Zeitschriftenartikel zum Thema „Grable roof“

“Triangle zone” geometry is well established in thrust tectonics, where the leading edge of a frontal thrust branches backward onto a hinterland-directed roof thrust, and the triangle zone thus formed defines the thrust system’s leading edge. Similar geometries occur in extension and inversion settings, where a triangle zone can form between a deep-seated master fault and a roof fault or backthrust located in a hanging-wall detachment. In basement-controlled extension, triangle zone development can occur when the shear strength of the master fault plane in the zone above a hanging-wall detachment cutoff exceeds that of a new or reactivated antithetic fault detaching on the hanging-wall dip slope. This structural style is characterized by pronounced hanging-wall synclines linked to detached extensional faults higher up the hanging-wall dip slopes. The same principles apply during early phases of inversion tectonics. The part of the master fault that is above the hanging-wall detachment cutoff may constitute a buttress that causes displacement to backthrust along any available detachment into accommodation structures such as emergent ramps. This structural style is characterized by compressional structures within the graben while there is minor or even no sign of inversion on the graben margin faults. These geometries could be accounted for by other processes, for example, localized deep-seated fault-controlled structures within graben, or salt redistribution. However, fieldwork and analog models demonstrate the admissibility of triangle zone kinematics across a range of tectonic settings in the presence of detachment layers that are thin relative to the overall stratigraphy — typically tens to hundreds of meters in thickness. These models can guide seismic interpretation of unusual fold structures in extensional and inverted graben. Seismic interpretation examples were evaluated from the North Sea and Saudi Arabia.

Abstract Background IA is a major cause of morbidity and mortality for patients with hematological malignancies and has been mainly reported in patients with acute myeloblastic leukemia (AML) and stem cell transplantation. Much less is known about the role of IA during the treatment of lymphoproliferative diseases like ALL. Here, we retrospectively evaluated the characteristics of patients and the incidence of IA occurring during the induction course in adult ALL patients enrolled in the GRAALL-2005 trial. Methods We collected the data of 36 patients with IA during induction chemotherapy. All were included between May 2006 and October 2012 in the multicentric GRAALL-2005 phase III trial. According to ALL characteristics, these patients were treated in 3 different substudies: GRAALL, GRAALL-Rituximab (GRAALL-R) for CD20+ ALL, GRAAPH for Philadelphia (Ph) chromosome-positive ALL. IA was defined retrospectively using the EORTC modified criteria (De Pauw, CID 2008). Results Among the 969 patients enrolled, 36 (3.7%) developed IA during induction therapy. The median age was 30 years for all patients receiving induction and 47 years (range, 18 to 59) for patients with IA. We observed 18 IA (3%) by the GRAALL protocol (593 patients enrolled), 16 (8.3%) by the GRAALL-R protocol (191 patients enrolled), and 2 (0.7%) by the GRAAPH protocol (270 patients enrolled). In the GRAALL-R protocol, IA was diagnosed in 6 patients randomly assigned to receive rituximab and in 10 patients treated in the control group. The median time between first day of induction therapy and IA diagnosis was 20 days (range, -2 to 71). The median time between the first day of neutropenia and IA diagnosis was 18 days (range, 0 to 76). At the time of IA diagnosis, 13 patients were hospitalized in laminar airflow rooms, 10 patients in rooms with overpressure, 1 patient in a room with high-efficiency particulate filter, 5 patients in conventional rooms, 1 patient received home care and the type of hospitalization was unknown for the 6 remaining patients. Four patients with IA (11%) had received antifungal drug for invasive fungal infection (IFI) prophylaxis: one patient received fluconazole, one received caspofungin, and two received liposomal amphotericin B. All patients with IA presented pulmonary symptoms associated with a sinusal or cutaneous localization in 1 and 2 patients respectively. The diagnosis of IA was classified as possible in 7 episodes (19 %), probable in 22 episodes (61%), proven in 4 episodes (11%), and indeterminate in the remaining 3 episodes. Detection of Aspergillus antigen in serum by latex agglutination was positive in 24 cases (67%). Chest CT scans were taken for 33 patients (92%): nodules were found in 19 patients, halo sign in 20 patients, and “air crescent sign” in 1 patient. Bronchoalveolar lavage was performed in 11 patients (31%): culture was positive in 7 of them and Aspergillus antigen was positive in 2 of them. Biopsies where positive in 4 cases: in pulmonary biopsy in 3 patients and in cutaneous biopsy in 1 patient. Of all the Aspergillus isolates identified to the species level, Aspergillus fumigatus was isolated from 4 patients and Aspergillus flavus from 1 patient. Overall and IA-attributable 12-week mortality was 8 (0.8%) and 6 (16.7%) patients respectively. Conclusion IA is less frequently observed during induction therapy in adult ALL as compared to adult AML patients. However, the attributable mortality appears to be high in these patients. They are as at risk patients for IA and should be included in prophylactic and empirical antifungal clinical trials. Disclosures: No relevant conflicts of interest to declare.

The recent upsurge of violence against Muslims in various parts of Sri Lanka has grabbed the attention of popular discourses. However, little scholarly analysis has dealt with the recent rise of anti-Muslim sentiment and violence in the country, particularly the violence in Ampara and Kandy. As such, this article explores the implications and root causes of violence in Ampara and Kandy. This article is descriptive and interpretative in nature and mainly relies on secondary data. The article reveals that the violence in Ampara and Kandy unleashed by Sinhala Buddhist hardliners with complicity of law enforcement agencies caused much damage on the mosques, businesses and properties of Muslims. I argue that phobia against growing Muslim population, myth of sterilization pills, and economic jealousy and rivalry between Muslims and Sinhalese are the root causes of the violence against Muslims in Ampara and Kandy with some other sub-factors associated with it. Thus, there is a desperate need of better managing human and social security of all groups in the country, especially ethno-religious minorities.

AbstractA geomorphic investigation of the Salinas de Oro salt diapir in the Pyrenees reveals that the ring fracture pattern related to the karstic collapse of the diapir crest may vary significantly depending on the rates of dissolution and salt flow, and the rheology of the overburden. The salt diapir has well-developed concentric faults related to salt dissolution subsidence throughout the Quaternary. Roof strata accommodate subsidence by a combination of downward sagging and brittle collapse leading to the development of a ring monocline that is broken by 5 to 20 m throw conjugated normal faults and a 40 m throw, 9.5-km-long and 200-m-wide keystone graben. The salt diapir top has >100-m-long sinkholes that coalesce to form hollows >70 m deep. Up to 3-km-long radial grabens with a 70 to 90 m vertical throw overprint concentric-ring faulting and displace Quaternary deposits demonstrating active salt flow and diapir rise. Radial faults are linked with salt-withdrawal faults of the Andia Fault Zone (AFZ). Salt flow from the AFZ into the Salinas de Oro salt diapir causes brittle gravitational extension of limestone strata leading to a sequence of grabens and Quaternary faults >10 km long and several hundred meters deep.

A randomized complete block experiment (factorially arranged) with Ilex x attenuata `Foster II' semi-hardwood cuttings was conducted to test the efficacy on rooting of three IBA carriers (water, talc, and a hydrophilic gel--“Water Grabber”). Three IBA concentrations (0, 4000, 8000 ppm) and three rooting medium temperatures [ambient (13.3 - 20.6), 18.3, and 23.9° C] also were employed. Cuttings were harvested at 8 and 15 wk after sticking under intermittent mist. Rooting did not vary with talc IBA concentration. The 29.3° C rooting medium increased stem (1.24 cm, basal)/root dry weight (g) during the first 8 wk but not at 15 wk. More rooting occurred at 8 wk with 4000 ppm IBA gel treatment than with talc, with reduced rooting at 8000 ppm IBA (gel). Increased rooting (8, 15 wk) occurred with 4000 ppm IBA with water and gel carriers; however, rooting was less (below the 4000 ppm IBA levels) with 8000 ppm IBA. Overall, water and gel treatments performed about the same.

Quantitative analysis of neurite outgrowth and growth cone (filopodia and lamellipodia) motility provides key information for developing new therapeutic strategies for treating peripheral nerve injury and disease. Neurite outgrowth and growth cone properties will be measured for neurons taken from the dorsal root ganglia of 8-day old chick embryos. Ganglia will be enzymatically dissociated into single neurons and cultured in a serum-free medium. Cultures will be grown on glass coverslips coated with the basement membrane protein laminin. Following a brief incubation period of 4 hr to allow the initiation of neurites from the nerve cell bodies, cultures will be moved to an incubated microscope stage maintained at 37 C. Subsequent growth of the neurites will be recorded at a rate of 2 frames/sec with a time-lapse videocassette recorder connected to the phase-contrast microscope through a high-resolution (800 lines) video camera.The videotaped growth sequence will be digitized at a specified time interval, using a frame grabber.

<span>Palm oil is one of the main agricultural contributors to Malaysia’s Gross Domestic Product (GDP). Although commercial palm oil plantations have flourished in Malaysia for decades, there is still room for improvement especially in minimizing manpower load and developing efficient machinery to improve the various processes involved in the palm oil industry from estate to the mills. This paper presents a modified towable backhoe to assist in the Fresh Fruit Bunch (FFB) collecting process as an effort to save time. The main objective of this study is to design a machine that can be used by smallholders of oil palm in order to help speed up the work process. With a boom extension and an innovative grabber, the pressure needed to operate the hydraulic system was analyzed to ensure the towable backhoe functioned effectively and fulfilled its objectives. From the calculations done, the maximum pressure that the system can supply is 31.28 MPa which is higher than the 11 MPa minimum required for the hydraulic system to operate.</span>

The association of coal and oil shale had been a hot topic for a long time. Various types of association of coal and oil shale can be found in one basin, for instance, the coal can act as the roof or floor or interlayer of the oil shale, etc. The most crucial factor for the formation of oil shale is stratification and seasonal blooming of lower plankton, while the final formation of the coal still need a hypoxia restored deposition environment. We take Huangxian and Fushun basins as typical examples to study the coal and oil shale sedimentary mechanisms controlled by the boundary fault. We found that the sedimentary mechanisms are different in different stages during the process of basin evolution. In the early stage, the association of coal and oil shale with thinner layers can be found. In the late part of early stage, thick layer coal seams and oil shale can be formed because of the relative stable faults. In the middle stage, thicker oil shale can be formed in deep lake and thicker coal seams can be formed in the lacustrine shore. In the late stage of basin evolution, the association of thickest coal seams and oil shale can be formed as the stable tectonic environment. Compared with the depression basin, more active fault and short cycle subsidence controlled by the episodic tectonic movements are the obvious characteristics. Higher rate of tectonic subsidence and a vast difference between sedimentary (peat-bearing) supply rate and accommodation space change rate are in favor of forming oil shale, and slower rate of tectonic subsidence is favor of forming coal. The study found that faulted structures obviously control the development, thickness and distribution characteristics of oil shale and coal. As mentioned the above, the episodic tectonic movement of continental rift basin controls the types and filling and evolution of deposits.

Abstract The aim of this study was to determine the potential development of water sorptivity of soil aggregates by heating. Soil aggregates were sampled from arable layer of 5 Polish soils: Haplic Luvisol 1 from Czesławice, Haplic Luvisol 2 from Wierzchucinek, Haplic Cambisol from Felin, Gleyic Mollic Cambisol from Chylice, and Haplic Phaeozem from Grabiec. Three aggregates of each soil type with minimum diameter between 4 and 10 mm were heated in the oven for at least 3 hours at temperatures 20, 100, 200, 250, and 360ºC. After each temperature treatment the soil aggregates were conditioned at the room temperature for 16 hours. Laboratory measurements of water sorptivity of soil aggregates were performed under a negative tension h0 = -2 cm using tension infiltrometer. It was found that the exposure to temperatures between 100 and 200°C tends to decrease water sorptivity of aggregates from all the studied soils but one (Haplic Luvisol 1), followed by about two- to four-fold increase in water sorptivity for exposure to temperatures of 250°C (in Haplic Luvisol 1, Haplic Luvisol 2, and Haplic Phaeozem) or 360°C (in Haplic Cambisol and Gleyic Mollic Cambisol).

As was my custom, I moved from one exam room to the next with a fluidity that comes from years of practice, yet I was stopped in my tracks when Mr. North rose to his feet to greet me. His deep ebony, six foot-three-inch frame dwarfed my pale, five-foot-three presence. The tremendous hands on his 260 pound body grabbed my own outstretched right hand and shook it…. I glanced at his face, trying to see through my initial discomfort, only to be greeted by my own face staring back at me from the silver, reflective sunglasses he wore beneath a baseball cap that covered his head and any hair that might have been growing on it. His huge chest was tightly wrapped in a black T-shirt that, even in its largest version, couldn't stretch comfortably to encompass his pectoral girth….Mr. North became one of my favorite patients….I like him because I realize how hard I have had to work all of my life to overcome the racist feelings that made me fear him when we first met and that never allow me to act completely naturally in his presence.

Abstract In this paper, we use mainly field data from the Massif Central area, which have been presented in a companion paper [Michon and Merle, 2001], to discuss the origin and the evolution of the West European Rift system. It is shown that the tectonic event in the Tertiary is two-stage. The overall geological evolution reveal a tectonic paradox as the first stage strongly suggests passive rifting, whereas the second stage displays the first stage of active rifting. In the north, crustal thinning, graben formation and sedimentation at sea level without volcanism during the Lower Oligocene, followed by scattered volcanism in a thinned area during Upper Oligocene and Lower Miocene, represent the classical evolution of a rift resulting from extensional stresses within the lithosphere (i.e. passive rifting). In the south, thinning of the lithospheric mantle associated with doming and volcanism in the Upper Miocene, together with the lack of crustal thinning, may be easily interpreted in terms of the first stage of active rifting due to the ascent of a mantle plume. This active rifting process would have been inhibited before stretching of the crust, as asthenospheric rise associated with uplift and volcanism are the only tectonic events observed. The diachronism of these two events is emphasized by two clearly distinct orientations of crustal thinning in the north and mantle lithospheric thinning in the south. To understand this tectonic paradox, a new model is discussed taking into account the Tertiary evolution of the Alpine chain. It is shown that the formation of a deep lithospheric root may have important mechanical consequences on the adjacent lithosphere. The downward gravitational force acting on the descending slab may induce coeval extension in the surrounding lithosphere. This could trigger graben formation and laguno-marine sedimentation at sea level followed by volcanism as expected for passive rifting. Concurrently, the descending lithospheric flow induces a flow pattern in the asthenosphere which can bring up hot mantle to the base of the adjacent lithosphere. Slow thermal erosion of the base of the lithosphere may lead to a late-stage volcanism and uplift as expected for active rifting.

Abstract: Omah dudur is a typical house of rural community in the region of Urut Sewu, Grabag, Purworejo district. Omah dudur originated from the kingdom of Mataram Yogyakarta as a queen house, joglo-shaped and serves as a main pendapa. In the area of the Urut Sewu, the form of joglo omah dudur is imitated and renamed dudur, transformed into a typical rural dwelling as a pendapa and a family home (sleeping area, family room), but still predicated as queen house. Residents of Urut Sewu believe there is a revelation (soul / spirit) that dwells in the omah dudur and makes it live. Omah dudur in the Urut Sewu area is a traditional Javanese architectural heritage, yet it is still hidden and has not been recorded and recognized in Javanese Traditional architecture science. The condition of omah dudur in the modern era is faced with modernization, its development is stagnant and endangered. This research is part of the exploration of knowledge of omah dudur to become science of architecture. The methods used are naturalistic (Lincoln and Guba, 1985) and Qualitative Inductive Methods of Phenomenology. This research produces the concept of omah dudur as omah ratu kawula, that is omah dudur as omah for queen and kawula and as life artifact. Omah dudur alive because of the soul / spirit that lives in omah dudur. The Life Omah dudur is omah dudur which has dignified and influential to good or bad life of the inhabitants.Keywords: Urut Sewu region, dudur house, joglo, wahyu , living queen-kawula houseAbstrak: Omah dudur merupakan bentuk rumah khas masyarakat pedesaan di wilayah Urut Sewu, kecamatan Grabag, kabupaten Purworejo. Omah dudur berasal dari kerajaan Mataram Yogyakarta sebagai rumah ratu, berbentuk joglo dan berfungsi utama sebagai pendapa. Di wilayah Urut Sewu, bentuk joglo omah dudur ditiru dan diganti nama menjadi dudur, berubah menjadi hunian rakyat pedesaan khas berfungsi sebagai pendapa dan rumah keluarga (ruang tidur, ruang keluarga), namun tetap berpredikat sebagai rumah ratu. Warga Urut Sewu percaya ada wahyu (nyawa/sukma) yang tinggal (menetap) di dalam omah dudur dan menjadikannya hidup. Omah dudur di wilayah Urut Sewu adalah warisan arsitektur tradisional Jawa, namun masih tersembunyi dan belum tercatat dan diakui dalam ilmu pengetahuan arsitektur Tradisional Jawa. Kondisi omah dudur dalam era modern berhadapan dengan modernisasi, perkembangannya stagnan dan terancam punah. Penelitian ini bagian dari eksplorasi mengungkap pengetahuan omah dudur agar menjadi ilmu pengetahuan arsitektur. Metode yang digunakan adalah naturalistik (Lincoln dan Guba, 1985) dan metode Induktif Kualitatif Fenomenolgi . Penelitian ini menghasilkan konsep omah dudur sebagai omah ratu kawula yang hidup, yaitu omah dudur sebagai omah bagi ratu dan kawula dan artefak hidup. Omah dudur hidup karena sukma/nyawa yang hidup dan manggon dalam diri omah dudur. Omah dudur hidup adalah omah dudur yang berwibawa dan berpengaruh terhadap baik buruk kehidupan penghuni.Kata Kunci: Wilayah Urut Sewu, omah dudur, joglo, wahyu , omah ratu-kawula yang hidup.

