Journal articles on the topic 'Ankle Wounds and injuries Australia'

The management of extremity injuries above the knee has been well described, but the evaluation and treatment guidelines for penetrating injuries below the popliteal crease has received less attention. A 6-year retrospective review of 100 patients who sustained isolated below-knee gunshot wounds. Patients with proximal extremity, torso, or head wounds were excluded from review so that we could focus on principles of managing below-knee wounds. All patients were evaluated with complete physical examination, ankle-brachial index, and plain X-rays. One patient presented with hemodynamic instability. Twenty-four patients underwent arteriography based on physical examination, an ankle-brachial index less than 0.9, or both. Twenty-two vascular injuries were identified in 19 patients, and an additional injury was found in a patient who went directly to surgery for pulsatile bleeding. Six of these 22 vascular injuries required treatment for bleeding or arteriovenous fistula. Treatment was by embolization in 5 and surgical ligation in 1. Thirteen patients had compartment syndromes. Thirty-five patients had fractures, and ten (29%) of these had an associated vascular injury. Four patients had peroneal nerve injuries, and three of these had long term disability. No limb loss or death occurred. We conclude that patients with low-velocity below-knee gunshot wounds sustain fractures, vascular injuries, compartment syndromes, and nerve injuries, in decreasing order of frequency. Arteriography and embolization may be useful to control bleeding; vascular reconstruction was unnecessary in our experience, and limb loss did not occur.

Netball is a ball game played by two groups of seven players. Its improvement, got from early forms of ball, started in England during the 1890s. By 1960, universal playing guidelines had been institutionalized for the game. The ankle joint is a pivot joint framed between the tibia and fibula and the bone and enables the foot to twist upwards and downwards. The joint likewise permits a modest quantity of pivot. The joint's dependability originates from the basic course of action of the bones and the encompassing tendons. Ankle injuries can transpire at any age. This article surveys epidemiological investigations on ankle injuries in netball, and what are the sorts of ankle injuries, how it's happen and also survey how counteractive action from ankle injuries and aversion strategies. Furthermore, talk about around a few activities that can use for prevent from ankle injuries in netball. The purpose of the study was to investigate the several Ankle injuries of netball players in different countries. The methodology used for this review was based on previously published guidelines. It included research articles, journals, research publications, reviews and books. Collect all the findings and add the references. Of 47 articles are found and 18 are included in this review essay. Results demonstrate that the ankle injury was the most widely recognized harmed body site in netball and an Ankle sprain was the real lower leg damage happen in Netball. Ankle sprains represent an enormous level of wounds supported in netball. This efficient survey gives a synopsis of the study of disease transmission of ankle damage in Netball.

O b j e c t i v e ; To find out types of traumatic injuries in bicycle passenger children. S e t t i n g : At PAC hospital Kamra. P e r i o d :From October 2005 to October 2007. Patients & M e t h o d s : The children between the ages of 03 to 10 years were included in this study.They were divided into two groups. First group(Gp-l) sustained injuries due to ankle or foot entrapment in rear running wheel while thesecond group(Gp-ll) sustained injuries due to fall of bicycle, while child sitting alone either at front bar or rear luggage carrier unattended.R e s u l t s : Gp-I sustained mostly frictional injuries ranging from simple abrasion to deep lacerated wounds of lower leg, ankle and foot. Whilein Gp-ll severe injuries like fractures of upper and lower limbs, visceral abdominal injuries and head injuries were observed. C o n c l u s i o n :Bicycle passenger injuries are common injuries of the children in less developed countries. These injuries range from simple "road rash' toserious head injuries.

Acute projectile injuries to the foot can present a challenge for the podiatric physician, especially in terms of their chronic effects. The case of a shrapnel wound to the right foot and ankle that resulted in recurrent episodes of soft tissue infection and disability is presented. Treatment consisted of excision of the shrapnel fragment, debridement, and primary closure of the sinus tract created by the projectile. The authors discuss the acute and chronic effects of projectile injuries, factors responsible for determining the severity of these wounds, and various methods of treatment.

In 1998, the Canadian historian and politician Michael Ignatieff wrote: “All nations depend on forgetting: on forging myths of unity and identity that allow a society to forget its founding crimes, its hidden injuries and divisions, its unhealed wounds.” Ironically, Ignatieff's home country has belied his assertion. Canada has engaged in collective remembering of one of its hidden injuries—the Indian residential schools—through a Truth and Reconciliation Commission (TRC) from 2009 to 2015. Australia, too, has reckoned since the 1990s with its own unhealed wounds—the separation of Aboriginal and Torres Strait Islander children from their families, or, in common parlance, the “Stolen Generations.”

Introduction Diagnosis and repair of arterial injury from penetrating trauma is critical because the lack of intervention can result in limb loss or death. Patients that have conspicuous arterial injuries can be explored and repaired in the operating room with or without preoperative diagnostic imaging. Patients without definite clinical evidence of vascular injury (i.e., hematoma, pulsatile mass, bruit, or pulse deficit) generally undergo angiography because of proximity of injury. Arteriography is an expensive and invasive procedure for patients; it carries some discomfort and has potential complications associated with its use. In our experience, ankle/brachial index (ABI) alone has not been a dependable study to rule out significant arterial injury of extremities. Color flow duplex imaging is a painless procedure, has no risk to the patient, is not as expensive as arteriography and is readily available in most institutions. We present two patients who had normal pulses and ABIs after gunshot wounds to extremities. Both patients had significant arterial injury detected by color flow duplex imaging as the initial diagnostic modality and subsequently proceeded on to arteriography based on the findings of the duplex studies. Conclusions The findings of the duplex imaging were in direct correlation with arteriography. These two cases demonstrate the sensitivity of color flow duplex ultrasonography to detect extremity arterial injuries in a community hospital.

Introduction:The Misericord, or stabbing pike, was a frequently used battlefield implement in medieval times. The misericord was used by battlefield clerics to relieve the suffering of irreparably wounded soldiers. Its cultural parallels include the Roman gladius, the Japanese wakazashi, and the eponymous Liston knife used in pre-Victorian era surgery in England.Methods:This demonstration will analyze modern misericord injuries in the light of the current epidemic of long knife (or zombie knife) attacks in London and the domestic terrorist threat in Australia.Discussion:A review of this weapon is pertinent to the projected low-technology, low-impact, and deep-penetrating wounds expected in urban terrorism in Australia and other cities globally. The talk will emphasize field discussion, demonstration, and disarming techniques against modern misericord-type weapons.

Simultaneous dislocation of three joints the hip knee and ankle joint in an ipsilateral limb is a very rare pattern of injury and only a single case has been reported in the literature, but it is associated with acetabulum fracture. A 34-year-old male had met with a road traffic accident involving left lower limb. Radiographic examination revealed (i) Posterior dislocation of the hip joint without any fracture (ii) Posterior dislocation of the knee joint(iii)Open fracture dislocation of the ankle joint with medial malleolus fracture tibial pilon fracture. The patient underwent an immediate closed reduction of the hip joint by Allis method. Simultaneous reduction of the knee and ankle joint was done and appropriate splintage gave. Open wounds were well debrided and trans-articular fixator was placed over knee and ankle joint. At a second stage, the medial malleolus fracture and tibia pilon fracture were fixed. MRI scan was done which revealed an anterior cruciate ligament injury of the knee. At 6-month follow-up, the patient was ambulating with full weight-bearing on both lower extremities without any assistive devices. There always lies a high risk of hemodynamic instability and other serious and life-threatening injuries due to the high velocity of trauma involved in such cases. The outcome of ipsilateral hip knee and ankle dislocation can vary widely depending on the circumstances and other associated injuries.

OBJECTIVE: To evaluate the ability of a novel topical antimicrobial gel containing cetrimide, bacitracin, and polymyxin B sulfate to prevent infections of minor wounds. DESIGN: A clinical trial compared the test preparation with placebo and a povidone iodine antiseptic cream. SETTING: Five primary schools in Sydney, Australia, participated in the study over a 6-week spring/summer school term. SUBJECTS: Children aged 5–12 years with parental consent were eligible for study participation. Accidental injuries occurring at school were treated in a standardized manner by nurses at each site. OUTCOME MEASURES: Wounds were evaluated by the medical practitioner after 3 days of topical treatment. The clinical outcome was classified as resolution or suspected infection. If a clinical infection was suspected, the injury was swabbed for microbiologic evaluation. Growth of a dominant microorganism was classified as a microbiologic infection. RESULTS: Of the 177 injuries treated, there were nine clinical infections. A comparison of these showed a significant difference among treatment groups (p < 0.05). This difference was associated with the test preparation and placebo; the test preparation reduced the incidence of clinical infection from 12.5% to 1.6% (p < 0.05; 95% CI, 0.011 to 0.207). A comparison of microbiologic infections showed no significant differences among treatment groups (p > 0.05). CONCLUSIONS: The novel gel preparation containing cetrimide, bacitracin, and polymyxin B sulfate showed therapeutic action and reduced the incidence of clinical infections in minor accidental wounds. It may be a suitable product for first aid prophylaxis.

Introduction: Traumatic rupture of posterior tibialis tendon in association with medial malleolus fracture is extremely rare. Case Presentation: We demonstrate our experience in the management of a complete posterior tibialis tendon (PTT) rupture and anterior talofibular ligament avulsion fracture from the talus in association with medial malleolus fracture in a 30-year-old male motorcyclist without any open wounds. Discussion: We believe this to be the first reported injury of this type in the literature. Closed ankle fractures may obscure surrounding tendon rupture and the clinician may be tempted to focus on the osseous injuries rather than the significance of associated soft tissue injures. Conclusion: This particular case demonstrates the importance of assessing for PTT injury in situations where high velocity impact to the ankle results in malleolar fracture.

The use of Hoffmann external fixation in the treatment of ankle and foot trauma in 26 patients is reviewed. There were 21 males and five females, ranging in age from 14 to 56 years. There were 22 fresh fractures and four arthrodeses. Fourteen of the 22 injuries were open fractures. Eight of 22 involved foot joint disruptions. This form of treatment required a complete set of external fixation equipment, sound knowledge of foot and ankle anatomy, and technical skill in frame construction and application. This fixateur allowed three plane stabilization of complex fractures, mobilization of unaffected joints, and access to wounds for soft tissue care. Follow-up evaluations from 24 to 48 months demonstrated good clinical results. The fractures healed and soft tissue and joint function were preserved. The arthrodeses fused. There were no neurovascular complications, pin tract infections, or equipment breakage. Foot trauma frequently combines soft tissue injury and complex skeletal instability, which makes external fixation particularly attractive. Although ideal indications for the use of this technique have not yet been determined, the theoretical advantages and initial results are encouraging. External fixation is a useful addition to the treatment armamentarium of the foot surgeon.

Electrical burns, especially high-voltage burns, usually cause necrosis of the subcutaneous fat, fascia, muscle, and bone. The reconstruction of electrical injuries often involves multiple surgeries. We present the case of a 56-year-old man who was injured by a high-voltage current resulting in multiple soft tissue defects on the left ankle and plantar area. The wounds on the malleolar and lateral plantar areas had burned the muscle, tendon, and bone. Because the patient had multiple wounds and unstable vessels, we took the strategy of operating in stages. The primary aim of treatment was wound healing and maintaining the support structure for mobility. Several rounds of wide debridement and negative-pressure wound therapy, followed by application of acellular dermal matrix and split-thickness skin graft were performed as part of the first stage. At the 1-year follow-up, the patient could walk independently wearing a splint to prevent foot drop. A second reconstructive surgery is possible, if necessary.

New Zealand fur seals Arctocephalus forsteri are the most abundant of the 4 otariid (eared seal) species distributed across Australasia. Analyses of stomach contents, scats and regurgitates suggest a diet dominated by bony fish and squid, with cartilaginous species (e.g. sharks and rays) either absent or underrepresented because of a lack of preservable hard parts. Here we report on a subadult specimen from south-eastern Australia, which was found ashore emaciated and with numerous puncture wounds across its lips, cheeks, throat and the inside of its oral cavity. Fish spines embedded in the carcass revealed that these injuries were inflicted by chimaeras and myliobatiform rays (stingrays and relatives), which matches reports on the diet of A. forsteri from New Zealand, but not South Australia. Shaking and tearing of prey at the surface may help to avoid ingestion of the venomous spines, perhaps contributing to their absence from scats and regurgitates. Nevertheless, the number and severity of the facial stab wounds, some of which led to local necrosis, likely affected the animal’s ability to feed, and may account for its death. Despite their detrimental effects, fish spine-related injuries are difficult to spot, and may be a common, albeit cryptic, type of trauma. We therefore recommend that stranded seals be systematically examined for this potentially life-threatening pathology.

Aim. To present the technique and efficacy of extended ankle and foot fasciotomy, as a surgical limb-salvage procedure associated with the successful revascularization after the gold interval. Method. A retrospective review of six patients at the age of 16?79 years (mean 39) in the period from 1996 to 2003, treated with the extended ankle and foot fasciotomy. There were four males undergoing the delayed treatment of war injuries to the lower extremity, and two females with atherosclerotic occlusive disease (a. illiacae dex and a. poplitealis dex.). The average ishemic time in the wounded patients was 22 hours (range, 14?30 hours), and ischemic time in occlusive disease (range, 48?72 hours). Clinical signs, indications, surgical access and the technique of extended ankle and foot fasciotomy was reported. Results. The obtained results were classified as early and late. There was no cases with lethal outcome. Incisional wounds closed 15 days after the intervention, using secondary suture or skin transplant sec. Thiersch. The satisfactory functional results were achieved in 4 of the patients, 1 had a small edema, while amputation was performed in 1 patient. Conclusion. In cases of prolonged foot ischemia with edema and paresthesia in the toes, extended ankle and foot fasciotomy should be performed as a surgical limb-salvage procedure.

The rate of aerobic dance injuries has been high for two decades. To determine the types of lower-extremity injuries to aerobic instructors, a questionnaire was sent to 18 fitness centers in the Sydney, Australia, metropolitan area requesting information on the number and types of injuries, frequency of activity levels, footwear worn, and treatments sought. The reported rate of injury was 77%. The leg was the most common site of injury, reported by 52.9% of respondents, followed by the foot and ankle (32.8%), and the knee (20%). These figures are comparable to previous studies. Further investigation is warranted into causes and preventive measures, and information on the kinetics and kinematics of the lower extremity may increase understanding of the incidence of lower-extremity injuries to aerobic instructors and participants. (J Am Podiatr Med Assoc 91(10): 528-532, 2001)

Background. The incidence and risk factors of wound-healing complications following rotational ankle fracture surgery are well documented in the literature. However, there is a paucity regarding management options following these complications. The goal of this study was to provide a descriptive analysis of one surgeon’s experience managing wound complications in patients who have undergone ankle fracture surgery. Methods. A total of 215 patients who were operatively treated for an unstable ankle were retrospectively identified. Patient demographics, medical histories, initial injury characteristics, surgical interventions, and clinical follow-up were collected. Twenty-five of these patients developed postoperative wound problems. Results. Of the original cohort of 215 patients, 25 (11.6%) developed wound-healing complications. Their average age was 53.6 ± 18.0 years; there were 12 males (48.0%). Connective tissue/inflammatory disease (odds ratio [OR] 3.9), cardiovascular disease (OR 3.6), and active smoking (OR 3.3) were associated with an increased likelihood of developing postoperative wound complications. With regard to injuries, open fractures (OR 17.9) had the highest likelihood of developing postoperative complications, followed by type 44-C (OR 2.8) and trimalleolar fractures (OR 2.0). Conclusion. Wound complications following open treatment of ankle fractures occurred with an incidence of 11.6% in this series, of which only about half required operative intervention. A third of wounds were managed by orthopaedics in conjunction with plastic surgery. Levels of Evidence: Level III: Retrospective comparative study

Category: Trauma Introduction/Purpose: Gunshot wounds are common injuries encountered by orthopaedists in urban settings. Retained missiles can lead to significant morbidity and functional impairment. Despite the potential for adverse sequelae, controversy remains regarding the role of routine bullet removal. Suggested indications for bullet removal include those leading to infection and lead toxicity. Bullets located in the palm of the hand, sole of the foot, or intraarticularly are commonly removed as well. Given the unlikeliness of a retained missile sparing the many joints or sole of the foot, we question the indications for conservative management. The purpose of this case series of is to further develop indications for bullet removal from the foot. Methods: A medical record search was performed at a single one trauma institution, with high volume of patients with ballistic injury, for patients who underwent bulletectomy from 2008 until 2018. Of the 169 patients originally obtained, 17 patients underwent bulletectomy, with associated irrigation and debridement, of the foot and ankle. The record of each patient in this retrospective case series was individually reviewed for location of retained missile, indications for removal, whether the procedure was performed at the bedside or in the operating room, concomitant injuries or surgeries, and follow up. Results: Of the 17 patients with retained bullets removed from the foot and ankle, four (23.5%) were removed at the bedside versus the operating room. Indications for removal were painful palpable subcutaneous position of the bullet (11 or 64.7%), periarticular or intraarticular bullet (five or 29.4%), and infected wound with removal of foreign body to optimize healing (one or 5.9%). The location of the palpable missiles included three on the plantar foot, four on the dorsal foot, and four located in subcutaneous tissues adjacent to the ankle joint. Nine out of seventeen (52.9%) had fractures associated with the retained missile. Of the patients with OR procedure (13), the majority of them (nine or 69.2%) were in the operating room for another procedure as well. Conclusion: The indications for bulletectomy of the foot and ankle are not definite, however, it is recommended that bullets located in the weightbearing plantar foot or intraarticularly be removed. After analysis of a seventeen patient retrospective case series, we support these indications but also advocate for the removal of any painful subcutaneous or periarticular bullet, whether under local anesthesia or in the operating room. In our experience, the prominent foot and ankle bullet is often removed during a procedure for another anatomic site. Bulletectomy of the foot and ankle in a stable polytrauma patient should be considered.

