Journal articles on the topic 'Nurses Great Britain'

There has been much debate about effective treatments, service configurations and costs within Britain's mental health care system, but it has largely taken place in academic and management circles. We were interested in the views of those providing care. We organised a meeting of community psychiatric nurses, general practitioners and consultant psychiatrists (funded with an educational grant from Zeneca Pharmaceuticals). Participants worked in various parts of Great Britain, including rural and inner city areas. The authors facilitated the discussion, the emphasis of which was on participants' clinical experience.

BackgroundDoctors have a higher prevalence of mental ill health compared with other professional occupations but incidence rates are poorly studied.AimsTo determine incidence rates and trends of work-related ill health (WRIH) and work-related mental ill health (WRMIH) in doctors compared with other professions in Great Britain.MethodIncidence rates were calculated using an occupational physician reporting scheme from 2005–2010. Multilevel regression was use to study incidence rates from 2001 to 2014.ResultsAnnual incidence rates for WRIH and WRIMH in doctors were 515 and 431 per 100000 people employed, respectively. Higher incidence rates for WRIH and WRMIH were observed for ambulance staff and nurses, respectively. Doctors demonstrated an annual average incidence rates increase for WRIH and WRMIH, especially in women, whereas the other occupations demonstrated a decreasing or static trend. The difference in trends between the occupations was statistically significant.ConclusionsWRIH and WRMIH incidence rate are increasing in doctors, especially in women, warranting further research.

Campaigns for state nursing registration in the United States and Great Britain have a prominent place in the historical scholarship on nursing professionalization; the closely related German campaign has received less scholarly attention. Applying a transnational perspective to these three national movements highlights the collaborative and interrelated nature of nursing reform prior to World War I and recognizes the important contribution of German nurses to this dialogue and agenda. Focusing particularly on the years 1909–12, this article depicts a generation of German, American, and British nurses who organized national and international nursing associations to realize state registration as a stepping stone to other markers of professional recognition, such as collegiate education, full political citizenship, social welfare, and labor legislation. However, the consequent reliance of these strategies on nation-states as arbiters of citizenship and professional status undermined the shared ideological foundation of international and national nursing leaders. This article contributes to a more multinational understanding of how these international nursing leaders transcended and were confined by the limits of their nation-states in the years leading up to World War I.

Background: Prior to the development of the Journal of Vascular Societies Great Britain & Ireland (JVSGBI), there were limited opportunities for UK based vascular health professionals to publish research relevant for UK vascular practice. A survey was developed to evaluate the appetite and potential infrastructure for a UK vascular journal amongst vascular healthcare professionals. Methods: In May 2020, an online questionnaire was administered by The Vascular Society of Great Britain and Ireland (VSGBI) Research Committee, surveying vascular health professionals regarding the development of a UK-specific vascular journal. The survey was disseminated via email to multi-disciplinary members of the vascular community with links promoted on social media. Results: Responses were received from 359 individuals identifying predominantly as surgeons (38%), nurses (8%), technologists (10%), radiologists (20%), trainees (10%), physiotherapists (7%) and other (7%). The majority of participants (67%) indicated they would be in favour of a UK-specific vascular journal and that it should be available as an online quarterly publication. Almost three quarters (74%) of respondents thought a subscription fee should be included in societies’ membership fees. Free text comments highlighted a few concerns, suggesting the focus should instead be to improve the quality of existing vascular journals. However, most respondents welcomed the idea of a journal relevant to UK practice, with inclusivity of all UK vascular professions to encourage more collaborative working. Conclusions: Overall, feedback collected from the survey was positive and suggested a demand for a UK-specific vascular journal, providing an indication that the development of such a journal should be further explored. The results of this survey helped to inform the development of the JVSGBI.

BackgroundAnticipatory prescribing (AP) of injectable medications in advance of clinical need is established practice in community end-of-life care. Changes to prescribing guidelines and practice have been reported during the COVID-19 pandemic.Aims and objectivesTo investigate UK and Ireland clinicians’ experiences concerning changes in AP during the COVID-19 pandemic and their recommendations for change.MethodsOnline survey of participants at previous AP national workshops, members of the Association for Palliative Medicine of Great Britain and Ireland and other professional organisations, with snowball sampling.ResultsTwo hundred and sixty-one replies were received between 9 and 19 April 2020 from clinicians in community, hospice and hospital settings across all areas of the UK and Ireland. Changes to AP local guidance and practice were reported: route of administration (47%), drugs prescribed (38%), total quantities prescribed (35%), doses and ranges (29%). Concerns over shortages of nurses and doctors to administer subcutaneous injections led 37% to consider drug administration by family or social caregivers, often by buccal, sublingual and transdermal routes. Clinical contact and patient assessment were more often remote via telephone or video (63%). Recommendations for regulatory changes to permit drug repurposing and easier community access were made.ConclusionsThe challenges of the COVID-19 pandemic for UK community palliative care has stimulated rapid innovation in AP. The extent to which these are implemented and their clinical efficacy need further examination.

Purpose – The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare organisations. Design/methodology/approach – The Östergötland county council, Sweden (CCÖ) was chosen as a case study for an healthcare Lean-thinking dissemination strategies. Document analysis and interviews were used and results were compared with similar strategies employed by staff at the National Health Service Institute for Innovation (NHSI) and improvement in Great Britain and the Odense University Hospital in Denmark. Findings – The Lean improvement programme was introduced to tackle challenges such as an ageing society, rising care expectations and budgetary and economic constraints. It was designed as a long-term programme to create added value for patients and employee involvement. The dissemination strategy was: forming clear visions and objectives; piloting; training potential adopters; and formal dissemination. The CCÖ strategy was focused primarily on managers and was not meant to involve all staff until the implementation stage. Staff at the NHSI attempted to address nurses’ needs during dissemination, which questioned whether the CCÖ managers’ dissemination strategy is sustainable. Practical implications – This paper inspires healthcare managers and decision makers who aim to disseminate Lean production in their organisations. Originality/value – There are many case studies describing Lean implementation in single healthcare organisations, but little is known about effective dissemination and implementation strategies in large healthcare systems. The authors, therefore, suggest activities for developing and implementing dissemination strategies in multiple healthcare organisations.

Ulcerative colitis and Crohn’s disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn’s and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn’s disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn’s disease, including patients, their families and friends.

Abstract The article covers current problems of professional training of junior medical staff. The main disadvantages of Ukrainian system of medical education that impede the intention of improving quality of professional training of junior medical staff have been analyzed. European experience in organizing medical education, namely, in Great Britain, Georgia, Italy, Poland and France has been studied. It has been determined that foreign experience in training medical junior staff differs from that in Ukraine. Comparative characterization of European and Ukrainian experience in training future nurses and midwives has been presented. The advantages of European professional training of future medical junior staff have been highlighted. It has been found out that in Europe more attention is paid to clinical disciplines than in Ukraine due to an increase in the number of academic hours allocated for practical training at clinical sites. The author emphasizes importance of independence in the process of training future junior medical staff in European educational space. The need for introducing into the education process of professional medical training in Ukraine communicative disciplines, including Pedagogy, which have long been used in medical education in Europe, has been specified. The author has considered the main features of apprenticeship being a new form of training in Ukrainian medical education that combines theoretical training and paid hospital placement. It has been concluded about European innovative trends in Ukrainian medical industry and gradual introduction of continuing consecutive education. It has been stressed that it is rather relevant to incorporate positive aspects of foreign experience in organizing medical education into modern reforms as well as new curricula in Ukraine.

This paper discusses the change in women’s mentality towards the concept of war and their own role in it according to autobiographical sources such as was journals, diaries, letters or autobiographical novels authored by women who were present at the front during the Great War. The primary sources quoted in this analysis include letters and diaries from nurses who worked in Dr. Elsie Inglis’s Scottish Women’s Hospitals unit as well as the “testament” of Vera Mary Brittain, famous English Voluntary Aid Detachment nurse and writer and women’s rights activist. Among the secondary sources employed in the analysis are the seminal works of Christine E. Hallett, Maxine Alterio, Santanu Das, Eric J. Leed and Claire M. Tylee. Before arriving at a conclusion, the paper highlights important changes in women’s discourse towards the war as well as the way in which such changes were supported by the novel situation in which women found themselves, namely as active participants at the front, and their aspirations towards equal rights and equal treatment.

E.P. Thompson was nursed on a mother's milk of transatlantic missionary work and writings on the Middle East that reached back to the last half of the nineteenth century. Fathered on Bengali literature, the poetry of the Great War, cricket with the likes of Nehru, and the struggle for Indian independence, Thompson was born into a highly literate and deeply politicized global village. Small wonder that at seventeen he was an anti-fascist and a soldier. But he took a wide Left turn, following in a brother's footsteps, to become a Marxist and a Communist in his twenties, only to find himself, by 1956, donning dissident dress, leading an exodus from the Communist Party of Great Britain, building a revolutionary New Left in the seemingly unpropitious climate of the late 1950s.

Objectives: Controversy exists regarding the management of varicose veins at the level of the popliteal fossa. This questionnaire reviews the current practice of vascular surgeons. Methods: A postal questionnaire was sent to 440 consultant surgeon members of the Vascular Society of Great Britain and Ireland. Recipients were asked to indicate their current practice of investigation and management of small saphenous (SSV), gastrocnemius and Giacomini varicosities. Results: We have received 296 (67%) responses to the questionnaire. Duplex scanning is utilized by 275 (93%) for the initial assessment of patients. Preoperatively, 188 (64%) reuse duplex scanning to mark the saphenopopliteal junction (SPJ) site, 53 (18%) mark with handheld Doppler only and 24 (8%) do not mark the SPJ. At operation, 198 (67%) flush ligate the SPJ and 87 (29%) tie the SSV 2–3 cm from the junction. A total of 101 (34%) usually strip the SSV to various levels. In symptomatic patients, 158 (53%) ligate the SPJ when an incompetent segment of SSV with a competent SPJ exists. One hundred and sixty-nine (57%) disconnect incompetent gastrocnemius veins during SPJ surgery and 172 (58%) regularly look for the Giacomini vein. Routine follow-up after surgery is practised by 172 (58%), most commonly at six weeks. This is mostly (88%) by clinical examination, with 14 (8.1%) using duplex scanning and six (4.7%) using a nurse-run clinic for the follow-up. Conclusions: This review suggests marked variation in the management of popliteal fossa venous incompetence. There is a clear need for further research to clarify the role of ablation in the management of symptoms and skin changes.

