publishers. Petro, Patrice (1989) Joyless Streets: Women and Melodramatic Representation in Weimer Germany. Princeton, Princeton University Press. Vidler, Anthony (1993) 'Bodies in Space/Subjects in the City: Psychopathologies of Modern Urbanism.' Differences: A Journal of Feminist Cultural Studies, 5.3: 31-51. Walkowitz, Judith. (1992) City of Dreadful Delight: Narratives of Sexual Danger in late Victorian London. Chicago, Chicago University Press. Watson, Sophie and Gibson, Katherine. (1995) Postmodern Cities and Spaces. Oxford, Basil Blackwell. Wilson, Elizabeth. (1991) The Sphinx in the City: Urban Life, The Control of Disorder and Women. London: Virago. Citation reference for this article MLA Style Felton, Emma. "The City" M/C: A Journal of Media and Culture 5.2 (2002). [your date of access] < http://www.media-culture.org.au/0205/eros.php>. Chicago Style Felton, Emma, "The City" M/C: A Journal of Media and Culture 5, no. 2 (2002), < http://www.media-culture.org.au/0205/eros.php> ([your date of access]). APA Style Felton, Emma. (2002) The City. M/C: A Journal of Media and Culture 5(2). < http://www.media-culture.org.au/0205/eros.php> ([your date of access]).

Abstract Introduction Coronary artery disease (CAD) may progress to left ventricular dysfunction (LVD) and chronic heart failure. A reduced ventilatory efficiency in these patients is associated with worse outcome. However, breathing patterns at rest and during exercise and their change during exercise-based cardiac rehabilitation (exCR) have been poorly described in this population. We aimed to analyse respiratory and gas-exchange parameters in elderly patients with CAD included in a multicentre study on effectiveness of exCR across seven European countries (EU-CaRE). Methods Patients aged 65 years and older with acute (ACS) and chronic coronary syndromes (CCS) who participated in exCR were included. Cardiopulmonary exercise testing (CPET) was performed before (T0) and at termination of exCR (T1), and 12 months after start of exCR (T2). Ventilation (VE), breathing frequency (BF), and end-expiratory carbon dioxide pressure (PetCO2) were measured at rest, at first ventilatory threshold and peak exercise. Ventilatory efficiency, expressed as VE/VCO2 slope and the nadir of VE/VCO2 ratio were measured during the ramp test. Peak oxygen uptake was averaged over 30 s. Breathing parameters over time were compared between patients without and with left ventricular dysfunction (LVD, defined as LV ejection fraction &lt;45%) by mixed linear models corrected for age, sex and body mass index. Results 818 out of 1633 patients of the EU-CaRE study fulfilled inclusion criteria, 151 (18%) had LVD, of these, 86% were in New York Heart Association (NYHA) functional class I. Mean age was 72.5±5.4 years, 21.9% were women, and 79.8% had acute ACS. Compared to patients without LVD, in patients with LVD resting VE was increased 9%, VE/VCO2 slope 14%, and nadir VE/VCO2 ratio 9%, while PetCO2 was reduced at rest and peak exercise by 6%. From before to after exCR, resting ventilation and breathing frequency, as well as VE/VCO2 slope and nadir VE/VCO2 during exercise decreased significantly more in patients with LVD compared to patients without, while improvement in peak oxygen uptake was similar (Figure 1). Conclusions In contrast to their own perception based on NYHA class, patients with LVD had exaggerated breathing at rest and as response to exercise with consistently reduced PetCO2 and ventilatory efficiency. Abnormal breathing patterns may be an early and clinically relevant sign of LVD and linked to increased chemosensitivity and/or abnormal ergoreflex. Exercise-based CR may contribute to improvements of breathing patterns and ventilator efficiency in this population. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation program and Swiss State Secretariat for Education, Research and Innovation for the Swiss consortium partner

Photo by Sharon McCutcheon on Unsplash ABSTRACT COVID-19 highlighted a disproportionate impact upon marginalized communities that needs to be addressed. Specifically, a focus on equity rather than equality would better address and prevent the disparities seen in COVID-19. A distributive justice framework can provide this great benefit but will succeed only if the medical community engages in outreach, anti-racism measures, and listens to communities in need. INTRODUCTION COVID-19 disproportionately impacted communities of color and lower socioeconomic status, sparking political discussion about existing inequities in the US.[1] Some states amended their guidelines for allocating resources, including vaccines, to provide care for marginalized communities experiencing these inequities, but there has been no clear consensus on which guidelines states should amend or how they should be ethically grounded. In part, this is because traditional justice theories do not acknowledge the deep-seated institutional and interpersonal discrimination embedded in our medical system. Therefore, a revamped distributive justice approach that accounts for these shortcomings is needed to guide healthcare decision-making now and into the post-COVID era. BACKGROUND Three terms – health disparity, health inequities, and health equity – help frame the issue. A health disparity is defined as any difference between populations in terms of disease incidence or adverse health events, such as morbidity or mortality. In contrast, health inequities are health disparities due to avoidable systematic structures rooted in racial, social, and economic injustice.[2] For example, current data demonstrate that Black, Latino, Indigenous Americans, and those living in poverty suffer higher morbidity and mortality rates from COVID-19.[3] Finally, health equity is the opportunity for anyone to attain his or her full health potential without interference from systematic structures and factors that generate health inequities, including race, socioeconomic status, gender, ethnicity, religion, sexual orientation, or geography.[4] ANALYSIS Health inequities for people of color with COVID-19 have led to critiques of states that do not account for race in their resource allocation guidelines.[5] For example, the Massachusetts Department of Public Health revised its COVID-19 guidelines regarding resource allocation to patients with the best chance of short-term survival.[6] Critics have argued that this change addresses neither preexisting structural inequities nor provider bias that may have led to comorbidities and increased vulnerability to COVID-19. By failing to address race specifically, they argue the policy will perpetuate poorer outcomes in already marginalized groups. As the inequities in COVID-19 outcomes continue to be uncovered and the data continue to prove that marginalized communities suffered disproportionately, we, as healthcare providers, must reconsider our role in addressing the injustices. Our actions must be ethically grounded in the concept of justice. l. Primary Theories of Justice The principle of justice in medical ethics relates to how we ought to treat people and allocate resources. Multiple theories have emerged to explain how justice should be implemented, with three of the most prominent being egalitarianism, utilitarianism, and distributive. This paper argues that distributive justice is the best framework for remedying past actions and enacting systemic changes that may persistently prevent injustices. An egalitarian approach to justice states all individuals are equal and, therefore, should have identical access to resources. In the allocation of resources, an egalitarian approach would support a strict distribution of equal value regardless of one’s attributes or characteristics. Putting this theory into practice would place a premium on guidelines based upon first-come, first-served basis or random selection.