Artículos de revistas sobre el tema "Inc First Frontier"

Markowitz's portfolio model laid the foundation of the modern portfolio theory (MPT). As an intuitive and effective quantitative method, the Markowitz model has long been considered one of the most successful approaches in financial modeling. This paper tries to illustrate the process of Markowitz modeling and demonstrate the usefulness of the Markowitz theory empirically. Three high-tech companies, Apple Inc. (AAPL), Alphabet Inc. (GOOG), and Microsoft Corporation (MSFT) investigated to build the Markowitz model. We first retrieve the dataset from the website of yahoo finance and provide the descriptive statistics for the three companies, respectively. Then, the global minimum variance (GMV) portfolio is constructed to identify the boundary point of the efficient frontier. The optimized portfolio model at the given risk level is constructed according to the Markowitz theory. Also, the random portfolio weights under the budget constraint are generated for comparison. To evaluate the performance, we provide the Sharpe ratio for the constructed Markowitz portfolio.

6546 Background: In underserved rural communities, hospice personnel often travel great distances to reach patients, resulting in challenges to maintain access, quality, cost-effectiveness and safety. To address these disparities, the University of Kansas Medical Center piloted the country’s first TeleHospice (TH) service in 1998. Barriers such as technology limitations, costs and attitudes towards technology limited adoption (Cook et al., 2001). An updated academic-community project utilizes secure mobile videoconferencing to support TH services in Kansas’ frontier communities. Methods: Leveraging lessons learned from the early work, a secure cloud-based videoconferencing solution was chosen for ease of use. To maximize limited resources, the selection of hospice partners was guided by Gustafson et al.’s (2003) Organizational Change Manager, which also informed implementation gaps. The academic team partnered with Hospice Services, Inc., a leader in rural hospice care, providing services to 16 Kansas counties. Results: From February 2016 through January 2017, 116 TH encounters occurred, encompassing 707 attendees over 7,462 minutes. The most common TH uses to date have been: administrative (e.g., connecting hospice staff across 16 counties); professional-to-professional (e.g., connecting hospice nurses at homes to additional TH professionals); and family support (e.g., connecting adult children with loved ones). Initial use of videoconferencing for administrative purposes developed a comfort level in using it for clinical and family support purposes. For staff meetings alone, the hospice has saved approximately $2,500/month in travel, with TH staff noting increased morale driven by increased team communication. Conclusions: Compared with early work, technology advances and a community-centered approach have increased TH adoption. With decreasing budgets as well as rural hospice closures, innovative, cost-effective and community-driven approaches such as TH are needed to decrease disparities. As dissemination occurs in national hospice organizations, continued research is needed to understand best fit within frontier hospices, to inform future urban applications and to address reimbursement.

Background: In rural communities, providing hospice care can be a challenge. Hospice personnel sometimes travel great distances to reach patients, resulting in difficulty maintaining access, quality, cost-effectiveness, and safety. In 1998, the University of Kansas Medical Center piloted the country’s first TeleHospice (TH) service. At that time, challenges with broad adoption due to cost and attitudes regarding technology were noted. A second TH project was launched in early 2017 using newer technology; this article updates that ongoing implementation. Methods: The Organizational Change Manager was followed for the guided selection of the hospice partner. The University of Kansas Medical Center partnered with Hospice Services, Inc. (HSI), a leader in rural hospice care, providing services to 16 Kansas counties. Along with mobile tablets, a secure cloud-based videoconferencing solution was chosen for ease of use. Results: From August 2017 through January 2018, 218 TH videoconferencing encounters including 917 attendees occurred. Calls were made for direct patient care, family support, and administrative purposes. These TH calls have been shown to save HSI money, and initial reports suggest they may strengthen the communication and relationships between staff, patients, and the patient’s family. Conclusion: Finding innovative, cost-effective, and community-driven approaches such as TH are needed to continually advance hospice care. TeleHospice’s potential to supplement and improve hospice services while reducing costs is significant, but continued research is needed to understand best fit within frontier hospices, to inform future urban applications, and to address reimbursement.

This article was written in order to characterize the innovative activity of enterprises in terms of its financing sources. Obtaining sufficient fundsis a basic requirement for undertaking any investment activ- ity and it largely determines the further investment process and related decisions. An analysis of the available sources of financing indicates the interdependence between the innovation’s subject area and the structure of its financing. The functioning of two selected companies dealing with the implementation of innovative products will serve as an illustration of both the theoretical and practical aspects of financing innovative projects. Design and methodology The paper hypothesizes that the financing of modern innovations requires flexible conditions and high level of capital,as verified by literature review and analysis of innovative products and companies. The article consists of three parts. The first defines the concept of innovation and characterizes individual types of innovation: technological, organizational and social. Also discussed are the characteristic features of the phenomenon of innovation, the conditions shaping itand the impact it has on economic growth. The second part is a review of existing sources of capital and methods of raising it through market and public instruments. Also discussed are the conditions for the use of individual instruments, depend- ing on the stage of enterprise development, as well as their potential advantages and limitations from the entrepreneur’s point of view. The third part analyzes innovative products and companies responsible for their creation and devel- opment: the self-driving vehicle created by the American company Tesla Inc. and a thermographic tester for oncological diagnostics created by the Polish company BRASTER. Findings and implications Innovation belongs to the developing field of economy and economics. Statistical and econometric studies prove that, due to the significant risk level, innovation needs to be stimulated. Its development has a positive impact both on GDP growth and living conditions. However, in order to keep up with the technological frontier, it is necessary to under take appropriate actions serving to reduce the technological gap. This is why financing innovation is a complex process, requiring a flexible approach. And there is a considerable variety of financial instruments dedicated to innovations offered by market entities and by state institutions. This theoretical work is illustrated with examples of companies implementing technologically sophisticated products. Tesla Inc. finances work on the self-driving vehicle by increasing operational obligations, issuing debt securities, additional capital contributions and even the sale of CO2 emission rights. On the other hand, BRASTER SA, while working on introducing the oncological tester on the market, accumulated capital as a result of large issues of shares and taking out bank loans, which indicates that the company is just learning investment processes.

Abstract Background: Blood transfusions are routine medical procedures in which stored blood or blood products (i.e., red blood cells, RBCs) are given to the patient to prevent adverse health outcomes due to acute or chronic anemia. The current regulations require RBCs to be stored at 4 ºC not more than 42 days before a transfusion. However, RBCs undergo extensive rheological changes during storage and may contribute to complications associated with transfusion. Hemanext has recently introduced an innovative storage system to ameliorate such storage lesions, in which RBCs are stored in a hypoxic environment, and thus they are exposed to much lower oxidative stress during storage. In this study, we report the changes in adhesion properties of stored RBCs to human endothelial cells following a 42-day storage in normoxia vs hypoxia, using a standardized endothelialized microfluidic platform: Endothelium-on-a-chip. Methods: Two units of 1-day old blood type O positive leukocyte reduced RBCs in additive solution were pooled and divided into equal aliquots (300mL each) A and B. Unit A was stored under conventional normoxic storage condition at 4°C for 42 days. Unit B was deoxygenated so that the percent oxygen saturation of the hemoglobin was less than 20%. The deoxygenated RBCs were stored in an oxygen impermeable storage bag for 42 days at 4°C. Adhesion levels were tested at the beginning (baseline, Week 1) and the end of the storage period (Week 6). To conduct the adhesion experiments, human umbilical vein endothelial cells (HUVECs) were first cultured within microfluidic channels under flow for at least 48 hours. Next, the HUVECs were treated with 40 µM heme for 4 hours at 37 ºC [1]. RBCs were centrifuged to remove the storage buffer and resuspended in basal cell culture medium (EGM, Lonza, Morristown, USA) supplemented with 10 mM HEPES at a hematocrit of 40%. A 15 µl of RBC solution was then injected over heme-activated HUVECs at a shear stress of 1 dyne/cm 2 followed by a 10-minute rinse with fresh basal culture medium to remove non-adherent RBCs. At the end of the experiment, adherent erythrocytes were manually quantified. Control experiments were conducted with non-activated HUVECs. Results: We found that RBCs that were stored under conventional normoxic condition displayed higher adhesion to heme-activated HUVECs than hypoxic condition as illustrated in Figure 1A and 1B. The baseline adhesion levels (Week 1) to non-activated HUVECs (control) were negligible (Fig. 1C, normoxia: 13±6; hypoxia: 18±10, p>0.05) while both cell populations had considerable adhesion levels to heme-activated HUVECs at baseline (Fig. 1C, normoxia: 372±59; hypoxia: 335±37). Following a 6-week storage, adhesion of RBCs stored in normoxia to heme-activated HUVECs was higher compared to those stored in hypoxic conditions while the p-value was not significant, which was likely due to the limited sample size (Fig. 1C, 1782±519 vs 594±55, p=0.08, N=3). These results suggest that storage-mediated RBC adhesion to heme-activated HUVECs may be ameliorated by the novel hypoxic-storage condition. Discussion: This study showed a decrease in the adhesion of hypoxic RBCs to heme-activated HUVECs when compared to conventionally stored RBCs for transfusion. This result suggests that hypoxic RBCs may reduce the risk of developing vaso-occlusion (VOC) after RBC transfusion in patients such as in sickle cell disease where adhesion to heme-activated HUVECs has been implicated in the pathogenesis of VOC [1]. Acknowledgements: This work was funded by Hemanext. The authors would like to thank the Ohio Third Frontier Technology Validation and Start-up Fund (TVSF) and National Science Foundation Phase-I Small Business Technology Transfer (STTR) award, which supported this work in part. Stored RBCs were donated by Hemanext. Reference: 1. Kucukal, E., et al., American Journal of Hematology, 2018. 93(8): p.1050-1060 Figure 1 Figure 1. Disclosures Kucukal: BioChip Labs: Current Employment, Patents & Royalties. Kocevar: BioChip Labs: Current Employment. Nayak: BioChip Labs: Current Employment. Sowemimo-Coker: Hemanext: Current Employment. Zak: BioChip Labs: Current Employment, Current holder of stock options in a privately-held company; XaTek: Current Employment, Current holder of stock options in a privately-held company; TecTraum Inc: Current Employment, Current holder of stock options in a privately-held company. Omert: Hemanext: Current Employment. Gurkan: Biochip Labs: Patents & Royalties; Hemex Health, Inc.: Current Employment, Patents & Royalties; Dx Now Inc.: Patents & Royalties; Xatek Inc.: Patents & Royalties.

Abstract Background: Chronic upregulation of P-selectin (P-sel) on blood cells and the endothelium leads to abnormal red blood cell (RBC) adhesion to endothelial cells, significantly contributing to vaso-occlusive crises (VOCs), which are a major cause of morbidity and mortality in patients with sickle cell disease (SCD). Crizanlizumab (criz, a.k.a. SEG101) is a humanized anti-P-sel monoclonal antibody and has recently been approved by the Food and Drug Administration to reduce the frequency of VOCs in SCD patients. Here, we report in vitro assessment of the effect of criz on patient-specific RBC adhesion to heme-activated human endothelial cells using a standardized endothelialized microfluidic platform, the Endothelium-on-a-chip. Methods: Whole blood samples were collected from 13 subjects with SCD (13 HbSS and 1 HbSC) in EDTA vacutainers. RBCs were isolated via centrifugation from whole blood and then resuspended in basal cell culture medium (EBM, Lonza, Morristown, USA) at a hematocrit of 20% buffered with 10 mM of HEPES. Human umbilical vein endothelial cells (HUVECs) were obtained from Lonza and cultured within the microfluidic channels at 15 dyne/cm 2 for at least 48 hours prior to experiments. For long-term activation, HUVECs were treated with 40 µM heme for 4 hours +/- 100 µg/ml criz for 1 hour followed by injection of blood samples through the microfluidic channels. For short-term activation, blood samples were supplemented with 40 µM heme +/- 100 µg/ml criz and injected through the microfluidic channels for 15 minutes. Thereafter, non-adherent RBCs were rinsed via either only heme-containing EGM or heme- and criz-containing EGM, and the remaining RBCs were quantified based on published methods [1]. Student's t-test was used to calculate statistical significance. Results: We found that 4-hour heme activation of HUVECs resulted in significantly elevated RBC adhesion compared to baseline although adhesion levels were heterogenous among the patient population (Fig. 1A, 1671±522 vs 17±4, p<0.05). Treatment of 4-hour heme-activated HUVECs with criz did not significantly decrease RBC adhesion (Fig. 1A, 1170±413 vs 1671±522, p>0.05), while we observed lower RBC adhesion to criz treated HUVECs for certain subjects (Fig. 1B). By contrast, criz treatment significantly reduced the number of adherent RBCs to 15-min heme-activated HUVECs (Fig. 1C, 135±40 vs 1513±617, p<0.05). Next, we assessed whether criz would disrupt already established adhesive interactions between RBCs and 15-min heme-activated HUVECs. To do so, we first allowed RBCs to adhere to heme-activated HUVECs (for 15-min) and then rinsed the microchannels (at 10 μl/min) via either a heme- or both heme- and criz-containing solution (for 15 min). We then quantified the number of adherent RBCs at min=0 and min=15. While only 10% of the adherent RBCs remained in the microchannels following a 15-minute wash with criz, this ratio was 60% without criz (Fig. 1E). Discussion: Our results show that the magnitude of inhibition of RBC adhesion to HUVECs with criz correlated with the duration of heme-activation (4 hours vs 15 minutes). This is likely due to variable levels of different adhesion molecules on acute or chronically activated HUVECs. For instance, it has been shown that P-selectin is rapidly translocated to the cell surface following heme activation [1], but its concentration on cell surface significantly decays with time. Previous experiments have shown that sickle RBCs can adhere to cell adhesion molecules such as ICAM-1 [2], which mechanistically may play a role in the case of a chronically activated endothelium. We are currently exploring whether criz would also reduce RBC adhesion to acutely activated endothelial cells that are under chronic stress. These preliminary results suggest that the Endothelium-on-a-chip, as partner in novel therapeutic studies, could help monitoring dynamics of targeted therapies in SCD patients during drug development and in clinical trials. Acknowledgements: This work was funded by Novartis. The authors would like to thank the Ohio Third Frontier Technology Validation and Start-up Fund (TVSF) and National Science Foundation Phase-I Small Business Technology Transfer (STTR) award, which supported this work in part. Crizanlizumab was donated by Novartis. References: 1. Kucukal, E., et al., American Journal of Hematology, 2018. 93(8): p.1050-60 2. Kucukal, E., et al., Blood Advances, 2020. 4(15):3688-98 Figure 1 Figure 1. Disclosures Kucukal: BioChip Labs: Current Employment, Patents & Royalties. Kocevar: BioChip Labs: Current Employment. Nayak: BioChip Labs: Current Employment. Bruederle: Novartis Pharma AG: Current Employment. Zak: XaTek: Current Employment, Current holder of stock options in a privately-held company; BioChip Labs: Current Employment, Current holder of stock options in a privately-held company; TecTraum Inc: Current Employment, Current holder of stock options in a privately-held company. Gurkan: Dx Now Inc.: Patents & Royalties; Hemex Health, Inc.: Current Employment, Patents & Royalties; Biochip Labs: Patents & Royalties; Xatek Inc.: Patents & Royalties.

Background:ALPN-101 (ICOSL vIgD-Fc) is an Fc fusion protein of a human inducible T cell costimulatory ligand (ICOSL) variant immunoglobulin domain (vIgD™) designed to inhibit simultaneously the CD28 and ICOS inflammation pathways (1). ALPN-101 is effective in preclinical studies of lupus, arthritis, and Sjögren’s, and shows greater activity than single pathway inhibitors (2,3,4). It is in development for the treatment of multiple rheumatic and other inflammatory diseases.Objectives:To evaluate the safety, pharmacokinetics (PK), and pharmacodynamics (PD) of ALPN-101 in HVMethods:This was a first-in-human study of ALPN-101 (NCT03748836). 72 HV were allocated 4:2 to single intravenous (IV) or subcutaneous (SC) doses of ALPN-101: placebo at 0.001 – 10 mg/kg; 24 HV were allocated 6:2 to repeated IV doses of up to 1 mg/kg weekly x 4. Subjects were followed for 28 (SAD) or 49 (MAD) days to assess safety, PK, target saturation (TS) on T cells, circulating cytokines and PD, the latter based on suppression of IgG responses to keyhole limpet hemocyanin (KLH).Results:ALPN-101 was generally well-tolerated, with no treatment related serious adverse events, no cytokine release, no clinical immunogenicity, and no adverse trends in safety laboratories. Overall, adverse events were reported in 74.2% of subjects on ALPN-101 and 66.7% of subjects on placebo. All events were mild or moderate and resolved without sequelae. Dose-dependent increase in ALPN-101 exposure was observed from 0.012 to 10 mg/kg. The estimated t1/2was 2-8.6 days over 0.3 – 10 mg/kg. SC bioavailability was ~60% at 3 mg/kg. Minimal to modest accumulation was observed with repeat IV dosing. The TS at Cmaxincreased with dose between 0.001–0.03 mg/kg; thereafter the duration of high level TS (>95%) increased with dose (Figure 1). The duration of suppression of IgG anti-KLH response paralleled the duration of high level TS (Figure 2).Figure 1.Mean + SD Target Saturation of ALPN-101 on Circulating CD4+T LymphocytesFigure 2.Mean + SD Serum Anti-KLH IgG Change Relative to BaselineConclusion:ALPN-101 was well tolerated when administered as single doses up to 10 mg/kg or as repeated doses of up to 1 mg/kg weekly for 4 weeks, exhibiting dose-dependent PK, TS and PD including the inhibition of antibody responses to KLH immunization. These findings support future studies to evaluate the efficacy of ALPN-101 in multiple rheumatic and other inflammatory diseases.References:[1]Levin SD et al. Frontiers in Immunology 2020; 10:3086[2]Evans L et al. Arthritis and Rheumatology 2019:71: Supplement: Abstract 1531[3]Dillon S et al. Arthritis and Rheumatology 2018:70: Supplement: Abstract 136[4]Dillon S et al. Arthritis and Rheumatology 2019:71: Supplement: Abstract 2416Disclosure of Interests:Jing Yang Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Jan Hillson Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Jason Lickliter Consultant of: AUD 2500 from QBiotics for participation in an expert review panel for development of their oncology phase 1 trial (in Nov 2015), Kristi Manjarrez Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine immune sciences, Inc., Almudena Tercero Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Jennifer Wiley Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Gary Means Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Russell Sanderson Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Kay Carley Shareholder of: Alpine Immune Sciences, Inc., Employee of: Alpine Immune Sciences, Inc., Stanford L. Peng Shareholder of: Alpine Immune Sciences, Inc., Employee of: CMO and President of Alpine Immune Sciences, Inc.

An overview of linear collider programs is given. The history and technical challenges are described and the pioneering electron–positron linear collider, the SLC, is first introduced. For future energy frontier linear collider projects, the International Linear Collider (ILC) and the Compact Linear Collider (CLIC) are introduced and their technical features are discussed. The ILC is based on superconducting RF technology and the CLIC is based on two-beam acceleration technology. The ILC collaboration completed the Technical Design Report in 2013, and has come to the stage of "Design to Reality." The CLIC collaboration published the Conceptual Design Report in 2012, and the key technology demonstration is in progress. The prospects for further advanced acceleration technology are briefly discussed for possible long-term future linear colliders.

Frontier markets, particularly the Moroccan financial market, are characterized by a narrowness of market, inability to absorb erratic price fluctuations and the low liquidity of securities that encourage investors to herd and imitate those who have all the information about the market. A quantitative research approach was used to analyze the existence of herding n Moroccan stock market. The daily data used in this study concerns the period from 04/01/2010 to 29/12/2017 and contains the daily returns of the MASI and a total of 43 traded stocks. Statistical and econometric methods such as multidimensional scaling and Cross-sectional absolute deviation were used. Subsequently, after the regression models were examined, findings indicated that the first stocks with the highest similarity to the index return are BMCE, BCP, IAM, ATW and CMSR, and the first stocks with the highest dissimilarity are PAP, IBC and SNP, This will have to allow investors to choose profitable alternatives and avoid those that present a possible risk. The results did also show the existence of herding in the Moroccan stock market both upward and downward. This finding was supported by the clear existence of a non-linearity between market performance and CSAD measurement, which confirms the prediction of a non-linear inversion relationship between CSAD and 𝑅𝑚. This could be due to the low level of transparency that prevails in frontier stock exchanges and reduces the quality of their information environment, which leads investors not to react rationally and to draw information from the transactions of their peers.

Breast cancer patients undergoing neoadjuvant chemotherapy with anthracyclines or trastuzumab can suffer cardiotoxic issues. Nowadays, the markers of cardiac damage are still not reliable, and extracellular volume (ECV) calculated from CT could be a promising cardiotoxic marker. Eighty-two patients, treated with two different chemotherapy regimens based on doxorubicin (DOX) or epirubicin-trastuzumab (EPI–TRAS), were retrospectively selected and the variations in extracellular volume (ECV) values were measured and analyzed. Whole Body CT (WB-CT) scans were acquired after 1 min, in the portal phase (PP), and after 5 min, in the delayed phases (DP), at the baseline (T0), after one year (T1) and after five years (T5) from the end of chemotherapies. The values measured by two radiologists with different levels of experience were evaluated in order to assess the inter-reader reproducibility assessment (ICC = 0.52 for PP and DP). Further, we performed a population-based analysis and a drug-oriented subgroup analysis in 54 DOX-treated and 28 EPI–TRAS-treated patients. In the general cohort of women treated with any of the two drugs, we observed in the lapse T0–T1 a relative increase (RI) of 25% vs. 20% (PP vs. DP, p < 0.001) as well as in the lapse T0–T5 an RI of 17% vs. 15% (PP vs. DP, p < 0.01). The DOX-treated patients reported in the lapse T0–T1 an RI of 22% (p < 0.0001) in PP and an RI of 16% (p = 0.018) in the DP, with ECV values remaining stably high at T5 both in PP (RI 14.0%, p < 0.0001) and in DP (RI 17%, p = 0.005) highlighting a possible hallmark of a persisting CTX sub-damage. On the other hand, ECV measured in EPI–TRAS-treated women showed an RI in T0–T1 of 18% (p = 0.001) and 29% (p = 0.006) in PP and DP, respectively, but the values returned to basal levels in T5 both in the PP (p = 0.12) and in DP setting (p = 0.13), suggesting damage in the first-year post-treatment and a possible recovery over time. For the 82 patients, an echocardiography was performed at T0, T1= 12 m + 3 m and T5 = 60 m + 6 m with LVEF values at T0 (64% ± 5%), T1 (54% ± 6%) and T5 (53% ± 8%). WB-CT-derived ECV values could provide a valid imaging marker for the early diagnosis of cardiotoxic damage in BC patients undergoing oncological treatments. We detected different patterns during the follow-up, with stably high values for DOX, whereas EPI–TRAS showed a peak within the first year, suggesting different mechanisms of cardiac damage.