Purpose: to determine the causes of injuries in sports and the factors that cause them. Material and methods: study of special literature and generalization of experience of preparation of sportsmen in various kinds of sports. Analysis of factors influencing sports injuries in order to develop measures for their prevention. Results: There are a large number of injuries that can be received during sports. In our article we will consider some of them. Trauma is a lesion of the surface of the body or internal organs, which arose under the influence of external factors, as a result of which one or another organ has lost the ability to perform its function. Depending on the nature of the injured tissue, there are skin (strokes, wounds), subcutaneous (ligament ruptures, bone fractures, etc.) and abdominal (hemorrhage, chest injuries, joints) injuries. Injuries are divided into direct and indirect, depending on the point of application of force. They can be single (eg, transverse femoral fracture), multiple (multiple rib fracture), combined (pelvic fracture with rupture of the bladder) and combined (hip fracture and frostbite, etc.). Injuries are open with a violation of integrity and closed, when the replacement of tissues and organs occurs with intact skin and mucous membranes. According to the level of severity of injuries are divided into mild, moderate and severe. Injuries to the extremities are most often observed in the localization of injuries in athletes, among them injuries of the joints, especially the knee and ankle, predominate. Upper limb injuries (70.0% of all injuries) are more common during gymnastics. Most sports are characterized by injuries of the lower extremities, such as athletics and skiing (66,0 %). Head and face injuries are typical for boxers (65,0 %), fingers - for basketball players and volleyball players (80,0 %), elbow joint for tennis players (70,0 %), knee joint - for football players (48,0 %). etc. Among sports injuries, as a rule, a high percentage of injuries of medium severity. Conclusion: analysis of the causes of injuries in sports, allows us to conclude that injuries in sports can be prevented. A coach in a certain sport plays a crucial role in injury prevention. Its activities should take place in close contact with medical staff. It is the physician's responsibility to systematically record all injuries. Not only severe injuries, but also moderate injuries must be carefully studied, the causes of their occurrence must be identified and the necessary measures to eliminate them must be developed.

Abstract Background We present a case of Clostridium beijerinckii osteomyelitis in the presence of retained foreign bodies not seen on MRI. Methods A 45-year-old female with type 2 diabetes sustained multiple open right leg injuries, grossly contaminated with gravel, after a motor vehicle collision. She underwent external fixation (ex-fix) and 5 irrigations and debridements (I&D) initially. Polymicrobial intraoperative cultures (Cx) were treated with vancomycin and ertapenem for 6 weeks. One month post-antibiotic completion, pain, and swelling developed in ankle; contrast MRI revealed avascular necrosis and osteomyelitis (OM) of talus. Cx from repeat I&D grew same organisms; meropenem was recommended for 6 weeks. During meropenem week 6, pain was minimal and wound was closed. During attempt to implant hardware, pus was seen around peroneal tendon. Cx grew Clostridium species and Bacteroides from tibia, calcaneus, talus, and peroneal tendon sheath; meropenem was continued. Pain worsened 3 weeks later; I&D revealed pus in lateral ankle. To better access the medial ankle, a longitudinal incision was made along posterior tibial tendon, perpendicular to prior surgical incision. Immediate purulence, grass blades, and rocks were seen. Brucella agar had a rare gray colony at 48 hours and was subbed to blood and Brucella agar; it grew on Brucella agar with aero tolerance test. Gram stain showed Gram-positive rods with subterminal spores. Rapid ANA panel identified isolate as Clostridium beijerinckii (Cb) with > 99.9% probability and bioscore 1/24. Results Cb is a strict anaerobic gram-positive rod with oval subterminal spores. Found in soil and water, its main use is industrial solvent production. Infection by Cb is rare; only 2 cases of OM, 1 traumatic endophthalmitis, and 1 mitral valve endocarditis have been reported. While uncommon, Clostridial osteomyelitis is associated with contaminated open traumatic injuries. It can be difficult to eradicate, despite aggressive surgical intervention and appropriate antibiotics. Conclusion This is the third case of Cb OM described. Anaerobic cultures should be collected during I&D of open traumatic wounds. If infection persists, careful intraoperative evaluation of wound for residual foreign bodies, even if not seen radiologically, should be performed. Disclosures All authors: No reported disclosures.

Introduction. Achilles tendon rupture is a common injury requiring surgical repair. Re-ruptures, infections, delayed wound healing, and hematomas have been reported postoperatively. Objective. This case series described the use of ultraportable negative pressure wound therapy (NPWT) and compression bandaging following postoperative dehiscence of Achilles tendon repair. Materials and Methods. Retrospective records were reviewed to identify patients who underwent wound management for Achilles tendon dehiscence between January 2014 and January 2018. Patient demographics, wound size at first and last visit, number of visits, and previous treatment data were extracted. Wound management included wound irrigation, surgical debridement, and application of silver dressings, as needed. Therapy was transitioned to ultraportable NPWT with twice-weekly dressing changes. When possible, patients with an ankle-brachial index greater than 0.8 received multilayer, multicomponent compression. Treatment response was evaluated using a wound imaging system at 2-week to 4-week intervals for a total of 24 weeks. Results. Nine male patients with a mean age of 69.7 years presented for care. One patient sustained injury during sports activities, and the other 8 patients sustained injuries resulting from household accidents. Six patients achieved complete wound closure. Three patients achieved a mean 90% wound closure. No adverse effects were observed during treatment with NPWT and compression therapy. Conclusions. In the current study, ultraportable NPWT and compression bandaging were found to be effective in the management of wounds with critical local vascularity. Larger, randomized controlled studies are necessary to fully assess the potential clinical benefit of NPWT and compression therapy in the management of postoperative wounds of the Achilles tendon.

Category: Ankle; Hindfoot; Trauma Introduction/Purpose: Talus fractures, although rare, can lead to devastating complications of posttraumatic osteoarthritis (PTA), mal-union, non-unions and avascular necrosis (AVN). The timing and method of fixation has been controversial, especially for open and extruded fractures. The purpose of this study is to present short term outcomes using a posterior talus arthroscopic reduction internal fixation (TARIF) technique. Methods: We performed a retrospective study on 12 consecutive patients undergoing primary posterior arthroscopic reduction internal fixation for talus fractures from August 2020 to January 2021. All cases were performed completely arthroscopically, utilizing a posterior approach and cannulated screws. Patient demographics, fracture pattern, perioperative complications, and radiographic findings were collected. Results: The mean age of our cohort was 37.3 years (range, 19-75), including 6 males and 6 females, with 58% utilizing nicotine. Motor vehicle accidents accounted for 58% of injuries, followed by falls and gunshot wounds. Fracture location included 7 body fractures, 5 neck fractures Hawkins type 2 (1), 3 (3), and 4 (1). Five fractures were open injuries, 2 of which had vascular injuries that underwent irrigation and debridement followed by external fixation. Intraoperatively, all patients had 2-3 anterior to posterior 3.5mm cannulated headless screws placed with a mean tourniquet time of 87 minutes (range, 0 - 88). Postoperatively, all fractures had the articular surface restored to within 2mm on radiographs. No patients required antibiotics and no debridement's were performed. No acute AVN has been recorded. Conclusion: Our short-term results indicate posterior arthroscopic reduction internal fixation of talus fractures are safe and able to restore the articular surfaces. It also suggests that an all-inside soft-tissue preserving technique may reduce short term complications.

Objective: To identify and analyze articles in which the authors examined risk factors for soldiers during military static-line airborne operations. Data Sources: We searched for articles in PubMed, the Defense Technical Information Center, reference lists, and other sources using the key words airborne, parachuting, parachutes, paratrooper, injuries, wounds, trauma, and musculoskeletal. Study Selection: The search identified 17 684 potential studies. Studies were included if they were written in English, involved military static-line parachute operations, recorded injuries directly from events on the landing zone or from safety or medical records, and provided data for quantitative assessment of injury risk factors. A total of 23 studies met the review criteria, and 15 were included in the meta-analysis. Data Extraction: The summary statistic obtained for each risk factor was the risk ratio, which was the ratio of the injury risk in 1 group to that of another (baseline) group. Where data were sufficient, meta-analyses were performed and heterogeneity and publication bias were assessed. Data Synthesis: Risk factors for static-line parachuting injuries included night jumps, jumps with extra equipment, higher wind speeds, higher air temperatures, jumps from fixed-wing aircraft rather than balloons or helicopters, jumps onto certain types of terrain, being a female paratrooper, greater body weight, not using the parachute ankle brace, smaller parachute canopies, simultaneous exits from both sides of an aircraft, higher heat index, winds from the rear of the aircraft on exit entanglements, less experience with a particular parachute system, being an enlisted soldier rather than an officer, and jumps involving a greater number of paratroopers. Conclusions: We analyzed and summarized factors that increased the injury risk for soldiers during military static-line parachute operations. Understanding and considering these factors in risk evaluations may reduce the likelihood of injury during parachuting.

Basketball is one of the most played games in the world with a huge amount of fan following and has a great number of basketballers. Sometimes players get severe lower body wounds such as ankle sprains, shortage of breath, head, teeth, hand, and fingers. Female players have a higher risk of knee injuries than male players. These are health issues that players face while playing basketball. Sports organizations spend millions to train fresh basketball players or for the development of the previous basketball players. The internet of things (IoT) made everyday things readable, controllable and recognizable through the internet and the wireless sensor networks. It is simply the network of interconnected devices that are embedded with sensors, software, and connectivity modules.Nowadays, with this growing technology it is possible to protect the life of players in the game as well as in training sessions, if we detect the problems early in players and appropriate actions will be taken to reduce adverse health effects which can be very dangerous. In this paper, we will propose an architecturefor basketball based on the internet of things (IoT). The main goal behind this approach is to introduce a healthcare system based upon sensors, actuators, devices and telecommunication technologies to communicating real-time stats.

This study assessed the efficacy of physical examination as a screening modality for the diagnosis of surgically significant arterial injury in proximity penetrating extremity trauma (PPET). All cases of PPET were assessed and admitted per established protocol over a 30-month period from January 1, 1993, to June 30, 1995. No patients were excluded if other body regions were also injured. Landmarks defining upper extremity injuries were the deltopectoral groove to the wrist and for lower extremities from the inguinal ligament to the ankle. Patients admitted with PPET fell into one of three categories: 1) no hard signs of vascular injury present—admitted for 24-hour observation; 2) presence of at least one hard sign of vascular injury—taken immediately to the operating room; 3) positive sign of arterial injury that requires angiography (i.e., diminished but appreciable pulse by physical examination or doppler, large nonexpanding hematoma, bilateral pulse deficit, no appreciable pulse with unreconstructable trajectory). Four hundred six patients with 489 injured extremities secondary to PPET were admitted over a 30-month period. Sixty-two extremities suffered multiple injuries. Of the extremities injured, 83 per cent were secondary to gunshot wounds, 12 per cent were attributed to stabs/lacerations, and 5 per cent were due to shotgun injuries. Four hundred twenty-one extremities with PPET fell into Group 1. There were four missed injuries (specificity, 99%) in this group (one ulnar artery, one radial artery, one posterior tibial artery, and one anterior tibial artery). Two of these injuries were considered surgically significant. None of the patients suffered limb or functional loss as a consequence of their missed arterial injury. Thirty-nine extremities were entered into Group 2, with two patients found to have no arterial injury. Twenty-nine extremities were placed into Group 3 with 10 (35%) found to have surgically significant injury on angiogram. The overall sensitivity and specificity for physical examination was 92 per cent and 95 per cent, respectively, for surgically significant injury. Physical examination is a highly sensitive and specific screening modality for the identification of surgically significant arterial injury in PPET. Patients who present with diminished, but appreciable, pulses by physical examination or doppler, large nonexpanding hematomas as the only sign, bilateral pulse deficits and nonappreciable pulses with unreconstructable trajectory benefit from further investigation with angiography.

Background: Chronic osteomyelitis is still an important problem in the orthopedic field, especially in developing countries. Cat's claws contain many harmful microorganisms and can cause significant morbidity ranging from infection of skin tissue, muscle, and even deeper to bone tissue (osteomyelitis). The aim of this study was to report that injuries caused by cat-scratches and not receiving proper treatment can develop into chronic osteomyelitis. Case presentation: A 14-year-old boy came to the orthopedic polyclinic of Wangaya General Hospital with complaints of a left leg wound that had not healed since 2 years ago after got cat-scratches. The wound was oozing pus, tenderness, and the ankle area was found to be difficult to move because the patient's leg felt stiff. On physical, laboratory, and radiographic examination were found to be suggestive of chronic osteomyelitis. Conclusion: In general, cat scratch injuries are simple and harmless wounds, but if left untreated can lead to infection and morbidity in the future. Persistent symptoms and unrelieved wound conditions should be important indications for patients and practitioners of the possibility of infection that extends to soft tissue or bone tissue. A good understanding of acute wound management is very important in preventing serious infections. Latar belakang: Osteomielitis kronik masih merupakan masalah penting di bidang ortopedi terutama di negara berkembang. Pada cakaran kuku kucing mengandung banyak mikroorganisme berbahaya dan dapat menyebabkan morbiditas yang signifikan mulai dari infeksi jaringan kulit, otot, bahkan lebih dalam sampai mengenai jaringan tulang (osteomielitis). Tujuan dari penelitian ini adalah untuk melaporkan cidera yang disebabkan oleh cakaran kucing dan tidak mendapatkan pengobatan dengan baik dapat berkembang menjadi osteomielitis kronis. Laporan kasus: Seorang anak laki-laki berusia 14 tahun datang ke poliklinik ortopedi RSUD Wangaya dengan keluhan luka kaki kiri yang tidak kunjung sembuh sejak 2 tahun yang lalu, luka mengeluarkan nanah, nyeri tekan, serta pada daerah ankle ditemukan sulit untuk digerakkan yang dikarenakan kaki pasien terasa kaku. Pada pemeriksaan fisik dan laboratorium ditemukan mengarah pada osteomielitis kronis. Simpulan: Pada umumnya cidera cakaran kucing hanya luka sederhana dan tidak berbahaya, tetapi jika diabaikan dapat menyebabkan infeksi dan morbiditas dikemudian hari. Gejala yang menetap dan kondisi luka yang tidak membaik harus menjadi indikasi penting bagi penderita dan praktisi terhadap kemungkinan infeksi yang meluas ke jaringan lunak ataupun jaringan tulang. Pemahaman yang baik tentang penanganan luka akut menjadi sangat penting dalam mencegah terjadinya infeksi yang serius.

