Journal articles on the topic 'Medical economics Victoria'

Objective: This study aimed to detect the common organisms by culture and KOH mount microscopy of nail infections.Setting: It was cross sectional study. Three hundred sixty clinically diagnosed cases were collected from 1st July 2018 to 31st July 2021 from Dermatology OPD of Bahawal Victoria Hospital and clinics. The samples were processed in the Microbiology section of the Pathology department of Quaid-e-Azam Medical College Bahawalpur, Pakistan. Method: The nail specimen was directly inoculated on SDA culture media and aerobically incubate at 25 Ć to 30 Ć for 3 to 4 weeks. The growth was identified in colony characteristics by using cotton blue stains. Whereas the nail is immersed in 20% KOH solution. The microscopic study revealed the hyphae or spores and that is considered a positive for the test. Result: out of three hundred sixty cases the culture positivity was 56.94% of the specimen while KOH mount was positive in 60.83% of specimens and the combination of Culture with KOH was 66.67%.Conclusion: The fungal culture and KOH mount microscopy combination are subtle laboratory methods for the detection of organisms causing onychomycosis. The species detection and precise usage of anti-mycological agents to prevent the complications raised public health considerably.

Higher Education Studies wishes to acknowledge the following individuals for their assistance with peer review of manuscripts for this issue. Their help and contributions in maintaining the quality of the journal are greatly appreciated. Higher Education Studies is recruiting reviewers for the journal. If you are interested in becoming a reviewer, we welcome you to join us. Please find the application form and details at http://recruitment.ccsenet.org and e-mail the completed application form to hes@ccsenet.org. Reviewers for Volume 8, Number 4 Abdelaziz Mohammed, Albaha University, Saudi Arabia Anna Liduma, University of Latvia, Latvia Arbabisarjou Azizollah, Zahedan University of Medical Sciences, Iran Bahar Gün, İzmir University of Economics, Turkey Barba Patton, University of Houston-Victoria, USA Edward Lehner, Bronx Community College, City University of New York, USA Evrim Ustunluoglu, Izmir University of Economics, Turkey Gerard Hoyne, University of Notre Dame Australia, Australia Gregory S. Ching, Fu Jen Catholic University, Taiwan John Cowan, Edinburgh Napier University, United Kingdom John Rafferty, Charles Sturt University, Australia Kartheek R. Balapala, University Tunku Abdul Rahman, Malaysia Laid Fekih, University of Tlemcen Algeria, Algeria Mehmet Ersoy, Eskisehir Osmangazi University, Turkey Meric Ozgeldi, Mersin University, Turkey Michael John Maxel Okoche, Uganda Management Institute, Uganda Mirosław Kowalski, University of Zielona Góra, Poland Najia Sabir, Indiana University Bloomington, USA Nancy Maynes, Nipissing University, Schulich School of Education, Canada, Canada Philip Denton, Liverpool John Moores University, United Kingdom Qing Xie, Jiangnan University, China Sahar Ahadi, Islamic Azad University of Mashhad, Iran Savitri Bevinakoppa, Melbourne Institute of Technology, Australia Suat Capuk, Adiyaman University, Turkey Teguh Budiharso, Center of Language and Culture Studies, Indonesia Tuija A. Turunen, University of Lapland, Finland Zahra Shahsavar, Shiraz University of Medical Sciences, Iran

In 2020, several geographically isolated farms in Victoria, Australia, experienced an outbreak of highly pathogenic avian influenza (HPAI) virus H7N7 and low pathogenic avian influenza (LPAI) viruses H5N2 and H7N6. Effective containment and control measures ensured the eradication of these viruses but the event culminated in substantial loss of livestock and significant economic impact. The avian HPAI H7N7 virus generally does not infect humans; however, evidence shows the ocular pathway presents a favourable tissue tropism for human infection. Through antigenic drift, mutations in the H7N7 viral genome may increase virulence and pathogenicity in humans. The Victorian outbreak also detected LPAI H7N6 in emus at a commercial farm. Novel influenza A viruses can emerge by mixing different viral strains in a host susceptible to avian and human influenza strains. Studies show that emus are susceptible to infections from a wide range of influenza viral subtypes, including H5N1 and the pandemic H1N1. The emu’s internal organs and tissues express abundant cell surface sialic acid receptors that favour the attachment of avian and human influenza viruses, increasing the potential for internal genetic reassortment and the emergence of novel influenza A viruses. This review summarises the historical context of H7N7 in Australia, considers the potential for increased virulence and pathogenesis through mutations and draws attention to the emu as potentially an unrecognised viral mixing vessel.

The ecological fecundity of the northern shore of Lake Victoria was vital to Buganda’s dominance of the interlacustrine region during the pre-colonial period. Despite this, protein-energy malnutrition was notoriously common throughout the twentieth century. This paper charts changes in nutritional illness in a relatively wealthy, food-secure area of Africa during a time of vast social, economic and medical change. In Buganda at least, it appears that both the causation and epidemiology of malnutrition moved away from the endemic societal causes described by early colonial doctors and became instead more defined by individual position within a rapidly modernising economy.

Victor Fuchs is a towering figure. His contributions to economics have spanned nearly 35 years. As his career has progressed, he has increasingly come to write on subjects of broad interest in a style that is accessible to noneconomists, thereby magnifying his influence. His gift is an ability to ask questions that are usually based on simple theory, but which nonetheless in his hands seem novel, and then proceed to answer those questions with simple, straightforward data analysis that is all the more powerful for its simplicity. Victor's work is usually “low tech,” to use his term, but almost always persuasive in ways that high-tech methods would not necessarily be. In this essay, I focus principally on Victor's contributions to the economics of health and medical care, but I have a bit to say about his other contributions as well.

On Wednesday 27 April 1898, Dr Luigi [Louis] Westenra Sambon (1865–1931) addressed the Royal Geographical Society in London on a topic of much interest to the Victorian public. An Anglo-French medical graduate of the University of Naples, a Fellow of the London Zoological Society and a recent visitor to Central Africa, he was well equipped to tackle the subject of the ‘Acclimatization of Europeans in Tropical Lands’. The ‘problem of tropical colonization’, he began, ‘is one of the most important and pressing with which European states have to deal. Civilization has favoured unlimited multiplication, and thereby intensified that struggle for existence the limitation of which seemed to be its very object…I know full well that the question of emigration is beset with a variety of moral, social, political, and economic difficulties; but it is the law of nature, and civilization has no better remedy for the evils caused by overcrowding.’Even from these introductory remarks, it is already plain that Sambon's project was a compound product of medical diagnosis, colonial imperative, Darwinian demography and moral evaluation. And it is the rhetorical zone roughly marked out by this quadrilateral of disease, empire, struggle and virtue that I want to explore here. First, however, it will be instructive to return to that afternoon a century ago and spend a little more time listening in on the deliberations.

Privatizations of public services are often driven by economic scarcity and changes in political leadership, in particular election victories for conservative or neoliberal political parties. Data from Norwegian counties on numbers of medical specialists in secondary care over a period of 11 years (1991–2001) allow us to analyse effects of economic, socioeconomic, and political factors on supply of both public and private specialists and the private–public mix. We find striking variations between the main explanatory factors related to public and private supply. Supply of public specialists is explained by counties' revenue levels and demographic factors and is not affected by the party composition of councils. The supply of private specialist medical services is negatively related to the proportion of elderly patients. The scarcity hypothesis is confirmed as lower county revenue levels increase both the absolute and relative proportions of private supply. Political composition of councils affects the private proportion of medical specialists as increased representation of conservatives leads to privatization.

This article considers the remedial and transformative potential of litigation based on legally enforceable socio-economic entitlements, such as the justiciable socio-economic rights contained in the 1996 South African Constitution. It focuses on the interpretation and enforcement of South African prisoners' constitutional rights to dignified conditions of detention (including the provision of adequate medical treatment at state expense) and to consult with medical practitioners of their choice. Although these rights have not yet been the subject of a decision by the South African Constitutional Court, they have been central or incidental to a number of High Court decisions. The article discusses these decisions in an attempt to illustrate, first, that courts are institutionally equipped to effectively vindicate socio-economic rights, secondly, that the enforcement of socio-economic rights may result in tangible and affirmative relief for individual beneficiaries, and thirdly, that victories in socio-economic rights matters may cumulatively have significant transformative potential. The article situates prisoners' rights to medical treatment in the South African social, legal and constitutional contexts, discusses the ambit, scope and remedial potential of the rights, and considers the affirmative and transformative effects of the judgments in which they have been enforced. In particular, the article considers the impact of this distinct body of socio-economic rights jurisprudence on overarching social struggles for improved access to health care services (especially antiretroviral treatment) in South African prisons.

The lunatic asylum remains one of the most remarkable institutional monuments of the modern world, dominating the social landscape of Victorian Britain and exercising a powerful attraction for social historians of medicine, an attraction almost as great as the spectre of the madhouse for contemporary novelists. Our image of the Victorian asylum is still pervaded to a surprising degree by the gloomy spectacle of the total institution presented by Michel Foucault, though it has been modified by a whole range of institutional and philosophical accounts undertaken in the past three decades. Pioneering studies by researchers such as Andrew Scull have illuminated not only the power exercised by the new asylum superintendents, armed with medical discourses of moral treatment and the early promise of curability, but also the continuing dominance of the ‘mad doctors’ in the sombre years of neo-Darwinian pessimism and eugenics doctrines. More recent contributions to the now enormous literature on the social history of insanity have shifted the focus of attention from earlier concerns with charting the rise of the asylum and the elaboration of medical discourses under the psychiatric gaze of physicians to a detailed reconstruction of the social environment of the asylum and especially to the interplay between familial circumstances and the way institutions responded to the insane. Such concerns were also clearly evident in important earlier studies by Walton, Scull, Digby and others, which drew on fundamental work by Anderson on the changing role of the family during industrialization. These scholars drew attention to the importance of family and kinship relations in the negotiation of a lunatic's passage to the Victorian asylum, as well as the role of wider forces of economic change, population growth and migration in shaping the environment in which decisions about the care of the mad were made.

Background. Injection drug use (IDU) is a well-recognized risk factor for infective endocarditis (IE). Associated complications from IDU result in significant morbidity and mortality with substantial cost implications. The aim of this study was to determine the cost burden associated with the management of IE due to IDU (IE-IDU). Methods. We used data collected prospectively on patients with a diagnosis of IE-IDU as part of the international collaboration on endocarditis (ICE). The cost of medical treatment was estimated based on diagnosis-related groups (DRG) and weighted inlier equivalent separation (WIES). Results. There were 23 episodes from 21 patients in 12 years (2002 to 2014). The costing was done for 22 episodes due to data missing on 1 patient. The median age was 39 years. The gender distribution was equal. Heroin (71%) and methamphetamine (33%) were the most frequently used. 74% (17/23) required intensive care unit (ICU) admission. The median ICU length of stay (LOS) was 4 days (IQR (Interquartile range); 2 to 40 days) whilst median total hospital LOS was 40 days (IQR; 1 to 119 days). Twelve patients (52%) underwent valve replacement surgery. Mortality was 13% (3/23). The total medical cost for the 22 episodes is estimated at $1,628,359 Australian dollars (AUD). The median cost per episode was a median cost of $ 61363 AUD (IQR: $2806 to $266,357 AUD). We did not account for lost productivity and collateral costs attributed to concurrent morbidity. Conclusion. Within the limitations of this small retrospective study, we report that the management of infective endocarditis caused by injection drug use can be associated with significant financial cost.

The influence of Queen Victoria on the acceptance of obstetric anesthesia has been overstated, and the role of John Snow has been somewhat overlooked. It was his meticulous, careful approach and his clinical skills that influenced many of his colleagues, Tyler-Smith and Ramsbotham and the Queen's own physicians. The fact that the Queen received anesthesia was a manifestation that the conversion of Snow's colleagues had already taken place. This is not to say that this precipitated a revolution in practice. Medical theory may have changed, but practice did not, and the actual number of women anesthetized for childbirth remained quite low. This, however, was a reflection of economic and logistical problems, too few women were delivered of newborn infants during the care of physicians or in hospitals. Conversely, it is important to recognize that John Snow succeeded in lifting theoretical restrictions on the use of anesthesia.

Influenza B is responsible for a significant proportion of the global morbidity, mortality and economic loss caused by influenza-related disease. Two antigenically distinct lineages co-circulate worldwide, often resulting in mismatches in vaccine coverage when vaccine predictions fail. There are currently operational issues with gold standard serological assays for influenza B, such as lack of sensitivity and requirement for specific antigen treatment. This study encompasses the gold standard assays with the more recent Pseudotype-based Microneutralisation assay in order to study comparative serological outcomes. Haemagglutination Inhibition, Single Radial Haemolysis and Pseudotype-based Microneutralisation correlated strongly for strains in the Yamagata lineage; however, it correlated with neither gold standard assays for the Victoria lineage.

Public health is currently evolving, expanding, and reinforcing itself as a governance project in which health authorities’ concerns meet and blend with epidemiology and civil engineering. Rarely, however, are those concerns found worthy of examination, at least not to account for the multiplying involvements of public health, its ability to find political life in things, and its many translations. The shape of public health is dictated as much by its matters of concern as it is by biopolitical and brute matters of fact. This article presents a genealogy of public health in Victorian England between 1834 and 1848 in order to glimpse the matters of concern around which it stabilized. The political medicine that preceded public health holds the clue in its assertion of life as a form of worth, as prominent a criterion for the assessment of sociomaterial arrangements as profitability or efficiency. This article describes public health as an ensemble presence, a unique gathering, in which political will follows medical diagnosis, and life is worth at least as much as money.

Objectives To determine national service usage for initial and subsequent outpatient consultations with a consultant physician and any variation in service-use patterns between states and territories relative to population. Methods An analysis was conducted of consultant physician Medicare claims data from the year 2014 for an initial (item 110) and subsequent consultation (item 116) and, for patients with multiple morbidities, initial management planning (item 132) and review (133). The analysis included 12 medical specialties representative of common adult non-surgical medical care (cardiology, endocrinology, gastroenterology, general medicine, geriatric medicine, haematology, immunology and allergy, medical oncology, nephrology, neurology, respiratory medicine and rheumatology). Main outcome measures were per-capita service use by medical speciality and by state and territory and ratio of subsequent consultations to initial consultations by medical speciality and by state and territory. Results There was marked variation in per-capita consultant physician service use across the states and territories, tending higher than average in New South Wales and Victoria, and lower than average in the Northern Territory. There was variation between and within specialties across states and territories in the ratio of subsequent consultations to initial consultations. Conclusion Significant per-capita variation in consultant physician utilisation is occurring across Australia. Future studies should explore the variation in greater detail to discern whether workforce issues, access or economic barriers to care, or the possibility of over- or under-servicing in certain geographic areas is leading to this variation. What is known about the topic? There are nearly 11million initial and subsequent consultant physician consultations billed to Medicare per year, incurring nearly A$850million in Medicare benefits. Little attention has been paid to per-capita variation in rates of consultant physician service use across states and territories. What does this paper add? There is marked variation in per-capita consultant physician service use across different states and territories both within and between specialties. What are the implications for practitioners? Variation in service use may be due to limitations in the healthcare workforce, access or economic barriers, or systematic over- or under-servicing. The clinical appropriateness of repeated follow-up consultations is unclear.

Abstract Perforated cardboards were common and economic supports for embroidery in the Victorian Era. Despite their popularity, they had a brief life and are almost forgotten today. Different types of cardboard were chosen according to the materials and techniques to be applied. This article presents nineteenth century documentary sources on perforated cardboard and its use in various objects of everyday life. The types of cardboard, commercialization, decorative techniques and motifs and applied materials will be discussed.

Abstract In Victorian England excessive drinking was seen as almost exclusively a male prob- lem, but around 1900 the issue of female intemperance began to be widely discussed. In the first years of the twentieth century concern about women's drinking habits was voiced by an otherwise disparate group which included temperance workers, eugeni- cists, social reformers, imperialists and members of the medical profession. It is by no means certain that women were in fact using and abusing alcohol to a significantly greater extent than before: the evidence was and remains inconclusive. The Edwardian outcry against female intemperance derived its intensity less from the known dimen- sions of the problem than from the broader concerns of the time. Foremost among these were doubts about Britain's economic and imperial future, fears that her urban-based population was in the process of physical decline, and uncertainties in the face of challenges to traditional nineteenth-century assumptions about the place of women in society.

62The Victorian Department of Human Services has developed a classification andfunding model for non-admitted radiation oncology patients. Agencies were previouslyfunded on an historical cost input basis. For 1996?97, payments were made accordingto the new Non-admitted Radiation Oncology Classification System and include fourkey components. Fixed grants are based on Weighted Radiation Therapy Servicestargets for megavoltage courses, planning procedures (dosimetry and simulation) andconsultations. The additional throughput pool covers additional Weighted RadiationTherapy Services once targets are reached, with access conditional on the utilisationof a minimum number of megavoltage fields by each hospital. Block grants coverspecialised treatments, such as brachytherapy, allied health payments and other supportservices. Compensation grants were available to bring payments up to the level of theprevious year. There is potential to provide incentives to promote best practice inAustralia through linking appropriate practice to funding models. Key Australian andinternational developments should be monitored, including economic evaluationstudies, classification and funding models, and the deliberations of the AmericanCollege of Radiology, the American Society for Therapeutic Radiology and Oncology,the Trans-Tasman Radiation Oncology Group and the Council of Oncology Societiesof Australia. National impact on clinical practice guidelines in Australia can beachieved through the Quality of Care and Health Outcomes Committee of theNational Health and Medical Research Council.

Mutations of the H3N2 vaccine strain during the egg-based vaccine manufacturing process partly explain the suboptimal effectiveness of traditional seasonal influenza vaccines. Cell-based influenza vaccines improve antigenic match and vaccine effectiveness by avoiding such egg-adaptation. This study evaluated the public health and economic impact of a cell-based quadrivalent influenza vaccine (QIVc) in adults (18–64 years) compared to the standard egg-based quadrivalent influenza vaccine (QIVe) in the US. The impact of QIVc over QIVe in public health and cost outcomes was estimated using a dynamic age-structured SEIR transmission model, which accounted for four circulating influenza strains [A/H1N1pdm9, A/H3N2, B(Victoria), and B(Yamagata)] and was calibrated on the 2013–2018 influenza seasons. The robustness of the results was assessed in univariate and probabilistic sensitivity analyses. Switching from QIVe to QIVc in 18- to 64-year-olds may prevent 5.7 million symptomatic cases, 1.8 million outpatient visits, 50,000 hospitalizations, and 5453 deaths annually. The switch could save 128,000 Quality-Adjusted Life Years (QALYs) and US $ 845 M in direct costs, resulting in cost-savings in a three-year time horizon analysis. Probabilistic sensitivity analyses confirmed the robustness of the cost-saving result. The analysis shows that QIVc is expected to prevent hospitalizations and deaths, and result in substantial savings in healthcare costs.

Abstract BACKGROUND Influenza remains a constant threat worldwide, and WHO estimates that it affects 5% to 15% of the global population each season, with an associated 3 to 5 million severe cases and up to 500000 deaths. To limit the morbidity and the economic burden of influenza, improved diagnostic assays are needed. METHODS We developed a multiplexed assay for the detection and subtyping of seasonal influenza based on padlock probes and rolling circle amplification. The assay simultaneously targets all 8 genome segments of the 4 circulating influenza variants—A(H1N1), A(H3N2), B/Yamagata, and B/Victoria—and was combined with a prototype cartridge for inexpensive digital quantification. Characterized virus isolates and patient nasopharyngeal swabs were used for assay design and analytical validation. The diagnostic performance was assessed by blinded testing of 50 clinical samples analyzed in parallel with a commercial influenza assay, Simplexa™ Flu A/B & RSV Direct. RESULTS The assay had a detection limit of 18 viral RNA copies and achieved 100% analytical and clinical specificity for differential detection and subtyping of seasonal circulating influenza variants. The diagnostic sensitivity on the 50 clinical samples was 77.5% for detecting influenza and up to 73% for subtyping seasonal variants. CONCLUSIONS We have presented a proof-of-concept padlock probe assay combined with an inexpensive digital readout for the detection and subtyping of seasonal influenza strains A and B. The demonstrated high specificity and multiplexing capability, together with the digital quantification, established the assay as a promising diagnostic tool for seasonal influenza.

Behaviour change communication experts consider individual beliefs vital to identifying communication needs in healthcare programmes. This study examined the use of four constructs of the health belief model, viz. the belief that a person is vulnerable to a disease, and that the disease is severe; and the belief that an intervention against the disease has benefits and that there are barriers to adopting that intervention, as the basis for developing communication strategies in the implementation of the voluntary medical male circumcision (VMMC) programme for prevention of HIV/AIDS in Siaya county of Kenya. A structured questionnaire was administered on 350 male residents of the county aged between 18 and 50 years selected using the snowball sampling techniques. Qualitative data were collected through two focus groups discussions involving five men and five women residents. The study found that the residents of Siaya, particularly those living along the shores of Lake Victoria, believe that, because of their occupation and lifestyle, they are susceptible to HIV, the same way they perceive the disease as severe. The best known benefit of VMMC among the residents is its ability to reduce a man’s chances of contracting HIV. Other benefits, such as prevention of sex-related diseases among women are largely obscure. There are specific barriers to VMMC such as apprehension over pain and disruption of economic engagements. The study concurs that the health belief model is crucial for the development of audience-focused health communication and recommends its use in VMMC programme to produce targeted messages for different audience segments.

Among the four genera of influenza viruses (IVs) and the four genera of coronaviruses (CoVs), zoonotic αIV and βCoV have occasionally caused airborne epidemic outbreaks in humans, who are immunologically naïve, and the outbreaks have resulted in high fatality rates as well as social and economic disruption and losses. The most devasting influenza A virus (IAV) in αIV, pandemic H1N1 in 1918, which caused at least 40 million deaths from about 500 million cases of infection, was the first recorded emergence of IAVs in humans. Usually, a novel human-adapted virus replaces the preexisting human-adapted virus. Interestingly, two IAV subtypes, A/H3N2/1968 and A/H1N1/2009 variants, and two lineages of influenza B viruses (IBV) in βIV, B/Yamagata and B/Victoria lineage-like viruses, remain seasonally detectable in humans. Both influenza C viruses (ICVs) in γIV and four human CoVs, HCoV-229E and HCoV-NL63 in αCoV and HCoV-OC43 and HCoV-HKU1 in βCoV, usually cause mild respiratory infections. Much attention has been given to CoVs since the global epidemic outbreaks of βSARS-CoV in 2002–2004 and βMERS-CoV from 2012 to present. βSARS-CoV-2, which is causing the ongoing COVID-19 pandemic that has resulted in 890,392 deaths from about 27 million cases of infection as of 8 September 2020, has provoked worldwide investigations of CoVs. With the aim of developing efficient strategies for controlling virus outbreaks and recurrences of seasonal virus variants, here we overview the structures, diversities, host ranges and host receptors of all IVs and CoVs and critically review current knowledge of receptor binding specificity of spike glycoproteins, which mediates infection, of IVs and of zoonotic, pandemic and seasonal CoVs.

