Auswahl der wissenschaftlichen Literatur zum Thema „David Berry Hospital“

Chair Elliott Antman, MD, FAHA Brigham and Women's Hospital Boston, MA Vice-Chair Robert A. Harrington, MD, FACC, FAHA Stanford University Stanford, CA Incoming Vice Chair/At Large Ken Bloch, MD, FAHA Massachusetts General Hospital Boston, MA President Donna Arnett, PhD, FAHA University of Alabama at Birmingham Birmingham, AL 3CPR, Council Program Chair Ben Abella, MD, MPhil, FACEP University of Pennsylvania Philadelphia, PA 3CPR Francois Haddad, MD Stanford University Palo Alto, CA 3CPR Fumito Ichinose, MD, PhD, FAHA Massachusetts General Hospital Boston, MA 3CPR Graham Nichol, MD, MPH, FRCP(C) University of Washington Seattle, WA At Large Lisa de las Fuentes, MD, MS, FASE Washington University School of Medicine Saint Louis, MO At Large Angel Leon, MD, FACC Emory University Hospital Midtown Atlanta, Georgia At Large Jorge Saucedo, MD, FACC, MBA University of Oklahoma Health Sciences Center Oklahoma City, OK At Large Kevin Sneed, PharmD USF College of Medicine Tampa, FL ATVB, Council Program Chair William M. Chilian, PhD, FAHA Northeastern Ohio University College of Medicine Rootstown, OH ATVB Yabing Chen, PhD, FAHA University of Alabama Birmingham, AL ATVB Gregory S. Shelness, PhD, FAHA Wake Forest University Winston-Salem, NC BCVS, Council Program Chair Yibin Wang, PhD, FAHA UCLA Los Angeles, CA BCVS Gerald W. Dorn, II, MD, FAHA Washington University School of Medicine St. Louis, MO BCVS Bjorn Knollman, MD, PhD, FAHA Vanderbilt University School of Medicine Nashville, TN BCVS Hong Wang, MD, PhD, EMBA Temple University School of Medicine Philadelphia, PA BCVS Joseph C. Wu, MD, PhD Stanford University School of Medicine Stanford, CA BCVS Jianyi (Jay) Zhang, MD, PhD, FAHA University of Minnesota Medical School Minneapolis, MN Clinical Cardiology, Council Program Chair Eric R Bates, MD, FAHA, FACC University of Michigan Medical Center Ann Arbor, MI Clinical Cardiology Monica Colvin-Adams, MD, MS University of Minnesota Minneapolis, MN Clinical Cardiology Patrick Ellinor, MD, PhD, FAHA Massachusetts General Hospital Boston, MA Clinical Cardiology Navin K. Kapur, MD Tufts Medical Center Hanover, MA Clinical Cardiology Mark S. Link, MD Tufts University School of Medicine Boston, MA Clinical Cardiology J. V. (Ian) Nixon, MD, FACC VCU Health System Richmond, VA Clinical Cardiology Manesh R. Patel, MD Duke University Durham, NC CVDY, Council Program Chair Wolfgang A. Radtke, MD, FAHA AI Dupont Hospital for Children Wilmington, DE CVDY David Dunbar Ivy, MD University of Colorado Denver School of Medicine Children's Hospital Colorado Aurora, CO CVDY Ariane Marelli, MD, MPH McGill University Health Center Montreal, Quebec, Canada CVN, Council Program Chair Nancy T. Artinian, PhD, RN, FAHA, FPCNA, FAAN Wayne State University Detroit, MI CVN Bunny J. Pozehl, RN, PhD, CRNP, FAHA UNMC College of Nursing Lincoln, NE CVN Sue Sendelbach, PhD, RN, CCNS, FAHA Abbott Northwestern Hospital Minneapolis, MN CVN Kathy Wood, RN, PhD Duke University School of Nursing Durham, NC CVRI, Council Program Chair Constantino Peña, MD Baptist Cardiac & Vascular Institute Miami, FL CVRI Sanjay Misra, MD Mayo Clinic Rochester, MN CVSA, Council Program Chair Y. Joseph Woo, MD, FAHA University of Pennsylvania Philadelphia, PA CVSA Marc Ruel, MD, MPH, FRCSC, FAHA University of Ottawa Heart Institute Ottawa, Ontario, Canada EPI, Council Program Chair Donald M. Lloyd-Jones, MD, ScM, FACC Northwestern University Feinberg School of Medicine Chicago, IL EPI Jarett D. Berry, MD UT Southwestern Medical School Dallas, TX FGTB, Council Program Chair Christopher Newton-Cheh, MD, MPH, FAHA Harvard Medical School Massachusetts General Hospital Broad Institute of Harvard and MIT Boston, MA FGTB Roberta A. Gottlieb, MD, FAHA San Diego State University San Diego, CA FGTB Jennifer L. Hall, PhD, FAHA University of Minnesota Minneapolis, MN FGTB Peipei Ping, PhD, FISHR, FAHA UCLA School of Medicine Los Angeles, CA HBPR, Council Program Chair Kenneth Baker, MD, FAHA Texas A Health Science Center, College of Medicine Temple, TX HBPR Patrice Delafontaine, MD, FAHA Tulane University School of Medicine New Orleans, LA HBPR Michael Ryan, MD, PhD, FAHA University of Mississippi Medical Center Jackson, MS KCVD, Council Program Chair Christine Maric, PhD, FAHA University of Mississippi Medical Center Jackson, MS NPAM, Council Program Chair Eliot A. Brinton, MD, FAHA University of Utah Salt Lake City, UT NPAM Caroline Fox, MD, MPH National Heart, Lung and Blood Institute Framingham, MA NPAM Paul Poirier, MD, PhD, FRCPC, FACC, FAHA Institut Universitaire de Cardiologie et de Pneumologie de Québec Québec, Québec, Canada PVD, Council Program Chair Alan T. Hirsch, MD University of Minnesota Medical School Minneapolis, MN PVD James B. Froehlich, MD, MPH University of Michigan Medical School Ann Arbor, MI PVD Christopher Kramer, MD, FAHA University of Virginia Health System Charlottesville, VA QCOR, Council Program Chair Mikhail Kosiborod, MD Saint Luke's Hospital Mid-America Heart Institute Kansas City, MO QCOR Adrian Hernandez, MD, MHS Duke Clinical Research Institute Durham, NC QCOR Henry Ting, MD, MBA, FAHA Mayo Clinic Rochester, MN Stroke, Council Program Chair Cathy A. Sila, MD, FAHA Case Medical Center Cleveland, OH Stroke, Council Michael A. De Georgia, MD, FACP, FAHA, FCCM Case Western Reserve University School of Medicine Cleveland, OH International Congress Subcommittee Eric R. Bates, MD, FAHA, FACC, Chair Robert O. Bonow, MD, Vice Chair Helene Eltchaninoff, MD Kathy E. Magliato, MD, MBA, FACS Audrey Marshall, MD Kathy Hoercher, RN International Subcommittee Robert Harrington, MD, FACC, FAHA, Chair Conville Brown, MD, MBBS, FACC, FESC Anthony J. Dalby, MB, ChB, FCP, FACC, FESC Basil Lewis, MD, FRCP Akira Matsumori, MD, PhD, FAHA, FACC, FAPSC, FESC John McMurray, BSc, MB, ChB, MD, FRCP, FESC, FACC, FAHA, FRSE Eduardo F. Mele, MD, FACC, FESC Ali Oto, MD, MD, FESC, FACC, FHRS Daniel Piniero, MD Dong Zhao, MD, PhD Inteventional Cardiology Subcommittee Manesh R. Patel, MD, Chair Duane S. Pinto, MD, MPH, Vice Chair J. Dawn Abbott, MD Deepak L. Bhatt, MD, MPH, FAHA Mauricio G. Cohen MD, FSCAI Douglas E. Drachman, MD C. Michael Gibson, MS, MD Allen Jeremias, MD, MSc W. Schuyler Jones MD David E. Kandzari, MD, FSCAI Navin K. Kapur, MD, FAHA Raj R. Makkar, MD Laura Mauri, MD, MSc Julie M. Miller, MD Seung-Jung Park, MD, PhD, Sunil V. Rao, MD Horst Sievert, MD Paul Sorajja, MD Thomas T. Tsai, MD, MSc Christopher J. White, MD, FSCAI, FAHA, FESC

The challenges and uncertainties of working in the developing field of Acute Medicine have been a regular theme for editorial comment in this journal since I took the helm in 2002. Almost four years on, with sub-specialty status confirmed, over 200 consultants and many SpRs enrolled in higher specialist training programmes throughout the UK, Acute Medicine finds itself in a much stronger position than any could have predicted at that time. Enthusiasm for the field is clear from the numbers of applicants for training programmes at SpR level, as well as the dramatic rise in attendances at acute medicine meetings across the country in the last year. However, on-going challenges remain. Eighteen months from now, Modernising Medical Careers will send shockwaves throughout hospital medicine. The exact nature of the change to our training programmes remains unclear, and will probably have changed again between my writing this and its publication. However it is essential that Acute Medicine is ready for whatever comes our way. We must work closely with our colleagues in Emergency Medicine and Critical Care to develop common stem training schemes which allow doctors to choose the area of ‘front door’ medicine which suits them best. Where possible we should seek to encourage dual accreditation in two or more of these areas. But most of all we need to maintain the momentum which has carried us so far in such a short space of time, and which has the potential to make Acute Medicine one of the largest hospital specialties. This edition’s review articles cover a varied mix of common and less common conditions on the acute medical ‘take’. Most medical admission units will be faced with at least one patient presenting with a seizure in each 24 hour period. Dr Kinton emphasises the importance of a good history in the management of this problem, but also provides some useful tips to help distinguish seizures from other causes of blackout. Distinction from syncope can be a particular challenge, not least because of the differing implications for driving, the loss of