Journal articles on the topic 'Samuel Marsden'

Moore College Library has successfully applied for four Community Heritage Grants from the National Library of Australia between 2009 and 2019. This report outlines the grant process and describes the conservation projects which have been undertaken on significant collections within Moore College's Samuel Marsden Archives.

Remarkably little is recorded to suggest that lunacy was regarded as a problem in the transports, by the reported suicides or the reactions to starvation, privation and cruelty in the early years of settlement [1]. Nevertheless, in 1787, Phillip, the first Governor of New South Wales, was specifically directed to exercise powers regarding the insane. Part of these orders were: “Wee have thought fit to entrust you with the care and commitment of the said ideots and lunaticks and their estates” [2]. From then onwards nothing is heard of “the lunaticks” until after Samuel Marsden was given official duties in this field.

In 1846, in his serialized novel Woman’s Love: A Romance of Smiles and Tears!, G. Herbert Rodwell (1800–52) introduced a Pākehā Māori character, ‘the wandering Missionary, Tang-goo’. Although Jules Sébastien César Dumont d’Urville (1790–1842) had included a Pākehā Māori in his earlier novel, Les Zélandais: Histoire Australienne, written in 1824–25, this remained unpublished, and therefore Rodwell’s Tang-goo appears to be the first such character in a published novel. Tang-goo is a richly imaginative conception drawing on various sources, including the Pākehā Māori who had come to London, a ‘White Father’ character in G. P. R. novel, The Gipsy, the Native American category of ‘medicine men’, the experiences of missionaries in New Zealand, especially Samuel Marsden’s 1820 travels, and the Biblical John the Baptist. For much of Rodwell’s novel, Tang-goo is taken to be authentically Māori and as such seems to be a fantastical representation of Britain’s civilizing influence in New Zealand. The novel’s late revelation that Tang-goo was born an English nobleman explodes such a fantasy and also subverts the stereotyped negative portrayals of Pākehā Māori in missionary literature. Tang-goo knows himself to be a unique figure; his creation of a Māori identity is complete only once he is dead.

MS Glow For Men merupakan brand skincare pria yang melakukan pendekatan komunikasi melalui penggunaan brand ambassador Babecabita dan Marshel Widianto dan tagline #SemuaJugaBisa. Penelitian ini dilakukan untuk menguji dan menganalisis adanya dan seberapa besar Pengaruh Brand Ambassador dan Tagline Terhadap Respon Khalayak Pada Brand MS Glow For Men baik secara parsial maupun simultan. Untuk melihat efek yang ditimbulkan brand ambassador dan tagline terhadap respon khalayak pada penelitian ini maka akan diukur melalui teori hierarchy of effect model yang terdiri dari 3 tahap yaitu cognitive stage, affective stage, dan behaviour stage. Metode penelitian yang digunakan adalah metode kuantitatif dengan menggunakan teknik analisis regresi linier berganda dan korelasi parsial. Teknik penentuan sampel menggunakan non probability sampling melalui pendekatan purposive sampling yang diujikan pada 100 responden. Hasil penelitian ini adalah ditemukan adanya pengaruh brand ambassador dan tagline secara parsial, dimana keduanya memiliki thitung > t tabel dan nilai signifikansi < 0,05. Kemudian brand ambassador memiliki pengaruh kuat sebesar 57,3049% terhadap respon khalayak dan tagline memiliki pengaruh kuat sebesar 38,1924% terhadap respon khalayak. Ditemukan bahwa adanya pengaruh signifikan dan positif brand ambassador dan tagline terhadap respon khalayak. Hal ini dibuktikan dengan Fhitung 84,139 > Ftabel 3,09 dan nilai signifikansi 0,000 < 0,5. Berdasarkan hasil koefisien determinasi didapatkan bahwa brand ambassador dan tagline berpengaruh terhadap respon khalayak sebesar 63,4% sedangkan 36,6% dipengaruhi oleh faktor lain diluar penelitian.

FAKTOR-FAKTOR YANG MEMPENGARUHI MORTALITAS PADA PASIEN DENGAN FRAKTUR COSTA: Literature Review Anna Tri Wahyuni1), Masfuri2), Liya Arista3)1,2,3 Fakultas Ilmu Keperawatan Universitas Indonesia ABSTRAK Cedera paling umum yang terjadi pada trauma tumpul adalah fraktur costa (patah tulang iga/rusuk) dimana mekanisme cedera berpotensi mengancam jiwa. Pasien fraktur costa yang menunjukkan tingkat keparahan trauma lebih dari 90% melibatkan kepala, perut dan ekstremitas. Nyeri yang dirasakan akibat dari fraktur costa berkontribusi pada gangguan pernafasan, peningkatan resiko pneumonia dan gagal nafas yang meningkatkan angka morbiditas dan mortalitas. Pedoman penanganan fraktur costa sangat dibutuhkan untuk terjadinya komplikasi. Studi literature ini bertujuan menganalisis faktor-faktor yang mempengaruhi mortalitas pada pasien fraktur costa. Metode penulisan artikel ini menggunakan literature review yang didapat melalui 5 online database yaitu Sage Publishing, Science Direct, SpringerLink, Pub Med dan Google Scholar. Kriteria inklusi jurnal terkait meliputi: free fulltext, berbahasa Indonesia atau Bahasa asing lainnya, metode penelitian prospective, retrospective, case-control, cohort dan terbit antara tahun 2004-2021. Kata kunci yang yang digunakan dalam pencarian adalah “Respiratory depression OR Respiratory failure AND fraktur ribs AND Mortality”. Dari pencarian artikel diperoleh hasil akhir sebanyak 7 artikel yang relevan dan dilakukan proses review. Artikel tersebut menunjukkan hasil bahwa angka mortalitas dipengaruhi oleh faktor usia, skor keparahan cedera, jumlah patah tulang rusuk, dan implementasi penanganan infeksi. Faktor usia, tingkat keparahan cedera dan jumlah tulang rusuk yang patah menentukan tinggi rendahnya angka mortalitas pasien fraktur costa. Penanganan yang tepat dan manajemen nyeri yang sesuai dapat mempengaruhi penurunan angka morbiditas dan mortalitas pasien dengan fraktur costa. Pengembangan intervensi perawatan pasien fraktur costa terkait manajemen nyeri dan kontrol infeksi menjadi penelitian menarik selanjutnya.Kata kunci : Depresi pernafasan, gagal nafas, fraktur iga, angka kematian, angka kesakitanABSTRACT The most common injury in blunt trauma is a rib fracture, where the mechanism of injury is potentially life-threatening. Patients with rib fracture whose severity of the injury is greater than 90% are associated with damage to the head, abdomen, and extremities. Pain from rib fractures contributes to respiratory failure, increasing the risk of pneumonia and respiratory failure, which increases morbidity and mortality. Recommendations are needed for the treatment of complicated rib fractures. This literature study aims to analyze the factors that influence mortality in rib fracture patients. The method of writing this article uses a literature review sourced from 5 online databases, namely Sage Publishing, Science Direct, SpringerLink, Pub Med, and Google Scholar. The inclusion criteria for related journals included: free full text, in Bahasa or another foreign language, prospective, retrospective, case-control, cohort study method, and published between 2004 and 2021. Keywords used in the search were: "respiratory depression OR respiratory failure AND rib fractures AND death." From the article search results, we obtained 7 relevant articles which are the final results and a review process is carried out. The article showed that mortality was influenced by age, injury severity score, number of rib fractures, and infection control practices. The mortality rate of patient with rib fracture is determined by Factors such as age, severity of injury, and number of rib fractures. Appropriate care and adequate pain management can help reduce morbidity and mortality in patients with rib fractures. Another interesting research is the development of interventions in the treatment of rib fracture patients related to pain management and infection control.Key words: respiratory depression; respiratory failure; rib fracture; mortality; morbidity. Alamat korespondensi: RSUD Dr.Kanujoso Djatiwibowo Jalan MT.Haryono No 656 Ringroad BalikpapanEmail: annazahra30@gmail.com PENDAHULUAN Fraktur costa adalah cedera pada dada karena trauma tumpul, tajam atau kondisi patologis angka morbiditas dan mortilitas. Berdasarkan Western Trauma Association (WTA) sekitar 10% kematian pada orang dewasa muda disebabkan oleh cedera patah tulang rusuk yang melibatkan kepala, perut dan ekstremitas. Sebaliknya, pasien lanjut usia dengan patah tulang rusuk memiliki setidaknya 20% kematian yang secara langsung menyebabkan gagal napas progresif