Background: Placenta has a long history of use for treating burns and wounds. It is a rich source of collagen and other extracellular matrix proteins, tissue reparative growth factors, and stem cells, including mesenchymal stem cells (MSCs). Recent data show its therapeutic potential for orthopaedic sports medicine indications. Purpose: To provide orthopaedic surgeons with an anatomic description of the placenta, to characterize its cellular composition, and to review the literature reporting the use of placenta-derived cells and placental tissue allografts for orthopaedic sports medicine indications in animal models and in humans. Study Design: Systematic review. Methods: Using a total of 63 keyword combinations, the PubMed and MEDLINE databases were searched for published articles describing the use of placental cells and/or tissue for orthopaedic sports medicine indications. Information was collected on placental tissue type, indications, animal model, study design, treatment regimen, safety, and efficacy outcomes. Results were categorized by indication and subcategorized by animal model. Results: Outcomes for 29 animal studies and 6 human studies reporting the use of placenta-derived therapeutics were generally positive; however, the placental tissue source, clinical indication, and administration route were highly variable across these studies. Fourteen animal studies described the use of placental tissue for tendon injuries, 13 studies for osteoarthritis or articular cartilage injuries, 3 for ligament injuries, and 1 for synovitis. Both placenta-derived culture-expanded cells (epithelial cells or MSCs) and placental tissue allografts were used in animal studies. In all human studies, commercial placental allografts were used. Five of 6 human studies examined the treatment of foot and ankle pathological conditions, and 1 studied the treatment of knee osteoarthritis. Conclusion: A review of the small number of reported studies revealed a high degree of variability in placental cell types, placental tissue preparation, routes of administration, and treatment regimens, which prohibits making any definitive conclusions. Currently, the clinical use of placenta is limited to only commercial placental tissue allografts, as there are no placenta-derived biological drugs approved for the treatment of orthopaedic sports medicine conditions in the United States. However, this review shows that the application of placental cells or tissue allografts appears to be safe and has potential to improve outcomes for orthopaedic sports medicine indications.

Development of functional socks for people with special needs who have diseases associated with ankle defects, including patients with diabetes.Methodology. The analytical method of reviewing scientifi c, technical, and patent documentation in the fi eld of research is used in the work. An experimental method for determining the elongation on a tensile tester WDW-05M, unfolding method. Analysis of problems associated with the elimination of excess pressure of the sock on the foot in people with increased measurements of the feet and ankles due to gunshot wounds, injuries or chronic diseases, including varicose veins, diabetes, edema, tumors, etc. confi rms the need to deve lop a new range of functional sock products. In the course of the research, the properties of weft-knitted structures were analyzed and a scientifi cally substantiated design of adaptive socks for home use was proposed. The design includes at least two sections, the elastic properties of which diff er. The back side of the leg, heel, sole, and toe are made of 1x1 rib knit, the instep and the front part of the leg are made of 3x3 rib knit. The section with higher stretchability and elasticity, made of 3x3 rib knit, softly maintains the shape of the socks’ leg, practically without creating pressure on the ankle and allowing to signifi cantly increase the perimeter of the sock in the area of the foot, toes, and/or heel. A sam ple of adaptive socks made of PAN yarn 32x2 tex х4 by knitting according to the shape of the unfolding of its 3D surface was made on the fl at knitting machine PVRK of the 8-th gauge. The connection of the product's parts in order to give the product a three-dimensional shape is made on a linker machine Hague D280E.Practical value. The design and technology of manufacturing functional socks have been developed. It is proposed to use industrial and semi-industrial double-bed fl at-knitting machines as technologic al equipment for their production. The use of various rib knit patterns for diff erent functional zones o f a sock allows providing the set value of conditional tension of threads when using the sock on a foot of atypical measurements.

Introduction: Posterior cruciate ligament is the primary stabilizer of the knee. Among the potential complications in arthroscopic repair of this ligament, there are vascular lesions, due to laceration, thrombosis and injury of the intima of the popliteal artery. We used one case to show the vascular complications that may arise in arthroscopic repair of the posterior cruciate ligament, how to handle it and the results. Methods: One patient, 33 years old, with a history of traffic accident. In a physical exam the patient shows pain and swelling of the knee, positive posterior drawer test and positive Godfrey test. X-rays on the knee show posterior tibial translation and MRI a complete fibers rupture at the middle third of the posterior cruciate ligament. An arthroscopic repair surgery was scheduled three weeks after trauma, with PCL reconstruction using simple band technique.After surgical intervention, hemostatic cuff was released, no peripheral pulse, paleness and coldness of the member was confirmed. An arteriography was carried out, which confirmed absences of distal vascular filling in the popliteal artery. An urgent referral was carried out with Vascular Surgery Services, who had been informed of the surgery previously (a notification that is part of our routine for this kind of interventions). Arteriorrhaphy and venorrhaphy of the popliteal arteries was fulfilled 12 hours later, with a leg fasciotomy. Daily monitoring was performed, and after 72 hours, muscle necrosis is seen with wound drainage, analysis shows presence of gram-negative bacilli, Proteus Mirabilis-Pseudomonas spp and the lab results showed leukocytes: 8.700/ml, ESR: 58, CRP: 48. A new surgery is performed with complete resection of the anterior external compartment of the leg, and a system of continuous cleansing is applied with physiological saline solution and boric acid for 14 days until drainage is eliminated. Vancomycin and ceftazidime EV was indicated for 14 days and, after a good evolution of the wounds, patient is discharged from hospital with Sulfamethoxazole/trimethoprim 160mg/800mg to be taken orally for 14 days. Results: After treatment with oral antibiotic is completed, wounds progress positively. Foot in equinus position, has positive distal pulses with distal sensibility. Use of a thermoforming brace is indicated for movement. Vascular Surgery Services are currently following patient’s evolution. An ankle arthrodesis surgery is evaluated for the future. Conclusion: Combined injuries that result in a posterior tibial translation over 15 mm and, those that come along with injuries in the anterior cruciate ligament or posterior lateral structures of the knee, should be repaired through surgery. Vascular lesion caused by laceration, thrombosis or injury of the intima of the popliteal artery, mainly during perforation and preparation of tibial tunnel, is a serious lesion. Although these vascular lesions during arthroscopy are complications relatively rare, a potential risk should be considered, with consequences that could be fatal for the extremity and for patient’s life when bleeding is involved. In those cases, urgent treatment is imperative, that is the reason we believe it is safe to coordinate with Vascular Surgery Services before the surgery is carried out.

Talus fracture are extremely rare in children. The talus is predominantly made up of cartilage with higher elastic resistance than adult bone thus the pediatric talus bone can sustain higher forces before fractures. The prevalence for paediatric trauma in talus fracture is estimated to be five times rarer than for adult trauma . The most common mechanism of injury in talus fractures is axial loading of the talus against the anterior tibia with the foot in dorsiflexion. The talar neck is the most common fracture site, followed by the talar body. Report: A 9-year-old boy was brought to emergency department following a fall from bicycle after his right foot caught in back wheel. He was unable to weightbear on his right foot and his anterior ankle region was swollen, with no open wounds or abrasions. Radiographs of right ankle revealed a fracture at neck of right talus (Hawkins type II ) then proceed with CT scan to characterize the fracture pattern and extent of injury. His fracture was fixed with two headless cannulated screws size 4.0 under I/I guidance. The patient was advised non-weight bearing with below knee cast for 6 weeks. After 2 months the patient was pain free and had resumed all his activities. X-ray after 1 year showed a consolidation of the fracture without evidence of avascular necrosis. The Hawkins classification can be used to describe the different types of fractures of the talar neck and to predict the risk of avascular necrosis. These injuries can be difficult to diagnose with plain radiograph, and further assessment with CT scan or MRI may be necessary. Undisplaced fracture can be managed non-operatively with cast immobilization and displaced fracture can be treated with either closed or open reduction. Complications are still likely to be encountered in the course of talus fractures treatment considering the precarious blood supply to the bone as well as complex ankle and subtalar articulations. According to Smith et al study with 29 subjects , displaced pediatric talus fractures and those associated with high-energy trauma resulted in more complications ; avascular necrosis (7%), arthrosis (17%),delayed union (3%),neuropraxia (7%) and the need for further surgery (10%). [Figure: see text][Figure: see text] Conclusion: Talar fractures in the pediatric age group are very rare. A minimal or undisplaced fracture of talus is less likely to undergo avascular necrosis than a displaced fracture but even with optimal treatment, avascular necrosis may still occur. It is of prime significance that these fractures should be diagnosed well in time to avert complications. Therefore an appropriate length of follow-up is required. References: Vivek D , Jairam DJ , Paediatric Talus Fracture :Volume 5 Issue 8, International Journal of Science and Research August 2016 PG 1040-1041

Studies on species that attain very large body sizes provide a powerful opportunity to clarify the ecological correlates and consequences of body size, but logistical obstacles mean that most ‘giant’ species have attracted little field-based research. The Australian scrub python, Morelia kinghorni (= M. amethistina in earlier literature), is the largest Australian snake. Our three-year field study in the Tully River Gorge of tropical north-eastern Australia provides the first detailed ecological data on this species. Snakes aggregate in the gorge during the dry season for reproductive activities (combat, courtship and mating), and these aggregations consist primarily of large adult males. Wet-season samples from a nearby road contained more females, and more juvenile animals. Body temperatures of diurnally active pythons averaged 25.2°C, and were highly correlated with air and substrate temperatures. Larger snakes were cooler than smaller conspecifics, perhaps reflecting their slower heating rates. Recapture of marked individuals suggests that pythons of both sexes and all body sizes maintain fixed home ranges, as the distance from initial capture did not increase through time; most animals were recaptured <100 m from their initial capture point, but some dispersed at least 1.5 km. Adult male pythons spanned a massive range in body sizes (1.3–3.76 m in snout–vent length, 0.30–11 kg in mass), and larger males were more likely to engage in combat, exhibit combat-related injuries (bite wounds) and obtain matings. Presumably reflecting the reproductive advantage of larger body size, males attained much larger maximum sizes than did females within our study population.

Category: Trauma; Ankle; Hindfoot; Sports Introduction/Purpose: Achilles tendon ruptures are challenging injuries and complications following Achilles repair surgery can lead to poor patient outcomes. The objective of this study was to determine if time to surgery and an open versus closed surgical technique were related to postoperative complications. We hypothesized that an increased time to surgery and an open surgical technique would correlate with an increase in complications. Methods: One hundred ninety-four patients at a single institution who underwent Achilles rupture repair surgery between October 2016 and November 2020 were included. All patients had a minimum follow-up of 3 months +- 14 days. A retrospective review was performed collecting data which included injury and treatment timepoints, surgical technique (open or percutaneous), and complications. Patients were separated into 3 categories based on time to surgery: acute (<2 weeks), sub-acute (2-6 weeks), and chronic (>6 weeks). Complications were categorized as minor (wounds and/or infections that resolved with outpatient care), major (wounds and/or infections requiring operative intervention), re-rupture, DVT, and all other complications. A Fisher's exact test was used to determine if there was a statistically significant relationship between time to surgery and post-surgical complications as well as surgical technique and post-surgical complications. Results: In total, 194 patients were included for analysis: 134 with an acute rupture (69%), 36 sub-acute (18.6%), and 24 chronic (12.4%). 45 complications were observed in 37 patients (19.0% of patients); 8 patients had a minor complication (4.1%), 8 major (4.1%), 7 re-ruptures (3.6%), 12 DVTs (6.2%), and 8 others (4.1%). 25 acute ruptures had complications (18.7%), 6 sub-acute (16.7%), and 6 chronic (25%). No statistical differences were determined between time to surgery or surgical technique and complications among groups. There was an increase in complications in the chronic group, the most notable being Achilles tendon re-rupture (P = 0.06). The mean re-rupture time from the date of original injury to surgery was 47 days (range 3-131 days), and mean time from surgery to re-rupture was 49 days (range 7-133 days). Conclusion: This study did not demonstrate any statistically significant relationship between time to surgery or open versus percutaneous surgical technique and post-surgical complications following operative treatment of Achilles ruptures. Though not statistically significant, complications and re-ruptures were more frequent in patients undergoing surgery >6 weeks following injury. These results suggest increased time to surgery may be a predictor of increased risk for postoperative complications following Achilles repair surgery, however further research including studies with larger patient populations is needed to support this determination.

In this study the evolutionary development of orthopedics (management of diseases of bones and joints), which commenced in early Mesopotamia and Egypt, is followed through Classical times.The Greek infl uence probably commenced in the 6thcentury BC with Democedes of Croton who cured the Persian king’s dislocated ankle. The Corpus Hippocraticum laid the foundation of orthopedic practice in antiquity. Although knowledge of anatomy was limited, its four books on orthopedics (The Nature of Bones, Mochlicon, On Fractures, On Joints) count amongst the outstanding contributions of Hippocratic writers. In systematic manner the general recognition and management of fractures and dislocations are covered, followed by the handling of individual lesions. Hippocrates differentiated between closed and open fractures (with overlaying skin wounds). Closed fractures were reduced to as normal a position as possible – manually where possible, but with large bones and in the presence of formidable muscle mass, mechanical traction was often employed (e.g. the Hippocratic bench and the bizarre succusion ladder for spinal deformities). There is no mention of the use of analgetic drugs. After application of cerate (mixture of olive oil, soda and pitch) to the skin, the fracture was immobilized by a combination of plasters and compresses (often fi rmed up with gum-mixtures) – but never very fi rmly. On the 3rd, 6/7th, 9thand 12th days the bandaging was removed, the lesion inspected and if considered necessary, re-aligned, A variety of splints were then applied. Strict bed rest was enforced, as well as a light diet (no wine or meat for 10 days). It was believed that fractures of the feet, clavicle, ribs and jaw healed after 20 days, of the forearm after 30 days, and fractures of the upper arm and leg after 40 days. Open fractures were considered very serious injuries, and reduced very carefully. Protruding bone fragments were removed (sawn off if necessary) and the wound was covered with black cerate, compresses and light bandages. Pressure and heavy splints were thought to induce infection and gangrene and thus avoided. Dislocations were reduced as soon and as effectively as possible, before muscle spasm set in. As with fractures manual reduction was, where necessary, complemented by mechanical traction. After extensive washing of the joint area with warm water, cerate was applied to the wound and specialised bandaging (even splints) ensured immobilization. Open dislocations like open fractures were considered very serious and reduction was not attempted. Again all pressure bandaging was avoided. A non-functional joint was commonly the end result. The management of 18 specifi c fractures is described in detail. Jaw fractures were fi xed by the binding of contiguous teeth. Fractures of the spinal column clearly presented a major problem. Although knowledge of spinal anatomy was surprisingly good, the diagnosis of fractures was very difficult and its association with spinal curvatures presented almost insurmountable problems of management. It was recognized that rib fractures could cause serious damage to the lung and pleura. Complex problems caused by arm fractures involving the elbow or shoulder joints, and combined radius and ulna fractures, are addressed. Femur fractures presented major problems and permanent leg deformity was very common. Open femur fractures were extremely serious and Hippocrates even stated that a physician who could ethically avoid becoming involved in treating such an injury, should do so. Fractures of femur necks were not recognised. The Hippocratic work, Wounds of the head, dealing with fractures of the skull, is not covered in this study.Management of the major joints are individually described. Seven different techniques of reducing a dislocated shoulder joint are mentioned The original description of the management of the dislocation of the wrist and hand is lost. Proper reduction of hip-dislocation was essential to avoid muscle atrophy and life-long limping, and was achieved by intricate mechanical suspension. Strangely enough, lateral dislocation of the knee was a common occurrence and not seen as a serious problem. Congenital club feet were effectively treated by prolonged fi xation in the correct position by way of tight bandaging with compresses stiffened in glue-mixtures.There is abundant skeletal evidence of osteo-arthritis in Neolithic man, but no clear description of it in the Corpus Hippocraticum. Gout is repeatedly mentioned in the Corpus but without detailed descriptions of the disease. In the Roman era authors like Heliodorus, Antyllus and Celsus in particular, wrote authoritatively on orthopedic subjects, Osteo-archaeological evidence is that fractures were treated expertly in the Roman army. Conditions consistent with degenerative osteoarthritis and true gout (as podagra and chiragra) were described by Celsus and Aretaeus of Cappadocia. Soranus, Rufus of Ephesus and Galen also wrote on orthopedic subjects. We will today differ from many statements made in the Corpus Hippocraticum, but it is clear that the orthopedic basis laid by those documents was not seriously challenged for 1 000 years.