The periodontal ligament is a unique specialised connective tissue between the cementum covering the tooth root and the alveolar bone. It is believed that periodontal ligament cells are responsible for not only osteogenesis and osteoclasia of the alveolar bone but also for fibrogenesis and fibroplasia of the ligament itself, as well as cementogenesis and the presence of cementoblasts on the root surface. Injury to the periodontal ligament (PDL) and its compromised healing (external inflammatory resorption and replacement resorption) has been cited as one of the major reasons for the failure of transplantation and replantation procedures. The necessity of having a healthy PDL so that the tooth can re-attach and be retained in the socket determines the prognosis of replanted teeth. Thus, the importance of maintaining the periodontal viability has led to an increased interest in the development of platelet concentrates, which have been considered as autologous biomaterials having the ability to potentiate healing, repair, and regenerate. PRF (platelet rich fibrin) is a living biomaterial derived from human blood containing fibrin, platelets, growth factors, leukocytes and stem cells entrapped in a fibrin-based scaffold / matrix, which has been documented to promote bone and soft tissue healing and regeneration. PRF technology has grabbed the attention of clinicians because it is readily available, is easy to prepare, can be produced immediately at the chairside, is easy to use, and widely applicable in dentistry, while being financially realistic for the patient and the clinician. Thus, the purpose of this review is to enumerate the biologic, chemical and physical properties of PRF and highlight the essential role it plays in periodontal regeneration and repair, which can be highly beneficial in improving the treatment success rate of transplantation and replantation procedures. KEY WORDS Platelet Rich Fibrin, Replantation, Transplantation, Periodontal Ligament, Periodontal Regeneration

The methods used to estimate recovery factor change through the life cycle of a field. During appraisal, prior to development when there are no production data, we typically rely on analog fields and empirical methods. Given the absence of a perfect analog, these methods are typically associated with a wide range of uncertainty. During plateau, recovery factors are typically associated with simulation and dynamic modeling, whereas in later field life, once the field drops off the plateau, a decline curve analysis is also used. The use of different methods during different stages of the field life leads to uncertainty and potential inconsistencies in recovery estimates. A wide range of interacting, partially related, reservoir and production variables controls the production and recovery factor. Machine learning allows more complex multivariate analysis that can be used to investigate the roles of these variables using a training data set and then to ultimately predict future performance in fields. To investigate this approach, we used a data set consisting of producing reservoirs all of which are at plateau or in decline to train a series of machine-learning algorithms that can potentially predict the recovery factor with minimal percentage error. The database for this study consists of categorical and numerical properties for 93 reservoirs from the Norwegian Continental Shelf. Of these, 75 are from the Norwegian Sea, the Norwegian North Sea, and the Barents Sea, whereas the remaining 18 reservoirs are from the Viking Graben in the UK sector of the North Sea. The data set was divided into training and testing sets: The training set comprised approximately 80% of the total data, and the remaining 20% was the testing set. Linear regression models and a support vector machine (SVM) models were trained with all parameters in the data set (30 parameters); then with the 16 most influential parameters in the data set, the performance of these models was compared from results of fivefold crossvalidation. SVM training using a combination of 16 geologic/engineering parameters models with Gaussian kernel function has a root-mean-square error of 0.12, mean square error of 0.01, and [Formula: see text]-squared of 0.76. This model was tested on 18 reservoirs from the testing set; the test results are very similar to crossvalidation results during models training phase, suggesting that this method can potentially be used to predict the future recovery factor.

Zusammenfassung: Zur Nutzungsanalyse großer ovaler, erstmalig entdeckter und dokumentierter von einem niedrigen Graben-Wall-System umgebener Anlagen wurden Bodenproben auf spezifische Lipide untersucht, die Hinweise auf die Anwesenheit – hinterlassene Verdauungsreste – bestimmter Nutztierarten und Menschen in den beprobten Bereichen geben könnten. Wahrscheinlich dienten die Anlagen dem Gartenbau, sicherlich nicht der Viehhaltung; in den angrenzenden Dachziegel und Keramikscherben aufweisenden viereckigen, deutlich kleineren umwallten Anlagen siedelten Menschen. Solche ovalen Anlagen sind in der Mongolei bisher nur aus dem Umfeld der uighurischen Hauptstadt Karabalgasun bekannt geworden, deren Stadtgebiet eine deutlich größere Fläche einnimmt als bisher angenommen wurde und vielteiliger sowie funktional gegliedert ist. Dieses erste stichpunktartige Ergebnis zeigt das Potential der Lipidanalysen, frühere Landnutzung zu rekonstruieren, beispielsweise Viehhaltung von acker- oder gartenbaulicher Nutzung zu unterscheiden. Gerade dieser viel zu wenig erforschte Aspekt ist für die Einschätzung der häufig postulierten ‚Abhängigkeit‘ der Nomaden von ackerbautreibenden Gesellschaften von zentraler Bedeutung. Résumé: Un échantillonnage du sol à peu de profondeur de la surface du terrain actuel a été effectué afin de déterminer à quoi servaient les grandes enceintes ovales, cernées d’un mur bas et d’un fossé, découvertes et relevées récemment en Mongolie. L’échantillonnage avait pour but l’analyse de lipides spécifiques à certaines espèces; en effet les données provenant de résidus de digestion fournissent de précieuses indications sur les concentrations d’animaux d’élevage spécifiques dans les zones étudiées. Les enceintes ont fort probablement été utilisées à des fins horticoles, et certainement pas pour le bétail. L’habitat humain, documenté par des trouvailles de tuiles et de céramique, se situait dans des enclos carrés et bien plus petits à proximité de ces enceintes. Les enceintes ovales n’ont été repérées en Mongolie que dans les environs de la capitale Ouïghoure de Karabalghasun. L’étendue de cette capitale est de toute évidence bien plus grande que l’on ne l’avait pensé jusqu’à présent, et la zone d’occupation avait été subdivisée en divers secteurs d’activité. Les premiers résultats de notre échantillonnage démontrent que l’analyse des lipides donne l’occasion d’aborder l’étude de la culture des céréales et des légumes sous un nouvel angle. Etant donné le peu de recherches conduites dans ce domaine, cet aspect est particulièrement important pour l’évaluation d’une ‘dépendance’ des nomades envers les sociétés agraires si souvent invoquée. Abstract: In order to investigate the use to which recently discovered and recorded large oval enclosures surrounded by a low wall and ditch were put, a series of topsoil samples were taken and subjected to an analysis of specific lipids; such soil chemical evidence from human and domesticated animal faeces can provide significant insights into the land use history of the areas sampled. The enclosures are likely to have been used for horticulture, and certainly not for keeping livestock. Human settlement, as attested by the presence of roof tiles and ceramic sherds, was in square, enclosed compounds nearby, and these were clearly smaller. Oval complexes have so far only been documented in Mongolia in the vicinity of the Uyghur capital of Karabalgasun. Karabalgasun was evidently much greater in extent than had hitherto been assumed and it was divided into a number of functional areas. Initial results from our targeted samples show that the analysis of lipids has much potential, offering new opportunities to elucidate land use, e.g. the cultivation of cereals and vegetables in contrast to livestock keeping. It is precisely this aspect, so far largely neglected by research, which will allow us to assess the oft-claimed ‘dependence’ of the nomads on agricultural communities.

Abstract Pain often starts in infancy and continues throughout life in sickle cell disease (SCD). Subjects typically quantify pain by themselves, which may lead to overtreatment or under-treatment of pain. Patient's quantification of their own pain may also be influenced by external factors (mood, stress, sleep, etc.). Therefore, we examined the possibility of developing observer-based quantifiable measures of pain using facial features to obtain a mouse grimace scale (MGS) and body dimensions as measures of pain in HbSS-BERK (sickle) and control HbAA-BERK (control) mice. Methods: Mice aged 6-8 months, were placed in transparent cubicles on a Plexiglas surface at room temperature (RT) or on a cold plate (CP) at 4.5¡C. Mice were acclimated and digitally videotaped at RT for 5 min to capture action units (AU) and then videotaped on the cold plate for 5 min. Individual frames of clear, unobstructed headshots were 'grabbed'. The experiment was repeated after 24h. Four AUs, (orbital tightening, nose bulge, cheek bulge, and ear position) were assessed for each mouse and condition using 4 randomized pictures of each by 3 blinded 'coders'. For MGS, intensity of each AU was scored as follows: '0' = absence; '1'= moderate and '2' = severe. Average AU scores from the 3 coders were averaged for each AU. Cumulative pain calculations were made by averaging all AUs as described (Langford et al., 2010, Nature Methods). For length and body parameter measurements, one camera was placed with a top down view of the mouse with a Plexiglas graph template (1x1cm squares) in the background and another camera was placed in front of the mouse to capture the back curvature. Length was calculated using the graph template. To analyze spinal curvature, best-fit ellipses were constructed from points plotted on the arch of the spine of the mouse. Points were placed between the neck where the arch begins and at the end of the arch, near the tail. Two ellipses were generated for each mouse and difference between maximum and minimum axes were recorded. Smaller differences in max and min axes indicated more pain and a more circular shape and larger differences indicated less pain and a more elliptical shape. To validate facial AU data, sensitivity to 1.0 g Von Frey filament was used. Results: We observed significantly higher MGS in pain totals for control on CP vs. control at RT (P<0.01), sickle CP vs. sickle RT (P<0.05), and sickle CP vs. control CP (P<0.001), suggesting that both control and sickle mice exhibited a 'pain face' on the cold plate, but sickle mice showed increased intensity as compared to control on the cold plate. Curvature differences were significant in control on CP vs. control at RT (P<0.01), and sickle on CP vs. sickle at RT (P<0.01). Sickle mice showed an average 55% increase in curvature compared to 39% in control mice on a cold plate vs. RT for each (P<0.05), suggesting that sickle mice exhibit more pain in response to cold environment. Complementary to the curvature, sickle mice showed a significant decrease in length on a cold plate vs. RT (24%; P<0.01), but control mice did not show a significant difference in length. The Von Frey test demonstrated increased hyperalgesia in sickle mice as compared to control at RT (P<0.0001). Together, these data show that facial expressions and body dimensions provide quantifiable means to assess pain intensity in sickle mice. Thus facial characteristics, length and curvature can be adapted to assess pain in sickle patients particularly in children, who may not be able to express pain scores accurately in an unbiased way. Disclosures No relevant conflicts of interest to declare.

Background: Identifying perioperative bleeding risk in pediatric patients undergoing major surgery is challenging because personal history is often not sufficiently informative and laboratory tests are also more susceptible to pre-analytical variables. Children with low Willebrand add further uncertainty in the treatment options. The aim of this study was to evaluate practices to assess hemorrhagic risk and manage bleeding prophylaxis in children with low von Willebrand factor levels (30 and 50 IU/dL; low VWF), known von Willebrand disease (VWD) or healthy controls undergoing ear, nose and throat (ENT) surgery. Methods: In this retrospective observational study, data from consecutive paediatric patients undergoing ENT surgery between January 1, 2010 and December 31, 2017 at the Turin Paediatric Hospital were analysed. All statistical analyses were performed using STATA (StataCorp. 2013. Been Statistical Software: Release 13. College Station, TX: StataCorp LP). Demographic and clinical characteristics of patients were assessed using the absolute frequencies and percentages for qualitative variables and percentiles for quantitative variables. The risk of bleeding was estimated from the number of patients who experienced bleeding within 21 days as a proportion of the number of patients subjected to surgery. 90% confidence intervals (90% CIs) were estimated for the evaluation of bleeding risk, using the Jeffreys method and any differences in the risk of bleeding between patient groups were tested using a proportions test. To investigate any factors associated with the therapeutic strategy used, multinomial logistic regression models were conducted. Results: Major perioperative bleeding was seen in 6.3% (5/79) of low VWF patients, 3.0% (35/1152) of healthy controls and 20.0% (5/25) of patients with VWD. In low VWF patients, perioperative bleeding prophylaxis was given to 59.5% and included subcutaneously desmopressin (n=21) and VWF-containing concentrate (n=26). Oral or intravenous tranexamic acid was administered to all low VWF patients. Of these patients, one major hemorrhagic event occurred in patients who did not receive prophylaxis and the remaining events occurred in patients treated with VWF-containing concentrate. In patients who received a VWF-containing concentrate, lower VWF ristocetin cofactor levels were observed compared with patients who received desmopressin or were untreated during surgery. No differences in clinical and laboratory features were observed between patients with low VWF treated with desmopressin and those who were untreated. Conclusions: Patients with low VWF have a higher risk of perioperative bleeding compared with healthy controls but a significantly lower risk compared with patients with VWD. The perioperative management of these patients is complex with a high risk of overtreatment. In our experience the caution of keeping the VWF-containing concentrate in the operating room available for use in case of bleeding appears to be a balanced approach. Prospective randomized studies to identify accurate methods of assessing bleeding risk and evaluate the most effective perioperative bleeding prevention are warranted. Essential bibliography: Ruchika Sharma and Veronica H. Flood. Advances in the diagnosis and treatment of Von Willebrand disease. Hematology American Society of Hematology Education Program 2017:379-384 Sadler JE. Low von Willebrand factor: sometimes a risk factor and sometimes a disease. Hematology American Society of Hematology Education Program 2009:106-112 Rodeghiero F, Tosetto A, Abshire T, et al. ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders. J Thromb Haemost. 2010;8(9):2063-2065. Casey LJ, Tuttle A, Grabell J, et al. Generation and optimization of the self-administered pediatric bleeding questionnaire and its validation as a screening tool for von Willebrand disease. Pediatr Blood Cancer. 2017;64(10) Mannuccio Mannucci P, Kyrle PA, Schulman S, Di Paola J, Schneppenheim R, Cox Gill J. Prophylactic efficacy and pharmacokinetically guided dosing of a von Willebrand factor/factor VIII concentrate in adults and children with von Willebrand's disease undergoing elective surgery: a pooled and comparative analysis of data from USA and European Union clinical trials. Blood Transfus. 2013;11(4):533-540 Disclosures No relevant conflicts of interest to declare.

AbstractThe Mikawa Bay Region, central Japan, is characterized by many active faults recording Quaternary activities. It is, however, difficult to understand the overall tectonic character of the region due to a thick sedimentary cover. We report the first finding of Neogene basin inversion in southwest Japan by estimating the depth and structure of the basement surface in the Mikawa Bay Region by analyzing gravity data. Our gravity basement map and two-dimensional density-structure model automatically determined using the genetic algorithm revealed a half-graben bounded on the south by the north-dipping Utsumi Fault. The motion of the Utsumi Fault, which inverted from normal faulting during the Miocene to recent reverse faulting, indicated the inversion of the half-graben. The timing of the inversion of the fault motion, i.e., the reverse faulting of the Miocene normal fault, can be compared with an episode of basin inversion observed at the eastern margin of the Japan Sea, northeastern Japan. The Takahama Fault in the southwestern part of the Nishi–Mikawa Plain is considered to have formed as a result of the backthrust of the Utsumi Fault under inversion tectonics. If the Takahama Fault is indeed the backthrust fault of the Utsumi Fault, the root of the Takahama Fault may be deep such that the Takahama Fault is seismogenic and linked to the 1945 Mikawa earthquake.

Water is the liquid of life, given its importance, this fluid is essential in the vegetative development of plants. Thus, the physiological actions of the drugs were made in the form of water, which are among the tasks on the plant can be useful, there is no protoplasm, gas exchange and thermal regulation of plants. Moreover, the relationship between plant, soil and atmosphere is integrally linked to water, which is the essential agent for this system. Due to its importance, it is essential to quantify the amount of water present in the plant, for subsequent physiological and relationship analysis with the soil and the atmosphere. Water content and degree of juiciness were performed in leaf, stem and root organs, comparing the results to better understand the percentage of water present in each organ.

AbstractThis study re-examines large and deep U-shaped reflections (2–4 km wide and 100–200 m deep) within the Upper Cretaceous–Danian Chalk Group in the inverted Roar Basin of the Danish North Sea, previously interpreted as a moat associated with a contour-parallel current system and/or erosive channels formed by gravity-driven turbidites. Improved 3D seismic data quality and seismic interpretation techniques helped to identify overlooked reflection terminations, which suggest that rather than a linear depression, the U-shaped reflections outline several bowl-shaped depressions. In addition, vertical high-amplitude columns and vertical discontinuity zones within and below the depressions were recognized and interpreted to indicate the presence of small fluid pipes, suggesting that the formation of the depressions is more complex. Carbon isotope analysis of high acoustic impedance beds within the underlying Lower Cretaceous chalk showed negative δ13C values down to −20‰, and are interpreted to indicate sediments influenced by methane-derived authigenic carbonates. Permo-Triassic half-grabens seem to have been a major source of gas-bearing fluids, as evidenced by hydrocarbon leakage phenomena within Triassic–Lower Cretaceous strata. In areas where Zechstein salt is present, the leakage root lies at salt welds, causing the formation of focused seismic reflection wipe-out and dim zones. In areas where salt was absent, the leakage root comprises a much more diffuse zone across the fault boundaries of the Permo-Triassic half-graben, and gas chimneys are characterized seismically as broad vertical dim zones up to 10 km wide. Campanian inversion tectonics caused fault reactivation and several hundreds of metres of uplift in the Roar Basin, which created an instability for the trapped gas-bearing fluids. Gentle fluid venting through observed pipes caused sediment suspension and entrainment, which could be carried away by bottom-current activity, causing localized zones of non-deposition and the formation of individual depressions. This model thus does not disregard the role of bottom-current activity in the formation of the depressions, yet it includes a fluid-venting element that fits better with the architecture and overall evidence for fluid-venting features in pre-chalk strata, as well as in the Chalk Group. Importantly, it shows that prior to the thermogenic maturation of the main source rock (i.e. the Bo Member of the Farsund Formation in the Late Miocene), fluid venting had already occurred on the Late Cretaceous seafloor from deeper source rocks that are at present overmature.

Lip balm is defined as a cosmetic formulation that is applied to the lips to prevent dryness of the lips and protect the lips from foreign bodies, which makes lip balms different from lipsticks. There are many plant oils that can be used in making moisturizers, including lip balm, one of which is grapeseed oil. Although less popular with the public, Balinese grape has a higher flavonoid content than other grapes. The purpose of this study was to create a lip balm product derived from Balinese grape seed oil and find the best concentration of Balinese grape seed oil to create a lip balm product. The research method used in this research is experimental. Making lip balm preparations based on Balinese grape seed oil with various concentrations of 20%, 30%, 40%, 50%, 60%, and 70%. The ingredients used are Balinese grapeseed oil, lanolin, beeswax, propylene glycol and essential oils (perfume). Evaluation of lip balm preparations, namely homogeneity test, stability test carried out for three months at room temperature by observing changes in color, odor and dosage form, pH test, smear test, irritation test, and testing the ability of lip balm preparations to moisturize lips on the tested volunteers by using the preparation every day before going to bed and then measuring the moisture content of the lips every week until the fourth week using a skin analyzer. The result of this study is that grapeseed oil has the potential to be developed into cosmetic products, especially lip balm with the best concentration is 70%.

Abstract The share of equipment and power use in smaller data centers (DCs) is comparable with that of more massive counterparts. However, they grabbed less attention in the literature despite being less energy-efficient. This study highlights the challenges of setting up a computational fluid dynamics (CFD) model of a 180-m2 small-size high-performance computing (HPC) DC and the validation procedure leading to a reasonably accurate model for the investigation of the thermal environment and potential energy efficiency improvements. Leaky floors, uneven placement of computing equipment and perforated tiles preventing separation of hot and cold air, low-temperature operation, and excessive cooling capacity and fan power were identified sources of energy inefficiency in the DC. Computational fluid dynamics model predictions were gradually improved by using experimental measurements for various boundary conditions (BCs) and detailed geometrical representation of large leakage openings. Eventually, the model led to predictions with an error of less than 1 °C at the rack inlet and less than 5 °C at the rack outlet. The ultimate objective was to use the validated CFD model to test various energy efficiency measures in the form of operational or design changes in line with the best practices. Impact of leakage between the raised floor and the room, reduced airflow rate, cold-aisle and hot-aisle separation, workload consolidation, and higher temperature operation were among the phenomena tested by using the validated CFD model. The estimated power usage effectiveness (PUE) value reduced from 1.95 to 1.40 with the proposed energy efficiency measures.

