Journal articles on the topic 'First Aid for the USMLE Step 1 2013'

Background 94% of program directors cited the USMLE Step 1 score as the most important factor in determining an applicant’s competitiveness for residency. Thus, medical students are motivated to attain the highest possible score. With the recent announcement of Step 1 switching to a pass/fail standard, it is important to analyze factors which predict meeting this goal. Objective To investigate the factors which can influence or predict performance on USMLE Step 1. Methods We conducted a systematic literature search on PubMed, Web of Science, Scopus and ERIC in 2019. The key words were “USMLE”, “Step-1”, “score”, “success” and “predictors.” The search included articles published between 2005 and 2019. Studies that did not focus on Step 1 outcome or allopathic medical students in the United States were excluded. Results 275 articles were found, 29 of which met our inclusion criteria. Analysis from these articles demonstrated that predictors of USMLE Step 1 score can be divided into unmodifiable and modifiable factors. Unmodifiable factors include gender, MCAT score, pre-clinical grades and NBME/CBSE scores. Modifiable factors include taking USMLE Step 1 within two months of completing pre-clinical courses, motivation from anxiety, multiple-choice questions completed, unique Anki cards seen and complete passes of First Aid for the USMLE Step 1. Conclusion Our review suggests that although students can focus on modifiable factors to increase their score, the energy expenditure required to increase Step 1 score by one point is unrealistic. This may have impacted the NBME’s decision to change Step 1 to a pass/fail exam.

Context.—Factors that correlate with success or failure on the American Board of Pathology (ABP) examination are not known. Other medical residency programs have shown that standardized test scores correlate with specialty board examination scores; however, data from pathology programs are lacking. Objective.—To investigate whether the 2-digit score on step 1 of the United States Medical Licensing Examination (USMLE) was correlated with ABP examination performance at a large university pathology program. Design.—Nine years of data (2001–2009) from pathology residents (n = 72) at the University of Pittsburgh Medical Center (UPMC, Pittsburgh, Pennsylvania) was collected from existing files and deidentified. Step 1 USMLE 2-digit scores and ABP failure rates for first-time test takers were compared. Results are reported as the percentage of residents who failed either the anatomic pathology or clinical pathology part of the ABP examination in cohorts by their USMLE 2-digit score (≤80, 81–85, 86–89, ≥90). Results.—The rolling 5-year (2005–2009) ABP average failure rate for first-time test takers of the anatomic pathology examination was 3.1% (UPMC) and 14.1% (nationally); in clinical pathology, it was 13.8% (UPMC) and 23.6% (nationally). At UPMC, no resident failed the anatomic pathology or clinical pathology parts of the ABP examination if his or her 2-digit USMLE step 1 score was 90 or more across 9 years of training (2001–2009). Conclusions.—In the UPMC pathology program, 2-digit scores on USMLE step 1 of 90 or more and 80 or less were strong measures of ABP first-time pass/failure rates, whereas scores of 81 to 89 were less-accurate measures. The USMLE step 1 score is one of many criteria that can be used for screening applicants for a pathology residency program.

ABSTRACT Background: The Medical College Admissions Test (MCAT) is a high-stakes test required for entry to most U.S. medical schools; admissions committees use this test to predict future accomplishment. Although there is evidence that the MCAT predicts success on multiple choice–based assessments, there is little information on whether the MCAT predicts clinical-based assessments of undergraduate and graduate medical education performance. This study looked at associations between the MCAT and medical school grade point average (GPA), Medical Licensing Examination (USMLE) scores, observed patient care encounters, and residency performance assessments. Methods: This study used data collected as part of the Long-Term Career Outcome Study to determine associations between MCAT scores, USMLE Step 1, Step 2 clinical knowledge and clinical skill, and Step 3 scores, Objective Structured Clinical Examination performance, medical school GPA, and PGY-1 program director (PD) assessment of physician performance for students graduating 2010 and 2011. Results: MCAT data were available for all students, and the PGY PD evaluation response rate was 86.2% (N = 340). All permutations of MCAT scores (first, last, highest, average) were weakly associated with GPA, Step 2 clinical knowledge scores, and Step 3 scores. MCAT scores were weakly to moderately associated with Step 1 scores. MCAT scores were not significantly associated with Step 2 clinical skills Integrated Clinical Encounter and Communication and Interpersonal Skills subscores, Objective Structured Clinical Examination performance or PGY-1 PD evaluations. Discussion: MCAT scores were weakly to moderately associated with assessments that rely on multiple choice testing. The association is somewhat stronger for assessments occurring earlier in medical school, such as USMLE Step 1. The MCAT was not able to predict assessments relying on direct clinical observation, nor was it able to predict PD assessment of PGY-1 performance.

ABSTRACT Background Over the past decade, the number of unfilled positions in the National Resident Matching Program (NRMP) Main Residency Match has declined by one-third, while the number of unmatched applicants has grown by more than 50%, largely due to a rise in the number of international medical school students and graduates (IMGs). Although only half of IMG participants historically have matched to a first-year position, the Match experiences of unmatched IMGs have not been studied. Objective We examined differences in interview and ranking behaviors between matched and unmatched IMGs participating in the 2013 Match and explored strategic errors made by unmatched IMGs when creating rank order lists. Methods Rank order lists of IMGs who failed to match were analyzed in conjunction with their United States Medical Licensing Examination (USMLE) Step 1 scores and responses on the 2013 NRMP Applicant Survey. IMGs were categorized as “strong,” “solid,” “marginal,” or “weak” based on the perceived competitiveness of their USMLE Step 1 scores compared to other IMG applicants who matched in the same specialty. We examined ranking preferences and strategies by Match outcome. Results Most unmatched IMGs were categorized as “marginal” or “weak”. However, unmatched IMGs who were non-US citizens presented more competitive USMLE Step 1 scores compared to unmatched IMGs who were US citizens. Unmatched IMGs were more likely than matched IMGs to rank programs at which they did not interview and to rank programs based on their perceived likelihood of matching. Conclusions The interview and ranking behaviors of IMGs can have far-reaching consequences on their Match experience and outcomes.

Objective To develop a probability model of matching into a US ophthalmology residency program using San Francisco Matching Program (SF Match) data. Design Retrospective data analysis of de-identified application and matching data. Participants Registrants for the 2013, 2014, and 2015 ophthalmology residency matches conducted by the SF Match. Methods Descriptive statistics of candidates, comparison of continuous and categorical variables between matched and nonmatched candidates, and linear regression modeling were performed. A recursive partitioning method was used to create a probability of matching algorithm. Main Outcome Measures Probability of successfully matching based on quantifiable candidate characteristics. Results Over the 3-year period, 1,959 individuals submitted an average of 64 applications and received a mean of nine interview invitations. The overall match rate was 71%, with 78% matching at one of their top five choices. Successful matches were more likely to occur in US medical school graduates (78% vs 20%, p < 0.001) and applicants on their first attempt (76% vs 29%, p < 0.001). The association between matching and number of programs applied became negative with > 48 applications. Probability of matching was “high” (> 80%) among US graduates with a step 1 United States Medical Licensing Examination (USMLE) score >243 (regardless of number of programs applied to), a step 1 USMLE score of 231 to 243 who applied to at least 30 programs, and first-time applicants with a step 1 score >232. No international medical graduates or repeat applicants had a “high” probability of matching. Conclusions Although advice must be individualized for each candidate, applicants for ophthalmology residency who fall into a “high” probability of matching group are likely to be successful with applications to 45 or fewer programs. Applying to 80 or more programs should be considered for international medical graduates and/or applicants who are previously unmatched. Modification of the match application data form may allow more detailed analysis of variables such as Alpha Omega Alpha or Gold Humanism Honor Society membership, research activity, and composite evaluation on a standardized letter of recommendation.

Introduction. Cardiac involvement of myasthenia gravis (MG) accompanies a poor prognosis. In the present study, we aimed to investigate the relationship between ECG abnormality and cardiac involvement.Methods. Of 178 patients diagnosed with MG between 2001 and 2013 at our hospital, we retrospectively analyzed consecutive 58 patients who underwent both ECG and echocardiography and without underlying cardiovascular disease. ECG abnormalities were defined by computer-assigned Minnesota-codes. Cardiac damage was defined as either (1) ejection fraction (EF) <55% on echocardiography or (2) elevatedE/e′, the ratio of mitral velocity to early diastolic velocity of the mitral annulus >8 on echocardiography.Results. Thirty-three patients (56.8%) had ECG abnormality. An elevatedE/e′was observed in patients with ECG abnormality compared to those without ECG abnormality (11.2±3.2,8.7±2.2, resp.,p=0.03). Among patients with ECG abnormality, 14 of 15 patients showed cardiac damage. Among patients without ECG abnormality, 6 of 33 patients showed cardiac damage (p=0.003). Reduced EF was observed in five patients (8.6%) with ECG abnormality and none in patients without ECG abnormality.Conclusions. ECG may aid as the first step for the further examination of cardiac damage in patients with MG.

Abstract Objective Some have commented that the limited number of underrepresented minorities (URMs) in United States' residency programs is due to a lack of qualified candidates. At the University of Michigan, an objective structured clinical examination is administered to incoming residents at the beginning of training to determine baseline competence. In this study we wanted to determine if competence differed for underrepresented minorities when compared to non-URM residents. Method The postgraduate orientation assessment, a 10-station examination, was developed that focused specifically on the knowledge and skills needed in the first 6 to 18 weeks of training. Stations assessed competence in informed consent, aseptic technique, evidence-based medicine, diagnostic images, critical laboratory values, cross-cultural communication, and Joint Commission requirements such as surgical fire safety, pain assessment, and management. We used various assessment measures including standardized patients, computer-based testing, and multiple-choice questions. Results Our study found no significant differences in overall mean scores between URM residents and all other residents for the 5 years during which we administered the examination, except for 2002. This stands in contrast to the consistently worse performances of URM students on USMLE Step 1 and Step 2 Clinical Knowledge. Also, URM residents did not perform better or worse than their non-URM colleagues on standardized patient stations during the course of 5 years during which the examination was administered. Conclusions The postgraduate orientation assessment provides residency program directors with a standard format to measure initial clinical skills. When compared to incoming non-URM residents from a variety of medical schools, URM residents perform as well as other trainees. Our results may aid in the recruitment efforts of URM medical students into academic residency programs such as those at the University of Michigan.

Due to the rapid growth in world population, the pressure on water resources to feed the growing population is increasing. The Nile water share of Sudan is almost exploited; and agricultural production by rained water is threatened by the pressure of climate change. It is inevitable that the production per unit water consumed, the water productivity, must be increased to meet this challenge. This research therefore focuses on the benchmarking of physical water productivity in rain fed areas and gaining a better understanding of the temporal and spatial variations and the scope for possible improvement. A review of the available records and sources that provide measurements of crop-water productivity was consulted to assess plausible ranges of water productivity levels for rain fed Sorghum crop and to provide a first explanation for the differences that are found using AQUACROP model. As such this study may be considered as crucial step was to establish a water productivity database for the rain fed sorghum crop in the country. Sorghum (Sorghum bicolor (L.) Moench) which is the most important cereal crop in Sudan has been constrained by the detrimental effect of drought which has often caused food shortages. Almost 90% of the total sorghum cropped area is rain-fed, and 60% of that is in drought prone soil conditions. Spatial information on water use, crop production and water productivity will play a vital role for water managers to assess where scarce water resources are wasted and where in a given region the water productivity can be improved. Hence, a methodology has been developed in this study to quantify spatial variation of crop yield, evapotranspiration and water productivity using the AQUACROP model in five stations. The AQUACROP model is used to investigate optimum sowing date that result in maximization of grain yield.Benchmarking of rain fed Sorghum actual and potential grain efficiency in different agro-climate zones was made for the year 1979 to 2013. AQUACROP model was applied at five locations (Gedaref, Damazin, Dalang, El Fashir, and El Obyied) each representing an agro-climate zone. Causes of poor yield performance were investigated and consequently measures needed to improve performance were identified. The study indicates that increase in sorghum yields under historical climate conditions in the different studied stations is possible when early sowing is used and initial rain showers are utilized, yield decrease by 43% when sowing date is delayed from July 15 (the recommended date) to August 1. Stations with high rain fall (Damazin, Gadaref and Dalang) show little variations in inter-annual yields but with a tendency towards high yields, 3536, 3741, 3737 kg/fed for the above stations respectively compared to 2266 and 1086 kg/fed for El Obyied and El Fashir respectively at 15 June. The obtained WUE is lower in the driest regions (El Fashir, and El Obyied) and higher for those of high rain fall. To aid decision makers and crop growers in rain fed areas a set of recommendations for policy making and for future research were identified.

