Journal articles on the topic 'Alcoholism Treatment Victoria Melbourne'

Melbourne Pathology, a subsidiary of Sonic Health Care, provided a comprehensive range of pathology services as an aid in the diagnosis and treatment of patients in Melbourne and Central Victoria. In a capped funding and highly regulated market such as the pathology service market in Australia, the only way in which the sales of a provider could grow was usually at the expense of another provider. To combat this situation, Melbourne Pathology opted to compete by providing higher quality service and faster turnaround time. The recent results of Melbourne Pathology, however, indicated that although the average turnaround time was within the promised targets, significant percentage of jobs in routine category and over 10% of jobs in the urgent category failed to meet the established targets. The case is primarily intended to illustrate the impact of demand distortions in a service setting that arise due to lack of coordination among various entities in the service value chain and a failure to have an integrated perspective that aligns all departments towards a common goal. This phenomenon is similar to the bullwhip effect in supply chains of manufactured products which has received considerable attention during the past decade. The case provides opportunities for students to develop corrective actions to mitigate this problem.

Objective: The aim of the study was to compare the efficacy of atypical and typical anti-psychotics in treating behavioural disturbance in people with psychotic disorders, in a naturalistic setting. Method: This was a prospective naturalistic study of 303 incidents of behavioural disturbance at Royal Melbourne Hospital, Melbourne, Victoria, Australia. Results: There was no significant difference between atypicals and typicals on two efficacy measures and some evidence on a third measure, that typicals are more effective. Conclusions: In the pharmacological treatment of behavioural disturbance in psychosis, typical and atypical anti-psychotics have largely comparable efficacy.

Abstract In September 2018, the Federal Court of Australia found that a Victorian woman did not need her estranged husband’s consent to undergo in vitro fertilisation treatment (IVF) using donor sperm. The woman, who was 45 years of age, made an urgent application to the Court for permission to undergo IVF using donor sperm. In a single judge ruling, Griffiths J held that the requirement in the Assisted Reproductive Treatment Act 2008 (Vic) (‘ART Act’) for a married woman to obtain the consent of her husband discriminated against the woman in question on the basis of her marital status in contravention of the Commonwealth Sex Discrimination Act 1984 (Cth) (‘SD Act’). His Honour declared the Victorian law in this instance ‘invalid and inoperable’ by operation of section 109 of the Commonwealth Constitution to the extent it was inconsistent with the Commonwealth law. Although the declarations by the Federal Court were limited in their terms to the circumstances of the case, the judgment raises broader issues about equity of access to assisted reproductive treatment (ART) in Victoria. The issue of partner consent as a barrier to access to ART was specifically raised by an independent review of the ART Act in Victoria. The Victorian Government released an interim report late last year as a first stage of the review, which canvasses some options for reform. This raises a broader question as to whether prescriptive legislation imposing detailed access requirements for ART is necessary or even helpful.

The advent of fasciotomy by intralesional collagenase injection has been a significant step forward in the treatment of Dupuytren’s contracture. While the therapeutic benefit of collagenase injection in the treatment of Dupuytren’s contracture has been established, seeking its value relative to the surgery has stimulated an interesting debate about the management of the condition, causing us to examine the results of surgery in more detail. Dupuytren’s disease and its treatment has become topical and will be the subject of the hand surgery symposium at this year’s Plastic Surgery Congress from 30 May – 1 June 2019 at the Melbourne Convention and Exhibition Centre, Victoria, Australia.

IntroductionThe ambulance clinical triage-for acute stroke treatment (ACT-FAST) algorithm is a severity based 3-step paramedic triage tool for pre-hospital recognition of large vessel occlusion (LVO), designed to improve specificity and paramedic assessment reliability compared to existing triage scales. ACT-FAST sequentially assesses 1. Unilateral arm fall to stretcher <10 s; 2a. Severe language disturbance (right arm weak), or 2b. Severe gaze deviation/hemi-neglect assessed by shoulder tap (left arm weak); 3. Clinical eligibility questions. We present the results of the ongoing Ambulance Victoria paramedic validation study.MethodsAmbulance Victoria paramedics assessed ACT-FAST in all suspected stroke patients pre-hospital in metropolitan Melbourne, Australia, and in the Royal Melbourne Hospital Emergency Department since July 2017. Algorithm results were validated against a comparator of ICA/M1 occlusion on CT-angiography with NIHSS ≥6 (Class 1 indications for endovascular thrombectomy).ResultsData were available from n=119 assessments (ED n=68, pre-hospital n=51). Patient diagnoses were LVO n=20 (15.6%), non-LVO infarcts n=45 (38.5%), ICH n=10 (8.3%) and no stroke on imaging n=44 (37.6%). ACT-FAST showed 85% sensitivity, 88.9% specificity, 60.7% (72% excluding ICH) positive predictive value and 96.7% negative predictive value for LVO. Of 10 false-positives, 4 received thrombectomy for non-Class 1 indications (basilar/M2 occlusions/cervical dissection), 3 were ICH, and 1 was tumour. Three false-negatives were LVO with milder syndromes.DiscussionThe ongoing ACT-FAST algorithm validation study shows high accuracy for clinical recognition of LVO. The streamlined algorithmic approach with just two examination items provides a more practical option for implementation in large emergency service networks. Accurate pre-hospital recognition of LVO will allow bypass to endovascular centres and early activation of neuro-intervention services to expedite endovascular thrombectomy.

BackgroundMost calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches.ObjectivesTo examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch.DesignA retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted.SettingThe secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period.ParticipantsThere were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses.Main outcome measuresDescriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients.ResultsThe dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005).ConclusionSecondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.

AbstractIn 1887 Qing Imperial Commissioners General Wong Yung Ho and U Tsing visited Melbourne as part of an investigative mission to enquire into the treatment of Chinese imperial subjects in Southeast Asia and the Australian colonies. In this article I suggest that the political ramifications of their visit should be understood in the context of the larger imperial and national contestations occurring in the colony of Victoria in the 1880s. White colonial assertions of the rights of self-government — argued in defiance of imperial power both British and Chinese — and Chinese appeals to international law were antagonistic, but mutually constitutive claims. The more Chinese community leaders and the Imperial Commissioners appealed to the primacy of international law, the more strident were white colonial invocations of a newly defined national interest couched in a republican discourse on national sovereignty defined as border protection.

Since April 1997, in Melbourne, Australia, speech pathologists have collaborated to establish a prospective database of functional outcomes of speech, swallowing and voice for patients undergoing head and neck cancer treatments.Staff at eight acute care hospitals, all of which offer speech pathology for head and neck cancer services in Victoria, are contributing data, collated centrally, in an agreed pro forma.Early results are given (after 12 months’ data collection). The implications for clinically-based research, and the future potential for benchmarking outcomes – by expansion of the rehabilitation database beyond the current participating sites – is discussed.This paper outlines the rationale of establishing the database is multicentred, and explores some of the complexities involved, including the challenges inherent in long-term accurate data collection in the head and neck cancer patient population. This work represents the development of an appropriate, usable tool for data collection on functional outcomes.

Urban drainage systems historically were developed on principles of hydraulic capacity for the transport of storm water to reduce the risk of flooding. However, with urbanization the percent of impervious surfaces increases dramatically resulting in increased flood volumes, peak discharge rates, velocities and duration, and a significant increase in pollutant loads. Storm water and urban runoff are the leading causes of the impairment of receiving waters and their beneficial uses in Australia and the United States today. Strict environmental and technology controls on wastewater treatment facilities and industry for more than three decades have ensured that these sources are less significant today as the cause of impairment of receiving waters. This paper compares the approach undertaken by the Environmental Protection Authority Victoria for the Melbourne metropolitan area with the approach implemented by the California Environmental Protection Agency for the Los Angeles area to control storm water pollution. Both these communities are largely similar in population size and the extent of urbanization. The authors present an analysis of the different approaches contrasting Australia with the USA, comment on their comparative success, and discuss the relevance of the two experiences for developed and developing nations in the context of environmental policy making to control storm water and urban runoff pollution.

Chlamydia is the most common notifiable infectious disease in Australia with the number of notifications increasing 92% over the past 5 years. The "Sex and Sport" Project is piloting a community based chlamydia testing and treatment program reaching young people in a specific community setting, sporting clubs. This multifaceted approach utilises health education, population screening and collection of data on risk taking behaviour as the first steps in enhancing health and shaping future service provisions. The project's primary aim is to assess the feasibility of an outreach testing and treatment program. Secondary aims are to measure the prevalence of chlamydia and assess sexual risk behaviour in this population. Strong community collaborations and integration into local health services through the Primary Care Partnerships is important in the project's sustainability; in particular key community members respected by sporting clubs needed to be identified, capacity developed to deliver effective health promotion messages and improve young people's access to sexual health services. Additionally, local knowledge has guided overall program implementation and provides opportunities for capacity building to regionally based services. For example, poor access to sexual health services is being addressed by the participants being able to access services via telephone consultation with Melbourne Sexual Health Centre. Approximately 1000 Victorians aged 16-25 years from the Loddon Mallee region of Victoria will be tested between June and September 2007. This paper will report on the feasibility, challenges and possible solutions in establishing a community based outreach testing and treatment program.

Family violence is endemic. It has a dramatic and negative impact upon the victims and the family systems in which it occurs. While there is a growing evidence base to support our understanding, prevention and treatment of family violence, little is known about some of its “hidden victims” (e.g., kinship carers). In 2017, Baptcare commenced research with 101 kinship carers in Victoria to gain a better understanding of how family violence, perpetrated by the child's close family member once the placement started, was impacting on children and families. In this context, family violence means any act of physical violence, emotional/psychological violence, verbal abuse and property damage. The study utilised a mixed design methodology that specifically targeted kinship carers who had direct experience of family violence. Findings from this study demonstrated that (1) many kinship carers, and the children in their care, experienced family violence early in the placement, (2) that the violence occurred frequently and (3) the incidents of violence did not occur in isolation. Carers sought support from multiple sources to deal with the family violence, however, the study illustrated that the usefulness of these supports varied. Additionally, findings highlighted reasons why many kinship carers felt reluctant to file a report to end the violence. The study described in this paper is the first step in understanding and exposing this multifaceted issue and delineates some of the major issues confronting Victorian kinship carers experiencing family violence – and the support required to ensure the safety of them and the children they care for. This paper will describe the approach that Baptcare is taking to address family violence in kinship care in western metropolitan Melbourne. This is the second paper in a three-part series relating to family violence in kinship care.

This study aimed to describe regional variations in service use and distance travelled to post-discharge health services in the first three years following hospital discharge for people with transport-related orthopaedic, brain, and spinal cord injuries. Using linked data from the Victorian State Trauma Registry (VSTR) and Transport Accident Commission (TAC), we identified 1597 people who had sustained transport-related orthopaedic, brain, or spinal cord injuries between 2006 and 2016 that met the study inclusion criteria. The adjusted odds of GP service use for regional participants were 76% higher than for metropolitan participants in the orthopaedic and traumatic brain injury (TBI) groups. People with spinal cord injury (SCI) living in regional areas had 72% lower adjusted odds of accessing mental health, 76% lower adjusted odds of accessing OT services, and 82% lower adjusted odds of accessing physical therapies compared with people living in major cities. People with a TBI living in regional areas on average travelled significantly further to access all post-discharge health services compared with people with TBI in major cities. For visits to medical services, the median trip distance for regional participants was 76.61 km (95%CI: 16.01–132.21) for orthopaedic injuries, 104.05 km (95% CI: 51.55–182.78) for TBI, and 68.70 km (95%CI: 8.34–139.84) for SCI. Disparities in service use and distance travelled to health services exist between metropolitan Melbourne and regional Victoria following serious injury.

The oratorio genre was regarded amongst the most edifying and instructive artforms of the Victorian era, and it was to these lofty ideals that George Tolhurst (1827–1877) aspired when composing his 1864 oratorioRuth. The first work of its kind written in the British colony of Victoria, Australia,Ruthreceived an initially favourable local reception; Tolhurst was urged by the Melbourne press to aim higher and present his work to a wider and more discerning audience. Consequently, he took his work to London where it was roundly criticized, widely mocked and eventually dubbed ‘the worst oratorio ever’. It might be assumed that a work so poorly received in the cultural metropolis of London would be, like so much other Victorian music, immediately forgotten. However, through its notoriously bad reception,Ruth– in what Percy Scholes describes as a ‘succès de ridicule’ – found a cult following that has spanned from the nineteenth century to the present day. This article examines the critical reception ofRuththrough the lens of colonial social relations, arguing that the treatment ofRuthin both London and Melbourne is emblematic of broader trends in the nineteenth-century relationship between parent state and settler colony. It also explores the surprising phenomenon of twentieth- and twenty-first-century consumption ofRuthin Britain, questioning whether the legacies of certain Victorian social and cultural prejudices relating to the artistic products of the colonies have been mitigated. Aesthetic and representational decisions made in recent revivals of Ruth suggest that cultural hierarchies forged during the Victorian era continue to be reinforced in the present day.

The Mt Buller Alpine Resort is located approximately 200 km north of Melbourne, in Victoria, Australia. A wastewater treatment plant services the resort and currently treats to advanced nutrient removal standards. The treated effluent is presently discharged into the Howqua River. Most Australian ski resorts are not blessed with abundant snow cover on a regular basis. Artificial snow allows most of the popular ski runs to operate for the whole of the season. At the Mt Buller resort, snow-making is presently limited by lack of water supply in the catchment. The conditions at Mt Buller resort present a unique opportunity to utilise reclaimed wastewater to allow increased snow-making capacity. It is one of the unique opportunities where the wastewater is valued as a resource rather than merely viewed as a waste problem. Wastewater reclamation for snow-making will require additional treatment for pathogen removal. It is proposed that following advanced nutrient removal, the effluent will require further treatment, including membrane ultrafiltration, so as to ensure a minimum of four barriers for pathogen removal. Pilot plant operation of a membrane ultrafiltration system commenced in June 2000 and will continue until the end of 2001, to primarily demonstrate the extent of pathogen removal.

The Community Correction Order, introduced in Victoria, Australia in 2012, provides a sentencing option that enables eligible offenders to serve their sanction in the community, with access to treatment or other rehabilitative activities. This paper contributes to a scant body of research investigating the specific needs of this group, their barriers to inclusion and the extent to which they experience the rehabilitative aspects of Community Correction Orders. It draws on survey data collected from 200 adults (137 men and 63 women) on Community Correction Orders in outer west metropolitan Melbourne and qualitative analysis of in-depth interviews conducted with a sub-set of 20 participants. Long-term unemployment, severe economic hardship, physical and mental health issues, social isolation and troubled personal relationships were common. While participants experienced the punitive aspects of Community Correction Orders, there was limited evidence that they were supported to address key issues that may be predictive of future offending. Support to re/engage in education, training and employment was a key area of unmet need and engagement in other therapeutic programs was low. Opportunities to enhance the rehabilitative potential of Community Correction Orders are discussed, with the paper highlighting that there is a need for rigorous evaluation of community work program activities.

This paper reports on the successful management of hyperphagia (exaggerated hunger) in a 14yr-old female with Prader–Willi syndrome (PWS). This child was diagnosed with PWS, (maternal uniparental disomy) at 18 months due to developmental delay, hypertonia, weight gain and extreme eating behaviour. Treatment of a supplement for appetite suppression commenced at 2 years of age. This single-case records ingestion of an Indian cactus succulent Caralluma fimbriata extract (CFE) over 12 years, resulting in anecdotal satiety, free access to food and management of weight within normal range. CFE was administered in a drink daily and dose was slowly escalated by observation for appetite suppression. Rigorous testing determined blood count, vitamins, key minerals, HbA1c, IGF-1 and function of the liver and thyroid all within normal range. The report suggests a strategy for early intervention against hyperphagia and obesity in PWS. This case was the instigator of the successful Australian PWS/CFE pilot and though anecdotal, the adolescent continues to ingest CFE followed by paediatricians at the Royal Children’s Hospital Melbourne, Victoria, Australia. Future clinical trials are worth considering, to determine an appropriate dose for individuals with PWS.

High-density polyethylene (HDPE) is commonly the material of choice for covered anaerobic lagoons (CAL) at wastewater treatment plants. The membrane floats on the wastewater, and hence is called a “floating cover”, and is used for odour control and to harvest the methane-rich biogas as a renewable resource to generate electricity. The floating cover is an expensive and high-value asset that demands an efficient methodology for the determination of a set of engineering quantities for structural integrity assessment. Given the dynamics of the anaerobic activities under the floating cover, the state of deformation of the floating cover is an engineering measurand that is useful for its structural health assessment. A non-contact measurement strategy is preferred as it offers practical and safety-related benefits over other methods. In collaboration with Melbourne Water Corporation (MWC), an unmanned aerial vehicle (UAV) assisted photogrammetry approach was developed to address this need. Following the definition of the appropriate flight parameters required to quantify the state of deformation of the cover, a series of periodic flights were operated over the very large floating covers at MWC’s Western Treatment Plant (WTP) at Werribee, Victoria, Australia. This paper aims to demonstrate the effectiveness and practicality of this inspection technique to determine the state of deformation of the floating covers measured over a ten-month period.

e18324 Background: Discussion of cancer cases at multi-disciplinary meetings (MDMs) for treatment planning is expected standard care in Australia. There has been rapid uptake of MDMs in the last 10 - 15 years and in the state of Victoria approximately 70% of cancer cases are discussed. MDMs have strong support from medical staff and we investigated their motivation in attending MDMs. Methods: Over 12 months, Austin Health in Melbourne, Victoria, hosted 452 cancer MDMs discussing 5943 patients. MDMs covered 15 tumour areas: 11 solid tumour, one lymphoma and three haematological. Over a 4-week period, medical staff attending MDMs were surveyed and asked to rank what they valued most about cancer MDMs, over and above the benefits for patients. Results: Responses were received from 84% of the 285 medical staff surveyed, which included consultants as well as trainees (registrars and fellows). For 75% of respondents the highest ranking was given to multi-disciplinary communication, 9% gave the highest ranking to quality assurance and governance, 5% ongoing learning for consultants, 5% collegiate relationships, 2% learning and teaching for non-consultant staff, 2% peer support 1% job satisfaction and 1% clinical trials engagement. Similar results were obtained for consultant staff and for registrars / fellows. For consultant medical staff, if multidisciplinary communication was excluded, 44% of respondents gave the highest ranking to quality assurance and governance, 23% to collegiate relationships, 20% ongoing learning for consultants, 10% peer support and 3% clinical trials engagement. Conclusions: When we asked doctors what they valued most about attending cancer MDMs, besides the benefits for patients, communication between disciplines was clearly the most valued aspect. The benefits for quality and governance was the next most valued, then collegiate relationships and peer support, and ongoing learning.

Background: Micro-dissection testicular sperm extraction (micro-TESE) for non-obstructive azoospermia (NOA) was shown to achieve the best sperm retrieval rate (SRR) compared to other techniques. However, to date there is no large series of published Australian data. Aim: To study the incidence and predicting factors of successful sperm extraction in men with NOA undergoing micro-TESE in Victoria. Method: We retrospectively analyzed the clinical data of all consecutive patients with confirmed NOA who were treated between August 2014 and April 2020 in a single medical centre in Melbourne, Victoria. None were excluded. Patients underwent micro-TESE and upon a successful sperm retrieval, sperm was either frozen for fertility preservation or used fresh for ICSI. Results: During the study period, 85 men with NOA underwent micro-TESE in our centre. The overall sperm retrieval rate (SRR) was 61.2% (52/85). All patients with a history of surgically treated cryptorchidism or childhood diseases had a successful sperm retrieval. Patients with Kleinfelter syndrome had a 75% SRR. Patients with Idiopathic NOA and patients with a history of chemotherapy had a 50% and 40% SRR, respectively. Among the different types of testicular pathology, the highest SRR was found in men with complete hyalinization (100%). Hypospermatogenesis was associated with a high SRR of 93.3%, while Sertoli-cell-only histology was associated with only 46.3% SRR. The SRR has significantly increased from 33.3% in 2015-2016 to 73.6% in 2019-2020 (p=0.003). On Multivariate logistic regression analysis, baseline FSH levels <20 IU and history of childhood disease or Klinefelter syndrome were significantly associated with successful sperm retrieval. The cumulative pregnancy rate was 23.7%. Conclusion: This first report from Australia indicates that micro-TESE is an effective method for the treatment of NOA with high SRR and pregnancy rate. Our results can help patient management and counseling.

The use of poison baiting in Australia to control foxes is impractical in urban areas and some wildlife reserves because of hazards to non-target animals. More acceptable methods of fox control in such environments are needed. Cabergoline is a dopamine agonist that has previously been demonstrated to have an abortifacient effect in cats (Felis catus) and dogs (Canis familiaris). The prolactin-inhibiting action of cabergoline may also result in cessation of lactation. Cabergoline has been shown to be completely palatable to foxes and is easily incorporated into a non-poisonous bait. The ability of bait-delivered cabergoline to effect the birth of viable fox cubs was tested in urban Melbourne and rural Bendigo, Victoria. A sample of 51 natal dens were chosen for this study on the basis that they had been active for 3 consecutive years (1991-93). 30 treatment dens were randomly selected and each treated once during August and again during September 1994 with 8 non-poisonous Foxoff baits containing 170 micro g of cabergoline and 200 mg of tetracycline to act as a biomarker. The remaining 21 dens were used as controls. Baits were randomly placed by burial within a 50-m radius of the den. Activity of all dens was assessed until December 1994 for direct/indirect signs of fox cubs. Bait uptake was >88% overall for the treatment dens. The resulting incidence of cubs was significantly lower in the treatment dens than in the controls. The potential for cabergoline to be used in urban areas and island populations as an adjunct to conventional control methods is discussed.

BACKGROUND: There are few reports of the use of the lidocaine 5% patch (L5%P) for neuropathic pain (NP) in the cancer patient. Within a comprehensive cancer centre, L5%P has been prescribed by the Pain and Palliative Care Service (Peter McCallum Cancer Centre, East Melbourne, Victoria, Australia) for selected patients with NP since 2001.OBJECTIVE: To retrospectively audit the use of L5%P within a comprehensive cancer centre.METHODS: All L5%P prescriptions up to January 2009 were listed and patient medical records were searched to determine neuropathic pain syndromes treated, the presence of allodynia, previous analgesic medications, treatment duration and outcome.RESULTS: L5%P was prescribed for 97 patients, most frequently for persistent postsurgical NP (n=26), postherpetic neuralgia (n=24) and cancer-related NP (n=18). Six patients had no history of cancer and two patients never applied L5%P. Reviewers classed L5%P analgesic efficacy as ‘potent’ in 38% of patients with postherpetic neuralgia, 35% of patients with postsurgical pain, 27% of patients with NP after other treatments for cancer and 12% of patients with NP attributed to cancer alone. Allodynia featured in at least 60% of patients. Where allodynia was present, the efficacy of L5%P was assessed as ‘potent’ in 38% and ‘partial’ in 24%, but ‘ineffective’ in 26%, and ‘causing worse pain’ in 3.4% of patients. Treatment duration extended longer than one month in 52 patients, longer than two months in 29 patients and longer than one year in 13 patients. Therapy was ceased due to skin irritation in seven patients. The outcomes in relation to other reports are discussed.CONCLUSION: The present data support trials of L5%P for cancer patients with NP syndromes associated with allodynia.

Background: Pancreatic pseudocysts can occur as a complication of acute or chronic pancreatitis. Understanding of pseudocysts has changed with times due to advancement in radiology and introduction of new treatment modalities. This study was done to access clinical features etiology and various managements for pseudocyst in a tertiary care hospital.Methods: It is a prospective study of 40 adult patients admitted in Victoria and Bowring and Lady Curzon Hospital, attached to Bangalore Medical College and Research Institute, Karnataka, India from January 2015 to December 2016.Results: Pseudocysts are more common in males. The commonest etiology associated was alcohol. Ultrasound was the basic radiological investigation done in all patients followed by CECT abdomen. Complications associated with pseudocyst were Gastric outlet obstruction and ascites. Internal drainage was done in most of the patients. Post drainage complications included infection which was managed by antibiotics and endoscopic drainage in case of recollection. Pain was most important post-operative complication. Endoscopic drainage is being preferred as it is less invasive, has a high long term success rate, has shorter duration of hospital stay and more patient comfort.Conclusions: Pseudocyst of pancreas is most commonly seen in males probably because of alcoholism. Clinical presentation can be varied, with pain abdomen being the most common complaint followed by, nausea vomiting. Initial management consists of supportive care and if the symptoms persist and complications develop surgical drainage was the most common management modality. Newer modalities of treatments like endoscopic intervention have an added advantage of lesser pain, shorter duration of hospital stay and recurrence.

Background: Despite evidence for early integration of palliative care for people with advanced cancer and their families, patterns of late engagement continue. Prior research has focused on health professionals’ attitudes to palliative care with few studies exploring the views of patients and their carers. Aim: To explore initial perceptions of palliative care when this is first raised with patients with advanced cancer and their families in Australian settings. Design: Cross-sectional, prospective, exploratory qualitative design, involving narrative-style interviews and underpinned by an interpretative phenomenological framework. Setting/participants: Purposively sampled, English-speaking, adult patients with advanced cancer ( n = 30) and their nominated family caregivers ( n = 25) recruited from cancer services at a tertiary metropolitan hospital in Melbourne, Victoria, Australia. Results: Three major themes evolved which represent the common initial perceptions of palliative care held by patients with advanced cancer and their carers when this concept is first raised: (1) diminished care, (2) diminished possibility and (3) diminished choice. Palliative care was negatively associated with a system of diminished care which is seen as a ‘lesser’ treatment alternative, diminished possibilities for hope and achievement of ambitions previously centred upon cure and diminished choices for the circumstances of one’s care given all other options have expired. Conclusion: While there is an increasing move towards early integration of palliative care, this study suggests that patient and caregiver understandings have not equally progressed. A targeted public health campaign is warranted to disentangle understandings of palliative care as the ‘institutional death’ and to reframe community rhetoric surrounding palliative care from that of disempowered dying to messages of choice, accomplishment and possibility.

Background Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise–based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. Objective We aimed to evaluate the efficacy of a group exercise–based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. Methods A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. Results The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. Conclusions This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12621001417875; https://tinyurl.com/yc5crwtr International Registered Report Identifier (IRRID) PRR1-10.2196/38553

IntroductionThe sexually transmitted infection chlamydia can cause significant complications, particularly among people with female reproductive organs. Optimal management includes timely and appropriate treatment, notifying and treating sexual partners, timely retesting for reinfection and detecting complications including pelvic inflammatory disease (PID). In Australia, mainstream primary care (general practice) is where most chlamydia infections are diagnosed, making it a key setting for optimising chlamydia management. High reinfection and low retesting rates suggest partner notification and retesting are not uniformly provided. The Management of Chlamydia Cases in Australia (MoCCA) study seeks to address gaps in chlamydia management in Australian general practice through implementing interventions shown to improve chlamydia management in specialist services. MoCCA will focus on improving retesting, partner management (including patient-delivered partner therapy) and PID diagnosis.Methods and analysisMoCCA is a non-randomised implementation and feasibility trial aiming to determine how best to implement interventions to support general practice in delivering best practice chlamydia management. Our method is guided by the Consolidated Framework for Implementation Research and the Normalisation Process Theory. MoCCA interventions include a website, flow charts, fact sheets, mailed specimen kits and autofills to streamline chlamydia consultation documentation. We aim to recruit 20 general practices across three Australian states (Victoria, New South Wales, Queensland) through which we will implement the interventions over 12–18 months. Mixed methods involving qualitative and quantitative data collection and analyses (observation, interviews, surveys) from staff and patients will be undertaken to explore our intervention implementation, acceptability and uptake. Deidentified general practice and laboratory data will be used to measure pre-post chlamydia testing, retesting, reinfection and PID rates, and to estimate MoCCA intervention costs. Our findings will guide scale-up plans for Australian general practice.Ethics and disseminationEthics approval was obtained from The University of Melbourne Human Research Ethics Committee (Ethics ID: 22665). Findings will be disseminated via conference presentations, peer-reviewed publications and study reports.