[7] However, the egalitarian approach taken in the UK continues to worsen health inequities due to institutional and structural discrimination.[8] A utilitarian approach to justice emphasizes maximizing overall benefits and achieving the greatest good for the greatest number of people. When resources are limited, the utilitarian principle historically guides decision-making. In contrast to the egalitarian focus on equal distribution, utilitarianism focuses on managing distributions to maximize numerical outcomes. During the COVID-19 pandemic, guidelines for allocating resources had utilitarian goals like saving the most lives, which may prioritize the youthful and those deemed productive in society, followed by the elderly and the very ill. It is important to reconsider using utilitarian approaches as the default in the post-COVID healthcare community. These approaches fail to address past inequity, sacrificing the marginalized in their emphasis on the greatest amount of good rather than the type of good. Finally, a distributive approach to justice mandates resources should be allocated in a manner that does not infringe individual liberties to those with the greatest need. Proposed by John Rawls in a Theory of Justice, this approach requires accounting for societal inequality, a factor absent from egalitarianism and utilitarianism.[9] Naomi Zack elaborates how distributive justice can be applied to healthcare, outlining why racism is a social determinant of health that must be acknowledged and addressed.[10] Until there are parallel health opportunities and better alignment of outcomes among different social and racial groups, the underlying systemic social and economic variables that are driving the disparities must be fixed. As a society and as healthcare providers, we should be striving to address the factors that perpetuate health inequities. While genetics and other variables influence health, the data show proportionately more exposure, more cases, and more deaths in the Black American and Hispanic populations. Preexisting conditions and general health disparities are signs of health inequity that increased vulnerability. Distributive justice as a theoretical and applied framework can be applied to preventable conditions that increase vulnerability and can justify systemic changes to prevent further bias in the medical community. During a pandemic, egalitarian and utilitarian approaches to justice are prioritized by policymakers and health systems. Yet, as COVID-19 has demonstrated, they further perpetuate the death and morbidity of populations that face discrimination. These outcomes are due to policies and guidelines that overall benefit white communities over communities of color. Historically, US policy that looks to distribute resources equally (focusing on equal access instead of outcomes), in a color-blind manner, has further perpetuated poor outcomes for marginalized communities.[11] ll. Historical and Ongoing Disparities Across socio-demographic groups, the medical system exacerbates historical and current inequities. Members of marginalized races,[12] women,[13] LGBTQ people,[14] and poor people[15] experience trauma caused by discrimination, marginalization, and failure to access high-quality public and private goods. Through the unequal treatment of marginalized communities, these historic traumas continue. In the US, people of color do not receive equal and fair medical treatment. A meta-analysis found that Hispanics and Black Americans were significantly undertreated for pain compared to their white counterparts over the last 20 years.[16] This is partly due to provider bias. Through interviewing medical trainees, a study by the National Academy of Science found that half of medical students and residents harbored racist beliefs such as “Black people’s nerve endings are less sensitive than white people’s” or “Black people’s skin is thicker than white people’s skin.”[17] More than 3,000 Indigenous American women were coerced, threatened, and deliberately misinformed to ensure cooperation in forced sterilization.[18] Hispanic people have less support in seeking medical care, in receiving culturally appropriate care, and they suffer from the medical community’s lack of resources to address language barriers.[19] In the US, patients of different sexes do not receive the same quality of healthcare. Despite having greater health needs, middle-aged and older women are more likely to have fewer hospital stays and fewer physician visits compared to men of similar demographics and health risk profiles.[20] In the field of critical care, women are less likely to be admitted to the ICU, less likely to receive interventions such as mechanical ventilation, and more likely to die compared to their male ICU counterparts.[21] In the US, patients of different socioeconomic statuses do not receive the same quality of healthcare. Low-income patients are more likely to have higher rates of infant mortality, chronic disease, and a shorter life span.[22] This is partly due to the insurance-based discrimination in the medical community.[23] One in three deaths of those experiencing homelessness could have been prevented by timely and effective medical care. An individual experiencing homelessness has a life expectancy that is decades shorter than that of the average American.[24] lll. Action Needed: Policy Reform While steps need to be taken to provide equitable care in the current pandemic, including the allocation of vaccines, they may not address the historical failures of health policy, hospital policy, and clinical care to eliminate bias and ensure equal treatment of patients. According to an applied distributive justice framework, inequities must be corrected. Rather than focusing primarily on fair resource allocation, medicine must be actively anti-racist, anti-sexist, anti-transphobic, and anti-discriminatory. Evidence has shown that the health inequities caused by COVID-19 are smaller in regions that have addressed racial wealth gaps through forms of reparations.[25] Distributive justice calls for making up for the past using tools of allocation as well as tools to remedy persistent problems. For example, Brigham and Women’s Hospital in Boston, MA, began “Healing ARC,” a pilot initiative that involves acknowledgement, redress, and closure on an institutional level.[26] Acknowledgement entails informing patients about disparities at the hospital, claiming responsibility, and incorporating community ideas for redress. Redress involves a preferential admission option for Black and Hispanic patients to specialty services, especially cardiovascular services, rather than general medicine. Closure requires that community and patient stakeholders work together to ensure that a new system is in place that will continue to prioritize equity. Of note, redress could take the form of cash transfers, discounted or free care, taxes on nonprofit hospitals that exclude patients of color,[27] or race-explicit protocol changes (such as those being instituted by Brigham and Women’s Hospital that admit patients historically denied access to certain forms of medical care). In New York, for instance, the New York State Bar Association drafted the COVID-19 resolutions to ensure that emergency regulations and guidelines do not discriminate against communities of color, and even mandate that diverse patient populations be included in clinical trials.