INTRODUCTION The use of supervised exercise in the management of intermittent claudication is well supported by level I evidence upon which are based grade A recommendations by the TASC II Inter-Society Consensus for the Management of Peripheral Arterial Disease and the Scottish Intercollegiate Guidelines Network (SIGN). These include that supervised exercise should be made available as part of the initial treatment for all peripheral arteriopaths. SUBJECTS AND METHODS A questionnaire, comprising 10 questions, was drawn up to address the issues pertinent to supervised exercise in intermittent claudication. This was distributed by post, along with a pre-stamped return envelope, to all ordinary members of the Vascular Society of Great Britain and Ireland (VSGBI). All returned and received questionnaires had their responses entered onto a pre-prepared spreadsheet. RESULTS Of the 186 questionnaires posted to UK resident surgeons, 84 were returned. This equates to a response rate of 45%. Of the responders, only 24% had access to supervised exercise. There was a large spread in the proportion of eligible patients which were referred to a programme, with only 14% of VSGBI members recommending 100% of eligible patients. Rates of non-compliance varied greatly. Contra-indications to supervised exercise included cardiac (27%), and vascular, musculoskeletal, geographic, and respiratory (8% each). Most supervised exercise sessions (85%) were 1 h in duration. The majority (65%) of programmes comprised one session per week. With regards the duration of programme, 55% were 3 months. Almost all classes were led by either a physiotherapist (41%) or a nurse (48%). In centres where no supervised exercise programme was available, verbal advice was given by 63%, with 34% offering leaflets. A supervised exercise set up has not been achieved due to lack of resource in 72%. CONCLUSIONS These results are contrary to the recommendations offered by the TASC II Inter-Society Consensus and SIGN, in particular in terms of availability and referral to supervised exercise, as well as frequency of the classes where programmes were in place. The offer of information either verbally or via leaflet is commended; however, this has been shown as inferior to supervised exercise. Quoting resource as the reason for non-implementation goes against the published quality-of-life and pharmaco-economic data, which promote supervised exercise as both functionally and financially effective. This work highlights the importance of translating the results of research into evidence-based clinical practice.

Dear Editor, I was exposed to a COVID-19 positive cardiologist last March 1. I had ENT clinics until March 11, treating mostly patients with complaints of cough and fever (sinusitis and bronchitis). I felt that my facial mask, hooded magnifier lens, and gloves gave me enough protection. I was wrong. They were not sufficient. I had a temperature of 38°C on March 13 and went home immediately to self-isolate. By March 15, I was coughing unremittingly and persistently as if a feather was stuck in my throat. I had no phlegm. I had no running nose, nor respiratory difficulty. But my rib muscles ached continuously - an intense, miserable pain not relieved by any position. I felt a severe point tenderness over both lower back ribs that even soft pillows could not diminish. I lacked sleep. I felt weaker as days went by. My taste was flat as I swallowed soups and arroz caldo but I still had my sense of smell. On March 16, I took Clarithromycin 500 mg and N-Acetylcysteine 600 mg, both twice daily to treat what I diagnosed as acute pharyngitis. Two more days of severe coughing, fever and sore throat made me worry about COVID-19. How come I was not getting better? In fact, I was getting BITTER over this uncertainty of COVID-19 and the treatment I had prescribed myself. I had been religiously taking probiotics to imbue me with immunity for infections like these.1 I believed that lactobacillus acidophilus, the friendly gut bacteria, stimulates the Gut Associated Lymphoid Tissue (GALT) to produce antibodies against virus and bacteria shedding into small intestines and against bacteria abnormally multiplying in the large intestine.2 I was assured by the research of Russian Dr. Elie Metchnikoff on the potent lactobacillus in yogurt (which comprised almost 50% of the Bulgarian diet and made them strong and healthy). Dr. Metchnikoff (who had won the 1908 Nobel Prize in Physiology and Medicine) honored Bulgaria by naming his friendly bacteria lactobacillus bulgaricus.3,4 Dr. Metchnikoff was later honored as the “father of natural immunity.”5 Then came the Spanish flu of 1918-1919 that killed more than 2.5 million Europeans, mostly Italians and British.6 Yet the number of those killed in Bulgaria was as close to that in Switzerland, which was the lowest. Now, the COVID-19 pandemic marched into 2020 killing 4,633 patients out of 82,918 COVID+ in Wuhan, China; 31,855 out of 219,183 COVID+ in Great Britain; 30,560 out of 219,070 COVID+ in Italy; and 80,787 out of 1,367,638 COVID+ in the USA. Ninety-one died of COVID out of 1,965 positive for COVID-19 in Bulgaria.7 I was confident that the lactobacillus acidophilus 20 billion Colony Forming Units (CFU) were stimulating production of the IgG and IgM (from GALT which produces 70% of the body’s immune globulins) needed to neutralize viruses or bacteria.8 The acidophilus produces Vitamin B specially Vit B129 which I believe made for my stronger body. I had prepared myself as I prepared my patients for the flu by consuming Vit C and Zinc. Zinc stimulates the thymus to increase immune responses to viruses.10,11 I was fortified with 2 Colostrum pills daily, preformed sources of IgG and IgA.12 I followed my regimen for acute rhinitis (though there was no nasal obstruction) which meant doing nasal SALINE washing or sprays thrice a day. I knew that the flu virus (or even the SARS-COV2) hides EARLY in the nose and sinuses and is able to produce toxins which inflame the whole body. Worse for SARS-COV2 because these drop into the tonsils and into the lungs. The nasal sprays were meant to reduce the virus numbers (viral load) in the nose and sinuses so there were less shedding. Saline washes decongest the nose to improve breathing. The 60 seconds antiseptic mouthwash followed a regimen of brushing the teeth then the palate and the tonsils and to the base of the tongue. This was to extinguish any virus lurking to go down into the lungs or GIT. This regimen was routine at 3x a day. The fever dropped slowly. Coughing diminished though the muscles constantly ached after 3 days of Clarithromycin. I was determined to have the COVID tests and a high resolution CT scan of the chest. On March 20 at the hospital ER, I explained I was a patient requesting a CBC, a COVID test, and a chest CT scan and that I will wait for my turn since the ER was full (took me 3 hours). After the interview with the ER physician, I was led to a seat one meter apart from others. Elderly patients with cough all quizzically looked at me in my white doctor’s gown wondering if I was sick. I changed to the gown, mask, and gloves I was provided with when the nurse escorted me to cubicle one. First came the CBC. Next were Rt-PCR swabs of the nose and nasopharynx and of the throat. Finally after the staff sterilized the CT scan room, my scan was completed in a few minutes. The chest scan showed ground glass appearance consistent with Bilateral Basal Pneumonia. I was told that the PCR results would be ready within 7 days. I was advised urgently by my classmate, a pulmonary specialist from another hospital, for admission for oxygen inhalation and treatment. She went out of her way to look for a pulmonologist but none was available due to quarantine. She looked for an Infectious Disease Specialist who was now in isolation. I requested her that since I was not in respiratory distress and because of my weakened state, I was worried about getting a hospital acquired infection and that I be committed to strict home isolation with treatment prescribed by her. She reluctantly acceded with the admonition that I proceed immediately back to hospital if respiratory difficulties occur. I started the Oseltamivir (Tamiflu) at 2x a day for 5 days and Azithromycin once daily for 7 days plus a mucolytic N- Acetylcysteine 600 mg 2x a day. There was another dimension beyond my physical stress. I was in MENTAL stress, the pervasive fear of not surviving this that engulfed me. Knowing my close colleagues died from COVID-19 pneumonia after a short battle in ICU with intubation, I realized THIS certainty of death and THAT uncertainty of recovery. I asked for a lifeline from my UP Med ‘76 classmates. (The lifeline in the family was unconditionally given though from a distance). My pulmonologist classmate closely monitored my condition daily. Some offered their listening ears to my echoing worries. Most prayed to God with their unconditional love for me to recover. Another classmate had extraordinary pranic sessions for my healing, my relaxation and my energy. I reflected on my dad’s advice that in a righteous fight (like against this pneumonia), “you use all means and all ways to win.” I started deep breathing into the nose and slowly out through the mouth knowing full well that the nitric oxide I absorbed through the roof of the nose dilated my coronaries for better heart function and my pulmonary arteries for better oxygen exchange. The deep breathing provided nitric oxide to the bronchus and bronchioles to dilate them for more airflow. Moreover, I was taking in lots of calamansi juices (or lemon or oranges) for its citrulline which has been researched to prolong the effects of nitric oxide.13 These breathing sessions were the MOST IMPORTANT activities if I were to survive and were continuous morning, noon and evening. Fortunately, I was isolated in 3rd floor Music Room with access to the roof deck garden and fresh air from Laguna de Bay (about 1.5 km from the house in Taguig) and of course, LPs of the Beatles, Aiza and Sharon, and Mozart. I did chest thumping or percussion as far as I could reach my back to loosen the phlegm in my lungs. This self ‘physical therapy’ was 3x a day. I started to spit scanty whitish, thick phlegm. I made sure that Oseltamivir (Tamiflu) was taken mornings and evenings and the Azithromycin was taken at lunch so there were no drug interactions. The 2 Colostrum tabs were swallowed on waking up. The probiotics were taken after breakfast and after dinner. The Zinc was taken after lunch. Soft stools were present but that was my GIT reacting to the medications. Adding to the controversy was the new regimen US President Donald Trump was trumpeting on Fox News and CNN. A hospitalist physician treating COVID-19 pneumonias in San Francisco was giving us the new protocols for Chloroquine and Azithromycin, with promising results. He was the classmate of my daughter in UP Med. I went to pharmacies in Taguig and Greenhills for Chloroquine. It was not available. My pulmonologist classmate was firm; “No!” when I suggested the shift. “You will need confinement and an ECG because these combination drugs prolong QTc on electrocardiogram.” This meant Chloroquine and Azithromycin combination may initially precipitate bradycardia (lower heart rate) then ventricular tachycardia (heightened heart rate), and finally, cardiac arrest for senior patients (68 years old) like me with a history of hypertension. This discussion stopped all controversies in treatment. Moreover, I was getting better. My temperature decreased to 37.8 °C. The muscle pain diminished. The severe point tenderness over the lower ribs persisted. I was deep-breathing which I could not hold for more than 10 seconds. That was not normal! I listened to my lungs for the CRACKLING sounds of pneumonia with my stethoscope. The maze of gurgling and churning sounds from the stomach and intestines seemed to mask the sounds I was listening for. Or was I in denial? I decided to go back to ER on the 3rd day for a chest X ray. The objective was to see if my pneumonia was progressing. The chest X ray still showed basal pneumonia. I had mixed feelings-- good that pneumonia did not progress to middle lung fields and --- bad that pneumonia was festering. I completed the 5-day regimen of Oseltamivir (Tamiflu) and was continuing the 8th day of Azithromycin and N-Acetylcysteine when my COVID test finally arrived through email-- I was COVID positive #1906 . By this time, I was recovering physically and mentally. I had no fever (37.2 °C average), no cough, no sore throat. Breathing was full. I had my appetite back. My outlook was as OPTIMISTIC as the blooming flowers I nurtured during this trial. This timing was fortunate because even with confirmed COVID-19 positive, I knew I had beaten COVID-19 pneumonia at home. Isolation was completed 2 weeks from my recovery which necessitated another COVID test and rapid test April 10, 2020. This test was still positive. A third PCR done on April 20 was negative for SARSCoV-2. The new DOH protocol was to isolate up to May 5 which I have followed. I am practicing social distancing and wearing a mask.