AbstractIntroductionComprehensive studies on the relationship between patient demographics and subsequent treatment and disposition at a single mass-gathering event are lacking. The Sydney Royal Easter Show (SRES; Sydney Olympic Park, New South Wales, Australia) is an annual, 14-day, agricultural mass-gathering event occurring around the Easter weekend, attracting more than 800,000 patrons per year. In this study, patient records from the SRES were analyzed to examine relationships between weather, crowd size, day of week, and demographics on treatment and disposition. This information would help to predict factors affecting patient treatment and disposition to guide ongoing training of first responders and to evaluate the appropriateness of staffing skills mix at future events.HypothesisPatient demographics, environmental factors, and attendance would influence the nature and severity of presentations at the SRES, which would influence staffing requirements.MethodsA retrospective analysis of 4,141 patient record forms was performed for patients who presented to St John Ambulance (Australian Capital Territory, Australia) at the SRES between 2012 and 2014 inclusive. Presentation type was classified using a previously published minimum data set. Data on weather and crowd size were obtained from the Australian Bureau of Meteorology (Melbourne, Victoria, Australia) and the SRES, respectively. Statistical analyses were performed using SPSS v22 (IBM; Armonk, New York USA).ResultsBetween 2012 to 2014, over 2.5 million people attended the SRES with 4,141 patients treated onsite. As expected, the majority of presentations were injuries (49%) and illnesses (46%). Although patient demographics and presentation types did not change over time, the duration of treatment increased. A higher proportion of patients were discharged to hospital or home compared to the proportion of patients discharged back to the event. Patients from rural/regional locations (accounting for 15% of all patients) were more likely to require advanced treatment, health professional review, and were more likely to be discharged to hospital or home rather than discharged back to the event. Extremes of temperature were associated with a lower crowd size and higher patient presentation rate (PPR), but had no impact on transfer or referral rates to hospital.ConclusionThis study demonstrated that analyses of patient presentations at an agricultural show provide unique insights on weather, attendance, and demographic features that correlated with treatment and disposition. These data can help guide organizers with information on how to better staff and train health care providers at future mass-gathering events of this type.CrabtreeN,MoS,OngL,JegatheesT,WeiD,FaheyD,LiuJ.Retrospective analysis of patient presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014.Prehosp Disaster Med.2017;32(2)187–194.

BackgroundImmune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but can result in toxicities, known as immune-related adverse events (irAEs), due to a hyperactivated immune system. ICI-related inflammatory arthritis has been described in literature, but herewith we introduce and characterize post-ICI activated osteoarthritis (ICI-aOA).MethodsWe conducted a multi-center, retrospective, observational study of patients with cancer treated with ICIs and diagnosed with ICI-aOA by a rheumatologist. ICI-aOA was defined by (1) an increase in non-inflammatory joint pain after ICI initiation, (2) in joints characteristically affected by osteoarthritis and (3) lack of inflammation on exam. Cases were graded using the CTCAE (Common Terminology Criteria for Adverse Events) V6.0 rubric for arthralgia. RECIST (Response evaluation criteria in solid tumors) V.1.1 (v.4.03) guidelines determined tumor response. Results were analyzed using Chi-squared tests of association and multivariate logistic regression.ResultsThirty-six patients had ICI-aOA with mean age at time of rheumatology presentation of 66 years (51–81yrs). Most patients had metastatic melanoma (10/36, 28%) and had received a PD1/PDL1 inhibitor monotherapy (31/36, 86%) with 5/36 (14%) combination therapy. Large joint involvement (hip/knee) was noted in 53% (19/36), small joints of hand 25% (9/36), and spine 14% (5/36). Two-thirds (24/36) suffered multiple joint involvement. Three of 36 (8%) had CTCAE grade 3, 14 (39%) grade 2 and 19 (53%) grade 1 manifestations. Symptom onset ranged from six days to 33.8 months with median of 5.2 months after ICI initiation; 5 patients suffered ICI-aOA after ICI cessation (0.6, 3.5, 4.4, 7.3 and 15.4 months after ICI cessation) (figure 1). Most common form of therapy was intra-articular corticosteroid injections only (15/36, 42%) followed by NSAIDs only (7/36, 20%) (figure 2). Twenty patients (56%) experienced other irAEs, with rheumatic and dermatologic being the most common. All three patients with high-grade ICI-aOA also had another irAE diagnosis at some point after ICI initiation.ConclusionsICI-aOA should be recognized as an adverse event of ICI immunotherapy. Early referral to a rheumatologist can facilitate the distinction between ICI induced inflammatory arthritis from post-ICI mechanical arthropathy, the latter of which can be managed with local therapy that will not compromise ICI efficacy.Ethics ApprovalCollection of patient data was approved by local Institutional Review Boards at respective institutions: Hospital for Special Surgery in New York (HSS IRB # 2017–1898), University of Chicago in Chicago, Illinois (IRB150837) and Austin Health in Melbourne, Victoria, Australia (HREC/18/Austin/102).Abstract 817 Figure 1Incidence of ICI-aOA (activated osteoarthritis after immune-checkpoint inhibitor) ranged from the first month after ICI initiation up until month 22 after ICI initiation, with most cases occurring in the first 6 months after start of ICI. Five of 36 patients experienced ICI-aOA after ICI cessation (0.6, 3.5, 4.4, 7.3 and 15.4 months after ICI cessation), corresponding to presentation after ICI initiation as follows: 2.0, 9.6, 19.1, 8.7 and 16.1 months after ICI initiation, respectively (as denoted in darker color). ICI: Immune-checkpoint inhibitor, NSAIDs: Non-steroidal anti-inflammatory drugs, DMARDs: Disease modifying anti-rheumatic drugsAbstract 817 Figure 2Therapeutic option most used was local or intra-articular corticosteroid therapy, followed by conservative management with physical therapy only then NSAIDs. Most patients experienced improvement in signs and symptoms with treatment. ICI: Immune-checkpoint inhibitor, NSAIDs: Non-steroidal anti-inflammatory drugs, DMARDs: Disease modifying anti-rheumatic drugs

Melbourne Water Corporation has two large anaerobic lagoons at the Western Treatment Plant (WTP), Werribee, Victoria, Australia. The lagoons are covered using numerous sheets of high-density polyethylene (HDPE) geomembranes to prevent the emission of odorous gases and to harness biogas as a source of renewable energy. Some of the content of raw sewage can accumulate and form into a solid mass (called “scum”). The development of a large body of solid scum that rises to the surface of the lagoon (called “scumbergs”) deforms the covers and may affect its structural integrity. Currently, there is no method able to effectively “see-through” the opaque covers to define the spread of the scum underneath the cover. Hence, this paper investigates a new quasi-active thermal imaging method that uses ambient solar radiation to determine the extent of the solid matter under the geomembrane. This method was devised by using infrared thermography and a pyranometer to constantly monitor the transient temperature response of the HDPE geomembrane using the time varying ambient solar radiation. Newton’s cooling law is implemented to define the resultant cooling constants. The results of laboratory-scale tests demonstrate the capability of the quasi-active thermography to identify the presence and the extent of solid matter under the cover. This paper demonstrates, experimentally, the importance of measuring the surface temperature of the cover and solar intensity profiles to obtain the cooling process when during variations in solar intensity during normal sunrise, sunset, daily transitioning from morning–afternoon–evening and cloud cover events. The timescale associated with these events are different and the results show that these daily transient temperature cycles of the geomembranes can be used to detect the extent of the accumulation of solid matter underneath the geomembrane. The conclusions from this work will be further developed for field trials to practically monitor the growth in the extent of the scum under the floating covers in WTP with the ambient solar energy.

Background and context: The Bridge of Support Program (BOS) is adapting a successful community based model of peer support to an acute setting, at the Sunshine Hospital Breast Clinic, to meet the cultural and socioeconomic diverse needs of women with breast cancer. This two year project was funded by LUCRF Community Partnership Trust. Aim: To improve the experience of women undergoing treatment of breast cancer at Western Health. To improve access to psych-social, emotional and practical support for women by extending the reach of CounterPart- a state-wide service of women´s Health Victoria, funded by the Victorian Department of Health and Human Services to provide peer support and information to people affected by breast or a gynecologic cancer. Program/Policy process: Peer support volunteers actively guided women to current and credible evidence-based information, support decision making and provide emotional support. Peer support volunteers are rostered once a week at Sunshine Hospital to coincide with breast clinic and include access to the day oncology unit and radiotherapy center. Detailed contact information is recorded and women receive follow-up contact (with consent) from the peer support volunteers at the CounterPart Resource Centre in Melbourne. A CounterPart staff member oversees the project and provides direct support and supervision to the volunteers on site at the hospital. Women can self refer. Outcomes: Between February and December 2016 the BOS program had 159 separate contacts with patients and their families. 82 contacts were with men and women who were new to CounterPart and 77 were follow-up contacts. 90 individuals treated for breast cancer at Western Health accessed the program, which represent 53% of the women seen by the breast service. 48% of the contacts were follow-up contacts with the CounterPart volunteers indicating that once engaged with the service many men and women continue to make contact. 38% of contacts were with women diagnosed with metastatic disease, a group who often have higher levels of unmet or more complex needs. 49% were born in a nonmain English speaking country (compared with the overall state of Victoria average of 19.6%) thus reflecting an accessible service to the non-English speaking community. What was learned: At a time when peer support is being increasingly recognized as a key part of effective supportive care in cancer services, the BOS program offers a model of integrated peer support that is respected, reliable, well supported and safe within the acute setting. This acute-community sector partnership demonstrates how the medical and social models of health care can work together to provide a connected and quality service for men and women diagnosed with breast cancer. An active research approach is enabling the project to be responsive to issues and challenges as they arise including the ongoing recruitment of women as volunteers from the local community to work within the acute setting.

Abstract Background and Aims The detection of sequence variants and copy number changes can improve diagnosis, inform prognosis and guide treatment in patients with bone marrow failure syndromes (BMFS). We aimed to establish and prospectively assess the impact of comprehensive genomic evaluation on diagnostic categorisation and clinical outcomes in patients with genomically uncharacterised BMFS. Methods Eligible patients were recruited from four participating institutions across Victoria, Australia. Inclusion criteria were (i) age >3 months (ii) clinicopathological diagnosis or suspicion of either acquired aplastic anaemia (AA), inherited BMFS, hypoplastic myelodysplastic syndrome (hMDS) or a BMFS with marrow hypoplasia/aplasia not able to be definitively categorised. Patients initially underwent 90-gene targeted sequencing (Peter MacCallum Cancer Centre PanHaem and Myeloid Amplicon next generation sequencing [NGS] panels) for rapid turnaround of accredited results for clinical decision-making. In addition, whole exome sequencing (WES), whole genome copy number analysis, NGS T-cell receptor β (TRB) repertoire assessment and longitudinal monitoring of selected mutations by digital droplet PCR (ddPCR) were performed. All patients received pre-test counselling and assessment. Genomic results were reviewed in centralised multidisciplinary case conferences including the treating clinician, molecular haematopathologists, medical scientists, clinical geneticists and genetic counsellors. Results 100 patients were enrolled. Median age was 25 years (range 3 months - 80 years); 39% were under 18 years. Detection of sequence variants or copy number abnormalities led to or confirmed a diagnosis of either an inherited or acquired BMFS in 36 patients. In 17 patients a diagnosis of an inherited BMFS was positively made by detection of pathogenic sequence variants or copy number changes in FANCA(1 patient [pt]), FANCM(1 pt), FANCI(1 pt), RAD51C(1 pt), HAX1(1 pt), SBDS(1 pt), DNAJC21(1 pt), RPS19(5 pts), RPL35A(1 pt), TERT(1 pt), TINF2(1 pt) and SAMD9L(1 pt). In five patients the clinical BMFS was considered undifferentiated without a clear candidate gene suspected on phenotypic features prior to genomic evaluation. Importantly, an established diagnosis of AA was altered to an inherited BMFS by genomic characterisation in two patients (SAMD9L, FANCA). In 19 patients pathogenic sequence variants or copy number changes were detected either leading to or confirming a diagnosis of an acquired BMFS (paroxysmal nocturnal haemoglobinuria, hMDS or AA). Pathogenic sequence variants were detected in TET2(n=5), RUNX1(n=4), ASXL1(n=3), PIGA(n=3), DNMT3A(n=3),CBL(n=2), and BCOR/IDH2/SF3B1/SRSF2/TP53/U2AF1(n=1 each). Sequencing-detected copy number abnormalities included loss of chromosome 7 (n=6), losses on chromosome 5q (n=2) and copy number loss of ETV6(n=2). Longitudinal monitoring of an acquired truncating RUNX1 mutation by ddPCR resulted in one patient undergoing allogeneic bone marrow transplant for a progressively rising allelic burden. There was a trend towards more restricted TRB diversity in patients with genomically-defined acquired BMFS versus inherited BMFS (normalised Shannon index ≤0.85, 36.4% vs 0%, p=0.09). Conclusion We have established and evaluated a model of comprehensive multimodal genomic characterisation and multidisciplinary care for 100 patients with BMFS. Our results demonstrate a significant contribution to diagnostic categorisation and patient care in this area of clinical need. Disclosures Lieschke: CSL Behring Australia: Consultancy. Tam:Janssen: Honoraria, Research Funding; Gilead: Honoraria; AbbVie: Honoraria, Research Funding; Pharmacyclics: Honoraria, Travel funding; Pharmacyclics: Honoraria; Beigene: Honoraria, Other: Travel funding; Roche: Honoraria; Beigene: Honoraria, Other: Travel funding; Gilead: Honoraria; Roche: Honoraria; AbbVie: Honoraria, Research Funding.

Carrum Carrum Swamp was a vast wetland to the south-east of Melbourne, Victoria, Australia, at the time that it was first sighted by white colonists in 1803. By 1878, the colonists had commenced converting the swamp to dry land for agricultural and horticultural pursuits, and 100 years later it was predominantly residential land. Shifting values in the 1970s led to environmental concerns about water quality in local creeks and Port Phillip Bay and subsequent residential development on the former swamp included the construction of stormwater treatment wetlands. Perceptions of wetlands are now diverse, including positive perceptions that support their presence in urban settings. In contrast, traditionally, wetlands have been perceived negatively, as waste lands, leading to their drainage. Nevertheless, alternative, perhaps positive, perceptions could have existed, only to be overwhelmed by the negative perceptions driving drainage. Understanding the full range of past perceptions is important to ensure that the historical record is correct and to provide historical context to contemporary perceptions of wetlands. It will better equip natural resource managers and designers and managers of constructed wetlands in urban locations to ensure that wetlands are healthy, functioning and appreciated by their local and wider communities. Thus, the perceptions of Carrum Carrum Swamp by colonists from 1803 to 1878 were examined through qualitative content analysis of historical documents, and a typology was developed. Seven different perceptions were identified: scientific, premodern, exploitative, romantic, aesthetic, medico-mythic and ecological. Most could be traced to the colonists’ predominantly British heritage, but one perception arose in the colony in response to the specific environmental conditions that the colonists encountered. This ecological perception valued wetlands as places of predictable water supply in a land of unpredictable rainfall. It recognised wetlands as part of a broader hydrological system, with influences on the local climate. Its proponents promoted the need for a different approach to the management of wetlands than in Britain and Europe. Nevertheless, a dominant exploitative perception prevailed, leading to the drainage of Carrum Carrum Swamp. The typology developed in this study will be useful for exploring perceptions of other wetlands, both colonial and contemporary.

AbstractBackground and purposePain is a common symptom associated with multiple sclerosis (MS), and has lasting effects on an individual’s functional capacity and quality of life. A wide range of prevalence rates of pain (between 23% and 90%)have been reported in MS and this is mainly due to the methodological differences amongst the studies such as variability in patient sources, method of sampling and the definition of pain used. Chronic pain in MS, defined as pain lasting for greater than 3–6 months, can have a significant impact on their biopsychosocial health, including negative impact on activities of daily living, relationships and social participation. The long-term course of MS-related pain and its impact in an Australian cohort over a 7-year period has been investigated earlier. The aim of this longitudinal study was to describe the impact of chronic pain, pain-related disability and carer burden in persons with MS over a 10-year period. The aim of this longitudinal study was to describe the impact of chronic pain, pain-related disability and carer burden in persons with MS over a 10-year period.MethodsThis was a prospective longitudinal study conducted at the Rehabilitation Department of Royal Melbourne Hospital (RMH), a tertiary referral hospital in Victoria and Australia. The source of participants was from the RMH MS database and contains detailed MS patient information including demographic data, diagnosis details (using McDonald’s criteria), pain characteristics. Structured face-face interviews and validated measures were used, which include the visual analogue scale (VAS); chronic pain grade (CPG); the assessment of quality of life (AQoL) and the carer strain index (CSI). The mean age of the participants (n = 70) was 55.3 years and majority (70%) were female.ResultsThe mean age of the participants (n = 70) was 55.3 years and majority (70%) were female. The findings show that over time (10 years), participants report having greater bilateral bodily pain and greater description of pain as ‘worse as it could be’. Pain types were similar to 7-years follow-up but remained higher than baseline. There was a significant deterioration in quality of life in those with more severe CPG over time. Almost half of the participants 31 (44%) required care either from a private carer, institution or from a family member. Although fear of taking medications and side effects were common barriers to treatment for pain, there was an increase in the use of pharmacological treatment over time and an increase in the use of healthcare services, mainly neurologists and general practitioners.ConclusionsThe pain measures reported by the participants were similar to those at the 7-year follow-up except there was a greater representation of bilateral pain locations (limb, trunk and facial pain) compared to baseline and 7-year follow-up. At 10-year follow-up, more participants used medications compared tc 7-year follow-up and there was an increase in the use of health professionals at the 10-year follow-up At the 10-year follow up QoL of the participants deteriorated significantly and more participants had progressed to higher CPGIII and CPGIV. This study demonstrates that chronic pain is a significant issue over time in MS, with clinical and health implications, impact on quality of life, disability and healthcare utilization.ImplicationsGreater awareness of chronic pain in pwMS, cognitive classifications and an interdisciplinary approach is required to improve long-term patient outcomes and well-being.Crown Copyright © 2017 Published by Elsevier B.V. on behalf of Scandinavian Association for the Study of Pain. All rights reserved.

Designing stormwater treatment measures generally requires a continuous simulation modelling approach using a small time step to properly consider the influence of a range of local storm characteristics and hydrologic conditions. This can be a complex and costly exercise and requires both technical expertise and the availability of a suitably long period of rainfall data. This paper describes the development of a simple but rigorous procedure to transpose known performance data from one geographic location to another within the state of Victoria in Australia. The procedure is based on continuous modelling of the performance of a number of stormwater treatment measures using 6 minute rainfall recorded over a suitably long period for 45 sites across Victoria. The size of the treatment measures required to attain prescribed water quality outcomes for each of the sites investigated is determined from application of the model. These data are then normalised and correlated to geographic and meteorological characteristics of the individual sites to enable regional relationships to be derived. Five hydrologic regions within Victoria and a further four regions for the metropolitan region in Melbourne were delineated. Their corresponding regional formulae are applicable for all sites within Victoria.

The aim of this research was to ascertain General Practitioners’ (GPs) perceptions and experiences of prostate cancer (PCa) diagnosis, treatment, and care in metropolitan Melbourne and in a regional area of Victoria, Australia, associated with poorer PCa outcomes. Semi-structured qualitative interviews were conducted with GPs (N= 10) practising in the selected region and in metropolitan Melbourne, Australia. GPs thought that most men wanted PSA testing and were willing to undergo rectal examination. Some GPs were troubled by inconsistent screening guidelines from different professional bodies. They identified a need for resources to support them in educating patients about PCa. GPs thought it might be more difficult for young female GPs to care for patients in relation to PCa screening; differences were evident between younger female GPs and older male GPs in the approach they adopted in interviews. Regional GPs often referred patients to services in larger centres because no local specialists were available. GPs also found it hard to explain differences in PCa outcomes in regional and metropolitan areas. Potential age and gender differences in GPs in relation to prostate care warrant further examination. Although GPs were able to offer only limited insights into the poorer outcomes in regional areas, they identified ways in which they could be assisted to provide best-practice care. Multidisciplinary care, resources for patients, and consistent guidelines for the detection and treatment of PCa should contribute to better care in all areas.

Pressure injuries (PIs) substantively impact quality of care during hospital stays, although only when they are severe or acquired as a result of the hospital stay are they reported as quality indicators. Globally, researchers have repeatedly highlighted the need to invest more in quality improvement, risk assessment, prevention, early detection, and care for PI to avoid the higher costs associated with treatment of PI. Coders' perspectives on quality assurance of the clinical coded PI data have never been investigated. This study aimed to explore challenges that hospital coders face in accurately coding and reporting PI data and subsequently, explore reasons why data sources may vary in their reporting of PI data. This article is based upon data collected as part of a multi-phase collaborative project to build capacity for optimizing PI prevention across Monash Partners health services. We have conducted 16 semi-structured phone interviews with clinical coders recruited from four participating health services located in Melbourne, Australia. One of the main findings was that hospital coders often lacked vital information in clinicians' records needed to code PI and report quality indicators accurately and highlighted the need for quality improvement processes for PI clinical documentation. Nursing documentation improvement is a vital component of the complex capacity building programs on PI prevention in acute care services and is relied on by coders. Coders reported the benefit of inter-professional collaborative workshops, where nurses and coders shared their perspectives. Collaborative workshops had the potential to improve coders' knowledge of PI classification and clinicians' understanding of what information should be included when documenting PI in the medical notes. Our findings identified three methods of quality assurance were important to coders to ensure accuracy of PI reporting: (1) training prior to initiation of coding activity and (2) continued education, and (3) audit and feedback communication about how to handle specific complex cases and complex documentation. From a behavioral perspective, most of the coders reported confidence in their own abilities and were open to changes in coding standards. Transitioning from paper-based to electronic records highlighted the need to improve training of both clinicians and coders.

Abstract Background South Asian women are at a high risk of developing gestational diabetes mellitus than other women in Australia. Gestational diabetes affects up to 14–19% of all pregnancies among South Asian, South East Asian, and Arabic populations placing women at risk of adverse pregnancy outcomes. Although, gestational diabetes resolves after childbirth, women with gestational diabetes are up to seven times more likely to develop type 2 diabetes within five to ten years of the index pregnancy. Increasingly, South Asian women are being diagnosed with gestational diabetes in Australia. Therefore, we aimed to gain a better understanding of the lived experiences of South Asian women and their experiences of self-management and their health care providers’ perspectives of treatment strategies. Methods Using an ethnographic qualitative research methodology, semi-structured one-on-one, face-to-face interviews were conducted with 21 health care providers involved in gestational diabetes management and treatment from the three largest tertiary level maternity hospitals in Melbourne, Victoria, Australia. In-depth interviews were conducted with 23 South Asian women post diagnosis between 24–28 weeks gestation in pregnancy. Results Health care providers had challenges in providing care to South Asian women. The main challenge was to get women to self-manage their blood glucose levels with lifestyle modification. Whilst, women felt self-management information provided were inadequate and inappropriate to their needs. Women felt ‘losing control over their pregnancy’, because of being preoccupied with diet and exercise to control their blood glucose level. Conclusions The gestational diabetes clinical practice at the study hospitals were unable to meet consumer expectations. Health care providers need to be familiar of diverse patient cultures, rather than applying the current ‘one size fits all’ approach that failed to engage and meet the needs of immigrant and ethnic women. Future enabling strategies should aim to co-design and develop low Glycaemic Index diet plans of staple South Asian foods and lifestyle modification messages.

BackgroundAn adverse interaction whereby opioids impair and delay the gastrointestinal absorption of oral P2Y12 inhibitors has been established, however the clinical significance of this in acute coronary syndrome (ACS) is uncertain. We sought to characterise the relationship between prehospital opioid dose and clinical outcomes in patients with ACS.MethodsPatients given opioid treatment by emergency medical services (EMS) with ACS who underwent percutaneous coronary intervention (PCI) between 1 January 2014 and 31 December 2018 were included in this retrospective cohort analysis using data linkage between the Ambulance Victoria, Victorian Cardiac Outcomes Registry and Melbourne Interventional Group databases. Patients with cardiogenic shock, out-of-hospital cardiac arrest and fibrinolysis were excluded. The primary end point was the risk-adjusted odds of 30-day major adverse cardiac events (MACE) between patients who received opioids and those that did not.Results10 531 patients were included in the primary analysis. There was no significant difference in 30-day MACE between patients receiving opioids and those who did not after adjusting for key patient and clinical factors. Among patients with ST-elevation myocardial infarction (STEMI), there were significantly more patients with thrombolysis in myocardial infarction (TIMI) 0 or 1 flow pre-PCI in a subset of patients with high opioid dose versus no opioids (56% vs 25%, p<0.001). This remained significant after adjusting for known confounders with a higher predicted probability of TIMI 0/1 flow in the high versus no opioid groups (33% vs 11%, p<0.001).ConclusionsOpioid use was not associated with 30-day MACE. There were higher rates of TIMI 0/1 flow pre-PCI in patients with STEMI prescribed opioids. Future prospective research is required to verify these findings and investigate alternative analgesia for ischaemic chest pain.

AbstractAge related macular degeneration (AMD) is the most common cause of vision loss in the elderly population. Neovascular AMD comprises 10% of all cases and can lead to devastating visual loss due to choroidal neovascularization (CNV). There are various cytokine pathways involved in the formation and leakage from CNV. Prior treatments have included focal laser therapy, verteporfin (Visudyne, Bausch and Lomb, Rochester, New York) ocular photodynamic therapy, transpupillary thermotherapy, intravitreal steroids and surgical excision of choroidal neovascular membranes. Currently, the major therapies in AMD focus on the VEGF-A pathway, of which the most common are bevacizumab (Avastin; Genentech, San Francisco, California), ranibizumab (Lucentis; Genentech, South San Francisco, California), and aflibercept (Eylea; Regeneron, Tarrytown, New York). Anti-VEGF agents have revolutionized our treatment of wet AMD; however, real world studies have shown limited visual improvement in patients over time, largely due to the large treatment burden. Cheaper alternatives, including ranibizumab biosimilars, include razumab (Intas Pharmaceuticals Ltd., Ahmedabad, India), FYB 201 (Formycon AG, Munich, Germany and Bioeq Gmbh Holzkirchen, Germany), SB-11 (Samsung Bioepsis, Incheon, South Korea), xlucane (Xbrane Biopharma, Solna, Sweden), PF582 (Pfnex, San Diego, California), CHS3551 (Coherus BioSciences, Redwood City, California). Additionally, aflibercept biosimilars under development include FYB203 (Formycon AG, Munich, Germany and Bioeq Gmbh Holzkirchen, Germany), ALT-L9 (Alteogen, Deajeon, South Korea), MYL1710 (Momenta Pharamaceuticals, Cambridge, MA, and Mylan Pharmacueticals, Canonsburg, PA), CHS-2020 (Coherus BioSciences, Redwood City, California). Those in the pipeline of VEGF targets include abicipar pegol (Abicipar; Allergan, Coolock, Dublin), OPT-302 (Opthea; OPTHEA limited; Victoria, Melbourne), conbercept (Lumitin; Chengdu Kanghong Pharmaceutical Group, Chengdu, Sichuan), and KSI-301 (Kodiak Sciences, Palo Alto, CA). There are also combination medications, which target VEGF and PDGF, VEGF and tissue factor, VEGF and Tie-2, which this paper will also discuss in depth. Furthermore, long lasting depots, such as the ranibizumab port delivery system (PDS) (Genentech, San Francisco, CA), as well as others are under evaluation. Gene therapy present possible longer treatments options as well and are reviewed here. This paper will highlight the past approved medications as well as pipeline therapies for neovascular AMD.