OBJECTIVES/SPECIFIC AIMS: Individuals with autism spectrum disorder (ASD) and developmental coordination disorder (DCD) share overlap in their motor symptom profile and underlying neurology (Sumner, Leonard, & Hill, 2016, JADD). DSM-5 guidelines allow these 2 disorders to be independent or co-occurring (APA, 2013), but common clinical practice does not include systematic assessment to determine the presence or absence of co-occurring DCD in children with ASD, or vice versa. Furthermore, in many cases DCD is managed in a nonspecific manner, with schools making accommodations for a child’s motor challenges without formally assigning a diagnosis of DCD. Thus, somewhat subjective, qualitative judgments are made by clinicians to classify children as DCD, ASD, or ASD+DCD in the absence of a reliable, valid, quantitative measure to distinguish between these profiles. As a first step toward developing such a measure, researchers must tease apart the nuanced differences in the motor symptoms of these 2 developmental disorders using methods that are scalable to clinical and educational settings. These methods must also be developed with consideration for logistical variables such as cost, clinical utility of data output, and ease-of-use if they are to be transferrable to physicians, school nurses, and other community health workers outside of academic laboratory settings. To that end, we conducted 2 complementary studies: 1 in the lab and 1 in the community. METHODS/STUDY POPULATION: In the community-based study, we used an affordable, user-friendly, portable balance testing system to assess postural stability during quiet standing (feet shoulder-width apart) with eyes open for 30 seconds. Data were generated from a single force plate in the balance platform. Potential participants were screened for other medical and neurological conditions that might impact their postural stability, and those with significant comorbidities were excluded. We tested 15 children with a reported diagnosis of ASD, 8 children with suspected or diagnosed DCD who were enrolled in a motor intervention program, and 30 typically-developing (TD) children with no significant developmental history reported. The ASD group ranged in age from 7 to 20, the DCD group ranged from 7 to 10, and the TD group ranged from 7 to 19. In the lab-based study, we again obtained force plate data during quiet standing (feet shoulder-width apart) with eyes open for 30 seconds, in our system that also included full-body motion capture, virtual reality, and mobile eye tracking. (Data from these additional sources are not discussed in this disseminaton, as our current focus is on identifying a simple, scalable metric that can be used to distinguish ASD from DCD.) We tested 10 children with a diagnosis of ASD that was confirmed by the research team, 10 children with a diagnosis of DCD that was confirmed by the research team, and 5 TD children with no significant developmental history reported. The ASD group ranged in age from 7 to 18, the DCD group ranged from 8 to 12, and the TD group ranged from 9 to 18. RESULTS/ANTICIPATED RESULTS: Primary outcome measures in both studies were related to Center of Pressure (CoP), including CoP sway, CoP velocity, and amount of sway relative to the base of support. Data analysis from both studies is ongoing, but preliminary trends suggest that CoP metrics may effectively differentiate between ASD, DCD, and TD. During quiet standing, individuals with DCD exhibited the greatest postural sway. Individuals with ASD followed, having greater instability than the TD group. Differences were also evident in the velocity profiles of postural sway. DISCUSSION/SIGNIFICANCE OF IMPACT: Preliminary findings suggest that CoP offers a means of differentiating between typical and atypical development specifically with respect to motor symptoms. This simple, quantifiable measure may prove a sensitive and specific means of systematically assessing co-occurrence of ASD and DCD in clinical and educational settings, leading to more accurate diagnostic classification and tailored intervention. Future directions include conducting analyses that account for participant age and developmental stage with respect to motor skills, determining whether trends hold in a larger sample, and using advanced statistical methods to determine whether CoP variables have predictive validity in discriminating between classifications of ASD, DCD, ASD+DCD, and TD. Eye-movement data were also obtained during these tasks, and may further aid in understanding the factors contributing to atypical postural control. These 2 studies also yielded methodological findings, namely that the portable force platform carries the benefit of high ease-of-use, low cost, and portability, but also has important drawbacks. Specifically, it is not capable of registering accurate CoP data for participants who weigh <40 lbs, and the error variance for the load cells is greater than that of most nonportable, higher-end plates like those embedded in our laboratory’s platform. As technological advances continue to facilitate development of more portable, higher-resolution systems, these drawbacks may be significantly reduced. Future directions include further assessment of portable, affordable solutions for this type of testing to identify whether higher-resolution options are available, whether this added resolution increases classification accuracy, and how ease-of-use is perceived by clinical and community health workers.

This paper aims to portray the overall picture of poverty in the world and mentions the key solution to overcome poverty from a critical perspective. The data and figures were quoted from a number of researchers and organizations in the field of poverty around the world. Simultaneously, the information strengthens the correlations among poverty and lack of education. Only appropriate philosophies of education can improve the country’s socio-economic conditions and contribute to effective solutions to worldwide poverty. In the 21st century, despite the rapid development of science and technology with a series of inventions brought into the world to make life more comfortable, human poverty remains a global problem, especially in developing countries. Poverty, according to Lister (2004), is reflected by the state of “low living standards and/or inability to participate fully in society because of lack of material resources” (p.7). The impact and serious consequences of poverty on multiple aspects of human life have been realized by different organizations and researchers from different contexts (Fraser, 2000; Lister, 2004; Lipman, 2004; Lister, 2008). This paper will indicate some of the concepts and research results on poverty. Figures and causes of poverty, and some solutions from education as a key breaker to poverty will also be discussed. Creating a universal definition of poverty is not simple (Nyasulu, 2010). There are conflicts among different groups of people defining poverty, based on different views and fields. Some writers, according to Nyasulu, tend to connect poverty with social problems, while others focus on political or other causes. However, the reality of poverty needs to be considered from different sides and ways; for that reason, the diversity of definitions assigned to poverty can help form the basis on which interventions are drawn (Ife and Tesoriero, 2006). For instance, in dealing with poverty issues, it is essential to intervene politically; economic intervention is very necessary to any definition of this matter. A political definition necessitates political interventions in dealing with poverty, and economic definitions inevitably lead to economic interventions. Similarly, Księżopolski (1999) uses several models to show the perspectives on poverty as marginal, motivation and socialist. These models look at poverty and solutions from different angles. Socialists, for example, emphasize the responsibilities of social organization. The state manages the micro levels and distributes the shares of national gross resources, at the same time fighting to maintain the narrow gap among classes. In his book, Księżopolski (1999) also emphasizes the changes and new values of charity funds or financial aid from churches or organizations recognized by the Poor Law. Speaking specifically, in the new stages poverty has been recognized differently, and support is also delivered in limited categories related to more specific and visible objectives, with the aim of helping the poor change their own status for sustainable improvement. Three ways of categorizing the poor and locating them in the appropriate places are (1) the powerless, (2) who is willing to work and (3) who is dodging work. Basically, poverty is determined not to belong to any specific cultures or politics; otherwise, it refers to the situation in which people’s earnings cannot support their minimum living standard (Rowntree, 1910). Human living standard is defined in Alfredsson & Eide’s work (1999) as follows: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” (p. 524). In addition, poverty is measured by Global Hunger Index (GHI), which is calculated by the International Food Policy Institute (IFPRI) every year. The GHI measures hunger not only globally, but also by country and region. To have the figures multi-dimensionally, the GHI is based on three indicators: 1. Undernourishment: the proportion of the undernourished as a percentage of the population (reflecting the share of the population with insufficient calorie intake). 2. Child underweight: the proportion of children under age 5 who are underweight (low weight for their age, reflecting wasting, stunted growth or both), which is one indicator of child under-nutrition. 3. Child mortality: the mortality rate of children under 5 (partially reflecting the fatal synergy of inadequate dietary intake and unhealthy environments). Apart from the individual aspects and the above measurement based on nutrition, which help partly imagine poverty, poverty is more complicated, not just being closely related to human physical life but badly affecting spiritual life. According to Jones and Novak (1999 cited in Lister, 2008), poverty not only characterizes the precarious financial situation but also makes people self-deprecating. Poverty turns itself into the roots of shame, guilt, humiliation and resistance. It leads the poor to the end of the road, and they will never call for help except in the worst situations. Education can help people escape poverty or make it worse. In fact, inequality in education has stolen opportunity for fighting poverty from people in many places around the world, in both developed and developing countries (Lipman, 2004). Lipman confirms: “Students need an education that instills a sense of hope and possibility that they can make a difference in their own family, school, and community and in the broader national and global community while it prepare them for multiple life choices.” (p.181) Bradshaw (2005) synthesizes five main causes of poverty: (1) individual deficiencies, (2) cultural belief systems that support subcultures of poverty, (3) economic, political and social distortions or discrimination, (4) geographical disparities and (5) cumulative and cyclical interdependencies. The researcher suggests the most appropriate solution corresponding with each cause. This reflects the diverse causes of poverty; otherwise, poverty easily happens because of social and political issues. From the literature review, it can be said that poverty comes from complex causes and reasons, and is not a problem of any single individual or country. Poverty has brought about serious consequences and needs to be dealt with by many methods and collective effort of many countries and organizations. This paper will focus on representing some alarming figures on poverty, problems of poverty and then the education as a key breaker to poverty. According to a statistics in 2012 on poverty from the United Nations Development Program (UNDP), nearly half the world's population lives below the poverty line, of which is less than $1.25 a day . In a statistics in 2015, of every 1,000 children, 93 do not live to age 5 , and about 448 million babies are stillborn each year . Poverty in the world is happening alarmingly. According to a World Bank study, the risk of poverty continues to increase on a global scale and, of the 2009 slowdown in economic growth, which led to higher prices for fuel and food, further pushed 53 million people into poverty in addition to almost 155 million in 2008. From 1990 to 2009, the average GHI in the world decreased by nearly one-fifth. Many countries had success in solving the problem of child nutrition; however, the mortality rate of children under 5 and the proportion of undernourished people are still high. From 2011 to 2013, the number of hungry people in the world was estimated at 842 million, down 17 percent compared with the period 1990 to 1992, according to a report released by the Food and Agriculture Organization of the United Nations (FAO) titled “The State of Food Insecurity in the World 2013” . Although poverty in some African countries had been improved in this stage, sub-Saharan Africa still maintained an area with high the highest percentage of hungry people in the world. The consequences and big problems resulting from poverty are terrible in the extreme. The following will illustrate the overall picture under the issues of health, unemployment, education and society and politics ➢ Health issues: According a report by Manos Unidas, a non- government organization (NGO) in Spain , poverty kills more than 30,000 children under age 5 worldwide every day, and 11 million children die each year because of poverty. Currently, 42 million people are living with HIV, 39 million of them in developing countries. The Manos Unidas report also shows that 15 million children globally have been orphaned because of AIDS. Scientists predict that by 2020 a number of African countries will have lost a quarter of their population to this disease. Simultaneously, chronic drought and lack of clean water have not only hindered economic development but also caused disastrous consequences of serious diseases across Africa. In fact, only 58 percent of Africans have access to clean water; as a result, the average life expectancy in Africa is the lowest in the world, just 45 years old (Bui, 2010). ➢ Unemployment issues: According to the United Nations, the youth unemployment rate in Africa is the highest in the world: 25.6 percent in the Middle East and North Africa. Unemployment with growth rates of 10 percent a