The focus of this article is to provide the reader with reflexivity and a framework for using mobile ethnography. Based on a case study with an ethnographic approach (including mobile ethnography using WhatsApp), we identified perceptions and practices for improved workflows and procedures related to nurses’ introduction and implementation of self-catheterization at the National Spinal Injuries Centre in Great Britain. We offer detailed procedures, advantages, and challenges in using mobile ethnography. The ethnographic approach consisted of four phases, including initial workshops, go-along observations, interviews, and a mobile ethnographic approach using WhatsApp as a mobile diary for six nurses. Within the case study, three major themes were revealed by the ethnographic approach, with the conclusion that nurses have positive attitudes towards self-catheterization, but these nurses are becoming less influential and the practices around this technique are consequently disappearing. The main result is that use of WhatsApp as a self-tracking tool can extend the methodological toolbox, but reflexivity and preliminary work are required to make the practice beneficial.

The COVID-19 pandemic has negatively affected the work of many medical professionals, including the group of nurses. This study aimed at assessing the impact of the COVID-19 pandemic on job satisfaction of nursing staff in five European countries. The study was conducted using the Job Satisfaction Scale (SSP) and original questions on the job satisfaction. The cross-sectional online study was conducted with a sample of 1,012 professionally active nurses working in Poland, Germany, Italy, Great Britain and Sweden, who assessed their job satisfaction before (retrospectively) and during the pandemic. The results showed a significant decrease in job satisfaction due to the need to perform it during the pandemic caused by the SARS-CoV-2 virus. In 8 out of 10 examined parameters of job satisfaction, a statistically significant decrease in job satisfaction was observed at the level of p < 0.05. Among the examined factors influencing job satisfaction, the highest decrease was recorded based on the assessment of working conditions (1,480). A high level of satisfaction with the work of nurses has a significant impact on providing better patient care as well as reducing the risk of professional burnout of nurses.

BackgroundTelemedicine for medical abortion care was rapidly introduced in Great Britain in response to the COVID-19 pandemic. A growing body of literature demonstrates that telemedicine abortion care is safe, effective and highly acceptable to patients. Less is known about the perspectives of abortion care providers (ACPs).MethodsQualitative research within the telemedicine abortion service in Lothian (Edinburgh and surrounding region), UK. We conducted qualitative in-depth interviews with ACPs between May and July 2020 (doctors, n=6; nurses, n=10) and analysed the data thematically.ResultsWe present three themes from our qualitative analysis: (1) Selective use of ultrasound – the move away from routine ultrasound for determination of gestational age was generally viewed positively. Initial anxiety about non-detection of ectopic pregnancy and later gestations was expressed by some ACPs, but concerns were addressed through clinical practice and support structures within the clinic. (2) Identifying safeguarding issues – in the absence of visual cues some ACPs reported concerns about their ability to identify safeguarding issues, specifically domestic violence. Conversely it was acknowledged that teleconsultations may improve detection of this in some situations. (3) Provision of information during the consultation – telephone consultations were considered more focused than in-person consultations and formed only part of the overall ‘package’ of information provided to patients, supplemented by online and written information.ConclusionsACPs providing telemedicine abortion care value this option for patients and believe it should remain beyond the COVID-19 pandemic. Safeguarding patients and the selective use of ultrasound can be initially challenging; however, with experience, staff confidence improves.

Abstract Social theory has long predicted that social mobility, in particular downward social mobility, is detrimental to the well-being of individuals. Dissociative and “falling from grace” theories suggest that mobility is stressful due to the weakening of social ties, feelings of alienation, and loss of status. In light of these theories, it is a puzzle that the majority of quantitative studies in this area have shown null results. Our approach to resolve the puzzle is two-fold. First, we argue for a broader conception of the mobility process than is often used and thus focus on intragenerational occupational class mobility rather than restricting ourselves to the more commonly studied intergenerational mobility. Second, we argue that self-reported measures may be biased by habituation (or “entrenched deprivation”). Using nurse-collected health and biomarker data from the UK Household Longitudinal Study (2010–2012, N = 4,123), we derive a measure of allostatic load as an objective gauge of physiological “wear and tear” and compare patterns of mobility effects with self-reports of health using diagonal reference models. Our findings indicate a strong class gradient in both allostatic load and self-rated health, and that both first and current job matter for current well-being outcomes. However, in terms of the effects of mobility itself, we find that intragenerational social mobility is consequential for allostatic load, but not for self-rated health. Downward mobility is detrimental and upward mobility beneficial for well-being as assessed by allostatic load. Thus, these findings do not support the idea of generalized stress from dissociation, but they do support the “falling from grace” hypothesis of negative downward mobility effects. Our findings have a further implication, namely that the differences in mobility effects between the objective and subjective outcome infer the presence of entrenched deprivation. Null results in studies of self-rated outcomes may therefore be a methodological artifact, rather than an outright rejection of decades-old social theory.

Abstract Background The technical competence of oesophagogastroduodenoscopy (OGD) is rapidly acquired but to support the practice of complete examination, the British Society of Gastroenterology (BSG) and Association of Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) strongly recommend photo-documentation of 8 standardized set stations in an OGD. Photo-documentation ensures complete examination, opportunity to inspect area of interest and serves as a legal record of adequate procedure. Methods Retrospective single center study involving review of randomly selected 100 OGD reports from 1/1/2018 till 31/3/2020 from the Endorad system. The reports on online Endorad system were reviewed for photo-documentation of 8 set stations and was also used to collect data on age, sex and the endoscopist. Microsoft Excel was used for data entry and analysis. Results Out of the 100 OGDs reviewed, 58% were males and 42% females. The mean age being 62.7 +/- 13.5. 60% of OGDs were done by surgeons, 25% by gastroenterologist and 15% by Advanced Nurse Practioner. No report had photo-documentation of all 8 stations. Most (40%) had photos of 5 stations, most common was photo evidence at retroflexion (95%) followed by photographic evidence of intubation to D2 (84%). Conclusions OGD is the gold standard test for the investigation of upper gastrointestinal symptoms, the importance lies in the early detection of cancers which maybe amenable to endoscopic treatment. For this reason its important to adhere to guidelines to improve quality in OGD

Purpose-With increased demand and restricted healthcare resources, it becomes important to take a step back and evaluate the efficiency of healthcare delivery. The present study aims to evaluate the health system efficiency of India by benchmarking it against its peers in BRICS countries and against OECD countries. Design/Methodology/Approach: The input and output variables required for measuring the efficiency of healthcare system were identified. A Data Envelopment Analysis (DEA) approach was used and efficiency frontier identified with the rankings of the BRICS and OECD countries. India is thus benchmarked against its peers (BRICS) and against OECD countries. Finding: India was found to operate at the efficiency frontier along with China, Russia, Brazil, and South Africa, however it ranked fourth. When benchmarked against OECD countries, India operates on the efficiency frontier along with Canada, Greece, Japan, Korea, Mexico, Spain, Sweden, Switzerland, Turkey, Great Britain, Chile and Israel. Countries like Germany, United States of America, Czech Republic, Slovakia and Lithuania operate at a lower healthcare efficiency and need to use their resources wisely. Practical/Research Implications: Developing countries like India can look to improve its healthcare system delivery by replicating best practices of healthcare systems from its peers and the top 10 OECD countries. Majority of the OECD countries in the top 10 have implemented universal health coverage, have higher physician and nurse density and higher hospital bed ratios. They are inclined towards branded drugs vis-à-vis generics and have follow evidence based medicine. From a theoretical perspective, it adds to the body of literature of DEA and health system efficiency. Originality/Value: This is a pioneer study that benchmarks India against its peers and against OECD countries drawing unique insights about healthcare efficiency