In early 1888, Miss Margaret Pearson arrived in Melbourne under engagement to the Working Men’s College there to give cookery lessons to young women. The College committee had applied to the National School of Cookery in London—an establishment effusively praised in the colonial press—for a suitable culinary educator, and Pearson, a graduate of that institute, was dispatched. After six months or so spent educating her antipodean pupils she published a cookbook, Cookery Recipes For The People, which she described in the preface as a handbook of “plain wholesome cookery” (Pearson 3). The book ran to three editions and sold more than 13,000 copies. A decade later, Hanna Maclurcan, co-proprietor of the popular Queen’s Hotel in Townsville, published Mrs Maclurcan’s Cookery Book: A Collection of Practical Recipes, Specially Suitable for Australia. A review of this work in the Brisbane Courier described it, positively, as a book of “good plain cooking”. Maclurcan had gained some renown as a cook after the Governor of Queensland, Lord Lamington, publicly praised the meals he had eaten at the Queen’s as “exceptionally good and above the average of Australian hotels” (Morning Bulletin 5). The first print run of Mrs Maclurcan’s Cookery Book sold out in weeks, and a second edition was swiftly produced. By 1903 there were 26,000 copies of Maclurcan’s book in print—one of which was deposited in the library of Queen Victoria. While the existence of any particular cookbook does not constitute evidence that any person ever reproduced a recipe from it, the not immodest sales enjoyed by Pearson and Maclurcan can, at the least, be taken to indicate a popular interest in the style of cookery, that is “plain cookery”, delineated in their respective works. If those who bought these books never actually turned them into working copies—that is, cooked from them—they likely aspired to do so. Practical classes in plain cookery were also popular in Australia in the latter part of the nineteenth century. The adjectival coupling of the word “plain” to “cookery” in colonial Australia can be seen then to have formed an appealing duet at that time If a modern author or reviewer described the body of recipes encapsulated in a cookbook as “plain cookery”, it would not serve to recommend it to the contemporary market—indeed it would likely condemn such a publication to pulping, rather than sales of many thousands—as the term would be understood by most modern cooks, and eaters, to describe food that was dull and lacking in flavour and cosmopolitan appeal. We now prefer cookery books that offer instruction on the preparation of dishes that are described as “exotic”, “global”, “ethnic”, “seasonal”, “local”, and “full of flavour”, and that lend those that prepare and consume the dishes they contain the “glamour of culinary ethnicity” (Appadurai 10). It would seem to be stating the obvious then to say that “plain cookery” meant something entirely different to colonial Australians, except that modern Australians commonly believe that their nineteenth century brethren ate an “abominable”, “monotonous”, “low standard” diet (Santich, The High and The Low 37), and therefore if they preferred their meals to be plain cooked, that these would have been exactly as our present-day interpretation would have them. Yet Pearson describes plain cookery as an “art” (3), arguably a rhetorical epithet, but she was a zealous educator and would not have used such a term to describe a style of cookery that she expected to turn out low quality dishes that were vile and dull. What Pearson and Maclurcan actually present in their respective books is English cookery: which was also known as plain cookery. The Anglo-Celtic population of Australia in the nineteenth century held varied opinions—ranging from obsequious to hateful—about England, depending on their background. The majority, however, considered it their natural home—including many who were colonial born—and the cultural model they reproduced, with local modifications, was that of the “mother country” (Abbott 10) some 10,000 long miles away. English political, legal, economic, and social systems were the foundation of white Australian society. In keeping with this, colonial cooks “perpetuated an English style of cookery, English food values, [and] an English meal structure” (Santich, Looking for Flavour 6) and English cookbooks were the models that colonial cooks and cookery writers drew upon. When Polly, the heroine of Henry Handel Richardson’s novel The Fortunes of Richard Mahoney, teaches herself to make pastry from a cookbook in her rudimentary kitchen on the Victorian goldfields circa 1853, historical accuracy requires her to have employed an imported publication to guide her. It was another decade before the first Australian cookbook, Edward Abbott’s The English And Australian Cookery Book, was published in 1864. Prior to the appearance of Abbott’s work, colonial cooks wanting the guidance of a culinary manual were reliant on the imported English titles stocked by Australian booksellers, such as Eliza Acton’s Modern Cookery for Private Families, Beeton’s Book of Household Management and William Kitchiner’s The Cook’s Oracle. These three particular cookbooks were amongst the most successful and influential works in the nineteenth century Anglo-sphere and were commonly considered as manuals of plain cookery: Acton’s particular work is also the source of the most commonly quoted definition of “plain cookery” as “the principles of roasting, boiling, stewing and baking” (Acton 167) and I am going let it stand as the model of such in this piece. If a curt literary catalogue, such as that used by Acton to delineate plain cookery, were used to describe any cuisine it would serve to make it seem austere, and the reputation of English food and cookery has likely suffered from a face value acceptance of it (and by association so has its Australian culinary doppelganger). A considered inspection of Acton’s work shows that her instructions for the plain methods of roasting, boiling, and stewing of food, cover 13 pages, followed by more than 100 pages of recipes for 19 different varieties of meat, poultry, and game that are further divided into numerous variant cuts. Three pages were dedicated to instruction for boiling potatoes properly. When preparing any of these dishes she enjoins her readers to follow the “slow methods of cooking recommended” (167) to ensure a superior end product. The principles of baking were elucidated across several chapters, taking under this classification the preparation of various types of pastry and a multitude of baked puddings, cakes and biscuits: all prepared from base ingredients—not a packet harmed in their production. We now venerate the taste of so-called “slow cooked” food, so to discover that this was the method prescribed for producing plain cooked dishes suggests that plain cookery potentially had more flavour than we imagine. Acton’s work also challenges the charge that the product of plain cookery was monotonous. We have developed a view that we must have a multitudinous array of different types of food available, all year round, for it to be satisfactory to us. Acton demonstrates that variety in cookery can be achieved in other ways such as in types and cuts of meat, and that “plain” was not necessarily synonymous with sameness. The celebrated twentieth century English food writer Elizabeth David says that Modern Cookery was the “most admired and copied English cookery book of the nineteenth century” (305). As the aspiration of most colonial cooks was the reproduction of English cookery it is not unreasonable to expect that Acton’s work might have had some influence on those that wrote cookery manuals for them. We know that Edward Abbott borrowed from her as he writes in his introduction that he has combined “the advantages of Acton’s work” (5) into this own. Neither Pearson or Maclurcan acknowledge any influence at all upon their works but their respective manuals are not particularly original in content—with the exception of some unique regional recipes in Maclurcan—and they must have drawn upon other cookery manuals of the same style to develop their repertoire. By the time they were writing, “large portions [of Acton’s] volume [had] been appropriated [by] contemporary [cookbook] authors [such as Abbott] without the slightest acknowledgment” (Acton 4): the famous Mrs. Beeton is generally considered to have borrowed heavily from Acton for the cookery section of her successful tome Household Management. If Pearson and Maclurcan did not draw directly on Acton—and they well might have—then they likely used culinary sources that had subsumed her influence as their inspiration. What was considered to constitute plain cookery was not as straightforward as Acton’s definition; it was also “generally understood” to be free of any French influence (David 35). It was a commonly held suspicion amongst nineteenth century English men and women that Gallic cooks employed sauces and strong flavourings such as garlic and other “low and treacherous devices” (Saunders 4), to disguise the fact that they had such poor quality ingredients to work with. On the other hand, the English “had such faith” in the superior quality of their native produce that they considered it only required treatment with plain cookery techniques to be rendered toothsome: this culinary Francophobia persisted in the colonies. In the novel, The Three Miss Kings, set in Melbourne in 1880, the trio of the title take lodgings with a landlady, who informs them from the outset that she is “only a plain cook, and can’t make them French things which spile [sic] the stomach” (Cambridge 36). While a good plain cook might have defined herself by the absence of any Gallic, or indeed any other “foreign”, influence in the meals she created, there had been a significant absorption of elements of both of these in the plain cookery she practised, but these had become so far embedded in English cookery that she was unaware of it. A telling example of this is the unremarked inclusion of curry in the plain cookery cannon. While the name and homogenised form of this dish is of British invention, it retained the varied spices, including pungent chillies, of the Indian cuisine it simulated. Pearson and Maclurcan, and Abbott, all included recipes for curries and curried dishes in their respective cookery books. Over time, plain cookery seems to have become conflated with “plain food”, but the latter was not necessarily the result of the former. There was little of Pearson’s “art” involved in creating plain food, except perhaps an ability to keep this style of food so flavourless and dull that it offered neither pleasure nor temptation to eat any more than that required to sustain life. This very real plainness was actively sought by some as “plain food was synonymous with moral rectitude […] and the plainer the food the more virtuous the eater” (Santich, Looking 28). A common societal appreciation of moral virtue is barely perceptible in modern Australian society but it was an attribute that was greatly valued in the nineteenth century Anglo-world and the consumption of plain food a necessary practice in the achievement of good character. (Our modern habit of labelling of foods “good” or “bad” shows that we continue to imbue food with moral overtones.) The list of “gustatory temptations” “proscribed by the plain food lobby” included “salt, spices, sauces and any flavourings that might have cheered the senses” (Santich, Looking 28). If this were the case then both Pearson and Maclurcan’s cookbooks would have dramatically failed to qualify as manuals of plain food. The recipes contained in their respective works feature a much greater use of components associated with flavour enhancement than we imagine to have been employed in plain cookery, particularly if we erroneously believe it to be analogous to plain food. Spices are used extensively in sweet and savoury dishes, as are various fresh green herbs and lemon juice and rind; homemade condiments such as mushroom ketchup (a type of essence pressed from a seasonal abundance of fungi), and a liberal employment of sherry, port, Madeira, and brandy that a “virtuous” plain food advocate would have considered most intemperate. Pearson and Maclurcan both give instructions for preparing rich stocks and gravies drawn from meat, bones and aromatic vegetables, and prescribe the end product of this process as the foundation for a variety of soups, sauces, and stews. Recipes are given for a greater diversity of vegetables than the stereotyped cabbage and potatoes of colonial culinary legend. Maclurcan displays a distinct tropical regionalism in her book providing recipes that use green bananas and pawpaw as vegetables, alongside other exotic species—for that time—such as eggplant, choko, mango, granadilla, passionfruit, rosella, prickly pear, and guava. Her distinct location, the coastal city of Townsville, is also reflected in the extensive selection of recipes for local species of fish and seafood such as beche-de-mer, prawns, and barramundi, which won Maclurcan a reputation as an expert on seafood. Ultimately, to gain a respectably informed understanding as to the taste, aroma, and texture of the plain cookery presented in the respective works of Pearson and Maclurcan one needs to prepare their recipes: I have done so, reproducing a wide selection of dishes from both books. Admittedly, I am a professionally trained cook with the skills to execute recipes to a high standard, but my practice is to scrupulously maintain the original listing of ingredients in the reproduction and follow the method as best I can. Through this practice I have made some delicious discoveries, which have helped inform my opinion that some colonial Australians, and perhaps significant numbers of them, must have been eating meals that were a long way from dull, flavourless and monotonous. It has been said that we employ our tongues for the “twin offices of rhetoric and taste” (Jaine 61). Words can exercise a significant influence on how we value the taste of—or actually taste—any particular food or indeed a cuisine. In the case of the popularly held opinion about the unappetizing state of colonial meals, it might be that the absence of rhetoric has contributed to this. Colonial food writers such as Pearson and Maclurcan did not “mince words” (Bannerman 166) and chose to use “plain titling” (David 306) and language that lacked the excessive adjectives and laudatory hyperbole typically employed by modern food writers. Perhaps if Pearson or Maclurcan had indulged in anointing their own works with enthusiastic recommendation and reference to international influences in their recipes, this might have contributed to a more positive impression of the food of our Anglo-Celtic ancestors. As an experiment with this idea I have taken a recipe from Cookery Recipes For The People and reframed its title and description in a modern food writing style. The recipe in question is titled “White Sauce” and Pearson writes that “this sauce will answer well for boiled fowl” (48): hardly language to make the dish sound appealing to the modern cook, and likely to confirm an expectation of plain cookery as tasteless and boring. But what if the recipe remained the same but the words used to describe it were changed, for example: the title to “Salsa Blanca” and the introductory remark to “this luxurious silky sauce infused with eschalot, mace, lemon, and sherry wine is perfect for perking up poached free-range chicken”. How much better might it then taste? References Abbott, Edward. The English And Australian Cookery Book: Cookery For The Many, As Well As The Upper Ten Thousand. London: Sampson Low, Son, & Marston, 1864. Acton, Eliza. Modern Cookery for Private Families. London: Longman, Brown, Green, Longmans, and Roberts, 1858. Appadurai, Arjun. “How to Make a National Cuisine: Cookbooks in Contemporary India”. Comparative Studies in Society and History 30 (1988): 3–24. Bannerman, Colin. A Friend In The Kitchen. Kenthurst NSW: Kangaroo Press, 1996. Brisbane Courier. “Mrs Maclurcan’s Cookery Book: A Collection of Practical Recipes, Specially Suitable for Australia [review].” Brisbane Courier c.1898. [Author’s manuscript collection.] Cambridge, Ada. The Three Miss Kings. London: Virago Press, 1987 (1st pub. Melbourne, 1891). David, Elizabeth. An Omelette and a Glass of Wine. London: Penguin, 1986. Freeman, Sarah. Mutton and Oysters: The Victorians and their Food. London: Victor Golllancz, 1989. Humble, Nicola. Culinary Pleasures. London, Faber & Faber, 2005. Jaine, Tom. “Banquets and Meals”. Pleasures of the Table: Proceedings of the Fifth Symposium of Australian Gastronomy (1991): 61–4. Jones, Shar, and Otto, Kirsten. Colonial Food and Drink 1788-1901. Sydney: Historic Houses Trust of New South Wales, 1985. Hartley, Dorothy. Food in England. London: Macdonald General, 1979. Hughes, Kathryn. The Short Life & Long Times of Mrs Beeton. London: Harper Perennial, 2006. Maclurcah, Hannah. Mrs Maclurcan’s Cookery Book: A Collection of Practical Recipes, Specially Suitable for Australia. Melbourne: George Robertson, 1905 (1st pub. Townsville, 1898). Morning Bulletin. “Gossip.” Morning Bulletin (Rockhampton) 10 May 1898: 5. Pearson, Margaret. Cookery Recipes for the People. Melbourne: Hutchinson, 1888. Richardson, Henry Handel. The Fortunes of Richard Mahony. London: Heinemann, 1954. Santich, Barbara. What the Doctors Ordered: 150 Years of Dietary Advice in Australia. Melbourne: Hyland House, 1995. ---. “The High and the Low: Australian Cuisine in the Late Nineteenth and Early Twentieth Centuries”. Journal of Australian Studies 30 (2006): 37–49. ---. Looking For Flavour. Kent Town: Wakefield, 1996 Saunders, Alan. “Why Do We Want An Australian Cuisine?”. Journal of Australian Studies 30 (2006): 1-17. Young, Linda. Middle-Class Culture in the Nineteenth Century: America, Australia and Britain. Basingstoke: Palgrave Macmilian, 2002.

In this article I discuss a story told by the South Australian Ngarrindjeri Aboriginal elder, Aunty Hilda Wilson (nee Varcoe), about the time when, at not quite sixteen, she was sent from the Point Pearce Aboriginal Station to work in the Adelaide Hills, some 500 kilometres away, as a housekeeper for “one of Adelaide’s leading doctors”. Her secondment was part of a widespread practice in early and mid-twentieth century Australia of placing young Aboriginal women “of marriageable age” from missions and government reserves into domestic service. Consciously deploying Indigenous storytelling practices as pedagogy, Hilda Wilson recounted this episode in a number of distinct ways during the late 1990s and early 2000s. Across these iterations, each building on the other, she exhibited a personal resilience in her subjectivity, embedded in Indigenous knowledge systems of relationality, kin and work, which informed her agency and determination in a challenging situation in which she was both caring for a white socially-privileged family of five, while simultaneously grappling with the injustices of a state system of segregated indentured labour. Kirmayer and colleagues propose that “notions of resilience emerging from developmental psychology and psychiatry in recent years address the distinctive cultures, geographic and social settings, and histories of adversity of indigenous peoples”. Resilience is understood here as an ability to actively engage with traumatic change, involving the capacity to absorb stress and to transform in order to cope with it (Luthar et al.). Further to this, in an Indigenous context, Marion Kickett has found the capacity for resilience to be supported by three key factors: family connections, culture and belonging as well as notions of identity and history. In exploring the layers of this autobiographical story, I employ this extended psychological notion of resilience in both a domestic ambit as well as the broader social context for Indigenous people surviving a system of external domination. Additionally I consider the resilience Aunty Hilda demonstrates at a pivotal interlude between girlhood and womanhood within the trajectory of her overall long and productive life, and within an intergenerational history of resistance and accommodation. What is especially important about her storytelling is its refusal to be contained by the imaginary of the settler nation and its generic Aboriginal-female subject. She refuses victimhood while at the same time illuminating the mechanisms of injustice, hinting also at possibilities for alternative and more equitable relationships of family and work across cultural divides. Considered through this prism, resilience is, I suggest, also a quality firmly connected to ideas of Aboriginal cultural-sovereignty and standpoint and to, what Victoria Grieves has identified as, the Aboriginal knowledge value of sharing (25, 28, 45). Storytelling as Pedagogy The story I discuss was verbally recounted in a manner that Westphalen describes as “a continuation of Dreaming Stories”, functioning to educate and connect people and country (13-14). As MacGill et al. note, “the critical and transformative aspects of decolonising pedagogies emerge from storytelling and involve the gift of narrative and the enactment of reciprocity that occurs between the listener and the storyteller.” Hilda told me that as a child she was taught not to ask questions when listening to the stories of an Elder, and her own children were raised in this manner. Hilda's oldest daughter described this as a process involving patience, intrigue and surprise (Elva Wanganeen). Narratives unfold through nuance and repetition in a complexity of layers that can generate multiple levels of meaning over time. Circularity and recursivity underlie this pedagogy through which mnemonic devices are built so that stories become re-membered and inscribed on the body of the listener. When a perceived level of knowledge-transference has occurred, a narrator may elect to elaborate further, adding another detail that will often transform the story’s social, cultural, moral or political context. Such carefully chosen additional detail, however, might re-contextualise all that has gone before. As well as being embodied, stories are also emplaced, and thus most appropriately told in the Country where events occurred. (Here I use the Aboriginal English term “Country” which encompasses home, clan estate, and the powerful complex of spiritual, animate and inanimate forces that bind people and place.) Hilda Wilson’s following account of her first job as a housekeeper for “one of Adelaide’s leading doctors”, Dr Frank Swann, provides an illustration of how she expertly uses traditional narrative forms of incrementally structured knowledge transmission within a cross-cultural setting to tell a story that expresses practices of resilience as resistance and transformation at its core. A “White Doctor” Story: The First Layer Aunty Hilda first told me this story when we were winding along the South Eastern Freeway through the Adelaide hills between Murray Bridge and Mount Barker, in 1997, on our way home to Adelaide from a trip to Camp Coorong, the Ngarrindjeri cultural education centre co-founded by her granddaughter. She was then 86 years old. Ahead of us, the profile of Mt Lofty rose out of the plains and into view. The highest peak in the Mount Lofty ranges, Yurrebilla, as it is known to Kaurna Aboriginal people, or Mt Lofty, has been an affluent enclave of white settlement for Adelaide’s moneyed elite since early colonial times. Being in place, or in view of place, provided the appropriate opportunity for her to tell me the story. It belongs to a group of stories that during our initial period of working together changed little over time until one day two years later she an added contextual detail which turned it inside out. Hilda described the doctor’s spacious hill-top residence, and her responsibilities of caring for Dr Swann’s invalid wife (“an hysteric who couldn't do anything for herself”), their twin teenage boys (who attended private college in the city) along with another son and younger daughter living at home (pers. com. Hilda Wilson). Recalling the exhilaration of looking down over the sparkling lights of Adelaide at night from this position of apparent “privilege” on the summit, she related this undeniably as a success story, justifiably taking great pride in her achievements as a teenager, capable of stepping into the place of the non-Indigenous doctor's wife in running the large and demanding household. Successfully undertaking a wide range of duties employed in the care of a family, including the disabled mother, she is an active participant crucial to the lives of all in the household, including to the work of the doctor and the twin boys in private education. Hilda recalled that Mrs Swann was unable to eat without her assistance. As the oldest daughter of a large family Hilda had previously assisted in caring for her younger siblings. Told in this way, her account collapses social distinctions, delineating a shared social and physical space, drawing its analytic frame from an Indigenous ethos of subjectivity, relationality, reciprocity and care. Moreover Hilda’s narrative of domestic service demonstrates an assertion of agency that resists colonial and patriarchal hegemony and inverts the master/mistress-servant relationship, one she firmly eschews in favour of the self-affirming role of the lady of the house. (It stands in contrast to the abuse found in other accounts for example Read, Tucker, Kartinyeri. Often the key difference was a continuity of family connections and ongoing family support.) Indeed the home transformed into a largely feminised and cross-culturalised space in which she had considerable agency and responsibility when the doctor was absent. Hilda told me this story several times in much the same way during our frequent encounters over the next two years. Each telling revealed further details that fleshed a perspective gained from what Patricia Hill Collins terms an “epistemic privilege” via her “outsider-within status” of working within a white household, lending an understanding of its social mechanisms (12-15). She also stressed the extent of her duty of care in upholding the family’s well-being, despite the work at times being too burdensome. The Second Version: Coming to Terms with Intersecting Oppressions Later, as our relationship developed and deepened, when I began to record her life-narrative as part of my doctoral work, she added an unexpected detail that altered its context completely: It was all right except I slept outside in a tin shed and it was very cold at night. Mount Lofty, by far the coldest part of Adelaide, frequently experiences winter maximum temperatures of two or three degrees and often light snowfalls. This skilful reframing draws on Indigenous storytelling pedagogy and is expressly used to invite reflexivity, opening questions that move the listener from the personal to the public realm in which domestic service and the hegemony of the home are pivotal in coming to terms with the overlapping historical oppressions of class, gender, race and nation. Suddenly we witness her subjectivity starkly shift from one self-defined and allied with an equal power relationship – or even of dependency reversal cast as “de-facto doctor's wife” – to one diminished by inequity and power imbalance in the outsider-defined role of “mistreated servant”. The latter was signalled by the dramatic addition of a single signifying detail as a decoding device to a deeper layer of meaning. In this parallel stratum of the story, Hilda purposefully brings into relief the politics in which “the private domain of women's housework intersected with the public domain of governmental social engineering policies” (Haskins 4). As Aileen Moreton-Robinson points out, what for White Australia was cheap labour and a civilising mission, for Indigenous women constituted stolen children and slavery. Protection and then assimilation were government policies under which Indigenous women grew up. (96) Hilda was sent away from her family to work in 1927 by the universally-feared Sister Pearl McKenzie, a nurse who too-zealously (Katinyeri, Ngarrindjeri Calling, 23) oversaw the Chief Protector’s policies of “training” Aboriginal children from the South Australian missions in white homes once they reached fourteen (Haebich, 316—20). Indeed many prominent Adelaide hills’ families benefited from Aboriginal labour under this arrangement. Hilda explained her struggle with the immense cultural dislocation that removal into domestic service entailed, a removal her grandfather William Rankine had travelled from Raukkan to Government House to protest against less than a decade earlier (The Register December 21, 1923). This additional layer of story also illuminates Hilda’s capacity for resilience and persistence in finding a way forward through the challenge of her circumstances (Luthar et al.), drawing on her family networks and sense of personhood (Kickett). Hilda related that her father visited her at Mount Lofty twice, though briefly, on his way to shearing jobs in the south-east of the state. “He said it was no good me living like this,” she stated. Through his active intervention, reinforcement was requested and another teenager from Point Pearce, Hilda’s future husband’s cousin, Annie Sansbury, soon arrived to share the workload. But, Hilda explained, the onerous expectations coupled with the cultural segregation of retiring to the tin shed quickly became too much for Annie, who stayed only three months, leaving Hilda coping again alone, until her father applied additional pressure for a more suitable placement to be found for his daughter. In her next position, working for the family of a racehorse trainer, Hilda contentedly shared the bedroom with the small boy for whom she cared, and not long after returned to Point Pearce where she married Robert Wilson and began a family of her own. Gendered Resilience across Cultural Divides Hilda explicitly speaks into these spaces to educate me, because all but a few white women involved have remained silent about their complicity with state sanctioned practices which exploited Indigenous labour and removed children from their families through the policies of protection and assimilation. For Indigenous women, speaking out was often fraught with the danger of a deeper removal from family and Country, even of disappearance. Victoria Haskins writes extensively of two cases in New South Wales where young Aboriginal women whose protests concerning their brutal treatment at the hands of white employers, resulted in their wrongful and prolonged committal to mental health and other institutions (147-52, 228-39). In the indentured service of Indigenous women it is possible to see oppression operating through Eurocentric ideologies of race, class and gender, in which Indigenous women were assumed to take on, through displacement, the more oppressed role of white women in pre-second world war non-Aboriginal Australian society. The troubling silent shadow-figure of the “doctor’s wife” indeed provides a haunting symbol of - and also a forceful rebellion against – the docile upper middle-class white femininity of the inter-war era. Susan Bordo has argued that that “the hysteric” is archetypal of a discourse of ‘pathology as embodied protest’ in which the body may […] be viewed as a surface on which conventional constructions of femininity are exposed starkly to view in extreme or hyperliteral form. (20) Mrs Swann’s vulnerability contrasts markedly with the strength Hilda expresses in coping with a large family, emanating from a history of equitable gender relations characteristic of Ngarrindjeri society (Bell). The intersection of race and gender, as Marcia Langton contends “continues to require deconstruction to allow us to decolonise our consciousness” (54). From Hilda’s brief description one grasps a relationship resonant with that between the protagonists in Tracy Moffat's Night Cries, (a response to the overt maternalism in the film Jedda) in which the white mother finds herself utterly reliant on her “adopted” Aboriginal daughter at the end of her life (46-7). Resilience and Survival The different versions of story Hilda deploys, provide a pedagogical basis to understanding the broader socio-political framework of her overall life narrative in which an ability to draw on the cultural continuity of the past to transform the future forms an underlying dynamic. This demonstrated capacity to meet the challenging conditions thrown up by the settler-colonial state has its foundations in the connectivity and cultural strength sustained generationally in her family. Resilience moves from being individually to socially determined, as in Kickett’s model. During the onslaught of dispossession, following South Australia’s 1836 colonial invasion, Ngarrindjeri were left near-starving and decimated from introduced diseases. Pullume (c1808-1888), the rupuli (elected leader of the Ngarrindjeri Tendi, or parliament), Hilda’s third generation great-grandfather, decisively steered his people through the traumatic changes, eventually negotiating a middle-path after the Point McLeay Mission was established on Ngarrindjeri country in 1859 (Jenkin, 59). Pullume’s granddaughter, the accomplished, independent-thinking Ellen Sumner (1842—1925), played an influential educative role during Hilda’s youth. Like other Ngarrindjeri women in her lineage, Ellen Sumner was skilled in putari practice (female doctor) and midwifery culture that extended to a duty of care concerning women and children (teaching her “what to do and what not to do”), which I suggest is something Hilda herself drew from when working with the Swann family. Hilda’s mother and aunties continued aspects of the putari tradition, attending births and giving instruction to women in the community (Bell, 171, Hughes Grandmother, 52-4). As mentioned earlier, when the South Australian government moved to introduce The Training of Children Act (SA) Hilda’s maternal grandfather William Rankine campaigned vigorously against this, taking a petition to the SA Governor in December 1923 (Haebich, 315-19). As with Aunty Hilda, William Rankine used storytelling as a method to draw public attention to the inequities of his times in an interview with The Register which drew on his life-narrative (Hughes, My Grandmother, 61). Hilda’s father Wilfred Varcoe, a Barngarrla-Wirrungu man, almost a thousand kilometres away from his Poonindie birthplace, resisted assimilation by actively pursuing traditional knowledge networks using his mobility as a highly sought after shearer to link up with related Elders in the shearing camps, (and as we saw to inspect the conditions his daughter was working under at Mt Lofty). The period Hilda spent as a servant to white families to be trained in white ways was in fact only a brief interlude in a long life in which family connections, culture and belonging (Kickett) served as the backbone of her resilience and resistance. On returning to the Point Pearce Mission, Hilda successfully raised a large family and activated a range of community initiatives that fostered well-being. In the 1960s she moved to Adelaide, initially as the sole provider of her family (her husband later followed), to give her younger children better educational opportunities. Working with Aunty Gladys Elphick OBE through the Council of Aboriginal Women, she played a foundational role in assisting other Aboriginal women establish their families in the city (Mattingly et al., 154, Fisher). In Adelaide, Aunty Hilda became an influential, much loved Elder, living in good health to the age of ninety-six years. The ability to survive changing circumstances, to extend care over and over to her children and Elders along with qualities of leadership, determination, agency and resilience have passed down through her family, several of whom have become successful in public life. These include her great-grandson and former AFL football player, Michael O’Loughlin, her great-nephew Adam Goodes and her-grand-daughter, the cultural weaver Aunty Ellen Trevorrow. Arguably, resilience contributes to physical as well as cultural longevity, through caring for the self and others. Conclusion This story demonstrates how sociocultural dimensions of resilience are contextualised in practices of everyday lives. We see this in the way that Aunty Hilda Wilson’s self-narrated story resolutely defies attempts to know, subjugate and categorise, operating instead in accord with distinctively Aboriginal expressions of gender and kinship relations that constitute an Aboriginal sovereignty. Her storytelling activates a revision of collective history in ways that valorise Indigenous identity (Kirmayer et al.). Her narrative of agency and personal achievement, one that has sustained her through life, interacts with the larger narrative of state-endorsed exploitation, diffusing its power and exposing it to wider moral scrutiny. Resilience in this context is inextricably entwined with practices of cultural survival and resistance developed in response to the introduction of government policies and the encroachment of settlers and their world. We see resilience too operating across Hilda Wilson’s family history, and throughout her long life. The agency and strategies displayed suggest alternative realities and imagine other, usually more equitable, possible worlds. References Bell, Diane. Ngarrindjeri Wurruwarrin: A World That Is, Was and Will Be. Melbourne: Spinifex, 1998. Bordo, Susan. “The Body and the Reproduction of Femininity.” Writing on the Body: Female Embodiment and Feminist Theory. Eds. Katie Conboy, Nadia Medina, and Sarah Stanbury. New York: Columbia UP, 1997. 90-110. Collins, Patricia Hill. Black Feminist Thought. New York: Routledge, 2000. Fisher, Elizabeth M. "Elphick, Gladys (1904–1988)." Australian Dictionary of Biography. National Centre of Biography, Australian National University, 29 Sep. 2013. ‹http://adb.anu.edu.au/biography/elphick-gladys-12460/text22411>. Grieves, Victoria. Aboriginal Spirituality: Aboriginal Philosophy, The Basis of Aboriginal Social and Emotional Wellbeing, Melbourne University: Cooperative Research Centre for Aboriginal Health, 2009. Haebich, Anna. Broken Circles: The Fragmenting of Indigenous Families. Fremantle: Fremantle Arts Press, 2000. Haskins, Victoria. My One Bright Spot. London: Palgrave, 2005. Hughes, Karen. "My Grandmother on the Other Side of the Lake." PhD thesis, Department of Australian Studies and Department of History, Flinders University. Adelaide, 2009. ———. “Microhistories and Things That Matter.” Australian Feminist Studies 27.73 (2012): 269-278. ———. “I’d Grown Up as a Child amongst Natives.” Outskirts: Feminisms along the Edge 28 (2013). 29 Sep. 2013 ‹http://www.outskirts.arts.uwa.edu.au/volumes/volume-28/karen-hughes>. Jenkin, Graham. Conquest of the Ngarrindjeri. Adelaide: Rigby, 1979. Kartinyeri, Doris. Kick the Tin. Melbourne: Spinifex, 2000. Kartinyeri, Doreen. My Ngarrindjeri Calling, Adelaide: Wakefield, 2007. Kickett, Marion. “Examination of How a Culturally Appropriate Definition of Resilience Affects the Physical and Mental Health of Aboriginal People.” PhD thesis, Curtin University, 2012. Kirmayer, L.J., S. Dandeneau, E. Marshall, M.K. Phillips, K. Jenssen Williamson. “Rethinking Resilience from Indigenous Perspectives.” Canadian Journal of Psychiatry 56.2 (2011): 84-91. Luthar, S., D. Cicchetti, and B. Becker. “The Construct of Resilience: A Critical Evaluation and Guidelines for Future Work.” Child Development 71.3 (2000): 543-62. MacGill, Bindi, Julie Mathews, Ellen Trevorrow, Alice Abdulla, and Deb Rankine. “Ecology, Ontology, and Pedagogy at Camp Coorong,” M/C Journal 15.3 (2012). Mattingly, Christobel, and Ken Hampton. Survival in Our Own Land, Adelaide: Wakefield, 1988. Moreton-Robinson, Aileen. Talkin’ Up to the White Woman. St Lucia: UQP, 2000. Night Cries, A Rural Tragedy. Dir. Tracy Moffatt. Chili Films, 1990. Read, Peter. A Rape of the Soul So Profound. Crows Nest: Allen & Unwin, 2002. Tucker, Margaret. If Everyone Cared. Sydney: Ure Smith, 1977. Wanganeen, Elva. Personal Communication, 2000. Westphalen, Linda. An Anthropological and Literary Study of Two Aboriginal Women's Life Histories: The Impacts of Enforced Child Removal and Policies of Assimilation. New York: Mellen Press, 2011.