year is one of the key issues causing poverty in African and negatively affecting programs and development plans. Total African debt amounts to $425 billion (Bui, 2010). In addition, joblessness caused by the global economic downturn pushed more than 140 million people in Asia into extreme poverty in 2009, the International Labor Organization (ILO) warned in a report titled The Fallout in Asia, prepared for the High-Level Regional Forum on Responding to the Economic Crisis in Asia and the Pacific, in Manila from Feb. 18 to 20, 2009 . Surprisingly, this situation also happens in developed countries. About 12.5 million people in the United Kingdom (accounting for 20 percent of the population) are living below the poverty line, and in 2005, 35 million people in the United States could not live without charity. At present, 620 million people in Asia are living on less than $1 per day; half of them are in India and China, two countries whose economies are considered to be growing. ➢ Education issues: Going to school is one of the basic needs of human beings, but poor people cannot achieve it. Globally, 130 million children do not attend school, 55 percent of them girls, and 82 million children have lost their childhoods by marrying too soon (Bui, 2010). Similarly, two-thirds of the 759 million illiterate people in total are women. Specifically, the illiteracy rate in Africa keeps increasing, accounting for about 40 percent of the African population at age 15 and over 50 percent of women at age 25. The number of illiterate people in the six countries with the highest number of illiterate people in the world - China, India, Indonesia, Brazil, Bangladesh and Egypt - reached 510 million, accounting for 70 percent of total global illiteracy. ➢ Social and political issues: Poverty leads to a number of social problems and instability in political systems of countries around the world. Actually, 246 million children are underage labors, including 72 million under age 10. Simultaneously, according to an estimate by the United Nations (UN), about 100 million children worldwide are living on the streets. For years, Africa has suffered a chronic refugee problem, with more than 7 million refugees currently and over 200 million people without homes because of a series of internal conflicts and civil wars. Poverty threatens stability and development; it also directly influences human development. Solving the problems caused by poverty takes a lot of time and resources, but afterward they can focus on developing their societies. Poverty has become a global issue with political significance of particular importance. It is a potential cause of political and social instability, even leading to violence and war not only within a country, but also in the whole world. Poverty and injustice together have raised fierce conflicts in international relations; if these conflicts are not satisfactorily resolved by peaceful means, war will inevitably break out. Obviously, poverty plus lack of understanding lead to disastrous consequences such as population growth, depletion of water resources, energy scarcity, pollution, food shortages and serious diseases (especially HIV/AIDS), which are not easy to control; simultaneously, poverty plus injustice will cause international crimes such as terrorism, drug and human trafficking, and money laundering. Among recognizable four issues above which reflected the serious consequences of poverty, the third ones, education, if being prioritized in intervention over other issues in the fighting against poverty is believed to bring more effectiveness in resolving the problems from the roots. In fact, human being with the possibility of being educated resulted from their distinctive linguistic ability makes them differential from other beings species on the earth (Barrow and Woods 2006, p.22). With education, human can be aware and more critical with their situations, they are aimed with abilities to deal with social problems as well as adversity for a better life; however, inequality in education has stolen opportunity for fighting poverty from unprivileged people (Lipman, 2004). An appropriate education can help increase chances for human to deal with all of the issues related to poverty; simultaneously it can narrow the unexpected side-effect of making poverty worse. A number of philosophies from ancient Greek to contemporary era focus on the aspect of education with their own epistemology, for example, idealism of Plato encouraged students to be truth seekers and pragmatism of Dewey enhanced the individual needs of students (Gutex, 1997). Education, more later on, especially critical pedagogy focuses on developing people independently and critically which is essential for poor people to have ability of being aware of what they are facing and then to have equivalent solutions for their problems. In other words, critical pedagogy helps people emancipate themselves and from that they can contribute to transform the situations or society they live in. In this sense, in his most influential work titled “Pedagogy of the Oppressed” (1972), Paulo Freire carried out his critical pedagogy by building up a community network of peasants- the marginalized and unprivileged party in his context, aiming at awakening their awareness about who they are and their roles in society at that time. To do so, he involved the peasants into a problem-posing education which was different from the traditional model of banking education with the technique of dialogue. Dialogue wasn’t just simply for people to learn about each other; but it was for figuring out the same voice; more importantly, for cooperation to build a social network for changing society. The peasants in such an educational community would be relieved from stressfulness and the feeling of being outsiders when all of them could discuss and exchange ideas with each other about the issues from their “praxis”. Praxis which was derived from what people act and linked to some values in their social lives, was defined by Freire as “reflection and action upon the world in order to transform it” (p.50). Critical pedagogy dialogical approach in Pedagogy of the Oppressed of Freire seems to be one of the helpful ways for solving poverty for its close connection to the nature of equality. It doesn’t require any highly intellectual teachers who lead the process; instead, everything happens naturally and the answers are identified by the emancipation of the learners themselves. It can be said that the effectiveness of this pedagogy for people to escape poverty comes from its direct impact on human critical consciousness; from that, learners would be fully aware of their current situations and self- figure out the appropriate solutions for their own. In addition, equality which was one of the essences making learners in critical pedagogy intellectually emancipate was reflected via the work titled “The Ignorant Schoolmaster” by Jacques Rancière (1991). In this work, the teacher and students seemed to be equal in terms of the knowledge. The explicator- teacher Joseph Jacotot employed the interrogative approach which was discovered to be universal because “he taught what he didn’t know”. Obviously, this teacher taught French to Flemish students while he couldn’t speak his students’ language. The ignorance which was not used in the literal sense but a metaphor showed that learners can absolutely realize their capacity for self-emancipation without the traditional teaching of transmission of knowledge from teachers. Regarding this, Rancière (1991, p.17) stated “that every common person might conceive his human dignity, take the measure of his intellectual capacity, and decide how to use it”. This education is so meaningful for poor people by being able to evoking their courageousness to develop themselves when they always try to stay away from the community due the fact that poverty is the roots of shame, guilt, humiliation and resistance (Novak, 1999). The contribution of critical pedagogy to solving poverty by changing the consciousness of people from their immanence is summarized by Freire’s argument in his “Pedagogy of Indignation” as follows: “It is certain that men and women can change the world for the better, can make it less unjust, but they can do so from starting point of concrete reality they “come upon” in their generation. They cannot do it on the basis of reveries, false dreams, or pure illusion”. (p.31) To sum up, education could be an extremely helpful way of solving poverty regarding the possibilities from the applications of studies in critical pedagogy for educational and social issues. Therefore, among the world issues, poverty could be possibly resolved in accordance with the indigenous people’s understanding of their praxis, their actions, cognitive transformation, and the solutions with emancipation in terms of the following keynotes: First, because the poor are powerless, they usually fall into the states of self-deprecation, shame, guilt and humiliation, as previously mentioned. In other words, they usually build a barrier between themselves and society, or they resist changing their status. Therefore, approaching them is not a simple matter; it requires much time and the contributions of psychologists and sociologists in learning about their aspirations, as well as evoking and nurturing the will and capacities of individuals, then providing people with chances to carry out their own potential for overcoming obstacles in life. Second, poverty happens easily in remote areas not endowed with favorable conditions for development. People there haven’t had a lot of access to modern civilization; nor do they earn a lot of money for a better life. Low literacy, together with the lack of healthy forms of entertainment and despair about life without exit, easily lead people into drug addiction, gambling and alcoholism. In other words, the vicious circle of poverty and powerlessness usually leads the poor to a dead end. Above all, they are lonely and need to be listened to, shared with and led to escape from their states. Community meetings for exchanging ideas, communicating and immediate intervening, along with appropriate forms of entertainment, should be held frequently to meet the expectations of the poor, direct them to appropriate jobs and, step by step, change their favorite habits of entertainment. Last but not least, poor people should be encouraged to participate in social forums where they can both raise their voices about their situations and make valuable suggestions for dealing with their poverty. Children from poor families should be completely exempted from school fees to encourage them to go to school, and curriculum should also focus on raising community awareness of poverty issues through extracurricular and volunteer activities, such as meeting and talking with the community, helping poor people with odd jobs, or simply spending time listening to them. Not a matter of any individual country, poverty has become a major problem, a threat to the survival, stability and development of the world and humanity. Globalization has become a bridge linking countries; for that reason, instability in any country can directly and deeply affect the stability of others. The international community has been joining hands to solve poverty; many anti-poverty organizations, including FAO (Food and Agriculture Organization), BecA (the Biosciences eastern and central Africa), UN-REDD (the United Nations Programme on Reducing Emissions from Deforestation and Forest Degradation), BRAC (Building Resources Across Communities), UNDP (United Nations Development Programme), WHO (World Health Organization) and Manos Unidas, operate both regionally and internationally, making some achievements by reducing the number of hungry people, estimated 842 million in the period 1990 to 1992, by 17 percent in 2011- to 2013 . The diverse methods used to deal with poverty have invested billions of dollars in education, health and healing. The Millennium Development Goals set by UNDP put forward eight solutions for addressing issues related to poverty holistically: 1) Eradicate extreme poverty and hunger. 2) Achieve universal primary education. 3) Promote gender equality and empower women. 4) Reduce child mortality. 5) Improve maternal health. 6) Combat HIV/AIDS, malaria and other diseases. 7) Ensure environmental sustainability. 8) Develop a global partnership for development. Although all of the mentioned solutions carried out directly by countries and organizations not only focus on the roots of poverty but break its circle, it is recognized that the solutions do not emphasize the role of the poor themselves which a critical pedagogy does. More than anyone, the poor should have a sense of their poverty so that they can become responsible for their own fate and actively fight poverty instead of waiting for help. It is not different from the cores of critical theory in solving educational and political issues that the poor should be aware and conscious about their situation and reflected context. It is required a critical transformation from their own praxis which would allow them to go through a process of learning, sharing, solving problems, and leading to social movements. This is similar to the method of giving poor people fish hooks rather than giving them fish. The government and people of any country understand better than anyone else clearly the strengths and characteristics of their homelands. It follows that they can efficiently contribute to causing poverty, preventing the return of poverty, and solving consequences of the poverty in their countries by many ways, especially a critical pedagogy; and indirectly narrow the scale of poverty in the world. In a word, the wars against poverty take time, money, energy and human resources, and they are absolutely not simple to end. Again, the poor and the challenged should be educated to be fully aware of their situation to that they can overcome poverty themselves. They need to be respected and receive sharing from the community. All forms of discrimination should be condemned and excluded from human society. When whole communities join hands in solving this universal problem, the endless circle of poverty can be addressed definitely someday. More importantly, every country should be responsible for finding appropriate ways to overcome poverty before receiving supports from other countries as well as the poor self-conscious responsibilities about themselves before receiving supports from the others, but the methods leading them to emancipation for their own transformation and later the social change.