Background: The University of Southampton, in collaboration with the University Hospital Southampton (UHS) NHS Foundation Trust and industrial partners, has been at the forefront of developing three-dimensional (3D) imaging workflows using X-ray microfocus computed tomography (μCT) -based technology. This article presents the outcomes of these endeavours and highlights the distinctive characteristics of a μCT facility specifically tailored for 3D X-ray Histology, with primary focus on applications in biomedical research and preclinical and clinical studies. Methods: The UHS houses a unique 3D X-ray Histology (XRH) facility, offering a range of services to national and international clients. The facility employs specialised μCT equipment designed specifically for histology applications, allowing whole-block XRH imaging of formalin-fixed and paraffin-embedded tissue specimens. It also enables correlative imaging by combining μCT imaging with other microscopy techniques, such as immunohistochemistry (IHC) and serial block-face scanning electron microscopy, as well as data visualization, image quantification, and bespoke analysis. Results: Over the past seven years, the XRH facility has successfully completed over 120 projects in collaboration with researchers from 60 affiliations, resulting in numerous published manuscripts and conference proceedings. The facility has streamlined the μCT imaging process, improving productivity, and enabling efficient acquisition of 3D datasets. Conclusions: The 3D X-ray Histology (XRH) facility at UHS is a pioneering platform in the field of histology and biomedical imaging. To the best of our knowledge, it stands out as the world's first dedicated XRH facility, encompassing every aspect of the imaging process, from user support to data generation, analysis, training, archiving, and metadata generation. This article serves as a comprehensive guide for establishing similar XRH facilities, covering key aspects of facility setup and operation. Researchers and institutions interested in developing state-of-the-art histology and imaging facilities can utilize this resource to explore new frontiers in their research and discoveries.

Background The University of Southampton, in collaboration with the University Hospital Southampton (UHS) NHS Foundation Trust and industrial partners, has been at the forefront of developing three-dimensional (3D) imaging workflows using X-ray microfocus computed tomography (μCT) -based technology. This article presents the outcomes of these endeavours and highlights the distinctive characteristics of a μCT facility tailored explicitly for 3D X-ray Histology, with a primary focus on applications in biomedical research and preclinical and clinical studies. Methods The UHS houses a unique 3D X-ray Histology (XRH) facility, offering a range of services to national and international clients. The facility employs specialised μCT equipment explicitly designed for histology applications, allowing whole-block XRH imaging of formalin-fixed and paraffin-embedded tissue specimens. It also enables correlative imaging by combining μCT imaging with other microscopy techniques, such as immunohistochemistry (IHC) and serial block-face scanning electron microscopy, as well as data visualisation, image quantification, and bespoke analysis. Results Over the past seven years, the XRH facility has successfully completed over 120 projects in collaboration with researchers from 60 affiliations, resulting in numerous published manuscripts and conference proceedings. The facility has streamlined the μCT imaging process, improving productivity and enabling efficient acquisition of 3D datasets. Discussion & Conclusions The 3D X-ray Histology (XRH) facility at UHS is a pioneering platform in the field of histology and biomedical imaging. To the best of our knowledge, it stands out as the world's first dedicated XRH facility, encompassing every aspect of the imaging process, from user support to data generation, analysis, training, archiving, and metadata generation. This article serves as a comprehensive guide for establishing similar XRH facilities, covering key aspects of facility setup and operation. Researchers and institutions interested in developing state-of-the-art histology and imaging facilities can utilise this resource to explore new frontiers in their research and discoveries.

Abstract Background: Approximately 3540 children are diagnosed with leukemia in the United States yearly (Bhatia and Robison, Oncology of Infancy and Childhood, 2008). Cooperative group trials have increased survival, particularly for acute lymphoblastic leukemia (ALL), but successful treatment of recurrent leukemia remains an unmet medical need. Resistance pathways and epigenetic alterations suggest a role for histone deacetylase (HDAC) inhibitors in children with leukemia (Burke and Bhatla, Frontiers in Pediatrics, 2014). Panobinostat is an orally administered pan-deacetylase inhibitor with activity against HDACs at concentrations in the nanomolar range (Atadja, Cancer Letters, 2009), and for which there is pre-clinical evidence of activity in pediatric leukemia (Stubbs, et al., ASH 2010). Panobinostat shows promise in a variety of adult hematologic malignancies (Khot et al., Expert Opinion on Investigational Drugs, 2013). We undertook a phase I trial of panobinostat in children with recurrent hematologic malignancies, and herein report the safety and pharmacokinetics (PK) from enrolled children with leukemia. Methods: T2009-012 is a first-in-child study coordinated by Therapeutic Advances in Childhood Leukemia and Lymphoma (TACL). Children with relapsed or refractory leukemia between the ages of 1 and 21 years were enrolled to a multi-center, single agent trial of panobinostat dosed once per day three days per week for four successive weeks. Dose escalation was a standard 3+3 design with three dose levels planned. Subjects underwent lumbar puncture with prophylactic chemotherapy at treatment start and after a 28 day course. Blood was sampled pre-dose, at 0.5, 1, 6, 24 and 28-48 hours following the first dose. PK was obtained from blood on patients concurrently with optional specimens obtained from cerebrospinal fluid (CSF) on Day 29. Subjects who received fewer than 11 of the 12 planned doses and did not experience a dose limiting toxicity (DLT) were considered not evaluable for DLT, but were included in the summary of toxicities. Serial ECGs were monitored. Results: Seventeen subjects were enrolled with a diagnosis of acute leukemia, 10 with ALL and 7 with acute myelogenous leukemia (AML). Five were enrolled at dose level 1, 24 mg/m2/dose, 6 at dose level 2, 30 mg/m2/dose, and 6 at dose level 3, 34 mg/m2/dose. There have been no DLTs. Nine subjects are evaluable for DLT and 4 subjects were taken off study early due to increasing blast count. No subjects required removal from protocol therapy for QTc prolongation. One subject with infant ALL was removed early for progressive Aspergillus infection, 1 subject only received 10 doses owing to electrolyte abnormalities, and 2 subjects had nausea and vomiting after administration of 4 doses and did not continue. Grade 3/4 adverse events occurring in more than 20% of subjects included anemia in 82%, diarrhea in 24%, febrile neutropenia in 65%, hypokalemia in 41%, and hypophosphatemia in 24%. Concentration-time profiles were obtained from 9 subjects ages 16 months to 14 years in the 3 dose levels. Mean ± SE of PK for all subjects were Cmax 28.8 ± 6.1 ng/mL, Tmax 2.0 ± 0.8 hours, and T1/2 12.8 ± 3.0 hours. Two toddlers had the highest dose-normalized AUC0-inf and lowest oral clearance. Apparent oral clearance proportionally increased with increase in BSA. To date, 4 CSF specimens have been evaluated and found to have panobinostat below the lower limit of the quantification of 0.1 ng/mL, despite appreciable levels in the plasma. Two subjects on dose level two began a second cycle of therapy; one completed a second cycle for MLL rearranged leukemia and one discontinued study participation in the second cycle to undergo hematopoietic stem cell transplant for secondary AML after achieving a CRp in the first cycle. Conclusions: Panobinostat was tolerated these heavily pre-treated patients without unanticipated toxicities. PK in larger children and adults appears similar but PK in smaller children needs to be further explored. Penetration of panobinostat into the CSF was negligible. Two of 17 patients were able to receive a second cycle of therapy, but 4 had to be withdrawn early because of rapid increase in blast counts. Future trials will explore combination therapy in children with refractory hematologic malignancies, particularly those known to be driven by epigenetic mechanisms, in order to better control risk of rapid progression and improve efficacy through synergy. Disclosures Off Label Use: panobinostat for leukemia. Manley:Seattle Genetics, Inc.: Employment, Equity Ownership. Thomson:Epizyme, Inc: Employment.

Abstract Background: In the past decade, immunotherapy has transformed cancer treatment, with the development of immune-checkpoint inhibitors and adoptive cell therapies. A novel frontier is personalized vaccines targeting neoantigens unique to tumor cells. Vaccines based on neoantigens have several advantages. First, neoantigens are exclusively expressed by tumor cells and can, therefore, elicit truly tumor-specific T cell responses, thereby preventing ‘off-target’ damage to nonmalignant tissues. Second, neoantigens are de novo epitopes derived from somatic mutations, which presents the possibility to circumvent T cell central tolerance of self-epitopes and thus induce immune responses to tumors. One of the major challenges is the optimal neoantigen discovery/selection. Our study combines in silico HLA binding models with the 'MHC-PepSeq' platform to enhance neoantigen prediction, creating a personalized neoantigen peptide vaccine. We aim to demonstrate its efficacy in a mouse CT26 colon cancer model. Methods: Our method involved whole exome sequencing of tumor and normal DNA to identify neoantigens expressed in CT26 tumors, generating a peptide library. The peptides were further filtered using an in-silico prediction algorithm and our proprietary peptide-MHC binding assay (PepSeq assay), to determine those exhibiting the highest binding affinity with mice HLAs. Vaccines were prepared by dissolving these peptides in sterile PBS. Mice (BALB/C) were subcutaneously implanted with CT26 tumors, then immunized with the vaccine via IV injection in combination with a TLR7/8 agonist. Mice received a second vaccine dose on Day 14, and some groups were treated with an anti-PD-1 agent. Tumors and spleens from the mice were collected, processed into single-cell suspensions, and analyzed by single-cell sequencing, TCR analysis, IHC, and flow cytometry assays. Peripheral blood mononuclear cells (PBMCs) were collected and utilized in MHC tetramer assays. Results: Preliminary in vivo studies demonstrated significant tumor growth restrictions (TGI around 70%) and prolonged tumor-free survival in some mice. Our data showed the generation of neoantigen-specific T cells in vaccinated mice. Remarkably, vaccinated, tumor-free mice, when re-challenged with the same tumor cells, maintained their tumor-free status, suggesting the vaccine induced post-treatment immunological memory. Combining the vaccine with checkpoint inhibition resulted in better tumor growth restriction in mice (TGI around 93%). Conclusion: Overall, our data suggests that our personalized neoantigen vaccine platform has the potential to evoke robust and durable immune responses and, when paired with suitable complementary therapies and immune adjuvants, may serve as an effective cancer treatment. Citation Format: Tithi Ghosh Halder, Kate Gutowsky, Serina Ng, Trason Thode, Alexis Weston, Erin Kelley, Jorge Soria-Bustos, Jorge A. Giron, Taylor Bargenquast, Mohan Kaadige, Sanjana Tripuraneni, Brian Durbin, Shelby Rheinschmidt, Sydney Adamson, Michael Gordon, Justin Moser, John Altin, Raffaella Soldi, Sunil Sharma. Evaluating the efficacy of personalized neoantigen cancer vaccine in preclinical model: A promising step towards precision immunotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4107.

BackgroundRLS-0071-101 was a first in human clinical trial to evaluate safety of the peptide RLS-0071 in healthy volunteers in a single ascending dose and multiple ascending dose format. RLS-0071, previously referred to as Peptide Inhibitor of Complement C1 (PIC1) is a dual-targeting peptide being developed for clinical use to moderate humoral and cellular inflammation via inhibition of complement activation and neutrophil effectors including myeloperoxidase (MPO) and Neutrophil extracellular trap formation (NETosis).1,2 Humans that are otherwise asymptomatic are considered at risk for cardiovascular complications if they have a plasma MPO level of > 420 pmol.3 A post hoc analysis of plasma samples from subjects participating in RLS-0071-101 identified an individual with mildly elevated baseline MPO level (142 pmol/L).ObjectivesEvaluate if RLS-0071 dosing would change MPO level or activity in a subject with elevated baseline MPO.MethodsFrozen plasma samples prepared from blood collected by venipunture into K2EDTA tubes (BD) was utilized to determine MPO quantity and activity levels. MPO quantity in the plasma was analyzed using a human MPO ELISA kit (BMS2038INST, Invitrogen) and MPO activity within the plasma was analyzed using a fluorescence-based myeloperoxidase assay kit (K745-100, BioVision).ResultsUpon screening 54 subjects from RLS-0071-101 we identified one individual with a mildly elevated MPO level at baseline, a 21-year-old white female with BMI of 21.7. The subject received 9 intravenous infusions of RLS-0071 each at a dose of 10 mg/kg. Her vital signs and body temperature remained normal throughout the study and the only blood laboratory abnormality were a mildly low plasma protein concentration of Day 2 and Day 4 which was noted both among recipients of the peptide and placebo subjects. Analysis of MPO blood concentrations demonstrated a mildly elevated baseline plasma MPO concentration that decreased after multiple doses of RLS-0071 with partial recovery to baseline 24 hours after cessation of dosing. MPO activity analyzed using a fluorescence-based myeloperoxidase assay kit demonstrated an elevated baseline plasma MPO activity level that decreased after multiple doses of RLS-0071 with partial recovery after 24 hours.ConclusionThese results suggest promise for RLS-0071 to reversibly moderate plasma MPO activity and potentially affect MPO-mediated diseases including acute coronary syndrome (ACS), atheromatous plaque vulnerability and auto immune conditions.4,5,6,7.References[1]Sharp, Julia A., et al. “Peptide inhibitor of complement c1, a novel suppressor of classical pathway activation: mechanistic studies and clinical potential.” Frontiers in immunology 5 (2014): 406.[2]Hair, Pamela S., et al. “Inhibition of myeloperoxidase activity in cystic fibrosis sputum by peptide inhibitor of complement C1 (PIC1).” PLoS One 12.1 (2017): e0170203.[3]Tang WH, Wu Y, Nicholls SJ, Hazen SL. Plasma myeloperoxidase predicts incident cardiovascular risks in stable patients undergoing medical management for coronary artery disease. Clin Chem. 2011;57(1):33-9.[4]Malle, E.; Marsche, G.; Panzenboeck, U.; Sattler, W. Myeloperoxidase-mediated oxidation of high-density lipoproteins: Fingerprints of newly recognized potential proatherogenic lipoproteins. Arch. Biochem. Biophys., 2006, 445 (2), 245-255.[5]Nurcombe, H. L.; Bucknall, R. C.; Edwards, S. W. Activation of the neutrophil myeloperoxidase-H2O2 system by synovial fluid isolated from patients with rheumatoid arthritis. Ann. Rheum. Dis., 1991, 50 (4), 237-242[6]Malle, E.; Buch, T.; Grone, H. J. Myeloperoxidase in kidney disease. Kidney Int., 2003, 64 (6), 1956-1967.[7]Nicholls, S. J.; Hazen, S. L. Myeloperoxidase and cardiovascular disease. Arterioscler., Thromb., Vasc. Biol., 2005, 25 (6), 1102- 1111.Disclosure of InterestsParvathi Kumar Shareholder of: I have stock options available, Consultant of: Served as a consultant for ReAlta life Sciences INC from April- July 2020, Employee of: I am employed by ReAlta Life Sciences, Kenji Cunnion Shareholder of: Shareholder of ReAlta life sciences, Employee of: ReAlta Life Sciences, Neel Krishna Employee of: I am an employee of ReAlta Life Sciences., Ulrich Thienel Shareholder of: Shareholder of ReAlta and JNJ, Employee of: ReAlta Life Sciences, Pamela Hair Employee of: ReAlta Life Sciences, Jessica Goss Employee of: ReAlta Life Sciences, Christos Gabriel: None declared

BackgroundPolymyalgia rheumatica (PMR) is a common, rheumatic inflammatory disease. Synovial inflammation of the shoulder bursae and tendon sheaths is a hallmark feature of PMR. Data on the immune pathology of PMR are scarce, with glucocorticoid treatment remaining the mainstay treatment for this condition. An earlier study reported that macrophages dominate the inflammatory infiltrates in the synovium of PMR patients[1]. Recently, macrophages were identified as potent producers of IL-6 and GM-CSF in PMR bursa tissue[2,3], while a strong IFN-γ signature was observed among bursa T cells[4]. GM-CSF and IFN-γ might potentially skew macrophages towards a pro-inflammatory phenotype. To what extent bursa macrophages in PMR also produce other pro-inflammatory cytokines remains unknown.Objectives:1) To investigate the pro-inflammatory cytokine signature of bursa tissue macrophages in PMR.2) To determine whether GM-CSF and IFN-γ stimulated monocytes adopt a pro-inflammatory macrophage phenotype.MethodsUltrasound-guided bursa tissue biopsies were obtained from 12 PMR patients with active disease. Immunohistochemistry staining for proinflammatory cytokines (IL-6, IFN-γ, IL-1β, TNF-α, IL-12, IL-23 and GM-CSF) and homeostatic cytokines M-CSF was scored quantitatively. Double immunofluorescence staining was performed linking cytokine expression to CD68+ macrophages.In vitrostudies were performed with monocytes isolated from peripheral blood mononuclear cells of 8 patients with active PMR and 8 healthy donors. Monocytes were differentiated into macrophages during a 7-day culture in the presence of GM-CSF, with or without 24 hours co-incubation with IFN-γ on day 7 for additional polarization. Real-time qPCR was performed to determine expression of IL-6 in the cultured cells.ResultsCD68+ macrophages were the predominant immune cells in PMR bursa biopsies. IHC staining showed high expression (>60% of positive cells) of proinflammatory cytokines (IL-6, IL-12, IL-23, TNF-α and GM-CSF) and the homeostatic cytokine M-CSF throughout the bursal tissue, while IFN-γ and IL-1β were moderately expressed (>35% of positive cells). Double immunofluorescence staining confirmed the expression of these cytokines by the bursa tissue macrophages.In vitroexperiments showed a slight upregulation of IL-6 expression when monocytes were differentiated into macrophages by GM-CSF. In the presence of IFN-γ, a substantially stronger upregulation of IL-6 was observed. In essence, similarin vitrofindings were observed for monocytes/macrophages obtained from PMR patients and healthy controls.ConclusionMacrophages are the predominant immune cells in PMR bursa tissue and produce a wide array of pro-inflammatory cytokines. GM-CSF and IFN-γ may contribute to the pro-inflammatory phenotype of macrophages in PMR, as indicated by their strong ability to promote IL-6 expressionin vitro. This study provides the first glance on the complex cytokine network present in key tissues affected by PMR.Figure 1.Hypothetic pathogenesis of PMR in bursa tissue. GM-CSF and IFN-γ, together with other factors in the bursa tissue steer monocytes to differentiate into macrophages that produce pro-inflammatory cytokines such as IL-6.References[1]Meliconi, R et al. “Leukocyte infiltration in synovial tissue from the shoulder of patients with polymyalgia rheumatica. Quantitative analysis and influence of corticosteroid treatment.” Arthritis and rheumatism vol. 39,7 (1996): 1199-207.[2]Jiemy, WF et al. “OP0015PROINFLAMMATORY MONOCYTES AND MACROPHAGES IN SYNOVIAL FLUID AND BURSAL TISSUE OF PATIENTS WITH POLYMYALGIA RHEUMATICA: POTENT PRODUCERS OF IL-6 AND GM-CSF.” Annals of the Rheumatic Diseases 2022; 81:8-9.[3]Jiemy, WF et al. “Expression of interleukin-6 in synovial tissue of patients with polymyalgia rheumatica.” Annals of the rheumatic diseases. 12 Aug. 2022[4]Reitsema, RD et al. “Contribution of pathogenic T helper 1 and 17 cells to bursitis and tenosynovitis in polymyalgia rheumatica.” Frontiers in immunology. 11 Aug. 2022AcknowledgementsThis work was supported by a research grant from FOREUM Foundation for Research in Rheumatology and CSC scholarship for PhD students. The PMR Research On disease Mechanisms In Synovium (PROMIS) study was also funded by the Rheumatology Grant (Dutch Society for Rheumatology) and Mandema Stipend (University Medical Center Groningen).Disclosure of InterestsWilliam Febry Jiemy: None declared, Anqi Zhang: None declared, Maria Sandovici: None declared, Peter Heeringa: None declared, Arjan Diepstra: None declared, Elisabeth Brouwer Speakers bureau: E. Brouwer reports speaker and consulting fees from Roche in 2017-2018, outside the submitted work, Consultant of: E. Brouwer reports speaker and consulting fees from Roche in 2017-2018, outside the submitted work, Kornelis van der Geest Consultant of: K. van der Geest reports personal fees from Roche and AbbVie, outside the submitted work.