Dear Colleagues! Our Authors and Friends! New Year 2022 rushes towards humanity. This universal arrangement of life on our planet presupposes changes. Their essence is in hopes for the best. We wish all of us not just hopes but confidence in the victory of good over evil, reasons over greed and cruelty. We hope that the Planet will overcome humankind's most severe viral attack – the SARS-CoV2 pandemic. We hope that the future brings us victories over epidemics, serious diseases, hunger, and lack of water. We hope that all types of violence, military conflicts, political, economic, religious confrontations will be stopped in a New Year. We are opening the third year of our journal, which was focused on different aspects of medicine. Last year we published eight papers from seven countries experts, each substantially contributed to medicine. We talked about COVID-19 pandemic, vital pediatric problems, and adult medicine. We will continue our mission to support and distribute the most valuable medical knowledge in the New Year. May the New Year celebrations bring only joy and harmony to your homes, souls, and the reasoning, which illuminate confidence in the future for our beautiful multinational green Planet - Earth! "Every end is a new beginning…." We wish you and your family a Happy Holidays! We hope that your New Year will be filled with peace, new ideas, and success! Editorial office

Abstract Background Influenza generates a substantial economic burden ($3.2B in the U.S. annually) due to direct medical costs such as physician office visits or hospitalizations, especially among the elderly. Recent published literature for the 2018–19 influenza season has demonstrated similar clinical effectiveness between adjuvanted trivalent influenza vaccine (aTIV) and trivalent high dose influenza vaccine (TIV-HD). This research aimed to assess the annualized mean all-cause and influenza-related healthcare costs among subjects 65+ years vaccinated with aTIV or TIV-HD during the 2018–19 influenza season. Methods A retrospective cohort analysis was conducted using professional fee, prescription claims and hospital charge master data in the U.S. Baseline characteristics included age, gender, payer type, region, Charlson Comorbidity Index, comorbidities, indicators of frail health status, and pre-index hospitalization rates. Treatment selection bias was adjusted through 1:1 propensity score matching (PSM). Economic outcomes included annualized mean all-cause costs and influenza-related costs, which comprised influenza-related hospitalizations, emergency room (ER) visits, and physician office visits costs. Mean costs were compared using paired t-test. Adjusted analyses were conducted using generalized estimating equation (GEE) models, with two-part models for influenza-related costs. With the GEEs, adjustment for outliers (99th percentile) were addressed and predicted healthcare costs were obtained through bootstrapping (500 replications). Results During the 2018–19 influenza season, the PSM sample comprised 561,243 recipients of aTIV and 561,243 recipients of TIV-HD. Following GEE adjustment, predicted mean annualized all-cause and influenza-related costs per patient were statistically similar between aTIV and TIV-HD (US$9,676 vs. US$9,625 and US$23.75 vs. US$21.79, respectively). Both aTIV and TIV-HD were comparable in terms of predicted mean annualized costs for influenza-related hospitalizations (US$20.28 vs. US$18.13) and influenza-related office visits (US$1.29 vs. US$1.34). Conclusion In adjusted analyses, total all-cause and influenza-related healthcare costs were comparable among elderly subjects vaccinated with either aTIV or TIV-HD. Disclosures Maarten Postma, Dr., IQVIA (Consultant) Stephen I. Pelton, MD, Merck vaccine (Consultant, Grant/Research Support)Pfizer (Consultant, Grant/Research Support)Sanofi Pasteur (Consultant, Other Financial or Material Support, DSMB)Seqirus Vaccine Ltd. (Consultant) Victoria Divino, PhD, Seiqrus Vaccines Ltd. (Consultant) Joaquin F. Mould-Quevedo, PhD, Seqirus Vaccines Ltd. (Employee, Shareholder) Drishti Shah, PhD, Seqirus Vaccines Ltd. (Consultant) Mitchell DeKoven, PhD, Seqirus Vaccines Ltd. (Consultant) Girishanthy Krishnarajah, PhD, Seqirus Vaccines Ltd. (Employee, Shareholder)

BACKGROUND Acute pancreatitis (AP) is an inflammatory disease of the pancreas, that results from intrapancreatic activation, release, and digestion of the organ by its own enzymes. The diagnosis of acute pancreatitis can be made when a patient presents with threefold elevated serum levels of amylase or lipase, abdominal pain and vomiting. In this study, we wanted to assess the severity of acute pancreatitis by using BISAP (Bedside index for severity in acute pancreatitis) and APACHE-II (Acute physiology and chronic health evaluation) scoring systems and compare the accuracy of BISAP scores with APACHE-II scores. METHODS A prospective study including 201 patients was conducted from April 2018 to March 2020 in Victoria Hospital, affiliated to BMCRI. RESULTS Among 201 AP patients, 129 were found to have mild acute pancreatitis (MAP), 72 were of severe acute pancreatitis (SAP), 192 survival cases, and 9 death cases. The larger the rating score, the higher the proportion of severe pancreatitis and mortality risk. Two kinds of scoring criteria; BISAP score points and Apache II score points compared in patients with MAP and SAP, In Apache II score to predict severity of organ failure, the sensitivity, specificity, positive predictive value, negative predictive value was 84.72 %, 93.02 %, 87.14 %, 91.60 % and area under the curve was 0.958 (P < 0.0001). In BISAP, the sensitivity, specificity, positive predictive value, negative predictive value was 90.28 %, 80.62 %, 72.22 %, 93.69 % and area under the curve was 0.917 (P < 0.0001). CONCLUSIONS Ability of APACHE II score prediction of AP in severity of organ failure and mortality are stronger than BISAP score, But APACHE II scoring system indicators were cumbersome, complicated assessment. BISAP scoring system is simple, economical, rapid and reliable, and it can effectively predict the severity and mortality of acute pancreatitis, and can be used as a preliminary screening method in accurate risk stratification and initiation of management accordingly at community health care, secondary health care and tertiary health care Hospitals. KEYWORDS Pancreatitis, Severity, Prediction, APACHE II and BISAP

Background:The lifetime prevalence of lower back pain is between 60% and 70%, with surgical treatments spared for those not responding to other options.Objectives:To investigate the age, gender and socio-economic status differences in back pain procedures in the UK between 2000, 2008 and 2016.Methods:Data was obtained from primary care electronic medical records (CPRD GOLD) linked to English hospital admissions data. Lower back procedures in patients aged 35+ were identified using OPCS-4 codes for Decompression (Dc), Fusion (F), Therapeutic injections (TI) and Denervation (Dn). Standardised incidence rates (IR) of each type of lower back procedures were calculated per 10,000 CPRD registered person years for each age group, gender, region and SES strata in 2000, 2008 and 2016. IR were also calculated for combinations of age and gender. Negative binomial regression calculated incidence rate ratios (IRR) and 95% confidence intervals.Results:The IR of lower back procedures was 21.5 [20.7, 22.3] per 10,000 person years in 2000. This doubled by 2008 (45.5 [44.5, 46.5]) and trebled by 2016 (62.5 [60.8, 64.2]). Number of events and incidence rates of each procedure type are shown in table 1 below. The incidence of Dn has increased 6-fold whilst Dc and F have doubled. Female (IR in 2016 of 73.99 [71.43, 76.61] vs 50.08 [47.90, 52.33] in men, IRR 1.50 [1.41, 1.59]) and age are associated with back procedure rates (figure 1). Large socio-economic differences were observed, with higher procedure rates seen in the most deprived areas. These differences did however narrow over time during the study period (figure 2).Table 1.Event numbers and incidence rates of different types of lower back procedure.FusionDecompressionTherapeutic InjectionDenervationEventsIR (95% CI)EventsIR (95% CI)EventsIR (95% CI)EventsIR (95% CI)20001090.86 (0.71, 1.04)4663.69 (3.36, 4.04)203516.11 (15.42, 16.82)910.72 (0.58, 0.88)20083331.77 (1.58, 1.97)11976.35 (6.00, 6.72)628333.35 (32.53, 34.18)5963.16 (2.91, 3.43)20161591.93 (1.65, 2.26)5256.39 (5.85, 6.96)386547.03 (45.56, 48.54)4875.93 (5.41, 6.48)Figure 1.Age and Gender stratified incidence rate ratios of all back procedures in 2000, 2008 and 2016Figure 2.Deprivation status incidence rate ratios by yearConclusion:The incidence of lower back procedures has more than trebled since 2000. Women are more likely to have lower back procedures than men, with patients aged 65-74 the most likely to have a procedure. Procedures in those aged 75+ have become more common over time, potentially increasing the risk of post-operative complications. Socio-economic differences in the incidence of low back procedures are probably related to the known higher prevalence of back pain in deprived areas. Whether the observed narrowing in socio-economic variation over time is explained by a reduced need or by lowered provision needs further research.Disclosure of Interests:Danielle E Robinson: None declared, Jennifer Lane: None declared, Richard Craig: None declared, Andrew Judge: None declared, James Bailey: None declared, Dahai Yu: None declared, Kelvin Jordan: None declared, George Peat: None declared, Ross Wilkie: None declared, Alan Silman: None declared, Victoria Y Strauss: None declared, Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen

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BackgroundHealthcare utilization by patients with axial spondyloarthritis (axSpA) is substantial, leading to a considerable social and economic burden1. Understanding patients’ characteristics and the main determinants of healthcare utilization is essential to reduce this burden.ObjectivesThe aim of the present study is to assess healthcare utilization in patients with axSpA in Spain.MethodsData from an online survey of 680 unselected axSpA patients pertaining to the Spanish Atlas of Axial Spondyloarthritis were analysed. Total healthcare utilization was assessed as the sum of number of healthcare visits, medical tests, hospital admissions, and emergency visits, all relying on the last 12 months prior to the survey. Mann-Whitney and Pearson’s χ2 tests were used to analyse possible associations between sociodemographic (age, gender, educational level, marital status, and patient organizations membership) and patient-reported outcomes (disease activity measured by BASDAI [0-10], mental health measured by GHQ-12 [0-12], functional limitation index (0-54), spinal stiffness index (3-12), and diagnostic delay) with respect to total healthcare utilization. Simple and multiple linear regression was used to analyse its possible associated factors.ResultsA total of 530 axSpA patients participated in this study: the mean age was 45.3 years, 51.1% were female, 39.6% had a university degree, and 70.6% were married. In the previous 12 months, 77.9% (n= 530) used at least one healthcare source, of which 75.3% visited at least once a rheumatologist (n= 512, mean= 4.4), 55.6% GP (n= 378, mean= 9.4) and 33.5% physiotherapist (n= 228, mean= 20.1). With respect to medical tests performed in the last 12 months, 75.3% performed at least one x-rays test (n= 512, mean= 4.4) and 71.2% blood test (n= 484, mean= 4.5). Furthermore, 7.9% of patients were hospitalised (n= 54, mean= 2.2 and 23.1% of patients visited outpatient centre (n= 157, mean= 5.5).Younger patients (r= -0.195) and females (52.0 vs 32.2 of males) showed higher healthcare utilization (p<0.001). In addition, a low positive correlation was found between healthcare utilization and disease activity (r= 0.290), mental health (r= 0.257), functional limitation (r= 0.283) and diagnostic delay (r= 0.151), all p-values <0.001.In the multiple linear regression, the qualitative factors associated with higher healthcare utilization was female gender (B= 12.854), while the quantitative factors associated with high healthcare utilization were younger age (B= -0.737), higher disease activity (B= 3.378), greater functional limitation (B= 0.576), and longer diagnostic delay (B= 0.959; Table 1).Table 1.Linear regression analysis of socio-demographic and patient-reported outcomes according to healthcare utilization (N= 402)Simple linear regressionMultiple linear regressionBeta95% CIBeta95% CIAge-0.884-1,266, -0.503-0.737-1.190, -0.283Gender. Female19.79211.600, 27.98412.8543.502, 22.207BASDAI (0-10)7.2604.934, 9.5863.3780,571, 6.185GHQ-12 (0-12)2.7241.786, 3.6631.126-0.048, 2.300Functional Limitation (0-54)1.4181.007, 1.8280.5760.007, 1.145Diagnostic Delay0.9660.419, 1.5120.9590.374, 1.544ConclusionHigher healthcare utilization was associated with higher disease activity, greater functional limitation, and longer diagnostic delay, in younger and females axSpA patients. Optimal monitoring of axSpA patients may help to minimise healthcare utilisation in patients with axSpA.References[1]Boonen et al. (2003). Direct Costs of Ankylosing Spondylitis and its Determinants: an Analysis among three European countries. Annals of the Rheumatic Diseases, 62(8), 732–740.https://doi.org/10.1136/ard.62.8.732AcknowledgementsThis study was supported by Novartis España. The authors would like to thank all patients who participated in the Atlas study.Disclosure of InterestsMarco Garrido-Cumbrera Grant/research support from: has a research collaboration with and provides services to Novartis Pharma AG, Eduardo Collantes-Estévez Grant/research support from: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Victoria Navarro-Compán Grant/research support from: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Pedro Zarco-Montejo: None declared, Carlos Sastré Employee of: Novartis Farmacéutica, José Correa-Fernández: None declared, Jordi Gratacos-Masmitja Grant/research support from: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB

Рассмотрена проблема патриотического воспитания подростков в современных условиях информационной войны, направленной в том числе на подрастающее поколение. Отмечено деструктивное влияние потребительской субкультуры, доминирование псевдоискусства над истинным искусством и культурой, что приводит к деформации ценностных понятий об истине, добре и красоте, чувства патриотизма, любви к Отечеству. Обоснована ничем другим незаменимая роль искусства в патриотическом воспитании современных подростков, поскольку эмоционально-чувственный компонент (любовь к родине и ее народу, гордость за прошлые победы в борьбе за независимость, культурные достижения современности и привязанность к родным местам) является основным содержанием понятия «патриотизм» и произведений искусства. Музыка, соприкасаясь с тончайшими движениями человеческой души, ближе других видов искусства к самой сути возвышенного в природе, обществе, индивидуальной жизни человека. Приведены примеры реализации воспитательных возможностей произведений отечественных композиторов патриотической направленности (А. П. Бородина, Д. Д. Шостаковича, Г. В. Свиридова) студентами-музыкантами во время педагогической практики в общеобразовательной школе. Выбор произведений отражает разные периоды отечественной истории: от начала XII в. и до наших дней. Оправданность методических подходов в решении задач патриотического воспитания подростков на примере прослушивания и исполнения музыки отечественных композиторов подтверждена данными устного и письменного опроса учащихся 7-го класса, которые позволяют судить о достаточно высоком уровне их патриотической воспитанности на данном возрастном этапе развития. The article observes the problem of patriotic education of teenagers in modern condition of information war, which is also aimed at the younger generation. It marks the destructive influence of consumer subculture, domination of pseudo-art over true art and culture, which leads to deformation of value understanding about truth, kindness and beauty, sense of patriotism and love for Motherland. The irreplaceable role of art in the patriotic education of modern teenagers is substantiated by nothing else, since the emotional and sensual component (love for the motherland and its people, pride in past victories in the struggle for independence, cultural achievements of our time and attachment to native places) is the main content of the concept of «patriotism» and works of art. Music, in contact with the subtlest movements of the human soul, is closer than other forms of art to the very essence of the sublime in nature, society, and the individual life of a person. Examples of the realization of the educational possibilities of works by domestic composers of a patriotic orientation (A. P. Borodin, D. D. Shostakovich, G. V. Sviridov) by students-musicians during pedagogical practice in a comprehensive school are given. The choice of creations reflects different periods of Russian history: from XII century till our days. Justification of the methodical approaches in solving the problems of patriotic education of teenagers on the examples of listening and performance of the music of the Russian composers is confirmed by the data of oral and written interviews of 7th grade students, which allow us to estimate a fairly high level of their patriotic education at this age stage of development.

ABSTRACT: Teacher performance has been the focus of educational policy reforms in recent decades for the professional development of teachers. The purpose of this study was to determine the effect of teaching experience and peer teaching skills on basic training on ECE teacher performance. This research uses ex-post facto quantitative method of comparative analysis and design by level. The population is all ECE teachers who attend basic-level education and training in Tangerang Regency, totaling 3358 people consisting of 116 male teachers and 3,242 female teachers. Data collection techniques using a questionnaire with data analysis include descriptive analysis. Requirements test analysis and inferential analysis. The results show that there are differences in the performance of ECE teachers between teachers with more than five years of teaching experience and less than five years, in the group of ECE teachers with high peer teaching skills and low peer teaching skills. 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<p><strong>1. How can we maintain a sustainable private practice in the current political and economic climate?</strong></p><p>Eugene Allers</p><p><strong>2. SASOP Clinical guidelines, protocols and algorithms: Development of treatment guidelines for bipolar mood disorder and major depression</strong></p><p> Eugene Allers, Margaret Nair, Gerhard Grobler</p><p><strong>3. The revolving door phenomenon in psychiatry: Comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country</strong></p><p>U A Botha, P Oosthuien, L Koen, J A Joska, J Parker, N Horn</p><p><strong>4. Neurophysiology of emotion and senses - The interface between psyche and soma</strong></p><p>Eugene Allers</p><p><strong>5. Suicide prevention: From and beyond the psychiatrist's hands</strong></p><p>O Alonso Betanourt, M Morales Herrera</p><p><strong>6. Treatment of first-episod psychosis: Efficacy and toleabilty of a long-acting typical antipsychotic </strong></p><p>B Chiliza, R Schoeman, R Emsey, P Oosthuizen, L KOen, D Niehaus, S Hawkridge</p><p><strong>7. Treatment of attention deficit hyperactivity disorder in the young child</strong></p><p>Helen Clark</p><p><strong>8. Holistic/ Alternative treatment in psychiatry: The value of indigenous knowledge systems in cllaboration with moral, ethical and religious approaches in the military services</strong></p><p>J Dill</p><p><strong>9. Treating Schizophrenia: Have we got it wrong?</strong></p><p>Robin Emsley</p><p><strong>10.Terminal questions in the elderly</strong></p><p>Mike Ewart Smith</p><p><strong>11. Mental Health Policy development and implementation in Ghana, South Africa, Uganda and Zambia</strong></p><p>Alan J Flisher, Crick Lund, Michelle Frank, Arvin Bhana, Victor Doku, Natalie Drew, Fred N Kigozi, Martin Knapp, Mayeh Omar, Inge Petersen, Andrew Green andthe MHaPP Research Programme Consortium</p><p><strong>12. What indicators should be used to monitor progress in scaling uo services for people with mental disorders?</strong></p><p>Lancet Global Mental Health Group (Alan J Flisher, Dan Chisholm, Crick Lund, Vikram Patel, Shokhar Saxena, Graham Thornicroft, Mark Tomlinson)</p><p><strong>13. Does unipolar mania merit research in South Africa? A look at the literature</strong></p><p>Christoffel Grobler</p><p><strong>14. Revisiting the Cartesian duality of mind and body</strong></p><p>Oye Gureje</p><p><strong>15. Child and adolescent psychopharmacology: Current trends and complexities</strong></p><p>S M Hawkridge</p><p><strong>16. Integrating mental illness, suicide and religion</strong></p><p>Volker Hitzeroth</p><p><strong>17. Cost of acute inpatient mental health care in a 72-hour assessment uniy</strong></p><p>A B R Janse van Rensburg, W Jassat</p><p><strong>18. Management of Schizophrenia according to South African standard treatment guidelines</strong></p><p>A B R Janse van Rensburg</p><p><strong>19. Structural brain imaging in the clinical management of psychiatric illness</strong></p><p>F Y Jeenah</p><p><strong>20. ADHD: Change in symptoms from child to adulthood</strong></p><p>S A Jeeva, A Turgay</p><p><strong>21. HIV-Positive psychiatric patients in antiretrovirals</strong></p><p>G Jonsson, F Y Jeenah, M Y H Moosa</p><p><strong>22. A one year review of patients admitted to tertiary HIV/Neuropsychiatry beds in the Western Cape</strong></p><p>John Joska, Paul Carey, Ian Lewis, Paul Magni, Don Wilson, Dan J Stein</p><p><strong>23. Star'd - Critical review and treatment implications</strong></p><p>Andre Joubert</p><p><strong>24. Options for treatment-resistent depression: Lessons from Star'd; an interactive session</strong></p><p>Andre Joubert</p><p><strong>25. My brain made me do it: How Neuroscience may change the insanity defence</strong></p><p>Sean Kaliski</p><p><strong>26. Child andadolescent mental health services in four African countries</strong></p><p>Sharon Kleintjies, Alan Flisher, Victoruia Campbell-Hall, Arvin Bhana, Phillippa Bird, Victor Doku, Natalie, Drew, Michelle Funk, Andrew Green, Fred Kigozi, Crick Lund, Angela Ofori-Atta, Mayeh Omar, Inge Petersen, Mental Health and Poverty Research Programme Consortium</p><p><strong>27. Individualistic theories of risk behaviour</strong></p><p>Liezl Kramer, Volker Hitzeroth</p><p><strong>28. Development and implementation of mental health poliy and law in South Africa: What is the impact of stigma?</strong></p><p>Ritsuko Kakuma, Sharon Kleintjes, Crick Lund, Alan J Flisher, Paula Goering, MHaPP Research Programme Consortium</p><p><strong>29. Factors contributing to community reintegration of long-term mental health crae users of Weskoppies Hospital</strong></p><p>Carri Lewis, Christa Kruger</p><p><strong>30. Mental health and poverty: A systematic review of the research in low- and middle-income countries</strong></p><p>Crick Lund, Allison Breen, Allan J Flisher, Ritsuko Kakuma, Leslie Swartz, John Joska, Joanne Corrigall, Vikram Patel, MHaPP Research Programe Consortium</p><p><strong>31. The cost of scaling up mental health care in low- and middle-income countries</strong></p><p>Crick Lund, Dan Chishlom, Shekhar Saxena</p><p><strong>32. 'Tikking'Clock: The impact of a methamphetamine epidemic at a psychiatric hospital in the Western Cape</strong></p><p>P Milligan, J S Parker</p><p><strong>33. Durban youth healh-sk behaviour: Prevalence f Violence-related behaviour</strong></p><p>D L Mkize</p><p><strong>34. Profile of morality of patients amitted Weskoppies Psychiatric Hospital in Sout frican over a 5-Year period (2001-2005)</strong></p><p>N M Moola, N Khamker, J L Roos, P Rheeder</p><p><strong>35. One flew over Psychiatry nest</strong></p><p>Leverne Mountany</p><p><strong>36. The ethical relationship betwe psychiatrists and the pharmaceutical indutry</strong></p><p>Margaret G Nair</p><p><strong>37. Developing the frameor of a postgraduate da programme in mental health</strong></p><p>R J Nichol, B de Klerk, M M Nel, G van Zyl, J Hay</p><p><strong>38. An unfolding story: The experience with HIV-ve patients at a Psychiatric Hospital</strong></p><p>J S Parker, P Milligan</p><p><strong>39. Task shifting: A practical strategy for scalingup mental health care in developing countries</strong></p><p>Vikram Patel</p><p><strong>40. Ethics: Informed consent and competency in the elderly</strong></p><p>Willie Pienaar</p><p><strong>41. Confronting ommonmoral dilemmas. Celebrating uncertainty, while in search patient good</strong></p><p>Willie Pienaar</p><p><strong>42. Moral dilemmas in the treatment and repatriation of patients with psychtorders while visiting our country</strong></p><p>Duncan Ian Rodseth</p><p><strong>43. Geriatrics workshop (Psegal symposium): Medico-legal issuess in geriatric psyhiatry</strong></p><p>Felix Potocnik</p><p><strong>44. Brain stimulation techniques - update on recent research</strong></p><p>P J Pretorius</p><p><strong>45. Holistic/Alternative treatments in psychiatry</strong></p><p>T Rangaka, J Dill</p><p><strong>46. Cognitive behaviour therapy and other brief interventions for management of substances</strong></p><p>Solomon Rataemane</p><p><strong>47. A Transtheoretical view of change</strong></p><p>Nathan P Rogerson</p><p><strong>48. Profile of security breaches in longerm mental health care users at Weskoppies Hospital over a 6-month period</strong></p><p>Deleyn Rema, Lindiwe Mthethwa, Christa Kruger</p><p><strong>49. Management of psychogenic and chronic pain - A novel approach</strong></p><p>M S Salduker</p><p><strong>50. Childhood ADHD and bipolar mood disorders: Differences and similarities</strong></p><p>L Scribante</p><p><strong>51. The choice of antipsychotic in HIV-infected patients and psychopharmacocal responses to antipsychotic medication</strong></p><p>Dinesh Singh, Karl Goodkin</p><p><strong>52. Pearls in clinical neuroscience: A teaching column in CNS Spectrums</strong></p><p><strong></strong>Dan J Stein</p><p><strong>53. Urinary Cortisol secretion and traumatics in a cohort of SA Metro policemen A longitudinal study</strong></p><p>Ugash Subramaney</p><p><strong>54. Canabis use in Psychiatric inpatients</strong></p><p><strong></strong>M Talatala, G M Nair, D L Mkize</p><p><strong>55. Pathways to care and treatmt in first and multi-episodepsychosis: Findings fm a developing country</strong></p><p>H S Teh, P P Oosthuizen</p><p><strong>56. Mental disorders in HIV-infected indivat various HIV Treatment sites in South Africa</strong></p><p>Rita Thom</p><p><strong>57. Attendanc ile of long-term mental health care users at ocupational therapy group sessions at Weskoppies Hospital</strong></p><p>Ronel van der Westhuizen, Christa Kruger</p><p><strong>58. Epidemiological patterns of extra-medical drug use in South Africa: Results from the South African stress and health study</strong></p><p>Margaretha S van Heerden, Anna Grimsrud, David Williams, Dan Stein</p><p><strong>59. Persocentred diagnosis: Where d ps and mental disorders fit in the International classificaton of diseases (ICD)?</strong></p><p>Werdie van Staden</p><p><strong>60. What every psychiatrist needs to know about scans</strong></p><p>Herman van Vuuren</p><p><strong>61. Psychiatric morbidity in health care workers withle drug-resistant erulosis (MDR-TB) A case series</strong></p><p>Urvashi Vasant, Dinesh Singh</p><p><strong>62. Association between uetrine artery pulsatility index and antenatal maternal psychological stress</strong></p><p>Bavanisha Vythilingum, Lut Geerts, Annerine Roos, Sheila Faure, Dan J Stein</p><p><strong>63. Approaching the dual diagnosis dilemma</strong></p><p>Lize Weich</p><p><strong>64. Women's mental health: Onset of mood disturbance in midlife - Fact or fiction</strong></p><p>Denise White</p><p><strong>65. Failing or faking: Isses in the fiagnosis and treatment of adult ADHD</strong></p><p>Dora Wynchank</p>

Introduction: Telemedicine can address limited access to medical specialists in rural hospitals. Stroke provides an important case study because: it is a major cause of disease burden; effective treatments to reduce disability (e.g., thrombolysis) can be provided within the initial hours of stroke onset; careful selection of patients is needed by skilled doctors to minimize adverse events from thrombolysis; and there are major treatment gaps (only about half of regional hospitals in Australia provide thrombolysis for stroke). Few economic analyses have been undertaken on telestroke and the majority have been simulation models. The aim of this protocol and statistical analysis plan is to outline the methods for the cost-effectiveness evaluation of a large, multicentre acute stroke telemedicine program being conducted in Victoria, Australia.Methods: Using a historical- and prospective-controlled design, we will compare patient-level data obtained in the 12 months prior to the Victorian Stroke Telemedicine (VST) program implementation and during the first 12 months of VST to determine the incremental difference in costs and patient outcomes at 3 and 12 months. Secondary aims include assessing the cost per additional patient receiving intravenous thrombolysis and the cost per additional patient receiving intravenous thrombolysis within 60 min. Tertiary aims include assessing the potential longer-term cost-effectiveness in the second year of the program at the hospitals to determine whether any program benefits are sustained once site coordinators are no longer employed; and modeling the potential net life-time costs and benefits from a societal perspective. Multivariable uncertainty and one-way sensitivity analyses will be performed to assess the robustness of results.Results: Sixteen hospitals participated. Patient-level data collection including 12-month outcomes for the cohorts obtained in the first and second year of the program for each hospital was completed in January 2020.Conclusion: The results from this real-world study with patient-level data will provide high quality evidence of the costs, health benefits and policy implications of telestroke programs, including the potential for application in other locations within Australia or other countries with similar health system delivery and financing.