Abstract Background Family Medicine residencies are navigating recruitment in a changing environment. The consolidation of accreditation for allopathic and osteopathic programs, the high volume of applicants, and the forthcoming transition of the United States Medical Licensing Exam (USMLE) Step 1 to pass/fail reporting all contribute. This retrospective cohort study evaluated which components of a student’s academic history best predict readiness for residency. Methods In 2020, we analyzed applicant data and initial residency data for program graduates at a single residency program between 2013 and 2020. This included undergraduate education characteristics, medical school academic performance, medical school academic problems (including professionalism), STEP exams, location of medical school, and assessments during the first 6 months of residency. Of 110 matriculating residents, assessment data was available for 97 (88%). Results Pre-matriculation USMLE data had a positive correlation with initial American Board of Family Medicine (ABFM) in-training exams. Pre-matriculation exam data did not have a positive correlation with resident assessment across any of the six Accreditation Council for Graduate Medical Education (ACGME) competency domains. A defined cohort of residents with a history of academic struggles during medical school or failure on a USMLE exam performed statistically similarly to residents with no such history on assessments across the six ACGME competency domains. Conclusions Applicants with a history of academic problems perform similarly in the clinical environment to those without. While a positive correlation between pre-matriculation exams and the ABFM in-training exam was found, this did not extend to clinical assessments across the ACGME competency domains.

Introduction: The University of Washington School of Medicine has six campuses in the five state WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region. The WRITE (WWAMI Rural Integrated Training Experience) program is a 22 to 24 week long rural longitudinal integrated clerkship experience offered to medical students in their clinical phase (third year) of training. This program seeks to meet the rural workforce needs of the WWAMI region by increasing the number of medical students going into primary care. Critics of LIC’s have expressed concern about overall quality control of the more remote educational experience and the lack of specialty specific teaching. The aim of this study was to compare medical school and PGY-1 performance of WRITE and Non-WRITE students while determining how well each cohort is meeting the regional workforce needs. Methods: The study group was all UWSOM students who matriculated from 2009 to 2013, advanced to graduation, and subsequently matched to a residency through the National Residency Match Program. WRITE and non-WRITE cohorts were compared for USMLE step 1 and 2 scores, MSPE (Medical Student Performance Evaluation) key word, and self and program director assessments in the first year of residency. The match results of the two cohorts were also compared to determine the proportions entering primary care residencies. Finally, for both cohorts the specialty choice at matriculation was compared with the match results. Descriptive statistics were used to test the comparisons. Results: The medical school performance of the WRITE and Non-WRITE cohorts was equivalent in all metrics (USMLE Step 1 and 2, MSPE key word, self and program director assessment of performance in the first year of residency). WRITE students were significantly more likely to match into primary care (67.6% vs 48.3%, p<0.001) overall and, in particular, Family Medicine as their specialty (40% vs 14.3%, p<0.001). WRITE students were also more likely to match into the same specialty that they indicated on the UWSOM matriculation survey. For Family Medicine the loss of fidelity between matriculation and match among WRITE students was 3% (43.4 - 40.4) and among Non-WRITE students, it was 6.3% (20.6 - 14.3). Conclusions: Performance outcomes of the WRITE program are equivalent to a traditional block curriculum. However, the WRITE cohort is significantly more likely to go into primary care fields, especially family medicine and is more likely to stay with the declared specialty at matriculation. Medical schools that seek to increase the number of students going into primary care may benefit from adopting a similar model.

This article analyses the public persona of Jeremy Gilley, a documentary filmmaker, peace campaigner, and the founder of the organisation Peace One Day (POD). It begins by outlining how Gilley’s persona is presented in a manner which resonates with established archetypes of social campaigners, and how this creates POD’s legitimacy among grassroots organisations. I then describe a distinct, but not inconsistent, facet of Gilley’s persona which speaks specifically to entrepreneurs. The article outlines how Gilley’s individuality works to simultaneously address these overlapping audiences and argues that his persona can be read as an articulation of social entrepreneurship. Gilley represents an example of a public personality working to “crystallise issues and to normativise debates” (Marshall “Personifying” 370) concerning corporate involvement with non-profit organisations and the marketisation of the non-profit sector. Peace One Day (POD) is a UK-based non-profit organisation established in 1999 by actor-turned-documentary-filmmaker Jeremy Gilley. In the 1990s, while filming a documentary about global conflict, Gilley realised there was no internationally recognised day of ceasefire and non-violence. He created POD to found such a day and began lobbying the United Nations. In 2001, the 111th plenary meeting of the General Assembly passed a resolution which marked 21 September as the annual International Day of Peace (United Nations). Since 2001, POD has worked to create global awareness of Peace Day. By 2006, other NGOs began using the day to negotiate 24-hour ceasefires in various conflict zones, allowing them to carry out work in areas normally too dangerous to enter. For example, in 2007, the inoculation of 1.3 million Afghan children against polio was possible due to an agreement from the Taliban to allow safe passage to agencies working in the country during the day. This was repeated in subsequent years and, by 2009, 4.5 million children had been immunised (POD Part Three). While neither POD nor Gilley played a direct part in the polio vaccination programmes or specific ceasefires, his organisation acted as a catalyst for such endeavours and these initiatives would not have occurred without POD’s efforts.Gilley is not only the founder of POD, he is also the majority shareholder, key decision-maker, and predominant public spokesperson in this private, non-charitable, non-profit organisation (Frances 73). While POD’s celebrity supporters participate in press conferences, it is Gilley who does most to raise awareness. His public persona is inextricably linked with POD and is created through a range of presentational media with which he is engaged. These include social media content, regular blogposts on POD’s website, as well as appearances at a series of speaking events. Most significantly, Gilley establishes his public persona through a number of documentary films (Peace One Day; Day After; POD Part Three), which are shot largely from his perspective and narrated by his voiceover, and which depict POD’s key struggles and successes.The Peace Campaigner as an Activist and Entrepreneur In common with other non-profit organisations, POD relies on celebrities from the entertainment industries. It works with them in two key ways: raising the public profile of the organisation, and shaping the public persona of its founder by inviting comparisons of their perceived exceptionalness with his ostensible ordinariness. For example, Gilley’s documentaries depict various press conferences held by POD over a number of years. Those organised prior to POD recruiting celebrity spokespeople were “completely ignored by the media” whereas those held after celebrity backing from Jude Law and Angelina Jolie had been secured attracted considerable interest (Day After). Gilley explains his early difficulties in publicising his message by suggesting that he “was a nobody” (POD Part Three). This representation as a “nobody” or, more diplomatically, as “ordinary,” is a central component of Gilley’s persona. “Ordinariness” here means situating Gilley outside the political and entertainment elites and aligning him with more everyday suburban settings. This is done through a combination of the aesthetic qualities of his public presentation and his publically narrated back-story.Aesthetically speaking, Gilley presents his ordinariness through his casual attire and long hair. His appearance is similar to the campaigners, youth groups and school children he addresses, suggesting he is a representative of that demographic but also distancing him from political elites. The diplomats Gilley meets, such as those at the UN, wear the appropriate attire for their elite political setting: suits. In one key scene in the documentary Peace One Day, Gilley makes his first trip to the UN to meet Kofi Annan, UN General Secretary at the time, and appears at their doors clean cut and suitably dressed. He declares that his new appearance was designed to aid his credibility with the UN. Yet, at the same time, he makes explicit that he borrowed the suit from a friend and the tie from his grandfather and, prior to the meeting, it was decided, “the pony tail had to go.” Thus Gilley seeks the approval of both political elites and the ordinary public, and constructs a persona that speaks to both, though he aligns himself with the latter.Gilley’s back-story permeates his films and works to present his ordinariness. For example, POD has humble beginnings as an almost grassroots, family-run organisation, and Gilley depicts a campaign run on a shoestring from his mother’s spare bedroom in an ordinary suburban home. Although British Airways provided free flights from the organisation’s outset, Gilley shows his friends volunteering their time by organising fundraising events. POD’s modest beginnings are reflected in its founder, who confides about both his lack of formal education and lack of success as an actor (Day After). This “ordinariness” is constructed in opposition to the exceptional qualities of POD’s A-list celebrity backers—such as Angelina Jolie, who does enjoy success as an actor. This contrast is emphasised by inviting Jolie into Gilley’s everyday domestic setting and highlighting the icons of success she brings with her. For example, at his first meeting with Jolie, Gilley waits patiently for her and remarks about the expensive car which eventually arrives outside his house, denoting Jolie’s arrival. He notes in the voiceover to his The Day after Peace documentary, “this was unbelievable, Angelina Jolie sat on my sofa asking me what she could do, I couldn’t stop talking. I was so nervous.”Gilley promotes his ordinariness by using aesthetics and personal narrative. Evidence of how he struggled to realise his goals and the financial burdens he carried (Peace One Day) suggest that there is something authentic about Gilley’s vision for Peace Day. This also helps Gilley to align his public persona with common understandings of the political activist as a prophetic social visionary. POD is able to tap into the idea of the power of the individual as a force for change with references to Martin Luther King and Gandhi. Although Gilley makes no direct comparison between himself and these figures, blog entries such as “ten years ago, I had an idea; I dared to dream that I could galvanise the countries of the world to recognise an official day of ceasefire and nonviolence. Mad? Ambitious? Idealistic? All of the above” (Gilley “Dream”), invite comparisons with King’s “I Have a Dream” speech. This is further augmented by references to Gilley as an outsider to political establishments, such as the UN, which he is sure have “become cynical about the opportunity” they have to unite the world (BBC Interview).Interestingly, Gilley’s presentation as a pragmatic “change-maker” whose “passion is contagious” (Ahmad Fawzi, in POD Concert) also aligns him with a second figure: the entrepreneur. Where Gilley’s performances at school and community groups present his persona as an activist, his entrepreneur persona is presented through his performances at a series of business seminars. These seminars, entitled “Unleash Your Power of Influence,” are targeted towards young entrepreneurs and business-people very much consistent with the “creative class” demographic (Florida). The speakers, including Gilley, have all been successful in business (POD is a private company) and they offer to their audiences motivational presentations, and business advice. Although a semi-regular occurrence, it is the first two events held in July 2010 (Unleash 1) and November 2010 (Unleash 2) that are discussed here. Held in a luxury five-star London hotel, the events demonstrate a starkly different aspect of POD than that presented to community groups and schools, and the amateur grassroots ethic presented in Gilley’s documentary films—for example, tickets for Unleash 2 started at £69 and offered ‘goody bags’ for £95 (author’s observation of the event)—yet consistencies remain.Aesthetically speaking, Gilley’s appearance signifies a connection with these innovative, stereotypically young, founders of start-up companies