Loving the environment is a character that must be instilled in children from an early age. This study aims to describe how efforts to instil love for the environment in preschool. This research uses a collaboration action research method with the intervention of providing information and motivation about the importance of environmental education for ECE educators. The participants were the ECE community represented by eleven ECE teachers in the Tangerang, Sawangan Bogor, Medan, and Batam areas. Data collection was carried out by focus group discussions and interviews as well as the delivery of information related to learning and environmental literacy for children through online meetings. Content analysis was used to interpret the data in this study. The findings of this study indicate that the provision of information and motivation to eleven ECE teachers can make the eleven teachers form the spirit and knowledge of teachers to develop learning and teaching environmental literacy in early childhood classes. The teachers are also trying to green the school environment by planting trees and making various learning activities with the children to get to know and love the environment better. Keywords: ECE educators training, environmental literacy, environmental education References: Bryman, A. (2021). Social Research Methods. Oxford University Press. https://books.google.co.id/books?id=kDZwzgEACAAJ Burdette, H. L., & Whitaker, R. C. (2005). Resurrecting Free Play in Young Children: Looking Beyond Fitness and Fatness to Attention, Affiliation, and Affect. Archives of Pediatrics & Adolescent Medicine, 159(1), 46–50. https://doi.org/10.1001/archpedi.159.1.46 Chu, H., Lee, E. 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Appreciation of nature and appreciation of environmental protection: How stable are these attitudes and which comes first? European Review of Applied Psychology-Revue Europeenne De Psychologie Appliquee, 64, 269–277. Kaya, V., & Elster, D. (2019). A Critical Consideration of Environmental Literacy: Concepts, Contexts, and Competencies. Sustainability, 11(6), 1581. https://doi.org/10.3390/su11061581 Kidman, G., & Casinader, N. (2019). Developing Teachers’ Environmental Literacy through Inquiry-based Practices. EURASIA Journal of Mathematics, Science and Technology Education, 15(6). https://doi.org/10.29333/ejmste/103065 Kim, G., Vaswani, R. T., Kang, W., Nam, M., & Lee, D. (2017). Enhancing Ecoliteracy through Traditional Ecological Knowledge in Proverbs. Sustainability, 9(7). https://doi.org/10.3390/su9071182 Larimore, R. (2016). Defining Nature-Based Preschools. The International Journal of Early Childhood Environmental Education, 4(1), 5. Lincoln, Y. S., Guba, E. G., & Publishing, S. (1985). Naturalistic Inquiry. SAGE Publications. https://books.google.co.id/books?id=2oA9aWlNeooC López-Alcarria, A., Gutiérrez-Pérez, J., & Poza-Vilches, F. (2014). Preschool Education Professionals as Mediators of Environmental Health Education. 6th International Conference on Intercultural Education “Education and Health: From a Transcultural Perspective", 132, 639–646. https://doi.org/10.1016/j.sbspro.2014.04.366 Miles, M. B., Huberman, A. M., & Saldaña, J. (2014). Qualitative data analysis: A methods sourcebook (Third edition). SAGE Publications, Inc. Mills, G. E. (2011). Action Research: A Guide for the Teacher Researcher. Pearson. https://books.google.co.id/books?id=-d1XAAAAYAAJ Olgan, R., & Kahri̇Man-Öztürk, D. (2011). An Investigation in the Playgrounds of Public and Private Preschools in Ankara. Education and Science, 36(161), 13. Otto, S., Evans, G. W., Moon, M. J., & Kaiser, F. G. (2019). 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Abstract Background: Isatuximab (ISA) targets CD38-expressing tumor cells through a combination of activities, including antibody-dependent cellular cytotoxicity, direct pro-apoptotic activity, and complement-dependent cytotoxicity. A phase I study evaluating ISA monotherapy demonstrated promising clinical activity in 35 patients with relapsed/refractory multiple myeloma (RRMM) (Martin T et al, J Clin Oncol 2014; 32:8532). This is an ongoing phase II study (NCT01084252) with 2 stages: stage 1 to select the dose for stage 2 of the study, and stage 2 to assess efficacy and safety of ISA monotherapy or in combination with dexamethasone in RRMM. In stage 1, patients were randomized to 1 of 3 dose groups: ISA 3 mg/kg Q2W, 10 mg/kg Q2W × 2 cycles then Q4W, or 10 mg/kg Q2W. Based on pharmacokinetic data, a fourth dose of 20 mg/kg QW × 4 doses then Q2W was added. The overall response rates (ORRs) for the 4 dosing schemes were 4% (1/23), 20% (5/25), 29% (7/24), and 24% (6/25), respectively. Based on these results, a dose of 20 mg/kg QW for cycle 1 followed by 20 mg/kg Q2W in subsequent cycles was chosen for stage 2 of the study (Richter J et al, J Clin Oncol 2016;34:8005). Here, we report the baseline characteristics and demographic data from stage 2 at the selected dosing scheme from stage 1. Full safety and efficacy data will be presented at the meeting. Methods: This study enrolled patients with MM who had previously received an immunomodulatory drug and a proteasome inhibitor. Patients received ISA monotherapy (20 mg/kg on Day 1, 8, 15, and 22 [QW] of cycle 1 followed by 20 mg/kg on Day 1 and 15 [Q2W] of subsequent cycles) or ISA in combination with dexamethasone (40 mg/day [20 mg/day in patients ≥75 years old]). The primary objective was to evaluate the activity of ISA as monotherapy and in combination with dexamethasone in patients with RRMM in terms of ORR. Results: A total of 165 patients received at least 1 cycle of treatment. Median age was 67 (37-85) years. Median time from diagnosis to first dose was 5.35 (0.7-23.0) years. Median number of prior lines was 4 (2-11) and median number of prior regimens was 6 (2-17). Patients received a median of 5 (1-17) cycles of treatment, with a median duration of exposure of 22 (1-69) weeks. Discontinuation occurred in 106 (64.2%) patients due to adverse events (15 patients, 9.1%), disease progression (85 patients, 51.5%), or patient decision (6 patients, 3.6%). Conclusion: The full efficacy and safety data for this heavily pre-treated RRMM population will be available for presentation at the meeting. Funding: Sanofi Disclosures Dimopoulos: Janssen: Honoraria; Takeda: Honoraria; Bristol-Myers Squibb: Honoraria; Amgen: Honoraria; Celgene: Honoraria. Bringhen:Celgene: Honoraria; Amgen: Honoraria, Other: Advisory Board; Janssen: Honoraria, Other: Advisory Board; Takeda: Consultancy; Bristol-Myers Squibb: Honoraria. Anttila:Janssen: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees. Capra:Janssen: Research Funding, Speakers Bureau; Roche: Speakers Bureau; Amgen: Speakers Bureau; AbbVie: Research Funding; Sanofi: Research Funding; Bristol Myers Squibb: Research Funding; Novartis: Research Funding. Cavo:AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; GlaxoSmithKline: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Adaptive Biotechnologies: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees. Cole:University of Michigan: Employment; Cancer Support Community myeloma advisory board: Membership on an entity's Board of Directors or advisory committees. Gasparetto:Celgene: Consultancy, Honoraria, Other: Travel, Research Funding; Janssen: Consultancy, Honoraria, Other: Travel; Bristol-Myers Squibb: Consultancy, Honoraria, Other: Travel; Takeda: Honoraria. Hungria:Janssen: Honoraria; Celgene: Honoraria; Amgen: Honoraria; Takeda: Honoraria. Jenner:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Vorobyev:Janssen: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau; Biocad: Consultancy; Takeda: Speakers Bureau; BMS: Speakers Bureau; Astellas: Speakers Bureau. Yanez Ruiz:Universidad de la Frontera: Employment. Yin:Sanofi: Employment. Hamlett:BDM Consulting Inc.: Employment; Sanofi: Consultancy. Vij:Jansson: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Karyopharma: Honoraria, Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

Parents play an important role in the development of their children. This research reflects the role of parents in developing children. Through four stages of identification, screening, eligibility, and acceptable results, this method uses a systematic literature review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) method. The findings from the fourteen articles examined show that parenting skills play an important role in a child's growth and development from birth to death. The determining factor in the development of physical, motoric, moral, language, social-emotional, and life skills aspects is the role of both parents as important teachers for children from birth to adulthood. Parents can also use a variety of parenting strategies and skills, many of which they have learned throughout their lives and passed on to their children, to help their children grow. 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Many robot exploration algorithms that are used to explore office, home, or outdoor environments, rely on the concept of frontier cells. Frontier cells define the border between known and unknown space. Frontier-based exploration is the process of repeatedly detecting frontiers and moving towards them, until there are no more frontiers and therefore no more unknown regions. The faster frontier cells can be detected, the more efficient exploration becomes. This paper proposes several algorithms for detecting frontiers. The first is called Naïve Active Area (NaïveAA) frontier detection and achieves frontier detection in constant time by only evaluating the cells in the active area defined by scans taken. The second algorithm is called Expanding-Wavefront Frontier Detection (EWFD) and uses frontiers from the previous timestep as a starting point for searching for frontiers in newly discovered space. The third approach is called Frontier-Tracing Frontier Detection (FTFD) and also uses the frontiers from the previous timestep as well as the endpoints of the scan, to determine the frontiers at the current timestep. Algorithms are compared to state-of-the-art algorithms such as Naïve, WFD, and WFD-INC. NaïveAA is shown to operate in constant time and therefore is suitable as a basic benchmark for frontier detection algorithms. EWFD and FTFD are found to be significantly faster than other algorithms.

Introduction & Objective: Sensor-based glucose monitoring technology may reduce risks of hypoglycemia and DKA by providing people with DM key insights into their glucose variability and trends. This study investigated HbA1c and healthcare resource utilization (HCRU) before and after adoption of flash glucose monitoring in people with DM. Methods: This longitudinal retrospective cohort study used the IC/ES database of publicly funded administrative health data in Ontario, Canada. The analysis cohort comprised 45,523 people with DM in groups aged &lt; 66 or ≥ 66 years who had a first flash glucose monitoring claim between 16 Sep 2019 and 10 Apr 2021 (index date) and remained active on flash glucose monitoring for 24 months’ follow-up after the index date. ED visits and hospitalization were measured for 12 months before the index date and the last 12 months of follow-up. HbA1c data were taken from the last tests in each period. Results: Mean HbA1c was significantly improved in both age cohorts (both p &lt;.0001; Table); reductions were seen for both T1DM and T2DM, regardless of treatment used. Mean ED visits and hospitalization rates (overall, for DKA, and for hypoglycemia) improved significantly in both age cohorts, with no change in mean resource intensity weight. Conclusions: HbA1c levels and HCRU were reduced 12-24 months after sensor-based technology initiation in patients with DM. Disclosure S.B. Harris: Consultant; Abbott. Research Support; Boehringer-Ingelheim. Consultant; Dexcom, Inc. Advisory Panel; Eli Lilly and Company. Consultant; Eli Lilly and Company, Novo Nordisk, Sanofi. Research Support; Novartis AG. Consultant; Bayer Inc. R.P. Rabasa-Lhoret: Other Relationship; Abbott, AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Dexcom, Inc. Research Support; Diabetes Canada. Other Relationship; Eli Lilly and Company. Research Support; Cystic Fibrosis Canada, Canadian Institutes of Health Research, FFRD - Fondation Francophone pour la Recherche du Diabète. Other Relationship; Janssen Pharmaceuticals, Inc. Research Support; Juvenile Diabetes Research Foundation (JDRF). Other Relationship; Novo Nordisk, GlaxoSmithKline plc. Consultant; HLS Therapeutics Inc., Insulet Corporation. Speaker's Bureau; CPD Networks. Other Relationship; Medtronic. Consultant; Pfizer Inc. Speaker's Bureau; Tandem Diabetes Care, Inc. Other Relationship; Sanofi. Speaker's Bureau; Vertex Pharmaceuticals Incorporated. Research Support; SFD - Société Francophone du Diabète. A. Ratzki-Leewing: Research Support; Sanofi. Advisory Panel; Dexcom, Inc. Consultant; Abbott. Advisory Panel; Sanofi-Aventis U.S. Other Relationship; American Diabetes Association. Consultant; Novo Nordisk, Eli Lilly and Company. Y. Poon: Employee; Abbott.

Unconventional energy sources have become increasingly important to the global energy mix. These include coal seam gas, shale gas and shale oil. The unconventional gas industry was pioneered in the United States and embraced following the first oil shock in 1973 (Rogers). As has been the case with many global resources (Hiscock), many of the same companies that worked in the USA carried their experience in this industry to early Australian explorations. Recently the USA has secured significant energy security with the development of unconventional energy deposits such as the Marcellus shale gas and the Bakken shale oil (Dobb; McGraw). But this has not come without environmental impact, including contamination to underground water supply (Osborn, Vengosh, Warner, Jackson) and potential greenhouse gas contributions (Howarth, Santoro, Ingraffea; McKenna). The environmental impact of unconventional gas extraction has raised serious public concern about the introduction and growth of the industry in Australia. In coal rich Australia coal seam gas is currently the major source of unconventional gas. Large gas deposits have been found in prime agricultural land along eastern Australia, such as the Liverpool Plains in New South Wales and the Darling Downs in Queensland. Competing land-uses and a series of environmental incidents from the coal seam gas industry have warranted major protest from a coalition of environmentalists and farmers (Berry; McLeish). Conflict between energy companies wanting development and environmentalists warning precaution is an easy script to cast for frontline media coverage. But historical perspectives are often missing in these contemporary debates. While coal mining and natural gas have often received “boosting” historical coverage (Diamond; Wilkinson), and although historical themes of “development” and “rushes” remain predominant when observing the span of the industry (AGA; Blainey), the history of unconventional gas, particularly the history of its environmental impact, has been little studied. Few people are aware, for example, that the first shale gas exploratory well was completed in late 2010 in the Cooper Basin in Central Australia (Molan) and is considered as a “new” frontier in Australian unconventional gas. Moreover many people are unaware that the first coal seam gas wells were completed in 1976 in Queensland. The first four wells offer an important moment for reflection in light of the industry’s recent move into Central Australia. By locating and analysing the first four coal seam gas wells, this essay identifies the roots of the unconventional gas industry in Australia and explores the early environmental impact of these wells. By analysing exploration reports that have been placed online by the Queensland Department of Natural Resources and Mines through the lens of environmental history, the dominant developmental narrative of this industry can also be scrutinised. These narratives often place more significance on economic and national benefits while displacing the environmental and social impacts of the industry (Connor, Higginbotham, Freeman, Albrecht; Duus; McEachern; Trigger). This essay therefore seeks to bring an environmental insight into early unconventional gas mining in Australia. As the author, I am concerned that nearly four decades on and it seems that no one has heeded the warning gleaned from these early wells and early exploration reports, as gas exploration in Australia continues under little scrutiny. Arrival The first four unconventional gas wells in Australia appear at the beginning of the industry world-wide (Schraufnagel, McBane, and Kuuskraa; McClanahan). The wells were explored by Houston Oils and Minerals—a company that entered the Australian mining scene by sharing a mining prospect with International Australian Energy Company (Wiltshire). The International Australian Energy Company was owned by Black Giant Oil Company in the US, which in turn was owned by International Royalty and Oil Company also based in the US. The Texan oilman Robert Kanton held a sixteen percent share in the latter. Kanton had an idea that the Mimosa Syncline in the south-eastern Bowen Basin was a gas trap waiting to be exploited. To test the theory he needed capital. Kanton presented the idea to Houston Oil and Minerals which had the financial backing to take the risk. Shotover No. 1 was drilled by Houston Oil and Minerals thirty miles south-east of the coal mining town of Blackwater. By late August 1975 it was drilled to 2,717 metres, discovered to have little gas, spudded, and, after a spend of $610,000, abandoned. The data from the Shotover well showed that the porosity of the rocks in the area was not a trap, and the Mimosa Syncline was therefore downgraded as a possible hydrocarbon location. There was, however, a small amount of gas found in the coal seams (Benbow 16). The well had passed through the huge coal seams of both the Bowen and Surat basins—important basins for the future of both the coal and gas industries. Mining Concepts In 1975, while Houston Oil and Minerals was drilling the Shotover well, US Steel and the US Bureau of Mines used hydraulic fracture, a technique already used in the petroleum industry, to drill vertical surface wells to drain gas from a coal seam (Methane Drainage Taskforce 102). They were able to remove gas from the coal seam before it was mined and sold enough to make a profit. With the well data from the Shotover well in Australia compiled, Houston returned to the US to research the possibility of harvesting methane in Australia. As the company saw it, methane drainage was “a novel exploitation concept” and the methane in the Bowen Basin was an “enormous hydrocarbon resource” (Wiltshire 7). The Shotover well passed through a section of the German Creek Coal measures and this became their next target. In September 1976 the Shotover well was re-opened and plugged at 1499 meters to become Australia’s first exploratory unconventional gas well. By the end of the month the rig was released and gas production tested. At one point an employee on the drilling operation observed a gas flame “the size of a 44 gal drum” (HOMA, “Shotover # 1” 9). But apart from the brief show, no gas flowed. And yet, Houston Oil and Minerals was not deterred, as they had already taken out other leases for further prospecting (Wiltshire 4). Only a week after the Shotover well had failed, Houston moved the methane search south-east to an area five miles north of the Moura township. Houston Oil and Minerals had researched the coal exploration seismic surveys of the area that were conducted in 1969, 1972, and 1973 to choose the location. Over the next two months in late 1976, two new wells—Kinma No.1 and Carra No.1—were drilled within a mile from each other and completed as gas wells. Houston Oil and Minerals also purchased the old oil exploration well Moura No. 1 from the Queensland Government and completed it as a suspended gas well. The company must have mined the Department of Mines archive to find Moura No.1, as the previous exploration report from 1969 noted methane given off from the coal seams (Sell). By December 1976 Houston Oil and Minerals had three gas wells in the vicinity of each other and by early 1977 testing had occurred. The results were disappointing with minimal gas flow at Kinma and Carra, but Moura showed a little more promise. Here, the drillers were able to convert their Fairbanks-Morse engine driving the pump from an engine run on LPG to one run on methane produced from the well (Porter, “Moura # 1”). Drink This? Although there was not much gas to find in the test production phase, there was a lot of water. The exploration reports produced by the company are incomplete (indeed no report was available for the Shotover well), but the information available shows that a large amount of water was extracted before gas started to flow (Porter, “Carra # 1”; Porter, “Moura # 1”; Porter, “Kinma # 1”). As Porter’s reports outline, prior to gas flowing, the water produced at Carra, Kinma and Moura totalled 37,600 litres, 11,900 and 2,900 respectively. It should be noted that the method used to test the amount of water was not continuous and these amounts were not the full amount of water produced; also, upon gas coming to the surface some of the wells continued to produce water. In short, before any gas flowed at the first unconventional gas wells in Australia at least 50,000 litres of water were taken from underground. Results show that the water was not ready to drink (Mathers, “Moura # 1”; Mathers, “Appendix 1”; HOMA, “Miscellaneous Pages” 21-24). The water had total dissolved solids (minerals) well over the average set by the authorities (WHO; Apps Laboratories; NHMRC; QDAFF). The well at Kinma recorded the highest levels, almost two and a half times the unacceptable standard. On average the water from the Moura well was of reasonable standard, possibly because some water was extracted from the well when it was originally sunk in 1969; but the water from Kinma and Carra was very poor quality, not good enough for crops, stock or to be let run into creeks. The biggest issue was the sodium concentration; all wells had very high salt levels. Kinma and Carra were four and two times the maximum standard respectively. In short, there was a substantial amount of poor quality water produced from drilling and testing the three wells. Fracking Australia Hydraulic fracturing is an artificial process that can encourage more gas to flow to the surface (McGraw; Fischetti; Senate). Prior to the testing phase at the Moura field, well data was sent to the Chemical Research and Development Department at Halliburton in Oklahoma, to examine the ability to fracture the coal and shale in the Australian wells. Halliburton was the founding father of hydraulic fracture. In Oklahoma on 17 March 1949, operating under an exclusive license from Standard Oil, this company conducted the first ever hydraulic fracture of an oil well (Montgomery and Smith). To come up with a program of hydraulic fracturing for the Australian field, Halliburton went back to the laboratory. They bonded together small slabs of coal and shale similar to Australian samples, drilled one-inch holes into the sample, then pressurised the holes and completed a “hydro-frac” in miniature. “These samples were difficult to prepare,” they wrote in their report to Houston Oil and Minerals (HOMA, “Miscellaneous Pages” 10). Their program for fracturing was informed by a field of science that had been evolving since the first hydraulic fracture but had rapidly progressed since the first oil shock. Halliburton’s laboratory test had confirmed that the model of Perkins and Kern developed for widths of hydraulic fracture—in an article that defined the field—should also apply to Australian coals (Perkins and Kern). By late January 1977 Halliburton had issued Houston Oil and Minerals with a program of hydraulic fracture to use on the central Queensland wells. On the final page of their report they warned: “There are many unknowns in a vertical fracture design procedure” (HOMA, “Miscellaneous Pages” 17). In July 1977, Moura No. 1 became the first coal seam gas well hydraulically fractured in Australia. The exploration report states: “During July 1977 the well was killed with 1% KCL solution and the tubing and packer were pulled from the well … and pumping commenced” (Porter 2-3). The use of the word “kill” is interesting—potassium chloride (KCl) is the third and final drug administered in the lethal injection of humans on death row in the USA. Potassium chloride was used to minimise the effect on parts of the coal seam that were water-sensitive and was the recommended solution prior to adding other chemicals (Montgomery and Smith 28); but a word such as “kill” also implies that the well and the larger environment were alive before fracking commenced (Giblett; Trigger). Pumping recommenced after the fracturing fluid was unloaded. Initially gas supply was very good. It increased from an average estimate of 7,000 cubic feet per day to 30,000, but this only lasted two days before coal and sand started flowing back up to the surface. In effect, the cleats were propped open but the coal did not close and hold onto them which meant coal particles and sand flowed back up the pipe with diminishing amounts of gas (Walters 12). Although there were some interesting results, the program was considered a failure. In April 1978, Houston Oil and Minerals finally abandoned the methane concept. Following the failure, they reflected on the possibilities for a coal seam gas industry given the gas prices in Queensland: “Methane drainage wells appear to offer no economic potential” (Wooldridge 2). At the wells they let the tubing drop into the hole, put a fifteen foot cement plug at the top of the hole, covered it with a steel plate and by their own description restored the area to its “original state” (Wiltshire 8). Houston Oil and Minerals now turned to “conventional targets” which included coal exploration (Wiltshire 7). A Thousand Memories The first four wells show some of the critical environmental issues that were present from the outset of the industry in Australia. The process of hydraulic fracture was not just a failure, but conducted on a science that had never been tested in Australia, was ponderous at best, and by Halliburton’s own admission had “many unknowns”. There was also the role of large multinationals providing “experience” (Briody; Hiscock) and conducting these tests while having limited knowledge of the Australian landscape. Before any gas came to the surface, a large amount of water was produced that was loaded with a mixture of salt and other heavy minerals. The source of water for both the mud drilling of Carra and Kinma, as well as the hydraulic fracture job on Moura, was extracted from Kianga Creek three miles from the site (HOMA, “Carra # 1” 5; HOMA, “Kinma # 1” 5; Porter, “Moura # 1”). No location was listed for the disposal of the water from the wells, including the hydraulic fracture liquid. Considering the poor quality of water, if the water was disposed on site or let drain into a creek, this would have had significant environmental impact. Nobody has yet answered the question of where all this water went. The environmental issues of water extraction, saline water and hydraulic fracture were present at the first four wells. At the first four wells environmental concern was not a priority. The complexity of inter-company relations, as witnessed at the Shotover well, shows there was little time. The re-use of old wells, such as the Moura well, also shows that economic priorities were more important. Even if environmental information was considered important at the time, no one would have had access to it because, as handwritten notes on some of the reports show, many of the reports were “confidential” (Sell). Even though coal mines commenced filing Environmental Impact Statements in the early 1970s, there is no such documentation for gas exploration conducted by Houston Oil and Minerals. A lack of broader awareness for the surrounding environment, from floral and faunal health to the impact on habitat quality, can be gleaned when reading across all the exploration reports. Nearly four decades on and we now have thousands of wells throughout the world. Yet, the challenges of unconventional gas still persist. The implications of the environmental history of the first four wells in Australia for contemporary unconventional gas exploration and development in this country and beyond are significant. Many environmental issues were present from the beginning of the coal seam gas industry in Australia. Owning up to this history would place policy makers and regulators in a position to strengthen current regulation. The industry continues to face the same challenges today as it did at the start of development—including water extraction, hydraulic fracturing and problems associated with drilling through underground aquifers. Looking more broadly at the unconventional gas industry, shale gas has appeared as the next target for energy resources in Australia. Reflecting on the first exploratory shale gas wells drilled in Central Australia, the chief executive of the company responsible for the shale gas wells noted their deliberate decision to locate their activities in semi-desert country away from “an area of prime agricultural land” and conflict with environmentalists (quoted in Molan). Moreover, the journalist Paul Cleary recently complained about the coal seam gas industry polluting Australia’s food-bowl but concluded that the “next frontier” should be in “remote” Central Australia with shale gas (Cleary 195). It appears that preference is to move the industry to the arid centre of Australia, to the ecologically and culturally unique Lake Eyre Basin region (Robin and Smith). 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IntroductionIntrahepatic cholangiocarcinoma (iCC) is the liver’s second most common neoplasm. Until now, surgery is the only curative option, but only 35% of the cases are considered resectable at the diagnosis, with a post-resection survival of around 30%. Advancements in surgical techniques and perioperative care related to liver transplantation (LT) have facilitated the expansion of indications for hepatic neoplasms.MethodThis study is a comprehensive review of the global experience in living donor LT (LDLT) for treating iCC and describes our first case of LDLT for an unresectable iCC.ResultsWhile exploring LT for intrahepatic cholangiocarcinoma dates to the 1990s, the initial outcomes were discouraging, marked by poor survival and high recurrence rates. Nevertheless, contemporary perspectives underscore a reinvigorated emphasis on extending the frontiers of LT indications within the context of the “oncologic era.” The insights gleaned from examining explants, wherein incidental iCC was categorized as hepatocellular carcinoma in the preoperative period, have demonstrated comparable survival rates to small hepatocellular carcinoma. These findings substantiate the potential viability of LT as a curative alternative for iCC. Another investigated scenario pertains to “unresectable tumors with favorable biological behavior,” LT presents a theoretical advantage by providing free margins without the concern of a small future liver remnant. The constraint of organ shortage persists, particularly in nations with low donation rates. LDLT emerges as a viable and secure alternative for treating iCC.ConclusionLDLT is an excellent option for augmenting the graft pool, particularly in carefully selected patients.