Cognitive biases, or systematic errors in cognition, are important contributors to diagnostic error in medicine. In our review, we explore the psychological underpinnings of cognitive bias and highlight several common biases using clinical cases. We conclude by reviewing strategies to improve diagnostic accuracy and by discussing controversies and future research directions.RésuméLes préjugés cognitifs, ou les erreurs systématiques dans la cognition, sont des contributeurs importants à l'erreur diagnostique dans la médecine. Dans notre examen, nous explorons les fondements psychologiques du biais cognitif et soulignons plusieurs préjugés communs en utilisant des cas cliniques. Nous concluons en examinant les stratégies visant à améliorer la précision diagnostique et en discutant des controverses et des futures orientations de recherche.Research in the field of behavioural psychology and its application to medicine has been ongoing for several decades in an effort to better understand clinical decision making.1 Cognitive biases (systematic errors in cognition) are increasingly recognized in behavioural economics2 and more recently have been shown to affect medical decision making.3 Over 100 such cognitive biases have been identified and several dozen are postulated to play a major role in diagnostic error.4 Cognitive errors can take many forms and in one study contributed to as many as 74% of diagnostic errors by internists. 5 Most of these errors were due to “faulty synthesis” of information, including premature diagnostic closure and failed use of heuristics.5 Inadequate medical knowledge, on the other hand, was rare and mostly identified in cases concerning rare conditions. 5 Professional organizations such as the Royal College of Physicians and Surgeons of Canada and the Canadian Medical Protective Association have since been working to raise awareness of cognitive bias in clinical practice.6In our review, we explore the role of cognitive bias in diagnostic error through the use of clinical cases. We also review the literature on de-biasing strategies and comment on limitations and future directions of research.The Dual Process TheoryA prevailing theory to explain the existence of cognitive bias is the dual process theory, which asserts that two cognitive systems are used in decision making, herein called System 1 and System 2 (Table 1). 2,7System 1 can be thought of as our intuitive mode of thinking. It generates hypotheses rapidly, operates beneath our perceptible consciousness and makes judgments that are highly dependent on contextual clues. System 1 is characterized by heuristics (short cuts, or “rules of thumb”) and is an important component of clinical judgment or expertise. In contrast, System 2 is slow, deliberate, analytical and more demanding on cognition. It applies rules that are acquired through learning and it can play a “monitoring role” over System 1, and thus overrides heuristics when their use is inappropriate. The dual process theory implies that errors result when inappropriate judgments generated by System 1 fail to be recognized and corrected by System 2. Maintaining constant vigilance over System 1 would be both impractical and time consuming for routine decisions and would diminish the value of intuition. It follows that a more practical way of improving reasoning is to identify the most common biases of System 1 and to recognize situations when mistakes are most likely to occur.2Alternative Theories of CognitionVariations of dual process theory have further refined our understanding of medical decision making. Fuzzy trace theory, for example, proposes that individuals process information through parallel gist and verbatim representations.8 The “gist” is analogous to System 1 and represents the bottom-line “meaning” of information. This representation is subject to an individual’s worldview, emotions and experiences. In contrast, verbatim representations are precise, literal and analogous to System 2. Fuzzy trace theory is particularly useful in explaining how patients might interpret health information. Proponents of this theory contend that in order for information to lead to meaningful behavioural change, physicians must appeal to both gist and verbatim representations when communicating with patients.8 Other models, such as dynamic graded continuum theory, do away with the dichotomy of System 1 and System 2 and instead represent implicit, automatic and explicit cognitive processes on a continuous scale.9 These single system models are useful to compare against dual process theory but have not replaced it as a well-established framework for understanding and mitigating cognitive bias in clinical decision making.7Case 1: A 55-Year-Old Male with Retrosternal Chest PainA 55year-old non-smoking male was assessed in a busy Emergency Department (ED) for retrosternal chest pain. Past medical history is significant for osteoarthritis for which he takes naproxen. On review of his history, the patient has had multiple visits for retrosternal chest pain in the previous two months. At each encounter, he was discharged home after a negative cardiac workup.Vital signs in the ED were within normal limits except for sinus tachycardia at 112 beats per minute. On exam, the patient was visibly distressed. Cardiac and respiratory exams were normal. There was mild tenderness in the epigastrium. Basic blood-work revealed leukocytosis (16.0 × 109/L), a mildly elevated high sensitivity cardiac troponin, and no other abnormalities. An ECG revealed T wave flattening in leads V3-V4.The patient was referred to the internal medicine service with a diagnosis of non-ST-elevation myocardial infarction and treated with aspirin, clopidogrel, and fondaparinux. Several hours later, the patient became more agitated and complained of worsening retrosternal and epigastric pain. On re-examination, heart rate had increased to 139 beats per minute, blood pressure dropped to 77/60 and he had a rigid abdomen. Abdominal radiography revealed free air under the right hemi-diaphragm and the patient was rushed to the operating room where a perforated gastric ulcer was detected and repaired. The case above illustrates numerous cognitive biases, including:1. Premature diagnostic closure: the tendency to accept a diagnosis before it is fully verified.42. Anchoring: the tendency to over-emphasize features in the patient’s initial presentation and failing to adjust the clinical impression after learning new information.43. Confirmation bias: the tendency to look for confirming evidence to support a diagnosis, rather than to look for (or explain) evidence which puts the diagnosis in question.4In this case, the physician based the diagnosis of myocardial infarction primarily on symptoms of chest pain and an elevated cardiac troponin. However, several other objective findings were present and when taken together, suggested a diagnosis other than myocardial infarction. These included a tender epigastrium, leukocytosis, and resting sinus tachycardia. These symptoms/signs were not explicitly explained or investigated before a treatment decision was made. Premature diagnostic closure is one of the most common cognitive biases underlying medical errors5 and it affects clinicians at all levels of training.10 It is multifactorial in origin5 and is especially common in the face of other cognitive biases such as anchoring and confirmation bias.The physician in this case “anchored” to a diagnosis of cardiac chest pain given the patient’s previous ED visit history and his/her best intentions of ruling out a “worst case scenario.” Anchoring can be especially powerful in the face of abnormal screening investigations that have been reviewed even before the physician has acquired a history or performed a physical examination. If the physician had reviewed the screening investigations before seeing the patient, he/she might have narrowed the differential diagnosis prematurely, failed to gather all the relevant information and failed to adjust the clinical impression based on new information.The physician demonstrated confirmation bias by failing to explain the abnormalities that put the diagnosis of myocardial infarction in question (e.g. tender epigastrium, leukocytosis). Confirmation bias arises from an attempt to avoid cognitive dissonance, a distressing psychological conflict which occurs when inconsistent beliefs or theories are held simultaneously.11 In one study evaluating clinical decision making amongst 75 psychiatrists and 75 medical students,12 13% of psychiatrists and 25% of medical students demonstrated confirmation bias when searching for information after having made a preliminary diagnosis. In this study, confirmation bias resulted in more frequent diagnostic errors and predictably impacted subsequent treatment decisions.An appropriate consideration of all diagnostic possibilities is the first step in avoiding diagnostic error. While acquiring information, physicians should step back and consolidate new data with the working diagnosis, as failure to do so can result in confirmation bias.13 All abnormal findings and tests, especially if considered clinically relevant should be explained by the most probable diagnosis. An alternate diagnosis or the possibility of more than one diagnosis should be considered when an abnormal finding or test cannot reasonably be explained by the working diagnosis.Tschen et al observed a team of physicians working through a simulated scenario which had diagnostic ambiguity.14 Two approaches were found to be effective in reducing the effect of confirmation bias: explicit reasoning and talking to the room. Explicit reasoning involves making causal inferences when interpreting and communicating information. Talking to the room is a process whereby diagnostic reasoning is explained in an unstructured way to a team member or colleague in the room. This allows the clinician the opportunity to elaborate on their thoughts and observers to point out errors or suggest alternate diagnoses in a shared mental model.Case 2: A 30-Yearold Male with Confusion and SeizuresA 30-year-old homeless male is found confused on the street by paramedics and brought to the ED for assessment. Empty bottles of alcohol were noted at the scene. The CIWA (Clinical Institute Withdrawal Assessment for Alcohol) protocol is initiated and he is given several doses of lorazepam to minimal effect. Several hours after the patient is admitted, a resident on-call is paged for elevated CIWA scores on the basis of diaphoresis and agitation. Several additional doses of lorazepam are ordered which fail to completely resolve the symptoms. Gradually, the patient becomes more obtunded. The on-call resident orders a capillary blood glucose and it measures 1.1 mmol/L. Intravenous D50W is promptly administered, the blood glucose normalizes and the patient’s level of consciousness improves.The case above illustrates the following biases:1. Availability bias: the tendency to weigh a diagnosis as being more likely if it comes to mind more readily.42. Diagnostic momentum: the tendency for labels to “stick” to patients and become more definite with time.4Although the symptoms of diaphoresis and agitation are not specific to alcohol withdrawal, this diagnosis was deemed most likely based on how readily it came to mind, the empty alcohol bottles at the scene, and potentially on the patient’s demographics. The unproven diagnosis of alcohol withdrawal “stuck” with the patient despite minimal improvement after a therapeutic trial of benzodiazepines.Availability bias has been shown to affect internal medicine residents. In one single-centre study,15 18 first-year and 18 second-year residents were exposed to case descriptions with associated diagnoses as part of an exercise. They were then asked to diagnose a series of new cases, some of which appeared similar to those they had previously encountered but with pertinent differences that made an alternate diagnosis more likely. Second year residents had lower diagnostic accuracy on these similar-appearing cases; a result consistent with availability bias. First year residents were less prone to this bias because of their limited clinical experience. Most importantly, subsequent reflective diagnostic reasoning countered the bias and improved accuracy.General Strategies to Avoid Cognitive BiasInterventions aimed at mitigating diagnostic error due to cognitive bias take several approaches.1. Improving clinical reasoning2. Reducing cognitive burden3. Improving knowledge and experienceDespite a large number of proposed interventions, there is a lack of empirical evidence supporting the efficacy of many de-biasing strategies. 16 What follows is a brief review of the current evidence.Improving Clinical ReasoningSeveral “de-biasing” strategies have been proposed to improve clinical reasoning. De-biasing strategies assume that System 1 processes are more prone to bias due to their heavy reliance on heuristics and therefore the solution is to activate System 2 at critical points in decision making. De-biasing occurs in several stages: at first an individual is educated about the presence of a cognitive bias, they then employ strategies to eliminate that bias and finally they maintain those strategies in the long term.17Metacognition, or “thinking about thinking,” involves reflecting on one’s own diagnostic reasoning. Internal reflection along with awareness of potential biases should allow the clinician to identify faulty reasoning. However, the evidence underlying reflective practice is mixed.16 Several studies have tried to encourage reflective practice and System 2 processes by instructing participants to proceed slowly through their reasoning18 or by giving participants the opportunity to review their diagnoses.19 These studies have found minimal or no impact on reducing the rate of diagnostic error. On the other hand, some studies have shown improved diagnostic accuracy when physicians are asked to explicitly state their differential diagnoses along with features that are consistent or inconsistent with each diagnosis.20 These results suggest that if reflective practice is to be effective, it must involve a thorough review of the differential diagnosis as opposed to simply taking additional time.Reducing Cognitive BurdenTools that reduce the cognitive burden placed on physicians may reduce the frequency of diagnostic errors. One suggestion has been to incorporate the use of checklists in the diagnostic process. These checklists would be matched to common presenting symptoms and include a list of possible diagnoses. One randomized controlled trial failed to show a statistically significant reduction in the diagnostic error rate with the use of checklists, except in a small subgroup of patients treated in the ED. 21 These findings challenge the results of two other studies that found checklists to be effective in improving scrutiny22 and diagnostic accuracy23 when interpreting electrocardiograms. More advanced forms of clinician decision support systems have also been studied.24 Software programs such as DXplain generate a list of potential diagnoses based on a patient’s chief complaint. In one study, when the software provided physicians a list of possible diagnoses before evaluating patients, diagnoses were 1.31 times more likely to be correct. 25 The use of diagnostic support tools may grow in the future as they are integrated into electronic medical record systems.Improving Knowledge and ExperienceA combination of experience, knowledge and feedback are integral in developing a clinician’s intuition to produce the best hypotheses. Experience without feedback can lead to overconfidence, which itself is a cognitive bias. The evidence supporting feedback is strong. Fridriksson et al showed a significant reduction in diagnostic error when referring doctors were provided feedback on the identification of subarachnoid hemorrhage.26 A systematic review of 118 randomized trials concluded that feedback was effective in improving professional practice.27 The specific characteristics of the best feedback were elusive. In general, however, feedback was thought to be most effective when it was explicit and delivered close to the time of decision making. ConclusionsIn our review, we explore clinical decision making through the lens of dual-process theory. However, multiple different dual-processing models are still being explored and fundamental questions are still under debate. For example, some experts believe that instead of focusing on de-biasing strategies, the key to improving intuitive (System 1) processes is simply to acquire more formal and experiential knowledge.19 Other unanswered questions include: the impact and magnitude of cognitive bias in actual clinical practice, which biases are most prevalent in each medical specialty and which strategies are the most effective in mitigating bias. Further study is also needed to assess the impact of novel educational methods, such as case-based and simulation-based learning, which are promising venues where trainees may identify and correct cognitive biases in a directly observed setting. References 1. Norman G. Research in clinical reasoning: past history and current trends. Med Educ 2005;39:418–27.2. Kahneman D. Thinking, fast and slow. Farrar, Straus and Giroux; 2011.3. Croskerry P. From mindless to mindful practice — cognitive bias and clinical decision making. N Engl J Med 2013;368:2445–8.4. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Academic Medicine 2003;78:775–80.5. Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med 2005;165:1493–9.6. Parush A, Campbell C, Hunter A, et al. Situational awareness and patient safety - a short primer. Ottawa ON: The Royal College of Physicians and Surgeons of Canada; 2011.7. Pelaccia T, Tardif J, Triby E, Charlin B. An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory. Med Educ Online 2011;16.8. Reyna VF. A theory of medical decision making and health: fuzzy trace theory. Med Decis 2008;28:850–65.9. Osman M. An evaluation of dual-process theories of reasoning. Psychonom Bull review 2004;11:988–1010.10. Dubeau CE, Voytovich AE, Rippey RM. Premature conclusions in the diagnosis of iron-deficiency anemia: cause and effect. Med Dec Mak 1986;6:169–73.11. Nickerson RS. Confirmation bias: A ubiquitous phenomenon in many guises. Rev Gen Psychol 1998;2:175.12. Mendel R, Traut-Mattausch E, Jonas E, et al. Confirmation bias: why psychiatrists stick to wrong preliminary diagnoses. Psychol Med 2011;41:2651–9.13. Pines JM. Profiles in patient safety: confirmation bias in emergency medicine. Acad Emerg Med 2006;13:90–4.14. Tschan F, Semmer NK, Gurtner A, et al. Explicit reasoning, confirmation bias, and illusory transactive memory: a simulation study of group medical decision making. Small Group Res 2009;40:271–300.15. Mamede S, van Gog T, van den Berge K, et al. Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA 2010;304:1198–203.16. Graber ML, Kissam S, Payne VL, et al. Cognitive interventions to reduce diagnostic error: a narrative review. BMJ Qual Safe 2012;21:535–57.17. Croskerry P, Singhal G, Mamede S. Cognitive debiasing 2: impediments to and strategies for change. BMJ Qual Saf 2013.18. Norman G, Sherbino J, Dore K, et al. The etiology of diagnostic errors: a controlled trial of system 1 versus system 2 reasoning. Acad Med 2014;89:277–84.19. Monteiro SD, Sherbino J, Patel A, Mazzetti I, Norman GR, Howey E. Reflecting on diagnostic errors: taking a second look is not enough. J Gen Intern Med 2015;30:1270–4.20. Bass A, Geddes C, Wright B, Coderre S, Rikers R, McLaughlin K. Experienced physicians benefit from analyzing initial diagnostic hypotheses. Can Med Educ J 2013;4:e7–e15.21. Ely JW, Graber MA. Checklists to prevent diagnostic errors: a pilot randomized controlled trial. Diagnosis 2015;2.22. Sibbald M, de Bruin ABH, Yu E, van Merrienboer JJG. Why verifying diagnostic decisions with a checklist can help: insights from eye tracking. Adv Health Sci Educ Theory Pract 2015;20:1053–60.23. Sibbald M, de Bruin ABH, van Merrienboer JJG. Checklists improve experts' diagnostic decisions. Med Educ 2013;47:301–8.24. Garg AX, Adhikari NKJ, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005;293:1223–38.25. Kostopoulou O, Rosen A, Round T, et al. Early diagnostic suggestions improve accuracy of GPs: a randomised controlled trial using computer-simulated patients. Br J Gen Pract 2015;65:e49–54.26. Fridriksson S, Hillman J, Landtblom AM, Boive J. Education of referring doctors about sudden onset headache in subarachnoid hemorrhage. A prospective study. Acta Neurol Scand 2001;103:238–42.27. Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD. Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. Qual Saf Health Care 2006;15:433–6.