which can have devastating consequences. Acute ischaemic stroke is another common problem, the management of which is comprehensively reviewed by David Jarrett and Hemang Dave. As well as summarising some of the major trial data for thrombolytic and antiplatelet therapy, this review includes some advice on some of the common clinical challenges which don’t usually feature in text book descriptions of this condition. Less common, but no less important, Acute liver failure must be distinguished from decompensated chronic liver disease – the former often requiring discussion with a regional liver unit. Phil Berry has included a useful checklist to have to hand before making this phone call. Headache, palpitations and sweating is a common problem on the post-take ward round – particularly amongst the junior staff completing a night shift. Fortunately most junior doctors do not have a phaeochromocytoma – in common with every patient for whom I have ever requested 24 hour urinary catecholamine measurement. Having read Dr Solomon’s thorough review of the acute management of this condition I will now feel equipped to manage this condition when I finally get a positive result back from the laboratory! Apologies that this edition has been a little delayed – I hope you consider it to have been worth waiting for….

Neural tube defects (NTDs), such as spinal cord and brain defects, are due to abnormal embryonic development of the neural tube and associated with increased fetal and infant mortality, morbidity, lifelong disability, and high economic costs. Globally, more than 260,000 pregnancies are estimated to be affected by NTDs, and 75% of the NTD live births result in under-5 deaths.1 Majority of NTDs are folic acid-sensitive; with much of the NTD burden preventable through consumption of folic acid before and during early pregnancy (periconception). An association between low folate status of women of reproductive age (WRA) and risk of NTD-affected pregnancy was first proposed in 1965 by Hibbard et al.2 and was subsequently substantiated in several randomized controlled trials which demonstrated the effectiveness of folic acid supplementation during periconception in preventing the first occurrence of NTDs.3 These findings resulted in a recommendation in 1992 by the U.S. Public Health Service that WTA consume 400 μg of folic acid daily to prevent occurrence of an NTD-affected pregnancy.4 This recommendation together with other large-scale, global intervention studies demonstrated the efficacy of a daily periconceptional supplement of 400 μg in preventing a large percentage of NTDs.5 Folic acid is a synthetic, oxidized form of folate that acts as a coenzyme in the biosynthesis of DNA and RNA. With 4 mg folic acid daily, it may take 20 weeks to reach red-blood-cell folate levels between 1050 and 1340 nmol/L, which is optimal for reduction of the neural tube defect risk. Therefore, folic acid supplementation should be started 5–6 months before conception. The residual risk with optimal red-blood-cell folate levels is reportedly 4.5 per 10,000 total births whereas the residual risk in pooled data from countries with mandatory folic acid fortification is 7.5 per 10,000 pregnancies, regardless of pre-fortification rates.6 In one study, the optimal RBC folate level was achieved in 80.4% of women who started FA 400 μg 4–8 weeks before their last menstrual period (LMP) compared to only 53.6% in women who started 4–8 weeks after their LMP (P < 0.001). 7 A worldwide survey of folic acid supplementation in WRA showed inadequate compliance to folic acid intake.8 A systematic review and meta-analysis of pooled prevalence estimates of folic acid compliance showed 32–51% in North America, 9–78% in Europe, 21–46% in Asia, 4–34% in the Middle East, 32–39% in Australia/New Zealand, and 0% in Africa. Poor compliance was secondary to many factors. In the United States, the recommendation of 400 μg supplemental intake of folic acid daily has limitations as many pregnancies, including up to 50% of all pregnancies are unplanned.9 In many countries, particularly among low- and middle-income countries, many barriers exist for the access of WRA to folic acid supplements, such as procurement of the micronutrients in a relatively costly prepackaged form and ineffective distribution system. An evaluation of NTD trends in multiple countries indicated that, regardless of form, timing, or intended target, issuing recommendations on folic acid use alone, in the absence of fortification, had no detectable impact on NTD incidence. Thus, food fortification with folic acid has been a component of national public health strategies; in particular, where folate status is insufficient and a fortifiable food vehicle, processed by a centralized industry is consumed regularly by WRA.10,11 Other factors associated with poor compliance in folic acid intake include low income, smoking during pregnancy, alcohol consumption, multiple pregnancy, geographic location, and religious beliefs. On the other hand, preconception counselling, previous infertility therapy, multivitamin intake before pregnancy, older age planned pregnancy, previous infertility therapy, and multivitamin intake before pregnancy increased compliance.12-16 Women who also believed that they had good general and obstetric health (e.g., no history of illness or miscarriage) had attitudes of not being susceptible to the health consequences of not taking folic acid supplements and were the low users of folic acid supplement.17 In the Philippines, although WRA are advised to consume 320 ug dietary folate equivalent per day,18 about 0.9 % (around 1 in 5) are folate-deficient based on red cell folate count, while 38.7% (around 2 in 5) are folate-deficient based on serum folate.19 Congenital malformations including NTDs remain in the top ten leading causes of infant mortality from 1960 to 2005.20 In the index paper of Bernardo21 a cross-sectional, cluster sampling survey of 184 healthy, pregnant women, of age 15–49 years was conducted in the Batangas province from May to July 2017 to assess the level of knowledge, attitude, and perceived practice among the subjects on the importance of folate periconceptionally. A pretested interview questionnaire was used. The mean scores were 77% (moderate level) for knowledge, 82% for positive attitude, and 71% for positive perceived practice. The scores in the survey were related to patient’s age, civil status and to some extent, education. The study suggested that while respondents knew about folate (70%), they had low knowledge of the effect of its deficiency especially as it can lead to infant death. Knowledge had significant and positive moderate correlation with attitude (r = 0.7) and perceived practice (r = 0.5), but there was a weak positive correlation between attitude and perceived practice (r = 0.4). This likely indicates failure to emphasize the translation of knowledge and awareness properly and sufficiently into actual practice. As recommended by the author, education is the principal means to achieve the desired outcome. However, it is not clear in the study whether some amount of educational intervention besides determination of prevalence was included. As in any prevalence study, the golden opportunity to improve health outcomes is to accompany the survey with educational intervention, which in many instances, is required by the institutional board review. Some regression analysis of the data may also have been useful to determine which factors contributed most to the outcome measures. Enrique M. Ostrea, Jr., MD Wayne State University Hutzel Women’s Hospital Children’s Hospital of Michigan Detroit, Michigan, United States of America; National Institutes of Health University of the Philippines, Manila REFERENCES Blencowe H, Kancherla V, Moorthie S, Darlison D, Modell B. Estimates of global and regional prevalence of neural tube defects for 2015: a systematic analysis. Ann NY Acad Sci. 2018; 1414:31-46. Hibbard B, Hibbard E, Jeffcoate J. Folic acid and reproduction. Acta Obstet Gynecol Scand. 1965; 44:375-400. MRC Vitamin Study Research Group. Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. Lancet 1991; 338:131-7. Centers for Disease Control and Prevention. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR Recomm Rep. 1992; 11:1-7. Berry R, Li Z, Erickson J, Li S, Moore C, Wang H, et al. Prevention of neural-tube defects with folic acid in China. N Engl J Med. 1999; 341:1485-890. Cawley S, McCartney D, Woodside J, Sweeney M, McDonnell R, Molloy A, et al. Optimization of folic acid supplementation in the prevention of neural tube defects. J Public Health (Oxf ). 