A rhetoric of freedom characterises much of the literature dealing with online communities: freedom from fixed identity and appearance, from the confines of geographic space, and from control. The prevailing view, a combination of futurism and utopianism, is that the lack of order in cyberspace enables the creation of social spaces that will enhance personal freedom and advance the common good. Sherry Turkle argues that computer-mediated communication allows us to create a new form of community, in which identity is multiple and fluid (15-17). Marcos Novak celebrates the possibilities of a dematerialized, ethereal virtual architecture in which the relationships between abstract elements are in a constant state of flux (250). John Perry Barlow employs the frontier metaphor to frame cyberspace as an unmapped, ungoverned territory in which a romantic and a peculiarly American form of individualism can be enjoyed by rough and ready pioneers (“Crime” 460). In his 1993 account as an active participant in The WELL (Whole Earth ‘Lectronic Link), one of the earliest efforts to construct a social space online, Howard Rheingold celebrates the freedom to create a “new kind of culture” and an “authentic community” in the “electronic frontier.” He worries, however, that the freedom enjoyed by early homesteaders may be short lived, because “big power and big money” might soon find ways to control the Internet, just as they have come to dominate and direct other communications media. “The Net,” he states, “is still out of control in fundamental ways, but it might not stay that way for long” (Virtual Community 2-5). The uses of order and disorder Some theorists have identified disorder as a necessary condition for the development of healthy communities. In The Uses of Disorder (1970), Richard Sennett argues that “the freedom to accept and to live with disorder” is integral to our search for community (xviii). In his 1989 study of social space, Ray Oldenburg maintains that public hangouts, which constitute the heart of vibrant communities, support sociability best when activities are unplanned, unorganized, and unrestricted (33). He claims that without the constraints of preplanned control we will be more in control of ourselves and more aware of one another (198). More recently, Charles Landry suggests that “structured instability” and “controlled disruption,” resulting from competition, conflict, crisis, and debate, make cities less comfortable but more exciting. Further, he argues that “endemic structural disorder” requiring ongoing adjustments can generate healthy creative activity and stimulate continual innovation (156-58). Kevin Robins, too, believes that any viable social system must be prepared to accept a level of uncertainty, disorder, and fear. He observes, however, that techno-communities are “driven by the compulsion to neutralize,” and they therefore exclude these possibilities in favour of order and security (90-91). Indeed, order and security are the dominant characteristics that less idealistic observers have identified with cyberspace. Alexander Galloway explains how, despite its potential as a liberating development, the Internet is based on technologies of control. This control is exercised at the code level through technical protocols, such as TCP/IP, DNS, and HTM, that determine disconnections as well as connections (Galloway). Lawrence Lessig suggests that in our examination of the ownership, regulation, and governance of the virtual commons, we must take into account three distinct layers. As well as the “logical” or “code” layer that Galloway foregrounds, we should also consider the “physical” layer, consisting of the computers and wires that carry Internet communications, and the “content” layer, which includes everything that we see and hear over the network. In principle, each of these layers could be free and unorganized, or privately owned and controlled (Lessig 23). Dan Schiller documents the increasing privatization of the Net and argues that corporate cyberspace extends the reach of the market, enabling it to penetrate into areas that have previously been considered to be part of the public domain. For Schiller, the Internet now serves as the main production and control mechanism of a global market system (xiv). Checking into Habbo Hotel Habbo Hotel is an example of a highly ordered and controlled online social space that uses community and game metaphors to suggest something much more open and playful. Designed to attract the teenage market, this graphically intensive cartoon-like hotel is like an interactive Legoland, in which participants assemble a toy-like “Habbo” character and chat, play games, and construct personal environments. The first Habbo Hotel opened its doors in the United Kingdom in 2000, and, by September 2004, localized sites were based in a dozen countries, including Canada, the Unites States, Finland, Japan, Switzerland and Spain, with further expansion planned. At that time, there were more than seventeen million registered Habbo characters worldwide with 2.3 million unique visitors each month (“Strong Growth”). The hotel contains thousands of private rooms and twenty-two public spaces, including a welcome lounge, three lobbies, cinema, game hall, café, pub, and an extensive hallway. Anyone can go to the Room-O-Matic and instantly create a free guest room. However, there are a limited number of layouts to choose from and the furnishings, which must be purchased, have be chosen from a catalog of fixed offerings. All rooms are located on one of five floors, which categorize them according to use (parties, games, models, mazes, and trading). Paradoxically, the so-called public spaces are more restricted and less public than the private guest quarters. The limited capacity of the rooms means that all of the public spaces are full most of the time. Priority is given to paying Habbo Club members and others are denied entry or are unceremoniously ejected from a room when it becomes full. Most visitors never make it into the front lobby. This rigid and restricted construction is far from Novak’s vision of a “liquid architecture” without barriers, that morphs in response to the constantly changing desires of individual inhabitants (Novak 250). Before entering the virtual hotel, individuals must first create a Lego-like avatar. Users choose a unique name for their Habbo (no foul language is allowed) and construct their online persona from a limited selection and colour of body parts. One of two different wardrobes is available, depending on whether “Boy” or “Girl” is chosen. The gender of every Habbo is easily recognizable and the restricted wardrobe results in remarkably similar looking young characters. The lack of differentiation encourages participants to treat other Habbos as generic “Boys” or “Girls” and it encourages limited and predictable conversations that fit the stereotype of male-female interactions in most chat sites. Contrary to Turkle’s contention that computer mediated communication technologies expose the fallacy of a single, fixed, identity, and free participants to experiment with alternative selves (15-17), Habbo characters are permitted just one unchangeable name, and are capable of only limited visual transformations. A fixed link between each Habbo character and its registered user (information that is not available to other participants) allows the hotel management to track members through the site and monitor their behavior. Habbo movements are limited to walking, waving, dancing and drinking virtual alcohol-free beverages. Movement between spaces is accomplished by entering a teleport booth, or by selecting a location by name from the hotel Navigator. Habbos cannot jump, fly or walk through objects or other Habbos. They have no special powers and only a limited ability to interact with objects in their environment. They cannot be hurt or otherwise affected by anything in their surroundings, including other Habbos. The emphasis is on safety and avoidance of conflict. Text chat in Habbo Hotel is limited to one sixty-one-character line, which appears above the Habbo, floats upward, and quickly disappears off the top of the screen. Text must be typed in real time while reading on-going conversations and it is not possible to archive a chat sessions or view past exchanges. There is no way of posting a message on a public board. Using the Habbo Console, shorter messages can also be exchanged between Habbos who may be occupying different rooms. The only other narratives available on the site are in the form of official news and promotions. Before checking into the hotel, Habbos can stop to read Habbo Today, which promotes current offers and activities, and HabboHood Happenings, which offers safety tips, information about membership benefits, jobs (paid in furniture), contest winners, and polls. According to Rheingold, a virtual community can form online when enough people participate in meaningful public discussions over an extended period of time and develop “webs of personal relationships” (Virtual Community 5). By restricting communication to short, fleeting messages between individual Habbos, the hotel frustrates efforts by members to engage in significant dialogue and create a viable social group. Although “community” is an important part of the Habbo Hotel brand, it is unlikely to be a substantial part of the actual experience. The virtual hotel is promoted as a safe, non-threatening environment suitable for the teenagers is designed to attract. Parents’ concerns about the dangers of an unregulated chat space provide the hotel management with a justification for creating a highly controlled social space. The hotel is patrolled twenty-four hours a day by professional moderators backed-up by a team of 180 volunteer “Hobbas,” or guides, who can issue warnings to misbehaving Habbos, or temporarily ban them from the site. All text keyed in by Habbos passes through an automated “Bobba Filter” that removes swearing, racist words, explicit sexual comments and “anything that goes against the “Habbo Way” (“Bad Language”). Stick to the rules and you’ll have fun, Habbos are told, “break them and you’ll get yourself banned” (“Habbo Way”). In Big Brother fashion, messages are displayed throughought the hotel advising members to “Stay safe, read the Habbohood Watch,” “Never give out your details!” and “Obey the Habbo way and you’ll be OK.” This miniature surveillance society contradicts Barlow’s observation that cyberspace serves as “a perfect breeding ground for both outlaws and new ideas about liberty” (“Crime” 460). In his manifesto declaring the independence of cyberspace from government control, he maintains that the state has no authority in the electronic “global social space,” where, he asserts, “[w]e are forming our own Social Contract” based on the Golden Rule (“Declaration”). However, Habbo Hotel shows how the rule of the marketplace, which values profits more than social practices, can limit the freedoms of online civil society just as effectively as the most draconian government regulation. Place your order Far from permitting the “controlled disruption” advocated by Landry, the hotel management ensures that nothing is allowed to disrupt their control over the participants. Without conflict and debate, there are few triggers for creative activity in the site, which is designed to encourage consumption, not community. Timo Soininen, the managing director of the company that designed the hotel, states that, because teenagers like to showcase their own personal style, “self-expression is the key to our whole concept.” However, since it isn’t possible to create a Habbo from scratch, or to import clothing or other objects from outside the site, the only way for members to effectively express themselves is by decorating and furnishing their room with items purchased from the Habbo Catalogue. “You see, this,” admits Soininen, “is where our revenue model kicks in” (Shalit). Real-world products and services are also marketed through ads and promotions that are integrated into chat, news, and games. The result, according to Habbo Ltd, is “the ideal vehicle for third party brands to reach this highly desired 12-18 year-old market in a cost-effective and creative manner” (“Habbo Company Profile”). Habbo Hotel is a good example of what Herbert Schiller describes as the corporate capture of sites of public expression. He notes that, when put at the service of growing corporate power, new technologies “provide the instrumentation for organizing and channeling expression” (5-6). In an afterword to a revised edition of The Virtual Community, published in 2000, Rheingold reports on the sale of the WELL to a privately owned corporation, and its decline as a lively social space when order was imposed from the top down. Although he believes that there is a place for commercial virtual communities on the Net, he acknowledges that as economic forces become more entrenched, “more controls will be instituted because there is more at stake.” While remaining hopeful that activists can leverage the power of many-to-many communications for the public good, he wonders what will happen when “the decentralized network infrastructure and freewheeling network economy collides with the continuing growth of mammoth, global, communication empires” (Virtual Community Rev. 375-7). Although the company that built Habbo Hotel is far from achieving global empire status, their project illustrates how the dominant ethos of privatization and the increasing emphasis on consumption results in gated virtual communities that are highly ordered, restricted, and controlled. The popularity of the hotel reflects the desire of millions of Habbos to express their identities and ideas in a playful environment that they are free to create and manipulate. However, they soon find that the rules are stacked against them. Restricted design options, severe communication limitations, and fixed architectural constraints mean that the only freedom left is the freedom to choose from a narrow range of provided options. In private cyberspaces like Habbo Hotel, the logic of the market rules out unrestrained many-to-many communications in favour of controlled commercial relationships. The liberating potential of the Internet that was recognized by Rheingold and others has been diminished as the forces of globalized commerce impose their order on the electronic frontier. References “Bad Language.” Habbo Hotel. 2004. Sulake UK Ltd. 15 Apr. 2004 http://www.habbohotel.co.uk/habbo/en/help/safety/badlanguage/>. Barlow, John Perry. “Crime and Puzzlement.” High Noon on the Electronic Frontier: Conceptual Issues in Cyberspace. Ed. Peter Ludlow. Cambridge, Mass.: MIT P, 1996. 459-86. ———. “A Declaration of the Independence of Cyberspace.” 8 Feb. 1996. 3 July 2004 http://www.eff.org/~barlow/Declaration-Final.html>. Galloway, Alexander R. Protocol: How Control Exists after Decentralization. Cambridge, Mass.: MIT P, 2004. “Habbo Company Profile.” Habbo Hotel. 2002. Habbo Ltd. 20 Jan. 2003 http://www.habbogroup.com>. “The Habbo Way.” Habbo Hotel. 2004. Sulake UK Ltd. 15 Apr. 2004 http://www.habbohotel.co.uk/habbo/en/help/safety/habboway/>. Landry, Charles. The Creative City: A Toolkit for Urban Innovators. London: Earthscan, 2000. Lessig, Lawrence. The Future of Ideas: The Fate of the Commons in a Connected World. New York: Random, 2001. Novak, Marcos. “Liquid Architecture in Cyberspace.” Cyberspace: First Steps. Ed. Michael Benedikt. Cambridge, Mass.: MIT P, 1991. 225-54. Oldenburg, Ray. The Great Good Place: Cafés, Coffee Shops, Community Centers, Beauty Parlors, General Stores, Bars, Hangouts and How They Get You through the Day. New York: Paragon, 1989. Rheingold, Howard. The Virtual Community: Homesteading on the Electronic Frontier. New York: Harper, 1993. ———. The Virtual Community: Homesteading on the Electronic Frontier. Rev. ed. Cambridge, Mass.: MIT P, 2000. Robins, Kevin. “Cyberspace and the World We Live In.” The Cybercultures Reader. Eds. David Bell and Barbara M. Kennedy. London: Routledge, 2000. 77-95. Schiller, Dan. Digital Capitalism: Networking the Global Market System. Cambridge, Mass.: MIT P, 1999. Schiller, Herbert I. Culture Inc.: The Corporate Takeover of Public Expression. New York: Oxford UP, 1991. Sennett, Richard. The Uses of Disorder: Personal Identity & City Life. New York: Vintage, 1970. Shalit, Ruth. “Welcome to the Habbo Hotel.” mpulse Magazine. Mar. 2002. Hewlett-Packard. 1 Apr. 2004 http://www.cooltown.com/cooltown/mpulse/0302-habbo.asp>. “Strong Growth in Sulake’s Revenues and Profit – Habbo Hotel Online Game Will Launch in the US in September.” 3 Sept. 2004. Sulake. Sulake Corp. 9 Jan. 2005 http://www.sulake.com/>. Turkle, Sherry. Life on the Screen: Identity in the Age of the Internet. New York: Simon, 1997. Citation reference for this article MLA Style McGuire, Mark. "Ordered Communities." M/C Journal 7.6 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0501/06-mcguire.php>. APA Style McGuire, M. (Jan. 2005) "Ordered Communities," M/C Journal, 7(6). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0501/06-mcguire.php>.