Abstract Background Pancreatico-duodenectomy (PD) results in major anatomical changes that have an impact on nutritional status and quality of life. Issues such as pancreatic exocrine insufficiency (PEI), diabetes mellitus (DM), malnutrition, micronutrient deficiency, osteoporosis and other gastrointestinal diseases are common in the post-operative setting (1, 2). Appropriate treatment of these surgical consequences is associated with improved survival (3, 4), and should improve quality of life. The aim of this survey was to assess current practice and identify which disciplines were reviewing patients following PD, what format that review takes and the duration of follow up. Methods A UK wide electronic survey was developed using Qualtrics® software (SAP America Inc. USA) to capture all the nutritional aspects of follow up thought to be relevant in the long term. Markers of endocrine failure and malnutrition (weight, nutritional assessment and biochemical vitamin and mineral screens), smoking and alcohol cessation advice and the use of dual energy x-ray absorptiometry (DEXA) scans were included. The survey was piloted on 5 staff locally prior to being circulated through a professional network – the Pancreatic Society of Great Britain and Ireland (PSGBI). Data were analysed using Chi-Square tests in SPSS (Version 26). Results One hundred and one (23% response rate) clinicians completed the survey, with 83 useable data sets. Surgeons and dietitians were most likely to reply to the questionnaire, 88% of respondents worked in tertiary centres, half (55%) had more than 10 years’ experience. There were highly significant variations in practice according to clinician experience, underlying pathology, and institution (p < 0.001 in all cases). Diabetes screening did not occur in 30% of cases. Lifelong follow up was offered by 24% of clinicians (17 surgeons, 3 dietitians, 1 nurse), in pre-malignant (n = 15), benign (n = 11) and malignant disease (n = 10) (P < 0.001). Conclusions Whilst this study may be biased towards those with an interest in follow up, we still demonstrated a need to improve the provision of long-term follow up for patients who have undergone PD, especially since provision of a comprehensive assessment appeared to be associated with clinician experience, and varies between institutions. More evidence for the benefits of long-term follow up and the optimal content is required to inform the development of clinical guidance. Early detection of clinical consequences may improve quality of life and reduce complications associated with poorly managed endocrine and exocrine failure.