In recent years a number of dramas focussing on Indigenous Australians and Australian history have appeared on the ABC, one of Australia's two public television channels. These dramas have different foci but all represent some aspects of Australian Indigenous history and how it interacts with 'mainstream' representations of Australian history. The four programs I will look at are Cleverman (Goalpost Pictures, 2016-ongoing), Glitch (Matchbox Films, 2015-ongoing), The Secret River (Ruby Entertainment, 2015) and Redfern Now (Blackfella Films, 2012), each of which engages with the past in a unique way.Clearly, different creators, working with different plots and in different genres will have different ways of representing the past. Redfern Now and Cleverman are both produced by Indigenous creators whereas the creators of The Secret River and Glitch are white Australians. Redfern Now and The Secret River are in a realist mode, whereas Glitch and Cleverman are speculative fiction. My argument proceeds on two axes: first, speculative genres allow for more creative ways of representing the past. They give more freedom for the creators to present affective representations of the historical past. Speculative genres also allow for more interesting intellectual examinations of what we consider to be history and its uncertainties. My second axis argues, because it is hard to avoid when looking at this group of texts, that Indigenous creators represent the past in different ways than non-Indigenous creators. Indigenous creators present a more elliptical vision. Non-Indigenous creators tend to address historical stories in more overt ways. It is apparent that even when dealing with the same histories and the same facts, the understanding of the past held by different groups is presented differently because it has different affective meanings.These television programs were all made in the 2010s but the roots of their interpretations go much further back, not only to the history they represent but also to the arguments about history that have raged in Australian intellectual and popular culture. Throughout most of the twentieth century, indigenous history was not discussed in Australia, until this was disturbed by WEH Stanner's reference in the Boyer lectures of 1968 to "our great Australian silence" (Clark 73). There was, through the 1970s and 80s, increased discussion of Indigenous history, and then in the 1990s there was a period of social and cultural argument known locally as the 'History Wars'. This long-running public disagreement took place in both academic and public arenas, and involved historians, other academics, politicians, journalists and social commentators on each side. One side argued that the arrival of white people in Australia led to frontier wars, massacre, attempted genocide and the ongoing oppression of Indigenous people (Reynolds). The other posited that when white people arrived they killed a few Aborigines but mostly Aboriginal people were killed by disease or failure to 'defend' their culture (Windschuttle). The first viewpoint was revisionist from the 1960s onwards and the second represented an attempt at counter-revision – to move the understanding of history back to what it was prior to the revision. The argument took place not only among historians, but was taken up by politicians with Paul Keating, prime minister 1993-1996, holding the first view and John Howard, prime minister 1996-2007, aggressively pursuing the second. The revisionist viewpoint was championed by historians such as Henry Reynolds and Lyndall Ryan and academics and Aboriginal activists such as Tony Birch and Aileen Moreton Robinson; whereas the counter-revisionists had Keith Windschuttle and Geoffrey Blainey. By and large the revisionist viewpoint has become dominant and the historical work of the counter-revisionists is highly disputed and not accepted.This argument was prominent in Australian cultural discourse throughout the 1990s and has never entirely disappeared. The TV shows I am examining were not made in the 1990s, nor were they made in the 2000s - it took nearly twenty years for responses to the argument to make the jump from politicians' speeches and opinion pieces to television drama. John Ellis argues that the role of television in popular discourse is "working through," meaning contentious issues are first raised in news reports, then they move to current affairs, then talk shows and documentaries, then sketch comedy, then drama (Ellis). Australian Indigenous history was extensively discussed in the news, current affairs and talk shows in the 1990s, documentaries appeared somewhat later, notably First Australians in 2008, but sketch comedy and drama did not happen until in 2014, when Black Comedy's programme first aired, offering sketches engaging often and fiercely with indigenous history.The existence of this public discourse in the political and academic realms was reflected in film before television. Felicity Collins argues that the "Blak Wave" of Indigenous film came to exist in the context of, and as a response to, the history wars (Collins 232). This wave of film making by Indigenous film makers included the works of Rachel Perkins, Warwick Thornton and Ivan Sen – whose films chronicled the lives of Indigenous Australians. There was also what Collins calls "back-tracking films" such as Rabbit-Proof Fence (2002) and The Tracker (2010) made by white creators that presented arguments from the history wars for general audiences. Collins argues that both the "blak wave" and the "back track" created an alternative cultural sphere where past injustices are acknowledged. She says: "the films of the Blak Wave… cut across the history wars by turning an Indigenous gaze on the colonial past and its afterlife in the present" (Collins 232). This group of films sees Indigenous gazes relate the past and present whereas the white gaze represents specific history. In this article I examine a similar group of representations in television programs.History is not an innocent discourse. In western culture 'history' describes a certain way of looking at the past that was codified in the 19th century (Lloyd 375). It is however not the only way to look at the past, theorist Mark Day has described it as a type of relation with the past and argues that other understandings of the past such as popular memory and mythology are also available (Day). The codification of history in the 19th century involved an increased reliance on documentary evidence, a claim to objectivity, a focus on causation and, often though not always, a focus on national, political history. This sort of history became the academic understanding of history – which claims to be, if not objective, at least capable of disinterest; which bases its arguments on facts and which can establish its facts through reference to documentary records (Froeyman 219). Aileen Moreton-Robinson would call this "white patriarchal knowledge" that seeks to place the indigenous within its own type of knowledge production ("The White Man's Burden" 414). The western version of history tends to focus on causation and to present the past as a coherent narrative leading to the current point in time. This is not an undisputed conception of history in the western academy but it is common and often dominant.Post-colonialist analyses of history argue that western writing about non-western subjects is biased and forces non-westerners into categories used to oppress them (Anderson 44). These categories exist ahistorically and deny non-westerners the ability to act because if history cannot be perceived then it is difficult to see the future. That is to say, because non-western subjects in the past are not seen as historical actors, as people whose actions effected the future, then, in the present, they are unable to access to powerful arguments from history. Historians' usual methodology casts Indigenous people as the 'subjects' of history which is about them, not by them or for them (Tuhiwai Smith 7, 30-32, 144-5). Aboriginal people are characterised as prehistoric, ancient, timeless and dying (Birch 150). This way of thinking about Indigenous Australia removes all agency from Aboriginal actors and restoring agency has been a goal of Aboriginal activists and historians. Aileen Moreton Robinson discusses how Aboriginal resistance is embodied through "oral history (and) social memory," engaging with how Aboriginal actors represent themselves and are represented in relation to the past and historical settings is an important act ("Introduction" 127).Redfern Now and Cleverman were produced through the ABC's Indigenous Department and made by Indigenous filmmakers, whereas Glitch and The Secret River are from the ABC drama department and were made by white Australians. The different programs also have different generic backgrounds. Redfern Now and The Secret River are different forms of realist texts; social realism and historical realism. Cleverman and Glitch, however, are speculative fiction texts that can be argued to be in the mode of magical realism, they "denaturalise the real and naturalise the marvellous" they are also closely tied ideas of retelling colonial stories and "resignify(ing) colonial territories and pasts" (Siskind 834-5).Redfern Now was produced by Blackfella Films for the ABC. It was, with much fanfare, released as the first drama made for television, by Aboriginal people and about Aboriginal people (Blundell). The central concerns of the program are issues in the present, its plots and settings are entirely contemporary. In this way it circumvents the idea and standard representation of Indigenous Australians as ancient and timeless. It places the characters in the program very much in the present.However, one episode "Stand Up" does obliquely engage with historical concerns. In this episode a young boy, Joel Shields, gets a scholarship to an expensive private school. When he attends his first school assembly he does not sing the national anthem with the other students. This leads to a dispute with the school that forms the episode's plot. As punishment for not singing Joel is set an assignment to research the anthem, which he does and he finds the song off-putting – with the words 'boundless plains to share' particularly disconcerting. His father supports him saying "it's not our song" and compares Joel singing it to a "whitefella doing a corrobboree". The national anthem stands metaphorically for the white hegemony in Australia.The school itself is also a metaphor for hegemony. The camerawork lingers on the architecture which is intended to imply historical strength and imperviousness to challenge or change. The school stands for all the force of history white Australia can bring to bear, but in Australia, all architecture of this type is a lie, or at least an exaggeration – the school cannot be more than 200 years old and is probably much more recent.Many of the things the program says about history are conveyed in half sentences or single glances. Arguably this is because of its aesthetic mode – social realism – that prides itself on its mimicry of everyday life and in everyday life people are unlikely to set out arguments in organised dot-point form. At one point the English teacher quotes Orwell, "those who control the past control the future", which seems overt but it is stated off-screen as Joel walks into the room. This seeming aside is a statement about history and directly recalls central arguments of the history wars, which make strong political arguments about the effects of the past, and perceptions of the past, on the present and future. Despite its subtlety, this story takes place within the context of the history wars: it is about who controls the past. The subtlety of the discussion of history allows the film makers the freedom to comment on the content and effects of history and the history wars without appearing didactic. They discuss the how history has effected the present history without having to make explicit historical causes.The other recent television drama in the realist tradition is The Secret River. This was an adaptation of a novel by Kate Grenville. It deals with Aboriginal history from the perspective of white people, in this way it differs from Redfern Now which discusses the issues from the perspective of Aboriginal people. The plot concerns a man transported to Australia as a convict in the early 19th century. The man is later freed and, with his family, attempts to move to the Hawksbury river region. The land they try to settle is, of course, already in use by Aboriginal people. The show sets up the definitional conflict between the idea of settler and invader and suggests the difference between the two is a matter of perspective. Of the shows I am examining, it is the most direct in its representation of historical massacre and brutality. It represents what Felicity Collins described as a back-tracking text recapitulating the colonial past in the light of recovered knowledge. However, from an Indigenous perspective it is another settler tale implying Aboriginal people were wiped out at the time of colonisation (Godwin).The Secret River is told entirely from the perspective of the invaders. Even as it portrays their actions as wrong, it also suggests they were unavoidable or inevitable. Therefore it does what many western histories of Indigenous people do – it classifies and categorises. It sets limits on interpretation. It is also limited by its genre, as a straightforward historical drama and an adaptation, it can only tell its story in a certain way. The television series, like the book before it, prides itself on its 'accurate' rendition of an historical story. However, because it comes from such a very narrow perspective it falls into the trap of categorising histories that might have usefully been allowed to develop further.The program is based on a novel that attracted controversy of its own. It became part of ongoing historiographical debate about the relationship between fiction and history. The book's author Kate Grenville claimed to have written a kind of affectively accurate history that actual history can never convey because the emotions of the past are hidden from the present. The book was critiqued by historians including Inge Clendinnen, who argued that many of the claims made about its historical accuracy were largely overblown (Clendinnen). The book is not the same as the TV program, but the same limitations identified by Clendinnen are present in the television text. However, I would not agree with Clendinnen that formal history is any better. I argue that the limitation of both these mimetic genres can be escaped in speculative fiction.In Glitch, Yurana, a small town in rural Victoria becomes, for no apparent reason, the site of seven people rising from the dead. Each person is from a different historical period. None are Indigenous. They are not zombies but simply people who used to be dead. One of the first characters to appear in the series is an Aboriginal teenager, Beau, we see from his point of view the characters crawling from their graves. He becomes friendly with one of the risen characters, Patrick Fitzgerald, who had been the town's first mayor. At first Fitzgerald's story seems to be one of working class man made good in colonial Australia - a standard story of Australian myth and historiography. However, it emerges that Fitzgerald was in love with an Aboriginal woman called Kalinda and Beau is his descendant. Fitzgerald, once he becomes aware of how he has been remembered by history, decides to revise the history of the town – he wants to reclaim his property from his white descendants and give it to his Indigenous descendants. Over the course of the six episodes Fitzgerald moves from being represented as a violent, racist boor who had inexplicably become the town's mayor, to being a romantic whose racism was mostly a matter of vocabulary. Beau is important to the plot and he is a sympathetic character but he is not central and he is a child. Indigenous people in the past have no voice in this story – when flashbacks are shown they are silent, and in the present their voices are present but not privileged or central to the plot.The program demonstrates a profoundly metaphorical relationship with the past – the past has literally come to life bringing with it surprising buried histories. The program represents some dominant themes in Australian historiography – other formerly dead characters include a convict-turned-bush-ranger, a soldier who was at Gallipoli, two Italian migrants and a girl who died as a result of sexual violence – but it does not engage directly with Indigenous history. Indigenous people's stories are told only in relation to the stories of white people. The text's magical realism allows a less prescriptive relationship with the past than in The Secret River but it is still restricted in its point of view and allows only limited agency to Aboriginal actors.The text's magical realism allows for a thought-provoking representation of relationships with the past. The town of Yurana is represented as a place deeply committed to the representation and glorification of its past. Its main street contains statues of its white founders and war memorials, one of its main social institutions is the RSL, its library preserves relics of the past and its publican is a war history buff. All these indicate that the past is central to the town's identity. The risen dead however dispute and revise almost every aspect of this past. Even the history that is unmentioned in the town's apparent official discourse, such as the WWII internment camp and the history of crimes, is disputed by the different stories of the past that the risen dead have to tell. This indicates the uncertainty of the past, even when it seems literally set in stone it can still be revised. Nonetheless the history of Indigenous people is only revised in ways that re-engage with white history.Cleverman is a magical realist text profoundly based in allegory. The story concerns the emergence into a near future society of a group of people known as the "Hairies." It is never made clear where they came from or why but it seems they appeared recently and are unable to return. They are an allegory for refugees. Hairypeople are part of many Indigenous Australian stories, the show's creator, Ryan Griffen, stated that "there are different hairy stories throughout Australia and they differ in each country. You have some who are a tall, some are short, some are aggressive, some are friendly. We got to sort of pick which ones will fit for us and create the Hairies for our show" (Bizzaca).The Hairies are forced to live in an area called the Zone, which, prior to the arrival of the Hairy people, was a place where Aboriginal people lived. This place might be seen as a metaphor for Redfern but it is also an allegory for Australia's history of displacing Aboriginal people and moving and restricting them to missions and reserves. The Zone is becoming increasingly securitised and is also operating as a metaphor for Australia's immigration detention centres. The prison the Hairy characters, Djukura and Bunduu, are confined to is yet another metaphor, this time for both the over-representation of Aboriginal people in prison and the securitisation of immigration detention. These multiple allegorical movements place Australia's present refugee policies and historical treatment of Aboriginal people within the same lens. They also place the present, the past and the future within the same narrative space.Most of the cast is Aboriginal and much of the character interaction is between Aboriginal people and Hairies, with both groups played by Indigenous actors. The disadvantages suffered by Indigenous people are part of the story and clearly presented as affecting the behaviour of characters but within the story Aboriginal people are more advantaged than Hairies, as they have systems, relationships and structures that Hairy people lack. The fact that so much of the interaction in the story is between Indigenous people and Hairies is important: it can be seen to be an interaction between Aboriginal people and Aboriginal mythology or between Indigenous past and present. It demonstrates Aboriginal identities being created in relation to other Aboriginal identities and not in relation to white people, where in this narrative, Aboriginal people have an identity other than that allowed for in colonialist terms.Cleverman does not really engage with the history of white invasion. The character who speaks most about this part of Aboriginal history and whose stated understanding of himself is based on that identity is Waruu. But Waruu is also a villain whose self-identity is also presented as jealous and dishonest. However, despite only passing mentions of westernised history the show is deeply concerned with a relationship with the past. The program engages with Aboriginal traditions about the past that have nothing to do with white history. It presents a much longer view of history than that of white Australia. It engages with the Aboriginal tradition of the Cleverman - demonstrated in the character of Uncle Jimmy who passes a nulla nulla (knob-headed hardwood club), as a symbol of the past, to his nephew Koen and tells him he is the new Cleverman. Cleverman demonstrates a discussion of Australian history with the potential to ignore white people. It doesn't ignore them, it doesn't ignore the invasion but it presents the possibility that it could be ignored.There is a danger in this sort of representation of the past that Aboriginal people could be relegated to the type of ahistorical, metahistorical myths that comprise colonialist history's representation of Indigenous people (Birch). But Cleverman's magical realist, near future setting tends to undermine this. It grounds representation in history through text and metaphor and then expands the definition.The four programs have different relationships with the past but all of them engage with it. The programs are both restrained and freed by the genres they operate in. It is much easier to escape the bounds of formal history in the genre of magical realism and both Glitch and Cleverman do this but have significantly different ways of dealing with history. "Stand up" and The Secret River both operate within more formally realist structures. The Secret River gives us an emotional reading of the past and a very affective one. However, it cuts off avenues of interpretation by presenting a seemingly inevitable tragedy. Through use of metaphor and silence "Stand up" presents a much more productive relationship with the past – seeing it as an ongoing argument rather than a settled one. Glitch engages with the past as a topic that is not settled and that can therefore be changed whereas Cleverman expands our definition of past and understanding of the past through allegory.It is possible to draw further connections. Those stories created by Indigenous people do not engage with the specifics of traditional dominant Australian historiography. However, they work with the assumption that everyone already knows this historiography. They do not re-present the pain of the past, instead they deal with it in oblique terms with allegory. Whereas the programs made by non-Indigenous Australians are much more overt in their representation of the sins of the past, they overtly engage with the History Wars in specific historical arenas in which those wars were fought. The non-Indigenous shows align themselves with the revisionist view of history but they do so in a very different way than the Indigenous shows.ReferencesAnderson, Ian. "Introduction: The Aboriginal Critique of Colonial Knowing." Blacklines: Contemporary Critical Writing by Indigenous Australians. Ed. Michele Grossman. Melbourne: Melbourne University Press, 2003.Birch, Tony. "'Nothing Has Changed': The Making and Unmaking of Koori Culture." Blacklines: Contemporary Critical Writing by Indigenous Australians. Ed. Michele Grossman. Melbourne: Melbourne University Press, 2003.Bizzaca, Chris. "The World of Cleverman." Screen Australia 2016.Blundell, Graeme. "Redfern Now Delves into the Lives of Ordinary People." The Australian 26 Oct. 2013: News Review.Clark, Anna. History's Children: History Wars in the Classroom. Sydney: New South, 2008.Clendinnen, Inga. “The History Question: Who Owns the Past?” The Quarterly Essay. Melbourne: Black Inc., 2006.Collins, Felicity. "After Dispossession: Blackfella Films and the Politics of Radical Hope." The Routledge Companion to Cinema and Politics. Eds. Yannis Tzioumakis and Claire Molloy. New York: Routledge, 2016.Day, Mark. "Our Relations with the Past." Philosophia 36.4 (2008): 417-27.Ellis, John. Seeing Things: Television in the Age of Uncertainty. London: I.B. Tauris, 2000.Froeyman, Anton. "The Ideal of Objectivity and the Public Role of the Historian: Some Lessons from the Historikerstreit and the History Wars." Rethinking History 20.2 (2016): 217-34.Godwin, Carisssa Lee. "Shedding the 'Victim Narrative' for Tales of Magic, Myth and Superhero Pride." The Conversation 2016.Lloyd, Christopher. "Historiographic Schools." A Companion to the Philosophy of History and Historiography Ed. Tucker, Aviezer. Oxford: Wiley-Blackwell, 2009.Moreton-Robinson, Aileen. "Introduction: Resistance, Recovery and Revitalisation." Blacklines: Contemporary Critical Writing by Indigenous Australians. Ed. Michele Grossman. Melbourne: Melbourne University Press, 2003.———. "The White Man's Burden." Australian Feminist Studies 26.70 (2011): 413-31.Reynolds, Henry. The Other Side of the Frontier: Aboriginal Resistance to the European Invasion of Australia. 2nd ed. Ringwood, Vic.: Penguin Books, 1995.Siskind, Mariano. "Magical Realism." The Cambridge History of Postcolonial Literature. Vol. 2. Ed. Ato Quayson. Cambridge: Cambridge University Press, 2012. 833-68.Tuhiwai Smith, Linda. Decolonizing Methodologies Research and Indigenous Peoples. 2nd ed. London: Zed Books, 2012.Windschuttle, Keith. The Fabrication of Aboriginal History. Paddington, NSW: Macleay Press, 2002.