Since the eruption of the global justice movement at 1999’s Battle of Seattle, much has been made about the impact of the Internet on progressive activism. Of particular interest have been the ways in which activists have used the Internet as a communication medium, as a forum for information dissemination and as a tool for organizing (Deibert, Kahn & Kellner; Meikle; Smith). Applications like Websites, email and Internet Relay Chat have largely facilitated the new movement as a global phenomenon (Bennett; van Aelst & Walgrave). Cyberactivism – political activism on the Internet – is a new mode of contentious action, and new practices such as virtual sit-ins, online petitions and email campaigns have enhanced the repertoire of contention (McCaughey & Ayers). But what effects have activists had on the Internet? How have they shaped the Internet to fit both their technical needs and movement goals? Geeks and Global Justice The global justice movement (GJM) has broadened to include a new brand of activism, one that moves beyond simply using technology toward particular ends to include the modification and transformation of technology itself. Tech activism combines the free software ethos derived from geek culture with concerns for social justice on a planetary scale. Tech activists are the computer programmers who write, develop and deploy software for the online projects of activist groups. They also develop and maintain activist Websites and provide technical support, largely on a volunteer basis. The novelty of tech activism moves beyond the political alliance of social justice activists and computer geeks, however. Rather, it lies in the way tech activists incorporate the democratic goals of the GJM into the very technology used to pursue those goals. That is to say, tech activists recode software intended for use by activists in a way that anticipates the progressive social change they pursue. In this way, tech activists produce both an alternative version of the technology that is accessible, participatory, and non-hierarchical, and an alternate vision of society based on those same ideals. Detailed histories of the Internet reveal it to be a social construction contingent upon social factors (Abbate; Ceruzzi). Conceptualizing it this way, we can better understand how the goals and values of the global justice movement are inflected in the Internet’s ongoing “invention” (Abbate). The tension between capitalist logic and democratic impulses that characterizes the Internet suggests that it is an unfinished and flexible technology (Feenberg & Bakardjieva). Thus it is not surprising that as corporate interests continue to settle the virtual frontier, the Internet emerges as the locus of a new struggle. Like the Internet itself, this struggle is multilayered. It is at once a contest between private and public interests manifested at the “content” layer of the Internet, composed of applications such as the World Wide Web, and also at the Internet’s underlying infrastructure, the “logical” layer comprising the data transport and transmission protocols (Lessig). Commercial interests are poised to dominate the Web, pushing democratic and public uses to the margins of cyberspace; further, corporate influence threatens to further close and commodify access to the Internet (Meikle). Politicizing Technology But if the Internet is a social construction that turns upon human agency in its ongoing development, opportunities for contestation and change exist. The chance to challenge power imbalances entrenched in contemporary industrial society, where technical action is an exercise of power, arises in the technical sphere. Technology, therefore, is recast as a political project. It is not a reified “thing” but rather and ambivalent process, one pregnant with both liberating and oppressive possibilities (Feenberg, “Critical Theory”). The current strain of tech activism embodied in the global justice movement exploits this ambivalence, returning to the radicalism of the Free Software Movement. The FSM in turn has roots in 1960s digital counterculture, with its foundational belief that information should be free (Stallman). While today the wider tech community has drifted from these radical origins, the enduring legacy of the FSM is twofold. It is at once the redefinition of technology as a political project subject to democratic intervention, and the promotion of an alternative social model based on decentralization, volunteerism, cooperation and self-empowerment. The disarticulation of software from the logic of capitalism thus appears as an example of democratic rationalization: the creation and use of technology that undermines the existing social hierarchy (Feenberg, “Questioning”). Tech activists in the global justice movement have reclaimed computer technology development as a political frontier for contentious action. It was at 1999’s Battle of Seattle that activists first realized the potential and power of the Internet for their burgeoning movement. Since then, tech activists have been central to the global justice movement, facilitating the novel combination of interactive digital technology and social justice activism. From hosting hacklabs and sending reclaimed computers to developing countries, to setting up transient media centres amidst political actions and natural disasters, tech activists have clearly embraced the politics of technology. One prominent example of tech activism in the GJM is the Independent Media Centre (IMC), a Web-based network of radical media making collectives that went live for the Seattle protest. Tech activists are responsible for the technical implementation and continued maintenance of IMC, which was founded to give voice to activists protesting the ill effects of global capitalism. Today it is widely recognized as the media arm of the GJM. Indymedia and Free Software The choice of free software for the global site, indymedia.org, was deliberate, and suggests a philosophical inheritance from the free software movement. It also shows with clarity the project’s political objectives. At present, all the software on the global network, which includes more than 130 “nodes”, is by charter free software. Throughout Indymedia’s six-year history, free software has enabled the IMC tech collective to develop applications “that encourage cooperation, solidarity, an equal field of participation” among volunteers (Henshaw-Plath. “Proposal”). Critically, free software met technical requirements while promoting social objectives: “It’s clear that the technology we use and process by which it’s constructed and articulated [are] deeply political. We are creating the technical systems that prefigure the change we want to see in society” (Henshaw-Plath, “IMC-Tech”). Clearly, tech activists understand coding as technical process with social implications. They make an explicit attempt to imbue software with ideals that mirror their social justice objectives, never losing sight of the social purpose of the software, nor of the user-technology relation. In the case of the continual hacking of Active, the original open publishing software, “the geeks of IMC-Tech were keenly aware that each technological design or set of features creates a particular publishing structure and, as a result, empowers users…in an equally particular way” (Hill 2). This is an example of user agency at the level of technical design; by including a wider array of values and needs in their software, tech activists are helping to democratize Internet technology. Tech activists thus display insight into the power asymmetries inherent in capitalist socio-technical systems, like the Internet, as well as the knowledge that such asymmetries are both socially constructed and reflective of inequality in the broader social context. Wild Wild Wikis: The Latest Frontier Activists in the global justice movement, supported by geeks who share their social conscience, created Indymedia to communicate their social objectives, including economic and environmental justice, participatory democracy and racial and gender equality. But internal communication among Indymedia activists was also important. Initially, the IMC Tech Collective communicated by email lists and Internet Relay Chat (IRC). They subsequently adopted wiki technology in an effort to create a sustainable system for documenting its project. As one member of the Docs Tech Working Group observed: “Getting a functioning and used wiki is really vital for the network…Email lists just aren’t cutting it for the level of organizing and information exchange and growth we need to help facilitate” (Windmueller). The purpose of the Global Indymedia Documentation Project is to gather collective knowledge about IMC’s history, its current projects and its short and long-term goals. Such documentation is vital to the success of Indymedia; not only does it provide a public record, it creates a fluidity that facilitates participation at varying levels. “The Indymedia Documentation Project looks like a normal Web site… except that it encourages contribution and editing of pages, questions, answers, comments and updates” (Indymedia). Wiki software has been popular in the business community as a “conversational knowledge management solution” that fosters an efficient and collaborative work process (Gonzalez-Reinhart, 5). A wiki is a series of linked, dynamic Web pages that can be created, edited and deleted by a logged-on user, with no coding skills necessary. All changes are documented, so the wiki’s history is preserved and accessible for viewing. Because of its accessible, collective and participatory design, Kahn and Kellner call the wiki “the next wave in the emerging democratic Internet” (196). By 2002, IMC techs adopted and hacked up TWiki, a free software wiki clone aimed at the corporate intranet world, assembling a number of separately running wikis in one Website, docs.indymedia.org. While mailing lists facilitate information exchange, and IRC enables real time discussion, neither application provides a collaborative space for Indymedia volunteers to work asynchronously on common projects. The wiki, however, facilitates information flow, which allows distributed teams to work together seamlessly and productively, and eliminates the one-Webmaster syndrome of outdated content. Further, the wiki has proven useful as a forum for discussing technical issues regarding the smooth running of the network, while its ability to store policy documents, research papers, proposals and meeting logs create an invaluable store of cumulative knowledge. A successful wiki has political implications beyond the virtual sphere, offering alternative ways of social organization offline. “The recognition of this might lead some people to take the organization of work in a wiki as a model that could succeed in the real world as well (Ebersbach & Glaser)” The “wiki way” (Cunningham) of self-organization and collaboration to produce high quality work without capitalist incentives reveals other ways to value technology, ways not currently embraced by the dominant social order as it is underwritten by corporate capitalism. As social software, wikis create prospects for democratic communication and collaboration online, making it an important new application for activist work. Conclusion The Internet remains an unfinished and contested technology. Because it is socially constructed, users can intervene in its development and shape its future direction(s). Tech activists in the global justice movement bridge the divide between geek and activist communities, developing and maintaining the digital infrastructure that supports progressive activism on a planetary scale. Through their free software work, tech activists develop Internet technology that reflects their technical needs and social objectives, deliberately opposing the commercial encroachment of cyberspace. In the case of Indymedia, tech activists redeployed wiki software to facilitate movement goals – by creating a public and democratic space for online collaboration, and by challenging inherent power inequities reflected in the broader society. By addressing such imbalances at the level of technical design, they have created an alternative version of Internet technology as well as an alternate vision of society. References Abbate, Janet. Inventing the Internet. Cambridge, MA: MIT Press, 1999. Bennett, W.L. “Communicating Global Activism: Strengths and Vulnerabilities of Networked Politics.” Eds. W. van de Donk, B.D. Loader, P.G. Nixon and D. Rucht. Cyberprotest: New Media, Citizens, and Social Movements. London and New York: Routledge (2004): 123-146. Ceruzzi, Paul. A History of Modern Computing. 2nd ed. Cambridge, MA: MIT Press, 2003. Cunningham, Ward. “Why Wiki Works.” Cunningham and Cunningham Website, n.d. 25 Nov. 2005 http://www.c2.com/cgi/wiki?WhyWikiWorks>. Deibert, Ronald J. “International Plug n’ Play? Citizen Activism, the Internet and Global Public Policy.” International Studies Perspectives 1 (2000): 255-272. Feenberg, Andrew. Critical Theory of Technology. New York: Oxford University Press, 1991. ———. Questioning Technology. London and New York: Routledge. 1999. ———, and Maria Bakardjieva. “Consumers or Citizens? The Online Community Debate.” Eds. Andrew Feenberg and Darrin Barney. Community in the Digital Age: Philosophy and Practice. Lanham: Rowman and Littlefield (2004): 1-28. Ebersbach, Anja, and Markus Glaser. “Towards Emancipatory Use of a Medium: The Wiki.” International Journal of Information Ethics 2 (2004): 1-9. GNU. “Overview of the GNU System.” GNU Website, n.d. 22 Nov. 2005 http://www.gnu.org/gnu/gnu-history.html>. Gonzalez-Reinhart, Jennifer. “Wiki and the Wiki Way: Beyond a Knowledge Management System.” 2005. 5 Dec. 2005 http://www.uhisrc.com/FTB/Wiki/wiki_way_brief%5B1%5D-Jennifer%2005.pdf>. Henshaw-Plath, Evan. “Proposal to Reform www.indy by Highlighting Local IMCs.” 2002. 29 Apr. 2003 http://internal.indymedia.org/front.php3?article_id=538>. Henshaw-Plath, Evan. “IMC-Tech Summary for November 16th 2001.” 2001. 28 Nov. 2005 http://archives.lists.indymedia.org/imc-summaries/2001-November/000028.html>. Hill, Benjamin Mako. “Software, Politics and Indymedia.” 2003. 25 Nov. 2005 http://mako.cc/writing/mute-indymedia_software.html>. Indymedia. “Welcome Guest.” Indymedia Website, n.d. 2 Dec. 2005 http://docs.indymedia.org/viewauth/TWiki/WelcomeGuest>. Kahn, Richard V., and Douglas Kellner. “Virtually Democratic: Online Communities and Internet Activism.” Eds. Andrew Feenberg and Darrin Barney. Community in the Digital Age: Philosophy and Practice. Lanham: Rowman and Littlefield (2004): 183-200. Lessig, Lawrence. Code and Other Laws of Cyberspace. New York: Basic Books. 1999. McCaughey, Martha and Michael D. Ayers. Cyberactivism: Online Activism in Theory and Practice. New York: Routledge. 2003. Meikle, Graham. Future Active: Media Activism and the Internet. New York: Routledge. 1999. Smith, Jackie. “Cyber Subversion in the Information Economy.” Dissent Spring 2001: 48-52. Stallman, Richard. “The GNU Project.” GNU Website. 1999. 22 Nov. 2005 http://www.gnu.org/gnu/thegnuproject.html>. Van Aelst, Peter and Stefaan Walgrave. “New Media, New Movements? The Role of the Internet in Shaping the ‘Anti-Globalization’ Movement.” Eds. W. van de Donk, B.D. Loader, P.G. Nixon and D. Rucht, Cyberprotest: New Media, Citizens, and Social Movements. London and New York: Routledge (2004): 123-146. Windmueller, John. Comment posted to Indymedia Documentation Project wiki. 15 Nov. 2005 http://docs.indymedia.org/view/Sysadmin/ImcDocsReplaceWikiEngine>. Citation reference for this article MLA Style Milberry, Kate. "Reconstructing the Internet: How Social Justice Activists Contest Technical Design in Cyberspace." M/C Journal 9.1 (2006). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0603/10-milberry.php>. APA Style Milberry, K. (Mar. 2006) "Reconstructing the Internet: How Social Justice Activists Contest Technical Design in Cyberspace," M/C Journal, 9(1). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0603/10-milberry.php>.

In recent years a number of dramas focussing on Indigenous Australians and Australian history have appeared on the ABC, one of Australia's two public television channels. These dramas have different foci but all represent some aspects of Australian Indigenous history and how it interacts with 'mainstream' representations of Australian history. The four programs I will look at are Cleverman (Goalpost Pictures, 2016-ongoing), Glitch (Matchbox Films, 2015-ongoing), The Secret River (Ruby Entertainment, 2015) and Redfern Now (Blackfella Films, 2012), each of which engages with the past in a unique way.Clearly, different creators, working with different plots and in different genres will have different ways of representing the past. Redfern Now and Cleverman are both produced by Indigenous creators whereas the creators of The Secret River and Glitch are white Australians. Redfern Now and The Secret River are in a realist mode, whereas Glitch and Cleverman are speculative fiction. My argument proceeds on two axes: first, speculative genres allow for more creative ways of representing the past. They give more freedom for the creators to present affective representations of the historical past. Speculative genres also allow for more interesting intellectual examinations of what we consider to be history and its uncertainties. My second axis argues, because it is hard to avoid when looking at this group of texts, that Indigenous creators represent the past in different ways than non-Indigenous creators. Indigenous creators present a more elliptical vision. Non-Indigenous creators tend to address historical stories in more overt ways. It is apparent that even when dealing with the same histories and the same facts, the understanding of the past held by different groups is presented differently because it has different affective meanings.These television programs were all made in the 2010s but the roots of their interpretations go much further back, not only to the history they represent but also to the arguments about history that have raged in Australian intellectual and popular culture. Throughout most of the twentieth century, indigenous history was not discussed in Australia, until this was disturbed by WEH Stanner's reference in the Boyer lectures of 1968 to "our great Australian silence" (Clark 73). There was, through the 1970s and 80s, increased discussion of Indigenous history, and then in the 1990s there was a period of social and cultural argument known locally as the 'History Wars'. This long-running public disagreement took place in both academic and public arenas, and involved historians, other academics, politicians, journalists and social commentators on each side. One side argued that the arrival of white people in Australia led to frontier wars, massacre, attempted genocide and the ongoing oppression of Indigenous people (Reynolds). The other posited that when white people arrived they killed a few Aborigines but mostly Aboriginal people were killed by disease or failure to 'defend' their culture (Windschuttle). The first viewpoint was revisionist from the 1960s onwards and the second represented an attempt at counter-revision – to move the understanding of history back to what it was prior to the revision. The argument took place not only among historians, but was taken up by politicians with Paul Keating, prime minister 1993-1996, holding the first view and John Howard, prime minister 1996-2007, aggressively pursuing the second. The revisionist viewpoint was championed by historians such as Henry Reynolds and Lyndall Ryan and academics and Aboriginal activists such as Tony Birch and Aileen Moreton Robinson; whereas the counter-revisionists had Keith Windschuttle and Geoffrey Blainey. By and large the revisionist viewpoint has become dominant and the historical work of the counter-revisionists is highly disputed and not accepted.This argument was prominent in Australian cultural discourse throughout the 1990s and has never entirely disappeared. The TV shows I am examining were not made in the 1990s, nor were they made in the 2000s - it took nearly twenty years for responses to the argument to make the jump from politicians' speeches and opinion pieces to television drama. John Ellis argues that the role of television in popular discourse is "working through," meaning contentious issues are first raised in news reports, then they move to current affairs, then talk shows and documentaries, then sketch comedy, then drama (Ellis). Australian Indigenous history was extensively discussed in the news, current affairs and talk shows in the 1990s, documentaries appeared somewhat later, notably First Australians in 2008, but sketch comedy and drama did not happen until in 2014, when Black Comedy's programme first aired, offering sketches engaging often and fiercely with indigenous history.The existence of this public discourse in the political and academic realms was reflected in film before television. Felicity Collins argues that the "Blak Wave" of Indigenous film came to exist in the context of, and as a response to, the history wars (Collins 232). This wave of film making by Indigenous film makers included the works of Rachel Perkins, Warwick Thornton and Ivan Sen – whose films chronicled the lives of Indigenous Australians. There was also what Collins calls "back-tracking films" such as Rabbit-Proof Fence (2002) and The Tracker (2010) made by white creators that presented arguments from the history wars for general audiences. Collins argues that both the "blak wave" and the "back track" created an alternative cultural sphere where past injustices are acknowledged. She says: "the films of the Blak Wave… cut across the history wars by turning an Indigenous gaze on the colonial past and its afterlife in the present" (Collins 232). This group of films sees Indigenous gazes relate the past and present whereas the white gaze represents specific history. In this article I examine a similar group of representations in television programs.History is not an innocent discourse. In western culture 'history' describes a certain way of looking at the past that was codified in the 19th century (Lloyd 375). It is however not the only way to look at the past, theorist Mark Day has described it as a type of relation with the past and argues that other understandings of the past such as popular memory and mythology are also available (Day). The codification of history in the 19th century involved an increased reliance on documentary evidence, a claim to objectivity, a focus on causation and, often though not always, a focus on national, political history. This sort of history became the academic understanding of history – which claims to be, if not objective, at least capable of disinterest; which bases its arguments on facts and which can establish its facts through reference to documentary records (Froeyman 219). Aileen Moreton-Robinson would call this "white patriarchal knowledge" that seeks to place the indigenous within its own type of knowledge production ("The White Man's Burden" 414). The western version of history tends to focus on causation and to present the past as a coherent narrative leading to the current point in time. This is not an undisputed conception of history in the western academy but it is common and often dominant.Post-colonialist analyses of history argue that western writing about non-western subjects is biased and forces non-westerners into categories used to oppress them (Anderson 44). These categories exist ahistorically and deny non-westerners the ability to act because if history cannot be perceived then it is difficult to see the future. That is to say, because non-western subjects in the past are not seen as historical actors, as people whose actions effected the future, then, in the present, they are unable to access to powerful arguments from history. Historians' usual methodology casts Indigenous people as the 'subjects' of history which is about them, not by them or for them (Tuhiwai Smith 7, 30-32, 144-5). Aboriginal people are characterised as prehistoric, ancient, timeless and dying (Birch 150). This way of thinking about Indigenous Australia removes all agency from Aboriginal actors and restoring agency has been a goal of Aboriginal activists and historians. Aileen Moreton Robinson discusses how Aboriginal resistance is embodied through "oral history (and) social memory," engaging with how Aboriginal actors represent themselves and are represented in relation to the past and historical settings is an important act ("Introduction" 127).Redfern Now and Cleverman were produced through the ABC's Indigenous Department and made by Indigenous filmmakers, whereas Glitch and The Secret River are from the ABC drama department and were made by white Australians. The different programs also have different generic backgrounds. Redfern Now and The Secret River are different forms of realist texts; social realism and historical realism. Cleverman and Glitch, however, are speculative fiction texts that can be argued to be in the mode of magical realism, they "denaturalise the real and naturalise the marvellous" they are also closely tied ideas of retelling colonial stories and "resignify(ing) colonial territories and pasts" (Siskind 834-5).Redfern Now was produced by Blackfella Films for the ABC. It was, with much fanfare, released as the first drama made for television, by Aboriginal people and about Aboriginal people (Blundell). The central concerns of the program are issues in the present, its plots and settings are entirely contemporary. In this way it circumvents the idea and standard representation of Indigenous Australians as ancient and timeless. It places the characters in the program very much in the present.However, one episode "Stand Up" does obliquely engage with historical concerns. In this episode a young boy, Joel Shields, gets a scholarship to an expensive private school. When he attends his first school assembly he does not sing the national anthem with the other students. This leads to a dispute with the school that forms the episode's plot. As punishment for not singing Joel is set an assignment to research the anthem, which he does and he finds the song off-putting – with the words 'boundless plains to share' particularly disconcerting. His father supports him saying "it's not our song" and compares Joel singing it to a "whitefella doing a corrobboree". The national anthem stands metaphorically for the white hegemony in Australia.The school itself is also a metaphor for hegemony. The camerawork lingers on the architecture which is intended to imply historical strength and imperviousness to challenge or change. The school stands for all the force of history white Australia can bring to bear, but in Australia, all architecture of this type is a lie, or at least an exaggeration – the school cannot be more than 200 years old and is probably much more recent.Many of the things the program says about history are conveyed in half sentences or single glances. Arguably this is because of its aesthetic mode – social realism – that prides itself on its mimicry of everyday life and in everyday life people are unlikely to set out arguments in organised dot-point form. At one point the English teacher quotes Orwell, "those who control the past control the future", which seems overt but it is stated off-screen as Joel walks into the room. This seeming aside is a statement about history and directly recalls central arguments of the history wars, which make strong political arguments about the effects of the past, and perceptions of the past, on the present and future. Despite its subtlety, this story takes place within the context of the history wars: it is about who controls the past. The subtlety of the discussion of history allows the film makers the freedom to comment on the content and effects of history and the history wars without appearing didactic. They discuss the how history has effected the present history without having to make explicit historical causes.The other recent television drama in the realist tradition is The Secret River. This was an adaptation of a novel by Kate Grenville. It deals with Aboriginal history from the perspective of white people, in this way it differs from Redfern Now which discusses the issues from the perspective of Aboriginal people. The plot concerns a man transported to Australia as a convict in the early 19th century. The man is later freed and, with his family, attempts to move to the Hawksbury river region. The land they try to settle is, of course, already in use by Aboriginal people. The show sets up the definitional conflict between the idea of settler and invader and suggests the difference between the two is a matter of perspective. Of the shows I am examining, it is the most direct in its representation of historical massacre and brutality. It represents what Felicity Collins described as a back-tracking text recapitulating the colonial past in the light of recovered knowledge. However, from an Indigenous perspective it is another settler tale implying Aboriginal people were wiped out at the time of colonisation (Godwin).The Secret River is told entirely from the perspective of the invaders. Even as it portrays their actions as wrong, it also suggests they were unavoidable or inevitable. Therefore it does what many western histories of Indigenous people do – it classifies and categorises. It sets limits on interpretation. It is also limited by its genre, as a straightforward historical drama and an adaptation, it can only tell its story in a certain way. The television series, like the book before it, prides itself on its 'accurate' rendition of an historical story. However, because it comes from such a very narrow perspective it falls into the trap of categorising histories that might have usefully been allowed to develop further.The program is based on a novel that attracted controversy of its own. It became part of ongoing historiographical debate about the relationship between fiction and history. The book's author Kate Grenville claimed to have written a kind of affectively accurate history that actual history can never convey because the emotions of the past are hidden from the present. The book was critiqued by historians including Inge Clendinnen, who argued that many of the claims made about its historical accuracy were largely overblown (Clendinnen). The book is not the same as the TV program, but the same limitations identified by Clendinnen are present in the television text. However, I would not agree with Clendinnen that formal history is any better. I argue that the limitation of both these mimetic genres can be escaped in speculative fiction.In Glitch, Yurana, a small town in rural Victoria becomes, for no apparent reason, the site of seven people rising from the dead. Each person is from a different historical period. None are Indigenous. They are not zombies but simply people who used to be dead. One of the first characters to appear in the series is an Aboriginal teenager, Beau, we see from his point of view the characters crawling from their graves. He becomes friendly with one of the risen characters, Patrick Fitzgerald, who had been the town's first mayor. At first Fitzgerald's story seems to be one of working class man made good in colonial Australia - a standard story of Australian myth and historiography. However, it emerges that Fitzgerald was in love with an Aboriginal woman called Kalinda and Beau is his descendant. Fitzgerald, once he becomes aware of how he has been remembered by history, decides to revise the history of the town – he wants to reclaim his property from his white descendants and give it to his Indigenous descendants. Over the course of the six episodes Fitzgerald moves from being represented as a violent, racist boor who had inexplicably become the town's mayor, to being a romantic whose racism was mostly a matter of vocabulary. Beau is important to the plot and he is a sympathetic character but he is not central and he is a child. Indigenous people in the past have no voice in this story – when flashbacks are shown they are silent, and in the present their voices are present but not privileged or central to the plot.The program demonstrates a profoundly metaphorical relationship with the past – the past has literally come to life bringing with it surprising buried histories. The program represents some dominant themes in Australian historiography – other formerly dead characters include a convict-turned-bush-ranger, a soldier who was at Gallipoli, two Italian migrants and a girl who died as a result of sexual violence – but it does not engage directly with Indigenous history. Indigenous people's stories are told only in relation to the stories of white people. The text's magical realism allows a less prescriptive relationship with the past than in The Secret River but it is still restricted in its point of view and allows only limited agency to Aboriginal actors.The text's magical realism allows for a thought-provoking representation of relationships with the past. The town of Yurana is represented as a place deeply committed to the representation and glorification of its past. Its main street contains statues of its white founders and war memorials, one of its main social institutions is the RSL, its library preserves relics of the past and its publican is a war history buff. All these indicate that the past is central to the town's identity. The risen dead however dispute and revise almost every aspect of this past. Even the history that is unmentioned in the town's apparent official discourse, such as the WWII internment camp and the history of crimes, is disputed by the different stories of the past that the risen dead have to tell. This indicates the uncertainty of the past, even when it seems literally set in stone it can still be revised. Nonetheless the history of Indigenous people is only revised in ways that re-engage with white history.Cleverman is a magical realist text profoundly based in allegory. The story concerns the emergence into a near future society of a group of people known as the "Hairies." It is never made clear where they came from or why but it seems they appeared recently and are unable to return. They are an allegory for refugees. Hairypeople are part of many Indigenous Australian stories, the show's creator, Ryan Griffen, stated that "there are different hairy stories throughout Australia and they differ in each country. You have some who are a tall, some are short, some are aggressive, some are friendly. We got to sort of pick which ones will fit for us and create the Hairies for our show" (Bizzaca).The Hairies are forced to live in an area called the Zone, which, prior to the arrival of the Hairy people, was a place where Aboriginal people lived. This place might be seen as a metaphor for Redfern but it is also an allegory for Australia's history of displacing Aboriginal people and moving and restricting them to missions and reserves. The Zone is becoming increasingly securitised and is also operating as a metaphor for Australia's immigration detention centres. The prison the Hairy characters, Djukura and Bunduu, are confined to is yet another metaphor, this time for both the over-representation of Aboriginal people in prison and the securitisation of immigration detention. These multiple allegorical movements place Australia's present refugee policies and historical treatment of Aboriginal people within the same lens. They also place the present, the past and the future within the same narrative space.Most of the cast is Aboriginal and much of the character interaction is between Aboriginal people and Hairies, with both groups played by Indigenous actors. The disadvantages suffered by Indigenous people are part of the story and clearly presented as affecting the behaviour of characters but within the story Aboriginal people are more advantaged than Hairies, as they have systems, relationships and structures that Hairy people lack. The fact that so much of the interaction in the story is between Indigenous people and Hairies is important: it can be seen to be an interaction between Aboriginal people and Aboriginal mythology or between Indigenous past and present. It demonstrates Aboriginal identities being created in relation to other Aboriginal identities and not in relation to white people, where in this narrative, Aboriginal people have an identity other than that allowed for in colonialist terms.Cleverman does not really engage with the history of white invasion. The character who speaks most about this part of Aboriginal history and whose stated understanding of himself is based on that identity is Waruu. But Waruu is also a villain whose self-identity is also presented as jealous and dishonest. However, despite only passing mentions of westernised history the show is deeply concerned with a relationship with the past. The program engages with Aboriginal traditions about the past that have nothing to do with white history. It presents a much longer view of history than that of white Australia. It engages with the Aboriginal tradition of the Cleverman - demonstrated in the character of Uncle Jimmy who passes a nulla nulla (knob-headed hardwood club), as a symbol of the past, to his nephew Koen and tells him he is the new Cleverman. Cleverman demonstrates a discussion of Australian history with the potential to ignore white people. It doesn't ignore them, it doesn't ignore the invasion but it presents the possibility that it could be ignored.There is a danger in this sort of representation of the past that Aboriginal people could be relegated to the type of ahistorical, metahistorical myths that comprise colonialist history's representation of Indigenous people (Birch). But Cleverman's magical realist, near future setting tends to undermine this. It grounds representation in history through text and metaphor and then expands the definition.The four programs have different relationships with the past but all of them engage with it. The programs are both restrained and freed by the genres they operate in. It is much easier to escape the bounds of formal history in the genre of magical realism and both Glitch and Cleverman do this but have significantly different ways of dealing with history. "Stand up" and The Secret River both operate within more formally realist structures. The Secret River gives us an emotional reading of the past and a very affective one. However, it cuts off avenues of interpretation by presenting a seemingly inevitable tragedy. Through use of metaphor and silence "Stand up" presents a much more productive relationship with the past – seeing it as an ongoing argument rather than a settled one. Glitch engages with the past as a topic that is not settled and that can therefore be changed whereas Cleverman expands our definition of past and understanding of the past through allegory.It is possible to draw further connections. Those stories created by Indigenous people do not engage with the specifics of traditional dominant Australian historiography. However, they work with the assumption that everyone already knows this historiography. They do not re-present the pain of the past, instead they deal with it in oblique terms with allegory. Whereas the programs made by non-Indigenous Australians are much more overt in their representation of the sins of the past, they overtly engage with the History Wars in specific historical arenas in which those wars were fought. The non-Indigenous shows align themselves with the revisionist view of history but they do so in a very different way than the Indigenous shows.ReferencesAnderson, Ian. "Introduction: The Aboriginal Critique of Colonial Knowing." Blacklines: Contemporary Critical Writing by Indigenous Australians. Ed. Michele Grossman. Melbourne: Melbourne University Press, 2003.Birch, Tony. "'Nothing Has Changed': The Making and Unmaking of Koori Culture." Blacklines: Contemporary Critical Writing by Indigenous Australians. Ed. Michele Grossman. Melbourne: Melbourne University Press, 2003.Bizzaca, Chris. "The World of Cleverman." Screen Australia 2016.Blundell, Graeme. "Redfern Now Delves into the Lives of Ordinary People." The Australian 26 Oct. 2013: News Review.Clark, Anna. History's Children: History Wars in the Classroom. Sydney: New South, 2008.Clendinnen, Inga. “The History Question: Who Owns the Past?” The Quarterly Essay. Melbourne: Black Inc., 2006.Collins, Felicity. "After Dispossession: Blackfella Films and the Politics of Radical Hope." The Routledge Companion to Cinema and Politics. Eds. Yannis Tzioumakis and Claire Molloy. New York: Routledge, 2016.Day, Mark. "Our Relations with the Past." Philosophia 36.4 (2008): 417-27.Ellis, John. Seeing Things: Television in the Age of Uncertainty. London: I.B. Tauris, 2000.Froeyman, Anton. "The Ideal of Objectivity and the Public Role of the Historian: Some Lessons from the Historikerstreit and the History Wars." Rethinking History 20.2 (2016): 217-34.Godwin, Carisssa Lee. "Shedding the 'Victim Narrative' for Tales of Magic, Myth and Superhero Pride." The Conversation 2016.Lloyd, Christopher. "Historiographic Schools." A Companion to the Philosophy of History and Historiography Ed. Tucker, Aviezer. Oxford: Wiley-Blackwell, 2009.Moreton-Robinson, Aileen. "Introduction: Resistance, Recovery and Revitalisation." Blacklines: Contemporary Critical Writing by Indigenous Australians. Ed. Michele Grossman. Melbourne: Melbourne University Press, 2003.———. "The White Man's Burden." Australian Feminist Studies 26.70 (2011): 413-31.Reynolds, Henry. The Other Side of the Frontier: Aboriginal Resistance to the European Invasion of Australia. 2nd ed. Ringwood, Vic.: Penguin Books, 1995.Siskind, Mariano. "Magical Realism." The Cambridge History of Postcolonial Literature. Vol. 2. Ed. Ato Quayson. Cambridge: Cambridge University Press, 2012. 833-68.Tuhiwai Smith, Linda. Decolonizing Methodologies Research and Indigenous Peoples. 2nd ed. London: Zed Books, 2012.Windschuttle, Keith. The Fabrication of Aboriginal History. Paddington, NSW: Macleay Press, 2002.