Introduction“From every kind of man obedience I expect; I’m the Emperor of Japan.” (“Miyasama,” from Gilbert and Sullivan’s musical The Mikado, 1885)This commentary is facilitated by—surprisingly resilient—oriental stereotypes of an imagined Japan (think of Oscar Wilde’s assertion, in 1889, that Japan was a European invention). During the Victorian era, in Britain, there was a craze for all things oriental, particularly ceramics and “there was a craze for all things Japanese and no middle class drawing room was without its Japanese fan or teapot.“ (V&A Victorian). These pastoral depictions of the ‘oriental life’ included the figures of men and women in oriental garb, with fans, stilt shoes, kimono-like robes, and appropriate headdresses, engaging in garden-based activities, especially tea ceremony variations (Landow). In fact, tea itself, and the idea of a ceremony of serving it, had taken up a central role, even an obsession in middle- and upper-class Victorian life. Similarly, landscapes with wild seas, rugged rocks and stunted pines, wizened monks, pagodas and temples, and particular fauna and flora (cranes and other birds flying through clouds of peonies, cherry blossoms and chrysanthemums) were very popular motifs (see Martin and Koda). Rather than authenticity, these designs heightened the Western-based romantic stereotypes associated with a stylised form of Japanese life, conducted sedately under rule of the Japanese Imperial Court. In reality, prior to the Meiji period (1868–1912), the Emperor was largely removed from everyday concerns, residing as an isolated, holy figure in Kyoto, the traditional capital of Japan. Japan was instead ruled from Edo (modern day Tokyo) led by the Shogun and his generals, according to a strict Confucian influenced code (see Keene). In Japan, as elsewhere, the presence of feudal-style governance includes policies that determine much of everyday life, including restrictions on clothing (Rall 169). The Samurai code was no different, and included a series of protocols that restricted rank, movement, behaviour, and clothing. As Vincent has noted in the case of the ‘lace tax’ in Great Britain, these restrictions were designed to punish those who seek to penetrate the upper classes through their costume (28-30). In Japan, pre-Meiji sumptuary laws, for example, restricted the use of gold, and prohibited the use of a certain shade of red by merchant classes (V&A Kimono).Therefore, in the governance of pre-globalised societies, the importance of clothing and textile is evident; as Jones and Stallybrass comment: We need to understand the antimatedness of clothes, their ability to “pick up” subjects, to mould and shape them both physically and socially—to constitute subjects through their power as material memories […] Clothing is a worn world: a world of social relations put upon the wearer’s body. (2-3, emphasis added)The significant re-imagining of Japanese cultural and national identities are explored here through the cataclysmic impact of Western ideologies on Japanese cultural traditions. There are many ways to examine how indigenous cultures respond to European, British, or American (hereafter Western) influences, particularly in times of conflict (Wilk). Western ideology arrived in Japan after a long period of isolation (during which time Japan’s only contact was with Dutch traders) through the threat of military hostility and war. It is after this outside threat was realised that Japan’s adoption of military and industrial practices begins. The re-imagining of their national identity took many forms, and the inclusion of a Western-style military costuming as a schoolboy uniform became a highly visible indicator of Japan’s mission to protect its sovereign integrity. A brief history of Japan’s rise from a collection of isolated feudal states to a unified military power, in not only the Asian Pacific region but globally, demonstrates the speed at which they adopted the Western mode of warfare. Gunboats on Japan’s ShorelinesJapan was forcefully opened to the West in the 1850s by America under threat of First Name Perry’s ‘gunboat diplomacy’ (Hillsborough 7-8). Following this, Japan underwent a rapid period of modernisation, and an upsurge in nationalism and military expansion that was driven by a desire to catch up to the European powers present in the Pacific. Noted by Ian Ferguson in Civilization: The West and the Rest, Unsure, the Japanese decided […] to copy everything […] Japanese institutions were refashioned on Western models. The army drilled like Germans; the navy sailed like Britons. An American-style system of state elementary and middle schools was also introduced. (221, emphasis added)This was nothing short of a wide-scale reorganisation of Japan’s entire social structure and governance. Under the Emperor Meiji, who wrested power from the Shogunate and reclaimed it for the Imperial head, Japan steamed into an industrial revolution, achieving in a matter of years what had taken Europe over a century.Japan quickly became a major player-elect on the world stage. However, as an island nation, Japan lacked the essentials of both coal and iron with which to fashion not only industrial machinery but also military equipment, the machinery of war. In 1875 Japan forced Korea to open itself to foreign (read: Japanese) trade. In the same treaty, Korea was recognised as a sovereign nation, separate from Qing China (Tucker 1461). The necessity for raw materials then led to the Sino-Japanese War (1894–95), a conflict between Japan and China that marked the emergence of Japan as a major world power. The Korean Peninsula had long been China’s most important client state, but its strategic location adjacent to the Japanese archipelago, and its natural resources of coal and iron, attracted Japan’s interest. Later, the Russo-Japanese War (1904–05), allowed a victorious Japan to force Russia to abandon its expansionist policy in the Far East, becoming the first Asian power in modern times to defeat a European power. The Russo-Japanese War developed out of the rivalry between Russia and Japan for dominance in Korea and Manchuria, again in the struggle for natural resources (Tucker 1534-46).Japan’s victories, together with the county’s drive for resources, meant that Japan could now determine its role within the Asia-Pacific sphere of influence. As Japan’s military, and their adoption of Westernised combat, proved effective in maintaining national integrity, other social institutions also looked to the West (Ferguson 221). In an ironic twist—while Victorian and Continental fashion was busy adopting the exotic, oriental look (Martin and Koda)—the kimono, along with other essentials of Japanese fashions, were rapidly altered (both literally and figuratively) to suit new, warlike ideology. It should be noted that kimono literally means ‘things that you wear’ and which, prior to exposure to Western fashions, signified all worn clothing (Dalby 65-119). “Wearing Things” in Westernised JapanAs Japan modernised during the late 1800s the kimono was positioned as symbolising barbaric, pre-modern, ‘oriental’ Japan. Indeed, on 17 January 1887 the Meiji Empress issued a memorandum on the subject of women’s clothing in Japan: “She [the Empress] believed that western clothes were in fact closer to the dress of women in ancient Japan than the kimonos currently worn and urged that they be adopted as the standard clothes of the reign” (Keene 404). The resemblance between Western skirts and blouses and the simple skirt and separate top that had been worn in ancient times by a people descended from the sun goddess, Amaterasu wo mikami, was used to give authority and cultural authenticity to Japan’s modernisation projects. The Imperial Court, with its newly ennobled European style aristocrats, exchanged kimono silks for Victorian finery, and samurai armour for military pomp and splendour (Figure 1).Figure 1: The Meiji Emperor, Empress and Crown Prince resplendent in European fashions on an outing to Asukayama Park. Illustration: Toyohara Chikanobu, circa 1890.It is argued here that the function of a uniform is to prepare the body for service. Maids and butlers, nurses and courtesans, doctors, policemen, and soldiers are all distinguished by their garb. Prudence Black states: “as a technology, uniforms shape and code the body so they become a unit that belongs to a collective whole” (93). The requirement to discipline bodies through clothing, particularly through uniforms, is well documented (see Craik, Peoples, and Foucault). The need to distinguish enemies from allies on the battlefield requires adherence to a set of defined protocols, as referenced in military fashion compendiums (see Molloy). While the postcolonial adoption of Western-based clothing reflects a new form of subservience (Rall, Kuechler and Miller), in Japan, the indigenous garments were clearly designed in the interests of ideological allegiance. To understand the Japanese sartorial traditions, the kimono itself must be read as providing a strong disciplinary element. The traditional garment is designed to represent an upright and unbending column—where two meters of under bindings are used to discipline the body into shape are then topped with a further four meters of a stiffened silk obi wrapped around the waist and lower chest. To dress formally in such a garment requires helpers (see Dalby). The kimono both constructs and confines the women who wear it, and presses them into their roles as dutiful, upper-class daughters (see Craik). From the 1890s through to the 1930s, when Japan again enters a period of militarism, the myth of the kimono again changes as it is integrated into the build-up towards World War II.Decades later, when Japan re-established itself as a global economic power in the 1970s and 1980s, the kimono was re-authenticated as Japan’s ‘traditional’ garment. This time it was not the myth of a people descended from solar deities that was on display, but that of samurai strength and propriety for men, alongside an exaggerated femininity for women, invoking a powerful vision of Japanese sartorial tradition. This reworking of the kimono was only possible as the garment was already contained within the framework of Confucian family duty. However, in the lead up to World War II, Japanese military advancement demanded of its people soldiers that could win European-style wars. The quickest solution was to copy the military acumen and strategies of global warfare, and the costumes of the soldiery and seamen of Europe, including Great Britain (Ferguson). It was also acknowledged that soldiers were ‘made not born’ so the Japanese educational system was re-vamped to emulate those of its military rivals (McVeigh). It was in the uptake of schoolboy uniforms that this re-imagining of Japanese imperial strength took place.The Japanese Schoolboy UniformCentral to their rapid modernisation, Japan adopted a constitutional system of education that borrowed from American and French models (Tipton 68-69). The government viewed education as a “primary means of developing a sense of nation,” and at its core, was the imperial authorities’ obsession with defining “Japan and Japaneseness” (Tipton 68-69). Numerous reforms eventually saw, after an abolition of fees, nearly 100% attendance by both boys and girls, despite a lingering mind-set that educating women was “a waste of time” (Tipton 68-69). A boys’ uniform based on the French and Prussian military uniforms of the 