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STAVRICĂ, Laura Georgiana Popescu, Ana Carmen Albeșteanu, Ali-Osman Saglam, Gelu Onose - 12 minutes DIAGNOSTIC PARTICULARITIES AND MULTIMODAL THERAPEUTIC AND REHABILITATION APPROACHES TO A COMPLEX CASE OF POST ISCHEMIC STROKE WITH DYSPHAGIA AND DYSPHONIA, ASSOCIATING MILLARD-GUBLER AND WALLENBERG SYNDROMES - CASE REPORT Link L11 Cristina Octaviana DAIA, Croitoru Stefana, Mariana Axente, Gelu ONOSE - 14 minutes IONTOPHORESIS AND LASER APPLICATIONS IN FACIAL NERVE PALSY Link L12 Doina Maria MOLDOVAN, Gabriela DOGARU - 12 minutes SPLINTING VERSUS SURGICAL TREATMENT IN MALLET FINGER Link L13 Doina Maria MOLDOVAN, Gabriela DOGARU - 12 minutes EARLY REHABILITATION IN PATIENT AFTER TREATMENT FOR DISTAL RADIUS FRACTURE Link L14 Liliana PADURE, Raluca PETCU, Anca Irina GRIGORIU - 12 minutes THE IMPACT OF MULTIFACTORIAL GAIT ANALYSIS ON THE DIAGNOSIS AND REHABILITATION OF CHILDREN WITH WALKING DISORDERS Link L15 Valerica Creanga-Zarnescu, Ana-Maria Fatu, Mihaela Lungu, Violeta Sapira, Anamaria Ciubara - 12 minutes REHABILITATION POSSIBILITIES OF APHASIC PATIENT Link L16 Cristina DAIA, Simona SCHEK, Stefana CROITORU, Alina GHERGHICEANU, Gelu ONOSE - 12 minutes FAVORABLE REHABILITATION RESULTS ON A PATIENT WITH SEVERE LEFT HEMIPLEGIA AFTER AN INTRAPARENCHYMAL HEMATOMA Link L17 Elena VIZITIU, Mihai CONSTANTINESCU, Sînziana Călina SILIȘTEANU - 12 minutes THE ROLE OF THERAPEUTIC SWIMMING IN THE PROPHYLAXIS OF SCOLIOSIS IN THE "C" LEFT IN CHILDREN DURING THE PREPUBERTAL PERIOD Link L18 Q & A – 12 minutes Authors Title Abstract Alexandru G. STAVRICĂ, Luminiţa Nirlu, Laura Georgiana Popescu, Ana Carmen Albeşteanu, Gelu ONOSE - 12 minutes DIAGNOSTIC AND THERAPEUTIC APPROACHES IN REHABILITATION CORRELATED TO A CASE OF TETRAPARESIS (WITH PREDOMINANCE OF PARAPARESIS) AFTER SEVERE CCT - BIFRONTO - BASAL AND BITEMPORAL CONTUSION. Link L19 Ana Maria Bumbea, Otilia Rogoveanu, Carmen,Albu Rodica Traistaru, Catalin,Bostina, Bogdan Stefan Bumbea, Roxana Dumitrascu, Borcan Madalina MANAGEMENT OF SPASTICITY IN NEUROLOGICAL PATIENTS Link L20 Laura Georgiana Popescu, Luminița Nirlu, Ana Carmen Albeșteanu, Ali Osman Saglam, Gelu Onose - 12 minutes PARTICULARITIES OF COMPLEX THERAPEUTICALLY-REHABILITATIVE MANAGEMENT, STEPWISE, IN A PATIENT WITH POST-CCT PSYCHO-COGNITIVE IMPAIRMENT IN A LARGE POLYTRAMATIC CONTEXT - CASE REPORT Link L21 Adrian MELNIC, Oleg PASCAL - 12 minutes DEVELOPING STRATEGIES TO ADDRESS COMORBIDITY IN STROKE REHABILITATION. Link L22 Dorin-Gheorghe TRIFF, Simona POP - 12 minutes MONOGENIC DISEASES WITH MUSCULO ARTICULAR LAXITY. DIAGNOSTIC CRITERIA AND PRINCIPLES OF RECOVERY THERAPY Link L23 Catalin Ionite, Dragos Arotaritei, Mihai Ilea, Mariana Rotariu - 12 minutes THE USE OF ELASTIC BANDS IN THE RECOVERY OF ANKLE SPRAINS Link L24 Mariana Rotariu, Marius Turnea, Calin Corciova, Catalin Ionite - 12 minutes THE EFFECTS OF CUBE THERAPY IN THE RECOVERY OF THE ARTHROSIS HAND IN GERIATRICS Link L25 Cristian Ştefan LIUŞNEA - 12 minutes FITNESS AND WELLNESS. CONCEPTUAL DELIMITATIONS Link L26 Adriana LUPU - 12 minutes NSAID THERAPY OF MUSCULOSKELETAL PAINS AND ITS PARTICULARITIES IN THE PATIENTS SUFFERING FROM CARDIOVASCULAR DISORDERS Link L27 Q & A – 12 minutes Authors Title Abstract Mihaela MANDU, Cristinel Dumitru BADIU, Raluca PETCU, Cosmin OPREA, Gelu ONOSE - 12 minutes CLINICAL-EVOLUTIVE PARTICULARITIES AND A MULTIMODAL THERAPEUTIC-REHABILITATIVE, AS WELL AS THROUGH CONNECTED CARES, APPROACH, IN A CASE OF HEMIPLEGIA AFTER ISCHEMIC CARDIO-EMBOLIC STROKE WITHIN A POLYPATHOLOGICAL CONTEXT Link L28 Ana Carmen Albesteanu, Laura Georgiana Popescu, Luminița Nirlu, Ali Osman Saglam, Gelu Onose - 12 minutes MULTIMODAL - REHABILITATIVE THERAPEUTICAL APPROACHES IN A COMPLEX OF PATHOLOGY INCLUDING POSSIBLY EVOLVING DISCARIOTIC TYPE - CASE REPORT Link L29 Liliana PADURE, Cristian Adam, Laura Fierbinteanu - 12 minutes ATTACHMENT - PROGNOSTIC FACTOR IN MEDICAL RECOVERY Link L30 Prof. Alexandru Vlad Ciurea - 20 minutes MOTILITY OR MORBIDITY IN NEUROSURGERY Link L31 Valerica CREANGA-ZARNESCU, Ana-Maria FATU, Anamaria CIUBARA, Violeta SAPIRA,Aurelia ROMILA, Mihaela LUNGU - 12 minutes EXERCISES PROGRAM AND REHABILITATION IN PARKINSON’S DISEASE Link L32 Irina VERINCEANU,Alice MUNTEANU, Andreea STOICA, Stefan ISPAS - 12 minutes THE CARDIAC REHABILITATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION Link L33 Marius Turnea, Catalin Ionite, Mihai Ilea, Dragos Arotaritei - 12 minutes STATISTICAL ANALYSIS OF PHYSIOTHERAPEUTIC MEANS USED IN THE RECOVERY OF MUSCLE INJURIES IN ATHLETES Link L34 Mihaiela CHICU, Eugen BITERE - 10 minutes THE ROLE OF IL1β IN CARTILAGINOUS DISTRUCTION IN RHEUMATOID ARTHRITIS Link L35 Mihaiela CHICU, Eugen BITERE - 10 minutes THE ROLE OF THE INFLAMMASOMS IN THE PATHOGENESIS OF INFLAMMATORY REACTION Link L36 Q & A – 8 minutes Authors Title Abstract Prof. Dr. Gelu Onose, (Keynote Speaker) Vlad Ciobanu, Corina Sporea - 20 minutes A TOPICAL SYSTEMATIC LITERATURE REVIEW AND REAPPRAISAL ON ESSAYS TOWARDS SYSTEMATIZING CLINICAL ASSESSMENT INSTRUMENTS USED TO EVALUATE NEURO-functional deficits after spinal cord injuries, mainly in adults, including through the ICF(-DH) conceptual framework Link L37 Diana-Elena SERBAN, Aurelian ANGHELESCU, Elena CONSTANTIN, Gelu ONOSE - 12 minutes THE ACQUISITION OF SELF-DEFENSE TECHNIQUES AND PROCEDURES AGAINST THE ACT OF AGGRESSION IN THE PACIENT WITH PARAPLEGIA, WHEEL-CHAIR INDEPENDENT Link L38 Aurelian Anghelescu, Elena Constantin, Anca Sanda Mihaescu, Gelu Onose - 12 minutes “PREVENTION IS CURE, EDUCATION IS ESSENTIAL” - RESPONSIBLE IMPLICATION OF YOUNG PEOPLE IN EDUCATIONAL AND PROPHYLACTIC ACTIONS AGAINST ACCIDENTAL CERVICAL SPINAL CORD INJURY AND SEVERE DISABILITIES BY DIVING IN UNVERIFIED WATERS. Link L39 Alexandra SPORICI, Irina ANGHEL, Lapadat MAGDALENA, Gelu ONOSE - 12 minutes RECOVERABLE RESULTS AT A PATIENT WITH AIS/FRANKEL D INCOMPLETE TETRAPLEGIA / POST SPINAL CORD INJURY BY FALLING FROM A HEIGHT, ON AN ANKYLOSING SPONDYLITIS BACKGROUND Link L40 Ioana ANDONE, Carmen CHIPĂRUȘ, Andreea FRUNZA, Aura SPÎNU, Simona STOICA, Liliana ONOSE, George PATRASCU, Gelu ONOSE -12 minutes CLINICAL, PARACLINICAL ASPECTS AND COMPLEX THERAPEUTICAL APPROACHES IN A PATIENT WITH INCOMPLETE PARAPLEGIA, POST THORACIC MENIGIOMA SURGICALLY TREATED, IN NEUROFIBROMATOSIS CONTEXT Link L41 Cristina Octaviana DAIA, Alina-Elena Gherghiceanu, Helene Ivan, Gelu ONOSE - 12 minutes RESEARCH ON NEUROREHABILITATION RESULTS IN VERTEBRO-MEDULLARY POST-TRAUMATIC CONDITIONS ASSOCIATING FRACTURES, IN A POLITRAMATIC CONTEXT Link L42 Ali-Osman Saglam, Alexandru G. Stavrica, Ana Carmen Albeşteanu, Laura Georgiana Popescu, Luminita Nirlu, Gelu Onose - 12 minutes MEDICAL-REHABILITATION ENDEAVORS, CARE INTERVENTIONS AND CONNOTATIONS OF A MEDICO-SOCIAL TYPE, IN A COMPLEX POLYPATHOLOGICAL CASE: PARAPLEGIA, SPONDYLODISCITIS, KIDNEY FAILURE IN THE HAEMODIALYSIS STAGE AND BILATERAL NEPHROSTOMIES AFTER SURGICALY TREATTED BLADDER NEOPLASM. Link L43 Sorina Petrușan-Dunca, Liviu Lazăr, Tiberiu-Dorin Corha - 12 minutes INDICATIONS AND LIMITIS OF REHABILITATION TREATMENT FOR LUMBAR DISCOPATHY IN PREGNACY Link L44 Q & A – 8 minutes Authors Title Abstract Elena Silvia SHELBY, Mihaela AXENTE, Liliana PĂDURE - 12 minutes CHARCOT MARIE TOOTH DISEASE. CASE PRESENTATION. GENETIC DISEASES WHICH REQUIRE physical rehabilitation Link L45 Link L46 Simona Carniciu - 12 minutes Influence of nutrition and exercise on the use of different energy substrates in the prevention of metabolic diseases Link L81 Simona-Isabelle STOICA, Carmen Elena CHIPĂRUȘ, Magdalena Vasilica LAPADAT, George PĂTRAȘCU, Gelu ONOSE - 12 minutes CLINICAL-THERAPEUTIC AND RECUPERATORY FEATURES IN A PATIENT WITH PLURIPATOLOGY: ISCHEMIC STROKE, ISCHEMIC HEART DISEASE (SECHELAR MYOCARDIAL INFARCTION), CHRONIC KIDNEY DISEASE AND MONSTROUS GOUT- CASE PRESENTATION Link L47 Eugen BITERE, Mihaiela CHICU - 12 minutes PATHOPHYSIOLOGY OF ATHEROGENESIS AND CARDIOVASCULAR RISK IN CHRONIC INFLAMMATORY DISEASES Link L48 Victoria CHIHAI, Alisa TĂBÎRȚĂ, Anastasia ROTĂREANU, Vladlena MIHAILOV, Mihail CÎRÎM - 12 minutes THE IMPACT OF ACTIVE KINETIC PROGRAMS ON CLINICAL AND FUNCTIONAL STATUS ADRESSED TO PEOPLE WITH DIABETIC ANGIOPATHY Link L49 Ana-Maria Fătu, Ana Maria Pâslaru, Valerica Creangă-Zărnescu, Alexandru Nechifor, Mădălina Verenca, Mihaela Lungu, Anamaria Ciubară - 12 minutes THE IMPACT OF COGNITIVE DECLINE ON STROKE REHABILITATION Link L50 Alisa TĂBÎRŢĂ, Victoria CHIHAI - 12 minutes THE USE OF TRINITY AMPUTATION AND PROSTHESIS EXPERIENCE SCALES IN THE COMPLEX REHABILITATION OF PERSONS WITH LOWER LIBM AMPUTATION Link L51 Ilie ONU, Mariana ROTARIU, Elvina MIHALAȘ, Călin CORCIOVĂ - 12 minutes STUDY ON EFFICIENCY OF ELECTROTHERAPY AND PHYSIOTHERAPY MANAGEMENT ON HERNIATED LUMBAR DISC Link L52 María G. Souto Figueroa, Antonio Freire Magariños RESEARCH - SURVEY TO 142 THERMALIST WHO HAVE PERFORMED A THERMAL CURE AT THE BATHS OF BAÑOS DE MOLGAS (OURENSE) AND AUGAS SANTAS (LUGO) - GALICIA – SPAIN Link L53 Q & A – 12 minutes Authors Title Abstract Irina Ionica - 12 minutes ACUPUNCTURE IN REHABILITATION - A GENERAL VIEW Link L54 Denisa COAJĂ, Gabriela DOGARU - 12 minutes THE HEALTH BENEFITS OF FINNISH SAUNA BATHING Link L55 Otilia ROGOVEANU, Florin GHERGHINA , Rodica TRAISTARU - 12 minutes SPINA BIFIDA – FUNCTIONAL REHABILITATION METHODS IN CHILDREN Link L56 Mihaela DUTESCU, Raluca OLTEAN, Petru NENADICI - 12 minutes GEOAGIU BAI RESORT - OUR EXPERIENCE OF MEDICAL REHABILITATION TREATMENT Link L57 Dumitru MIHĂILĂ, SILISTEANU Sinziana Calina, ȚICULEANU Mihaela (Ciurlică) - 12 minutes THE METEOROLOGICAL COMPLEX AND THE HUMAN PATHOLOGY. CASE STUDY – SUCEAVA COUNTY Link L58 Mariana VARODI, Gabriela DOGARU - 12 minutes EFFICACY OF NATURAL THERAPEUTIC FACTORS FROM OCNA SIBIULUI SPA RESORT IN GONARTHROSIS Link L59 Boróka-Panna GÁSPÁR, Gabriela DOGARU - 12 minutes BONE HYDRATION AND MINERAL WATERS Link L60 CALIN BOCHIS, LIVIU LAZAR, HORAȚIU URECHESCU, CARMEN NISTOR-CSEPPENTO, FELICIA CIOARA, NICOLETA PASCALAU, ALIN BOCHIS , DIANA IOVANOVICI - 12 minutes CORRELATION OF VAS PAIN SCORE WITH FUNCTION AT THE PACIENTS WITH TEMPOROMANDIBULAR OSTEOARTHRITIS Link L61 Marian Romeo CALIN, Ileana RADULESCU, Mihaela Antonina CALIN, Elena Roxana ALMASAN - 12 minutes RADIOMETRIC ASSESSMENT OF PELOID AND SALT WATER USED FOR THERAPY AND BALNEARY TRATAMENT FROM TECHIRGHIOL LAKE, ROMANIA Link L62 Q & A – 12 minutes Authors Title Abstract Cristina PETRESCU - 12 minutes EFFICACY NATURAL THERAPEUTIC FACTORS FROM BAILE GOVORA IN BRONCHIAL ASTHMA Link L63 PARASCHIVA POSTOLACHE - 12 minutes PULMONARY REHABILITATION SAVES LIVES AND IMPROVES LIFE Link L64 DOINA-CLEMENTINA COJOCARU, PARASCHIVA POSTOLACHE - 12 minutes ASSESSMENT OF DYSPNEA IN PULMONARY REHABILITATION PRACTICE Link L65 PARASCHIVA POSTOLACHE, CRISTINA LACATUSI - 12 minutes HELIOTHERAPY, CLIMATOTHERAPY AND PATIENTS WITH RESPIRATORY DISEASES Link L66 CONSTANTIN MUNTEANU, DIANA MUNTEANU, MIHAIL HOTETEU - 12 minutes BIOLOGICAL INSIGHTS OF SPELEOTHERAPY Link L67 PARASCHIVA POSTOLACHE, CRISTINA LACATUSI, DOINA-CLEMENTINA COJOCARU - 12 minutes AEROSOLS AND BREATHING Link L68 PARASCHIVA POSTOLACHE, MADALINA ZEBEGA - 12 minutes RESPIRATORY MUSCLE TRAINING AND RESPIRATORY REHABILITATION Link L69 CRISTI FRENȚ, GEORGETA MAIORESCU - 12 minutes DEVELOPMENTS AND INVOLUTIONS OF TOURISM IN THE SPA RESORTS IN ROMANIA AND THE CASE STUDY FOR LACUL SĂRAT RESORT Link L70 Dragos Arotaritei, Andrei Gheorghita, Mariana Rotariu, Marius Turnea - 12 minutes MATHEMATICAL MODEL OF SULPHUR ABSORPTION PROCESS, A POSSIBLE APPLICATION IN CURE WITH SULPHUROUS MINERAL WATER Link L71 Q & A – 12 minutes Authors Title Abstract Mihai Ciocanu, Anișoara Cimil - 12 minutes THE EFFICIENCY OF THE REHABILITATION SERVICE IN HOSPITAL CONDITIONS Link L72 Sinziana Calina SILIȘTEANU, Andrei Emanuel SILIȘTEANU - 12 minutes TRIAL ON THE WATER CONSUMPTION BY THE PERSONS IN THE GROUP AGED 19-30 YEARS Link L73 Liviu Lazăr, Florin Marcu, Felicia Cioară, Carmen Nistor Csepentö - 12 minutes MANAGEMENT OF SPECIAL ARTERIAL DISEASES Link L74 Mihaela-Carmen SUCEVEANU, Paul-Nicolae SUCEVEANU - 12 minutes EVOLUTION OF CARDIOVASCULAR RISK FACTORS AFTER MORE THAN 2 PERIODIC HOSPITALIZATIONS IN THE COVASNA HOSPITAL FOR CARDIOVASCULAR REHABILITATION Link L75 Mihaela DUTESCU, Adina TRAILA, Margit SERBAN, Emilia URSU, Dorina MIU, Ioana MALITA, Bianca CIRESAN - 12 minutes THE EFFICIENCY OF MEDICAL REHABILITATION TREATMENT IN PATIENTS WITH HEMOPHILIA AFTER SURGICAL ORTHOPEDIC INTERVENTIONS - THE EXPERIENCE OF "CRISTIAN SERBAN" BUZIAS CENTER Link L76 Dorin-Gheorghe TRIFF, Simona POP - 12 minutes PRECURSORS OF BALENOLOGY EDUCATION IN ROMANIA Link L77 Dr. Eugenia Dumitrescu, Dr. Carmen Enescu - 12 minutes ANTIALLERGIC PROCEDURES MOST COMMONLY USED IN PHYSICAL RECOVERY MEDICINE AND BALNEOLOGY Link L78 Mihail HOTETEU, Constantin MUNTEANU, Diana MUNTEANU, Gabriela DOGARU - 12 minutes PELOIDS - PERSPECTIVES ON RESEARCH AND FUTURE PLANS Link L79 Liliana Stanciu, Daniela Profir, Viorica Marin, Doinița Oprea, Elena Ionescu, Elena Almășan, Carmen Oprea - 12 minutes THE SCIENCE OF AGING WELL Link L80 Q & A – 12 minutes POSTER SESSION Authors Title Abstract Andra Pintilie, Liliana Pădure, Andrada Mirea, Corina Sporea Proprioceptive Functional Vibration Stimulation as therapeutic tool in spasticity management of jump gait pattern of spastic diplegic children with cerebral palsy Poster 1 Andra Pintilie, Liliana Pădure, Andrada Mirea, Corina Sporea Modern computerized techniques for gait’s functional evaluation through a specialized wireless inertial sensor – premise for orthopedic corrective shoes wear in children with gait disorders secondary to Cerebral Palsy Poster 2 Ana Maria PÂSLARU, Ana Maria FĂTU, Anamaria CIUBARĂ The role of medical recovery in oncology Poster 3 Maria Veronica MORCOV, Liliana PADURE, Cristian Gabriel MORCOV, Gelu ONOSE Exercises availed by sensor-based computer advanced devices: part of the interactive cognitive recovery – adjuvant of the therapy applied in the Centrul National Clinic de Recuperare Neuropsihomotorie Copii “Dr. N. Robanescu” Poster 4 Avram Mihai, Liliana Padure, Gelu Onose Theoretical fundamentals and conceptual premise for advanced proprioceptive and sensory stimulus apparatus, with sequential evaluation for the treatment of the recuperator in the equilibrium disorder, from Cerebral Palsy (PC) casuistry. Poster 5 Andrada MIREA, Gelu ONOSE, Madalina LEANCA, Florin-Petru GRIGORAS, Mihaela AXENTE, Liliana PADURE, Corina SPOREA Respiratory management in patients with rare progressive neuromuscular diseases Poster 6 Mihaela MANDU, Elena CONSTANTIN, Cristinel Dumitru BADIU, Cosmin Daniel OPREA, Cristina DAIA, Gelu ONOSE Presentation od the Fugl Meyer Assesment scale and related suggesttion in order to enhance its level of implementation in inner neurorehabilitation units Poster 7 ALEXANDRU BOGDAN-CĂTĂLIN, ALINA SIMONA ȘOVREA, ANNE-MARIE CONSTANTIN, ADINA BIANCA BOȘCA, CARMEN GEORGIU, MONICA POPA Complex oral rehabilitation in an elderly patient with periodontal disease who exercises regularly Poster 8 Dorin-Gheorghe TRIFF, Simona POP MORBIDITY BY OSTEO-MUSCULO-ARTICULAR DISEASES IN THE OCCUPATIONAL ENVIRONMENT IN MARAMURES COUNTY. THE IMPORTANCE OF MEDICAL RECOVERY AND RECORDS THROUGH ELECTRONIC DATA MANAGEMENT SYSTEMS Poster 9 Authors Title Abstract Mihaela Antonina CALIN, Marian Romeo CALIN, Constantin Munteanu New evidence on the effects of pelotherapy on local microcirculation Poster 10 Izabela Lazar, Gabriela Dogaru The effectiveness of balnear treatment in the management of psoriasis Poster 11 Dorin-Gheorghe TRIFF, Mușata Dacia BOCOȘ CORRELATIONS OF OSTEOMUSCULO-ARTICULAR DISEASES WITH WORK ABILITY, PERCEIVED SELF EFFICACY AND OCCUPATIONAL STRESSORS AT A REGULAR MEDICAL CHECK-UP IN PRE-UNIVERSITY EDUCATION UNITS Poster 12 Doroteea Teoibas-Serban, Valentin Stan, Dan Blendea PREVENTION OF LUMBAR DISC HERNIATION IN YOUNG ADULT POPULATION: A PRACTICAL APPROACH Poster 13 Călin Corciovă, Cătălina Luca, Robert Fuior, Flavia Corciovă Development a Monitoring Device for Arm Rehabilitation Poster 14 Simona Daniela Zavalichi, Marius Andrei Zavalichi, Sorin Stratulat, Florin Mitu Cardiovascular rehabilitation: challenges in a case of acute myocardial infarction and familial hypercholesterolemia Poster 15 Simona-Isabelle STOICA, Ioana TANASE, Gelu ONOSE Influences and consequences resulting in addictions in general and to chronic alcoholism, especially for patients with spinal cord injury Poster 16 Roxana Dumitrascu, Ana Maria Bumbea, Carmen Albu, Otilia Rogoveanu, Catalin Bostina, Rodica Traistaru, Borcan Madalina BIOMECHANICAL DYSFUNCTIONS OF THE FOOT – MAJOR IMPACT ON THE KINETIC CHAIN Poster 17 Otilia Rogoveanu, Gherghina Florin, Caimac Dan, Trifu Ramona, Cruceru Andra, Beldie C Medical rehabilitation in post-stroke spastic hemiparesis in young patients Poster 18 Ana Maria Bumbea, Otilia Rogoveanu, Roxana Dumitrascu, Bogdan Stefan Bumbea, Catalin Bostina, Albu Carmen, Borcan Madalina PERIPHERAL MAGNETIC STIMULATION - A CHALLENGE IN VERTEBRAL POSTTRAUMATIC RECOVERY Poster 19 Authors Title Abstract Dănuţ PĂCURAR, Mihaela Ramona PĂCURAR KNEE ARTHROPLASTY RECOVERY OF AN CANCER PATIENT Poster 20 Dănuţ PĂCURAR, Mihaela Ramona PĂCURAR THE IMPACT OF OSTEOARTICULAR PATHOLOGY IN POSTSTROKE RECOVERY Poster 21 Borcan Madalina, Bumbea Ana Maria, Bostina Catalin, Radoi Georgeta, Bumbea Bogdan EFFICIENT REHABILITATION TREATMENT IN A CASE WITH MAV-RUPTA MALFORMATION Poster 22 Demirgian Sibel, Nan Simona, Lulea Adela, Lascu Ioana, Marin Viorica Is possible the management of synovial chondromatosis of the hip by arthroscopy or complex balneal treament? Poster 23 Mădălina Codruța Verenca, Sorina Mierlan, Claudiu Elisei Tanase The Efficiency of Medical Treatment of Scoliosis – Paediatrics Poster 24 Florentina NASTASE¹, Alin Laurentiu TATU², Madalina Codruta VERENCA¹ Orthopaedic manifestations of Neurofibromatosis type 1 – case report Poster 25 Simona CARNICIU, Anatolie BACIU, Vasile FEDAS The attenuation of energy metabolic misbalance by means of aerobic, hypoxic, hypothermal adaptation and environment optimization at recreation resort center Poster 26 Irina Anghel, Alexandra Sporici, Magdalena Lapadat, Gelu Onose Complex clinical and therapeutic rehabilitation approach of a patient with Complete AIS/Frankel A quadriplegia post cervical spinal cord injury after accidental fall off a trailer and multiple complications occurring during disease progression - case study Poster 27 Ana-Maria Pelin , Monica Georgescu , Cristina Stefanescu , Costinela Georgescu Molecular treatment strategies in osteoporosis Poster 28