2018; 40:827-34. van Gool J, Hirche H, Lax H, De Schaepdrijver L. Folic acid and primary prevention of neural tube defects: A review. Reprod Toxicol. 2018; 80:73-84. Crider K, Bailey L, Berry R. 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Eur J Obstet Gynecol Reprod Biol. 2014 May; 176:99-103. Philippine Dietary and Reference Intakes. Food and Nutrition Research Institute - Department of Science and Technology (FNRIDOST). 2015. DOST Complex, FNRI Bldg., Bicutan, Taguig City, Metro Manila Philippines. Available from: https://www.fnri.dost.gov.ph/images/images/news/PDRI-2018.pdf. Desnacido JA, Cheong RL, Madriaga JR, Perlas IA & Marcos JM. Folate status of Filipino women of childbearing age: Philippines 2008. [Internet]. [cited 2019 May]. Available from: http://122.53.86.125/Seminar%20Series/38th/folate%20status_filipino%20women.pdf. David-Padilla C, Cutiongco-dela Paz E, Cavan BC, Abarquez C, Sur ALD, Sale RI, et al. Establishment of the Philippine Birth Defects Surveillance. Acta Med Philipp. 2011; 45 (4). [Internet]. [cited 2019 May]. Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source. Bernardo A. 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Tujuan dari penelitian ini yaitu untuk menganalisis pengaruh persepsi kualitas, sikap pada iklan tv, dan brand image terhadap niat beli ulang pada konsumen mie instan merek indomie di Kota Pontianak. Berdasarkan tujuan penelitian ini, maka jenis penelitian yang diambil oleh peneliti adalah kuantitatif, yaitu penelitian yang data-datanya berupa angka. Pengumpulan data menggunakan data primer berupa kuesioner dan wawancara, pada penelitian ini menggunakan sampel sebanyak 100 orang. Penelitian ini menggunakan analisis Regresi Linear Berganda. Berdasarkan hasil pengamatan dan analisis data, maka dapat disimpulkan sebagai berikut: Adanya pengaruh antara persepsi kualitas, sikap pada iklan tv dan brand image terhadap niat beli ulang, hal ini menunjukkan bahwa semakin baik persepsi konsumen terhadap kualitas produk indomie, iklan yang ditampilkan di televisi mampu menarik niat konsumen dan citra merek yang tertanam dibenak konsumen, semakin tinggi keinginan melakukan pembelian terhadap produk indomie. Kata Kunci : Persepsi Kualitas, Sikap Pada Iklan TV, Brand Image dan Niat Beli UlangDAFTAR PUSTAKA Aaker, David A. 1997. Ekuitas Merek, Edisi Indonesia. Jakarta: Mitra Utama.Abdul Aziz Dahlan, 1999. Ensiklopedi Hukum Islam Jilid 4, Jakarta : PT . Ikhtiar Baru Van Hoeve.Amalia E Maulana, 2005, Selebriti Sebagai Bintang Iklan Majalah .SWA. (online) Senin, 10 Oktober, http://www.swa.com.Arikunto, Suharsimi. 2009. Prosedur Penelitian suatu Pendekatan Praktek. Jakarta: Rineka Cipta.Bagozzi R.P. 1979. 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This essay combines life writing with meditations on the significance of walking as integral to the ritual practice of pilgrimage, where the individual improves her soul or health through the act of walking to a shrine containing healing relics of a saint. Braiding together insights from medieval literature, contemporary ecocriticism, and memory studies, I reflect on my own pilgrimage practice as it impacts the land itself. Canterbury, England serves as the central shrine for four pilgrimages over decades: 1966, 1994, 1997, and 2003.The act of memory was not invented in the Anthropocene. Rather, the nonhuman world has taught humans how to remember. From ice-core samples retaining the history of Europe’s weather to rocks embedded with fossilized extinct species, nonhuman actors literally petrifying or freezing the past—from geologic sites to frozen water—become exposed through the process of anthropocentric discovery and human interference. The very act of human uncovery and analysis threatens to eliminate the nonhuman actor which has hospitably shared its own experience. How can humans script nonhuman memory?As for the history of memory studies itself, a new phase is arguably beginning, shifting from “the transnational, transcultural, or global to the planetary; from recorded to deep history; from the human to the nonhuman” (Craps et al. 3). Memory studies for the Anthropocene can “focus on the terrestrialized significance of (the historicized) forms of remembrance but also on the positioning of who is remembering and, ultimately, which ‘Anthropocene’ is remembered” (Craps et al. 5). In this era of the “self-conscious Anthropocene” (Craps et al. 6), narrative itself can focus on “the place of nonhuman beings in human stories of origins, identity, and futures point to a possible opening for the methods of memory studies” (Craps et al. 8). The nonhuman on the paths of this essay range from the dirt on the path to the rock used to build the sacred shrine, the ultimate goal. How they intersect with human actors reveals how the “human subject is no longer the one forming the world, but does indeed constitute itself through its relation to and dependence on the object world” (Marcussen 14, qtd. in Rodriguez 378). Incorporating “nonhuman species as objects, if not subjects, of memory [...] memory critics could begin by extending their objects to include the memory of nonhuman species,” linking both humans and nonhumans in “an expanded multispecies frame of remembrance” (Craps et al. 9). My narrative—from diaries recording sacred journey to a novel structured by pilgrimage—propels motion, but also secures in memory events from the past, including memories of those nonhuman beings I interact with.Childhood PilgrimageThe little girl with brown curls sat crying softly, whimpering, by the side of the road in lush grass. The mother with her soft brown bangs and an underflip to her hair told the story of a little girl, sitting by the side of the road in lush grass.The story book girl had forgotten her Black Watch plaid raincoat at the picnic spot where she had lunched with her parents and two older brothers. Ponchos spread out, the family had eaten their fresh yeasty rolls, hard cheese, apples, and macaroons. The tin clink of the canteen hit their teeth as they gulped metallic water, still icy cold from the taps of the ancient inn that morning. The father cut slices of Edam with his Swiss army knife, parsing them out to each child to make his or her own little sandwich. The father then lay back for his daily nap, while the boys played chess. The portable wooden chess set had inlaid squares, each piece no taller than a fingernail paring. The girl read a Junior Puffin book, while the mother silently perused Agatha Christie. The boy who lost at chess had to play his younger sister, a fitting punishment for the less able player. She cheerfully played with either brother. Once the father awakened, they packed up their gear into their rucksacks, and continued the pilgrimage to Canterbury.Only the little Black Watch plaid raincoat was left behind.The real mother told the real girl that the story book family continued to walk, forgetting the raincoat until it began to rain. The men pulled on their ponchos and the mother her raincoat, when the little girl discovered her raincoat missing. The story book men walked two miles back while the story book mother and girl sat under the dripping canopy of leaves provided by a welcoming tree.And there, the real mother continued, the storybook girl cried and whimpered, until a magic taxi cab in which the father and boys sat suddenly appeared out of the mist to drive the little girl and her mother to their hotel.The real girl’s eyes shone. “Did that actually happen?” she asked, perking up in expectation.