1860s and 1870s respectively (Kinsella 217), was adopted in 1879 (McVeigh 47). This jacket, initially with Prussian cape and cap, consists of a square body, standing mandarin style collar and a buttoned front. It was through these education reforms, as visually symbolised by the adoption of military style school uniforms, that citizen making, education, and military training became interrelated aspects of Meiji modernisation (Kinsella 217). Known as the gakuran (gaku: to study; ran: meaning both orchid, and a pun on Horanda, meaning Holland, the only Western country with trading relations in pre-Meiji Japan), these jackets were a symbol of education, indicating European knowledge, power and influence and came to reflect all things European in Meiji Japan. By adopting these jackets two objectives were realised:through the magical power of imitation, Japan would, by adopting the clothing of the West, naturally rise in military power; and boys were uniformed to become not only educated as quasi-Europeans, but as fighting soldiers and sons (suns) of the nation.The gakuran jacket was first popularised by state-run schools, however, in the century and a half that the garment has been in use it has come to symbolise young Japanese masculinity as showcased in campus films, anime, manga, computer games, and as fashion is the preeminent garment for boybands and Japanese hipsters.While the gakuran is central to the rise of global militarism in Japan (McVeigh 51-53), the jacket would go on to form the basis of the Sun Yat Sen and Mao Suits as symbols of revolutionary China (see McVeigh). Supposedly, Sun Yat Sen saw the schoolboy jacket in Japan as a utilitarian garment and adopted it with a turn down collar (Cumming et al.). For Sun Yat Sen, the gakuran was the perfect mix of civilian (school boy) and military (the garment’s Prussian heritage) allowing him to walk a middle path between the demands of both. Furthermore, the garment allowed Sun to navigate between Western style suits and old-fashioned Qing dynasty styles (Gerth 116); one was associated with the imperialism of the National Products Movement, while the other represented the corruption of the old dynasty. In this way, the gakuran was further politicised from a national (Japanese) symbol to a global one. While military uniforms have always been political garments, in the late 1800s and early 1900s, as the world was rocked by revolutions and war, civilian clothing also became a means of expressing political ideals (McVeigh 48-49). Note that Mahatma Ghandi’s clothing choices also evolved from wholly Western styles to traditional and emphasised domestic products (Gerth 116).Mao adopted this style circa 1927, further defining the style when he came to power by adding elements from the trousers, tunics, and black cotton shoes worn by peasants. The suit was further codified during the 1960s, reaching its height in the Cultural Revolution. While the gakuran has always been a scholarly black (see Figure 2), subtle differences in the colour palette differentiated the Chinese population—peasants and workers donned indigo blue Mao jackets, while the People’s Liberation Army Soldiers donned khaki green. This limited colour scheme somewhat paradoxically ensured that subtle hierarchical differences were maintained even whilst advocating egalitarian ideals (Davis 522). Both the Sun Yat Sen suit and the Mao jacket represented the rejection of bourgeois (Western) norms that objectified the female form in favour of a uniform society. Neo-Maoism and Mao fever of the early 1990s saw the Mao suit emerge again as a desirable piece of iconic/ironic youth fashion. Figure 2: An example of Gakuran uniform next to the girl’s equivalent on display at Ichikawa Gakuen School (Japan). Photo: Emerald King, 2015.There is a clear and vital link between the influence of the Prussian style Japanese schoolboy uniform on the later creation of the Mao jacket—that of the uniform as an integral piece of worn propaganda (Atkins).For Japan, the rapid deployment of new military and industrial technologies, as well as a sartorial need to present her leaders as modern (read: Western) demanded the adoption of European-style uniforms. The Imperial family had always been removed from Samurai battlefields, so the adoption of Western military costume allowed Japan’s rulers to present a uniform face to other global powers. When Japan found itself in conflict in the Asia Pacific Region, without an organised military, the first requirement was to completely reorganise their system of warfare from a feudal base and to train up national servicemen. Within an American-style compulsory education system, the European-based curriculum included training in mathematics, engineering and military history, as young Britons had for generations begun their education in Greek and Latin, with the study of Ancient Greek and Roman wars (Bantock). It is only in the classroom that ideological change on a mass scale can take place (Reference Please), a lesson not missed by later leaders such as Mao Zedong.ConclusionIn the 1880s, the Japanese leaders established their position in global politics by adopting clothing and practices from the West (Europeans, Britons, and Americans) in order to quickly re-shape their country’s educational system and military establishment. The prevailing military costume from foreign cultures not only disciplined their adopted European bodies, they enforced a new regime through dress (Rall 157-174). For boys, the gakuran symbolised the unity of education and militarism as central to Japanese masculinity. Wearing a uniform, as many authors suggest, furthers compliance (Craik, Nagasawa Kaiser and Hutton, and McVeigh). As conscription became a part of Japanese reality in World War II, the schoolboys just swapped their military-inspired school uniforms for genuine military garments.Re-imagining a Japanese schoolboy uniform from a European military costume might suit ideological purposes (Atkins), but there is more. The gakuran, as a uniform based on a close, but not fitted jacket, was the product of a process of advanced industrialisation in the garment-making industry also taking place in the 1800s:Between 1810 and 1830, technical calibrations invented by tailors working at the very highest level of the craft [in Britain] eventually made it possible for hundreds of suits to be cut up and made in advance [...] and the ready-to-wear idea was put into practice for men’s clothes […] originally for uniforms for the War of 1812. (Hollander 31) In this way, industrialisation became a means to mass production, which furthered militarisation, “the uniform is thus the clothing of the modern disciplinary society” (Black 102). There is a perfect resonance between Japan’s appetite for a modern military and their rise to an industrialised society, and their conquests in Asia Pacific supplied the necessary material resources that made such a rapid deployment possible. The Japanese schoolboy uniform was an integral part of the process of both industrialisation and militarisation, which instilled in the wearer a social role required by modern Japanese society in its rise for global power. Garments are never just clothing, but offer a “world of social relations put upon the wearer’s body” (Jones and Stallybrass 3-4).Today, both the Japanese kimono and the Japanese schoolboy uniform continue to interact with, and interrogate, global fashions as contemporary designers continue to call on the tropes of ‘military chic’ (Tonchi) and Japanese-inspired clothing (Kawamura). References Atkins, Jaqueline. Wearing Propaganda: Textiles on the Home Front in Japan, Britain, and the United States. Princeton: Yale UP, 2005.Bantock, Geoffrey Herman. Culture, Industrialisation and Education. London: Routledge & K. Paul, 1968.Black, Prudence. “The Discipline of Appearance: Military Style and Australian Flight Hostess Uniforms 1930–1964.” Fashion & War in Popular Culture. Ed. Denise N. Rall. Bristol: Intellect/U Chicago P, 2014. 91-106.Craik, Jenifer. Uniforms Exposed: From Conformity to Transgression. Oxford: Berg, 2005.Cumming, Valerie, Cecil Williet Cunnington, and Phillis Emily Cunnington. “Mao Style.” The Dictionary of Fashion History. Eds. Valerie Cumming, Cecil Williet Cunnington, and Phillis Emily Cunnington. Oxford: Berg, 2010.Dalby, Liza, ed. Kimono: Fashioning Culture. London: Vintage, 2001.Davis, Edward L., ed. Encyclopaedia of Contemporary Chinese Culture. London: Routledge, 2005.Dees, Jan. Taisho Kimono: Speaking of Past and Present. Milan: Skira, 2009.Ferguson, N. Civilization: The West and the Rest. London: Penguin, 2011.Foucault, Michel. Discipline and Punish: The Birth of the Prison. Trans. Alan Sheridan. London: Penguin, 1997. Gerth, Karl. China Made: Consumer Culture and the Creation of the Nation, Cambridge: East Asian Harvard Monograph 224, 2003.Gilbert, W.S., and Arthur Sullivan. The Mikado or, The Town of Titipu. 1885. 16 Nov. 2015 ‹http://math.boisestate.edu/gas/mikado/mk_lib.pdf›. Hillsborough, Romulus. Samurai Revolution: The Dawn of Modern Japan Seen through the Eyes of the Shogun's Last Samurai. Vermont: Tuttle, 2014.Jones, Anne R., and Peter Stallybrass, Renaissance Clothing and the Materials of Memory. Cambridge: Cambridge UP, 2000.Keene, Donald. Emperor of Japan: Meiji and His World, 1852-1912. New York: Columbia UP, 2002.King, Emerald L. “Schoolboys and Kimono Ladies.” Presentation to the Un-Thinking Asian Migrations Conference, University of Otago, Dunedin, New Zealand, 24-26 Aug. 2014. Kinsella, Sharon. “What’s Behind the Fetishism of Japanese School Uniforms?” Fashion Theory 6.2 (2002): 215-37. Kuechler, Susanne, and Daniel Miller, eds. Clothing as Material Culture. Oxford: Berg, 2005.Landow, George P. “Liberty and the Evolution of the Liberty Style.” 22 Aug. 2010. ‹http://www.victorianweb.org/art/design/liberty/lstyle.html›.Martin, Richard, and Harold Koda. Orientalism: Vision of the East in Western Dress. New York: Metropolitan Museum of Art, 1994.McVeigh, Brian J. Wearing Ideology: State, Schooling, and Self-Presentation in Japan. Oxford: Berg, 2000.Molloy, John. Military Fashion: A Comparative History of the Uniforms of the Great Armies from the 17th Century to the First World War. New York: Putnam, 1972.Peoples, Sharon. “Embodying the Military: Uniforms.” Critical Studies in Men’s Fashion 1.1 (2014): 7-21.Rall, Denise N. “Costume & Conquest: A Proximity Framework for Post-War Impacts on Clothing and Textile Art.” Fashion & War in Popular Culture, ed. Denise N. Rall. Bristol: Intellect/U Chicago P, 2014. 157-74. Tipton, Elise K. Modern Japan: A Social and Political History. 3rd ed. London: Routledge, 2016.Tucker, Spencer C., ed. A Global Chronology of Conflict: From the Ancient World to the Modern Middle East. Santa Barbara, CA: ABC-CLIO, 2013.V&A Kimono. Victoria and Albert Museum. “A History of the Kimono.” 2004. 2 Oct. 2015 ‹http://www.vam.ac.uk/content/articles/h/a-history-of-the-kimono/›.V&A Victorian. Victoria and Albert Museum. “The Victorian Vision of China and Japan.” 10 Nov. 2015 ‹http://www.vam.ac.uk/content/articles/t/the-victorian-vision-of-china-and-japan/›.Vincent, Susan J. The Anatomy of Fashion: Dressing the Body from the Renaissance to Today. Berg: Oxford, 2009.Wilde, Oscar. “The Decay of Lying.” 1889. In Intentions New York: Berentano’s 1905. 16 Nov. 2015 ‹http://virgil.org/dswo/courses/novel/wilde-lying.pdf›. Wilk, Richard. “Consumer Goods as a Dialogue about Development.” Cultural History 7 (1990) 79-100.