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

As a mode of open access public self-expression, blogs are one form of the unfolding massification of culture (Lovink). Though widely varied in content and style, they are characterised by a reverse chronological diary-like format, often produced by a single author, and often intimately expressive of that author’s thoughts and experiences. The purpose of this paper is to explore the use of blogs as a space for the detailed and on-going expression of the day to day experiences of sufferers of serious illness. We might traditionally consider the experience of illness as absolutely private, but illness, along with the process of recovery, retains a social and cultural aspect (Kleinman et al). A growing body of literature has recognised that the Internet has become a significant space for the recovery work that accompanies the diagnosis of serious illness (Orgad; Pitts; Hardey). Empowerment and agency are often emphasised in this literature, particularly in terms of the increased access to information and support groups, but also in the dynamic performances of self enabled by different forms of online communication and Web production. I am particularly interested in the ongoing shifts in the accessibility of “private” personal experience enabled by blog culture. Although there are thousands of others like them, three “illness blogs” have recently caught my attention for their candidness, completeness and complexity, expressing in vivid depth and detail individual lives transformed by serious illness. The late US journalist and television producer Leroy Sievers maintained a high profile blog, My Cancer, and weekly podcast on the National Public Radio website until his death from metastasised colon cancer in August 2008. Sievers used his public profile and the infrastructure of the NPR website to both detail his personal experience and bring together a community of people also affected by cancer or moved by his thoughts and experiences. The blogger Brainhell came to my attention through blogsphere comments and tributes when he died in February 2008. Spanning more than four years, Brainhell’s witty and charming blog attracted a significant audience and numerous comments, particularly toward the end of his life as the signs of his deteriorating motor system as a result of Amyotrophic Lateral Sclerosis (ALS, or “Lou Gherig’s disease”) riddled his intimate posts. Another blog of interest to me here, called Humanities Researcher, incorporates academic Stephanie Trigg’s period of illness and recovery from breast cancer within a pre-existing and ongoing blog about the intersection between professional and personal life. As I had crossed paths with Trigg while at Melbourne University, I was always interested in her blog. But her diagnosis with breast cancer and subsequent accounts of tests, the pain and debilitation of treatment and recovery within her blog also offer valuable insight into the role of online technologies in affecting experiences of illness and for the process of recovery.The subject matter of illness blogs revolves around significant personal transformations as a result of serious illness or trauma: transformations of everyday life, of body and emotional states, relationships, physical appearance, and the loss or recovery of physical ability. It is not my intention in this brief analysis to overgeneralise on the basis of some relatively limited observations. However, many blogs written in response to illness stand out for what they reveal about the shifting location or locatability of self, experience and the events of ongoing illness and thus how we can conceptualise the inherent “privacy” of illness as personal experience. Self-expression here is encompassing of the possibilities through which illness can be experienced – not as representation of that experience, a performance of a disembodied self (though these notions have their merits) – but an expressive element of the substance of the illness as it is experienced over time, as it affects the bodies, thoughts, events and relationships of individuals moving toward a state of full recovery or untimely death. Locating Oneself OnlineMany authors currently examining the role of online spaces in the lives of sufferers of serious illness see online communication as providing a means for configuring experience as a meaningful and coherent story, and thus conferring, or we could say recovering, a sense of agency amidst a tumultuous and ongoing battle with serious illness (Orgad, Pitts). In her study of breast cancer discussion forums, message boards and websites, Orgad (4) notes their role in regaining “the fundamentals disturbed by cancer” (see also Bury). Well before the emergence of online spaces, the act or writing has been seen as “a crucial affirmation of living, a statement against fearfulness, invisibility and silence” (Orgad, 67; Lorde, 61). For many decades scientists have asserted that “brief structured writing sessions can significantly improve mental and physical health for some groups of people” (Singer and Singer 485). The Internet has provided an infrastructure for bringing personal experiences of illness into the public realm, enabling a new level of visibility. Much of the work on illness and the Internet focuses on the liberatory and empowering act of story telling and “disembodied” self-expression. Discussion forums and cancer websites enable the formation of patient led “discourse communities” (Wuthnow). Online spaces such as discussion forums help their participants gain a foothold within a world they share with other sufferers, building communities of practice (Wegner) around specific forms of illness. In this way, these forms of self-expression and communication enable the sufferer of serious illness to counter the modes by which they are made “subjects”, in the Foucauldian sense, of medical discourse. All illness narratives are defined and constructed socially, and are infused with relations of power (Sontag; Foucault, Birth of the Clinic). Forms of online communication have shifted productive practice from professions to patients. Blogs, like discussion forums, websites, email lists etc., have come to play a central role in this contemporary shift. When Lovink (6) describes blogs as a “technology of the self” he points to their role in “self-fashioning”. Blogs written about and in the context of personal illness are a perfect example of this inclination to speak the truth of oneself in the confessional mode of modern culture borne of the church, science and talkshow television. For Foucault (Technologies of the Self, 17), technologies of the self: Permit individuals to effect by their own means or with the help of others a certain number of operations on their own bodies and souls, thoughts, conduct and way of being, so as to transform themselves in order to attain a state of happiness, purity, wisdom, perfection, immortality. Likewise, as a central concept for understanding Internet identity, the notion of performance (eg, Turkle) highlights the creativity with which illness bloggers may present their role as cancer patient in online spaces, perhaps as an act of resistance to “subjectifying” medical discourses and practices. Many bloggers wrest semiotic power through regular discussion of the language of pathology and medical knowledge, treatment processes and drugs. In the early stages of her treatment, Trigg plays with the new vocabulary, searching for etiologies and making her own semantic connections: I’ve learnt two new words. “Spiculated” describes the characteristic shape of a carcinoma on an ultrasound or x-ray. …The other word is at the other end of the spectrum of linguistic beauty: “lumpectomy”. It took me quite a while to realise that this was not really any different from partial mastectomy; or local excision. It’s an example of the powerful semantic connotations of words to realise that these phrases name the same processes: a long cut, and then the extraction of the diseased tissue (Humanities Researcher, 14 Oct. 2006).Partly due to the rarity of his illness, Brainhell goes through weeks of waiting for a diagnosis, and posts prolifically in an attempt to test out self-diagnoses. Amidst many serious and humorous posts analysing test results and discussing possible diagnoses Brainhell reflects on his targeted use of the blog: I am a word person. I think in sentences. I often take complex technical problems at work and describe them to myself in words. A story helps me understand things better. This blog has become a tool for me to organize my own thoughts about the Mystery Condition. (Brainhell, 6 Jan. 2004)The emancipatory potential of blog writing, however, can be easily overstated. While it is valuable to note and celebrate the performative potential of online production, and its “transformative” role as a technology of the self, it is easy to fall back on an unproblematic distinction between the actual and the virtual, the experience of illness, and its representation in online spaces. Textual expression should always refer us to the extra-textual practices that encompass it without imposing an artificial hierarchy of online and offline, actual experience and representation. As with other forms of online communication and production, the blog culture that has emerged around forms of serious illness plays a significant role in transforming our concepts of the relationship between online and offline spaces. In his My Cancer blog, Sievers often refers to “Cancer World”. He notes, for example, the many “passing friends” he makes in Cancer World through the medical staff and other regular patients at the radiation clinic, and refers to the equipment that sustains his life as the accoutrements of this world. His blog posts revolved around an articulation of the intricacies of this “world” that is in some ways a means of making sense of that world, but is also expressive of it. Sievers tries to explain the notion of Cancer World as a transformation of status between insider & outsider: “once we cross over into Cancer World, we become strangers in a strange land. What to expect, what to hope for, what to fear – none of those are clear right now” (My Cancer, 30 June 2008). Part of his struggle with the illness is also with the expression of himself as encompassed by this new “world” of the effects and activities of cancer. In a similar way, in her Humanities Researcher blog Trigg describes in beautiful detail the processes, routines and relationships formed during radiation treatment. I see these accounts of the textures of cancer spaces as lying at the point of juncture between expression and experience, not as a disembodied, emancipatory realm free from the fetters of illness and the everyday “real” self, but always encompassed by, and encompassing them, and in this way shifting what might be understood to remain “private” in personal experience and self-expression. Blogs as Public Diary Axel Bruns (171), following Matthew Rothenberg, characterises blogs as an accessible technological extension of the personal home page, gaining popularity in the late 1990s because they provided more easy to use templates and web publishing tools than earlier webpage applications. Personalised self expression is a defining element. However, the temporal quality of the reverse chronological, timestamped entry is equally significant for Bruns (171). Taking a broader focus to Bruns, who is most interested in the potential democratisation of media in news related blogs, Lovink sees the experimentation with a “public diary” format as fundamental, signalling their “productive contradiction between public and private” (Lovink 6). A diary may be written for posterity but it is primarily a secretive mode of communication. While blogs may mirror the temporal form of a diary, their intimate focus on self-expression of experience, thoughts and feelings, they do so in a very different communicative context.Despite research suggesting that a majority of bloggers report that they post primarily “for themselves” (Lenhart and Fox) – meaning that they do not deliberately seek a broad audience or readership – the step of making experiences and thoughts so widely accessible cannot be overlooked in any account of blogging. The question of audience or readership, for example, concerns Trigg in her Humanities Researcher blog: The immediacy of a blog distinguishes it from a journal or diary. I wrote for myself, of course, but also for a readership I could measure and chart and hear from, sometimes within minutes of posting. Mostly I don’t know who my readers are, but the kindness and friendship that come to me through the blog gave me courage to write about the intimacies of my treatment; and to chart the emotional upheaval it produced. (Trigg)In their ability to produce a comprehensive expression of the events, experiences, thoughts and feelings of an individual, blogs differ to other forms of online communication such as discussion forums or email lists. Illness blogs are perhaps an extreme example, an open mode of self-expression often arising abruptly in reaction to a life transforming diagnosis and tracking the process of recovery or deterioration, usually ending with remission or death. Brainhell’s blog begins with MRI results, and a series of posts about medical examination and self-examination regarding his mystery condition: So the MRI shows there is something on my brain that is not supposed to be there. The doctor thinks it is not a tumor. That would be good news. …As long as you are alive and have someone to complain to, you ain’t bad off. I am alive and I am complaining about a mystery spot on my brain, and lazy limbs. (Brainhell, 24 Dec. 2003)Brainhell spent many weeks documenting his search for a diagnosis, and continued writing up to his final deterioration and death in 2008. His final posts convey his physical deterioration in truncated sentences, spelling errors and mangled words. In one post he expresses his inability to wake his caregiver and to communicate his distress and physical discomfort at having to pee: when he snorted on waking, i shrieked and he got me up. splayed uncomfortably in the wc as he put dry clothes on me, i was gifted with his words: “you choose this, not me. you want to make it hard, what can i do?” (Brainhell, 13 Jan. 2008). The temporal and continuous format of the blog traverses the visceral, corporeal transformations of body and thought over time. The diary format goes beyond a straightforward narrative form in being far more experiential and even experimental in its self-reflective expression of the events of daily life, thoughts, feelings and states of being. Its public format bears directly on its role in shaping the communicative context in which that expression takes place, and thus to an extent shapes the experience of the illness itself. Nowhere does the expressive substance of the blog so fully encompass the possibilities through which the illness could be experienced than in the author’s death. At this point the blog feels like it is more than a catalogue, dialogue or self-presentation of a struggle with illness. It may take on the form of a memorial (see for example Tom’s Road to Recovery) – a recovery of the self expressed in the daily physical demise, through data maintained in the memory of servers. Ultimately the blog stands as a complex trace of the life lived within its posts. Brainhell’s lengthy blog exemplifies this quite hauntingly. Revealing the Private in Public Blogs exemplify a further step in the transformation of notions of public and private brought about by information and screen technologies. McQuire (103) refers to contemporary screen and Internet culture as “a social setting in which personal identity is subject to new exigencies”. Reality television, such as Big Brother, has promoted “a new mode for the public viewing of private life” (McQuire 114) contributing to the normalisation of open access to personal, intimate revelations, actions and experiences. However, privacy is “an elusive concept” that relates as much to information and property as to self-expression and personal experience (McCullagh). That is, what we consider private to an individual is itself constituted by our variable categories of personal information, material or immaterial possessions, or what counts as an expression of personal experience. Some analysts of online storytelling in the context of illness recognise the unsustainability of the distinction between public and private, but nonetheless rely on the notion of a continuum upon which activities or events could be considered as experienced in a public or private space (Orgad, 129-133). One of the characteristics of a blog, unlike other forms of online communication such as chat, discussion forums and email, is its predominantly public and openly accessible form. Though many illness bloggers do not seem to seek anonymity or hold back in allowing massive access to their self-expression and personal experience, a tension always seems to be there in the background. Identification through the proper name simply implies potential broader effects of blog writing, a pairing of the personal expressions with the person who expresses them in broader daily interactions and relationships. As already “public” figures, Stephanie Trigg and Leroy Sievers choose to forego anonymity, while Brainhell adopted his alias from the beginning and guarded his anonymity carefully. Each of these bloggers, however, shows signs of grappling with the public character of their site, and the interaction between the blog and their everyday life and relationships. In his etiquette page, Brainhell seems unclear about his readership, noting that his blog is for “friends and soul-mates, and complete strangers too”, but that he has not shared it with his family or all of his friends. He goes on to say: You may not have been invited but you are still welcome here. I made it public so that anyone could read it. Total strangers are welcome. Invited friends are welcome. But of those invited friends, I ask you to ask me before you out me as the blog author, or share the blog with other people who already know me. (Brainhell, 18 Feb. 2004) After his death Ratty took steps to continue to maintain his anonymity, vetting many comments and deleting others to “honor BH’s wishes as he outline in ‘Ettiquett for This Blog”’ (Brainhell, 2 Feb. 2008). In Leroy Sievers’ blog, one post exploring the conflict raised by publicly “sharing” his experiences provoked an interesting discussion. He relays a comment sent to him by a woman named Cherie: I have stage four colorectal cancer with liver mets. This is a strange journey, one I am not entirely sure I can share with my loved ones. I am scared it might rob them of the hope I see in their eyes. The hope which I sometimes don’t believe in. (My Cancer, 26 July 2006) Sievers struggles with this question: “How do you balance the need to talk about what is happening to you with the tears of a close friend when you tell him or her the truth? There’s no simple answer.” The blog, in this sense, seems to offer a more legitimate space for the ongoing, detailed expression of these difficult and affective, and traditionally private experiences. In some posts the privacy of the body and bodily experiences is directly challenged or re-negotiated. Stephanie Trigg was concerned with the effect of the blog on her interactions with colleagues. But another interesting dilemma presents itself to her when she is describing the physical effects of cancer, surgery and radiation treatment on her breast, and forces herself to hold back from comparing with the healthy breast: “it's not a medical breast, so I can't write about it here” (Humanities Researcher, 10 Jan. 2007). One prostate cancer blogger, identified as rdavisjr, seems to have no difficulties expressing the details of a physical intrusion on his “privacy” in the far more open forum of his blog: The pull-around ceiling mounted screen was missing (laundry?), so Kelly was called into the room and told to make a screen with a bed sheet. So here I am with one woman sticking her finger up my ass, while another woman is standing in front of the door holding an outstretched bed sheet under her chin (guess she wanted a view!)The screen was necessary to ensure my privacy in the event someone accidentally came into the room, something they said was a common thing. Well, Kelly peering over that sheet was hardly one of my more private moments in life! (Prostate Cancer Journal, 23 Feb. 2001). ConclusionWhatever emancipatory benefits may be found in expressing the most intimate of experiences and events of a serious illness online, it is the creative act of the blog as self-expression here, in its visceral, comprehensive, continuous timestamped format that dismantles the sense of privacy in the name of recovery. The blog is not the public face of private personal experience, but expressive of the life encompassed by that illness, and encompassing its author’s ongoing personal transformation. The blogs discussed here are not alone in demonstrating these practices. The blog format itself may soon evolve or disappear. Nonetheless, the massification enabled by Internet technologies and applications will continue to transform the ways in which personal experience may be considered private. ReferencesBruns, Axel. Gatewatching: Collaborative Online News Production. New York: Peter Lang, 2005.Bury, Michael. “Chronic Illness as Biographical Disruption.” Sociology of Health and Illness, 4.2 (1982): 167-182.Foucault, Michel. Birth of the Clinic: An Archaeology of Medical Perception. Trans. A.M. Sheridan. London: Tavistock, 1973.———. “Technologies of the Self” Technologies of the Self: A Seminar with Michel Foucault. Ed. Luther H. Martin, Huck Gutman, Patrick M. Hutton, 1988: 16-49. Hardey, Michael. “‘The Story of My Illness’: Personal Accounts of Illness on the Internet.” Health 6.1 (2002): 31-46Kleinman, Arthur, Veena Das, and Margaret Lock, eds. Social Suffering. Berkeley: University of California Press, 1997. Lenhart, Amanda, and Susannah Fox. Bloggers: A Portrait of the Internet’s New Storytellers. Washington: PEW Internet and American Life Project, 2006. Lorde, Audre. The Cancer Journals. San Francisco: Spinsters Ink, 1980.Lovink, Geert. Zero Comments: Blogging and Critical Internet Culture. London: Routledge, 2008. McCullagh, Karen. “Blogging: Self Presentation and Privacy.” Information and Communications Technology Law 17.1 (2008): 3-23. McQuire, Scott. “From Glass Architecture to Big Brother: Scenes from a Cultural History of Transparency.” Cultural Studies Review 9.1 (2003): 103-123.Orgad, Shani. Storytelling Online: Talking Breast Cancer on the Internet. New York: Peter Lang, 2005. Pitts, Victoria. “Illness and Internet Empowerment: Writing and Reading Breast Cancer in Cyberspace.” Health 8.1 (2004): 33-59.Rothenberg, Matthew. “Weblogs, Metadata, and the Semantic Web”, paper presented at the Association of Internet Researchers conference, Toronto, 16 Oct. 2003. ‹http://aoir.org/members/papers42/rothenberg_aoir.pdf›.Singer, Jessica, and George H.S. Singer. “Writing as Physical and Emotional Healing: Findings from Clinical Research.” Handbook of Research on Writing: History, Society, School, Individual, Text. Ed. Charles Bazerman. New York: Lawrence Erlbaum Associates, 2008: 485-498. Sontag, Susan. Illness as Metaphor; And, AIDS and Its Metaphors. London: Penguin, 1991. Trigg, Stephanie. “Life Lessons.” Sunday Age, 10 June 2007. Turkle, Sherry. Life on the Screen: Identity in the Age of the Internet. New York: Simon and Schuster, 1995. Wenger, Etienne. Communities of Practice: Learning, Meaning and Identity. Cambridge: Cambridge University Press, 1998. Wuthnow, Robert. Communities of Discourse: Ideology and Social Structure in the Reformation, the Enlightenment, and European Socialism. Cambridge, MA: Harvard University Press, 1989.BlogsBrainhell. ‹http://brainhell.blogspot.com/›. rdavisjr. Prostate Cancer Journal. ‹http://pcjournal-rrd.blogspot.com/›. Sievers, Leroy. My Cancer. ‹http://www.npr.org/blogs/mycancer/›. Tom’s Road to Recovery. ‹http://tomsrecovery.blog.com/›. Trigg, Stephanie. Humanities Researcher. ‹http://stephanietrigg.blogspot.com/›.

In the last months of his life, 86-year-old Albert Facey became a best-selling author and revered cultural figure following the publication of his autobiography, A Fortunate Life. Released on Anzac Day 1981, it was praised for its “plain, unembellished, utterly sincere and un-self-pitying account of the privations of childhood and youth” (Semmler) and “extremely powerful description of Gallipoli” (Dutton 16). Within weeks, critic Nancy Keesing declared it an “Enduring Classic.” Within six months, it was announced as the winner of two prestigious non-fiction awards, with judges acknowledging Facey’s “extraordinary memory” and “ability to describe scenes and characters with great precision” (“NBC” 4). A Fortunate Life also transformed the fortunes of its publisher. Founded in 1976 as an independent, not-for-profit publishing house, Fremantle Arts Centre Press (FACP) might have been expected, given the Australian average, to survive for just a few years. Former managing editor Ray Coffey attributes the Press’s ongoing viability, in no small measure, to Facey’s success (King 29). Along with Wendy Jenkins, Coffey edited Facey’s manuscript through to publication; only five months after its release, with demand outstripping the capabilities, FACP licensed Penguin to take over the book’s production and distribution. Adaptations soon followed. In 1984, Kerry Packer’s PBL launched a prospectus for a mini-series, which raised a record $6.3 million (PBL 7–8). Aired in 1986 with a high-rating documentary called The Facey Phenomenon, the series became the most watched television event of the year (Lucas). Syndication of chapters to national and regional newspapers, stage and radio productions, audio- and e-books, abridged editions for young readers, and inclusion on secondary school curricula extended the range and influence of Facey’s life writing. Recently, an option was taken out for a new television series (Fraser).A hundred reprints and two million readers on from initial publication, A Fortunate Life continues to rate among the most appreciated Australian books of all time. Commenting on a reader survey in 2012, writer and critic Marieke Hardy enthused, “I really loved it [. . .] I felt like I was seeing a part of my country and my country’s history through a very human voice . . .” (First Tuesday Book Club). Registering a transformed reading, Hardy’s reference to Australian “history” is unproblematically juxtaposed with amused delight in an autobiography that invents and embellishes: not believing “half” of what Facey wrote, she insists he was foremost a yarn spinner. While the work’s status as a witness account has become less authoritative over time, it seems appreciation of the author’s imagination and literary skill has increased (Williamson). A Fortunate Life has been read more commonly as an uncomplicated, first-hand account, such that editor Wendy Jenkins felt it necessary to refute as an “utter mirage” that memoir is “transferred to the page by an act of perfect dictation.” Sidonie Smith and Julia Watson argue of life narratives that some “autobiographical claims [. . .] can be verified or discounted by recourse to documentation outside the text. But autobiographical truth is a different matter” (16). With increased access to archives, especially digitised personnel records, historians have asserted that key elements of Facey’s autobiography are incorrect or “fabricated” (Roberts), including his enlistment in 1914 and participation in the Gallipoli Landing on 25 April 1915. We have researched various sources relevant to Facey’s early years and war service, including hard-copy medical and repatriation records released in 2012, and find A Fortunate Life in a range of ways deviates from “documentation outside of the text,” revealing intriguing, layered storytelling. We agree with Smith and Watson that “autobiographical acts” are “anything but simple or transparent” (63). As “symbolic interactions in the world,” they are “culturally and historically specific” and “engaged in an argument about identity” (63). Inevitably, they are also “fractured by the play of meaning” (63). Our approach, therefore, includes textual analysis of Facey’s drafts alongside the published narrative and his medical records. We do not privilege institutional records as impartial but rather interpret them in terms of their hierarchies and organisation of knowledge. This leads us to speculate on alternative readings of A Fortunate Life as an illness narrative that variously resists and subscribes to dominant cultural plots, tropes, and attitudes. Facey set about writing in earnest in the 1970s and generated (at least) three handwritten drafts, along with a typescript based on the third draft. FACP produced its own working copy from the typescript. Our comparison of the drafts offers insights into the production of Facey’s final text and the otherwise “hidden” roles of editors as transformers and enablers (Munro 1). The notion that a working man with basic literacy could produce a highly readable book in part explains Facey’s enduring appeal. His grandson and literary executor, John Rose, observed in early interviews that Facey was a “natural storyteller” who had related details of his life at every opportunity over a period of more than six decades (McLeod). Jenkins points out that Facey belonged to a vivid oral culture within which he “told and retold stories to himself and others,” so that they eventually “rubbed down into the lines and shapes that would so memorably underpin the extended memoir that became A Fortunate Life.” A mystique was thereby established that “time” was Albert Facey’s “first editor” (Jenkins). The publisher expressly aimed to retain Facey’s voice, content, and meaning, though editing included much correcting of grammar and punctuation, eradication of internal inconsistencies and anomalies, and structural reorganisation into six sections and 68 chapters. We find across Facey’s drafts a broadly similar chronology detailing childhood abandonment, life-threatening incidents, youthful resourcefulness, physical prowess, and participation in the Gallipoli Landing. However, there are also shifts and changed details, including varying descriptions of childhood abuse at a place called Cave Rock; the introduction of (incompatible accounts of) interstate boxing tours in drafts two and three which replace shearing activities in Draft One; divergent tales of Facey as a world-standard athlete, league footballer, expert marksman, and powerful swimmer; and changing stories of enlistment and war service (see Murphy and Nile, “Wounded”; “Naked”).Jenkins edited those sections concerned with childhood and youth, while Coffey attended to Facey’s war and post-war life. Drawing on C.E.W. Bean’s official war history, Coffey introduced specificity to the draft’s otherwise vague descriptions of battle and amended errors, such as Facey’s claim to have witnessed Lord Kitchener on the beach at Gallipoli. Importantly, Coffey suggested the now famous title, “A Fortunate Life,” and encouraged the author to alter the ending. When asked to suggest a title, Facey offered “Cave Rock” (Interview)—the site of his violent abuse and humiliation as a boy. Draft One concluded with Facey’s repatriation from the war and marriage in 1916 (106); Draft Two with a brief account of continuing post-war illness and ultimate defeat: “My war injuries caught up with me again” (107). The submitted typescript concludes: “I have often thought that going to War has caused my life to be wasted” (Typescript 206). This ending differs dramatically from the redemptive vision of the published narrative: “I have lived a very good life, it has been very rich and full. I have been very fortunate and I am thrilled by it when I look back” (412).In The Wounded Storyteller, Arthur Frank argues that literary markets exist for stories of “narrative wreckage” (196) that are redeemed by reconciliation, resistance, recovery, or rehabilitation, which is precisely the shape of Facey’s published life story and a source of its popularity. Musing on his post-war experiences in A Fortunate Life, Facey focuses on his ability to transform the material world around him: “I liked the challenge of building up a place from nothing and making a success where another fellow had failed” (409). If Facey’s challenge was building up something from nothing, something he could set to work on and improve, his life-writing might reasonably be regarded as a part of this broader project and desire for transformation, so that editorial interventions helped him realise this purpose. Facey’s narrative was produced within a specific zeitgeist, which historian Joy Damousi notes was signalled by publication in 1974 of Bill Gammage’s influential, multiply-reprinted study of front-line soldiers, The Broken Years, which drew on the letters and diaries of a thousand Great War veterans, and also the release in 1981 of Peter Weir’s film Gallipoli, for which Gammage was the historical advisor. The story of Australia’s war now conceptualised fallen soldiers as “innocent victims” (Damousi 101), while survivors were left to “compose” memories consistent with their sacrifice (Thomson 237–54). Viewing Facey’s drafts reminds us that life narratives are works of imagination, that the past is not fixed and memory is created in the present. Facey’s autobiographical efforts and those of his publisher to improve the work’s intelligibility and relevance together constitute an attempt to “objectify the self—to present it as a knowable object—through a narrative that re-structures [. . .] the self as history and conclusions” (Foster 10). Yet, such histories almost invariably leave “a crucial gap” or “censored chapter.” Dennis Foster argues that conceiving of narration as confession, rather than expression, “allows us to see the pathos of the simultaneous pursuit and evasion of meaning” (10); we believe a significant lacuna in Facey’s life writing is intimated by its various transformations.In a defining episode, A Fortunate Life proposes that Facey was taken from Gallipoli on 19 August 1915 due to wounding that day from a shell blast that caused sandbags to fall on him, crush his leg, and hurt him “badly inside,” and a bullet to the shoulder (348). The typescript, however, includes an additional but narratively irreconcilable date of 28 June for the same wounding. The later date, 19 August, was settled on for publication despite the author’s compelling claim for the earlier one: “I had been blown up by a shell and some 7 or 8 sandbags had fallen on top of me, the day was the 28th of June 1915, how I remembered this date, it was the day my brother Roy had been killed by a shell burst.” He adds: “I was very ill for about six weeks after the incident but never reported it to our Battalion doctor because I was afraid he would send me away” (Typescript 205). This account accords with Facey’s first draft and his medical records but is inconsistent with other parts of the typescript that depict an uninjured Facey taking a leading role in fierce fighting throughout July and August. It appears, furthermore, that Facey was not badly wounded at any time. His war service record indicates that he was removed from Gallipoli due to “heart troubles” (Repatriation), which he also claims in his first draft. Facey’s editors did not have ready access to military files in Canberra, while medical files were not released until 2012. There existed, therefore, virtually no opportunity to corroborate the author’s version of events, while the official war history and the records of the State Library of Western Australia, which were consulted, contain no reference to Facey or his war service (Interview). As a consequence, the editors were almost entirely dependent on narrative logic and clarifications by an author whose eyesight and memory had deteriorated to such an extent he was unable to read his amended text. A Fortunate Life depicts men with “nerve sickness” who were not permitted to “stay at the Front because they would be upsetting to the others, especially those who were inclined that way themselves” (350). By cross referencing the draft manuscripts against medical records, we can now perceive that Facey was regarded as one of those nerve cases. According to Facey’s published account, his wounds “baffled” doctors in Egypt and Fremantle (353). His medical records reveal that in September 1915, while hospitalised in Egypt, his “palpitations” were diagnosed as “Tachycardia” triggered by war-induced neuroses that began on 28 June. This suggests that Facey endured seven weeks in the field in this condition, with the implication being that his debility worsened, resulting in his hospitalisation. A diagnosis of “debility,” “nerves,” and “strain” placed Facey in a medical category of “Special Invalids” (Butler 541). Major A.W. Campbell noted in the Medical Journal of Australia in 1916 that the war was creating “many cases of little understood nervous and mental affections, not only where a definite wound has been received, but in many cases where nothing of the sort appears” (323). Enlisted doctors were either physicians or surgeons and sometimes both. None had any experience of trauma on the scale of the First World War. In 1915, Campbell was one of only two Australian doctors with any pre-war experience of “mental diseases” (Lindstrom 30). On staff at the Australian Base Hospital at Heliopolis throughout the Gallipoli campaign, he claimed that at times nerve cases “almost monopolised” the wards under his charge (319). Bearing out Facey’s description, Campbell also reported that affected men “received no sympathy” and, as “carriers of psychic contagion,” were treated as a “source of danger” to themselves and others (323). Credentialed by royal colleges in London and coming under British command, Australian medical teams followed the practice of classifying men presenting “nervous or mental symptoms” as “battle casualties” only if they had also been wounded by “enemy action” (Loughran 106). By contrast, functional disability, with no accompanying physical wounds, was treated as unmanly and a “hysterical” reaction to the pressures of war. Mental debility was something to be feared in the trenches and diagnosis almost invariably invoked charges of predisposition or malingering (Tyquin 148–49). This shifted responsibility (and blame) from the war to the individual. Even as late as the 1950s, medical notes referred to Facey’s condition as being “constitutional” (Repatriation).Facey’s narrative demonstrates awareness of how harshly sufferers were treated. We believe that he defended himself against this with stories of physical injury that his doctors never fully accepted and that he may have experienced conversion disorder, where irreconcilable experience finds somatic expression. His medical diagnosis in 1915 and later life writing establish a causal link with the explosion and his partial burial on 28 June, consistent with opinion at the time that linked concussive blasts with destabilisation of the nervous system (Eager 422). Facey was also badly shaken by exposure to the violence and abjection of war, including hand-to-hand combat and retrieving for burial shattered and often decomposed bodies, and, in particular, by the death of his brother Roy, whose body was blown to pieces on 28 June. (A second brother, Joseph, was killed by multiple bayonet wounds while Facey was convalescing in Egypt.) Such experiences cast a different light on Facey’s observation of men suffering nerves on board the hospital ship: “I have seen men doze off into a light sleep and suddenly jump up shouting, ‘Here they come! Quick! Thousands of them. We’re doomed!’” (350). Facey had escaped the danger of death by explosion or bayonet but at a cost, and the war haunted him for the rest of his days. On disembarkation at Fremantle on 20 November 1915, he was admitted to hospital where he remained on and off for several months. Forty-one other sick and wounded disembarked with him (HMAT). Around one third, experiencing nerve-related illness, had been sent home for rest; while none returned to the war, some of the physically wounded did (War Service Records). During this time, Facey continued to present with “frequent attacks of palpitation and giddiness,” was often “short winded,” and had “heart trouble” (Repatriation). He was discharged from the army in June 1916 but, his drafts suggest, his war never really ended. He began a new life as a wounded Anzac. His dependent and often fractious relationship with the Repatriation Department ended only with his death 66 years later. Historian Marina Larsson persuasively argues that repatriated sick and wounded servicemen from the First World War represented a displaced presence at home. Many led liminal lives of “disenfranchised grief” (80). Stephen Garton observes a distinctive Australian use of repatriation to describe “all policies involved in returning, discharging, pensioning, assisting and training returned men and women, and continuing to assist them throughout their lives” (74). Its primary definition invokes coming home but to repatriate also implies banishment from a place that is not home, so that Facey was in this sense expelled from Gallipoli and, by extension, excluded from the myth of Anzac. Unlike his two brothers, he would not join history as one of the glorious dead; his name would appear on no roll of honour. Return home is not equivalent to restoration of his prior state and identity, for baggage from the other place perpetually weighs. Furthermore, failure to regain health and independence strains hospitality and gratitude for the soldier’s service to King and country. This might be exacerbated where there is no evident or visible injury, creating suspicion of resistance, cowardice, or malingering. Over 26 assessments between 1916 and 1958, when Facey was granted a full war pension, the Repatriation Department observed him as a “neuropathic personality” exhibiting “paroxysmal tachycardia” and “neurocirculatory asthenia.” In 1954, doctors wrote, “We consider the condition is a real handicap and hindrance to his getting employment.” They noted that after “attacks,” Facey had a “busted depressed feeling,” but continued to find “no underlying myocardial disease” (Repatriation) and no validity in Facey’s claims that he had been seriously physically wounded in the war (though A Fortunate Life suggests a happier outcome, where an independent medical panel finally locates the cause of his ongoing illness—rupture of his spleen in the war—which results in an increased war pension). Facey’s condition was, at times, a source of frustration for the doctors and, we suspect, disappointment and shame to him, though this appeared to reduce on both sides when the Repatriation Department began easing proof of disability from the 1950s (Thomson 287), and the Department of Veteran’s Affairs was created in 1976. This had the effect of shifting public and media scrutiny back onto a system that had until then deprived some “innocent victims of the compensation that was their due” (Garton 249). Such changes anticipated the introduction of Post-Traumatic Shock Disorder (PTSD) to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. Revisions to the DSM established a “genealogy of trauma” and “panic disorders” (100, 33), so that diagnoses such as “neuropathic personality” (Echterling, Field, and Stewart 192) and “soldier’s heart,” that is, disorders considered “neurotic,” were “retrospectively reinterpreted” as a form of PTSD. However, Alberti points out that, despite such developments, war-related trauma continues to be contested (80). We propose that Albert Facey spent his adult life troubled by a sense of regret and failure because of his removal from Gallipoli and that he attempted to compensate through storytelling, which included his being an original Anzac and seriously wounded in action. By writing, Facey could shore up his rectitude, work ethic, and sense of loyalty to other servicemen, which became necessary, we believe, because repatriation doctors (and probably others) had doubted him. In 1927 and again in 1933, an examining doctor concluded: “The existence of a disability depends entirely on his own unsupported statements” (Repatriation). We argue that Facey’s Gallipoli experiences transformed his life. By his own account, he enlisted for war as a physically robust and supremely athletic young man and returned nine months later to life-long anxiety and ill-health. Publication transformed him into a national sage, earning him, in his final months, the credibility, empathy, and affirmation he had long sought. Exploring different accounts of Facey, in the shape of his drafts and institutional records, gives rise to new interpretations. In this context, we believe it is time for a new edition of A Fortunate Life that recognises it as a complex testimonial narrative and theorises Facey’s deployment of national legends and motifs in relation to his “wounded storytelling” as well as to shifting cultural and medical conceptualisations and treatments of shame and trauma. ReferencesAlberti, Fay Bound. Matters of the Heart: History, Medicine, and Emotions. Oxford: Oxford UP, 2010. Butler, A.G. Official History of the Australian Medical Services 1814-1918: Vol I Gallipoli, Palestine and New Guinea. Canberra: Australian War Memorial, 1930.Campbell, A.W. “Remarks on Some Neuroses and Psychoses in War.” Medical Journal of Australia 15 April (1916): 319–23.Damousi, Joy. “Why Do We Get So Emotional about Anzac.” What’s Wrong with Anzac. Ed. Marilyn Lake and Henry Reynolds. Sydney: UNSWP, 2015. 94–109.Dutton, Geoffrey. “Fremantle Arts Centre Press Publicity.” Australian Book Review May (1981): 16.Eager, R. “War Neuroses Occurring in Cases with a Definitive History of Shell Shock.” British Medical Journal 13 Apr. 1918): 422–25.Echterling, L.G., Thomas A. Field, and Anne L. Stewart. “Evolution of PTSD in the DSM.” Future Directions in Post-Traumatic Stress Disorder: Prevention, Diagnosis, and Treatment. Ed. Marilyn P. Safir and Helene S. Wallach. New York: Springer, 2015. 189–212.Facey, A.B. A Fortunate Life. 1981. Ringwood: Penguin, 2005.———. Drafts 1–3. University of Western Australia, Special Collections.———. Transcript. University of Western Australia, Special Collections.First Tuesday Book Club. ABC Splash. 4 Dec. 2012. <http://splash.abc.net.au/home#!/media/1454096/http&>.Foster, Dennis. Confession and Complicity in Narrative. Cambridge: Cambridge UP, 1987.Frank, Arthur. The Wounded Storyteller. London: U of Chicago P, 1995.Fraser, Jane. “CEO Says.” Fremantle Press. 7 July 2015. <https://www.fremantlepress.com.au/c/news/3747-ceo-says-9>.Garton, Stephen. The Cost of War: Australians Return. Melbourne: Oxford UP, 1994.HMAT Aeneas. “Report of Passengers for the Port of Fremantle from Ports Beyond the Commonwealth.” 20 Nov. 1915. <http://recordsearch.naa.gov.au/SearchNRetrieve/Interface/ViewImage.aspx?B=9870708&S=1>.“Interview with Ray Coffey.” Personal interview. 6 May 2016. Follow-up correspondence. 12 May 2016.Jenkins, Wendy. “Tales from the Backlist: A Fortunate Life Turns 30.” Fremantle Press, 14 April 2011. <https://www.fremantlepress.com.au/c/bookclubs/574-tales-from-the-backlist-a-fortunate-life-turns-30>.Keesing, Nancy. ‘An Enduring Classic.’ Australian Book Review (May 1981). FACP Press Clippings. Fremantle. n. pag.King, Noel. “‘I Can’t Go On … I’ll Go On’: Interview with Ray Coffey, Fremantle Arts Centre Press, 22 Dec. 2004; 24 May 2006.” Westerly 51 (2006): 31–54.Larsson, Marina. “A Disenfranchised Grief: Post War Death and Memorialisation in Australia after the First World War.” Australian Historical Studies 40.1 (2009): 79–95.Lindstrom, Richard. “The Australian Experience of Psychological Casualties in War: 1915-1939.” PhD dissertation. Victoria University, Feb. 1997.Loughran, Tracey. “Shell Shock, Trauma, and the First World War: The Making of a Diagnosis and its Histories.” Journal of the History of Medical and Allied Sciences 67.1 (2012): 99–119.Lucas, Anne. “Curator’s Notes.” A Fortunate Life. Australian Screen. <http://aso.gov.au/titles/tv/a-fortunate-life/notes/>.McLeod, Steve. “My Fortunate Life with Grandad.” Western Magazine Dec. (1983): 8.Munro, Craig. Under Cover: Adventures in the Art of Editing. Brunswick: Scribe, 2015.Murphy, Ffion, and Richard Nile. “The Naked Anzac: Exposure and Concealment in A.B. Facey’s A Fortunate Life.” Southerly 75.3 (2015): 219–37.———. “Wounded Storyteller: Revisiting Albert Facey’s Fortunate Life.” Westerly 60.2 (2015): 87–100.“NBC Book Awards.” Australian Book Review Oct. (1981): 1–4.PBL. Prospectus: A Fortunate Life, the Extraordinary Life of an Ordinary Bloke. 1–8.Repatriation Records. Albert Facey. National Archives of Australia.Roberts, Chris. “Turkish Machine Guns at the Landing.” Wartime: Official Magazine of the Australian War Memorial 50 (2010). <https://www.awm.gov.au/wartime/50/roberts_machinegun/>.Semmler, Clement. “The Way We Were before the Good Life.” Courier Mail 10 Oct. 1981. FACP Press Clippings. Fremantle. n. pag.Smith, Sidonie, and Julia Watson. Reading Autobiography: A Guide for Interpreting Life Narratives. 2001. 2nd ed. U of Minnesota P, 2010.Thomson, Alistair. Anzac Memories: Living with the Legend. 1994. 2nd ed. Melbourne: Monash UP, 2013. Tyquin, Michael. Gallipoli, the Medical War: The Australian Army Services in the Dardanelles Campaign of 1915. Kensington: UNSWP, 1993.War Service Records. National Archives of Australia. <http://recordsearch.naa.gov.au/NameSearch/Interface/NameSearchForm.aspx>.Williamson, Geordie. “A Fortunate Life.” Copyright Agency. <http://readingaustralia.com.au/essays/a-fortunate-life/>.