and where Gilley is an outsider to political organisations; they are outsiders to business establishments. Further, many of these companies typically started, like POD, in a spare bedroom. The speakers at the Unleash events provide insights into their background which frequently demonstrate a rise from humble beginnings to business success, in the face of adversity, and as a result of innovation and perseverance. Gilley is not out of place in this environment and the modest beginnings of POD are relayed to his audience in a manner which bears a striking similarity to his for-profit counterparts.An analysis of Gilley’s presentations at these events demonstrates clear links between the dual aspects of Gilley’s public persona, the political economy of POD, and the underlying philosophy of the organisation—social entrepreneurship. The next section sets out some of the principals of social entrepreneurship and how the aspects of Gilley’s persona, outlined above, reinforce these.Personifying Social EnterpriseGenerally speaking, the business literature greatly emphasises entrepreneurs as “resourceful, value-creating change agents” who are “never satisfied with the status quo [... and are] a forceful engine of growth in our economy” (Dees and Economy 3-4). More recently, the focus of discussion has included social entrepreneurs. These individuals work within “an organisation that attacks [social and environmental] problems through a business format, even if it is not legally structured as a profit-seeking entity” (Bornstein and Davis xv) and advocate commercially oriented non-profit organisations that establish “win-win” relationships between non-profits and business.This coming together of the for- and non-profit sectors has range of precedents, most notably in “philanthrocapitalism” (Bishop and Green) and the types of partnerships established between corporations and environmentalists, such as Greenpeace Australia (Beder). However, philanthrocapitalism often encompasses the application of business methods to social problems by those who have amassed fortunes in purely commercial ventures (such as Bill Gates), and Beder’s work describes established for- and non-profit institutions working together. While social entrepreneurship overlaps with these, social entrepreneurs seek to do well by doing good by making a profit while simultaneously realising social goals (Bornstein and Davis 25).Read as an articulation of the coming together of the activist and the entrepreneur, Gilley’s individuality encapsulates the social enterprise movement. His persona draws from the commonalities between the archetypes of the traditional grassroots activist and start-up entrepreneur, as pioneering visionary and outsider to the establishment. While his films establish his authenticity among politically attuned members of the public, his appearances at the Unleash events work to signify the legitimacy of his organisation to those who identify with social entrepreneurialism and take the position that business should play a positive role in social causes. As an activist, Gilley’s creates his persona through his aesthetic qualities and a performance that draws on historical precedents of social prophets. As an entrepreneur, Gilley draws on the same aesthetic qualities and, through his performance, mitigates the types of disjuncture evident in the 1980s between environmental activists, politicians and business leaders, when environmentalist’s narratives “were perceived as flaky and failed to transform” (Robèrt 7). To do this, Gilley reconstitutes social and environmental problems (such as conflict) within a market metric, and presents the market as a viable and efficient solution. Consequently, Gilley asserts that “we live in a culture of war because war makes money, we need to live in a culture of peace,” and this depends on “if we can make it economical, if we can make the numbers add up” (Unleash).Social enterprises often eschew formal charity and Gilley is consistent with this when he states that “for me, I think it has to be about business. [...] I think if it’s about charity it’s not going to work for me.” Gilley asserts that partnerships with corporations are essential as “our world is going to change, when the corporate sector becomes engaged.” He, therefore, “want[s] to work with large corporations” in order to “empower individuals to be involved in the process of [creating] a more peaceful and sustainable world” (Unleash). One example of POD’s success in this regard is a co-venture with Coca-Cola.To coincide with Peace Day in 2007, POD and Coca-Cola entered into a co-branding exercise which culminated in a sponsorship deal with the POD logo printed on Coca-Cola packaging. Prior to this, Gilley faced a desperate financial situation and conceded that the only alternative to a co-venture with Coca-Cola was shutting down POD (Day After). While Coca-Cola offered financial support and the potential to spread Gilley’s message through the medium of the Coke can, POD presumably offered good publicity to a corporation persistently the target of allegations of unethical practice (for example, Levenson-Estrada; Gill; Thomas). Gilley was aware of the potential image problems caused by a venture with Coke but accepted the partnership on pragmatic grounds, and with the proviso that Coke’s sponsorship not accompany any attempt to influence POD. Gilley, in effect, was using Coca-Cola, displaying the political independence of the social visionary and the pragmatism of the entrepreneur. By the same token, Coca-Cola was using POD to garner positive publicity, demonstrating the nature of this “win-win” relationship.In his film, Gilley consults Ray C. Anderson, social enterprise proponent, about his ethical concerns. Anderson explains the merits of working with Coke. In his Unleash addresses, such ethical considerations do not feature. Instead, it is relayed that Coca-Cola executives were looking to become involved with a social campaign, consistent with the famous 1970s hilltop advertisement of “teaching the world to sing in harmony.” From a meeting at Coca-Cola’s headquarters in Atlanta, Gilley reveals, a correlation emerged between Gilley’s emphasis on Peace Day as a moment of global unity—encapsulated by his belief that “the thing about corporations [...] the wonderful thing about everybody […] is that everybody’s just like us” (Unleash)—and the image of worldwide harmony that Coca-Cola wanted to portray. It is my contention that Gilley’s public persona underpinned the manner in which this co-branding campaign emerged. This is because his persona neatly tied the profit motive of the corporation to the socially spirited nature of the campaign, and spoke to Coca-Cola in a manner relatable to the market. At the same time, it promoted a social campaign premised on an inclusiveness that recast the corporation as a concerned global citizen, and the social campaigner as a free-market agent.Persona in the Competitive Non-Profit SectorThrough a series of works P. David Marshall charts the increasing centrality of individuality as “one of the ideological mainstays of consumer capitalism [...and] equally one of the ideological mainstays of how democracy is conceived” (Marshall “New Media-New Self” 635). Celebrity, accordingly, can be thought of as a powerful discourse that works “to make the cultural centrality of individuality concretely real” (Marshall “New Media-New Self” 635). Beyond celebrity, Marshall offers a wider framework that maps how “personalisation, individuality, and the move from the private to the public are now part of the wider populace rather than just at play in the representational field of celebrity” (Marshall, “Persona” 158). This framework includes fundamental changes to the global, specifically Western, labour market that, while not a fait accompli, point to a more competitive environment in which “greater portions of the culture are engaged in regular—probably frequent—selling of themselves” and where self-promotion becomes a key tool (Marshall, “Persona” 158). Therefore, while consumerism comprises a backdrop to the proliferation of celebrity culture, competition within market capitalism contributes to the wider expansion of personalisation and individualism.The non-profit sector is also a competitive environment. UK studies have found an increase in the number of International NGOs of 46.6% from 1995/6-2005/6 (Anheier, Kaldor, and Glasius. 310). At the same time, the number of large charities (with an income greater than £10 million) rose, between 1999-2013, from 307 to 1,005 and their annual income rose from approximately £10bn to £36bn (Charity Commission). These quantitative changes in the sector have occurred alongside qualitative changes in terms of the orientation of individual organisations. For example, Epstein and Gang describe a non-profit sector in which NGOs compete against each other for funds from aid donors (state and private). It is unclear whether “aid will be allocated properly, say to the poorest or to maximize the social welfare” or to the “efficient aid-seekers” (294)—that is, NGOs with the greatest competitive capabilities. A market for public awareness has also emerged and, in an increasingly crowded non-profit sector, it is clearly important for organisations to establish a public profile that can gain attention.It is in this competitive environment that the public personae of activists become assets for NGOs, and Gilley constitutes a successful example of this. His persona demonstrates an organisation’s response to the competitive nature of the non-profit sector, by appealing to both traditional activist circles and the business sector, and articulating the social enterprise movement. Gilley effectively embodies social entrepreneurship—in his appearance, his performance and his back-story—bridging a gap between the for- and non-profit sectors. His persona helps legitimate efforts to recast the activist as an entrepreneur (and conversely, entrepreneurs as activists) by incorporating activist ideals (in this instance, peace) within a market framework. This, to return to Marshall’s argument, crystallises the issue of peace within market metrics such and normativises debates about the role of corporate actors as global citizens, presenting it as pragmatism and therefore “common sense.” This is not to undermine Gilley’s achievements but, instead, to point out how reading his public persona enables an understanding of efforts to marketise the non-profit sector and align peace activism with corporate power.References Anheier, Helmut K., Mary Kaldor, and Marlies Glasius. Global Civil Society 2006/7. London: Sage, 2007.BBC Storyville. Director Interview: Jeremy Gilley. BBC. 2004. 7 Feb. 2010.Beder, Sharon. Global Spin: The Corporate Assault on Environmentalism. Totnes, UK: Green Books, 2002.Bishop, Matthew, and Michael Green. Philanthrocapitalism. London: A&C Black, 2008.Bornstein, David, and Susan Davis. Social Entrepreneurship: What Everyone Needs to Know. New York: Oxford University Press, 2010.Charity Commission for England and Wales. “Sector Facts and Figures.” N.d. 5 Apr 2014.Day after Peace, The. Dir. Jeremy Gilley. Peace One Day, 2008.Dees, J. Gregory, and Peter Economy. "Social Entrepreneurship." Enterprising Nonprofits: A Toolkit for Social Entrepreneurs. Eds. J. Gregory Dees, Jed Emerson, and Peter Economy. New York: Wiley, 2001. 1-18.Epstein, Gil S., and Ira N. Gang. “Contests, NGOs, and Decentralizing Aid.” Review of Development Economics 10. 2 (2006): 285-296.Florida, Richard. The Flight of the Creative Class: The New Global Competition for Talent. New York: Harper Business, 2006.Frances, Nic. The End of Charity: Time for Social Enterprise. New South Wales: Allen & Unwin, 2008.Fraser, Nick. “Can One Man Persuade the World, via the UN, to Sanction a Global Ceasefire Day?” BBC. 2005. 7 Feb. 2010.Gill, Leslie. “Labor and Human Rights: The ‘Real Thing’ in Colombia.” Transforming Anthropology 13.2 (2005): 110-115.Gilley, Jeremy. “Dream One Day.” Peace One Day. 2009. 23 Jun 2010.Levenson-Estrada, Deborah. Trade Unionists against Terror: Guatemala City, 1954-1985. Chapel Hill: U of North Carolina P, 1994.Marshall, P. David. Celebrity and Power. Minneapolis: University of Minnesota Press, 2001.Marshall, P. David. “Intimately Intertwined in the Most Public Way: Celebrity and Journalism.” The Celebrity Culture Reader. Ed. P. David Marshall. Oxon: Routledge, 2006. 316-323.Marshall, P. David. “New Media – New Self: The Changing Power of Celebrity.” The Celebrity Culture Reader. Ed. P. David. Marshall. Oxon: Routledge, 2006. 634-644.Marshall, P. David. “Personifying Agency: The Public–Persona–Place–Issue Continuum.” Celebrity Studies 4.3 (2013): 369-371.Marshall, P. David. “Persona Studies: Mapping the Proliferation of the Public Self.” Journalism 15.2 (2014): 153-170.Newsnight. BBC 2. 20 Sep. 2010. 22.30-23.00.Peace One Day. Dir. Jeremy Gilley. Peace One Day, 2004.Peace One Day Concert: Live at the Royal Albert Hall Gilley. Dir. Jeremy Gilley. Peace One Day, 2008.Peace One Day Part Three. Dir. Jeremy Gilley. Peace One Day, 2010.Robèrt, Karl-Henrik. The Natural Step: Seeding a Quiet Revolution. Gabriola Island, British Columbia: New Society Publishers, 2002.Thomas, Mark. Belching Out the Devil: Global Adventure with Coca-Cola. London: Ebury Press, 2008.United Nations General Assembly. “International Day of Peace. A/RES/55/282" 111th Plenary Meeting. 2001. 10 June 2014 ‹http://www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/55/282&Lang=E›.Unleash Your Power of Influence. Triumphant Events and Peace One Day. 2010.