dan pneumonia (Brasel et al., 2017). Risiko pneumonia meningkat sebesar 27%, dan kematian meningkat sebesar 19% untuk setiap fraktur costa lebih dari 2 pada kelompok lanjut usia (Wanek & Mayberry, 2004). Pasien dengan trauma dada atau fraktur costa harusnya dilakukan pemantauan ketat sejak masuk rumah sakit, 24 jam pertama merupakan identifikasi awal adanya komplikasi yang menyebabkan depresi pernafasan. Menurut penelitian Coary, et.al (2020) fraktur costa adalah cedera paling serius pada 55% pasien berusia di atas 60 tahun yang menyebabkan kematian karena 90% dari patah tulang rusuk menunjukkan cedera tambahan pada pemeriksaan sistemik. Trauma langsung dan hipoventilasi yang diinduksi nyeri menyebabkan komplikasi pernafasan sehingga menjadi beban morbiditas dan mortalitas. Komplikasi yang sering terjadi adalah pneumotoraks diikuti hemothoraks, kontusio paru dan flail chest.Nyeri adalah suatu pengalaman sensorik yang multidimensional dengan fenomena yang berbeda dalam intensitas (ringan,sedang, berat), kualitas (tumpul, seperti terbakar, tajam), durasi (transien, intermiten,persisten), dan penyebaran (superfisial atau dalam, terlokalisir atau difus) (Bahrudin, 2018). Induksi nyeri pada pasien dengan fraktur costa menyebabkan pasien kesulitan bernafas dimana keparahan memar paru yang mendasarinya signifikan dengan terjadinya hipoksemia atau gangguan pernafasan. Hal ini menyebabkan pasien cenderung membatasi pergerakan dan menjadi tirah baring lama. Kondisi tirah baring lama menyebabkan tubuh mengalami penurunan berbagai fungsi secara sistematis, yang disebut dengan sindroma dekondisi dan rentan terjadinya infeksi (Hashem, Nelliot, & Needham, 2016; Hunter, Johnson, & Coustasse, 2014; Phelan, Lin, Mitchell, & Chaboyer, 2018 dalam Ananta & Fitri, 2020).Fraktur costa atau patah tulang rusuk secara klinis penting disebabkan tiga hal yaitu: sebagai penanda penyakit serius cedera intrathoraks dan perut, sebagai sumber rasa sakit yang signifikan, dan sebagai prediktor untuk kerusakan paru, terutama pada pasien usia lanjut. Organ perut yang paling sering terluka adalah hati dan limpa. Pasien dengan patah tulang rusuk kanan, memiliki 19% hingga 56% kemungkinan cedera hati, sedangkan patah tulang sisi kiri memiliki 22% hingga 28% kemungkinan cedera limpa (Wanek & Mayberry, 2004). Kematian pada orang dewasa dan lansia cenderung terjadi kemudian (≥72 jam setelah masuk) dan biasanya sebagai akibat dari kegagalan multi-organ yang dipicu oleh insufisiensi pernapasan dan pneumonia sehingga tingkat kematian secara keseluruhan, tanpa memandang usia, diperkirakan antara 10 dan 12% (Wanek & Mayberry, 2004). Tingkat mortalitas untuk pasien trauma usia lanjut yang mengalami patah tulang rusuk lebih besar daripada mereka yang tidak mengalami cedera toraks (Coary, et.al, 2020). Penelitian yang dilakukan Marini, et.al, (2021) menyatakan indikator penyebab kematian pada pasien fraktur costa dengan atau tanpa trauma kepala dan cedera organ adalah usia, jenis kelamin, ISS (Injury Severe Score), dan GCS (Glasglow Coma Scale).Berdasarkan uraian diatas maka peneliti ingin menganalisis faktor-faktor yang mempengaruhi angka morbiditas dan mortalitas pada pasien dengan fraktur costa untuk meningkatkan pemahaman tentang penanganan fraktur costa serta mengidentifikasi dari beberapa artikel terkini dalam mengurangi mortalitas. METODE PENELITIAN Metode penulisan artikel ini menggunakan literature review yaitu studi yang berfokus pada hasil penulisan yang berkaitan dengan topik, tema atau variabel penulisan.dan dipakai untuk menghimpun data atau sebuah sintesa sumber-sumber yang berhubungan dengan topik penelitian (Nursalam, 2017). Didapatkan 5 database yang dilakukan melalui pencarian elektronik dari yaitu Sage Publishing, Science Direct, SpringerLink, Pub Med dan Google Scholar. Kriteria inklusi telaah jurnal ini adalah free fulltext, berbahasa Indonesia atau bahasa asing lainnya, dengan metode penelitian prospective, retrospective, case-control, cohort dan terbit tahun 2004-2021. Kata kunci yang yang digunakan dalam pencarian adalah “Respiratory depression OR Respiratory failure AND fraktur ribs AND Mortality”. HASIL DAN PEMBAHASAN Berdasarkan hasil studi literature terdapat banyak faktor yang mempengaruhi terjadinya depresi pernafasan pada pasien fraktur costa yang dapat menyebabkan kematian. Terdapat 17.500 artikel yang muncul setelah dilakukan telusur berdasarkan kata kunci dalam google scholar, 10.000 artikel tidak masuk kriteria inklusi, 350 artikel duplikat dengan database yang lain. Kemudian sisanya disaring kembali berdasarkan hasil abstrak, metode dan hasil temuan sesuai topik peneliti yang diinginkan dan diperoleh 7 artikel yang relevan dan tersedia dalam bentuk fulltext. Beberapa penelitian terkait pencegahan depresi pernafasan pada fraktur costa berfokus pada manajemen nyeri baik secara farmakologis maupun non farmakologis. Penanganan dan pemantauan yang ketat dapat mengurangi komplikasi yang menyebabkan terjadinya depresi pernafasan. Berikut faktor-faktor yang mempengaruhi angka morbiditas dan mortalitas pada fraktur costa menurut Coary, et.al (2020) yaitu: (1) Usia, pasien berusia > 65 tahun memiliki kematian 2-5 kali lebih tinggi dibandingkan usia dibawahnya pada kondisi fraktur costa lebih dari dua. Pasien dengan komorbid sering menjadi faktor penyulit ditambah dengan kondisi paru-paru yang buruk (misal: perokok). Faktor pemulihan menjadi terhambat disebabkan osteoporosis, sistem pernafasan yang buruk, gangguan pertukaran gas dan tergambar dari lama rawat inap. (2) Jumlah patah tulang, dari beberapa penelitian meta-analisis diperoleh hasil jumlah absolut fraktur tulang rusuk yang berjumlah >2 maka dua kali lebih mungkin meninggal dunia dibandingkan pasien dengan 1-2 patah tulang rusuk. (3) Posisi anatomi patah tulang, Fraktur costa bilateral memiliki resiko kematian lebih tinggi dimana segmen flail chest menghasilkan gerak paradox yang menyebabkan pergerakan dinding dada mengarah kedalam saat inspirasi sedangkan tulang rusuk yang sehat bergerak keluar sehingga ventilasi tidak adekuat dan terjadi depresi pernafasan dan kematian. Berbeda dengan penelitian yang dilakukan Brasel et al., (2006) faktor yang paling mempengaruhi kematian adalah faktor usia ditandai dengan Injury Severity Score (ISS) jika dikaitkan dengan peningkatan terjadinya pneumonia. Analisis yang menyatakan komorbiditas mempengaruhi kematian hal ini disertai dengan faktor usia bukan karena faktor komorbiditas murni. Komorbiditas yang biasanya menyertai fraktur costa menurut penelitian adalah komorbiditas yang spesifik seperti gagal jantung kongestif, aritmia, gagal ginjal, penyakit hati, kanker metastatik dan penyakit neurologis.Pada penelitian Bulger et al dalam Wanek & Mayberry, (2004), membandingkan pasien yang berusia minimal 65 tahun keatas dengan usia 18-64 tahun dengan metode cohort pada kasus fraktur costa pada kelompok >65 tahun memiliki dua kali mortalitas dan morbiditas yang tinggi. Risiko pneumonia meningkat sebesar 27%, dan kematian meningkat sebesar 19% untuk setiap fraktur tulang rusuk tambahan pada kelompok lanjut usia.Nyeri adalah keluhan yang paling dirasakan oleh pasien dengan fraktur costa. Oleh sebab itu penanganan manajemen nyeri untuk mengontrol nyeri terus-menerus dan mencegah depresi pernafasan harus diberikan terapi yang agresif dengan pendekatan multimodalitas. Penelitian yang dilakukan oleh Peek, et.al, (2019) dengan membandingkan pemberian analgesik dengan 4 metode yaitu analgesia epidural, analgesia intravena, blok paravertebral dan blok intercostal, diperoleh hasil berdasarkan systematic review dan meta-analysis analgesia epidural signifikan mengurangi rasa sakit dibandingkan intervensi yang lain. Intervensi keperawatan sendiri menekankan pada terapi non farmakologis untuk kontrol nyeri pada pasien fraktur. Terapi nonfarmakologis dengan guided imagery dapat mengurangi intensitas dan skala nyeri pada pasien fraktur. Guided imagery mempengaruhi hampir semua fisiologis sistem kontrol tubuh yaitu pernapasan, denyut jantung, tekanan darah, tingkat metabolisme dalam sel, mobilitas dan sekresi gastrointestinal, fungsi seksual, dan bahkan respon imun (Rossman, 2000). Intervensi ini juga dapat mempercepat penyembuhan pasien dan mengurangi hari rawat inap (Forward et.al, 2015) Gambar 1. Algorithma fraktur costa (Brasel K.J, et.al, 2016).Western Trauma Association (WTA) menyatakan algorithma penanganan fraktur costa sebagai suatu observasi atau pemantauan ketat pada fraktur costa lebih dari 2 patah tulang (Brasel et.al, 2017). Berdasarkan algoritma