Abstract Background Netball is estimated to be played by more than 20 million people worldwide, but there is evidence of high injury incidence. A thorough understanding of the types and rates of netball injuries is essential for effective injury management and prevention strategies to be developed and implemented. This systematic review summarises the published findings with respect to injury types, participant characteristics and any identified risk factors for netball injuries. Methods A librarian-assisted computer search of seven scientific databases was conducted for studies reporting on netball injuries. Inclusion criteria were studies published in English, in peer-reviewed journals, which reported data on injuries and variables (e.g. age and competition level) that have been proposed as possibly associated with netball injury risk. Results Forty-six studies (43.5% prospective, 37% hospital/insurance records, 19.5% retrospective) from 45 articles were included after screening. The majority of studies (74%) were conducted in Australia or New Zealand. There was little consistency in the definition of ‘injury’. Elite or sub-elite level players were included in 69% of studies where the level of competition was reported. The duration of injury surveillance was generally related to the format of competition from which data were collected. Self-report questionnaires were used in 48% of studies and only 26% of studies used qualified health professionals to collect data courtside. Injuries to the ankle and knee were the most common (in 19 studies) although the incidence varied considerably across the studies (ankle 13–84% and knee 8–50% of injuries). Prevention of ankle and knee injuries should be a priority. Children sustained more upper limb injuries (e.g. fractures) compared with adults who sustained more lower limb injuries (e.g. ankle and knee sprains/strains). A large number of potential risk factors for injury in netball have been investigated in small numbers of studies. The main circumstances of injury are landings, collisions and falls. Conclusion Further studies should be directed towards recreational netball, reporting on injury incidence in players by age and utilising high-quality, standardised methods and criteria. Specific injury diagnosis and a better understanding of the circumstances and mechanisms of injury would provide more meaningful data for developing prevention strategies.

Abstract Background The Australian wine industry is a valuable part of the wider Australian economy worth approximately A$45 billion annually and employs 163,790 people either full time or part time. Australian agricultural industries are amongst the nation’s most dangerous workplaces with joint, ligament, muscle and tendon injuries being commonplace along with wounds, lacerations and musculoskeletal diseases. It is therefore important to try and minimise the risk of injuries to workers. The aims of this study were to (1) identify whether lower limb problems occur in the Australian wine industry and (2) identify the types of safety footwear worn. Methods Participants were recruited from the Australian wine industry. The study was a cross-sectional anonymous survey of 82 questions with n = 207 respondents. Questions related to job role performed, types of lower limb problems experienced, level of pain, restriction of activities, types of footwear worn, general health and physical health. Results The main working roles were winery (73.4%), vineyard (52.2%), laboratory (39.6%), cellar door (32.4%) and office (8.2%), with 63.3% of participants working in more than one role. Lower back pain was the most commonly reported problem at 56% followed by foot pain (36.7%), knee pain (24.6%), leg pain (21.3%), ankle pain (17.9%), hip pain (15.5%), toe pain (13%) and heel pain (11.1%). The most popular footwear used by participants were elastic sided safety boots, followed by high cut lace up safety boots with side zip. Overall, although the pain experienced was moderate, it did not impact the workers ability to perform their duties and the majority self-reported as being in very good general and physical health. Conclusion To date no data have been published on the types of lower limb problems or the types of safety footwear worn in the Australian wine industry. This study is the first to demonstrate that elastic sided safety boots were the most popular amongst respondents and that lower limb problems occur with workers. Therefore, further research into the safety footwear used in the Australian wine industry is needed to better support workers health while working in their varied roles and conditions.

ABSTRACT Introduction: Reconstruction of distal wounds in lower extremities can be challenging due to the lack of tissue to perform local flaps. Fasciocutaneous and muscular flaps are some options for coverage, such as the reverse-flow fasciocutaneous sural flap. Objective: To present an 18-month experience on ankle, calcaneus, and foot reconstruction using the reverse-flow sural flap, performed by the Complex Wounds Group of the Plastic Surgery Department of the University of São Paulo Medical School. Methods: An observational, retrospective and descriptive study was performed through data survey on medical records of all patients treated between November 2018 and June 2020. Results: Nine reverse-flow fasciocutaneous sural flaps were performed. All patients were men. The mean age was 38 years old. Five patients had acute wounds for traffic collision, one electrical trauma and three chronic post-traumatic injuries. The ankle was the most common injury site (6), followed by foot (2) and calcaneus (1). Four patients had complications, three of which were partial necrosis and one distal epitheliosis. No case of total necrosis was recorded. The average hospital stay was 30.1 days. Conclusion: The reverse-flow fasciocutaneous sural flap proved to be a viable, reproducible, and reliable option for distal lower limb reconstruction. Level of Evidence IV, Case Series.

Background:Soft tissues injuries at foot especially at heel expose the tendons, bones and especially joints, which leads to risk of infections and necrosis. These often result from trauma (spoke wheel), tumors, systemic diseases and their wounds such as venous ulcers and diabetic foot wounds. Surgical planning of these defects remains a challenge due to shortage of local scar free tissue and reliable blood supply. The current study is conducted to observe the purposeful benefits of reverse sural artery flap to cover wounds at dorsum of foot, ankle & heel.Study Design:Descriptive, experimental study.Setting: Department of Plastic & Reconstructive Surgery, Dr. Ruth KM Pfau Civil Hospital Karachi.Period:January 2015 to January 2018.Material & Methods:All patients who presented with wounds at heel, dorsum of foot, and exposed calcaneus or Achilles tendon were included. A peroneal based perforator identified by hand held Doppler, a superficial vein, and the sural nerve were included in the pedicle. Patients were followed during the first 6 postoperative months. Postoperative outcomes like flap congestion, tip necrosis and flap failure were noted. Results:Total of 36reverse low sural flaps were done for the soft tissue coverage of the 24 heel defects, 8 ankle defects and4 dorsum of the foot defects. Twenty eight patients were male and eight were females and age ranged from 6 to 36 years (mean 21). Partial flap failure was seen in 3 cases and complete flap failure in 2 cases. There were no serious donor site complications and all patients were satisfied with the functional and aesthetic outcome postoperatively.Conclusion:Reverse sural artery flap is very suitable in providing soft tissue coverage of the wounds of heel and dorsum of foot. Harvesting sural flap is dependable and safe as it does not ends in any major postoperative donor site morbidity.

Abstract Background Ankle traumas are common presenting injuries to emergency departments in Australia and worldwide. The Ottawa Ankle Rules (OAR) are a clinical decision tool to exclude ankle fractures, thereby precluding the need for radiographic imaging in patients with acute ankle injury. Previous studies support the OAR as an accurate means of excluding ankle and midfoot fractures, but have included a paediatric population, report both the ankle and mid-foot, or are greater than 5 years old. This systematic review and meta-analysis aimed to update and assess the existing evidence of the diagnostic accuracy of the Ottawa Ankle Rule (OAR) acute ankle injuries in adults. Methods A systematic search and screen of was performed for relevant articles dated 1992 to 2020. Prospective and retrospective studies documenting OAR outcomes by physicians to assess ankle injuries were included. Critical appraisal of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Outcomes related to psychometric data were pooled using random effects or fixed effects modelling to calculate diagnostic performance of the OAR. Between-study heterogeneity was assessed using the Higgins I2 test, with Spearman’s correlation test for threshold effect. Results From 254 unique studies identified in the screening process, 15 were included, involving 8560 patients from 13 countries. Sensitivity, specificity, negative likelihood ratio, positive likelihood ratio and diagnostic odds ratio were 0.91 (95% CI, 0.89 to 0.92), 0.25 (95% CI, 0.24 to 0.26), 1.47 (95% CI, 1.11 to 1.93), 0.15 (95% CI, 0.72 to 0.29) and 10.95 (95% CI, 5.14 to 23.35) respectively, with high between-study heterogeneity observed (sensitivity: I2 = 94.3%, p < 0.01; specificity: I2 = 99.2%, p < 0.01). Most studies presented with low risk of bias and concern regarding applicability following assessment against QUADAS-2 criteria. Conclusions Application of the OAR is highly sensitive and can correctly predict the likelihood of ankle fractures when present, however, lower specificity rates increase the likelihood of false positives. Overall, the use of the OAR tool is supported as a cost-effective method of reducing unnecessary radiographic referral, that should improve efficiency, lower medical costs and reduce waiting times.

ABSTRACT Introduction Extremity injuries have comprised the majority of battlefield injuries in modern U.S. conflicts since World War II. Most reports have focused on serious injuries only and, to date, no reports have described the full extent of combat extremity injuries, from mild to severe, resulting from post-9/11 conflicts. This study aims to identify and characterize the full spectrum of non-amputation combat-related extremity injury and extend the findings of previous reports. Methods The Expeditionary Medical Encounter Database was queried for all extremity injured service members (SMs) deployed in support of post-9/11 conflicts through July 2018. Only injuries incurred during combat operations were included in this report. Major amputations were excluded as well as SMs killed in action or who died of wounds. Extremity injuries were categorized by body region, nature of injury, and severity. Demographics and injury event characteristics are also presented. Results A total of 17,629 SMs sustained 42,740 extremity injuries during 18,004 separate injury events. The highest number of SMs were injured in 2004 (n = 3,553), 2007 (n = 2,244), and 2011 (n = 2,023). Injured SMs were mostly young (78% under 30 years), male (97%), junior- to mid-level enlisted (89%), in the Army (69%) or Marine Corps (28%), active duty (84%), serving as infantry and gun crew (59%), and injured in support of Operation Iraqi Freedom (60%). Blast weaponry was responsible for 75% of extremity injuries. Injuries were similarly distributed between the lower (52%) and upper (48%) extremities. The most common sites of lower extremity injury were the lower leg/ankle complex (40%) and thigh (26%). The most common upper extremities sites were the shoulder and upper arms (37%), and the hand, wrist, and fingers (33%). Nearly half (48%) of all extremity injuries were open wounds (48%), followed by fractures (20%) and contusions/superficial injuries (16%). SMs sustained an average of 2.4 extremity injuries per event and 56% of injuries were considered mild, with a median Injury Severity Score (ISS) of 3. Conclusion This study is the first publication to capture, review, and characterize the full range, from mild to severe, of non-amputation combat-related extremity injuries resulting from post-9/11 conflicts. The high prevalence of extremity injury, particularly in such a young population, and associated short- and long-term health outcomes, will impact military health care systems for decades to come.

Introduction This study identifies injuries that arise at a public event in an environment where multiple industries, service providers and patrons are present simultaneously. Methods A prospective survey method was used to collect data relating to injuries occurring at the event. The event was the Royal Adelaide Show, a 9-day agricultural and horticultural show hosted in a capital city in Australia during 2002. All patients who presented to St John Volunteers for treatment were the population for this study with the sample population being people who sustained an injury at the event. Results Crowd attendance over the nine days was 622,234. A total of 1028 patients presented for treatment with 265 (26%) being the result of injury. It was observed that minor wounds were the most common injury treated (18%), followed closely by lacerations (17%). The majority of injuries occurring at the event were minor in nature. There were 42 persons injured while working at the event. Of these, 9 (21%) required transfer to hospital by ambulance. Conclusion At the event studied, there were a number of injuries occurring that required treatment/management. On average, there was one worker transported to hospital by ambulance each day of the event. There may be a role for more formalised injury surveillance at mass gathering events to assess and monitor injury trends to both patrons and workers in this dynamic setting.

Abstract Background To identify prognostic factors determining final visual outcome following open globe injuries. Methods Retrospective case series of patients presenting to Westmead Hospital, Sydney, Australia with open globe injuries from 1st January 2005 to 31st December 2017. Data collected included demographic information, ocular injury details, management and initial and final visual acuities. Results A total of 104 cases were identified. Predictors of poor final visual outcomes included poor presenting visual acuity (p < 0.001), globe rupture (p < 0.001), retinal detachment (p < 0.001), Zone III wounds (p < 0.001), hyphema (p = 0.003), lens expulsion (p = 0.003) and vitreous hemorrhage (p < 0.001). Multivariate analysis demonstrated presenting visual acuity (p < 0.001), globe rupture (p = 0.013) and retinal detachment (p = 0.011) as being statistically significant for predicting poor visual outcomes. The presence of lid laceration (p = 0.197) and uveal prolapse (p = 0.667) were not significantly associated with the final visual acuity. Conclusions Poor presenting visual acuity, globe rupture and retinal detachment are the most important prognostic factors determining final visual acuity following open globe injury.

Abstract Purpose Lateral ankle sprains are one of the most prevalent musculoskeletal injuries, with one of the highest recurrence rates. One in five people develops chronic ankle instability (CAI) after a lateral ankle sprain. CAI is mainly described as a subjective phenomenon, but is associated with recurrent symptoms, reduced dynamic stability, and reduced physical activity and quality of life. Understanding the relationship between perception of stability and effect on performance for people with CAI could inform rehabilitative strategies in clinical practice. This study aimed to investigate the relationship between the perception of stability and objective performance of dynamic stability this population. Methods This study is a sub-analysis of data from four separate studies in Australia and the United Kingdom. Participants were screened and categorised as a CAI, coper, or healthy participant. Each participant completed the Star Excursion Balance Test (SEBT) and Cumberland ankle instability tool (CAIT). Distances reached in the anterior, posterior-medial, and posterior-lateral directions, and average, of the SEBT were analysed. Results Data from 95 participants with CAI, 45 copers, and 101 healthy participants was analysed. There was a significant moderate correlation between CAIT score and SEBT reach distance in all directions for the CAI group (p < 0.001). For copers, there was small significant correlation in the posterior-lateral direction (p < 0.05). Conclusion This study highlights the discrepancies between the perception of stability and objective dynamic stability, and reinforces the importance of using both types of measures for continual assessment in practice to optimise selecting rehabilitative strategies.

PurposeThe purpose of this paper is to determine which factors are associated with 6,065 patient presentations with non-life-threatening urgent conditions (NLTUCs) to an after-hours general practice, an urgent care clinic (UCC) and an emergency department (ED) on Sundays in Southeast Queensland (Qld).Design/methodology/approachA retrospective, comparative and observational study was conducted involving the auditing of medical records of patients with NLTUCs consulting three medical services between 0,800 and 1,700 h, on Sundays, over a one-year period. The study was limited to 6,065 patients.FindingsThere were statistically significant differences in choice of location according to age, number of postcodes from the patient's residence, time of the day, season, patient presentations for infection and injury, non-infectious, non-injurious conditions of the circulatory, gastrointestinal and genitourinary systems, and need for imaging, pathology, plastering/back-slab application, splinting and wound closure. Older adults were more likely to be admitted to the hospital and Ed Short Stay Unit, compared with other age groups.Research limitations/implicationsBased on international models of UCC healthcare systems in United Kingdom (UK), USA and New Zealand (NZ) and the results of this study, it is recommended that UCCs in Australia have extended hours, walk-in availability, access to on-site radiology, ability to treat fractures and wounds and staffing by medical practitioners able to manage these conditions. Recommendations also include setting a national standard for UCC operation (National Urgent Care Centre Accreditation, 2018; NHS, 2020; RNZCUC, 2015) and requirements for vocational registration for medical practitioners (National Urgent Care Centre Accreditation, 2018; RNZCUC, 2015; The Royal College of Surgeons of Edinburgh, 2021a, b).Practical implicationsThis study has highlighted three key areas for future research: first, research involving general practitioners (GPs), emergency physicians, urgent care physicians, nurse practitioners, urgent care pharmacists and paramedics could help to predict the type of patients more accurately, patient presentations and associated comorbidities that might be encouraged to attend or be diverted to Urgent Care Clinics. Second, larger studies of more facilities and more patients could improve the accuracy and generalisability of the findings. Lastly, studies of public health messaging need to be undertaken to determine how best to encourage patients with NLTUCs (especially infections and injuries) to present to UCCs.Social implicationsThe Urgent Care Clinic model has existed in developed countries since 1973. The adoption of this model in Australia close to a patient's home, open extended hours and with onsite radiology could provide a community option, to ED, for NLTUCs (especially patient presentations with infections and injuries).Originality/valueThis study reviewed three types of medical facilities for the management of NLTUCs. They were an after-hours general practice, an urgent care clinic and an emergency department. This study found that the patient choice of destination depends on the ability of the service to manage their NLTUCs, patient age, type of condition, postcodes lived away from the facility, availability of testing and provision of consumables. This study also provides recommendations for the development of an urgent care healthcare system in Australia based on international models and includes requirements for extended hours, walk-in availability, radiology on-site, national standard and national requirements for vocational registration for medical professionals.