My father killed the boar when he was 16. He’d dreamed of killing the boar for some time. My father’s brother had killed a boar when he was only fifteen. My father’s brother was five years older than him. Like most big brothers, he treated his little brother with intolerant contempt. He’d been saying for months that my father would never kill a boar. He was too weak. He was a girl. He was useless. And, just the day before, he told him he was so worthless he better finish the fence on the bottom paddock before dusk or he could expect a kicking. The family farm was gradually being cleared from the bush and the fencing slow and arduous. My father finished the fence. My father was very good with his hands and in truth a much better fencer than his brother, which didn’t help matters between them. That night my father didn’t go to sleep in the room he shared with his brother. Instead he went out into the bush past the bottom paddock, where the boars roamed, his rifle strapped over his shoulder and a knife in his ankle scabbard. The cleared ground was rough and uneven, a broken landscape created by the eruptions and outpourings of the volcanoes Ruapehu, Ngauruhoe and Tongariro. In the bush, the terrain was even rougher, jagged rises and deep gullies, all ripe with the verdant vegetation flourishing on the rich volcanic soil. My father found himself a niche in a cliff on the edge of the bush above a small clearing near the creek. He huddled there in his woollen coat and dungarees and waited. He’d brought the dogs with him and they drove the boar out of the bush and into the clearing among the tree ferns just before dawn. By then my father was hunched on a rock, out of the way. The dogs worried the boar. They grabbed its tail, snapped at its balls, sank their teeth into its legs. The boar fought back. It lashed at them with its tusks. It caught one and tossed it into a tree fern, the dog yelping from the pain of its ripped rib cage. The boar roared, stomping and rooting. The dogs continued to circle. My father had waited all night in the cold, his rifle loaded and the safety catch off. My father was a very good shot. Better than his brother. That was why his parents had splurged on his birthday gift and bought him a .303 rifle. His brother had a .22, but he couldn’t shoot pigeons or ducks. My father, though, could use his brother’s gun to bring down a brace of ducks. Another reason his brother treated him like a piece of dirt. But out in the bush he couldn’t shoot the boar for fear of killing one of the dogs. He slipped the catch on and laid the gun down beside him. He took a knife from the scabbard on his belt. He waited until the boar was facing away from him, dogs in front and behind it. He jumped from the rock, and kicked the boar’s right hind leg out. The boar went down. My father threw himself on its back and plunged the knife in between the shoulders. Deep, to cut the spine and throat. The boar squealed, thrashed and subsided. My father thrust himself upright, knife still in blood-soaked hand, and stood away from the boar. The boar rolled over, the dogs still nipping at it. My father used the knife again, slashing deep across the boar’s throat. It screamed and lunged at him with head and tusks. He leapt away, falling over one of the dogs. The boar didn’t die straight away. It thrashed about on the ground, snorting and sighing at first, then whimpering as blood gushed out, steamed on the cold ground and coagulated in the crushed ferns. Eventually it was just panting, and slowly at that. Finally it was dead. My father shooed the dogs away. He cut off the boar’s balls and pizzle and tossed them to the dogs. He slit the boar from arse to belly and began the process of removing its warm innards, first working with the bladder to attempt to keep its contents from having too much contact with his game. His hands reached right inside to disentangle the intestines. His shirt and jacket were soaked with its blood. His hands were greasy with blood and shit. He washed himself as best as he could in the freezing water of the creek. He manoeuvred the boar so that it was half sitting on the ground then he lowered himself down and backed between the boar’s front legs, his head under its chin. Taking the weight of the beast on his shoulders, he slowly stood and began to trudge out of the bush and through the rough paddocks towards his family home on the top of the rise. The dogs kept him company for a bit, but the lure of home was too much for them and they took off up the hill in a barking frenzy. All except the one that had been tossed by the boar. It slunk at his heels, blood on its flank where the tusk had ripped through. His father and brother were waiting for him on the veranda. His brother glared and yelled at him because he had missed the morning milking of the cows, but his father told him to take the boar to the meat shack. This was behind the house. It was a rough weatherboard structure on the cool, south-side. It was secure against dogs and vermin and big enough to hang several carcases. A sheep and legs of ham were already there. The shack had a smooth stone floor with drainage channels grooved into it. My father laid the boar on the floor of the shack. He cut the hock of each hind leg just behind the tendon to make a space for the gambrel hook. He inserted the hook then used the hoist in the shack to raise the boar up to the rail that ran down the centre of the room and from which the meat hung. My father then began to skin the boar, stripping back the black bristled outer flesh as much as possible in one piece. Once it was scrubbed of the bristles and tanned, the skin would be soft and supple, suitable for a purse or for covering a saddle. He washed the carcass. Later, when the day’s farm work was over, the whole family would work on preparing and preserving the boar. His mother had already fired up the copper to boil water for the cleaning and salting. Lastly, he sawed off the boar’s head. He placed it on the butcher’s block in the shack and worked at the tusks. On this big beast the tusks were almost five inches long, curved and very sharp. They were much larger than the tusks from his brother’s boar. Once he had the tusks out of the boar’s mouth, he stripped of all but his underpants and washed himself as best as he could at the tap of the water tank at the back of the house. The water was icy and there was a stiff breeze from the snow on the mountains. It was still winter. But my father hardly noticed. He was still warm from the blood of the boar and the sight of his brother’s face when he had seen the size of it. Two months later, he took the tusks into the town of Taumaranui. He sought advice from the jeweller in the main street, who had made a speciality of working with tusks. The jeweller was known all over the King Country. The jeweller talked about how the tusks might be mounted. He suggested a band of gold, edges engraved with delicate leaves, to join the tusks base to base, so that the points formed a semicircle. Just below the points, he suggested two gold bands joined with a delicate gold chain, from which the tusks could be hung. And that is what my father agreed to. The jeweller took one month then my father claimed his tusks and took them home to mount on his bedroom wall, where his brother was forced to see them every day. My father signed up for the Air Force when he was 18. He wanted to fly away from his brother and the cows and the fencing and digging the rocks out of the paddock and that is exactly what he did. He learned to fly, something he’d dreamed of doing, same as he had dreamed of killing a boar. My father was a great dreamer. He left the tusks at home with his mother. She took them out of the bedroom them and placed them on the wall of the family room to remind her of him. His brother would turn them back to front. My father sent home photographs of himself: one from Cairo with him in tropical gear, sparkling eyes and a jaunty smile under his new moustache; another from Waddingham in his Sergeant pilot’s uniform standing with his crew in front of their Lancaster as it is loaded with bombs; a last one from an unknown place but he is wearing his Flying Officer’s uniform for he had been promoted and there are ribbons on his chest, too, but his eyes do not shine and he does not smile. As they arrived from the other side of the world in the slow mail his mother placed these photographs on the sideboard in the family room under my father’s tusks. In a mood after the Sunday roast his brother would turn them face down, saying my father wouldn’t be coming back so why did he have to be reminded of him. But he did come back, which even his brother had to acknowledge. He was 23. He was a shell of the boy who had killed the boar. He had been gutted by the war, though he showed no outward signs of the mutilation. It was all within, deep within, embedded in him like tusks in the jaw of a boar. My father began studying to be a veterinarian when he was 25. As part of his repatriation package, he was paid to study at the University of Sydney. He took the tusks down from his mother’s wall and packed them into one of the suitcases he and my mother took with them on the flying boat to Sydney. The tusks hung on the wall of the semi in Enmore they lived in for the five years he studied. Then after he had graduated they went back across the Tasman and my father began his work with animals. The animals received his ministrations with passive indifference and helped resolve the horror in his head, an unremitting memory of the perilous flights under attack across black skies and terrain, the fires unleashed by the phosphorous bombs released from his plane’s bomb bay let alone the destruction from other ordnance, the morning briefings after what was left of the squadron had returned and he learned which of his mates was no longer. He drank a bit. Maybe too much, but nobody ever sat down with him and talk about what he had been through. He had some medals and his old flying jacket and it was expected that he just get on with life. Which he did, overall. Once my parents were back in New Zealand, he set up practice in Waikato, with dairy cattle his most frequent patients. The Waikato district lies to the north of the King Country where my father had killed the boar. His family were not so far away, but he didn’t visit them that often. His brother was running things down there. His brother held vets in contempt and made that clear on the rare occasions my father did visit. Then his father, my grandfather, died. The farm went to his older brother as was the custom of those times. His widowed mother moved up to Auckland, so my father had no reason to visit the farm or his brother any more. Maybe it was only a matter of moving away from his brother but he lost and found himself in Australia. Maybe it was also the fact that a few years after he had made the move, the phone rang one night and he found he was talking to his brother’s wife. His brother had shot himself down in the bottom paddock that morning. It seems my father’s brother was never a very good farmer. From that time on my father mellowed, relaxed and began to enjoy himself. The tusks, though, were always on his bedside table, reminding him of that night he spent out in the bush and killed the boar. My father died three weeks before he was to turn 80. His death was long and painful to those of us who had to watch it, though for him it was ameliorated by painkillers and palliative care given him. It was my job to arrange the details of his funeral. Since his death was no surprise, all of his family, his three sons and his two daughters, grandsons and grand-daughters and his great grand children as well, had already gathered to say goodbye to him. But everybody was now under pressure to get back to jobs and other commitments. I spoke to the undertakers. They arranged the funeral the day following my father’s death in their own chapel. My mother wanted an open casket so my father had to be dressed in his best clothes. My mother and I selected the clothes and I took them to the undertakers. The next morning, before the ceremony, the undertakers called me and asked me to come to their rooms behind the chapel. They asked me to check that my father looked as much as we wanted him to look. He lay in the coffin, only his head and hands showing, the rest of him expertly trussed and dressed for this last display. His hair was neatly brushed and there was a bristle or two of whiskers on his cheek and chin. His eyes were closed and the skin on his face waxy, but cold from wherever he had been stored. I kissed him on his forehead. Then I placed the tusks on his chest, just under his neck and over the tie and jacket my mother had decided he should wear. My father was ready. I drove my mother down to the chapel just before 2 pm. She and I were the last people to be seated. We were both to sit in the front row. She walked straight up the aisle past the other mourners to my father’s coffin and she stood there for a moment looking at her husband of nearly sixty years. She stretched out her arm and stroked the tusks on his chest. Then she turned and I reached out and guided her to her seat. “He’ll like having them,” she whispered to me. Then we sang “There’s a hole in the bucket”. My father always liked that song. The crematorium was miles away. My father travelled there alone. Just as he had faced the boar. References De Hek, Danny. “Hunting regions—King Country: The home of wild pig hunting in New Zealand.” New Zealand’s Information Network 16 Aug. 2010 . Dick, Tim. “The boar wars.” WAtoday.com.au 13 Nov. 2008. 16 Aug. 2010 . Rushmer, Miles. “Bush surfing: That’s a New Zealand pig hunt.” ESPN Outdoors 28 Apr. 2005. 16 Aug. 2010 . Walrond, Carl. “Pig hunting.” Te Ara: The Encyclopaedia of New Zealand 1 Mar. 2009. 16 Aug. 2010 .

When deaf people work in professional environments and participate in public events, we are often accompanied by sign language interpreters. This usually means wonderfully enhanced access – we can learn, participate and network in ways which are difficult if not impossible on our own. But while we often try to insist that our interpreters are ‘invisible’, that we are the ones learning, engaging in dialogue and consuming services, we are regularly bemused by the public fascination and focus on our interpreters – sometimes at the expense of their attention to us. When interpreters are in our midst, it seems it is not always clear whose interests they are representing. After years of experience and observation, certain attitudes and responses no longer surprise us. We become familiar with the strange behaviour of hearing people. After an interpreter has worked at a public event, perhaps standing on a stage and interpreting a presentation or performance, there is bound to be a wild-eyed member of the public rushing up to say, “That was fantastic!” Or if they are particularly suggestive, they might gush, “That was beautiful!”. How would they know if it was good interpreting, we wonder. And why don’t they come up to us and say, “Your interpreter looks good, where did you find him/her?” Other people ask the interpreter questions about themselves and their use of sign language – “How long did it take you to learn that?”, “I’ve always wanted to learn sign language, where can I find a class?” Experienced interpreters joke wryly about carrying a tape or printout of answers to these predictable questions. But the most predictable thing of all is that people will ask the interpreter, not us. But of course most people aren’t comfortable talking to deaf people, at least when they first encounter them. We perceive that the interpreter is used as a kind of shield by some people, as a way of keeping the unfamiliar and possibly confronting reality of deafness at arm’s length. Indeed we often do the same thing ourselves, keeping tiresome hearing people at bay by making conversation with our interpreter. The interpreter represents facility not only with two languages, but also with two cultures. In a situation of potential cultural conflict, we each displace our awkwardness and discomfort with the other onto the interpreter. As a repository of bilingual and bicultural knowledge, they will simultaneously understand us and render us less strange to the other. Another dimension of people’s fascination with interpreters is that they can potentially represent us in new ways, or know things about us that they’re not telling. Just as we are fascinated by a photograph of ourselves that shows how we appear to others, we are drawn to the idea that what we have said may be presented to others in a different form, that we might appear or sound different from the way we projected ourselves. And conversely, we are aware of the interpreter’s power to misrepresent, edit or obfuscate, even though we know they are ethically bound not to do so. For some people these possibilities are intriguing, for others they arouse unease or suspicion. Indeed, for some people, interpreters appear as custodians of obscure and mysterious knowledge, with the potential—almost never realised but alarming nonetheless—to use or withhold this knowledge in unpredictable ways. Interpreters are, for the most part, highly trained professionals working with a Code of Ethics which requires them to ‘render faithfully’ a message from one language to another. There is an academic discipline, Interpreting and Translation Studies, with an extensive literature about their practice and the social contexts of their work. Interpreters work in all kinds of situations, from boardrooms to doctors’ offices, from international conferences to workplace staff meetings. The common denominator to almost all of these settings is people’s misconceptions about their role and skills. Where do these misconceptions spring from? I suspect that representations of interpreting in our popular culture help to feed some of the confusion. It seems that the world is most interested in interpreters when they are working in fraught situations, confronting ethical dilemmas, and especially when they are breaking the rules. This seems to apply to interpreters in any language, not only sign language interpreters. Many of us remember the news story in 2005 about the Ukrainian sign language interpreter, Natalia Dmytruk. A TV news interpreter in Ukrainian Sign Language, she broke with protocol and informed viewers that the election results were fraudulent. It grabbed international headlines and Dmytruk became a hero, with her “courageous action” winning awards and earning her speaking engagements around the world. It was hard not to join in the acclaim, but it was also hard to reconcile this with the way we expect interpreters to behave and to be perceived by the public. One of Nicole Kidman’s films a few years ago was “The Interpreter”, about a woman working for the United Nations as an interpreter in an obscure African language. She inadvertently eavesdrops on a plot to assassinate an African leader, feels obliged to reveal this, and immediately becomes an object of intense interest for rival politicians and minders. This film highlighted the way interpreters can be perceived as repositories of great and often mysterious knowledge, and objects of ambivalence because they have choices about what to do with that knowledge. What happens when their ethical obligations conflict with international security and diplomatic relations? And how is this different from interpreters who face ethical dilemmas every day, but whose situations don’t threaten to start World War III or warrant the attentions of Sean Penn – are their ethical dilemmas any less important and perplexing? John Le Carré, the wonderful novelist who specialises in stories of spying and intrigue, used a similar dilemma in his 2006 novel The Mission Song, about an interpreter of mixed Irish/Congolese descent, Bruno Salvador (known as Salvo). Salvo is brought in to interpret some delicate political negotiations between warring clans from his own country, and international agents who have an interest in the country. Before long, he is caught between his professional obligations and his own loyalties, and becomes entangled in a dangerous web of intrigue and corruption. Le Carré, the master of the spy genre, presents the interpreter as a “double-agent” by default. At the beginning of the meeting, one of the negotiators summons Salvo to the top of the table and demands of him, “So which are you, my boy? Are you one of us or one of them?” He replies, “Mwangaza, I am one of both of you!” But as modern interpreters might agree, it isn’t always so easy to resolve divided loyalties or to stay impartial. As Salvo remarks elsewhere, “top interpreters must always be prepared to act as diplomats when called upon.” While working on a recent research project with a colleague (who is also, coincidentally, an interpreter) we were intrigued by the tale of a 17th-century Native American man known as Squanto, who served as an interpreter between the first English settlers in New England – the Pilgrims – and the Native Americans of the area. Squanto’s story is fascinating not only as an example of how interpreters have been present throughout history, but also because he took advantage of his access to both groups in order to seek political power for himself and his relatives. The only person who was able to expose his machinations was, of course, another interpreter. But Squanto had developed such close relationships with the Pilgrims that the English Governor could not bear to hand him over to be punished even when confronted with evidence of his duplicity. And when Squanto was dying (probably poisoned by his fellow tribesmen), he asked the Governor to “pray … that he might go to the Englishmen’s God in Heaven.” The story is an intriguing historical example of an interpreter exploiting his access to two languages, and it also illustrates the bi-cultural affiliations and even the co-dependency that can arise from the interpreting relationship. Squanto has remained well-known for hundreds of years. Had he operated just as a disinterested translator, without his extra-curricular activities, his story would probably not have endured as long as it has. These are just a few examples of the fascination and ambivalence with which popular culture can view interpreters. But in each case, what brings the interpreter into the foreground is that they are confronting the possibilities of crossing the line of confidentiality, though it is rarely given that name in these stories. And – in all of these examples – they do cross it. The conflicted, flawed interpreter is becoming a handy plot device… just as the isolated, silent deaf person has been for centuries. Where are the news stories, movies, novels and historical sagas about the interpreters who do their job with care and attention, who work to make their ethical obligations clear and manageable, who successfully stay in the background and let their clients emerge as agents? There aren’t any of course, because people like that don’t make good copy or memorable fictional characters. And because these thousands of professional interpreters don’t get celebrated in popular culture, the average person doesn’t know how they work, and they still need to keep explaining their role to people. Sometimes we speculate about futuristic interpreters. It’s already possible to have a ‘remote’ interpreter working via video-conference. This can result in strangely stilted interactions, since we don’t have that live human buffer in the room to deflect – or absorb – deaf and hearing people’s uncertainty with each other. Will holograms or avatars be part of the interpreting scene in the future, as some have suggested? I hope not – the complex interplay of uneasiness, curiosity and communication in live interpreting experiences is just too interesting. Note An earlier version of this article was published as "Interpreters Behaving Badly" in Across the Board, the magazine of ASLIA (Vic.). Used with permission of the editor. References Australian Sign Language Interpreters Association. "Code of Ethics and Guidelines for Professional Conduct. 2007. 3 May 2010 < http://aslia.com.au/images/stories/ASLIA_Documents/ASLIA_Code_of_Ethics.pdf >. The Interpreter. Motion picture. Prod. G.M. Brown, A. Minghella, and S. Pollack. Dir. S. Pollack. Universal Pictures, 2005. Le Carré, J. The Mission Song. London: Hodder & Stoughton, 2006. Napier, J., R. McKee, and D. Goswell. Sign Language Interpreting: Theory and Practice in Australia and New Zealand. 2nd ed. Sydney: Federation Press, 2010. Philbrick, N. Mayflower: A Voyage to War. London: HarperPress, 2006. Washington Post. “As Ukraine Watched the Party Line, She Took the Truth into Her Hands.” 29 Apr. 2005. 25 Nov. 2008 < http://www.washingtonpost.com/wp-dyn/content/article/2005/04/28/AR2005042801696.html >.