diatas maka pasien dengan patah tulang rusuk >2 dengan usia lebih dari 65 tahun jika pada observasi kurang dari 24 jam menunjukkan peningkatan pada depresi pernafasan maka segera pindahkan ke ICU dan pertimbangkan penggunaan ventilator dan operasi rib fixaxion. Penggunaan terapi analgesia epidural digunakan untuk kontrol nyeri dilanjutkan batuk efektif, tehnik relaksasi nafas dalam dan mobilisasi dini (Brasel et.al, 2017). Analisis terkait studi literatur untuk memperkuat hasil analisis terdapat pada masing-masing artikel dibawah ini. Tabel 1. Artikel terkait faktor-faktor yang mempengaruhi terjadinya depresi pernafasan pada pasien dengan fraktur costa.Study citationMetode penelitian Desain PenelitianSampel dan Jumlah sampelHasil temuanA multidisciplinary clinical pathway decreases rib fracture–associated infectious morbidity and mortality in high-risk trauma patientsTodd,et.al,(2006)prospective cohort study Non eksperimental150 pasien dari Februari 2002-Oktober 2004 dengan > 45 tahun dan>4 patah tulang rusuk.Diperoleh hasil usia, skor keparahan cedera, dan jumlah patah tulang rusuk, jalur klinis menurunkan mekanisme hari tergantung ventilator, lama rawat inap, morbiditas infeksi, dan mortalitas dengan (interval kepercayaan 95% [CI] P<0.01).Predicting outcome of patients with chest wall injuryPressley, et.al, (2012)retrospectively reviewedNon eksperimental649 pasien (Juni 2008 hingga Februari 2010) termasuk usia, jumlah patah tulang, cedera bilateral, adanya kontusio paru, klasifikasi memar, LOS, masuk ICU, ventilasi mekanikSebuah sistem penilaian sederhana memprediksi kemungkinan bahwa pasien akan memerlukan ventilasi mekanik dan perawatan yang berkepanjangan. Skor 7 atau 8 memprediksi peningkatan risiko kematian, penerimaanke ICU, dan intubasi. Skor 5 memprediksi lama tinggal yang lebih lama dan periode ventilasi yang lebih lama. Factors Affecting Pneumonia Occurring to Patients with Multiple Rib FracturesByun & Kim., (2013).retrospectively reviewedNon eksperimentalData rekam medis 327 pasien laki-laki rata-rata usia 53 tahun dengan fraktur costa akibat kecelakaan dari Januari 2002- Desember 2008.Faktor yang mempengaruhi pneumonia pada pasien dengan fraktur tulang rusuk multipel dalam analisis multivariat termasuk usia (p=0,004), ISS (p＜0,001), dan skor tulang rusuk(p=0,038). Penggunaan antibiotik tidak berhubungan dengan kejadian pneumonia (p=0,28).Determinants of Mortality in Chest Trauma PatientsEkpe & Eyo, (2014)Retrospective and prospective Non eksperimental149 pasien dengan trauma thoraks 121 laki-laki, 28 perempuan dari Januari 2007-Desember 2011Variabel bebas, umur, jenis kelamin dan jenis cedera dada tidak terbukti berkorelasi dengan mortalitas dengan nilai P >0,05. Namun adanya cedera organ ekstra toraks terkait, skor MEWS saat masuk tinggi> 9, cedera pada interval presentasi lebih dari 24 jam, dan cedera dada yang parah ditandai dengan keterlibatan dada bilateral yang berkorelasi positif dengan mortalitas dengan nilai P <0,05.The number of displaced rib fractures is more predictive for complications in chest trauma patientsChien et.al, (2017)retrospectively reviewedNon eksperimentalJanuari 2013 -Mei 2015 diperoleh data di rumah sakit dengan total pasien 3151. Pasien yang dirawat dengan trauma dada dan patah tulang rusuk, termasuk cedera otak, limpa, panggul atau hatiJumlah patah tulang rusuk yang bergeser bisa menjadi prediktor kuat untuk berkembangnya penyakit paru-paru komplikasi. Untuk pasien dengan kurang dari tiga patah tulang rusuk tanpa perpindahan tulang rusuk dan paru-paru awal atau cedera organ lainnya, manajemen rawat jalan bisa aman dan efisien.Is the number of rib fractures a risk factor for delayed complications? Flores-Funes, et.al, (2020)Retrospective case–control studyNon eksperimentalPasien yang dirawat dengan diagnosis patah tulang rusuk antara 2010 dan 2014, diperoleh 141 pasien.Tidak ada perbedaan dalam karakteristik dasar pasien (usia, jenis kelamin dan Indeks Komorbiditas Charlson) antara kedua kelompok. Perbedaan ditemukan pada jumlah fraktur pada kelompok tanpa komplikasi p>0,05 (tidak signifikan) pada kelompok dengan komplikasi, (p=0,05) dan pada penurunan kadar hemoglobin (p=0,01). Hari rawat inap bervariasi pada setiap kelompok tetapi tanpa signifikansi statistik (p=0,11). Kesimpulan: Jumlah fraktur iga yang paling baik memprediksi munculnya komplikasi (delayed pleuro-pulmonary) dan perdarahan yang lebih besar) adalah patah tulang rusuk 3 atau lebihPredictors of mortality in patients with rib fracturesMarini, et.al, (2021) Retrospective review Non eksperimental1188 pasien patah tulang rusuk dan cedera tambahan yang dirawat selama Januari 2013-Desember 2014; 800 laki-laki dan 388 perempuan Usia, GCS, jenis kelamin laki-laki, dan Injury Severity Score (ISS) tetapi tidak jumlah patah tulang rusuk dan/atau Pulmonary contusion merupakan prediksi kematian. Peningkatan mortalitas pada pasien patah tulang rusuk dimulai pada usia 65-80 tahun tanpa peningkatan lebih lanjut. Jumlah patah tulang rusuk bukan faktor independen peningkatan mortalitas terlepas dari usia. Severe traumatic brain injury adalah penyebab kematian paling umum pada pasien usia 16-65 tahun, dibandingkan dengan komplikasi pernapasan pada pasien berusia 80 tahun atau lebih. Banyak penelitian yang telah dilakukan untuk menentukan faktor prediktor kematian pada pasien fraktur costa. Dari 7 artikel di atas terdapat berbagai bukti yang mempengaruhi kematian akibat fraktur costa dengan metode penelitian yang berbeda.Penelitian Chien, et.al, (2017) dan Flores-Funes, et.al, (2020) menunjukkan hasil yang hampir sama dimana jumlah fraktur costa yang >2 akan meningkatkan angka morbiditas dan mortalitas dikarenakan faktor komplikasi pada paru. Berbeda dengan penelitian yang dilakukan Marini, et.al, (2021) yang menyatakan jumlah dari fraktur costa tidak memprediksi peningkatan mortalitas terlepas dari usia. Menurut peneliti faktor usia menjadi prediktor utama dalam menentukan angka mortalitas pada pasien dengan fraktur costa, dimana peningkatan mortalitas pada pasien patah tulang rusuk dimulai pada usia 65-80 tahun ke atas.Penelitian yang dilakukan Todd et.al,(2006) menghasilkan hipotesa bahwa usia, skor keparahan cedera, dan jumlah patah tulang rusuk, dan implementasi jalur klinis signifikan dengan penurunan lama perawatan di unit perawatan intensif, lama rawat inap di rumah sakit, infeksi pneumonia, dan mortalitas. Maka semakin lanjut usia, tingkat keparahan yang tinggi dan jumlah patah tulang rusuk bilateral atau >2 dapat meningkatkan angka morbiditas dan mortalitas pasien dengan fraktur costa.Penelitian Pressley et.al, (2012) dilakukan dengan melakukan analisis dengan menggunakan trauma dada scoring system dimana skor >7 memprediksi peningkatan risiko kematian, penerimaan ke ICU, dan intubasi. Penilaian scoring system ini dapat digunakan untuk memprediksi kemungkinan pasien akan memerlukan ventilasi mekanik dan perawatan yang berkepanjangan sehingga dapat memperparah penyakit, menimbulkan infeksi oportunistik dan menyebabkan resiko mortalitas.Penelitian Ekpe & Eyo, (2014) menggunakan system MEWS (modified early warning signs) untuk menganalis faktor prognosis pada pasien dengan trauma dada. Sebagai variabel bebas, umur, jenis kelamin dan jenis cedera dada tidak terbukti berkorelasi dengan mortalitas dengan nilai P >0,05. Namun adanya cedera organ ekstra toraks terkait, skor MEWS saat masuk tinggi> 9, dimana interval presentasi lebih dari 24 jam dengan cedera dada yang parah ditandai dengan keterlibatan dada bilateral, berkorelasi positif pada mortalitas. Berbeda dengan penelitian sebelumnya Byun & Kim., (2013) dimana faktor umur berpengaruh pada terjadinya infeksi pneumonia dan meningkatkan angka mortilitas dengan atau tanpa diikuti tingkat keparahan pada trauma dada.Berdasarkan analisis diatas terdapat persamaan hasil penelitian dimana rata-rata metode penelitian yang dilakukan dengan menggunakan retrospective review non eksperimental. Peneliti mengamati data rekam medis dari beberapa rentang waktu dengan kriteria inklusi menderita patah tulang rusuk lebih dari dua. Namun, terdapat kriteria yang berbeda-beda pula dimana peneliti memasukkan trauma tambahan seperti brain injury dan cedera pada organ yang lain. Jumlah sampel antara penelitian satu dengan yang lain juga berbeda dari ratusan hingga ribuan data yang dianalisis. Hal ini menyebabkan hasil penelitian yang diperoleh sedikit berbeda antara satu dengan yang lain.Manajemen fraktur costa berfokus pada manajemen nyeri yang adekuat, batuk efektif, relaksasi nafas