Background: Unsafe abortions are the third leading cause of maternal mortality in India, close to 8 women die from unsafe abortion each day.(1) MMR in India is 103/100,000 live births (2017-2019),unsafe abortion account for 8% of the MMR. Both MTP act of 1971 and MTP amendment act 2021,which expanded the scope of the act and provides impetus for safer abortions, are progressive and encouraging. Each year 4.7-13.2%of maternal death attributed due to unsafe abortions (2). Unsafe abortion accounts for 13% of maternal deaths worldwide of which 19% occurs in South East Asia (3, 4).Medical methods of abortion has become preferable method with availability of prostaglandin analogue misoprostol and antiprogesterone mifepristone. There are many studies for both drugs and each study claims its schedule to be superior and safer than others.(5,6,7) AIM:This study mainly aims to compare efficacy of Mifepristone and Misoprostol combination versus Misoprostol alone in procuring complete abortions in first trimester by comparing their Need for Manual /electric vacuum aspiration. OBJECTIVES: Ÿ To compare efficacy in relation to gestational period. Ÿ To compare the Success rate of combination drugs with misoprostol alone. Ÿ To compare Induction to abortion time intervals. Ÿ To evaluate the Safety. This is a prospective observational study conducted at Government Victoria hospital, Department of Obstetrics & Gynaecology,Andhra Medical College,Visakhapatnam,and Andhra Pradesh Total no.of patients – 100 No.of women who were given Mifepristone & Misoprostol combination 50 No.of women received Misoprostol alone -50 Observations of this study 1.Maternal age was compared in both the groups.Majority of patients belongs to 21 to 25 years age group. 2.Majority are multigravida in both groups 3.Majority (64%) have opted for termination before 45days in mifepristone +misoprostol group,where as in misoprostol group 60% between 45-63 days 4.In both major indication for termination is unwanted pregnancy. 5. In mifepristone and misoprostol group 46 cases had complete abortion whereas 4 cases required electric vacuum aspiration 6.when comparing induction and abortion interval mifepristone and misoprostol group mean interval is 4.31 hours whereas misoprostol group is 16.18 hours and p value is <0.0001 showing induction abortion interval is less in mifepristone and misoprostol group 7.Unwanted symptoms were noted in both groups but significantly more with misoprostol only group but the p value was not significant. 8.There were no statistically significant major complications in both groups,none required blood transfusion 9. Although Mifepristone and Misoprostol combination is costly but more effective with higher rate of complete expulsion,should be preferred over Misoprostol alone where cost is not a restraining factor. CONCLUSION Based on findings from this study it can be concluded that 1. Mifepristone plus vaginal misoprostol combination group is associated with shorter induction abortion interval and 96% success rate when compared to misoprostol group alone. 2. Mifepristone plus vaginal misoprostol combination group is associated with complete abortion rate compared to misoprostol alone group.Vaginal misoprostol alone group is cost effective. 3. Routine use of Mifepristone-Misoprostol combination is an effective option for early MTP where cost is not a consideration and is ideal for home management. 4.Complication are less in Mifepristone-Misoprostol combination The only confounding factor is the cost involved which is about 20 times that of Misoprostol alone

Abstract Background The association of air pollution with cardiovascular morbidity and mortality has been attributed to acute events (atherothrombosis). It is unclear whether air pollution may influence the subclinical stage of coronary artery disease (CAD). This study investigated the relationship between particulate matter &lt;2.5μm (PM2.5) and nitrogen dioxide (NO2) with coronary calcium score (CCS). Methods This study included 606 asymptomatic adults (49% men, aged 56±7 years) recruited from the community in two States of Australia (Victoria and Tasmania). Annual PM2.5 and NO2 concentrations were matched with residential address. CCS was measured using coronary CT scan. Medical history, physical measurements, biochemistry, and socioeconomic status were recorded for assessment of confounders. Results Average exposure to PM2.5 and NO2 were 6.7±1.5 (ppm) and 3.6±2.1 (μg/m3), respectively. Of the 606 participants, 17% had high CCS (≥100) and 4% had very high CCS (≥400). Exposure to higher annual PM2.5 was associated with greater odds of high CCS (OR=1.20 [95% CI: 1.02, 1.42]) and very high CCS (OR=1.47 [95% CI: 1.03, 2.11]). Similar adverse associations were also present for NO2 and high CCS (OR=1.13 [95% CI: 1.02, 1.25]) and very high CCS (OR=1.25 [95% CI: 1.06, 1.47]). These findings were independent of age, sex, body size, smoking, comorbidities and socio-economic status. Conclusions Ambient air pollution was associated with degree of coronary calcification, independent of standard risk factors. The link between air pollution and CAD is not limited to acute events but appears to include atherogenesis. Funding Acknowledgement Type of funding source: None

En el Fundo LUFE I, ubicado en el Caserío La Victoria, distrito de Campo Verde en Pucallpa se evaluó el crecimiento, productividad y almacenamiento de carbono del componente forestal en dos parcelas contiguas (A y B) con un mismo sistema agroforestal basado en plantas de cacao de tres y cuatro años de edad. Se midieron variables cualitativas (cruzamiento de ramas, rectitud de tronco, forma de fuste, calidad de fuste y raleo) y cuantitativas (altura total, altura comercial, DAP y cantidad de trozas comerciales) de todos los árboles en ambas parcelas (Guazuma crinita Lam., Calycophyllum spruceanum (Benth.) K.Schum. and Swietenia macrophilla King). La parcela A presentó un mejor performance de las variables cualitativas y cuantitativas con el 63% de los árboles con fuste recto, a diferencia del 57% de la parcela B, en calidad de fuste 70% bueno y 54% malo. Ninguna parcela presentó raleo ni cruzamiento de ramas, y el 100% de ambas parcelas tenía un estado fitosanitario excelente, la parcela A presentó mayor promedio de DAP, volumen comercial, IMA, altura total, altura comercial y área basal asimismo con un almacenamiento de carbono de 4. 69 t/c/ha en comparación a 2.10 t/c/ha de la parcela B, y con 253 trozas comerciales a diferencia de 114 trozas para la parcela B.

Abstract One major legacy of the bacteriological revolution of the later nineteenth century is a simplified model of cause and effect. Looking back, this model seems entirely appropriate for a century dominated by infectious diseases. In this widely accepted picture of the nineteenth-century mortality experience the leading role is taken by the cholera epidemics which invaded Britain between 1831 and 1866. Historians have followed this lead by making cholera an exciting cause of political and social change, including the first Reform Bill. This essay suggests that the sporadic incursions of cholera were less a spur to reform than a distraction from the perpetual, or endemic, causes of death, which are inevitably those with the closest connections with the social, economic and political contexts of Victorian Britain. The Benthamite sanitarians built their case primarily on what they called continued fever, which we now identify as typhus and, increasingly, typhoid. The endemic diseases, year upon year, caused more deaths than cholera, and it is they which provided the quantitative definition of excess mortality which came to justify government intervention. Similarly, a further phase of public health reform was necessary after cholera was no longer a factor. These later reformers deplored the degeneration and mortality associated with extreme urbanization, and attributed them to respiratory conditions, fluxes, and what we might now call the pneumonia-diarrhoea complex among children. Cholera was an important phenomenon, but its effects on society need to be defined with some precision. Note: this is a revised version of the 12th Henry Cohen History of Medicine Lecture, given in 1983, and republished by kind permission of the Liverpool Medical Institution.

Abstract One major legacy of the bacteriological revolution of the later nineteenth century is a simplified model of cause and effect. Looking back, this model seems entirely appropriate for a century dominated by infectious diseases. In this widely accepted picture of the nineteenth-century mortality experience the leading role is taken by the cholera epidemics which invaded Britain between 1831 and 1866. Historians have followed this lead by making cholera an exciting cause of political and social change, including the first Reform Bill. This essay suggests that the sporadic incursions of cholera were less a spur to reform than a distraction from the perpetual, or endemic, causes of death, which are inevitably those with the closest connections with the social, economic and political contexts of Victorian Britain. The Benthamite sanitarians built their case primarily on what they called continued fever, which we now identify as typhus and, increasingly, typhoid. The endemic diseases, year upon year, caused more deaths than cholera, and it is they which provided the quantitative definition of excess mortality which came to justify government intervention. Similarly, a further phase of public health reform was necessary after cholera was no longer a factor. These later reformers deplored the degeneration and mortality associated with extreme urbanization, and attributed them to respiratory conditions, fluxes, and what we might now call the pneumonia-diarrhoea complex among children. Cholera was an important phenomenon, but its effects on society need to be defined with some precision. Note: this is a revised version of the 12th Henry Cohen History of Medicine Lecture, given in 1983, and republished by kind permission of the Liverpool Medical Institution.

Introduction: Cancer care studies suggest that being diagnosed with cancer, the patients and their families face various hardships such as financial crisis, increased mental stress, difficulty in managing their relationships and routine lifestyle activities. Moreover, psycho-oncological studies also describe the intense distress and disbelief experienced by patients on their initial diagnosis. The role of cancer care needs to be understood as well as implemented in cancer treatment, thus further enriching the insights of the treating oncologist about their patient’s state of mind. This ultimately allows for the betterment of treatment compliance. Aim: To study the experience of cancer patients on their visit to the cancer clinic and the emotional turmoil after diagnosis and throughout treatment. Materials and Methods: A descriptive phenomenological qualitative study was designed and conducted from August to September 2019 at the Oncology Department of Victoria Hospital, Mauritius. Participation in the study was voluntary, and written consent was taken from each of the study participants. The data was collected on an in-depth one on one interview basis and was recorded, and the purposive sampling technique was used for collecting the data. Results: Out of 12 patients, the male/female ratio equated to 5:7, these patients were from the ages of 23 to 70 years and the mean age of the participants was 48.2 years. A total of 25 different codes were generated in the study, seven main themes were established there from (Motivational factors, Psychological factors, Society, Message for others, Awareness about the disease, Economic factors and Perception towards the healthcare environment). Conclusion: The main implication that emerged from this study is the notion of the lateral views of informal caregivers, family members and medical professionals, towards the patient’s feelings and emotional reactions in respect to their experience of cancer. It has been noted that the positivity of the caregiver corresponds directly to positive outcomes in the cancer treatment whilst simultaneously decreasing the psychological ramifications of the process.

Abstract Background Thermal injuries are one of the commonest causes of unnatural deaths in females in developing countries. However, there is a lack of adequate research into the social and psychological aspects that lead to such deaths. The suicidal death due to immolation by fire is a scourge on Indian society that is not being adequately addressed in all its aspects. There is an attempt in this study to bring awareness of the population under risk and to motivate prevention measures. A retrospective cross-sectional study was conducted at the Victoria Hospital Mortuary for a period of 12 months between 2017 and 2018. Medicolegal and psychological autopsies were performed on 120 female burn victims over 15 years of age. The information gathered via medical records, police investigations, interviews with family, and postmortem findings was analyzed and compiled to obtain the following results. Results Most of the victims, i.e., 52% of the women, were illiterate. More than half of the victims, i.e., 53% of the women in this study, were found to be in the upper-lower socio-economic. Majority of the female victims (63.3%) were married for more than 7 years. Suicide was the commonest manner of death (52%). There was no alleged history of domestic abuse in most cases (73.3%). Only 2 cases, i.e., 1.7% of cases, were booked under Dowry Prohibition Act. Only 28.3% of cases were investigated by Magistrate’s Inquest. History of mental illnesses was reported only in 14.2% of victims. Alcohol was detected in only 2 of the victims (1.7%). Conclusions It is evident that in most cases of deaths in women due to thermal injuries, the entire narrative is not thoroughly investigated and any prior history of domestic abuse, dowry demands/harassment, and even mental illnesses gets under-reported or undocumented. Despite there being a plethora of information regarding the statistics as to how women die due to thermal injuries, very minimal data exists regarding the measures adopted to prevent it. There is a hope that this study inspires the concerned stakeholders to take stock and introduce measures to prevent such potential deaths among the vulnerable female population.