BackgroundInjury is a leading contributor to the global disease burden in children and places children at risk for adverse and lasting impacts on their health-related quality of life (HRQoL) and development. This study aimed to identify key predictors of HRQoL following injury in childhood and adolescence.MethodsData from 2259 injury survivors (<18 years when injured) were pooled from four longitudinal cohort studies (Australia, Canada, UK, USA) from the paediatric Validating Injury Burden Estimates Study (VIBES-Junior). Outcomes were the Paediatric Quality of Life Inventory (PedsQL) total, physical, psychosocial functioning scores at 1, 3–4, 6, 12, 24 months postinjury.ResultsMean PedsQL total score increased with higher socioeconomic status and decreased with increasing age. It was lower for transport-related incidents, ≥1 comorbidities, intentional injuries, spinal cord injury, vertebral column fracture, moderate/severe traumatic brain injury and fracture of patella/tibia/fibula/ankle. Mean PedsQL physical score was lower for females, fracture of femur, fracture of pelvis and burns. Mean PedsQL psychosocial score was lower for asphyxiation/non-fatal submersion and muscle/tendon/dislocation injuries.ConclusionsPostinjury HRQoL was associated with survivors’ socioeconomic status, intent, mechanism of injury and comorbidity status. Patterns of physical and psychosocial functioning postinjury differed according to sex and nature of injury sustained. The findings improve understanding of the long-term individual and societal impacts of injury in the early part of life and guide the prioritisation of prevention efforts, inform health and social service planning to help reduce injury burden, and help guide future Global Burden of Disease estimates.

In many dairy industries, but particularly those that are pasture-based and have seasonal calving, “surplus calves,” which are mostly male, are killed at a young age because they are of low value and it is not economically viable to raise them. Such calves are either killed on farm soon after birth or sent for slaughter at an abattoir. In countries where calves are sent for slaughter the age ranges from 3-4 days (New Zealand and Australia; “bobby calves”) to 3-4 weeks (e.g., Ireland); they are not weaned. All calves are at the greatest risk of death in the 1st month of life but when combined with their low value, this makes surplus calves destined for early slaughter (i.e., &lt;1 month of age) particularly vulnerable to poor welfare while on-farm. The welfare of these calves may also be compromised during transport and transit through markets and at the abattoir. There is growing recognition that feedback to farmers of results from animal-based indicators (ABI) of welfare (including health) collected prior to and after slaughter can protect animal welfare. Hence, the risk factors for poor on-farm, in-transit and at-abattoir calf welfare combined with an ante and post mortem (AM/PM) welfare assessment scheme specific to calves &lt;1 month of age are outlined. This scheme would also provide an evidence base with which to identify farms on which such animals are more at risk of poor welfare. The following ABIs, at individual or batch level, are proposed: AM indicators include assessment of age (umbilical maturity), nutritional status (body condition, dehydration), behavioral status (general demeanor, posture, able to and stability while standing and moving, shivering, vocalizations, oral behaviors/cross-sucking, fearfulness, playing), and evidence of disease processes (locomotory ability [lameness], cleanliness/fecal soiling [scour], injuries hairless patches, swellings, wounds], dyspnoea/coughing, nasal/ocular discharge, navel swelling/discharge); PM measures include assessment of feeding adequacy (abomasal contents, milk in rumen, visceral fat reserves) and evidence of disease processes (omphalitis, GIT disorders, peritonitis, abscesses [internal and external], arthritis, septicaemia, and pneumonia). Based on similar models in other species, this information can be used in a positive feedback loop not only to protect and improve calf welfare but also to inform on-farm calf welfare management plans, support industry claims regarding animal welfare and benchmark welfare performance nationally and internationally.

Most of us are aware that ozone is basically a treatment of pure oxygen and its effect on the human body is even better. As our human body is made up of 70% of water, we used ozone in many different way, one of them is what we know as ozonated water. As ozone when mix in water it diluted thoroughly and highly purifies the water, as it is soluble in water. It maintain its tri-oxygen identity. Biological Properties of Ozonated Water: • It kills viruses, bacteria, fungi and algae on contact. • It breakdown harmful synthetic chemicals into less dangerous molecules. • It purifies the blood by rupturing the cell wall of the microorganisms. • It kills some cancer cells, slows tumor growth, and may stop the spread of cancer. • It provides more oxygen to the brain. • It boosts the immune system. Preparation of Ozonated Water: In order to prepare this, we first use the glass cylinder filled with approximately ¾ of pure water (mineral water) through which O2-O3 gas mixture has to be bubbled continuously for at least 5-10 minutes by using diffuser to achieve saturation. The unused ozone flows out via silicon tubing in to the destructor and is converted to oxygen. As ozone physically dissolve in water therefor it's concentration is equally to approximately ¼ of total O3 concentration in gas. If put at 20 degree, half-life of it is only 9 hours and if put at room temperature half-life is approximately 4-5 hour, only if maintained properly. The stability of ozonated water depends largely on the temperature and also ionic contents and Ph. of water. Colder the water more ozone is absorbed and retained for a longer rate. Drinking Ozonated water Local Treatment Dental use Allergies Ankle sprain Aphthous stomatitis Cancers Athlete's Foot Candida Gastritis, indigestion Fresh/recent wounds Gum disease Candidiasis Burns - arms & legs Mouth ulcers Headaches Herpes zoster and simplex Wound treatment Viral infections Pains due to bad peripheral Disinfection after tooth blood circulation extraction & dental workIndication of Ozonated Water: Ozonated water is helpful in following diseases : Drinking ozonated water is highly energetic water. It has to be drunk immediately on empty stomach. On regular use of ozonated water will establish high level of oxygenation in the body.Topical application: Ozonated water is basically applied on account of its pain relieving, disinfectant and anti-inflammatory effects as well as tissue activating property in acute & chronic injuries with & without infection. Ozonated water also being used intra operatively for rinsing. The healing time for primary scar is shortened and irritation free.Dental use: Ozonated water strongly inhibited accumulation of experimenter dental plaque in vitro. Ozone destroys this niche in which acid loving bacteria grow. Ozone also destroys the protein coat over the lesion, which effectively protect the niche. Ozonized water can offer an efficient non antibiotic agent for the control of microorganism prior to replantation of contaminated avulsed teeth. Ozonated Oil and Products : Ozone therapy has been in India since over 2 decades. Every year, the awareness among people increases rapidly due to the factor that ozone has help a lot of people in curing the disease and medical problem. As ozone has been in India for over 2 decades now, there is a body that takes care and helps in not only promoting ozone but also manufacturing and distributing ozone product. Till the date Ozone Forum Of India have come out with eight different product and still researching and working in introducing more products, and we are still working on research and development of further new products. Ozonated oíl is made by using pure vegetable sesame oil and it prepare by bubbling the O2-O3 gas mixer for about 100 to 200hrs. After this it becomes more viscous. Due to prolong ozonation, it results in the formation of ozonides and peroxide which remain stable for 1 year at room temperature and for 2 year in refrigerator. In India, after completion of full procedure in order to check the degree of ozonation we use viscosity measurement and peroxide value, finally the viscosity increase up to 60% indicating that double bonds in oil has reacted with ozone to form more bulky molecules. For peroxide value which is maintain between 300 to 2000 by checking peroxide, represents the quantity of peroxide expressing in mili equivalent of active oxygen contained in 1kg of the oil. As ozonides and peroxide are the main active ingredients therefore triozonide become stable and comes into contact with the warm exudate of the wood. This then, slowly discomposes and generate reactive oxygen species (ROS) and lipid oxidation products (LOPs). This explains the prolonged disinfectentant and stimulatory activity. Ozonized oil helps in: Controlling bleeding, Disinfecting the lesion, Inhibiting the proliferation of potentially infective organisms, Improving metabolism, Stimulatory tissue regeneration, . . Thus, FAST HEALINGIn India, we have eight (8) different types of ozonized products: RAPID HEAL Oil is pure vegetable sesame oil with peroxide value is about more than 1500. It has a powerful germicidal effect and hence helps in all kind of skin related disease, non-healing ulcer, burns and dental pathology. PAIN RELIEF is healthy and safe massaging oil with main active ingredient is ozonized oil. It helps in relieving all kind of musculoskeletal pain. PAIN BALM is an instant pain relieving products. It is an extremely effective balm for body ache and joint pain. As ozonized oil is a major ingredient and due to which it helps in inflammation and reduce swelling and pain instantly. HAIR REVIVE is an effective hair oil for nourishing scalp and hair and makes hair healthy and smooth and shiny. Due to ozonated oil is an active ingredient it is very effective in dandruff and dry scalp. ANTIACIDITY OIL is excellent oil for the treatment of all kind of acidity related problem of the body. Using a unique formula with ozone, it helps in maintaining a good health by removing anaerobic germs from intestinal tract. At the same time it makes the immunity of the body stronger. SKIN BLOSSOM is a unique formula of cream with Ozonated oil is an active ingredient. Due to the pollution people's skin are effected in major way, therefore we suggest you the skin blossom, which detoxified and hydrated the skin. It also repair the skin Tissue and helps in sun burn and protect the skin. MIRAKLE CREAM makes your skin young, bright and cleaner and smoother. With the unique formula with ozone it superoxide's the skin, which in true Increase the metabolic rate and energy of the skin and promotes cell healing. As miracle also act as antioxidant, on using regularly, it helps in reducing Wrinkle, aging spots and damage of dull skin, which in turn skin looks younger.

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/>.