dalam dan mobilisasi dini (Brasel et al., 2017). Berdasarkan beberapa penelitian manajemen nyeri pada pasien orthopedic terutama pasca operasi adalah dengan guided imagery. The American Holistic Nurses Association menyatakan guided imagery adalah modalitas holistik yang membantu klien dalam menghubungkan pengetahuan batin mereka pada pemikiran, perasaan, dan tingkat penginderaan, mempromosikan penyembuhan bawaan mereka dengan kemampuan bersama-sama memandu klien mengatasi stres; resolusi konflik; masalah pemberdayaan diri; dan persiapan medis-bedah (Integrative & Review, 2016). Oleh sebab itu, guided imagery tepat jika digunakan pada managemen nyeri non farmakologis yang diterapkan dalam intervensi keperawatan.Dalam teori keperawatan Jean Watson tentang Transpersonal Caring mendefinisikan hubungan manusia yang bersifat caring, bersatu dengan orang lain dengan menghargai klien seutuhnya termasuk keberadaannya di dunia (Alligood, 2014). Watson menyatakan kepedulian transpersonal caring adalah dasar dari teori kepedulian manusia dimana fokus dari kepedulian transpersonal adalah pada peduli, penyembuhan, dan keutuhan, bukan pada penyakit, sakit dan patologi yang mencakup 10 faktor karatif dalam konsep utamanya (Integrative & Review, 2016). Sesuai dengan teori Watson, Guided Imagery (GI) menggabungkan kedua sains (melalui praktik berbasis bukti) dan seni (melalui aplikasi untuk berlatih) untuk mengobati rasa sakit pasien menggunakan imaginasi terbimbing dan teknik relaksasi nafas dalam. Kombinasi dengan terapi obat, GI menyediakan rezim pengobatan holistik untuk manajemen nyeri untuk menenangkan pikiran dan merilekskan tubuh mereka, memberikan kesempatan bagi klien untuk menciptakan lingkungan penyembuhan internalnya sendiri (Integrative & Review, 2016).Intervensi keperawatan untuk batuk efektif dan mobilisasi dini termasuk poin penting dalam manajemen perawatan pasien fraktur costa. Batuk efektif adalah suatu metode batuk dengan benar dan pasien dapat mengeluarkan dahak secara maksimal untuk mengeluarkan sekret dari saluran pernapasan bawah (Potter dan Perry, 2006). Mobilisasi sendiri dapat menghasilkan outcome yang baik bagi pasien seperti meningkatkan pertukaran gas, mengurangi angka Ventilator Associated Pneumoia (VAP), mengurangi durasi penggunaan ventilator, dan meningkatkan kemampuan fungsional jangka panjang (Green, Marzano, Leditschke, Mitchell, & Bissett, 2016 dalam Ananta & Fitri, 2020). Oleh sebab itu, kedua intervensi ini perlu diteliti lebih lanjut guna mengembangkan riset terkait manajemen pasien fraktur costa. SIMPULAN Pasien dengan usia lanjut dengan patah tulang rusuk atau fraktur costa biasanya menunjukkan tingkat kelemahan, multi-morbiditas, dan kompleksitas medis yang tinggi (Coary, et.al, 2020). Hal ini tentu menjadi penghambat dalam faktor penyembuhan tulang dan dapat meningkatkan angka mortalitas. Pemaparan hasil analisis menggambarkan faktor usia, cedera tulang rusuk atau costa bilateral lebih dari 2, terjadinya komplikasi dan cedera pada organ lain menyebabkan pasien harus dirawat di ruang ICU lebih lama karena resiko infeksi dan komplikasi yang dapat meningkatkan angka morbiditas dan mortalitas.Terlepas dari faktor usia, tingkat keparahan cedera dan jumlah tulang rusuk yang patah menentukan haluaran pasien yang lebih baik. Penanganan fraktur costa yang tepat yang berfokus pada kontrol kerusakan, manajemen nyeri, fiksasi seleksi, dan kualitas hidup mempengaruhi penurunan angka morbiditas dan mortalitas pasien dengan fraktur costa. Kedudukan dan peran perawat spesialis dalam tugas mengatur asuhan klien dengan kompleksitas tinggi menjadi sangat penting (Masfuri, et.all, 2019) SARAN Penelitian klinis terkait implementasi keperawatan berbasis kasus masih jarang dilakukan. Implementasi keperawatan pada pasien dengan fraktur costa terkait manajemen nyeri dan kontrol infeksi menjadi penelitian yang menarik untuk dilakukan karena hal ini menjadi indikator faktor yang mempengaruhi angka mortalitas pasien dengan fraktur costa. DAFTAR PUSTAKA Alligood Raile Martha,2014, Nursing Theorits and their Work, 8th edition, by Mosby, an imprint of Elsevier IncAnanta Tanujiarso, B., & Fitri Ayu Lestari, D. (2020). Mobilisasi Dini Pada Pasien Kritis Di Intensive Care Unit (Icu): Case Study. 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The Permanente Journal, 19(4), 18–28. https://doi.org/10.7812/TPP/14-236Flores-Funes, D., Lluna-Llorens, A. D., Jiménez-Ballester, M. Á., Valero-Navarro, G., Carrillo-Alcaráz, A., Campillo-Soto, Á., & Aguayo-Albasini, J. L. (2020). Is the number of rib fractures a risk factor for delayed complications? A case–control study. European Journal of Trauma and Emergency Surgery, 46(2), 435–440. https://doi.org/10.1007/s00068-018-1012-xIntegrative, A., & Review, L. (2016). jhn. 1–10.Marini, C. P., Petrone, P., Soto-Sánchez, A., García-Santos, E., Stoller, C., & Verde, J. (2021). Predictors of mortality in patients with rib fractures. European Journal of Trauma and Emergency Surgery, 47(5), 1527–1534. https://doi.org/10.1007/s00068-019-01183-5Masfuri Masfuri, Agung Waluyo, Yati Afiyanti, Achir Yani S. Hamid (2019) Educational background and clinical nursing tasks performed by nurses in Indonesian hospitals. Enfermería Clínica. 29 (2), 418-423. https://doi.org/10.1016/j.enfcli.2019.04.061.Nursalam. (2017). Metodologi Penelitian Ilmu Keperawatan: Pendekatan Praktis. (P. P. Lestari, Ed.) (4th ed.). Jakarta: Salemba Medika.Peek, J., Smeeing, D. P. J., Hietbrink, F., Houwert, R. M., Marsman, M., & de Jong, M. B. (2019). Comparison of analgesic interventions for traumatic rib fractures: a systematic review and meta-analysis. European Journal of Trauma and Emergency Surgery, 45(4), 597–622. https://doi.org/10.1007/s00068-018-0918-7Potter&Perry. (2006). Buku ajar Fundamental Keperawatan Konsep, Proses, dan Praktik. Jakarta: Penerbit Buku Kedokteran, EGC.Pressley, C. M., Fry, W. R., Philp, A. S., Berry, S. D., & Smith, R. S. (2012). Predicting outcome of patients with chest wall injury. American Journal of Surgery, 204(6), 910–914. https://doi.org/10.1016/j.amjsurg.2012.05.015Rossman, M. L. (2000). G uided I magery and I nteractive G uided I magery. M. L. Guided Imagery for Self Healing: An Essential for Anyone Seeking Wellness, 930.Simon, B. J., Cushman, J., Barraco, R., Lane, V., Luchette, F. A., Miglietta, M., Roccaforte, D. J., & Spector, R. (2005). Pain management guidelines for blunt thoracic trauma. Journal of Trauma - Injury, Infection and Critical Care, 59(5), 1256–1267. https://doi.org/10.1097/01.ta.0000178063.77946.f5Todd, S. R., McNally, M. M., Holcomb, J. B., Kozar, R. A., Kao, L. S., Gonzalez, E. A., Cocanour, C. S., Vercruysse, G. A., Lygas, M. H., Brasseaux, B. K., & Moore, F. A. (2006). A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. American Journal of Surgery, 192(6), 806–811. https://doi.org/10.1016/j.amjsurg.2006.08.048Wanek, S., & Mayberry, J. C. (2004). Blunt thoracic trauma: Flail chest, pulmonary contusion, and blast injury. Critical Care Clinics, 20(1), 71–81. https://doi.org/10.1016/S0749-0704(03)00098-8

Wellington-based social historian David Grant began his tenure as J. D. Stout Fellow in New Zealand Cultural Studies on 1 April 1999. In broad terms, his project encompasses an assessment of the social and economic impact and importance of horse racing on our recreational, sporting, business and community cultures. Within this framework, he will record and explain the changes that have occurred in the industry from when Samuel Marsden first brought horses into this country in1814, until the present time. From any perspective his task is daunting, as he explains...

Wellington-based social historian David Grant began his tenure as J. D. Stout Fellow in New Zealand Cultural Studies on 1 April 1999. In broad terms, his project encompasses an assessment of the social and economic impact and importance of horse racing on our recreational, sporting, business and community cultures. Within this framework, he will record and explain the changes that have occurred in the industry from when Samuel Marsden first brought horses into this country in1814, until the present time. From any perspective his task is daunting, as he explains...

This huge 926-page book would in former times have been published in two volumes, and become practicable for reading. The present reviewer in the end succumbed to purchasing an additional ebook version in order to make the monster transportable. Such gargantuan texts often prove unreadable, but this cannot be said for Sharp’s work.