[28] Also, physicians must listen to individuals from marginalized communities to identify needs and ensure that community members take part in decision-making. The solution is not to simply build new health centers in communities of color, as this may lead to tiers of care. Rather, local communities should have a chance to impact existing hospital policy and should also use their political participation to further their healthcare interests. Distributive justice does not seek to disenfranchise groups that hold power in the system. It aims to transform the system so that those in power do not continue to obtain unfair benefits at the expense of others. The framework accounts for unjust historical oppression and current injustices in our system to provide equitable outcomes to all who access the system. In this vein, we can begin to address the flagrant disparities between communities that have always – and continue to – exist in healthcare today.[29] CONCLUSION As equality focuses on access, it currently fails to do justice. Instead of outcomes, it is time to focus on equity. A focus on equity rather than equality would better address and prevent the disparities seen in COVID-19. A distributive justice framework can gain traction in clinical decision-making guidelines and system-level reallocation of resources but will succeed only if the medical community engages in outreach, anti-racism measures, and listens to communities in need. There should be an emphasis on implementing a distributive justice framework that treats all patients equitably, accounts for historical harm, and focuses on transparency in allocation and public health decision-making. [1] APM Research Lab Staff. 2020. “The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S.” APM Research Lab. https://www.apmresearchlab.org/covid/deaths-by-race. [2] Bharmal, N., K. P. Derose, M. Felician, and M. M. Weden. 2015. “Understanding the Upstream Social Determinants of Health.” California: RAND Corporation 1-18. https://www.rand.org/pubs/working_papers/WR1096.html. [3] Yancy, C. W. 2020. “COVID-19 and African Americans.” JAMA. 323 (19): 1891-2. https://doi.org/10.1001/jama.2020.6548; Centers for Disease Control and Prevention. 2020. “COVID-19 in Racial and Ethnic Health Disparities.” Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html. [4] Braveman, P., E. Arkin, T. Orleans, D. Proctor, and A. Plough. 2017. “What is Health Equity?” Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html. [5] Bedinger, M. 2020 Apr 22. “After Uproar, Mass. Revises Guidelines on Who Gets an ICU Bed or Ventilator Amid COVID-19 Surge.” Wbur. https://www.wbur.org/commonhealth/2020/04/20/mass-guidelines-ventilator-covid-coronavirus; Wigglesworth, A. 2020 May 11. “Institutional Racism, Inequity Fuel High Minority Death Toll from Coronavirus, L.A. Officials Say.” Los Angeles Times. https://www.latimes.com/california/story/2020-05-11/institutional-racism-inequity-high-minority-death-toll-coronavirus. [6] Executive Office of Health and Human Services Department of Public Health. 2020 Oct 20. “Crises Standards of Care Planning and Guidance for the COVID-19 Pandemic.” Commonwealth of Massachusetts. https://www.mass.gov/doc/crisis-standards-of-care-planning-guidance-for-the-covid-19-pandemic. [7] Emanuel, E. J., G. Persad, R. Upshur, et al. 2020. “Fair Allocation of Scarce Medical Resources in the Time of Covid-19. New England Journal of Medicine 382: 2049-55. https://doi.org/10.1056/NEJMsb2005114. [8] Salway, S., G. Mir, D. Turner, G. T. Ellison, L. Carter, and K. Gerrish. 2016. “Obstacles to "Race Equality" in the English National Health Service: Insights from the Healthcare Commissioning Arena.” Social Science and Medicine 152: 102-110. https://doi.org/10.1016/j.socscimed.2016.01.031. [9] Rawls, J. A Theory of Justice (Revised Edition) (Cambridge, MA: Belknap Press of Harvard University Press, 1999). [10] Zack, N. Applicative Justice: A Pragmatic Empirical Approach to Racial Injustice (New York: The Rowman & Littlefield Publishing Group, 2016). [11] Charatz-Litt, C. 1992. “A Chronicle of Racism: The Effects of the White Medical Community on Black Health.” Journal of the National Medical Association 84 (8): 717-25. http://hdl.handle.net/10822/857182. [12] Washington, H. A. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York: Doubleday, 2006). [13] d'Oliveira, A. F., S. G. Diniz, and L. B. Schraiber. 2002. “Violence Against Women in Health-care Institutions: An Emerging Problem.” Lancet. 359 (9318): 1681-5. https://doi.org/10.1016/S0140-6736(02)08592-6. [14] Hafeez, H., M. Zeshan, M. A. Tahir, N. Jahan, and S. Naveed. 2017. “Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus 9 (4): e1184. https://doi.org/10.7759/cureus.1184; Drescher, J., A. Schwartz, F. Casoy, et al. 2016. “The Growing Regulation of Conversion Therapy.” Journal of Medical Regulation 102 (2): 7-12. https://doi.org/10.30770/2572-1852-102.2.7; Stroumsa, D. 2014. “The State of Transgender Health Care: Policy, Law, and Medical Frameworks.” American Journal of Public Health. 104 (3): e31-8. https://doi.org/10.2105/AJPH.2013.301789. [15] Stepanikova, I., and G. R. Oates. 2017. “Perceived Discrimination and Privilege in Health Care: The Role of Socioeconomic Status and Race.” American Journal of Preventative Medicine. 52 (1s1): S86-s94. https://doi.org/10.1016/j.amepre.2016.09.024; Swartz, K. “Health Care for the Poor: For Whom, What Care, and Whose Responsibility?” In Cancian, M., and S. Danziger (Eds.). Changing Poverty, Changing Policies (New York: Russell Sage Foundation Press, 2009), 69-74. [16] Meghani, S. H., E. Byun, and R. M. Gallagher. 2012. “Time to Take Stock: A Meta-analysis and Systematic Review of Analgesic Treatment Disparities for Pain in the United States.” Pain Medicine 13 (2): 150-74. https://doi.org/10.1111/j.1526-4637.2011.01310.x; Williams, D. R., and T. D. Rucker. 2000. “Understanding and Addressing Racial Disparities in Health Care.” Health Care Financing Review 21 (4): 75-90. https://scholar.harvard.edu/davidrwilliams/dwilliam/publications/understanding-and-addressing-racial-disparities-health. [17] Hoffman, K. M., S. Trawalter, J. R. Axt, and M. N. Oliver. 2016. “Racial Bias in Pain assessment and treatment recommendations, and false beliefs about biological Differences Between Blacks and Whites.” PNAS 113 (16): 4296-4301. https://doi.org/10.1073/pnas.1516047113. [18] Pacheco, C. M., S. M. Daley, T. Brown, M. Filipp, K. A. Greiner, and C. M. Daley. 2013. “Moving Forward: Breaking the Cycle of Mistrust Between American Indians and Researchers.” American Journal of Public Health. 103 (12): 2152-9. https://doi.org/10.2105/AJPH.2013.301480. [19] Velasco-Mondragon, E., A. Jimenez, A. G. Palladino-Davis, D. Davis, and J. A. Escamilla-Cejudo. 2016. “Hispanic Health in the USA: A Scoping Review of the Literature.” Public Health Reviews 37:31. https://doi.org/10.1186/s40985-016-0043-2. [20] Cameron, K. A., J. Song, L. M. Manheim, and D. D. Dunlop. 2010. “Gender Disparities in Health and Healthcare Use Among Older Adults.” Journal of Women’s Health (Larchmt) 19 (9): 1643-50. https://doi.org/10.1089/jwh.2009.1701. [21] Bierman, A. S. 2007. “Sex Matters: Gender Disparities in Quality and Outcomes of Care. Canadian Medical Association Journal 177 (12): 1520-1. https://doi.org/10.1503/cmaj.071541; Fowler, R. A., S. Sabur, P. Li, et al. 2007. “Sex-and Age-based Differences in the Delivery and Outcomes of Critical Care. Canadian Medical Association Journal 177 (12): 1513-9. https://doi.org/10.1503/cmaj.071112. [22] McLaughlin, D. K., and C. S. Stokes. 