This single and critical case study evaluated a faith-based natural family planning program's salient features using a framework on implementation fidelity. Multiple focus group discussions were conducted, with three groups of stakeholders (n=100), to gather qualitative data on their knowledge and experience of the program. Overall, the findings showed that the program primarily adhered to the essential elements of implementation fidelity, such as content, frequency, duration, and coverage prescribed by its designers. Three lessons were drawn to address some issues that have influenced the degree of fidelity in which the program was implemented. The first is the need to secure adequate and sustained human and financial resources. The second is the need to strengthen its partnership with government and non-government organizations that have provided them with much-needed assistance. Finally, there is also the need to provide extensive training, materials, and support to its service providers to preserve their morale and interest. Other faith-based organizations may hold this case as an indicator of how and why an NFP program works and the extent to which the need for family planning can be met adapted to their local conditions and needs. References Arbuckle, Gerald A. Refounding the Church: Dissent for Leadership. Quezon City: Claretian Publications. 1993. Arevalo, Marcos. "Expanding the Availability and improving the delivery of natural family planning services and fertility awareness education: providers' perspectives. Adv Contracept. Jun-Sep 1997; 13(2-3):275-81. Arévalo, Marcos, Victoria Jennings, and Irit Sinai. "Efficacy of a new method of family planning: the Standard Days Method." Contraception 65, no. 5 (2002): 333-338.Arévalo, Marcos, Irit Sinai, and Victoria Jennings. "A fixed formula to define the fertile window of the menstrual cycle as the basis of a simple method of natural family planning." Contraception 60, no. 6 (1999): 357-360. Atun, Jenna (2013). Religiosity and Contraceptive Use among Filipino Youth. Philippine Center for Population and Development. (2013) Accessed April 15, 2019, from http://www.pcpd.ph/.../religiosity-and-contraceptive-use- Authority, P. S. ICF Philippines national demographic and health survey 2017. Quezon City, Philippines, and Rockville, Maryland, USA: PSA and ICF, 2018. Authority, Philippine Statistics. "Philippine statistics authority." Accessed from Philippine Statistics Authority Web site: https://psa. gov. ph/vegetable-root-crops-main/tomato (2018). Authority, P. S. “Philippine statistics authority.” Accessed July 20, 2019, from Philippine Statistics Authority Web site: https://psa. gov. ph/vegetable-root-crops-main/tomato.(2016) Authority, P. 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In this paper we explore the rise of anti-gambling apps in the context of the massive expansion of gambling in new spheres of life (online and offline) and an acceleration in strategies of anticipatory and individualised management of harm caused by gambling. These apps, and the techniques and forms of labour they demand, are examples of and a mechanism through which a mode of governance premised on ‘self-care’ and ‘self-control’ is articulated and put into practice. To support this argument, we explore two government initiatives in the Australian context. Quit Pokies, a mobile app project between the Moreland City Council, North East Primary Care Partnership and the Victorian Local Governance Association, is an example of an emerging service paradigm of ‘self-care’ that uses online and mobile platforms with geo-location to deliver real time health and support interventions. A similar mobile app, Gambling Terminator, was launched by the NSW government in late 2012. Both apps work on the premise that interrupting a gaming session through a trigger, described by Quit Pokies’ creator as a “tap on the shoulder” provides gamblers the opportunity to take a reflexive stance and cut short their gambling practice in the course of play. We critically examine these apps as self-disciplining techniques of contemporary neo-liberalism directed towards anticipating and reducing the personal harm and social risk associated with gambling. We analyse the material and discursive elements, and new forms of user labour, through which this consumable media is framed and assembled. We argue that understanding the role of these apps, and mobile media more generally, in generating new techniques and technologies of the self, is important for identifying emerging modes of governance and their implications at a time when gambling is going through an immense period of cultural normalisation in online and offline environments. The Australian context is particularly germane for the way gambling permeates everyday spaces of sociality and leisure, and the potential of gambling interventions to interrupt and re-configure these spaces and institute a new kind of subject-state relation. Gambling in Australia Though a global phenomenon, the growth and expansion of gambling manifests distinctly in Australia because of its long cultural and historical attachment to games of chance. Australians are among the biggest betters and losers in the world (Ziolkowski), mainly on Electronic Gaming Machines (EGM) or pokies. As of 2013, according to The World Count of Gaming Machine (Ziolkowski), there were 198,150 EGMs in the country, of which 197,274 were slot machines, with the rest being electronic table games of roulette, blackjack and poker. There are 118 persons per machine in Australia. New South Wales is the jurisdiction with most EGMs (95,799), followed by Queensland (46,680) and Victoria (28,758) (Ziolkowski). Gambling is significant in Australian cultural history and average Australian households spend at least some money on different forms of gambling, from pokies to scratch cards, every year (Worthington et al.). In 1985, long-time gambling researcher Geoffrey Caldwell stated thatAustralians seem to take a pride in the belief that we are a nation of gamblers. Thus we do not appear to be ashamed of our gambling instincts, habits and practices. Gambling is regarded by most Australians as a normal, everyday practice in contrast to the view that gambling is a sinful activity which weakens the moral fibre of the individual and the community. (Caldwell 18) The omnipresence of gambling opportunities in most Australian states has been further facilitated by the availability of online and mobile gambling and gambling-like spaces. Social casino apps, for instance, are widely popular in Australia. The slots social casino app Slotomania was the most downloaded product in the iTunes store in 2012 (Metherell). In response to the high rate of different forms of gambling in Australia, a range of disparate interest groups have identified the expansion of gambling as a concerning trend. Health researchers have pointed out that online gamblers have a higher risk of experiencing problems with gambling (at 30%) compared to 15% in offline bettors (Hastings). The incidence of gambling problems is also disproportionately high in specific vulnerable demographics, including university students (Cervini), young adults prone to substance abuse problems (Hayatbakhsh et al.), migrants (Tanasornnarong et al.; Scull & Woolcock; Ohtsuka & Ohtsuka), pensioners (Hing & Breen), female players (Lee), Aboriginal communities (Young et al.; McMillen & Donnelly) and individuals experiencing homelessness (Holsworth et al.). While there is general recognition of the personal and public health impacts of gambling in Australia, there is a contradiction in the approach to gambling at a governance level. On one hand, its expansion is promoted and even encouraged by the federal and state governments, as gambling is an enormous source of revenue, as evidenced, for example, by the construction of the new Crown casino in Barangaroo in Sydney (Markham & Young). Campaigns trying to limit the use of poker machines, which are associated with concerns over problem gambling and addiction, are deemed by the gambling lobby as un-Australian. Paradoxically, efforts to restrict gambling or control gambling winnings have also been described as un-Australian, such as in the Australian Taxation Office’s campaign against MONA’s founder, David Walsh, whose immense art collection was acquired with the funds from a gambling scheme (Global Mail). On the other hand, people experiencing problems with gambling are often categorised as addicts and the ultimate blame (and responsibility) is attributed to the individual. In Australia, attitudes towards people who are arguably addicted to gambling are different than those towards individuals afflicted by alcohol or drug abuse (Jean). While “Australians tend to be sympathetic towards people with alcohol and other drug addictions who seek help,” unless it is seen as one of the more socially acceptable forms of occasional, controlled gambling (such as sports betting, gambling on the Melbourne Cup or celebrating ANZAC Day with Two-Up), gambling is framed as an individual “problem” and “moral failing” (Jean). The expansion of gambling is the backdrop to another development in health care and public health discourse, which have for some time now been devoted to the ideal of what Lupton has called the “digitally engaged patient” (Lupton). Technologies are central to the delivery of this model of health service provision that puts the patient at the centre of, and responsible for, their own health and medical care. Lupton has pointed out how this discourse, while appearing new, is in fact the latest version of the 1970s emphasis on the ‘patient as consumer’, an idea given an extra injection by the massive development and availability of digital and interactive web-based and mobile platforms, many of these directed towards the provision of health and health-related information and services. What this means for patients is that, rather than relying solely on professional medical expertise and care, the patient is encouraged to take on some of this medical/health work to conduct practices of ‘self-care’ (Lupton). The Discourse of ‘Self-Management’ and ‘Self-Care’ The model of ‘self-care’ and ‘self-management’ by ‘empowering’ digital technology has now become a dominant discourse within health and medicine, and is increasingly deployed across a range of related sectors such as welfare services. In recent research conducted on homelessness and mobile media, for example, government department staff involved in the reform of welfare services referred to ‘self-management’ as the new service paradigm that underpins their digital reform strategy. Echoing ideas and language similar to the “digitally engaged patient”, customers of Centrelink, Medicare and other ‘human services’ are being encouraged (through planned strategic initiatives aimed at shifting targeted customer groups online) to transact with government services digitally and manage their own personal profiles and health information. One departmental staff member described this in terms of an “opportunity cost”, the savings in time otherwise spent standing in long queues in service centres (Humphry). Rather than view these examples as isolated incidents taking place within or across sectors or disciplines, these are better understood as features of an emerging ‘discursive formation’ , a term Foucault used to describe the way in which particular institutions and/or the state establish a regime of truth, or an accepted social reality and which gives definition to a new historical episteme and subject: in this case that of the self-disciplined and “digitally engaged medical/health patient”. As Foucault explained, once this subject has become fully integrated into and across the social field, it is no longer easy to excavate, since it lies below the surface of articulation and is held together through everyday actions, habits and institutional routines and techniques that appear to be universal, necessary and/normal. The way in which this citizen subject becomes a universal model and norm, however, is not a straightforward or linear story and since we are in the midst of its rise, is not a story with a foretold conclusion. Nevertheless, across a range of different fields of governance: medicine; health and welfare, we can see signs of this emerging figure of the self-caring “digitally engaged patient” constituted from a range of different techniques and practices of self-governance. In Australia, this figure is at the centre of a concerted strategy of service digitisation involving a number of cross sector initiatives such as Australia’s National EHealth Strategy (2008), the National Digital Economy Strategy (2011) and the Australian Public Service Mobile Roadmap (2013). This figure of the self-caring “digitally engaged” patient, aligns well and is entirely compatible with neo-liberal formulations of the individual and the reduced role of the state as a provider of welfare and care. Berry refers to Foucault’s definition of neoliberalism as outlined in his lectures to the College de France as a “particular form of post-welfare state politics in which the state essentially outsources the responsibility of the ‘well-being' of the population” (65). In the case of gambling, the neoliberal defined state enables the wedding of two seemingly contradictory stances: promoting gambling as a major source of revenue and capitalisation on the one hand, and identifying and treating gambling addiction as an individual pursuit and potential risk on the other. Risk avoidance strategies are focused on particular groups of people who are targeted for self-treatment to avoid the harm of gambling addiction, which is similarly framed as individual rather than socially and systematically produced. What unites and makes possible this alignment of neoliberalism and the new “digitally engaged subject/patient” is first and foremost, the construction of a subject in a chronic state of ill health. This figure is positioned as terminal from the start. They are ‘sick’, a ‘patient’, an ‘addict’: in need of immediate and continuous treatment. Secondly, this neoliberal patient/addict is enabled (we could even go so far as to say ‘empowered’) by digital technology, especially smartphones and the apps available through these devices in the form of a myriad of applications for intervening and treating ones afflictions. These apps range fromself-tracking programs such as mood regulators through to social media interventions. Anti-Pokie Apps and the Neoliberal Gambler We now turn to two examples which illustrate this alignment between neoliberalism and the new “digitally engaged subject/patient” in relation to gambling. Anti-gambling apps function to both replace or ‘take the place’ of institutions and individuals actively involved in the treatment of problem gambling and re-engineer this service through the logics of ‘self-care’ and ‘self-management’. Here, we depart somewhat from Foucault’s model of disciplinary power summed up in the institution (with the prison exemplifying this disciplinary logic) and move towards Deleuze’s understanding of power as exerted by the State not through enclosures but through diffuse and rhizomatic information flows and technologies (Deleuze). At the same time, we retain Foucault’s attention to the role and agency of the user in this power-dynamic, identifiable in the technics of self-regulation and in his ideas on governmentality. We now turn to analyse these apps more closely, and explore the way in which these articulate and perform these disciplinary logics. The app Quit Pokies was a joint venture of the North East Primary Care Partnership, the Victorian Local Governance Association and the Moreland City Council, launched in early 2014. The idea of the rational, self-reflexive and agentic user is evident in the description of the app by app developer Susan Rennie who described it this way: What they need is for someone to tap them on the shoulder and tell them to get out of there… I thought the phone could be that tap on the shoulder. The “tap on the shoulder” feature uses geolocation and works by emitting a sound alert when the user enters a gaming venue. It also provides information about each user’s losses at that venue. This “tap on the shoulder” is both an alert and a reprimand from past gambling sessions. Through the Responsible Gambling Fund, the NSW government also launched an anti-pokie app in 2013, Gambling Terminator, including a similar feature. The app runs on Apple and Android smartphone platforms, and when a person is inside a gambling venue in New South Wales it: sends reminder messages that interrupt gaming-machine play and gives you a chance to re-think your choices. It also provides instant access to live phone and online counselling services which operate 24 hours a day, seven days a week. (Google Play Store) Yet an approach that tries to prevent harm by anticipating the harm that will come from gambling at the point of entering a venue, also eliminates the chance of potential negotiations and encounters a user might have during a visit to the pub and how this experience will unfold. It reduces the “tap on the shoulder”, which may involve a far wider set of interactions and affects, to a software operation and it frames the pub or the club (which under some conditions functions as hubs for socialization and community building) as dangerous places that should be avoided. This has the potential to lead to further stigmatisation of gamblers, their isolation and their exclusion from everyday spaces. Moreland Mayor, Councillor Tapinos captures the implicit framing of self-care as a private act in his explanation of the app as a method for problem gamblers to avoid being stigmatised by, for example, publicly attending group meetings. Yet, curiously, the app has the potential to create a new kind of public stigmatisation through potentially drawing other peoples’ attention to users’ gambling play (as the alarm is triggered) generating embarrassment and humiliation at being “caught out” in an act framed as aberrant and literally, “alarming”. Both Quit Pokies and Gambling Terminator require their users to perform ‘acts’ of physical and affective labour aimed at behaviour change and developing the skills of self-control. After downloading Quit Pokies on the iPhone and launching the app, the user is presented an initial request: “Before you set up this app. please write a list of the pokies venues that you regularly use because the app will ask you to identify these venues so it can send you alerts if you spend time in these locations. It will also use your set up location to identify other venues you might use so we recommend that you set up the App in the location where you spend most time. Congratulation on choosing Quit Pokies.”Self-performed processes include installation, setting up, updating the app software, programming in gambling venues to be detected by the smartphone’s inbuilt GPS, monitoring and responding to the program’s alerts and engaging in alternate “legitimate” forms of leisure such as going to the movies or the library, having coffee with a friend or browsing Facebook. These self-performed labours can be understood as ‘technologies of the self’, a term used by Foucault to describe the way in which social members are obliged to regulate and police their ‘selves’ through a range of different techniques. While Foucault traces the origins of ‘technologies of the self’ to the Greco-Roman texts with their emphasis on “care of oneself” as one of the duties of citizenry, he notes the shift to “self-knowledge” under Christianity around the 8th century, where it became bound up in ideals of self-renunciation and truth. Quit Pokies and Gambling Terminator may signal a recuperation of the ideal of self-care, over confession and disclosure. These apps institute a set of bodily activities and obligations directed to the user’s health and wellbeing, aided through activities of self-examination such as charting your recovery through a Recovery Diary and implementing a number of suggested “Strategies for Change” such as “writing a list” and “learning about ways to manage your money better”. Writing is central to the acts of self-examination. As Jeremy Prangnell, gambling counsellor from Mission Australia for Wollongong and Shellharbour regions explained the app is “like an electronic diary, which is a really common tool for people who are trying to change their behaviour” (Thompson). The labours required by users are also implicated in the functionality and performance of the platform itself suggesting the way in which ‘technologies of the self’ simultaneously function as a form of platform work: user labour that supports and sustains the operation of digital systems and is central to the performance and continuation of digital capitalism in general (Humphry, Demanding Media). In addition to the acts of labour performed on the self and platform, bodies are themselves potentially mobilised (and put into new circuits of consumption and production), as a result of triggers to nudge users away from gambling venues, towards a range of other cultural practices in alternative social spaces considered to be more legitimate.Conclusion Whether or not these technological interventions are effective or successful is yet to be tested. Indeed, the lack of recent activity in the community forums and preponderance of issues reported on installation and use suggests otherwise, pointing to a need for more empirical research into these developments. Regardless, what we’ve tried to identify is the way in which apps such as these embody a new kind of subject-state relation that emphasises self-control of gambling harm and hastens the divestment of institutional and social responsibility at a time when gambling is going through an immense period of expansion in many respects backed by and sanctioned by the state. Patterns of smartphone take up in the mainstream population and the rise of the so called ‘mobile only population’ (ACMA) provide support for this new subject and service paradigm and are often cited as the rationale for digital service reform (APSMR). Media convergence feeds into these dynamics: service delivery becomes the new frontier for the merging of previously separate media distribution systems (Dwyer). Letters, customer service centres, face-to-face meetings and web sites, are combined and in some instances replaced, with online and mobile media platforms, accessible from multiple and mobile devices. These changes are not, however, simply the migration of services to a digital medium with little effective change to the service itself. Health and medical services are re-invented through their technological re-assemblage, bringing into play new meanings, practices and negotiations among the state, industry and neoliberal subjects (in the case of problem gambling apps, a new subjectivity, the ‘neoliberal addict’). These new assemblages are as much about bringing forth a new kind of subject and mode of governance, as they are a solution to problem gambling. 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Introduction The highly contagious COVID-19 virus has presented particularly difficult public policy challenges. The relatively late emergence of an effective treatments and vaccines, the structural stresses on health care systems, the lockdowns and the economic dislocations, the evident structural inequalities in effected societies, as well as the difficulty of prevention have tested social and political cohesion. Moreover, the intrusive nature of many prophylactic measures have led to individual liberty and human rights concerns. As noted by the Victorian (Australia) Ombudsman Report on the COVID-19 lockdown in Melbourne, we may be tempted, during a crisis, to view human rights as expendable in the pursuit of saving human lives. This thinking can lead to dangerous territory. It is not unlawful to curtail fundamental rights and freedoms when there are compelling reasons for doing so; human rights are inherently and inseparably a consideration of human lives. (5) These difficulties have raised issues about the importance of social or community capital in fighting the pandemic. This article discusses the impacts of social and community capital and other factors on the governmental efforts to combat the spread of infectious disease through the maintenance of social distancing and household ‘bubbles’. It argues that the beneficial effects of social and community capital towards fighting the pandemic, such as mutual respect and empathy, which underpins such public health measures as social distancing, the use of personal protective equipment, and lockdowns in the USA, have been undermined as preventive measures because they have been transmogrified to become a salient aspect of the “culture wars” (Peters). In contrast, states that have relatively lower social capital such a China have been able to more effectively arrest transmission of the disease because the government was been able to generate and personify a nationalist response to the virus and thus generate a more robust social consensus regarding the efforts to combat the disease. Social Capital and Culture Wars The response to COVID-19 required individuals, families, communities, and other types of groups to refrain from extensive interaction – to stay in their bubble. In these situations, especially given the asymptomatic nature of many COVID-19 infections and the serious imposition lockdowns and social distancing and isolation, the temptation for individuals to breach public health rules in high. From the perspective of policymakers, the response to fighting COVID-19 is a collective action problem. In studying collective action problems, scholars have paid much attention on the role of social and community capital (Ostrom and Ahn 17-35). Ostrom and Ahn comment that social capital “provides a synthesizing approach to how cultural, social, and institutional aspects of communities of various sizes jointly affect their capacity of dealing with collective-action problems” (24). Social capital is regarded as an evolving social type of cultural trait (Fukuyama; Guiso et al.). Adger argues that social capital “captures the nature of social relations” and “provides an explanation for how individuals use their relationships to other actors in societies for their own and for the collective good” (387). The most frequently used definition of social capital is the one proffered by Putnam who regards it as “features of social organization, such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit” (Putnam, “Bowling Alone” 65). All these studies suggest that social and community capital has at least two elements: “objective associations” and subjective ties among individuals. Objective associations, or social networks, refer to both formal and informal associations that are formed and engaged in on a voluntary basis by individuals and social groups. Subjective ties or norms, on the other hand, primarily stand for trust and reciprocity (Paxton). High levels of social capital have generally been associated with democratic politics and civil societies whose institutional performance benefits from the coordinated actions and civic culture that has been facilitated by high levels of social capital (Putnam, Democracy 167-9). Alternatively, a “good and fair” state and impartial institutions are important factors in generating and preserving high levels of social capital (Offe 42-87). Yet social capital is not limited to democratic civil societies and research is mixed on whether rising social capital manifests itself in a more vigorous civil society that in turn leads to democratising impulses. Castillo argues that various trust levels for institutions that reinforce submission, hierarchy, and cultural conservatism can be high in authoritarian governments, indicating that high levels of social capital do not necessarily lead to democratic civic societies (Castillo et al.). Roßteutscher concludes after a survey of social capita indicators in authoritarian states that social capital has little effect of democratisation and may in fact reinforce authoritarian rule: in nondemocratic contexts, however, it appears to throw a spanner in the works of democratization. Trust increases the stability of nondemocratic leaderships by generating popular support, by suppressing regime threatening forms of protest activity, and by nourishing undemocratic ideals concerning governance (752). In China, there has been ongoing debate concerning the presence of civil society and the level of social capital found across Chinese society. If one defines civil society as an intermediate associational realm between the state and the family, populated by autonomous organisations which are separate from the state that are formed voluntarily by members of society to protect or extend their interests or values, it is arguable that the PRC had a significant civil society or social capital in the first few decades after its establishment (White). However, most scholars agree that nascent civil society as well as a more salient social and community capital has emerged in China’s reform era. This was evident after the 2008 Sichuan earthquake, where the government welcomed community organising and community-driven donation campaigns for a limited period of time, giving the NGO sector and bottom-up social activism a boost, as evidenced in various policy areas such as disaster relief and rural community development (F. Wu 126; Xu 9). Nevertheless, the CCP and the Chinese state have been effective in maintaining significant control over civil society and autonomous groups without attempting to completely eliminate their autonomy or existence. The dramatic economic and social changes that have occurred since the 1978 Opening have unsurprisingly engendered numerous conflicts across the society. In response, the CCP and State have adjusted political economic policies to meet the changing demands of workers, migrants, the unemployed, minorities, farmers, local artisans, entrepreneurs, and the growing middle class. Often the demands arising from these groups have resulted in policy changes, including compensation. In other circumstances, where these groups remain dissatisfied, the government will tolerate them (ignore them but allow them to continue in the advocacy), or, when the need arises, supress the disaffected groups (F. Wu 2). At the same time, social organisations and other groups in civil society have often “refrained from open and broad contestation against the regime”, thereby gaining the space and autonomy to achieve the objectives (F. Wu 2). Studies of Chinese social or community capital suggest that a form of modern social capital has gradually emerged as Chinese society has become increasingly modernised and liberalised (despite being non-democratic), and that this social capital has begun to play an important role in shaping social and economic lives at the local level. However, this more modern form of social capital, arising from developmental and social changes, competes with traditional social values and social capital, which stresses parochial and particularistic feelings among known individuals while modern social capital emphasises general trust and reciprocal feelings among both known and unknown individuals. The objective element of these traditional values are those government-sanctioned, formal mass organisations such as Communist Youth and the All-China Federation of Women's Associations, where members are obliged to obey the organisation leadership. The predominant subjective values are parochial and particularistic feelings among individuals who know one another, such as guanxi and zongzu (Chen and Lu, 426). The concept of social capital emphasises that the underlying cooperative values found in individuals and groups within a culture are an important factor in solving collective problems. In contrast, the notion of “culture war” focusses on those values and differences that divide social and cultural groups. Barry defines culture wars as increases in volatility, expansion of polarisation, and conflict between those who are passionate about religiously motivated politics, traditional morality, and anti-intellectualism, and…those who embrace progressive politics, cultural openness, and scientific and modernist orientations. (90) The contemporary culture wars across the world manifest opposition by various groups in society who hold divergent worldviews and ideological positions. Proponents of culture war understand various issues as part of a broader set of religious, political, and moral/normative positions invoked in opposition to “elite”, “liberal”, or “left” ideologies. Within this Manichean universe opposition to such issues as climate change, Black Lives Matter, same sex rights, prison reform, gun control, and immigration becomes framed in binary terms, and infused with a moral sensibility (Chapman 8-10). In many disputes, the culture war often devolves into an epistemological dispute about the efficacy of scientific knowledge and authority, or a dispute between “practical” and theoretical knowledge. In this environment, even facts can become partisan narratives. For these “cultural” disputes are often how electoral prospects (generally right-wing) are advanced; “not through policies or promises of a better life, but by fostering a sense of threat, a fantasy that something profoundly pure … is constantly at risk of extinction” (Malik). This “zero-sum” social and policy environment that makes it difficult to compromise and has serious consequences for social stability or government policy, especially in a liberal democratic society. Of course, from the perspective of cultural materialism such a reductionist approach to culture and political and social values is not unexpected. “Culture” is one of the many arenas in which dominant social groups seek to express and reproduce their interests and preferences. “Culture” from this sense is “material” and is ultimately connected to the distribution of power, wealth, and resources in society. As such, the various policy areas that are understood as part of the “culture wars” are another domain where various dominant and subordinate groups and interests engaged in conflict express their values and goals. Yet it is unexpected that despite the pervasiveness of information available to individuals the pool of information consumed by individuals who view the “culture wars” as a touchstone for political behaviour and a narrative to categorise events and facts is relatively closed. This lack of balance has been magnified by social media algorithms, conspiracy-laced talk radio, and a media ecosystem that frames and discusses issues in a manner that elides into an easily understood “culture war” narrative. From this perspective, the groups (generally right-wing or traditionalist) exist within an information bubble that reinforces political, social, and cultural predilections. American and Chinese Reponses to COVID-19 The COVID-19 pandemic first broke out in Wuhan in December 2019. Initially unprepared and unwilling to accept the seriousness of the infection, the Chinese government regrouped from early mistakes and essentially controlled transmission in about three months. This positive outcome has been messaged as an exposition of the superiority of the Chinese governmental system and society both domestically and internationally; a positive, even heroic performance that evidences the populist credentials of the Chinese political leadership and demonstrates national excellence. The recently published White Paper entitled “Fighting COVID-19: China in Action” also summarises China’s “strategic achievement” in the simple language of numbers: in a month, the rising spread was contained; in two months, the daily case increase fell to single digits; and in three months, a “decisive victory” was secured in Wuhan City and Hubei Province (Xinhua). This clear articulation of the positive results has rallied political support. Indeed, a recent survey shows that 89 percent of citizens are satisfied with the government’s information dissemination during the pandemic (C Wu). As part of the effort, the government extensively promoted the provision of “political goods”, such as law and order, national unity and pride, and shared values. For example, severe publishments were introduced for violence against medical professionals and police, producing and selling counterfeit medications, raising commodity prices, spreading ‘rumours’, and being uncooperative with quarantine measures (Xu). Additionally, as an extension the popular anti-corruption campaign, many local political leaders were disciplined or received criminal charges for inappropriate behaviour, abuse of power, and corruption during the pandemic (People.cn, 2 Feb. 2020). Chinese state media also described fighting the virus as a global “competition”. In this competition a nation’s “material power” as well as “mental strength”, that calls for the highest level of nation unity and patriotism, is put to the test. This discourse recalled the global competition in light of the national mythology related to the formation of Chinese nation, the historical “hardship”, and the “heroic Chinese people” (People.cn, 7 Apr. 2020). Moreover, as the threat of infection receded, it was emphasised that China “won this competition” and the Chinese people have demonstrated the “great spirit of China” to the world: a result built upon the “heroism of the whole Party, Army, and Chinese people from all ethnic groups” (People.cn, 7 Apr. 2020). In contrast to the Chinese approach of emphasising national public goods as a justification for fighting the virus, the U.S. Trump Administration used nationalism, deflection, and “culture war” discourse to undermine health responses — an unprecedented response in American public health policy. The seriousness of the disease as well as the statistical evidence of its course through the American population was disputed. The President and various supporters raged against the COVID-19 “hoax”, social distancing, and lockdowns, disparaged public health institutions and advice, and encouraged protesters to “liberate” locked-down states (Russonello). “Our federal overlords say ‘no singing’ and ‘no shouting’ on Thanksgiving”, Representative Paul Gosar, a Republican of Arizona, wrote as he retweeted a Centers for Disease Control list of Thanksgiving safety tips (Weiner). People were encouraged, by way of the White House and Republican leadership, to ignore health regulations and not to comply with social distancing measures and the wearing of masks (Tracy). This encouragement led to threats against proponents of face masks such as Dr Anthony Fauci, one of the nation’s foremost experts on infectious diseases, who required bodyguards because of the many threats on his life. Fauci’s critics — including President Trump — countered Fauci’s promotion of mask wearing by stating accusingly that he once said mask-wearing was not necessary for ordinary people (Kelly). Conspiracy theories as to the safety of vaccinations also grew across the course of the year. As the 2020 election approached, the Administration ramped up efforts to downplay the serious of the virus by identifying it with “the media” and illegitimate “partisan” efforts to undermine the Trump presidency. It also ramped up its criticism of China as the source of the infection. This political self-centeredness undermined state and federal efforts to slow transmission (Shear et al.). At the same time, Trump chided health officials for moving too slowly on vaccine approvals, repeated charges that high infection rates were due to increased testing, and argued that COVID-19 deaths were exaggerated by medical providers for political and financial reasons. These claims were amplified by various conservative media personalities such as Rush Limbaugh, and Sean Hannity and Laura Ingraham of Fox News. The result of this “COVID-19 Denialism” and the alternative narrative of COVID-19 