AbstrakMalaria merupakan salah satu masalah kesehatan global yang menimbulkan angka kesakitan tinggi dan kematian terutama pada daerah beriklim tropis dan subtropis. Kenagarian Sungai Pinang merupakan salah satu daerah endemik malaria yang didukung oleh topografinya yang terdiri dari daerah pantai, rawa, sungai, daerah pertanian dan area pemukiman. Jenis rancangan penelitian adalah survei deskriptif dengan populasi semua larva nyamuk yang ditemukan di beberapa tempat perindukan. Sampel adalah semua larva nyamuk Anopheles yang tertangkap melalui proses cidukan. Identifikasi nyamuk anopheles dengan memakai buku acuan Stroker dan Koesoemawinangoen. Data dianalisis secara manual dan disajikan dalam bentuk tabel distribusi frekuensi. Penelitian dilakukan di Kenagarian Sungai Pinang dari Oktober 2011 sampai Maret 2012. Hasil penelitian adalah 5 spesies nyamuk anopheles yaitu An. aconitus, An. barbirostris, An. kochi, An. subpictus dan An. Sundaicus. Tempat perindukan yaitu kolam bekas kurungan ikan, lagoon, rawa-rawa, kubangan kerbau, tambak sawah dan sungai. Kesimpulan penelitian ini ialah rata-rata kepadatan larva anopheles tertinggi adalah An. subpictus yaitu 4,95 ekor/cidukan dengan tempat perindukan yang memiliki rata rata kepadatan larva Anopheles tertinggi yaitu kolam bekas kurungan ikan dengan 27,93 ekor/cidukan.Kata kunci: nyamuk anopheles, larva anopheles, tempat perindukan, kepadatan larva AbstractMalaria is a global health problem that causes high morbidity and mortality, especially in the tropics and subtropics areas. Kenagarian Sungai Pinang is one of endemic areas which supported by the topography of the area, consists of beaches, marshes, rivers, agricultural area and a residential area. Research conducted in Kenagarian Sungai Pinang from October 2011 to March 2012. Design of this study was a descriptive survey with a population was any mosquito larvae were found in some breeding places. The samples were all Anopheles larvae that caught through detention. Identification of the Anopheles mosquito using Stroker and Koesoemawinangoen (1950) reference books. The data were analyzed manually and presented in the form of a frequency distribution table. The results were five species of Anopheles mosquito; An. aconitus, An. barbirostris, An. kochi, An. subpictus dan An. Sundaicus. Seven breeding place were ex-fish cages ponds, lagoon, marsh, buffalo wallow, embankment, rice fields and rivers. The conclusion of this research are the highest larva density is An. subpictus with 4,95 larvae/detention and breeding place that has highest density of Anopheles larvae is ex-fish cage ponds with 27,93 larvae/detention.Keywords: anopheles mosquito, larvae anopheles, breeding places, larvae density

Imagine this historical scene, if you will. It is 1892, and you are up in the gallery at Her Majesty’s Theatre in Sydney, taking in an English burlesque. The people around you have just found out that Alice Leamar will not be performing her famed turn in Ta-ra-ra-boom-de-ay tonight, a high-kicking Can-Canesque number, very much the dance du jour. Your fellow audience members are none too pleased about this – they are shouting, and stamping the heels of their boots so loudly the whole theatre resounds with the noise. Most people in the expensive seats below look up in the direction of the gallery with a familiar blend of fear and loathing. The rough ‘gods’ up there are nearly always restless, more this time than usual. The uproar fulfils its purpose, though, because tomorrow night, Leamar’s act will be reinstated: the ‘gods’ will have their way (Bulletin, 1 October 1892). Another scene now, this time at the Newtown Bridge Theatre in Sydney, shortly after the turn of the twentieth century. A comedian is trying a new routine for the crowd, but no one seems much impressed so far. A few discontented rumbles begin at first – ‘I want to go home’, says one wag, and then another – and soon these gain momentum, so that almost everyone is caught up in an ecstasy of roisterous abuse. A burly ‘chucker out’ appears, trying to eject some of the loudest hecklers, and a fully-fledged punch-up ensues (Djubal 19, 23; Cheshire 86). Eventually, one or two men are made to leave – but so too is the hapless comedian, evicted by derisive howls from the stage. The scenes I have just described show that audience interaction was a key feature in late-nineteenth century popular theatre, and in some cases even persisted into the following century. Obviously, there was no formal voting mechanism used during these performances à la contemporary shows like Idol. But rowdy practises amounted to a kind of audience ‘vote’ nonetheless, through which people decided those entertainers they wanted to see and those they emphatically did not. In this paper, I intend to use these bald parallels between Victorian audience practices and new-millennium viewer-voting to investigate claims about the links between democracy and plebiscitary entertainment. The rise of voting for pleasure in televised contests and online polls is widely attended by debate about democracy (e.g. Andrejevic; Coleman; Hartley, “Reality”). The most hyped commentary on this count evokes a teleological assumption – that western history is inexorably moving towards direct democracy. This view becomes hard to sustain when we consider the extent to which the direct expression of audience views was a feature of Victorian popular entertainment, and that these participatory practices were largely suppressed by the turn of the twentieth century. Old audience practices also allow us to question some of the uses of the term ‘direct democracy’ in new media commentary. Descriptions of voting for pleasure as part of a growth towards direct democracy are often made to celebrate rather than investigate plebiscitary forms. They elide the fact that direct democracy is a vexed political ideal. And they limit our discussion of voting for leisure and fun. Ultimately, arguing back and forth about whether viewer-voting is democratic stops us from more interesting explorations of this emerging cultural phenomenon. ‘To a degree that would be unimaginable to theatregoers today’, says historian Robert Allen, ‘early nineteenth-century audiences controlled what went on at the theatre’. The so-called ‘shirt-sleeve’ crowd in the cheapest seats of theatrical venues were habitually given to hissing, shouting, and even throwing objects in order to evict performers during the course of a show. The control exerted by the peanut-chomping gallery was certainly apparent in the mid-century burlesques Allen writes about (55). It was also apparent in minstrel, variety and music hall productions until around the turn of the century. Audience members in the galleries of variety theatres and music halls regularly engaged in the pleasure of voicing their aesthetic preferences. Sometimes comic interjectors from among them even drew more laughs than the performers on stage. ‘We went there not as spectators but as performers’, as an English music-hall habitué put it (Bailey 154). In more downmarket venues such as Sydney’s Newtown Bridge Theatre, these participatory practices continued into the early 1900s. Boisterous audience practices came under sustained attack in the late-Victorian era. A series of measures were taken by authorities, theatre managers and social commentators to wrest the control of popular performances from those in theatre pits and galleries. These included restricting the sale of alcohol in theatre venues, employing brawn in the form of ‘chuckers out’, and darkening auditoriums, so that only the stage was illuminated and the audience thus de-emphasised (Allen 51–61; Bailey 157–68; Waterhouse 127, 138–43). They also included a relentless public critique of those engaging in heckling behaviours, thus displaying their ‘littleness of mind’ (Age, 6 Sep. 1876). The intensity of attacks on rowdy audience participation suggests that symbolic factors were at play in late-Victorian attempts to enforce decorous conduct at the theatre. The last half of the century was, after all, an era of intense debate about the qualities necessary for democratic citizenship. The suffrage was being dramatically expanded during this time, so that it encompassed the vast majority of white men – and by the early twentieth century, many white women as well. In Australia, the prelude to federation also involved debate about the type of democracy to be adopted. Should it be republican? Should it enfranchise all men and women; all people, or only white ones? At stake in these debates were the characteristics and subjectivities one needed to possess before being deemed capable of enfranchisement. To be worthy of the vote, as of other democratic privileges, one needed to be what Toby Miller has called a ‘well-tempered’ subject at the turn of the twentieth century (Miller; Joyce 4). One needed to be carefully deliberative and self-watching, to avoid being ‘savage’, ‘uncivilised’, emotive – all qualities which riotous audience members (like black people and women) were thought not to possess (Lake). This is why the growing respectability of popular theatre is so often considered a key feature of the modernisation of popular culture. Civil and respectful audience behaviours went hand in hand with liberal-democratic concepts of the well-tempered citizen. Working-class culture in late nineteenth-century England has famously (and notoriously) been described as a ‘culture of consolation’: an escapist desire for fun based on a fatalistic acceptance of under-privilege and social discrimination (Jones). This idea does not do justice to the range of hopes and efforts to create a better society among workingpeople at the time. But it still captures the motivation behind most unruly audience behaviours: a gleeful kind of resistance or ‘culture jamming’ which viewed disruption and uproar as ends in themselves, without the hope that they would be productive of improved social conditions. Whether or not theatrical rowdiness served a solely consolatory purpose for the shirt-sleeve crowd, it certainly evoked a sharp fear of disorderly exuberance in mainstream society. Anxieties about violent working-class uprisings leading to the institution of mob rule were a characteristic of the late-nineteenth century, often making their way into fiction (Brantlinger). Roisterous behaviours in popular theatres resonated with the concerns expressed in works such as Caesar’s Column (Donnelly), feeding on a long association between the theatre and misrule. These fears obviously stand in stark contrast to the ebullient commentary surrounding interactive entertainment today. Over-oxygenated rhetoric about the democratic potential of cyberspace was of course a feature of new media commentary at the beginning of the 1990s (for a critique of such rhetoric see Meikle 33–42; Grossman). Current helium-giddy claims about digital technologies as ‘democratising’ reprise this cyberhype (Andrejevic 12–15, 23–8; Jenkins and Thornburn). One recent example of upbeat talk about plebiscitary formats as direct democracy is John Hartley’s contribution to the edited collection, Politicotainment (Hartley, “Reality”). There are now a range of TV shows and online formats, he says, which offer audiences the opportunity to directly express their views. The development of these entertainment forms are part of a movement towards a ‘direct open network’ in global media culture (3). They are also part of a macro historical shift: a movement ‘down the value chain of meaning’ which has taken place over the past few centuries (Hartley, “Value Chain”). Hartley’s notion of a ‘value chain of meaning’ is an application of business analysis to media and cultural studies. In business, a value chain is what links the producer/originator, via commodity/distribution, to the consumer. In the same way, Hartley says, one might speak of a symbolic value chain moving from an author/producer, via the text, to the audience/consumer. Much of western history may indeed be understood as a movement along this chain. In pre-modern times, meaning resided in the author. The Divine Author, God, was regarded as the source of all meaning. In the modern period, ‘after Milton and Johnson’, meaning was located in texts. Experts