2002. “Income Inequality and Mortality in US Counties: Does Minority Racial Concentration Matter?” American Journal of Public Health 92 (1): 99-104. https://doi.org/.10.2105/ajph.92.1.99; Shea, S., J. Lima, A. Diez-Roux, N. W. Jorgensen, and R. L. McClelland. 2016. “Socioeconomic Status and Poor Health Outcome at 10 years of Follow-up in the Multi-ethnic Study of Atherosclerosis.” PLoS One 11 (11): e0165651. https://doi.org/10.1371/journal.pone.0165651. [23] Han, X., K. T. Call, J. K. Pintor, G. Alarcon-Espinoza, and A. B. Simon. 2015. “Reports of Insurance-based Discrimination in Health care and its Association with Access to Care.” American Journal of Public Health 105 Suppl 3 (Suppl 3): S517-25. https://doi.org/10.2105/AJPH.2015.302668. [24] Aldridge, R. W., D. Menezes, D. Lewer, et al. 2019. “Causes of Death Among Homeless People: A Population-based Cross-sectional Study of Linked Hospitalization and Mortality Data in England.” Wellcome Open Research 4:49. https://doi.org/10.12688/wellcomeopenres.15151.1. [25] Richardson, E. T., M. M. Malik, W. A. Darity Jr., et al. 2021. “Reparations for Black American Descendants of Persons Enslaved in the U.S. and their Potential Impact on SARS-CoV-2 Transmission.” Social Science and Medicine 276: 113741. https://doi.org/10.1016/j.socscimed.2021.113741. [26] Wispelwey, B., and M. Morse. 2021. “An Antiracist Agenda for Medicine.” Boston Review. http://bostonreview.net/science-nature-race/bram-wispelwey-michelle-morse-antiracist-agenda-medicine. [27] Johnson, S. F., A. Ojo, and H. J. Warraich. 2021. “Academic Health Centers’ Antiracism Strategies Must Extend to their Business Practices.” Annals of Internal Medicine 174 (2): 254-5. https://doi.org/10.7326/M20-6203; Golub, M., N. Calman, C. Ruddock, et al. 2011. “A Community Mobilizes to End Medical Apartheid.” Progress in Community Health Partnerships: Research, Education, and Action 5 (3): 317-25. https://doi.org/10.1353/cpr.2011.0041. [28] New York State Bar Association. 2020. “New York State Bar Association House of Delegates: Revised COVID-19 Resolutions.” https://nysba.org/app/uploads/2020/10/Final-Health-Law-Section-COVID-19-Resolutions_10-8-20-1-1.pdf. [29] Egede, L. E. 2006. “Race, Ethnicity, Culture, and Disparities in Health Care.” Journal of General Internal Medicine 21 (6): 667-669. https://doi.org/10.1111%2Fj.1525-1497.2006.0512.x

Taishū engeki—Entertainment for the Masses? What do a highway robber, a samurai, and a geisha have in common? They are all played by the same actor, often at the same time, in an incredible flurry of costume change, in a contemporary form of Japanese theatre called taishū engeki. Taishū engeki, translated as vaudeville, literally, “theatre for the masses”, would be better described as a parallel world of fantasy, glitter, and manga-esque beautiful men wearing elaborate wigs and even more elaborate kimonos, who dance and gracefully sway their hips to portray women, and simultaneously do their best to seduce the overwhelmingly female audience. Taishū engeki represents an escape into a world of romances enacted through dance, of tragic love stories that somehow end well when the main character reappears in the second act as a brilliant dragon-slaying god, and of literal dances with dragons. One performance by dance troupe Gekidan Kokoro included onna-gata buyō (traditional Japanese dance performed by a man playing the part of a woman), a play about brotherly love and devotion where the glamorous actor from the first part was a not too bright young boy (depicted with snot running down his nose), more crossdressing and dancing, a few shamisen songs, a totally unexpected breakdancing piece, and a collaboration with Iwami Kagura—a famous group from Shimane who performs sacred dances in association with various Shinto rituals. Despite being able to combine theatrical skills with dance and acrobatic feats, taishū engeki is seen as a minor theatrical genre, often included in the category of folk arts (Kurata 42), or “low art” intended merely for fun and entertainment” (Endo 151). Although the name would indicate that is addresses a wider audience (which may have been the case decades ago, when cheap entertainment was not so readily available as it is today), taishū engeki caters to a specific category of people. The performers are organised in small itinerant troupes who spend about one month in a specific location, putting on two shows daily—one starting at noon, and one in the evening. In most cases, the show has two parts: one is a play, followed by a free program of dancing, acrobatic features, and even playing instruments such as drums or shamisen. The audience itself consists of two categories: the local people, living in the vicinity of the small theatres where performances are held, and who might attend each new show two or three times, and the fans, who follow their favourite actor from place to place to the limit of their time and financial resources. When it comes to performing arts, Japan’s most famous form of theatre is definitely kabuki: a performative genre highly appreciated by the Japanese and whose extravagant costumes and make-up, as well as exaggerated gestures eliminate some of the language barriers and make it (at least to a certain degree) comprehensible to non-Japanese speakers. Besides kabuki, noh (a highly ritualised form of theatre characterised by its use of masks) and bunraku (puppet theatre) are most often mentioned together, popular both within and outside the borders of Japan as entertainment and objects of scholarly research. As a scholar of Japanese studies, I had learned about these three categories in my first year as an undergraduate student, but it took me over ten years in Japan to discover taishū engeki, something that Robert Schneider and Nathan Schneider (256) ironically call “a weed in Japan’s exquisite garden of classical theatre and a living fossil in the detritus of Asian modernity”. Is taishū engeki really a fossil or a weed accidentally left on the stage of classical theatre? Its faithful fans would beg to differ, and so would the accomplishments of some troupes, who are entirely self-sufficient, renting the venues where they perform and travelling with their own light and sound systems, as well as hundreds of exquisite costumes and wigs. To give just an example, Aotsuki Shinya, the leader of Gekidan Kokoro, told me that he possesses more than two hundred wigs, and mid-September this year will attempt to perform 120 different dances, with different costumes, during the three days that will celebrate his birthday. In contrast with noh or kabuki, where each gesture is highly stylised and must be performed in a pre-defined order, in a set context, taishū engeki is flexible: plays are based on known stories, but the plot is overly simplified, so that the audience can focus on the main characters and the way they perform more than on the storyline, and the second act is actually the main attraction of the show, when the actors can showcase their special skills to the delight of the audience. Kabuki developed in the seventeenth century, and it was aimed at the “common people”, while “the true professionals, the performers of the [noh] and the kyōgen [comedy], began to retreat behind the curtain of refinement” (Tsubaki 4). In the twenty-first century, noh has become more of a mixture of performance and ritual, appreciated by a small number of specialists, and often staged to accompany religious manifestations. Kabuki, on the other hand, has taken its place as the most valued theatrical art, with fans and aficionados vying for the best seats (whose prices can go up to 30,000 Japanese yen, and yet are hard to procure), but taishū engeki shows no signs