There are spells in the world: incantations that can transform reality through the power of procedural utterances. The marriage vow, the courtroom sentence, the shaman’s curse: these words are codes that change reality. (Finn 90) Introduction As a child, stories on magic were “opportunities to escape from reality” (Brugué and Llompart 1), or what Rosengren and Hickling describe as being part of a set of “causal belief systems” (77). As an adult, magic is typically seen as being “pure fantasy” (Rosengren and Hickling 75), while Bever argues that magic is something lost to time and materialism, and alternatively a skill that Yeats believed that anyone could develop with practice. The etymology of the word magic originates from magein, a Greek word used to describe “the science and religion of the priests of Zoroaster”, or, according to philologist Skeat, from Greek megas (great), thus signifying "the great science” (Melton 956). Not to be confused with sleight of hand or illusion, magic is traditionally associated with learned people, held in high esteem, who use supernatural or unseen forces to cause change in people and affect events. To use magic these people perform rituals and ceremonies associated with religion and spirituality and include people who may identify as Priests, Witches, Magicians, Wiccans, and Druids (Otto and Stausberg). Magic as Technology and Technology as Magic Although written accounts of the rituals and ceremonies performed by the Druids are rare, because they followed an oral tradition and didn’t record knowledge in a written form (Aldhouse-Green 19), they are believed to have considered magic as a practical technology to be used for such purposes as repelling enemies and divining lost items. They curse and blight humans and districts, raise storms and fogs, cause glamour and delusion, confer invisibility, inflict thirst and confusion on enemy warriors, transform people into animal shape or into stone, subdue and bind them with incantations, and raise magical barriers to halt attackers. (Hutton 33) Similarly, a common theme in The History of Magic by Chris Gosden is that magic is akin to science or mathematics—something to be utilised as a tool when there is a need, as well as being used to perform important rituals and ceremonies. In TechGnosis: Myth, Magic & Mysticism in the Age of Information, Davis discusses ideas on Technomysticism, and Thacker says that “the history of technology—from hieroglyphics to computer code—is itself inseparable from the often ambiguous exchanges with something nonhuman, something otherworldly, something divine. Technology, it seems, is religion by other means, then as now” (159). Written language, communication, speech, and instruction has always been used to transform the ordinary in people’s lives. In TechGnosis, Davis (32) cites Couliano (104): historians have been wrong in concluding that magic disappeared with the advent of 'quantitative science.’ The latter has simply substituted itself for a part of magic while extending its dreams and its goals by means of technology. Electricity, rapid transport, radio and television, the airplane, and the computer have merely carried into effect the promises first formulated by magic, resulting from the supernatural processes of the magician: to produce light, to move instantaneously from one point in space to another, to communicate with faraway regions of space, to fly through the air, and to have an infallible memory at one’s disposal. Non-Fungible Tokens (NFTs) In early 2021, at the height of the pandemic meta-crisis, blockchain and NFTs became well known (Umar et al. 1) and Crypto Art became the hot new money-making scheme for a small percentage of ‘artists’ and tech-bros alike. The popularity of Crypto Art continued until initial interest waned and Ether (ETH) started disappearing in the manner of a classic disappearing coin magic trick. In short, ETH is a type of cryptocurrency similar to Bitcoin. NFT is an acronym for Non-Fungible Token. An NFT is “a cryptographic digital asset that can be uniquely identified within its smart contract” (Myers, Proof of Work 316). The word Non-Fungible indicates that this token is unique and therefore cannot be substituted for a similar token. An example of something being fungible is being able to swap coins of the same denomination. The coins are different tokens but can be easily swapped and are worth the same as each other. Hackl, Lueth, and Bartolo define an NFT as “a digital asset that is unique and singular, backed by blockchain technology to ensure authenticity and ownership. An NFT can be bought, sold, traded, or collected” (7). Blockchain For the newcomer, blockchain can seem impenetrable and based on a type of esoterica or secret knowledge known only to an initiate of a certain type of programming (Cassino 22). The origins of blockchain can be found in the research article “How to Time-Stamp a Digital Document”, published by the Journal of Cryptology in 1991 by Haber, a cryptographer, and Stornetta, a physicist. They were attempting to answer “epistemological problems of how we trust what we believe to be true in a digital age” (Franceschet 310). Subsequently, in 2008, Satoshi Nakamoto wrote The White Paper, a document that describes the radical idea of Bitcoin or “Magic Internet Money” (Droitcour). As defined by Myers (Proof of Work 314), a blockchain is “a series of blocks of validated transactions, each linked to its predecessor by its cryptographic hash”. They go on to say that “Bitcoin’s innovation was not to produce a blockchain, which is essentially just a Merkle list, it was to produce a blockchain in a securely decentralised way”. In other words, blockchain is essentially a permanent record and secure database of information. The secure and permanent nature of blockchain is comparable to a chapter of the Akashic records: a metaphysical idea described as an infinite database where information on everything that has ever happened is stored. It is a mental plane where information is recorded and immutable for all time (Nash). The information stored in this infinite database is available to people who are familiar with the correct rituals and spells to access this knowledge. Blockchain Smart Contracts Blockchain smart contracts are written by a developer and stored on the blockchain. They contain the metadata required to set out the terms of the contract. IBM describes a smart contract as “programs stored on a blockchain that run when predetermined conditions are met”. There are several advantages of using a smart contract. Blockchain is a permanent and transparent record, archived using decentralised peer-to-peer Distributed Ledger Technology (DLT). This technology safeguards the security of a decentralised digital database because it eliminates the intermediary and reduces the chance of fraud, gives hackers fewer opportunities to access the information, and increases the stability of the system (Srivastava). They go on to say that “it is an emerging and revolutionary technology that is attracting a lot of public attention due to its capability to reduce risks and fraud in a scalable manner”. Despite being a dry subject, blockchain is frequently associated with magic. One example is Faustino, Maria, and Marques describing a “quasi-religious romanticism of the crypto-community towards blockchain technologies” (67), with Satoshi represented as King Arthur. The set of instructions that make up the blockchain smart contracts and NFTs tell the program, database, or computer what needs to happen. These instructions are similar to a recipe or spell. This “sourcery” is what Chun (19) describes when talking about the technological magic that mere mortals are unable to comprehend. “We believe in the power of code as a set of magical symbols linking the invisible and visible, echoing our long cultural tradition of logos, or language as an underlying system of order and reason, and its power as a kind of sourcery” (Finn 714). NFTs as a Conceptual Medium In a “massively distributed electronic ritual” (Myers, Proof of Work 100), NFTs became better-known with the sale of Beeple’s Everydays: The First 5000 Days by Christie’s for US$69,346,250. Because of the “thousandfold return” (Wang et al. 1) on the rapidly expanding market in October 2021, most people at that time viewed NFTs and cryptocurrencies as the latest cash cow; some artists saw them as a method to become financially independent, cut out the gallery intermediary, and be compensated on resales (Belk 5). In addition to the financial considerations, a small number of artists saw the conceptual potential of NFTs. Rhea Myers, a conceptual artist, has been using the blockchain as a conceptual medium for over 10 years. Myers describes themselves as “an artist, hacker and writer” (Myers, Bio). A recent work by Myers, titled Is Art (Token), made in 2023 as an Ethereum ERC-721 Token (NFT), is made using a digital image with text that says “this token is art”. The word ‘is’ is emphasised in a maroon colour that differentiates it from the rest in dark grey. The following is the didactic for the artwork. Own the creative power of a crypto artist. Is Art (Token) takes the artist’s power of nomination, of naming something as art, and delegates it to the artwork’s owner. Their assertion of its art or non-art status is secured and guaranteed by the power of the blockchain. Based on a common and understandable misunderstanding of how Is Art (2014) works, this is the first in a series of editions that inscribe ongoing and contemporary concerns onto this exemplar of a past or perhaps not yet realized blockchain artworld. (Myers, is art editions). This is a simple example of their work. A lot of Myers’s work appears to be uncomplicated but hides subtle levels of sophistication that use all the tools available to conceptual artists by questioning the notion of what art is—a hallmark of conceptual art (Goldie and Schellekens 22). Sol LeWitt, in Paragraphs on Conceptual Art, was the first to use the term, and described it by saying “the idea itself, even if not made visual, is as much a work of art as any finished product”. According to Bailey, the most influential American conceptual artists of the 1960s were Lucy Lippard, Sol LeWitt, and Joseph Kosuth, “despite deriving from radically diverse insights about the reason for calling it ‘Conceptual Art’” (8). Instruction-Based Art Artist Claudia Hart employs the instructions used to create an NFT as a medium and artwork in Digital Combines, a new genre the artist has proposed, that joins physical, digital, and virtual media together. The NFT, in a digital combine, functions as a type of glue that holds different elements of the work together. New media rely on digital technology to communicate with the viewer. Digital combines take this one step further—the media are held together by an invisible instruction linked to the object or installation with a QR code that magically takes the viewer to the NFT via a “portal to the cloud” (Hart, Digital Combine Paintings). QR codes are something we all became familiar with during the on-and-off lockdown phase of the pandemic (Morrison et al. 1). Denso Wave Inc., the inventor of the Quick Response Code or QR Code, describes them as being a scannable graphic that is “capable of handling several dozen to several hundred times more information than a conventional bar code that can only store up to 20 digits”. QR Codes were made available to the public in 1994, are easily detected by readers at nearly any size, and can be reconfigured to fit a variety of different shapes. A “QR Code is capable of handling all types of data, such as numeric and alphabetic characters, Kanji, Kana, Hiragana, symbols, binary, and control codes. Up to 7,089 characters can be encoded in one symbol” (Denso Wave). Similar to ideas used by the American conceptual artists of the 1960s, QR codes and NFTs are used in digital combines as conceptual tools. Analogous to Sol LeWitt’s wall drawings, the instruction is the medium and part of the artwork. An example of a Wall Drawing made by Sol LeWitt is as follows: Wall Drawing 11A wall divided horizontally and vertically into four equal parts. Within each part, three of the four kinds of lines are superimposed.(Sol LeWitt, May 1969; MASS MoCA, 2023) The act or intention of using an NFT as a medium in art-making transforms it from being solely a financial contract, which NFTs are widely known for, to an artistic medium or a standalone artwork. The interdisciplinary artist Sue Beyer uses Machine Learning and NFTs as conceptual media in her digital combines. Beyer’s use of machine learning corresponds to the automatic writing that André Breton and Philippe Soupault of the Surrealists were exploring from 1918 to 1924 when they wrote Les Champs Magnétiques (Magnetic Fields) (Bohn 7). Automatic writing was popular amongst the spiritualist movement that evolved from the 1840s to the early 1900s in Europe and the United States (Gosden 399). Michael Riffaterre (221; in Bohn 8) talks about how automatic writing differs from ordinary texts. Automatic writing takes a “total departure from logic, temporality, and referentiality”, in addition to violating “the rules of verisimilitude and the representation of the real”. Bohn adds that although “normal syntax is respected, they make only limited sense”. An artificial intelligence (AI) hallucination, or what Chintapali (1) describes as “distorted reality”, can be seen in the following paragraph that Deep Story provided after entering the prompt ‘Sue Beyer’ in March 2022. None of these sentences have any basis in truth about the person Sue Beyer from Melbourne, Australia. Suddenly runs to Jen from the bedroom window, her face smoking, her glasses shattering. Michaels (30) stands on the bed, pale and irritated. Dear Mister Shut Up! Sue’s loft – later – Sue is on the phone, looking upset. There is a new bruise on her face. There is a distinction between AI and machine learning. According to ChatGPT 3.5, “Machine Learning is a subset of AI that focuses on enabling computers to learn and make predictions or decisions without being explicitly programmed. It involves the development of algorithms and statistical models that allow machines to automatically learn from data, identify patterns, and make informed decisions or predictions”. Using the story generator Deep Story, Beyer uses the element of chance inherent in Machine Learning to create a biography on herself written by the alien other of AI. The paragraphs that Deep Story produces are nonsensical statements and made-up fantasies of what Beyer suspects AI wants the artist to hear. Like a psychic medium or oracle, providing wisdom and advice to a petitioner, the words tumble out of the story generator like a chaotic prediction meant to be deciphered at a later time. This element of chance might be a short-lived occurrence as machine learning is evolving and getting smarter exponentially, the potential of which is becoming very evident just from empirical observation. Something that originated in early modernist science fiction is quickly becoming a reality in our time. A Metamodern Spell Casting Metamodernism is an evolving term that emerged from a series of global catastrophes that occurred from the mid-1990s onwards. The term tolerates the concurrent use of ideas that arise in modernism and postmodernism without discord. It uses oppositional aspects or concepts in art-making and other cultural production that form what Dember calls a “complicated feeling” (Dember). These ideas in oscillation allow metamodernism to move beyond these fixed terms and encompass a wide range of cultural tendencies that reflect what is known collectively as a structure of feeling (van den Akker et al.). The oppositional media used in a digital combine oscillate with each other and also form meaning between each other, relating to material and immaterial concepts. These amalgamations place “technology and culture in mutual interrogation to produce new ways of seeing the world as it unfolds around us” (Myers Studio Ltd.). The use of the oppositional aspects of technology and culture indicates that Myers’s work can also be firmly placed within the domain of metamodernism. Advancements in AI over the years since the pandemic are overwhelming. In episode 23 of the MIT podcast Business Lab, Justice stated that “Covid-19 has accelerated the pace of digital in many ways, across many types of technologies.” They go on to say that “this is where we are starting to experience such a rapid pace of exponential change that it’s very difficult for most people to understand the progress” (MIT Technology Review Insights). Similarly, in 2021 NFTs burst forth in popularity in reaction to various conditions arising from the pandemic meta-crisis. A similar effect was seen around cryptocurrencies after the Global Financial Crisis (GFC) in 2007-2008 (Aliber and Zoega). “The popularity of cryptocurrencies represents in no small part a reaction to the financial crisis and austerity. That reaction takes the form of a retreat from conventional economic and political action and represents at least an economic occult” (Myers, Proof of Work 100). When a traumatic event occurs, like a pandemic, people turn to God, spirituality (Tumminio Hansen), or possibly the occult to look for answers. NFTs took on the role of precursor, promising access to untold riches, esoteric knowledge, and the comforting feeling of being part of the NFT cult. Similar to the effect of what Sutcliffe (15) calls spiritual “occultures” like “long-standing occult societies or New Age healers”, people can be lured by “the promise of secret knowledge”, which “can assist the deceptions of false gurus and create opportunities for cultic exploitation”. Conclusion NFTs are a metamodern spell casting, their popularity borne by the meta-crisis of the pandemic; they are made using magical instruction that oscillates between finance and conceptual abstraction, materialism and socialist idealism, financial ledger, and artistic medium. The metadata in the smart contract of the NFT provide instruction that combines the tangible and intangible. This oscillation, present in metamodern artmaking, creates and maintains a liminal space between these ideas, objects, and media. The in-between space allows for the perpetual transmutation of one thing to another. These ideas are a work in progress and additional exploration is necessary. An NFT is a new medium available to artists that does not physically exist but can be used to create meaning or to glue or hold objects together in a digital combine. Further investigation into the ontological aspects of this medium is required. The smart contract can be viewed as a recipe for the spell or incantation that, like instruction-based art, transforms an object from one thing to another. The blockchain that the NFT is housed in is a liminal space. The contract is stored on the threshold waiting for someone to view or purchase the NFT and turn the objects displayed in the gallery space into a digital combine. 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Goldie, Peter, and Elisabeth Schellekens. Who’s Afraid of Conceptual Art? Florence: Taylor and Francis, 2009. Gordon, Melton J. “Magic.” Encyclopedia of Occultism and Parapsychology. Ed Melton J. Gordon. 5th ed. Detroit, MI: Gale, 2001. 956–960. 21 July 2023 <https://link.gale.com/apps/doc/CX3403802897/GVRL?sid=bookmark-GVRL&xid=00061628>. Gosden, Chris. The History of Magic: From Alchemy to Witchcraft, from the Ice Age to the Present. London: Penguin, 2020. Haber, S., and W.S. Stornetta. “How to Time-Stamp a Digital Document.” Journal of Cryptology 3.2 (1991): 99–111. Hackl, Cathy, Dirk Lueth, and Tommaso di Bartolo. Navigating the Metaverse: A Guide to Limitless Possibilities in a Web 3.0 World. Ed. John Arkontaky. Hoboken, NJ: John Wiley & Sons, 2022. 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Inculturation emerged as a result of paradigm shifts in the missionary outlook of the Church necessitated by a heightened sense of culture, especially the plurality of cultures. This outlook saw culture as a tool for the transmission of the Gospel message to different frontiers. In view of this, dialogue with culture has passed from being an exception to the rule to becoming normative. Inculturation is a complex process, which must be undertaken gradually and critically. Overall, it aims to incarnate the Gospel in every culture by maintaining a healthy balance between tradition and progress. In this paper, the method of inculturation that is highlighted is the one developed by Charles Kraft and Anscar Chupungco known as “dynamic equivalence,” which seeks to build a “communicational bridge” between the Gospel message and human experience. This paper, therefore, embarks upon the discussion of faith-culture dialogue, keeping in mind Church’s efforts to proclaim the message of the Gospel: first, by first tracing the historical development of Inculturation, highlighting the Church’s disposition towards faith culture dialogue; second, by discussing the nature and dynamics of inculturation, focusing on its essential characteristics; and lastly, delineating the process of inculturation, which underscores dynamic equivalence as method. References Acevedo, Marcelo S.J., Inculturation and the Challenge of Modernity. Rome: Pontifical Gregorian University, 1982. Alberigo, Giuseppe “The Announcement of the Council: From Security of the Fortress to the Lure of Quest,” in History of Vatican II, 1 Announcing and Preparing Vatican II: Toward a New Era in Catholicism, ed. Giuseppe Alberigo and Joseph A. Komonchak. Maryknoll, NY: Orbis. 1-54. Aleaz, K.P. “The Theology of Inculturation Re-Examined,” Asia Journal of Theology 25, 2 (2011):232. Amalorpavadass, D.S. “Indian Culture. Integrating Cultural Elements into Spirituality” in Indian Christian Spirituality ed. By D.S. Amalorpvadass, Bangalore: NBCLC, 1982, 100. Arbuckle, Gerard A. “Christianity, Identity, and Cultures: A Case Study” The Australasian Catholic Report (January, 2013): 41-43. Arbuckle, Gerard Earthing the Gospel: An Inculturation Handbook for the Pastoral Worker. Maryknoll, New York: Orbis Books, 1990. Arevalo, Catalino “Inculturation in the Church: The Asian Context,” Landas 25 (2011): 83-134. Arrupe, P. 1978, “Letter to the Whole Society on Inculturation” Aixala (ed.) 3, 172-181. Barnes, Michael SJ, Theology and the Dialogue of Religions. Cambridge: Cambridge Unviersity Press, 2002. Bevans, Stephen SVD. “Revisiting Mission as Vatican II: Theology and Practice for Today’s Mission Church” Theological Studies 74 (2013): 26. Chupungco, Anscar. “Two Methods of Liturgical Inculturation: Creative Assimilation and Dynamic Equivalence” in Liturgy for the Filipino Church: A Collection of Talks of Anscar J. Chupungco, OSB given at the National Meeting of Diocesan Directors of Liturgy (1986-2004), ed. Josefina M. Manabat, SLD. Mendiola. Manila: San Beda College, Graduate School of Liturgy, 2004. 18-33. Chupungco, Anscar Liturgies of the Future: the Process and Methods of Inculturation. Collegeville Minnesota: A Pueblo Book, 1989. Chupungco, Anscar. “Liturgy and Inculturation,” East Asian Pastoral Review 18 (1981): 264. Costa R.O. (ed.) One Faith, Many Cultures: Inculturation, Indigenization, and Contextualization. Maryknoll: NY Orbis, 1988. Chupungco, Anscar in “Liturgy and Inculturation,” East Asian Pastoral Review 18 (1981): 264. De la Rosa, Rolando V. Beginnings of the Filipino Dominicans: History of the Filipinization of the Religious Orders in the Philippines, Revised Edition. Manila: UST Publishing House, 1990. De Mesa, Jose M. Why Theology is Never Far from Home. Manila: De La Salle University Press, Inc., 2003. Eilers, Franz-Josef. Communicating Between Cultures: An Introduction to Intercultural Communication. Fourth Updated Edition. Manila: Logos, Divine Word Publication, 2012. Federation of Asian Bishops’ Conferences, Resource Manual for Catholics in Asia: Dialogue. Thailand: FABC-OEIA, 2001. Follo, Francesco “Inculturation and Interculturality in John Paul II and Benedict XVI.” Retrieved 5 February 2014 from http://www.oasiscenter.eu/articles/interreligious-dialogue/2010/03/29/inculturation-and-interculturality-in-john-paul-ii-and-benedict-xvi quoting Ratzinger’s speech during the 25th anniversary of the John Paul II Institute for Studies on Marriage and Family, 11 May 2006. Genero, Bartolome. ed. Inculturazione della fede: Sagi Interdisciplinarii. Naple: Edizioni ehoniane, 1981. Gorski, John F. M.M., “Christology, Inculturation, and Their Missiological Implications: A Latin American Perspective,” International Bulletin of Missionary Research 28, 2 (2004): 61, Javier, Edgar G. SVD, Dialogue: Our Mission Today. Quezon City: Claretian Publication and ICLA Publications, 2006. Jeremiah, Anderson “Inculturation: A Sub-Altern Critique of K.P. Aleaz’ ‘Indian Christian Vedanta,’ The Asia Journal of Theology 21, 2. (October 2007): 398-411. Kraft, Charles H. Christianity in Culture: A Study in Biblical Theologizing in Cross-Cultural Perspective. New York: Orbis Books, 1980. Kroeger, James, H., “The Faith-Culture Dialogue in Asia: Ten FABC Insights on Inculturation,” oletin Eclesiastico de Filipinas 85, 870 (2009): 7-28. Masson, Joseph ‘L Église ouverte ser le monde’in NRT, 84 (1962) 1038. Mercado, Leonardo N. Inculturation and Filipino Theology, Asia Pacific Missiological Series 2. Manila: Divine Word Publication, 1992. Mercado, Leonardo N. Elements of Filipino Theology. Tacloban City, Philippines: Divine Word University, 1975. Mitchell, Nathan “Culture, Inculturation, and Sacrosanctum Concilium,” Worship 77, 2 (March 2003): 171-181. Pietrzak, Daniel Interculturality and Internationality: A Utopia or a Constructive Tension for a Franciscan Missiology? Retrieved September 9, 2014 from http://www2.ofmconv.pcn.net/docs/en/general/miscon06_india/Interculturality%20and%20Internationality%20%20a%20utopia%20or%20a%20constructive%20tension%20for%20a%20Franciscan%20Missiology.pdf Radcliffe, Timothy. “Inculturation,” Review for Religious (Sept – Oct 1994): 646-657. Schreiter, Robert. “The Legacy of St. Francis Xavier: Inculturation of the Gospel Then and Now” East Asian Pastoral Review 44 (2007): 17-31. Schreiter, Robert J. Constructing Local Theologies. Maryknoll, New York: Orbis Books, 1993. Shorter, Aylward Toward a Theology of Inculturation. Eugene, Oregon: Wipf and Stock Publishers, 1999. Stanley, Brian. “Inculturation: Historical Background, Theological Foundations and Contemporary Questions,” Transformation 24, 1 (January 2007): 21-27. Timoner, Gerard F. “Intercultural Theology as a Way of Doing Theology” in Philippiniana Sacra XLI, 121 (January-April, 2006): 75-46. Timoner, Gerard. “Theology of Inculturation: A Critical Appraisal,” Philippiniana Sacra XL no. 119 (2005): 322-325. Ustorf, Werner “The Cultural Origins of Intercultural Theology” Mission Studies 25 (2008): 229-251. Wijsen, Frans “Intercultural Theology” Exchange 30, 3 (2001): 222-230.