“Oh, yes,” said the real mother, kissing her on the brow. The girl’s tears dried. Only the plops of rain made her face moist. The little girl, now filled with hope, cuddled with her mother as they huddled together.Without warning, out of the mist, drove up a real magic taxi cab in which the real men sat. For magic taxi cabs really exist, even in the tangible world—especially in England. At the very least, in the England of little Susie’s imagination.Narrative and PilgrimageMy mother’s tale suggests how this story echoes in yet another pilgrimage story, maintaining a long tradition of pilgrimage stories embedded within frame tales as far back as the Middle Ages.The Christian pilgrim’s walk parallels Christ’s own pilgrimage to Emmaus. The blisters we suffer echo faintly the lash Christ endured. The social relations of the pilgrim are “diachronic” (Alworth 98), linking figures (Christ) from the past to the now (us, or, during the Middle Ages, William Langland’s Piers Plowman or Chaucer’s band who set out from Southwark). We embody the frame of the vera icon, the true image, thus “conjur[ing] a site of simultaneity or a plane of immanence where the actors of the past [...] meet those of the future” (Alworth 99). Our quotidian walk frames the true essence or meaning of our ambulatory travail.In 1966, my parents took my two older brothers and me on the Pilgrims’ Way—not the route from London to Canterbury that Chaucer’s pilgrims would have taken starting south of London in Southwark, rather the ancient trek from Winchester to Canterbury, famously chronicled in The Old Road by Hilaire Belloc. The route follows along the south side of the Downs, where the muddy path was dried by what sun there was. My parents first undertook the walk in the early 1950s. Slides from that pilgrimage depict my mother, voluptuous in her cashmere twinset and tweed skirt, as my father crosses a stile. My parents, inspired by Chaucer’s Canterbury Tales, decided to walk along the traditional Pilgrims’ Way to Canterbury. Story intersects with material traversal over earth on dirt-laden paths.By the time we children came along, the memories of that earlier pilgrimage resonated with my parents, inspiring them to take us on the same journey. We all carried our own rucksacks and walked five or six miles a day. Concerning our pilgrimage when I was seven, my mother wrote in her diary:As good pilgrims should, we’ve been telling tales along the way. Yesterday Jimmy told the whole (detailed) story of That Darn Cat, a Disney movie. Today I told about Stevenson’s Travels with a Donkey, which first inspired me to think of walking trips and everyone noted the resemblance between Stevenson’s lovable, but balky, donkey and our sweet Sue. (We hadn’t planned to tell tales, but they just happened along the way.)I don’t know how sweet I was; perhaps I was “balky” because the road was so hard. Landscape certainly shaped my experience.As I wrote about the pilgrimage in my diary then, “We went to another Hotel and walked. We went and had lunch at the Boggly [booglie] place. We went to a nother hotel called The Swan with fether Quits [quilts]. We went to the Queens head. We went to the Gest house. We went to aother Hotle called Srping wells and my tooth came out. We saw some taekeys [turkeys].” The repetition suggests how pilgrimage combines various aspects of life, from the emotional to the physical, the quotidian (walking and especially resting—in hotels with quilts) with the extraordinary (newly sprung tooth or the appearance of turkeys). “[W]ayfaring abilities depend on an emotional connection to the environment” (Easterlin 261), whether that environment is modified by humans or even manmade, inhabited by human or nonhuman actors. How can one model an “ecological relationship between humans and nonhumans” in narrative (Rodriguez 368)? Rodriguez proposes a “model of reading as encounter [...] encountering fictional story worlds as potential models” (Rodriguez 368), just as my mother did with the Magic Taxi Cab story.Taxis proliferate in my childhood pilgrimage. My mother writes in 1966 in her diary of journeying along the Pilgrims’ Way to St. Martha’s on the Hill. “Susie was moaning and groaning under her pack and at one desperate uphill moment gasped out, ‘Let’s take a taxi!’ – our highborn lady as we call her. But we finally made it.” “Martha’s”, as I later learned, is a corruption of “Martyrs”, a natural linguistic decay that developed over the medieval period. Just as the vernacular textures pilgrimage poems in the fourteeth century, the common tongue in all its glorious variety seeps into even the quotidian modern pilgrim’s journey.Part of the delight of pilgrimage lies in the characters one meets and the languages they speak. In 1994, the only time my husband and I cheated on a strictly ambulatory sacred journey occurred when we opted to ride a bus for ten miles where walking would have been dangerous. When I ask the bus driver if a stop were ours, he replied, “I'll give you a shout, love.” As though in a P. G. Wodehouse novel, when our stop finally came, he cried out, “Cheerio, love” to me and “Cheerio, mate” to Jim.Language changes. Which is a good thing. If it didn’t, it would be dead, like those martyrs of old. Like Latin itself. Disentangling pilgrimage from language proves impossible. The healthy ecopoetics of languages meshes with the sustainable vibrancy of the land we traverse.“Nettles of remorse…”: Derek Walcott, The Bounty Once my father had to carry me past a particularly tough patch of nettles. As my mother tells it, we “went through orchards and along narrow woodland path with face-high nettles. Susie put a scarf over her face and I wore a poncho though it was sunny and we survived almost unscathed.” Certain moments get preserved by the camera. At age seven in a field outside of Wye, I am captured in my father’s slides surrounded by grain. At age thirty-five, I am captured in film by my husband in the same spot, in the identical pose, though now quite a bit taller than the grain. Three years later, as a mother, I in turn snap him with a backpack containing baby Sarah, grumpily gazing off over the fields.When I was seven, we took off from Detling. My mother writes, “set off along old Pilgrims’ Way. Road is paved now, but much the same as fifteen years ago. Saw sheep, lambs, and enjoyed lovely scenery. Sudden shower sent us all to a lunch spot under trees near Thurnham Court, where we huddled under ponchos and ate happily, watching the weather move across the valley. When the sun came to us, we continued on our way which was lovely, past sheep, etc., but all on hard paved road, alas. Susie was a good little walker, but moaned from time to time.”I seem to whimper and groan a lot on pilgrimage. One thing is clear: the physical aspects of walking for days affected my phenomenological response to our pilgrimage which we’d undertaken both as historical ritual, touristic nature hike, and what Wendell Berry calls a “secular pilgrimage” (402), where the walker seeks “the world of the Creation” (403) in a “return to the wilderness in order to be restored” (416). The materiality of my experience was key to how I perceived this journey as a spiritual, somatic, and emotional event. The link between pilgrimage and memory, between pilgrimage poetics and memorial methods, occupies my thoughts on pilgrimage. As Nancy Easterlin’s work on “cognitive ecocriticism” (“Cognitive” 257) contends, environmental knowledge is intimately tied in with memory (“Cognitive” 260). She writes: “The advantage of extensive environmental knowledge most surely precipitates the evolution of memory, necessary to sustain vast knowledge” (“Cognitive” 260). Even today I can recall snatches of moments from that trip when I was a child, including the telling of tales.Landscape not only changes the writer, but writing transforms the landscape and our interaction with it. As Valerie Allen suggests, “If the subject acts upon the environment, so does the environment upon the subject” (“When Things Break” 82). Indeed, we can understand the “road as a strategic point of interaction between human and environment” (Allen and Evans 26; see also Oram)—even, or especially, when that interaction causes pain and inflames blisters. My relationship with moleskin on my blasted and blistered toes made me intimately conscious of my body with every step taken on the pilgrimage route.As an adult, my boots on the way from Winchester to Canterbury pinched and squeezed, packed dirt acting upon them and, in turn, my feet. After taking the train home and upon arrival in London, we walked through Bloomsbury to our flat on Russell Square, passing by what I saw as a new, less religious, but no less beckoning shrine: The London Foot Hospital at Fitzroy Square.Now, sadly, it is closed. Where do pilgrims go for sole—and soul—care?Slow Walking as WayfindingAll pilgrimages come to an end, just as, in 1966, my mother writes of our our arrival at last in Canterbury:On into Canterbury past nice grassy cricket field, where we sat and ate chocolate bars while we watched white-flannelled cricketers at play. Past town gates to our Queen’s Head Inn, where we have the smallest, slantingest room in the world. Everything is askew and we’re planning to use our extra pillows to brace our feet so we won’t slide out of bed. Children have nice big room with 3 beds and are busy playing store with pounds and shillings [that’s very hard mathematics!]