that it might ever reach that level of popularity. In 1995 Marilyn Ivy saw it as a “discourse of the vanishing”, an art that might disappear as, while “it appears to carry on an unarguably Japanese knowledge” (239), it has failed to create a “boom” or a vast audience. While novelty is part of the performance, it seems to somehow be not new enough, not entrancing enough. The actors are talented, creative, and versatile, but they do not attain the fame level of their kabuki counterparts. Despite all these, as an anthropologist, I could not help but wonder why taishū engeki has not attracted more scholarly interest. The studies on this topic, both in Japanese and English, are far less numerous than those on butoh, for example, “a post-modern dance genre” which has been the focus of both practical and theoretical interest on the part of Japanese studies specialists. To give just an example, in his book on Japanese theatre, Benito Ortolani has a subchapter on butoh, but does not even mention taishū engeki. Prince(ss) Charming My first encounters with taishū engeki were due to a class project—I had started teaching a class on theatre as ritual performance, and wanted my students to have a first-hand experience. The project was a success: students who had shown no enthusiasm at all when reading the syllabus were mesmerised once the performance had begun, to the level that they had attended shows by themselves, and even started following the actors on various social networks. Taishū engeki surpasses all expectations of a first-time viewer. It follows a canon, just like kabuki, but that canon is audience-oriented, so without having ever been part of that audience, it is difficult to imagine what will happen on stage. As mentioned above, each performance has two parts: the first one is a play, whose content changes during the one-month performance, usually based on historical events familiar to the audience, but not restricted to that, an intermission during which the leader of the troupe greets the audience, talks about the schedule for the remainder of the month, and promotes the merchandise available for sale (T-shirts, fans, boxes of sweets), followed by a free-style show where the performers are free to display their best skills. Photography is not allowed during the first part—and this may be due to the fact that most troupe leaders create their own plays using the vast available materials, and are reluctant to share that with other troupes—but is encouraged during the second part. Video taking is forbidden at all times. Crossdressing is a significant part of the performance, with men playing the part of women who are attractive to other women, and women playing the part of men who also attract women. The actresses, however, never become the star of the troupe. Just like in the case of Takarazuka Theatre, where the otoko yaku (women playing the male roles) receive significantly more appreciation than the female counterparts, the heavily made-up male actors of taishū engeki represent the dreamy ideal of their dedicated fans. Each performing group is centered around one male actor who is representative of the troupe—usually the leader or the leader’s son, and who gathers a dedicated fan base composed of women (most of whom are middle-aged or older). These women try to attend as many shows as they can, literally showering their favourite actor with money. The few available studies on taishū engeki tended to focus on two major aspects: crossdressing (mostly of the onnagata—men playing women—type) and on the money the actors receive while on stage. Fig. 1: An actor on the Gofukuza Stage (Osaka) displaying money gifts, 13 June 2018. Schneider and Schneider, for example, looked into how gender is performed, and what rules are applied when performing gender. Their conclusion? There are no clear rules, as “taishū engeki plays with gender, but it also quite simply plays gender” (262). My own interest was not in the actual gender performed, but in the most pervasive and permanent element of all taishū engeki performances: seduction. Those who go to see these shows may do so for mere amusement—and their expectations are never disappointed, as the costumes are complex and flamboyant, and the performers are skilled dancers, but those who go faithfully do so due to their admiration for a certain actor. The first act (the historical play) is a convention where the star appears slightly more human—less make-up, sometimes performing the role of a man—always strong and masculine, which is quite an artistic feat seeing that even in the role of a man, the actors will wear specific make-up and false eyelashes. The Takarazuka Revue, an all-female group founded in 1914, has a large and consistent fan base made-up almost entirely of women who fall in love with the actress playing the main male roles—a phenomenon explained by the desire to temporarily live in a fantasy world. The difference between the Takarazuka actresses and the taishū engeki actors is that the former do not aim to seduce, but to invite the audience into a dream world, while the latter’s goal is to fully entrance. Regardless of the gender they play, the taishū engeki stars create erotic characters, just like their kabuki precursors, where, as Samuel L. Leiter (212) puts it, “eros remained primary”. Dressed in kimonos of intricate patterns that go far outside the lines of tradition, and are representative of the creative spirit of the performer, using make-up which completely transforms their physiognomies through the heavy use of eyeliner, glitter, false eyelashes, and wearing exquisite wigs, the actors invite the audience into a dream world where the Fairy Godmother gave the best dress to the prince, not the princess. For hundreds if not thousands of years, the folktales focussed around the image of a beautiful prince, the kalos kagathos hero (beautiful and virtuous, the ancient Greek ideal) who takes the maiden from distress and into a happily ever after. Taishū engeki heroes switch perspectives: it is not Prince Charming, but Princess Charming, an utterly beautiful creature who enchants the female audience by being the impossible. Princess Charming represents an embodiment of the best possible features—beauty, glamour, grace, sex appeal, elegance—and none of the negative ones—lack of manners, roughness, insensitivity. Moreover, Princess Charming is accessible. For a mere 2,000 yen, anybody can spend three hours in her company, and shaking her hand starts at a similarly low price—2,000 or 3,000 yen for a trinket bought during the intermission, to hand over as a gift during the performance. Fig. 2: Aotsuki Shinya as a romantic lady in a flowing kimono, Gofukuza, 9 July 2022. Dressed as females, the actors move their bodies with the grace of a geisha, bat their eyelashes, smile coquettishly, and even wink at the audience. As males, they are either abandoned lovers who drown their sorrows in drink, or fierce warriors dancing with masks and swords. In all circumstances, they present exaggerated feminine or masculine ideals, with the difference that femininity is emphasised through the overuse of garments and accessories, while masculinity will almost always involve a certain degree of nakedness: chest, arms, legs. The reasons are both practical (showing various naked body parts would destroy the dreamy feminine beauty wrapped up in layers of cloth and glitter), and symbolic: femininity is mysterious and fragile, and thus cannot easily be revealed, while masculinity must re-assert its strength and vitality. The body presented on stage is more of an artistic act than the performance itself, because it is