policy told through the lens of culture war has resulted in the United States having the highest number of COVID-19 cases, and the highest number of COVID-19 deaths. At the same time, the underlying social consensus and social capital that have historically assisted in generating positive public health outcomes has been significantly eroded. According to the Pew Research Center, the share of U.S. adults who say public health officials such as those at the Centers for Disease Control and Prevention are doing an excellent or good job responding to the outbreak decreased from 79% in March to 63% in August, with an especially sharp decrease among Republicans (Pew Research Center 2020). Social Capital and COVID-19 From the perspective of social or community capital, it could be expected that the American response to the Pandemic would be more effective than the Chinese response. Historically, the United States has had high levels of social capital, a highly developed public health system, and strong governmental capacity. In contrast, China has a relatively high level of governmental and public health capacity, but the level of social capital has been lower and there is a significant presence of traditional values which emphasise parochial and particularistic values. Moreover, the antecedent institutions of social capital, such as weak and inefficient formal institutions (Batjargal et al.), environmental turbulence and resource scarcity along with the transactional nature of guanxi (gift-giving and information exchange and relationship dependence) militate against finding a more effective social and community response to the public health emergency. Yet China’s response has been significantly more successful than the Unites States’. Paradoxically, the American response under the Trump Administration and the Chinese response both relied on an externalisation of the both the threat and the justifications for their particular response. In the American case, President Trump, while downplaying the seriousness of the virus, consistently called it the “China virus” in an effort to deflect responsibly as well as a means to avert attention away from the public health impacts. As recently as 3 January 2021, Trump tweeted that the number of “China Virus” cases and deaths in the U.S. were “far exaggerated”, while critically citing the Centers for Disease Control and Prevention's methodology: “When in doubt, call it COVID-19. Fake News!” (Bacon). The Chinese Government, meanwhile, has pursued a more aggressive foreign policy across the South China Sea, on the frontier in the Indian sub-continent, and against states such as Australia who have criticised the initial Chinese response to COVID-19. To this international criticism, the government reiterated its sovereign rights and emphasised its “victimhood” in the face of “anti-China” foreign forces. Chinese state media also highlighted China as “victim” of the coronavirus, but also as a target of Western “political manoeuvres” when investigating the beginning stages of the pandemic. The major difference, however, is that public health policy in the United States was superimposed on other more fundamental political and cultural cleavages, and part of this externalisation process included the assignation of “otherness” and demonisation of internal political opponents or characterising political opponents as bent on destroying the United States. This assignation of “otherness” to various internal groups is a crucial element in the culture wars. While this may have been inevitable given the increasingly frayed nature of American society post-2008, such a characterisation has been activity pushed by local, state, and national leadership in the Republican Party and the Trump Administration (Vogel et al.). In such circumstances, minimising health risks and highlighting civil rights concerns due to public health measures, along with assigning blame to the democratic opposition and foreign states such as China, can have a major impact of public health responses. The result has been that social trust beyond the bubble of one’s immediate circle or those who share similar beliefs is seriously compromised — and the collective action problem presented by COVID-19 remains unsolved. Daniel Aldrich’s study of disasters in Japan, India, and US demonstrates that pre-existing high levels of social capital would lead to stronger resilience and better recovery (Aldrich). Social capital helps coordinate resources and facilitate the reconstruction collectively and therefore would lead to better recovery (Alesch et al.). Yet there has not been much research on how the pool of social capital first came about and how a disaster may affect the creation and store of social capital. Rebecca Solnit has examined five major disasters and describes that after these events, survivors would reach out and work together to confront the challenges they face, therefore increasing the social capital in the community (Solnit). However, there are studies that have concluded that major disasters can damage the social fabric in local communities (Peacock et al.). The COVID-19 epidemic does not have the intensity and suddenness of other disasters but has had significant knock-on effects in increasing or decreasing social capital, depending on the institutional and social responses to the pandemic. In China, it appears that the positive social capital effects have been partially subsumed into a more generalised patriotic or nationalist affirmation of the government’s policy response. Unlike civil society responses to earlier crises, such as the 2008 Sichuan earthquake, there is less evidence of widespread community organisation and response to combat the epidemic at its initial stages. This suggests better institutional responses to the crisis by the government, but also a high degree of porosity between civil society and a national “imagined community” represented by the national state. The result has been an increased legitimacy for the Chinese government. Alternatively, in the United States the transformation of COVID-19 public health policy into a culture war issue has seriously impeded efforts to combat the epidemic in the short term by undermining the social consensus and social capital necessary to fight such a pandemic. Trust in American institutions is historically low, and President Trump’s untrue contention that President Biden’s election was due to “fraud” has further undermined the legitimacy of the American government, as evidenced by the attacks directed at Congress in the U.S. capital on 6 January 2021. As such, the lingering effects the pandemic will have on social, economic, and political institutions will likely reinforce the deep cultural and political cleavages and weaken interpersonal networks in American society. Conclusion The COVID-19 pandemic has devastated global public health and impacted deeply on the world economy. Unsurprisingly, given the serious economic, social, and political consequences, different government responses have been highly politicised. Various quarantine and infection case tracking methods have caused concern over state power intruding into private spheres. The usage of face masks, social distancing rules, and intra-state travel restrictions have aroused passionate debate over public health restrictions, individual liberty, and human rights. Yet underlying public health responses grounded in higher levels of social capital enhance the effectiveness of public health measures. In China, a country that has generally been associated with lower social capital, it is likely that the relatively strong policy response to COVID-19 will both enhance feelings of nationalism and Chinese exceptionalism and help create and increase the store of social capital. 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IntroductionFor over five years, Romanians have been using their bodies in public spaces to challenge politicians’ disregard for the average citizen. In a region low in standards of civic engagement, such as voter turnout and petition signing, Romanian people’s “citizenship of the streets” has stopped environmentally destructive mining in 2013, ousted a corrupt cabinet in 2015, and blocked legislation legalising abuse of public office in 2017 (Solnit 214). This article explores the democratic affordances of collective resistive walking, by focusing on Romania’s capital, Bucharest. I illustrate how walking in protest of political corruption cultivates a democratic public and reconfigures city spaces as spaces of democratic engagement, in the context of increased illiberalism in the region. I examine two sites of protest: the Parliament Palace and Victoriei Square. The former is a construction emblematic of communist dictator Nicolae Ceaușescu and symbol of an authoritarian regime, whose surrounding area protestors reclaim as a civic space. The latter—a central part of the city bustling with the life of cafes, museums, bike lanes, and nearby parks—hosts the Government and has become an iconic site for pro-democratic movements. Spaces of Democracy: The Performativity of Public Assemblies Democracies are active achievements, dependent not only on the solidity of institutions —e.g., a free press and a constitution—but on people’s ability and desire to communicate about issues of concern and to occupy public space. Communicative approaches to democratic theory, formulated as inquiries into the public sphere and the plurality and evolution of publics, often return to establish the significance of public spaces and of bodies in the maintenance of our “rhetorical democracies” (Hauser). Speech and assembly, voice and space are sides of the same coin. In John Dewey’s work, communication is the main “loyalty” of democracy: the heart and final guarantee of democracy is in free gatherings of neighbors on the street corner to discuss back and forth what is read in the uncensored news of the day, and in gatherings of friends in the living rooms of houses and apartments to converse freely with one another. (Dewey qtd. in Asen 197, emphasis added) Dewey asserts the centrality of communication in the same breath that he affirms the spatial infrastructure supporting it.Historically, Richard Sennett explains, Athenian democracy has been organised around two “spaces of democracy” where people assembled: the agora or town square and the theatre or Pnyx. While the theatre has endured as the symbol of democratic communication, with its ideal of concentrated attention on the argument of one speaker, Sennett illuminates the square as an equally important space, one without which deliberation in the Pnyx would be impossible. In the agora, citizens cultivate an ability to see, expect, and think through difference. In its open architecture and inclusiveness, Sennett explains, the agora affords the walker and dweller a public space to experience, in a quick, fragmentary, and embodied way, the differences and divergences in fellow citizens. Through visual scrutiny and embodied exposure, the square thus cultivates “an outlook favorable to discussion of differing views and conflicting interests”, useful for deliberation in the Pnyx, and the capacity to recognise strangers as part of the imagined democratic community (19). Also stressing the importance of spaces for assembly, Jürgen Habermas’s historical theorisation of the bourgeois public sphere moves the functions of the agora to the modern “third places” (Oldenburg) of the civic society emerging in late seventeenth and eighteenth-century Europe: coffee houses, salons, and clubs. While Habermas’ conceptualization of a unified bourgeois public has been criticised for its class and gender exclusivism, and for its normative model of deliberation and consensus, such criticism has also opened paths of inquiry into the rhetorical pluralism of publics and into the democratic affordances of embodied performativity. Thus, unlike Habermas’s assumption of a single bourgeois public, work on twentieth and twenty-first century publics has attended to their wide variety in post-modern societies (e.g., Bruce; Butler; Delicath and DeLuca; Fraser; Harold and DeLuca; Hauser; Lewis; Mckinnon et al.; Pezzullo; Rai; Tabako). In contrast to the Habermasian close attention to verbal argumentation, such criticism prioritizes the embodied (performative, aesthetic, and material) ways in which publics manifest their attention to common issues. From suffragists to environmentalists and, most recently, anti-precarity movements across the globe, publics assemble and move through shared space, seeking to break hegemonies of media representation by creating media events of their own. In the process, Judith Butler explains, such embodied assemblies accomplish much more. They disrupt prevalent logics and dominant feelings of disposability, precarity, and anxiety, at the same time that they (re)constitute subjects and increasingly privatised spaces into citizens and public places of democracy, respectively. Butler proposes that to best understand recent protests we need to read collective assembly in the current political moment of “accelerating precarity” and responsibilisation (10). Globally, increasingly larger populations are exposed to economic insecurity and precarity through government withdrawal from labor protections and the diminishment of social services, to the profit of increasingly monopolistic business. A logic of self-investment and personal responsibility accompanies such structural changes, as people understand themselves as individual market actors in competition with other market actors rather than as citizens and community members (Brown). In this context, public assembly would enact an alternative, insisting on interdependency. Bodies, in such assemblies, signify both symbolically (their will to speak against power) and indexically. As Butler describes, “it is this body, and these bodies, that require employment, shelter, health care, and food, as well as a sense of a future that is not the future of unpayable debt” (10). Butler describes the function of these protests more fully:[P]lural enactments […] make manifest the understanding that a situation is shared, contesting the individualizing morality that makes a moral norm of economic self-sufficiency precisely […] when self-sufficiency is becoming increasingly unrealizable. Showing up, standing, breathing, moving, standing still, speech, and silence are all aspects of a sudden assembly, an unforeseen form of political performativity that puts livable life at the forefront of politics […] [T]he bodies assembled ‘say’ we are not disposable, even if they stand silently. (18)Though Romania is not included in her account of contemporary protest movements, Butler’s theoretical account aptly describes both the structural and ideological conditions, and the performativity of Romanian protestors. In Romania, citizens have started to assemble in the streets against austerity measures (2012), environmental destruction (2013), fatal infrastructures (2015) and against the government’s corruption and attempts to undermine the Judiciary (from February 2017 onward). While, as scholars have argued (Olteanu and Beyerle; Gubernat and Rammelt), political corruption has gradually crystallised into the dominant and enduring framework for the assembled publics, post-communist corruption has been part and parcel of the neoliberalisation of Central and Eastern-European societies after the fall of communism. In the region, Leslie Holmes explains, former communist elites or the nomenklatura, have remained the majority political class after 1989. With political power and under the shelter of political immunity, nomenklatura politicians “were able to take ethically questionable advantage in various ways […] of the sell-off of previously state-owned enterprises” (Holmes 12). The process through which the established political class became owners of a previously state-owned economy is known as “nomenklatura privatization”, a common form of political corruption in the region, Holmes explains (12). Such practices were common knowledge among a cynical population through most of the 1990s and the 2000s. They were not broadly challenged in an ideological milieu attached, as Mihaela Miroiu, Isabela Preoteasa, and Jerzy Szacki argued, to extreme forms of liberalism and neoliberalism, ideologies perceived by people just coming out of communism as anti-ideology. Almost three decades since the fall of communism, in the face of unyielding levels of poverty (Zaharia; Marin), the decaying state of healthcare and education (Bilefsky; “Education”), and migration rates second only to war-torn Syria (Deletant), Romanian protestors have come to attribute the diminution of life in post-communism to the political corruption of the established political class (“Romania Corruption Report”; “Corruption Perceptions”). Following systematic attempts by the nomenklatura-heavy governing coalition to undermine the judiciary and institutionalise de facto corruption of public officials (Deletant), protestors have been returning to public spaces on a weekly basis, de-normalising the political cynicism and isolation serving the established political class. Mothers Walking: Resignifying Communist Spaces, Imagining the New DemosOn 11 July 2018, a protest of mothers was streamed live by Corruption Kills (Corupția ucide), a Facebook group started by activist Florin Bădiță after a deadly nightclub fire attributed to the corruption of public servants, in 2015 (Commander). Organized protests at the time pressured the Social-Democratic cabinet into resignation. Corruption Kills has remained a key activist platform, organising assemblies, streaming live from demonstrations, and sharing personal acts of dissent, thus extending the life of embodied assemblies. In the mothers’ protest video, women carrying babies in body-wraps and strollers walk across the intersection leading to the Parliament Palace, while police direct traffic and ensure their safety (“Civil Disobedience”). This was an unusual scene for many reasons. Walkers met at the entrance to the Parliament Palace, an area most emblematic of the former regime. Built by Communist dictator, Nicolae Ceaușescu and inspired by Kim Il-sung’s North Korean architecture, the current Parliament building and its surrounding plaza remain, in the words of Renata Salecl, “one of the most traumatic remnants of the communist regime” (90). The construction is the second largest administrative building in the world, after the Pentagon, a size matching the ambitions of the dictator. It bears witness to the personal and cultural sacrifices the construction and its surrounded plaza required: the displacement of some 40,000 people from old neighbourhood Uranus, the death of reportedly thousands of workers, and the flattening of churches, monasteries, hospitals, schools (Parliament Palace). This arbitrary construction carved out of the old city remains a symbol of an authoritarian relation with the nation. As Salecl puts it, Ceaușescu’s project tried to realise the utopia of a new communist “centre” and created an artificial space as removed from the rest of the city as the leader himself was from the needs of his people. Twenty-nine years after the fall of communism, the plaza of the Parliament Palace remains as suspended from the life of the city as it was during the 1980s. The trees lining the boulevard have grown slightly and bike lanes are painted over decaying stones. Still, only few people walk by the neo-classical apartment buildings now discoloured and stained by weather and time. Salecl remarks on the panoptic experience of the Parliament Palace: “observed from the avenue, [the palace] appears to have no entrance; there are only numerous windows, which give the impression of an omnipresent gaze” (95). The building embodies, for Salecl, the logic of surveillance of the communist regime, which “created the impression of omnipresence” through a secret police that rallied members among regular citizens and inspired fear by striking randomly (95).Against this geography steeped in collective memories of fear and exposure to the gaze of the state, women turn their children’s bodies and their own into performances of resistance that draw on the rhetorical force of communist gender politics. Both motherhood and childhood were heavily regulated roles under Ceaușescu’s nationalist-socialist politics of forced birth, despite the official idealisation of both. Producing children for the nationalist-communist state was women’s mandated expression of citizenship. Declaring the foetus “the socialist property of the whole society”, in 1966 Ceaușescu criminalised abortion for women of reproductive ages who had fewer than four children, and, starting 1985, less than five children (Ceaușescu qtd. in Verdery). What followed was “a national tragedy”: illegal abortions became the leading cause of death for fertile women, children were abandoned into inhumane conditions in the infamous orphanages, and mothers experienced the everyday drama of caring for families in an economy of shortages (Kligman 364). The communist politicisation of natality during communist Romania exemplifies one of the worst manifestations of the political as biopolitical. The current maternal bodies and children’s bodies circulating in the communist-iconic plaza articulate past and present for Romanians, redeploying a traumatic collective memory to challenge increasingly authoritarian ambitions of the governing Social Democratic Party. The images of caring mothers walking in protest with their babies furthers the claims that anti-corruption publics have made in other venues: that the government, in their indifference and corruption, is driving millions of people, usually young, out of the country, in a braindrain of unprecedented proportions (Ursu; Deletant; #vavedemdinSibiu). In their determination to walk during the gruelling temperatures of mid-July, in their youth and their babies’ youth, the mothers’ walk performs the contrast between their generation of engaged, persistent, and caring citizens and the docile abused subject of a past indexed by the Ceaușescu-era architecture. In addition to performing a new caring imagined community (Anderson), women’s silent, resolute walk on the crosswalk turns a lifeless geography, heavy with the architectural traces of authoritarian history, into a public space that holds democratic protest. By inhabiting the cultural role of mothers, protestors disarmed state authorities: instead of the militarised gendarmerie usually policing protestors the Victoriei Square, only traffic police were called for the mothers’ protest. The police choreographed cars and people, as protestors walked across the intersection leading to the Parliament. Drivers, usually aggressive and insouciant, now moved in concert with the protestors. The mothers’ walk, immediately modeled by people in other cities (Cluj-Napoca), reconfigured a car-dominated geography and an unreliable, driver-friendly police, into a civic space that is struggling to facilitate the citizens’ peaceful disobedience. The walkers’ assembly thus begins to constitute the civic character of the plaza, collecting “the space itself […] the pavement and […] the architecture [to produce] the public character of that material environment” (Butler 71). It demonstrates the possibility of a new imagined community of caring and persistent citizens, one significantly different from the cynical, disconnected, and survivalist subjects that the nomenklatura politicians, nested in the Panoptic Parliament nearby, would prefer.Persisting in the Victoriei Square In addition to strenuous physical walking to reclaim city spaces, such as the mothers’ walking, the anti-corruption public also practices walking and gathering in less taxing environments. The Victoriei Square is such a place, a central plaza that connects major boulevards with large sidewalks, functional bike lanes, and old trees. The square is the architectural meeting point of old and new, where communist apartments meet late nineteenth and early twentieth century architecture, in a privileged neighbourhood of villas, museums, and foreign consulates. One of these 1930s constructions is the Government building, hosting the Prime Minister’s cabinet. Demonstrators gathered here during the major protests of 2015 and 2017, and have walked, stood, and wandered in the square almost weekly since (“Past Events”). On 24 June 2018, I arrive in the Victoriei Square to participate in the protest announced on social media by Corruption Kills. There is room to move, to pause, and rest. In some pockets, people assemble to pay attention to impromptu speakers who come onto a small platform to share their ideas. Occasionally someone starts chanting “We See You!” and “Down with Corruption!” and almost everyone joins the chant. A few young people circulate petitions. But there is little exultation in the group as a whole, shared mostly among those taking up the stage or waving flags. Throughout the square, groups of familiars stop to chat. Couples and families walk their bikes, strolling slowly through the crowds, seemingly heading to or coming from the nearby park on a summer evening. Small kids play together, drawing with chalk on the pavement, or greeting dogs while parents greet each other. Older children race one another, picking up on the sense of freedom and de-centred but still purposeful engagement. The openness of the space allows one to meander and observe all these groups, performing the function of the Ancient agora: making visible the strangers who are part of the polis. The overwhelming feeling is one of solidarity. This comes partly from the possibilities of collective agency and the feeling of comfortably taking up space and having your embodiment respected, otherwise hard to come by in other spaces of the city. Everyday walking in the streets of Romanian cities is usually an exercise in hypervigilant physical prowess and self-preserving numbness. You keep your eyes on the ground to not stumble on broken pavement. You watch ahead for unmarked construction work. You live with other people’s sweat on the hot buses. You hop among cars parked on sidewalks and listen keenly for when others may zoom by. In one of the last post-socialist states to join the European Union, living with generalised poverty means walking in cities where your senses must be dulled to manage the heat, the dust, the smells, and the waiting, irresponsive to beauty and to amiable sociality. The euphemistic vocabulary of neoliberalism may describe everyday walking through individualistic terms such as “grit” or “resilience.” And while people are called to effort, creativity, and endurance not needed in more functional states, what one experiences is the gradual diminution of one’s lives under a political regime where illiberalism keeps a citizen-serving democracy at bay. By contrast, the Victoriei Square holds bodies whose comfort in each other’s presence allow us to imagine a political community where survivalism, or what Lauren Berlant calls “lateral agency”, are no longer the norm. In “showing up, standing, breathing, moving, standing still […] an unforeseen form of political performativity that puts livable life at the forefront of politics” is enacted (Butler 18). In arriving to Victoriei Square repeatedly, Romanians demonstrate that there is room to breathe more easily, to engage with civility, and to trust the strangers in their country. They assert that they are not disposable, even if a neoliberal corrupt post-communist regime would have them otherwise.ConclusionBecoming a public, as Michael Warner proposes, is an ongoing process of attention to an issue, through the circulation of discourse and self-organisation with strangers. For the anti-corruption public of Romania’s past years, such ongoing work is accompanied by persistent, civil, embodied collective assembly, in an articulation of claims, bodies, and spaces that promotes a material agency that reconfigures the city and the imagined Romanian community into a more democratic one. The Romanian citizenship of the streets is particularly significant in the current geopolitical and ideological moment. In the region, increasing authoritarianism meets the alienating logics of neoliberalism, both trying to reduce citizens to disposable, self-reliant, and disconnected market actors. Populist autocrats—Recep Tayyip Erdogan in Turkey, the Peace and Justice Party in Poland, and recently E.U.-penalized Victor Orban, in Hungary—are dismantling the system of checks and balances, and posing threats to a European Union already challenged by refugee debates and Donald Trump’s unreliable alliance against authoritarianism. In such a moment, the Romanian anti-corruption public performs within the geographies of their city solidarity and commitment to democracy, demonstrating an alternative to the submissive and disconnected subjects preferred by authoritarianism and neoliberalism.Author's NoteIn addition to the anonymous reviewers, the author would like to thank Mary Tuominen and Jesse Schlotterbeck for their helpful comments on this essay.ReferencesAnderson, Benedict R. Imagined Communities: Reflections on the Origin and Spread of Nationalism. London: Verso, 2016.Asen, Robert. “A Discourse Theory of Citizenship.” Quarterly Journal of Speech 90.2 (2004): 189-211. 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In Australia the “intimacy” of citizenship (Berlant 2), is often used to reinforce subscription to heteronormative romantic and familial structures. Because this framing promotes discourses of moral failure, recent political attention to sexuality and same-sex couples can be filtered through insights into coalitional affiliations. This paper uses contemporary shifts in Australian politics and culture to think through the concept of coalition, and in particular to analyse connections between sexuality and governmentality (or more specifically normative bias and same-sex relationships) in what I’m calling post-coalitional Australia. Against the unpredictability of changing parties and governments, allegiances and alliances, this paper suggests the continuing adherence to a heteronormatively arranged public sphere. After the current Australian Prime Minister Julia Gillard deposed the previous leader, Kevin Rudd, she clung to power with the help of independents and the Greens, and clichés of a “rainbow coalition” and a “new paradigm” were invoked to describe the confused electorate and governmental configuration. Yet in 2007, a less confused Australia decisively threw out the Howard–led Liberal and National Party coalition government after eleven years, in favour of Rudd’s own rainbow coalition: a seemingly invigorated party focussed on gender equity, Indigenous Australians, multi-cultural visibility, workplace relations, Austral-Asian relations, humane refugee processing, the environment, and the rights and obligations of same-sex couples. A post-coalitional Australia invokes something akin to “aftermath culture” (Lambert and Simpson), referring not just to Rudd’s fall or Howard’s election loss, but to the broader shifting contexts within which most Australian citizens live, and within which they make sense of the terms “Australia” and “Australian”. Contemporary Australia is marked everywhere by cracks in coalitions and shifts in allegiances and belief systems – the Coalition of the Willing falling apart, the coalition government crushed by defeat, deposed leaders, and unlikely political shifts and (re)alignments in the face of a hung parliament and renewed pushes toward moral and cultural change. These breakdowns in allegiances are followed by swift symbolically charged manoeuvres. Gillard moved quickly to repair relations with mining companies damaged by Rudd’s plans for a mining tax and to water down frustration with the lack of a sustainable Emissions Trading Scheme. And one of the first things Kevin Rudd did as Prime Minister was to change the fittings and furnishings in the Prime Ministerial office, of which Wright observed that “Mr Howard is gone and Prime Minister Kevin Rudd has moved in, the Parliament House bureaucracy has ensured all signs of the old-style gentlemen's club… have been banished” (The Age, 5 Dec. 2007). Some of these signs were soon replaced by Ms. Gillard herself, who filled the office in turn with memorabilia from her beloved Footscray, an Australian Rules football team. In post-coalitional Australia the exile of the old Menzies’ desk and a pair of Chesterfield sofas works alongside the withdrawal of troops from Iraq and renewed pledges for military presence in Afghanistan, apologising to stolen generations of Indigenous Australians, the first female Governor General, deputy Prime Minister and then Prime Minister (the last two both Gillard), the repealing of disadvantageous workplace reform, a focus on climate change and global warming (with limited success as stated), a public, mandatory paid maternity leave scheme, changes to the processing and visas of refugees, and the amendments to more than one hundred laws that discriminate against same sex couples by the pre-Gillard, Rudd-led Labor government. The context for these changes was encapsulated in an announcement from Rudd, made in March 2008: Our core organising principle as a Government is equality of opportunity. And advancing people and their opportunities in life, we are a Government which prides itself on being blind to gender, blind to economic background, blind to social background, blind to race, blind to sexuality. (Rudd, “International”) Noting the political possibilities and the political convenience of blindness, this paper navigates the confusing context of post-coalitional Australia, whilst proffering an understanding of some of the cultural forces at work in this age of shifting and unstable alliances. I begin by interrogating the coalitional impulse post 9/11. I do this by connecting public coalitional shifts to the steady withdrawal of support for John Howard’s coalition, and movement away from George Bush’s Coalition of the Willing and the War on Terror. I then draw out a relationship between the rise and fall of such affiliations and recent shifts within government policy affecting same-sex couples, from former Prime Minister Howard’s amendments to The Marriage Act 1961 to the Rudd-Gillard administration’s attention to the discrimination in many Australian laws. Sexual Citizenship and Coalitions Rights and entitlements have always been constructed and managed in ways that live out understandings of biopower and social death (Foucault History; Discipline). The disciplining of bodies, identities and pleasures is so deeply entrenched in government and law that any non-normative claim to rights requires the negotiation of existing structures. Sexual citizenship destabilises the post-coalitional paradigm of Australian politics (one of “equal opportunity” and consensus) by foregrounding the normative biases that similarly transcend partisan politics. Sexual citizenship has been well excavated in critical work from Evans, Berlant, Weeks, Richardson, and Bell and Binnie’s The Sexual Citizen which argues that “many of the current modes of the political articulation of sexual citizenship are marked by compromise; this is inherent in the very notion itself… the twinning of rights with responsibilities in the logic of citizenship is another way of expressing compromise… Every entitlement is freighted with a duty” (2-3). This logic extends to political and economic contexts, where “natural” coalition refers primarily to parties, and in particular those “who have powerful shared interests… make highly valuable trades, or who, as a unit, can extract significant value from others without much risk of being split” (Lax and Sebinius 158). Though the term is always in some way politicised, it need not refer only to partisan, multiparty or multilateral configurations. The subscription to the norms (or normativity) of a certain familial, social, religious, ethnic, or leisure groups is clearly coalitional (as in a home or a front, a club or a team, a committee or a congregation). Although coalition is interrogated in political and social sciences, it is examined frequently in mathematical game theory and behavioural psychology. In the former, as in Axelrod’s The Evolution of Cooperation, it refers to people (or players) who collaborate to successfully pursue their own self-interests, often in the absence of central authority. In behavioural psychology the focus is on group formations and their attendant strategies, biases and discriminations. Experimental psychologists have found “categorizing individuals into two social groups predisposes humans to discriminate… against the outgroup in both allocation of resources and evaluation of conduct” (Kurzban, Tooby and Cosmides 15387). The actions of social organisation (and not unseen individual, supposedly innate impulses) reflect the cultural norms in coalitional attachments – evidenced by the relationship between resources and conduct that unquestioningly grants and protects the rights and entitlements of the larger, heteronormatively aligned “ingroup”. Terror Management Particular attention has been paid to coalitional formations and discriminatory practices in America and the West since September 11, 2001. Terror Management Theory or TMT (Greenberg, Pyszczynski and Solomon) has been the main framework used to explain the post-9/11 reassertion of large group identities along ideological, religious, ethnic and violently nationalistic lines. Psychologists have used “death-related stimuli” to explain coalitional mentalities within the recent contexts of globalised terror. The fear of death that results in discriminatory excesses is referred to as “mortality salience”, with respect to the highly visible aspects of terror that expose people to the possibility of their own death or suffering. Naverette and Fessler find “participants… asked to contemplate their own deaths exhibit increases in positive evaluations of people whose attitudes and values are similar to their own, and derogation of those holding dissimilar views” (299). It was within the climate of post 9/11 “mortality salience” that then Prime Minister John Howard set out to change The Marriage Act 1961 and the Family Law Act 1975. In 2004, the Government modified the Marriage Act to eliminate flexibility with respect to the definition of marriage. Agitation for gay marriage was not as noticeable in Australia as it was in the U.S where Bush publicly rejected it, and the UK where the Civil Union Act 2004 had just been passed. Following Bush, Howard’s “queer moral panic” seemed the perfect decoy for the increased scrutiny of Australia’s involvement in the Iraq war. Howard’s changes included outlawing adoption for same-sex couples, and no recognition for legal same-sex marriages performed in other countries. The centrepiece was the wording of The Marriage Amendment Act 2004, with marriage now defined as a union “between a man and a woman to the exclusion of all others”. The legislation was referred to by the Australian Greens Senator Bob Brown as “hateful”, “the marriage discrimination act” and the “straight Australia policy” (Commonwealth 26556). The Labor Party, in opposition, allowed the changes to pass (in spite of vocal protests from one member) by concluding the legal status of same-sex relations was in no way affected, seemingly missing (in addition to the obvious symbolic and physical discrimination) the equation of same-sex recognition with terror, terrorism and death. Non-normative sexual citizenship was deployed as yet another form of “mortality salience”, made explicit in Howard’s description of the changes as necessary in protecting the sanctity of the “bedrock institution” of marriage and, wait for it, “providing for the survival of the species” (Knight, 5 Aug. 2003). So two things seem to be happening here: the first is that when confronted with the possibility of their own death (either through terrorism or gay