. After dinner, walked over to cathedral, where evensong was just ending. Walked back to hotel and into bed where we are now.Up to early breakfast, dashed to cathedral and looked up, up, up. After our sins were forgiven, we picked up our rucksacks and headed into London by train.This experience in 1966 varies slightly from the one in 1994. Jim and I walk through a long walkway of tall, slim trees arching over us, a green, lush and silent cloister, finally gaining our first view of Canterbury with me in a similar photo to one taken almost thirty years before. We make our way into the city through the West Gate, first passing by St. Dunstan’s Church where Henry II had put on penitential garb and later Sir Thomas More’s head was buried. Canterbury is like Coney Island in the Middle Ages and still is: men with dreadlocks and slinky didjeridoos, fire tossers, mobs of people, tourists. We go to Mercery Lane as all good pilgrims should and under the gate festooned with the green statue of Christ, arriving just in time for evensong.Imagining a medieval woman arriving here and listening to the service, I pray to God my gratefulness for us having arrived safely. I can understand the fifteenth-century pilgrim, Margery Kempe, screaming emotionally—maybe her feet hurt like mine. I’m on the verge of tears during the ceremony: so glad to be here safe, finally got here, my favorite service, my beloved husband. After the service, we pass on through the Quire to the spot where St. Thomas’s relic sanctuary was. People stare at a lit candle commemorating it. Tears well up in my eyes.I suppose some things have changed since the Middle Ages. One Friday in Canterbury with my children in 2003 has some parallels with earlier iterations. Seven-year-old Sarah and I go to evensong at the Cathedral. I tell her she has to be absolutely quiet or the Archbishop will chop off her head.She still has her head.Though the road has been paved, the view has remained virtually unaltered. Some aspects seem eternal—sheep, lambs, and stiles dotting the landscape. The grinding down of the pilgrimage path, reflecting the “slowness of flat ontology” (Yates 207), occurs over vast expanses of time. Similarly, Easterlin reflects on human and more than human vitalism: “Although an understanding of humans as wayfinders suggests a complex and dynamic interest on the part of humans in the environment, the surround itself is complex and dynamic and is frequently in a state of change as the individual or group moves through it” (Easterlin “Cognitive” 261). An image of my mother in the 1970s by a shady tree along the Pilgrims’ Way in England shows that the path is lower by 6 inches than the neighboring verge (Bright 4). We don’t see dirt evolving, because its changes occur so slowly. Only big time allows us to see transformative change.Memorial PilgrimageOddly, the erasure of self through duplication with a precursor occurred for me while reading W.G. Sebald’s pilgrimage novel, The Rings of Saturn. I had experienced my own pilgrimage to many of these same locations he immortalizes. I, too, had gone to Somerleyton Hall with my elderly mother, husband, and two children. My memories, sacred shrines pooling in familial history, are infused with synchronic reflection, medieval to contemporary—my parents’ periodic sojourns in Suffolk for years, leading me to love the very landscape Sebald treks across; sadness at my parents’ decline; hope in my children’s coming to add on to their memory palimpsest a layer devoted to this land, to this history, to this family.Then, the oddest coincidence from my reading pilgrimage. After visiting Dunwich Heath, Sebald comes to his friend, Michael, whose wife Anne relays a story about a local man hired as a pallbearer by the local undertaker in Westleton. This man, whose memory was famously bad, nevertheless reveled in the few lines allotted him in an outdoor performance of King Lear. After her relating this story, Sebald asks for a taxi (Sebald 188-9).This might all seem unremarkable to the average reader. Yet, “human wayfinders are richly aware of and responsive to environment, meaning both physical places and living beings, often at a level below consciousness” (Easterlin “Cognitive” 265). For me, with a connection to this area, I startled with recollection emerging from my subconscience. The pallbearer’s name in Sebald’s story was Mr Squirrel, the very same name of the taxi driver my parents—and we—had driven with many times. The same Mr Squirrel? How many Mr Squirrels can there be in this small part of Suffolk? Surely it must be the same family, related in a genetic encoding of memory. I run to my archives. And there, in my mother’s address book—itself a palimpsest of time with names and addressed scored through; pasted-in cards, names, and numbers; and looseleaf memoranda—there, on the first page under “S”, “Mr. Squirrel” in my mother’s unmistakable scribble. She also had inscribed his phone number and the village Saxmundum, seven miles from Westleton. His name had been crossed out. Had he died? Retired? I don’t know. Yet quick look online tells me Squirrell’s Taxis still exists, as it does in my memory.Making KinAfter accompanying a class on a bucolic section of England’s Pilgrims’ Way, seven miles from Wye to Charing, we ended up at a pub drinking a pint, with which all good pilgrimages should conclude. There, students asked me why I became a medievalist who studies pilgrimage. Only after the publication of my first book on women pilgrims did I realize that the origin of my scholarly, long fascination with pilgrimage, blossoming into my professional career, began when I was seven years old along the way to Canterbury. The seeds of that pilgrimage when I was so young bore fruit and flowers decades later.One story illustrates Michel Serres’s point that we should not aim to appropriate the world, but merely act as temporary tenants (Serres 72-3). On pilgrimage in 1966 as a child, I had a penchant for ant spiders. That was not the only insect who took my heart. My mother shares how “Susie found a beetle up on the hill today and put him in the cheese box. Jimmy put holes in the top for him. She named him Alexander Beetle and really became very fond of him. After supper, we set him free in the garden here, with appropriate ceremony and a few over-dramatic tears of farewell.” He clearly made a great impression on me. I yearn for him today, that beetle in the cheese box. Though I tried to smuggle nature as contraband, I ultimately had to set him free.Passing through cities, landscape, forests, over seas and on roads, wandering by fields and vegetable patches, under a sky lit both by sun and moon, the pilgrim—even when in a group of fellow pilgrims—in her lonesome exercise endeavors to realize Serres’ ideal of the tenant inhabitant of earth. Nevertheless, we, as physical pilgrims, inevitably leave our traces through photos immortalizing the journey, trash left by the wayside, even excretions discretely deposited behind a convenient bush. Or a beetle who can tell the story of his adventure—or terror—at being ensconced for a time in a cheese box.On one notorious day of painful feet, my husband and I arrived in Otford, only to find the pub was still closed. Finally, it became time for dinner. We sat outside, me with feet ensconced in shoes blessedly inert and unmoving, as the server brought out our salads. The salad cream, white and viscous, was presented in an elegantly curved silver dish. Then Jim began to pick at the salad cream with his fork. Patiently, tenderly, he endeavored to assist a little bug who had gotten trapped in the gooey sauce. Every attempt seemed doomed to failure. The tiny creature kept falling back into the gloppy substance. Undaunted, Jim compassionately ministered to our companion. Finally, the little insect flew off, free to continue its own pilgrimage, which had intersected with ours in a tiny moment of affinity. Such moments of “making kin” work, according to Donna Haraway, as “life-saving strateg[ies] for the Anthropocene” (Oppermann 3, qtd. in Haraway 160).How can narrative avoid the anthropocentric centre of writing, which is inevitable given the human generator of such a piece? While words are a human invention, nonhuman entities vitally enact memory. The very Downs we walked along were created in the Cretaceous period at least seventy million years ago. The petrol propelling the magic taxi cab was distilled from organic bodies dating back millions of years. Jurassic limestone from the Bathonian Age almost two hundred million years ago constitutes the Caen stone quarried for building Canterbury Cathedral, while its Purbeck marble from Dorset dates from the Cretaceous period. Walking on pilgrimage propels me through a past millions—billions—of eons into the past, dwarfing my speck of existence. Yet, “if we wish to cross the darkness which separates us from [the past] we must lay down a little plank of words and step delicately over it” (Barfield 23). Elias Amidon asks us to consider how “the ground we dig into and walk upon is sacred. It is sacred because it makes us neighbors to each other, whether we like it or not. Tell this story” (Amidon 42). And, so, I have.We are winding down. Time has passed since that first pilgrimage of mine at seven years old. Yet now, here, I still put on my red plaid wollen jumper and jacket, crisp white button-up shirt, grey knee socks, and stout red walking shoes. Slinging on my rucksack, I take my mother’s hand.I’m ready to take my first step.We continue our pilgrimage, together.ReferencesAllen, Valerie. “When Things Break: Mending Rroads, Being Social.” Roadworks: Medieval Britain, Medieval Roads. Eds. Valerie Allen and Ruth Evans. Manchester: Manchester UP, 2016.