there that most of the actor’s talent is poured. Creating a persona means borrowing from the “traditional” Japanese culture which includes geisha, courtesans, heavy wigs, and heavily embroidered kimonos, as well as the contemporary manga and cosplay culture. With exaggerated eyes and hairstyles as the central features of the head, the characters moving in front of the audience seem to have directly descended from (or drawn the viewers into, “Take On Me” style) the pages of a fantasy manga. An interview with Aotsuki Shinya (stage name), leader and star of the Kokoro (“Heart”) troupe conducted on 15 June 2022, did not offer any insightful glimpses into the metamorphosis process. While acknowledging that he cannot present his true self on stage, thus using make-up to become Aotsuki Shinya, the actor did not admit to any conscious attempt of becoming attractive. In his own words, all their efforts are for the benefit of the audience, directed towards helping them have fun. “Tanoshii”, “fun” seemed to be a key concept when staging a new performance, and the reasoning behind that is easy to follow. Unlike the more elevated kabuki, a taishū engeki theatre is a small cosy place where the audience can interact quite freely with the performers, who do not shy away from showing momentarily glimpses of the face behind the mask: forgetting a line and admitting to it, laughing at a joke said by another actor, kneeling prettily to receive gifts from their fans. Rather than gender fluid, the bodies in taishū engeki are genderless because they are not, nor do they claim to be, real. An actor on the traditional stage is a photography, or, if the setting includes fantastic elements, a painting of an imaginable universe. An actor on the taishū engeki stage turns their body into a manga drawing: something that does not exist in real life, but it is highly desirable. Kabuki actors staged eroticism by impersonating women; taishū engeki actors play with desire becoming in turns both Cinderella and the Prince. Figs. 3 & 4: Aotsuki Shinya as a fantastic character (fig. 3) and as the god Susano-wo slaying the dragon (fig. 4). “Fantasy, Sweet Fantasy” Analysing the loyalty that Takarazuka actresses inspire into their fans, Makiko Yamanashi interprets it as something that goes beyond (dreams of) physical love or mere escapism, and sees it as the desire to belong to an ideal community of women—friends, sisters, mothers. While not wrong, this approach seems to gloss over the real erotic feelings and the longing for something not of this world which are most definitely present among performative arts (be they kabuki, revue, vaudeville, butoh, modern theatre) aficionados. The men performed by the Takarazuka actresses do not exist in real life, and just as in the case of taishū engeki actors, make-up plays a crucial role. Lorie Brau even mentions an incident where an American director hired to stage a production of “West Side Story” required the actresses playing male roles to give up their false eyelashes—a change that did not last after the director left (86). The taishū engeki actors are warriors who bring back to life the god Izanagi, the creator of Japan, who fought an army of underworld monsters, while wearing eyeliner, eyelashes, and sparkling make-up. They are completely unrecognisable without make-up, and yet changing their appearance takes approximately ten minutes, much less than it would take a drag queen to turn from ordinary man into glamorous woman (at least forty minutes). I am not mentioning here the drag queens by chance—the two types of performances are similar enough that they lead to collaborations. On 10 June 2022, the troupe Kokoro performed at the Gofukuza Theatre in Umeda in the company of five drag queens well known on the Osaka stage: Feminina, Rulu Daisy, Madame Cocco, Ozu, and Il Rosa. One characteristic of drag performances is that they are actor-centred: they are not about the storyline, but about the performer’s creation—“channeling your inner femininity, fusing it with the male, and creating something otherworldly” (Hastings). The noticeable difference between drag and taishū engeki is that drag is actor-oriented, while taishū engeki is audience-oriented. Drag queens interact with the audiences and entertain, but the focus is internal, towards freeing something that had been developing within. Taishū engeki actors do choose their characters, of course, and have individual preferences, but this is secondary to their goal of captivating the audiences. Both categories of performers learn to re-invent their bodies, to re-create them on stage; however, in one case we witness an individual metamorphosis from real life to theatrical persona, and in the other we have one individual who can shapeshift into whatever character might work better magic on the people in front of him. Drag is about freedom while taishū engeki is about seduction. Fig. 5: Il Rosa and two actors of the Shin troupe, Gofukuza, 10 June 2022 Taishū engeki may not be kabuki: it is not celebrated by the media or the researchers, and many people in contemporary Japanese society see it as an inferior form of entertainment. Considering the low price of the tickets and the fact that shows are seldom sold out, one might worry about its future. Nevertheless, a visit to the backstage of Gofukuza during the month when Shin was performing revealed a large room full of costumes, and another one full of wig boxes—more than two hundred, according to Aotsuki Shinya. The Shin troupe was founded five years ago, so everything was still new and shiny—a sign that the genre will not disappear any time in the near future. The same visit, when I could interact with the actors in their day-to-day attires, using their regular voices, and standing near the costumes and wigs like exhibits in a museum, made one more thing acutely clear: the fact that their performances are a fantasy world. More of a fantasy world than a kabuki performance (to remain consistent with the comparison), where the setting is clearly a setting, separate from the audience. The blurred lines between stage and audience, between performance and flirting of the taishū engeki create a tangible fantasy, where one can not only fall in love with the Prince(ss) Charming, but maybe even take them to a ball. References Brau, Lorie. “The Women’s Theater of Takarazuka”. TDR 34.4 (Winter 1990): 79-95. Endo, Yukihide. “Reconsidering the Traveling Theater of Today’s Japan: An Interdisciplinary Approach to a Stigmatized Form of Japanese Theater.” Athens Journal of Humanities and Arts 2.3. Hastings, Magnus. Why Drag? Hong Kong: Chronicle Books, 2016. Ivy, Marilyn. Discourses of the Vanishing. Modernity Phantasm Japan. Chicago: U of Chicago P, 1995. Kurata, Ryosuke. “Taishū Engeki as a Show Business: Exploring the Segmentation of Customers.” Mathesis Universalis 17.2. Leiter, Samuel L. “From Gay to Gei: The Onnagata and the Creation of Kabuki’s Female Characters.” In A Kabuki Reader: History and Performance, ed. Samuel L. Leitner. New York: M. E. Sharpe, 2002. 211-229. Ortolani, Benito. The Japanese Theatre. From Shamanistic Ritual to Contemporary Pluralism. New Jersey: Princeton UP, 1995. Schneider, Robert, and Nathan Schneider. “A Dive and a Dance with Kabuki Vaudeville: Taishū Engeki Comes Back!” New Theater Quarterly 36.3 (2020). 29 July 2020 <https://www.cambridge.org/core/journals/new-theatre-quarterly/article/abs/dive-and-a-dance-with-kabuki-vaudeville-taishu-engeki-comes-back/BB72486E86C79B70730B6F2DB5EC0FF8>. Yamanashi, Makiko. A History of the Takarazuka Revue Since 1914: Modernity, Girls’ Culture, Japan Pop. Leiden: Global Oriental, 2012.