IntroductionWhat can we learn about anomaly from the strangeness of a puppet, a lifeless object, that can both bleed and die? How does the filming process of a puppet’s death engage across media and produce a new media genre that is not easily classified within traditional conventions? Why do these fighting and bleeding puppets’ scenes consistently attract audiences? This study examines how Pili puppetry (1984-present), a popular TV series depicting martial arts-based narratives and fight sequences, interacts with digital technologies and constructs a new media genre. The transmedia constitution of a virtual world not only challenges the stereotype of puppetry’s target audience but also expands the audience’s bodily imagination and desires through the visual component of death scenes. Hence, the show does not merely represent or signify an anomaly, but even creates anomalous desires and imaginary bodies.Cultural commodification and advancing technologies have motivated the convergence and displacement of traditional boundaries, genres, and media, changing the very fabric of textuality itself. By exploring how new media affect the audience’s visual reception of fighting and death, this article sheds light on understanding the metamorphoses of Taiwanese puppetry and articulates a theoretical argument regarding the show’s artistic practice to explain how its form transverses traditional boundaries. This critical exploration focusses on how the form represents bleeding puppets, and in doing so, explicates the politics of transmedia performing and viewing. Pili is an example of an anomalous media form that proliferates anomalous media viewing experiences and desires in turn.Beyond a Media Genre: Taiwanese Pili PuppetryConverging the craft technique of puppeteering and digital technology of filmmaking and animation, Pili puppetry creates a new media genre that exceeds any conventional idea of a puppet show or digital puppet, as it is something in-between. Glove puppetry is a popular traditional theatre in Taiwan, often known as “theatre in the palm” because a traditional puppet was roughly the same size as an adult’s palm. The size enabled the puppeteer to easily manipulate a puppet in one hand and be close to the audience. Traditionally, puppet shows occurred to celebrate the local deities’ birthday. Despite its popularity, the form was limited by available technology. For instance, although stories with vigorous battles were particularly popular, bleeding scenes in such an auspicious occasion were inappropriate and rare. As a live theatrical event featuring immediate interaction between the performer and the spectator, realistic bleeding scenes were rare because it is hard to immediately clean the stage during the performance. Distinct from the traditional puppet show, digital puppetry features semi-animated puppets in a virtual world. Digital puppetry is not a new concept by any means in the Western film industry. Animating a 3D puppet is closely associated with motion capture technologies and animation that are manipulated in a digitalised virtual setting (Ferguson). Commonly, the target audience of the Western digital puppetry is children, so educators sometimes use digital puppetry as a pedagogical tool (Potter; Wohlwend). With these young target audience in mind, the producers often avoid violent and bleeding scenes.Pili puppetry differs from digital puppetry in several ways. For instance, instead of targeting a young audience, Pili puppetry consistently extends the traditional martial-arts performance to include bloody fight sequences that enrich the expressiveness of traditional puppetry as a performing art. Moreover, Pili puppetry does not apply the motion capture technologies to manipulate the puppet’s movement, thus retaining the puppeteers’ puppeteering craft (clips of Pili puppetry can be seen on Pili’s official YouTube page). Hence, Pili is a unique hybrid form, creating its own anomalous space in puppetry. Among over a thousand characters across the series, the realistic “human-like” puppet is one of Pili’s most popular selling points. The new media considerably intervene in the puppet design, as close-up shots and high-resolution images can accurately project details of a puppet’s face and body movements on the screen. Consequently, Pili’s puppet modelling becomes increasingly intricate and attractive and arguably makes its virtual figures more epic yet also more “human” (Chen). Figure 1: Su Huan-Jen in the TV series Pili Killing Blade (1993). His facial expressions were relatively flat and rigid then. Reproduced with permission of Pili International Multimedia Company.Figure 2: Su Huan-Jen in the TV series Pili Nine Thrones (2003). The puppet’s facial design and costume became more delicate and complex. Reproduced with permission of Pili International Multimedia Company.Figure 3: Su Huan-Jen in the TV series Pili Fantasy: War of Dragons (2019). His facial lines softened due to more precise design technologies. The new lightweight chiffon yarn costumes made him look more elegant. The multiple-layer costumes also created more space for puppeteers to hide behind the puppet and enact more complicated manipulations. Reproduced with permission of Pili International Multimedia Company.The design of the most well-known Pili swordsman, Su Huan-Jen, demonstrates how the Pili puppet modelling became more refined and intricate in the past 20 years. In 1993, the standard design was a TV puppet with the size and body proportion slightly enlarged from the traditional puppet. Su Huan-Jen’s costumes were made from heavy fabrics, and his facial expressions were relatively flat and rigid (fig. 1). Pili produced its first puppetry film Legend of the Sacred Stone in 2000; considering the visual quality of a big screen, Pili refined the puppet design including replacing wooden eyeballs and plastic hair with real hair and glass eyeballs (Chen). The filmmaking experience inspired Pili to dramatically improve the facial design for all puppets. In 2003, Su’s modelling in Pili Nine Thrones (TV series) became noticeably much more delicate. The puppet’s size was considerably enlarged by almost three times, so a puppeteer had to use two hands to manipulate a puppet. The complex costumes and props made more space for puppeteers to hide behind the puppet and enrich the performance of the fighting movements (fig. 2). In 2019, Su’s new modelling further included new layers of lightweight fabrics, and his makeup and props became more delicate and complex (fig. 3). Such a refined aesthetic design also lends to Pili’s novelty among puppetry performances.Through the transformation of Pili in the context of puppetry history, we see how the handicraft-like puppet itself gradually commercialised into an artistic object that the audience would yearn to collect and project their bodily imagination. Anthropologist Teri Silvio notices that, for some fans, Pili puppets are similar to worship icons through which they project their affection and imaginary identity (Silvio, “Pop Culture Icons”). Intermediating with the new media, the change in the refined puppet design also comes from the audience’s expectations. Pili’s senior puppet designer Fan Shih-Ching mentioned that Pili fans are very involved, so their preferences affect the design of puppets. The complexity, particularly the layer of costumes, most clearly differentiates the aesthetics of traditional and Pili puppets. Due to the “idolisation” of some famous Pili characters, Shih-Ching has had to design more and more gaudy costumes. Each resurgence of a well-known Pili swordsman, such as Su Huan-Jen, Yi Ye Shu, and Ye Hsiao-Chai, means he has to remodel the puppet.Pili fans represent their infatuation for puppet characters through cosplay (literally “costume play”), which is when fans dress up and pretend to be a Pili character. Their cosplay, in particular, reflects the bodily practice of imaginary identity. Silvio observes that most cosplayers choose to dress as characters that are the most visually appealing rather than characters that best suit their body type. They even avoid moving too “naturally” and mainly move from pose-to-pose, similar to the frame-to-frame techne of animation. Thus, we can understand this “cosplay more as reanimating the character using the body as a kind of puppet rather than as an embodied performance of some aspect of self-identity” (Silvio 2019, 167). Hence, Pili fans’ cosplay is indicative of an anomalous desire to become the puppet-like human, which helps them transcend their social roles in their everyday life. It turns out that not only fans’ preference drives the (re)modelling of puppets but also fans attempt to model themselves in the image of their beloved puppets. The reversible dialectic between fan-star and flesh-object further provokes an “anomaly” in terms of the relationship between the viewers and the puppets. Precisely because fans have such an intimate relationship with Pili, it is important to consider how the series’ content and form configure fans’ viewing experience.Filming Bleeding PuppetsDespite its intricate aesthetics, Pili is still a series with frequent fighting-to-the-death scenes, which creates, and is the result of, extraordinary transmedia production and viewing experiences. Due to the market demand of producing episodes around 500 minutes long every month, Pili constantly creates new characters to maintain the audience’s attention and retain its novelty. So far, Pili has released thousands of characters. To ensure that new characters supersede the old ones, numerous old characters have to die within the plot.The adoption of new media allows the fighting scenes in Pili to render as more delicate, rather than consisting of loud, intense action movements. Instead, the leading swordsmen’s death inevitably takes place in a pathetic and romantic setting and consummates with a bloody sacrifice. Fighting scenes in early Pili puppetry created in the late 1980s were still based on puppets’ body movements, as the knowledge and technology of animation were still nascent and underdeveloped. At that time, the prestigious swordsman mainly relied on the fast speed of brandishing his sword. Since the early 1990s, as animation technology matured, it has become very common to see Pili use CGI animation to create a damaging sword beam for puppets to kill target enemies far away. The sword beam can fly much faster than the puppets can move, so almost every fighting scene employs CGI to visualise both sword beams and flame. The change in fighting manners provokes different representations of the bleeding and death scenes. Open wounds replace puncture wounds caused by a traditional weapon; bleeding scenes become typical, and a special feature in Pili’s transmedia puppetry.In addition to CGI animation, the use of fake blood in the Pili studio makes the performance even more realistic. Pili puppet master Ting Chen-Ching recalled that exploded puppets in traditional puppetry were commonly made by styrofoam blocks. The white styrofoam chips that sprayed everywhere after the explosion inevitably made the performance seem less realistic. By contrast, in the Pili studio, the scene of a puppet spurting blood after the explosion usually applies the technology of editing several shots. The typical procedure would be a short take that captures a puppet being injured. In its injury location, puppeteers sprinkle red confetti to represent scattered blood clots in the following shot. Sometimes the fake blood was splashed with the red confetti to make it further three-dimensional (Ting). Bloody scenes can also be filmed through multiple layers of arranged performance conducted at the same time by a group of puppeteers. Ting describes the practice of filming a bleeding puppet. Usually, some puppeteers sprinkle fake blood in front of the camera, while other puppeteers blasted the puppets toward various directions behind the blood to make the visual effects match. If the puppeteers need to show how a puppet becomes injured and vomits blood during the fight, they can install tiny pipes in the puppet in advance. During the filming, the puppeteer slowly squeezes the pipe to make the fake blood flow out from the puppet’s mouth. Such a bloody scene sometimes accompanies tears dropping from the puppet’s eyes. In some cases, the puppeteer drops the blood on the puppet’s mouth prior to the filming and then uses a powerful electric fan to blow the blood drops (Ting). Such techniques direct the blood to flow laterally against the wind, which makes the puppet’s death more aesthetically tragic. Because it is not a live performance, the puppeteer can try repeatedly until the camera captures the most ideal blood drop pattern and bleeding speed. Puppeteers have to adjust the camera distance for different bleeding scenes, which creates new modes of viewing, sensing, and representing virtual life and death. One of the most representative examples of Pili’s bleeding scenes is when Su’s best friend, Ching Yang-Zi, fights with alien devils in Legend of the Sacred Stone. (The clip of how Ching Yang-Zi fights and bleeds to death can be seen on YouTube.) Ting described how Pili prepared three different puppets of Ching for the non-fighting, fighting, and bleeding scenes (Ting). The main fighting scene starts from a low-angle medium shot that shows how Ching Yang-Zi got injured and began bleeding from the corner of his mouth. Then, a sharp weapon flies across the screen; the following close-up shows that the weapon hits Ching and he begins bleeding immediately. The successive shots move back and forth between his face and the wound in medium shot and close-up. Next, a close-up shows him stepping back with blood dripping on the ground. He then pushes the weapon out of his body to defend enemies; a final close-up follows a medium take and a long take shows the massive hemorrhage. The eruption of fluid plasma creates a natural effect that is difficult to achieve, even with 3D animation. Beyond this impressive technicality, the exceptional production and design emphasise how Pili fully embraces the ethos of transmedia: to play with multiple media forms and thereby create a new form. In the case of Pili, its form is interactive, transcending the boundaries of what we might consider the “living” and the “dead”.Epilogue: Viewing Bleeding Puppets on the ScreenThe simulated, high-quality, realistic-looking puppet designs accompanying the Pili’s featured bloody fighting sequence draw another question: What is the effect of watching human-like puppets die? What does this do to viewer-fans? Violence is prevalent throughout the historical record of human behaviour, especially in art and entertainment because these serve as outlets to fulfill a basic human need to indulge in “taboo fantasies” and escape into “realms of forbidden experience” (Schechter). When discussing the visual representations of violence and the spectacle of the sufferings of others, Susan Sontag notes, “if we consider what emotions would be desirable” (102), viewing the pain of others may not simply evoke sympathy. She argues that “[no] moral charge attaches to the representation of these cruelties. Just the provocation: can you look at this? There is the satisfaction of being able to look at the image without flinching. There is the pleasure of flinching” (41). For viewers, the boldness of watching the bloody scenes can be very inviting. Watching human-like puppets die in the action scenes similarly validates the viewer’s need for pleasure and entertainment. Although different from a human body, the puppets still bears the materiality of being-object. Therefore, watching the puppets bleeding and die as distinctly “human-like’ puppets further prevent viewers’ from feeling guilty or morally involved. The conceptual distance of being aware of the puppet’s materiality acts as a moral buffer; audiences are intimately involved through the particular aesthetic arrangement, yet morally detached. The transmedia filming of puppetry adds another layer of mediation over the human-like “living” puppets that allows such a particular experience. Sontag notices that the media generates an inevitable distance between object and subject, between witness and victim. For Sontag, although images constitute “the imaginary proximity” because it makes the “faraway sufferers” be “seen close-up on the television screen”, it is a mystification to assume that images serve as a direct link between sufferers and viewers. Rather, Sontag insists: the distance makes the viewers feel “we are not accomplices to what caused the suffering. Our sympathy proclaims our innocence as well as our impotence” (102). Echoing Sontag’s argument, Jeffrey Goldstein points out that “distancing” oneself from the mayhem represented in media makes it tolerable. Media creates an “almost real” visuality of violence, so the audience feels relatively safe in their surroundings when exposed to threatening images. Thus, “violent imagery must carry cues to its unreality or it loses appeal” (280). Pili puppets that are human-like, thus not human, more easily enable the audience to seek sensational excitement through viewing puppets’ bloody violence and eventual death on the screen and still feel emotionally secure. Due to the distance granted by the medium, viewers gain a sense of power by excitedly viewing the violence with an accompanying sense of moral exemption. Thus, viewers can easily excuse the limits of their personal responsibility while still being captivated by Pili’s boundary-transgressing aesthetic.The anomalous power of Pili fans’ cosplay differentiates the viewing experience of puppets’ deaths from that of other violent entertainment productions. Cosplayers physically bridge viewing/acting and life/death by dressing up as the puppet characters, bringing them to life, as flesh. Cosplay allows fans to compensate for the helplessness they experience when watching the puppets’ deaths on the screen. They can both “enjoy” the innocent pleasure of watching bleeding puppets and bring their adored dead idols “back to life” through cosplay. The onscreen violence and death thus provide an additional layer of pleasure for such cosplayers. They not only take pleasure in watching the puppets—which are an idealized version of their bodily imagination—die, but also feel empowered to revitalise their loved idols. Therefore, Pili cosplayers’ desires incite a cycle of life, pleasure, and death, in which the company responds to their consumers’ demands in kind. The intertwining of social, economic, and political factors thus collectively thrives upon media violence as entertainment. Pili creates the potential for new cross-media genre configurations that transcend the traditional/digital puppetry binary. On the one hand, the design of swordsman puppets become a simulation of a “living object” responding to the camera distance. On the other hand, the fighting and death scenes heavily rely on the puppeteers’ cooperation with animation and editing. Therefore, Pili puppetry enriches existing discourse on both puppetry and animation as life-giving processes. What is animated by Pili puppetry is not simply the swordsmen characters themselves, but new potentials for media genres and violent entertainment. AcknowledgmentMy hearty gratitude to Amy Gaeta for sharing her insights with me on the early stage of this study.ReferencesChen, Jasmine Yu-Hsing. “Transmuting Tradition: The Transformation of Taiwanese Glove Puppetry in Pili Productions.” Journal of the Oriental Society of Australia 51 (2019): 26-46.Ferguson, Jeffrey. “Lessons from Digital Puppetry: Updating a Design Framework for a Perceptual User Interface.” IEEE International Conference on Computer and Information Technology, 2015.Goldstein, Jeffrey. “The Attractions of Violent Entertainment.” Media Psychology 1.3 (1999): 271-282.Potter, Anna. “Funding Contemporary Children’s Television: How Digital Convergence Encourages Retro Reboot.” International Journal on Communications Management 19.2 (2017): 108-112.Schechter, Harold. Savage Pastimes: A Cultural History of Violent Entertainment. New York: St. Martin’s, 2005.Silvio, Teri. “Pop Culture Icons: Religious Inflections of the Character Toy in Taiwan.” Mechademia 3.1 (2010): 200-220.———. Puppets, Gods, and Brands: Theorizing the Age of Animation from Taiwan. Honolulu: U Hawaii P, 2019. Sontag, Susan. Regarding the Pain of Others. New York: Farrar, Straus, and Giroux, 2004.Ting, Chen-Ching. Interview by the author. Yunlin, Taiwan. 24 June 2019.Wohlwend, Karen E. “One Screen, Many Fingers: Young Children's Collaborative Literacy Play with Digital Puppetry Apps and Touchscreen Technologies.” Theory into Practice 54.2 (2015): 154-162.