———, and Ruth Evans. Introduction. Roadworks: Medieval Britain, Medieval Roads. Eds. Valerie Allen and Ruth Evans. Manchester: Manchester UP, 2016.Alworth, David J. Site Reading: Fiction, Art, Social Form. Princeton: Princeton UP, 2016.Amidon, Elias. “Digging In.” Dirt: A Love Story. Ed. Barbara Richardson. Lebanon, NH: ForeEdge, 2015.Barfield, Owen. History in English Words. Grand Rapids: William B. 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The American Broadcasting Company (ABC) Family Network show Switched at Birth tells two stories—one which follows the unique plot of the show, and one about the new openness of television executives toward integrating more people with a variety of visible and invisible physical embodiments, such as hearing loss, into television content. It first aired in 2011 and in 2017 aired its fifth and final season.The show focuses on two teen girls in Kansas City who find out they were switched due to a hospital error on the day of their birth and who grew up with parents who were not biologically related to them. One, Bay Kennish (Vanessa Marano), lives with her wealthy parents—a stay-at-home mom Kathryn (Lea Thompson) and a former professional baseball player, now businessman, father John (D.W. Moffett). She has an older brother Toby (Lucas Grabeel) who is into music. In her high school science class, Bay learns about blood types and discovers her parents’ blood types could not have produced her. The family has professional genetic tests done and discovers the switch (ABC Family, “This Is Not a Pipe”).In the pilot episode, Bay’s parents find out that deaf teen, Daphne Vasquez (Katie Leclerc), is actually their daughter. She lives in a working class Hispanic neighbourhood with her hairdresser single mother Regina (Constance Marie) and grandmother Adrianna (Ivonne Coll), both of whom are of Puerto Rican ancestry. Daphne is deaf due to a case of meningitis when she was three, which the rich Kennishes feel happened because of inadequate healthcare provided by working class Regina. Daphne attends an all-deaf school, Carlton.The man who was thought to be her biological father, Angelo Sorrento (Gilles Marini), doesn’t appear in the show until episode 10 but becomes a series regular in season 2. It becomes apparent that Daphne believes her father left because of her deafness; however, as the first season progresses, the real reasons begin to emerge. From the pilot onwards, the show dives into clashes of language, culture, ethnicity, class, and even physical appearance—in one scene in the pilot, the waspy Kennishes ask Regina if she is “Mexican.” As later episodes reveal, many of these physical appearance issues are revealed to have fractured the Vasquez family early on—Daphne is a freckled, strawberry blonde, and her father (who is French and Italian) suspected infidelity.The two families merge when the Kennishes ask Daphne and her mother to move into their guest house in order get to know their daughter better. That forces the Kennishes into the world of deafness, and throughout the show this hearing family therefore becomes a surrogate for a hearing audience’s immersion into Deaf culture.Cultural Inclusivity: The Way ForwardShow creator Lizzy Weiss explained that it was actually the ABC Family network that “suggested making one of the kids disabled” (Academy of Television Arts & Sciences). Weiss was familiar with American Sign Language (ASL) because she had a “classical theatre of the Deaf” course in college. She said, “I had in the back of my head a little bit of background at least about how beautiful the language was. So I said, ‘What if one of the girls is deaf?’” The network thought it was wonderful idea, so she began researching the Deaf community, including spending time at a deaf high school in Los Angeles called Marlton, on which she modelled the Switched at Birth school, Carlton. Weiss (Academy of Television Arts & Sciences) says of the school visit experience:I learned so much that day and spoke to dozens of deaf teenagers about their lives and their experiences. And so, this is, of course, in the middle of writing the pilot, and I said to the network, you know, deaf kids wouldn’t voice orally. We would have to have those scenes only in ASL, and no sound and they said, ‘Great. Let’s do it.’ And frankly, we just kind of grew and grew from there.To accommodate the narrative structure of a television drama, Weiss said it became clear from the beginning that the show would need to use SimCom (simultaneous communication or sign supported speech) for the hearing or deaf characters who were signing so they could speak and sign at the same time. She knew this wasn’t the norm for two actual people communicating in ASL, but the production team worried about having a show that was heavily captioned as this might distance its key—overwhelmingly hearing—teen audience who would have to pay attention to the screen during captioned scenes. However, this did not appear to be the case—instead, viewers were drawn to the show because of its unique sign language-influenced television narrative structure. The show became popular very quickly and, with 3.3 million viewers, became the highest-rated premiere ever on the ABC Family network (Barney).Switched at Birth also received much praise from the media for allowing its deaf actors to communicate using sign language. The Huffington Post television critic Maureen Ryan said, “Allowing deaf characters to talk to each other directly—without a hearing person or a translator present—is a savvy strategy that allows the show to dig deeper into deaf culture and also to treat deaf characters as it would anyone else”. Importantly, it allowed the show to be unique in a way that was found nowhere else on television. “It’s practically avant-garde for television, despite the conventional teen-soap look of the show,” said Ryan.Usually a show’s success is garnered by audience numbers and media critique—by this measure Switched at Birth was a hit. However, programs that portray a disability—in any form—are often the target of criticism, particularly from the communities they attempting to represent. It should be noted that, while actress Katie Leclerc, who plays Daphne, has a condition, Meniere’s disease, which causes hearing loss and vertigo on an intermittent basis, she does not identify as a deaf actress and must use a deaf accent to portray Daphne. However, she is ASL fluent, learning it in high school (Orangejack). This meant her qualifications met the original casting call which said “actress must be deaf or hard of hearing and must speak English well, American Sign Language preferred” (Paz, 2010) Leclerc likens her role to that of any actor to who has to affect body and vocal changes for a role—she gives the example of Hugh Laurie in House, who is British with no limp, but was an American who uses a cane in that show (Bibel).As such, initially, some in the Deaf community complained about her casting though an online petition with 140 signatures (Nielson). Yet many in the Deaf community softened any criticism of the show when they saw the production’s ongoing attention to Deaf cultural details (Grushkin). Finally, any lingering criticisms from the Deaf community were quieted by the many deaf actors hired for the show who perform using ASL. This includes Sean Berdy, who plays Daphne’s best friend Emmett, his onscreen mother, played by actress Marlee Matlin, and Anthony Natale who plays his father; their characters both sign and vocalize in the show. The Emmett character only communicates in ASL and does not vocalise until he falls in love with the hearing character Bay—even then he rarely uses his voice.This seemingly all-round “acceptance” of