This article explores how fat women protesting challenges norms of womanhood, the place of women in society, and who has the power to have their say in public spaces. We use the term fat as a political reclamation; Fat Studies scholars and fat activists prefer the term fat, over the normative term “overweight” and the pathologising term “obese/obesity” (Lee and Pausé para 3). Who is and who isn’t fat, we suggest, is best left to self-determination, although it is generally accepted by fat activists that the term is most appropriately adopted by individuals who are unable to buy clothes in any store they choose. Using a tweet from conservative commentator Ann Coulter as a leaping-off point, we examine the narratives around women in the public sphere and explore how fat bodies might transgress further the norms set by society. The public representations of women in politics and protest are then are set in the context of ‘activist wisdom’ (Maddison and Scalmer) from two sides of the globe. Activist wisdom gives preference to the lived knowledge and experience of activists as tools to understand social movements. It seeks to draw theoretical implications from the practical actions of those on the ground. In centring the experiences of ourselves and other activists, we hope to expand existing understandings of body politics, gender, and political power in this piece. It is important in researching social movements to look both at the representations of protest and protestors in all forms of media as this is the ‘public face’ of movements, but also to examine the reflections of the individuals who collectively put their weight behind bringing social change.A few days after the 45th President of the United States was elected, people around the world spilled into the streets and participated in protests; precursors to the Women’s March which would take place the following January. Pictures of such marches were shared via social media, demonstrating the worldwide protest against the racism, misogyny, and overall oppressiveness, of the newly elected leader. Not everyone was supportive of these protests though; one such conservative commentator, Ann Coulter, shared this tweet: Image1: A tweet from Ann Coulter; the tweet contains a picture of a group of protestors, holding signs protesting Trump, white supremacy, and for the rights of immigrants. In front of the group, holding a megaphone is a woman. Below the picture, the text reads, “Without fat girls, there would be no protests”.Coulter continued on with two more tweets, sharing pictures of other girls protesting and suggesting that the protestors needed a diet programme. Kivan Bay (“Without Fat Girls”) suggested that perhaps Coulter was implying that skinny girls do not have time to protest because they are too busy doing skinny girl things, like buying jackets or trying on sweaters. Or perhaps Coulter was arguing that fat girls are too visible, too loud, and too big, to be taken seriously in their protests. These tweets provide a point of illustration for how fat women protesting challenge norms of womanhood, the place of women in society, and who has the power to have their say in public spaces While Coulter’s tweet was most likely intended as a hostile personal attack on political grounds, we find it useful in its foregrounding of gender, bodies and protest which we consider in this article, beginning with a review of fat girls’ role in social justice movements.Across the world, we can point to fat women who engage in activism related to body politics and more. Australian fat filmmaker and activist Kelli Jean Drinkwater makes documentaries, such as Aquaporko! and Nothing to Lose, that queer fat embodiment and confronts body norms. Newly elected Ontario MPP Jill Andrew has been fighting for equal rights for queer people and fat people in Canada for decades. Nigerian Latasha Ngwube founded About That Curvy Life, Africa’s leading body positive and empowerment site, and has organised plus-size fashion show events at Heineken Lagos Fashion and Design Week in Nigeria in 2016 and the Glitz Africa Fashion Week in Ghana in 2017. Fat women have been putting their bodies on the line for the rights of others to live, work, and love. American Heather Heyer was protesting the hate that white nationalists represent and the danger they posed to her friends, family, and neighbours when she died at a rally in Charlottesville, North Carolina in late 2017 (Caron). When Heyer was killed by one of those white nationalists, they declared that she was fat, and therefore her body size was lauded loudly as justification for her death (Bay, “How Nazis Use”; Spangler).Fat women protesting is not new. For example, the Fat Underground was a group of “radical fat feminist women”, who split off from the more conservative NAAFA (National Association to Aid Fat Americans) in the 1970s (Simic 18). The group educated the public about weight science, harassed weight-loss companies, and disrupted academic seminars on obesity. The Fat Underground made their first public appearance at a Women’s Equality Day in Los Angeles, taking over the stage at the public event to accuse the medical profession of murdering Cass Elliot, the lead singer of the folk music group, The Mamas and the Papas (Dean and Buss). In 1973, the Fat Underground produced the Fat Liberation Manifesto. This Manifesto began by declaring that they believed “that fat people are full entitled to human respect and recognition” (Freespirit and Aldebaran 341).Women have long been disavowed, or discouraged, from participating in the public sphere (Ginzberg; van Acker) or seen as “intruders or outsiders to the tough world of politics” (van Acker 118). The feminist slogan the personal is political was intended to shed light on the role that women needed to play in the public spheres of education, employment, and government (Caha 22). Across the world, the acceptance of women within the public sphere has been varied due to cultural, political, and religious, preferences and restrictions (Agenda Feminist Media Collective). Limited acceptance of women in the public sphere has historically been granted by those ‘anointed’ by a male family member or patron (Fountaine 47).Anti-feminists are quick to disavow women being in public spaces, preferring to assign them the role as helpmeet to male political elite. As Schlafly (in Rowland 30) notes: “A Positive Woman cannot defeat a man in a wrestling or boxing match, but she can motivate him, inspire him, encourage him, teach him, restrain him, reward him, and have power over him that he can never achieve over her with all his muscle.” This idea of women working behind the scenes has been very strong in New Zealand where the ‘sternly worded’ letter is favoured over street protest. An acceptable route for women’s activism was working within existing political institutions (Grey), with activity being ‘hidden’ inside government offices such as the Ministry of Women’s Affairs (Schuster, 23). But women’s movement organisations that engage in even the mildest form of disruptive protest are decried (Grey; van Acker).One way women have been accepted into public space is as the moral guardians or change agents of the entire political realm (Bliss; Ginzberg; van Acker; Ledwith). From the early suffrage movements both political actors and media representations highlighted women were more principled and conciliatory than men, and in many cases had a moral compass based on restraint. Cartoons showed women in the suffrage movement ‘sweeping up’ and ‘cleaning house’ (Sheppard 123). Groups like the Women’s Christian Temperance Union were celebrated for protesting against the demon drink and anti-pornography campaigners like Patricia Bartlett were seen as acceptable voices of moral reason (Moynihan). And as Cunnison and Stageman (in Ledwith 193) note, women bring a “culture of femininity to trade unions … an alternative culture, derived from the particularity of their lives as women and experiences of caring and subordination”. This role of moral guardian often derived from women as ‘mothers’, responsible for the physical and moral well-being of the nation.The body itself has been a sight of protest for women including fights for bodily autonomy in their medical decisions, reproductive justice, and to live lives free from physical and sexual abuse, have long been met with criticisms of being unladylike or inappropriate. Early examples decried in NZ include the women’s clothing movement which formed part of the suffrage movement. In the second half of the 20th century it was the freedom trash can protests that started the myth of ‘women burning their bras’ which defied acceptable feminine norms (Sawer and Grey). Recent examples of women protesting for body rights include #MeToo and Time’s Up. Both movements protest the lack of bodily autonomy women can assert when men believe they are entitled to women’s bodies for their entertainment, enjoyment, and pleasure. And both movements have received considerable backlash by those who suggest it is a witch hunt that might ensnare otherwise innocent men, or those who are worried that the real victims are white