Story spreads out through time the behaviors or bodies – the shapes – a self has been or will be, each replacing the one before. Hence a story has before and after, gain and loss. It goes somewhere…Moreover, shape or body is crucial, not incidental, to story. It carries story; it makes story visible; in a sense it is story. Shape (or visible body) is in space what story is in time. (Bynum, quoted in Garland Thomson, 113-114) Drawing on Goffman’s classic work on stigma, research documenting the existence of discrimination and bias against individuals classified as obese goes back five decades. Since Cahnman published “The Stigma of Obesity” in 1968, other researchers have well documented systematic and growing discrimination against fat people (cf. Puhl and Brownell; Puhl and Heuer; Puhl and Heuer; Fikkan and Rothblum). While weight-based stereotyping has a long history (Chang and Christakis; McPhail; Schwartz), contemporary forms of anti-fat stigma and discrimination must be understood within a social and economic context of neoliberal healthism. By neoliberal healthism (see Crawford; Crawford; Metzel and Kirkland), I refer to the set of discourses that suggest that humans are rational, self-determining actors who independently make their own best choices and are thus responsible for their life chances and health outcomes. In such a context, good health becomes associated with proper selfhood, and there are material and social consequences for those who either unwell or perceived to be unwell. While the greatest impacts of size-based discrimination are structural in nature, the interpersonal impacts are also significant. Because obesity is commonly represented (at least partially) as a matter of behavioral choices in public health, medicine, and media, to “remain fat” is to invite commentary from others that one is lacking in personal responsibility. Guthman suggests that this lack of empathy “also stems from the growing perception that obesity presents a social cost, made all the more tenable when the perception of health responsibility has been reversed from a welfare model” (1126). Because weight loss is commonly held to be a reasonable and feasible goal and yet is nearly impossible to maintain in practice (Kassierer and Angell; Mann et al.; Puhl and Heuer), fat people are “in effect, asked to do the impossible and then socially punished for failing” (Greenhalgh, 474). In this article, I explore how weight-based stigma shaped the decisions of bariatric patients to undergo weight loss surgery. In doing so, I underline the work that emotion does in circulating anti-fat stigma and in creating categories of subjects along lines of health and responsibility. As well, I highlight how fat bodies are lived and negotiated in space and place. I then explore ways in which participants take up notions of time, specifically in regard to risk, in discussing what brought them to the decision to have bariatric surgery. I conclude by arguing that it is a dynamic interaction between the material, social, emotional, discursive, and the temporal that produces not only fat embodiment, but fat subjectivity “failed”, and serves as an impetus for seeking bariatric surgery. Methods This article is based on 30 semi-structured interviews with American bariatric patients. At the time of the interview, individuals were between six months and 12 years out from surgery. After obtaining Intuitional Review Board approval, recruitment occurred through a snowball sample. All interviews were audio-taped with permission and verbatim interview transcripts were analyzed by means of a thematic analysis using Dedoose (www.dedoose.com). All names given in this article are pseudonyms. This work is part of a larger project that includes two additional interviews with bariatric surgeons as well as participant-observation research. Findings Navigating Anti-Fat Stigma In discussing what it was like to be fat, all but one of the individuals I interviewed discussed experiencing substantive size-based stigma and discrimination. Whether through overt comments, indirect remarks, dirty looks, open gawking, or being ignored and unrecognized, participants felt hurt, angry, and shamed by friends, family, coworkers, medical providers, and strangers on the street because of the size of their bodies. Several recalled being bullied and even physically assaulted by peers as children. Many described the experience of being fat or very fat as one of simultaneous hypervisibility and invisibility. One young woman, Kaia, said: “I absolutely was not treated like a person … . I was just like this object to people. Just this big, you know, thing. That’s how people treated me.” Nearly all of my participants described being told repeatedly by others, including medical professionals, that their inability to lose weight was effectively a failure of the will. They found these comments to be particularly hurtful because, in fact, they had spent years, even decades, trying to lose weight only to gain the weight back plus more. Some providers and family members seemed to take up the idea that shame could be a motivating force in weight loss. However, as research by Lewis et al.; Puhl and Huerer; and Schafer and Ferraro has demonstrated, the effect this had was the opposite of what was intended. Specifically, a number of the individuals I spoke with delayed care and avoided health-facilitating behaviors, like exercising, because of the discrimination they had experienced. Instead, they turned to health-harming practices, like crash dieting. Moreover, the internalization of shame and blame served to lower a sense of self-worth for many participants. And despite having a strong sense that something outside of personal behavior explained their escalating body weights, they deeply internalized messages about responsibility and self-control. Danielle, for instance, remarked: “Why could the one thing I want the most be so impossible for me to maintain?” It is important to highlight the work that emotion does in circulating such experiences of anti-fat stigma and discrimination. As Fraser et al have argued in their discussion on fat and emotion, the social, the emotional, and the corporeal cannot be separated. Drawing on Ahmed, they argue that strong emotions are neither interior psychological states that work between individuals nor societal states that impact individuals. Rather, emotions are constitutive of subjects and collectivities, (Ahmed; Fraser et al.). Negative emotions in particular, such as hate and fear, produce categories of people, by defining them as a common threat and, in the process, they also create categories of people who are deemed legitimate and those who are not. Thus following Fraser et al, it is possible to see that anti-fat hatred did more than just negatively impact the individuals I spoke with. Rather, it worked to produce, differentiate, and drive home categories of people along lines of health, weight, risk, responsibility, and worth. In this next section, I examine the ways in which anti-fat discrimination works at the interface of not only the discursive and the emotive, but the material as well. Big Bodies, Small Spaces When they discussed their previous lives as very fat people, all of the participants made reference to a social and built environment mismatch, or in Garland Thomson’s terms, a “misfit”. A misfit occurs “when the environment does not sustain the shape and function of the body that enters it” (594). Whereas the built environment offers a fit for the majority of bodies, Garland Thomson continues, it also creates misfits for minority forms of embodiment. While Garland Thomson’s analysis is particular to disability, I argue that it extends to fat embodiment as well. In discussing what it was like to navigate the world as fat, participants described both the physical and emotional pain entailed in living in bodies that did not fit and frequently discussed the ways in which leaving the house was always a potential, anxiety-filled problem. Whereas all of the participants I interviewed discussed such misfitting, it was notable that participants in the Greater New York City area (70% of the sample) spoke about this topic at length. Specifically, they made frequent and explicit mentions of the particular interface between their fat bodies and the Metropolitan Transit Authority (MTA), and the tightly packed spaces of the city itself. Greater New York City area participants frequently spoke of the shame and physical discomfort in having to stand on public transportation for fear that they would be openly disparaged for “taking up too much room.” Some mentioned that transit seats were made of molded plastic, indicating by design the amount of space a body should occupy. Because they knew they would require more space than what was allotted, these participants only took seats after calculating how crowded the subway or train car was and how crowded it would likely become. Notably, the decision to not take a seat was one that was made at a cost for some of the larger individuals who experienced joint pain. Many participants stated that the densely populated nature of New York City made navigating daily life very challenging. In Talia’s words, “More people, more obstacles, less space.” Participants described always having to be on guard, looking for the next obstacle. As Candice put it: “I would walk in some place and say, ‘Will I be able to fit? Will I be able to manoeuvre around these people and not bump into them?’ I was always self-conscious.” Although participants often found creative solutions to navigating the hostile environment of both the MTA and the city at large, they also identified an increasing sense of isolation that resulted from the physical discomfort and embarrassment of not fitting in. For instance, Talia rarely joined her partner and their friends on outings to movies or the theater because the seats were too tight. Similarly, Decenia would make excuses to her husband in order to avoid social situations outside of the home: “I’d say to my husband, ‘I don’t feel well, you go.’ But you know what? It was because I was afraid not to fit, you know?” The anticipatory scrutinizing described by these participants, and the anxieties it produced, echoes Kirkland’s contention that fat individuals use the technique of ‘scanning’ in order to navigate and manage hostile social and built environments. Scanning, she states, involves both literally rapidly looking over situations and places to determine accessibility, as well as a learned assessment and observation technique that allows fat people to anticipate how they will be received in new situations and new places. For my participants, worries about not fitting were more than just internal calculation. Rather, others made all too clear that fat bodies are not welcome. Nina recalled nasty looks she received from other subway riders when she attempted to sit down. Decenia described an experience on a crowded commuter train in which the woman next to her openly expressed annoyance and disgust that their thighs were touching. Talia recalled being aggressively handed a weight loss brochure by a fellow passenger. When asked to contrast their experiences living in New York City with having travelled or lived elsewhere, participants almost universally described the New York as a more difficult place to live for fat people. However, the experiences of three of the Latinas that I interviewed troubled this narrative. Katrina felt that the harassment she received in her country of origin, the Dominican Republic, was far worse than what she now experienced in the New York Metropolitan Area. Although Decenia detailed painful experiences of anti-fat stigma in New York City, she nevertheless described her life as relatively “easy” compared to what it was like in her home country of Brazil. And Denisa contrasted her neighbourhood of East Harlem with other parts of Manhattan: “In Harlem it's different. Everybody is really fat or plump – so you feel a bit more comfortable. Not everybody, but there's a mix. Downtown – there's no mix.” Collectively, their stories serve as a reminder (see Franko et al.; Grabe and Hyde) to be suspicious of over determined accounts that “Latino culture” is (or people of colour communities in general are), more accepting of larger bodies and more resistant to weight-based stigma and discrimination. Their comments also reflect arguments made by Colls, Grosz, and Garland Thomson, who have all pointed to the contingent nature between space and bodies. Colls argue that sizing is both a material and an emotional process – what size we take ourselves to be shifts in different physical and emotional contexts. Grosz suggests that there is a “mutually constitutive relationship between bodies and cities” – one that, I would add, is raced, classed, and gendered. Garland Thomson has described the relationship between bodies and space/place as “a dynamic encounter between world and flesh.” These encounters, she states, are always contingent and situated: “When the spatial and temporal context shifts, so does the fit, and with it meanings and consequences” (592). In this sense, fat is materialized differently in different contexts and in different scales – nation, state, city, neighbourhood – and the materialization of fatness is always entangled with raced, classed, and gendered social and political-economic relations. Nevertheless, it is possible to draw some structural commonalities between divergent parts of the Greater New York City Metropolitan Area. Specifically, a dense population, cramped physical spaces, inaccessible transportation and transportation funding cuts, social norms of fast paced life, and elite, raced, classed, and gendered norms of status and beauty work to materialize fatness in such a way that a ‘misfit’ is often the result for fat people who live and/or work in this area. And importantly, misfitting, as Garland Thomson argues, has consequences: it literally “casts out” when the “shape and function of … bodies comes into conflict with the shape and stuff of the built world” (594). This casting out produces some bodies as irrelevant to social and economic life, resulting in segregation and isolation. To misfit, she argues, is to be denied full citizenship. Responsibilising the Present Garland Thomson, discussing Bynum’s statement that “shape carries story”, argues the following: “the idea that shape carries story suggests … that material bodies are not only in the spaces of the world but that they are entwined with temporality as well” (596). In this section, I discuss how participants described their decisions to get weight loss surgery by making references to the need take responsibility for health now, in the present, in order to avoid further and future morbidity and mortality. Following Adams et al., I look at how the fat body is lived in a state of constant anticipation – “thinking and living toward the future” (246). All of the participants I spoke with described long histories of weight cycling. While many managed to lose weight, none were able to maintain this weight loss in the long term – a reality consistent with the medical fact that dieting does not produce durable results (Kassirer and Angell; Mann et al.; Puhl and Heuer). They experienced this inability as not only distressing, but terrifying, as they repeatedly regained the lost weight plus more. When participants discussed their decisions to have surgery, they highlighted concerns about weight related comorbidities and mobility limitations in their explanations. Consistent then with Boero, Lopez, and Wadden et al., the participants I spoke with did not seek out surgery in hopes of finding a permanent way to become thin, but rather a permanent way to become healthy and normal. Concerns about what is considered to be normative health, more than simply concerns about what is held to be an appropriate appearance, motivated their decisions. Significantly, for these participants the decision to have bariatric surgery was based on concerns about future morbidity (and mortality) at least as much, if not more so, than on concerns about a current state of ill health and impairment. Some individuals I spoke with were unquestionably suffering from multiple chronic and even life threatening illnesses and feared they would prematurely die from these conditions. Other participants, however, made the decision to have bariatric surgery despite the fact that they had no comorbidities whatsoever. Motivating their decisions was the fear that they would eventually develop them. Importantly, medial providers explicitly and repeatedly told all of these participants that lest they take drastic and immediate action, they would die. For example: Faith’s reproductive endocrinologist said: “you’re going to have diabetes by the time you’re 30; you’re going to have a stroke by the time you’re 40. And I can only hope that you can recover enough from your stroke that you’ll be able to take care of your family.” Several female participants were warned that without losing weight, they would either never become pregnant or they would die in childbirth. By contrast, participants stated that their bariatric surgeons were the first providers they had encountered to both assert that obesity was a medical condition outside of their control and to offer them a solution. Within an atmosphere in which obesity is held to be largely or entirely the result of behavioural choices, the bariatric profession thus positions itself as unique by offering both understanding and what it claims to be a durable treatment. Importantly, it would be a mistake to conclude that some bariatric patients needed surgery while others choose it for the wrong reasons. Regardless of their states of health at the time they made the decision to have surgery, the concerns that drove these patients to seek out these procedures were experienced as very real. Whether or not these concerns would have materialized as actual health conditions is unknown. Furthermore, bariatric patients should not be seen as having been duped or suffering from ‘false consciousness.’ Rather, they operate within a particular set of social, cultural, and political-economic conditions that suggest that good citizenship requires risk avoidance and personal health management. As these individuals experienced, there are material and social consequences for ‘failing’ to obtain normative conceptualizations of health. This set of conditions helps to produce a bariatric patient population that includes both those who were contending with serious health concerns and those who feared they would develop them. All bariatric patients operate within this set of conditions (as do medical providers) and make decisions regarding health (current, future, or both) by using the resources available to them. In her work on the temporalities of dieting, Coleman argues that rather than seeing dieting as a linear and progressive event, we might think of it instead a process that brings the future into the present as potential. Adams et al suggest concerns about potential futures, particularly in regard to health, are a defining characteristic of our time. They state: “The present is governed, at almost every scale, as if the future is what matters most. Anticipatory modes enable the production of possible futures that are lived and felt as inevitable in the present, rendering hope and fear as important political vectors” (249). The ability to act in the present based on potential future risks, they argue, has become a moral imperative and a marker of proper of citizenship. Importantly, however, our work to secure the ‘best possible future’ is never fully assured, as risks are constantly changing. The future is thus always uncertain. Acting responsibly in the present therefore requires “alertness and vigilance as normative affective states” (254). Importantly, these anticipations are not diagnostic, but productive. As Adams et al state, “the future arrives already formed in the present, as if the emergency has already happened…a ‘sense’ of the simultaneous uncertainty and inevitability of the future, usually manifest in entanglements of fear and hope” (250). It is in this light, then, that we might see the decision to have bariatric surgery. For these participants, their future weight-related morbidity and mortality had already arrived in the present and thus they felt they needed to act responsibly now, by undergoing what they had been told was the only durable medical intervention for obesity. The emotions of hope, fear, anxiety and I would suggest, hatred, were key in making these decisions. Conclusion Medical, public health, and media discourses frame obesity as an epidemic that threatens to bring untold financial disaster and escalating rates of morbidity and mortality upon the nation state and the world at large. As Fraser et al argue, strong emotions (such hatred, fear, anxiety, and hope), are at the centre of these discourses; they construct, circulate, and proliferate them. Moreover, they create categories of people who are deemed legitimate and categories of others who are not. In this context, the participants I spoke with were caught between a desire to have fatness understood as a medical condition needing intervention; the anti-fat attitudes of others, including providers, which held that obesity was a failure of the will and nothing more; their own internalization of these messages of personal responsibility for proper behavioural choices, and, the biologically intractable nature of fatness wherein dieting not only fails to reduce weight in the vast majority of cases but results, in the long term, in increased weight gain (Kassirer and Angell; Mann et al.; Puhl and Heuer). Widespread anxiety and embarrassment over and fear and hatred of fatness was something that the individuals I interviewed experienced directly and which signalled to them that they were less than human. Their desire for weight loss, therefore was partially a desire to become ‘normal.’ In Butler’s term, it was the desire for a ‘liveable life. ’A liveable life, for these participants, included a desire for a seamless fit with the built environment. The individuals I spoke with were never more ashamed of their fatness than when they experienced a ‘misfit’, in Garland Thomson’s terms, between their bodies and the material world. Moreover, feelings of shame over this disjuncture worked in tandem with a deeply felt, pressing sense that something must be done in the present to secure a better health future. The belief that bariatric surgery might finally provide a durable answer to obesity served as a strong motivating factor in their decisions to undergo bariatric surgery. By taking drastic action to lose weight, participants hoped to contest stigmatizing beliefs that their fat bodies reflected pathological interiors. Moreover, they sought to demonstrate responsibility and thus secure proper subjectivities and citizenship. In this sense, concerns, anxieties, and fears about health cannot be disentangled from the experience of anti-fat stigma and discrimination. Again, anti-fat bias, for these participants, was more than discursive: it operated through the circulation of emotion and was experienced in a very material sense. The decision to have weight loss surgery can thus be seen as occurring at the interface of emotion, flesh, space, place, and time, and in ways that are fundamentally shaped by the broader social context of neoliberal healthism. AcknowledgmentI am grateful to the anonymous reviewers of this article for their helpful feedback on earlier version. References Adams, Vincanne, Michelle Murphy, and Adele E. Clarke. “Anticipation: Technoscience, Life, Affect, Temporality.” Subjectivity 28.1 (2009): 246-265. Ahmed, Sara. “Affective Economies.” Social Text 22.2 (2004): 117-139 Boero, Natalie. Killer Fat: Media, Medicine, and Morals in the American "Obesity Epidemic". New Brunswick: Rutgers University Press, 2012. Butler, Judith. Undoing Gender. New York: Routledge, 2004. Bynum, Caroline Walker. 1999. Jefferson Lecture in the Humanities. National Endowment for the Humanities. Washington, DC, 1999. Cahnman, Werner J. “The Stigma of Obesity.” The Sociological Quarterly 9.3 (1968): 283-299. Chang, Virginia W., and Nicholas A. Christakis. “Medical Modeling of Obesity: A Transition from Action to Experience in a 20th Century American Medical Textbook.” Sociology of Health & Illness 24.2 (2002): 151-177. Coleman, Rebecca. “Dieting Temporalities: Interaction, Agency and the Measure of Online Weight Watching.” Time & Society 19.2 (2010): 265-285. Colls, Rachel. “‘Looking Alright, Feeling Alright:’ Emotions, Sizing, and the Geographies of Women’s Experience of Clothing Consumption.” Social & Cultural Geography 5.4 (2004): 583-596. Crawford, Robert. “You Are Dangerous to Your Health: The Ideology and Politics of Victim Blaming.” International Journal of Health Services 7.4 (1977): 663-680. ———. “Health as a Meaningful Social Practice.: Health 10.4 (2006): 401-20. Dedoose. Computer Software. n.d. Franko, Debra L., Emilie J. Coen, James P. Roehrig, Rachel Rodgers, Amy Jenkins, Meghan E. Lovering, Stephanie Dela Cruz. “Considering J. Lo and Ugly Betty: A Qualitative Examination of Risk Factors and Prevention Targets for Body Dissatisfaction, Eating Disorders, and Obesity in Young Latina Women.” Body Image 9.3 (2012), 381-387. Fikken, Janna J., and Esther D. Rothblum. “Is Fat a Feminist Issue? Exploring the Gendered Nature of Weight Bias.” Sex Roles 66.9-10 (2012): 575-592. Fraser, Suzanne, JaneMaree Maher, and Jan Wright. “Between Bodies and Collectivities: Articulating the Action of Emotion in Obesity Epidemic Discourse.” Social Theory & Health 8.2 (2010): 192-209. Garland Thomson, Rosemarie. “Misfits: A Feminist Materialist Disability Concept.” Hypatia 26.3 (2011): 591-609. Goffman, Erving. Stigma: Notes on the Management of Spoiled Identity. New York: Simon & Schuster, 1963. Grabe, Shelly, and Janet S. Hyde. “Ethnicity and Body Dissatisfaction among Women in the United States: A Meta-Analysis.” Psychological Bulletin 132.2 (2006): 622. Greenhalgh, Susan. “Weighty Subjects: The Biopolitics of the U.S. War on Fat.” American Ethnologist 39.3 (2012): 471-487. Grosz, Elizabeth A. “Bodies-Cities.” Feminist Theory and the Body: A Reader, eds. Janet Price and Margrit Shildrick. New York: Routledge, 1999. 381-387. Guthman, Julie. “Teaching the Politics of Obesity: Insights into Neoliberal Embodiment and Contemporary Biopolitics.” Antipode 41.5 (2009): 1110-1133. Kassirer, Jerome P., and M. Marcia Angell. “Losing Weight: An Ill-Fated New Year's Resolution.” The New England Journal of Medicine 338.1 (1998): 52. Kirkland, Anna. “Think of the Hippopotamus: Rights Consciousness in the Fat Acceptance Movement.” Law & Society Review 42.2 (2008): 397-432. Lewis, Sophie, Samantha L. Thomas, R. Warwick Blood, David Castle, Jim Hyde, and Paul A. Komesaroff. “How Do Obese Individuals Perceive and Respond to the Different Types of Obesity Stigma That They Encounter in Their Daily Lives? A Qualitative Study.” Social Science & Medicine 73.9 (2011): 1349-56. López, Julia Navas. “Socio-Anthropological Analysis of Bariatric Surgery Patients: A Preliminary Study.” Social Medicine 4.4 (2009): 209-217. McPhail, Deborah. “What to Do with the ‘Tubby Hubby?: ‘Obesity,’ the Crisis of Masculinity, and the Nuclear Family in Early Cold War Canada. Antipode 41.5 (2009): 1021-1050. Mann, Traci, A. Janet Tomiyama, Erika Westling, Ann-Marie Lew, Barbara Samuels, and Jason Chatman. “Medicare’s Search for Effective Obesity Treatments.” American Psychologist 62.3 (2007): 220-233. Metzl, Jonathan. “Introduction: Why ‘Against Health?’” Against Health: How Health Became the New Morality, eds. Jonathan Metzl and Anna Kirkland. New York: NYU Press, 2010. 1-14. Puhl, Rebecca M. “Obesity Stigma: Important Considerations for Public Health.” American Journal of Public Health 100.6 (2010): 1019-1028.———, and Kelly D. Brownell. “Psychosocial Origins of Obesity Stigma: Toward Changing a Powerful and Pervasive Bias.” Obesity Reviews 4.4 (2003): 213-227. ——— and Chelsea A. Heuer. “The Stigma of Obesity: A Review and Update.” Obesity 17.5 (2009): 941-964. Schafer, Markus H., and Kenneth F. Ferraro. “The Stigma of Obesity: Does Perceived Weight Discrimination Affect Identity and Physical Health?” Social Psychology Quarterly 74.1 (2011): 76-97. Schwartz, H. Never Satisfied: A Cultural History of Diets, Fantasies, and Fat. New York: Anchor Books, 1986. Wadden, Thomas A., David B. Sarwer, Anthony N. Fabricatore, LaShanda R. Jones, Rebecca Stack, and Noel Williams. “Psychosocial and Behavioral Status of Patients Undergoing Bariatric Surgery: What to Expect before and after Surgery.” The Medical Clinics of North America 91.3 (2007): 451-69. Wilson, Bianca. “Fat, the First Lady, and Fighting the Politics of Health Science.” Lecture. The Graduate Center of the City University of New York. 14 Feb. 2011.