observed the properties of a text or other object, and by this means discovered its meaning. In ‘the contemporary period’, however – the period roughly following the Second World War – meaning has overwhelming come to be located with audiences or consumers (Hartley, “Value Chain” 131–35). It is in this context, Hartley tells us, that the plebiscite is coming to the fore. As a means of allowing audiences to directly represent their own choices, the plebiscite is part of a new paradigm taking shape, as global culture moves away from the modern epoch and its text-dominated paradigm (Hartley, “Reality” 1–3). Talk of a symbolic value chain is a self-conscious example of the logic of business/cultural partnership currently circulating in neo-liberal discourse. It is also an example of a teleological understanding of history, through which the past few centuries are presented as part of a linear progression towards direct democracy. This teleology works well with the up-tempo talk of television as ‘democratainment’ in Hartley’s earlier work (Hartley, Uses of Television). Western history is essentially a triumphant progression, he implies, from the Dark Ages, to representative democracy, to the enlightened and direct ‘consumer democracy’ unfolding around us today (Hartley, “Reality” 47). Teleological assumptions are always suspect from an historical point of view. For a start, casting the modern period as one in which meaning resided overwhelmingly in the text fails to consider the culture of popular performance flourishing before the twentieth century. Popular theatrical forms were far more significant to ordinary people of the nineteenth century than the notions of empirical or textual analysis cultivated in elite circles. Burlesques, minstrel-shows, music hall and variety productions all took a playful approach to their texts, altering their tone and content in line with audience expectations (Chevalier 40). Before the commercialisation of popular theatre in the late-nineteenth century, many theatricals also worked in a relatively open-ended way. At concert saloons or ‘free-and-easies’ (pubs where musical performances were offered), amateur singers volunteered their services, stepping out from the audience to perform an act or two and then disappearing into it again (Joyce 206). As a precursor to TV talent contests and ‘open mic’ comedy sessions today, many theatrical managers held amateur nights in which would-be professionals tried their luck before a restless crowd, with a contract awarded to performers drawing the loudest applause (Watson 5). Each of these considerations challenge the view that open participatory networks are the expression of an historical process through which meaning has only recently come to reside with audiences and consumers. Another reason for suspecting teleological notions about democracy is that it proceeds as if Foucauldian analysis did not exist. Characterising history as a process of democratisation tends to equate democracy with openness and freedom in an uncritical way. It glosses over the fact that representative democracy involved the repression of directly participatory practices and unruly social groups. More pertinently, it ignores critiques of direct democracy. Even if there are positive aspects to the re-emergence of participatory practices among audiences today, there are still real problems with direct democracy as a political ideal. It would be fairly easy to make the case that rowdy Victorian audiences engaged in ‘direct democratic’ practices during the course of a variety show or burlesque. The ‘gods’ in Victorian galleries exulted in expressing their preferences: evicting lack-lustre comics and demanding more of other performers. It would also be easy to valorise these practices as examples of the kind of culture-jamming I referred to earlier – as forms of resistance to the tyranny of well-tempered citizenship gaining sway at the time. Given the often hysterical attacks directed at unruly audiences, there is an obvious satisfaction to be had from observing the reinstatement of Ta-ra-ra-boom-de-ay at Her Majesty’s Theatre, or in the pleasure that working-class audiences derived from ‘calling the tune’. The same kind of satisfaction is not to be had, however, when observing direct democracy in action on YouTube, or during a season of Dancing with the Stars, or some other kind of plebiscitary TV. The expression of audience preferences in this context hardly carries the subversive connotations of informal evictions during a late-Victorian music-hall show. Viewer-voting today is indeed dominated by a rhetoric of partnership which centres on audience participation, rather than a notion of opposition between producers and audiences (Jenkins). The terrain of plebiscitary entertainment is very different now from the terrain of popular culture described by Stuart Hall in the 1980s – let alone as it stood in the 1890s, during Alice Leamar’s tour. Most commentary on plebiscitary TV avoids talk of ‘cultural struggle’ (Hall 235) and instead adopts a language of collaboration and of people ‘having a ball’ (Neville; Hartley, “Reality” 3). The extent to which contemporary plebiscites are managed by what Hartley calls the ‘plebiscitary industries’ evokes one of the most powerful criticisms made against direct democracy. That is, it evokes the view that direct democracy allows commercial interests to set the terms of public participation in decision-making, and thus to influence its outcomes (Barber 36; Moore 55–56). There is obviously big money to be made from plebiscitary TV. The advertising blitz which takes place during viewer-voting programs, and the vote-rigging scandals so often surrounding them make this clear. These considerations highlight the fact that public involvement in a plebiscitary process is not something to make a song and dance about unless broad involvement first takes place in deciding the issues open for determination by plebiscite, and the way in which these issues are framed. In the absence of this kind of broad participation, engagement in plebiscitary forms serves a solely consolatory function, offering the pleasures of viewer-voting as a substitute for substantive involvement in cultural creation and political change. Another critique sometimes made against direct democracy is that it makes an easy vehicle for prejudice (Barber 36–7). This was certainly the case in Victorian theatres, where it was common for Anglo gallery-members to heckle female and non-white performers in an intimidatory way. A group of American vaudeville performers called the Cherry Sisters certainly experienced this phenomenon in the early 1900s. The Cherry Sisters were defiantly unglamorous middle-aged women in a period when female performers were increasingly expected to display scantily-clad youthful figures on stage. As a consequence, they were embroiled in a number of near-riots in which male audience members hurled abuse and heavy objects from the galleries, and in some cases chased them into the street to physically assault them there (Pittinger 76–77). Such incidents give us a glimpse of the dark face of direct democracy. In some cases, the direct expression of popular views becomes an attack on diversity, leading to the kind of violent mêlée experienced either by the Cherry Sisters or the Middle Eastern people attacked on Sydney’s Cronulla Beach at the end of 2005. ‘Democracy’ is always an obviously politically loaded term when used in debates about new media. It is frequently used to imply that particular cultural or technological forms are inherently liberatory and inclusive. As Graeme Turner points out, reality TV has been celebrated as ‘democratic’ in this way. Only rarely, however, is there an attempt to argue why this is the case – to show how viewer-voting formats actually serve a democratic agenda. It was for this reason that Turner argued that the inclusion of ordinary people on reality TV should be understood as demotic rather than democratic (Turner, Understanding Celebrity 82–5; Turner, “Mass Production”). Ultimately, however, it is immaterial whether one uses the term ‘demotic’ or ‘direct democratic’ to describe the growth of plebiscitary entertainment. What is important is that we avoid making inflated claims about the direct expression of audience views, using the term ‘democratic’ to give an unduly celebratory spin to the political complexities involved. People may indeed be having a ball as they take part in online polls or choose what they want to watch on YouTube or shout at the TV during an episode of Idol. The ‘participatory enthusiasm’ that fans feel watching a show like Big Brother may also have lessons for those interested in making parliamentary process more responsive to people’s interests and needs (Coleman 458). But the development of plebiscitary forms is not inherently democratic in the sense that Turner suggests the term should be used – that is, it does not of itself serve a liberatory or socially inclusive agenda. Nor does it lead to substantive participation in cultural and political processes. In the end, it seems to me that we need to move beyond the discussion of plebiscitary entertainment in terms of democracy. The whole concept of democracy as the yardstick against which new media should be measured is highly problematic. Not only is direct democracy a vexed political ideal to start off with – it also leads commentators to take predictable positions when debating its relationship to new technologies and cultural forms. Some turn to hype, others to critique, and the result often appears as a mere restatement of the commentators’ political inclinations rather than a useful investigation of the developments at hand. Some of the most intriguing aspects of plebiscitary entertainments are left unexplored if we remain preoccupied with democracy. One might well investigate the re-introduction of studio audiences and participatory audience practices, for example, as a nostalgia for the interactivity experienced in live theatres such as the Newtown Bridge in the early twentieth century. It certainly seems to me that a retro impulse informs some of the developments in televised stand-up comedy in recent years. This was obviously the case for Paul McDermott’s The Side Show on Australian television in 2007, with its nod to the late-Victorian or early twentieth-century fairground and its live-theatrical vibe. More relevantly here, it also seems to be the case for American viewer-voting programs such as Last Comic Standing and the Comedy Channel’s Open Mic Fight. Further, reviews of programs such as Idol sometimes emphasise the emotional engagement arising out of their combination of viewer-voting and live performance as a harking-back to the good old days when entertainment was about being real (Neville). One misses this nostalgia associated with plebiscitary entertainments if bound to a teleological assumption that they form part of an ineluctable progression towards the New and the Free. Perhaps, then, it is time to pay more attention to the historical roots of viewer-voting formats, to think about the way that new media is sometimes about a re-invention of the old, trying to escape the recurrent back-and-forthing of debate about their relationship to progress and democracy. References Allen, Robert C. Horrible Prettiness: Burlesque and American Culture .Chapel Hill: University of North Carolina Press, 1991. Andrejevic, Mark. Reality TV: The Work of Being Watched. Lanham, Maryland: Rowman and Littlefield Publishers, 2004. Bailey, Peter. Leisure and Class in Victorian England: Rational Recreation and the Contest for Control, 1830–1885. London: Routledge and Kegan Paul, 1978. Barber, Benjamin R. Strong Democracy: Participatory Politics for a New Age. Berkeley: University of California Press, 1984. ———. “Which Technology and Which Democracy?” Democracy and New Media. Eds. Henry Jenkins and David Thorburn. Cambridge, Massachusetts: MIT Press, 2003. 