men who are being left behind (see Garber; Haussegger). Women who advocate for bodily autonomy, including access to contraception and abortion, are often held up as morally irresponsible. As Archdeacon Bullock (cited in Smyth 55) asserted, “A woman should pay for her fun.”Many individuals believe that the stigma and discrimination fat people face are the consequences they sow from their own behaviours (Crandall 892); that fat people are fat because they have made poor decisions, being too indulgent with food and too lazy to exercise (Crandall 883). Therefore, fat people, like women, should have to pay for their fun. Fat women find themselves at this intersection, and are often judged more harshly for their weight than fat men (Tiggemann and Rothblum). Examining Coulter’s tweet with this perspective in mind, it can easily be read as an attempt to put fat girl protestors back into their place. It can also be read as a warning. Don’t go making too much noise or you may be labelled as fat. Presenting troublesome women as fat has a long history within political art and depictions. Marianne (the symbol of the French Republic) was depicted as fat and ugly; she also reinforced an anti-suffragist position (Chenut 441). These images are effective because of our societal views on fatness (Kyrölä). Fatness is undesirable, unworthy of love and attention, and a representation of poor character, lack of willpower, and an absence of discipline (Murray 14; Pausé, “Rebel Heart” para 1).Fat women who protest transgress rules around body size, gender norms, and the appropriate place for women in society. Take as an example the experiences of one of the authors of this piece, Sandra Grey, who was thrust in to political limelight nationally with the Campaign for MMP (Grey and Fitzsimmons) and when elected as the President of the New Zealand Tertiary Education Union in 2011. Sandra is a trade union activist who breaches too many norms set for the “good woman protestor,” as well as the norms for being a “good fat woman”. She looms large on a stage – literally – and holds enough power in public protest to make a crowd of 7,000 people “jump to left”, chant, sing, and march. In response, some perceive Sandra less as a tactical and strategic leader of the union movement, and more as the “jolly fat woman” who entertains, MCs, and leads public events. Though even in this role, she has been criticised for being too loud, too much, too big.These criticisms are loudest when Sandra is alongside other fat female bodies. When posting on social media photos with fellow trade union members the comments often note the need of the group to “go on a diet”. The collective fatness also brings comments about “not wanting to fuck any of that group of fat cows”. There is something politically and socially dangerous about fat women en masse. This was behind the responses to Sandra’s first public appearance as the President of TEU when one of the male union members remarked “Clearly you have to be a fat dyke to run this union.” The four top elected and appointed positions in the TEU have been women for eight years now and both their fatness and perceived sexuality present as a threat in a once male-dominated space. Even when not numerically dominant, unions are public spaces dominated by a “masculine culture … underpinned by the undervaluation of ‘women’s worth’ and notions of womanhood ‘defined in domesticity’” (Cockburn in Kirton 273-4). Sandra’s experiences in public space show that the derision and methods of putting fat girls back in their place varies dependent on whether the challenge to power is posed by a single fat body with positional power and a group of fat bodies with collective power.Fat Girls Are the FutureOn the other side of the world, Tara Vilhjálmsdóttir is protesting to change the law in Iceland. Tara believes that fat people should be protected against discrimination in public and private settings. Using social media such as Facebook and Instagram, Tara takes her message, and her activism, to her thousands of followers (Keller, 434; Pausé, “Rebel Heart”). And through mainstream media, she pushes back on fatphobia rhetoric and applies pressure on the government to classify weight as a protected status under the law.After a lifetime of living “under the oppression of diet culture,” Tara began her activism in 2010 (Vilhjálmsdóttir). She had suffered real harm from diet culture, developing an eating disorder as a teen and being told through her treatment for it that her fears as a fat woman – that she had no future, that fat people experienced discrimination and stigma – were unfounded. But Tara’s lived experiences demonstrated fat stigma and discrimination were real.In 2012, she co-founded the Icelandic Association for Body Respect, which promotes body positivity and fights weight stigma in Iceland. The group uses a mixture of real life and online tools; organising petitions, running campaigns against the Icelandic version of The Biggest Loser, and campaigning for weight to be a protected class in the Icelandic constitution. The Association has increased the visibility of the dangers of diet culture and the harm of fat stigma. They laid the groundwork that led to changing the human rights policy for the city of Reykjavík; fat people cannot be discriminated against in employment settings within government jobs. As the city is one of the largest employers in the country, this was a large step forward for fat rights.Tara does receive her fair share of hate messages; she’s shared that she’s amazed at the lengths people will go to misunderstand what she is saying (Vilhjálmsdóttir). “This isn’t about hurt feelings; I’m not insulted [by fat stigma]. It’s about [fat stigma] affecting the livelihood of fat people and the structural discrimination they face” (Vilhjálmsdóttir). She collects the hateful comments she receives online through screenshots and shares them in an album on her page. She believes it is important to keep a repository to demonstrate to others that the hatred towards fat people is real. But the hate she receives only fuels her work more. As does the encouragement she receives from people, both in Iceland and abroad. And she is not alone; fat activists across the world are using Web 2.0 tools to change the conversation around fatness and demand civil rights for fat people (Pausé, “Rebel Heart”; Pausé, “Live to Tell").Using Web 2.0 tools as a way to protest and engage in activism is an example of oppositional technologics; a “political praxis of resistance being woven into low-tech, amateur, hybrid, alternative subcultural feminist networks” (Garrison 151). Fat activists use social media to engage in anti-assimilationist activism and build communities of practice online in ways that would not be possible in real life (Pausé, “Express Yourself” 1). This is especially useful for those whose protests sit at the intersections of oppressions (Keller 435; Pausé, “Rebel Heart” para 19). Online protests have the ability to travel the globe quickly, providing opportunities for connections between protests and spreading protests across the globe, such as SlutWalks in 2011-2012 (Schuster 19). And online spaces open up unlimited venues for women to participate more freely in protest than other forms (Harris 479; Schuster 16; Garrison 162).Whether online or offline, women are represented as dangerous in the political sphere when they act without male champions breaching norms of femininity, when their involvement challenges the role of woman as moral guardians, and when they make the body the site of protest. Women must ‘do politics’ politely, with utmost control, and of course caringly; that is they must play their ‘designated roles’. Whether or not you fit the gendered norms of political life affects how your protest is perceived through the media (van Acker). Coulter’s tweet loudly proclaimed that the fat ‘girls’ protesting the election of the 45th President of the United States were unworthy, out of control, and not worthy of attention (ironic, then, as her tweet caused considerable conversation about protest, fatness, and the reasons not to like the President-Elect). What the Coulter tweet demonstrates is that fat women are perceived as doubly-problematic in public space, both as fat and as women. They do not do politics in a way that is befitting womanhood – they are too visible and loud; they are not moral guardians of conservative values; and, their bodies challenge masculine power.ReferencesAgenda Feminist Media Collective. “Women in Society: Public Debate.” Agenda: Empowering Women for Gender Equity 10 (1991): 31-44.Bay, Kivan. “How Nazis Use Fat to Excuse Violence.” Medium, 7 Feb. 2018. 1 May 2018 <https://medium.com/@kivabay/how-nazis-use-fat-to-excuse-violence-b7da7d18fea8>.———. “Without Fat Girls, There Would Be No Protests.” Bullshit.ist, 13 Nov. 2016. 16 May 2018 <https://bullshit.ist/without-fat-girls-there-would-be-no-protests-e66690de539a>.Bliss, Katherine Elaine. Compromised Positions: Prostitution, Public Health, and Gender Politics in Revolutionary Mexico City. Penn State Press, 2010.Caha, Omer. 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