This article explores how fat women protesting challenges norms of womanhood, the place of women in society, and who has the power to have their say in public spaces. We use the term fat as a political reclamation; Fat Studies scholars and fat activists prefer the term fat, over the normative term “overweight” and the pathologising term “obese/obesity” (Lee and Pausé para 3). Who is and who isn’t fat, we suggest, is best left to self-determination, although it is generally accepted by fat activists that the term is most appropriately adopted by individuals who are unable to buy clothes in any store they choose. Using a tweet from conservative commentator Ann Coulter as a leaping-off point, we examine the narratives around women in the public sphere and explore how fat bodies might transgress further the norms set by society. The public representations of women in politics and protest are then are set in the context of ‘activist wisdom’ (Maddison and Scalmer) from two sides of the globe. Activist wisdom gives preference to the lived knowledge and experience of activists as tools to understand social movements. It seeks to draw theoretical implications from the practical actions of those on the ground. In centring the experiences of ourselves and other activists, we hope to expand existing understandings of body politics, gender, and political power in this piece. It is important in researching social movements to look both at the representations of protest and protestors in all forms of media as this is the ‘public face’ of movements, but also to examine the reflections of the individuals who collectively put their weight behind bringing social change.A few days after the 45th President of the United States was elected, people around the world spilled into the streets and participated in protests; precursors to the Women’s March which would take place the following January. Pictures of such marches were shared via social media, demonstrating the worldwide protest against the racism, misogyny, and overall oppressiveness, of the newly elected leader. Not everyone was supportive of these protests though; one such conservative commentator, Ann Coulter, shared this tweet: Image1: A tweet from Ann Coulter; the tweet contains a picture of a group of protestors, holding signs protesting Trump, white supremacy, and for the rights of immigrants. In front of the group, holding a megaphone is a woman. Below the picture, the text reads, “Without fat girls, there would be no protests”.Coulter continued on with two more tweets, sharing pictures of other girls protesting and suggesting that the protestors needed a diet programme. Kivan Bay (“Without Fat Girls”) suggested that perhaps Coulter was implying that skinny girls do not have time to protest because they are too busy doing skinny girl things, like buying jackets or trying on sweaters. Or perhaps Coulter was arguing that fat girls are too visible, too loud, and too big, to be taken seriously in their protests. These tweets provide a point of illustration for how fat women protesting challenge norms of womanhood, the place of women in society, and who has the power to have their say in public spaces While Coulter’s tweet was most likely intended as a hostile personal attack on political grounds, we find it useful in its foregrounding of gender, bodies and protest which we consider in this article, beginning with a review of fat girls’ role in social justice movements.Across the world, we can point to fat women who engage in activism related to body politics and more. Australian fat filmmaker and activist Kelli Jean Drinkwater makes documentaries, such as Aquaporko! and Nothing to Lose, that queer fat embodiment and confronts body norms. Newly elected Ontario MPP Jill Andrew has been fighting for equal rights for queer people and fat people in Canada for decades. Nigerian Latasha Ngwube founded About That Curvy Life, Africa’s leading body positive and empowerment site, and has organised plus-size fashion show events at Heineken Lagos Fashion and Design Week in Nigeria in 2016 and the Glitz Africa Fashion Week in Ghana in 2017. Fat women have been putting their bodies on the line for the rights of others to live, work, and love. American Heather Heyer was protesting the hate that white nationalists represent and the danger they posed to her friends, family, and neighbours when she died at a rally in Charlottesville, North Carolina in late 2017 (Caron). When Heyer was killed by one of those white nationalists, they declared that she was fat, and therefore her body size was lauded loudly as justification for her death (Bay, “How Nazis Use”; Spangler).Fat women protesting is not new. For example, the Fat Underground was a group of “radical fat feminist women”, who split off from the more conservative NAAFA (National Association to Aid Fat Americans) in the 1970s (Simic 18). The group educated the public about weight science, harassed weight-loss companies, and disrupted academic seminars on obesity. The Fat Underground made their first public appearance at a Women’s Equality Day in Los Angeles, taking over the stage at the public event to accuse the medical profession of murdering Cass Elliot, the lead singer of the folk music group, The Mamas and the Papas (Dean and Buss). In 1973, the Fat Underground produced the Fat Liberation Manifesto. This Manifesto began by declaring that they believed “that fat people are full entitled to human respect and recognition” (Freespirit and Aldebaran 341).Women have long been disavowed, or discouraged, from participating in the public sphere (Ginzberg; van Acker) or seen as “intruders or outsiders to the tough world of politics” (van Acker 118). The feminist slogan the personal is political was intended to shed light on the role that women needed to play in the public spheres of education, employment, and government (Caha 22). Across the world, the acceptance of women within the public sphere has been varied due to cultural, political, and religious, preferences and restrictions (Agenda Feminist Media Collective). Limited acceptance of women in the public sphere has historically been granted by those ‘anointed’ by a male family member or patron (Fountaine 47).Anti-feminists are quick to disavow women being in public spaces, preferring to assign them the role as helpmeet to male political elite. As Schlafly (in Rowland 30) notes: “A Positive Woman cannot defeat a man in a wrestling or boxing match, but she can motivate him, inspire him, encourage him, teach him, restrain him, reward him, and have power over him that he can never achieve over her with all his muscle.” This idea of women working behind the scenes has been very strong in New Zealand where the ‘sternly worded’ letter is favoured over street protest. An acceptable route for women’s activism was working within existing political institutions (Grey), with activity being ‘hidden’ inside government offices such as the Ministry of Women’s Affairs (Schuster, 23). But women’s movement organisations that engage in even the mildest form of disruptive protest are decried (Grey; van Acker).One way women have been accepted into public space is as the moral guardians or change agents of the entire political realm (Bliss; Ginzberg; van Acker; Ledwith). From the early suffrage movements both political actors and media representations highlighted women were more principled and conciliatory than men, and in many cases had a moral compass based on restraint. Cartoons showed women in the suffrage movement ‘sweeping up’ and ‘cleaning house’ (Sheppard 123). Groups like the Women’s Christian Temperance Union were celebrated for protesting against the demon drink and anti-pornography campaigners like Patricia Bartlett were seen as acceptable voices of moral reason (Moynihan). And as Cunnison and Stageman (in Ledwith 193) note, women bring a “culture of femininity to trade unions … an alternative culture, derived from the particularity of their lives as women and experiences of caring and subordination”. This role of moral guardian often derived from women as ‘mothers’, responsible for the physical and moral well-being of the nation.The body itself has been a sight of protest for women including fights for bodily autonomy in their medical decisions, reproductive justice, and to live lives free from physical and sexual abuse, have long been met with criticisms of being unladylike or inappropriate. Early examples decried in NZ include the women’s clothing movement which formed part of the suffrage movement. In the second half of the 20th century it was the freedom trash can protests that started the myth of ‘women burning their bras’ which defied acceptable feminine norms (Sawer and Grey). Recent examples of women protesting for body rights include #MeToo and Time’s Up. Both movements protest the lack of bodily autonomy women can assert when men believe they are entitled to women’s bodies for their entertainment, enjoyment, and pleasure. And both movements have received considerable backlash by those who suggest it is a witch hunt that might ensnare otherwise innocent men, or those who are worried that the real victims are white men who are being left behind (see Garber; Haussegger). Women who advocate for bodily autonomy, including access to contraception and abortion, are often held up as morally irresponsible. As Archdeacon Bullock (cited in Smyth 55) asserted, “A woman should pay for her fun.”Many individuals believe that the stigma and discrimination fat people face are the consequences they sow from their own behaviours (Crandall 892); that fat people are fat because they have made poor decisions, being too indulgent with food and too lazy to exercise (Crandall 883). Therefore, fat people, like women, should have to pay for their fun. Fat women find themselves at this intersection, and are often judged more harshly for their weight than fat men (Tiggemann and Rothblum). Examining Coulter’s tweet with this perspective in mind, it can easily be read as an attempt to put fat girl protestors back into their place. It can also be read as a warning. Don’t go making too much noise or you may be labelled as fat. Presenting troublesome women as fat has a long history within political art and depictions. Marianne (the symbol of the French Republic) was depicted as fat and ugly; she also reinforced an anti-suffragist position (Chenut 441). These images are effective because of our societal views on fatness (Kyrölä). Fatness is undesirable, unworthy of love and attention, and a representation of poor character, lack of willpower, and an absence of discipline (Murray 14; Pausé, “Rebel Heart” para 1).Fat women who protest transgress rules around body size, gender norms, and the appropriate place for women in society. Take as an example the experiences of one of the authors of this piece, Sandra Grey, who was thrust in to political limelight nationally with the Campaign for MMP (Grey and Fitzsimmons) and when elected as the President of the New Zealand Tertiary Education Union in 2011. Sandra is a trade union activist who breaches too many norms set for the “good woman protestor,” as well as the norms for being a “good fat woman”. She looms large on a stage – literally – and holds enough power in public protest to make a crowd of 7,000 people “jump to left”, chant, sing, and march. In response, some perceive Sandra less as a tactical and strategic leader of the union movement, and more as the “jolly fat woman” who entertains, MCs, and leads public events. Though even in this role, she has been criticised for being too loud, too much, too big.These criticisms are loudest when Sandra is alongside other fat female bodies. When posting on social media photos with fellow trade union members the comments often note the need of the group to “go on a diet”. The collective fatness also brings comments about “not wanting to fuck any of that group of fat cows”. There is something politically and socially dangerous about fat women en masse. This was behind the responses to Sandra’s first public appearance as the President of TEU when one of the male union members remarked “Clearly you have to be a fat dyke to run this union.” The four top elected and appointed positions in the TEU have been women for eight years now and both their fatness and perceived sexuality present as a threat in a once male-dominated space. Even when not numerically dominant, unions are public spaces dominated by a “masculine culture … underpinned by the undervaluation of ‘women’s worth’ and notions of womanhood ‘defined in domesticity’” (Cockburn in Kirton 273-4). Sandra’s experiences in public space show that the derision and methods of putting fat girls back in their place varies dependent on whether the challenge to power is posed by a single fat body with positional power and a group of fat bodies with collective power.Fat Girls Are the FutureOn the other side of the world, Tara Vilhjálmsdóttir is protesting to change the law in Iceland. Tara believes that fat people should be protected against discrimination in public and private settings. Using social media such as Facebook and Instagram, Tara takes her message, and her activism, to her thousands of followers (Keller, 434; Pausé, “Rebel Heart”). And through mainstream media, she pushes back on fatphobia rhetoric and applies pressure on the government to classify weight as a protected status under the law.After a lifetime of living “under the oppression of diet culture,” Tara began her activism in 2010 (Vilhjálmsdóttir). She had suffered real harm from diet culture, developing an eating disorder as a teen and being told through her treatment for it that her fears as a fat woman – that she had no future, that fat people experienced discrimination and stigma – were unfounded. But Tara’s lived experiences demonstrated fat stigma and discrimination were real.In 2012, she co-founded the Icelandic Association for Body Respect, which promotes body positivity and fights weight stigma in Iceland. The group uses a mixture of real life and online tools; organising petitions, running campaigns against the Icelandic version of The Biggest Loser, and campaigning for weight to be a protected class in the Icelandic constitution. The Association has increased the visibility of the dangers of diet culture and the harm of fat stigma. They laid the groundwork that led to changing the human rights policy for the city of Reykjavík; fat people cannot be discriminated against in employment settings within government jobs. As the city is one of the largest employers in the country, this was a large step forward for fat rights.Tara does receive her fair share of hate messages; she’s