Introduction Documentary film has grown significantly in the past decade, with high profile films such as Fahrenheit 9/11, Supersize Me, and An Inconvenient Truth garnering increased attention both at the box office and in the news media. In addition, the rising prominence of web-based media has provided new opportunities for documentary to create social impact. Films are now typically released with websites, Facebook pages, twitter feeds, and web videos to increase both reach and impact. This combination of technology and broader audience appeal has given rise to a current landscape in which documentary films are imbedded within coordinated multi-media campaigns. New media have not only opened up new avenues for communicating with audiences, they have also created new opportunities for data collection and analysis of film impacts. A recent report by McKinsey and Company highlighted this potential, introducing and discussing the implications of increasing consumer information being recorded on the Internet as well as through networked sensors in the physical world. As they found: "Big data—large pools of data that can be captured, communicated, aggregated, stored, and analyzed—is now part of every sector and function of the global economy" (Manyika et al. iv). This data can be mined to learn a great deal about both individual and cultural response to documentary films and the issues they represent. Although film has a rich history in humanities research, this new set of tools enables an empirical approach grounded in the social sciences. However, several researchers across disciplines have noted that limited investigation has been conducted in this area. Although there has always been an emphasis on social impact in film and many filmmakers and scholars have made legitimate (and possibly illegitimate) claims of impact, few have attempted to empirically justify these claims. Over fifteen years ago, noted film scholar Brian Winston commented that "the underlying assumption of most social documentaries—that they shall act as agents of reform and change—is almost never demonstrated" (236). A decade later, Political Scientist David Whiteman repeated this sentiment, arguing that, "despite widespread speculation about the impact of documentaries, the topic has received relatively little systematic attention" ("Evolving"). And earlier this year, the introduction to a special issue of Mass Communication and Society on documentary film stated, "documentary film, despite its growing influence and many impacts, has mostly been overlooked by social scientists studying the media and communication" (Nisbet and Aufderheide 451). Film has been studied extensively as entertainment, as narrative, and as cultural event, but the study of film as an agent of social change is still in its infancy. This paper introduces a systematic approach to measuring the social impact of documentary film aiming to: (1) discuss the context of documentary film and its potential impact; and (2) argue for a social science approach, discussing key issues about conducting such research. Changes in Documentary Practice Documentary film has been used as a tool for promoting social change throughout its history. John Grierson, who coined the term "documentary" in 1926, believed it could be used to influence the ideas and actions of people in ways once reserved for church and school. He presented his thoughts on this emerging genre in his 1932 essay, First Principles of Documentary, saying, "We believe that the cinema's capacity for getting around, for observing and selecting from life itself, can be exploited in a new and vital art form" (97). Richard Barsam further specified the definition of documentary, distinguishing it from non-fiction film, such that all documentaries are non-fiction films but not all non-fiction films are documentaries. He distinguishes documentary from other forms of non-fiction film (i.e. travel films, educational films, newsreels) by its purpose; it is a film with an opinion and a specific message that aims to persuade or influence the audience. And Bill Nichols writes that the definition of documentary may even expand beyond the film itself, defining it as a "filmmaking practice, a cinematic tradition, and mode of audience reception" (12). Documentary film has undergone many significant changes since its inception, from the heavily staged romanticism movement of the 1920s to the propagandist tradition of governments using film to persuade individuals to support national agendas to the introduction of cinéma vérité in the 1960s and historical documentary in the 1980s (cf. Barnouw). However, the recent upsurge in popularity of documentary media, combined with technological advances of internet and computers have opened up a whole new set of opportunities for film to serve as both art and agent for social change. One such opportunity is in the creation of film-based social action campaigns. Over the past decade, filmmakers have taken a more active role in promoting social change by coordinating film releases with action campaigns. Companies such as Participant Media (An Inconvenient Truth, Food Inc., etc.) now create "specific social action campaigns for each film and documentary designed to give a voice to issues that resonate in the films" (Participant Media). In addition, a new sector of "social media" consultants are now offering services, including "consultation, strategic planning for alternative distribution, website and social media development, and complete campaign management services to filmmakers to ensure the content of nonfiction media truly meets the intention for change" (Working Films). The emergence of new forms of media and technology are changing our conceptions of both documentary film and social action. Technologies such as podcasts, video blogs, internet radio, social media and network applications, and collaborative web editing "both unsettle and extend concepts and assumptions at the heart of 'documentary' as a practice and as an idea" (Ellsworth). In the past decade, we have seen new forms of documentary creation, distribution, marketing, and engagement. Likewise, film campaigns are utilizing a broad array of strategies to engage audience members, including "action kits, screening programs, educational curriculums and classes, house parties, seminars, panels" that often turn into "ongoing 'legacy' programs that are updated and revised to continue beyond the film's domestic and international theatrical, DVD and television windows" (Participant Media). This move towards multi-media documentary film is becoming not only commonplace, but expected as a part of filmmaking. NYU film professor and documentary film pioneer George Stoney recently noted, "50 percent of the documentary filmmaker's job is making the movie, and 50 percent is figuring out what its impact can be and how it can move audiences to action" (qtd. in Nisbet, "Gasland"). In his book Convergence Culture, Henry Jenkins, coined the term "transmedia storytelling", which he later defined as "a process where integral elements of a fiction get dispersed systematically across multiple delivery channels for the purpose of creating a unified and coordinated entertainment experience" ("Transmedia"). When applied to documentary film, it is the elements of the "issue" raised by the film that get dispersed across these channels, coordinating, not just an entertainment experience, but a social action campaign. Dimensions of Evaluation It is not unreasonable to assume that such film campaigns, just like any policy or program, have the possibility to influence viewers' knowledge, attitudes, and behavior. Measuring this impact has become increasingly important, as funders of documentary and issue-based films want look to understand the "return on investment" of films in terms of social impact so that they can compare them with other projects, including non-media, direct service projects. Although we "feel" like films make a difference to the individuals who also see them in the broader cultures in which they are embedded, measurement and empirical analysis of this impact are vitally important for both providing feedback to filmmakers and funders as well as informing future efforts attempting to leverage film for social change. This type of systematic assessment, or program evaluation, is often discussed in terms of two primary goals—formative (or process) and summative (or impact) evaluation (cf. Muraskin; Trochim and Donnelly). Formative evaluation studies program materials and activities to strengthen a program, and summative evaluation examines program outcomes. In terms of documentary film, these two goals can be described as follows: Formative Evaluation: Informing the Process As programs (broadly defined as an intentional set of activities with the aim of having some specific impact), the people who interact with them, and the cultures they are situated in are constantly changing, program development and evaluation is an ongoing learning cycle. Film campaigns, which are an intentional set of activities with the aim of impacting individual viewers and broader cultures, fit squarely within this purview. Without formulating hypotheses about the relationships between program activities and goals and then collecting and analyzing data during implementation to test them, it is difficult to learn ways to improve programs (or continue doing what works best in the most efficient manner). Attention to this process enables those involved to learn more about, not only what works, but how and why it works and even gain insights about how program outcomes may be affected by changes to resource availability, potential audiences, or infrastructure. Filmmakers are constantly learning and honing their craft and realizing the impact of their practice can help the artistic process. Often faced with tight budgets and timelines, they are forced to confront tradeoffs all the time, in the writing, production and post-production process. Understanding where they are having impact can improve their decision-making, which can help both the individual project and the overall field. Summative Evaluation: Quantifying Impacts Evaluation is used in many different fields to determine whether programs are achieving their intended goals and objectives. It became popular in the 1960s as a way of understanding the impact of the Great Society programs and has continued to grow since that time (Madaus and Stufflebeam). A recent White House memo stated that "rigorous, independent program evaluations can be a key resource in determining whether government programs are achieving their intended outcomes as well as possible and at the lowest possible cost" and the United States Office of Management and Budget (OMB) launched an initiative to increase the practice of "impact evaluations, or evaluations aimed at determining the causal effects of programs" (Orszag 1). Documentary films, like government programs, generally target a national audience, aim to serve a social purpose, and often do not provide a return on their investment. Participant Media, the most visible and arguably most successful documentary production company in the film industry, made recent headlines for its difficulty in making a profit during its seven-year history (Cieply). Owner and founder Jeff Skoll reported investing hundreds of millions of dollars into the company and CEO James Berk added that the company sometimes measures success, not by profit, but by "whether Mr. Skoll could have exerted more impact simply by spending his money philanthropically" (Cieply). Because of this, documentary projects often rely on grant funding, and are starting to approach funders beyond traditional arts and media sources. "Filmmakers are finding new fiscal and non-fiscal partners, in constituencies that would not traditionally be considered—or consider themselves—media funders or partners" (BRITDOC 6). And funders increasingly expect tangible data about their return on investment. Says Luis Ubiñas, president of Ford Foundation, which recently launched the Just Films Initiative: In these times of global economic uncertainty, with increasing demand for limited philanthropic dollars, assessing our effectiveness is more important than ever. Today, staying on the frontlines of social change means gauging, with thoughtfulness and rigor, the immediate and distant outcomes of our funding. Establishing the need for evaluation is not enough—attention to methodology is also critical. Valid research methodology is a critical component of understanding around the role entertainment can play in impacting social and environmental issues. The following issues are vital to measuring impact. Defining the Project Though this may seem like an obvious step, it is essential to determine the nature of the project so one can create research questions and hypotheses based on a complete understanding of the "treatment". One organization that provides a great example of the integration of documentary film imbedded into a larger campaign or movement is Invisible Children. Founded in 2005, Invisible Children is both a media-based organization as well as an economic development NGO with the goal of raising awareness and meeting the needs of child soldiers and other youth suffering as a result of the ongoing war in northern Uganda. Although Invisible Children began as a documentary film, it has grown into a large non-profit organization with an operating budget of over $8 million and a staff of over a hundred employees and interns throughout the year as well as volunteers in all 50 states and several countries. Invisible Children programming includes films, events, fundraising campaigns, contests, social media platforms, blogs, videos, two national "tours" per year, merchandise, and even a 650-person three-day youth summit in August 2011 called The Fourth Estate. Individually, each of these components might lead to specific outcomes; collectively, they might lead to others. In order to properly assess impacts of the film "project", it is important to take all of these components into consideration and think about who they may impact and how. This informs the research questions, hypotheses, and methods used in evaluation. Film campaigns may even include partnerships with existing social movements and non-profit organizations targeting social change. The American University Center for Social Media concluded in a case study of three issue-based documentary film campaigns: Digital technologies do not replace, but are closely entwined with, longstanding on-the-ground activities of stakeholders and citizens working for social change. Projects like these forge new tools, pipelines, and circuits of circulation in a multiplatform media environment. They help to create sustainable network infrastructures for participatory public media that extend from local communities to transnational circuits and from grassroots communities to policy makers. (Abrash) Expanding the Focus of Impact beyond the Individual A recent focus has shifted the dialogue on film impact. Whiteman ("Theaters") argues that traditional metrics of film "success" tend to focus on studio economic indicators that are far more relevant to large budget films. Current efforts focused on box office receipts and audience size, the author claims, are really measures of successful film marketing or promotion, missing the mark when it comes to understanding social impact. He instead stresses the importance of developing a more comprehensive model. His "coalition model" broadens the range and types of impact of film beyond traditional metrics to include the entire filmmaking process, from production to distribution. Whiteman (“Theaters”) argues that a narrow focus on the size of the audience for a film, its box office receipts, and viewers' attitudes does not incorporate the potential reach of a documentary film. Impacts within the coalition model include both individual and policy levels. Individual impacts (with an emphasis on activist groups) include educating members, mobilizing for action, and raising group status; policy includes altering both agenda for and the substance of policy deliberations. The Fledgling Fund (Barrett and Leddy) expanded on this concept and identified five distinct impacts of documentary film campaigns. These potential impacts expand from individual viewers to groups, movements, and eventually to what they call the "ultimate goal" of social change. Each is introduced briefly below. Quality Film. The film itself can be presented as a quality film or media project, creating enjoyment or evoking emotion in the part of audiences. "By this we mean a film that has a compelling narrative that draws viewers in and can engage them in the issue and illustrate complex problems in ways that statistics cannot" (Barrett and Leddy, 6). Public Awareness. Film can increase public awareness by bringing light to issues and stories that may have otherwise been unknown or not often thought about. This is the level of impact that has received the most attention, as films are often discussed in terms of their "educational" value. "A project's ability to raise awareness around a particular issue, since awareness is a critical building block for both individual change and broader social change" (Barrett and Leddy, 6). Public Engagement. Impact, however, need not stop at simply raising public awareness. Engagement "indicates a shift from simply being aware of an issue to acting on this awareness. Were a film and its outreach campaign able to provide an answer to the question 'What can I do?' and more importantly mobilize that individual to act?" (Barrett and Leddy, 7). This is where an associated film campaign becomes increasingly important, as transmedia outlets such as Facebook, websites, blogs, etc. can build off the interest and awareness developed through watching a film and provide outlets for viewers channel their constructive efforts. Social Movement. In addition to impacts on individuals, films can also serve to mobilize groups focused on a particular problem. The filmmaker can create a campaign around the film to promote its goals and/or work with existing groups focused on a particular issue, so that the film can be used as a tool for mobilization and collaboration. "Moving beyond measures of impact as they relate to individual awareness and engagement, we look at the project's impact as it relates to the broader social movement … if a project can strengthen the work of key advocacy organizations that have strong commitment to the issues raised in the film" (Barrett and Leddy, 7). Social Change. The final level of impact and "ultimate goal" of an issue-based film is long-term and systemic social change. "While we understand that realizing social change is often a long and complex process, we do believe it is possible and that for some projects and issues there are key indicators of success" (Barrett and Leddy, 7). This can take the form of policy or legislative change, passed through film-based lobbying efforts, or shifts in public dialogue and behavior. Legislative change typically takes place beyond the social movement stage, when there is enough support to pressure legislators to change or create policy. Film-inspired activism has been seen in issues ranging from environmental causes such as agriculture (Food Inc.) and toxic products (Blue Vinyl) to social causes such as foreign conflict (Invisible Children) and education (Waiting for Superman). Documentary films can also have a strong influence as media agenda-setters, as films provide dramatic "news pegs" for journalists seeking to either sustain or generation new coverage of an issue (Nisbet "Introduction" 5), such as the media coverage of climate change in conjunction with An Inconvenient Truth. Barrett and Leddy, however, note that not all films target all five impacts and that different films may lead to different impacts. "In some cases we could look to key legislative or policy changes that were driven by, or at least supported by the project... In other cases, we can point to shifts in public dialogue and how issues are framed and discussed" (7). It is possible that specific film and/or campaign characteristics may lead to different impacts; this is a nascent area for research and one with great promise for both practical and theoretical utility. Innovations in Tools and Methods Finally, the selection of tools is a vital component for assessing impact and the new media landscape is enabling innovations in the methods and strategies for program evaluation. Whereas the traditional domain of film impact measurement included box office statistics, focus groups, and exit surveys, innovations in data collection and analysis have expanded the reach of what questions we can ask and how we are able to answer them. For example, press coverage can assist in understanding and measuring the increase in awareness about an issue post-release. Looking directly at web-traffic changes "enables the creation of an information-seeking curve that can define the parameters of a teachable moment" (Hart and Leiserowitz 360). Audience reception can be measured, not only via interviews and focus groups, but also through content and sentiment analysis of web content and online analytics. "Sophisticated analytics can substantially improve decision making, minimize risks, and unearth valuable insights that would otherwise remain hidden" (Manyika et al. 5). These new tools are significantly changing evaluation, expanding what we can learn about the social impacts of film through triangulation of self-report data with measurement of actual behavior in virtual environments. Conclusion The changing media landscape both allows and impels evaluation of film impacts on individual viewers and the broader culture in which they are imbedded. Although such analysis may have previously been limited to box office numbers, critics' reviews, and theater exit surveys, the rise of new media provides both the ability to connect filmmakers, activists, and viewers in new ways and the data in which to study the process. This capability, combined with significant growth in the documentary landscape, suggests a great potential for documentary film to contribute to some of our most pressing social and environmental needs. A social scientific approach, that combines empirical analysis with theory applied from basic science, ensures that impact can be measured and leveraged in a way that is useful for both filmmakers as well as funders. In the end, this attention to impact ensures a continued thriving marketplace for issue-based documentary films in our social landscape. References Abrash, Barbara. "Social Issue Documentary: The Evolution of Public Engagement." American University Center for Social Media 21 Apr. 2010. 26 Sep. 2011 ‹http://www.centerforsocialmedia.org/›. Aufderheide, Patricia. "The Changing Documentary Marketplace." Cineaste 30.3 (2005): 24-28. Barnouw, Eric. Documentary: A History of the Non-Fiction Film. New York: Oxford UP, 1993. Barrett, Diana and Sheila Leddy. "Assessing Creative Media's Social Impact." The Fledgling Fund, Dec. 2008. 15 Sep. 2011 ‹http://www.thefledglingfund.org/media/research.html›. Barsam, Richard M. Nonfiction Film: A Critical History. Bloomington: Indiana UP. 1992. BRITDOC Foundation. The End of the Line: A Social Impact Evaluation. London: Channel 4, 2011. 12 Oct. 2011 ‹http://britdoc.org/news_details/the_social_impact_of_the_end_of_the_line/›. Cieply, Michael. "Uneven Growth for Film Studio with a Message." New York Times 5 Jun. 2011: B1. Ellsworth, Elizabeth. "Emerging Media and Documentary Practice." The New School Graduate Program in International Affairs. Aug. 2008. 22 Sep. 2011. ‹http://www.gpia.info/node/911›. Grierson, John. "First Principles of Documentary (1932)." Imagining Reality: The Faber Book of Documentary. Eds. Kevin Macdonald and Mark Cousins. London: Faber and Faber, 1996. 97-102. Hart, Philip Solomon and Anthony Leiserowitz. "Finding the Teachable Moment: An Analysis of Information-Seeking Behavior on Global Warming Related Websites during the Release of The Day After Tomorrow." Environmental Communication: A Journal of Nature and Culture 3.3 (2009): 355-66. Jenkins, Henry. Convergence Culture: Where Old and New Media Collide. New York: New York UP, 2006. ———. "Transmedia Storytelling 101." Confessions of an Aca-Fan. The Official Weblog of Henry Jenkins. 22 Mar. 2007. 10 Oct. 2011 ‹http://www.henryjenkins.org/2007/03/transmedia_storytelling_101.html›. Madaus, George, and Daniel Stufflebeam. "Program Evaluation: A Historical Overview." Evaluation in Education and Human Services 49.1 (2002): 3-18. Manyika, James, Michael Chui, Jacques Bughin, Brad Brown, Richard Dobbs, Charles Roxburgh, and Angela Hung Byers. Big Data: The Next Frontier for Innovation, Competition, and Productivity. McKinsey Global Institute. May 2011 ‹http://www.mckinsey.com/mgi/publications/big_data/›. Muraskin, Lana. Understanding Evaluation: The Way to Better Prevention Programs. Washington: U.S. Department of Education, 1993. 8 Oct. 2011 ‹http://www2.ed.gov/PDFDocs/handbook.pdf›. Nichols, Bill. "Foreword." Documenting the Documentary: Close Readings of Documentary Film and Video. Eds. Barry Keith Grant and Jeannette Sloniowski. Detroit: Wayne State UP, 1997. 11-13. Nisbet, Matthew. "Gasland and Dirty Business: Documentary Films Shape Debate on Energy Policy." Big Think, 9 May 2011. 1 Oct. 2011 ‹http://bigthink.com/ideas/38345›. ———. "Introduction: Understanding the Social Impact of a Documentary Film." Documentaries on a Mission: How Nonprofits Are Making Movies for Public Engagement. Ed. Karen Hirsch, Center for Social Media. Mar. 2007. 10 Sep. 2011 ‹http://aladinrc.wrlc.org/bitstream/1961/4634/1/docs_on_a_mission.pdf›. Nisbet, Matthew, and Patricia Aufderheide. "Documentary Film: Towards a Research Agenda on Forms, Functions, and Impacts." Mass Communication and Society 12.4 (2011): 450-56. Orszag, Peter. Increased Emphasis on Program Evaluation. Washington: Office of Management and Budget. 7 Oct. 2009. 10 Oct. 2011 ‹http://www.whitehouse.gov/sites/default/files/omb/assets/memoranda_2010/m10-01.pdf›. Participant Media. "Our Mission." 2011. 2 Apr. 2011 ‹http://www.participantmedia.com/company/about_us.php.›. Plantinga, Carl. Rhetoric and Representation in Nonfiction Film. Cambridge: Cambridge UP, 1997. Trochim, William, and James Donnelly. Research Methods Knowledge Base. 3rd ed. Mason: Atomic Dogs, 2007. Ubiñas, Luis. "President's Message." 2009 Annual Report. Ford Foundation, Sep. 2010. 10 Oct. 2011 ‹http://www.fordfoundation.org/about-us/2009-annual-report/presidents-message›. Vladica, Florin, and Charles Davis. "Business Innovation and New Media Practices in Documentary Film Production and Distribution: Conceptual Framework and Review of Evidence." The Media as a Driver of the Information Society. Eds. Ed Albarran, Paulo Faustino, and R. Santos. Lisbon, Portugal: Media XXI / Formal, 2009. 299-319. Whiteman, David. "Out of the Theaters and into the Streets: A Coalition Model of the Political Impact of Documentary Film and Video." Political Communication 21.1 (2004): 51-69. ———. "The Evolving Impact of Documentary Film: Sacrifice and the Rise of Issue-Centered Outreach." Post Script 22 Jun. 2007. 10 Sep. 2011 ‹http://www.allbusiness.com/media-telecommunications/movies-sound-recording/5517496-1.html›. Winston, Brian. Claiming the Real: The Documentary Film Revisited. London: British Film Institute, 1995. Working Films. "Nonprofits: Working Films." Foundation Source Access 31 May 2011. 5 Oct. 2011 ‹http://access.foundationsource.com/nonprofit/working-films/›.