marriage) people value those who are most like them, joining to devalue those who aren’t; the second is that the worldview (the larger religious, political, social perspectives to which people subscribe) becomes protection from the potential death that terror/queerness represents. Coalition of the (Un)willing Yet, if contemporary coalitions are formed through fear of death or species survival, how, for example, might these explain the various forms of risk-taking behaviours exhibited within Western democracies targeted by such terrors? Navarette and Fessler (309) argue that “affiliation defences are triggered by a wider variety of threats” than “existential anxiety” and that worldviews are “in turn are reliant on ‘normative conformity’” (308) or “normative bias” for social benefits and social inclusions, because “a normative orientation” demonstrates allegiance to the ingroup (308-9). Coalitions are founded in conformity to particular sets of norms, values, codes or belief systems. They are responses to adaptive challenges, particularly since September 11, not simply to death but more broadly to change. In troubled times, coalitions restore a shared sense of predictability. In Howard’s case, he seemed to say, “the War in Iraq is tricky but we have a bigger (same-sex) threat to deal with right now. So trust me on both fronts”. Coalitional change as reflective of adaptive responses thus serves the critical location of subsequent shifts in public support. Before and since September 11 Australians were beginning to distinguish between moderation and extremism, between Christian fundamentalism and productive forms of nationalism. Howard’s unwavering commitment to the American-led war in Iraq saw Australia become a member of another coalition: the Coalition of the Willing, a post 1990s term used to describe militaristic or humanitarian interventions in certain parts of the world by groups of countries. Howard (in Pauly and Lansford 70) committed Australia to America’s fight but also to “civilization's fight… of all who believe in progress and pluralism, tolerance and freedom”. Although Bush claimed an international balance of power and influence within the coalition (94), some countries refused to participate, many quickly withdrew, and many who signed did not even have troops. In Australia, the war was never particularly popular. In 2003, forty-two legal experts found the war contravened International Law as well as United Nations and Geneva conventions (Sydney Morning Herald 26 Feb. 2003). After the immeasurable loss of Iraqi life, and as the bodies of young American soldiers (and the occasional non-American) began to pile up, the official term “coalition of the willing” was quietly abandoned by the White House in January of 2005, replaced by a “smaller roster of 28 countries with troops in Iraq” (ABC News Online 22 Jan. 2005). The coalition and its larger war on terror placed John Howard within the context of coalitional confusion, that when combined with the domestic effects of economic and social policy, proved politically fatal. The problem was the unclear constitution of available coalitional configurations. Howard’s continued support of Bush and the war in Iraq compounded with rising interest rates, industrial relations reform and a seriously uncool approach to the environment and social inclusion, to shift perceptions of him from father of the nation to dangerous, dithery and disconnected old man. Post-Coalitional Change In contrast, before being elected Kevin Rudd sought to reframe Australian coalitional relationships. In 2006, he positions the Australian-United States alliance outside of the notion of military action and Western territorial integrity. In Rudd-speak the Howard-Bush-Blair “coalition of the willing” becomes F. Scott Fitzgerald’s “willingness of the heart”. The term coalition was replaced by terms such as dialogue and affiliation (Rudd, “Friends”). Since the 2007 election, Rudd moved quickly to distance himself from the agenda of the coalition government that preceded him, proposing changes in the spirit of “blindness” toward marginality and sexuality. “Fix-it-all” Rudd as he was christened (Sydney Morning Herald 29 Sep. 2008) and his Labor government began to confront the legacies of colonial history, industrial relations, refugee detention and climate change – by apologising to Aboriginal people, timetabling the withdrawal from Iraq, abolishing the employee bargaining system Workchoices, giving instant visas and lessening detention time for refugees, and signing the Kyoto Protocol agreeing (at least in principle) to reduce green house gas emissions. As stated earlier, post-coalitional Australia is not simply talking about sudden change but an extension and a confusion of what has gone on before (so that the term resembles postcolonial, poststructural and postmodern because it carries the practices and effects of the original term within it). The post-coalitional is still coalitional to the extent that we must ask: what remains the same in the midst of such visible changes? An American focus in international affairs, a Christian platform for social policy, an absence of financial compensation for the Aboriginal Australians who received such an eloquent apology, the lack of coherent and productive outcomes in the areas of asylum and climate change, and an impenetrable resistance to the idea of same-sex marriage are just some of the ways in which these new governments continue on from the previous one. The Rudd-Gillard government’s dealings with gay law reform and gay marriage exemplify the post-coalitional condition. Emulating Christ’s relationship to “the marginalised and the oppressed”, and with Gillard at his side, Rudd understandings of the Christian Gospel as a “social gospel” (Rudd, “Faith”; see also Randell-Moon) to table changes to laws discriminating against gay couples – guaranteeing hospital visits, social security benefits and access to superannuation, resembling de-facto hetero relationships but modelled on the administering and registration of relationships, or on tax laws that speak primarily to relations of financial dependence – with particular reference to children. The changes are based on the report, Same Sex, Same Entitlements (HREOC) that argues for the social competence of queer folk, with respect to money, property and reproduction. They speak the language of an equitable economics; one that still leaves healthy and childless couples with limited recognition and advantage but increased financial obligation. Unable to marry in Australia, same-sex couples are no longer single for taxation purposes, but are now simultaneously subject to forms of tax/income auditing and governmental revenue collection should either same-sex partner require assistance from social security as if they were married. Heteronormative Coalition Queer citizens can quietly stake their economic claims and in most states discreetly sign their names on a register before becoming invisible again. Mardi Gras happens but once a year after all. On the topic of gay marriage Rudd and Gillard have deferred to past policy and to the immoveable nature of the law (and to Howard’s particular changes to marriage law). That same respect is not extended to laws passed by Howard on industrial relations or border control. In spite of finding no gospel references to Jesus the Nazarene “expressly preaching against homosexuality” (Rudd, “Faith”), and pre-election promises that territories could govern themselves with respect to same sex partnerships, the Rudd-Gillard government in 2008 pressured the ACT to reduce its proposed partnership legislation to that of a relationship register like the ones in Tasmania and Victoria, and explicitly demanded that there be absolutely no ceremony – no mimicking of the real deal, of the larger, heterosexual citizens’ “ingroup”. Likewise, with respect to the reintroduction of same-sex marriage legislation by Greens senator Sarah Hanson Young in September 2010, Gillard has so far refused a conscience vote on the issue and restated the “marriage is between a man and a woman” rhetoric of her predecessors (Topsfield, 30 Sep. 2010). At the same time, she has agreed to conscience votes on euthanasia and openly declared bi-partisan (with the federal opposition) support for the war in Afghanistan. We see now, from Howard to Rudd and now Gillard, that there are some coalitions that override political differences. As psychologists have noted, “if the social benefits of norm adherence are the ultimate cause of the individual’s subscription to worldviews, then the focus and salience of a given individual’s ideology can be expected to vary as a function of their need to ally themselves with relevant others” (Navarette and Fessler 307). Where Howard invoked the “Judaeo-Christian tradition”, Rudd chose to cite a “Christian ethical framework” (Rudd, “Faith”), that saw him and Gillard end up in exactly the same place: same sex relationships should be reduced to that of medical care or financial dependence; that a public ceremony marking relationship recognition somehow equates to “mimicking” the already performative and symbolic heterosexual institution of marriage and the associated romantic and familial arrangements. Conclusion Post-coalitional Australia refers to the state of confusion borne of a new politics of equality and change. The shift in Australia from conservative to mildly socialist government(s) is not as sudden as Howard’s 2007 federal loss or as short-lived as Gillard’s hung parliament might respectively suggest. Whilst allegiance shifts, political parties find support is reliant on persistence as much as it is on change – they decide how to buffer and bolster the same coalitions (ones that continue to privilege white settlement, Christian belief systems, heteronormative familial and symbolic practices), but also how to practice policy and social responsibility in a different way. Rudd’s and Gillard’s arguments against the mimicry of heterosexual symbolism and the ceremonial validation of same-sex partnerships imply there is one originary form of conduct and an associated sacred set of symbols reserved for that larger ingroup. Like Howard before them, these post-coalitional leaders fail to recognise, as Butler eloquently argues, “gay is to straight not as copy is to original, but as copy is to copy” (31). To make claims to status and entitlements that invoke the messiness of non-normative sex acts and romantic attachments necessarily requires the negotiation of heteronormative coalitional bias (and in some ways a reinforcement of this social power). As Bell and Binnie have rightly observed, “that’s what the hard choices facing the sexual citizen are: the push towards rights claims that make dissident sexualities fit into heterosexual culture, by demanding equality and recognition, versus the demand to reject settling for heteronormativity” (141). The new Australian political “blindness” toward discrimination produces positive outcomes whilst it explicitly reanimates the histories of oppression it seeks to redress. The New South Wales parliament recently voted to allow same-sex adoption with the proviso that concerned parties could choose not to adopt to gay couples. The Tasmanian government voted to recognise same-sex marriages and unions from outside Australia, in the absence of same-sex marriage beyond the current registration arrangements in its own state. In post-coalitional Australia the issue of same-sex partnership recognition pits parties and allegiances against each other and against themselves from within (inside Gillard’s “rainbow coalition” the Rainbow ALP group now unites gay people within the government’s own party). Gillard has hinted any new proposed legislation regarding same-sex marriage may not even come before parliament for debate, as it deals with real business. Perhaps the answer lies over the rainbow (coalition). As the saying goes, “there are none so blind as those that will not see”. References ABC News Online. “Whitehouse Scraps Coalition of the Willing List.” 22 Jan. 2005. 1 July 2007 ‹http://www.abc.net.au/news/newsitems/200501/s1286872.htm›. Axelrod, Robert. The Evolution of Cooperation. New York: Basic Books, 1984. 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New York: Springer-Verlag, 1986. 189-212. Human Rights and Equal Opportunity Commission. Same-Sex: Same Entitlements Report. 2007. 21 Aug. 2007 ‹http://www.hreoc.gov.au/human_rights/samesex/report/index.html›. Kaplan, Morris. Sexual Justice: Democratic Citizenship and the Politics of Desire. New York: Routledge, 1997. Knight, Ben. “Howard and Costello Reject Gay Marriage.” ABC Online 5 Aug. 2003. Kurzban, Robert, John Tooby, and Leda Cosmides. "Can Race Be Erased? Coalitional Computation and Social Categorization." Proceedings of the National Academy of Sciences 98.26 (2001): 15387–15392. Lambert, Anthony, and Catherine Simpson. "Jindabyne’s Haunted Alpine Country: Producing (an) Australian Badland." M/C Journal 11.5 (2008). 20 Oct. 2010 ‹http://journal.media-culture.org.au/index.php/mcjournal/article/view/81›. Lax, David A., and James K. Lebinius. “Thinking Coalitionally: Party Arithmetic Process Opportunism, and Strategic Sequencing.” Negotiation Analysis. Ed. H. Peyton Young. Michigan: University of Michigan Press, 1991. 153-194. Naverette, Carlos, and Daniel Fessler. “Normative Bias and Adaptive Challenges: A Relational Approach to Coalitional Psychology and a Critique of Terror Management Theory.” Evolutionary Psychology 3 (2005): 297-325. Pauly, Robert J., and Tom Lansford. Strategic Preemption: US Foreign Policy and Second Iraq War. Aldershot: Ashgate, 2005. Randall-Moon, Holly. "Neoliberal Governmentality with a Christian Twist: Religion and Social Security under the Howard-Led Australian Government." Eds. Michael Bailey and Guy Redden. Mediating Faiths: Religion and Socio- Cultural Change in the Twenty-First Century. Farnham: Ashgate, in press. Richardson, Diane. Rethinking Sexuality. London: Sage, 2000. Rudd, Kevin. “Faith in Politics.” The Monthly 17 (2006). 31 July 2007 ‹http://www.themonthly.com.au/monthly-essays-kevin-rudd-faith-politics--300›. 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On May 18, 2003, the Australian Minister for Education, Brendon Nelson, appeared on the Channel Nine Sunday programme. The Yoda of political journalism, Laurie Oakes, attacked him personally and professionally. He disclosed to viewers that the Minister for Education, Science and Training had suffered a false start in his education, enrolling in one semester of an economics degree that was never completed. The following year, he commenced a medical qualification and went on to become a practicing doctor. He did not pay fees for any of his University courses. When reminded of these events, Dr Nelson became agitated, and revealed information not included in the public presentation of the budget of that year, including a ‘cap’ on HECS-funded places of five years for each student. He justified such a decision with the cliché that Australia’s taxpayers do not want “professional students completing degree after degree.” The Minister confirmed that the primary – and perhaps the only – task for university academics was to ‘train’ young people for the workforce. The fact that nearly 50% of students in some Australian Universities are over the age of twenty five has not entered his vision. He wanted young people to complete a rapid degree and enter the workforce, to commence paying taxes and the debt or loan required to fund a full fee-paying place. Now – nearly two years after this interview and with the Howard government blessed with a new mandate – it is time to ask how this administration will order education and value teaching and learning. The curbing of the time available to complete undergraduate courses during their last term in office makes plain the Australian Liberal Government’s stance on formal, publicly-funded lifelong learning. The notion that a student/worker can attain all required competencies, skills, attributes, motivations and ambitions from a single degree is an assumption of the new funding model. It is also significant to note that while attention is placed on the changing sources of income for universities, there have also been major shifts in the pattern of expenditure within universities, focusing on branding, marketing, recruitment, ‘regional’ campuses and off-shore courses. Similarly, the short-term funding goals of university research agendas encourage projects required by industry, rather than socially inflected concerns. There is little inevitable about teaching, research and education in Australia, except that the Federal Government will not create a fully-funded model for lifelong learning. The task for those of us involved in – and committed to – education in this environment is to probe the form and rationale for a (post) publicly funded University. This short paper for the ‘order’ issue of M/C explores learning and teaching within our current political and economic order. Particularly, I place attention on the synergies to such an order via phrases like the knowledge economy and the creative industries. To move beyond the empty promises of just-in-time learning, on-the-job training, graduate attributes and generic skills, we must reorder our assumptions and ask difficult questions of those who frame the context in which education takes place. For the term of your natural life Learning is a big business. Whether discussing the University of the Third Age, personal development courses, self help bestsellers or hard-edged vocational qualifications, definitions of learning – let alone education – are expanding. Concurrent with this growth, governments are reducing centralized funding and promoting alternative revenue streams. The diversity of student interests – or to use the language of the time, client’s learning goals – is transforming higher education into more than the provision of undergraduate and postgraduate degrees. The expansion of the student body beyond the 18-25 age group and the desire to ‘service industry’ has reordered the form and purpose of formal education. The number of potential students has expanded extraordinarily. As Lee Bash realized Today, some estimates suggest that as many as 47 percent of all students enrolled in higher education are over 25 years old. In the future, as lifelong learning becomes more integrated into the fabric of our culture, the proportion of adult students is expected to increase. And while we may not yet realize it, the academy is already being transformed as a result. (35) Lifelong learning is the major phrase and trope that initiates and justifies these changes. Such expansive economic opportunities trigger the entrepreneurial directives within universities. If lifelong learning is taken seriously, then the goals, entry standards, curriculum, information management policies and assessments need to be challenged and changed. Attention must be placed on words and phrases like ‘access’ and ‘alternative entry.’ Even more consideration must be placed on ‘outcomes’ and ‘accountability.’ Lifelong learning is a catchphrase for a change in purpose and agenda. Courses are developed from a wide range of education providers so that citizens can function in, or at least survive, the agitation of the post-work world. Both neo-liberal and third way models of capitalism require the labeling and development of an aspirational class, a group who desires to move ‘above’ their current context. Such an ambiguous economic and social goal always involves more than the vocational education and training sector or universities, with the aim being to seamlessly slot education into a ‘lifestyle.’ The difficulties with this discourse are two-fold. Firstly, how effectively can these aspirational notions be applied and translated into a real family and a real workplace? Secondly, does this scheme increase the information divide between rich and poor? There are many characteristics of an effective lifelong learner including great personal motivation, self esteem, confidence and intellectual curiosity. In a double shifting, change-fatigued population, the enthusiasm for perpetual learning may be difficult to summon. With the casualization of the post-Fordist workplace, it is no surprise that policy makers and employers are placing the economic and personal responsibility for retraining on individual workers. Instead of funding a training scheme in the workplace, there has been a devolving of skill acquisition and personal development. Through the twentieth century, and particularly after 1945, education was the track to social mobility. The difficulty now – with degree inflation and the loss of stable, secure, long-term employment – is that new modes of exclusion and disempowerment are being perpetuated through the education system. Field recognized that “the new adult education has been embraced most enthusiastically by those who are already relatively well qualified.” (105) This is a significant realization. Motivation, meta-learning skills and curiosity are increasingly being rewarded when found in the already credentialed, empowered workforce. Those already in work undertake lifelong learning. Adult education operates well for members of the middle class who are doing well and wish to do better. If success is individualized, then failure is also cast on the self, not the social system or policy. The disempowered are blamed for their own conditions and ‘failures.’ The concern, through the internationalization of the workforce, technological change and privatization of national assets, is that failure in formal education results in social exclusion and immobility. Besides being forced into classrooms, there are few options for those who do not wish to learn, in a learning society. Those who ‘choose’ not be a part of the national project of individual improvement, increased market share, company competitiveness and international standards are not relevant to the economy. But there is a personal benefit – that may have long term political consequences – from being ‘outside’ society. Perhaps the best theorist of the excluded is not sourced from a University, but from the realm of fictional writing. Irvine Welsh, author of the landmark Trainspotting, has stated that What we really need is freedom from choice … People who are in work have no time for anything else but work. They have no mental space to accommodate anything else but work. Whereas people who are outside the system will always find ways of amusing themselves. Even if they are materially disadvantaged they’ll still find ways of coping, getting by and making their own entertainment. (145-6) A blurring of work and learning, and work and leisure, may seem to create a borderless education, a learning framework uninhibited by curriculum, assessment or power structures. But lifelong learning aims to place as many (national) citizens as possible in ‘the system,’ striving for success or at least a pay increase which will facilitate the purchase of more consumer goods. Through any discussion of work-place training and vocationalism, it is important to remember those who choose not to choose life, who choose something else, who will not follow orders. Everybody wants to work The great imponderable for complex economic systems is how to manage fluctuations in labour and the market. The unstable relationship between need and supply necessitates flexibility in staffing solutions, and short-term supplementary labour options. When productivity and profit are the primary variables through which to judge successful management, then the alignments of education and employment are viewed and skewed through specific ideological imperatives. The library profession is an obvious occupation that has confronted these contradictions. It is ironic that the occupation that orders knowledge is experiencing a volatile and disordered workplace. In the past, it had been assumed that librarians hold a degree while technicians do not, and that technicians would not be asked to perform – unsupervised – the same duties as librarians. Obviously, such distinctions are increasingly redundant. Training packages, structured through competency-based training principles, have ensured technicians and librarians share knowledge systems which are taught through incremental stages. Mary Carroll recognized the primary questions raised through this change. If it is now the case that these distinctions have disappeared do we need to continue to draw them between professional and para-professional education? Does this mean that all sectors of the education community are in fact learning/teaching the same skills but at different levels so that no unique set of skills exist? (122) With education reduced to skills, thereby discrediting generalist degrees, the needs of industry have corroded the professional standards and stature of librarians. Certainly, the abilities of library technicians are finally being valued, but it is too convenient that one of the few professions dominated by women has suffered a demeaning of knowledge into competency. Lifelong learning, in this context, has collapsed high level abilities in information management into bite sized chunks of ‘skills.’ The ideology of lifelong learning – which is rarely discussed – is that it serves to devalue prior abilities and knowledges into an ever-expanding imperative for ‘new’ skills and software competencies. For example, ponder the consequences of Hitendra Pillay and Robert Elliott’s words: The expectations inherent in new roles, confounded by uncertainty of the environment and the explosion of information technology, now challenge us to reconceptualise human cognition and develop education and training in a way that resonates with current knowledge and skills. (95) Neophilliacal urges jut from their prose. The stress on ‘new roles,’ and ‘uncertain environments,’ the ‘explosion of information technology,’ ‘challenges,’ ‘reconceptualisations,’ and ‘current knowledge’ all affirms the present, the contemporary, and the now. Knowledge and expertise that have taken years to develop, nurture and apply are not validated through this educational brief. The demands of family, work, leisure, lifestyle, class and sexuality stretch the skin taut over economic and social contradictions. To ease these paradoxes, lifelong learning should stress pedagogy rather than applications, and context rather than content. Put another way, instead of stressing the link between (gee wizz) technological change and (inevitable) workplace restructuring and redundancies, emphasis needs to be placed on the relationship between professional development and verifiable technological outcomes, rather than spruiks and promises. Short term vocationalism in educational policy speaks to the ordering of our public culture, requiring immediate profits and a tight dialogue between education and work. Furthering this logic, if education ‘creates’ employment, then it also ‘creates’ unemployment. Ironically, in an environment that focuses on the multiple identities and roles of citizens, students are reduced to one label – ‘future workers.’ Obviously education has always been marinated in the political directives of the day. The industrial revolution introduced a range of technical complexities to the workforce. Fordism necessitated that a worker complete a task with precision and speed, requiring a high tolerance of stress and boredom. Now, more skills are ‘assumed’ by employers at the time that workplaces are off-loading their training expectations to the post-compulsory education sector. Therefore ‘lifelong learning’ is a political mask to empower the already empowered and create a low-level skill base for low paid workers, with the promise of competency-based training. Such ideologies never need to be stated overtly. A celebration of ‘the new’ masks this task. Not surprisingly therefore, lifelong learning has a rich new life in ordering creative industries strategies and frameworks. Codifying the creative The last twenty years have witnessed an expanding jurisdiction and justification of the market. As part of Tony Blair’s third way, the creative industries and the knowledge economy became catchwords to demonstrate that cultural concerns are not only economically viable but a necessity in the digital, post-Fordist, information age. Concerns with intellectual property rights, copyright, patents, and ownership of creative productions predominate in such a discourse. Described by Charles Leadbeater as Living on Thin Air, this new economy is “driven by new actors of production and sources of competitive advantage – innovation, design, branding, know-how – which are at work on all industries.” (10) Such market imperatives offer both challenges and opportunity for educationalists and students. Lifelong learning is a necessary accoutrement to the creative industries project. Learning cities and communities are the foundations for design, music, architecture and journalism. In British policy, and increasingly in Queensland, attention is placed on industry-based research funding to address this changing environment. In 2000, Stuart Cunningham and others listed the eight trends that order education, teaching and learning in this new environment. The Changes to the Provision of Education Globalization The arrival of new information and communication technologies The development of a knowledge economy, shortening the time between the development of new ideas and their application. The formation of learning organizations User-pays education The distribution of knowledge through interactive communication technologies (ICT) Increasing demand for education and training Scarcity of an experienced and trained workforce Source: S. Cunningham, Y. Ryan, L. Stedman, S. Tapsall, K. Bagdon, T. Flew and P. Coaldrake. The Business of Borderless Education. Canberra: DETYA Evaluation and Investigations Program [EIP], 2000. This table reverberates with the current challenges confronting education. Mobilizing such changes requires the lubrication of lifelong learning tropes in university mission statements and the promotion of a learning culture, while also acknowledging the limited financial conditions in which the educational sector is placed. For university scholars facilitating the creative industries approach, education is “supplying high value-added inputs to other enterprises,” (Hartley and Cunningham 5) rather than having value or purpose beyond the immediately and applicably economic. The assumption behind this table is that the areas of expansion in the workforce are the creative and service industries. In fact, the creative industries are the new service sector. This new economy makes specific demands of education. Education in the ‘old economy’ and the ‘new economy’ Old Economy New Economy Four-year degree Forty-year degree Training as a cost Training as a source of competitive advantage Learner mobility Content mobility Distance education Distributed learning Correspondence materials with video Multimedia centre Fordist training – one size fits all Tailored programmes Geographically fixed institutions Brand named universities and celebrity professors Just-in-case Just-in-time Isolated learners Virtual learning communities Source: T. Flew. “Educational Media in Transition: Broadcasting, Digital Media and Lifelong Learning in the Knowledge Economy.” International Journal of Instructional Media 29.1 (2002): 20. There are myriad assumptions lurking in Flew’s fascinating table. The imperative is short courses on the web, servicing the needs of industry. He described the product of this system as a “learner-earner.” (50) This ‘forty year degree’ is based on lifelong learning ideologies. However Flew’s ideas are undermined by the current government higher education agenda, through the capping – through time – of courses. The effect on the ‘learner-earner’ in having to earn more to privately fund a continuance of learning – to ensure that they keep on earning – needs to be addressed. There will be consequences to the housing market, family structures and leisure time. The costs of education will impact on other sectors of the economy and private lives. Also, there is little attention to the groups who are outside this taken-for-granted commitment to learning. Flew noted that barriers to greater participation in education and training at all levels, which is a fundamental requirement of lifelong learning in the knowledge economy, arise in part out of the lack of provision of quality technology-mediated learning, and also from inequalities of access to ICTs, or the ‘digital divide.’ (51) In such a statement, there is a misreading of teaching and learning. Such confusion is fuelled by the untheorised gap between ‘student’ and ‘consumer.’ The notion that technology (which in this context too often means computer-mediated platforms) is a barrier to education does not explain why conventional distance education courses, utilizing paper, ink and postage, were also unable to welcome or encourage groups disengaged from formal learning. Flew and others do not confront the issue of motivation, or the reason why citizens choose to add or remove the label of ‘student’ from their bag of identity labels. The stress on technology as both a panacea and problem for lifelong learning may justify theories of convergence and the integration of financial, retail, community, health and education provision into a services sector, but does not explain why students desire to learn, beyond economic necessity and employer expectations. Based on these assumptions of expanding creative industries and lifelong learning, the shape of education is warping. An ageing population requires educational expenditure to be reallocated from primary and secondary schooling and towards post-compulsory learning and training. This cost will also be privatized. When coupled with immigration flows, technological changes and alterations to market and labour structures, lifelong learning presents a profound and personal cost. An instrument for economic and social progress has been individualized, customized and privatized. The consequence of the ageing population in many nations including Australia is that there will be fewer young people in schools or employment. Such a shift will have consequences for the workplace and the taxation system. Similarly, those young workers who remain will be far more entrepreneurial and less loyal to their employers. Public education is now publically-assisted education. Jane Jenson and Denis Saint-Martin realized the impact of this change. The 1980s ideological shift in economic and social policy thinking towards policies and programmes inspired by neo-liberalism provoked serious social strains, especially income polarization and persistent poverty. An increasing reliance on market forces and the family for generating life-chances, a discourse of ‘responsibility,’ an enthusiasm for off-loading to the voluntary sector and other altered visions of the welfare architecture inspired by neo-liberalism have prompted a reaction. There has been a wide-ranging conversation in the 1990s and the first years of the new century in policy communities in Europe as in Canada, among policy makers who fear the high political, social and economic costs of failing to tend to social cohesion. (78) There are dense social reorderings initiated by neo-liberalism and changing the notions of learning, teaching and education. There are yet to be tracked costs to citizenship. The legacy of the 1980s and 1990s is that all organizations must behave like businesses. In such an environment, there are problems establishing social cohesion, let alone social justice. To stress the product – and not the process – of education contradicts the point of lifelong learning. Compliance and complicity replace critique. (Post) learning The Cold War has ended. The great ideological battle between communism and Western liberal democracy is over. Most countries believe both in markets and in a necessary role for Government. There will be thunderous debates inside nations about the balance, but the struggle for world hegemony by political ideology is gone. What preoccupies decision-makers now is a different danger. It is extremism driven by fanaticism, personified either in terrorist groups or rogue states. Tony Blair (http://www.number-10.gov.uk/output/Page6535.asp) Tony Blair, summoning his best Francis Fukuyama impersonation, signaled the triumph of liberal democracy over other political and economic systems. His third way is unrecognizable from the Labour party ideals of Clement Attlee. Probably his policies need to be. Yet in his second term, he is not focused on probing the specificities of the market-orientation of education, health and social welfare. Instead, decision makers are preoccupied with a war on terror. Such a conflict seemingly justifies large defense budgets which must be at the expense of social programmes. There is no recognition by Prime Ministers Blair or Howard that ‘high-tech’ armory and warfare is generally impotent to the terrorist’s weaponry of cars, bodies and bombs. This obvious lesson is present for them to see. After the rapid and successful ‘shock and awe’ tactics of Iraq War II, terrorism was neither annihilated nor slowed by the Coalition’s victory. Instead, suicide bombers in Saudi Arabia, Morocco, Indonesia and Israel snuck have through defenses, requiring little more than a car and explosives. More Americans have been killed since the war ended than during the conflict. Wars are useful when establishing a political order. They sort out good and evil, the just and the unjust. Education policy will never provide the ‘big win’ or the visible success of toppling Saddam Hussein’s statue. The victories of retraining, literacy, competency and knowledge can never succeed on this scale. As Blair offered, “these are new times. New threats need new measures.” (ht tp://www.number-10.gov.uk/output/Page6535.asp) These new measures include – by default – a user pays education system. In such an environment, lifelong learning cannot succeed. It requires a dense financial commitment in the long term. A learning society requires a new sort of war, using ideas not bullets. References Bash, Lee. “What Serving Adult Learners Can Teach Us: The Entrepreneurial Response.” Change January/February 2003: 32-7. Blair, Tony. “Full Text of the Prime Minister’s Speech at the Lord Mayor’s Banquet.” November 12, 2002. http://www.number-10.gov.uk/output/Page6535.asp. Carroll, Mary. “The Well-Worn Path.” The Australian Library Journal May 2002: 117-22. Field, J. Lifelong Learning and the New Educational Order. Stoke on Trent: Trentham Books, 2000. Flew, Terry. “Educational Media in Transition: Broadcasting, Digital Media and Lifelong Learning in the Knowledge Economy.” International Journal of Instructional Media 29.1 (2002): 47-60. Hartley, John, and Cunningham, Stuart. “Creative Industries – from Blue Poles to Fat Pipes.” Department of Education, Science and Training, Commonwealth of Australia (2002). Jenson, Jane, and Saint-Martin, Denis. “New Routes to Social Cohesion? Citizenship and the Social Investment State.” Canadian Journal of Sociology 28.1 (2003): 77-99. Leadbeater, Charles. Living on Thin Air. London: Viking, 1999. Pillay, Hitendra, and Elliott, Robert. “Distributed Learning: Understanding the Emerging Workplace Knowledge.” Journal of Interactive Learning Research 13.1-2 (2002): 93-107. Welsh, Irvine, from Redhead, Steve. “Post-Punk Junk.” Repetitive Beat Generation. Glasgow: Rebel Inc, 2000: 138-50. Citation reference for this article MLA Style Brabazon, Tara. "Freedom from Choice: Who Pays for Customer Service in the Knowledge Economy?." M/C Journal 7.6 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0501/02-brabazon.php>. APA Style Brabazon, T. (Jan. 2005) "Freedom from Choice: Who Pays for Customer Service in the Knowledge Economy?," M/C Journal, 7(6). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0501/02-brabazon.php>.