shared that she’s amazed at the lengths people will go to misunderstand what she is saying (Vilhjálmsdóttir). “This isn’t about hurt feelings; I’m not insulted [by fat stigma]. It’s about [fat stigma] affecting the livelihood of fat people and the structural discrimination they face” (Vilhjálmsdóttir). She collects the hateful comments she receives online through screenshots and shares them in an album on her page. She believes it is important to keep a repository to demonstrate to others that the hatred towards fat people is real. But the hate she receives only fuels her work more. As does the encouragement she receives from people, both in Iceland and abroad. And she is not alone; fat activists across the world are using Web 2.0 tools to change the conversation around fatness and demand civil rights for fat people (Pausé, “Rebel Heart”; Pausé, “Live to Tell").Using Web 2.0 tools as a way to protest and engage in activism is an example of oppositional technologics; a “political praxis of resistance being woven into low-tech, amateur, hybrid, alternative subcultural feminist networks” (Garrison 151). Fat activists use social media to engage in anti-assimilationist activism and build communities of practice online in ways that would not be possible in real life (Pausé, “Express Yourself” 1). This is especially useful for those whose protests sit at the intersections of oppressions (Keller 435; Pausé, “Rebel Heart” para 19). Online protests have the ability to travel the globe quickly, providing opportunities for connections between protests and spreading protests across the globe, such as SlutWalks in 2011-2012 (Schuster 19). And online spaces open up unlimited venues for women to participate more freely in protest than other forms (Harris 479; Schuster 16; Garrison 162).Whether online or offline, women are represented as dangerous in the political sphere when they act without male champions breaching norms of femininity, when their involvement challenges the role of woman as moral guardians, and when they make the body the site of protest. Women must ‘do politics’ politely, with utmost control, and of course caringly; that is they must play their ‘designated roles’. Whether or not you fit the gendered norms of political life affects how your protest is perceived through the media (van Acker). Coulter’s tweet loudly proclaimed that the fat ‘girls’ protesting the election of the 45th President of the United States were unworthy, out of control, and not worthy of attention (ironic, then, as her tweet caused considerable conversation about protest, fatness, and the reasons not to like the President-Elect). What the Coulter tweet demonstrates is that fat women are perceived as doubly-problematic in public space, both as fat and as women. They do not do politics in a way that is befitting womanhood – they are too visible and loud; they are not moral guardians of conservative values; and, their bodies challenge masculine power.ReferencesAgenda Feminist Media Collective. “Women in Society: Public Debate.” Agenda: Empowering Women for Gender Equity 10 (1991): 31-44.Bay, Kivan. “How Nazis Use Fat to Excuse Violence.” Medium, 7 Feb. 2018. 1 May 2018 <https://medium.com/@kivabay/how-nazis-use-fat-to-excuse-violence-b7da7d18fea8>.———. “Without Fat Girls, There Would Be No Protests.” Bullshit.ist, 13 Nov. 2016. 16 May 2018 <https://bullshit.ist/without-fat-girls-there-would-be-no-protests-e66690de539a>.Bliss, Katherine Elaine. Compromised Positions: Prostitution, Public Health, and Gender Politics in Revolutionary Mexico City. Penn State Press, 2010.Caha, Omer. 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As a genre, science fiction deals with possible futures, imagining places and technologies that typically do not exist in audiences’ own lives. Science fiction film takes this directive a step further by creating visual representations of these futures and possibilities, presenting audiences with imagined ideas of what new technologies or unfamiliar places might look like. Thus, although any science fiction text can describe sociocultural and technological futures, science fiction film goes a step further by providing images that viewers do not have to envision for themselves. This difference can enable science fiction films to deliver even more incisive stories and commentaries on futuristic technologies as “sociotechnical assemblages” (Gillespie 18) – that is, as machines whose possibilities stem from humans’ interactions with them as much as from the technologies themselves.Marquard Smith and Joanne Morra maintain that today’s society is already interested in a real-world version of sociotechnologies: they call this interest the “prosthetic impulse” (4). For Smith and Morra, the prosthetic impulse can denote either “ways that the body and technology come into contact with one another” (4) or else any exploration of boundaries between technoculture and “the body, its histories, and its mutability” (6). However, Smith and Morra also warn that the prosthetic impulse often creates unreasonable expectations of what technology can accomplish: a prosthetic can “assume an epic status that is out of proportion with its abilities to fulfill our ambitions for it” (Smith and Morra 2), and the drive to “enhance” human bodies’ capabilities can signify beliefs that abled bodies are the standard, desirable norm (S. Smith).Science fiction films in turn often pick up on real-world ideas such as Smith and Morra’s prosthetic impulse as new ways of visualizing possible futures. Knowledgeable fans could undoubtedly list several examples of prosthetics in favorite sci-fi movies, including those donned by Star Wars’ Luke Skywalker, Star Trek’s Borg collective, Mad Max: Fury Road’s Imperator Furiosa, and many more. However, these films can also heighten the prosthetic’s immoderately “epic status” (Smith and Morra 2) and result in “our fantasies for technological possibility [being] played out across depictions of impairment” (Hung par. 10). In science fiction film, then, the prosthetic impulse can strongly reinforce problematic assumptions about what human beings “need” to have added, augmented, or replaced in order to function according to subjective norms.Steven Spielberg’s 2001 film A.I. Artificial Intelligence, though, expands the implications of the prosthetic impulse even further by broadening the types of bodies, losses, and functions that we imagine prosthetics can address. Set in a dystopian future where human-driven climate change has decimated the environment, world governments have instituted mandatory birth control, and socioeconomic stratification has skyrocketed, A.I. Artificial Intelligence speaks directly to Vivian Carol Sobchack’s 2006 concern that “theoretical use of the prosthetic metaphor tends to transfer agency [from] human actors to human artifacts” (23), though it does so in a novel way.The film’s human characters, or “human actors” to use Sobchack’s term, expend their creativity and resources not to address the issues of environmental catastrophe, starvation, and class warfare that humans themselves have created: instead, they turn to manufacturing advanced robots, or “mechas”, that are literally “human artifacts” (Sobchack 23) created to help humanity avoid the debilitating consequences of its own destructive actions. As a result, the film’s mecha characters, seen most clearly in the “child-substitute mecha” David and the mecha prostitute Gigolo Joe, are positioned as prosthetic humans intended to fill social roles and functions that human beings themselves are incapable of fully satisfying.The Prosthetic HumanEven though it offers a new angle to this concept, A.I. Artificial Intelligence is hardly the only science fiction film concerned with some configuration of the prosthetic impulse. In fact, several other science fiction films incorporate one of three other versions, each building up to more and more complex possibilities before we reach the prosthetic human as envisioned in A.I.The first – and arguably most common – treatment of the prosthetic impulse in science fiction film is found in the partial prosthetic, where technology is depicted as replacing or repairing one visible part of the perceptible bodily whole. Common versions of the partial prosthetic include replacements for limbs or even certain organs, with examples such as Luke Skywalker’s prosthetic hand in Star Wars, the techno-organic Borg collective in Star Trek: The Next Generation, Bucky Barnes’s metal arm in Captain America: The Winter Soldier and other Marvel Cinematic Universe (MCU) films, and Furiosa’s metal arm in Mad Max: Fury Road. The partial prosthetic in science fiction film is the most analogous to real-world prosthetics, despite problematic conflations created by this comparison (S. Smith), and the partial prosthetic is also the one that Mailee Hung is describing when she maintains that in science fiction film “it is technological, or even technophilic, fantasy that is being explored rather than the spectrum of human ability” (par. 11).A second treatment of the prosthetic impulse in science fiction film is visible in the full-body prosthetic, which denotes a technology that completely encloses or envelops the human body. Anne McCaffrey offers an early example of this type with her “Ship Who Sang” series (1961–1969), where “brainships” are created when children with severe physical disabilities but above-average brains can be rescued from euthanasia by having their minds linked with spaceships. Thankfully, later science fiction narratives tend to avoid most of the eugenicist and ableist overtones plaguing McCaffrey’s work. Science fiction films also offer examples of full-body prosthetics that can be departed or disengaged from at will, and these prosthetics may be used to enhance an abled body rather than housing a disabled one. Examples of full-body prosthetics in science fiction film include the boxing robots of Real Steel (2011), the Jaegers of Pacific Rim (2013) and Pacific Rim: Uprising (2018), the genetically-engineered alien bodies operated by remote human pilots in James Cameron’s Avatar (2009), and the police robot MOOSE in Chappie (2015), among others. In these cases, the full-body prosthetic is a technological entity that must be interfaced with by a human consciousness – and sometimes the whole human body – in order to perform some function that the human body alone cannot accomplish.A third way of depicting the prosthetic impulse in science fiction film can be found in what Victor Grech calls Pinocchio Syndrome, or a “reverse prosthetic impulse” (265). Here technological, non-human characters “desire to become human” (Grech 263) and often attempt to gain humanity in the form of a human body, “its histories, and its mutability” (Smith and Morra 6) that will replace their own mechanical components. Examples of this third type include Data of Star Trek: The Next Generation (1987–1994 television, 1994–2002 films) and NDR-113/Andrew of the novelette “Bicentennial Man” (1967), the novel Positronic Man (1992), and the film Bicentennial Man (1999). Data is an android, and Andrew is a service robot, who both explore what it would mean to “be” human and actively pursue different means of achieving humanness – Data through human emotions and NDR-113/Andrew through a fully human body.All three of these science fiction versions – the partial prosthetic, the full prosthetic, and the reverse prosthetic impulse or Pinocchio Syndrome – tend to reinforce Smith and Morra’s warning that the prosthetic, both as an aid and as a technology, can “assume an epic status that is out of proportion with its abilities to fulfill our ambitions for it” (2). Put differently, just because these technologies exist within the films’ storyworlds does not mean that they can fix the characters’ or even the worlds’ problems, and the plots of many science fiction films actually stem from these assumptions.Of these three versions, Grech’s “reverse prosthetic impulse” (265) might initially seem the most applicable to A.I. Artificial Intelligence, particularly because most of the film follows David’s quest to find the Blue Fairy of the Pinocchio tale and petition her to make him “a real boy” (A.I. Artificial Intelligence). However, even Grech’s term does not fully cover what Spielberg’s film is attempting through its characters and its setting. Unlike robot characters who embody Grech’s reverse prosthetic impulse, David is not attempting to “become” human: instead, he articulates his struggle as the desire to “become real”, which prioritizes not humanness via a human body but instead David’s self-perceived ability to better fulfill a particular role within a nuclear family. Moreover, unlike the ways in which Data and NDR-113/Andrew fulfill primarily career-adjacent roles in their respective storyworlds – Data as a ship’s officer, NDR-113/Andrew initially as a caretaker and butler – A.I. Artificial Intelligence depicts a world in which mechas are both an “essential” form of labor in a decimated global economy, but can also be constructed to fill specifically social roles such as child or lover. Where robots like Data and NDR-113/Andrew enact a reverse prosthetic impulse in their yearning to “become” human (Grech 263), thus treating humanness and the human body as prosthetics to technology, David as a “child-substitute mecha” and Gigolo Joe as a “lover robot” (A.I. Artificial Intelligence) are more like prosthetic humans.In A.I. Artificial Intelligence, humans attempt to replace, enhance, or augment specific interpersonal relationships using “human artifacts” that function like Sobchack’s “human actors” – only, better than those human actors ever could be. David is continually described as a child who demonstrates unconditional love but never loses his temper, catches ill, or grows older; Gigolo Joe describes mecha prostitutes like himself as “the guiltless pleasures of the lonely human being” (A.I. Artificial Intelligence) and promises that they will never get pregnant, clingy, or tired of sex. Because David is a “toy boy” and Gigolo Joe is a “boy toy” (Sobchack 2) – both meant to enhance different types of human relationships without the inconveniences that a human actor would bring into the picture – A.I. Artificial Intelligence is also imagining sociocultural structures like the nuclear family or the heterosexual romantic relationship as the wholes, the social bodies, that the prosthetic human will supposedly repair. Here the prosthetic impulse becomes human beings’ drive to use reparative technologies to replace other human beings entirely, rather than simply parts or functions of the human body.David as Prosthetic