Hundreds of thousands of Australian children were born in the shadow of the Great War, fathered by men who had enlisted between 1914 and 1918. Their lives could be and often were hard and unhappy, as Anzac historian Alistair Thomson observed of his father’s childhood in the 1920s and 1930s. David Thomson was son of a returned serviceman Hector Thomson who spent much of his adult life in and out of repatriation hospitals (257-259) and whose memory was subsequently expunged from Thomson family stories (299-267). These children of trauma fit within a pattern suggested by Marianne Hirsch in her influential essay “The Generation of Postmemory”. According to Hirsch, “postmemory describes the relationship of the second generation to powerful, often traumatic, experiences that preceded their births but that were nevertheless transmitted to them so deeply as to seem to constitute memories in their own right” (n.p.). This article attempts to situate George Johnston’s novel My Brother Jack (1964) within the context of postmemory narratives of violence that were complicated in Australia by the Anzac legend which occluded any too open discussion about the extent of war trauma present within community, including the children of war.“God knows what damage” the war “did to me psychologically” (48), ponders Johnston’s protagonist and alter-ego David Meredith in My Brother Jack. Published to acclaim fifty years after the outbreak of the First World War, My Brother Jack became a widely read text that seemingly spoke to the shared cultural memories of a generation which did not know battlefield violence directly but experienced its effects pervasively and vicariously in the aftermath through family life, storytelling, and the memorabilia of war. For these readers, the novel represented more than a work of fiction; it was a touchstone to and indicative of their own negotiations though often unspoken post-war trauma.Meredith, like his creator, is born in 1912. Strictly speaking, therefore, both are not part of the post-war generation. However, they are representative and therefore indicative of the post-war “hinge generation” which was expected to assume “guardianship” of the Anzac Legend, though often found the narrative logic challenging. They had been “too young for the war to have any direct effect”, and yet “every corner” of their family’s small suburban homes appear to be “impregnated with some gigantic and sombre experience that had taken place thousands of miles away” (17).According to Johnston’s biographer, Garry Kinnane, the “most teasing puzzle” of George Johnston’s “fictional version of his childhood in My Brother Jack is the monstrous impression he creates of his returned serviceman father, John George Johnston, known to everyone as ‘Pop.’ The first sixty pages are dominated by the tyrannical figure of Jack Meredith senior” (1).A large man purported to be six foot three inches (1.9 metres) in height and weighing fifteen stone (95 kilograms), the real-life Pop Johnston reputedly stood head and shoulders above the minimum requirement of five foot and six inches (1.68 metres) at the time of his enlistment for war in 1914 (Kinnane 4). In his fortieth year, Jack Johnston senior was also around twice the age of the average Australian soldier and among one in five who were married.According to Kinnane, Pop Johnston had “survived the ordeal of Gallipoli” in 1915 only to “endure three years of trench warfare in the Somme region”. While the biographer and the Johnston family may well have held this to be true, the claim is a distortion. There are a few intimations throughout My Brother Jack and its sequel Clean Straw for Nothing (1969) to suggest that George Johnston may have suspected that his father’s wartime service stories had been embellished, though the depicted wartime service of Pop Meredith remains firmly within the narrative arc of the Anzac legend. This has the effect of layering the postmemory violence experienced by David Meredith and, by implication, his creator, George Johnston. Both are expected to be keepers of a lie masquerading as inviolable truth which further brutalises them.John George (Pop) Johnston’s First World War military record reveals a different story to the accepted historical account and his fictionalisation in My Brother Jack. He enlisted two and a half months after the landing at Gallipoli on 12 July 1915 and left for overseas service on 23 November. Not quite the imposing six foot three figure of Kinnane’s biography, he was fractionally under five foot eleven (1.8 metres) and weighed thirteen stone (82.5 kilograms). Assigned to the Fifth Field Engineers on account of his experience as an electric tram fitter, he did not see frontline service at Gallipoli (NAA).Rather, according to the Company’s history, the Fifth Engineers were involved in a range of infrastructure and support work on the Western Front, including the digging and maintenance of trenches, laying duckboard, pontoons and tramlines, removing landmines, building huts, showers and latrines, repairing roads, laying drains; they built a cinema at Beaulencourt Piers for “Brigade Swimming Carnival” and baths at Malhove consisting of a large “galvanised iron building” with a “concrete floor” and “setting tanks capable of bathing 2,000 men per day” (AWM). It is likely that members of the company were also involved in burial details.Sapper Johnston was hospitalised twice during his service with influenza and saw out most of his war from October 1917 attached to the Army Cookery School (NAA). He returned to Australia on board the HMAT Kildonian Castle in May 1919 which, according to the Sydney Morning Herald, also carried the official war correspondent and creator of the Anzac legend C.E.W. Bean, national poet Banjo Paterson and “Warrant Officer C G Macartney, the famous Australian cricketer”. The Herald also listed the names of “Returned Officers” and “Decorated Men”, but not Pop Johnston who had occupied the lower decks with other returning men (“Soldiers Return”).Like many of the more than 270,000 returned soldiers, Pop Johnston apparently exhibited observable changes upon his repatriation to Australia: “he was partially deaf” which was attributed to the “constant barrage of explosions”, while “gas” was suspected to have “left him with a legacy of lung disorders”. Yet, if “anyone offered commiserations” on account of this war legacy, he was quick to “dismiss the subject with the comment that ‘there were plenty worse off’” (Kinnane 6). The assumption is that Pop’s silence is stoic; the product of unspeakable horror and perhaps a symptom of survivor guilt.An alternative interpretation, suggested by Alistair Thomson in Anzac Memories, is that the experiences of the vast majority of returned soldiers were expected to fit within the master narrative of the Anzac legend in order to be accepted and believed, and that there was no space available to speak truthfully about alternative war service. Under pressure of Anzac expectations a great many composed stories or remained selectively silent (14).Data gleaned from the official medical history suggest that as many as four out of every five returned servicemen experienced emotional or psychological disturbance related to their war service. However, the two branches of medicine represented by surgeons and physicians in the Repatriation Department—charged with attending to the welfare of returned servicemen—focused on the body rather than the mind and the emotions (Murphy and Nile).The repatriation records of returned Australian soldiers reveal that there were, indeed, plenty physically worse off than Pop Johnston on account of bodily disfigurement or because they had been somatically compromised. An estimated 30,000 returned servicemen died in the decade after the cessation of hostilities to 1928, bringing the actual number of war dead to around 100,000, while a 1927 official report tabled the medical conditions of a further 72,388 veterans: 28,305 were debilitated by gun and shrapnel wounds; 22,261 were rheumatic or had respiratory diseases; 4534 were afflicted with eye, ear, nose, or throat complaints; 9,186 had tuberculosis or heart disease; 3,204 were amputees while only; 2,970 were listed as suffering “war neurosis” (“Enlistment”).Long after the guns had fallen silent and the wounded survivors returned home, the physical effects of war continued to be apparent in homes and hospital wards around the country, while psychological and emotional trauma remained largely undiagnosed and consequently untreated. David Meredith’s attitude towards his able-bodied father is frequently dismissive and openly scathing: “dad, who had been gassed, but not seriously, near Vimy Ridge, went back to his old job at the tramway depot” (9). The narrator-son later considers:what I realise now, although I never did at the time, is that my father, too, was oppressed by intimidating factors of fear and change. By disillusion and ill-health too. As is so often the case with big, strong, athletic men, he was an extreme hypochondriac, and he had convinced himself that the severe bronchitis which plagued him could only be attributed to German gas he had swallowed at Vimy Ridge. He was too afraid to go to a doctor about it, so he lived with a constant fear that his lungs were decaying, and that he might die at any time, without warning. (42-3)During the writing of My Brother Jack, the author-son was in chronically poor health and had been recently diagnosed with the romantic malady and poet’s disease of tuberculosis (Lawler) which plagued him throughout his work on the novel. George Johnston believed (correctly as it turned out) that he was dying on account of the disease, though, he was also an alcoholic and smoker, and had been reluctant to consult a doctor. It is possible and indeed likely that he resentfully viewed his condition as being an extension of his father—vicariously expressed through the depiction of Pop Meredith who exhibits hysterical symptoms which his son finds insufferable. David Meredith remains embittered and unforgiving to the very end. Pop Meredith “lived to seventy-three having died, not of German gas, but of a heart attack” (46).Pop Meredith’s return from the war in 1919 terrifies his seven-year-old son “Davy”, who accompanies the family to the wharf to welcome home a hero. The young boy is unable to recall anything about the father he is about to meet ostensibly for the first time. Davy becomes overwhelmed by the crowds and frightened by the “interminable blaring of horns” of the troopships and the “ceaseless roar of shouting”. Dwarfed by the bodies of much larger men he becomestoo frightened to look up at the hours-long progression of dark, hard faces under wide, turned-up hats seen against bayonets and barrels that are more blue than black ... the really strong image that is preserved now is of the stiff fold and buckle of coarse khaki trousers moving to the rhythm of knees and thighs and the tight spiral curves of puttees and the thick boots hammering, hollowly off the pier planking and thunderous on the asphalt roadway.Depicted as being small for his age, Davy is overwrought “with a huge and numbing terror” (10).In the years that follow, the younger Meredith desires emotional stability but remains denied because of the war’s legacy which manifests in the form of a violent patriarch who is convinced that his son has been rendered effeminate on account of the manly absence during vital stages of development. With the return of the father to the household, Davy grows to fear and ultimately despise a man who remains as alien to him as the formerly absent soldier had been during the war:exactly when, or why, Dad introduced his system of monthly punishments I no longer remember. We always had summary punishment, of course, for offences immediately detected—a cuffing around the ears or a sash with a stick of a strap—but Dad’s new system was to punish for the offences which had escaped his attention. So on the last day of every month Jack and I would be summoned in turn to the bathroom and the door would be locked and each of us would be questioned about the sins which we had committed and which he had not found out about. This interrogation was the merest formality; whether we admitted to crimes or desperately swore our innocence it was just the same; we were punished for the offences which, he said, he knew we must have committed and had to lie about. We then had to take our shirts and singlets off and bend over the enamelled bath-tub while he thrashed us with the razor-strop. In the blind rages of these days he seemed not to care about the strength he possessed nor the injuries he inflicted; more often than not it was the metal end of the strop that was used against our backs. (48)Ironically, the ritualised brutality appears to be a desperate effort by the old man to compensate for his own emasculation in war and unresolved trauma now that the war is ended. This plays out in complicated fashion in the development of David Meredith in Clean Straw for Nothing, Johnston’s sequel to My Brother Jack.The imputation is that Pop Meredith practices violence in an attempt to reassert his failed masculinity and reinstate his status as the head of the household. Older son Jack’s beatings cease when, as a more physically able young man, he is able to threaten the aggressor with violent retaliation. This action does not spare the younger weaker Davy who remains dominated. “My beating continued, more ferociously than ever, … . They ceased only because one day my father went too far; he lambasted me so savagely that I fell unconscious into the bath-tub, and the welts across my back made by the steel end of the razor-strop had to be treated by a doctor” (53).Pop Meredith is persistently reminded that he has no corporeal signifiers of war trauma (only a cough); he is surrounded by physically disabled former soldiers who are presumed to be worse off than he on account of somatic wounding. He becomes “morose, intolerant, bitter and violently bad-tempered”, expressing particular “displeasure and resentment” toward his wife, a trained nurse, who has assumed carer responsibilities for homing the injured men: “he had altogether lost patience with her role of Florence Nightingale to the halt and the lame” (40). Their marriage is loveless: “one can only suppose that he must have been darkly and profoundly disturbed by the years-long procession through our house of Mother’s ‘waifs and strays’—those shattered former comrades-in-arms who would have been a constant and sinister reminder of the price of glory” (43); a price he had failed to adequately pay with his uncompromised body intact.Looking back, a more mature David Meredith attempts to establish order, perspective and understanding to the “mess of memory and impressions” of his war-affected childhood in an effort to wrest control back over his postmemory violation: “Jack and I must have spent a good part of our boyhood in the fixed belief that grown-up men who were complete were pretty rare beings—complete, that is, in that they had their sight or hearing or all of their limbs” (8). While the father is physically complete, his brooding presence sets the tone for the oppressively “dark experience” within the family home where all rooms are “inhabited by the jetsam that the Somme and the Marne and the salient at Ypres and the Gallipoli beaches had thrown up” (18). It is not until Davy explores the contents of the “big deep drawer at the bottom of the cedar wardrobe” in his parents’ bedroom that he begins to “sense a form in the shadow” of the “faraway experience” that had been the war. The drawer contains his father’s service revolver and ammunition, battlefield souvenirs and French postcards but, “most important of all, the full set of the Illustrated War News” (19), with photographs of battlefield carnage. These are the equivalent of Hirsch’s photographs of the Holocaust that establish in Meredith an ontology that links him more realistically to the brutalising past and source of his ongoing traumatistion (Hirsch). From these, Davy begins to discern something of his father’s torment but also good fortune at having survived, and he makes curatorial interventions not by becoming a custodian of abjection like second generation Holocaust survivors but by disposing of the printed material, leaving behind artefacts of heroism: gun, the bullets, the medals and ribbons. The implication is that he has now become complicit in the very narrative that had oppressed him since his father’s return from war.No one apparently notices or at least comments on the removal of the journals, the images of which become linked in the young boys mind to an incident outside a “dilapidated narrow-fronted photographer’s studio which had been deserted and padlocked for as long as I could remember”. A number of sun-damaged photographs are still displayed in the window. Faded to a “ghostly, deathly pallor”, and speckled with fly droppings, years earlier, they had captured young men in uniforms before embarkation for the war. An “agate-eyed” boy from Davy’s school joins in the gazing, saying nothing for a long time until the silence is broken: “all them blokes there is dead, you know” (20).After the unnamed boy departs with a nonchalant “hoo-roo”, young Davy runs “all the way home, trying not to cry”. He cannot adequately explain the reason for his sudden reaction: “I never after that looked in the window of the photographer’s studio or the second hand shop”. From that day on Davy makes a “long detour” to ensure he never passes the shops again (20-1). Having witnessed images of pre-war undamaged young men in the prime of their youth, he has come face-to-face with the consequences of war which he is unable to reconcile in terms of the survival and return of his much older father.The photographs of the young men establishes a causal connection to the physically wrecked remnants that have shaped Davy’s childhood. These are the living remains that might otherwise have been the “corpses sprawled in mud or drowned in flooded shell craters” depicted in the Illustrated News. The photograph of the young men establishes Davy’s connection to the things “propped up our hallway”, of “Bert ‘sobbing’ in the backyard and Gabby Dixon’s face at the dark end of the room”, and only reluctantly the “bronchial cough of my father going off in the dawn light to the tramways depot” (18).That is to say, Davy has begun to piece together sense from senselessness, his father’s complicity and survival—and, by association, his own implicated life and psychological wounding. He has approached the source of his father’s abjection and also his own though he continues to be unable to accept and forgive. Like his father—though at the remove—he has been damaged by the legacies of the war and is also its victim.Ravaged by tuberculosis and alcoholism, George Johnston died in 1970. According to the artist Sidney Nolan he had for years resembled the ghastly photographs of survivors of the Holocaust (Marr 278). George’s forty five year old alcoholic wife Charmian Clift predeceased him by twelve months, having committed suicide in 1969. Four years later, in 1973, George and Charmian’s twenty four year old daughter Shane also took her own life. Their son Martin drank himself to death and died of organ failure at the age of forty three in 1990. They are all “dead, you know”.ReferencesAWM. Fifth Field Company, Australian Engineers. Diaries, AWM4 Sub-class 14/24.“Enlistment Report”. Reveille, 29 Sep. 1928.Hirsch, Marianne. “The Generation of Postmemory.” Poetics Today 29.1 (Spring 2008): 103-128. <https://read.dukeupress.edu/poetics-today/article/29/1/103/20954/The-Generation-of-Postmemory>.Johnston, George. Clean Straw for Nothing. London: Collins, 1969.———. My Brother Jack. London: Collins, 1964.Kinnane, Garry. George Johnston: A Biography. Melbourne: Nelson, 1986.Lawler, Clark. Consumption and Literature: the Making of the Romantic Disease. Basingstoke: Palgrave Macmillan, 2006.Marr, David, ed. Patrick White Letters. Sydney: Random House, 1994.Murphy, Ffion, and Richard Nile. “Gallipoli’s Troubled Hearts: Fear, Nerves and Repatriation.” Studies in Western Australian History 32 (2018): 25-38.NAA. John George Johnston War Service Records. <https://recordsearch.naa.gov.au/SearchNRetrieve/Interface/ViewImage.aspx?B=1830166>.“Soldiers Return by the Kildonan Castle.” Sydney Morning Herald, 10 May 1919: 18.Thomson, Alistair. Anzac Memories: Living with the Legend. Clayton: Monash UP, 2013.