33–48. Brantlinger, Patrick, Rule of Darkness: British Literature and Imperialism, 1830–1914. Ithaca, New York: Cornell University Press, 1988. Cheshire, D. F. Music Hall in Britain. Rutherford: Fairleigh Dickinson University Press, 1974. Chevalier, Albert. Before I Forget: The Autobiography of a Chevalier d’Industrie. London: T. Fisher Unwin, 1901. Coleman, Stephen. “How the Other Half Votes: Big Brother Viewers and the 2005 General Election”. International Journal of Cultural Studies 9.4 (2006): 457–79. Djubal, Clay. “From Minstrel Tenor to Vaudeville Showman: Harry Clay, ‘A Friend of the Australian Performer’”. Australasian Drama Studies 34 (April 1999): 10–24. Donnelly, Ignatius. Caesar’s Column: A Story of the Twentieth Century. London: Sampson Low, Marston and Co., 1891. Grossman, Lawrence. The Electronic Republic: Reshaping Democracy in the Information Age. New York: Penguin, 1995. Hall, Stuart. “Notes on Deconstructing the ‘Popular’”. People’s History and Socialist Theory. Ed. Raphael Samuel. London: Routledge and Kegan Paul, 1981. 227–49. Hartley, John, The Uses of Television. London: Routledge, 1999. ———. “‘Reality’ and the Plebiscite”. Politoctainment: Television’s Take on the Real. Ed. Kristina Riegert. New York: Peter Lang Publishing, 2006. http://www.cci.edu.au/hartley/downloads/Plebiscite%20(Riegert%20chapter) %20revised%20FINAL%20%5BFeb%2014%5D.pdf. ———. “The ‘Value-Chain of Meaning’ and the New Economy”. International Journal of Cultural Studies 7.1 (2004): 129–41. Jenkins, Henry. “The Cultural Logic of Media Convergence”. International Journal of Cultural Studies 7.1 (2004): 33–43. ———, and David Thornburn. “Introduction: The Digital Revolution, the Informed Citizen, and the Culture of Democracy”. Democracy and New Media. Eds. Henry Jenkins and David Thorburn. Cambridge, Mass.: MIT Press, 2003. 1–20. Jones, Gareth Stedman. ‘Working-Class Culture and Working-Class Politics in London, 1870-1900: Notes on the Remaking of a Working Class’. Languages of Class: Studies in English Working-Class History, 1832–1982. Cambridge: Cambridge University Press, 1983. 179–238. Joyce, Patrick. The Rule of Freedom: Liberalism and the Modern City. London: Verso, 2003. Lake, Marilyn. “White Man’s Country: The Trans-National History of a National Project”. Australian Historical Studies 122 ( 2003): 346–63. Meikle, Graham. Future Active: Media Activism and the Internet. London: Routledge, 2002. Miller, Toby. The Well-Tempered Self: Citizenship, Culture and the Postmodern Subject. Baltimore: Johns Hopkins Press, 1993. Moore, Richard K. “Democracy and Cyberspace”. Digital Democracy: Discourse and Decision Making in the Information Age. Eds. Barry Hague and Brian D. Loader. London and New York: Routledge, 1999. 39–59. Neville, Richard. “Crass, Corny, But Still a Woodstock Moment for a New Generation”. Sydney Morning Herald, 23 November 2004. Pittinger, Peach R. “The Cherry Sisters in Early Vaudeville: Performing a Failed Femininity”. Theatre History Studies 24 (2004): 73–97. Turner, Graeme. Understanding Celebrity. London: Sage, 2004. ———. “The Mass Production of Celebrity: ‘Celetoids’, Reality TV and the ‘Demotic Turn’”. International Journal of Cultural Studies 9.2 (2006): 153–165. Waterhouse, Richard. From Minstrel Show to Vaudeville: The Australian Popular Stage, 1788–1914. Sydney: New South Wales University Press, 1990. Watson, Bobby. Fifty Years Behind the Scenes. Sydney: Slater, 1924. Citation reference for this article MLA Style Bellanta, Melissa. "Voting for Pleasure, Or a View from a Victorian Theatre Gallery." M/C Journal 10.6/11.1 (2008). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0804/02-bellanta.php>. APA Style Bellanta, M. (Apr. 2008) "Voting for Pleasure, Or a View from a Victorian Theatre Gallery," M/C Journal, 10(6)/11(1). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0804/02-bellanta.php>.

Imagine this historical scene, if you will. It is 1892, and you are up in the gallery at Her Majesty’s Theatre in Sydney, taking in an English burlesque. The people around you have just found out that Alice Leamar will not be performing her famed turn in Ta-ra-ra-boom-de-ay tonight, a high-kicking Can-Canesque number, very much the dance du jour. Your fellow audience members are none too pleased about this – they are shouting, and stamping the heels of their boots so loudly the whole theatre resounds with the noise. Most people in the expensive seats below look up in the direction of the gallery with a familiar blend of fear and loathing. The rough ‘gods’ up there are nearly always restless, more this time than usual. The uproar fulfils its purpose, though, because tomorrow night, Leamar’s act will be reinstated: the ‘gods’ will have their way (Bulletin, 1 October 1892). Another scene now, this time at the Newtown Bridge Theatre in Sydney, shortly after the turn of the twentieth century. A comedian is trying a new routine for the crowd, but no one seems much impressed so far. A few discontented rumbles begin at first – ‘I want to go home’, says one wag, and then another – and soon these gain momentum, so that almost everyone is caught up in an ecstasy of roisterous abuse. A burly ‘chucker out’ appears, trying to eject some of the loudest hecklers, and a fully-fledged punch-up ensues (Djubal 19, 23; Cheshire 86). Eventually, one or two men are made to leave – but so too is the hapless comedian, evicted by derisive howls from the stage. The scenes I have just described show that audience interaction was a key feature in late-nineteenth century popular theatre, and in some cases even persisted into the following century. Obviously, there was no formal voting mechanism used during these performances à la contemporary shows like Idol. But rowdy practises amounted to a kind of audience ‘vote’ nonetheless, through which people decided those entertainers they wanted to see and those they emphatically did not. In this paper, I intend to use these bald parallels between Victorian audience practices and new-millennium viewer-voting to investigate claims about the links between democracy and plebiscitary entertainment. The rise of voting for pleasure in televised contests and online polls is widely attended by debate about democracy (e.g. Andrejevic; Coleman; Hartley, “Reality”). The most hyped commentary on this count evokes a teleological assumption – that western history is inexorably moving towards direct democracy. This view becomes hard to sustain when we consider the extent to which the direct expression of audience views was a feature of Victorian popular entertainment, and that these participatory practices were largely suppressed by the turn of the twentieth century. Old audience practices also allow us to question some of the uses of the term ‘direct democracy’ in new media commentary. Descriptions of voting for pleasure as part of a growth towards direct democracy are often made to celebrate rather than investigate plebiscitary forms. They elide the fact that direct democracy is a vexed political ideal. And they limit our discussion of voting for leisure and fun. Ultimately, arguing back and forth about whether viewer-voting is democratic stops us from more interesting explorations of this emerging cultural phenomenon. ‘To a degree that would be unimaginable to theatregoers today’, says historian Robert Allen, ‘early nineteenth-century audiences controlled what went on at the theatre’. The so-called ‘shirt-sleeve’ crowd in the cheapest seats of theatrical venues were habitually given to hissing, shouting, and even throwing objects in order to evict performers during the course of a show. The control exerted by the peanut-chomping gallery was certainly apparent in the mid-century burlesques Allen writes about (55). It was also apparent in minstrel, variety and music hall productions until around the turn of the century. Audience members in the galleries of variety theatres and music halls regularly engaged in the pleasure of voicing their aesthetic preferences. Sometimes comic interjectors from among them even drew more laughs than the performers on stage. ‘We went there not as spectators but as performers’, as an English music-hall habitué put it (Bailey 154). In more downmarket venues such as Sydney’s Newtown Bridge Theatre, these participatory practices continued into the early 1900s. Boisterous audience practices came under sustained attack in the late-Victorian era. A series of measures were taken by authorities, theatre managers and social commentators to wrest the control of popular performances from those in theatre pits and galleries. These included restricting the sale of alcohol in theatre venues, employing brawn in the form of ‘chuckers out’, and darkening auditoriums, so that only the stage was illuminated and the audience thus de-emphasised (Allen 51–61; Bailey 157–68; Waterhouse 127, 138–43). They also included a relentless public critique of those engaging in heckling behaviours, thus displaying their ‘littleness of mind’ (Age, 6 Sep. 1876). The intensity of attacks on rowdy audience participation suggests that symbolic factors were at play in late-Victorian attempts to enforce decorous conduct at the theatre. The last half of the century was, after all, an era of intense debate about the qualities necessary for democratic citizenship. The suffrage was being dramatically expanded during this time, so that it encompassed the vast majority of white men – and by the early twentieth century, many white women as well. In Australia, the prelude to federation also involved debate about the type of democracy to be adopted. Should it be republican? Should it enfranchise all men and women; all people, or only white ones? At stake in these debates were the characteristics and subjectivities one needed to possess before being deemed capable of enfranchisement. To be worthy of the vote, as of other democratic privileges, one needed to be what Toby Miller has called a ‘well-tempered’ subject at the turn of the twentieth century (Miller; Joyce 4). One needed to be carefully deliberative and self-watching, to avoid being ‘savage’, ‘uncivilised’, emotive – all qualities which riotous audience members (like black people and women) were thought not to possess (Lake). This is why the growing respectability of popular theatre is so often considered a key feature of the modernisation of popular culture. Civil and respectful audience behaviours went hand in hand with liberal-democratic concepts of the well-tempered citizen. Working-class culture in late nineteenth-century England has famously (and notoriously) been described as a ‘culture of consolation’: an escapist desire for fun based on a fatalistic acceptance of under-privilege and social discrimination (Jones). This idea does not do justice to the range of hopes and efforts to create a better society among workingpeople at the time. But it still captures the motivation behind most unruly audience behaviours: a gleeful kind of resistance or ‘culture jamming’ which viewed disruption and uproar as ends in themselves, without the hope that they would be productive of improved social conditions. Whether or not theatrical rowdiness served a solely consolatory purpose for the shirt-sleeve crowd, it certainly evoked a sharp fear of disorderly exuberance in mainstream society. Anxieties about violent working-class uprisings leading to the institution of mob rule were a characteristic of the late-nineteenth century, often making their way into fiction (Brantlinger). Roisterous behaviours in popular theatres resonated with the concerns expressed in works such as Caesar’s Column (Donnelly), feeding on a long association between the theatre and misrule. These fears obviously stand in stark contrast to the ebullient commentary surrounding interactive entertainment today. Over-oxygenated rhetoric about the democratic potential of cyberspace was of course a feature of new media commentary at the beginning of the 1990s (for a critique of such rhetoric see Meikle 33–42; Grossman). Current helium-giddy claims about digital technologies as ‘democratising’ reprise this cyberhype (Andrejevic 12–15, 23–8; Jenkins and Thornburn). One recent example of upbeat talk about plebiscitary formats as direct democracy is John Hartley’s contribution to the edited collection, Politicotainment (Hartley, “Reality”). There are now a range of TV shows and online formats, he says, which offer audiences the opportunity to directly express their views. The development of these entertainment forms are part of a movement towards a ‘direct open network’ in global media culture (3). They are also part of a macro historical shift: a movement ‘down the value chain of meaning’ which has taken place over the past few centuries (Hartley, “Value Chain”). Hartley’s notion of a ‘value chain of meaning’ is an application of business analysis to media and cultural studies. In business, a value chain is what links the producer/originator, via commodity/distribution, to the consumer. In the same way, Hartley says, one might speak of a symbolic value chain moving from an author/producer, via the text, to the audience/consumer. Much of western history may indeed be understood as a movement along this chain. In pre-modern times, meaning resided in the author. The Divine Author, God, was regarded as the source of all meaning. In the modern period, ‘after Milton and Johnson’, meaning was located in texts. Experts observed the properties of a text or other object, and by this means discovered its meaning. In ‘the contemporary period’, however – the period roughly following the Second World War – meaning has overwhelming come to be located with audiences or consumers (Hartley, “Value Chain” 131–35). It is in this context, Hartley tells us, that the plebiscite is coming to the fore. As a means of allowing audiences to directly represent their own choices, the plebiscite is part of a new paradigm taking shape, as global culture moves away from the modern epoch and its text-dominated paradigm (Hartley, “Reality” 1–3). Talk of a symbolic value chain is a self-conscious example of the logic of business/cultural partnership currently circulating in neo-liberal discourse. It is also an example of a teleological understanding of history, through which the past few centuries are presented as part of a linear progression towards direct democracy. This teleology works well with the up-tempo talk of television as ‘democratainment’ in Hartley’s earlier work (Hartley, Uses of Television). Western history is essentially a triumphant progression, he implies, from the Dark Ages, to representative democracy, to the enlightened and direct ‘consumer democracy’ unfolding around us today (Hartley, “Reality” 47). Teleological assumptions are always suspect from an historical point of view. For a start, casting the modern period as one in which meaning resided overwhelmingly in the text fails to consider the culture of popular performance flourishing before the twentieth century. Popular theatrical forms were far more significant to ordinary people of the nineteenth century than the notions of empirical or textual analysis cultivated in elite circles. Burlesques, minstrel-shows, music hall and variety productions all took a playful approach to their texts, altering their tone and content in line with audience expectations (Chevalier 40). Before the commercialisation of popular theatre in the late-nineteenth century, many theatricals also worked in a relatively open-ended way. At concert saloons or ‘free-and-easies’ (pubs where musical performances were offered), amateur singers volunteered their services, stepping out from the audience to perform an act or two and then disappearing into it again (Joyce 206). As a precursor to TV talent contests and ‘open mic’ comedy sessions today, many theatrical managers held amateur nights in which would-be professionals tried their luck before a restless crowd, with a contract awarded to performers drawing the loudest applause (Watson 5). Each of these considerations challenge the view that open participatory networks are the expression of an historical process through which meaning has only recently come to reside with audiences and consumers. Another reason for suspecting teleological notions about democracy is that it proceeds as if Foucauldian analysis did not exist. Characterising history as a process of democratisation tends to equate democracy with openness and freedom in an uncritical way. It glosses over the fact that representative democracy involved the repression of directly participatory practices and unruly social groups. More pertinently, it ignores critiques of direct democracy. Even if there are positive aspects to the re-emergence of participatory practices among audiences today, there are still real problems with direct democracy as a political ideal. It would be fairly easy to make the case that rowdy Victorian audiences engaged in ‘direct democratic’ practices during the course of a variety show or burlesque. The ‘gods’ in Victorian galleries exulted in expressing their preferences: evicting lack-lustre comics and demanding more of other performers. It would also be easy to valorise these practices as examples of the kind of culture-jamming I referred to earlier – as forms of resistance to the tyranny of well-tempered citizenship gaining sway at the time. Given the often hysterical attacks directed at unruly audiences, there is an obvious satisfaction to be had from observing the reinstatement of Ta-ra-ra-boom-de-ay at Her Majesty’s Theatre, or in the pleasure that working-class audiences derived from ‘calling the tune’. The same kind of satisfaction is not to be had, however, when observing direct democracy in action on YouTube, or during a season of Dancing with the Stars, or some other kind of plebiscitary TV. The expression of audience preferences in this context hardly carries the subversive connotations of informal evictions during a late-Victorian music-hall show. Viewer-voting today is indeed dominated by a rhetoric of partnership which centres on audience participation, rather than a notion of opposition between producers and audiences (Jenkins). The terrain of plebiscitary entertainment is very different now from the terrain of popular culture described by Stuart Hall in the 1980s – let alone as it stood in the 1890s, during Alice Leamar’s tour. Most commentary on plebiscitary TV avoids talk of ‘cultural struggle’ (Hall 235) and instead adopts a language of collaboration and of people ‘having a ball’ (Neville; Hartley, “Reality” 3). The extent to which contemporary plebiscites are managed by what Hartley calls the ‘plebiscitary industries’ evokes one of the most powerful criticisms made against direct democracy. That is, it evokes the view that direct democracy allows commercial interests to set the terms of public participation in decision-making, and thus to influence its outcomes (Barber 36; Moore 55–56). There is obviously big money to be made from plebiscitary TV. The advertising blitz which takes place during viewer-voting programs, and the vote-rigging scandals so often surrounding them make this clear. These considerations highlight the fact that public involvement in a plebiscitary process is not something to make a song and dance about unless broad involvement first takes place in deciding the issues open for determination by plebiscite, and the way in which these issues are framed. In the absence of this kind of broad participation, engagement in plebiscitary forms serves a solely consolatory function, offering the pleasures of viewer-voting as a substitute for substantive involvement in cultural creation and political change. Another critique sometimes made against direct democracy is that it makes an easy vehicle for prejudice (Barber 36–7). This was certainly the case in Victorian theatres, where it was common for Anglo gallery-members to heckle female and non-white performers in an intimidatory way. A group of American vaudeville performers called the Cherry Sisters certainly experienced this phenomenon in the early 1900s. The Cherry Sisters were defiantly unglamorous middle-aged women in a period when female performers were increasingly expected to display scantily-clad youthful figures on stage. As a consequence, they were embroiled in a number of near-riots in which male audience members hurled abuse and heavy objects from the galleries, and in some cases chased them into the street to physically assault them there (Pittinger 76–77). Such incidents give us a glimpse of the dark face of direct democracy. In some cases, the direct expression of popular views becomes an attack on diversity, leading to the kind of violent mêlée experienced either by the Cherry Sisters or the Middle Eastern people attacked on Sydney’s Cronulla Beach at the end of 2005. ‘Democracy’ is always an obviously politically loaded term when used in debates about new media. It is frequently used to imply that particular cultural or technological forms are inherently liberatory and inclusive. As Graeme Turner points out, reality TV has been celebrated as ‘democratic’ in this way. Only rarely, however, is there an attempt to argue why this is the case – to show how viewer-voting formats actually serve a democratic agenda. It was for this reason that Turner argued that the inclusion of ordinary people on reality TV should be understood as demotic rather than democratic (Turner, Understanding Celebrity 82–5; Turner, “Mass Production”). Ultimately, however, it is immaterial whether one uses the term ‘demotic’ or ‘direct democratic’ to describe the growth of plebiscitary entertainment. What is important is that we avoid making inflated claims about the direct expression of audience views, using the term ‘democratic’ to give an unduly celebratory spin to the political complexities involved. People may indeed be having a ball as they take part in online polls or choose what they want to watch on YouTube or shout at the TV during an episode of Idol. The ‘participatory enthusiasm’ that fans feel watching a show like Big Brother may also have lessons for those interested in making parliamentary process more responsive to people’s interests and needs (Coleman 458). But the development of plebiscitary forms is not inherently democratic in the sense that Turner suggests the term should be used – that is, it does not of itself serve a liberatory or socially inclusive agenda. Nor does it lead to substantive participation in cultural and political processes. In the end, it seems to me that we need to move beyond the discussion of plebiscitary entertainment in terms of democracy. The whole concept of democracy as the yardstick against which new media should be measured is highly problematic. Not only is direct democracy a vexed political ideal to start off with – it also leads commentators to take predictable positions when debating its relationship to new technologies and cultural forms. Some turn to hype, others to critique, and the result often appears as a mere restatement of the commentators’ political inclinations rather than a useful investigation of the developments at hand. Some of the most intriguing aspects of plebiscitary entertainments are left unexplored if we remain preoccupied with democracy. One might well investigate the re-introduction of studio audiences and participatory audience practices, for example, as a nostalgia for the interactivity experienced in live theatres such as the Newtown Bridge in the early twentieth century. It certainly seems to me that a retro impulse informs some of the developments in televised stand-up comedy in recent years. This was obviously the case for Paul McDermott’s The Side Show on Australian television in 2007, with its nod to the late-Victorian or early twentieth-century fairground and its live-theatrical vibe. More relevantly here, it also seems to be the case for American viewer-voting programs such as Last Comic Standing and the Comedy Channel’s Open Mic Fight. Further, reviews of programs such as Idol sometimes emphasise the emotional engagement arising out of their combination of viewer-voting and live performance as a harking-back to the good old days when entertainment was about being real (Neville). One misses this nostalgia associated with plebiscitary entertainments if bound to a teleological assumption that they form part of an ineluctable progression towards the New and the Free. Perhaps, then, it is time to pay more attention to the historical roots of viewer-voting formats, to think about the way that new media is sometimes about a re-invention of the old, trying to escape the recurrent back-and-forthing of debate about their relationship to progress and democracy. References Allen, Robert C. 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