HumanDavid’s role as a prosthetic human meant to repair or augment human relationships is made clear even before the character himself first appears onscreen. Instead, the film’s initial scene follows Professor Allen Hobby, the scientist who leads the team that later creates David, as he pitches a new mecha of “a qualitatively different order” to a skeptical audience (A.I. Artificial Intelligence). Hobby contends that his new robot will be capable of love “like a child for its parents” instead of the “sensuality simulators” already available (A.I. Artificial Intelligence), and moreover, that this kind of love “will be the key by which they [mechas] acquire a kind of sub-consciousness never before achieved. An inner world of metaphor, of intuition, of self-motivated reasoning, of dreams” (A.I. Artificial Intelligence). However, these plans are quickly challenged by a female scientist who poses a moral question: “Isn’t the real conundrum [whether] you can get a human to love them back?” (A.I. Artificial Intelligence). Hobby then cycles through three responses to his peer’s question, all of which point to the ways in which David is positioned as a prosthetic human.First, Hobby stresses that this new mecha will be “a perfect child caught in a freeze-frame: always loving, never ill, never changing” (A.I. Artificial Intelligence). His claim implies that families want or need a perfect child, and also that childhood perfection entails unwavering physical health, a permanently positive attitude, and unshakeable devotion to the parent(s) – all features that a real human child, as Sobchack’s “human actor”, cannot provide. Then too, Hobby’s claim that David is a child caught in “freeze-frame” perfection also hints that, as a form of technology, a prosthetic human supersedes many of a biological human’s limitations: just moments later, for example, the film’s audience learns that David’s adoptive family the Swintons have a young son, Martin, who has been placed in a cryogenic chamber until his terminal illness can be treated. For David, being “caught in a freeze-frame” of eternal and “perfect” childhood is beneficial to the Swintons, who will then experience his love and participation in their family unit forever – unlike Martin, who when similarly “frozen” cannot express or reciprocate familial affection at all, and so has been superseded by David.Hobby’s second response to the female scientist’s moral question is to assert that David, as a “child-substitute mecha” (A.I. Artificial Intelligence), will answer both a market need and a human one: because world governments issue a limited number of pregnancy licenses, Hobby argues, mechas like David may become many families’ only way of having children. Here, the family unit is imagined as incomplete without offspring, to the extent that there is a species-wide “human need” for children (A.I. Artificial Intelligence) even though global catastrophes such as climate change and mass starvation are unavoidable threats to real children’s future welfare. To this end, Hobby positions a “child-substitute mecha” like David as a prosthetic for the family unit, filling in for children without taking up any of the resources needed to raise an actual member of the population who will then face and inherit unfixable global issues. Moreover, toward the end of A.I. audiences also learn that David was created to look like Hobby’s own dead son, meaning that this entire line of child-substitute mechas has stemmed from Hobby’s own grief – and perhaps his need of a prosthetic to repair it.Finally, Hobby’s last response to his peer’s challenge is to ask: “In the beginning, didn’t God create Adam to love him?” (A.I. Artificial Intelligence). This rhetorical question reiterates how Hobby built David, reminding Hobby’s challenger – and by extension the film’s audience – that human actors are technology’s creators. The question’s rhetorical nature also implies that a creator’s status translates to their right to use such created technologies however they choose – regardless of the potential harm to either the prosthetic human or the "real" humans around them.Thus, although most of A.I. Artificial Intelligence does follow David’s journey to become “real”, it is important to realize that this quest actually stems from his being a prosthetic human rather than just Pinocchio Syndrome or a “reverse prosthetic impulse” (Grech 265). The very features of unconditional love, eternal innocence, and unchanging health that initially made David so attractive to the grieving Swintons are the same attributes that later lead to the family’s hostility when Martin does recover, and David is eventually abandoned in the woods – the prosthetic human child ousted for the “real” human child he was intended to replace. David’s longing to become “a real boy” so that Monica Swinton will return his love and welcome him home stems from his realization that he was always just a “technological substitution” (Hung par. 9) for Martin, and because of this, David’s desire to “become real” is better understood as him seeking to become a true part of the whole nuclear family instead of remaining a replacement or attachment to it. Rather than just “desire to become human” (Grech 263), David seeks to move from being a “human artifact” to becoming a “human actor” (Sobchack 23).Gigolo Joe as Prosthetic HumanWhile Gigolo Joe also serves as a prosthetic human in A.I. Artificial Intelligence, he does so in different ways than David. As a “child-substitute mecha”, David was created for intentionally prosthetic ends: even though he “can never be anything more than an approximate substitute” (Rosenbaum 74), he was still made specifically to repair or complete family units like the Swintons, rendering them “whole” by taking the place of an unavailable human child. As a mecha prostitute, though, Gigolo Joe was not created with prosthetic ends in mind: he was made to augment or supplement sexual experiences on a temporary basis, not to replace a long-term human partner or to make a sexual or romantic relationship whole by his presence within it. Also in obvious contrast to David, Gigolo Joe addresses sexual appetite rather than a need for filial love, provides short-term pleasure instead of a long-term connection, and is never intended to be seen by the film’s human characters as a human man instead of a male-shaped mecha. These are crucial differences between the two mechas’ purposes, functions, and target audiences, and Sobchack sums up this disparity by describing David and Gigolo Joe as two different types of “love machines” that remain “[s]uspended between an ironic Kubrickian critique of technological man and his Spielbergian redemption” (12–13).However, these differences between David and Gigolo Joe also translate into their being different kinds of prosthetic human. Where David was created to be a prosthetic human in the context of a childless family, replacing a needed member in order to make that family whole, Gigolo Joe takes the initiative to position himself as a prosthetic human, substituting the technology of his mecha body for the various physiological and/or emotional shortcomings of absent human sexual partners. Then too, where David rejects and attempts to outstrip his status as a “technological substitution” (Hung par. 9) for a human being, Gigolo Joe seems to exult in his part as substitute for human being.Audiences are shown this difference immediately. Where David is introduced through descriptions by Hobby, the scientist who created him and knows exactly what he wants David to accomplish, Gigolo Joe is introduced in person, alongside a nervous young woman who has apparently solicited him for sex. This unnamed woman admits that she has never had sex with a mecha before, and Gigolo Joe quickly discovers bruises from physical abuse by a human partner. In implied contrast to this unseen human partner, Gigolo Joe remains quiet, respectful, and gentle as he navigates the young woman’s communication of her fears and desires: he also assures her first that “once you’ve had a lover robot, you’ll never want a real man again” and then that “you are a goddess ... [and] you deserve much better in your life. You deserve me” (A.I. Artificial Intelligence). Both implicitly and explicitly, then, Gigolo Joe promises to provide his client with sexual and pseudo-romantic fulfillment: Sobchack frames this appeal as Gigolo Joe's ability to "satisfy every female sexual need and desire (including the illusion of romance) without wearing out” (5). But Gigolo Joe can only accomplish all of this because he is a perceptible, self-aware substitution for a human man – and a substitution that does not replicate the intentions and behaviors of his clients' "real" human partners.Gigolo Joe returns frequently to this idea that substitution is positive. Later, for instance, he explains to several fascinated teenage boys that mecha prostitutes “are the guiltless pleasures of the lonely human being. You’re not going to get us pregnant or have us to supper with Mommy and Daddy” (A.I. Artificial Intelligence), emphasizing that humans do not need to fulfill any social obligations toward mechas precisely because they are not “real” lovers. Gigolo Joe also pitches mecha sex workers by reminding his listeners that “We work under you, we work on you, and we work for you. Man made us better at what we do than was ever humanly possible” (A.I. Artificial Intelligence), suggesting that a substitute sexual partner will offer technological advantages over their human counterparts.Through dialogues and exchanges such as these, Gigolo Joe positions himself as a prosthetic human, acknowledging that he and his sex worker peers were not really meant to “repair” or “complete” human relationships even as he also maintains that mechas do replace human partners in important ways, even if temporarily. However, Gigolo Joe also recognizes the realities of being a prosthetic human in ways that David seems incapable of. For instance, when one of his clients is murdered by her human partner for seeking a replacement lover, Gigolo Joe realizes immediately that the man won’t even be suspected while Gigolo Joe himself automatically takes the blame. Similarly, Gigolo Joe is the one who can tell David that Monica Swinton “loves what you do for her, as my customers love what it is I do for them. But she does not love you. . . You were designed and built specific like the rest of us” (A.I. Artificial Intelligence). David rejects this warning, demonstrating that his creation as a prosthetic human has made him impervious to that same reality, but Gigolo Joe’s positioning himself as a prosthetic human has made him aware that being “designed and built specific” to meet humans’ needs does not negate the dangers that come along with a designed, perfected form of substitution.Prosthetic Humans and the End of HumanityThe ending of AI: Artificial Intelligence has baffled critics and audiences alike since its theatrical release. Are the alien-like Specialists real, or does David imagine these beings as a means of explaining away Hobby’s entire line of child-substitute mechas? Does David actually see Monica again, or is this the robotic equivalent of a comforting dream before he dies? Frances Flannery-Dailey outlines nine possible ways of understanding how the film ends before noting that its ambiguity and length often frustrate audiences, leaving them with a negative impression of the film.No matter which way we try to explain the ending of A.I. Artificial Intelligence, though, it is worth noting the presence of the Specialists, who claim that they are advanced beings that evolved from mechas following humanity’s extinction. Though Flannery-Daily correctly questions whether the Specialists actually exist or else are just dream-specters of David's “death”, their presence at the end of the film suggests at least the possibility of a distant future in which the prosthetic human has completely overtaken and supplanted the “real” humans that David so wanted to join. This potential ending, as well as David’s and Gigolo Joe’s poor treatment by "real" humans throughout the film, all demonstrate that the prosthetic humans in A.I. Artificial Intelligence suffer from more than the “epic status” that Smith and Morra assign to real-world prosthetics (2), or even the shortcomings visible in other versions of the prosthetic impulse as depicted in science fiction films. Instead, A.I. Artificial Intelligence becomes bleak when we realize that these prosthetic humans actually function very well, even when (wrongly) touted as miracle technologies (Smith and Morra 2), and that instead it is humans, their needs, and their visions that have fallen sadly short. Both David and Gigolo Joe do exactly what they were "designed and built specific” to do (A.I. Artificial Intelligence) and more, yet humanity has destroyed both them and itself by the end of the film regardless.ReferencesA.I. Artificial Intelligence. Dir. Steven Spielberg. Warner Bros. Pictures, 2001. Flannery-Dailey, Frances. "Robot Heavens and Robot Dreams: Ultimate Reality in A.I. and Other Recent Films." Journal of Religion & Film 7.2 (2016). 1 July 2019 <https://digitalcommons.unomaha.edu/jrf/vol7/iss2/7>.Gillespie, Tarleton. Custodians of the Internet: Platforms, Content Moderation, and the Hidden Decisions That Shape Social Media. New Haven: Yale University Press, 2018.Grech, Victor. "The Pinocchio Syndrome and the Prosthetic Impulse." Intelligence Unbound: The Future of Uploaded and Machine Minds. Eds. Russel Blackford and Damien Broderick. Malden: Wiley Blackwell, 2014. 263–278.Hung, Mailee. “We Are More than Our Machines.” Bitch Media (24 Aug. 2017). 2 July 2019 <https://www.bitchmedia.org/article/more-our-machines/aesthetics-and-prosthetics-science-fiction>.Rosenbaum, Jonathan. "A Matter of Life and Death: A.I. Artificial Intelligence (Directed by Steven Spielberg)." Film Quarterly 65.3 (2012): 74-78.Smith, Susan. "‘Limbitless Solutions’: The Prosthetic Arm, Iron Man and the Science Fiction of Technoscience." Medical Humanities 42.4 (2016): 259–264.Smith, Marquard, and Joanne Morra. “Introduction.” The Prosthetic Impulse: From a Posthuman Present to a Biocultural Future. Eds. Marquard Smith and Joanne Morra. Cambridge: MIT Press, 2006. 1–15. Sobchack, Vivian. “A Leg to Stand On: Prosthetics, Metaphor, and Materiality.” The Prosthetic Impulse: From a Posthuman Present to a Biocultural Future. Eds. Marquard Smith and Joanne Morra. Cambridge: The MIT Press, 2006. 17–42.Sobchack, Vivian Carol. "Love Machines: Boy Toys, Toy Boys and the Oxymorons of A.I.: Artificial Intelligence." Science Fiction Film and Television 1.1 (2009): 1–13.