the show gave the production team more freedom to be innovative—by season 3 the audience was deemed to be so comfortable with captions that the shows began to feature less SimCom and more all-captioned scenes. This lead to the full episode in ASL, a first on American mainstream television.For an Hour, Welcome to Our WorldSwitched at Birth writer Chad Fiveash explained that when the production team came up with the idea for a captioned all-ASL episode, they “didn’t want to do the ASL episode as a gimmick. It needed to be thematically resonant”. As a result, they decided to link the episode to the most significant event in American Deaf history, an event that solidified its status as a cultural community—the 1988 Deaf President Now (DPN) protest at Gallaudet University in Washington. This protest inspired the March 2013 episode for Switched at Birth and aired 25 years to the week that the actual DPN protest happened. This episode makes it clear the show is trying to completely embrace Deaf culture and wants its audience to better understand Deaf identity.DPN was a pivotal moment for Deaf people—it truly solidified members of a global Deaf community who felt more empowered to fight for their rights. Students demanded that Gallaudet—as the premier university for deaf and hard-of-hearing students—no longer have a hearing person as its president. The Gallaudet board of trustees, the majority of whom were hearing, tried to force students and faculty to accept a hearing president; their attitude was that they knew what was best for the deaf persons there. For eight days, deaf people across America and the world rallied around the student protestors, refusing to give in until a deaf president was appointed. Their success came in the form of I. King Jordan, a deaf man who had served as dean of the College of Arts & Sciences at the time of the protest.The event was covered by media around the world, giving the American Deaf community international attention. Indeed, Gallaudet University says the DPN protest symbolized more than just the hiring of a Deaf president; it brought Deaf issues before the public and “raised the nation’s consciousness of the rights and abilities of deaf and hard of hearing people” (Gallaudet University).The activities of the students and their supporters showed dramatically that in the 1980s deaf people could be galvanized to unite around a common issue, particularly one of great symbolic meaning, such as the Gallaudet presidency. Gallaudet University represents the pinnacle of education for deaf people, not only in the United States but throughout the world. The assumption of its presidency by a person himself deaf announced to the world that deaf Americans were now a mature minority (Van Cleve and Crouch, 172).Deaf people were throwing off the oppression of the hearing world by demanding that their university have someone from their community at its helm. Jankowski (Deaf Empowerment; A Metaphorical Analysis of Conflict) studied the Gallaudet protest within the framework of a metaphor. She found a recurring theme during the DPN protest to be Gallaudet as “plantation”—which metaphorically refers to deaf persons as slaves trying to break free from the grip of the dominant mastery of the hearing world—and she parallels the civil rights movement of African Americans in the 1960s. As an example, Gallaudet was referred to as the “Selma of the Deaf” during the protest, and protest signs used the language of Martin Luther King such as “we still have a dream.” For deaf Americans, the presidency of Gallaudet became a symbol of hope for the future. As Jankowski attests:deaf people perceived themselves as possessing the ability to manage their own kind, pointing to black-managed organization, women-managed organizations, etc., struggling for that same right. They argued that it was a fight for their basic human rights, a struggle to free themselves, to release the hold their ‘masters’ held on them. (“A Metaphorical Analysis”)The creators of the Switched at Birth episode wanted to ensure of these emotions, as well as historical and cultural references, were prevalent in the modern-day, all-ASL episode, titled Uprising. That show therefore wanted to represent both the 1988 DPN protest as well as a current issue in the US—the closing of deaf schools (Anderson). The storyline focuses on the deaf students at the fictitious Carlton School for the Deaf seizing one of the school buildings to stage a protest because the school board has decided to shut down the school and mainstream the deaf students into hearing schools. When the deaf students try to come up with a list of demands, conflicts arise about what the demands should be and whether a pilot program—allowing hearing kids who sign to attend the deaf school—should remain.This show accomplished multiple things with its reach into Deaf history and identity, but it also did something technologically unique for the modern world—it made people pay attention. Because captioning translated the sign language for viewers, Lizzy Weiss, the creator of the series, said, “Every single viewer—deaf or hearing—was forced to put away their phones and iPads and anything else distracting … and focus … you had to read … you couldn’t do anything else. And that made you get into it more. It drew you in” (Stelter). The point, Weiss said, “was about revealing something new to the viewer—what does it feel like to be an outsider? What does it feel like to have to read and focus for an entire episode, like deaf viewers do all the time?” (Stelter). As one deaf reviewer of the Uprising episode said, “For an hour, welcome to our world! A world that’s inconvenient, but one most of us wouldn’t leave if offered a magic pill” (DR_Staff).This episode, more than any other, afforded hearing television viewers an experience perhaps similar to deaf viewers. The New York Times reported that “Deaf and hard-of-hearing viewers commented by the thousands after the show, with many saying in effect, “Yes! That’s what it feels like” (Stelter).Continued ResonancesWhat is also unique about the episode is that in teaching the hearing viewers more about the Deaf community, it also reinforced Deaf community pride and even taught young deaf people a bit of their own history. The Deaf community and Gallaudet were very pleased with their history showing up on a television show—the university produced a 30-second commercial which aired within the episode, and held viewing parties. Gallaudet also forwarded the 35 pages of Facebook comments they’d received about the episode to ABC Family and Gallaudet President T. Alan Hurwitz said of the episode (Yahr), “Over the past 25 years, [DPN] has symbolised self-determination and empowerment for deaf and hard of hearing people around the world”. The National Association of the Deaf (NAD) also lauded the episode, describing it as “phenomenal and groundbreaking, saying the situation is very real to us” (Stelter)—NAD had been vocally against budget cuts and closings of US deaf schools.Deaf individuals all over the Internet and social media also spoke out about the episode, with overwhelmingly favourable opinions. Deaf blogger Amy Cohen Efron, who participated in 1988′s DPN movement, said that DPN was “a turning point of my life, forcing me to re-examine my own personal identity, and develop self-determinism as a Deaf person” and led to her becoming an activist.When she watched the Uprising episode, she said the symbolic and historical representations in the show resonated with her. In the episode, a huge sign is unfurled on the side of the Carlton School for the Deaf with a girl with a fist in the air under the slogan “Take Back Carlton.” During the DPN protest, the deaf student protesters unfurled a sign that said “Deaf President Now” with the US Capitol in the background; this image has become an iconic symbol of modern Deaf culture. Efron says the image in the television episode was much more militant than the actual DPN sign. However, it could be argued that society now sees the Deaf community as much more militant because of the DPN protest, and that the imagery in the Uprising episode played into that connection. Efron also acknowledged the episode’s strong nod to the Gallaudet student protestors who defied the hearing community’s expectations by practising civil disobedience. As Efron explained, “Society expected that the Deaf people are submissive and accept to whatever decision done by the majority without any of our input and/or participation in the process.”She also argues that the episode educated more than just the hearing community. In addition