Photo by Naveed Ahmed on Unsplash ABSTRACT India has had a solid standard for medical ethics since the birth of Ayurvedic holistic science over 5000 years ago. The country’s views on healthcare policy, counsel on how to deal with patients, and what constitutes good behavior within the profession stem from ancient outlines for medical practice. These “codes of conduct” were heavily influenced by religious and spiritual practices, emphasizing the sanctity of life and transcending the needs of the body. With time, however, medical care evolved through shifting priorities in education and governmental pressures. These once-cherished “codes of conduct” were referred to less often, while malpractice issues have steadily increased. There is a need for an open discussion of why this spike in medical malpractice is happening in a country that used to condemn it and how improving ethics, limiting the role of profits, and returning traditional philosophies to the medical ethics curricula could help. INTRODUCTION Currently, India has the largest number of bioethics units of any country, reflecting the importance of ethical behavior in Indian society. These centers do not affiliate with schools, yet they serve as spaces for bioethical discourse. The Indian Psychiatric Society (IPS) was the first to address escalating malpractice cases. Other major medical organizations (e.g., the Indian Medical Association and the Medical Council of India) followed, stressing the importance of standardized ethics. Some have formed symposiums and organized conferences to address these concerns.[1] There have been several calls to revisit the classic “codes of conduct” and their focus on the spiritual concept of life-death-rebirth. Toward this end, modern Indian doctors were reminded that physicians existed not for fortune or status but for the welfare of their patients. These altruistic teachings came from the seminal Ayurvedic texts, the cornerstone of India’s modern medicine. Happiness for the “healer” was to come out of showing compassion for all living beings and prolonging the precious gift of life.[2] In contrast, Indian novelist, Shashi Tharoor, speaking on the current state of medical practice, recently remarked: “India is not an underdeveloped country, but a highly developed one in an advanced state of decay.”[3] Taking a closer look at what caused the core values of an ancient healthcare system to change so drastically involves evaluating how the Indian medical education system evolved. This paper examines the development of medical principles, their influence across the subcontinent, commercialization, and the government’s role in India’s healthcare instability. This paper then lists some of the measures taken by bioethical units to counteract some of the issues brought on by corruption. l. Western Influence Western influence on medical practices came when the French, Portuguese, and British arrived in India. They almost completely reinvented India’s healthcare system. Medical ethics based on the values of spirituality were almost completely stripped away and replaced by Western concepts.[4] Established traditional ethical standards were no longer taught, resulting in less deference to traditional moral beliefs. Coupled with an increase in medical misconduct, the general population lost trust in their healthcare leaders.[5] Before the influence of Western medicine, the Carakha Sumhita, a millennia-old Sanskrit text detailing Ayurveda, helped establish healthcare guidelines. A passage from the text sums up the ethics of that time: “He who practices medicine out of compassion for all creatures, rather than for gain or for gratification of the senses, surpasses all.”[6] The Carakha Sumhita’s focus on medical ethics was ahead of its time, centuries before bioethics became a subject in its own right. Healthcare was predicated on aphorisms that all medical students internalized rather than on business models, as in many developed nations. India’s caste system, established generations ago, permeated every aspect of South Asian society except for when it came to medicine. Healers tended to ignore the conventions of adhering to an individual’s caste. Instead, they treated patients as if they were family and incorporated elements of spirituality when dealing with patients, making ethical misconduct a rare phenomenon. This was the case for almost two centuries.[7] To become practicing physicians, doctors committed to a consecration ceremony to prove their good moral standing to the people they were to serve.[8] Their schooling prepared them for a profession designed to “give back,” not for monetary gain. The core values taught in medical school affect the mentality doctors carry with them. The lack of ethics training may have been at fault for the underlying corruption levels that now plague the healthcare space in India. There is a 110 percent increase in the rise of medical negligence cases in India every year.[9] To pinpoint why this occurred, we must look at current medical training practices and how they influence doctors of our time period. After colonization, many established core values were stripped from the medical curriculum.[10] In fact, by 1998, only one medical college in India, St. John’s in Bangalore, even addressed medical ethics in its curriculum.[11] Graduates across the country were left ill-equipped to deal with the ethical issues that cropped up once they made it into the field. As a result, they were not prepared to think through consequences pertaining to patients and their families. Some suggest that the curriculum changes were linked to rising malpractice cases. “When society at large is corrupt and unethical, how can you expect doctors to be honest?”[12] This topic arises regularly in bioethics discussions and the answer lies in education. Reverting to a system of medicine that encourages students to recognize ethical consequences can solve many of the ethical problems in contemporary society. ll. Privatization and Tuition Some argue that the global increase in capitalism caused the subcontinent’s ethical problems, that the Indian medical education system began its descent into corruption and nepotism, and its loss in prestige, with the privatization of their colleges.[13] In India, just over 50 percent of medical schools are public, and just under 50 percent are private.[14] Through changing policies, private medical schools became increasingly for-profit like other businesses.[15] Despite having more medical schools than any other country, India has a shortage of doctors, primarily due to low enrollment rates and high university fees. While there are 202 medical schools in India, its large population means there are 5 million people per medical school.[16] Christian Medical College, a top-ranked university in Vellore, once had an acceptance rate of 0.25 percent, with only 100 seats for medical students.[17] Now its acceptance rate hovers around 5 percent. There has been minimal progress in making it easier to get a medical school acceptance; there is still a long way to go in equalizing access to education. India’s system for training doctors is now rife with corruption, with bribes accepted under the guise of “donations” and new curricula completely devoid of traditional Indian training methods.[18] Nepotism in the industry has made qualifications even less significant. In 2010, 69 hospitals and medical colleges were reported for selling exam papers to students, and most employed staff lied about their clinical experience.[19] In a cheating scandal in 2013 involving several Indian universities, students purchased falsified entrance exam results. Not only are these students unqualified for the placements they secured, but legal action by the government did not materialize.[20] Dr. Anand Rai, a physician who had to go into protective hiding following death threats for being a whistleblower in the 2013 scandal subsequently remarked: “...the next generation of doctors is being taught to cheat and deceive before they even enter the classroom.”[21] The effects of this scandal can be felt far beyond its borders - India also happens to be the world’s largest exporter of doctors, with about 47,000 currently practicing in the United States.[22] lll. Hospital Privatization With the privatization of major hospitals and the shift to a “United States” business focus, another serious problem emerged. In the recent past, patients hailing from rural villages and often living in poverty could access quality health care from public hospitals. They had access to highly trained doctors, and all costs were usually fully subsidized.[23] This was in keeping with the old tradition that believed in aid no matter the circumstance. As the focus shifted towards maximizing profitability, these opportunities for poor patients vanished. Chains of private hospitals are rapidly replacing public ones. Their purchasing model is to consolidate through a centralized subsidiary.[24] This usually results in significant savings. Instead of passing on some savings to patients through reduced pricing, any savings are used to fulfill a key objective of privatized businesses: maximize profitability. The poor now contend with inflated prices and are being turned away from facilities that once treated them at no cost, all while levels of trust in the healthcare system have plummeted. This distrust can discourage people who cannot afford care from seeking medical aid when they need it. The healthcare system has devolved to the point whereby remaining public hospitals are overrun by huge numbers of patients unable to afford the hugely inflated prices at private institutions. This, coupled with healthcare workers that often have substandard training, has created deplorable public health conditions. lV. Corruption This deplorable public health condition reflects a failing healthcare system. To make matters worse, hospitals hire unqualified graduates untrained in medical ethics to meet India's urgent need for large numbers of qualified doctors. Many hospitals have even resorted to employing corrupt doctors to counteract the physician shortage. According to the Indian Medical Association (IMA), about 45 percent of those who practice medicine in India have no formal training.[25] IMA also reported that close to 700,000 doctors employed at some of the biggest hospitals, who are currently diagnosing, treating, and operating, have neither the training nor experience to do so. A large-scale forgery ring, broken up in 2011, revealed that buyers could pay as little as 100 US dollars for a medical degree from a non-existent college. This “cleared” them for practice.[26] It has been estimated that over 50,000 fraudulent medical degrees have been purchased in the past decade. Government level corruption is widespread, as one can gain placement into medical school, “graduate” with fake degrees, and sell fake practicing licenses. V. Solutions These topics, raised by bioethics centers, are now being taken more seriously by healthcare professionals taking steps to address medical misconduct. As many as five million people in India die each year due to medical negligence.[27] By requiring each physician to complete a new comprehensive Acute Critical Care Course (ACCC), specialists estimate that physicians can reduce the rate of malpractice deaths by as much as 50 percent in rural areas.[28] This intensive two-year course contains detailed training methods built off of current knowledge and walks healthcare professionals through crucial steps designed to reduce errors. Even small errors, such as a poorly inserted IV for fluid or a minor surgery mishap, can be life threatening. The course thoroughly covers these as mandated.[29] The ACCC is unfortunately not a widely spread concept in a lot of rural areas. For now, while many major hospitals continue to ignore the high rates of avoidable deaths, implementation of the ACCC program seems slow. The current Medical Council of India needs to be more effective at addressing malpractice cases, as there are so many of them.[30] One possible solution to the growth of unethical business practices in medicine is to offer physicians incentives to make ethically sound decisions. This can start by increasing the number of slots available for medical students at government-run medical schools. Less student debt would lead more doctors away from overbilling their patients. This is a strategy currently being employed in the state of Tamil Nadu, where a centrally sponsored scheme has approved the induction of an additional 3,496 MBBS seats in government colleges.[31] More students studying at subsidized costs with less competition lowers the inclination toward deceit and profiteering. Another incentive for ethical practice can come from accountability and transparency. The background of every doctor operating should be public information, including the rate of successful surgeries versus unsuccessful ones resulting from personal negligence. This would encourage doctors to keep a clean record and, in turn, encourage hospitals to hire and train those who will preserve or improve their reputation. This information is kept in a medical record monitored in most parts of India through a traditional paper method.[32] While eliminating paper in medical recording and reverting to digital use is the ultimate aim, it will take time to implement a system that takes into account e-signatures and verifiable witnesses. CONCLUSION India’s history of leadership in medical ethics has undergone some major changes. A relatively recent privatization of the education system has caused a shift in values and decimated the medical industry on many levels. The moral principles of doctors have come into question. While industry and government leaders are trying to solve the multi-faceted issues facing the medical industry, it is obvious that this is an undertaking requiring inventive solutions. Prioritizing ethics in medical education, de-privatizing medical schools and hospitals, offering affordable options, and limiting corruption would improve India’s ability to offer high-quality medical care. Adding traditional Indian medical ethics back into the curricula would foster a workforce dedicated to serving patients over profiteering. - [1] Deshpande, SmitaN. 2016. “The UNESCO Movement for Bioethics in Medical Education and the Indian Scenario.” Indian Journal of Psychiatry 58 (4): 359. https://doi.org/10.4103/0019-5545.196722. [2] Mukherjee, Ambarish, Mousumi Banerjee, Vivekananda Mandal, Amritesh C. Shukla, and Subhash C. Mandal. 2014. “Modernization of Ayurveda: A Brief Overview of Indian Initiatives.” Natural Product Communications 9 (2): 1934578X1400900. https://doi.org/10.1177/1934578x1400900239. [3] 2020. Eubios.info. 2020. https://www.eubios.info/EJ102/EJ102E.htm. [4] Arnold, David, ed. 2000. “Western Medicine in an Indian Environment.” Cambridge University Press. Cambridge: Cambridge University Press. 2000. https://www.cambridge.org/core/books/abs/science-technology-and-medicine-in-colonial-india/western-medicine-in-an-indian-environment/28BAB761BE205B06D32BC3DC972E9384. [5] Kulkarni, Vani, Veena Kulkarni, and Raghav Gaiha. 2019. “Trust in Hospitals-Evidence from India.” https://repository.upenn.edu/cgi/viewcontent.cgi?article=1026&context=psc_publications. [6] Bhasin, Dr Sanjay K. 2005 “What Ails Medical Profession.” Www.academia.edu. Accessed September 17, 2022. https://www.academia.edu/7631547/What_Ails_Medical_Profession. [7] Shapiro, Natasha, and Urmila Patel. (2006) “Asian Indian Culture: Influences and Implications for Health Care.” https://www.molinahealthcare.com/~/media/Molina/PublicWebsite/PDF/providers/fl/medicaid/resource_fl_asianindianculture_influencesandimplicationsforhealthcare.pdf. [8] Swihart, Diana L, and Romaine L Martin. 2021. “Cultural Religious Competence in Clinical Practice.” Nih.gov. StatPearls Publishing. 2021. https://www.ncbi.nlm.nih.gov/books/NBK493216/. [9] “India’s Mighty Medical Education Mess.” 2022. Education World. July 11, 2022. https://www.educationworld.in/indias-mighty-medical-education-mess/. [10] Pandya, Sunil. 2020. “Medical Education in India: Past, Present, and Future Perspectives. in Sun Kim, ed. Medical Schools Nova Science Publishers, Inc. (= [11] Ravindran, G. D., T. Kalam, S. Lewin, and P. Pais. 1997. “Teaching Medical Ethics in a Medical College in India.” The National Medical Journal of India 10 (6): 288–89. https://pubmed.ncbi.nlm.nih.gov/9481103/. [12] “Chapter 9: Opinions on Professional Self-Regulation”(2016) https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-9.pdf. [13]Sanjiv Das. 2020. “The Pill for India’s Ailing Medical Education System.” Express Healthcare. February 3, 2020. https://www.expresshealthcare.in/education/the-pill-for-indias-ailing-medical-education-system/416711/. [14] https://www.marketresearch.com/Netscribes-India-Pvt-Ltd-v3676/Private-Medical-Colleges-India-30399614/."There are ~50.89% government medical colleges and ~49.11% private medical colleges in the country.”; NPR.org. (2021) “When Students in India Can’t Earn College Admission on Merit, They Buy Their Way In.” Accessed September 19, 2022. https://www.npr.org/2019/08/04/745182272/when-students-in-india-cant-earn-college-admission-on-merit-they-buy-their-way-i. [15] https://timesofindia.indiatimes.com/india/how-medical-colleges-in-india-became-a-business-one-policy-change-at-a-time/articleshow/69707594.cms [16] Muula A. S. (2006). Every country or state needs two medical schools. Croatian medical journal, 47(4), 669–672. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080437/ [17] Miglani, Andrew MacAskill, Steve Stecklow, Sanjeev. 2015. “Why India’s Medical Schools Are Plagued with Fraud.” Mint. June 17, 2015. https://www.livemint.com/Politics/BDGOx3SApU3QbsRMjZUK9M/Why-Indias-medical-schools-are-plagued-with-fraud.html. [18] Clark, J. 2015. “Indian Medical Education System Is Broken, Reuters Investigation Finds.” BMJ 350 (jun18 3): h3324–24. https://doi.org/10.1136/bmj.h3324. [19] Reuters. 2015. “Special Report - Why India’s Medical Schools Are Plagued with Fraud,” June 16, 2015, sec. Special Reports. https://www.reuters.com/article/uk-india-medicine-education-specialrepor/special-report-why-indias-medical-schools-are-plagued-with-fraud-idINKBN0OW1N520150616. [20] Andrew Emett. (2015) “Over Two Dozen Witnesses and Suspects Mysteriously Die in Indian Cheating Scandal | NationofChange.” Accessed September 19, 2022. https://www.nationofchange.org/2015/07/08/over-two-dozen-witnesses-and-suspects-mysteriously-die-in-indian-cheating-scandal/. [21] (Reuters 2015) [22] Clark, J. 2015. “Indian Medical Education System Is Broken, Reuters Investigation Finds.” BMJ 350 (jun18 3): h3324–24. https://doi.org/10.1136/bmj.h3324. [23] Barik, Debasis, and Amit Thorat. 2015. “Issues of Unequal Access to Public Health in India.” Frontiers in Public Health 3 (October). https://doi.org/10.3389/fpubh.2015.00245. [24] “Investment Opportunities in India’s Healthcare Sector.” (2021) https://www.niti.gov.in/sites/default/files/2021-03/InvestmentOpportunities_HealthcareSector_0.pdf. [25] Clark, J. 2015. “Indian Medical Education System Is Broken, Reuters Investigation Finds.” BMJ 350 (jun18 3): h3324–24. https://doi.org/10.1136/bmj.h3324. [26] “Are We Importing Fake Doctors?” (2015) Www.workerscompensation.com. Accessed September 19, 2022. https://www.workerscompensation.com/news_read.php?id=21672&forgot=yes. [27] Boston, 677 Huntington Avenue, and Ma 02115 +1495‑1000. 2013. “Millions Harmed Each Year from Unsafe Medical Care.” News. September 19, 2013. https://www.hsph.harvard.edu/news/press-releases/millions-harmed-each-year-from-unsafe-medical-care/. [28] “Specialised Course for Doctors Can Help Cut the Deaths due to Medical Errors; Experts.” 2018. DailyRounds. October 29, 2018. https://www.dailyrounds.org/blog/specialised-course-for-doctors-can-help-cut-the-deaths-due-to-medical-errors-experts/. [29] Sokhal, Navdeep, Akshay Kumar, Richa Aggarwal, Keshav Goyal, Kapil Dev Soni, Rakesh Garg, Ashok Deorari, and Ajay Sharma. 2021. “Acute Critical Care Course for Interns to Develop Competence.” The National Medical Journal of India 34 (3): 167–70. https://doi.org/10.25259/NMJI_103_19. [30] Singhania, Meghna A. 2020. “How Much Punishment?- MCI Formulates Sentencing Guidelines for Cases of Medical Negligence.” Medicaldialogues.in. February 13, 2020. https://medicaldialogues.in/news/health/mci/how-much-punishment-mci-formulates-sentencing-guidelines-for-cases-of-medical-negligence-62645. [31] “Health Ministry Reports 30% Increase in Number of Functional Medical Colleges in Five Years.” (2022) Www.pharmabiz.com. Accessed September 19, 2022. http://www.pharmabiz.com/NewsDetails.aspx?aid=152299&sid=1. [32] Honavar, Santosh G. 2020. “Electronic Medical Records – the Good, the Bad and the Ugly.” Indian Journal of Ophthalmology 68 (3): 417. https://doi.org/10.4103/ijo.ijo_278_20.