1909–22: Turkey exterminated over 1.5 million of its ethnically Armenian, and hundreds of thousands of its ethnically Greek and Assyrian, citizens. Most died in 1915. This period of decimation in now widely called the Armenian Genocide (Balakian 179-80).1910: Siamanto first published his poem, The Dance: “The corpses were piled as trees, / and from the springs, from the streams and the road, / the blood was a stubborn murmur.” When springs run red, when the dead are stacked tree-high, when “everything that could happen has already happened,” then time is nothing: “there is no future [and] the language of civilised humanity is not our language” (Nichanian 142).2007: In my novel The Edge of the World a ceramic bowl, luminous blue, recurs as motif. Imagine you are tiny: the bowl is broken but you don’t remember breaking it. You’re awash with tears. You sit on the floor, gather shards but, no matter how you try, you can’t fix it. Imagine, now, that the bowl is the sky, huge and upturned above your head. You have always known, through every wash of your blood, that life is shockingly precarious. Silence—between heartbeats, between the words your parents speak—tells you: something inside you is terribly wrong; home is not home but there is no other home; you “can never be fully grounded in a community which does not share or empathise with the experience of persecution” (Wajnryb 130). This is the stubborn murmur of your body.Because time is nothing, this essay is fragmented, non-linear. Its main characters: my mother, grandmother (Hovsanna), grandfather (Benyamin), some of my mother’s older siblings (Krikor, Maree, Hovsep, Arusiak), and Mustafa Kemal Ataturk (Ottoman military officer, Young Turk leader, first president of Turkey). 1915–2013: Turkey invests much energy in genocide denial, minimisation and deflection of responsibility. 24 April 2012: Barack Obama refers to the Medz Yeghern (Great Calamity). The use of this term is decried as appeasement, privileging political alliance with Turkey over human rights. 2003: Between Genocide and Catastrophe, letters between Armenian-American theorist David Kazanjian and Armenian-French theorist Marc Nichanian, contest the naming of the “event” (126). Nichanian says those who call it the Genocide are:repeating every day, everywhere, in all places, the original denial of the Catastrophe. But this is part of the catastrophic structure of the survivor. By using the word “Genocide”, we survivors are only repeating […] the denial of the loss. We probably cannot help it. We are doing what the executioner wanted us to do […] we claim all over the world that we have been “genocided;” we relentlessly need to prove our own death. We are still in the claws of the executioner. We still belong to the logic of the executioner. (127)1992: In Revolution and Genocide, historian Robert Melson identifies the Armenian Genocide as “total” because it was public policy intended to exterminate a large fraction of Armenian society, “including the families of its members, and the destruction of its social and cultural identity in most or all aspects” (26).1986: Boyajian and Grigorian assert that the Genocide “is still operative” because, without full acknowledgement, “the ghosts won’t go away” (qtd. in Hovannisian 183). They rise up from earth, silence, water, dreams: Armenian literature, Armenian homes haunted by them. 2013: My heart pounds: Medz Yeghern, Aksor (Exile), Anashmaneli (Indefinable), Darakrutiun (Deportation), Chart (Massacre), Brnagaght (Forced migration), Aghed (Catastrophe), Genocide. I am awash. Time is nothing.1909–15: Mustafa Kemal Ataturk was both a serving Ottoman officer and a leader of the revolutionary Young Turks. He led Ottoman troops in the repulsion of the Allied invasion before dawn on 25 April at Gallipoli and other sites. Many troops died in a series of battles that eventually saw the Ottomans triumph. Out of this was born one of Australia’s founding myths: Australian and New Zealand Army Corps (ANZACs), courageous in the face of certain defeat. They are commemorated yearly on 25 April, ANZAC Day. To question this myth is to risk being labelled traitor.1919–23: Ataturk began a nationalist revolution against the occupying Allies, the nascent neighbouring Republic of Armenia, and others. The Allies withdrew two years later. Ataturk was installed as unofficial leader, becoming President in 1923. 1920–1922: The last waves of the Genocide. 2007: Robert Manne published A Turkish Tale: Gallipoli and the Armenian Genocide, calling for a recontextualisation of the cultural view of the Gallipoli landings in light of the concurrence of the Armenian Genocide, which had taken place just over the rise, had been witnessed by many military personnel and widely reported by international media at the time. Armenian networks across Australia were abuzz. There were media discussions. I listened, stared out of my office window at the horizon, imagined Armenian communities in Sydney and Melbourne. Did they feel like me—like they were holding their breath?Then it all went quiet. Manne wrote: “It is a wonderful thing when, at the end of warfare, hatred dies. But I struggle to understand why Gallipoli and the Armenian Genocide continue to exist for Australians in parallel moral universes.” 1992: I bought an old house to make a home for me and my two small children. The rooms were large, the ceilings high, and behind it was a jacaranda with a sturdy tree house built high up in its fork. One of my mother’s Armenian friends kindly offered to help with repairs. He and my mother would spend Saturdays with us, working, looking after the kids. Mum would stay the night; her friend would go home. But one night he took a sleeping bag up the ladder to the tree house, saying it reminded him of growing up in Lebanon. The following morning he was subdued; I suspect there were not as many mosquitoes in Lebanon as we had in our garden. But at dinner the previous night he had been in high spirits. The conversation had turned, as always, to politics. He and my mother had argued about Turkey and Russia, Britain’s role in the development of the Middle East conflict, the USA’s roughshod foreign policy and its effect on the world—and, of course, the Armenian Genocide, and the killingof Turkish governmental representatives by Armenians, in Australia and across the world, during the 1980s. He had intimated he knew the attackers and had materially supported them. But surely it was the beer talking. Later, when I asked my mother, she looked at me with round eyes and shrugged, uncharacteristically silent. 2002: Greek-American diva Diamanda Galas performed Dexifiones: Will and Testament at the Perth Concert Hall, her operatic work for “the forgotten victims of the Armenian and Anatolian Greek Genocide” (Galas).Her voice is so powerful it alters me.1925: My grandmother, Hovsanna, and my grandfather, Benyamin, had twice been separated in the Genocide (1915 and 1922) and twice reunited. But in early 1925, she had buried him, once a prosperous businessman, in a swamp. Armenians were not permitted burial in cemeteries. Once they had lived together in a big house with their dozen children; now there were only three with her. Maree, half-mad and 18 years old, and quiet Hovsep, aged seven,walked. Then five-year-old aunt, Arusiak—small, hungry, tired—had been carried by Hovsanna for months. They were walking from Cilicia to Jerusalem and its Armenian Quarter. Someone had said they had seen Krikor, her eldest son, there. Hovsanna was pregnant for the last time. Together the four reached Aleppo in Syria, found a Christian orphanage for girls, and Hovsanna, her pregnancy near its end, could carry Arusiak no further. She left her, promising to return. Hovsanna’s pains began in Beirut’s busy streets. She found privacy in the only place she could, under a house, crawled in. Whenever my mother spoke of her birth she described it like this: I was born under a stranger’s house like a dog.1975: My friend and I travelled to Albany by bus. After six hours we were looking down York Street, between Mount Clarence and Mount Melville, and beyond to Princess Royal Harbour, sapphire blue, and against which the town’s prosperous life—its shopfronts, hotels, cars, tourists, historic buildings—played out. It took away my breath: the deep harbour, whaling history, fishing boats. Rain and sun and scudding cloud; cliffs and swells; rocky points and the white curves of bays. It was from Albany that young Western Australian men, volunteers for World War I, embarked on ships for the Middle East, Gallipoli, sailing out of Princess Royal Harbour.1985: The Australian Government announced that Turkey had agreed to have the site of the 1915 Gallipoli landings renamed Anzac Cove. Commentators and politicians acknowledged it as historic praised Turkey for her generosity, expressed satisfaction that, 70 years on, former foes were able to embrace the shared human experience of war. We were justifiably proud of ourselves.2005: Turkey made her own requests. The entrance to Albany’s Princess Royal Harbour was renamed Ataturk Channel. A large bronze statue of Ataturk was erected on the headland overlooking the Harbour entrance. 24 April 1915: In the town of Hasan Beyli, in Cilicia, southwest Turkey, my great grandfather, a successful and respected businessman in his 50s, was asleep in his bed beside his wife. He had been born in that house, as had his father, grandfather, and all his children. His brother, my great uncle, had bought the house next door as a young man, brought his bride home to it, lived there ever since; between the two households there had been one child after another. All the cousins grew up together. My great grandfather and great uncle had gone to work that morning, despite their wives’ concerns, but had returned home early. The women had been relieved to see them. They made coffee, talked. Everyone had heard the rumours. Enemy ships were massing off the coast. 1978: The second time in Albany was my honeymoon. We had driven into the Goldfields then headed south. Such distance, such beautiful strangeness: red earth, red rocks; scant forests of low trees, thin arms outstretched; the dry, pale, flat land of Norseman. Shimmering heat. Then the big, wild coast.On our second morning—a cool, overcast day—we took our handline to a jetty. The ocean was mercury; a line of cormorants settled and bobbed. Suddenly fish bit; we reeled them in. I leaned over the jetty’s side, looked down into the deep. The water was clear and undisturbed save the twirling of a pike that looked like it had reversed gravity and was shooting straight up to me. Its scales flashed silver as itbroke the surface.1982: How could I concentrate on splicing a film with this story in my head? Besides the desk, the only other furniture in the editing suite was a whiteboard. I took a marker and divided the board into three columns for the three generations: my grandparents, Hovsanna and Benyamin; my mother; someone like me. There was a lot in the first column, some in the second, nothing in the third. I stared at the blankness of my then-young life.A teacher came in to check my editing. I tried to explain what I had been doing. “I think,” he said, stony-faced, “that should be your third film, not your first.”When he had gone I stared at the reels of film, the white board blankness, the wall. It took 25 years to find the form, the words to say it: a novel not a film, prose not pictures.2007: Ten minutes before the launch of The Edge of the World, the venue was empty. I made myself busy, told myself: what do you expect? Your research has shown, over and over, this is a story about which few know or very much care, an inconvenient, unfashionable story; it is perfectly in keeping that no-one will come. When I stepped onto the rostrum to speak, there were so many people that they crowded the doorway, spilled onto the pavement. “I want to thank my mother,” I said, “who, pretending to do her homework, listened instead to the story her mother told other Armenian survivor-women, kept that story for 50 years, and then passed it on to me.” 2013: There is a section of The Edge of the World I needed to find because it had really happened and, when it happened, I knew, there in my living room, that Boyajian and Grigorian (183) were right about the Armenian Genocide being “still operative.” But I knew even more than that: I knew that the Diaspora triggered by genocide is both rescue and weapon, the new life in this host nation both sanctuary and betrayal. I picked up a copy, paced, flicked, followed my nose, found it:On 25 April, the day after Genocide memorial-day, I am watching television. The Prime Minister stands at the ANZAC memorial in western Turkey and delivers a poetic and moving speech. My eyes fill with tears, and I moan a little and cover them. In his speech he talks about the heroism of the Turkish soldiers in their defence of their homeland, about the extent of their losses – sixty thousand men. I glance at my son. He raises his eyebrows at me. I lose count of how many times Kemal Ataturk is mentioned as the Father of Modern Turkey. I think of my grandmother and grandfather, and all my baby aunts and uncles […] I curl over like a mollusc; the ache in my chest draws me in. I feel small and very tired; I feel like I need to wash.Is it true that if we repeat something often enough and loud enough it becomes the truth? The Prime Minister quotes Kemal Ataturk: the ANZACS who died and are buried on that western coast are deemed ‘sons of Turkey’. My son turns my grandfather’s, my mother’s, my eyes to me and says, It is amazing they can be so friendly after we attacked them.I draw up my knees to my chest, lay my head and arms down. My limbs feel weak and useless. My throat hurts. I look at my Australian son with his Armenian face (325-6).24 April 1915 cont: There had been trouble all my great grandfather’s life: pogrom here, massacre there. But this land was accustomed to colonisers: the Mongols, the Persians, latterly the Ottomans. They invade, conquer, rise, fall; Armenians stay. This had been Armenian homeland for thousands of years.No-one masses ships off a coast unless planning an invasion. So be it. These Europeans could not be worse than the Ottomans. That night, were my great grandfather and great uncle awoken by the pounding at each door, or by the horses and gendarmes’ boots? They were seized, each family herded at gunpoint into its garden, and made to watch. Hanging is slow. There could be no mistakes. The gendarmes used the stoutest branches, stayed until they were sure the men weredead. This happened to hundreds of prominent Armenian men all over Turkey that night.Before dawn, the Allies made landfall.Each year those lost in the Genocide are remembered on 24 April, the day before ANZAC Day.1969: I asked my mother if she had any brothers and sisters. She froze, her hands in the sink. I stared at her, then slipped from the room.1915: The Ottoman government decreed: all Armenians were to surrender their documents and report to authorities. Able-bodied men were taken away, my grandfather among them. Women and children, the elderly and disabled, were told to prepare to walk to a safe camp where they would stay for the duration of the war. They would be accompanied by armed soldiers for their protection. They were permitted to take with them what they could carry (Bryce 1916).It began immediately, pretty young women and children first. There are so many ways to kill. Months later, a few dazed, starved survivors stumbled into the Syrian desert, were driven into lakes, or herded into churches and set alight.Most husbands and fathers were never seen again. 2003: I arrived early at my son’s school, parked in the shade, opened The Silence: How Tragedy Shapes Talk, and began to read. Soon I was annotating furiously. Ruth Wajnryb writes of “growing up among innocent peers in an innocent landscape” and also that the notion of “freedom of speech” in Australia “seems often, to derive from that innocent landscape where reside people who have no personal scars or who have little relevant historical knowledge” (141).1984: I travelled to Vancouver, Canada, and knocked on Arusiak’s door. Afraid she would not agree to meet me, I hadn’t told her I was coming. She was welcoming and gracious. This was my first experience of extended family and I felt loved in a new and important way, a way I had read about, had observed in my friends, had longed for. One afternoon she said, “You know our mother left me in an orphanage…When I saw her again, it was too late. I didn’t know who they were, what a family was. I felt nothing.” “Yes, I know,” I replied, my heart full and hurting. The next morning, over breakfast, she quietly asked me to leave. 1926: When my mother was a baby, her 18 year-old sister, Maree, tried to drown her in the sea. My mother clearly recalled Maree’s face had been disfigured by a sword. Hovsanna, would ask my mother to forgive Maree’s constant abuse and bad behaviour, saying, “She is only half a person.”1930: Someone gave Hovsanna the money to travel to Aleppo and reclaim Arusiak, by then 10 years old. My mother was intrigued by the appearance of this sister but Arusiak was watchful and withdrawn. When she finally did speak to my then five-year-old mother, she hissed: “Why did she leave me behind and keep you?”Soon after Arusiak appeared, Maree, “only half a person,” disappeared. My mother was happy about that.1935: At 15, Arusiak found a live-in job and left. My mother was 10 years old; her brother Hovsep, who cared for her before and after school every day while their mother worked, and always had, was seventeen. She adored him. He had just finished high school and was going to study medicine. One day he fell ill. He died within a week.1980: My mother told me she never saw her mother laugh or, once Hovsep died, in anything other than black. Two or three times before Hovsep died, she saw her smile a little, and twice she heard her singing when she thought she was alone: “A very sad song,” my mother would say, “that made me cry.”1942: At seventeen, my mother had been working as a live-in nanny for three years. Every week on her only half-day off she had caught the bus home. But now Hovsanna was in hospital, so my mother had been visiting her there. One day her employer told her she must go to the hospital immediately. She ran. Hovsanna was lying alone and very still. Something wasn’t right. My mother searched the hospital corridors but found no-one. She picked up a phone. When someone answered she told them to send help. Then she ran all the way home, grabbed Arusiak’s photograph and ran all the way back. She laid it on her mother’s chest, said, “It’s all right, Mama, Arusiak’s here.”1976: My mother said she didn’t like my boyfriend; I was not to go out with him. She said she never disobeyed her own mother because she really loved her mother. I went out with my boyfriend. When I came home, my belongings were on the front porch. The door was bolted. I was seventeen.2003: I read Wajnryb who identifies violent eruptions of anger and frozen silences as some of the behaviours consistent in families with a genocidal history (126). 1970: My father had been dead over a year. My brothers and I were, all under 12, made too much noise. My mother picked up the phone: she can’t stand us, she screamed; she will call an orphanage to take us away. We begged.I fled to my room. I couldn’t sit down. I couldn’t keep still. I paced, pressed my face into a corner; shook and cried, knowing (because she had always told us so) that she didn’t make idle threats, knowing that this was what I had sometimes glimpsed on her face when she looked at us.2012: The Internet reveals images of Ataturk’s bronze statue overlooking Princess Royal Harbour. Of course, it’s outsized, imposing. The inscription on its plinth reads: "Peace at Home/ Peace in the World." He wears a suit, looks like a scholar, is moving towards us, a scroll in his hand. The look in his eyes is all intensity. Something distant has arrested him – a receding or re-emerging vision. Perhaps a murmur that builds, subsides, builds again. (Medz Yeghern, Aksor, Aghed, Genocide). And what is written on that scroll?2013: My partner suggested we go to Albany, escape Perth’s brutal summer. I tried to explain why it’s impossible. There is no memorial in Albany, or anywhere else in Western Australia, to the 1.5 million victims of the Armenian Genocide. ReferencesAkcam, Taner. “The Politics of Genocide.” Online Video Clip. YouTube. YouTube, 11 Dec. 2011. 6 Mar. 2013 ‹http://www.youtube.com/watchv=OxAJaaw81eU&noredirect=1genocide›.Balakian, Peter. The Burning Tigress: The Armenian Genocide. London: William Heinemann, 2004.BBC. “Kemal Ataturk (1881–1938).” BBC History. 2013. 6 Mar. 2013 ‹http://www.bbc.co.uk/history/historic_figures/ataturk_kemal.shtml›.Boyajian, Levon, and Haigaz Grigorian. “Psychological Sequelae of the Armenian Genocide.”The Armenian Genocide in Perspective. Ed. Richard Hovannisian. New Brunswick: Transaction, 1987. 177–85.Bryce, Viscount. The Treatment of the Armenians in the Ottoman Empire. London: Hodder and Stoughton, 1916.Galas, Diamanda. Program Notes. Dexifiones: Will and Testament. Perth Concert Hall, Perth, Australia. 2001.———.“Dexifiones: Will and Testament FULL Live Lisboa 2001 Part 1.” Online Video Clip. YouTube, 5 Nov. 2011. Web. 6 Mar. 2013 ‹http://www.youtube.com/watch?v=mvVnYbxWArM›.Kazanjian, David, and Marc Nichanian. “Between Genocide and Catastrophe.” Loss. Eds. David Eng and David Kazanjian. Los Angeles: U of California P, 2003. 125–47.Manne, Robert. “A Turkish Tale: Gallipoli and the Armenian Genocide.” The Monthly Feb. 2007. 6 Mar. 2013 ‹http://www.themonthly.com.au/turkish-tale-gallipoli-and-armenian-genocide-robert-manne-459›.Matiossian, Vartan. “When Dictionaries Are Left Unopened: How ‘Medz Yeghern’ Turned into a Terminology of Denial.” The Armenian Weekly 27 Nov. 2012. 6 Mar. 2013 ‹http://www.armenianweekly.com/2012/11/27/when-dictionaries-are-left-unopened-how-medz-yeghern-turned-into-terminology-of-denial/›.Melson, Robert. Revolution and Genocide. Chicago: U of Chicago P, 1996.Nicholson, Brendan. “ASIO Detected Bomb Plot by Armenian Terrorists.” The Australian 2 Jan. 2012. 6 Mar. 2013 ‹http://www.theaustralian.com.au/in-depth/cabinet-papers/asio-detected-bomb-plot-by-armenian-terrorists/story-fnbkqb54-1226234411154›.“President Obama Issues Statement on Armenian Remembrance Day.” The Armenian Weekly 24 Apr. 2012. 5 Mar. 2013 ‹http://www.armenianweekly.com/2012/04/24/president-obama-issues-statement-on-armenian-remembrance-day/›.Polain, Marcella. The Edge of the World. Fremantle: Fremantle Press, 2007.Siamanto. “The Dance.” Trans. Peter Balakian and Nervart Yaghlian. Adonias Dalgas Memorial Page 5 Mar. 2013 ‹http://www.terezakis.com/dalgas.html›.Stockings, Craig. “Let’s Have a Truce in the Battle of the Anzac Myth.” The Australian 25 Apr. 2012. 6 Mar. 2013 ‹http://www.theaustralian.com.au/national-affairs/opinion/lets-have-a-truce-in-the-battle-of-the-anzac-myth/story-e6frgd0x-1226337486382›.Wajnryb, Ruth. The Silence: How Tragedy Shapes Talk. Crows Nest: Allen and Unwin, 2001.