There is a moment in Al Gore’s 2006 documentary An Inconvenient Truth devised to expose the sheer audacity of fossil fuel lobby groups in the United States. In their attempts to address significant scientific consensus and growing public concern over climate change, these groups are resorting to what Gore’s film suggests are grotesque distortions of fact. A particular example highlighted in the film is the Competitive Enterprise Institute’s (CPE—a lobby group funded by ExxonMobil) “pro” energy industry advertisement: “Carbon dioxide”, the ad states. “They call it pollution, we call it life.” While on the one hand employing rhetoric against the “inconvenient truth” that carbon dioxide emissions are ratcheting up the Earth’s temperature, these advertisements also pose a question – though perhaps unintended – that is worth addressing. Where does life reside? This is not an issue of essentialism, but relates to the claims, materials and technologies through which life as a political object emerges. The danger of entertaining the vested interests of polluting industry in a discussion of climate change and its biopolitics is countered by an imperative to acknowledge the ways in which multiple positions in the climate change debate invoke and appeal to ‘life’ as the bottom line, or inviolable interest, of their political, social or economic work. In doing so, other questions come to the fore that a politics of climate change framed in terms of moral positions or competing values will tend to overlook. These questions concern the manifold practices of life that constitute the contemporary terrain of the political, and the actors and instruments put in this employ. Who speaks for life? And who or what produces it? Climate change as a matter of concern (Latour) has gathered and generated a host of experts, communities, narratives and technical devices all invested in the administration of life. It is, as Malcom Bull argues, “the paradigmatic issue of the new politics,” a politics which “draws people towards the public realm and makes life itself subject to the caprices of state and market” (2). This paper seeks to highlight the politics of life that have emerged around climate change as a public issue. It will argue that these politics appear in incremental and multiple ways that situate an array of actors and interests as active in both contesting and generating the terms of life: what life is and how we come to know it. This way of thinking about climate change debates opposes a prevalent moralistic framework that reads the practices and discourses of debate in terms of oppositional positions alone. While sympathies may flow in varying directions, especially when it comes to such a highly charged and massively consequential issue as climate change, there is little insight to be had from charging the CPE (for example) with manipulating consumers, or misrepresenting well-known facts. Where new and more productive understandings open up is in relation to the fields through which these gathering actors play out their claims to the project of life. These fields, from the state, to the corporation, to the domestic sphere, reveal a complex network of strategies and devices that seek to secure life in constantly renovated terms. Life Politics Biopolitical scholarship in the wake of Foucault has challenged life as a pre-given uncritical category, and sought to highlight the means through which it is put under question and constituted through varying and composing assemblages of practitioners and practices. Such work regards the project of human well-being as highly complex and technical, and has undertaken to document this empirically through close attention to the everyday ecologies in which humans are enmeshed. This is a political and theoretical project in itself, situating political processes in micro, as well as macro, registers, including daily life as a site of (self) management and governance. Rabinow and Rose refer to biopolitical circuits that draw together and inter-relate the multiple sites and scales operative in the administration of life. These involve not just technologies, rationalities and regimes of authority and control, but also politics “from below” in the form of rights claims and community formation and agitation (198). Active in these circuits, too, are corporate and non-state interests for whom the pursuit of maximising life’s qualities and capabilities has become a concern through which “market relations and shareholder value” are negotiated (Rabinow and Rose 211). As many biopolitical scholars argue, biopower—the strategies through which biopolitics are enacted—is characteristic of the “disciplinary neo-liberalism” that has come to define the modern state, and through which the conduct of conduct is practiced (Di Muzio 305). Foucault’s concept of governmentality describes the devolution of state-based disciplinarity and sovereignty to a host of non-state actors, rationalities and strategies of governing, including the self-managing subject, not in opposition to the state, but contributing to its form. According to Bratich, Packer and McCarthy, everyday life is thus “saturated with governmental techniques” (18) in which we are all enrolled. Unlike regimes of biopolitics identified with what Agamben terms “thanopolitics”—the exercise of biopower “which ultimately rests on the power of some to threaten the death of others” (Rabinow and Rose 198), such as the Nazi’s National Socialism and other eugenic campaigns—governmental arts in the service of “vitalist” biopolitics (Rose 1) are increasingly diffused amongst all those with an “interest” in sustaining life, from organisations to individuals. The integration of techniques of self-governance which ask the individual to work on themselves and their own dispositions with State functions has broadened the base by which life is governed, and foregrounded an unsettled terrain of life claims. Rose argues that medical science is at the forefront of these contemporary biopolitics, and to this effect “has […] been fully engaged in the ethical questions of how we should live—of what kinds of creatures we are, of the kinds of obligations that we have to ourselves and to others, of the kinds of techniques we can and should use to improve ourselves” (20). Asking individuals to self-identify through their medical histories and bodily specificities, medical cultures are also shaping new political arrangements, as communities connected by shared genetics or physical conditions, for instance, emerge, evolve and agitate according to the latest medical knowledge. Yet it is not just medicine that provokes ethical work and new political forms. The environment is a key site for life politics that entails a multi-faceted discourse of obligations and entitlements, across fields and scales of engagement. Calculating Environments In line with neo-liberal logic, environmental discourse concerned with ameliorating climate change has increasingly focused upon the individual as an agent of self-monitoring, to both facilitate government agendas at a distance, and to “self-fashion” in the mode of the autonomous subject, securing against external risks (Ong 501). Climate change is commonly represented as such a risk, to both human and non-human life. A recent letter published by the Royal Australasian College of Physicians in two leading British medical journals, named climate change as the “biggest global health threat of the twenty-first century” (Morton). As I have argued elsewhere (Potter), security is central to dominant cultures of environmental governance in the West; these cultures tie sustainability goals to various and interrelated regimes of monitoring which attach to concepts of what Clark and Stevenson call “the good ecological citizen” (238). Citizenship is thus practiced through strategies of governmentality which call on individuals to invest not just in their own well-being, but in the broader project of life. Calculation is a primary technique through which modern environmental governance is enacted; calculative strategies are seen to mediate risk, according to Foucault, and consequently to “assure living” (Elden 575). Rationalised schemes for self-monitoring are proliferating under climate change and the project of environmentalism more broadly, something which critics of neo-liberalism have identified as symptomatic of the privatisation of politics that liberal governmentality has fostered. As we have seen in Australia, an evolving policy emphasis on individual practices and the domestic sphere as crucial sites of environmental action – for instance, the introduction of domestic water restrictions, and the phasing out of energy-inefficient light bulbs in the home—provides a leading discourse of ethico-political responsibility. The rise of carbon dioxide counting is symptomatic of this culture, and indicates the distributed fields of life management in contemporary governmentality. Carbon dioxide, as the CPE is keen to point out, is crucial to life, but it is also—in too large an amount—a force of destruction. Its management, in vitalist terms, is thus established as an effort to protect life in the face of death. The concept of “carbon footprinting” has been promoted by governments, NGOs, industry and individuals as a way of securing this goal, and a host of calculative techniques and strategies are employed to this end, across a spectrum of activities and contexts all framed in the interests of life. The footprinting measure seeks to secure living via self-policed limits, which also—in classic biopolitical form—shift previously private practices into a public realm of count-ability and accountability. The carbon footprint, like its associates the ecological footprint and the water footprint, has developed as a multi-faceted tool of citizenship beyond the traditional boundaries of the state. Suggesting an ecological conception of territory and of our relationships and responsibilities to this, the footprint, as a measure of resource use and emissions relative to the Earth’s capacities to absorb these, calculates and visualises the “specific qualities” (Elden 575) that, in a spatialised understanding of security, constitute and define this territory. The carbon footprint’s relatively simple remit of measuring carbon emissions per unit of assessment—be that the individual, the corporation, or the nation—belies the ways in which life is formatted and produced through its calculations. A tangled set of devices, practices and discourses is employed to make carbon and thus life calculable and manageable. Treading Lightly The old environmental adage to “tread lightly upon the Earth” has been literalised in the metaphor of the footprint, which attempts both to symbolise environmental practice and to directly translate data in order to meaningfully communicate necessary boundaries for our living. The World Wildlife Fund’s Living Planet Report 2008 exemplifies the growing popularity of the footprint as a political and poetic hook: speaking in terms of our “ecological overshoot,” and the move from “ecological credit to ecological deficit”, the report urges an attendance to our “global footprint” which “now exceeds the world’s capacity to regenerate by about 30 per cent” (1). Angela Crombie’s A Lighter Footprint, an instruction manual for sustainable living, is one of a host of media through which individuals are educated in modes of footprint calculation and management. She presents a range of techniques, including carbon offsetting, shifting to sustainable modes of transport, eating and buying differently, recycling and conserving water, to mediate our carbon dioxide output, and to “show […] politicians how easy it is” (13). Governments however, need no persuading from citizens that carbon calculation is an exercise to be harnessed. As governments around the world move (slowly) to address climate change, policies that instrumentalise carbon dioxide emission and reduction via an auditing of credits and deficits have come to the fore—for example, the European Union Emissions Trading Scheme and the Chicago Climate Exchange. In Australia, we have the currently-under-debate Carbon Pollution Reduction Scheme, a part of which is the Australian Emissions Trading Scheme (AETS) that will introduce a system of “carbon credits” and trading in a market-based model of supply and demand. This initiative will put a price on carbon dioxide emissions, and cap the amount of emissions any one polluter can produce without purchasing further credits. In readiness for the scheme, business initiatives are forming to take advantage of this new carbon market. Industries in carbon auditing and off-setting services are consolidating; hectares of trees, already active in the carbon sequestration market, are being cultivated as “carbon sinks” and key sites of compliance for polluters under the AETS. Governments are also planning to turn their tracts of forested public land into carbon credits worth billions of dollars (Arup 7). The attachment of emission measures to goods and services requires a range of calculative experts, and the implementation of new marketing and branding strategies, aimed at conveying the carbon “health” of a product. The introduction of “food mile” labelling (the amount of carbon dioxide emitted in the transportation of the food from source to consumer) in certain supermarkets in the United Kingdom is an example of this. Carbon risk analysis and management programs are being introduced across businesses in readiness for the forthcoming “carbon economy”. As one flyer selling “a suite of carbon related services” explains, “early action will give you the edge in understanding and mitigating the risks, and puts you in a prime position to capitalise on the rewards” (MGI Business Solutions Worldwide). In addition, lobby groups are working to ensure exclusions from or the free allocation of permits within the proposed AETS, with degrees of compulsion applied to different industries – the Federal Government, for instance, will provide a $3.9 billion compensation package for the electric power sector when the AETS commences, to enable their “adjustment” to this carbon regime. Performing Life Noortje Mares provides a further means of thinking through the politics of life in the context of climate change by complicating the distinction between public and private interest. Her study of “green living experiments” describes the rise of carbon calculation in the home in recent years, and the implementation of technologies such as the smart electricity meter that provides a constantly updating display of data relating to amounts and cost of energy consumed and the carbon dioxide emitted in the routines of domestic life. Her research tracks the entry of these personal calculative regimes into public life via internet forums such as blogs, where individuals notate or discuss their experiences of pursing low-carbon lifestyles. On the one hand, these calculative practices of living and their public representation can be read as evidencing the pervasive neo-liberal governmentality at work in contemporary environmental practice, where individuals are encouraged to scrupulously monitor their domestic cultures. The rise of auditing as a technology of self, and more broadly as a technique of public accountability, has come under fire for its “immunity-granting role” (Charkiewicz 79), where internal audits become substituted for external compliance and regulation. Mares challenges this reading, however, by demonstrating the ways in which green living experiments “transform everyday material practices into practices of public involvement” that (118) don’t resolve or pin down relations between the individual, the non-human environment, and the social, or reveal a mappable flow of actions and effects between the public realm and the home. The empirical modes of publicity that these individuals employ, “the careful recording of measurements and the reliable descriptions of sensory observation, so as to enable ‘virtual witnessing’ by wider audiences”, open up to much more complex understandings than one of calculative self-discipline at work. As “instrument[s] of public involvement” (120), the experiments that Mares describe locate the politics of life in the embodied socio-material entanglements of the domestic sphere, in arrangements of humans and non-human technologies. Such arrangements, she suggests, are ontologically productive in that they introduce “not only new knowledge, but also new entities […] to society” (119), and as such these experiments and the modes of calculation they employ become active in the composition of reality. Recent work in economic sociology and cultural studies has similarly contended that calculation, far from either a naturalised or thoroughly abstract process, relies upon a host of devices, relations, and techniques: that is, as Gay Hawkins explains, calculative processes “have to be enacted” (108). Environmental governmentality in the service of securing life is a networked practice that draws in a host of actors, not a top-down imposition. The institution of carbon economies and carbon emissions as a new register of public accountability, brings alternative ways to calculate the world into being, and consequently re-calibrates life as it emerges from these heterogeneous arrangements. All That Gathers Latour writes that we come to know a matter of concern by all the things that gather around it (Latour). This includes the human, as well as the non-human actors, policies, practices and technologies that are put to work in the making of our realities. Climate change is routinely represented as a threat to life, with predicted (and occurring) species extinction, growing numbers of climate change refugees, dispossessed from uninhabitable lands, and the rise of diseases and extreme weather scenarios that put human life in peril. There is no doubt, of course, that climate change does mean death for some: indeed, there are thanopolitical overtones in inequitable relations between the fall-out of impacts from major polluting nations on poorer countries, or those much more susceptible to rising sea levels. Biosocial equity, as Bull points out, is a “matter of being equally alive and equally dead” (2). Yet in the biopolitical project of assuring living, life is burgeoning around the problem of climate change. The critique of neo-liberalism as a blanketing system that subjects all aspects of life to market logic, and in which the cynical techniques of industry seek to appropriate ethico-political stances for their own material ends, are insufficient responses to what is actually unfolding in the messy terrain of climate change and its biopolitics. What this paper has attempted to show is that there is no particular purchase on life that can be had by any one actor who gathers around this concern. Varying interests, ambitions, and intentions, without moral hierarchy, stake their claim in life as a constantly constituting site in which they participate, and from this perspective, the ways in which we understand life to be both produced and managed expand. This is to refuse either an opposition or a conflation between the market and nature, or the market and life. It is also to argue that we cannot essentialise human-ness in the climate change debate. For while human relations with animals, plants and weathers may make us what we are, so too do our relations with (in a much less romantic view) non-human things, technologies, schemes, and even markets—from carbon auditing services, to the label on a tin on the supermarket shelf. As these intersect and entangle, the project of life, in the new politics of climate change, is far from straightforward. References An Inconvenient Truth. Dir. Davis Guggenheim. Village Roadshow, 2006. Arup, Tom. “Victoria Makes Enormous Carbon Stocktake in Bid for Offset Billions.” The Age 24 Sep. 2009: 7. Bratich, Jack Z., Jeremy Packer, and Cameron McCarthy. “Governing the Present.” Foucault, Cultural Studies and Governmentality. Ed. Bratich, Packer and McCarthy. Albany: State University of New York Press, 2003. 3-21. Bull, Malcolm. “Globalization and Biopolitics.” New Left Review 45 (2007): 12 May 2009 . < http://newleftreview.org/?page=article&view=2675 >. Charkiewicz, Ewa. “Corporations, the UN and Neo-liberal Bio-politics.” Development 48.1 (2005): 75-83. Clark, Nigel, and Nick Stevenson. “Care in a Time of Catastrophe: Citizenship, Community and the Ecological Imagination.” Journal of Human Rights 2.2 (2003): 235-246. Crombie, Angela. A Lighter Footprint: A Practical Guide to Minimising Your Impact on the Planet. Carlton North, Vic.: Scribe, 2007. Di Muzio, Tim. “Governing Global Slums: The Biopolitics of Target 11.” Global Governance. 14.3 (2008): 305-326. Elden, Stuart. “Governmentality, Calculation and Territory.” Environment and Planning D: Society and Space 25 (2007): 562-580. Hawkins, Gay. The Ethics of Waste: How We Relate to Rubbish. Sydney: University of New South Wales Press, 2006. Latour, Bruno. “Why Has Critique Run Out of Steam?: From Matters of Fact to Matters of Concern.” Critical Inquiry 30.2 (2004): 225-248. Mares, Noortje. “Testing Powers of Engagement: Green Living Experiments, the Ontological Turn and the Undoability and Involvement.” European Journal of Social Theory 12.1 (2009): 117-133. MGI Business Solutions Worldwide. “Carbon News.” Adelaide. 2 Aug. 2009. Ong, Aihwa. “Mutations in Citizenship.” Theory, Culture and Society 23.2-3 (2006): 499-505. Potter, Emily. “Footprints in the Mallee: Climate Change, Sustaining Communities, and the Nature of Place.” Landscapes and Learning: Place Studies in a Global World. Ed. Margaret Somerville, Kerith Power and Phoenix de Carteret. Sense Publishers. Forthcoming. Rabinow, Paul, and Nikolas Rose. “Biopower Today.” Biosocieties 1 (2006): 195-217. Rose, Nikolas. “The Politics of Life Itself.” Theory, Culture and Society 18.6 (2001): 1-30. World Wildlife Fund. Living Planet Report 2008. Switzerland, 2008.