IntroductionLike other forms of embodiment, pregnancy has increasingly become subject to representation and interpretation via digital technologies. Pregnancy and the unborn entity were largely private, and few people beyond the pregnant women herself had access to the foetus growing within her (Duden). Now pregnant and foetal bodies have become open to public portrayal and display (Lupton The Social Worlds of the Unborn). A plethora of online materials – websites depicting the unborn entity from the moment of conception, amateur YouTube videos of births, social media postings of ultrasounds and self-taken photos (‘selfies’) showing changes in pregnant bellies, and so on – now ensure the documentation of pregnant and unborn bodies in extensive detail, rendering them open to other people’s scrutiny. Other recent digital technologies directed at pregnancy include mobile software applications, or ‘apps’. In this article, we draw on our study involving a critical discourse analysis of a corpus of pregnancy-related apps offered in the two major app stores. In so doing, we discuss the ways in which pregnancy-related apps portray pregnant and unborn bodies. We place a particular focus on the ludification and gamification strategies employed to position pregnancy as a playful, creative and fulfilling experience that is frequently focused on consumption. As we will demonstrate, these strategies have wider implications for concepts of pregnant and foetal embodiment and subjectivity.It is important here to make a distinction between ludification and gamification. Ludification is a broader term than gamification. It is used in the academic literature on gaming (sometimes referred to as ‘ludology’) to refer to elements of games reaching into other aspects of life beyond leisure pursuits (Frissen et al. Playful Identities: The Ludification of Digital Media Cultures; Raessens). Frissen et al. (Frissen et al. "Homo Ludens 2.0: Play, Media and Identity") for example, claim that even serious pursuits such as work, politics, education and warfare have been subjected to ludification. They note that digital technologies in general tend to incorporate ludic dimensions. Gamification has been described as ‘the use of game design elements in non-game contexts’ (Deterding et al. 9). The term originated in the digital media industry to describe the incorporation of features into digital technologies that not explicitly designed as games, such as competition, badges, rewards and fun that engaged and motivated users to make them more enjoyable to use. Gamification is now often used in literatures on marketing strategies, persuasive computing or behaviour modification. It is an important element of ‘nudge’, an approach to behaviour change that involves persuasion over coercion (Jones, Pykett and Whitehead). Gamification thus differs from ludification in that the former involves applying ludic principles for reasons other than the pleasures of enjoying the game for their own sake, often to achieve objectives set by actors and agencies other than the gamer. Indeed, this is why gamification software has been described by Bogost (Bogost) as ‘exploitationware’. Analysing Pregnancy AppsMobile apps have become an important medium in contemporary digital technology use. As of May 2015, 1.5 million apps were available to download on Google Play while 1.4 million were available in the Apple App Store (Statista). Apps related to pregnancy are a popular item in app stores, frequently appearing on the Apple App Store’s list of most-downloaded apps. Google Play’s figures show that many apps directed at pregnant women have been downloaded hundreds of thousands, or even millions, of times. For example, ‘Pregnancy +’, ‘I’m Expecting - Pregnancy App’ and ‘What to Expect - Pregnancy Tracker’ have each been downloaded between one and five million times, while ‘My Pregnancy Today’ has received between five and ten million downloads. Pregnancy games for young girls are also popular. Google Play figures show that the ‘Pregnant Emergency Doctor’ game, for example, has received between one and five million downloads. Research has found that pregnant women commonly download pregnancy-related apps and find them useful sources of information and support (Hearn, Miller and Fletcher; Rodger et al.; Kraschnewski et al.; Declercq et al.; Derbyshire and Dancey; O'Higgins et al.). We conducted a comprehensive analysis of all pregnancy-related smartphone apps in the two major app stores, Apple App Store and Google Play, in late June 2015. Android and Apple’s iOS have a combined market share of 91 percent of apps installed on mobile phones (Seneviratne et al.). A search for all pregnancy-related apps offered in these stores used key terms such as pregnancy, childbirth, conception, foetus/fetus and baby. After eliminating apps listed in these searches that were clearly not human pregnancy-related, 665 apps on Google Play and 1,141 on the Apple App Store remained for inclusion in our study. (Many of these apps were shared across the stores.)We carried out a critical discourse analysis of these apps, looking closely at the app descriptions offered in the two stores. We adopted the perspective that sees apps, like any other form of media, as sociocultural artefacts that both draw on and reproduce shared norms, ideals, knowledges and beliefs (Lupton "Quantified Sex: A Critical Analysis of Sexual and Reproductive Self-Tracking Using Apps"; Millington "Smartphone Apps and the Mobile Privatization of Health and Fitness"; Lupton "Apps as Artefacts: Towards a Critical Perspective on Mobile Health and Medical Apps"). In undertaking our analysis of the app descriptions in our corpus, attention was paid to the title of each app, the textual accounts of its content and use and the images that were employed, such as the logo of the app and the screenshots that were used to illustrate its content and style. Our focus in this article is on the apps that we considered as including elements of entertainment. Pregnancy-related game apps were by far the largest category of the apps in our corpus. These included games for young girls and expectant fathers as well as apps for ultrasound manipulation, pregnancy pranks, foetal sex prediction, choosing baby names, and quizzes. Less obviously, many other apps included in our analysis offered some elements of gamification and ludification, and these were considered in our analysis. ‘Pregnant Adventures’: App Games for GirlsOne of the major genres of apps that we identified was games directed at young girls. These apps invited users to shop for clothes, dress up, give a new hair style, ‘make-over’ and otherwise beautify a pregnant woman. These activities were directed at the goal of improving the physical attractiveness and therefore (it was suggested) the confidence of the woman, who was presented as struggling with coming to terms with changes in her body during pregnancy. Other apps for this target group involved the player assuming the role of a doctor in conducting medical treatments for injured pregnant women or assisting the birth of her baby.Many of these games represented the pregnant woman visually as looking like an archetypal Barbie doll, with a wardrobe to match. One app (‘Barbara Pregnancy Shopping’) even uses the name ‘Barbara’ and the screenshots show a woman similar in appearance to the doll. Its description urges players to use the game to ‘cheer up’ an ‘unconfident’ Barbara by taking her on a ‘shopping spree’ for new, glamorous clothes ‘to make Barbara feel beautiful throughout her pregnancy’. Players may find ‘sparkly accessories’ as well for Barbara and help her find a new hairstyle so that she ‘can be her fashionable self again’ and ‘feel prepared to welcome her baby!’. Likewise, the game ‘Pregnant Mommy Makeover Spa’ involves players selecting clothes, applying beauty treatments and makeup and adding accessories to give a makeover to ‘Pregnant Princess’ Leila. The ‘Celebrity Mommy’s Newborn Baby Doctor’ game combines the drawcard of ‘celebrity’ with ‘mommy’. Players are invited to ‘join the celebrities in their pregnancy adventure!’ and ‘take care of Celebrity Mom during her pregnancy!’.An app by the same developer of ‘Barbara Pregnancy Shopping’ also offers ‘Barbara’s Caesarean Birth’. The app description claims that: ‘Of course her poor health doesn’t allow Barbara to give birth to her baby herself.’ It is up to players to ‘make everything perfect’ for Barbara’s caesarean birth. The screenshots show Barbara’s pregnant abdomen being slit open, retracted and a rosy, totally clean infant extracted from the incision, complete with blonde hair. Players then sew up the wound. A final screenshot displays an image of a smiling Barbara standing holding her sleeping, swaddled baby, with the words ‘You win’.Similar games involve princesses, mermaids, fairies and even monster and vampire pregnant women giving birth either vaginally or by caesarean. Despite their preternatural status, the monster and vampire women conform to the same aesthetic as the other pregnant women in these games: usually with long hair and pretty, made-up faces, wearing fashionable clothing even on the operating table. Their newborn infants are similarly uniform in their appearance as they emerge from the uterus. They are white-skinned, clean and cherubic (described in ‘Mommy’s Newborn Baby Princess’ as ‘the cutest baby you probably want’), a far cry from the squalling, squashed-faced infants smeared in birth fluids produced by the real birth process.In these pregnancy games for girls, the pain and intense bodily effort of birthing and the messiness produced by the blood and other body fluids inherent to the process of labour and birth are completely missing. The fact that caesarean birth is a major abdominal surgery requiring weeks of recovery is obviated in these games. Apart from the monsters and vampires, who may have green- or blue-hued skin, nearly all other pregnant women are portrayed as white-skinned, young, wearing makeup and slim, conforming to conventional stereotypical notions of female beauty. In these apps, the labouring women remain glamorous, usually smiling, calm and unsullied by the visceral nature of birth.‘Track Your Pregnancy Day by Day’: Self-Monitoring and Gamified PregnancyElements of gamification were evident in a large number of the apps in our corpus, including many apps that invite pregnant users to engage in self-tracking of their bodies and that of their foetuses. Users are asked to customise the apps to document their changing bodies and track their foetus’ development as part of reproducing the discourse of the miraculous nature of pregnancy and promoting the pleasures of self-tracking and self-transformation from pregnant woman to mother. When using the ‘Pregnancy+’ app, for example, users can choose to construct a ‘Personal Dashboard’ that includes details of their pregnancy. They can input their photograph, first name and their expected date of delivery so that that each daily update begins with ‘Hello [name of user], you are [ ] weeks and [ ] days pregnant’ with the users’ photograph attached to the message. The woman’s weight gain over time and a foetal kick counter are also included in this app. It provides various ways for users to mark the passage of time, observe the ways in which their foetuses change and move week by week and monitor changes in their bodies. According to the app description for ‘My Pregnancy Today’, using such features allows a pregnant woman to: ‘Track your pregnancy day by day.’ Other apps encourage women to track such aspects of physical activity, vitamin and fluid intake, diet, mood and symptoms. The capacity to visually document the pregnant user’s body is also a feature of several apps. The ‘Baby Bump Pregnancy’, ‘WebMD Pregnancy’, ‘I’m Expecting’,’iPregnant’ and ‘My Pregnancy Today’ apps, for example, all offer an album feature for pregnant bump photos taken by the user of herself (described as a ‘bumpie’ in the blurb for ‘My Pregnancy Today’). ‘Baby Buddy’ encourages women to create a pregnant avatar of themselves (looking glamorous, well-dressed and happy). Some apps even advise users on how they should feel. As a screenshot from ‘Pregnancy Tracker Week by Week’ claims: ‘Victoria, your baby is growing in your body. You should be the happiest woman in the world.’Just as pregnancy games for little girls portrayal pregnancy as a commodified and asetheticised experience, the apps directed at pregnant women themselves tend to shy away from discomforting fleshly realities of pregnant and birthing embodiment. Pregnancy is represented as an enjoyable and fashionable state of embodiment: albeit one that requires constant self-surveillance and vigilance.‘Hello Mommy!’: The Personalisation and Aestheticisation of the FoetusA dominant feature of pregnancy-related apps is the representation of the foetus as already a communicative person in its own right. For example, the ‘Pregnancy Tickers – Widget’ app features the image of a foetus (looking far more like an infant, with a full head of wavy hair and open eyes) holding a pencil and marking a tally on the walls of the uterus. The app is designed to provide various icons showing the progress of the user’s pregnancy each day on her mobile device. The ‘Hi Mommy’ app features a cartoon-like pink and cuddly foetus looking very baby-like addressing its mother from the womb, as in the following message that appears on the user’s smartphone: ‘Hi Mommy! When will I see you for the first time?’ Several pregnancy-tracking apps also allow women to input the name that they have chosen for their expected baby, to receive customised notifications of its progress (‘Justin is nine weeks and two days old today’).Many apps also incorporate images of foetuses that represent them as wondrous entities, adopting the visual style of 1960s foetal photography pioneer Lennart Nilsson, or what Stormer (Stormer) has referred to as ‘prenatal sublimity’. The ‘Pregnancy+’ app features such images. Users can choose to view foetal development week-by-week as a colourful computerised animation or 2D and 3D ultrasound scans that have been digitally manipulated to render them aesthetically appealing. These images replicate the softly pink, glowing portrayals of miraculous unborn life typical of Nilsson’s style.Other apps adopt a more contemporary aesthetic and allow parents to store and manipulate images of their foetal ultrasounds and then share them via social media. The ‘Pimp My Ultrasound’ app, for example, invites prospective parents to manipulate images of their foetal ultrasounds by adding in novelty features to the foetal image such as baseball caps, jewellery, credit cards and musical instruments. The ‘Hello Mom’ app creates a ‘fetal album’ of ultrasounds taken of the user’s foetus, while the ‘Ultrasound Viewer’ app lets users manipulate their 3/4 D foetal ultrasound images: ‘Have fun viewing it from every angle, rotating, panning and zooming to see your babies [sic] features and share with your family and friends via Facebook and Twitter! … Once uploaded, you can customise your scan with a background colour and skin colour of your choice’.DiscussionPregnancy, like any other form of embodiment, is performative. Pregnant women are expected to conform to norms and assumptions about their physical appearance and deportment of their bodies that expect them to remain well-groomed, fit and physically attractive without appearing overly sexual (Longhurst "(Ad)Dressing Pregnant Bodies in New Zealand: Clothing, Fashion, Subjectivities and Spatialities"; Longhurst "'Corporeographies’ of Pregnancy: ‘Bikini Babes'"; Nash; Littler). Simultaneously they must negotiate the burden of bodily management in the interests of risk regulation. They are expected to protect their vulnerable unborn from potential dangers by stringently disciplining their bodies and policing to what substances they allow entry (Lupton The Social Worlds of the Unborn; Lupton "'Precious Cargo': Risk and Reproductive Citizenship"). Pregnancy self-tracking apps enact the soft politics of algorithmic authority, encouraging people to conform to expectations of self-responsibility and self-management by devoting attention to monitoring their bodies and acting on the data that they generate (Whitson; Millington "Amusing Ourselves to Life: Fitness Consumerism and the Birth of Bio-Games"; Lupton The Quantified Self: A Sociology of Self-Tracking).Many commentators have remarked on the sexism inherent in digital games (e.g. Dickerman, Christensen and Kerl-McClain; Thornham). Very little research has been conducted specifically on the gendered nature of app games. However our analysis suggests that, at least in relation to the pregnant woman, reductionist heteronormative, cisgendered, patronising and paternalistic stereotypes abound. In the games for girls, pregnant women are ideally young, heterosexual, partnered, attractive, slim and well-groomed, before, during and after birth. In self-tracking apps, pregnant women are portrayed as ideally self-responsible, enthused about their pregnancy and foetus to the point that they are counting the days until the birth and enthusiastic about collecting and sharing details about themselves and their unborn (often via social media).Ambivalence about pregnancy, the foetus or impending motherhood, and lack of interest in monitoring the pregnancy or sharing details of it with others are not accommodated, acknowledged or expected by these apps. Acknowledgement of the possibility of pregnant women who are not overtly positive about their pregnancy or lack interest in it or who identify as transgender or lesbian or who are sole mothers is distinctly absent.Common practices we noted in apps – such as giving foetuses names before birth and representing them as verbally communicating with their mothers from inside the womb – underpin a growing intensification around the notion of the unborn entity as already an infant and social actor in its own right. These practices have significant implications for political agendas around the treatment of pregnant women in terms of their protection or otherwise of their unborn, and for debates about women’s reproductive rights and access to abortion (Lupton The Social Worlds of the Unborn; Taylor The Public Life of the Fetal Sonogram: Technology, Consumption and the Politics of Reproduction). Further, the gamification and ludification of pregnancy serve to further commodify the experience of pregnancy and childbirth, contributing to an already highly commercialised environment in which expectant parents, and particularly mothers, are invited to purchase many goods and services related to pregnancy and early parenthood (Taylor "Of Sonograms and Baby Prams: Prenatal Diagnosis, Pregnancy, and Consumption"; Kroløkke; Thomson et al.; Taylor The Public Life of the Fetal Sonogram: Technology, Consumption and the Politics of Reproduction; Thomas).In the games for girls we examined, the pregnant woman herself was a commodity, a selling point for the app. The foetus was also frequently commodified in its representation as an aestheticised entity and the employment of its image (either as an ultrasound or other visual representations) or identity to market apps such as the girls’ games, apps for manipulating ultrasound images, games for predicting the foetus’ sex and choosing its name, and prank apps using fake ultrasounds purporting to reveal a foetus inside a person’s body. As the pregnant user engages in apps, she becomes a commodity in yet another way: the generator of personal data that are marketable in themselves. In this era of the digital data knowledge economy, the personal information about people gathered from their online interactions and content creation has become highly profitable for third parties (Andrejevic; van Dijck). Given that pregnant women are usually in the market for many new goods and services, their personal data is a key target for data mining companies, who harvest it to sell to advertisers (Marwick).To conclude, our analysis suggests that gamification and ludification strategies directed at pregnancy and childbirth can serve to obfuscate the societal pressures that expect and seek to motivate pregnant women to maintain physical fitness and attractiveness, simultaneously ensuring that they protect their foetuses from all possible risks. In achieving both ends, women are encouraged to engage in intense self-monitoring and regulation of their bodies. These apps also reproduce concepts of the unborn entity as a precious and beautiful already-human. These types of portrayals have important implications for how young girls learn about pregnancy and childbirth, for pregnant women’s experiences and for concepts of foetal personhood that in turn may influence women’s reproductive rights and abortion politics.ReferencesAndrejevic, Mark. Infoglut: How Too Much Information Is Changing the Way We Think and Know. New York: Routledge, 2013. Print.Bogost, Ian. "Why Gamification Is Bullshit." The Gameful World: Approaches, Issues, Applications. Eds. Steffen Walz and Sebastian Deterding. Boston, MA: MIT Press, 2015. 65-80. Print.Declercq, E.R., et al. Listening to Mothers III: Pregnancy and Birth. New York: Childbirth Connection, 2013. Print.Derbyshire, Emma, and Darren Dancey. "Smartphone Medical Applications for Women's Health: What Is the Evidence-Base and Feedback?" International Journal of Telemedicine and Applications (2013).Deterding, Sebastian, et al. "From Game Design Elements to Gamefulness: Defining Gamification." Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments. ACM, 2011. Dickerman, Charles, Jeff Christensen, and Stella Beatríz Kerl-McClain. "Big Breasts and Bad Guys: Depictions of Gender and Race in Video Games." Journal of Creativity in Mental Health 3.1 (2008): 20-29. Duden, Barbara. Disembodying Women: Perspectives on Pregnancy and the Unborn. Trans. Lee Hoinacki. Cambridge, MA: Harvard University Press, 1993. Frissen, Valerie, et al. "Homo Ludens 2.0: Play, Media and Identity." Playful Identities: The Ludification of Digital Media Cultures. Eds. Valerie Frissen et al. Amsterdam: University of Amsterdam Press, 2015. 9-50. ———, eds. Playful Identities: The Ludification of Digital Media Cultures. Amsterdam: Amsterdam University Press, 2015. Hearn, Lydia, Margaret Miller, and Anna Fletcher. "Online Healthy Lifestyle Support in the Perinatal Period: What Do Women Want and Do They Use It?" Australian Journal of Primary Health 19.4 (2013): 313-18. Jones, Rhys, Jessica Pykett, and Mark Whitehead. "Big Society's Little Nudges: The Changing Politics of Health Care in an Age of Austerity." Political Insight 1.3 (2010): 85-87. Kraschnewski, L. Jennifer, et al. "Paging “Dr. Google”: Does Technology Fill the Gap Created by the Prenatal Care Visit Structure? Qualitative Focus Group Study with Pregnant Women." Journal of Medical Internet Research. 16.6 (2014): e147. Kroløkke, Charlotte. "On a Trip to the Womb: Biotourist Metaphors in Fetal Ultrasound Imaging." Women's Studies in Communication 33.2 (2010): 138-53. Littler, Jo. "The Rise of the 'Yummy Mummy': Popular Conservatism and the Neoliberal Maternal in Contemporary British Culture." Communication, Culture & Critique 6.2 (2013): 227-43. Longhurst, Robyn. "(Ad)Dressing Pregnant Bodies in New Zealand: Clothing, Fashion, Subjectivities and Spatialities." Gender, Place & Culture 12.4 (2005): 433-46. ———. "'Corporeographies’ of Pregnancy: ‘Bikini Babes'." Environment and Planning D: Society and Space 18.4 (2000): 453-72. Lupton, Deborah. "Apps as Artefacts: Towards a Critical Perspective on Mobile Health and Medical Apps." Societies 4.4 (2014): 606-22. ———. "'Precious Cargo': Risk and Reproductive Citizenship." Critical Public Health 22.3 (2012): 329-40. ———. The Quantified Self: A Sociology of Self-Tracking. Cambridge: Polity Press, 2016. ———. "Quantified Sex: A Critical Analysis of Sexual and Reproductive Self-Tracking Using Apps." Culture, Health & Sexuality 17.4 (2015): 440-53. ———. The Social Worlds of the Unborn. Houndmills: Palgrave Macmillan, 2013. Marwick, Alice. "How Your Data Are Being Deeply Mined." The New York Review of Books (2014). Millington, Brad. "Amusing Ourselves to Life: Fitness Consumerism and the Birth of Bio-Games." Journal of Sport & Social Issues 38.6 (2014): 491-508. ———. "Smartphone Apps and the Mobile Privatization of Health and Fitness." Critical Studies in Media Communication 31.5 (2014): 479-93. Nash, Meredith. Making 'Postmodern' Mothers: Pregnant Embodiment, Baby Bumps and Body Image. Houndmills: Palgrave Macmillan, 2013. O'Higgins, A., et al. "The Use of Digital Media by Women Using the Maternity Services in a Developed Country." Irish Medical Journal 108.5 (2015). Raessens, Joost. "Playful Identities, or the Ludification of Culture." Games and Culture 1.1 (2006): 52-57. Rodger, D., et al. "Pregnant Women’s Use of Information and Communications Technologies to Access Pregnancy-Related Health Information in South Australia." Australian Journal of Primary Health 19.4 (2013): 308-12. Seneviratne, Suranga, et al. "Your Installed Apps Reveal Your Gender and More!" Mobile Computing and Communications Review 18.3 (2015): 55-61. Statista. "Number of Apps Available in Leading App Stores as of May 2015." 2015. Stormer, Nathan. "Looking in Wonder: Prenatal Sublimity and the Commonplace 'Life'." Signs 33.3 (2008): 647-73. Taylor, Janelle. "Of Sonograms and Baby Prams: Prenatal Diagnosis, Pregnancy, and Consumption." Feminist Studies 26.2 (2000): 391-418. ———. The Public Life of the Fetal Sonogram: Technology, Consumption and the Politics of Reproduction. New Brunswick, NJ: Rutgers University Press, 2008. Thomas, Gareth M. "Picture Perfect: ‘4d’ Ultrasound and the Commoditisation of the Private Prenatal Clinic." Journal of Consumer Culture. Online first, 2015. Thomson, Rachel, et al. Making Modern Mothers. Bristol: Policy Press, 2011. Thornham, Helen. “'It's a Boy Thing'.” Feminist Media Studies 8.2 (2008): 127-42. Van Dijck, José. "Datafication, Dataism and Dataveillance: Big Data between Scientific Paradigm and Ideology." Surveillance & Society 12.2 (2014): 197-208. Whitson, Jennifer. "Gaming the Quantified Self." Surveillance & Society 11.1/2 (2013): 163-76.