Edith and John Power were a wealthy expatriate Australian couple who lived in England and Europe from the early years of the 20th century until their deaths. In 1915 John Power married Edith Lee in London before serving as a surgeon on the Western Front in the Royal Army Medical Corps. After the war Edith and John left Britain to live in Paris and Brussels in the centre of a large international group of avant-garde artists. Edith, who was twelve years older than her husband, and had been married twice before (once widowed and once divorced), was to all accounts the driving force behind John's success as an artist -- he exhibited alongside Picasso, Braque and Kandinsky -- and the great love of his life. The following comes from a book-length fictionalised biography of their lives, narrated by Edith in the early 1960s when she was ninety-two years old. This extract comes from the part of the manuscript dealing with the Nazi Occupation of the Channel Island of Jersey in the second world war; the 'safe haven' to which the Powers had fled in 1938 when war threatened. The first winter under the Germans was very hard and there were reports of old people dying of starvation and exposure. Jack had terrible chilblains and we were both very thin. Cooking fat was only available for doctors to give to invalids, and one poor chap was so desperate that he used sump oil from his car to fry up some gull eggs, and poisoned himself. Sitting down to a plate of boiled potatoes I couldn't sometimes help but reminisce about the wonderful meals we had eaten in Paris and Brussels. How decadent they seemed -- oysters, poached salmon, grilled tournedos with asparagus or a roasted duck, then a glass of champagne, a slice or two of Ange à Cheval and some wild strawberries to finish off with. I also realised how petty all our worries had been up 'til then. We would be upset if the hotel we fancied was booked out for the summer, the bath water cold or a soufflé heavy. When the stock market dropped a point or two we were devastated, and Jack used to sulk for days when he had trouble with a painting or if his frames were not exactly as ordered, the moulding wrong, the gilding scratched or too bright. Such concerns seemed absurd when we faced death every day and misery and fear were all around us. Then the prisoners-of-war arrived from Russia, dressed in rags and even thinner than us. They suffered terribly, working impossibly hard every day on the railway and underground hospital, with nowhere proper to sleep and very little to eat. We felt so sorry for them, and admired those Islanders who, although it was a serious crime, sheltered them if they managed to escape. We had another dreadful reminder of just how awful the Germans could be when they started shooting anyone caught with a crystal radio set. By the summer of 1942 Jack was very ill, although he continued to deny anything was wrong. He finally confided in me just how dire things were one afternoon when we were sitting on the terrace. We were drinking the last of our English tea and discussing how wild the garden had become. One minute Jack was saying how much he enjoyed watching everything return to its natural state, the next he was telling me that he thought he had a cancerous tumour in his kidneys and should see a doctor. I listened in a daze as he detailed the possible treatments and his prognosis, which he anticipated to be poor. Then he stood, drank the dregs in his cup, kissed me and said he had to return to the studio. He had salvaged a piece of wood from somewhere to paint on and didn't want to lose the last light. I was stunned, not wanting to believe what he had told me. I never found out whether Jack suspected the cancer before the Occupation, but if he did, I can't understand why he didn't tell me. We could have gone back to England or over to Switzerland and seen the best doctors. This still puzzles me for Jack was never reticent to seek medical treatment. Tony even laughingly called Jack a hypochondriac, he was so careful with his health, but then again, I know Jack's father had hidden the same condition from his family some forty years before. For many years after the war Ceylon tea only ever tasted of trouble and dismay to me. Nowadays everyone wants to give me tea all the time, especially the nurses. I tell them I'd really like a stiff gin and tonic, but alcohol is another of life's pleasures denied to the elderly. If I could only get out of this bed, I'd get one for myself -- a big one. I have forgotten the name of that doctor we consulted a few days later, but I remember exactly what he said. He confirmed what Jack thought, that the tumours were in his kidneys, but added that they had possibly settled in his lungs as well. In a last (but futile) effort, my poor darling was operated on by this old fashioned surgeon who had to work in the most primitive conditions; without the drugs, anaesthetics or antiseptics he needed. By that time it was difficult to find soap whatever price you were willing to pay, and I gave him some fancy little rose scented tablets to wash up with before he cut Jack open. Jack had never been a fast healer and all the odds were against him; the strain of the advancing cancer, the inadequacy of our diet and the lack of proper medicines. The only foods we could obtain were quite coarse, there was no lean meat to make beef tea or eggs for milk puddings. Jack once said to me something to the effect that the ghastly jokes of fate are not always in the best of taste but they could be extremely witty. I never, however, found anything except the most savage cruelty in his situation, that such a highly trained surgeon had to endure such a crude assault on his body, and that a wealthy philanthropist could suffer so for the want of the most basic requirements of food, firewood and pain killers. My darling, who had been so dreadful when struck down with the slightest illness, was a model patient. It took a long time, but eventually he was able to leave his bed, and the first thing he did was to boil up his own analgesics, potent narcotics which he followed with a stiff whisky. When his condition deteriorated and I had to tend to all his most intimate needs, he was always good tempered and never made me feel I was humiliating or demeaning him. We grew closer than ever, but I knew our time was running out. In another cruel twist of fate Jack was only exempted from deportation to a German internment camp by the sick certificate. An order of 1942 decreed that all the British men not born on the Channel Islands, from the young boys of sixteen to poor old men of seventy, would be transferred to Germany. Thinking about it now, it seems bizarre that such a reasonable bureaucratic rule could regulate the Germans' inhumanity. My darling's last days are as clear in my memory as if they were yesterday. He lay in our yellow bedroom, looking out over the garden to the sea. I only left his side for the briefest periods, and slept in a chair by his bed. Early one morning I woke from an uneasy doze. I looked over to Jack. His face was grey and much too old for his sixty-two years, he was no longer the boy he had always been in my heart. Lying stiffly in the middle of the bed, arms by his side, eyes and lips closed, his breathing was so shallow that his chest hardly rose or fell. I wondered if he felt the weight of the blankets or heard the wind outside. Did he even know how I sat with him? I looked out over the garden. The vegetable patches dug in the chamomile lawn were flourishing, but the grass was long, the roses run to briars, the pond filled with sludge and rotting weeds. I wanted to lie beside my darling and hold him, just as I had each night for so many years, so after I had removed my shoes and placed them together under the bed, I pulled back the sheets and lay on my side facing Jack. He didn't move. I traced my finger across his cheekbones and down his nose to the mouth I had kissed so often. His skin was cool and very dry. I moved over and pressed my body close to his and as he made no sign that this was uncomfortable, I began to relax. The house was quiet and, for the first time in weeks, I sank into a peaceful sleep. When I woke, the soft light of late afternoon was filtering through the curtains. The breeze had dropped outside and I heard a lone bird calling for its mate. Most of the birds had been killed and I thought I would put out some potato bread for him. What depths we were reduced to in those days, eating the gentle creatures around us. It was rumoured that some desperate soul had roasted and eaten a hedgehog, but I still can't believe that was true. There were so many dreadful stories in those days, you never knew what to believe. My hand found Jack's. It was icy. I willed myself not to think of it, but I knew he was gone. I touched his cheek, my fingers slightly warming the cold flesh, then I put my arms right around him and pressed my face into his neck. We lay like that for a long time. Eventually I got up, tucked the blankets around him and closed the window. Downstairs I washed in cold water and dressed in black stockings, black slip and my best black dress. My black shoes were still under Jack's bed, so I laced on my tan brogues. I found my veiled black hat and put it on the sideboard. Even though I knew it was ridiculous, I felt uncomfortable wearing brown shoes with black and returned them to the cupboard. I looked around for my pearls, and realised I had left them upstairs too. I stood outside the bedroom door for some time before I could enter. Then I went in, raised the window and sat on the chair. I don't know what I thought about, but after some time the chirping of the little bird brought me back to the present. I bent and retrieved my shoes from under the bed and placed them beside the door. I could see my pearls lying in a shining mound on top of the blankets just below his hip. As I was picking them up I finally looked at Jack properly. His eyes were closed and his face was relaxed as if in a deep dreamless sleep. He looked years younger. He wore his favourite blue striped pyjamas from Jeremyn Street, but he was a stranger to me. I kissed him for the last time, then lifted the linen sheet to cover the face I had loved so much. I turned away, picked up my shoes and left the room, closing the door behind me. Although I hadn't noticed, that dreadful Sunday, the 1st of August 1943, had been a beautifully hot summer's day, just the sort of day Jack had always loved. Citation reference for this article MLA style: Donna Lee Brien. "Just the Sort of Day Jack Had Always Loved." M/C: A Journal of Media and Culture 2.8 (1999). [your date of access] <http://www.uq.edu.au/mc/9912/day.php>. Chicago style: Donna Lee Brien, "Just the Sort of Day Jack Had Always Loved," M/C: A Journal of Media and Culture 2, no. 8 (1999), <http://www.uq.edu.au/mc/9912/day.php> ([your date of access]). APA style: Donna Lee Brien. (1999) Just the sort of day Jack had always loved. M/C: A Journal of Media and Culture 2(8). <http://www.uq.edu.au/mc/9912/day.php> ([your date of access]).