The past two decades have seen the publication of at least half a dozen books that consider the part that fairs, circuses, sideshows and freakshows play in the continuing cultural labour to define, categorise and control the human body, including Robert Bogdan’s Freakshow, Rosemarie Garland-Thomson’s Extraordinary Bodies, and her edited collection Freakery, and Rachel Adams’s Sideshow USA. These writers cast the freakshow as a theatre of culture, worthy of critical attention precisely because of the ways in which it has provided a popular forum for staging, solidifying and transforming ideas about the body and bodily difference, and because of its prominence in the project of modernity (Garland-Thomson “From Wonder to Error” 2-13). They point to the theatrical mechanisms by which the freakshow maps cultural anxieties about corporeal difference across ‘suitable’ bodies. For, as Bogdan (3) says, being a freak is far more than a fact of biology. The freak personae that populate the Western cultural imaginary—the fat lady, the bearded lady, the hermaphrodite and the geek—can only be produced by a performative isolation, manipulation and exaggeration of the peculiar characteristics of particular human bodies. These peculiarities have to be made explicit, in Rebecca Schneider’s (1) terms; the horror-inducing tropes of the savage, the bestial and the monstrous have to be cast across supposedly suitable and compliant flesh. The scopic mechanisms of the freakshow as a theatre, as a cabinet of corporeal curiosities in which spectators are excited, amazed and edified by the spectacle of the extraordinary body, thus support the specific forms of seeing and looking by which freak bodies are produced. It would, however, be a mistake to suggest that the titillating threat of this face-to-face encounter with the Levinasian other fully destabilises the space between signifier and signified, between the specific body and the symbolic framework in which it sits. In a somewhat paradoxical cultural manoeuvre, the ableist, sexist and racist symbolic frameworks of the freakshow unfold according to what Deleuze and Guattari (178) would call a logic of sameness. The roles, relationships and representational mechanisms of the freakshow—including the ‘talkers’ that frame the spectator’s engagement with the extraordinary body of the freak—in fact function to delineate “degrees of deviance” (178) or difference from an illusory bodily norm. So configured, the monstrous corporeality of the freak is also monstrously familiar, and is made more so by the freak spectacle’s frequent emphasis on the ways in which non-normative bodies accommodate basic functions such as grooming and eating. In such incarnations, the scenography and iconography of the freakshow in fact draws spectators into performative (mis)recognitions that manage the difference of other bodies by positioning them along a continuum that confirms the stability of the symbolic order, and the centrality of the able, white, male self in this symbolic order. Singular, specific, extraordinary bodies are subject to what might, in a Levinasian paradigm, be called the violence of categorisation and comprehension (“Is Ontology Fundamental?” 9). The circumstances of the encounter reduce the radical, unreadable difference of the other, transporting them “into the horizon of knowledge” (“Transcendence and Height” 12), and transforming them into something that serves the dominant cultural logic. In this sense, Petra Kuppers suggests, “the psychic effects of the freak spectacle have destabilizing effects, assaulting the boundaries of firm knowledge about self, but only to strengthen them again in cathartic effect” (45). By casting traits they abhor across the freak body (Garland-Thomson Extraordinary Bodies 55-56), spectators become complicit in this abhorrence; comforted, cajoled and strangely pleasured by a sense of distance from what they desire not to be. The subversive potential of the prodigious body evaporates (Garland-Thomson “From Wonder to Error” 3; Extraordinary Bodies 78). An evaporation more fully effected, writers on the freakshow explain, as the discursive construct of the freak was drawn into the sphere of medical spectacle in the late nineteenth century. As the symbolic framework for understanding disabled bodies ‘advances’ from the freak, the monster and the mutant to the medical specimen (Garland-Thomson “From Wonder to Error” 13; Extraordinary Bodies 70, 78-80; Synder and Mitchell 370-373; Stephens 492), the cultural trajectory away from extraordinary bodies with the capacity to expand the classes and categories of the human is complete. The medical profession finally fulfils the cultural compulsion to abstract peculiar bodily characteristics into symptoms, and, as Foucault says in The Birth of the Clinic, these symptoms become surveillable, and controllable, within an objective schema of human biology. Physical differences and idiosyncrasies are “enclosed within the singularity of the patient, in that region of ‘subjective symptoms’ that—for the doctor—defines not only the mode of knowledge, but the world of objects to be known” (xi). The freak body becomes no more than an example of human misfortune, to be examined, categorised and cared for by medical experts behind closed doors, and the freakshow fades from the stage of popular culture (Garland-Thomson Extraordinary Bodies 70). There can, of course, be no denying the need to protect people with disabilities from exploitation at the service of a cultural fetish that enacts a compulsion to define and control bodily difference. However, recent debates in disability, cultural and performance studies have been characterised by the desire to reconsider the freakshow as a site for contesting some of the cultural logics it enacts. Theorists like Synder and Mitchell argue that medical discourse “disarms the [disabled] body of its volatile potency” (378), in the process denying people with disabilities a potentially interesting site to contest the cultural logics by which their bodies are defined. The debate begins with Bogdan’s discussion of the ways in which well-meaning disability activists may, in their desire to protect people with disabilities from exploitative practices and producers, have overlooked the fact that freakshows provided people with disabilities a degree of independence and freedom otherwise impossible (280-81). After all, as disabled performer Mat Fraser says in his documentary Born Freak, The Victorian marvels found fame and some fortune, and this actually raised the visibility, even the acceptability, of disabled people in general during a time when you could be attacked on the streets just for looking different. These disabled performers found independence and commanded respect.… If I had been born a hundred years ago, given the alternatives of—what? living the life of a village monster or idiot or being poked or prodded for cataloguing by medical types—there’s no doubt about it, I would have wanted to be in show business. (Born Freak) This question of agency extends to discussion of whether disabled performers like Fraser can, by consciously appropriating the figures, symbols and scenography of the freakshow, start to deconstruct the mechanisms by which this contested sphere of cultural practice has historically defined them, confronting spectators with their own complicity in the construction of the freak. In her analysis of Coney Island’s Sideshows by the Seashore, Elizabeth Stephens reflects on this contemporary sideshow’s capacity to reclaim the political currency of the freak. For Stephens, sideshows are sites in which norms about the body, its limits and capabilities, are theatricalized and transformed into spectacle, but, in which, for this very reason, they can also be contested. Non-normative bodies are not simply exhibited or put on display on the sideshow stage, but are rather performed as the unstable—indeed, destabilising—product of the dynamic interrelationship between performer, audience and theatrical space. (486) Theorists like Stephens (487) point to disabled performers who manipulate the scopic and discursive mechanisms of the sideshow, street performance and circus, setting them against more or less personal accounts of the way their bodies have historically been seen, to disrupt the modes of subjection the freak spectacle makes possible and precipitate a crisis in prescribed categories of meaning. Stephens (485-498) writes of Mat Fraser, who reperformed the historical personal of the short-armed Sealo the Sealboy, and Jennifer Miller, who reperformed the persona of Zenobia the bearded lady, at Sideshows by the Seashore. Sharon Mazer (257-276) writes of Katy Dierlam, who donned a Dolly Dimples babydoll dress to reperform the clichéd fat lady figure Helon Melon, again at Sideshows by the Seashore, counterposing Melon’s monstrous obesity with comments affirming her body’s potent humanity, and quotes from feminist scholars and artists such as Suzy Orbach, Karen Finley and Annie Sprinkle. Sharon Synder and David Mitchell (383) write of Mary Duffy, who reperforms the armless figure of the Venus de Milo. These practices constitute performative interventions into the cultural sphere, aligned with a broader set of contemporary performance practices which contest the symbolic frameworks by which racial and gender characteristics are displayed on the popular stage in similar ways. Their confrontational performance strategies recall, for instance, the work of American performance artist Guillermo Gómez-Peña, who reappropriates colonial and pop cultural figurations of the racialised body in works like Two Undiscovered Amerindians Visit…, in which he and Coco Fusco cast themselves as two caged savages. In such works, Gómez-Peña and his collaborators use parallel performance strategies to engage the “spectacle of the Other-as-freak” (297). “The idea is to exaggerate the features of fear and desire in the Anglo imagination and ‘spectacularize’ our ‘extreme identities’, so to speak, with the clear understanding that these identities have been invented by the surgery of the global media” (297) Gómez-Peña says. These remobilisations of the monstrous operate within the paradigm of the explicit, a term Schneider coined a decade ago to describe the performance art practices of women who write the animalised, sexualised characteristics with which they are symbolically aligned across their own corporeally ‘suitable’ bodies, replaying their culturally assigned identities “with a voluble, ‘in your face’ vengeance” (100), “a literal vengeance” (109). Such practices reclaim the destablising potential of the freak spectacle, collapsing, complicating or exploding the space between signifier and signified to show that the freak is a discursive construct (22-23), and thus for Schneider, following Benjamin, threatening the whole symbolic system with collapse (2, 6). By positioning their bodies as a ground that manifestly fails to ground the reality they represent, these performers play with the idea that the reality of the freak is really just part of the order of representation. There is nothing behind it, nothing beyond it, nothing up the magician’s sleeve—identity is but a sideshow hall of mirrors in which the ‘blow off’ is always a big disappointment. Bodies marked by disability are not commodified, or even clearly visible, in the Western capitalist scopic economy in the same way as Schneider’s women performers. Nevertheless, disabled performers still use related strategies to reclaim a space for what Schneider calls a postmodern politics of transgression (4), exposing “the sedimented layers of signification themselves” (21), rather than establishing “an originary, true or redemptive body” (21) beneath. The contestational logic of these modes of practice notwithstanding, Stephens (486) notes that performers still typically cite a certain ambivalence about their potential. There are, after all, specific risks for people with disabilities working in this paradigm that are not fully drawn out in the broader debate about critical reappropriation of racist and sexist imagery in performance art. Mobilisations of the freak persona are complicated by the performer’s own corporeal ‘suitability’ to that persona, by the familiar theatrical mechanisms of recognition and reception (which can remain undertheorised in meta-level considerations of the political currency of the freakshow in disability and cultural—rather than performance—studies), and by a dominant cultural discourse that insists on configuring disability as an individual problem detached from the broader sphere of identity politics (Sandahl 598-99). In other words, the territory that still needs to be addressed in this emergent field of practice is the ethics of reception, and the risk of spectatorial (mis)recognitions that reduce the political potency of the freak spectacle. The main risk, of course, is that mobilisations of the freak persona may still be read by spectators as part of the phenomenon they are trying to challenge, the critical counterpositions failing to register, or failing to disrupt fully the familiar scopic and discursive framework. More problematically, the counterpositions themselves may be reduced by spectators to a rhetorical device that distances them from the corporeal reality of the encounter with the other, enabling them to interpret or explain the experience of disability as a personal experience by which an individual comes to accommodate their problems. Whilst the human desire to construct narrative and psychological contexts for traumatic experience cannot be denied, Carrie Sandahl (583) notes that there is a risk that the encounter with the disabled body will be interpreted as part of the broader phenomenon Synder and Mitchell describe in Narrative Prosthesis, in which disability is little more than a metaphor for the problems people have to get past in life. In this interpretative paradigm, disability enters a discursive and theoretical terrain that fails to engage fully the lived experience of the other. Perhaps most problematically, mobilisations of the freak persona may be read as one more manifestation of the distinctively postmodern desire to break free from the constraints of culturally condoned identity categories. This desire finds expression in the increasingly prevalent cultural phenomenon of voluntary enfreakment, in which people voluntarily differentiate, or queer their own experience of self. As Fraser says when he finds out that a company of able-bodied freaks is competing with him for audiences at the Edinburgh Fringe Festival, “[t]he irony is, these days, everyone is trying to get in on our act” (Born Freak). In a brave new world where everybody wants to be a freak, activist artists “must be watchful”, Gómez-Peña warns, “for we can easily get lost in the funhouse of virtual mirrors, epistemological inversions, and distorted perceptions” (288). The reclamation of disability as a positive metaphor for a more dispersed set of human differences in the spectacle of daily life (287-98), and in theoretical figurations of feminist philosophy that favour the grotesque, the monstrous and the mechanical (Haraway Simians, Cyborgs and Women; Braidotti Nomadic Subjects), raises questions for Garland-Thomson (“Integrating Disability, Transforming Feminist Theory” 9) and Sandahl (581-83). If “disability serves as a master trope for difference,” Sandahl says, then anybody can adopt it “…to serve as a metaphor expressing their own outsider status, alienation and alterity, not necessarily the social, economic and political concerns of actual disabled people” (583). The work of disabled performers can disappear into a wider sphere of self-differentiated identities, which threatens to withdraw ‘disability’ as a politically useful category around which a distinctive group of people can generate an activist politics. To negotiate these risks, disabled performers need to work somewhere between a specific, minoritarian politics and a universal, majoritarian politics, as Sedgwick describes in Epistemology of the Closet (91; cf. Garland-Thompson “Integrating Disability, Transforming Feminist Theory” 5; cf. Stephens 493). Performers need to make their experience of otherness explicit, so that their corporeal specificity is not abstracted into a symbolic system that serves the dominant cultural logic. Performers need to contextualise this experience in social terms, so that it is not isolated from the sphere of identity politics. But performers cannot always afford to allow the freak persona to become one more manifestation of the myriad idiosyncratic identities that circulate in the postmodern popular imaginary. It is by negotiating these risks that performers encourage spectators to experience—if only fleetingly, and provisionally—a relationship to the other that is characterised not by generalisation, domestication and containment (Levinas “Substitution” 80, 88), but by respect for the other’s radical alterity, by vulnerability, and, in Derrida’s reformation of Levinasian ethics, by a singular, reciprocal and undecidable responsibility towards the other (Derrida 60-70). This is what Levinas would call an ethical relationship, in which the other exists, but as an excess, a class of being that can be recognised but never seized by comprehension (“Is Ontology Fundamental?” 7, “Transcendence and Height” 17), or sublimated as a category of, or complement to, the same (13, “Meaning and Sense” 51). Mat Fraser’s mobilisation of Sealo the Sealboy is one of the most engaging examples of the way disabled performers negotiate the complexities of this terrain. On his website, Fraser says he has always been aware of the power of confrontational presentations of his own body, and has found live forms that blur the boundaries between freakshow, sideshow and conventional theatre the best forums for “the more brutal and confrontational aspect of my investigation into disability’s difficult interface with mainstream cultural concerns” (MatFraser.co.uk). Fraser’s appropriation of Sealo was born of a fascination with the historical figure of Stanley Berent. “Stanley Berent was an American freakshow entertainer from the 1940s who looked like me,” Fraser says. “He had phocomelia. That’s the medical term for my condition. It literally means seal-like limbs. Berent’s stage name was Sealo the Sealboy” (Born Freak). Fraser first restaged Sealo after a challenge from Dick Zigun, founder of the modern Sideshows by the Seashore. He restaged Berant’s act, focused on Berant’s ability to do basic things like shaving and sawing wood with his deformed hands, for the sideshow’s audiences. While Fraser had fun playing the character on stage, he says he felt a particular discomfort playing the character on the bally platform used to pull punters into the sideshow from the street outside. “There is no powerful dynamic there,” Fraser laments. “It’s just ‘come look at the freak’” (Born Freak). Accordingly, after a season at Sideshows by the Seashore, Fraser readapted the experience as a stage play, Sealboy: Freak, in which Sealo is counterposed with the character Tam, “a modern disabled actor struggling to be seen as more than a freak” (Born Freak). This shift in the theatrical mechanisms by which he stages the freak gives Fraser the power to draw contemporary, politically correct spectators at the Edinburgh Fringe Festival into the position of sideshow gawkers, confronting them with their own fascination with his body. A potent example is a post-audition scene, in which Tam says I read this book once that said that the mainstream will only see a disabled performer in the same way they view a performing seal. Very clever, but just mimicry. No. No it can’t be like that anymore. We’ve all moved on. People are no longer more fascinated by how I do things, rather than what I say. I am an actor, not a fucking freak. (Born Freak) But, as Tam says this, he rolls a joint, and spectators are indeed wrapped up in how he does it, hardly attending to what he says. What is interesting about Fraser’s engagement with Sealo in Sealboy: Freak is the way he works with a complicated—even contradictory—range of presentational strategies. Fraser’s performance becomes explicit, expositional and estranging by turns. At times, he collapses his own identity into that of the freak, the figure so stark, so recognisable, so much more harshly drawn than its real-life referent, that it becomes a simulacrum (cf. Baudrillard 253-282), exceeding and escaping the complications of the human corporeality beneath it. Fraser allows spectators to inhabit the horror, and the humour, his disabled identity has historically provoked, reengaging the reactions they hide in everyday life. And, perhaps, if they are an educated audience at the Fringe, applauding themselves for their own ability to comprehend the freak, and the crudity of sideshow display. However, self-congratulatory comprehension of the freak persona is interrupted by the discomforting encounter with Tam, suspending—if only provisionally—spectators’ ability to reconcile this reaction with their credentials as a politically correct audience. What a closer look at mobilisations of the freak in performances such as Fraser’s demonstrates is that manipulating the theatrical mechanisms of the stage, and their potential to rapidly restructure engagement with the extraordinary body, enables performers to negotiate the risk of (mis)recognition embedded in the face-to-face encounter between self and spectator. So configured, the stage can become a site for contesting the cultural logic by which the disabled body has historically been defined. It can challenge spectators to experience—if fleetingly—the uncertainties of the face-to-face encounter with the extraordinary body, acknowledging this body’s specificity, without immediately being able to abstract, domesticate or abdicate responsibility for it—or abdicate responsibility for their own reaction to it. Whilst spectators’ willingness to reflect further on their complicity in the construction of the other remains an open and individual question, these theatrical manipulations can at least increase the chance that the cathartic effect of the encounter with the so-called freak will be disrupted or deferred. References Adams, Rachel. Sideshow USA: Freaks and the American Cultural Imagination. Chicago, IL: University of Chigaco Press, 2001. Baudrillard, Jean. “The Precision of Simulacra”. Art After Modernism: Rethinking Representation. Ed. Brian Wallis. Boston, MA: David R. Godine, 1984, 253-282. Born Freak. Dir. Paul Sapin. Written Paul Sapin and Mat Fraser. Planet Wild for Channel 4 UK, 2001. Braidotti, Rosi. Nomadic Subjects: Embodiment and Sexual Difference in Contemporary Feminist Thought. New York, NY: Columbia University Press, 1994. Bogdan, Robert. Freakshow: Presenting Human Oddities for Amusement and Profit. Chicago, IL: University of Chicago Press, 1988. Deleuze, Gilles, and Felix Guattari. A Thousand Plateaus: Capitalism and Schizophrenia. Trans. Brian Massumi. Minneapolis, MN and London: University of Minnesota Press, 1987. Derrida, Jacques. Gift of Death. Trans. David Wills. Chicago IL: University of Chicago Press, 1995. Fraser, Mat. “Live Art”. MatFraser.co.uk. n.date. 30 April 2008 ‹http://www.matfraser.co.uk/live_art.php›. Foucault, Michel. The Birth of the Clinic: An Archeology of Medical Perception. Trans. AM Sheridan Smith. London: Routledge, 1976. Garland-Thomson, Rosmarie. “Integrating Disability, Transforming Feminist Theory”. NSWA Journal 14.3 (2002): 1-33. ———. Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature. New York, NY: Columbia University Press, 1997. ———. “Introduction: From Wonder to Error—A Genealogy of Freak Discourse”. Freakery: Cultural Spectacles of the Extraordinary Body. Ed. Rosmarie Garland-Thomspon. New York, NY and London: New York University Press, 1996. Gómez-Peña, Guillermo. “Culture-in-extremis: Performing Against the Cultural Backdrop of the Mainstream Bizarre”. The Performance Studies Reader. Ed. Henry Bial. London and New York: Routledge, 2004, 287-298. Haraway, Donna. Simians, Cyborgs and Women. New York, NY: Routledge, 1991. Kuppers, Petra. Disability and Contemporary Performance: Bodies on Edge. New York, NY: Routledge, 2004. Levinas, Emmanuel. “Is Ontology Fundamental?”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 1-10. ———. “Transcendence and Height”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 11-31. ———. “Meaning and Sense”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 33-64. ———. “Substitution”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 79-95. Mazer, Sharon. “‘She’s so fat…’ Facing the Fat Lady at Coney Island’s Sideshows by the Seashore”. Bodies Out of Bounds: Fatness and Transgression. Ed. Jana Evens Braziel and Kathryn LeBesco. Berkeley, CA: University of California Press, 2001, 257-276. Sandahl, Carrie. “Black Man, Blind Man: Disability Identity Politics and Performance”. Theatre Journal 56 (2004): 597-602. Schneider, Rebecca. The Explicit Body in Performance. New York, NY and London: Routledge, 1997. Sedgwick, Eve Kosofsky. Epistemology of the Closet. Berkeley, CA: University of California Press, 1990. Snyder, Sharon L. and David T Mitchell. “Re-engaging the Body: Disability Studies and the Resistance to Embodiment”. Public Culture, 13.3 (2001): 367-389. ———. Narrative Prosthesis: Disability and the Dependencies of Discourse. Ann Arbor, MI: University of Michigan Press, 2000. Stephens, Elizabeth. “Cultural Fixations of the Freak Body: Coney Island and the Postmodern Sideshow”. Continuum: Journal of Media and Cultural Studies 20.4 (2006): 485-498. Acknowledgements An earlier version of this paper was presented at “Extreme States: Issues of Scale—Political, Performative, Emotional”, the Australasian Association for Drama Theatre and Performance Studies Annual Conference 2007.

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). 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