to DPN, Uprising was filled with other references to Deaf history. For example a glass door to the room at Carlton was covered with posters about people like Helen Keller and Jean-Ferdinand Berthier, a deaf educator in 19th century France who promoted the concept of deaf identity and culture—Efron says most people in the Deaf community have never heard of him. She also claims that the younger Deaf community may also not be aware of the 1988 DPN protest—“It was not in high school textbooks available for students. Many deaf and hard of hearing students are mainstreamed and they have not the slightest idea about the DPN movement, even about the Deaf Community’s ongoing fight against discrimination, prejudice and oppression, along with our victories”.Long before the Uprising episode aired, the Deaf community had been watching Switched at Birth carefully to make sure Deaf culture was accurately represented. Throughout season 3 David Martin created weekly videos in sign language that were an ASL/Deaf cultural analysis of Switched at Birth. He highlighted content he liked and signs that were incorrect, a kind of a Deaf culture/ASL fact checker. From the Uprising episode, he said he thought this quote from Marlee Matlin’s character said it all, “Until hearing people walk a day in our shoes they will never understand” (Martin). That succinctly states what the all-ASL episode was trying to capture—creating an awareness of Deaf people’s cultural experience and their oppression in hearing society.Even a deaf person who was an early critic of Switched at Birth because of the hiring of Katie Leclerc and the use of SimCom admitted he was impressed with the all-ASL episode (Grushkin):all too often, we see media accounts of Deaf people which play into our society’s perceptions of Deaf people: as helpless, handicapped individuals who are in need of fixes such as cochlear implants in order to “restore” us to society. Almost never do we see accounts of Deaf people as healthy, capable individuals who live ordinary, successful lives without necessarily conforming to the Hearing ‘script’ for how we should be. And important issues such as language rights or school closings are too often virtually ignored by the general media.In addition to the episode being widely discussed within the Deaf community, the mainstream news media also covered Uprising intensely, seeing it as a meaningful cultural moment, not just for the Deaf community but for popular culture in general. Lacob wrote that he realises that hearing viewers probably won’t understand what it means to be a deaf person in modern America, but he believes that the episodeposits that there are moments of understanding, commonalities, and potential bridge-building between these two communities. And the desire for understanding is the first step toward a more inclusive and broad-minded future.He continues:the significance of this moment can’t be undervalued, nor can the show’s rich embrace of deaf history, manifested here in the form of Gallaudet and the historical figures whose photographs and stories are papered on the windows of Carlton during the student protest. What we’re seeing on screen—within the confines of a teen drama, no less—is an engaged exploration of a culture and a civil rights movement brought to life with all of the color and passion it deserves. It may be 25 years since Gallaudet, but the dreams of those protesters haven’t faded. And they—and the ideals of identity and equality that they express—are most definitely being heard.Lacob’s analysis was praised by several Deaf people—by a Deaf graduate student who teaches a Disability in Popular Culture course and by a Gallaudet student who said, “From someone who is deaf, and not ashamed of it either, let me say right here and now: that was the most eloquent piece of writing by someone hearing I have ever seen” (Emma72). The power of the Uprising episode illustrated a political space where “groups actively fuse and blend their culture with the mainstream culture” (Foley 119, as cited in Chang 3). Switched at Birth—specifically the Uprising episode—has indeed fused Deaf culture and ASL into a place in mainstream television culture.ReferencesABC Family. “Switched at Birth Deaf Actor Search.” Facebook (2010). <https://www.facebook.com/SwitchedSearch>.———. “This Is Not a Pipe.” Switched at Birth. Pilot episode. 6 June 2011. <http://freeform.go.com/shows/switched-at-birth>.———. “Not Hearing Loss, Deaf Gain.” Switched at Birth. YouTube video, 11 Feb. 2013. <https://www.youtube.com/watch?v=F5W604uSkrk>.Academy of Television Arts & Sciences. “Talking Diversity: ABC Family’s Switched at Birth.” Emmys.com (Feb. 2012). <http://www.emmys.com/content/webcast-talking-diversity-abc-familys-switched-birth>.Anderson, G. “‘Switched at Birth’ Celebrates 25th Anniversary of ‘Deaf President Now’.” Pop-topia (5 Mar. 2013). <http://www.pop-topia.com/switched-at-birth-celebrates-25th-anniversary-of-deaf-president-now/>.Barney, C. “’Switched at Birth’ Another Winner for ABC Family.” Contra Costa News (29 June 2011). <http://www.mercurynews.com/tv/ci_18369762>.Bibel, S. “‘Switched at Birth’s Katie LeClerc Is Proud to Represent the Deaf Community.” Xfinity TV blog (20 June 2011). <http://xfinity.comcast.net/blogs/tv/2011/06/20/switched-at-births-katie-leclerc-is-proud-to-represent-the-deaf-community/>.Chang, H. “Re-Examining the Rhetoric of the ‘Cultural Border’.” Essay presented at the American Anthropological Association Annual Meeting, Philadelphia, Dec. 1988.DR_Staff. “Switched at Birth: How #TakeBackCarlton Made History.” deafReview (6 Mar. 2013). <http://deafreview.com/deafreview-news/switched-at-birth-how-takebackcarlton-made-history/>.Efron, Amy Cohen. “Switched At Birth: Uprising – Deaf Adult’s Commentary.” Deaf World as I See It (Mar. 2013). <http://www.deafeyeseeit.com/2013/03/05/sabcommentary/>.Emma72. “ABC Family’s ‘Switched at Birth’ ASL Episode Recalls Gallaudet Protest.” Comment. The Daily Beast (28 Feb. 2013). <http://www.thedailybeast.com/articles/2013/02/28/abc-family-s-switched-at-birth-asl-episode-recalls-gallaudet-protest.html>.Fiveash, Chad. Personal interview. 17 Jan. 2014.Gallaudet University. “The Issues.” Deaf President Now (2013). <http://www.gallaudet.edu/dpn_home/issues.html>.Grushkin, D. “A Cultural Review. ASL Challenged.” Switched at Birth Facebook page. Facebook (2013). <https://www.facebook.com/SwitchedatBirth/posts/508748905835658>.Jankowski, K.A. Deaf Empowerment: Emergence, Struggle, and Rhetoric. Washington: Gallaudet UP, 1997.———. “A Metaphorical Analysis of Conflict at the Gallaudet Protest.” Unpublished seminar paper presented at the University of Maryland, 1990.Lacob, J. “ABC Family’s ‘Switched at Birth’ ASL Episode Recalls Gallaudet Protest.” The Daily Beast 28 Feb. 2013. <http://www.thedailybeast.com/articles/2013/02/28/abc-family-s-switched-at-birth-asl-episode-recalls-gallaudet-protest.html>.Martin, D. “Switched at Birth Season 2 Episode 9 ‘Uprising’ ASL/Deaf Cultural Analysis.” David Martin YouTube channel (6 Mar. 2013). <http://www.youtube.com/watch?v=JA0vqCysoVU>.Nielson, R. “Petitioned ABC Family and the ‘Switched at Birth’ Series, Create Responsible, Accurate, and Family-Oriented TV Programming.” Change.org (2011). <http://www.change.org/p/abc-family-and-the-switched-at-birth-series-create-responsible-accurate-and-family-oriented-tv-programming>.Orangejack. “Details about Katie Leclerc’s Hearing Loss.” My ASL Journey Blog (29 June 2011). <http://asl.orangejack.com/details-about-katie-leclercs-hearing-loss>.Paz, G. “Casting Call: Open Auditions for Switched at Birth by ABC Family.” Series & TV (3 Oct. 2010). <http://seriesandtv.com/casting-call-open-auditions-for-switched-at-birth-by-abc-family/4034>.Ryan, Maureen. “‘Switched at Birth’ Season 1.5 Has More Drama and Subversive Soapiness.” The Huffington Post (31 Aug. 2012). <http://www.huffingtonpost.com/maureen-ryan/switched-at-birth-season-1_b_1844957.html>.Stelter, B. “Teaching Viewers to Hear with Their Eyes Only.” The New York Times 8 Mar. 2013. <http://www.nytimes.com/2013/03/09/arts/television/teaching-viewers-to-hear-the-tv-with-eyes-only.html>.Van Cleve, J.V., and B.A. Crouch. A Place of Their Own: Creating the Deaf Community in America. DC: Gallaudet University Press, 1989.Yahr, E. “Gallaudet University Uses All-Sign Language Episode of ‘Switched at Birth’ to Air New Commercial.” The Washington Post 3 Mar. 2013 <http://www.washingtonpost.com/blogs/tv-column/post/gallaudet-university-uses-all-sign-language-episode-of-switched-at-birth-to-air-new-commercial/2013/03/04/0017a45a-8508-11e2-9d71-f0feafdd1394_blog.html>.