All history of this area and the general talk and all of that is that 1973 was a turning point and the Aquarius Festival is credited with having turned this region around in so many ways, but I think that is a myth ... and I have to honour the truth; and the truth is that old Dicke Donelly came and did a Welcome to Country the night before the festival. (Joseph in Joseph and Hanley)In 1973 the Australian Union of Students (AUS) held the Aquarius Arts and Lifestyle Festival in a small, rural New South Wales town called Nimbin. The festival was seen as the peak expression of Australian counterculture and is attributed to creating the “Rainbow Region”, an area with a concentration of alternative life stylers in Northern NSW (Derrett 28). While the Aquarius Festival is recognised as a founding historical and countercultural event, the unique and important relationships established with Indigenous people at this time are generally less well known. This article investigates claims that the 1973 Aquarius Festival was “the first event in Australian history that sought permission for the use of the land from the Traditional Owners” (Joseph and Hanley). The diverse international, national and local conditions that coalesced at the Aquarius Festival suggest a fertile environment was created for reconciliatory bonds to develop. Often dismissed as a “tree hugging, soap dodging movement,” the counterculture was radically politicised having sprung from the 1960s social revolutions when the world witnessed mass demonstrations that confronted war, racism, sexism and capitalism. Primarily a youth movement, it was characterised by flamboyant dress, music, drugs and mass gatherings with universities forming the epicentre and white, middle class youth leading the charge. As their ideals of changing the world were frustrated by lack of systematic change, many decided to disengage and a migration to rural settings occurred (Jacob; Munro-Clarke; Newton). In the search for alternatives, the counterculture assimilated many spiritual practices, such as Eastern traditions and mysticism, which were previously obscure to the Western world. This practice of spiritual syncretism can be represented as a direct resistance to the hegemony of the dominant Western culture (Stell). As the new counterculture developed, its progression from urban to rural settings was driven by philosophies imbued with a desire to reconnect with and protect the natural world while simultaneously rejecting the dominant conservative order. A recurring feature of this countercultural ‘back to the land’ migration was not only an empathetic awareness of the injustices of colonial past, but also a genuine desire to learn from the Indigenous people of the land. Indigenous people were generally perceived as genuine opposers of Westernisation, inherently spiritual, ecological, tribal and communal, thus encompassing the primary values to which the counterculture was aspiring (Smith). Cultures converged. One, a youth culture rebelling from its parent culture; the other, ancient cultures reeling from the historical conquest by the youths’ own ancestors. Such cultural intersections are rich with complex scenarios and politics. As a result, often naïve, but well-intended relations were established with Native Americans, various South American Indigenous peoples, New Zealand Maori and, as this article demonstrates, the Original People of Australia (Smith; Newton; Barr-Melej; Zolov). The 1960s protest era fostered the formation of groups aiming to address a variety of issues, and at times many supported each other. Jennifer Clarke says it was the Civil Rights movement that provided the first models of dissent by formulating a “method, ideology and language of protest” as African Americans stood up and shouted prior to other movements (2). The issue of racial empowerment was not lost on Australia’s Indigenous population. Clarke writes that during the 1960s, encouraged by events overseas and buoyed by national organisation, Aborigines “slowly embarked on a political awakening, demanded freedom from the trappings of colonialism and responded to the effects of oppression at worst and neglect at best” (4). Activism of the 1960s had the “profoundly productive effect of providing Aborigines with the confidence to assert their racial identity” (159). Many Indigenous youth were compelled by the zeitgeist to address their people’s issues, fulfilling Charlie Perkins’s intentions of inspiring in Indigenous peoples a will to resist (Perkins). Enjoying new freedoms of movement out of missions, due to the 1967 Constitutional change and the practical implementation of the assimilation policy, up to 32,000 Indigenous youth moved to Redfern, Sydney between 1967 and 1972 (Foley, “An Evening With”). Gary Foley reports that a dynamic new Black Power Movement emerged but the important difference between this new younger group and the older Indigenous leaders of the day was the diverse range of contemporary influences. Taking its mantra from the Black Panther movement in America, though having more in common with the equivalent Native American Red Power movement, the Black Power Movement acknowledged many other international struggles for independence as equally inspiring (Foley, “An Evening”). People joined together for grassroots resistance, formed anti-hierarchical collectives and established solidarities between varied groups who previously would have had little to do with each other. The 1973 Aquarius Festival was directly aligned with “back to the land” philosophies. The intention was to provide a place and a reason for gathering to “facilitate exchanges on survival techniques” and to experience “living in harmony with the natural environment.” without being destructive to the land (Dunstan, “A Survival Festival”). Early documents in the archives, however, reveal no apparent interest in Australia’s Indigenous people, referring more to “silken Arabian tents, mediaeval banners, circus, jugglers and clowns, peace pipes, maypole and magic circles” (Dunstan, “A Survival Festival”). Obliterated from the social landscape and minimally referred to in the Australian education system, Indigenous people were “off the radar” to the majority mindset, and the Australian counterculture similarly was slow to appreciate Indigenous culture. Like mainstream Australia, the local counterculture movement largely perceived the “race” issue as something occurring in other countries, igniting the phrase “in your own backyard” which became a catchcry of Indigenous activists (Foley, “Whiteness and Blackness”) With no mention of any Indigenous interest, it seems likely that the decision to engage grew from the emerging climate of Indigenous activism in Australia. Frustrated by student protestors who seemed oblivious to local racial issues, focusing instead on popular international injustices, Indigenous activists accused them of hypocrisy. Aquarius Festival directors, found themselves open to similar accusations when public announcements elicited a range of responses. Once committed to the location of Nimbin, directors Graeme Dunstan and Johnny Allen began a tour of Australian universities to promote the upcoming event. While at the annual conference of AUS in January 1973 at Monash University, Dunstan met Indigenous activist Gary Foley: Gary witnessed the presentation of Johnny Allen and myself at the Aquarius Foundation session and our jubilation that we had agreement from the village residents to not only allow, but also to collaborate in the production of the Festival. After our presentation which won unanimous support, it was Gary who confronted me with the question “have you asked permission from local Aboriginal folk?” This threw me into confusion because we had seen no Aboriginals in Nimbin. (Dunstan, e-mail) Such a challenge came at a time when the historical climate was etched with political activism, not only within the student movement, but more importantly with Indigenous activists’ recent demonstrations, such as the installation in 1972 of the Tent Embassy in Canberra. As representatives of the counterculture movement, which was characterised by its inclinations towards consciousness-raising, AUS organisers were ethically obliged to respond appropriately to the questions about Indigenous permission and involvement in the Aquarius Festival at Nimbin. In addition to this political pressure, organisers in Nimbin began hearing stories of the area being cursed or taboo for women. This most likely originated from the tradition of Nimbin Rocks, a rocky outcrop one kilometre from Nimbin, as a place where only certain men could go. Jennifer Hoff explains that many major rock formations were immensely sacred places and were treated with great caution and respect. Only a few Elders and custodians could visit these places and many such locations were also forbidden for women. Ceremonies were conducted at places like Nimbin Rocks to ensure the wellbeing of all tribespeople. Stories of the Nimbin curse began to spread and most likely captivated a counterculture interested in mysticism. As organisers had hoped that news of the festival would spread on the “lips of the counterculture,” they were alarmed to hear how “fast the bad news of this curse was travelling” (Dunstan, e-mail). A diplomatic issue escalated with further challenges from the Black Power community when organisers discovered that word had spread to Sydney’s Indigenous community in Redfern. Organisers faced a hostile reaction to their alleged cultural insensitivity and were plagued by negative publicity with accusations the AUS were “violating sacred ground” (Janice Newton 62). Faced with such bad press, Dunstan was determined to repair what was becoming a public relations disaster. It seemed once prompted to the path, a sense of moral responsibility prevailed amongst the organisers and they took the unprecedented step of reaching out to Australia’s Indigenous people. Dunstan claimed that an expedition was made to the local Woodenbong mission to consult with Elder, Uncle Lyle Roberts. To connect with local people required crossing the great social divide present in that era of Australia’s history. Amy Nethery described how from the nineteenth century to the 1960s, a “system of reserves, missions and other institutions isolated, confined and controlled Aboriginal people” (9). She explains that the people were incarcerated as a solution to perceived social problems. For Foley, “the widespread genocidal activity of early “settlement” gave way to a policy of containment” (Foley, “Australia and the Holocaust”). Conditions on missions were notoriously bad with alcoholism, extreme poverty, violence, serious health issues and depression common. Of particular concern to mission administrators was the perceived need to keep Indigenous people separate from the non-indigenous population. Dunstan described the mission he visited as having “bad vibes.” He found it difficult to communicate with the elderly man, and was not sure if he understood Dunstan’s quest, as his “responses came as disjointed raves about Jesus and saving grace” (Dunstan, e-mail). Uncle Lyle, he claimed, did not respond affirmatively or negatively to the suggestion that Nimbin was cursed, and so Dunstan left assuming it was not true. Other organisers began to believe the curse and worried that female festival goers might get sick or worse, die. This interpretation reflected, as Vanessa Bible argues, a general Eurocentric misunderstanding of the relationship of Indigenous peoples with the land. Paul Joseph admits they were naïve whites coming into a place with very little understanding, “we didn’t know if we needed a witch doctor or what we needed but we knew we needed something from the Aborigines to lift the spell!”(Joseph and Hanley). Joseph, one of the first “hippies” who moved to the area, had joined forces with AUS organisers. He said, “it just felt right” to get Indigenous involvement and recounted how organisers made another trip to Woodenbong Mission to find Dickee (Richard) Donnelly, a Song Man, who was very happy to be invited. Whether the curse was valid or not it proved to be productive in further instigating respectful action. Perhaps feeling out of their depth, the organisers initiated another strategy to engage with Australian Indigenous people. A call out was sent through the AUS network to diversify the cultural input and it was recommended they engage the services of South African artist, Bauxhau Stone. Timing aligned well as in 1972 Australia had voted in a new Prime Minister, Gough Whitlam. Whitlam brought about significant political changes, many in response to socialist protests that left a buoyancy in the air for the counterculturalist movement. He made prodigious political changes in support of Indigenous people, including creating the Aboriginal Arts Board as part of the Australian Council of the Arts (ACA). As the ACA were already funding activities for the Aquarius Festival, organisers were successful in gaining two additional grants specifically for Indigenous participation (Farnham). As a result We were able to hire […] representatives, a couple of Kalahari bushmen. ‘Cause we were so dumb, we didn’t think we could speak to the black people, you know what I mean, we thought we would be rejected, or whatever, so for us to really reach out, we needed somebody black to go and talk to them, or so we thought, and it was remarkable. This one Bau, a remarkable fellow really, great artist, great character, he went all over Australia. He went to Pitjantjatjara, Yirrkala and we arranged buses and tents when they got here. We had a very large contingent of Aboriginal people come to the Aquarius Festival, thanks to Whitlam. (Joseph in Joseph and Henley) It was under the aegis of these government grants that Bauxhau Stone conducted his work. Stone embodied a nexus of contemporary issues. Acutely aware of the international movement for racial equality and its relevance to Australia, where conditions were “really appalling”, Stone set out to transform Australian race relations by engaging with the alternative arts movement (Stone). While his white Australian contemporaries may have been unaccustomed to dealing with the Indigenous racial issue, Stone was actively engaged and thus well suited to act as a cultural envoy for the Aquarius Festival. He visited several local missions, inviting people to attend and notifying them of ceremonies being conducted by respected Elders. Nimbin was then the site of the Aquarius Lifestyle and Celebration Festival, a two week gathering of alternative cultures, technologies and youth. It innovatively demonstrated its diversity of influences, attracted people from all over the world and was the first time that the general public really witnessed Australia’s counterculture (Derrett 224). As markers of cultural life, counterculture festivals of the 1960s and 1970s were as iconic as the era itself and many around the world drew on the unique Indigenous heritage of their settings in some form or another (Partridge; Perone; Broadley and Jones; Zolov). The social phenomenon of coming together to experience, celebrate and foster a sense of unity was triggered by protests, music and a simple, yet deep desire to reconnect with each other. Festivals provided an environment where the negative social pressures of race, gender, class and mores (such as clothes) were suspended and held the potential “for personal and social transformation” (St John 167). With the expressed intent to “take matters into our own hands” and try to develop alternative, innovative ways of doing things with collective participation, the Aquarius Festival thus became an optimal space for reinvigorating ancient and Indigenous ways (Dunstan, “A Survival Festival”). With philosophies that venerated collectivism, tribalism, connecting with the earth, and the use of ritual, the Indigenous presence at the Aquarius Festival gave attendees the opportunity to experience these values. To connect authentically with Nimbin’s landscape, forming bonds with the Traditional Owners was essential. Participants were very fortunate to have the presence of the last known initiated men of the area, Uncle Lyle Roberts and Uncle Dickee Donnely. These Elders represented the last vestiges of an ancient culture and conducted innovative ceremonies, song, teachings and created a sacred fire for the new youth they encountered in their land. They welcomed the young people and were very happy for their presence, believing it represented a revolutionary shift (Wedd; King; John Roberts; Cecil Roberts). Images 1 and 2: Ceremony and talks conducted at the Aquarius Festival (people unknown). Photographs reproduced by permission of photographer and festival attendee Paul White. The festival thus provided an important platform for the regeneration of cultural and spiritual practices. John Roberts, nephew of Uncle Lyle, recalled being surprised by the reaction of festival participants to his uncle: “He was happy and then he started to sing. And my God … I couldn’t get near him! There was this big ring of hippies around him. They were about twenty deep!” Sharing to an enthusiastic, captive audience had a positive effect and gave the non-indigenous a direct Indigenous encounter (Cecil Roberts; King; Oshlak). Estimates of the number of Indigenous people in attendance vary, with the main organisers suggesting 800 to 1000 and participants suggesting 200 to 400 (Stone; Wedd; Oshlak: Joseph; King; Cecil Roberts). As the Festival lasted over a two week period, many came and left within that time and estimates are at best reliant on memory, engagement and perspectives. With an estimated total attendance at the Festival between 5000 and 10,000, either number of Indigenous attendees is symbolic and a significant symbolic statistic for Indigenous and non-indigenous to be together on mutual ground in Australia in 1973. Images 3-5: Performers from Yirrkala Dance Group, brought to the festival by Stone with funding from the Federal Government. Photographs reproduced by permission of photographer and festival attendee Dr Ian Cameron. For Indigenous people, the event provided an important occasion to reconnect with their own people, to share their culture with enthusiastic recipients, as well as the chance to experience diverse aspects of the counterculture. Though the northern NSW region has a history of diverse cultural migration of Italian and Indian families, the majority of non-indigenous and Indigenous people had limited interaction with cosmopolitan influences (Kijas 20). Thus Nimbin was a conservative region and many Christianised Indigenous people were also conservative in their outlook. The Aquarius Festival changed that as the Indigenous people experienced the wide-ranging cultural elements of the alternative movement. The festival epitomised countercultural tendencies towards flamboyant fashion and hairstyles, architectural design, fantastical art, circus performance, Asian clothes and religious products, vegetarian food and nudity. Exposure to this bohemian culture would have surely led to “mind expansion and consciousness raising,” explicit aims adhered to by the movement (Roszak). Performers and participants from Africa, America and India also gave attending Indigenous Australians the opportunity to interact with non-European cultures. Many people interviewed for this paper indicated that Indigenous people’s reception of this festival experience was joyous. For Australia’s early counterculture, interest in Indigenous Australia was limited and for organisers of the AUS Aquarius Festival, it was not originally on the agenda. The counterculture in the USA and New Zealand had already started to engage with their Indigenous people some years earlier. However due to the Aquarius Festival’s origins in the student movement and its solidarities with the international Indigenous activist movement, they were forced to shift their priorities. The coincidental selection of a significant spiritual location at Nimbin to hold the festival brought up additional challenges and countercultural intrigue with mystical powers and a desire to connect authentically to the land, further prompted action. Essentially, it was the voices of empowered Indigenous activists, like Gary Foley, which in fact triggered the reaching out to Indigenous involvement. While the counterculture organisers were ultimately receptive and did act with unprecedented respect, credit must be given to Indigenous activists. The activist’s role is to trigger action and challenge thinking and in this case, it was ultimately productive. Therefore the Indigenous people were not merely passive recipients of beneficiary goodwill, but active instigators of appropriate cultural exchange. After the 1973 festival many attendees decided to stay in Nimbin to purchase land collectively and a community was born. Relationships established with local Indigenous people developed further. Upon visiting Nimbin now, one will see a vibrant visual display of Indigenous and psychedelic themed art, a central park with an open fire tended by local custodians and other Indigenous community members, an Aboriginal Centre whose rent is paid for by local shopkeepers, and various expressions of a fusion of counterculture and Indigenous art, music and dance. While it appears that reconciliation became the aspiration for mainstream society in the 1990s, Nimbin’s early counterculture history had Indigenous reconciliation at its very foundation. The efforts made by organisers of the 1973 Aquarius Festival stand as one of very few examples in Australian history where non-indigenous Australians have respectfully sought to learn from Indigenous people and to assimilate their cultural practices. It also stands as an example for the world, of reconciliation, based on hippie ideals of peace and love. They encouraged the hippies moving up here, even when they came out for Aquarius, old Uncle Lyle and Richard Donnelly, they came out and they blessed the mob out here, it was like the hairy people had come back, with the Nimbin, cause the Nimbynji is the little hairy people, so the hairy people came back (Jerome). References Barr-Melej, Patrick. “Siloísmo and the Self in Allende’s Chile: Youth, 'Total Revolution,' and the Roots of the Humanist Movement.” Hispanic American Historical Review 86.4 (Nov. 2006): 747-784. Bible, Vanessa. Aquarius Rising: Terania Creek and the Australian Forest Protest Movement. BA (Honours) Thesis. University of New England, Armidale, 2010. Broadley, Colin, and Judith Jones, eds. Nambassa: A New Direction. Auckland: Reed, 1979. Bryant, Gordon M. Parliament of Australia. Minister for Aboriginal Affairs. 1 May 1973. Australian Union of Students. Records of the AUS, 1934-1991. National Library of Australia MS ACC GB 1992.0505. Cameron, Ian. “Aquarius Festival Photographs.” 1973. Clarke, Jennifer. Aborigines and Activism: Race, Aborigines and the Coming of the Sixties to Australia. Crawley: University of Western Australia Press, 2008. Derrett, Ross. Regional Festivals: Nourishing Community Resilience: The Nature and Role of Cultural Festivals in Northern Rivers NSW Communities. PhD Thesis. Southern Cross University, Lismore, 2008. Dunstan, Graeme. “A Survival Festival May 1973.” 1 Aug. 1972. Pamphlet. MS 6945/1. Nimbin Aquarius Festival Archives. National Library of Australia, Canberra. ---. E-mail to author, 11 July 2012. ---. “The Aquarius Festival.” Aquarius Rainbow Region. n.d. Farnham, Ken. Acting Executive Officer, Aboriginal Council for the Arts. 19 June 1973. Letter. MS ACC GB 1992.0505. Australian Union of Students. Records of the AUS, 1934-1991. National Library of Australia, Canberra. Foley, Gary. “Australia and the Holocaust: A Koori Perspective (1997).” The Koori History Website. n.d. 20 May 2013 ‹http://www.kooriweb.org/foley/essays/essay_8.html›. ---. “Whiteness and Blackness in the Koori Struggle for Self-Determination (1999).” The Koori History Website. n.d. 20 May 2013 ‹http://www.kooriweb.org/foley/essays/essay_9.html›. ---. “Black Power in Redfern 1968-1972 (2001).” The Koori History Website. n.d. 20 May 2013 ‹http://www.kooriweb.org/foley/essays/essay_1.html›. ---. “An Evening with Legendary Aboriginal Activist Gary Foley.” Conference Session. Marxism 2012 “Revolution in the Air”, Melbourne, Mar. 2012. Hoff, Jennifer. Bundjalung Jugun: Bundjalung Country. Lismore: Richmond River Historical Society, 2006. Jacob, Jeffrey. New Pioneers: The Back-to-the-Land Movement and the Search for a Sustainable Future. Pennsylvania: Penn State Press, 1997. Jerome, Burri. Interview. 31 July 2012. Joseph, Paul. Interview. 7 Aug. 2012. 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Introduction: Bubbles and Sport The ephemeral materiality of bubbles – beautiful, spectacular, and distracting but ultimately fragile – when applied to protect or conserve in the interests of sport-media profit, creates conditions that exacerbate existing inequalities in sport and society. Bubbles are usually something to watch, admire, and chase after in their brief yet shiny lives. There is supposed to be, technically, nothing inside them other than one or more gasses, and yet we constantly refer to people and objects being inside bubbles. The metaphor of the bubble has been used to describe the life of celebrities, politicians in purpose-built capital cities like Canberra, and even leftist, environmentally activist urban dwellers. The metaphorical and material qualities of bubbles are aligned—they cannot be easily captured and are liable to change at any time. In this article we address the metaphorical sporting bubble, which is often evoked in describing life in professional sport. This is a vernacular term used to capture and condemn the conditions of life of elite sportspeople (usually men), most commonly after there has been a sport-related scandal, especially of a sexual nature (Rowe). It is frequently paired with connotatively loaded adjectives like pampered and indulged. The sporting bubble is rarely interrogated in academic literature, the concept largely being left to the media and moral entrepreneurs. It is represented as involving a highly privileged but also pressurised life for those who live inside it. A sporting bubble is a world constructed for its most prized inhabitants that enables them to be protected from insurgents and to set the terms of their encounters with others, especially sport fans and disciplinary agents of the state. The Covid-19 pandemic both reinforced and reconfigured the operational concept of the bubble, re-arranging tensions between safety (protecting athletes) and fragility (short careers, risks of injury, etc.) for those within, while safeguarding those without from bubble contagion. Privilege and Precarity Bubble-induced social isolation, critics argue, encourages a loss of perspective among those under its protection, an entitled disconnection from the usual rules and responsibilities of everyday life. For this reason, the denizens of the sporting bubble are seen as being at risk to themselves and, more troublingly, to those allowed temporarily to penetrate it, especially young women who are first exploited by and then ejected from it (Benedict). There are many well-documented cases of professional male athletes “behaving badly” and trying to rely on institutional status and various versions of the sporting bubble for shelter (Flood and Dyson; Reel and Crouch; Wade). In the age of mobile and social media, it is increasingly difficult to keep misbehaviour in-house, resulting in a slew of media stories about, for example, drunkenness and sexual misconduct, such as when then-Sydney Roosters co-captain Mitchell Pearce was suspended and fined in 2016 after being filmed trying to force an unwanted kiss on a woman and then simulating a lewd act with her dog while drunk. There is contestation between those who condemn such behaviour as aberrant and those who regard it as the conventional expression of youthful masculinity as part of the familiar “boys will be boys” dictum. The latter naturalise an inequitable gender order, frequently treating sportsmen as victims of predatory women, and ignoring asymmetries of power between men and women, especially in homosocial environments (Toffoletti). For those in the sporting bubble (predominantly elite sportsmen and highly paid executives, also mostly men, with an array of service staff of both sexes moving in and out of it), life is reflected for those being protected via an array of screens (small screens in homes and indoor places of entertainment, and even smaller screens on theirs and others’ phones, as well as huge screens at sport events). These male sport stars are paid handsomely to use their skill and strength to perform for the sporting codes, their every facial expression and bodily action watched by the media and relayed to audiences. This is often a precarious existence, the usually brief career of an athlete worker being dependent on health, luck, age, successful competition with rivals, networks, and club and coach preferences. There is a large, aspirational reserve army of athletes vying to play at the elite level, despite risks of injury and invasive, life-changing medical interventions. Responsibility for avoiding performance and image enhancing drugs (PIEDs) also weighs heavily on their shoulders (Connor). Professional sportspeople, in their more reflective moments, know that their time in the limelight will soon be up, meaning that getting a ticket to the sporting bubble, even for a short time, can make all the difference to their post-sport lives and those of their families. The most vulnerable of the small minority of participants in sport who make a good, short-term living from it are those for whom, in the absence of quality education and prior social status, it is their sole likely means of upward social mobility (Spaaij). Elite sport performers are surrounded by minders, doctors, fitness instructors, therapists, coaches, advisors and other service personnel, all supporting athletes to stay focussed on and maximise performance quality to satisfy co-present crowds, broadcasters, sponsors, sports bodies and mass media audiences. The shield offered by the sporting bubble supports the teleological win-at-all-costs mentality of professional sport. The stakes are high, with athlete and executive salaries, sponsorships and broadcasting deals entangled in a complex web of investments in keeping the “talent” pivotal to the “attention economy” (Davenport and Beck)—the players that provide the content for sale—in top form. Yet, the bubble cannot be entirely secured and poor behaviour or performance can have devastating effects, including permanent injury or disability, mental illness and loss of reputation (Rowe, “Scandals and Sport”). Given this fragile materiality of the sporting bubble, it is striking that, in response to the sudden shutdown following the economic and health crisis caused by the 2020 global pandemic, the leaders of professional sport decided to create more of them and seek to seal the metaphorical and material space with unprecedented efficiency. The outcome was a multi-sided tale of mobility, confinement, capital, labour, and the gendering of sport and society. The Covid-19 Gilded Cage Sociologists such as Zygmunt Bauman and John Urry have analysed the socio-politics of mobilities, whereby some people in the world, such as tourists, can traverse the globe at their leisure, while others remain fixed in geographical space because they lack the means to be mobile or, in contrast, are involuntarily displaced by war, so-called “ethnic cleansing”, famine, poverty or environmental degradation. The Covid-19 global pandemic re-framed these matters of mobilities (Rowe, “Subjecting Pandemic Sport”), with conventional moving around—between houses, businesses, cities, regions and countries—suddenly subjected to the imperative to be static and, in perniciously unreflective technocratic discourse, “socially distanced” (when what was actually meant was to be “physically distanced”). The late-twentieth century analysis of the “risk society” by Ulrich Beck, in which the mysterious consequences of humans’ predation on their environment are visited upon them with terrifying force, was dramatically realised with the coming of Covid-19. In another iteration of the metaphor, it burst the bubble of twenty-first century global sport. What we today call sport was formed through the process of sportisation (Maguire), whereby hyper-local, folk physical play was reconfigured as multi-spatial industrialised sport in modernity, becoming increasingly reliant on individual athletes and teams travelling across the landscape and well over the horizon. Co-present crowds were, in turn, overshadowed in the sport economy when sport events were taken to much larger, dispersed audiences via the media, especially in broadcast mode (Nicholson, Kerr, and Sherwood). This lucrative mediation of professional sport, though, came with an unforgiving obligation to generate an uninterrupted supply of spectacular live sport content. The pandemic closed down most sports events and those that did take place lacked the crucial participation of the co-present crowd to provide the requisite event atmosphere demanded by those viewers accustomed to a sense of occasion. Instead, they received a strange spectacle of sport performers operating in empty “cathedrals”, often with a “faked” crowd presence. The mediated sport spectacle under the pandemic involved cardboard cut-out and sex doll spectators, Zoom images of fans on large screens, and sampled sounds of the crowd recycled from sport video games. Confected co-presence produced simulacra of the “real” as Baudrillardian visions came to life. The sporting bubble had become even more remote. For elite sportspeople routinely isolated from the “common people”, the live sport encounter offered some sensory experience of the social – the sounds, sights and even smells of the crowd. Now the sporting bubble closed in on an already insulated and insular existence. It exposed the irony of the bubble as a sign of both privileged mobility and incarcerated athlete work, both refuge and prison. Its logic of contagion also turned a structure intended to protect those inside from those outside into, as already observed, a mechanism to manage the threat of insiders to outsiders. In Australia, as in many other countries, the populace was enjoined by governments and health authorities to help prevent the spread of Covid-19 through isolation and immobility. There were various exceptions, principally those classified as essential workers, a heterogeneous cohort ranging from supermarket shelf stackers to pharmacists. People in the cultural, leisure and sports industries, including musicians, actors, and athletes, were not counted among this crucial labour force. Indeed, the performing arts (including dance, theatre and music) were put on ice with quite devastating effects on the livelihoods and wellbeing of those involved. So, with all major sports shut down (the exception being horse racing, which received the benefit both of government subsidies and expanding online gambling revenue), sport organisations began to represent themselves as essential services that could help sustain collective mental and even spiritual wellbeing. This case was made most aggressively by Australian Rugby League Commission Chairman, Peter V’landys, in contending that “an Australia without rugby league is not Australia”. In similar vein, prominent sport and media figure Phil Gould insisted, when describing rugby league fans in Western Sydney’s Penrith, “they’re lost, because the football’s not on … . It holds their families together. People don’t understand that … . Their life begins in the second week of March, and it ends in October”. Despite misgivings about public safety and equality before the pandemic regime, sporting bubbles were allowed to form, re-form and circulate. The indefinite shutdown of the National Rugby League (NRL) on 23 March 2020 was followed after negotiation between multiple entities by its reopening on 28 May 2020. The competition included a team from another nation-state (the Warriors