The first time I read Hélène Cixous’s The Laugh of the Medusa I swooned. I wanted to write the whole thing out, large, and black, and pin it across an entire wall. I was 32 and vulnerable around polemic texts (I was always copying out quotes and sticking them to my walls, trying to hold onto meaning, unable to let the writing I read slip out and away). You must "write your self, your body must be heard" (Cixous 880), I read, as if for the hundredth time, even though it was the first. Those decades old words had an echoing, a resonance to them, as if each person who had read them had left their own mnemonic mark there, so that by the time they reached me, they struck, immediately, at my core (not the heart or the spine, or even the gut, but somewhere stickier; some pulsing place in amongst my organs, somewhere not touched, a space forgotten). The body that read The Laugh was so big its knees had trouble lifting it from chairs (“more body, hence more writing”, Cixous 886), and was soon to have its gallbladder taken. Its polycystic ovaries dreamed, lumpily and without much hope, of zygotes. The body that read The Laugh was a wobbling thing, sheathed in fat (as if this could protect it), with a yearning for sveltness, for muscle, for strength. Cixous sang through its cells, and called it to itself. The body that read The Laugh wrote itself back. It spoke about dungeons, and walls that had collected teenaged fists, and needles that turned it somnambulant and concave and warm until it was not. It wrote trauma in short and staggering sentences (out, get it out) as if narrative could save it from a fat-laden and static decline. Text leaked from tissue and bone, out through fingers and onto the page, and in increments so small I did not notice them, the body took its place. I was, all-of-a-sudden, more than my head. And then the body that read The Laugh performed the ultimate coup, and conceived.The body wrote then about its own birth, and the birth of its mother, and when its own children were born, of course, of course, about them. “Oral drive, anal drive, vocal drive–all these drives are our strengths, and among them is the gestation drive–all just like the desire to write: a desire to live self from within, a desire for the swollen belly, for language, for blood” (Cixous 891). The fat was gone, and in its place this other tissue, that later would be he. What I know now is that the body gets what the body wants. What I know now is that the body will tell its story, because if you “censor the body [… then] you censor breath and speech at the same time” (Cixous 880).I am trying to find a beginning. Because where is the place where I start? I was never a twinkle in my mother’s eye. It was the seventies. She was 22 and then 23–there was nothing planned about me. Her eyes a flinty green, hair long and straight. When I think of her then I remember this photo: black and white on the thick photo paper that is hard to get now. No shiny oblong spat from a machine, this paper was pulled in and out of three chemical trays and hung, dripping, in a dark red room to show me a woman in a long white t-shirt and nothing else. She stares straight out at me. On the shirt is a women’s symbol with a fist in the middle of it. Do you know the one? It might have been purple (the symbol I mean). When I think of her then I see her David Bowie teeth, the ones she hated, and a packet of Drum tobacco with Tally-Hos tucked inside, and some of the scars on her forearms, but not all of them, not yet. I can imagine her pregnant with me, the slow gait, that fleshy weight dragging at her spine and pelvis. She told me the story of my birth every year on my birthday. She remembers what day of the week the contractions started. The story is told with a kind of glory in the detail, with a relishing of small facts. I do the same with my children now. I was delivered by forceps. The dent in my skull, up above my right ear, was a party trick when I was a teenager, and an annoyance when I wanted to shave my head down to the bone at 18. Just before Jem was born, I discovered a second dent behind my left ear. My skull holds the footprint of those silver clamps. My bones say here, and here, this is where I was pulled from you. I have seen babies being born this way. They don’t slide out all sealish and purple and slippy. They are pulled. The person holding the forcep handles uses their whole body weight to yank that baby out. It makes me squirm, all that pulling, those tiny neck bones concertinaing out, the silver scoops sinking into the skull and leaving prints, like a warm spoon in dough. The urgency of separation, of the need to make two things from one. After Jem was born he lay on my chest for hours. As the placenta was birthed he weed on me. I felt the warm trickle down my side and was glad. There was nothing so right as my naked body making a bed for his. I lay in a pool of wet (blood and lichor and Jem’s little wee) and the midwives pushed towels under me so I wouldn’t get cold. He sucked. White waffle weave blankets over both of us. That bloody nest. I lay in it and rested my free hand on his vernix covered back; the softest thing I had ever touched. We basked in the warm wet. We basked. How do I sew theory into this writing? Julia Kristeva especially, whose Stabat Mater describes those early moments of holding the one who was inside and then out so perfectly that I am left silent. The smell of milk, dew-drenched greenery, sour and clear, a memory of wind, of air, of seaweed (as if a body lived without waste): it glides under my skin, not stopping at the mouth or nose but caressing my veins, and stripping the skin from the bones fills me like a balloon full of ozone and I plant my feet firmly on the ground in order to carry him, safe, stable, unuprootable, while he dances in my neck, floats with my hair, looks right and left for a soft shoulder, “slips on the breast, swingles, silver vivid blossom of my belly” and finally flies up from my navel in his dream, borne by my hands. My son (Kristeva, Stabat Mater 141). Is theory more important than this? The smell of milk (dried, it is soursweet and will draw any baby to you, nuzzling and mewling), which resides alongside the Virgin Mother and the semiotics of milk and tears. The language of fluid. While the rest of this writing, the stories not of mothers and babies, but one mother and one baby, came out smooth and fast, as soon as I see or hear or write that word, theory, I slow. I am concerned with the placement of things. I do not have the sense of being free. But if there’s anything that should come from this vain attempt to answer Cixous, to “write your self. Your body must be heard” (880), it should be that freedom and theory, boundary-lessness, is where I reside. If anything should come from this, it is the knowing that theory is the most creative pursuit, and that creativity will always speak to theory. There are fewer divisions than any of us realise, and the leakiness of bodies, of this body, will get me there. The smell of this page is of lichor; a clean but heady smell, thick with old cells and a foetus’s breath. The smell of this page is of blood and saliva and milk mixed (the colour like rotten strawberries or the soaked pad at the bottom of your tray of supermarket mince). It is a smell that you will secretly savour, breathe deeply, and then long for lemon zest or the sharpness of coffee beans to send away that angelic fug. That milk and tears have a language of their own is undeniable. Kristeva says they are “metaphors of non-language, of a ‘semiotic’ that does not coincide with linguistic communication” (Stabat Mater 143) but what I know is that these fluids were the first language for my children. Were they the first language for me? Because “it must be true: babies drink language along with the breastmilk: Curling up over their tongues while they take siestas–Mots au lait, verbae cum lacta, palabros con leche” (Wasserman quoted in Giles 223). The enduring picture I have of myself as an infant is of a baby who didn’t cry, but my mother will tell you a different story, in the way that all of us do. She will tell you I didn’t smile until I was five months old (Soli and Jem were both beaming at three months). Born six weeks premature, my muscles took longer to find their place, to assemble themselves under my skin. She will tell you I screamed in the night, because all babies do. Is this non-language? Jem was unintelligible much of the time. I felt as if I was holding a puzzle. Three o’clock in the morning, having tried breastfeeds, a bath with Nick Drake’s Pink Moon, bouncing him in a baby sling on the fitball (wedged into a corner so that if I nodded off I would hopefully swoon backwards, and the wall would wake me), walking him around and around while rocking and singing, then breastfeeding again, and still he did not sleep, and still he cried and clawed at my cheeks and shoulders and wrists and writhed; I could not guess at what it was he needed. I had never been less concerned with the self that was me. I was all breasts and milk and a craving for barbecued chicken and watermelon at three in the morning because he was drinking every ounce of energy I had. I was arms and a voice. I was food. And then I learnt other things; about let downs and waking up in pools of the stuff. Wet. Everywhere. “Lactating bodies tend towards anarchy” (Bartlett 163). Any body will tend towards anarchy – there is so much to keep in – but there are only so many openings a person can keep track of, and breastfeeding meant a kind of levelling up, meant I was as far from clean and proper as I possibly could be (Kristeva, Powers of Horror 72).In the nights I was not alone. Caren could not breastfeed him, but could do everything else, and never said I have to work tomorrow, because she knew I was working too. During waking hours I watched him constantly for those mystical tired signs, which often were hungry signs, which quickly became overtired signs. There was no figuring it out. But Soli, with Soli, I knew. The language of babies had been sung into my bones. There is a grammar in crying, a calling out and telling, a way of knowing that is older than I’ll ever be. Those tiny bodies are brimming with semiotics. Knees pulled up is belly ache, arching is tired, a look to the side I-want-that-take-me-there-not-there. There. Curling in, the whole of him, is don’t-look-at-me-now-hands-away. Now he is one he uses his hands to tell me what he wants. Sign language because I sign and so, then, does he, but also an emphatic placing of my hands on his body or toys, utensils, swings, things. In the early hours of a Wednesday morning I tried to stroke his head, to close his wide-open eyes with my fingertips. He grabbed my hand and moved it to his chest before I could alight on the bridge of his nose. And yesterday he raised his arm into the air, then got my hand and placed it into his raised hand, then stood, and led me down to the laundry to play with the dustpan and broom. His body, literally, speaks.This is the language of mothers and babies. It is laid down in the darkest part of the night. Laid down like memory, like dreams, stitched into tiredness and circled with dread adrenalin and fear. It will never stop. That baby will cry and I will stare owl-eyed into the dark and bend my cracking knees (don’t shake the baby it will only make it worse don’t shake don’t). These babies will grow into children and then adults who will never remember those screaming nights, cots like cages, a stuffed toy pushed on them as if it could replace the warmth of skin and breath (please, please, little bear, replace the warmth of skin and breath). I will never remember it, but she will. They will never remember it, but we will. Kristeva says too that mothers are in a “catastrophe of identity which plunges the proper Name into that ‘unnameable’ that somehow involves our imaginary representations of femininity, non-language, or the body” (Stabat Mater 134). A catastrophe of identity. The me and the not-me. In the night, with a wrapped baby and aching biceps, the I-was batting quietly at the I-am. The I-am is all body. Arms to hold and bathe and change him, milk to feed him, a voice to sing and soothe him. The I-was is a different beast, made of words and books, uninterrupted conversation and the kind of self-obsession and autonomy I didn’t know existed until it was gone. Old friends stopped asking me about my day. They asked Caren, who had been at work, but not me. It did not matter that she was a woman; in this, for most people we spoke to, she was the public and I was the private, her work mattered and mine did not. Later she would commiserate and I would fume, but while it was happening, it was near impossible to contest. A catastrophe of identity. In a day I had fed and walked and cried and sung and fed and rocked and pointed and read books with no words and rolled inane balls across the lounge room floor and washed and sung and fed. I had circled in and around while the sun traced its arc. I had waited with impatience for adult company. I had loved harder than I ever had before. I had metamorphosed and nobody noticed. Nobody noticed. A catastrophe of identity it was, but the noise and visibility that the word catastrophe invokes was entirely absent. And where was the language to describe this peeling inside out? I was burnished bright by those sleepless nights, by the requirement of the I-am. And in those nights I learned what my mother already knew. That having children is a form of grief. That we lose. But that we gain. At 23, what’s lost is possibility. She must have seen her writer’s life drilling down to nothing. She knew that Sylvia Plath had placed her head, so carefully on its pillow, in that gas filled place. No pungent metaphor, just a poet, a mother, who could not continue. I had my babies at 34 and 36. I knew some of what I would lose, but had more than I needed. My mother had started out with not enough, and so was left concave and edged with desperation as she made her way through inner-city Sydney’s grime, her children singing from behind her wait for me, wait for me, Mama please wait for me, I’m going just as fast as I can.Nothing could be more ‘normal’ than that a maternal image should establish itself on the site of that tempered anguish known as love. No one is spared. Except perhaps the saint or the mystic, or the writer who, by force of language, can still manage nothing more than to demolish the fiction of the mother-as-love’s-mainstay and to identify with love as it really is: a fire of tongues, an escape from representation (Kristeva, Stabat Mater 145).We transformed, she and I. She hoped to make herself new with children. A writer born of writers, the growing and birthing of our tiny bodies forced her to place pen to paper, to fight to write. She carved a place for herself with words but it kept collapsing in on her. My father’s bi-polar rages, his scrubbing evil spirits from the soles of her shoes in the middle of the night, wore her down, and soon she inhabited that maternal image anyway, in spite of all her attempts to side step it. The mad mother, the single mother, the sad mother. And yes I remember those mothers. But I also remember her holding me so hard sometimes I couldn’t breathe properly, and that some nights when I couldn’t sleep she had warm eyes and made chamomile tea, and that she called me angel. A fire of tongues, but even she, with her words, couldn’t escape from representation. I am a writer born of writers born of writers (triply blessed or cursed with text). In my scramble to not be mad or bad or sad, I still could not escape the maternal image. More days than I can count I lay under my babies wishing I could be somewhere, anywhere else, but they needed to sleep or feed or be. With me. Held captive by the need to be a good mother, to be the best mother, no saint or mystic presenting itself, all I could do was write. Whole poems sprang unbidden and complete from my pen. My love for my children, that fire of tongues, was demolishing me, and the only way through was to inhabit this vessel of text, to imbibe the language of bodies and tears and night, and make from it my boat.Those children wrote my body in the night. They taught me about desire, that unbounded scribbling thing that will not be bound by subjectivity, by me. They taught me that “the body is literally written on, inscribed, by desire and signification” (Grosz 60), and every morning I woke with ashen bones and poetry aching out through my pores, with my body writing me.This Mother ThingI maintain that I do not have to leavethe house at nightall leathery and eyelinered,all booted up and raw.I maintain that I do not miss thosesmoky rooms (wait that’s not allowed any more)where we strut and, without looking,compare tattoos.Because two years ago I had you.You with your blonde hair shining, your eyes like a creek after rain, that veinthat’s so blue on the side of your small nosethat people think you’ve been bruised.Because two years ago you cameout of me and landed here and grew. There is no going out. We (she and me) washand cook and wash and clean and love.This mother thing is the making of me but I missthose pulsing rooms,the feel of all of you pressing in onall of me.This mother thing is the making of me. And in text, in poetry, I find my home. “You only have to look at the Medusa straight on to see her. And she’s not deadly. She’s beautiful and she’s laughing” (Cixous 885). The mother-body writes herself, and is made new. The mother-body writes her own mother, and knows she was always-already here. The mother-body births, and breastfeeds, and turns to me in the aching night and says this: the Medusa? The Medusa is me.ReferencesBartlett, Alison. Breastwork: Rethinking Breastfeeding. Sydney: UNSW Press, 2005.Cixous, Hélène, Keith Cohen, and Paula Cohen (Trans.). "The Laugh of the Medusa." Signs 1.4 (1976): 875-93. Giles, Fiona. Fresh Milk. Crows Nest, NSW: Allen & Unwin, 2003. Grosz, Elizabeth. Volatile Bodies: Toward a Corporeal Feminism. St Leonards, NSW: Allen & Unwin, 1994.Kristeva, Julia, and Leon S. Roudiez (Trans.) Powers of Horror: An Essay on Abjection. New York: Columbia University Press, 1982.Kristeva, Julia, and Arthur Goldhammer (Trans.). "Stabat Mater." Poetics Today 6.1-2 (1985): 133-52.