Kangatarianism is the rather inelegant word coined in the first decade of the twenty-first century to describe an omnivorous diet in which the only meat consumed is that of the kangaroo. First published in the media in 2010 (Barone; Zukerman), the term circulated in Australian environmental and academic circles including the Global Animal conference at the University of Wollongong in July 2011 where I first heard it from members of the Think Tank for Kangaroos (THINKK) group. By June 2017, it had gained enough attention to be named the Oxford English Dictionary’s Australian word of the month (following on from May’s “smashed avo,” another Australian food innovation), but it took the Nine Network reality television series Love Island Australia to raise kangatarian to trending status on social media (Oxford UP). During the first episode, aired in late May 2018, Justin, a concreter and fashion model from Melbourne, declared himself to have previously been a kangatarian as he chatted with fellow contestant, Millie. Vet nurse and animal lover Millie appeared to be shocked by his revelation but was tentatively accepting when Justin explained what kangatarian meant, and justified his choice on the grounds that kangaroo are not farmed. In the social media response, it was clear that eating only the meat of kangaroos as an ethical choice was an entirely new concept to many viewers, with one tweet stating “Kangatarian isn’t a thing”, while others variously labelled the diet brutal, intriguing, or quintessentially Australian (see #kangatarian on Twitter).There is a well developed literature around the arguments for and against eating kangaroo, and why settler Australians tend to be so reluctant to do so (see for example, Probyn; Cawthorn and Hoffman). Here, I will concentrate on the role that ethics play in this food choice by examining how the adoption of kangatarianism can be understood as a bargain struck to help to manage grief in the Anthropocene, and the limitations of that bargain. As Lesley Head has argued, we are living in a time of loss and of grieving, when much that has been taken for granted is becoming unstable, and “we must imagine that drastic changes to everyday life are in the offing” (313). Applying the classic (and contested) model of five stages of grief, first proposed by Elisabeth Kübler-Ross in her book On Death and Dying in 1969, much of the population of the western world seems to be now experiencing denial, her first stage of loss, while those in the most vulnerable environments have moved on to anger with developed countries for destructive actions in the past and inaction in the present. The next stages (or states) of grieving—bargaining, depression, and acceptance—are likely to be manifested, although not in any predictable sequence, as the grief over current and future losses continues (Haslam).The great expansion of food restrictive diets in the Anthropocene can be interpreted as part of this bargaining state of grieving as individuals attempt to respond to the imperative to reduce their environmental impact but also to limit the degree of change to their own diet required to do so. Meat has long been identified as a key component of an individual’s environmental footprint. From Frances Moore Lappé’s 1971 Diet for a Small Planet through the United Nations’ Food and Agriculture Organisation’s 2006 report Livestock’s Long Shadow to the 2019 report of the EAT–Lancet Commission on Healthy Diets from Sustainable Food Systems, the advice has been consistent: meat consumption should be minimised in, if not eradicated from, the human diet. The EAT–Lancet Commission Report quantified this to less than 28 grams (just under one ounce) of beef, lamb or pork per day (12, 25). For many this would be keenly felt, in terms of how meals are constructed, the sensory experiences associated with eating meat and perceptions of well-being but meat is offered up as a sacrifice to bring about the return of the beloved healthy planet.Rather than accept the advice to cut out meat entirely, those seeking to bargain with the Anthropocene also find other options. This has given rise to a suite of foodways based around restricting meat intake in volume or type. Reducing the amount of commercially produced beef, lamb and pork eaten is one approach, while substituting a meat the production of which has a smaller environmental footprint, most commonly chicken or fish, is another. For those willing to make deeper changes, the meat of free living animals, especially those which are killed accidentally on the roads or for deliberately for environmental management purposes, is another option. Further along this spectrum are the novel protein sources suggested in the Lancet report, including insects, blue-green algae and laboratory-cultured meats.Kangatarianism is another form of this bargain, and is backed by at least half a century of advocacy. The Australian Conservation Foundation made calls to reduce the numbers of other livestock and begin a sustainable harvest of kangaroo for food in 1970 when the sale of kangaroo meat for human consumption was still illegal across the country (Conservation of Kangaroos). The idea was repeated by biologist Gordon Grigg in the late 1980s (Jackson and Vernes 173), and again in the Garnaut Climate Change Review in 2008 (547–48). Kangaroo meat is high in protein and iron, low in fat, and high in healthy polyunsaturated fatty acids and conjugated linoleic acid, and, as these authors showed, has a smaller environmental footprint than beef, lamb, or pork. Kangaroo require less water than cattle, sheep or pigs, and no land is cleared to grow feed for them or give them space to graze. Their paws cause less erosion and compaction of soil than do the hooves of common livestock. They eat less fodder than ruminants and their digestive processes result in lower emissions of the powerful greenhouse gas methane and less solid waste.As Justin of Love Island was aware, kangaroo are not farmed in the sense of being deliberately bred, fed, confined, or treated with hormones, drugs or chemicals, which also adds to their lighter impact on the environment. However, some pastoralists argue that because they cannot prevent kangaroos from accessing the food, water, shelter, and protection from predators they provide for their livestock, they do effectively farm them, although they receive no income from sales of kangaroo meat. This type of light touch farming of kangaroos has a very long history in Australia going back to the continent’s first peopling some 60,000 years ago. Kangaroos were so important to Aboriginal people that a wide range of environments were manipulated to produce their favoured habitats of open grasslands edged by sheltering trees. As Bill Gammage demonstrated, fire was used as a tool to preserve and extend grassy areas, to encourage regrowth which would attract kangaroos and to drive the animals from one patch to another or towards hunters waiting with spears (passim, for example, 58, 72, 76, 93). Gammage and Bruce Pascoe agree that this was a form of animal husbandry in which the kangaroos were drawn to the areas prepared for them for the young grass or, more forcefully, physically directed using nets, brush fences or stone walls. Burnt ground served to contain the animals in place of fencing, and regular harvesting kept numbers from rising to levels which would place pressure on other species (Gammage 79, 281–86; Pascoe 42–43). Contemporary advocates of eating kangaroo have promoted the idea that they should be deliberately co-produced with other livestock instead of being killed to preserve feed and water for sheep and cattle (Ellicott; Wilson 39). Substituting kangaroo for the meat of more environmentally damaging animals would facilitate a reduction in the numbers of cattle and sheep, lessening the harm they do.Most proponents have assumed that their audience is current meat eaters who would substitute kangaroo for the meat of other more environmentally costly animals, but kangatarianism can also emerge from vegetarianism. Wendy Zukerman, who wrote about kangaroo hunting for New Scientist in 2010, was motivated to conduct the research because she was considering becoming an early adopter of kangatarianism as the least environmentally taxing way to counter the longterm anaemia she had developed as a vegetarian. In 2018, George Wilson, honorary professor in the Australian National University’s Fenner School of Environment and Society called for vegetarians to become kangatarians as a means of boosting overall consumption of kangaroo for environmental and economic benefits to rural Australia (39).Given these persuasive environmental arguments, it might be expected that many people would have perceived eating kangaroo instead of other meat as a favourable bargain and taken up the call to become kangatarian. Certainly, there has been widespread interest in trying kangaroo meat. In 1997, only five years after the sale of kangaroo meat for human consumption had been legalised in most states (South Australia did so in 1980), 51% of 500 people surveyed in five capital cities said they had tried kangaroo. However, it had not become a meat of choice with very few found to eat it more than three times a year (Des Purtell and Associates iv). Just over a decade later, a study by Ampt and Owen found an increase to 58% of 1599 Australians surveyed across the country who had tried kangaroo but just 4.7% eating it at least monthly (14). Bryce Appleby, in his study of kangaroo consumption in the home based on interviews with 28 residents of Wollongong in 2010, specifically noted the absence of kangatarians—then a very new concept. A study of 261 Sydney university students in 2014 found that half had tried kangaroo meat and 10% continued to eat it with any regularity. Only two respondents identified themselves as kangatarian (Grant 14–15). Kangaroo meat advocate Michael Archer declared in 2017 that “there’s an awful lot of very, very smart vegetarians [who] have opted for semi vegetarianism and they’re calling themselves ‘kangatarians’, as they’re quite happy to eat kangaroo meat”, but unless there had been a significant change in a few years, the surveys did not bear out his assertion (154).The ethical calculations around eating kangaroo are complicated by factors beyond the strictly environmental. One Tweeter advised Justin: “‘I’m a kangatarian’ isn’t a pickup line, mate”, and certainly the reception of his declaration could have been very cool, especially as it was delivered to a self declared animal warrior (N’Tash Aha). All of the studies of beliefs and practices around the eating of kangaroo have noted a significant minority of Australians who would not consider eating kangaroo based on issues of animal welfare and animal rights. The 1997 study found that 11% were opposed to the idea of eating kangaroo, while in Grant’s 2014 study, 15% were ethically opposed to eating kangaroo meat (Des Purtell and Associates iv; Grant 14–15). Animal ethics complicate the bargains calculated principally on environmental grounds.These ethical concerns work across several registers. One is around the flesh and blood kangaroo as a charismatic native animal unique to Australia and which Australians have an obligation to respect and nurture. Sheep, cattle and pigs have been subject to longterm propaganda campaigns which entrench the idea that they are unattractive and unintelligent, and veil their transition to meat behind euphemistic language and abattoir walls, making it easier to eat them. Kangaroos are still seen as resourceful and graceful animals, and no linguistic tricks shield consumers from the knowledge that it is a roo on their plate. A proposal in 2009 to market a “coat of arms” emu and kangaroo-flavoured potato chip brought complaints to the Advertising Standards Bureau that this was disrespectful to these native animals, although the flavours were to be simulated and the product vegetarian (Black). Coexisting with this high regard to kangaroos is its antithesis. That is, a valuation of them informed by their designation as a pest in the pastoral industry, and the use of the carcasses of those killed to feed dogs and other companion animals. Appleby identified a visceral, disgust response to the idea of eating kangaroo in many of his informants, including both vegetarians who would not consider eating kangaroo because of their commitment to a plant-based diet, and at least one omnivore who would prefer to give up all meat rather than eat kangaroo. While diametrically opposed, the end point of both positions is that kangaroo meat should not be eaten.A second animal ethics stance relates to the imagined kangaroo, a cultural construct which for most urban Australians is much more present in their lives and likely to shape their actions than the living animals. It is behind the rejection of eating an animal which holds such an iconic place in Australian culture: to the dexter on the 1912 national coat of arms; hopping through the Hundred Acre Wood as Kanga and Roo in A.A. Milne’s Winnie-the-Pooh children’s books from the 1920s and the Disney movies later made from them; as a boy’s best friend as Skippy the Bush Kangaroo in a fondly remembered 1970s television series; and high in the sky on QANTAS planes. The anthropomorphising of kangaroos permitted the spectacle of the boxing kangaroo from the late nineteenth century. By framing natural kangaroo behaviours as boxing, these exhibitions encouraged an ambiguous understanding of kangaroos as human-like, moving them further from the category of food (Golder and Kirkby). Australian government bodies used this idea of the kangaroo to support food exports to Britain, with kangaroos as cooks or diners rather than ingredients. The Kangaroo Kookery Book of 1932 (see fig. 1 below) portrayed kangaroos as a nuclear family in a suburban kitchen and another official campaign supporting sales of Australian produce in Britain in the 1950s featured a Disney-inspired kangaroo eating apples and chops washed down with wine (“Kangaroo to Be ‘Food Salesman’”). This imagining of kangaroos as human-like has persisted, leading to the opinion expressed in a 2008 focus group, that consuming kangaroo amounted to “‘eating an icon’ … Although they are pests they are still human nature … these are native animals, people and I believe that is a form of cannibalism!” (Ampt and Owen 26). Figure 1: Rather than promoting the eating of kangaroos, the portrayal of kangaroos as a modern suburban family in the Kangaroo Kookery Book (1932) made it unthinkable. (Source: Kangaroo Kookery Book, Director of Australian Trade Publicity, Australia House, London, 1932.)The third layer of ethical objection on the ground of animal welfare is more specific, being directed to the method of killing the kangaroos which become food. Kangaroos are perhaps the only native animals for which state governments set quotas for commercial harvest, on the grounds that they compete with livestock for pasturage and water. In most jurisdictions, commercially harvested kangaroo carcasses can be processed for human consumption, and they are the ones which ultimately appear in supermarket display cases.Kangaroos are killed by professional shooters at night using swivelling spotlights mounted on their vehicles to locate and daze the animals. While clean head shots are the ideal and regulations state that animals should be killed when at rest and without causing “undue agonal struggle”, this is not always achieved and some animals do suffer prolonged deaths (NSW Code of Practice for Kangaroo Meat for Human Consumption). By regulation, the young of any female kangaroo must be killed along with her. While averting a slow death by neglect, this is considered cruel and wasteful. The hunt has drawn international criticism, including from Greenpeace which organised campaigns against the sale of kangaroo meat in Europe in the 1980s, and Viva! which was successful in securing the withdrawal of kangaroo from sale in British supermarkets (“Kangaroo Meat Sales Criticised”). These arguments circulate and influence opinion within Australia.A final animal ethics issue is that what is actually behind the push for greater use of kangaroo meat is not concern for the environment or animal welfare but the quest to turn a profit from these animals. The Kangaroo Industries Association of Australia, formed in 1970 to represent those who dealt in the marsupials’ meat, fur and skins, has been a vocal advocate of eating kangaroo and a sponsor of market research into how it can be made more appealing to the market. The Association argued in 1971 that commercial harvest was part of the intelligent conservation of the kangaroo. They sought minimum size regulations to prevent overharvesting and protect their livelihoods (“Assn. Backs Kangaroo Conservation”). The Association’s current website makes the claim that wild harvested “Australian kangaroo meat is among the healthiest, tastiest and most sustainable red meats in the world” (Kangaroo Industries Association of Australia). That this is intended to initiate a new and less controlled branch of the meat industry for the benefit of hunters and processors, rather than foster a shift from sheep or cattle to kangaroos which might serve farmers and the environment, is the opinion of Dr. Louise Boronyak, of the Centre for Compassionate Conservation at the University of Technology Sydney (Boyle 19).Concerns such as these have meant that kangaroo is most consumed where it is least familiar, with most of the meat for human consumption recovered from culled animals being exported to Europe and Asia. Russia has been the largest export market. There, kangaroo meat is made less strange by blending it with other meats and traditional spices to make processed meats, avoiding objections to its appearance and uncertainty around preparation. With only a low profile as a novelty animal in Russia, there are fewer sentimental concerns about consuming kangaroo, although the additional food miles undermine its environmental credentials. The variable acceptability of kangaroo in more distant markets speaks to the role of culture in determining how patterns of eating are formed and can be shifted, or, as Elspeth Probyn phrased it “how natural entities are transformed into commodities within a context of globalisation and local communities”, underlining the impossibility of any straightforward ethics of eating kangaroo (33, 35).Kangatarianism is a neologism which makes the eating of kangaroo meat something it has not been in the past, a voluntary restriction based on environmental ethics. These environmental benefits are well founded and eating kangaroo can be understood as an Anthropocenic bargain struck to allow the continuation of the consumption of red meat while reducing one’s environmental footprint. Although superficially attractive, the numbers entering into this bargain remain small because environmental ethics cannot be disentangled from animal ethics. The anthropomorphising of the kangaroo and its use as a national symbol coexist with its categorisation as a pest and use of its meat as food for companion animals. Both understandings of kangaroos made their meat uneatable for many Australians. Paired with concerns over how kangaroos are killed and the commercialisation of a native species, kangaroo meat has a very mixed reception despite decades of advocacy for eating its meat in favour of that of more harmed and more harmful introduced species. Given these constraints, kangatarianism is unlikely to become widespread and indeed it should be viewed as at best a temporary exigency. As the climate warms and rainfall becomes more erratic, even animals which have evolved to suit Australian conditions will come under increasing pressure, and humans will need to reach Kübler-Ross’ final state of grief: acceptance. In this case, this would mean acceptance that our needs cannot be placed ahead of those of other animals.ReferencesAmpt, Peter, and Kate Owen. Consumer Attitudes to Kangaroo Meat Products. Canberra: Rural Industries Research and Development Corporation, 2008.Appleby, Bryce. “Skippy the ‘Green’ Kangaroo: Identifying Resistances to Eating Kangaroo in the Home in a Context of Climate Change.” BSc Hons, U of Wollongong, 2010 <http://ro.uow.edu.au/thsci/103>.Archer, Michael. “Zoology on the Table: Plenary Session 4.” Australian Zoologist 39, 1 (2017): 154–60.“Assn. 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Improving Consumer Perceptions of Kangaroo Products: A Survey and Report. Canberra: Rural Industries Research and Development Corporation, 1997.Ellicott, John. “Little Pay Incentive for Shooters to Join Kangaroo Meat Industry.” The Land 15 Mar. 2018. 28 Mar. 2019 <https://www.theland.com.au/story/5285265/top-roo-shooter-says-harvesting-is-a-low-paid-job/>.Garnaut, Ross. Garnaut Climate Change Review. 2008. 26 Feb. 2019 <http://www.garnautreview.org.au/index.htm>.Gammage, Bill. The Biggest Estate on Earth: How Aborigines Made Australia. Sydney: Allen and Unwin, 2012.Golder, Hilary, and Diane Kirkby. “Mrs. Mayne and Her Boxing Kangaroo: A Married Woman Tests Her Property Rights in Colonial New South Wales.” Law and History Review 21.3 (2003): 585–605.Grant, Elisabeth. “Sustainable Kangaroo Harvesting: Perceptions and Consumption of Kangaroo Meat among University Students in New South Wales.” Independent Study Project (ISP). 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Livestock’s Long Shadow: Environmental Issues and Options. Rome: Food and Agriculture Organisation of the United Nations, 2006.Trust Nature. Essence of Kangaroo Capsules. 26 Feb. 2019 <http://ncpro.com.au/products/all-products/item/88139-essence-of-kangaroo-35000>.Victoria Department of Environment, Land, Water and Planning. Kangaroo Pet Food Trial. 28 Mar. 2019 <https://www.wildlife.vic.gov.au/managing-wildlife/wildlife-management-and-control-authorisations/kangaroo-pet-food-trial>.Willett, Walter, et al. “Food in the Anthropocene: The EAT–Lancet Commission on Healthy Diets from Sustainable Food Systems.” The Lancet 16 Jan. 2019. 26 Feb. 2019 <https://www.thelancet.com/commissions/EAT>.Wilson, George. “Kangaroos Can Be an Asset Rather than a Pest.” Australasian Science 39.1 (2018): 39.Zukerman, Wendy. “Eating Skippy: The Future of Kangaroo Meat.” New Scientist 208.2781 (2010): 42–5.