from Aotearoa/New Zealand) in creating an international sporting bubble on the Central Coast of New South Wales, separating them from their families and friends across the Tasman Sea. Appeals to the mental health of fans and the importance of the NRL to myths of “Australianness” notwithstanding, the league had not prudently maintained a financial reserve and so could not afford to shut down for long. Significant gambling revenue for leagues like the NRL and Australian Football League (AFL) also influenced the push to return to sport business as usual. Sport contests were needed in order to exploit the gambling opportunities – especially online and mobile – stimulated by home “confinement”. During the coronavirus lockdowns, Australians’ weekly spending on gambling went up by 142 per cent, and the NRL earned significantly more than usual from gambling revenue—potentially $10 million above forecasts for 2020. Despite the clear financial imperative at play, including heavy reliance on gambling, sporting bubble-making involved special licence. The state of Queensland, which had pursued a hard-line approach by closing its borders for most of those wishing to cross them for biographical landmark events like family funerals and even for medical treatment in border communities, became “the nation's sporting hub”. Queensland became the home of most teams of the men’s AFL (notably the women’s AFLW season having been cancelled) following a large Covid-19 second wave in Melbourne. The women’s National Netball League was based exclusively in Queensland. This state, which for the first time hosted the AFL Grand Final, deployed sport as a tool in both national sports tourism marketing and internal pre-election politics, sponsoring a documentary, The Sporting Bubble 2020, via its Tourism and Events arm. While Queensland became the larger bubble incorporating many other sporting bubbles, both the AFL and the NRL had versions of the “fly in, fly out” labour rhythms conventionally associated with the mining industry in remote and regional areas. In this instance, though, the bubble experience did not involve long stays in miners’ camps or even the one-night hotel stopovers familiar to the popular music and sport industries. Here, the bubble moved, usually by plane, to fulfil the requirements of a live sport “gig”, whereupon it was immediately returned to its more solid bubble hub or to domestic self-isolation. In the space created between disciplined expectation and deplored non-compliance, the sporting bubble inevitably became the scrutinised object and subject of scandal. Sporting Bubble Scandals While people with a very low risk of spreading Covid-19 (coming from areas with no active cases) were denied entry to Queensland for even the most serious of reasons (for example, the death of a child), images of AFL players and their families socialising and enjoying swimming at the Royal Pines Resort sporting bubble crossed our screens. Yet, despite their (players’, officials’ and families’) relative privilege and freedom of movement under the AFL Covid-Safe Plan, some players and others inside the bubble were involved in “scandals”. Most notable was the case of a drunken brawl outside a Gold Coast strip club which led to two Richmond players being “banished”, suspended for 10 matches, and the club fined $100,000. But it was not only players who breached Covid-19 bubble protocols: Collingwood coaches Nathan Buckley and Brenton Sanderson paid the $50,000 fine imposed on the club for playing tennis in Perth outside their bubble, while Richmond was fined $45,000 after Brooke Cotchin, wife of team captain Trent, posted an image to Instagram of a Gold Coast day spa that she had visited outside the “hub” (the institutionally preferred term for bubble). She was subsequently distressed after being trolled. Also of concern was the lack of physical distancing, and the range of people allowed into the sporting bubble, including babysitters, grandparents, and swimming coaches (for children). There were other cases of players being caught leaving the bubble to attend parties and sharing videos of their “antics” on social media. Biosecurity breaches of bubbles by players occurred relatively frequently, with stern words from both the AFL and NRL leaders (and their clubs) and fines accumulating in the thousands of dollars. Some people were also caught sneaking into bubbles, with Lekahni Pearce, the girlfriend of Swans player Elijah Taylor, stating that it was easy in Perth, “no security, I didn’t see a security guard” (in Barron, Stevens, and Zaczek) (a month later, outside the bubble, they had broken up and he pled guilty to unlawfully assaulting her; Ramsey). Flouting the rules, despite stern threats from government, did not lead to any bubble being popped. The sport-media machine powering sporting bubbles continued to run, the attendant emotional or health risks accepted in the name of national cultural therapy, while sponsorship, advertising and gambling revenue continued to accumulate mostly for the benefit of men. Gendering Sporting Bubbles Designed as biosecurity structures to maintain the supply of media-sport content, keep players and other vital cogs of the machine running smoothly, and to exclude Covid-19, sporting bubbles were, in their most advanced form, exclusive luxury camps that illuminated the elevated socio-cultural status of sportsmen. The ongoing inequalities between men’s and women’s sport in Australia and around the world were clearly in evidence, as well as the politics of gender whereby women are obliged to “care” and men are enabled to be “careless” – or at least to manage carefully their “duty of care”. In Australia, the only sport for women that continued during the height of the Covid-19 lockdown was netball, which operated in a bubble that was one of sacrifice rather than privilege. With minimum salaries of only $30,000 – significantly less than the lowest-paid “rookies” in the AFL – and some being mothers of small children and/or with professional jobs juggled alongside their netball careers, these elite sportswomen wanted to continue to play despite the personal inconvenience or cost (Pavlidis). Not one breach of the netballers out of the bubble was reported, indicating that they took their responsibilities with appropriate seriousness and, perhaps, were subjected to less scrutiny than the sportsmen accustomed to attracting front-page headlines. National Netball League (also known after its Queensland-based naming rights sponsor as Suncorp Super Netball) players could be regarded as fortunate to have the opportunity to be in a bubble and to participate in their competition. The NRL Women’s (NRLW) Premiership season was also completed, but only involved four teams subject to fly in, fly out and bubble arrangements, and being played in so-called curtain-raiser games for the NRL. As noted earlier, the AFLW season was truncated, despite all the prior training and sacrifice required of its players. Similarly, because of their resource advantages, the UK men’s and boy’s top six tiers of association football were allowed to continue during lockdown, compared to only two for women and girls. In the United States, inequalities between men’s and women’s sports were clearly demonstrated by the conditions afforded to those elite sportswomen inside the Women’s National Basketball Association (WNBA) sport bubble in the IMG Academy in Florida. Players shared photos of rodent traps in their rooms, insect traps under their mattresses, inedible food and blocked plumbing in their bubble accommodation. These conditions were a far cry from the luxury usually afforded elite sportsmen, including in Florida’s Walt Disney World for the men’s NBA, and is just one of the many instances of how gendered inequality was both reproduced and exacerbated by Covid-19. Bursting the Bubble As we have seen, governments and corporate leaders in sport were able to create material and metaphorical bubbles during the Covid-19 lockdown in order to transmit stadium sport contests into home spaces. The rationale was the importance of sport to national identity, belonging and the routines and rhythms of life. But for whom? Many women, who still carry the major responsibilities of “care”, found that Covid-19 intensified the affective relations and gendered inequities of “home” as a leisure site (Fullagar and Pavlidis). Rates of domestic violence surged, and many women experienced significant anxiety and depression related to the stress of home confinement and home schooling. During the pandemic, women were also more likely to experience the stress and trauma of being first responders, witnessing virus-related sickness and death as the majority of nurses and care workers. They also bore the brunt of much of the economic and employment loss during this time. Also, as noted above, livelihoods in the arts and cultural sector did not receive the benefits of the “bubble”, despite having a comparable claim to sport in contributing significantly to societal wellbeing. This sector’s workforce is substantially female, although men dominate its senior roles. Despite these inequalities, after the late March to May hiatus, many elite male sportsmen – and some sportswomen - operated in a bubble. Moving in and out of them was not easy. Life inside could be mentally stressful (especially in long stays of up to 150 days in sports like cricket), and tabloid and social media troll punishment awaited those who were caught going “over the fence”. But, life in the sporting bubble was generally preferable to the daily realities of those afflicted by the trauma arising from forced home confinement, and for whom watching moving sports images was scant compensation for compulsory immobility. The ethical foundation of the sparkly, ephemeral fantasy of the sporting bubble is questionable when it is placed in the service of a voracious “media sports cultural complex” (Rowe, Global Media Sport) that consumes sport labour power and rolls back progress in gender relations as a default response to a global pandemic. Covid-19 dramatically highlighted social inequalities in many areas of life, including medical care, work, and sport. For the small minority of people involved in sport who are elite professionals, the only thing worse than being in a sporting bubble during the pandemic was not being in one, as being outside precluded their participation. Being inside the bubble was a privilege, albeit a dubious one. But, as in wider society, not all sporting bubbles are created equal. Some are more opulent than others, and the experiences of the supporting and the supported can be very different. The surface of the sporting bubble may be impermanent, but when its interior is opened up to scrutiny, it reveals some very durable structures of inequality. Bubbles are made to burst. They are, by nature, temporary, translucent structures created as spectacles. As a form of luminosity, bubbles “allow a thing or object to exist only as a flash, sparkle or shimmer” (Deleuze, 52). In echoing Deleuze, Angela McRobbie (54) argues that luminosity “softens and disguises the regulative dynamics of neoliberal society”. The sporting bubble was designed to discharge that function for those millions rendered immobile by home confinement legislation in Australia and around the world, who were having to deal with the associated trauma, risk and disadvantage. 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Introduction The highly contagious COVID-19 virus has presented particularly difficult public policy challenges. The relatively late emergence of an effective treatments and vaccines, the structural stresses on health care systems, the lockdowns and the economic dislocations, the evident structural inequalities in effected societies, as well as the difficulty of prevention have tested social and political cohesion. Moreover, the intrusive nature of many prophylactic measures have led to individual liberty and human rights concerns. As noted by the Victorian (Australia) Ombudsman Report on the COVID-19 lockdown in Melbourne, we may be tempted, during a crisis, to view human rights as expendable in the pursuit of saving human lives. This thinking can lead to dangerous territory. It is not unlawful to curtail fundamental rights and freedoms when there are compelling reasons for doing so; human rights are inherently and inseparably a consideration of human lives. (5) These difficulties have raised issues about the importance of social or community capital in fighting the pandemic. This article discusses the impacts of social and community capital and other factors on the governmental efforts to combat the spread of infectious disease through the maintenance of social distancing and household ‘bubbles’. It argues that the beneficial effects of social and community capital towards fighting the pandemic, such as mutual respect and empathy, which underpins such public health measures as social distancing, the use of personal protective equipment, and lockdowns in the USA, have been undermined as preventive measures because they have been transmogrified to become a salient aspect of the “culture wars” (Peters). In contrast, states that have relatively lower social capital such a China have been able to more effectively arrest transmission of the disease because the government was been able to generate and personify a nationalist response to the virus and thus generate a more robust social consensus regarding the efforts to combat the disease. Social Capital and Culture Wars The response to COVID-19 required individuals, families, communities, and other types of groups to refrain from extensive interaction – to stay in their bubble. In these situations, especially given the asymptomatic nature of many COVID-19 infections and the serious imposition lockdowns and social distancing and isolation, the temptation for individuals to breach public health rules in high. From the perspective of policymakers, the response to fighting COVID-19 is a collective action problem. In studying collective action problems, scholars have paid much attention on the role of social and community capital (Ostrom and Ahn 17-35). Ostrom and Ahn comment that social capital “provides a synthesizing approach to how cultural, social, and institutional aspects of communities of various sizes jointly affect their capacity of dealing with collective-action problems” (24). Social capital is regarded as an evolving social type of cultural trait (Fukuyama; Guiso et al.). Adger argues that social capital “captures the nature of social relations” and “provides an explanation for how individuals use their relationships to other actors in societies for their own and for the collective good” (387). The most frequently used definition of social capital is the one proffered by Putnam who regards it as “features of social organization, such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit” (Putnam, “Bowling Alone” 65). All these studies suggest that social and community capital has at least two elements: “objective associations” and subjective ties among individuals. Objective associations, or social networks, refer to both formal and informal associations that are formed and engaged in on a voluntary basis by individuals and social groups. Subjective ties or norms, on the other hand, primarily stand for trust and reciprocity (Paxton). High levels of social capital have generally been associated with democratic politics and civil societies whose institutional performance benefits from the coordinated actions and civic culture that has been facilitated by high levels of social capital (Putnam, Democracy 167-9). Alternatively, a “good and fair” state and impartial institutions are important factors in generating and preserving high levels of social capital (Offe 42-87). Yet social capital is not limited to democratic civil societies and research is mixed on whether rising social capital manifests itself in a more vigorous civil society that in turn leads to democratising impulses. Castillo argues that various trust levels for institutions that reinforce submission, hierarchy, and cultural conservatism can be high in authoritarian governments, indicating that high levels of social capital do not necessarily lead to democratic civic societies (Castillo et al.). Roßteutscher concludes after a survey of social capita indicators in authoritarian states that social capital has little effect of democratisation and may in fact reinforce authoritarian rule: in nondemocratic contexts, however, it appears to throw a spanner in the works of democratization. Trust increases the stability of nondemocratic leaderships by generating popular support, by suppressing regime threatening forms of protest activity, and by nourishing undemocratic ideals concerning governance (752). In China, there has been ongoing debate concerning the presence of civil society and the level of social capital found across Chinese society. If one defines civil society as an intermediate associational realm between the state and the family, populated by autonomous organisations which are separate from the state that are formed voluntarily by members of society to protect or extend their interests or values, it is arguable that the PRC had a significant civil society or social capital in the first few decades after its establishment (White). However, most scholars agree that nascent civil society as well as a more salient social and community capital has emerged in China’s reform era. This was evident after the 2008 Sichuan earthquake, where the government welcomed community organising and community-driven donation campaigns for a limited period of time, giving the NGO sector and bottom-up social activism a boost, as evidenced in various policy areas such as disaster relief and rural community development (F. Wu 126; Xu 9). Nevertheless, the CCP and the Chinese state have been effective in maintaining significant control over civil society and autonomous groups without attempting to completely eliminate their autonomy or existence. The dramatic economic and social changes that have occurred since the 1978 Opening have unsurprisingly engendered numerous conflicts across the society. In response, the CCP and State have adjusted political economic policies to meet the changing demands of workers, migrants, the unemployed, minorities, farmers, local artisans, entrepreneurs, and the growing middle class. Often the demands arising from these groups have resulted in policy changes, including compensation. In other circumstances, where these groups remain dissatisfied, the government will tolerate them (ignore them but allow them to continue in the advocacy), or, when the need arises, supress the disaffected groups (F. Wu 2). At the same time, social organisations and other groups in civil society have often “refrained from open and broad contestation against the regime”, thereby gaining the space and autonomy to achieve the objectives (F. Wu 2). Studies of Chinese social or community capital suggest that a form of modern social capital has gradually emerged as Chinese society has become increasingly modernised and liberalised (despite being non-democratic), and that this social capital has begun to play an important role in shaping social and economic lives at the local level. However, this more modern form of social capital, arising from developmental and social changes, competes with traditional social values and social capital, which stresses parochial and particularistic feelings among known individuals while modern social capital emphasises general trust and reciprocal feelings among both known and unknown individuals. The objective element of these traditional values are those government-sanctioned, formal mass organisations such as Communist Youth and the All-China Federation of Women's Associations, where members are obliged to obey the organisation leadership. The predominant subjective values are parochial and particularistic feelings among individuals who know one another, such as guanxi and zongzu (Chen and Lu, 426). The concept of social capital emphasises that the underlying cooperative values found in individuals and groups within a culture are an important factor in solving collective problems. In contrast, the notion of “culture war” focusses on those values and differences that divide social and cultural groups. Barry defines culture wars as increases in volatility, expansion of polarisation, and conflict between those who are passionate about religiously motivated politics, traditional morality, and anti-intellectualism, and…those who embrace progressive politics, cultural openness, and scientific and modernist orientations. (90) The contemporary culture wars across the world manifest opposition by various groups in society who hold divergent worldviews and ideological positions. Proponents of culture war understand various issues as part of a broader set of religious, political, and moral/normative positions invoked in opposition to “elite”, “liberal”, or “left” ideologies. Within this Manichean universe opposition to such issues as climate change, Black Lives Matter, same sex rights, prison reform, gun control, and immigration becomes framed in binary terms, and infused with a moral sensibility (Chapman 8-10). In many disputes, the culture war often devolves into an epistemological dispute about the efficacy of scientific knowledge and authority, or a dispute between “practical” and theoretical knowledge. In this environment, even facts can become partisan narratives. For these “cultural” disputes are often how electoral prospects (generally right-wing) are advanced; “not through policies or promises of a better life, but by fostering a sense of threat, a fantasy that something profoundly pure … is constantly at risk of extinction” (Malik). This “zero-sum” social and policy environment that makes it difficult to compromise and has serious consequences for social stability or government policy, especially in a liberal democratic society. Of course, from the perspective of cultural materialism such a reductionist approach to culture and political and social values is not unexpected. “Culture” is one of the many arenas in which dominant social groups seek to express and reproduce their interests and preferences. “Culture” from this sense is “material” and is ultimately connected to the distribution of power, wealth, and resources in society. As such, the various policy areas that are understood as part of the “culture wars” are another domain where various dominant and subordinate groups and interests engaged in conflict express their values and goals. Yet it is unexpected that despite the pervasiveness of information available to individuals the pool of information consumed by individuals who view the “culture wars” as a touchstone for political behaviour and a narrative to categorise events and facts is relatively closed. This lack of balance has been magnified by social media algorithms, conspiracy-laced talk radio, and a media ecosystem that frames and discusses issues in a manner that elides into an easily understood “culture war” narrative. From this perspective, the groups (generally right-wing or traditionalist) exist within an information bubble that reinforces political, social, and cultural predilections. American and Chinese Reponses to COVID-19 The COVID-19 pandemic first broke out in Wuhan in December 2019. Initially unprepared and unwilling to accept the seriousness of the infection, the Chinese government regrouped from early mistakes and essentially controlled transmission in about three months. This positive outcome has been messaged as an exposition of the superiority of the Chinese governmental system and society both domestically and internationally; a positive, even heroic performance that evidences the populist credentials of the Chinese political leadership and demonstrates national excellence. The recently published White Paper entitled “Fighting COVID-19: China in Action” also summarises China’s “strategic achievement” in the simple language of numbers: in a month, the rising spread was contained; in two months, the daily case increase fell to single digits; and in three months, a “decisive victory” was secured in Wuhan City and Hubei Province (Xinhua). This clear articulation of the positive results has rallied political support. Indeed, a recent survey shows that 89 percent of citizens are satisfied with the government’s information dissemination during the pandemic (C Wu). As part of the effort, the government extensively promoted the provision of “political goods”, such as law and order, national unity and pride, and shared values. For example, severe publishments were introduced for violence against medical professionals and police, producing and selling counterfeit medications, raising commodity prices, spreading ‘rumours’, and being uncooperative with quarantine measures (Xu). Additionally, as an extension the popular anti-corruption campaign, many local political leaders were disciplined or received criminal charges for inappropriate behaviour, abuse of power, and corruption during the pandemic (People.cn, 2 Feb. 2020). Chinese state media also described fighting the virus as a global “competition”. In this competition a nation’s “material power” as well as “mental strength”, that calls for the highest level of nation unity and patriotism, is put to the test. This discourse recalled the global competition in light of the national mythology related to the formation of Chinese nation, the historical “hardship”, and the “heroic Chinese people” (People.cn, 7 Apr. 2020). Moreover, as the threat of infection receded, it was emphasised that China “won this competition” and the Chinese people have demonstrated the “great spirit of China” to the world: a result built upon the “heroism of the whole Party, Army, and Chinese people from all ethnic groups” (People.cn, 7 Apr. 2020). In contrast to the Chinese approach of emphasising national public goods as a justification for fighting the virus, the U.S. Trump Administration used nationalism, deflection, and “culture war” discourse to undermine health responses — an unprecedented response in American public health policy. The seriousness of the disease as well as the statistical evidence of its course through the American population was disputed. The President and various supporters raged against the COVID-19 “hoax”, social distancing, and lockdowns, disparaged public health institutions and advice, and encouraged protesters to “liberate” locked-down states (Russonello). “Our federal overlords say ‘no singing’ and ‘no shouting’ on Thanksgiving”, Representative Paul Gosar, a Republican of Arizona, wrote as he retweeted a Centers for Disease Control list of Thanksgiving safety tips (Weiner). People were encouraged, by way of the White House and Republican leadership, to ignore health regulations and not to comply with social distancing measures and the wearing of masks (Tracy). This encouragement led to threats against proponents of face masks such as Dr Anthony Fauci, one of the nation’s foremost experts on infectious diseases, who required bodyguards because of the many threats on his life. Fauci’s critics — including President Trump — countered Fauci’s promotion of mask wearing by stating accusingly that he once said mask-wearing was not necessary for ordinary people (Kelly). Conspiracy theories as to the safety of vaccinations also grew across the course of the year. As the 2020 election approached, the Administration ramped up efforts to downplay the serious of the virus by identifying it with “the media” and illegitimate “partisan” efforts to undermine the Trump presidency. It also ramped up its criticism of China as the source of the infection. This political self-centeredness undermined state and federal efforts to slow transmission (Shear et al.). At the same time, Trump chided health officials for moving too slowly on vaccine approvals, repeated charges that high infection rates were due to increased testing, and argued that COVID-19 deaths were exaggerated by medical providers for political and financial reasons. These claims were amplified by various conservative media personalities such as Rush Limbaugh, and Sean Hannity and Laura Ingraham of Fox News. The result of this “COVID-19 Denialism” and the alternative narrative of COVID-19 policy told through the lens of culture war has resulted in the United States having the highest number of COVID-19 cases, and the highest number of COVID-19 deaths. At the same time, the underlying social consensus and social capital that have historically assisted in generating positive public health outcomes has been significantly eroded. According to the Pew Research Center, the share of U.S. adults who say public health officials such as those at the Centers for Disease Control and Prevention are doing an excellent or good job responding to the outbreak decreased from 79% in March to 63% in August, with an especially sharp decrease among Republicans (Pew Research Center 2020). Social Capital and COVID-19 From the perspective of social or community capital, it could be expected that the American response to the Pandemic would be more effective than the Chinese response. Historically, the United States has had high levels of social capital, a highly developed public health system, and strong governmental capacity. In contrast, China has a relatively high level of governmental and public health capacity, but the level of social capital has been lower and there is a significant presence of traditional values which emphasise parochial and particularistic values. Moreover, the antecedent institutions of social capital, such as weak and inefficient formal institutions (Batjargal et al.), environmental turbulence and resource scarcity along with the transactional nature of guanxi (gift-giving and information exchange and relationship dependence) militate against finding a more effective social and community response to the public health emergency. Yet China’s response has been significantly more successful than the Unites States’. Paradoxically, the American response under the Trump Administration and the Chinese response both relied on an externalisation of the both the threat and the justifications for their particular response. In the American case, President Trump, while downplaying the seriousness of the virus, consistently called it the “China virus” in an effort to deflect responsibly as well as a means to avert attention away from the public health impacts. As recently as 3 January 2021, Trump tweeted that the number of “China Virus” cases and deaths in the U.S. were “far exaggerated”, while critically citing the Centers for Disease Control and Prevention's methodology: “When in doubt, call it COVID-19. Fake News!” (Bacon). The Chinese Government, meanwhile, has pursued a more aggressive foreign policy across the South China Sea, on the frontier in the Indian sub-continent, and against states such as Australia who have criticised the initial Chinese response to COVID-19. To this international criticism, the government reiterated its sovereign rights and emphasised its “victimhood” in the face of “anti-China” foreign forces. Chinese state media also highlighted China as “victim” of the coronavirus, but also as a target of Western “political manoeuvres” when investigating the beginning stages of the pandemic. The major difference, however, is that public health policy in the United States was superimposed on other more fundamental political and cultural cleavages, and part of this externalisation process included the assignation of “otherness” and demonisation of internal political opponents or characterising political opponents as bent on destroying the United States. This assignation of “otherness” to various internal groups is a crucial element in the culture wars. While this may have been inevitable given the increasingly frayed nature of American society post-2008, such a characterisation has been activity pushed by local, state, and national leadership in the Republican Party and the Trump Administration (Vogel et al.). In such circumstances, minimising health risks and highlighting civil rights concerns due to public health measures, along with assigning blame to the democratic opposition and foreign states such as China, can have a major impact of public health responses. The result has been that social trust beyond the bubble of one’s immediate circle or those who share similar beliefs is seriously compromised — and the collective action problem presented by COVID-19 remains unsolved. Daniel Aldrich’s study of disasters in Japan, India, and US demonstrates that pre-existing high levels of social capital would lead to stronger resilience and better recovery (Aldrich). Social capital helps coordinate resources and facilitate the reconstruction collectively and therefore would lead to better recovery (Alesch et al.). Yet there has not been much research on how the pool of social capital first came about and how a disaster may affect the creation and store of social capital. Rebecca Solnit has examined five major disasters and describes that after these events, survivors would reach out and work together to confront the challenges they face, therefore increasing the social capital in the community (Solnit). However, there are studies that have concluded that major disasters can damage the social fabric in local communities (Peacock et al.). The COVID-19 epidemic does not have the intensity and suddenness of other disasters but has had significant knock-on effects in increasing or decreasing social capital, depending on the institutional and social responses to the pandemic. In China, it appears that the positive social capital effects have been partially subsumed into a more generalised patriotic or nationalist affirmation of the government’s policy response. Unlike civil society responses to earlier crises, such as the 2008 Sichuan earthquake, there is less evidence of widespread community organisation and response to combat the epidemic at its initial stages. This suggests better institutional responses to the crisis by the government, but also a high degree of porosity between civil society and a national “imagined community” represented by the national state. The result has been an increased legitimacy for the Chinese government. Alternatively, in the United States the transformation of COVID-19 public health policy into a culture war issue has seriously impeded efforts to combat the epidemic in the short term by undermining the social consensus and social capital necessary to fight such a pandemic. Trust in American institutions is historically low, and President Trump’s untrue contention that President Biden’s election was due to “fraud” has further undermined the legitimacy of the American government, as evidenced by the attacks directed at Congress in the U.S. capital on 6 January 2021. As such, the lingering effects the pandemic will have on social, economic, and political institutions will likely reinforce the deep cultural and political cleavages and weaken interpersonal networks in American society. Conclusion The COVID-19 pandemic has devastated global public health and impacted deeply on the world economy. Unsurprisingly, given the serious economic, social, and political consequences, different government responses have been highly politicised. Various quarantine and infection case tracking methods have caused concern over state power intruding into private spheres. The usage of face masks, social distancing rules, and intra-state travel restrictions have aroused passionate debate over public health restrictions, individual liberty, and human rights. Yet underlying public health responses grounded in higher levels of social capital enhance the effectiveness of public health measures. In China, a country that has generally been associated with lower social capital, it is likely that the relatively strong policy response to COVID-19 will both enhance feelings of nationalism and Chinese exceptionalism and help create and increase the store of social capital. 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