During the War on Terror, the United States military has been conducting an increasing number of foreign campaigns by remote control using drones—also called unmanned aerial vehicles (UAVs) or remotely piloted vehicles (RPVs)—to extend the reach of military power and augment the technical precision of targeted strikes while minimizing bodily risk to American combatants. Stationed on bases throughout the southwest, operators fly weaponized drones over the Middle East. Viewing the battle zone through a computer screen that presents them with imagery captured from a drone-mounted camera, these combatants participate in war from a safe distance via an interface that resembles a video game. Increasingly, this participation takes the form of targeted killing. Despite their relative physical safety, in 2008 reports began mounting that like boots-on-the-ground combatants, many drone operators seek the services of chaplains or other mental health professionals to deal with the emotional toll of their work (Associated Press; Schachtman). Questions about the nature of the stress or trauma that drone operators experience have become a trope in news coverage of drone warfare (see Bumiller; Bowden; Saleton; Axe). This was exemplified in May 2013, when former Air Force drone pilot Brandon Bryant became a public figure after speaking to National Public Radio about his remorse for participating in targeted killing strikes and his subsequent struggle with post-traumatic stress (PTS) (Greene and McEvers). Stories like Bryant’s express American culture’s struggle to understand the role screen-mediated, remotely controlled killing plays in shifting the location of combatants’s sense of moral agency. That is, their sense of their ability to act based on their own understanding of right and wrong. Historically, one of the primary ways that psychiatry has conceptualized combat trauma has been as combatants’s psychological response losing their sense of moral agency on the battlefield (Lifton).This articleuses the popular science fiction novel Ender's Game as an analytic lens through which to examine the ways that screen-mediated warfare may result in combat trauma by investigating the ways in which it may compromise moral agency. The goal of this analysis is not to describe the present state of drone operators’s experience (see Asaro), but rather to compare and contrast contemporary public discourses on the psychological impact of screen-mediated war with the way it is represented in one of the most influential science fiction novels of all times (The book won the Nebula Award in 1985, the Hugo Award in 1986, and appears on both the Modern Library 100 Best Novels and American Library Association’s “100 Best Books for Teens” lists). In so doing, the paper aims to counter prevalent modes of critical analysis of screen-mediated war that cannot account for drone operators’s trauma. For decades, critics of postmodern warfare have denounced how fighting from inside tanks, the cockpits of planes, or at office desks has removed combatants from the experiences of risk and endangerment that historically characterized war (see Gray; Levidow & Robins). They suggest that screen-mediation enables not only physical but also cognitive and emotional distance from the violence of war-fighting by circumscribing it in a “magic circle.” Virtual worlds scholars adopted the term “magic circle” from cultural historian Johan Huizinga, who described it as the membrane that separates the time and space of game-play from those of real life (Salen and Zimmerman). While military scholars have long recognized that only 2% of soldiers can kill without hesitation (Grossman), critics of “video game wars” suggest that screen-mediation puts war in a magic circle, thereby creating cyborg human-machine assemblages capable of killing in cold blood. In other words, these critics argue that screen-mediated war distributes agency between humans and machines in such a way that human combatants do not feel morally responsible for killing. In contrast, Ender’s Game suggests that even when militaries utilize video game aesthetics to create weapons control interfaces, screen-mediation alone ultimately cannot blur the line between war and play and thereby psychically shield cyborg soldiers from combat trauma.Orson Scott Card’s 1985 novel Ender’s Game—and the 2013 film adaptation—tells the story of a young boy at an elite military academy. Set several decades after a terrible war between humans and an alien race called the buggers, the novel follows the life of a boy named Ender. At age 6, recruiters take Andrew “Ender” Wiggin from his family to begin military training. He excels in all areas and eventually enters officer training. There he encounters a new video game-like simulator in which he commands space ship battalions against increasingly complex configurations of bugger ships. At the novel’s climax, Ender's mentor, war hero Mazer Rackham, brings him to a room crowded with high-ranking military personnel in order to take his final test on the simulator. In order to win Ender opts to launch a massive bomb, nicknamed “Little Doctor”, at the bugger home world. The image on his screen of a ball of space dust where once sat the enemy planet is met by victory cheers. Mazer then informs Ender that since he began officer training, he has been remotely controlling real ships. The video game war was, "Real. Not a game" (Card 297); Ender has exterminated the bugger species. But rather than join the celebration, Ender is devastated to learn he has committed "xenocide." Screen-mediation, the novel shows, can enable people to commit acts that they would otherwise find heinous.US military advisors have used the story to set an agenda for research and development in augmented media. For example, Dr. Michael Macedonia, Chief Technology Officer of the Army Office for Simulation, Training, and Instrumentation told a reporter for the New York Times that Ender's Game "has had a lot of influence on our thinking" about how to use video game-like technologies in military operations (Harmon; Silberman; Mead). Many recent programs to develop and study video game-like military training simulators have been directly inspired by the book and its promise of being able to turn even a six-year-old into a competent combatant through well-structured human-computer interaction (Mead). However, it would appear that the novel’s moral regarding the psychological impact of actual screen-mediated combat did not dissuade military investment in drone warfare. The Air Force began using drones for surveillance during the Gulf War, but during the Global War on Terror they began to be equipped with weapons. By 2010, the US military operated over 7,000 drones, including over 200 weapons-ready Predator and Reaper drones. It now invests upwards of three-billion dollars a year into the drone program (Zucchino). While there are significant differences between contemporary drone warfare and the plot of Ender's Game—including the fact that Ender is a child, that he alone commands a fleet, that he thinks he is playing a game, and that, except for a single weapon of mass destruction, he and his enemies are equally well equipped—for this analysis, I will focus on their most important similarities: both Ender and actual drone operators work on teams for long shifts using video game-like technology to remotely control vehicles in aerial combat against an enemy. After he uses the Little Doctor, Mazer and Graff, Ender's long-time training supervisors, first work to circumvent his guilt by reframing his actions as heroic. “You're a hero, Ender. They've seen what you did, you and the others. I don't think there's a government on Earth that hasn't voted you their highest metal.” “I killed them all, didn't I?” Ender asked. “All who?” asked Graff. “The buggers? That was the idea.” Mazer leaned in close. “That's what the war was for.” “All their queens. So I killed all their children, all of everything.” “They decided that when they attacked us. It wasn't your fault. It's what had to happen.” Ender grabbed Mazer's uniform and hung onto it, pulling him down so they were face to face. “I didn't want to kill them all. I didn't want to kill anybody! I'm not a killer! […] but you made me do it, you tricked me into it!” He was crying. He was out of control. (Card 297–8)The novel up to this point has led us to believe that Ender at the very least understands that what he does in the game will be asked of him in real life. But his traumatic response to learning the truth reveals that he was in the magic circle. When he thinks he is playing a game, succeeding is a matter of ego: he wants to be the best, to live up to the expectations of his trainers that he is humanity’s last hope. When the magic circle is broken, Ender reconsiders his decision to use the Little Doctor. Tactics he could justify to win the game, reframed as real military tactics, threaten his sense of himself as a moral agent. Being told he is a hero provides no solace.Card wrote the novel during the Cold War, when computers were coming to play an increasingly large role in military operations. Historians of military technology have shown that during this time human behavior began to be defined in machine-like, functionalist terms by scientists working on cybernetic systems (see Edwards; Galison; Orr). Human skills were defined as components of large technological systems, such as tanks and anti-aircraft weaponry: a human skill was treated as functionally the same as a machine one. The only issue of importance was how all the components could work together in order to meet strategic goals—a cybernetic problem. The reasons that Mazer and Graff have for lying to Ender suggest that the author believed that as a form of technical augmentation, screen-mediation can be used to evacuate individual moral agency and submit human will to the command of the larger cybernetic system. Issues of displaced agency in the military cyborg assemblage are apparent in the following quote, in which Mazer compares Ender himself to the bomb he used to destroy the bugger home world: “You had to be a weapon, Ender. Like a gun, like the Little Doctor, functioning perfectly but not knowing what you were aimed at. We aimed you. We're responsible. If there was something wrong, we did it” (298). Questions of distributed agency have also surfaced in the drone debates. Government and military leaders have attempted to depersonalize drone warfare by assuring the American public that the list of targets is meticulously researched: drones kill those who we need killed. Drone warfare, media theorist Peter Asaro argues, has “created new and complex forms of human-machine subjectivity” that cannot be understood by considering the agency of the technology alone because it is distributed between humans and machines (25). While our leaders’s decisions about who to kill are central to this new cyborg subjectivity, the operators who fire the weapons nevertheless experience at least a retrospective sense of agency. As phenomenologist John Protevi notes, in the wake of wars fought by modern military networks, many veterans diagnosed with PTS still express guilt and personal responsibility for the outcomes of their participation in killing (Protevi). Mazer and Graff explain that the two qualities that make Ender such a good weapon also create an imperative to lie to him: his compassion and his innocence. For his trainers, compassion means a capacity to truly think like others, friend or foe, and understand their motivations. Graff explains that while his trainers recognized Ender's compassion as an invaluable tool, they also recognized that it would preclude his willingness to kill.It had to be a trick or you couldn't have done it. It's the bind we were in. We had to have a commander with so much empathy that he would think like the buggers, understand them and anticipate them. So much compassion that he could win the love of his underlings and work with them like a perfect machine, as perfect as the buggers. But somebody with that much compassion could never be the killer we needed. Could never go into battle willing to win at all costs. If you knew, you couldn't do it. If you were the kind of person who would do it even if you knew, you could never have understood the buggers well enough. (298)In learning that the game was real, Ender learns that he was not merely coming to understand a programmed simulation of bugger behavior, but their actual psychology. Therefore, his compassion has not only helped him understand the buggers’ military strategy, but also to identify with them.Like Ender, drone operators spend weeks or months following their targets, getting to know them and their routines from a God’s eye perspective. They both also watch the repercussions of their missions on screen. Unlike fighter pilots who drop bombs and fly away, drone operators use high-resolution cameras and fly much closer to the ground both when flying and assessing the results of their strikes. As one drone operator interviewed by the Los Angeles Times explained, "When I flew the B-52, it was at 30,000 to 40,000 feet, and you don't even see the bombs falling … Here, you're a lot closer to the actual fight, or that's the way it seems" (Zucchino). Brookings Institute scholar Peter Singer has argued that in this way screen mediation actually enables a more intimate experience of violence for drone operators than airplane pilots (Singer).The second reason Ender’s trainers give for lying is that they need someone not only compassionate, but also innocent of the horrors of war. The war veteran Mazer explains: “And it had to be a child, Ender,” said Mazer. “You were faster than me. Better than me. I was too old and cautious. Any decent person who knows what warfare is can never go into battle with a whole heart. But you didn't know. We made sure you didn't know" (298). When Ender discovers what he has done, he loses not only his innocence but his sense of himself as a moral agent. After such a trauma, his heart is no longer whole.Actual drone operators are, of course, not kept in a magic circle, innocent of the repercussions of their actions. Nor do they otherwise feel as though they are playing, as several have publicly stated. Instead, they report finding drone work tedious, and some even play video games for fun (Asaro). However, Air Force recruitment advertising makes clear analogies between the skills they desire and those of video game play (Brown). Though the first generations of drone operators were pulled from the ranks of flight pilots, in 2009 the Air Force began training them from the ground. Many drone operators, then, enter the role having no other military service and may come into it believing, on some level, that their work will be play.Recent military studies of drone operators have raised doubts about whether drone operators really experience high rates of trauma, suggesting that the stresses they experience are seated instead in occupational issues like long shifts (Ouma, Chappelle, and Salinas; Chappelle, Psy, and Salinas). But several critics of these studies have pointed out that there is a taboo against speaking about feelings of regret and trauma in the military in general and among drone operators in particular. A PTS diagnosis can end a military career; given the Air Force’s career-focused recruiting emphasis, it makes sense that few would come forward (Dao). Therefore, it is still important to take drone operator PTS seriously and try to understand how screen-mediation augments their experience of killing.While critics worry that warfare mediated by a screen and joystick leads to a “‘Playstation’ mentality towards killing” (Alston 25), Ender's Game presents a theory of remote-control war wherein this technological redistribution of the act of killing does not, in itself, create emotional distance or evacuate the killer’s sense of moral agency. In order to kill, Ender must be distanced from reality as well. While drone operators do not work shielded by the magic circle—and therefore do not experience the trauma of its dissolution—every day when they leave the cyborg assemblage of their work stations and rejoin their families they still have to confront themselves as individual moral agents and bear their responsibility for ending lives. In both these scenarios, a human agent’s combat trauma serves to remind us that even when their bodies are physically safe, war is hell for those who fight. This paper has illustrated how a science fiction story can be used as an analytic lens for thinking through contemporary discourses about human-technology relationships. However, the US military is currently investing in drones that are increasingly autonomous from human operators. This redistribution of agency may reduce incidence of PTS among operators by decreasing their role in, and therefore sense of moral responsibility for, killing (Axe). Reducing mental illness may seem to be a worthwhile goal, but in a world wherein militaries distribute the agency for killing to machines in order to reduce the burden on humans, societies will have to confront the fact that combatants’s trauma cannot be a compass by which to measure the morality of wars. Too often in the US media, the primary stories that Americans are told about the violence of their country’s wars are those of their own combatants—not only about their deaths and physical injuries, but their suicide and PTS. To understand war in such a world, we will need new, post-humanist stories where the cyborg assemblage and not the individual is held accountable for killing and morality is measured in lives taken, not rates of mental illness. ReferencesAlston, Phillip. “Report of the Special Rapporteur on Extrajudicial, Summary, or Arbitrary Executions, Addendum: Study on Targeted Killings.” United Nations Human Rights Council (2010). Asaro, Peter M. “The Labor of Surveillance and Bureaucratized Killing: New Subjectivities of Military Drone Operators”. Social Semiotics 23.2 (2013): 196-22. Associated Press. “Predator Pilots Suffering War Stress.” Military.com 2008. Axe, David. “How to Prevent Drone Pilot PTSD: Blame the ’Bot.” Wired June 2012.Bowden, Mark. “The Killing Machines: How to Think about Drones.” The Atlantic Sep. 2013.Brown, Melissa T. Enlisting Masculinity: The Construction of Gender in US Military Recruiting Advertising during the All-Volunteer Force. London: Oxford University Press, 2012. Bumiller, Elisabeth. “Air Force Drone Operators Report High Levels of Stress.” New York Times 18 Dec. 2011: n. pag. Card, Orson Scott. Ender’s Game. Tom Doherty Associates, Inc., 1985. Chappelle, Wayne, D. Psy, and Amber Salinas. “Psychological Health Screening of Remotely Piloted Aircraft (RPA) Operators and Supporting Units.” Paper presented at the Symposium on Mental Health and Well-Being across the Military Spectrum, Bergen, Norway, 12 April 2011: 1–12. Dao, James. “Drone Pilots Are Found to Get Stress Disorders Much as Those in Combat Do.” New York Times 22 Feb. 2013: n. pag. Edwards, Paul N. The Closed World: Computers and the Politics of Discourse in Cold War America. Cambridge: MIT Press, 1997.Galison, Peter. “The Ontology of the Enemy: Norbert Wiener and the Cybernetic Vision.” Critical Inquiry 21.1 (1994): 228.Gray, Chris Hables “Posthuman Soldiers in Postmodern War.” Body & Society 9.4 (2003): 215–226. 27 Nov. 2010.Greene, David, and Kelly McEvers. “Former Air Force Pilot Has Cautionary Tales about Drones.” National Public Radio 10 May 2013.Grossman, David. On Killing. Revised. Boston: Back Bay Books, 2009. Harmon, Amy. “More than Just a Game, But How Close to Reality?” New York Times 3 Apr. 2003: n. pag. Levidow, Les, and Robins. Cyborg Worlds: The Military Information Society. London: Free Association Books, 1989. Lifton, Robert Jay. Home from the War: Vietnam Veterans: Neither Victims nor Executioners. New York: Random House, 1973. Mead, Corey. War Play: Video Games and the Future of Armed Conflict. Boston: Houghton Mifflin Harcourt, 2013. Orr, Jackie. Panic Diaries: A Genealogy of Panic Disorder. Durham: Duke University Press, 2006.Ouma, J.A., W.L. Chappelle, and A. Salinas. Facets of Occupational Burnout among US Air Force Active Duty and National Guard/Reserve MQ-1 Predator and MQ-9 Reaper Operators. Air Force Research Labs Technical Report AFRL-SA-WP-TR-2011-0003. Wright-Patterson AFB, OH: Air Force Research Laboratory. 2011.Protevi, John. “Affect, Agency and Responsibility: The Act of Killing in the Age of Cyborgs.” Phenomenology and the Cognitive Sciences 7.3 (2008): 405–413. Salen, Katie, and Eric Zimmerman. Rules of Play: Game Design Fundamentals. Cambridge, MA: MIT Press, 2003. Saleton, William. “Ghosts in the Machine: Do Remote-Control War Pilots Get Combat Stress?” Slate.com Aug. 2008. Schachtman, Nathan. “Shrinks Help Drone Pilots Cope with Robo-Violence.” Wired Aug. 2008.Silberman, Steve. “The War Room.” Wired Sep. 2004: 1–5.Singer, P.W. Wired for War: The Robotics Revolution and Conflict in the Twenty-First Century. New York: Penguin Press, 2009. Zucchino, David. “Drone Pilots Have Front-Row Seat on War, from Half a World Away.” Los Angeles Times 21 Feb. 2010: n. pag.

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>.